Full Text of HB0974 99th General Assembly
HB0974 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB0974 Introduced , by Rep. Michael J. Madigan SYNOPSIS AS INTRODUCED: |
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305 ILCS 5/5-4.2 | from Ch. 23, par. 5-4.2 |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning ambulance services payments.
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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 5-4.2 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
the | 10 | | Illinois Department shall reimburse ambulance service
| 11 | | providers at rates calculated in accordance with this Section. | 12 | | It is the 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 filed by December 15, 2012 and | 24 | | shall provide that, for any decision rendered by the Department | 25 | | or its agent on or after the date the rule takes effect, the | 26 | | ground ambulance service provider shall have 60 days from the |
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| 1 | | date the decision is received to file an appeal. The rule | 2 | | established by the Department shall be, insofar as is | 3 | | practical, consistent with the Illinois Administrative | 4 | | Procedure Act. The Director's decision on an appeal under this | 5 | | Section shall be a final administrative decision subject to | 6 | | review under the Administrative Review Law. | 7 | | (f-5) Beginning 90 days after July 20, 2012 (the effective | 8 | | date of Public Act 97-842), (i) no denial of a request for | 9 | | approval for payment of non-emergency transportation by means | 10 | | of ground ambulance service, and (ii) no approval of | 11 | | non-emergency transportation by means of ground ambulance | 12 | | service at a level of service that entitles the ground | 13 | | ambulance service provider to a lower level of compensation | 14 | | from the Department than would have been received at the level | 15 | | of service submitted by the ground ambulance service provider, | 16 | | may be issued by the Department or its agent unless the | 17 | | Department has submitted the criteria for determining the | 18 | | appropriateness of the transport for first notice publication | 19 | | in the Illinois Register pursuant to Section 5-40 of the | 20 | | Illinois Administrative Procedure Act. | 21 | | (g) Whenever a patient covered by a medical assistance | 22 | | program under this Code or by another medical program | 23 | | administered by the Department is being discharged from a | 24 | | facility, a physician discharge order as described in this | 25 | | Section shall be required for each patient whose discharge | 26 | | requires medically supervised ground ambulance services. |
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| 1 | | Facilities shall develop procedures for a physician with | 2 | | medical staff privileges to provide a written and signed | 3 | | physician discharge order. The physician discharge order shall | 4 | | specify the level of ground ambulance services needed and | 5 | | complete a medical certification establishing the criteria for | 6 | | approval of non-emergency ambulance transportation, as | 7 | | published by the Department of Healthcare and Family Services, | 8 | | that is met by the patient. This order and the medical | 9 | | certification shall be completed prior to ordering an ambulance | 10 | | service and prior to patient discharge. | 11 | | Pursuant to subsection (E) of Section 12-4.25 of this Code, | 12 | | the Department is entitled to recover overpayments paid to a | 13 | | provider or vendor, including, but not limited to, from the | 14 | | discharging physician, the discharging facility, and the | 15 | | ground ambulance service provider, in instances where a | 16 | | non-emergency ground ambulance service is rendered as the | 17 | | result of improper or false certification. | 18 | | (h) On and after July 1, 2012, the Department shall reduce | 19 | | any rate of reimbursement for services or other payments or | 20 | | alter any methodologies authorized by this Code to reduce any | 21 | | rate of reimbursement for services or other payments in | 22 | | accordance with Section 5-5e. | 23 | | (Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12; | 24 | | 97-842, eff. 7-20-12; 98-463, eff. 8-16-13.)
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