Full Text of SB2348 95th General Assembly
SB2348ham004 95TH GENERAL ASSEMBLY
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Rep. Elizabeth Hernandez
Filed: 5/30/2008
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| AMENDMENT TO SENATE BILL 2348
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| AMENDMENT NO. ______. Amend Senate Bill 2348 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing Sections 5-2 and 5-5 as follows:
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| (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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| Sec. 5-2. Classes of Persons Eligible. Medical assistance | 8 |
| under this
Article shall be available to any of the following | 9 |
| classes of persons in
respect to whom a plan for coverage has | 10 |
| been submitted to the Governor
by the Illinois Department and | 11 |
| approved by him:
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| 1. Recipients of basic maintenance grants under | 13 |
| Articles III and IV.
| 14 |
| 2. Persons otherwise eligible for basic maintenance | 15 |
| under Articles
III and IV but who fail to qualify |
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| thereunder on the basis of need, and
who have insufficient | 2 |
| income and resources to meet the costs of
necessary medical | 3 |
| care, including but not limited to the following:
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| (a) All persons otherwise eligible for basic | 5 |
| maintenance under Article
III but who fail to qualify | 6 |
| under that Article on the basis of need and who
meet | 7 |
| either of the following requirements:
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| (i) their income, as determined by the | 9 |
| Illinois Department in
accordance with any federal | 10 |
| requirements, is equal to or less than 70% in
| 11 |
| fiscal year 2001, equal to or less than 85% in | 12 |
| fiscal year 2002 and until
a date to be determined | 13 |
| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the | 15 |
| Department by rule, of the nonfarm income official | 16 |
| poverty
line, as defined by the federal Office of | 17 |
| Management and Budget and revised
annually in | 18 |
| accordance with Section 673(2) of the Omnibus | 19 |
| Budget Reconciliation
Act of 1981, applicable to | 20 |
| families of the same size; or
| 21 |
| (ii) their income, after the deduction of | 22 |
| costs incurred for medical
care and for other types | 23 |
| of remedial care, is equal to or less than 70% in
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| fiscal year 2001, equal to or less than 85% in | 25 |
| fiscal year 2002 and until
a date to be determined | 26 |
| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the | 2 |
| Department by rule, of the nonfarm income official | 3 |
| poverty
line, as defined in item (i) of this | 4 |
| subparagraph (a).
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| (b) All persons who would be determined eligible | 6 |
| for such basic
maintenance under Article IV by | 7 |
| disregarding the maximum earned income
permitted by | 8 |
| federal law.
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| 3. Persons who would otherwise qualify for Aid to the | 10 |
| Medically
Indigent under Article VII.
| 11 |
| 4. Persons not eligible under any of the preceding | 12 |
| paragraphs who fall
sick, are injured, or die, not having | 13 |
| sufficient money, property or other
resources to meet the | 14 |
| costs of necessary medical care or funeral and burial
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| expenses.
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| 5.(a) Women during pregnancy, after the fact
of | 17 |
| pregnancy has been determined by medical diagnosis, and | 18 |
| during the
60-day period beginning on the last day of the | 19 |
| pregnancy, together with
their infants and children born | 20 |
| after September 30, 1983,
whose income and
resources are | 21 |
| insufficient to meet the costs of necessary medical care to
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| the maximum extent possible under Title XIX of the
Federal | 23 |
| Social Security Act.
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| (b) The Illinois Department and the Governor shall | 25 |
| provide a plan for
coverage of the persons eligible under | 26 |
| paragraph 5(a) by April 1, 1990. Such
plan shall provide |
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| ambulatory prenatal care to pregnant women during a
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| presumptive eligibility period and establish an income | 3 |
| eligibility standard
that is equal to 133%
of the nonfarm | 4 |
| income official poverty line, as defined by
the federal | 5 |
| Office of Management and Budget and revised annually in
| 6 |
| accordance with Section 673(2) of the Omnibus Budget | 7 |
| Reconciliation Act of
1981, applicable to families of the | 8 |
| same size, provided that costs incurred
for medical care | 9 |
| are not taken into account in determining such income
| 10 |
| eligibility.
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| (c) The Illinois Department may conduct a | 12 |
| demonstration in at least one
county that will provide | 13 |
| medical assistance to pregnant women, together
with their | 14 |
| infants and children up to one year of age,
where the | 15 |
| income
eligibility standard is set up to 185% of the | 16 |
| nonfarm income official
poverty line, as defined by the | 17 |
| federal Office of Management and Budget.
The Illinois | 18 |
| Department shall seek and obtain necessary authorization
| 19 |
| provided under federal law to implement such a | 20 |
| demonstration. Such
demonstration may establish resource | 21 |
| standards that are not more
restrictive than those | 22 |
| established under Article IV of this Code.
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| 6. Persons under the age of 18 who fail to qualify as | 24 |
| dependent under
Article IV and who have insufficient income | 25 |
| and resources to meet the costs
of necessary medical care | 26 |
| to the maximum extent permitted under Title XIX
of the |
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| Federal Social Security Act.
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| 7. Persons who are under 21 years of age and would
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| qualify as
disabled as defined under the Federal | 4 |
| Supplemental Security Income Program,
provided medical | 5 |
| service for such persons would be eligible for Federal
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| Financial Participation, and provided the Illinois | 7 |
| Department determines that:
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| (a) the person requires a level of care provided by | 9 |
| a hospital, skilled
nursing facility, or intermediate | 10 |
| care facility, as determined by a physician
licensed to | 11 |
| practice medicine in all its branches;
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| (b) it is appropriate to provide such care outside | 13 |
| of an institution, as
determined by a physician | 14 |
| licensed to practice medicine in all its branches;
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| (c) the estimated amount which would be expended | 16 |
| for care outside the
institution is not greater than | 17 |
| the estimated amount which would be
expended in an | 18 |
| institution.
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| 8. Persons who become ineligible for basic maintenance | 20 |
| assistance
under Article IV of this Code in programs | 21 |
| administered by the Illinois
Department due to employment | 22 |
| earnings and persons in
assistance units comprised of | 23 |
| adults and children who become ineligible for
basic | 24 |
| maintenance assistance under Article VI of this Code due to
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| employment earnings. The plan for coverage for this class | 26 |
| of persons shall:
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| (a) extend the medical assistance coverage for up | 2 |
| to 12 months following
termination of basic | 3 |
| maintenance assistance; and
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| (b) offer persons who have initially received 6 | 5 |
| months of the
coverage provided in paragraph (a) above, | 6 |
| the option of receiving an
additional 6 months of | 7 |
| coverage, subject to the following:
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| (i) such coverage shall be pursuant to | 9 |
| provisions of the federal
Social Security Act;
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| (ii) such coverage shall include all services | 11 |
| covered while the person
was eligible for basic | 12 |
| maintenance assistance;
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| (iii) no premium shall be charged for such | 14 |
| coverage; and
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| (iv) such coverage shall be suspended in the | 16 |
| event of a person's
failure without good cause to | 17 |
| file in a timely fashion reports required for
this | 18 |
| coverage under the Social Security Act and | 19 |
| coverage shall be reinstated
upon the filing of | 20 |
| such reports if the person remains otherwise | 21 |
| eligible.
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| 9. Persons with acquired immunodeficiency syndrome | 23 |
| (AIDS) or with
AIDS-related conditions with respect to whom | 24 |
| there has been a determination
that but for home or | 25 |
| community-based services such individuals would
require | 26 |
| the level of care provided in an inpatient hospital, |
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| skilled
nursing facility or intermediate care facility the | 2 |
| cost of which is
reimbursed under this Article. Assistance | 3 |
| shall be provided to such
persons to the maximum extent | 4 |
| permitted under Title
XIX of the Federal Social Security | 5 |
| Act.
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| 10. Participants in the long-term care insurance | 7 |
| partnership program
established under the Illinois | 8 |
| Long-Term Care Partnership Program Act
Partnership for | 9 |
| Long-Term Care Act who meet the
qualifications for | 10 |
| protection of resources described in Section 15
25 of that
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| Act.
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| 11. Persons with disabilities who are employed and | 13 |
| eligible for Medicaid,
pursuant to Section | 14 |
| 1902(a)(10)(A)(ii)(xv) of the Social Security Act, as
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| provided by the Illinois Department by rule. In | 16 |
| establishing eligibility standards under this paragraph | 17 |
| 11, the Department shall, subject to federal approval: | 18 |
| (a) set the income eligibility standard at not | 19 |
| lower than 350% of the federal poverty level; | 20 |
| (b) exempt retirement accounts that the person | 21 |
| cannot access without penalty before the age
of 59 1/2, | 22 |
| and medical savings accounts established pursuant to | 23 |
| 26 U.S.C. 220; | 24 |
| (c) allow non-exempt assets up to $25,000 as to | 25 |
| those assets accumulated during periods of eligibility | 26 |
| under this paragraph 11; and
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| (d) continue to apply subparagraphs (b) and (c) in | 2 |
| determining the eligibility of the person under this | 3 |
| Article even if the person loses eligibility under this | 4 |
| paragraph 11.
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| 12. Subject to federal approval, persons who are | 6 |
| eligible for medical
assistance coverage under applicable | 7 |
| provisions of the federal Social Security
Act and the | 8 |
| federal Breast and Cervical Cancer Prevention and | 9 |
| Treatment Act of
2000. Those eligible persons are defined | 10 |
| to include, but not be limited to,
the following persons:
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| (1) persons who have been screened for breast or | 12 |
| cervical cancer under
the U.S. Centers for Disease | 13 |
| Control and Prevention Breast and Cervical Cancer
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| Program established under Title XV of the federal | 15 |
| Public Health Services Act in
accordance with the | 16 |
| requirements of Section 1504 of that Act as | 17 |
| administered by
the Illinois Department of Public | 18 |
| Health; and
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| (2) persons whose screenings under the above | 20 |
| program were funded in whole
or in part by funds | 21 |
| appropriated to the Illinois Department of Public | 22 |
| Health
for breast or cervical cancer screening.
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| "Medical assistance" under this paragraph 12 shall be | 24 |
| identical to the benefits
provided under the State's | 25 |
| approved plan under Title XIX of the Social Security
Act. | 26 |
| The Department must request federal approval of the |
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| coverage under this
paragraph 12 within 30 days after the | 2 |
| effective date of this amendatory Act of
the 92nd General | 3 |
| Assembly.
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| 13. Subject to appropriation and to federal approval, | 5 |
| persons living with HIV/AIDS who are not otherwise eligible | 6 |
| under this Article and who qualify for services covered | 7 |
| under Section 5-5.04 as provided by the Illinois Department | 8 |
| by rule.
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| 14. Subject to the availability of funds for this | 10 |
| purpose, the Department may provide coverage under this | 11 |
| Article to persons who reside in Illinois who are not | 12 |
| eligible under any of the preceding paragraphs and who meet | 13 |
| the income guidelines of paragraph 2(a) of this Section and | 14 |
| (i) have an application for asylum pending before the | 15 |
| federal Department of Homeland Security or on appeal before | 16 |
| a court of competent jurisdiction and are represented | 17 |
| either by counsel or by an advocate accredited by the | 18 |
| federal Department of Homeland Security and employed by a | 19 |
| not-for-profit organization in regard to that application | 20 |
| or appeal, or (ii) are receiving services through a | 21 |
| federally funded torture treatment center. Medical | 22 |
| coverage under this paragraph 14 may be provided for up to | 23 |
| 24 continuous months from the initial eligibility date so | 24 |
| long as an individual continues to satisfy the criteria of | 25 |
| this paragraph 14. If an individual has an appeal pending | 26 |
| regarding an application for asylum before the Department |
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| of Homeland Security, eligibility under this paragraph 14 | 2 |
| may be extended until a final decision is rendered on the | 3 |
| appeal. The Department may adopt rules governing the | 4 |
| implementation of this paragraph 14.
| 5 |
| 15. Subject to federal approval, persons with | 6 |
| medically improved disability who are employed or eligible | 7 |
| for Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) | 8 |
| of the Social Security Act that meet applicable eligibility | 9 |
| standards established in paragraph 11. The Department may | 10 |
| not otherwise adopt any rule to implement this paragraph. | 11 |
| The Illinois Department and the Governor shall provide a | 12 |
| plan for
coverage of the persons eligible under paragraph 7 as | 13 |
| soon as possible after
July 1, 1984.
| 14 |
| The eligibility of any such person for medical assistance | 15 |
| under this
Article is not affected by the payment of any grant | 16 |
| under the Senior
Citizens and Disabled Persons Property Tax | 17 |
| Relief and Pharmaceutical
Assistance Act or any distributions | 18 |
| or items of income described under
subparagraph (X) of
| 19 |
| paragraph (2) of subsection (a) of Section 203 of the Illinois | 20 |
| Income Tax
Act. The Department shall by rule establish the | 21 |
| amounts of
assets to be disregarded in determining eligibility | 22 |
| for medical assistance,
which shall at a minimum equal the | 23 |
| amounts to be disregarded under the
Federal Supplemental | 24 |
| Security Income Program. The amount of assets of a
single | 25 |
| person to be disregarded
shall not be less than $2,000, and the | 26 |
| amount of assets of a married couple
to be disregarded shall |
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| not be less than $3,000.
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| To the extent permitted under federal law, any person found | 3 |
| guilty of a
second violation of Article VIIIA
shall be | 4 |
| ineligible for medical assistance under this Article, as | 5 |
| provided
in Section 8A-8.
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| The eligibility of any person for medical assistance under | 7 |
| this Article
shall not be affected by the receipt by the person | 8 |
| of donations or benefits
from fundraisers held for the person | 9 |
| in cases of serious illness,
as long as neither the person nor | 10 |
| members of the person's family
have actual control over the | 11 |
| donations or benefits or the disbursement
of the donations or | 12 |
| benefits.
| 13 |
| (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06; | 14 |
| 95-546, eff. 8-29-07; revised 1-22-08.)
| 15 |
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
| 16 |
| Sec. 5-5. Medical services. The Illinois Department, by | 17 |
| rule, shall
determine the quantity and quality of and the rate | 18 |
| of reimbursement for the
medical assistance for which
payment | 19 |
| will be authorized, and the medical services to be provided,
| 20 |
| which may include all or part of the following: (1) inpatient | 21 |
| hospital
services; (2) outpatient hospital services; (3) other | 22 |
| laboratory and
X-ray services; (4) skilled nursing home | 23 |
| services; (5) physicians'
services whether furnished in the | 24 |
| office, the patient's home, a
hospital, a skilled nursing home, | 25 |
| or elsewhere; (6) medical care, or any
other type of remedial |
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| care furnished by licensed practitioners; (7)
home health care | 2 |
| services; (8) private duty nursing service; (9) clinic
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| services; (10) dental services, including prevention and | 4 |
| treatment of periodontal disease and dental caries disease for | 5 |
| pregnant women; (11) physical therapy and related
services; | 6 |
| (12) prescribed drugs, dentures, and prosthetic devices; and
| 7 |
| eyeglasses prescribed by a physician skilled in the diseases of | 8 |
| the eye,
or by an optometrist, whichever the person may select; | 9 |
| (13) other
diagnostic, screening, preventive, and | 10 |
| rehabilitative services; (14)
transportation and such other | 11 |
| expenses as may be necessary; (15) medical
treatment of sexual | 12 |
| assault survivors, as defined in
Section 1a of the Sexual | 13 |
| Assault Survivors Emergency Treatment Act, for
injuries | 14 |
| sustained as a result of the sexual assault, including
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| examinations and laboratory tests to discover evidence which | 16 |
| may be used in
criminal proceedings arising from the sexual | 17 |
| assault; (16) the
diagnosis and treatment of sickle cell | 18 |
| anemia; and (17)
any other medical care, and any other type of | 19 |
| remedial care recognized
under the laws of this State, but not | 20 |
| including abortions, or induced
miscarriages or premature | 21 |
| births, unless, in the opinion of a physician,
such procedures | 22 |
| are necessary for the preservation of the life of the
woman | 23 |
| seeking such treatment, or except an induced premature birth
| 24 |
| intended to produce a live viable child and such procedure is | 25 |
| necessary
for the health of the mother or her unborn child. The | 26 |
| Illinois Department,
by rule, shall prohibit any physician from |
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| providing medical assistance
to anyone eligible therefor under | 2 |
| this Code where such physician has been
found guilty of | 3 |
| performing an abortion procedure in a wilful and wanton
manner | 4 |
| upon a woman who was not pregnant at the time such abortion
| 5 |
| procedure was performed. The term "any other type of remedial | 6 |
| care" shall
include nursing care and nursing home service for | 7 |
| persons who rely on
treatment by spiritual means alone through | 8 |
| prayer for healing.
| 9 |
| Notwithstanding any other provision of this Section, a | 10 |
| comprehensive
tobacco use cessation program that includes | 11 |
| purchasing prescription drugs or
prescription medical devices | 12 |
| approved by the Food and Drug administration shall
be covered | 13 |
| under the medical assistance
program under this Article for | 14 |
| persons who are otherwise eligible for
assistance under this | 15 |
| Article.
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| Notwithstanding any other provision of this Code, the | 17 |
| Illinois
Department may not require, as a condition of payment | 18 |
| for any laboratory
test authorized under this Article, that a | 19 |
| physician's handwritten signature
appear on the laboratory | 20 |
| test order form. The Illinois Department may,
however, impose | 21 |
| other appropriate requirements regarding laboratory test
order | 22 |
| documentation.
| 23 |
| The Department of Healthcare and Family Services shall | 24 |
| provide the following services to
persons
eligible for | 25 |
| assistance under this Article who are participating in
| 26 |
| education, training or employment programs operated by the |
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| Department of Human
Services as successor to the Department of | 2 |
| Public Aid:
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| (1) dental services, which shall include but not be | 4 |
| limited to
prosthodontics; and
| 5 |
| (2) eyeglasses prescribed by a physician skilled in the | 6 |
| diseases of the
eye, or by an optometrist, whichever the | 7 |
| person may select.
| 8 |
| The Illinois Department, by rule, may distinguish and | 9 |
| classify the
medical services to be provided only in accordance | 10 |
| with the classes of
persons designated in Section 5-2.
| 11 |
| The Department of Healthcare and Family Services must | 12 |
| provide coverage and reimbursement for amino acid-based | 13 |
| elemental formulas, regardless of delivery method, for the | 14 |
| diagnosis and treatment of (i) eosinophilic disorders and (ii) | 15 |
| short bowel syndrome when the prescribing physician has issued | 16 |
| a written order stating that the amino acid-based elemental | 17 |
| formula is medically necessary.
| 18 |
| The Illinois Department shall authorize the provision of, | 19 |
| and shall
authorize payment for, screening by low-dose | 20 |
| mammography for the presence of
occult breast cancer for women | 21 |
| 35 years of age or older who are eligible
for medical | 22 |
| assistance under this Article, as follows: a baseline
mammogram | 23 |
| for women 35 to 39 years of age and an
annual mammogram for | 24 |
| women 40 years of age or older. All screenings
shall
include a | 25 |
| physical breast exam, instruction on self-examination and
| 26 |
| information regarding the frequency of self-examination and |
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| its value as a
preventative tool. As used in this Section, | 2 |
| "low-dose mammography" means
the x-ray examination of the | 3 |
| breast using equipment dedicated specifically
for mammography, | 4 |
| including the x-ray tube, filter, compression device,
image | 5 |
| receptor, and cassettes, with an average radiation exposure | 6 |
| delivery
of less than one rad mid-breast, with 2 views for each | 7 |
| breast.
| 8 |
| Any medical or health care provider shall immediately | 9 |
| recommend, to
any pregnant woman who is being provided prenatal | 10 |
| services and is suspected
of drug abuse or is addicted as | 11 |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | 12 |
| Act, referral to a local substance abuse treatment provider
| 13 |
| licensed by the Department of Human Services or to a licensed
| 14 |
| hospital which provides substance abuse treatment services. | 15 |
| The Department of Healthcare and Family Services
shall assure | 16 |
| coverage for the cost of treatment of the drug abuse or
| 17 |
| addiction for pregnant recipients in accordance with the | 18 |
| Illinois Medicaid
Program in conjunction with the Department of | 19 |
| Human Services.
| 20 |
| All medical providers providing medical assistance to | 21 |
| pregnant women
under this Code shall receive information from | 22 |
| the Department on the
availability of services under the Drug | 23 |
| Free Families with a Future or any
comparable program providing | 24 |
| case management services for addicted women,
including | 25 |
| information on appropriate referrals for other social services
| 26 |
| that may be needed by addicted women in addition to treatment |
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| for addiction.
| 2 |
| The Illinois Department, in cooperation with the | 3 |
| Departments of Human
Services (as successor to the Department | 4 |
| of Alcoholism and Substance
Abuse) and Public Health, through a | 5 |
| public awareness campaign, may
provide information concerning | 6 |
| treatment for alcoholism and drug abuse and
addiction, prenatal | 7 |
| health care, and other pertinent programs directed at
reducing | 8 |
| the number of drug-affected infants born to recipients of | 9 |
| medical
assistance.
| 10 |
| Neither the Department of Healthcare and Family Services | 11 |
| nor the Department of Human
Services shall sanction the | 12 |
| recipient solely on the basis of
her substance abuse.
| 13 |
| The Illinois Department shall establish such regulations | 14 |
| governing
the dispensing of health services under this Article | 15 |
| as it shall deem
appropriate. The Department
should
seek the | 16 |
| advice of formal professional advisory committees appointed by
| 17 |
| the Director of the Illinois Department for the purpose of | 18 |
| providing regular
advice on policy and administrative matters, | 19 |
| information dissemination and
educational activities for | 20 |
| medical and health care providers, and
consistency in | 21 |
| procedures to the Illinois Department.
| 22 |
| Notwithstanding any other provision of law, a medical or | 23 |
| health care provider under the medical assistance program may | 24 |
| elect, in lieu of receiving direct payment for goods or | 25 |
| services provided under that program, to participate in the | 26 |
| Illinois State Employees Deferred Compensation Plan adopted |
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| under Article 24 of the Illinois Pension Code. A medical or | 2 |
| health care provider who elects to participate in that Plan | 3 |
| shall, for purposes of that participation, be deemed an | 4 |
| "employee" as defined in Section 24-102 of the Illinois Pension | 5 |
| Code. A medical or health care provider who elects to | 6 |
| participate in the Plan does not have a cause of action against | 7 |
| the State for any damages allegedly suffered by the provider as | 8 |
| a result of any delay by the State in crediting the amount of | 9 |
| any contribution to the provider's Plan account. | 10 |
| The Illinois Department may develop and contract with | 11 |
| Partnerships of
medical providers to arrange medical services | 12 |
| for persons eligible under
Section 5-2 of this Code. | 13 |
| Implementation of this Section may be by
demonstration projects | 14 |
| in certain geographic areas. The Partnership shall
be | 15 |
| represented by a sponsor organization. The Department, by rule, | 16 |
| shall
develop qualifications for sponsors of Partnerships. | 17 |
| Nothing in this
Section shall be construed to require that the | 18 |
| sponsor organization be a
medical organization.
| 19 |
| The sponsor must negotiate formal written contracts with | 20 |
| medical
providers for physician services, inpatient and | 21 |
| outpatient hospital care,
home health services, treatment for | 22 |
| alcoholism and substance abuse, and
other services determined | 23 |
| necessary by the Illinois Department by rule for
delivery by | 24 |
| Partnerships. Physician services must include prenatal and
| 25 |
| obstetrical care. The Illinois Department shall reimburse | 26 |
| medical services
delivered by Partnership providers to clients |
|
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|
| 1 |
| in target areas according to
provisions of this Article and the | 2 |
| Illinois Health Finance Reform Act,
except that:
| 3 |
| (1) Physicians participating in a Partnership and | 4 |
| providing certain
services, which shall be determined by | 5 |
| the Illinois Department, to persons
in areas covered by the | 6 |
| Partnership may receive an additional surcharge
for such | 7 |
| services.
| 8 |
| (2) The Department may elect to consider and negotiate | 9 |
| financial
incentives to encourage the development of | 10 |
| Partnerships and the efficient
delivery of medical care.
| 11 |
| (3) Persons receiving medical services through | 12 |
| Partnerships may receive
medical and case management | 13 |
| services above the level usually offered
through the | 14 |
| medical assistance program.
| 15 |
| Medical providers shall be required to meet certain | 16 |
| qualifications to
participate in Partnerships to ensure the | 17 |
| delivery of high quality medical
services. These | 18 |
| qualifications shall be determined by rule of the Illinois
| 19 |
| Department and may be higher than qualifications for | 20 |
| participation in the
medical assistance program. Partnership | 21 |
| sponsors may prescribe reasonable
additional qualifications | 22 |
| for participation by medical providers, only with
the prior | 23 |
| written approval of the Illinois Department.
| 24 |
| Nothing in this Section shall limit the free choice of | 25 |
| practitioners,
hospitals, and other providers of medical | 26 |
| services by clients.
In order to ensure patient freedom of |
|
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LRB095 15983 DRJ 51766 a |
|
| 1 |
| choice, the Illinois Department shall
immediately promulgate | 2 |
| all rules and take all other necessary actions so that
provided | 3 |
| services may be accessed from therapeutically certified | 4 |
| optometrists
to the full extent of the Illinois Optometric | 5 |
| Practice Act of 1987 without
discriminating between service | 6 |
| providers.
| 7 |
| The Department shall apply for a waiver from the United | 8 |
| States Health
Care Financing Administration to allow for the | 9 |
| implementation of
Partnerships under this Section.
| 10 |
| The Illinois Department shall require health care | 11 |
| providers to maintain
records that document the medical care | 12 |
| and services provided to recipients
of Medical Assistance under | 13 |
| this Article. The Illinois Department shall
require health care | 14 |
| providers to make available, when authorized by the
patient, in | 15 |
| writing, the medical records in a timely fashion to other
| 16 |
| health care providers who are treating or serving persons | 17 |
| eligible for
Medical Assistance under this Article. All | 18 |
| dispensers of medical services
shall be required to maintain | 19 |
| and retain business and professional records
sufficient to | 20 |
| fully and accurately document the nature, scope, details and
| 21 |
| receipt of the health care provided to persons eligible for | 22 |
| medical
assistance under this Code, in accordance with | 23 |
| regulations promulgated by
the Illinois Department. The rules | 24 |
| and regulations shall require that proof
of the receipt of | 25 |
| prescription drugs, dentures, prosthetic devices and
| 26 |
| eyeglasses by eligible persons under this Section accompany |
|
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LRB095 15983 DRJ 51766 a |
|
| 1 |
| each claim
for reimbursement submitted by the dispenser of such | 2 |
| medical services.
No such claims for reimbursement shall be | 3 |
| approved for payment by the Illinois
Department without such | 4 |
| proof of receipt, unless the Illinois Department
shall have put | 5 |
| into effect and shall be operating a system of post-payment
| 6 |
| audit and review which shall, on a sampling basis, be deemed | 7 |
| adequate by
the Illinois Department to assure that such drugs, | 8 |
| dentures, prosthetic
devices and eyeglasses for which payment | 9 |
| is being made are actually being
received by eligible | 10 |
| recipients. Within 90 days after the effective date of
this | 11 |
| amendatory Act of 1984, the Illinois Department shall establish | 12 |
| a
current list of acquisition costs for all prosthetic devices | 13 |
| and any
other items recognized as medical equipment and | 14 |
| supplies reimbursable under
this Article and shall update such | 15 |
| list on a quarterly basis, except that
the acquisition costs of | 16 |
| all prescription drugs shall be updated no
less frequently than | 17 |
| every 30 days as required by Section 5-5.12.
| 18 |
| The rules and regulations of the Illinois Department shall | 19 |
| require
that a written statement including the required opinion | 20 |
| of a physician
shall accompany any claim for reimbursement for | 21 |
| abortions, or induced
miscarriages or premature births. This | 22 |
| statement shall indicate what
procedures were used in providing | 23 |
| such medical services.
| 24 |
| The Illinois Department shall require all dispensers of | 25 |
| medical
services, other than an individual practitioner or | 26 |
| group of practitioners,
desiring to participate in the Medical |
|
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LRB095 15983 DRJ 51766 a |
|
| 1 |
| Assistance program
established under this Article to disclose | 2 |
| all financial, beneficial,
ownership, equity, surety or other | 3 |
| interests in any and all firms,
corporations, partnerships, | 4 |
| associations, business enterprises, joint
ventures, agencies, | 5 |
| institutions or other legal entities providing any
form of | 6 |
| health care services in this State under this Article.
| 7 |
| The Illinois Department may require that all dispensers of | 8 |
| medical
services desiring to participate in the medical | 9 |
| assistance program
established under this Article disclose, | 10 |
| under such terms and conditions as
the Illinois Department may | 11 |
| by rule establish, all inquiries from clients
and attorneys | 12 |
| regarding medical bills paid by the Illinois Department, which
| 13 |
| inquiries could indicate potential existence of claims or liens | 14 |
| for the
Illinois Department.
| 15 |
| Enrollment of a vendor that provides non-emergency medical | 16 |
| transportation,
defined by the Department by rule,
shall be
| 17 |
| conditional for 180 days. During that time, the Department of | 18 |
| Healthcare and Family Services may
terminate the vendor's | 19 |
| eligibility to participate in the medical assistance
program | 20 |
| without cause. That termination of eligibility is not subject | 21 |
| to the
Department's hearing process.
| 22 |
| The Illinois Department shall establish policies, | 23 |
| procedures,
standards and criteria by rule for the acquisition, | 24 |
| repair and replacement
of orthotic and prosthetic devices and | 25 |
| durable medical equipment. Such
rules shall provide, but not be | 26 |
| limited to, the following services: (1)
immediate repair or |
|
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LRB095 15983 DRJ 51766 a |
|
| 1 |
| replacement of such devices by recipients without
medical | 2 |
| authorization; and (2) rental, lease, purchase or | 3 |
| lease-purchase of
durable medical equipment in a | 4 |
| cost-effective manner, taking into
consideration the | 5 |
| recipient's medical prognosis, the extent of the
recipient's | 6 |
| needs, and the requirements and costs for maintaining such
| 7 |
| equipment. Such rules shall enable a recipient to temporarily | 8 |
| acquire and
use alternative or substitute devices or equipment | 9 |
| pending repairs or
replacements of any device or equipment | 10 |
| previously authorized for such
recipient by the Department.
| 11 |
| The Department shall execute, relative to the nursing home | 12 |
| prescreening
project, written inter-agency agreements with the | 13 |
| Department of Human
Services and the Department on Aging, to | 14 |
| effect the following: (i) intake
procedures and common | 15 |
| eligibility criteria for those persons who are receiving
| 16 |
| non-institutional services; and (ii) the establishment and | 17 |
| development of
non-institutional services in areas of the State | 18 |
| where they are not currently
available or are undeveloped.
| 19 |
| The Illinois Department shall develop and operate, in | 20 |
| cooperation
with other State Departments and agencies and in | 21 |
| compliance with
applicable federal laws and regulations, | 22 |
| appropriate and effective
systems of health care evaluation and | 23 |
| programs for monitoring of
utilization of health care services | 24 |
| and facilities, as it affects
persons eligible for medical | 25 |
| assistance under this Code.
| 26 |
| The Illinois Department shall report annually to the |
|
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LRB095 15983 DRJ 51766 a |
|
| 1 |
| General Assembly,
no later than the second Friday in April of | 2 |
| 1979 and each year
thereafter, in regard to:
| 3 |
| (a) actual statistics and trends in utilization of | 4 |
| medical services by
public aid recipients;
| 5 |
| (b) actual statistics and trends in the provision of | 6 |
| the various medical
services by medical vendors;
| 7 |
| (c) current rate structures and proposed changes in | 8 |
| those rate structures
for the various medical vendors; and
| 9 |
| (d) efforts at utilization review and control by the | 10 |
| Illinois Department.
| 11 |
| The period covered by each report shall be the 3 years | 12 |
| ending on the June
30 prior to the report. The report shall | 13 |
| include suggested legislation
for consideration by the General | 14 |
| Assembly. The filing of one copy of the
report with the | 15 |
| Speaker, one copy with the Minority Leader and one copy
with | 16 |
| the Clerk of the House of Representatives, one copy with the | 17 |
| President,
one copy with the Minority Leader and one copy with | 18 |
| the Secretary of the
Senate, one copy with the Legislative | 19 |
| Research Unit, and such additional
copies
with the State | 20 |
| Government Report Distribution Center for the General
Assembly | 21 |
| as is required under paragraph (t) of Section 7 of the State
| 22 |
| Library Act shall be deemed sufficient to comply with this | 23 |
| Section.
| 24 |
| (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07.)".
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