Illinois General Assembly - Full Text of HB0542
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Full Text of HB0542  96th General Assembly


Sen. John M. Sullivan

Filed: 5/15/2009





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2     AMENDMENT NO. ______. Amend House Bill 542 by replacing
3 everything after the enacting clause with the following:
4     "Section 5. The Illinois Public Aid Code is amended by
5 changing Sections 5-4.2 and 5-5 as follows:
6     (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
7     Sec. 5-4.2. Ground ambulance Ambulance services payments.
8     (a) For purposes of this Section, the following terms have
9 the following meanings:
10     "Department" means the Illinois Department of Healthcare
11 and Family Services.
12     "Ground ambulance services" means medical transportation
13 services that are described as ground ambulance services by the
14 Centers for Medicare and Medicaid Services and provided in a
15 vehicle that is licensed as an ambulance by the Illinois
16 Department of Public Health pursuant to the Emergency Medical



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1 Services (EMS) Systems Act.
2     "Ground ambulance services provider" means a vehicle
3 service provider as described in the Emergency Medical Services
4 (EMS) Systems Act that operates licensed ambulances for the
5 purpose of providing emergency ambulance services, or
6 non-emergency ambulance services, or both. For purposes of this
7 Section, this includes both ambulance providers and ambulance
8 suppliers as described by the Centers for Medicare and Medicaid
9 Services.
10     "Rural county" means: any county not located in a U.S.
11 Bureau of the Census Metropolitan Statistical Area (MSA); or
12 any county located within a U.S. Bureau of the Census
13 Metropolitan Statistical Area but having a population of 60,000
14 or less.
15     (b) It is the intent of the General Assembly to provide for
16 the payment for ground ambulance services as part of the State
17 Medicaid plan and to provide adequate payment for ground
18 ambulance services under the State Medicaid plan so as to
19 ensure adequate access to ground ambulance services for both
20 recipients of aid under this Article and for the general
21 population of Illinois. Unless otherwise indicated in this
22 Section, the practices of the Department concerning payments
23 for ground ambulance services provided to recipients of aid
24 under this Article shall be consistent with the payment
25 principles of Medicare, including the statutes, regulations,
26 policies, procedures, principles, definitions, guidelines,



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1 coding systems, including the ambulance condition coding
2 system, and manuals used by the Centers for Medicare and
3 Medicaid Services and the Medicare Part B Carrier or the
4 Medicare Administrative Contractor for the State of Illinois to
5 determine the payment system to ground ambulance services
6 providers under Title XVIII of the Social Security Act.
7     (c) For ground ambulance services provided to a recipient
8 of aid under this Article on or after July 1, 2009, the
9 Department shall provide payment to ground ambulance services
10 providers for base charges and mileage charges based upon the
11 lesser of the provider's charge, as reflected on the provider's
12 claim form, or the Illinois Medicaid Ambulance Fee Schedule
13 rates calculated in accordance with this Section.
14     Effective July 1, 2009, the Illinois Medicaid Ambulance Fee
15 Schedule shall be established and shall include only the ground
16 ambulance services rates outlined in the Medicare Ambulance Fee
17 Schedule as promulgated by the Centers for Medicare and
18 Medicaid Services and adjusted for the 4 Medicare Localities in
19 Illinois, with an adjustment of 100% of the Medicare Ambulance
20 Fee Schedule rates, by Medicare Locality, for both base rates
21 and mileage for rural counties, and an adjustment of 80% of the
22 Medicare Ambulance Fee Schedule rates, by Medicare Locality,
23 for both base rates and mileage for all other counties.
24     Effective for dates of service on or after July 1, 2010,
25 the Department shall update the Illinois Medicaid Ambulance Fee
26 Schedule rates so that they comply with the Medicare Ambulance



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1 Fee Schedule rates for ground ambulance services in effect at
2 the time of the update, in the manner prescribed in the second
3 paragraph of this subsection (c).
4     (d) Payment for mileage shall be per loaded mile with no
5 loaded mileage included in the base rate. If a natural
6 disaster, weather, road repairs, traffic congestion, or other
7 conditions necessitate a route other than the most direct
8 route, payment shall be based upon the actual distance
9 traveled. Notwithstanding the payment principles in subsection
10 (b) of this Section, the Department shall develop the Illinois
11 Medicaid Ambulance Fee Schedule using the ground mileage rate,
12 as defined by the Centers for Medicare and Medicaid Services,
13 and no other mileage rates which act as enhancements to the
14 ground mileage rate, whether permanent or temporary, shall be
15 recognized by the Department. When a ground ambulance services
16 provider provides transport pursuant to an emergency call as
17 defined by the Centers for Medicare and Medicaid Services, no
18 reduction in the mileage payment shall be made based upon the
19 fact that a closer facility may have been available, so long as
20 the ground ambulance services provider provided transport to
21 the recipient's facility of choice within the scope of the
22 Illinois Emergency Medical Services (EMS) Systems Act and
23 associated rules and the policies and procedures of the EMS
24 System of which the provider is a member.
25     (e) The Department shall provide payment for emergency
26 ground ambulance services provided to a recipient of aid under



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1 this Article according to the requirements provided in
2 subsection (b) of this Section when those services are provided
3 pursuant to a request made through a 9-1-1 or equivalent
4 emergency telephone number for evaluation, treatment, and
5 transport from or on behalf of an individual with a condition
6 of such a nature that a prudent layperson would have reasonably
7 expected that a delay in seeking immediate medical attention
8 would have been hazardous to life or health. This standard is
9 deemed to be met if there is an emergency medical condition
10 manifesting itself by acute symptoms of sufficient severity,
11 including but not limited to severe pain, such that a prudent
12 layperson who possesses an average knowledge of medicine and
13 health can reasonably expect that the absence of immediate
14 medical attention could result in placing the health of the
15 individual or, with respect to a pregnant woman, the health of
16 the woman or her unborn child, in serious jeopardy, cause
17 serious impairment to bodily functions, or cause serious
18 dysfunction of any bodily organ or part.
19     (f) For ground ambulance services provided to a recipient
20 enrolled in a Medicaid managed care plan by a ground ambulance
21 services provider that is not a contracted provider to the
22 Medicaid managed care plan in question, the amount of the
23 payment for ground ambulance services by the Medicaid managed
24 care plan shall be the lesser of the provider's charge, as
25 reflected on the provider's claim form, or the Illinois
26 Medicaid Ambulance Fee Schedule rates calculated in accordance



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1 with this Section.
2     (g) Nothing in this Section prohibits the Department from
3 setting payment rates for out-of-State ground ambulance
4 services providers by administrative rule.
5     (h) Effective for dates of service on or after July 1,
6 2009, payments for stretcher van services provided by ground
7 ambulance services providers shall be as follows:
8         (1) For each individual base rate, the amount of the
9     payment shall be the lesser of the provider's charge, as
10     reflected on the provider's claim form, or 80% of the
11     Illinois Medicaid Ambulance Fee Schedule rate for the basic
12     life support non-emergency base rate.
13         (2) For each loaded mile, the amount of the payment
14     shall be the lesser of the provider's charge, as reflected
15     on the provider's claim form, or 80% of the Illinois
16     Medicaid Ambulance Fee Schedule rate for mileage.
17     For ambulance services provided to a recipient of aid under
18 this Article on or after January 1, 1993, the Illinois
19 Department shall reimburse ambulance service providers at
20 rates calculated in accordance with this Section. It is the
21 intent of the General Assembly to provide adequate
22 reimbursement for ambulance services so as to ensure adequate
23 access to services for recipients of aid under this Article and
24 to provide appropriate incentives to ambulance service
25 providers to provide services in an efficient and
26 cost-effective manner. Thus, it is the intent of the General



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1 Assembly that the Illinois Department implement a
2 reimbursement system for ambulance services that, to the extent
3 practicable and subject to the availability of funds
4 appropriated by the General Assembly for this purpose, is
5 consistent with the payment principles of Medicare. To ensure
6 uniformity between the payment principles of Medicare and
7 Medicaid, the Illinois Department shall follow, to the extent
8 necessary and practicable and subject to the availability of
9 funds appropriated by the General Assembly for this purpose,
10 the statutes, laws, regulations, policies, procedures,
11 principles, definitions, guidelines, and manuals used to
12 determine the amounts paid to ambulance service providers under
13 Title XVIII of the Social Security Act (Medicare).
14     For ambulance services provided to a recipient of aid under
15 this Article on or after January 1, 1996, the Illinois
16 Department shall reimburse ambulance service providers based
17 upon the actual distance traveled if a natural disaster,
18 weather conditions, road repairs, or traffic congestion
19 necessitates the use of a route other than the most direct
20 route.
21     For purposes of this Section, "ambulance services"
22 includes medical transportation services provided by means of
23 an ambulance, medi-car, service car, or taxi.
24     This Section does not prohibit separate billing by
25 ambulance service providers for oxygen furnished while
26 providing advanced life support services.



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1     (i) Beginning with services rendered on or after July 1,
2 2008, all providers of non-emergency medi-car and service car
3 transportation must certify that the driver and employee
4 attendant, as applicable, have completed a safety program
5 approved by the Department to protect both the patient and the
6 driver, prior to transporting a patient. The provider must
7 maintain this certification in its records. The provider shall
8 produce such documentation upon demand by the Department or its
9 representative. Failure to produce documentation of such
10 training shall result in recovery of any payments made by the
11 Department for services rendered by a non-certified driver or
12 employee attendant. Medi-car and service car providers must
13 maintain legible documentation in their records of the driver
14 and, as applicable, employee attendant that actually
15 transported the patient. Providers must recertify all drivers
16 and employee attendants every 3 years.
17     Notwithstanding the requirements above, any public
18 transportation provider of medi-car and service car
19 transportation that receives federal funding under 49 U.S.C.
20 5307 and 5311 need not certify its drivers and employee
21 attendants under this Section, since safety training is already
22 federally mandated.
23 (Source: P.A. 95-501, eff. 8-28-07.)
24     (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
25     Sec. 5-5. Medical services. The Illinois Department, by



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1 rule, shall determine the quantity and quality of and the rate
2 of reimbursement for the medical assistance for which payment
3 will be authorized, and the medical services to be provided,
4 which may include all or part of the following: (1) inpatient
5 hospital services; (2) outpatient hospital services; (3) other
6 laboratory and X-ray services; (4) skilled nursing home
7 services; (5) physicians' services whether furnished in the
8 office, the patient's home, a hospital, a skilled nursing home,
9 or elsewhere; (6) medical care, or any other type of remedial
10 care furnished by licensed practitioners; (7) home health care
11 services; (8) private duty nursing service; (9) clinic
12 services; (10) dental services, including prevention and
13 treatment of periodontal disease and dental caries disease for
14 pregnant women; (11) physical therapy and related services;
15 (12) prescribed drugs, dentures, and prosthetic devices; and
16 eyeglasses prescribed by a physician skilled in the diseases of
17 the eye, or by an optometrist, whichever the person may select;
18 (13) other diagnostic, screening, preventive, and
19 rehabilitative services; (14) transportation and such other
20 expenses as may be necessary, provided that payment for ground
21 ambulance services shall be as provided in Section 5-4.2; (15)
22 medical treatment of sexual assault survivors, as defined in
23 Section 1a of the Sexual Assault Survivors Emergency Treatment
24 Act, for injuries sustained as a result of the sexual assault,
25 including examinations and laboratory tests to discover
26 evidence which may be used in criminal proceedings arising from



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1 the sexual assault; (16) the diagnosis and treatment of sickle
2 cell anemia; and (17) any other medical care, and any other
3 type of remedial care recognized under the laws of this State,
4 but not including abortions, or induced miscarriages or
5 premature births, unless, in the opinion of a physician, such
6 procedures are necessary for the preservation of the life of
7 the woman seeking such treatment, or except an induced
8 premature birth intended to produce a live viable child and
9 such procedure is necessary for the health of the mother or her
10 unborn child. The Illinois Department, by rule, shall prohibit
11 any physician from providing medical assistance to anyone
12 eligible therefor under this Code where such physician has been
13 found guilty of performing an abortion procedure in a wilful
14 and wanton manner upon a woman who was not pregnant at the time
15 such abortion procedure was performed. The term "any other type
16 of remedial care" shall include nursing care and nursing home
17 service for persons who rely on treatment by spiritual means
18 alone through prayer for healing.
19     Notwithstanding any other provision of this Section, a
20 comprehensive tobacco use cessation program that includes
21 purchasing prescription drugs or prescription medical devices
22 approved by the Food and Drug administration shall be covered
23 under the medical assistance program under this Article for
24 persons who are otherwise eligible for assistance under this
25 Article.
26     Notwithstanding any other provision of this Code, the



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1 Illinois Department may not require, as a condition of payment
2 for any laboratory test authorized under this Article, that a
3 physician's handwritten signature appear on the laboratory
4 test order form. The Illinois Department may, however, impose
5 other appropriate requirements regarding laboratory test order
6 documentation.
7     The Department of Healthcare and Family Services shall
8 provide the following services to persons eligible for
9 assistance under this Article who are participating in
10 education, training or employment programs operated by the
11 Department of Human Services as successor to the Department of
12 Public Aid:
13         (1) dental services, which shall include but not be
14     limited to prosthodontics; and
15         (2) eyeglasses prescribed by a physician skilled in the
16     diseases of the eye, or by an optometrist, whichever the
17     person may select.
18     The Illinois Department, by rule, may distinguish and
19 classify the medical services to be provided only in accordance
20 with the classes of persons designated in Section 5-2.
21     The Department of Healthcare and Family Services must
22 provide coverage and reimbursement for amino acid-based
23 elemental formulas, regardless of delivery method, for the
24 diagnosis and treatment of (i) eosinophilic disorders and (ii)
25 short bowel syndrome when the prescribing physician has issued
26 a written order stating that the amino acid-based elemental



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1 formula is medically necessary.
2     The Illinois Department shall authorize the provision of,
3 and shall authorize payment for, screening by low-dose
4 mammography for the presence of occult breast cancer for women
5 35 years of age or older who are eligible for medical
6 assistance under this Article, as follows:
7         (A) A baseline mammogram for women 35 to 39 years of
8     age.
9         (B) An annual mammogram for women 40 years of age or
10     older.
11         (C) A mammogram at the age and intervals considered
12     medically necessary by the woman's health care provider for
13     women under 40 years of age and having a family history of
14     breast cancer, prior personal history of breast cancer,
15     positive genetic testing, or other risk factors.
16         (D) A comprehensive ultrasound screening of an entire
17     breast or breasts if a mammogram demonstrates
18     heterogeneous or dense breast tissue, when medically
19     necessary as determined by a physician licensed to practice
20     medicine in all of its branches.
21     All screenings shall include a physical breast exam,
22 instruction on self-examination and information regarding the
23 frequency of self-examination and its value as a preventative
24 tool. For purposes of this Section, "low-dose mammography"
25 means the x-ray examination of the breast using equipment
26 dedicated specifically for mammography, including the x-ray



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1 tube, filter, compression device, and image receptor, with an
2 average radiation exposure delivery of less than one rad per
3 breast for 2 views of an average size breast. The term also
4 includes digital mammography.
5     On and after July 1, 2008, screening and diagnostic
6 mammography shall be reimbursed at the same rate as the
7 Medicare program's rates, including the increased
8 reimbursement for digital mammography.
9     The Department shall convene an expert panel including
10 representatives of hospitals, free-standing mammography
11 facilities, and doctors, including radiologists, to establish
12 quality standards. Based on these quality standards, the
13 Department shall provide for bonus payments to mammography
14 facilities meeting the standards for screening and diagnosis.
15 The bonus payments shall be at least 15% higher than the
16 Medicare rates for mammography.
17     Subject to federal approval, the Department shall
18 establish a rate methodology for mammography at federally
19 qualified health centers and other encounter-rate clinics.
20 These clinics or centers may also collaborate with other
21 hospital-based mammography facilities.
22     The Department shall establish a methodology to remind
23 women who are age-appropriate for screening mammography, but
24 who have not received a mammogram within the previous 18
25 months, of the importance and benefit of screening mammography.
26     The Department shall establish a performance goal for



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1 primary care providers with respect to their female patients
2 over age 40 receiving an annual mammogram. This performance
3 goal shall be used to provide additional reimbursement in the
4 form of a quality performance bonus to primary care providers
5 who meet that goal.
6     The Department shall devise a means of case-managing or
7 patient navigation for beneficiaries diagnosed with breast
8 cancer. This program shall initially operate as a pilot program
9 in areas of the State with the highest incidence of mortality
10 related to breast cancer. At least one pilot program site shall
11 be in the metropolitan Chicago area and at least one site shall
12 be outside the metropolitan Chicago area. An evaluation of the
13 pilot program shall be carried out measuring health outcomes
14 and cost of care for those served by the pilot program compared
15 to similarly situated patients who are not served by the pilot
16 program.
17     Any medical or health care provider shall immediately
18 recommend, to any pregnant woman who is being provided prenatal
19 services and is suspected of drug abuse or is addicted as
20 defined in the Alcoholism and Other Drug Abuse and Dependency
21 Act, referral to a local substance abuse treatment provider
22 licensed by the Department of Human Services or to a licensed
23 hospital which provides substance abuse treatment services.
24 The Department of Healthcare and Family Services shall assure
25 coverage for the cost of treatment of the drug abuse or
26 addiction for pregnant recipients in accordance with the



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1 Illinois Medicaid Program in conjunction with the Department of
2 Human Services.
3     All medical providers providing medical assistance to
4 pregnant women under this Code shall receive information from
5 the Department on the availability of services under the Drug
6 Free Families with a Future or any comparable program providing
7 case management services for addicted women, including
8 information on appropriate referrals for other social services
9 that may be needed by addicted women in addition to treatment
10 for addiction.
11     The Illinois Department, in cooperation with the
12 Departments of Human Services (as successor to the Department
13 of Alcoholism and Substance Abuse) and Public Health, through a
14 public awareness campaign, may provide information concerning
15 treatment for alcoholism and drug abuse and addiction, prenatal
16 health care, and other pertinent programs directed at reducing
17 the number of drug-affected infants born to recipients of
18 medical assistance.
19     Neither the Department of Healthcare and Family Services
20 nor the Department of Human Services shall sanction the
21 recipient solely on the basis of her substance abuse.
22     The Illinois Department shall establish such regulations
23 governing the dispensing of health services under this Article
24 as it shall deem appropriate. The Department should seek the
25 advice of formal professional advisory committees appointed by
26 the Director of the Illinois Department for the purpose of



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1 providing regular advice on policy and administrative matters,
2 information dissemination and educational activities for
3 medical and health care providers, and consistency in
4 procedures to the Illinois Department.
5     The Illinois Department may develop and contract with
6 Partnerships of medical providers to arrange medical services
7 for persons eligible under Section 5-2 of this Code.
8 Implementation of this Section may be by demonstration projects
9 in certain geographic areas. The Partnership shall be
10 represented by a sponsor organization. The Department, by rule,
11 shall develop qualifications for sponsors of Partnerships.
12 Nothing in this Section shall be construed to require that the
13 sponsor organization be a medical organization.
14     The sponsor must negotiate formal written contracts with
15 medical providers for physician services, inpatient and
16 outpatient hospital care, home health services, treatment for
17 alcoholism and substance abuse, and other services determined
18 necessary by the Illinois Department by rule for delivery by
19 Partnerships. Physician services must include prenatal and
20 obstetrical care. The Illinois Department shall reimburse
21 medical services delivered by Partnership providers to clients
22 in target areas according to provisions of this Article and the
23 Illinois Health Finance Reform Act, except that:
24         (1) Physicians participating in a Partnership and
25     providing certain services, which shall be determined by
26     the Illinois Department, to persons in areas covered by the



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1     Partnership may receive an additional surcharge for such
2     services.
3         (2) The Department may elect to consider and negotiate
4     financial incentives to encourage the development of
5     Partnerships and the efficient delivery of medical care.
6         (3) Persons receiving medical services through
7     Partnerships may receive medical and case management
8     services above the level usually offered through the
9     medical assistance program.
10     Medical providers shall be required to meet certain
11 qualifications to participate in Partnerships to ensure the
12 delivery of high quality medical services. These
13 qualifications shall be determined by rule of the Illinois
14 Department and may be higher than qualifications for
15 participation in the medical assistance program. Partnership
16 sponsors may prescribe reasonable additional qualifications
17 for participation by medical providers, only with the prior
18 written approval of the Illinois Department.
19     Nothing in this Section shall limit the free choice of
20 practitioners, hospitals, and other providers of medical
21 services by clients. In order to ensure patient freedom of
22 choice, the Illinois Department shall immediately promulgate
23 all rules and take all other necessary actions so that provided
24 services may be accessed from therapeutically certified
25 optometrists to the full extent of the Illinois Optometric
26 Practice Act of 1987 without discriminating between service



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1 providers.
2     The Department shall apply for a waiver from the United
3 States Health Care Financing Administration to allow for the
4 implementation of Partnerships under this Section.
5     The Illinois Department shall require health care
6 providers to maintain records that document the medical care
7 and services provided to recipients of Medical Assistance under
8 this Article. The Illinois Department shall require health care
9 providers to make available, when authorized by the patient, in
10 writing, the medical records in a timely fashion to other
11 health care providers who are treating or serving persons
12 eligible for Medical Assistance under this Article. All
13 dispensers of medical services shall be required to maintain
14 and retain business and professional records sufficient to
15 fully and accurately document the nature, scope, details and
16 receipt of the health care provided to persons eligible for
17 medical assistance under this Code, in accordance with
18 regulations promulgated by the Illinois Department. The rules
19 and regulations shall require that proof of the receipt of
20 prescription drugs, dentures, prosthetic devices and
21 eyeglasses by eligible persons under this Section accompany
22 each claim for reimbursement submitted by the dispenser of such
23 medical services. No such claims for reimbursement shall be
24 approved for payment by the Illinois Department without such
25 proof of receipt, unless the Illinois Department shall have put
26 into effect and shall be operating a system of post-payment



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1 audit and review which shall, on a sampling basis, be deemed
2 adequate by the Illinois Department to assure that such drugs,
3 dentures, prosthetic devices and eyeglasses for which payment
4 is being made are actually being received by eligible
5 recipients. Within 90 days after the effective date of this
6 amendatory Act of 1984, the Illinois Department shall establish
7 a current list of acquisition costs for all prosthetic devices
8 and any other items recognized as medical equipment and
9 supplies reimbursable under this Article and shall update such
10 list on a quarterly basis, except that the acquisition costs of
11 all prescription drugs shall be updated no less frequently than
12 every 30 days as required by Section 5-5.12.
13     The rules and regulations of the Illinois Department shall
14 require that a written statement including the required opinion
15 of a physician shall accompany any claim for reimbursement for
16 abortions, or induced miscarriages or premature births. This
17 statement shall indicate what procedures were used in providing
18 such medical services.
19     The Illinois Department shall require all dispensers of
20 medical services, other than an individual practitioner or
21 group of practitioners, desiring to participate in the Medical
22 Assistance program established under this Article to disclose
23 all financial, beneficial, ownership, equity, surety or other
24 interests in any and all firms, corporations, partnerships,
25 associations, business enterprises, joint ventures, agencies,
26 institutions or other legal entities providing any form of



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1 health care services in this State under this Article.
2     The Illinois Department may require that all dispensers of
3 medical services desiring to participate in the medical
4 assistance program established under this Article disclose,
5 under such terms and conditions as the Illinois Department may
6 by rule establish, all inquiries from clients and attorneys
7 regarding medical bills paid by the Illinois Department, which
8 inquiries could indicate potential existence of claims or liens
9 for the Illinois Department.
10     Enrollment of a vendor that provides non-emergency medical
11 transportation, defined by the Department by rule, shall be
12 conditional for 180 days. During that time, the Department of
13 Healthcare and Family Services may terminate the vendor's
14 eligibility to participate in the medical assistance program
15 without cause. That termination of eligibility is not subject
16 to the Department's hearing process.
17     The Illinois Department shall establish policies,
18 procedures, standards and criteria by rule for the acquisition,
19 repair and replacement of orthotic and prosthetic devices and
20 durable medical equipment. Such rules shall provide, but not be
21 limited to, the following services: (1) immediate repair or
22 replacement of such devices by recipients without medical
23 authorization; and (2) rental, lease, purchase or
24 lease-purchase of durable medical equipment in a
25 cost-effective manner, taking into consideration the
26 recipient's medical prognosis, the extent of the recipient's



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1 needs, and the requirements and costs for maintaining such
2 equipment. Such rules shall enable a recipient to temporarily
3 acquire and use alternative or substitute devices or equipment
4 pending repairs or replacements of any device or equipment
5 previously authorized for such recipient by the Department.
6     The Department shall execute, relative to the nursing home
7 prescreening project, written inter-agency agreements with the
8 Department of Human Services and the Department on Aging, to
9 effect the following: (i) intake procedures and common
10 eligibility criteria for those persons who are receiving
11 non-institutional services; and (ii) the establishment and
12 development of non-institutional services in areas of the State
13 where they are not currently available or are undeveloped.
14     The Illinois Department shall develop and operate, in
15 cooperation with other State Departments and agencies and in
16 compliance with applicable federal laws and regulations,
17 appropriate and effective systems of health care evaluation and
18 programs for monitoring of utilization of health care services
19 and facilities, as it affects persons eligible for medical
20 assistance under this Code.
21     The Illinois Department shall report annually to the
22 General Assembly, no later than the second Friday in April of
23 1979 and each year thereafter, in regard to:
24         (a) actual statistics and trends in utilization of
25     medical services by public aid recipients;
26         (b) actual statistics and trends in the provision of



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1     the various medical services by medical vendors;
2         (c) current rate structures and proposed changes in
3     those rate structures for the various medical vendors; and
4         (d) efforts at utilization review and control by the
5     Illinois Department.
6     The period covered by each report shall be the 3 years
7 ending on the June 30 prior to the report. The report shall
8 include suggested legislation for consideration by the General
9 Assembly. The filing of one copy of the report with the
10 Speaker, one copy with the Minority Leader and one copy with
11 the Clerk of the House of Representatives, one copy with the
12 President, one copy with the Minority Leader and one copy with
13 the Secretary of the Senate, one copy with the Legislative
14 Research Unit, and such additional copies with the State
15 Government Report Distribution Center for the General Assembly
16 as is required under paragraph (t) of Section 7 of the State
17 Library Act shall be deemed sufficient to comply with this
18 Section.
19     Rulemaking authority to implement this amendatory Act of
20 the 95th General Assembly, if any, is conditioned on the rules
21 being adopted in accordance with all provisions of the Illinois
22 Administrative Procedure Act and all rules and procedures of
23 the Joint Committee on Administrative Rules; any purported rule
24 not so adopted, for whatever reason, is unauthorized.
25 (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07;
26 95-1045, eff. 3-27-09.)



09600HB0542sam001 - 23 - LRB096 03750 DRJ 26939 a

1     Section 99. Effective date. This Act takes effect upon
2 becoming law.".