Full Text of SB2367 93rd General Assembly
SB2367sam002 93RD GENERAL ASSEMBLY
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Sen. Donne E. Trotter
Filed: 3/23/2004
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| AMENDMENT TO SENATE BILL 2367
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| AMENDMENT NO. ______. Amend Senate Bill 2367 by replacing | 3 |
| the title with the following: | 4 |
| "AN ACT in relation to health."; and | 5 |
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| by replacing everything after the enacting clause with the | 7 |
| following:
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| "Section 5. The Children's Health Insurance Program Act is | 9 |
| amended by changing Section 40 as follows:
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| (215 ILCS 106/40)
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| Sec. 40. Waivers.
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| (a) The Department shall request any necessary waivers of | 13 |
| federal
requirements in order to allow receipt of federal | 14 |
| funding for:
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| (1) the coverage of families with eligible children | 16 |
| under this Act; and
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| (2) for the coverage of
children who would otherwise be | 18 |
| eligible under this Act, but who have health
insurance.
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| (b) The failure of the responsible federal agency to | 20 |
| approve a
waiver for children who would otherwise be eligible | 21 |
| under this Act but who have
health insurance shall not prevent | 22 |
| the implementation of any Section of this
Act provided that | 23 |
| there are sufficient appropriated funds.
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| (c) Eligibility of a person under an approved waiver due to |
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| the
relationship with a child pursuant to Article V of the | 2 |
| Illinois Public Aid
Code or this Act shall be limited to such a | 3 |
| person whose countable income is
determined by the Department | 4 |
| to be at or below such income eligibility
standard as the | 5 |
| Department by rule shall establish. The income level
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| established by the Department shall not be below 90% of the | 7 |
| federal
poverty
level. Such persons who are determined to be | 8 |
| eligible must reapply, or
otherwise establish eligibility, at | 9 |
| least annually. An eligible person shall
be required, as | 10 |
| determined by the Department by rule, to report promptly those
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| changes in income and other circumstances that affect | 12 |
| eligibility. The
eligibility of a person may be
redetermined | 13 |
| based on the information reported or may be terminated based on
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| the failure to report or failure to report accurately. A person | 15 |
| may also be
held liable to the Department for any payments made | 16 |
| by the Department on such
person's behalf that were | 17 |
| inappropriate. An applicant shall be provided with
notice of | 18 |
| these obligations.
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| (d) Subject to specific appropriation, the Department | 20 |
| shall provide outreach grants to community organizations to | 21 |
| enroll families in the program under this Section.
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| (Source: P.A. 92-597, eff. 6-28-02; 93-63, eff. 6-30-03.)
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| Section 10. The Illinois Public Aid Code is amended by | 24 |
| changing Section 5-5 as follows: | 25 |
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
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| Sec. 5-5. Medical services. The Illinois Department, by | 27 |
| rule, shall
determine the quantity and quality of and the rate | 28 |
| of reimbursement for the
medical assistance for which
payment | 29 |
| 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 | 31 |
| hospital
services; (2) outpatient hospital services; (3) other | 32 |
| laboratory and
X-ray services; (4) skilled nursing home |
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| 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
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| services; (10) dental services , including prevention and | 7 |
| treatment of periodontal disease and dental caries disease for | 8 |
| pregnant women ; (11) physical therapy and related
services; | 9 |
| (12) prescribed drugs, dentures, and prosthetic devices; and
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| eyeglasses prescribed by a physician skilled in the diseases of | 11 |
| the eye,
or by an optometrist, whichever the person may select; | 12 |
| (13) other
diagnostic, screening, preventive, and | 13 |
| rehabilitative services; (14)
transportation and such other | 14 |
| expenses as may be necessary; (15) medical
treatment of sexual | 15 |
| assault survivors, as defined in
Section 1a of the Sexual | 16 |
| Assault Survivors Emergency Treatment Act, for
injuries | 17 |
| sustained as a result of the sexual assault, including
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| examinations and laboratory tests to discover evidence which | 19 |
| may be used in
criminal proceedings arising from the sexual | 20 |
| assault; (16) the
diagnosis and treatment of sickle cell | 21 |
| anemia; and (17)
any other medical care, and any other type of | 22 |
| remedial care recognized
under the laws of this State, but not | 23 |
| including abortions, or induced
miscarriages or premature | 24 |
| births, unless, in the opinion of a physician,
such procedures | 25 |
| are necessary for the preservation of the life of the
woman | 26 |
| seeking such treatment, or except an induced premature birth
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| intended to produce a live viable child and such procedure is | 28 |
| necessary
for the health of the mother or her unborn child. The | 29 |
| Illinois Department,
by rule, shall prohibit any physician from | 30 |
| providing medical assistance
to anyone eligible therefor under | 31 |
| this Code where such physician has been
found guilty of | 32 |
| performing an abortion procedure in a wilful and wanton
manner | 33 |
| 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 |
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| care" shall
include nursing care and nursing home service for | 2 |
| persons who rely on
treatment by spiritual means alone through | 3 |
| prayer for healing.
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| Notwithstanding any other provision of this Section, a | 5 |
| comprehensive
tobacco use cessation program that includes | 6 |
| purchasing prescription drugs or
prescription medical devices | 7 |
| approved by the Food and Drug administration shall
be covered | 8 |
| under the medical assistance
program under this Article for | 9 |
| persons who are otherwise eligible for
assistance under this | 10 |
| Article.
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| Notwithstanding any other provision of this Code, the | 12 |
| Illinois
Department may not require, as a condition of payment | 13 |
| for any laboratory
test authorized under this Article, that a | 14 |
| physician's handwritten signature
appear on the laboratory | 15 |
| test order form. The Illinois Department may,
however, impose | 16 |
| other appropriate requirements regarding laboratory test
order | 17 |
| documentation.
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| The Illinois Department of Public Aid shall provide the | 19 |
| following services to
persons
eligible for assistance under | 20 |
| this Article who are participating in
education, training or | 21 |
| 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 | 24 |
| limited to
prosthodontics; and
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| (2) eyeglasses prescribed by a physician skilled in the | 26 |
| diseases of the
eye, or by an optometrist, whichever the | 27 |
| person may select.
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| The Illinois Department, by rule, may distinguish and | 29 |
| classify the
medical services to be provided only in accordance | 30 |
| with the classes of
persons designated in Section 5-2.
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| The Illinois Department shall authorize the provision of, | 32 |
| and shall
authorize payment for, screening by low-dose | 33 |
| mammography for the presence of
occult breast cancer for women | 34 |
| 35 years of age or older who are eligible
for medical |
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| assistance under this Article, as follows: a baseline
mammogram | 2 |
| for women 35 to 39 years of age and an
annual mammogram for | 3 |
| women 40 years of age or older. All screenings
shall
include a | 4 |
| physical breast exam, instruction on self-examination and
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| information regarding the frequency of self-examination and | 6 |
| its value as a
preventative tool. As used in this Section, | 7 |
| "low-dose mammography" means
the x-ray examination of the | 8 |
| breast using equipment dedicated specifically
for mammography, | 9 |
| including the x-ray tube, filter, compression device,
image | 10 |
| receptor, and cassettes, with an average radiation exposure | 11 |
| delivery
of less than one rad mid-breast, with 2 views for each | 12 |
| breast.
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| Any medical or health care provider shall immediately | 14 |
| recommend, to
any pregnant woman who is being provided prenatal | 15 |
| services and is suspected
of drug abuse or is addicted as | 16 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | 17 |
| 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. | 20 |
| The Department of
Public Aid shall assure coverage for the cost | 21 |
| of treatment of the drug abuse or
addiction for pregnant | 22 |
| recipients in accordance with the Illinois Medicaid
Program in | 23 |
| conjunction with the Department of Human Services.
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| All medical providers providing medical assistance to | 25 |
| pregnant women
under this Code shall receive information from | 26 |
| the Department on the
availability of services under the Drug | 27 |
| Free Families with a Future or any
comparable program providing | 28 |
| case management services for addicted women,
including | 29 |
| information on appropriate referrals for other social services
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| that may be needed by addicted women in addition to treatment | 31 |
| for addiction.
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| The Illinois Department, in cooperation with the | 33 |
| Departments of Human
Services (as successor to the Department | 34 |
| of Alcoholism and Substance
Abuse) and Public Health, through a |
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| public awareness campaign, may
provide information concerning | 2 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 3 |
| health care, and other pertinent programs directed at
reducing | 4 |
| the number of drug-affected infants born to recipients of | 5 |
| medical
assistance.
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| Neither the Illinois Department of Public Aid nor the | 7 |
| Department of Human
Services shall sanction the recipient | 8 |
| solely on the basis of
her substance abuse.
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| The Illinois Department shall establish such regulations | 10 |
| governing
the dispensing of health services under this Article | 11 |
| as it shall deem
appropriate. The Department
should
seek the | 12 |
| advice of formal professional advisory committees appointed by
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| the Director of the Illinois Department for the purpose of | 14 |
| providing regular
advice on policy and administrative matters, | 15 |
| information dissemination and
educational activities for | 16 |
| medical and health care providers, and
consistency in | 17 |
| procedures to the Illinois Department.
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| The Illinois Department may develop and contract with | 19 |
| Partnerships of
medical providers to arrange medical services | 20 |
| for persons eligible under
Section 5-2 of this Code. | 21 |
| Implementation of this Section may be by
demonstration projects | 22 |
| in certain geographic areas. The Partnership shall
be | 23 |
| represented by a sponsor organization. The Department, by rule, | 24 |
| shall
develop qualifications for sponsors of Partnerships. | 25 |
| Nothing in this
Section shall be construed to require that the | 26 |
| sponsor organization be a
medical organization.
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| The sponsor must negotiate formal written contracts with | 28 |
| medical
providers for physician services, inpatient and | 29 |
| outpatient hospital care,
home health services, treatment for | 30 |
| alcoholism and substance abuse, and
other services determined | 31 |
| necessary by the Illinois Department by rule for
delivery by | 32 |
| Partnerships. Physician services must include prenatal and
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| obstetrical care. The Illinois Department shall reimburse | 34 |
| medical services
delivered by Partnership providers to clients |
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| in target areas according to
provisions of this Article and the | 2 |
| Illinois Health Finance Reform Act,
except that:
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| (1) Physicians participating in a Partnership and | 4 |
| providing certain
services, which shall be determined by | 5 |
| the Illinois Department, to persons
in areas covered by the | 6 |
| Partnership may receive an additional surcharge
for such | 7 |
| services.
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| (2) The Department may elect to consider and negotiate | 9 |
| financial
incentives to encourage the development of | 10 |
| Partnerships and the efficient
delivery of medical care.
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| (3) Persons receiving medical services through | 12 |
| Partnerships may receive
medical and case management | 13 |
| services above the level usually offered
through the | 14 |
| medical assistance program.
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| Medical providers shall be required to meet certain | 16 |
| qualifications to
participate in Partnerships to ensure the | 17 |
| delivery of high quality medical
services. These | 18 |
| qualifications shall be determined by rule of the Illinois
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| Department and may be higher than qualifications for | 20 |
| participation in the
medical assistance program. Partnership | 21 |
| sponsors may prescribe reasonable
additional qualifications | 22 |
| for participation by medical providers, only with
the prior | 23 |
| written approval of the Illinois Department.
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| Nothing in this Section shall limit the free choice of | 25 |
| practitioners,
hospitals, and other providers of medical | 26 |
| services by clients.
In order to ensure patient freedom of | 27 |
| choice, the Illinois Department shall
immediately promulgate | 28 |
| all rules and take all other necessary actions so that
provided | 29 |
| services may be accessed from therapeutically certified | 30 |
| optometrists
to the full extent of the Illinois Optometric | 31 |
| Practice Act of 1987 without
discriminating between service | 32 |
| providers.
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| The Department shall apply for a waiver from the United | 34 |
| States Health
Care Financing Administration to allow for the |
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| implementation of
Partnerships under this Section.
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| The Illinois Department shall require health care | 3 |
| providers to maintain
records that document the medical care | 4 |
| and services provided to recipients
of Medical Assistance under | 5 |
| this Article. The Illinois Department shall
require health care | 6 |
| providers to make available, when authorized by the
patient, in | 7 |
| writing, the medical records in a timely fashion to other
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| health care providers who are treating or serving persons | 9 |
| eligible for
Medical Assistance under this Article. All | 10 |
| dispensers of medical services
shall be required to maintain | 11 |
| and retain business and professional records
sufficient to | 12 |
| fully and accurately document the nature, scope, details and
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| receipt of the health care provided to persons eligible for | 14 |
| medical
assistance under this Code, in accordance with | 15 |
| regulations promulgated by
the Illinois Department. The rules | 16 |
| and regulations shall require that proof
of the receipt of | 17 |
| prescription drugs, dentures, prosthetic devices and
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| eyeglasses by eligible persons under this Section accompany | 19 |
| each claim
for reimbursement submitted by the dispenser of such | 20 |
| medical services.
No such claims for reimbursement shall be | 21 |
| approved for payment by the Illinois
Department without such | 22 |
| proof of receipt, unless the Illinois Department
shall have put | 23 |
| 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 | 25 |
| adequate by
the Illinois Department to assure that such drugs, | 26 |
| dentures, prosthetic
devices and eyeglasses for which payment | 27 |
| is being made are actually being
received by eligible | 28 |
| recipients. Within 90 days after the effective date of
this | 29 |
| amendatory Act of 1984, the Illinois Department shall establish | 30 |
| a
current list of acquisition costs for all prosthetic devices | 31 |
| and any
other items recognized as medical equipment and | 32 |
| supplies reimbursable under
this Article and shall update such | 33 |
| list on a quarterly basis, except that
the acquisition costs of | 34 |
| all prescription drugs shall be updated no
less frequently than |
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| every 30 days as required by Section 5-5.12.
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| The rules and regulations of the Illinois Department shall | 3 |
| require
that a written statement including the required opinion | 4 |
| of a physician
shall accompany any claim for reimbursement for | 5 |
| abortions, or induced
miscarriages or premature births. This | 6 |
| statement shall indicate what
procedures were used in providing | 7 |
| such medical services.
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| The Illinois Department shall require all dispensers of | 9 |
| medical
services, other than an individual practitioner or | 10 |
| group of practitioners,
desiring to participate in the Medical | 11 |
| Assistance program
established under this Article to disclose | 12 |
| all financial, beneficial,
ownership, equity, surety or other | 13 |
| interests in any and all firms,
corporations, partnerships, | 14 |
| associations, business enterprises, joint
ventures, agencies, | 15 |
| institutions or other legal entities providing any
form of | 16 |
| health care services in this State under this Article.
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| The Illinois Department may require that all dispensers of | 18 |
| medical
services desiring to participate in the medical | 19 |
| assistance program
established under this Article disclose, | 20 |
| under such terms and conditions as
the Illinois Department may | 21 |
| by rule establish, all inquiries from clients
and attorneys | 22 |
| regarding medical bills paid by the Illinois Department, which
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| inquiries could indicate potential existence of claims or liens | 24 |
| for the
Illinois Department.
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| Enrollment of a vendor that provides non-emergency medical | 26 |
| transportation,
defined by the Department by rule,
shall be
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| conditional for 180 days. During that time, the Department of | 28 |
| Public Aid may
terminate the vendor's eligibility to | 29 |
| participate in the medical assistance
program without cause. | 30 |
| 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, | 33 |
| procedures,
standards and criteria by rule for the acquisition, | 34 |
| repair and replacement
of orthotic and prosthetic devices and |
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| durable medical equipment. Such
rules shall provide, but not be | 2 |
| limited to, the following services: (1)
immediate repair or | 3 |
| replacement of such devices by recipients without
medical | 4 |
| authorization; and (2) rental, lease, purchase or | 5 |
| lease-purchase of
durable medical equipment in a | 6 |
| cost-effective manner, taking into
consideration the | 7 |
| recipient's medical prognosis, the extent of the
recipient's | 8 |
| needs, and the requirements and costs for maintaining such
| 9 |
| equipment. Such rules shall enable a recipient to temporarily | 10 |
| acquire and
use alternative or substitute devices or equipment | 11 |
| pending repairs or
replacements of any device or equipment | 12 |
| previously authorized for such
recipient by the Department. | 13 |
| Rules under clause (2) above shall not provide
for purchase or | 14 |
| lease-purchase of durable medical equipment or supplies
used | 15 |
| for the purpose of oxygen delivery and respiratory care.
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| The Department shall execute, relative to the nursing home | 17 |
| prescreening
project, written inter-agency agreements with the | 18 |
| Department of Human
Services and the Department on Aging, to | 19 |
| effect the following: (i) intake
procedures and common | 20 |
| eligibility criteria for those persons who are receiving
| 21 |
| non-institutional services; and (ii) the establishment and | 22 |
| development of
non-institutional services in areas of the State | 23 |
| where they are not currently
available or are undeveloped.
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| The Illinois Department shall develop and operate, in | 25 |
| cooperation
with other State Departments and agencies and in | 26 |
| compliance with
applicable federal laws and regulations, | 27 |
| appropriate and effective
systems of health care evaluation and | 28 |
| programs for monitoring of
utilization of health care services | 29 |
| and facilities, as it affects
persons eligible for medical | 30 |
| assistance under this Code.
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| The Illinois Department shall report annually to the | 32 |
| General Assembly,
no later than the second Friday in April of | 33 |
| 1979 and each year
thereafter, in regard to:
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| (a) actual statistics and trends in utilization of |
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| medical services by
public aid recipients;
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| (b) actual statistics and trends in the provision of | 3 |
| the various medical
services by medical vendors;
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| (c) current rate structures and proposed changes in | 5 |
| those rate structures
for the various medical vendors; and
| 6 |
| (d) efforts at utilization review and control by the | 7 |
| Illinois Department.
| 8 |
| The period covered by each report shall be the 3 years | 9 |
| ending on the June
30 prior to the report. The report shall | 10 |
| include suggested legislation
for consideration by the General | 11 |
| Assembly. The filing of one copy of the
report with the | 12 |
| Speaker, one copy with the Minority Leader and one copy
with | 13 |
| the Clerk of the House of Representatives, one copy with the | 14 |
| President,
one copy with the Minority Leader and one copy with | 15 |
| the Secretary of the
Senate, one copy with the Legislative | 16 |
| Research Unit, and such additional
copies
with the State | 17 |
| Government Report Distribution Center for the General
Assembly | 18 |
| as is required under paragraph (t) of Section 7 of the State
| 19 |
| Library Act shall be deemed sufficient to comply with this | 20 |
| Section.
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| (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02; | 22 |
| 92-789, eff. 8-6-02; 93-632, eff. 2-1-04.)".
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