HB3027 101ST GENERAL ASSEMBLY

LRB101 10853 KTG 56190 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3027

Introduced , by Rep. Kathleen Willis

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.10 new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall cover charges incurred, and anesthetics provided, in conjunction with dental care that is provided to an individual in a hospital or an ambulatory surgical treatment center if the individual is otherwise eligible for medical assistance and any of the following applies: (1) the individual has a medical condition that requires hospitalization or general anesthesia for dental care; or (2) the individual is a person with a disability. Defines "person with a disability" to mean a person, regardless of age, with a chronic disability if the chronic disability meets specified conditions. Provides that the medical assistance program shall cover charges incurred, and anesthetics provided by a dentist with a permit provided under the Illinois Dental Practice Act or by a physician licensed under the Medical Practice Act to practice medicine in all of its branches, in conjunction with dental care that is provided to an individual in a dental office, oral surgeon's office, hospital, or ambulatory surgical treatment center if the individual, regardless of age, is otherwise eligible for medical assistance and has been diagnosed with (i) an autism spectrum disorder as defined in the Autism Spectrum Disorders Reporting Act or (ii) a developmental disability. Defines "developmental disability". Requires the Department of Healthcare and Family Services to reimburse providers of services covered under the amendatory Act at the same rates as the Medicare program's rates for similar services.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by adding Section 5-5.10 as follows:

(305 ILCS 5/5-5.10 new)

Sec. 5-5.10. Coverage for adjunctive services in dental care.

(a) As used in this Section:

"Ambulatory surgical treatment center" has the meaning given to that term in Section 3 of the Ambulatory Surgical Treatment Center Act.

"Person with a disability" means a person, regardless of age, with a chronic disability if the chronic disability meets all of the following conditions:

(1) It is attributable to a mental or physical impairment or combination of mental and physical impairments.

(2) It is likely to continue.

(3) It results in substantial functional limitations in one or more of the following areas of major life activity:

(A) self-care;

(B) receptive and expressive language;

(C) learning;

(D) mobility;

(E) capacity for independent living; or

(F) economic self-sufficiency.

(b) The medical assistance program shall cover charges incurred, and anesthetics provided, in conjunction with dental care that is provided to an individual in a hospital or an ambulatory surgical treatment center if the individual is otherwise eligible for medical assistance and any of the following applies:

(1) the individual has a medical condition that requires hospitalization or general anesthesia for dental care; or

(2) the individual is a person with a disability.

(c) The medical assistance program shall cover charges incurred, and anesthetics provided by a dentist with a permit provided under Section 8.1 of the Illinois Dental Practice Act or by a physician licensed under the Medical Practice Act to practice medicine in all of its branches, in conjunction with dental care that is provided to an individual in a dental office, oral surgeon's office, hospital, or ambulatory surgical treatment center if the individual, regardless of age, is otherwise eligible for medical assistance and has been diagnosed with an autism spectrum disorder as defined in Section 10 of the Autism Spectrum Disorders Reporting Act or a developmental disability.

As used in this subsection, "developmental disability" means a disability that is attributable to an intellectual disability or a related condition, if the related condition meets all of the following conditions:

(1) it is attributable to cerebral palsy, epilepsy, or any other condition, other than mental illness, found to be closely related to an intellectual disability because that condition results in impairment of general intellectual functioning or adaptive behavior similar to that of individuals with an intellectual disability and requires treatment or services similar to those required for those individuals; for purposes of this definition, autism is considered a related condition;

(2) it is manifested before the individual reaches age 22;

(3) it is likely to continue indefinitely; and

(4) it results in substantial functional limitations in 3 or more of the following areas of major life activity: self-care, language, learning, mobility, self-direction, and capacity for independent living.

(d) The Department shall reimburse providers of services covered under this Section at the same rates as the Medicare program's rates for similar services.