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90_SB0882 305 ILCS 5/5-5 from Ch. 23, par. 5-5 Amends the Medicaid Article of the Public Aid Code. Makes stylistic changes in a Section concerning requirement that the Department of Public Aid provide certain medical services for persons participating in education, training, or employment programs. LRB9003202DJmg LRB9003202DJmg 1 AN ACT to amend the Illinois Public Aid Code by changing 2 Section 5-5. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Illinois Public Aid Code is amended by 6 changing Section 5-5 as follows: 7 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5) 8 (Text of Section before amendment by P.A. 89-507) 9 Sec. 5-5. Medical services. The Illinois Department, by 10 rule, shall determine the quantity and quality of and the 11 rate of reimbursement for the medical assistance for which 12 payment will be authorized, and the medical services to be 13 provided, which may include all or part of the following: (1) 14 inpatient hospital services; (2) outpatient hospital 15 services; (3) other laboratory and X-ray services; (4) 16 skilled nursing home services; (5) physicians' services 17 whether furnished in the office, the patient's home, a 18 hospital, a skilled nursing home, or elsewhere; (6) medical 19 care, or any other type of remedial care furnished by 20 licensed practitioners; (7) home health care services; (8) 21 private duty nursing service; (9) clinic services; (10) 22 dental services; (11) physical therapy and related services; 23 (12) prescribed drugs, dentures, and prosthetic devices; and 24 eyeglasses prescribed by a physician skilled in the diseases 25 of the eye, or by an optometrist, whichever the person may 26 select; (13) other diagnostic, screening, preventive, and 27 rehabilitative services; (14) transportation and such other 28 expenses as may be necessary; (15) medical treatment of 29 sexual assault survivors, as defined in Section 1a of the 30 Sexual Assault Survivors Emergency Treatment Act, for 31 injuries sustained as a result of the sexual assault, -2- LRB9003202DJmg 1 including examinations and laboratory tests to discover 2 evidence which may be used in criminal proceedings arising 3 from the sexual assault; (16) the diagnosis and treatment of 4 sickle cell anemia; and (17) any other medical care, and any 5 other type of remedial care recognized under the laws of this 6 State, but not including abortions, or induced miscarriages 7 or premature births, unless, in the opinion of a physician, 8 such procedures are necessary for the preservation of the 9 life of the woman seeking such treatment, or except an 10 induced premature birth intended to produce a live viable 11 child and such procedure is necessary for the health of the 12 mother or her unborn child. The Illinois Department, by rule, 13 shall prohibit any physician from providing medical 14 assistance to anyone eligible therefor under this Code where 15 such physician has been found guilty of performing an 16 abortion procedure in a wilful and wanton manner upon a woman 17 who was not pregnant at the time such abortion procedure was 18 performed. The term "any other type of remedial care" shall 19 include nursing care and nursing home service for persons who 20 rely on treatment by spiritual means alone through prayer for 21 healing. 22 The Illinois Department shall provide the following 23 services to persons who are eligible for assistance under 24 this Article and who are participating in education, training 25 or employment programs: 26 (1) dental services, which shall include but not be 27 limited to prosthodontics; and 28 (2) eyeglasses prescribed by a physician skilled in 29 the diseases of the eye, or by an optometrist, whichever 30 the person may select. 31 The Illinois Department, by rule, may distinguish and 32 classify the medical services to be provided only in 33 accordance with the classes of persons designated in Section 34 5-2. -3- LRB9003202DJmg 1 The Illinois Department shall authorize the provision of, 2 and shall authorize payment for, screening by low-dose 3 mammography for the presence of occult breast cancer for 4 women 35 years of age or older who are eligible for medical 5 assistance under this Article, as follows: a baseline 6 mammogram for women 35 to 39 years of age; a mammogram every 7 1 to 2 years, even if no symptoms are present, for women 40 8 to 49 years of age; and an annual mammogram for women 50 9 years of age or older. All screenings shall include a 10 physical breast exam, instruction on self-examination and 11 information regarding the frequency of self-examination and 12 its value as a preventative tool. As used in this Section, 13 "low-dose mammography" means the x-ray examination of the 14 breast using equipment dedicated specifically for 15 mammography, including the x-ray tube, filter, compression 16 device, image receptor, and cassettes, with an average 17 radiation exposure delivery of less than one rad mid-breast, 18 with 2 views for each breast. 19 Any medical or health care provider shall immediately 20 recommend, to any pregnant woman who is being provided 21 prenatal services and is suspected of drug abuse or is 22 addicted as defined in the Alcoholism and Other Drug Abuse 23 and Dependency Act, referral to a local substance abuse 24 treatment provider licensed by the Department of Alcoholism 25 and Substance Abuse or to a licensed hospital which provides 26 substance abuse treatment services. The Department of Public 27 Aid shall assure coverage for the cost of treatment of the 28 drug abuse or addiction for pregnant recipients in accordance 29 with the Illinois Medicaid Program in conjunction with the 30 Department of Alcoholism and Substance Abuse. 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 -4- LRB9003202DJmg 1 providing case management services for addicted women, 2 including information on appropriate referrals for other 3 social services that may be needed by addicted women in 4 addition to treatment for addiction. 5 The Illinois Department, in cooperation with the 6 Departments of Alcoholism and Substance Abuse and Public 7 Health, through a public awareness campaign, may provide 8 information concerning treatment for alcoholism and drug 9 abuse and addiction, prenatal health care, and other 10 pertinent programs directed at reducing the number of 11 drug-affected infants born to recipients of medical 12 assistance. 13 The Department shall not sanction the recipient solely on 14 the basis of her substance abuse. 15 The Illinois Department shall establish such regulations 16 governing the dispensing of health services under this 17 Article as it shall deem appropriate. In formulating these 18 regulations the Illinois Department shall consult with and 19 give substantial weight to the recommendations offered by the 20 Citizens Assembly/Council on Public Aid. The Department 21 should seek the advice of formal professional advisory 22 committees appointed by the Director of the Illinois 23 Department for the purpose of providing regular advice on 24 policy and administrative matters, information dissemination 25 and educational activities for medical and health care 26 providers, and consistency in procedures to the Illinois 27 Department. 28 The Illinois Department may develop and contract with 29 Partnerships of medical providers to arrange medical services 30 for persons eligible under Section 5-2 of this Code. 31 Implementation of this Section may be by demonstration 32 projects in certain geographic areas. The Partnership shall 33 be represented by a sponsor organization. The Department, by 34 rule, shall develop qualifications for sponsors of -5- LRB9003202DJmg 1 Partnerships. Nothing in this Section shall be construed to 2 require that the sponsor organization be a medical 3 organization. 4 The sponsor must negotiate formal written contracts with 5 medical providers for physician services, inpatient and 6 outpatient hospital care, home health services, treatment for 7 alcoholism and substance abuse, and other services determined 8 necessary by the Illinois Department by rule for delivery by 9 Partnerships. Physician services must include prenatal and 10 obstetrical care. The Illinois Department shall reimburse 11 medical services delivered by Partnership providers to 12 clients in target areas according to provisions of this 13 Article and the Illinois Health Finance Reform Act, except 14 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 18 the Partnership may receive an additional surcharge for 19 such services. 20 (2) The Department may elect to consider and 21 negotiate financial incentives to encourage the 22 development of Partnerships and the efficient delivery of 23 medical care. 24 (3) Persons receiving medical services through 25 Partnerships may receive medical and case management 26 services above the level usually offered through the 27 medical assistance program. 28 Medical providers shall be required to meet certain 29 qualifications to participate in Partnerships to ensure the 30 delivery of high quality medical services. These 31 qualifications shall be determined by rule of the Illinois 32 Department and may be higher than qualifications for 33 participation in the medical assistance program. Partnership 34 sponsors may prescribe reasonable additional qualifications -6- LRB9003202DJmg 1 for participation by medical providers, only with the prior 2 written approval of the Illinois Department. 3 Nothing in this Section shall limit the free choice of 4 practitioners, hospitals, and other providers of medical 5 services by clients. 6 The Department shall apply for a waiver from the United 7 States Health Care Financing Administration to allow for the 8 implementation of Partnerships under this Section. 9 The Illinois Department shall require health care 10 providers to maintain records that document the medical care 11 and services provided to recipients of Medical Assistance 12 under this Article. The Illinois Department shall require 13 health care providers to make available, when authorized by 14 the patient, in writing, the medical records in a timely 15 fashion to other health care providers who are treating or 16 serving persons eligible for Medical Assistance under this 17 Article. All dispensers of medical services shall be 18 required to maintain and retain business and professional 19 records sufficient to fully and accurately document the 20 nature, scope, details and receipt of the health care 21 provided to persons eligible for medical assistance under 22 this Code, in accordance with regulations promulgated by the 23 Illinois Department. The rules and regulations shall require 24 that proof of the receipt of prescription drugs, dentures, 25 prosthetic devices and eyeglasses by eligible persons under 26 this Section accompany each claim for reimbursement submitted 27 by the dispenser of such medical services. No such claims for 28 reimbursement shall be approved for payment by the Illinois 29 Department without such proof of receipt, unless the Illinois 30 Department shall have put into effect and shall be operating 31 a system of post-payment audit and review which shall, on a 32 sampling basis, be deemed adequate by the Illinois Department 33 to assure that such drugs, dentures, prosthetic devices and 34 eyeglasses for which payment is being made are actually being -7- LRB9003202DJmg 1 received by eligible recipients. Within 90 days after the 2 effective date of this amendatory Act of 1984, the Illinois 3 Department shall establish a current list of acquisition 4 costs for all prosthetic devices and any other items 5 recognized as medical equipment and supplies reimbursable 6 under this Article and shall update such list on a quarterly 7 basis, except that the acquisition costs of all prescription 8 drugs shall be updated no less frequently than every 30 days 9 as required by Section 5-5.12. 10 The rules and regulations of the Illinois Department 11 shall require that a written statement including the required 12 opinion of a physician shall accompany any claim for 13 reimbursement for abortions, or induced miscarriages or 14 premature births. This statement shall indicate what 15 procedures were used in providing such medical services. 16 The Illinois Department shall require that all dispensers 17 of medical services, other than an individual practitioner or 18 group of practitioners, desiring to participate in the 19 Medical Assistance program established under this Article to 20 disclose all financial, beneficial, ownership, equity, surety 21 or other interests in any and all firms, corporations, 22 partnerships, associations, business enterprises, joint 23 ventures, agencies, institutions or other legal entities 24 providing any form of health care services in this State 25 under this Article. 26 The Illinois Department may require that all dispensers 27 of medical services desiring to participate in the medical 28 assistance program established under this Article disclose, 29 under such terms and conditions as the Illinois Department 30 may by rule establish, all inquiries from clients and 31 attorneys regarding medical bills paid by the Illinois 32 Department, which inquiries could indicate potential 33 existence of claims or liens for the Illinois Department. 34 The Illinois Department shall establish policies, -8- LRB9003202DJmg 1 procedures, standards and criteria by rule for the 2 acquisition, repair and replacement of orthotic and 3 prosthetic devices and durable medical equipment. Such rules 4 shall provide, but not be limited to, the following services: 5 (1) immediate repair or replacement of such devices by 6 recipients without medical authorization; and (2) rental, 7 lease, purchase or lease-purchase of durable medical 8 equipment in a cost-effective manner, taking into 9 consideration the recipient's medical prognosis, the extent 10 of the recipient's needs, and the requirements and costs for 11 maintaining such equipment. Such rules shall enable a 12 recipient to temporarily acquire and use alternative or 13 substitute devices or equipment pending repairs or 14 replacements of any device or equipment previously authorized 15 for such recipient by the Department. Rules under clause (2) 16 above shall not provide for purchase or lease-purchase of 17 durable medical equipment or supplies used for the purpose of 18 oxygen delivery and respiratory care. 19 The Department shall execute, relative to the nursing 20 home prescreening project, written inter-agency agreements 21 with the Department of Rehabilitation Services and the 22 Department on Aging, to effect the following: (i) intake 23 procedures and common eligibility criteria for those persons 24 who are receiving non-institutional services; and (ii) the 25 establishment and development of non-institutional services 26 in areas of the State where they are not currently available 27 or are undeveloped. 28 The Illinois Department shall develop and operate, in 29 cooperation with other State Departments and agencies and in 30 compliance with applicable federal laws and regulations, 31 appropriate and effective systems of health care evaluation 32 and programs for monitoring of utilization of health care 33 services and facilities, as it affects persons eligible for 34 medical assistance under this Code. The Illinois Department -9- LRB9003202DJmg 1 shall report regularly the results of the operation of such 2 systems and programs to the Citizens Assembly/Council on 3 Public Aid to enable the Committee to ensure, from time to 4 time, that these programs are effective and meaningful. 5 The Illinois Department shall report annually to the 6 General Assembly, no later than the second Friday in April of 7 1979 and each year thereafter, in regard to: 8 (a) actual statistics and trends in utilization of 9 medical services by public aid recipients; 10 (b) actual statistics and trends in the provision 11 of the various medical services by medical vendors; 12 (c) current rate structures and proposed changes in 13 those rate structures for the various medical vendors; 14 and 15 (d) efforts at utilization review and control by 16 the Illinois Department. 17 The period covered by each report shall be the 3 years 18 ending on the June 30 prior to the report. The report shall 19 include suggested legislation for consideration by the 20 General Assembly. The filing of one copy of the report with 21 the Speaker, one copy with the Minority Leader and one copy 22 with the Clerk of the House of Representatives, one copy with 23 the President, one copy with the Minority Leader and one copy 24 with the Secretary of the Senate, one copy with the 25 Legislative Research Unit, such additional copies with the 26 State Government Report Distribution Center for the General 27 Assembly as is required under paragraph (t) of Section 7 of 28 the State Library Act and one copy with the Citizens 29 Assembly/Council on Public Aid or its successor shall be 30 deemed sufficient to comply with this Section. 31 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95; 32 89-517, eff. 1-1-97.) 33 (Text of Section after amendment by P.A. 89-507) 34 Sec. 5-5. Medical services. The Illinois Department, by -10- LRB9003202DJmg 1 rule, shall determine the quantity and quality of and the 2 rate of reimbursement for the medical assistance for which 3 payment will be authorized, and the medical services to be 4 provided, which may include all or part of the following: (1) 5 inpatient hospital services; (2) outpatient hospital 6 services; (3) other laboratory and X-ray services; (4) 7 skilled nursing home services; (5) physicians' services 8 whether furnished in the office, the patient's home, a 9 hospital, a skilled nursing home, or elsewhere; (6) medical 10 care, or any other type of remedial care furnished by 11 licensed practitioners; (7) home health care services; (8) 12 private duty nursing service; (9) clinic services; (10) 13 dental services; (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 16 of the eye, or by an optometrist, whichever the person may 17 select; (13) other diagnostic, screening, preventive, and 18 rehabilitative services; (14) transportation and such other 19 expenses as may be necessary; (15) medical treatment of 20 sexual assault survivors, as defined in Section 1a of the 21 Sexual Assault Survivors Emergency Treatment Act, for 22 injuries sustained as a result of the sexual assault, 23 including examinations and laboratory tests to discover 24 evidence which may be used in criminal proceedings arising 25 from the sexual assault; (16) the diagnosis and treatment of 26 sickle cell anemia; and (17) any other medical care, and any 27 other type of remedial care recognized under the laws of this 28 State, but not including abortions, or induced miscarriages 29 or premature births, unless, in the opinion of a physician, 30 such procedures are necessary for the preservation of the 31 life of the woman seeking such treatment, or except an 32 induced premature birth intended to produce a live viable 33 child and such procedure is necessary for the health of the 34 mother or her unborn child. The Illinois Department, by rule, -11- LRB9003202DJmg 1 shall prohibit any physician from providing medical 2 assistance to anyone eligible therefor under this Code where 3 such physician has been found guilty of performing an 4 abortion procedure in a wilful and wanton manner upon a woman 5 who was not pregnant at the time such abortion procedure was 6 performed. The term "any other type of remedial care" shall 7 include nursing care and nursing home service for persons who 8 rely on treatment by spiritual means alone through prayer for 9 healing. 10 The Illinois Department of Public Aid shall provide the 11 following services to persons who are eligible for assistance 12 under this Article and who are participating in education, 13 training or employment programs operated by the Department of 14 Human Services as successor to the Department of Public Aid: 15 (1) dental services, which shall include but not be 16 limited to prosthodontics; and 17 (2) eyeglasses prescribed by a physician skilled in 18 the diseases of the eye, or by an optometrist, whichever 19 the person may select. 20 The Illinois Department, by rule, may distinguish and 21 classify the medical services to be provided only in 22 accordance with the classes of persons designated in Section 23 5-2. 24 The Illinois Department shall authorize the provision of, 25 and shall authorize payment for, screening by low-dose 26 mammography for the presence of occult breast cancer for 27 women 35 years of age or older who are eligible for medical 28 assistance under this Article, as follows: a baseline 29 mammogram for women 35 to 39 years of age; a mammogram every 30 1 to 2 years, even if no symptoms are present, for women 40 31 to 49 years of age; and an annual mammogram for women 50 32 years of age or older. All screenings shall include a 33 physical breast exam, instruction on self-examination and 34 information regarding the frequency of self-examination and -12- LRB9003202DJmg 1 its value as a preventative tool. As used in this Section, 2 "low-dose mammography" means the x-ray examination of the 3 breast using equipment dedicated specifically for 4 mammography, including the x-ray tube, filter, compression 5 device, image receptor, and cassettes, with an average 6 radiation exposure delivery of less than one rad mid-breast, 7 with 2 views for each breast. 8 Any medical or health care provider shall immediately 9 recommend, to any pregnant woman who is being provided 10 prenatal services and is suspected of drug abuse or is 11 addicted as defined in the Alcoholism and Other Drug Abuse 12 and Dependency Act, referral to a local substance abuse 13 treatment provider licensed by the Department of Human 14 Services or to a licensed hospital which provides substance 15 abuse treatment services. The Department of Public Aid shall 16 assure coverage for the cost of treatment of the drug abuse 17 or addiction for pregnant recipients in accordance with the 18 Illinois Medicaid Program in conjunction with the Department 19 of Human Services. 20 All medical providers providing medical assistance to 21 pregnant women under this Code shall receive information from 22 the Department on the availability of services under the Drug 23 Free Families with a Future or any comparable program 24 providing case management services for addicted women, 25 including information on appropriate referrals for other 26 social services that may be needed by addicted women in 27 addition to treatment for addiction. 28 The Illinois Department, in cooperation with the 29 Departments of Human Services (as successor to the Department 30 of Alcoholism and Substance Abuse) and Public Health, through 31 a public awareness campaign, may provide information 32 concerning treatment for alcoholism and drug abuse and 33 addiction, prenatal health care, and other pertinent programs 34 directed at reducing the number of drug-affected infants born -13- LRB9003202DJmg 1 to recipients of medical assistance. 2 Neither the Illinois Department of Public Aid nor the 3 Department of Human Services shall sanction the recipient 4 solely on the basis of her substance abuse. 5 The Illinois Department shall establish such regulations 6 governing the dispensing of health services under this 7 Article as it shall deem appropriate. In formulating these 8 regulations the Illinois Department shall consult with and 9 give substantial weight to the recommendations offered by the 10 Citizens Assembly/Council on Public Aid. The Department 11 should seek the advice of formal professional advisory 12 committees appointed by the Director of the Illinois 13 Department for the purpose of providing regular advice on 14 policy and administrative matters, information dissemination 15 and educational activities for medical and health care 16 providers, and consistency in procedures to the Illinois 17 Department. 18 The Illinois Department may develop and contract with 19 Partnerships of medical providers to arrange medical services 20 for persons eligible under Section 5-2 of this Code. 21 Implementation of this Section may be by demonstration 22 projects in certain geographic areas. The Partnership shall 23 be represented by a sponsor organization. The Department, by 24 rule, shall develop qualifications for sponsors of 25 Partnerships. Nothing in this Section shall be construed to 26 require that the sponsor organization be a medical 27 organization. 28 The sponsor must negotiate formal written contracts with 29 medical providers for physician services, inpatient and 30 outpatient hospital care, home health services, treatment for 31 alcoholism and substance abuse, and other services determined 32 necessary by the Illinois Department by rule for delivery by 33 Partnerships. Physician services must include prenatal and 34 obstetrical care. The Illinois Department shall reimburse -14- LRB9003202DJmg 1 medical services delivered by Partnership providers to 2 clients in target areas according to provisions of this 3 Article and the Illinois Health Finance Reform Act, except 4 that: 5 (1) Physicians participating in a Partnership and 6 providing certain services, which shall be determined by 7 the Illinois Department, to persons in areas covered by 8 the Partnership may receive an additional surcharge for 9 such services. 10 (2) The Department may elect to consider and 11 negotiate financial incentives to encourage the 12 development of Partnerships and the efficient delivery of 13 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. 30 The Department shall apply for a waiver from the United 31 States Health Care Financing Administration to allow for the 32 implementation of Partnerships under this Section. 33 The Illinois Department shall require health care 34 providers to maintain records that document the medical care -15- LRB9003202DJmg 1 and services provided to recipients of Medical Assistance 2 under this Article. The Illinois Department shall require 3 health care providers to make available, when authorized by 4 the patient, in writing, the medical records in a timely 5 fashion to other health care providers who are treating or 6 serving persons eligible for Medical Assistance under this 7 Article. All dispensers of medical services shall be 8 required to maintain and retain business and professional 9 records sufficient to fully and accurately document the 10 nature, scope, details and receipt of the health care 11 provided to persons eligible for medical assistance under 12 this Code, in accordance with regulations promulgated by the 13 Illinois Department. The rules and regulations shall require 14 that proof of the receipt of prescription drugs, dentures, 15 prosthetic devices and eyeglasses by eligible persons under 16 this Section accompany each claim for reimbursement submitted 17 by the dispenser of such medical services. No such claims for 18 reimbursement shall be approved for payment by the Illinois 19 Department without such proof of receipt, unless the Illinois 20 Department shall have put into effect and shall be operating 21 a system of post-payment audit and review which shall, on a 22 sampling basis, be deemed adequate by the Illinois Department 23 to assure that such drugs, dentures, prosthetic devices and 24 eyeglasses for which payment is being made are actually being 25 received by eligible recipients. Within 90 days after the 26 effective date of this amendatory Act of 1984, the Illinois 27 Department shall establish a current list of acquisition 28 costs for all prosthetic devices and any other items 29 recognized as medical equipment and supplies reimbursable 30 under this Article and shall update such list on a quarterly 31 basis, except that the acquisition costs of all prescription 32 drugs shall be updated no less frequently than every 30 days 33 as required by Section 5-5.12. 34 The rules and regulations of the Illinois Department -16- LRB9003202DJmg 1 shall require that a written statement including the required 2 opinion of a physician shall accompany any claim for 3 reimbursement for abortions, or induced miscarriages or 4 premature births. This statement shall indicate what 5 procedures were used in providing such medical services. 6 The Illinois Department shall require that all dispensers 7 of medical services, other than an individual practitioner or 8 group of practitioners, desiring to participate in the 9 Medical Assistance program established under this Article to 10 disclose all financial, beneficial, ownership, equity, surety 11 or other interests in any and all firms, corporations, 12 partnerships, associations, business enterprises, joint 13 ventures, agencies, institutions or other legal entities 14 providing any form of health care services in this State 15 under this Article. 16 The Illinois Department may require that all dispensers 17 of 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 20 may by rule establish, all inquiries from clients and 21 attorneys regarding medical bills paid by the Illinois 22 Department, which inquiries could indicate potential 23 existence of claims or liens for the Illinois Department. 24 The Illinois Department shall establish policies, 25 procedures, standards and criteria by rule for the 26 acquisition, repair and replacement of orthotic and 27 prosthetic devices and durable medical equipment. Such rules 28 shall provide, but not be limited to, the following services: 29 (1) immediate repair or replacement of such devices by 30 recipients without medical authorization; and (2) rental, 31 lease, purchase or lease-purchase of durable medical 32 equipment in a cost-effective manner, taking into 33 consideration the recipient's medical prognosis, the extent 34 of the recipient's needs, and the requirements and costs for -17- LRB9003202DJmg 1 maintaining such equipment. Such rules shall enable a 2 recipient to temporarily acquire and use alternative or 3 substitute devices or equipment pending repairs or 4 replacements of any device or equipment previously authorized 5 for such recipient by the Department. Rules under clause (2) 6 above shall not provide for purchase or lease-purchase of 7 durable medical equipment or supplies used for the purpose of 8 oxygen delivery and respiratory care. 9 The Department shall execute, relative to the nursing 10 home prescreening project, written inter-agency agreements 11 with the Department of Human Services and the Department on 12 Aging, to effect the following: (i) intake procedures and 13 common eligibility criteria for those persons who are 14 receiving non-institutional services; and (ii) the 15 establishment and development of non-institutional services 16 in areas of the State where they are not currently available 17 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 22 and programs for monitoring of utilization of health care 23 services and facilities, as it affects persons eligible for 24 medical assistance under this Code. The Illinois Department 25 shall report regularly the results of the operation of such 26 systems and programs to the Citizens Assembly/Council on 27 Public Aid to enable the Committee to ensure, from time to 28 time, that these programs are effective and meaningful. 29 The Illinois Department shall report annually to the 30 General Assembly, no later than the second Friday in April of 31 1979 and each year thereafter, in regard to: 32 (a) actual statistics and trends in utilization of 33 medical services by public aid recipients; 34 (b) actual statistics and trends in the provision -18- LRB9003202DJmg 1 of the various medical services by medical vendors; 2 (c) current rate structures and proposed changes in 3 those rate structures for the various medical vendors; 4 and 5 (d) efforts at utilization review and control by 6 the Illinois Department. 7 The period covered by each report shall be the 3 years 8 ending on the June 30 prior to the report. The report shall 9 include suggested legislation for consideration by the 10 General Assembly. The filing of one copy of the report with 11 the Speaker, one copy with the Minority Leader and one copy 12 with the Clerk of the House of Representatives, one copy with 13 the President, one copy with the Minority Leader and one copy 14 with the Secretary of the Senate, one copy with the 15 Legislative Research Unit, such additional copies with the 16 State Government Report Distribution Center for the General 17 Assembly as is required under paragraph (t) of Section 7 of 18 the State Library Act and one copy with the Citizens 19 Assembly/Council on Public Aid or its successor shall be 20 deemed sufficient to comply with this Section. 21 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95; 22 89-507, eff. 7-1-97; 89-517, eff. 1-1-97; revised 8-26-96.) 23 Section 95. No acceleration or delay. Where this Act 24 makes changes in a statute that is represented in this Act by 25 text that is not yet or no longer in effect (for example, a 26 Section represented by multiple versions), the use of that 27 text does not accelerate or delay the taking effect of (i) 28 the changes made by this Act or (ii) provisions derived from 29 any other Public Act.