Bill Text: IL SB2957 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to implement an average commercial rate supplemental payment program for ground ambulance service providers for dates of service beginning no later than July 1, 2016. Provides that no later than September 30, 2016, the Department must submit to the federal Centers for Medicare and Medicaid Services (CMS) a State plan amendment to implement an average commercial rate supplemental payment program. Provides that the Department must require managed care organizations, including managed care community networks, to pay the CMS approved average commercial rates in coordination with the Department. Effective immediately.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2016-07-31 - Pursuant to Senate Rule 3-9(b) / Referred to Assignments [SB2957 Detail]

Download: Illinois-2015-SB2957-Introduced.html

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99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 SB2957 Introduced 2/18/2016, by Sen. Antonio Muñoz SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-4.2 from Ch. 23, par. 5-4.2
Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to implement an average commercial rate supplemental payment program for ground ambulance service providers for dates of service beginning no later that July 1, 2016. Provides that no later than September 30, 2016, the Department must submit to the federal Centers for Medicare and Medicaid Services (CMS) a State plan amendment to implement an average commercial rate supplemental payment program. Provides that the Department must require managed care organizations, including managed care community networks, to pay the CMS approved average commercial rates in coordination with the Department. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 5-4.2 as follows:
(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
Sec. 5-4.2. Ambulance services payments.
(a) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1993, the Illinois
Department shall reimburse ambulance service providers at
rates calculated in accordance with this Section. It is the
intent of the General Assembly to provide adequate
reimbursement for ambulance services so as to ensure adequate
access to services for recipients of aid under this Article and
to provide appropriate incentives to ambulance service
providers to provide services in an efficient and
cost-effective manner. Thus, it is the intent of the General
Assembly that the Illinois Department implement a
reimbursement system for ambulance services that, to the extent
practicable and subject to the availability of funds
appropriated by the General Assembly for this purpose, is
consistent with the payment principles of Medicare. To ensure
uniformity between the payment principles of Medicare and

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

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in the Emergency Medical Services (EMS) Systems Act that
operates licensed ambulances for the purpose of providing
emergency ambulance services, or non-emergency ambulance
services, or both. For purposes of this Section, this includes
both ambulance providers and ambulance suppliers as described
by the Centers for Medicare and Medicaid Services.
(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

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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

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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 is being discharged from a
facility, a physician discharge order as described in this
Section shall be required for each patient whose discharge
requires medically supervised ground ambulance services.

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Facilities shall develop procedures for a physician with
medical staff privileges to provide a written and signed
physician discharge order. The physician discharge order shall
specify the level of ground ambulance 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 order and the medical
certification shall be completed prior to ordering an ambulance
service and prior to patient discharge.
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.
(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) The Department must implement an average commercial
rate supplemental payment program for ground ambulance service
providers for dates of service beginning no later that July 1,
2016. No later than September 30, 2016, the Department must

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submit to the federal Centers for Medicare and Medicaid
Services (CMS) a State plan amendment to implement an average
commercial rate supplemental payment program. The Department
must require managed care organizations as defined in Section
5-30.1 of this Code, including managed care community networks
as defined in Section 5-11 of this Code, to pay the CMS
approved average commercial rates in coordination with the
Department.
(Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12;
97-842, eff. 7-20-12; 98-463, eff. 8-16-13.)
Section 99. Effective date. This Act takes effect upon
becoming law.