Full Text of HB3596 094th General Assembly
HB3596eng 94TH GENERAL ASSEMBLY
|
|
|
HB3596 Engrossed |
|
LRB094 05070 DRJ 35106 b |
|
| 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 Sections 5-2 and 5-5 as follows:
| 6 |
| (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
| 7 |
| Sec. 5-2. Classes of Persons Eligible. Medical assistance | 8 |
| under this
Article shall be available to any of the following | 9 |
| classes of persons in
respect to whom a plan for coverage has | 10 |
| been submitted to the Governor
by the Illinois Department and | 11 |
| approved by him:
| 12 |
| 1. Recipients of basic maintenance grants under Articles | 13 |
| III and IV.
| 14 |
| 2. Persons otherwise eligible for basic maintenance under | 15 |
| Articles
III and IV but who fail to qualify thereunder on the | 16 |
| basis of need, and
who have insufficient income and resources | 17 |
| to meet the costs of
necessary medical care, including but not | 18 |
| limited to the following:
| 19 |
| (a) All persons otherwise eligible for basic | 20 |
| maintenance under Article
III but who fail to qualify under | 21 |
| that Article on the basis of need and who
meet either of | 22 |
| the following requirements:
| 23 |
| (i) their income, as determined by the Illinois | 24 |
| Department in
accordance with any federal | 25 |
| requirements, is equal to or less than 70% in
fiscal | 26 |
| year 2001, equal to or less than 85% in fiscal year | 27 |
| 2002 and until
a date to be determined by the | 28 |
| Department by rule, and equal to or less
than 100% | 29 |
| beginning on the date determined by the Department by | 30 |
| rule, of the nonfarm income official poverty
line, as | 31 |
| defined by the federal Office of Management and Budget | 32 |
| and revised
annually in accordance with Section 673(2) |
|
|
|
HB3596 Engrossed |
- 2 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| of the Omnibus Budget Reconciliation
Act of 1981, | 2 |
| applicable to families of the same size; or
| 3 |
| (ii) their income, after the deduction of costs | 4 |
| incurred for medical
care and for other types of | 5 |
| remedial care, is equal to or less than 70% in
fiscal | 6 |
| year 2001, equal to or less than 85% in fiscal year | 7 |
| 2002 and until
a date to be determined by the | 8 |
| Department by rule, and equal to or less
than 100% | 9 |
| beginning on the date determined by the Department by | 10 |
| rule, of the nonfarm income official poverty
line, as | 11 |
| defined in item (i) of this subparagraph (a).
| 12 |
| (b) All persons who would be determined eligible for | 13 |
| such basic
maintenance under Article IV by disregarding the | 14 |
| maximum earned income
permitted by federal law.
| 15 |
| 3. Persons who would otherwise qualify for Aid to the | 16 |
| Medically
Indigent under Article VII.
| 17 |
| 4. Persons not eligible under any of the preceding | 18 |
| paragraphs who fall
sick, are injured, or die, not having | 19 |
| sufficient money, property or other
resources to meet the costs | 20 |
| of necessary medical care or funeral and burial
expenses.
| 21 |
| 5. (a) Women during pregnancy, after the fact
of pregnancy | 22 |
| has been determined by medical diagnosis, and during the
| 23 |
| 60-day period beginning on the last day of the pregnancy, | 24 |
| together with
their infants and children born after | 25 |
| September 30, 1983,
whose income and
resources are | 26 |
| insufficient to meet the costs of necessary medical care to
| 27 |
| the maximum extent possible under Title XIX of the
Federal | 28 |
| Social Security Act.
| 29 |
| (b) The Illinois Department and the Governor shall | 30 |
| provide a plan for
coverage of the persons eligible under | 31 |
| paragraph 5(a) by April 1, 1990. Such
plan shall provide | 32 |
| ambulatory prenatal care to pregnant women during a
| 33 |
| presumptive eligibility period and establish an income | 34 |
| eligibility standard
that is equal to 133%
of the nonfarm | 35 |
| income official poverty line, as defined by
the federal | 36 |
| Office of Management and Budget and revised annually in
|
|
|
|
HB3596 Engrossed |
- 3 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| accordance with Section 673(2) of the Omnibus Budget | 2 |
| Reconciliation Act of
1981, applicable to families of the | 3 |
| same size, provided that costs incurred
for medical care | 4 |
| are not taken into account in determining such income
| 5 |
| eligibility.
| 6 |
| (c) The Illinois Department may conduct a | 7 |
| demonstration in at least one
county that will provide | 8 |
| medical assistance to pregnant women, together
with their | 9 |
| infants and children up to one year of age,
where the | 10 |
| income
eligibility standard is set up to 185% of the | 11 |
| nonfarm income official
poverty line, as defined by the | 12 |
| federal Office of Management and Budget.
The Illinois | 13 |
| Department shall seek and obtain necessary authorization
| 14 |
| provided under federal law to implement such a | 15 |
| demonstration. Such
demonstration may establish resource | 16 |
| standards that are not more
restrictive than those | 17 |
| established under Article IV of this Code.
| 18 |
| 6. Persons under the age of 18 who fail to qualify as | 19 |
| dependent under
Article IV and who have insufficient income and | 20 |
| resources to meet the costs
of necessary medical care to the | 21 |
| maximum extent permitted under Title XIX
of the Federal Social | 22 |
| Security Act.
| 23 |
| 7. Persons who are under 21 years of age and would
qualify | 24 |
| as
disabled as defined under the Federal Supplemental Security | 25 |
| Income Program,
provided medical service for such persons would | 26 |
| be eligible for Federal
Financial Participation, and provided | 27 |
| the Illinois Department determines that:
| 28 |
| (a) the person requires a level of care provided by a | 29 |
| hospital, skilled
nursing facility, or intermediate care | 30 |
| facility, as determined by a physician
licensed to practice | 31 |
| medicine in all its branches;
| 32 |
| (b) it is appropriate to provide such care outside of | 33 |
| an institution, as
determined by a physician licensed to | 34 |
| practice medicine in all its branches;
| 35 |
| (c) the estimated amount which would be expended for | 36 |
| care outside the
institution is not greater than the |
|
|
|
HB3596 Engrossed |
- 4 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| estimated amount which would be
expended in an institution.
| 2 |
| 8. Persons who become ineligible for basic maintenance | 3 |
| assistance
under Article IV of this Code in programs | 4 |
| administered by the Illinois
Department due to employment | 5 |
| earnings and persons in
assistance units comprised of adults | 6 |
| and children who become ineligible for
basic maintenance | 7 |
| assistance under Article VI of this Code due to
employment | 8 |
| earnings. The plan for coverage for this class of persons | 9 |
| shall:
| 10 |
| (a) extend the medical assistance coverage for up to 12 | 11 |
| months following
termination of basic maintenance | 12 |
| assistance; and
| 13 |
| (b) offer persons who have initially received 6 months | 14 |
| of the
coverage provided in paragraph (a) above, the option | 15 |
| of receiving an
additional 6 months of coverage, subject to | 16 |
| the following:
| 17 |
| (i) such coverage shall be pursuant to provisions | 18 |
| of the federal
Social Security Act;
| 19 |
| (ii) such coverage shall include all services | 20 |
| covered while the person
was eligible for basic | 21 |
| maintenance assistance;
| 22 |
| (iii) no premium shall be charged for such | 23 |
| coverage; and
| 24 |
| (iv) such coverage shall be suspended in the event | 25 |
| of a person's
failure without good cause to file in a | 26 |
| timely fashion reports required for
this coverage | 27 |
| under the Social Security Act and coverage shall be | 28 |
| reinstated
upon the filing of such reports if the | 29 |
| person remains otherwise eligible.
| 30 |
| 9. Persons with acquired immunodeficiency syndrome (AIDS) | 31 |
| or with
AIDS-related conditions with respect to whom there has | 32 |
| been a determination
that but for home or community-based | 33 |
| services such individuals would
require the level of care | 34 |
| provided in an inpatient hospital, skilled
nursing facility or | 35 |
| intermediate care facility the cost of which is
reimbursed | 36 |
| under this Article. Assistance shall be provided to such
|
|
|
|
HB3596 Engrossed |
- 5 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| persons to the maximum extent permitted under Title
XIX of the | 2 |
| Federal Social Security Act.
| 3 |
| 10. Participants in the long-term care insurance | 4 |
| partnership program
established under the Partnership for | 5 |
| Long-Term Care Act who meet the
qualifications for protection | 6 |
| of resources described in Section 25 of that
Act.
| 7 |
| 11. Persons with disabilities who are employed and eligible | 8 |
| for Medicaid,
pursuant to Section 1902(a)(10)(A)(ii)(xv) of | 9 |
| the Social Security Act, as
provided by the Illinois Department | 10 |
| by rule.
| 11 |
| 12. Subject to federal approval, persons who are eligible | 12 |
| for medical
assistance coverage under applicable provisions of | 13 |
| the federal Social Security
Act and the federal Breast and | 14 |
| Cervical Cancer Prevention and Treatment Act of
2000. Those | 15 |
| eligible persons are defined to include, but not be limited to,
| 16 |
| the following persons:
| 17 |
| (1) persons who have been screened for breast or | 18 |
| cervical cancer under
the U.S. Centers for Disease Control | 19 |
| and Prevention Breast and Cervical Cancer
Program | 20 |
| established under Title XV of the federal Public Health | 21 |
| Services Act in
accordance with the requirements of Section | 22 |
| 1504 of that Act as administered by
the Illinois Department | 23 |
| of Public Health; and
| 24 |
| (2) persons whose screenings under the above program | 25 |
| were funded in whole
or in part by funds appropriated to | 26 |
| the Illinois Department of Public Health
for breast or | 27 |
| cervical cancer screening.
| 28 |
| "Medical assistance" under this paragraph 12 shall be identical | 29 |
| to the benefits
provided under the State's approved plan under | 30 |
| Title XIX of the Social Security
Act. The Department must | 31 |
| request federal approval of the coverage under this
paragraph | 32 |
| 12 within 30 days after the effective date of this amendatory | 33 |
| Act of
the 92nd General Assembly. | 34 |
| 13. Subject to the approval of a waiver under Section | 35 |
| 1915(c) of the federal Social Security Act and consistent with
| 36 |
| that waiver, persons who are 21 years of age or older who have
|
|
|
|
HB3596 Engrossed |
- 6 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| received benefits under paragraph 7 of this Section and who
| 2 |
| continue to meet the requirements of subparagraphs (a), (b) and
| 3 |
| (c) of paragraph 7 shall remain eligible for continued
| 4 |
| benefits, outside an institution, at a level of care
| 5 |
| appropriate to meet the individual needs of the person,
| 6 |
| provided that a physician, licensed to practice medicine in all
| 7 |
| its branches, annually determines that the person requires the
| 8 |
| level of care provided by a hospital, skilled nursing facility,
| 9 |
| or intermediate care facility. The Illinois Department of
| 10 |
| Public Aid shall apply for an applicable waiver under Section
| 11 |
| 1915(c) of the federal Social Security Act. The waiver
| 12 |
| application may limit the number of persons served by the
| 13 |
| waiver in any State fiscal year, but that annual limit shall be
| 14 |
| no fewer than 15 persons. The Department of Public Aid and the
| 15 |
| Department of Human Services shall jointly adopt rules
| 16 |
| governing the eligibility of persons under this paragraph 13.
| 17 |
| The Department of Human
Services must make an annual report to | 18 |
| the Governor and the General Assembly with respect to the class | 19 |
| of persons eligible
for medical assistance under this paragraph | 20 |
| 13. The report is
due on January 1 of each year and must cover | 21 |
| the State fiscal
year ending on June 30 of the preceding year. | 22 |
| The first report
is due on January 1, 2007. The report must | 23 |
| include the
following information for the fiscal year covered | 24 |
| by the
report:
| 25 |
| (a) The number of persons eligible for medical
| 26 |
| assistance under this paragraph 13. | 27 |
| (b) The number of persons who applied for medical
| 28 |
| assistance under this paragraph 13. | 29 |
| (c) The number of persons who received medical
| 30 |
| assistance under this paragraph 13. | 31 |
| (d) The number of persons who were denied medical
| 32 |
| assistance under this paragraph 13, together with the
| 33 |
| reasons for the denial of assistance. | 34 |
| (e) The nature, scope, and cost of services provided
| 35 |
| under this paragraph 13. | 36 |
| (f) The comparative cost of providing those services in
|
|
|
|
HB3596 Engrossed |
- 7 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| a hospital, skilled nursing facility, or intermediate care
| 2 |
| facility.
| 3 |
| The Illinois Department and the Governor shall provide a | 4 |
| plan for
coverage of the persons eligible under paragraph 7 as | 5 |
| soon as possible after
July 1, 1984.
| 6 |
| The eligibility of any such person for medical assistance | 7 |
| under this
Article is not affected by the payment of any grant | 8 |
| under the Senior
Citizens and Disabled Persons Property Tax | 9 |
| Relief and Pharmaceutical
Assistance Act or any distributions | 10 |
| or items of income described under
subparagraph (X) of
| 11 |
| paragraph (2) of subsection (a) of Section 203 of the Illinois | 12 |
| Income Tax
Act. The Department shall by rule establish the | 13 |
| amounts of
assets to be disregarded in determining eligibility | 14 |
| for medical assistance,
which shall at a minimum equal the | 15 |
| amounts to be disregarded under the
Federal Supplemental | 16 |
| Security Income Program. The amount of assets of a
single | 17 |
| person to be disregarded
shall not be less than $2,000, and the | 18 |
| amount of assets of a married couple
to be disregarded shall | 19 |
| not be less than $3,000.
| 20 |
| To the extent permitted under federal law, any person found | 21 |
| guilty of a
second violation of Article VIIIA
shall be | 22 |
| ineligible for medical assistance under this Article, as | 23 |
| provided
in Section 8A-8.
| 24 |
| The eligibility of any person for medical assistance under | 25 |
| this Article
shall not be affected by the receipt by the person | 26 |
| of donations or benefits
from fundraisers held for the person | 27 |
| in cases of serious illness,
as long as neither the person nor | 28 |
| members of the person's family
have actual control over the | 29 |
| donations or benefits or the disbursement
of the donations or | 30 |
| benefits.
| 31 |
| (Source: P.A. 92-16, eff. 6-28-01; 92-47, eff. 7-3-01; 92-597, | 32 |
| eff. 6-28-02;
93-20, eff. 6-20-03.)
| 33 |
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
| 34 |
| Sec. 5-5. Medical services. The Illinois Department, by | 35 |
| rule, shall
determine the quantity and quality of and the rate |
|
|
|
HB3596 Engrossed |
- 8 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| of reimbursement for the
medical assistance for which
payment | 2 |
| will be authorized, and the medical services to be provided,
| 3 |
| which may include all or part of the following: (1) inpatient | 4 |
| hospital
services; (2) outpatient hospital services; (3) other | 5 |
| laboratory and
X-ray services; (4) skilled nursing home | 6 |
| services; (5) physicians'
services whether furnished in the | 7 |
| office, the patient's home, a
hospital, a skilled nursing home, | 8 |
| or elsewhere; (6) medical care, or any
other type of remedial | 9 |
| care furnished by licensed practitioners; (7)
home health care | 10 |
| services; (8) private duty nursing service; (9) clinic
| 11 |
| services; (10) dental services, including prevention and | 12 |
| treatment of periodontal disease and dental caries disease for | 13 |
| pregnant women; (11) physical therapy and related
services; | 14 |
| (12) prescribed drugs, dentures, and prosthetic devices; and
| 15 |
| eyeglasses prescribed by a physician skilled in the diseases of | 16 |
| the eye,
or by an optometrist, whichever the person may select; | 17 |
| (13) other
diagnostic, screening, preventive, and | 18 |
| rehabilitative services; (14)
transportation and such other | 19 |
| expenses as may be necessary; (15) medical
treatment of sexual | 20 |
| assault survivors, as defined in
Section 1a of the Sexual | 21 |
| Assault Survivors Emergency Treatment Act, for
injuries | 22 |
| sustained as a result of the sexual assault, including
| 23 |
| examinations and laboratory tests to discover evidence which | 24 |
| may be used in
criminal proceedings arising from the sexual | 25 |
| assault; (16) the
diagnosis and treatment of sickle cell | 26 |
| anemia; and (17)
any other medical care, and any other type of | 27 |
| remedial care recognized
under the laws of this State, but not | 28 |
| including abortions, or induced
miscarriages or premature | 29 |
| births, unless, in the opinion of a physician,
such procedures | 30 |
| are necessary for the preservation of the life of the
woman | 31 |
| seeking such treatment, or except an induced premature birth
| 32 |
| intended to produce a live viable child and such procedure is | 33 |
| necessary
for the health of the mother or her unborn child. The | 34 |
| Illinois Department,
by rule, shall prohibit any physician from | 35 |
| providing medical assistance
to anyone eligible therefor under | 36 |
| this Code where such physician has been
found guilty of |
|
|
|
HB3596 Engrossed |
- 9 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| performing an abortion procedure in a wilful and wanton
manner | 2 |
| upon a woman who was not pregnant at the time such abortion
| 3 |
| procedure was performed. The term "any other type of remedial | 4 |
| care" shall
include nursing care and nursing home service for | 5 |
| persons who rely on
treatment by spiritual means alone through | 6 |
| prayer for healing.
| 7 |
| Notwithstanding any other provision of this Section, a | 8 |
| comprehensive
tobacco use cessation program that includes | 9 |
| purchasing prescription drugs or
prescription medical devices | 10 |
| approved by the Food and Drug administration shall
be covered | 11 |
| under the medical assistance
program under this Article for | 12 |
| persons who are otherwise eligible for
assistance under this | 13 |
| Article.
| 14 |
| Notwithstanding any other provision of this Code, the | 15 |
| Illinois
Department may not require, as a condition of payment | 16 |
| for any laboratory
test authorized under this Article, that a | 17 |
| physician's handwritten signature
appear on the laboratory | 18 |
| test order form. The Illinois Department may,
however, impose | 19 |
| other appropriate requirements regarding laboratory test
order | 20 |
| documentation.
| 21 |
| The Illinois Department of Public Aid shall provide the | 22 |
| following services to
persons
eligible for assistance under | 23 |
| this Article who are participating in
education, training or | 24 |
| employment programs operated by the Department of Human
| 25 |
| Services as successor to the Department of Public Aid:
| 26 |
| (1) dental services, which shall include but not be | 27 |
| limited to
prosthodontics; and
| 28 |
| (2) eyeglasses prescribed by a physician skilled in the | 29 |
| diseases of the
eye, or by an optometrist, whichever the | 30 |
| person may select.
| 31 |
| In order to ensure compliance with the Disabilities | 32 |
| Services Act of 2003 and the federal Americans with
| 33 |
| Disabilities Act, the Illinois Department of Human Services,
| 34 |
| the Illinois Department of Public Aid, and the Division of
| 35 |
| Specialized Care for Children of the University of Illinois
| 36 |
| shall enter into an interagency agreement within 90 days after
|
|
|
|
HB3596 Engrossed |
- 10 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| the effective date of this amendatory Act of the 94th General
| 2 |
| Assembly for the purpose of cooperatively establishing a
| 3 |
| program of case management for any person who receives benefits
| 4 |
| under paragraph 7 of Section 5-2 of this Code. The program of
| 5 |
| case management shall include a review of each person's needs
| 6 |
| at least annually starting at age 16 in order to prepare the
| 7 |
| person and his or her family for the transition to services
| 8 |
| that are available to the person and his or her family starting
| 9 |
| at age 21, including services provided under paragraph 13 of
| 10 |
| Section 5-2 of this Code. The person or his or her authorized
| 11 |
| representative shall participate in the case management
| 12 |
| program. These case management services shall include: (1) an
| 13 |
| assessment of the person's medical needs, including
| 14 |
| consultation with a physician licensed to practice medicine in
| 15 |
| all its branches and the person's treating physician; (2)
| 16 |
| counseling the person and his or her family about the services
| 17 |
| available to the person when he or she reaches age 21; (3)
| 18 |
| providing the opportunity to receive service options between
| 19 |
| the ages of 16 and 21 that will permit the person to gradually
| 20 |
| make a successful transition to services available starting at
| 21 |
| the age of 21; (4) assisting the person and his or her family
| 22 |
| to adjust to changes, if any, that may occur in the provision
| 23 |
| of services starting at the age of 21; (5) assessing the needs
| 24 |
| of the person for educational and vocational planning and
| 25 |
| services; (6) evaluating the need of the person for assistive
| 26 |
| technology services and devices; (7) establishing linkages for
| 27 |
| the person and his or her family to support services,
| 28 |
| independent living services, employment and vocational skills
| 29 |
| training, educational resources, and other transition
| 30 |
| services; and (8) developing a transition plan for the person
| 31 |
| with the participation of the person and his or her family. The
| 32 |
| Department of Human Services, the Division of Specialized Care
| 33 |
| for Children, and the Department of Public Aid shall jointly
| 34 |
| adopt rules governing the criteria, standards, and procedures
| 35 |
| concerning the case management program and procedures required
| 36 |
| by this paragraph.
|
|
|
|
HB3596 Engrossed |
- 11 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| The Illinois Department, by rule, may distinguish and | 2 |
| classify the
medical services to be provided only in accordance | 3 |
| with the classes of
persons designated in Section 5-2.
| 4 |
| The Illinois Department shall authorize the provision of, | 5 |
| and shall
authorize payment for, screening by low-dose | 6 |
| mammography for the presence of
occult breast cancer for women | 7 |
| 35 years of age or older who are eligible
for medical | 8 |
| assistance under this Article, as follows: a baseline
mammogram | 9 |
| for women 35 to 39 years of age and an
annual mammogram for | 10 |
| women 40 years of age or older. All screenings
shall
include a | 11 |
| physical breast exam, instruction on self-examination and
| 12 |
| information regarding the frequency of self-examination and | 13 |
| its value as a
preventative tool. As used in this Section, | 14 |
| "low-dose mammography" means
the x-ray examination of the | 15 |
| breast using equipment dedicated specifically
for mammography, | 16 |
| including the x-ray tube, filter, compression device,
image | 17 |
| receptor, and cassettes, with an average radiation exposure | 18 |
| delivery
of less than one rad mid-breast, with 2 views for each | 19 |
| breast.
| 20 |
| Any medical or health care provider shall immediately | 21 |
| recommend, to
any pregnant woman who is being provided prenatal | 22 |
| services and is suspected
of drug abuse or is addicted as | 23 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | 24 |
| Act, referral to a local substance abuse treatment provider
| 25 |
| licensed by the Department of Human Services or to a licensed
| 26 |
| hospital which provides substance abuse treatment services. | 27 |
| The Department of
Public Aid shall assure coverage for the cost | 28 |
| of treatment of the drug abuse or
addiction for pregnant | 29 |
| recipients in accordance with the Illinois Medicaid
Program in | 30 |
| conjunction with the Department of Human Services.
| 31 |
| All medical providers providing medical assistance to | 32 |
| pregnant women
under this Code shall receive information from | 33 |
| the Department on the
availability of services under the Drug | 34 |
| Free Families with a Future or any
comparable program providing | 35 |
| case management services for addicted women,
including | 36 |
| information on appropriate referrals for other social services
|
|
|
|
HB3596 Engrossed |
- 12 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| that may be needed by addicted women in addition to treatment | 2 |
| for addiction.
| 3 |
| The Illinois Department, in cooperation with the | 4 |
| Departments of Human
Services (as successor to the Department | 5 |
| of Alcoholism and Substance
Abuse) and Public Health, through a | 6 |
| public awareness campaign, may
provide information concerning | 7 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 8 |
| health care, and other pertinent programs directed at
reducing | 9 |
| the number of drug-affected infants born to recipients of | 10 |
| medical
assistance.
| 11 |
| Neither the Illinois Department of Public Aid nor the | 12 |
| Department of Human
Services shall sanction the recipient | 13 |
| solely on the basis of
her substance abuse.
| 14 |
| The Illinois Department shall establish such regulations | 15 |
| governing
the dispensing of health services under this Article | 16 |
| as it shall deem
appropriate. The Department
should
seek the | 17 |
| advice of formal professional advisory committees appointed by
| 18 |
| the Director of the Illinois Department for the purpose of | 19 |
| providing regular
advice on policy and administrative matters, | 20 |
| information dissemination and
educational activities for | 21 |
| medical and health care providers, and
consistency in | 22 |
| procedures to the Illinois Department.
| 23 |
| The Illinois Department may develop and contract with | 24 |
| Partnerships of
medical providers to arrange medical services | 25 |
| for persons eligible under
Section 5-2 of this Code. | 26 |
| Implementation of this Section may be by
demonstration projects | 27 |
| in certain geographic areas. The Partnership shall
be | 28 |
| represented by a sponsor organization. The Department, by rule, | 29 |
| shall
develop qualifications for sponsors of Partnerships. | 30 |
| Nothing in this
Section shall be construed to require that the | 31 |
| sponsor organization be a
medical organization.
| 32 |
| The sponsor must negotiate formal written contracts with | 33 |
| medical
providers for physician services, inpatient and | 34 |
| outpatient hospital care,
home health services, treatment for | 35 |
| alcoholism and substance abuse, and
other services determined | 36 |
| necessary by the Illinois Department by rule for
delivery by |
|
|
|
HB3596 Engrossed |
- 13 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| Partnerships. Physician services must include prenatal and
| 2 |
| obstetrical care. The Illinois Department shall reimburse | 3 |
| medical services
delivered by Partnership providers to clients | 4 |
| in target areas according to
provisions of this Article and the | 5 |
| Illinois Health Finance Reform Act,
except that:
| 6 |
| (1) Physicians participating in a Partnership and | 7 |
| providing certain
services, which shall be determined by | 8 |
| the Illinois Department, to persons
in areas covered by the | 9 |
| Partnership may receive an additional surcharge
for such | 10 |
| services.
| 11 |
| (2) The Department may elect to consider and negotiate | 12 |
| financial
incentives to encourage the development of | 13 |
| Partnerships and the efficient
delivery of medical care.
| 14 |
| (3) Persons receiving medical services through | 15 |
| Partnerships may receive
medical and case management | 16 |
| services above the level usually offered
through the | 17 |
| medical assistance program.
| 18 |
| Medical providers shall be required to meet certain | 19 |
| qualifications to
participate in Partnerships to ensure the | 20 |
| delivery of high quality medical
services. These | 21 |
| qualifications shall be determined by rule of the Illinois
| 22 |
| Department and may be higher than qualifications for | 23 |
| participation in the
medical assistance program. Partnership | 24 |
| sponsors may prescribe reasonable
additional qualifications | 25 |
| for participation by medical providers, only with
the prior | 26 |
| written approval of the Illinois Department.
| 27 |
| Nothing in this Section shall limit the free choice of | 28 |
| practitioners,
hospitals, and other providers of medical | 29 |
| services by clients.
In order to ensure patient freedom of | 30 |
| choice, the Illinois Department shall
immediately promulgate | 31 |
| all rules and take all other necessary actions so that
provided | 32 |
| services may be accessed from therapeutically certified | 33 |
| optometrists
to the full extent of the Illinois Optometric | 34 |
| Practice Act of 1987 without
discriminating between service | 35 |
| providers.
| 36 |
| The Department shall apply for a waiver from the United |
|
|
|
HB3596 Engrossed |
- 14 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| States Health
Care Financing Administration to allow for the | 2 |
| implementation of
Partnerships under this Section.
| 3 |
| The Illinois Department shall require health care | 4 |
| providers to maintain
records that document the medical care | 5 |
| and services provided to recipients
of Medical Assistance under | 6 |
| this Article. The Illinois Department shall
require health care | 7 |
| providers to make available, when authorized by the
patient, in | 8 |
| writing, the medical records in a timely fashion to other
| 9 |
| health care providers who are treating or serving persons | 10 |
| eligible for
Medical Assistance under this Article. All | 11 |
| dispensers of medical services
shall be required to maintain | 12 |
| and retain business and professional records
sufficient to | 13 |
| fully and accurately document the nature, scope, details and
| 14 |
| receipt of the health care provided to persons eligible for | 15 |
| medical
assistance under this Code, in accordance with | 16 |
| regulations promulgated by
the Illinois Department. The rules | 17 |
| and regulations shall require that proof
of the receipt of | 18 |
| prescription drugs, dentures, prosthetic devices and
| 19 |
| eyeglasses by eligible persons under this Section accompany | 20 |
| each claim
for reimbursement submitted by the dispenser of such | 21 |
| medical services.
No such claims for reimbursement shall be | 22 |
| approved for payment by the Illinois
Department without such | 23 |
| proof of receipt, unless the Illinois Department
shall have put | 24 |
| into effect and shall be operating a system of post-payment
| 25 |
| audit and review which shall, on a sampling basis, be deemed | 26 |
| adequate by
the Illinois Department to assure that such drugs, | 27 |
| dentures, prosthetic
devices and eyeglasses for which payment | 28 |
| is being made are actually being
received by eligible | 29 |
| recipients. Within 90 days after the effective date of
this | 30 |
| amendatory Act of 1984, the Illinois Department shall establish | 31 |
| a
current list of acquisition costs for all prosthetic devices | 32 |
| and any
other items recognized as medical equipment and | 33 |
| supplies reimbursable under
this Article and shall update such | 34 |
| list on a quarterly basis, except that
the acquisition costs of | 35 |
| all prescription drugs shall be updated no
less frequently than | 36 |
| every 30 days as required by Section 5-5.12.
|
|
|
|
HB3596 Engrossed |
- 15 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| The rules and regulations of the Illinois Department shall | 2 |
| require
that a written statement including the required opinion | 3 |
| of a physician
shall accompany any claim for reimbursement for | 4 |
| abortions, or induced
miscarriages or premature births. This | 5 |
| statement shall indicate what
procedures were used in providing | 6 |
| such medical services.
| 7 |
| The Illinois Department shall require all dispensers of | 8 |
| medical
services, other than an individual practitioner or | 9 |
| group of practitioners,
desiring to participate in the Medical | 10 |
| Assistance program
established under this Article to disclose | 11 |
| all financial, beneficial,
ownership, equity, surety or other | 12 |
| interests in any and all firms,
corporations, partnerships, | 13 |
| associations, business enterprises, joint
ventures, agencies, | 14 |
| institutions or other legal entities providing any
form of | 15 |
| health care services in this State under this Article.
| 16 |
| The Illinois Department may require that all dispensers of | 17 |
| medical
services desiring to participate in the medical | 18 |
| assistance program
established under this Article disclose, | 19 |
| under such terms and conditions as
the Illinois Department may | 20 |
| by rule establish, all inquiries from clients
and attorneys | 21 |
| regarding medical bills paid by the Illinois Department, which
| 22 |
| inquiries could indicate potential existence of claims or liens | 23 |
| for the
Illinois Department.
| 24 |
| Enrollment of a vendor that provides non-emergency medical | 25 |
| transportation,
defined by the Department by rule,
shall be
| 26 |
| conditional for 180 days. During that time, the Department of | 27 |
| Public Aid may
terminate the vendor's eligibility to | 28 |
| participate in the medical assistance
program without cause. | 29 |
| That termination of eligibility is not subject to the
| 30 |
| Department's hearing process.
| 31 |
| The Illinois Department shall establish policies, | 32 |
| procedures,
standards and criteria by rule for the acquisition, | 33 |
| repair and replacement
of orthotic and prosthetic devices and | 34 |
| durable medical equipment. Such
rules shall provide, but not be | 35 |
| limited to, the following services: (1)
immediate repair or | 36 |
| replacement of such devices by recipients without
medical |
|
|
|
HB3596 Engrossed |
- 16 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| authorization; and (2) rental, lease, purchase or | 2 |
| lease-purchase of
durable medical equipment in a | 3 |
| cost-effective manner, taking into
consideration the | 4 |
| recipient's medical prognosis, the extent of the
recipient's | 5 |
| needs, and the requirements and costs for maintaining such
| 6 |
| equipment. Such rules shall enable a recipient to temporarily | 7 |
| acquire and
use alternative or substitute devices or equipment | 8 |
| pending repairs or
replacements of any device or equipment | 9 |
| previously authorized for such
recipient by the Department.
| 10 |
| The Department shall execute, relative to the nursing home | 11 |
| prescreening
project, written inter-agency agreements with the | 12 |
| Department of Human
Services and the Department on Aging, to | 13 |
| effect the following: (i) intake
procedures and common | 14 |
| eligibility criteria for those persons who are receiving
| 15 |
| non-institutional services; and (ii) the establishment and | 16 |
| development of
non-institutional services in areas of the State | 17 |
| where they are not currently
available or are undeveloped.
| 18 |
| The Illinois Department shall develop and operate, in | 19 |
| cooperation
with other State Departments and agencies and in | 20 |
| compliance with
applicable federal laws and regulations, | 21 |
| appropriate and effective
systems of health care evaluation and | 22 |
| programs for monitoring of
utilization of health care services | 23 |
| and facilities, as it affects
persons eligible for medical | 24 |
| assistance under this Code.
| 25 |
| The Illinois Department shall report annually to the | 26 |
| General Assembly,
no later than the second Friday in April of | 27 |
| 1979 and each year
thereafter, in regard to:
| 28 |
| (a) actual statistics and trends in utilization of | 29 |
| medical services by
public aid recipients;
| 30 |
| (b) actual statistics and trends in the provision of | 31 |
| the various medical
services by medical vendors;
| 32 |
| (c) current rate structures and proposed changes in | 33 |
| those rate structures
for the various medical vendors; and
| 34 |
| (d) efforts at utilization review and control by the | 35 |
| Illinois Department.
| 36 |
| The period covered by each report shall be the 3 years |
|
|
|
HB3596 Engrossed |
- 17 - |
LRB094 05070 DRJ 35106 b |
|
| 1 |
| ending on the June
30 prior to the report. The report shall | 2 |
| include suggested legislation
for consideration by the General | 3 |
| Assembly. The filing of one copy of the
report with the | 4 |
| Speaker, one copy with the Minority Leader and one copy
with | 5 |
| the Clerk of the House of Representatives, one copy with the | 6 |
| President,
one copy with the Minority Leader and one copy with | 7 |
| the Secretary of the
Senate, one copy with the Legislative | 8 |
| Research Unit, and such additional
copies
with the State | 9 |
| Government Report Distribution Center for the General
Assembly | 10 |
| as is required under paragraph (t) of Section 7 of the State
| 11 |
| Library Act shall be deemed sufficient to comply with this | 12 |
| Section.
| 13 |
| (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02; | 14 |
| 92-789, eff. 8-6-02; 93-632, eff. 2-1-04; 93-841, eff. 7-30-04; | 15 |
| 93-981, eff. 8-23-04; revised 10-22-04.)
| 16 |
| Section 99. Effective date. This Act takes effect upon | 17 |
| becoming law.
|
|