Bill Text: IL HB2912 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must implement an average commercial rate supplemental payment program for ground ambulance services providers for dates of service beginning no later than January 1, 2020. Provides that no later than July 1, 2019, the Department must submit to the Centers for Medicare and Medicaid Services an Illinois Title XIX State Plan amendment to implement an average commercial rate supplemental payment program for ground ambulance services providers; and that the Department must require Medicaid managed care organizations, including managed care community networks, to pay the approved average commercial rates in coordination with the Department. Effective immediately.

Spectrum: Slight Partisan Bill (Republican 2-1)

Status: (Introduced - Dead) 2019-03-29 - Rule 19(a) / Re-referred to Rules Committee [HB2912 Detail]

Download: Illinois-2019-HB2912-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB2912 Introduced , by Rep. Gregory Harris SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-4.2 from Ch. 23, par. 5-4.2
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must implement an average commercial rate supplemental payment program for ground ambulance services providers for dates of service beginning no later than January 1, 2020. Provides that no later than July 1, 2019, the Department must submit to the Centers for Medicare and Medicaid Services an Illinois Title XIX State Plan amendment to implement an average commercial rate supplemental payment program for ground ambulance services providers; and that the Department must require Medicaid managed care organizations, including managed care community networks, to pay the approved average commercial rates in coordination with the Department. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 10. The Illinois Public Aid Code is amended by
changing Section 5-4.2 as follows:
(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
Sec. 5-4.2. Ambulance services payments.
(a) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1993, the Illinois
Department shall reimburse ambulance service providers at
rates calculated in accordance with this Section. It is the
intent of the General Assembly to provide adequate
reimbursement for ambulance services so as to ensure adequate
access to services for recipients of aid under this Article and
to provide appropriate incentives to ambulance service
providers to provide services in an efficient and
cost-effective manner. Thus, it is the intent of the General
Assembly that the Illinois Department implement a
reimbursement system for ambulance services that, to the extent
practicable and subject to the availability of funds
appropriated by the General Assembly for this purpose, is
consistent with the payment principles of Medicare. To ensure
uniformity between the payment principles of Medicare and

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Medicaid, the Illinois Department shall follow, to the extent
necessary and practicable and subject to the availability of
funds appropriated by the General Assembly for this purpose,
the statutes, laws, regulations, policies, procedures,
principles, definitions, guidelines, and manuals used to
determine the amounts paid to ambulance service providers under
Title XVIII of the Social Security Act (Medicare).
(b) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1996, the Illinois
Department shall reimburse ambulance service providers based
upon the actual distance traveled if a natural disaster,
weather conditions, road repairs, or traffic congestion
necessitates the use of a route other than the most direct
route.
(c) For purposes of this Section, "ambulance services"
includes medical transportation services provided by means of
an ambulance, medi-car, service car, or taxi.
(c-1) For purposes of this Section, "ground ambulance
service" means medical transportation services that are
described as ground ambulance services by the Centers for
Medicare and Medicaid Services and provided in a vehicle that
is licensed as an ambulance by the Illinois Department of
Public Health pursuant to the Emergency Medical Services (EMS)
Systems Act.
(c-2) For purposes of this Section, "ground ambulance
service provider" means a vehicle service provider as described

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in the Emergency Medical Services (EMS) Systems Act that
operates licensed ambulances for the purpose of providing
emergency ambulance services, or non-emergency ambulance
services, or both. For purposes of this Section, this includes
both ambulance providers and ambulance suppliers as described
by the Centers for Medicare and Medicaid Services.
(c-3) For purposes of this Section, "medi-car" means
transportation services provided to a patient who is confined
to a wheelchair and requires the use of a hydraulic or electric
lift or ramp and wheelchair lockdown when the patient's
condition does not require medical observation, medical
supervision, medical equipment, the administration of
medications, or the administration of oxygen.
(c-4) For purposes of this Section, "service car" means
transportation services provided to a patient by a passenger
vehicle where that patient does not require the specialized
modes described in subsection (c-1) or (c-3).
(d) This Section does not prohibit separate billing by
ambulance service providers for oxygen furnished while
providing advanced life support services.
(e) Beginning with services rendered on or after July 1,
2008, all providers of non-emergency medi-car and service car
transportation must certify that the driver and employee
attendant, as applicable, have completed a safety program
approved by the Department to protect both the patient and the
driver, prior to transporting a patient. The provider must

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maintain this certification in its records. The provider shall
produce such documentation upon demand by the Department or its
representative. Failure to produce documentation of such
training shall result in recovery of any payments made by the
Department for services rendered by a non-certified driver or
employee attendant. Medi-car and service car providers must
maintain legible documentation in their records of the driver
and, as applicable, employee attendant that actually
transported the patient. Providers must recertify all drivers
and employee attendants every 3 years.
Notwithstanding the requirements above, any public
transportation provider of medi-car and service car
transportation that receives federal funding under 49 U.S.C.
5307 and 5311 need not certify its drivers and employee
attendants under this Section, since safety training is already
federally mandated.
(f) With respect to any policy or program administered by
the Department or its agent regarding approval of non-emergency
medical transportation by ground ambulance service providers,
including, but not limited to, the Non-Emergency
Transportation Services Prior Approval Program (NETSPAP), the
Department shall establish by rule a process by which ground
ambulance service providers of non-emergency medical
transportation may appeal any decision by the Department or its
agent for which no denial was received prior to the time of
transport that either (i) denies a request for approval for

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payment of non-emergency transportation by means of ground
ambulance service or (ii) grants a request for approval of
non-emergency transportation by means of ground ambulance
service at a level of service that entitles the ground
ambulance service provider to a lower level of compensation
from the Department than the ground ambulance service provider
would have received as compensation for the level of service
requested. The rule shall be filed by December 15, 2012 and
shall provide that, for any decision rendered by the Department
or its agent on or after the date the rule takes effect, the
ground ambulance service provider shall have 60 days from the
date the decision is received to file an appeal. The rule
established by the Department shall be, insofar as is
practical, consistent with the Illinois Administrative
Procedure Act. The Director's decision on an appeal under this
Section shall be a final administrative decision subject to
review under the Administrative Review Law.
(f-5) Beginning 90 days after July 20, 2012 (the effective
date of Public Act 97-842), (i) no denial of a request for
approval for payment of non-emergency transportation by means
of ground ambulance service, and (ii) no approval of
non-emergency transportation by means of ground ambulance
service at a level of service that entitles the ground
ambulance service provider to a lower level of compensation
from the Department than would have been received at the level
of service submitted by the ground ambulance service provider,

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may be issued by the Department or its agent unless the
Department has submitted the criteria for determining the
appropriateness of the transport for first notice publication
in the Illinois Register pursuant to Section 5-40 of the
Illinois Administrative Procedure Act.
(g) Whenever a patient covered by a medical assistance
program under this Code or by another medical program
administered by the Department, including a patient covered
under the State's Medicaid managed care program, is being
transported from a facility and requires non-emergency
transportation including ground ambulance, medi-car, or
service car transportation, a Physician Certification
Statement as described in this Section shall be required for
each patient. Facilities shall develop procedures for a
licensed medical professional to provide a written and signed
Physician Certification Statement. The Physician Certification
Statement shall specify the level of transportation services
needed and complete a medical certification establishing the
criteria for approval of non-emergency ambulance
transportation, as published by the Department of Healthcare
and Family Services, that is met by the patient. This
certification shall be completed prior to ordering the
transportation service and prior to patient discharge. The
Physician Certification Statement is not required prior to
transport if a delay in transport can be expected to negatively
affect the patient outcome.

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The medical certification specifying the level and type of
non-emergency transportation needed shall be in the form of the
Physician Certification Statement on a standardized form
prescribed by the Department of Healthcare and Family Services.
Within 75 days after July 27, 2018 (the effective date of
Public Act 100-646) this amendatory Act of the 100th General
Assembly, the Department of Healthcare and Family Services
shall develop a standardized form of the Physician
Certification Statement specifying the level and type of
transportation services needed in consultation with the
Department of Public Health, Medicaid managed care
organizations, a statewide association representing ambulance
providers, a statewide association representing hospitals, 3
statewide associations representing nursing homes, and other
stakeholders. The Physician Certification Statement shall
include, but is not limited to, the criteria necessary to
demonstrate medical necessity for the level of transport needed
as required by (i) the Department of Healthcare and Family
Services and (ii) the federal Centers for Medicare and Medicaid
Services as outlined in the Centers for Medicare and Medicaid
Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap.
10, Sec. 10.2.1, et seq. The use of the Physician Certification
Statement shall satisfy the obligations of hospitals under
Section 6.22 of the Hospital Licensing Act and nursing homes
under Section 2-217 of the Nursing Home Care Act.
Implementation and acceptance of the Physician Certification

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Statement shall take place no later than 90 days after the
issuance of the Physician Certification Statement by the
Department of Healthcare and Family Services.
Pursuant to subsection (E) of Section 12-4.25 of this Code,
the Department is entitled to recover overpayments paid to a
provider or vendor, including, but not limited to, from the
discharging physician, the discharging facility, and the
ground ambulance service provider, in instances where a
non-emergency ground ambulance service is rendered as the
result of improper or false certification.
Beginning October 1, 2018, the Department of Healthcare and
Family Services shall collect data from Medicaid managed care
organizations and transportation brokers, including the
Department's NETSPAP broker, regarding denials and appeals
related to the missing or incomplete Physician Certification
Statement forms and overall compliance with this subsection.
The Department of Healthcare and Family Services shall publish
quarterly results on its website within 15 days following the
end of each quarter.
(h) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in
accordance with Section 5-5e.
(i) On and after July 1, 2018, the Department shall
increase the base rate of reimbursement for both base charges

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and mileage charges for ground ambulance service providers for
medical transportation services provided by means of a ground
ambulance to a level not lower than 112% of the base rate in
effect as of June 30, 2018.
(m) The Department must implement an average commercial
rate supplemental payment program for ground ambulance
services providers for dates of service beginning no later than
January 1, 2020. No later than July 1, 2019, the Department
must submit to the Centers for Medicare and Medicaid Services
an Illinois Title XIX State Plan amendment to implement an
average commercial rate supplemental payment program for
ground ambulance services providers. The Department must
require Medicaid managed care organizations as defined in
Section 5-30.1 of this Article, including managed care
community networks as defined in Section 5-11 of this Article,
to pay the approved average commercial rates in coordination
with the Department.
(Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18;
revised 8-27-18.)
Section 99. Effective date. This Act takes effect upon
becoming law.