Bill Text: IL SB0636 | 2013-2014 | 98th General Assembly | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Public Utilities Act. Makes a technical change in a Section concerning the short title and applicability of the Electric Service Customer Choice and Rate Relief Law of 1997.
Spectrum: Partisan Bill (Democrat 27-0)
Status: (Failed) 2015-01-13 - Session Sine Die [SB0636 Detail]
Download: Illinois-2013-SB0636-Engrossed.html
Bill Title: Amends the Public Utilities Act. Makes a technical change in a Section concerning the short title and applicability of the Electric Service Customer Choice and Rate Relief Law of 1997.
Spectrum: Partisan Bill (Democrat 27-0)
Status: (Failed) 2015-01-13 - Session Sine Die [SB0636 Detail]
Download: Illinois-2013-SB0636-Engrossed.html
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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5-4.2 as follows:
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6 | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
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7 | Sec. 5-4.2. Ambulance services payments. | ||||||
8 | (a) For
ambulance
services provided to a recipient of aid | ||||||
9 | under this Article on or after
January 1, 1993, the Illinois | ||||||
10 | Department shall reimburse ambulance service
providers at | ||||||
11 | rates calculated in accordance with this Section. It is the | ||||||
12 | intent
of the General Assembly to provide adequate | ||||||
13 | reimbursement for ambulance
services so as to ensure adequate | ||||||
14 | access to services for recipients of aid
under this Article and | ||||||
15 | to provide appropriate incentives to ambulance service
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16 | providers to provide services in an efficient and | ||||||
17 | cost-effective manner. It is also the intent of the General | ||||||
18 | Assembly to ensure that ambulance service providers are | ||||||
19 | appropriately reimbursed for medically necessary ambulance | ||||||
20 | services by requiring the Illinois Department to adopt, by | ||||||
21 | rule, criteria establishing medical necessity and appropriate | ||||||
22 | procedures for the processing of claims for reimbursement. | ||||||
23 | Thus,
it is the intent of the General Assembly that the |
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1 | Illinois Department implement
a reimbursement system for | ||||||
2 | ambulance services that, to the extent practicable
and subject | ||||||
3 | to the availability of funds appropriated by the General | ||||||
4 | Assembly
for this purpose, is consistent with the payment | ||||||
5 | principles of Medicare. To
ensure uniformity between the | ||||||
6 | payment principles of Medicare and Medicaid, the
Illinois | ||||||
7 | Department shall follow, to the extent necessary and | ||||||
8 | practicable and
subject to the availability of funds | ||||||
9 | appropriated by the General Assembly for
this purpose, the | ||||||
10 | statutes, laws, regulations, policies, procedures,
principles, | ||||||
11 | definitions, guidelines, and manuals used to determine the | ||||||
12 | amounts
paid to ambulance service providers under Title XVIII | ||||||
13 | of the Social Security
Act (Medicare).
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14 | (b) For ambulance services provided to a recipient of aid | ||||||
15 | under this Article
on or after January 1, 1996, the Illinois | ||||||
16 | Department shall reimburse ambulance
service providers based | ||||||
17 | upon the actual distance traveled if a natural
disaster, | ||||||
18 | weather conditions, road repairs, or traffic congestion | ||||||
19 | necessitates
the use of a
route other than the most direct | ||||||
20 | route.
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21 | (c) For purposes of this Section, "ambulance services" | ||||||
22 | includes medical
transportation services provided by means of | ||||||
23 | an ambulance, medi-car, service
car, or
taxi.
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24 | (c-1) For purposes of this Section, "ground ambulance | ||||||
25 | service" means medical transportation services that are | ||||||
26 | described as ground ambulance services by the Centers for |
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1 | Medicare and Medicaid Services and provided in a vehicle that | ||||||
2 | is licensed as an ambulance by the Illinois Department of | ||||||
3 | Public Health pursuant to the Emergency Medical Services (EMS) | ||||||
4 | Systems Act. | ||||||
5 | (c-2) For purposes of this Section, "ground ambulance | ||||||
6 | service provider" means a vehicle service provider as described | ||||||
7 | in the Emergency Medical Services (EMS) Systems Act that | ||||||
8 | operates licensed ambulances for the purpose of providing | ||||||
9 | emergency ambulance services, or non-emergency ambulance | ||||||
10 | services, or both. For purposes of this Section, this includes | ||||||
11 | both ambulance providers and ambulance suppliers as described | ||||||
12 | by the Centers for Medicare and Medicaid Services. | ||||||
13 | (d) This Section does not prohibit separate billing by | ||||||
14 | ambulance service
providers for oxygen furnished while | ||||||
15 | providing advanced life support
services.
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16 | (e) Beginning with services rendered on or after July 1, | ||||||
17 | 2008, all providers of non-emergency medi-car and service car | ||||||
18 | transportation must certify that the driver and employee | ||||||
19 | attendant, as applicable, have completed a safety program | ||||||
20 | approved by the Department to protect both the patient and the | ||||||
21 | driver, prior to transporting a patient.
The provider must | ||||||
22 | maintain this certification in its records. The provider shall | ||||||
23 | produce such documentation upon demand by the Department or its | ||||||
24 | representative. Failure to produce documentation of such | ||||||
25 | training shall result in recovery of any payments made by the | ||||||
26 | Department for services rendered by a non-certified driver or |
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1 | employee attendant. Medi-car and service car providers must | ||||||
2 | maintain legible documentation in their records of the driver | ||||||
3 | and, as applicable, employee attendant that actually | ||||||
4 | transported the patient. Providers must recertify all drivers | ||||||
5 | and employee attendants every 3 years.
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6 | Notwithstanding the requirements above, any public | ||||||
7 | transportation provider of medi-car and service car | ||||||
8 | transportation that receives federal funding under 49 U.S.C. | ||||||
9 | 5307 and 5311 need not certify its drivers and employee | ||||||
10 | attendants under this Section, since safety training is already | ||||||
11 | federally mandated.
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12 | (f) With respect to any policy or program administered by | ||||||
13 | the Department or its agent regarding approval of non-emergency | ||||||
14 | medical transportation by ground ambulance service providers, | ||||||
15 | including, but not limited to, the Non-Emergency | ||||||
16 | Transportation Services Prior Approval Program (NETSPAP), the | ||||||
17 | Department shall establish by rule a process by which ground | ||||||
18 | ambulance service providers of non-emergency medical | ||||||
19 | transportation may appeal any decision by the Department or its | ||||||
20 | agent in for which a claim is not approved for payment, but the | ||||||
21 | patient meets the criteria for medical necessity and the | ||||||
22 | appropriate level of ambulance service was provided. The | ||||||
23 | Department shall consider appeals filed for reimbursement | ||||||
24 | denials based upon the lack of availability of a physician | ||||||
25 | discharge order occurring on or after July 1, 2013 if such | ||||||
26 | appeal is filed within 90 days of the effective date of this |
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1 | amendatory Act of the 98th General Assembly. The Department | ||||||
2 | shall apply the medical criteria established by rule in | ||||||
3 | determining all appeals and shall take into account all | ||||||
4 | relevant documentation substantiating the patient's condition | ||||||
5 | as it relates to the criteria for medical necessity and may | ||||||
6 | accept a provider's run report or equivalent. no denial was | ||||||
7 | received prior to the time of transport that either (i) denies | ||||||
8 | a request for approval for payment of non-emergency | ||||||
9 | transportation by means of ground ambulance service or (ii) | ||||||
10 | grants a request for approval of non-emergency transportation | ||||||
11 | by means of ground ambulance service at a level of service that | ||||||
12 | entitles the ground ambulance service provider to a lower level | ||||||
13 | of compensation from the Department than the ground ambulance | ||||||
14 | service provider would have received as compensation for the | ||||||
15 | level of service requested. The rule shall be filed by December | ||||||
16 | 15, 2012 and shall provide that, for any decision rendered by | ||||||
17 | the Department or its agent on or after the date the rule takes | ||||||
18 | effect, the ground ambulance service provider shall have 60 | ||||||
19 | days from the date the decision is received to file an appeal. | ||||||
20 | The rule established by the Department shall be, insofar as is | ||||||
21 | practical, consistent with the Illinois Administrative | ||||||
22 | Procedure Act. The Director's decision on an appeal under this | ||||||
23 | Section shall be a final administrative decision subject to | ||||||
24 | review under the Administrative Review Law. | ||||||
25 | (f-5) Beginning 90 days after July 20, 2012 (the effective | ||||||
26 | date of Public Act 97-842), (i) no denial of a request for |
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1 | approval for payment of non-emergency transportation by means | ||||||
2 | of ground ambulance service, and (ii) no approval of | ||||||
3 | non-emergency transportation by means of ground ambulance | ||||||
4 | service at a level of service that entitles the ground | ||||||
5 | ambulance service provider to a lower level of compensation | ||||||
6 | from the Department than would have been received at the level | ||||||
7 | of service submitted by the ground ambulance service provider, | ||||||
8 | may be issued by the Department or its agent unless the | ||||||
9 | Department has submitted the criteria for determining the | ||||||
10 | appropriateness of the transport for first notice publication | ||||||
11 | in the Illinois Register pursuant to Section 5-40 of the | ||||||
12 | Illinois Administrative Procedure Act. | ||||||
13 | (g) Whenever a patient covered by a medical assistance | ||||||
14 | program under this Code or by another medical program | ||||||
15 | administered by the Department is being discharged from a | ||||||
16 | facility, a physician discharge order as described in this | ||||||
17 | Section shall be required for each patient whose discharge | ||||||
18 | requires medically supervised ground ambulance services. | ||||||
19 | Facilities shall develop procedures for a physician with | ||||||
20 | medical staff privileges to provide a written and signed | ||||||
21 | physician discharge order. The physician discharge order shall | ||||||
22 | specify the level of ground ambulance services needed and | ||||||
23 | complete a medical certification establishing the criteria for | ||||||
24 | approval of non-emergency ambulance transportation, as | ||||||
25 | published by the Department of Healthcare and Family Services, | ||||||
26 | that is met by the patient. This order and the medical |
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1 | certification shall be completed prior to ordering an ambulance | ||||||
2 | service and prior to patient discharge. | ||||||
3 | Pursuant to subsection (E) of Section 12-4.25 of this Code, | ||||||
4 | the Department is entitled to recover overpayments paid to a | ||||||
5 | provider or vendor, including, but not limited to, from the | ||||||
6 | discharging physician, the discharging facility, and the | ||||||
7 | ground ambulance service provider, in instances where a | ||||||
8 | non-emergency ground ambulance service is rendered as the | ||||||
9 | result of improper or false certification. | ||||||
10 | (h) On and after July 1, 2012, the Department shall reduce | ||||||
11 | any rate of reimbursement for services or other payments or | ||||||
12 | alter any methodologies authorized by this Code to reduce any | ||||||
13 | rate of reimbursement for services or other payments in | ||||||
14 | accordance with Section 5-5e. | ||||||
15 | (Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12; | ||||||
16 | 97-842, eff. 7-20-12; 98-463, eff. 8-16-13.)
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17 | Section 99. Effective date. This Act takes effect upon | ||||||
18 | becoming law.
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