Illinois General Assembly - Bill Status for HB5331

Amends the Illinois Public Aid Code. Provides formulas for Medicaid reimbursement of ambulance service providers for emergency ambulance services, non-emergency ambulance services, mileage, advanced life support services, and specialty care transport services. Provides that the requirement for payment of ground ambulance services by the Illinois Department of Healthcare and Family Services is met if the services are provided pursuant to a request for evaluation, treatment, and transport for an individual with a condition of such a nature that a prudent layperson would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to life or health. Requires the Department to annually update the ambulance fee schedule rates on July 1 of each year. Makes other changes.

Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. Replaces provisions concerning medical assistance payments for ambulance services. Provides for payment for ground ambulance services under the medical assistance program. Provides that for ground ambulance services provided to a medical assistance recipient on or after July 1, 2010, the Department of Healthcare and Family Services shall provide payment to ground ambulance services providers for base charges and mileage charges based upon the lesser of the provider's charge, as reflected on the provider's claim form, or the Illinois Medicaid Ambulance Fee Schedule payment rates. Provides for establishment of the Illinois Medicaid Ambulance Fee Schedule, and provides for a 2-year phase-in of that Schedule. Provides that effective for dates of service on or after July 1, 2011, the Department shall update the Illinois Medicaid Ambulance Fee Schedule payment rates to be in compliance with the Medicare Ambulance Fee Schedule payment rates for ground ambulance services in effect at the time of the update. Makes other changes in connection with medical assistance payments for ground ambulance services. Effective immediately.

Provides that all payments for services under the provisions added by the bill are subject to the availability of appropriations for those purposes.

Provides that payments made under the State Medicaid plan to ground ambulance service providers for base charges and mileage charges incurred during the provision of ground ambulance services and for stretcher van services shall be subject to the availability of appropriations for those purposes (rather than providing that payments made under the State Medicaid plan for (i) ground ambulance services provided to a recipient enrolled in a Medicaid managed care plan, (ii) out-of-State ground ambulance services, (iii) emergency ground ambulance services, (iv) base charges and mileage charges incurred during the provision of ground ambulance services, and (v) stretcher van services are subject to the availability of appropriations for those purposes). Grants the Department of Healthcare and Family Services the authority to set payment rates for State ground ambulance services providers by administrative rule pending the availability of appropriations dedicated to specified rate increases.

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