Full Text of SB2302 99th General Assembly
SB2302 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 SB2302 Introduced 1/27/2016, by Sen. Heather A. Steans SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning elimination and limitations of medical assistance services.
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| | A BILL FOR |
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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 5-5f as follows:
| 6 | | (305 ILCS 5/5-5f)
| 7 | | Sec. 5-5f. Elimination and limitations of medical | 8 | | assistance services. Notwithstanding any any other provision | 9 | | of this Code to the contrary, on and after July 1, 2012: | 10 | | (a) The following services shall no longer be a covered | 11 | | service available under this Code: group psychotherapy for | 12 | | residents of any facility licensed under the Nursing Home | 13 | | Care Act or the Specialized Mental Health Rehabilitation | 14 | | Act of 2013; and adult chiropractic services. | 15 | | (b) The Department shall place the following | 16 | | limitations on services: (i) the Department shall limit | 17 | | adult eyeglasses to one pair every 2 years; (ii) the | 18 | | Department shall set an annual limit of a maximum of 20 | 19 | | visits for each of the following services: adult speech, | 20 | | hearing, and language therapy services, adult occupational | 21 | | therapy services, and physical therapy services; on or | 22 | | after October 1, 2014, the annual maximum limit of 20 | 23 | | visits shall expire but the Department shall require prior |
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| 1 | | approval for all individuals for speech, hearing, and | 2 | | language therapy services, occupational therapy services, | 3 | | and physical therapy services; (iii) the Department shall | 4 | | limit adult podiatry services to individuals with | 5 | | diabetes; on or after October 1, 2014, podiatry services | 6 | | shall not be limited to individuals with diabetes; (iv) the | 7 | | Department shall pay for caesarean sections at the normal | 8 | | vaginal delivery rate unless a caesarean section was | 9 | | medically necessary; (v) the Department shall limit adult | 10 | | dental services to emergencies; beginning July 1, 2013, the | 11 | | Department shall ensure that the following conditions are | 12 | | recognized as emergencies: (A) dental services necessary | 13 | | for an individual in order for the individual to be cleared | 14 | | for a medical procedure, such as a transplant;
(B) | 15 | | extractions and dentures necessary for a diabetic to | 16 | | receive proper nutrition;
(C) extractions and dentures | 17 | | necessary as a result of cancer treatment; and (D) dental | 18 | | services necessary for the health of a pregnant woman prior | 19 | | to delivery of her baby; on or after July 1, 2014, adult | 20 | | dental services shall no longer be limited to emergencies, | 21 | | and dental services necessary for the health of a pregnant | 22 | | woman prior to delivery of her baby shall continue to be | 23 | | covered; and (vi) effective July 1, 2012, the Department | 24 | | shall place limitations and require concurrent review on | 25 | | every inpatient detoxification stay to prevent repeat | 26 | | admissions to any hospital for detoxification within 60 |
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| 1 | | days of a previous inpatient detoxification stay. The | 2 | | Department shall convene a workgroup of hospitals, | 3 | | substance abuse providers, care coordination entities, | 4 | | managed care plans, and other stakeholders to develop | 5 | | recommendations for quality standards, diversion to other | 6 | | settings, and admission criteria for patients who need | 7 | | inpatient detoxification, which shall be published on the | 8 | | Department's website no later than September 1, 2013. | 9 | | (c) The Department shall require prior approval of the | 10 | | following services: wheelchair repairs costing more than | 11 | | $400, coronary artery bypass graft, and bariatric surgery | 12 | | consistent with Medicare standards concerning patient | 13 | | responsibility. Wheelchair repair prior approval requests | 14 | | shall be adjudicated within one business day of receipt of | 15 | | complete supporting documentation. Providers may not break | 16 | | wheelchair repairs into separate claims for purposes of | 17 | | staying under the $400 threshold for requiring prior | 18 | | approval. The wholesale price of manual and power | 19 | | wheelchairs, durable medical equipment and supplies, and | 20 | | complex rehabilitation technology products and services | 21 | | shall be defined as actual acquisition cost including all | 22 | | discounts. | 23 | | (d) The Department shall establish benchmarks for | 24 | | hospitals to measure and align payments to reduce | 25 | | potentially preventable hospital readmissions, inpatient | 26 | | complications, and unnecessary emergency room visits. In |
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| 1 | | doing so, the Department shall consider items, including, | 2 | | but not limited to, historic and current acuity of care and | 3 | | historic and current trends in readmission. The Department | 4 | | shall publish provider-specific historical readmission | 5 | | data and anticipated potentially preventable targets 60 | 6 | | days prior to the start of the program. In the instance of | 7 | | readmissions, the Department shall adopt policies and | 8 | | rates of reimbursement for services and other payments | 9 | | provided under this Code to ensure that, by June 30, 2013, | 10 | | expenditures to hospitals are reduced by, at a minimum, | 11 | | $40,000,000. | 12 | | (e) The Department shall establish utilization | 13 | | controls for the hospice program such that it shall not pay | 14 | | for other care services when an individual is in hospice. | 15 | | (f) For home health services, the Department shall | 16 | | require Medicare certification of providers participating | 17 | | in the program and implement the Medicare face-to-face | 18 | | encounter rule. The Department shall require providers to | 19 | | implement auditable electronic service verification based | 20 | | on global positioning systems or other cost-effective | 21 | | technology. | 22 | | (g) For the Home Services Program operated by the | 23 | | Department of Human Services and the Community Care Program | 24 | | operated by the Department on Aging, the Department of | 25 | | Human Services, in cooperation with the Department on | 26 | | Aging, shall implement an electronic service verification |
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| 1 | | based on global positioning systems or other | 2 | | cost-effective technology. | 3 | | (h) Effective with inpatient hospital admissions on or | 4 | | after July 1, 2012, the Department shall reduce the payment | 5 | | for a claim that indicates the occurrence of a | 6 | | provider-preventable condition during the admission as | 7 | | specified by the Department in rules. The Department shall | 8 | | not pay for services related to an other | 9 | | provider-preventable condition. | 10 | | As used in this subsection (h): | 11 | | "Provider-preventable condition" means a health care | 12 | | acquired condition as defined under the federal Medicaid | 13 | | regulation found at 42 CFR 447.26 or an other | 14 | | provider-preventable condition. | 15 | | "Other provider-preventable condition" means a wrong | 16 | | surgical or other invasive procedure performed on a | 17 | | patient, a surgical or other invasive procedure performed | 18 | | on the wrong body part, or a surgical procedure or other | 19 | | invasive procedure performed on the wrong patient. | 20 | | (i) The Department shall implement cost savings | 21 | | initiatives for advanced imaging services, cardiac imaging | 22 | | services, pain management services, and back surgery. Such | 23 | | initiatives shall be designed to achieve annual costs | 24 | | savings.
| 25 | | (j) The Department shall ensure that beneficiaries | 26 | | with a diagnosis of epilepsy or seizure disorder in |
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| 1 | | Department records will not require prior approval for | 2 | | anticonvulsants. | 3 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section | 4 | | 6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff. | 5 | | 7-22-13; 98-651, eff. 6-16-14; 98-756, eff. 7-16-14.)
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