Bill Text: IL SB2302 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning elimination and limitations of medical assistance services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2016-01-27 - Referred to Assignments [SB2302 Detail]

Download: Illinois-2015-SB2302-Introduced.html

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99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 SB2302 Introduced 1/27/2016, by Sen. Heather A. Steans SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5f
Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning elimination and limitations of medical assistance services.
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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 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; on or
after October 1, 2014, the annual maximum limit of 20
visits shall expire but the Department shall require prior

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approval for all individuals for speech, hearing, and
language therapy services, occupational therapy services,
and physical therapy services; (iii) the Department shall
limit adult podiatry services to individuals with
diabetes; on or after October 1, 2014, podiatry services
shall not be limited to individuals with diabetes; (iv) the
Department shall pay for caesarean sections at the normal
vaginal delivery rate unless a caesarean section was
medically necessary; (v) 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; on or after July 1, 2014, adult
dental services shall no longer be limited to emergencies,
and dental services necessary for the health of a pregnant
woman prior to delivery of her baby shall continue to be
covered; 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

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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. 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

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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.
(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

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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 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

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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; 98-651, eff. 6-16-14; 98-756, eff. 7-16-14.)