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Public Act 096-0806
Public Act 0806 96TH GENERAL ASSEMBLY
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Public Act 096-0806
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| HB0489 Enrolled |
LRB096 04643 AMC 14702 b |
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| AN ACT concerning deferred compensation.
| Be it enacted by the People of the State of Illinois,
| represented in the General Assembly:
| Section 5. The Illinois Pension Code is amended by changing | Section 24-102 and adding Section 24-104.2 as follows:
| (40 ILCS 5/24-102) (from Ch. 108 1/2, par. 24-102)
| Sec. 24-102.
As used in this Article, "employee" means any | person,
including a person elected, appointed or under | contract, receiving
compensation from the State or a unit of | local government or school
district for personal services | rendered, including salaried persons. A health care provider | who elects to participate in the State Employees Deferred | Compensation Plan established under Section 24-104 of this Code | shall, for purposes of that participation, be deemed an | "employee" as defined in this Section.
| As used in this Article, "health care provider" means a | dentist, physician, optometrist, pharmacist, or podiatrist | that participates and receives compensation as a provider under | the Illinois Public Aid Code, the Children's Health Insurance | Act, or the Covering ALL KIDS Health Insurance Act. | As used in this Article, "compensation" includes | compensation received
in a lump sum for accumulated unused | vacation, personal leave or sick leave, with the exception of |
| health care providers. "Compensation" with respect to health | care providers is defined under the Illinois Public Aid Code, | the Children's Health Insurance Act, or the Covering ALL KIDS | Health Insurance Act.
| Where applicable, in In no event shall the total of the | amount of deferred compensation of an
employee set aside in | relation to a particular year under the Illinois
State | Employees Deferred Compensation Plan and the employee's
| nondeferred compensation for that year exceed the total annual | salary or
compensation under the existing salary schedule or | classification plan
applicable to such employee in such year; | except that any compensation
received in a lump sum for | accumulated unused vacation, personal leave or sick
leave shall | not be included in the calculation of such totals.
| (Source: P.A. 84-878.)
| (40 ILCS 5/24-104.2 new)
| Sec. 24-104.2. Health care providers; tax-exempt status. | Health care providers may participate in the Illinois State | Employees Deferred Compensation Plan to the extent that the | health care providers' participation does not interfere with | the Plan's tax-exempt status under the Internal Revenue Code.
| Section 10. The Children's Health Insurance Program Act is | amended by adding Section 31 as follows:
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| (215 ILCS 106/31 new)
| Sec. 31. Health care provider participation in State | Employees Deferred Compensation Plan. Notwithstanding any | other provision of law, a health care provider who participates | under the Program may elect, in lieu of receiving direct | payment for services provided under the Program, to participate | in the State Employees Deferred Compensation Plan adopted under | Article 24 of the Illinois Pension Code. A health care provider | who elects to participate in the plan does not have a cause of | action against the State for any damages allegedly suffered by | the provider as a result of any delay by the State in crediting | the amount of any contribution to the provider's plan account.
| Section 15. The Covering ALL KIDS Health Insurance Act is | amended by adding Section 41 as follows:
| (215 ILCS 170/41 new)
| Sec. 41. Health care provider participation in State | Employees Deferred Compensation Plan. Notwithstanding any | other provision of law, a health care provider who participates | under the Program may elect, in lieu of receiving direct | payment for services provided under the Program, to participate | in the State Employees Deferred Compensation Plan adopted under | Article 24 of the Illinois Pension Code. A health care provider | who elects to participate in the plan does not have a cause of | action against the State for any damages allegedly suffered by |
| the provider as a result of any delay by the State in crediting | the amount of any contribution to the provider's plan account.
| Section 20. The Illinois Public Aid Code is amended by | changing Section 5-5 as follows:
| (305 ILCS 5/5-5) (from Ch. 23, par. 5-5) | Sec. 5-5. Medical services. The Illinois Department, by | rule, shall
determine the quantity and quality of and the rate | of reimbursement for the
medical assistance for which
payment | will be authorized, and the medical services to be provided,
| which may include all or part of the following: (1) inpatient | hospital
services; (2) outpatient hospital services; (3) other | laboratory and
X-ray services; (4) skilled nursing home | services; (5) physicians'
services whether furnished in the | office, the patient's home, a
hospital, a skilled nursing home, | or elsewhere; (6) medical care, or any
other type of remedial | care furnished by licensed practitioners; (7)
home health care | services; (8) private duty nursing service; (9) clinic
| services; (10) dental services, including prevention and | treatment of periodontal disease and dental caries disease for | pregnant women; (11) physical therapy and related
services; | (12) prescribed drugs, dentures, and prosthetic devices; and
| eyeglasses prescribed by a physician skilled in the diseases of | the eye,
or by an optometrist, whichever the person may select; | (13) other
diagnostic, screening, preventive, and |
| rehabilitative services; (14)
transportation and such other | expenses as may be necessary; (15) medical
treatment of sexual | assault survivors, as defined in
Section 1a of the Sexual | Assault Survivors Emergency Treatment Act, for
injuries | sustained as a result of the sexual assault, including
| examinations and laboratory tests to discover evidence which | may be used in
criminal proceedings arising from the sexual | assault; (16) the
diagnosis and treatment of sickle cell | anemia; and (17)
any other medical care, and any other type of | remedial care recognized
under the laws of this State, but not | including abortions, or induced
miscarriages or premature | births, unless, in the opinion of a physician,
such procedures | are necessary for the preservation of the life of the
woman | seeking such treatment, or except an induced premature birth
| intended to produce a live viable child and such procedure is | necessary
for the health of the mother or her unborn child. The | Illinois Department,
by rule, shall prohibit any physician from | providing medical assistance
to anyone eligible therefor under | this Code where such physician has been
found guilty of | performing an abortion procedure in a wilful and wanton
manner | upon a woman who was not pregnant at the time such abortion
| procedure was performed. The term "any other type of remedial | care" shall
include nursing care and nursing home service for | persons who rely on
treatment by spiritual means alone through | prayer for healing.
| Notwithstanding any other provision of this Section, a |
| comprehensive
tobacco use cessation program that includes | purchasing prescription drugs or
prescription medical devices | approved by the Food and Drug administration shall
be covered | under the medical assistance
program under this Article for | persons who are otherwise eligible for
assistance under this | Article.
| Notwithstanding any other provision of this Code, the | Illinois
Department may not require, as a condition of payment | for any laboratory
test authorized under this Article, that a | physician's handwritten signature
appear on the laboratory | test order form. The Illinois Department may,
however, impose | other appropriate requirements regarding laboratory test
order | documentation.
| The Department of Healthcare and Family Services shall | provide the following services to
persons
eligible for | assistance under this Article who are participating in
| education, training or employment programs operated by the | Department of Human
Services as successor to the Department of | Public Aid:
| (1) dental services, which shall include but not be | limited to
prosthodontics; and
| (2) eyeglasses prescribed by a physician skilled in the | diseases of the
eye, or by an optometrist, whichever the | person may select.
| The Illinois Department, by rule, may distinguish and | classify the
medical services to be provided only in accordance |
| with the classes of
persons designated in Section 5-2.
| The Department of Healthcare and Family Services must | provide coverage and reimbursement for amino acid-based | elemental formulas, regardless of delivery method, for the | diagnosis and treatment of (i) eosinophilic disorders and (ii) | short bowel syndrome when the prescribing physician has issued | a written order stating that the amino acid-based elemental | formula is medically necessary.
| The Illinois Department shall authorize the provision of, | and shall
authorize payment for, screening by low-dose | mammography for the presence of
occult breast cancer for women | 35 years of age or older who are eligible
for medical | assistance under this Article, as follows: | (A) A baseline
mammogram for women 35 to 39 years of | age.
| (B) An annual mammogram for women 40 years of age or | older. | (C) A mammogram at the age and intervals considered | medically necessary by the woman's health care provider for | women under 40 years of age and having a family history of | breast cancer, prior personal history of breast cancer, | positive genetic testing, or other risk factors. | (D) A comprehensive ultrasound screening of an entire | breast or breasts if a mammogram demonstrates | heterogeneous or dense breast tissue, when medically | necessary as determined by a physician licensed to practice |
| medicine in all of its branches. | All screenings
shall
include a physical breast exam, | instruction on self-examination and
information regarding the | frequency of self-examination and its value as a
preventative | tool. For purposes of this Section, "low-dose mammography" | means
the x-ray examination of the breast using equipment | dedicated specifically
for mammography, including the x-ray | tube, filter, compression device,
and image receptor, with an | average radiation exposure delivery
of less than one rad per | breast for 2 views of an average size breast. The term also | includes digital mammography.
| On and after July 1, 2008, screening and diagnostic | mammography shall be reimbursed at the same rate as the | Medicare program's rates, including the increased | reimbursement for digital mammography. | The Department shall convene an expert panel including | representatives of hospitals, free-standing mammography | facilities, and doctors, including radiologists, to establish | quality standards. Based on these quality standards, the | Department shall provide for bonus payments to mammography | facilities meeting the standards for screening and diagnosis. | The bonus payments shall be at least 15% higher than the | Medicare rates for mammography. | Subject to federal approval, the Department shall | establish a rate methodology for mammography at federally | qualified health centers and other encounter-rate clinics. |
| These clinics or centers may also collaborate with other | hospital-based mammography facilities. | The Department shall establish a methodology to remind | women who are age-appropriate for screening mammography, but | who have not received a mammogram within the previous 18 | months, of the importance and benefit of screening mammography. | The Department shall establish a performance goal for | primary care providers with respect to their female patients | over age 40 receiving an annual mammogram. This performance | goal shall be used to provide additional reimbursement in the | form of a quality performance bonus to primary care providers | who meet that goal. | The Department shall devise a means of case-managing or | patient navigation for beneficiaries diagnosed with breast | cancer. This program shall initially operate as a pilot program | in areas of the State with the highest incidence of mortality | related to breast cancer. At least one pilot program site shall | be in the metropolitan Chicago area and at least one site shall | be outside the metropolitan Chicago area. An evaluation of the | pilot program shall be carried out measuring health outcomes | and cost of care for those served by the pilot program compared | to similarly situated patients who are not served by the pilot | program. | Any medical or health care provider shall immediately | recommend, to
any pregnant woman who is being provided prenatal | services and is suspected
of drug abuse or is addicted as |
| defined in the Alcoholism and Other Drug Abuse
and Dependency | Act, referral to a local substance abuse treatment provider
| licensed by the Department of Human Services or to a licensed
| hospital which provides substance abuse treatment services. | The Department of Healthcare and Family Services
shall assure | coverage for the cost of treatment of the drug abuse or
| addiction for pregnant recipients in accordance with the | Illinois Medicaid
Program in conjunction with the Department of | Human Services.
| All medical providers providing medical assistance to | pregnant women
under this Code shall receive information from | the Department on the
availability of services under the Drug | Free Families with a Future or any
comparable program providing | case management services for addicted women,
including | information on appropriate referrals for other social services
| that may be needed by addicted women in addition to treatment | for addiction.
| The Illinois Department, in cooperation with the | Departments of Human
Services (as successor to the Department | of Alcoholism and Substance
Abuse) and Public Health, through a | public awareness campaign, may
provide information concerning | treatment for alcoholism and drug abuse and
addiction, prenatal | health care, and other pertinent programs directed at
reducing | the number of drug-affected infants born to recipients of | medical
assistance.
| Neither the Department of Healthcare and Family Services |
| nor the Department of Human
Services shall sanction the | recipient solely on the basis of
her substance abuse.
| The Illinois Department shall establish such regulations | governing
the dispensing of health services under this Article | as it shall deem
appropriate. The Department
should
seek the | advice of formal professional advisory committees appointed by
| the Director of the Illinois Department for the purpose of | providing regular
advice on policy and administrative matters, | information dissemination and
educational activities for | medical and health care providers, and
consistency in | procedures to the Illinois Department.
| Notwithstanding any other provision of law, a health care | provider under the medical assistance program may elect, in | lieu of receiving direct payment for services provided under | that program, to participate in the State Employees Deferred | Compensation Plan adopted under Article 24 of the Illinois | Pension Code. A health care provider who elects to participate | in the plan does not have a cause of action against the State | for any damages allegedly suffered by the provider as a result | of any delay by the State in crediting the amount of any | contribution to the provider's plan account. | The Illinois Department may develop and contract with | Partnerships of
medical providers to arrange medical services | for persons eligible under
Section 5-2 of this Code. | Implementation of this Section may be by
demonstration projects | in certain geographic areas. The Partnership shall
be |
| represented by a sponsor organization. The Department, by rule, | shall
develop qualifications for sponsors of Partnerships. | Nothing in this
Section shall be construed to require that the | sponsor organization be a
medical organization.
| The sponsor must negotiate formal written contracts with | medical
providers for physician services, inpatient and | outpatient hospital care,
home health services, treatment for | alcoholism and substance abuse, and
other services determined | necessary by the Illinois Department by rule for
delivery by | Partnerships. Physician services must include prenatal and
| obstetrical care. The Illinois Department shall reimburse | medical services
delivered by Partnership providers to clients | in target areas according to
provisions of this Article and the | Illinois Health Finance Reform Act,
except that:
| (1) Physicians participating in a Partnership and | providing certain
services, which shall be determined by | the Illinois Department, to persons
in areas covered by the | Partnership may receive an additional surcharge
for such | services.
| (2) The Department may elect to consider and negotiate | financial
incentives to encourage the development of | Partnerships and the efficient
delivery of medical care.
| (3) Persons receiving medical services through | Partnerships may receive
medical and case management | services above the level usually offered
through the | medical assistance program.
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| Medical providers shall be required to meet certain | qualifications to
participate in Partnerships to ensure the | delivery of high quality medical
services. These | qualifications shall be determined by rule of the Illinois
| Department and may be higher than qualifications for | participation in the
medical assistance program. Partnership | sponsors may prescribe reasonable
additional qualifications | for participation by medical providers, only with
the prior | written approval of the Illinois Department.
| Nothing in this Section shall limit the free choice of | practitioners,
hospitals, and other providers of medical | services by clients.
In order to ensure patient freedom of | choice, the Illinois Department shall
immediately promulgate | all rules and take all other necessary actions so that
provided | services may be accessed from therapeutically certified | optometrists
to the full extent of the Illinois Optometric | Practice Act of 1987 without
discriminating between service | providers.
| The Department shall apply for a waiver from the United | States Health
Care Financing Administration to allow for the | implementation of
Partnerships under this Section.
| The Illinois Department shall require health care | providers to maintain
records that document the medical care | and services provided to recipients
of Medical Assistance under | this Article. The Illinois Department shall
require health care | providers to make available, when authorized by the
patient, in |
| writing, the medical records in a timely fashion to other
| health care providers who are treating or serving persons | eligible for
Medical Assistance under this Article. All | dispensers of medical services
shall be required to maintain | and retain business and professional records
sufficient to | fully and accurately document the nature, scope, details and
| receipt of the health care provided to persons eligible for | medical
assistance under this Code, in accordance with | regulations promulgated by
the Illinois Department. The rules | and regulations shall require that proof
of the receipt of | prescription drugs, dentures, prosthetic devices and
| eyeglasses by eligible persons under this Section accompany | each claim
for reimbursement submitted by the dispenser of such | medical services.
No such claims for reimbursement shall be | approved for payment by the Illinois
Department without such | proof of receipt, unless the Illinois Department
shall have put | into effect and shall be operating a system of post-payment
| audit and review which shall, on a sampling basis, be deemed | adequate by
the Illinois Department to assure that such drugs, | dentures, prosthetic
devices and eyeglasses for which payment | is being made are actually being
received by eligible | recipients. Within 90 days after the effective date of
this | amendatory Act of 1984, the Illinois Department shall establish | a
current list of acquisition costs for all prosthetic devices | and any
other items recognized as medical equipment and | supplies reimbursable under
this Article and shall update such |
| list on a quarterly basis, except that
the acquisition costs of | all prescription drugs shall be updated no
less frequently than | every 30 days as required by Section 5-5.12.
| The rules and regulations of the Illinois Department shall | require
that a written statement including the required opinion | of a physician
shall accompany any claim for reimbursement for | abortions, or induced
miscarriages or premature births. This | statement shall indicate what
procedures were used in providing | such medical services.
| The Illinois Department shall require all dispensers of | medical
services, other than an individual practitioner or | group of practitioners,
desiring to participate in the Medical | Assistance program
established under this Article to disclose | all financial, beneficial,
ownership, equity, surety or other | interests in any and all firms,
corporations, partnerships, | associations, business enterprises, joint
ventures, agencies, | institutions or other legal entities providing any
form of | health care services in this State under this Article.
| The Illinois Department may require that all dispensers of | medical
services desiring to participate in the medical | assistance program
established under this Article disclose, | under such terms and conditions as
the Illinois Department may | by rule establish, all inquiries from clients
and attorneys | regarding medical bills paid by the Illinois Department, which
| inquiries could indicate potential existence of claims or liens | for the
Illinois Department.
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| Enrollment of a vendor that provides non-emergency medical | transportation,
defined by the Department by rule,
shall be
| conditional for 180 days. During that time, the Department of | Healthcare and Family Services may
terminate the vendor's | eligibility to participate in the medical assistance
program | without cause. That termination of eligibility is not subject | to the
Department's hearing process.
| The Illinois Department shall establish policies, | procedures,
standards and criteria by rule for the acquisition, | repair and replacement
of orthotic and prosthetic devices and | durable medical equipment. Such
rules shall provide, but not be | limited to, the following services: (1)
immediate repair or | replacement of such devices by recipients without
medical | authorization; and (2) rental, lease, purchase or | lease-purchase of
durable medical equipment in a | cost-effective manner, taking into
consideration the | recipient's medical prognosis, the extent of the
recipient's | needs, and the requirements and costs for maintaining such
| equipment. Such rules shall enable a recipient to temporarily | acquire and
use alternative or substitute devices or equipment | pending repairs or
replacements of any device or equipment | previously authorized for such
recipient by the Department.
| The Department shall execute, relative to the nursing home | prescreening
project, written inter-agency agreements with the | Department of Human
Services and the Department on Aging, to | effect the following: (i) intake
procedures and common |
| eligibility criteria for those persons who are receiving
| non-institutional services; and (ii) the establishment and | development of
non-institutional services in areas of the State | where they are not currently
available or are undeveloped.
| The Illinois Department shall develop and operate, in | cooperation
with other State Departments and agencies and in | compliance with
applicable federal laws and regulations, | appropriate and effective
systems of health care evaluation and | programs for monitoring of
utilization of health care services | and facilities, as it affects
persons eligible for medical | assistance under this Code.
| The Illinois Department shall report annually to the | General Assembly,
no later than the second Friday in April of | 1979 and each year
thereafter, in regard to:
| (a) actual statistics and trends in utilization of | medical services by
public aid recipients;
| (b) actual statistics and trends in the provision of | the various medical
services by medical vendors;
| (c) current rate structures and proposed changes in | those rate structures
for the various medical vendors; and
| (d) efforts at utilization review and control by the | Illinois Department.
| The period covered by each report shall be the 3 years | ending on the June
30 prior to the report. The report shall | include suggested legislation
for consideration by the General | Assembly. The filing of one copy of the
report with the |
| Speaker, one copy with the Minority Leader and one copy
with | the Clerk of the House of Representatives, one copy with the | President,
one copy with the Minority Leader and one copy with | the Secretary of the
Senate, one copy with the Legislative | Research Unit, and such additional
copies
with the State | Government Report Distribution Center for the General
Assembly | as is required under paragraph (t) of Section 7 of the State
| Library Act shall be deemed sufficient to comply with this | Section.
| Rulemaking authority to implement this amendatory Act of | the 95th General Assembly, if any, is conditioned on the rules | being adopted in accordance with all provisions of the Illinois | Administrative Procedure Act and all rules and procedures of | the Joint Committee on Administrative Rules; any purported rule | not so adopted, for whatever reason, is unauthorized. | (Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07; | 95-1045, eff. 3-27-09.)
| Section 99. Effective date. This Act takes effect July 1, | 2010.
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Effective Date: 7/1/2010
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