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91_HB0709ham006
LRB9100307DJcdam01
1 AMENDMENT TO HOUSE BILL 709
2 AMENDMENT NO. . Amend House Bill 709, AS AMENDED, by
3 replacing everything before the enacting clause with the
4 following:
5 "AN ACT to amend the Illinois Public Aid Code by changing
6 Sections 5-5 and 6-1.
7 WHEREAS, There has been entered in the Circuit Court of
8 Cook County, in the case of Doe v. Wright, case no. 91 CH
9 1958, an order (i) finding that Sections 5-5 and 6-1 of the
10 Illinois Public Aid Code violate the Illinois Constitution,
11 (ii) enjoining the Department of Public Aid from enforcing
12 those Sections insofar as they deny reimbursement for an
13 abortion necessary to protect a woman's health although not
14 necessary to preserve her life, and (iii) ordering the
15 Department to provide reimbursement through the State's
16 medical assistance programs for abortions necessary to
17 protect a woman's health; and
18 WHEREAS, The General Assembly desires to re-express its
19 intent that State moneys not be used to provide reimbursement
20 for abortions unless necessary to preserve the woman's life
21 and that the Department of Public Aid enforce Sections 5-5
22 and 6-1 of the Illinois Public Aid Code in all cases;
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1 therefore"; and
2 by replacing everything after the enacting clause with the
3 following:
4 "Section 5. The Illinois Public Aid Code is amended by
5 changing Sections 5-5 and 6-1 as follows:
6 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
7 Sec. 5-5. Medical services. The Illinois Department, by
8 rule, shall determine the quantity and quality of and the
9 rate of reimbursement for the medical assistance for which
10 payment will be authorized, and the medical services to be
11 provided, which may include all or part of the following: (1)
12 inpatient hospital services; (2) outpatient hospital
13 services; (3) other laboratory and X-ray services; (4)
14 skilled nursing home services; (5) physicians' services
15 whether furnished in the office, the patient's home, a
16 hospital, a skilled nursing home, or elsewhere; (6) medical
17 care, or any other type of remedial care furnished by
18 licensed practitioners; (7) home health care services; (8)
19 private duty nursing service; (9) clinic services; (10)
20 dental services; (11) physical therapy and related services;
21 (12) prescribed drugs, dentures, and prosthetic devices; and
22 eyeglasses prescribed by a physician skilled in the diseases
23 of the eye, or by an optometrist, whichever the person may
24 select; (13) other diagnostic, screening, preventive, and
25 rehabilitative services; (14) transportation and such other
26 expenses as may be necessary; (15) medical treatment of
27 sexual assault survivors, as defined in Section 1a of the
28 Sexual Assault Survivors Emergency Treatment Act, for
29 injuries sustained as a result of the sexual assault,
30 including examinations and laboratory tests to discover
31 evidence which may be used in criminal proceedings arising
32 from the sexual assault; (16) the diagnosis and treatment of
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1 sickle cell anemia; and (17) any other medical care, and any
2 other type of remedial care recognized under the laws of this
3 State, but not including abortions, or induced miscarriages
4 or premature births, unless, in the opinion of a physician,
5 such procedures are necessary for the preservation of the
6 life of the woman seeking such treatment, or except an
7 induced premature birth intended to produce a live viable
8 child and such procedure is necessary for the health of the
9 mother or her unborn child; State funds may also be used to
10 pay for abortions to terminate a pregnancy resulting from an
11 act of criminal sexual assault, as defined in Section 12-13
12 of the Criminal Code of 1961, an act of aggravated criminal
13 sexual assault, as defined in Section 12-14 of the Criminal
14 Code of 1961, or an act of sexual relations within families,
15 as defined in Section 11-11 of the Criminal Code of 1961, but
16 only to the extent that payment for such abortions is
17 required by federal law as determined by a court of competent
18 jurisdiction but not including abortions, or induced
19 miscarriages or premature births, unless, in the opinion of a
20 physician, such procedures are necessary for the preservation
21 of the life of the woman seeking such treatment, or except an
22 induced premature birth intended to produce a live viable
23 child and such procedure is necessary for the health of the
24 mother or her unborn child. The Illinois Department, by rule,
25 shall prohibit any physician from providing medical
26 assistance to anyone eligible therefor under this Code where
27 such physician has been found guilty of performing an
28 abortion procedure in a wilful and wanton manner upon a woman
29 who was not pregnant at the time such abortion procedure was
30 performed. The term "any other type of remedial care" shall
31 include nursing care and nursing home service for persons who
32 rely on treatment by spiritual means alone through prayer for
33 healing.
34 Notwithstanding any other provision of this Code, the
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1 Illinois Department may not require, as a condition of
2 payment for any laboratory test authorized under this
3 Article, that a physician's handwritten signature appear on
4 the laboratory test order form. The Illinois Department may,
5 however, impose other appropriate requirements regarding
6 laboratory test order documentation.
7 The Illinois Department of Public Aid shall provide the
8 following services to persons eligible for assistance under
9 this Article who are participating in education, training or
10 employment programs operated by the Department of Human
11 Services as successor to the Department of Public Aid:
12 (1) dental services, which shall include but not be
13 limited to prosthodontics; and
14 (2) eyeglasses prescribed by a physician skilled in
15 the diseases of the eye, or by an optometrist, whichever
16 the person may select.
17 The Illinois Department, by rule, may distinguish and
18 classify the medical services to be provided only in
19 accordance with the classes of persons designated in Section
20 5-2.
21 The Illinois Department shall authorize the provision of,
22 and shall authorize payment for, screening by low-dose
23 mammography for the presence of occult breast cancer for
24 women 35 years of age or older who are eligible for medical
25 assistance under this Article, as follows: a baseline
26 mammogram for women 35 to 39 years of age and an annual
27 mammogram for women 40 years of age or older. All screenings
28 shall include a physical breast exam, instruction on
29 self-examination and information regarding the frequency of
30 self-examination and its value as a preventative tool. As
31 used in this Section, "low-dose mammography" means the x-ray
32 examination of the breast using equipment dedicated
33 specifically for mammography, including the x-ray tube,
34 filter, compression device, image receptor, and cassettes,
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1 with an average radiation exposure delivery of less than one
2 rad mid-breast, with 2 views for each breast.
3 Any medical or health care provider shall immediately
4 recommend, to any pregnant woman who is being provided
5 prenatal services and is suspected of drug abuse or is
6 addicted as defined in the Alcoholism and Other Drug Abuse
7 and Dependency Act, referral to a local substance abuse
8 treatment provider licensed by the Department of Human
9 Services or to a licensed hospital which provides substance
10 abuse treatment services. The Department of Public Aid shall
11 assure coverage for the cost of treatment of the drug abuse
12 or addiction for pregnant recipients in accordance with the
13 Illinois Medicaid Program in conjunction with the Department
14 of Human Services.
15 All medical providers providing medical assistance to
16 pregnant women under this Code shall receive information from
17 the Department on the availability of services under the Drug
18 Free Families with a Future or any comparable program
19 providing case management services for addicted women,
20 including information on appropriate referrals for other
21 social services that may be needed by addicted women in
22 addition to treatment for addiction.
23 The Illinois Department, in cooperation with the
24 Departments of Human Services (as successor to the Department
25 of Alcoholism and Substance Abuse) and Public Health, through
26 a public awareness campaign, may provide information
27 concerning treatment for alcoholism and drug abuse and
28 addiction, prenatal health care, and other pertinent programs
29 directed at reducing the number of drug-affected infants born
30 to recipients of medical assistance.
31 Neither the Illinois Department of Public Aid nor the
32 Department of Human Services shall sanction the recipient
33 solely on the basis of her substance abuse.
34 The Illinois Department shall establish such regulations
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1 governing the dispensing of health services under this
2 Article as it shall deem appropriate. In formulating these
3 regulations the Illinois Department shall consult with and
4 give substantial weight to the recommendations offered by the
5 Citizens Assembly/Council on Public Aid. The Department
6 should seek the advice of formal professional advisory
7 committees appointed by the Director of the Illinois
8 Department for the purpose of providing regular advice on
9 policy and administrative matters, information dissemination
10 and educational activities for medical and health care
11 providers, and consistency in procedures to the Illinois
12 Department.
13 The Illinois Department may develop and contract with
14 Partnerships of medical providers to arrange medical services
15 for persons eligible under Section 5-2 of this Code.
16 Implementation of this Section may be by demonstration
17 projects in certain geographic areas. The Partnership shall
18 be represented by a sponsor organization. The Department, by
19 rule, shall develop qualifications for sponsors of
20 Partnerships. Nothing in this Section shall be construed to
21 require that the sponsor organization be a medical
22 organization.
23 The sponsor must negotiate formal written contracts with
24 medical providers for physician services, inpatient and
25 outpatient hospital care, home health services, treatment for
26 alcoholism and substance abuse, and other services determined
27 necessary by the Illinois Department by rule for delivery by
28 Partnerships. Physician services must include prenatal and
29 obstetrical care. The Illinois Department shall reimburse
30 medical services delivered by Partnership providers to
31 clients in target areas according to provisions of this
32 Article and the Illinois Health Finance Reform Act, except
33 that:
34 (1) Physicians participating in a Partnership and
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1 providing certain services, which shall be determined by
2 the Illinois Department, to persons in areas covered by
3 the Partnership may receive an additional surcharge for
4 such services.
5 (2) The Department may elect to consider and
6 negotiate financial incentives to encourage the
7 development of Partnerships and the efficient delivery of
8 medical care.
9 (3) Persons receiving medical services through
10 Partnerships may receive medical and case management
11 services above the level usually offered through the
12 medical assistance program.
13 Medical providers shall be required to meet certain
14 qualifications to participate in Partnerships to ensure the
15 delivery of high quality medical services. These
16 qualifications shall be determined by rule of the Illinois
17 Department and may be higher than qualifications for
18 participation in the medical assistance program. Partnership
19 sponsors may prescribe reasonable additional qualifications
20 for participation by medical providers, only with the prior
21 written approval of the Illinois Department.
22 Nothing in this Section shall limit the free choice of
23 practitioners, hospitals, and other providers of medical
24 services by clients. In order to ensure patient freedom of
25 choice, the Illinois Department shall immediately promulgate
26 all rules and take all other necessary actions so that
27 provided services may be accessed from therapeutically
28 certified optometrists to the full extent of the Illinois
29 Optometric Practice Act of 1987 without discriminating
30 between service providers.
31 The Department shall apply for a waiver from the United
32 States Health Care Financing Administration to allow for the
33 implementation of Partnerships under this Section.
34 The Illinois Department shall require health care
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1 providers to maintain records that document the medical care
2 and services provided to recipients of Medical Assistance
3 under this Article. The Illinois Department shall require
4 health care providers to make available, when authorized by
5 the patient, in writing, the medical records in a timely
6 fashion to other health care providers who are treating or
7 serving persons eligible for Medical Assistance under this
8 Article. All dispensers of medical services shall be
9 required to maintain and retain business and professional
10 records sufficient to fully and accurately document the
11 nature, scope, details and receipt of the health care
12 provided to persons eligible for medical assistance under
13 this Code, in accordance with regulations promulgated by the
14 Illinois Department. The rules and regulations shall require
15 that proof of the receipt of prescription drugs, dentures,
16 prosthetic devices and eyeglasses by eligible persons under
17 this Section accompany each claim for reimbursement submitted
18 by the dispenser of such medical services. No such claims for
19 reimbursement shall be approved for payment by the Illinois
20 Department without such proof of receipt, unless the Illinois
21 Department shall have put into effect and shall be operating
22 a system of post-payment audit and review which shall, on a
23 sampling basis, be deemed adequate by the Illinois Department
24 to assure that such drugs, dentures, prosthetic devices and
25 eyeglasses for which payment is being made are actually being
26 received by eligible recipients. Within 90 days after the
27 effective date of this amendatory Act of 1984, the Illinois
28 Department shall establish a current list of acquisition
29 costs for all prosthetic devices and any other items
30 recognized as medical equipment and supplies reimbursable
31 under this Article and shall update such list on a quarterly
32 basis, except that the acquisition costs of all prescription
33 drugs shall be updated no less frequently than every 30 days
34 as required by Section 5-5.12.
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1 The rules and regulations of the Illinois Department
2 shall require that a written statement including the required
3 opinion of a physician shall accompany any claim for
4 reimbursement for abortions, or induced miscarriages or
5 premature births. This statement shall indicate what
6 procedures were used in providing such medical services.
7 The Illinois Department shall require that all dispensers
8 of medical services, other than an individual practitioner or
9 group of practitioners, desiring to participate in the
10 Medical Assistance program established under this Article to
11 disclose all financial, beneficial, ownership, equity, surety
12 or other interests in any and all firms, corporations,
13 partnerships, associations, business enterprises, joint
14 ventures, agencies, institutions or other legal entities
15 providing any form of health care services in this State
16 under this Article.
17 The Illinois Department may require that all dispensers
18 of medical services desiring to participate in the medical
19 assistance program established under this Article disclose,
20 under such terms and conditions as the Illinois Department
21 may by rule establish, all inquiries from clients and
22 attorneys regarding medical bills paid by the Illinois
23 Department, which inquiries could indicate potential
24 existence of claims or liens for the Illinois Department.
25 The Illinois Department shall establish policies,
26 procedures, standards and criteria by rule for the
27 acquisition, repair and replacement of orthotic and
28 prosthetic devices and durable medical equipment. Such rules
29 shall provide, but not be limited to, the following services:
30 (1) immediate repair or replacement of such devices by
31 recipients without medical authorization; and (2) rental,
32 lease, purchase or lease-purchase of durable medical
33 equipment in a cost-effective manner, taking into
34 consideration the recipient's medical prognosis, the extent
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1 of the recipient's needs, and the requirements and costs for
2 maintaining such equipment. Such rules shall enable a
3 recipient to temporarily acquire and use alternative or
4 substitute devices or equipment pending repairs or
5 replacements of any device or equipment previously authorized
6 for such recipient by the Department. Rules under clause (2)
7 above shall not provide for purchase or lease-purchase of
8 durable medical equipment or supplies used for the purpose of
9 oxygen delivery and respiratory care.
10 The Department shall execute, relative to the nursing
11 home prescreening project, written inter-agency agreements
12 with the Department of Human Services and the Department on
13 Aging, to effect the following: (i) intake procedures and
14 common eligibility criteria for those persons who are
15 receiving non-institutional services; and (ii) the
16 establishment and development of non-institutional services
17 in areas of the State where they are not currently available
18 or are undeveloped.
19 The Illinois Department shall develop and operate, in
20 cooperation with other State Departments and agencies and in
21 compliance with applicable federal laws and regulations,
22 appropriate and effective systems of health care evaluation
23 and programs for monitoring of utilization of health care
24 services and facilities, as it affects persons eligible for
25 medical assistance under this Code. The Illinois Department
26 shall report regularly the results of the operation of such
27 systems and programs to the Citizens Assembly/Council on
28 Public Aid to enable the Committee to ensure, from time to
29 time, that these programs are effective and meaningful.
30 The Illinois Department shall report annually to the
31 General Assembly, no later than the second Friday in April of
32 1979 and each year thereafter, in regard to:
33 (a) actual statistics and trends in utilization of
34 medical services by public aid recipients;
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1 (b) actual statistics and trends in the provision
2 of the various medical services by medical vendors;
3 (c) current rate structures and proposed changes in
4 those rate structures for the various medical vendors;
5 and
6 (d) efforts at utilization review and control by
7 the Illinois Department.
8 The period covered by each report shall be the 3 years
9 ending on the June 30 prior to the report. The report shall
10 include suggested legislation for consideration by the
11 General Assembly. The filing of one copy of the report with
12 the Speaker, one copy with the Minority Leader and one copy
13 with the Clerk of the House of Representatives, one copy with
14 the President, one copy with the Minority Leader and one copy
15 with the Secretary of the Senate, one copy with the
16 Legislative Research Unit, such additional copies with the
17 State Government Report Distribution Center for the General
18 Assembly as is required under paragraph (t) of Section 7 of
19 the State Library Act and one copy with the Citizens
20 Assembly/Council on Public Aid or its successor shall be
21 deemed sufficient to comply with this Section.
22 (Source: P.A. 90-7, eff. 6-10-97; 90-14, eff. 7-1-97; 91-344,
23 eff. 1-1-00; 91-462, eff. 8-6-99; revised 10-15-99.)
24 (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
25 Sec. 6-1. Eligibility requirements. Financial aid in
26 meeting basic maintenance requirements shall be given under
27 this Article to or in behalf of persons who meet the
28 eligibility conditions of Sections 6-1.1 through 6-1.10. In
29 addition, each unit of local government subject to this
30 Article shall provide persons receiving financial aid in
31 meeting basic maintenance requirements with financial aid for
32 either (a) necessary treatment, care, and supplies required
33 because of illness or disability, or (b) acute medical
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1 treatment, care, and supplies only. If a local governmental
2 unit elects to provide financial aid for acute medical
3 treatment, care, and supplies only, the general types of
4 acute medical treatment, care, and supplies for which
5 financial aid is provided shall be specified in the general
6 assistance rules of the local governmental unit, which rules
7 shall provide that financial aid is provided, at a minimum,
8 for acute medical treatment, care, or supplies necessitated
9 by a medical condition for which prior approval or
10 authorization of medical treatment, care, or supplies is not
11 required by the general assistance rules of the Illinois
12 Department. Nothing in this Article shall be construed to
13 permit the granting of financial aid where the purpose of
14 such aid is to obtain an abortion, induced miscarriage or
15 induced premature birth unless, in the opinion of a
16 physician, such procedures are necessary for the preservation
17 of the life of the woman seeking such treatment, or except an
18 induced premature birth intended to produce a live viable
19 child and such procedure is necessary for the health of the
20 mother or her unborn child; State funds may also be used to
21 pay for abortions to terminate a pregnancy resulting from an
22 act of criminal sexual assault, as defined in Section 12-13
23 of the Criminal Code of 1961, an act of aggravated criminal
24 sexual assault, as defined in Section 12-14 of the Criminal
25 Code of 1961, or an act of sexual relations within families,
26 as defined in Section 11-11 of the Criminal Code of 1961, but
27 only to the extent that payment for such abortions is
28 required by federal law as determined by a court of competent
29 jurisdiction. Nothing in this Article shall be construed to
30 permit the granting of financial aid where the purpose of
31 such aid is to obtain an abortion, induced miscarriage or
32 induced premature birth unless, in the opinion of a
33 physician, such procedures are necessary for the preservation
34 of the life of the woman seeking such treatment, or except an
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1 induced premature birth intended to produce a live viable
2 child and such procedure is necessary for the health of the
3 mother or her unborn child.
4 Until August 1, 1969, children who require care outside
5 their own homes, where no other sources of funds or
6 insufficient funds are available to provide the necessary
7 care, are included among persons eligible for aid under this
8 Article. After July 31, 1969, the Department of Children and
9 Family Services shall have the responsibility of providing
10 child welfare services to such children, as provided in
11 Section 5 of "An Act creating the Department of Children and
12 Family Services, codifying its powers and duties, and
13 repealing certain Acts and Sections herein named", approved
14 June 4, 1963, as amended.
15 In cities, villages and incorporated towns of more than
16 500,000 population, the Illinois Department may establish a
17 separate program under this Article. The 2 programs shall be
18 differentiated, but the placement of persons under both
19 programs shall be based upon their ability or inability to
20 engage in employment in accordance with the rules and
21 regulations promulgated by the Illinois Department. In
22 establishing rules and regulations for determining whether a
23 person is able to engage in employment, the Illinois
24 Department may establish rules different than those set out
25 under Section 11-20. In determining need and the amount of
26 aid under Sections 6-1.2 and 6-2 for the 2 programs, the
27 Illinois Department may establish different standards for the
28 2 programs based upon the specific needs of the different
29 populations to be served by the 2 programs. The Illinois
30 Department may enter into contracts with entities to
31 establish work or training related projects under the program
32 established for persons determined to be able to engage in
33 employment.
34 (Source: P.A. 89-646, eff. 1-1-97.)
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1 Section 90. Severability. If any provision, word,
2 phrase or clause of this amendatory Act of the 91st General
3 Assembly or its application to any person or circumstance is
4 held invalid, the invalidity does not affect the provisions,
5 words, phrases, clauses or application of this amendatory Act
6 of the 91st General Assembly which can be given effect
7 without the invalid provision, word, phrase, clause, or
8 application, and to this end the provisions, words, phrases,
9 and clauses of this amendatory Act of the 91st General
10 Assembly are declared to be severable.
11 Section 99. Effective date. This Act takes effect July
12 1, 2000.".