Public Act 100-0135
 
HB2909 EnrolledLRB100 08468 KTG 18586 b


  
    AN ACT concerning public aid.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    Section 5. The Illinois Public Aid Code is amended  by 
changing Section 5-5f as follows:
 
 

    (305 ILCS 5/5-5f)

 
    Sec. 5-5f. Elimination and limitations of medical 
assistance services. Notwithstanding any other provision of 
this Code to the contrary, on and after July 1, 2012:
        (a) The following services shall no longer be a covered 
    service available under this Code: group psychotherapy for 
    residents of any facility licensed under the Nursing Home 
    Care Act or the Specialized Mental Health Rehabilitation 
    Act of 2013; and adult chiropractic services. 
        (b) The Department shall place the following 
    limitations on services: (i) the Department shall limit 
    adult eyeglasses to one pair every 2 years; however, the 
    limitation does not apply to an individual who needs 
    different eyeglasses following a surgical procedure such 
    as cataract surgery; (ii) the Department shall set an 
    annual limit of a maximum of 20 visits for each of the 
    following services: adult speech, hearing, and language 
    therapy services, adult occupational therapy services, and 
    physical therapy services; on or after October 1, 2014, the 
    annual maximum limit of 20 visits shall expire but the 
    Department shall require prior approval for all 
    individuals for speech, hearing, and language therapy 
    services, occupational therapy services, and physical 
    therapy services; (iii) the Department shall limit adult 
    podiatry services to individuals with diabetes;  on or after 
    October 1, 2014, podiatry services shall not be limited to 
    individuals with diabetes; (iv) the Department shall pay 
    for caesarean sections at the normal vaginal delivery rate 
    unless a caesarean section was medically necessary; (v) the 
    Department shall limit adult dental services to 
    emergencies; beginning July 1, 2013, the Department shall 
    ensure that the following conditions are recognized as 
    emergencies: (A) dental services necessary for an 
    individual in order for the individual to be cleared for a 
    medical procedure, such as a transplant;
(B) extractions 
    and dentures necessary for a diabetic to receive proper 
    nutrition;
(C) extractions and dentures necessary as a 
    result of cancer treatment; and (D) dental services 
    necessary for the health of a pregnant woman prior to 
    delivery of her baby; on or after July 1, 2014, adult 
    dental services shall no longer be limited to emergencies, 
    and dental services necessary for the health of a pregnant 
    woman prior to delivery of her baby shall continue to be 
    covered; and (vi) effective July 1, 2012, the Department 
    shall place limitations and require concurrent review on 
    every inpatient detoxification stay to prevent repeat 
    admissions to any hospital for detoxification within 60 
    days of a previous inpatient detoxification stay. The 
    Department shall convene a workgroup of hospitals, 
    substance abuse providers, care coordination entities, 
    managed care plans, and other stakeholders to develop 
    recommendations for quality standards, diversion to other 
    settings, and admission criteria for patients who need 
    inpatient detoxification, which shall be published on the 
    Department's website no later than September 1, 2013. 
        (c) The Department shall require prior approval of the 
    following services: wheelchair repairs costing more than 
    $400, coronary artery bypass graft, and bariatric surgery 
    consistent with Medicare standards concerning patient 
    responsibility. Wheelchair repair prior approval requests 
    shall be adjudicated within one business day of receipt of 
    complete supporting documentation. Providers may not break 
    wheelchair repairs into separate claims for purposes of 
    staying under the $400 threshold for requiring prior 
    approval. The wholesale price of manual and power 
    wheelchairs, durable medical equipment and supplies, and 
    complex rehabilitation technology products and services 
    shall be defined as actual acquisition cost including all 
    discounts. 
        (d) The Department shall establish benchmarks for 
    hospitals to measure and align payments to reduce 
    potentially preventable hospital readmissions, inpatient 
    complications, and unnecessary emergency room visits. In 
    doing so, the Department shall consider items, including, 
    but not limited to, historic and current acuity of care and 
    historic and current trends in readmission. The Department 
    shall publish provider-specific historical readmission 
    data and anticipated potentially preventable targets 60 
    days prior to the start of the program. In the instance of 
    readmissions, the Department shall adopt policies and 
    rates of reimbursement for services and other payments 
    provided under this Code to ensure that, by June 30, 2013, 
    expenditures to hospitals are reduced by, at a minimum, 
    $40,000,000. 
        (e) The Department shall establish utilization 
    controls for the hospice program such that it shall not pay 
    for other care services when an individual is in hospice. 
        (f) For home health services, the Department shall 
    require Medicare certification of providers participating 
    in the program and implement the Medicare face-to-face 
    encounter rule. The Department shall require providers to 
    implement auditable electronic service verification based 
    on global positioning systems or other cost-effective 
    technology. 
        (g) For the Home Services Program operated by the 
    Department of Human Services and the Community Care Program 
    operated by  the Department on Aging, the Department of 
    Human Services, in cooperation with the Department on 
    Aging, shall implement an electronic service verification 
    based on global positioning systems or other 
    cost-effective technology. 
        (h) Effective with inpatient hospital admissions on or 
    after July 1, 2012, the Department shall reduce the payment 
    for a claim that indicates the occurrence of a 
    provider-preventable condition during the admission as 
    specified by the Department in rules. The Department shall 
    not pay for services related to an other 
    provider-preventable condition.
        As used in this subsection (h):
        "Provider-preventable condition" means a health care 
    acquired condition as defined under the federal Medicaid 
    regulation found at 42 CFR 447.26 or an other 
    provider-preventable condition.
        "Other provider-preventable condition" means a wrong 
    surgical or other invasive procedure performed on a 
    patient, a surgical or other invasive procedure performed 
    on the wrong body part, or a surgical procedure or other 
    invasive procedure performed on the wrong patient. 
        (i) The Department shall implement cost savings 
    initiatives for advanced imaging services, cardiac imaging 
    services, pain management services, and back surgery. Such 
    initiatives shall be designed to achieve annual costs 
    savings. 

        (j) The Department shall ensure that beneficiaries 
    with a diagnosis of epilepsy or seizure disorder in 
    Department records will not require prior approval for 
    anticonvulsants. 
(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section 
6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff. 
7-22-13; 98-651, eff. 6-16-14; 98-756, eff. 7-16-14.)
 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.