Public Act 097-1061 Public Act 1061 97TH GENERAL ASSEMBLY |
Public Act 097-1061 | HB3893 Enrolled | LRB097 14519 KTG 60158 b |
|
| AN ACT concerning health.
| Be it enacted by the People of the State of Illinois,
| represented in the General Assembly:
| Section 5. The Alcoholism and Other Drug Abuse and | Dependency Act is amended by changing Section 1-10 as follows:
| (20 ILCS 301/1-10)
| Sec. 1-10. Definitions. As used in this Act, unless the | context clearly
indicates otherwise, the following words and | terms have the following meanings:
| "Act" means the Alcoholism and Other Drug Abuse and | Dependency Act.
| "Addict" means a person who exhibits the disease known as | "addiction".
| "Addiction" means a disease process characterized by the | continued use of a
specific psycho-active substance despite | physical, psychological or social
harm. The term also describes | the advanced stages of chemical dependency.
| "Administrator" means a person responsible for | administration of a program.
| "Alcoholic" means a person who exhibits the disease known | as "alcoholism".
| "Alcoholism" means a chronic and progressive disease or | illness
characterized by preoccupation with and loss of control |
| over the consumption of
alcohol, and the use of alcohol despite | adverse consequences. Typically,
combinations of the following | tendencies are also present: periodic or chronic
intoxication; | physical disability; impaired emotional, occupational or | social
adjustment; tendency toward relapse; a detrimental | effect on the individual,
his family and society; psychological | dependence; and physical dependence.
Alcoholism is also known | as addiction to alcohol. Alcoholism is described and
further | categorized in clinical detail in the DSM and the ICD.
| "Array of services" means assistance to individuals, | families and communities
in response to alcohol or other drug | abuse or dependency. The array of
services includes, but is not | limited to: prevention assistance for communities
and schools; | case finding, assessment and intervention to help individuals | stop
abusing alcohol or other drugs; a uniform screening, | assessment, and evaluation process including criteria for | substance use disorders and mental disorders or co-occurring | substance use and mental health disorders; case management; | detoxification to aid
individuals in physically withdrawing | from alcohol or other drugs; short-term
and long-term treatment | and support services to help individuals and family
members | begin the process of recovery; prescription and dispensing of | the drug
methadone or other medications as an adjunct to | treatment; relapse prevention
services; education and | counseling for children or other co-dependents of
alcoholics or | other drug abusers or addicts. For purposes of this Section, a |
| uniform screening, assessment, and evaluation process refers | to a process that includes an appropriate evaluation and, as | warranted, a referral. "Uniform" does not mean the use of a | singular instrument, tool, or process that all must utilize.
| "Case management" means those services which will assist | individuals in
gaining access to needed social, educational, | medical, treatment and other
services.
| "Children of alcoholics or drug addicts or abusers of | alcohol and other
drugs" means the minor or adult children of | individuals who have abused or been
dependent upon alcohol or | other drugs. These children may or may not become
dependent | upon alcohol or other drugs themselves; however, they are | physically,
psychologically, and behaviorally at high risk of | developing the illness.
Children of alcoholics and other drug | abusers experience emotional and other
problems, and benefit | from prevention and treatment services provided by funded
and | non-funded agencies licensed by the Department.
| "Co-dependents" means individuals who are involved in the | lives of and are
affected by people who are dependent upon | alcohol and other drugs.
Co-dependents compulsively engage in | behaviors that cause them to suffer
adverse physical, | emotional, familial, social, behavioral, vocational, and
legal | consequences as they attempt to cope with the alcohol or drug | dependent
person. People who become co-dependents include | spouses, parents, siblings,
and friends of alcohol or drug | dependent people. Co-dependents benefit from
prevention and |
| treatment services provided by agencies licensed by the
| Department.
| "Controlled substance" means any substance or immediate | precursor which is
enumerated in the schedules of Article II of | the Illinois Controlled Substances
Act or the Cannabis Control | Act.
| "Crime of violence" means any of the following crimes: | murder, voluntary
manslaughter, criminal sexual assault, | aggravated criminal sexual assault,
predatory criminal sexual | assault of a child,
armed robbery, robbery, arson, kidnapping, | aggravated battery, aggravated
arson, or any
other felony which | involves the use or threat of physical force or violence
| against another individual.
| "Department" means the Illinois Department of Human | Services as successor to
the former Department of Alcoholism | and Substance Abuse.
| "Designated program" means a program designated by the | Department to provide
services described in subsection (c) or | (d) of Section 15-10 of this Act.
A
designated program's | primary function is screening, assessing, referring and
| tracking clients identified by the criminal justice system, and | the program
agrees to apply statewide the standards, uniform | criteria and procedures
established by the Department pursuant | to such designation.
| "Detoxification" means the process of allowing an | individual to safely
withdraw from a drug in a controlled |
| environment.
| "DSM" means the most current edition of the Diagnostic and | Statistical
Manual of Mental Disorders.
| "D.U.I." means driving under the influence of alcohol or | other substances
which may cause impairment of driving ability.
| "Facility" means the building or premises which are used | for the provision
of licensable program services, including | support services, as set forth by
rule.
| "ICD" means the most current edition of the International | Classification of
Diseases.
| "Incapacitated" means that a person is unconscious or | otherwise exhibits, by
overt behavior or by extreme physical | debilitation, an inability to care for
his own needs or to | recognize the obvious danger of his situation or to make
| rational decisions with respect to his need for treatment.
| "Intermediary person" means a person with expertise | relative to addiction,
alcoholism, and the abuse of alcohol or | other drugs who may be called on to
assist the police in | carrying out enforcement or other activities with respect
to | persons who abuse or are dependent on alcohol or other drugs.
| "Intervention" means readily accessible activities which | assist individuals
and their partners or family members in | coping with the immediate problems of
alcohol and other drug | abuse or dependency, and in reducing their alcohol and
other | drug use. Intervention can facilitate emotional and social | stability, and
involves referring people for further treatment |
| as needed.
| "Intoxicated person" means a person whose mental or | physical functioning is
substantially impaired as a result of | the current effects of alcohol or other
drugs within the body.
| "Local advisory council" means an alcohol and substance | abuse body
established in a county, township or community area, | which represents public
and private entities having an interest | in the prevention and treatment of
alcoholism or other drug | abuse.
| "Off-site services" means licensable program services or | activities which are
conducted at a location separate from the | primary service location of the
provider, and which services | are operated by a program or entity licensed under
this Act.
| "Person" means any individual, firm, group, association, | partnership,
corporation, trust, government or governmental | subdivision or agency.
| "Prevention" means an interactive process of individuals, | families, schools,
religious organizations, communities and | regional, state and national
organizations to reduce | alcoholism, prevent the use of illegal drugs and the
abuse of | legal drugs by persons of all ages, prevent the use of alcohol | by
minors, build the capacities of individuals and systems, and | promote healthy
environments, lifestyles and behaviors.
| "Program" means a licensable or fundable activity or | service, or a
coordinated range of such activities or services, | as the Department may
establish by rule.
|
| "Recovery" means the long-term, often life-long, process | in which an addicted
person changes the way in which he makes | decisions and establishes personal and
life priorities. The | evolution of this decision-making and priority-setting
process | is generally manifested by an obvious improvement in the | individual's
life and lifestyle and by his overcoming the abuse | of or
dependence on alcohol or other drugs. Recovery is also | generally manifested by
prolonged periods of abstinence from | addictive chemicals which are not
medically supervised. | Recovery is the goal of treatment.
| "Rehabilitation" means a process whereby those clinical | services necessary
and appropriate for improving an | individual's life and lifestyle and for
overcoming his or her | abuse of or dependency upon alcohol or other drugs, or
both, | are delivered in an appropriate setting and manner as defined | in rules
established by the Department.
| "Relapse" means a process which is manifested by a | progressive pattern of
behavior that reactivates the symptoms | of a disease or creates debilitating
conditions in an | individual who has experienced remission from addiction or
| alcoholism.
| "Secretary" means the Secretary of Human Services or his or | her designee.
| "Substance abuse" or "abuse" means a pattern of use of | alcohol or other drugs
with the potential of leading to | immediate functional problems or to alcoholism
or other drug |
| dependency, or to the use of alcohol and/or other drugs solely
| for purposes of intoxication. The term also means the use of | illegal drugs by
persons of any age, and the use of alcohol by | persons under the age of 21.
| "Treatment" means the broad range of emergency, | outpatient, intermediate
and residential services and care | (including assessment, diagnosis, medical,
psychiatric, | psychological and social services, care and counseling, and
| aftercare) which may be extended to individuals who abuse or | are dependent
on alcohol or other drugs or families of those | persons.
| (Source: P.A. 89-202, eff. 7-21-95; 89-428, eff. 12-13-95; | 89-462, eff.
5-29-96; 89-507, eff. 7-1-97; 90-14, eff. 7-1-97; | 90-135, eff. 7-22-97.)
| Section 8. 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, provided by an individual licensed to practice | dentistry or dental surgery; for purposes of this item (10), | "dental services" means diagnostic, preventive, or corrective | procedures provided by or under the supervision of a dentist in | the practice of his or her profession; (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, including | to ensure that the individual's need for intervention or | treatment of mental disorders or substance use disorders or | co-occurring mental health and substance use disorders is | determined using a uniform screening, assessment, and | evaluation process inclusive of criteria, for children and | adults; for purposes of this item (13), a uniform screening, | assessment, and evaluation process refers to a process that | includes an appropriate evaluation and, as warranted, a | referral; "uniform" does not mean the use of a singular |
| instrument, tool, or process that all must utilize; (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 provided by or under the | supervision of a dentist; and
| (2) eyeglasses prescribed by a physician skilled in the | diseases of the
eye, or by an optometrist, whichever the | person may select.
| Notwithstanding any other provision of this Code and | subject to federal approval, the Department may adopt rules to |
| allow a dentist who is volunteering his or her service at no | cost to render dental services through an enrolled | not-for-profit health clinic without the dentist personally | enrolling as a participating provider in the medical assistance | program. A not-for-profit health clinic shall include a public | health clinic or Federally Qualified Health Center or other | enrolled provider, as determined by the Department, through | which dental services covered under this Section are performed. | The Department shall establish a process for payment of claims | for reimbursement for covered dental services rendered under | this provision. | 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 January 1, 2012, providers participating in a | quality improvement program approved by the Department shall be |
| reimbursed for screening and diagnostic mammography 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. | 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.
| 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. Such records must be retained for a period of not | less than 6 years from the date of service or as provided by | applicable State law, whichever period is longer, except that | if an audit is initiated within the required retention period | then the records must be retained until the audit is completed | and every exception is resolved. 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.
| 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 Public Act 95-1045, 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. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926, | eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638, | eff. 1-1-12.) | Section 10. The Community Services Act is amended by | changing Section 2 as follows:
| (405 ILCS 30/2) (from Ch. 91 1/2, par. 902)
| Sec. 2. Community Services System. Services should be | planned,
developed, delivered and evaluated as part of a | comprehensive and
coordinated system. The Department of Human | Services
shall encourage the establishment of services in each | area of the State
which cover the services categories described | below. What specific
services are provided under each service | category shall be based on local
needs; special attention shall | be given to unserved and underserved
populations, including | children and youth, racial and ethnic minorities,
and the | elderly. The service categories shall include:
| (a) Prevention: services designed primarily to reduce the | incidence
and ameliorate the severity of developmental | disabilities, mental illness and
alcohol and drug dependence;
| (b) Client Assessment and Diagnosis: services designed to |
| identify
persons with developmental disabilities, mental | illness and alcohol and
drug dependency; to determine the | extent of the disability and the level of
functioning; to | ensure that the individual's need for treatment of mental | disorders or substance use disorders or co-occurring substance | use and mental health disorders is determined using a uniform | screening, assessment, and evaluation process inclusive of | criteria; for purposes of this subsection (b), a uniform | screening, assessment, and evaluation process refers to a | process that includes an appropriate evaluation and, as | warranted, a referral; "uniform" does not mean the use of a | singular instrument, tool, or process that all must utilize; | information obtained through client evaluation can be used in
| individual treatment and habilitation plans; to assure | appropriate
placement and to assist in program evaluation;
| (c) Case Coordination: services to provide information and | assistance to
disabled persons to insure that they obtain | needed services provided by the
private and public sectors; | case coordination services should be available
to individuals | whose functioning level or history of institutional
recidivism | or long-term care indicate that such assistance is required for
| successful community living;
| (d) Crisis and Emergency: services to assist individuals | and
their families through crisis periods, to stabilize | individuals under stress
and to prevent unnecessary | institutionalization;
|
| (e) Treatment, Habilitation and Support: services designed | to help
individuals develop skills which promote independence | and improved levels
of social and vocational functioning and | personal growth; and to provide
non-treatment support services | which are necessary for successful
community living;
| (f) Community Residential Alternatives to Institutional | Settings:
services to provide living arrangements for persons | unable to live
independently; the level of supervision, | services provided and length of
stay at community residential | alternatives will vary by the type of program
and the needs and | functioning level of the residents; other services may be
| provided in a community residential alternative which promote | the
acquisition of independent living skills and integration | with the community.
| (Source: P.A. 89-507, eff. 7-1-97.)
| Section 99. Effective date. This Act takes effect upon | becoming law.
|
Effective Date: 8/24/2012
|