Illinois General Assembly - Full Text of SB0935
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Full Text of SB0935  95th General Assembly

SB0935enr 95TH GENERAL ASSEMBLY



 


 
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1     AN ACT concerning health.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The State Employees Group Insurance Act of 1971
5 is amended by changing Section 6.11 as follows:
 
6     (5 ILCS 375/6.11)
7     Sec. 6.11. Required health benefits; Illinois Insurance
8 Code requirements. The program of health benefits shall provide
9 the post-mastectomy care benefits required to be covered by a
10 policy of accident and health insurance under Section 356t of
11 the Illinois Insurance Code. The program of health benefits
12 shall provide the coverage required under Sections 356u, 356w,
13 356x, 356z.2, 356z.4, and 356z.6, and 356z.9 of the Illinois
14 Insurance Code. The program of health benefits must comply with
15 Section 155.37 of the Illinois Insurance Code.
16 (Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03;
17 93-102, eff. 1-1-04; 93-853, eff. 1-1-05.)
 
18     Section 10. The Counties Code is amended by changing
19 Section 5-1069.3 as follows:
 
20     (55 ILCS 5/5-1069.3)
21     Sec. 5-1069.3. Required health benefits. If a county,

 

 

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1 including a home rule county, is a self-insurer for purposes of
2 providing health insurance coverage for its employees, the
3 coverage shall include coverage for the post-mastectomy care
4 benefits required to be covered by a policy of accident and
5 health insurance under Section 356t and the coverage required
6 under Sections 356u, 356w, 356x, and 356z.6, and 356z.9 of the
7 Illinois Insurance Code. The requirement that health benefits
8 be covered as provided in this Section is an exclusive power
9 and function of the State and is a denial and limitation under
10 Article VII, Section 6, subsection (h) of the Illinois
11 Constitution. A home rule county to which this Section applies
12 must comply with every provision of this Section.
13 (Source: P.A. 93-853, eff. 1-1-05.)
 
14     Section 15. The Illinois Municipal Code is amended by
15 changing Section 10-4-2.3 as follows:
 
16     (65 ILCS 5/10-4-2.3)
17     Sec. 10-4-2.3. Required health benefits. If a
18 municipality, including a home rule municipality, is a
19 self-insurer for purposes of providing health insurance
20 coverage for its employees, the coverage shall include coverage
21 for the post-mastectomy care benefits required to be covered by
22 a policy of accident and health insurance under Section 356t
23 and the coverage required under Sections 356u, 356w, 356x, and
24 356z.6, and 356z.9 of the Illinois Insurance Code. The

 

 

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1 requirement that health benefits be covered as provided in this
2 is an exclusive power and function of the State and is a denial
3 and limitation under Article VII, Section 6, subsection (h) of
4 the Illinois Constitution. A home rule municipality to which
5 this Section applies must comply with every provision of this
6 Section.
7 (Source: P.A. 93-853, eff. 1-1-05.)
 
8     Section 20. The Illinois Insurance Code is amended by
9 adding Section 356z.9 as follows:
 
10     (215 ILCS 5/356z.9 new)
11     Sec. 356z.9. Amino acid-based elemental formulas.
12     A group or individual major medical accident and health
13 insurance policy or managed care plan amended, delivered,
14 issued, or renewed after the effective date of this amendatory
15 Act of the 95th General Assembly must provide coverage and
16 reimbursement for amino acid-based elemental formulas,
17 regardless of delivery method, for the diagnosis and treatment
18 of (i) eosinophilic disorders and (ii) short bowel syndrome
19 when the prescribing physician has issued a written order
20 stating that the amino acid-based elemental formula is
21 medically necessary.
 
22     Section 25. The Health Maintenance Organization Act is
23 amended by changing Section 5-3 as follows:
 

 

 

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1     (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2     Sec. 5-3. Insurance Code provisions.
3     (a) Health Maintenance Organizations shall be subject to
4 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
5 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
6 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x,
7 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 364.01,
8 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 401,
9 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
10 paragraph (c) of subsection (2) of Section 367, and Articles
11 IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
12 the Illinois Insurance Code.
13     (b) For purposes of the Illinois Insurance Code, except for
14 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
15 Maintenance Organizations in the following categories are
16 deemed to be "domestic companies":
17         (1) a corporation authorized under the Dental Service
18     Plan Act or the Voluntary Health Services Plans Act;
19         (2) a corporation organized under the laws of this
20     State; or
21         (3) a corporation organized under the laws of another
22     state, 30% or more of the enrollees of which are residents
23     of this State, except a corporation subject to
24     substantially the same requirements in its state of
25     organization as is a "domestic company" under Article VIII

 

 

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1     1/2 of the Illinois Insurance Code.
2     (c) In considering the merger, consolidation, or other
3 acquisition of control of a Health Maintenance Organization
4 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
5         (1) the Director shall give primary consideration to
6     the continuation of benefits to enrollees and the financial
7     conditions of the acquired Health Maintenance Organization
8     after the merger, consolidation, or other acquisition of
9     control takes effect;
10         (2)(i) the criteria specified in subsection (1)(b) of
11     Section 131.8 of the Illinois Insurance Code shall not
12     apply and (ii) the Director, in making his determination
13     with respect to the merger, consolidation, or other
14     acquisition of control, need not take into account the
15     effect on competition of the merger, consolidation, or
16     other acquisition of control;
17         (3) the Director shall have the power to require the
18     following information:
19             (A) certification by an independent actuary of the
20         adequacy of the reserves of the Health Maintenance
21         Organization sought to be acquired;
22             (B) pro forma financial statements reflecting the
23         combined balance sheets of the acquiring company and
24         the Health Maintenance Organization sought to be
25         acquired as of the end of the preceding year and as of
26         a date 90 days prior to the acquisition, as well as pro

 

 

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1         forma financial statements reflecting projected
2         combined operation for a period of 2 years;
3             (C) a pro forma business plan detailing an
4         acquiring party's plans with respect to the operation
5         of the Health Maintenance Organization sought to be
6         acquired for a period of not less than 3 years; and
7             (D) such other information as the Director shall
8         require.
9     (d) The provisions of Article VIII 1/2 of the Illinois
10 Insurance Code and this Section 5-3 shall apply to the sale by
11 any health maintenance organization of greater than 10% of its
12 enrollee population (including without limitation the health
13 maintenance organization's right, title, and interest in and to
14 its health care certificates).
15     (e) In considering any management contract or service
16 agreement subject to Section 141.1 of the Illinois Insurance
17 Code, the Director (i) shall, in addition to the criteria
18 specified in Section 141.2 of the Illinois Insurance Code, take
19 into account the effect of the management contract or service
20 agreement on the continuation of benefits to enrollees and the
21 financial condition of the health maintenance organization to
22 be managed or serviced, and (ii) need not take into account the
23 effect of the management contract or service agreement on
24 competition.
25     (f) Except for small employer groups as defined in the
26 Small Employer Rating, Renewability and Portability Health

 

 

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1 Insurance Act and except for medicare supplement policies as
2 defined in Section 363 of the Illinois Insurance Code, a Health
3 Maintenance Organization may by contract agree with a group or
4 other enrollment unit to effect refunds or charge additional
5 premiums under the following terms and conditions:
6         (i) the amount of, and other terms and conditions with
7     respect to, the refund or additional premium are set forth
8     in the group or enrollment unit contract agreed in advance
9     of the period for which a refund is to be paid or
10     additional premium is to be charged (which period shall not
11     be less than one year); and
12         (ii) the amount of the refund or additional premium
13     shall not exceed 20% of the Health Maintenance
14     Organization's profitable or unprofitable experience with
15     respect to the group or other enrollment unit for the
16     period (and, for purposes of a refund or additional
17     premium, the profitable or unprofitable experience shall
18     be calculated taking into account a pro rata share of the
19     Health Maintenance Organization's administrative and
20     marketing expenses, but shall not include any refund to be
21     made or additional premium to be paid pursuant to this
22     subsection (f)). The Health Maintenance Organization and
23     the group or enrollment unit may agree that the profitable
24     or unprofitable experience may be calculated taking into
25     account the refund period and the immediately preceding 2
26     plan years.

 

 

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1     The Health Maintenance Organization shall include a
2 statement in the evidence of coverage issued to each enrollee
3 describing the possibility of a refund or additional premium,
4 and upon request of any group or enrollment unit, provide to
5 the group or enrollment unit a description of the method used
6 to calculate (1) the Health Maintenance Organization's
7 profitable experience with respect to the group or enrollment
8 unit and the resulting refund to the group or enrollment unit
9 or (2) the Health Maintenance Organization's unprofitable
10 experience with respect to the group or enrollment unit and the
11 resulting additional premium to be paid by the group or
12 enrollment unit.
13     In no event shall the Illinois Health Maintenance
14 Organization Guaranty Association be liable to pay any
15 contractual obligation of an insolvent organization to pay any
16 refund authorized under this Section.
17 (Source: P.A. 93-102, eff. 1-1-04; 93-261, eff. 1-1-04; 93-477,
18 eff. 8-8-03; 93-529, eff. 8-14-03; 93-853, eff. 1-1-05;
19 93-1000, eff. 1-1-05; 94-906, eff. 1-1-07; 94-1076, eff.
20 12-29-06; revised 1-5-07.)
 
21     Section 30. The Limited Health Service Organization Act is
22 amended by changing Section 4003 as follows:
 
23     (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
24     Sec. 4003. Illinois Insurance Code provisions. Limited

 

 

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1 health service organizations shall be subject to the provisions
2 of Sections 133, 134, 137, 140, 141.1, 141.2, 141.3, 143, 143c,
3 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6, 154.7, 154.8,
4 155.04, 155.37, 355.2, 356v, 356z.9, 368a, 401, 401.1, 402,
5 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
6 IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
7 the Illinois Insurance Code. For purposes of the Illinois
8 Insurance Code, except for Sections 444 and 444.1 and Articles
9 XIII and XIII 1/2, limited health service organizations in the
10 following categories are deemed to be domestic companies:
11         (1) a corporation under the laws of this State; or
12         (2) a corporation organized under the laws of another
13     state, 30% of more of the enrollees of which are residents
14     of this State, except a corporation subject to
15     substantially the same requirements in its state of
16     organization as is a domestic company under Article VIII
17     1/2 of the Illinois Insurance Code.
18 (Source: P.A. 91-549, eff. 8-14-99; 91-605, eff. 12-14-99;
19 91-788, eff. 6-9-00; 92-440, eff. 8-17-01.)
 
20     Section 35. The Voluntary Health Services Plans Act is
21 amended by changing Section 10 as follows:
 
22     (215 ILCS 165/10)  (from Ch. 32, par. 604)
23     Sec. 10. Application of Insurance Code provisions. Health
24 services plan corporations and all persons interested therein

 

 

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1 or dealing therewith shall be subject to the provisions of
2 Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
3 149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v, 356w, 356x,
4 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
5 364.01, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
6 and 412, and paragraphs (7) and (15) of Section 367 of the
7 Illinois Insurance Code.
8 (Source: P.A. 93-102, eff. 1-1-04; 93-529, eff. 8-14-03;
9 93-853, eff. 1-1-05; 93-1000, eff. 1-1-05; 94-1076, eff.
10 12-29-06.)
 
11     Section 40. The Illinois Public Aid Code is amended by
12 changing Section 5-5 as follows:
 
13     (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
14     Sec. 5-5. Medical services. The Illinois Department, by
15 rule, shall determine the quantity and quality of and the rate
16 of reimbursement for the medical assistance for which payment
17 will be authorized, and the medical services to be provided,
18 which may include all or part of the following: (1) inpatient
19 hospital services; (2) outpatient hospital services; (3) other
20 laboratory and X-ray services; (4) skilled nursing home
21 services; (5) physicians' services whether furnished in the
22 office, the patient's home, a hospital, a skilled nursing home,
23 or elsewhere; (6) medical care, or any other type of remedial
24 care furnished by licensed practitioners; (7) home health care

 

 

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1 services; (8) private duty nursing service; (9) clinic
2 services; (10) dental services, including prevention and
3 treatment of periodontal disease and dental caries disease for
4 pregnant women; (11) physical therapy and related services;
5 (12) prescribed drugs, dentures, and prosthetic devices; and
6 eyeglasses prescribed by a physician skilled in the diseases of
7 the eye, or by an optometrist, whichever the person may select;
8 (13) other diagnostic, screening, preventive, and
9 rehabilitative services; (14) transportation and such other
10 expenses as may be necessary; (15) medical treatment of sexual
11 assault survivors, as defined in Section 1a of the Sexual
12 Assault Survivors Emergency Treatment Act, for injuries
13 sustained as a result of the sexual assault, including
14 examinations and laboratory tests to discover evidence which
15 may be used in criminal proceedings arising from the sexual
16 assault; (16) the diagnosis and treatment of sickle cell
17 anemia; and (17) any other medical care, and any other type of
18 remedial care recognized under the laws of this State, but not
19 including abortions, or induced miscarriages or premature
20 births, unless, in the opinion of a physician, such procedures
21 are necessary for the preservation of the life of the woman
22 seeking such treatment, or except an induced premature birth
23 intended to produce a live viable child and such procedure is
24 necessary for the health of the mother or her unborn child. The
25 Illinois Department, by rule, shall prohibit any physician from
26 providing medical assistance to anyone eligible therefor under

 

 

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1 this Code where such physician has been found guilty of
2 performing an abortion procedure in a wilful and wanton manner
3 upon a woman who was not pregnant at the time such abortion
4 procedure was performed. The term "any other type of remedial
5 care" shall include nursing care and nursing home service for
6 persons who rely on treatment by spiritual means alone through
7 prayer for healing.
8     Notwithstanding any other provision of this Section, a
9 comprehensive tobacco use cessation program that includes
10 purchasing prescription drugs or prescription medical devices
11 approved by the Food and Drug administration shall be covered
12 under the medical assistance program under this Article for
13 persons who are otherwise eligible for assistance under this
14 Article.
15     Notwithstanding any other provision of this Code, the
16 Illinois Department may not require, as a condition of payment
17 for any laboratory test authorized under this Article, that a
18 physician's handwritten signature appear on the laboratory
19 test order form. The Illinois Department may, however, impose
20 other appropriate requirements regarding laboratory test order
21 documentation.
22     The Illinois Department of Healthcare and Family Services
23 Public Aid shall provide the following services to persons
24 eligible for assistance under this Article who are
25 participating in education, training or employment programs
26 operated by the Department of Human Services as successor to

 

 

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1 the Department of Public Aid:
2         (1) dental services, which shall include but not be
3     limited to prosthodontics; and
4         (2) eyeglasses prescribed by a physician skilled in the
5     diseases of the eye, or by an optometrist, whichever the
6     person may select.
7     The Illinois Department, by rule, may distinguish and
8 classify the medical services to be provided only in accordance
9 with the classes of persons designated in Section 5-2.
10     The Department of Healthcare and Family Services must
11 provide coverage and reimbursement for amino acid-based
12 elemental formulas, regardless of delivery method, for the
13 diagnosis and treatment of (i) eosinophilic disorders and (ii)
14 short bowel syndrome when the prescribing physician has issued
15 a written order stating that the amino acid-based elemental
16 formula is medically necessary.
17     The Illinois Department shall authorize the provision of,
18 and shall authorize payment for, screening by low-dose
19 mammography for the presence of occult breast cancer for women
20 35 years of age or older who are eligible for medical
21 assistance under this Article, as follows: a baseline mammogram
22 for women 35 to 39 years of age and an annual mammogram for
23 women 40 years of age or older. All screenings shall include a
24 physical breast exam, instruction on self-examination and
25 information regarding the frequency of self-examination and
26 its value as a preventative tool. As used in this Section,

 

 

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1 "low-dose mammography" means the x-ray examination of the
2 breast using equipment dedicated specifically for mammography,
3 including the x-ray tube, filter, compression device, image
4 receptor, and cassettes, with an average radiation exposure
5 delivery of less than one rad mid-breast, with 2 views for each
6 breast.
7     Any medical or health care provider shall immediately
8 recommend, to any pregnant woman who is being provided prenatal
9 services and is suspected of drug abuse or is addicted as
10 defined in the Alcoholism and Other Drug Abuse and Dependency
11 Act, referral to a local substance abuse treatment provider
12 licensed by the Department of Human Services or to a licensed
13 hospital which provides substance abuse treatment services.
14 The Department of Healthcare and Family Services Public Aid
15 shall assure coverage for the cost of treatment of the drug
16 abuse or addiction for pregnant recipients in accordance with
17 the Illinois Medicaid Program in conjunction with the
18 Department of Human Services.
19     All medical providers providing medical assistance to
20 pregnant women under this Code shall receive information from
21 the Department on the availability of services under the Drug
22 Free Families with a Future or any comparable program providing
23 case management services for addicted women, including
24 information on appropriate referrals for other social services
25 that may be needed by addicted women in addition to treatment
26 for addiction.

 

 

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1     The Illinois Department, in cooperation with the
2 Departments of Human Services (as successor to the Department
3 of Alcoholism and Substance Abuse) and Public Health, through a
4 public awareness campaign, may provide information concerning
5 treatment for alcoholism and drug abuse and addiction, prenatal
6 health care, and other pertinent programs directed at reducing
7 the number of drug-affected infants born to recipients of
8 medical assistance.
9     Neither the Illinois Department of Healthcare and Family
10 Services Public Aid nor the Department of Human Services shall
11 sanction the recipient solely on the basis of her substance
12 abuse.
13     The Illinois Department shall establish such regulations
14 governing the dispensing of health services under this Article
15 as it shall deem appropriate. The Department should seek the
16 advice of formal professional advisory committees appointed by
17 the Director of the Illinois Department for the purpose of
18 providing regular advice on policy and administrative matters,
19 information dissemination and educational activities for
20 medical and health care providers, and consistency in
21 procedures to the Illinois Department.
22     The Illinois Department may develop and contract with
23 Partnerships of medical providers to arrange medical services
24 for persons eligible under Section 5-2 of this Code.
25 Implementation of this Section may be by demonstration projects
26 in certain geographic areas. The Partnership shall be

 

 

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1 represented by a sponsor organization. The Department, by rule,
2 shall develop qualifications for sponsors of Partnerships.
3 Nothing in this Section shall be construed to require that the
4 sponsor organization be a medical organization.
5     The sponsor must negotiate formal written contracts with
6 medical providers for physician services, inpatient and
7 outpatient hospital care, home health services, treatment for
8 alcoholism and substance abuse, and other services determined
9 necessary by the Illinois Department by rule for delivery by
10 Partnerships. Physician services must include prenatal and
11 obstetrical care. The Illinois Department shall reimburse
12 medical services delivered by Partnership providers to clients
13 in target areas according to provisions of this Article and the
14 Illinois Health Finance Reform Act, except that:
15         (1) Physicians participating in a Partnership and
16     providing certain services, which shall be determined by
17     the Illinois Department, to persons in areas covered by the
18     Partnership may receive an additional surcharge for such
19     services.
20         (2) The Department may elect to consider and negotiate
21     financial incentives to encourage the development of
22     Partnerships and the efficient delivery of medical care.
23         (3) Persons receiving medical services through
24     Partnerships may receive medical and case management
25     services above the level usually offered through the
26     medical assistance program.

 

 

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1     Medical providers shall be required to meet certain
2 qualifications to participate in Partnerships to ensure the
3 delivery of high quality medical services. These
4 qualifications shall be determined by rule of the Illinois
5 Department and may be higher than qualifications for
6 participation in the medical assistance program. Partnership
7 sponsors may prescribe reasonable additional qualifications
8 for participation by medical providers, only with the prior
9 written approval of the Illinois Department.
10     Nothing in this Section shall limit the free choice of
11 practitioners, hospitals, and other providers of medical
12 services by clients. In order to ensure patient freedom of
13 choice, the Illinois Department shall immediately promulgate
14 all rules and take all other necessary actions so that provided
15 services may be accessed from therapeutically certified
16 optometrists to the full extent of the Illinois Optometric
17 Practice Act of 1987 without discriminating between service
18 providers.
19     The Department shall apply for a waiver from the United
20 States Health Care Financing Administration to allow for the
21 implementation of Partnerships under this Section.
22     The Illinois Department shall require health care
23 providers to maintain records that document the medical care
24 and services provided to recipients of Medical Assistance under
25 this Article. The Illinois Department shall require health care
26 providers to make available, when authorized by the patient, in

 

 

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1 writing, the medical records in a timely fashion to other
2 health care providers who are treating or serving persons
3 eligible for Medical Assistance under this Article. All
4 dispensers of medical services shall be required to maintain
5 and retain business and professional records sufficient to
6 fully and accurately document the nature, scope, details and
7 receipt of the health care provided to persons eligible for
8 medical assistance under this Code, in accordance with
9 regulations promulgated by the Illinois Department. The rules
10 and regulations shall require that proof of the receipt of
11 prescription drugs, dentures, prosthetic devices and
12 eyeglasses by eligible persons under this Section accompany
13 each claim for reimbursement submitted by the dispenser of such
14 medical services. No such claims for reimbursement shall be
15 approved for payment by the Illinois Department without such
16 proof of receipt, unless the Illinois Department shall have put
17 into effect and shall be operating a system of post-payment
18 audit and review which shall, on a sampling basis, be deemed
19 adequate by the Illinois Department to assure that such drugs,
20 dentures, prosthetic devices and eyeglasses for which payment
21 is being made are actually being received by eligible
22 recipients. Within 90 days after the effective date of this
23 amendatory Act of 1984, the Illinois Department shall establish
24 a current list of acquisition costs for all prosthetic devices
25 and any other items recognized as medical equipment and
26 supplies reimbursable under this Article and shall update such

 

 

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1 list on a quarterly basis, except that the acquisition costs of
2 all prescription drugs shall be updated no less frequently than
3 every 30 days as required by Section 5-5.12.
4     The rules and regulations of the Illinois Department shall
5 require that a written statement including the required opinion
6 of a physician shall accompany any claim for reimbursement for
7 abortions, or induced miscarriages or premature births. This
8 statement shall indicate what procedures were used in providing
9 such medical services.
10     The Illinois Department shall require all dispensers of
11 medical services, other than an individual practitioner or
12 group of practitioners, desiring to participate in the Medical
13 Assistance program established under this Article to disclose
14 all financial, beneficial, ownership, equity, surety or other
15 interests in any and all firms, corporations, partnerships,
16 associations, business enterprises, joint ventures, agencies,
17 institutions or other legal entities providing any form of
18 health care services in this State under this Article.
19     The Illinois Department may require that all dispensers of
20 medical services desiring to participate in the medical
21 assistance program established under this Article disclose,
22 under such terms and conditions as the Illinois Department may
23 by rule establish, all inquiries from clients and attorneys
24 regarding medical bills paid by the Illinois Department, which
25 inquiries could indicate potential existence of claims or liens
26 for the Illinois Department.

 

 

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1     Enrollment of a vendor that provides non-emergency medical
2 transportation, defined by the Department by rule, shall be
3 conditional for 180 days. During that time, the Department of
4 Healthcare and Family Services Public Aid may terminate the
5 vendor's eligibility to participate in the medical assistance
6 program without cause. That termination of eligibility is not
7 subject to the Department's hearing process.
8     The Illinois Department shall establish policies,
9 procedures, standards and criteria by rule for the acquisition,
10 repair and replacement of orthotic and prosthetic devices and
11 durable medical equipment. Such rules shall provide, but not be
12 limited to, the following services: (1) immediate repair or
13 replacement of such devices by recipients without medical
14 authorization; and (2) rental, lease, purchase or
15 lease-purchase of durable medical equipment in a
16 cost-effective manner, taking into consideration the
17 recipient's medical prognosis, the extent of the recipient's
18 needs, and the requirements and costs for maintaining such
19 equipment. Such rules shall enable a recipient to temporarily
20 acquire and use alternative or substitute devices or equipment
21 pending repairs or replacements of any device or equipment
22 previously authorized for such recipient by the Department.
23     The Department shall execute, relative to the nursing home
24 prescreening project, written inter-agency agreements with the
25 Department of Human Services and the Department on Aging, to
26 effect the following: (i) intake procedures and common

 

 

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1 eligibility criteria for those persons who are receiving
2 non-institutional services; and (ii) the establishment and
3 development of non-institutional services in areas of the State
4 where they are not currently available or are undeveloped.
5     The Illinois Department shall develop and operate, in
6 cooperation with other State Departments and agencies and in
7 compliance with applicable federal laws and regulations,
8 appropriate and effective systems of health care evaluation and
9 programs for monitoring of utilization of health care services
10 and facilities, as it affects persons eligible for medical
11 assistance under this Code.
12     The Illinois Department shall report annually to the
13 General Assembly, no later than the second Friday in April of
14 1979 and each year thereafter, in regard to:
15         (a) actual statistics and trends in utilization of
16     medical services by public aid recipients;
17         (b) actual statistics and trends in the provision of
18     the various medical services by medical vendors;
19         (c) current rate structures and proposed changes in
20     those rate structures for the various medical vendors; and
21         (d) efforts at utilization review and control by the
22     Illinois Department.
23     The period covered by each report shall be the 3 years
24 ending on the June 30 prior to the report. The report shall
25 include suggested legislation for consideration by the General
26 Assembly. The filing of one copy of the report with the

 

 

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1 Speaker, one copy with the Minority Leader and one copy with
2 the Clerk of the House of Representatives, one copy with the
3 President, one copy with the Minority Leader and one copy with
4 the Secretary of the Senate, one copy with the Legislative
5 Research Unit, and such additional copies with the State
6 Government Report Distribution Center for the General Assembly
7 as is required under paragraph (t) of Section 7 of the State
8 Library Act shall be deemed sufficient to comply with this
9 Section.
10 (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02;
11 92-789, eff. 8-6-02; 93-632, eff. 2-1-04; 93-841, eff. 7-30-04;
12 93-981, eff. 8-23-04; revised 12-15-05.)
 
13     Section 99. Effective date. This Act takes effect upon
14 becoming law.