Bill Text: IL HB2909 | 2017-2018 | 100th General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision limiting medical assistance recipients to one pair of adult eyeglasses every 2 years, provides that the limitation does not apply to an individual who needs different eyeglasses following a surgical procedure such as cataract surgery. Effective immediately.

Spectrum: Moderate Partisan Bill (Democrat 8-1)

Status: (Passed) 2017-08-18 - Public Act . . . . . . . . . 100-0135 [HB2909 Detail]

Download: Illinois-2017-HB2909-Introduced.html

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100TH GENERAL ASSEMBLY State of Illinois 2017 and 2018 HB2909 Introduced , by Rep. Robyn Gabel SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5f
Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision limiting medical assistance recipients to one pair of adult eyeglasses every 2 years, provides that the limitation does not apply to an individual who needs different eyeglasses following a surgical procedure such as cataract surgery. 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 of 2013; 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; however, the
limitation does not apply to an individual who needs
different eyeglasses following a surgical procedure such
as cataract surgery; (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

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physical therapy services; on or after October 1, 2014, the
annual maximum limit of 20 visits shall expire but the
Department shall require prior approval for all
individuals for speech, hearing, and language therapy
services, occupational therapy services, and physical
therapy services; (iii) the Department shall limit adult
podiatry services to individuals with diabetes; on or after
October 1, 2014, podiatry services shall not be limited to
individuals with diabetes; (iv) the Department shall pay
for caesarean sections at the normal vaginal delivery rate
unless a caesarean section was medically necessary; (v) the
Department shall limit adult dental services to
emergencies; beginning July 1, 2013, the Department shall
ensure that the following conditions are recognized as
emergencies: (A) dental services necessary for an
individual in order for the individual to be cleared for a
medical procedure, such as a transplant; (B) extractions
and dentures necessary for a diabetic to receive proper
nutrition; (C) extractions and dentures necessary as a
result of cancer treatment; and (D) dental services
necessary for the health of a pregnant woman prior to
delivery of her baby; on or after July 1, 2014, adult
dental services shall no longer be limited to emergencies,
and dental services necessary for the health of a pregnant
woman prior to delivery of her baby shall continue to be
covered; and (vi) effective July 1, 2012, the Department

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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, which shall be published on the
Department's website no later than September 1, 2013.
(c) The Department shall require prior approval of the
following services: wheelchair repairs costing more than
$400, coronary artery bypass graft, and bariatric surgery
consistent with Medicare standards concerning patient
responsibility. Wheelchair repair prior approval requests
shall be adjudicated within one business day of receipt of
complete supporting documentation. Providers may not break
wheelchair repairs into separate claims for purposes of
staying under the $400 threshold for requiring prior
approval. The wholesale price of manual and power
wheelchairs, durable medical equipment and supplies, and
complex rehabilitation technology products and services
shall be defined as actual acquisition cost including all
discounts.
(d) The Department shall establish benchmarks for

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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 and implement the Medicare face-to-face
encounter rule. 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
Department of Human Services and the Community Care Program

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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) Effective with inpatient hospital admissions on or
after July 1, 2012, the Department shall reduce the payment
for a claim that indicates the occurrence of a
provider-preventable condition during the admission as
specified by the Department in rules. The Department shall
not pay for services related to an other
provider-preventable condition.
As used in this subsection (h):
"Provider-preventable condition" means a health care
acquired condition as defined under the federal Medicaid
regulation found at 42 CFR 447.26 or an other
provider-preventable condition.
"Other provider-preventable condition" means a wrong
surgical or other invasive procedure performed on a
patient, a surgical or other invasive procedure performed
on the wrong body part, or a surgical procedure or other
invasive procedure performed on the wrong patient.
(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

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savings.
(j) The Department shall ensure that beneficiaries
with a diagnosis of epilepsy or seizure disorder in
Department records will not require prior approval for
anticonvulsants.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff.
7-22-13; 98-651, eff. 6-16-14; 98-756, eff. 7-16-14.)
Section 99. Effective date. This Act takes effect upon
becoming law.