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1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Alcoholism and Other Drug Abuse and
5Dependency Act is amended by changing Section 1-10 as follows:
6    (20 ILCS 301/1-10)
7    Sec. 1-10. Definitions. As used in this Act, unless the
8context clearly indicates otherwise, the following words and
9terms have the following meanings:
10    "Act" means the Alcoholism and Other Drug Abuse and
11Dependency Act.
12    "Addict" means a person who exhibits the disease known as
14    "Addiction" means a disease process characterized by the
15continued use of a specific psycho-active substance despite
16physical, psychological or social harm. The term also describes
17the advanced stages of chemical dependency.
18    "Administrator" means a person responsible for
19administration of a program.
20    "Alcoholic" means a person who exhibits the disease known
21as "alcoholism".
22    "Alcoholism" means a chronic and progressive disease or
23illness characterized by preoccupation with and loss of control



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1over the consumption of alcohol, and the use of alcohol despite
2adverse consequences. Typically, combinations of the following
3tendencies are also present: periodic or chronic intoxication;
4physical disability; impaired emotional, occupational or
5social adjustment; tendency toward relapse; a detrimental
6effect on the individual, his family and society; psychological
7dependence; and physical dependence. Alcoholism is also known
8as addiction to alcohol. Alcoholism is described and further
9categorized in clinical detail in the DSM and the ICD.
10    "Array of services" means assistance to individuals,
11families and communities in response to alcohol or other drug
12abuse or dependency. The array of services includes, but is not
13limited to: prevention assistance for communities and schools;
14case finding, assessment and intervention to help individuals
15stop abusing alcohol or other drugs; a uniform screening,
16assessment, and evaluation process including criteria for
17substance use disorders and mental disorders or co-occurring
18substance use and mental health disorders; case management;
19detoxification to aid individuals in physically withdrawing
20from alcohol or other drugs; short-term and long-term treatment
21and support services to help individuals and family members
22begin the process of recovery; prescription and dispensing of
23the drug methadone or other medications as an adjunct to
24treatment; relapse prevention services; education and
25counseling for children or other co-dependents of alcoholics or
26other drug abusers or addicts. For purposes of this Section, a



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1uniform screening, assessment, and evaluation process refers
2to a process that includes an appropriate evaluation and, as
3warranted, a referral. "Uniform" does not mean the use of a
4singular instrument, tool, or process that all must utilize.
5    "Case management" means those services which will assist
6individuals in gaining access to needed social, educational,
7medical, treatment and other services.
8    "Children of alcoholics or drug addicts or abusers of
9alcohol and other drugs" means the minor or adult children of
10individuals who have abused or been dependent upon alcohol or
11other drugs. These children may or may not become dependent
12upon alcohol or other drugs themselves; however, they are
13physically, psychologically, and behaviorally at high risk of
14developing the illness. Children of alcoholics and other drug
15abusers experience emotional and other problems, and benefit
16from prevention and treatment services provided by funded and
17non-funded agencies licensed by the Department.
18    "Co-dependents" means individuals who are involved in the
19lives of and are affected by people who are dependent upon
20alcohol and other drugs. Co-dependents compulsively engage in
21behaviors that cause them to suffer adverse physical,
22emotional, familial, social, behavioral, vocational, and legal
23consequences as they attempt to cope with the alcohol or drug
24dependent person. People who become co-dependents include
25spouses, parents, siblings, and friends of alcohol or drug
26dependent people. Co-dependents benefit from prevention and



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1treatment services provided by agencies licensed by the
3    "Controlled substance" means any substance or immediate
4precursor which is enumerated in the schedules of Article II of
5the Illinois Controlled Substances Act or the Cannabis Control
7    "Crime of violence" means any of the following crimes:
8murder, voluntary manslaughter, criminal sexual assault,
9aggravated criminal sexual assault, predatory criminal sexual
10assault of a child, armed robbery, robbery, arson, kidnapping,
11aggravated battery, aggravated arson, or any other felony which
12involves the use or threat of physical force or violence
13against another individual.
14    "Department" means the Illinois Department of Human
15Services as successor to the former Department of Alcoholism
16and Substance Abuse.
17    "Designated program" means a program designated by the
18Department to provide services described in subsection (c) or
19(d) of Section 15-10 of this Act. A designated program's
20primary function is screening, assessing, referring and
21tracking clients identified by the criminal justice system, and
22the program agrees to apply statewide the standards, uniform
23criteria and procedures established by the Department pursuant
24to such designation.
25    "Detoxification" means the process of allowing an
26individual to safely withdraw from a drug in a controlled



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2    "DSM" means the most current edition of the Diagnostic and
3Statistical Manual of Mental Disorders.
4    "D.U.I." means driving under the influence of alcohol or
5other substances which may cause impairment of driving ability.
6    "Facility" means the building or premises which are used
7for the provision of licensable program services, including
8support services, as set forth by rule.
9    "ICD" means the most current edition of the International
10Classification of Diseases.
11    "Incapacitated" means that a person is unconscious or
12otherwise exhibits, by overt behavior or by extreme physical
13debilitation, an inability to care for his own needs or to
14recognize the obvious danger of his situation or to make
15rational decisions with respect to his need for treatment.
16    "Intermediary person" means a person with expertise
17relative to addiction, alcoholism, and the abuse of alcohol or
18other drugs who may be called on to assist the police in
19carrying out enforcement or other activities with respect to
20persons who abuse or are dependent on alcohol or other drugs.
21    "Intervention" means readily accessible activities which
22assist individuals and their partners or family members in
23coping with the immediate problems of alcohol and other drug
24abuse or dependency, and in reducing their alcohol and other
25drug use. Intervention can facilitate emotional and social
26stability, and involves referring people for further treatment



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1as needed.
2    "Intoxicated person" means a person whose mental or
3physical functioning is substantially impaired as a result of
4the current effects of alcohol or other drugs within the body.
5    "Local advisory council" means an alcohol and substance
6abuse body established in a county, township or community area,
7which represents public and private entities having an interest
8in the prevention and treatment of alcoholism or other drug
10    "Off-site services" means licensable program services or
11activities which are conducted at a location separate from the
12primary service location of the provider, and which services
13are operated by a program or entity licensed under this Act.
14    "Person" means any individual, firm, group, association,
15partnership, corporation, trust, government or governmental
16subdivision or agency.
17    "Prevention" means an interactive process of individuals,
18families, schools, religious organizations, communities and
19regional, state and national organizations to reduce
20alcoholism, prevent the use of illegal drugs and the abuse of
21legal drugs by persons of all ages, prevent the use of alcohol
22by minors, build the capacities of individuals and systems, and
23promote healthy environments, lifestyles and behaviors.
24    "Program" means a licensable or fundable activity or
25service, or a coordinated range of such activities or services,
26as the Department may establish by rule.



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1    "Recovery" means the long-term, often life-long, process
2in which an addicted person changes the way in which he makes
3decisions and establishes personal and life priorities. The
4evolution of this decision-making and priority-setting process
5is generally manifested by an obvious improvement in the
6individual's life and lifestyle and by his overcoming the abuse
7of or dependence on alcohol or other drugs. Recovery is also
8generally manifested by prolonged periods of abstinence from
9addictive chemicals which are not medically supervised.
10Recovery is the goal of treatment.
11    "Rehabilitation" means a process whereby those clinical
12services necessary and appropriate for improving an
13individual's life and lifestyle and for overcoming his or her
14abuse of or dependency upon alcohol or other drugs, or both,
15are delivered in an appropriate setting and manner as defined
16in rules established by the Department.
17    "Relapse" means a process which is manifested by a
18progressive pattern of behavior that reactivates the symptoms
19of a disease or creates debilitating conditions in an
20individual who has experienced remission from addiction or
22    "Secretary" means the Secretary of Human Services or his or
23her designee.
24    "Substance abuse" or "abuse" means a pattern of use of
25alcohol or other drugs with the potential of leading to
26immediate functional problems or to alcoholism or other drug



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1dependency, or to the use of alcohol and/or other drugs solely
2for purposes of intoxication. The term also means the use of
3illegal drugs by persons of any age, and the use of alcohol by
4persons under the age of 21.
5    "Treatment" means the broad range of emergency,
6outpatient, intermediate and residential services and care
7(including assessment, diagnosis, medical, psychiatric,
8psychological and social services, care and counseling, and
9aftercare) which may be extended to individuals who abuse or
10are dependent on alcohol or other drugs or families of those
12(Source: P.A. 89-202, eff. 7-21-95; 89-428, eff. 12-13-95;
1389-462, eff. 5-29-96; 89-507, eff. 7-1-97; 90-14, eff. 7-1-97;
1490-135, eff. 7-22-97.)
15    Section 8. The Illinois Public Aid Code is amended by
16changing Section 5-5 as follows:
17    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
18    Sec. 5-5. Medical services. The Illinois Department, by
19rule, shall determine the quantity and quality of and the rate
20of reimbursement for the medical assistance for which payment
21will be authorized, and the medical services to be provided,
22which may include all or part of the following: (1) inpatient
23hospital services; (2) outpatient hospital services; (3) other
24laboratory and X-ray services; (4) skilled nursing home



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1services; (5) physicians' services whether furnished in the
2office, the patient's home, a hospital, a skilled nursing home,
3or elsewhere; (6) medical care, or any other type of remedial
4care furnished by licensed practitioners; (7) home health care
5services; (8) private duty nursing service; (9) clinic
6services; (10) dental services, including prevention and
7treatment of periodontal disease and dental caries disease for
8pregnant women, provided by an individual licensed to practice
9dentistry or dental surgery; for purposes of this item (10),
10"dental services" means diagnostic, preventive, or corrective
11procedures provided by or under the supervision of a dentist in
12the practice of his or her profession; (11) physical therapy
13and related services; (12) prescribed drugs, dentures, and
14prosthetic devices; and eyeglasses prescribed by a physician
15skilled in the diseases of the eye, or by an optometrist,
16whichever the person may select; (13) other diagnostic,
17screening, preventive, and rehabilitative services, including
18to ensure that the individual's need for intervention or
19treatment of mental disorders or substance use disorders or
20co-occurring mental health and substance use disorders is
21determined using a uniform screening, assessment, and
22evaluation process inclusive of criteria, for children and
23adults; for purposes of this item (13), a uniform screening,
24assessment, and evaluation process refers to a process that
25includes an appropriate evaluation and, as warranted, a
26referral; "uniform" does not mean the use of a singular



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1instrument, tool, or process that all must utilize; (14)
2transportation and such other expenses as may be necessary;
3(15) medical treatment of sexual assault survivors, as defined
4in Section 1a of the Sexual Assault Survivors Emergency
5Treatment Act, for injuries sustained as a result of the sexual
6assault, including examinations and laboratory tests to
7discover evidence which may be used in criminal proceedings
8arising from the sexual assault; (16) the diagnosis and
9treatment of sickle cell anemia; and (17) any other medical
10care, and any other type of remedial care recognized under the
11laws of this State, but not including abortions, or induced
12miscarriages or premature births, unless, in the opinion of a
13physician, such procedures are necessary for the preservation
14of the life of the woman seeking such treatment, or except an
15induced premature birth intended to produce a live viable child
16and such procedure is necessary for the health of the mother or
17her unborn child. The Illinois Department, by rule, shall
18prohibit any physician from providing medical assistance to
19anyone eligible therefor under this Code where such physician
20has been found guilty of performing an abortion procedure in a
21wilful and wanton manner upon a woman who was not pregnant at
22the time such abortion procedure was performed. The term "any
23other type of remedial care" shall include nursing care and
24nursing home service for persons who rely on treatment by
25spiritual means alone through prayer for healing.
26    Notwithstanding any other provision of this Section, a



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1comprehensive tobacco use cessation program that includes
2purchasing prescription drugs or prescription medical devices
3approved by the Food and Drug Administration shall be covered
4under the medical assistance program under this Article for
5persons who are otherwise eligible for assistance under this
7    Notwithstanding any other provision of this Code, the
8Illinois Department may not require, as a condition of payment
9for any laboratory test authorized under this Article, that a
10physician's handwritten signature appear on the laboratory
11test order form. The Illinois Department may, however, impose
12other appropriate requirements regarding laboratory test order
14    The Department of Healthcare and Family Services shall
15provide the following services to persons eligible for
16assistance under this Article who are participating in
17education, training or employment programs operated by the
18Department of Human Services as successor to the Department of
19Public Aid:
20        (1) dental services provided by or under the
21    supervision of a dentist; and
22        (2) eyeglasses prescribed by a physician skilled in the
23    diseases of the eye, or by an optometrist, whichever the
24    person may select.
25    Notwithstanding any other provision of this Code and
26subject to federal approval, the Department may adopt rules to



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1allow a dentist who is volunteering his or her service at no
2cost to render dental services through an enrolled
3not-for-profit health clinic without the dentist personally
4enrolling as a participating provider in the medical assistance
5program. A not-for-profit health clinic shall include a public
6health clinic or Federally Qualified Health Center or other
7enrolled provider, as determined by the Department, through
8which dental services covered under this Section are performed.
9The Department shall establish a process for payment of claims
10for reimbursement for covered dental services rendered under
11this provision.
12    The Illinois Department, by rule, may distinguish and
13classify the medical services to be provided only in accordance
14with the classes of persons designated in Section 5-2.
15    The Department of Healthcare and Family Services must
16provide coverage and reimbursement for amino acid-based
17elemental formulas, regardless of delivery method, for the
18diagnosis and treatment of (i) eosinophilic disorders and (ii)
19short bowel syndrome when the prescribing physician has issued
20a written order stating that the amino acid-based elemental
21formula is medically necessary.
22    The Illinois Department shall authorize the provision of,
23and shall authorize payment for, screening by low-dose
24mammography for the presence of occult breast cancer for women
2535 years of age or older who are eligible for medical
26assistance under this Article, as follows:



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1        (A) A baseline mammogram for women 35 to 39 years of
2    age.
3        (B) An annual mammogram for women 40 years of age or
4    older.
5        (C) A mammogram at the age and intervals considered
6    medically necessary by the woman's health care provider for
7    women under 40 years of age and having a family history of
8    breast cancer, prior personal history of breast cancer,
9    positive genetic testing, or other risk factors.
10        (D) A comprehensive ultrasound screening of an entire
11    breast or breasts if a mammogram demonstrates
12    heterogeneous or dense breast tissue, when medically
13    necessary as determined by a physician licensed to practice
14    medicine in all of its branches.
15    All screenings shall include a physical breast exam,
16instruction on self-examination and information regarding the
17frequency of self-examination and its value as a preventative
18tool. For purposes of this Section, "low-dose mammography"
19means the x-ray examination of the breast using equipment
20dedicated specifically for mammography, including the x-ray
21tube, filter, compression device, and image receptor, with an
22average radiation exposure delivery of less than one rad per
23breast for 2 views of an average size breast. The term also
24includes digital mammography.
25    On and after January 1, 2012, providers participating in a
26quality improvement program approved by the Department shall be



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1reimbursed for screening and diagnostic mammography at the same
2rate as the Medicare program's rates, including the increased
3reimbursement for digital mammography.
4    The Department shall convene an expert panel including
5representatives of hospitals, free-standing mammography
6facilities, and doctors, including radiologists, to establish
7quality standards.
8    Subject to federal approval, the Department shall
9establish a rate methodology for mammography at federally
10qualified health centers and other encounter-rate clinics.
11These clinics or centers may also collaborate with other
12hospital-based mammography facilities.
13    The Department shall establish a methodology to remind
14women who are age-appropriate for screening mammography, but
15who have not received a mammogram within the previous 18
16months, of the importance and benefit of screening mammography.
17    The Department shall establish a performance goal for
18primary care providers with respect to their female patients
19over age 40 receiving an annual mammogram. This performance
20goal shall be used to provide additional reimbursement in the
21form of a quality performance bonus to primary care providers
22who meet that goal.
23    The Department shall devise a means of case-managing or
24patient navigation for beneficiaries diagnosed with breast
25cancer. This program shall initially operate as a pilot program
26in areas of the State with the highest incidence of mortality



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1related to breast cancer. At least one pilot program site shall
2be in the metropolitan Chicago area and at least one site shall
3be outside the metropolitan Chicago area. An evaluation of the
4pilot program shall be carried out measuring health outcomes
5and cost of care for those served by the pilot program compared
6to similarly situated patients who are not served by the pilot
8    Any medical or health care provider shall immediately
9recommend, to any pregnant woman who is being provided prenatal
10services and is suspected of drug abuse or is addicted as
11defined in the Alcoholism and Other Drug Abuse and Dependency
12Act, referral to a local substance abuse treatment provider
13licensed by the Department of Human Services or to a licensed
14hospital which provides substance abuse treatment services.
15The Department of Healthcare and Family Services shall assure
16coverage for the cost of treatment of the drug abuse or
17addiction for pregnant recipients in accordance with the
18Illinois Medicaid Program in conjunction with the Department of
19Human Services.
20    All medical providers providing medical assistance to
21pregnant women under this Code shall receive information from
22the Department on the availability of services under the Drug
23Free Families with a Future or any comparable program providing
24case management services for addicted women, including
25information on appropriate referrals for other social services
26that may be needed by addicted women in addition to treatment



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1for addiction.
2    The Illinois Department, in cooperation with the
3Departments of Human Services (as successor to the Department
4of Alcoholism and Substance Abuse) and Public Health, through a
5public awareness campaign, may provide information concerning
6treatment for alcoholism and drug abuse and addiction, prenatal
7health care, and other pertinent programs directed at reducing
8the number of drug-affected infants born to recipients of
9medical assistance.
10    Neither the Department of Healthcare and Family Services
11nor the Department of Human Services shall sanction the
12recipient solely on the basis of her substance abuse.
13    The Illinois Department shall establish such regulations
14governing the dispensing of health services under this Article
15as it shall deem appropriate. The Department should seek the
16advice of formal professional advisory committees appointed by
17the Director of the Illinois Department for the purpose of
18providing regular advice on policy and administrative matters,
19information dissemination and educational activities for
20medical and health care providers, and consistency in
21procedures to the Illinois Department.
22    Notwithstanding any other provision of law, a health care
23provider under the medical assistance program may elect, in
24lieu of receiving direct payment for services provided under
25that program, to participate in the State Employees Deferred
26Compensation Plan adopted under Article 24 of the Illinois



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1Pension Code. A health care provider who elects to participate
2in the plan does not have a cause of action against the State
3for any damages allegedly suffered by the provider as a result
4of any delay by the State in crediting the amount of any
5contribution to the provider's plan account.
6    The Illinois Department may develop and contract with
7Partnerships of medical providers to arrange medical services
8for persons eligible under Section 5-2 of this Code.
9Implementation of this Section may be by demonstration projects
10in certain geographic areas. The Partnership shall be
11represented by a sponsor organization. The Department, by rule,
12shall develop qualifications for sponsors of Partnerships.
13Nothing in this Section shall be construed to require that the
14sponsor organization be a medical organization.
15    The sponsor must negotiate formal written contracts with
16medical providers for physician services, inpatient and
17outpatient hospital care, home health services, treatment for
18alcoholism and substance abuse, and other services determined
19necessary by the Illinois Department by rule for delivery by
20Partnerships. Physician services must include prenatal and
21obstetrical care. The Illinois Department shall reimburse
22medical services delivered by Partnership providers to clients
23in target areas according to provisions of this Article and the
24Illinois Health Finance Reform Act, except that:
25        (1) Physicians participating in a Partnership and
26    providing certain services, which shall be determined by



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1    the Illinois Department, to persons in areas covered by the
2    Partnership may receive an additional surcharge for such
3    services.
4        (2) The Department may elect to consider and negotiate
5    financial incentives to encourage the development of
6    Partnerships and the efficient delivery of medical care.
7        (3) Persons receiving medical services through
8    Partnerships may receive medical and case management
9    services above the level usually offered through the
10    medical assistance program.
11    Medical providers shall be required to meet certain
12qualifications to participate in Partnerships to ensure the
13delivery of high quality medical services. These
14qualifications shall be determined by rule of the Illinois
15Department and may be higher than qualifications for
16participation in the medical assistance program. Partnership
17sponsors may prescribe reasonable additional qualifications
18for participation by medical providers, only with the prior
19written approval of the Illinois Department.
20    Nothing in this Section shall limit the free choice of
21practitioners, hospitals, and other providers of medical
22services by clients. In order to ensure patient freedom of
23choice, the Illinois Department shall immediately promulgate
24all rules and take all other necessary actions so that provided
25services may be accessed from therapeutically certified
26optometrists to the full extent of the Illinois Optometric



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1Practice Act of 1987 without discriminating between service
3    The Department shall apply for a waiver from the United
4States Health Care Financing Administration to allow for the
5implementation of Partnerships under this Section.
6    The Illinois Department shall require health care
7providers to maintain records that document the medical care
8and services provided to recipients of Medical Assistance under
9this Article. Such records must be retained for a period of not
10less than 6 years from the date of service or as provided by
11applicable State law, whichever period is longer, except that
12if an audit is initiated within the required retention period
13then the records must be retained until the audit is completed
14and every exception is resolved. The Illinois Department shall
15require health care providers to make available, when
16authorized by the patient, in writing, the medical records in a
17timely fashion to other health care providers who are treating
18or serving persons eligible for Medical Assistance under this
19Article. All dispensers of medical services shall be required
20to maintain and retain business and professional records
21sufficient to fully and accurately document the nature, scope,
22details and receipt of the health care provided to persons
23eligible for medical assistance under this Code, in accordance
24with regulations promulgated by the Illinois Department. The
25rules and regulations shall require that proof of the receipt
26of prescription drugs, dentures, prosthetic devices and



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1eyeglasses by eligible persons under this Section accompany
2each claim for reimbursement submitted by the dispenser of such
3medical services. No such claims for reimbursement shall be
4approved for payment by the Illinois Department without such
5proof of receipt, unless the Illinois Department shall have put
6into effect and shall be operating a system of post-payment
7audit and review which shall, on a sampling basis, be deemed
8adequate by the Illinois Department to assure that such drugs,
9dentures, prosthetic devices and eyeglasses for which payment
10is being made are actually being received by eligible
11recipients. Within 90 days after the effective date of this
12amendatory Act of 1984, the Illinois Department shall establish
13a current list of acquisition costs for all prosthetic devices
14and any other items recognized as medical equipment and
15supplies reimbursable under this Article and shall update such
16list on a quarterly basis, except that the acquisition costs of
17all prescription drugs shall be updated no less frequently than
18every 30 days as required by Section 5-5.12.
19    The rules and regulations of the Illinois Department shall
20require that a written statement including the required opinion
21of a physician shall accompany any claim for reimbursement for
22abortions, or induced miscarriages or premature births. This
23statement shall indicate what procedures were used in providing
24such medical services.
25    The Illinois Department shall require all dispensers of
26medical services, other than an individual practitioner or



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1group of practitioners, desiring to participate in the Medical
2Assistance program established under this Article to disclose
3all financial, beneficial, ownership, equity, surety or other
4interests in any and all firms, corporations, partnerships,
5associations, business enterprises, joint ventures, agencies,
6institutions or other legal entities providing any form of
7health care services in this State under this Article.
8    The Illinois Department may require that all dispensers of
9medical services desiring to participate in the medical
10assistance program established under this Article disclose,
11under such terms and conditions as the Illinois Department may
12by rule establish, all inquiries from clients and attorneys
13regarding medical bills paid by the Illinois Department, which
14inquiries could indicate potential existence of claims or liens
15for the Illinois Department.
16    Enrollment of a vendor that provides non-emergency medical
17transportation, defined by the Department by rule, shall be
18conditional for 180 days. During that time, the Department of
19Healthcare and Family Services may terminate the vendor's
20eligibility to participate in the medical assistance program
21without cause. That termination of eligibility is not subject
22to the Department's hearing process.
23    The Illinois Department shall establish policies,
24procedures, standards and criteria by rule for the acquisition,
25repair and replacement of orthotic and prosthetic devices and
26durable medical equipment. Such rules shall provide, but not be



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1limited to, the following services: (1) immediate repair or
2replacement of such devices by recipients without medical
3authorization; and (2) rental, lease, purchase or
4lease-purchase of durable medical equipment in a
5cost-effective manner, taking into consideration the
6recipient's medical prognosis, the extent of the recipient's
7needs, and the requirements and costs for maintaining such
8equipment. Such rules shall enable a recipient to temporarily
9acquire and use alternative or substitute devices or equipment
10pending repairs or replacements of any device or equipment
11previously authorized for such recipient by the Department.
12    The Department shall execute, relative to the nursing home
13prescreening project, written inter-agency agreements with the
14Department of Human Services and the Department on Aging, to
15effect the following: (i) intake procedures and common
16eligibility criteria for those persons who are receiving
17non-institutional services; and (ii) the establishment and
18development of non-institutional services in areas of the State
19where they are not currently available or are undeveloped.
20    The Illinois Department shall develop and operate, in
21cooperation with other State Departments and agencies and in
22compliance with applicable federal laws and regulations,
23appropriate and effective systems of health care evaluation and
24programs for monitoring of utilization of health care services
25and facilities, as it affects persons eligible for medical
26assistance under this Code.



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1    The Illinois Department shall report annually to the
2General Assembly, no later than the second Friday in April of
31979 and each year thereafter, in regard to:
4        (a) actual statistics and trends in utilization of
5    medical services by public aid recipients;
6        (b) actual statistics and trends in the provision of
7    the various medical services by medical vendors;
8        (c) current rate structures and proposed changes in
9    those rate structures for the various medical vendors; and
10        (d) efforts at utilization review and control by the
11    Illinois Department.
12    The period covered by each report shall be the 3 years
13ending on the June 30 prior to the report. The report shall
14include suggested legislation for consideration by the General
15Assembly. The filing of one copy of the report with the
16Speaker, one copy with the Minority Leader and one copy with
17the Clerk of the House of Representatives, one copy with the
18President, one copy with the Minority Leader and one copy with
19the Secretary of the Senate, one copy with the Legislative
20Research Unit, and such additional copies with the State
21Government Report Distribution Center for the General Assembly
22as is required under paragraph (t) of Section 7 of the State
23Library Act shall be deemed sufficient to comply with this
25    Rulemaking authority to implement Public Act 95-1045, if
26any, is conditioned on the rules being adopted in accordance



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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926,
6eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638,
7eff. 1-1-12.)
8    Section 10. The Community Services Act is amended by
9changing Section 2 as follows:
10    (405 ILCS 30/2)  (from Ch. 91 1/2, par. 902)
11    Sec. 2. Community Services System. Services should be
12planned, developed, delivered and evaluated as part of a
13comprehensive and coordinated system. The Department of Human
14Services shall encourage the establishment of services in each
15area of the State which cover the services categories described
16below. What specific services are provided under each service
17category shall be based on local needs; special attention shall
18be given to unserved and underserved populations, including
19children and youth, racial and ethnic minorities, and the
20elderly. The service categories shall include:
21    (a) Prevention: services designed primarily to reduce the
22incidence and ameliorate the severity of developmental
23disabilities, mental illness and alcohol and drug dependence;
24    (b) Client Assessment and Diagnosis: services designed to



HB3893 Enrolled- 25 -LRB097 14519 KTG 60158 b

1identify persons with developmental disabilities, mental
2illness and alcohol and drug dependency; to determine the
3extent of the disability and the level of functioning; to
4ensure that the individual's need for treatment of mental
5disorders or substance use disorders or co-occurring substance
6use and mental health disorders is determined using a uniform
7screening, assessment, and evaluation process inclusive of
8criteria; for purposes of this subsection (b), a uniform
9screening, assessment, and evaluation process refers to a
10process that includes an appropriate evaluation and, as
11warranted, a referral; "uniform" does not mean the use of a
12singular instrument, tool, or process that all must utilize;
13information obtained through client evaluation can be used in
14individual treatment and habilitation plans; to assure
15appropriate placement and to assist in program evaluation;
16    (c) Case Coordination: services to provide information and
17assistance to disabled persons to insure that they obtain
18needed services provided by the private and public sectors;
19case coordination services should be available to individuals
20whose functioning level or history of institutional recidivism
21or long-term care indicate that such assistance is required for
22successful community living;
23    (d) Crisis and Emergency: services to assist individuals
24and their families through crisis periods, to stabilize
25individuals under stress and to prevent unnecessary



HB3893 Enrolled- 26 -LRB097 14519 KTG 60158 b

1    (e) Treatment, Habilitation and Support: services designed
2to help individuals develop skills which promote independence
3and improved levels of social and vocational functioning and
4personal growth; and to provide non-treatment support services
5which are necessary for successful community living;
6    (f) Community Residential Alternatives to Institutional
7Settings: services to provide living arrangements for persons
8unable to live independently; the level of supervision,
9services provided and length of stay at community residential
10alternatives will vary by the type of program and the needs and
11functioning level of the residents; other services may be
12provided in a community residential alternative which promote
13the acquisition of independent living skills and integration
14with the community.
15(Source: P.A. 89-507, eff. 7-1-97.)
16    Section 99. Effective date. This Act takes effect upon
17becoming law.