SB2170eng 94TH GENERAL ASSEMBLY

SB2170 Engrossed LRB094 13493 DRJ 50420 b

AN ACT concerning business.

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

Section 5. The Nursing Home Care Act is amended by adding Sections 2-217 and 2-218 as follows:

(210 ILCS 45/2-217 new)

Sec. 2-217. Order for transportation of resident by ambulance. If a facility orders transportation of a resident of the facility by ambulance, the facility must maintain a written record that shows (i) the name of the person who placed the order for that transportation and (ii) the medical reason for that transportation. The facility must maintain the record for a period of at least 3 years after the date of the order for transportation by ambulance.

(210 ILCS 45/2-218 new)

Sec. 2-218. Inducement to vehicle service provider; penalty.

(a) If the Department determines, after an opportunity for a hearing in accordance with rules adopted by the Department, that (i) a facility knowingly or willingly offered or provided, solicited, or received any remuneration (including any kickback, bribe, rebate, or discount) directly or indirectly, overtly or covertly, in cash or in kind, to any Vehicle Service Provider licensed under the Emergency Medical Services (EMS) Systems Act for the purpose of providing referrals for transportation by the Vehicle Service Provider or (ii) an employee or contractual agent of a facility knowingly or willingly falsified any documentation of medical necessity for non-emergency ambulance transportation, the Department may impose against the facility, or against the employer of the facility's contractual agent in the case of an individual who became the facility's contractual agent by virtue of his or her employment by that employer, a civil penalty in an amount not exceeding $10,000.

(b) If the Department makes a determination described in subsection (a), the Department shall refer that determination to the United States Department of Health and Human Services Office of Inspector General.

Section 10. The Emergency Medical Services (EMS) Systems Act is amended by changing Section 3.85 as follows:

(210 ILCS 50/3.85)

Sec. 3.85. Vehicle Service Providers.

(a) "Vehicle Service Provider" means an entity licensed by the Department to provide emergency or non-emergency medical services in compliance with this Act, the rules promulgated by the Department pursuant to this Act, and an operational plan approved by its EMS System(s), utilizing at least ambulances or specialized emergency medical service vehicles (SEMSV).

(1) "Ambulance" means any publicly or privately owned on-road vehicle that is specifically designed, constructed or modified and equipped, and is intended to be used for, and is maintained or operated for the emergency transportation of persons who are sick, injured, wounded or otherwise incapacitated or helpless, or the non-emergency medical transportation of persons who require the presence of medical personnel to monitor the individual's condition or medical apparatus being used on such individuals.

(2) "Specialized Emergency Medical Services Vehicle" or "SEMSV" means a vehicle or conveyance, other than those owned or operated by the federal government, that is primarily intended for use in transporting the sick or injured by means of air, water, or ground transportation, that is not an ambulance as defined in this Act. The term includes watercraft, aircraft and special purpose ground transport vehicles or conveyances not intended for use on public roads.

(3) An ambulance or SEMSV may also be designated as a Limited Operation Vehicle or Special-Use Vehicle:

(A) "Limited Operation Vehicle" means a vehicle which is licensed by the Department to provide basic, intermediate or advanced life support emergency or non-emergency medical services that are exclusively limited to specific events or locales.

(B) "Special-Use Vehicle" means any publicly or privately owned vehicle that is specifically designed, constructed or modified and equipped, and is intended to be used for, and is maintained or operated solely for the emergency or non-emergency transportation of a specific medical class or category of persons who are sick, injured, wounded or otherwise incapacitated or helpless (e.g. high-risk obstetrical patients, neonatal patients).

(b) The Department shall have the authority and responsibility to:

(1) Require all Vehicle Service Providers, both publicly and privately owned, to function within an EMS System;

(2) Require a Vehicle Service Provider utilizing ambulances to have a primary affiliation with an EMS System within the EMS Region in which its Primary Service Area is located, which is the geographic areas in which the provider renders the majority of its emergency responses. This requirement shall not apply to Vehicle Service Providers which exclusively utilize Limited Operation Vehicles;

(3) Establish licensing standards and requirements for Vehicle Service Providers, through rules adopted pursuant to this Act, including but not limited to:

(A) Vehicle design, specification, operation and maintenance standards;

(B) Equipment requirements;

(C) Staffing requirements; and

(D) Annual license renewal.

(4) License all Vehicle Service Providers that have met the Department's requirements for licensure, unless such Provider is owned or licensed by the federal government. All Provider licenses issued by the Department shall specify the level and type of each vehicle covered by the license (BLS, ILS, ALS, ambulance, SEMSV, limited operation vehicle, special use vehicle);

(5) Annually inspect all licensed Vehicle Service Providers, and relicense such Providers that have met the Department's requirements for license renewal;

(6) Suspend, revoke, refuse to issue or refuse to renew the license of any Vehicle Service Provider, or that portion of a license pertaining to a specific vehicle operated by the Provider, after an opportunity for a hearing, when findings show that the Provider or one or more of its vehicles has failed to comply with the standards and requirements of this Act or rules adopted by the Department pursuant to this Act;

(6.5) Impose against a Vehicle Service Provider a civil penalty in an amount not exceeding $10,000, if the Department determines, after an opportunity for a hearing in accordance with rules adopted by the Department, that the Vehicle Service Provider knowingly or willingly offered or provided, solicited, or received any remuneration (including any kickback, bribe, rebate, or discount) directly or indirectly, overtly or covertly, in cash or in kind, to any long-term care facility licensed under the Nursing Home Care Act or any hospital licensed under the Hospital Licensing Act for the purpose of influencing the long-term care facility or hospital to provide referrals to the Vehicle Service Provider for the transportation of residents of the long-term care facility or patients of the hospital; the Department shall refer any such determination to the United States Department of Health and Human Services Office of Inspector General;

(7) Issue an Emergency Suspension Order for any Provider or vehicle licensed under this Act, when the Director or his designee has determined that an immediate and serious danger to the public health, safety and welfare exists. Suspension or revocation proceedings which offer an opportunity for hearing shall be promptly initiated after the Emergency Suspension Order has been issued;

(8) Exempt any licensed vehicle from subsequent vehicle design standards or specifications required by the Department, as long as said vehicle is continuously in compliance with the vehicle design standards and specifications originally applicable to that vehicle, or until said vehicle's title of ownership is transferred;

(9) Exempt any vehicle (except an SEMSV) which was being used as an ambulance on or before December 15, 1980, from vehicle design standards and specifications required by the Department, until said vehicle's title of ownership is transferred. Such vehicles shall not be exempt from all other licensing standards and requirements prescribed by the Department;

(10) Prohibit any Vehicle Service Provider from advertising, identifying its vehicles, or disseminating information in a false or misleading manner concerning the Provider's type and level of vehicles, location, primary service area, response times, level of personnel, licensure status or System participation; and

(11) Charge each Vehicle Service Provider a fee, to be submitted with each application for licensure and license renewal, which shall not exceed $25.00 per vehicle, up to $500.00 per Provider.

(Source: P.A. 89-177, eff. 7-19-95.)

Section 15. The Hospital Licensing Act is amended by adding Sections 6.22 and 6.23 as follows:

(210 ILCS 85/6.22 new)

Sec. 6.22. Order for transportation of patient by ambulance. If a hospital orders transportation of a patient of the hospital by ambulance, the hospital must maintain a written record that shows (i) the name of the person who placed the order for that transportation and (ii) the medical reason for that transportation. The hospital must maintain the record for a period of at least 3 years after the date of the order for transportation by ambulance.

(210 ILCS 85/6.23 new)

Sec. 6.23. Inducement to vehicle service provider; penalty.

(a) If the Department determines, after an opportunity for a hearing in accordance with rules adopted by the Department, that (i) a hospital knowingly or willingly offered or provided, solicited, or received any remuneration (including any kickback, bribe, rebate, or discount) directly or indirectly, overtly or covertly, in cash or in kind, to any Vehicle Service Provider licensed under the Emergency Medical Services (EMS) Systems Act for the purpose of providing referrals for transportation by the Vehicle Service Provider or (ii) an employee or contractual agent of a hospital knowingly or willingly falsified any documentation of medical necessity for non-emergency ambulance transportation, the Department may impose against the hospital, or against the employer of the hospital's contractual agent in the case of an individual who became the hospital's contractual agent by virtue of his or her employment by that employer, a civil penalty in an amount not exceeding $10,000.

(b) If the Department makes a determination described in subsection (a), the Department shall refer that determination to the United States Department of Health and Human Services Office of Inspector General.

Section 20. The Consumer Fraud and Deceptive Business Practices Act is amended by adding Section 2XX as follows:

(815 ILCS 505/2XX new)

Sec. 2XX. Notification requirements for non-emergency ambulance services.

(a) In this Section:

"Ambulance service provider" means a Vehicle Service Provider, as defined in the Emergency Medical Services (EMS) Systems Act, who provides non-emergency transportation services by ambulance.

"Patient" means a person who is transported by an ambulance service provider.

(b) An ambulance service provider shall provide a written notice, and a verbal explanation of the written notice, prior to non-emergency ambulance transports that originate at a hospital or other health care facility when no written documentation of medical necessity is available at the time of transport. This notice must meet all of the following requirements:

(1) The following caption must appear at the beginning of the notice, in at least 14-point type: Notice to Patient Regarding Non-Emergency Ambulance Services.

(2) The remainder of the notice must be expressed in clear, simple language and in at least 14-point type.

(3) The notice must contain each of the following statements:

(A) Notice: Medicare and other insurers may not pay for any part of the cost of your transport by ambulance unless certified by your physician or healthcare provider as allowed under federal rules as being medically necessary.

(B) The purpose of this notice is to help you make an informed choice about whether or not you want to be transported by ambulance, knowing that you might have to pay for this transport yourself. Before you make any decision about your options, you should:

(i) Read this entire notice carefully.

(ii) Ask a representative of the physician or facility ordering transport to explain, if you do not understand or are not sure, the guidelines regarding medical necessity for transport by ambulance and to tell you whether or not you meet these guidelines.

(iii) Ask us how much being transported by ambulance will cost you, in case you have to pay for transport by ambulance out of your own pocket or through other insurance. The estimated cost will be $(amount).

(C) Please choose one option by checking one box and signing and dating your selection below:

(i) Option 1. Yes. I want to be transported by ambulance. I understand that Medicare and many other insurers may not pay for any part of the cost of my ambulance transport unless certified by my physician or healthcare provider as allowed under federal rules as being medically necessary. I understand that you will file a claim on my behalf to Medicare or my other insurer. I understand that you may bill me for items or services and that I may have to pay the bill while Medicare or my other insurer is making its decision. If Medicare or my other insurer does pay on my behalf, I understand that you will refund to me any payments that I made to you that are due to me. If Medicare or my other insurer denies payment, I agree to be personally and fully responsible for payment. I understand that I can appeal the decision made by Medicare or my other insurer.

(ii) Option 2. No. I have decided not to be transported by ambulance.

(4) The notice must be signed by the patient or by the patient's authorized representative.

(5) The notice must contain the patient's full name and the date of service.

(6) The notice must contain the full name and business address (including the street name and number, city, state, and zip code) of the ambulance service provider.

(c) If a patient is physically or mentally unable to sign the notice described in subsection (b) at the time of transport by ambulance and no authorized representative of the patient is available to sign the notice on the patient's behalf, the ambulance service provider must be able to provide documentation of the patient's inability to sign the notice and the unavailability of an authorized representative. In any case described in this subsection (c), the ambulance service provider shall be considered to have met the requirements of subsection (b).

(d) If an ambulance service provider has obtained documentation of medical necessity prior to transport and the patient's Medicare or other insurer denies the claim for transport by ambulance despite this fact, the ambulance service provider is considered to have met the requirements of subsection (b).

(e) In addition to any other penalty provided in this Act, if the court finds that an ambulance service provider has violated any provision of subsection (b), the court may order that the ambulance service provider pay to the patient an amount equal to 3 times the amount claimed due by the ambulance provider, including any interest, collection costs, and attorney's fees claimed by the ambulance service provider, and any attorney's fees incurred by the patient.