Rep. David R. Leitch

Filed: 4/20/2015





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2    AMENDMENT NO. ______. Amend House Bill 1876 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5 as follows:
6    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
7    Sec. 5-5. Medical services. The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing home,
16or elsewhere; (6) medical care, or any other type of remedial



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1care furnished by licensed practitioners; (7) home health care
2services; (8) private duty nursing service; (9) clinic
3services; (10) dental services, including prevention and
4treatment of periodontal disease and dental caries disease for
5pregnant women, provided by an individual licensed to practice
6dentistry or dental surgery; for purposes of this item (10),
7"dental services" means diagnostic, preventive, or corrective
8procedures provided by or under the supervision of a dentist in
9the practice of his or her profession; (11) physical therapy
10and related services; (12) prescribed drugs, dentures, and
11prosthetic devices; and eyeglasses prescribed by a physician
12skilled in the diseases of the eye, or by an optometrist,
13whichever the person may select; (13) other diagnostic,
14screening, preventive, and rehabilitative services, including
15to ensure that the individual's need for intervention or
16treatment of mental disorders or substance use disorders or
17co-occurring mental health and substance use disorders is
18determined using a uniform screening, assessment, and
19evaluation process inclusive of criteria, for children and
20adults; for purposes of this item (13), a uniform screening,
21assessment, and evaluation process refers to a process that
22includes an appropriate evaluation and, as warranted, a
23referral; "uniform" does not mean the use of a singular
24instrument, tool, or process that all must utilize; (14)
25transportation and such other expenses as may be necessary;
26(15) medical treatment of sexual assault survivors, as defined



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1in Section 1a of the Sexual Assault Survivors Emergency
2Treatment Act, for injuries sustained as a result of the sexual
3assault, including examinations and laboratory tests to
4discover evidence which may be used in criminal proceedings
5arising from the sexual assault; (16) the diagnosis and
6treatment of sickle cell anemia; and (17) any other medical
7care, and any other type of remedial care recognized under the
8laws of this State, but not including abortions, or induced
9miscarriages or premature births, unless, in the opinion of a
10physician, such procedures are necessary for the preservation
11of the life of the woman seeking such treatment, or except an
12induced premature birth intended to produce a live viable child
13and such procedure is necessary for the health of the mother or
14her unborn child. The Illinois Department, by rule, shall
15prohibit any physician from providing medical assistance to
16anyone eligible therefor under this Code where such physician
17has been found guilty of performing an abortion procedure in a
18wilful and wanton manner upon a woman who was not pregnant at
19the time such abortion procedure was performed. The term "any
20other type of remedial care" shall include nursing care and
21nursing home service for persons who rely on treatment by
22spiritual means alone through prayer for healing.
23    Notwithstanding any other provision of this Section, a
24comprehensive tobacco use cessation program that includes
25purchasing prescription drugs or prescription medical devices
26approved by the Food and Drug Administration shall be covered



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



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1payment and shall be reimbursed at the Department's or the
2MCE's established rates or rate methodologies for eyeglasses.
3    On and after July 1, 2012, the Department of Healthcare and
4Family Services may provide the following services to persons
5eligible for assistance under this Article who are
6participating in education, training or employment programs
7operated by the Department of Human Services as successor to
8the Department of Public Aid:
9        (1) dental services provided by or under the
10    supervision of a dentist; and
11        (2) eyeglasses prescribed by a physician skilled in the
12    diseases of the eye, or by an optometrist, whichever the
13    person may select.
14    Notwithstanding any other provision of this Code and
15subject to federal approval, the Department may adopt rules to
16allow a dentist who is volunteering his or her service at no
17cost to render dental services through an enrolled
18not-for-profit health clinic without the dentist personally
19enrolling as a participating provider in the medical assistance
20program. A not-for-profit health clinic shall include a public
21health clinic or Federally Qualified Health Center or other
22enrolled provider, as determined by the Department, through
23which dental services covered under this Section are performed.
24The Department shall establish a process for payment of claims
25for reimbursement for covered dental services rendered under
26this provision.



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1    The Illinois Department, by rule, may distinguish and
2classify the medical services to be provided only in accordance
3with the classes of persons designated in Section 5-2.
4    The Department of Healthcare and Family Services must
5provide coverage and reimbursement for amino acid-based
6elemental formulas, regardless of delivery method, for the
7diagnosis and treatment of (i) eosinophilic disorders and (ii)
8short bowel syndrome when the prescribing physician has issued
9a written order stating that the amino acid-based elemental
10formula is medically necessary.
11    The Illinois Department shall authorize the provision of,
12and shall authorize payment for, screening by low-dose
13mammography for the presence of occult breast cancer for women
1435 years of age or older who are eligible for medical
15assistance under this Article, as follows:
16        (A) A baseline mammogram for women 35 to 39 years of
17    age.
18        (B) An annual mammogram for women 40 years of age or
19    older.
20        (C) A mammogram at the age and intervals considered
21    medically necessary by the woman's health care provider for
22    women under 40 years of age and having a family history of
23    breast cancer, prior personal history of breast cancer,
24    positive genetic testing, or other risk factors.
25        (D) A comprehensive ultrasound screening of an entire
26    breast or breasts if a mammogram demonstrates



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1    heterogeneous or dense breast tissue, when medically
2    necessary as determined by a physician licensed to practice
3    medicine in all of its branches.
4    All screenings shall include a physical breast exam,
5instruction on self-examination and information regarding the
6frequency of self-examination and its value as a preventative
7tool. For purposes of this Section, "low-dose mammography"
8means the x-ray examination of the breast using equipment
9dedicated specifically for mammography, including the x-ray
10tube, filter, compression device, and image receptor, with an
11average radiation exposure delivery of less than one rad per
12breast for 2 views of an average size breast. The term also
13includes digital mammography.
14    On and after January 1, 2012, providers participating in a
15quality improvement program approved by the Department shall be
16reimbursed for screening and diagnostic mammography at the same
17rate as the Medicare program's rates, including the increased
18reimbursement for digital mammography.
19    The Department shall convene an expert panel including
20representatives of hospitals, free-standing mammography
21facilities, and doctors, including radiologists, to establish
22quality standards.
23    Subject to federal approval, the Department shall
24establish a rate methodology for mammography at federally
25qualified health centers and other encounter-rate clinics.
26These clinics or centers may also collaborate with other



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1hospital-based mammography facilities.
2    The Department shall establish a methodology to remind
3women who are age-appropriate for screening mammography, but
4who have not received a mammogram within the previous 18
5months, of the importance and benefit of screening mammography.
6    The Department shall establish a performance goal for
7primary care providers with respect to their female patients
8over age 40 receiving an annual mammogram. This performance
9goal shall be used to provide additional reimbursement in the
10form of a quality performance bonus to primary care providers
11who meet that goal.
12    The Department shall devise a means of case-managing or
13patient navigation for beneficiaries diagnosed with breast
14cancer. This program shall initially operate as a pilot program
15in areas of the State with the highest incidence of mortality
16related to breast cancer. At least one pilot program site shall
17be in the metropolitan Chicago area and at least one site shall
18be outside the metropolitan Chicago area. An evaluation of the
19pilot program shall be carried out measuring health outcomes
20and cost of care for those served by the pilot program compared
21to similarly situated patients who are not served by the pilot
23    Any medical or health care provider shall immediately
24recommend, to any pregnant woman who is being provided prenatal
25services and is suspected of drug abuse or is addicted as
26defined in the Alcoholism and Other Drug Abuse and Dependency



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1Act, referral to a local substance abuse treatment provider
2licensed by the Department of Human Services or to a licensed
3hospital which provides substance abuse treatment services.
4The Department of Healthcare and Family Services shall assure
5coverage for the cost of treatment of the drug abuse or
6addiction for pregnant recipients in accordance with the
7Illinois Medicaid Program in conjunction with the Department of
8Human Services.
9    All medical providers providing medical assistance to
10pregnant women under this Code shall receive information from
11the Department on the availability of services under the Drug
12Free Families with a Future or any comparable program providing
13case management services for addicted women, including
14information on appropriate referrals for other social services
15that may be needed by addicted women in addition to treatment
16for addiction.
17    The Illinois Department, in cooperation with the
18Departments of Human Services (as successor to the Department
19of Alcoholism and Substance Abuse) and Public Health, through a
20public awareness campaign, may provide information concerning
21treatment for alcoholism and drug abuse and addiction, prenatal
22health care, and other pertinent programs directed at reducing
23the number of drug-affected infants born to recipients of
24medical assistance.
25    Neither the Department of Healthcare and Family Services
26nor the Department of Human Services shall sanction the



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1recipient solely on the basis of her substance abuse.
2    The Illinois Department shall establish such regulations
3governing the dispensing of health services under this Article
4as it shall deem appropriate. The Department should seek the
5advice of formal professional advisory committees appointed by
6the Director of the Illinois Department for the purpose of
7providing regular advice on policy and administrative matters,
8information dissemination and educational activities for
9medical and health care providers, and consistency in
10procedures to the Illinois Department.
11    The Illinois Department may develop and contract with
12Partnerships of medical providers to arrange medical services
13for persons eligible under Section 5-2 of this Code.
14Implementation of this Section may be by demonstration projects
15in certain geographic areas. The Partnership shall be
16represented by a sponsor organization. The Department, by rule,
17shall develop qualifications for sponsors of Partnerships.
18Nothing in this Section shall be construed to require that the
19sponsor organization be a medical organization.
20    The sponsor must negotiate formal written contracts with
21medical providers for physician services, inpatient and
22outpatient hospital care, home health services, treatment for
23alcoholism and substance abuse, and other services determined
24necessary by the Illinois Department by rule for delivery by
25Partnerships. Physician services must include prenatal and
26obstetrical care. The Illinois Department shall reimburse



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1medical services delivered by Partnership providers to clients
2in target areas according to provisions of this Article and the
3Illinois Health Finance Reform Act, except that:
4        (1) Physicians participating in a Partnership and
5    providing certain services, which shall be determined by
6    the Illinois Department, to persons in areas covered by the
7    Partnership may receive an additional surcharge for such
8    services.
9        (2) The Department may elect to consider and negotiate
10    financial incentives to encourage the development of
11    Partnerships and the efficient delivery of medical care.
12        (3) Persons receiving medical services through
13    Partnerships may receive medical and case management
14    services above the level usually offered through the
15    medical assistance program.
16    Medical providers shall be required to meet certain
17qualifications to participate in Partnerships to ensure the
18delivery of high quality medical services. These
19qualifications shall be determined by rule of the Illinois
20Department and may be higher than qualifications for
21participation in the medical assistance program. Partnership
22sponsors may prescribe reasonable additional qualifications
23for participation by medical providers, only with the prior
24written approval of the Illinois Department.
25    Nothing in this Section shall limit the free choice of
26practitioners, hospitals, and other providers of medical



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1services by clients. In order to ensure patient freedom of
2choice, the Illinois Department shall immediately promulgate
3all rules and take all other necessary actions so that provided
4services may be accessed from therapeutically certified
5optometrists to the full extent of the Illinois Optometric
6Practice Act of 1987 without discriminating between service
8    The Department shall apply for a waiver from the United
9States Health Care Financing Administration to allow for the
10implementation of Partnerships under this Section.
11    The Illinois Department shall require health care
12providers to maintain records that document the medical care
13and services provided to recipients of Medical Assistance under
14this Article. Such records must be retained for a period of not
15less than 6 years from the date of service or as provided by
16applicable State law, whichever period is longer, except that
17if an audit is initiated within the required retention period
18then the records must be retained until the audit is completed
19and every exception is resolved. The Illinois Department shall
20require health care providers to make available, when
21authorized by the patient, in writing, the medical records in a
22timely fashion to other health care providers who are treating
23or serving persons eligible for Medical Assistance under this
24Article. All dispensers of medical services shall be required
25to maintain and retain business and professional records
26sufficient to fully and accurately document the nature, scope,



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1details and receipt of the health care provided to persons
2eligible for medical assistance under this Code, in accordance
3with regulations promulgated by the Illinois Department. The
4rules and regulations shall require that proof of the receipt
5of prescription drugs, dentures, prosthetic devices and
6eyeglasses by eligible persons under this Section accompany
7each claim for reimbursement submitted by the dispenser of such
8medical services. No such claims for reimbursement shall be
9approved for payment by the Illinois Department without such
10proof of receipt, unless the Illinois Department shall have put
11into effect and shall be operating a system of post-payment
12audit and review which shall, on a sampling basis, be deemed
13adequate by the Illinois Department to assure that such drugs,
14dentures, prosthetic devices and eyeglasses for which payment
15is being made are actually being received by eligible
16recipients. Within 90 days after the effective date of this
17amendatory Act of 1984, the Illinois Department shall establish
18a current list of acquisition costs for all prosthetic devices
19and any other items recognized as medical equipment and
20supplies reimbursable under this Article and shall update such
21list on a quarterly basis, except that the acquisition costs of
22all prescription drugs shall be updated no less frequently than
23every 30 days as required by Section 5-5.12.
24    The rules and regulations of the Illinois Department shall
25require that a written statement including the required opinion
26of a physician shall accompany any claim for reimbursement for



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1abortions, or induced miscarriages or premature births. This
2statement shall indicate what procedures were used in providing
3such medical services.
4    Notwithstanding any other law to the contrary, the Illinois
5Department shall, within 365 days after July 22, 2013, (the
6effective date of Public Act 98-104), establish procedures to
7permit skilled care facilities licensed under the Nursing Home
8Care Act to submit monthly billing claims for reimbursement
9purposes. Following development of these procedures, the
10Department shall, by July 1, 2016, have an additional 365 days
11to test the viability of the new system and implement to ensure
12that any necessary operational or structural changes to its
13information technology platforms in order to allow for the
14direct acceptance and payment of nursing home claims are
16    Notwithstanding any other law to the contrary, the Illinois
17Department shall, within 365 days after August 15, 2014 (the
18effective date of Public Act 98-963) this amendatory Act of the
1998th General Assembly, establish procedures to permit ID/DD
20facilities licensed under the ID/DD Community Care Act to
21submit monthly billing claims for reimbursement purposes.
22Following development of these procedures, the Department
23shall have an additional 365 days to test the viability of the
24new system and to ensure that any necessary operational or
25structural changes to its information technology platforms are



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1    The Illinois Department shall require all dispensers of
2medical services, other than an individual practitioner or
3group of practitioners, desiring to participate in the Medical
4Assistance program established under this Article to disclose
5all financial, beneficial, ownership, equity, surety or other
6interests in any and all firms, corporations, partnerships,
7associations, business enterprises, joint ventures, agencies,
8institutions or other legal entities providing any form of
9health care services in this State under this Article.
10    The Illinois Department may require that all dispensers of
11medical services desiring to participate in the medical
12assistance program established under this Article disclose,
13under such terms and conditions as the Illinois Department may
14by rule establish, all inquiries from clients and attorneys
15regarding medical bills paid by the Illinois Department, which
16inquiries could indicate potential existence of claims or liens
17for the Illinois Department.
18    Enrollment of a vendor shall be subject to a provisional
19period and shall be conditional for one year. During the period
20of conditional enrollment, the Department may terminate the
21vendor's eligibility to participate in, or may disenroll the
22vendor from, the medical assistance program without cause.
23Unless otherwise specified, such termination of eligibility or
24disenrollment is not subject to the Department's hearing
25process. However, a disenrolled vendor may reapply without



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1    The Department has the discretion to limit the conditional
2enrollment period for vendors based upon category of risk of
3the vendor.
4    Prior to enrollment and during the conditional enrollment
5period in the medical assistance program, all vendors shall be
6subject to enhanced oversight, screening, and review based on
7the risk of fraud, waste, and abuse that is posed by the
8category of risk of the vendor. The Illinois Department shall
9establish the procedures for oversight, screening, and review,
10which may include, but need not be limited to: criminal and
11financial background checks; fingerprinting; license,
12certification, and authorization verifications; unscheduled or
13unannounced site visits; database checks; prepayment audit
14reviews; audits; payment caps; payment suspensions; and other
15screening as required by federal or State law.
16    The Department shall define or specify the following: (i)
17by provider notice, the "category of risk of the vendor" for
18each type of vendor, which shall take into account the level of
19screening applicable to a particular category of vendor under
20federal law and regulations; (ii) by rule or provider notice,
21the maximum length of the conditional enrollment period for
22each category of risk of the vendor; and (iii) by rule, the
23hearing rights, if any, afforded to a vendor in each category
24of risk of the vendor that is terminated or disenrolled during
25the conditional enrollment period.
26    To be eligible for payment consideration, a vendor's



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1payment claim or bill, either as an initial claim or as a
2resubmitted claim following prior rejection, must be received
3by the Illinois Department, or its fiscal intermediary, no
4later than 180 days after the latest date on the claim on which
5medical goods or services were provided, with the following
7        (1) In the case of a provider whose enrollment is in
8    process by the Illinois Department, the 180-day period
9    shall not begin until the date on the written notice from
10    the Illinois Department that the provider enrollment is
11    complete.
12        (2) In the case of errors attributable to the Illinois
13    Department or any of its claims processing intermediaries
14    which result in an inability to receive, process, or
15    adjudicate a claim, the 180-day period shall not begin
16    until the provider has been notified of the error.
17        (3) In the case of a provider for whom the Illinois
18    Department initiates the monthly billing process.
19        (4) In the case of a provider operated by a unit of
20    local government with a population exceeding 3,000,000
21    when local government funds finance federal participation
22    for claims payments.
23    For claims for services rendered during a period for which
24a recipient received retroactive eligibility, claims must be
25filed within 180 days after the Department determines the
26applicant is eligible. For claims for which the Illinois



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1Department is not the primary payer, claims must be submitted
2to the Illinois Department within 180 days after the final
3adjudication by the primary payer.
4    In the case of long term care facilities, within 5 days of
5receipt by the facility of required prescreening information,
6data for new admissions shall be entered into the Medical
7Electronic Data Interchange (MEDI) or the Recipient
8Eligibility Verification (REV) System or successor system, and
9within 15 days of receipt by the facility of required
10prescreening information, admission documents shall be
11submitted through MEDI or REV or shall be submitted directly to
12the Department of Human Services using required admission
13forms. Effective September 1, 2014, admission documents,
14including all prescreening information, must be submitted
15through MEDI or REV. Confirmation numbers assigned to an
16accepted transaction shall be retained by a facility to verify
17timely submittal. Once an admission transaction has been
18completed, all resubmitted claims following prior rejection
19are subject to receipt no later than 180 days after the
20admission transaction has been completed.
21    Claims that are not submitted and received in compliance
22with the foregoing requirements shall not be eligible for
23payment under the medical assistance program, and the State
24shall have no liability for payment of those claims.
25    To the extent consistent with applicable information and
26privacy, security, and disclosure laws, State and federal



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1agencies and departments shall provide the Illinois Department
2access to confidential and other information and data necessary
3to perform eligibility and payment verifications and other
4Illinois Department functions. This includes, but is not
5limited to: information pertaining to licensure;
6certification; earnings; immigration status; citizenship; wage
7reporting; unearned and earned income; pension income;
8employment; supplemental security income; social security
9numbers; National Provider Identifier (NPI) numbers; the
10National Practitioner Data Bank (NPDB); program and agency
11exclusions; taxpayer identification numbers; tax delinquency;
12corporate information; and death records.
13    The Illinois Department shall enter into agreements with
14State agencies and departments, and is authorized to enter into
15agreements with federal agencies and departments, under which
16such agencies and departments shall share data necessary for
17medical assistance program integrity functions and oversight.
18The Illinois Department shall develop, in cooperation with
19other State departments and agencies, and in compliance with
20applicable federal laws and regulations, appropriate and
21effective methods to share such data. At a minimum, and to the
22extent necessary to provide data sharing, the Illinois
23Department shall enter into agreements with State agencies and
24departments, and is authorized to enter into agreements with
25federal agencies and departments, including but not limited to:
26the Secretary of State; the Department of Revenue; the



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1Department of Public Health; the Department of Human Services;
2and the Department of Financial and Professional Regulation.
3    Beginning in fiscal year 2013, the Illinois Department
4shall set forth a request for information to identify the
5benefits of a pre-payment, post-adjudication, and post-edit
6claims system with the goals of streamlining claims processing
7and provider reimbursement, reducing the number of pending or
8rejected claims, and helping to ensure a more transparent
9adjudication process through the utilization of: (i) provider
10data verification and provider screening technology; and (ii)
11clinical code editing; and (iii) pre-pay, pre- or
12post-adjudicated predictive modeling with an integrated case
13management system with link analysis. Such a request for
14information shall not be considered as a request for proposal
15or as an obligation on the part of the Illinois Department to
16take any action or acquire any products or services.
17    The Illinois Department shall establish policies,
18procedures, standards and criteria by rule for the acquisition,
19repair and replacement of orthotic and prosthetic devices and
20durable medical equipment. Such rules shall provide, but not be
21limited to, the following services: (1) immediate repair or
22replacement of such devices by recipients; and (2) rental,
23lease, purchase or lease-purchase of durable medical equipment
24in a cost-effective manner, taking into consideration the
25recipient's medical prognosis, the extent of the recipient's
26needs, and the requirements and costs for maintaining such



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1equipment. Subject to prior approval, such rules shall enable a
2recipient to temporarily acquire and use alternative or
3substitute devices or equipment pending repairs or
4replacements of any device or equipment previously authorized
5for such recipient by the Department.
6    The Department shall execute, relative to the nursing home
7prescreening project, written inter-agency agreements with the
8Department of Human Services and the Department on Aging, to
9effect the following: (i) intake procedures and common
10eligibility criteria for those persons who are receiving
11non-institutional services; and (ii) the establishment and
12development of non-institutional services in areas of the State
13where they are not currently available or are undeveloped; and
14(iii) notwithstanding any other provision of law, subject to
15federal approval, on and after July 1, 2012, an increase in the
16determination of need (DON) scores from 29 to 37 for applicants
17for institutional and home and community-based long term care;
18if and only if federal approval is not granted, the Department
19may, in conjunction with other affected agencies, implement
20utilization controls or changes in benefit packages to
21effectuate a similar savings amount for this population; and
22(iv) no later than July 1, 2013, minimum level of care
23eligibility criteria for institutional and home and
24community-based long term care; and (v) no later than October
251, 2013, establish procedures to permit long term care
26providers access to eligibility scores for individuals with an



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1admission date who are seeking or receiving services from the
2long term care provider. In order to select the minimum level
3of care eligibility criteria, the Governor shall establish a
4workgroup that includes affected agency representatives and
5stakeholders representing the institutional and home and
6community-based long term care interests. This Section shall
7not restrict the Department from implementing lower level of
8care eligibility criteria for community-based services in
9circumstances where federal approval has been granted.
10    The Illinois Department shall develop and operate, in
11cooperation with other State Departments and agencies and in
12compliance with applicable federal laws and regulations,
13appropriate and effective systems of health care evaluation and
14programs for monitoring of utilization of health care services
15and facilities, as it affects persons eligible for medical
16assistance under this Code.
17    The Illinois Department shall report annually to the
18General Assembly, no later than the second Friday in April of
191979 and each year thereafter, in regard to:
20        (a) actual statistics and trends in utilization of
21    medical services by public aid recipients;
22        (b) actual statistics and trends in the provision of
23    the various medical services by medical vendors;
24        (c) current rate structures and proposed changes in
25    those rate structures for the various medical vendors; and
26        (d) efforts at utilization review and control by the



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1    Illinois Department.
2    The period covered by each report shall be the 3 years
3ending on the June 30 prior to the report. The report shall
4include suggested legislation for consideration by the General
5Assembly. The filing of one copy of the report with the
6Speaker, one copy with the Minority Leader and one copy with
7the Clerk of the House of Representatives, one copy with the
8President, one copy with the Minority Leader and one copy with
9the Secretary of the Senate, one copy with the Legislative
10Research Unit, and such additional copies with the State
11Government Report Distribution Center for the General Assembly
12as is required under paragraph (t) of Section 7 of the State
13Library Act shall be deemed sufficient to comply with this
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21    On and after July 1, 2012, the Department shall reduce any
22rate of reimbursement for services or other payments or alter
23any methodologies authorized by this Code to reduce any rate of
24reimbursement for services or other payments in accordance with
25Section 5-5e.
26    Because kidney transplantation can be an appropriate, cost



09900HB1876ham001- 24 -LRB099 06677 KTG 34378 a

1effective alternative to renal dialysis when medically
2necessary and notwithstanding the provisions of Section 1-11 of
3this Code, beginning October 1, 2014, the Department shall
4cover kidney transplantation for noncitizens with end-stage
5renal disease who are not eligible for comprehensive medical
6benefits, who meet the residency requirements of Section 5-3 of
7this Code, and who would otherwise meet the financial
8requirements of the appropriate class of eligible persons under
9Section 5-2 of this Code. To qualify for coverage of kidney
10transplantation, such person must be receiving emergency renal
11dialysis services covered by the Department. Providers under
12this Section shall be prior approved and certified by the
13Department to perform kidney transplantation and the services
14under this Section shall be limited to services associated with
15kidney transplantation.
16(Source: P.A. 97-48, eff. 6-28-11; 97-638, eff. 1-1-12; 97-689,
17eff. 6-14-12; 97-1061, eff. 8-24-12; 98-104, Article 9, Section
189-5, eff. 7-22-13; 98-104, Article 12, Section 12-20, eff.
197-22-13; 98-303, eff. 8-9-13; 98-463, eff. 8-16-13; 98-651,
20eff. 6-16-14; 98-756, eff. 7-16-14; 98-963, eff. 8-15-14;
21revised 10-2-14.)
22    Section 99. Effective date. This Act takes effect upon
23becoming law.".