Full Text of HB6205 96th General Assembly
HB6205eng 96TH GENERAL ASSEMBLY
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| AN ACT concerning health.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the | 5 |
| Reproductive Health and Access Act. | 6 |
| Section 5. Findings and policy. The General Assembly finds | 7 |
| and declares that every individual possesses a fundamental | 8 |
| right of privacy with respect to reproductive decisions. | 9 |
| It is the public policy of this State to ensure that all | 10 |
| individuals have appropriate and necessary access to the full | 11 |
| range of reproductive education, healthcare, and services, | 12 |
| including, but not limited to, prenatal care, adoption, | 13 |
| contraceptive care including timely access to emergency | 14 |
| contraception, pregnancy termination, comprehensive sexual | 15 |
| health education, and screening and treatment for sexually | 16 |
| transmitted infections. | 17 |
| Section 10. Definitions. In this Act: | 18 |
| "Physician" means a person licensed to practice medicine in | 19 |
| all of its branches under the Medical Practice Act of 1987. | 20 |
| "Pregnancy termination" or "termination of pregnancy" | 21 |
| means any medical treatment intended to terminate a pregnancy. | 22 |
| Pregnancy termination shall not include medical treatment |
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| conducted for the purpose of increasing the probability of the | 2 |
| birth of a sustainable life. | 3 |
| "Viability" means that stage of fetal development when, in | 4 |
| the medical judgment of the attending physician, based on the | 5 |
| particular medical facts of the case before the physician, | 6 |
| there is a reasonable likelihood of the sustained survival of | 7 |
| the fetus outside of the uterus with or without artificial | 8 |
| support. | 9 |
| Section 15. Prohibition of interference. | 10 |
| (a) Notwithstanding any other provision of this Act or any | 11 |
| other law to the contrary, the State of Illinois, any | 12 |
| municipality, county, township, school district, or other | 13 |
| political subdivision of the State, or any agency, department, | 14 |
| or division of any governmental entity shall not: | 15 |
| (1) deny or interfere with an individual's right to use | 16 |
| or refuse contraception; | 17 |
| (2) deny or interfere with a pregnant woman's right to | 18 |
| bear a child; | 19 |
| (3) deny or interfere with a pregnant woman's right to | 20 |
| terminate a pregnancy:
(i) prior to the viability of the | 21 |
| fetus or
(ii) when the abortion is necessary to protect the | 22 |
| life or health of the pregnant woman; or
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| (4) require any woman to terminate pregnancy without | 24 |
| her consent. | 25 |
| (b) Any party aggrieved by conduct that violates subsection |
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| (a) of this Section may bring a civil lawsuit against the | 2 |
| offending governmental entity, including the State or Illinois | 3 |
| or any city, county, township, school district, or other | 4 |
| political subdivision of the State, or any agency, department | 5 |
| or division of any such governmental entity, in a State circuit | 6 |
| court or in a federal district court, for declaratory or | 7 |
| injunctive relief, compensatory and punitive damages, and any | 8 |
| other appropriate relief. A prevailing plaintiff shall, upon | 9 |
| motion, be awarded reasonable attorneys' fees, costs and | 10 |
| expenses, including expert witness and other litigation | 11 |
| expenses, including where the plaintiff's pursuit of a | 12 |
| non-frivolous claim was a catalyst for a unilateral change in | 13 |
| position by the opposing party. | 14 |
| Section 20. Non-discrimination in funding. Notwithstanding | 15 |
| any other provision of this Act or any other law to the | 16 |
| contrary, the State shall ensure that individuals eligible for | 17 |
| medical assistance under the Public Aid Code, or other State | 18 |
| medical assistance, or health benefits under the Children's | 19 |
| Health Insurance Program Act, the Covering ALL KIDS Health | 20 |
| Insurance Act, or the Veterans' Health Insurance Program Act of | 21 |
| 2008 shall receive coverage for reproductive healthcare at | 22 |
| least to the same extent as other comparable services. | 23 |
| Violation of this provision shall constitute a denial or | 24 |
| interference in contravention of Section 15 of this Act. Such | 25 |
| provision shall not prohibit the Department from establishing |
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| reasonable utilization control or cost containment measures | 2 |
| designed to assure the quality, cost effectiveness, and | 3 |
| appropriateness of healthcare services provided. | 4 |
| Section 25. Pregnancy terminations. | 5 |
| (a) Pregnancy terminations shall be performed in | 6 |
| accordance with accepted standards of medical practice, by the | 7 |
| method that, in the clinical judgment of the attending | 8 |
| physician, will best serve the interests of the pregnant | 9 |
| patient. A qualified medical professional shall not be liable | 10 |
| for civil damages or subject to criminal penalty relating to a | 11 |
| pregnancy termination performed in good faith and in accordance | 12 |
| with accepted standards of medical practice. | 13 |
| (b) Notwithstanding any other provision of this Act or any | 14 |
| other law to the contrary, a report of each pregnancy | 15 |
| termination performed shall be made to the Illinois Department | 16 |
| of Public Health on forms prescribed by the Department. Such | 17 |
| report forms shall not identify the patient by name and shall | 18 |
| preserve the anonymity of each woman who has obtained a | 19 |
| pregnancy termination. The Department of Public Health shall | 20 |
| promulgate and enforce regulations regarding the | 21 |
| administration of these reporting requirements that secure | 22 |
| protection of patient identity and ensure the anonymity of each | 23 |
| woman who has undergone a pregnancy termination. Failure of the | 24 |
| Department to preserve confidentiality and anonymity shall | 25 |
| constitute interference in contravention of Section 15 of this |
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| Act.
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| Section 30. Sexual health education. Notwithstanding any | 3 |
| other provision of this Act or any other law, all Illinois | 4 |
| public schools shall offer medically accurate, age | 5 |
| appropriate, comprehensive sexual health education as a part of | 6 |
| the Comprehensive Health Education Program established in | 7 |
| Section 3 of the Critical Health Problems and Comprehensive | 8 |
| Health Education Act. Course material and instruction shall be | 9 |
| free of bias in accordance with the nondiscrimination | 10 |
| provisions of the Illinois Human Rights Act. The State Board of | 11 |
| Education shall promulgate and enforce rules consistent with | 12 |
| this provision. | 13 |
| Section 35. Construction. This Act and the rules now or | 14 |
| hereafter applicable thereto shall be liberally construed | 15 |
| consistent with the public policies announced in this Act. | 16 |
| Section 40. Parental notice. Notwithstanding any other | 17 |
| provision of this Act, nothing in this Act shall be construed | 18 |
| to repeal, amend, or otherwise change the Illinois Parental | 19 |
| Notice of Abortion Act of 1995. To the extent that this Act | 20 |
| conflicts with the Illinois Parental Notice of Abortion Act of | 21 |
| 1995, the Illinois Parental Notice of Abortion Act of 1995 | 22 |
| controls. |
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| Section 45. Other Acts. Notwithstanding any other | 2 |
| provision of this Act, nothing in this Act shall be construed | 3 |
| to repeal, amend, or otherwise change the Health Care Right of | 4 |
| Conscience Act. To the extent that this Act conflicts with the | 5 |
| Health Care Right of Conscience Act, the Health Care Right of | 6 |
| Conscience Act controls. | 7 |
| Section 85. The State Employees Group Insurance Act of 1971 | 8 |
| is amended by changing Section 6 as follows:
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| (5 ILCS 375/6) (from Ch. 127, par. 526)
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| Sec. 6. Program of health benefits.
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| (a) The program of health benefits shall provide for | 12 |
| protection
against the financial costs of health care expenses | 13 |
| incurred in and out
of hospital including basic | 14 |
| hospital-surgical-medical coverages. The program
may include, | 15 |
| but shall not be limited to, such supplemental coverages as
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| out-patient diagnostic X-ray and laboratory expenses, | 17 |
| prescription drugs,
dental services, hearing evaluations, | 18 |
| hearing aids, the dispensing and
fitting
of hearing aids, and | 19 |
| similar group benefits
as are now or may become available. | 20 |
| However, nothing in this Act shall
be construed to permit, on | 21 |
| or after July 1, 1980, the non-contributory portion
of any such | 22 |
| program to include the expenses of obtaining an abortion, | 23 |
| induced
miscarriage or induced premature birth unless, in the | 24 |
| opinion of a physician,
such procedures are necessary for the |
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| preservation of the life of the woman
seeking such treatment, | 2 |
| or except an induced premature birth intended to
produce a live | 3 |
| viable child and such procedure is necessary for the health
of | 4 |
| the mother or the unborn child. The program may also include
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| coverage for those who rely on treatment by prayer or spiritual | 6 |
| means
alone for healing in accordance with the tenets and | 7 |
| practice of a
recognized religious denomination.
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| The program of health benefits shall be designed by the | 9 |
| Director
(1) to provide a reasonable relationship between the | 10 |
| benefits to be
included and the expected distribution of | 11 |
| expenses of each such type to
be incurred by the covered | 12 |
| members and dependents,
(2) to specify, as covered benefits and | 13 |
| as optional benefits, the
medical services of practitioners in | 14 |
| all categories licensed under the
Medical Practice Act of 1987, | 15 |
| (3) to include
reasonable controls, which may include | 16 |
| deductible and co-insurance
provisions, applicable to some or | 17 |
| all of the benefits, or a coordination
of benefits provision, | 18 |
| to prevent or minimize unnecessary utilization of
the various | 19 |
| hospital, surgical and medical expenses to be provided and
to | 20 |
| provide reasonable assurance of stability of the program, and | 21 |
| (4) to
provide benefits to the extent possible to members | 22 |
| throughout the
State, wherever located, on an equitable basis.
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| Notwithstanding any other provision of this Section or Act,
for | 24 |
| all members or dependents who are eligible for benefits under | 25 |
| Social
Security or the
Railroad Retirement system or who had | 26 |
| sufficient Medicare-covered government
employment,
the
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| Department shall reduce benefits
which would otherwise be paid | 2 |
| by Medicare, by the amount of benefits for
which the member or | 3 |
| dependents are eligible
under Medicare, except that such | 4 |
| reduction in benefits shall apply only to
those members or | 5 |
| dependents who (1) first become
eligible for such medicare | 6 |
| coverage on or after the effective date of this
amendatory Act | 7 |
| of 1992; or (2) are Medicare-eligible members or dependents of
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| a local government unit which began participation in the | 9 |
| program on or after
July 1, 1992; or (3) remain eligible for | 10 |
| but no longer receive
Medicare coverage which they had been | 11 |
| receiving on or after the effective date
of this amendatory Act | 12 |
| of 1992.
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| Notwithstanding any other provisions of this Act, where a | 14 |
| covered member or
dependents are eligible for benefits under | 15 |
| the federal Medicare health
insurance program (Title XVIII of | 16 |
| the Social Security Act as added by
Public Law 89-97, 89th | 17 |
| Congress), benefits paid under the State of Illinois
program or | 18 |
| plan will be reduced by the amount of benefits paid by | 19 |
| Medicare.
For members or dependents
who are eligible for | 20 |
| benefits under Social Security
or the Railroad Retirement | 21 |
| system or who had sufficient Medicare-covered
government | 22 |
| employment, benefits shall be reduced by the amount for which
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| the member or dependent is eligible under Medicare,
except that | 24 |
| such reduction in benefits shall apply only to those
members or | 25 |
| dependents who (1) first become eligible for such
Medicare | 26 |
| coverage on or after the effective date of this amendatory Act
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| of 1992; or (2) are Medicare-eligible members or dependents of | 2 |
| a local
government unit which began participation in the | 3 |
| program on or after July 1,
1992; or (3) remain eligible for, | 4 |
| but no longer receive Medicare
coverage which they had been | 5 |
| receiving on or after the effective date of this
amendatory Act | 6 |
| of 1992. Premiums may be adjusted, where applicable, to an
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| amount deemed by the Director to be reasonably consistent with | 8 |
| any reduction
of benefits.
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| (b) A member, not otherwise covered by this Act, who has | 10 |
| retired as a
participating member under Article 2 of the | 11 |
| Illinois Pension Code
but is ineligible for the retirement | 12 |
| annuity under Section 2-119 of the
Illinois
Pension Code, shall | 13 |
| pay the premiums for coverage, not
exceeding the amount paid by | 14 |
| the State for the non-contributory coverage for
other members, | 15 |
| under the group health benefits program under this Act. The
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| Director shall determine the premiums to be paid
by a member | 17 |
| under this subsection (b).
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| (Source: P.A. 93-47, eff. 7-1-03.)
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| Section 90. The Critical Health Problems and Comprehensive | 20 |
| Health
Education Act is amended by changing Section 3 as | 21 |
| follows:
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| (105 ILCS 110/3)
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| Sec. 3. Comprehensive Health Education Program. The | 24 |
| program established
under this Act shall include, but not be |
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| limited to, the following major
educational areas as a basis | 2 |
| for curricula in all elementary and secondary
schools in this | 3 |
| State: human ecology and health, human growth and
development, | 4 |
| the emotional, psychological, physiological, hygienic and
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| social responsibilities of family life, including sexual | 6 |
| abstinence until
marriage , prevention and control of disease, | 7 |
| including instruction in
grades 6 through 12 on the prevention, | 8 |
| transmission and spread of AIDS,
sexual assault awareness in | 9 |
| secondary schools, public and environmental health, consumer | 10 |
| health, safety education and
disaster survival, mental health | 11 |
| and illness, personal health habits,
alcohol, drug use, and | 12 |
| abuse including the medical and legal ramifications
of alcohol, | 13 |
| drug, and tobacco use, abuse during pregnancy, sexual
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| abstinence until marriage , tobacco, nutrition, and dental | 15 |
| health. The program shall also provide course material and | 16 |
| instruction to advise pupils of the Abandoned Newborn Infant | 17 |
| Protection Act.
The program shall include information about | 18 |
| cancer, including without limitation types of cancer, signs and | 19 |
| symptoms, risk factors, the importance of early prevention and | 20 |
| detection, and information on where to go for help. | 21 |
| Notwithstanding the above educational areas, the following | 22 |
| areas may also
be included as a basis for curricula in all | 23 |
| elementary and secondary
schools in this State: basic first aid | 24 |
| (including, but not limited to,
cardiopulmonary resuscitation | 25 |
| and the Heimlich maneuver), heart disease, diabetes, stroke, | 26 |
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prevention of child abuse, neglect, and suicide, and teen |
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| dating violence in grades 8 through 12. | 2 |
| The school board of each
public elementary and secondary | 3 |
| school in the State
shall encourage all teachers and other | 4 |
| school personnel to acquire,
develop, and maintain the | 5 |
| knowledge and skills necessary to properly
administer | 6 |
| life-saving techniques, including without limitation the
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| Heimlich maneuver and rescue breathing.
The training shall be | 8 |
| in
accordance with standards of the
American Red Cross, the | 9 |
| American Heart Association, or another nationally
recognized | 10 |
| certifying organization.
A school board may use the
services of | 11 |
| non-governmental entities whose personnel have expertise in
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| life-saving techniques to instruct teachers and other school | 13 |
| personnel in
these techniques. Each school board
is encouraged | 14 |
| to have in
its employ, or on its volunteer staff, at least one | 15 |
| person who is certified, by
the American Red Cross or by | 16 |
| another qualified certifying agency,
as qualified to | 17 |
| administer first aid and
cardiopulmonary resuscitation. In | 18 |
| addition, each school board is authorized to
allocate | 19 |
| appropriate portions of its institute or inservice days to | 20 |
| conduct
training programs for teachers and other school | 21 |
| personnel who have expressed an
interest in becoming qualified | 22 |
| to administer emergency first aid or
cardiopulmonary | 23 |
| resuscitation. School boards are urged to
encourage their | 24 |
| teachers and other school personnel who coach school athletic
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| programs and other extracurricular school activities to | 26 |
| acquire, develop, and
maintain the knowledge and skills |
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| necessary to properly administer first aid
and cardiopulmonary | 2 |
| resuscitation in accordance with standards and requirements
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| established by the American Red Cross or another qualified | 4 |
| certifying agency. Subject to appropriation, the State Board of | 5 |
| Education shall establish and administer a matching grant | 6 |
| program to pay for half of the cost that a school district | 7 |
| incurs in training those teachers and other school personnel | 8 |
| who express an interest in becoming qualified to administer | 9 |
| cardiopulmonary resuscitation (which training must be in
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| accordance with standards of the
American Red Cross, the | 11 |
| American Heart Association, or another nationally
recognized | 12 |
| certifying organization) or in learning how to use an automated | 13 |
| external defibrillator. A school district that applies for a | 14 |
| grant must demonstrate that it has funds to pay half of the | 15 |
| cost of the training for which matching grant money is sought. | 16 |
| The State Board of Education shall award the grants on a | 17 |
| first-come, first-serve basis.
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| No pupil shall be
required to take or participate in any | 19 |
| class or course on comprehensive sexual health education, AIDS , | 20 |
| or family
life instruction if his parent or guardian submits | 21 |
| written objection
thereto, and refusal to take or participate | 22 |
| in the course or program shall
not be reason for suspension or | 23 |
| expulsion of the pupil.
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| Curricula developed under programs established in | 25 |
| accordance with this
Act in the major educational area of | 26 |
| alcohol and drug use and abuse shall
include classroom |
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| instruction in grades 5 through 12. The instruction,
which | 2 |
| shall include matters relating to both the physical and legal | 3 |
| effects
and ramifications of drug and substance abuse, shall be | 4 |
| integrated into
existing curricula; and the State Board of | 5 |
| Education shall develop and make
available to all elementary | 6 |
| and secondary schools in this State
instructional materials and | 7 |
| guidelines which will assist the schools in
incorporating the | 8 |
| instruction into their existing curricula. In
addition, school | 9 |
| districts may offer, as part of existing curricula during
the | 10 |
| school day or as part of an after school program, support | 11 |
| services and
instruction for pupils or pupils whose parent, | 12 |
| parents, or guardians are
chemically dependent.
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| (Source: P.A. 95-43, eff. 1-1-08; 95-764, eff. 1-1-09; 96-128, | 14 |
| eff. 1-1-10; 96-328, eff. 8-11-09; 96-383, eff. 1-1-10; revised | 15 |
| 9-25-09.)
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| Section 95. The Illinois Public Aid Code is amended by | 17 |
| changing Section 5-5 as follows: | 18 |
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
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| (Text of Section before amendment by P.A. 96-806 ) | 20 |
| Sec. 5-5. Medical services. The Illinois Department, by | 21 |
| rule, shall
determine the quantity and quality of and the rate | 22 |
| of reimbursement for the
medical assistance for which
payment | 23 |
| will be authorized, and the medical services to be provided,
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| which may include all or part of the following: (1) inpatient |
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| hospital
services; (2) outpatient hospital services; (3) other | 2 |
| laboratory and
X-ray services; (4) skilled nursing home | 3 |
| services; (5) physicians'
services whether furnished in the | 4 |
| office, the patient's home, a
hospital, a skilled nursing home, | 5 |
| or elsewhere; (6) medical care, or any
other type of remedial | 6 |
| care furnished by licensed practitioners; (7)
home health care | 7 |
| services; (8) private duty nursing service; (9) clinic
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| services; (10) dental services, including prevention and | 9 |
| treatment of periodontal disease and dental caries disease for | 10 |
| pregnant women, provided by an individual licensed to practice | 11 |
| dentistry or dental surgery; for purposes of this item (10), | 12 |
| "dental services" means diagnostic, preventive, or corrective | 13 |
| procedures provided by or under the supervision of a dentist in | 14 |
| the practice of his or her profession; (11) physical therapy | 15 |
| and related
services; (12) prescribed drugs, dentures, and | 16 |
| prosthetic devices; and
eyeglasses prescribed by a physician | 17 |
| skilled in the diseases of the eye,
or by an optometrist, | 18 |
| whichever the person may select; (13) other
diagnostic, | 19 |
| screening, preventive, and rehabilitative services; (14)
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| transportation and such other expenses as may be necessary; | 21 |
| (15) medical
treatment of sexual assault survivors, as defined | 22 |
| in
Section 1a of the Sexual Assault Survivors Emergency | 23 |
| Treatment Act, for
injuries sustained as a result of the sexual | 24 |
| assault, including
examinations and laboratory tests to | 25 |
| discover evidence which may be used in
criminal proceedings | 26 |
| arising from the sexual assault; (16) the
diagnosis and |
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| treatment of sickle cell anemia; and (17)
any other medical | 2 |
| care, and any other type of remedial care recognized
under the | 3 |
| laws of this State , but not including abortions, or induced
| 4 |
| miscarriages or premature births, unless, in the opinion of a | 5 |
| physician,
such procedures are necessary for the preservation | 6 |
| of the life of the
woman seeking such treatment, or except an | 7 |
| induced premature birth
intended to produce a live viable child | 8 |
| and such procedure is necessary
for the health of the mother or | 9 |
| her unborn child . The Illinois Department,
by rule, shall | 10 |
| prohibit any physician from providing medical assistance
to | 11 |
| anyone eligible therefor under this Code where such physician | 12 |
| has been
found guilty of performing an abortion procedure in a | 13 |
| wilful and wanton
manner upon a woman who was not pregnant at | 14 |
| the time such abortion
procedure was performed. The term "any | 15 |
| other type of remedial care" shall
include nursing care and | 16 |
| nursing home service for persons who rely on
treatment by | 17 |
| spiritual means alone through prayer for healing.
| 18 |
| Notwithstanding any other provision of this Section, a | 19 |
| comprehensive
tobacco use cessation program that includes | 20 |
| purchasing prescription drugs or
prescription medical devices | 21 |
| approved by the Food and Drug administration shall
be covered | 22 |
| under the medical assistance
program under this Article for | 23 |
| persons who are otherwise eligible for
assistance under this | 24 |
| Article.
| 25 |
| Notwithstanding any other provision of this Code, the | 26 |
| Illinois
Department may not require, as a condition of payment |
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| for any laboratory
test authorized under this Article, that a | 2 |
| physician's handwritten signature
appear on the laboratory | 3 |
| test order form. The Illinois Department may,
however, impose | 4 |
| other appropriate requirements regarding laboratory test
order | 5 |
| documentation.
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| The Department of Healthcare and Family Services shall | 7 |
| provide the following services to
persons
eligible for | 8 |
| assistance under this Article who are participating in
| 9 |
| education, training or employment programs operated by the | 10 |
| Department of Human
Services as successor to the Department of | 11 |
| Public Aid:
| 12 |
| (1) dental services provided by or under the | 13 |
| supervision of a dentist; and
| 14 |
| (2) eyeglasses prescribed by a physician skilled in the | 15 |
| diseases of the
eye, or by an optometrist, whichever the | 16 |
| person may select.
| 17 |
| The Illinois Department, by rule, may distinguish and | 18 |
| classify the
medical services to be provided only in accordance | 19 |
| with the classes of
persons designated in Section 5-2.
| 20 |
| The Department of Healthcare and Family Services must | 21 |
| provide coverage and reimbursement for amino acid-based | 22 |
| elemental formulas, regardless of delivery method, for the | 23 |
| diagnosis and treatment of (i) eosinophilic disorders and (ii) | 24 |
| short bowel syndrome when the prescribing physician has issued | 25 |
| a written order stating that the amino acid-based elemental | 26 |
| formula is medically necessary.
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| The Illinois Department shall authorize the provision of, | 2 |
| and shall
authorize payment for, screening by low-dose | 3 |
| mammography for the presence of
occult breast cancer for women | 4 |
| 35 years of age or older who are eligible
for medical | 5 |
| assistance under this Article, as follows: | 6 |
| (A) A baseline
mammogram for women 35 to 39 years of | 7 |
| age.
| 8 |
| (B) An annual mammogram for women 40 years of age or | 9 |
| older. | 10 |
| (C) A mammogram at the age and intervals considered | 11 |
| medically necessary by the woman's health care provider for | 12 |
| women under 40 years of age and having a family history of | 13 |
| breast cancer, prior personal history of breast cancer, | 14 |
| positive genetic testing, or other risk factors. | 15 |
| (D) A comprehensive ultrasound screening of an entire | 16 |
| breast or breasts if a mammogram demonstrates | 17 |
| heterogeneous or dense breast tissue, when medically | 18 |
| necessary as determined by a physician licensed to practice | 19 |
| medicine in all of its branches. | 20 |
| All screenings
shall
include a physical breast exam, | 21 |
| instruction on self-examination and
information regarding the | 22 |
| frequency of self-examination and its value as a
preventative | 23 |
| tool. For purposes of this Section, "low-dose mammography" | 24 |
| means
the x-ray examination of the breast using equipment | 25 |
| dedicated specifically
for mammography, including the x-ray | 26 |
| tube, filter, compression device,
and image receptor, with an |
|
|
|
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| 1 |
| average radiation exposure delivery
of less than one rad per | 2 |
| breast for 2 views of an average size breast.
The term also | 3 |
| includes digital mammography.
| 4 |
| On and after July 1, 2008, screening and diagnostic | 5 |
| mammography shall be reimbursed at the same rate as the | 6 |
| Medicare program's rates, including the increased | 7 |
| reimbursement for digital mammography. | 8 |
| The Department shall convene an expert panel including | 9 |
| representatives of hospitals, free-standing mammography | 10 |
| facilities, and doctors, including radiologists, to establish | 11 |
| quality standards. Based on these quality standards, the | 12 |
| Department shall provide for bonus payments to mammography | 13 |
| facilities meeting the standards for screening and diagnosis. | 14 |
| The bonus payments shall be at least 15% higher than the | 15 |
| Medicare rates for mammography. | 16 |
| Subject to federal approval, the Department shall | 17 |
| establish a rate methodology for mammography at federally | 18 |
| qualified health centers and other encounter-rate clinics. | 19 |
| These clinics or centers may also collaborate with other | 20 |
| hospital-based mammography facilities. | 21 |
| The Department shall establish a methodology to remind | 22 |
| women who are age-appropriate for screening mammography, but | 23 |
| who have not received a mammogram within the previous 18 | 24 |
| months, of the importance and benefit of screening mammography. | 25 |
| The Department shall establish a performance goal for | 26 |
| primary care providers with respect to their female patients |
|
|
|
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| 1 |
| over age 40 receiving an annual mammogram. This performance | 2 |
| goal shall be used to provide additional reimbursement in the | 3 |
| form of a quality performance bonus to primary care providers | 4 |
| who meet that goal. | 5 |
| The Department shall devise a means of case-managing or | 6 |
| patient navigation for beneficiaries diagnosed with breast | 7 |
| cancer. This program shall initially operate as a pilot program | 8 |
| in areas of the State with the highest incidence of mortality | 9 |
| related to breast cancer. At least one pilot program site shall | 10 |
| be in the metropolitan Chicago area and at least one site shall | 11 |
| be outside the metropolitan Chicago area. An evaluation of the | 12 |
| pilot program shall be carried out measuring health outcomes | 13 |
| and cost of care for those served by the pilot program compared | 14 |
| to similarly situated patients who are not served by the pilot | 15 |
| program. | 16 |
| Any medical or health care provider shall immediately | 17 |
| recommend, to
any pregnant woman who is being provided prenatal | 18 |
| services and is suspected
of drug abuse or is addicted as | 19 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | 20 |
| Act, referral to a local substance abuse treatment provider
| 21 |
| licensed by the Department of Human Services or to a licensed
| 22 |
| hospital which provides substance abuse treatment services. | 23 |
| The Department of Healthcare and Family Services
shall assure | 24 |
| coverage for the cost of treatment of the drug abuse or
| 25 |
| addiction for pregnant recipients in accordance with the | 26 |
| Illinois Medicaid
Program in conjunction with the Department of |
|
|
|
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| 1 |
| Human Services.
| 2 |
| All medical providers providing medical assistance to | 3 |
| pregnant women
under this Code shall receive information from | 4 |
| the Department on the
availability of services under the Drug | 5 |
| Free Families with a Future or any
comparable program providing | 6 |
| case management services for addicted women,
including | 7 |
| information on appropriate referrals for other social services
| 8 |
| that may be needed by addicted women in addition to treatment | 9 |
| for addiction.
| 10 |
| The Illinois Department, in cooperation with the | 11 |
| Departments of Human
Services (as successor to the Department | 12 |
| of Alcoholism and Substance
Abuse) and Public Health, through a | 13 |
| public awareness campaign, may
provide information concerning | 14 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 15 |
| health care, and other pertinent programs directed at
reducing | 16 |
| the number of drug-affected infants born to recipients of | 17 |
| medical
assistance.
| 18 |
| Neither the Department of Healthcare and Family Services | 19 |
| nor the Department of Human
Services shall sanction the | 20 |
| recipient solely on the basis of
her substance abuse.
| 21 |
| The Illinois Department shall establish such regulations | 22 |
| governing
the dispensing of health services under this Article | 23 |
| as it shall deem
appropriate. The Department
should
seek the | 24 |
| advice of formal professional advisory committees appointed by
| 25 |
| the Director of the Illinois Department for the purpose of | 26 |
| providing regular
advice on policy and administrative matters, |
|
|
|
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| 1 |
| information dissemination and
educational activities for | 2 |
| medical and health care providers, and
consistency in | 3 |
| procedures to the Illinois Department.
| 4 |
| The Illinois Department may develop and contract with | 5 |
| Partnerships of
medical providers to arrange medical services | 6 |
| for persons eligible under
Section 5-2 of this Code. | 7 |
| Implementation of this Section may be by
demonstration projects | 8 |
| in certain geographic areas. The Partnership shall
be | 9 |
| represented by a sponsor organization. The Department, by rule, | 10 |
| shall
develop qualifications for sponsors of Partnerships. | 11 |
| Nothing in this
Section shall be construed to require that the | 12 |
| sponsor organization be a
medical organization.
| 13 |
| The sponsor must negotiate formal written contracts with | 14 |
| medical
providers for physician services, inpatient and | 15 |
| outpatient hospital care,
home health services, treatment for | 16 |
| alcoholism and substance abuse, and
other services determined | 17 |
| necessary by the Illinois Department by rule for
delivery by | 18 |
| Partnerships. Physician services must include prenatal and
| 19 |
| obstetrical care. The Illinois Department shall reimburse | 20 |
| medical services
delivered by Partnership providers to clients | 21 |
| in target areas according to
provisions of this Article and the | 22 |
| Illinois Health Finance Reform Act,
except that:
| 23 |
| (1) Physicians participating in a Partnership and | 24 |
| providing certain
services, which shall be determined by | 25 |
| the Illinois Department, to persons
in areas covered by the | 26 |
| Partnership may receive an additional surcharge
for such |
|
|
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| 1 |
| services.
| 2 |
| (2) The Department may elect to consider and negotiate | 3 |
| financial
incentives to encourage the development of | 4 |
| Partnerships and the efficient
delivery of medical care.
| 5 |
| (3) Persons receiving medical services through | 6 |
| Partnerships may receive
medical and case management | 7 |
| services above the level usually offered
through the | 8 |
| medical assistance program.
| 9 |
| Medical providers shall be required to meet certain | 10 |
| qualifications to
participate in Partnerships to ensure the | 11 |
| delivery of high quality medical
services. These | 12 |
| qualifications shall be determined by rule of the Illinois
| 13 |
| Department and may be higher than qualifications for | 14 |
| participation in the
medical assistance program. Partnership | 15 |
| sponsors may prescribe reasonable
additional qualifications | 16 |
| for participation by medical providers, only with
the prior | 17 |
| written approval of the Illinois Department.
| 18 |
| Nothing in this Section shall limit the free choice of | 19 |
| practitioners,
hospitals, and other providers of medical | 20 |
| services by clients.
In order to ensure patient freedom of | 21 |
| choice, the Illinois Department shall
immediately promulgate | 22 |
| all rules and take all other necessary actions so that
provided | 23 |
| services may be accessed from therapeutically certified | 24 |
| optometrists
to the full extent of the Illinois Optometric | 25 |
| Practice Act of 1987 without
discriminating between service | 26 |
| providers.
|
|
|
|
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| 1 |
| The Department shall apply for a waiver from the United | 2 |
| States Health
Care Financing Administration to allow for the | 3 |
| implementation of
Partnerships under this Section.
| 4 |
| The Illinois Department shall require health care | 5 |
| providers to maintain
records that document the medical care | 6 |
| and services provided to recipients
of Medical Assistance under | 7 |
| this Article. The Illinois Department shall
require health care | 8 |
| providers to make available, when authorized by the
patient, in | 9 |
| writing, the medical records in a timely fashion to other
| 10 |
| health care providers who are treating or serving persons | 11 |
| eligible for
Medical Assistance under this Article. All | 12 |
| dispensers of medical services
shall be required to maintain | 13 |
| and retain business and professional records
sufficient to | 14 |
| fully and accurately document the nature, scope, details and
| 15 |
| receipt of the health care provided to persons eligible for | 16 |
| medical
assistance under this Code, in accordance with | 17 |
| regulations promulgated by
the Illinois Department. The rules | 18 |
| and regulations shall require that proof
of the receipt of | 19 |
| prescription drugs, dentures, prosthetic devices and
| 20 |
| eyeglasses by eligible persons under this Section accompany | 21 |
| each claim
for reimbursement submitted by the dispenser of such | 22 |
| medical services.
No such claims for reimbursement shall be | 23 |
| approved for payment by the Illinois
Department without such | 24 |
| proof of receipt, unless the Illinois Department
shall have put | 25 |
| into effect and shall be operating a system of post-payment
| 26 |
| audit and review which shall, on a sampling basis, be deemed |
|
|
|
HB6205 Engrossed |
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| 1 |
| adequate by
the Illinois Department to assure that such drugs, | 2 |
| dentures, prosthetic
devices and eyeglasses for which payment | 3 |
| is being made are actually being
received by eligible | 4 |
| recipients. Within 90 days after the effective date of
this | 5 |
| amendatory Act of 1984, the Illinois Department shall establish | 6 |
| a
current list of acquisition costs for all prosthetic devices | 7 |
| and any
other items recognized as medical equipment and | 8 |
| supplies reimbursable under
this Article and shall update such | 9 |
| list on a quarterly basis, except that
the acquisition costs of | 10 |
| all prescription drugs shall be updated no
less frequently than | 11 |
| every 30 days as required by Section 5-5.12.
| 12 |
| The rules and regulations of the Illinois Department shall | 13 |
| require
that a written statement including the required opinion | 14 |
| of a physician
shall accompany any claim for reimbursement for | 15 |
| abortions, or induced
miscarriages or premature births. This | 16 |
| statement shall indicate what
procedures were used in providing | 17 |
| such medical services.
| 18 |
| The Illinois Department shall require all dispensers of | 19 |
| medical
services, other than an individual practitioner or | 20 |
| group of practitioners,
desiring to participate in the Medical | 21 |
| Assistance program
established under this Article to disclose | 22 |
| all financial, beneficial,
ownership, equity, surety or other | 23 |
| interests in any and all firms,
corporations, partnerships, | 24 |
| associations, business enterprises, joint
ventures, agencies, | 25 |
| institutions or other legal entities providing any
form of | 26 |
| health care services in this State under this Article.
|
|
|
|
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| 1 |
| The Illinois Department may require that all dispensers of | 2 |
| medical
services desiring to participate in the medical | 3 |
| assistance program
established under this Article disclose, | 4 |
| under such terms and conditions as
the Illinois Department may | 5 |
| by rule establish, all inquiries from clients
and attorneys | 6 |
| regarding medical bills paid by the Illinois Department, which
| 7 |
| inquiries could indicate potential existence of claims or liens | 8 |
| for the
Illinois Department.
| 9 |
| Enrollment of a vendor that provides non-emergency medical | 10 |
| transportation,
defined by the Department by rule,
shall be
| 11 |
| conditional for 180 days. During that time, the Department of | 12 |
| Healthcare and Family Services may
terminate the vendor's | 13 |
| eligibility to participate in the medical assistance
program | 14 |
| without cause. That termination of eligibility is not subject | 15 |
| to the
Department's hearing process.
| 16 |
| The Illinois Department shall establish policies, | 17 |
| procedures,
standards and criteria by rule for the acquisition, | 18 |
| repair and replacement
of orthotic and prosthetic devices and | 19 |
| durable medical equipment. Such
rules shall provide, but not be | 20 |
| limited to, the following services: (1)
immediate repair or | 21 |
| replacement of such devices by recipients without
medical | 22 |
| authorization; and (2) rental, lease, purchase or | 23 |
| lease-purchase of
durable medical equipment in a | 24 |
| cost-effective manner, taking into
consideration the | 25 |
| recipient's medical prognosis, the extent of the
recipient's | 26 |
| needs, and the requirements and costs for maintaining such
|
|
|
|
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|
| 1 |
| equipment. Such rules shall enable a recipient to temporarily | 2 |
| acquire and
use alternative or substitute devices or equipment | 3 |
| pending repairs or
replacements of any device or equipment | 4 |
| previously authorized for such
recipient by the Department.
| 5 |
| The Department shall execute, relative to the nursing home | 6 |
| prescreening
project, written inter-agency agreements with the | 7 |
| Department of Human
Services and the Department on Aging, to | 8 |
| effect the following: (i) intake
procedures and common | 9 |
| eligibility criteria for those persons who are receiving
| 10 |
| non-institutional services; and (ii) the establishment and | 11 |
| development of
non-institutional services in areas of the State | 12 |
| where they are not currently
available or are undeveloped.
| 13 |
| The Illinois Department shall develop and operate, in | 14 |
| cooperation
with other State Departments and agencies and in | 15 |
| compliance with
applicable federal laws and regulations, | 16 |
| appropriate and effective
systems of health care evaluation and | 17 |
| programs for monitoring of
utilization of health care services | 18 |
| and facilities, as it affects
persons eligible for medical | 19 |
| assistance under this Code.
| 20 |
| The Illinois Department shall report annually to the | 21 |
| General Assembly,
no later than the second Friday in April of | 22 |
| 1979 and each year
thereafter, in regard to:
| 23 |
| (a) actual statistics and trends in utilization of | 24 |
| medical services by
public aid recipients;
| 25 |
| (b) actual statistics and trends in the provision of | 26 |
| the various medical
services by medical vendors;
|
|
|
|
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| 1 |
| (c) current rate structures and proposed changes in | 2 |
| those rate structures
for the various medical vendors; and
| 3 |
| (d) efforts at utilization review and control by the | 4 |
| Illinois Department.
| 5 |
| The period covered by each report shall be the 3 years | 6 |
| ending on the June
30 prior to the report. The report shall | 7 |
| include suggested legislation
for consideration by the General | 8 |
| Assembly. The filing of one copy of the
report with the | 9 |
| Speaker, one copy with the Minority Leader and one copy
with | 10 |
| the Clerk of the House of Representatives, one copy with the | 11 |
| President,
one copy with the Minority Leader and one copy with | 12 |
| the Secretary of the
Senate, one copy with the Legislative | 13 |
| Research Unit, and such additional
copies
with the State | 14 |
| Government Report Distribution Center for the General
Assembly | 15 |
| as is required under paragraph (t) of Section 7 of the State
| 16 |
| Library Act shall be deemed sufficient to comply with this | 17 |
| Section.
| 18 |
| Rulemaking authority to implement Public Act 95-1045 this | 19 |
| amendatory Act of the 95th General Assembly , if any, is | 20 |
| conditioned on the rules being adopted in accordance with all | 21 |
| provisions of the Illinois Administrative Procedure Act and all | 22 |
| rules and procedures of the Joint Committee on Administrative | 23 |
| Rules; any purported rule not so adopted, for whatever reason, | 24 |
| is unauthorized. | 25 |
| (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07; | 26 |
| 95-1045, eff. 3-27-09; 96-156, eff. 1-1-10; revised 11-4-09.)
|
|
|
|
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|
| 1 |
| (Text of Section after amendment by P.A. 96-806 ) | 2 |
| Sec. 5-5. Medical services. The Illinois Department, by | 3 |
| rule, shall
determine the quantity and quality of and the rate | 4 |
| of reimbursement for the
medical assistance for which
payment | 5 |
| will be authorized, and the medical services to be provided,
| 6 |
| which may include all or part of the following: (1) inpatient | 7 |
| hospital
services; (2) outpatient hospital services; (3) other | 8 |
| laboratory and
X-ray services; (4) skilled nursing home | 9 |
| services; (5) physicians'
services whether furnished in the | 10 |
| office, the patient's home, a
hospital, a skilled nursing home, | 11 |
| or elsewhere; (6) medical care, or any
other type of remedial | 12 |
| care furnished by licensed practitioners; (7)
home health care | 13 |
| services; (8) private duty nursing service; (9) clinic
| 14 |
| services; (10) dental services, including prevention and | 15 |
| treatment of periodontal disease and dental caries disease for | 16 |
| pregnant women, provided by an individual licensed to practice | 17 |
| dentistry or dental surgery; for purposes of this item (10), | 18 |
| "dental services" means diagnostic, preventive, or corrective | 19 |
| procedures provided by or under the supervision of a dentist in | 20 |
| the practice of his or her profession; (11) physical therapy | 21 |
| and related
services; (12) prescribed drugs, dentures, and | 22 |
| prosthetic devices; and
eyeglasses prescribed by a physician | 23 |
| skilled in the diseases of the eye,
or by an optometrist, | 24 |
| whichever the person may select; (13) other
diagnostic, | 25 |
| screening, preventive, and rehabilitative services; (14)
|
|
|
|
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| 1 |
| transportation and such other expenses as may be necessary; | 2 |
| (15) medical
treatment of sexual assault survivors, as defined | 3 |
| in
Section 1a of the Sexual Assault Survivors Emergency | 4 |
| Treatment Act, for
injuries sustained as a result of the sexual | 5 |
| assault, including
examinations and laboratory tests to | 6 |
| discover evidence which may be used in
criminal proceedings | 7 |
| arising from the sexual assault; (16) the
diagnosis and | 8 |
| treatment of sickle cell anemia; and (17)
any other medical | 9 |
| care, and any other type of remedial care recognized
under the | 10 |
| laws of this State , but not including abortions, or induced
| 11 |
| miscarriages or premature births, unless, in the opinion of a | 12 |
| physician,
such procedures are necessary for the preservation | 13 |
| of the life of the
woman seeking such treatment, or except an | 14 |
| induced premature birth
intended to produce a live viable child | 15 |
| and such procedure is necessary
for the health of the mother or | 16 |
| her unborn child . The Illinois Department,
by rule, shall | 17 |
| prohibit any physician from providing medical assistance
to | 18 |
| anyone eligible therefor under this Code where such physician | 19 |
| has been
found guilty of performing an abortion procedure in a | 20 |
| wilful and wanton
manner upon a woman who was not pregnant at | 21 |
| the time such abortion
procedure was performed. The term "any | 22 |
| other type of remedial care" shall
include nursing care and | 23 |
| nursing home service for persons who rely on
treatment by | 24 |
| spiritual means alone through prayer for healing.
| 25 |
| Notwithstanding any other provision of this Section, a | 26 |
| comprehensive
tobacco use cessation program that includes |
|
|
|
HB6205 Engrossed |
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| 1 |
| purchasing prescription drugs or
prescription medical devices | 2 |
| approved by the Food and Drug administration shall
be covered | 3 |
| under the medical assistance
program under this Article for | 4 |
| persons who are otherwise eligible for
assistance under this | 5 |
| Article.
| 6 |
| Notwithstanding any other provision of this Code, the | 7 |
| Illinois
Department may not require, as a condition of payment | 8 |
| for any laboratory
test authorized under this Article, that a | 9 |
| physician's handwritten signature
appear on the laboratory | 10 |
| test order form. The Illinois Department may,
however, impose | 11 |
| other appropriate requirements regarding laboratory test
order | 12 |
| documentation.
| 13 |
| The Department of Healthcare and Family Services shall | 14 |
| provide the following services to
persons
eligible for | 15 |
| assistance under this Article who are participating in
| 16 |
| education, training or employment programs operated by the | 17 |
| Department of Human
Services as successor to the Department of | 18 |
| Public Aid:
| 19 |
| (1) dental services provided by or under the | 20 |
| supervision of a dentist; and
| 21 |
| (2) eyeglasses prescribed by a physician skilled in the | 22 |
| diseases of the
eye, or by an optometrist, whichever the | 23 |
| person may select.
| 24 |
| The Illinois Department, by rule, may distinguish and | 25 |
| classify the
medical services to be provided only in accordance | 26 |
| with the classes of
persons designated in Section 5-2.
|
|
|
|
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| 1 |
| The Department of Healthcare and Family Services must | 2 |
| provide coverage and reimbursement for amino acid-based | 3 |
| elemental formulas, regardless of delivery method, for the | 4 |
| diagnosis and treatment of (i) eosinophilic disorders and (ii) | 5 |
| short bowel syndrome when the prescribing physician has issued | 6 |
| a written order stating that the amino acid-based elemental | 7 |
| formula is medically necessary.
| 8 |
| The Illinois Department shall authorize the provision of, | 9 |
| and shall
authorize payment for, screening by low-dose | 10 |
| mammography for the presence of
occult breast cancer for women | 11 |
| 35 years of age or older who are eligible
for medical | 12 |
| assistance under this Article, as follows: | 13 |
| (A) A baseline
mammogram for women 35 to 39 years of | 14 |
| age.
| 15 |
| (B) An annual mammogram for women 40 years of age or | 16 |
| older. | 17 |
| (C) A mammogram at the age and intervals considered | 18 |
| medically necessary by the woman's health care provider for | 19 |
| women under 40 years of age and having a family history of | 20 |
| breast cancer, prior personal history of breast cancer, | 21 |
| positive genetic testing, or other risk factors. | 22 |
| (D) A comprehensive ultrasound screening of an entire | 23 |
| breast or breasts if a mammogram demonstrates | 24 |
| heterogeneous or dense breast tissue, when medically | 25 |
| necessary as determined by a physician licensed to practice | 26 |
| medicine in all of its branches. |
|
|
|
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|
| 1 |
| All screenings
shall
include a physical breast exam, | 2 |
| instruction on self-examination and
information regarding the | 3 |
| frequency of self-examination and its value as a
preventative | 4 |
| tool. For purposes of this Section, "low-dose mammography" | 5 |
| means
the x-ray examination of the breast using equipment | 6 |
| dedicated specifically
for mammography, including the x-ray | 7 |
| tube, filter, compression device,
and image receptor, with an | 8 |
| average radiation exposure delivery
of less than one rad per | 9 |
| breast for 2 views of an average size breast.
The term also | 10 |
| includes digital mammography.
| 11 |
| On and after July 1, 2008, screening and diagnostic | 12 |
| mammography shall be reimbursed at the same rate as the | 13 |
| Medicare program's rates, including the increased | 14 |
| reimbursement for digital mammography. | 15 |
| The Department shall convene an expert panel including | 16 |
| representatives of hospitals, free-standing mammography | 17 |
| facilities, and doctors, including radiologists, to establish | 18 |
| quality standards. Based on these quality standards, the | 19 |
| Department shall provide for bonus payments to mammography | 20 |
| facilities meeting the standards for screening and diagnosis. | 21 |
| The bonus payments shall be at least 15% higher than the | 22 |
| Medicare rates for mammography. | 23 |
| Subject to federal approval, the Department shall | 24 |
| establish a rate methodology for mammography at federally | 25 |
| qualified health centers and other encounter-rate clinics. | 26 |
| These clinics or centers may also collaborate with other |
|
|
|
HB6205 Engrossed |
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LRB096 20273 RPM 35870 b |
|
| 1 |
| hospital-based mammography facilities. | 2 |
| The Department shall establish a methodology to remind | 3 |
| women who are age-appropriate for screening mammography, but | 4 |
| who have not received a mammogram within the previous 18 | 5 |
| months, of the importance and benefit of screening mammography. | 6 |
| The Department shall establish a performance goal for | 7 |
| primary care providers with respect to their female patients | 8 |
| over age 40 receiving an annual mammogram. This performance | 9 |
| goal shall be used to provide additional reimbursement in the | 10 |
| form of a quality performance bonus to primary care providers | 11 |
| who meet that goal. | 12 |
| The Department shall devise a means of case-managing or | 13 |
| patient navigation for beneficiaries diagnosed with breast | 14 |
| cancer. This program shall initially operate as a pilot program | 15 |
| in areas of the State with the highest incidence of mortality | 16 |
| related to breast cancer. At least one pilot program site shall | 17 |
| be in the metropolitan Chicago area and at least one site shall | 18 |
| be outside the metropolitan Chicago area. An evaluation of the | 19 |
| pilot program shall be carried out measuring health outcomes | 20 |
| and cost of care for those served by the pilot program compared | 21 |
| to similarly situated patients who are not served by the pilot | 22 |
| program. | 23 |
| Any medical or health care provider shall immediately | 24 |
| recommend, to
any pregnant woman who is being provided prenatal | 25 |
| services and is suspected
of drug abuse or is addicted as | 26 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency |
|
|
|
HB6205 Engrossed |
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LRB096 20273 RPM 35870 b |
|
| 1 |
| Act, referral to a local substance abuse treatment provider
| 2 |
| licensed by the Department of Human Services or to a licensed
| 3 |
| hospital which provides substance abuse treatment services. | 4 |
| The Department of Healthcare and Family Services
shall assure | 5 |
| coverage for the cost of treatment of the drug abuse or
| 6 |
| addiction for pregnant recipients in accordance with the | 7 |
| Illinois Medicaid
Program in conjunction with the Department of | 8 |
| Human Services.
| 9 |
| All medical providers providing medical assistance to | 10 |
| pregnant women
under this Code shall receive information from | 11 |
| the Department on the
availability of services under the Drug | 12 |
| Free Families with a Future or any
comparable program providing | 13 |
| case management services for addicted women,
including | 14 |
| information on appropriate referrals for other social services
| 15 |
| that may be needed by addicted women in addition to treatment | 16 |
| for addiction.
| 17 |
| The Illinois Department, in cooperation with the | 18 |
| Departments of Human
Services (as successor to the Department | 19 |
| of Alcoholism and Substance
Abuse) and Public Health, through a | 20 |
| public awareness campaign, may
provide information concerning | 21 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 22 |
| health care, and other pertinent programs directed at
reducing | 23 |
| the number of drug-affected infants born to recipients of | 24 |
| medical
assistance.
| 25 |
| Neither the Department of Healthcare and Family Services | 26 |
| nor the Department of Human
Services shall sanction the |
|
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| recipient solely on the basis of
her substance abuse.
| 2 |
| The Illinois Department shall establish such regulations | 3 |
| governing
the dispensing of health services under this Article | 4 |
| as it shall deem
appropriate. The Department
should
seek the | 5 |
| advice of formal professional advisory committees appointed by
| 6 |
| the Director of the Illinois Department for the purpose of | 7 |
| providing regular
advice on policy and administrative matters, | 8 |
| information dissemination and
educational activities for | 9 |
| medical and health care providers, and
consistency in | 10 |
| procedures to the Illinois Department.
| 11 |
| Notwithstanding any other provision of law, a health care | 12 |
| provider under the medical assistance program may elect, in | 13 |
| lieu of receiving direct payment for services provided under | 14 |
| that program, to participate in the State Employees Deferred | 15 |
| Compensation Plan adopted under Article 24 of the Illinois | 16 |
| Pension Code. A health care provider who elects to participate | 17 |
| in the plan does not have a cause of action against the State | 18 |
| for any damages allegedly suffered by the provider as a result | 19 |
| of any delay by the State in crediting the amount of any | 20 |
| contribution to the provider's plan account. | 21 |
| The Illinois Department may develop and contract with | 22 |
| Partnerships of
medical providers to arrange medical services | 23 |
| for persons eligible under
Section 5-2 of this Code. | 24 |
| Implementation of this Section may be by
demonstration projects | 25 |
| in certain geographic areas. The Partnership shall
be | 26 |
| represented by a sponsor organization. The Department, by rule, |
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| shall
develop qualifications for sponsors of Partnerships. | 2 |
| Nothing in this
Section shall be construed to require that the | 3 |
| sponsor organization be a
medical organization.
| 4 |
| The sponsor must negotiate formal written contracts with | 5 |
| medical
providers for physician services, inpatient and | 6 |
| outpatient hospital care,
home health services, treatment for | 7 |
| alcoholism and substance abuse, and
other services determined | 8 |
| necessary by the Illinois Department by rule for
delivery by | 9 |
| Partnerships. Physician services must include prenatal and
| 10 |
| obstetrical care. The Illinois Department shall reimburse | 11 |
| medical services
delivered by Partnership providers to clients | 12 |
| in target areas according to
provisions of this Article and the | 13 |
| Illinois Health Finance Reform Act,
except that:
| 14 |
| (1) Physicians participating in a Partnership and | 15 |
| providing certain
services, which shall be determined by | 16 |
| the Illinois Department, to persons
in areas covered by the | 17 |
| Partnership may receive an additional surcharge
for such | 18 |
| services.
| 19 |
| (2) The Department may elect to consider and negotiate | 20 |
| financial
incentives to encourage the development of | 21 |
| Partnerships and the efficient
delivery of medical care.
| 22 |
| (3) Persons receiving medical services through | 23 |
| Partnerships may receive
medical and case management | 24 |
| services above the level usually offered
through the | 25 |
| medical assistance program.
| 26 |
| Medical providers shall be required to meet certain |
|
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| qualifications to
participate in Partnerships to ensure the | 2 |
| delivery of high quality medical
services. These | 3 |
| qualifications shall be determined by rule of the Illinois
| 4 |
| Department and may be higher than qualifications for | 5 |
| participation in the
medical assistance program. Partnership | 6 |
| sponsors may prescribe reasonable
additional qualifications | 7 |
| for participation by medical providers, only with
the prior | 8 |
| written approval of the Illinois Department.
| 9 |
| Nothing in this Section shall limit the free choice of | 10 |
| practitioners,
hospitals, and other providers of medical | 11 |
| services by clients.
In order to ensure patient freedom of | 12 |
| choice, the Illinois Department shall
immediately promulgate | 13 |
| all rules and take all other necessary actions so that
provided | 14 |
| services may be accessed from therapeutically certified | 15 |
| optometrists
to the full extent of the Illinois Optometric | 16 |
| Practice Act of 1987 without
discriminating between service | 17 |
| providers.
| 18 |
| The Department shall apply for a waiver from the United | 19 |
| States Health
Care Financing Administration to allow for the | 20 |
| implementation of
Partnerships under this Section.
| 21 |
| The Illinois Department shall require health care | 22 |
| providers to maintain
records that document the medical care | 23 |
| and services provided to recipients
of Medical Assistance under | 24 |
| this Article. The Illinois Department shall
require health care | 25 |
| providers to make available, when authorized by the
patient, in | 26 |
| writing, the medical records in a timely fashion to other
|
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| health care providers who are treating or serving persons | 2 |
| eligible for
Medical Assistance under this Article. All | 3 |
| dispensers of medical services
shall be required to maintain | 4 |
| and retain business and professional records
sufficient to | 5 |
| fully and accurately document the nature, scope, details and
| 6 |
| receipt of the health care provided to persons eligible for | 7 |
| medical
assistance under this Code, in accordance with | 8 |
| regulations promulgated by
the Illinois Department. The rules | 9 |
| and regulations shall require that proof
of the receipt of | 10 |
| prescription drugs, dentures, prosthetic devices and
| 11 |
| eyeglasses by eligible persons under this Section accompany | 12 |
| each claim
for reimbursement submitted by the dispenser of such | 13 |
| medical services.
No such claims for reimbursement shall be | 14 |
| approved for payment by the Illinois
Department without such | 15 |
| proof of receipt, unless the Illinois Department
shall have put | 16 |
| into effect and shall be operating a system of post-payment
| 17 |
| audit and review which shall, on a sampling basis, be deemed | 18 |
| adequate by
the Illinois Department to assure that such drugs, | 19 |
| dentures, prosthetic
devices and eyeglasses for which payment | 20 |
| is being made are actually being
received by eligible | 21 |
| recipients. Within 90 days after the effective date of
this | 22 |
| amendatory Act of 1984, the Illinois Department shall establish | 23 |
| a
current list of acquisition costs for all prosthetic devices | 24 |
| and any
other items recognized as medical equipment and | 25 |
| supplies reimbursable under
this Article and shall update such | 26 |
| list on a quarterly basis, except that
the acquisition costs of |
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| all prescription drugs shall be updated no
less frequently than | 2 |
| every 30 days as required by Section 5-5.12.
| 3 |
| The rules and regulations of the Illinois Department shall | 4 |
| require
that a written statement including the required opinion | 5 |
| of a physician
shall accompany any claim for reimbursement for | 6 |
| abortions, or induced
miscarriages or premature births. This | 7 |
| statement shall indicate what
procedures were used in providing | 8 |
| such medical services.
| 9 |
| The Illinois Department shall require all dispensers of | 10 |
| medical
services, other than an individual practitioner or | 11 |
| group of practitioners,
desiring to participate in the Medical | 12 |
| Assistance program
established under this Article to disclose | 13 |
| all financial, beneficial,
ownership, equity, surety or other | 14 |
| interests in any and all firms,
corporations, partnerships, | 15 |
| associations, business enterprises, joint
ventures, agencies, | 16 |
| institutions or other legal entities providing any
form of | 17 |
| health care services in this State under this Article.
| 18 |
| The Illinois Department may require that all dispensers of | 19 |
| medical
services desiring to participate in the medical | 20 |
| assistance program
established under this Article disclose, | 21 |
| under such terms and conditions as
the Illinois Department may | 22 |
| by rule establish, all inquiries from clients
and attorneys | 23 |
| regarding medical bills paid by the Illinois Department, which
| 24 |
| inquiries could indicate potential existence of claims or liens | 25 |
| for the
Illinois Department.
| 26 |
| Enrollment of a vendor that provides non-emergency medical |
|
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| transportation,
defined by the Department by rule,
shall be
| 2 |
| conditional for 180 days. During that time, the Department of | 3 |
| Healthcare and Family Services may
terminate the vendor's | 4 |
| eligibility to participate in the medical assistance
program | 5 |
| without cause. That termination of eligibility is not subject | 6 |
| to the
Department's hearing process.
| 7 |
| The Illinois Department shall establish policies, | 8 |
| procedures,
standards and criteria by rule for the acquisition, | 9 |
| repair and replacement
of orthotic and prosthetic devices and | 10 |
| durable medical equipment. Such
rules shall provide, but not be | 11 |
| limited to, the following services: (1)
immediate repair or | 12 |
| replacement of such devices by recipients without
medical | 13 |
| authorization; and (2) rental, lease, purchase or | 14 |
| lease-purchase of
durable medical equipment in a | 15 |
| cost-effective manner, taking into
consideration the | 16 |
| recipient's medical prognosis, the extent of the
recipient's | 17 |
| needs, and the requirements and costs for maintaining such
| 18 |
| equipment. Such rules shall enable a recipient to temporarily | 19 |
| acquire and
use alternative or substitute devices or equipment | 20 |
| pending repairs or
replacements of any device or equipment | 21 |
| previously authorized for such
recipient by the Department.
| 22 |
| The Department shall execute, relative to the nursing home | 23 |
| prescreening
project, written inter-agency agreements with the | 24 |
| Department of Human
Services and the Department on Aging, to | 25 |
| effect the following: (i) intake
procedures and common | 26 |
| eligibility criteria for those persons who are receiving
|
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| non-institutional services; and (ii) the establishment and | 2 |
| development of
non-institutional services in areas of the State | 3 |
| where they are not currently
available or are undeveloped.
| 4 |
| The Illinois Department shall develop and operate, in | 5 |
| cooperation
with other State Departments and agencies and in | 6 |
| compliance with
applicable federal laws and regulations, | 7 |
| appropriate and effective
systems of health care evaluation and | 8 |
| programs for monitoring of
utilization of health care services | 9 |
| and facilities, as it affects
persons eligible for medical | 10 |
| assistance under this Code.
| 11 |
| The Illinois Department shall report annually to the | 12 |
| General Assembly,
no later than the second Friday in April of | 13 |
| 1979 and each year
thereafter, in regard to:
| 14 |
| (a) actual statistics and trends in utilization of | 15 |
| medical services by
public aid recipients;
| 16 |
| (b) actual statistics and trends in the provision of | 17 |
| the various medical
services by medical vendors;
| 18 |
| (c) current rate structures and proposed changes in | 19 |
| those rate structures
for the various medical vendors; and
| 20 |
| (d) efforts at utilization review and control by the | 21 |
| Illinois Department.
| 22 |
| The period covered by each report shall be the 3 years | 23 |
| ending on the June
30 prior to the report. The report shall | 24 |
| include suggested legislation
for consideration by the General | 25 |
| Assembly. The filing of one copy of the
report with the | 26 |
| Speaker, one copy with the Minority Leader and one copy
with |
|
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| the Clerk of the House of Representatives, one copy with the | 2 |
| President,
one copy with the Minority Leader and one copy with | 3 |
| the Secretary of the
Senate, one copy with the Legislative | 4 |
| Research Unit, and such additional
copies
with the State | 5 |
| Government Report Distribution Center for the General
Assembly | 6 |
| as is required under paragraph (t) of Section 7 of the State
| 7 |
| Library Act shall be deemed sufficient to comply with this | 8 |
| Section.
| 9 |
| Rulemaking authority to implement Public Act 95-1045 this | 10 |
| amendatory Act of the 95th General Assembly , if any, is | 11 |
| conditioned on the rules being adopted in accordance with all | 12 |
| provisions of the Illinois Administrative Procedure Act and all | 13 |
| rules and procedures of the Joint Committee on Administrative | 14 |
| Rules; any purported rule not so adopted, for whatever reason, | 15 |
| is unauthorized. | 16 |
| (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07; | 17 |
| 95-1045, eff. 3-27-09; 96-156, eff. 1-1-10; 96-806, eff. | 18 |
| 7-1-10; revised 11-4-09.) | 19 |
| Section 96. No acceleration or delay. Where this Act makes | 20 |
| changes in a statute that is represented in this Act by text | 21 |
| that is not yet or no longer in effect (for example, a Section | 22 |
| represented by multiple versions), the use of that text does | 23 |
| not accelerate or delay the taking effect of (i) the changes | 24 |
| made by this Act or (ii) provisions derived from any other | 25 |
| Public Act. |
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| Section 97. Severability. If any portion of this Act or any | 2 |
| amendments thereto, or its applicability to any person or | 3 |
| circumstance is held invalid by a court, the remainder of this | 4 |
| Act or its applicability to other persons or circumstances | 5 |
| shall not be affected.
|
|