Illinois General Assembly - Full Text of HB0489
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Full Text of HB0489  96th General Assembly


Sen. Iris Y. Martinez

Filed: 5/12/2009





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2     AMENDMENT NO. ______. Amend House Bill 489 by replacing
3 everything after the enacting clause with the following:
4     "Section 5. The Illinois Pension Code is amended by
5 changing Section 24-102 and adding Section 24-104.2 as follows:
6     (40 ILCS 5/24-102)  (from Ch. 108 1/2, par. 24-102)
7     Sec. 24-102. As used in this Article, "employee" means any
8 person, including a person elected, appointed or under
9 contract, receiving compensation from the State or a unit of
10 local government or school district for personal services
11 rendered, including salaried persons. A health care provider
12 who elects to participate in the State Employees Deferred
13 Compensation Plan established under Section 24-104 of this Code
14 shall, for purposes of that participation, be deemed an
15 "employee" as defined in this Section.
16     As used in this Article, "health care provider" means a



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1 dentist, physician, optometrist, pharmacist, or podiatrist
2 that participates and receives compensation as a provider under
3 the Illinois Public Aid Code, the Children's Health Insurance
4 Act, or the Covering ALL KIDS Health Insurance Act.
5     As used in this Article, "compensation" includes
6 compensation received in a lump sum for accumulated unused
7 vacation, personal leave or sick leave, with the exception of
8 health care providers. "Compensation" with respect to health
9 care providers is defined under the Illinois Public Aid Code,
10 the Children's Health Insurance Act, or the Covering ALL KIDS
11 Health Insurance Act.
12     Where applicable, in In no event shall the total of the
13 amount of deferred compensation of an employee set aside in
14 relation to a particular year under the Illinois State
15 Employees Deferred Compensation Plan and the employee's
16 nondeferred compensation for that year exceed the total annual
17 salary or compensation under the existing salary schedule or
18 classification plan applicable to such employee in such year;
19 except that any compensation received in a lump sum for
20 accumulated unused vacation, personal leave or sick leave shall
21 not be included in the calculation of such totals.
22 (Source: P.A. 84-878.)
23     (40 ILCS 5/24-104.2 new)
24     Sec. 24-104.2. Health care providers; tax-exempt status.
25 Health care providers may participate in the Illinois State



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1 Employees Deferred Compensation Plan to the extent that the
2 health care providers' participation does not interfere with
3 the Plan's tax-exempt status under the Internal Revenue Code.
4     Section 10. The Children's Health Insurance Program Act is
5 amended by adding Section 31 as follows:
6     (215 ILCS 106/31 new)
7     Sec. 31. Health care provider participation in State
8 Employees Deferred Compensation Plan. Notwithstanding any
9 other provision of law, a health care provider who participates
10 under the Program may elect, in lieu of receiving direct
11 payment for services provided under the Program, to participate
12 in the State Employees Deferred Compensation Plan adopted under
13 Article 24 of the Illinois Pension Code. A health care provider
14 who elects to participate in the plan does not have a cause of
15 action against the State for any damages allegedly suffered by
16 the provider as a result of any delay by the State in crediting
17 the amount of any contribution to the provider's plan account.
18     Section 15. The Covering ALL KIDS Health Insurance Act is
19 amended by adding Section 41 as follows:
20     (215 ILCS 170/41 new)
21     Sec. 41. Health care provider participation in State
22 Employees Deferred Compensation Plan. Notwithstanding any



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1 other provision of law, a health care provider who participates
2 under the Program may elect, in lieu of receiving direct
3 payment for services provided under the Program, to participate
4 in the State Employees Deferred Compensation Plan adopted under
5 Article 24 of the Illinois Pension Code. A health care provider
6 who elects to participate in the plan does not have a cause of
7 action against the State for any damages allegedly suffered by
8 the provider as a result of any delay by the State in crediting
9 the amount of any contribution to the provider's plan account.
10     Section 20. The Illinois Public Aid Code is amended by
11 changing Section 5-5 as follows:
12     (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
13     Sec. 5-5. Medical services. The Illinois Department, by
14 rule, shall determine the quantity and quality of and the rate
15 of reimbursement for the medical assistance for which payment
16 will be authorized, and the medical services to be provided,
17 which may include all or part of the following: (1) inpatient
18 hospital services; (2) outpatient hospital services; (3) other
19 laboratory and X-ray services; (4) skilled nursing home
20 services; (5) physicians' services whether furnished in the
21 office, the patient's home, a hospital, a skilled nursing home,
22 or elsewhere; (6) medical care, or any other type of remedial
23 care furnished by licensed practitioners; (7) home health care
24 services; (8) private duty nursing service; (9) clinic



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1 services; (10) dental services, including prevention and
2 treatment of periodontal disease and dental caries disease for
3 pregnant women; (11) physical therapy and related services;
4 (12) prescribed drugs, dentures, and prosthetic devices; and
5 eyeglasses prescribed by a physician skilled in the diseases of
6 the eye, or by an optometrist, whichever the person may select;
7 (13) other diagnostic, screening, preventive, and
8 rehabilitative services; (14) transportation and such other
9 expenses as may be necessary; (15) medical treatment of sexual
10 assault survivors, as defined in Section 1a of the Sexual
11 Assault Survivors Emergency Treatment Act, for injuries
12 sustained as a result of the sexual assault, including
13 examinations and laboratory tests to discover evidence which
14 may be used in criminal proceedings arising from the sexual
15 assault; (16) the diagnosis and treatment of sickle cell
16 anemia; and (17) any other medical care, and any other type of
17 remedial care recognized under the laws of this State, but not
18 including abortions, or induced miscarriages or premature
19 births, unless, in the opinion of a physician, such procedures
20 are necessary for the preservation of the life of the woman
21 seeking such treatment, or except an induced premature birth
22 intended to produce a live viable child and such procedure is
23 necessary for the health of the mother or her unborn child. The
24 Illinois Department, by rule, shall prohibit any physician from
25 providing medical assistance to anyone eligible therefor under
26 this Code where such physician has been found guilty of



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1 performing an abortion procedure in a wilful and wanton manner
2 upon a woman who was not pregnant at the time such abortion
3 procedure was performed. The term "any other type of remedial
4 care" shall include nursing care and nursing home service for
5 persons who rely on treatment by spiritual means alone through
6 prayer for healing.
7     Notwithstanding any other provision of this Section, a
8 comprehensive tobacco use cessation program that includes
9 purchasing prescription drugs or prescription medical devices
10 approved by the Food and Drug administration shall be covered
11 under the medical assistance program under this Article for
12 persons who are otherwise eligible for assistance under this
13 Article.
14     Notwithstanding any other provision of this Code, the
15 Illinois Department may not require, as a condition of payment
16 for any laboratory test authorized under this Article, that a
17 physician's handwritten signature appear on the laboratory
18 test order form. The Illinois Department may, however, impose
19 other appropriate requirements regarding laboratory test order
20 documentation.
21     The Department of Healthcare and Family Services shall
22 provide the following services to persons eligible for
23 assistance under this Article who are participating in
24 education, training or employment programs operated by the
25 Department of Human Services as successor to the Department of
26 Public Aid:



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1         (1) dental services, which shall include but not be
2     limited to prosthodontics; and
3         (2) eyeglasses prescribed by a physician skilled in the
4     diseases of the eye, or by an optometrist, whichever the
5     person may select.
6     The Illinois Department, by rule, may distinguish and
7 classify the medical services to be provided only in accordance
8 with the classes of persons designated in Section 5-2.
9     The Department of Healthcare and Family Services must
10 provide coverage and reimbursement for amino acid-based
11 elemental formulas, regardless of delivery method, for the
12 diagnosis and treatment of (i) eosinophilic disorders and (ii)
13 short bowel syndrome when the prescribing physician has issued
14 a written order stating that the amino acid-based elemental
15 formula is medically necessary.
16     The Illinois Department shall authorize the provision of,
17 and shall authorize payment for, screening by low-dose
18 mammography for the presence of occult breast cancer for women
19 35 years of age or older who are eligible for medical
20 assistance under this Article, as follows:
21         (A) A baseline mammogram for women 35 to 39 years of
22     age.
23         (B) An annual mammogram for women 40 years of age or
24     older.
25         (C) A mammogram at the age and intervals considered
26     medically necessary by the woman's health care provider for



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1     women under 40 years of age and having a family history of
2     breast cancer, prior personal history of breast cancer,
3     positive genetic testing, or other risk factors.
4         (D) A comprehensive ultrasound screening of an entire
5     breast or breasts if a mammogram demonstrates
6     heterogeneous or dense breast tissue, when medically
7     necessary as determined by a physician licensed to practice
8     medicine in all of its branches.
9     All screenings shall include a physical breast exam,
10 instruction on self-examination and information regarding the
11 frequency of self-examination and its value as a preventative
12 tool. For purposes of this Section, "low-dose mammography"
13 means the x-ray examination of the breast using equipment
14 dedicated specifically for mammography, including the x-ray
15 tube, filter, compression device, and image receptor, with an
16 average radiation exposure delivery of less than one rad per
17 breast for 2 views of an average size breast. The term also
18 includes digital mammography.
19     On and after July 1, 2008, screening and diagnostic
20 mammography shall be reimbursed at the same rate as the
21 Medicare program's rates, including the increased
22 reimbursement for digital mammography.
23     The Department shall convene an expert panel including
24 representatives of hospitals, free-standing mammography
25 facilities, and doctors, including radiologists, to establish
26 quality standards. Based on these quality standards, the



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



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



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1 of Alcoholism and Substance Abuse) and Public Health, through a
2 public awareness campaign, may provide information concerning
3 treatment for alcoholism and drug abuse and addiction, prenatal
4 health care, and other pertinent programs directed at reducing
5 the number of drug-affected infants born to recipients of
6 medical assistance.
7     Neither the Department of Healthcare and Family Services
8 nor the Department of Human Services shall sanction the
9 recipient solely on the basis of her substance abuse.
10     The Illinois Department shall establish such regulations
11 governing the dispensing of health services under this Article
12 as it shall deem appropriate. The Department should seek the
13 advice of formal professional advisory committees appointed by
14 the Director of the Illinois Department for the purpose of
15 providing regular advice on policy and administrative matters,
16 information dissemination and educational activities for
17 medical and health care providers, and consistency in
18 procedures to the Illinois Department.
19     Notwithstanding any other provision of law, a health care
20 provider under the medical assistance program may elect, in
21 lieu of receiving direct payment for services provided under
22 that program, to participate in the State Employees Deferred
23 Compensation Plan adopted under Article 24 of the Illinois
24 Pension Code. A health care provider who elects to participate
25 in the plan does not have a cause of action against the State
26 for any damages allegedly suffered by the provider as a result



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1 of any delay by the State in crediting the amount of any
2 contribution to the provider's plan account.
3     The Illinois Department may develop and contract with
4 Partnerships of medical providers to arrange medical services
5 for persons eligible under Section 5-2 of this Code.
6 Implementation of this Section may be by demonstration projects
7 in certain geographic areas. The Partnership shall be
8 represented by a sponsor organization. The Department, by rule,
9 shall develop qualifications for sponsors of Partnerships.
10 Nothing in this Section shall be construed to require that the
11 sponsor organization be a medical organization.
12     The sponsor must negotiate formal written contracts with
13 medical providers for physician services, inpatient and
14 outpatient hospital care, home health services, treatment for
15 alcoholism and substance abuse, and other services determined
16 necessary by the Illinois Department by rule for delivery by
17 Partnerships. Physician services must include prenatal and
18 obstetrical care. The Illinois Department shall reimburse
19 medical services delivered by Partnership providers to clients
20 in target areas according to provisions of this Article and the
21 Illinois Health Finance Reform Act, except that:
22         (1) Physicians participating in a Partnership and
23     providing certain services, which shall be determined by
24     the Illinois Department, to persons in areas covered by the
25     Partnership may receive an additional surcharge for such
26     services.



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



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



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1 dentures, prosthetic devices and eyeglasses for which payment
2 is being made are actually being received by eligible
3 recipients. Within 90 days after the effective date of this
4 amendatory Act of 1984, the Illinois Department shall establish
5 a current list of acquisition costs for all prosthetic devices
6 and any other items recognized as medical equipment and
7 supplies reimbursable under this Article and shall update such
8 list on a quarterly basis, except that the acquisition costs of
9 all prescription drugs shall be updated no less frequently than
10 every 30 days as required by Section 5-5.12.
11     The rules and regulations of the Illinois Department shall
12 require that a written statement including the required opinion
13 of a physician shall accompany any claim for reimbursement for
14 abortions, or induced miscarriages or premature births. This
15 statement shall indicate what procedures were used in providing
16 such medical services.
17     The Illinois Department shall require all dispensers of
18 medical services, other than an individual practitioner or
19 group of practitioners, desiring to participate in the Medical
20 Assistance program established under this Article to disclose
21 all financial, beneficial, ownership, equity, surety or other
22 interests in any and all firms, corporations, partnerships,
23 associations, business enterprises, joint ventures, agencies,
24 institutions or other legal entities providing any form of
25 health care services in this State under this Article.
26     The Illinois Department may require that all dispensers of



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1 medical services desiring to participate in the medical
2 assistance program established under this Article disclose,
3 under such terms and conditions as the Illinois Department may
4 by rule establish, all inquiries from clients and attorneys
5 regarding medical bills paid by the Illinois Department, which
6 inquiries could indicate potential existence of claims or liens
7 for the Illinois Department.
8     Enrollment of a vendor that provides non-emergency medical
9 transportation, defined by the Department by rule, shall be
10 conditional for 180 days. During that time, the Department of
11 Healthcare and Family Services may terminate the vendor's
12 eligibility to participate in the medical assistance program
13 without cause. That termination of eligibility is not subject
14 to the Department's hearing process.
15     The Illinois Department shall establish policies,
16 procedures, standards and criteria by rule for the acquisition,
17 repair and replacement of orthotic and prosthetic devices and
18 durable medical equipment. Such rules shall provide, but not be
19 limited to, the following services: (1) immediate repair or
20 replacement of such devices by recipients without medical
21 authorization; and (2) rental, lease, purchase or
22 lease-purchase of durable medical equipment in a
23 cost-effective manner, taking into consideration the
24 recipient's medical prognosis, the extent of the recipient's
25 needs, and the requirements and costs for maintaining such
26 equipment. Such rules shall enable a recipient to temporarily



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1 acquire and use alternative or substitute devices or equipment
2 pending repairs or replacements of any device or equipment
3 previously authorized for such recipient by the Department.
4     The Department shall execute, relative to the nursing home
5 prescreening project, written inter-agency agreements with the
6 Department of Human Services and the Department on Aging, to
7 effect the following: (i) intake procedures and common
8 eligibility criteria for those persons who are receiving
9 non-institutional services; and (ii) the establishment and
10 development of non-institutional services in areas of the State
11 where they are not currently available or are undeveloped.
12     The Illinois Department shall develop and operate, in
13 cooperation with other State Departments and agencies and in
14 compliance with applicable federal laws and regulations,
15 appropriate and effective systems of health care evaluation and
16 programs for monitoring of utilization of health care services
17 and facilities, as it affects persons eligible for medical
18 assistance under this Code.
19     The Illinois Department shall report annually to the
20 General Assembly, no later than the second Friday in April of
21 1979 and each year thereafter, in regard to:
22         (a) actual statistics and trends in utilization of
23     medical services by public aid recipients;
24         (b) actual statistics and trends in the provision of
25     the various medical services by medical vendors;
26         (c) current rate structures and proposed changes in



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1     those rate structures for the various medical vendors; and
2         (d) efforts at utilization review and control by the
3     Illinois Department.
4     The period covered by each report shall be the 3 years
5 ending on the June 30 prior to the report. The report shall
6 include suggested legislation for consideration by the General
7 Assembly. The filing of one copy of the report with the
8 Speaker, one copy with the Minority Leader and one copy with
9 the Clerk of the House of Representatives, one copy with the
10 President, one copy with the Minority Leader and one copy with
11 the Secretary of the Senate, one copy with the Legislative
12 Research Unit, and such additional copies with the State
13 Government Report Distribution Center for the General Assembly
14 as is required under paragraph (t) of Section 7 of the State
15 Library Act shall be deemed sufficient to comply with this
16 Section.
17     Rulemaking authority to implement this amendatory Act of
18 the 95th General Assembly, if any, is conditioned on the rules
19 being adopted in accordance with all provisions of the Illinois
20 Administrative Procedure Act and all rules and procedures of
21 the Joint Committee on Administrative Rules; any purported rule
22 not so adopted, for whatever reason, is unauthorized.
23 (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07;
24 95-1045, eff. 3-27-09.)
25     Section 99. Effective date. This Act takes effect July 1,



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1 2010.".