98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB4635

 

Introduced , by Rep. Michael W. Tryon

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5  from Ch. 23, par. 5-5

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to provide medical assistance coverage for diabetes education provided by a certified diabetes education provider for children with Type 1 diabetes who are under the age of 18. Defines "certified diabetes education provider" to mean a professional who has undergone training and certification under conditions approved by the American Association of Diabetes Educators or a successor association of professionals. Defines "Type 1 diabetes" to have the same meaning ascribed to it by the American Diabetes Association or any successor association. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB4635LRB098 18127 KTG 53256 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5 as follows:
 
6    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
7    Sec. 5-5. Medical services. The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing home,
16or elsewhere; (6) medical care, or any other type of remedial
17care furnished by licensed practitioners; (7) home health care
18services; (8) private duty nursing service; (9) clinic
19services; (10) dental services, including prevention and
20treatment of periodontal disease and dental caries disease for
21pregnant women, provided by an individual licensed to practice
22dentistry or dental surgery; for purposes of this item (10),
23"dental services" means diagnostic, preventive, or corrective

 

 

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1procedures provided by or under the supervision of a dentist in
2the practice of his or her profession; (11) physical therapy
3and related services; (12) prescribed drugs, dentures, and
4prosthetic devices; and eyeglasses prescribed by a physician
5skilled in the diseases of the eye, or by an optometrist,
6whichever the person may select; (13) other diagnostic,
7screening, preventive, and rehabilitative services, including
8to ensure that the individual's need for intervention or
9treatment of mental disorders or substance use disorders or
10co-occurring mental health and substance use disorders is
11determined using a uniform screening, assessment, and
12evaluation process inclusive of criteria, for children and
13adults; for purposes of this item (13), a uniform screening,
14assessment, and evaluation process refers to a process that
15includes an appropriate evaluation and, as warranted, a
16referral; "uniform" does not mean the use of a singular
17instrument, tool, or process that all must utilize; (14)
18transportation and such other expenses as may be necessary;
19(15) medical treatment of sexual assault survivors, as defined
20in Section 1a of the Sexual Assault Survivors Emergency
21Treatment Act, for injuries sustained as a result of the sexual
22assault, including examinations and laboratory tests to
23discover evidence which may be used in criminal proceedings
24arising from the sexual assault; (16) the diagnosis and
25treatment of sickle cell anemia; and (17) any other medical
26care, and any other type of remedial care recognized under the

 

 

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1laws of this State, but not including abortions, or induced
2miscarriages or premature births, unless, in the opinion of a
3physician, such procedures are necessary for the preservation
4of the life of the woman seeking such treatment, or except an
5induced premature birth intended to produce a live viable child
6and such procedure is necessary for the health of the mother or
7her unborn child. The Illinois Department, by rule, shall
8prohibit any physician from providing medical assistance to
9anyone eligible therefor under this Code where such physician
10has been found guilty of performing an abortion procedure in a
11wilful and wanton manner upon a woman who was not pregnant at
12the time such abortion procedure was performed. The term "any
13other type of remedial care" shall include nursing care and
14nursing home service for persons who rely on treatment by
15spiritual means alone through prayer for healing.
16    Notwithstanding any other provision of this Section, a
17comprehensive tobacco use cessation program that includes
18purchasing prescription drugs or prescription medical devices
19approved by the Food and Drug Administration shall be covered
20under the medical assistance program under this Article for
21persons who are otherwise eligible for assistance under this
22Article.
23    Notwithstanding any other provision of this Code, the
24Illinois Department may not require, as a condition of payment
25for any laboratory test authorized under this Article, that a
26physician's handwritten signature appear on the laboratory

 

 

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1test order form. The Illinois Department may, however, impose
2other appropriate requirements regarding laboratory test order
3documentation.
4    Notwithstanding any other provision of this Code, the
5Department shall provide medical assistance coverage for
6diabetes education provided by a certified diabetes education
7provider for children with Type 1 diabetes who are under the
8age of 18. For purposes of this paragraph:
9        "Certified diabetes education provider" means a
10    professional who has undergone training and certification
11    under conditions approved by the American Association of
12    Diabetes Educators or a successor association of
13    professionals.
14        "Type 1 diabetes" shall have the same meaning ascribed
15    to it by the American Diabetes Association or any successor
16    association.
17    On and after July 1, 2012, the Department of Healthcare and
18Family Services may provide the following services to persons
19eligible for assistance under this Article who are
20participating in education, training or employment programs
21operated by the Department of Human Services as successor to
22the Department of Public Aid:
23        (1) dental services provided by or under the
24    supervision of a dentist; and
25        (2) eyeglasses prescribed by a physician skilled in the
26    diseases of the eye, or by an optometrist, whichever the

 

 

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1    person may select.
2    Notwithstanding any other provision of this Code and
3subject to federal approval, the Department may adopt rules to
4allow a dentist who is volunteering his or her service at no
5cost to render dental services through an enrolled
6not-for-profit health clinic without the dentist personally
7enrolling as a participating provider in the medical assistance
8program. A not-for-profit health clinic shall include a public
9health clinic or Federally Qualified Health Center or other
10enrolled provider, as determined by the Department, through
11which dental services covered under this Section are performed.
12The Department shall establish a process for payment of claims
13for reimbursement for covered dental services rendered under
14this provision.
15    The Illinois Department, by rule, may distinguish and
16classify the medical services to be provided only in accordance
17with the classes of persons designated in Section 5-2.
18    The Department of Healthcare and Family Services must
19provide coverage and reimbursement for amino acid-based
20elemental formulas, regardless of delivery method, for the
21diagnosis and treatment of (i) eosinophilic disorders and (ii)
22short bowel syndrome when the prescribing physician has issued
23a written order stating that the amino acid-based elemental
24formula is medically necessary.
25    The Illinois Department shall authorize the provision of,
26and shall authorize payment for, screening by low-dose

 

 

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1mammography for the presence of occult breast cancer for women
235 years of age or older who are eligible for medical
3assistance under this Article, as follows:
4        (A) A baseline mammogram for women 35 to 39 years of
5    age.
6        (B) An annual mammogram for women 40 years of age or
7    older.
8        (C) A mammogram at the age and intervals considered
9    medically necessary by the woman's health care provider for
10    women under 40 years of age and having a family history of
11    breast cancer, prior personal history of breast cancer,
12    positive genetic testing, or other risk factors.
13        (D) A comprehensive ultrasound screening of an entire
14    breast or breasts if a mammogram demonstrates
15    heterogeneous or dense breast tissue, when medically
16    necessary as determined by a physician licensed to practice
17    medicine in all of its branches.
18    All screenings shall include a physical breast exam,
19instruction on self-examination and information regarding the
20frequency of self-examination and its value as a preventative
21tool. For purposes of this Section, "low-dose mammography"
22means the x-ray examination of the breast using equipment
23dedicated specifically for mammography, including the x-ray
24tube, filter, compression device, and image receptor, with an
25average radiation exposure delivery of less than one rad per
26breast for 2 views of an average size breast. The term also

 

 

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1includes digital mammography.
2    On and after January 1, 2012, providers participating in a
3quality improvement program approved by the Department shall be
4reimbursed for screening and diagnostic mammography at the same
5rate as the Medicare program's rates, including the increased
6reimbursement for digital mammography.
7    The Department shall convene an expert panel including
8representatives of hospitals, free-standing mammography
9facilities, and doctors, including radiologists, to establish
10quality standards.
11    Subject to federal approval, the Department shall
12establish a rate methodology for mammography at federally
13qualified health centers and other encounter-rate clinics.
14These clinics or centers may also collaborate with other
15hospital-based mammography facilities.
16    The Department shall establish a methodology to remind
17women who are age-appropriate for screening mammography, but
18who have not received a mammogram within the previous 18
19months, of the importance and benefit of screening mammography.
20    The Department shall establish a performance goal for
21primary care providers with respect to their female patients
22over age 40 receiving an annual mammogram. This performance
23goal shall be used to provide additional reimbursement in the
24form of a quality performance bonus to primary care providers
25who meet that goal.
26    The Department shall devise a means of case-managing or

 

 

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1patient navigation for beneficiaries diagnosed with breast
2cancer. This program shall initially operate as a pilot program
3in areas of the State with the highest incidence of mortality
4related to breast cancer. At least one pilot program site shall
5be in the metropolitan Chicago area and at least one site shall
6be outside the metropolitan Chicago area. An evaluation of the
7pilot program shall be carried out measuring health outcomes
8and cost of care for those served by the pilot program compared
9to similarly situated patients who are not served by the pilot
10program.
11    Any medical or health care provider shall immediately
12recommend, to any pregnant woman who is being provided prenatal
13services and is suspected of drug abuse or is addicted as
14defined in the Alcoholism and Other Drug Abuse and Dependency
15Act, referral to a local substance abuse treatment provider
16licensed by the Department of Human Services or to a licensed
17hospital which provides substance abuse treatment services.
18The Department of Healthcare and Family Services shall assure
19coverage for the cost of treatment of the drug abuse or
20addiction for pregnant recipients in accordance with the
21Illinois Medicaid Program in conjunction with the Department of
22Human Services.
23    All medical providers providing medical assistance to
24pregnant women under this Code shall receive information from
25the Department on the availability of services under the Drug
26Free Families with a Future or any comparable program providing

 

 

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1case management services for addicted women, including
2information on appropriate referrals for other social services
3that may be needed by addicted women in addition to treatment
4for addiction.
5    The Illinois Department, in cooperation with the
6Departments of Human Services (as successor to the Department
7of Alcoholism and Substance Abuse) and Public Health, through a
8public awareness campaign, may provide information concerning
9treatment for alcoholism and drug abuse and addiction, prenatal
10health care, and other pertinent programs directed at reducing
11the number of drug-affected infants born to recipients of
12medical assistance.
13    Neither the Department of Healthcare and Family Services
14nor the Department of Human Services shall sanction the
15recipient solely on the basis of her substance abuse.
16    The Illinois Department shall establish such regulations
17governing the dispensing of health services under this Article
18as it shall deem appropriate. The Department should seek the
19advice of formal professional advisory committees appointed by
20the Director of the Illinois Department for the purpose of
21providing regular advice on policy and administrative matters,
22information dissemination and educational activities for
23medical and health care providers, and consistency in
24procedures to the Illinois Department.
25    The Illinois Department may develop and contract with
26Partnerships of medical providers to arrange medical services

 

 

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1for persons eligible under Section 5-2 of this Code.
2Implementation of this Section may be by demonstration projects
3in certain geographic areas. The Partnership shall be
4represented by a sponsor organization. The Department, by rule,
5shall develop qualifications for sponsors of Partnerships.
6Nothing in this Section shall be construed to require that the
7sponsor organization be a medical organization.
8    The sponsor must negotiate formal written contracts with
9medical providers for physician services, inpatient and
10outpatient hospital care, home health services, treatment for
11alcoholism and substance abuse, and other services determined
12necessary by the Illinois Department by rule for delivery by
13Partnerships. Physician services must include prenatal and
14obstetrical care. The Illinois Department shall reimburse
15medical services delivered by Partnership providers to clients
16in target areas according to provisions of this Article and the
17Illinois Health Finance Reform Act, except that:
18        (1) Physicians participating in a Partnership and
19    providing certain services, which shall be determined by
20    the Illinois Department, to persons in areas covered by the
21    Partnership may receive an additional surcharge for such
22    services.
23        (2) The Department may elect to consider and negotiate
24    financial incentives to encourage the development of
25    Partnerships and the efficient delivery of medical care.
26        (3) Persons receiving medical services through

 

 

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1    Partnerships may receive medical and case management
2    services above the level usually offered through the
3    medical assistance program.
4    Medical providers shall be required to meet certain
5qualifications to participate in Partnerships to ensure the
6delivery of high quality medical services. These
7qualifications shall be determined by rule of the Illinois
8Department and may be higher than qualifications for
9participation in the medical assistance program. Partnership
10sponsors may prescribe reasonable additional qualifications
11for participation by medical providers, only with the prior
12written approval of the Illinois Department.
13    Nothing in this Section shall limit the free choice of
14practitioners, hospitals, and other providers of medical
15services by clients. In order to ensure patient freedom of
16choice, the Illinois Department shall immediately promulgate
17all rules and take all other necessary actions so that provided
18services may be accessed from therapeutically certified
19optometrists to the full extent of the Illinois Optometric
20Practice Act of 1987 without discriminating between service
21providers.
22    The Department shall apply for a waiver from the United
23States Health Care Financing Administration to allow for the
24implementation of Partnerships under this Section.
25    The Illinois Department shall require health care
26providers to maintain records that document the medical care

 

 

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1and services provided to recipients of Medical Assistance under
2this Article. Such records must be retained for a period of not
3less than 6 years from the date of service or as provided by
4applicable State law, whichever period is longer, except that
5if an audit is initiated within the required retention period
6then the records must be retained until the audit is completed
7and every exception is resolved. The Illinois Department shall
8require health care providers to make available, when
9authorized by the patient, in writing, the medical records in a
10timely fashion to other health care providers who are treating
11or serving persons eligible for Medical Assistance under this
12Article. All dispensers of medical services shall be required
13to maintain and retain business and professional records
14sufficient to fully and accurately document the nature, scope,
15details and receipt of the health care provided to persons
16eligible for medical assistance under this Code, in accordance
17with regulations promulgated by the Illinois Department. The
18rules and regulations shall require that proof of the receipt
19of prescription drugs, dentures, prosthetic devices and
20eyeglasses by eligible persons under this Section accompany
21each claim for reimbursement submitted by the dispenser of such
22medical services. No such claims for reimbursement shall be
23approved for payment by the Illinois Department without such
24proof of receipt, unless the Illinois Department shall have put
25into effect and shall be operating a system of post-payment
26audit and review which shall, on a sampling basis, be deemed

 

 

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1adequate by the Illinois Department to assure that such drugs,
2dentures, prosthetic devices and eyeglasses for which payment
3is being made are actually being received by eligible
4recipients. Within 90 days after the effective date of this
5amendatory Act of 1984, the Illinois Department shall establish
6a current list of acquisition costs for all prosthetic devices
7and any other items recognized as medical equipment and
8supplies reimbursable under this Article and shall update such
9list on a quarterly basis, except that the acquisition costs of
10all prescription drugs shall be updated no less frequently than
11every 30 days as required by Section 5-5.12.
12    The rules and regulations of the Illinois Department shall
13require that a written statement including the required opinion
14of a physician shall accompany any claim for reimbursement for
15abortions, or induced miscarriages or premature births. This
16statement shall indicate what procedures were used in providing
17such medical services.
18    Notwithstanding any other law to the contrary, the Illinois
19Department shall, within 365 days after July 22, 2013 (the
20effective date of Public Act 98-104) this amendatory Act of the
2198th General Assembly, establish procedures to permit skilled
22care facilities licensed under the Nursing Home Care Act to
23submit monthly billing claims for reimbursement purposes.
24Following development of these procedures, the Department
25shall have an additional 365 days to test the viability of the
26new system and to ensure that any necessary operational or

 

 

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1structural changes to its information technology platforms are
2implemented.
3    The Illinois Department shall require all dispensers of
4medical services, other than an individual practitioner or
5group of practitioners, desiring to participate in the Medical
6Assistance program established under this Article to disclose
7all financial, beneficial, ownership, equity, surety or other
8interests in any and all firms, corporations, partnerships,
9associations, business enterprises, joint ventures, agencies,
10institutions or other legal entities providing any form of
11health care services in this State under this Article.
12    The Illinois Department may require that all dispensers of
13medical services desiring to participate in the medical
14assistance program established under this Article disclose,
15under such terms and conditions as the Illinois Department may
16by rule establish, all inquiries from clients and attorneys
17regarding medical bills paid by the Illinois Department, which
18inquiries could indicate potential existence of claims or liens
19for the Illinois Department.
20    Enrollment of a vendor shall be subject to a provisional
21period and shall be conditional for one year. During the period
22of conditional enrollment, the Department may terminate the
23vendor's eligibility to participate in, or may disenroll the
24vendor from, the medical assistance program without cause.
25Unless otherwise specified, such termination of eligibility or
26disenrollment is not subject to the Department's hearing

 

 

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1process. However, a disenrolled vendor may reapply without
2penalty.
3    The Department has the discretion to limit the conditional
4enrollment period for vendors based upon category of risk of
5the vendor.
6    Prior to enrollment and during the conditional enrollment
7period in the medical assistance program, all vendors shall be
8subject to enhanced oversight, screening, and review based on
9the risk of fraud, waste, and abuse that is posed by the
10category of risk of the vendor. The Illinois Department shall
11establish the procedures for oversight, screening, and review,
12which may include, but need not be limited to: criminal and
13financial background checks; fingerprinting; license,
14certification, and authorization verifications; unscheduled or
15unannounced site visits; database checks; prepayment audit
16reviews; audits; payment caps; payment suspensions; and other
17screening as required by federal or State law.
18    The Department shall define or specify the following: (i)
19by provider notice, the "category of risk of the vendor" for
20each type of vendor, which shall take into account the level of
21screening applicable to a particular category of vendor under
22federal law and regulations; (ii) by rule or provider notice,
23the maximum length of the conditional enrollment period for
24each category of risk of the vendor; and (iii) by rule, the
25hearing rights, if any, afforded to a vendor in each category
26of risk of the vendor that is terminated or disenrolled during

 

 

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1the conditional enrollment period.
2    To be eligible for payment consideration, a vendor's
3payment claim or bill, either as an initial claim or as a
4resubmitted claim following prior rejection, must be received
5by the Illinois Department, or its fiscal intermediary, no
6later than 180 days after the latest date on the claim on which
7medical goods or services were provided, with the following
8exceptions:
9        (1) In the case of a provider whose enrollment is in
10    process by the Illinois Department, the 180-day period
11    shall not begin until the date on the written notice from
12    the Illinois Department that the provider enrollment is
13    complete.
14        (2) In the case of errors attributable to the Illinois
15    Department or any of its claims processing intermediaries
16    which result in an inability to receive, process, or
17    adjudicate a claim, the 180-day period shall not begin
18    until the provider has been notified of the error.
19        (3) In the case of a provider for whom the Illinois
20    Department initiates the monthly billing process.
21        (4) In the case of a provider operated by a unit of
22    local government with a population exceeding 3,000,000
23    when local government funds finance federal participation
24    for claims payments.
25    For claims for services rendered during a period for which
26a recipient received retroactive eligibility, claims must be

 

 

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1filed within 180 days after the Department determines the
2applicant is eligible. For claims for which the Illinois
3Department is not the primary payer, claims must be submitted
4to the Illinois Department within 180 days after the final
5adjudication by the primary payer.
6    In the case of long term care facilities, admission
7documents shall be submitted within 30 days of an admission to
8the facility through the Medical Electronic Data Interchange
9(MEDI) or the Recipient Eligibility Verification (REV) System,
10or shall be submitted directly to the Department of Human
11Services using required admission forms. Confirmation numbers
12assigned to an accepted transaction shall be retained by a
13facility to verify timely submittal. Once an admission
14transaction has been completed, all resubmitted claims
15following prior rejection are subject to receipt no later than
16180 days after the admission transaction has been completed.
17    Claims that are not submitted and received in compliance
18with the foregoing requirements shall not be eligible for
19payment under the medical assistance program, and the State
20shall have no liability for payment of those claims.
21    To the extent consistent with applicable information and
22privacy, security, and disclosure laws, State and federal
23agencies and departments shall provide the Illinois Department
24access to confidential and other information and data necessary
25to perform eligibility and payment verifications and other
26Illinois Department functions. This includes, but is not

 

 

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1limited to: information pertaining to licensure;
2certification; earnings; immigration status; citizenship; wage
3reporting; unearned and earned income; pension income;
4employment; supplemental security income; social security
5numbers; National Provider Identifier (NPI) numbers; the
6National Practitioner Data Bank (NPDB); program and agency
7exclusions; taxpayer identification numbers; tax delinquency;
8corporate information; and death records.
9    The Illinois Department shall enter into agreements with
10State agencies and departments, and is authorized to enter into
11agreements with federal agencies and departments, under which
12such agencies and departments shall share data necessary for
13medical assistance program integrity functions and oversight.
14The Illinois Department shall develop, in cooperation with
15other State departments and agencies, and in compliance with
16applicable federal laws and regulations, appropriate and
17effective methods to share such data. At a minimum, and to the
18extent necessary to provide data sharing, the Illinois
19Department shall enter into agreements with State agencies and
20departments, and is authorized to enter into agreements with
21federal agencies and departments, including but not limited to:
22the Secretary of State; the Department of Revenue; the
23Department of Public Health; the Department of Human Services;
24and the Department of Financial and Professional Regulation.
25    Beginning in fiscal year 2013, the Illinois Department
26shall set forth a request for information to identify the

 

 

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1benefits of a pre-payment, post-adjudication, and post-edit
2claims system with the goals of streamlining claims processing
3and provider reimbursement, reducing the number of pending or
4rejected claims, and helping to ensure a more transparent
5adjudication process through the utilization of: (i) provider
6data verification and provider screening technology; and (ii)
7clinical code editing; and (iii) pre-pay, pre- or
8post-adjudicated predictive modeling with an integrated case
9management system with link analysis. Such a request for
10information shall not be considered as a request for proposal
11or as an obligation on the part of the Illinois Department to
12take any action or acquire any products or services.
13    The Illinois Department shall establish policies,
14procedures, standards and criteria by rule for the acquisition,
15repair and replacement of orthotic and prosthetic devices and
16durable medical equipment. Such rules shall provide, but not be
17limited to, the following services: (1) immediate repair or
18replacement of such devices by recipients; and (2) rental,
19lease, purchase or lease-purchase of durable medical equipment
20in a cost-effective manner, taking into consideration the
21recipient's medical prognosis, the extent of the recipient's
22needs, and the requirements and costs for maintaining such
23equipment. Subject to prior approval, such rules shall enable a
24recipient to temporarily acquire and use alternative or
25substitute devices or equipment pending repairs or
26replacements of any device or equipment previously authorized

 

 

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1for such recipient by the Department.
2    The Department shall execute, relative to the nursing home
3prescreening project, written inter-agency agreements with the
4Department of Human Services and the Department on Aging, to
5effect the following: (i) intake procedures and common
6eligibility criteria for those persons who are receiving
7non-institutional services; and (ii) the establishment and
8development of non-institutional services in areas of the State
9where they are not currently available or are undeveloped; and
10(iii) notwithstanding any other provision of law, subject to
11federal approval, on and after July 1, 2012, an increase in the
12determination of need (DON) scores from 29 to 37 for applicants
13for institutional and home and community-based long term care;
14if and only if federal approval is not granted, the Department
15may, in conjunction with other affected agencies, implement
16utilization controls or changes in benefit packages to
17effectuate a similar savings amount for this population; and
18(iv) no later than July 1, 2013, minimum level of care
19eligibility criteria for institutional and home and
20community-based long term care; and (v) no later than October
211, 2013, establish procedures to permit long term care
22providers access to eligibility scores for individuals with an
23admission date who are seeking or receiving services from the
24long term care provider. In order to select the minimum level
25of care eligibility criteria, the Governor shall establish a
26workgroup that includes affected agency representatives and

 

 

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1stakeholders representing the institutional and home and
2community-based long term care interests. This Section shall
3not restrict the Department from implementing lower level of
4care eligibility criteria for community-based services in
5circumstances where federal approval has been granted.
6    The Illinois Department shall develop and operate, in
7cooperation with other State Departments and agencies and in
8compliance with applicable federal laws and regulations,
9appropriate and effective systems of health care evaluation and
10programs for monitoring of utilization of health care services
11and facilities, as it affects persons eligible for medical
12assistance under this Code.
13    The Illinois Department shall report annually to the
14General Assembly, no later than the second Friday in April of
151979 and each year thereafter, in regard to:
16        (a) actual statistics and trends in utilization of
17    medical services by public aid recipients;
18        (b) actual statistics and trends in the provision of
19    the various medical services by medical vendors;
20        (c) current rate structures and proposed changes in
21    those rate structures for the various medical vendors; and
22        (d) efforts at utilization review and control by the
23    Illinois Department.
24    The period covered by each report shall be the 3 years
25ending on the June 30 prior to the report. The report shall
26include suggested legislation for consideration by the General

 

 

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1Assembly. The filing of one copy of the report with the
2Speaker, one copy with the Minority Leader and one copy with
3the Clerk of the House of Representatives, one copy with the
4President, one copy with the Minority Leader and one copy with
5the Secretary of the Senate, one copy with the Legislative
6Research Unit, and such additional copies with the State
7Government Report Distribution Center for the General Assembly
8as is required under paragraph (t) of Section 7 of the State
9Library Act shall be deemed sufficient to comply with this
10Section.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate of
20reimbursement for services or other payments in accordance with
21Section 5-5e.
22(Source: P.A. 97-48, eff. 6-28-11; 97-638, eff. 1-1-12; 97-689,
23eff. 6-14-12; 97-1061, eff. 8-24-12; 98-104, Article 9, Section
249-5, eff. 7-22-13; 98-104, Article 12, Section 12-20, eff.
257-22-13; 98-303, eff. 8-9-13; 98-463, eff. 8-16-13; revised
269-19-13.)
 

 

 

HB4635- 23 -LRB098 18127 KTG 53256 b

1    Section 99. Effective date. This Act takes effect upon
2becoming law.