Full Text of HB0486 93rd General Assembly
HB0486enr 93RD GENERAL ASSEMBLY
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| AN ACT concerning health care for women.
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| Be it enacted by the People of the State of Illinois, | 3 |
| represented in the General Assembly:
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| Section 5. The Hospital Licensing Act is amended by adding | 5 |
| Section 11.5 as
follows:
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| (210 ILCS 85/11.5 new)
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| Sec. 11.5. Uniform standards of obstetrical care | 8 |
| regardless of
ability to pay.
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| (a) No hospital may promulgate policies or implement | 10 |
| practices that determine
differing standards of obstetrical | 11 |
| care based upon a patient's source of
payment or ability
to pay | 12 |
| for medical services.
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| (b) Each hospital shall develop a written policy statement | 14 |
| reflecting the
requirements of subsection (a) and shall post | 15 |
| written notices of this policy in
the obstetrical admitting | 16 |
| areas of the hospital by July 1, 2004. Notices
posted pursuant | 17 |
| to this Section shall be posted in the predominant language or
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| languages spoken in the hospital's service area.
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| Section 15. The Illinois Public Aid Code is amended by | 20 |
| changing Section 5-5 and adding Section 5-16.7a as follows:
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| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
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| Sec. 5-5. Medical services. The Illinois Department, by | 23 |
| rule, shall
determine the quantity and quality of and the rate | 24 |
| of reimbursement for the
medical assistance for which
payment | 25 |
| 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 | 27 |
| hospital
services; (2) outpatient hospital services; (3) other | 28 |
| laboratory and
X-ray services; (4) skilled nursing home | 29 |
| services; (5) physicians'
services whether furnished in the | 30 |
| office, the patient's home, a
hospital, a skilled nursing home, |
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| or elsewhere; (6) medical care, or any
other type of remedial | 2 |
| care furnished by licensed practitioners; (7)
home health care | 3 |
| services; (8) private duty nursing service; (9) clinic
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| services; (10) dental services , including prevention and | 5 |
| treatment of periodontal disease and dental caries disease for | 6 |
| pregnant women ; (11) physical therapy and related
services; | 7 |
| (12) prescribed drugs, dentures, and prosthetic devices; and
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| eyeglasses prescribed by a physician skilled in the diseases of | 9 |
| the eye,
or by an optometrist, whichever the person may select; | 10 |
| (13) other
diagnostic, screening, preventive, and | 11 |
| rehabilitative services; (14)
transportation and such other | 12 |
| expenses as may be necessary; (15) medical
treatment of sexual | 13 |
| assault survivors, as defined in
Section 1a of the Sexual | 14 |
| Assault Survivors Emergency Treatment Act, for
injuries | 15 |
| sustained as a result of the sexual assault, including
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| examinations and laboratory tests to discover evidence which | 17 |
| may be used in
criminal proceedings arising from the sexual | 18 |
| assault; (16) the
diagnosis and treatment of sickle cell | 19 |
| anemia; and (17)
any other medical care, and any other type of | 20 |
| remedial care recognized
under the laws of this State, but not | 21 |
| including abortions, or induced
miscarriages or premature | 22 |
| births, unless, in the opinion of a physician,
such procedures | 23 |
| are necessary for the preservation of the life of the
woman | 24 |
| seeking such treatment, or except an induced premature birth
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| intended to produce a live viable child and such procedure is | 26 |
| necessary
for the health of the mother or her unborn child. The | 27 |
| Illinois Department,
by rule, shall prohibit any physician from | 28 |
| providing medical assistance
to anyone eligible therefor under | 29 |
| this Code where such physician has been
found guilty of | 30 |
| performing an abortion procedure in a wilful and wanton
manner | 31 |
| upon a woman who was not pregnant at the time such abortion
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| procedure was performed. The term "any other type of remedial | 33 |
| care" shall
include nursing care and nursing home service for | 34 |
| persons who rely on
treatment by spiritual means alone through | 35 |
| prayer for healing.
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| Notwithstanding any other provision of this Section, a |
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| 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.
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| 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.
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| The Illinois Department of Public Aid shall provide the | 15 |
| following services to
persons
eligible for assistance under | 16 |
| this Article who are participating in
education, training or | 17 |
| employment programs operated by the Department of Human
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| Services as successor to the Department of Public Aid:
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| (1) dental services, which shall include but not be | 20 |
| limited to
prosthodontics; and
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| (2) eyeglasses prescribed by a physician skilled in the | 22 |
| diseases of the
eye, or by an optometrist, whichever the | 23 |
| person may select.
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| 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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| The Illinois Department shall authorize the provision of, | 28 |
| and shall
authorize payment for, screening by low-dose | 29 |
| mammography for the presence of
occult breast cancer for women | 30 |
| 35 years of age or older who are eligible
for medical | 31 |
| assistance under this Article, as follows: a baseline
mammogram | 32 |
| for women 35 to 39 years of age and an
annual mammogram for | 33 |
| women 40 years of age or older. All screenings
shall
include a | 34 |
| physical breast exam, instruction on self-examination and
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| information regarding the frequency of self-examination and | 36 |
| its value as a
preventative tool. As used in this Section, |
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| "low-dose mammography" means
the x-ray examination of the | 2 |
| breast using equipment dedicated specifically
for mammography, | 3 |
| including the x-ray tube, filter, compression device,
image | 4 |
| receptor, and cassettes, with an average radiation exposure | 5 |
| delivery
of less than one rad mid-breast, with 2 views for each | 6 |
| breast.
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| Any medical or health care provider shall immediately | 8 |
| recommend, to
any pregnant woman who is being provided prenatal | 9 |
| services and is suspected
of drug abuse or is addicted as | 10 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | 11 |
| Act, referral to a local substance abuse treatment provider
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| licensed by the Department of Human Services or to a licensed
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| hospital which provides substance abuse treatment services. | 14 |
| The Department of
Public Aid shall assure coverage for the cost | 15 |
| of treatment of the drug abuse or
addiction for pregnant | 16 |
| recipients in accordance with the Illinois Medicaid
Program in | 17 |
| conjunction with the Department of Human Services.
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| All medical providers providing medical assistance to | 19 |
| pregnant women
under this Code shall receive information from | 20 |
| the Department on the
availability of services under the Drug | 21 |
| Free Families with a Future or any
comparable program providing | 22 |
| case management services for addicted women,
including | 23 |
| information on appropriate referrals for other social services
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| that may be needed by addicted women in addition to treatment | 25 |
| for addiction.
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| The Illinois Department, in cooperation with the | 27 |
| Departments of Human
Services (as successor to the Department | 28 |
| of Alcoholism and Substance
Abuse) and Public Health, through a | 29 |
| public awareness campaign, may
provide information concerning | 30 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 31 |
| health care, and other pertinent programs directed at
reducing | 32 |
| the number of drug-affected infants born to recipients of | 33 |
| medical
assistance.
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| Neither the Illinois Department of Public Aid nor the | 35 |
| Department of Human
Services shall sanction the recipient | 36 |
| solely on the basis of
her substance abuse.
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| The Illinois Department shall establish such regulations | 2 |
| governing
the dispensing of health services under this Article | 3 |
| as it shall deem
appropriate. The Department
should
seek the | 4 |
| advice of formal professional advisory committees appointed by
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| the Director of the Illinois Department for the purpose of | 6 |
| providing regular
advice on policy and administrative matters, | 7 |
| information dissemination and
educational activities for | 8 |
| medical and health care providers, and
consistency in | 9 |
| procedures to the Illinois Department.
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| The Illinois Department may develop and contract with | 11 |
| Partnerships of
medical providers to arrange medical services | 12 |
| for persons eligible under
Section 5-2 of this Code. | 13 |
| Implementation of this Section may be by
demonstration projects | 14 |
| in certain geographic areas. The Partnership shall
be | 15 |
| represented by a sponsor organization. The Department, by rule, | 16 |
| shall
develop qualifications for sponsors of Partnerships. | 17 |
| Nothing in this
Section shall be construed to require that the | 18 |
| sponsor organization be a
medical organization.
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| The sponsor must negotiate formal written contracts with | 20 |
| medical
providers for physician services, inpatient and | 21 |
| outpatient hospital care,
home health services, treatment for | 22 |
| alcoholism and substance abuse, and
other services determined | 23 |
| necessary by the Illinois Department by rule for
delivery by | 24 |
| Partnerships. Physician services must include prenatal and
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| obstetrical care. The Illinois Department shall reimburse | 26 |
| medical services
delivered by Partnership providers to clients | 27 |
| in target areas according to
provisions of this Article and the | 28 |
| Illinois Health Finance Reform Act,
except that:
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| (1) Physicians participating in a Partnership and | 30 |
| providing certain
services, which shall be determined by | 31 |
| the Illinois Department, to persons
in areas covered by the | 32 |
| Partnership may receive an additional surcharge
for such | 33 |
| services.
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| (2) The Department may elect to consider and negotiate | 35 |
| financial
incentives to encourage the development of | 36 |
| Partnerships and the efficient
delivery of medical care.
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| (3) Persons receiving medical services through | 2 |
| Partnerships may receive
medical and case management | 3 |
| services above the level usually offered
through the | 4 |
| medical assistance program.
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| Medical providers shall be required to meet certain | 6 |
| qualifications to
participate in Partnerships to ensure the | 7 |
| delivery of high quality medical
services. These | 8 |
| qualifications shall be determined by rule of the Illinois
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| Department and may be higher than qualifications for | 10 |
| participation in the
medical assistance program. Partnership | 11 |
| sponsors may prescribe reasonable
additional qualifications | 12 |
| for participation by medical providers, only with
the prior | 13 |
| written approval of the Illinois Department.
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| Nothing in this Section shall limit the free choice of | 15 |
| practitioners,
hospitals, and other providers of medical | 16 |
| services by clients.
In order to ensure patient freedom of | 17 |
| choice, the Illinois Department shall
immediately promulgate | 18 |
| all rules and take all other necessary actions so that
provided | 19 |
| services may be accessed from therapeutically certified | 20 |
| optometrists
to the full extent of the Illinois Optometric | 21 |
| Practice Act of 1987 without
discriminating between service | 22 |
| providers.
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| The Department shall apply for a waiver from the United | 24 |
| States Health
Care Financing Administration to allow for the | 25 |
| implementation of
Partnerships under this Section.
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| The Illinois Department shall require health care | 27 |
| providers to maintain
records that document the medical care | 28 |
| and services provided to recipients
of Medical Assistance under | 29 |
| this Article. The Illinois Department shall
require health care | 30 |
| providers to make available, when authorized by the
patient, in | 31 |
| writing, the medical records in a timely fashion to other
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| health care providers who are treating or serving persons | 33 |
| eligible for
Medical Assistance under this Article. All | 34 |
| dispensers of medical services
shall be required to maintain | 35 |
| and retain business and professional records
sufficient to | 36 |
| fully and accurately document the nature, scope, details and
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| receipt of the health care provided to persons eligible for | 2 |
| medical
assistance under this Code, in accordance with | 3 |
| regulations promulgated by
the Illinois Department. The rules | 4 |
| and regulations shall require that proof
of the receipt of | 5 |
| prescription drugs, dentures, prosthetic devices and
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| eyeglasses by eligible persons under this Section accompany | 7 |
| each claim
for reimbursement submitted by the dispenser of such | 8 |
| medical services.
No such claims for reimbursement shall be | 9 |
| approved for payment by the Illinois
Department without such | 10 |
| proof of receipt, unless the Illinois Department
shall have put | 11 |
| into effect and shall be operating a system of post-payment
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| audit and review which shall, on a sampling basis, be deemed | 13 |
| adequate by
the Illinois Department to assure that such drugs, | 14 |
| dentures, prosthetic
devices and eyeglasses for which payment | 15 |
| is being made are actually being
received by eligible | 16 |
| recipients. Within 90 days after the effective date of
this | 17 |
| amendatory Act of 1984, the Illinois Department shall establish | 18 |
| a
current list of acquisition costs for all prosthetic devices | 19 |
| and any
other items recognized as medical equipment and | 20 |
| supplies reimbursable under
this Article and shall update such | 21 |
| list on a quarterly basis, except that
the acquisition costs of | 22 |
| all prescription drugs shall be updated no
less frequently than | 23 |
| every 30 days as required by Section 5-5.12.
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| The rules and regulations of the Illinois Department shall | 25 |
| require
that a written statement including the required opinion | 26 |
| of a physician
shall accompany any claim for reimbursement for | 27 |
| abortions, or induced
miscarriages or premature births. This | 28 |
| statement shall indicate what
procedures were used in providing | 29 |
| such medical services.
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| The Illinois Department shall require all dispensers of | 31 |
| medical
services, other than an individual practitioner or | 32 |
| group of practitioners,
desiring to participate in the Medical | 33 |
| Assistance program
established under this Article to disclose | 34 |
| all financial, beneficial,
ownership, equity, surety or other | 35 |
| interests in any and all firms,
corporations, partnerships, | 36 |
| associations, business enterprises, joint
ventures, agencies, |
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| institutions or other legal entities providing any
form of | 2 |
| health care services in this State under this Article.
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| The Illinois Department may require that all dispensers of | 4 |
| medical
services desiring to participate in the medical | 5 |
| assistance program
established under this Article disclose, | 6 |
| under such terms and conditions as
the Illinois Department may | 7 |
| by rule establish, all inquiries from clients
and attorneys | 8 |
| regarding medical bills paid by the Illinois Department, which
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| inquiries could indicate potential existence of claims or liens | 10 |
| for the
Illinois Department.
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| Enrollment of a vendor that provides non-emergency medical | 12 |
| transportation,
defined by the Department by rule,
shall be
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| conditional for 180 days. During that time, the Department of | 14 |
| Public Aid may
terminate the vendor's eligibility to | 15 |
| participate in the medical assistance
program without cause. | 16 |
| That termination of eligibility is not subject to the
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| Department's hearing process.
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| The Illinois Department shall establish policies, | 19 |
| procedures,
standards and criteria by rule for the acquisition, | 20 |
| repair and replacement
of orthotic and prosthetic devices and | 21 |
| durable medical equipment. Such
rules shall provide, but not be | 22 |
| limited to, the following services: (1)
immediate repair or | 23 |
| replacement of such devices by recipients without
medical | 24 |
| authorization; and (2) rental, lease, purchase or | 25 |
| lease-purchase of
durable medical equipment in a | 26 |
| cost-effective manner, taking into
consideration the | 27 |
| recipient's medical prognosis, the extent of the
recipient's | 28 |
| needs, and the requirements and costs for maintaining such
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| equipment. Such rules shall enable a recipient to temporarily | 30 |
| acquire and
use alternative or substitute devices or equipment | 31 |
| pending repairs or
replacements of any device or equipment | 32 |
| previously authorized for such
recipient by the Department. | 33 |
| Rules under clause (2) above shall not provide
for purchase or | 34 |
| lease-purchase of durable medical equipment or supplies
used | 35 |
| for the purpose of oxygen delivery and respiratory care.
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| The Department shall execute, relative to the nursing home |
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| prescreening
project, written inter-agency agreements with the | 2 |
| Department of Human
Services and the Department on Aging, to | 3 |
| effect the following: (i) intake
procedures and common | 4 |
| eligibility criteria for those persons who are receiving
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| non-institutional services; and (ii) the establishment and | 6 |
| development of
non-institutional services in areas of the State | 7 |
| where they are not currently
available or are undeveloped.
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| The Illinois Department shall develop and operate, in | 9 |
| cooperation
with other State Departments and agencies and in | 10 |
| compliance with
applicable federal laws and regulations, | 11 |
| appropriate and effective
systems of health care evaluation and | 12 |
| programs for monitoring of
utilization of health care services | 13 |
| and facilities, as it affects
persons eligible for medical | 14 |
| assistance under this Code.
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| The Illinois Department shall report annually to the | 16 |
| General Assembly,
no later than the second Friday in April of | 17 |
| 1979 and each year
thereafter, in regard to:
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| (a) actual statistics and trends in utilization of | 19 |
| medical services by
public aid recipients;
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| (b) actual statistics and trends in the provision of | 21 |
| the various medical
services by medical vendors;
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| (c) current rate structures and proposed changes in | 23 |
| those rate structures
for the various medical vendors; and
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| (d) efforts at utilization review and control by the | 25 |
| Illinois Department.
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| The period covered by each report shall be the 3 years | 27 |
| ending on the June
30 prior to the report. The report shall | 28 |
| include suggested legislation
for consideration by the General | 29 |
| Assembly. The filing of one copy of the
report with the | 30 |
| Speaker, one copy with the Minority Leader and one copy
with | 31 |
| the Clerk of the House of Representatives, one copy with the | 32 |
| President,
one copy with the Minority Leader and one copy with | 33 |
| the Secretary of the
Senate, one copy with the Legislative | 34 |
| Research Unit, and such additional
copies
with the State | 35 |
| Government Report Distribution Center for the General
Assembly | 36 |
| as is required under paragraph (t) of Section 7 of the State
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| Library Act shall be deemed sufficient to comply with this | 2 |
| Section.
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| (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02; | 4 |
| 92-789, eff. 8-6-02; 93-632, eff. 2-1-04.)
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| (305 ILCS 5/5-16.7a new)
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| Sec. 5-16.7a. Reimbursement for epidural anesthesia | 7 |
| services.
In addition to other procedures authorized by the
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| Department under this Code, the
Department shall provide | 9 |
| reimbursement to medical providers for epidural
anesthesia | 10 |
| services when ordered by the attending practitioner at the time | 11 |
| of
delivery.
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| Section 99. Effective date. This Act takes effect upon | 13 |
| becoming law. |
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