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90_SB1585ham001
LRB9011272ACsbam06
1 AMENDMENT TO SENATE BILL 1585
2 AMENDMENT NO. . Amend Senate Bill 1585 on page 1,
3 immediately below line 3, by inserting the following:
4 "Section 1. The Mental Health and Developmental
5 Disabilities Administrative Act is amended by changing
6 Section 56 as follows:
7 (20 ILCS 1705/56) (from Ch. 91 1/2, par. 100-56)
8 Sec. 56. The Secretary, upon making a determination
9 based upon information in the possession of the Department,
10 that continuation in practice of a licensed health care
11 professional would constitute an immediate danger to the
12 public, shall submit a written communication to the Director
13 of Professional Regulation indicating such determination and
14 additionally providing a complete summary of the information
15 upon which such determination is based, and recommending that
16 the Director of Professional Regulation immediately suspend
17 such person's license. All relevant evidence, or copies
18 thereof, in the Department's possession may also be submitted
19 in conjunction with the written communication. A copy of
20 such written communication, which is exempt from the copying
21 and inspection provisions of The Freedom of Information Act,
22 shall at the time of submittal to the Director of
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1 Professional Regulation be simultaneously mailed to the last
2 known business address of such licensed health care
3 professional by certified or registered postage, United
4 States Mail, return receipt requested. Any evidence, or
5 copies thereof, which is submitted in conjunction with the
6 written communication is also exempt from the copying and
7 inspection provisions of The Freedom of Information Act.
8 For the purposes of this Section, "licensed health care
9 professional" means any person licensed under the Illinois
10 Dental Practice Act, the Illinois Nursing and Advanced
11 Practice Nursing Act of 1987, the Medical Practice Act of
12 1987, the Pharmacy Practice Act of 1987, the Podiatric
13 Medical Practice Act of 1987, and the Illinois Optometric
14 Practice Act of 1987.
15 (Source: P.A. 89-507, eff. 7-1-97.)
16 Section 2. The Civil Administrative Code of Illinois is
17 amended by changing Sections 55.37a and 55.62a as follows:
18 (20 ILCS 2310/55.37a) (from Ch. 127, par. 55.37a)
19 Sec. 55.37a. The Director of Public Health, upon making
20 a determination based upon information in the possession of
21 the Department, that continuation in practice of a licensed
22 health care professional would constitute an immediate danger
23 to the public, shall submit a written communication to the
24 Director of the Department of Professional Regulation
25 indicating such determination and additionally providing a
26 complete summary of the information upon which such
27 determination is based, and recommending that the Director of
28 Professional Regulation immediately suspend such person's
29 license. All relevant evidence, or copies thereof, in the
30 Department's possession may also be submitted in conjunction
31 with the written communication. A copy of such written
32 communication, which is exempt from the copying and
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1 inspection provisions of The Freedom of Information Act,
2 shall at the time of submittal to the Director of the
3 Department of Professional Regulation be simultaneously
4 mailed to the last known business address of such licensed
5 health care professional by certified or registered postage,
6 United States Mail, return receipt requested. Any evidence,
7 or copies thereof, which is submitted in conjunction with the
8 written communication is also exempt for the copying and
9 inspection provisions of The Freedom of Information Act.
10 For the purposes of this Section "licensed health care
11 professional" means any person licensed under the Illinois
12 Dental Practice Act, the Illinois Nursing and Advanced
13 Practice Nursing Act of 1987, the Medical Practice Act of
14 1987, the Pharmacy Practice Act of 1987, the Podiatric
15 Medical Practice Act of 1987, and the Illinois Optometric
16 Practice Act of 1987.
17 (Source: P.A. 85-1209.)
18 (20 ILCS 2310/55.62a)
19 Sec. 55.62a. Advisory Panel on Minority Health.
20 (a) In this Section:
21 "Health profession" means any health profession regulated
22 under the laws of this State, including, without limitation,
23 professions regulated under the Illinois Athletic Trainers
24 Practice Act, the Clinical Psychologist Licensing Act, the
25 Clinical Social Work and Social Work Practice Act, the
26 Illinois Dental Practice Act, the Dietetic and Nutrition
27 Services Practice Act, the Marriage and Family Therapy
28 Licensing Act, the Medical Practice Act of 1987, the
29 Naprapathic Practice Act, the Illinois Nursing and Advanced
30 Practice Nursing Act of 1987, the Illinois Occupational
31 Therapy Practice Act, the Illinois Optometric Practice Act of
32 1987, the Illinois Physical Therapy Act, the Physician
33 Assistant Practice Act of 1987, the Podiatric Medical
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1 Practice Act of 1987, the Professional Counselor and Clinical
2 Professional Counselor Licensing Act, and the Illinois
3 Speech-Language Pathology and Audiology Practice Act.
4 "Minority" has the same meaning as in Section 55.62.
5 (b) The General Assembly finds as follows:
6 (1) The health status of individuals from ethnic
7 and racial minorities in this State is significantly
8 lower than the health status of the general population of
9 the State.
10 (2) Minorities suffer disproportionately high rates
11 of cancer, stroke, heart disease, diabetes, sickle-cell
12 anemia, lupus, substance abuse, acquired immune
13 deficiency syndrome, other diseases and disorders,
14 unintentional injuries, and suicide.
15 (3) The incidence of infant mortality among
16 minorities is almost double that for the general
17 population.
18 (4) Minorities suffer disproportionately from lack
19 of access to health care and poor living conditions.
20 (5) Minorities are under-represented in the health
21 care professions.
22 (6) Minority participation in the procurement
23 policies of the health care industry is lacking.
24 (7) Minority health professionals historically have
25 tended to practice in low-income areas and to serve
26 minorities.
27 (8) National experts on minority health report that
28 access to health care among minorities can be
29 substantially improved by increasing the number of
30 minority health professionals.
31 (9) Increasing the number of minorities serving on
32 the facilities of health professional schools is an
33 important factor in attracting minorities to pursue a
34 career in health professions.
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1 (10) Retaining minority health professionals
2 currently practicing in this State and those receiving
3 training and education in this State is an important
4 factor in maintaining and increasing the number of
5 minority health professionals in Illinois.
6 (11) An Advisory Panel on Minority Health is
7 necessary to address the health issues affecting
8 minorities in this State.
9 (c) The General Assembly's intent is as follows:
10 (1) That all Illinoisans have access to health
11 care.
12 (2) That the gap between the health status of
13 minorities and other Illinoisans be closed.
14 (3) That the health issues that disproportionately
15 affect minorities be addressed to improve the health
16 status of minorities.
17 (4) That the number of minorities in the health
18 professions be increased.
19 (d) The Advisory Panel on Minority Health is created.
20 The Advisory Panel shall consist of 25 members appointed by
21 the Director of Public Health. The members shall represent
22 health professions and the General Assembly.
23 (e) The Advisory Panel shall assist the Department in
24 the following manner:
25 (1) Examination of the following areas as they
26 relate to minority health:
27 (A) Access to health care.
28 (B) Demographic factors.
29 (C) Environmental factors.
30 (D) Financing of health care.
31 (E) Health behavior.
32 (F) Health knowledge.
33 (G) Utilization of quality care.
34 (H) Minorities in health care professions.
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1 (2) Development of monitoring, tracking, and
2 reporting mechanisms for programs and services with
3 minority health goals and objectives.
4 (3) Communication with local health departments,
5 community-based organizations, voluntary health
6 organizations, and other public and private organizations
7 statewide, on an ongoing basis, to learn more about their
8 services to minority communities, the health problems of
9 minority communities, and their ideas for improving
10 minority health.
11 (4) Promotion of communication among all State
12 agencies that provide services to minority populations.
13 (5) Building coalitions between the State and
14 leadership in minority communities.
15 (6) Encouragement of recruitment and retention of
16 minority health professionals.
17 (7) Improvement in methods for collecting and
18 reporting data on minority health.
19 (8) Improvement in accessibility to health and
20 medical care for minority populations in under-served
21 rural and urban areas.
22 (9) Reduction of communication barriers for
23 non-English speaking residents.
24 (10) Coordination of the development and
25 dissemination of culturally appropriate and sensitive
26 education material, public awareness messages, and health
27 promotion programs for minorities.
28 (f) On or before January 1, 1997 the Advisory Panel
29 shall submit an interim report to the Governor and the
30 General Assembly. The interim report shall include an update
31 on the Advisory Panel's progress in performing its functions
32 under this Section and shall include recommendations,
33 including recommendations for any necessary legislative
34 changes.
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1 On or before January 1, 1998 the Advisory Panel shall
2 submit a final report to the Governor and the General
3 Assembly. The final report shall include the following:
4 (1) An evaluation of the health status of
5 minorities in this State.
6 (2) An evaluation of minority access to health care
7 in this State.
8 (3) Recommendations for improving the health status
9 of minorities in this State.
10 (4) Recommendations for increasing minority access
11 to health care in this State.
12 (5) Recommendations for increasing minority
13 participation in the procurement policies of the health
14 care industry.
15 (6) Recommendations for increasing the number of
16 minority health professionals in this State.
17 (7) Recommendations that will ensure that the
18 health status of minorities in this State continues to be
19 addressed beyond the expiration of the Advisory Panel.
20 (Source: P.A. 89-298, eff. 1-1-96.)
21 Section 3. The Geriatric Medicine Assistance Act is
22 amended by changing Section 2 as follows:
23 (20 ILCS 3945/2) (from Ch. 144, par. 2002)
24 Sec. 2. There is created the Geriatric Medicine
25 Assistance Commission. The Commission shall receive and
26 approve applications for grants from schools, recognized by
27 the Department of Professional Regulation as being authorized
28 to confer doctor of medicine, doctor of osteopathy, doctor of
29 chiropractic or registered professional nursing degrees in
30 the State, to help finance the establishment of geriatric
31 medicine programs within such schools. In determining
32 eligibility for grants, the Commission shall give preference
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1 to those programs which exhibit the greatest potential for
2 directly benefiting the largest number of elderly citizens in
3 the State. The Commission may not approve the application of
4 any institution which is unable to demonstrate its current
5 financial stability and reasonable prospects for future
6 stability. No institution which fails to possess and maintain
7 an open policy with respect to race, creed, color and sex as
8 to admission of students, appointment of faculty and
9 employment of staff shall be eligible for grants under this
10 Act. The Commission shall establish such rules and standards
11 as it deems necessary for the implementation of this Act.
12 The Commission shall be composed of 8 members selected as
13 follows: 2 physicians licensed to practice under the Medical
14 Practice Act of 1987 and specializing in geriatric medicine;
15 a registered professional nurse licensed under the Illinois
16 Nursing and Advanced Practice Nursing Act of 1987 and
17 specializing in geriatric health care medicine; 2
18 representatives of organizations interested in geriatric
19 medicine or the care of the elderly; and 3 individuals 60 or
20 older who are interested in geriatric health care medicine or
21 the care of the elderly. The members of the Commission shall
22 be selected by the Governor from a list of recommendations
23 submitted to him by organizations concerned with geriatric
24 medicine or the care of the elderly.
25 The terms of the members of the Commission shall be 4
26 years, except that of the members initially appointed, 2
27 shall be designated to serve until January 1, 1986, 3 until
28 January 1, 1988, and 2 until January 1, 1990. Members of the
29 Commission shall receive no compensation, but shall be
30 reimbursed for actual expenses incurred in carrying out their
31 duties.
32 (Source: P.A. 85-1209.)
33 Section 4. The Baccalaureate Assistance Law for
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1 Registered Nurses is amended by changing Section 3 as
2 follows:
3 (110 ILCS 915/3) (from Ch. 144, par. 1403)
4 Sec. 3. Definitions. The following terms, whenever used
5 or referred to, have the following meanings except where the
6 context clearly indicates otherwise:
7 (a) "Board" means: the Board of Higher Education created
8 by "An Act creating a Board of Higher Education, defining its
9 powers and duties, making an appropriation therefor, and
10 repealing an Act therein named", approved August 22, 1961, as
11 now or hereafter amended.
12 (b) "Department" means: the Illinois Department of
13 Public Health.
14 (c) "Approved institution" means: a college or
15 university located in this State which has National League
16 for Nursing accreditation for the baccalaureate degree
17 program in nursing.
18 (d) "Enrollment" means: the establishment and
19 maintenance of an individual's status as a student in an
20 approved institution, regardless of the terms used at the
21 institution to describe such status.
22 (e) "Academic year" means: the period of time from
23 September 1 of one year through August 31 of the next year.
24 (f) "Registered Nurse" or "professional nurse" means: a
25 nurse holding a valid existing license in good standing as a
26 registered professional nurse issued by the Department of
27 Professional Regulation under the Illinois Nursing and
28 Advanced Practice Nursing Act of 1987.
29 (g) "Regions" means: the official and uniform state
30 planning and administrative regions established by the
31 Governor by Executive Order No. 7, dated June 22, 1971, as
32 amended.
33 (h) "Director" means: the Director of the Illinois
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1 Department of Public Health.
2 (Source: P.A. 85-1209.)
3 Section 5. The Nursing Education Scholarship Law is
4 amended by changing Section 6 as follows:
5 (110 ILCS 975/6) (from Ch. 144, par. 2756)
6 Sec. 6. Nursing requirements for scholarship recipients.
7 Upon graduation from an associate degree or hospital
8 based program in professional nursing, baccalaureate degree
9 in nursing program, or other program or course of study any
10 person who accepted a scholarship under Section 5 shall,
11 during the 7 year period immediately following his or her
12 graduation, be employed in this State as a registered
13 professional nurse or licensed practical nurse, as each term
14 defined in the Illinois Nursing and Advanced Practice Nursing
15 Act of 1987, for at least one year for each year of full-time
16 scholarship support received. If the recipient spends up to
17 4 years in military service before or after he or she
18 graduates, the period of military service shall be excluded
19 from the computation of that 7 year period. A recipient who
20 is enrolled in an academic program leading to a graduate
21 degree in nursing shall have the period of graduate study
22 excluded from the computation of that 7 year period.
23 Calendar years of required employment will be
24 proportionally reduced for less than full academic year
25 scholarship support; provided that employment must be at
26 least 17.5 hours per week.
27 Any person who fails to fulfill the nursing employment
28 requirement shall pay to the Department an amount equal to
29 the amount of scholarship funds received per year for each
30 unfulfilled year of the nursing employment requirement,
31 together with interest at 7% per year on the unpaid balance.
32 All repayments must be completed within 6 years from the date
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1 of the occurrence initiating the repayment. However, this
2 obligation to repay does not apply when the failure to
3 fulfill the nursing requirement results from involuntarily
4 leaving the profession due to a decrease in the number of
5 nurses employed in the State or from the death or
6 adjudication as incompetent of the person holding the
7 scholarship. No claim for repayment may be filed against the
8 estate of such a decedent or incompetent.
9 Each person applying for such a scholarship shall be
10 provided with a copy of this Section at the time he or she
11 applies for the benefits of such scholarship.
12 (Source: P.A. 86-1467; 87-577.)
13 Section 6. The Academic Degree Act is amended by
14 changing Section 11 as follows:
15 (110 ILCS 1010/11) (from Ch. 144, par. 241)
16 Sec. 11. Exemptions. This Act shall not apply to any
17 school or educational institution regulated or approved under
18 the Illinois Nursing and Advanced Practice Nursing Act of
19 1987, as heretofore and hereafter amended.
20 This Act shall not apply to any of the following:
21 (a) in-training programs by corporations or other
22 business organizations for the training of their personnel;
23 (b) education or other improvement programs by business,
24 trade and similar organizations and associations for the
25 benefit of their members only; or
26 (c) apprentice or other training programs by labor
27 unions.
28 (Source: P.A. 85-1209.)
29 Section 7. The Ambulatory Surgical Treatment Center Act
30 is amended by adding Section 6.5 as follows:
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1 (210 ILCS 5/6.5 new)
2 Sec. 6.5. Clinical privileges; advanced practice nurses.
3 No policy, rule, regulation, or practice of an ambulatory
4 surgical treatment center licensed under this Act shall be
5 inconsistent with the provision of adequate collaboration,
6 including medical direction of licensed advanced practice
7 nurses, in accordance with Section 54.5 of the Medical
8 Practice Act of 1987."; and
9 on page 1, line 4, by replacing "Section 5." with "Section
10 8."; and
11 on page 1, immediately below line 31, by inserting the
12 following:
13 "Section 9. The Life Care Facilities Act is amended by
14 changing Section 2 as follows:
15 (210 ILCS 40/2) (from Ch. 111 1/2, par. 4160-2)
16 Sec. 2. As used in this Act, unless the context
17 otherwise requires:
18 (a) "Department" means the Department of Public Health.
19 (b) "Director" means the Director of the Department.
20 (c) "Life care contract" means a contract to provide to
21 a person for the duration of such person's life or for a term
22 in excess of one year, nursing services, medical services or
23 personal care services, in addition to maintenance services
24 for such person in a facility, conditioned upon the transfer
25 of an entrance fee to the provider of such services in
26 addition to or in lieu of the payment of regular periodic
27 charges for the care and services involved.
28 (d) "Provider" means a person who provides services
29 pursuant to a life care contract.
30 (e) "Resident" means a person who enters into a life
31 care contract with a provider, or who is designated in a life
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1 care contract to be a person provided with maintenance and
2 nursing, medical or personal care services.
3 (f) "Facility" means a place or places in which a
4 provider undertakes to provide a resident with nursing
5 services, medical services or personal care services, in
6 addition to maintenance services for a term in excess of one
7 year or for life pursuant to a life care contract. The term
8 also means a place or places in which a provider undertakes
9 to provide such services to a non-resident.
10 (g) "Living unit" means an apartment, room or other area
11 within a facility set aside for the exclusive use of one or
12 more identified residents.
13 (h) "Entrance fee" means an initial or deferred transfer
14 to a provider of a sum of money or property, made or promised
15 to be made by a person entering into a life care contract,
16 which assures a resident of services pursuant to a life care
17 contract.
18 (i) "Permit" means a written authorization to enter into
19 life care contracts issued by the Department to a provider.
20 (j) "Medical services" means those services pertaining
21 to medical or dental care that are performed in behalf of
22 patients at the direction of a physician licensed under the
23 Medical Practice Act of 1987 or a dentist licensed under "the
24 Illinois Dental Practice Act" by such physicians or dentists,
25 or by a registered or licensed practical nurse as defined in
26 the Illinois Nursing and Advanced Practice Nursing Act of
27 1987 or by other professional and technical personnel.
28 (k) "Nursing services" means those services pertaining
29 to the curative, restorative and preventive aspects of
30 nursing care that are performed at the direction of a
31 physician licensed under the Medical Practice Act of 1987 by
32 or under the supervision of a registered or licensed
33 practical nurse as defined in the Illinois Nursing and
34 Advanced Practice Nursing Act of 1987.
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1 (l) "Personal care services" means assistance with
2 meals, dressing, movement, bathing or other personal needs or
3 maintenance, or general supervision and oversight of the
4 physical and mental well-being of an individual, who is
5 incapable of maintaining a private, independent residence or
6 who is incapable of managing his person whether or not a
7 guardian has been appointed for such individual.
8 (m) "Maintenance services" means food, shelter and
9 laundry services.
10 (n) "Certificates of Need" means those permits issued
11 pursuant to the Illinois Health Facilities Planning Act as
12 now or hereafter amended.
13 (o) "Non-resident" means a person admitted to a facility
14 who has not entered into a life care contract.
15 (Source: P.A. 85-1440.)
16 Section 10. The Nursing Home Care Act is amended by
17 changing Section 1-118 as follows:
18 (210 ILCS 45/1-118) (from Ch. 111 1/2, par. 4151-118)
19 Sec. 1-118. "Nurse" means a registered nurse or a
20 licensed practical nurse as defined in the Illinois Nursing
21 and Advanced Practice Nursing Act of 1987, as now or
22 hereafter amended.
23 (Source: P.A. 85-1209)
24 Section 11. The Emergency Medical Services (EMS) Systems
25 Act is amended by changing Section 3.80 as follows:
26 (210 ILCS 50/3.80)
27 Sec. 3.80. Pre-Hospital RN and Emergency Communications
28 Registered Nurse.
29 (a) Emergency Communications Registered Nurse or "ECRN"
30 means a registered professional nurse, licensed under the
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1 Illinois Nursing and Advanced Practice Nursing Act of 1987
2 who has successfully completed supplemental education in
3 accordance with rules adopted by the Department, and who is
4 approved by an EMS Medical Director to monitor
5 telecommunications from and give voice orders to EMS System
6 personnel, under the authority of the EMS Medical Director
7 and in accordance with System protocols.
8 Upon the effective date of this amendatory Act of 1995,
9 all existing Registered Professional Nurse/MICNs shall be
10 considered ECRNs.
11 (b) "Pre-Hospital Registered Nurse" or "Pre-Hospital RN"
12 means a registered professional nurse, licensed under the
13 Illinois Nursing and Advanced Practice Nursing Act of 1987
14 who has successfully completed supplemental education in
15 accordance with rules adopted by the Department pursuant to
16 this Act, and who is approved by an EMS Medical Director to
17 practice within an EMS System as emergency medical services
18 personnel for pre-hospital and inter-hospital emergency care
19 and non-emergency medical transports.
20 Upon the effective date of this amendatory Act of 1995,
21 all existing Registered Professional Nurse/Field RNs shall be
22 considered Pre-Hospital RNs.
23 (c) The Department shall have the authority and
24 responsibility to:
25 (1) Prescribe education and continuing education
26 requirements for Pre-Hospital RN and ECRN candidates
27 through rules adopted pursuant to this Act:
28 (A) Education for Pre-Hospital RN shall
29 include extrication, telecommunications, and
30 pre-hospital cardiac and trauma care;
31 (B) Education for ECRN shall include
32 telecommunications, System standing medical orders
33 and the procedures and protocols established by the
34 EMS Medical Director;
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1 (C) A Pre-Hospital RN candidate who is
2 fulfilling clinical training and in-field supervised
3 experience requirements may perform prescribed
4 procedures under the direct supervision of a
5 physician licensed to practice medicine in all of
6 its branches, a qualified registered professional
7 nurse or a qualified EMT, only when authorized by
8 the EMS Medical Director;
9 (D) An EMS Medical Director may impose
10 in-field supervised field experience requirements on
11 System ECRNs as part of their training or continuing
12 education, in which they perform prescribed
13 procedures under the direct supervision of a
14 physician licensed to practice medicine in all of
15 its branches, a qualified registered professional
16 nurse or qualified EMT, only when authorized by the
17 EMS Medical Director;
18 (2) Require EMS Medical Directors to reapprove
19 Pre-Hospital RNs and ECRNs every 4 years, based on
20 compliance with continuing education requirements
21 prescribed by the Department through rules adopted
22 pursuant to this Act;
23 (3) Allow EMS Medical Directors to grant inactive
24 status to any Pre-Hospital RN or ECRN who qualifies,
25 based on standards and procedures established by the
26 Department in rules adopted pursuant to this Act;
27 (4) Require a Pre-Hospital RN to honor Do Not
28 Resuscitate (DNR) orders and powers of attorney for
29 health care only in accordance with rules adopted by the
30 Department pursuant to this Act and protocols of the EMS
31 System in which he or she practices.
32 (Source: P.A. 89-177, eff. 7-19-95.)
33 Section 12. The Hospice Program Licensing Act is amended
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1 by changing Section 3 as follows:
2 (210 ILCS 60/3) (from Ch. 111 1/2, par. 6103)
3 Sec. 3. Definitions. As used in this Act, unless the
4 context otherwise requires:
5 (a) "Bereavement" means the period of time during which
6 the hospice patient's family experiences and adjusts to the
7 death of the hospice patient.
8 (b) "Department" means the Illinois Department of Public
9 Health.
10 (c) "Director" means the Director of the Illinois
11 Department of Public Health.
12 (d) "Full hospice" means a coordinated program of home
13 and inpatient care providing directly, or through agreement,
14 palliative and supportive medical, health and other services
15 to terminally ill patients and their families. A full
16 hospice utilizes a medically directed interdisciplinary
17 hospice care team of professionals and volunteers. The
18 program provides care to meet the physical, psychological,
19 social, spiritual and other special needs which are
20 experienced during the final stages of illness and during
21 dying and bereavement. Home care is to be provided on a
22 part-time, intermittent, regularly scheduled basis, and on an
23 on-call around-the-clock basis according to patient and
24 family need. To the maximum extent possible, care shall be
25 furnished in the patient's home. Should in-patient care be
26 required, services are to be provided with the intent of
27 minimizing the length of such care and shall only be provided
28 in a hospital licensed under the Hospital Licensing Act, or a
29 skilled nursing facility licensed under the Nursing Home Care
30 Act.
31 (e) "Hospice care team" means an interdisciplinary
32 working unit composed of but not limited to a physician
33 licensed to practice medicine in all of its branches, a nurse
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1 licensed pursuant to the Illinois Nursing and Advanced
2 Practice Nursing Act of 1987, a social worker, a pastoral or
3 other counselor, and trained volunteers. The patient and the
4 patient's family are considered members of the hospice care
5 team when development or revision of the patient's plan of
6 care takes place.
7 (f) "Hospice patient" means a terminally ill person
8 receiving hospice services.
9 (g) "Hospice patient's family" means a hospice patient's
10 immediate family consisting of a spouse, sibling, child,
11 parent and those individuals designated as such by the
12 patient for the purposes of this Act.
13 (g-1) "Hospice residence" means a home, apartment
14 building, or similar building providing living quarters:
15 (1) that is owned or operated by a person licensed
16 to operate as a full hospice; and
17 (2) at which hospice services are provided to
18 facility residents.
19 A building that is licensed under the Hospital Licensing
20 Act or the Nursing Home Care Act is not a hospice residence.
21 (h) "Hospice services" means palliative and supportive
22 care provided to a hospice patient and his family to meet the
23 special need arising out of the physical, emotional,
24 spiritual and social stresses which are experienced during
25 the final stages of illness and during dying and bereavement.
26 Services provided to the terminally ill patient shall be
27 furnished, to the maximum extent possible, in the patient's
28 home. Should inpatient care be required, services are to be
29 provided with the intent of minimizing the length of such
30 care.
31 (i) "Palliative care" means treatment to provide for the
32 reduction or abatement of pain and other troubling symptoms,
33 rather than treatment aimed at investigation and intervention
34 for the purpose of cure or inappropriate prolongation of
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1 life.
2 (j) "Hospice service plan" means a plan detailing the
3 specific hospice services offered by a full or volunteer
4 hospice, and the administrative and direct care personnel
5 responsible for those services. The plan shall include but
6 not be limited to:
7 (1) Identification of the person or persons
8 administratively responsible for the program, and the
9 affiliation of such person or persons with a licensed
10 home health agency, hospital or nursing home.
11 (2) The estimated average monthly patient census.
12 (3) The proposed geographic area the hospice will
13 serve.
14 (4) A listing of those hospice services provided
15 directly by the hospice, and those hospice services
16 provided indirectly through a contractual agreement.
17 (5) The name and qualifications of those persons or
18 entities under contract to provide indirect hospice
19 services.
20 (6) The name and qualifications of those persons
21 providing direct hospice services, with the exception of
22 volunteers.
23 (7) A description of how the hospice plans to
24 utilize volunteers in the provision of hospice services.
25 (8) A description of the program's record keeping
26 system.
27 (k) "Terminally ill" means a medical prognosis by a
28 physician licensed to practice medicine in all of its
29 branches that a patient has an anticipated life expectancy of
30 6 months or less.
31 (l) "Volunteer" means a person who offers his or her
32 services to a hospice without compensation. Reimbursement
33 for a volunteer's expenses in providing hospice service shall
34 not be considered compensation.
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1 (m) "Volunteer hospice" means a program which provides
2 hospice services to patients regardless of their ability to
3 pay, with emphasis on the utilization of volunteers to
4 provide services, under the administration of a
5 not-for-profit agency. This definition does not prohibit the
6 employment of staff.
7 (Source: P.A. 89-278, eff. 8-10-95.)
8 Section 13. The Hospital Licensing Act is amended by
9 changing Section 10 as follows:
10 (210 ILCS 85/10) (from Ch. 111 1/2, par. 151)
11 Sec. 10. Board creation; Department rules.
12 (a) The Governor shall appoint a Hospital Licensing Board
13 composed of 14 persons, which shall advise and consult with
14 the Director in the administration of this Act. The
15 Secretary of Human Services (or his or her designee) shall
16 serve on the Board, along with one additional representative
17 of the Department of Human Services to be designated by the
18 Secretary. Four appointive members shall represent the
19 general public and 2 of these shall be members of hospital
20 governing boards; one appointive member shall be a registered
21 professional nurse or advanced practice nurse as defined in
22 the Illinois Nursing and Advanced Practice Nursing Act of
23 1987, as now or hereafter amended, who is employed in a
24 hospital; 3 appointive members shall be hospital
25 administrators actively engaged in the supervision or
26 administration of hospitals; 2 appointive members shall be
27 practicing physicians, licensed in Illinois to practice
28 medicine in all of its branches; and one appointive member
29 shall be a physician licensed to practice podiatric medicine
30 under the Podiatric Medical Practice Act of 1987; and one
31 appointive member shall be a dentist licensed to practice
32 dentistry under the "Illinois Dental Practice Act", approved
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1 September 14, 1985, as amended. In making Board appointments,
2 the Governor shall give consideration to recommendations made
3 through the Director by professional organizations concerned
4 with hospital administration for the hospital administrative
5 and governing board appointments, registered professional
6 nurse organizations for the registered professional nurse
7 appointment, professional medical organizations for the
8 physician appointments, and professional dental organizations
9 for the dentist appointment.
10 (b) Each appointive member shall hold office for a term
11 of 3 years, except that any member appointed to fill a
12 vacancy occurring prior to the expiration of the term for
13 which his predecessor was appointed shall be appointed for
14 the remainder of such term and the terms of office of the
15 members first taking office shall expire, as designated at
16 the time of appointment, 2 at the end of the first year, 2 at
17 the end of the second year, and 3 at the end of the third
18 year, after the date of appointment. The initial terms of
19 office of the 2 additional members representing the general
20 public provided for in this Section shall expire at the end
21 of the third year after the date of appointment. The term of
22 office of each original appointee shall commence July 1,
23 1953; the term of office of the original registered
24 professional nurse appointee shall commence July 1, 1969; the
25 term of office of the original licensed podiatrist appointee
26 shall commence July 1, 1981; the term of office of the
27 original dentist appointee shall commence July 1, 1987; and
28 the term of office of each successor shall commence on July 1
29 of the year in which his predecessor's term expires. Board
30 members, while serving on business of the Board, shall
31 receive actual and necessary travel and subsistence expenses
32 while so serving away from their places of residence. The
33 Board shall meet as frequently as the Director deems
34 necessary, but not less than once a year. Upon request of 5
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1 or more members, the Director shall call a meeting of the
2 Board.
3 (c) The Director shall prescribe rules, regulations,
4 standards, and statements of policy needed to implement,
5 interpret, or make specific the provisions and purposes of
6 this Act. The Department shall adopt rules which set forth
7 standards for determining when the public interest, safety or
8 welfare requires emergency action in relation to termination
9 of a research program or experimental procedure conducted by
10 a hospital licensed under this Act. No rule, regulation, or
11 standard shall be adopted by the Department concerning the
12 operation of hospitals licensed under this Act which has not
13 had prior approval of the Hospital Licensing Board, nor shall
14 the Department adopt any rule, regulation or standard
15 relating to the establishment of a hospital without
16 consultation with the Hospital Licensing Board.
17 (d) Within one year after the effective date of this
18 amendatory Act of 1984, all hospitals licensed under this Act
19 and providing perinatal care shall comply with standards of
20 perinatal care promulgated by the Department. The Director
21 shall promulgate rules or regulations under this Act which
22 are consistent with "An Act relating to the prevention of
23 developmental disabilities", approved September 6, 1973, as
24 amended.
25 (Source: P.A. 89-507, eff. 7-1-97.)
26 Section 14. The Hospital Licensing Act is amended by
27 adding Section 10.7 as follows:
28 (210 ILCS 85/10.7 new)
29 Sec. 10.7. Clinical privileges; advanced practice
30 registered nurses. No policy, rule, regulation, or practice
31 of a hospital licensed under this Act shall be inconsistent
32 with the provision of adequate collaboration, including
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1 medical direction of licensed advanced practice nurses, in
2 accordance with Section 54.5 of the Medical Practice Act of
3 1987.
4 Section 15. The Health Care Worker Self-Referral Act is
5 amended by changing Section 15 as follows:
6 (225 ILCS 47/15)
7 Sec. 15. Definitions. In this Act:
8 (a) "Board" means the Health Facilities Planning Board.
9 (b) "Entity" means any individual, partnership, firm,
10 corporation, or other business that provides health services
11 but does not include an individual who is a health care
12 worker who provides professional services to an individual.
13 (c) "Group practice" means a group of 2 or more health
14 care workers legally organized as a partnership, professional
15 corporation, not-for-profit corporation, faculty practice
16 plan or a similar association in which:
17 (1) each health care worker who is a member or
18 employee or an independent contractor of the group
19 provides substantially the full range of services that
20 the health care worker routinely provides, including
21 consultation, diagnosis, or treatment, through the use of
22 office space, facilities, equipment, or personnel of the
23 group;
24 (2) the services of the health care workers are
25 provided through the group, and payments received for
26 health services are treated as receipts of the group; and
27 (3) the overhead expenses and the income from the
28 practice are distributed by methods previously determined
29 by the group.
30 (d) "Health care worker" means any individual licensed
31 under the laws of this State to provide health services,
32 including but not limited to: dentists licensed under the
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1 Illinois Dental Practice Act; dental hygienists licensed
2 under the Illinois Dental Practice Act; nurses and advanced
3 practice nurses licensed under the Illinois Nursing and
4 Advanced Practice Nursing Act of 1987; occupational
5 therapists licensed under the Illinois Occupational Therapy
6 Practice Act; optometrists licensed under the Illinois
7 Optometric Practice Act of 1987; pharmacists licensed under
8 the Pharmacy Practice Act of 1987; physical therapists
9 licensed under the Illinois Physical Therapy Act; physicians
10 licensed under the Medical Practice Act of 1987; physician
11 assistants licensed under the Physician Assistant Practice
12 Act of 1987; podiatrists licensed under the Podiatric Medical
13 Practice Act of 1987; clinical psychologists licensed under
14 the Clinical Psychologist Licensing Act; clinical social
15 workers licensed under the Clinical Social Work and Social
16 Work Practice Act; speech-language pathologists and
17 audiologists licensed under the Illinois Speech-Language
18 Pathology and Audiology Practice Act; or hearing instrument
19 dispensers licensed under the Hearing Instrument Consumer
20 Protection Act, or any of their successor Acts.
21 (e) "Health services" means health care procedures and
22 services provided by or through a health care worker.
23 (f) "Immediate family member" means a health care
24 worker's spouse, child, child's spouse, or a parent.
25 (g) "Investment interest" means an equity or debt
26 security issued by an entity, including, without limitation,
27 shares of stock in a corporation, units or other interests in
28 a partnership, bonds, debentures, notes, or other equity
29 interests or debt instruments except that investment interest
30 for purposes of Section 20 does not include interest in a
31 hospital licensed under the laws of the State of Illinois.
32 (h) "Investor" means an individual or entity directly or
33 indirectly owning a legal or beneficial ownership or
34 investment interest, (such as through an immediate family
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1 member, trust, or another entity related to the investor).
2 (i) "Office practice" includes the facility or
3 facilities at which a health care worker, on an ongoing
4 basis, provides or supervises the provision of professional
5 health services to individuals.
6 (j) "Referral" means any referral of a patient for
7 health services, including, without limitation:
8 (1) The forwarding of a patient by one health care
9 worker to another health care worker or to an entity
10 outside the health care worker's office practice or group
11 practice that provides health services.
12 (2) The request or establishment by a health care
13 worker of a plan of care outside the health care worker's
14 office practice or group practice that includes the
15 provision of any health services.
16 (Source: P.A. 89-72, eff. 12-31-95.)"; and
17 on page 2, line 1, by replacing "Section 10." with "Section
18 16."; and
19 on page 14, line 11, by deleting "in a team relationship";
20 and
21 on page 15, line 16, by replacing "acts." with "acts or
22 commits willful and wanton misconduct."; and
23 on page 15, line 17, by replacing "Section 15." with "Section
24 17."; and
25 on page 15, line 23, after "15-55," by inserting "15-100,";
26 and
27 on page 32, line 1, by replacing "2 years" with "one year 2
28 years"; and
29 on page 64, immediately below line 25, by inserting the
30 following:
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1 "(225 ILCS 65/15-100 new)
2 Sec. 15-100. Joint Committee on Licensure of CRNAs.
3 There is created the Joint Committee on Licensure of CRNAs,
4 consisting of the chairperson and minority spokesperson of
5 the Licensed Activities Committee of the Senate, the
6 chairperson and minority spokesperson of the Registration and
7 Regulation Committee of the House of Representatives, and 4
8 other members who shall be appointed, one each, by the
9 President and the Minority Leader of the Senate and the
10 Speaker and Minority Leader of the House of Representatives.
11 The Joint Committee shall meet initially at the call of the
12 Speaker and the President and shall select one member as
13 chairperson at its initial meeting. Thereafter, it shall
14 meet at the call of the chairperson, hold public hearings,
15 and issue a report of legislative recommendations concerning
16 the proper standards for licensure of certified registered
17 nurse anesthetists (CRNAs) to the House and the Senate by
18 filing copies of its report with the Clerk of the House and
19 the Secretary of the Senate on or before April 1, 1999. In
20 making its determinations, the Joint Committee also shall
21 consider the extent to which existing laws and rules are
22 adequate to protect the public health, safety, and welfare in
23 all settings where anesthesia services are administered. The
24 Joint Committee on Licensure of CRNAs shall be dissolved on
25 April 15, 1999."; and
26 on page 85, immediately below line 23, by inserting the
27 following:
28 "Section 25. The Nursing Home Administrators Licensing
29 and Disciplinary Act is amended by changing Section 4 as
30 follows:
31 (225 ILCS 70/4) (from Ch. 111, par. 3654)
32 Sec. 4. Definitions. For purposes of this Act, the
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1 following definitions shall have the following meanings,
2 except where the context requires otherwise:
3 (1) "Act" means the Nursing Home Administrators
4 Licensing and Disciplinary Act.
5 (2) "Department" means the Department of
6 Professional Regulation.
7 (3) "Director" means the Director of Professional
8 Regulation.
9 (4) "Board" means the Nursing Home Administrators
10 Licensing and Disciplinary Board appointed by the
11 Governor.
12 (5) "Nursing home administrator" means the
13 individual licensed under this Act and directly
14 responsible for planning, organizing, directing and
15 supervising the operation of a nursing home, or who in
16 fact performs such functions, whether or not such
17 functions are delegated to one or more other persons.
18 (6) "Nursing home" or "facility" means any entity
19 that is required to be licensed by the Department of
20 Public Health under the Nursing Home Care Act, as
21 amended, other than a sheltered care home as defined
22 thereunder, and includes private homes, institutions,
23 buildings, residences, or other places, whether operated
24 for profit or not, irrespective of the names attributed
25 to them, county homes for the infirm and chronically ill
26 operated pursuant to the County Nursing Home Act, as
27 amended, and any similar institutions operated by a
28 political subdivision of the State of Illinois that
29 provide, though their ownership or management,
30 maintenance, personal care, and nursing for 3 or more
31 persons, not related to the owner by blood or marriage,
32 or any similar facilities in which maintenance is
33 provided to 3 or more persons who by reason of illness of
34 physical infirmity require personal care and nursing.
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1 (7) "Maintenance" means food, shelter and laundry.
2 (8) "Personal care" means assistance with meals,
3 dressing, movement, bathing, or other personal needs, or
4 general supervision of the physical and mental well-being
5 of an individual who because of age, physical, or mental
6 disability, emotion or behavior disorder, or mental
7 retardation is incapable of managing his or her person,
8 whether or not a guardian has been appointed for such
9 individual. For the purposes of this Act, this definition
10 does not include the professional services of a nurse.
11 (9) "Nursing" means professional nursing or
12 practical nursing, as those terms are defined in the
13 Illinois Nursing and Advanced Practice Nursing Act of
14 1987, as amended, for sick or infirm persons who are
15 under the care and supervision of licensed physicians or
16 dentists.
17 (10) "Disciplinary action" means revocation,
18 suspension, probation, supervision, reprimand, required
19 education, fines or any other action taken by the
20 Department against a person holding a license.
21 (11) "Impaired" means the inability to practice
22 with reasonable skill and safety due to physical or
23 mental disabilities as evidenced by a written
24 determination or written consent based on clinical
25 evidence including deterioration through the aging
26 process or loss of motor skill, or abuse of drugs or
27 alcohol, of sufficient degree to diminish a person's
28 ability to administer a nursing home.
29 (Source: P.A. 90-61, eff. 12-30-97.)"; and
30 on page 93, immediately below line 5, by inserting the
31 following:
32 "Section 31. The Barber, Cosmetology, Esthetics, and
33 Nail Technology Act of 1985 is amended by changing Section
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1 1-11 as follows:
2 (225 ILCS 410/1-11) (from Ch. 111, par. 1701-11)
3 Sec. 1-11. Exceptions to Act.
4 (a) Nothing in this Act shall be construed to apply to
5 the educational activities conducted in connection with any
6 monthly, annual or other special educational program of any
7 bona fide association of licensed cosmetologists,
8 estheticians, nail technicians, or barbers, or licensed
9 cosmetology, esthetics, nail technology, or barber schools
10 from which the general public is excluded.
11 (b) Nothing in this Act shall be construed to apply to
12 the activities and services of registered nurses or licensed
13 practical nurses, as defined in the Illinois Nursing and
14 Advanced Practice Nursing Act of 1987.
15 (c) Nothing in this Act shall be deemed to require
16 licensure of individuals employed by the motion picture,
17 film, television, stage play or related industry for the
18 purpose of providing cosmetology or esthetics services to
19 actors of that industry while engaged in the practice of
20 cosmetology or esthetics as a part of that person's
21 employment.
22 (Source: P.A. 89-387, eff. 1-1-96.)
23 Section 32. The Nurse Agency Licensing Act is amended by
24 changing Section 3 as follows:
25 (225 ILCS 510/3) (from Ch. 111, par. 953)
26 Sec. 3. Definitions. As used in this Act:
27 (a) "Certified nurse aide" means an individual certified
28 as defined in Section 3-206 of the Nursing Home Care Act, as
29 now or hereafter amended.
30 (b) "Department" means the Department of Labor.
31 (c) "Director" means the Director of Labor.
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1 (d) "Health care facility" is defined as in Section 3 of
2 the Illinois Health Facilities Planning Act, as now or
3 hereafter amended.
4 (e) "Licensee" means any nursing agency which is
5 properly licensed under this Act.
6 (f) "Nurse" means a registered nurse or a licensed
7 practical nurse as defined in the Illinois Nursing and
8 Advanced Practice Nursing Act of 1987, as now or hereafter
9 amended.
10 (g) "Nurse agency" means any individual, firm,
11 corporation, partnership or other legal entity that employs,
12 assigns or refers nurses or certified nurse aides to a health
13 care facility for a fee. The term "nurse agency" includes
14 nurses registries. The term "nurse agency" does not include
15 services provided by home health agencies licensed and
16 operated under the Home Health Agency Licensing Act or a
17 licensed or certified individual who provides his or her own
18 services as a regular employee of a health care facility, nor
19 does it apply to a health care facility's organizing
20 nonsalaried employees to provide services only in that
21 facility.
22 (Source: P.A. 86-817; 86-1472.)
23 Section 33. The Illinois Public Aid Code is amended by
24 changing Sections 5-16.3 and 8A-7.1 as follows:
25 (305 ILCS 5/5-16.3)
26 Sec. 5-16.3. System for integrated health care services.
27 (a) It shall be the public policy of the State to adopt,
28 to the extent practicable, a health care program that
29 encourages the integration of health care services and
30 manages the health care of program enrollees while preserving
31 reasonable choice within a competitive and cost-efficient
32 environment. In furtherance of this public policy, the
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1 Illinois Department shall develop and implement an integrated
2 health care program consistent with the provisions of this
3 Section. The provisions of this Section apply only to the
4 integrated health care program created under this Section.
5 Persons enrolled in the integrated health care program, as
6 determined by the Illinois Department by rule, shall be
7 afforded a choice among health care delivery systems, which
8 shall include, but are not limited to, (i) fee for service
9 care managed by a primary care physician licensed to practice
10 medicine in all its branches, (ii) managed health care
11 entities, and (iii) federally qualified health centers
12 (reimbursed according to a prospective cost-reimbursement
13 methodology) and rural health clinics (reimbursed according
14 to the Medicare methodology), where available. Persons
15 enrolled in the integrated health care program also may be
16 offered indemnity insurance plans, subject to availability.
17 For purposes of this Section, a "managed health care
18 entity" means a health maintenance organization or a managed
19 care community network as defined in this Section. A "health
20 maintenance organization" means a health maintenance
21 organization as defined in the Health Maintenance
22 Organization Act. A "managed care community network" means
23 an entity, other than a health maintenance organization, that
24 is owned, operated, or governed by providers of health care
25 services within this State and that provides or arranges
26 primary, secondary, and tertiary managed health care services
27 under contract with the Illinois Department exclusively to
28 enrollees of the integrated health care program. A managed
29 care community network may contract with the Illinois
30 Department to provide only pediatric health care services. A
31 county provider as defined in Section 15-1 of this Code may
32 contract with the Illinois Department to provide services to
33 enrollees of the integrated health care program as a managed
34 care community network without the need to establish a
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1 separate entity that provides services exclusively to
2 enrollees of the integrated health care program and shall be
3 deemed a managed care community network for purposes of this
4 Code only to the extent of the provision of services to those
5 enrollees in conjunction with the integrated health care
6 program. A county provider shall be entitled to contract
7 with the Illinois Department with respect to any contracting
8 region located in whole or in part within the county. A
9 county provider shall not be required to accept enrollees who
10 do not reside within the county.
11 Each managed care community network must demonstrate its
12 ability to bear the financial risk of serving enrollees under
13 this program. The Illinois Department shall by rule adopt
14 criteria for assessing the financial soundness of each
15 managed care community network. These rules shall consider
16 the extent to which a managed care community network is
17 comprised of providers who directly render health care and
18 are located within the community in which they seek to
19 contract rather than solely arrange or finance the delivery
20 of health care. These rules shall further consider a variety
21 of risk-bearing and management techniques, including the
22 sufficiency of quality assurance and utilization management
23 programs and whether a managed care community network has
24 sufficiently demonstrated its financial solvency and net
25 worth. The Illinois Department's criteria must be based on
26 sound actuarial, financial, and accounting principles. In
27 adopting these rules, the Illinois Department shall consult
28 with the Illinois Department of Insurance. The Illinois
29 Department is responsible for monitoring compliance with
30 these rules.
31 This Section may not be implemented before the effective
32 date of these rules, the approval of any necessary federal
33 waivers, and the completion of the review of an application
34 submitted, at least 60 days before the effective date of
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1 rules adopted under this Section, to the Illinois Department
2 by a managed care community network.
3 All health care delivery systems that contract with the
4 Illinois Department under the integrated health care program
5 shall clearly recognize a health care provider's right of
6 conscience under the Health Care Right of Conscience Act. In
7 addition to the provisions of that Act, no health care
8 delivery system that contracts with the Illinois Department
9 under the integrated health care program shall be required to
10 provide, arrange for, or pay for any health care or medical
11 service, procedure, or product if that health care delivery
12 system is owned, controlled, or sponsored by or affiliated
13 with a religious institution or religious organization that
14 finds that health care or medical service, procedure, or
15 product to violate its religious and moral teachings and
16 beliefs.
17 (b) The Illinois Department may, by rule, provide for
18 different benefit packages for different categories of
19 persons enrolled in the program. Mental health services,
20 alcohol and substance abuse services, services related to
21 children with chronic or acute conditions requiring
22 longer-term treatment and follow-up, and rehabilitation care
23 provided by a free-standing rehabilitation hospital or a
24 hospital rehabilitation unit may be excluded from a benefit
25 package if the State ensures that those services are made
26 available through a separate delivery system. An exclusion
27 does not prohibit the Illinois Department from developing and
28 implementing demonstration projects for categories of persons
29 or services. Benefit packages for persons eligible for
30 medical assistance under Articles V, VI, and XII shall be
31 based on the requirements of those Articles and shall be
32 consistent with the Title XIX of the Social Security Act.
33 Nothing in this Act shall be construed to apply to services
34 purchased by the Department of Children and Family Services
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1 and the Department of Human Services (as successor to the
2 Department of Mental Health and Developmental Disabilities)
3 under the provisions of Title 59 of the Illinois
4 Administrative Code, Part 132 ("Medicaid Community Mental
5 Health Services Program").
6 (c) The program established by this Section may be
7 implemented by the Illinois Department in various contracting
8 areas at various times. The health care delivery systems and
9 providers available under the program may vary throughout the
10 State. For purposes of contracting with managed health care
11 entities and providers, the Illinois Department shall
12 establish contracting areas similar to the geographic areas
13 designated by the Illinois Department for contracting
14 purposes under the Illinois Competitive Access and
15 Reimbursement Equity Program (ICARE) under the authority of
16 Section 3-4 of the Illinois Health Finance Reform Act or
17 similarly-sized or smaller geographic areas established by
18 the Illinois Department by rule. A managed health care entity
19 shall be permitted to contract in any geographic areas for
20 which it has a sufficient provider network and otherwise
21 meets the contracting terms of the State. The Illinois
22 Department is not prohibited from entering into a contract
23 with a managed health care entity at any time.
24 (c-5) A managed health care entity may not engage in
25 door-to-door marketing activities or marketing activities at
26 an office of the Illinois Department or a county department
27 in order to enroll in the entity's health care delivery
28 system persons who are enrolled in the integrated health care
29 program established under this Section. The Illinois
30 Department shall adopt rules defining "marketing activities"
31 prohibited by this subsection (c-5).
32 Before a managed health care entity may market its health
33 care delivery system to persons enrolled in the integrated
34 health care program established under this Section, the
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1 Illinois Department must approve a marketing plan submitted
2 by the entity to the Illinois Department. The Illinois
3 Department shall adopt guidelines for approving marketing
4 plans submitted by managed health care entities under this
5 subsection. Besides prohibiting door-to-door marketing
6 activities and marketing activities at public aid offices,
7 the guidelines shall include at least the following:
8 (1) A managed health care entity may not offer or
9 provide any gift, favor, or other inducement in marketing
10 its health care delivery system to integrated health care
11 program enrollees. A managed health care entity may
12 provide health care related items that are of nominal
13 value and pre-approved by the Illinois Department to
14 prospective enrollees. A managed health care entity may
15 also provide to enrollees health care related items that
16 have been pre-approved by the Illinois Department as an
17 incentive to manage their health care appropriately.
18 (2) All persons employed or otherwise engaged by a
19 managed health care entity to market the entity's health
20 care delivery system to integrated health care program
21 enrollees or to supervise that marketing shall register
22 with the Illinois Department.
23 The Inspector General appointed under Section 12-13.1 may
24 conduct investigations to determine whether the marketing
25 practices of managed health care entities participating in
26 the integrated health care program comply with the
27 guidelines.
28 (d) A managed health care entity that contracts with the
29 Illinois Department for the provision of services under the
30 program shall do all of the following, solely for purposes of
31 the integrated health care program:
32 (1) Provide that any individual physician licensed
33 under the Medical Practice Act of 1987, any pharmacy, any
34 federally qualified health center, any therapeutically
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1 certified optometrist, and any podiatrist, that
2 consistently meets the reasonable terms and conditions
3 established by the managed health care entity, including
4 but not limited to credentialing standards, quality
5 assurance program requirements, utilization management
6 requirements, financial responsibility standards,
7 contracting process requirements, and provider network
8 size and accessibility requirements, must be accepted by
9 the managed health care entity for purposes of the
10 Illinois integrated health care program. Notwithstanding
11 the preceding sentence, only a physician licensed to
12 practice medicine in all its branches shall act as a
13 primary care physician within a managed health care
14 entity for purposes of the Illinois integrated health
15 care program. Any individual who is either terminated
16 from or denied inclusion in the panel of physicians of
17 the managed health care entity shall be given, within 10
18 business days after that determination, a written
19 explanation of the reasons for his or her exclusion or
20 termination from the panel. This paragraph (1) does not
21 apply to the following:
22 (A) A managed health care entity that
23 certifies to the Illinois Department that:
24 (i) it employs on a full-time basis 125
25 or more Illinois physicians licensed to
26 practice medicine in all of its branches; and
27 (ii) it will provide medical services
28 through its employees to more than 80% of the
29 recipients enrolled with the entity in the
30 integrated health care program; or
31 (B) A domestic stock insurance company
32 licensed under clause (b) of class 1 of Section 4 of
33 the Illinois Insurance Code if (i) at least 66% of
34 the stock of the insurance company is owned by a
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1 professional corporation organized under the
2 Professional Service Corporation Act that has 125 or
3 more shareholders who are Illinois physicians
4 licensed to practice medicine in all of its branches
5 and (ii) the insurance company certifies to the
6 Illinois Department that at least 80% of those
7 physician shareholders will provide services to
8 recipients enrolled with the company in the
9 integrated health care program.
10 (2) Provide for reimbursement for providers for
11 emergency care, as defined by the Illinois Department by
12 rule, that must be provided to its enrollees, including
13 an emergency room screening fee, and urgent care that it
14 authorizes for its enrollees, regardless of the
15 provider's affiliation with the managed health care
16 entity. Providers shall be reimbursed for emergency care
17 at an amount equal to the Illinois Department's
18 fee-for-service rates for those medical services rendered
19 by providers not under contract with the managed health
20 care entity to enrollees of the entity.
21 (3) Provide that any provider affiliated with a
22 managed health care entity may also provide services on a
23 fee-for-service basis to Illinois Department clients not
24 enrolled in a managed health care entity.
25 (4) Provide client education services as determined
26 and approved by the Illinois Department, including but
27 not limited to (i) education regarding appropriate
28 utilization of health care services in a managed care
29 system, (ii) written disclosure of treatment policies and
30 any restrictions or limitations on health services,
31 including, but not limited to, physical services,
32 clinical laboratory tests, hospital and surgical
33 procedures, prescription drugs and biologics, and
34 radiological examinations, and (iii) written notice that
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1 the enrollee may receive from another provider those
2 services covered under this program that are not provided
3 by the managed health care entity.
4 (5) Provide that enrollees within its system may
5 choose the site for provision of services and the panel
6 of health care providers.
7 (6) Not discriminate in its enrollment or
8 disenrollment practices among recipients of medical
9 services or program enrollees based on health status.
10 (7) Provide a quality assurance and utilization
11 review program that (i) for health maintenance
12 organizations meets the requirements of the Health
13 Maintenance Organization Act and (ii) for managed care
14 community networks meets the requirements established by
15 the Illinois Department in rules that incorporate those
16 standards set forth in the Health Maintenance
17 Organization Act.
18 (8) Issue a managed health care entity
19 identification card to each enrollee upon enrollment.
20 The card must contain all of the following:
21 (A) The enrollee's signature.
22 (B) The enrollee's health plan.
23 (C) The name and telephone number of the
24 enrollee's primary care physician.
25 (D) A telephone number to be used for
26 emergency service 24 hours per day, 7 days per week.
27 The telephone number required to be maintained
28 pursuant to this subparagraph by each managed health
29 care entity shall, at minimum, be staffed by
30 medically trained personnel and be provided
31 directly, or under arrangement, at an office or
32 offices in locations maintained solely within the
33 State of Illinois. For purposes of this
34 subparagraph, "medically trained personnel" means
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1 licensed practical nurses or registered nurses
2 located in the State of Illinois who are licensed
3 pursuant to the Illinois Nursing and Advanced
4 Practice Nursing Act of 1987.
5 (9) Ensure that every primary care physician and
6 pharmacy in the managed health care entity meets the
7 standards established by the Illinois Department for
8 accessibility and quality of care. The Illinois
9 Department shall arrange for and oversee an evaluation of
10 the standards established under this paragraph (9) and
11 may recommend any necessary changes to these standards.
12 The Illinois Department shall submit an annual report to
13 the Governor and the General Assembly by April 1 of each
14 year regarding the effect of the standards on ensuring
15 access and quality of care to enrollees.
16 (10) Provide a procedure for handling complaints
17 that (i) for health maintenance organizations meets the
18 requirements of the Health Maintenance Organization Act
19 and (ii) for managed care community networks meets the
20 requirements established by the Illinois Department in
21 rules that incorporate those standards set forth in the
22 Health Maintenance Organization Act.
23 (11) Maintain, retain, and make available to the
24 Illinois Department records, data, and information, in a
25 uniform manner determined by the Illinois Department,
26 sufficient for the Illinois Department to monitor
27 utilization, accessibility, and quality of care.
28 (12) Except for providers who are prepaid, pay all
29 approved claims for covered services that are completed
30 and submitted to the managed health care entity within 30
31 days after receipt of the claim or receipt of the
32 appropriate capitation payment or payments by the managed
33 health care entity from the State for the month in which
34 the services included on the claim were rendered,
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1 whichever is later. If payment is not made or mailed to
2 the provider by the managed health care entity by the due
3 date under this subsection, an interest penalty of 1% of
4 any amount unpaid shall be added for each month or
5 fraction of a month after the due date, until final
6 payment is made. Nothing in this Section shall prohibit
7 managed health care entities and providers from mutually
8 agreeing to terms that require more timely payment.
9 (13) Provide integration with community-based
10 programs provided by certified local health departments
11 such as Women, Infants, and Children Supplemental Food
12 Program (WIC), childhood immunization programs, health
13 education programs, case management programs, and health
14 screening programs.
15 (14) Provide that the pharmacy formulary used by a
16 managed health care entity and its contract providers be
17 no more restrictive than the Illinois Department's
18 pharmaceutical program on the effective date of this
19 amendatory Act of 1994 and as amended after that date.
20 (15) Provide integration with community-based
21 organizations, including, but not limited to, any
22 organization that has operated within a Medicaid
23 Partnership as defined by this Code or by rule of the
24 Illinois Department, that may continue to operate under a
25 contract with the Illinois Department or a managed health
26 care entity under this Section to provide case management
27 services to Medicaid clients in designated high-need
28 areas.
29 The Illinois Department may, by rule, determine
30 methodologies to limit financial liability for managed health
31 care entities resulting from payment for services to
32 enrollees provided under the Illinois Department's integrated
33 health care program. Any methodology so determined may be
34 considered or implemented by the Illinois Department through
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1 a contract with a managed health care entity under this
2 integrated health care program.
3 The Illinois Department shall contract with an entity or
4 entities to provide external peer-based quality assurance
5 review for the integrated health care program. The entity
6 shall be representative of Illinois physicians licensed to
7 practice medicine in all its branches and have statewide
8 geographic representation in all specialties of medical care
9 that are provided within the integrated health care program.
10 The entity may not be a third party payer and shall maintain
11 offices in locations around the State in order to provide
12 service and continuing medical education to physician
13 participants within the integrated health care program. The
14 review process shall be developed and conducted by Illinois
15 physicians licensed to practice medicine in all its branches.
16 In consultation with the entity, the Illinois Department may
17 contract with other entities for professional peer-based
18 quality assurance review of individual categories of services
19 other than services provided, supervised, or coordinated by
20 physicians licensed to practice medicine in all its branches.
21 The Illinois Department shall establish, by rule, criteria to
22 avoid conflicts of interest in the conduct of quality
23 assurance activities consistent with professional peer-review
24 standards. All quality assurance activities shall be
25 coordinated by the Illinois Department.
26 (e) All persons enrolled in the program shall be
27 provided with a full written explanation of all
28 fee-for-service and managed health care plan options and a
29 reasonable opportunity to choose among the options as
30 provided by rule. The Illinois Department shall provide to
31 enrollees, upon enrollment in the integrated health care
32 program and at least annually thereafter, notice of the
33 process for requesting an appeal under the Illinois
34 Department's administrative appeal procedures.
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1 Notwithstanding any other Section of this Code, the Illinois
2 Department may provide by rule for the Illinois Department to
3 assign a person enrolled in the program to a specific
4 provider of medical services or to a specific health care
5 delivery system if an enrollee has failed to exercise choice
6 in a timely manner. An enrollee assigned by the Illinois
7 Department shall be afforded the opportunity to disenroll and
8 to select a specific provider of medical services or a
9 specific health care delivery system within the first 30 days
10 after the assignment. An enrollee who has failed to exercise
11 choice in a timely manner may be assigned only if there are 3
12 or more managed health care entities contracting with the
13 Illinois Department within the contracting area, except that,
14 outside the City of Chicago, this requirement may be waived
15 for an area by rules adopted by the Illinois Department after
16 consultation with all hospitals within the contracting area.
17 The Illinois Department shall establish by rule the procedure
18 for random assignment of enrollees who fail to exercise
19 choice in a timely manner to a specific managed health care
20 entity in proportion to the available capacity of that
21 managed health care entity. Assignment to a specific provider
22 of medical services or to a specific managed health care
23 entity may not exceed that provider's or entity's capacity as
24 determined by the Illinois Department. Any person who has
25 chosen a specific provider of medical services or a specific
26 managed health care entity, or any person who has been
27 assigned under this subsection, shall be given the
28 opportunity to change that choice or assignment at least once
29 every 12 months, as determined by the Illinois Department by
30 rule. The Illinois Department shall maintain a toll-free
31 telephone number for program enrollees' use in reporting
32 problems with managed health care entities.
33 (f) If a person becomes eligible for participation in
34 the integrated health care program while he or she is
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1 hospitalized, the Illinois Department may not enroll that
2 person in the program until after he or she has been
3 discharged from the hospital. This subsection does not apply
4 to newborn infants whose mothers are enrolled in the
5 integrated health care program.
6 (g) The Illinois Department shall, by rule, establish
7 for managed health care entities rates that (i) are certified
8 to be actuarially sound, as determined by an actuary who is
9 an associate or a fellow of the Society of Actuaries or a
10 member of the American Academy of Actuaries and who has
11 expertise and experience in medical insurance and benefit
12 programs, in accordance with the Illinois Department's
13 current fee-for-service payment system, and (ii) take into
14 account any difference of cost to provide health care to
15 different populations based on gender, age, location, and
16 eligibility category. The rates for managed health care
17 entities shall be determined on a capitated basis.
18 The Illinois Department by rule shall establish a method
19 to adjust its payments to managed health care entities in a
20 manner intended to avoid providing any financial incentive to
21 a managed health care entity to refer patients to a county
22 provider, in an Illinois county having a population greater
23 than 3,000,000, that is paid directly by the Illinois
24 Department. The Illinois Department shall by April 1, 1997,
25 and annually thereafter, review the method to adjust
26 payments. Payments by the Illinois Department to the county
27 provider, for persons not enrolled in a managed care
28 community network owned or operated by a county provider,
29 shall be paid on a fee-for-service basis under Article XV of
30 this Code.
31 The Illinois Department by rule shall establish a method
32 to reduce its payments to managed health care entities to
33 take into consideration (i) any adjustment payments paid to
34 hospitals under subsection (h) of this Section to the extent
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1 those payments, or any part of those payments, have been
2 taken into account in establishing capitated rates under this
3 subsection (g) and (ii) the implementation of methodologies
4 to limit financial liability for managed health care entities
5 under subsection (d) of this Section.
6 (h) For hospital services provided by a hospital that
7 contracts with a managed health care entity, adjustment
8 payments shall be paid directly to the hospital by the
9 Illinois Department. Adjustment payments may include but
10 need not be limited to adjustment payments to:
11 disproportionate share hospitals under Section 5-5.02 of this
12 Code; primary care access health care education payments (89
13 Ill. Adm. Code 149.140); payments for capital, direct medical
14 education, indirect medical education, certified registered
15 nurse anesthetist, and kidney acquisition costs (89 Ill. Adm.
16 Code 149.150(c)); uncompensated care payments (89 Ill. Adm.
17 Code 148.150(h)); trauma center payments (89 Ill. Adm. Code
18 148.290(c)); rehabilitation hospital payments (89 Ill. Adm.
19 Code 148.290(d)); perinatal center payments (89 Ill. Adm.
20 Code 148.290(e)); obstetrical care payments (89 Ill. Adm.
21 Code 148.290(f)); targeted access payments (89 Ill. Adm. Code
22 148.290(g)); Medicaid high volume payments (89 Ill. Adm. Code
23 148.290(h)); and outpatient indigent volume adjustments (89
24 Ill. Adm. Code 148.140(b)(5)).
25 (i) For any hospital eligible for the adjustment
26 payments described in subsection (h), the Illinois Department
27 shall maintain, through the period ending June 30, 1995,
28 reimbursement levels in accordance with statutes and rules in
29 effect on April 1, 1994.
30 (j) Nothing contained in this Code in any way limits or
31 otherwise impairs the authority or power of the Illinois
32 Department to enter into a negotiated contract pursuant to
33 this Section with a managed health care entity, including,
34 but not limited to, a health maintenance organization, that
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1 provides for termination or nonrenewal of the contract
2 without cause upon notice as provided in the contract and
3 without a hearing.
4 (k) Section 5-5.15 does not apply to the program
5 developed and implemented pursuant to this Section.
6 (l) The Illinois Department shall, by rule, define those
7 chronic or acute medical conditions of childhood that require
8 longer-term treatment and follow-up care. The Illinois
9 Department shall ensure that services required to treat these
10 conditions are available through a separate delivery system.
11 A managed health care entity that contracts with the
12 Illinois Department may refer a child with medical conditions
13 described in the rules adopted under this subsection directly
14 to a children's hospital or to a hospital, other than a
15 children's hospital, that is qualified to provide inpatient
16 and outpatient services to treat those conditions. The
17 Illinois Department shall provide fee-for-service
18 reimbursement directly to a children's hospital for those
19 services pursuant to Title 89 of the Illinois Administrative
20 Code, Section 148.280(a), at a rate at least equal to the
21 rate in effect on March 31, 1994. For hospitals, other than
22 children's hospitals, that are qualified to provide inpatient
23 and outpatient services to treat those conditions, the
24 Illinois Department shall provide reimbursement for those
25 services on a fee-for-service basis, at a rate at least equal
26 to the rate in effect for those other hospitals on March 31,
27 1994.
28 A children's hospital shall be directly reimbursed for
29 all services provided at the children's hospital on a
30 fee-for-service basis pursuant to Title 89 of the Illinois
31 Administrative Code, Section 148.280(a), at a rate at least
32 equal to the rate in effect on March 31, 1994, until the
33 later of (i) implementation of the integrated health care
34 program under this Section and development of actuarially
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1 sound capitation rates for services other than those chronic
2 or acute medical conditions of childhood that require
3 longer-term treatment and follow-up care as defined by the
4 Illinois Department in the rules adopted under this
5 subsection or (ii) March 31, 1996.
6 Notwithstanding anything in this subsection to the
7 contrary, a managed health care entity shall not consider
8 sources or methods of payment in determining the referral of
9 a child. The Illinois Department shall adopt rules to
10 establish criteria for those referrals. The Illinois
11 Department by rule shall establish a method to adjust its
12 payments to managed health care entities in a manner intended
13 to avoid providing any financial incentive to a managed
14 health care entity to refer patients to a provider who is
15 paid directly by the Illinois Department.
16 (m) Behavioral health services provided or funded by the
17 Department of Human Services, the Department of Children and
18 Family Services, and the Illinois Department shall be
19 excluded from a benefit package. Conditions of an organic or
20 physical origin or nature, including medical detoxification,
21 however, may not be excluded. In this subsection,
22 "behavioral health services" means mental health services and
23 subacute alcohol and substance abuse treatment services, as
24 defined in the Illinois Alcoholism and Other Drug Dependency
25 Act. In this subsection, "mental health services" includes,
26 at a minimum, the following services funded by the Illinois
27 Department, the Department of Human Services (as successor to
28 the Department of Mental Health and Developmental
29 Disabilities), or the Department of Children and Family
30 Services: (i) inpatient hospital services, including related
31 physician services, related psychiatric interventions, and
32 pharmaceutical services provided to an eligible recipient
33 hospitalized with a primary diagnosis of psychiatric
34 disorder; (ii) outpatient mental health services as defined
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1 and specified in Title 59 of the Illinois Administrative
2 Code, Part 132; (iii) any other outpatient mental health
3 services funded by the Illinois Department pursuant to the
4 State of Illinois Medicaid Plan; (iv) partial
5 hospitalization; and (v) follow-up stabilization related to
6 any of those services. Additional behavioral health services
7 may be excluded under this subsection as mutually agreed in
8 writing by the Illinois Department and the affected State
9 agency or agencies. The exclusion of any service does not
10 prohibit the Illinois Department from developing and
11 implementing demonstration projects for categories of persons
12 or services. The Department of Children and Family Services
13 and the Department of Human Services shall each adopt rules
14 governing the integration of managed care in the provision of
15 behavioral health services. The State shall integrate managed
16 care community networks and affiliated providers, to the
17 extent practicable, in any separate delivery system for
18 mental health services.
19 (n) The Illinois Department shall adopt rules to
20 establish reserve requirements for managed care community
21 networks, as required by subsection (a), and health
22 maintenance organizations to protect against liabilities in
23 the event that a managed health care entity is declared
24 insolvent or bankrupt. If a managed health care entity other
25 than a county provider is declared insolvent or bankrupt,
26 after liquidation and application of any available assets,
27 resources, and reserves, the Illinois Department shall pay a
28 portion of the amounts owed by the managed health care entity
29 to providers for services rendered to enrollees under the
30 integrated health care program under this Section based on
31 the following schedule: (i) from April 1, 1995 through June
32 30, 1998, 90% of the amounts owed; (ii) from July 1, 1998
33 through June 30, 2001, 80% of the amounts owed; and (iii)
34 from July 1, 2001 through June 30, 2005, 75% of the amounts
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1 owed. The amounts paid under this subsection shall be
2 calculated based on the total amount owed by the managed
3 health care entity to providers before application of any
4 available assets, resources, and reserves. After June 30,
5 2005, the Illinois Department may not pay any amounts owed to
6 providers as a result of an insolvency or bankruptcy of a
7 managed health care entity occurring after that date. The
8 Illinois Department is not obligated, however, to pay amounts
9 owed to a provider that has an ownership or other governing
10 interest in the managed health care entity. This subsection
11 applies only to managed health care entities and the services
12 they provide under the integrated health care program under
13 this Section.
14 (o) Notwithstanding any other provision of law or
15 contractual agreement to the contrary, providers shall not be
16 required to accept from any other third party payer the rates
17 determined or paid under this Code by the Illinois
18 Department, managed health care entity, or other health care
19 delivery system for services provided to recipients.
20 (p) The Illinois Department may seek and obtain any
21 necessary authorization provided under federal law to
22 implement the program, including the waiver of any federal
23 statutes or regulations. The Illinois Department may seek a
24 waiver of the federal requirement that the combined
25 membership of Medicare and Medicaid enrollees in a managed
26 care community network may not exceed 75% of the managed care
27 community network's total enrollment. The Illinois
28 Department shall not seek a waiver of this requirement for
29 any other category of managed health care entity. The
30 Illinois Department shall not seek a waiver of the inpatient
31 hospital reimbursement methodology in Section 1902(a)(13)(A)
32 of Title XIX of the Social Security Act even if the federal
33 agency responsible for administering Title XIX determines
34 that Section 1902(a)(13)(A) applies to managed health care
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1 systems.
2 Notwithstanding any other provisions of this Code to the
3 contrary, the Illinois Department shall seek a waiver of
4 applicable federal law in order to impose a co-payment system
5 consistent with this subsection on recipients of medical
6 services under Title XIX of the Social Security Act who are
7 not enrolled in a managed health care entity. The waiver
8 request submitted by the Illinois Department shall provide
9 for co-payments of up to $0.50 for prescribed drugs and up to
10 $0.50 for x-ray services and shall provide for co-payments of
11 up to $10 for non-emergency services provided in a hospital
12 emergency room and up to $10 for non-emergency ambulance
13 services. The purpose of the co-payments shall be to deter
14 those recipients from seeking unnecessary medical care.
15 Co-payments may not be used to deter recipients from seeking
16 necessary medical care. No recipient shall be required to
17 pay more than a total of $150 per year in co-payments under
18 the waiver request required by this subsection. A recipient
19 may not be required to pay more than $15 of any amount due
20 under this subsection in any one month.
21 Co-payments authorized under this subsection may not be
22 imposed when the care was necessitated by a true medical
23 emergency. Co-payments may not be imposed for any of the
24 following classifications of services:
25 (1) Services furnished to person under 18 years of
26 age.
27 (2) Services furnished to pregnant women.
28 (3) Services furnished to any individual who is an
29 inpatient in a hospital, nursing facility, intermediate
30 care facility, or other medical institution, if that
31 person is required to spend for costs of medical care all
32 but a minimal amount of his or her income required for
33 personal needs.
34 (4) Services furnished to a person who is receiving
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1 hospice care.
2 Co-payments authorized under this subsection shall not be
3 deducted from or reduce in any way payments for medical
4 services from the Illinois Department to providers. No
5 provider may deny those services to an individual eligible
6 for services based on the individual's inability to pay the
7 co-payment.
8 Recipients who are subject to co-payments shall be
9 provided notice, in plain and clear language, of the amount
10 of the co-payments, the circumstances under which co-payments
11 are exempted, the circumstances under which co-payments may
12 be assessed, and their manner of collection.
13 The Illinois Department shall establish a Medicaid
14 Co-Payment Council to assist in the development of co-payment
15 policies for the medical assistance program. The Medicaid
16 Co-Payment Council shall also have jurisdiction to develop a
17 program to provide financial or non-financial incentives to
18 Medicaid recipients in order to encourage recipients to seek
19 necessary health care. The Council shall be chaired by the
20 Director of the Illinois Department, and shall have 6
21 additional members. Two of the 6 additional members shall be
22 appointed by the Governor, and one each shall be appointed by
23 the President of the Senate, the Minority Leader of the
24 Senate, the Speaker of the House of Representatives, and the
25 Minority Leader of the House of Representatives. The Council
26 may be convened and make recommendations upon the appointment
27 of a majority of its members. The Council shall be appointed
28 and convened no later than September 1, 1994 and shall report
29 its recommendations to the Director of the Illinois
30 Department and the General Assembly no later than October 1,
31 1994. The chairperson of the Council shall be allowed to
32 vote only in the case of a tie vote among the appointed
33 members of the Council.
34 The Council shall be guided by the following principles
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1 as it considers recommendations to be developed to implement
2 any approved waivers that the Illinois Department must seek
3 pursuant to this subsection:
4 (1) Co-payments should not be used to deter access
5 to adequate medical care.
6 (2) Co-payments should be used to reduce fraud.
7 (3) Co-payment policies should be examined in
8 consideration of other states' experience, and the
9 ability of successful co-payment plans to control
10 unnecessary or inappropriate utilization of services
11 should be promoted.
12 (4) All participants, both recipients and
13 providers, in the medical assistance program have
14 responsibilities to both the State and the program.
15 (5) Co-payments are primarily a tool to educate the
16 participants in the responsible use of health care
17 resources.
18 (6) Co-payments should not be used to penalize
19 providers.
20 (7) A successful medical program requires the
21 elimination of improper utilization of medical resources.
22 The integrated health care program, or any part of that
23 program, established under this Section may not be
24 implemented if matching federal funds under Title XIX of the
25 Social Security Act are not available for administering the
26 program.
27 The Illinois Department shall submit for publication in
28 the Illinois Register the name, address, and telephone number
29 of the individual to whom a request may be directed for a
30 copy of the request for a waiver of provisions of Title XIX
31 of the Social Security Act that the Illinois Department
32 intends to submit to the Health Care Financing Administration
33 in order to implement this Section. The Illinois Department
34 shall mail a copy of that request for waiver to all
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1 requestors at least 16 days before filing that request for
2 waiver with the Health Care Financing Administration.
3 (q) After the effective date of this Section, the
4 Illinois Department may take all planning and preparatory
5 action necessary to implement this Section, including, but
6 not limited to, seeking requests for proposals relating to
7 the integrated health care program created under this
8 Section.
9 (r) In order to (i) accelerate and facilitate the
10 development of integrated health care in contracting areas
11 outside counties with populations in excess of 3,000,000 and
12 counties adjacent to those counties and (ii) maintain and
13 sustain the high quality of education and residency programs
14 coordinated and associated with local area hospitals, the
15 Illinois Department may develop and implement a demonstration
16 program for managed care community networks owned, operated,
17 or governed by State-funded medical schools. The Illinois
18 Department shall prescribe by rule the criteria, standards,
19 and procedures for effecting this demonstration program.
20 (s) (Blank).
21 (t) On April 1, 1995 and every 6 months thereafter, the
22 Illinois Department shall report to the Governor and General
23 Assembly on the progress of the integrated health care
24 program in enrolling clients into managed health care
25 entities. The report shall indicate the capacities of the
26 managed health care entities with which the State contracts,
27 the number of clients enrolled by each contractor, the areas
28 of the State in which managed care options do not exist, and
29 the progress toward meeting the enrollment goals of the
30 integrated health care program.
31 (u) The Illinois Department may implement this Section
32 through the use of emergency rules in accordance with Section
33 5-45 of the Illinois Administrative Procedure Act. For
34 purposes of that Act, the adoption of rules to implement this
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1 Section is deemed an emergency and necessary for the public
2 interest, safety, and welfare.
3 (Source: P.A. 89-21, eff. 7-1-95; 89-507, eff. 7-1-97;
4 89-673, eff. 8-14-96; 90-14, eff. 7-1-97; 90-254, eff.
5 1-1-98; 90-538, eff. 12-1-97; revised 12-3-97.)
6 (305 ILCS 5/8A-7.1) (from Ch. 23, par. 8A-7.1)
7 Sec. 8A-7.1. The Director, upon making a determination
8 based upon information in the possession of the Illinois
9 Department, that continuation in practice of a licensed
10 health care professional would constitute an immediate danger
11 to the public, shall submit a written communication to the
12 Director of Professional Regulation indicating such
13 determination and additionally providing a complete summary
14 of the information upon which such determination is based,
15 and recommending that the Director of Professional Regulation
16 immediately suspend such person's license. All relevant
17 evidence, or copies thereof, in the Illinois Department's
18 possession may also be submitted in conjunction with the
19 written communication. A copy of such written communication,
20 which is exempt from the copying and inspection provisions of
21 The Freedom of Information Act, shall at the time of
22 submittal to the Director of Professional Regulation be
23 simultaneously mailed to the last known business address of
24 such licensed health care professional by certified or
25 registered postage, United States Mail, return receipt
26 requested. Any evidence, or copies thereof, which is
27 submitted in conjunction with the written communication is
28 also exempt from the copying and inspection provisions of The
29 Freedom of Information Act.
30 The Director, upon making a determination based upon
31 information in the possession of the Illinois Department,
32 that a licensed health care professional is willfully
33 committing fraud upon the Illinois Department's medical
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1 assistance program, shall submit a written communication to
2 the Director of Professional Regulation indicating such
3 determination and additionally providing a complete summary
4 of the information upon which such determination is based.
5 All relevant evidence, or copies thereof, in the Illinois
6 Department's possession may also be submitted in conjunction
7 with the written communication.
8 Upon receipt of such written communication, the Director
9 of Professional Regulation shall promptly investigate the
10 allegations contained in such written communication. A copy
11 of such written communication, which is exempt from the
12 copying and inspection provisions of The Freedom of
13 Information Act, shall at the time of submission to the
14 Director of Professional Regulation, be simultaneously mailed
15 to the last known address of such licensed health care
16 professional by certified or registered postage, United
17 States Mail, return receipt requested. Any evidence, or
18 copies thereof, which is submitted in conjunction with the
19 written communication is also exempt from the copying and
20 inspection provisions of The Freedom of Information Act.
21 For the purposes of this Section, "licensed health care
22 professional" means any person licensed under the Illinois
23 Dental Practice Act, the Illinois Nursing and Advanced
24 Practice Nursing Act of 1987, the Medical Practice Act of
25 1987, the Pharmacy Practice Act of 1987, the Podiatric
26 Medical Practice Act of 1987, and the Illinois Optometric
27 Practice Act of 1987.
28 (Source: P.A. 85-1209.)
29 Section 34. The Prenatal and Newborn Care Act is amended
30 by changing Section 2 as follows:
31 (410 ILCS 225/2) (from Ch. 111 1/2, par. 7022)
32 Sec. 2. Definitions. As used in this Act, unless the
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1 context otherwise requires:
2 (a) "Department" means the Illinois Department of Human
3 Services.
4 (b) "Early and Periodic Screening, Diagnosis and
5 Treatment (EPSDT)" means the provision of preventative health
6 care under 42 C.F.R. 441.50 et seq., including medical and
7 dental services, needed to assess growth and development and
8 detect and treat health problems.
9 (c) "Hospital" means a hospital as defined under the
10 Hospital Licensing Act.
11 (d) "Local health authority" means the full-time
12 official health department or board of health, as recognized
13 by the Illinois Department of Public Health, having
14 jurisdiction over a particular area.
15 (e) "Nurse" means a nurse licensed under the Illinois
16 Nursing and Advanced Practice Nursing Act.
17 (f) "Physician" means a physician licensed to practice
18 medicine in all of its branches.
19 (g) "Postnatal visit" means a visit occurring after
20 birth, with reference to the newborn.
21 (h) "Prenatal visit" means a visit occurring before
22 birth.
23 (i) "Program" means the Prenatal and Newborn Care
24 Program established pursuant to this Act.
25 (Source: P.A. 89-507, eff. 7-1-97.)
26 Section 35. The Illinois Abortion Law of 1975 is amended
27 by changing Section 11 as follows:
28 (720 ILCS 510/11) (from Ch. 38, par. 81-31)
29 Sec. 11. (1) Any person who intentionally violates any
30 provision of this Law commits a Class A misdemeanor unless a
31 specific penalty is otherwise provided. Any person who
32 intentionally falsifies any writing required by this Law
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1 commits a Class A misdemeanor.
2 Intentional, knowing, reckless, or negligent violations
3 of this Law shall constitute unprofessional conduct which
4 causes public harm under Section 22 of the Medical Practice
5 Act of 1987, as amended; Sections 10-45 and 15-50 Section 25
6 of the Illinois Nursing and Advanced Practice Nursing Act of
7 1987, as amended, and Section 21 of the Physician Assistant
8 Practice Act of 1987, as amended.
9 Intentional, knowing, reckless or negligent violations of
10 this Law will constitute grounds for refusal, denial,
11 revocation, suspension, or withdrawal of license,
12 certificate, or permit under Section 30 of the Pharmacy
13 Practice Act of 1987, as amended; Section 7 of the
14 "Ambulatory Surgical Treatment Center Act", effective July
15 19, 1973, as amended; and Section 7 of the "Hospital
16 Licensing Act", approved July 1, 1953, as amended.
17 (2) Any hospital or licensed facility which, or any
18 physician who intentionally, knowingly, or recklessly fails
19 to submit a complete report to the Department in accordance
20 with the provisions of Section 10 of this Law and any person
21 who intentionally, knowingly, recklessly or negligently fails
22 to maintain the confidentiality of any reports required under
23 this Law or reports required by Sections 10.1 or 12 of this
24 Law commits a Class B misdemeanor.
25 (3) Any person who sells any drug, medicine, instrument
26 or other substance which he knows to be an abortifacient and
27 which is in fact an abortifacient, unless upon prescription
28 of a physician, is guilty of a Class B misdemeanor. Any
29 person who prescribes or administers any instrument,
30 medicine, drug or other substance or device, which he knows
31 to be an abortifacient, and which is in fact an
32 abortifacient, and intentionally, knowingly or recklessly
33 fails to inform the person for whom it is prescribed or upon
34 whom it is administered that it is an abortifacient commits a
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1 Class C misdemeanor.
2 (4) Any person who intentionally, knowingly or
3 recklessly performs upon a woman what he represents to that
4 woman to be an abortion when he knows or should know that she
5 is not pregnant commits a Class 2 felony and shall be
6 answerable in civil damages equal to 3 times the amount of
7 proved damages.
8 (Source: P.A. 85-1209.)"; and
9 on page 93, line 6, by replacing "Section 35." with "Section
10 37."; and
11 on page 104, in line 19, by replacing "Sections 3 and 34"
12 with "Section 34"; and
13 on page 104, by deleting lines 21 through 26; and
14 on page 110, immediately below line 16, by inserting the
15 following:
16 Section 45. The Unemployment Insurance Act is amended by
17 changing Section 230 as follows:
18 (820 ILCS 405/230) (from Ch. 48, par. 340)
19 Sec. 230. The term "employment" shall not include service
20 performed after 1971:
21 (A) A. In the employ of a hospital, if such service
22 is performed by a patient of the hospital.
23 (B) B. As a student nurse in the employ of a
24 hospital or a nurses' training school by an individual
25 who is enrolled and is regularly attending classes in a
26 nurses' training school approved pursuant to the Illinois
27 Nursing and Advanced Practice Nursing Act of 1987.
28 (C) C. As an intern in the employ of a hospital by
29 an individual who has completed a 4 years' course in a
30 medical school chartered or approved pursuant to State
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1 law.
2 (Source: P.A. 85-1209.)".