98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB2605

 

Introduced 10/16/2013, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Exempts pregnant women, persons who are classified as mentally or developmentally disabled, persons who are aged, blind, or disabled, persons who are being treated at a dental school as part of the clinical education process for dental students, and persons treated at a public health clinic or a federally qualified health center (FQHC) from a provision limiting adult dental services to emergencies. Deletes language requiring the Department of Healthcare and Family Services to recognize certain conditions as emergencies. Provides that (i) the Department shall limit the ALL KIDS school-based dental program; (ii) school-based dental providers must provide children receiving an oral health score of 2 or 3 indicating the need for restorative or urgent follow-up care with the diagnosed follow-up care by providing the care themselves at the school or at the provider's local clinic or the children must be referred by the provider's case manager to a dental provider who is willing to accept each child into the provider's practice to perform required follow-up care and provide a dental home; and (iii) the Department may limit dental coverage for children to 2 cleanings and 2 fluoride treatments per year regardless of where the services are performed and shall require prior approval from any requests exceeding this limit. In a provision concerning a dental clinic grant program administered by the Department, adds dental school clinics to the list of dental entities that can apply for grant money. In addition to other specified expenses, provides that grant moneys must be used for those services provided as part of the educational process at State dental schools. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB2605LRB098 14351 KTG 48986 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 Sections 5-5f and 12-4.39 as follows:
 
6    (305 ILCS 5/5-5f)
7    Sec. 5-5f. Elimination and limitations of medical
8assistance services. Notwithstanding any other provision of
9this Code to the contrary, on and after July 1, 2012:
10    (a) The following services shall no longer be a covered
11service available under this Code: group psychotherapy for
12residents of any facility licensed under the Nursing Home Care
13Act or the Specialized Mental Health Rehabilitation Act of
142013; and adult chiropractic services.
15    (b) The Department shall place the following limitations on
16services: (i) the Department shall limit adult eyeglasses to
17one pair every 2 years; (ii) the Department shall set an annual
18limit of a maximum of 20 visits for each of the following
19services: adult speech, hearing, and language therapy
20services, adult occupational therapy services, and physical
21therapy services; (iii) the Department shall limit adult
22podiatry services to individuals with diabetes; (iv) the
23Department shall pay for caesarean sections at the normal

 

 

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1vaginal delivery rate unless a caesarean section was medically
2necessary; (v) the Department shall limit adult dental services
3to emergencies, except that this limitation shall not apply to
4pregnant women, persons who are classified as mentally or
5developmentally disabled, persons who are aged, blind, or
6disabled, persons who are being treated at a dental school as
7part of the clinical education process for dental students, or
8persons treated at a public health clinic or a federally
9qualified health center (FQHC); (vi) the Department shall limit
10the ALL KIDS school-based dental program; school-based dental
11providers must provide children receiving an oral health score
12of 2 or 3 indicating the need for restorative or urgent
13follow-up care with the diagnosed follow-up care by providing
14the care themselves at the school or at the provider's local
15clinic or the children must be referred by the provider's case
16manager to a dental provider who is willing to accept each
17child into the provider's practice to perform required
18follow-up care and provide a dental home; in addition, the
19Department may limit dental coverage for children to 2
20cleanings and 2 fluoride treatments per year regardless of
21where the services are performed and shall require prior
22approval from any requests exceeding this limit; beginning July
231, 2013, the Department shall ensure that the following
24conditions are recognized as emergencies: (A) dental services
25necessary for an individual in order for the individual to be
26cleared for a medical procedure, such as a transplant; (B)

 

 

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1extractions and dentures necessary for a diabetic to receive
2proper nutrition; (C) extractions and dentures necessary as a
3result of cancer treatment; and (D) dental services necessary
4for the health of a pregnant woman prior to delivery of her
5baby; and (vii) (vi) effective July 1, 2012, the Department
6shall place limitations and require concurrent review on every
7inpatient detoxification stay to prevent repeat admissions to
8any hospital for detoxification within 60 days of a previous
9inpatient detoxification stay. The Department shall convene a
10workgroup of hospitals, substance abuse providers, care
11coordination entities, managed care plans, and other
12stakeholders to develop recommendations for quality standards,
13diversion to other settings, and admission criteria for
14patients who need inpatient detoxification, which shall be
15published on the Department's website no later than September
161, 2013.
17    (c) The Department shall require prior approval of the
18following services: wheelchair repairs costing more than $400,
19coronary artery bypass graft, and bariatric surgery consistent
20with Medicare standards concerning patient responsibility.
21Wheelchair repair prior approval requests shall be adjudicated
22within one business day of receipt of complete supporting
23documentation. Providers may not break wheelchair repairs into
24separate claims for purposes of staying under the $400
25threshold for requiring prior approval. The wholesale price of
26manual and power wheelchairs, durable medical equipment and

 

 

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1supplies, and complex rehabilitation technology products and
2services shall be defined as actual acquisition cost including
3all discounts.
4    (d) The Department shall establish benchmarks for
5hospitals to measure and align payments to reduce potentially
6preventable hospital readmissions, inpatient complications,
7and unnecessary emergency room visits. In doing so, the
8Department shall consider items, including, but not limited to,
9historic and current acuity of care and historic and current
10trends in readmission. The Department shall publish
11provider-specific historical readmission data and anticipated
12potentially preventable targets 60 days prior to the start of
13the program. In the instance of readmissions, the Department
14shall adopt policies and rates of reimbursement for services
15and other payments provided under this Code to ensure that, by
16June 30, 2013, expenditures to hospitals are reduced by, at a
17minimum, $40,000,000.
18    (e) The Department shall establish utilization controls
19for the hospice program such that it shall not pay for other
20care services when an individual is in hospice.
21    (f) For home health services, the Department shall require
22Medicare certification of providers participating in the
23program and implement the Medicare face-to-face encounter
24rule. The Department shall require providers to implement
25auditable electronic service verification based on global
26positioning systems or other cost-effective technology.

 

 

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1    (g) For the Home Services Program operated by the
2Department of Human Services and the Community Care Program
3operated by the Department on Aging, the Department of Human
4Services, in cooperation with the Department on Aging, shall
5implement an electronic service verification based on global
6positioning systems or other cost-effective technology.
7    (h) Effective with inpatient hospital admissions on or
8after July 1, 2012, the Department shall reduce the payment for
9a claim that indicates the occurrence of a provider-preventable
10condition during the admission as specified by the Department
11in rules. The Department shall not pay for services related to
12an other provider-preventable condition.
13    As used in this subsection (h):
14    "Provider-preventable condition" means a health care
15acquired condition as defined under the federal Medicaid
16regulation found at 42 CFR 447.26 or an other
17provider-preventable condition.
18    "Other provider-preventable condition" means a wrong
19surgical or other invasive procedure performed on a patient, a
20surgical or other invasive procedure performed on the wrong
21body part, or a surgical procedure or other invasive procedure
22performed on the wrong patient.
23    (i) The Department shall implement cost savings
24initiatives for advanced imaging services, cardiac imaging
25services, pain management services, and back surgery. Such
26initiatives shall be designed to achieve annual costs savings.

 

 

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1    (j) The Department shall ensure that beneficiaries with a
2diagnosis of epilepsy or seizure disorder in Department records
3will not require prior approval for anticonvulsants.
4(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
56-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff.
67-22-13; revised 9-19-13.)
 
7    (305 ILCS 5/12-4.39)
8    Sec. 12-4.39. Dental clinic grant program.
9    (a) Grant program. On and after July 1, 2012, and subject
10to funding availability, the Department of Healthcare and
11Family Services may administer a grant program. The purpose of
12this grant program shall be to build the public infrastructure
13for dental care and to make grants to local health departments,
14federally qualified health clinics (FQHCs), and rural health
15clinics (RHCs), and dental schools for development of
16comprehensive dental clinics for dental care services. The
17primary purpose of these new dental clinics will be to increase
18dental access for low-income and Department of Healthcare and
19Family Services clients who have no dental arrangements with a
20dental provider in a project's service area. The dental clinic
21must be willing to accept out-of-area clients who need dental
22services, including emergency services for adults and Early and
23Periodic Screening, Diagnosis and Treatment (EPSDT)-referral
24children. Medically Underserved Areas (MUAs) and Health
25Professional Shortage Areas (HPSAs) shall receive special

 

 

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1priority for grants under this program.
2    (b) Eligible applicants. The following entities are
3eligible to apply for grants:
4        (1) Local health departments.
5        (2) Federally Qualified Health Centers (FQHCs).
6        (3) Rural health clinics (RHCs).
7        (4) Dental school clinics.
8    (c) Use of grant moneys. Grant moneys must be used to
9support projects that develop dental services or training to
10meet the dental health care needs of Department of Healthcare
11and Family Services Dental Program clients. Grant moneys must
12be used for operating expenses, including, but not limited to:
13insurance; dental supplies and equipment; dental support
14services, including those services provided as part of the
15educational process at State dental schools; and renovation
16expenses. Grant moneys may not be used to offset existing
17indebtedness, supplant existing funds, purchase real property,
18or pay for personnel service salaries for dental employees.
19    (d) Application process. The Department shall establish
20procedures for applying for dental clinic grants.
21(Source: P.A. 96-67, eff. 7-23-09; 96-1000, eff. 7-2-10;
2297-689, eff. 6-14-12.)
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    305 ILCS 5/5-5f
4    305 ILCS 5/12-4.39