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|[ Introduced ]||[ Engrossed ]||[ Senate Amendment 002 ]|
92_HB4580enr HB4580 Enrolled LRB9213371REmb 1 AN ACT in relation to budget implementation. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 1. Short title. This Act may be cited as the 5 FY2003 Budget Implementation Act. 6 Section 5. Purpose. It is the purpose of this Act to 7 make certain changes in State programs that are necessary to 8 implement the State's FY2003 budget. 9 Section 10. The Illinois Administrative Procedure Act is 10 amended by changing Section 5-45 as follows: 11 (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45) 12 Sec. 5-45. Emergency rulemaking. 13 (a) "Emergency" means the existence of any situation 14 that any agency finds reasonably constitutes a threat to the 15 public interest, safety, or welfare. 16 (b) If any agency finds that an emergency exists that 17 requires adoption of a rule upon fewer days than is required 18 by Section 5-40 and states in writing its reasons for that 19 finding, the agency may adopt an emergency rule without prior 20 notice or hearing upon filing a notice of emergency 21 rulemaking with the Secretary of State under Section 5-70. 22 The notice shall include the text of the emergency rule and 23 shall be published in the Illinois Register. Consent orders 24 or other court orders adopting settlements negotiated by an 25 agency may be adopted under this Section. Subject to 26 applicable constitutional or statutory provisions, an 27 emergency rule becomes effective immediately upon filing 28 under Section 5-65 or at a stated date less than 10 days 29 thereafter. The agency's finding and a statement of the HB4580 Enrolled -2- LRB9213371REmb 1 specific reasons for the finding shall be filed with the 2 rule. The agency shall take reasonable and appropriate 3 measures to make emergency rules known to the persons who may 4 be affected by them. 5 (c) An emergency rule may be effective for a period of 6 not longer than 150 days, but the agency's authority to adopt 7 an identical rule under Section 5-40 is not precluded. No 8 emergency rule may be adopted more than once in any 24 month 9 period, except that this limitation on the number of 10 emergency rules that may be adopted in a 24 month period does 11 not apply to (i) emergency rules that make additions to and 12 deletions from the Drug Manual under Section 5-5.16 of the 13 Illinois Public Aid Code or the generic drug formulary under 14 Section 3.14 of the Illinois Food, Drug and Cosmetic Act or 15 (ii) emergency rules adopted by the Pollution Control Board 16 before July 1, 1997 to implement portions of the Livestock 17 Management Facilities Act. Two or more emergency rules 18 having substantially the same purpose and effect shall be 19 deemed to be a single rule for purposes of this Section. 20 (d) In order to provide for the expeditious and timely 21 implementation of the State's fiscal year 1999 budget, 22 emergency rules to implement any provision of Public Act 23 90-587 or 90-588 or any other budget initiative for fiscal 24 year 1999 may be adopted in accordance with this Section by 25 the agency charged with administering that provision or 26 initiative, except that the 24-month limitation on the 27 adoption of emergency rules and the provisions of Sections 28 5-115 and 5-125 do not apply to rules adopted under this 29 subsection (d). The adoption of emergency rules authorized 30 by this subsection (d) shall be deemed to be necessary for 31 the public interest, safety, and welfare. 32 (e) In order to provide for the expeditious and timely 33 implementation of the State's fiscal year 2000 budget, 34 emergency rules to implement any provision of this amendatory HB4580 Enrolled -3- LRB9213371REmb 1 Act of the 91st General Assembly or any other budget 2 initiative for fiscal year 2000 may be adopted in accordance 3 with this Section by the agency charged with administering 4 that provision or initiative, except that the 24-month 5 limitation on the adoption of emergency rules and the 6 provisions of Sections 5-115 and 5-125 do not apply to rules 7 adopted under this subsection (e). The adoption of emergency 8 rules authorized by this subsection (e) shall be deemed to be 9 necessary for the public interest, safety, and welfare. 10 (f) In order to provide for the expeditious and timely 11 implementation of the State's fiscal year 2001 budget, 12 emergency rules to implement any provision of this amendatory 13 Act of the 91st General Assembly or any other budget 14 initiative for fiscal year 2001 may be adopted in accordance 15 with this Section by the agency charged with administering 16 that provision or initiative, except that the 24-month 17 limitation on the adoption of emergency rules and the 18 provisions of Sections 5-115 and 5-125 do not apply to rules 19 adopted under this subsection (f). The adoption of emergency 20 rules authorized by this subsection (f) shall be deemed to be 21 necessary for the public interest, safety, and welfare. 22 (g) In order to provide for the expeditious and timely 23 implementation of the State's fiscal year 2002 budget, 24 emergency rules to implement any provision of this amendatory 25 Act of the 92nd General Assembly or any other budget 26 initiative for fiscal year 2002 may be adopted in accordance 27 with this Section by the agency charged with administering 28 that provision or initiative, except that the 24-month 29 limitation on the adoption of emergency rules and the 30 provisions of Sections 5-115 and 5-125 do not apply to rules 31 adopted under this subsection (g). The adoption of emergency 32 rules authorized by this subsection (g) shall be deemed to be 33 necessary for the public interest, safety, and welfare. 34 (h) In order to provide for the expeditious and timely HB4580 Enrolled -4- LRB9213371REmb 1 implementation of the State's fiscal year 2003 budget, 2 emergency rules to implement any provision of this amendatory 3 Act of the 92nd General Assembly or any other budget 4 initiative for fiscal year 2003 may be adopted in accordance 5 with this Section by the agency charged with administering 6 that provision or initiative, except that the 24-month 7 limitation on the adoption of emergency rules and the 8 provisions of Sections 5-115 and 5-125 do not apply to rules 9 adopted under this subsection (h). The adoption of emergency 10 rules authorized by this subsection (h) shall be deemed to be 11 necessary for the public interest, safety, and welfare. 12 (Source: P.A. 91-24, eff. 7-1-99; 91-357, eff. 7-29-99; 13 91-712, eff. 7-1-00; 92-10, eff. 6-11-01.) 14 Section 15. The Illinois Act on the Aging is amended by 15 changing Section 4.02 as follows: 16 (20 ILCS 105/4.02) (from Ch. 23, par. 6104.02) 17 Sec. 4.02. The Department shall establish a program of 18 services to prevent unnecessary institutionalization of 19 persons age 60 and older in need of long term care or who are 20 established as persons who suffer from Alzheimer's disease or 21 a related disorder under the Alzheimer's Disease Assistance 22 Act, thereby enabling them to remain in their own homes or in 23 other living arrangements. Such preventive services, which 24 may be coordinated with other programs for the aged and 25 monitored by area agencies on aging in cooperation with the 26 Department, may include, but are not limited to, any or all 27 of the following: 28 (a) home health services; 29 (b) home nursing services; 30 (c) homemaker services; 31 (d) chore and housekeeping services; 32 (e) day care services; HB4580 Enrolled -5- LRB9213371REmb 1 (f) home-delivered meals; 2 (g) education in self-care; 3 (h) personal care services; 4 (i) adult day health services; 5 (j) habilitation services; 6 (k) respite care; 7 (l) other nonmedical social services that may 8 enable the person to become self-supporting; or 9 (m) clearinghouse for information provided by 10 senior citizen home owners who want to rent rooms to or 11 share living space with other senior citizens. 12 The Department shall establish eligibility standards for 13 such services taking into consideration the unique economic 14 and social needs of the target population for whom they are 15 to be provided. Such eligibility standards shall be based on 16 the recipient's ability to pay for services; provided, 17 however, that in determining the amount and nature of 18 services for which a person may qualify, consideration shall 19 not be given to the value of cash, property or other assets 20 held in the name of the person's spouse pursuant to a written 21 agreement dividing marital property into equal but separate 22 shares or pursuant to a transfer of the person's interest in 23 a home to his spouse, provided that the spouse's share of the 24 marital property is not made available to the person seeking 25 such services. 26 Beginning July 1, 2002, the Department shall require as a 27 condition of eligibility that all applicants and recipients 28 apply for medical assistance under Article V of the Illinois 29 Public Aid Code in accordance with rules promulgated by the 30 Department. 31 The Department shall, in conjunction with the Department 32 of Public Aid, seek appropriate amendments under Sections 33 1915 and 1924 of the Social Security Act. The purpose of the 34 amendments shall be to extend eligibility for home and HB4580 Enrolled -6- LRB9213371REmb 1 community based services under Sections 1915 and 1924 of the 2 Social Security Act to persons who transfer to or for the 3 benefit of a spouse those amounts of income and resources 4 allowed under Section 1924 of the Social Security Act. 5 Subject to the approval of such amendments, the Department 6 shall extend the provisions of Section 5-4 of the Illinois 7 Public Aid Code to persons who, but for the provision of home 8 or community-based services, would require the level of care 9 provided in an institution, as is provided for in federal 10 law. Those persons no longer found to be eligible for 11 receiving noninstitutional services due to changes in the 12 eligibility criteria shall be given 60 days notice prior to 13 actual termination. Those persons receiving notice of 14 termination may contact the Department and request the 15 determination be appealed at any time during the 60 day 16 notice period. With the exception of the lengthened notice 17 and time frame for the appeal request, the appeal process 18 shall follow the normal procedure. In addition, each person 19 affected regardless of the circumstances for discontinued 20 eligibility shall be given notice and the opportunity to 21 purchase the necessary services through the Community Care 22 Program. If the individual does not elect to purchase 23 services, the Department shall advise the individual of 24 alternative services. The target population identified for 25 the purposes of this Section are persons age 60 and older 26 with an identified service need. Priority shall be given to 27 those who are at imminent risk of institutionalization. The 28 services shall be provided to eligible persons age 60 and 29 older to the extent that the cost of the services together 30 with the other personal maintenance expenses of the persons 31 are reasonably related to the standards established for care 32 in a group facility appropriate to the person's condition. 33 These non-institutional services, pilot projects or 34 experimental facilities may be provided as part of or in HB4580 Enrolled -7- LRB9213371REmb 1 addition to those authorized by federal law or those funded 2 and administered by the Department of Human Services. The 3 Departments of Human Services, Public Aid, Public Health, 4 Veterans' Affairs, and Commerce and Community Affairs and 5 other appropriate agencies of State, federal and local 6 governments shall cooperate with the Department on Aging in 7 the establishment and development of the non-institutional 8 services. The Department shall require an annual audit from 9 all chore/housekeeping and homemaker vendors contracting with 10 the Department under this Section. The annual audit shall 11 assure that each audited vendor's procedures are in 12 compliance with Department's financial reporting guidelines 13 requiring a 27% administrative cost split and a 73% employee 14 wages and benefits cost split. The audit is a public record 15 under the Freedom of Information Act. The Department shall 16 execute, relative to the nursing home prescreening project, 17 written inter-agency agreements with the Department of Human 18 Services and the Department of Public Aid, to effect the 19 following: (1) intake procedures and common eligibility 20 criteria for those persons who are receiving 21 non-institutional services; and (2) the establishment and 22 development of non-institutional services in areas of the 23 State where they are not currently available or are 24 undeveloped. On and after July 1, 1996, all nursing home 25 prescreenings for individuals 60 years of age or older shall 26 be conducted by the Department. 27 The Department is authorized to establish a system of 28 recipient copayment for services provided under this Section, 29 such copayment to be based upon the recipient's ability to 30 pay but in no case to exceed the actual cost of the services 31 provided. Additionally, any portion of a person's income 32 which is equal to or less than the federal poverty standard 33 shall not be considered by the Department in determining the 34 copayment. The level of such copayment shall be adjusted HB4580 Enrolled -8- LRB9213371REmb 1 whenever necessary to reflect any change in the officially 2 designated federal poverty standard. 3 The Department, or the Department's authorized 4 representative, shall recover the amount of moneys expended 5 for services provided to or in behalf of a person under this 6 Section by a claim against the person's estate or against the 7 estate of the person's surviving spouse, but no recovery may 8 be had until after the death of the surviving spouse, if any, 9 and then only at such time when there is no surviving child 10 who is under age 21, blind, or permanently and totally 11 disabled. This paragraph, however, shall not bar recovery, 12 at the death of the person, of moneys for services provided 13 to the person or in behalf of the person under this Section 14 to which the person was not entitled; provided that such 15 recovery shall not be enforced against any real estate while 16 it is occupied as a homestead by the surviving spouse or 17 other dependent, if no claims by other creditors have been 18 filed against the estate, or, if such claims have been filed, 19 they remain dormant for failure of prosecution or failure of 20 the claimant to compel administration of the estate for the 21 purpose of payment. This paragraph shall not bar recovery 22 from the estate of a spouse, under Sections 1915 and 1924 of 23 the Social Security Act and Section 5-4 of the Illinois 24 Public Aid Code, who precedes a person receiving services 25 under this Section in death. All moneys for services paid to 26 or in behalf of the person under this Section shall be 27 claimed for recovery from the deceased spouse's estate. 28 "Homestead", as used in this paragraph, means the dwelling 29 house and contiguous real estate occupied by a surviving 30 spouse or relative, as defined by the rules and regulations 31 of the Illinois Department of Public Aid, regardless of the 32 value of the property. 33 The Department shall develop procedures to enhance 34 availability of services on evenings, weekends, and on an HB4580 Enrolled -9- LRB9213371REmb 1 emergency basis to meet the respite needs of caregivers. 2 Procedures shall be developed to permit the utilization of 3 services in successive blocks of 24 hours up to the monthly 4 maximum established by the Department. Workers providing 5 these services shall be appropriately trained. 6 Beginning on the effective date of this Amendatory Act of 7 1991, no person may perform chore/housekeeping and homemaker 8 services under a program authorized by this Section unless 9 that person has been issued a certificate of pre-service to 10 do so by his or her employing agency. Information gathered 11 to effect such certification shall include (i) the person's 12 name, (ii) the date the person was hired by his or her 13 current employer, and (iii) the training, including dates and 14 levels. Persons engaged in the program authorized by this 15 Section before the effective date of this amendatory Act of 16 1991 shall be issued a certificate of all pre- and in-service 17 training from his or her employer upon submitting the 18 necessary information. The employing agency shall be 19 required to retain records of all staff pre- and in-service 20 training, and shall provide such records to the Department 21 upon request and upon termination of the employer's contract 22 with the Department. In addition, the employing agency is 23 responsible for the issuance of certifications of in-service 24 training completed to their employees. 25 The Department is required to develop a system to ensure 26 that persons working as homemakers and chore housekeepers 27 receive increases in their wages when the federal minimum 28 wage is increased by requiring vendors to certify that they 29 are meeting the federal minimum wage statute for homemakers 30 and chore housekeepers. An employer that cannot ensure that 31 the minimum wage increase is being given to homemakers and 32 chore housekeepers shall be denied any increase in 33 reimbursement costs. 34 The Department on Aging and the Department of Human HB4580 Enrolled -10- LRB9213371REmb 1 Services shall cooperate in the development and submission of 2 an annual report on programs and services provided under this 3 Section. Such joint report shall be filed with the Governor 4 and the General Assembly on or before September 30 each year. 5 The requirement for reporting to the General Assembly 6 shall be satisfied by filing copies of the report with the 7 Speaker, the Minority Leader and the Clerk of the House of 8 Representatives and the President, the Minority Leader and 9 the Secretary of the Senate and the Legislative Research 10 Unit, as required by Section 3.1 of the General Assembly 11 Organization Act and filing such additional copies with the 12 State Government Report Distribution Center for the General 13 Assembly as is required under paragraph (t) of Section 7 of 14 the State Library Act. 15 Those persons previously found eligible for receiving 16 non-institutional services whose services were discontinued 17 under the Emergency Budget Act of Fiscal Year 1992, and who 18 do not meet the eligibility standards in effect on or after 19 July 1, 1992, shall remain ineligible on and after July 1, 20 1992. Those persons previously not required to cost-share 21 and who were required to cost-share effective March 1, 1992, 22 shall continue to meet cost-share requirements on and after 23 July 1, 1992. Beginning July 1, 1992, all clients will be 24 required to meet eligibility, cost-share, and other 25 requirements and will have services discontinued or altered 26 when they fail to meet these requirements. 27 (Source: P.A. 91-303, eff. 1-1-00; 91-798, eff. 7-9-00.) 28 Section 20. The Mental Health and Developmental 29 Disabilities Administrative Act is amended by adding Section 30 18.4 as follows: 31 (20 ILCS 1705/18.4 new) 32 Sec. 18.4. Community Mental Health Medicaid Trust Fund; HB4580 Enrolled -11- LRB9213371REmb 1 reimbursement. 2 (a) The Community Mental Health Medicaid Trust Fund is 3 hereby created in the State Treasury. 4 (b) Any funds paid to the State by the federal 5 government under Title XIX or Title XXI of the Social 6 Security Act for services delivered by community mental 7 health services providers, and any interest earned thereon, 8 shall be deposited directly into the Community Mental Health 9 Medicaid Trust Fund. 10 (c) The Department shall reimburse community mental 11 health services providers for Medicaid-reimbursed mental 12 health services provided to eligible individuals. Moneys in 13 the Community Mental Health Medicaid Trust Fund may be used 14 for that purpose. 15 (d) As used in this Section: 16 "Medicaid-reimbursed mental health services" means 17 services provided by a community mental health provider under 18 an agreement with the Department that is eligible for 19 reimbursement under the federal Title XIX program or Title 20 XXI program. 21 "Provider" means a community agency that is funded by the 22 Department to provide a Medicaid-reimbursed service. 23 "Services" means mental health services provided under 24 one of the following programs: 25 (1) Medicaid Clinic Option; 26 (2) Medicaid Rehabilitation Option; 27 (3) Targeted Case Management. 28 Section 25. The Illinois Health Finance Reform Act is 29 amended by changing Sections 2-1, 4-1, 4-2, and 4-4 as 30 follows: 31 (20 ILCS 2215/2-1) (from Ch. 111 1/2, par. 6502-1) 32 Sec. 2-1. Council abolished.
Authorized. There isHB4580 Enrolled -12- LRB9213371REmb 1 hereby createdThe Illinois Health Care Cost Containment 2 Council is abolished at the close of business on June 30, 3 2002. Its successor agency, for purposes of the Successor 4 Agency Act and Section 9b of the State Finance Act, is the 5 Illinois Department of Public Health. It shall consist of 136 members appointed by the Governor with the advice and consent7 of the Senate as follows: 5 members to represent providers as8 follows: 2 members to represent Illinois hospitals at least9 one of which must represent a small rural hospital, 2 members10 to represent physicians licensed to practice medicine in all11 its branches, and 1 member to represent ambulatory surgical12 treatment centers; 3 members to represent consumers; 213 members to represent insurance companies; and 3 members to14 represent businesses.15 The members of the Council shall be appointed for 3-year16 terms.17 No more than 7 members may be from the same political18 party.19 Members shall be appointed within 30 days after the20 effective date of this Act. The additional members appointed21 under the amendatory Act of the 91st General Assembly must be22 appointed within 30 days after the effective date of this23 amendatory Act of the 91st General Assembly. The members of24 the Council shall receive reimbursement of their actual25 expenses incurred in connection with their service; in26 addition, each member shall receive compensation of $150 a27 day for each day served at regular or special meetings of the28 Council, except that such compensation shall not exceed29 $20,000 in any one year for any member. The Council shall30 elect a Chairman from among its members, and shall have the31 power to organize and appoint such other officers as it may32 deem necessary.33 All appointments shall be made in writing and filed with34 the Secretary of State as a public record.HB4580 Enrolled -13- LRB9213371REmb 1 (Source: P.A. 91-756, eff. 6-2-00.) 2 (20 ILCS 2215/4-1) (from Ch. 111 1/2, par. 6504-1) 3 Sec. 4-1. Illinois Health Finance Data Collection. The 4 General Assembly finds that public sector and private sector 5 purchasers of health care need health care cost and 6 utilization data to enable them to make informed choices 7 among health care providers in the market place. The General 8 Assembly finds it necessary to create a mandated uniform 9 system in Illinois for the collection, analysis, and 10 distribution of health care cost and utilization data. 11 The purpose of this Article is to insure that data are 12 available to make valid comparisons among health care 13 providers of prices and utilization of services provided and 14 to support ongoing analysis of the health care delivery 15 system so that the Council can fulfill its mandate. 16 (Source: P.A. 91-756, eff. 6-2-00.) 17 (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2) 18 Sec. 4-2. Powers and duties. 19 (a) (Blank). The Illinois Health Care Cost Containment20 Council may enter into any agreement with any corporation,21 association or other entity it deems appropriate to undertake22 the process described in this Article for the compilation and23 analysis of data collected by the Council and to conduct or24 contract for studies on health-related questions carried out25 in pursuance of the purposes of this Article. The agreement26 may provide for the corporation, association or entity to27 prepare and distribute or make available data to health care28 providers, health care subscribers, third-party payors,29 government and the general public, in accordance with the30 rules of confidentiality and review to be developed under31 this Act.32 (b) (Blank). The input data collected by and furnishedHB4580 Enrolled -14- LRB9213371REmb 1 to the Council or designated corporation, association or2 entity pursuant to this Section shall not be a public record3 under the Illinois Freedom of Information Act. It is the4 intent of this Act and of the regulations written pursuant to5 it to protect the confidentiality of individual patient6 information and the proprietary information of commercial7 insurance carriers and health care providers. Data specified8 in subsections (e) and (e-5) shall be released on a hospital9 specific and licensed ambulatory surgical treatment center10 specific basis to facilitate comparisons among hospitals and11 licensed ambulatory surgical treatment centers by purchasers.12 (c) (Blank). The Council shall require the Departments13 of Public Health and Public Aid and hospitals located in the14 State to assist the Council in gathering and submitting the15 following hospital-specific financial information, and the16 Council is authorized to share this data with both17 Departments to reduce the burden on hospitals by avoiding18 duplicate data collection:19 OPERATING REVENUES20 (1) Net patient service revenue21 (2) Other revenue22 (3) Total operating revenue23 OPERATING EXPENSES24 (4) Bad debt expense25 (5) Total operating expenses26 NON-OPERATING GAINS/LOSSES27 (6) Total non-operating gains28 (7) Total non-operating losses29 PATIENT CARE REVENUES30 (8) Gross inpatient revenue31 (9) Gross outpatient revenue32 (10) Other Patient care revenueHB4580 Enrolled -15- LRB9213371REmb 1 (11) Total patient revenue2 (12) Total gross patient care revenue3 (13) Medicare gross revenue4 (14) Medicaid gross revenue5 (15) Total other gross revenue6 DEDUCTIONS FROM REVENUE7 (16) Charity care8 (17) Medicare allowance9 (18) Medicaid allowance10 (19) Other contractual allowances11 (20) Other allowances12 (21) Total Deductions13 ASSETS14 (22) Operating cash and short-term investments15 (23) Estimated patient accounts receivable16 (24) Other current assets17 (25) Total current assets18 (26) Total other assets19 (27) Total Assets20 LIABILITIES AND FUND BALANCES21 (28) Total current liabilities22 (29) Long Term Debt23 (30) Other liabilities24 (31) Total liabilities25 (32) Total liabilities and fund balances26 All financial data collected by the Council from publicly27 available sources such as the HCFA is releasable by the28 Council on a hospital specific basis when appropriate.29 (d) Uniform Provider Utilization and Charge Information. 30 The Council shall require that:31 (1) The Department of Public Health shall require 32 that hospitals licensed to operate in the State of 33 Illinois adopt a uniform system for submitting patient HB4580 Enrolled -16- LRB9213371REmb 1 charges for payment from public and private payors 2 effective January 1, 1985. This system shall be based 3 upon adoption of the uniform hospital billing form 4 (UB-92) or its successor form developed by the National 5 Uniform Billing Committee. 6 (2) (Blank). 7 (3) The Department of Insurance shall require all 8 third-party payors, including but not limited to, 9 licensed insurers, medical and hospital service 10 corporations, health maintenance organizations, and 11 self-funded employee health plans, to accept the uniform 12 billing form, without attachment as submitted by 13 hospitals pursuant to paragraph (1) of subsection (d) 14 above, effective January 1, 1985; provided, however, 15 nothing shall prevent all such third party payors from 16 requesting additional information necessary to determine 17 eligibility for benefits or liability for reimbursement 18 for services provided. 19 (e) (Blank). The Council, in cooperation with the State20 Departments of Public Aid, Insurance, and Public Health,21 shall establish a system for the collection of the following22 information from hospitals utilizing the raw data available23 on the uniform billing forms. Such data shall include the24 following elements and other elements contained on the25 uniform billing form or its successor form determined as26 necessary by the Council:27 (1) Patient date of birth28 (2) Patient sex29 (3) Patient zip code30 (4) Third-party coverage31 (5) Date of admission32 (6) Source of admission33 (7) Type of admission34 (8) Discharge dateHB4580 Enrolled -17- LRB9213371REmb 1 (9) Principal and up to 8 other diagnoses2 (10) Principal procedure and date3 (11) Patient status4 (12) Other procedures and dates5 (13) Total charges and components of those charges6 (14) Attending and consulting physician identification7 numbers8 (15) Hospital identification number9 (16) An alphanumeric number based on the information to10 identify the payor11 (17) Principal source of payment.12 (e-5) The Council, in cooperation with the Department of13 Public Aid, the Department of Insurance, and the Department14 of Public Health, shall establish a system for the collection15 of the following information for each outpatient surgery16 performed at hospitals and licensed ambulatory surgical17 treatment centers using the raw data available on outpatient18 billing forms submitted by hospitals and licensed ambulatory19 surgical treatment centers to payors. The data must include20 the following elements, if available on the billing forms,21 and other elements contained on the billing forms that the22 Council determines are necessary:23 (1) patient date of birth;24 (2) patient sex;25 (3) patient zip code;26 (4) third-party coverage;27 (5) date of admission;28 (6) source of admission;29 (7) type of admission;30 (8) discharge date;31 (9) principal diagnosis and up to 8 other32 diagnoses;33 (10) principal procedure and the date of the34 procedure;HB4580 Enrolled -18- LRB9213371REmb 1 (11) patient status;2 (12) other procedures and the dates of those3 procedures;4 (13) attending and consulting physician5 identification numbers;6 (14) hospital or licensed ambulatory surgical7 treatment center identification number;8 (15) an alphanumeric number based on the9 information needed to identify the payor; and10 (16) principal source of payment.11 (f) Extracts of the UB-92 transactions shall be prepared12 by hospitals according to regulations promulgated by the13 Council and submitted in electronic format to the Council or14 the corporation, association or entity designated by the15 Council.16 For hospitals unable to submit extracts in electronic17 format, the Council shall determine an alternate method for18 submission of data. Such extract reporting systems shall be19 in operation before January 1, 1987; however, the Council may20 grant time extensions to individual hospital.21 (f-5) Extracts of the billing forms shall be prepared by22 licensed ambulatory surgical treatment centers according to23 rules adopted by the Council and submitted to the Council or24 a corporation, association, or entity designated by the25 Council. Electronic submissions shall be encouraged. For26 licensed ambulatory surgical treatment centers unable to27 submit extracts in an electronic format the Council must28 determine an alternate method for submission of data.29 (g) Under no circumstances shall patient name and social30 security number appear on the extracts.31 (h) Hospitals and licensed ambulatory surgical treatment32 centers shall be assigned a standard identification number by33 the Council to be used in the submission of all data.34 (i) The Council shall collect a 100% inpatient sampleHB4580 Enrolled -19- LRB9213371REmb 1 from hospitals annually. The Council shall require each2 hospital in the State to submit the UB-92 data extracts3 required in subsection (e) to the Council, except that4 hospitals with fewer than 50 beds may be exempted by the5 Council from the filing requirements if they prove to the6 Council's satisfaction that the requirements would impose7 undue economic hardship and if the Council determines that8 the data submitted from these hospitals are not essential to9 its data base and its concomitant health care cost comparison10 efforts.11 (i-5) The Council shall collect up to a 100% outpatient12 sample annually from hospitals and licensed ambulatory13 surgical treatment centers. The Council shall require each14 hospital and licensed ambulatory surgical treatment center in15 the State to submit the data extracts required under16 subsection (e-5) to the Council, except that hospitals and17 licensed ambulatory surgical treatment centers may be18 exempted by the Council from the filing requirements if the19 hospitals or licensed ambulatory surgical treatment centers20 prove to the Council's satisfaction that the requirements21 would impose undue economic hardship and if the Council22 determines that the data submitted from those hospitals and23 licensed ambulatory surgical treatment centers are not24 essential to the Council's database and its concomitant25 health care comparison efforts.26 (i-10) The outpatient data shall be collected by the27 Council on a phase-in and trial basis for a one-year period28 beginning on January 1, 2001. The Council shall implement29 outpatient data collection for reporting purposes beginning30 on January 1, 2002.31 (j) The information submitted to the Council pursuant to32 subsections (e) and (e-5) shall be reported for each primary33 payor category, including Medicare, Medicaid, other34 government programs, private insurance, health maintenanceHB4580 Enrolled -20- LRB9213371REmb 1 organizations, self-insured, private pay patients, and2 others. Preferred provider organization reimbursement shall3 also be reported for each primary third party payor category.4 (k) The Council shall require and the designated5 corporation, association or entity, if applicable, shall6 prepare quarterly basic reports in the aggregate on health7 care cost and utilization trends in Illinois. The Council8 shall provide these reports to the public, if requested.9 These shall include, but not be limited to, comparative10 information on average charges, total and ancillary charge11 components, length of stay on diagnosis-specific and12 procedure specific cases, and number of discharges, compiled13 in aggregate by hospital and licensed ambulatory surgical14 treatment center, by diagnosis, and by primary payor15 category.16 (l) The Council shall, from information submitted17 pursuant to subsection (e), prepare an annual report in the18 aggregate by hospital containing the following:19 (1) the ratio of caesarean section deliveries to20 total deliveries;21 (2) the average length of stay for patients who22 undergo caesarean sections;23 (3) the average total charges for patients who have24 normal deliveries without any significant complications;25 (4) the average total charges for patients who26 deliver by caesarean section.27 The Council shall provide this report to the public, if28 requested.29 (l-5) (Blank).30 (m) Prior to the release or dissemination of these31 reports, the Council or the designated corporation shall32 permit providers the opportunity to verify the accuracy of33 any information pertaining to the provider. The providers34 may submit to the Council any corrections or errors in theHB4580 Enrolled -21- LRB9213371REmb 1 compilation of the data with any supporting evidence and2 documents the providers may submit. The Council or3 corporation shall correct data found to be in error and4 include additional commentary as requested by the provider5 for major deviations in the charges from the average charges.6 For purposes of this subsection (m), "providers" includes7 physicians licensed to practice medicine in all of its8 branches.9 (n) In addition to the reports indicated above, the10 Council shall respond to requests by agencies of government11 and organizations in the private sector for data products,12 special studies and analysis of data collected pursuant to13 this Section. Such reports shall be undertaken only by the14 agreement of a majority of the members of the Council who15 shall designate the form in which the information shall be16 made available. The Council or the corporation, association17 or entity in consultation with the Council shall also18 determine a fee to be charged to the requesting agency or19 private sector organization to cover the direct and indirect20 costs for producing such a report, and shall permit affected21 providers the rights to review the accuracy of the report22 before it is released. Such reports shall not be subject to23 The Freedom of Information Act.24 (Source: P.A. 91-756, eff. 6-2-00.) 25 (20 ILCS 2215/4-4) (from Ch. 111 1/2, par. 6504-4) 26 Sec. 4-4. (a) Hospitals shall make available to 27 prospective patients information on the normal charge 28 incurred for any procedure or operation the prospective 29 patient is considering. 30 (b) The Department of Public Health Councilshall 31 require hospitals to post in letters no more than one inch in 32 height the established charges for services, where 33 applicable, including but not limited to the hospital's HB4580 Enrolled -22- LRB9213371REmb 1 private room charge, semi-private room charge, charge for a 2 room with 3 or more beds, intensive care room charges, 3 emergency room charge, operating room charge, 4 electrocardiogram charge, anesthesia charge, chest x-ray 5 charge, blood sugar charge, blood chemistry charge, tissue 6 exam charge, blood typing charge and Rh factor charge. The 7 definitions of each charge to be posted shall be determined 8 by the Department Council. 9 (Source: P.A. 90-655, eff. 7-30-98.) 10 (20 ILCS 2215/1-2 rep.) 11 (20 ILCS 2215/2-2 rep.) 12 (20 ILCS 2215/2-3 rep.) 13 (20 ILCS 2215/2-4 rep.) 14 (20 ILCS 2215/2-5 rep.) 15 (20 ILCS 2215/2-6 rep.) 16 (20 ILCS 2215/4-3 rep.) 17 (20 ILCS 2215/4-5 rep.) 18 (20 ILCS 2215/5-2 rep.) 19 Section 26. The Illinois Health Finance Reform Act is 20 amended by repealing Sections 1-2, 2-2, 2-3, 2-4, 2-5, 2-6, 21 4-3, 4-5, and 5-2. 22 Section 30. The Department of Public Health Powers and 23 Duties Law of the Civil Administrative Code of Illinois is 24 amended by adding Section 2310-57 as follows: 25 (20 ILCS 2310/2310-57 new) 26 Sec. 2310-57. Collecting information regarding hospital 27 discharges and surgery. The Department of Public Health 28 shall establish a system for the collection of data regarding 29 hospital discharges and inpatient and outpatient surgery 30 performed at hospitals and licensed ambulatory surgical 31 treatment centers. HB4580 Enrolled -23- LRB9213371REmb 1 The Department may establish a system to provide data to 2 hospitals required for accreditation, including data required 3 by the Joint Commission on Accreditation of Healthcare 4 Organizations. 5 The Department may adopt any rules necessary to carry out 6 this function, including reasonable fees for providing 7 accreditation data. The Department may contract with a 8 vendor to collect any data required to be submitted to the 9 Department under this Section. 10 Section 35. The Illinois Emergency Management Agency Act 11 is amended by changing Section 5 as follows: 12 (20 ILCS 3305/5) (from Ch. 127, par. 1055) 13 Sec. 5. Illinois Emergency Management Agency. 14 (a) There is created within the executive branch of the 15 State Government an Illinois Emergency Management Agency and 16 a Director of the Illinois Emergency Management Agency, 17 herein called the "Director" who shall be the head thereof. 18 The Director shall be appointed by the Governor, with the 19 advice and consent of the Senate, and shall serve for a term 20 of 2 years beginning on the third Monday in January of the 21 odd-numbered year, and until a successor is appointed and has 22 qualified; except that the term of the first Director 23 appointed under this Act shall expire on the third Monday in 24 January, 1989. The Director shall not hold any other 25 remunerative public office. The Director shall receive an 26 annual salary as set by the Governor from time to time or the 27 amount set by the Compensation Review Board, whichever is 28 higher. If set by the Governor, the Director's annual salary 29 may not exceed 85% of the Governor's annual salary. 30 (b) The Illinois Emergency Management Agency shall 31 obtain, under the provisions of the Personnel Code, 32 technical, clerical, stenographic and other administrative HB4580 Enrolled -24- LRB9213371REmb 1 personnel, and may make expenditures within the appropriation 2 therefor as may be necessary to carry out the purpose of this 3 Act. The agency created by this Act is intended to be a 4 successor to the agency created under the Illinois Emergency 5 Services and Disaster Agency Act of 1975 and the personnel, 6 equipment, records, and appropriations of that agency are 7 transferred to the successor agency as of the effective date 8 of this Act. 9 (c) The Director, subject to the direction and control 10 of the Governor, shall be the executive head of the Illinois 11 Emergency Management Agency and the State Emergency Response 12 Commission and shall be responsible under the direction of 13 the Governor, for carrying out the program for emergency 14 management of this State. The Director shall also maintain 15 liaison and cooperate with the emergency management 16 organizations of this State and other states and of the 17 federal government. 18 (d) The Illinois Emergency Management Agency shall take 19 an integral part in the development and revision of political 20 subdivision emergency operations plans prepared under 21 paragraph (f) of Section 10. To this end it shall employ or 22 otherwise secure the services of professional and technical 23 personnel capable of providing expert assistance to the 24 emergency services and disaster agencies. These personnel 25 shall consult with emergency services and disaster agencies 26 on a regular basis and shall make field examinations of the 27 areas, circumstances, and conditions that particular 28 political subdivision emergency operations plans are intended 29 to apply. 30 (e) The Illinois Emergency Management Agency and 31 political subdivisions shall be encouraged to form an 32 emergency management advisory committee composed of private 33 and public personnel representing the emergency management 34 phases of mitigation, preparedness, response, and recovery. HB4580 Enrolled -25- LRB9213371REmb 1 The Local Emergency Planning Committee, as created under the 2 Illinois Emergency Planning and Community Right to Know Act, 3 shall serve as an advisory committee to the emergency 4 services and disaster agency or agencies serving within the 5 boundaries of that Local Emergency Planning Committee 6 planning district for: 7 (1) the development of emergency operations plan 8 provisions for hazardous chemical emergencies; and 9 (2) the assessment of emergency response 10 capabilities related to hazardous chemical emergencies. 11 (f) The Illinois Emergency Management Agency shall: 12 (1) Coordinate the overall emergency management 13 program of the State. 14 (2) Cooperate with local governments, the federal 15 government and any public or private agency or entity in 16 achieving any purpose of this Act and in implementing 17 emergency management programs for mitigation, 18 preparedness, response, and recovery. 19 (2.5) Cooperate with the Department of Nuclear 20 Safety in development of the comprehensive emergency 21 preparedness and response plan for any nuclear accident 22 in accordance with Section 2005-65 of the Department of 23 Nuclear Safety Law of the Civil Administrative Code of 24 Illinois and in development of the Illinois Nuclear 25 Safety Preparedness program in accordance with Section 8 26 of the Illinois Nuclear Safety Preparedness Act. 27 (3) Prepare, for issuance by the Governor, 28 executive orders, proclamations, and regulations as 29 necessary or appropriate in coping with disasters. 30 (4) Promulgate rules and requirements for political 31 subdivision emergency operations plans that are not 32 inconsistent with and are at least as stringent as 33 applicable federal laws and regulations. 34 (5) Review and approve, in accordance with Illinois HB4580 Enrolled -26- LRB9213371REmb 1 Emergency Management Agency rules, emergency operations 2 plans for those political subdivisions required to have 3 an emergency services and disaster agency pursuant to 4 this Act. 5 (5.5) Promulgate rules and requirements for the 6 political subdivision emergency management exercises, 7 including, but not limited to, exercises of the emergency 8 operations plans. 9 (5.10) Review, evaluate, and approve, in accordance 10 with Illinois Emergency Management Agency rules, 11 political subdivision emergency management exercises for 12 those political subdivisions required to have an 13 emergency services and disaster agency pursuant to this 14 Act. 15 (6) Determine requirements of the State and its 16 political subdivisions for food, clothing, and other 17 necessities in event of a disaster. 18 (7) Establish a register of persons with types of 19 emergency management training and skills in mitigation, 20 preparedness, response, and recovery. 21 (8) Establish a register of government and private 22 response resources available for use in a disaster. 23 (9) Expand the Earthquake Awareness Program and its 24 efforts to distribute earthquake preparedness materials 25 to schools, political subdivisions, community groups, 26 civic organizations, and the media. Emphasis will be 27 placed on those areas of the State most at risk from an 28 earthquake. Maintain the list of all school districts, 29 hospitals, airports, power plants, including nuclear 30 power plants, lakes, dams, emergency response facilities 31 of all types, and all other major public or private 32 structures which are at the greatest risk of damage from 33 earthquakes under circumstances where the damage would 34 cause subsequent harm to the surrounding communities and HB4580 Enrolled -27- LRB9213371REmb 1 residents. 2 (10) Disseminate all information, completely and 3 without delay, on water levels for rivers and streams and 4 any other data pertaining to potential flooding supplied 5 by the Division of Water Resources within the Department 6 of Natural Resources to all political subdivisions to the 7 maximum extent possible. 8 (11) Develop agreements, if feasible, with medical 9 supply and equipment firms to supply resources as are 10 necessary to respond to an earthquake or any other 11 disaster as defined in this Act. These resources will be 12 made available upon notifying the vendor of the disaster. 13 Payment for the resources will be in accordance with 14 Section 7 of this Act. The Illinois Department of Public 15 Health shall determine which resources will be required 16 and requested. 17 (12) Out of funds appropriated for these purposes, 18 award capital and non-capital grants to Illinois 19 hospitals or health care facilities located outside of a 20 city with a population in excess of 1,000,000 to be used 21 for purposes that include, but are not limited to, 22 preparing to respond to mass casualties and disasters, 23 maintaining and improving patient safety and quality of 24 care, and protecting the confidentiality of patient 25 information. No single grant for a capital expenditure 26 shall exceed $300,000. No single grant for a non-capital 27 expenditure shall exceed $100,000. In awarding such 28 grants, preference shall be given to hospitals that serve 29 a significant number of Medicaid recipients, but do not 30 qualify for disproportionate share hospital adjustment 31 payments under the Illinois Public Aid Code. To receive 32 such a grant, a hospital or health care facility must 33 provide funding of at least 50% of the cost of the 34 project for which the grant is being requested. In HB4580 Enrolled -28- LRB9213371REmb 1 awarding such grants the Illinois Emergency Management 2 Agency shall consider the recommendations of the Illinois 3 Hospital Association. 4 (13) (12)Do all other things necessary, incidental 5 or appropriate for the implementation of this Act. 6 (Source: P.A. 91-25, eff. 6-9-99; 92-73, eff. 1-1-02.) 7 Section 40. The State Finance Act is amended by changing 8 Sections 5.198, 6z-12, and 6z-43, changing and renumbering 9 Section 6z-51 (as added by Public Act 92-208), and adding 10 Sections 5.570 and 5.571 as follows: 11 (30 ILCS 105/5.198) (from Ch. 127, par. 141.198) 12 (Section scheduled to be repealed on October 15, 2002.) 13 Sec. 5.198. The Illinois Health Care Cost Containment 14 Council Special Studies Fund. This Section is repealed on 15 October 15, 2002. 16 (Source: P.A. 84-1240; 84-1438.) 17 (30 ILCS 105/5.570 new) 18 Sec. 5.570. The Illinois Student Assistance Commission 19 Contracts and Grants Fund. 20 (30 ILCS 105/5.571 new) 21 Sec. 5.571. The Career and Technical Education Fund. 22 (30 ILCS 105/6z-12) (from Ch. 127, par. 142z-12) 23 (Section scheduled to be repealed on October 15, 2002.) 24 Sec. 6z-12. Funds received by the Illinois Health Care 25 Cost Containment Council for special studies pursuant to the 26 Illinois Health Finance Reform Act shall be deposited in the 27 Illinois Health Care Cost Containment Council Special Studies 28 Fund. The General Assembly shall from time to time make 29 appropriations from the Illinois Health Care Cost Containment HB4580 Enrolled -29- LRB9213371REmb 1 Council Special Studies Fund for the payment of the direct 2 and indirect costs of special studies. The Illinois Health 3 Care Cost Containment Council shall by rule, adopted pursuant 4 to the Illinois Administrative Procedure Act, provide for the 5 allocation of the direct and indirect costs of producing 6 special studies pursuant to the Illinois Health Finance 7 Reform Act. 8 In addition to any other permitted use of moneys in the 9 Fund, moneys in the Illinois Health Care Cost Containment 10 Council Special Studies Fund may be used by the Council, 11 subject to appropriation, to provide services to the Illinois 12 Health Care Reform Task Force created under Section 6-4 of 13 the Medicaid Revenue Act and to support Council operations. 14 The Illinois Health Care Cost Containment Council Special 15 Studies Fund is abolished on October 15, 2002. Any balance 16 remaining in the Fund on that date shall be transferred to 17 the Public Health Special State Projects Fund. 18 This Section is repealed on October 15, 2002. 19 (Source: P.A. 87-838; 87-1248.) 20 (30 ILCS 105/6z-43) 21 Sec. 6z-43. Tobacco Settlement Recovery Fund. 22 (a) There is created in the State Treasury a special 23 fund to be known as the Tobacco Settlement Recovery Fund, 24 into which shall be deposited all monies paid to the State 25 pursuant to (1) the Master Settlement Agreement entered in 26 the case of People of the State of Illinois v. Philip Morris, 27 et al. (Circuit Court of Cook County, No. 96-L13146) and (2) 28 any settlement with or judgment against any tobacco product 29 manufacturer other than one participating in the Master 30 Settlement Agreement in satisfaction of any released claim as 31 defined in the Master Settlement Agreement, as well as any 32 other monies as provided by law. All earnings on Fund 33 investments shall be deposited into the Fund. Upon the HB4580 Enrolled -30- LRB9213371REmb 1 creation of the Fund, the State Comptroller shall order the 2 State Treasurer to transfer into the Fund any monies paid to 3 the State as described in item (1) or (2) of this Section 4 before the creation of the Fund plus any interest earned on 5 the investment of those monies. The Treasurer may invest the 6 moneys in the Fund in the same manner, in the same types of 7 investments, and subject to the same limitations provided in 8 the Illinois Pension Code for the investment of pension funds 9 other than those established under Article 3 or 4 of the 10 Code. 11 (b) As soon as may be practical after June 30, 2001, 12 upon notification from and at the direction of the Governor, 13 the State Comptroller shall direct and the State Treasurer 14 shall transfer the unencumbered balance in the Tobacco 15 Settlement Recovery Fund as of June 30, 2001, as determined 16 by the Governor, into the Budget Stabilization Fund. The 17 Treasurer may invest the moneys in the Budget Stabilization 18 Fund in the same manner, in the same types of investments, 19 and subject to the same limitations provided in the Illinois 20 Pension Code for the investment of pension funds other than 21 those established under Article 3 or 4 of the Code. 22 (c) All federal financial participation moneys received 23 pursuant to expenditures from the Fund shall be deposited 24 into the Fund. 25 (Source: P.A. 91-646, eff. 11-19-99; 91-704, eff. 7-1-00; 26 91-797, eff. 6-9-00; 92-11, eff. 6-11-01; 92-16, eff. 27 6-28-01.) 28 (30 ILCS 105/6z-55) 29 Sec. 6z-55. 6z-51.Statewide Economic Development Fund. 30 (a)The Statewide Economic Development Fund is created as a 31 special fund in the State treasury. Moneys in the Fund shall 32 be used, subject to appropriation, for the purpose of 33 statewide economic development activities or by the Illinois HB4580 Enrolled -31- LRB9213371REmb 1 Emergency Management Agency for awarding grants to Illinois 2 hospitals and health care facilities to provide for the 3 health and security of Illinois residents. 4 (Source: P.A. 92-208, eff. 8-2-01; revised 10-17-01.) 5 Section 45. The School Code is amended by changing 6 Sections 14-7.03 and 18-3 as follows: 7 (105 ILCS 5/14-7.03) (from Ch. 122, par. 14-7.03) 8 Sec. 14-7.03. Special Education Classes for Children from 9 Orphanages, Foster Family Homes, Children's Homes, or in 10 State Housing Units. If a school district maintains special 11 education classes on the site of orphanages and children's 12 homes, or if children from the orphanages, children's homes, 13 foster family homes, other State agencies, or State 14 residential units for children attend classes for children 15 with disabilities in which the school district is a 16 participating member of a joint agreement, or if the children 17 from the orphanages, children's homes, foster family homes, 18 other State agencies, or State residential units attend 19 classes for the children with disabilities maintained by the 20 school district, then reimbursement shall be paid to eligible 21 districts in accordance with the provisions of this Section 22 by the Comptroller as directed by the State Superintendent of 23 Education. 24 The amount of tuition for such children shall be 25 determined by the actual cost of maintaining such classes, 26 using the per capita cost formula set forth in Section 27 14-7.01, such program and cost to be pre-approved by the 28 State Superintendent of Education. 29 On forms prepared by the State Superintendent of 30 Education, the district shall certify to the regional 31 superintendent the following: 32 (1) The name of the home or State residential unit HB4580 Enrolled -32- LRB9213371REmb 1 with the name of the owner or proprietor and address of 2 those maintaining it; 3 (2) That no service charges or other payments 4 authorized by law were collected in lieu of taxes 5 therefrom or on account thereof during either of the 6 calendar years included in the school year for which 7 claim is being made; 8 (3) The number of children qualifying under this 9 Act in special education classes for instruction on the 10 site of the orphanages and children's homes; 11 (4) The number of children attending special 12 education classes for children with disabilities in which 13 the district is a participating member of a special 14 education joint agreement; 15 (5) The number of children attending special 16 education classes for children with disabilities 17 maintained by the district; 18 (6) The computed amount of tuition payment claimed 19 as due, as approved by the State Superintendent of 20 Education, for maintaining these classes. 21 If a school district makes a claim for reimbursement 22 under Section 18-3 or 18-4 of this Act it shall not include 23 in any claim filed under this Section a claim for such 24 children. Payments authorized by law, including State or 25 federal grants for education of children included in this 26 Section, shall be deducted in determining the tuition amount. 27 Nothing in this Act shall be construed so as to prohibit 28 reimbursement for the tuition of children placed in for 29 profit facilities. Private facilities shall provide adequate 30 space at the facility for special education classes provided 31 by a school district or joint agreement for children with 32 disabilities who are residents of the facility at no cost to 33 the school district or joint agreement upon request of the 34 school district or joint agreement. If such a private HB4580 Enrolled -33- LRB9213371REmb 1 facility provides space at no cost to the district or joint 2 agreement for special education classes provided to children 3 with disabilities who are residents of the facility, the 4 district or joint agreement shall not include any costs for 5 the use of those facilities in its claim for reimbursement. 6 Reimbursement for tuition may include the cost of 7 providing summer school programs for children with severe and 8 profound disabilities served under this Section. Claims for 9 that reimbursement shall be filed by November 1 and shall be 10 paid on or before December 15 from appropriations made for 11 the purposes of this Section. 12 The State Board of Education shall establish such rules 13 and regulations as may be necessary to implement the 14 provisions of this Section. 15 Claims filed on behalf of programs operated under this 16 Section housed in a jail or detention center shall be on an 17 individual student basis only for eligible students with 18 disabilities. These claims shall be in accordance with 19 applicable rules. 20 Each district claiming reimbursement for a program 21 operated as a group program shall have an approved budget on 22 file with the State Board of Education prior to the 23 initiation of the program's operation. On September 30, 24 December 31, and March 31, the State Board of Education shall 25 voucher payments to group programs based upon the approved 26 budget during the year of operation. Final claims for group 27 payments shall be filed on or before July 15. Final claims 28 for group programs received at the State Board of Education 29 on or before June 15 shall be vouchered by June 30. Final 30 claims received at the State Board of Education between June 31 16 and July 15 shall be vouchered by August 30. Claims for 32 group programs received after July 15 shall not be honored. 33 Each district claiming reimbursement for individual 34 students shall have the eligibility of those students HB4580 Enrolled -34- LRB9213371REmb 1 verified by the State Board of Education. On September 30, 2 December 31, and March 31, the State Board of Education shall 3 voucher payments for individual students based upon an 4 estimated cost calculated from the prior year's claim. Final 5 claims for individual students for the regular school term 6 must be received at the State Board of Education by July 15. 7 Claims for individual students received after July 15 shall 8 not be honored. Final claims for individual students shall be 9 vouchered by August 30. 10 Reimbursement shall be made based upon approved group 11 programs or individual students. The State Superintendent of 12 Education shall direct the Comptroller to pay a specified 13 amount to the district by the 30th day of September, 14 December, March, June, or August, respectively. However, 15 notwithstanding any other provisions of this Section or the 16 School Code, beginning with fiscal year 1994 and each fiscal 17 year thereafter through fiscal year 2002, if the amount 18 appropriated for any fiscal year is less than the amount 19 required for purposes of this Section, the amount required to 20 eliminate any insufficient reimbursement for each district 21 claim under this Section shall be reimbursed on August 30 of 22 the next fiscal year, and the .payments required to eliminate 23 any insufficiency for prior fiscal year claims shall be made 24 before any claims are paid for the current fiscal year. 25 Notwithstanding any other provision of this Section or this 26 Code, beginning with fiscal year 2003, total reimbursement 27 under this Section in any fiscal year is limited to the 28 amount appropriated for that purpose for that fiscal year, 29 and if the amount appropriated for any fiscal year is less 30 than the amount required for purposes of this Section, the 31 insufficiency shall be apportioned pro rata among the school 32 districts seeking reimbursement. 33 The claim of a school district otherwise eligible to be 34 reimbursed in accordance with Section 14-12.01 for the HB4580 Enrolled -35- LRB9213371REmb 1 1976-77 school year but for this amendatory Act of 1977 shall 2 not be paid unless the district ceases to maintain such 3 classes for one entire school year. 4 If a school district's current reimbursement payment for 5 the 1977-78 school year only is less than the prior year's 6 reimbursement payment owed, the district shall be paid the 7 amount of the difference between the payments in addition to 8 the current reimbursement payment, and the amount so paid 9 shall be subtracted from the amount of prior year's 10 reimbursement payment owed to the district. 11 Regional superintendents may operate special education 12 classes for children from orphanages, foster family homes, 13 children's homes or State housing units located within the 14 educational services region upon consent of the school board 15 otherwise so obligated. In electing to assume the powers and 16 duties of a school district in providing and maintaining such 17 a special education program, the regional superintendent may 18 enter into joint agreements with other districts and may 19 contract with public or private schools or the orphanage, 20 foster family home, children's home or State housing unit for 21 provision of the special education program. The regional 22 superintendent exercising the powers granted under this 23 Section shall claim the reimbursement authorized by this 24 Section directly from the State Board of Education. 25 Any child who is not a resident of Illinois who is placed 26 in a child welfare institution, private facility, foster 27 family home, State operated program, orphanage or children's 28 home shall have the payment for his educational tuition and 29 any related services assured by the placing agent. 30 Commencing July 1, 1992, for each disabled student who is 31 placed residentially by a State agency or the courts for care 32 or custody or both care and custody, welfare, medical or 33 mental health treatment or both medical and mental health 34 treatment, rehabilitation, and protection, whether placed HB4580 Enrolled -36- LRB9213371REmb 1 there on, before, or after July 1, 1992, the costs for 2 educating the student are eligible for reimbursement under 3 this Section providing the placing agency or court has 4 notified the appropriate school district authorities of the 5 status of student residency where applicable prior to or upon 6 placement. 7 The district of residence of the parent, guardian, or 8 disabled student as defined in Sections 14-1.11 and 14-1.11a 9 is responsible for the actual costs of the student's special 10 education program and is eligible for reimbursement under 11 this Section when placement is made by a State agency or the 12 courts. Payments shall be made by the resident district to 13 the district wherein the facility is located no less than 14 once per quarter unless otherwise agreed to in writing by the 15 parties. 16 When a dispute arises over the determination of the 17 district of residence, the district or districts may appeal 18 the decision in writing to the State Superintendent of 19 Education. The decision of the State Superintendent of 20 Education shall be final. 21 In the event a district does not make a tuition payment 22 to another district that is providing the special education 23 program and services, the State Board of Education shall 24 immediately withhold 125% of the then remaining annual 25 tuition cost from the State aid or categorical aid payment 26 due to the school district that is determined to be the 27 resident school district. All funds withheld by the State 28 Board of Education shall immediately be forwarded to the 29 school district where the student is being served. 30 When a child eligible for services under this Section 31 14-7.03 must be placed in a nonpublic facility, that facility 32 shall meet the programmatic requirements of Section 14-7.02 33 and its regulations, and the educational services shall be 34 funded only in accordance with this Section 14-7.03. HB4580 Enrolled -37- LRB9213371REmb 1 (Source: P.A. 89-235, eff. 8-4-95; 89-397, eff. 8-20-95; 2 89-698, eff. 1-14-97; 90-463, eff. 8-17-97; 90-644, eff. 3 7-24-98.) 4 (105 ILCS 5/18-3) (from Ch. 122, par. 18-3) 5 Sec. 18-3. Tuition of children from orphanages and 6 children's homes. 7 When the children from any home for orphans, dependent, 8 abandoned or maladjusted children maintained by any 9 organization or association admitting to such home children 10 from the State in general or when children residing in a 11 school district wherein the State of Illinois maintains and 12 operates any welfare or penal institution on property owned 13 by the State of Illinois, which contains houses, housing 14 units or housing accommodations within a school district, 15 attend grades kindergarten through 12 of the public schools 16 maintained by that school district, the State Superintendent 17 of Education shall direct the State Comptroller to pay a 18 specified amount sufficient to pay the annual tuition cost of 19 such children who attended such public schools during the 20 regular school year ending on June 30 or the summer term for 21 that school year, and the Comptroller shall pay the amount 22 after receipt of a voucher submitted by the State 23 Superintendent of Education. 24 The amount of the tuition for such children attending the 25 public schools of the district shall be determined by the 26 State Superintendent of Education by multiplying the number 27 of such children in average daily attendance in such schools 28 by 1.2 times the total annual per capita cost of 29 administering the schools of the district. Such total annual 30 per capita cost shall be determined by totaling all expenses 31 of the school district in the educational, operations and 32 maintenance, bond and interest, transportation, Illinois 33 municipal retirement, and rent funds for the school year HB4580 Enrolled -38- LRB9213371REmb 1 preceding the filing of such tuition claims less expenditures 2 not applicable to the regular K-12 program, less offsetting 3 revenues from State sources except those from the common 4 school fund, less offsetting revenues from federal sources 5 except those from federal impaction aid, less student and 6 community service revenues, plus a depreciation allowance; 7 and dividing such total by the average daily attendance for 8 the year. 9 Annually on or before June 30 the superintendent of the 10 district upon forms prepared by the State Superintendent of 11 Education shall certify to the regional superintendent the 12 following: 13 1. The name of the home and of the organization or 14 association maintaining it; or the legal description of 15 the real estate upon which the house, housing units, or 16 housing accommodations are located and that no taxes or 17 service charges or other payments authorized by law to be 18 made in lieu of taxes were collected therefrom or on 19 account thereof during either of the calendar years 20 included in the school year for which claim is being 21 made; 22 2. The number of children from the home or living 23 in such houses, housing units or housing accommodations 24 and attending the schools of the district; 25 3. The total number of children attending the 26 schools of the district; 27 4. The per capita tuition charge of the district; 28 and 29 5. The computed amount of the tuition payment 30 claimed as due. 31 Whenever the persons in charge of such home for orphans, 32 dependent, abandoned or maladjusted children have received 33 from the parent or guardian of any such child or by virtue of 34 an order of court a specific allowance for educating such HB4580 Enrolled -39- LRB9213371REmb 1 child, such persons shall pay to the school board in the 2 district where the child attends school such amount of the 3 allowance as is necessary to pay the tuition required by such 4 district for the education of the child. If the allowance is 5 insufficient to pay the tuition in full the State 6 Superintendent of Education shall direct the Comptroller to 7 pay to the district the difference between the total tuition 8 charged and the amount of the allowance. 9 Whenever the facilities of a school district in which 10 such house, housing units or housing accommodations are 11 located, are limited, pupils may be assigned by that district 12 to the schools of any adjacent district to the limit of the 13 facilities of the adjacent district to properly educate such 14 pupils as shall be determined by the school board of the 15 adjacent district, and the State Superintendent of Education 16 shall direct the Comptroller to pay a specified amount 17 sufficient to pay the annual tuition of the children so 18 assigned to and attending public schools in the adjacent 19 districts and the Comptroller shall draw his warrant upon the 20 State Treasurer for the payment of such amount for the 21 benefit of the adjacent school districts in the same manner 22 as for districts in which the houses, housing units or 23 housing accommodations are located. 24 The school district shall certify to the State 25 Superintendent of Education the report of claims due for such 26 tuition payments on or before July 31. Failure on the part of 27 the school board to certify its claim on July 31 shall 28 constitute a forfeiture by the district of its right to the 29 payment of any such tuition claim for the school year. The 30 State Superintendent of Education shall direct the 31 Comptroller to pay to the district, on or before August 15, 32 the amount due the district for the school year in accordance 33 with the calculation of the claim as set forth in this 34 Section. HB4580 Enrolled -40- LRB9213371REmb 1 Claims for tuition for children from any home for orphans 2 or dependent, abandoned, or maladjusted children beginning 3 with the 1993-1994 school year shall be paid on a current 4 year basis. On September 30, December 31, and March 31, the 5 State Board of Education shall voucher payments for districts 6 with those students based on an estimated cost calculated 7 from the prior year's claim. Final claims for those students 8 for the regular school term and summer term must be received 9 at the State Board of Education by July 31 following the end 10 of the regular school year. Final claims for those students 11 shall be vouchered by August 15. During fiscal year 1994 12 both the 1992-1993 school year and the 1993-1994 school year 13 shall be paid in order to change the cycle of payment from a 14 reimbursement basis to a current year funding basis of 15 payment. However, notwithstanding any other provisions of 16 this Section or the School Code, beginning with fiscal year 17 1994 and each fiscal year thereafter through fiscal year 18 2002, if the amount appropriated for any fiscal year is less 19 than the amount required for purposes of this Section, the 20 amount required to eliminate any insufficient reimbursement 21 for each district claim under this Section shall be 22 reimbursed on August 30 of the next fiscal year, and the .23 payments required to eliminate any insufficiency for prior 24 fiscal year claims shall be made before any claims are paid 25 for the current fiscal year. Notwithstanding any other 26 provision of this Section or this Code, beginning with fiscal 27 year 2003, total reimbursement under this Section in any 28 fiscal year is limited to the amount appropriated for that 29 purpose for that fiscal year, and if the amount appropriated 30 for any fiscal year is less than the amount required for 31 purposes of this Section, the insufficiency shall be 32 apportioned pro rata among the school districts seeking 33 reimbursement. 34 If a school district makes a claim for reimbursement HB4580 Enrolled -41- LRB9213371REmb 1 under Section 18-4 or 14-7.03 it shall not include in any 2 claim filed under this Section children residing on the 3 property of State institutions included in its claim under 4 Section 18-4 or 14-7.03. 5 Any child who is not a resident of Illinois who is placed 6 in a child welfare institution, private facility, State 7 operated program, orphanage or children's home shall have the 8 payment for his educational tuition and any related services 9 assured by the placing agent. 10 In order to provide services appropriate to allow a 11 student under the legal guardianship or custodianship of the 12 State to participate in local school district educational 13 programs, costs may be incurred in appropriate cases by the 14 district that are in excess of 1.2 times the district per 15 capita tuition charge allowed under the provisions of this 16 Section. In the event such excess costs are incurred, they 17 must be documented in accordance with cost rules established 18 under the authority of this Section and may then be claimed 19 for reimbursement under this Section. 20 Planned services for students eligible for this funding 21 must be a collaborative effort between the appropriate State 22 agency or the student's group home or institution and the 23 local school district. 24 (Source: P.A. 91-764, eff. 6-9-00; 92-94, eff. 1-1-02.) 25 Section 50. The State Aid Continuing Appropriation Law 26 is amended by changing Sections 15-10, 15-15, and 15-25 as 27 follows: 28 (105 ILCS 235/15-10) 29 (Section scheduled to be repealed on June 30, 2002) 30 Sec. 15-10. Annual budget; recommendation. The Governor 31 shall include a Common School Fund recommendation to the 32 State Board of Education in the fiscal year 1999 through 2003 HB4580 Enrolled -42- LRB9213371REmb 1 2002annual Budgets sufficient to fund (i) the General State 2 Aid Formula set forth in subsection (E) (Computation of 3 General State Aid) and subsection (H) (Supplemental General 4 State Aid) of Section 18-8.05 of the School Code and (ii) the 5 supplementary payments for school districts set forth in 6 subsection (J) (Supplementary Grants in Aid) of Section 7 18-8.05 of the School Code. 8 (Source: P.A. 92-7, eff. 6-29-01.) 9 (105 ILCS 235/15-15) 10 (Section scheduled to be repealed on June 30, 2002) 11 Sec. 15-15. State Aid Formula; Funding. The General 12 Assembly shall annually make Common School Fund 13 appropriations to the State Board of Education in fiscal 14 years 1999 through 2003 2002sufficient to fund (i) the 15 General State Aid Formula set forth in subsection (E) 16 (Computation of General State Aid) and subsection (H) 17 (Supplemental General State Aid) of Section 18-8.05 of the 18 School Code and (ii) the supplementary payments for school 19 districts set forth in subsection (J) (Supplementary Grants 20 in Aid) of Section 18-8.05 of the School Code. 21 (Source: P.A. 92-7, eff. 6-29-01.) 22 (105 ILCS 235/15-25) 23 (Section scheduled to be repealed on June 30, 2002) 24 Sec. 15-25. Repeal. This Article is repealed June 30, 25 2003. Section 15-20 of this Article is repealed June 30, 26 2002. 27 (Source: P.A. 92-7, eff. 6-29-01.) 28 Section 55. The Public Community College Act is amended 29 by adding Section 2-16.07 as follows: 30 (110 ILCS 805/2-16.07 new) HB4580 Enrolled -43- LRB9213371REmb 1 Sec. 2-16.07. Career and Technical Education Fund. The 2 Career and Technical Education Fund is created as a special 3 fund in the State treasury. The Comptroller shall order 4 transferred and the State Treasurer shall transfer from the 5 Federal Department of Education Fund into the Career and 6 Technical Education Fund such amounts as may be directed in 7 writing by the State Board of Education. All moneys so 8 deposited into the Career and Technical Education Fund may be 9 used, subject to appropriation, by the State Board for 10 operational expenses associated with the administration of 11 Career and Technical Education, for payment of Career and 12 Technical Education grants to colleges, and for payment of 13 costs relating to State leadership activities, as provided by 14 the United States Department of Education. 15 Section 60. The Higher Education Student Assistance 16 Act is amended by adding Sections 65.56 and 77 as 17 follows: 18 (110 ILCS 947/65.56 new) 19 Sec. 65.56. Illinois Teachers and Child Care Providers 20 Loan Repayment Program. 21 (a) In order to encourage academically talented Illinois 22 students to enter and continue teaching in Illinois schools 23 in low-income areas and to encourage students to enter the 24 early child care profession and serve low-income areas, the 25 Commission shall, each year, receive and consider 26 applications for loan repayment assistance under this 27 Section. This program shall be known as the Illinois Teachers 28 and Child Care Providers Loan Repayment Program. The 29 Commission shall administer the program and shall make all 30 necessary and proper rules not inconsistent with this Section 31 for the program's effective implementation. The Commission 32 may use up to 5% of the appropriation for this program for HB4580 Enrolled -44- LRB9213371REmb 1 administration and promotion of teacher incentive programs. 2 (b) Beginning January 1, 2003, subject to a separate 3 appropriation made for such purposes, the Commission shall 4 award a grant to each qualified applicant in an amount equal 5 to the amount of educational loans forgiven on behalf of the 6 qualified applicant pursuant to Sections 424 and 425 of Title 7 IV of the Higher Education Amendments of 1998 (20 U.S.C. 8 1078-10 and 1078-11), up to a maximum of $5,000. The 9 Commission shall encourage the recipient of a grant under 10 this Section to use the grant amount awarded to pay off his 11 or her educational loans. 12 (c) A person is a qualified applicant under this Section 13 if he or she meets all of the following qualifications: 14 (1) The person is a United States citizen or 15 eligible noncitizen. 16 (2) The person is a resident of this State. 17 (3) The person is a borrower who has had an amount 18 of his or her educational loans forgiven pursuant to 19 Sections 424 and 425 of Title IV of the Higher Education 20 Amendments of 1998. 21 (4) The person has fulfilled the obligations set 22 forth by Sections 424 and 425 of Title IV of the Higher 23 Education Amendments of 1998 in this State. 24 (d) All applications for grant assistance under this 25 Section shall be made to the Commission. The form of 26 application and the information required to be set forth in 27 the application shall be determined by the Commission, and 28 the Commission shall require applicants to submit with their 29 applications such supporting documents as the Commission 30 deems necessary. 31 (e) A qualified applicant must apply for a grant under 32 this Section within 6 months after receiving notification of 33 loan forgiveness pursuant to Sections 424 and 425 of Title IV 34 of the Higher Education Amendments of 1998. HB4580 Enrolled -45- LRB9213371REmb 1 (110 ILCS 947/77 new) 2 Sec. 77. Illinois Student Assistance Commission 3 Contracts and Grants Fund. 4 (a) The Illinois Student Assistance Commission Contracts 5 and Grants Fund is created as a special fund in the State 6 treasury. All gifts, grants, or donations of money received 7 by the Commission must be deposited into this Fund. 8 (b) Moneys in the Fund may be used by the Commission, 9 subject to appropriation, for support of the Commission's 10 student assistance outreach activities. 11 (110 ILCS 947/65.57 rep.) 12 Section 65. The Higher Education Student Assistance Act 13 is amended by repealing Section 65.57. 14 Section 70. The Comprehensive Health Insurance Plan Act 15 is amended by changing Section 3 as follows: 16 (215 ILCS 105/3) (from Ch. 73, par. 1303) 17 Sec. 3. Operation of the Plan. 18 a. There is hereby created an Illinois Comprehensive 19 Health Insurance Plan. 20 b. The Plan shall operate subject to the supervision and 21 control of the board. The board is created as a political 22 subdivision and body politic and corporate and, as such, is 23 not a State agency. The board shall consist of 10 public 24 members, appointed by the Governor with the advice and 25 consent of the Senate. 26 Initial members shall be appointed to the Board by the 27 Governor as follows: 2 members to serve until July 1, 1988, 28 and until their successors are appointed and qualified; 2 29 members to serve until July 1, 1989, and until their 30 successors are appointed and qualified; 3 members to serve 31 until July 1, 1990, and until their successors are appointed HB4580 Enrolled -46- LRB9213371REmb 1 and qualified; and 3 members to serve until July 1, 1991, and 2 until their successors are appointed and qualified. As terms 3 of initial members expire, their successors shall be 4 appointed for terms to expire the first day in July 3 years 5 thereafter, and until their successors are appointed and 6 qualified. 7 Any vacancy in the Board occurring for any reason other 8 than the expiration of a term shall be filled for the 9 unexpired term in the same manner as the original 10 appointment. 11 Any member of the Board may be removed by the Governor 12 for neglect of duty, misfeasance, malfeasance, or nonfeasance 13 in office. 14 In addition, a representative of the Bureau of the Budget 15 Illinois Health Care Cost Containment Council, a 16 representative of the Office of the Attorney General and the 17 Director or the Director's designated representative shall be 18 members of the board. Four members of the General Assembly, 19 one each appointed by the President and Minority Leader of 20 the Senate and by the Speaker and Minority Leader of the 21 House of Representatives, shall serve as nonvoting members of 22 the board. At least 2 of the public members shall be 23 individuals reasonably expected to qualify for coverage under 24 the Plan, the parent or spouse of such an individual, or a 25 surviving family member of an individual who could have 26 qualified for the plan during his lifetime. The Director or 27 Director's representative shall be the chairperson of the 28 board. Members of the board shall receive no compensation, 29 but shall be reimbursed for reasonable expenses incurred in 30 the necessary performance of their duties. 31 c. The board shall make an annual report in September 32 and shall file the report with the Secretary of the Senate 33 and the Clerk of the House of Representatives. The report 34 shall summarize the activities of the Plan in the preceding HB4580 Enrolled -47- LRB9213371REmb 1 calendar year, including net written and earned premiums, the 2 expense of administration, the paid and incurred losses for 3 the year and other information as may be requested by the 4 General Assembly. The report shall also include analysis and 5 recommendations regarding utilization review, quality 6 assurance and access to cost effective quality health care. 7 d. In its plan of operation the board shall: 8 (1) Establish procedures for selecting a plan 9 administrator in accordance with Section 5 of this Act. 10 (2) Establish procedures for the operation of the 11 board. 12 (3) Create a Plan fund, under management of the 13 board, to fund administrative, claim, and other expenses 14 of the Plan. 15 (4) Establish procedures for the handling and 16 accounting of assets and monies of the Plan. 17 (5) Develop and implement a program to publicize 18 the existence of the Plan, the eligibility requirements 19 and procedures for enrollment and to maintain public 20 awareness of the Plan. 21 (6) Establish procedures under which applicants and 22 participants may have grievances reviewed by a grievance 23 committee appointed by the board. The grievances shall 24 be reported to the board immediately after completion of 25 the review. The Department and the board shall retain 26 all written complaints regarding the Plan for at least 3 27 years. Oral complaints shall be reduced to written form 28 and maintained for at least 3 years. 29 (7) Provide for other matters as may be necessary 30 and proper for the execution of its powers, duties and 31 obligations under the Plan. 32 e. No later than 5 years after the Plan is operative the 33 board and the Department shall conduct cooperatively a study 34 of the Plan and the persons insured by the Plan to determine: HB4580 Enrolled -48- LRB9213371REmb 1 (1) claims experience including a breakdown of medical 2 conditions for which claims were paid; (2) whether 3 availability of the Plan affected employment opportunities 4 for participants; (3) whether availability of the Plan 5 affected the receipt of medical assistance benefits by Plan 6 participants; (4) whether a change occurred in the number of 7 personal bankruptcies due to medical or other health related 8 costs; (5) data regarding all complaints received about the 9 Plan including its operation and services; (6) and any other 10 significant observations regarding utilization of the Plan. 11 The study shall culminate in a written report to be presented 12 to the Governor, the President of the Senate, the Speaker of 13 the House and the chairpersons of the House and Senate 14 Insurance Committees. The report shall be filed with the 15 Secretary of the Senate and the Clerk of the House of 16 Representatives. The report shall also be available to 17 members of the general public upon request. 18 f. The board may: 19 (1) Prepare and distribute certificate of 20 eligibility forms and enrollment instruction forms to 21 insurance producers and to the general public in this 22 State. 23 (2) Provide for reinsurance of risks incurred by 24 the Plan and enter into reinsurance agreements with 25 insurers to establish a reinsurance plan for risks of 26 coverage described in the Plan, or obtain commercial 27 reinsurance to reduce the risk of loss through the Plan. 28 (3) Issue additional types of health insurance 29 policies to provide optional coverages as are otherwise 30 permitted by this Act including a Medicare supplement 31 policy designed to supplement Medicare. 32 (4) Provide for and employ cost containment 33 measures and requirements including, but not limited to, 34 preadmission certification, second surgical opinion, HB4580 Enrolled -49- LRB9213371REmb 1 concurrent utilization review programs, and individual 2 case management for the purpose of making the pool more 3 cost effective. 4 (5) Design, utilize, contract, or otherwise arrange 5 for the delivery of cost effective health care services, 6 including establishing or contracting with preferred 7 provider organizations, health maintenance organizations, 8 and other limited network provider arrangements. 9 (6) Adopt bylaws, rules, regulations, policies and 10 procedures as may be necessary or convenient for the 11 implementation of the Act and the operation of the Plan. 12 (7) Administer separate pools, separate accounts, 13 or other plans or arrangements as required by this Act to 14 separate federally eligible individuals or groups of 15 federally eligible individuals who qualify for plan 16 coverage under Section 15 of this Act from eligible 17 persons or groups of eligible persons who qualify for 18 plan coverage under Section 7 of this Act and apportion 19 the costs of the administration among such separate 20 pools, separate accounts, or other plans or arrangements. 21 g. The Director may, by rule, establish additional 22 powers and duties of the board and may adopt rules for any 23 other purposes, including the operation of the Plan, as are 24 necessary or proper to implement this Act. 25 h. The board is not liable for any obligation of the 26 Plan. There is no liability on the part of any member or 27 employee of the board or the Department, and no cause of 28 action of any nature may arise against them, for any action 29 taken or omission made by them in the performance of their 30 powers and duties under this Act, unless the action or 31 omission constitutes willful or wanton misconduct. The board 32 may provide in its bylaws or rules for indemnification of, 33 and legal representation for, its members and employees. 34 i. There is no liability on the part of any insurance HB4580 Enrolled -50- LRB9213371REmb 1 producer for the failure of any applicant to be accepted by 2 the Plan unless the failure of the applicant to be accepted 3 by the Plan is due to an act or omission by the insurance 4 producer which constitutes willful or wanton misconduct. 5 (Source: P.A. 90-30, eff. 7-1-97.) 6 Section 75. The Children's Health Insurance Program Act 7 is amended by changing Sections 20, 40, and 97 as follows: 8 (215 ILCS 106/20) 9 (Section scheduled to be repealed on July 1, 2002) 10 Sec. 20. Eligibility. 11 (a) To be eligible for this Program, a person must be a 12 person who has a child eligible under this Act and who is 13 eligible under a waiver of federal requirements pursuant to 14 an application made pursuant to subdivision (a)(1) of Section 15 40 of this Act or who is a child who: 16 (1) is a child who is not eligible for medical 17 assistance; 18 (2) is a child whose annual household income, as 19 determined by the Department, is above 133% of the 20 federal poverty level and at or below 185% of the federal 21 poverty level; 22 (3) is a resident of the State of Illinois; and 23 (4) is a child who is either a United States 24 citizen or included in one of the following categories of 25 non-citizens: 26 (A) unmarried dependent children of either a 27 United States Veteran honorably discharged or a 28 person on active military duty; 29 (B) refugees under Section 207 of the 30 Immigration and Nationality Act; 31 (C) asylees under Section 208 of the 32 Immigration and Nationality Act; HB4580 Enrolled -51- LRB9213371REmb 1 (D) persons for whom deportation has been 2 withheld under Section 243(h) of the Immigration 3 and Nationality Act; 4 (E) persons granted conditional entry under 5 Section 203(a)(7) of the Immigration and Nationality 6 Act as in effect prior to April 1, 1980; 7 (F) persons lawfully admitted for permanent 8 residence under the Immigration and Nationality Act; 9 and 10 (G) parolees, for at least one year, under 11 Section 212(d)(5) of the Immigration and Nationality 12 Act. 13 Those children who are in the categories set forth in 14 subdivisions (4)(F) and (4)(G) of this subsection, who enter 15 the United States on or after August 22, 1996, shall not be 16 eligible for 5 years beginning on the date the child entered 17 the United States. 18 (b) A child who is determined to be eligible for 19 assistance may shallremain eligible for 12 months, provided 20 the child maintains his or her residence in the State, has 21 not yet attained 19 years of age, and is not excluded 22 pursuant to subsection (c). A child who has been determined 23 to be eligible for assistance must reapply or otherwise 24 establish eligibility Eligibility shall be re-determined by25 the Departmentat least annually. An eligible child shall be 26 required, as determined by the Department by rule, to report 27 promptly those changes in income and other circumstances that 28 affect eligibility. The eligibility of a child may be 29 redetermined based on the information reported or may be 30 terminated based on the failure to report or failure to 31 report accurately. A child's responsible relative or 32 caretaker may also be held liable to the Department for any 33 payments made by the Department on such child's behalf that 34 were inappropriate. An applicant shall be provided with HB4580 Enrolled -52- LRB9213371REmb 1 notice of these obligations. 2 (c) A child shall not be eligible for coverage under 3 this Program if: 4 (1) the premium required pursuant to Section 30 of 5 this Act has not been paid. If the required premiums are 6 not paid the liability of the Program shall be limited to 7 benefits incurred under the Program for the time period 8 for which premiums had been paid. If the required 9 monthly premium is not paid, the child shall be 10 ineligible for re-enrollment for a minimum period of 3 11 months. Re-enrollment shall be completed prior to the 12 next covered medical visit and the first month's required 13 premium shall be paid in advance of the next covered 14 medical visit. The Department shall promulgate rules 15 regarding grace periods, notice requirements, and hearing 16 procedures pursuant to this subsection; 17 (2) the child is an inmate of a public institution 18 or a patient in an institution for mental diseases; or 19 (3) the child is a member of a family that is 20 eligible for health benefits covered under the State of 21 Illinois health benefits plan on the basis of a member's 22 employment with a public agency. 23 (Source: P.A. 90-736, eff. 8-12-98.) 24 (215 ILCS 106/40) 25 (Section scheduled to be repealed on July 1, 2002) 26 Sec. 40. Waivers. 27 (a) The Department shall request any necessary waivers 28 of federal requirements in order to allow receipt of federal 29 funding for: 30 (1) the coverage of families with eligible children 31 under this Act; and 32 (2) for the coverage of children who would 33 otherwise be eligible under this Act, but who have health HB4580 Enrolled -53- LRB9213371REmb 1 insurance. 2 (b) The failure of the responsible federal agency to 3 approve a waiver for children who would otherwise be eligible 4 under this Act but who have health insurance shall not 5 prevent the implementation of any Section of this Act 6 provided that there are sufficient appropriated funds. 7 (c) Eligibility of a person under an approved waiver due 8 to the relationship with a child pursuant to Article V of the 9 Illinois Public Aid Code or this Act shall be limited to such 10 a person whose countable income is determined by the 11 Department to be at or below 65% of the federal poverty 12 level. Such persons who are determined to be eligible must 13 reapply, or otherwise establish eligibility, at least 14 annually. An eligible person shall be required, as 15 determined by the Department by rule, to report promptly 16 those changes in income and other circumstances that affect 17 eligibility. The eligibility of a person may be redetermined 18 based on the information reported or may be terminated based 19 on the failure to report or failure to report accurately. A 20 person may also be held liable to the Department for any 21 payments made by the Department on such person's behalf that 22 were inappropriate. An applicant shall be provided with 23 notice of these obligations. 24 (Source: P.A. 90-736, eff. 8-12-98.) 25 (215 ILCS 106/97) 26 (Section scheduled to be repealed on July 1, 2002) 27 Sec. 97. Repealer. This Act is repealed on July 1, 2003 28 2002. 29 (Source: P.A. 90-736, eff. 8-12-98; 91-712, eff. 7-1-00.) 30 Section 80. The Illinois Public Aid Code is amended by 31 changing Sections 5-2, 5-4.1, 5-5.4, 5-5.12, 11-16, 12-3, 32 12-4.34, 12-10.5, and 12-13.05 as follows: HB4580 Enrolled -54- LRB9213371REmb 1 (305 ILCS 5/5-2) (from Ch. 23, par. 5-2) 2 Sec. 5-2. Classes of Persons Eligible. Medical 3 assistance under this Article shall be available to any of 4 the following classes of persons in respect to whom a plan 5 for coverage has been submitted to the Governor by the 6 Illinois Department and approved by him: 7 1. Recipients of basic maintenance grants under Articles 8 III and IV. 9 2. Persons otherwise eligible for basic maintenance 10 under Articles III and IV but who fail to qualify thereunder 11 on the basis of need, and who have insufficient income and 12 resources to meet the costs of necessary medical care, 13 including but not limited to the following: 14 (a) All persons otherwise eligible for basic 15 maintenance under Article III but who fail to qualify 16 under that Article on the basis of need and who meet 17 either of the following requirements: 18 (i) their income, as determined by the 19 Illinois Department in accordance with any federal 20 requirements, is equal to or less than 70% in fiscal 21 year 2001, equal to or less than 85% in fiscal year 22 2002 and until a date to be determined by the 23 Department by rule, and equal to or less than 100% 24 beginning on the date determined by the Department 25 by rule, in fiscal year 2003 and thereafterof the 26 nonfarm income official poverty line, as defined by 27 the federal Office of Management and Budget and 28 revised annually in accordance with Section 673(2) 29 of the Omnibus Budget Reconciliation Act of 1981, 30 applicable to families of the same size; or 31 (ii) their income, after the deduction of 32 costs incurred for medical care and for other types 33 of remedial care, is equal to or less than 70% in 34 fiscal year 2001, equal to or less than 85% in HB4580 Enrolled -55- LRB9213371REmb 1 fiscal year 2002 and until a date to be determined 2 by the Department by rule, and equal to or less than 3 100% beginning on the date determined by the 4 Department by rule, in fiscal year 2003 and5 thereafterof the nonfarm income official poverty 6 line, as defined in item (i) of this subparagraph 7 (a). 8 (b) All persons who would be determined eligible 9 for such basic maintenance under Article IV by 10 disregarding the maximum earned income permitted by 11 federal law. 12 3. Persons who would otherwise qualify for Aid to the 13 Medically Indigent under Article VII. 14 4. Persons not eligible under any of the preceding 15 paragraphs who fall sick, are injured, or die, not having 16 sufficient money, property or other resources to meet the 17 costs of necessary medical care or funeral and burial 18 expenses. 19 5. (a) Women during pregnancy, after the fact of 20 pregnancy has been determined by medical diagnosis, and 21 during the 60-day period beginning on the last day of the 22 pregnancy, together with their infants and children born 23 after September 30, 1983, whose income and resources are 24 insufficient to meet the costs of necessary medical care 25 to the maximum extent possible under Title XIX of the 26 Federal Social Security Act. 27 (b) The Illinois Department and the Governor shall 28 provide a plan for coverage of the persons eligible under 29 paragraph 5(a) by April 1, 1990. Such plan shall provide 30 ambulatory prenatal care to pregnant women during a 31 presumptive eligibility period and establish an income 32 eligibility standard that is equal to 133% of the nonfarm 33 income official poverty line, as defined by the federal 34 Office of Management and Budget and revised annually in HB4580 Enrolled -56- LRB9213371REmb 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 20 and resources to meet the costs of necessary medical care to 21 the maximum extent permitted under Title XIX of the Federal 22 Social Security Act. 23 7. Persons who are 18 years of age or younger and would 24 qualify as disabled as defined under the Federal Supplemental 25 Security Income Program, provided medical service for such 26 persons would be eligible for Federal Financial 27 Participation, and provided the Illinois Department 28 determines that: 29 (a) the person requires a level of care provided by 30 a hospital, skilled nursing facility, or intermediate 31 care facility, as determined by a physician licensed to 32 practice medicine in all its branches; 33 (b) it is appropriate to provide such care outside 34 of an institution, as determined by a physician licensed HB4580 Enrolled -57- LRB9213371REmb 1 to practice medicine in all its branches; 2 (c) the estimated amount which would be expended 3 for care outside the institution is not greater than the 4 estimated amount which would be expended in an 5 institution. 6 8. Persons who become ineligible for basic maintenance 7 assistance under Article IV of this Code in programs 8 administered by the Illinois Department due to employment 9 earnings and persons in assistance units comprised of adults 10 and children who become ineligible for basic maintenance 11 assistance under Article VI of this Code due to employment 12 earnings. The plan for coverage for this class of persons 13 shall: 14 (a) extend the medical assistance coverage for up 15 to 12 months following termination of basic maintenance 16 assistance; and 17 (b) offer persons who have initially received 6 18 months of the coverage provided in paragraph (a) above, 19 the option of receiving an additional 6 months of 20 coverage, subject to the following: 21 (i) such coverage shall be pursuant to 22 provisions of the federal Social Security Act; 23 (ii) such coverage shall include all services 24 covered while the person was eligible for basic 25 maintenance assistance; 26 (iii) no premium shall be charged for such 27 coverage; and 28 (iv) such coverage shall be suspended in the 29 event of a person's failure without good cause to 30 file in a timely fashion reports required for this 31 coverage under the Social Security Act and coverage 32 shall be reinstated upon the filing of such reports 33 if the person remains otherwise eligible. 34 9. Persons with acquired immunodeficiency syndrome HB4580 Enrolled -58- LRB9213371REmb 1 (AIDS) or with AIDS-related conditions with respect to whom 2 there has been a determination that but for home or 3 community-based services such individuals would require the 4 level of care provided in an inpatient hospital, skilled 5 nursing facility or intermediate care facility the cost of 6 which is reimbursed under this Article. Assistance shall be 7 provided to such persons to the maximum extent permitted 8 under Title XIX of the Federal Social Security Act. 9 10. Participants in the long-term care insurance 10 partnership program established under the Partnership for 11 Long-Term Care Act who meet the qualifications for protection 12 of resources described in Section 25 of that Act. 13 11. Persons with disabilities who are employed and 14 eligible for Medicaid, pursuant to Section 15 1902(a)(10)(A)(ii)(xv) of the Social Security Act, as 16 provided by the Illinois Department by rule. 17 12. Subject to federal approval, persons who are 18 eligible for medical assistance coverage under applicable 19 provisions of the federal Social Security Act and the federal 20 Breast and Cervical Cancer Prevention and Treatment Act of 21 2000. Those eligible persons are defined to include, but not 22 be limited to, the following persons: 23 (1) persons who have been screened for breast or 24 cervical cancer under the U.S. Centers for Disease 25 Control and Prevention Breast and Cervical Cancer Program 26 established under Title XV of the federal Public Health 27 Services Act in accordance with the requirements of 28 Section 1504 of that Act as administered by the Illinois 29 Department of Public Health; and 30 (2) persons whose screenings under the above 31 program were funded in whole or in part by funds 32 appropriated to the Illinois Department of Public Health 33 for breast or cervical cancer screening. 34 "Medical assistance" under this paragraph 12 shall be HB4580 Enrolled -59- LRB9213371REmb 1 identical to the benefits provided under the State's approved 2 plan under Title XIX of the Social Security Act. The 3 Department must request federal approval of the coverage 4 under this paragraph 12 within 30 days after the effective 5 date of this amendatory Act of the 92nd General Assembly. 6 The Illinois Department and the Governor shall provide a 7 plan for coverage of the persons eligible under paragraph 7 8 as soon as possible after July 1, 1984. 9 The eligibility of any such person for medical assistance 10 under this Article is not affected by the payment of any 11 grant under the Senior Citizens and Disabled Persons Property 12 Tax Relief and Pharmaceutical Assistance Act or any 13 distributions or items of income described under subparagraph 14 (X) of paragraph (2) of subsection (a) of Section 203 of the 15 Illinois Income Tax Act. The Department shall by rule 16 establish the amounts of assets to be disregarded in 17 determining eligibility for medical assistance, which shall 18 at a minimum equal the amounts to be disregarded under the 19 Federal Supplemental Security Income Program. The amount of 20 assets of a single person to be disregarded shall not be less 21 than $2,000, and the amount of assets of a married couple to 22 be disregarded shall not be less than $3,000. 23 To the extent permitted under federal law, any person 24 found guilty of a second violation of Article VIIIA shall be 25 ineligible for medical assistance under this Article, as 26 provided in Section 8A-8. 27 The eligibility of any person for medical assistance 28 under this Article shall not be affected by the receipt by 29 the person of donations or benefits from fundraisers held for 30 the person in cases of serious illness, as long as neither 31 the person nor members of the person's family have actual 32 control over the donations or benefits or the disbursement of 33 the donations or benefits. 34 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00; HB4580 Enrolled -60- LRB9213371REmb 1 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff. 2 7-3-01.) 3 (305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1) 4 Sec. 5-4.1. Co-payments. The Department may by rule 5 provide that recipients under any Article of this Code (other6 than group care recipients)shall pay a fee as a co-payment 7 for services. Co-payments may not exceed $3 for brand name 8 drugs, $1 one dollarfor other pharmacy services, and $2 for 9 physicians services, dental services, optical services and 10 supplies, chiropractic services, podiatry services, and 11 encounter rate clinic services. Co-payments may not exceed 12 $3 three dollarsfor hospital outpatient and clinic services. 13 Provided, however, that any such rule must provide that no 14 co-payment requirement can exist for renal dialysis, 15 radiation therapy, cancer chemotherapy, or insulin, and other 16 products necessary on a recurring basis, the absence of which 17 would be life threatening, or where co-payment expenditures 18 for required services and/or medications for chronic diseases 19 that the Illinois Department shall by rule designate shall 20 cause an extensive financial burden on the recipient, and 21 provided no co-payment shall exist for emergency room 22 encounters which are for medical emergencies. 23 (Source: P.A. 82-664.) 24 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) 25 Sec. 5-5.4. Standards of Payment - Department of Public 26 Aid. The Department of Public Aid shall develop standards of 27 payment of skilled nursing and intermediate care services in 28 facilities providing such services under this Article which: 29 (1) Provide Providesfor the determination of a 30 facility's payment for skilled nursing and intermediate care 31 services on a prospective basis. The amount of the payment 32 rate for all nursing facilities certified under the medical HB4580 Enrolled -61- LRB9213371REmb 1 assistance program shall be prospectively established 2 annually on the basis of historical, financial, and 3 statistical data reflecting actual costs from prior years, 4 which shall be applied to the current rate year and updated 5 for inflation, except that the capital cost element for newly 6 constructed facilities shall be based upon projected budgets. 7 The annually established payment rate shall take effect on 8 July 1 in 1984 and subsequent years. Rate increases shall be 9 provided annually thereafter on July 1 in 1984 and on each 10 subsequent July 1 in the following years, except that no rate 11 increase and no update for inflation shall be provided on or 12 after July 1, 1994 and before July 1, 2003 2002, unless 13 specifically provided for in this Section. 14 For facilities licensed by the Department of Public 15 Health under the Nursing Home Care Act as Intermediate Care 16 for the Developmentally Disabled facilities or Long Term Care 17 for Under Age 22 facilities, the rates taking effect on July 18 1, 1998 shall include an increase of 3%. For facilities 19 licensed by the Department of Public Health under the Nursing 20 Home Care Act as Skilled Nursing facilities or Intermediate 21 Care facilities, the rates taking effect on July 1, 1998 22 shall include an increase of 3% plus $1.10 per resident-day, 23 as defined by the Department. 24 For facilities licensed by the Department of Public 25 Health under the Nursing Home Care Act as Intermediate Care 26 for the Developmentally Disabled facilities or Long Term Care 27 for Under Age 22 facilities, the rates taking effect on July 28 1, 1999 shall include an increase of 1.6% plus $3.00 per 29 resident-day, as defined by the Department. For facilities 30 licensed by the Department of Public Health under the Nursing 31 Home Care Act as Skilled Nursing facilities or Intermediate 32 Care facilities, the rates taking effect on July 1, 1999 33 shall include an increase of 1.6% and, for services provided 34 on or after October 1, 1999, shall be increased by $4.00 per HB4580 Enrolled -62- LRB9213371REmb 1 resident-day, as defined by the Department. 2 For facilities licensed by the Department of Public 3 Health under the Nursing Home Care Act as Intermediate Care 4 for the Developmentally Disabled facilities or Long Term Care 5 for Under Age 22 facilities, the rates taking effect on July 6 1, 2000 shall include an increase of 2.5% per resident-day, 7 as defined by the Department. For facilities licensed by the 8 Department of Public Health under the Nursing Home Care Act 9 as Skilled Nursing facilities or Intermediate Care 10 facilities, the rates taking effect on July 1, 2000 shall 11 include an increase of 2.5% per resident-day, as defined by 12 the Department. 13 For facilities licensed by the Department of Public 14 Health under the Nursing Home Care Act as Intermediate Care 15 for the Developmentally Disabled facilities or Long Term Care 16 for Under Age 22 facilities, the rates taking effect on March 17 1, 2001 shall include a statewide increase of 7.85%, as 18 defined by the Department. 19 For facilities licensed by the Department of Public 20 Health under the Nursing Home Care Act as Intermediate Care 21 for the Developmentally Disabled facilities or Long Term Care 22 for Under Age 22 facilities, the rates taking effect on April 23 1, 2002 shall include a statewide increase of 2.0%, as 24 defined by the Department. This increase terminates on July 25 1, 2002; beginning July 1, 2002 these rates are reduced to 26 the level of the rates in effect on March 31, 2002, as 27 defined by the Department. 28 For facilities licensed by the Department of Public 29 Health under the Nursing Home Care Act as skilled nursing 30 facilities or intermediate care facilities, the rates taking 31 effect on July 1, 2001, and each subsequent year thereafter, 32 shall be computed using the most recent cost reports on file 33 with the Department of Public Aid no later than April 1, 34 2000, updated for inflation to January 1, 2001. For rates HB4580 Enrolled -63- LRB9213371REmb 1 effective July 1, 2001 only, rates shall be the greater of 2 the rate computed for July 1, 2001 or the rate effective on 3 June 30, 2001. 4 Notwithstanding any other provision of this Section, for 5 facilities licensed by the Department of Public Health under 6 the Nursing Home Care Act as skilled nursing facilities or 7 intermediate care facilities, the Illinois Department shall 8 determine by rule the rates taking effect on July 1, 2002, 9 which shall be 5.9% less than the rates in effect on June 30, 10 2002. 11 Rates established effective each July 1 shall govern 12 payment for services rendered throughout that fiscal year, 13 except that rates established on July 1, 1996 shall be 14 increased by 6.8% for services provided on or after January 15 1, 1997. Such rates will be based upon the rates calculated 16 for the year beginning July 1, 1990, and for subsequent years 17 thereafter until June 30, 2001 shall be based on the facility 18 cost reports for the facility fiscal year ending at any point 19 in time during the previous calendar year, updated to the 20 midpoint of the rate year. The cost report shall be on file 21 with the Department no later than April 1 of the current rate 22 year. Should the cost report not be on file by April 1, the 23 Department shall base the rate on the latest cost report 24 filed by each skilled care facility and intermediate care 25 facility, updated to the midpoint of the current rate year. 26 In determining rates for services rendered on and after July 27 1, 1985, fixed time shall not be computed at less than zero. 28 The Department shall not make any alterations of regulations 29 which would reduce any component of the Medicaid rate to a 30 level below what that component would have been utilizing in 31 the rate effective on July 1, 1984. 32 (2) Shall take into account the actual costs incurred by 33 facilities in providing services for recipients of skilled 34 nursing and intermediate care services under the medical HB4580 Enrolled -64- LRB9213371REmb 1 assistance program. 2 (3) Shall take into account the medical and 3 psycho-social characteristics and needs of the patients. 4 (4) Shall take into account the actual costs incurred by 5 facilities in meeting licensing and certification standards 6 imposed and prescribed by the State of Illinois, any of its 7 political subdivisions or municipalities and by the U.S. 8 Department of Health and Human Services pursuant to Title XIX 9 of the Social Security Act. 10 The Department of Public Aid shall develop precise 11 standards for payments to reimburse nursing facilities for 12 any utilization of appropriate rehabilitative personnel for 13 the provision of rehabilitative services which is authorized 14 by federal regulations, including reimbursement for services 15 provided by qualified therapists or qualified assistants, and 16 which is in accordance with accepted professional practices. 17 Reimbursement also may be made for utilization of other 18 supportive personnel under appropriate supervision. 19 (Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10, 20 eff. 6-11-01; 92-31, eff. 6-28-01; revised 12-13-01.) 21 (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12) 22 Sec. 5-5.12. Pharmacy payments. 23 (a) Every request submitted by a pharmacy for 24 reimbursement under this Article for prescription drugs 25 provided to a recipient of aid under this Article shall 26 include the name of the prescriber or an acceptable 27 identification number as established by the Department. 28 (b) Pharmacies providing prescription drugs under this 29 Article shall be reimbursed at a rate which shall include a 30 professional dispensing fee as determined by the Illinois 31 Department, plus the current acquisition cost of the 32 prescription drug dispensed. The Illinois Department shall 33 update its information on the acquisition costs of all HB4580 Enrolled -65- LRB9213371REmb 1 prescription drugs no less frequently than every 30 days. 2 However, the Illinois Department may set the rate of 3 reimbursement for the acquisition cost, by rule, at a 4 percentage of the current average wholesale acquisition cost. 5 (c) Reimbursement under this Article for prescription 6 drugs shall be limited to reimbursement for 4 brand-name 7 prescription drugs per patient per month. This subsection 8 applies only if (i) the brand-name drug was not prescribed 9 for an acute or urgent condition, (ii) the brand-name drug 10 was not prescribed for Alzheimer's disease, arthritis, 11 diabetes, HIV/AIDS, a mental health condition, or respiratory 12 disease, and (iii) a therapeutically equivalent generic 13 medication has been approved by the federal Food and Drug 14 Administration. 15 (Source: P.A. 88-554, eff. 7-26-94; 89-673, eff. 8-14-96.) 16 (305 ILCS 5/11-16) (from Ch. 23, par. 11-16) 17 Sec. 11-16. Changes in grants; cancellations, 18 revocations, suspensions. 19 (a) All grants of financial aid under this Code shall be 20 considered as frequently as may be required by the rules of 21 the Illinois Department. The Department of Public Aid shall 22 consider grants of financial aid to children who are eligible 23 under Article V of this Code at least annually and shall take 24 into account those reports filed, or required to be filed, 25 pursuant to Sections 11-18 and 11-19. After such 26 investigation as may be necessary, the amount and manner of 27 giving aid may be changed or the aid may be entirely 28 withdrawn if the County Department, local governmental unit, 29 or Illinois Department finds that the recipient's 30 circumstances have altered sufficiently to warrant such 31 action. Financial aid may at any time be canceled or revoked 32 for cause or suspended for such period as may be proper. 33 (b) Whenever any such grant of financial aid is HB4580 Enrolled -66- LRB9213371REmb 1 cancelled, revoked, reduced, or terminated because of the 2 failure of the recipient to cooperate with the Department, 3 including but not limited to the failure to keep an 4 appointment, attend a meeting, or produce proof or 5 verification of eligibility or need, the grant shall be 6 reinstated in full, retroactive to the date of the change in 7 or termination of the grant, provided that within 10 working 8 days after the first day the financial aid would have been 9 available, the recipient cooperates with the Department and 10 is not otherwise ineligible for benefits for the period in 11 question. This subsection (b) does not apply to sanctions 12 imposed for the failure of any recipient to participate as 13 required in the child support enforcement program or in any 14 educational, training, or employment program under this Code 15 or any other sanction under Section 4-21, nor does this 16 subsection (b) apply to any cancellation, revocation, 17 reduction, termination, or sanction imposed for the failure 18 of any recipient to cooperate in the monthly reporting 19 process or the quarterly reporting process. 20 (Source: P.A. 90-17, eff. 7-1-97; 91-357, eff. 7-29-99.) 21 (305 ILCS 5/12-3) (from Ch. 23, par. 12-3) 22 Sec. 12-3. Local governmental units. As provided in 23 Article VI, local governmental units shall provide funds for 24 and administer the programs provided in that Article subject, 25 where so provided, to the supervision of the Illinois 26 Department. Local governmental units shall also provide the 27 social services and utilize the rehabilitative facilities 28 authorized in Article IX for persons served through Article 29 VI, and shall discharge such other duties as may be required 30 by this Code or other laws of this State. 31 In counties not under township organization, the county 32 shall provide funds for and administer such programs. 33 In counties under township organization (including any HB4580 Enrolled -67- LRB9213371REmb 1 such counties in which the governing authority is a board of 2 commissioners) the various towns other than those towns lying 3 entirely within the corporate limits of any city, village or 4 incorporated town having a population of more than 500,000 5 inhabitants shall provide funds for and administer such 6 programs. 7 Cities, villages, and incorporated towns having a 8 population of more than 500,000 inhabitants shall provide 9 funds for public aid purposes under Article VI but the 10 Department of Human Services shall administer the program for 11 such municipality. For the fiscal year beginning July 1, 12 2003, however, the municipality shall decrease by $5,000,000 13 the amount of funds it provides for public aid purposes under 14 Article VI. For each fiscal year thereafter, the 15 municipality shall decrease the amount of funds it provides 16 for public aid purposes under Article VI in that fiscal year 17 by an additional amount equal to (i) $5,000,000 or (ii) the 18 amount provided by the municipality in the preceding fiscal 19 year, whichever is less, until the municipality does not 20 provide any funds for public aid purposes under Article VI. 21 Incorporated towns which have superseded civil townships 22 shall provide funds for and administer the public aid program 23 provided by Article VI. 24 In counties of less than 3 million population having a 25 County Veterans Assistance Commission in which there has been 26 levied a tax as authorized by Section 5-2006 of the Counties 27 Code for the purpose of providing assistance to military 28 veterans and their families, the County Veterans Assistance 29 Commission shall administer the programs provided by Article 30 VI for such military veterans and their families as seek aid 31 through the County Veterans Assistance Commission. 32 (Source: P.A. 92-111, eff. 1-1-02.) 33 (305 ILCS 5/12-4.34) HB4580 Enrolled -68- LRB9213371REmb 1 (Section scheduled to be repealed on August 31, 2002) 2 Sec. 12-4.34. Services to noncitizens. 3 (a) Subject to specific appropriation for this purpose 4 and notwithstanding Sections 1-11 and 3-1 of this Code, the 5 Department of Human Services is authorized to provide 6 services to legal immigrants, including but not limited to 7 naturalization and nutrition services and financial 8 assistance. The nature of these services, payment levels, 9 and eligibility conditions shall be determined by rule. 10 (b) The Illinois Department is authorized to lower the 11 payment levels established under this subsection or take such 12 other actions during the fiscal year as are necessary to 13 ensure that payments under this subsection do not exceed the 14 amounts appropriated for this purpose. These changes may be 15 accomplished by emergency rule under Section 5-45 of the 16 Illinois Administrative Procedure Act, except that the 17 limitation on the number of emergency rules that may be 18 adopted in a 24-month period shall not apply. 19 (c) This Section is repealed on August 31, 2002.20 (Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10, 21 eff. 6-11-01.) 22 (305 ILCS 5/12-10.5) 23 Sec. 12-10.5. Medical Special Purposes Trust Fund. 24 (a) The Medical Special Purposes Trust Fund ("the Fund") 25 is created. Any grant, gift, donation, or legacy of money or 26 securities that the Department of Public Aid is authorized to 27 receive under Section 12-4.18 or Section 12-4.19, and that is 28 dedicated for functions connected with the administration of 29 any medical program administered by the Department, shall be 30 deposited into the Fund. All federal moneys received by the 31 Department as reimbursement for disbursements authorized to 32 be made from the Fund shall also be deposited into the Fund. 33 In addition, federal moneys received on account of State HB4580 Enrolled -69- LRB9213371REmb 1 expenditures made in connection with obtaining compliance 2 with the federal Health Insurance Portability and 3 Accountability Act (HIPAA) shall be deposited into the Fund. 4 (b) No moneys received from a service provider or a 5 governmental or private entity that is enrolled with the 6 Department as a provider of medical services shall be 7 deposited into the Fund. 8 (c) Disbursements may be made from the Fund for the 9 purposes connected with the grants, gifts, donations, or 10 legacies deposited into the Fund, including, but not limited 11 to, medical quality assessment projects, eligibility 12 population studies, medical information systems evaluations, 13 and other administrative functions that assist the Department 14 in fulfilling its health care mission under the Illinois 15 Public Aid Code and the Children's Health Insurance Program 16 Act. 17 (Source: P.A. 92-37, eff. 7-1-01.) 18 (305 ILCS 5/12-13.05) 19 Sec. 12-13.05. Rules for Temporary Assistance for Needy 20 Families. All rules regulating the Temporary Assistance for 21 Needy Families program and all other rules regulating the 22 amendatory changes to this Code made by this amendatory Act 23 of 1997 shall be promulgated pursuant to this Section. All 24 rules regulating the Temporary Assistance for Needy Families 25 program and all other rules regulating the amendatory changes 26 to this Code made by this amendatory Act of 1997 are repealed 27 on July 1 2006 January 1, 2003. On and after July 1, 2006 28 January 1, 2003, the Illinois Department may not promulgate 29 any rules regulating the Temporary Assistance for Needy 30 Families program or regulating the amendatory changes to this 31 Code made by this amendatory Act of 1997. 32 (Source: P.A. 91-5, eff. 5-27-99; 92-111, eff. 1-1-02.) HB4580 Enrolled -70- LRB9213371REmb 1 Section 85. The Senior Citizens and Disabled Persons 2 Property Tax Relief and Pharmaceutical Assistance Act is 3 amended by changing Section 3.16 as follows: 4 (320 ILCS 25/3.16) (from Ch. 67 1/2, par. 403.16) 5 Sec. 3.16. "Reasonable cost" means Average Wholesale 6 Price (AWP) minus 10% for products provided by authorized 7 pharmacies plus a professional dispensing fee determined by 8 the Department in accordance with its findings in a survey of 9 professional pharmacy dispensing fees conducted at least 10 every 12 months. For the purpose of this Act, AWP shall be 11 determined from the latest publication of the Blue Book, a 12 universally subscribed pharmacist reference guide annually 13 published by the Hearst Corporation. AWP may also be derived 14 electronically from the drug pricing database synonymous with 15 the latest publication of the Blue Book and furnished in the 16 National Drug Data File (NDDF) by First Data Bank (FDB), a 17 service of the Hearst Corporation. The elements of such fees 18 and methodology of such survey shall be promulgated as an 19 administrative rule. Effective July 1, 1986, the 20 professional dispensing fee shall be $3.60 per prescription 21 and such amount shall be adjusted on July 1st of each year 22 thereafter in accordance with a survey of professional 23 pharmacy dispensing fees. The Department may establish 24 maximum acquisition costs from time to time based upon 25 information as to the cost at which covered products may be 26 readily acquired by authorized pharmacies. In no case shall 27 the reasonable cost of any given pharmacy exceed the price 28 normally charged to the general public by that pharmacy. In 29 the event that generic equivalents for covered prescription 30 drugs are available at lower cost, the Department shall 31 establish the maximum acquisition costs for such covered 32 prescription drugs at the lower generic cost unless, pursuant 33 to the conditions described in subsection (f) of Section 4, a HB4580 Enrolled -71- LRB9213371REmb 1 non-generic drug may be substituted. 2 Effective July 1, 2002, the rates paid for products 3 provided by authorized pharmacies and a professional 4 dispensing fee shall be determined by the Department by rule. 5 (Source: P.A. 91-699, eff. 1-1-01.) 6 Section 99. Effective date. This Act takes effect upon 7 becoming law, except that Sections 25, 26, 45, 60, and 65 8 take effect on July 1, 2002.
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