Illinois General Assembly - Full Text of HB1876
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Full Text of HB1876  99th General Assembly



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1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
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
17care furnished by licensed practitioners; (7) home health care
18services; (8) private duty nursing service; (9) clinic
19services; (10) dental services, including prevention and
20treatment of periodontal disease and dental caries disease for
21pregnant women, provided by an individual licensed to practice
22dentistry or dental surgery; for purposes of this item (10),
23"dental services" means diagnostic, preventive, or corrective



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1procedures provided by or under the supervision of a dentist in
2the practice of his or her profession; (11) physical therapy
3and related services; (12) prescribed drugs, dentures, and
4prosthetic devices; and eyeglasses prescribed by a physician
5skilled in the diseases of the eye, or by an optometrist,
6whichever the person may select; (13) other diagnostic,
7screening, preventive, and rehabilitative services, including
8to ensure that the individual's need for intervention or
9treatment of mental disorders or substance use disorders or
10co-occurring mental health and substance use disorders is
11determined using a uniform screening, assessment, and
12evaluation process inclusive of criteria, for children and
13adults; for purposes of this item (13), a uniform screening,
14assessment, and evaluation process refers to a process that
15includes an appropriate evaluation and, as warranted, a
16referral; "uniform" does not mean the use of a singular
17instrument, tool, or process that all must utilize; (14)
18transportation and such other expenses as may be necessary;
19(15) medical treatment of sexual assault survivors, as defined
20in Section 1a of the Sexual Assault Survivors Emergency
21Treatment Act, for injuries sustained as a result of the sexual
22assault, including examinations and laboratory tests to
23discover evidence which may be used in criminal proceedings
24arising from the sexual assault; (16) the diagnosis and
25treatment of sickle cell anemia; and (17) any other medical
26care, and any other type of remedial care recognized under the



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1laws of this State, but not including abortions, or induced
2miscarriages or premature births, unless, in the opinion of a
3physician, such procedures are necessary for the preservation
4of the life of the woman seeking such treatment, or except an
5induced premature birth intended to produce a live viable child
6and such procedure is necessary for the health of the mother or
7her unborn child. The Illinois Department, by rule, shall
8prohibit any physician from providing medical assistance to
9anyone eligible therefor under this Code where such physician
10has been found guilty of performing an abortion procedure in a
11wilful and wanton manner upon a woman who was not pregnant at
12the time such abortion procedure was performed. The term "any
13other type of remedial care" shall include nursing care and
14nursing home service for persons who rely on treatment by
15spiritual means alone through prayer for healing.
16    Notwithstanding any other provision of this Section, a
17comprehensive tobacco use cessation program that includes
18purchasing prescription drugs or prescription medical devices
19approved by the Food and Drug Administration shall be covered
20under the medical assistance program under this Article for
21persons who are otherwise eligible for assistance under this
23    Notwithstanding any other provision of this Code, the
24Illinois Department may not require, as a condition of payment
25for any laboratory test authorized under this Article, that a
26physician's handwritten signature appear on the laboratory



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1test order form. The Illinois Department may, however, impose
2other appropriate requirements regarding laboratory test order
4    Upon receipt of federal approval of an amendment to the
5Illinois Title XIX State Plan for this purpose, the Department
6shall authorize the Chicago Public Schools (CPS) to procure a
7vendor or vendors to manufacture eyeglasses for individuals
8enrolled in a school within the CPS system. CPS shall ensure
9that its vendor or vendors are enrolled as providers in the
10medical assistance program and in any capitated Medicaid
11managed care entity (MCE) serving individuals enrolled in a
12school within the CPS system. Under any contract procured under
13this provision, the vendor or vendors must serve only
14individuals enrolled in a school within the CPS system. Claims
15for services provided by CPS's vendor or vendors to recipients
16of benefits in the medical assistance program under this Code,
17the Children's Health Insurance Program, or the Covering ALL
18KIDS Health Insurance Program shall be submitted to the
19Department or the MCE in which the individual is enrolled for
20payment and shall be reimbursed at the Department's or the
21MCE's established rates or rate methodologies for eyeglasses.
22    On and after July 1, 2012, the Department of Healthcare and
23Family Services may provide the following services to persons
24eligible for assistance under this Article who are
25participating in education, training or employment programs
26operated by the Department of Human Services as successor to



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1the Department of Public Aid:
2        (1) dental services provided by or under the
3    supervision of a dentist; and
4        (2) eyeglasses prescribed by a physician skilled in the
5    diseases of the eye, or by an optometrist, whichever the
6    person may select.
7    Notwithstanding any other provision of this Code and
8subject to federal approval, the Department may adopt rules to
9allow a dentist who is volunteering his or her service at no
10cost to render dental services through an enrolled
11not-for-profit health clinic without the dentist personally
12enrolling as a participating provider in the medical assistance
13program. A not-for-profit health clinic shall include a public
14health clinic or Federally Qualified Health Center or other
15enrolled provider, as determined by the Department, through
16which dental services covered under this Section are performed.
17The Department shall establish a process for payment of claims
18for reimbursement for covered dental services rendered under
19this provision.
20    The Illinois Department, by rule, may distinguish and
21classify the medical services to be provided only in accordance
22with the classes of persons designated in Section 5-2.
23    The Department of Healthcare and Family Services must
24provide coverage and reimbursement for amino acid-based
25elemental formulas, regardless of delivery method, for the
26diagnosis and treatment of (i) eosinophilic disorders and (ii)



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1short bowel syndrome when the prescribing physician has issued
2a written order stating that the amino acid-based elemental
3formula is medically necessary.
4    The Illinois Department shall authorize the provision of,
5and shall authorize payment for, screening by low-dose
6mammography for the presence of occult breast cancer for women
735 years of age or older who are eligible for medical
8assistance under this Article, as follows:
9        (A) A baseline mammogram for women 35 to 39 years of
10    age.
11        (B) An annual mammogram for women 40 years of age or
12    older.
13        (C) A mammogram at the age and intervals considered
14    medically necessary by the woman's health care provider for
15    women under 40 years of age and having a family history of
16    breast cancer, prior personal history of breast cancer,
17    positive genetic testing, or other risk factors.
18        (D) A comprehensive ultrasound screening of an entire
19    breast or breasts if a mammogram demonstrates
20    heterogeneous or dense breast tissue, when medically
21    necessary as determined by a physician licensed to practice
22    medicine in all of its branches.
23    All screenings shall include a physical breast exam,
24instruction on self-examination and information regarding the
25frequency of self-examination and its value as a preventative
26tool. For purposes of this Section, "low-dose mammography"



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1means the x-ray examination of the breast using equipment
2dedicated specifically for mammography, including the x-ray
3tube, filter, compression device, and image receptor, with an
4average radiation exposure delivery of less than one rad per
5breast for 2 views of an average size breast. The term also
6includes digital mammography.
7    On and after January 1, 2012, providers participating in a
8quality improvement program approved by the Department shall be
9reimbursed for screening and diagnostic mammography at the same
10rate as the Medicare program's rates, including the increased
11reimbursement for digital mammography.
12    The Department shall convene an expert panel including
13representatives of hospitals, free-standing mammography
14facilities, and doctors, including radiologists, to establish
15quality standards.
16    Subject to federal approval, the Department shall
17establish a rate methodology for mammography at federally
18qualified health centers and other encounter-rate clinics.
19These clinics or centers may also collaborate with other
20hospital-based mammography facilities.
21    The Department shall establish a methodology to remind
22women who are age-appropriate for screening mammography, but
23who have not received a mammogram within the previous 18
24months, of the importance and benefit of screening mammography.
25    The Department shall establish a performance goal for
26primary care providers with respect to their female patients



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1over age 40 receiving an annual mammogram. This performance
2goal shall be used to provide additional reimbursement in the
3form of a quality performance bonus to primary care providers
4who meet that goal.
5    The Department shall devise a means of case-managing or
6patient navigation for beneficiaries diagnosed with breast
7cancer. This program shall initially operate as a pilot program
8in areas of the State with the highest incidence of mortality
9related to breast cancer. At least one pilot program site shall
10be in the metropolitan Chicago area and at least one site shall
11be outside the metropolitan Chicago area. An evaluation of the
12pilot program shall be carried out measuring health outcomes
13and cost of care for those served by the pilot program compared
14to similarly situated patients who are not served by the pilot
16    Any medical or health care provider shall immediately
17recommend, to any pregnant woman who is being provided prenatal
18services and is suspected of drug abuse or is addicted as
19defined in the Alcoholism and Other Drug Abuse and Dependency
20Act, referral to a local substance abuse treatment provider
21licensed by the Department of Human Services or to a licensed
22hospital which provides substance abuse treatment services.
23The Department of Healthcare and Family Services shall assure
24coverage for the cost of treatment of the drug abuse or
25addiction for pregnant recipients in accordance with the
26Illinois Medicaid Program in conjunction with the Department of



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1Human Services.
2    All medical providers providing medical assistance to
3pregnant women under this Code shall receive information from
4the Department on the availability of services under the Drug
5Free Families with a Future or any comparable program providing
6case management services for addicted women, including
7information on appropriate referrals for other social services
8that may be needed by addicted women in addition to treatment
9for addiction.
10    The Illinois Department, in cooperation with the
11Departments of Human Services (as successor to the Department
12of Alcoholism and Substance Abuse) and Public Health, through a
13public awareness campaign, may provide information concerning
14treatment for alcoholism and drug abuse and addiction, prenatal
15health care, and other pertinent programs directed at reducing
16the number of drug-affected infants born to recipients of
17medical assistance.
18    Neither the Department of Healthcare and Family Services
19nor the Department of Human Services shall sanction the
20recipient solely on the basis of her substance abuse.
21    The Illinois Department shall establish such regulations
22governing the dispensing of health services under this Article
23as it shall deem appropriate. The Department should seek the
24advice of formal professional advisory committees appointed by
25the Director of the Illinois Department for the purpose of
26providing regular advice on policy and administrative matters,



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



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



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1    The Department shall apply for a waiver from the United
2States Health Care Financing Administration to allow for the
3implementation of Partnerships under this Section.
4    The Illinois Department shall require health care
5providers to maintain records that document the medical care
6and services provided to recipients of Medical Assistance under
7this Article. Such records must be retained for a period of not
8less than 6 years from the date of service or as provided by
9applicable State law, whichever period is longer, except that
10if an audit is initiated within the required retention period
11then the records must be retained until the audit is completed
12and every exception is resolved. The Illinois Department shall
13require health care providers to make available, when
14authorized by the patient, in writing, the medical records in a
15timely fashion to other health care providers who are treating
16or serving persons eligible for Medical Assistance under this
17Article. All dispensers of medical services shall be required
18to maintain and retain business and professional records
19sufficient to fully and accurately document the nature, scope,
20details and receipt of the health care provided to persons
21eligible for medical assistance under this Code, in accordance
22with regulations promulgated by the Illinois Department. The
23rules and regulations shall require that proof of the receipt
24of prescription drugs, dentures, prosthetic devices and
25eyeglasses by eligible persons under this Section accompany
26each claim for reimbursement submitted by the dispenser of such



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1medical services. No such claims for reimbursement shall be
2approved for payment by the Illinois Department without such
3proof of receipt, unless the Illinois Department shall have put
4into effect and shall be operating a system of post-payment
5audit and review which shall, on a sampling basis, be deemed
6adequate by the Illinois Department to assure that such drugs,
7dentures, prosthetic devices and eyeglasses for which payment
8is being made are actually being received by eligible
9recipients. Within 90 days after the effective date of this
10amendatory Act of 1984, the Illinois Department shall establish
11a current list of acquisition costs for all prosthetic devices
12and any other items recognized as medical equipment and
13supplies reimbursable under this Article and shall update such
14list on a quarterly basis, except that the acquisition costs of
15all prescription drugs shall be updated no less frequently than
16every 30 days as required by Section 5-5.12.
17    The rules and regulations of the Illinois Department shall
18require that a written statement including the required opinion
19of a physician shall accompany any claim for reimbursement for
20abortions, or induced miscarriages or premature births. This
21statement shall indicate what procedures were used in providing
22such medical services.
23    Notwithstanding any other law to the contrary, the Illinois
24Department shall, within 365 days after July 22, 2013, (the
25effective date of Public Act 98-104), establish procedures to
26permit skilled care facilities licensed under the Nursing Home



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1Care Act to submit monthly billing claims for reimbursement
2purposes. Following development of these procedures, the
3Department shall, by July 1, 2016, have an additional 365 days
4to test the viability of the new system and implement to ensure
5that any necessary operational or structural changes to its
6information technology platforms in order to allow for the
7direct acceptance and payment of nursing home claims are
9    Notwithstanding any other law to the contrary, the Illinois
10Department shall, within 365 days after August 15, 2014 (the
11effective date of Public Act 98-963) this amendatory Act of the
1298th General Assembly, establish procedures to permit ID/DD
13facilities licensed under the ID/DD Community Care Act to
14submit monthly billing claims for reimbursement purposes.
15Following development of these procedures, the Department
16shall have an additional 365 days to test the viability of the
17new system and to ensure that any necessary operational or
18structural changes to its information technology platforms are
20    The Illinois Department shall require all dispensers of
21medical services, other than an individual practitioner or
22group of practitioners, desiring to participate in the Medical
23Assistance program established under this Article to disclose
24all financial, beneficial, ownership, equity, surety or other
25interests in any and all firms, corporations, partnerships,
26associations, business enterprises, joint ventures, agencies,



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1institutions or other legal entities providing any form of
2health care services in this State under this Article.
3    The Illinois Department may require that all dispensers of
4medical services desiring to participate in the medical
5assistance program established under this Article disclose,
6under such terms and conditions as the Illinois Department may
7by rule establish, all inquiries from clients and attorneys
8regarding medical bills paid by the Illinois Department, which
9inquiries could indicate potential existence of claims or liens
10for the Illinois Department.
11    Enrollment of a vendor shall be subject to a provisional
12period and shall be conditional for one year. During the period
13of conditional enrollment, the Department may terminate the
14vendor's eligibility to participate in, or may disenroll the
15vendor from, the medical assistance program without cause.
16Unless otherwise specified, such termination of eligibility or
17disenrollment is not subject to the Department's hearing
18process. However, a disenrolled vendor may reapply without
20    The Department has the discretion to limit the conditional
21enrollment period for vendors based upon category of risk of
22the vendor.
23    Prior to enrollment and during the conditional enrollment
24period in the medical assistance program, all vendors shall be
25subject to enhanced oversight, screening, and review based on
26the risk of fraud, waste, and abuse that is posed by the



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1category of risk of the vendor. The Illinois Department shall
2establish the procedures for oversight, screening, and review,
3which may include, but need not be limited to: criminal and
4financial background checks; fingerprinting; license,
5certification, and authorization verifications; unscheduled or
6unannounced site visits; database checks; prepayment audit
7reviews; audits; payment caps; payment suspensions; and other
8screening as required by federal or State law.
9    The Department shall define or specify the following: (i)
10by provider notice, the "category of risk of the vendor" for
11each type of vendor, which shall take into account the level of
12screening applicable to a particular category of vendor under
13federal law and regulations; (ii) by rule or provider notice,
14the maximum length of the conditional enrollment period for
15each category of risk of the vendor; and (iii) by rule, the
16hearing rights, if any, afforded to a vendor in each category
17of risk of the vendor that is terminated or disenrolled during
18the conditional enrollment period.
19    To be eligible for payment consideration, a vendor's
20payment claim or bill, either as an initial claim or as a
21resubmitted claim following prior rejection, must be received
22by the Illinois Department, or its fiscal intermediary, no
23later than 180 days after the latest date on the claim on which
24medical goods or services were provided, with the following
26        (1) In the case of a provider whose enrollment is in



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1    process by the Illinois Department, the 180-day period
2    shall not begin until the date on the written notice from
3    the Illinois Department that the provider enrollment is
4    complete.
5        (2) In the case of errors attributable to the Illinois
6    Department or any of its claims processing intermediaries
7    which result in an inability to receive, process, or
8    adjudicate a claim, the 180-day period shall not begin
9    until the provider has been notified of the error.
10        (3) In the case of a provider for whom the Illinois
11    Department initiates the monthly billing process.
12        (4) In the case of a provider operated by a unit of
13    local government with a population exceeding 3,000,000
14    when local government funds finance federal participation
15    for claims payments.
16    For claims for services rendered during a period for which
17a recipient received retroactive eligibility, claims must be
18filed within 180 days after the Department determines the
19applicant is eligible. For claims for which the Illinois
20Department is not the primary payer, claims must be submitted
21to the Illinois Department within 180 days after the final
22adjudication by the primary payer.
23    In the case of long term care facilities, within 5 days of
24receipt by the facility of required prescreening information,
25data for new admissions shall be entered into the Medical
26Electronic Data Interchange (MEDI) or the Recipient



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1Eligibility Verification (REV) System or successor system, and
2within 15 days of receipt by the facility of required
3prescreening information, admission documents shall be
4submitted through MEDI or REV or shall be submitted directly to
5the Department of Human Services using required admission
6forms. Effective September 1, 2014, admission documents,
7including all prescreening information, must be submitted
8through MEDI or REV. Confirmation numbers assigned to an
9accepted transaction shall be retained by a facility to verify
10timely submittal. Once an admission transaction has been
11completed, all resubmitted claims following prior rejection
12are subject to receipt no later than 180 days after the
13admission transaction has been completed.
14    Claims that are not submitted and received in compliance
15with the foregoing requirements shall not be eligible for
16payment under the medical assistance program, and the State
17shall have no liability for payment of those claims.
18    To the extent consistent with applicable information and
19privacy, security, and disclosure laws, State and federal
20agencies and departments shall provide the Illinois Department
21access to confidential and other information and data necessary
22to perform eligibility and payment verifications and other
23Illinois Department functions. This includes, but is not
24limited to: information pertaining to licensure;
25certification; earnings; immigration status; citizenship; wage
26reporting; unearned and earned income; pension income;



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1employment; supplemental security income; social security
2numbers; National Provider Identifier (NPI) numbers; the
3National Practitioner Data Bank (NPDB); program and agency
4exclusions; taxpayer identification numbers; tax delinquency;
5corporate information; and death records.
6    The Illinois Department shall enter into agreements with
7State agencies and departments, and is authorized to enter into
8agreements with federal agencies and departments, under which
9such agencies and departments shall share data necessary for
10medical assistance program integrity functions and oversight.
11The Illinois Department shall develop, in cooperation with
12other State departments and agencies, and in compliance with
13applicable federal laws and regulations, appropriate and
14effective methods to share such data. At a minimum, and to the
15extent necessary to provide data sharing, the Illinois
16Department shall enter into agreements with State agencies and
17departments, and is authorized to enter into agreements with
18federal agencies and departments, including but not limited to:
19the Secretary of State; the Department of Revenue; the
20Department of Public Health; the Department of Human Services;
21and the Department of Financial and Professional Regulation.
22    Beginning in fiscal year 2013, the Illinois Department
23shall set forth a request for information to identify the
24benefits of a pre-payment, post-adjudication, and post-edit
25claims system with the goals of streamlining claims processing
26and provider reimbursement, reducing the number of pending or



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1rejected claims, and helping to ensure a more transparent
2adjudication process through the utilization of: (i) provider
3data verification and provider screening technology; and (ii)
4clinical code editing; and (iii) pre-pay, pre- or
5post-adjudicated predictive modeling with an integrated case
6management system with link analysis. Such a request for
7information shall not be considered as a request for proposal
8or as an obligation on the part of the Illinois Department to
9take any action or acquire any products or services.
10    The Illinois Department shall establish policies,
11procedures, standards and criteria by rule for the acquisition,
12repair and replacement of orthotic and prosthetic devices and
13durable medical equipment. Such rules shall provide, but not be
14limited to, the following services: (1) immediate repair or
15replacement of such devices by recipients; and (2) rental,
16lease, purchase or lease-purchase of durable medical equipment
17in a cost-effective manner, taking into consideration the
18recipient's medical prognosis, the extent of the recipient's
19needs, and the requirements and costs for maintaining such
20equipment. Subject to prior approval, such rules shall enable a
21recipient to temporarily acquire and use alternative or
22substitute devices or equipment pending repairs or
23replacements of any device or equipment previously authorized
24for such recipient by the Department.
25    The Department shall execute, relative to the nursing home
26prescreening project, written inter-agency agreements with the



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1Department of Human Services and the Department on Aging, to
2effect the following: (i) intake procedures and common
3eligibility criteria for those persons who are receiving
4non-institutional services; and (ii) the establishment and
5development of non-institutional services in areas of the State
6where they are not currently available or are undeveloped; and
7(iii) notwithstanding any other provision of law, subject to
8federal approval, on and after July 1, 2012, an increase in the
9determination of need (DON) scores from 29 to 37 for applicants
10for institutional and home and community-based long term care;
11if and only if federal approval is not granted, the Department
12may, in conjunction with other affected agencies, implement
13utilization controls or changes in benefit packages to
14effectuate a similar savings amount for this population; and
15(iv) no later than July 1, 2013, minimum level of care
16eligibility criteria for institutional and home and
17community-based long term care; and (v) no later than October
181, 2013, establish procedures to permit long term care
19providers access to eligibility scores for individuals with an
20admission date who are seeking or receiving services from the
21long term care provider. In order to select the minimum level
22of care eligibility criteria, the Governor shall establish a
23workgroup that includes affected agency representatives and
24stakeholders representing the institutional and home and
25community-based long term care interests. This Section shall
26not restrict the Department from implementing lower level of



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1care eligibility criteria for community-based services in
2circumstances where federal approval has been granted.
3    The Illinois Department shall develop and operate, in
4cooperation with other State Departments and agencies and in
5compliance with applicable federal laws and regulations,
6appropriate and effective systems of health care evaluation and
7programs for monitoring of utilization of health care services
8and facilities, as it affects persons eligible for medical
9assistance under this Code.
10    The Illinois Department shall report annually to the
11General Assembly, no later than the second Friday in April of
121979 and each year thereafter, in regard to:
13        (a) actual statistics and trends in utilization of
14    medical services by public aid recipients;
15        (b) actual statistics and trends in the provision of
16    the various medical services by medical vendors;
17        (c) current rate structures and proposed changes in
18    those rate structures for the various medical vendors; and
19        (d) efforts at utilization review and control by the
20    Illinois Department.
21    The period covered by each report shall be the 3 years
22ending on the June 30 prior to the report. The report shall
23include suggested legislation for consideration by the General
24Assembly. The filing of one copy of the report with the
25Speaker, one copy with the Minority Leader and one copy with
26the Clerk of the House of Representatives, one copy with the



HB1876 Enrolled- 23 -LRB099 06677 KTG 26750 b

1President, one copy with the Minority Leader and one copy with
2the Secretary of the Senate, one copy with the Legislative
3Research Unit, and such additional copies with the State
4Government Report Distribution Center for the General Assembly
5as is required under paragraph (t) of Section 7 of the State
6Library Act shall be deemed sufficient to comply with this
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14    On and after July 1, 2012, the Department shall reduce any
15rate of reimbursement for services or other payments or alter
16any methodologies authorized by this Code to reduce any rate of
17reimbursement for services or other payments in accordance with
18Section 5-5e.
19    Because kidney transplantation can be an appropriate, cost
20effective alternative to renal dialysis when medically
21necessary and notwithstanding the provisions of Section 1-11 of
22this Code, beginning October 1, 2014, the Department shall
23cover kidney transplantation for noncitizens with end-stage
24renal disease who are not eligible for comprehensive medical
25benefits, who meet the residency requirements of Section 5-3 of
26this Code, and who would otherwise meet the financial



HB1876 Enrolled- 24 -LRB099 06677 KTG 26750 b

1requirements of the appropriate class of eligible persons under
2Section 5-2 of this Code. To qualify for coverage of kidney
3transplantation, such person must be receiving emergency renal
4dialysis services covered by the Department. Providers under
5this Section shall be prior approved and certified by the
6Department to perform kidney transplantation and the services
7under this Section shall be limited to services associated with
8kidney transplantation.
9(Source: P.A. 97-48, eff. 6-28-11; 97-638, eff. 1-1-12; 97-689,
10eff. 6-14-12; 97-1061, eff. 8-24-12; 98-104, Article 9, Section
119-5, eff. 7-22-13; 98-104, Article 12, Section 12-20, eff.
127-22-13; 98-303, eff. 8-9-13; 98-463, eff. 8-16-13; 98-651,
13eff. 6-16-14; 98-756, eff. 7-16-14; 98-963, eff. 8-15-14;
14revised 10-2-14.)
15    Section 99. Effective date. This Act takes effect upon
16becoming law.