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1 AN ACT concerning public aid.


2 Be it enacted by the People of the State of Illinois,

3represented in the General Assembly:



4 Section 5. The Illinois Public Aid Code is amended by 
5changing Section 5-5f as follows:



6 (305 ILCS 5/5-5f)


7 Sec. 5-5f. Elimination and limitations of medical 
8assistance services. Notwithstanding any other provision of 
9this Code to the contrary, on and after July 1, 2012:
10  (a) The following services shall no longer be a covered 
11 service available under this Code: group psychotherapy for 
12 residents of any facility licensed under the Nursing Home 
13 Care Act or the Specialized Mental Health Rehabilitation 
14 Act of 2013; and adult chiropractic services. 
15  (b) The Department shall place the following 
16 limitations on services: (i) the Department shall limit 
17 adult eyeglasses to one pair every 2 years; however, the 
18 limitation does not apply to an individual who needs 
19 different eyeglasses following a surgical procedure such 
20 as cataract surgery; (ii) the Department shall set an 
21 annual limit of a maximum of 20 visits for each of the 
22 following services: adult speech, hearing, and language 
23 therapy services, adult occupational therapy services, and 
 
 
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1 physical therapy services; on or after October 1, 2014, the 
2 annual maximum limit of 20 visits shall expire but the 
3 Department shall require prior approval for all 
4 individuals for speech, hearing, and language therapy 
5 services, occupational therapy services, and physical 
6 therapy services; (iii) the Department shall limit adult 
7 podiatry services to individuals with diabetes; on or after 
8 October 1, 2014, podiatry services shall not be limited to 
9 individuals with diabetes; (iv) the Department shall pay 
10 for caesarean sections at the normal vaginal delivery rate 
11 unless a caesarean section was medically necessary; (v) the 
12 Department shall limit adult dental services to 
13 emergencies; beginning July 1, 2013, the Department shall 
14 ensure that the following conditions are recognized as 
15 emergencies: (A) dental services necessary for an 
16 individual in order for the individual to be cleared for a 
17 medical procedure, such as a transplant;
(B) extractions 
18 and dentures necessary for a diabetic to receive proper 
19 nutrition;
(C) extractions and dentures necessary as a 
20 result of cancer treatment; and (D) dental services 
21 necessary for the health of a pregnant woman prior to 
22 delivery of her baby; on or after July 1, 2014, adult 
23 dental services shall no longer be limited to emergencies, 
24 and dental services necessary for the health of a pregnant 
25 woman prior to delivery of her baby shall continue to be 
26 covered; and (vi) effective July 1, 2012, the Department 
 
 
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1 shall place limitations and require concurrent review on 
2 every inpatient detoxification stay to prevent repeat 
3 admissions to any hospital for detoxification within 60 
4 days of a previous inpatient detoxification stay. The 
5 Department shall convene a workgroup of hospitals, 
6 substance abuse providers, care coordination entities, 
7 managed care plans, and other stakeholders to develop 
8 recommendations for quality standards, diversion to other 
9 settings, and admission criteria for patients who need 
10 inpatient detoxification, which shall be published on the 
11 Department's website no later than September 1, 2013. 
12  (c) The Department shall require prior approval of the 
13 following services: wheelchair repairs costing more than 
14 $400, coronary artery bypass graft, and bariatric surgery 
15 consistent with Medicare standards concerning patient 
16 responsibility. Wheelchair repair prior approval requests 
17 shall be adjudicated within one business day of receipt of 
18 complete supporting documentation. Providers may not break 
19 wheelchair repairs into separate claims for purposes of 
20 staying under the $400 threshold for requiring prior 
21 approval. The wholesale price of manual and power 
22 wheelchairs, durable medical equipment and supplies, and 
23 complex rehabilitation technology products and services 
24 shall be defined as actual acquisition cost including all 
25 discounts. 
26  (d) The Department shall establish benchmarks for 
 
 
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1 hospitals to measure and align payments to reduce 
2 potentially preventable hospital readmissions, inpatient 
3 complications, and unnecessary emergency room visits. In 
4 doing so, the Department shall consider items, including, 
5 but not limited to, historic and current acuity of care and 
6 historic and current trends in readmission. The Department 
7 shall publish provider-specific historical readmission 
8 data and anticipated potentially preventable targets 60 
9 days prior to the start of the program. In the instance of 
10 readmissions, the Department shall adopt policies and 
11 rates of reimbursement for services and other payments 
12 provided under this Code to ensure that, by June 30, 2013, 
13 expenditures to hospitals are reduced by, at a minimum, 
14 $40,000,000. 
15  (e) The Department shall establish utilization 
16 controls for the hospice program such that it shall not pay 
17 for other care services when an individual is in hospice. 
18  (f) For home health services, the Department shall 
19 require Medicare certification of providers participating 
20 in the program and implement the Medicare face-to-face 
21 encounter rule. The Department shall require providers to 
22 implement auditable electronic service verification based 
23 on global positioning systems or other cost-effective 
24 technology. 
25  (g) For the Home Services Program operated by the 
26 Department of Human Services and the Community Care Program 
 
 
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1 operated by the Department on Aging, the Department of 
2 Human Services, in cooperation with the Department on 
3 Aging, shall implement an electronic service verification 
4 based on global positioning systems or other 
5 cost-effective technology. 
6  (h) Effective with inpatient hospital admissions on or 
7 after July 1, 2012, the Department shall reduce the payment 
8 for a claim that indicates the occurrence of a 
9 provider-preventable condition during the admission as 
10 specified by the Department in rules. The Department shall 
11 not pay for services related to an other 
12 provider-preventable condition.
13  As used in this subsection (h):
14  "Provider-preventable condition" means a health care 
15 acquired condition as defined under the federal Medicaid 
16 regulation found at 42 CFR 447.26 or an other 
17 provider-preventable condition.
18  "Other provider-preventable condition" means a wrong 
19 surgical or other invasive procedure performed on a 
20 patient, a surgical or other invasive procedure performed 
21 on the wrong body part, or a surgical procedure or other 
22 invasive procedure performed on the wrong patient. 
23  (i) The Department shall implement cost savings 
24 initiatives for advanced imaging services, cardiac imaging 
25 services, pain management services, and back surgery. Such 
26 initiatives shall be designed to achieve annual costs 
 
 
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1 savings. 

2  (j) The Department shall ensure that beneficiaries 
3 with a diagnosis of epilepsy or seizure disorder in 
4 Department records will not require prior approval for 
5 anticonvulsants. 
6(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section 
76-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff. 
87-22-13; 98-651, eff. 6-16-14; 98-756, eff. 7-16-14.)


9 Section 99. Effective date. This Act takes effect upon 
10becoming law.