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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Children's Health Insurance Program Act is | ||||||||||||||||||||||||||||||
5 | amended by changing Section 30 as follows:
| ||||||||||||||||||||||||||||||
6 | (215 ILCS 106/30)
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7 | Sec. 30. Cost sharing.
| ||||||||||||||||||||||||||||||
8 | (a) Children enrolled in a health benefits program pursuant | ||||||||||||||||||||||||||||||
9 | to subdivision
(a)(2) of Section 25 and persons enrolled in a | ||||||||||||||||||||||||||||||
10 | health benefits waiver program pursuant to Section 40 shall be | ||||||||||||||||||||||||||||||
11 | subject to the following cost sharing
requirements:
| ||||||||||||||||||||||||||||||
12 | (1) There shall be no co-payment required for well-baby | ||||||||||||||||||||||||||||||
13 | or well-child
care, including age-appropriate | ||||||||||||||||||||||||||||||
14 | immunizations as required under
federal law. | ||||||||||||||||||||||||||||||
15 | (1.5) There shall be no co-payment or other | ||||||||||||||||||||||||||||||
16 | cost-sharing requirement for any tobacco use cessation | ||||||||||||||||||||||||||||||
17 | medication prescribed by a physician, by a physician's | ||||||||||||||||||||||||||||||
18 | assistant, or by an advanced practice
nurse with | ||||||||||||||||||||||||||||||
19 | prescriptive authority delegated under Section 65-40 of | ||||||||||||||||||||||||||||||
20 | the Nurse Practice Act who issues a prescription for such a | ||||||||||||||||||||||||||||||
21 | medication in accordance
with
a written collaborative | ||||||||||||||||||||||||||||||
22 | agreement under Section 65-35 the Nurse Practice Act.
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23 | (2) Health insurance premiums for family members, |
| |||||||
| |||||||
1 | either children or adults, in families whose household
| ||||||
2 | income is above 150% of the federal poverty level shall be | ||||||
3 | payable
monthly, subject to rules promulgated by the | ||||||
4 | Department for grace periods and
advance payments, and | ||||||
5 | shall be as follows:
| ||||||
6 | (A) $15 per month for one family member.
| ||||||
7 | (B) $25 per month for 2 family members.
| ||||||
8 | (C) $30 per month for 3 family members. | ||||||
9 | (D) $35 per month for 4 family members. | ||||||
10 | (E) $40 per month for 5 or more family members.
| ||||||
11 | (3) Co-payments for children or adults in families | ||||||
12 | whose income is at or below
150% of the federal poverty | ||||||
13 | level, at a minimum and to the extent permitted
under | ||||||
14 | federal law, shall be $2 for all medical visits and | ||||||
15 | prescriptions
provided under this Act.
| ||||||
16 | (4) Co-payments for children or adults in families | ||||||
17 | whose income is above 150%
of the federal poverty level, at | ||||||
18 | a minimum and to the extent permitted under
federal law | ||||||
19 | shall be as follows:
| ||||||
20 | (A) $5 for medical visits.
| ||||||
21 | (B) $3 for generic prescriptions and $5 for brand | ||||||
22 | name
prescriptions.
| ||||||
23 | (C) $25 for emergency room use for a non-emergency
| ||||||
24 | situation as defined by the Department by rule.
| ||||||
25 | (5) The maximum amount of out-of-pocket expenses for | ||||||
26 | co-payments shall be
$100 per family per year.
|
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| |||||||
1 | (b) Individuals enrolled in a privately sponsored health | ||||||
2 | insurance plan
pursuant to subdivision (a)(1) of Section 25 | ||||||
3 | shall be subject to the cost
sharing provisions as stated in | ||||||
4 | the privately sponsored health insurance plan.
| ||||||
5 | (Source: P.A. 94-48, eff. 7-1-05.)
| ||||||
6 | Section 10. The Covering ALL KIDS Health Insurance Act is | ||||||
7 | amended by changing Section 40 as follows: | ||||||
8 | (215 ILCS 170/40) | ||||||
9 | (Section scheduled to be repealed on July 1, 2011)
| ||||||
10 | Sec. 40. Cost-sharing. | ||||||
11 | (a) Children enrolled in the Program under subsection (a) | ||||||
12 | of Section 35 are subject to the following cost-sharing | ||||||
13 | requirements:
| ||||||
14 | (1) The Department, by rule, shall set forth | ||||||
15 | requirements concerning co-payments and coinsurance for | ||||||
16 | health care services and monthly premiums. This | ||||||
17 | cost-sharing shall be on a sliding scale based on family | ||||||
18 | income. The Department may periodically modify such | ||||||
19 | cost-sharing.
| ||||||
20 | (2) Notwithstanding paragraph (1), there shall be no | ||||||
21 | co-payment required for well-baby or well-child health | ||||||
22 | care, including, but not limited to, age-appropriate | ||||||
23 | immunizations as required under State or federal law.
| ||||||
24 | (3) Notwithstanding paragraph (1), there shall be no |
| |||||||
| |||||||
1 | co-payment or other cost-sharing requirement for any | ||||||
2 | tobacco use cessation medication prescribed by a | ||||||
3 | physician, by a physician's assistant, or by an advanced | ||||||
4 | practice
nurse with prescriptive authority delegated under | ||||||
5 | Section 65-40 of the Nurse Practice Act who issues a | ||||||
6 | prescription for such a medication in accordance
with
a | ||||||
7 | written collaborative agreement under Section 65-35 the | ||||||
8 | Nurse Practice Act. | ||||||
9 | (b) Children enrolled in a privately sponsored health | ||||||
10 | insurance plan under subsection (b) of Section 35 are subject | ||||||
11 | to the cost-sharing provisions stated in the privately | ||||||
12 | sponsored health insurance plan.
| ||||||
13 | (c) Notwithstanding any other provision of law, rates paid | ||||||
14 | by the Department shall not be used in any way to determine the | ||||||
15 | usual and customary or reasonable charge, which is the charge | ||||||
16 | for health care that is consistent with the average rate or | ||||||
17 | charge for similar services furnished by similar providers in a | ||||||
18 | certain geographic area.
| ||||||
19 | (Source: P.A. 94-693, eff. 7-1-06 .) | ||||||
20 | Section 15. The Illinois Public Aid Code is amended by | ||||||
21 | changing Sections 5-4.1 and 5-5 as follows:
| ||||||
22 | (305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
| ||||||
23 | Sec. 5-4.1. Co-payments. The Department may by rule provide | ||||||
24 | that recipients
under any Article of this Code shall pay a fee |
| |||||||
| |||||||
1 | as a co-payment for services.
Co-payments may not exceed $3 for | ||||||
2 | brand name drugs, $1 for other pharmacy
services other than for | ||||||
3 | generic drugs, and $2 for physicians services, dental
services, | ||||||
4 | optical services and supplies, chiropractic services, podiatry
| ||||||
5 | services, and encounter rate clinic services. There shall be no | ||||||
6 | co-payment for
generic drugs. Notwithstanding any other | ||||||
7 | provision of this Section, there shall be no co-payment or | ||||||
8 | other cost-sharing requirement for any tobacco use cessation | ||||||
9 | medication prescribed by a physician, by a physician's | ||||||
10 | assistant, or by an advanced practice
nurse with prescriptive | ||||||
11 | authority delegated under Section 65-40 of the Nurse Practice | ||||||
12 | Act who issues a prescription for such a medication in | ||||||
13 | accordance
with
a written collaborative agreement under | ||||||
14 | Section 65-35 the Nurse Practice Act. Co-payments may not | ||||||
15 | exceed $3 for hospital outpatient and clinic
services. | ||||||
16 | Provided, however, that any such rule must provide that no
| ||||||
17 | co-payment requirement can exist
for renal dialysis, radiation | ||||||
18 | therapy, cancer chemotherapy, or insulin, and
other products | ||||||
19 | necessary on a recurring basis, the absence of which would
be | ||||||
20 | life threatening, or where co-payment expenditures for | ||||||
21 | required services
and/or medications for chronic diseases that | ||||||
22 | the Illinois Department shall
by rule designate shall cause an | ||||||
23 | extensive financial burden on the
recipient, and provided no | ||||||
24 | co-payment shall exist for emergency room
encounters which are | ||||||
25 | for medical emergencies.
| ||||||
26 | (Source: P.A. 92-597, eff. 6-28-02; 93-593, eff. 8-25-03 .)
|
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| |||||||
1 | (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
| ||||||
2 | Sec. 5-5. Medical services. The Illinois Department, by | ||||||
3 | rule, shall
determine the quantity and quality of and the rate | ||||||
4 | of reimbursement for the
medical assistance for which
payment | ||||||
5 | will be authorized, and the medical services to be provided,
| ||||||
6 | which may include all or part of the following: (1) inpatient | ||||||
7 | hospital
services; (2) outpatient hospital services; (3) other | ||||||
8 | laboratory and
X-ray services; (4) skilled nursing home | ||||||
9 | services; (5) physicians'
services whether furnished in the | ||||||
10 | office, the patient's home, a
hospital, a skilled nursing home, | ||||||
11 | or elsewhere; (6) medical care, or any
other type of remedial | ||||||
12 | care furnished by licensed practitioners; (7)
home health care | ||||||
13 | services; (8) private duty nursing service; (9) clinic
| ||||||
14 | services; (10) dental services, including prevention and | ||||||
15 | treatment of periodontal disease and dental caries disease for | ||||||
16 | pregnant women; (11) physical therapy and related
services; | ||||||
17 | (12) prescribed drugs, dentures, and prosthetic devices; and
| ||||||
18 | eyeglasses prescribed by a physician skilled in the diseases of | ||||||
19 | the eye,
or by an optometrist, whichever the person may select; | ||||||
20 | (13) other
diagnostic, screening, preventive, and | ||||||
21 | rehabilitative services; (14)
transportation and such other | ||||||
22 | expenses as may be necessary; (15) medical
treatment of sexual | ||||||
23 | assault survivors, as defined in
Section 1a of the Sexual | ||||||
24 | Assault Survivors Emergency Treatment Act, for
injuries | ||||||
25 | sustained as a result of the sexual assault, including
|
| |||||||
| |||||||
1 | examinations and laboratory tests to discover evidence which | ||||||
2 | may be used in
criminal proceedings arising from the sexual | ||||||
3 | assault; (16) the
diagnosis and treatment of sickle cell | ||||||
4 | anemia; and (17)
any other medical care, and any other type of | ||||||
5 | remedial care recognized
under the laws of this State, but not | ||||||
6 | including abortions, or induced
miscarriages or premature | ||||||
7 | births, unless, in the opinion of a physician,
such procedures | ||||||
8 | are necessary for the preservation of the life of the
woman | ||||||
9 | seeking such treatment, or except an induced premature birth
| ||||||
10 | intended to produce a live viable child and such procedure is | ||||||
11 | necessary
for the health of the mother or her unborn child. The | ||||||
12 | Illinois Department,
by rule, shall prohibit any physician from | ||||||
13 | providing medical assistance
to anyone eligible therefor under | ||||||
14 | this Code where such physician has been
found guilty of | ||||||
15 | performing an abortion procedure in a wilful and wanton
manner | ||||||
16 | upon a woman who was not pregnant at the time such abortion
| ||||||
17 | procedure was performed. The term "any other type of remedial | ||||||
18 | care" shall
include nursing care and nursing home service for | ||||||
19 | persons who rely on
treatment by spiritual means alone through | ||||||
20 | prayer for healing.
| ||||||
21 | Notwithstanding any other provision of this Section, a | ||||||
22 | comprehensive
tobacco use cessation program that includes | ||||||
23 | purchasing prescription drugs or
prescription medical devices | ||||||
24 | approved by the Food and Drug Administration administration | ||||||
25 | shall
be covered under the medical assistance
program under | ||||||
26 | this Article for persons who are otherwise eligible for
|
| |||||||
| |||||||
1 | assistance under this Article. In implementing the | ||||||
2 | comprehensive
tobacco use cessation program under this | ||||||
3 | paragraph, the Department of Healthcare and Family Services may | ||||||
4 | develop a formulary of covered medications, which may include | ||||||
5 | over-the-counter medications if they are prescribed by a | ||||||
6 | physician, by a physician's assistant, or by an advanced | ||||||
7 | practice
nurse with prescriptive authority delegated under | ||||||
8 | Section 65-40 of the Nurse Practice Act who issues a | ||||||
9 | prescription for such a medication in accordance
with
a written | ||||||
10 | collaborative agreement under Section 65-35 of the Nurse | ||||||
11 | Practice Act. The Department shall make any changes in the | ||||||
12 | State's approved plan under Title XIX of the Social Security | ||||||
13 | Act necessary to ensure that the provisions of this paragraph | ||||||
14 | apply to the Children's Health Insurance Program as provided in | ||||||
15 | Section 25 of the Children's Health Insurance Program Act and | ||||||
16 | to the Covering ALL KIDS Health Insurance Program as provided | ||||||
17 | in Section 35 of the Covering ALL KIDS Health Insurance Act.
| ||||||
18 | Notwithstanding any other provision of this Code, the | ||||||
19 | Illinois
Department may not require, as a condition of payment | ||||||
20 | for any laboratory
test authorized under this Article, that a | ||||||
21 | physician's handwritten signature
appear on the laboratory | ||||||
22 | test order form. The Illinois Department may,
however, impose | ||||||
23 | other appropriate requirements regarding laboratory test
order | ||||||
24 | documentation.
| ||||||
25 | The Department of Healthcare and Family Services shall | ||||||
26 | provide the following services to
persons
eligible for |
| |||||||
| |||||||
1 | assistance under this Article who are participating in
| ||||||
2 | education, training or employment programs operated by the | ||||||
3 | Department of Human
Services as successor to the Department of | ||||||
4 | Public Aid:
| ||||||
5 | (1) dental services, which shall include but not be | ||||||
6 | limited to
prosthodontics; and
| ||||||
7 | (2) eyeglasses prescribed by a physician skilled in the | ||||||
8 | diseases of the
eye, or by an optometrist, whichever the | ||||||
9 | person may select.
| ||||||
10 | The Illinois Department, by rule, may distinguish and | ||||||
11 | classify the
medical services to be provided only in accordance | ||||||
12 | with the classes of
persons designated in Section 5-2.
| ||||||
13 | The Department of Healthcare and Family Services must | ||||||
14 | provide coverage and reimbursement for amino acid-based | ||||||
15 | elemental formulas, regardless of delivery method, for the | ||||||
16 | diagnosis and treatment of (i) eosinophilic disorders and (ii) | ||||||
17 | short bowel syndrome when the prescribing physician has issued | ||||||
18 | a written order stating that the amino acid-based elemental | ||||||
19 | formula is medically necessary.
| ||||||
20 | The Illinois Department shall authorize the provision of, | ||||||
21 | and shall
authorize payment for, screening by low-dose | ||||||
22 | mammography for the presence of
occult breast cancer for women | ||||||
23 | 35 years of age or older who are eligible
for medical | ||||||
24 | assistance under this Article, as follows: a baseline
mammogram | ||||||
25 | for women 35 to 39 years of age and an
annual mammogram for | ||||||
26 | women 40 years of age or older. All screenings
shall
include a |
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| |||||||
1 | physical breast exam, instruction on self-examination and
| ||||||
2 | information regarding the frequency of self-examination and | ||||||
3 | its value as a
preventative tool. As used in this Section, | ||||||
4 | "low-dose mammography" means
the x-ray examination of the | ||||||
5 | breast using equipment dedicated specifically
for mammography, | ||||||
6 | including the x-ray tube, filter, compression device,
image | ||||||
7 | receptor, and cassettes, with an average radiation exposure | ||||||
8 | delivery
of less than one rad mid-breast, with 2 views for each | ||||||
9 | breast.
| ||||||
10 | Any medical or health care provider shall immediately | ||||||
11 | recommend, to
any pregnant woman who is being provided prenatal | ||||||
12 | services and is suspected
of drug abuse or is addicted as | ||||||
13 | defined in the Alcoholism and Other Drug Abuse
and Dependency | ||||||
14 | Act, referral to a local substance abuse treatment provider
| ||||||
15 | licensed by the Department of Human Services or to a licensed
| ||||||
16 | hospital which provides substance abuse treatment services. | ||||||
17 | The Department of Healthcare and Family Services
shall assure | ||||||
18 | coverage for the cost of treatment of the drug abuse or
| ||||||
19 | addiction for pregnant recipients in accordance with the | ||||||
20 | Illinois Medicaid
Program in conjunction with the Department of | ||||||
21 | Human Services.
| ||||||
22 | All medical providers providing medical assistance to | ||||||
23 | pregnant women
under this Code shall receive information from | ||||||
24 | the Department on the
availability of services under the Drug | ||||||
25 | Free Families with a Future or any
comparable program providing | ||||||
26 | case management services for addicted women,
including |
| |||||||
| |||||||
1 | information on appropriate referrals for other social services
| ||||||
2 | that may be needed by addicted women in addition to treatment | ||||||
3 | for addiction.
| ||||||
4 | The Illinois Department, in cooperation with the | ||||||
5 | Departments of Human
Services (as successor to the Department | ||||||
6 | of Alcoholism and Substance
Abuse) and Public Health, through a | ||||||
7 | public awareness campaign, may
provide information concerning | ||||||
8 | treatment for alcoholism and drug abuse and
addiction, prenatal | ||||||
9 | health care, and other pertinent programs directed at
reducing | ||||||
10 | the number of drug-affected infants born to recipients of | ||||||
11 | medical
assistance.
| ||||||
12 | Neither the Department of Healthcare and Family Services | ||||||
13 | nor the Department of Human
Services shall sanction the | ||||||
14 | recipient solely on the basis of
her substance abuse.
| ||||||
15 | The Illinois Department shall establish such regulations | ||||||
16 | governing
the dispensing of health services under this Article | ||||||
17 | as it shall deem
appropriate. The Department
should
seek the | ||||||
18 | advice of formal professional advisory committees appointed by
| ||||||
19 | the Director of the Illinois Department for the purpose of | ||||||
20 | providing regular
advice on policy and administrative matters, | ||||||
21 | information dissemination and
educational activities for | ||||||
22 | medical and health care providers, and
consistency in | ||||||
23 | procedures to the Illinois Department.
| ||||||
24 | The Illinois Department may develop and contract with | ||||||
25 | Partnerships of
medical providers to arrange medical services | ||||||
26 | for persons eligible under
Section 5-2 of this Code. |
| |||||||
| |||||||
1 | Implementation of this Section may be by
demonstration projects | ||||||
2 | in certain geographic areas. The Partnership shall
be | ||||||
3 | represented by a sponsor organization. The Department, by rule, | ||||||
4 | shall
develop qualifications for sponsors of Partnerships. | ||||||
5 | Nothing in this
Section shall be construed to require that the | ||||||
6 | sponsor organization be a
medical organization.
| ||||||
7 | The sponsor must negotiate formal written contracts with | ||||||
8 | medical
providers for physician services, inpatient and | ||||||
9 | outpatient hospital care,
home health services, treatment for | ||||||
10 | alcoholism and substance abuse, and
other services determined | ||||||
11 | necessary by the Illinois Department by rule for
delivery by | ||||||
12 | Partnerships. Physician services must include prenatal and
| ||||||
13 | obstetrical care. The Illinois Department shall reimburse | ||||||
14 | medical services
delivered by Partnership providers to clients | ||||||
15 | in target areas according to
provisions of this Article and the | ||||||
16 | Illinois Health Finance Reform Act,
except that:
| ||||||
17 | (1) Physicians participating in a Partnership and | ||||||
18 | providing certain
services, which shall be determined by | ||||||
19 | the Illinois Department, to persons
in areas covered by the | ||||||
20 | Partnership may receive an additional surcharge
for such | ||||||
21 | services.
| ||||||
22 | (2) The Department may elect to consider and negotiate | ||||||
23 | financial
incentives to encourage the development of | ||||||
24 | Partnerships and the efficient
delivery of medical care.
| ||||||
25 | (3) Persons receiving medical services through | ||||||
26 | Partnerships may receive
medical and case management |
| |||||||
| |||||||
1 | services above the level usually offered
through the | ||||||
2 | medical assistance program.
| ||||||
3 | Medical providers shall be required to meet certain | ||||||
4 | qualifications to
participate in Partnerships to ensure the | ||||||
5 | delivery of high quality medical
services. These | ||||||
6 | qualifications shall be determined by rule of the Illinois
| ||||||
7 | Department and may be higher than qualifications for | ||||||
8 | participation in the
medical assistance program. Partnership | ||||||
9 | sponsors may prescribe reasonable
additional qualifications | ||||||
10 | for participation by medical providers, only with
the prior | ||||||
11 | written approval of the Illinois Department.
| ||||||
12 | Nothing in this Section shall limit the free choice of | ||||||
13 | practitioners,
hospitals, and other providers of medical | ||||||
14 | services by clients.
In order to ensure patient freedom of | ||||||
15 | choice, the Illinois Department shall
immediately promulgate | ||||||
16 | all rules and take all other necessary actions so that
provided | ||||||
17 | services may be accessed from therapeutically certified | ||||||
18 | optometrists
to the full extent of the Illinois Optometric | ||||||
19 | Practice Act of 1987 without
discriminating between service | ||||||
20 | providers.
| ||||||
21 | The Department shall apply for a waiver from the United | ||||||
22 | States Health
Care Financing Administration to allow for the | ||||||
23 | implementation of
Partnerships under this Section.
| ||||||
24 | The Illinois Department shall require health care | ||||||
25 | providers to maintain
records that document the medical care | ||||||
26 | and services provided to recipients
of Medical Assistance under |
| |||||||
| |||||||
1 | this Article. The Illinois Department shall
require health care | ||||||
2 | providers to make available, when authorized by the
patient, in | ||||||
3 | writing, the medical records in a timely fashion to other
| ||||||
4 | health care providers who are treating or serving persons | ||||||
5 | eligible for
Medical Assistance under this Article. All | ||||||
6 | dispensers of medical services
shall be required to maintain | ||||||
7 | and retain business and professional records
sufficient to | ||||||
8 | fully and accurately document the nature, scope, details and
| ||||||
9 | receipt of the health care provided to persons eligible for | ||||||
10 | medical
assistance under this Code, in accordance with | ||||||
11 | regulations promulgated by
the Illinois Department. The rules | ||||||
12 | and regulations shall require that proof
of the receipt of | ||||||
13 | prescription drugs, dentures, prosthetic devices and
| ||||||
14 | eyeglasses by eligible persons under this Section accompany | ||||||
15 | each claim
for reimbursement submitted by the dispenser of such | ||||||
16 | medical services.
No such claims for reimbursement shall be | ||||||
17 | approved for payment by the Illinois
Department without such | ||||||
18 | proof of receipt, unless the Illinois Department
shall have put | ||||||
19 | into effect and shall be operating a system of post-payment
| ||||||
20 | audit and review which shall, on a sampling basis, be deemed | ||||||
21 | adequate by
the Illinois Department to assure that such drugs, | ||||||
22 | dentures, prosthetic
devices and eyeglasses for which payment | ||||||
23 | is being made are actually being
received by eligible | ||||||
24 | recipients. Within 90 days after the effective date of
this | ||||||
25 | amendatory Act of 1984, the Illinois Department shall establish | ||||||
26 | a
current list of acquisition costs for all prosthetic devices |
| |||||||
| |||||||
1 | and any
other items recognized as medical equipment and | ||||||
2 | supplies reimbursable under
this Article and shall update such | ||||||
3 | list on a quarterly basis, except that
the acquisition costs of | ||||||
4 | all prescription drugs shall be updated no
less frequently than | ||||||
5 | every 30 days as required by Section 5-5.12.
| ||||||
6 | The rules and regulations of the Illinois Department shall | ||||||
7 | require
that a written statement including the required opinion | ||||||
8 | of a physician
shall accompany any claim for reimbursement for | ||||||
9 | abortions, or induced
miscarriages or premature births. This | ||||||
10 | statement shall indicate what
procedures were used in providing | ||||||
11 | such medical services.
| ||||||
12 | The Illinois Department shall require all dispensers of | ||||||
13 | medical
services, other than an individual practitioner or | ||||||
14 | group of practitioners,
desiring to participate in the Medical | ||||||
15 | Assistance program
established under this Article to disclose | ||||||
16 | all financial, beneficial,
ownership, equity, surety or other | ||||||
17 | interests in any and all firms,
corporations, partnerships, | ||||||
18 | associations, business enterprises, joint
ventures, agencies, | ||||||
19 | institutions or other legal entities providing any
form of | ||||||
20 | health care services in this State under this Article.
| ||||||
21 | The Illinois Department may require that all dispensers of | ||||||
22 | medical
services desiring to participate in the medical | ||||||
23 | assistance program
established under this Article disclose, | ||||||
24 | under such terms and conditions as
the Illinois Department may | ||||||
25 | by rule establish, all inquiries from clients
and attorneys | ||||||
26 | regarding medical bills paid by the Illinois Department, which
|
| |||||||
| |||||||
1 | inquiries could indicate potential existence of claims or liens | ||||||
2 | for the
Illinois Department.
| ||||||
3 | Enrollment of a vendor that provides non-emergency medical | ||||||
4 | transportation,
defined by the Department by rule,
shall be
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5 | conditional for 180 days. During that time, the Department of | ||||||
6 | Healthcare and Family Services may
terminate the vendor's | ||||||
7 | eligibility to participate in the medical assistance
program | ||||||
8 | without cause. That termination of eligibility is not subject | ||||||
9 | to the
Department's hearing process.
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10 | The Illinois Department shall establish policies, | ||||||
11 | procedures,
standards and criteria by rule for the acquisition, | ||||||
12 | repair and replacement
of orthotic and prosthetic devices and | ||||||
13 | durable medical equipment. Such
rules shall provide, but not be | ||||||
14 | limited to, the following services: (1)
immediate repair or | ||||||
15 | replacement of such devices by recipients without
medical | ||||||
16 | authorization; and (2) rental, lease, purchase or | ||||||
17 | lease-purchase of
durable medical equipment in a | ||||||
18 | cost-effective manner, taking into
consideration the | ||||||
19 | recipient's medical prognosis, the extent of the
recipient's | ||||||
20 | needs, and the requirements and costs for maintaining such
| ||||||
21 | equipment. Such rules shall enable a recipient to temporarily | ||||||
22 | acquire and
use alternative or substitute devices or equipment | ||||||
23 | pending repairs or
replacements of any device or equipment | ||||||
24 | previously authorized for such
recipient by the Department.
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25 | The Department shall execute, relative to the nursing home | ||||||
26 | prescreening
project, written inter-agency agreements with the |
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| |||||||
1 | Department of Human
Services and the Department on Aging, to | ||||||
2 | effect the following: (i) intake
procedures and common | ||||||
3 | eligibility criteria for those persons who are receiving
| ||||||
4 | non-institutional services; and (ii) the establishment and | ||||||
5 | development of
non-institutional services in areas of the State | ||||||
6 | where they are not currently
available or are undeveloped.
| ||||||
7 | The Illinois Department shall develop and operate, in | ||||||
8 | cooperation
with other State Departments and agencies and in | ||||||
9 | compliance with
applicable federal laws and regulations, | ||||||
10 | appropriate and effective
systems of health care evaluation and | ||||||
11 | programs for monitoring of
utilization of health care services | ||||||
12 | and facilities, as it affects
persons eligible for medical | ||||||
13 | assistance under this Code.
| ||||||
14 | The Illinois Department shall report annually to the | ||||||
15 | General Assembly,
no later than the second Friday in April of | ||||||
16 | 1979 and each year
thereafter, in regard to:
| ||||||
17 | (a) actual statistics and trends in utilization of | ||||||
18 | medical services by
public aid recipients;
| ||||||
19 | (b) actual statistics and trends in the provision of | ||||||
20 | the various medical
services by medical vendors;
| ||||||
21 | (c) current rate structures and proposed changes in | ||||||
22 | those rate structures
for the various medical vendors; and
| ||||||
23 | (d) efforts at utilization review and control by the | ||||||
24 | Illinois Department.
| ||||||
25 | The period covered by each report shall be the 3 years | ||||||
26 | ending on the June
30 prior to the report. The report shall |
| |||||||
| |||||||
1 | include suggested legislation
for consideration by the General | ||||||
2 | Assembly. The filing of one copy of the
report with the | ||||||
3 | Speaker, one copy with the Minority Leader and one copy
with | ||||||
4 | the Clerk of the House of Representatives, one copy with the | ||||||
5 | President,
one copy with the Minority Leader and one copy with | ||||||
6 | the Secretary of the
Senate, one copy with the Legislative | ||||||
7 | Research Unit, and such additional
copies
with the State | ||||||
8 | Government Report Distribution Center for the General
Assembly | ||||||
9 | as is required under paragraph (t) of Section 7 of the State
| ||||||
10 | Library Act shall be deemed sufficient to comply with this | ||||||
11 | Section.
| ||||||
12 | (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07.)
| ||||||
13 | Section 99. Effective date. This Act takes effect upon | ||||||
14 | becoming law.
|