Full Text of SB2170 94th General Assembly
SB2170eng 94TH GENERAL ASSEMBLY
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| AN ACT concerning business.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Nursing Home Care Act is amended by adding | 5 |
| Sections 2-217 and 2-218 as follows: | 6 |
| (210 ILCS 45/2-217 new) | 7 |
| Sec. 2-217. Order for transportation of resident by | 8 |
| ambulance. If a facility orders transportation of a resident of | 9 |
| the facility by ambulance, the facility must maintain a written | 10 |
| record that shows (i) the name of the person who placed the | 11 |
| order for that transportation and (ii) the medical reason for | 12 |
| that transportation. The facility must maintain the record for | 13 |
| a period of at least 3 years after the date of the order for | 14 |
| transportation by ambulance. | 15 |
| (210 ILCS 45/2-218 new)
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| Sec. 2-218. Inducement to vehicle service provider; | 17 |
| penalty. | 18 |
| (a) If the Department determines, after an opportunity for | 19 |
| a hearing in accordance with rules adopted by the Department, | 20 |
| that (i) a facility knowingly or willingly offered or provided, | 21 |
| solicited, or received any remuneration (including any | 22 |
| kickback, bribe, rebate, or discount) directly or indirectly, | 23 |
| overtly or covertly, in cash or in kind, to any Vehicle Service | 24 |
| Provider licensed under the Emergency Medical Services (EMS) | 25 |
| Systems Act for the purpose of providing referrals for | 26 |
| transportation by the Vehicle Service Provider or (ii) an | 27 |
| employee or contractual agent of a facility knowingly or | 28 |
| willingly falsified any documentation of medical necessity for | 29 |
| non-emergency ambulance transportation, the Department may | 30 |
| impose against the facility, or against the employer of the | 31 |
| facility's contractual agent in the case of an individual who |
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| became the facility's contractual agent by virtue of his or her | 2 |
| employment by that employer, a civil penalty in an amount not | 3 |
| exceeding $10,000. | 4 |
| (b) If the Department makes a determination described in | 5 |
| subsection (a), the Department shall refer that determination | 6 |
| to the United States Department of Health and Human Services | 7 |
| Office of Inspector General. | 8 |
| Section 10. The Emergency Medical Services (EMS) Systems | 9 |
| Act is amended by changing Section 3.85 as follows:
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| (210 ILCS 50/3.85)
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| Sec. 3.85. Vehicle Service Providers.
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| (a) "Vehicle Service Provider" means an entity
licensed by | 13 |
| the Department to provide emergency or
non-emergency medical | 14 |
| services in compliance with this Act,
the rules promulgated by | 15 |
| the Department pursuant to this
Act, and an operational plan | 16 |
| approved by its EMS System(s),
utilizing at least ambulances or | 17 |
| specialized emergency
medical service vehicles (SEMSV).
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| (1) "Ambulance" means any publicly or
privately owned | 19 |
| on-road vehicle that is specifically designed,
constructed | 20 |
| or modified and equipped, and is intended to be
used for, | 21 |
| and is maintained or operated for the emergency
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| transportation of persons who are sick, injured, wounded or
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| otherwise incapacitated or helpless, or the non-emergency
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| medical transportation of persons who require the presence
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| of medical personnel to monitor the individual's condition
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| or medical apparatus being used on such individuals.
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| (2) "Specialized Emergency Medical Services
Vehicle" | 28 |
| or "SEMSV" means a vehicle or conveyance, other
than those | 29 |
| owned or operated by the federal government, that
is | 30 |
| primarily intended for use in transporting the sick or
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| injured by means of air, water, or ground transportation,
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| that is not an ambulance as defined in this Act. The term
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| includes watercraft, aircraft and special purpose ground
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| transport vehicles or conveyances not intended for use on
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| public roads.
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| (3) An ambulance or SEMSV may also be
designated as a | 3 |
| Limited Operation Vehicle or Special-Use Vehicle:
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| (A) "Limited Operation Vehicle" means a
vehicle | 5 |
| which is licensed by the Department to provide
basic, | 6 |
| intermediate or advanced life support emergency or
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| non-emergency medical services that are exclusively | 8 |
| limited
to specific events or locales.
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| (B) "Special-Use Vehicle" means any
publicly or | 10 |
| privately owned vehicle that is specifically designed,
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| constructed or modified and equipped, and is intended | 12 |
| to be
used for, and is maintained or operated solely | 13 |
| for the
emergency or non-emergency transportation of a | 14 |
| specific
medical class or category of persons who are | 15 |
| sick, injured,
wounded or otherwise incapacitated or | 16 |
| helpless (e.g.
high-risk obstetrical patients, | 17 |
| neonatal patients).
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| (b) The Department shall have the authority and
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| responsibility to:
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| (1) Require all Vehicle Service Providers, both
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| publicly and privately owned, to function within an EMS
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| System;
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| (2) Require a Vehicle Service Provider
utilizing | 24 |
| ambulances to have a primary affiliation with an EMS System
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| within the EMS Region in which its Primary Service Area is
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| located, which is the geographic areas in which the | 27 |
| provider
renders the majority of its emergency responses. | 28 |
| This
requirement shall not apply to Vehicle Service | 29 |
| Providers
which exclusively utilize Limited Operation | 30 |
| Vehicles;
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| (3) Establish licensing standards and
requirements for | 32 |
| Vehicle Service Providers, through rules
adopted pursuant | 33 |
| to this Act, including but not limited to:
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| (A) Vehicle design, specification,
operation and | 35 |
| maintenance standards;
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| (B) Equipment requirements;
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| (C) Staffing requirements; and
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| (D) Annual license renewal.
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| (4) License all Vehicle Service Providers
that have met | 4 |
| the Department's requirements for licensure, unless
such | 5 |
| Provider is owned or licensed by the federal
government. | 6 |
| All Provider licenses issued by the Department
shall | 7 |
| specify the level and type of each vehicle covered by
the | 8 |
| license (BLS, ILS, ALS, ambulance, SEMSV, limited
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| operation vehicle, special use vehicle);
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| (5) Annually inspect all licensed Vehicle
Service | 11 |
| Providers, and relicense such Providers that have met the
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| Department's requirements for license renewal;
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| (6) Suspend, revoke, refuse to issue or refuse to
renew | 14 |
| the license of any Vehicle Service Provider, or that
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| portion of a license pertaining to a specific vehicle
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| operated by the Provider, after an opportunity for a
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| hearing, when findings show that the Provider or one or | 18 |
| more
of its vehicles has failed to comply with the | 19 |
| standards and
requirements of this Act or rules adopted by | 20 |
| the Department
pursuant to this Act; | 21 |
| (6.5) Impose against a Vehicle Service Provider a civil | 22 |
| penalty in an amount not exceeding $10,000, if the | 23 |
| Department determines, after an opportunity for a hearing | 24 |
| in accordance with rules adopted by the Department, that | 25 |
| the Vehicle Service Provider knowingly or willingly | 26 |
| offered or provided, solicited, or received any | 27 |
| remuneration (including any kickback, bribe, rebate, or | 28 |
| discount) directly or indirectly, overtly or covertly, in | 29 |
| cash or in kind, to any long-term care facility licensed | 30 |
| under the Nursing Home Care Act or any hospital licensed | 31 |
| under the Hospital Licensing Act for the purpose of | 32 |
| influencing the long-term care facility or hospital to | 33 |
| provide referrals to the Vehicle Service Provider for the | 34 |
| transportation of residents of the long-term care facility | 35 |
| or patients of the hospital; the Department shall refer any | 36 |
| such determination to the United States Department of |
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| Health and Human Services Office of Inspector General;
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| (7) Issue an Emergency Suspension Order for
any | 3 |
| Provider or vehicle licensed under this Act, when the
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| Director or his designee has determined that an immediate
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| and serious danger to the public health, safety and welfare
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| exists. Suspension or revocation proceedings which offer | 7 |
| an
opportunity for hearing shall be promptly initiated | 8 |
| after
the Emergency Suspension Order has been issued;
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| (8) Exempt any licensed vehicle from
subsequent | 10 |
| vehicle design standards or specifications required by the
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| Department, as long as said vehicle is continuously in
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| compliance with the vehicle design standards and
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| specifications originally applicable to that vehicle, or
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| until said vehicle's title of ownership is transferred;
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| (9) Exempt any vehicle (except an SEMSV)
which was | 16 |
| being used as an ambulance on or before December 15,
1980, | 17 |
| from vehicle design standards and specifications
required | 18 |
| by the Department, until said vehicle's title of
ownership | 19 |
| is transferred. Such vehicles shall not be exempt
from all | 20 |
| other licensing standards and requirements
prescribed by | 21 |
| the Department;
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| (10) Prohibit any Vehicle Service Provider
from | 23 |
| advertising, identifying its vehicles, or disseminating
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| information in a false or misleading manner concerning the
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| Provider's type and level of vehicles, location, primary
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| service area, response times, level of personnel, | 27 |
| licensure
status or System participation; and
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| (11) Charge each Vehicle Service Provider a
fee, to be | 29 |
| submitted with each application for licensure and
license | 30 |
| renewal, which shall not exceed $25.00 per vehicle,
up to | 31 |
| $500.00 per Provider.
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| (Source: P.A. 89-177, eff. 7-19-95.)
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| Section 15. The Hospital Licensing Act is amended by adding | 34 |
| Sections 6.22 and 6.23 as follows: |
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| (210 ILCS 85/6.22 new) | 2 |
| Sec. 6.22. Order for transportation of patient by | 3 |
| ambulance. If a hospital orders transportation of a patient of | 4 |
| the hospital by ambulance, the hospital must maintain a written | 5 |
| record that shows (i) the name of the person who placed the | 6 |
| order for that transportation and (ii) the medical reason for | 7 |
| that transportation. The hospital must maintain the record for | 8 |
| a period of at least 3 years after the date of the order for | 9 |
| transportation by ambulance. | 10 |
| (210 ILCS 85/6.23 new)
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| Sec. 6.23. Inducement to vehicle service provider; | 12 |
| penalty. | 13 |
| (a) If the Department determines, after an opportunity for | 14 |
| a hearing in accordance with rules adopted by the Department, | 15 |
| that (i) a hospital knowingly or willingly offered or provided, | 16 |
| solicited, or received any remuneration (including any | 17 |
| kickback, bribe, rebate, or discount) directly or indirectly, | 18 |
| overtly or covertly, in cash or in kind, to any Vehicle Service | 19 |
| Provider licensed under the Emergency Medical Services (EMS) | 20 |
| Systems Act for the purpose of providing referrals for | 21 |
| transportation by the Vehicle Service Provider or (ii) an | 22 |
| employee or contractual agent of a hospital knowingly or | 23 |
| willingly falsified any documentation of medical necessity for | 24 |
| non-emergency ambulance transportation, the Department may | 25 |
| impose against the hospital, or against the employer of the | 26 |
| hospital's contractual agent in the case of an individual who | 27 |
| became the hospital's contractual agent by virtue of his or her | 28 |
| employment by that employer, a civil penalty in an amount not | 29 |
| exceeding $10,000. | 30 |
| (b) If the Department makes a determination described in | 31 |
| subsection (a), the Department shall refer that determination | 32 |
| to the United States Department of Health and Human Services | 33 |
| Office of Inspector General. | 34 |
| Section 20. The Consumer Fraud and Deceptive Business |
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| Practices Act is amended by adding Section 2XX as follows: | 2 |
| (815 ILCS 505/2XX new) | 3 |
| Sec. 2XX. Notification requirements for non-emergency | 4 |
| ambulance services. | 5 |
| (a) In this Section: | 6 |
| "Ambulance service provider" means a Vehicle Service | 7 |
| Provider, as defined in the Emergency Medical Services (EMS) | 8 |
| Systems Act, who provides non-emergency transportation | 9 |
| services by ambulance. | 10 |
| "Patient" means a person who is transported by an ambulance | 11 |
| service provider. | 12 |
| (b) An ambulance service provider shall provide a written | 13 |
| notice, and a verbal explanation of the written notice, prior | 14 |
| to non-emergency ambulance transports that originate at a | 15 |
| hospital or other health care facility when no written | 16 |
| documentation of medical necessity is available at the time of | 17 |
| transport. This notice must meet all of the following | 18 |
| requirements: | 19 |
| (1) The following caption must appear at the beginning | 20 |
| of the notice, in at least 14-point type: Notice to Patient | 21 |
| Regarding Non-Emergency Ambulance Services. | 22 |
| (2) The remainder of the notice must be expressed in | 23 |
| clear, simple language and in at least 14-point type. | 24 |
| (3) The notice must contain each of the following | 25 |
| statements: | 26 |
| (A) Notice: Medicare and other insurers may not pay | 27 |
| for any part of the cost of your transport by ambulance | 28 |
| unless certified by your physician or healthcare | 29 |
| provider as allowed under federal rules as being | 30 |
| medically necessary. | 31 |
| (B) The purpose of this notice is to help you make | 32 |
| an informed choice about whether or not you want to be | 33 |
| transported by ambulance, knowing that you might have | 34 |
| to pay for this transport yourself. Before you make any | 35 |
| decision about your options, you should: |
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| (i) Read this entire notice carefully.
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| (ii) Ask a representative of the physician or | 3 |
| facility ordering transport to explain, if you do | 4 |
| not understand or are not sure, the guidelines | 5 |
| regarding medical necessity for transport by | 6 |
| ambulance and to tell you whether or not you meet | 7 |
| these guidelines. | 8 |
| (iii) Ask us how much being transported by | 9 |
| ambulance will cost you, in case you have to pay | 10 |
| for transport by ambulance out of your own pocket | 11 |
| or through other insurance. The estimated cost | 12 |
| will be $(amount).
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| (C) Please choose one option by checking one box | 14 |
| and signing and dating your selection below: | 15 |
| (i) Option 1. Yes. I want to be transported by | 16 |
| ambulance. I understand that Medicare and many | 17 |
| other insurers may not pay for any part of the cost | 18 |
| of my ambulance transport unless certified by my | 19 |
| physician or healthcare provider as allowed under | 20 |
| federal rules as being medically necessary. I | 21 |
| understand that you will file a claim on my behalf | 22 |
| to Medicare or my other insurer. I understand that | 23 |
| you may bill me for items or services and that I | 24 |
| may have to pay the bill while Medicare or my other | 25 |
| insurer is making its decision. If Medicare or my | 26 |
| other insurer does pay on my behalf, I understand | 27 |
| that you will refund to me any payments that I made | 28 |
| to you that are due to me. If Medicare or my other | 29 |
| insurer denies payment, I agree to be personally | 30 |
| and fully responsible for payment. I understand | 31 |
| that I can appeal the decision made by Medicare or | 32 |
| my other insurer. | 33 |
| (ii) Option 2. No. I have decided not to be | 34 |
| transported by ambulance. | 35 |
| (4) The notice must be signed by the patient or by the | 36 |
| patient's authorized
representative. |
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| (5) The notice must contain the patient's full name and | 2 |
| the date of service.
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| (6) The notice must contain the full name and business | 4 |
| address (including the street name and number, city, state, | 5 |
| and zip code) of the ambulance service provider.
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| (c) If a patient is physically or mentally unable to sign | 7 |
| the notice described in subsection (b) at the time of transport | 8 |
| by ambulance and no authorized representative of the patient is | 9 |
| available to sign the notice on the patient's behalf, the | 10 |
| ambulance service provider must be able to provide | 11 |
| documentation of the patient's inability to sign the notice and | 12 |
| the unavailability of an authorized representative. In any case | 13 |
| described in this subsection (c), the ambulance service | 14 |
| provider shall be considered to have met the requirements of | 15 |
| subsection (b).
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| (d) If an ambulance service provider has obtained | 17 |
| documentation of medical necessity prior to transport and the | 18 |
| patient's Medicare or other insurer denies the claim for | 19 |
| transport by ambulance despite this fact, the ambulance service | 20 |
| provider is considered to have met the requirements of | 21 |
| subsection (b). | 22 |
| (e) In addition to any other penalty provided in this Act, | 23 |
| if the court finds that an ambulance service provider has | 24 |
| violated any provision of subsection (b), the court may order | 25 |
| that the ambulance service provider pay to the patient an | 26 |
| amount equal to 3 times the amount claimed due by the ambulance | 27 |
| provider, including any interest, collection costs, and | 28 |
| attorney's fees claimed by the ambulance service provider, and | 29 |
| any attorney's fees incurred by the patient.
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