Illinois General Assembly - Full Text of HB5203
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Full Text of HB5203  103rd General Assembly

HB5203 103RD GENERAL ASSEMBLY

 


 
103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB5203

 

Introduced 2/9/2024, by Rep. Brad Halbrook

 

SYNOPSIS AS INTRODUCED:
 
New Act
5 ILCS 375/6  from Ch. 127, par. 526
5 ILCS 375/6.1  from Ch. 127, par. 526.1
305 ILCS 5/5-5
305 ILCS 5/5-8  from Ch. 23, par. 5-8
305 ILCS 5/5-9  from Ch. 23, par. 5-9
305 ILCS 5/6-1  from Ch. 23, par. 6-1
410 ILCS 230/4-100  from Ch. 111 1/2, par. 4604-100

    Creates the No Taxpayer Funding for Abortion Act. Provides that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code. Excludes from the programs of health benefits and services authorized under those Acts coverage for elective abortions as provided in the No Taxpayer Funding for Abortion Act. Prohibits a physician who has been found guilty of performing an abortion procedure in a willful and wanton manner upon a woman who was not pregnant when the abortion procedure was performed from participating in the State's Medical Assistance Program. Provides that the Department of Healthcare and Family Services shall require a written statement, including the required opinion of a physician, to accompany a claim for reimbursement for abortions or induced miscarriages or premature births. Makes other changes. Amends the Problem Pregnancy Health Services and Care Act. Permits the Department of Human Services to make grants to nonprofit agencies and organizations that do not use those grants to refer or counsel for, or perform, abortions. Contains provisions regarding applicability and preempts home rule. Effective June 1, 2024.


LRB103 38434 KTG 68570 b

 

 

A BILL FOR

 

HB5203LRB103 38434 KTG 68570 b

1    AN ACT concerning abortion.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the No
5Taxpayer Funding for Abortion Act.
 
6    Section 5. Public policy. It is the public policy of this
7State that the General Assembly of the State of Illinois does
8solemnly declare and find in reaffirmation of the longstanding
9policy of this State that the unborn child is a human being
10from the time of conception and has a right to life and, to the
11extent consistent with the United States Constitution,
12Illinois law should be interpreted to recognize that right to
13life and to protect unborn life.
14    The General Assembly further declares and finds that,
15while the people of Illinois hold a variety of positions on the
16issue of abortion, they generally oppose the use of tax
17dollars to pay for elective abortions and support the federal
18Hyde Amendment, named after the late Henry J. Hyde, whose
19memory is revered and service celebrated as a Congressman from
20the great State of Illinois. This Act honors the strong
21beliefs of the people of Illinois by prohibiting the taxpayer
22funding of abortion in this State.
 

 

 

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1    Section 10. Use of funds to pay for abortions prohibited;
2exceptions. Notwithstanding any other provision of law,
3neither the State nor any of its subdivisions may authorize
4the use of, appropriate, or expend any funds to pay for any
5abortion or to cover any part of the costs of any health plan
6that includes coverage of abortion or to provide or refer for
7any abortion, except in the case where a woman suffers from a
8physical disorder, physical injury, or physical illness that
9would, as certified by a physician, place the woman in danger
10of death unless an abortion is performed, including a
11life-endangering physical condition caused by or arising from
12the pregnancy itself, or in such other circumstances as
13required by federal law.
 
14    Section 900. The State Employees Group Insurance Act of
151971 is amended by changing Sections 6 and 6.1 as follows:
 
16    (5 ILCS 375/6)  (from Ch. 127, par. 526)
17    Sec. 6. Program of health benefits.
18    (a) The program of health benefits shall provide for
19protection against the financial costs of health care expenses
20incurred in and out of hospital including basic
21hospital-surgical-medical coverages. The program may include,
22but shall not be limited to, such supplemental coverages as
23out-patient diagnostic X-ray and laboratory expenses,
24prescription drugs, dental services, hearing evaluations,

 

 

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1hearing aids, the dispensing and fitting of hearing aids, and
2similar group benefits as are now or may become available,
3except as provided in the No Taxpayer Funding for Abortion
4Act. The program may also include coverage for those who rely
5on treatment by prayer or spiritual means alone for healing in
6accordance with the tenets and practice of a recognized
7religious denomination.
8    The program of health benefits shall be designed by the
9Director (1) to provide a reasonable relationship between the
10benefits to be included and the expected distribution of
11expenses of each such type to be incurred by the covered
12members and dependents, (2) to specify, as covered benefits
13and as optional benefits, the medical services of
14practitioners in all categories licensed under the Medical
15Practice Act of 1987, (3) to include reasonable controls,
16which may include deductible and co-insurance provisions,
17applicable to some or all of the benefits, or a coordination of
18benefits provision, to prevent or minimize unnecessary
19utilization of the various hospital, surgical and medical
20expenses to be provided and to provide reasonable assurance of
21stability of the program, and (4) to provide benefits to the
22extent possible to members throughout the State, wherever
23located, on an equitable basis. Notwithstanding any other
24provision of this Section or Act, for all members or
25dependents who are eligible for benefits under Social Security
26or the Railroad Retirement system or who had sufficient

 

 

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1Medicare-covered government employment, the Department shall
2reduce benefits which would otherwise be paid by Medicare, by
3the amount of benefits for which the member or dependents are
4eligible under Medicare, except that such reduction in
5benefits shall apply only to those members or dependents who
6(1) first become eligible for such medicare coverage on or
7after the effective date of this amendatory Act of 1992; or (2)
8are Medicare-eligible members or dependents of a local
9government unit which began participation in the program on or
10after July 1, 1992; or (3) remain eligible for but no longer
11receive Medicare coverage which they had been receiving on or
12after the effective date of this amendatory Act of 1992.
13    Notwithstanding any other provisions of this Act, where a
14covered member or dependents are eligible for benefits under
15the federal Medicare health insurance program (Title XVIII of
16the Social Security Act as added by Public Law 89-97, 89th
17Congress), benefits paid under the State of Illinois program
18or plan will be reduced by the amount of benefits paid by
19Medicare. For members or dependents who are eligible for
20benefits under Social Security or the Railroad Retirement
21system or who had sufficient Medicare-covered government
22employment, benefits shall be reduced by the amount for which
23the member or dependent is eligible under Medicare, except
24that such reduction in benefits shall apply only to those
25members or dependents who (1) first become eligible for such
26Medicare coverage on or after the effective date of this

 

 

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1amendatory Act of 1992; or (2) are Medicare-eligible members
2or dependents of a local government unit which began
3participation in the program on or after July 1, 1992; or (3)
4remain eligible for, but no longer receive Medicare coverage
5which they had been receiving on or after the effective date of
6this amendatory Act of 1992. Premiums may be adjusted, where
7applicable, to an amount deemed by the Director to be
8reasonably consistent with any reduction of benefits.
9    (b) A member, not otherwise covered by this Act, who has
10retired as a participating member under Article 2 of the
11Illinois Pension Code but is ineligible for the retirement
12annuity under Section 2-119 of the Illinois Pension Code,
13shall pay the premiums for coverage, not exceeding the amount
14paid by the State for the non-contributory coverage for other
15members, under the group health benefits program under this
16Act. The Director shall determine the premiums to be paid by a
17member under this subsection (b).
18(Source: P.A. 100-538, eff. 1-1-18.)
 
19    (5 ILCS 375/6.1)  (from Ch. 127, par. 526.1)
20    Sec. 6.1. The program of health benefits may offer as an
21alternative, available on an optional basis, coverage through
22health maintenance organizations or other managed care
23programs. That part of the premium for such coverage which is
24in excess of the amount which would otherwise be paid by the
25State for the program of health benefits shall be paid by the

 

 

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1member who elects such alternative coverage and shall be
2collected as provided for premiums for other optional
3coverages, except as provided in the No Taxpayer Funding for
4Abortion Act.
5(Source: P.A. 102-19, eff. 7-1-21.)
 
6    Section 905. The Illinois Public Aid Code is amended by
7changing Sections 5-5, 5-8, 5-9, and 6-1 as follows:
 
8    (305 ILCS 5/5-5)
9    Sec. 5-5. Medical services. The Illinois Department, by
10rule, shall determine the quantity and quality of and the rate
11of reimbursement for the medical assistance for which payment
12will be authorized, and the medical services to be provided,
13which may include all or part of the following: (1) inpatient
14hospital services; (2) outpatient hospital services; (3) other
15laboratory and X-ray services; (4) skilled nursing home
16services; (5) physicians' services whether furnished in the
17office, the patient's home, a hospital, a skilled nursing
18home, or elsewhere; (6) medical care, or any other type of
19remedial care furnished by licensed practitioners; (7) home
20health care services; (8) private duty nursing service; (9)
21clinic services; (10) dental services, including prevention
22and treatment of periodontal disease and dental caries disease
23for pregnant individuals, provided by an individual licensed
24to practice dentistry or dental surgery; for purposes of this

 

 

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1item (10), "dental services" means diagnostic, preventive, or
2corrective procedures provided by or under the supervision of
3a dentist in the practice of his or her profession; (11)
4physical therapy and related services; (12) prescribed drugs,
5dentures, and prosthetic devices; and eyeglasses prescribed by
6a physician skilled in the diseases of the eye, or by an
7optometrist, whichever the person may select; (13) other
8diagnostic, screening, preventive, and rehabilitative
9services, including to ensure that the individual's need for
10intervention or treatment of mental disorders or substance use
11disorders or co-occurring mental health and substance use
12disorders is determined using a uniform screening, assessment,
13and evaluation process inclusive of criteria, for children and
14adults; for purposes of this item (13), a uniform screening,
15assessment, and evaluation process refers to a process that
16includes an appropriate evaluation and, as warranted, a
17referral; "uniform" does not mean the use of a singular
18instrument, tool, or process that all must utilize; (14)
19transportation and such other expenses as may be necessary;
20(15) medical treatment of sexual assault survivors, as defined
21in Section 1a of the Sexual Assault Survivors Emergency
22Treatment Act, for injuries sustained as a result of the
23sexual assault, including examinations and laboratory tests to
24discover evidence which may be used in criminal proceedings
25arising from the sexual assault; (16) the diagnosis and
26treatment of sickle cell anemia; (16.5) services performed by

 

 

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1a chiropractic physician licensed under the Medical Practice
2Act of 1987 and acting within the scope of his or her license,
3including, but not limited to, chiropractic manipulative
4treatment; and (17) any other medical care, and any other type
5of remedial care recognized under the laws of this State,
6except as provided in the No Taxpayer Funding for Abortion
7Act. The Illinois Department, by rule, shall prohibit any
8physician from providing medical assistance to anyone eligible
9therefor under this Code where such physician has been found
10guilty of performing an abortion procedure in a willful and
11wanton manner upon a woman who was not pregnant at the time
12such abortion procedure was performed. The term "any other
13type of remedial care" shall include nursing care and nursing
14home service for persons who rely on treatment by spiritual
15means alone through prayer for healing.
16    Notwithstanding any other provision of this Section, a
17comprehensive tobacco use cessation program that includes
18purchasing prescription drugs or prescription medical devices
19approved by the Food and Drug Administration shall be covered
20under the medical assistance program under this Article for
21persons who are otherwise eligible for assistance under this
22Article.
23    Notwithstanding any other provision of this Code,
24reproductive health care that is otherwise legal in Illinois
25shall be covered under the medical assistance program for
26persons who are otherwise eligible for medical assistance

 

 

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1under this Article, except as provided in the No Taxpayer
2Funding for Abortion Act.
3    Notwithstanding any other provision of this Section, all
4tobacco cessation medications approved by the United States
5Food and Drug Administration and all individual and group
6tobacco cessation counseling services and telephone-based
7counseling services and tobacco cessation medications provided
8through the Illinois Tobacco Quitline shall be covered under
9the medical assistance program for persons who are otherwise
10eligible for assistance under this Article. The Department
11shall comply with all federal requirements necessary to obtain
12federal financial participation, as specified in 42 CFR
13433.15(b)(7), for telephone-based counseling services provided
14through the Illinois Tobacco Quitline, including, but not
15limited to: (i) entering into a memorandum of understanding or
16interagency agreement with the Department of Public Health, as
17administrator of the Illinois Tobacco Quitline; and (ii)
18developing a cost allocation plan for Medicaid-allowable
19Illinois Tobacco Quitline services in accordance with 45 CFR
2095.507. The Department shall submit the memorandum of
21understanding or interagency agreement, the cost allocation
22plan, and all other necessary documentation to the Centers for
23Medicare and Medicaid Services for review and approval.
24Coverage under this paragraph shall be contingent upon federal
25approval.
26    Notwithstanding any other provision of this Code, the

 

 

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1Illinois Department may not require, as a condition of payment
2for any laboratory test authorized under this Article, that a
3physician's handwritten signature appear on the laboratory
4test order form. The Illinois Department may, however, impose
5other appropriate requirements regarding laboratory test order
6documentation.
7    Upon receipt of federal approval of an amendment to the
8Illinois Title XIX State Plan for this purpose, the Department
9shall authorize the Chicago Public Schools (CPS) to procure a
10vendor or vendors to manufacture eyeglasses for individuals
11enrolled in a school within the CPS system. CPS shall ensure
12that its vendor or vendors are enrolled as providers in the
13medical assistance program and in any capitated Medicaid
14managed care entity (MCE) serving individuals enrolled in a
15school within the CPS system. Under any contract procured
16under this provision, the vendor or vendors must serve only
17individuals enrolled in a school within the CPS system. Claims
18for services provided by CPS's vendor or vendors to recipients
19of benefits in the medical assistance program under this Code,
20the Children's Health Insurance Program, or the Covering ALL
21KIDS Health Insurance Program shall be submitted to the
22Department or the MCE in which the individual is enrolled for
23payment and shall be reimbursed at the Department's or the
24MCE's established rates or rate methodologies for eyeglasses.
25    On and after July 1, 2012, the Department of Healthcare
26and Family Services may provide the following services to

 

 

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1persons eligible for assistance under this Article who are
2participating in education, training or employment programs
3operated by the Department of Human Services as successor to
4the Department of Public Aid:
5        (1) dental services provided by or under the
6    supervision of a dentist; and
7        (2) eyeglasses prescribed by a physician skilled in
8    the diseases of the eye, or by an optometrist, whichever
9    the person may select.
10    On and after July 1, 2018, the Department of Healthcare
11and Family Services shall provide dental services to any adult
12who is otherwise eligible for assistance under the medical
13assistance program. As used in this paragraph, "dental
14services" means diagnostic, preventative, restorative, or
15corrective procedures, including procedures and services for
16the prevention and treatment of periodontal disease and dental
17caries disease, provided by an individual who is licensed to
18practice dentistry or dental surgery or who is under the
19supervision of a dentist in the practice of his or her
20profession.
21    On and after July 1, 2018, targeted dental services, as
22set forth in Exhibit D of the Consent Decree entered by the
23United States District Court for the Northern District of
24Illinois, Eastern Division, in the matter of Memisovski v.
25Maram, Case No. 92 C 1982, that are provided to adults under
26the medical assistance program shall be established at no less

 

 

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1than the rates set forth in the "New Rate" column in Exhibit D
2of the Consent Decree for targeted dental services that are
3provided to persons under the age of 18 under the medical
4assistance program.
5    Notwithstanding any other provision of this Code and
6subject to federal approval, the Department may adopt rules to
7allow a dentist who is volunteering his or her service at no
8cost to render dental services through an enrolled
9not-for-profit health clinic without the dentist personally
10enrolling as a participating provider in the medical
11assistance program. A not-for-profit health clinic shall
12include a public health clinic or Federally Qualified Health
13Center or other enrolled provider, as determined by the
14Department, through which dental services covered under this
15Section are performed. The Department shall establish a
16process for payment of claims for reimbursement for covered
17dental services rendered under this provision.
18    On and after January 1, 2022, the Department of Healthcare
19and Family Services shall administer and regulate a
20school-based dental program that allows for the out-of-office
21delivery of preventative dental services in a school setting
22to children under 19 years of age. The Department shall
23establish, by rule, guidelines for participation by providers
24and set requirements for follow-up referral care based on the
25requirements established in the Dental Office Reference Manual
26published by the Department that establishes the requirements

 

 

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1for dentists participating in the All Kids Dental School
2Program. Every effort shall be made by the Department when
3developing the program requirements to consider the different
4geographic differences of both urban and rural areas of the
5State for initial treatment and necessary follow-up care. No
6provider shall be charged a fee by any unit of local government
7to participate in the school-based dental program administered
8by the Department. Nothing in this paragraph shall be
9construed to limit or preempt a home rule unit's or school
10district's authority to establish, change, or administer a
11school-based dental program in addition to, or independent of,
12the school-based dental program administered by the
13Department.
14    The Illinois Department, by rule, may distinguish and
15classify the medical services to be provided only in
16accordance with the classes of persons designated in Section
175-2.
18    The Department of Healthcare and Family Services must
19provide coverage and reimbursement for amino acid-based
20elemental formulas, regardless of delivery method, for the
21diagnosis and treatment of (i) eosinophilic disorders and (ii)
22short bowel syndrome when the prescribing physician has issued
23a written order stating that the amino acid-based elemental
24formula is medically necessary.
25    The Illinois Department shall authorize the provision of,
26and shall authorize payment for, screening by low-dose

 

 

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1mammography for the presence of occult breast cancer for
2individuals 35 years of age or older who are eligible for
3medical assistance under this Article, as follows:
4        (A) A baseline mammogram for individuals 35 to 39
5    years of age.
6        (B) An annual mammogram for individuals 40 years of
7    age or older.
8        (C) A mammogram at the age and intervals considered
9    medically necessary by the individual's health care
10    provider for individuals under 40 years of age and having
11    a family history of breast cancer, prior personal history
12    of breast cancer, positive genetic testing, or other risk
13    factors.
14        (D) A comprehensive ultrasound screening and MRI of an
15    entire breast or breasts if a mammogram demonstrates
16    heterogeneous or dense breast tissue or when medically
17    necessary as determined by a physician licensed to
18    practice medicine in all of its branches.
19        (E) A screening MRI when medically necessary, as
20    determined by a physician licensed to practice medicine in
21    all of its branches.
22        (F) A diagnostic mammogram when medically necessary,
23    as determined by a physician licensed to practice medicine
24    in all its branches, advanced practice registered nurse,
25    or physician assistant.
26    The Department shall not impose a deductible, coinsurance,

 

 

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1copayment, or any other cost-sharing requirement on the
2coverage provided under this paragraph; except that this
3sentence does not apply to coverage of diagnostic mammograms
4to the extent such coverage would disqualify a high-deductible
5health plan from eligibility for a health savings account
6pursuant to Section 223 of the Internal Revenue Code (26
7U.S.C. 223).
8    All screenings shall include a physical breast exam,
9instruction on self-examination and information regarding the
10frequency of self-examination and its value as a preventative
11tool.
12     For purposes of this Section:
13    "Diagnostic mammogram" means a mammogram obtained using
14diagnostic mammography.
15    "Diagnostic mammography" means a method of screening that
16is designed to evaluate an abnormality in a breast, including
17an abnormality seen or suspected on a screening mammogram or a
18subjective or objective abnormality otherwise detected in the
19breast.
20    "Low-dose mammography" means the x-ray examination of the
21breast using equipment dedicated specifically for mammography,
22including the x-ray tube, filter, compression device, and
23image receptor, with an average radiation exposure delivery of
24less than one rad per breast for 2 views of an average size
25breast. The term also includes digital mammography and
26includes breast tomosynthesis.

 

 

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1    "Breast tomosynthesis" means a radiologic procedure that
2involves the acquisition of projection images over the
3stationary breast to produce cross-sectional digital
4three-dimensional images of the breast.
5    If, at any time, the Secretary of the United States
6Department of Health and Human Services, or its successor
7agency, promulgates rules or regulations to be published in
8the Federal Register or publishes a comment in the Federal
9Register or issues an opinion, guidance, or other action that
10would require the State, pursuant to any provision of the
11Patient Protection and Affordable Care Act (Public Law
12111-148), including, but not limited to, 42 U.S.C.
1318031(d)(3)(B) or any successor provision, to defray the cost
14of any coverage for breast tomosynthesis outlined in this
15paragraph, then the requirement that an insurer cover breast
16tomosynthesis is inoperative other than any such coverage
17authorized under Section 1902 of the Social Security Act, 42
18U.S.C. 1396a, and the State shall not assume any obligation
19for the cost of coverage for breast tomosynthesis set forth in
20this paragraph.
21    On and after January 1, 2016, the Department shall ensure
22that all networks of care for adult clients of the Department
23include access to at least one breast imaging Center of
24Imaging Excellence as certified by the American College of
25Radiology.
26    On and after January 1, 2012, providers participating in a

 

 

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1quality improvement program approved by the Department shall
2be reimbursed for screening and diagnostic mammography at the
3same rate as the Medicare program's rates, including the
4increased reimbursement for digital mammography and, after
5January 1, 2023 (the effective date of Public Act 102-1018),
6breast tomosynthesis.
7    The Department shall convene an expert panel including
8representatives of hospitals, free-standing mammography
9facilities, and doctors, including radiologists, to establish
10quality standards for mammography.
11    On and after January 1, 2017, providers participating in a
12breast cancer treatment quality improvement program approved
13by the Department shall be reimbursed for breast cancer
14treatment at a rate that is no lower than 95% of the Medicare
15program's rates for the data elements included in the breast
16cancer treatment quality program.
17    The Department shall convene an expert panel, including
18representatives of hospitals, free-standing breast cancer
19treatment centers, breast cancer quality organizations, and
20doctors, including breast surgeons, reconstructive breast
21surgeons, oncologists, and primary care providers to establish
22quality standards for breast cancer treatment.
23    Subject to federal approval, the Department shall
24establish a rate methodology for mammography at federally
25qualified health centers and other encounter-rate clinics.
26These clinics or centers may also collaborate with other

 

 

HB5203- 18 -LRB103 38434 KTG 68570 b

1hospital-based mammography facilities. By January 1, 2016, the
2Department shall report to the General Assembly on the status
3of the provision set forth in this paragraph.
4    The Department shall establish a methodology to remind
5individuals who are age-appropriate for screening mammography,
6but who have not received a mammogram within the previous 18
7months, of the importance and benefit of screening
8mammography. The Department shall work with experts in breast
9cancer outreach and patient navigation to optimize these
10reminders and shall establish a methodology for evaluating
11their effectiveness and modifying the methodology based on the
12evaluation.
13    The Department shall establish a performance goal for
14primary care providers with respect to their female patients
15over age 40 receiving an annual mammogram. This performance
16goal shall be used to provide additional reimbursement in the
17form of a quality performance bonus to primary care providers
18who meet that goal.
19    The Department shall devise a means of case-managing or
20patient navigation for beneficiaries diagnosed with breast
21cancer. This program shall initially operate as a pilot
22program in areas of the State with the highest incidence of
23mortality related to breast cancer. At least one pilot program
24site shall be in the metropolitan Chicago area and at least one
25site shall be outside the metropolitan Chicago area. On or
26after July 1, 2016, the pilot program shall be expanded to

 

 

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1include one site in western Illinois, one site in southern
2Illinois, one site in central Illinois, and 4 sites within
3metropolitan Chicago. An evaluation of the pilot program shall
4be carried out measuring health outcomes and cost of care for
5those served by the pilot program compared to similarly
6situated patients who are not served by the pilot program.
7    The Department shall require all networks of care to
8develop a means either internally or by contract with experts
9in navigation and community outreach to navigate cancer
10patients to comprehensive care in a timely fashion. The
11Department shall require all networks of care to include
12access for patients diagnosed with cancer to at least one
13academic commission on cancer-accredited cancer program as an
14in-network covered benefit.
15    The Department shall provide coverage and reimbursement
16for a human papillomavirus (HPV) vaccine that is approved for
17marketing by the federal Food and Drug Administration for all
18persons between the ages of 9 and 45. Subject to federal
19approval, the Department shall provide coverage and
20reimbursement for a human papillomavirus (HPV) vaccine for
21persons of the age of 46 and above who have been diagnosed with
22cervical dysplasia with a high risk of recurrence or
23progression. The Department shall disallow any
24preauthorization requirements for the administration of the
25human papillomavirus (HPV) vaccine.
26    On or after July 1, 2022, individuals who are otherwise

 

 

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1eligible for medical assistance under this Article shall
2receive coverage for perinatal depression screenings for the
312-month period beginning on the last day of their pregnancy.
4Medical assistance coverage under this paragraph shall be
5conditioned on the use of a screening instrument approved by
6the Department.
7    Any medical or health care provider shall immediately
8recommend, to any pregnant individual who is being provided
9prenatal services and is suspected of having a substance use
10disorder as defined in the Substance Use Disorder Act,
11referral to a local substance use disorder treatment program
12licensed by the Department of Human Services or to a licensed
13hospital which provides substance abuse treatment services.
14The Department of Healthcare and Family Services shall assure
15coverage for the cost of treatment of the drug abuse or
16addiction for pregnant recipients in accordance with the
17Illinois Medicaid Program in conjunction with the Department
18of Human Services.
19    All medical providers providing medical assistance to
20pregnant individuals under this Code shall receive information
21from the Department on the availability of services under any
22program providing case management services for addicted
23individuals, including information on appropriate referrals
24for other social services that may be needed by addicted
25individuals in addition to treatment for addiction.
26    The Illinois Department, in cooperation with the

 

 

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

 

 

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

 

 

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1    Medical providers shall be required to meet certain
2qualifications to participate in Partnerships to ensure the
3delivery of high quality medical services. These
4qualifications shall be determined by rule of the Illinois
5Department and may be higher than qualifications for
6participation in the medical assistance program. Partnership
7sponsors may prescribe reasonable additional qualifications
8for participation by medical providers, only with the prior
9written approval of the Illinois Department.
10    Nothing in this Section shall limit the free choice of
11practitioners, hospitals, and other providers of medical
12services by clients. In order to ensure patient freedom of
13choice, the Illinois Department shall immediately promulgate
14all rules and take all other necessary actions so that
15provided services may be accessed from therapeutically
16certified optometrists to the full extent of the Illinois
17Optometric Practice Act of 1987 without discriminating between
18service providers.
19    The Department shall apply for a waiver from the United
20States Health Care Financing Administration to allow for the
21implementation of Partnerships under this Section.
22    The Illinois Department shall require health care
23providers to maintain records that document the medical care
24and services provided to recipients of Medical Assistance
25under this Article. Such records must be retained for a period
26of not less than 6 years from the date of service or as

 

 

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1provided by applicable State law, whichever period is longer,
2except that if an audit is initiated within the required
3retention period then the records must be retained until the
4audit is completed and every exception is resolved. The
5Illinois Department shall require health care providers to
6make available, when authorized by the patient, in writing,
7the medical records in a timely fashion to other health care
8providers who are treating or serving persons eligible for
9Medical Assistance under this Article. All dispensers of
10medical services shall be required to maintain and retain
11business and professional records sufficient to fully and
12accurately document the nature, scope, details and receipt of
13the health care provided to persons eligible for medical
14assistance under this Code, in accordance with regulations
15promulgated by the Illinois Department. The rules and
16regulations shall require that proof of the receipt of
17prescription drugs, dentures, prosthetic devices and
18eyeglasses by eligible persons under this Section accompany
19each claim for reimbursement submitted by the dispenser of
20such medical services. No such claims for reimbursement shall
21be approved for payment by the Illinois Department without
22such proof of receipt, unless the Illinois Department shall
23have put into effect and shall be operating a system of
24post-payment audit and review which shall, on a sampling
25basis, be deemed adequate by the Illinois Department to assure
26that such drugs, dentures, prosthetic devices and eyeglasses

 

 

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1for which payment is being made are actually being received by
2eligible recipients. Within 90 days after September 16, 1984
3(the effective date of Public Act 83-1439), the Illinois
4Department shall establish a current list of acquisition costs
5for all prosthetic devices and any other items recognized as
6medical equipment and supplies reimbursable under this Article
7and shall update such list on a quarterly basis, except that
8the acquisition costs of all prescription drugs shall be
9updated no less frequently than every 30 days as required by
10Section 5-5.12.
11    The rules and regulations of the Illinois Department shall
12require that a written statement including the required
13opinion of a physician shall accompany any claim for
14reimbursement for abortions or induced miscarriages or
15premature births. This statement shall indicate what
16procedures were used in providing such medical services.
17    Notwithstanding any other law to the contrary, the
18Illinois Department shall, within 365 days after July 22, 2013
19(the effective date of Public Act 98-104), establish
20procedures to permit skilled care facilities licensed under
21the Nursing Home Care Act to submit monthly billing claims for
22reimbursement purposes. Following development of these
23procedures, the Department shall, by July 1, 2016, test the
24viability of the new system and implement any necessary
25operational or structural changes to its information
26technology platforms in order to allow for the direct

 

 

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1acceptance and payment of nursing home claims.
2    Notwithstanding any other law to the contrary, the
3Illinois Department shall, within 365 days after August 15,
42014 (the effective date of Public Act 98-963), establish
5procedures to permit ID/DD facilities licensed under the ID/DD
6Community Care Act and MC/DD facilities licensed under the
7MC/DD Act to submit monthly billing claims for reimbursement
8purposes. Following development of these procedures, the
9Department shall have an additional 365 days to test the
10viability of the new system and to ensure that any necessary
11operational or structural changes to its information
12technology platforms are implemented.
13    The Illinois Department shall require all dispensers of
14medical services, other than an individual practitioner or
15group of practitioners, desiring to participate in the Medical
16Assistance program established under this Article to disclose
17all financial, beneficial, ownership, equity, surety or other
18interests in any and all firms, corporations, partnerships,
19associations, business enterprises, joint ventures, agencies,
20institutions or other legal entities providing any form of
21health care services in this State under this Article.
22    The Illinois Department may require that all dispensers of
23medical services desiring to participate in the medical
24assistance program established under this Article disclose,
25under such terms and conditions as the Illinois Department may
26by rule establish, all inquiries from clients and attorneys

 

 

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1regarding medical bills paid by the Illinois Department, which
2inquiries could indicate potential existence of claims or
3liens for the Illinois Department.
4    Enrollment of a vendor shall be subject to a provisional
5period and shall be conditional for one year. During the
6period of conditional enrollment, the Department may terminate
7the vendor's eligibility to participate in, or may disenroll
8the vendor from, the medical assistance program without cause.
9Unless otherwise specified, such termination of eligibility or
10disenrollment is not subject to the Department's hearing
11process. However, a disenrolled vendor may reapply without
12penalty.
13    The Department has the discretion to limit the conditional
14enrollment period for vendors based upon the category of risk
15of the vendor.
16    Prior to enrollment and during the conditional enrollment
17period in the medical assistance program, all vendors shall be
18subject to enhanced oversight, screening, and review based on
19the risk of fraud, waste, and abuse that is posed by the
20category of risk of the vendor. The Illinois Department shall
21establish the procedures for oversight, screening, and review,
22which may include, but need not be limited to: criminal and
23financial background checks; fingerprinting; license,
24certification, and authorization verifications; unscheduled or
25unannounced site visits; database checks; prepayment audit
26reviews; audits; payment caps; payment suspensions; and other

 

 

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1screening as required by federal or State law.
2    The Department shall define or specify the following: (i)
3by provider notice, the "category of risk of the vendor" for
4each type of vendor, which shall take into account the level of
5screening applicable to a particular category of vendor under
6federal law and regulations; (ii) by rule or provider notice,
7the maximum length of the conditional enrollment period for
8each category of risk of the vendor; and (iii) by rule, the
9hearing rights, if any, afforded to a vendor in each category
10of risk of the vendor that is terminated or disenrolled during
11the conditional enrollment period.
12    To be eligible for payment consideration, a vendor's
13payment claim or bill, either as an initial claim or as a
14resubmitted claim following prior rejection, must be received
15by the Illinois Department, or its fiscal intermediary, no
16later than 180 days after the latest date on the claim on which
17medical goods or services were provided, with the following
18exceptions:
19        (1) In the case of a provider whose enrollment is in
20    process by the Illinois Department, the 180-day period
21    shall not begin until the date on the written notice from
22    the Illinois Department that the provider enrollment is
23    complete.
24        (2) In the case of errors attributable to the Illinois
25    Department or any of its claims processing intermediaries
26    which result in an inability to receive, process, or

 

 

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1    adjudicate a claim, the 180-day period shall not begin
2    until the provider has been notified of the error.
3        (3) In the case of a provider for whom the Illinois
4    Department initiates the monthly billing process.
5        (4) In the case of a provider operated by a unit of
6    local government with a population exceeding 3,000,000
7    when local government funds finance federal participation
8    for claims payments.
9    For claims for services rendered during a period for which
10a recipient received retroactive eligibility, claims must be
11filed within 180 days after the Department determines the
12applicant is eligible. For claims for which the Illinois
13Department is not the primary payer, claims must be submitted
14to the Illinois Department within 180 days after the final
15adjudication by the primary payer.
16    In the case of long term care facilities, within 120
17calendar days of receipt by the facility of required
18prescreening information, new admissions with associated
19admission documents shall be submitted through the Medical
20Electronic Data Interchange (MEDI) or the Recipient
21Eligibility Verification (REV) System or shall be submitted
22directly to the Department of Human Services using required
23admission forms. Effective September 1, 2014, admission
24documents, including all prescreening information, must be
25submitted through MEDI or REV. Confirmation numbers assigned
26to an accepted transaction shall be retained by a facility to

 

 

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1verify timely submittal. Once an admission transaction has
2been completed, all resubmitted claims following prior
3rejection are subject to receipt no later than 180 days after
4the admission transaction has been completed.
5    Claims that are not submitted and received in compliance
6with the foregoing requirements shall not be eligible for
7payment under the medical assistance program, and the State
8shall have no liability for payment of those claims.
9    To the extent consistent with applicable information and
10privacy, security, and disclosure laws, State and federal
11agencies and departments shall provide the Illinois Department
12access to confidential and other information and data
13necessary to perform eligibility and payment verifications and
14other Illinois Department functions. This includes, but is not
15limited to: information pertaining to licensure;
16certification; earnings; immigration status; citizenship; wage
17reporting; unearned and earned income; pension income;
18employment; supplemental security income; social security
19numbers; National Provider Identifier (NPI) numbers; the
20National Practitioner Data Bank (NPDB); program and agency
21exclusions; taxpayer identification numbers; tax delinquency;
22corporate information; and death records.
23    The Illinois Department shall enter into agreements with
24State agencies and departments, and is authorized to enter
25into agreements with federal agencies and departments, under
26which such agencies and departments shall share data necessary

 

 

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1for medical assistance program integrity functions and
2oversight. The Illinois Department shall develop, in
3cooperation with other State departments and agencies, and in
4compliance with applicable federal laws and regulations,
5appropriate and effective methods to share such data. At a
6minimum, and to the extent necessary to provide data sharing,
7the Illinois Department shall enter into agreements with State
8agencies and departments, and is authorized to enter into
9agreements with federal agencies and departments, including,
10but not limited to: the Secretary of State; the Department of
11Revenue; the Department of Public Health; the Department of
12Human Services; and the Department of Financial and
13Professional Regulation.
14    Beginning in fiscal year 2013, the Illinois Department
15shall set forth a request for information to identify the
16benefits of a pre-payment, post-adjudication, and post-edit
17claims system with the goals of streamlining claims processing
18and provider reimbursement, reducing the number of pending or
19rejected claims, and helping to ensure a more transparent
20adjudication process through the utilization of: (i) provider
21data verification and provider screening technology; and (ii)
22clinical code editing; and (iii) pre-pay, pre-adjudicated, or
23post-adjudicated predictive modeling with an integrated case
24management system with link analysis. Such a request for
25information shall not be considered as a request for proposal
26or as an obligation on the part of the Illinois Department to

 

 

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1take any action or acquire any products or services.
2    The Illinois Department shall establish policies,
3procedures, standards and criteria by rule for the
4acquisition, repair and replacement of orthotic and prosthetic
5devices and durable medical equipment. Such rules shall
6provide, but not be limited to, the following services: (1)
7immediate repair or replacement of such devices by recipients;
8and (2) rental, lease, purchase or lease-purchase of durable
9medical equipment in a cost-effective manner, taking into
10consideration the recipient's medical prognosis, the extent of
11the recipient's needs, and the requirements and costs for
12maintaining such equipment. Subject to prior approval, such
13rules shall enable a recipient to temporarily acquire and use
14alternative or substitute devices or equipment pending repairs
15or replacements of any device or equipment previously
16authorized for such recipient by the Department.
17Notwithstanding any provision of Section 5-5f to the contrary,
18the Department may, by rule, exempt certain replacement
19wheelchair parts from prior approval and, for wheelchairs,
20wheelchair parts, wheelchair accessories, and related seating
21and positioning items, determine the wholesale price by
22methods other than actual acquisition costs.
23    The Department shall require, by rule, all providers of
24durable medical equipment to be accredited by an accreditation
25organization approved by the federal Centers for Medicare and
26Medicaid Services and recognized by the Department in order to

 

 

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1bill the Department for providing durable medical equipment to
2recipients. No later than 15 months after the effective date
3of the rule adopted pursuant to this paragraph, all providers
4must meet the accreditation requirement.
5    In order to promote environmental responsibility, meet the
6needs of recipients and enrollees, and achieve significant
7cost savings, the Department, or a managed care organization
8under contract with the Department, may provide recipients or
9managed care enrollees who have a prescription or Certificate
10of Medical Necessity access to refurbished durable medical
11equipment under this Section (excluding prosthetic and
12orthotic devices as defined in the Orthotics, Prosthetics, and
13Pedorthics Practice Act and complex rehabilitation technology
14products and associated services) through the State's
15assistive technology program's reutilization program, using
16staff with the Assistive Technology Professional (ATP)
17Certification if the refurbished durable medical equipment:
18(i) is available; (ii) is less expensive, including shipping
19costs, than new durable medical equipment of the same type;
20(iii) is able to withstand at least 3 years of use; (iv) is
21cleaned, disinfected, sterilized, and safe in accordance with
22federal Food and Drug Administration regulations and guidance
23governing the reprocessing of medical devices in health care
24settings; and (v) equally meets the needs of the recipient or
25enrollee. The reutilization program shall confirm that the
26recipient or enrollee is not already in receipt of the same or

 

 

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1similar equipment from another service provider, and that the
2refurbished durable medical equipment equally meets the needs
3of the recipient or enrollee. Nothing in this paragraph shall
4be construed to limit recipient or enrollee choice to obtain
5new durable medical equipment or place any additional prior
6authorization conditions on enrollees of managed care
7organizations.
8    The Department shall execute, relative to the nursing home
9prescreening project, written inter-agency agreements with the
10Department of Human Services and the Department on Aging, to
11effect the following: (i) intake procedures and common
12eligibility criteria for those persons who are receiving
13non-institutional services; and (ii) the establishment and
14development of non-institutional services in areas of the
15State where they are not currently available or are
16undeveloped; and (iii) notwithstanding any other provision of
17law, subject to federal approval, on and after July 1, 2012, an
18increase in the determination of need (DON) scores from 29 to
1937 for applicants for institutional and home and
20community-based long term care; if and only if federal
21approval is not granted, the Department may, in conjunction
22with other affected agencies, implement utilization controls
23or changes in benefit packages to effectuate a similar savings
24amount for this population; and (iv) no later than July 1,
252013, minimum level of care eligibility criteria for
26institutional and home and community-based long term care; and

 

 

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1(v) no later than October 1, 2013, establish procedures to
2permit long term care providers access to eligibility scores
3for individuals with an admission date who are seeking or
4receiving services from the long term care provider. In order
5to select the minimum level of care eligibility criteria, the
6Governor shall establish a workgroup that includes affected
7agency representatives and stakeholders representing the
8institutional and home and community-based long term care
9interests. This Section shall not restrict the Department from
10implementing lower level of care eligibility criteria for
11community-based services in circumstances where federal
12approval has been granted.
13    The Illinois Department shall develop and operate, in
14cooperation with other State Departments and agencies and in
15compliance with applicable federal laws and regulations,
16appropriate and effective systems of health care evaluation
17and programs for monitoring of utilization of health care
18services and facilities, as it affects persons eligible for
19medical assistance under this Code.
20    The Illinois Department shall report annually to the
21General Assembly, no later than the second Friday in April of
221979 and each year thereafter, in regard to:
23        (a) actual statistics and trends in utilization of
24    medical services by public aid recipients;
25        (b) actual statistics and trends in the provision of
26    the various medical services by medical vendors;

 

 

HB5203- 36 -LRB103 38434 KTG 68570 b

1        (c) current rate structures and proposed changes in
2    those rate structures for the various medical vendors; and
3        (d) efforts at utilization review and control by the
4    Illinois Department.
5    The period covered by each report shall be the 3 years
6ending on the June 30 prior to the report. The report shall
7include suggested legislation for consideration by the General
8Assembly. The requirement for reporting to the General
9Assembly shall be satisfied by filing copies of the report as
10required by Section 3.1 of the General Assembly Organization
11Act, and filing such additional copies with the State
12Government Report Distribution Center for the General Assembly
13as is required under paragraph (t) of Section 7 of the State
14Library Act.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21    On and after July 1, 2012, the Department shall reduce any
22rate of reimbursement for services or other payments or alter
23any methodologies authorized by this Code to reduce any rate
24of reimbursement for services or other payments in accordance
25with Section 5-5e.
26    Because kidney transplantation can be an appropriate,

 

 

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1cost-effective alternative to renal dialysis when medically
2necessary and notwithstanding the provisions of Section 1-11
3of this Code, beginning October 1, 2014, the Department shall
4cover kidney transplantation for noncitizens with end-stage
5renal disease who are not eligible for comprehensive medical
6benefits, who meet the residency requirements of Section 5-3
7of this Code, and who would otherwise meet the financial
8requirements of the appropriate class of eligible persons
9under Section 5-2 of this Code. To qualify for coverage of
10kidney transplantation, such person must be receiving
11emergency renal dialysis services covered by the Department.
12Providers under this Section shall be prior approved and
13certified by the Department to perform kidney transplantation
14and the services under this Section shall be limited to
15services associated with kidney transplantation.
16    Notwithstanding any other provision of this Code to the
17contrary, on or after July 1, 2015, all FDA approved forms of
18medication assisted treatment prescribed for the treatment of
19alcohol dependence or treatment of opioid dependence shall be
20covered under both fee-for-service fee for service and managed
21care medical assistance programs for persons who are otherwise
22eligible for medical assistance under this Article and shall
23not be subject to any (1) utilization control, other than
24those established under the American Society of Addiction
25Medicine patient placement criteria, (2) prior authorization
26mandate, or (3) lifetime restriction limit mandate.

 

 

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1    On or after July 1, 2015, opioid antagonists prescribed
2for the treatment of an opioid overdose, including the
3medication product, administration devices, and any pharmacy
4fees or hospital fees related to the dispensing, distribution,
5and administration of the opioid antagonist, shall be covered
6under the medical assistance program for persons who are
7otherwise eligible for medical assistance under this Article.
8As used in this Section, "opioid antagonist" means a drug that
9binds to opioid receptors and blocks or inhibits the effect of
10opioids acting on those receptors, including, but not limited
11to, naloxone hydrochloride or any other similarly acting drug
12approved by the U.S. Food and Drug Administration. The
13Department shall not impose a copayment on the coverage
14provided for naloxone hydrochloride under the medical
15assistance program.
16    Upon federal approval, the Department shall provide
17coverage and reimbursement for all drugs that are approved for
18marketing by the federal Food and Drug Administration and that
19are recommended by the federal Public Health Service or the
20United States Centers for Disease Control and Prevention for
21pre-exposure prophylaxis and related pre-exposure prophylaxis
22services, including, but not limited to, HIV and sexually
23transmitted infection screening, treatment for sexually
24transmitted infections, medical monitoring, assorted labs, and
25counseling to reduce the likelihood of HIV infection among
26individuals who are not infected with HIV but who are at high

 

 

HB5203- 39 -LRB103 38434 KTG 68570 b

1risk of HIV infection.
2    A federally qualified health center, as defined in Section
31905(l)(2)(B) of the federal Social Security Act, shall be
4reimbursed by the Department in accordance with the federally
5qualified health center's encounter rate for services provided
6to medical assistance recipients that are performed by a
7dental hygienist, as defined under the Illinois Dental
8Practice Act, working under the general supervision of a
9dentist and employed by a federally qualified health center.
10    Within 90 days after October 8, 2021 (the effective date
11of Public Act 102-665), the Department shall seek federal
12approval of a State Plan amendment to expand coverage for
13family planning services that includes presumptive eligibility
14to individuals whose income is at or below 208% of the federal
15poverty level. Coverage under this Section shall be effective
16beginning no later than December 1, 2022.
17    Subject to approval by the federal Centers for Medicare
18and Medicaid Services of a Title XIX State Plan amendment
19electing the Program of All-Inclusive Care for the Elderly
20(PACE) as a State Medicaid option, as provided for by Subtitle
21I (commencing with Section 4801) of Title IV of the Balanced
22Budget Act of 1997 (Public Law 105-33) and Part 460
23(commencing with Section 460.2) of Subchapter E of Title 42 of
24the Code of Federal Regulations, PACE program services shall
25become a covered benefit of the medical assistance program,
26subject to criteria established in accordance with all

 

 

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1applicable laws.
2    Notwithstanding any other provision of this Code,
3community-based pediatric palliative care from a trained
4interdisciplinary team shall be covered under the medical
5assistance program as provided in Section 15 of the Pediatric
6Palliative Care Act.
7    Notwithstanding any other provision of this Code, within
812 months after June 2, 2022 (the effective date of Public Act
9102-1037) and subject to federal approval, acupuncture
10services performed by an acupuncturist licensed under the
11Acupuncture Practice Act who is acting within the scope of his
12or her license shall be covered under the medical assistance
13program. The Department shall apply for any federal waiver or
14State Plan amendment, if required, to implement this
15paragraph. The Department may adopt any rules, including
16standards and criteria, necessary to implement this paragraph.
17    Notwithstanding any other provision of this Code, the
18medical assistance program shall, subject to appropriation and
19federal approval, reimburse hospitals for costs associated
20with a newborn screening test for the presence of
21metachromatic leukodystrophy, as required under the Newborn
22Metabolic Screening Act, at a rate not less than the fee
23charged by the Department of Public Health. The Department
24shall seek federal approval before the implementation of the
25newborn screening test fees by the Department of Public
26Health.

 

 

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1    Notwithstanding any other provision of this Code,
2beginning on January 1, 2024, subject to federal approval,
3cognitive assessment and care planning services provided to a
4person who experiences signs or symptoms of cognitive
5impairment, as defined by the Diagnostic and Statistical
6Manual of Mental Disorders, Fifth Edition, shall be covered
7under the medical assistance program for persons who are
8otherwise eligible for medical assistance under this Article.
9    Notwithstanding any other provision of this Code,
10medically necessary reconstructive services that are intended
11to restore physical appearance shall be covered under the
12medical assistance program for persons who are otherwise
13eligible for medical assistance under this Article. As used in
14this paragraph, "reconstructive services" means treatments
15performed on structures of the body damaged by trauma to
16restore physical appearance.
17(Source: P.A. 102-43, Article 30, Section 30-5, eff. 7-6-21;
18102-43, Article 35, Section 35-5, eff. 7-6-21; 102-43, Article
1955, Section 55-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123,
20eff. 1-1-22; 102-558, eff. 8-20-21; 102-598, eff. 1-1-22;
21102-655, eff. 1-1-22; 102-665, eff. 10-8-21; 102-813, eff.
225-13-22; 102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22;
23102-1038, eff. 1-1-23; 103-102, Article 15, Section 15-5, eff.
241-1-24; 103-102, Article 95, Section 95-15, eff. 1-1-24;
25103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-368, eff.
261-1-24; revised 12-15-23.)
 

 

 

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1    (305 ILCS 5/5-8)  (from Ch. 23, par. 5-8)
2    Sec. 5-8. Practitioners. In supplying medical assistance,
3the Illinois Department may provide for the legally authorized
4services of (i) persons licensed under the Medical Practice
5Act of 1987, as amended, except as hereafter in this Section
6stated, whether under a general or limited license, (ii)
7persons licensed under the Nurse Practice Act as advanced
8practice registered nurses, regardless of whether or not the
9persons have written collaborative agreements, (iii) persons
10licensed or registered under other laws of this State to
11provide dental, medical, pharmaceutical, optometric,
12podiatric, or nursing services, or other remedial care
13recognized under State law, (iv) persons licensed under other
14laws of this State as a clinical social worker, and (v) persons
15licensed under other laws of this State as physician
16assistants. The Department shall adopt rules, no later than 90
17days after January 1, 2017 (the effective date of Public Act
1899-621), for the legally authorized services of persons
19licensed under other laws of this State as a clinical social
20worker. The Department shall provide for the legally
21authorized services of persons licensed under the Professional
22Counselor and Clinical Professional Counselor Licensing and
23Practice Act as clinical professional counselors and for the
24legally authorized services of persons licensed under the
25Marriage and Family Therapy Licensing Act as marriage and

 

 

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1family therapists. The Department may not provide for legally
2authorized services of any physician who has been convicted of
3having performed an abortion procedure in a willful and wanton
4manner on a woman who was not pregnant at the time such
5abortion procedure was performed. The utilization of the
6services of persons engaged in the treatment or care of the
7sick, which persons are not required to be licensed or
8registered under the laws of this State, is not prohibited by
9this Section.
10(Source: P.A. 102-43, eff. 7-6-21.)
 
11    (305 ILCS 5/5-9)  (from Ch. 23, par. 5-9)
12    Sec. 5-9. Choice of medical dispensers. Applicants and
13recipients shall be entitled to free choice of those qualified
14practitioners, hospitals, nursing homes, and other dispensers
15of medical services meeting the requirements and complying
16with the rules and regulations of the Illinois Department.
17However, the Director of Healthcare and Family Services may,
18after providing reasonable notice and opportunity for hearing,
19deny, suspend or terminate any otherwise qualified person,
20firm, corporation, association, agency, institution, or other
21legal entity, from participation as a vendor of goods or
22services under the medical assistance program authorized by
23this Article if the Director finds such vendor of medical
24services in violation of this Act or the policy or rules and
25regulations issued pursuant to this Act. Any physician who has

 

 

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1been convicted of performing an abortion procedure in a
2willful and wanton manner upon a woman who was not pregnant at
3the time such abortion procedure was performed shall be
4automatically removed from the list of physicians qualified to
5participate as a vendor of medical services under the medical
6assistance program authorized by this Article.
7(Source: P.A. 100-538, eff. 1-1-18.)
 
8    (305 ILCS 5/6-1)  (from Ch. 23, par. 6-1)
9    Sec. 6-1. Eligibility requirements. Financial aid in
10meeting basic maintenance requirements shall be given under
11this Article to or in behalf of persons who meet the
12eligibility conditions of Sections 6-1.1 through 6-1.10,
13except as provided in the No Taxpayer Funding for Abortion
14Act. In addition, each unit of local government subject to
15this Article shall provide persons receiving financial aid in
16meeting basic maintenance requirements with financial aid for
17either (a) necessary treatment, care, and supplies required
18because of illness or disability, or (b) acute medical
19treatment, care, and supplies only. If a local governmental
20unit elects to provide financial aid for acute medical
21treatment, care, and supplies only, the general types of acute
22medical treatment, care, and supplies for which financial aid
23is provided shall be specified in the general assistance rules
24of the local governmental unit, which rules shall provide that
25financial aid is provided, at a minimum, for acute medical

 

 

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1treatment, care, or supplies necessitated by a medical
2condition for which prior approval or authorization of medical
3treatment, care, or supplies is not required by the general
4assistance rules of the Illinois Department.
5(Source: P.A. 100-538, eff. 1-1-18.)
 
6    Section 910. The Problem Pregnancy Health Services and
7Care Act is amended by changing Section 4-100 as follows:
 
8    (410 ILCS 230/4-100)  (from Ch. 111 1/2, par. 4604-100)
9    Sec. 4-100. The Department may make grants to nonprofit
10agencies and organizations which do not use such grants to
11refer or counsel for, or perform, abortions and which
12coordinate and establish linkages among services that will
13further the purposes of this Act and, where appropriate, will
14provide, supplement, or improve the quality of such services.
15(Source: P.A. 100-538, eff. 1-1-18.)
 
16    Section 990. Application of Act; home rule powers.
17    (a) This Act applies to all State and local (including
18home rule unit) laws, ordinances, policies, procedures,
19practices, and governmental actions and their implementation,
20whether statutory or otherwise and whether adopted before or
21after the effective date of this Act.
22    (b) A home rule unit may not adopt any rule in a manner
23inconsistent with this Act. This Act is a limitation under

 

 

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1subsection (i) of Section 6 of Article VII of the Illinois
2Constitution on the concurrent exercise by home rule units of
3powers and functions exercised by the State.
 
4    Section 999. Effective date. This Act takes effect June 1,
52024.