Sen. Jeffrey M. Schoenberg
Filed: 3/2/2010
 
 

 




 

 		












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AMENDMENT TO SENATE BILL 3762




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    AMENDMENT NO. ______. Amend Senate Bill 3762 by replacing 
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everything after the enacting clause with the following:

 
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    "Section 5. The Illinois Public Aid Code is amended  by 
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adding Section 5-5.5b as follows:
 
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    (305 ILCS 5/5-5.5b new)
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    Sec. 5-5.5b. Medicaid Revenue Maximization.
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    (a) Purpose. The General Assembly finds that there is a 
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need to make changes to the administration of services provided 
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by State and local governments in order to maximize federal 
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financial participation. 
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    (b) Definitions. As used in this Section: 
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    "Community Medicaid mental health services" means all 
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mental health services outlined in Section 132 of Title 59 of 
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the Illinois Administrative Code that are Medicaid funded and 
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provided by a community-based provider. 
 


 






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    "Community-based provider" means an entity enrolled as a 
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provider pursuant to Sections 140.11 and 140.12 of Title 89 of 
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the Illinois Administrative Code and certified to provide 
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community Medicaid mental health services in accordance with 
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Section 132 of Title 59 of the Illinois Administrative Code. 
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    "CTA" means the Chicago Transit Authority.
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    "DCFS" means the Department of Children and Family 
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Services.
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    "Department" means the Illinois Department of Healthcare 
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and Family Services.
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    "Developmentally disabled care facility" means an 
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intermediate care facility for the mentally retarded within the 
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meaning of Title XIX of the Social Security Act, whether public 
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or private and whether organized for profit or not-for-profit, 
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but shall not include any facility operated by the State.
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    "Developmentally disabled care provider" means a person 
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conducting, operating, or maintaining a developmentally 
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disabled care facility. For purposes of this definition, 
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"person" means any political subdivision of the State, 
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municipal corporation, individual, firm, partnership, 
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corporation, company, limited liability company, association, 
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joint stock association, or trust, or a receiver, executor, 
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trustee, guardian, or other representative appointed by order 
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of any court.
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    "DHS" means the Illinois Department of Human Services.
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    "Hospital" means an institution, place, building, or 
 


 






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agency located in this State that is licensed as a general 
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acute hospital by the Illinois Department of Public Health 
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under the Hospital Licensing Act, whether public or private and 
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whether organized for profit or not-for-profit.
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    "Long term care facility" means (i) a skilled nursing or 
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intermediate long term care facility, whether public or private 
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and whether organized for profit or not-for-profit, that is 
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subject to licensure by the Illinois Department of Public 
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Health under the Nursing Home Care Act, including a county 
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nursing home directed and maintained under Section 5-1005 of 
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the Counties Code, and (ii) a part of a hospital in which 
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skilled or intermediate long term care services within the 
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meaning of Title XVIII or XIX of the Social Security Act are 
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provided; except that the term "long term care facility" does 
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not include a facility operated solely as an intermediate care 
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facility for the mentally retarded within the meaning of Title 
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XIX of the Social Security Act.
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    "Long term care provider" means (i) a person licensed by 
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the Department of Public Health to operate and maintain a 
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skilled nursing or intermediate long term care facility or (ii) 
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a hospital provider that provides skilled or intermediate long 
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term care services within the meaning of Title XVIII or XIX of 
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the Social Security Act. For purposes of this definition, 
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"person" means any political subdivision of the State, 
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municipal corporation, individual, firm, partnership, 
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corporation, company, limited liability company, association, 
 


 






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joint stock association, or trust, or a receiver, executor, 
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trustee, guardian, or other representative appointed by order 
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of any court.
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    "State-operated developmentally disabled care facility" 
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means an intermediate care facility for the mentally retarded 
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within the meaning of Title XIX of the Social Security Act 
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operated by the State. 
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    (c) Administration and deposit of Revenues. The Department 
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shall coordinate the implementation of changes required by this 
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amendatory Act of the 96th General Assembly amongst the various 
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State and local government bodies that administer programs 
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referred to in this Section.
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    Revenues generated by program changes mandated by any 
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provision in this Section, less reasonable administrative 
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costs associated with the implementation of these program 
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changes, shall be deposited into the Healthcare Provider Relief 
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Fund. 
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    All changes required by this Section shall be implemented 
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no later than December 15, 2010. 
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    The Department shall issue a report to the General Assembly 
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detailing the implementation of this amendatory Act of the 96th 
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General Assembly no later than March 31, 2011. 
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    (d) Acceleration of administrative vouchers. The 
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Department shall create all vouchers for long term care 
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facilities and developmentally disabled care facilities for 
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dates of service in November and December 2010 and shall, no 
 


 






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later than December 15, 2010, submit these vouchers to the 
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Comptroller for payment. 
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    The Department of Human Services shall create the necessary 
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documentation for State-operated developmentally disabled care 
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facilities so that the necessary data for dates of service 
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before January 1, 2011 can be adjudicated by the Department no 
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later than December 15, 2010. 
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    (e) Conversion of DHS grant programs to fee-for-service. 
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After the effective date of this amendatory Act of the 96th 
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General Assembly, community Medicaid mental health services 
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provided by community-based providers shall no longer be 
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included in contracts with DHS. Instead, community Medicaid 
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mental health services provided by a community-based provider 
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must be billed directly to the Department and must be separate 
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from contracts between the Department of Human Services and 
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community-based providers for all other mental health 
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services. 
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    Rates of reimbursement for community Medicaid mental 
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health services shall be consistent with rates outlined in 
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Section 132 of Title 59 of the Illinois Administrative Code. 
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    (f) DCFS Medicaid services. The Department shall work with 
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DCFS to identify all existing grants that can be converted to 
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Medicaid fee-for-service in order to secure federal financial 
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revenue. 
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    All appropriations and administrative responsibilities for 
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such services shall be transferred to the Department from DCFS. 
 


 






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    (g) Third Party Liability recoveries. The Department shall 
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contract with a vendor to support the Department in 
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coordinating benefits for Medicaid enrollees.   The scope of work 
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shall include, at a minimum, the identification of other 
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insurance for Medicaid enrollees and the recovery of funds paid 
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by the Department when another payer was liable. The vendor 
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shall be paid a percentage of the recovered funds when 
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practical and subject to federal law. 
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    (h) CTA transportation to Medical providers for service. 
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The Department, working with its DataWarehouse vendor and the 
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CTA, shall create a process to identify transportation services 
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provided to Medicaid enrollees.
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    The Department shall assist the CTA in determining total 
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costs associated with the provision of transportation services 
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to Medicaid enrollees.
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    The Department shall determine and draw the maximum 
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allowable federal matching dollars associated with the cost of 
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CTA services provided to Medicaid enrollees. 
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    (i) Public health departments.
The Department shall 
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identify unreimbursed costs for persons covered by Medicaid who 
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are served by the Chicago Department of Public Health.
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    The Department shall assist the Chicago Department of 
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Public Health in determining total unreimbursed costs 
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associated with the provision of healthcare services to 
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Medicaid enrollees.
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    The Department shall determine and draw the maximum 
 


 






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allowable federal matching dollars associated with the cost of 
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Chicago Department of Public Health services provided to 
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Medicaid enrollees. 
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    (j) Acceleration of hospital-based payments.
The 
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Department shall, by December 10, 2010, create vouchers for all 
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State fiscal year 2011 hospital payments exempt from the prompt 
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payment requirements of the American Recovery and Reinvestment 
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Act of 2009.  The Department shall, no later than December 15, 
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2010, submit these vouchers to the Comptroller for payment. 
 
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    Section 10. The Community Services Act is amended  by adding 
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Section 4.8 as follows:
 
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    (405 ILCS 30/4.8 new)
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    Sec. 4.8. Payments for community Medicaid mental health 
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services. 
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    (a) After the effective date of this amendatory Act of the 
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96th General Assembly, community Medicaid mental health 
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services provided by community-based providers shall no longer 
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be included in contracts with the Department of Human Services. 
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Instead, community Medicaid mental health services provided by 
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a community-based provider must be billed directly to the 
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Department of Healthcare and Family Services and must be 
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separate from contracts between the Department of Human 
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Services and community-based providers for all other mental  
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health services. Rates of reimbursement for community Medicaid 
 


 






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mental health services shall be consistent with rates outlined 
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in Section 132 of Title 59 of the Illinois Administrative Code.
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    (b) For purposes of this Section:
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    "Community Medicaid mental health services" means all 
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mental health services outlined in Section 132 of Title 59 of 
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the Illinois Administrative Code that are Medicaid funded and 
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provided by a community-based provider.
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    "Community-based provider" means an entity enrolled as a 
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provider pursuant to Sections 140.11 and 140.12 of Title 89 of 
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the Illinois Administrative Code and certified to provide 
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community Medicaid mental health services in accordance with 
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Section 132 of Title 59 of the Illinois Administrative Code. 
 

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