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91_HB3205
LRB9110567DJcd
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Sections 5-5, 5-8, and 12-13.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Sections 5-5, 5-8, and 12-13 as follows:
7 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
8 Sec. 5-5. Medical services. The Illinois Department, by
9 rule, shall determine the quantity and quality of and the
10 rate of reimbursement for the medical assistance for which
11 payment will be authorized, and the medical services to be
12 provided, which may include all or part of the following: (1)
13 inpatient hospital services; (2) outpatient hospital
14 services; (3) other laboratory and X-ray services; (4)
15 skilled nursing home services; (5) physicians' services
16 whether furnished in the office, the patient's home, a
17 hospital, a skilled nursing home, or elsewhere; (6) medical
18 care, or any other type of remedial care furnished by
19 licensed practitioners; (6.5) behavioral health services as
20 defined in subsection (m) of Section 5-16.3; (6.10) mental
21 health services as defined in subsection (m) of Section
22 5-16.3; (7) home health care services; (8) private duty
23 nursing service; (9) clinic services; (10) dental services;
24 (11) physical therapy and related services; (12) prescribed
25 drugs, dentures, and prosthetic devices; and eyeglasses
26 prescribed by a physician skilled in the diseases of the eye,
27 or by an optometrist, whichever the person may select; (13)
28 other diagnostic, screening, preventive, and rehabilitative
29 services; (14) transportation and such other expenses as may
30 be necessary; (15) medical treatment of sexual assault
31 survivors, as defined in Section 1a of the Sexual Assault
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1 Survivors Emergency Treatment Act, for injuries sustained as
2 a result of the sexual assault, including examinations and
3 laboratory tests to discover evidence which may be used in
4 criminal proceedings arising from the sexual assault; (16)
5 the diagnosis and treatment of sickle cell anemia; and (17)
6 any other medical care, and any other type of remedial care
7 recognized under the laws of this State, but not including
8 abortions, or induced miscarriages or premature births,
9 unless, in the opinion of a physician, such procedures are
10 necessary for the preservation of the life of the woman
11 seeking such treatment, or except an induced premature birth
12 intended to produce a live viable child and such procedure is
13 necessary for the health of the mother or her unborn child.
14 The Illinois Department, by rule, shall prohibit any
15 physician from providing medical assistance to anyone
16 eligible therefor under this Code where such physician has
17 been found guilty of performing an abortion procedure in a
18 wilful and wanton manner upon a woman who was not pregnant at
19 the time such abortion procedure was performed. The term "any
20 other type of remedial care" shall include nursing care and
21 nursing home service for persons who rely on treatment by
22 spiritual means alone through prayer for healing.
23 Notwithstanding any other provision of this Section, a
24 comprehensive tobacco use cessation program that includes
25 purchasing prescription drugs or prescription medical devices
26 approved by the Food and Drug administration shall be covered
27 under the medical assistance program under this Article for
28 persons who are otherwise eligible for assistance under this
29 Article.
30 Notwithstanding any other provision of this Code, the
31 Illinois Department may not require, as a condition of
32 payment for any laboratory test authorized under this
33 Article, that a physician's handwritten signature appear on
34 the laboratory test order form. The Illinois Department may,
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1 however, impose other appropriate requirements regarding
2 laboratory test order documentation.
3 The Illinois Department of Public Aid shall provide the
4 following services to persons eligible for assistance under
5 this Article who are participating in education, training or
6 employment programs operated by the Department of Human
7 Services as successor to the Department of Public Aid:
8 (1) dental services, which shall include but not be
9 limited to prosthodontics; and
10 (2) eyeglasses prescribed by a physician skilled in
11 the diseases of the eye, or by an optometrist, whichever
12 the person may select.
13 The Illinois Department, by rule, may distinguish and
14 classify the medical services to be provided only in
15 accordance with the classes of persons designated in Section
16 5-2.
17 The Illinois Department shall authorize the provision of,
18 and shall authorize payment for, screening by low-dose
19 mammography for the presence of occult breast cancer for
20 women 35 years of age or older who are eligible for medical
21 assistance under this Article, as follows: a baseline
22 mammogram for women 35 to 39 years of age and an annual
23 mammogram for women 40 years of age or older. All screenings
24 shall include a physical breast exam, instruction on
25 self-examination and information regarding the frequency of
26 self-examination and its value as a preventative tool. As
27 used in this Section, "low-dose mammography" means the x-ray
28 examination of the breast using equipment dedicated
29 specifically for mammography, including the x-ray tube,
30 filter, compression device, image receptor, and cassettes,
31 with an average radiation exposure delivery of less than one
32 rad mid-breast, with 2 views for each breast.
33 Any medical or health care provider shall immediately
34 recommend, to any pregnant woman who is being provided
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1 prenatal services and is suspected of drug abuse or is
2 addicted as defined in the Alcoholism and Other Drug Abuse
3 and Dependency Act, referral to a local substance abuse
4 treatment provider licensed by the Department of Human
5 Services or to a licensed hospital which provides substance
6 abuse treatment services. The Department of Public Aid shall
7 assure coverage for the cost of treatment of the drug abuse
8 or addiction for pregnant recipients in accordance with the
9 Illinois Medicaid Program in conjunction with the Department
10 of Human Services.
11 All medical providers providing medical assistance to
12 pregnant women under this Code shall receive information from
13 the Department on the availability of services under the Drug
14 Free Families with a Future or any comparable program
15 providing case management services for addicted women,
16 including information on appropriate referrals for other
17 social services that may be needed by addicted women in
18 addition to treatment for addiction.
19 The Illinois Department, in cooperation with the
20 Departments of Human Services (as successor to the Department
21 of Alcoholism and Substance Abuse) and Public Health, through
22 a public awareness campaign, may provide information
23 concerning treatment for alcoholism and drug abuse and
24 addiction, prenatal health care, and other pertinent programs
25 directed at reducing the number of drug-affected infants born
26 to recipients of medical assistance.
27 Neither the Illinois Department of Public Aid nor the
28 Department of Human Services shall sanction the recipient
29 solely on the basis of her substance abuse.
30 The Illinois Department shall establish such regulations
31 governing the dispensing of health services under this
32 Article as it shall deem appropriate. In formulating these
33 regulations the Illinois Department shall consult with and
34 give substantial weight to the recommendations offered by the
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1 Citizens Assembly/Council on Public Aid. The Department
2 should seek the advice of formal professional advisory
3 committees appointed by the Director of the Illinois
4 Department for the purpose of providing regular advice on
5 policy and administrative matters, information dissemination
6 and educational activities for medical and health care
7 providers, and consistency in procedures to the Illinois
8 Department.
9 The Illinois Department may develop and contract with
10 Partnerships of medical providers to arrange medical services
11 for persons eligible under Section 5-2 of this Code.
12 Implementation of this Section may be by demonstration
13 projects in certain geographic areas. The Partnership shall
14 be represented by a sponsor organization. The Department, by
15 rule, shall develop qualifications for sponsors of
16 Partnerships. Nothing in this Section shall be construed to
17 require that the sponsor organization be a medical
18 organization.
19 The sponsor must negotiate formal written contracts with
20 medical providers for physician services, inpatient and
21 outpatient hospital care, home health services, treatment for
22 alcoholism and substance abuse, and other services determined
23 necessary by the Illinois Department by rule for delivery by
24 Partnerships. Physician services must include prenatal and
25 obstetrical care. The Illinois Department shall reimburse
26 medical services delivered by Partnership providers to
27 clients in target areas according to provisions of this
28 Article and the Illinois Health Finance Reform Act, except
29 that:
30 (1) Physicians participating in a Partnership and
31 providing certain services, which shall be determined by
32 the Illinois Department, to persons in areas covered by
33 the Partnership may receive an additional surcharge for
34 such services.
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1 (2) The Department may elect to consider and
2 negotiate financial incentives to encourage the
3 development of Partnerships and the efficient delivery of
4 medical care.
5 (3) Persons receiving medical services through
6 Partnerships may receive medical and case management
7 services above the level usually offered through the
8 medical assistance program.
9 Medical providers shall be required to meet certain
10 qualifications to participate in Partnerships to ensure the
11 delivery of high quality medical services. These
12 qualifications shall be determined by rule of the Illinois
13 Department and may be higher than qualifications for
14 participation in the medical assistance program. Partnership
15 sponsors may prescribe reasonable additional qualifications
16 for participation by medical providers, only with the prior
17 written approval of the Illinois Department.
18 Nothing in this Section shall limit the free choice of
19 practitioners, hospitals, and other providers of medical
20 services by clients. In order to ensure patient freedom of
21 choice, the Illinois Department shall immediately promulgate
22 all rules and take all other necessary actions so that
23 provided services may be accessed from therapeutically
24 certified optometrists to the full extent of the Illinois
25 Optometric Practice Act of 1987 without discriminating
26 between service providers.
27 The Department shall apply for a waiver from the United
28 States Health Care Financing Administration to allow for the
29 implementation of Partnerships under this Section.
30 The Illinois Department shall require health care
31 providers to maintain records that document the medical care
32 and services provided to recipients of Medical Assistance
33 under this Article. The Illinois Department shall require
34 health care providers to make available, when authorized by
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1 the patient, in writing, the medical records in a timely
2 fashion to other health care providers who are treating or
3 serving persons eligible for Medical Assistance under this
4 Article. All dispensers of medical services shall be
5 required to maintain and retain business and professional
6 records sufficient to fully and accurately document the
7 nature, scope, details and receipt of the health care
8 provided to persons eligible for medical assistance under
9 this Code, in accordance with regulations promulgated by the
10 Illinois Department. The rules and regulations shall require
11 that proof of the receipt of prescription drugs, dentures,
12 prosthetic devices and eyeglasses by eligible persons under
13 this Section accompany each claim for reimbursement submitted
14 by the dispenser of such medical services. No such claims for
15 reimbursement shall be approved for payment by the Illinois
16 Department without such proof of receipt, unless the Illinois
17 Department shall have put into effect and shall be operating
18 a system of post-payment audit and review which shall, on a
19 sampling basis, be deemed adequate by the Illinois Department
20 to assure that such drugs, dentures, prosthetic devices and
21 eyeglasses for which payment is being made are actually being
22 received by eligible recipients. Within 90 days after the
23 effective date of this amendatory Act of 1984, the Illinois
24 Department shall establish a current list of acquisition
25 costs for all prosthetic devices and any other items
26 recognized as medical equipment and supplies reimbursable
27 under this Article and shall update such list on a quarterly
28 basis, except that the acquisition costs of all prescription
29 drugs shall be updated no less frequently than every 30 days
30 as required by Section 5-5.12.
31 The rules and regulations of the Illinois Department
32 shall require that a written statement including the required
33 opinion of a physician shall accompany any claim for
34 reimbursement for abortions, or induced miscarriages or
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1 premature births. This statement shall indicate what
2 procedures were used in providing such medical services.
3 The Illinois Department shall require that all dispensers
4 of medical services, other than an individual practitioner or
5 group of practitioners, desiring to participate in the
6 Medical Assistance program established under this Article to
7 disclose all financial, beneficial, ownership, equity, surety
8 or other interests in any and all firms, corporations,
9 partnerships, associations, business enterprises, joint
10 ventures, agencies, institutions or other legal entities
11 providing any form of health care services in this State
12 under this Article.
13 The Illinois Department may require that all dispensers
14 of medical services desiring to participate in the medical
15 assistance program established under this Article disclose,
16 under such terms and conditions as the Illinois Department
17 may by rule establish, all inquiries from clients and
18 attorneys regarding medical bills paid by the Illinois
19 Department, which inquiries could indicate potential
20 existence of claims or liens for the Illinois Department.
21 The Illinois Department shall establish policies,
22 procedures, standards and criteria by rule for the
23 acquisition, repair and replacement of orthotic and
24 prosthetic devices and durable medical equipment. Such rules
25 shall provide, but not be limited to, the following services:
26 (1) immediate repair or replacement of such devices by
27 recipients without medical authorization; and (2) rental,
28 lease, purchase or lease-purchase of durable medical
29 equipment in a cost-effective manner, taking into
30 consideration the recipient's medical prognosis, the extent
31 of the recipient's needs, and the requirements and costs for
32 maintaining such equipment. Such rules shall enable a
33 recipient to temporarily acquire and use alternative or
34 substitute devices or equipment pending repairs or
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1 replacements of any device or equipment previously authorized
2 for such recipient by the Department. Rules under clause (2)
3 above shall not provide for purchase or lease-purchase of
4 durable medical equipment or supplies used for the purpose of
5 oxygen delivery and respiratory care.
6 The Department shall execute, relative to the nursing
7 home prescreening project, written inter-agency agreements
8 with the Department of Human Services and the Department on
9 Aging, to effect the following: (i) intake procedures and
10 common eligibility criteria for those persons who are
11 receiving non-institutional services; and (ii) the
12 establishment and development of non-institutional services
13 in areas of the State where they are not currently available
14 or are undeveloped.
15 The Illinois Department shall develop and operate, in
16 cooperation with other State Departments and agencies and in
17 compliance with applicable federal laws and regulations,
18 appropriate and effective systems of health care evaluation
19 and programs for monitoring of utilization of health care
20 services and facilities, as it affects persons eligible for
21 medical assistance under this Code. The Illinois Department
22 shall report regularly the results of the operation of such
23 systems and programs to the Citizens Assembly/Council on
24 Public Aid to enable the Committee to ensure, from time to
25 time, that these programs are effective and meaningful.
26 The Illinois Department shall report annually to the
27 General Assembly, no later than the second Friday in April of
28 1979 and each year thereafter, in regard to:
29 (a) actual statistics and trends in utilization of
30 medical services by public aid recipients;
31 (b) actual statistics and trends in the provision
32 of the various medical services by medical vendors;
33 (c) current rate structures and proposed changes in
34 those rate structures for the various medical vendors;
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1 and
2 (d) efforts at utilization review and control by
3 the Illinois Department.
4 The period covered by each report shall be the 3 years
5 ending on the June 30 prior to the report. The report shall
6 include suggested legislation for consideration by the
7 General Assembly. The filing of one copy of the report with
8 the Speaker, one copy with the Minority Leader and one copy
9 with the Clerk of the House of Representatives, one copy with
10 the President, one copy with the Minority Leader and one copy
11 with the Secretary of the Senate, one copy with the
12 Legislative Research Unit, such additional copies with the
13 State Government Report Distribution Center for the General
14 Assembly as is required under paragraph (t) of Section 7 of
15 the State Library Act and one copy with the Citizens
16 Assembly/Council on Public Aid or its successor shall be
17 deemed sufficient to comply with this Section.
18 (Source: P.A. 90-7, eff. 6-10-97; 90-14, eff. 7-1-97; 91-344,
19 eff. 1-1-00; 91-462, eff. 8-6-99; 91-666, eff. 12-22-99;
20 revised 1-6-00.)
21 (305 ILCS 5/5-8) (from Ch. 23, par. 5-8)
22 Sec. 5-8. Practitioners. In supplying medical assistance,
23 the Illinois Department may provide for the legally
24 authorized services of (i) persons licensed under the Medical
25 Practice Act of 1987, as amended, except as hereafter in this
26 Section stated, whether under a general or limited license,
27 (ii) and of persons licensed or registered under other laws
28 of this State to provide dental, medical, pharmaceutical,
29 optometric, podiatric, or nursing services, or other remedial
30 care recognized under State law, and (iii) persons licensed
31 under other laws of this State as a clinical psychologist,
32 clinical social worker, or clinical professional counselor.
33 In authorizing reimbursement for behavioral health services
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1 and mental health services, the Illinois Department may
2 provide for the legally authorized services of persons
3 licensed under the Medical Practice Act of 1987. The
4 Department may not provide for legally authorized services of
5 any physician who has been convicted of having performed an
6 abortion procedure in a wilful and wanton manner on a woman
7 who was not pregnant at the time such abortion procedure was
8 performed. The utilization of the services of persons
9 engaged in the treatment or care of the sick, which persons
10 are not required to be licensed or registered under the laws
11 of this State, is not prohibited by this Section.
12 (Source: P.A. 85-1209.)
13 (305 ILCS 5/12-13) (from Ch. 23, par. 12-13)
14 Sec. 12-13. Rules and regulations. The Department shall
15 make all rules and regulations and take such action as may be
16 necessary or desirable for carrying out the provisions of
17 this Code, to the end that its spirit and purpose may be
18 achieved and the public aid programs administered efficiently
19 throughout the State. However, the rules and regulations
20 shall not provide that payment for services rendered to a
21 specific recipient by (i) a person licensed under the Medical
22 Practice Act of 1987, whether under a general or limited
23 license, (ii) or a person licensed or registered under other
24 laws of this State to provide dental, optometric, or
25 pediatric care, or (iii) a licensed clinical psychologist,
26 licensed clinical social worker, or licensed clinical
27 professional counselor may be authorized only when services
28 are recommended for that recipient by a person licensed to
29 practice medicine in all its branches.
30 Whenever a rule of the Department requires that an
31 applicant or recipient verify information submitted to the
32 Department, the rule, in order to make the public fully aware
33 of what information is required for verification, shall
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1 specify the acceptable means of verification or shall list
2 examples of acceptable means of verification.
3 The provisions of the Illinois Administrative Procedure
4 Act are hereby expressly adopted and incorporated herein, and
5 shall apply to all administrative rules and procedures of the
6 Illinois Department under this Act, except that Section 5-35
7 of the Illinois Administrative Procedure Act relating to
8 procedures for rule-making does not apply to the adoption of
9 any rule required by federal law in connection with which the
10 Illinois Department is precluded by law from exercising any
11 discretion, and the requirements of the Administrative
12 Procedure Act with respect to contested cases are not
13 applicable to (1) hearings involving eligibility of
14 applicants or recipients of public aid, (2) support hearings
15 involving responsible relatives, or (3) personnel hearings
16 involving matters arising under Section 12-18.1.
17 (Source: P.A. 88-45.)
18 Section 99. Effective date. This Act takes effect upon
19 becoming law.