Bill Text: IL HB3547 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: Amends the Public Assistance Fraud Article of the Illinois Public Aid Code. Provides that providers and suppliers of healthcare services under the State's medical assistance program shall be screened by the Department of Healthcare and Family Services prior to being accepted by the State as service providers. Contains provisions concerning screening measures; payment audits; and mandatory compliance plans.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-01-08 - Session Sine Die [HB3547 Detail]

Download: Illinois-2011-HB3547-Introduced.html

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97TH GENERAL ASSEMBLY State of Illinois 2011 and 2012 HB3547 Introduced 2/24/2011, by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
305 ILCS 5/8A-3.5a new
Amends the Public Assistance Fraud Article of the Illinois Public Aid Code. Provides that providers and suppliers of healthcare services under the State's medical assistance program shall be screened by the Department of Healthcare and Family Services prior to being accepted by the State as service providers. Contains provisions concerning screening measures; payment audits; and mandatory compliance plans.
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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
adding Section 8A-3.5a as follows:
(305 ILCS 5/8A-3.5a new)
Sec. 8A-3.5a. Medical assistance abuse and waste;
screening measures for providers and suppliers.
(a) Providers and suppliers of healthcare services under
the State's medical assistance program shall be screened by the
Department of Healthcare and Family Services prior to being
accepted by the State as service providers. Screening measures,
the cost of which may be covered by charging application fees,
shall include, but not be limited to:
(1) Application of accreditation standards.
(2) Proof of business integrity.
(3) Full disclosure of ownership and business
interests.
(4) An initial provisional period with enhanced
oversight.
(5) Onsite verification.
(6) Periodic recertification.
(b) Medical assistance payments to providers and suppliers

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of healthcare services under the medical assistance program
shall be reviewed and audited at regular intervals to ensure
that payments are linked to changes in the marketplace, medical
practice, and medical technology to avoid wasteful
overspending and ensure appropriate payments for the items and
services covered. The appropriate oversight agencies for the
State shall utilize information technology, including
databases that are coordinated with other relevant databases,
and claims-processing mechanisms that are effective in
detecting improper claims before they are paid.
(c) Each provider and supplier of healthcare services under
the medical assistance program shall file a mandatory written
compliance plan as a condition of participation in the program.
The compliance plan shall list and describe in writing the
policies and procedures that will be implemented to ensure
compliance with federal and State regulations and other
requirements designed to control fraud, waste, and abuse,
including procedures to protect the anonymity of complainants
and to protect whistleblowers from retaliation. Each provider
and supplier of healthcare services under the medical
assistance program shall designate a compliance officer and a
compliance committee to monitor the compliance plan, and shall
establish a mechanism, such as an anonymous and confidential
hotline, to receive, record, and respond to compliance
questions.
(d) Each provider and supplier of healthcare services under

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the medical assistance program, and the appropriate oversight
agencies of the State, shall respond swiftly to detected
frauds, promptly remedy program vulnerabilities, and impose
sufficient punishment to deter fraud by medical assistance
providers and suppliers.