Full Text of HB3893 97th General Assembly
HB3893enr 97TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning health.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Alcoholism and Other Drug Abuse and | 5 | | Dependency Act is amended by changing Section 1-10 as follows:
| 6 | | (20 ILCS 301/1-10)
| 7 | | Sec. 1-10. Definitions. As used in this Act, unless the | 8 | | context clearly
indicates otherwise, the following words and | 9 | | terms have the following meanings:
| 10 | | "Act" means the Alcoholism and Other Drug Abuse and | 11 | | Dependency Act.
| 12 | | "Addict" means a person who exhibits the disease known as | 13 | | "addiction".
| 14 | | "Addiction" means a disease process characterized by the | 15 | | continued use of a
specific psycho-active substance despite | 16 | | physical, psychological or social
harm. The term also describes | 17 | | the advanced stages of chemical dependency.
| 18 | | "Administrator" means a person responsible for | 19 | | administration of a program.
| 20 | | "Alcoholic" means a person who exhibits the disease known | 21 | | as "alcoholism".
| 22 | | "Alcoholism" means a chronic and progressive disease or | 23 | | illness
characterized by preoccupation with and loss of control |
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| 1 | | over the consumption of
alcohol, and the use of alcohol despite | 2 | | adverse consequences. Typically,
combinations of the following | 3 | | tendencies are also present: periodic or chronic
intoxication; | 4 | | physical disability; impaired emotional, occupational or | 5 | | social
adjustment; tendency toward relapse; a detrimental | 6 | | effect on the individual,
his family and society; psychological | 7 | | dependence; and physical dependence.
Alcoholism is also known | 8 | | as addiction to alcohol. Alcoholism is described and
further | 9 | | categorized in clinical detail in the DSM and the ICD.
| 10 | | "Array of services" means assistance to individuals, | 11 | | families and communities
in response to alcohol or other drug | 12 | | abuse or dependency. The array of
services includes, but is not | 13 | | limited to: prevention assistance for communities
and schools; | 14 | | case finding, assessment and intervention to help individuals | 15 | | stop
abusing alcohol or other drugs; a uniform screening, | 16 | | assessment, and evaluation process including criteria for | 17 | | substance use disorders and mental disorders or co-occurring | 18 | | substance use and mental health disorders; case management; | 19 | | detoxification to aid
individuals in physically withdrawing | 20 | | from alcohol or other drugs; short-term
and long-term treatment | 21 | | and support services to help individuals and family
members | 22 | | begin the process of recovery; prescription and dispensing of | 23 | | the drug
methadone or other medications as an adjunct to | 24 | | treatment; relapse prevention
services; education and | 25 | | counseling for children or other co-dependents of
alcoholics or | 26 | | other drug abusers or addicts. For purposes of this Section, a |
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| 1 | | uniform screening, assessment, and evaluation process refers | 2 | | to a process that includes an appropriate evaluation and, as | 3 | | warranted, a referral. "Uniform" does not mean the use of a | 4 | | singular instrument, tool, or process that all must utilize.
| 5 | | "Case management" means those services which will assist | 6 | | individuals in
gaining access to needed social, educational, | 7 | | medical, treatment and other
services.
| 8 | | "Children of alcoholics or drug addicts or abusers of | 9 | | alcohol and other
drugs" means the minor or adult children of | 10 | | individuals who have abused or been
dependent upon alcohol or | 11 | | other drugs. These children may or may not become
dependent | 12 | | upon alcohol or other drugs themselves; however, they are | 13 | | physically,
psychologically, and behaviorally at high risk of | 14 | | developing the illness.
Children of alcoholics and other drug | 15 | | abusers experience emotional and other
problems, and benefit | 16 | | from prevention and treatment services provided by funded
and | 17 | | non-funded agencies licensed by the Department.
| 18 | | "Co-dependents" means individuals who are involved in the | 19 | | lives of and are
affected by people who are dependent upon | 20 | | alcohol and other drugs.
Co-dependents compulsively engage in | 21 | | behaviors that cause them to suffer
adverse physical, | 22 | | emotional, familial, social, behavioral, vocational, and
legal | 23 | | consequences as they attempt to cope with the alcohol or drug | 24 | | dependent
person. People who become co-dependents include | 25 | | spouses, parents, siblings,
and friends of alcohol or drug | 26 | | dependent people. Co-dependents benefit from
prevention and |
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| 1 | | treatment services provided by agencies licensed by the
| 2 | | Department.
| 3 | | "Controlled substance" means any substance or immediate | 4 | | precursor which is
enumerated in the schedules of Article II of | 5 | | the Illinois Controlled Substances
Act or the Cannabis Control | 6 | | Act.
| 7 | | "Crime of violence" means any of the following crimes: | 8 | | murder, voluntary
manslaughter, criminal sexual assault, | 9 | | aggravated criminal sexual assault,
predatory criminal sexual | 10 | | assault of a child,
armed robbery, robbery, arson, kidnapping, | 11 | | aggravated battery, aggravated
arson, or any
other felony which | 12 | | involves the use or threat of physical force or violence
| 13 | | against another individual.
| 14 | | "Department" means the Illinois Department of Human | 15 | | Services as successor to
the former Department of Alcoholism | 16 | | and Substance Abuse.
| 17 | | "Designated program" means a program designated by the | 18 | | Department to provide
services described in subsection (c) or | 19 | | (d) of Section 15-10 of this Act.
A
designated program's | 20 | | primary function is screening, assessing, referring and
| 21 | | tracking clients identified by the criminal justice system, and | 22 | | the program
agrees to apply statewide the standards, uniform | 23 | | criteria and procedures
established by the Department pursuant | 24 | | to such designation.
| 25 | | "Detoxification" means the process of allowing an | 26 | | individual to safely
withdraw from a drug in a controlled |
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| 1 | | environment.
| 2 | | "DSM" means the most current edition of the Diagnostic and | 3 | | Statistical
Manual of Mental Disorders.
| 4 | | "D.U.I." means driving under the influence of alcohol or | 5 | | other substances
which may cause impairment of driving ability.
| 6 | | "Facility" means the building or premises which are used | 7 | | for the provision
of licensable program services, including | 8 | | support services, as set forth by
rule.
| 9 | | "ICD" means the most current edition of the International | 10 | | Classification of
Diseases.
| 11 | | "Incapacitated" means that a person is unconscious or | 12 | | otherwise exhibits, by
overt behavior or by extreme physical | 13 | | debilitation, an inability to care for
his own needs or to | 14 | | recognize the obvious danger of his situation or to make
| 15 | | rational decisions with respect to his need for treatment.
| 16 | | "Intermediary person" means a person with expertise | 17 | | relative to addiction,
alcoholism, and the abuse of alcohol or | 18 | | other drugs who may be called on to
assist the police in | 19 | | carrying out enforcement or other activities with respect
to | 20 | | persons who abuse or are dependent on alcohol or other drugs.
| 21 | | "Intervention" means readily accessible activities which | 22 | | assist individuals
and their partners or family members in | 23 | | coping with the immediate problems of
alcohol and other drug | 24 | | abuse or dependency, and in reducing their alcohol and
other | 25 | | drug use. Intervention can facilitate emotional and social | 26 | | stability, and
involves referring people for further treatment |
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| 1 | | as needed.
| 2 | | "Intoxicated person" means a person whose mental or | 3 | | physical functioning is
substantially impaired as a result of | 4 | | the current effects of alcohol or other
drugs within the body.
| 5 | | "Local advisory council" means an alcohol and substance | 6 | | abuse body
established in a county, township or community area, | 7 | | which represents public
and private entities having an interest | 8 | | in the prevention and treatment of
alcoholism or other drug | 9 | | abuse.
| 10 | | "Off-site services" means licensable program services or | 11 | | activities which are
conducted at a location separate from the | 12 | | primary service location of the
provider, and which services | 13 | | are operated by a program or entity licensed under
this Act.
| 14 | | "Person" means any individual, firm, group, association, | 15 | | partnership,
corporation, trust, government or governmental | 16 | | subdivision or agency.
| 17 | | "Prevention" means an interactive process of individuals, | 18 | | families, schools,
religious organizations, communities and | 19 | | regional, state and national
organizations to reduce | 20 | | alcoholism, prevent the use of illegal drugs and the
abuse of | 21 | | legal drugs by persons of all ages, prevent the use of alcohol | 22 | | by
minors, build the capacities of individuals and systems, and | 23 | | promote healthy
environments, lifestyles and behaviors.
| 24 | | "Program" means a licensable or fundable activity or | 25 | | service, or a
coordinated range of such activities or services, | 26 | | as the Department may
establish by rule.
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| 1 | | "Recovery" means the long-term, often life-long, process | 2 | | in which an addicted
person changes the way in which he makes | 3 | | decisions and establishes personal and
life priorities. The | 4 | | evolution of this decision-making and priority-setting
process | 5 | | is generally manifested by an obvious improvement in the | 6 | | individual's
life and lifestyle and by his overcoming the abuse | 7 | | of or
dependence on alcohol or other drugs. Recovery is also | 8 | | generally manifested by
prolonged periods of abstinence from | 9 | | addictive chemicals which are not
medically supervised. | 10 | | Recovery is the goal of treatment.
| 11 | | "Rehabilitation" means a process whereby those clinical | 12 | | services necessary
and appropriate for improving an | 13 | | individual's life and lifestyle and for
overcoming his or her | 14 | | abuse of or dependency upon alcohol or other drugs, or
both, | 15 | | are delivered in an appropriate setting and manner as defined | 16 | | in rules
established by the Department.
| 17 | | "Relapse" means a process which is manifested by a | 18 | | progressive pattern of
behavior that reactivates the symptoms | 19 | | of a disease or creates debilitating
conditions in an | 20 | | individual who has experienced remission from addiction or
| 21 | | alcoholism.
| 22 | | "Secretary" means the Secretary of Human Services or his or | 23 | | her designee.
| 24 | | "Substance abuse" or "abuse" means a pattern of use of | 25 | | alcohol or other drugs
with the potential of leading to | 26 | | immediate functional problems or to alcoholism
or other drug |
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| 1 | | dependency, or to the use of alcohol and/or other drugs solely
| 2 | | for purposes of intoxication. The term also means the use of | 3 | | illegal drugs by
persons of any age, and the use of alcohol by | 4 | | persons under the age of 21.
| 5 | | "Treatment" means the broad range of emergency, | 6 | | outpatient, intermediate
and residential services and care | 7 | | (including assessment, diagnosis, medical,
psychiatric, | 8 | | psychological and social services, care and counseling, and
| 9 | | aftercare) which may be extended to individuals who abuse or | 10 | | are dependent
on alcohol or other drugs or families of those | 11 | | persons.
| 12 | | (Source: P.A. 89-202, eff. 7-21-95; 89-428, eff. 12-13-95; | 13 | | 89-462, eff.
5-29-96; 89-507, eff. 7-1-97; 90-14, eff. 7-1-97; | 14 | | 90-135, eff. 7-22-97.)
| 15 | | Section 8. The Illinois Public Aid Code is amended by | 16 | | changing Section 5-5 as follows: | 17 | | (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
| 18 | | Sec. 5-5. Medical services. The Illinois Department, by | 19 | | rule, shall
determine the quantity and quality of and the rate | 20 | | of reimbursement for the
medical assistance for which
payment | 21 | | will be authorized, and the medical services to be provided,
| 22 | | which may include all or part of the following: (1) inpatient | 23 | | hospital
services; (2) outpatient hospital services; (3) other | 24 | | laboratory and
X-ray services; (4) skilled nursing home |
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| 1 | | services; (5) physicians'
services whether furnished in the | 2 | | office, the patient's home, a
hospital, a skilled nursing home, | 3 | | or elsewhere; (6) medical care, or any
other type of remedial | 4 | | care furnished by licensed practitioners; (7)
home health care | 5 | | services; (8) private duty nursing service; (9) clinic
| 6 | | services; (10) dental services, including prevention and | 7 | | treatment of periodontal disease and dental caries disease for | 8 | | pregnant women, provided by an individual licensed to practice | 9 | | dentistry or dental surgery; for purposes of this item (10), | 10 | | "dental services" means diagnostic, preventive, or corrective | 11 | | procedures provided by or under the supervision of a dentist in | 12 | | the practice of his or her profession; (11) physical therapy | 13 | | and related
services; (12) prescribed drugs, dentures, and | 14 | | prosthetic devices; and
eyeglasses prescribed by a physician | 15 | | skilled in the diseases of the eye,
or by an optometrist, | 16 | | whichever the person may select; (13) other
diagnostic, | 17 | | screening, preventive, and rehabilitative services, including | 18 | | to ensure that the individual's need for intervention or | 19 | | treatment of mental disorders or substance use disorders or | 20 | | co-occurring mental health and substance use disorders is | 21 | | determined using a uniform screening, assessment, and | 22 | | evaluation process inclusive of criteria, for children and | 23 | | adults; for purposes of this item (13), a uniform screening, | 24 | | assessment, and evaluation process refers to a process that | 25 | | includes an appropriate evaluation and, as warranted, a | 26 | | referral; "uniform" does not mean the use of a singular |
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| 1 | | instrument, tool, or process that all must utilize; (14)
| 2 | | transportation and such other expenses as may be necessary; | 3 | | (15) medical
treatment of sexual assault survivors, as defined | 4 | | in
Section 1a of the Sexual Assault Survivors Emergency | 5 | | Treatment Act, for
injuries sustained as a result of the sexual | 6 | | assault, including
examinations and laboratory tests to | 7 | | discover evidence which may be used in
criminal proceedings | 8 | | arising from the sexual assault; (16) the
diagnosis and | 9 | | treatment of sickle cell anemia; and (17)
any other medical | 10 | | care, and any other type of remedial care recognized
under the | 11 | | laws of this State, but not including abortions, or induced
| 12 | | miscarriages or premature births, unless, in the opinion of a | 13 | | physician,
such procedures are necessary for the preservation | 14 | | of the life of the
woman seeking such treatment, or except an | 15 | | induced premature birth
intended to produce a live viable child | 16 | | and such procedure is necessary
for the health of the mother or | 17 | | her unborn child. The Illinois Department,
by rule, shall | 18 | | prohibit any physician from providing medical assistance
to | 19 | | anyone eligible therefor under this Code where such physician | 20 | | has been
found guilty of performing an abortion procedure in a | 21 | | wilful and wanton
manner upon a woman who was not pregnant at | 22 | | the time such abortion
procedure was performed. The term "any | 23 | | other type of remedial care" shall
include nursing care and | 24 | | nursing home service for persons who rely on
treatment by | 25 | | spiritual means alone through prayer for healing.
| 26 | | Notwithstanding any other provision of this Section, a |
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| 1 | | comprehensive
tobacco use cessation program that includes | 2 | | purchasing prescription drugs or
prescription medical devices | 3 | | approved by the Food and Drug Administration shall
be covered | 4 | | under the medical assistance
program under this Article for | 5 | | persons who are otherwise eligible for
assistance under this | 6 | | Article.
| 7 | | Notwithstanding any other provision of this Code, the | 8 | | Illinois
Department may not require, as a condition of payment | 9 | | for any laboratory
test authorized under this Article, that a | 10 | | physician's handwritten signature
appear on the laboratory | 11 | | test order form. The Illinois Department may,
however, impose | 12 | | other appropriate requirements regarding laboratory test
order | 13 | | documentation.
| 14 | | The Department of Healthcare and Family Services shall | 15 | | provide the following services to
persons
eligible for | 16 | | assistance under this Article who are participating in
| 17 | | education, training or employment programs operated by the | 18 | | Department of Human
Services as successor to the Department of | 19 | | Public Aid:
| 20 | | (1) dental services provided by or under the | 21 | | supervision of a dentist; and
| 22 | | (2) eyeglasses prescribed by a physician skilled in the | 23 | | diseases of the
eye, or by an optometrist, whichever the | 24 | | person may select.
| 25 | | Notwithstanding any other provision of this Code and | 26 | | subject to federal approval, the Department may adopt rules to |
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| 1 | | allow a dentist who is volunteering his or her service at no | 2 | | cost to render dental services through an enrolled | 3 | | not-for-profit health clinic without the dentist personally | 4 | | enrolling as a participating provider in the medical assistance | 5 | | program. A not-for-profit health clinic shall include a public | 6 | | health clinic or Federally Qualified Health Center or other | 7 | | enrolled provider, as determined by the Department, through | 8 | | which dental services covered under this Section are performed. | 9 | | The Department shall establish a process for payment of claims | 10 | | for reimbursement for covered dental services rendered under | 11 | | this provision. | 12 | | The Illinois Department, by rule, may distinguish and | 13 | | classify the
medical services to be provided only in accordance | 14 | | with the classes of
persons designated in Section 5-2.
| 15 | | The Department of Healthcare and Family Services must | 16 | | provide coverage and reimbursement for amino acid-based | 17 | | elemental formulas, regardless of delivery method, for the | 18 | | diagnosis and treatment of (i) eosinophilic disorders and (ii) | 19 | | short bowel syndrome when the prescribing physician has issued | 20 | | a written order stating that the amino acid-based elemental | 21 | | formula is medically necessary.
| 22 | | The Illinois Department shall authorize the provision of, | 23 | | and shall
authorize payment for, screening by low-dose | 24 | | mammography for the presence of
occult breast cancer for women | 25 | | 35 years of age or older who are eligible
for medical | 26 | | assistance under this Article, as follows: |
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| 1 | | (A) A baseline
mammogram for women 35 to 39 years of | 2 | | age.
| 3 | | (B) An annual mammogram for women 40 years of age or | 4 | | older. | 5 | | (C) A mammogram at the age and intervals considered | 6 | | medically necessary by the woman's health care provider for | 7 | | women under 40 years of age and having a family history of | 8 | | breast cancer, prior personal history of breast cancer, | 9 | | positive genetic testing, or other risk factors. | 10 | | (D) A comprehensive ultrasound screening of an entire | 11 | | breast or breasts if a mammogram demonstrates | 12 | | heterogeneous or dense breast tissue, when medically | 13 | | necessary as determined by a physician licensed to practice | 14 | | medicine in all of its branches. | 15 | | All screenings
shall
include a physical breast exam, | 16 | | instruction on self-examination and
information regarding the | 17 | | frequency of self-examination and its value as a
preventative | 18 | | tool. For purposes of this Section, "low-dose mammography" | 19 | | means
the x-ray examination of the breast using equipment | 20 | | dedicated specifically
for mammography, including the x-ray | 21 | | tube, filter, compression device,
and image receptor, with an | 22 | | average radiation exposure delivery
of less than one rad per | 23 | | breast for 2 views of an average size breast.
The term also | 24 | | includes digital mammography.
| 25 | | On and after January 1, 2012, providers participating in a | 26 | | quality improvement program approved by the Department shall be |
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| 1 | | reimbursed for screening and diagnostic mammography at the same | 2 | | rate as the Medicare program's rates, including the increased | 3 | | reimbursement for digital mammography. | 4 | | The Department shall convene an expert panel including | 5 | | representatives of hospitals, free-standing mammography | 6 | | facilities, and doctors, including radiologists, to establish | 7 | | quality standards. | 8 | | Subject to federal approval, the Department shall | 9 | | establish a rate methodology for mammography at federally | 10 | | qualified health centers and other encounter-rate clinics. | 11 | | These clinics or centers may also collaborate with other | 12 | | hospital-based mammography facilities. | 13 | | The Department shall establish a methodology to remind | 14 | | women who are age-appropriate for screening mammography, but | 15 | | who have not received a mammogram within the previous 18 | 16 | | months, of the importance and benefit of screening mammography. | 17 | | The Department shall establish a performance goal for | 18 | | primary care providers with respect to their female patients | 19 | | over age 40 receiving an annual mammogram. This performance | 20 | | goal shall be used to provide additional reimbursement in the | 21 | | form of a quality performance bonus to primary care providers | 22 | | who meet that goal. | 23 | | The Department shall devise a means of case-managing or | 24 | | patient navigation for beneficiaries diagnosed with breast | 25 | | cancer. This program shall initially operate as a pilot program | 26 | | in areas of the State with the highest incidence of mortality |
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| 1 | | related to breast cancer. At least one pilot program site shall | 2 | | be in the metropolitan Chicago area and at least one site shall | 3 | | be outside the metropolitan Chicago area. An evaluation of the | 4 | | pilot program shall be carried out measuring health outcomes | 5 | | and cost of care for those served by the pilot program compared | 6 | | to similarly situated patients who are not served by the pilot | 7 | | program. | 8 | | Any medical or health care provider shall immediately | 9 | | recommend, to
any pregnant woman who is being provided prenatal | 10 | | services and is suspected
of drug abuse or is addicted as | 11 | | defined in the Alcoholism and Other Drug Abuse
and Dependency | 12 | | Act, referral to a local substance abuse treatment provider
| 13 | | licensed by the Department of Human Services or to a licensed
| 14 | | hospital which provides substance abuse treatment services. | 15 | | The Department of Healthcare and Family Services
shall assure | 16 | | coverage for the cost of treatment of the drug abuse or
| 17 | | addiction for pregnant recipients in accordance with the | 18 | | Illinois Medicaid
Program in conjunction with the Department of | 19 | | Human Services.
| 20 | | All medical providers providing medical assistance to | 21 | | pregnant women
under this Code shall receive information from | 22 | | the Department on the
availability of services under the Drug | 23 | | Free Families with a Future or any
comparable program providing | 24 | | case management services for addicted women,
including | 25 | | information on appropriate referrals for other social services
| 26 | | that may be needed by addicted women in addition to treatment |
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| 1 | | for addiction.
| 2 | | The Illinois Department, in cooperation with the | 3 | | Departments of Human
Services (as successor to the Department | 4 | | of Alcoholism and Substance
Abuse) and Public Health, through a | 5 | | public awareness campaign, may
provide information concerning | 6 | | treatment for alcoholism and drug abuse and
addiction, prenatal | 7 | | health care, and other pertinent programs directed at
reducing | 8 | | the number of drug-affected infants born to recipients of | 9 | | medical
assistance.
| 10 | | Neither the Department of Healthcare and Family Services | 11 | | nor the Department of Human
Services shall sanction the | 12 | | recipient solely on the basis of
her substance abuse.
| 13 | | The Illinois Department shall establish such regulations | 14 | | governing
the dispensing of health services under this Article | 15 | | as it shall deem
appropriate. The Department
should
seek the | 16 | | advice of formal professional advisory committees appointed by
| 17 | | the Director of the Illinois Department for the purpose of | 18 | | providing regular
advice on policy and administrative matters, | 19 | | information dissemination and
educational activities for | 20 | | medical and health care providers, and
consistency in | 21 | | procedures to the Illinois Department.
| 22 | | Notwithstanding any other provision of law, a health care | 23 | | provider under the medical assistance program may elect, in | 24 | | lieu of receiving direct payment for services provided under | 25 | | that program, to participate in the State Employees Deferred | 26 | | Compensation Plan adopted under Article 24 of the Illinois |
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| 1 | | Pension Code. A health care provider who elects to participate | 2 | | in the plan does not have a cause of action against the State | 3 | | for any damages allegedly suffered by the provider as a result | 4 | | of any delay by the State in crediting the amount of any | 5 | | contribution to the provider's plan account. | 6 | | The Illinois Department may develop and contract with | 7 | | Partnerships of
medical providers to arrange medical services | 8 | | for persons eligible under
Section 5-2 of this Code. | 9 | | Implementation of this Section may be by
demonstration projects | 10 | | in certain geographic areas. The Partnership shall
be | 11 | | represented by a sponsor organization. The Department, by rule, | 12 | | shall
develop qualifications for sponsors of Partnerships. | 13 | | Nothing in this
Section shall be construed to require that the | 14 | | sponsor organization be a
medical organization.
| 15 | | The sponsor must negotiate formal written contracts with | 16 | | medical
providers for physician services, inpatient and | 17 | | outpatient hospital care,
home health services, treatment for | 18 | | alcoholism and substance abuse, and
other services determined | 19 | | necessary by the Illinois Department by rule for
delivery by | 20 | | Partnerships. Physician services must include prenatal and
| 21 | | obstetrical care. The Illinois Department shall reimburse | 22 | | medical services
delivered by Partnership providers to clients | 23 | | in target areas according to
provisions of this Article and the | 24 | | Illinois Health Finance Reform Act,
except that:
| 25 | | (1) Physicians participating in a Partnership and | 26 | | providing certain
services, which shall be determined by |
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| 1 | | the Illinois Department, to persons
in areas covered by the | 2 | | Partnership may receive an additional surcharge
for such | 3 | | services.
| 4 | | (2) The Department may elect to consider and negotiate | 5 | | financial
incentives to encourage the development of | 6 | | Partnerships and the efficient
delivery of medical care.
| 7 | | (3) Persons receiving medical services through | 8 | | Partnerships may receive
medical and case management | 9 | | services above the level usually offered
through the | 10 | | medical assistance program.
| 11 | | Medical providers shall be required to meet certain | 12 | | qualifications to
participate in Partnerships to ensure the | 13 | | delivery of high quality medical
services. These | 14 | | qualifications shall be determined by rule of the Illinois
| 15 | | Department and may be higher than qualifications for | 16 | | participation in the
medical assistance program. Partnership | 17 | | sponsors may prescribe reasonable
additional qualifications | 18 | | for participation by medical providers, only with
the prior | 19 | | written approval of the Illinois Department.
| 20 | | Nothing in this Section shall limit the free choice of | 21 | | practitioners,
hospitals, and other providers of medical | 22 | | services by clients.
In order to ensure patient freedom of | 23 | | choice, the Illinois Department shall
immediately promulgate | 24 | | all rules and take all other necessary actions so that
provided | 25 | | services may be accessed from therapeutically certified | 26 | | optometrists
to the full extent of the Illinois Optometric |
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| 1 | | Practice Act of 1987 without
discriminating between service | 2 | | providers.
| 3 | | The Department shall apply for a waiver from the United | 4 | | States Health
Care Financing Administration to allow for the | 5 | | implementation of
Partnerships under this Section.
| 6 | | The Illinois Department shall require health care | 7 | | providers to maintain
records that document the medical care | 8 | | and services provided to recipients
of Medical Assistance under | 9 | | this Article. Such records must be retained for a period of not | 10 | | less than 6 years from the date of service or as provided by | 11 | | applicable State law, whichever period is longer, except that | 12 | | if an audit is initiated within the required retention period | 13 | | then the records must be retained until the audit is completed | 14 | | and every exception is resolved. The Illinois Department shall
| 15 | | require health care providers to make available, when | 16 | | authorized by the
patient, in writing, the medical records in a | 17 | | timely fashion to other
health care providers who are treating | 18 | | or serving persons eligible for
Medical Assistance under this | 19 | | Article. All dispensers of medical services
shall be required | 20 | | to maintain and retain business and professional records
| 21 | | sufficient to fully and accurately document the nature, scope, | 22 | | details and
receipt of the health care provided to persons | 23 | | eligible for medical
assistance under this Code, in accordance | 24 | | with regulations promulgated by
the Illinois Department. The | 25 | | rules and regulations shall require that proof
of the receipt | 26 | | of prescription drugs, dentures, prosthetic devices and
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| 1 | | eyeglasses by eligible persons under this Section accompany | 2 | | each claim
for reimbursement submitted by the dispenser of such | 3 | | medical services.
No such claims for reimbursement shall be | 4 | | approved for payment by the Illinois
Department without such | 5 | | proof of receipt, unless the Illinois Department
shall have put | 6 | | into effect and shall be operating a system of post-payment
| 7 | | audit and review which shall, on a sampling basis, be deemed | 8 | | adequate by
the Illinois Department to assure that such drugs, | 9 | | dentures, prosthetic
devices and eyeglasses for which payment | 10 | | is being made are actually being
received by eligible | 11 | | recipients. Within 90 days after the effective date of
this | 12 | | amendatory Act of 1984, the Illinois Department shall establish | 13 | | a
current list of acquisition costs for all prosthetic devices | 14 | | and any
other items recognized as medical equipment and | 15 | | supplies reimbursable under
this Article and shall update such | 16 | | list on a quarterly basis, except that
the acquisition costs of | 17 | | all prescription drugs shall be updated no
less frequently than | 18 | | every 30 days as required by Section 5-5.12.
| 19 | | The rules and regulations of the Illinois Department shall | 20 | | require
that a written statement including the required opinion | 21 | | of a physician
shall accompany any claim for reimbursement for | 22 | | abortions, or induced
miscarriages or premature births. This | 23 | | statement shall indicate what
procedures were used in providing | 24 | | such medical services.
| 25 | | The Illinois Department shall require all dispensers of | 26 | | medical
services, other than an individual practitioner or |
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| 1 | | group of practitioners,
desiring to participate in the Medical | 2 | | Assistance program
established under this Article to disclose | 3 | | all financial, beneficial,
ownership, equity, surety or other | 4 | | interests in any and all firms,
corporations, partnerships, | 5 | | associations, business enterprises, joint
ventures, agencies, | 6 | | institutions or other legal entities providing any
form of | 7 | | health care services in this State under this Article.
| 8 | | The Illinois Department may require that all dispensers of | 9 | | medical
services desiring to participate in the medical | 10 | | assistance program
established under this Article disclose, | 11 | | under such terms and conditions as
the Illinois Department may | 12 | | by rule establish, all inquiries from clients
and attorneys | 13 | | regarding medical bills paid by the Illinois Department, which
| 14 | | inquiries could indicate potential existence of claims or liens | 15 | | for the
Illinois Department.
| 16 | | Enrollment of a vendor that provides non-emergency medical | 17 | | transportation,
defined by the Department by rule,
shall be
| 18 | | conditional for 180 days. During that time, the Department of | 19 | | Healthcare and Family Services may
terminate the vendor's | 20 | | eligibility to participate in the medical assistance
program | 21 | | without cause. That termination of eligibility is not subject | 22 | | to the
Department's hearing process.
| 23 | | The Illinois Department shall establish policies, | 24 | | procedures,
standards and criteria by rule for the acquisition, | 25 | | repair and replacement
of orthotic and prosthetic devices and | 26 | | durable medical equipment. Such
rules shall provide, but not be |
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| 1 | | limited to, the following services: (1)
immediate repair or | 2 | | replacement of such devices by recipients without
medical | 3 | | authorization; and (2) rental, lease, purchase or | 4 | | lease-purchase of
durable medical equipment in a | 5 | | cost-effective manner, taking into
consideration the | 6 | | recipient's medical prognosis, the extent of the
recipient's | 7 | | needs, and the requirements and costs for maintaining such
| 8 | | equipment. Such rules shall enable a recipient to temporarily | 9 | | acquire and
use alternative or substitute devices or equipment | 10 | | pending repairs or
replacements of any device or equipment | 11 | | previously authorized for such
recipient by the Department.
| 12 | | The Department shall execute, relative to the nursing home | 13 | | prescreening
project, written inter-agency agreements with the | 14 | | Department of Human
Services and the Department on Aging, to | 15 | | effect the following: (i) intake
procedures and common | 16 | | eligibility criteria for those persons who are receiving
| 17 | | non-institutional services; and (ii) the establishment and | 18 | | development of
non-institutional services in areas of the State | 19 | | where they are not currently
available or are undeveloped.
| 20 | | The Illinois Department shall develop and operate, in | 21 | | cooperation
with other State Departments and agencies and in | 22 | | compliance with
applicable federal laws and regulations, | 23 | | appropriate and effective
systems of health care evaluation and | 24 | | programs for monitoring of
utilization of health care services | 25 | | and facilities, as it affects
persons eligible for medical | 26 | | assistance under this Code.
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| 1 | | The Illinois Department shall report annually to the | 2 | | General Assembly,
no later than the second Friday in April of | 3 | | 1979 and each year
thereafter, in regard to:
| 4 | | (a) actual statistics and trends in utilization of | 5 | | medical services by
public aid recipients;
| 6 | | (b) actual statistics and trends in the provision of | 7 | | the various medical
services by medical vendors;
| 8 | | (c) current rate structures and proposed changes in | 9 | | those rate structures
for the various medical vendors; and
| 10 | | (d) efforts at utilization review and control by the | 11 | | Illinois Department.
| 12 | | The period covered by each report shall be the 3 years | 13 | | ending on the June
30 prior to the report. The report shall | 14 | | include suggested legislation
for consideration by the General | 15 | | Assembly. The filing of one copy of the
report with the | 16 | | Speaker, one copy with the Minority Leader and one copy
with | 17 | | the Clerk of the House of Representatives, one copy with the | 18 | | President,
one copy with the Minority Leader and one copy with | 19 | | the Secretary of the
Senate, one copy with the Legislative | 20 | | Research Unit, and such additional
copies
with the State | 21 | | Government Report Distribution Center for the General
Assembly | 22 | | as is required under paragraph (t) of Section 7 of the State
| 23 | | Library Act shall be deemed sufficient to comply with this | 24 | | Section.
| 25 | | Rulemaking authority to implement Public Act 95-1045, if | 26 | | any, is conditioned on the rules being adopted in accordance |
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| 1 | | with all provisions of the Illinois Administrative Procedure | 2 | | Act and all rules and procedures of the Joint Committee on | 3 | | Administrative Rules; any purported rule not so adopted, for | 4 | | whatever reason, is unauthorized. | 5 | | (Source: P.A. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926, | 6 | | eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638, | 7 | | eff. 1-1-12.) | 8 | | Section 10. The Community Services Act is amended by | 9 | | changing Section 2 as follows:
| 10 | | (405 ILCS 30/2) (from Ch. 91 1/2, par. 902)
| 11 | | Sec. 2. Community Services System. Services should be | 12 | | planned,
developed, delivered and evaluated as part of a | 13 | | comprehensive and
coordinated system. The Department of Human | 14 | | Services
shall encourage the establishment of services in each | 15 | | area of the State
which cover the services categories described | 16 | | below. What specific
services are provided under each service | 17 | | category shall be based on local
needs; special attention shall | 18 | | be given to unserved and underserved
populations, including | 19 | | children and youth, racial and ethnic minorities,
and the | 20 | | elderly. The service categories shall include:
| 21 | | (a) Prevention: services designed primarily to reduce the | 22 | | incidence
and ameliorate the severity of developmental | 23 | | disabilities, mental illness and
alcohol and drug dependence;
| 24 | | (b) Client Assessment and Diagnosis: services designed to |
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| 1 | | identify
persons with developmental disabilities, mental | 2 | | illness and alcohol and
drug dependency; to determine the | 3 | | extent of the disability and the level of
functioning; to | 4 | | ensure that the individual's need for treatment of mental | 5 | | disorders or substance use disorders or co-occurring substance | 6 | | use and mental health disorders is determined using a uniform | 7 | | screening, assessment, and evaluation process inclusive of | 8 | | criteria; for purposes of this subsection (b), a uniform | 9 | | screening, assessment, and evaluation process refers to a | 10 | | process that includes an appropriate evaluation and, as | 11 | | warranted, a referral; "uniform" does not mean the use of a | 12 | | singular instrument, tool, or process that all must utilize; | 13 | | information obtained through client evaluation can be used in
| 14 | | individual treatment and habilitation plans; to assure | 15 | | appropriate
placement and to assist in program evaluation;
| 16 | | (c) Case Coordination: services to provide information and | 17 | | assistance to
disabled persons to insure that they obtain | 18 | | needed services provided by the
private and public sectors; | 19 | | case coordination services should be available
to individuals | 20 | | whose functioning level or history of institutional
recidivism | 21 | | or long-term care indicate that such assistance is required for
| 22 | | successful community living;
| 23 | | (d) Crisis and Emergency: services to assist individuals | 24 | | and
their families through crisis periods, to stabilize | 25 | | individuals under stress
and to prevent unnecessary | 26 | | institutionalization;
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| 1 | | (e) Treatment, Habilitation and Support: services designed | 2 | | to help
individuals develop skills which promote independence | 3 | | and improved levels
of social and vocational functioning and | 4 | | personal growth; and to provide
non-treatment support services | 5 | | which are necessary for successful
community living;
| 6 | | (f) Community Residential Alternatives to Institutional | 7 | | Settings:
services to provide living arrangements for persons | 8 | | unable to live
independently; the level of supervision, | 9 | | services provided and length of
stay at community residential | 10 | | alternatives will vary by the type of program
and the needs and | 11 | | functioning level of the residents; other services may be
| 12 | | provided in a community residential alternative which promote | 13 | | the
acquisition of independent living skills and integration | 14 | | with the community.
| 15 | | (Source: P.A. 89-507, eff. 7-1-97.)
| 16 | | Section 99. Effective date. This Act takes effect upon | 17 | | becoming law.
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