Bill Text: IL HB2503 | 2013-2014 | 98th General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall require prior approval of wheelchair repairs when the cost of any one part is greater than or equal to $500 per line item, when the sum of the parts is greater than or equal to a total of $1,500, or when 8 or more units of labor are to be billed (rather than shall require prior approval of wheelchair repairs regardless of the cost of repairs). Provides that the payment rate for custom manual wheelchairs, power wheelchairs, seating and positioning items, and related options and accessories shall be set at the current Medicare fee schedule minus 6%; and that for those items that do not have an established rate on the Medicare fee schedule, the payment rate shall be the manufacturer's suggested retail price minus 10%. Effective immediately.

Spectrum: Bipartisan Bill

Status: (Failed) 2014-12-03 - Session Sine Die [HB2503 Detail]

Download: Illinois-2013-HB2503-Introduced.html

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98TH GENERAL ASSEMBLY State of Illinois 2013 and 2014 HB2503 Introduced , by Rep. Esther Golar SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5f
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall require prior approval of wheelchair repairs when the cost of any one part is greater than or equal to $500 per line item, when the sum of the parts is greater than or equal to a total of $1,500, or when 8 or more units of labor are to be billed (rather than shall require prior approval of wheelchair repairs regardless of the cost of repairs). Provides that the payment rate for custom manual wheelchairs, power wheelchairs, seating and positioning items, and related options and accessories shall be set at the current Medicare fee schedule minus 6%; and that for those items that do not have an established rate on the Medicare fee schedule, the payment rate shall be the manufacturer's suggested retail price minus 10%. 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 5-5f as follows:
(305 ILCS 5/5-5f)
Sec. 5-5f. Elimination and limitations of medical
assistance services. Notwithstanding any other provision of
this Code to the contrary, on and after July 1, 2012:
(a) The following services shall no longer be a covered
service available under this Code: group psychotherapy for
residents of any facility licensed under the Nursing Home Care
Act or the Specialized Mental Health Rehabilitation Act; and
adult chiropractic services.
(b) The Department shall place the following limitations on
services: (i) the Department shall limit adult eyeglasses to
one pair every 2 years; (ii) the Department shall set an annual
limit of a maximum of 20 visits for each of the following
services: adult speech, hearing, and language therapy
services, adult occupational therapy services, and physical
therapy services; (iii) the Department shall limit podiatry
services to individuals with diabetes; (iv) the Department
shall pay for caesarean sections at the normal vaginal delivery

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rate unless a caesarean section was medically necessary; (v)
the Department shall limit adult dental services to
emergencies; and (vi) effective July 1, 2012, the Department
shall place limitations and require concurrent review on every
inpatient detoxification stay to prevent repeat admissions to
any hospital for detoxification within 60 days of a previous
inpatient detoxification stay. The Department shall convene a
workgroup of hospitals, substance abuse providers, care
coordination entities, managed care plans, and other
stakeholders to develop recommendations for quality standards,
diversion to other settings, and admission criteria for
patients who need inpatient detoxification.
(c) The Department shall require prior approval of the
following services: wheelchair repairs when the cost of any one
part is greater than or equal to $500 per line item, when the
sum of the parts is greater than or equal to a total of $1,500,
or when 8 or more units of labor are to be billed; , regardless
of the cost of the repairs, coronary artery bypass graft; , and
bariatric surgery consistent with Medicare standards
concerning patient responsibility. The payment rate for custom
manual wheelchairs, power wheelchairs, seating and positioning
items, and related options and accessories shall be set at the
current Medicare fee schedule minus 6%. For those items that do
not have an established rate on the Medicare fee schedule, the
payment rate shall be the manufacturer's suggested retail price
minus 10%. The wholesale cost of power wheelchairs shall be

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actual acquisition cost including all discounts.
(d) The Department shall establish benchmarks for
hospitals to measure and align payments to reduce potentially
preventable hospital readmissions, inpatient complications,
and unnecessary emergency room visits. In doing so, the
Department shall consider items, including, but not limited to,
historic and current acuity of care and historic and current
trends in readmission. The Department shall publish
provider-specific historical readmission data and anticipated
potentially preventable targets 60 days prior to the start of
the program. In the instance of readmissions, the Department
shall adopt policies and rates of reimbursement for services
and other payments provided under this Code to ensure that, by
June 30, 2013, expenditures to hospitals are reduced by, at a
minimum, $40,000,000.
(e) The Department shall establish utilization controls
for the hospice program such that it shall not pay for other
care services when an individual is in hospice.
(f) For home health services, the Department shall require
Medicare certification of providers participating in the
program, implement the Medicare face-to-face encounter rule,
and limit services to post-hospitalization. The Department
shall require providers to implement auditable electronic
service verification based on global positioning systems or
other cost-effective technology.
(g) For the Home Services Program operated by the

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Department of Human Services and the Community Care Program
operated by the Department on Aging, the Department of Human
Services, in cooperation with the Department on Aging, shall
implement an electronic service verification based on global
positioning systems or other cost-effective technology.
(h) The Department shall not pay for hospital admissions
when the claim indicates a hospital acquired condition that
would cause Medicare to reduce its payment on the claim had the
claim been submitted to Medicare, nor shall the Department pay
for hospital admissions where a Medicare identified "never
event" occurred.
(i) The Department shall implement cost savings
initiatives for advanced imaging services, cardiac imaging
services, pain management services, and back surgery. Such
initiatives shall be designed to achieve annual costs savings.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 99. Effective date. This Act takes effect upon
becoming law.