|
| | 98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB3693 Introduced , by Rep. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
|
| |
Amends the Medical Assistance Article of the Illinois Public Aid Code. Deletes provisions limiting adult dental services to emergencies. Effective July 1, 2014.
| |
| | |
| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
|
|
| | HB3693 | | LRB098 14190 KTG 48784 b |
|
|
| 1 | | AN ACT concerning public aid.
|
| 2 | | Be it enacted by the People of the State of Illinois,
|
| 3 | | represented in the General Assembly:
|
| 4 | | Section 5. The Illinois Public Aid Code is amended by |
| 5 | | changing Section 5-5f as follows:
|
| 6 | | (305 ILCS 5/5-5f)
|
| 7 | | Sec. 5-5f. Elimination and limitations of medical |
| 8 | | assistance services. Notwithstanding any other provision of |
| 9 | | this Code to the contrary, on and after July 1, 2012: |
| 10 | | (a) The following services shall no longer be a covered |
| 11 | | service available under this Code: group psychotherapy for |
| 12 | | residents of any facility licensed under the Nursing Home Care |
| 13 | | Act or the Specialized Mental Health Rehabilitation Act of |
| 14 | | 2013; and adult chiropractic services. |
| 15 | | (b) The Department shall place the following limitations on |
| 16 | | services: (i) the Department shall limit adult eyeglasses to |
| 17 | | one pair every 2 years; (ii) the Department shall set an annual |
| 18 | | limit of a maximum of 20 visits for each of the following |
| 19 | | services: adult speech, hearing, and language therapy |
| 20 | | services, adult occupational therapy services, and physical |
| 21 | | therapy services; (iii) the Department shall limit adult |
| 22 | | podiatry services to individuals with diabetes; (iv) the |
| 23 | | Department shall pay for caesarean sections at the normal |
|
| | HB3693 | - 2 - | LRB098 14190 KTG 48784 b |
|
|
|
| 1 | | vaginal delivery rate unless a caesarean section was medically |
| 2 | | necessary; (v) (blank) the Department shall limit adult dental |
| 3 | | services to emergencies; beginning July 1, 2013, the Department |
| 4 | | shall ensure that the following conditions are recognized as |
| 5 | | emergencies: (A) dental services necessary for an individual in |
| 6 | | order for the individual to be cleared for a medical procedure, |
| 7 | | such as a transplant;
(B) extractions and dentures necessary |
| 8 | | for a diabetic to receive proper nutrition;
(C) extractions and |
| 9 | | dentures necessary as a result of cancer treatment; and (D) |
| 10 | | dental services necessary for the health of a pregnant woman |
| 11 | | prior to delivery of her baby; and (vi) effective July 1, 2012, |
| 12 | | the Department shall place limitations and require concurrent |
| 13 | | review on every inpatient detoxification stay to prevent repeat |
| 14 | | admissions to any hospital for detoxification within 60 days of |
| 15 | | a previous inpatient detoxification stay. The Department shall |
| 16 | | convene a workgroup of hospitals, substance abuse providers, |
| 17 | | care coordination entities, managed care plans, and other |
| 18 | | stakeholders to develop recommendations for quality standards, |
| 19 | | diversion to other settings, and admission criteria for |
| 20 | | patients who need inpatient detoxification, which shall be |
| 21 | | published on the Department's website no later than September |
| 22 | | 1, 2013. |
| 23 | | (c) The Department shall require prior approval of the |
| 24 | | following services: wheelchair repairs costing more than $400, |
| 25 | | coronary artery bypass graft, and bariatric surgery consistent |
| 26 | | with Medicare standards concerning patient responsibility. |
|
| | HB3693 | - 3 - | LRB098 14190 KTG 48784 b |
|
|
|
| 1 | | Wheelchair repair prior approval requests shall be adjudicated |
| 2 | | within one business day of receipt of complete supporting |
| 3 | | documentation. Providers may not break wheelchair repairs into |
| 4 | | separate claims for purposes of staying under the $400 |
| 5 | | threshold for requiring prior approval. The wholesale price of |
| 6 | | manual and power wheelchairs, durable medical equipment and |
| 7 | | supplies, and complex rehabilitation technology products and |
| 8 | | services shall be defined as actual acquisition cost including |
| 9 | | all discounts. |
| 10 | | (d) The Department shall establish benchmarks for |
| 11 | | hospitals to measure and align payments to reduce potentially |
| 12 | | preventable hospital readmissions, inpatient complications, |
| 13 | | and unnecessary emergency room visits. In doing so, the |
| 14 | | Department shall consider items, including, but not limited to, |
| 15 | | historic and current acuity of care and historic and current |
| 16 | | trends in readmission. The Department shall publish |
| 17 | | provider-specific historical readmission data and anticipated |
| 18 | | potentially preventable targets 60 days prior to the start of |
| 19 | | the program. In the instance of readmissions, the Department |
| 20 | | shall adopt policies and rates of reimbursement for services |
| 21 | | and other payments provided under this Code to ensure that, by |
| 22 | | June 30, 2013, expenditures to hospitals are reduced by, at a |
| 23 | | minimum, $40,000,000. |
| 24 | | (e) The Department shall establish utilization controls |
| 25 | | for the hospice program such that it shall not pay for other |
| 26 | | care services when an individual is in hospice. |
|
| | HB3693 | - 4 - | LRB098 14190 KTG 48784 b |
|
|
|
| 1 | | (f) For home health services, the Department shall require |
| 2 | | Medicare certification of providers participating in the |
| 3 | | program and implement the Medicare face-to-face encounter |
| 4 | | rule. The Department shall require providers to implement |
| 5 | | auditable electronic service verification based on global |
| 6 | | positioning systems or other cost-effective technology. |
| 7 | | (g) For the Home Services Program operated by the |
| 8 | | Department of Human Services and the Community Care Program |
| 9 | | operated by the Department on Aging, the Department of Human |
| 10 | | Services, in cooperation with the Department on Aging, shall |
| 11 | | implement an electronic service verification based on global |
| 12 | | positioning systems or other cost-effective technology. |
| 13 | | (h) Effective with inpatient hospital admissions on or |
| 14 | | after July 1, 2012, the Department shall reduce the payment for |
| 15 | | a claim that indicates the occurrence of a provider-preventable |
| 16 | | condition during the admission as specified by the Department |
| 17 | | in rules. The Department shall not pay for services related to |
| 18 | | an other provider-preventable condition. |
| 19 | | As used in this subsection (h): |
| 20 | | "Provider-preventable condition" means a health care |
| 21 | | acquired condition as defined under the federal Medicaid |
| 22 | | regulation found at 42 CFR 447.26 or an other |
| 23 | | provider-preventable condition. |
| 24 | | "Other provider-preventable condition" means a wrong |
| 25 | | surgical or other invasive procedure performed on a patient, a |
| 26 | | surgical or other invasive procedure performed on the wrong |
|
| | HB3693 | - 5 - | LRB098 14190 KTG 48784 b |
|
|
|
| 1 | | body part, or a surgical procedure or other invasive procedure |
| 2 | | performed on the wrong patient. |
| 3 | | (i) The Department shall implement cost savings |
| 4 | | initiatives for advanced imaging services, cardiac imaging |
| 5 | | services, pain management services, and back surgery. Such |
| 6 | | initiatives shall be designed to achieve annual costs savings.
|
| 7 | | (j) The Department shall ensure that beneficiaries with a |
| 8 | | diagnosis of epilepsy or seizure disorder in Department records |
| 9 | | will not require prior approval for anticonvulsants. |
| 10 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section |
| 11 | | 6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff. |
| 12 | | 7-22-13; revised 9-19-13.)
|