Bill Text: IL SB2605 | 2013-2014 | 98th General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Exempts pregnant women, persons who are classified as mentally or developmentally disabled, persons who are aged, blind, or disabled, persons who are being treated at a dental school as part of the clinical education process for dental students, and persons treated at a public health clinic or a federally qualified health center (FQHC) from a provision limiting adult dental services to emergencies. Deletes language requiring the Department of Healthcare and Family Services to recognize certain conditions as emergencies. Provides that (i) the Department shall limit the ALL KIDS school-based dental program; (ii) school-based dental providers must provide children receiving an oral health score of 2 or 3 indicating the need for restorative or urgent follow-up care with the diagnosed follow-up care by providing the care themselves at the school or at the provider's local clinic or the children must be referred by the provider's case manager to a dental provider who is willing to accept each child into the provider's practice to perform required follow-up care and provide a dental home; and (iii) the Department may limit dental coverage for children to 2 cleanings and 2 fluoride treatments per year regardless of where the services are performed and shall require prior approval from any requests exceeding this limit. In a provision concerning a dental clinic grant program administered by the Department, adds dental school clinics to the list of dental entities that can apply for grant money. In addition to other specified expenses, provides that grant moneys must be used for those services provided as part of the educational process at State dental schools. Effective immediately.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Failed) 2015-01-13 - Session Sine Die [SB2605 Detail]

Download: Illinois-2013-SB2605-Introduced.html

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98TH GENERAL ASSEMBLY State of Illinois 2013 and 2014 SB2605 Introduced 10/16/2013, by Sen. Heather A. Steans SYNOPSIS AS INTRODUCED:
See Index
Amends the Medical Assistance Article of the Illinois Public Aid Code. Exempts pregnant women, persons who are classified as mentally or developmentally disabled, persons who are aged, blind, or disabled, persons who are being treated at a dental school as part of the clinical education process for dental students, and persons treated at a public health clinic or a federally qualified health center (FQHC) from a provision limiting adult dental services to emergencies. Deletes language requiring the Department of Healthcare and Family Services to recognize certain conditions as emergencies. Provides that (i) the Department shall limit the ALL KIDS school-based dental program; (ii) school-based dental providers must provide children receiving an oral health score of 2 or 3 indicating the need for restorative or urgent follow-up care with the diagnosed follow-up care by providing the care themselves at the school or at the provider's local clinic or the children must be referred by the provider's case manager to a dental provider who is willing to accept each child into the provider's practice to perform required follow-up care and provide a dental home; and (iii) the Department may limit dental coverage for children to 2 cleanings and 2 fluoride treatments per year regardless of where the services are performed and shall require prior approval from any requests exceeding this limit. In a provision concerning a dental clinic grant program administered by the Department, adds dental school clinics to the list of dental entities that can apply for grant money. In addition to other specified expenses, provides that grant moneys must be used for those services provided as part of the educational process at State dental schools. Effective immediately.
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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 Sections 5-5f and 12-4.39 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) the Department shall limit adult dental services
to emergencies, except that this limitation shall not apply to
pregnant women, persons who are classified as mentally or
developmentally disabled, persons who are aged, blind, or
disabled, persons who are being treated at a dental school as
part of the clinical education process for dental students, or
persons treated at a public health clinic or a federally
qualified health center (FQHC); (vi) the Department shall limit
the ALL KIDS school-based dental program; school-based dental
providers must provide children receiving an oral health score
of 2 or 3 indicating the need for restorative or urgent
follow-up care with the diagnosed follow-up care by providing
the care themselves at the school or at the provider's local
clinic or the children must be referred by the provider's case
manager to a dental provider who is willing to accept each
child into the provider's practice to perform required
follow-up care and provide a dental home; in addition, the
Department may limit dental coverage for children to 2
cleanings and 2 fluoride treatments per year regardless of
where the services are performed and shall require prior
approval from any requests exceeding this limit; 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)

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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 (vii) (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.
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

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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.
(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.

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(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
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.

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(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.)
(305 ILCS 5/12-4.39)
Sec. 12-4.39. Dental clinic grant program.
(a) Grant program. On and after July 1, 2012, and subject
to funding availability, the Department of Healthcare and
Family Services may administer a grant program. The purpose of
this grant program shall be to build the public infrastructure
for dental care and to make grants to local health departments,
federally qualified health clinics (FQHCs), and rural health
clinics (RHCs), and dental schools for development of
comprehensive dental clinics for dental care services. The
primary purpose of these new dental clinics will be to increase
dental access for low-income and Department of Healthcare and
Family Services clients who have no dental arrangements with a
dental provider in a project's service area. The dental clinic
must be willing to accept out-of-area clients who need dental
services, including emergency services for adults and Early and
Periodic Screening, Diagnosis and Treatment (EPSDT)-referral
children. Medically Underserved Areas (MUAs) and Health
Professional Shortage Areas (HPSAs) shall receive special

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priority for grants under this program.
(b) Eligible applicants. The following entities are
eligible to apply for grants:
(1) Local health departments.
(2) Federally Qualified Health Centers (FQHCs).
(3) Rural health clinics (RHCs).
(4) Dental school clinics.
(c) Use of grant moneys. Grant moneys must be used to
support projects that develop dental services or training to
meet the dental health care needs of Department of Healthcare
and Family Services Dental Program clients. Grant moneys must
be used for operating expenses, including, but not limited to:
insurance; dental supplies and equipment; dental support
services, including those services provided as part of the
educational process at State dental schools; and renovation
expenses. Grant moneys may not be used to offset existing
indebtedness, supplant existing funds, purchase real property,
or pay for personnel service salaries for dental employees.
(d) Application process. The Department shall establish
procedures for applying for dental clinic grants.
(Source: P.A. 96-67, eff. 7-23-09; 96-1000, eff. 7-2-10;
97-689, eff. 6-14-12.)
Section 99. Effective date. This Act takes effect upon
becoming law.
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INDEX
Statutes amended in order of appearance