Rep. Elgie R. Sims, Jr.

Filed: 3/21/2013

 

 


 

 


 
09800HB2802ham002LRB098 05642 KTG 43684 a

1
AMENDMENT TO HOUSE BILL 2802

2    AMENDMENT NO. ______. Amend House Bill 2802 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5 as follows:
 
6    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
7    Sec. 5-5. Medical services. The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing home,
16or elsewhere; (6) medical care, or any other type of remedial

 

 

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1care furnished by licensed practitioners; (7) home health care
2services; (8) private duty nursing service; (9) clinic
3services; (10) dental services, including prevention and
4treatment of periodontal disease and dental caries disease for
5pregnant women, provided by an individual licensed to practice
6dentistry or dental surgery; for purposes of this item (10),
7"dental services" means diagnostic, preventive, or corrective
8procedures provided by or under the supervision of a dentist in
9the practice of his or her profession; (11) physical therapy
10and related services; (12) prescribed drugs, dentures, and
11prosthetic devices; and eyeglasses prescribed by a physician
12skilled in the diseases of the eye, or by an optometrist,
13whichever the person may select; (13) other diagnostic,
14screening, preventive, and rehabilitative services, including
15to ensure that the individual's need for intervention or
16treatment of mental disorders or substance use disorders or
17co-occurring mental health and substance use disorders is
18determined using a uniform screening, assessment, and
19evaluation process inclusive of criteria, for children and
20adults; for purposes of this item (13), a uniform screening,
21assessment, and evaluation process refers to a process that
22includes an appropriate evaluation and, as warranted, a
23referral; "uniform" does not mean the use of a singular
24instrument, tool, or process that all must utilize; (14)
25transportation and such other expenses as may be necessary;
26(15) medical treatment of sexual assault survivors, as defined

 

 

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1in Section 1a of the Sexual Assault Survivors Emergency
2Treatment Act, for injuries sustained as a result of the sexual
3assault, including examinations and laboratory tests to
4discover evidence which may be used in criminal proceedings
5arising from the sexual assault; (16) the diagnosis and
6treatment of sickle cell anemia; and (17) any other medical
7care, and any other type of remedial care recognized under the
8laws of this State, but not including abortions, or induced
9miscarriages or premature births, unless, in the opinion of a
10physician, such procedures are necessary for the preservation
11of the life of the woman seeking such treatment, or except an
12induced premature birth intended to produce a live viable child
13and such procedure is necessary for the health of the mother or
14her unborn child. The Illinois Department, by rule, shall
15prohibit any physician from providing medical assistance to
16anyone eligible therefor under this Code where such physician
17has been found guilty of performing an abortion procedure in a
18wilful and wanton manner upon a woman who was not pregnant at
19the time such abortion procedure was performed. The term "any
20other type of remedial care" shall include nursing care and
21nursing home service for persons who rely on treatment by
22spiritual means alone through prayer for healing.
23    Notwithstanding any other provision of this Section, a
24comprehensive tobacco use cessation program that includes
25purchasing prescription drugs or prescription medical devices
26approved by the Food and Drug Administration shall be covered

 

 

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1under the medical assistance program under this Article for
2persons who are otherwise eligible for assistance under this
3Article.
4    Notwithstanding any other provision of this Code, the
5Illinois Department may not require, as a condition of payment
6for any laboratory test authorized under this Article, that a
7physician's handwritten signature appear on the laboratory
8test order form. The Illinois Department may, however, impose
9other appropriate requirements regarding laboratory test order
10documentation.
11    On and after July 1, 2012, the Department of Healthcare and
12Family Services may provide the following services to persons
13eligible for assistance under this Article who are
14participating in education, training or employment programs
15operated by the Department of Human Services as successor to
16the Department of Public Aid:
17        (1) dental services provided by or under the
18    supervision of a dentist; and
19        (2) eyeglasses prescribed by a physician skilled in the
20    diseases of the eye, or by an optometrist, whichever the
21    person may select.
22    Notwithstanding any other provision of this Code and
23subject to federal approval, the Department may adopt rules to
24allow a dentist who is volunteering his or her service at no
25cost to render dental services through an enrolled
26not-for-profit health clinic without the dentist personally

 

 

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1enrolling as a participating provider in the medical assistance
2program. A not-for-profit health clinic shall include a public
3health clinic or Federally Qualified Health Center or other
4enrolled provider, as determined by the Department, through
5which dental services covered under this Section are performed.
6The Department shall establish a process for payment of claims
7for reimbursement for covered dental services rendered under
8this provision.
9    The Illinois Department, by rule, may distinguish and
10classify the medical services to be provided only in accordance
11with the classes of persons designated in Section 5-2.
12    The Department of Healthcare and Family Services must
13provide coverage and reimbursement for amino acid-based
14elemental formulas, regardless of delivery method, for the
15diagnosis and treatment of (i) eosinophilic disorders and (ii)
16short bowel syndrome when the prescribing physician has issued
17a written order stating that the amino acid-based elemental
18formula is medically necessary.
19    The Illinois Department shall authorize the provision of,
20and shall authorize payment for, screening by low-dose
21mammography for the presence of occult breast cancer for women
2235 years of age or older who are eligible for medical
23assistance under this Article, as follows:
24        (A) A baseline mammogram for women 35 to 39 years of
25    age.
26        (B) An annual mammogram for women 40 years of age or

 

 

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1    older.
2        (C) A mammogram at the age and intervals considered
3    medically necessary by the woman's health care provider for
4    women under 40 years of age and having a family history of
5    breast cancer, prior personal history of breast cancer,
6    positive genetic testing, or other risk factors.
7        (D) A comprehensive ultrasound screening of an entire
8    breast or breasts if a mammogram demonstrates
9    heterogeneous or dense breast tissue, when medically
10    necessary as determined by a physician licensed to practice
11    medicine in all of its branches.
12    All screenings shall include a physical breast exam,
13instruction on self-examination and information regarding the
14frequency of self-examination and its value as a preventative
15tool. For purposes of this Section, "low-dose mammography"
16means the x-ray examination of the breast using equipment
17dedicated specifically for mammography, including the x-ray
18tube, filter, compression device, and image receptor, with an
19average radiation exposure delivery of less than one rad per
20breast for 2 views of an average size breast. The term also
21includes digital mammography.
22    On and after January 1, 2012, providers participating in a
23quality improvement program approved by the Department shall be
24reimbursed for screening and diagnostic mammography at the same
25rate as the Medicare program's rates, including the increased
26reimbursement for digital mammography.

 

 

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1    The Department shall convene an expert panel including
2representatives of hospitals, free-standing mammography
3facilities, and doctors, including radiologists, to establish
4quality standards.
5    Subject to federal approval, the Department shall
6establish a rate methodology for mammography at federally
7qualified health centers and other encounter-rate clinics.
8These clinics or centers may also collaborate with other
9hospital-based mammography facilities.
10    The Department shall establish a methodology to remind
11women who are age-appropriate for screening mammography, but
12who have not received a mammogram within the previous 18
13months, of the importance and benefit of screening mammography.
14    The Department shall establish a performance goal for
15primary care providers with respect to their female patients
16over age 40 receiving an annual mammogram. This performance
17goal shall be used to provide additional reimbursement in the
18form of a quality performance bonus to primary care providers
19who meet that goal.
20    The Department shall devise a means of case-managing or
21patient navigation for beneficiaries diagnosed with breast
22cancer. This program shall initially operate as a pilot program
23in areas of the State with the highest incidence of mortality
24related to breast cancer. At least one pilot program site shall
25be in the metropolitan Chicago area and at least one site shall
26be outside the metropolitan Chicago area. An evaluation of the

 

 

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1pilot program shall be carried out measuring health outcomes
2and cost of care for those served by the pilot program compared
3to similarly situated patients who are not served by the pilot
4program.
5    Any medical or health care provider shall immediately
6recommend, to any pregnant woman who is being provided prenatal
7services and is suspected of drug abuse or is addicted as
8defined in the Alcoholism and Other Drug Abuse and Dependency
9Act, referral to a local substance abuse treatment provider
10licensed by the Department of Human Services or to a licensed
11hospital which provides substance abuse treatment services.
12The Department of Healthcare and Family Services shall assure
13coverage for the cost of treatment of the drug abuse or
14addiction for pregnant recipients in accordance with the
15Illinois Medicaid Program in conjunction with the Department of
16Human Services.
17    All medical providers providing medical assistance to
18pregnant women under this Code shall receive information from
19the Department on the availability of services under the Drug
20Free Families with a Future or any comparable program providing
21case management services for addicted women, including
22information on appropriate referrals for other social services
23that may be needed by addicted women in addition to treatment
24for addiction.
25    The Illinois Department, in cooperation with the
26Departments of Human Services (as successor to the Department

 

 

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1of Alcoholism and Substance Abuse) and Public Health, through a
2public awareness campaign, may provide information concerning
3treatment for alcoholism and drug abuse and addiction, prenatal
4health care, and other pertinent programs directed at reducing
5the number of drug-affected infants born to recipients of
6medical assistance.
7    Neither the Department of Healthcare and Family Services
8nor the Department of Human Services shall sanction the
9recipient solely on the basis of her substance abuse.
10    The Illinois Department shall establish such regulations
11governing the dispensing of health services under this Article
12as it shall deem appropriate. The Department should seek the
13advice of formal professional advisory committees appointed by
14the Director of the Illinois Department for the purpose of
15providing regular advice on policy and administrative matters,
16information dissemination and educational activities for
17medical and health care providers, and consistency in
18procedures to the Illinois Department.
19    The Illinois Department may develop and contract with
20Partnerships of medical providers to arrange medical services
21for persons eligible under Section 5-2 of this Code.
22Implementation of this Section may be by demonstration projects
23in certain geographic areas. The Partnership shall be
24represented by a sponsor organization. The Department, by rule,
25shall develop qualifications for sponsors of Partnerships.
26Nothing in this Section shall be construed to require that the

 

 

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1sponsor organization be a medical organization.
2    The sponsor must negotiate formal written contracts with
3medical providers for physician services, inpatient and
4outpatient hospital care, home health services, treatment for
5alcoholism and substance abuse, and other services determined
6necessary by the Illinois Department by rule for delivery by
7Partnerships. Physician services must include prenatal and
8obstetrical care. The Illinois Department shall reimburse
9medical services delivered by Partnership providers to clients
10in target areas according to provisions of this Article and the
11Illinois Health Finance Reform Act, except that:
12        (1) Physicians participating in a Partnership and
13    providing certain services, which shall be determined by
14    the Illinois Department, to persons in areas covered by the
15    Partnership may receive an additional surcharge for such
16    services.
17        (2) The Department may elect to consider and negotiate
18    financial incentives to encourage the development of
19    Partnerships and the efficient delivery of medical care.
20        (3) Persons receiving medical services through
21    Partnerships may receive medical and case management
22    services above the level usually offered through the
23    medical assistance program.
24    Medical providers shall be required to meet certain
25qualifications to participate in Partnerships to ensure the
26delivery of high quality medical services. These

 

 

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1qualifications shall be determined by rule of the Illinois
2Department and may be higher than qualifications for
3participation in the medical assistance program. Partnership
4sponsors may prescribe reasonable additional qualifications
5for participation by medical providers, only with the prior
6written approval of the Illinois Department.
7    Nothing in this Section shall limit the free choice of
8practitioners, hospitals, and other providers of medical
9services by clients. In order to ensure patient freedom of
10choice, the Illinois Department shall immediately promulgate
11all rules and take all other necessary actions so that provided
12services may be accessed from therapeutically certified
13optometrists to the full extent of the Illinois Optometric
14Practice Act of 1987 without discriminating between service
15providers.
16    The Department shall apply for a waiver from the United
17States Health Care Financing Administration to allow for the
18implementation of Partnerships under this Section.
19    The Illinois Department shall require health care
20providers to maintain records that document the medical care
21and services provided to recipients of Medical Assistance under
22this Article. Such records must be retained for a period of not
23less than 6 years from the date of service or as provided by
24applicable State law, whichever period is longer, except that
25if an audit is initiated within the required retention period
26then the records must be retained until the audit is completed

 

 

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1and every exception is resolved. The Illinois Department shall
2require health care providers to make available, when
3authorized by the patient, in writing, the medical records in a
4timely fashion to other health care providers who are treating
5or serving persons eligible for Medical Assistance under this
6Article. All dispensers of medical services shall be required
7to maintain and retain business and professional records
8sufficient to fully and accurately document the nature, scope,
9details and receipt of the health care provided to persons
10eligible for medical assistance under this Code, in accordance
11with regulations promulgated by the Illinois Department. The
12rules and regulations shall require that proof of the receipt
13of prescription drugs, dentures, prosthetic devices and
14eyeglasses by eligible persons under this Section accompany
15each claim for reimbursement submitted by the dispenser of such
16medical services. No such claims for reimbursement shall be
17approved for payment by the Illinois Department without such
18proof of receipt, unless the Illinois Department shall have put
19into effect and shall be operating a system of post-payment
20audit and review which shall, on a sampling basis, be deemed
21adequate by the Illinois Department to assure that such drugs,
22dentures, prosthetic devices and eyeglasses for which payment
23is being made are actually being received by eligible
24recipients. Within 90 days after the effective date of this
25amendatory Act of 1984, the Illinois Department shall establish
26a current list of acquisition costs for all prosthetic devices

 

 

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1and any other items recognized as medical equipment and
2supplies reimbursable under this Article and shall update such
3list on a quarterly basis, except that the acquisition costs of
4all prescription drugs shall be updated no less frequently than
5every 30 days as required by Section 5-5.12.
6    The rules and regulations of the Illinois Department shall
7require that a written statement including the required opinion
8of a physician shall accompany any claim for reimbursement for
9abortions, or induced miscarriages or premature births. This
10statement shall indicate what procedures were used in providing
11such medical services.
12    The Illinois Department shall require all dispensers of
13medical services, other than an individual practitioner or
14group of practitioners, desiring to participate in the Medical
15Assistance program established under this Article to disclose
16all financial, beneficial, ownership, equity, surety or other
17interests in any and all firms, corporations, partnerships,
18associations, business enterprises, joint ventures, agencies,
19institutions or other legal entities providing any form of
20health care services in this State under this Article.
21    The Illinois Department may require that all dispensers of
22medical services desiring to participate in the medical
23assistance program established under this Article disclose,
24under such terms and conditions as the Illinois Department may
25by rule establish, all inquiries from clients and attorneys
26regarding medical bills paid by the Illinois Department, which

 

 

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1inquiries could indicate potential existence of claims or liens
2for the Illinois Department.
3    Enrollment of a vendor shall be subject to a provisional
4period and shall be conditional for one year. During the period
5of conditional enrollment, the Department may terminate the
6vendor's eligibility to participate in, or may disenroll the
7vendor from, the medical assistance program without cause.
8Unless otherwise specified, such termination of eligibility or
9disenrollment is not subject to the Department's hearing
10process. However, a disenrolled vendor may reapply without
11penalty.
12    The Department has the discretion to limit the conditional
13enrollment period for vendors based upon category of risk of
14the vendor.
15    Prior to enrollment and during the conditional enrollment
16period in the medical assistance program, all vendors shall be
17subject to enhanced oversight, screening, and review based on
18the risk of fraud, waste, and abuse that is posed by the
19category of risk of the vendor. The Illinois Department shall
20establish the procedures for oversight, screening, and review,
21which may include, but need not be limited to: criminal and
22financial background checks; fingerprinting; license,
23certification, and authorization verifications; unscheduled or
24unannounced site visits; database checks; prepayment audit
25reviews; audits; payment caps; payment suspensions; and other
26screening as required by federal or State law.

 

 

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1    The Department shall define or specify the following: (i)
2by provider notice, the "category of risk of the vendor" for
3each type of vendor, which shall take into account the level of
4screening applicable to a particular category of vendor under
5federal law and regulations; (ii) by rule or provider notice,
6the maximum length of the conditional enrollment period for
7each category of risk of the vendor; and (iii) by rule, the
8hearing rights, if any, afforded to a vendor in each category
9of risk of the vendor that is terminated or disenrolled during
10the conditional enrollment period.
11    To be eligible for payment consideration, a vendor's
12payment claim or bill, either as an initial claim or as a
13resubmitted claim following prior rejection, must be received
14by the Illinois Department, or its fiscal intermediary, no
15later than 180 days after the latest date on the claim on which
16medical goods or services were provided, with the following
17exceptions:
18        (1) In the case of a provider whose enrollment is in
19    process by the Illinois Department, the 180-day period
20    shall not begin until the date on the written notice from
21    the Illinois Department that the provider enrollment is
22    complete.
23        (2) In the case of errors attributable to the Illinois
24    Department or any of its claims processing intermediaries
25    which result in an inability to receive, process, or
26    adjudicate a claim, the 180-day period shall not begin

 

 

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1    until the provider has been notified of the error.
2        (3) In the case of a provider for whom the Illinois
3    Department initiates the monthly billing process.
4    For claims for services rendered during a period for which
5a recipient received retroactive eligibility, claims must be
6filed within 180 days after the Department determines the
7applicant is eligible. For claims for which the Illinois
8Department is not the primary payer, claims must be submitted
9to the Illinois Department within 180 days after the final
10adjudication by the primary payer.
11    In the case of long term care facilities, admission
12documents shall be submitted within 30 days of an admission to
13the facility through the Medical Electronic Data Interchange
14(MEDI) or the Recipient Eligibility Verification (REV) System,
15or shall be submitted directly to the Department of Human
16Services using required admission forms. Confirmation numbers
17assigned to an accepted transaction shall be retained by a
18facility to verify timely submittal. Once an admission
19transaction has been completed, all resubmitted claims
20following prior rejection are subject to receipt no later than
21180 days after the admission transaction has been completed.
22    Claims that are not submitted and received in compliance
23with the foregoing requirements shall not be eligible for
24payment under the medical assistance program, and the State
25shall have no liability for payment of those claims.
26    To the extent consistent with applicable information and

 

 

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1privacy, security, and disclosure laws, State and federal
2agencies and departments shall provide the Illinois Department
3access to confidential and other information and data necessary
4to perform eligibility and payment verifications and other
5Illinois Department functions. This includes, but is not
6limited to: information pertaining to licensure;
7certification; earnings; immigration status; citizenship; wage
8reporting; unearned and earned income; pension income;
9employment; supplemental security income; social security
10numbers; National Provider Identifier (NPI) numbers; the
11National Practitioner Data Bank (NPDB); program and agency
12exclusions; taxpayer identification numbers; tax delinquency;
13corporate information; and death records.
14    The Illinois Department shall enter into agreements with
15State agencies and departments, and is authorized to enter into
16agreements with federal agencies and departments, under which
17such agencies and departments shall share data necessary for
18medical assistance program integrity functions and oversight.
19The Illinois Department shall develop, in cooperation with
20other State departments and agencies, and in compliance with
21applicable federal laws and regulations, appropriate and
22effective methods to share such data. At a minimum, and to the
23extent necessary to provide data sharing, the Illinois
24Department shall enter into agreements with State agencies and
25departments, and is authorized to enter into agreements with
26federal agencies and departments, including but not limited to:

 

 

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1the Secretary of State; the Department of Revenue; the
2Department of Public Health; the Department of Human Services;
3and the Department of Financial and Professional Regulation.
4    Beginning in fiscal year 2013, the Illinois Department
5shall set forth a request for information to identify the
6benefits of a pre-payment, post-adjudication, and post-edit
7claims system with the goals of streamlining claims processing
8and provider reimbursement, reducing the number of pending or
9rejected claims, and helping to ensure a more transparent
10adjudication process through the utilization of: (i) provider
11data verification and provider screening technology; and (ii)
12clinical code editing; and (iii) pre-pay, pre- or
13post-adjudicated predictive modeling with an integrated case
14management system with link analysis. Such a request for
15information shall not be considered as a request for proposal
16or as an obligation on the part of the Illinois Department to
17take any action or acquire any products or services.
18    The Illinois Department shall establish policies,
19procedures, standards and criteria by rule for the acquisition,
20repair and replacement of orthotic and prosthetic devices and
21durable medical equipment. Such rules shall provide, but not be
22limited to, the following services: (1) immediate repair or
23replacement of such devices by recipients; and (2) rental,
24lease, purchase or lease-purchase of durable medical equipment
25in a cost-effective manner, taking into consideration the
26recipient's medical prognosis, the extent of the recipient's

 

 

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1needs, and the requirements and costs for maintaining such
2equipment. Subject to prior approval, such rules shall enable a
3recipient to temporarily acquire and use alternative or
4substitute devices or equipment pending repairs or
5replacements of any device or equipment previously authorized
6for such recipient by the Department.
7    The Department shall execute, relative to the nursing home
8prescreening project, written inter-agency agreements with the
9Department of Human Services and the Department on Aging, to
10effect the following: (i) intake procedures and common
11eligibility criteria for those persons who are receiving
12non-institutional services; and (ii) the establishment and
13development of non-institutional services in areas of the State
14where they are not currently available or are undeveloped; and
15(iii) notwithstanding any other provision of law, subject to
16federal approval, on and after July 1, 2012, an increase in the
17determination of need (DON) scores from 29 to 37 for applicants
18for institutional and home and community-based long term care;
19if and only if federal approval is not granted, the Department
20may, in conjunction with other affected agencies, implement
21utilization controls or changes in benefit packages to
22effectuate a similar savings amount for this population; and
23(iv) no later than July 1, 2013, minimum level of care
24eligibility criteria for institutional and home and
25community-based long term care; and (v) no later than October
261, 2013, establish procedures to permit long term care

 

 

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1providers access to eligibility scores for individuals who are
2seeking or receiving services from the long term care provider.
3In order to select the minimum level of care eligibility
4criteria, the Governor shall establish a workgroup that
5includes affected agency representatives and stakeholders
6representing the institutional and home and community-based
7long term care interests. This Section shall not restrict the
8Department from implementing lower level of care eligibility
9criteria for community-based services in circumstances where
10federal approval has been granted.
11    The Illinois Department shall develop and operate, in
12cooperation with other State Departments and agencies and in
13compliance with applicable federal laws and regulations,
14appropriate and effective systems of health care evaluation and
15programs for monitoring of utilization of health care services
16and facilities, as it affects persons eligible for medical
17assistance under this Code.
18    The Illinois Department shall report annually to the
19General Assembly, no later than the second Friday in April of
201979 and each year thereafter, in regard to:
21        (a) actual statistics and trends in utilization of
22    medical services by public aid recipients;
23        (b) actual statistics and trends in the provision of
24    the various medical services by medical vendors;
25        (c) current rate structures and proposed changes in
26    those rate structures for the various medical vendors; and

 

 

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1        (d) efforts at utilization review and control by the
2    Illinois Department.
3    The period covered by each report shall be the 3 years
4ending on the June 30 prior to the report. The report shall
5include suggested legislation for consideration by the General
6Assembly. The filing of one copy of the report with the
7Speaker, one copy with the Minority Leader and one copy with
8the Clerk of the House of Representatives, one copy with the
9President, one copy with the Minority Leader and one copy with
10the Secretary of the Senate, one copy with the Legislative
11Research Unit, and such additional copies with the State
12Government Report Distribution Center for the General Assembly
13as is required under paragraph (t) of Section 7 of the State
14Library Act shall be deemed sufficient to comply with this
15Section.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22    On and after July 1, 2012, the Department shall reduce any
23rate of reimbursement for services or other payments or alter
24any methodologies authorized by this Code to reduce any rate of
25reimbursement for services or other payments in accordance with
26Section 5-5e.

 

 

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1(Source: P.A. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926,
2eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638,
3eff. 1-1-12; 97-689, eff. 6-14-12; 97-1061, eff. 8-24-12;
4revised 9-20-12.)
 
5    Section 99. Effective date. This Act takes effect upon
6becoming law.".