100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB1434

 

Introduced , by Rep. Michael J. Madigan

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-4.2  from Ch. 23, par. 5-4.2

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning ambulance services payments.


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A BILL FOR

 

HB1434LRB100 03144 KTG 13149 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-4.2 as follows:
 
6    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)
7    Sec. 5-4.2. Ambulance services payments.
8    (a) For ambulance services provided to a recipient of aid
9under this Article on or after January 1, 1993, the the
10Illinois Department shall reimburse ambulance service
11providers at rates calculated in accordance with this Section.
12It is the intent of the General Assembly to provide adequate
13reimbursement for ambulance services so as to ensure adequate
14access to services for recipients of aid under this Article and
15to provide appropriate incentives to ambulance service
16providers to provide services in an efficient and
17cost-effective manner. Thus, it is the intent of the General
18Assembly that the Illinois Department implement a
19reimbursement system for ambulance services that, to the extent
20practicable and subject to the availability of funds
21appropriated by the General Assembly for this purpose, is
22consistent with the payment principles of Medicare. To ensure
23uniformity between the payment principles of Medicare and

 

 

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1Medicaid, the Illinois Department shall follow, to the extent
2necessary and practicable and subject to the availability of
3funds appropriated by the General Assembly for this purpose,
4the statutes, laws, regulations, policies, procedures,
5principles, definitions, guidelines, and manuals used to
6determine the amounts paid to ambulance service providers under
7Title XVIII of the Social Security Act (Medicare).
8    (b) For ambulance services provided to a recipient of aid
9under this Article on or after January 1, 1996, the Illinois
10Department shall reimburse ambulance service providers based
11upon the actual distance traveled if a natural disaster,
12weather conditions, road repairs, or traffic congestion
13necessitates the use of a route other than the most direct
14route.
15    (c) For purposes of this Section, "ambulance services"
16includes medical transportation services provided by means of
17an ambulance, medi-car, service car, or taxi.
18    (c-1) For purposes of this Section, "ground ambulance
19service" means medical transportation services that are
20described as ground ambulance services by the Centers for
21Medicare and Medicaid Services and provided in a vehicle that
22is licensed as an ambulance by the Illinois Department of
23Public Health pursuant to the Emergency Medical Services (EMS)
24Systems Act.
25    (c-2) For purposes of this Section, "ground ambulance
26service provider" means a vehicle service provider as described

 

 

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1in the Emergency Medical Services (EMS) Systems Act that
2operates licensed ambulances for the purpose of providing
3emergency ambulance services, or non-emergency ambulance
4services, or both. For purposes of this Section, this includes
5both ambulance providers and ambulance suppliers as described
6by the Centers for Medicare and Medicaid Services.
7    (d) This Section does not prohibit separate billing by
8ambulance service providers for oxygen furnished while
9providing advanced life support services.
10    (e) Beginning with services rendered on or after July 1,
112008, all providers of non-emergency medi-car and service car
12transportation must certify that the driver and employee
13attendant, as applicable, have completed a safety program
14approved by the Department to protect both the patient and the
15driver, prior to transporting a patient. The provider must
16maintain this certification in its records. The provider shall
17produce such documentation upon demand by the Department or its
18representative. Failure to produce documentation of such
19training shall result in recovery of any payments made by the
20Department for services rendered by a non-certified driver or
21employee attendant. Medi-car and service car providers must
22maintain legible documentation in their records of the driver
23and, as applicable, employee attendant that actually
24transported the patient. Providers must recertify all drivers
25and employee attendants every 3 years.
26    Notwithstanding the requirements above, any public

 

 

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1transportation provider of medi-car and service car
2transportation that receives federal funding under 49 U.S.C.
35307 and 5311 need not certify its drivers and employee
4attendants under this Section, since safety training is already
5federally mandated.
6    (f) With respect to any policy or program administered by
7the Department or its agent regarding approval of non-emergency
8medical transportation by ground ambulance service providers,
9including, but not limited to, the Non-Emergency
10Transportation Services Prior Approval Program (NETSPAP), the
11Department shall establish by rule a process by which ground
12ambulance service providers of non-emergency medical
13transportation may appeal any decision by the Department or its
14agent for which no denial was received prior to the time of
15transport that either (i) denies a request for approval for
16payment of non-emergency transportation by means of ground
17ambulance service or (ii) grants a request for approval of
18non-emergency transportation by means of ground ambulance
19service at a level of service that entitles the ground
20ambulance service provider to a lower level of compensation
21from the Department than the ground ambulance service provider
22would have received as compensation for the level of service
23requested. The rule shall be filed by December 15, 2012 and
24shall provide that, for any decision rendered by the Department
25or its agent on or after the date the rule takes effect, the
26ground ambulance service provider shall have 60 days from the

 

 

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1date the decision is received to file an appeal. The rule
2established by the Department shall be, insofar as is
3practical, consistent with the Illinois Administrative
4Procedure Act. The Director's decision on an appeal under this
5Section shall be a final administrative decision subject to
6review under the Administrative Review Law.
7    (f-5) Beginning 90 days after July 20, 2012 (the effective
8date of Public Act 97-842), (i) no denial of a request for
9approval for payment of non-emergency transportation by means
10of ground ambulance service, and (ii) no approval of
11non-emergency transportation by means of ground ambulance
12service at a level of service that entitles the ground
13ambulance service provider to a lower level of compensation
14from the Department than would have been received at the level
15of service submitted by the ground ambulance service provider,
16may be issued by the Department or its agent unless the
17Department has submitted the criteria for determining the
18appropriateness of the transport for first notice publication
19in the Illinois Register pursuant to Section 5-40 of the
20Illinois Administrative Procedure Act.
21    (g) Whenever a patient covered by a medical assistance
22program under this Code or by another medical program
23administered by the Department is being discharged from a
24facility, a physician discharge order as described in this
25Section shall be required for each patient whose discharge
26requires medically supervised ground ambulance services.

 

 

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1Facilities shall develop procedures for a physician with
2medical staff privileges to provide a written and signed
3physician discharge order. The physician discharge order shall
4specify the level of ground ambulance services needed and
5complete a medical certification establishing the criteria for
6approval of non-emergency ambulance transportation, as
7published by the Department of Healthcare and Family Services,
8that is met by the patient. This order and the medical
9certification shall be completed prior to ordering an ambulance
10service and prior to patient discharge.
11    Pursuant to subsection (E) of Section 12-4.25 of this Code,
12the Department is entitled to recover overpayments paid to a
13provider or vendor, including, but not limited to, from the
14discharging physician, the discharging facility, and the
15ground ambulance service provider, in instances where a
16non-emergency ground ambulance service is rendered as the
17result of improper or false certification.
18    (h) On and after July 1, 2012, the Department shall reduce
19any rate of reimbursement for services or other payments or
20alter any methodologies authorized by this Code to reduce any
21rate of reimbursement for services or other payments in
22accordance with Section 5-5e.
23(Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12;
2497-842, eff. 7-20-12; 98-463, eff. 8-16-13.)