Illinois General Assembly - Full Text of HB5598
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Full Text of HB5598  102nd General Assembly

HB5598ham002 102ND GENERAL ASSEMBLY

Rep. Mary E. Flowers

Filed: 3/30/2022

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 5598

2    AMENDMENT NO. ______. Amend House Bill 5598, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The Emergency Medical Services (EMS) Systems
6Act is amended by changing Section 3.10 as follows:
 
7    (210 ILCS 50/3.10)
8    Sec. 3.10. Scope of services.
9    (a) "Advanced Life Support (ALS) Services" means an
10advanced level of pre-hospital and inter-hospital emergency
11care and non-emergency medical services that includes basic
12life support care, cardiac monitoring, cardiac defibrillation,
13electrocardiography, intravenous therapy, administration of
14medications, drugs and solutions, use of adjunctive medical
15devices, trauma care, and other authorized techniques and
16procedures, as outlined in the provisions of the National EMS

 

 

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1Education Standards relating to Advanced Life Support and any
2modifications to that curriculum specified in rules adopted by
3the Department pursuant to this Act.
4    That care shall be initiated as authorized by the EMS
5Medical Director in a Department approved advanced life
6support EMS System, under the written or verbal direction of a
7physician licensed to practice medicine in all of its branches
8or under the verbal direction of an Emergency Communications
9Registered Nurse.
10    (b) "Intermediate Life Support (ILS) Services" means an
11intermediate level of pre-hospital and inter-hospital
12emergency care and non-emergency medical services that
13includes basic life support care plus intravenous cannulation
14and fluid therapy, invasive airway management, trauma care,
15and other authorized techniques and procedures, as outlined in
16the Intermediate Life Support national curriculum of the
17United States Department of Transportation and any
18modifications to that curriculum specified in rules adopted by
19the Department pursuant to this Act.
20    That care shall be initiated as authorized by the EMS
21Medical Director in a Department approved intermediate or
22advanced life support EMS System, under the written or verbal
23direction of a physician licensed to practice medicine in all
24of its branches or under the verbal direction of an Emergency
25Communications Registered Nurse.
26    (c) "Basic Life Support (BLS) Services" means a basic

 

 

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1level of pre-hospital and inter-hospital emergency care and
2non-emergency medical services that includes medical
3monitoring, clinical observation, airway management,
4cardiopulmonary resuscitation (CPR), control of shock and
5bleeding and splinting of fractures, as outlined in the
6provisions of the National EMS Education Standards relating to
7Basic Life Support and any modifications to that curriculum
8specified in rules adopted by the Department pursuant to this
9Act.
10    That care shall be initiated, where authorized by the EMS
11Medical Director in a Department approved EMS System, under
12the written or verbal direction of a physician licensed to
13practice medicine in all of its branches or under the verbal
14direction of an Emergency Communications Registered Nurse.
15    (d) "Emergency Medical Responder Services" means a
16preliminary level of pre-hospital emergency care that includes
17cardiopulmonary resuscitation (CPR), monitoring vital signs
18and control of bleeding, as outlined in the Emergency Medical
19Responder (EMR) curriculum of the National EMS Education
20Standards and any modifications to that curriculum specified
21in rules adopted by the Department pursuant to this Act.
22    (e) "Pre-hospital care" means those medical services
23rendered to patients for analytic, resuscitative, stabilizing,
24or preventive purposes, precedent to and during transportation
25of such patients to health care facilities.
26    (f) "Inter-hospital care" means those medical services

 

 

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1rendered to patients for analytic, resuscitative, stabilizing,
2or preventive purposes, during transportation of such patients
3from one hospital to another hospital.
4    (f-5) "Critical care transport" means the pre-hospital or
5inter-hospital transportation of a critically injured or ill
6patient by a vehicle service provider, including the provision
7of medically necessary supplies and services, at a level of
8service beyond the scope of the Paramedic. When medically
9indicated for a patient, as determined by a physician licensed
10to practice medicine in all of its branches, an advanced
11practice registered nurse, or a physician physician's
12assistant, in compliance with subsections (b) and (c) of
13Section 3.155 of this Act, critical care transport may be
14provided by:
15        (1) Department-approved critical care transport
16    providers, not owned or operated by a hospital, utilizing
17    Paramedics with additional training, nurses, or other
18    qualified health professionals; or
19        (2) Hospitals, when utilizing any vehicle service
20    provider or any hospital-owned or operated vehicle service
21    provider. Nothing in Public Act 96-1469 requires a
22    hospital to use, or to be, a Department-approved critical
23    care transport provider when transporting patients,
24    including those critically injured or ill. Nothing in this
25    Act shall restrict or prohibit a hospital from providing,
26    or arranging for, the medically appropriate transport of

 

 

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1    any patient, as determined by a physician licensed to
2    practice in all of its branches, an advanced practice
3    registered nurse, or a physician physician's assistant.
4    (g) "Non-emergency medical services" means the provision
5of, and all actions necessary before and after the provision
6of, Basic Life Support (BLS) Services, Advanced Life Support
7(ALS) Services, and critical care transport to patients whose
8conditions do not meet this Act's definition of emergency,
9before, after, or during transportation of such patients to or
10from health care facilities visited for the purpose of
11obtaining medical or health care services which are not
12emergency in nature, using a vehicle regulated by this Act and
13personnel licensed under this Act.
14    (g-5) The Department shall have the authority to
15promulgate minimum standards for critical care transport
16providers through rules adopted pursuant to this Act. All
17critical care transport providers must function within a
18Department-approved EMS System. Nothing in Department rules
19shall restrict a hospital's ability to furnish personnel,
20equipment, and medical supplies to any vehicle service
21provider, including a critical care transport provider.
22Minimum critical care transport provider standards shall
23include, but are not limited to:
24        (1) Personnel staffing and licensure.
25        (2) Education, certification, and experience.
26        (3) Medical equipment and supplies.

 

 

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1        (4) Vehicular standards.
2        (5) Treatment and transport protocols.
3        (6) Quality assurance and data collection.
4    (h) The provisions of this Act shall not apply to the use
5of an ambulance or SEMSV, unless and until emergency or
6non-emergency medical services are needed during the use of
7the ambulance or SEMSV.
8(Source: P.A. 102-623, eff. 8-27-21; revised 12-1-21.)
 
9    Section 10. The Illinois Public Aid Code is amended by
10changing Section 5-4.2 and by adding Section 5-30c as follows:
 
11    (305 ILCS 5/5-4.2)
12    Sec. 5-4.2. Ambulance services payments.
13    (a) For ambulance services provided to a recipient of aid
14under this Article on or after January 1, 1993, the Illinois
15Department shall reimburse ambulance service providers at
16rates calculated in accordance with this Section. It is the
17intent of the General Assembly to provide adequate
18reimbursement for ambulance services so as to ensure adequate
19access to services for recipients of aid under this Article
20and to provide appropriate incentives to ambulance service
21providers to provide services in an efficient and
22cost-effective manner. Thus, it is the intent of the General
23Assembly that the Illinois Department implement a
24reimbursement system for ambulance services that, to the

 

 

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1extent practicable and subject to the availability of funds
2appropriated by the General Assembly for this purpose, is
3consistent with the payment principles of Medicare. To ensure
4uniformity between the payment principles of Medicare and
5Medicaid, the Illinois Department shall follow, to the extent
6necessary and practicable and subject to the availability of
7funds appropriated by the General Assembly for this purpose,
8the statutes, laws, regulations, policies, procedures,
9principles, definitions, guidelines, and manuals used to
10determine the amounts paid to ambulance service providers
11under Title XVIII of the Social Security Act (Medicare).
12    (b) For ambulance services provided to a recipient of aid
13under this Article on or after January 1, 1996, the Illinois
14Department shall reimburse ambulance service providers based
15upon the actual distance traveled if a natural disaster,
16weather conditions, road repairs, or traffic congestion
17necessitates the use of a route other than the most direct
18route.
19    (c) For purposes of this Section, "ambulance services"
20includes medical transportation services provided by means of
21an ambulance, medi-car, service car, or taxi.
22    (c-1) For purposes of this Section, "ground ambulance
23service" means medical transportation services that are
24described as ground ambulance services by the Centers for
25Medicare and Medicaid Services and provided in a vehicle that
26is licensed as an ambulance by the Illinois Department of

 

 

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1Public Health pursuant to the Emergency Medical Services (EMS)
2Systems Act.
3    (c-2) For purposes of this Section, "ground ambulance
4service provider" means a vehicle service provider as
5described in the Emergency Medical Services (EMS) Systems Act
6that operates licensed ambulances for the purpose of providing
7emergency ambulance services, or non-emergency ambulance
8services, or both. For purposes of this Section, this includes
9both ambulance providers and ambulance suppliers as described
10by the Centers for Medicare and Medicaid Services.
11    (c-3) For purposes of this Section, "medi-car" means
12transportation services provided to a patient who is confined
13to a wheelchair and requires the use of a hydraulic or electric
14lift or ramp and wheelchair lockdown when the patient's
15condition does not require medical observation, medical
16supervision, medical equipment, the administration of
17medications, or the administration of oxygen.
18    (c-4) For purposes of this Section, "service car" means
19transportation services provided to a patient by a passenger
20vehicle where that patient does not require the specialized
21modes described in subsection (c-1) or (c-3).
22    (d) This Section does not prohibit separate billing by
23ambulance service providers for oxygen furnished while
24providing advanced life support services.
25    (e) Beginning with services rendered on or after July 1,
262008, all providers of non-emergency medi-car and service car

 

 

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1transportation must certify that the driver and employee
2attendant, as applicable, have completed a safety program
3approved by the Department to protect both the patient and the
4driver, prior to transporting a patient. The provider must
5maintain this certification in its records. The provider shall
6produce such documentation upon demand by the Department or
7its representative. Failure to produce documentation of such
8training shall result in recovery of any payments made by the
9Department for services rendered by a non-certified driver or
10employee attendant. Medi-car and service car providers must
11maintain legible documentation in their records of the driver
12and, as applicable, employee attendant that actually
13transported the patient. Providers must recertify all drivers
14and employee attendants every 3 years. If they meet the
15established training components set forth by the Department,
16providers of non-emergency medi-car and service car
17transportation that are either directly or through an
18affiliated company licensed by the Department of Public Health
19shall be approved by the Department to have in-house safety
20programs for training their own staff.
21    Notwithstanding the requirements above, any public
22transportation provider of medi-car and service car
23transportation that receives federal funding under 49 U.S.C.
245307 and 5311 need not certify its drivers and employee
25attendants under this Section, since safety training is
26already federally mandated.

 

 

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1    (f) With respect to any policy or program administered by
2the Department or its agent regarding approval of
3non-emergency medical transportation by ground ambulance
4service providers, including, but not limited to, the
5Non-Emergency Transportation Services Prior Approval Program
6(NETSPAP), the Department shall establish by rule a process by
7which ground ambulance service providers of non-emergency
8medical transportation may appeal any decision by the
9Department or its agent for which no denial was received prior
10to the time of transport that either (i) denies a request for
11approval for payment of non-emergency transportation by means
12of ground ambulance service or (ii) grants a request for
13approval of non-emergency transportation by means of ground
14ambulance service at a level of service that entitles the
15ground ambulance service provider to a lower level of
16compensation from the Department than the ground ambulance
17service provider would have received as compensation for the
18level of service requested. The rule shall be filed by
19December 15, 2012 and shall provide that, for any decision
20rendered by the Department or its agent on or after the date
21the rule takes effect, the ground ambulance service provider
22shall have 60 days from the date the decision is received to
23file an appeal. The rule established by the Department shall
24be, insofar as is practical, consistent with the Illinois
25Administrative Procedure Act. The Director's decision on an
26appeal under this Section shall be a final administrative

 

 

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1decision subject to review under the Administrative Review
2Law.
3    (f-5) Beginning 90 days after July 20, 2012 (the effective
4date of Public Act 97-842), (i) no denial of a request for
5approval for payment of non-emergency transportation by means
6of ground ambulance service, and (ii) no approval of
7non-emergency transportation by means of ground ambulance
8service at a level of service that entitles the ground
9ambulance service provider to a lower level of compensation
10from the Department than would have been received at the level
11of service submitted by the ground ambulance service provider,
12may be issued by the Department or its agent unless the
13Department has submitted the criteria for determining the
14appropriateness of the transport for first notice publication
15in the Illinois Register pursuant to Section 5-40 of the
16Illinois Administrative Procedure Act.
17    (f-6) Within 90 days after the effective date of this
18amendatory Act of the 102nd General Assembly, the Department
19shall adjust the criteria established under subsection (f-5)
20by striking any reference to prohibiting approval of ground
21ambulance services when the sole purpose of the transport is
22for the navigation of stairs or the assisting or lifting of a
23patient at a medical facility or during a medical appointment.
24It is the intent of the General Assembly to permit ground
25ambulance reimbursement for lifting, moving, or navigating
26stairs in instances when a recipient exhibits extenuating

 

 

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1circumstances related to the social determinants of health
2which would make an otherwise non-eligible ground ambulance
3transport eligible for transportation. Such extenuating
4circumstances may include a condition which would present an
5unreasonable risk for the patient to navigate the stairs
6without the assistance of medically trained ground ambulance
7personnel. Such extenuating circumstances may be established
8through the completion of a Physician Certification Statement
9as set forth in subsection (g).
10    (f-7) For non-emergency ground ambulance claims properly
11denied under Department policy at the time the claim is filed
12due to failure to submit a valid Medical Certification for
13Non-Emergency Ambulance on and after December 15, 2012 and
14prior to January 1, 2021, the Department shall allot
15$2,000,000 to a pool to reimburse such claims if the provider
16proves medical necessity for the service by other means.
17Providers must submit any such denied claims for which they
18seek compensation to the Department no later than December 31,
192021 along with documentation of medical necessity. No later
20than May 31, 2022, the Department shall determine for which
21claims medical necessity was established. Such claims for
22which medical necessity was established shall be paid at the
23rate in effect at the time of the service, provided the
24$2,000,000 is sufficient to pay at those rates. If the pool is
25not sufficient, claims shall be paid at a uniform percentage
26of the applicable rate such that the pool of $2,000,000 is

 

 

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1exhausted. The appeal process described in subsection (f)
2shall not be applicable to the Department's determinations
3made in accordance with this subsection.
4    (g) Whenever a patient covered by a medical assistance
5program under this Code or by another medical program
6administered by the Department, including a patient covered
7under the State's Medicaid managed care program, is being
8transported from a facility and requires non-emergency
9transportation including ground ambulance, medi-car, or
10service car transportation, a Physician Certification
11Statement as described in this Section shall be required for
12each patient. Facilities shall develop procedures for a
13licensed medical professional to provide a written and signed
14Physician Certification Statement. The Physician Certification
15Statement shall specify the level of transportation services
16needed and complete a medical certification establishing the
17criteria for approval of non-emergency ambulance
18transportation, as published by the Department of Healthcare
19and Family Services, that is met by the patient. This
20certification shall be completed prior to ordering the
21transportation service and prior to patient discharge. The
22Physician Certification Statement is not required prior to
23transport if a delay in transport can be expected to
24negatively affect the patient outcome. If the ground ambulance
25provider, medi-car provider, or service car provider is unable
26to obtain the required Physician Certification Statement

 

 

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1within 10 calendar days following the date of the service, the
2ground ambulance provider, medi-car provider, or service car
3provider must document its attempt to obtain the requested
4certification and may then submit the claim for payment.
5Acceptable documentation includes a signed return receipt from
6the U.S. Postal Service, facsimile receipt, email receipt, or
7other similar service that evidences that the ground ambulance
8provider, medi-car provider, or service car provider attempted
9to obtain the required Physician Certification Statement.
10    The medical certification specifying the level and type of
11non-emergency transportation needed shall be in the form of
12the Physician Certification Statement on a standardized form
13prescribed by the Department of Healthcare and Family
14Services. Within 75 days after July 27, 2018 (the effective
15date of Public Act 100-646), the Department of Healthcare and
16Family Services shall develop a standardized form of the
17Physician Certification Statement specifying the level and
18type of transportation services needed in consultation with
19the Department of Public Health, Medicaid managed care
20organizations, a statewide association representing ambulance
21providers, a statewide association representing hospitals, 3
22statewide associations representing nursing homes, and other
23stakeholders. The Physician Certification Statement shall
24include, but is not limited to, the criteria necessary to
25demonstrate medical necessity for the level of transport
26needed as required by (i) the Department of Healthcare and

 

 

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1Family Services and (ii) the federal Centers for Medicare and
2Medicaid Services as outlined in the Centers for Medicare and
3Medicaid Services' Medicare Benefit Policy Manual, Pub.
4100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician
5Certification Statement shall satisfy the obligations of
6hospitals under Section 6.22 of the Hospital Licensing Act and
7nursing homes under Section 2-217 of the Nursing Home Care
8Act. Implementation and acceptance of the Physician
9Certification Statement shall take place no later than 90 days
10after the issuance of the Physician Certification Statement by
11the Department of Healthcare and Family Services.
12    Pursuant to subsection (E) of Section 12-4.25 of this
13Code, the Department is entitled to recover overpayments paid
14to a provider or vendor, including, but not limited to, from
15the discharging physician, the discharging facility, and the
16ground ambulance service provider, in instances where a
17non-emergency ground ambulance service is rendered as the
18result of improper or false certification.
19    Beginning October 1, 2018, the Department of Healthcare
20and Family Services shall collect data from Medicaid managed
21care organizations and transportation brokers, including the
22Department's NETSPAP broker, regarding denials and appeals
23related to the missing or incomplete Physician Certification
24Statement forms and overall compliance with this subsection.
25The Department of Healthcare and Family Services shall publish
26quarterly results on its website within 15 days following the

 

 

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1end of each quarter.
2    (h) On and after July 1, 2012, the Department shall reduce
3any rate of reimbursement for services or other payments or
4alter any methodologies authorized by this Code to reduce any
5rate of reimbursement for services or other payments in
6accordance with Section 5-5e.
7    (i) On and after July 1, 2018, the Department shall
8increase the base rate of reimbursement for both base charges
9and mileage charges for ground ambulance service providers for
10medical transportation services provided by means of a ground
11ambulance to a level not lower than 112% of the base rate in
12effect as of June 30, 2018.
13    (k) Within 90 days after the effective date of this
14amendatory Act of the 102nd General Assembly, the Department
15shall establish a methodology for providing reimbursement for:
16(i) bariatric transports at an amount of one base rate for each
17additional 2 personnel necessary to safely move the patient;
18and (ii) specialty care transports to include transports
19originating or terminating at a residence and for
20intra-facility transports.
21(Source: P.A. 101-81, eff. 7-12-19; 101-649, eff. 7-7-20;
22102-364, eff. 1-1-22; 102-650, eff. 8-27-21; revised 11-8-21.)
 
23    (305 ILCS 5/5-30c new)
24    Sec. 5-30c. Medi-car and stretcher van services; rate
25increase. To ensure access to medical appointments and covered

 

 

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1services and realize the objectives of the medical assistance
2program, the General Assembly must address the inadequate
3supply of non-emergency medical transportation providers
4across the State. To increase access to non-emergency
5transportation services, the Department shall increase the
6base rate for medi-car and stretcher van services to at least
7$50, and the rate of each attendant for medi-car services and
8stretcher van to at least $50. The Department shall establish
9a grant program for the purpose of building capacity among
10IMPACT-enrolled and BEP-certified providers of medi-car and
11stretcher van transportation services.
 
12    Section 99. Effective date. This Act takes effect upon
13becoming law.".