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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| the
relationship with a child pursuant to Article V of the |
2 |
| Illinois Public Aid
Code or this Act shall be limited to such a |
3 |
| person whose countable income is
determined by the Department |
4 |
| to be at or below such income eligibility
standard as the |
5 |
| Department by rule shall establish. The income level
|
6 |
| established by the Department shall not be below 90% of the |
7 |
| federal
poverty
level. Such persons who are determined to be |
8 |
| eligible must reapply, or
otherwise establish eligibility, at |
9 |
| least annually. An eligible person shall
be required, as |
10 |
| determined by the Department by rule, to report promptly those
|
11 |
| changes in income and other circumstances that affect |
12 |
| eligibility. The
eligibility of a person may be
redetermined |
13 |
| based on the information reported or may be terminated based on
|
14 |
| the failure to report or failure to report accurately. A person |
15 |
| may also be
held liable to the Department for any payments made |
16 |
| by the Department on such
person's behalf that were |
17 |
| inappropriate. An applicant shall be provided with
notice of |
18 |
| these obligations.
|
19 |
| (d) Subject to specific appropriation, the Department |
20 |
| shall provide outreach grants to community organizations to |
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| enroll families in the program under this Section.
|
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| (Source: P.A. 92-597, eff. 6-28-02; 93-63, eff. 6-30-03.)
|
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| Section 10. The Illinois Public Aid Code is amended by |
24 |
| changing Section 5-5 as follows: |
25 |
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
|
26 |
| Sec. 5-5. Medical services. The Illinois Department, by |
27 |
| rule, shall
determine the quantity and quality of and the rate |
28 |
| of reimbursement for the
medical assistance for which
payment |
29 |
| will be authorized, and the medical services to be provided,
|
30 |
| which may include all or part of the following: (1) inpatient |
31 |
| hospital
services; (2) outpatient hospital services; (3) other |
32 |
| laboratory and
X-ray services; (4) skilled nursing home |
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| services; (5) physicians'
services whether furnished in the |
2 |
| office, the patient's home, a
hospital, a skilled nursing home, |
3 |
| or elsewhere; (6) medical care, or any
other type of remedial |
4 |
| care furnished by licensed practitioners; (7)
home health care |
5 |
| services; (8) private duty nursing service; (9) clinic
|
6 |
| services; (10) dental services , including prevention and |
7 |
| treatment of periodontal disease and dental caries disease for |
8 |
| pregnant women ; (11) physical therapy and related
services; |
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| (12) prescribed drugs, dentures, and prosthetic devices; and
|
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| eyeglasses prescribed by a physician skilled in the diseases of |
11 |
| the eye,
or by an optometrist, whichever the person may select; |
12 |
| (13) other
diagnostic, screening, preventive, and |
13 |
| rehabilitative services; (14)
transportation and such other |
14 |
| expenses as may be necessary; (15) medical
treatment of sexual |
15 |
| assault survivors, as defined in
Section 1a of the Sexual |
16 |
| Assault Survivors Emergency Treatment Act, for
injuries |
17 |
| sustained as a result of the sexual assault, including
|
18 |
| examinations and laboratory tests to discover evidence which |
19 |
| may be used in
criminal proceedings arising from the sexual |
20 |
| assault; (16) the
diagnosis and treatment of sickle cell |
21 |
| anemia; and (17)
any other medical care, and any other type of |
22 |
| remedial care recognized
under the laws of this State, but not |
23 |
| including abortions, or induced
miscarriages or premature |
24 |
| births, unless, in the opinion of a physician,
such procedures |
25 |
| are necessary for the preservation of the life of the
woman |
26 |
| seeking such treatment, or except an induced premature birth
|
27 |
| intended to produce a live viable child and such procedure is |
28 |
| necessary
for the health of the mother or her unborn child. The |
29 |
| Illinois Department,
by rule, shall prohibit any physician from |
30 |
| providing medical assistance
to anyone eligible therefor under |
31 |
| this Code where such physician has been
found guilty of |
32 |
| performing an abortion procedure in a wilful and wanton
manner |
33 |
| upon a woman who was not pregnant at the time such abortion
|
34 |
| procedure was performed. The term "any other type of remedial |
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| care" shall
include nursing care and nursing home service for |
2 |
| persons who rely on
treatment by spiritual means alone through |
3 |
| prayer for healing.
|
4 |
| Notwithstanding any other provision of this Section, a |
5 |
| comprehensive
tobacco use cessation program that includes |
6 |
| purchasing prescription drugs or
prescription medical devices |
7 |
| approved by the Food and Drug administration shall
be covered |
8 |
| under the medical assistance
program under this Article for |
9 |
| persons who are otherwise eligible for
assistance under this |
10 |
| Article.
|
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| Notwithstanding any other provision of this Code, the |
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| Illinois
Department may not require, as a condition of payment |
13 |
| for any laboratory
test authorized under this Article, that a |
14 |
| physician's handwritten signature
appear on the laboratory |
15 |
| test order form. The Illinois Department may,
however, impose |
16 |
| other appropriate requirements regarding laboratory test
order |
17 |
| documentation.
|
18 |
| The Illinois Department of Public Aid shall provide the |
19 |
| following services to
persons
eligible for assistance under |
20 |
| this Article who are participating in
education, training or |
21 |
| employment programs operated by the Department of Human
|
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| Services as successor to the Department of Public Aid:
|
23 |
| (1) dental services, which shall include but not be |
24 |
| limited to
prosthodontics; and
|
25 |
| (2) eyeglasses prescribed by a physician skilled in the |
26 |
| diseases of the
eye, or by an optometrist, whichever the |
27 |
| person may select.
|
28 |
| The Illinois Department, by rule, may distinguish and |
29 |
| classify the
medical services to be provided only in accordance |
30 |
| with the classes of
persons designated in Section 5-2.
|
31 |
| The Illinois Department shall authorize the provision of, |
32 |
| and shall
authorize payment for, screening by low-dose |
33 |
| mammography for the presence of
occult breast cancer for women |
34 |
| 35 years of age or older who are eligible
for medical |
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| assistance under this Article, as follows: a baseline
mammogram |
2 |
| for women 35 to 39 years of age and an
annual mammogram for |
3 |
| women 40 years of age or older. All screenings
shall
include a |
4 |
| physical breast exam, instruction on self-examination and
|
5 |
| information regarding the frequency of self-examination and |
6 |
| its value as a
preventative tool. As used in this Section, |
7 |
| "low-dose mammography" means
the x-ray examination of the |
8 |
| breast using equipment dedicated specifically
for mammography, |
9 |
| including the x-ray tube, filter, compression device,
image |
10 |
| receptor, and cassettes, with an average radiation exposure |
11 |
| delivery
of less than one rad mid-breast, with 2 views for each |
12 |
| breast.
|
13 |
| Any medical or health care provider shall immediately |
14 |
| recommend, to
any pregnant woman who is being provided prenatal |
15 |
| services and is suspected
of drug abuse or is addicted as |
16 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency |
17 |
| Act, referral to a local substance abuse treatment provider
|
18 |
| licensed by the Department of Human Services or to a licensed
|
19 |
| hospital which provides substance abuse treatment services. |
20 |
| The Department of
Public Aid shall assure coverage for the cost |
21 |
| of treatment of the drug abuse or
addiction for pregnant |
22 |
| recipients in accordance with the Illinois Medicaid
Program in |
23 |
| conjunction with the Department of Human Services.
|
24 |
| All medical providers providing medical assistance to |
25 |
| pregnant women
under this Code shall receive information from |
26 |
| the Department on the
availability of services under the Drug |
27 |
| Free Families with a Future or any
comparable program providing |
28 |
| case management services for addicted women,
including |
29 |
| information on appropriate referrals for other social services
|
30 |
| that may be needed by addicted women in addition to treatment |
31 |
| for addiction.
|
32 |
| The Illinois Department, in cooperation with the |
33 |
| Departments of Human
Services (as successor to the Department |
34 |
| of Alcoholism and Substance
Abuse) and Public Health, through a |
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| public awareness campaign, may
provide information concerning |
2 |
| treatment for alcoholism and drug abuse and
addiction, prenatal |
3 |
| health care, and other pertinent programs directed at
reducing |
4 |
| the number of drug-affected infants born to recipients of |
5 |
| medical
assistance.
|
6 |
| Neither the Illinois Department of Public Aid nor the |
7 |
| Department of Human
Services shall sanction the recipient |
8 |
| solely on the basis of
her substance abuse.
|
9 |
| The Illinois Department shall establish such regulations |
10 |
| governing
the dispensing of health services under this Article |
11 |
| as it shall deem
appropriate. The Department
should
seek the |
12 |
| advice of formal professional advisory committees appointed by
|
13 |
| the Director of the Illinois Department for the purpose of |
14 |
| providing regular
advice on policy and administrative matters, |
15 |
| information dissemination and
educational activities for |
16 |
| medical and health care providers, and
consistency in |
17 |
| procedures to the Illinois Department.
|
18 |
| The Illinois Department may develop and contract with |
19 |
| Partnerships of
medical providers to arrange medical services |
20 |
| for persons eligible under
Section 5-2 of this Code. |
21 |
| Implementation of this Section may be by
demonstration projects |
22 |
| in certain geographic areas. The Partnership shall
be |
23 |
| represented by a sponsor organization. The Department, by rule, |
24 |
| shall
develop qualifications for sponsors of Partnerships. |
25 |
| Nothing in this
Section shall be construed to require that the |
26 |
| sponsor organization be a
medical organization.
|
27 |
| The sponsor must negotiate formal written contracts with |
28 |
| medical
providers for physician services, inpatient and |
29 |
| outpatient hospital care,
home health services, treatment for |
30 |
| alcoholism and substance abuse, and
other services determined |
31 |
| necessary by the Illinois Department by rule for
delivery by |
32 |
| Partnerships. Physician services must include prenatal and
|
33 |
| obstetrical care. The Illinois Department shall reimburse |
34 |
| medical services
delivered by Partnership providers to clients |
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| in target areas according to
provisions of this Article and the |
2 |
| Illinois Health Finance Reform Act,
except that:
|
3 |
| (1) Physicians participating in a Partnership and |
4 |
| providing certain
services, which shall be determined by |
5 |
| the Illinois Department, to persons
in areas covered by the |
6 |
| Partnership may receive an additional surcharge
for such |
7 |
| services.
|
8 |
| (2) The Department may elect to consider and negotiate |
9 |
| financial
incentives to encourage the development of |
10 |
| Partnerships and the efficient
delivery of medical care.
|
11 |
| (3) Persons receiving medical services through |
12 |
| Partnerships may receive
medical and case management |
13 |
| services above the level usually offered
through the |
14 |
| medical assistance program.
|
15 |
| Medical providers shall be required to meet certain |
16 |
| qualifications to
participate in Partnerships to ensure the |
17 |
| delivery of high quality medical
services. These |
18 |
| qualifications shall be determined by rule of the Illinois
|
19 |
| Department and may be higher than qualifications for |
20 |
| participation in the
medical assistance program. Partnership |
21 |
| sponsors may prescribe reasonable
additional qualifications |
22 |
| for participation by medical providers, only with
the prior |
23 |
| written approval of the Illinois Department.
|
24 |
| Nothing in this Section shall limit the free choice of |
25 |
| practitioners,
hospitals, and other providers of medical |
26 |
| services by clients.
In order to ensure patient freedom of |
27 |
| choice, the Illinois Department shall
immediately promulgate |
28 |
| all rules and take all other necessary actions so that
provided |
29 |
| services may be accessed from therapeutically certified |
30 |
| optometrists
to the full extent of the Illinois Optometric |
31 |
| Practice Act of 1987 without
discriminating between service |
32 |
| providers.
|
33 |
| The Department shall apply for a waiver from the United |
34 |
| States Health
Care Financing Administration to allow for the |
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| implementation of
Partnerships under this Section.
|
2 |
| The Illinois Department shall require health care |
3 |
| providers to maintain
records that document the medical care |
4 |
| and services provided to recipients
of Medical Assistance under |
5 |
| this Article. The Illinois Department shall
require health care |
6 |
| providers to make available, when authorized by the
patient, in |
7 |
| writing, the medical records in a timely fashion to other
|
8 |
| health care providers who are treating or serving persons |
9 |
| eligible for
Medical Assistance under this Article. All |
10 |
| dispensers of medical services
shall be required to maintain |
11 |
| and retain business and professional records
sufficient to |
12 |
| fully and accurately document the nature, scope, details and
|
13 |
| receipt of the health care provided to persons eligible for |
14 |
| medical
assistance under this Code, in accordance with |
15 |
| regulations promulgated by
the Illinois Department. The rules |
16 |
| and regulations shall require that proof
of the receipt of |
17 |
| prescription drugs, dentures, prosthetic devices and
|
18 |
| eyeglasses by eligible persons under this Section accompany |
19 |
| each claim
for reimbursement submitted by the dispenser of such |
20 |
| medical services.
No such claims for reimbursement shall be |
21 |
| approved for payment by the Illinois
Department without such |
22 |
| proof of receipt, unless the Illinois Department
shall have put |
23 |
| into effect and shall be operating a system of post-payment
|
24 |
| audit and review which shall, on a sampling basis, be deemed |
25 |
| adequate by
the Illinois Department to assure that such drugs, |
26 |
| dentures, prosthetic
devices and eyeglasses for which payment |
27 |
| is being made are actually being
received by eligible |
28 |
| recipients. Within 90 days after the effective date of
this |
29 |
| amendatory Act of 1984, the Illinois Department shall establish |
30 |
| a
current list of acquisition costs for all prosthetic devices |
31 |
| and any
other items recognized as medical equipment and |
32 |
| supplies reimbursable under
this Article and shall update such |
33 |
| list on a quarterly basis, except that
the acquisition costs of |
34 |
| all prescription drugs shall be updated no
less frequently than |
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| every 30 days as required by Section 5-5.12.
|
2 |
| The rules and regulations of the Illinois Department shall |
3 |
| require
that a written statement including the required opinion |
4 |
| of a physician
shall accompany any claim for reimbursement for |
5 |
| abortions, or induced
miscarriages or premature births. This |
6 |
| statement shall indicate what
procedures were used in providing |
7 |
| such medical services.
|
8 |
| The Illinois Department shall require all dispensers of |
9 |
| medical
services, other than an individual practitioner or |
10 |
| group of practitioners,
desiring to participate in the Medical |
11 |
| Assistance program
established under this Article to disclose |
12 |
| all financial, beneficial,
ownership, equity, surety or other |
13 |
| interests in any and all firms,
corporations, partnerships, |
14 |
| associations, business enterprises, joint
ventures, agencies, |
15 |
| institutions or other legal entities providing any
form of |
16 |
| health care services in this State under this Article.
|
17 |
| The Illinois Department may require that all dispensers of |
18 |
| medical
services desiring to participate in the medical |
19 |
| assistance program
established under this Article disclose, |
20 |
| under such terms and conditions as
the Illinois Department may |
21 |
| by rule establish, all inquiries from clients
and attorneys |
22 |
| regarding medical bills paid by the Illinois Department, which
|
23 |
| inquiries could indicate potential existence of claims or liens |
24 |
| for the
Illinois Department.
|
25 |
| Enrollment of a vendor that provides non-emergency medical |
26 |
| transportation,
defined by the Department by rule,
shall be
|
27 |
| conditional for 180 days. During that time, the Department of |
28 |
| Public Aid may
terminate the vendor's eligibility to |
29 |
| participate in the medical assistance
program without cause. |
30 |
| That termination of eligibility is not subject to the
|
31 |
| Department's hearing process.
|
32 |
| The Illinois Department shall establish policies, |
33 |
| procedures,
standards and criteria by rule for the acquisition, |
34 |
| repair and replacement
of orthotic and prosthetic devices and |
|
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| durable medical equipment. Such
rules shall provide, but not be |
2 |
| limited to, the following services: (1)
immediate repair or |
3 |
| replacement of such devices by recipients without
medical |
4 |
| authorization; and (2) rental, lease, purchase or |
5 |
| lease-purchase of
durable medical equipment in a |
6 |
| cost-effective manner, taking into
consideration the |
7 |
| recipient's medical prognosis, the extent of the
recipient's |
8 |
| needs, and the requirements and costs for maintaining such
|
9 |
| equipment. Such rules shall enable a recipient to temporarily |
10 |
| acquire and
use alternative or substitute devices or equipment |
11 |
| pending repairs or
replacements of any device or equipment |
12 |
| previously authorized for such
recipient by the Department. |
13 |
| Rules under clause (2) above shall not provide
for purchase or |
14 |
| lease-purchase of durable medical equipment or supplies
used |
15 |
| for the purpose of oxygen delivery and respiratory care.
|
16 |
| The Department shall execute, relative to the nursing home |
17 |
| prescreening
project, written inter-agency agreements with the |
18 |
| Department of Human
Services and the Department on Aging, to |
19 |
| effect the following: (i) intake
procedures and common |
20 |
| eligibility criteria for those persons who are receiving
|
21 |
| non-institutional services; and (ii) the establishment and |
22 |
| development of
non-institutional services in areas of the State |
23 |
| where they are not currently
available or are undeveloped.
|
24 |
| The Illinois Department shall develop and operate, in |
25 |
| cooperation
with other State Departments and agencies and in |
26 |
| compliance with
applicable federal laws and regulations, |
27 |
| appropriate and effective
systems of health care evaluation and |
28 |
| programs for monitoring of
utilization of health care services |
29 |
| and facilities, as it affects
persons eligible for medical |
30 |
| assistance under this Code.
|
31 |
| The Illinois Department shall report annually to the |
32 |
| General Assembly,
no later than the second Friday in April of |
33 |
| 1979 and each year
thereafter, in regard to:
|
34 |
| (a) actual statistics and trends in utilization of |
|
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09300SB2367sam002 |
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LRB093 19989 DRJ 48988 a |
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| medical services by
public aid recipients;
|
2 |
| (b) actual statistics and trends in the provision of |
3 |
| the various medical
services by medical vendors;
|
4 |
| (c) current rate structures and proposed changes in |
5 |
| those rate structures
for the various medical vendors; and
|
6 |
| (d) efforts at utilization review and control by the |
7 |
| Illinois Department.
|
8 |
| The period covered by each report shall be the 3 years |
9 |
| ending on the June
30 prior to the report. The report shall |
10 |
| include suggested legislation
for consideration by the General |
11 |
| Assembly. The filing of one copy of the
report with the |
12 |
| Speaker, one copy with the Minority Leader and one copy
with |
13 |
| the Clerk of the House of Representatives, one copy with the |
14 |
| President,
one copy with the Minority Leader and one copy with |
15 |
| the Secretary of the
Senate, one copy with the Legislative |
16 |
| Research Unit, and such additional
copies
with the State |
17 |
| Government Report Distribution Center for the General
Assembly |
18 |
| as is required under paragraph (t) of Section 7 of the State
|
19 |
| Library Act shall be deemed sufficient to comply with this |
20 |
| Section.
|
21 |
| (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02; |
22 |
| 92-789, eff. 8-6-02; 93-632, eff. 2-1-04.)".
|