Bill Text: IL HB3693 | 2013-2014 | 98th General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Deletes provisions limiting adult dental services to emergencies. Effective July 1, 2014.

Spectrum: Partisan Bill (Democrat 18-0)

Status: (Failed) 2014-12-03 - Session Sine Die [HB3693 Detail]

Download: Illinois-2013-HB3693-Introduced.html

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98TH GENERAL ASSEMBLY State of Illinois 2013 and 2014 HB3693 Introduced , by Rep. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5f
Amends the Medical Assistance Article of the Illinois Public Aid Code. Deletes provisions limiting adult dental services to emergencies. Effective July 1, 2014.
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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; (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 adult
podiatry services to individuals with diabetes; (iv) the
Department shall pay for caesarean sections at the normal

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vaginal delivery rate unless a caesarean section was medically
necessary; (v) (blank) 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; 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, 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.

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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
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.

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(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
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

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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 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; revised 9-19-13.)