HB1366ham001 94TH GENERAL ASSEMBLY

Rep. Dave Winters

Filed: 4/6/2005

09400HB1366ham001 LRB094 05548 DRJ 44463 a

AMENDMENT TO HOUSE BILL 1366

AMENDMENT NO. ______. Amend House Bill 1366 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Public Aid Code is amended by changing Section 5-4.2 as follows:

(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)

Sec. 5-4.2. Ambulance services payments. For ambulance services provided to a recipient of aid under this Article on or after January 1, 1993, the Illinois Department shall reimburse ambulance service providers at rates calculated in accordance with this Section. It is the intent of the General Assembly to provide adequate reimbursement for ambulance services so as to ensure adequate access to services for recipients of aid under this Article and to provide appropriate incentives to ambulance service providers to provide services in an efficient and cost-effective manner. Thus, it is the intent of the General Assembly that the Illinois Department implement a reimbursement system for ambulance services that, to the extent practicable and subject to the availability of funds appropriated by the General Assembly for this purpose, is consistent with the payment principles of Medicare. To ensure uniformity between the payment principles of Medicare and Medicaid, the Illinois Department shall follow, to the extent necessary and practicable and subject to the availability of funds appropriated by the General Assembly for this purpose, the statutes, laws, regulations, policies, procedures, principles, definitions, guidelines, and manuals used to determine the amounts paid to ambulance service providers under Title XVIII of the Social Security Act (Medicare).

For ambulance services provided to a recipient of aid under this Article on or after January 1, 1996, the Illinois Department shall reimburse ambulance service providers based upon the actual distance traveled if a natural disaster, weather conditions, road repairs, or traffic congestion necessitates the use of a route other than the most direct route.

Notwithstanding any other provision of this Section, for ambulance services provided to a recipient of aid under this Article on or after January 1, 2006, the Department of Public Aid shall reimburse providers of medical transportation services by means of a medi-car, service car, or taxi at a rate that is based on the cost of providing the services. The rate may not vary between different regions of the State unless any such variation is based on differences in the cost of providing the services between those regions. The Department need not establish the rate or rates to provide reimbursement of any particular percentage of the cost of providing the services. The Department may determine the cost of providing the services through the use of cost reports or in any other appropriate manner determined by the Department.

For purposes of this Section, "ambulance services" includes medical transportation services provided by means of an ambulance, medi-car, service car, or taxi.

This Section does not prohibit separate billing by ambulance service providers for oxygen furnished while providing advanced life support services.

(Source: P.A. 88-104; 89-43, eff. 1-1-96.)".