SB3718 EnrolledLRB097 17624 KTG 62896 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-4.2 as follows:
 
6    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
7    Sec. 5-4.2. Ambulance services payments.
8    (a) For ambulance services provided to a recipient of aid
9under this Article on or after January 1, 1993, the Illinois
10Department shall reimburse ambulance service providers at
11rates calculated in accordance with this Section. It is the
12intent of the General Assembly to provide adequate
13reimbursement for ambulance services so as to ensure adequate
14access to services for recipients of aid under this Article and
15to provide appropriate incentives to ambulance service
16providers to provide services in an efficient and
17cost-effective manner. Thus, it is the intent of the General
18Assembly that the Illinois Department implement a
19reimbursement system for ambulance services that, to the extent
20practicable and subject to the availability of funds
21appropriated by the General Assembly for this purpose, is
22consistent with the payment principles of Medicare. To ensure
23uniformity between the payment principles of Medicare and

 

 

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1Medicaid, the Illinois Department shall follow, to the extent
2necessary and practicable and subject to the availability of
3funds appropriated by the General Assembly for this purpose,
4the statutes, laws, regulations, policies, procedures,
5principles, definitions, guidelines, and manuals used to
6determine the amounts paid to ambulance service providers under
7Title XVIII of the Social Security Act (Medicare).
8    (b) For ambulance services provided to a recipient of aid
9under this Article on or after January 1, 1996, the Illinois
10Department shall reimburse ambulance service providers based
11upon the actual distance traveled if a natural disaster,
12weather conditions, road repairs, or traffic congestion
13necessitates the use of a route other than the most direct
14route.
15    (c) For purposes of this Section, "ambulance services"
16includes medical transportation services provided by means of
17an ambulance, medi-car, service car, or taxi.
18    (c-1) For purposes of this Section, "ground ambulance
19service" means medical transportation services that are
20described as ground ambulance services by the Centers for
21Medicare and Medicaid Services and provided in a vehicle that
22is licensed as an ambulance by the Illinois Department of
23Public Health pursuant to the Emergency Medical Services (EMS)
24Systems Act.
25    (c-2) For purposes of this Section, "ground ambulance
26service provider" means a vehicle service provider as described

 

 

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1in the Emergency Medical Services (EMS) Systems Act that
2operates licensed ambulances for the purpose of providing
3emergency ambulance services, or non-emergency ambulance
4services, or both. For purposes of this Section, this includes
5both ambulance providers and ambulance suppliers as described
6by the Centers for Medicare and Medicaid Services.
7    (d) This Section does not prohibit separate billing by
8ambulance service providers for oxygen furnished while
9providing advanced life support services.
10    (e) Beginning with services rendered on or after July 1,
112008, all providers of non-emergency medi-car and service car
12transportation must certify that the driver and employee
13attendant, as applicable, have completed a safety program
14approved by the Department to protect both the patient and the
15driver, prior to transporting a patient. The provider must
16maintain this certification in its records. The provider shall
17produce such documentation upon demand by the Department or its
18representative. Failure to produce documentation of such
19training shall result in recovery of any payments made by the
20Department for services rendered by a non-certified driver or
21employee attendant. Medi-car and service car providers must
22maintain legible documentation in their records of the driver
23and, as applicable, employee attendant that actually
24transported the patient. Providers must recertify all drivers
25and employee attendants every 3 years.
26    Notwithstanding the requirements above, any public

 

 

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1transportation provider of medi-car and service car
2transportation that receives federal funding under 49 U.S.C.
35307 and 5311 need not certify its drivers and employee
4attendants under this Section, since safety training is already
5federally mandated.
6    (f) With respect to any policy or program administered by
7the Department or its agent regarding approval of non-emergency
8medical transportation by ground ambulance service providers,
9including, but not limited to, the Non-Emergency
10Transportation Services Prior Approval Program (NETSPAP), the
11Department shall establish by rule a process by which ground
12ambulance service providers of non-emergency medical
13transportation may appeal any decision by the Department or its
14agent for which no denial was received prior to the time of
15transport that either (i) denies a request for approval for
16payment of non-emergency transportation by means of ground
17ambulance service or (ii) grants a request for approval of
18non-emergency transportation by means of ground ambulance
19service at a level of service that entitles the ground
20ambulance service provider to a lower level of compensation
21from the Department than the ground ambulance service provider
22would have received as compensation for the level of service
23requested. The rule shall be established within 12 months after
24the effective date of this amendatory Act of the 97th General
25Assembly and shall provide that, for any decision rendered by
26the Department or its agent on or after the date the rule takes

 

 

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1effect, the ground ambulance service provider shall have 60
2days from the date the decision is received to file an appeal.
3The rule established by the Department shall be, insofar as is
4practical, consistent with the Illinois Administrative
5Procedure Act. The Director's decision on an appeal under this
6Section shall be a final administrative decision subject to
7review under the Administrative Review Law.
8    (g) Beginning 90 days after the effective date of this
9amendatory Act of the 97th General Assembly, (i) no denial of a
10request for approval for payment of non-emergency
11transportation by means of ground ambulance service, and (ii)
12no approval of non-emergency transportation by means of ground
13ambulance service at a level of service that entitles the
14ground ambulance service provider to a lower level of
15compensation from the Department than would have been received
16at the level of service submitted by the ground ambulance
17service provider, may be issued by the Department or its agent
18unless the Department has submitted the criteria for
19determining the appropriateness of the transport for first
20notice publication in the Illinois Register pursuant to Section
215-40 of the Illinois Administrative Procedure Act.
22(Source: P.A. 97-584, eff. 8-26-11.)
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.