[ Search ] [ Legislation ] [ Bill Summary ]
[ Home ] [ Back ] [ Bottom ]
90_HB0391
5 ILCS 375/6 from Ch. 127, par. 526
5 ILCS 375/6.1 from Ch. 127, par. 526.1
305 ILCS 5/5-5 from Ch. 23, par. 5-5
Amends the State Employees Group Insurance Act and the
Illinois Public Aid Code. Removes language prohibiting the
coverage of abortions for State employees. Provides that the
Department of Public Aid may not pay for abortions for public
aid recipients unless, in the physician's professional
judgement, the abortion is medically necessary or medically
indicated taking into account the physical and psychological
factors as well as the age and family situation of the woman
(now, only to preserve the life of the woman).
LRB9001350NTsb
LRB9001350NTsb
1 AN ACT concerning abortions, amending named Acts.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The State Employees Group Insurance Act of
5 1971 is amended by changing Sections 6 and 6.1 as follows:
6 (5 ILCS 375/6) (from Ch. 127, par. 526)
7 Sec. 6. (a) The program of health benefits shall provide
8 for protection against the financial costs of health care
9 expenses incurred in and out of hospital including basic
10 hospital-surgical-medical coverages. The program may include,
11 but shall not be limited to, such supplemental coverages as
12 out-patient diagnostic X-ray and laboratory expenses,
13 prescription drugs, dental services and similar group
14 benefits as are now or may become available. However,
15 nothing in this Act shall be construed to permit, on or after
16 July 1, 1980, the non-contributory portion of any such
17 program to include the expenses of obtaining an abortion,
18 induced miscarriage or induced premature birth unless, in the
19 opinion of a physician, such procedures are necessary for the
20 preservation of the life of the woman seeking such treatment,
21 or except an induced premature birth intended to produce a
22 live viable child and such procedure is necessary for the
23 health of the mother or the unborn child. The program may
24 also include coverage for those who rely on treatment by
25 prayer or spiritual means alone for healing in accordance
26 with the tenets and practice of a recognized religious
27 denomination.
28 The program of health benefits shall be designed by the
29 Director (1) to provide a reasonable relationship between the
30 benefits to be included and the expected distribution of
31 expenses of each such type to be incurred by the covered
-2- LRB9001350NTsb
1 members and dependents, (2) to specify, as covered benefits
2 and as optional benefits, the medical services of
3 practitioners in all categories licensed under the Medical
4 Practice Act of 1987, (3) to include reasonable controls,
5 which may include deductible and co-insurance provisions,
6 applicable to some or all of the benefits, or a coordination
7 of benefits provision, to prevent or minimize unnecessary
8 utilization of the various hospital, surgical and medical
9 expenses to be provided and to provide reasonable assurance
10 of stability of the program, and (4) to provide benefits to
11 the extent possible to members throughout the State, wherever
12 located, on an equitable basis. Notwithstanding any other
13 provision of this Section or Act, for all retired members or
14 retired dependents aged 65 years or older who are entitled to
15 benefits under Social Security or the Railroad Retirement
16 system or who had sufficient Medicare-covered government
17 employment, the Department shall reduce benefits which would
18 otherwise be paid by Medicare, by the amount of benefits for
19 which the retired member or retired dependents are eligible
20 under Medicare, except that such reduction in benefits shall
21 apply only to those retired members or retired dependents who
22 (1) first become eligible for such medicare coverage on or
23 after the effective date of this amendatory Act of 1992; or
24 (2) remain eligible for but no longer receive Medicare
25 coverage which they had been receiving on or after the
26 effective date of this amendatory Act of 1992.
27 Notwithstanding any other provisions of this Act, where a
28 covered member or dependents are eligible for benefits under
29 the Federal Medicare health insurance program (Title XVIII of
30 the Social Security Act as added by Public Law 89-97, 89th
31 Congress), benefits paid under the State of Illinois program
32 or plan will be reduced by the amount of benefits paid by
33 Medicare. For retired members or retired dependents aged 65
34 years or older who are entitled to benefits under Social
-3- LRB9001350NTsb
1 Security or the Railroad Retirement system or who had
2 sufficient Medicare-covered government employment, benefits
3 shall be reduced by the amount for which the retired member
4 or retired dependent is eligible under Medicare, except that
5 such reduction in benefits shall apply only to those retired
6 members or retired dependents who (1) first become eligible
7 for such Medicare coverage on or after the effective date of
8 this amendatory Act of 1992; or (2) remain eligible for, but
9 no longer receive Medicare coverage which they had been
10 receiving on or after the effective date of this amendatory
11 Act of 1992. Premiums may be adjusted, where applicable, to
12 an amount deemed by the Director to be reasonably consistent
13 with any reduction of benefits.
14 (b) A member, not otherwise covered by this Act, who has
15 retired as a participating member under Article 2 of the
16 "Illinois Pension Code" but is ineligible for the retirement
17 annuity under Section 2-119 of the "Illinois Pension Code",
18 shall pay the premiums for coverage, not exceeding the amount
19 paid by the State for the non-contributory coverage for other
20 members, under the group health insurance program or the
21 self-insurance health plan under this Act. The Director shall
22 promulgate rules and regulations to determine the premiums to
23 be paid by a member under this subsection (b).
24 (Source: P.A. 87-860.)
25 (5 ILCS 375/6.1) (from Ch. 127, par. 526.1)
26 Sec. 6.1. The program of health benefits may offer as an
27 alternative, available on an optional basis, coverage through
28 health maintenance organizations. That part of the premium
29 for such coverage which is in excess of the amount which
30 would otherwise be paid by the State for the program of
31 health benefits shall be paid by the member who elects such
32 alternative coverage and shall be collected as provided for
33 premiums for other optional coverages.
-4- LRB9001350NTsb
1 However, nothing in this Act shall be construed to
2 permit, after the effective date of this amendatory Act of
3 1983, the noncontributory portion of any such program to
4 include the expenses of obtaining an abortion, induced
5 miscarriage or induced premature birth unless, in the opinion
6 of a physician, such procedures are necessary for the
7 preservation of the life of the woman seeking such treatment,
8 or except an induced premature birth intended to produce a
9 live viable child and such procedure is necessary for the
10 health of the mother or her unborn child.
11 (Source: P.A. 85-848.)
12 Section 10. The Illinois Public Aid Code is amended by
13 changing Section 5-5 as follows:
14 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
15 (Text of Section before amendment by P.A. 89-507)
16 Sec. 5-5. Medical services. The Illinois Department, by
17 rule, shall determine the quantity and quality of and the
18 rate of reimbursement for the medical assistance for which
19 payment will be authorized, and the medical services to be
20 provided, which may include all or part of the following: (1)
21 inpatient hospital services; (2) outpatient hospital
22 services; (3) other laboratory and X-ray services; (4)
23 skilled nursing home services; (5) physicians' services
24 whether furnished in the office, the patient's home, a
25 hospital, a skilled nursing home, or elsewhere; (6) medical
26 care, or any other type of remedial care furnished by
27 licensed practitioners; (7) home health care services; (8)
28 private duty nursing service; (9) clinic services; (10)
29 dental services; (11) physical therapy and related services;
30 (12) prescribed drugs, dentures, and prosthetic devices; and
31 eyeglasses prescribed by a physician skilled in the diseases
32 of the eye, or by an optometrist, whichever the person may
-5- LRB9001350NTsb
1 select; (13) other diagnostic, screening, preventive, and
2 rehabilitative services; (14) transportation and such other
3 expenses as may be necessary; (15) medical treatment of
4 sexual assault survivors, as defined in Section 1a of the
5 Sexual Assault Survivors Emergency Treatment Act, for
6 injuries sustained as a result of the sexual assault,
7 including examinations and laboratory tests to discover
8 evidence which may be used in criminal proceedings arising
9 from the sexual assault; (16) the diagnosis and treatment of
10 sickle cell anemia; and (17) any other medical care, and any
11 other type of remedial care recognized under the laws of this
12 State, but not including abortions, or induced miscarriages,
13 or premature births, unless, in the professional judgement of
14 a physician, the procedure is medically necessary or
15 medically indicated taking into account all factors that
16 affect a woman's health, including but not limited to her
17 physical and emotional well-being, age, and familial
18 situation in the opinion of a physician, such procedures are
19 necessary for the preservation of the life of the woman
20 seeking such treatment, or except an induced premature birth
21 intended to produce a live viable child and such procedure is
22 necessary for the health of the mother or her unborn child.
23 The Illinois Department, by rule, shall prohibit any
24 physician from providing medical assistance to anyone
25 eligible therefor under this Code where such physician has
26 been found guilty of performing an abortion procedure in a
27 wilful and wanton manner upon a woman who was not pregnant at
28 the time such abortion procedure was performed. The term "any
29 other type of remedial care" shall include nursing care and
30 nursing home service for persons who rely on treatment by
31 spiritual means alone through prayer for healing.
32 The Illinois Department shall provide the following
33 services to persons eligible for assistance under this
34 Article who are participating in education, training or
-6- LRB9001350NTsb
1 employment programs:
2 (1) dental services, which shall include but not be
3 limited to prosthodontics; and
4 (2) eyeglasses prescribed by a physician skilled in
5 the diseases of the eye, or by an optometrist, whichever
6 the person may select.
7 The Illinois Department, by rule, may distinguish and
8 classify the medical services to be provided only in
9 accordance with the classes of persons designated in Section
10 5-2.
11 The Illinois Department shall authorize the provision of,
12 and shall authorize payment for, screening by low-dose
13 mammography for the presence of occult breast cancer for
14 women 35 years of age or older who are eligible for medical
15 assistance under this Article, as follows: a baseline
16 mammogram for women 35 to 39 years of age; a mammogram every
17 1 to 2 years, even if no symptoms are present, for women 40
18 to 49 years of age; and an annual mammogram for women 50
19 years of age or older. All screenings shall include a
20 physical breast exam, instruction on self-examination and
21 information regarding the frequency of self-examination and
22 its value as a preventative tool. As used in this Section,
23 "low-dose mammography" means the x-ray examination of the
24 breast using equipment dedicated specifically for
25 mammography, including the x-ray tube, filter, compression
26 device, image receptor, and cassettes, with an average
27 radiation exposure delivery of less than one rad mid-breast,
28 with 2 views for each breast.
29 Any medical or health care provider shall immediately
30 recommend, to any pregnant woman who is being provided
31 prenatal services and is suspected of drug abuse or is
32 addicted as defined in the Alcoholism and Other Drug Abuse
33 and Dependency Act, referral to a local substance abuse
34 treatment provider licensed by the Department of Alcoholism
-7- LRB9001350NTsb
1 and Substance Abuse or to a licensed hospital which provides
2 substance abuse treatment services. The Department of Public
3 Aid shall assure coverage for the cost of treatment of the
4 drug abuse or addiction for pregnant recipients in accordance
5 with the Illinois Medicaid Program in conjunction with the
6 Department of Alcoholism and Substance Abuse.
7 All medical providers providing medical assistance to
8 pregnant women under this Code shall receive information from
9 the Department on the availability of services under the Drug
10 Free Families with a Future or any comparable program
11 providing case management services for addicted women,
12 including information on appropriate referrals for other
13 social services that may be needed by addicted women in
14 addition to treatment for addiction.
15 The Illinois Department, in cooperation with the
16 Departments of Alcoholism and Substance Abuse and Public
17 Health, through a public awareness campaign, may provide
18 information concerning treatment for alcoholism and drug
19 abuse and addiction, prenatal health care, and other
20 pertinent programs directed at reducing the number of
21 drug-affected infants born to recipients of medical
22 assistance.
23 The Department shall not sanction the recipient solely on
24 the basis of her substance abuse.
25 The Illinois Department shall establish such regulations
26 governing the dispensing of health services under this
27 Article as it shall deem appropriate. In formulating these
28 regulations the Illinois Department shall consult with and
29 give substantial weight to the recommendations offered by the
30 Citizens Assembly/Council on Public Aid. The Department
31 should seek the advice of formal professional advisory
32 committees appointed by the Director of the Illinois
33 Department for the purpose of providing regular advice on
34 policy and administrative matters, information dissemination
-8- LRB9001350NTsb
1 and educational activities for medical and health care
2 providers, and consistency in procedures to the Illinois
3 Department.
4 The Illinois Department may develop and contract with
5 Partnerships of medical providers to arrange medical services
6 for persons eligible under Section 5-2 of this Code.
7 Implementation of this Section may be by demonstration
8 projects in certain geographic areas. The Partnership shall
9 be represented by a sponsor organization. The Department, by
10 rule, shall develop qualifications for sponsors of
11 Partnerships. Nothing in this Section shall be construed to
12 require that the sponsor organization be a medical
13 organization.
14 The sponsor must negotiate formal written contracts with
15 medical providers for physician services, inpatient and
16 outpatient hospital care, home health services, treatment for
17 alcoholism and substance abuse, and other services determined
18 necessary by the Illinois Department by rule for delivery by
19 Partnerships. Physician services must include prenatal and
20 obstetrical care. The Illinois Department shall reimburse
21 medical services delivered by Partnership providers to
22 clients in target areas according to provisions of this
23 Article and the Illinois Health Finance Reform Act, except
24 that:
25 (1) Physicians participating in a Partnership and
26 providing certain services, which shall be determined by
27 the Illinois Department, to persons in areas covered by
28 the Partnership may receive an additional surcharge for
29 such services.
30 (2) The Department may elect to consider and
31 negotiate financial incentives to encourage the
32 development of Partnerships and the efficient delivery of
33 medical care.
34 (3) Persons receiving medical services through
-9- LRB9001350NTsb
1 Partnerships may receive medical and case management
2 services above the level usually offered through the
3 medical assistance program.
4 Medical providers shall be required to meet certain
5 qualifications to participate in Partnerships to ensure the
6 delivery of high quality medical services. These
7 qualifications shall be determined by rule of the Illinois
8 Department and may be higher than qualifications for
9 participation in the medical assistance program. Partnership
10 sponsors may prescribe reasonable additional qualifications
11 for participation by medical providers, only with the prior
12 written approval of the Illinois Department.
13 Nothing in this Section shall limit the free choice of
14 practitioners, hospitals, and other providers of medical
15 services by clients.
16 The Department shall apply for a waiver from the United
17 States Health Care Financing Administration to allow for the
18 implementation of Partnerships under this Section.
19 The Illinois Department shall require health care
20 providers to maintain records that document the medical care
21 and services provided to recipients of Medical Assistance
22 under this Article. The Illinois Department shall require
23 health care providers to make available, when authorized by
24 the patient, in writing, the medical records in a timely
25 fashion to other health care providers who are treating or
26 serving persons eligible for Medical Assistance under this
27 Article. All dispensers of medical services shall be
28 required to maintain and retain business and professional
29 records sufficient to fully and accurately document the
30 nature, scope, details and receipt of the health care
31 provided to persons eligible for medical assistance under
32 this Code, in accordance with regulations promulgated by the
33 Illinois Department. The rules and regulations shall require
34 that proof of the receipt of prescription drugs, dentures,
-10- LRB9001350NTsb
1 prosthetic devices and eyeglasses by eligible persons under
2 this Section accompany each claim for reimbursement submitted
3 by the dispenser of such medical services. No such claims for
4 reimbursement shall be approved for payment by the Illinois
5 Department without such proof of receipt, unless the Illinois
6 Department shall have put into effect and shall be operating
7 a system of post-payment audit and review which shall, on a
8 sampling basis, be deemed adequate by the Illinois Department
9 to assure that such drugs, dentures, prosthetic devices and
10 eyeglasses for which payment is being made are actually being
11 received by eligible recipients. Within 90 days after the
12 effective date of this amendatory Act of 1984, the Illinois
13 Department shall establish a current list of acquisition
14 costs for all prosthetic devices and any other items
15 recognized as medical equipment and supplies reimbursable
16 under this Article and shall update such list on a quarterly
17 basis, except that the acquisition costs of all prescription
18 drugs shall be updated no less frequently than every 30 days
19 as required by Section 5-5.12.
20 The rules and regulations of the Illinois Department
21 shall require that a written statement including the required
22 opinion of a physician shall accompany any claim for
23 reimbursement for abortions, or induced miscarriages or
24 premature births. This statement shall indicate what
25 procedures were used in providing such medical services.
26 The Illinois Department shall require that all dispensers
27 of medical services, other than an individual practitioner or
28 group of practitioners, desiring to participate in the
29 Medical Assistance program established under this Article to
30 disclose all financial, beneficial, ownership, equity, surety
31 or other interests in any and all firms, corporations,
32 partnerships, associations, business enterprises, joint
33 ventures, agencies, institutions or other legal entities
34 providing any form of health care services in this State
-11- LRB9001350NTsb
1 under this Article.
2 The Illinois Department may require that all dispensers
3 of medical services desiring to participate in the medical
4 assistance program established under this Article disclose,
5 under such terms and conditions as the Illinois Department
6 may by rule establish, all inquiries from clients and
7 attorneys regarding medical bills paid by the Illinois
8 Department, which inquiries could indicate potential
9 existence of claims or liens for the Illinois Department.
10 The Illinois Department shall establish policies,
11 procedures, standards and criteria by rule for the
12 acquisition, repair and replacement of orthotic and
13 prosthetic devices and durable medical equipment. Such rules
14 shall provide, but not be limited to, the following services:
15 (1) immediate repair or replacement of such devices by
16 recipients without medical authorization; and (2) rental,
17 lease, purchase or lease-purchase of durable medical
18 equipment in a cost-effective manner, taking into
19 consideration the recipient's medical prognosis, the extent
20 of the recipient's needs, and the requirements and costs for
21 maintaining such equipment. Such rules shall enable a
22 recipient to temporarily acquire and use alternative or
23 substitute devices or equipment pending repairs or
24 replacements of any device or equipment previously authorized
25 for such recipient by the Department. Rules under clause (2)
26 above shall not provide for purchase or lease-purchase of
27 durable medical equipment or supplies used for the purpose of
28 oxygen delivery and respiratory care.
29 The Department shall execute, relative to the nursing
30 home prescreening project, written inter-agency agreements
31 with the Department of Rehabilitation Services and the
32 Department on Aging, to effect the following: (i) intake
33 procedures and common eligibility criteria for those persons
34 who are receiving non-institutional services; and (ii) the
-12- LRB9001350NTsb
1 establishment and development of non-institutional services
2 in areas of the State where they are not currently available
3 or are undeveloped.
4 The Illinois Department shall develop and operate, in
5 cooperation with other State Departments and agencies and in
6 compliance with applicable federal laws and regulations,
7 appropriate and effective systems of health care evaluation
8 and programs for monitoring of utilization of health care
9 services and facilities, as it affects persons eligible for
10 medical assistance under this Code. The Illinois Department
11 shall report regularly the results of the operation of such
12 systems and programs to the Citizens Assembly/Council on
13 Public Aid to enable the Committee to ensure, from time to
14 time, that these programs are effective and meaningful.
15 The Illinois Department shall report annually to the
16 General Assembly, no later than the second Friday in April of
17 1979 and each year thereafter, in regard to:
18 (a) actual statistics and trends in utilization of
19 medical services by public aid recipients;
20 (b) actual statistics and trends in the provision
21 of the various medical services by medical vendors;
22 (c) current rate structures and proposed changes in
23 those rate structures for the various medical vendors;
24 and
25 (d) efforts at utilization review and control by
26 the Illinois Department.
27 The period covered by each report shall be the 3 years
28 ending on the June 30 prior to the report. The report shall
29 include suggested legislation for consideration by the
30 General Assembly. The filing of one copy of the report with
31 the Speaker, one copy with the Minority Leader and one copy
32 with the Clerk of the House of Representatives, one copy with
33 the President, one copy with the Minority Leader and one copy
34 with the Secretary of the Senate, one copy with the
-13- LRB9001350NTsb
1 Legislative Research Unit, such additional copies with the
2 State Government Report Distribution Center for the General
3 Assembly as is required under paragraph (t) of Section 7 of
4 the State Library Act and one copy with the Citizens
5 Assembly/Council on Public Aid or its successor shall be
6 deemed sufficient to comply with this Section.
7 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95;
8 89-517, eff. 1-1-97.)
9 (Text of Section after amendment by P.A. 89-507)
10 Sec. 5-5. Medical services. The Illinois Department, by
11 rule, shall determine the quantity and quality of and the
12 rate of reimbursement for the medical assistance for which
13 payment will be authorized, and the medical services to be
14 provided, which may include all or part of the following: (1)
15 inpatient hospital services; (2) outpatient hospital
16 services; (3) other laboratory and X-ray services; (4)
17 skilled nursing home services; (5) physicians' services
18 whether furnished in the office, the patient's home, a
19 hospital, a skilled nursing home, or elsewhere; (6) medical
20 care, or any other type of remedial care furnished by
21 licensed practitioners; (7) home health care services; (8)
22 private duty nursing service; (9) clinic services; (10)
23 dental services; (11) physical therapy and related services;
24 (12) prescribed drugs, dentures, and prosthetic devices; and
25 eyeglasses prescribed by a physician skilled in the diseases
26 of the eye, or by an optometrist, whichever the person may
27 select; (13) other diagnostic, screening, preventive, and
28 rehabilitative services; (14) transportation and such other
29 expenses as may be necessary; (15) medical treatment of
30 sexual assault survivors, as defined in Section 1a of the
31 Sexual Assault Survivors Emergency Treatment Act, for
32 injuries sustained as a result of the sexual assault,
33 including examinations and laboratory tests to discover
34 evidence which may be used in criminal proceedings arising
-14- LRB9001350NTsb
1 from the sexual assault; (16) the diagnosis and treatment of
2 sickle cell anemia; and (17) any other medical care, and any
3 other type of remedial care recognized under the laws of this
4 State, but not including abortions, or induced miscarriages
5 or premature births, unless, in the professional judgement of
6 a physician, the procedure is medically necessary or
7 medically indicated taking into account all factors that
8 affect a woman's health, including but not limited to her
9 physical and emotional well-being, age, and familial
10 situation in the opinion of a physician, such procedures are
11 necessary for the preservation of the life of the woman
12 seeking such treatment, or except an induced premature birth
13 intended to produce a live viable child and such procedure is
14 necessary for the health of the mother or her unborn child.
15 The Illinois Department, by rule, shall prohibit any
16 physician from providing medical assistance to anyone
17 eligible therefor under this Code where such physician has
18 been found guilty of performing an abortion procedure in a
19 wilful and wanton manner upon a woman who was not pregnant at
20 the time such abortion procedure was performed. The term "any
21 other type of remedial care" shall include nursing care and
22 nursing home service for persons who rely on treatment by
23 spiritual means alone through prayer for healing.
24 The Illinois Department of Public Aid shall provide the
25 following services to persons eligible for assistance under
26 this Article who are participating in education, training or
27 employment programs operated by the Department of Human
28 Services as successor to the Department of Public Aid:
29 (1) dental services, which shall include but not be
30 limited to prosthodontics; and
31 (2) eyeglasses prescribed by a physician skilled in
32 the diseases of the eye, or by an optometrist, whichever
33 the person may select.
34 The Illinois Department, by rule, may distinguish and
-15- LRB9001350NTsb
1 classify the medical services to be provided only in
2 accordance with the classes of persons designated in Section
3 5-2.
4 The Illinois Department shall authorize the provision of,
5 and shall authorize payment for, screening by low-dose
6 mammography for the presence of occult breast cancer for
7 women 35 years of age or older who are eligible for medical
8 assistance under this Article, as follows: a baseline
9 mammogram for women 35 to 39 years of age; a mammogram every
10 1 to 2 years, even if no symptoms are present, for women 40
11 to 49 years of age; and an annual mammogram for women 50
12 years of age or older. All screenings shall include a
13 physical breast exam, instruction on self-examination and
14 information regarding the frequency of self-examination and
15 its value as a preventative tool. As used in this Section,
16 "low-dose mammography" means the x-ray examination of the
17 breast using equipment dedicated specifically for
18 mammography, including the x-ray tube, filter, compression
19 device, image receptor, and cassettes, with an average
20 radiation exposure delivery of less than one rad mid-breast,
21 with 2 views for each breast.
22 Any medical or health care provider shall immediately
23 recommend, to any pregnant woman who is being provided
24 prenatal services and is suspected of drug abuse or is
25 addicted as defined in the Alcoholism and Other Drug Abuse
26 and Dependency Act, referral to a local substance abuse
27 treatment provider licensed by the Department of Human
28 Services or to a licensed hospital which provides substance
29 abuse treatment services. The Department of Public Aid shall
30 assure coverage for the cost of treatment of the drug abuse
31 or addiction for pregnant recipients in accordance with the
32 Illinois Medicaid Program in conjunction with the Department
33 of Human Services.
34 All medical providers providing medical assistance to
-16- LRB9001350NTsb
1 pregnant women under this Code shall receive information from
2 the Department on the availability of services under the Drug
3 Free Families with a Future or any comparable program
4 providing case management services for addicted women,
5 including information on appropriate referrals for other
6 social services that may be needed by addicted women in
7 addition to treatment for addiction.
8 The Illinois Department, in cooperation with the
9 Departments of Human Services (as successor to the Department
10 of Alcoholism and Substance Abuse) and Public Health, through
11 a public awareness campaign, may provide information
12 concerning treatment for alcoholism and drug abuse and
13 addiction, prenatal health care, and other pertinent programs
14 directed at reducing the number of drug-affected infants born
15 to recipients of medical assistance.
16 Neither the Illinois Department of Public Aid nor the
17 Department of Human Services shall sanction the recipient
18 solely on the basis of her substance abuse.
19 The Illinois Department shall establish such regulations
20 governing the dispensing of health services under this
21 Article as it shall deem appropriate. In formulating these
22 regulations the Illinois Department shall consult with and
23 give substantial weight to the recommendations offered by the
24 Citizens Assembly/Council on Public Aid. The Department
25 should seek the advice of formal professional advisory
26 committees appointed by the Director of the Illinois
27 Department for the purpose of providing regular advice on
28 policy and administrative matters, information dissemination
29 and educational activities for medical and health care
30 providers, and consistency in procedures to the Illinois
31 Department.
32 The Illinois Department may develop and contract with
33 Partnerships of medical providers to arrange medical services
34 for persons eligible under Section 5-2 of this Code.
-17- LRB9001350NTsb
1 Implementation of this Section may be by demonstration
2 projects in certain geographic areas. The Partnership shall
3 be represented by a sponsor organization. The Department, by
4 rule, shall develop qualifications for sponsors of
5 Partnerships. Nothing in this Section shall be construed to
6 require that the sponsor organization be a medical
7 organization.
8 The sponsor must negotiate formal written contracts with
9 medical providers for physician services, inpatient and
10 outpatient hospital care, home health services, treatment for
11 alcoholism and substance abuse, and other services determined
12 necessary by the Illinois Department by rule for delivery by
13 Partnerships. Physician services must include prenatal and
14 obstetrical care. The Illinois Department shall reimburse
15 medical services delivered by Partnership providers to
16 clients in target areas according to provisions of this
17 Article and the Illinois Health Finance Reform Act, except
18 that:
19 (1) Physicians participating in a Partnership and
20 providing certain services, which shall be determined by
21 the Illinois Department, to persons in areas covered by
22 the Partnership may receive an additional surcharge for
23 such services.
24 (2) The Department may elect to consider and
25 negotiate financial incentives to encourage the
26 development of Partnerships and the efficient delivery of
27 medical care.
28 (3) Persons receiving medical services through
29 Partnerships may receive medical and case management
30 services above the level usually offered through the
31 medical assistance program.
32 Medical providers shall be required to meet certain
33 qualifications to participate in Partnerships to ensure the
34 delivery of high quality medical services. These
-18- LRB9001350NTsb
1 qualifications shall be determined by rule of the Illinois
2 Department and may be higher than qualifications for
3 participation in the medical assistance program. Partnership
4 sponsors may prescribe reasonable additional qualifications
5 for participation by medical providers, only with the prior
6 written approval of the Illinois Department.
7 Nothing in this Section shall limit the free choice of
8 practitioners, hospitals, and other providers of medical
9 services by clients.
10 The Department shall apply for a waiver from the United
11 States Health Care Financing Administration to allow for the
12 implementation of Partnerships under this Section.
13 The Illinois Department shall require health care
14 providers to maintain records that document the medical care
15 and services provided to recipients of Medical Assistance
16 under this Article. The Illinois Department shall require
17 health care providers to make available, when authorized by
18 the patient, in writing, the medical records in a timely
19 fashion to other health care providers who are treating or
20 serving persons eligible for Medical Assistance under this
21 Article. All dispensers of medical services shall be
22 required to maintain and retain business and professional
23 records sufficient to fully and accurately document the
24 nature, scope, details and receipt of the health care
25 provided to persons eligible for medical assistance under
26 this Code, in accordance with regulations promulgated by the
27 Illinois Department. The rules and regulations shall require
28 that proof of the receipt of prescription drugs, dentures,
29 prosthetic devices and eyeglasses by eligible persons under
30 this Section accompany each claim for reimbursement submitted
31 by the dispenser of such medical services. No such claims for
32 reimbursement shall be approved for payment by the Illinois
33 Department without such proof of receipt, unless the Illinois
34 Department shall have put into effect and shall be operating
-19- LRB9001350NTsb
1 a system of post-payment audit and review which shall, on a
2 sampling basis, be deemed adequate by the Illinois Department
3 to assure that such drugs, dentures, prosthetic devices and
4 eyeglasses for which payment is being made are actually being
5 received by eligible recipients. Within 90 days after the
6 effective date of this amendatory Act of 1984, the Illinois
7 Department shall establish a current list of acquisition
8 costs for all prosthetic devices and any other items
9 recognized as medical equipment and supplies reimbursable
10 under this Article and shall update such list on a quarterly
11 basis, except that the acquisition costs of all prescription
12 drugs shall be updated no less frequently than every 30 days
13 as required by Section 5-5.12.
14 The rules and regulations of the Illinois Department
15 shall require that a written statement including the required
16 opinion of a physician shall accompany any claim for
17 reimbursement for abortions, or induced miscarriages or
18 premature births. This statement shall indicate what
19 procedures were used in providing such medical services.
20 The Illinois Department shall require that all dispensers
21 of medical services, other than an individual practitioner or
22 group of practitioners, desiring to participate in the
23 Medical Assistance program established under this Article to
24 disclose all financial, beneficial, ownership, equity, surety
25 or other interests in any and all firms, corporations,
26 partnerships, associations, business enterprises, joint
27 ventures, agencies, institutions or other legal entities
28 providing any form of health care services in this State
29 under this Article.
30 The Illinois Department may require that all dispensers
31 of medical services desiring to participate in the medical
32 assistance program established under this Article disclose,
33 under such terms and conditions as the Illinois Department
34 may by rule establish, all inquiries from clients and
-20- LRB9001350NTsb
1 attorneys regarding medical bills paid by the Illinois
2 Department, which inquiries could indicate potential
3 existence of claims or liens for the Illinois Department.
4 The Illinois Department shall establish policies,
5 procedures, standards and criteria by rule for the
6 acquisition, repair and replacement of orthotic and
7 prosthetic devices and durable medical equipment. Such rules
8 shall provide, but not be limited to, the following services:
9 (1) immediate repair or replacement of such devices by
10 recipients without medical authorization; and (2) rental,
11 lease, purchase or lease-purchase of durable medical
12 equipment in a cost-effective manner, taking into
13 consideration the recipient's medical prognosis, the extent
14 of the recipient's needs, and the requirements and costs for
15 maintaining such equipment. Such rules shall enable a
16 recipient to temporarily acquire and use alternative or
17 substitute devices or equipment pending repairs or
18 replacements of any device or equipment previously authorized
19 for such recipient by the Department. Rules under clause (2)
20 above shall not provide for purchase or lease-purchase of
21 durable medical equipment or supplies used for the purpose of
22 oxygen delivery and respiratory care.
23 The Department shall execute, relative to the nursing
24 home prescreening project, written inter-agency agreements
25 with the Department of Human Services and the Department on
26 Aging, to effect the following: (i) intake procedures and
27 common eligibility criteria for those persons who are
28 receiving non-institutional services; and (ii) the
29 establishment and development of non-institutional services
30 in areas of the State where they are not currently available
31 or are undeveloped.
32 The Illinois Department shall develop and operate, in
33 cooperation with other State Departments and agencies and in
34 compliance with applicable federal laws and regulations,
-21- LRB9001350NTsb
1 appropriate and effective systems of health care evaluation
2 and programs for monitoring of utilization of health care
3 services and facilities, as it affects persons eligible for
4 medical assistance under this Code. The Illinois Department
5 shall report regularly the results of the operation of such
6 systems and programs to the Citizens Assembly/Council on
7 Public Aid to enable the Committee to ensure, from time to
8 time, that these programs are effective and meaningful.
9 The Illinois Department shall report annually to the
10 General Assembly, no later than the second Friday in April of
11 1979 and each year thereafter, in regard to:
12 (a) actual statistics and trends in utilization of
13 medical services by public aid recipients;
14 (b) actual statistics and trends in the provision
15 of the various medical services by medical vendors;
16 (c) current rate structures and proposed changes in
17 those rate structures for the various medical vendors;
18 and
19 (d) efforts at utilization review and control by
20 the Illinois Department.
21 The period covered by each report shall be the 3 years
22 ending on the June 30 prior to the report. The report shall
23 include suggested legislation for consideration by the
24 General Assembly. The filing of one copy of the report with
25 the Speaker, one copy with the Minority Leader and one copy
26 with the Clerk of the House of Representatives, one copy with
27 the President, one copy with the Minority Leader and one copy
28 with the Secretary of the Senate, one copy with the
29 Legislative Research Unit, such additional copies with the
30 State Government Report Distribution Center for the General
31 Assembly as is required under paragraph (t) of Section 7 of
32 the State Library Act and one copy with the Citizens
33 Assembly/Council on Public Aid or its successor shall be
34 deemed sufficient to comply with this Section.
-22- LRB9001350NTsb
1 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95;
2 89-507, eff. 7-1-97; 89-517, eff. 1-1-97; revised 8-26-96.)
3 Section 95. No acceleration or delay. Where this Act
4 makes changes in a statute that is represented in this Act by
5 text that is not yet or no longer in effect (for example, a
6 Section represented by multiple versions), the use of that
7 text does not accelerate or delay the taking effect of (i)
8 the changes made by this Act or (ii) provisions derived from
9 any other Public Act.