Bill Text: IL SB3719 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning ambulance services payments.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-01-08 - Session Sine Die [SB3719 Detail]

Download: Illinois-2011-SB3719-Introduced.html

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97TH GENERAL ASSEMBLY State of Illinois 2011 and 2012 SB3719 Introduced 2/10/2012, by Sen. Don Harmon SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-4.2 from Ch. 23, par. 5-4.2
Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning ambulance services payments.
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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 5-4.2 as follows:
(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
Sec. 5-4.2. Ambulance services payments.
(a) For ambulance services provided to a recipient of aid
under this 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
uniformity between the payment principles of Medicare and

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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
service provider" means a vehicle service provider as described

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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.
(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.
Notwithstanding the requirements above, any public

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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.
(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 any decision rendered by
the Department or its agent on or after the date the rule takes

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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.)