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| [ Introduced ] | [ Engrossed ] | [ House Amendment 003 ] |
90_SB0860ham001
LRB9002988SMdvam01
1 AMENDMENT TO SENATE BILL 860
2 AMENDMENT NO. . Amend Senate Bill 860 by replacing
3 the title with the following:
4 "AN ACT to amend the Illinois Public Aid Code by changing
5 Section 12-13.1."; and
6 by replacing everything after the enacting clause with the
7 following:
8 "Section 5. The Illinois Public Aid Code is amended by
9 changing Section 12-13.1 as follows:
10 (305 ILCS 5/12-13.1)
11 (Text of Section before amendment by P.A. 89-507)
12 Sec. 12-13.1. Inspector General.
13 (a) The Governor shall appoint, and the Senate shall
14 confirm, an Inspector General who shall function within the
15 Illinois Department and report to the Governor. The term of
16 the Inspector General shall expire on the third Monday of
17 January, 1997 and every 4 years thereafter.
18 (b) In order to prevent, detect, and eliminate fraud,
19 waste, abuse, mismanagement, and misconduct, the Inspector
20 General shall oversee the Illinois Department's integrity
21 functions, which include, but are not limited to, the
22 following:
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1 (1) Investigation of misconduct by employees,
2 vendors, contractors and medical providers.
3 (2) Audits of medical providers related to ensuring
4 that appropriate payments are made for services rendered
5 and to the recovery of overpayments.
6 (3) Monitoring of quality assurance programs
7 generally related to the medical assistance program and
8 specifically related to any managed care program.
9 (4) Quality control measurements of the programs
10 administered by the Illinois Department.
11 (5) Investigations of fraud or intentional program
12 violations committed by clients of the Illinois
13 Department.
14 (6) Actions initiated against contractors or
15 medical providers for any of the following reasons:
16 (A) Violations of the medical assistance
17 program.
18 (B) Sanctions against providers brought in
19 conjunction with the Department of Public Health or
20 the Department of Mental Health and Developmental
21 Disabilities.
22 (C) Recoveries of assessments against
23 hospitals and long-term care facilities.
24 (D) Sanctions mandated by the United States
25 Department of Health and Human Services against
26 medical providers.
27 (E) Violations of contracts related to any
28 managed care programs.
29 (7) Representation of the Illinois Department at
30 hearings with the Illinois Department of Professional
31 Regulation in actions taken against professional licenses
32 held by persons who are in violation of orders for child
33 support payments.
34 (c) The Inspector General shall have access to all
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1 information, personnel and facilities of the Illinois
2 Department, its employees, vendors, contractors and medical
3 providers and any federal, State or local governmental agency
4 that are necessary to perform the duties of the Office as
5 directly related to public assistance programs administered
6 by the Illinois Department. No medical provider shall be
7 compelled, however, to provide individual medical records of
8 patients who are not clients of the Medical Assistance
9 Program. State and local governmental agencies are
10 authorized and directed to provide the requested information,
11 assistance or cooperation.
12 (d) The Inspector General shall serve as the Illinois
13 Department's primary liaison with law enforcement,
14 investigatory and prosecutorial agencies, including but not
15 limited to the following:
16 (1) The Department of State Police.
17 (2) The Federal Bureau of Investigation and other
18 federal law enforcement agencies.
19 (3) The various Inspectors General of federal
20 agencies overseeing the programs administered by the
21 Illinois Department.
22 (4) The various Inspectors General of any other
23 State agencies with responsibilities for portions of
24 programs primarily administered by the Illinois
25 Department.
26 (5) The Offices of the several United States
27 Attorneys in Illinois.
28 (6) The several State's Attorneys.
29 The Inspector General shall meet on a regular basis with
30 these entities to share information regarding possible
31 misconduct by any persons or entities involved with the
32 public aid programs administered by the Illinois Department.
33 (e) All investigations conducted by the Inspector
34 General shall be conducted in a manner that ensures the
-4- LRB9002988SMdvam01
1 preservation of evidence for use in criminal prosecutions.
2 If the Inspector General determines that a possible criminal
3 act relating to fraud in the provision or administration of
4 the medical assistance program has been committed, the
5 Inspector General shall immediately notify the Medicaid Fraud
6 Control Unit. If the Inspector General determines that a
7 possible criminal act has been committed within the
8 jurisdiction of the Office, the Inspector General may request
9 the special expertise of the Department of State Police. The
10 Inspector General may present for prosecution the findings of
11 any criminal investigation to the Office of the Attorney
12 General, the Offices of the several United State Attorneys in
13 Illinois or the several State's Attorneys.
14 (f) To carry out his or her duties as described in this
15 Section, the Inspector General and his or her designees shall
16 have the power to compel by subpoena the attendance and
17 testimony of witnesses and the production of books,
18 electronic records and papers as directly related to public
19 assistance programs administered by the Illinois Department.
20 No medical provider shall be compelled, however, to provide
21 individual medical records of patients who are not clients of
22 the Medical Assistance Program.
23 (g) The Inspector General shall report all convictions,
24 terminations, and suspensions taken against vendors,
25 contractors and medical providers to the Illinois Department
26 and to any agency responsible for licensing or regulating
27 those persons or entities.
28 (h) The Inspector General shall make annual quarterly
29 reports, findings, and recommendations regarding the Office's
30 investigations into reports of fraud, waste, abuse,
31 mismanagement, or misconduct relating to any public aid
32 programs administered by the Illinois Department to the
33 General Assembly and the Governor. These reports shall
34 include, but not be limited to, the following information:
-5- LRB9002988SMdvam01
1 (1) Aggregate provider billing and payment
2 information, including the number of providers at various
3 Medicaid earning levels.
4 (2) The number of audits of the medical assistance
5 program and the dollar savings resulting from those
6 audits.
7 (3) The number of prescriptions rejected annually
8 under the Illinois Department's Refill Too Soon program
9 and the dollar savings resulting from that program.
10 (4) Provider sanctions, in the aggregate, including
11 terminations and suspensions.
12 (5) A detailed summary of the investigations
13 undertaken in the previous fiscal year. These summaries
14 shall comply with all laws and rules regarding
15 maintaining confidentiality in the public aid programs.
16 (i) Nothing in this Section shall limit investigations
17 by the Illinois Department that may otherwise be required by
18 law or that may be necessary in the Illinois Department's
19 capacity as the central administrative authority responsible
20 for administration of public aid programs in this State.
21 (Source: P.A. 88-554, eff. 7-26-94.)
22 (Text of Section after amendment by P.A. 89-507)
23 Sec. 12-13.1. Inspector General.
24 (a) The Governor shall appoint, and the Senate shall
25 confirm, an Inspector General who shall function within the
26 Illinois Department of Public Aid and report to the Governor.
27 The term of the Inspector General shall expire on the third
28 Monday of January, 1997 and every 4 years thereafter.
29 (b) In order to prevent, detect, and eliminate fraud,
30 waste, abuse, mismanagement, and misconduct, the Inspector
31 General shall oversee the Illinois Department of Public Aid's
32 integrity functions, which include, but are not limited to,
33 the following:
34 (1) Investigation of misconduct by employees,
-6- LRB9002988SMdvam01
1 vendors, contractors and medical providers.
2 (2) Audits of medical providers related to ensuring
3 that appropriate payments are made for services rendered
4 and to the recovery of overpayments.
5 (3) Monitoring of quality assurance programs
6 generally related to the medical assistance program and
7 specifically related to any managed care program.
8 (4) Quality control measurements of the programs
9 administered by the Illinois Department of Public Aid.
10 (5) Investigations of fraud or intentional program
11 violations committed by clients of the Illinois
12 Department of Public Aid.
13 (6) Actions initiated against contractors or
14 medical providers for any of the following reasons:
15 (A) Violations of the medical assistance
16 program.
17 (B) Sanctions against providers brought in
18 conjunction with the Department of Public Health or
19 the Department of Human Services (as successor to
20 the Department of Mental Health and Developmental
21 Disabilities).
22 (C) Recoveries of assessments against
23 hospitals and long-term care facilities.
24 (D) Sanctions mandated by the United States
25 Department of Health and Human Services against
26 medical providers.
27 (E) Violations of contracts related to any
28 managed care programs.
29 (7) Representation of the Illinois Department of
30 Public Aid at hearings with the Illinois Department of
31 Professional Regulation in actions taken against
32 professional licenses held by persons who are in
33 violation of orders for child support payments.
34 (b-5) At the request of the Secretary of Human Services,
-7- LRB9002988SMdvam01
1 the Inspector General shall, in relation to any function
2 performed by the Department of Human Services as successor to
3 the Department of Public Aid, exercise one or more of the
4 powers provided under this Section as if those powers related
5 to the Department of Human Services; in such matters, the
6 Inspector General shall report his or her findings to the
7 Secretary of Human Services.
8 (c) The Inspector General shall have access to all
9 information, personnel and facilities of the Illinois
10 Department of Public Aid and the Department of Human Services
11 (as successor to the Department of Public Aid), their
12 employees, vendors, contractors and medical providers and any
13 federal, State or local governmental agency that are
14 necessary to perform the duties of the Office as directly
15 related to public assistance programs administered by those
16 departments. No medical provider shall be compelled,
17 however, to provide individual medical records of patients
18 who are not clients of the Medical Assistance Program. State
19 and local governmental agencies are authorized and directed
20 to provide the requested information, assistance or
21 cooperation.
22 (d) The Inspector General shall serve as the Illinois
23 Department of Public Aid's primary liaison with law
24 enforcement, investigatory and prosecutorial agencies,
25 including but not limited to the following:
26 (1) The Department of State Police.
27 (2) The Federal Bureau of Investigation and other
28 federal law enforcement agencies.
29 (3) The various Inspectors General of federal
30 agencies overseeing the programs administered by the
31 Illinois Department of Public Aid.
32 (4) The various Inspectors General of any other
33 State agencies with responsibilities for portions of
34 programs primarily administered by the Illinois
-8- LRB9002988SMdvam01
1 Department of Public Aid.
2 (5) The Offices of the several United States
3 Attorneys in Illinois.
4 (6) The several State's Attorneys.
5 The Inspector General shall meet on a regular basis with
6 these entities to share information regarding possible
7 misconduct by any persons or entities involved with the
8 public aid programs administered by the Illinois Department
9 of Public Aid.
10 (e) All investigations conducted by the Inspector
11 General shall be conducted in a manner that ensures the
12 preservation of evidence for use in criminal prosecutions.
13 If the Inspector General determines that a possible criminal
14 act relating to fraud in the provision or administration of
15 the medical assistance program has been committed, the
16 Inspector General shall immediately notify the Medicaid Fraud
17 Control Unit. If the Inspector General determines that a
18 possible criminal act has been committed within the
19 jurisdiction of the Office, the Inspector General may request
20 the special expertise of the Department of State Police. The
21 Inspector General may present for prosecution the findings of
22 any criminal investigation to the Office of the Attorney
23 General, the Offices of the several United State Attorneys in
24 Illinois or the several State's Attorneys.
25 (f) To carry out his or her duties as described in this
26 Section, the Inspector General and his or her designees shall
27 have the power to compel by subpoena the attendance and
28 testimony of witnesses and the production of books,
29 electronic records and papers as directly related to public
30 assistance programs administered by the Illinois Department
31 of Public Aid or the Department of Human Services (as
32 successor to the Department of Public Aid). No medical
33 provider shall be compelled, however, to provide individual
34 medical records of patients who are not clients of the
-9- LRB9002988SMdvam01
1 Medical Assistance Program.
2 (g) The Inspector General shall report all convictions,
3 terminations, and suspensions taken against vendors,
4 contractors and medical providers to the Illinois Department
5 of Public Aid and to any agency responsible for licensing or
6 regulating those persons or entities.
7 (h) The Inspector General shall make annual quarterly
8 reports, findings, and recommendations regarding the Office's
9 investigations into reports of fraud, waste, abuse,
10 mismanagement, or misconduct relating to any public aid
11 programs administered by the Illinois Department of Public
12 Aid or the Department of Human Services (as successor to the
13 Department of Public Aid) to the General Assembly and the
14 Governor. These reports shall include, but not be limited
15 to, the following information:
16 (1) Aggregate provider billing and payment
17 information, including the number of providers at various
18 Medicaid earning levels.
19 (2) The number of audits of the medical assistance
20 program and the dollar savings resulting from those
21 audits.
22 (3) The number of prescriptions rejected annually
23 under the Illinois Department of Public Aid's Refill Too
24 Soon program and the dollar savings resulting from that
25 program.
26 (4) Provider sanctions, in the aggregate, including
27 terminations and suspensions.
28 (5) A detailed summary of the investigations
29 undertaken in the previous fiscal year. These summaries
30 shall comply with all laws and rules regarding
31 maintaining confidentiality in the public aid programs.
32 (i) Nothing in this Section shall limit investigations
33 by the Illinois Department of Public Aid or the Department of
34 Human Services that may otherwise be required by law or that
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1 may be necessary in their capacity as the central
2 administrative authorities responsible for administration of
3 public aid programs in this State.
4 (Source: P.A. 88-554, eff. 7-26-94; 89-507, eff. 7-1-97.)
5 Section 95. No acceleration or delay. Where this Act
6 makes changes in a statute that is represented in this Act by
7 text that is not yet or no longer in effect (for example, a
8 Section represented by multiple versions), the use of that
9 text does not accelerate or delay the taking effect of (i)
10 the changes made by this Act or (ii) provisions derived from
11 any other Public Act.
12 Section 99. Effective date. This Act takes effect upon
13 becoming law.".