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1 | | AN ACT concerning public aid.
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2 | | Be it enacted by the People of the State of Illinois, |
3 | | represented in the General Assembly:
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4 | | Section 5. The Emergency Medical Services (EMS) Systems |
5 | | Act is amended by changing Section 3.10 as follows:
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6 | | (210 ILCS 50/3.10)
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7 | | Sec. 3.10. Scope of services.
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8 | | (a) "Advanced Life Support (ALS) Services" means
an |
9 | | advanced level of pre-hospital and inter-hospital emergency
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10 | | care and non-emergency medical services that includes basic |
11 | | life
support care, cardiac monitoring, cardiac defibrillation,
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12 | | electrocardiography, intravenous therapy, administration of
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13 | | medications, drugs and solutions, use of adjunctive medical
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14 | | devices, trauma care, and other authorized techniques and
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15 | | procedures, as outlined in the provisions of the National EMS |
16 | | Education Standards relating to Advanced Life Support and any |
17 | | modifications to that curriculum
specified in rules adopted by |
18 | | the Department pursuant to
this Act.
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19 | | That care shall be initiated as authorized by the EMS
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20 | | Medical Director in a Department approved advanced life
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21 | | support EMS System, under the written or verbal direction of
a |
22 | | physician licensed to practice medicine in all of its
branches |
23 | | or under the verbal direction of an Emergency
Communications |
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1 | | Registered Nurse.
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2 | | (b) "Intermediate Life Support (ILS) Services"
means an |
3 | | intermediate level of pre-hospital and inter-hospital
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4 | | emergency care and non-emergency medical services that |
5 | | includes
basic life support care plus intravenous cannulation |
6 | | and
fluid therapy, invasive airway management, trauma care, |
7 | | and
other authorized techniques and procedures, as outlined in
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8 | | the Intermediate Life Support national curriculum of the
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9 | | United States Department of Transportation and any
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10 | | modifications to that curriculum specified in rules adopted
by |
11 | | the Department pursuant to this Act.
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12 | | That care shall be initiated as authorized by the EMS
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13 | | Medical Director in a Department approved intermediate or
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14 | | advanced life support EMS System, under the written or
verbal |
15 | | direction of a physician licensed to practice
medicine in all |
16 | | of its branches or under the verbal
direction of an Emergency |
17 | | Communications Registered Nurse.
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18 | | (c) "Basic Life Support (BLS) Services" means a
basic |
19 | | level of pre-hospital and inter-hospital emergency care and
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20 | | non-emergency medical services that includes medical |
21 | | monitoring, clinical observation, airway management,
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22 | | cardiopulmonary resuscitation (CPR), control of shock and
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23 | | bleeding and splinting of fractures, as outlined in the |
24 | | provisions of the National EMS Education Standards relating to |
25 | | Basic Life Support and any modifications to that
curriculum |
26 | | specified in rules adopted by the Department
pursuant to this |
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1 | | Act.
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2 | | That care shall be initiated, where authorized by the
EMS |
3 | | Medical Director in a Department approved EMS System,
under |
4 | | the written or verbal direction of a physician
licensed to |
5 | | practice medicine in all of its branches or
under the verbal |
6 | | direction of an Emergency Communications
Registered Nurse.
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7 | | (d) "Emergency Medical Responder Services" means a |
8 | | preliminary
level of pre-hospital emergency care that includes
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9 | | cardiopulmonary resuscitation (CPR), monitoring vital signs
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10 | | and control of bleeding, as outlined in the Emergency Medical |
11 | | Responder (EMR) curriculum of the National EMS Education |
12 | | Standards
and any modifications to that curriculum specified |
13 | | in rules
adopted by the Department pursuant to this Act.
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14 | | (e) "Pre-hospital care" means those
medical services |
15 | | rendered to patients for analytic,
resuscitative, stabilizing, |
16 | | or preventive purposes,
precedent to and during transportation |
17 | | of such patients to
health care facilities.
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18 | | (f) "Inter-hospital care" means those
medical services |
19 | | rendered to patients for
analytic, resuscitative, stabilizing, |
20 | | or preventive
purposes, during transportation of such patients |
21 | | from one
hospital to another hospital.
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22 | | (f-5) "Critical care transport" means transportation which |
23 | | includes the provision of pre-hospital or inter-hospital |
24 | | emergency care or non-emergency medical services to |
25 | | transportation of a critically injured or ill patient by a |
26 | | vehicle service provider, including the provision of medically |
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1 | | necessary supplies and services, at a level of service beyond |
2 | | the scope of the Paramedic. When medically indicated for a |
3 | | patient, as determined by a physician licensed to practice |
4 | | medicine in all of its branches, an advanced practice |
5 | | registered nurse, or a physician physician's assistant, in |
6 | | compliance with subsections (b) and (c) of Section 3.155 of |
7 | | this Act, critical care transport may be provided by: |
8 | | (1) Department-approved critical care transport |
9 | | providers, not owned or operated by a hospital, utilizing |
10 | | Paramedics with additional training, nurses, or other |
11 | | qualified health professionals; or |
12 | | (2) Hospitals, when utilizing any vehicle service |
13 | | provider or any hospital-owned or operated vehicle service |
14 | | provider. Nothing in Public Act 96-1469 requires a |
15 | | hospital to use, or to be, a Department-approved critical |
16 | | care transport provider when transporting patients, |
17 | | including those critically injured or ill. Nothing in this |
18 | | Act shall restrict or prohibit a hospital from providing, |
19 | | or arranging for, the medically appropriate transport of |
20 | | any patient, as determined by a physician licensed to |
21 | | practice in all of its branches, an advanced practice |
22 | | registered nurse, or a physician physician's assistant. |
23 | | (g) "Non-emergency medical services" means the provision |
24 | | of, and all actions necessary before and after the provision |
25 | | of, Basic Life Support (BLS) Services, Advanced Life Support |
26 | | (ALS) Services, and critical care transport to
patients whose |
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1 | | conditions do not meet this Act's definition of emergency, |
2 | | before, after, or
during transportation of such patients to or |
3 | | from health care facilities visited for the
purpose of |
4 | | obtaining medical or health care services which are not |
5 | | emergency in
nature, using a vehicle regulated by this Act and |
6 | | personnel licensed under this Act.
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7 | | (g-5) The Department shall have the authority to |
8 | | promulgate minimum standards for critical care transport |
9 | | providers through rules adopted pursuant to this Act. All |
10 | | critical care transport providers must function within a |
11 | | Department-approved EMS System. Nothing in Department rules |
12 | | shall restrict a hospital's ability to furnish personnel, |
13 | | equipment, and medical supplies to any vehicle service |
14 | | provider, including a critical care transport provider. |
15 | | Minimum critical care transport provider standards shall |
16 | | include, but are not limited to: |
17 | | (1) Personnel staffing and licensure. |
18 | | (2) Education, certification, and experience. |
19 | | (3) Medical equipment and supplies. |
20 | | (4) Vehicular standards. |
21 | | (5) Treatment and transport protocols. |
22 | | (6) Quality assurance and data collection. |
23 | | (h)
The provisions of this Act shall not apply to
the use |
24 | | of an ambulance or SEMSV, unless and until
emergency or |
25 | | non-emergency medical services are needed
during the use of |
26 | | the ambulance or SEMSV.
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1 | | (Source: P.A. 102-623, eff. 8-27-21; revised 12-1-21.)
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2 | | Section 10. The Illinois Public Aid Code is amended by |
3 | | changing Section 5-4.2 and by adding Section 5-30c as follows:
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4 | | (305 ILCS 5/5-4.2)
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5 | | Sec. 5-4.2. Ambulance services payments. |
6 | | (a) For
ambulance
services provided to a recipient of aid |
7 | | under this Article on or after
January 1, 1993, the Illinois |
8 | | Department shall reimburse ambulance service
providers at |
9 | | rates calculated in accordance with this Section. It is the |
10 | | intent
of the General Assembly to provide adequate |
11 | | reimbursement for ambulance
services so as to ensure adequate |
12 | | access to services for recipients of aid
under this Article |
13 | | and to provide appropriate incentives to ambulance service
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14 | | providers to provide services in an efficient and |
15 | | cost-effective manner. Thus,
it is the intent of the General |
16 | | Assembly that the Illinois Department implement
a |
17 | | reimbursement system for ambulance services that, to the |
18 | | extent practicable
and subject to the availability of funds |
19 | | appropriated by the General Assembly
for this purpose, is |
20 | | consistent with the payment principles of Medicare. To
ensure |
21 | | uniformity between the payment principles of Medicare and |
22 | | Medicaid, the
Illinois Department shall follow, to the extent |
23 | | necessary and practicable and
subject to the availability of |
24 | | funds appropriated by the General Assembly for
this purpose, |
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1 | | the statutes, laws, regulations, policies, procedures,
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2 | | principles, definitions, guidelines, and manuals used to |
3 | | determine the amounts
paid to ambulance service providers |
4 | | under Title XVIII of the Social Security
Act (Medicare).
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5 | | (b) For ambulance services provided to a recipient of aid |
6 | | under this Article
on or after January 1, 1996, the Illinois |
7 | | Department shall reimburse ambulance
service providers based |
8 | | upon the actual distance traveled if a natural
disaster, |
9 | | weather conditions, road repairs, or traffic congestion |
10 | | necessitates
the use of a
route other than the most direct |
11 | | route.
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12 | | (c) For purposes of this Section, "ambulance services" |
13 | | includes medical
transportation services provided by means of |
14 | | an ambulance, medi-car, service
car, or
taxi.
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15 | | (c-1) For purposes of this Section, "ground ambulance |
16 | | service" means medical transportation services that are |
17 | | described as ground ambulance services by the Centers for |
18 | | Medicare and Medicaid Services and provided in a vehicle that |
19 | | is licensed as an ambulance by the Illinois Department of |
20 | | Public Health pursuant to the Emergency Medical Services (EMS) |
21 | | Systems Act. |
22 | | (c-2) For purposes of this Section, "ground ambulance |
23 | | service provider" means a vehicle service provider as |
24 | | described in the Emergency Medical Services (EMS) Systems Act |
25 | | that operates licensed ambulances for the purpose of providing |
26 | | emergency ambulance services, or non-emergency ambulance |
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1 | | services, or both. For purposes of this Section, this includes |
2 | | both ambulance providers and ambulance suppliers as described |
3 | | by the Centers for Medicare and Medicaid Services. |
4 | | (c-3) For purposes of this Section, "medi-car" means |
5 | | transportation services provided to a patient who is confined |
6 | | to a wheelchair and requires the use of a hydraulic or electric |
7 | | lift or ramp and wheelchair lockdown when the patient's |
8 | | condition does not require medical observation, medical |
9 | | supervision, medical equipment, the administration of |
10 | | medications, or the administration of oxygen. |
11 | | (c-4) For purposes of this Section, "service car" means |
12 | | transportation services provided to a patient by a passenger |
13 | | vehicle where that patient does not require the specialized |
14 | | modes described in subsection (c-1) or (c-3). |
15 | | (d) This Section does not prohibit separate billing by |
16 | | ambulance service
providers for oxygen furnished while |
17 | | providing advanced life support
services.
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18 | | (e) Beginning with services rendered on or after July 1, |
19 | | 2008, all providers of non-emergency medi-car and service car |
20 | | transportation must certify that the driver and employee |
21 | | attendant, as applicable, have completed a safety program |
22 | | approved by the Department to protect both the patient and the |
23 | | driver, prior to transporting a patient.
The provider must |
24 | | maintain this certification in its records. The provider shall |
25 | | produce such documentation upon demand by the Department or |
26 | | its representative. Failure to produce documentation of such |
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1 | | training shall result in recovery of any payments made by the |
2 | | Department for services rendered by a non-certified driver or |
3 | | employee attendant. Medi-car and service car providers must |
4 | | maintain legible documentation in their records of the driver |
5 | | and, as applicable, employee attendant that actually |
6 | | transported the patient. Providers must recertify all drivers |
7 | | and employee attendants every 3 years.
If they meet the |
8 | | established training components set forth by the Department, |
9 | | providers of non-emergency medi-car and service car |
10 | | transportation that are either directly or through an |
11 | | affiliated company licensed by the Department of Public Health |
12 | | shall be approved by the Department to have in-house safety |
13 | | programs for training their own staff. |
14 | | Notwithstanding the requirements above, any public |
15 | | transportation provider of medi-car and service car |
16 | | transportation that receives federal funding under 49 U.S.C. |
17 | | 5307 and 5311 need not certify its drivers and employee |
18 | | attendants under this Section, since safety training is |
19 | | already federally mandated.
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20 | | (f) With respect to any policy or program administered by |
21 | | the Department or its agent regarding approval of |
22 | | non-emergency medical transportation by ground ambulance |
23 | | service providers, including, but not limited to, the |
24 | | Non-Emergency Transportation Services Prior Approval Program |
25 | | (NETSPAP), the Department shall establish by rule a process by |
26 | | which ground ambulance service providers of non-emergency |
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1 | | medical transportation may appeal any decision by the |
2 | | Department or its agent for which no denial was received prior |
3 | | to the time of transport that either (i) denies a request for |
4 | | approval for payment of non-emergency transportation by means |
5 | | of ground ambulance service or (ii) grants a request for |
6 | | approval of non-emergency transportation by means of ground |
7 | | ambulance service at a level of service that entitles the |
8 | | ground ambulance service provider to a lower level of |
9 | | compensation from the Department than the ground ambulance |
10 | | service provider would have received as compensation for the |
11 | | level of service requested. The rule shall be filed by |
12 | | December 15, 2012 and shall provide that, for any decision |
13 | | rendered by the Department or its agent on or after the date |
14 | | the rule takes effect, the ground ambulance service provider |
15 | | shall have 60 days from the date the decision is received to |
16 | | file an appeal. The rule established by the Department shall |
17 | | be, insofar as is practical, consistent with the Illinois |
18 | | Administrative Procedure Act. The Director's decision on an |
19 | | appeal under this Section shall be a final administrative |
20 | | decision subject to review under the Administrative Review |
21 | | Law. |
22 | | (f-5) Beginning 90 days after July 20, 2012 (the effective |
23 | | date of Public Act 97-842), (i) no denial of a request for |
24 | | approval for payment of non-emergency transportation by means |
25 | | of ground ambulance service, and (ii) no approval of |
26 | | non-emergency transportation by means of ground ambulance |
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1 | | service at a level of service that entitles the ground |
2 | | ambulance service provider to a lower level of compensation |
3 | | from the Department than would have been received at the level |
4 | | of service submitted by the ground ambulance service provider, |
5 | | may be issued by the Department or its agent unless the |
6 | | Department has submitted the criteria for determining the |
7 | | appropriateness of the transport for first notice publication |
8 | | in the Illinois Register pursuant to Section 5-40 of the |
9 | | Illinois Administrative Procedure Act. |
10 | | (f-6) Within 90 days after the effective date of this |
11 | | amendatory Act of the 102nd General Assembly, the Department |
12 | | shall adjust the criteria established under subsection (f-5) |
13 | | by striking any reference to prohibiting approval of ground |
14 | | ambulance services when the sole purpose of the transport is |
15 | | for the navigation of stairs or the assisting or lifting of a |
16 | | patient at a medical facility or during a medical appointment. |
17 | | It is the intent of the General Assembly to permit ground |
18 | | ambulance reimbursement for lifting, moving, or navigating |
19 | | stairs in instances when a recipient exhibits extenuating |
20 | | circumstances related to the social determinants of health |
21 | | which would make an otherwise non-eligible ground ambulance |
22 | | transport eligible for reimbursement. Such extenuating |
23 | | circumstances may include a condition which would present an |
24 | | unreasonable risk for the patient to navigate the stairs |
25 | | without the assistance of medically trained ground ambulance |
26 | | personnel. Such extenuating circumstances may be established |
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1 | | through the completion of a Physician Certification Statement |
2 | | as set forth in subsection (g). |
3 | | (f-7) For non-emergency ground ambulance claims properly |
4 | | denied under Department policy at the time the claim is filed |
5 | | due to failure to submit a valid Medical Certification for |
6 | | Non-Emergency Ambulance on and after December 15, 2012 and |
7 | | prior to January 1, 2021, the Department shall allot |
8 | | $2,000,000 to a pool to reimburse such claims if the provider |
9 | | proves medical necessity for the service by other means. |
10 | | Providers must submit any such denied claims for which they |
11 | | seek compensation to the Department no later than December 31, |
12 | | 2021 along with documentation of medical necessity. No later |
13 | | than May 31, 2022, the Department shall determine for which |
14 | | claims medical necessity was established. Such claims for |
15 | | which medical necessity was established shall be paid at the |
16 | | rate in effect at the time of the service, provided the |
17 | | $2,000,000 is sufficient to pay at those rates. If the pool is |
18 | | not sufficient, claims shall be paid at a uniform percentage |
19 | | of the applicable rate such that the pool of $2,000,000 is |
20 | | exhausted. The appeal process described in subsection (f) |
21 | | shall not be applicable to the Department's determinations |
22 | | made in accordance with this subsection. |
23 | | (g) Whenever a patient covered by a medical assistance |
24 | | program under this Code or by another medical program |
25 | | administered by the Department, including a patient covered |
26 | | under the State's Medicaid managed care program, is being |
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1 | | transported from a facility and requires non-emergency |
2 | | transportation including ground ambulance, medi-car, or |
3 | | service car transportation, a Physician Certification |
4 | | Statement as described in this Section shall be required for |
5 | | each patient. Facilities shall develop procedures for a |
6 | | licensed medical professional to provide a written and signed |
7 | | Physician Certification Statement. The Physician Certification |
8 | | Statement shall specify the level of transportation services |
9 | | needed and complete a medical certification establishing the |
10 | | criteria for approval of non-emergency ambulance |
11 | | transportation, as published by the Department of Healthcare |
12 | | and Family Services, that is met by the patient. This |
13 | | certification shall be completed prior to ordering the |
14 | | transportation service and prior to patient discharge. The |
15 | | Physician Certification Statement is not required prior to |
16 | | transport if a delay in transport can be expected to |
17 | | negatively affect the patient outcome. If the ground ambulance |
18 | | provider, medi-car provider, or service car provider is unable |
19 | | to obtain the required Physician Certification Statement |
20 | | within 10 calendar days following the date of the service, the |
21 | | ground ambulance provider, medi-car provider, or service car |
22 | | provider must document its attempt to obtain the requested |
23 | | certification and may then submit the claim for payment. |
24 | | Acceptable documentation includes a signed return receipt from |
25 | | the U.S. Postal Service, facsimile receipt, email receipt, or |
26 | | other similar service that evidences that the ground ambulance |
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1 | | provider, medi-car provider, or service car provider attempted |
2 | | to obtain the required Physician Certification Statement. |
3 | | The medical certification specifying the level and type of |
4 | | non-emergency transportation needed shall be in the form of |
5 | | the Physician Certification Statement on a standardized form |
6 | | prescribed by the Department of Healthcare and Family |
7 | | Services. Within 75 days after July 27, 2018 (the effective |
8 | | date of Public Act 100-646), the Department of Healthcare and |
9 | | Family Services shall develop a standardized form of the |
10 | | Physician Certification Statement specifying the level and |
11 | | type of transportation services needed in consultation with |
12 | | the Department of Public Health, Medicaid managed care |
13 | | organizations, a statewide association representing ambulance |
14 | | providers, a statewide association representing hospitals, 3 |
15 | | statewide associations representing nursing homes, and other |
16 | | stakeholders. The Physician Certification Statement shall |
17 | | include, but is not limited to, the criteria necessary to |
18 | | demonstrate medical necessity for the level of transport |
19 | | needed as required by (i) the Department of Healthcare and |
20 | | Family Services and (ii) the federal Centers for Medicare and |
21 | | Medicaid Services as outlined in the Centers for Medicare and |
22 | | Medicaid Services' Medicare Benefit Policy Manual, Pub. |
23 | | 100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician |
24 | | Certification Statement shall satisfy the obligations of |
25 | | hospitals under Section 6.22 of the Hospital Licensing Act and |
26 | | nursing homes under Section 2-217 of the Nursing Home Care |
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1 | | Act. Implementation and acceptance of the Physician |
2 | | Certification Statement shall take place no later than 90 days |
3 | | after the issuance of the Physician Certification Statement by |
4 | | the Department of Healthcare and Family Services. |
5 | | Pursuant to subsection (E) of Section 12-4.25 of this |
6 | | Code, the Department is entitled to recover overpayments paid |
7 | | to a provider or vendor, including, but not limited to, from |
8 | | the discharging physician, the discharging facility, and the |
9 | | ground ambulance service provider, in instances where a |
10 | | non-emergency ground ambulance service is rendered as the |
11 | | result of improper or false certification. |
12 | | Beginning October 1, 2018, the Department of Healthcare |
13 | | and Family Services shall collect data from Medicaid managed |
14 | | care organizations and transportation brokers, including the |
15 | | Department's NETSPAP broker, regarding denials and appeals |
16 | | related to the missing or incomplete Physician Certification |
17 | | Statement forms and overall compliance with this subsection. |
18 | | The Department of Healthcare and Family Services shall publish |
19 | | quarterly results on its website within 15 days following the |
20 | | end of each quarter. |
21 | | (h) On and after July 1, 2012, the Department shall reduce |
22 | | any rate of reimbursement for services or other payments or |
23 | | alter any methodologies authorized by this Code to reduce any |
24 | | rate of reimbursement for services or other payments in |
25 | | accordance with Section 5-5e. |
26 | | (i) On and after July 1, 2018, the Department shall |
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1 | | increase the base rate of reimbursement for both base charges |
2 | | and mileage charges for ground ambulance service providers for |
3 | | medical transportation services provided by means of a ground |
4 | | ambulance to a level not lower than rates 112% of the base rate |
5 | | in effect as of July 1, 2021 June 30, 2018 . |
6 | | (k) Within 90 days after the effective date of this |
7 | | amendatory Act of the 102nd General Assembly, the Department |
8 | | shall establish a methodology for providing reimbursement for: |
9 | | (i) bariatric transports at an amount of one additional base |
10 | | rate for each additional 2 personnel necessary to safely move |
11 | | the patient; and (ii) specialty care transports to include |
12 | | transports originating or terminating at a residence and for |
13 | | intra-facility transports. |
14 | | (Source: P.A. 101-81, eff. 7-12-19; 101-649, eff. 7-7-20; |
15 | | 102-364, eff. 1-1-22; 102-650, eff. 8-27-21; revised 11-8-21.)
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16 | | (305 ILCS 5/5-30c new) |
17 | | Sec. 5-30c. Medi-car and stretcher van services; rate |
18 | | increase. To ensure access to medical appointments and covered |
19 | | services and realize the objectives of the medical assistance |
20 | | program, the General Assembly must address the inadequate |
21 | | supply of non-emergency medical transportation providers |
22 | | across the State. To increase access to non-emergency |
23 | | transportation services, the Department shall increase the |
24 | | base rate for medi-car and stretcher van services to at least |
25 | | $50, and the rate of each attendant for medi-car and stretcher |
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1 | | van services to at least $50. This reimbursement rate shall |
2 | | only apply to stretcher van providers licensed by the |
3 | | Department of Public Health in accordance with Section 3.86 of |
4 | | the Emergency Medical Services (EMS) Systems Act. The |
5 | | Department shall establish a grant program for the purpose of |
6 | | building capacity among IMPACT-enrolled and BEP-certified |
7 | | providers of medi-car and stretcher van transportation |
8 | | services.
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9 | | Section 99. Effective date. This Act takes effect upon |
10 | | becoming law.
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