Full Text of SB0647 101st General Assembly
SB0647 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 SB0647 Introduced 1/31/2019, by Sen. John J. Cullerton SYNOPSIS AS INTRODUCED: |
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305 ILCS 5/5-4.2 | from Ch. 23, par. 5-4.2 |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning ambulance services payments.
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| | A BILL FOR |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 5-4.2 as follows:
| 6 | | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
| 7 | | Sec. 5-4.2. Ambulance services payments.
| 8 | | (a) For
ambulance
services provided to a recipient of aid | 9 | | under this Article on or after
January 1, 1993, the
the | 10 | | Illinois Department shall reimburse ambulance service
| 11 | | providers at rates calculated in accordance with this Section. | 12 | | It is the intent
of the General Assembly to provide adequate | 13 | | reimbursement for ambulance
services so as to ensure adequate | 14 | | access to services for recipients of aid
under this Article and | 15 | | to provide appropriate incentives to ambulance service
| 16 | | providers to provide services in an efficient and | 17 | | cost-effective manner. Thus,
it is the intent of the General | 18 | | Assembly that the Illinois Department implement
a | 19 | | reimbursement system for ambulance services that, to the extent | 20 | | practicable
and subject to the availability of funds | 21 | | appropriated by the General Assembly
for this purpose, is | 22 | | consistent with the payment principles of Medicare. To
ensure | 23 | | uniformity between the payment principles of Medicare and |
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| 1 | | Medicaid, the
Illinois Department shall follow, to the extent | 2 | | necessary and practicable and
subject to the availability of | 3 | | funds appropriated by the General Assembly for
this purpose, | 4 | | the statutes, laws, regulations, policies, procedures,
| 5 | | principles, definitions, guidelines, and manuals used to | 6 | | determine the amounts
paid to ambulance service providers under | 7 | | Title XVIII of the Social Security
Act (Medicare). | 8 | | (b) For ambulance services provided to a recipient of aid | 9 | | under this Article
on or after January 1, 1996, the Illinois | 10 | | Department shall reimburse ambulance
service providers based | 11 | | upon the actual distance traveled if a natural
disaster, | 12 | | weather conditions, road repairs, or traffic congestion | 13 | | necessitates
the use of a
route other than the most direct | 14 | | route.
| 15 | | (c) For purposes of this Section, "ambulance services" | 16 | | includes medical
transportation services provided by means of | 17 | | an ambulance, medi-car, service
car, or
taxi.
| 18 | | (c-1) For purposes of this Section, "ground ambulance | 19 | | service" means medical transportation services that are | 20 | | described as ground ambulance services by the Centers for | 21 | | Medicare and Medicaid Services and provided in a vehicle that | 22 | | is licensed as an ambulance by the Illinois Department of | 23 | | Public Health pursuant to the Emergency Medical Services (EMS) | 24 | | Systems Act. | 25 | | (c-2) For purposes of this Section, "ground ambulance | 26 | | service provider" means a vehicle service provider as described |
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| 1 | | in the Emergency Medical Services (EMS) Systems Act that | 2 | | operates licensed ambulances for the purpose of providing | 3 | | emergency ambulance services, or non-emergency ambulance | 4 | | services, or both. For purposes of this Section, this includes | 5 | | both ambulance providers and ambulance suppliers as described | 6 | | by the Centers for Medicare and Medicaid Services. | 7 | | (c-3) For purposes of this Section, "medi-car" means | 8 | | transportation services provided to a patient who is confined | 9 | | to a wheelchair and requires the use of a hydraulic or electric | 10 | | lift or ramp and wheelchair lockdown when the patient's | 11 | | condition does not require medical observation, medical | 12 | | supervision, medical equipment, the administration of | 13 | | medications, or the administration of oxygen. | 14 | | (c-4) For purposes of this Section, "service car" means | 15 | | transportation services provided to a patient by a passenger | 16 | | vehicle where that patient does not require the specialized | 17 | | modes described in subsection (c-1) or (c-3). | 18 | | (d) This Section does not prohibit separate billing by | 19 | | ambulance service
providers for oxygen furnished while | 20 | | providing advanced life support
services.
| 21 | | (e) Beginning with services rendered on or after July 1, | 22 | | 2008, all providers of non-emergency medi-car and service car | 23 | | transportation must certify that the driver and employee | 24 | | attendant, as applicable, have completed a safety program | 25 | | approved by the Department to protect both the patient and the | 26 | | driver, prior to transporting a patient.
The provider must |
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| 1 | | maintain this certification in its records. The provider shall | 2 | | produce such documentation upon demand by the Department or its | 3 | | representative. Failure to produce documentation of such | 4 | | training shall result in recovery of any payments made by the | 5 | | Department for services rendered by a non-certified driver or | 6 | | employee attendant. Medi-car and service car providers must | 7 | | maintain legible documentation in their records of the driver | 8 | | and, as applicable, employee attendant that actually | 9 | | transported the patient. Providers must recertify all drivers | 10 | | and employee attendants every 3 years.
| 11 | | Notwithstanding the requirements above, any public | 12 | | transportation provider of medi-car and service car | 13 | | transportation that receives federal funding under 49 U.S.C. | 14 | | 5307 and 5311 need not certify its drivers and employee | 15 | | attendants under this Section, since safety training is already | 16 | | federally mandated.
| 17 | | (f) With respect to any policy or program administered by | 18 | | the Department or its agent regarding approval of non-emergency | 19 | | medical transportation by ground ambulance service providers, | 20 | | including, but not limited to, the Non-Emergency | 21 | | Transportation Services Prior Approval Program (NETSPAP), the | 22 | | Department shall establish by rule a process by which ground | 23 | | ambulance service providers of non-emergency medical | 24 | | transportation may appeal any decision by the Department or its | 25 | | agent for which no denial was received prior to the time of | 26 | | transport that either (i) denies a request for approval for |
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| 1 | | payment of non-emergency transportation by means of ground | 2 | | ambulance service or (ii) grants a request for approval of | 3 | | non-emergency transportation by means of ground ambulance | 4 | | service at a level of service that entitles the ground | 5 | | ambulance service provider to a lower level of compensation | 6 | | from the Department than the ground ambulance service provider | 7 | | would have received as compensation for the level of service | 8 | | requested. The rule shall be filed by December 15, 2012 and | 9 | | shall provide that, for any decision rendered by the Department | 10 | | or its agent on or after the date the rule takes effect, the | 11 | | ground ambulance service provider shall have 60 days from the | 12 | | date the decision is received to file an appeal. The rule | 13 | | established by the Department shall be, insofar as is | 14 | | practical, consistent with the Illinois Administrative | 15 | | Procedure Act. The Director's decision on an appeal under this | 16 | | Section shall be a final administrative decision subject to | 17 | | review under the Administrative Review Law. | 18 | | (f-5) Beginning 90 days after July 20, 2012 (the effective | 19 | | date of Public Act 97-842), (i) no denial of a request for | 20 | | approval for payment of non-emergency transportation by means | 21 | | of ground ambulance service, and (ii) no approval of | 22 | | non-emergency transportation by means of ground ambulance | 23 | | service at a level of service that entitles the ground | 24 | | ambulance service provider to a lower level of compensation | 25 | | from the Department than would have been received at the level | 26 | | of service submitted by the ground ambulance service provider, |
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| 1 | | may be issued by the Department or its agent unless the | 2 | | Department has submitted the criteria for determining the | 3 | | appropriateness of the transport for first notice publication | 4 | | in the Illinois Register pursuant to Section 5-40 of the | 5 | | Illinois Administrative Procedure Act. | 6 | | (g) Whenever a patient covered by a medical assistance | 7 | | program under this Code or by another medical program | 8 | | administered by the Department, including a patient covered | 9 | | under the State's Medicaid managed care program, is being | 10 | | transported from a facility and requires non-emergency | 11 | | transportation including ground ambulance, medi-car, or | 12 | | service car transportation, a Physician Certification | 13 | | Statement as described in this Section shall be required for | 14 | | each patient. Facilities shall develop procedures for a | 15 | | licensed medical professional to provide a written and signed | 16 | | Physician Certification Statement. The Physician Certification | 17 | | Statement shall specify the level of transportation services | 18 | | needed and complete a medical certification establishing the | 19 | | criteria for approval of non-emergency ambulance | 20 | | transportation, as published by the Department of Healthcare | 21 | | and Family Services, that is met by the patient. This | 22 | | certification shall be completed prior to ordering the | 23 | | transportation service and prior to patient discharge. The | 24 | | Physician Certification Statement is not required prior to | 25 | | transport if a delay in transport can be expected to negatively | 26 | | affect the patient outcome. |
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| 1 | | The medical certification specifying the level and type of | 2 | | non-emergency transportation needed shall be in the form of the | 3 | | Physician Certification Statement on a standardized form | 4 | | prescribed by the Department of Healthcare and Family Services. | 5 | | Within 75 days after July 27, 2018 ( the effective date of | 6 | | Public Act 100-646)
this amendatory Act of the 100th General | 7 | | Assembly , the Department of Healthcare and Family Services | 8 | | shall develop a standardized form of the Physician | 9 | | Certification Statement specifying the level and type of | 10 | | transportation services needed in consultation with the | 11 | | Department of Public Health, Medicaid managed care | 12 | | organizations, a statewide association representing ambulance | 13 | | providers, a statewide association representing hospitals, 3 | 14 | | statewide associations representing nursing homes, and other | 15 | | stakeholders. The Physician Certification Statement shall | 16 | | include, but is not limited to, the criteria necessary to | 17 | | demonstrate medical necessity for the level of transport needed | 18 | | as required by (i) the Department of Healthcare and Family | 19 | | Services and (ii) the federal Centers for Medicare and Medicaid | 20 | | Services as outlined in the Centers for Medicare and Medicaid | 21 | | Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap. | 22 | | 10, Sec. 10.2.1, et seq. The use of the Physician Certification | 23 | | Statement shall satisfy the obligations of hospitals under | 24 | | Section 6.22 of the Hospital Licensing Act and nursing homes | 25 | | under Section 2-217 of the Nursing Home Care Act. | 26 | | Implementation and acceptance of the Physician Certification |
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| 1 | | Statement shall take place no later than 90 days after the | 2 | | issuance of the Physician Certification Statement by the | 3 | | Department of Healthcare and Family Services. | 4 | | Pursuant to subsection (E) of Section 12-4.25 of this Code, | 5 | | the Department is entitled to recover overpayments paid to a | 6 | | provider or vendor, including, but not limited to, from the | 7 | | discharging physician, the discharging facility, and the | 8 | | ground ambulance service provider, in instances where a | 9 | | non-emergency ground ambulance service is rendered as the | 10 | | result of improper or false certification. | 11 | | Beginning October 1, 2018, the Department of Healthcare and | 12 | | Family Services shall collect data from Medicaid managed care | 13 | | organizations and transportation brokers, including the | 14 | | Department's NETSPAP broker, regarding denials and appeals | 15 | | related to the missing or incomplete Physician Certification | 16 | | Statement forms and overall compliance with this subsection. | 17 | | The Department of Healthcare and Family Services shall publish | 18 | | quarterly results on its website within 15 days following the | 19 | | end of each quarter. | 20 | | (h) On and after July 1, 2012, the Department shall reduce | 21 | | any rate of reimbursement for services or other payments or | 22 | | alter any methodologies authorized by this Code to reduce any | 23 | | rate of reimbursement for services or other payments in | 24 | | accordance with Section 5-5e. | 25 | | (i) On and after July 1, 2018, the Department shall | 26 | | increase the base rate of reimbursement for both base charges |
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| 1 | | and mileage charges for ground ambulance service providers for | 2 | | medical transportation services provided by means of a ground | 3 | | ambulance to a level not lower than 112% of the base rate in | 4 | | effect as of June 30, 2018. | 5 | | (Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18; | 6 | | revised 8-27-18.)
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