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91_SB0261
LRB9102337SMdv
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Sections 5-5 and 6-1.
3 WHEREAS, There has been entered in the Circuit Court of
4 Cook County, in the case of Doe v. Wright, case no. 91 CH
5 1958, an order (i) finding that Sections 5-5 and 6-1 of the
6 Illinois Public Aid Code violate the Illinois Constitution,
7 (ii) enjoining the Department of Public Aid from enforcing
8 those Sections insofar as they deny reimbursement for an
9 abortion necessary to protect a woman's health although not
10 necessary to preserve her life, and (iii) ordering the
11 Department to provide reimbursement through the State's
12 medical assistance programs for abortions necessary to
13 protect a woman's health; and
14 WHEREAS, The General Assembly desires to re-express its
15 intent that State moneys not be used to provide reimbursement
16 for abortions unless necessary to preserve the woman's life
17 and that the Department of Public Aid enforce Sections 5-5
18 and 6-1 of the Illinois Public Aid Code in all cases;
19 therefore
20 Be it enacted by the People of the State of Illinois,
21 represented in the General Assembly:
22 Section 5. The Illinois Public Aid Code is amended by
23 changing Sections 5-5 and 6-1 as follows:
24 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
25 Sec. 5-5. Medical services. The Illinois Department, by
26 rule, shall determine the quantity and quality of and the
27 rate of reimbursement for the medical assistance for which
28 payment will be authorized, and the medical services to be
29 provided, which may include all or part of the following: (1)
30 inpatient hospital services; (2) outpatient hospital
31 services; (3) other laboratory and X-ray services; (4)
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1 skilled nursing home services; (5) physicians' services
2 whether furnished in the office, the patient's home, a
3 hospital, a skilled nursing home, or elsewhere; (6) medical
4 care, or any other type of remedial care furnished by
5 licensed practitioners; (7) home health care services; (8)
6 private duty nursing service; (9) clinic services; (10)
7 dental services; (11) physical therapy and related services;
8 (12) prescribed drugs, dentures, and prosthetic devices; and
9 eyeglasses prescribed by a physician skilled in the diseases
10 of the eye, or by an optometrist, whichever the person may
11 select; (13) other diagnostic, screening, preventive, and
12 rehabilitative services; (14) transportation and such other
13 expenses as may be necessary; (15) medical treatment of
14 sexual assault survivors, as defined in Section 1a of the
15 Sexual Assault Survivors Emergency Treatment Act, for
16 injuries sustained as a result of the sexual assault,
17 including examinations and laboratory tests to discover
18 evidence which may be used in criminal proceedings arising
19 from the sexual assault; (16) the diagnosis and treatment of
20 sickle cell anemia; and (17) any other medical care, and any
21 other type of remedial care recognized under the laws of this
22 State, but not including abortions, or induced miscarriages
23 or premature births, unless, in the opinion of a physician,
24 such procedures are necessary for the preservation of the
25 life of the woman seeking such treatment, or except an
26 induced premature birth intended to produce a live viable
27 child and such procedure is necessary for the health of the
28 mother or her unborn child; State funds may also be used to
29 pay for abortions to terminate a pregnancy resulting from an
30 act of criminal sexual assault, as defined in Section 12-13
31 of the Criminal Code of 1961, an act of aggravated criminal
32 sexual assault, as defined in Section 12-14 of the Criminal
33 Code of 1961, or an act of sexual relations within families,
34 as defined in Section 11-11 of the Criminal Code of 1961, but
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1 only to the extent that payment for such abortions is
2 required by federal law as determined by a court of competent
3 jurisdiction; provided further that payment for an abortion
4 to terminate a pregnancy resulting from an act of criminal
5 sexual assault, aggravated criminal sexual assault, or sexual
6 relations within families is reported to a law enforcement
7 agency before the abortion is performed 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 The Illinois Department of Public Aid shall provide the
24 following services to persons eligible for assistance under
25 this Article who are participating in education, training or
26 employment programs operated by the Department of Human
27 Services as successor to the Department of Public Aid:
28 (1) dental services, which shall include but not be
29 limited to prosthodontics; and
30 (2) eyeglasses prescribed by a physician skilled in
31 the diseases of the eye, or by an optometrist, whichever
32 the person may select.
33 The Illinois Department, by rule, may distinguish and
34 classify the medical services to be provided only in
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1 accordance with the classes of persons designated in Section
2 5-2.
3 The Illinois Department shall authorize the provision of,
4 and shall authorize payment for, screening by low-dose
5 mammography for the presence of occult breast cancer for
6 women 35 years of age or older who are eligible for medical
7 assistance under this Article, as follows: a baseline
8 mammogram for women 35 to 39 years of age and an annual
9 mammogram for women 40 years of age or older. All screenings
10 shall include a physical breast exam, instruction on
11 self-examination and information regarding the frequency of
12 self-examination and its value as a preventative tool. As
13 used in this Section, "low-dose mammography" means the x-ray
14 examination of the breast using equipment dedicated
15 specifically for mammography, including the x-ray tube,
16 filter, compression device, image receptor, and cassettes,
17 with an average radiation exposure delivery of less than one
18 rad mid-breast, with 2 views for each breast.
19 Any medical or health care provider shall immediately
20 recommend, to any pregnant woman who is being provided
21 prenatal services and is suspected of drug abuse or is
22 addicted as defined in the Alcoholism and Other Drug Abuse
23 and Dependency Act, referral to a local substance abuse
24 treatment provider licensed by the Department of Human
25 Services or to a licensed hospital which provides substance
26 abuse treatment services. The Department of Public Aid shall
27 assure coverage for the cost of treatment of the drug abuse
28 or addiction for pregnant recipients in accordance with the
29 Illinois Medicaid Program in conjunction with the Department
30 of Human Services.
31 All medical providers providing medical assistance to
32 pregnant women under this Code shall receive information from
33 the Department on the availability of services under the Drug
34 Free Families with a Future or any comparable program
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1 providing case management services for addicted women,
2 including information on appropriate referrals for other
3 social services that may be needed by addicted women in
4 addition to treatment for addiction.
5 The Illinois Department, in cooperation with the
6 Departments of Human Services (as successor to the Department
7 of Alcoholism and Substance Abuse) and Public Health, through
8 a public awareness campaign, may provide information
9 concerning treatment for alcoholism and drug abuse and
10 addiction, prenatal health care, and other pertinent programs
11 directed at reducing the number of drug-affected infants born
12 to recipients of medical assistance.
13 Neither the Illinois Department of Public Aid nor the
14 Department of Human Services shall sanction the recipient
15 solely on the basis of her substance abuse.
16 The Illinois Department shall establish such regulations
17 governing the dispensing of health services under this
18 Article as it shall deem appropriate. In formulating these
19 regulations the Illinois Department shall consult with and
20 give substantial weight to the recommendations offered by the
21 Citizens Assembly/Council on Public Aid. The Department
22 should seek the advice of formal professional advisory
23 committees appointed by the Director of the Illinois
24 Department for the purpose of providing regular advice on
25 policy and administrative matters, information dissemination
26 and educational activities for medical and health care
27 providers, and consistency in procedures to the Illinois
28 Department.
29 The Illinois Department may develop and contract with
30 Partnerships of medical providers to arrange medical services
31 for persons eligible under Section 5-2 of this Code.
32 Implementation of this Section may be by demonstration
33 projects in certain geographic areas. The Partnership shall
34 be represented by a sponsor organization. The Department, by
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1 rule, shall develop qualifications for sponsors of
2 Partnerships. Nothing in this Section shall be construed to
3 require that the sponsor organization be a medical
4 organization.
5 The sponsor must negotiate formal written contracts with
6 medical providers for physician services, inpatient and
7 outpatient hospital care, home health services, treatment for
8 alcoholism and substance abuse, and other services determined
9 necessary by the Illinois Department by rule for delivery by
10 Partnerships. Physician services must include prenatal and
11 obstetrical care. The Illinois Department shall reimburse
12 medical services delivered by Partnership providers to
13 clients in target areas according to provisions of this
14 Article and the Illinois Health Finance Reform Act, except
15 that:
16 (1) Physicians participating in a Partnership and
17 providing certain services, which shall be determined by
18 the Illinois Department, to persons in areas covered by
19 the Partnership may receive an additional surcharge for
20 such services.
21 (2) The Department may elect to consider and
22 negotiate financial incentives to encourage the
23 development of Partnerships and the efficient delivery of
24 medical care.
25 (3) Persons receiving medical services through
26 Partnerships may receive medical and case management
27 services above the level usually offered through the
28 medical assistance program.
29 Medical providers shall be required to meet certain
30 qualifications to participate in Partnerships to ensure the
31 delivery of high quality medical services. These
32 qualifications shall be determined by rule of the Illinois
33 Department and may be higher than qualifications for
34 participation in the medical assistance program. Partnership
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1 sponsors may prescribe reasonable additional qualifications
2 for participation by medical providers, only with the prior
3 written approval of the Illinois Department.
4 Nothing in this Section shall limit the free choice of
5 practitioners, hospitals, and other providers of medical
6 services by clients.
7 The Department shall apply for a waiver from the United
8 States Health Care Financing Administration to allow for the
9 implementation of Partnerships under this Section.
10 The Illinois Department shall require health care
11 providers to maintain records that document the medical care
12 and services provided to recipients of Medical Assistance
13 under this Article. The Illinois Department shall require
14 health care providers to make available, when authorized by
15 the patient, in writing, the medical records in a timely
16 fashion to other health care providers who are treating or
17 serving persons eligible for Medical Assistance under this
18 Article. All dispensers of medical services shall be
19 required to maintain and retain business and professional
20 records sufficient to fully and accurately document the
21 nature, scope, details and receipt of the health care
22 provided to persons eligible for medical assistance under
23 this Code, in accordance with regulations promulgated by the
24 Illinois Department. The rules and regulations shall require
25 that proof of the receipt of prescription drugs, dentures,
26 prosthetic devices and eyeglasses by eligible persons under
27 this Section accompany each claim for reimbursement submitted
28 by the dispenser of such medical services. No such claims for
29 reimbursement shall be approved for payment by the Illinois
30 Department without such proof of receipt, unless the Illinois
31 Department shall have put into effect and shall be operating
32 a system of post-payment audit and review which shall, on a
33 sampling basis, be deemed adequate by the Illinois Department
34 to assure that such drugs, dentures, prosthetic devices and
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1 eyeglasses for which payment is being made are actually being
2 received by eligible recipients. Within 90 days after the
3 effective date of this amendatory Act of 1984, the Illinois
4 Department shall establish a current list of acquisition
5 costs for all prosthetic devices and any other items
6 recognized as medical equipment and supplies reimbursable
7 under this Article and shall update such list on a quarterly
8 basis, except that the acquisition costs of all prescription
9 drugs shall be updated no less frequently than every 30 days
10 as required by Section 5-5.12.
11 The rules and regulations of the Illinois Department
12 shall require that a written statement including the required
13 opinion of a physician shall accompany any claim for
14 reimbursement for abortions, or induced miscarriages or
15 premature births. This statement shall indicate what
16 procedures were used in providing such medical services.
17 The Illinois Department shall require that all dispensers
18 of medical services, other than an individual practitioner or
19 group of practitioners, desiring to participate in the
20 Medical Assistance program established under this Article to
21 disclose all financial, beneficial, ownership, equity, surety
22 or other interests in any and all firms, corporations,
23 partnerships, associations, business enterprises, joint
24 ventures, agencies, institutions or other legal entities
25 providing any form of health care services in this State
26 under this Article.
27 The Illinois Department may require that all dispensers
28 of medical services desiring to participate in the medical
29 assistance program established under this Article disclose,
30 under such terms and conditions as the Illinois Department
31 may by rule establish, all inquiries from clients and
32 attorneys regarding medical bills paid by the Illinois
33 Department, which inquiries could indicate potential
34 existence of claims or liens for the Illinois Department.
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1 The Illinois Department shall establish policies,
2 procedures, standards and criteria by rule for the
3 acquisition, repair and replacement of orthotic and
4 prosthetic devices and durable medical equipment. Such rules
5 shall provide, but not be limited to, the following services:
6 (1) immediate repair or replacement of such devices by
7 recipients without medical authorization; and (2) rental,
8 lease, purchase or lease-purchase of durable medical
9 equipment in a cost-effective manner, taking into
10 consideration the recipient's medical prognosis, the extent
11 of the recipient's needs, and the requirements and costs for
12 maintaining such equipment. Such rules shall enable a
13 recipient to temporarily acquire and use alternative or
14 substitute devices or equipment pending repairs or
15 replacements of any device or equipment previously authorized
16 for such recipient by the Department. Rules under clause (2)
17 above shall not provide for purchase or lease-purchase of
18 durable medical equipment or supplies used for the purpose of
19 oxygen delivery and respiratory care.
20 The Department shall execute, relative to the nursing
21 home prescreening project, written inter-agency agreements
22 with the Department of Human Services and the Department on
23 Aging, to effect the following: (i) intake procedures and
24 common eligibility criteria for those persons who are
25 receiving non-institutional services; and (ii) the
26 establishment and development of non-institutional services
27 in areas of the State where they are not currently available
28 or are undeveloped.
29 The Illinois Department shall develop and operate, in
30 cooperation with other State Departments and agencies and in
31 compliance with applicable federal laws and regulations,
32 appropriate and effective systems of health care evaluation
33 and programs for monitoring of utilization of health care
34 services and facilities, as it affects persons eligible for
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1 medical assistance under this Code. The Illinois Department
2 shall report regularly the results of the operation of such
3 systems and programs to the Citizens Assembly/Council on
4 Public Aid to enable the Committee to ensure, from time to
5 time, that these programs are effective and meaningful.
6 The Illinois Department shall report annually to the
7 General Assembly, no later than the second Friday in April of
8 1979 and each year thereafter, in regard to:
9 (a) actual statistics and trends in utilization of
10 medical services by public aid recipients;
11 (b) actual statistics and trends in the provision
12 of the various medical services by medical vendors;
13 (c) current rate structures and proposed changes in
14 those rate structures for the various medical vendors;
15 and
16 (d) efforts at utilization review and control by
17 the Illinois Department.
18 The period covered by each report shall be the 3 years
19 ending on the June 30 prior to the report. The report shall
20 include suggested legislation for consideration by the
21 General Assembly. The filing of one copy of the report with
22 the Speaker, one copy with the Minority Leader and one copy
23 with the Clerk of the House of Representatives, one copy with
24 the President, one copy with the Minority Leader and one copy
25 with the Secretary of the Senate, one copy with the
26 Legislative Research Unit, such additional copies with the
27 State Government Report Distribution Center for the General
28 Assembly as is required under paragraph (t) of Section 7 of
29 the State Library Act and one copy with the Citizens
30 Assembly/Council on Public Aid or its successor shall be
31 deemed sufficient to comply with this Section.
32 (Source: P.A. 89-21, eff. 7-1-95; 89-507, eff. 7-1-97;
33 89-517, eff. 1-1-97; 90-7, eff. 6-10-97; 90-14, eff. 7-1-97.)
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1 (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
2 Sec. 6-1. Eligibility requirements. Financial aid in
3 meeting basic maintenance requirements shall be given under
4 this Article to or in behalf of persons who meet the
5 eligibility conditions of Sections 6-1.1 through 6-1.10. In
6 addition, each unit of local government subject to this
7 Article shall provide persons receiving financial aid in
8 meeting basic maintenance requirements with financial aid for
9 either (a) necessary treatment, care, and supplies required
10 because of illness or disability, or (b) acute medical
11 treatment, care, and supplies only. If a local governmental
12 unit elects to provide financial aid for acute medical
13 treatment, care, and supplies only, the general types of
14 acute medical treatment, care, and supplies for which
15 financial aid is provided shall be specified in the general
16 assistance rules of the local governmental unit, which rules
17 shall provide that financial aid is provided, at a minimum,
18 for acute medical treatment, care, or supplies necessitated
19 by a medical condition for which prior approval or
20 authorization of medical treatment, care, or supplies is not
21 required by the general assistance rules of the Illinois
22 Department. Nothing in this Article shall be construed to
23 permit the granting of financial aid where the purpose of
24 such aid is to obtain an abortion, induced miscarriage or
25 induced premature birth unless, in the opinion of a
26 physician, such procedures are necessary for the preservation
27 of the life of the woman seeking such treatment, or except an
28 induced premature birth intended to produce a live viable
29 child and such procedure is necessary for the health of the
30 mother or her unborn child; State funds may also be used to
31 pay for abortions to terminate a pregnancy resulting from an
32 act of criminal sexual assault, as defined in Section 12-13
33 of the Criminal Code of 1961, an act of aggravated criminal
34 sexual assault, as defined in Section 12-14 of the Criminal
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1 Code of 1961, or an act of sexual relations within families,
2 as defined in Section 11-11 of the Criminal Code of 1961, but
3 only to the extent that payment for such abortions is
4 required by federal law as determined by a court of competent
5 jurisdiction; provided further that payment for an abortion
6 to terminate a pregnancy resulting from an act of criminal
7 sexual assault, aggravated criminal sexual assault, or sexual
8 relations within families is reported to a law enforcement
9 agency before the abortion is performed. Nothing in this
10 Article shall be construed to permit the granting of
11 financial aid where the purpose of such aid is to obtain an
12 abortion, induced miscarriage or induced premature birth
13 unless, in the opinion of a physician, such procedures are
14 necessary for the preservation of the life of the woman
15 seeking such treatment, or except an induced premature birth
16 intended to produce a live viable child and such procedure is
17 necessary for the health of the mother or her unborn child.
18 Until August 1, 1969, children who require care outside
19 their own homes, where no other sources of funds or
20 insufficient funds are available to provide the necessary
21 care, are included among persons eligible for aid under this
22 Article. After July 31, 1969, the Department of Children and
23 Family Services shall have the responsibility of providing
24 child welfare services to such children, as provided in
25 Section 5 of "An Act creating the Department of Children and
26 Family Services, codifying its powers and duties, and
27 repealing certain Acts and Sections herein named", approved
28 June 4, 1963, as amended.
29 In cities, villages and incorporated towns of more than
30 500,000 population, the Illinois Department may establish a
31 separate program under this Article. The 2 programs shall be
32 differentiated, but the placement of persons under both
33 programs shall be based upon their ability or inability to
34 engage in employment in accordance with the rules and
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1 regulations promulgated by the Illinois Department. In
2 establishing rules and regulations for determining whether a
3 person is able to engage in employment, the Illinois
4 Department may establish rules different than those set out
5 under Section 11-20. In determining need and the amount of
6 aid under Sections 6-1.2 and 6-2 for the 2 programs, the
7 Illinois Department may establish different standards for the
8 2 programs based upon the specific needs of the different
9 populations to be served by the 2 programs. The Illinois
10 Department may enter into contracts with entities to
11 establish work or training related projects under the program
12 established for persons determined to be able to engage in
13 employment.
14 (Source: P.A. 89-646, eff. 1-1-97.)
15 Section 90. Severability. If any provision, word,
16 phrase or clause of this amendatory Act of 1999 or its
17 application to any person or circumstance is held invalid,
18 the invalidity does not affect the provisions, words,
19 phrases, clauses or application of this amendatory Act of
20 1999 which can be given effect without the invalid provision,
21 word, phrase, clause, or application, and to this end the
22 provisions, words, phrases, and clauses of this amendatory
23 Act of 1999 are declared to be severable.
24 Section 99. Effective date. This Act takes effect upon
25 becoming law.