Full Text of SB0769 97th General Assembly
SB0769ham002 97TH GENERAL ASSEMBLY | Rep. Lou Lang Filed: 10/24/2011
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| 1 | | AMENDMENT TO SENATE BILL 769
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 769, AS AMENDED, by | 3 | | replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 5. The Illinois Public Aid Code is amended by | 6 | | changing Section 5-4.2 as follows:
| 7 | | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
| 8 | | Sec. 5-4.2. Ambulance services payments. | 9 | | (a) For
ambulance
services provided to a recipient of aid | 10 | | under this Article on or after
January 1, 1993, the Illinois | 11 | | Department shall reimburse ambulance service
providers at | 12 | | rates calculated in accordance with this Section. It is the | 13 | | intent
of the General Assembly to provide adequate | 14 | | reimbursement for ambulance
services so as to ensure adequate | 15 | | access to services for recipients of aid
under this Article and | 16 | | to provide appropriate incentives to ambulance service
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| 1 | | providers to provide services in an efficient and | 2 | | cost-effective manner. Thus,
it is the intent of the General | 3 | | Assembly that the Illinois Department implement
a | 4 | | reimbursement system for ambulance services that, to the extent | 5 | | practicable
and subject to the availability of funds | 6 | | appropriated by the General Assembly
for this purpose, is | 7 | | consistent with the payment principles of Medicare. To
ensure | 8 | | uniformity between the payment principles of Medicare and | 9 | | Medicaid, the
Illinois Department shall follow, to the extent | 10 | | necessary and practicable and
subject to the availability of | 11 | | funds appropriated by the General Assembly for
this purpose, | 12 | | the statutes, laws, regulations, policies, procedures,
| 13 | | principles, definitions, guidelines, and manuals used to | 14 | | determine the amounts
paid to ambulance service providers under | 15 | | Title XVIII of the Social Security
Act (Medicare).
| 16 | | (b) For ambulance services provided to a recipient of aid | 17 | | under this Article
on or after January 1, 1996, the Illinois | 18 | | Department shall reimburse ambulance
service providers based | 19 | | upon the actual distance traveled if a natural
disaster, | 20 | | weather conditions, road repairs, or traffic congestion | 21 | | necessitates
the use of a
route other than the most direct | 22 | | route.
| 23 | | (b-1) It is the intent of the General Assembly to provide | 24 | | adequate reimbursement for the cost of fuel used during the | 25 | | provision of emergency ambulance services. Beginning with | 26 | | emergency ambulance services rendered on or after July 1, 2011, |
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| 1 | | the Department shall reimburse no less than 75% of the Medicare | 2 | | mileage rate for emergency ambulance services. | 3 | | (c) For purposes of this Section, "ambulance services" | 4 | | includes medical
transportation services provided by means of | 5 | | an ambulance, medi-car, service
car, or
taxi.
| 6 | | (c-1) For purposes of this Section, "ground ambulance | 7 | | service" means medical transportation services that are | 8 | | described as ground ambulance services by the Centers for | 9 | | Medicare and Medicaid Services and provided in a vehicle that | 10 | | is licensed as an ambulance by the Illinois Department of | 11 | | Public Health pursuant to the Emergency Medical Services (EMS) | 12 | | Systems Act. | 13 | | (c-2) For purposes of this Section, "ground ambulance | 14 | | service provider" means a vehicle service provider as described | 15 | | in the Emergency Medical Services (EMS) Systems Act that | 16 | | operates licensed ambulances for the purpose of providing | 17 | | emergency ambulance services, or non-emergency ambulance | 18 | | services, or both. For purposes of this Section, this includes | 19 | | both ambulance providers and ambulance suppliers as described | 20 | | by the Centers for Medicare and Medicaid Services. | 21 | | (d) This Section does not prohibit separate billing by | 22 | | ambulance service
providers for oxygen furnished while | 23 | | providing advanced life support
services.
| 24 | | (e) Beginning with services rendered on or after July 1, | 25 | | 2008, all providers of non-emergency medi-car and service car | 26 | | transportation must certify that the driver and employee |
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| 1 | | attendant, as applicable, have completed a safety program | 2 | | approved by the Department to protect both the patient and the | 3 | | driver, prior to transporting a patient.
The provider must | 4 | | maintain this certification in its records. The provider shall | 5 | | produce such documentation upon demand by the Department or its | 6 | | representative. Failure to produce documentation of such | 7 | | training shall result in recovery of any payments made by the | 8 | | Department for services rendered by a non-certified driver or | 9 | | employee attendant. Medi-car and service car providers must | 10 | | maintain legible documentation in their records of the driver | 11 | | and, as applicable, employee attendant that actually | 12 | | transported the patient. Providers must recertify all drivers | 13 | | and employee attendants every 3 years.
| 14 | | Notwithstanding the requirements above, any public | 15 | | transportation provider of medi-car and service car | 16 | | transportation that receives federal funding under 49 U.S.C. | 17 | | 5307 and 5311 need not certify its drivers and employee | 18 | | attendants under this Section, since safety training is already | 19 | | federally mandated.
| 20 | | (f) With respect to any policy or program administered by | 21 | | the Department or its agent regarding approval of non-emergency | 22 | | medical transportation by ground ambulance service providers, | 23 | | including, but not limited to, the Non-Emergency | 24 | | Transportation Services Prior Approval Program (NETSPAP), the | 25 | | Department shall establish by rule a process by which ground | 26 | | ambulance service providers of non-emergency medical |
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| 1 | | transportation may appeal any decision by the Department or its | 2 | | agent for which no denial was received prior to the time of | 3 | | transport that either (i) denies a request for approval for | 4 | | payment of non-emergency transportation by means of ground | 5 | | ambulance service or (ii) grants a request for approval of | 6 | | non-emergency transportation by means of ground ambulance | 7 | | service at a level of service that entitles the ground | 8 | | ambulance service provider to a lower level of compensation | 9 | | from the Department than the ground ambulance service provider | 10 | | would have received as compensation for the level of service | 11 | | requested. The rule shall be established within 12 months after | 12 | | the effective date of this amendatory Act of the 97th General | 13 | | Assembly and shall provide that, for any decision rendered by | 14 | | the Department or its agent on or after the date the rule takes | 15 | | effect, the ground ambulance service provider shall have 60 | 16 | | days from the date the decision is received to file an appeal. | 17 | | The rule established by the Department shall be, insofar as is | 18 | | practical, consistent with the Illinois Administrative | 19 | | Procedure Act. The Director's decision on an appeal under this | 20 | | Section shall be a final administrative decision subject to | 21 | | review under the Administrative Review Law. | 22 | | (Source: P.A. 97-584, eff. 8-26-11.)
| 23 | | Section 99. Effective date. This Act takes effect upon | 24 | | becoming law.".
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