Bill Text: IL SB1864 | 2019-2020 | 101st General Assembly | Chaptered

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Bill Title: Creates the Health Care Affordability Act. Requires the Department of Healthcare and Family Services, in consultation with the Department of Insurance, to oversee a feasibility study to explore options to make health insurance more affordable for Illinois residents. Provides that the Departments shall develop and submit a proposal to the General Assembly and the Governor concerning the design, costs, benefits, and implementation of a State option for health care coverage that leverages existing State infrastructure. Creates the Kidney Disease Prevention and Education Task Force Act. Creates the Kidney Disease Prevention and Education Task Force. Provides for membership and meetings of the Task Force. Requires the Task Force to develop a sustainable plan to raise awareness about early detection, promote health equity, and reduce the burden of kidney disease throughout the State and submit a final report to the General Assembly on or before December 21, 2022. Repeals the Act on June 1, 2022. Amends the Pharmacy Practice Act. Provides that an offsite institutional pharmacy may supply emergency kits to a licensed facility. Makes other changes. Amends the Illinois Public Aid Code. Provides that the medical assistance program shall provide coverage for routine care costs that are incurred in the course of an approved clinical trial if the medical assistance program would provide coverage for the same routine care costs not incurred in a clinical trial. Defines "approved clinical trial" to mean a phase I, II, III, or IV clinical trial involving the prevention, detection, or treatment of cancer or any other life-threatening disease or condition. Provides that "routine care cost" shall be defined by the Department of Healthcare and Family Services by rule. Provides that implementation of this coverage for routine care costs shall be contingent upon federal approval. Requires the Department of Healthcare and Family Services and the Department of Human Services to jointly submit the necessary application to the federal Centers for Medicare and Medicaid Services for a waiver or State Plan amendment to allow remote monitoring and support services as a waiver-reimbursable service for persons with intellectual and developmental disabilities. Provides that the application shall be submitted no later than January 1, 2021. Amends the Illinois Health Information Exchange and Technology Act. Changes the name of the Health Information Exchange Authority to the Health Information Exchange Office. Provides that staff employed by the Illinois Health Information Exchange Authority on the effective date of the amendatory Act shall transfer to the Health Information Exchange Office within the Department of Healthcare and Family Services. Makes conforming changes to several Acts including the Medical Patient Rights Act, Genetic Information Privacy Act, and the Mental Health and Developmental Disabilities Confidentiality Act. Amends the Children's Health Insurance Program Act, the Covering ALL KIDS Health Insurance Act, and the Medical Assistance Article of the Illinois Public Aid Code. Permits the Department of Healthcare and Family Services to take necessary actions to address the COVID-19 public health emergency to the extent such actions are required, approved, or authorized by the Centers for Medicare and Medicaid Services. Provides that such actions may continue throughout the public health emergency and for up to 12 months after the period ends, and may include, but are not limited to: accepting an applicant's or recipient's attestation of income, incurred medical expenses, residency, and insured status when electronic verification is not available. Further amends the Illinois Public Aid Code. Permits the Department of Healthcare and Family Services to cover the treatment of COVID-19 to persons who qualify for medical assistance under federal law and regulations and to noncitizens. Contains provisions concerning payment claims for ambulance providers that are unable to obtain a Physician Certification Statement; assessment forms for long-term care facilities; income verification for medical assistance recipients; remote monitoring and support services as a waiver-reimbursable service for persons with intellectual and developmental disabilities; and other matters. Effective immediately.

Spectrum: Partisan Bill (Democrat 10-0)

Status: (Passed) 2020-07-07 - Public Act . . . . . . . . . 101-0649 [SB1864 Detail]

Download: Illinois-2019-SB1864-Chaptered.html

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Public Act 101-0649
SB1864 Enrolled LRB101 10924 CPF 56080 b
AN ACT concerning health.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Article 5. Health Care Affordability Act
Section 5-1. Short title. This Article may be cited as the
Health Care Affordability Act. References in this Article to
"this Act" mean this Article.
Section 5-5. Findings. The General Assembly finds that:
(1) The State is committed to improving the health and
well-being of Illinois residents and families.
(2) Illinois has over 835,000 uninsured residents,
with a total uninsured rate of 7.9%.
(3) 774,500 of Illinois' uninsured residents are below
400% of the federal poverty level, with higher uninsured
rates of more than 13% below 250% of the federal poverty
level and an uninsured rate of 8.3% below 400% of the
federal poverty level.
(4) The cost of health insurance premiums remains a
barrier to obtaining health insurance coverage for many
Illinois residents and families.
(5) Many Illinois residents and families who have
health insurance cannot afford to use it due to high

deductibles and cost sharing.
(6) Improving health insurance affordability is key to
increasing health insurance coverage and access.
(7) Despite progress made under the Patient Protection
and Affordable Care Act, health insurance is still not
affordable enough for many Illinois residents and
families.
(8) Illinois has a lower uninsured rate than the
national average of 10.2%, but a higher uninsured rate
compared to states that have state-directed policies to
improve affordability, including Massachusetts with an
uninsured rate of 3.2%.
(9) Illinois has an opportunity to create a healthy
Illinois where health insurance coverage is more
affordable and accessible for all Illinois residents,
families, and small businesses.
Section 5-10. Feasibility study.
(a) The Department of Healthcare and Family Services, in
consultation with the Department of Insurance, shall oversee a
feasibility study to explore options to make health insurance
more affordable for low-income and middle-income residents.
The study shall include policies targeted at increasing health
care affordability and access, including policies being
discussed in other states and nationally. The study shall
follow the best practices of other states and include an

Illinois-specific actuarial and economic analysis of
demographic and market dynamics.
(b) The study shall produce cost estimates for the policies
studied under subsection (a) along with the impact of the
policies on health insurance affordability and access and the
uninsured rates for low-income and middle-income residents,
with break-out data by geography, race, ethnicity, and income
level. The study shall evaluate how multiple policies
implemented together affect costs and outcomes and how policies
could be structured to leverage federal matching funds and
federal pass-through awards.
(c) The Department of Healthcare and Family Services, in
consultation with the Department of Insurance, shall develop
and submit no later than February 28, 2021 a report to the
General Assembly and the Governor concerning the design, costs,
benefits, and implementation of State options to increase
access to affordable health care coverage that leverage
existing State infrastructure.
Article 10. Kidney Disease Prevention and Education Task Force
Act
Section 10-1. Short title. This Article may be cited as the
Kidney Disease Prevention and Education Task Force Act.
References in this Article to "this Act" mean this Article.

Section 10-5. Findings. The General Assembly finds that:
(1) Chronic kidney disease is the 9th-leading cause of
death in the United States. An estimated 31 million people
in the United States have chronic kidney disease and over
1.12 million people in the State of Illinois are living
with the disease. Early chronic kidney disease has no signs
or symptoms and, without early detection, can progress to
kidney failure.
(2) If a person has high blood pressure, heart disease,
diabetes, or a family history of kidney failure, the risk
of kidney disease is greater. In Illinois, 13% of all
adults have diabetes, and 32% have high blood pressure. The
prevalence of diabetes, heart disease, and hypertension is
higher for African Americans, who develop kidney failure at
a rate of nearly 4 to 1 compared to Caucasians, while
Hispanics develop kidney failure at a rate of 2 to 1.
Almost half of the people waiting for a kidney in Illinois
identify as African American, but, in 2017, less than 10%
of them received a kidney.
(3) Although dialysis is a life-extending treatment,
the best and most cost-effective treatment for kidney
failure is a kidney transplant. Currently, the wait in
Illinois for a deceased donor kidney is 5-7 years, and 13
people die while waiting every day.
(4) If chronic kidney disease is detected early and
managed appropriately, the individual can receive

treatment sooner to help protect the kidneys, the
deterioration in kidney function can be slowed or even
stopped, and the risk of associated cardiovascular
complications and other complications can be reduced.
(5) In light of the COVID-19 pandemic and the increased
risk of infection to patients with preexisting conditions,
it is imperative to provide those with kidney disease with
support.
Section 10-10. Kidney Disease Prevention and Education
Task Force.
(a) There is hereby established the Kidney Disease
Prevention and Education Task Force to work directly with
educational institutions to create health education programs
to increase awareness of and to examine chronic kidney disease,
transplantations, living and deceased kidney donation, and the
existing disparity in the rates of those afflicted between
Caucasians and minorities.
(b) The Task Force shall develop a sustainable plan to
raise awareness about early detection, promote health equity,
and reduce the burden of kidney disease throughout the State,
which shall include an ongoing campaign that includes health
education workshops and seminars, relevant research, and
preventive screenings and that promotes social media campaigns
and TV and radio commercials.
(c) Membership of the Task Force shall be as follows:

(1) one member of the Senate, appointed by the Senate
President, who shall serve as Co-Chair;
(2) one member of the House of Representatives,
appointed by the Speaker of the House, who shall serve as
Co-Chair;
(3) one member of the House of Representatives,
appointed by the Minority Leader of the House;
(4) one member of the Senate, appointed by the Senate
Minority Leader;
(5) one member representing the Department of Public
Health, appointed by the Governor;
(6) one member representing the Department of
Healthcare and Family Services, appointed by the Governor;
(7) one member representing a medical center in a
county with a population of more 3 million residents,
appointed by the Co-Chairs;
(8) one member representing a physician's association
in a county with a population of more than 3 million
residents, appointed by the Co-Chairs;
(9) one member representing a not-for-profit organ
procurement organization, appointed by the Co-Chairs;
(10) one member representing a national nonprofit
research kidney organization in the State of Illinois,
appointed by the Co-Chairs; and
(11) the Secretary of State or his or her designee.
(d) Members of the Task Force shall serve without

compensation.
(e) The Department of Public Health shall provide
administrative support to the Task Force.
(f) The Task Force shall submit its final report to the
General Assembly on or before December 31, 2021 and, upon the
filing of its final report, is dissolved.
Section 10-15. Repeal. This Act is repealed on June 1,
2022.
Article 90. Amendatory Provisions
Section 90-5. The Freedom of Information Act is amended by
changing Section 7.5 as follows:
(5 ILCS 140/7.5)
Sec. 7.5. Statutory exemptions. To the extent provided for
by the statutes referenced below, the following shall be exempt
from inspection and copying:
(a) All information determined to be confidential
under Section 4002 of the Technology Advancement and
Development Act.
(b) Library circulation and order records identifying
library users with specific materials under the Library
Records Confidentiality Act.
(c) Applications, related documents, and medical

records received by the Experimental Organ Transplantation
Procedures Board and any and all documents or other records
prepared by the Experimental Organ Transplantation
Procedures Board or its staff relating to applications it
has received.
(d) Information and records held by the Department of
Public Health and its authorized representatives relating
to known or suspected cases of sexually transmissible
disease or any information the disclosure of which is
restricted under the Illinois Sexually Transmissible
Disease Control Act.
(e) Information the disclosure of which is exempted
under Section 30 of the Radon Industry Licensing Act.
(f) Firm performance evaluations under Section 55 of
the Architectural, Engineering, and Land Surveying
Qualifications Based Selection Act.
(g) Information the disclosure of which is restricted
and exempted under Section 50 of the Illinois Prepaid
Tuition Act.
(h) Information the disclosure of which is exempted
under the State Officials and Employees Ethics Act, and
records of any lawfully created State or local inspector
general's office that would be exempt if created or
obtained by an Executive Inspector General's office under
that Act.
(i) Information contained in a local emergency energy

plan submitted to a municipality in accordance with a local
emergency energy plan ordinance that is adopted under
Section 11-21.5-5 of the Illinois Municipal Code.
(j) Information and data concerning the distribution
of surcharge moneys collected and remitted by carriers
under the Emergency Telephone System Act.
(k) Law enforcement officer identification information
or driver identification information compiled by a law
enforcement agency or the Department of Transportation
under Section 11-212 of the Illinois Vehicle Code.
(l) Records and information provided to a residential
health care facility resident sexual assault and death
review team or the Executive Council under the Abuse
Prevention Review Team Act.
(m) Information provided to the predatory lending
database created pursuant to Article 3 of the Residential
Real Property Disclosure Act, except to the extent
authorized under that Article.
(n) Defense budgets and petitions for certification of
compensation and expenses for court appointed trial
counsel as provided under Sections 10 and 15 of the Capital
Crimes Litigation Act. This subsection (n) shall apply
until the conclusion of the trial of the case, even if the
prosecution chooses not to pursue the death penalty prior
to trial or sentencing.
(o) Information that is prohibited from being

disclosed under Section 4 of the Illinois Health and
Hazardous Substances Registry Act.
(p) Security portions of system safety program plans,
investigation reports, surveys, schedules, lists, data, or
information compiled, collected, or prepared by or for the
Regional Transportation Authority under Section 2.11 of
the Regional Transportation Authority Act or the St. Clair
County Transit District under the Bi-State Transit Safety
Act.
(q) Information prohibited from being disclosed by the
Personnel Record Review Act.
(r) Information prohibited from being disclosed by the
Illinois School Student Records Act.
(s) Information the disclosure of which is restricted
under Section 5-108 of the Public Utilities Act.
(t) All identified or deidentified health information
in the form of health data or medical records contained in,
stored in, submitted to, transferred by, or released from
the Illinois Health Information Exchange, and identified
or deidentified health information in the form of health
data and medical records of the Illinois Health Information
Exchange in the possession of the Illinois Health
Information Exchange Office Authority due to its
administration of the Illinois Health Information
Exchange. The terms "identified" and "deidentified" shall
be given the same meaning as in the Health Insurance

Portability and Accountability Act of 1996, Public Law
104-191, or any subsequent amendments thereto, and any
regulations promulgated thereunder.
(u) Records and information provided to an independent
team of experts under the Developmental Disability and
Mental Health Safety Act (also known as Brian's Law).
(v) Names and information of people who have applied
for or received Firearm Owner's Identification Cards under
the Firearm Owners Identification Card Act or applied for
or received a concealed carry license under the Firearm
Concealed Carry Act, unless otherwise authorized by the
Firearm Concealed Carry Act; and databases under the
Firearm Concealed Carry Act, records of the Concealed Carry
Licensing Review Board under the Firearm Concealed Carry
Act, and law enforcement agency objections under the
Firearm Concealed Carry Act.
(w) Personally identifiable information which is
exempted from disclosure under subsection (g) of Section
19.1 of the Toll Highway Act.
(x) Information which is exempted from disclosure
under Section 5-1014.3 of the Counties Code or Section
8-11-21 of the Illinois Municipal Code.
(y) Confidential information under the Adult
Protective Services Act and its predecessor enabling
statute, the Elder Abuse and Neglect Act, including
information about the identity and administrative finding

against any caregiver of a verified and substantiated
decision of abuse, neglect, or financial exploitation of an
eligible adult maintained in the Registry established
under Section 7.5 of the Adult Protective Services Act.
(z) Records and information provided to a fatality
review team or the Illinois Fatality Review Team Advisory
Council under Section 15 of the Adult Protective Services
Act.
(aa) Information which is exempted from disclosure
under Section 2.37 of the Wildlife Code.
(bb) Information which is or was prohibited from
disclosure by the Juvenile Court Act of 1987.
(cc) Recordings made under the Law Enforcement
Officer-Worn Body Camera Act, except to the extent
authorized under that Act.
(dd) Information that is prohibited from being
disclosed under Section 45 of the Condominium and Common
Interest Community Ombudsperson Act.
(ee) Information that is exempted from disclosure
under Section 30.1 of the Pharmacy Practice Act.
(ff) Information that is exempted from disclosure
under the Revised Uniform Unclaimed Property Act.
(gg) Information that is prohibited from being
disclosed under Section 7-603.5 of the Illinois Vehicle
Code.
(hh) Records that are exempt from disclosure under

Section 1A-16.7 of the Election Code.
(ii) Information which is exempted from disclosure
under Section 2505-800 of the Department of Revenue Law of
the Civil Administrative Code of Illinois.
(jj) Information and reports that are required to be
submitted to the Department of Labor by registering day and
temporary labor service agencies but are exempt from
disclosure under subsection (a-1) of Section 45 of the Day
and Temporary Labor Services Act.
(kk) Information prohibited from disclosure under the
Seizure and Forfeiture Reporting Act.
(ll) Information the disclosure of which is restricted
and exempted under Section 5-30.8 of the Illinois Public
Aid Code.
(mm) Records that are exempt from disclosure under
Section 4.2 of the Crime Victims Compensation Act.
(nn) Information that is exempt from disclosure under
Section 70 of the Higher Education Student Assistance Act.
(oo) Communications, notes, records, and reports
arising out of a peer support counseling session prohibited
from disclosure under the First Responders Suicide
Prevention Act.
(pp) Names and all identifying information relating to
an employee of an emergency services provider or law
enforcement agency under the First Responders Suicide
Prevention Act.

(qq) Information and records held by the Department of
Public Health and its authorized representatives collected
under the Reproductive Health Act.
(rr) Information that is exempt from disclosure under
the Cannabis Regulation and Tax Act.
(ss) Data reported by an employer to the Department of
Human Rights pursuant to Section 2-108 of the Illinois
Human Rights Act.
(tt) Recordings made under the Children's Advocacy
Center Act, except to the extent authorized under that Act.
(uu) Information that is exempt from disclosure under
Section 50 of the Sexual Assault Evidence Submission Act.
(vv) Information that is exempt from disclosure under
subsections (f) and (j) of Section 5-36 of the Illinois
Public Aid Code.
(ww) Information that is exempt from disclosure under
Section 16.8 of the State Treasurer Act.
(xx) Information that is exempt from disclosure or
information that shall not be made public under the
Illinois Insurance Code.
(yy) (oo) Information prohibited from being disclosed
under the Illinois Educational Labor Relations Act.
(zz) (pp) Information prohibited from being disclosed
under the Illinois Public Labor Relations Act.
(aaa) (qq) Information prohibited from being disclosed
under Section 1-167 of the Illinois Pension Code.

(Source: P.A. 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
8-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517,
eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19;
100-863, eff. 8-14-18; 100-887, eff. 8-14-18; 101-13, eff.
6-12-19; 101-27, eff. 6-25-19; 101-81, eff. 7-12-19; 101-221,
eff. 1-1-20; 101-236, eff. 1-1-20; 101-375, eff. 8-16-19;
101-377, eff. 8-16-19; 101-452, eff. 1-1-20; 101-466, eff.
1-1-20; 101-600, eff. 12-6-19; 101-620, eff 12-20-19; revised
1-6-20.)
Section 90-10. The Illinois Health Information Exchange
and Technology Act is amended by changing Sections 10, 20, 25,
30, 35, and 40, as follows:
(20 ILCS 3860/10)
(Section scheduled to be repealed on January 1, 2021)
Sec. 10. Creation of the Health Information Exchange Office
Authority. There is hereby created the Illinois Health
Information Exchange Office ("Office") Authority
("Authority"), which is hereby constituted as an
instrumentality and an administrative agency of the State of
Illinois.
As part of its program to promote, develop, and sustain
health information exchange at the State level, the Office
Authority shall do the following:

(1) Establish the Illinois Health Information Exchange
("ILHIE"), to promote and facilitate the sharing of health
information among health care providers within Illinois
and in other states. ILHIE shall be an entity operated by
the Office Authority to serve as a State-level electronic
medical records exchange providing for the transfer of
health information, medical records, and other health data
in a secure environment for the benefit of patient care,
patient safety, reduction of duplicate medical tests,
reduction of administrative costs, and any other benefits
deemed appropriate by the Office Authority.
(2) Foster the widespread adoption of electronic
health records and participation in the ILHIE.
(Source: P.A. 96-1331, eff. 7-27-10.)
(20 ILCS 3860/20)
(Section scheduled to be repealed on January 1, 2021)
Sec. 20. Powers and duties of the Illinois Health
Information Exchange Office Authority. The Office Authority
has the following powers, together with all powers incidental
or necessary to accomplish the purposes of this Act:
(1) The Office Authority shall create and administer
the ILHIE using information systems and processes that are
secure, are cost effective, and meet all other relevant
privacy and security requirements under State and federal
law.

(2) The Office Authority shall establish and adopt
standards and requirements for the use of health
information and the requirements for participation in the
ILHIE by persons or entities including, but not limited to,
health care providers, payors, and local health
information exchanges.
(3) The Office Authority shall establish minimum
standards for accessing the ILHIE to ensure that the
appropriate security and privacy protections apply to
health information, consistent with applicable federal and
State standards and laws. The Office Authority shall have
the power to suspend, limit, or terminate the right to
participate in the ILHIE for non-compliance or failure to
act, with respect to applicable standards and laws, in the
best interests of patients, users of the ILHIE, or the
public. The Office Authority may seek all remedies allowed
by law to address any violation of the terms of
participation in the ILHIE.
(4) The Office Authority shall identify barriers to the
adoption of electronic health records systems, including
researching the rates and patterns of dissemination and use
of electronic health record systems throughout the State.
The Office Authority shall make the results of the research
available on the Department of Healthcare and Family
Services' website its website.
(5) The Office Authority shall prepare educational

materials and educate the general public on the benefits of
electronic health records, the ILHIE, and the safeguards
available to prevent unauthorized disclosure of health
information.
(6) The Office Authority may appoint or designate an
institutional review board in accordance with federal and
State law to review and approve requests for research in
order to ensure compliance with standards and patient
privacy and security protections as specified in paragraph
(3) of this Section.
(7) The Office Authority may enter into all contracts
and agreements necessary or incidental to the performance
of its powers under this Act. The Office's Authority's
expenditures of private funds are exempt from the Illinois
Procurement Code, pursuant to Section 1-10 of that Act.
Notwithstanding this exception, the Office Authority shall
comply with the Business Enterprise for Minorities, Women,
and Persons with Disabilities Act.
(8) The Office Authority may solicit and accept grants,
loans, contributions, or appropriations from any public or
private source and may expend those moneys, through
contracts, grants, loans, or agreements, on activities it
considers suitable to the performance of its duties under
this Act.
(9) The Office Authority may determine, charge, and
collect any fees, charges, costs, and expenses from any

healthcare provider or entity in connection with its duties
under this Act. Moneys collected under this paragraph (9)
shall be deposited into the Health Information Exchange
Fund.
(10) The Office Authority may, under the direction of
the Executive Director, employ and discharge staff,
including administrative, technical, expert, professional,
and legal staff, as is necessary or convenient to carry out
the purposes of this Act and as authorized by the Personnel
Code. The Authority may establish and administer standards
of classification regarding compensation, benefits,
duties, performance, and tenure for that staff and may
enter into contracts of employment with members of that
staff for such periods and on such terms as the Authority
deems desirable. All employees of the Authority are exempt
from the Personnel Code as provided by Section 4 of the
Personnel Code.
(10.5) Staff employed by the Illinois Health
Information Exchange Authority on the effective date of
this amendatory Act of the 101st General Assembly shall
transfer to the Office within the Department of Healthcare
and Family Services.
(10.6) The status and rights of employees transferring
from the Illinois Health Information Exchange Authority
under paragraph (10.5) shall not be affected by such
transfer except that, notwithstanding any other State law

to the contrary, those employees shall maintain their
seniority and their positions shall convert to titles of
comparable organizational level under the Personnel Code
and become subject to the Personnel Code. Other than the
changes described in this paragraph, the rights of
employees, the State of Illinois, and State agencies under
the Personnel Code or under any pension, retirement, or
annuity plan shall not be affected by this amendatory Act
of the 101st General Assembly. Transferring personnel
shall continue their service within the Office.
(11) The Office Authority shall consult and coordinate
with the Department of Public Health to further the
Office's Authority's collection of health information from
health care providers for public health purposes. The
collection of public health information shall include
identifiable information for use by the Office Authority or
other State agencies to comply with State and federal laws.
Any identifiable information so collected shall be
privileged and confidential in accordance with Sections
8-2101, 8-2102, 8-2103, 8-2104, and 8-2105 of the Code of
Civil Procedure.
(12) All identified or deidentified health information
in the form of health data or medical records contained in,
stored in, submitted to, transferred by, or released from
the Illinois Health Information Exchange, and identified
or deidentified health information in the form of health

data and medical records of the Illinois Health Information
Exchange in the possession of the Illinois Health
Information Exchange Office Authority due to its
administration of the Illinois Health Information
Exchange, shall be exempt from inspection and copying under
the Freedom of Information Act. The terms "identified" and
"deidentified" shall be given the same meaning as in the
Health Insurance Portability and Accountability Act of
1996, Public Law 104-191, or any subsequent amendments
thereto, and any regulations promulgated thereunder.
(13) To address gaps in the adoption of, workforce
preparation for, and exchange of electronic health records
that result in regional and socioeconomic disparities in
the delivery of care, the Office Authority may evaluate
such gaps and provide resources as available, giving
priority to healthcare providers serving a significant
percentage of Medicaid or uninsured patients and in
medically underserved or rural areas.
(14) The Office shall perform its duties under this Act
in consultation with the Office of the Governor and with
the Departments of Public Health, Insurance, and Human
Services.
(Source: P.A. 99-642, eff. 7-28-16; 100-391, eff. 8-25-17.)
(20 ILCS 3860/25)
(Section scheduled to be repealed on January 1, 2021)

Sec. 25. Health Information Exchange Fund.
(a) The Health Information Exchange Fund (the "Fund") is
created as a separate fund outside the State treasury. Moneys
in the Fund are not subject to appropriation by the General
Assembly. The State Treasurer shall be ex-officio custodian of
the Fund. Revenues arising from the operation and
administration of the Office Authority and the ILHIE shall be
deposited into the Fund. Fees, charges, State and federal
moneys, grants, donations, gifts, interest, or other moneys
shall be deposited into the Fund. "Private funds" means gifts,
donations, and private grants.
(b) The Office Authority is authorized to spend moneys in
the Fund on activities suitable to the performance of its
duties as provided in Section 20 of this Act and authorized by
this Act. Disbursements may be made from the Fund for purposes
related to the operations and functions of the Office Authority
and the ILHIE.
(c) The Illinois General Assembly may appropriate moneys to
the Office Authority and the ILHIE, and those moneys shall be
deposited into the Fund.
(d) The Fund is not subject to administrative charges or
charge-backs, including but not limited to those authorized
under Section 8h of the State Finance Act.
(e) The Office's Authority's accounts and books shall be
set up and maintained in accordance with the Office of the
Comptroller's requirements, and the Authority's Executive

Director of the Department of Healthcare and Family Services
shall be responsible for the approval of recording of receipts,
approval of payments, and proper filing of required reports.
The moneys held and made available by the Office Authority
shall be subject to financial and compliance audits by the
Auditor General in compliance with the Illinois State Auditing
Act.
(Source: P.A. 96-1331, eff. 7-27-10.)
(20 ILCS 3860/30)
(Section scheduled to be repealed on January 1, 2021)
Sec. 30. Participation in health information systems
maintained by State agencies.
(a) By no later than January 1, 2015, each State agency
that implements, acquires, or upgrades health information
technology systems shall use health information technology
systems and products that meet minimum standards adopted by the
Office Authority for accessing the ILHIE. State agencies that
have health information which supports and develops the ILHIE
shall provide access to patient-specific data to complete the
patient record at the ILHIE. Notwithstanding any other
provision of State law, the State agencies shall provide
patient-specific data to the ILHIE.
(b) Participation in the ILHIE shall have no impact on the
content of or use or disclosure of health information of
patient participants that is held in locations other than the

ILHIE. Nothing in this Act shall limit or change an entity's
obligation to exchange health information in accordance with
applicable federal and State laws and standards.
(Source: P.A. 96-1331, eff. 7-27-10.)
(20 ILCS 3860/35)
(Section scheduled to be repealed on January 1, 2021)
Sec. 35. Illinois Administrative Procedure Act. The
provisions of the Illinois Administrative Procedure Act are
hereby expressly adopted and shall apply to all administrative
rules and procedures of the Office Authority, except that
Section 5-35 of the Illinois Administrative Procedure Act
relating to procedures for rulemaking does not apply to the
adoption of any rule required by federal law when the Office
Authority is precluded by that law from exercising any
discretion regarding that rule.
(Source: P.A. 96-1331, eff. 7-27-10.)
(20 ILCS 3860/40)
(Section scheduled to be repealed on January 1, 2021)
Sec. 40. Reliance on data. Any health care provider who
relies in good faith upon any information provided through the
ILHIE in his, her, or its treatment of a patient shall be
immune from criminal or civil liability or professional
discipline arising from any damages caused by such good faith
reliance. This immunity does not apply to acts or omissions

constituting gross negligence or reckless, wanton, or
intentional misconduct. Notwithstanding this provision, the
Office Authority does not waive any immunities provided under
State or federal law.
(Source: P.A. 98-1046, eff. 1-1-15.)
(20 ILCS 3860/15 rep.)
Section 90-15. The Illinois Health Information Exchange
and Technology Act is amended by repealing Section 15.
Section 90-20. The Children's Health Insurance Program Act
is amended by changing Section 7 and by adding Section 8 as
follows:
(215 ILCS 106/7)
Sec. 7. Eligibility verification. Notwithstanding any
other provision of this Act, with respect to applications for
benefits provided under the Program, eligibility shall be
determined in a manner that ensures program integrity and that
complies with federal law and regulations while minimizing
unnecessary barriers to enrollment. To this end, as soon as
practicable, and unless the Department receives written denial
from the federal government, this Section shall be implemented:
(a) The Department of Healthcare and Family Services or its
designees shall:
(1) By no later than July 1, 2011, require verification

of, at a minimum, one month's income from all sources
required for determining the eligibility of applicants to
the Program. Such verification shall take the form of pay
stubs, business or income and expense records for
self-employed persons, letters from employers, and any
other valid documentation of income including data
obtained electronically by the Department or its designees
from other sources as described in subsection (b) of this
Section. A month's income may be verified by a single pay
stub with the monthly income extrapolated from the time
period covered by the pay stub.
(2) By no later than October 1, 2011, require
verification of, at a minimum, one month's income from all
sources required for determining the continued eligibility
of recipients at their annual review of eligibility under
the Program. Such verification shall take the form of pay
stubs, business or income and expense records for
self-employed persons, letters from employers, and any
other valid documentation of income including data
obtained electronically by the Department or its designees
from other sources as described in subsection (b) of this
Section. A month's income may be verified by a single pay
stub with the monthly income extrapolated from the time
period covered by the pay stub. The Department shall send a
notice to the recipient at least 60 days prior to the end
of the period of eligibility that informs them of the

requirements for continued eligibility. Information the
Department receives prior to the annual review, including
information available to the Department as a result of the
recipient's application for other non-health care
benefits, that is sufficient to make a determination of
continued eligibility for medical assistance or for
benefits provided under the Program may be reviewed and
verified, and subsequent action taken including client
notification of continued eligibility for medical
assistance or for benefits provided under the Program. The
date of client notification establishes the date for
subsequent annual eligibility reviews. If a recipient does
not fulfill the requirements for continued eligibility by
the deadline established in the notice, a notice of
cancellation shall be issued to the recipient and coverage
shall end no later than the last day of the month following
the last day of the eligibility period. A recipient's
eligibility may be reinstated without requiring a new
application if the recipient fulfills the requirements for
continued eligibility prior to the end of the third month
following the last date of coverage (or longer period if
required by federal regulations). Nothing in this Section
shall prevent an individual whose coverage has been
cancelled from reapplying for health benefits at any time.
(3) By no later than July 1, 2011, require verification
of Illinois residency.

(b) The Department shall establish or continue cooperative
arrangements with the Social Security Administration, the
Illinois Secretary of State, the Department of Human Services,
the Department of Revenue, the Department of Employment
Security, and any other appropriate entity to gain electronic
access, to the extent allowed by law, to information available
to those entities that may be appropriate for electronically
verifying any factor of eligibility for benefits under the
Program. Data relevant to eligibility shall be provided for no
other purpose than to verify the eligibility of new applicants
or current recipients of health benefits under the Program.
Data will be requested or provided for any new applicant or
current recipient only insofar as that individual's
circumstances are relevant to that individual's or another
individual's eligibility.
(c) Within 90 days of the effective date of this amendatory
Act of the 96th General Assembly, the Department of Healthcare
and Family Services shall send notice to current recipients
informing them of the changes regarding their eligibility
verification.
(Source: P.A. 101-209, eff. 8-5-19.)
(215 ILCS 106/8 new)
Sec. 8. COVID-19 public health emergency. Notwithstanding
any other provision of this Act, the Department may take
necessary actions to address the COVID-19 public health

emergency to the extent such actions are required, approved, or
authorized by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services. Such
actions may continue throughout the public health emergency and
for up to 12 months after the period ends, and may include, but
are not limited to: accepting an applicant's or recipient's
attestation of income, incurred medical expenses, residency,
and insured status when electronic verification is not
available; eliminating resource tests for some eligibility
determinations; suspending redeterminations; suspending
changes that would adversely affect an applicant's or
recipient's eligibility; phone or verbal approval by an
applicant to submit an application in lieu of applicant
signature; allowing adult presumptive eligibility; allowing
presumptive eligibility for children, pregnant women, and
adults as often as twice per calendar year; paying for
additional services delivered by telehealth; and suspending
premium and co-payment requirements.
The Department's authority under this Section shall only
extend to encompass, incorporate, or effectuate the terms,
items, conditions, and other provisions approved, authorized,
or required by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services, and shall
not extend beyond the time of the COVID-19 public health
emergency and up to 12 months after the period expires.

Section 90-25. The Covering ALL KIDS Health Insurance Act
is amended by changing Section 7 and by adding Section 8 as
follows:
(215 ILCS 170/7)
(Section scheduled to be repealed on October 1, 2024)
Sec. 7. Eligibility verification. Notwithstanding any
other provision of this Act, with respect to applications for
benefits provided under the Program, eligibility shall be
determined in a manner that ensures program integrity and that
complies with federal law and regulations while minimizing
unnecessary barriers to enrollment. To this end, as soon as
practicable, and unless the Department receives written denial
from the federal government, this Section shall be implemented:
(a) The Department of Healthcare and Family Services or its
designees shall:
(1) By July 1, 2011, require verification of, at a
minimum, one month's income from all sources required for
determining the eligibility of applicants to the Program.
Such verification shall take the form of pay stubs,
business or income and expense records for self-employed
persons, letters from employers, and any other valid
documentation of income including data obtained
electronically by the Department or its designees from
other sources as described in subsection (b) of this
Section. A month's income may be verified by a single pay

stub with the monthly income extrapolated from the time
period covered by the pay stub.
(2) By October 1, 2011, require verification of, at a
minimum, one month's income from all sources required for
determining the continued eligibility of recipients at
their annual review of eligibility under the Program. Such
verification shall take the form of pay stubs, business or
income and expense records for self-employed persons,
letters from employers, and any other valid documentation
of income including data obtained electronically by the
Department or its designees from other sources as described
in subsection (b) of this Section. A month's income may be
verified by a single pay stub with the monthly income
extrapolated from the time period covered by the pay stub.
The Department shall send a notice to recipients at least
60 days prior to the end of their period of eligibility
that informs them of the requirements for continued
eligibility. Information the Department receives prior to
the annual review, including information available to the
Department as a result of the recipient's application for
other non-health care benefits, that is sufficient to make
a determination of continued eligibility for benefits
provided under this Act, the Children's Health Insurance
Program Act, or Article V of the Illinois Public Aid Code
may be reviewed and verified, and subsequent action taken
including client notification of continued eligibility for

benefits provided under this Act, the Children's Health
Insurance Program Act, or Article V of the Illinois Public
Aid Code. The date of client notification establishes the
date for subsequent annual eligibility reviews. If a
recipient does not fulfill the requirements for continued
eligibility by the deadline established in the notice, a
notice of cancellation shall be issued to the recipient and
coverage shall end no later than the last day of the month
following the last day of the eligibility period. A
recipient's eligibility may be reinstated without
requiring a new application if the recipient fulfills the
requirements for continued eligibility prior to the end of
the third month following the last date of coverage (or
longer period if required by federal regulations). Nothing
in this Section shall prevent an individual whose coverage
has been cancelled from reapplying for health benefits at
any time.
(3) By July 1, 2011, require verification of Illinois
residency.
(b) The Department shall establish or continue cooperative
arrangements with the Social Security Administration, the
Illinois Secretary of State, the Department of Human Services,
the Department of Revenue, the Department of Employment
Security, and any other appropriate entity to gain electronic
access, to the extent allowed by law, to information available
to those entities that may be appropriate for electronically

verifying any factor of eligibility for benefits under the
Program. Data relevant to eligibility shall be provided for no
other purpose than to verify the eligibility of new applicants
or current recipients of health benefits under the Program.
Data will be requested or provided for any new applicant or
current recipient only insofar as that individual's
circumstances are relevant to that individual's or another
individual's eligibility.
(c) Within 90 days of the effective date of this amendatory
Act of the 96th General Assembly, the Department of Healthcare
and Family Services shall send notice to current recipients
informing them of the changes regarding their eligibility
verification.
(Source: P.A. 101-209, eff. 8-5-19.)
(215 ILCS 170/8 new)
Sec. 8. COVID-19 public health emergency. Notwithstanding
any other provision of this Act, the Department may take
necessary actions to address the COVID-19 public health
emergency to the extent such actions are required, approved, or
authorized by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services. Such
actions may continue throughout the public health emergency and
for up to 12 months after the period ends, and may include, but
are not limited to: accepting an applicant's or recipient's
attestation of income, incurred medical expenses, residency,

and insured status when electronic verification is not
available; eliminating resource tests for some eligibility
determinations; suspending redeterminations; suspending
changes that would adversely affect an applicant's or
recipient's eligibility; phone or verbal approval by an
applicant to submit an application in lieu of applicant
signature; allowing adult presumptive eligibility; allowing
presumptive eligibility for children, pregnant women, and
adults as often as twice per calendar year; paying for
additional services delivered by telehealth; and suspending
premium and co-payment requirements.
The Department's authority under this Section shall only
extend to encompass, incorporate, or effectuate the terms,
items, conditions, and other provisions approved, authorized,
or required by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services, and shall
not extend beyond the time of the COVID-19 public health
emergency and up to 12 months after the period expires.
Section 90-30. The Pharmacy Practice Act is amended by
adding Section 39.5 as follows:
(225 ILCS 85/39.5 new)
Sec. 39.5. Emergency kits.
(a) As used in this Section:
"Emergency kit" means a kit containing drugs that may be

required to meet the immediate therapeutic needs of a patient
and that are not available from any other source in sufficient
time to prevent the risk of harm to a patient by delay
resulting from obtaining the drugs from another source. An
automated dispensing and storage system may be used as an
emergency kit.
"Licensed facility" means an entity licensed under the
Nursing Home Care Act, the Hospital Licensing Act, or the
University of Illinois Hospital Act or a facility licensed
under the Illinois Department of Human Services, Division of
Substance Use Prevention and Recovery, for the prevention,
intervention, treatment, and recovery support of substance use
disorders or certified by the Illinois Department of Human
Services, Division of Mental Health for the treatment of mental
health.
"Offsite institutional pharmacy" means: (1) a pharmacy
that is not located in facilities it serves and whose primary
purpose is to provide services to patients or residents of
facilities licensed under the Nursing Home Care Act, the
Hospital Licensing Act, or the University of Illinois Hospital
Act; and (2) a pharmacy that is not located in the facilities
it serves and the facilities it serves are licensed under the
Illinois Department of Human Services, Division of Substance
Use Prevention and Recovery, for the prevention, intervention,
treatment, and recovery support of substance use disorders or
for the treatment of mental health.

(b) An offsite institutional pharmacy may supply emergency
kits to a licensed facility.
Section 90-35. The Illinois Public Aid Code is amended by
changing Sections 5-2, 5-4.2, 5-5e, 5-16.8, 5B-4, and 11-5.1
and by adding Sections 5-1.5, 5-5.27 and 12-21.21 as follows:
(305 ILCS 5/5-1.5 new)
Sec. 5-1.5. COVID-19 public health emergency.
Notwithstanding any other provision of Articles V, XI, and XII
of this Code, the Department may take necessary actions to
address the COVID-19 public health emergency to the extent such
actions are required, approved, or authorized by the United
States Department of Health and Human Services, Centers for
Medicare and Medicaid Services. Such actions may continue
throughout the public health emergency and for up to 12 months
after the period ends, and may include, but are not limited to:
accepting an applicant's or recipient's attestation of income,
incurred medical expenses, residency, and insured status when
electronic verification is not available; eliminating resource
tests for some eligibility determinations; suspending
redeterminations; suspending changes that would adversely
affect an applicant's or recipient's eligibility; phone or
verbal approval by an applicant to submit an application in
lieu of applicant signature; allowing adult presumptive
eligibility; allowing presumptive eligibility for children,

pregnant women, and adults as often as twice per calendar year;
paying for additional services delivered by telehealth; and
suspending premium and co-payment requirements.
The Department's authority under this Section shall only
extend to encompass, incorporate, or effectuate the terms,
items, conditions, and other provisions approved, authorized,
or required by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services, and shall
not extend beyond the time of the COVID-19 public health
emergency and up to 12 months after the period expires.
(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
Sec. 5-2. Classes of Persons Eligible.
Medical assistance under this Article shall be available to
any of the following classes of persons in respect to whom a
plan for coverage has been submitted to the Governor by the
Illinois Department and approved by him. If changes made in
this Section 5-2 require federal approval, they shall not take
effect until such approval has been received:
1. Recipients of basic maintenance grants under
Articles III and IV.
2. Beginning January 1, 2014, persons otherwise
eligible for basic maintenance under Article III,
excluding any eligibility requirements that are
inconsistent with any federal law or federal regulation, as
interpreted by the U.S. Department of Health and Human

Services, but who fail to qualify thereunder on the basis
of need, and who have insufficient income and resources to
meet the costs of necessary medical care, including but not
limited to the following:
(a) All persons otherwise eligible for basic
maintenance under Article III but who fail to qualify
under that Article on the basis of need and who meet
either of the following requirements:
(i) their income, as determined by the
Illinois Department in accordance with any federal
requirements, is equal to or less than 100% of the
federal poverty level; or
(ii) their income, after the deduction of
costs incurred for medical care and for other types
of remedial care, is equal to or less than 100% of
the federal poverty level.
(b) (Blank).
3. (Blank).
4. Persons not eligible under any of the preceding
paragraphs who fall sick, are injured, or die, not having
sufficient money, property or other resources to meet the
costs of necessary medical care or funeral and burial
expenses.
5.(a) Beginning January 1, 2020, women during
pregnancy and during the 12-month period beginning on the
last day of the pregnancy, together with their infants,

whose income is at or below 200% of the federal poverty
level. Until September 30, 2019, or sooner if the
maintenance of effort requirements under the Patient
Protection and Affordable Care Act are eliminated or may be
waived before then, women during pregnancy and during the
12-month period beginning on the last day of the pregnancy,
whose countable monthly income, after the deduction of
costs incurred for medical care and for other types of
remedial care as specified in administrative rule, is equal
to or less than the Medical Assistance-No Grant(C)
(MANG(C)) Income Standard in effect on April 1, 2013 as set
forth in administrative rule.
(b) The plan for coverage shall provide ambulatory
prenatal care to pregnant women during a presumptive
eligibility period and establish an income eligibility
standard that is equal to 200% of the federal poverty
level, provided that costs incurred for medical care are
not taken into account in determining such income
eligibility.
(c) The Illinois Department may conduct a
demonstration in at least one county that will provide
medical assistance to pregnant women, together with their
infants and children up to one year of age, where the
income eligibility standard is set up to 185% of the
nonfarm income official poverty line, as defined by the
federal Office of Management and Budget. The Illinois

Department shall seek and obtain necessary authorization
provided under federal law to implement such a
demonstration. Such demonstration may establish resource
standards that are not more restrictive than those
established under Article IV of this Code.
6. (a) Children younger than age 19 when countable
income is at or below 133% of the federal poverty level.
Until September 30, 2019, or sooner if the maintenance of
effort requirements under the Patient Protection and
Affordable Care Act are eliminated or may be waived before
then, children younger than age 19 whose countable monthly
income, after the deduction of costs incurred for medical
care and for other types of remedial care as specified in
administrative rule, is equal to or less than the Medical
Assistance-No Grant(C) (MANG(C)) Income Standard in effect
on April 1, 2013 as set forth in administrative rule.
(b) Children and youth who are under temporary custody
or guardianship of the Department of Children and Family
Services or who receive financial assistance in support of
an adoption or guardianship placement from the Department
of Children and Family Services.
7. (Blank).
8. As required under federal law, persons who are
eligible for Transitional Medical Assistance as a result of
an increase in earnings or child or spousal support
received. The plan for coverage for this class of persons

shall:
(a) extend the medical assistance coverage to the
extent required by federal law; and
(b) offer persons who have initially received 6
months of the coverage provided in paragraph (a) above,
the option of receiving an additional 6 months of
coverage, subject to the following:
(i) such coverage shall be pursuant to
provisions of the federal Social Security Act;
(ii) such coverage shall include all services
covered under Illinois' State Medicaid Plan;
(iii) no premium shall be charged for such
coverage; and
(iv) such coverage shall be suspended in the
event of a person's failure without good cause to
file in a timely fashion reports required for this
coverage under the Social Security Act and
coverage shall be reinstated upon the filing of
such reports if the person remains otherwise
eligible.
9. Persons with acquired immunodeficiency syndrome
(AIDS) or with AIDS-related conditions with respect to whom
there has been a determination that but for home or
community-based services such individuals would require
the level of care provided in an inpatient hospital,
skilled nursing facility or intermediate care facility the

cost of which is reimbursed under this Article. Assistance
shall be provided to such persons to the maximum extent
permitted under Title XIX of the Federal Social Security
Act.
10. Participants in the long-term care insurance
partnership program established under the Illinois
Long-Term Care Partnership Program Act who meet the
qualifications for protection of resources described in
Section 15 of that Act.
11. Persons with disabilities who are employed and
eligible for Medicaid, pursuant to Section
1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
subject to federal approval, persons with a medically
improved disability who are employed and eligible for
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
the Social Security Act, as provided by the Illinois
Department by rule. In establishing eligibility standards
under this paragraph 11, the Department shall, subject to
federal approval:
(a) set the income eligibility standard at not
lower than 350% of the federal poverty level;
(b) exempt retirement accounts that the person
cannot access without penalty before the age of 59 1/2,
and medical savings accounts established pursuant to
26 U.S.C. 220;
(c) allow non-exempt assets up to $25,000 as to

those assets accumulated during periods of eligibility
under this paragraph 11; and
(d) continue to apply subparagraphs (b) and (c) in
determining the eligibility of the person under this
Article even if the person loses eligibility under this
paragraph 11.
12. Subject to federal approval, persons who are
eligible for medical assistance coverage under applicable
provisions of the federal Social Security Act and the
federal Breast and Cervical Cancer Prevention and
Treatment Act of 2000. Those eligible persons are defined
to include, but not be limited to, the following persons:
(1) persons who have been screened for breast or
cervical cancer under the U.S. Centers for Disease
Control and Prevention Breast and Cervical Cancer
Program established under Title XV of the federal
Public Health Services Act in accordance with the
requirements of Section 1504 of that Act as
administered by the Illinois Department of Public
Health; and
(2) persons whose screenings under the above
program were funded in whole or in part by funds
appropriated to the Illinois Department of Public
Health for breast or cervical cancer screening.
"Medical assistance" under this paragraph 12 shall be
identical to the benefits provided under the State's

approved plan under Title XIX of the Social Security Act.
The Department must request federal approval of the
coverage under this paragraph 12 within 30 days after the
effective date of this amendatory Act of the 92nd General
Assembly.
In addition to the persons who are eligible for medical
assistance pursuant to subparagraphs (1) and (2) of this
paragraph 12, and to be paid from funds appropriated to the
Department for its medical programs, any uninsured person
as defined by the Department in rules residing in Illinois
who is younger than 65 years of age, who has been screened
for breast and cervical cancer in accordance with standards
and procedures adopted by the Department of Public Health
for screening, and who is referred to the Department by the
Department of Public Health as being in need of treatment
for breast or cervical cancer is eligible for medical
assistance benefits that are consistent with the benefits
provided to those persons described in subparagraphs (1)
and (2). Medical assistance coverage for the persons who
are eligible under the preceding sentence is not dependent
on federal approval, but federal moneys may be used to pay
for services provided under that coverage upon federal
approval.
13. Subject to appropriation and to federal approval,
persons living with HIV/AIDS who are not otherwise eligible
under this Article and who qualify for services covered

under Section 5-5.04 as provided by the Illinois Department
by rule.
14. Subject to the availability of funds for this
purpose, the Department may provide coverage under this
Article to persons who reside in Illinois who are not
eligible under any of the preceding paragraphs and who meet
the income guidelines of paragraph 2(a) of this Section and
(i) have an application for asylum pending before the
federal Department of Homeland Security or on appeal before
a court of competent jurisdiction and are represented
either by counsel or by an advocate accredited by the
federal Department of Homeland Security and employed by a
not-for-profit organization in regard to that application
or appeal, or (ii) are receiving services through a
federally funded torture treatment center. Medical
coverage under this paragraph 14 may be provided for up to
24 continuous months from the initial eligibility date so
long as an individual continues to satisfy the criteria of
this paragraph 14. If an individual has an appeal pending
regarding an application for asylum before the Department
of Homeland Security, eligibility under this paragraph 14
may be extended until a final decision is rendered on the
appeal. The Department may adopt rules governing the
implementation of this paragraph 14.
15. Family Care Eligibility.
(a) On and after July 1, 2012, a parent or other

caretaker relative who is 19 years of age or older when
countable income is at or below 133% of the federal
poverty level. A person may not spend down to become
eligible under this paragraph 15.
(b) Eligibility shall be reviewed annually.
(c) (Blank).
(d) (Blank).
(e) (Blank).
(f) (Blank).
(g) (Blank).
(h) (Blank).
(i) Following termination of an individual's
coverage under this paragraph 15, the individual must
be determined eligible before the person can be
re-enrolled.
16. Subject to appropriation, uninsured persons who
are not otherwise eligible under this Section who have been
certified and referred by the Department of Public Health
as having been screened and found to need diagnostic
evaluation or treatment, or both diagnostic evaluation and
treatment, for prostate or testicular cancer. For the
purposes of this paragraph 16, uninsured persons are those
who do not have creditable coverage, as defined under the
Health Insurance Portability and Accountability Act, or
have otherwise exhausted any insurance benefits they may
have had, for prostate or testicular cancer diagnostic

evaluation or treatment, or both diagnostic evaluation and
treatment. To be eligible, a person must furnish a Social
Security number. A person's assets are exempt from
consideration in determining eligibility under this
paragraph 16. Such persons shall be eligible for medical
assistance under this paragraph 16 for so long as they need
treatment for the cancer. A person shall be considered to
need treatment if, in the opinion of the person's treating
physician, the person requires therapy directed toward
cure or palliation of prostate or testicular cancer,
including recurrent metastatic cancer that is a known or
presumed complication of prostate or testicular cancer and
complications resulting from the treatment modalities
themselves. Persons who require only routine monitoring
services are not considered to need treatment. "Medical
assistance" under this paragraph 16 shall be identical to
the benefits provided under the State's approved plan under
Title XIX of the Social Security Act. Notwithstanding any
other provision of law, the Department (i) does not have a
claim against the estate of a deceased recipient of
services under this paragraph 16 and (ii) does not have a
lien against any homestead property or other legal or
equitable real property interest owned by a recipient of
services under this paragraph 16.
17. Persons who, pursuant to a waiver approved by the
Secretary of the U.S. Department of Health and Human

Services, are eligible for medical assistance under Title
XIX or XXI of the federal Social Security Act.
Notwithstanding any other provision of this Code and
consistent with the terms of the approved waiver, the
Illinois Department, may by rule:
(a) Limit the geographic areas in which the waiver
program operates.
(b) Determine the scope, quantity, duration, and
quality, and the rate and method of reimbursement, of
the medical services to be provided, which may differ
from those for other classes of persons eligible for
assistance under this Article.
(c) Restrict the persons' freedom in choice of
providers.
18. Beginning January 1, 2014, persons aged 19 or
older, but younger than 65, who are not otherwise eligible
for medical assistance under this Section 5-2, who qualify
for medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) and applicable federal
regulations, and who have income at or below 133% of the
federal poverty level plus 5% for the applicable family
size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
applicable federal regulations. Persons eligible for
medical assistance under this paragraph 18 shall receive
coverage for the Health Benefits Service Package as that
term is defined in subsection (m) of Section 5-1.1 of this

Code. If Illinois' federal medical assistance percentage
(FMAP) is reduced below 90% for persons eligible for
medical assistance under this paragraph 18, eligibility
under this paragraph 18 shall cease no later than the end
of the third month following the month in which the
reduction in FMAP takes effect.
19. Beginning January 1, 2014, as required under 42
U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
and younger than age 26 who are not otherwise eligible for
medical assistance under paragraphs (1) through (17) of
this Section who (i) were in foster care under the
responsibility of the State on the date of attaining age 18
or on the date of attaining age 21 when a court has
continued wardship for good cause as provided in Section
2-31 of the Juvenile Court Act of 1987 and (ii) received
medical assistance under the Illinois Title XIX State Plan
or waiver of such plan while in foster care.
20. Beginning January 1, 2018, persons who are
foreign-born victims of human trafficking, torture, or
other serious crimes as defined in Section 2-19 of this
Code and their derivative family members if such persons:
(i) reside in Illinois; (ii) are not eligible under any of
the preceding paragraphs; (iii) meet the income guidelines
of subparagraph (a) of paragraph 2; and (iv) meet the
nonfinancial eligibility requirements of Sections 16-2,
16-3, and 16-5 of this Code. The Department may extend

medical assistance for persons who are foreign-born
victims of human trafficking, torture, or other serious
crimes whose medical assistance would be terminated
pursuant to subsection (b) of Section 16-5 if the
Department determines that the person, during the year of
initial eligibility (1) experienced a health crisis, (2)
has been unable, after reasonable attempts, to obtain
necessary information from a third party, or (3) has other
extenuating circumstances that prevented the person from
completing his or her application for status. The
Department may adopt any rules necessary to implement the
provisions of this paragraph.
21. Persons who are not otherwise eligible for medical
assistance under this Section who may qualify for medical
assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
duration of any federal or State declared emergency due to
COVID-19. Medical assistance to persons eligible for
medical assistance solely pursuant to this paragraph 21
shall be limited to any in vitro diagnostic product (and
the administration of such product) described in 42 U.S.C.
1396d(a)(3)(B) on or after March 18, 2020, any visit
described in 42 U.S.C. 1396o(a)(2)(G), or any other medical
assistance that may be federally authorized for this class
of persons. The Department may also cover treatment of
COVID-19 for this class of persons, or any similar category

of uninsured individuals, to the extent authorized under a
federally approved 1115 Waiver or other federal authority.
Notwithstanding the provisions of Section 1-11 of this
Code, due to the nature of the COVID-19 public health
emergency, the Department may cover and provide the medical
assistance described in this paragraph 21 to noncitizens
who would otherwise meet the eligibility requirements for
the class of persons described in this paragraph 21 for the
duration of the State emergency period.
In implementing the provisions of Public Act 96-20, the
Department is authorized to adopt only those rules necessary,
including emergency rules. Nothing in Public Act 96-20 permits
the Department to adopt rules or issue a decision that expands
eligibility for the FamilyCare Program to a person whose income
exceeds 185% of the Federal Poverty Level as determined from
time to time by the U.S. Department of Health and Human
Services, unless the Department is provided with express
statutory authority.
The eligibility of any such person for medical assistance
under this Article is not affected by the payment of any grant
under the Senior Citizens and Persons with Disabilities
Property Tax Relief Act or any distributions or items of income
described under subparagraph (X) of paragraph (2) of subsection
(a) of Section 203 of the Illinois Income Tax Act.
The Department shall by rule establish the amounts of
assets to be disregarded in determining eligibility for medical

assistance, which shall at a minimum equal the amounts to be
disregarded under the Federal Supplemental Security Income
Program. The amount of assets of a single person to be
disregarded shall not be less than $2,000, and the amount of
assets of a married couple to be disregarded shall not be less
than $3,000.
To the extent permitted under federal law, any person found
guilty of a second violation of Article VIIIA shall be
ineligible for medical assistance under this Article, as
provided in Section 8A-8.
The eligibility of any person for medical assistance under
this Article shall not be affected by the receipt by the person
of donations or benefits from fundraisers held for the person
in cases of serious illness, as long as neither the person nor
members of the person's family have actual control over the
donations or benefits or the disbursement of the donations or
benefits.
Notwithstanding any other provision of this Code, if the
United States Supreme Court holds Title II, Subtitle A, Section
2001(a) of Public Law 111-148 to be unconstitutional, or if a
holding of Public Law 111-148 makes Medicaid eligibility
allowed under Section 2001(a) inoperable, the State or a unit
of local government shall be prohibited from enrolling
individuals in the Medical Assistance Program as the result of
federal approval of a State Medicaid waiver on or after the
effective date of this amendatory Act of the 97th General

Assembly, and any individuals enrolled in the Medical
Assistance Program pursuant to eligibility permitted as a
result of such a State Medicaid waiver shall become immediately
ineligible.
Notwithstanding any other provision of this Code, if an Act
of Congress that becomes a Public Law eliminates Section
2001(a) of Public Law 111-148, the State or a unit of local
government shall be prohibited from enrolling individuals in
the Medical Assistance Program as the result of federal
approval of a State Medicaid waiver on or after the effective
date of this amendatory Act of the 97th General Assembly, and
any individuals enrolled in the Medical Assistance Program
pursuant to eligibility permitted as a result of such a State
Medicaid waiver shall become immediately ineligible.
Effective October 1, 2013, the determination of
eligibility of persons who qualify under paragraphs 5, 6, 8,
15, 17, and 18 of this Section shall comply with the
requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
regulations.
The Department of Healthcare and Family Services, the
Department of Human Services, and the Illinois health insurance
marketplace shall work cooperatively to assist persons who
would otherwise lose health benefits as a result of changes
made under this amendatory Act of the 98th General Assembly to
transition to other health insurance coverage.
(Source: P.A. 101-10, eff. 6-5-19.)

(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
Sec. 5-4.2. Ambulance services payments.
(a) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1993, the Illinois
Department shall reimburse ambulance service providers at
rates calculated in accordance with this Section. It is the
intent of the General Assembly to provide adequate
reimbursement for ambulance services so as to ensure adequate
access to services for recipients of aid under this Article and
to provide appropriate incentives to ambulance service
providers to provide services in an efficient and
cost-effective manner. Thus, it is the intent of the General
Assembly that the Illinois Department implement a
reimbursement system for ambulance services that, to the extent
practicable and subject to the availability of funds
appropriated by the General Assembly for this purpose, is
consistent with the payment principles of Medicare. To ensure
uniformity between the payment principles of Medicare and
Medicaid, the Illinois Department shall follow, to the extent
necessary and practicable and subject to the availability of
funds appropriated by the General Assembly for this purpose,
the statutes, laws, regulations, policies, procedures,
principles, definitions, guidelines, and manuals used to
determine the amounts paid to ambulance service providers under
Title XVIII of the Social Security Act (Medicare).

(b) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1996, the Illinois
Department shall reimburse ambulance service providers based
upon the actual distance traveled if a natural disaster,
weather conditions, road repairs, or traffic congestion
necessitates the use of a route other than the most direct
route.
(c) For purposes of this Section, "ambulance services"
includes medical transportation services provided by means of
an ambulance, medi-car, service car, or taxi.
(c-1) For purposes of this Section, "ground ambulance
service" means medical transportation services that are
described as ground ambulance services by the Centers for
Medicare and Medicaid Services and provided in a vehicle that
is licensed as an ambulance by the Illinois Department of
Public Health pursuant to the Emergency Medical Services (EMS)
Systems Act.
(c-2) For purposes of this Section, "ground ambulance
service provider" means a vehicle service provider as described
in the Emergency Medical Services (EMS) Systems Act that
operates licensed ambulances for the purpose of providing
emergency ambulance services, or non-emergency ambulance
services, or both. For purposes of this Section, this includes
both ambulance providers and ambulance suppliers as described
by the Centers for Medicare and Medicaid Services.
(c-3) For purposes of this Section, "medi-car" means

transportation services provided to a patient who is confined
to a wheelchair and requires the use of a hydraulic or electric
lift or ramp and wheelchair lockdown when the patient's
condition does not require medical observation, medical
supervision, medical equipment, the administration of
medications, or the administration of oxygen.
(c-4) For purposes of this Section, "service car" means
transportation services provided to a patient by a passenger
vehicle where that patient does not require the specialized
modes described in subsection (c-1) or (c-3).
(d) This Section does not prohibit separate billing by
ambulance service providers for oxygen furnished while
providing advanced life support services.
(e) Beginning with services rendered on or after July 1,
2008, all providers of non-emergency medi-car and service car
transportation must certify that the driver and employee
attendant, as applicable, have completed a safety program
approved by the Department to protect both the patient and the
driver, prior to transporting a patient. The provider must
maintain this certification in its records. The provider shall
produce such documentation upon demand by the Department or its
representative. Failure to produce documentation of such
training shall result in recovery of any payments made by the
Department for services rendered by a non-certified driver or
employee attendant. Medi-car and service car providers must
maintain legible documentation in their records of the driver

and, as applicable, employee attendant that actually
transported the patient. Providers must recertify all drivers
and employee attendants every 3 years.
Notwithstanding the requirements above, any public
transportation provider of medi-car and service car
transportation that receives federal funding under 49 U.S.C.
5307 and 5311 need not certify its drivers and employee
attendants under this Section, since safety training is already
federally mandated.
(f) With respect to any policy or program administered by
the Department or its agent regarding approval of non-emergency
medical transportation by ground ambulance service providers,
including, but not limited to, the Non-Emergency
Transportation Services Prior Approval Program (NETSPAP), the
Department shall establish by rule a process by which ground
ambulance service providers of non-emergency medical
transportation may appeal any decision by the Department or its
agent for which no denial was received prior to the time of
transport that either (i) denies a request for approval for
payment of non-emergency transportation by means of ground
ambulance service or (ii) grants a request for approval of
non-emergency transportation by means of ground ambulance
service at a level of service that entitles the ground
ambulance service provider to a lower level of compensation
from the Department than the ground ambulance service provider
would have received as compensation for the level of service

requested. The rule shall be filed by December 15, 2012 and
shall provide that, for any decision rendered by the Department
or its agent on or after the date the rule takes effect, the
ground ambulance service provider shall have 60 days from the
date the decision is received to file an appeal. The rule
established by the Department shall be, insofar as is
practical, consistent with the Illinois Administrative
Procedure Act. The Director's decision on an appeal under this
Section shall be a final administrative decision subject to
review under the Administrative Review Law.
(f-5) Beginning 90 days after July 20, 2012 (the effective
date of Public Act 97-842), (i) no denial of a request for
approval for payment of non-emergency transportation by means
of ground ambulance service, and (ii) no approval of
non-emergency transportation by means of ground ambulance
service at a level of service that entitles the ground
ambulance service provider to a lower level of compensation
from the Department than would have been received at the level
of service submitted by the ground ambulance service provider,
may be issued by the Department or its agent unless the
Department has submitted the criteria for determining the
appropriateness of the transport for first notice publication
in the Illinois Register pursuant to Section 5-40 of the
Illinois Administrative Procedure Act.
(g) Whenever a patient covered by a medical assistance
program under this Code or by another medical program

administered by the Department, including a patient covered
under the State's Medicaid managed care program, is being
transported from a facility and requires non-emergency
transportation including ground ambulance, medi-car, or
service car transportation, a Physician Certification
Statement as described in this Section shall be required for
each patient. Facilities shall develop procedures for a
licensed medical professional to provide a written and signed
Physician Certification Statement. The Physician Certification
Statement shall specify the level of transportation services
needed and complete a medical certification establishing the
criteria for approval of non-emergency ambulance
transportation, as published by the Department of Healthcare
and Family Services, that is met by the patient. This
certification shall be completed prior to ordering the
transportation service and prior to patient discharge. The
Physician Certification Statement is not required prior to
transport if a delay in transport can be expected to negatively
affect the patient outcome. If the ground ambulance provider,
medi-car provider, or service car provider is unable to obtain
the required Physician Certification Statement within 10
calendar days following the date of the service, the ground
ambulance provider, medi-car provider, or service car provider
must document its attempt to obtain the requested certification
and may then submit the claim for payment. Acceptable
documentation includes a signed return receipt from the U.S.

Postal Service, facsimile receipt, email receipt, or other
similar service that evidences that the ground ambulance
provider, medi-car provider, or service car provider attempted
to obtain the required Physician Certification Statement.
The medical certification specifying the level and type of
non-emergency transportation needed shall be in the form of the
Physician Certification Statement on a standardized form
prescribed by the Department of Healthcare and Family Services.
Within 75 days after July 27, 2018 (the effective date of
Public Act 100-646), the Department of Healthcare and Family
Services shall develop a standardized form of the Physician
Certification Statement specifying the level and type of
transportation services needed in consultation with the
Department of Public Health, Medicaid managed care
organizations, a statewide association representing ambulance
providers, a statewide association representing hospitals, 3
statewide associations representing nursing homes, and other
stakeholders. The Physician Certification Statement shall
include, but is not limited to, the criteria necessary to
demonstrate medical necessity for the level of transport needed
as required by (i) the Department of Healthcare and Family
Services and (ii) the federal Centers for Medicare and Medicaid
Services as outlined in the Centers for Medicare and Medicaid
Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap.
10, Sec. 10.2.1, et seq. The use of the Physician Certification
Statement shall satisfy the obligations of hospitals under

Section 6.22 of the Hospital Licensing Act and nursing homes
under Section 2-217 of the Nursing Home Care Act.
Implementation and acceptance of the Physician Certification
Statement shall take place no later than 90 days after the
issuance of the Physician Certification Statement by the
Department of Healthcare and Family Services.
Pursuant to subsection (E) of Section 12-4.25 of this Code,
the Department is entitled to recover overpayments paid to a
provider or vendor, including, but not limited to, from the
discharging physician, the discharging facility, and the
ground ambulance service provider, in instances where a
non-emergency ground ambulance service is rendered as the
result of improper or false certification.
Beginning October 1, 2018, the Department of Healthcare and
Family Services shall collect data from Medicaid managed care
organizations and transportation brokers, including the
Department's NETSPAP broker, regarding denials and appeals
related to the missing or incomplete Physician Certification
Statement forms and overall compliance with this subsection.
The Department of Healthcare and Family Services shall publish
quarterly results on its website within 15 days following the
end of each quarter.
(h) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in

accordance with Section 5-5e.
(i) On and after July 1, 2018, the Department shall
increase the base rate of reimbursement for both base charges
and mileage charges for ground ambulance service providers for
medical transportation services provided by means of a ground
ambulance to a level not lower than 112% of the base rate in
effect as of June 30, 2018.
(Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18;
101-81, eff. 7-12-19.)
(305 ILCS 5/5-5.27 new)
Sec. 5-5.27. Coverage for clinical trials.
(a) The medical assistance program shall provide coverage
for routine care costs that are incurred in the course of an
approved clinical trial if the medical assistance program would
provide coverage for the same routine care costs not incurred
in a clinical trial. "Routine care cost" shall be defined by
the Department by rule.
(b) The coverage that must be provided under this Section
is subject to the terms, conditions, restrictions, exclusions,
and limitations that apply generally under the medical
assistance program, including terms, conditions, restrictions,
exclusions, or limitations that apply to health care services
rendered by participating providers and nonparticipating
providers.
(c) Implementation of this Section shall be contingent upon

federal approval. Upon receipt of federal approval, if
required, the Department shall adopt any rules necessary to
implement this Section.
(d) As used in this Section:
"Approved clinical trial" means a phase I, II, III, or IV
clinical trial involving the prevention, detection, or
treatment of cancer or any other life-threatening disease or
condition if one or more of the following conditions apply:
(1) the Department makes a determination that the study
or investigation is an approved clinical trial;
(2) the study or investigation is conducted under an
investigational new drug application or an investigational
device exemption reviewed by the federal Food and Drug
Administration;
(3) the study or investigation is a drug trial that is
exempt from having an investigational new drug application
or an investigational device exemption from the federal
Food and Drug Administration; or
(4) the study or investigation is approved or funded
(which may include funding through in-kind contributions)
by:
(A) the National Institutes of Health;
(B) the Centers for Disease Control and
Prevention;
(C) the Agency for Healthcare Research and
Quality;

(D) the Patient-Centered Outcomes Research
Institute;
(E) the federal Centers for Medicare and Medicaid
Services;
(F) a cooperative group or center of any of the
entities described in subparagraphs (A) through (E) or
the United States Department of Defense or the United
States Department of Veterans Affairs;
(G) a qualified non-governmental research entity
identified in the guidelines issued by the National
Institutes of Health for center support grants; or
(H) the United States Department of Veterans
Affairs, the United States Department of Defense, or
the United States Department of Energy, provided that
review and approval of the study or investigation
occurs through a system of peer review that is
comparable to the peer review of studies performed by
the National Institutes of Health, including an
unbiased review of the highest scientific standards by
qualified individuals who have no interest in the
outcome of the review.
"Care method" means the use of a particular drug or device
in a particular manner.
"Life-threatening disease or condition" means a disease or
condition from which the likelihood of death is probable unless
the course of the disease or condition is interrupted.

(305 ILCS 5/5-5e)
Sec. 5-5e. Adjusted rates of reimbursement.
(a) Rates or payments for services in effect on June 30,
2012 shall be adjusted and services shall be affected as
required by any other provision of Public Act 97-689. In
addition, the Department shall do the following:
(1) Delink the per diem rate paid for supportive living
facility services from the per diem rate paid for nursing
facility services, effective for services provided on or
after May 1, 2011 and before July 1, 2019.
(2) Cease payment for bed reserves in nursing
facilities and specialized mental health rehabilitation
facilities; for purposes of therapeutic home visits for
individuals scoring as TBI on the MDS 3.0, beginning June
1, 2015, the Department shall approve payments for bed
reserves in nursing facilities and specialized mental
health rehabilitation facilities that have at least a 90%
occupancy level and at least 80% of their residents are
Medicaid eligible. Payment shall be at a daily rate of 75%
of an individual's current Medicaid per diem and shall not
exceed 10 days in a calendar month.
(2.5) Cease payment for bed reserves for purposes of
inpatient hospitalizations to intermediate care facilities
for persons with developmental development disabilities,
except in the instance of residents who are under 21 years

of age.
(3) Cease payment of the $10 per day add-on payment to
nursing facilities for certain residents with
developmental disabilities.
(b) After the application of subsection (a),
notwithstanding any other provision of this Code to the
contrary and to the extent permitted by federal law, on and
after July 1, 2012, the rates of reimbursement for services and
other payments provided under this Code shall further be
reduced as follows:
(1) Rates or payments for physician services, dental
services, or community health center services reimbursed
through an encounter rate, and services provided under the
Medicaid Rehabilitation Option of the Illinois Title XIX
State Plan shall not be further reduced, except as provided
in Section 5-5b.1.
(2) Rates or payments, or the portion thereof, paid to
a provider that is operated by a unit of local government
or State University that provides the non-federal share of
such services shall not be further reduced, except as
provided in Section 5-5b.1.
(3) Rates or payments for hospital services delivered
by a hospital defined as a Safety-Net Hospital under
Section 5-5e.1 of this Code shall not be further reduced,
except as provided in Section 5-5b.1.
(4) Rates or payments for hospital services delivered

by a Critical Access Hospital, which is an Illinois
hospital designated as a critical care hospital by the
Department of Public Health in accordance with 42 CFR 485,
Subpart F, shall not be further reduced, except as provided
in Section 5-5b.1.
(5) Rates or payments for Nursing Facility Services
shall only be further adjusted pursuant to Section 5-5.2 of
this Code.
(6) Rates or payments for services delivered by long
term care facilities licensed under the ID/DD Community
Care Act or the MC/DD Act and developmental training
services shall not be further reduced.
(7) Rates or payments for services provided under
capitation rates shall be adjusted taking into
consideration the rates reduction and covered services
required by Public Act 97-689.
(8) For hospitals not previously described in this
subsection, the rates or payments for hospital services
shall be further reduced by 3.5%, except for payments
authorized under Section 5A-12.4 of this Code.
(9) For all other rates or payments for services
delivered by providers not specifically referenced in
paragraphs (1) through (8), rates or payments shall be
further reduced by 2.7%.
(c) Any assessment imposed by this Code shall continue and
nothing in this Section shall be construed to cause it to

cease.
(d) Notwithstanding any other provision of this Code to the
contrary, subject to federal approval under Title XIX of the
Social Security Act, for dates of service on and after July 1,
2014, rates or payments for services provided for the purpose
of transitioning children from a hospital to home placement or
other appropriate setting by a children's community-based
health care center authorized under the Alternative Health Care
Delivery Act shall be $683 per day.
(e) (Blank) Notwithstanding any other provision of this
Code to the contrary, subject to federal approval under Title
XIX of the Social Security Act, for dates of service on and
after July 1, 2014, rates or payments for home health visits
shall be $72.
(f) (Blank) Notwithstanding any other provision of this
Code to the contrary, subject to federal approval under Title
XIX of the Social Security Act, for dates of service on and
after July 1, 2014, rates or payments for the certified nursing
assistant component of the home health agency rate shall be
$20.
(Source: P.A. 101-10, eff. 6-5-19; revised 9-12-19.)
(305 ILCS 5/5-16.8)
Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and

health insurance under Section 356t and the coverage required
under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
356z.29, and 356z.32, and 356z.33, 356z.34, and 356z.35 of the
Illinois Insurance Code and (ii) be subject to the provisions
of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois
Insurance Code.
The Department, by rule, shall adopt a model similar to the
requirements of Section 356z.39 of the Illinois Insurance Code.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with
Section 5-5e.
To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)
(305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
Sec. 5B-4. Payment of assessment; penalty.
(a) The assessment imposed by Section 5B-2 shall be due and

payable monthly, on the last State business day of the month
for occupied bed days reported for the preceding third month
prior to the month in which the tax is payable and due. A
facility that has delayed payment due to the State's failure to
reimburse for services rendered may request an extension on the
due date for payment pursuant to subsection (b) and shall pay
the assessment within 30 days of reimbursement by the
Department. The Illinois Department may provide that county
nursing homes directed and maintained pursuant to Section
5-1005 of the Counties Code may meet their assessment
obligation by certifying to the Illinois Department that county
expenditures have been obligated for the operation of the
county nursing home in an amount at least equal to the amount
of the assessment.
(a-5) The Illinois Department shall provide for an
electronic submission process for each long-term care facility
to report at a minimum the number of occupied bed days of the
long-term care facility for the reporting period and other
reasonable information the Illinois Department requires for
the administration of its responsibilities under this Code.
Beginning July 1, 2013, a separate electronic submission shall
be completed for each long-term care facility in this State
operated by a long-term care provider. The Illinois Department
shall provide a self-reporting notice of the assessment form
that the long-term care facility completes for the required
period and submits with its assessment payment to the Illinois

Department. shall prepare an assessment bill stating the amount
due and payable each month and submit it to each long-term care
facility via an electronic process. Each assessment payment
shall be accompanied by a copy of the assessment bill sent to
the long-term care facility by the Illinois Department. To the
extent practicable, the Department shall coordinate the
assessment reporting requirements with other reporting
required of long-term care facilities.
(b) The Illinois Department is authorized to establish
delayed payment schedules for long-term care providers that are
unable to make assessment payments when due under this Section
due to financial difficulties, as determined by the Illinois
Department. The Illinois Department may not deny a request for
delay of payment of the assessment imposed under this Article
if the long-term care provider has not been paid for services
provided during the month on which the assessment is levied or
the Medicaid managed care organization has not been paid by the
State.
(c) If a long-term care provider fails to pay the full
amount of an assessment payment when due (including any
extensions granted under subsection (b)), there shall, unless
waived by the Illinois Department for reasonable cause, be
added to the assessment imposed by Section 5B-2 a penalty
assessment equal to the lesser of (i) 5% of the amount of the
assessment payment not paid on or before the due date plus 5%
of the portion thereof remaining unpaid on the last day of each

month thereafter or (ii) 100% of the assessment payment amount
not paid on or before the due date. For purposes of this
subsection, payments will be credited first to unpaid
assessment payment amounts (rather than to penalty or
interest), beginning with the most delinquent assessment
payments. Payment cycles of longer than 60 days shall be one
factor the Director takes into account in granting a waiver
under this Section.
(c-5) If a long-term care facility fails to file its
assessment bill with payment, there shall, unless waived by the
Illinois Department for reasonable cause, be added to the
assessment due a penalty assessment equal to 25% of the
assessment due. After July 1, 2013, no penalty shall be
assessed under this Section if the Illinois Department does not
provide a process for the electronic submission of the
information required by subsection (a-5).
(d) Nothing in this amendatory Act of 1993 shall be
construed to prevent the Illinois Department from collecting
all amounts due under this Article pursuant to an assessment
imposed before the effective date of this amendatory Act of
1993.
(e) Nothing in this amendatory Act of the 96th General
Assembly shall be construed to prevent the Illinois Department
from collecting all amounts due under this Code pursuant to an
assessment, tax, fee, or penalty imposed before the effective
date of this amendatory Act of the 96th General Assembly.

(f) No installment of the assessment imposed by Section
5B-2 shall be due and payable until after the Department
notifies the long-term care providers, in writing, that the
payment methodologies to long-term care providers required
under Section 5-5.4 of this Code have been approved by the
Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services and the waivers under
42 CFR 433.68 for the assessment imposed by this Section, if
necessary, have been granted by the Centers for Medicare and
Medicaid Services of the U.S. Department of Health and Human
Services. Upon notification to the Department of approval of
the payment methodologies required under Section 5-5.4 of this
Code and the waivers granted under 42 CFR 433.68, all
installments otherwise due under Section 5B-4 prior to the date
of notification shall be due and payable to the Department upon
written direction from the Department within 90 days after
issuance by the Comptroller of the payments required under
Section 5-5.4 of this Code.
(Source: P.A. 100-501, eff. 6-1-18.)
(305 ILCS 5/11-5.1)
Sec. 11-5.1. Eligibility verification. Notwithstanding any
other provision of this Code, with respect to applications for
medical assistance provided under Article V of this Code,
eligibility shall be determined in a manner that ensures
program integrity and complies with federal laws and

regulations while minimizing unnecessary barriers to
enrollment. To this end, as soon as practicable, and unless the
Department receives written denial from the federal
government, this Section shall be implemented:
(a) The Department of Healthcare and Family Services or its
designees shall:
(1) By no later than July 1, 2011, require verification
of, at a minimum, one month's income from all sources
required for determining the eligibility of applicants for
medical assistance under this Code. Such verification
shall take the form of pay stubs, business or income and
expense records for self-employed persons, letters from
employers, and any other valid documentation of income
including data obtained electronically by the Department
or its designees from other sources as described in
subsection (b) of this Section. A month's income may be
verified by a single pay stub with the monthly income
extrapolated from the time period covered by the pay stub.
(2) By no later than October 1, 2011, require
verification of, at a minimum, one month's income from all
sources required for determining the continued eligibility
of recipients at their annual review of eligibility for
medical assistance under this Code. Information the
Department receives prior to the annual review, including
information available to the Department as a result of the
recipient's application for other non-Medicaid benefits,

that is sufficient to make a determination of continued
Medicaid eligibility may be reviewed and verified, and
subsequent action taken including client notification of
continued Medicaid eligibility. The date of client
notification establishes the date for subsequent annual
Medicaid eligibility reviews. Such verification shall take
the form of pay stubs, business or income and expense
records for self-employed persons, letters from employers,
and any other valid documentation of income including data
obtained electronically by the Department or its designees
from other sources as described in subsection (b) of this
Section. A month's income may be verified by a single pay
stub with the monthly income extrapolated from the time
period covered by the pay stub. The Department shall send a
notice to recipients at least 60 days prior to the end of
their period of eligibility that informs them of the
requirements for continued eligibility. If a recipient
does not fulfill the requirements for continued
eligibility by the deadline established in the notice a
notice of cancellation shall be issued to the recipient and
coverage shall end no later than the last day of the month
following the last day of the eligibility period. A
recipient's eligibility may be reinstated without
requiring a new application if the recipient fulfills the
requirements for continued eligibility prior to the end of
the third month following the last date of coverage (or

longer period if required by federal regulations). Nothing
in this Section shall prevent an individual whose coverage
has been cancelled from reapplying for health benefits at
any time.
(3) By no later than July 1, 2011, require verification
of Illinois residency.
The Department, with federal approval, may choose to adopt
continuous financial eligibility for a full 12 months for
adults on Medicaid.
(b) The Department shall establish or continue cooperative
arrangements with the Social Security Administration, the
Illinois Secretary of State, the Department of Human Services,
the Department of Revenue, the Department of Employment
Security, and any other appropriate entity to gain electronic
access, to the extent allowed by law, to information available
to those entities that may be appropriate for electronically
verifying any factor of eligibility for benefits under the
Program. Data relevant to eligibility shall be provided for no
other purpose than to verify the eligibility of new applicants
or current recipients of health benefits under the Program.
Data shall be requested or provided for any new applicant or
current recipient only insofar as that individual's
circumstances are relevant to that individual's or another
individual's eligibility.
(c) Within 90 days of the effective date of this amendatory
Act of the 96th General Assembly, the Department of Healthcare

and Family Services shall send notice to current recipients
informing them of the changes regarding their eligibility
verification.
(d) As soon as practical if the data is reasonably
available, but no later than January 1, 2017, the Department
shall compile on a monthly basis data on eligibility
redeterminations of beneficiaries of medical assistance
provided under Article V of this Code. This data shall be
posted on the Department's website, and data from prior months
shall be retained and available on the Department's website.
The data compiled and reported shall include the following:
(1) The total number of redetermination decisions made
in a month and, of that total number, the number of
decisions to continue or change benefits and the number of
decisions to cancel benefits.
(2) A breakdown of enrollee language preference for the
total number of redetermination decisions made in a month
and, of that total number, a breakdown of enrollee language
preference for the number of decisions to continue or
change benefits, and a breakdown of enrollee language
preference for the number of decisions to cancel benefits.
The language breakdown shall include, at a minimum,
English, Spanish, and the next 4 most commonly used
languages.
(3) The percentage of cancellation decisions made in a
month due to each of the following:

(A) The beneficiary's ineligibility due to excess
income.
(B) The beneficiary's ineligibility due to not
being an Illinois resident.
(C) The beneficiary's ineligibility due to being
deceased.
(D) The beneficiary's request to cancel benefits.
(E) The beneficiary's lack of response after
notices mailed to the beneficiary are returned to the
Department as undeliverable by the United States
Postal Service.
(F) The beneficiary's lack of response to a request
for additional information when reliable information
in the beneficiary's account, or other more current
information, is unavailable to the Department to make a
decision on whether to continue benefits.
(G) Other reasons tracked by the Department for the
purpose of ensuring program integrity.
(4) If a vendor is utilized to provide services in
support of the Department's redetermination decision
process, the total number of redetermination decisions
made in a month and, of that total number, the number of
decisions to continue or change benefits, and the number of
decisions to cancel benefits (i) with the involvement of
the vendor and (ii) without the involvement of the vendor.
(5) Of the total number of benefit cancellations in a

month, the number of beneficiaries who return from
cancellation within one month, the number of beneficiaries
who return from cancellation within 2 months, and the
number of beneficiaries who return from cancellation
within 3 months. Of the number of beneficiaries who return
from cancellation within 3 months, the percentage of those
cancellations due to each of the reasons listed under
paragraph (3) of this subsection.
(e) The Department shall conduct a complete review of the
Medicaid redetermination process in order to identify changes
that can increase the use of ex parte redetermination
processing. This review shall be completed within 90 days after
the effective date of this amendatory Act of the 101st General
Assembly. Within 90 days of completion of the review, the
Department shall seek written federal approval of policy
changes the review recommended and implement once approved. The
review shall specifically include, but not be limited to, use
of ex parte redeterminations of the following populations:
(1) Recipients of developmental disabilities services.
(2) Recipients of benefits under the State's Aid to the
Aged, Blind, or Disabled program.
(3) Recipients of Medicaid long-term care services and
supports, including waiver services.
(4) All Modified Adjusted Gross Income (MAGI)
populations.
(5) Populations with no verifiable income.

(6) Self-employed people.
The report shall also outline populations and
circumstances in which an ex parte redetermination is not a
recommended option.
(f) The Department shall explore and implement, as
practical and technologically possible, roles that
stakeholders outside State agencies can play to assist in
expediting eligibility determinations and redeterminations
within 24 months after the effective date of this amendatory
Act of the 101st General Assembly. Such practical roles to be
explored to expedite the eligibility determination processes
shall include the implementation of hospital presumptive
eligibility, as authorized by the Patient Protection and
Affordable Care Act.
(g) The Department or its designee shall seek federal
approval to enhance the reasonable compatibility standard from
5% to 10%.
(h) Reporting. The Department of Healthcare and Family
Services and the Department of Human Services shall publish
quarterly reports on their progress in implementing policies
and practices pursuant to this Section as modified by this
amendatory Act of the 101st General Assembly.
(1) The reports shall include, but not be limited to,
the following:
(A) Medical application processing, including a
breakdown of the number of MAGI, non-MAGI, long-term

care, and other medical cases pending for various
incremental time frames between 0 to 181 or more days.
(B) Medical redeterminations completed, including:
(i) a breakdown of the number of households that were
redetermined ex parte and those that were not; (ii) the
reasons households were not redetermined ex parte; and
(iii) the relative percentages of these reasons.
(C) A narrative discussion on issues identified in
the functioning of the State's Integrated Eligibility
System and progress on addressing those issues, as well
as progress on implementing strategies to address
eligibility backlogs, including expanding ex parte
determinations to ensure timely eligibility
determinations and renewals.
(2) Initial reports shall be issued within 90 days
after the effective date of this amendatory Act of the
101st General Assembly.
(3) All reports shall be published on the Department's
website.
(Source: P.A. 101-209, eff. 8-5-19.)
(305 ILCS 5/12-21.21 new)
Sec. 12-21.21. Federal waiver or State Plan amendment. The
Department of Healthcare and Family Services and the Department
of Human Services shall jointly submit the necessary
application to the federal Centers for Medicare and Medicaid

Services for a waiver or State Plan amendment to allow remote
monitoring and support services as a waiver-reimbursable
service for persons with intellectual and developmental
disabilities. The application shall be submitted no later than
January 1, 2021.
No later than July 1, 2021, the Department of Human
Services shall adopt rules to allow remote monitoring and
support services at community-integrated living arrangements.
Section 90-40. The Medical Patient Rights Act is amended by
changing Section 3 as follows:
(410 ILCS 50/3) (from Ch. 111 1/2, par. 5403)
Sec. 3. The following rights are hereby established:
(a) The right of each patient to care consistent with sound
nursing and medical practices, to be informed of the name of
the physician responsible for coordinating his or her care, to
receive information concerning his or her condition and
proposed treatment, to refuse any treatment to the extent
permitted by law, and to privacy and confidentiality of records
except as otherwise provided by law.
(b) The right of each patient, regardless of source of
payment, to examine and receive a reasonable explanation of his
total bill for services rendered by his physician or health
care provider, including the itemized charges for specific
services received. Each physician or health care provider shall

be responsible only for a reasonable explanation of those
specific services provided by such physician or health care
provider.
(c) In the event an insurance company or health services
corporation cancels or refuses to renew an individual policy or
plan, the insured patient shall be entitled to timely, prior
notice of the termination of such policy or plan.
An insurance company or health services corporation that
requires any insured patient or applicant for new or continued
insurance or coverage to be tested for infection with human
immunodeficiency virus (HIV) or any other identified causative
agent of acquired immunodeficiency syndrome (AIDS) shall (1)
give the patient or applicant prior written notice of such
requirement, (2) proceed with such testing only upon the
written authorization of the applicant or patient, and (3) keep
the results of such testing confidential. Notice of an adverse
underwriting or coverage decision may be given to any
appropriately interested party, but the insurer may only
disclose the test result itself to a physician designated by
the applicant or patient, and any such disclosure shall be in a
manner that assures confidentiality.
The Department of Insurance shall enforce the provisions of
this subsection.
(d) The right of each patient to privacy and
confidentiality in health care. Each physician, health care
provider, health services corporation and insurance company

shall refrain from disclosing the nature or details of services
provided to patients, except that such information may be
disclosed: (1) to the patient, (2) to the party making
treatment decisions if the patient is incapable of making
decisions regarding the health services provided, (3) for
treatment in accordance with 45 CFR 164.501 and 164.506, (4)
for payment in accordance with 45 CFR 164.501 and 164.506, (5)
to those parties responsible for peer review, utilization
review, and quality assurance, (6) for health care operations
in accordance with 45 CFR 164.501 and 164.506, (7) to those
parties required to be notified under the Abused and Neglected
Child Reporting Act or the Illinois Sexually Transmissible
Disease Control Act, or (8) as otherwise permitted, authorized,
or required by State or federal law. This right may be waived
in writing by the patient or the patient's guardian or legal
representative, but a physician or other health care provider
may not condition the provision of services on the patient's,
guardian's, or legal representative's agreement to sign such a
waiver. In the interest of public health, safety, and welfare,
patient information, including, but not limited to, health
information, demographic information, and information about
the services provided to patients, may be transmitted to or
through a health information exchange, as that term is defined
in Section 2 of the Mental Health and Developmental
Disabilities Confidentiality Act, in accordance with the
disclosures permitted pursuant to this Section. Patients shall

be provided the opportunity to opt out of their health
information being transmitted to or through a health
information exchange in accordance with the regulations,
standards, or contractual obligations adopted by the Illinois
Health Information Exchange Office Authority in accordance
with Section 9.6 of the Mental Health and Developmental
Disabilities Confidentiality Act, Section 9.6 of the AIDS
Confidentiality Act, or Section 31.8 of the Genetic Information
Privacy Act, as applicable. In the case of a patient choosing
to opt out of having his or her information available on an
HIE, nothing in this Act shall cause the physician or health
care provider to be liable for the release of a patient's
health information by other entities that may possess such
information, including, but not limited to, other health
professionals, providers, laboratories, pharmacies, hospitals,
ambulatory surgical centers, and nursing homes.
(Source: P.A. 98-1046, eff. 1-1-15.)
Section 90-45. The Genetic Information Privacy Act is
amended by changing Section 10 as follows:
(410 ILCS 513/10)
Sec. 10. Definitions. As used in this Act:
"Office Authority" means the Illinois Health Information
Exchange Office Authority established pursuant to the Illinois
Health Information Exchange and Technology Act.

"Business associate" has the meaning ascribed to it under
HIPAA, as specified in 45 CFR 160.103.
"Covered entity" has the meaning ascribed to it under
HIPAA, as specified in 45 CFR 160.103.
"De-identified information" means health information that
is not individually identifiable as described under HIPAA, as
specified in 45 CFR 164.514(b).
"Disclosure" has the meaning ascribed to it under HIPAA, as
specified in 45 CFR 160.103.
"Employer" means the State of Illinois, any unit of local
government, and any board, commission, department,
institution, or school district, any party to a public
contract, any joint apprenticeship or training committee
within the State, and every other person employing employees
within the State.
"Employment agency" means both public and private
employment agencies and any person, labor organization, or
labor union having a hiring hall or hiring office regularly
undertaking, with or without compensation, to procure
opportunities to work, or to procure, recruit, refer, or place
employees.
"Family member" means, with respect to an individual, (i)
the spouse of the individual; (ii) a dependent child of the
individual, including a child who is born to or placed for
adoption with the individual; (iii) any other person qualifying
as a covered dependent under a managed care plan; and (iv) all

other individuals related by blood or law to the individual or
the spouse or child described in subsections (i) through (iii)
of this definition.
"Genetic information" has the meaning ascribed to it under
HIPAA, as specified in 45 CFR 160.103.
"Genetic monitoring" means the periodic examination of
employees to evaluate acquired modifications to their genetic
material, such as chromosomal damage or evidence of increased
occurrence of mutations that may have developed in the course
of employment due to exposure to toxic substances in the
workplace in order to identify, evaluate, and respond to
effects of or control adverse environmental exposures in the
workplace.
"Genetic services" has the meaning ascribed to it under
HIPAA, as specified in 45 CFR 160.103.
"Genetic testing" and "genetic test" have the meaning
ascribed to "genetic test" under HIPAA, as specified in 45 CFR
160.103. "Genetic testing" includes direct-to-consumer
commercial genetic testing.
"Health care operations" has the meaning ascribed to it
under HIPAA, as specified in 45 CFR 164.501.
"Health care professional" means (i) a licensed physician,
(ii) a licensed physician assistant, (iii) a licensed advanced
practice registered nurse, (iv) a licensed dentist, (v) a
licensed podiatrist, (vi) a licensed genetic counselor, or
(vii) an individual certified to provide genetic testing by a

state or local public health department.
"Health care provider" has the meaning ascribed to it under
HIPAA, as specified in 45 CFR 160.103.
"Health facility" means a hospital, blood bank, blood
center, sperm bank, or other health care institution, including
any "health facility" as that term is defined in the Illinois
Finance Authority Act.
"Health information exchange" or "HIE" means a health
information exchange or health information organization that
exchanges health information electronically that (i) is
established pursuant to the Illinois Health Information
Exchange and Technology Act, or any subsequent amendments
thereto, and any administrative rules promulgated thereunder;
(ii) has established a data sharing arrangement with the Office
Authority; or (iii) as of August 16, 2013, was designated by
the Illinois Health Information Exchange Authority (now
Office) Board as a member of, or was represented on, the
Authority Board's Regional Health Information Exchange
Workgroup; provided that such designation shall not require the
establishment of a data sharing arrangement or other
participation with the Illinois Health Information Exchange or
the payment of any fee. In certain circumstances, in accordance
with HIPAA, an HIE will be a business associate.
"Health oversight agency" has the meaning ascribed to it
under HIPAA, as specified in 45 CFR 164.501.
"HIPAA" means the Health Insurance Portability and

Accountability Act of 1996, Public Law 104-191, as amended by
the Health Information Technology for Economic and Clinical
Health Act of 2009, Public Law 111-05, and any subsequent
amendments thereto and any regulations promulgated thereunder.
"Insurer" means (i) an entity that is subject to the
jurisdiction of the Director of Insurance and (ii) a managed
care plan.
"Labor organization" includes any organization, labor
union, craft union, or any voluntary unincorporated
association designed to further the cause of the rights of
union labor that is constituted for the purpose, in whole or in
part, of collective bargaining or of dealing with employers
concerning grievances, terms or conditions of employment, or
apprenticeships or applications for apprenticeships, or of
other mutual aid or protection in connection with employment,
including apprenticeships or applications for apprenticeships.
"Licensing agency" means a board, commission, committee,
council, department, or officers, except a judicial officer, in
this State or any political subdivision authorized to grant,
deny, renew, revoke, suspend, annul, withdraw, or amend a
license or certificate of registration.
"Limited data set" has the meaning ascribed to it under
HIPAA, as described in 45 CFR 164.514(e)(2).
"Managed care plan" means a plan that establishes,
operates, or maintains a network of health care providers that
have entered into agreements with the plan to provide health

care services to enrollees where the plan has the ultimate and
direct contractual obligation to the enrollee to arrange for
the provision of or pay for services through:
(1) organizational arrangements for ongoing quality
assurance, utilization review programs, or dispute
resolution; or
(2) financial incentives for persons enrolled in the
plan to use the participating providers and procedures
covered by the plan.
A managed care plan may be established or operated by any
entity including a licensed insurance company, hospital or
medical service plan, health maintenance organization, limited
health service organization, preferred provider organization,
third party administrator, or an employer or employee
organization.
"Minimum necessary" means HIPAA's standard for using,
disclosing, and requesting protected health information found
in 45 CFR 164.502(b) and 164.514(d).
"Nontherapeutic purpose" means a purpose that is not
intended to improve or preserve the life or health of the
individual whom the information concerns.
"Organized health care arrangement" has the meaning
ascribed to it under HIPAA, as specified in 45 CFR 160.103.
"Patient safety activities" has the meaning ascribed to it
under 42 CFR 3.20.
"Payment" has the meaning ascribed to it under HIPAA, as

specified in 45 CFR 164.501.
"Person" includes any natural person, partnership,
association, joint venture, trust, governmental entity, public
or private corporation, health facility, or other legal entity.
"Protected health information" has the meaning ascribed to
it under HIPAA, as specified in 45 CFR 164.103.
"Research" has the meaning ascribed to it under HIPAA, as
specified in 45 CFR 164.501.
"State agency" means an instrumentality of the State of
Illinois and any instrumentality of another state which
pursuant to applicable law or a written undertaking with an
instrumentality of the State of Illinois is bound to protect
the privacy of genetic information of Illinois persons.
"Treatment" has the meaning ascribed to it under HIPAA, as
specified in 45 CFR 164.501.
"Use" has the meaning ascribed to it under HIPAA, as
specified in 45 CFR 160.103, where context dictates.
(Source: P.A. 100-513, eff. 1-1-18; 101-132, eff. 1-1-20.)
Section 90-50. The Mental Health and Developmental
Disabilities Confidentiality Act is amended by changing
Sections 2, 9.5, 9.6, 9.8, 9.9, and 9.11 as follows:
(740 ILCS 110/2) (from Ch. 91 1/2, par. 802)
Sec. 2. The terms used in this Act, unless the context
requires otherwise, have the meanings ascribed to them in this

Section.
"Agent" means a person who has been legally appointed as an
individual's agent under a power of attorney for health care or
for property.
"Business associate" has the meaning ascribed to it under
HIPAA, as specified in 45 CFR 160.103.
"Confidential communication" or "communication" means any
communication made by a recipient or other person to a
therapist or to or in the presence of other persons during or
in connection with providing mental health or developmental
disability services to a recipient. Communication includes
information which indicates that a person is a recipient.
"Communication" does not include information that has been
de-identified in accordance with HIPAA, as specified in 45 CFR
164.514.
"Covered entity" has the meaning ascribed to it under
HIPAA, as specified in 45 CFR 160.103.
"Guardian" means a legally appointed guardian or
conservator of the person.
"Health information exchange" or "HIE" means a health
information exchange or health information organization that
oversees and governs the electronic exchange of health
information that (i) is established pursuant to the Illinois
Health Information Exchange and Technology Act, or any
subsequent amendments thereto, and any administrative rules
promulgated thereunder; or (ii) has established a data sharing

arrangement with the Illinois Health Information Exchange; or
(iii) as of the effective date of this amendatory Act of the
98th General Assembly, was designated by the Illinois Health
Information Exchange Office Authority Board as a member of, or
was represented on, the Office Authority Board's Regional
Health Information Exchange Workgroup; provided that such
designation shall not require the establishment of a data
sharing arrangement or other participation with the Illinois
Health Information Exchange or the payment of any fee.
"HIE purposes" means those uses and disclosures (as those
terms are defined under HIPAA, as specified in 45 CFR 160.103)
for activities of an HIE: (i) set forth in the Illinois Health
Information Exchange and Technology Act or any subsequent
amendments thereto and any administrative rules promulgated
thereunder; or (ii) which are permitted under federal law.
"HIPAA" means the Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, and any
subsequent amendments thereto and any regulations promulgated
thereunder, including the Security Rule, as specified in 45 CFR
164.302-18, and the Privacy Rule, as specified in 45 CFR
164.500-34.
"Integrated health system" means an organization with a
system of care which incorporates physical and behavioral
healthcare and includes care delivered in an inpatient and
outpatient setting.
"Interdisciplinary team" means a group of persons

representing different clinical disciplines, such as medicine,
nursing, social work, and psychology, providing and
coordinating the care and treatment for a recipient of mental
health or developmental disability services. The group may be
composed of individuals employed by one provider or multiple
providers.
"Mental health or developmental disabilities services" or
"services" includes but is not limited to examination,
diagnosis, evaluation, treatment, training, pharmaceuticals,
aftercare, habilitation or rehabilitation.
"Personal notes" means:
(i) information disclosed to the therapist in
confidence by other persons on condition that such
information would never be disclosed to the recipient or
other persons;
(ii) information disclosed to the therapist by the
recipient which would be injurious to the recipient's
relationships to other persons, and
(iii) the therapist's speculations, impressions,
hunches, and reminders.
"Parent" means a parent or, in the absence of a parent or
guardian, a person in loco parentis.
"Recipient" means a person who is receiving or has received
mental health or developmental disabilities services.
"Record" means any record kept by a therapist or by an
agency in the course of providing mental health or

developmental disabilities service to a recipient concerning
the recipient and the services provided. "Records" includes all
records maintained by a court that have been created in
connection with, in preparation for, or as a result of the
filing of any petition or certificate under Chapter II, Chapter
III, or Chapter IV of the Mental Health and Developmental
Disabilities Code and includes the petitions, certificates,
dispositional reports, treatment plans, and reports of
diagnostic evaluations and of hearings under Article VIII of
Chapter III or under Article V of Chapter IV of that Code.
Record does not include the therapist's personal notes, if such
notes are kept in the therapist's sole possession for his own
personal use and are not disclosed to any other person, except
the therapist's supervisor, consulting therapist or attorney.
If at any time such notes are disclosed, they shall be
considered part of the recipient's record for purposes of this
Act. "Record" does not include information that has been
de-identified in accordance with HIPAA, as specified in 45 CFR
164.514. "Record" does not include a reference to the receipt
of mental health or developmental disabilities services noted
during a patient history and physical or other summary of care.
"Record custodian" means a person responsible for
maintaining a recipient's record.
"Therapist" means a psychiatrist, physician, psychologist,
social worker, or nurse providing mental health or
developmental disabilities services or any other person not

prohibited by law from providing such services or from holding
himself out as a therapist if the recipient reasonably believes
that such person is permitted to do so. Therapist includes any
successor of the therapist.
"Therapeutic relationship" means the receipt by a
recipient of mental health or developmental disabilities
services from a therapist. "Therapeutic relationship" does not
include independent evaluations for a purpose other than the
provision of mental health or developmental disabilities
services.
(Source: P.A. 98-378, eff. 8-16-13; 99-28, eff. 1-1-16.)
(740 ILCS 110/9.5)
Sec. 9.5. Use and disclosure of information to an HIE.
(a) An HIE, person, therapist, facility, agency,
interdisciplinary team, integrated health system, business
associate, or covered entity may, without a recipient's
consent, use or disclose information from a recipient's record
in connection with an HIE, including disclosure to the Illinois
Health Information Exchange Office Authority, an HIE, or the
business associate of either. An HIE and its business associate
may, without a recipient's consent, use or disclose and
re-disclose such information for HIE purposes or for such other
purposes as are specifically allowed under this Act.
(b) As used in this Section:
(1) "facility" means a developmental disability

facility as defined in Section 1-107 of the Mental Health
and Developmental Disabilities Code or a mental health
facility as defined in Section 1-114 of the Mental Health
and Developmental Disabilities Code; and
(2) the terms "disclosure" and "use" have the meanings
ascribed to them under HIPAA, as specified in 45 CFR
160.103.
(Source: P.A. 98-378, eff. 8-16-13.)
(740 ILCS 110/9.6)
Sec. 9.6. HIE opt-out. The Illinois Health Information
Exchange Office Authority shall, through appropriate rules,
standards, or contractual obligations, which shall be binding
upon any HIE, as defined under Section 2, require that
participants of such HIE provide each recipient whose record is
accessible through the health information exchange the
reasonable opportunity to expressly decline the further
disclosure of the record by the health information exchange to
third parties, except to the extent permitted by law such as
for purposes of public health reporting. These rules,
standards, or contractual obligations shall permit a recipient
to revoke a prior decision to opt-out or a decision not to
opt-out. These rules, standards, or contractual obligations
shall provide for written notice of a recipient's right to
opt-out which directs the recipient to a health information
exchange website containing (i) an explanation of the purposes

of the health information exchange; and (ii) audio, visual, and
written instructions on how to opt-out of participation in
whole or in part to the extent possible. These rules,
standards, or contractual obligations shall be reviewed
annually and updated as the technical options develop. The
recipient shall be provided meaningful disclosure regarding
the health information exchange, and the recipient's decision
whether to opt-out should be obtained without undue inducement
or any element of force, fraud, deceit, duress, or other form
of constraint or coercion. To the extent that HIPAA, as
specified in 45 CFR 164.508(b)(4), prohibits a covered entity
from conditioning the provision of its services upon an
individual's provision of an authorization, an HIE participant
shall not condition the provision of its services upon a
recipient's decision to opt-out of further disclosure of the
record by an HIE to third parties. The Illinois Health
Information Exchange Office Authority shall, through
appropriate rules, standards, or contractual obligations,
which shall be binding upon any HIE, as defined under Section
2, give consideration to the format and content of the
meaningful disclosure and the availability to recipients of
information regarding an HIE and the rights of recipients under
this Section to expressly decline the further disclosure of the
record by an HIE to third parties. The Illinois Health
Information Exchange Office Authority shall also give annual
consideration to enable a recipient to expressly decline the

further disclosure by an HIE to third parties of selected
portions of the recipient's record while permitting disclosure
of the recipient's remaining patient health information. In
establishing rules, standards, or contractual obligations
binding upon HIEs under this Section to give effect to
recipient disclosure preferences, the Illinois Health
Information Exchange Office Authority in its discretion may
consider the extent to which relevant health information
technologies reasonably available to therapists and HIEs in
this State reasonably enable the effective segmentation of
specific information within a recipient's electronic medical
record and reasonably enable the effective exclusion of
specific information from disclosure by an HIE to third
parties, as well as the availability of sufficient
authoritative clinical guidance to enable the practical
application of such technologies to effect recipient
disclosure preferences. The provisions of this Section 9.6
shall not apply to the secure electronic transmission of data
which is point-to-point communication directed by the data
custodian. Any rules or standards promulgated under this
Section which apply to HIEs shall be limited to that subject
matter required by this Section and shall not include any
requirement that an HIE enter a data sharing arrangement or
otherwise participate with the Illinois Health Information
Exchange. In connection with its annual consideration
regarding the issue of segmentation of information within a

medical record and prior to the adoption of any rules or
standards regarding that issue, the Office Authority Board
shall consider information provided by affected persons or
organizations regarding the feasibility, availability, cost,
reliability, and interoperability of any technology or process
under consideration by the Board. Nothing in this Act shall be
construed to limit the authority of the Illinois Health
Information Exchange Office Authority to impose limits or
conditions on consent for disclosures to or through any HIE, as
defined under Section 2, which are more restrictive than the
requirements under this Act or under HIPAA.
(Source: P.A. 98-378, eff. 8-16-13.)
(740 ILCS 110/9.8)
Sec. 9.8. Business associates. An HIE, person, therapist,
facility, agency, interdisciplinary team, integrated health
system, business associate, covered entity, the Illinois
Health Information Exchange Office Authority, or entity
facilitating the establishment or operation of an HIE may,
without a recipient's consent, utilize the services of and
disclose information from a recipient's record to a business
associate, as defined by and in accordance with the
requirements set forth under HIPAA. As used in this Section,
the term "disclosure" has the meaning ascribed to it by HIPAA,
as specified in 45 CFR 160.103.
(Source: P.A. 98-378, eff. 8-16-13.)

(740 ILCS 110/9.9)
Sec. 9.9. Record locator service.
(a) An HIE, person, therapist, facility, agency,
interdisciplinary team, integrated health system, business
associate, covered entity, the Illinois Health Information
Exchange Office Authority, or entity facilitating the
establishment or operation of an HIE may, without a recipient's
consent, disclose the existence of a recipient's record to a
record locator service, master patient index, or other
directory or services necessary to support and enable the
establishment and operation of an HIE.
(b) As used in this Section:
(1) the term "disclosure" has the meaning ascribed to
it under HIPAA, as specified in 45 CFR 160.103; and
(2) "facility" means a developmental disability
facility as defined in Section 1-107 of the Mental Health
and Developmental Disabilities Code or a mental health
facility as defined in Section 1-114 of the Mental Health
and Developmental Disabilities Code.
(Source: P.A. 98-378, eff. 8-16-13.)
(740 ILCS 110/9.11)
Sec. 9.11. Establishment and disclosure of limited data
sets and de-identified information.
(a) An HIE, person, therapist, facility, agency,

interdisciplinary team, integrated health system, business
associate, covered entity, the Illinois Health Information
Exchange Office Authority, or entity facilitating the
establishment or operation of an HIE may, without a recipient's
consent, use information from a recipient's record to
establish, or disclose such information to a business associate
to establish, and further disclose information from a
recipient's record as part of a limited data set as defined by
and in accordance with the requirements set forth under HIPAA,
as specified in 45 CFR 164.514(e). An HIE, person, therapist,
facility, agency, interdisciplinary team, integrated health
system, business associate, covered entity, the Illinois
Health Information Exchange Office Authority, or entity
facilitating the establishment or operation of an HIE may,
without a recipient's consent, use information from a
recipient's record or disclose information from a recipient's
record to a business associate to de-identity the information
in accordance with HIPAA, as specified in 45 CFR 164.514.
(b) As used in this Section:
(1) the terms "disclosure" and "use" shall have the
meanings ascribed to them by HIPAA, as specified in 45 CFR
160.103; and
(2) "facility" means a developmental disability
facility as defined in Section 1-107 of the Mental Health
and Developmental Disabilities Code or a mental health
facility as defined in Section 1-114 of the Mental Health

and Developmental Disabilities Code.
(Source: P.A. 98-378, eff. 8-16-13.)
Article 99. Effective Date