102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB1740

 

Introduced 2/26/2021, by Sen. Emil Jones, III

 

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

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, if they meet the established training components set forth by the Department of Healthcare and Family Services, providers of non-emergency medi-car and service car transportation that are either directly or through an affiliated company licensed by the Department of Public Health shall be approved to have in-house safety programs for training their own staff.


LRB102 16620 KTG 22020 b

 

 

A BILL FOR

 

SB1740LRB102 16620 KTG 22020 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 Illinois
10Department shall reimburse ambulance service providers at
11rates calculated in accordance with this Section. It is the
12intent 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
15and to 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
20extent practicable 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
7under Title 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

 

 

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1described in the Emergency Medical Services (EMS) Systems Act
2that operates 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    (c-3) For purposes of this Section, "medi-car" means
8transportation services provided to a patient who is confined
9to a wheelchair and requires the use of a hydraulic or electric
10lift or ramp and wheelchair lockdown when the patient's
11condition does not require medical observation, medical
12supervision, medical equipment, the administration of
13medications, or the administration of oxygen.
14    (c-4) For purposes of this Section, "service car" means
15transportation services provided to a patient by a passenger
16vehicle where that patient does not require the specialized
17modes described in subsection (c-1) or (c-3).
18    (d) This Section does not prohibit separate billing by
19ambulance service providers for oxygen furnished while
20providing advanced life support services.
21    (e) Beginning with services rendered on or after July 1,
222008, all providers of non-emergency medi-car and service car
23transportation must certify that the driver and employee
24attendant, as applicable, have completed a safety program
25approved by the Department to protect both the patient and the
26driver, prior to transporting a patient. The provider must

 

 

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1maintain this certification in its records. The provider shall
2produce such documentation upon demand by the Department or
3its representative. Failure to produce documentation of such
4training shall result in recovery of any payments made by the
5Department for services rendered by a non-certified driver or
6employee attendant. Medi-car and service car providers must
7maintain legible documentation in their records of the driver
8and, as applicable, employee attendant that actually
9transported the patient. Providers must recertify all drivers
10and employee attendants every 3 years. If they meet the
11established training components set forth by the Department,
12providers of non-emergency medi-car and service car
13transportation that are either directly or through an
14affiliated company licensed by the Department of Public Health
15shall be approved by the Department to have in-house safety
16programs for training their own staff.
17    Notwithstanding the requirements above, any public
18transportation provider of medi-car and service car
19transportation that receives federal funding under 49 U.S.C.
205307 and 5311 need not certify its drivers and employee
21attendants under this Section, since safety training is
22already federally mandated.
23    (f) With respect to any policy or program administered by
24the Department or its agent regarding approval of
25non-emergency medical transportation by ground ambulance
26service providers, including, but not limited to, the

 

 

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1Non-Emergency Transportation Services Prior Approval Program
2(NETSPAP), the Department shall establish by rule a process by
3which ground ambulance service providers of non-emergency
4medical transportation may appeal any decision by the
5Department or its agent for which no denial was received prior
6to the time of transport that either (i) denies a request for
7approval for payment of non-emergency transportation by means
8of ground ambulance service or (ii) grants a request for
9approval of non-emergency transportation by means of ground
10ambulance service at a level of service that entitles the
11ground ambulance service provider to a lower level of
12compensation from the Department than the ground ambulance
13service provider would have received as compensation for the
14level of service requested. The rule shall be filed by
15December 15, 2012 and shall provide that, for any decision
16rendered by the Department or its agent on or after the date
17the rule takes effect, the ground ambulance service provider
18shall have 60 days from the date the decision is received to
19file an appeal. The rule established by the Department shall
20be, insofar as is practical, consistent with the Illinois
21Administrative Procedure Act. The Director's decision on an
22appeal under this Section shall be a final administrative
23decision subject to review under the Administrative Review
24Law.
25    (f-5) Beginning 90 days after July 20, 2012 (the effective
26date of Public Act 97-842), (i) no denial of a request for

 

 

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1approval for payment of non-emergency transportation by means
2of ground ambulance service, and (ii) no approval of
3non-emergency transportation by means of ground ambulance
4service at a level of service that entitles the ground
5ambulance service provider to a lower level of compensation
6from the Department than would have been received at the level
7of service submitted by the ground ambulance service provider,
8may be issued by the Department or its agent unless the
9Department has submitted the criteria for determining the
10appropriateness of the transport for first notice publication
11in the Illinois Register pursuant to Section 5-40 of the
12Illinois Administrative Procedure Act.
13    (g) Whenever a patient covered by a medical assistance
14program under this Code or by another medical program
15administered by the Department, including a patient covered
16under the State's Medicaid managed care program, is being
17transported from a facility and requires non-emergency
18transportation including ground ambulance, medi-car, or
19service car transportation, a Physician Certification
20Statement as described in this Section shall be required for
21each patient. Facilities shall develop procedures for a
22licensed medical professional to provide a written and signed
23Physician Certification Statement. The Physician Certification
24Statement shall specify the level of transportation services
25needed and complete a medical certification establishing the
26criteria for approval of non-emergency ambulance

 

 

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1transportation, as published by the Department of Healthcare
2and Family Services, that is met by the patient. This
3certification shall be completed prior to ordering the
4transportation service and prior to patient discharge. The
5Physician Certification Statement is not required prior to
6transport if a delay in transport can be expected to
7negatively affect the patient outcome. If the ground ambulance
8provider, medi-car provider, or service car provider is unable
9to obtain the required Physician Certification Statement
10within 10 calendar days following the date of the service, the
11ground ambulance provider, medi-car provider, or service car
12provider must document its attempt to obtain the requested
13certification and may then submit the claim for payment.
14Acceptable documentation includes a signed return receipt from
15the U.S. Postal Service, facsimile receipt, email receipt, or
16other similar service that evidences that the ground ambulance
17provider, medi-car provider, or service car provider attempted
18to obtain the required Physician Certification Statement.
19    The medical certification specifying the level and type of
20non-emergency transportation needed shall be in the form of
21the Physician Certification Statement on a standardized form
22prescribed by the Department of Healthcare and Family
23Services. Within 75 days after July 27, 2018 (the effective
24date of Public Act 100-646), the Department of Healthcare and
25Family Services shall develop a standardized form of the
26Physician Certification Statement specifying the level and

 

 

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1type of transportation services needed in consultation with
2the Department of Public Health, Medicaid managed care
3organizations, a statewide association representing ambulance
4providers, a statewide association representing hospitals, 3
5statewide associations representing nursing homes, and other
6stakeholders. The Physician Certification Statement shall
7include, but is not limited to, the criteria necessary to
8demonstrate medical necessity for the level of transport
9needed as required by (i) the Department of Healthcare and
10Family Services and (ii) the federal Centers for Medicare and
11Medicaid Services as outlined in the Centers for Medicare and
12Medicaid Services' Medicare Benefit Policy Manual, Pub.
13100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician
14Certification Statement shall satisfy the obligations of
15hospitals under Section 6.22 of the Hospital Licensing Act and
16nursing homes under Section 2-217 of the Nursing Home Care
17Act. Implementation and acceptance of the Physician
18Certification Statement shall take place no later than 90 days
19after the issuance of the Physician Certification Statement by
20the Department of Healthcare and Family Services.
21    Pursuant to subsection (E) of Section 12-4.25 of this
22Code, the Department is entitled to recover overpayments paid
23to a provider or vendor, including, but not limited to, from
24the discharging physician, the discharging facility, and the
25ground ambulance service provider, in instances where a
26non-emergency ground ambulance service is rendered as the

 

 

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1result of improper or false certification.
2    Beginning October 1, 2018, the Department of Healthcare
3and Family Services shall collect data from Medicaid managed
4care organizations and transportation brokers, including the
5Department's NETSPAP broker, regarding denials and appeals
6related to the missing or incomplete Physician Certification
7Statement forms and overall compliance with this subsection.
8The Department of Healthcare and Family Services shall publish
9quarterly results on its website within 15 days following the
10end of each quarter.
11    (h) On and after July 1, 2012, the Department shall reduce
12any rate of reimbursement for services or other payments or
13alter any methodologies authorized by this Code to reduce any
14rate of reimbursement for services or other payments in
15accordance with Section 5-5e.
16    (i) On and after July 1, 2018, the Department shall
17increase the base rate of reimbursement for both base charges
18and mileage charges for ground ambulance service providers for
19medical transportation services provided by means of a ground
20ambulance to a level not lower than 112% of the base rate in
21effect as of June 30, 2018.
22(Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18;
23101-81, eff. 7-12-19; 101-649, eff. 7-7-20.)