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91_HB0709enr
HB0709 Enrolled LRB9100307SMdv
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
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1 services; (3) other laboratory and X-ray services; (4)
2 skilled nursing home services; (5) physicians' services
3 whether furnished in the office, the patient's home, a
4 hospital, a skilled nursing home, or elsewhere; (6) medical
5 care, or any other type of remedial care furnished by
6 licensed practitioners; (7) home health care services; (8)
7 private duty nursing service; (9) clinic services; (10)
8 dental services; (11) physical therapy and related services;
9 (12) prescribed drugs, dentures, and prosthetic devices; and
10 eyeglasses prescribed by a physician skilled in the diseases
11 of the eye, or by an optometrist, whichever the person may
12 select; (13) other diagnostic, screening, preventive, and
13 rehabilitative services; (14) transportation and such other
14 expenses as may be necessary; (15) medical treatment of
15 sexual assault survivors, as defined in Section 1a of the
16 Sexual Assault Survivors Emergency Treatment Act, for
17 injuries sustained as a result of the sexual assault,
18 including examinations and laboratory tests to discover
19 evidence which may be used in criminal proceedings arising
20 from the sexual assault; (16) the diagnosis and treatment of
21 sickle cell anemia; and (17) any other medical care, and any
22 other type of remedial care recognized under the laws of this
23 State, but not including abortions, or induced miscarriages
24 or premature births, unless, in the opinion of a physician,
25 such procedures are necessary for the preservation of the
26 life of the woman seeking such treatment, or except an
27 induced premature birth intended to produce a live viable
28 child and such procedure is necessary for the health of the
29 mother or her unborn child; State funds may also be used to
30 pay for abortions to terminate a pregnancy resulting from an
31 act of criminal sexual assault, as defined in Section 12-13
32 of the Criminal Code of 1961, an act of aggravated criminal
33 sexual assault, as defined in Section 12-14 of the Criminal
34 Code of 1961, or an act of sexual relations within families,
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1 as defined in Section 11-11 of the Criminal Code of 1961, but
2 only to the extent that payment for such abortions is
3 required by federal law as determined by a court of competent
4 jurisdiction but not including abortions, or induced
5 miscarriages or premature births, unless, in the opinion of a
6 physician, such procedures are necessary for the preservation
7 of the life of the woman seeking such treatment, or except an
8 induced premature birth intended to produce a live viable
9 child and such procedure is necessary for the health of the
10 mother or her unborn child. The Illinois Department, by rule,
11 shall prohibit any physician from providing medical
12 assistance to anyone eligible therefor under this Code where
13 such physician has been found guilty of performing an
14 abortion procedure in a wilful and wanton manner upon a woman
15 who was not pregnant at the time such abortion procedure was
16 performed. The term "any other type of remedial care" shall
17 include nursing care and nursing home service for persons who
18 rely on treatment by spiritual means alone through prayer for
19 healing.
20 Notwithstanding any other provision of this Code, the
21 Illinois Department may not require, as a condition of
22 payment for any laboratory test authorized under this
23 Article, that a physician's handwritten signature appear on
24 the laboratory test order form. The Illinois Department may,
25 however, impose other appropriate requirements regarding
26 laboratory test order documentation.
27 The Illinois Department of Public Aid shall provide the
28 following services to persons eligible for assistance under
29 this Article who are participating in education, training or
30 employment programs operated by the Department of Human
31 Services as successor to the Department of Public Aid:
32 (1) dental services, which shall include but not be
33 limited to prosthodontics; and
34 (2) eyeglasses prescribed by a physician skilled in
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1 the diseases of the eye, or by an optometrist, whichever
2 the person may select.
3 The Illinois Department, by rule, may distinguish and
4 classify the medical services to be provided only in
5 accordance with the classes of persons designated in Section
6 5-2.
7 The Illinois Department shall authorize the provision of,
8 and shall authorize payment for, screening by low-dose
9 mammography for the presence of occult breast cancer for
10 women 35 years of age or older who are eligible for medical
11 assistance under this Article, as follows: a baseline
12 mammogram for women 35 to 39 years of age and an annual
13 mammogram for women 40 years of age or older. All screenings
14 shall include a physical breast exam, instruction on
15 self-examination and information regarding the frequency of
16 self-examination and its value as a preventative tool. As
17 used in this Section, "low-dose mammography" means the x-ray
18 examination of the breast using equipment dedicated
19 specifically for mammography, including the x-ray tube,
20 filter, compression device, image receptor, and cassettes,
21 with an average radiation exposure delivery of less than one
22 rad mid-breast, with 2 views for each breast.
23 Any medical or health care provider shall immediately
24 recommend, to any pregnant woman who is being provided
25 prenatal services and is suspected of drug abuse or is
26 addicted as defined in the Alcoholism and Other Drug Abuse
27 and Dependency Act, referral to a local substance abuse
28 treatment provider licensed by the Department of Human
29 Services or to a licensed hospital which provides substance
30 abuse treatment services. The Department of Public Aid shall
31 assure coverage for the cost of treatment of the drug abuse
32 or addiction for pregnant recipients in accordance with the
33 Illinois Medicaid Program in conjunction with the Department
34 of Human Services.
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1 All medical providers providing medical assistance to
2 pregnant women under this Code shall receive information from
3 the Department on the availability of services under the Drug
4 Free Families with a Future or any comparable program
5 providing case management services for addicted women,
6 including information on appropriate referrals for other
7 social services that may be needed by addicted women in
8 addition to treatment for addiction.
9 The Illinois Department, in cooperation with the
10 Departments of Human Services (as successor to the Department
11 of Alcoholism and Substance Abuse) and Public Health, through
12 a public awareness campaign, may provide information
13 concerning treatment for alcoholism and drug abuse and
14 addiction, prenatal health care, and other pertinent programs
15 directed at reducing the number of drug-affected infants born
16 to recipients of medical assistance.
17 Neither the Illinois Department of Public Aid nor the
18 Department of Human Services shall sanction the recipient
19 solely on the basis of her substance abuse.
20 The Illinois Department shall establish such regulations
21 governing the dispensing of health services under this
22 Article as it shall deem appropriate. In formulating these
23 regulations the Illinois Department shall consult with and
24 give substantial weight to the recommendations offered by the
25 Citizens Assembly/Council on Public Aid. The Department
26 should seek the advice of formal professional advisory
27 committees appointed by the Director of the Illinois
28 Department for the purpose of providing regular advice on
29 policy and administrative matters, information dissemination
30 and educational activities for medical and health care
31 providers, and consistency in procedures to the Illinois
32 Department.
33 The Illinois Department may develop and contract with
34 Partnerships of medical providers to arrange medical services
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1 for persons eligible under Section 5-2 of this Code.
2 Implementation of this Section may be by demonstration
3 projects in certain geographic areas. The Partnership shall
4 be represented by a sponsor organization. The Department, by
5 rule, shall develop qualifications for sponsors of
6 Partnerships. Nothing in this Section shall be construed to
7 require that the sponsor organization be a medical
8 organization.
9 The sponsor must negotiate formal written contracts with
10 medical providers for physician services, inpatient and
11 outpatient hospital care, home health services, treatment for
12 alcoholism and substance abuse, and other services determined
13 necessary by the Illinois Department by rule for delivery by
14 Partnerships. Physician services must include prenatal and
15 obstetrical care. The Illinois Department shall reimburse
16 medical services delivered by Partnership providers to
17 clients in target areas according to provisions of this
18 Article and the Illinois Health Finance Reform Act, except
19 that:
20 (1) Physicians participating in a Partnership and
21 providing certain services, which shall be determined by
22 the Illinois Department, to persons in areas covered by
23 the Partnership may receive an additional surcharge for
24 such services.
25 (2) The Department may elect to consider and
26 negotiate financial incentives to encourage the
27 development of Partnerships and the efficient delivery of
28 medical care.
29 (3) Persons receiving medical services through
30 Partnerships may receive medical and case management
31 services above the level usually offered through the
32 medical assistance program.
33 Medical providers shall be required to meet certain
34 qualifications to participate in Partnerships to ensure the
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1 delivery of high quality medical services. These
2 qualifications shall be determined by rule of the Illinois
3 Department and may be higher than qualifications for
4 participation in the medical assistance program. Partnership
5 sponsors may prescribe reasonable additional qualifications
6 for participation by medical providers, only with the prior
7 written approval of the Illinois Department.
8 Nothing in this Section shall limit the free choice of
9 practitioners, hospitals, and other providers of medical
10 services by clients. In order to ensure patient freedom of
11 choice, the Illinois Department shall immediately promulgate
12 all rules and take all other necessary actions so that
13 provided services may be accessed from therapeutically
14 certified optometrists to the full extent of the Illinois
15 Optometric Practice Act of 1987 without discriminating
16 between service providers.
17 The Department shall apply for a waiver from the United
18 States Health Care Financing Administration to allow for the
19 implementation of Partnerships under this Section.
20 The Illinois Department shall require health care
21 providers to maintain records that document the medical care
22 and services provided to recipients of Medical Assistance
23 under this Article. The Illinois Department shall require
24 health care providers to make available, when authorized by
25 the patient, in writing, the medical records in a timely
26 fashion to other health care providers who are treating or
27 serving persons eligible for Medical Assistance under this
28 Article. All dispensers of medical services shall be
29 required to maintain and retain business and professional
30 records sufficient to fully and accurately document the
31 nature, scope, details and receipt of the health care
32 provided to persons eligible for medical assistance under
33 this Code, in accordance with regulations promulgated by the
34 Illinois Department. The rules and regulations shall require
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1 that proof of the receipt of prescription drugs, dentures,
2 prosthetic devices and eyeglasses by eligible persons under
3 this Section accompany each claim for reimbursement submitted
4 by the dispenser of such medical services. No such claims for
5 reimbursement shall be approved for payment by the Illinois
6 Department without such proof of receipt, unless the Illinois
7 Department shall have put into effect and shall be operating
8 a system of post-payment audit and review which shall, on a
9 sampling basis, be deemed adequate by the Illinois Department
10 to assure that such drugs, dentures, prosthetic devices and
11 eyeglasses for which payment is being made are actually being
12 received by eligible recipients. Within 90 days after the
13 effective date of this amendatory Act of 1984, the Illinois
14 Department shall establish a current list of acquisition
15 costs for all prosthetic devices and any other items
16 recognized as medical equipment and supplies reimbursable
17 under this Article and shall update such list on a quarterly
18 basis, except that the acquisition costs of all prescription
19 drugs shall be updated no less frequently than every 30 days
20 as required by Section 5-5.12.
21 The rules and regulations of the Illinois Department
22 shall require that a written statement including the required
23 opinion of a physician shall accompany any claim for
24 reimbursement for abortions, or induced miscarriages or
25 premature births. This statement shall indicate what
26 procedures were used in providing such medical services.
27 The Illinois Department shall require that all dispensers
28 of medical services, other than an individual practitioner or
29 group of practitioners, desiring to participate in the
30 Medical Assistance program established under this Article to
31 disclose all financial, beneficial, ownership, equity, surety
32 or other interests in any and all firms, corporations,
33 partnerships, associations, business enterprises, joint
34 ventures, agencies, institutions or other legal entities
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1 providing any form of health care services in this State
2 under this Article.
3 The Illinois Department may require that all dispensers
4 of medical services desiring to participate in the medical
5 assistance program established under this Article disclose,
6 under such terms and conditions as the Illinois Department
7 may by rule establish, all inquiries from clients and
8 attorneys regarding medical bills paid by the Illinois
9 Department, which inquiries could indicate potential
10 existence of claims or liens for the Illinois Department.
11 The Illinois Department shall establish policies,
12 procedures, standards and criteria by rule for the
13 acquisition, repair and replacement of orthotic and
14 prosthetic devices and durable medical equipment. Such rules
15 shall provide, but not be limited to, the following services:
16 (1) immediate repair or replacement of such devices by
17 recipients without medical authorization; and (2) rental,
18 lease, purchase or lease-purchase of durable medical
19 equipment in a cost-effective manner, taking into
20 consideration the recipient's medical prognosis, the extent
21 of the recipient's needs, and the requirements and costs for
22 maintaining such equipment. Such rules shall enable a
23 recipient to temporarily acquire and use alternative or
24 substitute devices or equipment pending repairs or
25 replacements of any device or equipment previously authorized
26 for such recipient by the Department. Rules under clause (2)
27 above shall not provide for purchase or lease-purchase of
28 durable medical equipment or supplies used for the purpose of
29 oxygen delivery and respiratory care.
30 The Department shall execute, relative to the nursing
31 home prescreening project, written inter-agency agreements
32 with the Department of Human Services and the Department on
33 Aging, to effect the following: (i) intake procedures and
34 common eligibility criteria for those persons who are
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1 receiving non-institutional services; and (ii) the
2 establishment and development of non-institutional services
3 in areas of the State where they are not currently available
4 or are undeveloped.
5 The Illinois Department shall develop and operate, in
6 cooperation with other State Departments and agencies and in
7 compliance with applicable federal laws and regulations,
8 appropriate and effective systems of health care evaluation
9 and programs for monitoring of utilization of health care
10 services and facilities, as it affects persons eligible for
11 medical assistance under this Code. The Illinois Department
12 shall report regularly the results of the operation of such
13 systems and programs to the Citizens Assembly/Council on
14 Public Aid to enable the Committee to ensure, from time to
15 time, that these programs are effective and meaningful.
16 The Illinois Department shall report annually to the
17 General Assembly, no later than the second Friday in April of
18 1979 and each year thereafter, in regard to:
19 (a) actual statistics and trends in utilization of
20 medical services by public aid recipients;
21 (b) actual statistics and trends in the provision
22 of the various medical services by medical vendors;
23 (c) current rate structures and proposed changes in
24 those rate structures for the various medical vendors;
25 and
26 (d) efforts at utilization review and control by
27 the Illinois Department.
28 The period covered by each report shall be the 3 years
29 ending on the June 30 prior to the report. The report shall
30 include suggested legislation for consideration by the
31 General Assembly. The filing of one copy of the report with
32 the Speaker, one copy with the Minority Leader and one copy
33 with the Clerk of the House of Representatives, one copy with
34 the President, one copy with the Minority Leader and one copy
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1 with the Secretary of the Senate, one copy with the
2 Legislative Research Unit, such additional copies with the
3 State Government Report Distribution Center for the General
4 Assembly as is required under paragraph (t) of Section 7 of
5 the State Library Act and one copy with the Citizens
6 Assembly/Council on Public Aid or its successor shall be
7 deemed sufficient to comply with this Section.
8 (Source: P.A. 90-7, eff. 6-10-97; 90-14, eff. 7-1-97; 91-344,
9 eff. 1-1-00; 91-462, eff. 8-6-99; revised 10-15-99.)
10 (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
11 Sec. 6-1. Eligibility requirements. Financial aid in
12 meeting basic maintenance requirements shall be given under
13 this Article to or in behalf of persons who meet the
14 eligibility conditions of Sections 6-1.1 through 6-1.10. In
15 addition, each unit of local government subject to this
16 Article shall provide persons receiving financial aid in
17 meeting basic maintenance requirements with financial aid for
18 either (a) necessary treatment, care, and supplies required
19 because of illness or disability, or (b) acute medical
20 treatment, care, and supplies only. If a local governmental
21 unit elects to provide financial aid for acute medical
22 treatment, care, and supplies only, the general types of
23 acute medical treatment, care, and supplies for which
24 financial aid is provided shall be specified in the general
25 assistance rules of the local governmental unit, which rules
26 shall provide that financial aid is provided, at a minimum,
27 for acute medical treatment, care, or supplies necessitated
28 by a medical condition for which prior approval or
29 authorization of medical treatment, care, or supplies is not
30 required by the general assistance rules of the Illinois
31 Department. Nothing in this Article shall be construed to
32 permit the granting of financial aid where the purpose of
33 such aid is to obtain an abortion, induced miscarriage or
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1 induced premature birth unless, in the opinion of a
2 physician, such procedures are necessary for the preservation
3 of the life of the woman seeking such treatment, or except an
4 induced premature birth intended to produce a live viable
5 child and such procedure is necessary for the health of the
6 mother or her unborn child; State funds may also be used to
7 pay for abortions to terminate a pregnancy resulting from an
8 act of criminal sexual assault, as defined in Section 12-13
9 of the Criminal Code of 1961, an act of aggravated criminal
10 sexual assault, as defined in Section 12-14 of the Criminal
11 Code of 1961, or an act of sexual relations within families,
12 as defined in Section 11-11 of the Criminal Code of 1961, but
13 only to the extent that payment for such abortions is
14 required by federal law as determined by a court of competent
15 jurisdiction. Nothing in this Article shall be construed to
16 permit the granting of financial aid where the purpose of
17 such aid is to obtain an abortion, induced miscarriage or
18 induced premature birth unless, in the opinion of a
19 physician, such procedures are necessary for the preservation
20 of the life of the woman seeking such treatment, or except an
21 induced premature birth intended to produce a live viable
22 child and such procedure is necessary for the health of the
23 mother or her unborn child.
24 Until August 1, 1969, children who require care outside
25 their own homes, where no other sources of funds or
26 insufficient funds are available to provide the necessary
27 care, are included among persons eligible for aid under this
28 Article. After July 31, 1969, the Department of Children and
29 Family Services shall have the responsibility of providing
30 child welfare services to such children, as provided in
31 Section 5 of "An Act creating the Department of Children and
32 Family Services, codifying its powers and duties, and
33 repealing certain Acts and Sections herein named", approved
34 June 4, 1963, as amended.
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1 In cities, villages and incorporated towns of more than
2 500,000 population, the Illinois Department may establish a
3 separate program under this Article. The 2 programs shall be
4 differentiated, but the placement of persons under both
5 programs shall be based upon their ability or inability to
6 engage in employment in accordance with the rules and
7 regulations promulgated by the Illinois Department. In
8 establishing rules and regulations for determining whether a
9 person is able to engage in employment, the Illinois
10 Department may establish rules different than those set out
11 under Section 11-20. In determining need and the amount of
12 aid under Sections 6-1.2 and 6-2 for the 2 programs, the
13 Illinois Department may establish different standards for the
14 2 programs based upon the specific needs of the different
15 populations to be served by the 2 programs. The Illinois
16 Department may enter into contracts with entities to
17 establish work or training related projects under the program
18 established for persons determined to be able to engage in
19 employment.
20 (Source: P.A. 89-646, eff. 1-1-97.)
21 Section 90. Severability. If any provision, word,
22 phrase or clause of this amendatory Act of the 91st General
23 Assembly or its application to any person or circumstance is
24 held invalid, the invalidity does not affect the provisions,
25 words, phrases, clauses or application of this amendatory Act
26 of the 91st General Assembly which can be given effect
27 without the invalid provision, word, phrase, clause, or
28 application, and to this end the provisions, words, phrases,
29 and clauses of this amendatory Act of the 91st General
30 Assembly are declared to be severable.
31 Section 99. Effective date. This Act takes effect July
32 1, 2000.
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