Illinois 2023-2024 Regular Session

Illinois House Bill HB2577 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2577 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-4.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning reimbursement rates for ambulance services, provides that ambulance services includes medical transportation services provided by means of air ambulance. Provides that on and after July 1, 2023, the Department of Healthcare and Family Services shall increase the base rate of reimbursement for both base charges and mileage charges for medical transportation services provided by means of an air ambulance to a level not lower than 75% of the Medicare ambulance fee schedule rates, by designated Medicare locality, in effect on January 1, 2023. Effective July 1, 2023. LRB103 29817 KTG 56225 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2577 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-4.2 305 ILCS 5/5-4.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning reimbursement rates for ambulance services, provides that ambulance services includes medical transportation services provided by means of air ambulance. Provides that on and after July 1, 2023, the Department of Healthcare and Family Services shall increase the base rate of reimbursement for both base charges and mileage charges for medical transportation services provided by means of an air ambulance to a level not lower than 75% of the Medicare ambulance fee schedule rates, by designated Medicare locality, in effect on January 1, 2023. Effective July 1, 2023. LRB103 29817 KTG 56225 b LRB103 29817 KTG 56225 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2577 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-4.2 305 ILCS 5/5-4.2
4	4	305 ILCS 5/5-4.2
5	5	Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning reimbursement rates for ambulance services, provides that ambulance services includes medical transportation services provided by means of air ambulance. Provides that on and after July 1, 2023, the Department of Healthcare and Family Services shall increase the base rate of reimbursement for both base charges and mileage charges for medical transportation services provided by means of an air ambulance to a level not lower than 75% of the Medicare ambulance fee schedule rates, by designated Medicare locality, in effect on January 1, 2023. Effective July 1, 2023.
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8	8	A BILL FOR
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11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Public Aid Code is amended by
15	15	5 changing Section 5-4.2 as follows:
16	16	6 (305 ILCS 5/5-4.2)
17	17	7 Sec. 5-4.2. Ambulance services payments.
18	18	8 (a) For ambulance services provided to a recipient of aid
19	19	9 under this Article on or after January 1, 1993, the Illinois
20	20	10 Department shall reimburse ambulance service providers at
21	21	11 rates calculated in accordance with this Section. It is the
22	22	12 intent of the General Assembly to provide adequate
23	23	13 reimbursement for ambulance services so as to ensure adequate
24	24	14 access to services for recipients of aid under this Article
25	25	15 and to provide appropriate incentives to ambulance service
26	26	16 providers to provide services in an efficient and
27	27	17 cost-effective manner. Thus, it is the intent of the General
28	28	18 Assembly that the Illinois Department implement a
29	29	19 reimbursement system for ambulance services that, to the
30	30	20 extent practicable and subject to the availability of funds
31	31	21 appropriated by the General Assembly for this purpose, is
32	32	22 consistent with the payment principles of Medicare. To ensure
33	33	23 uniformity between the payment principles of Medicare and
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2577 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/5-4.2 305 ILCS 5/5-4.2
39	39	305 ILCS 5/5-4.2
40	40	Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning reimbursement rates for ambulance services, provides that ambulance services includes medical transportation services provided by means of air ambulance. Provides that on and after July 1, 2023, the Department of Healthcare and Family Services shall increase the base rate of reimbursement for both base charges and mileage charges for medical transportation services provided by means of an air ambulance to a level not lower than 75% of the Medicare ambulance fee schedule rates, by designated Medicare locality, in effect on January 1, 2023. Effective July 1, 2023.
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43	43	A BILL FOR
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68	68	1 Medicaid, the Illinois Department shall follow, to the extent
69	69	2 necessary and practicable and subject to the availability of
70	70	3 funds appropriated by the General Assembly for this purpose,
71	71	4 the statutes, laws, regulations, policies, procedures,
72	72	5 principles, definitions, guidelines, and manuals used to
73	73	6 determine the amounts paid to ambulance service providers
74	74	7 under Title XVIII of the Social Security Act (Medicare).
75	75	8 (b) For ambulance services provided to a recipient of aid
76	76	9 under this Article on or after January 1, 1996, the Illinois
77	77	10 Department shall reimburse ambulance service providers based
78	78	11 upon the actual distance traveled if a natural disaster,
79	79	12 weather conditions, road repairs, or traffic congestion
80	80	13 necessitates the use of a route other than the most direct
81	81	14 route.
82	82	15 (c) For purposes of this Section, "ambulance services"
83	83	16 includes medical transportation services provided by means of
84	84	17 an ambulance, air ambulance, medi-car, service car, or taxi.
85	85	18 (c-1) For purposes of this Section, "ground ambulance
86	86	19 service" means medical transportation services that are
87	87	20 described as ground ambulance services by the Centers for
88	88	21 Medicare and Medicaid Services and provided in a vehicle that
89	89	22 is licensed as an ambulance by the Illinois Department of
90	90	23 Public Health pursuant to the Emergency Medical Services (EMS)
91	91	24 Systems Act.
92	92	25 (c-2) For purposes of this Section, "ground ambulance
93	93	26 service provider" means a vehicle service provider as
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104	104	1 described in the Emergency Medical Services (EMS) Systems Act
105	105	2 that operates licensed ambulances for the purpose of providing
106	106	3 emergency ambulance services, or non-emergency ambulance
107	107	4 services, or both. For purposes of this Section, this includes
108	108	5 both ambulance providers and ambulance suppliers as described
109	109	6 by the Centers for Medicare and Medicaid Services.
110	110	7 (c-3) For purposes of this Section, "medi-car" means
111	111	8 transportation services provided to a patient who is confined
112	112	9 to a wheelchair and requires the use of a hydraulic or electric
113	113	10 lift or ramp and wheelchair lockdown when the patient's
114	114	11 condition does not require medical observation, medical
115	115	12 supervision, medical equipment, the administration of
116	116	13 medications, or the administration of oxygen.
117	117	14 (c-4) For purposes of this Section, "service car" means
118	118	15 transportation services provided to a patient by a passenger
119	119	16 vehicle where that patient does not require the specialized
120	120	17 modes described in subsection (c-1) or (c-3).
121	121	18 (c-5) For purposes of this Section, "air ambulance
122	122	19 service" means medical transport by helicopter or airplane for
123	123	20 patients, as defined in 29 U.S.C. 1185f(c)(1), and any service
124	124	21 that is described as an air ambulance service by the federal
125	125	22 Centers for Medicare and Medicaid Services.
126	126	23 (d) This Section does not prohibit separate billing by
127	127	24 ambulance service providers for oxygen furnished while
128	128	25 providing advanced life support services.
129	129	26 (e) Beginning with services rendered on or after July 1,
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140	140	1 2008, all providers of non-emergency medi-car and service car
141	141	2 transportation must certify that the driver and employee
142	142	3 attendant, as applicable, have completed a safety program
143	143	4 approved by the Department to protect both the patient and the
144	144	5 driver, prior to transporting a patient. The provider must
145	145	6 maintain this certification in its records. The provider shall
146	146	7 produce such documentation upon demand by the Department or
147	147	8 its representative. Failure to produce documentation of such
148	148	9 training shall result in recovery of any payments made by the
149	149	10 Department for services rendered by a non-certified driver or
150	150	11 employee attendant. Medi-car and service car providers must
151	151	12 maintain legible documentation in their records of the driver
152	152	13 and, as applicable, employee attendant that actually
153	153	14 transported the patient. Providers must recertify all drivers
154	154	15 and employee attendants every 3 years. If they meet the
155	155	16 established training components set forth by the Department,
156	156	17 providers of non-emergency medi-car and service car
157	157	18 transportation that are either directly or through an
158	158	19 affiliated company licensed by the Department of Public Health
159	159	20 shall be approved by the Department to have in-house safety
160	160	21 programs for training their own staff.
161	161	22 Notwithstanding the requirements above, any public
162	162	23 transportation provider of medi-car and service car
163	163	24 transportation that receives federal funding under 49 U.S.C.
164	164	25 5307 and 5311 need not certify its drivers and employee
165	165	26 attendants under this Section, since safety training is
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176	176	1 already federally mandated.
177	177	2 (f) With respect to any policy or program administered by
178	178	3 the Department or its agent regarding approval of
179	179	4 non-emergency medical transportation by ground ambulance
180	180	5 service providers, including, but not limited to, the
181	181	6 Non-Emergency Transportation Services Prior Approval Program
182	182	7 (NETSPAP), the Department shall establish by rule a process by
183	183	8 which ground ambulance service providers of non-emergency
184	184	9 medical transportation may appeal any decision by the
185	185	10 Department or its agent for which no denial was received prior
186	186	11 to the time of transport that either (i) denies a request for
187	187	12 approval for payment of non-emergency transportation by means
188	188	13 of ground ambulance service or (ii) grants a request for
189	189	14 approval of non-emergency transportation by means of ground
190	190	15 ambulance service at a level of service that entitles the
191	191	16 ground ambulance service provider to a lower level of
192	192	17 compensation from the Department than the ground ambulance
193	193	18 service provider would have received as compensation for the
194	194	19 level of service requested. The rule shall be filed by
195	195	20 December 15, 2012 and shall provide that, for any decision
196	196	21 rendered by the Department or its agent on or after the date
197	197	22 the rule takes effect, the ground ambulance service provider
198	198	23 shall have 60 days from the date the decision is received to
199	199	24 file an appeal. The rule established by the Department shall
200	200	25 be, insofar as is practical, consistent with the Illinois
201	201	26 Administrative Procedure Act. The Director's decision on an
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212	212	1 appeal under this Section shall be a final administrative
213	213	2 decision subject to review under the Administrative Review
214	214	3 Law.
215	215	4 (f-5) Beginning 90 days after July 20, 2012 (the effective
216	216	5 date of Public Act 97-842), (i) no denial of a request for
217	217	6 approval for payment of non-emergency transportation by means
218	218	7 of ground ambulance service, and (ii) no approval of
219	219	8 non-emergency transportation by means of ground ambulance
220	220	9 service at a level of service that entitles the ground
221	221	10 ambulance service provider to a lower level of compensation
222	222	11 from the Department than would have been received at the level
223	223	12 of service submitted by the ground ambulance service provider,
224	224	13 may be issued by the Department or its agent unless the
225	225	14 Department has submitted the criteria for determining the
226	226	15 appropriateness of the transport for first notice publication
227	227	16 in the Illinois Register pursuant to Section 5-40 of the
228	228	17 Illinois Administrative Procedure Act.
229	229	18 (f-6) Within 90 days after the effective date of this
230	230	19 amendatory Act of the 102nd General Assembly and subject to
231	231	20 federal approval, the Department shall file rules to allow for
232	232	21 the approval of ground ambulance services when the sole
233	233	22 purpose of the transport is for the navigation of stairs or the
234	234	23 assisting or lifting of a patient at a medical facility or
235	235	24 during a medical appointment in instances where the Department
236	236	25 or a contracted Medicaid managed care organization or their
237	237	26 transportation broker is unable to secure transportation
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248	248	1 through any other transportation provider.
249	249	2 (f-7) For non-emergency ground ambulance claims properly
250	250	3 denied under Department policy at the time the claim is filed
251	251	4 due to failure to submit a valid Medical Certification for
252	252	5 Non-Emergency Ambulance on and after December 15, 2012 and
253	253	6 prior to January 1, 2021, the Department shall allot
254	254	7 $2,000,000 to a pool to reimburse such claims if the provider
255	255	8 proves medical necessity for the service by other means.
256	256	9 Providers must submit any such denied claims for which they
257	257	10 seek compensation to the Department no later than December 31,
258	258	11 2021 along with documentation of medical necessity. No later
259	259	12 than May 31, 2022, the Department shall determine for which
260	260	13 claims medical necessity was established. Such claims for
261	261	14 which medical necessity was established shall be paid at the
262	262	15 rate in effect at the time of the service, provided the
263	263	16 $2,000,000 is sufficient to pay at those rates. If the pool is
264	264	17 not sufficient, claims shall be paid at a uniform percentage
265	265	18 of the applicable rate such that the pool of $2,000,000 is
266	266	19 exhausted. The appeal process described in subsection (f)
267	267	20 shall not be applicable to the Department's determinations
268	268	21 made in accordance with this subsection.
269	269	22 (g) Whenever a patient covered by a medical assistance
270	270	23 program under this Code or by another medical program
271	271	24 administered by the Department, including a patient covered
272	272	25 under the State's Medicaid managed care program, is being
273	273	26 transported from a facility and requires non-emergency
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284	284	1 transportation including ground ambulance, medi-car, or
285	285	2 service car transportation, a Physician Certification
286	286	3 Statement as described in this Section shall be required for
287	287	4 each patient. Facilities shall develop procedures for a
288	288	5 licensed medical professional to provide a written and signed
289	289	6 Physician Certification Statement. The Physician Certification
290	290	7 Statement shall specify the level of transportation services
291	291	8 needed and complete a medical certification establishing the
292	292	9 criteria for approval of non-emergency ambulance
293	293	10 transportation, as published by the Department of Healthcare
294	294	11 and Family Services, that is met by the patient. This
295	295	12 certification shall be completed prior to ordering the
296	296	13 transportation service and prior to patient discharge. The
297	297	14 Physician Certification Statement is not required prior to
298	298	15 transport if a delay in transport can be expected to
299	299	16 negatively affect the patient outcome. If the ground ambulance
300	300	17 provider, medi-car provider, or service car provider is unable
301	301	18 to obtain the required Physician Certification Statement
302	302	19 within 10 calendar days following the date of the service, the
303	303	20 ground ambulance provider, medi-car provider, or service car
304	304	21 provider must document its attempt to obtain the requested
305	305	22 certification and may then submit the claim for payment.
306	306	23 Acceptable documentation includes a signed return receipt from
307	307	24 the U.S. Postal Service, facsimile receipt, email receipt, or
308	308	25 other similar service that evidences that the ground ambulance
309	309	26 provider, medi-car provider, or service car provider attempted
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320	320	1 to obtain the required Physician Certification Statement.
321	321	2 The medical certification specifying the level and type of
322	322	3 non-emergency transportation needed shall be in the form of
323	323	4 the Physician Certification Statement on a standardized form
324	324	5 prescribed by the Department of Healthcare and Family
325	325	6 Services. Within 75 days after July 27, 2018 (the effective
326	326	7 date of Public Act 100-646), the Department of Healthcare and
327	327	8 Family Services shall develop a standardized form of the
328	328	9 Physician Certification Statement specifying the level and
329	329	10 type of transportation services needed in consultation with
330	330	11 the Department of Public Health, Medicaid managed care
331	331	12 organizations, a statewide association representing ambulance
332	332	13 providers, a statewide association representing hospitals, 3
333	333	14 statewide associations representing nursing homes, and other
334	334	15 stakeholders. The Physician Certification Statement shall
335	335	16 include, but is not limited to, the criteria necessary to
336	336	17 demonstrate medical necessity for the level of transport
337	337	18 needed as required by (i) the Department of Healthcare and
338	338	19 Family Services and (ii) the federal Centers for Medicare and
339	339	20 Medicaid Services as outlined in the Centers for Medicare and
340	340	21 Medicaid Services' Medicare Benefit Policy Manual, Pub.
341	341	22 100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician
342	342	23 Certification Statement shall satisfy the obligations of
343	343	24 hospitals under Section 6.22 of the Hospital Licensing Act and
344	344	25 nursing homes under Section 2-217 of the Nursing Home Care
345	345	26 Act. Implementation and acceptance of the Physician
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356	356	1 Certification Statement shall take place no later than 90 days
357	357	2 after the issuance of the Physician Certification Statement by
358	358	3 the Department of Healthcare and Family Services.
359	359	4 Pursuant to subsection (E) of Section 12-4.25 of this
360	360	5 Code, the Department is entitled to recover overpayments paid
361	361	6 to a provider or vendor, including, but not limited to, from
362	362	7 the discharging physician, the discharging facility, and the
363	363	8 ground ambulance service provider, in instances where a
364	364	9 non-emergency ground ambulance service is rendered as the
365	365	10 result of improper or false certification.
366	366	11 Beginning October 1, 2018, the Department of Healthcare
367	367	12 and Family Services shall collect data from Medicaid managed
368	368	13 care organizations and transportation brokers, including the
369	369	14 Department's NETSPAP broker, regarding denials and appeals
370	370	15 related to the missing or incomplete Physician Certification
371	371	16 Statement forms and overall compliance with this subsection.
372	372	17 The Department of Healthcare and Family Services shall publish
373	373	18 quarterly results on its website within 15 days following the
374	374	19 end of each quarter.
375	375	20 (h) On and after July 1, 2012, the Department shall reduce
376	376	21 any rate of reimbursement for services or other payments or
377	377	22 alter any methodologies authorized by this Code to reduce any
378	378	23 rate of reimbursement for services or other payments in
379	379	24 accordance with Section 5-5e.
380	380	25 (i) On and after July 1, 2018, the Department shall
381	381	26 increase the base rate of reimbursement for both base charges
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392	392	1 and mileage charges for ground ambulance service providers for
393	393	2 medical transportation services provided by means of a ground
394	394	3 ambulance to a level not lower than 112% of the base rate in
395	395	4 effect as of June 30, 2018.
396	396	5 (j) On and after July 1, 2023, the Department shall
397	397	6 increase the base rate of reimbursement for both base charges
398	398	7 and mileage charges for medical transportation services
399	399	8 provided by means of an air ambulance to a level not lower than
400	400	9 75% of the Medicare ambulance fee schedule rates, by
401	401	10 designated Medicare locality, in effect on January 1, 2023.
402	402	11 (Source: P.A. 101-81, eff. 7-12-19; 101-649, eff. 7-7-20;
403	403	12 102-364, eff. 1-1-22; 102-650, eff. 8-27-21; 102-813, eff.
404	404	13 5-13-22; 102-1037, eff. 6-2-22.)
405	405	14 Section 99. Effective date. This Act takes effect July 1,
406	406	15 2023.
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