99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB4341

 

Introduced , by Rep. Robyn Gabel

 

SYNOPSIS AS INTRODUCED:
 
New Act
5 ILCS 80/4.37 new
225 ILCS 60/4  from Ch. 111, par. 4400-4
225 ILCS 65/50-15  was 225 ILCS 65/5-15
305 ILCS 5/5-5  from Ch. 23, par. 5-5

    Creates the Home Birth Safety Act. Provides for the licensure of midwives by the Department of Financial and Professional Regulation. Creates the Illinois Midwifery Board. Sets forth provisions concerning qualifications, grounds for disciplinary action, and administrative procedures. Amends the Regulatory Sunset Act to set a repeal date for the new Act of January 1, 2027. Amends the Medical Practice Act of 1987, the Nurse Practice Act, and the Illinois Public Aid Code to make related changes. Effective July 1, 2016.


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CORRECTIONAL BUDGET AND IMPACT NOTE ACT MAY APPLY
FISCAL NOTE ACT MAY APPLY
HOME RULE NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the Home
5Birth Safety Act.
 
6    Section 5. Purpose. The practice of midwifery in
7out-of-hospital settings is hereby declared to affect the
8public health, safety, and welfare and to be subject to
9regulation in the public interest. The purpose of this Act is
10to protect and benefit the public by setting standards for the
11qualifications, education, training, and experience of those
12who seek to obtain licensure and hold the title of licensed
13midwife, to promote high standards of professional performance
14for those licensed to practice midwifery in out-of-hospital
15settings in this State, and to protect the public from
16unprofessional conduct by persons licensed to practice
17midwifery, as defined in this Act. This Act shall be liberally
18construed to best carry out these purposes.
 
19    Section 10. Exemptions.
20    (a) This Act does not prohibit a person licensed under any
21other Act in this State from engaging in the practice for which
22he or she is licensed or from delegating services as provided

 

 

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1for under that other Act.
2    (b) Nothing in this Act shall be construed to prohibit or
3require licensing under this Act, with regard to:
4        (1) the gratuitous rendering of services;
5        (2) the rendering of services by a person, if such
6    attendance is in accordance with the person's religious
7    faith and is rendered to persons with a similar religious
8    faith as an exercise and enjoyment of their religious
9    freedom; and
10        (3) a student midwife working under the direction of a
11    licensed midwife.
12    (c) Nothing in this Act abridges, limits, or changes in any
13way the right of parents to deliver their baby where, when,
14how, and with whom they choose, regardless of licensure under
15this Act.
 
16    Section 15. Definitions. In this Act:
17    "Board" means the Illinois Midwifery Board.
18    "Certified professional midwife" or "CPM" means a person
19who has met the standards for certification set by the North
20American Registry of Midwives and has been awarded the
21Certified Professional Midwife credential.
22    "Department" means the Department of Financial and
23Professional Regulation.
24    "International Confederation of Midwives" means the
25organization that sets global standards for the education and

 

 

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1autonomous practice of midwifery.
2    "Licensed midwife" means a person who has been granted a
3license under this Act to engage in the practice of midwifery.
4    "Midwifery Bridge Certificate" means the certificate
5issued by NARM based upon completion of accredited continuing
6education specific to content in emergency skills for
7pregnancy, birth, and newborn care, along with other midwifery
8topics addressing the core competencies of the International
9Confederation of Midwives.
10    "Midwifery Education and Accreditation Council" or "MEAC"
11means the nationally-recognized accrediting agency that
12establishes standards for the education of direct-entry
13midwifery in the United States.
14    "National Association of Certified Professional Midwives"
15means the professional organization, or its successor, that
16promotes the growth and development of the profession of
17certified professional midwives.
18    "North American Registry of Midwives" or "NARM" means the
19accredited international agency, or its successor, that has
20established and has continued to administer certification for
21the credentialing of certified professional midwives.
22    "Practice of midwifery" means providing the necessary
23supervision, care, education, and advice to pregnant people
24during the antepartum, intrapartum, and postpartum period,
25conducting deliveries independently, and caring for the
26newborn, with such care including without limitation

 

 

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1preventative measures, the detection of abnormal conditions in
2the mother and the child, the procurement of medical
3assistance, and the execution of emergency measures in the
4absence of medical help. "Practice of midwifery" includes
5non-prescriptive family planning and basic well-woman care.
6    "Secretary" means the Secretary of Financial and
7Professional Regulation.
 
8    Section 20. Unlicensed practice. Beginning January 1,
92017, no person may practice, attempt to practice, or hold
10himself or herself out to practice as a licensed midwife unless
11he or she is licensed as a midwife under this Act.
 
12    Section 25. Title. A licensed midwife may identify himself
13or herself as a "licensed midwife" and may use the abbreviation
14L.M.
 
15    Section 30. Informed consent.
16    (a) A licensed midwife shall, at an initial consultation
17with a client, provide a copy of the rules under this Act and
18disclose to the client orally and in writing all of the
19following:
20        (1) The licensed midwife's experience and training.
21        (2) Whether the licensed midwife has malpractice
22    liability insurance coverage and the policy limits of any
23    such coverage.

 

 

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1        (3) A written protocol for the handling of medical
2    emergencies, including transportation to a hospital,
3    particular to each client.
4    (b) A copy of the informed consent document, signed and
5dated by the client, must be kept in each client's chart.
 
6    Section 33. Vicarious liability. No physician licensed to
7practice medicine in all its branches or advanced practice
8nurse shall be held liable for an injury solely resulting from
9an act or omission by a licensed midwife.
10    Except as may otherwise be provided by law, nothing in this
11Section shall exempt any physician licensed to practice
12medicine in all its branches or advanced practice nurse from
13liability for his or her own negligent, grossly negligent, or
14willful or wanton acts or omissions.
 
15    Section 35. Advertising.
16    (a) Any person licensed under this Act may advertise the
17availability of professional midwifery services in the public
18media or on premises where professional services are rendered,
19if the advertising is truthful and not misleading and is in
20conformity with any rules regarding the practice of a licensed
21midwife.
22    (b) A licensee must include in every advertisement for
23midwifery services regulated under this Act his or her title as
24it appears on the license or the initials authorized under this

 

 

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1Act.
 
2    Section 40. Powers and duties of the Department; rules.
3    (a) The Department shall exercise the powers and duties
4prescribed by the Civil Administrative Code of Illinois for the
5administration of licensing Acts and shall exercise such other
6powers and duties necessary for effectuating the purposes of
7this Act.
8    (b) The Secretary shall adopt rules consistent with the
9provisions of this Act for the administration and enforcement
10of the Act and for the payment of fees connected to the Act and
11may prescribe forms that shall be issued in connection with the
12Act.
13    (c) Rules adopted by the Department must provide for the
14following:
15        (1) The scope of practice and services provided and the
16    use of equipment, procedures, and medications, including
17    the creation of a formulary of allowable drugs and
18    procedures for use by a licensed midwife which are
19    determined by the Department to be necessarily available in
20    order to assure the health and safety of the mother and
21    newborn and are in keeping with current midwifery
22    standards. All rules for equipment, procedures, and
23    medications may be updated as the Department deems
24    necessary to be in keeping with changing standards.
25        (2) The issuance of temporary licenses to practice

 

 

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1    midwifery pending qualification for licensure.
2    (d) The rules adopted by the Department under this Section
3may not:
4        (1) require a licensed midwife to practice midwifery
5    under the supervision of another health care provider;
6        (2) require a licensed midwife to enter into a written
7    agreement with another health care provider;
8        (3) limit the location where a licensed midwife may
9    practice midwifery; or
10        (4) permit a licensed midwife to do any of the
11    following:
12            (A) administer prescription pharmacological agents
13        intended to induce or augment labor;
14            (B) administer prescription pharmacological agents
15        to provide pain management;
16            (C) use vacuum extractors or forceps;
17            (D) prescribe medications; or
18            (E) perform major surgical procedures, including,
19        but not limited to, abortions, caesarean sections, and
20        circumcisions.
21    (e) With regards to Medicaid reimbursement, no rules
22prescribed by the Department shall require the licensed midwife
23to carry liability insurance in order to be reimbursed by the
24State as a Medicaid provider.
25    (f) The Department shall consult with the Board in adopting
26rules. Notice of proposed rulemaking shall be transmitted to

 

 

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1the Board and the Department shall review the Board's response
2and any recommendations made. The Department shall notify the
3Board in writing with proper explanation of deviations from the
4Board's recommendations and responses.
5    (g) The Department may at any time seek the advice and the
6expert knowledge of the Board on any matter relating to the
7administration of this Act.
8    (h) The Department shall issue quarterly a report to the
9Board of the status of all complaints related to the profession
10filed with the Department.
11    (i) Administration by the Department of this Act must be
12consistent with standards regarding the practice of midwifery
13established by the National Association of Certified
14Professional Midwives or a successor organization whose
15essential documents include without limitation subject matter
16concerning scope of practice, standards of practice, informed
17consent, appropriate consultation, collaboration or referral,
18and acknowledgement of a woman's right to self-determination
19concerning her maternity care.
 
20    Section 45. Illinois Midwifery Board.
21    (a) There is created under the authority of the Department
22the Illinois Midwifery Board, which shall consist of 5 members
23appointed by the Secretary, 3 of whom shall be licensed
24midwives who carry the CPM credential, except that initial
25appointees must have at least 3 years of experience in the

 

 

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1practice of midwifery in an out-of-hospital setting, be
2certified by the North American Registry of Midwives, and meet
3the qualifications for licensure set forth in this Act; one of
4whom shall be a licensed obstetrician or a family practice
5physician or certified nurse midwife who has a minimum of 2
6years of experience providing home birth services; and one of
7whom shall be a knowledgeable public member who has given birth
8with the assistance of a certified professional midwife in an
9out-of-hospital birth setting. A physician or certified nurse
10midwife who has a minimum of 2 years' experience consulting or
11collaborating with a home birth provider may stand in
12substitution if the criteria for physician or certified nurse
13midwife Board members cannot be met. Board members shall serve
144-year terms, except that in the case of initial appointments,
15terms shall be staggered as follows: 3 members shall serve for
164 years, and 2 members shall serve for 2 years. The Board shall
17annually elect a chairperson and vice chairperson.
18    (b) Any appointment made to fill a vacancy shall be for the
19unexpired portion of the term. Appointments to fill vacancies
20shall be made in the same manner as original appointments. No
21Board member may be reappointed for a term that would cause his
22or her continuous service on the Board to exceed 9 years.
23    (c) Board membership must have reasonable representation
24from different geographic areas of this State.
25    (d) The members of the Board may be reimbursed for all
26legitimate, necessary, and authorized expenses incurred in

 

 

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1attending the meetings of the Board.
2    (e) The Secretary may remove any member of the Board for
3misconduct, incapacity, or neglect of duty at any time prior to
4the expiration of his or her term.
5    (f) Three Board members shall constitute a quorum. A
6vacancy in the membership of the Board shall not impair the
7right of a quorum to perform all of the duties of the Board.
8    (g) The Board shall provide the Department with
9recommendations concerning the administration of this Act and
10may perform each of the following duties:
11        (1) Recommend to the Department the prescription and,
12    from time to time, the revision of any rules that may be
13    necessary to carry out the provisions of this Act,
14    including those that are designed to protect the health,
15    safety, and welfare of the public.
16        (2) Conduct hearings and disciplinary conferences on
17    disciplinary charges of licensees.
18        (3) Report to the Department, upon completion of a
19    hearing, the disciplinary actions recommended to be taken
20    against a person found in violation of this Act.
21        (4) Recommend the approval, denial of approval, and
22    withdrawal of approval of required education and
23    continuing educational programs.
24    (h) The Secretary shall give due consideration to all
25recommendations of the Board. If the Secretary takes action
26contrary to a recommendation of the Board, the Secretary must

 

 

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1promptly provide a written explanation of that action.
2    (i) The Board may recommend to the Secretary that one or
3more licensed midwives be selected by the Secretary to assist
4in any investigation under this Act. Compensation shall be
5provided to any licensee who provides assistance under this
6subsection (i), in an amount determined by the Secretary.
7    (j) Members of the Board shall be immune from suit in an
8action based upon a disciplinary proceeding or other activity
9performed in good faith as a member of the Board, except for
10willful or wanton misconduct.
11    (k) Members of the Board may participate in and act at any
12meeting of the Illinois Midwifery Board through the use of any
13real-time internet or telephone communication media, by means
14of which all persons participating in the meeting can
15communicate with each other. Participation in such meeting
16shall constitute attendance and presence in person at the
17meeting of the person or persons so participating.
 
18    Section 50. Qualifications.
19    (a) A person is qualified for licensure as a midwife if he
20or she has received certification and holds a valid CPM
21credential granted by NARM. In addition to earning his or her
22CPM credential: (1) a CPM certified before January 1, 2020 who
23has obtained certification through an educational pathway not
24accredited by MEAC must earn and submit a Midwifery Bridge
25Certificate issued by NARM or (2) a CPM certified after January

 

 

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11, 2020 must have completed an educational program or pathway
2accredited by MEAC.
3    (b) A CPM who has maintained licensure in a state that does
4not require an accredited education shall submit a Midwifery
5Bridge Certificate regardless of the date of their
6certification.
7    (c) An applicant for licensure who is a CPM applying in the
8first 3 months that licensure is available shall be issued a
9temporary license and shall have 18 months to earn and submit a
10completed Midwifery Bridge Certificate.
 
11    Section 55. Social Security Number on application. In
12addition to any other information required to be contained in
13the application, every application for an original, renewal,
14reinstated, or restored license under this Act shall include
15the applicant's Social Security Number.
 
16    Section 60. Renewal of licensure.
17    (a) Licensed midwives shall renew their license biannually
18at the discretion of the Department.
19    (b) Rules adopted under this Act shall require the licensed
20midwife to maintain CPM certification by meeting all the
21continuing education requirements and other requirements set
22forth by the North American Registry of Midwives.
 
23    Section 65. Inactive status.

 

 

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1    (a) A licensed midwife who notifies the Department in
2writing on forms prescribed by the Department may elect to
3place his or her license on an inactive status and shall be
4excused from payment of renewal fees until he or she notifies
5the Department in writing of his or her intent to restore the
6license.
7    (b) A licensed midwife whose license is on inactive status
8may not practice licensed midwifery in the State of Illinois.
9    (c) A licensed midwife requesting restoration from
10inactive status shall be required to pay the current renewal
11fee and to restore his or her license, as provided by the
12Department.
13    (d) Any licensee who engages in the practice of midwifery
14while his or her license is lapsed or on inactive status shall
15be considered to be practicing without a license, which shall
16be grounds for discipline.
 
17    Section 70. Renewal, reinstatement, or restoration of
18licensure; military service.
19    (a) The expiration date and renewal period for each license
20issued under this Act shall be set by the Department.
21    (b) All renewal applicants shall provide proof of having
22maintained CPM certification by meeting continuing education
23requirements and other requirements set forth by the North
24American Registry of Midwives.
25    (c) Any licensed midwife who has permitted his or her

 

 

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1license to expire or who has had his or her license on inactive
2status may have his or her license restored by making
3application to the Department and filing proof acceptable to
4the Department of fitness to have the license restored and by
5paying the required fees. Proof of fitness may include evidence
6attesting to active lawful practice in another jurisdiction.
7    (d) The Department shall determine, by an evaluation
8program, fitness for restoration of a license under this
9Section and shall establish procedures and requirements for
10restoration.
11    (e) Any licensed midwife whose license expired while he or
12she was (i) in federal service on active duty with the Armed
13Forces of the United States or the State Militia and called
14into service or training or (ii) received education under the
15supervision of the United States preliminary to induction into
16the military service may have his or her license restored
17without paying any lapsed renewal fees, if, within 2 years
18after honorable termination of service, training, or
19education, he or she furnishes the Department with satisfactory
20evidence to the effect that he or she has been so engaged.
 
21    Section 75. Roster. The Department shall maintain a roster
22of the names and addresses of all licensees and of all persons
23whose licenses have been suspended or revoked. This roster
24shall be available upon written request and payment of the
25required fee.
 

 

 

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1    Section 80. Fees.
2    (a) The Department shall provide for a schedule of fees for
3the administration and enforcement of this Act, including
4without limitation original licensure, renewal, and
5restoration, which fees shall be nonrefundable.
6    (b) All fees collected under this Act shall be deposited
7into the General Professions Dedicated Fund and appropriated to
8the Department for the ordinary and contingent expenses of the
9Department in the administration of this Act.
 
10    Section 85. Returned checks; fines. Any person who delivers
11a check or other payment to the Department that is returned to
12the Department unpaid by the financial institution upon which
13it is drawn shall pay to the Department, in addition to the
14amount already owed to the Department, a fine of $50. The fines
15imposed by this Section are in addition to any other discipline
16provided under this Act for unlicensed practice or practice on
17a non-renewed license. The Department shall notify the person
18that fees and fines shall be paid to the Department by
19certified check or money order within 30 calendar days after
20the notification. If, after the expiration of 30 days from the
21date of the notification, the person has failed to submit the
22necessary remittance, the Department shall automatically
23terminate the license or deny the application, without hearing.
24If, after termination or denial, the person seeks a license, he

 

 

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1or she shall apply to the Department for restoration or
2issuance of the license and pay all fees and fines due to the
3Department. The Department may establish a fee for the
4processing of an application for restoration of a license to
5defray all expenses of processing the application. The
6Secretary may waive the fines due under this Section in
7individual cases where the Secretary finds that the fines would
8be unreasonable or unnecessarily burdensome.
 
9    Section 90. Unlicensed practice; civil penalty. Any person
10who practices, offers to practice, attempts to practice, or
11holds himself or herself out to practice midwifery or as a
12midwife without being licensed under this Act shall, in
13addition to any other penalty provided by law, pay a civil
14penalty to the Department in an amount not to exceed $5,000 for
15each offense, as determined by the Department. The civil
16penalty shall be assessed by the Department after a hearing is
17held in accordance with the provisions set forth in this Act
18regarding the provision of a hearing for the discipline of a
19licensee. The civil penalty shall be paid within 60 days after
20the effective date of the order imposing the civil penalty. The
21order shall constitute a judgment and may be filed and
22execution had thereon in the same manner as any judgment from
23any court of record. The Department may investigate any
24unlicensed activity.
 

 

 

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1    Section 95. Grounds for disciplinary action.
2    (a) The Department may refuse to issue or to renew or may
3revoke, suspend, place on probation, reprimand or take other
4disciplinary action as the Department may deem proper,
5including fines not to exceed $5,000 for each violation, with
6regard to any licensee or license for any one or combination of
7the following causes:
8        (1) Violations of this Act or its rules.
9        (2) Material misstatement in furnishing information to
10    the Department.
11        (3) Conviction of any crime under the laws of any U.S.
12    jurisdiction that is (i) a felony, (ii) a misdemeanor, an
13    essential element of which is dishonesty, or (iii) directly
14    related to the practice of the profession.
15        (4) Making any misrepresentation for the purpose of
16    obtaining a license.
17        (5) Professional incompetence or gross negligence.
18        (6) Gross malpractice.
19        (7) Aiding or assisting another person in violating any
20    provision of this Act or its rules.
21        (8) Failing to provide information within 60 days in
22    response to a written request made by the Department.
23        (9) Engaging in dishonorable, unethical, or
24    unprofessional conduct of a character likely to deceive,
25    defraud, or harm the public.
26        (10) Habitual or excessive use or addiction to alcohol,

 

 

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1    narcotics, stimulants, or any other chemical agent or drug
2    that results in the inability to practice with reasonable
3    judgment, skill, or safety.
4        (11) Discipline by another U.S. jurisdiction or
5    foreign nation if at least one of the grounds for the
6    discipline is the same or substantially equivalent to those
7    set forth in this Act.
8        (12) Directly or indirectly giving to or receiving from
9    any person, firm, corporation, partnership, or association
10    any fee, commission, rebate, or other form of compensation
11    for any professional services not actually or personally
12    rendered. This shall not be deemed to include rent or other
13    remunerations paid to an individual, partnership, or
14    corporation by a licensed midwife for the lease, rental, or
15    use of space, owned or controlled by the individual,
16    partnership, corporation, or association.
17        (13) A finding by the Department that the licensee,
18    after having his or her license placed on probationary
19    status, has violated the terms of probation.
20        (14) Abandonment of a patient without cause.
21        (15) Willfully making or filing false records or
22    reports relating to a licensee's practice, including, but
23    not limited to, false records filed with State agencies or
24    departments.
25        (16) Physical illness or mental illness, including,
26    but not limited to, deterioration through the aging process

 

 

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1    or loss of motor skill that results in the inability to
2    practice the profession with reasonable judgment, skill,
3    or safety.
4        (17) Failure to provide a patient with a copy of his or
5    her record upon the written request of the patient.
6        (18) Conviction by any court of competent
7    jurisdiction, either within or without this State, of any
8    violation of any law governing the practice of licensed
9    midwifery or conviction in this or another state of any
10    crime that is a felony under the laws of this State or
11    conviction of a felony in a federal court, if the
12    Department determines, after investigation, that the
13    person has not been sufficiently rehabilitated to warrant
14    the public trust.
15        (19) A finding that licensure has been applied for or
16    obtained by fraudulent means.
17        (20) Being named as a perpetrator in an indicated
18    report by the Department of Healthcare and Family Services
19    under the Abused and Neglected Child Reporting Act and upon
20    proof by clear and convincing evidence that the licensee
21    has caused a child to be an abused child or a neglected
22    child, as defined in the Abused and Neglected Child
23    Reporting Act.
24        (21) Practicing or attempting to practice under a name
25    other than the full name shown on a license issued under
26    this Act.

 

 

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1        (22) Immoral conduct in the commission of any act, such
2    as sexual abuse, sexual misconduct, or sexual
3    exploitation, related to the licensee's practice.
4        (23) Maintaining a professional relationship with any
5    person, firm, or corporation when the licensed midwife
6    knows or should know that a person, firm, or corporation is
7    violating this Act.
8        (24) Failure to provide satisfactory proof of having
9    participated in approved continuing education programs as
10    determined by the Board and approved by the Secretary.
11    Exceptions for extreme hardships are to be defined by the
12    Department.
13    (b) The Department may refuse to issue or may suspend the
14license of any person who fails to (i) file a tax return or to
15pay the tax, penalty, or interest shown in a filed return or
16(ii) pay any final assessment of the tax, penalty, or interest,
17as required by any tax Act administered by the Illinois
18Department of Revenue, until the time that the requirements of
19that tax Act are satisfied.
20    (c) The determination by a circuit court that a licensee is
21subject to involuntary admission or judicial admission as
22provided in the Mental Health and Developmental Disabilities
23Code operates as an automatic suspension. The suspension shall
24end only upon a finding by a court that the patient is no
25longer subject to involuntary admission or judicial admission,
26the issuance of an order so finding and discharging the

 

 

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1patient, and the recommendation of the Board to the Secretary
2that the licensee be allowed to resume his or her practice.
3    (d) In enforcing this Section, the Department, upon a
4showing of a possible violation, may compel any person licensed
5to practice under this Act or who has applied for licensure or
6certification pursuant to this Act to submit to a mental or
7physical examination, or both, as required by and at the
8expense of the Department. The examining physicians shall be
9those specifically designated by the Department. The
10Department may order an examining physician to present
11testimony concerning the mental or physical examination of the
12licensee or applicant. No information shall be excluded by
13reason of any common law or statutory privilege relating to
14communications between the licensee or applicant and the
15examining physician. The person to be examined may have, at his
16or her own expense, another physician of his or her choice
17present during all aspects of the examination. Failure of any
18person to submit to a mental or physical examination when
19directed shall be grounds for suspension of a license until the
20person submits to the examination if the Department finds,
21after notice and hearing, that the refusal to submit to the
22examination was without reasonable cause.
23    If the Department finds an individual unable to practice
24because of the reasons set forth in this subsection (d), the
25Department may require that individual to submit to care,
26counseling, or treatment by physicians approved or designated

 

 

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1by the Department, as a condition, term, or restriction for
2continued, reinstated, or renewed licensure to practice or, in
3lieu of care, counseling, or treatment, the Department may file
4a complaint to immediately suspend, revoke, or otherwise
5discipline the license of the individual. Any person whose
6license was granted, reinstated, renewed, disciplined, or
7supervised subject to such terms, conditions, or restrictions
8and who fails to comply with such terms, conditions, or
9restrictions shall be referred to the Secretary for a
10determination as to whether or not the person shall have his or
11her license suspended immediately, pending a hearing by the
12Department.
13    In instances in which the Secretary immediately suspends a
14person's license under this Section, a hearing on that person's
15license must be convened by the Department within 15 days after
16the suspension and completed without appreciable delay. The
17Department may review the person's record of treatment and
18counseling regarding the impairment, to the extent permitted by
19applicable federal statutes and regulations safeguarding the
20confidentiality of medical records.
21    A person licensed under this Act and affected under this
22subsection (d) shall be afforded an opportunity to demonstrate
23to the Department that he or she can resume practice in
24compliance with acceptable and prevailing standards under the
25provisions of his or her license.
 

 

 

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1    Section 100. Failure to pay restitution. The Department,
2without further process or hearing, shall suspend the license
3or other authorization to practice of any person issued under
4this Act who has been certified by court order as not having
5paid restitution to a person under Section 8A-3.5 of the
6Illinois Public Aid Code, under Section 46-1 of the Criminal
7Code of 1961, or under Sections 17-8.5 or 17-10.5 of the
8Criminal Code of 2012. A person whose license or other
9authorization to practice is suspended under this Section is
10prohibited from practicing until restitution is made in full.
 
11    Section 105. Injunction; cease and desist order.
12    (a) If a person violates any provision of this Act, the
13Secretary may, in the name of the People of the State of
14Illinois, through the Attorney General or the State's Attorney
15of any county in which the action is brought, petition for an
16order enjoining the violation or enforcing compliance with this
17Act. Upon the filing of a verified petition in court, the court
18may issue a temporary restraining order, without notice or
19bond, and may preliminarily and permanently enjoin the
20violation. If it is established that the person has violated or
21is violating the injunction, the court may punish the offender
22for contempt of court. Proceedings under this Section shall be
23in addition to, and not in lieu of, all other remedies and
24penalties provided by this Act.
25    (b) If any person practices as a licensed midwife or holds

 

 

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1himself or herself out as a licensed midwife without being
2licensed under the provisions of this Act, then any licensed
3midwife, any interested party, or any person injured thereby
4may, in addition to the Secretary, petition for relief as
5provided in subsection (a) of this Section.
6    (c) Whenever, in the opinion of the Department, any person
7violates any provision of this Act, the Department may issue a
8rule to show cause why an order to cease and desist should not
9be entered against that person. The rule shall clearly set
10forth the grounds relied upon by the Department and shall
11provide a period of 7 days after the date of the rule to file an
12answer to the satisfaction of the Department. Failure to answer
13to the satisfaction of the Department shall cause an order to
14cease and desist to be issued immediately.
 
15    Section 110. Violation; criminal penalty.
16    (a) Whoever knowingly practices or offers to practice
17midwifery in this State without being licensed for that purpose
18or exempt under this Act shall be guilty of a Class A
19misdemeanor and, for each subsequent conviction, shall be
20guilty of a Class 4 felony.
21    (b) Notwithstanding any other provision of this Act, all
22criminal fines, moneys, or other property collected or received
23by the Department under this Section or any other State or
24federal statute, including, but not limited to, property
25forfeited to the Department under Section 505 of the Illinois

 

 

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1Controlled Substances Act or Section 85 of the Methamphetamine
2Control and Community Protection Act, shall be deposited into
3the Professional Regulation Evidence Fund.
 
4    Section 115. Investigation; notice; hearing. The
5Department may investigate the actions of any applicant or of
6any person or persons holding or claiming to hold a license
7under this Act. Before refusing to issue or to renew or taking
8any disciplinary action regarding a license, the Department
9shall, at least 30 days prior to the date set for the hearing,
10notify in writing the applicant or licensee of the nature of
11any charges and that a hearing shall be held on a date
12designated. The Department shall direct the applicant or
13licensee to file a written answer with the Board under oath
14within 20 days after the service of the notice and inform the
15applicant or licensee that failure to file an answer shall
16result in default being taken against the applicant or licensee
17and that the license may be suspended, revoked, or placed on
18probationary status or that other disciplinary action may be
19taken, including limiting the scope, nature, or extent of
20practice, as the Secretary may deem proper. Written notice may
21be served by personal delivery or certified or registered mail
22to the respondent at the address of his or her last
23notification to the Department. If the person fails to file an
24answer after receiving notice, his or her license may, in the
25discretion of the Department, be suspended, revoked, or placed

 

 

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1on probationary status, or the Department may take any
2disciplinary action deemed proper, including limiting the
3scope, nature, or extent of the person's practice or the
4imposition of a fine, without a hearing, if the act or acts
5charged constitute sufficient grounds for such action under
6this Act. At the time and place fixed in the notice, the Board
7shall proceed to hear the charges and the parties or their
8counsel shall be accorded ample opportunity to present such
9statements, testimony, evidence, and argument as may be
10pertinent to the charges or to their defense. The Board may
11continue a hearing from time to time.
 
12    Section 120. Formal hearing; preservation of record. The
13Department, at its expense, shall preserve a record of all
14proceedings at the formal hearing of any case. The notice of
15hearing, complaint, and all other documents in the nature of
16pleadings and written motions filed in the proceedings, the
17transcript of testimony, the report of the Board or hearing
18officer, and order of the Department shall be the record of the
19proceeding. The Department shall furnish a transcript of the
20record to any person interested in the hearing upon payment of
21the fee required under Section 2105-115 of the Department of
22Professional Regulation Law.
 
23    Section 125. Witnesses; production of documents; contempt.
24Any circuit court may upon application of the Department or its

 

 

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1designee or of the applicant or licensee against whom
2proceedings under Section 95 of this Act are pending, enter an
3order requiring the attendance of witnesses and their testimony
4and the production of documents, papers, files, books, and
5records in connection with any hearing or investigation. The
6court may compel obedience to its order by proceedings for
7contempt.
 
8    Section 130. Subpoena; oaths. The Department shall have the
9power to subpoena and bring before it any person in this State
10and to take testimony either orally or by deposition or both
11with the same fees and mileage and in the same manner as
12prescribed in civil cases in circuit courts of this State. The
13Secretary, the designated hearing officer, and every member of
14the Board has the power to administer oaths to witnesses at any
15hearing that the Department is authorized to conduct and any
16other oaths authorized in any Act administered by the
17Department. Any circuit court may, upon application of the
18Department or its designee or upon application of the person
19against whom proceedings under this Act are pending, enter an
20order requiring the attendance of witnesses and their
21testimony, and the production of documents, papers, files,
22books, and records in connection with any hearing or
23investigation. The court may compel obedience to its order by
24proceedings for contempt.
 

 

 

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1    Section 135. Findings of fact, conclusions of law, and
2recommendations. At the conclusion of the hearing the Board
3shall present to the Secretary a written report of its findings
4of fact, conclusions of law, and recommendations. The report
5shall contain a finding as to whether or not the accused person
6violated this Act or failed to comply with the conditions
7required under this Act. The Board shall specify the nature of
8the violation or failure to comply and shall make its
9recommendations to the Secretary.
10    The report of findings of fact, conclusions of law, and
11recommendations of the Board shall be the basis for the
12Department's order. If the Secretary disagrees in any regard
13with the report of the Board, the Secretary may issue an order
14in contravention of the report. The finding is not admissible
15in evidence against the person in a criminal prosecution
16brought for the violation of this Act, but the hearing and
17findings are not a bar to a criminal prosecution brought for
18the violation of this Act.
 
19    Section 140. Hearing officer. The Secretary may appoint any
20attorney duly licensed to practice law in the State of Illinois
21to serve as the hearing officer in any action for departmental
22refusal to issue, renew, or license an applicant or for
23disciplinary action against a licensee. The hearing officer
24shall have full authority to conduct the hearing. The hearing
25officer shall report his or her findings of fact, conclusions

 

 

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1of law, and recommendations to the Board and the Secretary. The
2Board shall have 60 calendar days after receipt of the report
3to review the report of the hearing officer and present its
4findings of fact, conclusions of law, and recommendations to
5the Secretary. If the Board fails to present its report within
6the 60-day period, the Secretary may issue an order based on
7the report of the hearing officer. If the Secretary disagrees
8with the recommendation of the Board or the hearing officer, he
9or she may issue an order in contravention of that
10recommendation.
 
11    Section 145. Service of report; motion for rehearing. In
12any case involving the discipline of a license, a copy of the
13Board's report shall be served upon the respondent by the
14Department, either personally or as provided in this Act for
15the service of the notice of hearing. Within 20 days after the
16service, the respondent may present to the Department a motion
17in writing for a rehearing that shall specify the particular
18grounds for rehearing. If no motion for rehearing is filed,
19then upon the expiration of the time specified for filing a
20motion, or if a motion for rehearing is denied, then upon the
21denial, the Secretary may enter an order in accordance with
22this Act. If the respondent orders from the reporting service
23and pays for a transcript of the record within the time for
24filing a motion for rehearing, the 20-day period within which
25the motion may be filed shall commence upon the delivery of the

 

 

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1transcript to the respondent.
 
2    Section 150. Rehearing. Whenever the Secretary is
3satisfied that substantial justice has not been done in the
4revocation, suspension, or refusal to issue or renew a license,
5the Secretary may order a rehearing by the same or another
6hearing officer or by the Board.
 
7    Section 155. Prima facie proof. An order or a certified
8copy thereof, over the seal of the Department and purporting to
9be signed by the Secretary, shall be prima facie proof of the
10following:
11        (1) that the signature is the genuine signature of the
12    Secretary;
13        (2) that such Secretary is duly appointed and
14    qualified; and
15        (3) that the Board and its members are qualified to
16    act.
 
17    Section 160. Restoration of license. At any time after the
18suspension or revocation of any license, the Department may
19restore the license to the accused person, unless after an
20investigation and a hearing the Department determines that
21restoration is not in the public interest.
 
22    Section 165. Surrender of license. Upon the revocation or

 

 

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1suspension of any license, the licensee shall immediately
2surrender the license to the Department. If the licensee fails
3to do so, the Department shall have the right to seize the
4license.
 
5    Section 170. Summary suspension. The Secretary may
6summarily suspend the license of a licensee under this Act
7without a hearing, simultaneously with the institution of
8proceedings for a hearing provided for in this Act, if the
9Secretary finds that evidence in his or her possession
10indicates that continuation in practice would constitute an
11imminent danger to the public. In the event that the Secretary
12summarily suspends a license without a hearing, a hearing by
13the Department must be held within 30 days after the suspension
14has occurred.
 
15    Section 175. Certificate of record. The Department shall
16not be required to certify any record to the court or file any
17answer in court or otherwise appear in any court in a judicial
18review proceeding, unless there is filed in the court, with the
19complaint, a receipt from the Department acknowledging payment
20of the costs of furnishing and certifying the record. Failure
21on the part of the plaintiff to file a receipt in court shall
22be grounds for dismissal of the action.
 
23    Section 180. Administrative Review Law. All final

 

 

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1administrative decisions of the Department are subject to
2judicial review under the Administrative Review Law and its
3rules. The term "administrative decision" is defined as in
4Section 3-101 of the Code of Civil Procedure.
 
5    Section 185. Illinois Administrative Procedure Act. The
6Illinois Administrative Procedure Act is hereby expressly
7adopted and incorporated in this Act as if all of the
8provisions of such Act were included in this Act, except that
9the provision of subsection (d) of Section 10-65 of the
10Illinois Administrative Procedure Act that provides that at
11hearings the licensee has the right to show compliance with all
12lawful requirements for retention, continuation, or renewal of
13the license is specifically excluded. For purposes of this Act,
14the notice required under Section 10-25 of the Illinois
15Administrative Procedure Act is deemed sufficient when mailed
16to the last known address of a party.
 
17    Section 190. Home rule. Pursuant to paragraph (h) of
18Section 6 of Article VII of the Illinois Constitution of 1970,
19the power to regulate and issue licenses for the practice of
20midwifery shall, except as may otherwise be provided within and
21pursuant to the provisions of this Act, be exercised by the
22State and may not be exercised by any unit of local government,
23including home rule units.
 

 

 

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1    Section 195. Severability. The provisions of this Act are
2severable under Section 1.31 of the Statute on Statutes.
 
3    Section 900. The Regulatory Sunset Act is amended by adding
4Section 4.37 as follows:
 
5    (5 ILCS 80/4.37 new)
6    Sec. 4.37. Act repealed on January 1, 2027. The following
7Act is repealed on January 1, 2027:
8    The Home Birth Safety Act.
 
9    Section 905. The Medical Practice Act of 1987 is amended by
10changing Section 4 as follows:
 
11    (225 ILCS 60/4)  (from Ch. 111, par. 4400-4)
12    (Section scheduled to be repealed on December 31, 2015)
13    Sec. 4. Exemptions. This Act does not apply to the
14following:
15        (1) persons lawfully carrying on their particular
16    profession or business under any valid existing regulatory
17    Act of this State, including without limitation persons
18    engaged in the practice of midwifery who are licensed under
19    the Home Birth Safety Act;
20        (2) persons rendering gratuitous services in cases of
21    emergency; or
22        (3) persons treating human ailments by prayer or

 

 

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1    spiritual means as an exercise or enjoyment of religious
2    freedom.
3(Source: P.A. 96-7, eff. 4-3-09; 97-622, eff. 11-23-11.)
 
4    Section 910. The Nurse Practice Act is amended by changing
5Section 50-15 as follows:
 
6    (225 ILCS 65/50-15)   (was 225 ILCS 65/5-15)
7    (Section scheduled to be repealed on January 1, 2018)
8    Sec. 50-15. Policy; application of Act.
9    (a) For the protection of life and the promotion of health,
10and the prevention of illness and communicable diseases, any
11person practicing or offering to practice advanced,
12professional, or practical nursing in Illinois shall submit
13evidence that he or she is qualified to practice, and shall be
14licensed as provided under this Act. No person shall practice
15or offer to practice advanced, professional, or practical
16nursing in Illinois or use any title, sign, card or device to
17indicate that such a person is practicing professional or
18practical nursing unless such person has been licensed under
19the provisions of this Act.
20    (b) This Act does not prohibit the following:
21        (1) The practice of nursing in Federal employment in
22    the discharge of the employee's duties by a person who is
23    employed by the United States government or any bureau,
24    division or agency thereof and is a legally qualified and

 

 

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1    licensed nurse of another state or territory and not in
2    conflict with Sections 50-50, 55-10, 60-10, and 70-5 of
3    this Act.
4        (2) Nursing that is included in the program of study by
5    students enrolled in programs of nursing or in current
6    nurse practice update courses approved by the Department.
7        (3) The furnishing of nursing assistance in an
8    emergency.
9        (4) The practice of nursing by a nurse who holds an
10    active license in another state when providing services to
11    patients in Illinois during a bonafide emergency or in
12    immediate preparation for or during interstate transit.
13        (5) The incidental care of the sick by members of the
14    family, domestic servants or housekeepers, or care of the
15    sick where treatment is by prayer or spiritual means.
16        (6) Persons from being employed as unlicensed
17    assistive personnel in private homes, long term care
18    facilities, nurseries, hospitals or other institutions.
19        (7) The practice of practical nursing by one who is a
20    licensed practical nurse under the laws of another U.S.
21    jurisdiction and has applied in writing to the Department,
22    in form and substance satisfactory to the Department, for a
23    license as a licensed practical nurse and who is qualified
24    to receive such license under this Act, until (i) the
25    expiration of 6 months after the filing of such written
26    application, (ii) the withdrawal of such application, or

 

 

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1    (iii) the denial of such application by the Department.
2        (8) The practice of advanced practice nursing by one
3    who is an advanced practice nurse under the laws of another
4    state, territory of the United States, or country and has
5    applied in writing to the Department, in form and substance
6    satisfactory to the Department, for a license as an
7    advanced practice nurse and who is qualified to receive
8    such license under this Act, until (i) the expiration of 6
9    months after the filing of such written application, (ii)
10    the withdrawal of such application, or (iii) the denial of
11    such application by the Department.
12        (9) The practice of professional nursing by one who is
13    a registered professional nurse under the laws of another
14    state, territory of the United States or country and has
15    applied in writing to the Department, in form and substance
16    satisfactory to the Department, for a license as a
17    registered professional nurse and who is qualified to
18    receive such license under Section 55-10, until (1) the
19    expiration of 6 months after the filing of such written
20    application, (2) the withdrawal of such application, or (3)
21    the denial of such application by the Department.
22        (10) The practice of professional nursing that is
23    included in a program of study by one who is a registered
24    professional nurse under the laws of another state or
25    territory of the United States or foreign country,
26    territory or province and who is enrolled in a graduate

 

 

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1    nursing education program or a program for the completion
2    of a baccalaureate nursing degree in this State, which
3    includes clinical supervision by faculty as determined by
4    the educational institution offering the program and the
5    health care organization where the practice of nursing
6    occurs.
7        (11) Any person licensed in this State under any other
8    Act from engaging in the practice for which she or he is
9    licensed, including without limitation any person engaged
10    in the practice of midwifery who is licensed under the Home
11    Birth Safety Act.
12        (12) Delegation to authorized direct care staff
13    trained under Section 15.4 of the Mental Health and
14    Developmental Disabilities Administrative Act consistent
15    with the policies of the Department.
16        (13) The practice, services, or activities of persons
17    practicing the specified occupations set forth in
18    subsection (a) of, and pursuant to a licensing exemption
19    granted in subsection (b) or (d) of, Section 2105-350 of
20    the Department of Professional Regulation Law of the Civil
21    Administrative Code of Illinois, but only for so long as
22    the 2016 Olympic and Paralympic Games Professional
23    Licensure Exemption Law is operable.
24        (14) County correctional personnel from delivering
25    prepackaged medication for self-administration to an
26    individual detainee in a correctional facility.

 

 

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1    Nothing in this Act shall be construed to limit the
2delegation of tasks or duties by a physician, dentist, or
3podiatric physician to a licensed practical nurse, a registered
4professional nurse, or other persons.
5(Source: P.A. 98-214, eff. 8-9-13.)
 
6    Section 990. The Illinois Public Aid Code is amended by
7changing Section 5-5 as follows:
 
8    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
9    (Text of Section before amendment by P.A. 99-407)
10    Sec. 5-5. Medical services. The Illinois Department, by
11rule, shall determine the quantity and quality of and the rate
12of reimbursement for the medical assistance for which payment
13will be authorized, and the medical services to be provided,
14which may include all or part of the following: (1) inpatient
15hospital services; (2) outpatient hospital services; (3) other
16laboratory and X-ray services; (4) skilled nursing home
17services; (5) physicians' services whether furnished in the
18office, the patient's home, a hospital, a skilled nursing home,
19or elsewhere; (6) medical care, or any other type of remedial
20care furnished by licensed practitioners, including the
21services of certified professional midwives licensed pursuant
22to the Home Birth Safety Act; (7) home health care services;
23(8) private duty nursing service; (9) clinic services; (10)
24dental services, including prevention and treatment of

 

 

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

 

 

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

 

 

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1    Notwithstanding any other provision of this Code, the
2Illinois Department may not require, as a condition of payment
3for any laboratory test authorized under this Article, that a
4physician's handwritten signature appear on the laboratory
5test order form. The Illinois Department may, however, impose
6other appropriate requirements regarding laboratory test order
7documentation.
8    Upon receipt of federal approval of an amendment to the
9Illinois Title XIX State Plan for this purpose, the Department
10shall authorize the Chicago Public Schools (CPS) to procure a
11vendor or vendors to manufacture eyeglasses for individuals
12enrolled in a school within the CPS system. CPS shall ensure
13that its vendor or vendors are enrolled as providers in the
14medical assistance program and in any capitated Medicaid
15managed care entity (MCE) serving individuals enrolled in a
16school within the CPS system. Under any contract procured under
17this provision, the vendor or vendors must serve only
18individuals enrolled in a school within the CPS system. Claims
19for services provided by CPS's vendor or vendors to recipients
20of benefits in the medical assistance program under this Code,
21the Children's Health Insurance Program, or the Covering ALL
22KIDS Health Insurance Program shall be submitted to the
23Department or the MCE in which the individual is enrolled for
24payment and shall be reimbursed at the Department's or the
25MCE's established rates or rate methodologies for eyeglasses.
26    On and after July 1, 2012, the Department of Healthcare and

 

 

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1Family Services may provide the following services to persons
2eligible for assistance under this Article who are
3participating in education, training or employment programs
4operated by the Department of Human Services as successor to
5the Department of Public Aid:
6        (1) dental services provided by or under the
7    supervision of a dentist; and
8        (2) eyeglasses prescribed by a physician skilled in the
9    diseases of the eye, or by an optometrist, whichever the
10    person may select.
11    Notwithstanding any other provision of this Code and
12subject to federal approval, the Department may adopt rules to
13allow a dentist who is volunteering his or her service at no
14cost to render dental services through an enrolled
15not-for-profit health clinic without the dentist personally
16enrolling as a participating provider in the medical assistance
17program. A not-for-profit health clinic shall include a public
18health clinic or Federally Qualified Health Center or other
19enrolled provider, as determined by the Department, through
20which dental services covered under this Section are performed.
21The Department shall establish a process for payment of claims
22for reimbursement for covered dental services rendered under
23this provision.
24    The Illinois Department, by rule, may distinguish and
25classify the medical services to be provided only in accordance
26with the classes of persons designated in Section 5-2.

 

 

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1    The Department of Healthcare and Family Services must
2provide coverage and reimbursement for amino acid-based
3elemental formulas, regardless of delivery method, for the
4diagnosis and treatment of (i) eosinophilic disorders and (ii)
5short bowel syndrome when the prescribing physician has issued
6a written order stating that the amino acid-based elemental
7formula is medically necessary.
8    The Illinois Department shall authorize the provision of,
9and shall authorize payment for, screening by low-dose
10mammography for the presence of occult breast cancer for women
1135 years of age or older who are eligible for medical
12assistance under this Article, as follows:
13        (A) A baseline mammogram for women 35 to 39 years of
14    age.
15        (B) An annual mammogram for women 40 years of age or
16    older.
17        (C) A mammogram at the age and intervals considered
18    medically necessary by the woman's health care provider for
19    women under 40 years of age and having a family history of
20    breast cancer, prior personal history of breast cancer,
21    positive genetic testing, or other risk factors.
22        (D) A comprehensive ultrasound screening of an entire
23    breast or breasts if a mammogram demonstrates
24    heterogeneous or dense breast tissue, when medically
25    necessary as determined by a physician licensed to practice
26    medicine in all of its branches.

 

 

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1        (E) A screening MRI when medically necessary, as
2    determined by a physician licensed to practice medicine in
3    all of its branches.
4    All screenings shall include a physical breast exam,
5instruction on self-examination and information regarding the
6frequency of self-examination and its value as a preventative
7tool. For purposes of this Section, "low-dose mammography"
8means the x-ray examination of the breast using equipment
9dedicated specifically for mammography, including the x-ray
10tube, filter, compression device, and image receptor, with an
11average radiation exposure delivery of less than one rad per
12breast for 2 views of an average size breast. The term also
13includes digital mammography.
14    On and after January 1, 2016, the Department shall ensure
15that all networks of care for adult clients of the Department
16include access to at least one breast imaging Center of Imaging
17Excellence as certified by the American College of Radiology.
18    On and after January 1, 2012, providers participating in a
19quality improvement program approved by the Department shall be
20reimbursed for screening and diagnostic mammography at the same
21rate as the Medicare program's rates, including the increased
22reimbursement for digital mammography.
23    The Department shall convene an expert panel including
24representatives of hospitals, free-standing mammography
25facilities, and doctors, including radiologists, to establish
26quality standards for mammography.

 

 

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1    On and after January 1, 2017, providers participating in a
2breast cancer treatment quality improvement program approved
3by the Department shall be reimbursed for breast cancer
4treatment at a rate that is no lower than 95% of the Medicare
5program's rates for the data elements included in the breast
6cancer treatment quality program.
7    The Department shall convene an expert panel, including
8representatives of hospitals, free standing breast cancer
9treatment centers, breast cancer quality organizations, and
10doctors, including breast surgeons, reconstructive breast
11surgeons, oncologists, and primary care providers to establish
12quality standards for breast cancer treatment.
13    Subject to federal approval, the Department shall
14establish a rate methodology for mammography at federally
15qualified health centers and other encounter-rate clinics.
16These clinics or centers may also collaborate with other
17hospital-based mammography facilities. By January 1, 2016, the
18Department shall report to the General Assembly on the status
19of the provision set forth in this paragraph.
20    The Department shall establish a methodology to remind
21women who are age-appropriate for screening mammography, but
22who have not received a mammogram within the previous 18
23months, of the importance and benefit of screening mammography.
24The Department shall work with experts in breast cancer
25outreach and patient navigation to optimize these reminders and
26shall establish a methodology for evaluating their

 

 

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1effectiveness and modifying the methodology based on the
2evaluation.
3    The Department shall establish a performance goal for
4primary care providers with respect to their female patients
5over age 40 receiving an annual mammogram. This performance
6goal shall be used to provide additional reimbursement in the
7form of a quality performance bonus to primary care providers
8who meet that goal.
9    The Department shall devise a means of case-managing or
10patient navigation for beneficiaries diagnosed with breast
11cancer. This program shall initially operate as a pilot program
12in areas of the State with the highest incidence of mortality
13related to breast cancer. At least one pilot program site shall
14be in the metropolitan Chicago area and at least one site shall
15be outside the metropolitan Chicago area. On or after July 1,
162016, the pilot program shall be expanded to include one site
17in western Illinois, one site in southern Illinois, one site in
18central Illinois, and 4 sites within metropolitan Chicago. An
19evaluation of the pilot program shall be carried out measuring
20health outcomes and cost of care for those served by the pilot
21program compared to similarly situated patients who are not
22served by the pilot program.
23    The Department shall require all networks of care to
24develop a means either internally or by contract with experts
25in navigation and community outreach to navigate cancer
26patients to comprehensive care in a timely fashion. The

 

 

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1Department shall require all networks of care to include access
2for patients diagnosed with cancer to at least one academic
3commission on cancer-accredited cancer program as an
4in-network covered benefit.
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    Notwithstanding any other law to the contrary, the Illinois
13Department shall, within 365 days after July 22, 2013 (the
14effective date of Public Act 98-104), establish procedures to
15permit skilled care facilities licensed under the Nursing Home
16Care Act to submit monthly billing claims for reimbursement
17purposes. Following development of these procedures, the
18Department shall, by July 1, 2016, test the viability of the
19new system and implement any necessary operational or
20structural changes to its information technology platforms in
21order to allow for the direct acceptance and payment of nursing
22home claims.
23    Notwithstanding any other law to the contrary, the Illinois
24Department shall, within 365 days after August 15, 2014 (the
25effective date of Public Act 98-963), establish procedures to
26permit ID/DD facilities licensed under the ID/DD Community Care

 

 

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1Act and MC/DD facilities licensed under the MC/DD Act to submit
2monthly billing claims for reimbursement purposes. Following
3development of these procedures, the Department shall have an
4additional 365 days to test the viability of the new system and
5to ensure that any necessary operational or structural changes
6to its information technology platforms are implemented.
7    The Illinois Department shall require all dispensers of
8medical services, other than an individual practitioner or
9group of practitioners, desiring to participate in the Medical
10Assistance program established under this Article to disclose
11all financial, beneficial, ownership, equity, surety or other
12interests in any and all firms, corporations, partnerships,
13associations, business enterprises, joint ventures, agencies,
14institutions or other legal entities providing any form of
15health care services in this State under this Article.
16    The Illinois Department may require that all dispensers of
17medical services desiring to participate in the medical
18assistance program established under this Article disclose,
19under such terms and conditions as the Illinois Department may
20by rule establish, all inquiries from clients and attorneys
21regarding medical bills paid by the Illinois Department, which
22inquiries could indicate potential existence of claims or liens
23for the Illinois Department.
24    Enrollment of a vendor shall be subject to a provisional
25period and shall be conditional for one year. During the period
26of conditional enrollment, the Department may terminate the

 

 

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1vendor's eligibility to participate in, or may disenroll the
2vendor from, the medical assistance program without cause.
3Unless otherwise specified, such termination of eligibility or
4disenrollment is not subject to the Department's hearing
5process. However, a disenrolled vendor may reapply without
6penalty.
7    The Department has the discretion to limit the conditional
8enrollment period for vendors based upon category of risk of
9the vendor.
10    Prior to enrollment and during the conditional enrollment
11period in the medical assistance program, all vendors shall be
12subject to enhanced oversight, screening, and review based on
13the risk of fraud, waste, and abuse that is posed by the
14category of risk of the vendor. The Illinois Department shall
15establish the procedures for oversight, screening, and review,
16which may include, but need not be limited to: criminal and
17financial background checks; fingerprinting; license,
18certification, and authorization verifications; unscheduled or
19unannounced site visits; database checks; prepayment audit
20reviews; audits; payment caps; payment suspensions; and other
21screening as required by federal or State law.
22    The Department shall define or specify the following: (i)
23by provider notice, the "category of risk of the vendor" for
24each type of vendor, which shall take into account the level of
25screening applicable to a particular category of vendor under
26federal law and regulations; (ii) by rule or provider notice,

 

 

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1the maximum length of the conditional enrollment period for
2each category of risk of the vendor; and (iii) by rule, the
3hearing rights, if any, afforded to a vendor in each category
4of risk of the vendor that is terminated or disenrolled during
5the conditional enrollment period.
6    To be eligible for payment consideration, a vendor's
7payment claim or bill, either as an initial claim or as a
8resubmitted claim following prior rejection, must be received
9by the Illinois Department, or its fiscal intermediary, no
10later than 180 days after the latest date on the claim on which
11medical goods or services were provided, with the following
12exceptions:
13        (1) In the case of a provider whose enrollment is in
14    process by the Illinois Department, the 180-day period
15    shall not begin until the date on the written notice from
16    the Illinois Department that the provider enrollment is
17    complete.
18        (2) In the case of errors attributable to the Illinois
19    Department or any of its claims processing intermediaries
20    which result in an inability to receive, process, or
21    adjudicate a claim, the 180-day period shall not begin
22    until the provider has been notified of the error.
23        (3) In the case of a provider for whom the Illinois
24    Department initiates the monthly billing process.
25        (4) In the case of a provider operated by a unit of
26    local government with a population exceeding 3,000,000

 

 

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1    when local government funds finance federal participation
2    for claims payments.
3    For claims for services rendered during a period for which
4a recipient received retroactive eligibility, claims must be
5filed within 180 days after the Department determines the
6applicant is eligible. For claims for which the Illinois
7Department is not the primary payer, claims must be submitted
8to the Illinois Department within 180 days after the final
9adjudication by the primary payer.
10    In the case of long term care facilities, within 5 days of
11receipt by the facility of required prescreening information,
12data for new admissions shall be entered into the Medical
13Electronic Data Interchange (MEDI) or the Recipient
14Eligibility Verification (REV) System or successor system, and
15within 15 days of receipt by the facility of required
16prescreening information, admission documents shall be
17submitted through MEDI or REV or shall be submitted directly to
18the Department of Human Services using required admission
19forms. Effective September 1, 2014, admission documents,
20including all prescreening information, must be submitted
21through MEDI or REV. Confirmation numbers assigned to an
22accepted transaction shall be retained by a facility to verify
23timely submittal. Once an admission transaction has been
24completed, all resubmitted claims following prior rejection
25are subject to receipt no later than 180 days after the
26admission transaction has been completed.

 

 

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1    Claims that are not submitted and received in compliance
2with the foregoing requirements shall not be eligible for
3payment under the medical assistance program, and the State
4shall have no liability for payment of those claims.
5    To the extent consistent with applicable information and
6privacy, security, and disclosure laws, State and federal
7agencies and departments shall provide the Illinois Department
8access to confidential and other information and data necessary
9to perform eligibility and payment verifications and other
10Illinois Department functions. This includes, but is not
11limited to: information pertaining to licensure;
12certification; earnings; immigration status; citizenship; wage
13reporting; unearned and earned income; pension income;
14employment; supplemental security income; social security
15numbers; National Provider Identifier (NPI) numbers; the
16National Practitioner Data Bank (NPDB); program and agency
17exclusions; taxpayer identification numbers; tax delinquency;
18corporate information; and death records.
19    The Illinois Department shall enter into agreements with
20State agencies and departments, and is authorized to enter into
21agreements with federal agencies and departments, under which
22such agencies and departments shall share data necessary for
23medical assistance program integrity functions and oversight.
24The Illinois Department shall develop, in cooperation with
25other State departments and agencies, and in compliance with
26applicable federal laws and regulations, appropriate and

 

 

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

 

 

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1limited to, the following services: (1) immediate repair or
2replacement of such devices by recipients; and (2) rental,
3lease, purchase or lease-purchase of durable medical equipment
4in a cost-effective manner, taking into consideration the
5recipient's medical prognosis, the extent of the recipient's
6needs, and the requirements and costs for maintaining such
7equipment. Subject to prior approval, such rules shall enable a
8recipient to temporarily acquire and use alternative or
9substitute devices or equipment pending repairs or
10replacements of any device or equipment previously authorized
11for such recipient by the Department.
12    The Department shall execute, relative to the nursing home
13prescreening project, written inter-agency agreements with the
14Department of Human Services and the Department on Aging, to
15effect the following: (i) intake procedures and common
16eligibility criteria for those persons who are receiving
17non-institutional services; and (ii) the establishment and
18development of non-institutional services in areas of the State
19where they are not currently available or are undeveloped; and
20(iii) notwithstanding any other provision of law, subject to
21federal approval, on and after July 1, 2012, an increase in the
22determination of need (DON) scores from 29 to 37 for applicants
23for institutional and home and community-based long term care;
24if and only if federal approval is not granted, the Department
25may, in conjunction with other affected agencies, implement
26utilization controls or changes in benefit packages to

 

 

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1effectuate a similar savings amount for this population; and
2(iv) no later than July 1, 2013, minimum level of care
3eligibility criteria for institutional and home and
4community-based long term care; and (v) no later than October
51, 2013, establish procedures to permit long term care
6providers access to eligibility scores for individuals with an
7admission date who are seeking or receiving services from the
8long term care provider. In order to select the minimum level
9of care eligibility criteria, the Governor shall establish a
10workgroup that includes affected agency representatives and
11stakeholders representing the institutional and home and
12community-based long term care interests. This Section shall
13not restrict the Department from implementing lower level of
14care eligibility criteria for community-based services in
15circumstances where federal approval has been granted.
16    The Illinois Department shall develop and operate, in
17cooperation with other State Departments and agencies and in
18compliance with applicable federal laws and regulations,
19appropriate and effective systems of health care evaluation and
20programs for monitoring of utilization of health care services
21and facilities, as it affects persons eligible for medical
22assistance under this Code.
23    The Illinois Department shall report annually to the
24General Assembly, no later than the second Friday in April of
251979 and each year thereafter, in regard to:
26        (a) actual statistics and trends in utilization of

 

 

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1    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
9ending on the June 30 prior to the report. The report shall
10include suggested legislation for consideration by the General
11Assembly. The filing of one copy of the report with the
12Speaker, one copy with the Minority Leader and one copy with
13the Clerk of the House of Representatives, one copy with the
14President, one copy with the Minority Leader and one copy with
15the Secretary of the Senate, one copy with the Legislative
16Research Unit, and such additional copies with the State
17Government Report Distribution Center for the General Assembly
18as is required under paragraph (t) of Section 7 of the State
19Library Act shall be deemed sufficient to comply with this
20Section.
21    Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on
25Administrative Rules; any purported rule not so adopted, for
26whatever reason, is unauthorized.

 

 

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1    On and after July 1, 2012, the Department shall reduce any
2rate of reimbursement for services or other payments or alter
3any methodologies authorized by this Code to reduce any rate of
4reimbursement for services or other payments in accordance with
5Section 5-5e.
6    Because kidney transplantation can be an appropriate, cost
7effective alternative to renal dialysis when medically
8necessary and notwithstanding the provisions of Section 1-11 of
9this Code, beginning October 1, 2014, the Department shall
10cover kidney transplantation for noncitizens with end-stage
11renal disease who are not eligible for comprehensive medical
12benefits, who meet the residency requirements of Section 5-3 of
13this Code, and who would otherwise meet the financial
14requirements of the appropriate class of eligible persons under
15Section 5-2 of this Code. To qualify for coverage of kidney
16transplantation, such person must be receiving emergency renal
17dialysis services covered by the Department. Providers under
18this Section shall be prior approved and certified by the
19Department to perform kidney transplantation and the services
20under this Section shall be limited to services associated with
21kidney transplantation.
22(Source: P.A. 98-104, Article 9, Section 9-5, eff. 7-22-13;
2398-104, Article 12, Section 12-20, eff. 7-22-13; 98-303, eff.
248-9-13; 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 98-756,
25eff. 7-16-14; 98-963, eff. 8-15-14; 99-78, eff. 7-20-15;
2699-180, eff. 7-29-15; 99-236, eff. 8-3-15; 99-433, eff.

 

 

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18-21-15; revised 8-31-15.)
 
2    (Text of Section after amendment by P.A. 99-407)
3    Sec. 5-5. Medical services. The Illinois Department, by
4rule, shall determine the quantity and quality of and the rate
5of reimbursement for the medical assistance for which payment
6will be authorized, and the medical services to be provided,
7which may include all or part of the following: (1) inpatient
8hospital services; (2) outpatient hospital services; (3) other
9laboratory and X-ray services; (4) skilled nursing home
10services; (5) physicians' services whether furnished in the
11office, the patient's home, a hospital, a skilled nursing home,
12or elsewhere; (6) medical care, or any other type of remedial
13care furnished by licensed practitioners, including the
14services of certified professional midwives licensed pursuant
15to the Home Birth Safety Act; (7) home health care services;
16(8) private duty nursing service; (9) clinic services; (10)
17dental services, including prevention and treatment of
18periodontal disease and dental caries disease for pregnant
19women, provided by an individual licensed to practice dentistry
20or dental surgery; for purposes of this item (10), "dental
21services" means diagnostic, preventive, or corrective
22procedures provided by or under the supervision of a dentist in
23the practice of his or her profession; (11) physical therapy
24and related services; (12) prescribed drugs, dentures, and
25prosthetic devices; and eyeglasses prescribed by a physician

 

 

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1skilled in the diseases of the eye, or by an optometrist,
2whichever the person may select; (13) other diagnostic,
3screening, preventive, and rehabilitative services, including
4to ensure that the individual's need for intervention or
5treatment of mental disorders or substance use disorders or
6co-occurring mental health and substance use disorders is
7determined using a uniform screening, assessment, and
8evaluation process inclusive of criteria, for children and
9adults; for purposes of this item (13), a uniform screening,
10assessment, and evaluation process refers to a process that
11includes an appropriate evaluation and, as warranted, a
12referral; "uniform" does not mean the use of a singular
13instrument, tool, or process that all must utilize; (14)
14transportation and such other expenses as may be necessary;
15(15) medical treatment of sexual assault survivors, as defined
16in Section 1a of the Sexual Assault Survivors Emergency
17Treatment Act, for injuries sustained as a result of the sexual
18assault, including examinations and laboratory tests to
19discover evidence which may be used in criminal proceedings
20arising from the sexual assault; (16) the diagnosis and
21treatment of sickle cell anemia; and (17) any other medical
22care, and any other type of remedial care recognized under the
23laws of this State, but not including abortions, or induced
24miscarriages or premature births, unless, in the opinion of a
25physician, such procedures are necessary for the preservation
26of the life of the woman seeking such treatment, or except an

 

 

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1induced premature birth intended to produce a live viable child
2and such procedure is necessary for the health of the mother or
3her unborn child. The Illinois Department, by rule, shall
4prohibit any physician from providing medical assistance to
5anyone eligible therefor under this Code where such physician
6has been found guilty of performing an abortion procedure in a
7wilful and wanton manner upon a woman who was not pregnant at
8the time such abortion procedure was performed. The term "any
9other type of remedial care" shall include nursing care and
10nursing home service for persons who rely on treatment by
11spiritual means alone through prayer for healing.
12    Notwithstanding any other provision of this Section, a
13comprehensive tobacco use cessation program that includes
14purchasing prescription drugs or prescription medical devices
15approved by the Food and Drug Administration shall be covered
16under the medical assistance program under this Article for
17persons who are otherwise eligible for assistance under this
18Article.
19    Notwithstanding any other provision of this Code, the
20Illinois Department may not require, as a condition of payment
21for any laboratory test authorized under this Article, that a
22physician's handwritten signature appear on the laboratory
23test order form. The Illinois Department may, however, impose
24other appropriate requirements regarding laboratory test order
25documentation.
26    Upon receipt of federal approval of an amendment to the

 

 

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1Illinois Title XIX State Plan for this purpose, the Department
2shall authorize the Chicago Public Schools (CPS) to procure a
3vendor or vendors to manufacture eyeglasses for individuals
4enrolled in a school within the CPS system. CPS shall ensure
5that its vendor or vendors are enrolled as providers in the
6medical assistance program and in any capitated Medicaid
7managed care entity (MCE) serving individuals enrolled in a
8school within the CPS system. Under any contract procured under
9this provision, the vendor or vendors must serve only
10individuals enrolled in a school within the CPS system. Claims
11for services provided by CPS's vendor or vendors to recipients
12of benefits in the medical assistance program under this Code,
13the Children's Health Insurance Program, or the Covering ALL
14KIDS Health Insurance Program shall be submitted to the
15Department or the MCE in which the individual is enrolled for
16payment and shall be reimbursed at the Department's or the
17MCE's established rates or rate methodologies for eyeglasses.
18    On and after July 1, 2012, the Department of Healthcare and
19Family Services may provide the following services to persons
20eligible for assistance under this Article who are
21participating in education, training or employment programs
22operated by the Department of Human Services as successor to
23the Department of Public Aid:
24        (1) dental services provided by or under the
25    supervision of a dentist; and
26        (2) eyeglasses prescribed by a physician skilled in the

 

 

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1    diseases of the eye, or by an optometrist, whichever the
2    person may select.
3    Notwithstanding any other provision of this Code and
4subject to federal approval, the Department may adopt rules to
5allow a dentist who is volunteering his or her service at no
6cost to render dental services through an enrolled
7not-for-profit health clinic without the dentist personally
8enrolling as a participating provider in the medical assistance
9program. A not-for-profit health clinic shall include a public
10health clinic or Federally Qualified Health Center or other
11enrolled provider, as determined by the Department, through
12which dental services covered under this Section are performed.
13The Department shall establish a process for payment of claims
14for reimbursement for covered dental services rendered under
15this provision.
16    The Illinois Department, by rule, may distinguish and
17classify the medical services to be provided only in accordance
18with the classes of persons designated in Section 5-2.
19    The Department of Healthcare and Family Services must
20provide coverage and reimbursement for amino acid-based
21elemental formulas, regardless of delivery method, for the
22diagnosis and treatment of (i) eosinophilic disorders and (ii)
23short bowel syndrome when the prescribing physician has issued
24a written order stating that the amino acid-based elemental
25formula is medically necessary.
26    The Illinois Department shall authorize the provision of,

 

 

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1and shall authorize payment for, screening by low-dose
2mammography for the presence of occult breast cancer for women
335 years of age or older who are eligible for medical
4assistance under this Article, as follows:
5        (A) A baseline mammogram for women 35 to 39 years of
6    age.
7        (B) An annual mammogram for women 40 years of age or
8    older.
9        (C) A mammogram at the age and intervals considered
10    medically necessary by the woman's health care provider for
11    women under 40 years of age and having a family history of
12    breast cancer, prior personal history of breast cancer,
13    positive genetic testing, or other risk factors.
14        (D) A comprehensive ultrasound screening of an entire
15    breast or breasts if a mammogram demonstrates
16    heterogeneous or dense breast tissue, when medically
17    necessary as determined by a physician licensed to practice
18    medicine in all of its branches.
19        (E) A screening MRI when medically necessary, as
20    determined by a physician licensed to practice medicine in
21    all of its branches.
22    All screenings shall include a physical breast exam,
23instruction on self-examination and information regarding the
24frequency of self-examination and its value as a preventative
25tool. For purposes of this Section, "low-dose mammography"
26means the x-ray examination of the breast using equipment

 

 

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1dedicated specifically for mammography, including the x-ray
2tube, filter, compression device, and image receptor, with an
3average radiation exposure delivery of less than one rad per
4breast for 2 views of an average size breast. The term also
5includes digital mammography and includes breast
6tomosynthesis. As used in this Section, the term "breast
7tomosynthesis" means a radiologic procedure that involves the
8acquisition of projection images over the stationary breast to
9produce cross-sectional digital three-dimensional images of
10the breast.
11    On and after January 1, 2016, the Department shall ensure
12that all networks of care for adult clients of the Department
13include access to at least one breast imaging Center of Imaging
14Excellence as certified by the American College of Radiology.
15    On and after January 1, 2012, providers participating in a
16quality improvement program approved by the Department shall be
17reimbursed for screening and diagnostic mammography at the same
18rate as the Medicare program's rates, including the increased
19reimbursement for digital mammography.
20    The Department shall convene an expert panel including
21representatives of hospitals, free-standing mammography
22facilities, and doctors, including radiologists, to establish
23quality standards for mammography.
24    On and after January 1, 2017, providers participating in a
25breast cancer treatment quality improvement program approved
26by the Department shall be reimbursed for breast cancer

 

 

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1treatment at a rate that is no lower than 95% of the Medicare
2program's rates for the data elements included in the breast
3cancer treatment quality program.
4    The Department shall convene an expert panel, including
5representatives of hospitals, free standing breast cancer
6treatment centers, breast cancer quality organizations, and
7doctors, including breast surgeons, reconstructive breast
8surgeons, oncologists, and primary care providers to establish
9quality standards for breast cancer treatment.
10    Subject to federal approval, the Department shall
11establish a rate methodology for mammography at federally
12qualified health centers and other encounter-rate clinics.
13These clinics or centers may also collaborate with other
14hospital-based mammography facilities. By January 1, 2016, the
15Department shall report to the General Assembly on the status
16of the provision set forth in this paragraph.
17    The Department shall establish a methodology to remind
18women who are age-appropriate for screening mammography, but
19who have not received a mammogram within the previous 18
20months, of the importance and benefit of screening mammography.
21The Department shall work with experts in breast cancer
22outreach and patient navigation to optimize these reminders and
23shall establish a methodology for evaluating their
24effectiveness and modifying the methodology based on the
25evaluation.
26    The Department shall establish a performance goal for

 

 

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1primary care providers with respect to their female patients
2over age 40 receiving an annual mammogram. This performance
3goal shall be used to provide additional reimbursement in the
4form of a quality performance bonus to primary care providers
5who meet that goal.
6    The Department shall devise a means of case-managing or
7patient navigation for beneficiaries diagnosed with breast
8cancer. This program shall initially operate as a pilot program
9in areas of the State with the highest incidence of mortality
10related to breast cancer. At least one pilot program site shall
11be in the metropolitan Chicago area and at least one site shall
12be outside the metropolitan Chicago area. On or after July 1,
132016, the pilot program shall be expanded to include one site
14in western Illinois, one site in southern Illinois, one site in
15central Illinois, and 4 sites within metropolitan Chicago. An
16evaluation of the pilot program shall be carried out measuring
17health outcomes and cost of care for those served by the pilot
18program compared to similarly situated patients who are not
19served by the pilot program.
20    The Department shall require all networks of care to
21develop a means either internally or by contract with experts
22in navigation and community outreach to navigate cancer
23patients to comprehensive care in a timely fashion. The
24Department shall require all networks of care to include access
25for patients diagnosed with cancer to at least one academic
26commission on cancer-accredited cancer program as an

 

 

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1in-network covered benefit.
2    Any medical or health care provider shall immediately
3recommend, to any pregnant woman who is being provided prenatal
4services and is suspected of drug abuse or is addicted as
5defined in the Alcoholism and Other Drug Abuse and Dependency
6Act, referral to a local substance abuse treatment provider
7licensed by the Department of Human Services or to a licensed
8hospital which provides substance abuse treatment services.
9The Department of Healthcare and Family Services shall assure
10coverage for the cost of treatment of the drug abuse or
11addiction for pregnant recipients in accordance with the
12Illinois Medicaid Program in conjunction with the Department of
13Human Services.
14    All medical providers providing medical assistance to
15pregnant women under this Code shall receive information from
16the Department on the availability of services under the Drug
17Free Families with a Future or any comparable program providing
18case management services for addicted women, including
19information on appropriate referrals for other social services
20that may be needed by addicted women in addition to treatment
21for addiction.
22    The Illinois Department, in cooperation with the
23Departments of Human Services (as successor to the Department
24of Alcoholism and Substance Abuse) and Public Health, through a
25public awareness campaign, may provide information concerning
26treatment for alcoholism and drug abuse and addiction, prenatal

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1all prescription drugs shall be updated no less frequently than
2every 30 days as required by Section 5-5.12.
3    The rules and regulations of the Illinois Department shall
4require that a written statement including the required opinion
5of a physician shall accompany any claim for reimbursement for
6abortions, or induced miscarriages or premature births. This
7statement shall indicate what procedures were used in providing
8such medical services.
9    Notwithstanding any other law to the contrary, the Illinois
10Department shall, within 365 days after July 22, 2013 (the
11effective date of Public Act 98-104), establish procedures to
12permit skilled care facilities licensed under the Nursing Home
13Care Act to submit monthly billing claims for reimbursement
14purposes. Following development of these procedures, the
15Department shall, by July 1, 2016, test the viability of the
16new system and implement any necessary operational or
17structural changes to its information technology platforms in
18order to allow for the direct acceptance and payment of nursing
19home claims.
20    Notwithstanding any other law to the contrary, the Illinois
21Department shall, within 365 days after August 15, 2014 (the
22effective date of Public Act 98-963), establish procedures to
23permit ID/DD facilities licensed under the ID/DD Community Care
24Act and MC/DD facilities licensed under the MC/DD Act to submit
25monthly billing claims for reimbursement purposes. Following
26development of these procedures, the Department shall have an

 

 

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1additional 365 days to test the viability of the new system and
2to ensure that any necessary operational or structural changes
3to its information technology platforms are implemented.
4    The Illinois Department shall require all dispensers of
5medical services, other than an individual practitioner or
6group of practitioners, desiring to participate in the Medical
7Assistance program established under this Article to disclose
8all financial, beneficial, ownership, equity, surety or other
9interests in any and all firms, corporations, partnerships,
10associations, business enterprises, joint ventures, agencies,
11institutions or other legal entities providing any form of
12health care services in this State under this Article.
13    The Illinois Department may require that all dispensers of
14medical services desiring to participate in the medical
15assistance program established under this Article disclose,
16under such terms and conditions as the Illinois Department may
17by rule establish, all inquiries from clients and attorneys
18regarding medical bills paid by the Illinois Department, which
19inquiries could indicate potential existence of claims or liens
20for the Illinois Department.
21    Enrollment of a vendor shall be subject to a provisional
22period and shall be conditional for one year. During the period
23of conditional enrollment, the Department may terminate the
24vendor's eligibility to participate in, or may disenroll the
25vendor from, the medical assistance program without cause.
26Unless otherwise specified, such termination of eligibility or

 

 

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1disenrollment is not subject to the Department's hearing
2process. However, a disenrolled vendor may reapply without
3penalty.
4    The Department has the discretion to limit the conditional
5enrollment period for vendors based upon category of risk of
6the vendor.
7    Prior to enrollment and during the conditional enrollment
8period in the medical assistance program, all vendors shall be
9subject to enhanced oversight, screening, and review based on
10the risk of fraud, waste, and abuse that is posed by the
11category of risk of the vendor. The Illinois Department shall
12establish the procedures for oversight, screening, and review,
13which may include, but need not be limited to: criminal and
14financial background checks; fingerprinting; license,
15certification, and authorization verifications; unscheduled or
16unannounced site visits; database checks; prepayment audit
17reviews; audits; payment caps; payment suspensions; and other
18screening as required by federal or State law.
19    The Department shall define or specify the following: (i)
20by provider notice, the "category of risk of the vendor" for
21each type of vendor, which shall take into account the level of
22screening applicable to a particular category of vendor under
23federal law and regulations; (ii) by rule or provider notice,
24the maximum length of the conditional enrollment period for
25each category of risk of the vendor; and (iii) by rule, the
26hearing rights, if any, afforded to a vendor in each category

 

 

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1of risk of the vendor that is terminated or disenrolled during
2the conditional enrollment period.
3    To be eligible for payment consideration, a vendor's
4payment claim or bill, either as an initial claim or as a
5resubmitted claim following prior rejection, must be received
6by the Illinois Department, or its fiscal intermediary, no
7later than 180 days after the latest date on the claim on which
8medical goods or services were provided, with the following
9exceptions:
10        (1) In the case of a provider whose enrollment is in
11    process by the Illinois Department, the 180-day period
12    shall not begin until the date on the written notice from
13    the Illinois Department that the provider enrollment is
14    complete.
15        (2) In the case of errors attributable to the Illinois
16    Department or any of its claims processing intermediaries
17    which result in an inability to receive, process, or
18    adjudicate a claim, the 180-day period shall not begin
19    until the provider has been notified of the error.
20        (3) In the case of a provider for whom the Illinois
21    Department initiates the monthly billing process.
22        (4) In the case of a provider operated by a unit of
23    local government with a population exceeding 3,000,000
24    when local government funds finance federal participation
25    for claims payments.
26    For claims for services rendered during a period for which

 

 

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1a recipient received retroactive eligibility, claims must be
2filed within 180 days after the Department determines the
3applicant is eligible. For claims for which the Illinois
4Department is not the primary payer, claims must be submitted
5to the Illinois Department within 180 days after the final
6adjudication by the primary payer.
7    In the case of long term care facilities, within 5 days of
8receipt by the facility of required prescreening information,
9data for new admissions shall be entered into the Medical
10Electronic Data Interchange (MEDI) or the Recipient
11Eligibility Verification (REV) System or successor system, and
12within 15 days of receipt by the facility of required
13prescreening information, admission documents shall be
14submitted through MEDI or REV or shall be submitted directly to
15the Department of Human Services using required admission
16forms. Effective September 1, 2014, admission documents,
17including all prescreening information, must be submitted
18through MEDI or REV. Confirmation numbers assigned to an
19accepted transaction shall be retained by a facility to verify
20timely submittal. Once an admission transaction has been
21completed, all resubmitted claims following prior rejection
22are subject to receipt no later than 180 days after the
23admission transaction has been completed.
24    Claims that are not submitted and received in compliance
25with the foregoing requirements shall not be eligible for
26payment under the medical assistance program, and the State

 

 

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1shall have no liability for payment of those claims.
2    To the extent consistent with applicable information and
3privacy, security, and disclosure laws, State and federal
4agencies and departments shall provide the Illinois Department
5access to confidential and other information and data necessary
6to perform eligibility and payment verifications and other
7Illinois Department functions. This includes, but is not
8limited to: information pertaining to licensure;
9certification; earnings; immigration status; citizenship; wage
10reporting; unearned and earned income; pension income;
11employment; supplemental security income; social security
12numbers; National Provider Identifier (NPI) numbers; the
13National Practitioner Data Bank (NPDB); program and agency
14exclusions; taxpayer identification numbers; tax delinquency;
15corporate information; and death records.
16    The Illinois Department shall enter into agreements with
17State agencies and departments, and is authorized to enter into
18agreements with federal agencies and departments, under which
19such agencies and departments shall share data necessary for
20medical assistance program integrity functions and oversight.
21The Illinois Department shall develop, in cooperation with
22other State departments and agencies, and in compliance with
23applicable federal laws and regulations, appropriate and
24effective methods to share such data. At a minimum, and to the
25extent necessary to provide data sharing, the Illinois
26Department shall enter into agreements with State agencies and

 

 

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

 

 

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1in a cost-effective manner, taking into consideration the
2recipient's medical prognosis, the extent of the recipient's
3needs, and the requirements and costs for maintaining such
4equipment. Subject to prior approval, such rules shall enable a
5recipient to temporarily acquire and use alternative or
6substitute devices or equipment pending repairs or
7replacements of any device or equipment previously authorized
8for such recipient by the Department.
9    The Department shall execute, relative to the nursing home
10prescreening project, written inter-agency agreements with the
11Department of Human Services and the Department on Aging, to
12effect the following: (i) intake procedures and common
13eligibility criteria for those persons who are receiving
14non-institutional services; and (ii) the establishment and
15development of non-institutional services in areas of the State
16where they are not currently available or are undeveloped; and
17(iii) notwithstanding any other provision of law, subject to
18federal approval, on and after July 1, 2012, an increase in the
19determination of need (DON) scores from 29 to 37 for applicants
20for institutional and home and community-based long term care;
21if and only if federal approval is not granted, the Department
22may, in conjunction with other affected agencies, implement
23utilization controls or changes in benefit packages to
24effectuate a similar savings amount for this population; and
25(iv) no later than July 1, 2013, minimum level of care
26eligibility criteria for institutional and home and

 

 

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1community-based long term care; and (v) no later than October
21, 2013, establish procedures to permit long term care
3providers access to eligibility scores for individuals with an
4admission date who are seeking or receiving services from the
5long term care provider. In order to select the minimum level
6of care eligibility criteria, the Governor shall establish a
7workgroup that includes affected agency representatives and
8stakeholders representing the institutional and home and
9community-based long term care interests. This Section shall
10not restrict the Department from implementing lower level of
11care eligibility criteria for community-based services in
12circumstances where federal approval has been granted.
13    The Illinois Department shall develop and operate, in
14cooperation with other State Departments and agencies and in
15compliance with applicable federal laws and regulations,
16appropriate and effective systems of health care evaluation and
17programs for monitoring of utilization of health care services
18and facilities, as it affects persons eligible for medical
19assistance under this Code.
20    The Illinois Department shall report annually to the
21General Assembly, no later than the second Friday in April of
221979 and each year thereafter, in regard to:
23        (a) actual statistics and trends in utilization of
24    medical services by public aid recipients;
25        (b) actual statistics and trends in the provision of
26    the various medical services by medical vendors;

 

 

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

 

 

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1reimbursement for services or other payments in accordance with
2Section 5-5e.
3    Because kidney transplantation can be an appropriate, cost
4effective alternative to renal dialysis when medically
5necessary and notwithstanding the provisions of Section 1-11 of
6this Code, beginning October 1, 2014, the Department shall
7cover kidney transplantation for noncitizens with end-stage
8renal disease who are not eligible for comprehensive medical
9benefits, who meet the residency requirements of Section 5-3 of
10this Code, and who would otherwise meet the financial
11requirements of the appropriate class of eligible persons under
12Section 5-2 of this Code. To qualify for coverage of kidney
13transplantation, such person must be receiving emergency renal
14dialysis services covered by the Department. Providers under
15this Section shall be prior approved and certified by the
16Department to perform kidney transplantation and the services
17under this Section shall be limited to services associated with
18kidney transplantation.
19(Source: P.A. 98-104, Article 9, Section 9-5, eff. 7-22-13;
2098-104, Article 12, Section 12-20, eff. 7-22-13; 98-303, eff.
218-9-13; 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 98-756,
22eff. 7-16-14; 98-963, eff. 8-15-14; 99-78, eff. 7-20-15;
2399-180, eff. 7-29-15; 99-236, eff. 8-3-15; 99-407 (see Section
2499 of P.A. 99-407 for its effective date); 99-433, eff.
258-21-15; revised 8-31-15.)
 

 

 

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1    Section 995. No acceleration or delay. Where this Act makes
2changes in a statute that is represented in this Act by text
3that is not yet or no longer in effect (for example, a Section
4represented by multiple versions), the use of that text does
5not accelerate or delay the taking effect of (i) the changes
6made by this Act or (ii) provisions derived from any other
7Public Act.
 
8    Section 999. Effective date. This Act takes effect July 1,
92016.