Illinois General Assembly - Full Text of SB1586
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Full Text of SB1586  103rd General Assembly

SB1586 103RD GENERAL ASSEMBLY

  
  

 


 
103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1586

 

Introduced 2/8/2023, by Sen. Bill Cunningham

 

SYNOPSIS AS INTRODUCED:
 
225 ILCS 15/2  from Ch. 111, par. 5352
225 ILCS 15/4.3
305 ILCS 5/5-5  from Ch. 23, par. 5-5
720 ILCS 570/303.05

    Amends the Clinical Psychologist Licensing Act. In provisions concerning written collaborative agreements, removes a provision prohibiting a prescribing psychologist from prescribing medications to patients who are less than 17 years of age or over 65 years of age. Provides that no prescriptive authority for any Schedule II opioid shall be delegated. Provides that after the collaborating physician files a notice delegating authority to prescribe any nonnarcotic, nonopioid Schedule II through V controlled substances (rather than any nonnarcotic Schedule III through V controlled substances), the licensed clinical psychologist shall be eligible to register for a mid-level practitioner controlled substance license under the Illinois Controlled Substances Act. Defines "opioid". Makes corresponding changes in the Illinois Controlled Substances Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage and reimbursement for prescription management services provided by prescribing psychologists for persons who are otherwise eligible for medical assistance under the Article. Effective immediately.


LRB103 25489 AMQ 51838 b

 

 

A BILL FOR

 

SB1586LRB103 25489 AMQ 51838 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Clinical Psychologist Licensing Act is
5amended by changing Sections 2 and 4.3 as follows:
 
6    (225 ILCS 15/2)  (from Ch. 111, par. 5352)
7    (Section scheduled to be repealed on January 1, 2027)
8    Sec. 2. Definitions. As used in this Act:
9        (1) "Department" means the Department of Financial and
10    Professional Regulation.
11        (2) "Secretary" means the Secretary of Financial and
12    Professional Regulation.
13        (3) "Board" means the Clinical Psychologists Licensing
14    and Disciplinary Board appointed by the Secretary.
15        (4) (Blank).
16        (5) "Clinical psychology" means the independent
17    evaluation, classification, diagnosis, and treatment of
18    mental, emotional, behavioral or nervous disorders or
19    conditions, developmental disabilities, alcoholism and
20    substance abuse, disorders of habit or conduct, and the
21    psychological aspects of physical illness. The practice of
22    clinical psychology includes psychoeducational
23    evaluation, therapy, remediation and consultation, the use

 

 

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1    of psychological and neuropsychological testing,
2    assessment, psychotherapy, psychoanalysis, hypnosis,
3    biofeedback, and behavioral modification when any of these
4    are used for the purpose of preventing or eliminating
5    psychopathology, or for the amelioration of psychological
6    disorders of individuals or groups. "Clinical psychology"
7    does not include the use of hypnosis by unlicensed persons
8    pursuant to Section 3.
9        (6) A person represents himself or herself to be a
10    "clinical psychologist" or "psychologist" within the
11    meaning of this Act when he or she holds himself or herself
12    out to the public by any title or description of services
13    incorporating the words "psychological", "psychologic",
14    "psychologist", "psychology", or "clinical psychologist"
15    or under such title or description offers to render or
16    renders clinical psychological services as defined in
17    paragraph (7) of this Section to individuals or the public
18    for remuneration.
19        (7) "Clinical psychological services" refers to any
20    services under paragraph (5) of this Section if the words
21    "psychological", "psychologic", "psychologist",
22    "psychology" or "clinical psychologist" are used to
23    describe such services by the person or organization
24    offering to render or rendering them.
25        (8) "Collaborating physician" means a physician
26    licensed to practice medicine in all of its branches in

 

 

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1    Illinois who generally prescribes medications for the
2    treatment of mental health disease or illness to his or
3    her patients in the normal course of his or her clinical
4    medical practice.
5        (9) "Prescribing psychologist" means a licensed,
6    doctoral level psychologist who has undergone specialized
7    training, has passed an examination as determined by rule,
8    and has received a current license granting prescriptive
9    authority under Section 4.2 of this Act that has not been
10    revoked or suspended from the Department.
11        (10) "Prescriptive authority" means the authority to
12    prescribe, administer, discontinue, or distribute drugs or
13    medicines.
14        (11) "Prescription" means an order for a drug,
15    laboratory test, or any medicines, including controlled
16    substances as defined in the Illinois Controlled
17    Substances Act.
18        (12) "Drugs" has the meaning given to that term in the
19    Pharmacy Practice Act.
20        (13) "Medicines" has the meaning given to that term in
21    the Pharmacy Practice Act.
22        (14) "Address of record" means the designated address
23    recorded by the Department in the applicant's application
24    file or the licensee's license file maintained by the
25    Department's licensure maintenance unit.
26        (15) "Opioid" means a narcotic drug or substance that

 

 

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1    is a Schedule II controlled substance under paragraph (1),
2    (2), (3), or (5) of subsection (b) or under subsection (c)
3    of Section 206 of the Illinois Controlled Substances Act.
4    This Act shall not apply to persons lawfully carrying on
5their particular profession or business under any valid
6existing regulatory Act of the State.
7(Source: P.A. 98-668, eff. 6-25-14; 99-572, eff. 7-15-16.)
 
8    (225 ILCS 15/4.3)
9    (Section scheduled to be repealed on January 1, 2027)
10    Sec. 4.3. Written collaborative agreements.
11    (a) A written collaborative agreement is required for all
12prescribing psychologists practicing under a prescribing
13psychologist license issued pursuant to Section 4.2 of this
14Act.
15    (b) A written delegation of prescriptive authority by a
16collaborating physician may only include medications for the
17treatment of mental health disease or illness the
18collaborating physician generally provides to his or her
19patients in the normal course of his or her clinical practice
20with the exception of the following:
21        (1) (blank); patients who are less than 17 years of
22    age or over 65 years of age;
23        (2) patients during pregnancy;
24        (3) patients with serious medical conditions, such as
25    heart disease, cancer, stroke, or seizures, and with

 

 

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1    developmental disabilities and intellectual disabilities;
2    and
3        (4) prescriptive authority for benzodiazepine Schedule
4    III controlled substances; and .
5        (5) prescriptive authority for any Schedule II opioid.
6    (c) The collaborating physician shall file with the
7Department notice of delegation of prescriptive authority and
8termination of the delegation, in accordance with rules of the
9Department. Upon receipt of this notice delegating authority
10to prescribe any nonnarcotic, nonopioid Schedule II III
11through V controlled substances, the licensed clinical
12psychologist shall be eligible to register for a mid-level
13practitioner controlled substance license under Section 303.05
14of the Illinois Controlled Substances Act.
15    (d) All of the following shall apply to delegation of
16prescriptive authority:
17        (1) Any delegation of Schedule II III through V
18    controlled substances shall identify the specific
19    controlled substance by brand name or generic name. No
20    controlled substance to be delivered by injection may be
21    delegated. No Schedule II opioid controlled substance
22    shall be delegated.
23        (2) A prescribing psychologist shall not prescribe
24    narcotic drugs, as defined in Section 102 of the Illinois
25    Controlled Substances Act.
26    Any prescribing psychologist who writes a prescription for

 

 

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1a controlled substance without having valid and appropriate
2authority may be fined by the Department not more than $50 per
3prescription and the Department may take any other
4disciplinary action provided for in this Act.
5    All prescriptions written by a prescribing psychologist
6must contain the name of the prescribing psychologist and his
7or her signature. The prescribing psychologist shall sign his
8or her own name.
9    (e) The written collaborative agreement shall describe the
10working relationship of the prescribing psychologist with the
11collaborating physician and shall delegate prescriptive
12authority as provided in this Act. Collaboration does not
13require an employment relationship between the collaborating
14physician and prescribing psychologist. Absent an employment
15relationship, an agreement may not restrict third-party
16payment sources accepted by the prescribing psychologist. For
17the purposes of this Section, "collaboration" means the
18relationship between a prescribing psychologist and a
19collaborating physician with respect to the delivery of
20prescribing services in accordance with (1) the prescribing
21psychologist's training, education, and experience and (2)
22collaboration and consultation as documented in a jointly
23developed written collaborative agreement.
24    (f) The agreement shall promote the exercise of
25professional judgment by the prescribing psychologist
26corresponding to his or her education and experience.

 

 

SB1586- 7 -LRB103 25489 AMQ 51838 b

1    (g) The collaborative agreement shall not be construed to
2require the personal presence of a physician at the place
3where services are rendered. Methods of communication shall be
4available for consultation with the collaborating physician in
5person or by telecommunications in accordance with established
6written guidelines as set forth in the written agreement.
7    (h) Collaboration and consultation pursuant to all
8collaboration agreements shall be adequate if a collaborating
9physician does each of the following:
10        (1) participates in the joint formulation and joint
11    approval of orders or guidelines with the prescribing
12    psychologist and he or she periodically reviews the
13    prescribing psychologist's orders and the services
14    provided patients under the orders in accordance with
15    accepted standards of medical practice and prescribing
16    psychologist practice;
17        (2) provides collaboration and consultation with the
18    prescribing psychologist in person at least once a month
19    for review of safety and quality clinical care or
20    treatment;
21        (3) is available through telecommunications for
22    consultation on medical problems, complications,
23    emergencies, or patient referral; and
24        (4) reviews medication orders of the prescribing
25    psychologist no less than monthly, including review of
26    laboratory tests and other tests as available.

 

 

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1    (i) The written collaborative agreement shall contain
2provisions detailing notice for termination or change of
3status involving a written collaborative agreement, except
4when the notice is given for just cause.
5    (j) A copy of the signed written collaborative agreement
6shall be available to the Department upon request to either
7the prescribing psychologist or the collaborating physician.
8    (k) Nothing in this Section shall be construed to limit
9the authority of a prescribing psychologist to perform all
10duties authorized under this Act.
11    (l) A prescribing psychologist shall inform each
12collaborating physician of all collaborative agreements he or
13she has signed and provide a copy of these to any collaborating
14physician.
15    (m) No collaborating physician shall enter into more than
163 collaborative agreements with prescribing psychologists.
17(Source: P.A. 101-84, eff. 7-19-19.)
 
18    Section 10. The Illinois Public Aid Code is amended by
19changing Section 5-5 as follows:
 
20    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
21    Sec. 5-5. Medical services. The Illinois Department, by
22rule, shall determine the quantity and quality of and the rate
23of reimbursement for the medical assistance for which payment
24will be authorized, and the medical services to be provided,

 

 

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1which may include all or part of the following: (1) inpatient
2hospital services; (2) outpatient hospital services; (3) other
3laboratory and X-ray services; (4) skilled nursing home
4services; (5) physicians' services whether furnished in the
5office, the patient's home, a hospital, a skilled nursing
6home, or elsewhere; (6) medical care, or any other type of
7remedial care furnished by licensed practitioners; (7) home
8health care services; (8) private duty nursing service; (9)
9clinic services; (10) dental services, including prevention
10and treatment of periodontal disease and dental caries disease
11for pregnant individuals, provided by an individual licensed
12to practice dentistry or dental surgery; for purposes of this
13item (10), "dental services" means diagnostic, preventive, or
14corrective procedures provided by or under the supervision of
15a dentist in the practice of his or her profession; (11)
16physical therapy and related services; (12) prescribed drugs,
17dentures, and prosthetic devices; and eyeglasses prescribed by
18a physician skilled in the diseases of the eye, or by an
19optometrist, whichever the person may select; (13) other
20diagnostic, screening, preventive, and rehabilitative
21services, including to ensure that the individual's need for
22intervention or treatment of mental disorders or substance use
23disorders or co-occurring mental health and substance use
24disorders is determined using a uniform screening, assessment,
25and evaluation process inclusive of criteria, for children and
26adults; for purposes of this item (13), a uniform screening,

 

 

SB1586- 10 -LRB103 25489 AMQ 51838 b

1assessment, and evaluation process refers to a process that
2includes an appropriate evaluation and, as warranted, a
3referral; "uniform" does not mean the use of a singular
4instrument, tool, or process that all must utilize; (14)
5transportation and such other expenses as may be necessary;
6(15) medical treatment of sexual assault survivors, as defined
7in Section 1a of the Sexual Assault Survivors Emergency
8Treatment Act, for injuries sustained as a result of the
9sexual assault, including examinations and laboratory tests to
10discover evidence which may be used in criminal proceedings
11arising from the sexual assault; (16) the diagnosis and
12treatment of sickle cell anemia; (16.5) services performed by
13a chiropractic physician licensed under the Medical Practice
14Act of 1987 and acting within the scope of his or her license,
15including, but not limited to, chiropractic manipulative
16treatment; and (17) any other medical care, and any other type
17of remedial care recognized under the laws of this State. The
18term "any other type of remedial care" shall include nursing
19care and nursing home service for persons who rely on
20treatment by spiritual means alone through prayer for healing.
21    Notwithstanding any other provision of this Section, a
22comprehensive tobacco use cessation program that includes
23purchasing prescription drugs or prescription medical devices
24approved by the Food and Drug Administration shall be covered
25under the medical assistance program under this Article for
26persons who are otherwise eligible for assistance under this

 

 

SB1586- 11 -LRB103 25489 AMQ 51838 b

1Article.
2    Notwithstanding any other provision of this Code,
3reproductive health care that is otherwise legal in Illinois
4shall be covered under the medical assistance program for
5persons who are otherwise eligible for medical assistance
6under this Article.
7    Notwithstanding any other provision of this Section, all
8tobacco cessation medications approved by the United States
9Food and Drug Administration and all individual and group
10tobacco cessation counseling services and telephone-based
11counseling services and tobacco cessation medications provided
12through the Illinois Tobacco Quitline shall be covered under
13the medical assistance program for persons who are otherwise
14eligible for assistance under this Article. The Department
15shall comply with all federal requirements necessary to obtain
16federal financial participation, as specified in 42 CFR
17433.15(b)(7), for telephone-based counseling services provided
18through the Illinois Tobacco Quitline, including, but not
19limited to: (i) entering into a memorandum of understanding or
20interagency agreement with the Department of Public Health, as
21administrator of the Illinois Tobacco Quitline; and (ii)
22developing a cost allocation plan for Medicaid-allowable
23Illinois Tobacco Quitline services in accordance with 45 CFR
2495.507. The Department shall submit the memorandum of
25understanding or interagency agreement, the cost allocation
26plan, and all other necessary documentation to the Centers for

 

 

SB1586- 12 -LRB103 25489 AMQ 51838 b

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

 

 

SB1586- 13 -LRB103 25489 AMQ 51838 b

1payment and shall be reimbursed at the Department's or the
2MCE's established rates or rate methodologies for eyeglasses.
3    On and after July 1, 2012, the Department of Healthcare
4and Family Services may provide the following services to
5persons eligible for assistance under this Article who are
6participating in education, training or employment programs
7operated by the Department of Human Services as successor to
8the Department of Public Aid:
9        (1) dental services provided by or under the
10    supervision of a dentist; and
11        (2) eyeglasses prescribed by a physician skilled in
12    the diseases of the eye, or by an optometrist, whichever
13    the person may select.
14    On and after July 1, 2018, the Department of Healthcare
15and Family Services shall provide dental services to any adult
16who is otherwise eligible for assistance under the medical
17assistance program. As used in this paragraph, "dental
18services" means diagnostic, preventative, restorative, or
19corrective procedures, including procedures and services for
20the prevention and treatment of periodontal disease and dental
21caries disease, provided by an individual who is licensed to
22practice dentistry or dental surgery or who is under the
23supervision of a dentist in the practice of his or her
24profession.
25    On and after July 1, 2018, targeted dental services, as
26set forth in Exhibit D of the Consent Decree entered by the

 

 

SB1586- 14 -LRB103 25489 AMQ 51838 b

1United States District Court for the Northern District of
2Illinois, Eastern Division, in the matter of Memisovski v.
3Maram, Case No. 92 C 1982, that are provided to adults under
4the medical assistance program shall be established at no less
5than the rates set forth in the "New Rate" column in Exhibit D
6of the Consent Decree for targeted dental services that are
7provided to persons under the age of 18 under the medical
8assistance program.
9    Notwithstanding any other provision of this Code and
10subject to federal approval, the Department may adopt rules to
11allow a dentist who is volunteering his or her service at no
12cost to render dental services through an enrolled
13not-for-profit health clinic without the dentist personally
14enrolling as a participating provider in the medical
15assistance program. A not-for-profit health clinic shall
16include a public health clinic or Federally Qualified Health
17Center or other enrolled provider, as determined by the
18Department, through which dental services covered under this
19Section are performed. The Department shall establish a
20process for payment of claims for reimbursement for covered
21dental services rendered under this provision.
22    On and after January 1, 2022, the Department of Healthcare
23and Family Services shall administer and regulate a
24school-based dental program that allows for the out-of-office
25delivery of preventative dental services in a school setting
26to children under 19 years of age. The Department shall

 

 

SB1586- 15 -LRB103 25489 AMQ 51838 b

1establish, by rule, guidelines for participation by providers
2and set requirements for follow-up referral care based on the
3requirements established in the Dental Office Reference Manual
4published by the Department that establishes the requirements
5for dentists participating in the All Kids Dental School
6Program. Every effort shall be made by the Department when
7developing the program requirements to consider the different
8geographic differences of both urban and rural areas of the
9State for initial treatment and necessary follow-up care. No
10provider shall be charged a fee by any unit of local government
11to participate in the school-based dental program administered
12by the Department. Nothing in this paragraph shall be
13construed to limit or preempt a home rule unit's or school
14district's authority to establish, change, or administer a
15school-based dental program in addition to, or independent of,
16the school-based dental program administered by the
17Department.
18    The Illinois Department, by rule, may distinguish and
19classify the medical services to be provided only in
20accordance with the classes of persons designated in Section
215-2.
22    The Department of Healthcare and Family Services must
23provide coverage and reimbursement for amino acid-based
24elemental formulas, regardless of delivery method, for the
25diagnosis and treatment of (i) eosinophilic disorders and (ii)
26short bowel syndrome when the prescribing physician has issued

 

 

SB1586- 16 -LRB103 25489 AMQ 51838 b

1a written order stating that the amino acid-based elemental
2formula is medically necessary.
3    The Illinois Department shall authorize the provision of,
4and shall authorize payment for, screening by low-dose
5mammography for the presence of occult breast cancer for
6individuals 35 years of age or older who are eligible for
7medical assistance under this Article, as follows:
8        (A) A baseline mammogram for individuals 35 to 39
9    years of age.
10        (B) An annual mammogram for individuals 40 years of
11    age or older.
12        (C) A mammogram at the age and intervals considered
13    medically necessary by the individual's health care
14    provider for individuals under 40 years of age and having
15    a family history of breast cancer, prior personal history
16    of breast cancer, positive genetic testing, or other risk
17    factors.
18        (D) A comprehensive ultrasound screening and MRI of an
19    entire breast or breasts if a mammogram demonstrates
20    heterogeneous or dense breast tissue or when medically
21    necessary as determined by a physician licensed to
22    practice medicine in all of its branches.
23        (E) A screening MRI when medically necessary, as
24    determined by a physician licensed to practice medicine in
25    all of its branches.
26        (F) A diagnostic mammogram when medically necessary,

 

 

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1    as determined by a physician licensed to practice medicine
2    in all its branches, advanced practice registered nurse,
3    or physician assistant.
4    The Department shall not impose a deductible, coinsurance,
5copayment, or any other cost-sharing requirement on the
6coverage provided under this paragraph; except that this
7sentence does not apply to coverage of diagnostic mammograms
8to the extent such coverage would disqualify a high-deductible
9health plan from eligibility for a health savings account
10pursuant to Section 223 of the Internal Revenue Code (26
11U.S.C. 223).
12    All screenings shall include a physical breast exam,
13instruction on self-examination and information regarding the
14frequency of self-examination and its value as a preventative
15tool.
16     For purposes of this Section:
17    "Diagnostic mammogram" means a mammogram obtained using
18diagnostic mammography.
19    "Diagnostic mammography" means a method of screening that
20is designed to evaluate an abnormality in a breast, including
21an abnormality seen or suspected on a screening mammogram or a
22subjective or objective abnormality otherwise detected in the
23breast.
24    "Low-dose mammography" means the x-ray examination of the
25breast using equipment dedicated specifically for mammography,
26including the x-ray tube, filter, compression device, and

 

 

SB1586- 18 -LRB103 25489 AMQ 51838 b

1image receptor, with an average radiation exposure delivery of
2less than one rad per breast for 2 views of an average size
3breast. The term also includes digital mammography and
4includes breast tomosynthesis.
5    "Breast tomosynthesis" means a radiologic procedure that
6involves the acquisition of projection images over the
7stationary breast to produce cross-sectional digital
8three-dimensional images of the breast.
9    If, at any time, the Secretary of the United States
10Department of Health and Human Services, or its successor
11agency, promulgates rules or regulations to be published in
12the Federal Register or publishes a comment in the Federal
13Register or issues an opinion, guidance, or other action that
14would require the State, pursuant to any provision of the
15Patient Protection and Affordable Care Act (Public Law
16111-148), including, but not limited to, 42 U.S.C.
1718031(d)(3)(B) or any successor provision, to defray the cost
18of any coverage for breast tomosynthesis outlined in this
19paragraph, then the requirement that an insurer cover breast
20tomosynthesis is inoperative other than any such coverage
21authorized under Section 1902 of the Social Security Act, 42
22U.S.C. 1396a, and the State shall not assume any obligation
23for the cost of coverage for breast tomosynthesis set forth in
24this paragraph.
25    On and after January 1, 2016, the Department shall ensure
26that all networks of care for adult clients of the Department

 

 

SB1586- 19 -LRB103 25489 AMQ 51838 b

1include access to at least one breast imaging Center of
2Imaging Excellence as certified by the American College of
3Radiology.
4    On and after January 1, 2012, providers participating in a
5quality improvement program approved by the Department shall
6be reimbursed for screening and diagnostic mammography at the
7same rate as the Medicare program's rates, including the
8increased reimbursement for digital mammography and, after
9January 1, 2023 (the effective date of Public Act 102-1018)
10this amendatory Act of the 102nd General Assembly, breast
11tomosynthesis.
12    The Department shall convene an expert panel including
13representatives of hospitals, free-standing mammography
14facilities, and doctors, including radiologists, to establish
15quality standards for mammography.
16    On and after January 1, 2017, providers participating in a
17breast cancer treatment quality improvement program approved
18by the Department shall be reimbursed for breast cancer
19treatment at a rate that is no lower than 95% of the Medicare
20program's rates for the data elements included in the breast
21cancer treatment quality program.
22    The Department shall convene an expert panel, including
23representatives of hospitals, free-standing breast cancer
24treatment centers, breast cancer quality organizations, and
25doctors, including breast surgeons, reconstructive breast
26surgeons, oncologists, and primary care providers to establish

 

 

SB1586- 20 -LRB103 25489 AMQ 51838 b

1quality standards for breast cancer treatment.
2    Subject to federal approval, the Department shall
3establish a rate methodology for mammography at federally
4qualified health centers and other encounter-rate clinics.
5These clinics or centers may also collaborate with other
6hospital-based mammography facilities. By January 1, 2016, the
7Department shall report to the General Assembly on the status
8of the provision set forth in this paragraph.
9    The Department shall establish a methodology to remind
10individuals who are age-appropriate for screening mammography,
11but who have not received a mammogram within the previous 18
12months, of the importance and benefit of screening
13mammography. The Department shall work with experts in breast
14cancer outreach and patient navigation to optimize these
15reminders and shall establish a methodology for evaluating
16their effectiveness and modifying the methodology based on the
17evaluation.
18    The Department shall establish a performance goal for
19primary care providers with respect to their female patients
20over age 40 receiving an annual mammogram. This performance
21goal shall be used to provide additional reimbursement in the
22form of a quality performance bonus to primary care providers
23who meet that goal.
24    The Department shall devise a means of case-managing or
25patient navigation for beneficiaries diagnosed with breast
26cancer. This program shall initially operate as a pilot

 

 

SB1586- 21 -LRB103 25489 AMQ 51838 b

1program in areas of the State with the highest incidence of
2mortality related to breast cancer. At least one pilot program
3site shall be in the metropolitan Chicago area and at least one
4site shall be outside the metropolitan Chicago area. On or
5after July 1, 2016, the pilot program shall be expanded to
6include one site in western Illinois, one site in southern
7Illinois, one site in central Illinois, and 4 sites within
8metropolitan Chicago. An evaluation of the pilot program shall
9be carried out measuring health outcomes and cost of care for
10those served by the pilot program compared to similarly
11situated patients who are not served by the pilot program.
12    The Department shall require all networks of care to
13develop a means either internally or by contract with experts
14in navigation and community outreach to navigate cancer
15patients to comprehensive care in a timely fashion. The
16Department shall require all networks of care to include
17access for patients diagnosed with cancer to at least one
18academic commission on cancer-accredited cancer program as an
19in-network covered benefit.
20    The Department shall provide coverage and reimbursement
21for a human papillomavirus (HPV) vaccine that is approved for
22marketing by the federal Food and Drug Administration for all
23persons between the ages of 9 and 45 and persons of the age of
2446 and above who have been diagnosed with cervical dysplasia
25with a high risk of recurrence or progression. The Department
26shall disallow any preauthorization requirements for the

 

 

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1administration of the human papillomavirus (HPV) vaccine.
2    On or after July 1, 2022, individuals who are otherwise
3eligible for medical assistance under this Article shall
4receive coverage for perinatal depression screenings for the
512-month period beginning on the last day of their pregnancy.
6Medical assistance coverage under this paragraph shall be
7conditioned on the use of a screening instrument approved by
8the Department.
9    Any medical or health care provider shall immediately
10recommend, to any pregnant individual who is being provided
11prenatal services and is suspected of having a substance use
12disorder as defined in the Substance Use Disorder Act,
13referral to a local substance use disorder treatment program
14licensed by the Department of Human Services or to a licensed
15hospital which provides substance abuse treatment services.
16The Department of Healthcare and Family Services shall assure
17coverage for the cost of treatment of the drug abuse or
18addiction for pregnant recipients in accordance with the
19Illinois Medicaid Program in conjunction with the Department
20of Human Services.
21    All medical providers providing medical assistance to
22pregnant individuals under this Code shall receive information
23from the Department on the availability of services under any
24program providing case management services for addicted
25individuals, including information on appropriate referrals
26for other social services that may be needed by addicted

 

 

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1individuals in addition to treatment for addiction.
2    The Illinois Department, in cooperation with the
3Departments of Human Services (as successor to the Department
4of Alcoholism and Substance Abuse) and Public Health, through
5a public awareness campaign, may provide information
6concerning treatment for alcoholism and drug abuse and
7addiction, prenatal health care, and other pertinent programs
8directed at reducing the number of drug-affected infants born
9to recipients of medical assistance.
10    Neither the Department of Healthcare and Family Services
11nor the Department of Human Services shall sanction the
12recipient solely on the basis of the recipient's substance
13abuse.
14    The Illinois Department shall establish such regulations
15governing the dispensing of health services under this Article
16as it shall deem appropriate. The Department should seek the
17advice of formal professional advisory committees appointed by
18the Director of the Illinois Department for the purpose of
19providing regular advice on policy and administrative matters,
20information dissemination and educational activities for
21medical and health care providers, and consistency in
22procedures to the Illinois Department.
23    The Illinois Department may develop and contract with
24Partnerships of medical providers to arrange medical services
25for persons eligible under Section 5-2 of this Code.
26Implementation of this Section may be by demonstration

 

 

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1projects in certain geographic areas. The Partnership shall be
2represented by a sponsor organization. The Department, by
3rule, shall develop qualifications for sponsors of
4Partnerships. Nothing in this Section shall be construed to
5require that the sponsor organization be a medical
6organization.
7    The sponsor must negotiate formal written contracts with
8medical providers for physician services, inpatient and
9outpatient hospital care, home health services, treatment for
10alcoholism and substance abuse, and other services determined
11necessary by the Illinois Department by rule for delivery by
12Partnerships. Physician services must include prenatal and
13obstetrical care. The Illinois Department shall reimburse
14medical services delivered by Partnership providers to clients
15in target areas according to provisions of this Article and
16the Illinois Health Finance Reform Act, except that:
17        (1) Physicians participating in a Partnership and
18    providing certain services, which shall be determined by
19    the Illinois Department, to persons in areas covered by
20    the Partnership may receive an additional surcharge for
21    such services.
22        (2) The Department may elect to consider and negotiate
23    financial incentives to encourage the development of
24    Partnerships and the efficient delivery of medical care.
25        (3) Persons receiving medical services through
26    Partnerships may receive medical and case management

 

 

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1    services above the level usually offered through the
2    medical assistance program.
3    Medical providers shall be required to meet certain
4qualifications to participate in Partnerships to ensure the
5delivery of high quality medical services. These
6qualifications shall be determined by rule of the Illinois
7Department and may be higher than qualifications for
8participation in the medical assistance program. Partnership
9sponsors may prescribe reasonable additional qualifications
10for participation by medical providers, only with the prior
11written approval of the Illinois Department.
12    Nothing in this Section shall limit the free choice of
13practitioners, hospitals, and other providers of medical
14services by clients. In order to ensure patient freedom of
15choice, the Illinois Department shall immediately promulgate
16all rules and take all other necessary actions so that
17provided services may be accessed from therapeutically
18certified optometrists to the full extent of the Illinois
19Optometric Practice Act of 1987 without discriminating between
20service providers.
21    The Department shall apply for a waiver from the United
22States Health Care Financing Administration to allow for the
23implementation of Partnerships under this Section.
24    The Illinois Department shall require health care
25providers to maintain records that document the medical care
26and services provided to recipients of Medical Assistance

 

 

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1under this Article. Such records must be retained for a period
2of not less than 6 years from the date of service or as
3provided by applicable State law, whichever period is longer,
4except that if an audit is initiated within the required
5retention period then the records must be retained until the
6audit is completed and every exception is resolved. The
7Illinois Department shall require health care providers to
8make available, when authorized by the patient, in writing,
9the medical records in a timely fashion to other health care
10providers who are treating or serving persons eligible for
11Medical Assistance under this Article. All dispensers of
12medical services shall be required to maintain and retain
13business and professional records sufficient to fully and
14accurately document the nature, scope, details and receipt of
15the health care provided to persons eligible for medical
16assistance under this Code, in accordance with regulations
17promulgated by the Illinois Department. The rules and
18regulations shall require that proof of the receipt of
19prescription drugs, dentures, prosthetic devices and
20eyeglasses by eligible persons under this Section accompany
21each claim for reimbursement submitted by the dispenser of
22such medical services. No such claims for reimbursement shall
23be approved for payment by the Illinois Department without
24such proof of receipt, unless the Illinois Department shall
25have put into effect and shall be operating a system of
26post-payment audit and review which shall, on a sampling

 

 

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1basis, be deemed adequate by the Illinois Department to assure
2that such drugs, dentures, prosthetic devices and eyeglasses
3for which payment is being made are actually being received by
4eligible recipients. Within 90 days after September 16, 1984
5(the effective date of Public Act 83-1439), the Illinois
6Department shall establish a current list of acquisition costs
7for all prosthetic devices and any other items recognized as
8medical equipment and supplies reimbursable under this Article
9and shall update such list on a quarterly basis, except that
10the acquisition costs of all prescription drugs shall be
11updated no less frequently than every 30 days as required by
12Section 5-5.12.
13    Notwithstanding any other law to the contrary, the
14Illinois Department shall, within 365 days after July 22, 2013
15(the effective date of Public Act 98-104), establish
16procedures to permit skilled care facilities licensed under
17the Nursing Home Care Act to submit monthly billing claims for
18reimbursement purposes. Following development of these
19procedures, the Department shall, by July 1, 2016, test the
20viability of the new system and implement any necessary
21operational or structural changes to its information
22technology platforms in order to allow for the direct
23acceptance and payment of nursing home claims.
24    Notwithstanding any other law to the contrary, the
25Illinois Department shall, within 365 days after August 15,
262014 (the effective date of Public Act 98-963), establish

 

 

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

 

 

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

 

 

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

 

 

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1        (4) In the case of a provider operated by a unit of
2    local government with a population exceeding 3,000,000
3    when local government funds finance federal participation
4    for claims payments.
5    For claims for services rendered during a period for which
6a recipient received retroactive eligibility, claims must be
7filed within 180 days after the Department determines the
8applicant is eligible. For claims for which the Illinois
9Department is not the primary payer, claims must be submitted
10to the Illinois Department within 180 days after the final
11adjudication by the primary payer.
12    In the case of long term care facilities, within 120
13calendar days of receipt by the facility of required
14prescreening information, new admissions with associated
15admission documents shall be submitted through the Medical
16Electronic Data Interchange (MEDI) or the Recipient
17Eligibility Verification (REV) System or shall be submitted
18directly to the Department of Human Services using required
19admission forms. Effective September 1, 2014, admission
20documents, including all prescreening information, must be
21submitted through MEDI or REV. Confirmation numbers assigned
22to an accepted transaction shall be retained by a facility to
23verify timely submittal. Once an admission transaction has
24been completed, all resubmitted claims following prior
25rejection are subject to receipt no later than 180 days after
26the admission 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
9necessary to perform eligibility and payment verifications and
10other Illinois 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
21into agreements with federal agencies and departments, under
22which such agencies and departments shall share data necessary
23for medical assistance program integrity functions and
24oversight. The Illinois Department shall develop, in
25cooperation with other State departments and agencies, and in
26compliance with applicable federal laws and regulations,

 

 

SB1586- 33 -LRB103 25489 AMQ 51838 b

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

 

 

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1devices and durable medical equipment. Such rules shall
2provide, but not be limited to, the following services: (1)
3immediate repair or replacement of such devices by recipients;
4and (2) rental, lease, purchase or lease-purchase of durable
5medical equipment in a cost-effective manner, taking into
6consideration the recipient's medical prognosis, the extent of
7the recipient's needs, and the requirements and costs for
8maintaining such equipment. Subject to prior approval, such
9rules shall enable a recipient to temporarily acquire and use
10alternative or substitute devices or equipment pending repairs
11or replacements of any device or equipment previously
12authorized for such recipient by the Department.
13Notwithstanding any provision of Section 5-5f to the contrary,
14the Department may, by rule, exempt certain replacement
15wheelchair parts from prior approval and, for wheelchairs,
16wheelchair parts, wheelchair accessories, and related seating
17and positioning items, determine the wholesale price by
18methods other than actual acquisition costs.
19    The Department shall require, by rule, all providers of
20durable medical equipment to be accredited by an accreditation
21organization approved by the federal Centers for Medicare and
22Medicaid Services and recognized by the Department in order to
23bill the Department for providing durable medical equipment to
24recipients. No later than 15 months after the effective date
25of the rule adopted pursuant to this paragraph, all providers
26must meet the accreditation requirement.

 

 

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1    In order to promote environmental responsibility, meet the
2needs of recipients and enrollees, and achieve significant
3cost savings, the Department, or a managed care organization
4under contract with the Department, may provide recipients or
5managed care enrollees who have a prescription or Certificate
6of Medical Necessity access to refurbished durable medical
7equipment under this Section (excluding prosthetic and
8orthotic devices as defined in the Orthotics, Prosthetics, and
9Pedorthics Practice Act and complex rehabilitation technology
10products and associated services) through the State's
11assistive technology program's reutilization program, using
12staff with the Assistive Technology Professional (ATP)
13Certification if the refurbished durable medical equipment:
14(i) is available; (ii) is less expensive, including shipping
15costs, than new durable medical equipment of the same type;
16(iii) is able to withstand at least 3 years of use; (iv) is
17cleaned, disinfected, sterilized, and safe in accordance with
18federal Food and Drug Administration regulations and guidance
19governing the reprocessing of medical devices in health care
20settings; and (v) equally meets the needs of the recipient or
21enrollee. The reutilization program shall confirm that the
22recipient or enrollee is not already in receipt of the same or
23similar equipment from another service provider, and that the
24refurbished durable medical equipment equally meets the needs
25of the recipient or enrollee. Nothing in this paragraph shall
26be construed to limit recipient or enrollee choice to obtain

 

 

SB1586- 36 -LRB103 25489 AMQ 51838 b

1new durable medical equipment or place any additional prior
2authorization conditions on enrollees of managed care
3organizations.
4    The Department shall execute, relative to the nursing home
5prescreening project, written inter-agency agreements with the
6Department of Human Services and the Department on Aging, to
7effect the following: (i) intake procedures and common
8eligibility criteria for those persons who are receiving
9non-institutional services; and (ii) the establishment and
10development of non-institutional services in areas of the
11State where they are not currently available or are
12undeveloped; and (iii) notwithstanding any other provision of
13law, subject to federal approval, on and after July 1, 2012, an
14increase in the determination of need (DON) scores from 29 to
1537 for applicants for institutional and home and
16community-based long term care; if and only if federal
17approval is not granted, the Department may, in conjunction
18with other affected agencies, implement utilization controls
19or changes in benefit packages to effectuate a similar savings
20amount for this population; and (iv) no later than July 1,
212013, minimum level of care eligibility criteria for
22institutional and home and community-based long term care; and
23(v) no later than October 1, 2013, establish procedures to
24permit long term care providers access to eligibility scores
25for individuals with an admission date who are seeking or
26receiving services from the long term care provider. In order

 

 

SB1586- 37 -LRB103 25489 AMQ 51838 b

1to select the minimum level of care eligibility criteria, the
2Governor shall establish a workgroup that includes affected
3agency representatives and stakeholders representing the
4institutional and home and community-based long term care
5interests. This Section shall not restrict the Department from
6implementing lower level of care eligibility criteria for
7community-based services in circumstances where federal
8approval has been granted.
9    The Illinois Department shall develop and operate, in
10cooperation with other State Departments and agencies and in
11compliance with applicable federal laws and regulations,
12appropriate and effective systems of health care evaluation
13and programs for monitoring of utilization of health care
14services and facilities, as it affects persons eligible for
15medical assistance under this Code.
16    The Illinois Department shall report annually to the
17General Assembly, no later than the second Friday in April of
181979 and each year thereafter, in regard to:
19        (a) actual statistics and trends in utilization of
20    medical services by public aid recipients;
21        (b) actual statistics and trends in the provision of
22    the various medical services by medical vendors;
23        (c) current rate structures and proposed changes in
24    those rate structures for the various medical vendors; and
25        (d) efforts at utilization review and control by the
26    Illinois Department.

 

 

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1    The period covered by each report shall be the 3 years
2ending on the June 30 prior to the report. The report shall
3include suggested legislation for consideration by the General
4Assembly. The requirement for reporting to the General
5Assembly shall be satisfied by filing copies of the report as
6required by Section 3.1 of the General Assembly Organization
7Act, and filing such additional copies with the State
8Government Report Distribution Center for the General Assembly
9as is required under paragraph (t) of Section 7 of the State
10Library Act.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate
20of reimbursement for services or other payments in accordance
21with Section 5-5e.
22    Because kidney transplantation can be an appropriate,
23cost-effective alternative to renal dialysis when medically
24necessary and notwithstanding the provisions of Section 1-11
25of this Code, beginning October 1, 2014, the Department shall
26cover kidney transplantation for noncitizens with end-stage

 

 

SB1586- 39 -LRB103 25489 AMQ 51838 b

1renal disease who are not eligible for comprehensive medical
2benefits, who meet the residency requirements of Section 5-3
3of this Code, and who would otherwise meet the financial
4requirements of the appropriate class of eligible persons
5under Section 5-2 of this Code. To qualify for coverage of
6kidney transplantation, such person must be receiving
7emergency renal dialysis services covered by the Department.
8Providers under this Section shall be prior approved and
9certified by the Department to perform kidney transplantation
10and the services under this Section shall be limited to
11services associated with kidney transplantation.
12    Notwithstanding any other provision of this Code to the
13contrary, on or after July 1, 2015, all FDA approved forms of
14medication assisted treatment prescribed for the treatment of
15alcohol dependence or treatment of opioid dependence shall be
16covered under both fee for service and managed care medical
17assistance programs for persons who are otherwise eligible for
18medical assistance under this Article and shall not be subject
19to any (1) utilization control, other than those established
20under the American Society of Addiction Medicine patient
21placement criteria, (2) prior authorization mandate, or (3)
22lifetime restriction limit mandate.
23    On or after July 1, 2015, opioid antagonists prescribed
24for the treatment of an opioid overdose, including the
25medication product, administration devices, and any pharmacy
26fees or hospital fees related to the dispensing, distribution,

 

 

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1and administration of the opioid antagonist, shall be covered
2under the medical assistance program for persons who are
3otherwise eligible for medical assistance under this Article.
4As used in this Section, "opioid antagonist" means a drug that
5binds to opioid receptors and blocks or inhibits the effect of
6opioids acting on those receptors, including, but not limited
7to, naloxone hydrochloride or any other similarly acting drug
8approved by the U.S. Food and Drug Administration. The
9Department shall not impose a copayment on the coverage
10provided for naloxone hydrochloride under the medical
11assistance program.
12    Upon federal approval, the Department shall provide
13coverage and reimbursement for all drugs that are approved for
14marketing by the federal Food and Drug Administration and that
15are recommended by the federal Public Health Service or the
16United States Centers for Disease Control and Prevention for
17pre-exposure prophylaxis and related pre-exposure prophylaxis
18services, including, but not limited to, HIV and sexually
19transmitted infection screening, treatment for sexually
20transmitted infections, medical monitoring, assorted labs, and
21counseling to reduce the likelihood of HIV infection among
22individuals who are not infected with HIV but who are at high
23risk of HIV infection.
24    A federally qualified health center, as defined in Section
251905(l)(2)(B) of the federal Social Security Act, shall be
26reimbursed by the Department in accordance with the federally

 

 

SB1586- 41 -LRB103 25489 AMQ 51838 b

1qualified health center's encounter rate for services provided
2to medical assistance recipients that are performed by a
3dental hygienist, as defined under the Illinois Dental
4Practice Act, working under the general supervision of a
5dentist and employed by a federally qualified health center.
6    Within 90 days after October 8, 2021 (the effective date
7of Public Act 102-665), the Department shall seek federal
8approval of a State Plan amendment to expand coverage for
9family planning services that includes presumptive eligibility
10to individuals whose income is at or below 208% of the federal
11poverty level. Coverage under this Section shall be effective
12beginning no later than December 1, 2022.
13    Subject to approval by the federal Centers for Medicare
14and Medicaid Services of a Title XIX State Plan amendment
15electing the Program of All-Inclusive Care for the Elderly
16(PACE) as a State Medicaid option, as provided for by Subtitle
17I (commencing with Section 4801) of Title IV of the Balanced
18Budget Act of 1997 (Public Law 105-33) and Part 460
19(commencing with Section 460.2) of Subchapter E of Title 42 of
20the Code of Federal Regulations, PACE program services shall
21become a covered benefit of the medical assistance program,
22subject to criteria established in accordance with all
23applicable laws.
24    Notwithstanding any other provision of this Code,
25community-based pediatric palliative care from a trained
26interdisciplinary team shall be covered under the medical

 

 

SB1586- 42 -LRB103 25489 AMQ 51838 b

1assistance program as provided in Section 15 of the Pediatric
2Palliative Care Act.
3    Notwithstanding any other provision of this Code, within
412 months after June 2, 2022 (the effective date of Public Act
5102-1037) this amendatory Act of the 102nd General Assembly
6and subject to federal approval, acupuncture services
7performed by an acupuncturist licensed under the Acupuncture
8Practice Act who is acting within the scope of his or her
9license shall be covered under the medical assistance program.
10The Department shall apply for any federal waiver or State
11Plan amendment, if required, to implement this paragraph. The
12Department may adopt any rules, including standards and
13criteria, necessary to implement this paragraph.
14    Notwithstanding any other provision of this Code, the
15Department shall provide coverage and reimbursement for
16prescription management services provided by prescribing
17psychologists for persons who are otherwise eligible for
18medical assistance under this Article.
19(Source: P.A. 101-209, eff. 8-5-19; 101-580, eff. 1-1-20;
20102-43, Article 30, Section 30-5, eff. 7-6-21; 102-43, Article
2135, Section 35-5, eff. 7-6-21; 102-43, Article 55, Section
2255-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123, eff. 1-1-22;
23102-558, eff. 8-20-21; 102-598, eff. 1-1-22; 102-655, eff.
241-1-22; 102-665, eff. 10-8-21; 102-813, eff. 5-13-22;
25102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22; 102-1038 eff.
261-1-23; revised 12-14-22.)
 

 

 

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1    Section 15. The Illinois Controlled Substances Act is
2amended by changing Section 303.05 as follows:
 
3    (720 ILCS 570/303.05)
4    Sec. 303.05. Mid-level practitioner registration.
5    (a) The Department of Financial and Professional
6Regulation shall register licensed physician assistants,
7licensed advanced practice registered nurses, and prescribing
8psychologists licensed under Section 4.2 of the Clinical
9Psychologist Licensing Act to prescribe and dispense
10controlled substances under Section 303 and euthanasia
11agencies to purchase, store, or administer animal euthanasia
12drugs under the following circumstances:
13        (1) with respect to physician assistants,
14            (A) the physician assistant has been delegated
15        written authority to prescribe any Schedule III
16        through V controlled substances by a physician
17        licensed to practice medicine in all its branches in
18        accordance with Section 7.5 of the Physician Assistant
19        Practice Act of 1987; and the physician assistant has
20        completed the appropriate application forms and has
21        paid the required fees as set by rule; or
22            (B) the physician assistant has been delegated
23        authority by a collaborating physician licensed to
24        practice medicine in all its branches to prescribe or

 

 

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1        dispense Schedule II controlled substances through a
2        written delegation of authority and under the
3        following conditions:
4                (i) Specific Schedule II controlled substances
5            by oral dosage or topical or transdermal
6            application may be delegated, provided that the
7            delegated Schedule II controlled substances are
8            routinely prescribed by the collaborating
9            physician. This delegation must identify the
10            specific Schedule II controlled substances by
11            either brand name or generic name. Schedule II
12            controlled substances to be delivered by injection
13            or other route of administration may not be
14            delegated;
15                (ii) any delegation must be of controlled
16            substances prescribed by the collaborating
17            physician;
18                (iii) all prescriptions must be limited to no
19            more than a 30-day supply, with any continuation
20            authorized only after prior approval of the
21            collaborating physician;
22                (iv) the physician assistant must discuss the
23            condition of any patients for whom a controlled
24            substance is prescribed monthly with the
25            delegating physician;
26                (v) the physician assistant must have

 

 

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1            completed the appropriate application forms and
2            paid the required fees as set by rule;
3                (vi) the physician assistant must provide
4            evidence of satisfactory completion of 45 contact
5            hours in pharmacology from any physician assistant
6            program accredited by the Accreditation Review
7            Commission on Education for the Physician
8            Assistant (ARC-PA), or its predecessor agency, for
9            any new license issued with Schedule II authority
10            after the effective date of this amendatory Act of
11            the 97th General Assembly; and
12                (vii) the physician assistant must annually
13            complete at least 5 hours of continuing education
14            in pharmacology;
15        (2) with respect to advanced practice registered
16    nurses who do not meet the requirements of Section 65-43
17    of the Nurse Practice Act,
18            (A) the advanced practice registered nurse has
19        been delegated authority to prescribe any Schedule III
20        through V controlled substances by a collaborating
21        physician licensed to practice medicine in all its
22        branches or a collaborating podiatric physician in
23        accordance with Section 65-40 of the Nurse Practice
24        Act. The advanced practice registered nurse has
25        completed the appropriate application forms and has
26        paid the required fees as set by rule; or

 

 

SB1586- 46 -LRB103 25489 AMQ 51838 b

1            (B) the advanced practice registered nurse has
2        been delegated authority by a collaborating physician
3        licensed to practice medicine in all its branches to
4        prescribe or dispense Schedule II controlled
5        substances through a written delegation of authority
6        and under the following conditions:
7                (i) specific Schedule II controlled substances
8            by oral dosage or topical or transdermal
9            application may be delegated, provided that the
10            delegated Schedule II controlled substances are
11            routinely prescribed by the collaborating
12            physician. This delegation must identify the
13            specific Schedule II controlled substances by
14            either brand name or generic name. Schedule II
15            controlled substances to be delivered by injection
16            or other route of administration may not be
17            delegated;
18                (ii) any delegation must be of controlled
19            substances prescribed by the collaborating
20            physician;
21                (iii) all prescriptions must be limited to no
22            more than a 30-day supply, with any continuation
23            authorized only after prior approval of the
24            collaborating physician;
25                (iv) the advanced practice registered nurse
26            must discuss the condition of any patients for

 

 

SB1586- 47 -LRB103 25489 AMQ 51838 b

1            whom a controlled substance is prescribed monthly
2            with the delegating physician or in the course of
3            review as required by Section 65-40 of the Nurse
4            Practice Act;
5                (v) the advanced practice registered nurse
6            must have completed the appropriate application
7            forms and paid the required fees as set by rule;
8                (vi) the advanced practice registered nurse
9            must provide evidence of satisfactory completion
10            of at least 45 graduate contact hours in
11            pharmacology for any new license issued with
12            Schedule II authority after the effective date of
13            this amendatory Act of the 97th General Assembly;
14            and
15                (vii) the advanced practice registered nurse
16            must annually complete 5 hours of continuing
17            education in pharmacology;
18        (2.5) with respect to advanced practice registered
19    nurses certified as nurse practitioners, nurse midwives,
20    or clinical nurse specialists who do not meet the
21    requirements of Section 65-43 of the Nurse Practice Act
22    practicing in a hospital affiliate,
23            (A) the advanced practice registered nurse
24        certified as a nurse practitioner, nurse midwife, or
25        clinical nurse specialist has been privileged to
26        prescribe any Schedule II through V controlled

 

 

SB1586- 48 -LRB103 25489 AMQ 51838 b

1        substances by the hospital affiliate upon the
2        recommendation of the appropriate physician committee
3        of the hospital affiliate in accordance with Section
4        65-45 of the Nurse Practice Act, has completed the
5        appropriate application forms, and has paid the
6        required fees as set by rule; and
7            (B) an advanced practice registered nurse
8        certified as a nurse practitioner, nurse midwife, or
9        clinical nurse specialist has been privileged to
10        prescribe any Schedule II controlled substances by the
11        hospital affiliate upon the recommendation of the
12        appropriate physician committee of the hospital
13        affiliate, then the following conditions must be met:
14                (i) specific Schedule II controlled substances
15            by oral dosage or topical or transdermal
16            application may be designated, provided that the
17            designated Schedule II controlled substances are
18            routinely prescribed by advanced practice
19            registered nurses in their area of certification;
20            the privileging documents must identify the
21            specific Schedule II controlled substances by
22            either brand name or generic name; privileges to
23            prescribe or dispense Schedule II controlled
24            substances to be delivered by injection or other
25            route of administration may not be granted;
26                (ii) any privileges must be controlled

 

 

SB1586- 49 -LRB103 25489 AMQ 51838 b

1            substances limited to the practice of the advanced
2            practice registered nurse;
3                (iii) any prescription must be limited to no
4            more than a 30-day supply;
5                (iv) the advanced practice registered nurse
6            must discuss the condition of any patients for
7            whom a controlled substance is prescribed monthly
8            with the appropriate physician committee of the
9            hospital affiliate or its physician designee; and
10                (v) the advanced practice registered nurse
11            must meet the education requirements of this
12            Section;
13        (3) with respect to animal euthanasia agencies, the
14    euthanasia agency has obtained a license from the
15    Department of Financial and Professional Regulation and
16    obtained a registration number from the Department; or
17        (4) with respect to prescribing psychologists, the
18    prescribing psychologist has been delegated authority to
19    prescribe any nonnarcotic, nonopioid Schedule II III
20    through V controlled substances by a collaborating
21    physician licensed to practice medicine in all its
22    branches in accordance with Section 4.3 of the Clinical
23    Psychologist Licensing Act, and the prescribing
24    psychologist has completed the appropriate application
25    forms and has paid the required fees as set by rule.
26    (b) The mid-level practitioner shall only be licensed to

 

 

SB1586- 50 -LRB103 25489 AMQ 51838 b

1prescribe those schedules of controlled substances for which a
2licensed physician has delegated prescriptive authority,
3except that an animal euthanasia agency does not have any
4prescriptive authority. A physician assistant and an advanced
5practice registered nurse are prohibited from prescribing
6medications and controlled substances not set forth in the
7required written delegation of authority or as authorized by
8their practice Act.
9    (c) Upon completion of all registration requirements,
10physician assistants, advanced practice registered nurses, and
11animal euthanasia agencies may be issued a mid-level
12practitioner controlled substances license for Illinois.
13    (d) A collaborating physician may, but is not required to,
14delegate prescriptive authority to an advanced practice
15registered nurse as part of a written collaborative agreement,
16and the delegation of prescriptive authority shall conform to
17the requirements of Section 65-40 of the Nurse Practice Act.
18    (e) A collaborating physician may, but is not required to,
19delegate prescriptive authority to a physician assistant as
20part of a written collaborative agreement, and the delegation
21of prescriptive authority shall conform to the requirements of
22Section 7.5 of the Physician Assistant Practice Act of 1987.
23    (f) Nothing in this Section shall be construed to prohibit
24generic substitution.
25(Source: P.A. 99-173, eff. 7-29-15; 100-453, eff. 8-25-17;
26100-513, eff. 1-1-18; 100-863, eff. 8-14-18.)
 

 

 

SB1586- 51 -LRB103 25489 AMQ 51838 b

1    Section 99. Effective date. This Act takes effect upon
2becoming law.