Bill Text: IL SB0770 | 2011-2012 | 97th General Assembly | Amended

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

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Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section regarding Medicaid co-payments.

Spectrum: Bipartisan Bill

Status: (Passed) 2012-05-18 - Public Act . . . . . . . . . 97-0683 [SB0770 Detail]

Download: Illinois-2011-SB0770-Amended.html

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Rep. Edward J. Acevedo

Filed: 3/2/2012

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AMENDMENT TO SENATE BILL 770
AMENDMENT NO. ______. Amend Senate Bill 770 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Public Aid Code is amended by
changing Sections 5-4.2 and 5-5 as follows:
(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
Sec. 5-4.2. Ground ambulance Ambulance services payments.
(a) For purposes of this Section, the following terms have
the following meanings:
"Department" means the Illinois Department of Healthcare
and Family Services.
"Ground ambulance services" means medical transportation
services that are described as ground ambulance services by the
Centers for Medicare and Medicaid Services and provided in a
vehicle that is licensed as an ambulance by the Illinois
Department of Public Health pursuant to the Emergency Medical

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Services (EMS) Systems Act.
"Ground ambulance services provider" means a vehicle
service provider as described in the Emergency Medical Services
(EMS) Systems Act that operates licensed ambulances for the
purpose of providing emergency ambulance services, or
non-emergency ambulance services, or both. For purposes of this
Section, this includes both ambulance providers and ambulance
suppliers as described by the Centers for Medicare and Medicaid
Services.
"Payment principles of Medicare" means: the accepted
method propounded by the Centers for Medicare and Medicaid
Services and used to determine the payment system for ground
ambulance services providers and suppliers under Title XVIII of
the Social Security Act. These principles are outlined in the
United States Code, the Code of Federal Regulations, and the
CMS Online Manual System, including, but not limited to, the
Medicare Benefit Policy Manual and the Medicare Claims
Processing Manual, and include the statutes, regulations,
policies, procedures, definitions, guidelines, and coding
systems, including the Health Care Common Procedure Coding
System (HCPCS) and ambulance condition coding system, as well
as other resources which have been or will be developed and
recognized by the Centers for Medicare and Medicaid Services.
"Rural county" means: any county not located in a U.S.
Bureau of the Census Metropolitan Statistical Area (MSA); or
any county located within a U.S. Bureau of the Census

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Metropolitan Statistical Area but having a population of 60,000
or less.
(b) It is the intent of the General Assembly to provide for
the payment for ground ambulance services as part of the State
Medicaid plan and to provide adequate payment for ground
ambulance services under the State Medicaid plan so as to
ensure adequate access to ground ambulance services for both
recipients of aid under this Article and for the general
population of Illinois. Unless otherwise indicated in this
Section, the practices of the Department concerning payments
for ground ambulance services provided to recipients of aid
under this Article shall be consistent with the payment
principles of Medicare.
(c) For ground ambulance services provided to a recipient
of aid under this Article on or after July 1, 2012, the
Department shall provide payment to ground ambulance services
providers for base charges and mileage charges based upon the
lesser of the provider's charge, as reflected on the provider's
claim form, or the Illinois Medicaid Ambulance Fee Schedule
payment rates calculated in accordance with this Section.
Effective July 1, 2012, the Illinois Medicaid Ambulance Fee
Schedule shall be established and shall include only the ground
ambulance services payment rates outlined in the Medicare
Ambulance Fee Schedule as promulgated by the Centers for
Medicare and Medicaid Services in effect as of July 1, 2012 and
adjusted for the 4 Medicare Localities in Illinois, with an

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adjustment of 100% of the Medicare Ambulance Fee Schedule
payment rates, by Medicare Locality, for both base rates and
mileage for rural counties, and an adjustment of 80% of the
Medicare Ambulance Fee Schedule payment rates, by Medicare
Locality, for both base rates and mileage for all other
counties. The transition from the current payment system to the
Illinois Medicaid Ambulance Fee Schedule shall be as follows:
Effective for dates of service on or after July 1, 2012, for
each individual base rate and mileage rate, the payment rate
for ground ambulance services shall be based on the Illinois
Medicaid Ambulance Fee Schedule amount in effect on July 1,
2012 for the designated Medicare Locality, except that any
payment rate that was previously approved by the Department
that exceeds this amount shall remain in force.
Notwithstanding the payment principles in subsection (b)
of this Section, the Department shall develop the Illinois
Medicaid Ambulance Fee Schedule using the ground mileage
payment rate, as defined by the Centers for Medicare and
Medicaid Services, and no other mileage rates which act as
enhancements to the ground mileage rate, whether permanent or
temporary, shall be recognized by the Department.
(d) Payment for mileage shall be per loaded mile with no
loaded mileage included in the base rate. If a natural
disaster, weather, road repairs, traffic congestion, or other
conditions necessitate a route other than the most direct
route, payment shall be based upon the actual distance

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traveled. When a ground ambulance services provider provides
transport pursuant to an emergency call as defined by the
Centers for Medicare and Medicaid Services, no reduction in the
mileage payment shall be made based upon the fact that a closer
facility may have been available, so long as the ground
ambulance services provider provided transport to the
recipient's facility of choice or other appropriate facility
described within the scope of the Illinois Emergency Medical
Services (EMS) Systems Act and associated rules or the policies
and procedures of the EMS System of which the provider is a
member.
(e) The Department shall provide payment for emergency
ground ambulance services provided to a recipient of aid under
this Article according to the requirements provided in
subsection (b) of this Section when those services are provided
pursuant to a request made through a 9-1-1 or equivalent
emergency telephone number for evaluation, treatment, and
transport from or on behalf of an individual with a condition
of such a nature that a prudent layperson would have reasonably
expected that a delay in seeking immediate medical attention
would have been hazardous to life or health. This standard is
deemed to be met if there is an emergency medical condition
manifesting itself by acute symptoms of sufficient severity,
including but not limited to severe pain, such that a prudent
layperson who possesses an average knowledge of medicine and
health can reasonably expect that the absence of immediate

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medical attention could result in placing the health of the
individual or, with respect to a pregnant woman, the health of
the woman or her unborn child, in serious jeopardy, cause
serious impairment to bodily functions, or cause serious
dysfunction of any bodily organ or part.
(f) For ground ambulance services provided to a recipient
enrolled in a Medicaid managed care plan by a ground ambulance
services provider that is not a contracted provider to the
Medicaid managed care plan in question, the amount of the
payment for ground ambulance services by the Medicaid managed
care plan shall be the lesser of the provider's charge, as
reflected on the provider's claim form, or the Illinois
Medicaid Ambulance Fee Schedule payment rates calculated in
accordance with this Section.
(g) Nothing in this Section prohibits the Department from
setting payment rates for out-of-State ground ambulance
services providers by administrative rule.
(g-5) Nothing in this Section prohibits the Department from
setting payment rates for State ground ambulance services
providers by administrative rule pending the availability of
appropriations dedicated to rate increases provided under
subsections (c) and (h) of this Section.
(h) Effective for dates of service on or after July 1,
2012, payments for stretcher van services provided by ground
ambulance services providers shall be as follows:
(1) For each individual base rate, the amount of the

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payment shall be the lesser of the provider's charge, as
reflected on the provider's claim form, or 80% of the
Illinois Medicaid Ambulance Fee Schedule payment rate for
the basic life support non-emergency base rate.
(2) For each loaded mile, the amount of the payment
shall be the lesser of the provider's charge, as reflected
on the provider's claim form, or 80% of the Illinois
Medicaid Ambulance Fee Schedule payment rate for mileage.
(i) All payments under subsections (c) and (h) of this
Section are subject to the availability of appropriations for
those purposes.
(a) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1993, the Illinois
Department shall reimburse ambulance service providers at
rates calculated in accordance with this Section. It is the
intent of the General Assembly to provide adequate
reimbursement for ambulance services so as to ensure adequate
access to services for recipients of aid under this Article and
to provide appropriate incentives to ambulance service
providers to provide services in an efficient and
cost-effective manner. Thus, it is the intent of the General
Assembly that the Illinois Department implement a
reimbursement system for ambulance services that, to the extent
practicable and subject to the availability of funds
appropriated by the General Assembly for this purpose, is
consistent with the payment principles of Medicare. To ensure

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uniformity between the payment principles of Medicare and
Medicaid, the Illinois Department shall follow, to the extent
necessary and practicable and subject to the availability of
funds appropriated by the General Assembly for this purpose,
the statutes, laws, regulations, policies, procedures,
principles, definitions, guidelines, and manuals used to
determine the amounts paid to ambulance service providers under
Title XVIII of the Social Security Act (Medicare).
(b) For ambulance services provided to a recipient of aid
under this Article on or after January 1, 1996, the Illinois
Department shall reimburse ambulance service providers based
upon the actual distance traveled if a natural disaster,
weather conditions, road repairs, or traffic congestion
necessitates the use of a route other than the most direct
route.
(c) For purposes of this Section, "ambulance services"
includes medical transportation services provided by means of
an ambulance, medi-car, service car, or taxi.
(c-1) For purposes of this Section, "ground ambulance
service" means medical transportation services that are
described as ground ambulance services by the Centers for
Medicare and Medicaid Services and provided in a vehicle that
is licensed as an ambulance by the Illinois Department of
Public Health pursuant to the Emergency Medical Services (EMS)
Systems Act.
(c-2) For purposes of this Section, "ground ambulance

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service provider" means a vehicle service provider as described
in the Emergency Medical Services (EMS) Systems Act that
operates licensed ambulances for the purpose of providing
emergency ambulance services, or non-emergency ambulance
services, or both. For purposes of this Section, this includes
both ambulance providers and ambulance suppliers as described
by the Centers for Medicare and Medicaid Services.
(d) This Section does not prohibit separate billing by
ambulance service providers for oxygen furnished while
providing advanced life support services.
(j) (e) Beginning with services rendered on or after July
1, 2008, all providers of non-emergency medi-car and service
car transportation must certify that the driver and employee
attendant, as applicable, have completed a safety program
approved by the Department to protect both the patient and the
driver, prior to transporting a patient. The provider must
maintain this certification in its records. The provider shall
produce such documentation upon demand by the Department or its
representative. Failure to produce documentation of such
training shall result in recovery of any payments made by the
Department for services rendered by a non-certified driver or
employee attendant. Medi-car and service car providers must
maintain legible documentation in their records of the driver
and, as applicable, employee attendant that actually
transported the patient. Providers must recertify all drivers
and employee attendants every 3 years.

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Notwithstanding the requirements above, any public
transportation provider of medi-car and service car
transportation that receives federal funding under 49 U.S.C.
5307 and 5311 need not certify its drivers and employee
attendants under this Section, since safety training is already
federally mandated.
(k) (f) With respect to any policy or program administered
by the Department or its agent regarding approval of
non-emergency medical transportation by ground ambulance
service providers, including, but not limited to, the
Non-Emergency Transportation Services Prior Approval Program
(NETSPAP), the Department shall establish by rule a process by
which ground ambulance service providers of non-emergency
medical transportation may appeal any decision by the
Department or its agent for which no denial was received prior
to the time of transport that either (i) denies a request for
approval for payment of non-emergency transportation by means
of ground ambulance service or (ii) grants a request for
approval of non-emergency transportation by means of ground
ambulance service at a level of service that entitles the
ground ambulance service provider to a lower level of
compensation from the Department than the ground ambulance
service provider would have received as compensation for the
level of service requested. The rule shall be established
within 12 months after the effective date of this amendatory
Act of the 97th General Assembly and shall provide that, for

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any decision rendered by the Department or its agent on or
after the date the rule takes effect, the ground ambulance
service provider shall have 60 days from the date the decision
is received to file an appeal. The rule established by the
Department shall be, insofar as is practical, consistent with
the Illinois Administrative Procedure Act. The Director's
decision on an appeal under this Section shall be a final
administrative decision subject to review under the
Administrative Review Law.
(Source: P.A. 97-584, eff. 8-26-11.)
(305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
Sec. 5-5. Medical services. The Illinois Department, by
rule, shall determine the quantity and quality of and the rate
of reimbursement for the medical assistance for which payment
will be authorized, and the medical services to be provided,
which may include all or part of the following: (1) inpatient
hospital services; (2) outpatient hospital services; (3) other
laboratory and X-ray services; (4) skilled nursing home
services; (5) physicians' services whether furnished in the
office, the patient's home, a hospital, a skilled nursing home,
or elsewhere; (6) medical care, or any other type of remedial
care furnished by licensed practitioners; (7) home health care
services; (8) private duty nursing service; (9) clinic
services; (10) dental services, including prevention and
treatment of periodontal disease and dental caries disease for

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pregnant women, provided by an individual licensed to practice
dentistry or dental surgery; for purposes of this item (10),
"dental services" means diagnostic, preventive, or corrective
procedures provided by or under the supervision of a dentist in
the practice of his or her profession; (11) physical therapy
and related services; (12) prescribed drugs, dentures, and
prosthetic devices; and eyeglasses prescribed by a physician
skilled in the diseases of the eye, or by an optometrist,
whichever the person may select; (13) other diagnostic,
screening, preventive, and rehabilitative services, for
children and adults; (14) transportation and such other
expenses as may be necessary, provided that payment for ground
ambulance services shall be as provided in Section 5-4.2; (15)
medical treatment of sexual assault survivors, as defined in
Section 1a of the Sexual Assault Survivors Emergency Treatment
Act, for injuries sustained as a result of the sexual assault,
including examinations and laboratory tests to discover
evidence which may be used in criminal proceedings arising from
the sexual assault; (16) the diagnosis and treatment of sickle
cell anemia; and (17) any other medical care, and any other
type of remedial care recognized under the laws of this State,
but not including abortions, or induced miscarriages or
premature births, unless, in the opinion of a physician, such
procedures are necessary for the preservation of the life of
the woman seeking such treatment, or except an induced
premature birth intended to produce a live viable child and

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such procedure is necessary for the health of the mother or her
unborn child. The Illinois Department, by rule, shall prohibit
any physician from providing medical assistance to anyone
eligible therefor under this Code where such physician has been
found guilty of performing an abortion procedure in a wilful
and wanton manner upon a woman who was not pregnant at the time
such abortion procedure was performed. The term "any other type
of remedial care" shall include nursing care and nursing home
service for persons who rely on treatment by spiritual means
alone through prayer for healing.
Notwithstanding any other provision of this Section, a
comprehensive tobacco use cessation program that includes
purchasing prescription drugs or prescription medical devices
approved by the Food and Drug Administration shall be covered
under the medical assistance program under this Article for
persons who are otherwise eligible for assistance under this
Article.
Notwithstanding any other provision of this Code, the
Illinois Department may not require, as a condition of payment
for any laboratory test authorized under this Article, that a
physician's handwritten signature appear on the laboratory
test order form. The Illinois Department may, however, impose
other appropriate requirements regarding laboratory test order
documentation.
The Department of Healthcare and Family Services shall
provide the following services to persons eligible for

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assistance under this Article who are participating in
education, training or employment programs operated by the
Department of Human Services as successor to the Department of
Public Aid:
(1) dental services provided by or under the
supervision of a dentist; and
(2) eyeglasses prescribed by a physician skilled in the
diseases of the eye, or by an optometrist, whichever the
person may select.
Notwithstanding any other provision of this Code and
subject to federal approval, the Department may adopt rules to
allow a dentist who is volunteering his or her service at no
cost to render dental services through an enrolled
not-for-profit health clinic without the dentist personally
enrolling as a participating provider in the medical assistance
program. A not-for-profit health clinic shall include a public
health clinic or Federally Qualified Health Center or other
enrolled provider, as determined by the Department, through
which dental services covered under this Section are performed.
The Department shall establish a process for payment of claims
for reimbursement for covered dental services rendered under
this provision.
The Illinois Department, by rule, may distinguish and
classify the medical services to be provided only in accordance
with the classes of persons designated in Section 5-2.
The Department of Healthcare and Family Services must

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provide coverage and reimbursement for amino acid-based
elemental formulas, regardless of delivery method, for the
diagnosis and treatment of (i) eosinophilic disorders and (ii)
short bowel syndrome when the prescribing physician has issued
a written order stating that the amino acid-based elemental
formula is medically necessary.
The Illinois Department shall authorize the provision of,
and shall authorize payment for, screening by low-dose
mammography for the presence of occult breast cancer for women
35 years of age or older who are eligible for medical
assistance under this Article, as follows:
(A) A baseline mammogram for women 35 to 39 years of
age.
(B) An annual mammogram for women 40 years of age or
older.
(C) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider for
women under 40 years of age and having a family history of
breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.
(D) A comprehensive ultrasound screening of an entire
breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue, when medically
necessary as determined by a physician licensed to practice
medicine in all of its branches.
All screenings shall include a physical breast exam,

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instruction on self-examination and information regarding the
frequency of self-examination and its value as a preventative
tool. For purposes of this Section, "low-dose mammography"
means the x-ray examination of the breast using equipment
dedicated specifically for mammography, including the x-ray
tube, filter, compression device, and image receptor, with an
average radiation exposure delivery of less than one rad per
breast for 2 views of an average size breast. The term also
includes digital mammography.
On and after January 1, 2012, providers participating in a
quality improvement program approved by the Department shall be
reimbursed for screening and diagnostic mammography at the same
rate as the Medicare program's rates, including the increased
reimbursement for digital mammography.
The Department shall convene an expert panel including
representatives of hospitals, free-standing mammography
facilities, and doctors, including radiologists, to establish
quality standards.
Subject to federal approval, the Department shall
establish a rate methodology for mammography at federally
qualified health centers and other encounter-rate clinics.
These clinics or centers may also collaborate with other
hospital-based mammography facilities.
The Department shall establish a methodology to remind
women who are age-appropriate for screening mammography, but
who have not received a mammogram within the previous 18

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months, of the importance and benefit of screening mammography.
The Department shall establish a performance goal for
primary care providers with respect to their female patients
over age 40 receiving an annual mammogram. This performance
goal shall be used to provide additional reimbursement in the
form of a quality performance bonus to primary care providers
who meet that goal.
The Department shall devise a means of case-managing or
patient navigation for beneficiaries diagnosed with breast
cancer. This program shall initially operate as a pilot program
in areas of the State with the highest incidence of mortality
related to breast cancer. At least one pilot program site shall
be in the metropolitan Chicago area and at least one site shall
be outside the metropolitan Chicago area. An evaluation of the
pilot program shall be carried out measuring health outcomes
and cost of care for those served by the pilot program compared
to similarly situated patients who are not served by the pilot
program.
Any medical or health care provider shall immediately
recommend, to any pregnant woman who is being provided prenatal
services and is suspected of drug abuse or is addicted as
defined in the Alcoholism and Other Drug Abuse and Dependency
Act, referral to a local substance abuse treatment provider
licensed by the Department of Human Services or to a licensed
hospital which provides substance abuse treatment services.
The Department of Healthcare and Family Services shall assure

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coverage for the cost of treatment of the drug abuse or
addiction for pregnant recipients in accordance with the
Illinois Medicaid Program in conjunction with the Department of
Human Services.
All medical providers providing medical assistance to
pregnant women under this Code shall receive information from
the Department on the availability of services under the Drug
Free Families with a Future or any comparable program providing
case management services for addicted women, including
information on appropriate referrals for other social services
that may be needed by addicted women in addition to treatment
for addiction.
The Illinois Department, in cooperation with the
Departments of Human Services (as successor to the Department
of Alcoholism and Substance Abuse) and Public Health, through a
public awareness campaign, may provide information concerning
treatment for alcoholism and drug abuse and addiction, prenatal
health care, and other pertinent programs directed at reducing
the number of drug-affected infants born to recipients of
medical assistance.
Neither the Department of Healthcare and Family Services
nor the Department of Human Services shall sanction the
recipient solely on the basis of her substance abuse.
The Illinois Department shall establish such regulations
governing the dispensing of health services under this Article
as it shall deem appropriate. The Department should seek the

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advice of formal professional advisory committees appointed by
the Director of the Illinois Department for the purpose of
providing regular advice on policy and administrative matters,
information dissemination and educational activities for
medical and health care providers, and consistency in
procedures to the Illinois Department.
Notwithstanding any other provision of law, a health care
provider under the medical assistance program may elect, in
lieu of receiving direct payment for services provided under
that program, to participate in the State Employees Deferred
Compensation Plan adopted under Article 24 of the Illinois
Pension Code. A health care provider who elects to participate
in the plan does not have a cause of action against the State
for any damages allegedly suffered by the provider as a result
of any delay by the State in crediting the amount of any
contribution to the provider's plan account.
The Illinois Department may develop and contract with
Partnerships of medical providers to arrange medical services
for persons eligible under Section 5-2 of this Code.
Implementation of this Section may be by demonstration projects
in certain geographic areas. The Partnership shall be
represented by a sponsor organization. The Department, by rule,
shall develop qualifications for sponsors of Partnerships.
Nothing in this Section shall be construed to require that the
sponsor organization be a medical organization.
The sponsor must negotiate formal written contracts with

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medical providers for physician services, inpatient and
outpatient hospital care, home health services, treatment for
alcoholism and substance abuse, and other services determined
necessary by the Illinois Department by rule for delivery by
Partnerships. Physician services must include prenatal and
obstetrical care. The Illinois Department shall reimburse
medical services delivered by Partnership providers to clients
in target areas according to provisions of this Article and the
Illinois Health Finance Reform Act, except that:
(1) Physicians participating in a Partnership and
providing certain services, which shall be determined by
the Illinois Department, to persons in areas covered by the
Partnership may receive an additional surcharge for such
services.
(2) The Department may elect to consider and negotiate
financial incentives to encourage the development of
Partnerships and the efficient delivery of medical care.
(3) Persons receiving medical services through
Partnerships may receive medical and case management
services above the level usually offered through the
medical assistance program.
Medical providers shall be required to meet certain
qualifications to participate in Partnerships to ensure the
delivery of high quality medical services. These
qualifications shall be determined by rule of the Illinois
Department and may be higher than qualifications for

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participation in the medical assistance program. Partnership
sponsors may prescribe reasonable additional qualifications
for participation by medical providers, only with the prior
written approval of the Illinois Department.
Nothing in this Section shall limit the free choice of
practitioners, hospitals, and other providers of medical
services by clients. In order to ensure patient freedom of
choice, the Illinois Department shall immediately promulgate
all rules and take all other necessary actions so that provided
services may be accessed from therapeutically certified
optometrists to the full extent of the Illinois Optometric
Practice Act of 1987 without discriminating between service
providers.
The Department shall apply for a waiver from the United
States Health Care Financing Administration to allow for the
implementation of Partnerships under this Section.
The Illinois Department shall require health care
providers to maintain records that document the medical care
and services provided to recipients of Medical Assistance under
this Article. Such records must be retained for a period of not
less than 6 years from the date of service or as provided by
applicable State law, whichever period is longer, except that
if an audit is initiated within the required retention period
then the records must be retained until the audit is completed
and every exception is resolved. The Illinois Department shall
require health care providers to make available, when

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authorized by the patient, in writing, the medical records in a
timely fashion to other health care providers who are treating
or serving persons eligible for Medical Assistance under this
Article. All dispensers of medical services shall be required
to maintain and retain business and professional records
sufficient to fully and accurately document the nature, scope,
details and receipt of the health care provided to persons
eligible for medical assistance under this Code, in accordance
with regulations promulgated by the Illinois Department. The
rules and regulations shall require that proof of the receipt
of prescription drugs, dentures, prosthetic devices and
eyeglasses by eligible persons under this Section accompany
each claim for reimbursement submitted by the dispenser of such
medical services. No such claims for reimbursement shall be
approved for payment by the Illinois Department without such
proof of receipt, unless the Illinois Department shall have put
into effect and shall be operating a system of post-payment
audit and review which shall, on a sampling basis, be deemed
adequate by the Illinois Department to assure that such drugs,
dentures, prosthetic devices and eyeglasses for which payment
is being made are actually being received by eligible
recipients. Within 90 days after the effective date of this
amendatory Act of 1984, the Illinois Department shall establish
a current list of acquisition costs for all prosthetic devices
and any other items recognized as medical equipment and
supplies reimbursable under this Article and shall update such

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list on a quarterly basis, except that the acquisition costs of
all prescription drugs shall be updated no less frequently than
every 30 days as required by Section 5-5.12.
The rules and regulations of the Illinois Department shall
require that a written statement including the required opinion
of a physician shall accompany any claim for reimbursement for
abortions, or induced miscarriages or premature births. This
statement shall indicate what procedures were used in providing
such medical services.
The Illinois Department shall require all dispensers of
medical services, other than an individual practitioner or
group of practitioners, desiring to participate in the Medical
Assistance program established under this Article to disclose
all financial, beneficial, ownership, equity, surety or other
interests in any and all firms, corporations, partnerships,
associations, business enterprises, joint ventures, agencies,
institutions or other legal entities providing any form of
health care services in this State under this Article.
The Illinois Department may require that all dispensers of
medical services desiring to participate in the medical
assistance program established under this Article disclose,
under such terms and conditions as the Illinois Department may
by rule establish, all inquiries from clients and attorneys
regarding medical bills paid by the Illinois Department, which
inquiries could indicate potential existence of claims or liens
for the Illinois Department.

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Enrollment of a vendor that provides non-emergency medical
transportation, defined by the Department by rule, shall be
conditional for 180 days. During that time, the Department of
Healthcare and Family Services may terminate the vendor's
eligibility to participate in the medical assistance program
without cause. That termination of eligibility is not subject
to the Department's hearing process.
The Illinois Department shall establish policies,
procedures, standards and criteria by rule for the acquisition,
repair and replacement of orthotic and prosthetic devices and
durable medical equipment. Such rules shall provide, but not be
limited to, the following services: (1) immediate repair or
replacement of such devices by recipients without medical
authorization; and (2) rental, lease, purchase or
lease-purchase of durable medical equipment in a
cost-effective manner, taking into consideration the
recipient's medical prognosis, the extent of the recipient's
needs, and the requirements and costs for maintaining such
equipment. Such rules shall enable a recipient to temporarily
acquire and use alternative or substitute devices or equipment
pending repairs or replacements of any device or equipment
previously authorized for such recipient by the Department.
The Department shall execute, relative to the nursing home
prescreening project, written inter-agency agreements with the
Department of Human Services and the Department on Aging, to
effect the following: (i) intake procedures and common

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eligibility criteria for those persons who are receiving
non-institutional services; and (ii) the establishment and
development of non-institutional services in areas of the State
where they are not currently available or are undeveloped.
The Illinois Department shall develop and operate, in
cooperation with other State Departments and agencies and in
compliance with applicable federal laws and regulations,
appropriate and effective systems of health care evaluation and
programs for monitoring of utilization of health care services
and facilities, as it affects persons eligible for medical
assistance under this Code.
The Illinois Department shall report annually to the
General Assembly, no later than the second Friday in April of
1979 and each year thereafter, in regard to:
(a) actual statistics and trends in utilization of
medical services by public aid recipients;
(b) actual statistics and trends in the provision of
the various medical services by medical vendors;
(c) current rate structures and proposed changes in
those rate structures for the various medical vendors; and
(d) efforts at utilization review and control by the
Illinois Department.
The period covered by each report shall be the 3 years
ending on the June 30 prior to the report. The report shall
include suggested legislation for consideration by the General
Assembly. The filing of one copy of the report with the

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Speaker, one copy with the Minority Leader and one copy with
the Clerk of the House of Representatives, one copy with the
President, one copy with the Minority Leader and one copy with
the Secretary of the Senate, one copy with the Legislative
Research Unit, and such additional copies with the State
Government Report Distribution Center for the General Assembly
as is required under paragraph (t) of Section 7 of the State
Library Act shall be deemed sufficient to comply with this
Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926,
eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638,
eff. 1-1-12.)
Section 99. Effective date. This Act takes effect July 1,
2012.".