98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB2815

 

Introduced 1/30/2014, by Sen. Dave Syverson

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5f
305 ILCS 5/12-4.39

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Removes language requiring the Department of Healthcare and Family Services to (i) limit adult dental services to emergencies; and (ii) beginning July 1, 2013, ensure certain conditions are recognized as emergencies. Provides that (i) the Department shall limit the ALL KIDS school-based dental program; (ii) school-based dental providers must provide children receiving an oral health score of 2 or 3 (indicating the need for restorative or urgent follow-up care) with the diagnosed follow-up care by providing the care themselves at the school or at the provider's local clinic, or the children must be referred by the provider's case manager to a dental provider who is willing to accept each child into the provider's practice to perform required follow-up care and provide a dental home; (iii) the Department may limit dental coverage for children to 2 cleanings and 2 fluoride treatments per year regardless of where the services are performed and shall require prior approval for any requests exceeding this limit; and (iv) beginning July 1, 2014, the Department shall require all adults to pay a $20 encounter fee to the provider at the time of services. In a provision concerning a dental clinic grant program administered by the Department, adds dental school clinics to the list of dental entities that may apply for grant money. Provides that grant money must be used to support projects that develop dental services or training (rather than only dental services) to meet the dental health care needs of the Department's dental program clients. In addition to other specified expenses, provides that grant moneys must be used for those services provided as part of the educational process at State dental schools. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB2815LRB098 17253 KTG 52347 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 Sections 5-5f and 12-4.39 as follows:
 
6    (305 ILCS 5/5-5f)
7    Sec. 5-5f. Elimination and limitations of medical
8assistance services. Notwithstanding any other provision of
9this Code to the contrary, on and after July 1, 2012:
10    (a) The following services shall no longer be a covered
11service available under this Code: group psychotherapy for
12residents of any facility licensed under the Nursing Home Care
13Act or the Specialized Mental Health Rehabilitation Act of
142013; and adult chiropractic services.
15    (b) The Department shall place the following limitations on
16services: (i) the Department shall limit adult eyeglasses to
17one pair every 2 years; (ii) the Department shall set an annual
18limit of a maximum of 20 visits for each of the following
19services: adult speech, hearing, and language therapy
20services, adult occupational therapy services, and physical
21therapy services; (iii) the Department shall limit adult
22podiatry services to individuals with diabetes; (iv) the
23Department shall pay for caesarean sections at the normal

 

 

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1vaginal delivery rate unless a caesarean section was medically
2necessary; (v) the Department shall limit the ALL KIDS
3school-based dental program; school-based dental providers
4must provide children receiving an oral health score of 2 or 3
5(indicating the need for restorative or urgent follow-up care)
6with the diagnosed follow-up care by providing the care
7themselves at the school or at the provider's local clinic, or
8the children must be referred by the provider's case manager to
9a dental provider who is willing to accept each child into the
10provider's practice to perform required follow-up care and
11provide a dental home; in addition, the Department may limit
12dental coverage for children to 2 cleanings and 2 fluoride
13treatments per year regardless of where the services are
14performed and shall require prior approval for any requests
15exceeding this limit; beginning July 1, 2014, the Department
16shall require all adults covered for dental services under this
17Code to pay a $20 encounter fee to the provider at the time of
18services the Department shall limit adult dental services to
19emergencies; beginning July 1, 2013, the Department shall
20ensure that the following conditions are recognized as
21emergencies: (A) dental services necessary for an individual in
22order for the individual to be cleared for a medical procedure,
23such as a transplant; (B) extractions and dentures necessary
24for a diabetic to receive proper nutrition; (C) extractions and
25dentures necessary as a result of cancer treatment; and (D)
26dental services necessary for the health of a pregnant woman

 

 

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1prior to delivery of her baby; and (vi) effective July 1, 2012,
2the Department shall place limitations and require concurrent
3review on every inpatient detoxification stay to prevent repeat
4admissions to any hospital for detoxification within 60 days of
5a previous inpatient detoxification stay. The Department shall
6convene a workgroup of hospitals, substance abuse providers,
7care coordination entities, managed care plans, and other
8stakeholders to develop recommendations for quality standards,
9diversion to other settings, and admission criteria for
10patients who need inpatient detoxification, which shall be
11published on the Department's website no later than September
121, 2013.
13    (c) The Department shall require prior approval of the
14following services: wheelchair repairs costing more than $400,
15coronary artery bypass graft, and bariatric surgery consistent
16with Medicare standards concerning patient responsibility.
17Wheelchair repair prior approval requests shall be adjudicated
18within one business day of receipt of complete supporting
19documentation. Providers may not break wheelchair repairs into
20separate claims for purposes of staying under the $400
21threshold for requiring prior approval. The wholesale price of
22manual and power wheelchairs, durable medical equipment and
23supplies, and complex rehabilitation technology products and
24services shall be defined as actual acquisition cost including
25all discounts.
26    (d) The Department shall establish benchmarks for

 

 

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1hospitals to measure and align payments to reduce potentially
2preventable hospital readmissions, inpatient complications,
3and unnecessary emergency room visits. In doing so, the
4Department shall consider items, including, but not limited to,
5historic and current acuity of care and historic and current
6trends in readmission. The Department shall publish
7provider-specific historical readmission data and anticipated
8potentially preventable targets 60 days prior to the start of
9the program. In the instance of readmissions, the Department
10shall adopt policies and rates of reimbursement for services
11and other payments provided under this Code to ensure that, by
12June 30, 2013, expenditures to hospitals are reduced by, at a
13minimum, $40,000,000.
14    (e) The Department shall establish utilization controls
15for the hospice program such that it shall not pay for other
16care services when an individual is in hospice.
17    (f) For home health services, the Department shall require
18Medicare certification of providers participating in the
19program and implement the Medicare face-to-face encounter
20rule. The Department shall require providers to implement
21auditable electronic service verification based on global
22positioning systems or other cost-effective technology.
23    (g) For the Home Services Program operated by the
24Department of Human Services and the Community Care Program
25operated by the Department on Aging, the Department of Human
26Services, in cooperation with the Department on Aging, shall

 

 

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1implement an electronic service verification based on global
2positioning systems or other cost-effective technology.
3    (h) Effective with inpatient hospital admissions on or
4after July 1, 2012, the Department shall reduce the payment for
5a claim that indicates the occurrence of a provider-preventable
6condition during the admission as specified by the Department
7in rules. The Department shall not pay for services related to
8an other provider-preventable condition.
9    As used in this subsection (h):
10    "Provider-preventable condition" means a health care
11acquired condition as defined under the federal Medicaid
12regulation found at 42 CFR 447.26 or an other
13provider-preventable condition.
14    "Other provider-preventable condition" means a wrong
15surgical or other invasive procedure performed on a patient, a
16surgical or other invasive procedure performed on the wrong
17body part, or a surgical procedure or other invasive procedure
18performed on the wrong patient.
19    (i) The Department shall implement cost savings
20initiatives for advanced imaging services, cardiac imaging
21services, pain management services, and back surgery. Such
22initiatives shall be designed to achieve annual costs savings.
23    (j) The Department shall ensure that beneficiaries with a
24diagnosis of epilepsy or seizure disorder in Department records
25will not require prior approval for anticonvulsants.
26(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section

 

 

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16-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff.
27-22-13; revised 9-19-13.)
 
3    (305 ILCS 5/12-4.39)
4    Sec. 12-4.39. Dental clinic grant program.
5    (a) Grant program. On and after July 1, 2012, and subject
6to funding availability, the Department of Healthcare and
7Family Services may administer a grant program. The purpose of
8this grant program shall be to build the public infrastructure
9for dental care and to make grants to local health departments,
10federally qualified health clinics (FQHCs), and rural health
11clinics (RHCs), and dental schools for development of
12comprehensive dental clinics for dental care services. The
13primary purpose of these new dental clinics will be to increase
14dental access for low-income and Department of Healthcare and
15Family Services clients who have no dental arrangements with a
16dental provider in a project's service area. The dental clinic
17must be willing to accept out-of-area clients who need dental
18services, including emergency services for adults and Early and
19Periodic Screening, Diagnosis and Treatment (EPSDT)-referral
20children. Medically Underserved Areas (MUAs) and Health
21Professional Shortage Areas (HPSAs) shall receive special
22priority for grants under this program.
23    (b) Eligible applicants. The following entities are
24eligible to apply for grants:
25        (1) Local health departments.

 

 

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1        (2) Federally Qualified Health Centers (FQHCs).
2        (3) Rural health clinics (RHCs).
3        (4) Dental school clinics.
4    (c) Use of grant moneys. Grant moneys must be used to
5support projects that develop dental services or training to
6meet the dental health care needs of Department of Healthcare
7and Family Services Dental Program clients. Grant moneys must
8be used for operating expenses, including, but not limited to:
9insurance; dental supplies and equipment; dental support
10services, including those services provided as part of the
11educational process at State dental schools; and renovation
12expenses. Grant moneys may not be used to offset existing
13indebtedness, supplant existing funds, purchase real property,
14or pay for personnel service salaries for dental employees.
15    (d) Application process. The Department shall establish
16procedures for applying for dental clinic grants.
17(Source: P.A. 96-67, eff. 7-23-09; 96-1000, eff. 7-2-10;
1897-689, eff. 6-14-12.)
 
19    Section 99. Effective date. This Act takes effect upon
20becoming law.