|
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.
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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:
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(a) actual statistics and trends in utilization of |
medical services by
public aid recipients;
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(b) actual statistics and trends in the provision of |
the various medical
services by medical vendors;
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(c) current rate structures and proposed changes in |
those rate structures
for the various medical vendors; and
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(d) efforts at utilization review and control by the |
Illinois Department.
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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.
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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:
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(a) Prevention: services designed primarily to reduce the |
incidence
and ameliorate the severity of developmental |
disabilities, mental illness and
alcohol and drug dependence;
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(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;
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(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;
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(d) Crisis and Emergency: services to assist individuals |
and
their families through crisis periods, to stabilize |
individuals under stress
and to prevent unnecessary |
institutionalization;
|
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(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;
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(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.
|