| ||||||||||||||||||||||||||
| ||||||||||||||||||||||||||
| ||||||||||||||||||||||||||
| ||||||||||||||||||||||||||
| ||||||||||||||||||||||||||
1 | AN ACT concerning regulation.
| |||||||||||||||||||||||||
2 | Be it enacted by the People of the State of Illinois,
| |||||||||||||||||||||||||
3 | represented in the General Assembly:
| |||||||||||||||||||||||||
4 | Section 5. The Clinical Psychologist Licensing Act is
| |||||||||||||||||||||||||
5 | amended by changing Sections 2 and 4.3 as follows:
| |||||||||||||||||||||||||
6 | (225 ILCS 15/2) (from Ch. 111, par. 5352)
| |||||||||||||||||||||||||
7 | (Section scheduled to be repealed on January 1, 2027)
| |||||||||||||||||||||||||
8 | Sec. 2. Definitions. As used in this Act:
| |||||||||||||||||||||||||
9 | (1) "Department" means the Department of Financial and
| |||||||||||||||||||||||||
10 | Professional Regulation.
| |||||||||||||||||||||||||
11 | (2) "Secretary" means the Secretary
of Financial and | |||||||||||||||||||||||||
12 | Professional Regulation.
| |||||||||||||||||||||||||
13 | (3) "Board" means the Clinical Psychologists Licensing
| |||||||||||||||||||||||||
14 | and
Disciplinary
Board appointed by the Secretary.
| |||||||||||||||||||||||||
15 | (4) (Blank).
| |||||||||||||||||||||||||
16 | (5) "Clinical psychology" means the independent
| |||||||||||||||||||||||||
17 | evaluation, classification, diagnosis, and treatment of | |||||||||||||||||||||||||
18 | mental, emotional, behavioral
or nervous disorders or | |||||||||||||||||||||||||
19 | conditions, developmental disabilities, alcoholism
and | |||||||||||||||||||||||||
20 | substance abuse, disorders of habit or conduct, and the | |||||||||||||||||||||||||
21 | psychological
aspects of physical illness. The practice of | |||||||||||||||||||||||||
22 | clinical psychology includes
psychoeducational | |||||||||||||||||||||||||
23 | evaluation, therapy, remediation and consultation, the
use |
| |||||||
| |||||||
1 | of psychological and neuropsychological testing, | ||||||
2 | assessment,
psychotherapy, psychoanalysis, hypnosis, | ||||||
3 | biofeedback, and behavioral
modification when any of these | ||||||
4 | are used for the purpose of preventing or
eliminating | ||||||
5 | psychopathology, or for the amelioration of psychological
| ||||||
6 | disorders of individuals or groups. "Clinical psychology" | ||||||
7 | does not include
the use of hypnosis by unlicensed persons
| ||||||
8 | pursuant to Section 3.
| ||||||
9 | (6) A person represents himself or herself to be a | ||||||
10 | "clinical psychologist" or "psychologist" within
the | ||||||
11 | meaning of this Act when he or she holds himself or herself | ||||||
12 | out to the public by
any title or description of services | ||||||
13 | incorporating the words "psychological",
"psychologic", | ||||||
14 | "psychologist", "psychology", or "clinical psychologist" | ||||||
15 | or
under such title or description offers to render or | ||||||
16 | renders clinical
psychological services as defined in | ||||||
17 | paragraph (7) of this Section to
individuals or the public | ||||||
18 | for remuneration.
| ||||||
19 | (7) "Clinical psychological services" refers to any | ||||||
20 | services under
paragraph (5) of this Section if the words | ||||||
21 | "psychological", "psychologic",
"psychologist", | ||||||
22 | "psychology" or "clinical psychologist" are used to
| ||||||
23 | describe such services by the person or
organization | ||||||
24 | offering to render or rendering them.
| ||||||
25 | (8) "Collaborating physician" means a physician | ||||||
26 | licensed to practice medicine in all of its branches in |
| |||||||
| |||||||
1 | Illinois who generally prescribes medications for the | ||||||
2 | treatment of mental health disease or illness to his or | ||||||
3 | her patients in the normal course of his or her clinical | ||||||
4 | medical practice. | ||||||
5 | (9) "Prescribing psychologist" means a licensed, | ||||||
6 | doctoral level psychologist who has undergone specialized | ||||||
7 | training, has passed an examination as determined by rule, | ||||||
8 | and has received a current license granting prescriptive | ||||||
9 | authority under Section 4.2 of this Act that has not been | ||||||
10 | revoked or suspended from the Department. | ||||||
11 | (10) "Prescriptive authority" means the authority to | ||||||
12 | prescribe, administer, discontinue, or distribute drugs or | ||||||
13 | medicines. | ||||||
14 | (11) "Prescription" means an order for a drug, | ||||||
15 | laboratory test, or any medicines, including controlled | ||||||
16 | substances as defined in the Illinois Controlled | ||||||
17 | Substances Act. | ||||||
18 | (12) "Drugs" has the meaning given to that term in the | ||||||
19 | Pharmacy Practice Act. | ||||||
20 | (13) "Medicines" has the meaning given to that term in | ||||||
21 | the Pharmacy Practice Act. | ||||||
22 | (14) "Address of record" means the designated address | ||||||
23 | recorded by the Department in the applicant's application | ||||||
24 | file or the licensee's license file maintained by the | ||||||
25 | Department's licensure maintenance unit. | ||||||
26 | (15) "Opioid" means a narcotic drug or substance that |
| |||||||
| |||||||
1 | is a Schedule II controlled substance under paragraph (1), | ||||||
2 | (2), (3), or (5) of subsection (b) or under subsection (c) | ||||||
3 | of Section 206 of the Illinois Controlled Substances Act. | ||||||
4 | This Act shall not apply to persons lawfully carrying on | ||||||
5 | their particular
profession or business under any valid | ||||||
6 | existing regulatory Act of the State.
| ||||||
7 | (Source: P.A. 98-668, eff. 6-25-14; 99-572, eff. 7-15-16.)
| ||||||
8 | (225 ILCS 15/4.3) | ||||||
9 | (Section scheduled to be repealed on January 1, 2027) | ||||||
10 | Sec. 4.3. Written collaborative agreements. | ||||||
11 | (a) A written collaborative agreement is required for all | ||||||
12 | prescribing psychologists practicing under a prescribing | ||||||
13 | psychologist license issued pursuant to Section 4.2 of this | ||||||
14 | Act. | ||||||
15 | (b) A written delegation of prescriptive authority by a | ||||||
16 | collaborating physician may only include medications for the | ||||||
17 | treatment of mental health disease or illness the | ||||||
18 | collaborating physician generally provides to his or her | ||||||
19 | patients in the normal course of his or her clinical practice | ||||||
20 | with the exception of the following: | ||||||
21 | (1) (blank); patients who are less than 17 years of | ||||||
22 | age or over 65 years of age; | ||||||
23 | (2) patients during pregnancy; | ||||||
24 | (3) patients with serious medical conditions, such as | ||||||
25 | heart disease, cancer, stroke, or seizures, and with |
| |||||||
| |||||||
1 | developmental disabilities and intellectual disabilities; | ||||||
2 | and | ||||||
3 | (4) prescriptive authority for benzodiazepine Schedule | ||||||
4 | III controlled substances ; and . | ||||||
5 | (5) prescriptive authority for any Schedule II opioid. | ||||||
6 | (c) The collaborating physician shall file with the | ||||||
7 | Department notice of delegation of prescriptive authority and | ||||||
8 | termination of the delegation, in accordance with rules of the | ||||||
9 | Department. Upon receipt of this notice delegating authority | ||||||
10 | to prescribe any nonnarcotic , nonopioid Schedule II III | ||||||
11 | through V controlled substances, the licensed clinical | ||||||
12 | psychologist shall be eligible to register for a mid-level | ||||||
13 | practitioner controlled substance license under Section 303.05 | ||||||
14 | of the Illinois Controlled Substances Act. | ||||||
15 | (d) All of the following shall apply to delegation of | ||||||
16 | prescriptive authority: | ||||||
17 | (1) Any delegation of Schedule II III through V | ||||||
18 | controlled substances shall identify the specific | ||||||
19 | controlled substance by brand name or generic name. No | ||||||
20 | controlled substance to be delivered by injection may be | ||||||
21 | delegated. No Schedule II opioid controlled substance | ||||||
22 | shall be delegated. | ||||||
23 | (2) A prescribing psychologist shall not prescribe | ||||||
24 | narcotic drugs, as defined in Section 102 of the Illinois | ||||||
25 | Controlled Substances Act. | ||||||
26 | Any prescribing psychologist who writes a prescription for |
| |||||||
| |||||||
1 | a controlled substance without having valid and appropriate | ||||||
2 | authority may be fined by the Department not more than $50 per | ||||||
3 | prescription and the Department may take any other | ||||||
4 | disciplinary action provided for in this Act. | ||||||
5 | All prescriptions written by a prescribing psychologist | ||||||
6 | must contain the name of the prescribing psychologist and his | ||||||
7 | or her signature. The prescribing psychologist shall sign his | ||||||
8 | or her own name. | ||||||
9 | (e) The written collaborative agreement shall describe the | ||||||
10 | working relationship of the prescribing psychologist with the | ||||||
11 | collaborating physician and shall delegate prescriptive | ||||||
12 | authority as provided in this Act. Collaboration does not | ||||||
13 | require an employment relationship between the collaborating | ||||||
14 | physician and prescribing psychologist. Absent an employment | ||||||
15 | relationship, an agreement may not restrict third-party | ||||||
16 | payment sources accepted by the prescribing psychologist. For | ||||||
17 | the purposes of this Section, "collaboration" means the | ||||||
18 | relationship between a prescribing psychologist and a | ||||||
19 | collaborating physician with respect to the delivery of | ||||||
20 | prescribing services in accordance with (1) the prescribing | ||||||
21 | psychologist's training, education, and experience and (2) | ||||||
22 | collaboration and consultation as documented in a jointly | ||||||
23 | developed written collaborative agreement. | ||||||
24 | (f) The agreement shall promote the exercise of | ||||||
25 | professional judgment by the prescribing psychologist | ||||||
26 | corresponding to his or her education and experience. |
| |||||||
| |||||||
1 | (g) The collaborative agreement shall not be construed to | ||||||
2 | require the personal presence of a physician at the place | ||||||
3 | where services are rendered. Methods of communication shall be | ||||||
4 | available for consultation with the collaborating physician in | ||||||
5 | person or by telecommunications in accordance with established | ||||||
6 | written guidelines as set forth in the written agreement. | ||||||
7 | (h) Collaboration and consultation pursuant to all | ||||||
8 | collaboration agreements shall be adequate if a collaborating | ||||||
9 | physician does each of the following: | ||||||
10 | (1) participates in the joint formulation and joint | ||||||
11 | approval of orders or guidelines with the prescribing | ||||||
12 | psychologist and he or she periodically reviews the | ||||||
13 | prescribing psychologist's orders and the services | ||||||
14 | provided patients under the orders in accordance with | ||||||
15 | accepted standards of medical practice and prescribing | ||||||
16 | psychologist practice; | ||||||
17 | (2) provides collaboration and consultation with the | ||||||
18 | prescribing psychologist in person at least once a month | ||||||
19 | for review of safety and quality clinical care or | ||||||
20 | treatment; | ||||||
21 | (3) is available through telecommunications for | ||||||
22 | consultation on medical problems, complications, | ||||||
23 | emergencies, or patient referral; and | ||||||
24 | (4) reviews medication orders of the prescribing | ||||||
25 | psychologist no less than monthly, including review of | ||||||
26 | laboratory tests and other tests as available. |
| |||||||
| |||||||
1 | (i) The written collaborative agreement shall contain | ||||||
2 | provisions detailing notice for termination or change of | ||||||
3 | status involving a written collaborative agreement, except | ||||||
4 | when the notice is given for just cause. | ||||||
5 | (j) A copy of the signed written collaborative agreement | ||||||
6 | shall be available to the Department upon request to either | ||||||
7 | the prescribing psychologist or the collaborating physician. | ||||||
8 | (k) Nothing in this Section shall be construed to limit | ||||||
9 | the authority of a prescribing psychologist to perform all | ||||||
10 | duties authorized under this Act. | ||||||
11 | (l) A prescribing psychologist shall inform each | ||||||
12 | collaborating physician of all collaborative agreements he or | ||||||
13 | she has signed and provide a copy of these to any collaborating | ||||||
14 | physician. | ||||||
15 | (m) No collaborating physician shall enter into more than | ||||||
16 | 3 collaborative agreements with prescribing psychologists.
| ||||||
17 | (Source: P.A. 101-84, eff. 7-19-19.)
| ||||||
18 | Section 10. The Illinois Public Aid Code is amended by | ||||||
19 | changing Section 5-5 as follows:
| ||||||
20 | (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
| ||||||
21 | Sec. 5-5. Medical services. The Illinois Department, by | ||||||
22 | rule, shall
determine the quantity and quality of and the rate | ||||||
23 | of reimbursement for the
medical assistance for which
payment | ||||||
24 | will be authorized, and the medical services to be provided,
|
| |||||||
| |||||||
1 | which may include all or part of the following: (1) inpatient | ||||||
2 | hospital
services; (2) outpatient hospital services; (3) other | ||||||
3 | laboratory and
X-ray services; (4) skilled nursing home | ||||||
4 | services; (5) physicians'
services whether furnished in the | ||||||
5 | office, the patient's home, a
hospital, a skilled nursing | ||||||
6 | home, or elsewhere; (6) medical care, or any
other type of | ||||||
7 | remedial care furnished by licensed practitioners; (7)
home | ||||||
8 | health care services; (8) private duty nursing service; (9) | ||||||
9 | clinic
services; (10) dental services, including prevention | ||||||
10 | and treatment of periodontal disease and dental caries disease | ||||||
11 | for pregnant individuals, provided by an individual licensed | ||||||
12 | to practice dentistry or dental surgery; for purposes of this | ||||||
13 | item (10), "dental services" means diagnostic, preventive, or | ||||||
14 | corrective procedures provided by or under the supervision of | ||||||
15 | a dentist in the practice of his or her profession; (11) | ||||||
16 | physical therapy and related
services; (12) prescribed drugs, | ||||||
17 | dentures, and prosthetic devices; and
eyeglasses prescribed by | ||||||
18 | a physician skilled in the diseases of the eye,
or by an | ||||||
19 | optometrist, whichever the person may select; (13) other
| ||||||
20 | diagnostic, screening, preventive, and rehabilitative | ||||||
21 | services, including to ensure that the individual's need for | ||||||
22 | intervention or treatment of mental disorders or substance use | ||||||
23 | disorders or co-occurring mental health and substance use | ||||||
24 | disorders is determined using a uniform screening, assessment, | ||||||
25 | and evaluation process inclusive of criteria, for children and | ||||||
26 | adults; for purposes of this item (13), a uniform screening, |
| |||||||
| |||||||
1 | assessment, and evaluation process refers to a process that | ||||||
2 | includes an appropriate evaluation and, as warranted, a | ||||||
3 | referral; "uniform" does not mean the use of a singular | ||||||
4 | instrument, tool, or process that all must utilize; (14)
| ||||||
5 | transportation and such other expenses as may be necessary; | ||||||
6 | (15) medical
treatment of sexual assault survivors, as defined | ||||||
7 | in
Section 1a of the Sexual Assault Survivors Emergency | ||||||
8 | Treatment Act, for
injuries sustained as a result of the | ||||||
9 | sexual assault, including
examinations and laboratory tests to | ||||||
10 | discover evidence which may be used in
criminal proceedings | ||||||
11 | arising from the sexual assault; (16) the
diagnosis and | ||||||
12 | treatment of sickle cell anemia; (16.5) services performed by | ||||||
13 | a chiropractic physician licensed under the Medical Practice | ||||||
14 | Act of 1987 and acting within the scope of his or her license, | ||||||
15 | including, but not limited to, chiropractic manipulative | ||||||
16 | treatment; and (17)
any other medical care, and any other type | ||||||
17 | of remedial care recognized
under the laws of this State. The | ||||||
18 | term "any other type of remedial care" shall
include nursing | ||||||
19 | care and nursing home service for persons who rely on
| ||||||
20 | treatment by spiritual means alone through 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 shall
be covered | ||||||
25 | under the medical assistance
program under this Article for | ||||||
26 | persons who are otherwise eligible for
assistance under this |
| |||||||
| |||||||
1 | Article.
| ||||||
2 | Notwithstanding any other provision of this Code, | ||||||
3 | reproductive health care that is otherwise legal in Illinois | ||||||
4 | shall be covered under the medical assistance program for | ||||||
5 | persons who are otherwise eligible for medical assistance | ||||||
6 | under this Article. | ||||||
7 | Notwithstanding any other provision of this Section, all | ||||||
8 | tobacco cessation medications approved by the United States | ||||||
9 | Food and Drug Administration and all individual and group | ||||||
10 | tobacco cessation counseling services and telephone-based | ||||||
11 | counseling services and tobacco cessation medications provided | ||||||
12 | through the Illinois Tobacco Quitline shall be covered under | ||||||
13 | the medical assistance program for persons who are otherwise | ||||||
14 | eligible for assistance under this Article. The Department | ||||||
15 | shall comply with all federal requirements necessary to obtain | ||||||
16 | federal financial participation, as specified in 42 CFR | ||||||
17 | 433.15(b)(7), for telephone-based counseling services provided | ||||||
18 | through the Illinois Tobacco Quitline, including, but not | ||||||
19 | limited to: (i) entering into a memorandum of understanding or | ||||||
20 | interagency agreement with the Department of Public Health, as | ||||||
21 | administrator of the Illinois Tobacco Quitline; and (ii) | ||||||
22 | developing a cost allocation plan for Medicaid-allowable | ||||||
23 | Illinois Tobacco Quitline services in accordance with 45 CFR | ||||||
24 | 95.507. The Department shall submit the memorandum of | ||||||
25 | understanding or interagency agreement, the cost allocation | ||||||
26 | plan, and all other necessary documentation to the Centers for |
| |||||||
| |||||||
1 | Medicare and Medicaid Services for review and approval. | ||||||
2 | Coverage under this paragraph shall be contingent upon federal | ||||||
3 | approval. | ||||||
4 | Notwithstanding any other provision of this Code, the | ||||||
5 | Illinois
Department may not require, as a condition of payment | ||||||
6 | for any laboratory
test authorized under this Article, that a | ||||||
7 | physician's handwritten signature
appear on the laboratory | ||||||
8 | test order form. The Illinois Department may,
however, impose | ||||||
9 | other appropriate requirements regarding laboratory test
order | ||||||
10 | documentation.
| ||||||
11 | Upon receipt of federal approval of an amendment to the | ||||||
12 | Illinois Title XIX State Plan for this purpose, the Department | ||||||
13 | shall authorize the Chicago Public Schools (CPS) to procure a | ||||||
14 | vendor or vendors to manufacture eyeglasses for individuals | ||||||
15 | enrolled in a school within the CPS system. CPS shall ensure | ||||||
16 | that its vendor or vendors are enrolled as providers in the | ||||||
17 | medical assistance program and in any capitated Medicaid | ||||||
18 | managed care entity (MCE) serving individuals enrolled in a | ||||||
19 | school within the CPS system. Under any contract procured | ||||||
20 | under this provision, the vendor or vendors must serve only | ||||||
21 | individuals enrolled in a school within the CPS system. Claims | ||||||
22 | for services provided by CPS's vendor or vendors to recipients | ||||||
23 | of benefits in the medical assistance program under this Code, | ||||||
24 | the Children's Health Insurance Program, or the Covering ALL | ||||||
25 | KIDS Health Insurance Program shall be submitted to the | ||||||
26 | Department or the MCE in which the individual is enrolled for |
| |||||||
| |||||||
1 | payment and shall be reimbursed at the Department's or the | ||||||
2 | MCE's established rates or rate methodologies for eyeglasses. | ||||||
3 | On and after July 1, 2012, the Department of Healthcare | ||||||
4 | and Family Services may provide the following services to
| ||||||
5 | persons
eligible for assistance under this Article who are | ||||||
6 | participating in
education, training or employment programs | ||||||
7 | operated by the Department of Human
Services as successor to | ||||||
8 | the Department of Public Aid:
| ||||||
9 | (1) dental services provided by or under the | ||||||
10 | supervision of a dentist; and
| ||||||
11 | (2) eyeglasses prescribed by a physician skilled in | ||||||
12 | the diseases of the
eye, or by an optometrist, whichever | ||||||
13 | the person may select.
| ||||||
14 | On and after July 1, 2018, the Department of Healthcare | ||||||
15 | and Family Services shall provide dental services to any adult | ||||||
16 | who is otherwise eligible for assistance under the medical | ||||||
17 | assistance program. As used in this paragraph, "dental | ||||||
18 | services" means diagnostic, preventative, restorative, or | ||||||
19 | corrective procedures, including procedures and services for | ||||||
20 | the prevention and treatment of periodontal disease and dental | ||||||
21 | caries disease, provided by an individual who is licensed to | ||||||
22 | practice dentistry or dental surgery or who is under the | ||||||
23 | supervision of a dentist in the practice of his or her | ||||||
24 | profession. | ||||||
25 | On and after July 1, 2018, targeted dental services, as | ||||||
26 | set forth in Exhibit D of the Consent Decree entered by the |
| |||||||
| |||||||
1 | United States District Court for the Northern District of | ||||||
2 | Illinois, Eastern Division, in the matter of Memisovski v. | ||||||
3 | Maram, Case No. 92 C 1982, that are provided to adults under | ||||||
4 | the medical assistance program shall be established at no less | ||||||
5 | than the rates set forth in the "New Rate" column in Exhibit D | ||||||
6 | of the Consent Decree for targeted dental services that are | ||||||
7 | provided to persons under the age of 18 under the medical | ||||||
8 | assistance program. | ||||||
9 | Notwithstanding any other provision of this Code and | ||||||
10 | subject to federal approval, the Department may adopt rules to | ||||||
11 | allow a dentist who is volunteering his or her service at no | ||||||
12 | cost to render dental services through an enrolled | ||||||
13 | not-for-profit health clinic without the dentist personally | ||||||
14 | enrolling as a participating provider in the medical | ||||||
15 | assistance program. A not-for-profit health clinic shall | ||||||
16 | include a public health clinic or Federally Qualified Health | ||||||
17 | Center or other enrolled provider, as determined by the | ||||||
18 | Department, through which dental services covered under this | ||||||
19 | Section are performed. The Department shall establish a | ||||||
20 | process for payment of claims for reimbursement for covered | ||||||
21 | dental services rendered under this provision. | ||||||
22 | On and after January 1, 2022, the Department of Healthcare | ||||||
23 | and Family Services shall administer and regulate a | ||||||
24 | school-based dental program that allows for the out-of-office | ||||||
25 | delivery of preventative dental services in a school setting | ||||||
26 | to children under 19 years of age. The Department shall |
| |||||||
| |||||||
1 | establish, by rule, guidelines for participation by providers | ||||||
2 | and set requirements for follow-up referral care based on the | ||||||
3 | requirements established in the Dental Office Reference Manual | ||||||
4 | published by the Department that establishes the requirements | ||||||
5 | for dentists participating in the All Kids Dental School | ||||||
6 | Program. Every effort shall be made by the Department when | ||||||
7 | developing the program requirements to consider the different | ||||||
8 | geographic differences of both urban and rural areas of the | ||||||
9 | State for initial treatment and necessary follow-up care. No | ||||||
10 | provider shall be charged a fee by any unit of local government | ||||||
11 | to participate in the school-based dental program administered | ||||||
12 | by the Department. Nothing in this paragraph shall be | ||||||
13 | construed to limit or preempt a home rule unit's or school | ||||||
14 | district's authority to establish, change, or administer a | ||||||
15 | school-based dental program in addition to, or independent of, | ||||||
16 | the school-based dental program administered by the | ||||||
17 | Department. | ||||||
18 | The Illinois Department, by rule, may distinguish and | ||||||
19 | classify the
medical services to be provided only in | ||||||
20 | accordance with the classes of
persons designated in Section | ||||||
21 | 5-2.
| ||||||
22 | The Department of Healthcare and Family Services must | ||||||
23 | provide coverage and reimbursement for amino acid-based | ||||||
24 | elemental formulas, regardless of delivery method, for the | ||||||
25 | diagnosis and treatment of (i) eosinophilic disorders and (ii) | ||||||
26 | short bowel syndrome when the prescribing physician has issued |
| |||||||
| |||||||
1 | a written order stating that the amino acid-based elemental | ||||||
2 | formula is medically necessary.
| ||||||
3 | The Illinois Department shall authorize the provision of, | ||||||
4 | and shall
authorize payment for, screening by low-dose | ||||||
5 | mammography for the presence of
occult breast cancer for | ||||||
6 | individuals 35 years of age or older who are eligible
for | ||||||
7 | medical assistance under this Article, as follows: | ||||||
8 | (A) A baseline
mammogram for individuals 35 to 39 | ||||||
9 | years of age.
| ||||||
10 | (B) An annual mammogram for individuals 40 years of | ||||||
11 | age or older. | ||||||
12 | (C) A mammogram at the age and intervals considered | ||||||
13 | medically necessary by the individual's health care | ||||||
14 | provider for individuals under 40 years of age and having | ||||||
15 | a family history of breast cancer, prior personal history | ||||||
16 | of breast cancer, positive genetic testing, or other risk | ||||||
17 | factors. | ||||||
18 | (D) A comprehensive ultrasound screening and MRI of an | ||||||
19 | entire breast or breasts if a mammogram demonstrates | ||||||
20 | heterogeneous or dense breast tissue or when medically | ||||||
21 | necessary as determined by a physician licensed to | ||||||
22 | practice medicine in all of its branches. | ||||||
23 | (E) A screening MRI when medically necessary, as | ||||||
24 | determined by a physician licensed to practice medicine in | ||||||
25 | all of its branches. | ||||||
26 | (F) A diagnostic mammogram when medically necessary, |
| |||||||
| |||||||
1 | as determined by a physician licensed to practice medicine | ||||||
2 | in all its branches, advanced practice registered nurse, | ||||||
3 | or physician assistant. | ||||||
4 | The Department shall not impose a deductible, coinsurance, | ||||||
5 | copayment, or any other cost-sharing requirement on the | ||||||
6 | coverage provided under this paragraph; except that this | ||||||
7 | sentence does not apply to coverage of diagnostic mammograms | ||||||
8 | to the extent such coverage would disqualify a high-deductible | ||||||
9 | health plan from eligibility for a health savings account | ||||||
10 | pursuant to Section 223 of the Internal Revenue Code (26 | ||||||
11 | U.S.C. 223). | ||||||
12 | All screenings
shall
include a physical breast exam, | ||||||
13 | instruction on self-examination and
information regarding the | ||||||
14 | frequency of self-examination and its value as a
preventative | ||||||
15 | tool. | ||||||
16 | For purposes of this Section: | ||||||
17 | "Diagnostic
mammogram" means a mammogram obtained using | ||||||
18 | diagnostic mammography. | ||||||
19 | "Diagnostic
mammography" means a method of screening that | ||||||
20 | is designed to
evaluate an abnormality in a breast, including | ||||||
21 | an abnormality seen
or suspected on a screening mammogram or a | ||||||
22 | subjective or objective
abnormality otherwise detected in the | ||||||
23 | breast. | ||||||
24 | "Low-dose mammography" means
the x-ray examination of the | ||||||
25 | breast using equipment dedicated specifically
for mammography, | ||||||
26 | including the x-ray tube, filter, compression device,
and |
| |||||||
| |||||||
1 | image receptor, with an average radiation exposure delivery
of | ||||||
2 | less than one rad per breast for 2 views of an average size | ||||||
3 | breast.
The term also includes digital mammography and | ||||||
4 | includes breast tomosynthesis. | ||||||
5 | "Breast tomosynthesis" means a radiologic procedure that | ||||||
6 | involves the acquisition of projection images over the | ||||||
7 | stationary breast to produce cross-sectional digital | ||||||
8 | three-dimensional images of the breast. | ||||||
9 | If, at any time, the Secretary of the United States | ||||||
10 | Department of Health and Human Services, or its successor | ||||||
11 | agency, promulgates rules or regulations to be published in | ||||||
12 | the Federal Register or publishes a comment in the Federal | ||||||
13 | Register or issues an opinion, guidance, or other action that | ||||||
14 | would require the State, pursuant to any provision of the | ||||||
15 | Patient Protection and Affordable Care Act (Public Law | ||||||
16 | 111-148), including, but not limited to, 42 U.S.C. | ||||||
17 | 18031(d)(3)(B) or any successor provision, to defray the cost | ||||||
18 | of any coverage for breast tomosynthesis outlined in this | ||||||
19 | paragraph, then the requirement that an insurer cover breast | ||||||
20 | tomosynthesis is inoperative other than any such coverage | ||||||
21 | authorized under Section 1902 of the Social Security Act, 42 | ||||||
22 | U.S.C. 1396a, and the State shall not assume any obligation | ||||||
23 | for the cost of coverage for breast tomosynthesis set forth in | ||||||
24 | this paragraph.
| ||||||
25 | On and after January 1, 2016, the Department shall ensure | ||||||
26 | that all networks of care for adult clients of the Department |
| |||||||
| |||||||
1 | include access to at least one breast imaging Center of | ||||||
2 | Imaging Excellence as certified by the American College of | ||||||
3 | Radiology. | ||||||
4 | On and after January 1, 2012, providers participating in a | ||||||
5 | quality improvement program approved by the Department shall | ||||||
6 | be reimbursed for screening and diagnostic mammography at the | ||||||
7 | same rate as the Medicare program's rates, including the | ||||||
8 | increased reimbursement for digital mammography and, after | ||||||
9 | January 1, 2023 ( the effective date of Public Act 102-1018) | ||||||
10 | this amendatory Act of the 102nd General Assembly , breast | ||||||
11 | tomosynthesis. | ||||||
12 | The Department shall convene an expert panel including | ||||||
13 | representatives of hospitals, free-standing mammography | ||||||
14 | facilities, and doctors, including radiologists, to establish | ||||||
15 | quality standards for mammography. | ||||||
16 | On and after January 1, 2017, providers participating in a | ||||||
17 | breast cancer treatment quality improvement program approved | ||||||
18 | by the Department shall be reimbursed for breast cancer | ||||||
19 | treatment at a rate that is no lower than 95% of the Medicare | ||||||
20 | program's rates for the data elements included in the breast | ||||||
21 | cancer treatment quality program. | ||||||
22 | The Department shall convene an expert panel, including | ||||||
23 | representatives of hospitals, free-standing breast cancer | ||||||
24 | treatment centers, breast cancer quality organizations, and | ||||||
25 | doctors, including breast surgeons, reconstructive breast | ||||||
26 | surgeons, oncologists, and primary care providers to establish |
| |||||||
| |||||||
1 | quality standards for breast cancer treatment. | ||||||
2 | Subject to federal approval, the Department shall | ||||||
3 | establish a rate methodology for mammography at federally | ||||||
4 | qualified health centers and other encounter-rate clinics. | ||||||
5 | These clinics or centers may also collaborate with other | ||||||
6 | hospital-based mammography facilities. By January 1, 2016, the | ||||||
7 | Department shall report to the General Assembly on the status | ||||||
8 | of the provision set forth in this paragraph. | ||||||
9 | The Department shall establish a methodology to remind | ||||||
10 | individuals who are age-appropriate for screening mammography, | ||||||
11 | but who have not received a mammogram within the previous 18 | ||||||
12 | months, of the importance and benefit of screening | ||||||
13 | mammography. The Department shall work with experts in breast | ||||||
14 | cancer outreach and patient navigation to optimize these | ||||||
15 | reminders and shall establish a methodology for evaluating | ||||||
16 | their effectiveness and modifying the methodology based on the | ||||||
17 | evaluation. | ||||||
18 | The Department shall establish a performance goal for | ||||||
19 | primary care providers with respect to their female patients | ||||||
20 | over age 40 receiving an annual mammogram. This performance | ||||||
21 | goal shall be used to provide additional reimbursement in the | ||||||
22 | form of a quality performance bonus to primary care providers | ||||||
23 | who meet that goal. | ||||||
24 | The Department shall devise a means of case-managing or | ||||||
25 | patient navigation for beneficiaries diagnosed with breast | ||||||
26 | cancer. This program shall initially operate as a pilot |
| |||||||
| |||||||
1 | program in areas of the State with the highest incidence of | ||||||
2 | mortality related to breast cancer. At least one pilot program | ||||||
3 | site shall be in the metropolitan Chicago area and at least one | ||||||
4 | site shall be outside the metropolitan Chicago area. On or | ||||||
5 | after July 1, 2016, the pilot program shall be expanded to | ||||||
6 | include one site in western Illinois, one site in southern | ||||||
7 | Illinois, one site in central Illinois, and 4 sites within | ||||||
8 | metropolitan Chicago. An evaluation of the pilot program shall | ||||||
9 | be carried out measuring health outcomes and cost of care for | ||||||
10 | those served by the pilot program compared to similarly | ||||||
11 | situated patients who are not served by the pilot program. | ||||||
12 | The Department shall require all networks of care to | ||||||
13 | develop a means either internally or by contract with experts | ||||||
14 | in navigation and community outreach to navigate cancer | ||||||
15 | patients to comprehensive care in a timely fashion. The | ||||||
16 | Department shall require all networks of care to include | ||||||
17 | access for patients diagnosed with cancer to at least one | ||||||
18 | academic commission on cancer-accredited cancer program as an | ||||||
19 | in-network covered benefit. | ||||||
20 | The Department shall provide coverage and reimbursement | ||||||
21 | for a human papillomavirus (HPV) vaccine that is approved for | ||||||
22 | marketing by the federal Food and Drug Administration for all | ||||||
23 | persons between the ages of 9 and 45 and persons of the age of | ||||||
24 | 46 and above who have been diagnosed with cervical dysplasia | ||||||
25 | with a high risk of recurrence or progression. The Department | ||||||
26 | shall disallow any preauthorization requirements for the |
| |||||||
| |||||||
1 | administration of the human papillomavirus (HPV) vaccine. | ||||||
2 | On or after July 1, 2022, individuals who are otherwise | ||||||
3 | eligible for medical assistance under this Article shall | ||||||
4 | receive coverage for perinatal depression screenings for the | ||||||
5 | 12-month period beginning on the last day of their pregnancy. | ||||||
6 | Medical assistance coverage under this paragraph shall be | ||||||
7 | conditioned on the use of a screening instrument approved by | ||||||
8 | the Department. | ||||||
9 | Any medical or health care provider shall immediately | ||||||
10 | recommend, to
any pregnant individual who is being provided | ||||||
11 | prenatal services and is suspected
of having a substance use | ||||||
12 | disorder as defined in the Substance Use Disorder Act, | ||||||
13 | referral to a local substance use disorder treatment program | ||||||
14 | licensed by the Department of Human Services or to a licensed
| ||||||
15 | hospital which provides substance abuse treatment services. | ||||||
16 | The Department of Healthcare and Family Services
shall assure | ||||||
17 | coverage for the cost of treatment of the drug abuse or
| ||||||
18 | addiction for pregnant recipients in accordance with the | ||||||
19 | Illinois Medicaid
Program in conjunction with the Department | ||||||
20 | of Human Services.
| ||||||
21 | All medical providers providing medical assistance to | ||||||
22 | pregnant individuals
under this Code shall receive information | ||||||
23 | from the Department on the
availability of services under any
| ||||||
24 | program providing case management services for addicted | ||||||
25 | individuals,
including information on appropriate referrals | ||||||
26 | for other social services
that may be needed by addicted |
| |||||||
| |||||||
1 | individuals in addition to treatment for addiction.
| ||||||
2 | The Illinois Department, in cooperation with the | ||||||
3 | Departments of Human
Services (as successor to the Department | ||||||
4 | of Alcoholism and Substance
Abuse) and Public Health, through | ||||||
5 | a public awareness campaign, may
provide information | ||||||
6 | concerning treatment for alcoholism and drug abuse and
| ||||||
7 | addiction, prenatal health care, and other pertinent programs | ||||||
8 | directed at
reducing the number of drug-affected infants born | ||||||
9 | to recipients of medical
assistance.
| ||||||
10 | Neither the Department of Healthcare and Family Services | ||||||
11 | nor the Department of Human
Services shall sanction the | ||||||
12 | recipient solely on the basis of the recipient's
substance | ||||||
13 | abuse.
| ||||||
14 | The Illinois Department shall establish such regulations | ||||||
15 | governing
the dispensing of health services under this Article | ||||||
16 | as it shall deem
appropriate. The Department
should
seek the | ||||||
17 | advice of formal professional advisory committees appointed by
| ||||||
18 | the Director of the Illinois Department for the purpose of | ||||||
19 | providing regular
advice on policy and administrative matters, | ||||||
20 | information dissemination and
educational activities for | ||||||
21 | medical and health care providers, and
consistency in | ||||||
22 | procedures to the Illinois Department.
| ||||||
23 | The Illinois Department may develop and contract with | ||||||
24 | Partnerships of
medical providers to arrange medical services | ||||||
25 | for persons eligible under
Section 5-2 of this Code. | ||||||
26 | Implementation of this Section may be by
demonstration |
| |||||||
| |||||||
1 | projects in certain geographic areas. The Partnership shall
be | ||||||
2 | represented by a sponsor organization. The Department, by | ||||||
3 | rule, shall
develop qualifications for sponsors of | ||||||
4 | Partnerships. Nothing in this
Section shall be construed to | ||||||
5 | require that the sponsor organization be a
medical | ||||||
6 | 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 | ||||||
16 | the 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 | ||||||
20 | the Partnership may receive an additional surcharge
for | ||||||
21 | such 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
| ||||||
17 | provided services may be accessed from therapeutically | ||||||
18 | certified optometrists
to the full extent of the Illinois | ||||||
19 | Optometric Practice Act of 1987 without
discriminating between | ||||||
20 | service 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 |
| |||||||
| |||||||
1 | under this Article. Such records must be retained for a period | ||||||
2 | of not less than 6 years from the date of service or as | ||||||
3 | provided by applicable State law, whichever period is longer, | ||||||
4 | except that if an audit is initiated within the required | ||||||
5 | retention period then the records must be retained until the | ||||||
6 | audit is completed and every exception is resolved. The | ||||||
7 | Illinois Department shall
require health care providers to | ||||||
8 | make available, when authorized by the
patient, in writing, | ||||||
9 | the medical records in a timely fashion to other
health care | ||||||
10 | providers who are treating or serving persons eligible for
| ||||||
11 | Medical Assistance under this Article. All dispensers of | ||||||
12 | medical services
shall be required to maintain and retain | ||||||
13 | business and professional records
sufficient to fully and | ||||||
14 | accurately document the nature, scope, details and
receipt of | ||||||
15 | the health care provided to persons eligible for medical
| ||||||
16 | assistance under this Code, in accordance with regulations | ||||||
17 | promulgated by
the Illinois Department. The rules and | ||||||
18 | regulations shall require that proof
of the receipt of | ||||||
19 | prescription drugs, dentures, prosthetic devices and
| ||||||
20 | eyeglasses by eligible persons under this Section accompany | ||||||
21 | each claim
for reimbursement submitted by the dispenser of | ||||||
22 | such medical services.
No such claims for reimbursement shall | ||||||
23 | be approved for payment by the Illinois
Department without | ||||||
24 | such proof of receipt, unless the Illinois Department
shall | ||||||
25 | have put into effect and shall be operating a system of | ||||||
26 | post-payment
audit and review which shall, on a sampling |
| |||||||
| |||||||
1 | basis, be deemed adequate by
the Illinois Department to assure | ||||||
2 | that such drugs, dentures, prosthetic
devices and eyeglasses | ||||||
3 | for which payment is being made are actually being
received by | ||||||
4 | eligible recipients. Within 90 days after September 16, 1984 | ||||||
5 | (the effective date of Public Act 83-1439), the Illinois | ||||||
6 | Department shall establish a
current list of acquisition costs | ||||||
7 | for all prosthetic devices and any
other items recognized as | ||||||
8 | medical equipment and supplies reimbursable under
this Article | ||||||
9 | and shall update such list on a quarterly basis, except that
| ||||||
10 | the acquisition costs of all prescription drugs shall be | ||||||
11 | updated no
less frequently than every 30 days as required by | ||||||
12 | Section 5-5.12.
| ||||||
13 | Notwithstanding any other law to the contrary, the | ||||||
14 | Illinois Department shall, within 365 days after July 22, 2013 | ||||||
15 | (the effective date of Public Act 98-104), establish | ||||||
16 | procedures to permit skilled care facilities licensed under | ||||||
17 | the Nursing Home Care Act to submit monthly billing claims for | ||||||
18 | reimbursement purposes. Following development of these | ||||||
19 | procedures, the Department shall, by July 1, 2016, test the | ||||||
20 | viability of the new system and implement any necessary | ||||||
21 | operational or structural changes to its information | ||||||
22 | technology platforms in order to allow for the direct | ||||||
23 | acceptance and payment of nursing home claims. | ||||||
24 | Notwithstanding any other law to the contrary, the | ||||||
25 | Illinois Department shall, within 365 days after August 15, | ||||||
26 | 2014 (the effective date of Public Act 98-963), establish |
| |||||||
| |||||||
1 | procedures to permit ID/DD facilities licensed under the ID/DD | ||||||
2 | Community Care Act and MC/DD facilities licensed under the | ||||||
3 | MC/DD Act to submit monthly billing claims for reimbursement | ||||||
4 | purposes. Following development of these procedures, the | ||||||
5 | Department shall have an additional 365 days to test the | ||||||
6 | viability of the new system and to ensure that any necessary | ||||||
7 | operational or structural changes to its information | ||||||
8 | technology platforms are implemented. | ||||||
9 | The Illinois Department shall require all dispensers of | ||||||
10 | medical
services, other than an individual practitioner or | ||||||
11 | group of practitioners,
desiring to participate in the Medical | ||||||
12 | Assistance program
established under this Article to disclose | ||||||
13 | all financial, beneficial,
ownership, equity, surety or other | ||||||
14 | interests in any and all firms,
corporations, partnerships, | ||||||
15 | associations, business enterprises, joint
ventures, agencies, | ||||||
16 | institutions or other legal entities providing any
form of | ||||||
17 | health care services in this State under this Article.
| ||||||
18 | The Illinois Department may require that all dispensers of | ||||||
19 | medical
services desiring to participate in the medical | ||||||
20 | assistance program
established under this Article disclose, | ||||||
21 | under such terms and conditions as
the Illinois Department may | ||||||
22 | by rule establish, all inquiries from clients
and attorneys | ||||||
23 | regarding medical bills paid by the Illinois Department, which
| ||||||
24 | inquiries could indicate potential existence of claims or | ||||||
25 | liens for the
Illinois Department.
| ||||||
26 | Enrollment of a vendor
shall be
subject to a provisional |
| |||||||
| |||||||
1 | period and shall be conditional for one year. During the | ||||||
2 | period of conditional enrollment, the Department may
terminate | ||||||
3 | the vendor's eligibility to participate in, or may disenroll | ||||||
4 | the vendor from, the medical assistance
program without cause. | ||||||
5 | Unless otherwise specified, such termination of eligibility or | ||||||
6 | disenrollment is not subject to the
Department's hearing | ||||||
7 | process.
However, a disenrolled vendor may reapply without | ||||||
8 | penalty.
| ||||||
9 | The Department has the discretion to limit the conditional | ||||||
10 | enrollment period for vendors based upon category of risk of | ||||||
11 | the vendor. | ||||||
12 | Prior to enrollment and during the conditional enrollment | ||||||
13 | period in the medical assistance program, all vendors shall be | ||||||
14 | subject to enhanced oversight, screening, and review based on | ||||||
15 | the risk of fraud, waste, and abuse that is posed by the | ||||||
16 | category of risk of the vendor. The Illinois Department shall | ||||||
17 | establish the procedures for oversight, screening, and review, | ||||||
18 | which may include, but need not be limited to: criminal and | ||||||
19 | financial background checks; fingerprinting; license, | ||||||
20 | certification, and authorization verifications; unscheduled or | ||||||
21 | unannounced site visits; database checks; prepayment audit | ||||||
22 | reviews; audits; payment caps; payment suspensions; and other | ||||||
23 | screening as required by federal or State law. | ||||||
24 | The Department shall define or specify the following: (i) | ||||||
25 | by provider notice, the "category of risk of the vendor" for | ||||||
26 | each type of vendor, which shall take into account the level of |
| |||||||
| |||||||
1 | screening applicable to a particular category of vendor under | ||||||
2 | federal law and regulations; (ii) by rule or provider notice, | ||||||
3 | the maximum length of the conditional enrollment period for | ||||||
4 | each category of risk of the vendor; and (iii) by rule, the | ||||||
5 | hearing rights, if any, afforded to a vendor in each category | ||||||
6 | of risk of the vendor that is terminated or disenrolled during | ||||||
7 | the conditional enrollment period. | ||||||
8 | To be eligible for payment consideration, a vendor's | ||||||
9 | payment claim or bill, either as an initial claim or as a | ||||||
10 | resubmitted claim following prior rejection, must be received | ||||||
11 | by the Illinois Department, or its fiscal intermediary, no | ||||||
12 | later than 180 days after the latest date on the claim on which | ||||||
13 | medical goods or services were provided, with the following | ||||||
14 | exceptions: | ||||||
15 | (1) In the case of a provider whose enrollment is in | ||||||
16 | process by the Illinois Department, the 180-day period | ||||||
17 | shall not begin until the date on the written notice from | ||||||
18 | the Illinois Department that the provider enrollment is | ||||||
19 | complete. | ||||||
20 | (2) In the case of errors attributable to the Illinois | ||||||
21 | Department or any of its claims processing intermediaries | ||||||
22 | which result in an inability to receive, process, or | ||||||
23 | adjudicate a claim, the 180-day period shall not begin | ||||||
24 | until the provider has been notified of the error. | ||||||
25 | (3) In the case of a provider for whom the Illinois | ||||||
26 | Department initiates the monthly billing process. |
| |||||||
| |||||||
1 | (4) In the case of a provider operated by a unit of | ||||||
2 | local government with a population exceeding 3,000,000 | ||||||
3 | when local government funds finance federal participation | ||||||
4 | for claims payments. | ||||||
5 | For claims for services rendered during a period for which | ||||||
6 | a recipient received retroactive eligibility, claims must be | ||||||
7 | filed within 180 days after the Department determines the | ||||||
8 | applicant is eligible. For claims for which the Illinois | ||||||
9 | Department is not the primary payer, claims must be submitted | ||||||
10 | to the Illinois Department within 180 days after the final | ||||||
11 | adjudication by the primary payer. | ||||||
12 | In the case of long term care facilities, within 120 | ||||||
13 | calendar days of receipt by the facility of required | ||||||
14 | prescreening information, new admissions with associated | ||||||
15 | admission documents shall be submitted through the Medical | ||||||
16 | Electronic Data Interchange (MEDI) or the Recipient | ||||||
17 | Eligibility Verification (REV) System or shall be submitted | ||||||
18 | directly to the Department of Human Services using required | ||||||
19 | admission forms. Effective September
1, 2014, admission | ||||||
20 | documents, including all prescreening
information, must be | ||||||
21 | submitted through MEDI or REV. Confirmation numbers assigned | ||||||
22 | to an accepted transaction shall be retained by a facility to | ||||||
23 | verify timely submittal. Once an admission transaction has | ||||||
24 | been completed, all resubmitted claims following prior | ||||||
25 | rejection are subject to receipt no later than 180 days after | ||||||
26 | the admission transaction has been completed. |
| |||||||
| |||||||
1 | Claims that are not submitted and received in compliance | ||||||
2 | with the foregoing requirements shall not be eligible for | ||||||
3 | payment under the medical assistance program, and the State | ||||||
4 | shall have no liability for payment of those claims. | ||||||
5 | To the extent consistent with applicable information and | ||||||
6 | privacy, security, and disclosure laws, State and federal | ||||||
7 | agencies and departments shall provide the Illinois Department | ||||||
8 | access to confidential and other information and data | ||||||
9 | necessary to perform eligibility and payment verifications and | ||||||
10 | other Illinois Department functions. This includes, but is not | ||||||
11 | limited to: information pertaining to licensure; | ||||||
12 | certification; earnings; immigration status; citizenship; wage | ||||||
13 | reporting; unearned and earned income; pension income; | ||||||
14 | employment; supplemental security income; social security | ||||||
15 | numbers; National Provider Identifier (NPI) numbers; the | ||||||
16 | National Practitioner Data Bank (NPDB); program and agency | ||||||
17 | exclusions; taxpayer identification numbers; tax delinquency; | ||||||
18 | corporate information; and death records. | ||||||
19 | The Illinois Department shall enter into agreements with | ||||||
20 | State agencies and departments, and is authorized to enter | ||||||
21 | into agreements with federal agencies and departments, under | ||||||
22 | which such agencies and departments shall share data necessary | ||||||
23 | for medical assistance program integrity functions and | ||||||
24 | oversight. The Illinois Department shall develop, in | ||||||
25 | cooperation with other State departments and agencies, and in | ||||||
26 | compliance with applicable federal laws and regulations, |
| |||||||
| |||||||
1 | appropriate and effective methods to share such data. At a | ||||||
2 | minimum, and to the extent necessary to provide data sharing, | ||||||
3 | the Illinois Department shall enter into agreements with State | ||||||
4 | agencies and departments, and is authorized to enter into | ||||||
5 | agreements with federal agencies and departments, including, | ||||||
6 | but not limited to: the Secretary of State; the Department of | ||||||
7 | Revenue; the Department of Public Health; the Department of | ||||||
8 | Human Services; and the Department of Financial and | ||||||
9 | Professional Regulation. | ||||||
10 | Beginning in fiscal year 2013, the Illinois Department | ||||||
11 | shall set forth a request for information to identify the | ||||||
12 | benefits of a pre-payment, post-adjudication, and post-edit | ||||||
13 | claims system with the goals of streamlining claims processing | ||||||
14 | and provider reimbursement, reducing the number of pending or | ||||||
15 | rejected claims, and helping to ensure a more transparent | ||||||
16 | adjudication process through the utilization of: (i) provider | ||||||
17 | data verification and provider screening technology; and (ii) | ||||||
18 | clinical code editing; and (iii) pre-pay, pre- or | ||||||
19 | post-adjudicated predictive modeling with an integrated case | ||||||
20 | management system with link analysis. Such a request for | ||||||
21 | information shall not be considered as a request for proposal | ||||||
22 | or as an obligation on the part of the Illinois Department to | ||||||
23 | take any action or acquire any products or services. | ||||||
24 | The Illinois Department shall establish policies, | ||||||
25 | procedures,
standards and criteria by rule for the | ||||||
26 | acquisition, repair and replacement
of orthotic and prosthetic |
| |||||||
| |||||||
1 | devices and durable medical equipment. Such
rules shall | ||||||
2 | provide, but not be limited to, the following services: (1)
| ||||||
3 | immediate repair or replacement of such devices by recipients; | ||||||
4 | and (2) rental, lease, purchase or lease-purchase of
durable | ||||||
5 | medical equipment in a cost-effective manner, taking into
| ||||||
6 | consideration the recipient's medical prognosis, the extent of | ||||||
7 | the
recipient's needs, and the requirements and costs for | ||||||
8 | maintaining such
equipment. Subject to prior approval, such | ||||||
9 | rules shall enable a recipient to temporarily acquire and
use | ||||||
10 | alternative or substitute devices or equipment pending repairs | ||||||
11 | or
replacements of any device or equipment previously | ||||||
12 | authorized for such
recipient by the Department. | ||||||
13 | Notwithstanding any provision of Section 5-5f to the contrary, | ||||||
14 | the Department may, by rule, exempt certain replacement | ||||||
15 | wheelchair parts from prior approval and, for wheelchairs, | ||||||
16 | wheelchair parts, wheelchair accessories, and related seating | ||||||
17 | and positioning items, determine the wholesale price by | ||||||
18 | methods other than actual acquisition costs. | ||||||
19 | The Department shall require, by rule, all providers of | ||||||
20 | durable medical equipment to be accredited by an accreditation | ||||||
21 | organization approved by the federal Centers for Medicare and | ||||||
22 | Medicaid Services and recognized by the Department in order to | ||||||
23 | bill the Department for providing durable medical equipment to | ||||||
24 | recipients. No later than 15 months after the effective date | ||||||
25 | of the rule adopted pursuant to this paragraph, all providers | ||||||
26 | must meet the accreditation requirement.
|
| |||||||
| |||||||
1 | In order to promote environmental responsibility, meet the | ||||||
2 | needs of recipients and enrollees, and achieve significant | ||||||
3 | cost savings, the Department, or a managed care organization | ||||||
4 | under contract with the Department, may provide recipients or | ||||||
5 | managed care enrollees who have a prescription or Certificate | ||||||
6 | of Medical Necessity access to refurbished durable medical | ||||||
7 | equipment under this Section (excluding prosthetic and | ||||||
8 | orthotic devices as defined in the Orthotics, Prosthetics, and | ||||||
9 | Pedorthics Practice Act and complex rehabilitation technology | ||||||
10 | products and associated services) through the State's | ||||||
11 | assistive technology program's reutilization program, using | ||||||
12 | staff with the Assistive Technology Professional (ATP) | ||||||
13 | Certification if the refurbished durable medical equipment: | ||||||
14 | (i) is available; (ii) is less expensive, including shipping | ||||||
15 | costs, than new durable medical equipment of the same type; | ||||||
16 | (iii) is able to withstand at least 3 years of use; (iv) is | ||||||
17 | cleaned, disinfected, sterilized, and safe in accordance with | ||||||
18 | federal Food and Drug Administration regulations and guidance | ||||||
19 | governing the reprocessing of medical devices in health care | ||||||
20 | settings; and (v) equally meets the needs of the recipient or | ||||||
21 | enrollee. The reutilization program shall confirm that the | ||||||
22 | recipient or enrollee is not already in receipt of the same or | ||||||
23 | similar equipment from another service provider, and that the | ||||||
24 | refurbished durable medical equipment equally meets the needs | ||||||
25 | of the recipient or enrollee. Nothing in this paragraph shall | ||||||
26 | be construed to limit recipient or enrollee choice to obtain |
| |||||||
| |||||||
1 | new durable medical equipment or place any additional prior | ||||||
2 | authorization conditions on enrollees of managed care | ||||||
3 | organizations. | ||||||
4 | The Department shall execute, relative to the nursing home | ||||||
5 | prescreening
project, written inter-agency agreements with the | ||||||
6 | Department of Human
Services and the Department on Aging, to | ||||||
7 | effect the following: (i) intake
procedures and common | ||||||
8 | eligibility criteria for those persons who are receiving
| ||||||
9 | non-institutional services; and (ii) the establishment and | ||||||
10 | development of
non-institutional services in areas of the | ||||||
11 | State where they are not currently
available or are | ||||||
12 | undeveloped; and (iii) notwithstanding any other provision of | ||||||
13 | law, subject to federal approval, on and after July 1, 2012, an | ||||||
14 | increase in the determination of need (DON) scores from 29 to | ||||||
15 | 37 for applicants for institutional and home and | ||||||
16 | community-based long term care; if and only if federal | ||||||
17 | approval is not granted, the Department may, in conjunction | ||||||
18 | with other affected agencies, implement utilization controls | ||||||
19 | or changes in benefit packages to effectuate a similar savings | ||||||
20 | amount for this population; and (iv) no later than July 1, | ||||||
21 | 2013, minimum level of care eligibility criteria for | ||||||
22 | institutional and home and community-based long term care; and | ||||||
23 | (v) no later than October 1, 2013, establish procedures to | ||||||
24 | permit long term care providers access to eligibility scores | ||||||
25 | for individuals with an admission date who are seeking or | ||||||
26 | receiving services from the long term care provider. In order |
| |||||||
| |||||||
1 | to select the minimum level of care eligibility criteria, the | ||||||
2 | Governor shall establish a workgroup that includes affected | ||||||
3 | agency representatives and stakeholders representing the | ||||||
4 | institutional and home and community-based long term care | ||||||
5 | interests. This Section shall not restrict the Department from | ||||||
6 | implementing lower level of care eligibility criteria for | ||||||
7 | community-based services in circumstances where federal | ||||||
8 | approval has been granted.
| ||||||
9 | The Illinois Department shall develop and operate, in | ||||||
10 | cooperation
with other State Departments and agencies and in | ||||||
11 | compliance with
applicable federal laws and regulations, | ||||||
12 | appropriate and effective
systems of health care evaluation | ||||||
13 | and programs for monitoring of
utilization of health care | ||||||
14 | services and facilities, as it affects
persons eligible for | ||||||
15 | medical assistance under this Code.
| ||||||
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 of | ||||||
22 | 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; and
| ||||||
25 | (d) efforts at utilization review and control by the | ||||||
26 | Illinois Department.
|
| |||||||
| |||||||
1 | The period covered by each report shall be the 3 years | ||||||
2 | ending on the June
30 prior to the report. The report shall | ||||||
3 | include suggested legislation
for consideration by the General | ||||||
4 | Assembly. The requirement for reporting to the General | ||||||
5 | Assembly shall be satisfied
by filing copies of the report as | ||||||
6 | required by Section 3.1 of the General Assembly Organization | ||||||
7 | Act, and filing 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.
| ||||||
11 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
12 | any, is conditioned on the rules being adopted in accordance | ||||||
13 | with all provisions of the Illinois Administrative Procedure | ||||||
14 | Act and all rules and procedures of the Joint Committee on | ||||||
15 | Administrative Rules; any purported rule not so adopted, for | ||||||
16 | whatever reason, is unauthorized. | ||||||
17 | On and after July 1, 2012, the Department shall reduce any | ||||||
18 | rate of reimbursement for services or other payments or alter | ||||||
19 | any methodologies authorized by this Code to reduce any rate | ||||||
20 | of reimbursement for services or other payments in accordance | ||||||
21 | with Section 5-5e. | ||||||
22 | Because kidney transplantation can be an appropriate, | ||||||
23 | cost-effective
alternative to renal dialysis when medically | ||||||
24 | necessary and notwithstanding the provisions of Section 1-11 | ||||||
25 | of this Code, beginning October 1, 2014, the Department shall | ||||||
26 | cover kidney transplantation for noncitizens with end-stage |
| |||||||
| |||||||
1 | renal disease who are not eligible for comprehensive medical | ||||||
2 | benefits, who meet the residency requirements of Section 5-3 | ||||||
3 | of this Code, and who would otherwise meet the financial | ||||||
4 | requirements of the appropriate class of eligible persons | ||||||
5 | under Section 5-2 of this Code. To qualify for coverage of | ||||||
6 | kidney transplantation, such person must be receiving | ||||||
7 | emergency renal dialysis services covered by the Department. | ||||||
8 | Providers under this Section shall be prior approved and | ||||||
9 | certified by the Department to perform kidney transplantation | ||||||
10 | and the services under this Section shall be limited to | ||||||
11 | services associated with kidney transplantation. | ||||||
12 | Notwithstanding any other provision of this Code to the | ||||||
13 | contrary, on or after July 1, 2015, all FDA approved forms of | ||||||
14 | medication assisted treatment prescribed for the treatment of | ||||||
15 | alcohol dependence or treatment of opioid dependence shall be | ||||||
16 | covered under both fee for service and managed care medical | ||||||
17 | assistance programs for persons who are otherwise eligible for | ||||||
18 | medical assistance under this Article and shall not be subject | ||||||
19 | to any (1) utilization control, other than those established | ||||||
20 | under the American Society of Addiction Medicine patient | ||||||
21 | placement criteria,
(2) prior authorization mandate, or (3) | ||||||
22 | lifetime restriction limit
mandate. | ||||||
23 | On or after July 1, 2015, opioid antagonists prescribed | ||||||
24 | for the treatment of an opioid overdose, including the | ||||||
25 | medication product, administration devices, and any pharmacy | ||||||
26 | fees or hospital fees related to the dispensing, distribution, |
| |||||||
| |||||||
1 | and administration of the opioid antagonist, shall be covered | ||||||
2 | under the medical assistance program for persons who are | ||||||
3 | otherwise eligible for medical assistance under this Article. | ||||||
4 | As used in this Section, "opioid antagonist" means a drug that | ||||||
5 | binds to opioid receptors and blocks or inhibits the effect of | ||||||
6 | opioids acting on those receptors, including, but not limited | ||||||
7 | to, naloxone hydrochloride or any other similarly acting drug | ||||||
8 | approved by the U.S. Food and Drug Administration. The | ||||||
9 | Department shall not impose a copayment on the coverage | ||||||
10 | provided for naloxone hydrochloride under the medical | ||||||
11 | assistance program. | ||||||
12 | Upon federal approval, the Department shall provide | ||||||
13 | coverage and reimbursement for all drugs that are approved for | ||||||
14 | marketing by the federal Food and Drug Administration and that | ||||||
15 | are recommended by the federal Public Health Service or the | ||||||
16 | United States Centers for Disease Control and Prevention for | ||||||
17 | pre-exposure prophylaxis and related pre-exposure prophylaxis | ||||||
18 | services, including, but not limited to, HIV and sexually | ||||||
19 | transmitted infection screening, treatment for sexually | ||||||
20 | transmitted infections, medical monitoring, assorted labs, and | ||||||
21 | counseling to reduce the likelihood of HIV infection among | ||||||
22 | individuals who are not infected with HIV but who are at high | ||||||
23 | risk of HIV infection. | ||||||
24 | A federally qualified health center, as defined in Section | ||||||
25 | 1905(l)(2)(B) of the federal
Social Security Act, shall be | ||||||
26 | reimbursed by the Department in accordance with the federally |
| |||||||
| |||||||
1 | qualified health center's encounter rate for services provided | ||||||
2 | to medical assistance recipients that are performed by a | ||||||
3 | dental hygienist, as defined under the Illinois Dental | ||||||
4 | Practice Act, working under the general supervision of a | ||||||
5 | dentist and employed by a federally qualified health center. | ||||||
6 | Within 90 days after October 8, 2021 (the effective date | ||||||
7 | of Public Act 102-665), the Department shall seek federal | ||||||
8 | approval of a State Plan amendment to expand coverage for | ||||||
9 | family planning services that includes presumptive eligibility | ||||||
10 | to individuals whose income is at or below 208% of the federal | ||||||
11 | poverty level. Coverage under this Section shall be effective | ||||||
12 | beginning no later than December 1, 2022. | ||||||
13 | Subject to approval by the federal Centers for Medicare | ||||||
14 | and Medicaid Services of a Title XIX State Plan amendment | ||||||
15 | electing the Program of All-Inclusive Care for the Elderly | ||||||
16 | (PACE) as a State Medicaid option, as provided for by Subtitle | ||||||
17 | I (commencing with Section 4801) of Title IV of the Balanced | ||||||
18 | Budget Act of 1997 (Public Law 105-33) and Part 460 | ||||||
19 | (commencing with Section 460.2) of Subchapter E of Title 42 of | ||||||
20 | the Code of Federal Regulations, PACE program services shall | ||||||
21 | become a covered benefit of the medical assistance program, | ||||||
22 | subject to criteria established in accordance with all | ||||||
23 | applicable laws. | ||||||
24 | Notwithstanding any other provision of this Code, | ||||||
25 | community-based pediatric palliative care from a trained | ||||||
26 | interdisciplinary team shall be covered under the medical |
| |||||||
| |||||||
1 | assistance program as provided in Section 15 of the Pediatric | ||||||
2 | Palliative
Care Act. | ||||||
3 | Notwithstanding any other provision of this Code, within | ||||||
4 | 12 months after June 2, 2022 ( the effective date of Public Act | ||||||
5 | 102-1037) this amendatory Act of the 102nd General Assembly | ||||||
6 | and subject to federal approval, acupuncture services | ||||||
7 | performed by an acupuncturist licensed under the Acupuncture | ||||||
8 | Practice Act who is acting within the scope of his or her | ||||||
9 | license shall be covered under the medical assistance program. | ||||||
10 | The Department shall apply for any federal waiver or State | ||||||
11 | Plan amendment, if required, to implement this paragraph. The | ||||||
12 | Department may adopt any rules, including standards and | ||||||
13 | criteria, necessary to implement this paragraph. | ||||||
14 | Notwithstanding any other provision of this Code, the | ||||||
15 | Department shall provide coverage and reimbursement for | ||||||
16 | prescription management services provided by prescribing | ||||||
17 | psychologists for persons who are otherwise eligible for | ||||||
18 | medical assistance under this Article. | ||||||
19 | (Source: P.A. 101-209, eff. 8-5-19; 101-580, eff. 1-1-20; | ||||||
20 | 102-43, Article 30, Section 30-5, eff. 7-6-21; 102-43, Article | ||||||
21 | 35, Section 35-5, eff. 7-6-21; 102-43, Article 55, Section | ||||||
22 | 55-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123, eff. 1-1-22; | ||||||
23 | 102-558, eff. 8-20-21; 102-598, eff. 1-1-22; 102-655, eff. | ||||||
24 | 1-1-22; 102-665, eff. 10-8-21; 102-813, eff. 5-13-22; | ||||||
25 | 102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22; 102-1038 eff. | ||||||
26 | 1-1-23; revised 12-14-22.) |
| |||||||
| |||||||
1 | Section 15. The Illinois Controlled Substances Act is | ||||||
2 | amended by changing Section 303.05 as follows:
| ||||||
3 | (720 ILCS 570/303.05)
| ||||||
4 | Sec. 303.05. Mid-level practitioner registration.
| ||||||
5 | (a) The Department of Financial and Professional | ||||||
6 | Regulation shall register licensed
physician assistants, | ||||||
7 | licensed advanced practice registered nurses, and prescribing | ||||||
8 | psychologists licensed under Section 4.2 of the Clinical | ||||||
9 | Psychologist Licensing Act to prescribe and
dispense | ||||||
10 | controlled substances under Section 303 and euthanasia
| ||||||
11 | agencies to purchase, store, or administer animal euthanasia | ||||||
12 | drugs under the
following circumstances:
| ||||||
13 | (1) with respect to physician assistants,
| ||||||
14 | (A) the physician assistant has been
delegated
| ||||||
15 | written authority to prescribe any Schedule III | ||||||
16 | through V controlled substances by a physician | ||||||
17 | licensed to practice medicine in all its
branches in | ||||||
18 | accordance with Section 7.5 of the Physician Assistant | ||||||
19 | Practice Act
of 1987;
and
the physician assistant has
| ||||||
20 | completed the
appropriate application forms and has | ||||||
21 | paid the required fees as set by rule;
or
| ||||||
22 | (B) the physician assistant has been delegated
| ||||||
23 | authority by a collaborating physician licensed to | ||||||
24 | practice medicine in all its branches to prescribe or |
| |||||||
| |||||||
1 | dispense Schedule II controlled substances through a | ||||||
2 | written delegation of authority and under the | ||||||
3 | following conditions: | ||||||
4 | (i) Specific Schedule II controlled substances | ||||||
5 | by oral dosage or topical or transdermal | ||||||
6 | application may be delegated, provided that the | ||||||
7 | delegated Schedule II controlled substances are | ||||||
8 | routinely prescribed by the collaborating | ||||||
9 | physician. This delegation must identify the | ||||||
10 | specific Schedule II controlled substances by | ||||||
11 | either brand name or generic name. Schedule II | ||||||
12 | controlled substances to be delivered by injection | ||||||
13 | or other route of administration may not be | ||||||
14 | delegated; | ||||||
15 | (ii) any delegation must be of controlled | ||||||
16 | substances prescribed by the collaborating | ||||||
17 | physician; | ||||||
18 | (iii) all prescriptions must be limited to no | ||||||
19 | more than a 30-day supply, with any continuation | ||||||
20 | authorized only after prior approval of the | ||||||
21 | collaborating physician; | ||||||
22 | (iv) the physician assistant must discuss the | ||||||
23 | condition of any patients for whom a controlled | ||||||
24 | substance is prescribed monthly with the | ||||||
25 | delegating physician; | ||||||
26 | (v) the physician assistant must have |
| |||||||
| |||||||
1 | completed the appropriate application forms and | ||||||
2 | paid the required fees as set by rule; | ||||||
3 | (vi) the physician assistant must provide | ||||||
4 | evidence of satisfactory completion of 45 contact | ||||||
5 | hours in pharmacology from any physician assistant | ||||||
6 | program accredited by the Accreditation Review | ||||||
7 | Commission on Education for the Physician | ||||||
8 | Assistant (ARC-PA), or its predecessor agency, for | ||||||
9 | any new license issued with Schedule II authority | ||||||
10 | after the effective date of this amendatory Act of | ||||||
11 | the 97th General Assembly; and | ||||||
12 | (vii) the physician assistant must annually | ||||||
13 | complete at least 5 hours of continuing education | ||||||
14 | in pharmacology; | ||||||
15 | (2) with respect to advanced practice registered | ||||||
16 | nurses who do not meet the requirements of Section 65-43 | ||||||
17 | of the Nurse Practice Act, | ||||||
18 | (A) the advanced practice registered nurse has | ||||||
19 | been delegated
authority to prescribe any Schedule III | ||||||
20 | through V controlled substances by a collaborating | ||||||
21 | physician licensed to practice medicine in all its | ||||||
22 | branches or a collaborating podiatric physician in | ||||||
23 | accordance with Section 65-40 of the Nurse Practice
| ||||||
24 | Act. The advanced practice registered nurse has | ||||||
25 | completed the
appropriate application forms and has | ||||||
26 | paid the required
fees as set by rule; or |
| |||||||
| |||||||
1 | (B) the advanced practice registered nurse has | ||||||
2 | been delegated
authority by a collaborating physician | ||||||
3 | licensed to practice medicine in all its branches to | ||||||
4 | prescribe or dispense Schedule II controlled | ||||||
5 | substances through a written delegation of authority | ||||||
6 | and under the following conditions: | ||||||
7 | (i) specific Schedule II controlled substances | ||||||
8 | by oral dosage or topical or transdermal | ||||||
9 | application may be delegated, provided that the | ||||||
10 | delegated Schedule II controlled substances are | ||||||
11 | routinely prescribed by the collaborating | ||||||
12 | physician. This delegation must identify the | ||||||
13 | specific Schedule II controlled substances by | ||||||
14 | either brand name or generic name. Schedule II | ||||||
15 | controlled substances to be delivered by injection | ||||||
16 | or other route of administration may not be | ||||||
17 | delegated; | ||||||
18 | (ii) any delegation must be of controlled | ||||||
19 | substances prescribed by the collaborating | ||||||
20 | physician; | ||||||
21 | (iii) all prescriptions must be limited to no | ||||||
22 | more than a 30-day supply, with any continuation | ||||||
23 | authorized only after prior approval of the | ||||||
24 | collaborating physician; | ||||||
25 | (iv) the advanced practice registered nurse | ||||||
26 | must discuss the condition of any patients for |
| |||||||
| |||||||
1 | whom a controlled substance is prescribed monthly | ||||||
2 | with the delegating physician or in the course of | ||||||
3 | review as required by Section 65-40 of the Nurse | ||||||
4 | Practice Act; | ||||||
5 | (v) the advanced practice registered nurse | ||||||
6 | must have completed the appropriate application | ||||||
7 | forms and paid the required fees as set by rule; | ||||||
8 | (vi) the advanced practice registered nurse | ||||||
9 | must provide evidence of satisfactory completion | ||||||
10 | of at least 45 graduate contact hours in | ||||||
11 | pharmacology for any new license issued with | ||||||
12 | Schedule II authority after the effective date of | ||||||
13 | this amendatory Act of the 97th General Assembly; | ||||||
14 | and | ||||||
15 | (vii) the advanced practice registered nurse | ||||||
16 | must annually complete 5 hours of continuing | ||||||
17 | education in pharmacology; | ||||||
18 | (2.5) with respect to advanced practice registered | ||||||
19 | nurses certified as nurse practitioners, nurse midwives, | ||||||
20 | or clinical nurse specialists who do not meet the | ||||||
21 | requirements of Section 65-43 of the Nurse Practice Act | ||||||
22 | practicing in a hospital affiliate, | ||||||
23 | (A) the advanced practice registered nurse | ||||||
24 | certified as a nurse practitioner, nurse midwife, or | ||||||
25 | clinical nurse specialist has been privileged to | ||||||
26 | prescribe any Schedule II through V controlled |
| |||||||
| |||||||
1 | substances by the hospital affiliate upon the | ||||||
2 | recommendation of the appropriate physician committee | ||||||
3 | of the hospital affiliate in accordance with Section | ||||||
4 | 65-45 of the Nurse Practice Act, has completed the | ||||||
5 | appropriate application forms, and has paid the | ||||||
6 | required fees as set by rule; and | ||||||
7 | (B) an advanced practice registered nurse | ||||||
8 | certified as a nurse practitioner, nurse midwife, or | ||||||
9 | clinical nurse specialist has been privileged to | ||||||
10 | prescribe any Schedule II controlled substances by the | ||||||
11 | hospital affiliate upon the recommendation of the | ||||||
12 | appropriate physician committee of the hospital | ||||||
13 | affiliate, then the following conditions must be met: | ||||||
14 | (i) specific Schedule II controlled substances | ||||||
15 | by oral dosage or topical or transdermal | ||||||
16 | application may be designated, provided that the | ||||||
17 | designated Schedule II controlled substances are | ||||||
18 | routinely prescribed by advanced practice | ||||||
19 | registered nurses in their area of certification; | ||||||
20 | the privileging documents must identify the | ||||||
21 | specific Schedule II controlled substances by | ||||||
22 | either brand name or generic name; privileges to | ||||||
23 | prescribe or dispense Schedule II controlled | ||||||
24 | substances to be delivered by injection or other | ||||||
25 | route of administration may not be granted; | ||||||
26 | (ii) any privileges must be controlled |
| |||||||
| |||||||
1 | substances limited to the practice of the advanced | ||||||
2 | practice registered nurse; | ||||||
3 | (iii) any prescription must be limited to no | ||||||
4 | more than a 30-day supply; | ||||||
5 | (iv) the advanced practice registered nurse | ||||||
6 | must discuss the condition of any patients for | ||||||
7 | whom a controlled substance is prescribed monthly | ||||||
8 | with the appropriate physician committee of the | ||||||
9 | hospital affiliate or its physician designee; and | ||||||
10 | (v) the advanced practice registered nurse | ||||||
11 | must meet the education requirements of this | ||||||
12 | Section; | ||||||
13 | (3) with respect to animal euthanasia agencies, the | ||||||
14 | euthanasia agency has
obtained a license from the | ||||||
15 | Department of
Financial and Professional Regulation and | ||||||
16 | obtained a registration number from the
Department; or
| ||||||
17 | (4) with respect to prescribing psychologists, the | ||||||
18 | prescribing psychologist has been delegated
authority to | ||||||
19 | prescribe any nonnarcotic , nonopioid Schedule II III | ||||||
20 | through V controlled substances by a collaborating | ||||||
21 | physician licensed to practice medicine in all its | ||||||
22 | branches in accordance with Section 4.3 of the Clinical | ||||||
23 | Psychologist Licensing Act, and the prescribing | ||||||
24 | psychologist has completed the
appropriate application | ||||||
25 | forms and has paid the required
fees as set by rule. | ||||||
26 | (b) The mid-level practitioner shall only be licensed to |
| |||||||
| |||||||
1 | prescribe those
schedules of controlled substances for which a | ||||||
2 | licensed physician has delegated
prescriptive authority, | ||||||
3 | except that an animal euthanasia agency does not have any
| ||||||
4 | prescriptive authority.
A physician assistant and an advanced | ||||||
5 | practice registered nurse are prohibited from prescribing | ||||||
6 | medications and controlled substances not set forth in the | ||||||
7 | required written delegation of authority or as authorized by | ||||||
8 | their practice Act.
| ||||||
9 | (c) Upon completion of all registration requirements, | ||||||
10 | physician
assistants, advanced practice registered nurses, and | ||||||
11 | animal euthanasia agencies may be issued a
mid-level | ||||||
12 | practitioner
controlled substances license for Illinois.
| ||||||
13 | (d) A collaborating physician may, but is not required to, | ||||||
14 | delegate prescriptive authority to an advanced practice | ||||||
15 | registered nurse as part of a written collaborative agreement, | ||||||
16 | and the delegation of prescriptive authority shall conform to | ||||||
17 | the requirements of Section 65-40 of the Nurse Practice Act. | ||||||
18 | (e) A collaborating physician may, but is not required to, | ||||||
19 | delegate prescriptive authority to a physician assistant as | ||||||
20 | part of a written collaborative agreement, and the delegation | ||||||
21 | of prescriptive authority shall conform to the requirements of | ||||||
22 | Section 7.5 of the Physician Assistant Practice Act of 1987. | ||||||
23 | (f) Nothing in this Section shall be construed to prohibit | ||||||
24 | generic substitution. | ||||||
25 | (Source: P.A. 99-173, eff. 7-29-15; 100-453, eff. 8-25-17; | ||||||
26 | 100-513, eff. 1-1-18; 100-863, eff. 8-14-18.)
|
| |||||||
| |||||||
1 | Section 99. Effective date. This Act takes effect upon | ||||||
2 | becoming law. |