Bill Text: IL SB1851 | 2017-2018 | 100th General Assembly | Enrolled


Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning Medicaid reimbursement for facilities that serve severely and chronically ill pediatric patients and clinically complex residents, replaces all references to "long-term care facilities for persons under 22 years of age" with "medically complex for the developmentally disabled facilities".

Spectrum: Moderate Partisan Bill (Democrat 13-4)

Status: (Enrolled) 2018-06-11 - Sent to the Governor [SB1851 Detail]

Download: Illinois-2017-SB1851-Enrolled.html



SB1851 EnrolledLRB100 10394 KTG 20591 b
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 1. Findings; intent. According to the
5Congressional Research Service reporting, approximately 35% to
660% of children placed in foster care have at least one chronic
7or acute physical health condition that requires treatment,
8including growth failure, asthma, obesity, vision impairment,
9hearing loss, neurological problems, and complex chronic
10illnesses; as many as 50% to 75% show behavioral or social
11competency issues that may warrant mental health services; many
12of these physical and mental health care issues persist and,
13relative to their peers in the general population, children who
14leave foster care for adoption and those who age out of care
15continue to have greater health needs.
16 Federal child welfare policy requires states to develop
17strategies to address the health care needs of each child in
18foster care and mandates coordination of state child welfare
19and Medicaid agencies to ensure that the health care needs of
20children in foster care are properly identified and treated.
21 The Department of Children and Family Services is
22responsible for ensuring safety, family permanence, and
23well-being for the children placed in its custody and
24protecting these children from further trauma by ensuring

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1timely access to appropriate placements and services,
2especially those children with complex emotional and
3behavioral needs who are at much greater risk for not achieving
4the fundamental child welfare goals of safety, permanence, and
5well-being.
6 The Department remains under federal court oversight
7pursuant to the B.H. Consent Decree, in part, for failure to
8provide constitutionally sufficient services and placements
9for children with psychological, behavioral, or emotional
10challenges; the 2015 court-appointed Expert Panel found too
11many children in the class experience multiple disruptions of
12placement, services, and relationships; these children and
13their families endure indeterminate waits, month upon month,
14for services the child and family need, without a concrete plan
15or timeframe; these disruptions and delays and the inaction of
16Department officials exacerbate children's already serious and
17chronic mental health problems; the Department's approach to
18treatment and its system of practice have been shaped by
19crises, practitioner preferences, tradition, and system
20expediency.
21 The American Academy of Pediatrics cautions that the
22effects of managed care on children's access to services and
23actual health outcomes are not yet clear; it outlines design
24and implementation principles if managed care is to be
25implemented for children.
26 It is the intent of the General Assembly to ensure that

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1children are provided a system of health care with full and
2inclusive access to physical and behavioral health services
3necessary for them to thrive.
4 The General Assembly finds it necessary to protect youth in
5care by requiring the Department to plan the use of managed
6care services transparently, collaboratively, and deliberately
7to ensure quality outcomes and accountable oversight.
8 Section 5. The Open Meetings Act is amended by changing
9Section 2 as follows:
10 (5 ILCS 120/2) (from Ch. 102, par. 42)
11 Sec. 2. Open meetings.
12 (a) Openness required. All meetings of public bodies shall
13be open to the public unless excepted in subsection (c) and
14closed in accordance with Section 2a.
15 (b) Construction of exceptions. The exceptions contained
16in subsection (c) are in derogation of the requirement that
17public bodies meet in the open, and therefore, the exceptions
18are to be strictly construed, extending only to subjects
19clearly within their scope. The exceptions authorize but do not
20require the holding of a closed meeting to discuss a subject
21included within an enumerated exception.
22 (c) Exceptions. A public body may hold closed meetings to
23consider the following subjects:
24 (1) The appointment, employment, compensation,

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1 discipline, performance, or dismissal of specific
2 employees of the public body or legal counsel for the
3 public body, including hearing testimony on a complaint
4 lodged against an employee of the public body or against
5 legal counsel for the public body to determine its
6 validity. However, a meeting to consider an increase in
7 compensation to a specific employee of a public body that
8 is subject to the Local Government Wage Increase
9 Transparency Act may not be closed and shall be open to the
10 public and posted and held in accordance with this Act.
11 (2) Collective negotiating matters between the public
12 body and its employees or their representatives, or
13 deliberations concerning salary schedules for one or more
14 classes of employees.
15 (3) The selection of a person to fill a public office,
16 as defined in this Act, including a vacancy in a public
17 office, when the public body is given power to appoint
18 under law or ordinance, or the discipline, performance or
19 removal of the occupant of a public office, when the public
20 body is given power to remove the occupant under law or
21 ordinance.
22 (4) Evidence or testimony presented in open hearing, or
23 in closed hearing where specifically authorized by law, to
24 a quasi-adjudicative body, as defined in this Act, provided
25 that the body prepares and makes available for public
26 inspection a written decision setting forth its

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1 determinative reasoning.
2 (5) The purchase or lease of real property for the use
3 of the public body, including meetings held for the purpose
4 of discussing whether a particular parcel should be
5 acquired.
6 (6) The setting of a price for sale or lease of
7 property owned by the public body.
8 (7) The sale or purchase of securities, investments, or
9 investment contracts. This exception shall not apply to the
10 investment of assets or income of funds deposited into the
11 Illinois Prepaid Tuition Trust Fund.
12 (8) Security procedures, school building safety and
13 security, and the use of personnel and equipment to respond
14 to an actual, a threatened, or a reasonably potential
15 danger to the safety of employees, students, staff, the
16 public, or public property.
17 (9) Student disciplinary cases.
18 (10) The placement of individual students in special
19 education programs and other matters relating to
20 individual students.
21 (11) Litigation, when an action against, affecting or
22 on behalf of the particular public body has been filed and
23 is pending before a court or administrative tribunal, or
24 when the public body finds that an action is probable or
25 imminent, in which case the basis for the finding shall be
26 recorded and entered into the minutes of the closed

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1 meeting.
2 (12) The establishment of reserves or settlement of
3 claims as provided in the Local Governmental and
4 Governmental Employees Tort Immunity Act, if otherwise the
5 disposition of a claim or potential claim might be
6 prejudiced, or the review or discussion of claims, loss or
7 risk management information, records, data, advice or
8 communications from or with respect to any insurer of the
9 public body or any intergovernmental risk management
10 association or self insurance pool of which the public body
11 is a member.
12 (13) Conciliation of complaints of discrimination in
13 the sale or rental of housing, when closed meetings are
14 authorized by the law or ordinance prescribing fair housing
15 practices and creating a commission or administrative
16 agency for their enforcement.
17 (14) Informant sources, the hiring or assignment of
18 undercover personnel or equipment, or ongoing, prior or
19 future criminal investigations, when discussed by a public
20 body with criminal investigatory responsibilities.
21 (15) Professional ethics or performance when
22 considered by an advisory body appointed to advise a
23 licensing or regulatory agency on matters germane to the
24 advisory body's field of competence.
25 (16) Self evaluation, practices and procedures or
26 professional ethics, when meeting with a representative of

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1 a statewide association of which the public body is a
2 member.
3 (17) The recruitment, credentialing, discipline or
4 formal peer review of physicians or other health care
5 professionals, or for the discussion of matters protected
6 under the federal Patient Safety and Quality Improvement
7 Act of 2005, and the regulations promulgated thereunder,
8 including 42 C.F.R. Part 3 (73 FR 70732), or the federal
9 Health Insurance Portability and Accountability Act of
10 1996, and the regulations promulgated thereunder,
11 including 45 C.F.R. Parts 160, 162, and 164, by a hospital,
12 or other institution providing medical care, that is
13 operated by the public body.
14 (18) Deliberations for decisions of the Prisoner
15 Review Board.
16 (19) Review or discussion of applications received
17 under the Experimental Organ Transplantation Procedures
18 Act.
19 (20) The classification and discussion of matters
20 classified as confidential or continued confidential by
21 the State Government Suggestion Award Board.
22 (21) Discussion of minutes of meetings lawfully closed
23 under this Act, whether for purposes of approval by the
24 body of the minutes or semi-annual review of the minutes as
25 mandated by Section 2.06.
26 (22) Deliberations for decisions of the State

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1 Emergency Medical Services Disciplinary Review Board.
2 (23) The operation by a municipality of a municipal
3 utility or the operation of a municipal power agency or
4 municipal natural gas agency when the discussion involves
5 (i) contracts relating to the purchase, sale, or delivery
6 of electricity or natural gas or (ii) the results or
7 conclusions of load forecast studies.
8 (24) Meetings of a residential health care facility
9 resident sexual assault and death review team or the
10 Executive Council under the Abuse Prevention Review Team
11 Act.
12 (25) Meetings of an independent team of experts under
13 Brian's Law.
14 (26) Meetings of a mortality review team appointed
15 under the Department of Juvenile Justice Mortality Review
16 Team Act.
17 (27) (Blank).
18 (28) Correspondence and records (i) that may not be
19 disclosed under Section 11-9 of the Illinois Public Aid
20 Code or (ii) that pertain to appeals under Section 11-8 of
21 the Illinois Public Aid Code.
22 (29) Meetings between internal or external auditors
23 and governmental audit committees, finance committees, and
24 their equivalents, when the discussion involves internal
25 control weaknesses, identification of potential fraud risk
26 areas, known or suspected frauds, and fraud interviews

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1 conducted in accordance with generally accepted auditing
2 standards of the United States of America.
3 (30) Those meetings or portions of meetings of a
4 fatality review team or the Illinois Fatality Review Team
5 Advisory Council during which a review of the death of an
6 eligible adult in which abuse or neglect is suspected,
7 alleged, or substantiated is conducted pursuant to Section
8 15 of the Adult Protective Services Act.
9 (31) Meetings and deliberations for decisions of the
10 Concealed Carry Licensing Review Board under the Firearm
11 Concealed Carry Act.
12 (32) Meetings between the Regional Transportation
13 Authority Board and its Service Boards when the discussion
14 involves review by the Regional Transportation Authority
15 Board of employment contracts under Section 28d of the
16 Metropolitan Transit Authority Act and Sections 3A.18 and
17 3B.26 of the Regional Transportation Authority Act.
18 (33) Those meetings or portions of meetings of the
19 advisory committee and peer review subcommittee created
20 under Section 320 of the Illinois Controlled Substances Act
21 during which specific controlled substance prescriber,
22 dispenser, or patient information is discussed.
23 (34) Meetings of the Tax Increment Financing Reform
24 Task Force under Section 2505-800 of the Department of
25 Revenue Law of the Civil Administrative Code of Illinois.
26 (35) Meetings of the group established to discuss

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1 Medicaid capitation rates under Section 5-30.8 of the
2 Illinois Public Aid Code.
3 (d) Definitions. For purposes of this Section:
4 "Employee" means a person employed by a public body whose
5relationship with the public body constitutes an
6employer-employee relationship under the usual common law
7rules, and who is not an independent contractor.
8 "Public office" means a position created by or under the
9Constitution or laws of this State, the occupant of which is
10charged with the exercise of some portion of the sovereign
11power of this State. The term "public office" shall include
12members of the public body, but it shall not include
13organizational positions filled by members thereof, whether
14established by law or by a public body itself, that exist to
15assist the body in the conduct of its business.
16 "Quasi-adjudicative body" means an administrative body
17charged by law or ordinance with the responsibility to conduct
18hearings, receive evidence or testimony and make
19determinations based thereon, but does not include local
20electoral boards when such bodies are considering petition
21challenges.
22 (e) Final action. No final action may be taken at a closed
23meeting. Final action shall be preceded by a public recital of
24the nature of the matter being considered and other information
25that will inform the public of the business being conducted.
26(Source: P.A. 99-78, eff. 7-20-15; 99-235, eff. 1-1-16; 99-480,

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1eff. 9-9-15; 99-642, eff. 7-28-16; 99-646, eff. 7-28-16;
299-687, eff. 1-1-17; 100-201, eff. 8-18-17; 100-465, eff.
38-31-17.)
4 Section 10. The Freedom of Information Act is amended by
5changing Section 7.5 as follows:
6 (5 ILCS 140/7.5)
7 (Text of Section before amendment by P.A. 100-512 and
8100-517)
9 Sec. 7.5. Statutory exemptions. To the extent provided for
10by the statutes referenced below, the following shall be exempt
11from inspection and copying:
12 (a) All information determined to be confidential
13 under Section 4002 of the Technology Advancement and
14 Development Act.
15 (b) Library circulation and order records identifying
16 library users with specific materials under the Library
17 Records Confidentiality Act.
18 (c) Applications, related documents, and medical
19 records received by the Experimental Organ Transplantation
20 Procedures Board and any and all documents or other records
21 prepared by the Experimental Organ Transplantation
22 Procedures Board or its staff relating to applications it
23 has received.
24 (d) Information and records held by the Department of

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1 Public Health and its authorized representatives relating
2 to known or suspected cases of sexually transmissible
3 disease or any information the disclosure of which is
4 restricted under the Illinois Sexually Transmissible
5 Disease Control Act.
6 (e) Information the disclosure of which is exempted
7 under Section 30 of the Radon Industry Licensing Act.
8 (f) Firm performance evaluations under Section 55 of
9 the Architectural, Engineering, and Land Surveying
10 Qualifications Based Selection Act.
11 (g) Information the disclosure of which is restricted
12 and exempted under Section 50 of the Illinois Prepaid
13 Tuition Act.
14 (h) Information the disclosure of which is exempted
15 under the State Officials and Employees Ethics Act, and
16 records of any lawfully created State or local inspector
17 general's office that would be exempt if created or
18 obtained by an Executive Inspector General's office under
19 that Act.
20 (i) Information contained in a local emergency energy
21 plan submitted to a municipality in accordance with a local
22 emergency energy plan ordinance that is adopted under
23 Section 11-21.5-5 of the Illinois Municipal Code.
24 (j) Information and data concerning the distribution
25 of surcharge moneys collected and remitted by carriers
26 under the Emergency Telephone System Act.

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1 (k) Law enforcement officer identification information
2 or driver identification information compiled by a law
3 enforcement agency or the Department of Transportation
4 under Section 11-212 of the Illinois Vehicle Code.
5 (l) Records and information provided to a residential
6 health care facility resident sexual assault and death
7 review team or the Executive Council under the Abuse
8 Prevention Review Team Act.
9 (m) Information provided to the predatory lending
10 database created pursuant to Article 3 of the Residential
11 Real Property Disclosure Act, except to the extent
12 authorized under that Article.
13 (n) Defense budgets and petitions for certification of
14 compensation and expenses for court appointed trial
15 counsel as provided under Sections 10 and 15 of the Capital
16 Crimes Litigation Act. This subsection (n) shall apply
17 until the conclusion of the trial of the case, even if the
18 prosecution chooses not to pursue the death penalty prior
19 to trial or sentencing.
20 (o) Information that is prohibited from being
21 disclosed under Section 4 of the Illinois Health and
22 Hazardous Substances Registry Act.
23 (p) Security portions of system safety program plans,
24 investigation reports, surveys, schedules, lists, data, or
25 information compiled, collected, or prepared by or for the
26 Regional Transportation Authority under Section 2.11 of

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1 the Regional Transportation Authority Act or the St. Clair
2 County Transit District under the Bi-State Transit Safety
3 Act.
4 (q) Information prohibited from being disclosed by the
5 Personnel Records Review Act.
6 (r) Information prohibited from being disclosed by the
7 Illinois School Student Records Act.
8 (s) Information the disclosure of which is restricted
9 under Section 5-108 of the Public Utilities Act.
10 (t) All identified or deidentified health information
11 in the form of health data or medical records contained in,
12 stored in, submitted to, transferred by, or released from
13 the Illinois Health Information Exchange, and identified
14 or deidentified health information in the form of health
15 data and medical records of the Illinois Health Information
16 Exchange in the possession of the Illinois Health
17 Information Exchange Authority due to its administration
18 of the Illinois Health Information Exchange. The terms
19 "identified" and "deidentified" shall be given the same
20 meaning as in the Health Insurance Portability and
21 Accountability Act of 1996, Public Law 104-191, or any
22 subsequent amendments thereto, and any regulations
23 promulgated thereunder.
24 (u) Records and information provided to an independent
25 team of experts under Brian's Law.
26 (v) Names and information of people who have applied

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1 for or received Firearm Owner's Identification Cards under
2 the Firearm Owners Identification Card Act or applied for
3 or received a concealed carry license under the Firearm
4 Concealed Carry Act, unless otherwise authorized by the
5 Firearm Concealed Carry Act; and databases under the
6 Firearm Concealed Carry Act, records of the Concealed Carry
7 Licensing Review Board under the Firearm Concealed Carry
8 Act, and law enforcement agency objections under the
9 Firearm Concealed Carry Act.
10 (w) Personally identifiable information which is
11 exempted from disclosure under subsection (g) of Section
12 19.1 of the Toll Highway Act.
13 (x) Information which is exempted from disclosure
14 under Section 5-1014.3 of the Counties Code or Section
15 8-11-21 of the Illinois Municipal Code.
16 (y) Confidential information under the Adult
17 Protective Services Act and its predecessor enabling
18 statute, the Elder Abuse and Neglect Act, including
19 information about the identity and administrative finding
20 against any caregiver of a verified and substantiated
21 decision of abuse, neglect, or financial exploitation of an
22 eligible adult maintained in the Registry established
23 under Section 7.5 of the Adult Protective Services Act.
24 (z) Records and information provided to a fatality
25 review team or the Illinois Fatality Review Team Advisory
26 Council under Section 15 of the Adult Protective Services

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1 Act.
2 (aa) Information which is exempted from disclosure
3 under Section 2.37 of the Wildlife Code.
4 (bb) Information which is or was prohibited from
5 disclosure by the Juvenile Court Act of 1987.
6 (cc) Recordings made under the Law Enforcement
7 Officer-Worn Body Camera Act, except to the extent
8 authorized under that Act.
9 (dd) Information that is prohibited from being
10 disclosed under Section 45 of the Condominium and Common
11 Interest Community Ombudsperson Act.
12 (ee) Information that is exempted from disclosure
13 under Section 30.1 of the Pharmacy Practice Act.
14 (ff) Information that is exempted from disclosure
15 under the Revised Uniform Unclaimed Property Act.
16 (gg) (ff) Information that is prohibited from being
17 disclosed under Section 7-603.5 of the Illinois Vehicle
18 Code.
19 (hh) (ff) Records that are exempt from disclosure under
20 Section 1A-16.7 of the Election Code.
21 (ii) (ff) Information which is exempted from
22 disclosure under Section 2505-800 of the Department of
23 Revenue Law of the Civil Administrative Code of Illinois.
24 (ll) Information the disclosure of which is restricted
25 and exempted under Section 5-30.8 of the Illinois Public
26 Aid Code.

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1(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352,
2eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16;
399-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
4100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
58-28-17; 100-465, eff. 8-31-17; revised 11-2-17.)
6 (Text of Section after amendment by P.A. 100-517 but before
7amendment by P.A. 100-512)
8 Sec. 7.5. Statutory exemptions. To the extent provided for
9by the statutes referenced below, the following shall be exempt
10from inspection and copying:
11 (a) All information determined to be confidential
12 under Section 4002 of the Technology Advancement and
13 Development Act.
14 (b) Library circulation and order records identifying
15 library users with specific materials under the Library
16 Records Confidentiality Act.
17 (c) Applications, related documents, and medical
18 records received by the Experimental Organ Transplantation
19 Procedures Board and any and all documents or other records
20 prepared by the Experimental Organ Transplantation
21 Procedures Board or its staff relating to applications it
22 has received.
23 (d) Information and records held by the Department of
24 Public Health and its authorized representatives relating
25 to known or suspected cases of sexually transmissible

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1 disease or any information the disclosure of which is
2 restricted under the Illinois Sexually Transmissible
3 Disease Control Act.
4 (e) Information the disclosure of which is exempted
5 under Section 30 of the Radon Industry Licensing Act.
6 (f) Firm performance evaluations under Section 55 of
7 the Architectural, Engineering, and Land Surveying
8 Qualifications Based Selection Act.
9 (g) Information the disclosure of which is restricted
10 and exempted under Section 50 of the Illinois Prepaid
11 Tuition Act.
12 (h) Information the disclosure of which is exempted
13 under the State Officials and Employees Ethics Act, and
14 records of any lawfully created State or local inspector
15 general's office that would be exempt if created or
16 obtained by an Executive Inspector General's office under
17 that Act.
18 (i) Information contained in a local emergency energy
19 plan submitted to a municipality in accordance with a local
20 emergency energy plan ordinance that is adopted under
21 Section 11-21.5-5 of the Illinois Municipal Code.
22 (j) Information and data concerning the distribution
23 of surcharge moneys collected and remitted by carriers
24 under the Emergency Telephone System Act.
25 (k) Law enforcement officer identification information
26 or driver identification information compiled by a law

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1 enforcement agency or the Department of Transportation
2 under Section 11-212 of the Illinois Vehicle Code.
3 (l) Records and information provided to a residential
4 health care facility resident sexual assault and death
5 review team or the Executive Council under the Abuse
6 Prevention Review Team Act.
7 (m) Information provided to the predatory lending
8 database created pursuant to Article 3 of the Residential
9 Real Property Disclosure Act, except to the extent
10 authorized under that Article.
11 (n) Defense budgets and petitions for certification of
12 compensation and expenses for court appointed trial
13 counsel as provided under Sections 10 and 15 of the Capital
14 Crimes Litigation Act. This subsection (n) shall apply
15 until the conclusion of the trial of the case, even if the
16 prosecution chooses not to pursue the death penalty prior
17 to trial or sentencing.
18 (o) Information that is prohibited from being
19 disclosed under Section 4 of the Illinois Health and
20 Hazardous Substances Registry Act.
21 (p) Security portions of system safety program plans,
22 investigation reports, surveys, schedules, lists, data, or
23 information compiled, collected, or prepared by or for the
24 Regional Transportation Authority under Section 2.11 of
25 the Regional Transportation Authority Act or the St. Clair
26 County Transit District under the Bi-State Transit Safety

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1 Act.
2 (q) Information prohibited from being disclosed by the
3 Personnel Records Review Act.
4 (r) Information prohibited from being disclosed by the
5 Illinois School Student Records Act.
6 (s) Information the disclosure of which is restricted
7 under Section 5-108 of the Public Utilities Act.
8 (t) All identified or deidentified health information
9 in the form of health data or medical records contained in,
10 stored in, submitted to, transferred by, or released from
11 the Illinois Health Information Exchange, and identified
12 or deidentified health information in the form of health
13 data and medical records of the Illinois Health Information
14 Exchange in the possession of the Illinois Health
15 Information Exchange Authority due to its administration
16 of the Illinois Health Information Exchange. The terms
17 "identified" and "deidentified" shall be given the same
18 meaning as in the Health Insurance Portability and
19 Accountability Act of 1996, Public Law 104-191, or any
20 subsequent amendments thereto, and any regulations
21 promulgated thereunder.
22 (u) Records and information provided to an independent
23 team of experts under Brian's Law.
24 (v) Names and information of people who have applied
25 for or received Firearm Owner's Identification Cards under
26 the Firearm Owners Identification Card Act or applied for

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1 or received a concealed carry license under the Firearm
2 Concealed Carry Act, unless otherwise authorized by the
3 Firearm Concealed Carry Act; and databases under the
4 Firearm Concealed Carry Act, records of the Concealed Carry
5 Licensing Review Board under the Firearm Concealed Carry
6 Act, and law enforcement agency objections under the
7 Firearm Concealed Carry Act.
8 (w) Personally identifiable information which is
9 exempted from disclosure under subsection (g) of Section
10 19.1 of the Toll Highway Act.
11 (x) Information which is exempted from disclosure
12 under Section 5-1014.3 of the Counties Code or Section
13 8-11-21 of the Illinois Municipal Code.
14 (y) Confidential information under the Adult
15 Protective Services Act and its predecessor enabling
16 statute, the Elder Abuse and Neglect Act, including
17 information about the identity and administrative finding
18 against any caregiver of a verified and substantiated
19 decision of abuse, neglect, or financial exploitation of an
20 eligible adult maintained in the Registry established
21 under Section 7.5 of the Adult Protective Services Act.
22 (z) Records and information provided to a fatality
23 review team or the Illinois Fatality Review Team Advisory
24 Council under Section 15 of the Adult Protective Services
25 Act.
26 (aa) Information which is exempted from disclosure

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1 under Section 2.37 of the Wildlife Code.
2 (bb) Information which is or was prohibited from
3 disclosure by the Juvenile Court Act of 1987.
4 (cc) Recordings made under the Law Enforcement
5 Officer-Worn Body Camera Act, except to the extent
6 authorized under that Act.
7 (dd) Information that is prohibited from being
8 disclosed under Section 45 of the Condominium and Common
9 Interest Community Ombudsperson Act.
10 (ee) Information that is exempted from disclosure
11 under Section 30.1 of the Pharmacy Practice Act.
12 (ff) Information that is exempted from disclosure
13 under the Revised Uniform Unclaimed Property Act.
14 (gg) (ff) Information that is prohibited from being
15 disclosed under Section 7-603.5 of the Illinois Vehicle
16 Code.
17 (hh) (ff) Records that are exempt from disclosure under
18 Section 1A-16.7 of the Election Code.
19 (ii) (ff) Information which is exempted from
20 disclosure under Section 2505-800 of the Department of
21 Revenue Law of the Civil Administrative Code of Illinois.
22 (jj) (ff) Information and reports that are required to
23 be submitted to the Department of Labor by registering day
24 and temporary labor service agencies but are exempt from
25 disclosure under subsection (a-1) of Section 45 of the Day
26 and Temporary Labor Services Act.

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1 (ll) Information the disclosure of which is restricted
2 and exempted under Section 5-30.8 of the Illinois Public
3 Aid Code.
4(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352,
5eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16;
699-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
7100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
88-28-17; 100-465, eff. 8-31-17; 100-517, eff. 6-1-18; revised
911-2-17.)
10 (Text of Section after amendment by P.A. 100-512)
11 Sec. 7.5. Statutory exemptions. To the extent provided for
12by the statutes referenced below, the following shall be exempt
13from inspection and copying:
14 (a) All information determined to be confidential
15 under Section 4002 of the Technology Advancement and
16 Development Act.
17 (b) Library circulation and order records identifying
18 library users with specific materials under the Library
19 Records Confidentiality Act.
20 (c) Applications, related documents, and medical
21 records received by the Experimental Organ Transplantation
22 Procedures Board and any and all documents or other records
23 prepared by the Experimental Organ Transplantation
24 Procedures Board or its staff relating to applications it
25 has received.

SB1851 Enrolled- 24 -LRB100 10394 KTG 20591 b
1 (d) Information and records held by the Department of
2 Public Health and its authorized representatives relating
3 to known or suspected cases of sexually transmissible
4 disease or any information the disclosure of which is
5 restricted under the Illinois Sexually Transmissible
6 Disease Control Act.
7 (e) Information the disclosure of which is exempted
8 under Section 30 of the Radon Industry Licensing Act.
9 (f) Firm performance evaluations under Section 55 of
10 the Architectural, Engineering, and Land Surveying
11 Qualifications Based Selection Act.
12 (g) Information the disclosure of which is restricted
13 and exempted under Section 50 of the Illinois Prepaid
14 Tuition Act.
15 (h) Information the disclosure of which is exempted
16 under the State Officials and Employees Ethics Act, and
17 records of any lawfully created State or local inspector
18 general's office that would be exempt if created or
19 obtained by an Executive Inspector General's office under
20 that Act.
21 (i) Information contained in a local emergency energy
22 plan submitted to a municipality in accordance with a local
23 emergency energy plan ordinance that is adopted under
24 Section 11-21.5-5 of the Illinois Municipal Code.
25 (j) Information and data concerning the distribution
26 of surcharge moneys collected and remitted by carriers

SB1851 Enrolled- 25 -LRB100 10394 KTG 20591 b
1 under the Emergency Telephone System Act.
2 (k) Law enforcement officer identification information
3 or driver identification information compiled by a law
4 enforcement agency or the Department of Transportation
5 under Section 11-212 of the Illinois Vehicle Code.
6 (l) Records and information provided to a residential
7 health care facility resident sexual assault and death
8 review team or the Executive Council under the Abuse
9 Prevention Review Team Act.
10 (m) Information provided to the predatory lending
11 database created pursuant to Article 3 of the Residential
12 Real Property Disclosure Act, except to the extent
13 authorized under that Article.
14 (n) Defense budgets and petitions for certification of
15 compensation and expenses for court appointed trial
16 counsel as provided under Sections 10 and 15 of the Capital
17 Crimes Litigation Act. This subsection (n) shall apply
18 until the conclusion of the trial of the case, even if the
19 prosecution chooses not to pursue the death penalty prior
20 to trial or sentencing.
21 (o) Information that is prohibited from being
22 disclosed under Section 4 of the Illinois Health and
23 Hazardous Substances Registry Act.
24 (p) Security portions of system safety program plans,
25 investigation reports, surveys, schedules, lists, data, or
26 information compiled, collected, or prepared by or for the

SB1851 Enrolled- 26 -LRB100 10394 KTG 20591 b
1 Regional Transportation Authority under Section 2.11 of
2 the Regional Transportation Authority Act or the St. Clair
3 County Transit District under the Bi-State Transit Safety
4 Act.
5 (q) Information prohibited from being disclosed by the
6 Personnel Records Review Act.
7 (r) Information prohibited from being disclosed by the
8 Illinois School Student Records Act.
9 (s) Information the disclosure of which is restricted
10 under Section 5-108 of the Public Utilities Act.
11 (t) All identified or deidentified health information
12 in the form of health data or medical records contained in,
13 stored in, submitted to, transferred by, or released from
14 the Illinois Health Information Exchange, and identified
15 or deidentified health information in the form of health
16 data and medical records of the Illinois Health Information
17 Exchange in the possession of the Illinois Health
18 Information Exchange Authority due to its administration
19 of the Illinois Health Information Exchange. The terms
20 "identified" and "deidentified" shall be given the same
21 meaning as in the Health Insurance Portability and
22 Accountability Act of 1996, Public Law 104-191, or any
23 subsequent amendments thereto, and any regulations
24 promulgated thereunder.
25 (u) Records and information provided to an independent
26 team of experts under Brian's Law.

SB1851 Enrolled- 27 -LRB100 10394 KTG 20591 b
1 (v) Names and information of people who have applied
2 for or received Firearm Owner's Identification Cards under
3 the Firearm Owners Identification Card Act or applied for
4 or received a concealed carry license under the Firearm
5 Concealed Carry Act, unless otherwise authorized by the
6 Firearm Concealed Carry Act; and databases under the
7 Firearm Concealed Carry Act, records of the Concealed Carry
8 Licensing Review Board under the Firearm Concealed Carry
9 Act, and law enforcement agency objections under the
10 Firearm Concealed Carry Act.
11 (w) Personally identifiable information which is
12 exempted from disclosure under subsection (g) of Section
13 19.1 of the Toll Highway Act.
14 (x) Information which is exempted from disclosure
15 under Section 5-1014.3 of the Counties Code or Section
16 8-11-21 of the Illinois Municipal Code.
17 (y) Confidential information under the Adult
18 Protective Services Act and its predecessor enabling
19 statute, the Elder Abuse and Neglect Act, including
20 information about the identity and administrative finding
21 against any caregiver of a verified and substantiated
22 decision of abuse, neglect, or financial exploitation of an
23 eligible adult maintained in the Registry established
24 under Section 7.5 of the Adult Protective Services Act.
25 (z) Records and information provided to a fatality
26 review team or the Illinois Fatality Review Team Advisory

SB1851 Enrolled- 28 -LRB100 10394 KTG 20591 b
1 Council under Section 15 of the Adult Protective Services
2 Act.
3 (aa) Information which is exempted from disclosure
4 under Section 2.37 of the Wildlife Code.
5 (bb) Information which is or was prohibited from
6 disclosure by the Juvenile Court Act of 1987.
7 (cc) Recordings made under the Law Enforcement
8 Officer-Worn Body Camera Act, except to the extent
9 authorized under that Act.
10 (dd) Information that is prohibited from being
11 disclosed under Section 45 of the Condominium and Common
12 Interest Community Ombudsperson Act.
13 (ee) Information that is exempted from disclosure
14 under Section 30.1 of the Pharmacy Practice Act.
15 (ff) Information that is exempted from disclosure
16 under the Revised Uniform Unclaimed Property Act.
17 (gg) (ff) Information that is prohibited from being
18 disclosed under Section 7-603.5 of the Illinois Vehicle
19 Code.
20 (hh) (ff) Records that are exempt from disclosure under
21 Section 1A-16.7 of the Election Code.
22 (ii) (ff) Information which is exempted from
23 disclosure under Section 2505-800 of the Department of
24 Revenue Law of the Civil Administrative Code of Illinois.
25 (jj) (ff) Information and reports that are required to
26 be submitted to the Department of Labor by registering day

SB1851 Enrolled- 29 -LRB100 10394 KTG 20591 b
1 and temporary labor service agencies but are exempt from
2 disclosure under subsection (a-1) of Section 45 of the Day
3 and Temporary Labor Services Act.
4 (kk) (ff) Information prohibited from disclosure under
5 the Seizure and Forfeiture Reporting Act.
6 (ll) Information the disclosure of which is restricted
7 and exempted under Section 5-30.8 of the Illinois Public
8 Aid Code.
9(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352,
10eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16;
1199-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
12100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
138-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517,
14eff. 6-1-18; revised 11-2-17.)
15 Section 15. The Children and Family Services Act is amended
16by adding Section 5.45 as follows:
17 (20 ILCS 505/5.45 new)
18 Sec. 5.45. Managed care plan services.
19 (a) As used in this Section:
20 "Caregiver" means an individual or entity directly
21providing the day-to-day care of a child ensuring the child's
22safety and well-being.
23 "Child" means a child placed in the care of the Department
24pursuant to the Juvenile Court Act of 1987.

SB1851 Enrolled- 30 -LRB100 10394 KTG 20591 b
1 "Department" means the Department of Children and Family
2Services, or any successor State agency.
3 "Director" means the Director of Children and Family
4Services.
5 "Managed care organization" has the meaning ascribed to
6that term in Section 5-30.1 of the Illinois Public Aid Code.
7 "Medicaid managed care plan" means a health care plan
8operated by a managed care organization under the Medical
9Assistance Program established in Article V of the Illinois
10Public Aid Code.
11 "Workgroup" means the Child Welfare Medicaid Managed Care
12Implementation Advisory Workgroup.
13 (b) Every child who is in the care of the Department
14pursuant to the Juvenile Court Act of 1987 shall receive the
15necessary services required by this Act and the Juvenile Court
16Act of 1987, including any child enrolled in a Medicaid managed
17care plan.
18 (c) The Department shall not relinquish its authority or
19diminish its responsibility to determine and provide necessary
20services that are in the best interest of a child even if those
21services are directly or indirectly:
22 (1) provided by a managed care organization, another
23 State agency, or other third parties;
24 (2) coordinated through a managed care organization,
25 another State agency, or other third parties; or
26 (3) paid for by a managed care organization, another

SB1851 Enrolled- 31 -LRB100 10394 KTG 20591 b
1 State agency, or other third parties.
2 (d) The Department shall:
3 (1) implement and enforce measures to ensure that a
4 child's enrollment in Medicaid managed care supports
5 continuity of treatment and does not hinder service
6 delivery;
7 (2) establish a single point of contact for health care
8 coverage inquiries and dispute resolution systemwide
9 without transferring this responsibility to a third party
10 such as a managed care coordinator;
11 (3) not require any child to participate in Medicaid
12 managed care if the child would otherwise be exempt from
13 enrolling in a Medicaid managed care plan under any rule or
14 statute of this State; and
15 (4) make recommendations regarding managed care
16 contract measures, quality assurance activities, and
17 performance delivery evaluations in consultation with the
18 Workgroup; and
19 (5) post on its website:
20 (A) a link to any rule adopted or procedures
21 changed to address the provisions of this Section, if
22 applicable;
23 (B) each managed care organization's contract,
24 enrollee handbook, and directory;
25 (C) the notification process and timeframe
26 requirements used to inform managed care plan

SB1851 Enrolled- 32 -LRB100 10394 KTG 20591 b
1 enrollees, enrollees' caregivers, and enrollees' legal
2 representation of any changes in health care coverage
3 or change in a child's managed care provider;
4 (D) defined prior authorization requirements for
5 prescriptions, goods, and services in emergency and
6 non-emergency situations;
7 (E) the State's current Health Care Oversight and
8 Coordination Plan developed in accordance with federal
9 requirements; and
10 (F) the transition plan required under subsection
11 (f), including:
12 (i) the public comments submitted to the
13 Department, the Department of Healthcare and
14 Family Services, and the Workgroup for
15 consideration in development of the transition
16 plan;
17 (ii) a list and summary of recommendations of
18 the Workgroup that the Director or Director of
19 Healthcare and Family Services declined to adopt
20 or implement; and
21 (iii) the Department's attestation that the
22 transition plan will not impede the Department's
23 ability to timely identify the service needs of
24 youth in care and the timely and appropriate
25 provision of services to address those identified
26 needs.

SB1851 Enrolled- 33 -LRB100 10394 KTG 20591 b
1 (e) The Child Welfare Medicaid Managed Care Implementation
2Advisory Workgroup is established to advise the Department on
3the transition and implementation of managed care for children.
4The Director of Children and Family Services and the Director
5of Healthcare and Family Services shall serve as
6co-chairpersons of the Workgroup. The Directors shall jointly
7appoint members to the Workgroup who are stakeholders from the
8child welfare community, including:
9 (1) employees of the Department of Children and Family
10 Services who have responsibility in the areas of (i)
11 managed care services, (ii) performance monitoring and
12 oversight, (iii) placement operations, and (iv) budget
13 revenue maximization;
14 (2) employees of the Department of Healthcare and
15 Family Services who have responsibility in the areas of (i)
16 managed care contracting, (ii) performance monitoring and
17 oversight, (iii) children's behavioral health, and (iv)
18 budget revenue maximization;
19 (3) 2 representatives of youth in care;
20 (4) one representative of managed care organizations
21 serving youth in care;
22 (5) 4 representatives of child welfare providers;
23 (6) one representative of parents of children in
24 out-of-home care;
25 (7) one representative of universities or research
26 institutions;

SB1851 Enrolled- 34 -LRB100 10394 KTG 20591 b
1 (8) one representative of pediatric physicians;
2 (9) one representative of the juvenile court;
3 (10) one representative of caregivers of youth in care;
4 (11) one practitioner with expertise in child and
5 adolescent psychiatry;
6 (12) one representative of substance abuse and mental
7 health providers with expertise in serving children
8 involved in child welfare and their families;
9 (13) at least one member of the Medicaid Advisory
10 Committee;
11 (14) one representative of a statewide organization
12 representing hospitals;
13 (15) one representative of a statewide organization
14 representing child welfare providers;
15 (16) one representative of a statewide organization
16 representing substance abuse and mental health providers;
17 and
18 (17) other child advocates as deemed appropriate by the
19 Directors.
20 To the greatest extent possible, the co-chairpersons shall
21appoint members who reflect the geographic diversity of the
22State and include members who represent rural service areas.
23Members shall serve 2-year terms or until the Workgroup
24dissolves. If a vacancy occurs in the Workgroup membership, the
25vacancy shall be filled in the same manner as the original
26appointment for the remainder of the unexpired term. The

SB1851 Enrolled- 35 -LRB100 10394 KTG 20591 b
1Workgroup shall hold meetings, as it deems appropriate, in the
2northern, central, and southern regions of the State to solicit
3public comments to develop its recommendations. To ensure the
4Department of Children and Family Services and the Department
5of Healthcare and Family Services are provided time to confer
6and determine their use of pertinent Workgroup recommendations
7in the transition plan required under subsection (f), the
8co-chairpersons shall convene at least 3 meetings. The
9Department of Children and Family Services and the Department
10of Healthcare and Family Services shall provide administrative
11support to the Workgroup. Workgroup members shall serve without
12compensation. The Workgroup shall dissolve 5 years after the
13Department of Children and Family Services' implementation of
14managed care.
15 (f) Prior to transitioning any child to managed care, the
16Department of Children and Family Services and the Department
17of Healthcare and Family Services, in consultation with the
18Workgroup, must develop and post publicly, a transition plan
19for the provision of health care services to children enrolled
20in Medicaid managed care plans. Interim transition plans must
21be posted to the Department's website by July 15, 2018. The
22transition plan shall be posted at least 28 days before the
23Department's implementation of managed care. The transition
24plan shall address, but is not limited to, the following:
25 (1) an assessment of existing network adequacy, plans
26 to address gaps in network, and ongoing network evaluation;

SB1851 Enrolled- 36 -LRB100 10394 KTG 20591 b
1 (2) a framework for preparing and training
2 organizations, caregivers, frontline staff, and managed
3 care organizations;
4 (3) the identification of administrative changes
5 necessary for successful transition to managed care, and
6 the timeframes to make changes;
7 (4) defined roles, responsibilities, and lines of
8 authority for care coordination, placement providers,
9 service providers, and each State agency involved in
10 management and oversight of managed care services;
11 (5) data used to establish baseline performance and
12 quality of care, which shall be utilized to assess quality
13 outcomes and identify ongoing areas for improvement;
14 (6) a process for stakeholder input into managed care
15 planning and implementation;
16 (7) a dispute resolution process, including the rights
17 of enrollees and representatives of enrollees under the
18 dispute process and timeframes for dispute resolution
19 determinations and remedies;
20 (8) the process for health care transition for youth
21 exiting the Department's care through emancipation or
22 achieving permanency; and
23 (9) protections to ensure the continued provision of
24 health care services if a child's residence or legal
25 guardian changes.
26 (g) Reports.

SB1851 Enrolled- 37 -LRB100 10394 KTG 20591 b
1 (1) On or before February 1, 2019, and on or before
2 each February 1 thereafter, the Department shall submit a
3 report to the House and Senate Human Services Committees,
4 or to any successor committees, on measures of access to
5 and the quality of health care services for children
6 enrolled in Medicaid managed care plans, including, but not
7 limited to, data showing whether:
8 (A) children enrolled in Medicaid managed care
9 plans have continuity of care across placement types,
10 geographic regions, and specialty service needs;
11 (B) each child is receiving the early periodic
12 screening, diagnosis, and treatment services as
13 required by federal law, including, but not limited to,
14 regular preventative care and timely specialty care;
15 (C) children are assigned to health homes;
16 (D) each child has a health care oversight and
17 coordination plan as required by federal law;
18 (E) there exist complaints and grievances
19 indicating gaps or barriers in service delivery; and
20 (F) the Workgroup and other stakeholders have and
21 continue to be engaged in quality improvement
22 initiatives.
23 The report shall be prepared in consultation with the
24 Workgroup and other agencies, organizations, or
25 individuals the Director deems appropriate in order to
26 obtain comprehensive and objective information about the

SB1851 Enrolled- 38 -LRB100 10394 KTG 20591 b
1 managed care plan operation.
2 (2) During each legislative session, the House and
3 Senate Human Services Committees shall hold hearings to
4 take public testimony about managed care implementation
5 for children in the care of, adopted from, or placed in
6 guardianship by the Department. The Department shall
7 present testimony, including information provided in the
8 report required under paragraph (1), the Department's
9 compliance with the provisions of this Section, and any
10 recommendations for statutory changes to improve health
11 care for children in the Department's care.
12 (h) If any provision of this Section or its application to
13any person or circumstance is held invalid, the invalidity of
14that provision or application does not affect other provisions
15or applications of this Section that can be given effect
16without the invalid provision or application.
17 Section 16. The Nursing Home Care Act is amended by
18changing Section 2-217 as follows:
19 (210 ILCS 45/2-217)
20 Sec. 2-217. Order for transportation of resident by an
21ambulance service provider. If a facility orders medi-car,
22service car, or ground ambulance transportation of a resident
23of the facility by an ambulance service provider, the facility
24must maintain a written record that shows (i) the name of the

SB1851 Enrolled- 39 -LRB100 10394 KTG 20591 b
1person who placed the order for that transportation and (ii)
2the medical reason for that transportation. Additionally, the
3facility must provide the ambulance service provider with a
4Physician Certification Statement on a form prescribed by the
5Department of Healthcare and Family Services in accordance with
6subsection (g) of Section 5-4.2 of the Illinois Public Aid
7Code. The facility shall provide a copy of the Physician
8Certification Statement to the ambulance service provider
9prior to or at the time of transport. The Physician
10Certification Statement is not required prior to the transport
11if a delay in transport can be expected to negatively affect
12the patient outcome; however, the facility shall provide a copy
13of the Physician Certification Statement to the ambulance
14service provider at no charge within 10 days after the request.
15A facility shall, upon request, furnish assistance to the
16transportation provider in the completion of the form if the
17Physician Certification Statement is incomplete. The facility
18must maintain the record for a period of at least 3 years after
19the date of the order for transportation by ambulance.
20(Source: P.A. 94-1063, eff. 1-31-07.)
21 Section 17. The Specialized Mental Health Rehabilitation
22Act of 2013 is amended by adding Section 5-104 as follows:
23 (210 ILCS 49/5-104 new)
24 Sec. 5-104. Therapeutic visit rates. For a facility

SB1851 Enrolled- 40 -LRB100 10394 KTG 20591 b
1licensed under this Act by June 1, 2018 or provisionally
2licensed under this Act by June 1, 2018, a payment shall be
3made for therapeutic visits that have been indicated by an
4interdisciplinary team as therapeutically beneficial. Payment
5under this Section shall be at a rate of 75% of the facility's
6rate on the effective date of this amendatory Act of the 100th
7General Assembly and may not exceed 20 days in a fiscal year
8and shall not exceed 10 days consecutively.
9 Section 18. The Hospital Licensing Act is amended by
10changing Section 6.22 as follows:
11 (210 ILCS 85/6.22)
12 Sec. 6.22. Arrangement for transportation of patient by an
13ambulance service provider.
14 (a) In this Section:
15 "Ambulance service provider" means a Vehicle Service
16 Provider as defined in the Emergency Medical Services (EMS)
17 Systems Act who provides non-emergency transportation
18 services by ambulance.
19 "Patient" means a person who is transported by an
20 ambulance service provider.
21 (b) If a hospital arranges for medi-car, service car, or
22ground ambulance transportation of a patient of the hospital by
23ambulance, the hospital must provide the ambulance service
24provider, at or prior to transport, a Physician Certification

SB1851 Enrolled- 41 -LRB100 10394 KTG 20591 b
1Statement formatted and completed in compliance with federal
2regulations or an equivalent form developed by the hospital.
3Each hospital shall develop a policy requiring a physician or
4the physician's designee to complete the Physician
5Certification Statement. The Physician Certification Statement
6shall be maintained as part of the patient's medical record. A
7hospital shall, upon request, furnish assistance to the
8ambulance service provider in the completion of the form if the
9Physician Certification Statement is incomplete. The Physician
10Certification Statement or equivalent form is not required
11prior to transport if a delay in transport can be expected to
12negatively affect the patient outcome; however, a hospital
13shall provide a copy of the Physician Certification Statement
14to the ambulance service provider at no charge within 10 days
15after the request.
16 (c) If a hospital is unable to provide a Physician
17Certification Statement or equivalent form, then the hospital
18shall provide to the patient a written notice and a verbal
19explanation of the written notice, which notice must meet all
20of the following requirements:
21 (1) The following caption must appear at the beginning
22 of the notice in at least 14-point type: Notice to Patient
23 Regarding Non-Emergency Ambulance Services.
24 (2) The notice must contain each of the following
25 statements in at least 14-point type:
26 (A) The purpose of this notice is to help you make

SB1851 Enrolled- 42 -LRB100 10394 KTG 20591 b
1 an informed choice about whether you want to be
2 transported by ambulance because your medical
3 condition does not meet medical necessity for
4 transportation by an ambulance.
5 (B) Your insurance may not cover the charges for
6 ambulance transportation.
7 (C) You may be responsible for the cost of
8 ambulance transportation.
9 (D) The estimated cost of ambulance transportation
10 is $(amount).
11 (3) The notice must be signed by the patient or by the
12 patient's authorized representative. A copy shall be given
13 to the patient and the hospital shall retain a copy.
14 (d) The notice set forth in subsection (c) of this Section
15shall not be required if a delay in transport can be expected
16to negatively affect the patient outcome.
17 (e) If a patient is physically or mentally unable to sign
18the notice described in subsection (c) of this Section and no
19authorized representative of the patient is available to sign
20the notice on the patient's behalf, the hospital must be able
21to provide documentation of the patient's inability to sign the
22notice and the unavailability of an authorized representative.
23In any case described in this subsection (e), the hospital
24shall be considered to have met the requirements of subsection
25(c) of this Section.
26(Source: P.A. 94-1063, eff. 1-31-07.)

SB1851 Enrolled- 43 -LRB100 10394 KTG 20591 b
1 Section 20. The Illinois Public Aid Code is amended by
2changing Sections 5-4.2, 5-5.4h, and 5A-16 and by adding
3Sections 5-5.07 and 5-30.8 as follows:
4 (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
5 Sec. 5-4.2. Ambulance services payments.
6 (a) For ambulance services provided to a recipient of aid
7under this Article on or after January 1, 1993, the Illinois
8Department shall reimburse ambulance service providers at
9rates calculated in accordance with this Section. It is the
10intent of the General Assembly to provide adequate
11reimbursement for ambulance services so as to ensure adequate
12access to services for recipients of aid under this Article and
13to provide appropriate incentives to ambulance service
14providers to provide services in an efficient and
15cost-effective manner. Thus, it is the intent of the General
16Assembly that the Illinois Department implement a
17reimbursement system for ambulance services that, to the extent
18practicable and subject to the availability of funds
19appropriated by the General Assembly for this purpose, is
20consistent with the payment principles of Medicare. To ensure
21uniformity between the payment principles of Medicare and
22Medicaid, the Illinois Department shall follow, to the extent
23necessary and practicable and subject to the availability of
24funds appropriated by the General Assembly for this purpose,

SB1851 Enrolled- 44 -LRB100 10394 KTG 20591 b
1the statutes, laws, regulations, policies, procedures,
2principles, definitions, guidelines, and manuals used to
3determine the amounts paid to ambulance service providers under
4Title XVIII of the Social Security Act (Medicare).
5 (b) For ambulance services provided to a recipient of aid
6under this Article on or after January 1, 1996, the Illinois
7Department shall reimburse ambulance service providers based
8upon the actual distance traveled if a natural disaster,
9weather conditions, road repairs, or traffic congestion
10necessitates the use of a route other than the most direct
11route.
12 (c) For purposes of this Section, "ambulance services"
13includes medical transportation services provided by means of
14an ambulance, medi-car, service car, or taxi.
15 (c-1) For purposes of this Section, "ground ambulance
16service" means medical transportation services that are
17described as ground ambulance services by the Centers for
18Medicare and Medicaid Services and provided in a vehicle that
19is licensed as an ambulance by the Illinois Department of
20Public Health pursuant to the Emergency Medical Services (EMS)
21Systems Act.
22 (c-2) For purposes of this Section, "ground ambulance
23service provider" means a vehicle service provider as described
24in the Emergency Medical Services (EMS) Systems Act that
25operates licensed ambulances for the purpose of providing
26emergency ambulance services, or non-emergency ambulance

SB1851 Enrolled- 45 -LRB100 10394 KTG 20591 b
1services, or both. For purposes of this Section, this includes
2both ambulance providers and ambulance suppliers as described
3by the Centers for Medicare and Medicaid Services.
4 (c-3) For purposes of this Section, "medi-car" means
5transportation services provided to a patient who is confined
6to a wheelchair and requires the use of a hydraulic or electric
7lift or ramp and wheelchair lockdown when the patient's
8condition does not require medical observation, medical
9supervision, medical equipment, the administration of
10medications, or the administration of oxygen.
11 (c-4) For purposes of this Section, "service car" means
12transportation services provided to a patient by a passenger
13vehicle where that patient does not require the specialized
14modes described in subsection (c-1) or (c-3).
15 (d) This Section does not prohibit separate billing by
16ambulance service providers for oxygen furnished while
17providing advanced life support services.
18 (e) Beginning with services rendered on or after July 1,
192008, all providers of non-emergency medi-car and service car
20transportation must certify that the driver and employee
21attendant, as applicable, have completed a safety program
22approved by the Department to protect both the patient and the
23driver, prior to transporting a patient. The provider must
24maintain this certification in its records. The provider shall
25produce such documentation upon demand by the Department or its
26representative. Failure to produce documentation of such

SB1851 Enrolled- 46 -LRB100 10394 KTG 20591 b
1training shall result in recovery of any payments made by the
2Department for services rendered by a non-certified driver or
3employee attendant. Medi-car and service car providers must
4maintain legible documentation in their records of the driver
5and, as applicable, employee attendant that actually
6transported the patient. Providers must recertify all drivers
7and employee attendants every 3 years.
8 Notwithstanding the requirements above, any public
9transportation provider of medi-car and service car
10transportation that receives federal funding under 49 U.S.C.
115307 and 5311 need not certify its drivers and employee
12attendants under this Section, since safety training is already
13federally mandated.
14 (f) With respect to any policy or program administered by
15the Department or its agent regarding approval of non-emergency
16medical transportation by ground ambulance service providers,
17including, but not limited to, the Non-Emergency
18Transportation Services Prior Approval Program (NETSPAP), the
19Department shall establish by rule a process by which ground
20ambulance service providers of non-emergency medical
21transportation may appeal any decision by the Department or its
22agent for which no denial was received prior to the time of
23transport that either (i) denies a request for approval for
24payment of non-emergency transportation by means of ground
25ambulance service or (ii) grants a request for approval of
26non-emergency transportation by means of ground ambulance

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1service at a level of service that entitles the ground
2ambulance service provider to a lower level of compensation
3from the Department than the ground ambulance service provider
4would have received as compensation for the level of service
5requested. The rule shall be filed by December 15, 2012 and
6shall provide that, for any decision rendered by the Department
7or its agent on or after the date the rule takes effect, the
8ground ambulance service provider shall have 60 days from the
9date the decision is received to file an appeal. The rule
10established by the Department shall be, insofar as is
11practical, consistent with the Illinois Administrative
12Procedure Act. The Director's decision on an appeal under this
13Section shall be a final administrative decision subject to
14review under the Administrative Review Law.
15 (f-5) Beginning 90 days after July 20, 2012 (the effective
16date of Public Act 97-842), (i) no denial of a request for
17approval for payment of non-emergency transportation by means
18of ground ambulance service, and (ii) no approval of
19non-emergency transportation by means of ground ambulance
20service at a level of service that entitles the ground
21ambulance service provider to a lower level of compensation
22from the Department than would have been received at the level
23of service submitted by the ground ambulance service provider,
24may be issued by the Department or its agent unless the
25Department has submitted the criteria for determining the
26appropriateness of the transport for first notice publication

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1in the Illinois Register pursuant to Section 5-40 of the
2Illinois Administrative Procedure Act.
3 (g) Whenever a patient covered by a medical assistance
4program under this Code or by another medical program
5administered by the Department, including a patient covered
6under the State's Medicaid managed care program, is being
7transported discharged from a facility and requires
8non-emergency transportation including ground ambulance,
9medi-car, or service car transportation, a Physician
10Certification Statement , a physician discharge order as
11described in this Section shall be required for each patient
12whose discharge requires medically supervised ground ambulance
13services. Facilities shall develop procedures for a licensed
14medical professional physician with medical staff privileges
15to provide a written and signed Physician Certification
16Statement physician discharge order. The Physician
17Certification Statement physician discharge order shall
18specify the level of transportation ground ambulance services
19needed and complete a medical certification establishing the
20criteria for approval of non-emergency ambulance
21transportation, as published by the Department of Healthcare
22and Family Services, that is met by the patient. This order and
23the medical certification shall be completed prior to ordering
24the transportation an ambulance service and prior to patient
25discharge. The Physician Certification Statement is not
26required prior to transport if a delay in transport can be

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1expected to negatively affect the patient outcome. discharge.
2 The medical certification specifying the level and type of
3non-emergency transportation needed shall be in the form of the
4Physician Certification Statement on a standardized form
5prescribed by the Department of Healthcare and Family Services.
6Within 75 days after the effective date of this amendatory Act
7of the 100th General Assembly, the Department of Healthcare and
8Family Services shall develop a standardized form of the
9Physician Certification Statement specifying the level and
10type of transportation services needed in consultation with the
11Department of Public Health, Medicaid managed care
12organizations, a statewide association representing ambulance
13providers, a statewide association representing hospitals, 3
14statewide associations representing nursing homes, and other
15stakeholders. The Physician Certification Statement shall
16include, but is not limited to, the criteria necessary to
17demonstrate medical necessity for the level of transport needed
18as required by (i) the Department of Healthcare and Family
19Services and (ii) the federal Centers for Medicare and Medicaid
20Services as outlined in the Centers for Medicare and Medicaid
21Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap.
2210, Sec. 10.2.1, et seq. The use of the Physician Certification
23Statement shall satisfy the obligations of hospitals under
24Section 6.22 of the Hospital Licensing Act and nursing homes
25under Section 2-217 of the Nursing Home Care Act.
26Implementation and acceptance of the Physician Certification

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1Statement shall take place no later than 90 days after the
2issuance of the Physician Certification Statement by the
3Department of Healthcare and Family Services.
4 Pursuant to subsection (E) of Section 12-4.25 of this Code,
5the Department is entitled to recover overpayments paid to a
6provider or vendor, including, but not limited to, from the
7discharging physician, the discharging facility, and the
8ground ambulance service provider, in instances where a
9non-emergency ground ambulance service is rendered as the
10result of improper or false certification.
11 Beginning October 1, 2018, the Department of Healthcare and
12Family Services shall collect data from Medicaid managed care
13organizations and transportation brokers, including the
14Department's NETSPAP broker, regarding denials and appeals
15related to the missing or incomplete Physician Certification
16Statement forms and overall compliance with this subsection.
17The Department of Healthcare and Family Services shall publish
18quarterly results on its website within 15 days following the
19end of each quarter.
20 (h) On and after July 1, 2012, the Department shall reduce
21any rate of reimbursement for services or other payments or
22alter any methodologies authorized by this Code to reduce any
23rate of reimbursement for services or other payments in
24accordance with Section 5-5e.
25(Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12;
2697-842, eff. 7-20-12; 98-463, eff. 8-16-13.)

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1 (305 ILCS 5/5-5.4h)
2 Sec. 5-5.4h. Medicaid reimbursement for medically complex
3for the developmentally disabled facilities licensed under the
4MC/DD Act long-term care facilities for persons under 22 years
5of age.
6 (a) Facilities licensed as medically complex for the
7developmentally disabled facilities long-term care facilities
8for persons under 22 years of age that serve severely and
9chronically ill pediatric patients shall have a specific
10reimbursement system designed to recognize the characteristics
11and needs of the patients they serve.
12 (b) For dates of services starting July 1, 2013 and until a
13new reimbursement system is designed, medically complex for the
14developmentally disabled facilities long-term care facilities
15for persons under 22 years of age that meet the following
16criteria:
17 (1) serve exceptional care patients; and
18 (2) have 30% or more of their patients receiving
19 ventilator care;
20shall receive Medicaid reimbursement on a 30-day expedited
21schedule.
22 (c) Subject to federal approval of changes to the Title XIX
23State Plan, for dates of services starting July 1, 2014 through
24March 31, 2019, medically complex for the developmentally
25disabled facilities and until a new reimbursement system is

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1designed, long-term care facilities for persons under 22 years
2of age which meet the criteria in subsection (b) of this
3Section shall receive a per diem rate for clinically complex
4residents of $304. Clinically complex residents on a ventilator
5shall receive a per diem rate of $669. Subject to federal
6approval of changes to the Title XIX State Plan, for dates of
7services starting April 1, 2019, medically complex for the
8developmentally disabled facilities must be reimbursed an
9exceptional care per diem rate, instead of the base rate, for
10services to residents with complex or extensive medical needs.
11Exceptional care per diem rates must be paid for the conditions
12or services specified under subsection (f) at the following per
13diem rates: Tier 1 $326, Tier 2 $546, and Tier 3 $735.
14 (d) For To qualify for the per diem rate of $669 for
15clinically complex residents on a ventilator pursuant to
16subsection (c) or subsection (f), facilities shall have a
17policy documenting their method of routine assessment of a
18resident's weaning potential with interventions implemented
19noted in the resident's medical record.
20 (e) For services provided prior to April 1, 2019 and for
21For the purposes of this Section, a resident is considered
22clinically complex if the resident requires at least one of the
23following medical services:
24 (1) Tracheostomy care with dependence on mechanical
25 ventilation for a minimum of 6 hours each day.
26 (2) Tracheostomy care requiring suctioning at least

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1 every 6 hours, room air mist or oxygen as needed, and
2 dependence on one of the treatment procedures listed under
3 paragraph (4) excluding the procedure listed in
4 subparagraph (A) of paragraph (4).
5 (3) Total parenteral nutrition or other intravenous
6 nutritional support and one of the treatment procedures
7 listed under paragraph (4).
8 (4) The following treatment procedures apply to the
9 conditions in paragraphs (2) and (3) of this subsection:
10 (A) Intermittent suctioning at least every 8 hours
11 and room air mist or oxygen as needed.
12 (B) Continuous intravenous therapy including
13 administration of therapeutic agents necessary for
14 hydration or of intravenous pharmaceuticals; or
15 intravenous pharmaceutical administration of more than
16 one agent via a peripheral or central line, without
17 continuous infusion.
18 (C) Peritoneal dialysis treatments requiring at
19 least 4 exchanges every 24 hours.
20 (D) Tube feeding via nasogastric or gastrostomy
21 tube.
22 (E) Other medical technologies required
23 continuously, which in the opinion of the attending
24 physician require the services of a professional
25 nurse.
26 (f) Complex or extensive medical needs for exceptional care

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1reimbursement. The conditions and services used for the
2purposes of this Section have the same meanings as ascribed to
3those conditions and services under the Minimum Data Set (MDS)
4Resident Assessment Instrument (RAI) and specified in the most
5recent manual. Instead of submitting minimum data set
6assessments to the Department, medically complex for the
7developmentally disabled facilities must document within each
8resident's medical record the conditions or services using the
9minimum data set documentation standards and requirements to
10qualify for exceptional care reimbursement.
11 (1) Tier 1 reimbursement is for residents who are
12 receiving at least 51% of their caloric intake via a
13 feeding tube.
14 (2) Tier 2 reimbursement is for residents who are
15 receiving tracheostomy care without a ventilator.
16 (3) Tier 3 reimbursement is for residents who are
17 receiving tracheostomy care and ventilator care.
18 (g) For dates of services starting April 1, 2019,
19reimbursement calculations and direct payment for services
20provided by medically complex for the developmentally disabled
21facilities are the responsibility of the Department of
22Healthcare and Family Services instead of the Department of
23Human Services. Appropriations for medically complex for the
24developmentally disabled facilities must be shifted from the
25Department of Human Services to the Department of Healthcare
26and Family Services. Nothing in this Section prohibits the

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1Department of Healthcare and Family Services from paying more
2than the rates specified in this Section. The rates in this
3Section must be interpreted as a minimum amount. Any
4reimbursement increases applied to providers licensed under
5the ID/DD Community Care Act must also be applied in an
6equivalent manner to medically complex for the developmentally
7disabled facilities.
8 (h) The Department of Healthcare and Family Services shall
9pay the rates in effect on March 31, 2019 until the changes
10made to this Section by this amendatory Act of the 100th
11General Assembly have been approved by the Centers for Medicare
12and Medicaid Services of the U.S. Department of Health and
13Human Services.
14 (i) The Department of Healthcare and Family Services may
15adopt rules as allowed by the Illinois Administrative Procedure
16Act to implement this Section; however, the requirements of
17this Section must be implemented by the Department of
18Healthcare and Family Services even if the Department of
19Healthcare and Family Services has not adopted rules by the
20implementation date of April 1, 2019.
21(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
22 (305 ILCS 5/5-5.07 new)
23 Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem
24rate. The Department of Children and Family Services shall pay
25the DCFS per diem rate for inpatient psychiatric stay at a

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1free-standing psychiatric hospital effective the 11th day when
2a child is in the hospital beyond medical necessity, and the
3parent or caregiver has denied the child access to the home and
4has refused or failed to make provisions for another living
5arrangement for the child or the child's discharge is being
6delayed due to a pending inquiry or investigation by the
7Department of Children and Family Services. This Section is
8repealed 6 months after the effective date of this amendatory
9Act of the 100th General Assembly.
10 (305 ILCS 5/5-30.8 new)
11 Sec. 5-30.8. Managed care organization rate transparency.
12 (a) For the establishment of managed care organization
13(MCO) capitation base rate payments from the State, including,
14but not limited to: (i) hospital fee schedule reforms and
15updates, (ii) rates related to a single State-mandated
16preferred drug list, (iii) rate updates related to the State's
17preferred drug list, (iv) inclusion of coverage for children
18with special needs, (v) inclusion of coverage for children
19within the child welfare system, (vi) annual MCO capitation
20rates, and (vii) any retroactive provider fee schedule
21adjustments or other changes required by legislation or other
22actions, the Department of Healthcare and Family Services shall
23implement a capitation base rate setting process beginning on
24the effective date of this amendatory Act of the 100th General
25Assembly which shall include all of the following elements of

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1transparency:
2 (1) The Department shall include participating MCOs
3 and a statewide trade association representing a majority
4 of participating MCOs in meetings to discuss the impact to
5 base capitation rates as a result of any new or updated
6 hospital fee schedules or other provider fee schedules.
7 Additionally, the Department shall share any data or
8 reports used to develop MCO capitation rates with
9 participating MCOs. This data shall be comprehensive
10 enough for MCO actuaries to recreate and verify the
11 accuracy of the capitation base rate build-up.
12 (2) The Department shall not limit the number of
13 experts that each MCO is allowed to bring to the draft
14 capitation base rate meeting or the final capitation base
15 rate review meeting. Draft and final capitation base rate
16 review meetings shall be held in at least 2 locations.
17 (3) The Department and its contracted actuary shall
18 meet with all participating MCOs simultaneously and
19 together along with consulting actuaries contracted with
20 statewide trade association representing a majority of
21 Medicaid health plans at the request of the plans.
22 Participating MCOs shall additionally, at their request,
23 be granted individual capitation rate development meetings
24 with the Department.
25 (4) Any quality incentive or other incentive
26 withholding of any portion of the actuarially certified

SB1851 Enrolled- 58 -LRB100 10394 KTG 20591 b
1 capitation rates must be budget-neutral. The entirety of
2 any aggregate withheld amounts must be returned to the MCOs
3 in proportion to their performance on the relevant
4 performance metric. No amounts shall be returned to the
5 Department if all performance measures are not achieved to
6 the extent allowable by federal law and regulations.
7 (5) Upon request, the Department shall provide written
8 responses to questions regarding MCO capitation base
9 rates, the capitation base development methodology, and
10 MCO capitation rate data, and all other requests regarding
11 capitation rates from MCOs. Upon request, the Department
12 shall also provide to the MCOs materials used in
13 incorporating provider fee schedules into base capitation
14 rates.
15 (b) For the development of capitation base rates for new
16capitation rate years:
17 (1) The Department shall take into account emerging
18 experience in the development of the annual MCO capitation
19 base rates, including, but not limited to, current-year
20 cost and utilization trends observed by MCOs in an
21 actuarially sound manner and in accordance with federal law
22 and regulations.
23 (2) No later than January 1 of each year, the
24 Department shall release an agreed upon annual calendar
25 that outlines dates for capitation rate setting meetings
26 for that year. The calendar shall include at least the

SB1851 Enrolled- 59 -LRB100 10394 KTG 20591 b
1 following meetings and deadlines:
2 (A) An initial meeting for the Department to review
3 MCO data and draft rate assumptions to be used in the
4 development of capitation base rates for the following
5 year.
6 (B) A draft rate meeting after the Department
7 provides the MCOs with the draft capitation base rates
8 to discuss, review, and seek feedback regarding the
9 draft capitation base rates.
10 (3) Prior to the submission of final capitation rates
11 to the federal Centers for Medicare and Medicaid Services,
12 the Department shall provide the MCOs with a final
13 actuarial report including the final capitation base rates
14 for the following year and subsequently conduct a final
15 capitation base review meeting. Final capitation rates
16 shall be marked final.
17 (c) For the development of capitation base rates reflecting
18policy changes:
19 (1) Unless contrary to federal law and regulation, the
20 Department must provide notice to MCOs of any significant
21 operational policy change no later than 60 days prior to
22 the effective date of an operational policy change in order
23 to give MCOs time to prepare for and implement the
24 operational policy change and to ensure that the quality
25 and delivery of enrollee health care is not disrupted.
26 "Operational policy change" means a change to operational

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1 requirements such as reporting formats, encounter
2 submission definitional changes, or required provider
3 interfaces made at the sole discretion of the Department
4 and not required by legislation with a retroactive
5 effective date. Nothing in this Section shall be construed
6 as a requirement to delay or prohibit implementation of
7 policy changes that impact enrollee benefits as determined
8 in the sole discretion of the Department.
9 (2) No later than 60 days after the effective date of
10 the policy change or program implementation, the
11 Department shall meet with the MCOs regarding the initial
12 data collection needed to establish capitation base rates
13 for the policy change. Additionally, the Department shall
14 share with the participating MCOs what other data is needed
15 to estimate the change and the processes for collection of
16 that data that shall be utilized to develop capitation base
17 rates.
18 (3) No later than 60 days after the effective date of
19 the policy change or program implementation, the
20 Department shall meet with MCOs to review data and the
21 Department's written draft assumptions to be used in
22 development of capitation base rates for the policy change,
23 and shall provide opportunities for questions to be asked
24 and answered.
25 (4) No later than 60 days after the effective date of
26 the policy change or program implementation, the

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1 Department shall provide the MCOs with draft capitation
2 base rates and shall also conduct a draft capitation base
3 rate meeting with MCOs to discuss, review, and seek
4 feedback regarding the draft capitation base rates.
5 (d) For the development of capitation base rates for
6retroactive policy or fee schedule changes:
7 (1) The Department shall meet with the MCOs regarding
8 the initial data collection needed to establish capitation
9 base rates for the policy change. Additionally, the
10 Department shall share with the participating MCOs what
11 other data is needed to estimate the change and the
12 processes for collection of the data that shall be utilized
13 to develop capitation base rates.
14 (2) The Department shall meet with MCOs to review data
15 and the Department's written draft assumptions to be used
16 in development of capitation base rates for the policy
17 change. The Department shall provide opportunities for
18 questions to be asked and answered.
19 (3) The Department shall provide the MCOs with draft
20 capitation rates and shall also conduct a draft rate
21 meeting with MCOs to discuss, review, and seek feedback
22 regarding the draft capitation base rates.
23 (4) The Department shall inform MCOs no less than
24 quarterly of upcoming benefit and policy changes to the
25 Medicaid program.
26 (e) Meetings of the group established to discuss Medicaid

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1capitation rates under this Section shall be closed to the
2public and shall not be subject to the Open Meetings Act.
3Records and information produced by the group established to
4discuss Medicaid capitation rates under this Section shall be
5confidential and not subject to the Freedom of Information Act.
6 (305 ILCS 5/5A-16)
7 Sec. 5A-16. State fiscal year 2019 implementation
8protection.
9 (a) To preserve access to hospital services and to ensure
10continuity of payments and stability of access to hospital
11services, it is the intent of the General Assembly that there
12not be a gap in payments to hospitals while the changes
13authorized under Public Act 100-581 this amendatory Act of the
14100th General Assembly are being reviewed by the federal
15Centers for Medicare and Medicaid Services and implemented by
16the Department. Therefore, pending the review and approval of
17the changes to the assessment and hospital reimbursement
18methodologies authorized under Public Act 100-581 this
19amendatory Act of the 100th General Assembly by the federal
20Centers for Medicare and Medicaid Services and the final
21implementation of such program by the Department, the
22Department shall take all actions necessary to continue the
23reimbursement methodologies and payments to hospitals that are
24changed under Public Act 100-581 this amendatory Act of the
25100th General Assembly, as they are in effect on June 30, 2018,

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1until the first day of the second month after the new and
2revised methodologies and payments authorized under Public Act
3100-581 this amendatory Act of the 100th General Assembly are
4effective and implemented by the Department. Such actions by
5the Department shall include, but not be limited to, requesting
6prior to June 15, 2018 the extension of any federal approval of
7the currently approved payment methodologies contained in
8Illinois' Medicaid State Plan while the federal Centers for
9Medicare and Medicaid Services reviews the proposed changes
10authorized under Public Act 100-581 this amendatory Act of the
11100th General Assembly.
12 (b) Notwithstanding any other provision of this Code, if
13the federal Centers for Medicare and Medicaid Services should
14approve the continuation of the reimbursement methodologies
15and payments to hospitals under Sections 5A-12.2, 5A-12.4,
165A-12.5 and , and Section 14-12, as they are in effect on June
1730, 2018, until the new and revised methodologies and payments
18authorized under Sections 5A-12.6 and Section 14-12 of this
19Code amendatory Act of the 100th General Assembly are federally
20approved, then the reimbursement methodologies and payments to
21hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12,
22and the assessments imposed under Section 5A-2, as they are in
23effect on June 30, 2018, shall continue until the effective
24date of the new and revised methodologies and payments, which
25shall be the first day of the second month following the date
26of approval by the federal Centers for Medicare and Medicaid

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1Services.
2 (c) Notwithstanding any other provision of this Code, if by
3July 11, 2018 the federal Centers for Medicare and Medicaid
4Services has neither approved the changes authorized under
5Public Act 100-581 nor has formally approved an extension of
6the reimbursement methodologies and payments to hospitals
7under Sections 5A-12.5 and 14-12 as they are in effect on June
830, 2018, then the following shall apply:
9 (1) All reimbursement methodologies and payments for
10 hospital services authorized under Sections 5A-12.2,
11 5A-12.4, and 5A-12.5 in effect on June 30, 2018 shall
12 continue subject to the availability of federal matching
13 funds for such expenditures and subject to the provisions
14 of subsection (c) of Section 5A-15.
15 (2) All supplemental payments to hospitals authorized
16 in Illinois' Medicaid State Plan in effect on June 30,
17 2018, which are scheduled to terminate under Illinois'
18 Medicaid State Plan on June 30, 2018, shall continue
19 subject to the availability of federal matching funds for
20 such expenditures.
21 (3) All assessments imposed under Section 5A-2, as they
22 are in effect on June 30, 2018, shall continue.
23 (4) Notwithstanding any other provision in this
24 subsection (c), the Department shall make monthly advance
25 payments to any safety-net hospital or critical access
26 hospital requesting such advance payments in an amount, as

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1 requested by the hospital, provided that the total monthly
2 payments to the hospital under this subsection shall not
3 exceed 1/12th of the payments the hospital would have
4 received under Sections 5A-12.2, 5A-12.4, and 5A-12.5 and
5 subsections (d) and (f) of Section 14-12.
6 Notwithstanding any other provision in this subsection
7 (c), the Department may make monthly advance payments to a
8 hospital requesting such advance payments in an amount, as
9 requested by the hospital, provided that the total monthly
10 payments to the hospital under this subsection shall not
11 exceed 1/12th of the payments the hospital would have
12 received under Sections 5A-12.2, 5A-12.4, and 5A-12.5 and
13 subsections (d) and (f) of Section 14-12.
14 Advance payments under this paragraph (4) shall be made
15 regardless of federal approval for federal financial
16 participation under Title XIX or XXI of the federal Social
17 Security Act.
18 As used in this paragraph (4), "safety-net hospital"
19 means a hospital as defined in Section 5-5e.1 for Rate Year
20 2017 or an Illinois hospital that meets the criteria in
21 paragraphs (2) and (3) of subsection (a) of Section 5-5e.1
22 for Rate Year 2017.
23 As used in this paragraph (4), "critical access
24 hospital" means a hospital that has such status as of June
25 30, 2018.
26 (5) The changes authorized under this subsection (c)

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1 shall continue, on the same time schedule as otherwise
2 authorized under this Article, until the effective date of
3 the new and revised methodologies and payments under Public
4 Act 100-581, which shall be the first day of the second
5 month following the date of approval by the federal Centers
6 for Medicare and Medicaid Services.
7(Source: P.A. 100-581, eff. 3-12-18.)
8 Section 95. No acceleration or delay. Where this Act makes
9changes in a statute that is represented in this Act by text
10that is not yet or no longer in effect (for example, a Section
11represented by multiple versions), the use of that text does
12not accelerate or delay the taking effect of (i) the changes
13made by this Act or (ii) provisions derived from any other
14Public Act.
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