SB2170ham001 94TH GENERAL ASSEMBLY

Rep. Elaine Nekritz

Filed: 4/3/2006

09400SB2170ham001 LRB094 13493 LCT 57972 a

AMENDMENT TO SENATE BILL 2170

AMENDMENT NO. ______. Amend Senate Bill 2170 by replacing everything after the enacting clause with the following:

"Section 5. The Nursing Home Care Act is amended by adding Section 2-217 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.

Section 10. The Hospital Licensing Act is amended by adding Section 6.22 as follows:

(210 ILCS 85/6.22 new)

Sec. 6.22. Arrangement for transportation of patient by ambulance.

(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) If a hospital arranges for transportation of a patient of the hospital by ambulance, the hospital must provide the ambulance service provider, prior to transport, a Physician Certification Statement formatted and completed in compliance with federal regulations or an equivalent form developed by the hospital. The Physician Certification Statement or equivalent form is not required prior to transport if a delay in transport can be expected to negatively affect the patient outcome.

(c) If a hospital is unable to provide a Physician Certification Statement or equivalent form, then the hospital shall provide to the patient a written notice and a verbal explanation of the written notice, which 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 notice must contain each of the following statements in at least 14-point type:

(A) The purpose of this notice is to help you make an informed choice about whether you want to be transported by ambulance because your medical condition does not meet medical necessity for transportation by an ambulance.

(B) Your insurance may not cover the charges for ambulance transportation.

(C) You may be responsible for the cost of ambulance transportation.

(D) The estimated cost of ambulance transportation is $(amount).

(3) The notice must be signed by the patient or by the patient's authorized representative. A copy shall be given to the patient and the hospital shall retain a copy.

(d) The notice set forth in subsection (c) of this Section shall not be required if a delay in transport can be expected to negatively affect the patient outcome.

(e) If a patient is physically or mentally unable to sign the notice described in subsection (c) of this Section and no authorized representative of the patient is available to sign the notice on the patient's behalf, the hospital 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 (e), the hospital shall be considered to have met the requirements of subsection (c) of this Section.

Section 15. 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 health care facility other than a hospital 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.".