Full Text of SB0626 98th General Assembly
SB0626eng 98TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. If and only if Senate Bill 2217 becomes law, the | 5 | | Illinois Insurance Code is amended by adding Section 367m as | 6 | | follows: | 7 | | (215 ILCS 5/367m new) | 8 | | Sec. 367m. Early intervention services. Parental consent | 9 | | is not required for the use of private insurance for early | 10 | | intervention services as defined in the Early Intervention | 11 | | Services System Act that are provided in this State pursuant to | 12 | | Part C of the federal Individuals with Disabilities Education | 13 | | Act. A policy of accident and health insurance that provides | 14 | | coverage for early intervention services must conform to the | 15 | | following criteria: | 16 | | (1) The use of private health insurance to pay for | 17 | | early intervention services under Part C of the federal | 18 | | Individuals with Disabilities Education Act may not count | 19 | | towards or result in a loss of benefits due to annual or | 20 | | lifetime insurance caps for an infant or toddler with a | 21 | | disability, the infant's or toddler's parent, or the | 22 | | infant's or toddler's family members who are covered under | 23 | | that health insurance policy. |
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| 1 | | (2) The use of private health insurance to pay for | 2 | | early intervention services under Part C of the federal | 3 | | Individuals with Disabilities Education Act may not | 4 | | negatively affect the availability of health insurance to | 5 | | an infant or toddler with a disability, the infant's or | 6 | | toddler's parent, or the infant's or toddler's family | 7 | | members who are covered under that health insurance policy, | 8 | | and health insurance coverage may not be discontinued for | 9 | | these individuals due to the use of the health insurance to | 10 | | pay for services under Part C of the federal Individuals | 11 | | with Disabilities Education Act. | 12 | | (3) The use of private health insurance to pay for | 13 | | early intervention services under Part C of the federal | 14 | | Individuals with Disabilities Education Act may not be the | 15 | | basis for increasing the health insurance premiums of an | 16 | | infant or toddler with a disability, the infant's or | 17 | | toddler's parent, or the infant's or toddler's family | 18 | | members covered under that health insurance policy.
| 19 | | Section 10. If and only if Senate Bill 2217 becomes law, | 20 | | the Early Intervention Services System Act is amended by | 21 | | changing Sections 11, 13, 13.10, and 13.15 as follows:
| 22 | | (325 ILCS 20/11) (from Ch. 23, par. 4161)
| 23 | | Sec. 11. Individualized Family Service Plans.
| 24 | | (a) Each eligible infant or toddler and that infant's or |
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| 1 | | toddler's family
shall receive:
| 2 | | (1) timely, comprehensive, multidisciplinary | 3 | | assessment of the unique
strengths and needs of each | 4 | | eligible infant and toddler, and assessment of the concerns
| 5 | | and priorities of the families to appropriately assist them | 6 | | in meeting
their needs and identify supports and services | 7 | | to meet those needs; and
| 8 | | (2) a written Individualized Family Service Plan | 9 | | developed by a
multidisciplinary team which includes the | 10 | | parent or guardian. The
individualized family service plan | 11 | | shall be based on the
multidisciplinary team's assessment | 12 | | of the resources, priorities,
and concerns of the family | 13 | | and its identification of the supports
and services | 14 | | necessary to enhance the family's capacity to meet the
| 15 | | developmental needs of the infant or toddler, and shall | 16 | | include the
identification of services appropriate to meet | 17 | | those needs, including the
frequency, intensity, and | 18 | | method of delivering services. During and as part of
the | 19 | | initial development of the individualized family services | 20 | | plan, and any
periodic reviews of the plan, the | 21 | | multidisciplinary team may seek consultation from the lead
| 22 | | agency's designated experts, if any, to help
determine | 23 | | appropriate services and the frequency and intensity of | 24 | | those
services. All services in the individualized family | 25 | | services plan must be
justified by the multidisciplinary | 26 | | assessment of the unique strengths and
needs of the infant |
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| 1 | | or toddler and must be appropriate to meet those needs.
At | 2 | | the periodic reviews, the team shall determine whether | 3 | | modification or
revision of the outcomes or services is | 4 | | necessary.
| 5 | | (b) The Individualized Family Service Plan shall be | 6 | | evaluated once a year
and the family shall be provided a review | 7 | | of the Plan at 6 month intervals or
more often where | 8 | | appropriate based on infant or toddler and family needs.
The | 9 | | lead agency shall create a quality review process regarding | 10 | | Individualized
Family Service Plan development and changes | 11 | | thereto, to monitor
and help assure that resources are being | 12 | | used to provide appropriate early
intervention services.
| 13 | | (c) The initial evaluation and initial assessment and | 14 | | initial
Plan meeting must be held within 45 days after the | 15 | | initial
contact with the early intervention services system. | 16 | | The 45-day timeline does not apply for any period when the | 17 | | child or parent is unavailable to complete the initial | 18 | | evaluation, the initial assessments of the child and family, or | 19 | | the initial Plan meeting, due to exceptional family | 20 | | circumstances that are documented in the child's early | 21 | | intervention records, or when the parent has not provided | 22 | | consent for the initial evaluation or the initial assessment of | 23 | | the child despite documented, repeated attempts to obtain | 24 | | parental consent. As soon as exceptional family circumstances | 25 | | no longer exist or parental consent has been obtained, the | 26 | | initial evaluation, the initial assessment, and the initial |
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| 1 | | Plan meeting must be completed as soon as possible. With | 2 | | parental consent,
early intervention services may commence | 3 | | before the completion of the
comprehensive assessment and | 4 | | development of the Plan.
| 5 | | (d) Parents must be informed that early
intervention
| 6 | | services shall be provided to each eligible infant and toddler, | 7 | | to the maximum extent appropriate, in the natural
environment, | 8 | | which may include the home or other community settings. Parents
| 9 | | shall make
the final decision to accept or decline
early | 10 | | intervention services. A decision to decline such services | 11 | | shall
not be a basis for administrative determination of | 12 | | parental fitness, or
other findings or sanctions against the | 13 | | parents. Parameters of the Plan
shall be set forth in rules.
| 14 | | (e) The regional intake offices shall explain to each | 15 | | family, orally and
in
writing, all of the following:
| 16 | | (1) That the early intervention program will pay for | 17 | | all early
intervention services set forth in the | 18 | | individualized family service plan that
are not
covered or | 19 | | paid under the family's public or private insurance plan or | 20 | | policy
and not
eligible for payment through any other third | 21 | | party payor.
| 22 | | (2) That services will not be delayed due to any rules | 23 | | or restrictions
under the family's insurance plan or | 24 | | policy.
| 25 | | (3) That the family may request, with appropriate | 26 | | documentation
supporting the request, a
determination of |
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| 1 | | an exemption from private insurance use under
Section | 2 | | 13.25.
| 3 | | (4) That responsibility for co-payments or
| 4 | | co-insurance under a family's private insurance
plan or | 5 | | policy will be transferred to the lead
agency's central | 6 | | billing office.
| 7 | | (5) That families will be responsible
for payments of | 8 | | family fees,
which will be based on a sliding scale
| 9 | | according to the State's definition of ability to pay which | 10 | | is comparing household size and income to the sliding scale | 11 | | and considering out-of-pocket medical or disaster | 12 | | expenses, and that these fees
are payable to the central | 13 | | billing office. Families who fail to provide income | 14 | | information shall be charged the maximum amount on the | 15 | | sliding scale.
| 16 | | (f) The individualized family service plan must state | 17 | | whether the family
has private insurance coverage and, if the | 18 | | family has such coverage and parental consent has been | 19 | | obtained , must
have attached to it a copy of the family's | 20 | | insurance identification card or
otherwise
include all of the | 21 | | following information:
| 22 | | (1) The name, address, and telephone number of the | 23 | | insurance
carrier.
| 24 | | (2) The contract number and policy number of the | 25 | | insurance plan.
| 26 | | (3) The name, address, and social security number of |
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| 1 | | the primary
insured.
| 2 | | (4) The beginning date of the insurance benefit year.
| 3 | | (g) A copy of the individualized family service plan must | 4 | | be provided to
each enrolled provider who is providing early | 5 | | intervention services to the
child
who is the subject of that | 6 | | plan.
| 7 | | (h) Children receiving services under this Act shall | 8 | | receive a smooth and effective transition by their third | 9 | | birthday consistent with federal regulations adopted pursuant | 10 | | to Sections 1431 through 1444 of Title 20 of the United States | 11 | | Code. | 12 | | (Source: P.A. 97-902, eff. 8-6-12; 09800SB2217eng.)
| 13 | | (325 ILCS 20/13) (from Ch. 23, par. 4163)
| 14 | | Sec. 13. Funding and Fiscal Responsibility.
| 15 | | (a) The lead agency and every
other participating State | 16 | | agency may receive and expend funds appropriated
by the General | 17 | | Assembly to implement the early intervention services system
as | 18 | | required by this Act.
| 19 | | (b) The lead agency and each participating State agency | 20 | | shall identify
and report on an annual basis to the Council the | 21 | | State agency funds utilized
for the provision of early | 22 | | intervention services to eligible infants and
toddlers.
| 23 | | (c) Funds provided under Section 633 of the Individuals | 24 | | with
Disabilities Education Act (20 United States Code 1433) | 25 | | and State funds
designated or appropriated for early |
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| 1 | | intervention services or programs
may not be used to satisfy a
| 2 | | financial commitment for services which would have been paid | 3 | | for from
another public or private source but for the enactment | 4 | | of this Act, except
whenever considered necessary to prevent | 5 | | delay in receiving appropriate early
intervention services by | 6 | | the eligible infant or toddler or family in a
timely manner. | 7 | | "Public or private source" includes public and private
| 8 | | insurance coverage.
| 9 | | Funds provided under Section 633 of the Individuals with
| 10 | | Disabilities Education Act
and State funds designated or | 11 | | appropriated for early intervention services or
programs
may be | 12 | | used by the lead agency to pay the
provider of services (A) | 13 | | pending reimbursement from the appropriate State
agency
or (B) | 14 | | if (i) the claim for payment is denied in whole or in part by a | 15 | | public
or private source, or would be denied under the written | 16 | | terms of the public
program or plan or private plan, or (ii) | 17 | | use of private insurance for the
service has been exempted | 18 | | under Section 13.25 , or (iii) parental consent has not been | 19 | | obtained for the use of private insurance . Payment under item | 20 | | (B)(i) may
be made based on a pre-determination telephone | 21 | | inquiry supported by written
documentation of the denial | 22 | | supplied thereafter by the insurance carrier.
| 23 | | (d) Nothing in this Act shall be construed to permit the | 24 | | State to reduce
medical or other assistance available or to | 25 | | alter eligibility under Title V
and Title XIX of the Social | 26 | | Security Act relating to the Maternal Child
Health Program and |
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| 1 | | Medicaid for eligible infants and toddlers in this State.
| 2 | | (e) The lead agency shall create a central billing office | 3 | | to receive and
dispense all relevant State and federal | 4 | | resources, as well as local
government or independent resources | 5 | | available, for early intervention
services. This office shall | 6 | | assure that maximum federal resources are
utilized and that | 7 | | providers receive funds with minimal duplications or
| 8 | | interagency reporting and with consolidated audit procedures.
| 9 | | (f) The lead agency shall, by rule, create a system of
| 10 | | payments by families, including
a schedule of fees. No fees, | 11 | | however, may be charged for: implementing
child find,
| 12 | | evaluation and assessment, service coordination, | 13 | | administrative and
coordination activities related to the | 14 | | development, review, and evaluation of
Individualized Family | 15 | | Service Plans, or the implementation of procedural
safeguards | 16 | | and other administrative components of the statewide early
| 17 | | intervention system.
| 18 | | The system of payments, called family fees, shall be
| 19 | | structured on a sliding
scale based on the family's ability to | 20 | | pay. The family's coverage
or lack
of coverage under a public | 21 | | or private insurance plan or
policy
shall not be a factor in | 22 | | determining the amount of the
family fees.
| 23 | | Each family's fee obligation shall be
established | 24 | | annually, and shall be paid by
families to
the central billing | 25 | | office in
installments. At the written request of the family, | 26 | | the fee obligation shall be
adjusted prospectively at any point |
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| 1 | | during the year upon proof of a change in
family income or | 2 | | family size. The inability of the parents
of an eligible child | 3 | | to pay family fees due to catastrophic
circumstances or | 4 | | extraordinary expenses shall not result in
the denial of | 5 | | services to the child or the child's family.
A family must | 6 | | document its extraordinary expenses or other catastrophic
| 7 | | circumstances
by showing one of the following: (i) | 8 | | out-of-pocket medical expenses in excess
of 15% of gross | 9 | | income; (ii) a fire, flood, or other disaster causing a direct
| 10 | | out-of-pocket loss in excess of 15% of gross income; or (iii) | 11 | | other
catastrophic
circumstances causing out-of-pocket losses | 12 | | in excess of 15% of gross income.
The family must present proof | 13 | | of loss to its service coordinator, who shall
document it, and | 14 | | the lead agency shall determine
whether the fees shall be | 15 | | reduced, forgiven, or suspended within 10 business
days after
| 16 | | the family's request.
| 17 | | (g) To ensure that early intervention funds are used as the | 18 | | payor of last
resort for early intervention services, the lead | 19 | | agency shall determine at the
point of early intervention | 20 | | intake, and again at any periodic review of
eligibility | 21 | | thereafter or upon a change in family circumstances, whether | 22 | | the
family is eligible for or enrolled in any program for which | 23 | | payment is made
directly or through public or private insurance | 24 | | for any or all of the early
intervention services made | 25 | | available under this Act. The lead agency shall
establish | 26 | | procedures to ensure that payments are made either directly |
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| 1 | | from
these public and private sources , when parental consent | 2 | | has been obtained, instead of from State or federal early
| 3 | | intervention funds, or as reimbursement for payments | 4 | | previously made from State
or federal early intervention funds.
| 5 | | (Source: P.A. 91-538, eff. 8-13-99; 92-10, eff. 6-11-01; | 6 | | 92-307, eff. 8-9-01; 92-651, eff. 7-11-02; 09800SB2217.)
| 7 | | (325 ILCS 20/13.10)
| 8 | | Sec. 13.10.
Private health insurance;
assignment. The lead | 9 | | agency
shall determine, at the point of new applications
for | 10 | | early
intervention services, and for all children enrolled
in | 11 | | the early
intervention program, at the regional intake offices,
| 12 | | whether
the child is insured under a private health insurance
| 13 | | plan or
policy. Parental consent must be obtained when the lead | 14 | | agency or enrolled provider who is providing a family with | 15 | | early intervention services seeks to use the child or parent's | 16 | | private insurance or benefits to pay for the initial provision | 17 | | of early intervention services in the Individualized Family | 18 | | Services Plan and anytime that an increase in frequency, | 19 | | length, duration, or intensity is made to existing services in | 20 | | the child's Individualized Family Services Plan.
| 21 | | (Source: P.A. 92-307, eff. 8-9-01; 09800SB2217.)
| 22 | | (325 ILCS 20/13.15)
| 23 | | Sec. 13.15. Billing of insurance carrier.
| 24 | | (a) Subject to the restrictions against
private
insurance |
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| 1 | | use on the basis of material risk of
loss of
coverage, as | 2 | | determined under Section 13.25, each
enrolled
provider who is | 3 | | providing a family with early
intervention
services shall bill | 4 | | the child's insurance carrier for
each
unit
of early | 5 | | intervention service for
which coverage may be
available and | 6 | | parental consent has been obtained . The lead agency may exempt | 7 | | from the
requirement of this paragraph any early intervention | 8 | | service
that it has deemed not to be covered by insurance | 9 | | plans.
When the service is not exempted, providers who
receive | 10 | | a denial of payment on the basis that the service is
not | 11 | | covered under any circumstance under the plan are not
required | 12 | | to bill that carrier for that service again until the following
| 13 | | insurance benefit year. That
explanation of benefits denying | 14 | | the claim, once submitted to
the central billing office, shall | 15 | | be sufficient to meet the
requirements of this paragraph as to | 16 | | subsequent services billed under the same
billing code provided | 17 | | to that child during that insurance benefit year. Any
time | 18 | | limit on a
provider's filing of a claim for payment with the | 19 | | central
billing office that is
imposed through a
policy, | 20 | | procedure, or rule of the lead agency shall be
suspended
until | 21 | | the provider receives an explanation of
benefits or
other final | 22 | | determination of the claim it files
with the
child's insurance | 23 | | carrier.
| 24 | | (b) In all instances when an insurance carrier has
been | 25 | | billed for early intervention services, whether paid in
full, | 26 | | paid in part, or denied by the carrier, the provider must
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| 1 | | provide the central billing office, within 90 days after | 2 | | receipt, with a copy
of the explanation
of benefits form and | 3 | | other information in the manner prescribed by the lead
agency.
| 4 | | (c) When the insurance carrier has denied the
claim or paid | 5 | | an amount for the early intervention service
billed that is | 6 | | less than the current State rate for early
intervention | 7 | | services, the provider shall submit the
explanation of benefits | 8 | | with a claim for payment, and the lead
agency shall pay the | 9 | | provider the difference between the sum
actually paid by the | 10 | | insurance carrier for each unit of service
provided under the | 11 | | individualized family service plan and
the current State rate | 12 | | for early intervention services.
The State shall also pay the | 13 | | family's co-payment or co-insurance under its
plan, but only to | 14 | | the extent that those
payments plus the balance of the claim do | 15 | | not exceed the
current State rate for early intervention | 16 | | services. The
provider may under no circumstances bill the | 17 | | family for the
difference between its charge for services and | 18 | | that which
has been paid by the insurance carrier or by the | 19 | | State.
| 20 | | (Source: P.A. 97-813, eff. 7-13-12; 09800SB2217.)
| 21 | | Section 99. Effective date. This Act takes effect upon | 22 | | becoming law. |
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