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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||||||||||||||||||||
5 | changing Section 5-5f as follows: | ||||||||||||||||||||||||
6 | (305 ILCS 5/5-5f) | ||||||||||||||||||||||||
7 | Sec. 5-5f. Elimination and limitations of medical | ||||||||||||||||||||||||
8 | assistance services. Notwithstanding any other provision of | ||||||||||||||||||||||||
9 | this Code to the contrary, on and after July 1, 2012: | ||||||||||||||||||||||||
10 | (a) The following services shall no longer be a covered | ||||||||||||||||||||||||
11 | service available under this Code: group psychotherapy for | ||||||||||||||||||||||||
12 | residents of any facility licensed under the Nursing Home Care | ||||||||||||||||||||||||
13 | Act or the Specialized Mental Health Rehabilitation Act; and | ||||||||||||||||||||||||
14 | adult chiropractic services. | ||||||||||||||||||||||||
15 | (b) The Department shall place the following limitations on | ||||||||||||||||||||||||
16 | services: (i) the Department shall limit adult eyeglasses to | ||||||||||||||||||||||||
17 | one pair every 2 years; (ii) the Department shall set an annual | ||||||||||||||||||||||||
18 | limit of a maximum of 20 visits for each of the following | ||||||||||||||||||||||||
19 | services: adult speech, hearing, and language therapy | ||||||||||||||||||||||||
20 | services, adult occupational therapy services, and physical | ||||||||||||||||||||||||
21 | therapy services; (iii) the Department shall limit podiatry | ||||||||||||||||||||||||
22 | services to individuals with diabetes; (iv) the Department | ||||||||||||||||||||||||
23 | shall pay for caesarean sections at the normal vaginal delivery |
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1 | rate unless a caesarean section was medically necessary; (v) | ||||||
2 | the Department shall limit adult dental services to | ||||||
3 | emergencies; and (vi) effective July 1, 2012, the Department | ||||||
4 | shall place limitations and require concurrent review on every | ||||||
5 | inpatient detoxification stay to prevent repeat admissions to | ||||||
6 | any hospital for detoxification within 60 days of a previous | ||||||
7 | inpatient detoxification stay. The Department shall convene a | ||||||
8 | workgroup of hospitals, substance abuse providers, care | ||||||
9 | coordination entities, managed care plans, and other | ||||||
10 | stakeholders to develop recommendations for quality standards, | ||||||
11 | diversion to other settings, and admission criteria for | ||||||
12 | patients who need inpatient detoxification. | ||||||
13 | (c) The Department shall require prior approval of the | ||||||
14 | following services: wheelchair repairs when the cost of any one | ||||||
15 | part is greater than or equal to $500 per line item, when the | ||||||
16 | sum of the parts is greater than or equal to a total of $1,500, | ||||||
17 | or when 8 or more units of labor are to be billed; , regardless | ||||||
18 | of the cost of the repairs, coronary artery bypass graft ; , and | ||||||
19 | bariatric surgery consistent with Medicare standards | ||||||
20 | concerning patient responsibility. The payment rate for custom | ||||||
21 | manual wheelchairs, power wheelchairs, seating and positioning | ||||||
22 | items, and related options and accessories shall be set at the | ||||||
23 | current Medicare fee schedule minus 6%. For those items that do | ||||||
24 | not have an established rate on the Medicare fee schedule, the | ||||||
25 | payment rate shall be the manufacturer's suggested retail price | ||||||
26 | minus 10%. The wholesale cost of power wheelchairs shall be |
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1 | actual acquisition cost including all discounts. | ||||||
2 | (d) The Department shall establish benchmarks for | ||||||
3 | hospitals to measure and align payments to reduce potentially | ||||||
4 | preventable hospital readmissions, inpatient complications, | ||||||
5 | and unnecessary emergency room visits. In doing so, the | ||||||
6 | Department shall consider items, including, but not limited to, | ||||||
7 | historic and current acuity of care and historic and current | ||||||
8 | trends in readmission. The Department shall publish | ||||||
9 | provider-specific historical readmission data and anticipated | ||||||
10 | potentially preventable targets 60 days prior to the start of | ||||||
11 | the program. In the instance of readmissions, the Department | ||||||
12 | shall adopt policies and rates of reimbursement for services | ||||||
13 | and other payments provided under this Code to ensure that, by | ||||||
14 | June 30, 2013, expenditures to hospitals are reduced by, at a | ||||||
15 | minimum, $40,000,000. | ||||||
16 | (e) The Department shall establish utilization controls | ||||||
17 | for the hospice program such that it shall not pay for other | ||||||
18 | care services when an individual is in hospice. | ||||||
19 | (f) For home health services, the Department shall require | ||||||
20 | Medicare certification of providers participating in the | ||||||
21 | program, implement the Medicare face-to-face encounter rule, | ||||||
22 | and limit services to post-hospitalization. The Department | ||||||
23 | shall require providers to implement auditable electronic | ||||||
24 | service verification based on global positioning systems or | ||||||
25 | other cost-effective technology. | ||||||
26 | (g) For the Home Services Program operated by the |
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1 | Department of Human Services and the Community Care Program | ||||||
2 | operated by the Department on Aging, the Department of Human | ||||||
3 | Services, in cooperation with the Department on Aging, shall | ||||||
4 | implement an electronic service verification based on global | ||||||
5 | positioning systems or other cost-effective technology. | ||||||
6 | (h) The Department shall not pay for hospital admissions | ||||||
7 | when the claim indicates a hospital acquired condition that | ||||||
8 | would cause Medicare to reduce its payment on the claim had the | ||||||
9 | claim been submitted to Medicare, nor shall the Department pay | ||||||
10 | for hospital admissions where a Medicare identified "never | ||||||
11 | event" occurred. | ||||||
12 | (i) The Department shall implement cost savings | ||||||
13 | initiatives for advanced imaging services, cardiac imaging | ||||||
14 | services, pain management services, and back surgery. Such | ||||||
15 | initiatives shall be designed to achieve annual costs savings.
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16 | (Source: P.A. 97-689, eff. 6-14-12.)
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17 | Section 99. Effective date. This Act takes effect upon | ||||||
18 | becoming law.
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