Full Text of SB3718 97th General Assembly
SB3718enr 97TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 5-4.2 as follows:
| 6 | | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
| 7 | | Sec. 5-4.2. Ambulance services payments. | 8 | | (a) For
ambulance
services provided to a recipient of aid | 9 | | under this Article on or after
January 1, 1993, the Illinois | 10 | | Department shall reimburse ambulance service
providers at | 11 | | rates calculated in accordance with this Section. It is the | 12 | | intent
of the General Assembly to provide adequate | 13 | | reimbursement for ambulance
services so as to ensure adequate | 14 | | access to services for recipients of aid
under this Article and | 15 | | to provide appropriate incentives to ambulance service
| 16 | | providers to provide services in an efficient and | 17 | | cost-effective manner. Thus,
it is the intent of the General | 18 | | Assembly that the Illinois Department implement
a | 19 | | reimbursement system for ambulance services that, to the extent | 20 | | practicable
and subject to the availability of funds | 21 | | appropriated by the General Assembly
for this purpose, is | 22 | | consistent with the payment principles of Medicare. To
ensure | 23 | | uniformity between the payment principles of Medicare and |
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| 1 | | Medicaid, the
Illinois Department shall follow, to the extent | 2 | | necessary and practicable and
subject to the availability of | 3 | | funds appropriated by the General Assembly for
this purpose, | 4 | | the statutes, laws, regulations, policies, procedures,
| 5 | | principles, definitions, guidelines, and manuals used to | 6 | | determine the amounts
paid to ambulance service providers under | 7 | | Title XVIII of the Social Security
Act (Medicare).
| 8 | | (b) For ambulance services provided to a recipient of aid | 9 | | under this Article
on or after January 1, 1996, the Illinois | 10 | | Department shall reimburse ambulance
service providers based | 11 | | upon the actual distance traveled if a natural
disaster, | 12 | | weather conditions, road repairs, or traffic congestion | 13 | | necessitates
the use of a
route other than the most direct | 14 | | route.
| 15 | | (c) For purposes of this Section, "ambulance services" | 16 | | includes medical
transportation services provided by means of | 17 | | an ambulance, medi-car, service
car, or
taxi.
| 18 | | (c-1) For purposes of this Section, "ground ambulance | 19 | | service" means medical transportation services that are | 20 | | described as ground ambulance services by the Centers for | 21 | | Medicare and Medicaid Services and provided in a vehicle that | 22 | | is licensed as an ambulance by the Illinois Department of | 23 | | Public Health pursuant to the Emergency Medical Services (EMS) | 24 | | Systems Act. | 25 | | (c-2) For purposes of this Section, "ground ambulance | 26 | | service provider" means a vehicle service provider as described |
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| 1 | | in the Emergency Medical Services (EMS) Systems Act that | 2 | | operates licensed ambulances for the purpose of providing | 3 | | emergency ambulance services, or non-emergency ambulance | 4 | | services, or both. For purposes of this Section, this includes | 5 | | both ambulance providers and ambulance suppliers as described | 6 | | by the Centers for Medicare and Medicaid Services. | 7 | | (d) This Section does not prohibit separate billing by | 8 | | ambulance service
providers for oxygen furnished while | 9 | | providing advanced life support
services.
| 10 | | (e) Beginning with services rendered on or after July 1, | 11 | | 2008, all providers of non-emergency medi-car and service car | 12 | | transportation must certify that the driver and employee | 13 | | attendant, as applicable, have completed a safety program | 14 | | approved by the Department to protect both the patient and the | 15 | | driver, prior to transporting a patient.
The provider must | 16 | | maintain this certification in its records. The provider shall | 17 | | produce such documentation upon demand by the Department or its | 18 | | representative. Failure to produce documentation of such | 19 | | training shall result in recovery of any payments made by the | 20 | | Department for services rendered by a non-certified driver or | 21 | | employee attendant. Medi-car and service car providers must | 22 | | maintain legible documentation in their records of the driver | 23 | | and, as applicable, employee attendant that actually | 24 | | transported the patient. Providers must recertify all drivers | 25 | | and employee attendants every 3 years.
| 26 | | Notwithstanding the requirements above, any public |
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| 1 | | transportation provider of medi-car and service car | 2 | | transportation that receives federal funding under 49 U.S.C. | 3 | | 5307 and 5311 need not certify its drivers and employee | 4 | | attendants under this Section, since safety training is already | 5 | | federally mandated.
| 6 | | (f) With respect to any policy or program administered by | 7 | | the Department or its agent regarding approval of non-emergency | 8 | | medical transportation by ground ambulance service providers, | 9 | | including, but not limited to, the Non-Emergency | 10 | | Transportation Services Prior Approval Program (NETSPAP), the | 11 | | Department shall establish by rule a process by which ground | 12 | | ambulance service providers of non-emergency medical | 13 | | transportation may appeal any decision by the Department or its | 14 | | agent for which no denial was received prior to the time of | 15 | | transport that either (i) denies a request for approval for | 16 | | payment of non-emergency transportation by means of ground | 17 | | ambulance service or (ii) grants a request for approval of | 18 | | non-emergency transportation by means of ground ambulance | 19 | | service at a level of service that entitles the ground | 20 | | ambulance service provider to a lower level of compensation | 21 | | from the Department than the ground ambulance service provider | 22 | | would have received as compensation for the level of service | 23 | | requested. The rule shall be established within 12 months after | 24 | | the effective date of this amendatory Act of the 97th General | 25 | | Assembly and shall provide that, for any decision rendered by | 26 | | the Department or its agent on or after the date the rule takes |
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| 1 | | effect, the ground ambulance service provider shall have 60 | 2 | | days from the date the decision is received to file an appeal. | 3 | | The rule established by the Department shall be, insofar as is | 4 | | practical, consistent with the Illinois Administrative | 5 | | Procedure Act. The Director's decision on an appeal under this | 6 | | Section shall be a final administrative decision subject to | 7 | | review under the Administrative Review Law. | 8 | | (g) Beginning 90 days after the effective date of this | 9 | | amendatory Act of the 97th General Assembly, (i) no denial of a | 10 | | request for approval for payment of non-emergency | 11 | | transportation by means of ground ambulance service, and (ii) | 12 | | no approval of non-emergency transportation by means of ground | 13 | | ambulance service at a level of service that entitles the | 14 | | ground ambulance service provider to a lower level of | 15 | | compensation from the Department than would have been received | 16 | | at the level of service submitted by the ground ambulance | 17 | | service provider, may be issued by the Department or its agent | 18 | | unless the Department has submitted the criteria for | 19 | | determining the appropriateness of the transport for first | 20 | | notice publication in the Illinois Register pursuant to Section | 21 | | 5-40 of the Illinois Administrative Procedure Act. | 22 | | (Source: P.A. 97-584, eff. 8-26-11.)
| 23 | | Section 99. Effective date. This Act takes effect upon | 24 | | becoming law.
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