Illinois 2023-2024 Regular Session

Illinois House Bill HB5203 Compare Versions

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

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5203 Introduced , by Rep. Brad Halbrook SYNOPSIS AS INTRODUCED: New Act5 ILCS 375/6 from Ch. 127, par. 5265 ILCS 375/6.1 from Ch. 127, par. 526.1305 ILCS 5/5-5305 ILCS 5/5-8 from Ch. 23, par. 5-8305 ILCS 5/5-9 from Ch. 23, par. 5-9305 ILCS 5/6-1 from Ch. 23, par. 6-1410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100 Creates the No Taxpayer Funding for Abortion Act. Provides that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code. Excludes from the programs of health benefits and services authorized under those Acts coverage for elective abortions as provided in the No Taxpayer Funding for Abortion Act. Prohibits a physician who has been found guilty of performing an abortion procedure in a willful and wanton manner upon a woman who was not pregnant when the abortion procedure was performed from participating in the State's Medical Assistance Program. Provides that the Department of Healthcare and Family Services shall require a written statement, including the required opinion of a physician, to accompany a claim for reimbursement for abortions or induced miscarriages or premature births. Makes other changes. Amends the Problem Pregnancy Health Services and Care Act. Permits the Department of Human Services to make grants to nonprofit agencies and organizations that do not use those grants to refer or counsel for, or perform, abortions. Contains provisions regarding applicability and preempts home rule. Effective June 1, 2024. LRB103 38434 KTG 68570 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5203 Introduced , by Rep. Brad Halbrook SYNOPSIS AS INTRODUCED: New Act5 ILCS 375/6 from Ch. 127, par. 5265 ILCS 375/6.1 from Ch. 127, par. 526.1305 ILCS 5/5-5305 ILCS 5/5-8 from Ch. 23, par. 5-8305 ILCS 5/5-9 from Ch. 23, par. 5-9305 ILCS 5/6-1 from Ch. 23, par. 6-1410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100 New Act 5 ILCS 375/6 from Ch. 127, par. 526 5 ILCS 375/6.1 from Ch. 127, par. 526.1 305 ILCS 5/5-5 305 ILCS 5/5-8 from Ch. 23, par. 5-8 305 ILCS 5/5-9 from Ch. 23, par. 5-9 305 ILCS 5/6-1 from Ch. 23, par. 6-1 410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100 Creates the No Taxpayer Funding for Abortion Act. Provides that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code. Excludes from the programs of health benefits and services authorized under those Acts coverage for elective abortions as provided in the No Taxpayer Funding for Abortion Act. Prohibits a physician who has been found guilty of performing an abortion procedure in a willful and wanton manner upon a woman who was not pregnant when the abortion procedure was performed from participating in the State's Medical Assistance Program. Provides that the Department of Healthcare and Family Services shall require a written statement, including the required opinion of a physician, to accompany a claim for reimbursement for abortions or induced miscarriages or premature births. Makes other changes. Amends the Problem Pregnancy Health Services and Care Act. Permits the Department of Human Services to make grants to nonprofit agencies and organizations that do not use those grants to refer or counsel for, or perform, abortions. Contains provisions regarding applicability and preempts home rule. Effective June 1, 2024. LRB103 38434 KTG 68570 b LRB103 38434 KTG 68570 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5203 Introduced , by Rep. Brad Halbrook SYNOPSIS AS INTRODUCED:
3	3	New Act5 ILCS 375/6 from Ch. 127, par. 5265 ILCS 375/6.1 from Ch. 127, par. 526.1305 ILCS 5/5-5305 ILCS 5/5-8 from Ch. 23, par. 5-8305 ILCS 5/5-9 from Ch. 23, par. 5-9305 ILCS 5/6-1 from Ch. 23, par. 6-1410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100 New Act 5 ILCS 375/6 from Ch. 127, par. 526 5 ILCS 375/6.1 from Ch. 127, par. 526.1 305 ILCS 5/5-5 305 ILCS 5/5-8 from Ch. 23, par. 5-8 305 ILCS 5/5-9 from Ch. 23, par. 5-9 305 ILCS 5/6-1 from Ch. 23, par. 6-1 410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100
4	4	New Act
5	5	5 ILCS 375/6 from Ch. 127, par. 526
6	6	5 ILCS 375/6.1 from Ch. 127, par. 526.1
7	7	305 ILCS 5/5-5
8	8	305 ILCS 5/5-8 from Ch. 23, par. 5-8
9	9	305 ILCS 5/5-9 from Ch. 23, par. 5-9
10	10	305 ILCS 5/6-1 from Ch. 23, par. 6-1
11	11	410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100
12	12	Creates the No Taxpayer Funding for Abortion Act. Provides that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code. Excludes from the programs of health benefits and services authorized under those Acts coverage for elective abortions as provided in the No Taxpayer Funding for Abortion Act. Prohibits a physician who has been found guilty of performing an abortion procedure in a willful and wanton manner upon a woman who was not pregnant when the abortion procedure was performed from participating in the State's Medical Assistance Program. Provides that the Department of Healthcare and Family Services shall require a written statement, including the required opinion of a physician, to accompany a claim for reimbursement for abortions or induced miscarriages or premature births. Makes other changes. Amends the Problem Pregnancy Health Services and Care Act. Permits the Department of Human Services to make grants to nonprofit agencies and organizations that do not use those grants to refer or counsel for, or perform, abortions. Contains provisions regarding applicability and preempts home rule. Effective June 1, 2024.
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15	15	A BILL FOR
16	16	HB5203LRB103 38434 KTG 68570 b HB5203 LRB103 38434 KTG 68570 b
17	17	HB5203 LRB103 38434 KTG 68570 b
18	18	1 AN ACT concerning abortion.
19	19	2 Be it enacted by the People of the State of Illinois,
20	20	3 represented in the General Assembly:
21	21	4 Section 1. Short title. This Act may be cited as the No
22	22	5 Taxpayer Funding for Abortion Act.
23	23	6 Section 5. Public policy. It is the public policy of this
24	24	7 State that the General Assembly of the State of Illinois does
25	25	8 solemnly declare and find in reaffirmation of the longstanding
26	26	9 policy of this State that the unborn child is a human being
27	27	10 from the time of conception and has a right to life and, to the
28	28	11 extent consistent with the United States Constitution,
29	29	12 Illinois law should be interpreted to recognize that right to
30	30	13 life and to protect unborn life.
31	31	14 The General Assembly further declares and finds that,
32	32	15 while the people of Illinois hold a variety of positions on the
33	33	16 issue of abortion, they generally oppose the use of tax
34	34	17 dollars to pay for elective abortions and support the federal
35	35	18 Hyde Amendment, named after the late Henry J. Hyde, whose
36	36	19 memory is revered and service celebrated as a Congressman from
37	37	20 the great State of Illinois. This Act honors the strong
38	38	21 beliefs of the people of Illinois by prohibiting the taxpayer
39	39	22 funding of abortion in this State.
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43	43	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5203 Introduced , by Rep. Brad Halbrook SYNOPSIS AS INTRODUCED:
44	44	New Act5 ILCS 375/6 from Ch. 127, par. 5265 ILCS 375/6.1 from Ch. 127, par. 526.1305 ILCS 5/5-5305 ILCS 5/5-8 from Ch. 23, par. 5-8305 ILCS 5/5-9 from Ch. 23, par. 5-9305 ILCS 5/6-1 from Ch. 23, par. 6-1410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100 New Act 5 ILCS 375/6 from Ch. 127, par. 526 5 ILCS 375/6.1 from Ch. 127, par. 526.1 305 ILCS 5/5-5 305 ILCS 5/5-8 from Ch. 23, par. 5-8 305 ILCS 5/5-9 from Ch. 23, par. 5-9 305 ILCS 5/6-1 from Ch. 23, par. 6-1 410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100
45	45	New Act
46	46	5 ILCS 375/6 from Ch. 127, par. 526
47	47	5 ILCS 375/6.1 from Ch. 127, par. 526.1
48	48	305 ILCS 5/5-5
49	49	305 ILCS 5/5-8 from Ch. 23, par. 5-8
50	50	305 ILCS 5/5-9 from Ch. 23, par. 5-9
51	51	305 ILCS 5/6-1 from Ch. 23, par. 6-1
52	52	410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100
53	53	Creates the No Taxpayer Funding for Abortion Act. Provides that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. Amends the State Employees Group Insurance Act of 1971 and the Illinois Public Aid Code. Excludes from the programs of health benefits and services authorized under those Acts coverage for elective abortions as provided in the No Taxpayer Funding for Abortion Act. Prohibits a physician who has been found guilty of performing an abortion procedure in a willful and wanton manner upon a woman who was not pregnant when the abortion procedure was performed from participating in the State's Medical Assistance Program. Provides that the Department of Healthcare and Family Services shall require a written statement, including the required opinion of a physician, to accompany a claim for reimbursement for abortions or induced miscarriages or premature births. Makes other changes. Amends the Problem Pregnancy Health Services and Care Act. Permits the Department of Human Services to make grants to nonprofit agencies and organizations that do not use those grants to refer or counsel for, or perform, abortions. Contains provisions regarding applicability and preempts home rule. Effective June 1, 2024.
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55	55	LRB103 38434 KTG 68570 b
56	56	A BILL FOR
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62	62	New Act
63	63	5 ILCS 375/6 from Ch. 127, par. 526
64	64	5 ILCS 375/6.1 from Ch. 127, par. 526.1
65	65	305 ILCS 5/5-5
66	66	305 ILCS 5/5-8 from Ch. 23, par. 5-8
67	67	305 ILCS 5/5-9 from Ch. 23, par. 5-9
68	68	305 ILCS 5/6-1 from Ch. 23, par. 6-1
69	69	410 ILCS 230/4-100 from Ch. 111 1/2, par. 4604-100
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88	88	1 Section 10. Use of funds to pay for abortions prohibited;
89	89	2 exceptions. Notwithstanding any other provision of law,
90	90	3 neither the State nor any of its subdivisions may authorize
91	91	4 the use of, appropriate, or expend any funds to pay for any
92	92	5 abortion or to cover any part of the costs of any health plan
93	93	6 that includes coverage of abortion or to provide or refer for
94	94	7 any abortion, except in the case where a woman suffers from a
95	95	8 physical disorder, physical injury, or physical illness that
96	96	9 would, as certified by a physician, place the woman in danger
97	97	10 of death unless an abortion is performed, including a
98	98	11 life-endangering physical condition caused by or arising from
99	99	12 the pregnancy itself, or in such other circumstances as
100	100	13 required by federal law.
101	101	14 Section 900. The State Employees Group Insurance Act of
102	102	15 1971 is amended by changing Sections 6 and 6.1 as follows:
103	103	16 (5 ILCS 375/6) (from Ch. 127, par. 526)
104	104	17 Sec. 6. Program of health benefits.
105	105	18 (a) The program of health benefits shall provide for
106	106	19 protection against the financial costs of health care expenses
107	107	20 incurred in and out of hospital including basic
108	108	21 hospital-surgical-medical coverages. The program may include,
109	109	22 but shall not be limited to, such supplemental coverages as
110	110	23 out-patient diagnostic X-ray and laboratory expenses,
111	111	24 prescription drugs, dental services, hearing evaluations,
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122	122	1 hearing aids, the dispensing and fitting of hearing aids, and
123	123	2 similar group benefits as are now or may become available,
124	124	3 except as provided in the No Taxpayer Funding for Abortion
125	125	4 Act. The program may also include coverage for those who rely
126	126	5 on treatment by prayer or spiritual means alone for healing in
127	127	6 accordance with the tenets and practice of a recognized
128	128	7 religious denomination.
129	129	8 The program of health benefits shall be designed by the
130	130	9 Director (1) to provide a reasonable relationship between the
131	131	10 benefits to be included and the expected distribution of
132	132	11 expenses of each such type to be incurred by the covered
133	133	12 members and dependents, (2) to specify, as covered benefits
134	134	13 and as optional benefits, the medical services of
135	135	14 practitioners in all categories licensed under the Medical
136	136	15 Practice Act of 1987, (3) to include reasonable controls,
137	137	16 which may include deductible and co-insurance provisions,
138	138	17 applicable to some or all of the benefits, or a coordination of
139	139	18 benefits provision, to prevent or minimize unnecessary
140	140	19 utilization of the various hospital, surgical and medical
141	141	20 expenses to be provided and to provide reasonable assurance of
142	142	21 stability of the program, and (4) to provide benefits to the
143	143	22 extent possible to members throughout the State, wherever
144	144	23 located, on an equitable basis. Notwithstanding any other
145	145	24 provision of this Section or Act, for all members or
146	146	25 dependents who are eligible for benefits under Social Security
147	147	26 or the Railroad Retirement system or who had sufficient
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158	158	1 Medicare-covered government employment, the Department shall
159	159	2 reduce benefits which would otherwise be paid by Medicare, by
160	160	3 the amount of benefits for which the member or dependents are
161	161	4 eligible under Medicare, except that such reduction in
162	162	5 benefits shall apply only to those members or dependents who
163	163	6 (1) first become eligible for such medicare coverage on or
164	164	7 after the effective date of this amendatory Act of 1992; or (2)
165	165	8 are Medicare-eligible members or dependents of a local
166	166	9 government unit which began participation in the program on or
167	167	10 after July 1, 1992; or (3) remain eligible for but no longer
168	168	11 receive Medicare coverage which they had been receiving on or
169	169	12 after the effective date of this amendatory Act of 1992.
170	170	13 Notwithstanding any other provisions of this Act, where a
171	171	14 covered member or dependents are eligible for benefits under
172	172	15 the federal Medicare health insurance program (Title XVIII of
173	173	16 the Social Security Act as added by Public Law 89-97, 89th
174	174	17 Congress), benefits paid under the State of Illinois program
175	175	18 or plan will be reduced by the amount of benefits paid by
176	176	19 Medicare. For members or dependents who are eligible for
177	177	20 benefits under Social Security or the Railroad Retirement
178	178	21 system or who had sufficient Medicare-covered government
179	179	22 employment, benefits shall be reduced by the amount for which
180	180	23 the member or dependent is eligible under Medicare, except
181	181	24 that such reduction in benefits shall apply only to those
182	182	25 members or dependents who (1) first become eligible for such
183	183	26 Medicare coverage on or after the effective date of this
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194	194	1 amendatory Act of 1992; or (2) are Medicare-eligible members
195	195	2 or dependents of a local government unit which began
196	196	3 participation in the program on or after July 1, 1992; or (3)
197	197	4 remain eligible for, but no longer receive Medicare coverage
198	198	5 which they had been receiving on or after the effective date of
199	199	6 this amendatory Act of 1992. Premiums may be adjusted, where
200	200	7 applicable, to an amount deemed by the Director to be
201	201	8 reasonably consistent with any reduction of benefits.
202	202	9 (b) A member, not otherwise covered by this Act, who has
203	203	10 retired as a participating member under Article 2 of the
204	204	11 Illinois Pension Code but is ineligible for the retirement
205	205	12 annuity under Section 2-119 of the Illinois Pension Code,
206	206	13 shall pay the premiums for coverage, not exceeding the amount
207	207	14 paid by the State for the non-contributory coverage for other
208	208	15 members, under the group health benefits program under this
209	209	16 Act. The Director shall determine the premiums to be paid by a
210	210	17 member under this subsection (b).
211	211	18 (Source: P.A. 100-538, eff. 1-1-18.)
212	212	19 (5 ILCS 375/6.1) (from Ch. 127, par. 526.1)
213	213	20 Sec. 6.1. The program of health benefits may offer as an
214	214	21 alternative, available on an optional basis, coverage through
215	215	22 health maintenance organizations or other managed care
216	216	23 programs. That part of the premium for such coverage which is
217	217	24 in excess of the amount which would otherwise be paid by the
218	218	25 State for the program of health benefits shall be paid by the
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229	229	1 member who elects such alternative coverage and shall be
230	230	2 collected as provided for premiums for other optional
231	231	3 coverages, except as provided in the No Taxpayer Funding for
232	232	4 Abortion Act.
233	233	5 (Source: P.A. 102-19, eff. 7-1-21.)
234	234	6 Section 905. The Illinois Public Aid Code is amended by
235	235	7 changing Sections 5-5, 5-8, 5-9, and 6-1 as follows:
236	236	8 (305 ILCS 5/5-5)
237	237	9 Sec. 5-5. Medical services. The Illinois Department, by
238	238	10 rule, shall determine the quantity and quality of and the rate
239	239	11 of reimbursement for the medical assistance for which payment
240	240	12 will be authorized, and the medical services to be provided,
241	241	13 which may include all or part of the following: (1) inpatient
242	242	14 hospital services; (2) outpatient hospital services; (3) other
243	243	15 laboratory and X-ray services; (4) skilled nursing home
244	244	16 services; (5) physicians' services whether furnished in the
245	245	17 office, the patient's home, a hospital, a skilled nursing
246	246	18 home, or elsewhere; (6) medical care, or any other type of
247	247	19 remedial care furnished by licensed practitioners; (7) home
248	248	20 health care services; (8) private duty nursing service; (9)
249	249	21 clinic services; (10) dental services, including prevention
250	250	22 and treatment of periodontal disease and dental caries disease
251	251	23 for pregnant individuals, provided by an individual licensed
252	252	24 to practice dentistry or dental surgery; for purposes of this
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263	263	1 item (10), "dental services" means diagnostic, preventive, or
264	264	2 corrective procedures provided by or under the supervision of
265	265	3 a dentist in the practice of his or her profession; (11)
266	266	4 physical therapy and related services; (12) prescribed drugs,
267	267	5 dentures, and prosthetic devices; and eyeglasses prescribed by
268	268	6 a physician skilled in the diseases of the eye, or by an
269	269	7 optometrist, whichever the person may select; (13) other
270	270	8 diagnostic, screening, preventive, and rehabilitative
271	271	9 services, including to ensure that the individual's need for
272	272	10 intervention or treatment of mental disorders or substance use
273	273	11 disorders or co-occurring mental health and substance use
274	274	12 disorders is determined using a uniform screening, assessment,
275	275	13 and evaluation process inclusive of criteria, for children and
276	276	14 adults; for purposes of this item (13), a uniform screening,
277	277	15 assessment, and evaluation process refers to a process that
278	278	16 includes an appropriate evaluation and, as warranted, a
279	279	17 referral; "uniform" does not mean the use of a singular
280	280	18 instrument, tool, or process that all must utilize; (14)
281	281	19 transportation and such other expenses as may be necessary;
282	282	20 (15) medical treatment of sexual assault survivors, as defined
283	283	21 in Section 1a of the Sexual Assault Survivors Emergency
284	284	22 Treatment Act, for injuries sustained as a result of the
285	285	23 sexual assault, including examinations and laboratory tests to
286	286	24 discover evidence which may be used in criminal proceedings
287	287	25 arising from the sexual assault; (16) the diagnosis and
288	288	26 treatment of sickle cell anemia; (16.5) services performed by
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299	299	1 a chiropractic physician licensed under the Medical Practice
300	300	2 Act of 1987 and acting within the scope of his or her license,
301	301	3 including, but not limited to, chiropractic manipulative
302	302	4 treatment; and (17) any other medical care, and any other type
303	303	5 of remedial care recognized under the laws of this State,
304	304	6 except as provided in the No Taxpayer Funding for Abortion
305	305	7 Act. The Illinois Department, by rule, shall prohibit any
306	306	8 physician from providing medical assistance to anyone eligible
307	307	9 therefor under this Code where such physician has been found
308	308	10 guilty of performing an abortion procedure in a willful and
309	309	11 wanton manner upon a woman who was not pregnant at the time
310	310	12 such abortion procedure was performed. The term "any other
311	311	13 type of remedial care" shall include nursing care and nursing
312	312	14 home service for persons who rely on treatment by spiritual
313	313	15 means alone through prayer for healing.
314	314	16 Notwithstanding any other provision of this Section, a
315	315	17 comprehensive tobacco use cessation program that includes
316	316	18 purchasing prescription drugs or prescription medical devices
317	317	19 approved by the Food and Drug Administration shall be covered
318	318	20 under the medical assistance program under this Article for
319	319	21 persons who are otherwise eligible for assistance under this
320	320	22 Article.
321	321	23 Notwithstanding any other provision of this Code,
322	322	24 reproductive health care that is otherwise legal in Illinois
323	323	25 shall be covered under the medical assistance program for
324	324	26 persons who are otherwise eligible for medical assistance
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335	335	1 under this Article, except as provided in the No Taxpayer
336	336	2 Funding for Abortion Act.
337	337	3 Notwithstanding any other provision of this Section, all
338	338	4 tobacco cessation medications approved by the United States
339	339	5 Food and Drug Administration and all individual and group
340	340	6 tobacco cessation counseling services and telephone-based
341	341	7 counseling services and tobacco cessation medications provided
342	342	8 through the Illinois Tobacco Quitline shall be covered under
343	343	9 the medical assistance program for persons who are otherwise
344	344	10 eligible for assistance under this Article. The Department
345	345	11 shall comply with all federal requirements necessary to obtain
346	346	12 federal financial participation, as specified in 42 CFR
347	347	13 433.15(b)(7), for telephone-based counseling services provided
348	348	14 through the Illinois Tobacco Quitline, including, but not
349	349	15 limited to: (i) entering into a memorandum of understanding or
350	350	16 interagency agreement with the Department of Public Health, as
351	351	17 administrator of the Illinois Tobacco Quitline; and (ii)
352	352	18 developing a cost allocation plan for Medicaid-allowable
353	353	19 Illinois Tobacco Quitline services in accordance with 45 CFR
354	354	20 95.507. The Department shall submit the memorandum of
355	355	21 understanding or interagency agreement, the cost allocation
356	356	22 plan, and all other necessary documentation to the Centers for
357	357	23 Medicare and Medicaid Services for review and approval.
358	358	24 Coverage under this paragraph shall be contingent upon federal
359	359	25 approval.
360	360	26 Notwithstanding any other provision of this Code, the
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371	371	1 Illinois Department may not require, as a condition of payment
372	372	2 for any laboratory test authorized under this Article, that a
373	373	3 physician's handwritten signature appear on the laboratory
374	374	4 test order form. The Illinois Department may, however, impose
375	375	5 other appropriate requirements regarding laboratory test order
376	376	6 documentation.
377	377	7 Upon receipt of federal approval of an amendment to the
378	378	8 Illinois Title XIX State Plan for this purpose, the Department
379	379	9 shall authorize the Chicago Public Schools (CPS) to procure a
380	380	10 vendor or vendors to manufacture eyeglasses for individuals
381	381	11 enrolled in a school within the CPS system. CPS shall ensure
382	382	12 that its vendor or vendors are enrolled as providers in the
383	383	13 medical assistance program and in any capitated Medicaid
384	384	14 managed care entity (MCE) serving individuals enrolled in a
385	385	15 school within the CPS system. Under any contract procured
386	386	16 under this provision, the vendor or vendors must serve only
387	387	17 individuals enrolled in a school within the CPS system. Claims
388	388	18 for services provided by CPS's vendor or vendors to recipients
389	389	19 of benefits in the medical assistance program under this Code,
390	390	20 the Children's Health Insurance Program, or the Covering ALL
391	391	21 KIDS Health Insurance Program shall be submitted to the
392	392	22 Department or the MCE in which the individual is enrolled for
393	393	23 payment and shall be reimbursed at the Department's or the
394	394	24 MCE's established rates or rate methodologies for eyeglasses.
395	395	25 On and after July 1, 2012, the Department of Healthcare
396	396	26 and Family Services may provide the following services to
397	397
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407	407	1 persons eligible for assistance under this Article who are
408	408	2 participating in education, training or employment programs
409	409	3 operated by the Department of Human Services as successor to
410	410	4 the Department of Public Aid:
411	411	5 (1) dental services provided by or under the
412	412	6 supervision of a dentist; and
413	413	7 (2) eyeglasses prescribed by a physician skilled in
414	414	8 the diseases of the eye, or by an optometrist, whichever
415	415	9 the person may select.
416	416	10 On and after July 1, 2018, the Department of Healthcare
417	417	11 and Family Services shall provide dental services to any adult
418	418	12 who is otherwise eligible for assistance under the medical
419	419	13 assistance program. As used in this paragraph, "dental
420	420	14 services" means diagnostic, preventative, restorative, or
421	421	15 corrective procedures, including procedures and services for
422	422	16 the prevention and treatment of periodontal disease and dental
423	423	17 caries disease, provided by an individual who is licensed to
424	424	18 practice dentistry or dental surgery or who is under the
425	425	19 supervision of a dentist in the practice of his or her
426	426	20 profession.
427	427	21 On and after July 1, 2018, targeted dental services, as
428	428	22 set forth in Exhibit D of the Consent Decree entered by the
429	429	23 United States District Court for the Northern District of
430	430	24 Illinois, Eastern Division, in the matter of Memisovski v.
431	431	25 Maram, Case No. 92 C 1982, that are provided to adults under
432	432	26 the medical assistance program shall be established at no less
433	433
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435	435
436	436
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443	443	1 than the rates set forth in the "New Rate" column in Exhibit D
444	444	2 of the Consent Decree for targeted dental services that are
445	445	3 provided to persons under the age of 18 under the medical
446	446	4 assistance program.
447	447	5 Notwithstanding any other provision of this Code and
448	448	6 subject to federal approval, the Department may adopt rules to
449	449	7 allow a dentist who is volunteering his or her service at no
450	450	8 cost to render dental services through an enrolled
451	451	9 not-for-profit health clinic without the dentist personally
452	452	10 enrolling as a participating provider in the medical
453	453	11 assistance program. A not-for-profit health clinic shall
454	454	12 include a public health clinic or Federally Qualified Health
455	455	13 Center or other enrolled provider, as determined by the
456	456	14 Department, through which dental services covered under this
457	457	15 Section are performed. The Department shall establish a
458	458	16 process for payment of claims for reimbursement for covered
459	459	17 dental services rendered under this provision.
460	460	18 On and after January 1, 2022, the Department of Healthcare
461	461	19 and Family Services shall administer and regulate a
462	462	20 school-based dental program that allows for the out-of-office
463	463	21 delivery of preventative dental services in a school setting
464	464	22 to children under 19 years of age. The Department shall
465	465	23 establish, by rule, guidelines for participation by providers
466	466	24 and set requirements for follow-up referral care based on the
467	467	25 requirements established in the Dental Office Reference Manual
468	468	26 published by the Department that establishes the requirements
469	469
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471	471
472	472
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479	479	1 for dentists participating in the All Kids Dental School
480	480	2 Program. Every effort shall be made by the Department when
481	481	3 developing the program requirements to consider the different
482	482	4 geographic differences of both urban and rural areas of the
483	483	5 State for initial treatment and necessary follow-up care. No
484	484	6 provider shall be charged a fee by any unit of local government
485	485	7 to participate in the school-based dental program administered
486	486	8 by the Department. Nothing in this paragraph shall be
487	487	9 construed to limit or preempt a home rule unit's or school
488	488	10 district's authority to establish, change, or administer a
489	489	11 school-based dental program in addition to, or independent of,
490	490	12 the school-based dental program administered by the
491	491	13 Department.
492	492	14 The Illinois Department, by rule, may distinguish and
493	493	15 classify the medical services to be provided only in
494	494	16 accordance with the classes of persons designated in Section
495	495	17 5-2.
496	496	18 The Department of Healthcare and Family Services must
497	497	19 provide coverage and reimbursement for amino acid-based
498	498	20 elemental formulas, regardless of delivery method, for the
499	499	21 diagnosis and treatment of (i) eosinophilic disorders and (ii)
500	500	22 short bowel syndrome when the prescribing physician has issued
501	501	23 a written order stating that the amino acid-based elemental
502	502	24 formula is medically necessary.
503	503	25 The Illinois Department shall authorize the provision of,
504	504	26 and shall authorize payment for, screening by low-dose
505	505
506	506
507	507
508	508
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515	515	1 mammography for the presence of occult breast cancer for
516	516	2 individuals 35 years of age or older who are eligible for
517	517	3 medical assistance under this Article, as follows:
518	518	4 (A) A baseline mammogram for individuals 35 to 39
519	519	5 years of age.
520	520	6 (B) An annual mammogram for individuals 40 years of
521	521	7 age or older.
522	522	8 (C) A mammogram at the age and intervals considered
523	523	9 medically necessary by the individual's health care
524	524	10 provider for individuals under 40 years of age and having
525	525	11 a family history of breast cancer, prior personal history
526	526	12 of breast cancer, positive genetic testing, or other risk
527	527	13 factors.
528	528	14 (D) A comprehensive ultrasound screening and MRI of an
529	529	15 entire breast or breasts if a mammogram demonstrates
530	530	16 heterogeneous or dense breast tissue or when medically
531	531	17 necessary as determined by a physician licensed to
532	532	18 practice medicine in all of its branches.
533	533	19 (E) A screening MRI when medically necessary, as
534	534	20 determined by a physician licensed to practice medicine in
535	535	21 all of its branches.
536	536	22 (F) A diagnostic mammogram when medically necessary,
537	537	23 as determined by a physician licensed to practice medicine
538	538	24 in all its branches, advanced practice registered nurse,
539	539	25 or physician assistant.
540	540	26 The Department shall not impose a deductible, coinsurance,
541	541
542	542
543	543
544	544
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551	551	1 copayment, or any other cost-sharing requirement on the
552	552	2 coverage provided under this paragraph; except that this
553	553	3 sentence does not apply to coverage of diagnostic mammograms
554	554	4 to the extent such coverage would disqualify a high-deductible
555	555	5 health plan from eligibility for a health savings account
556	556	6 pursuant to Section 223 of the Internal Revenue Code (26
557	557	7 U.S.C. 223).
558	558	8 All screenings shall include a physical breast exam,
559	559	9 instruction on self-examination and information regarding the
560	560	10 frequency of self-examination and its value as a preventative
561	561	11 tool.
562	562	12 For purposes of this Section:
563	563	13 "Diagnostic mammogram" means a mammogram obtained using
564	564	14 diagnostic mammography.
565	565	15 "Diagnostic mammography" means a method of screening that
566	566	16 is designed to evaluate an abnormality in a breast, including
567	567	17 an abnormality seen or suspected on a screening mammogram or a
568	568	18 subjective or objective abnormality otherwise detected in the
569	569	19 breast.
570	570	20 "Low-dose mammography" means the x-ray examination of the
571	571	21 breast using equipment dedicated specifically for mammography,
572	572	22 including the x-ray tube, filter, compression device, and
573	573	23 image receptor, with an average radiation exposure delivery of
574	574	24 less than one rad per breast for 2 views of an average size
575	575	25 breast. The term also includes digital mammography and
576	576	26 includes breast tomosynthesis.
577	577
578	578
579	579
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587	587	1 "Breast tomosynthesis" means a radiologic procedure that
588	588	2 involves the acquisition of projection images over the
589	589	3 stationary breast to produce cross-sectional digital
590	590	4 three-dimensional images of the breast.
591	591	5 If, at any time, the Secretary of the United States
592	592	6 Department of Health and Human Services, or its successor
593	593	7 agency, promulgates rules or regulations to be published in
594	594	8 the Federal Register or publishes a comment in the Federal
595	595	9 Register or issues an opinion, guidance, or other action that
596	596	10 would require the State, pursuant to any provision of the
597	597	11 Patient Protection and Affordable Care Act (Public Law
598	598	12 111-148), including, but not limited to, 42 U.S.C.
599	599	13 18031(d)(3)(B) or any successor provision, to defray the cost
600	600	14 of any coverage for breast tomosynthesis outlined in this
601	601	15 paragraph, then the requirement that an insurer cover breast
602	602	16 tomosynthesis is inoperative other than any such coverage
603	603	17 authorized under Section 1902 of the Social Security Act, 42
604	604	18 U.S.C. 1396a, and the State shall not assume any obligation
605	605	19 for the cost of coverage for breast tomosynthesis set forth in
606	606	20 this paragraph.
607	607	21 On and after January 1, 2016, the Department shall ensure
608	608	22 that all networks of care for adult clients of the Department
609	609	23 include access to at least one breast imaging Center of
610	610	24 Imaging Excellence as certified by the American College of
611	611	25 Radiology.
612	612	26 On and after January 1, 2012, providers participating in a
613	613
614	614
615	615
616	616
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619	619
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623	623	1 quality improvement program approved by the Department shall
624	624	2 be reimbursed for screening and diagnostic mammography at the
625	625	3 same rate as the Medicare program's rates, including the
626	626	4 increased reimbursement for digital mammography and, after
627	627	5 January 1, 2023 (the effective date of Public Act 102-1018),
628	628	6 breast tomosynthesis.
629	629	7 The Department shall convene an expert panel including
630	630	8 representatives of hospitals, free-standing mammography
631	631	9 facilities, and doctors, including radiologists, to establish
632	632	10 quality standards for mammography.
633	633	11 On and after January 1, 2017, providers participating in a
634	634	12 breast cancer treatment quality improvement program approved
635	635	13 by the Department shall be reimbursed for breast cancer
636	636	14 treatment at a rate that is no lower than 95% of the Medicare
637	637	15 program's rates for the data elements included in the breast
638	638	16 cancer treatment quality program.
639	639	17 The Department shall convene an expert panel, including
640	640	18 representatives of hospitals, free-standing breast cancer
641	641	19 treatment centers, breast cancer quality organizations, and
642	642	20 doctors, including breast surgeons, reconstructive breast
643	643	21 surgeons, oncologists, and primary care providers to establish
644	644	22 quality standards for breast cancer treatment.
645	645	23 Subject to federal approval, the Department shall
646	646	24 establish a rate methodology for mammography at federally
647	647	25 qualified health centers and other encounter-rate clinics.
648	648	26 These clinics or centers may also collaborate with other
649	649
650	650
651	651
652	652
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655	655
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659	659	1 hospital-based mammography facilities. By January 1, 2016, the
660	660	2 Department shall report to the General Assembly on the status
661	661	3 of the provision set forth in this paragraph.
662	662	4 The Department shall establish a methodology to remind
663	663	5 individuals who are age-appropriate for screening mammography,
664	664	6 but who have not received a mammogram within the previous 18
665	665	7 months, of the importance and benefit of screening
666	666	8 mammography. The Department shall work with experts in breast
667	667	9 cancer outreach and patient navigation to optimize these
668	668	10 reminders and shall establish a methodology for evaluating
669	669	11 their effectiveness and modifying the methodology based on the
670	670	12 evaluation.
671	671	13 The Department shall establish a performance goal for
672	672	14 primary care providers with respect to their female patients
673	673	15 over age 40 receiving an annual mammogram. This performance
674	674	16 goal shall be used to provide additional reimbursement in the
675	675	17 form of a quality performance bonus to primary care providers
676	676	18 who meet that goal.
677	677	19 The Department shall devise a means of case-managing or
678	678	20 patient navigation for beneficiaries diagnosed with breast
679	679	21 cancer. This program shall initially operate as a pilot
680	680	22 program in areas of the State with the highest incidence of
681	681	23 mortality related to breast cancer. At least one pilot program
682	682	24 site shall be in the metropolitan Chicago area and at least one
683	683	25 site shall be outside the metropolitan Chicago area. On or
684	684	26 after July 1, 2016, the pilot program shall be expanded to
685	685
686	686
687	687
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695	695	1 include one site in western Illinois, one site in southern
696	696	2 Illinois, one site in central Illinois, and 4 sites within
697	697	3 metropolitan Chicago. An evaluation of the pilot program shall
698	698	4 be carried out measuring health outcomes and cost of care for
699	699	5 those served by the pilot program compared to similarly
700	700	6 situated patients who are not served by the pilot program.
701	701	7 The Department shall require all networks of care to
702	702	8 develop a means either internally or by contract with experts
703	703	9 in navigation and community outreach to navigate cancer
704	704	10 patients to comprehensive care in a timely fashion. The
705	705	11 Department shall require all networks of care to include
706	706	12 access for patients diagnosed with cancer to at least one
707	707	13 academic commission on cancer-accredited cancer program as an
708	708	14 in-network covered benefit.
709	709	15 The Department shall provide coverage and reimbursement
710	710	16 for a human papillomavirus (HPV) vaccine that is approved for
711	711	17 marketing by the federal Food and Drug Administration for all
712	712	18 persons between the ages of 9 and 45. Subject to federal
713	713	19 approval, the Department shall provide coverage and
714	714	20 reimbursement for a human papillomavirus (HPV) vaccine for
715	715	21 persons of the age of 46 and above who have been diagnosed with
716	716	22 cervical dysplasia with a high risk of recurrence or
717	717	23 progression. The Department shall disallow any
718	718	24 preauthorization requirements for the administration of the
719	719	25 human papillomavirus (HPV) vaccine.
720	720	26 On or after July 1, 2022, individuals who are otherwise
721	721
722	722
723	723
724	724
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731	731	1 eligible for medical assistance under this Article shall
732	732	2 receive coverage for perinatal depression screenings for the
733	733	3 12-month period beginning on the last day of their pregnancy.
734	734	4 Medical assistance coverage under this paragraph shall be
735	735	5 conditioned on the use of a screening instrument approved by
736	736	6 the Department.
737	737	7 Any medical or health care provider shall immediately
738	738	8 recommend, to any pregnant individual who is being provided
739	739	9 prenatal services and is suspected of having a substance use
740	740	10 disorder as defined in the Substance Use Disorder Act,
741	741	11 referral to a local substance use disorder treatment program
742	742	12 licensed by the Department of Human Services or to a licensed
743	743	13 hospital which provides substance abuse treatment services.
744	744	14 The Department of Healthcare and Family Services shall assure
745	745	15 coverage for the cost of treatment of the drug abuse or
746	746	16 addiction for pregnant recipients in accordance with the
747	747	17 Illinois Medicaid Program in conjunction with the Department
748	748	18 of Human Services.
749	749	19 All medical providers providing medical assistance to
750	750	20 pregnant individuals under this Code shall receive information
751	751	21 from the Department on the availability of services under any
752	752	22 program providing case management services for addicted
753	753	23 individuals, including information on appropriate referrals
754	754	24 for other social services that may be needed by addicted
755	755	25 individuals in addition to treatment for addiction.
756	756	26 The Illinois Department, in cooperation with the
757	757
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759	759
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764	764
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767	767	1 Departments of Human Services (as successor to the Department
768	768	2 of Alcoholism and Substance Abuse) and Public Health, through
769	769	3 a public awareness campaign, may provide information
770	770	4 concerning treatment for alcoholism and drug abuse and
771	771	5 addiction, prenatal health care, and other pertinent programs
772	772	6 directed at reducing the number of drug-affected infants born
773	773	7 to recipients of medical assistance.
774	774	8 Neither the Department of Healthcare and Family Services
775	775	9 nor the Department of Human Services shall sanction the
776	776	10 recipient solely on the basis of the recipient's substance
777	777	11 abuse.
778	778	12 The Illinois Department shall establish such regulations
779	779	13 governing the dispensing of health services under this Article
780	780	14 as it shall deem appropriate. The Department should seek the
781	781	15 advice of formal professional advisory committees appointed by
782	782	16 the Director of the Illinois Department for the purpose of
783	783	17 providing regular advice on policy and administrative matters,
784	784	18 information dissemination and educational activities for
785	785	19 medical and health care providers, and consistency in
786	786	20 procedures to the Illinois Department.
787	787	21 The Illinois Department may develop and contract with
788	788	22 Partnerships of medical providers to arrange medical services
789	789	23 for persons eligible under Section 5-2 of this Code.
790	790	24 Implementation of this Section may be by demonstration
791	791	25 projects in certain geographic areas. The Partnership shall be
792	792	26 represented by a sponsor organization. The Department, by
793	793
794	794
795	795
796	796
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799	799
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803	803	1 rule, shall develop qualifications for sponsors of
804	804	2 Partnerships. Nothing in this Section shall be construed to
805	805	3 require that the sponsor organization be a medical
806	806	4 organization.
807	807	5 The sponsor must negotiate formal written contracts with
808	808	6 medical providers for physician services, inpatient and
809	809	7 outpatient hospital care, home health services, treatment for
810	810	8 alcoholism and substance abuse, and other services determined
811	811	9 necessary by the Illinois Department by rule for delivery by
812	812	10 Partnerships. Physician services must include prenatal and
813	813	11 obstetrical care. The Illinois Department shall reimburse
814	814	12 medical services delivered by Partnership providers to clients
815	815	13 in target areas according to provisions of this Article and
816	816	14 the Illinois Health Finance Reform Act, except that:
817	817	15 (1) Physicians participating in a Partnership and
818	818	16 providing certain services, which shall be determined by
819	819	17 the Illinois Department, to persons in areas covered by
820	820	18 the Partnership may receive an additional surcharge for
821	821	19 such services.
822	822	20 (2) The Department may elect to consider and negotiate
823	823	21 financial incentives to encourage the development of
824	824	22 Partnerships and the efficient delivery of medical care.
825	825	23 (3) Persons receiving medical services through
826	826	24 Partnerships may receive medical and case management
827	827	25 services above the level usually offered through the
828	828	26 medical assistance program.
829	829
830	830
831	831
832	832
833	833
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835	835
836	836
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839	839	1 Medical providers shall be required to meet certain
840	840	2 qualifications to participate in Partnerships to ensure the
841	841	3 delivery of high quality medical services. These
842	842	4 qualifications shall be determined by rule of the Illinois
843	843	5 Department and may be higher than qualifications for
844	844	6 participation in the medical assistance program. Partnership
845	845	7 sponsors may prescribe reasonable additional qualifications
846	846	8 for participation by medical providers, only with the prior
847	847	9 written approval of the Illinois Department.
848	848	10 Nothing in this Section shall limit the free choice of
849	849	11 practitioners, hospitals, and other providers of medical
850	850	12 services by clients. In order to ensure patient freedom of
851	851	13 choice, the Illinois Department shall immediately promulgate
852	852	14 all rules and take all other necessary actions so that
853	853	15 provided services may be accessed from therapeutically
854	854	16 certified optometrists to the full extent of the Illinois
855	855	17 Optometric Practice Act of 1987 without discriminating between
856	856	18 service providers.
857	857	19 The Department shall apply for a waiver from the United
858	858	20 States Health Care Financing Administration to allow for the
859	859	21 implementation of Partnerships under this Section.
860	860	22 The Illinois Department shall require health care
861	861	23 providers to maintain records that document the medical care
862	862	24 and services provided to recipients of Medical Assistance
863	863	25 under this Article. Such records must be retained for a period
864	864	26 of not less than 6 years from the date of service or as
865	865
866	866
867	867
868	868
869	869
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871	871
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875	875	1 provided by applicable State law, whichever period is longer,
876	876	2 except that if an audit is initiated within the required
877	877	3 retention period then the records must be retained until the
878	878	4 audit is completed and every exception is resolved. The
879	879	5 Illinois Department shall require health care providers to
880	880	6 make available, when authorized by the patient, in writing,
881	881	7 the medical records in a timely fashion to other health care
882	882	8 providers who are treating or serving persons eligible for
883	883	9 Medical Assistance under this Article. All dispensers of
884	884	10 medical services shall be required to maintain and retain
885	885	11 business and professional records sufficient to fully and
886	886	12 accurately document the nature, scope, details and receipt of
887	887	13 the health care provided to persons eligible for medical
888	888	14 assistance under this Code, in accordance with regulations
889	889	15 promulgated by the Illinois Department. The rules and
890	890	16 regulations shall require that proof of the receipt of
891	891	17 prescription drugs, dentures, prosthetic devices and
892	892	18 eyeglasses by eligible persons under this Section accompany
893	893	19 each claim for reimbursement submitted by the dispenser of
894	894	20 such medical services. No such claims for reimbursement shall
895	895	21 be approved for payment by the Illinois Department without
896	896	22 such proof of receipt, unless the Illinois Department shall
897	897	23 have put into effect and shall be operating a system of
898	898	24 post-payment audit and review which shall, on a sampling
899	899	25 basis, be deemed adequate by the Illinois Department to assure
900	900	26 that such drugs, dentures, prosthetic devices and eyeglasses
901	901
902	902
903	903
904	904
905	905
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907	907
908	908
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910	910	HB5203 - 25 - LRB103 38434 KTG 68570 b
911	911	1 for which payment is being made are actually being received by
912	912	2 eligible recipients. Within 90 days after September 16, 1984
913	913	3 (the effective date of Public Act 83-1439), the Illinois
914	914	4 Department shall establish a current list of acquisition costs
915	915	5 for all prosthetic devices and any other items recognized as
916	916	6 medical equipment and supplies reimbursable under this Article
917	917	7 and shall update such list on a quarterly basis, except that
918	918	8 the acquisition costs of all prescription drugs shall be
919	919	9 updated no less frequently than every 30 days as required by
920	920	10 Section 5-5.12.
921	921	11 The rules and regulations of the Illinois Department shall
922	922	12 require that a written statement including the required
923	923	13 opinion of a physician shall accompany any claim for
924	924	14 reimbursement for abortions or induced miscarriages or
925	925	15 premature births. This statement shall indicate what
926	926	16 procedures were used in providing such medical services.
927	927	17 Notwithstanding any other law to the contrary, the
928	928	18 Illinois Department shall, within 365 days after July 22, 2013
929	929	19 (the effective date of Public Act 98-104), establish
930	930	20 procedures to permit skilled care facilities licensed under
931	931	21 the Nursing Home Care Act to submit monthly billing claims for
932	932	22 reimbursement purposes. Following development of these
933	933	23 procedures, the Department shall, by July 1, 2016, test the
934	934	24 viability of the new system and implement any necessary
935	935	25 operational or structural changes to its information
936	936	26 technology platforms in order to allow for the direct
937	937
938	938
939	939
940	940
941	941
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943	943
944	944
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946	946	HB5203 - 26 - LRB103 38434 KTG 68570 b
947	947	1 acceptance and payment of nursing home claims.
948	948	2 Notwithstanding any other law to the contrary, the
949	949	3 Illinois Department shall, within 365 days after August 15,
950	950	4 2014 (the effective date of Public Act 98-963), establish
951	951	5 procedures to permit ID/DD facilities licensed under the ID/DD
952	952	6 Community Care Act and MC/DD facilities licensed under the
953	953	7 MC/DD Act to submit monthly billing claims for reimbursement
954	954	8 purposes. Following development of these procedures, the
955	955	9 Department shall have an additional 365 days to test the
956	956	10 viability of the new system and to ensure that any necessary
957	957	11 operational or structural changes to its information
958	958	12 technology platforms are implemented.
959	959	13 The Illinois Department shall require all dispensers of
960	960	14 medical services, other than an individual practitioner or
961	961	15 group of practitioners, desiring to participate in the Medical
962	962	16 Assistance program established under this Article to disclose
963	963	17 all financial, beneficial, ownership, equity, surety or other
964	964	18 interests in any and all firms, corporations, partnerships,
965	965	19 associations, business enterprises, joint ventures, agencies,
966	966	20 institutions or other legal entities providing any form of
967	967	21 health care services in this State under this Article.
968	968	22 The Illinois Department may require that all dispensers of
969	969	23 medical services desiring to participate in the medical
970	970	24 assistance program established under this Article disclose,
971	971	25 under such terms and conditions as the Illinois Department may
972	972	26 by rule establish, all inquiries from clients and attorneys
973	973
974	974
975	975
976	976
977	977
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979	979
980	980
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982	982	HB5203 - 27 - LRB103 38434 KTG 68570 b
983	983	1 regarding medical bills paid by the Illinois Department, which
984	984	2 inquiries could indicate potential existence of claims or
985	985	3 liens for the Illinois Department.
986	986	4 Enrollment of a vendor shall be subject to a provisional
987	987	5 period and shall be conditional for one year. During the
988	988	6 period of conditional enrollment, the Department may terminate
989	989	7 the vendor's eligibility to participate in, or may disenroll
990	990	8 the vendor from, the medical assistance program without cause.
991	991	9 Unless otherwise specified, such termination of eligibility or
992	992	10 disenrollment is not subject to the Department's hearing
993	993	11 process. However, a disenrolled vendor may reapply without
994	994	12 penalty.
995	995	13 The Department has the discretion to limit the conditional
996	996	14 enrollment period for vendors based upon the category of risk
997	997	15 of the vendor.
998	998	16 Prior to enrollment and during the conditional enrollment
999	999	17 period in the medical assistance program, all vendors shall be
1000	1000	18 subject to enhanced oversight, screening, and review based on
1001	1001	19 the risk of fraud, waste, and abuse that is posed by the
1002	1002	20 category of risk of the vendor. The Illinois Department shall
1003	1003	21 establish the procedures for oversight, screening, and review,
1004	1004	22 which may include, but need not be limited to: criminal and
1005	1005	23 financial background checks; fingerprinting; license,
1006	1006	24 certification, and authorization verifications; unscheduled or
1007	1007	25 unannounced site visits; database checks; prepayment audit
1008	1008	26 reviews; audits; payment caps; payment suspensions; and other
1009	1009
1010	1010
1011	1011
1012	1012
1013	1013
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1015	1015
1016	1016
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1019	1019	1 screening as required by federal or State law.
1020	1020	2 The Department shall define or specify the following: (i)
1021	1021	3 by provider notice, the "category of risk of the vendor" for
1022	1022	4 each type of vendor, which shall take into account the level of
1023	1023	5 screening applicable to a particular category of vendor under
1024	1024	6 federal law and regulations; (ii) by rule or provider notice,
1025	1025	7 the maximum length of the conditional enrollment period for
1026	1026	8 each category of risk of the vendor; and (iii) by rule, the
1027	1027	9 hearing rights, if any, afforded to a vendor in each category
1028	1028	10 of risk of the vendor that is terminated or disenrolled during
1029	1029	11 the conditional enrollment period.
1030	1030	12 To be eligible for payment consideration, a vendor's
1031	1031	13 payment claim or bill, either as an initial claim or as a
1032	1032	14 resubmitted claim following prior rejection, must be received
1033	1033	15 by the Illinois Department, or its fiscal intermediary, no
1034	1034	16 later than 180 days after the latest date on the claim on which
1035	1035	17 medical goods or services were provided, with the following
1036	1036	18 exceptions:
1037	1037	19 (1) In the case of a provider whose enrollment is in
1038	1038	20 process by the Illinois Department, the 180-day period
1039	1039	21 shall not begin until the date on the written notice from
1040	1040	22 the Illinois Department that the provider enrollment is
1041	1041	23 complete.
1042	1042	24 (2) In the case of errors attributable to the Illinois
1043	1043	25 Department or any of its claims processing intermediaries
1044	1044	26 which result in an inability to receive, process, or
1045	1045
1046	1046
1047	1047
1048	1048
1049	1049
1050	1050	HB5203 - 28 - LRB103 38434 KTG 68570 b
1051	1051
1052	1052
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1054	1054	HB5203 - 29 - LRB103 38434 KTG 68570 b
1055	1055	1 adjudicate a claim, the 180-day period shall not begin
1056	1056	2 until the provider has been notified of the error.
1057	1057	3 (3) In the case of a provider for whom the Illinois
1058	1058	4 Department initiates the monthly billing process.
1059	1059	5 (4) In the case of a provider operated by a unit of
1060	1060	6 local government with a population exceeding 3,000,000
1061	1061	7 when local government funds finance federal participation
1062	1062	8 for claims payments.
1063	1063	9 For claims for services rendered during a period for which
1064	1064	10 a recipient received retroactive eligibility, claims must be
1065	1065	11 filed within 180 days after the Department determines the
1066	1066	12 applicant is eligible. For claims for which the Illinois
1067	1067	13 Department is not the primary payer, claims must be submitted
1068	1068	14 to the Illinois Department within 180 days after the final
1069	1069	15 adjudication by the primary payer.
1070	1070	16 In the case of long term care facilities, within 120
1071	1071	17 calendar days of receipt by the facility of required
1072	1072	18 prescreening information, new admissions with associated
1073	1073	19 admission documents shall be submitted through the Medical
1074	1074	20 Electronic Data Interchange (MEDI) or the Recipient
1075	1075	21 Eligibility Verification (REV) System or shall be submitted
1076	1076	22 directly to the Department of Human Services using required
1077	1077	23 admission forms. Effective September 1, 2014, admission
1078	1078	24 documents, including all prescreening information, must be
1079	1079	25 submitted through MEDI or REV. Confirmation numbers assigned
1080	1080	26 to an accepted transaction shall be retained by a facility to
1081	1081
1082	1082
1083	1083
1084	1084
1085	1085
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1087	1087
1088	1088
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1090	1090	HB5203 - 30 - LRB103 38434 KTG 68570 b
1091	1091	1 verify timely submittal. Once an admission transaction has
1092	1092	2 been completed, all resubmitted claims following prior
1093	1093	3 rejection are subject to receipt no later than 180 days after
1094	1094	4 the admission transaction has been completed.
1095	1095	5 Claims that are not submitted and received in compliance
1096	1096	6 with the foregoing requirements shall not be eligible for
1097	1097	7 payment under the medical assistance program, and the State
1098	1098	8 shall have no liability for payment of those claims.
1099	1099	9 To the extent consistent with applicable information and
1100	1100	10 privacy, security, and disclosure laws, State and federal
1101	1101	11 agencies and departments shall provide the Illinois Department
1102	1102	12 access to confidential and other information and data
1103	1103	13 necessary to perform eligibility and payment verifications and
1104	1104	14 other Illinois Department functions. This includes, but is not
1105	1105	15 limited to: information pertaining to licensure;
1106	1106	16 certification; earnings; immigration status; citizenship; wage
1107	1107	17 reporting; unearned and earned income; pension income;
1108	1108	18 employment; supplemental security income; social security
1109	1109	19 numbers; National Provider Identifier (NPI) numbers; the
1110	1110	20 National Practitioner Data Bank (NPDB); program and agency
1111	1111	21 exclusions; taxpayer identification numbers; tax delinquency;
1112	1112	22 corporate information; and death records.
1113	1113	23 The Illinois Department shall enter into agreements with
1114	1114	24 State agencies and departments, and is authorized to enter
1115	1115	25 into agreements with federal agencies and departments, under
1116	1116	26 which such agencies and departments shall share data necessary
1117	1117
1118	1118
1119	1119
1120	1120
1121	1121
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1123	1123
1124	1124
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1126	1126	HB5203 - 31 - LRB103 38434 KTG 68570 b
1127	1127	1 for medical assistance program integrity functions and
1128	1128	2 oversight. The Illinois Department shall develop, in
1129	1129	3 cooperation with other State departments and agencies, and in
1130	1130	4 compliance with applicable federal laws and regulations,
1131	1131	5 appropriate and effective methods to share such data. At a
1132	1132	6 minimum, and to the extent necessary to provide data sharing,
1133	1133	7 the Illinois Department shall enter into agreements with State
1134	1134	8 agencies and departments, and is authorized to enter into
1135	1135	9 agreements with federal agencies and departments, including,
1136	1136	10 but not limited to: the Secretary of State; the Department of
1137	1137	11 Revenue; the Department of Public Health; the Department of
1138	1138	12 Human Services; and the Department of Financial and
1139	1139	13 Professional Regulation.
1140	1140	14 Beginning in fiscal year 2013, the Illinois Department
1141	1141	15 shall set forth a request for information to identify the
1142	1142	16 benefits of a pre-payment, post-adjudication, and post-edit
1143	1143	17 claims system with the goals of streamlining claims processing
1144	1144	18 and provider reimbursement, reducing the number of pending or
1145	1145	19 rejected claims, and helping to ensure a more transparent
1146	1146	20 adjudication process through the utilization of: (i) provider
1147	1147	21 data verification and provider screening technology; and (ii)
1148	1148	22 clinical code editing; and (iii) pre-pay, pre-adjudicated, or
1149	1149	23 post-adjudicated predictive modeling with an integrated case
1150	1150	24 management system with link analysis. Such a request for
1151	1151	25 information shall not be considered as a request for proposal
1152	1152	26 or as an obligation on the part of the Illinois Department to
1153	1153
1154	1154
1155	1155
1156	1156
1157	1157
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1159	1159
1160	1160
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1163	1163	1 take any action or acquire any products or services.
1164	1164	2 The Illinois Department shall establish policies,
1165	1165	3 procedures, standards and criteria by rule for the
1166	1166	4 acquisition, repair and replacement of orthotic and prosthetic
1167	1167	5 devices and durable medical equipment. Such rules shall
1168	1168	6 provide, but not be limited to, the following services: (1)
1169	1169	7 immediate repair or replacement of such devices by recipients;
1170	1170	8 and (2) rental, lease, purchase or lease-purchase of durable
1171	1171	9 medical equipment in a cost-effective manner, taking into
1172	1172	10 consideration the recipient's medical prognosis, the extent of
1173	1173	11 the recipient's needs, and the requirements and costs for
1174	1174	12 maintaining such equipment. Subject to prior approval, such
1175	1175	13 rules shall enable a recipient to temporarily acquire and use
1176	1176	14 alternative or substitute devices or equipment pending repairs
1177	1177	15 or replacements of any device or equipment previously
1178	1178	16 authorized for such recipient by the Department.
1179	1179	17 Notwithstanding any provision of Section 5-5f to the contrary,
1180	1180	18 the Department may, by rule, exempt certain replacement
1181	1181	19 wheelchair parts from prior approval and, for wheelchairs,
1182	1182	20 wheelchair parts, wheelchair accessories, and related seating
1183	1183	21 and positioning items, determine the wholesale price by
1184	1184	22 methods other than actual acquisition costs.
1185	1185	23 The Department shall require, by rule, all providers of
1186	1186	24 durable medical equipment to be accredited by an accreditation
1187	1187	25 organization approved by the federal Centers for Medicare and
1188	1188	26 Medicaid Services and recognized by the Department in order to
1189	1189
1190	1190
1191	1191
1192	1192
1193	1193
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1195	1195
1196	1196
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1198	1198	HB5203 - 33 - LRB103 38434 KTG 68570 b
1199	1199	1 bill the Department for providing durable medical equipment to
1200	1200	2 recipients. No later than 15 months after the effective date
1201	1201	3 of the rule adopted pursuant to this paragraph, all providers
1202	1202	4 must meet the accreditation requirement.
1203	1203	5 In order to promote environmental responsibility, meet the
1204	1204	6 needs of recipients and enrollees, and achieve significant
1205	1205	7 cost savings, the Department, or a managed care organization
1206	1206	8 under contract with the Department, may provide recipients or
1207	1207	9 managed care enrollees who have a prescription or Certificate
1208	1208	10 of Medical Necessity access to refurbished durable medical
1209	1209	11 equipment under this Section (excluding prosthetic and
1210	1210	12 orthotic devices as defined in the Orthotics, Prosthetics, and
1211	1211	13 Pedorthics Practice Act and complex rehabilitation technology
1212	1212	14 products and associated services) through the State's
1213	1213	15 assistive technology program's reutilization program, using
1214	1214	16 staff with the Assistive Technology Professional (ATP)
1215	1215	17 Certification if the refurbished durable medical equipment:
1216	1216	18 (i) is available; (ii) is less expensive, including shipping
1217	1217	19 costs, than new durable medical equipment of the same type;
1218	1218	20 (iii) is able to withstand at least 3 years of use; (iv) is
1219	1219	21 cleaned, disinfected, sterilized, and safe in accordance with
1220	1220	22 federal Food and Drug Administration regulations and guidance
1221	1221	23 governing the reprocessing of medical devices in health care
1222	1222	24 settings; and (v) equally meets the needs of the recipient or
1223	1223	25 enrollee. The reutilization program shall confirm that the
1224	1224	26 recipient or enrollee is not already in receipt of the same or
1225	1225
1226	1226
1227	1227
1228	1228
1229	1229
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1231	1231
1232	1232
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1235	1235	1 similar equipment from another service provider, and that the
1236	1236	2 refurbished durable medical equipment equally meets the needs
1237	1237	3 of the recipient or enrollee. Nothing in this paragraph shall
1238	1238	4 be construed to limit recipient or enrollee choice to obtain
1239	1239	5 new durable medical equipment or place any additional prior
1240	1240	6 authorization conditions on enrollees of managed care
1241	1241	7 organizations.
1242	1242	8 The Department shall execute, relative to the nursing home
1243	1243	9 prescreening project, written inter-agency agreements with the
1244	1244	10 Department of Human Services and the Department on Aging, to
1245	1245	11 effect the following: (i) intake procedures and common
1246	1246	12 eligibility criteria for those persons who are receiving
1247	1247	13 non-institutional services; and (ii) the establishment and
1248	1248	14 development of non-institutional services in areas of the
1249	1249	15 State where they are not currently available or are
1250	1250	16 undeveloped; and (iii) notwithstanding any other provision of
1251	1251	17 law, subject to federal approval, on and after July 1, 2012, an
1252	1252	18 increase in the determination of need (DON) scores from 29 to
1253	1253	19 37 for applicants for institutional and home and
1254	1254	20 community-based long term care; if and only if federal
1255	1255	21 approval is not granted, the Department may, in conjunction
1256	1256	22 with other affected agencies, implement utilization controls
1257	1257	23 or changes in benefit packages to effectuate a similar savings
1258	1258	24 amount for this population; and (iv) no later than July 1,
1259	1259	25 2013, minimum level of care eligibility criteria for
1260	1260	26 institutional and home and community-based long term care; and
1261	1261
1262	1262
1263	1263
1264	1264
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1267	1267
1268	1268
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1271	1271	1 (v) no later than October 1, 2013, establish procedures to
1272	1272	2 permit long term care providers access to eligibility scores
1273	1273	3 for individuals with an admission date who are seeking or
1274	1274	4 receiving services from the long term care provider. In order
1275	1275	5 to select the minimum level of care eligibility criteria, the
1276	1276	6 Governor shall establish a workgroup that includes affected
1277	1277	7 agency representatives and stakeholders representing the
1278	1278	8 institutional and home and community-based long term care
1279	1279	9 interests. This Section shall not restrict the Department from
1280	1280	10 implementing lower level of care eligibility criteria for
1281	1281	11 community-based services in circumstances where federal
1282	1282	12 approval has been granted.
1283	1283	13 The Illinois Department shall develop and operate, in
1284	1284	14 cooperation with other State Departments and agencies and in
1285	1285	15 compliance with applicable federal laws and regulations,
1286	1286	16 appropriate and effective systems of health care evaluation
1287	1287	17 and programs for monitoring of utilization of health care
1288	1288	18 services and facilities, as it affects persons eligible for
1289	1289	19 medical assistance under this Code.
1290	1290	20 The Illinois Department shall report annually to the
1291	1291	21 General Assembly, no later than the second Friday in April of
1292	1292	22 1979 and each year thereafter, in regard to:
1293	1293	23 (a) actual statistics and trends in utilization of
1294	1294	24 medical services by public aid recipients;
1295	1295	25 (b) actual statistics and trends in the provision of
1296	1296	26 the various medical services by medical vendors;
1297	1297
1298	1298
1299	1299
1300	1300
1301	1301
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1303	1303
1304	1304
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1307	1307	1 (c) current rate structures and proposed changes in
1308	1308	2 those rate structures for the various medical vendors; and
1309	1309	3 (d) efforts at utilization review and control by the
1310	1310	4 Illinois Department.
1311	1311	5 The period covered by each report shall be the 3 years
1312	1312	6 ending on the June 30 prior to the report. The report shall
1313	1313	7 include suggested legislation for consideration by the General
1314	1314	8 Assembly. The requirement for reporting to the General
1315	1315	9 Assembly shall be satisfied by filing copies of the report as
1316	1316	10 required by Section 3.1 of the General Assembly Organization
1317	1317	11 Act, and filing such additional copies with the State
1318	1318	12 Government Report Distribution Center for the General Assembly
1319	1319	13 as is required under paragraph (t) of Section 7 of the State
1320	1320	14 Library Act.
1321	1321	15 Rulemaking authority to implement Public Act 95-1045, if
1322	1322	16 any, is conditioned on the rules being adopted in accordance
1323	1323	17 with all provisions of the Illinois Administrative Procedure
1324	1324	18 Act and all rules and procedures of the Joint Committee on
1325	1325	19 Administrative Rules; any purported rule not so adopted, for
1326	1326	20 whatever reason, is unauthorized.
1327	1327	21 On and after July 1, 2012, the Department shall reduce any
1328	1328	22 rate of reimbursement for services or other payments or alter
1329	1329	23 any methodologies authorized by this Code to reduce any rate
1330	1330	24 of reimbursement for services or other payments in accordance
1331	1331	25 with Section 5-5e.
1332	1332	26 Because kidney transplantation can be an appropriate,
1333	1333
1334	1334
1335	1335
1336	1336
1337	1337
1338	1338	HB5203 - 36 - LRB103 38434 KTG 68570 b
1339	1339
1340	1340
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1342	1342	HB5203 - 37 - LRB103 38434 KTG 68570 b
1343	1343	1 cost-effective alternative to renal dialysis when medically
1344	1344	2 necessary and notwithstanding the provisions of Section 1-11
1345	1345	3 of this Code, beginning October 1, 2014, the Department shall
1346	1346	4 cover kidney transplantation for noncitizens with end-stage
1347	1347	5 renal disease who are not eligible for comprehensive medical
1348	1348	6 benefits, who meet the residency requirements of Section 5-3
1349	1349	7 of this Code, and who would otherwise meet the financial
1350	1350	8 requirements of the appropriate class of eligible persons
1351	1351	9 under Section 5-2 of this Code. To qualify for coverage of
1352	1352	10 kidney transplantation, such person must be receiving
1353	1353	11 emergency renal dialysis services covered by the Department.
1354	1354	12 Providers under this Section shall be prior approved and
1355	1355	13 certified by the Department to perform kidney transplantation
1356	1356	14 and the services under this Section shall be limited to
1357	1357	15 services associated with kidney transplantation.
1358	1358	16 Notwithstanding any other provision of this Code to the
1359	1359	17 contrary, on or after July 1, 2015, all FDA approved forms of
1360	1360	18 medication assisted treatment prescribed for the treatment of
1361	1361	19 alcohol dependence or treatment of opioid dependence shall be
1362	1362	20 covered under both fee-for-service fee for service and managed
1363	1363	21 care medical assistance programs for persons who are otherwise
1364	1364	22 eligible for medical assistance under this Article and shall
1365	1365	23 not be subject to any (1) utilization control, other than
1366	1366	24 those established under the American Society of Addiction
1367	1367	25 Medicine patient placement criteria, (2) prior authorization
1368	1368	26 mandate, or (3) lifetime restriction limit mandate.
1369	1369
1370	1370
1371	1371
1372	1372
1373	1373
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1375	1375
1376	1376
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1379	1379	1 On or after July 1, 2015, opioid antagonists prescribed
1380	1380	2 for the treatment of an opioid overdose, including the
1381	1381	3 medication product, administration devices, and any pharmacy
1382	1382	4 fees or hospital fees related to the dispensing, distribution,
1383	1383	5 and administration of the opioid antagonist, shall be covered
1384	1384	6 under the medical assistance program for persons who are
1385	1385	7 otherwise eligible for medical assistance under this Article.
1386	1386	8 As used in this Section, "opioid antagonist" means a drug that
1387	1387	9 binds to opioid receptors and blocks or inhibits the effect of
1388	1388	10 opioids acting on those receptors, including, but not limited
1389	1389	11 to, naloxone hydrochloride or any other similarly acting drug
1390	1390	12 approved by the U.S. Food and Drug Administration. The
1391	1391	13 Department shall not impose a copayment on the coverage
1392	1392	14 provided for naloxone hydrochloride under the medical
1393	1393	15 assistance program.
1394	1394	16 Upon federal approval, the Department shall provide
1395	1395	17 coverage and reimbursement for all drugs that are approved for
1396	1396	18 marketing by the federal Food and Drug Administration and that
1397	1397	19 are recommended by the federal Public Health Service or the
1398	1398	20 United States Centers for Disease Control and Prevention for
1399	1399	21 pre-exposure prophylaxis and related pre-exposure prophylaxis
1400	1400	22 services, including, but not limited to, HIV and sexually
1401	1401	23 transmitted infection screening, treatment for sexually
1402	1402	24 transmitted infections, medical monitoring, assorted labs, and
1403	1403	25 counseling to reduce the likelihood of HIV infection among
1404	1404	26 individuals who are not infected with HIV but who are at high
1405	1405
1406	1406
1407	1407
1408	1408
1409	1409
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1411	1411
1412	1412
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1415	1415	1 risk of HIV infection.
1416	1416	2 A federally qualified health center, as defined in Section
1417	1417	3 1905(l)(2)(B) of the federal Social Security Act, shall be
1418	1418	4 reimbursed by the Department in accordance with the federally
1419	1419	5 qualified health center's encounter rate for services provided
1420	1420	6 to medical assistance recipients that are performed by a
1421	1421	7 dental hygienist, as defined under the Illinois Dental
1422	1422	8 Practice Act, working under the general supervision of a
1423	1423	9 dentist and employed by a federally qualified health center.
1424	1424	10 Within 90 days after October 8, 2021 (the effective date
1425	1425	11 of Public Act 102-665), the Department shall seek federal
1426	1426	12 approval of a State Plan amendment to expand coverage for
1427	1427	13 family planning services that includes presumptive eligibility
1428	1428	14 to individuals whose income is at or below 208% of the federal
1429	1429	15 poverty level. Coverage under this Section shall be effective
1430	1430	16 beginning no later than December 1, 2022.
1431	1431	17 Subject to approval by the federal Centers for Medicare
1432	1432	18 and Medicaid Services of a Title XIX State Plan amendment
1433	1433	19 electing the Program of All-Inclusive Care for the Elderly
1434	1434	20 (PACE) as a State Medicaid option, as provided for by Subtitle
1435	1435	21 I (commencing with Section 4801) of Title IV of the Balanced
1436	1436	22 Budget Act of 1997 (Public Law 105-33) and Part 460
1437	1437	23 (commencing with Section 460.2) of Subchapter E of Title 42 of
1438	1438	24 the Code of Federal Regulations, PACE program services shall
1439	1439	25 become a covered benefit of the medical assistance program,
1440	1440	26 subject to criteria established in accordance with all
1441	1441
1442	1442
1443	1443
1444	1444
1445	1445
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1447	1447
1448	1448
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1451	1451	1 applicable laws.
1452	1452	2 Notwithstanding any other provision of this Code,
1453	1453	3 community-based pediatric palliative care from a trained
1454	1454	4 interdisciplinary team shall be covered under the medical
1455	1455	5 assistance program as provided in Section 15 of the Pediatric
1456	1456	6 Palliative Care Act.
1457	1457	7 Notwithstanding any other provision of this Code, within
1458	1458	8 12 months after June 2, 2022 (the effective date of Public Act
1459	1459	9 102-1037) and subject to federal approval, acupuncture
1460	1460	10 services performed by an acupuncturist licensed under the
1461	1461	11 Acupuncture Practice Act who is acting within the scope of his
1462	1462	12 or her license shall be covered under the medical assistance
1463	1463	13 program. The Department shall apply for any federal waiver or
1464	1464	14 State Plan amendment, if required, to implement this
1465	1465	15 paragraph. The Department may adopt any rules, including
1466	1466	16 standards and criteria, necessary to implement this paragraph.
1467	1467	17 Notwithstanding any other provision of this Code, the
1468	1468	18 medical assistance program shall, subject to appropriation and
1469	1469	19 federal approval, reimburse hospitals for costs associated
1470	1470	20 with a newborn screening test for the presence of
1471	1471	21 metachromatic leukodystrophy, as required under the Newborn
1472	1472	22 Metabolic Screening Act, at a rate not less than the fee
1473	1473	23 charged by the Department of Public Health. The Department
1474	1474	24 shall seek federal approval before the implementation of the
1475	1475	25 newborn screening test fees by the Department of Public
1476	1476	26 Health.
1477	1477
1478	1478
1479	1479
1480	1480
1481	1481
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1483	1483
1484	1484
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1486	1486	HB5203 - 41 - LRB103 38434 KTG 68570 b
1487	1487	1 Notwithstanding any other provision of this Code,
1488	1488	2 beginning on January 1, 2024, subject to federal approval,
1489	1489	3 cognitive assessment and care planning services provided to a
1490	1490	4 person who experiences signs or symptoms of cognitive
1491	1491	5 impairment, as defined by the Diagnostic and Statistical
1492	1492	6 Manual of Mental Disorders, Fifth Edition, shall be covered
1493	1493	7 under the medical assistance program for persons who are
1494	1494	8 otherwise eligible for medical assistance under this Article.
1495	1495	9 Notwithstanding any other provision of this Code,
1496	1496	10 medically necessary reconstructive services that are intended
1497	1497	11 to restore physical appearance shall be covered under the
1498	1498	12 medical assistance program for persons who are otherwise
1499	1499	13 eligible for medical assistance under this Article. As used in
1500	1500	14 this paragraph, "reconstructive services" means treatments
1501	1501	15 performed on structures of the body damaged by trauma to
1502	1502	16 restore physical appearance.
1503	1503	17 (Source: P.A. 102-43, Article 30, Section 30-5, eff. 7-6-21;
1504	1504	18 102-43, Article 35, Section 35-5, eff. 7-6-21; 102-43, Article
1505	1505	19 55, Section 55-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123,
1506	1506	20 eff. 1-1-22; 102-558, eff. 8-20-21; 102-598, eff. 1-1-22;
1507	1507	21 102-655, eff. 1-1-22; 102-665, eff. 10-8-21; 102-813, eff.
1508	1508	22 5-13-22; 102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22;
1509	1509	23 102-1038, eff. 1-1-23; 103-102, Article 15, Section 15-5, eff.
1510	1510	24 1-1-24; 103-102, Article 95, Section 95-15, eff. 1-1-24;
1511	1511	25 103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-368, eff.
1512	1512	26 1-1-24; revised 12-15-23.)
1513	1513
1514	1514
1515	1515
1516	1516
1517	1517
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1519	1519
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1523	1523	1 (305 ILCS 5/5-8) (from Ch. 23, par. 5-8)
1524	1524	2 Sec. 5-8. Practitioners. In supplying medical assistance,
1525	1525	3 the Illinois Department may provide for the legally authorized
1526	1526	4 services of (i) persons licensed under the Medical Practice
1527	1527	5 Act of 1987, as amended, except as hereafter in this Section
1528	1528	6 stated, whether under a general or limited license, (ii)
1529	1529	7 persons licensed under the Nurse Practice Act as advanced
1530	1530	8 practice registered nurses, regardless of whether or not the
1531	1531	9 persons have written collaborative agreements, (iii) persons
1532	1532	10 licensed or registered under other laws of this State to
1533	1533	11 provide dental, medical, pharmaceutical, optometric,
1534	1534	12 podiatric, or nursing services, or other remedial care
1535	1535	13 recognized under State law, (iv) persons licensed under other
1536	1536	14 laws of this State as a clinical social worker, and (v) persons
1537	1537	15 licensed under other laws of this State as physician
1538	1538	16 assistants. The Department shall adopt rules, no later than 90
1539	1539	17 days after January 1, 2017 (the effective date of Public Act
1540	1540	18 99-621), for the legally authorized services of persons
1541	1541	19 licensed under other laws of this State as a clinical social
1542	1542	20 worker. The Department shall provide for the legally
1543	1543	21 authorized services of persons licensed under the Professional
1544	1544	22 Counselor and Clinical Professional Counselor Licensing and
1545	1545	23 Practice Act as clinical professional counselors and for the
1546	1546	24 legally authorized services of persons licensed under the
1547	1547	25 Marriage and Family Therapy Licensing Act as marriage and
1548	1548
1549	1549
1550	1550
1551	1551
1552	1552
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1554	1554
1555	1555
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1558	1558	1 family therapists. The Department may not provide for legally
1559	1559	2 authorized services of any physician who has been convicted of
1560	1560	3 having performed an abortion procedure in a willful and wanton
1561	1561	4 manner on a woman who was not pregnant at the time such
1562	1562	5 abortion procedure was performed. The utilization of the
1563	1563	6 services of persons engaged in the treatment or care of the
1564	1564	7 sick, which persons are not required to be licensed or
1565	1565	8 registered under the laws of this State, is not prohibited by
1566	1566	9 this Section.
1567	1567	10 (Source: P.A. 102-43, eff. 7-6-21.)
1568	1568	11 (305 ILCS 5/5-9) (from Ch. 23, par. 5-9)
1569	1569	12 Sec. 5-9. Choice of medical dispensers. Applicants and
1570	1570	13 recipients shall be entitled to free choice of those qualified
1571	1571	14 practitioners, hospitals, nursing homes, and other dispensers
1572	1572	15 of medical services meeting the requirements and complying
1573	1573	16 with the rules and regulations of the Illinois Department.
1574	1574	17 However, the Director of Healthcare and Family Services may,
1575	1575	18 after providing reasonable notice and opportunity for hearing,
1576	1576	19 deny, suspend or terminate any otherwise qualified person,
1577	1577	20 firm, corporation, association, agency, institution, or other
1578	1578	21 legal entity, from participation as a vendor of goods or
1579	1579	22 services under the medical assistance program authorized by
1580	1580	23 this Article if the Director finds such vendor of medical
1581	1581	24 services in violation of this Act or the policy or rules and
1582	1582	25 regulations issued pursuant to this Act. Any physician who has
1583	1583
1584	1584
1585	1585
1586	1586
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1589	1589
1590	1590
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1593	1593	1 been convicted of performing an abortion procedure in a
1594	1594	2 willful and wanton manner upon a woman who was not pregnant at
1595	1595	3 the time such abortion procedure was performed shall be
1596	1596	4 automatically removed from the list of physicians qualified to
1597	1597	5 participate as a vendor of medical services under the medical
1598	1598	6 assistance program authorized by this Article.
1599	1599	7 (Source: P.A. 100-538, eff. 1-1-18.)
1600	1600	8 (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
1601	1601	9 Sec. 6-1. Eligibility requirements. Financial aid in
1602	1602	10 meeting basic maintenance requirements shall be given under
1603	1603	11 this Article to or in behalf of persons who meet the
1604	1604	12 eligibility conditions of Sections 6-1.1 through 6-1.10,
1605	1605	13 except as provided in the No Taxpayer Funding for Abortion
1606	1606	14 Act. In addition, each unit of local government subject to
1607	1607	15 this Article shall provide persons receiving financial aid in
1608	1608	16 meeting basic maintenance requirements with financial aid for
1609	1609	17 either (a) necessary treatment, care, and supplies required
1610	1610	18 because of illness or disability, or (b) acute medical
1611	1611	19 treatment, care, and supplies only. If a local governmental
1612	1612	20 unit elects to provide financial aid for acute medical
1613	1613	21 treatment, care, and supplies only, the general types of acute
1614	1614	22 medical treatment, care, and supplies for which financial aid
1615	1615	23 is provided shall be specified in the general assistance rules
1616	1616	24 of the local governmental unit, which rules shall provide that
1617	1617	25 financial aid is provided, at a minimum, for acute medical
1618	1618
1619	1619
1620	1620
1621	1621
1622	1622
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1624	1624
1625	1625
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1628	1628	1 treatment, care, or supplies necessitated by a medical
1629	1629	2 condition for which prior approval or authorization of medical
1630	1630	3 treatment, care, or supplies is not required by the general
1631	1631	4 assistance rules of the Illinois Department.
1632	1632	5 (Source: P.A. 100-538, eff. 1-1-18.)
1633	1633	6 Section 910. The Problem Pregnancy Health Services and
1634	1634	7 Care Act is amended by changing Section 4-100 as follows:
1635	1635	8 (410 ILCS 230/4-100) (from Ch. 111 1/2, par. 4604-100)
1636	1636	9 Sec. 4-100. The Department may make grants to nonprofit
1637	1637	10 agencies and organizations which do not use such grants to
1638	1638	11 refer or counsel for, or perform, abortions and which
1639	1639	12 coordinate and establish linkages among services that will
1640	1640	13 further the purposes of this Act and, where appropriate, will
1641	1641	14 provide, supplement, or improve the quality of such services.
1642	1642	15 (Source: P.A. 100-538, eff. 1-1-18.)
1643	1643	16 Section 990. Application of Act; home rule powers.
1644	1644	17 (a) This Act applies to all State and local (including
1645	1645	18 home rule unit) laws, ordinances, policies, procedures,
1646	1646	19 practices, and governmental actions and their implementation,
1647	1647	20 whether statutory or otherwise and whether adopted before or
1648	1648	21 after the effective date of this Act.
1649	1649	22 (b) A home rule unit may not adopt any rule in a manner
1650	1650	23 inconsistent with this Act. This Act is a limitation under
1651	1651
1652	1652
1653	1653
1654	1654
1655	1655
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1657	1657
1658	1658
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1660	1660	HB5203 - 46 - LRB103 38434 KTG 68570 b
1661	1661	1 subsection (i) of Section 6 of Article VII of the Illinois
1662	1662	2 Constitution on the concurrent exercise by home rule units of
1663	1663	3 powers and functions exercised by the State.
1664	1664
1665	1665
1666	1666
1667	1667
1668	1668
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