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90_SB0269
305 ILCS 5/5-5 from Ch. 23, par. 5-5
305 ILCS 5/6-1 from Ch. 23, par. 6-1
Amends the Public Aid Code. Replaces provisions
concerning medical assistance and general assistance funding
of abortions with identical language prohibiting payment of
aid for abortions unless necessary for preserving the woman's
life. Permits State funds to be used for abortions to
terminate a pregnancy resulting from an act of criminal
sexual assault or aggravated criminal sexual assault.
Provides that State funds shall only be used to the extent
that payment is required by federal law as determined by a
court of competent jurisdiction. Provides that if any
provision of this amendatory Act of 1997 is held invalid, the
invalidity does not affect the provisions which can be given
effect without the invalid provision. Effective immediately.
LRB9000743SMdvA
LRB9000743SMdvA
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Sections 5-5 and 6-1.
3 WHEREAS, There has been entered in the Circuit Court of
4 Cook County, in the case of Doe v. Wright, case no. 91 CH
5 1958, an order (i) finding that Sections 5-5 and 6-1 of the
6 Illinois Public Aid Code violate the Illinois Constitution,
7 (ii) enjoining the Department of Public Aid from enforcing
8 those Sections insofar as they deny reimbursement for an
9 abortion necessary to protect a woman's health although not
10 necessary to preserve her life, and (iii) ordering the
11 Department to provide reimbursement through the State's
12 medical assistance programs for abortions necessary to
13 protect a woman's health; and
14 WHEREAS, The General Assembly desires to re-express its
15 intent that State moneys not be used to provide reimbursement
16 for abortions unless necessary to preserve the woman's life
17 and that the Department of Public Aid enforce Sections 5-5
18 and 6-1 of the Illinois Public Aid Code in all cases;
19 therefore
20 Be it enacted by the People of the State of Illinois,
21 represented in the General Assembly:
22 Section 5. The Illinois Public Aid Code is amended by
23 changing Sections 5-5 and 6-1 as follows:
24 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
25 (Text of Section before amendment by P.A. 89-507)
26 Sec. 5-5. Medical services. The Illinois Department, by
27 rule, shall determine the quantity and quality of and the
28 rate of reimbursement for the medical assistance for which
29 payment will be authorized, and the medical services to be
30 provided, which may include all or part of the following: (1)
31 inpatient hospital services; (2) outpatient hospital
-2- LRB9000743SMdvA
1 services; (3) other laboratory and X-ray services; (4)
2 skilled nursing home services; (5) physicians' services
3 whether furnished in the office, the patient's home, a
4 hospital, a skilled nursing home, or elsewhere; (6) medical
5 care, or any other type of remedial care furnished by
6 licensed practitioners; (7) home health care services; (8)
7 private duty nursing service; (9) clinic services; (10)
8 dental services; (11) physical therapy and related services;
9 (12) prescribed drugs, dentures, and prosthetic devices; and
10 eyeglasses prescribed by a physician skilled in the diseases
11 of the eye, or by an optometrist, whichever the person may
12 select; (13) other diagnostic, screening, preventive, and
13 rehabilitative services; (14) transportation and such other
14 expenses as may be necessary; (15) medical treatment of
15 sexual assault survivors, as defined in Section 1a of the
16 Sexual Assault Survivors Emergency Treatment Act, for
17 injuries sustained as a result of the sexual assault,
18 including examinations and laboratory tests to discover
19 evidence which may be used in criminal proceedings arising
20 from the sexual assault; (16) the diagnosis and treatment of
21 sickle cell anemia; and (17) any other medical care, and any
22 other type of remedial care recognized under the laws of this
23 State, but not including abortions, or induced miscarriages
24 or premature births, unless, in the opinion of a physician,
25 such procedures are necessary for the preservation of the
26 life of the woman seeking such treatment, or except an
27 induced premature birth intended to produce a live viable
28 child and such procedure is necessary for the health of the
29 mother or her unborn child; State funds may also be used to
30 pay for abortions to terminate a pregnancy resulting from an
31 act of criminal sexual assault, as defined in Section 12-13
32 of the Criminal Code of 1961, an act of aggravated criminal
33 sexual assault, as defined in Section 12-14 of the Criminal
34 Code of 1961, or an act of sexual relations within families,
-3- LRB9000743SMdvA
1 as defined in Section 11-11 of the Criminal Code of 1961, but
2 only to the extent that payment for such abortions is
3 required by federal law as determined by a court of competent
4 jurisdiction; provided further that payment for an abortion
5 to terminate a pregnancy resulting from an act of criminal
6 sexual assault, aggravated criminal sexual assault, or sexual
7 relations within families is reported to a law enforcement
8 agency before the abortion is performed but not including
9 abortions, or induced miscarriages or premature births,
10 unless, 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 shall provide the following
25 services to persons eligible for assistance under this
26 Article who are participating in education, training or
27 employment programs:
28 (1) dental services, which shall include but not be
29 limited to prosthodontics; and
30 (2) eyeglasses prescribed by a physician skilled in
31 the diseases of the eye, or by an optometrist, whichever
32 the person may select.
33 The Illinois Department, by rule, may distinguish and
34 classify the medical services to be provided only in
-4- LRB9000743SMdvA
1 accordance with the classes of persons designated in Section
2 5-2.
3 The Illinois Department shall authorize the provision of,
4 and shall authorize payment for, screening by low-dose
5 mammography for the presence of occult breast cancer for
6 women 35 years of age or older who are eligible for medical
7 assistance under this Article, as follows: a baseline
8 mammogram for women 35 to 39 years of age; a mammogram every
9 1 to 2 years, even if no symptoms are present, for women 40
10 to 49 years of age; and an annual mammogram for women 50
11 years of age or older. All screenings shall include a
12 physical breast exam, instruction on self-examination and
13 information regarding the frequency of self-examination and
14 its value as a preventative tool. As used in this Section,
15 "low-dose mammography" means the x-ray examination of the
16 breast using equipment dedicated specifically for
17 mammography, including the x-ray tube, filter, compression
18 device, image receptor, and cassettes, with an average
19 radiation exposure delivery of less than one rad mid-breast,
20 with 2 views for each breast.
21 Any medical or health care provider shall immediately
22 recommend, to any pregnant woman who is being provided
23 prenatal services and is suspected of drug abuse or is
24 addicted as defined in the Alcoholism and Other Drug Abuse
25 and Dependency Act, referral to a local substance abuse
26 treatment provider licensed by the Department of Alcoholism
27 and Substance Abuse or to a licensed hospital which provides
28 substance abuse treatment services. The Department of Public
29 Aid shall assure coverage for the cost of treatment of the
30 drug abuse or addiction for pregnant recipients in accordance
31 with the Illinois Medicaid Program in conjunction with the
32 Department of Alcoholism and Substance Abuse.
33 All medical providers providing medical assistance to
34 pregnant women under this Code shall receive information from
-5- LRB9000743SMdvA
1 the Department on the availability of services under the Drug
2 Free Families with a Future or any comparable program
3 providing case management services for addicted women,
4 including information on appropriate referrals for other
5 social services that may be needed by addicted women in
6 addition to treatment for addiction.
7 The Illinois Department, in cooperation with the
8 Departments of Alcoholism and Substance Abuse and Public
9 Health, through a public awareness campaign, may provide
10 information concerning treatment for alcoholism and drug
11 abuse and addiction, prenatal health care, and other
12 pertinent programs directed at reducing the number of
13 drug-affected infants born to recipients of medical
14 assistance.
15 The Department shall not sanction the recipient solely on
16 the basis of her substance abuse.
17 The Illinois Department shall establish such regulations
18 governing the dispensing of health services under this
19 Article as it shall deem appropriate. In formulating these
20 regulations the Illinois Department shall consult with and
21 give substantial weight to the recommendations offered by the
22 Citizens Assembly/Council on Public Aid. The Department
23 should seek the advice of formal professional advisory
24 committees appointed by the Director of the Illinois
25 Department for the purpose of providing regular advice on
26 policy and administrative matters, information dissemination
27 and educational activities for medical and health care
28 providers, and consistency in procedures to the Illinois
29 Department.
30 The Illinois Department may develop and contract with
31 Partnerships of medical providers to arrange medical services
32 for persons eligible under Section 5-2 of this Code.
33 Implementation of this Section may be by demonstration
34 projects in certain geographic areas. The Partnership shall
-6- LRB9000743SMdvA
1 be represented by a sponsor organization. The Department, by
2 rule, shall develop qualifications for sponsors of
3 Partnerships. Nothing in this Section shall be construed to
4 require that the sponsor organization be a medical
5 organization.
6 The sponsor must negotiate formal written contracts with
7 medical providers for physician services, inpatient and
8 outpatient hospital care, home health services, treatment for
9 alcoholism and substance abuse, and other services determined
10 necessary by the Illinois Department by rule for delivery by
11 Partnerships. Physician services must include prenatal and
12 obstetrical care. The Illinois Department shall reimburse
13 medical services delivered by Partnership providers to
14 clients in target areas according to provisions of this
15 Article and the Illinois Health Finance Reform Act, except
16 that:
17 (1) Physicians participating in a Partnership and
18 providing certain services, which shall be determined by
19 the Illinois Department, to persons in areas covered by
20 the Partnership may receive an additional surcharge for
21 such services.
22 (2) The Department may elect to consider and
23 negotiate financial incentives to encourage the
24 development of Partnerships and the efficient delivery of
25 medical care.
26 (3) Persons receiving medical services through
27 Partnerships may receive medical and case management
28 services above the level usually offered through the
29 medical assistance program.
30 Medical providers shall be required to meet certain
31 qualifications to participate in Partnerships to ensure the
32 delivery of high quality medical services. These
33 qualifications shall be determined by rule of the Illinois
34 Department and may be higher than qualifications for
-7- LRB9000743SMdvA
1 participation in the medical assistance program. Partnership
2 sponsors may prescribe reasonable additional qualifications
3 for participation by medical providers, only with the prior
4 written approval of the Illinois Department.
5 Nothing in this Section shall limit the free choice of
6 practitioners, hospitals, and other providers of medical
7 services by clients.
8 The Department shall apply for a waiver from the United
9 States Health Care Financing Administration to allow for the
10 implementation of Partnerships under this Section.
11 The Illinois Department shall require health care
12 providers to maintain records that document the medical care
13 and services provided to recipients of Medical Assistance
14 under this Article. The Illinois Department shall require
15 health care providers to make available, when authorized by
16 the patient, in writing, the medical records in a timely
17 fashion to other health care providers who are treating or
18 serving persons eligible for Medical Assistance under this
19 Article. All dispensers of medical services shall be
20 required to maintain and retain business and professional
21 records sufficient to fully and accurately document the
22 nature, scope, details and receipt of the health care
23 provided to persons eligible for medical assistance under
24 this Code, in accordance with regulations promulgated by the
25 Illinois Department. The rules and regulations shall require
26 that proof of the receipt of prescription drugs, dentures,
27 prosthetic devices and eyeglasses by eligible persons under
28 this Section accompany each claim for reimbursement submitted
29 by the dispenser of such medical services. No such claims for
30 reimbursement shall be approved for payment by the Illinois
31 Department without such proof of receipt, unless the Illinois
32 Department shall have put into effect and shall be operating
33 a system of post-payment audit and review which shall, on a
34 sampling basis, be deemed adequate by the Illinois Department
-8- LRB9000743SMdvA
1 to assure that such drugs, dentures, prosthetic devices and
2 eyeglasses for which payment is being made are actually being
3 received by eligible recipients. Within 90 days after the
4 effective date of this amendatory Act of 1984, the Illinois
5 Department shall establish a current list of acquisition
6 costs for all prosthetic devices and any other items
7 recognized as medical equipment and supplies reimbursable
8 under this Article and shall update such list on a quarterly
9 basis, except that the acquisition costs of all prescription
10 drugs shall be updated no less frequently than every 30 days
11 as required by Section 5-5.12.
12 The rules and regulations of the Illinois Department
13 shall require that a written statement including the required
14 opinion of a physician shall accompany any claim for
15 reimbursement for abortions, or induced miscarriages or
16 premature births. This statement shall indicate what
17 procedures were used in providing such medical services.
18 The Illinois Department shall require that all dispensers
19 of medical services, other than an individual practitioner or
20 group of practitioners, desiring to participate in the
21 Medical Assistance program established under this Article to
22 disclose all financial, beneficial, ownership, equity, surety
23 or other interests in any and all firms, corporations,
24 partnerships, associations, business enterprises, joint
25 ventures, agencies, institutions or other legal entities
26 providing any form of health care services in this State
27 under this Article.
28 The Illinois Department may require that all dispensers
29 of medical services desiring to participate in the medical
30 assistance program established under this Article disclose,
31 under such terms and conditions as the Illinois Department
32 may by rule establish, all inquiries from clients and
33 attorneys regarding medical bills paid by the Illinois
34 Department, which inquiries could indicate potential
-9- LRB9000743SMdvA
1 existence of claims or liens for the Illinois Department.
2 The Illinois Department shall establish policies,
3 procedures, standards and criteria by rule for the
4 acquisition, repair and replacement of orthotic and
5 prosthetic devices and durable medical equipment. Such rules
6 shall provide, but not be limited to, the following services:
7 (1) immediate repair or replacement of such devices by
8 recipients without medical authorization; and (2) rental,
9 lease, purchase or lease-purchase of durable medical
10 equipment in a cost-effective manner, taking into
11 consideration the recipient's medical prognosis, the extent
12 of the recipient's needs, and the requirements and costs for
13 maintaining such equipment. Such rules shall enable a
14 recipient to temporarily acquire and use alternative or
15 substitute devices or equipment pending repairs or
16 replacements of any device or equipment previously authorized
17 for such recipient by the Department. Rules under clause (2)
18 above shall not provide for purchase or lease-purchase of
19 durable medical equipment or supplies used for the purpose of
20 oxygen delivery and respiratory care.
21 The Department shall execute, relative to the nursing
22 home prescreening project, written inter-agency agreements
23 with the Department of Rehabilitation Services and the
24 Department on Aging, to effect the following: (i) intake
25 procedures and common eligibility criteria for those persons
26 who are receiving non-institutional services; and (ii) the
27 establishment and development of non-institutional services
28 in areas of the State where they are not currently available
29 or are undeveloped.
30 The Illinois Department shall develop and operate, in
31 cooperation with other State Departments and agencies and in
32 compliance with applicable federal laws and regulations,
33 appropriate and effective systems of health care evaluation
34 and programs for monitoring of utilization of health care
-10- LRB9000743SMdvA
1 services and facilities, as it affects persons eligible for
2 medical assistance under this Code. The Illinois Department
3 shall report regularly the results of the operation of such
4 systems and programs to the Citizens Assembly/Council on
5 Public Aid to enable the Committee to ensure, from time to
6 time, that these programs are effective and meaningful.
7 The Illinois Department shall report annually to the
8 General Assembly, no later than the second Friday in April of
9 1979 and each year thereafter, in regard to:
10 (a) actual statistics and trends in utilization of
11 medical services by public aid recipients;
12 (b) actual statistics and trends in the provision
13 of the various medical services by medical vendors;
14 (c) current rate structures and proposed changes in
15 those rate structures for the various medical vendors;
16 and
17 (d) efforts at utilization review and control by
18 the Illinois Department.
19 The period covered by each report shall be the 3 years
20 ending on the June 30 prior to the report. The report shall
21 include suggested legislation for consideration by the
22 General Assembly. The filing of one copy of the report with
23 the Speaker, one copy with the Minority Leader and one copy
24 with the Clerk of the House of Representatives, one copy with
25 the President, one copy with the Minority Leader and one copy
26 with the Secretary of the Senate, one copy with the
27 Legislative Research Unit, such additional copies with the
28 State Government Report Distribution Center for the General
29 Assembly as is required under paragraph (t) of Section 7 of
30 the State Library Act and one copy with the Citizens
31 Assembly/Council on Public Aid or its successor shall be
32 deemed sufficient to comply with this Section.
33 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95;
34 89-517, eff. 1-1-97.)
-11- LRB9000743SMdvA
1 (Text of Section after amendment by P.A. 89-507)
2 Sec. 5-5. Medical services. The Illinois Department, by
3 rule, shall determine the quantity and quality of and the
4 rate of reimbursement for the medical assistance for which
5 payment will be authorized, and the medical services to be
6 provided, which may include all or part of the following: (1)
7 inpatient hospital services; (2) outpatient hospital
8 services; (3) other laboratory and X-ray services; (4)
9 skilled nursing home services; (5) physicians' services
10 whether furnished in the office, the patient's home, a
11 hospital, a skilled nursing home, or elsewhere; (6) medical
12 care, or any other type of remedial care furnished by
13 licensed practitioners; (7) home health care services; (8)
14 private duty nursing service; (9) clinic services; (10)
15 dental services; (11) physical therapy and related services;
16 (12) prescribed drugs, dentures, and prosthetic devices; and
17 eyeglasses prescribed by a physician skilled in the diseases
18 of the eye, or by an optometrist, whichever the person may
19 select; (13) other diagnostic, screening, preventive, and
20 rehabilitative services; (14) transportation and such other
21 expenses as may be necessary; (15) medical treatment of
22 sexual assault survivors, as defined in Section 1a of the
23 Sexual Assault Survivors Emergency Treatment Act, for
24 injuries sustained as a result of the sexual assault,
25 including examinations and laboratory tests to discover
26 evidence which may be used in criminal proceedings arising
27 from the sexual assault; (16) the diagnosis and treatment of
28 sickle cell anemia; and (17) any other medical care, and any
29 other type of remedial care recognized under the laws of this
30 State, but not including abortions, or induced miscarriages
31 or premature births, unless, in the opinion of a physician,
32 such procedures are necessary for the preservation of the
33 life of the woman seeking such treatment, or except an
34 induced premature birth intended to produce a live viable
-12- LRB9000743SMdvA
1 child and such procedure is necessary for the health of the
2 mother or her unborn child; State funds may also be used to
3 pay for abortions to terminate a pregnancy resulting from an
4 act of criminal sexual assault, as defined in Section 12-13
5 of the Criminal Code of 1961, an act of aggravated criminal
6 sexual assault, as defined in Section 12-14 of the Criminal
7 Code of 1961, or an act of sexual relations within families,
8 as defined in Section 11-11 of the Criminal Code of 1961, but
9 only to the extent that payment for such abortions is
10 required by federal law as determined by a court of competent
11 jurisdiction; provided further that payment for an abortion
12 to terminate a pregnancy resulting from an act of criminal
13 sexual assault, aggravated criminal sexual assault, or sexual
14 relations within families is reported to a law enforcement
15 agency before the abortion is performed but not including
16 abortions, or induced miscarriages or premature births,
17 unless, in the opinion of a physician, such procedures are
18 necessary for the preservation of the life of the woman
19 seeking such treatment, or except an induced premature birth
20 intended to produce a live viable child and such procedure is
21 necessary for the health of the mother or her unborn child.
22 The Illinois Department, by rule, shall prohibit any
23 physician from providing medical assistance to anyone
24 eligible therefor under this Code where such physician has
25 been found guilty of performing an abortion procedure in a
26 wilful and wanton manner upon a woman who was not pregnant at
27 the time such abortion procedure was performed. The term "any
28 other type of remedial care" shall include nursing care and
29 nursing home service for persons who rely on treatment by
30 spiritual means alone through prayer for healing.
31 The Illinois Department of Public Aid shall provide the
32 following services to persons eligible for assistance under
33 this Article who are participating in education, training or
34 employment programs operated by the Department of Human
-13- LRB9000743SMdvA
1 Services as successor to the Department of Public Aid:
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 Human
-14- LRB9000743SMdvA
1 Services or to a licensed hospital which provides substance
2 abuse treatment services. The Department of Public Aid shall
3 assure coverage for the cost of treatment of the drug abuse
4 or addiction for pregnant recipients in accordance with the
5 Illinois Medicaid Program in conjunction with the Department
6 of Human Services.
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 Human Services (as successor to the Department
17 of Alcoholism and Substance Abuse) and Public Health, through
18 a public awareness campaign, may provide information
19 concerning treatment for alcoholism and drug abuse and
20 addiction, prenatal health care, and other pertinent programs
21 directed at reducing the number of drug-affected infants born
22 to recipients of medical assistance.
23 Neither the Illinois Department of Public Aid nor the
24 Department of Human Services shall sanction the recipient
25 solely on the basis of her substance abuse.
26 The Illinois Department shall establish such regulations
27 governing the dispensing of health services under this
28 Article as it shall deem appropriate. In formulating these
29 regulations the Illinois Department shall consult with and
30 give substantial weight to the recommendations offered by the
31 Citizens Assembly/Council on Public Aid. The Department
32 should seek the advice of formal professional advisory
33 committees appointed by the Director of the Illinois
34 Department for the purpose of providing regular advice on
-15- LRB9000743SMdvA
1 policy and administrative matters, information dissemination
2 and educational activities for medical and health care
3 providers, and consistency in procedures to the Illinois
4 Department.
5 The Illinois Department may develop and contract with
6 Partnerships of medical providers to arrange medical services
7 for persons eligible under Section 5-2 of this Code.
8 Implementation of this Section may be by demonstration
9 projects in certain geographic areas. The Partnership shall
10 be represented by a sponsor organization. The Department, by
11 rule, shall develop qualifications for sponsors of
12 Partnerships. Nothing in this Section shall be construed to
13 require that the sponsor organization be a medical
14 organization.
15 The sponsor must negotiate formal written contracts with
16 medical providers for physician services, inpatient and
17 outpatient hospital care, home health services, treatment for
18 alcoholism and substance abuse, and other services determined
19 necessary by the Illinois Department by rule for delivery by
20 Partnerships. Physician services must include prenatal and
21 obstetrical care. The Illinois Department shall reimburse
22 medical services delivered by Partnership providers to
23 clients in target areas according to provisions of this
24 Article and the Illinois Health Finance Reform Act, except
25 that:
26 (1) Physicians participating in a Partnership and
27 providing certain services, which shall be determined by
28 the Illinois Department, to persons in areas covered by
29 the Partnership may receive an additional surcharge for
30 such services.
31 (2) The Department may elect to consider and
32 negotiate financial incentives to encourage the
33 development of Partnerships and the efficient delivery of
34 medical care.
-16- LRB9000743SMdvA
1 (3) Persons receiving medical services through
2 Partnerships may receive medical and case management
3 services above the level usually offered through the
4 medical assistance program.
5 Medical providers shall be required to meet certain
6 qualifications to participate in Partnerships to ensure the
7 delivery of high quality medical services. These
8 qualifications shall be determined by rule of the Illinois
9 Department and may be higher than qualifications for
10 participation in the medical assistance program. Partnership
11 sponsors may prescribe reasonable additional qualifications
12 for participation by medical providers, only with the prior
13 written approval of the Illinois Department.
14 Nothing in this Section shall limit the free choice of
15 practitioners, hospitals, and other providers of medical
16 services by clients.
17 The Department shall apply for a waiver from the United
18 States Health Care Financing Administration to allow for the
19 implementation of Partnerships under this Section.
20 The Illinois Department shall require health care
21 providers to maintain records that document the medical care
22 and services provided to recipients of Medical Assistance
23 under this Article. The Illinois Department shall require
24 health care providers to make available, when authorized by
25 the patient, in writing, the medical records in a timely
26 fashion to other health care providers who are treating or
27 serving persons eligible for Medical Assistance under this
28 Article. All dispensers of medical services shall be
29 required to maintain and retain business and professional
30 records sufficient to fully and accurately document the
31 nature, scope, details and receipt of the health care
32 provided to persons eligible for medical assistance under
33 this Code, in accordance with regulations promulgated by the
34 Illinois Department. The rules and regulations shall require
-17- LRB9000743SMdvA
1 that proof of the receipt of prescription drugs, dentures,
2 prosthetic devices and eyeglasses by eligible persons under
3 this Section accompany each claim for reimbursement submitted
4 by the dispenser of such medical services. No such claims for
5 reimbursement shall be approved for payment by the Illinois
6 Department without such proof of receipt, unless the Illinois
7 Department shall have put into effect and shall be operating
8 a system of post-payment audit and review which shall, on a
9 sampling basis, be deemed adequate by the Illinois Department
10 to assure that such drugs, dentures, prosthetic devices and
11 eyeglasses for which payment is being made are actually being
12 received by eligible recipients. Within 90 days after the
13 effective date of this amendatory Act of 1984, the Illinois
14 Department shall establish a current list of acquisition
15 costs for all prosthetic devices and any other items
16 recognized as medical equipment and supplies reimbursable
17 under this Article and shall update such list on a quarterly
18 basis, except that the acquisition costs of all prescription
19 drugs shall be updated no less frequently than every 30 days
20 as required by Section 5-5.12.
21 The rules and regulations of the Illinois Department
22 shall require that a written statement including the required
23 opinion of a physician shall accompany any claim for
24 reimbursement for abortions, or induced miscarriages or
25 premature births. This statement shall indicate what
26 procedures were used in providing such medical services.
27 The Illinois Department shall require that all dispensers
28 of medical services, other than an individual practitioner or
29 group of practitioners, desiring to participate in the
30 Medical Assistance program established under this Article to
31 disclose all financial, beneficial, ownership, equity, surety
32 or other interests in any and all firms, corporations,
33 partnerships, associations, business enterprises, joint
34 ventures, agencies, institutions or other legal entities
-18- LRB9000743SMdvA
1 providing any form of health care services in this State
2 under this Article.
3 The Illinois Department may require that all dispensers
4 of medical services desiring to participate in the medical
5 assistance program established under this Article disclose,
6 under such terms and conditions as the Illinois Department
7 may by rule establish, all inquiries from clients and
8 attorneys regarding medical bills paid by the Illinois
9 Department, which inquiries could indicate potential
10 existence of claims or liens for the Illinois Department.
11 The Illinois Department shall establish policies,
12 procedures, standards and criteria by rule for the
13 acquisition, repair and replacement of orthotic and
14 prosthetic devices and durable medical equipment. Such rules
15 shall provide, but not be limited to, the following services:
16 (1) immediate repair or replacement of such devices by
17 recipients without medical authorization; and (2) rental,
18 lease, purchase or lease-purchase of durable medical
19 equipment in a cost-effective manner, taking into
20 consideration the recipient's medical prognosis, the extent
21 of the recipient's needs, and the requirements and costs for
22 maintaining such equipment. Such rules shall enable a
23 recipient to temporarily acquire and use alternative or
24 substitute devices or equipment pending repairs or
25 replacements of any device or equipment previously authorized
26 for such recipient by the Department. Rules under clause (2)
27 above shall not provide for purchase or lease-purchase of
28 durable medical equipment or supplies used for the purpose of
29 oxygen delivery and respiratory care.
30 The Department shall execute, relative to the nursing
31 home prescreening project, written inter-agency agreements
32 with the Department of Human Services and the Department on
33 Aging, to effect the following: (i) intake procedures and
34 common eligibility criteria for those persons who are
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1 receiving non-institutional services; and (ii) the
2 establishment and development of non-institutional services
3 in areas of the State where they are not currently available
4 or are undeveloped.
5 The Illinois Department shall develop and operate, in
6 cooperation with other State Departments and agencies and in
7 compliance with applicable federal laws and regulations,
8 appropriate and effective systems of health care evaluation
9 and programs for monitoring of utilization of health care
10 services and facilities, as it affects persons eligible for
11 medical assistance under this Code. The Illinois Department
12 shall report regularly the results of the operation of such
13 systems and programs to the Citizens Assembly/Council on
14 Public Aid to enable the Committee to ensure, from time to
15 time, that these programs are effective and meaningful.
16 The Illinois Department shall report annually to the
17 General Assembly, no later than the second Friday in April of
18 1979 and each year thereafter, in regard to:
19 (a) actual statistics and trends in utilization of
20 medical services by public aid recipients;
21 (b) actual statistics and trends in the provision
22 of the various medical services by medical vendors;
23 (c) current rate structures and proposed changes in
24 those rate structures for the various medical vendors;
25 and
26 (d) efforts at utilization review and control by
27 the Illinois Department.
28 The period covered by each report shall be the 3 years
29 ending on the June 30 prior to the report. The report shall
30 include suggested legislation for consideration by the
31 General Assembly. The filing of one copy of the report with
32 the Speaker, one copy with the Minority Leader and one copy
33 with the Clerk of the House of Representatives, one copy with
34 the President, one copy with the Minority Leader and one copy
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1 with the Secretary of the Senate, one copy with the
2 Legislative Research Unit, such additional copies with the
3 State Government Report Distribution Center for the General
4 Assembly as is required under paragraph (t) of Section 7 of
5 the State Library Act and one copy with the Citizens
6 Assembly/Council on Public Aid or its successor shall be
7 deemed sufficient to comply with this Section.
8 (Source: P.A. 88-670, eff. 12-2-94; 89-21, eff. 7-1-95;
9 89-507, eff. 7-1-97; 89-517, eff. 1-1-97; revised 8-26-96.)
10 (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
11 Sec. 6-1. Eligibility requirements. Financial aid in
12 meeting basic maintenance requirements shall be given under
13 this Article to or in behalf of persons who meet the
14 eligibility conditions of Sections 6-1.1 through 6-1.10. In
15 addition, each unit of local government subject to this
16 Article shall provide persons receiving financial aid in
17 meeting basic maintenance requirements with financial aid for
18 either (a) necessary treatment, care, and supplies required
19 because of illness or disability, or (b) acute medical
20 treatment, care, and supplies only. If a local governmental
21 unit elects to provide financial aid for acute medical
22 treatment, care, and supplies only, the general types of
23 acute medical treatment, care, and supplies for which
24 financial aid is provided shall be specified in the general
25 assistance rules of the local governmental unit, which rules
26 shall provide that financial aid is provided, at a minimum,
27 for acute medical treatment, care, or supplies necessitated
28 by a medical condition for which prior approval or
29 authorization of medical treatment, care, or supplies is not
30 required by the general assistance rules of the Illinois
31 Department. Nothing in this Article shall be construed to
32 permit the granting of financial aid where the purpose of
33 such aid is to obtain an abortion, induced miscarriage or
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1 induced premature birth unless, in the opinion of a
2 physician, such procedures are necessary for the preservation
3 of the life of the woman seeking such treatment, or except an
4 induced premature birth intended to produce a live viable
5 child and such procedure is necessary for the health of the
6 mother or her unborn child; State funds may also be used to
7 pay for abortions to terminate a pregnancy resulting from an
8 act of criminal sexual assault, as defined in Section 12-13
9 of the Criminal Code of 1961, an act of aggravated criminal
10 sexual assault, as defined in Section 12-14 of the Criminal
11 Code of 1961, or an act of sexual relations within families,
12 as defined in Section 11-11 of the Criminal Code of 1961, but
13 only to the extent that payment for such abortions is
14 required by federal law as determined by a court of competent
15 jurisdiction; provided further that payment for an abortion
16 to terminate a pregnancy resulting from an act of criminal
17 sexual assault, aggravated criminal sexual assault, or sexual
18 relations within families is reported to a law enforcement
19 agency before the abortion is performed. Nothing in this
20 Article shall be construed to permit the granting of
21 financial aid where the purpose of such aid is to obtain an
22 abortion, induced miscarriage or induced premature birth
23 unless, in the opinion of a physician, such procedures are
24 necessary for the preservation of the life of the woman
25 seeking such treatment, or except an induced premature birth
26 intended to produce a live viable child and such procedure is
27 necessary for the health of the mother or her unborn child.
28 Until August 1, 1969, children who require care outside
29 their own homes, where no other sources of funds or
30 insufficient funds are available to provide the necessary
31 care, are included among persons eligible for aid under this
32 Article. After July 31, 1969, the Department of Children and
33 Family Services shall have the responsibility of providing
34 child welfare services to such children, as provided in
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1 Section 5 of "An Act creating the Department of Children and
2 Family Services, codifying its powers and duties, and
3 repealing certain Acts and Sections herein named", approved
4 June 4, 1963, as amended.
5 In cities, villages and incorporated towns of more than
6 500,000 population, the Illinois Department may establish a
7 separate program under this Article. The 2 programs shall be
8 differentiated, but the placement of persons under both
9 programs shall be based upon their ability or inability to
10 engage in employment in accordance with the rules and
11 regulations promulgated by the Illinois Department. In
12 establishing rules and regulations for determining whether a
13 person is able to engage in employment, the Illinois
14 Department may establish rules different than those set out
15 under Section 11-20. In determining need and the amount of
16 aid under Sections 6-1.2 and 6-2 for the 2 programs, the
17 Illinois Department may establish different standards for the
18 2 programs based upon the specific needs of the different
19 populations to be served by the 2 programs. The Illinois
20 Department may enter into contracts with entities to
21 establish work or training related projects under the program
22 established for persons determined to be able to engage in
23 employment.
24 (Source: P.A. 89-646, eff. 1-1-97.)
25 Setion 90. Severability. If any provision, word, phrase
26 or clause of this amendatory Act of 1997 or its application
27 to any person or circumstance is held invalid, the invalidity
28 does not affect the provisions, words, phrases, clauses or
29 application of this amendatory Act of 1997 which can be given
30 effect without the invalid provision, word, phrase, clause,
31 or application, and to this end the provisions, words,
32 phrases, and clauses of this amendatory Act of 1997 are
33 declared to be severable.
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1 Section 95. No acceleration or delay. Where this Act
2 makes changes in a statute that is represented in this Act by
3 text that is not yet or no longer in effect (for example, a
4 Section represented by multiple versions), the use of that
5 text does not accelerate or delay the taking effect of (i)
6 the changes made by this Act or (ii) provisions derived from
7 any other Public Act.
8 Section 99. Effective date. This Act takes effect upon
9 becoming law.