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1		AN ACT concerning public aid.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Public Aid Code is amended by
5		changing Sections 5-4.2 and 5-5 as follows:
6		(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
7		Sec. 5-4.2. Ground ambulance Ambulance services payments.
8		(a) For purposes of this Section, the following terms have
9		the following meanings:
10		"Department" means the Illinois Department of Healthcare
11		and Family Services.
12		"Ground ambulance services" means medical transportation
13		services that are described as ground ambulance services by the
14		Centers for Medicare and Medicaid Services and provided in a
15		vehicle that is licensed as an ambulance by the Illinois
16		Department of Public Health pursuant to the Emergency Medical
17		Services (EMS) Systems Act.
18		"Ground ambulance services provider" means a vehicle
19		service provider as described in the Emergency Medical Services
20		(EMS) Systems Act that operates licensed ambulances for the
21		purpose of providing emergency ambulance services, or
22		non-emergency ambulance services, or both. For purposes of this
23		Section, this includes both ambulance providers and ambulance

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1		suppliers as described by the Centers for Medicare and Medicaid
2		Services.
3		"Payment principles of Medicare" means: the accepted
4		method propounded by the Centers for Medicare and Medicaid
5		Services and used to determine the payment system for ground
6		ambulance services providers and suppliers under Title XVIII of
7		the Social Security Act. These principles are outlined in the
8		United States Code, the Code of Federal Regulations, and the
9		CMS Online Manual System, including, but not limited to, the
10		Medicare Benefit Policy Manual and the Medicare Claims
11		Processing Manual, and include the statutes, regulations,
12		policies, procedures, definitions, guidelines, and coding
13		systems, including the Health Care Common Procedure Coding
14		System (HCPCS) and ambulance condition coding system, as well
15		as other resources which have been or will be developed and
16		recognized by the Centers for Medicare and Medicaid Services.
17		"Rural county" means: any county not located in a U.S.
18		Bureau of the Census Metropolitan Statistical Area (MSA); or
19		any county located within a U.S. Bureau of the Census
20		Metropolitan Statistical Area but having a population of 60,000
21		or less.
22		(b) It is the intent of the General Assembly to provide for
23		the payment for ground ambulance services as part of the State
24		Medicaid plan and to provide adequate payment for ground
25		ambulance services under the State Medicaid plan so as to
26		ensure adequate access to ground ambulance services for both

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1		recipients of aid under this Article and for the general
2		population of Illinois. Unless otherwise indicated in this
3		Section, the practices of the Department concerning payments
4		for ground ambulance services provided to recipients of aid
5		under this Article shall be consistent with the payment
6		principles of Medicare.
7		(c) For ground ambulance services provided to a recipient
8		of aid under this Article on or after July 1, 2011, the
9		Department shall provide payment to ground ambulance services
10		providers for base charges and mileage charges based upon the
11		lesser of the provider's charge, as reflected on the provider's
12		claim form, or the Illinois Medicaid Ambulance Fee Schedule
13		payment rates calculated in accordance with this Section.
14		Effective July 1, 2011, the Illinois Medicaid Ambulance Fee
15		Schedule shall be established and shall include only the ground
16		ambulance services payment rates outlined in the Medicare
17		Ambulance Fee Schedule as promulgated by the Centers for
18		Medicare and Medicaid Services in effect as of July 1, 2011 and
19		adjusted for the 4 Medicare Localities in Illinois, with an
20		adjustment of 100% of the Medicare Ambulance Fee Schedule
21		payment rates, by Medicare Locality, for both base rates and
22		mileage for rural counties, and an adjustment of 80% of the
23		Medicare Ambulance Fee Schedule payment rates, by Medicare
24		Locality, for both base rates and mileage for all other
25		counties. The transition from the current payment system to the
26		Illinois Medicaid Ambulance Fee Schedule shall be as follows:

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1		Effective for dates of service on or after July 1, 2011, for
2		each individual base rate and mileage rate, the payment rate
3		for ground ambulance services shall be based on the Illinois
4		Medicaid Ambulance Fee Schedule amount in effect on July 1,
5		2011 for the designated Medicare Locality, except that any
6		payment rate that was previously approved by the Department
7		that exceeds this amount shall remain in force.
8		Notwithstanding the payment principles in subsection (b)
9		of this Section, the Department shall develop the Illinois
10		Medicaid Ambulance Fee Schedule using the ground mileage
11		payment rate, as defined by the Centers for Medicare and
12		Medicaid Services, and no other mileage rates which act as
13		enhancements to the ground mileage rate, whether permanent or
14		temporary, shall be recognized by the Department.
15		(d) Payment for mileage shall be per loaded mile with no
16		loaded mileage included in the base rate. If a natural
17		disaster, weather, road repairs, traffic congestion, or other
18		conditions necessitate a route other than the most direct
19		route, payment shall be based upon the actual distance
20		traveled. When a ground ambulance services provider provides
21		transport pursuant to an emergency call as defined by the
22		Centers for Medicare and Medicaid Services, no reduction in the
23		mileage payment shall be made based upon the fact that a closer
24		facility may have been available, so long as the ground
25		ambulance services provider provided transport to the
26		recipient's facility of choice or other appropriate facility

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1		described within the scope of the Illinois Emergency Medical
2		Services (EMS) Systems Act and associated rules or the policies
3		and procedures of the EMS System of which the provider is a
4		member.
5		(e) The Department shall provide payment for emergency
6		ground ambulance services provided to a recipient of aid under
7		this Article according to the requirements provided in
8		subsection (b) of this Section when those services are provided
9		pursuant to a request made through a 9-1-1 or equivalent
10		emergency telephone number for evaluation, treatment, and
11		transport from or on behalf of an individual with a condition
12		of such a nature that a prudent layperson would have reasonably
13		expected that a delay in seeking immediate medical attention
14		would have been hazardous to life or health. This standard is
15		deemed to be met if there is an emergency medical condition
16		manifesting itself by acute symptoms of sufficient severity,
17		including but not limited to severe pain, such that a prudent
18		layperson who possesses an average knowledge of medicine and
19		health can reasonably expect that the absence of immediate
20		medical attention could result in placing the health of the
21		individual or, with respect to a pregnant woman, the health of
22		the woman or her unborn child, in serious jeopardy, cause
23		serious impairment to bodily functions, or cause serious
24		dysfunction of any bodily organ or part.
25		(f) For ground ambulance services provided to a recipient
26		enrolled in a Medicaid managed care plan by a ground ambulance

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1		services provider that is not a contracted provider to the
2		Medicaid managed care plan in question, the amount of the
3		payment for ground ambulance services by the Medicaid managed
4		care plan shall be the lesser of the provider's charge, as
5		reflected on the provider's claim form, or the Illinois
6		Medicaid Ambulance Fee Schedule payment rates calculated in
7		accordance with this Section.
8		(g) Nothing in this Section prohibits the Department from
9		setting payment rates for out-of-State ground ambulance
10		services providers by administrative rule.
11		(g-5) Nothing in this Section prohibits the Department from
12		setting payment rates for State ground ambulance services
13		providers by administrative rule pending the availability of
14		appropriations dedicated to rate increases provided under
15		subsections (c) and (h) of this Section.
16		(h) Effective for dates of service on or after July 1,
17		2011, payments for stretcher van services provided by ground
18		ambulance services providers shall be as follows:
19		(1) For each individual base rate, the amount of the
20		payment shall be the lesser of the provider's charge, as
21		reflected on the provider's claim form, or 80% of the
22		Illinois Medicaid Ambulance Fee Schedule payment rate for
23		the basic life support non-emergency base rate.
24		(2) For each loaded mile, the amount of the payment
25		shall be the lesser of the provider's charge, as reflected
26		on the provider's claim form, or 80% of the Illinois

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1		Medicaid Ambulance Fee Schedule payment rate for mileage.
2		(i) All payments under subsections (c) and (h) of this
3		Section are subject to the availability of appropriations for
4		those purposes.
5		For ambulance services provided to a recipient of aid under
6		this Article on or after January 1, 1993, the Illinois
7		Department shall reimburse ambulance service providers at
8		rates calculated in accordance with this Section. It is the
9		intent of the General Assembly to provide adequate
10		reimbursement for ambulance services so as to ensure adequate
11		access to services for recipients of aid under this Article and
12		to provide appropriate incentives to ambulance service
13		providers to provide services in an efficient and
14		cost-effective manner. Thus, it is the intent of the General
15		Assembly that the Illinois Department implement a
16		reimbursement system for ambulance services that, to the extent
17		practicable and subject to the availability of funds
18		appropriated by the General Assembly for this purpose, is
19		consistent with the payment principles of Medicare. To ensure
20		uniformity between the payment principles of Medicare and
21		Medicaid, the Illinois Department shall follow, to the extent
22		necessary and practicable and subject to the availability of
23		funds appropriated by the General Assembly for this purpose,
24		the statutes, laws, regulations, policies, procedures,
25		principles, definitions, guidelines, and manuals used to
26		determine the amounts paid to ambulance service providers under

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1		Title XVIII of the Social Security Act (Medicare).
2		For ambulance services provided to a recipient of aid under
3		this Article on or after January 1, 1996, the Illinois
4		Department shall reimburse ambulance service providers based
5		upon the actual distance traveled if a natural disaster,
6		weather conditions, road repairs, or traffic congestion
7		necessitates the use of a route other than the most direct
8		route.
9		For purposes of this Section, "ambulance services"
10		includes medical transportation services provided by means of
11		an ambulance, medi-car, service car, or taxi.
12		This Section does not prohibit separate billing by
13		ambulance service providers for oxygen furnished while
14		providing advanced life support services.
15		(j) Beginning with services rendered on or after July 1,
16		2008, all providers of non-emergency medi-car and service car
17		transportation must certify that the driver and employee
18		attendant, as applicable, have completed a safety program
19		approved by the Department to protect both the patient and the
20		driver, prior to transporting a patient. The provider must
21		maintain this certification in its records. The provider shall
22		produce such documentation upon demand by the Department or its
23		representative. Failure to produce documentation of such
24		training shall result in recovery of any payments made by the
25		Department for services rendered by a non-certified driver or
26		employee attendant. Medi-car and service car providers must

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1		maintain legible documentation in their records of the driver
2		and, as applicable, employee attendant that actually
3		transported the patient. Providers must recertify all drivers
4		and employee attendants every 3 years.
5		Notwithstanding the requirements above, any public
6		transportation provider of medi-car and service car
7		transportation that receives federal funding under 49 U.S.C.
8		5307 and 5311 need not certify its drivers and employee
9		attendants under this Section, since safety training is already
10		federally mandated.
11		(Source: P.A. 95-501, eff. 8-28-07.)
12		(305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
13		Sec. 5-5. Medical services. The Illinois Department, by
14		rule, shall determine the quantity and quality of and the rate
15		of reimbursement for the medical assistance for which payment
16		will be authorized, and the medical services to be provided,
17		which may include all or part of the following: (1) inpatient
18		hospital services; (2) outpatient hospital services; (3) other
19		laboratory and X-ray services; (4) skilled nursing home
20		services; (5) physicians' services whether furnished in the
21		office, the patient's home, a hospital, a skilled nursing home,
22		or elsewhere; (6) medical care, or any other type of remedial
23		care furnished by licensed practitioners; (7) home health care
24		services; (8) private duty nursing service; (9) clinic
25		services; (10) dental services, including prevention and

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1		treatment of periodontal disease and dental caries disease for
2		pregnant women, provided by an individual licensed to practice
3		dentistry or dental surgery; for purposes of this item (10),
4		"dental services" means diagnostic, preventive, or corrective
5		procedures provided by or under the supervision of a dentist in
6		the practice of his or her profession; (11) physical therapy
7		and related services; (12) prescribed drugs, dentures, and
8		prosthetic devices; and eyeglasses prescribed by a physician
9		skilled in the diseases of the eye, or by an optometrist,
10		whichever the person may select; (13) other diagnostic,
11		screening, preventive, and rehabilitative services; (14)
12		transportation and such other expenses as may be necessary,
13		provided that payment for ground ambulance services shall be as
14		provided in Section 5-4.2; (15) medical treatment of sexual
15		assault survivors, as defined in Section 1a of the Sexual
16		Assault Survivors Emergency Treatment Act, for injuries
17		sustained as a result of the sexual assault, including
18		examinations and laboratory tests to discover evidence which
19		may be used in criminal proceedings arising from the sexual
20		assault; (16) the diagnosis and treatment of sickle cell
21		anemia; and (17) any other medical care, and any other type of
22		remedial care recognized under the laws of this State, but not
23		including abortions, or induced miscarriages or premature
24		births, unless, in the opinion of a physician, such procedures
25		are necessary for the preservation of the life of the woman
26		seeking such treatment, or except an induced premature birth

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1		intended to produce a live viable child and such procedure is
2		necessary for the health of the mother or her unborn child. The
3		Illinois Department, by rule, shall prohibit any physician from
4		providing medical assistance to anyone eligible therefor under
5		this Code where such physician has been found guilty of
6		performing an abortion procedure in a wilful and wanton manner
7		upon a woman who was not pregnant at the time such abortion
8		procedure was performed. The term "any other type of remedial
9		care" shall include nursing care and nursing home service for
10		persons who rely on treatment by spiritual means alone through
11		prayer for healing.
12		Notwithstanding any other provision of this Section, a
13		comprehensive tobacco use cessation program that includes
14		purchasing prescription drugs or prescription medical devices
15		approved by the Food and Drug Administration shall be covered
16		under the medical assistance program under this Article for
17		persons who are otherwise eligible for assistance under this
18		Article.
19		Notwithstanding any other provision of this Code, the
20		Illinois Department may not require, as a condition of payment
21		for any laboratory test authorized under this Article, that a
22		physician's handwritten signature appear on the laboratory
23		test order form. The Illinois Department may, however, impose
24		other appropriate requirements regarding laboratory test order
25		documentation.
26		The Department of Healthcare and Family Services shall

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1		provide the following services to persons eligible for
2		assistance under this Article who are participating in
3		education, training or employment programs operated by the
4		Department of Human Services as successor to the Department of
5		Public Aid:
6		(1) dental services provided by or under the
7		supervision of a dentist; and
8		(2) eyeglasses prescribed by a physician skilled in the
9		diseases of the eye, or by an optometrist, whichever the
10		person may select.
11		Notwithstanding any other provision of this Code and
12		subject to federal approval, the Department may adopt rules to
13		allow a dentist who is volunteering his or her service at no
14		cost to render dental services through an enrolled
15		not-for-profit health clinic without the dentist personally
16		enrolling as a participating provider in the medical assistance
17		program. A not-for-profit health clinic shall include a public
18		health clinic or Federally Qualified Health Center or other
19		enrolled provider, as determined by the Department, through
20		which dental services covered under this Section are performed.
21		The Department shall establish a process for payment of claims
22		for reimbursement for covered dental services rendered under
23		this provision.
24		The Illinois Department, by rule, may distinguish and
25		classify the medical services to be provided only in accordance
26		with the classes of persons designated in Section 5-2.

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1		The Department of Healthcare and Family Services must
2		provide coverage and reimbursement for amino acid-based
3		elemental formulas, regardless of delivery method, for the
4		diagnosis and treatment of (i) eosinophilic disorders and (ii)
5		short bowel syndrome when the prescribing physician has issued
6		a written order stating that the amino acid-based elemental
7		formula is medically necessary.
8		The Illinois Department shall authorize the provision of,
9		and shall authorize payment for, screening by low-dose
10		mammography for the presence of occult breast cancer for women
11		35 years of age or older who are eligible for medical
12		assistance under this Article, as follows:
13		(A) A baseline mammogram for women 35 to 39 years of
14		age.
15		(B) An annual mammogram for women 40 years of age or
16		older.
17		(C) A mammogram at the age and intervals considered
18		medically necessary by the woman's health care provider for
19		women under 40 years of age and having a family history of
20		breast cancer, prior personal history of breast cancer,
21		positive genetic testing, or other risk factors.
22		(D) A comprehensive ultrasound screening of an entire
23		breast or breasts if a mammogram demonstrates
24		heterogeneous or dense breast tissue, when medically
25		necessary as determined by a physician licensed to practice
26		medicine in all of its branches.

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1		All screenings shall include a physical breast exam,
2		instruction on self-examination and information regarding the
3		frequency of self-examination and its value as a preventative
4		tool. For purposes of this Section, "low-dose mammography"
5		means the x-ray examination of the breast using equipment
6		dedicated specifically for mammography, including the x-ray
7		tube, filter, compression device, and image receptor, with an
8		average radiation exposure delivery of less than one rad per
9		breast for 2 views of an average size breast. The term also
10		includes digital mammography.
11		On and after July 1, 2008, screening and diagnostic
12		mammography shall be reimbursed at the same rate as the
13		Medicare program's rates, including the increased
14		reimbursement for digital mammography.
15		The Department shall convene an expert panel including
16		representatives of hospitals, free-standing mammography
17		facilities, and doctors, including radiologists, to establish
18		quality standards. Based on these quality standards, the
19		Department shall provide for bonus payments to mammography
20		facilities meeting the standards for screening and diagnosis.
21		The bonus payments shall be at least 15% higher than the
22		Medicare rates for mammography.
23		Subject to federal approval, the Department shall
24		establish a rate methodology for mammography at federally
25		qualified health centers and other encounter-rate clinics.
26		These clinics or centers may also collaborate with other

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1		hospital-based mammography facilities.
2		The Department shall establish a methodology to remind
3		women who are age-appropriate for screening mammography, but
4		who have not received a mammogram within the previous 18
5		months, of the importance and benefit of screening mammography.
6		The Department shall establish a performance goal for
7		primary care providers with respect to their female patients
8		over age 40 receiving an annual mammogram. This performance
9		goal shall be used to provide additional reimbursement in the
10		form of a quality performance bonus to primary care providers
11		who meet that goal.
12		The Department shall devise a means of case-managing or
13		patient navigation for beneficiaries diagnosed with breast
14		cancer. This program shall initially operate as a pilot program
15		in areas of the State with the highest incidence of mortality
16		related to breast cancer. At least one pilot program site shall
17		be in the metropolitan Chicago area and at least one site shall
18		be outside the metropolitan Chicago area. An evaluation of the
19		pilot program shall be carried out measuring health outcomes
20		and cost of care for those served by the pilot program compared
21		to similarly situated patients who are not served by the pilot
22		program.
23		Any medical or health care provider shall immediately
24		recommend, to any pregnant woman who is being provided prenatal
25		services and is suspected of drug abuse or is addicted as
26		defined in the Alcoholism and Other Drug Abuse and Dependency

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1		Act, referral to a local substance abuse treatment provider
2		licensed by the Department of Human Services or to a licensed
3		hospital which provides substance abuse treatment services.
4		The Department of Healthcare and Family Services shall assure
5		coverage for the cost of treatment of the drug abuse or
6		addiction for pregnant recipients in accordance with the
7		Illinois Medicaid Program in conjunction with the Department of
8		Human Services.
9		All medical providers providing medical assistance to
10		pregnant women under this Code shall receive information from
11		the Department on the availability of services under the Drug
12		Free Families with a Future or any comparable program providing
13		case management services for addicted women, including
14		information on appropriate referrals for other social services
15		that may be needed by addicted women in addition to treatment
16		for addiction.
17		The Illinois Department, in cooperation with the
18		Departments of Human Services (as successor to the Department
19		of Alcoholism and Substance Abuse) and Public Health, through a
20		public awareness campaign, may provide information concerning
21		treatment for alcoholism and drug abuse and addiction, prenatal
22		health care, and other pertinent programs directed at reducing
23		the number of drug-affected infants born to recipients of
24		medical assistance.
25		Neither the Department of Healthcare and Family Services
26		nor the Department of Human Services shall sanction the

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1		recipient solely on the basis of her substance abuse.
2		The Illinois Department shall establish such regulations
3		governing the dispensing of health services under this Article
4		as it shall deem appropriate. The Department should seek the
5		advice of formal professional advisory committees appointed by
6		the Director of the Illinois Department for the purpose of
7		providing regular advice on policy and administrative matters,
8		information dissemination and educational activities for
9		medical and health care providers, and consistency in
10		procedures to the Illinois Department.
11		Notwithstanding any other provision of law, a health care
12		provider under the medical assistance program may elect, in
13		lieu of receiving direct payment for services provided under
14		that program, to participate in the State Employees Deferred
15		Compensation Plan adopted under Article 24 of the Illinois
16		Pension Code. A health care provider who elects to participate
17		in the plan does not have a cause of action against the State
18		for any damages allegedly suffered by the provider as a result
19		of any delay by the State in crediting the amount of any
20		contribution to the provider's plan account.
21		The Illinois Department may develop and contract with
22		Partnerships of medical providers to arrange medical services
23		for persons eligible under Section 5-2 of this Code.
24		Implementation of this Section may be by demonstration projects
25		in certain geographic areas. The Partnership shall be
26		represented by a sponsor organization. The Department, by rule,

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1		shall develop qualifications for sponsors of Partnerships.
2		Nothing in this Section shall be construed to require that the
3		sponsor organization be a medical organization.
4		The sponsor must negotiate formal written contracts with
5		medical providers for physician services, inpatient and
6		outpatient hospital care, home health services, treatment for
7		alcoholism and substance abuse, and other services determined
8		necessary by the Illinois Department by rule for delivery by
9		Partnerships. Physician services must include prenatal and
10		obstetrical care. The Illinois Department shall reimburse
11		medical services delivered by Partnership providers to clients
12		in target areas according to provisions of this Article and the
13		Illinois Health Finance Reform Act, except that:
14		(1) Physicians participating in a Partnership and
15		providing certain services, which shall be determined by
16		the Illinois Department, to persons in areas covered by the
17		Partnership may receive an additional surcharge for such
18		services.
19		(2) The Department may elect to consider and negotiate
20		financial incentives to encourage the development of
21		Partnerships and the efficient delivery of medical care.
22		(3) Persons receiving medical services through
23		Partnerships may receive medical and case management
24		services above the level usually offered through the
25		medical assistance program.
26		Medical providers shall be required to meet certain

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1		qualifications to participate in Partnerships to ensure the
2		delivery of high quality medical services. These
3		qualifications shall be determined by rule of the Illinois
4		Department and may be higher than qualifications for
5		participation in the medical assistance program. Partnership
6		sponsors may prescribe reasonable additional qualifications
7		for participation by medical providers, only with the prior
8		written approval of the Illinois Department.
9		Nothing in this Section shall limit the free choice of
10		practitioners, hospitals, and other providers of medical
11		services by clients. In order to ensure patient freedom of
12		choice, the Illinois Department shall immediately promulgate
13		all rules and take all other necessary actions so that provided
14		services may be accessed from therapeutically certified
15		optometrists to the full extent of the Illinois Optometric
16		Practice Act of 1987 without discriminating between service
17		providers.
18		The Department shall apply for a waiver from the United
19		States Health Care Financing Administration to allow for the
20		implementation of Partnerships under this Section.
21		The Illinois Department shall require health care
22		providers to maintain records that document the medical care
23		and services provided to recipients of Medical Assistance under
24		this Article. The Illinois Department shall require health care
25		providers to make available, when authorized by the patient, in
26		writing, the medical records in a timely fashion to other

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1		health care providers who are treating or serving persons
2		eligible for Medical Assistance under this Article. All
3		dispensers of medical services shall be required to maintain
4		and retain business and professional records sufficient to
5		fully and accurately document the nature, scope, details and
6		receipt of the health care provided to persons eligible for
7		medical assistance under this Code, in accordance with
8		regulations promulgated by the Illinois Department. The rules
9		and regulations shall require that proof of the receipt of
10		prescription drugs, dentures, prosthetic devices and
11		eyeglasses by eligible persons under this Section accompany
12		each claim for reimbursement submitted by the dispenser of such
13		medical services. No such claims for reimbursement shall be
14		approved for payment by the Illinois Department without such
15		proof of receipt, unless the Illinois Department shall have put
16		into effect and shall be operating a system of post-payment
17		audit and review which shall, on a sampling basis, be deemed
18		adequate by the Illinois Department to assure that such drugs,
19		dentures, prosthetic devices and eyeglasses for which payment
20		is being made are actually being received by eligible
21		recipients. Within 90 days after the effective date of this
22		amendatory Act of 1984, the Illinois Department shall establish
23		a current list of acquisition costs for all prosthetic devices
24		and any other items recognized as medical equipment and
25		supplies reimbursable under this Article and shall update such
26		list on a quarterly basis, except that the acquisition costs of

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1		all prescription drugs shall be updated no less frequently than
2		every 30 days as required by Section 5-5.12.
3		The rules and regulations of the Illinois Department shall
4		require that a written statement including the required opinion
5		of a physician shall accompany any claim for reimbursement for
6		abortions, or induced miscarriages or premature births. This
7		statement shall indicate what procedures were used in providing
8		such medical services.
9		The Illinois Department shall require all dispensers of
10		medical services, other than an individual practitioner or
11		group of practitioners, desiring to participate in the Medical
12		Assistance program established under this Article to disclose
13		all financial, beneficial, ownership, equity, surety or other
14		interests in any and all firms, corporations, partnerships,
15		associations, business enterprises, joint ventures, agencies,
16		institutions or other legal entities providing any form of
17		health care services in this State under this Article.
18		The Illinois Department may require that all dispensers of
19		medical services desiring to participate in the medical
20		assistance program established under this Article disclose,
21		under such terms and conditions as the Illinois Department may
22		by rule establish, all inquiries from clients and attorneys
23		regarding medical bills paid by the Illinois Department, which
24		inquiries could indicate potential existence of claims or liens
25		for the Illinois Department.
26		Enrollment of a vendor that provides non-emergency medical

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1		transportation, defined by the Department by rule, shall be
2		conditional for 180 days. During that time, the Department of
3		Healthcare and Family Services may terminate the vendor's
4		eligibility to participate in the medical assistance program
5		without cause. That termination of eligibility is not subject
6		to the Department's hearing process.
7		The Illinois Department shall establish policies,
8		procedures, standards and criteria by rule for the acquisition,
9		repair and replacement of orthotic and prosthetic devices and
10		durable medical equipment. Such rules shall provide, but not be
11		limited to, the following services: (1) immediate repair or
12		replacement of such devices by recipients without medical
13		authorization; and (2) rental, lease, purchase or
14		lease-purchase of durable medical equipment in a
15		cost-effective manner, taking into consideration the
16		recipient's medical prognosis, the extent of the recipient's
17		needs, and the requirements and costs for maintaining such
18		equipment. Such rules shall enable a recipient to temporarily
19		acquire and use alternative or substitute devices or equipment
20		pending repairs or replacements of any device or equipment
21		previously authorized for such recipient by the Department.
22		The Department shall execute, relative to the nursing home
23		prescreening project, written inter-agency agreements with the
24		Department of Human Services and the Department on Aging, to
25		effect the following: (i) intake procedures and common
26		eligibility criteria for those persons who are receiving

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1		non-institutional services; and (ii) the establishment and
2		development of non-institutional services in areas of the State
3		where they are not currently available or are undeveloped.
4		The Illinois Department shall develop and operate, in
5		cooperation with other State Departments and agencies and in
6		compliance with applicable federal laws and regulations,
7		appropriate and effective systems of health care evaluation and
8		programs for monitoring of utilization of health care services
9		and facilities, as it affects persons eligible for medical
10		assistance under this Code.
11		The Illinois Department shall report annually to the
12		General Assembly, no later than the second Friday in April of
13		1979 and each year thereafter, in regard to:
14		(a) actual statistics and trends in utilization of
15		medical services by public aid recipients;
16		(b) actual statistics and trends in the provision of
17		the various medical services by medical vendors;
18		(c) current rate structures and proposed changes in
19		those rate structures for the various medical vendors; and
20		(d) efforts at utilization review and control by the
21		Illinois Department.
22		The period covered by each report shall be the 3 years
23		ending on the June 30 prior to the report. The report shall
24		include suggested legislation for consideration by the General
25		Assembly. The filing of one copy of the report with the
26		Speaker, one copy with the Minority Leader and one copy with

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1		the Clerk of the House of Representatives, one copy with the
2		President, one copy with the Minority Leader and one copy with
3		the Secretary of the Senate, one copy with the Legislative
4		Research Unit, and such additional copies with the State
5		Government Report Distribution Center for the General Assembly
6		as is required under paragraph (t) of Section 7 of the State
7		Library Act shall be deemed sufficient to comply with this
8		Section.
9		Rulemaking authority to implement Public Act 95-1045, if
10		any, is conditioned on the rules being adopted in accordance
11		with all provisions of the Illinois Administrative Procedure
12		Act and all rules and procedures of the Joint Committee on
13		Administrative Rules; any purported rule not so adopted, for
14		whatever reason, is unauthorized.
15		(Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07;
16		95-1045, eff. 3-27-09; 96-156, eff. 1-1-10; 96-806, eff.
17		7-1-10; 96-926, eff. 1-1-11; 96-1000, eff. 7-2-10.)
18		Section 99. Effective date. This Act takes effect July 1,
19		2011.