Illinois 2023-2024 Regular Session

Illinois House Bill HB5857 Compare Versions

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

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5857 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED: 30 ILCS 105/5.1015 new305 ILCS 5/5-4.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. Sets forth the following findings of the General Assembly: (i) access to ground ambulance services improves health equity, increases access to quality care, and reduces health disparities in underserved communities; (ii) due to the underfunding of these critical services by the federal Medicare and Medicaid programs, there is a growing scarcity of non-emergency ground ambulance services in underserved, minority communities in this State; and (iii) the State has an interest in providing funding to nonemergency ground ambulance service providers in affected communities. Creates the Safety-Net Ambulance Sustainability Fund as a special fund in the State treasury. Provides that the Fund shall consist of any federal, State, or private moneys designated for deposit into the Fund and all interest earned on moneys in the Fund. Provides that moneys in the Fund, including all accrued interest thereon, shall only be used and disbursed by the Department of Healthcare and Family Services to support the operating expenses of nongovernmental ground ambulance providers in high-Medicaid communities. Provides that any amounts expended from the Fund that are later recouped by the Department following an audit or otherwise shall be returned to the Fund. Amends the State Finance Act. Adds the Safety-Net Ambulance Sustainability Fund to the list of special funds under the Act. LRB103 40887 KTG 73847 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5857 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED: 30 ILCS 105/5.1015 new305 ILCS 5/5-4.2 30 ILCS 105/5.1015 new 305 ILCS 5/5-4.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. Sets forth the following findings of the General Assembly: (i) access to ground ambulance services improves health equity, increases access to quality care, and reduces health disparities in underserved communities; (ii) due to the underfunding of these critical services by the federal Medicare and Medicaid programs, there is a growing scarcity of non-emergency ground ambulance services in underserved, minority communities in this State; and (iii) the State has an interest in providing funding to nonemergency ground ambulance service providers in affected communities. Creates the Safety-Net Ambulance Sustainability Fund as a special fund in the State treasury. Provides that the Fund shall consist of any federal, State, or private moneys designated for deposit into the Fund and all interest earned on moneys in the Fund. Provides that moneys in the Fund, including all accrued interest thereon, shall only be used and disbursed by the Department of Healthcare and Family Services to support the operating expenses of nongovernmental ground ambulance providers in high-Medicaid communities. Provides that any amounts expended from the Fund that are later recouped by the Department following an audit or otherwise shall be returned to the Fund. Amends the State Finance Act. Adds the Safety-Net Ambulance Sustainability Fund to the list of special funds under the Act. LRB103 40887 KTG 73847 b LRB103 40887 KTG 73847 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5857 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED:
3	3	30 ILCS 105/5.1015 new305 ILCS 5/5-4.2 30 ILCS 105/5.1015 new 305 ILCS 5/5-4.2
4	4	30 ILCS 105/5.1015 new
5	5	305 ILCS 5/5-4.2
6	6	Amends the Medical Assistance Article of the Illinois Public Aid Code. Sets forth the following findings of the General Assembly: (i) access to ground ambulance services improves health equity, increases access to quality care, and reduces health disparities in underserved communities; (ii) due to the underfunding of these critical services by the federal Medicare and Medicaid programs, there is a growing scarcity of non-emergency ground ambulance services in underserved, minority communities in this State; and (iii) the State has an interest in providing funding to nonemergency ground ambulance service providers in affected communities. Creates the Safety-Net Ambulance Sustainability Fund as a special fund in the State treasury. Provides that the Fund shall consist of any federal, State, or private moneys designated for deposit into the Fund and all interest earned on moneys in the Fund. Provides that moneys in the Fund, including all accrued interest thereon, shall only be used and disbursed by the Department of Healthcare and Family Services to support the operating expenses of nongovernmental ground ambulance providers in high-Medicaid communities. Provides that any amounts expended from the Fund that are later recouped by the Department following an audit or otherwise shall be returned to the Fund. Amends the State Finance Act. Adds the Safety-Net Ambulance Sustainability Fund to the list of special funds under the Act.
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12	12	1 AN ACT concerning public aid.
13	13	2 Be it enacted by the People of the State of Illinois,
14	14	3 represented in the General Assembly:
15	15	4 Section 1. The State Finance Act is amended by adding
16	16	5 Section 5.1015 as follows:
17	17	6 (30 ILCS 105/5.1015 new)
18	18	7 Sec. 5.1015. The Safety-Net Ambulance Sustainability Fund.
19	19	8 Section 5. The Illinois Public Aid Code is amended by
20	20	9 changing Section 5-4.2 as follows:
21	21	10 (305 ILCS 5/5-4.2)
22	22	11 Sec. 5-4.2. Ambulance services payments.
23	23	12 (a) For ambulance services provided to a recipient of aid
24	24	13 under this Article on or after January 1, 1993, the Illinois
25	25	14 Department shall reimburse ambulance service providers at
26	26	15 rates calculated in accordance with this Section. It is the
27	27	16 intent of the General Assembly to provide adequate
28	28	17 reimbursement for ambulance services so as to ensure adequate
29	29	18 access to services for recipients of aid under this Article
30	30	19 and to provide appropriate incentives to ambulance service
31	31	20 providers to provide services in an efficient and
32	32	21 cost-effective manner. Thus, it is the intent of the General
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36	36	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5857 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED:
37	37	30 ILCS 105/5.1015 new305 ILCS 5/5-4.2 30 ILCS 105/5.1015 new 305 ILCS 5/5-4.2
38	38	30 ILCS 105/5.1015 new
39	39	305 ILCS 5/5-4.2
40	40	Amends the Medical Assistance Article of the Illinois Public Aid Code. Sets forth the following findings of the General Assembly: (i) access to ground ambulance services improves health equity, increases access to quality care, and reduces health disparities in underserved communities; (ii) due to the underfunding of these critical services by the federal Medicare and Medicaid programs, there is a growing scarcity of non-emergency ground ambulance services in underserved, minority communities in this State; and (iii) the State has an interest in providing funding to nonemergency ground ambulance service providers in affected communities. Creates the Safety-Net Ambulance Sustainability Fund as a special fund in the State treasury. Provides that the Fund shall consist of any federal, State, or private moneys designated for deposit into the Fund and all interest earned on moneys in the Fund. Provides that moneys in the Fund, including all accrued interest thereon, shall only be used and disbursed by the Department of Healthcare and Family Services to support the operating expenses of nongovernmental ground ambulance providers in high-Medicaid communities. Provides that any amounts expended from the Fund that are later recouped by the Department following an audit or otherwise shall be returned to the Fund. Amends the State Finance Act. Adds the Safety-Net Ambulance Sustainability Fund to the list of special funds under the Act.
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69	69	1 Assembly that the Illinois Department implement a
70	70	2 reimbursement system for ambulance services that, to the
71	71	3 extent practicable and subject to the availability of funds
72	72	4 appropriated by the General Assembly for this purpose, is
73	73	5 consistent with the payment principles of Medicare. To ensure
74	74	6 uniformity between the payment principles of Medicare and
75	75	7 Medicaid, the Illinois Department shall follow, to the extent
76	76	8 necessary and practicable and subject to the availability of
77	77	9 funds appropriated by the General Assembly for this purpose,
78	78	10 the statutes, laws, regulations, policies, procedures,
79	79	11 principles, definitions, guidelines, and manuals used to
80	80	12 determine the amounts paid to ambulance service providers
81	81	13 under Title XVIII of the Social Security Act (Medicare).
82	82	14 (b) For ambulance services provided to a recipient of aid
83	83	15 under this Article on or after January 1, 1996, the Illinois
84	84	16 Department shall reimburse ambulance service providers based
85	85	17 upon the actual distance traveled if a natural disaster,
86	86	18 weather conditions, road repairs, or traffic congestion
87	87	19 necessitates the use of a route other than the most direct
88	88	20 route.
89	89	21 (c) For purposes of this Section, "ambulance services"
90	90	22 includes medical transportation services provided by means of
91	91	23 an ambulance, air ambulance, medi-car, service car, or taxi.
92	92	24 (c-1) For purposes of this Section, "ground ambulance
93	93	25 service" means medical transportation services that are
94	94	26 described as ground ambulance services by the Centers for
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105	105	1 Medicare and Medicaid Services and provided in a vehicle that
106	106	2 is licensed as an ambulance by the Illinois Department of
107	107	3 Public Health pursuant to the Emergency Medical Services (EMS)
108	108	4 Systems Act.
109	109	5 (c-2) For purposes of this Section, "ground ambulance
110	110	6 service provider" means a vehicle service provider as
111	111	7 described in the Emergency Medical Services (EMS) Systems Act
112	112	8 that operates licensed ambulances for the purpose of providing
113	113	9 emergency ambulance services, or non-emergency ambulance
114	114	10 services, or both. For purposes of this Section, this includes
115	115	11 both ambulance providers and ambulance suppliers as described
116	116	12 by the Centers for Medicare and Medicaid Services.
117	117	13 (c-3) For purposes of this Section, "medi-car" means
118	118	14 transportation services provided to a patient who is confined
119	119	15 to a wheelchair and requires the use of a hydraulic or electric
120	120	16 lift or ramp and wheelchair lockdown when the patient's
121	121	17 condition does not require medical observation, medical
122	122	18 supervision, medical equipment, the administration of
123	123	19 medications, or the administration of oxygen.
124	124	20 (c-4) For purposes of this Section, "service car" means
125	125	21 transportation services provided to a patient by a passenger
126	126	22 vehicle where that patient does not require the specialized
127	127	23 modes described in subsection (c-1) or (c-3).
128	128	24 (c-5) For purposes of this Section, "air ambulance
129	129	25 service" means medical transport by helicopter or airplane for
130	130	26 patients, as defined in 29 U.S.C. 1185f(c)(1), and any service
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141	141	1 that is described as an air ambulance service by the federal
142	142	2 Centers for Medicare and Medicaid Services.
143	143	3 (d) This Section does not prohibit separate billing by
144	144	4 ambulance service providers for oxygen furnished while
145	145	5 providing advanced life support services.
146	146	6 (e) Beginning with services rendered on or after July 1,
147	147	7 2008, all providers of non-emergency medi-car and service car
148	148	8 transportation must certify that the driver and employee
149	149	9 attendant, as applicable, have completed a safety program
150	150	10 approved by the Department to protect both the patient and the
151	151	11 driver, prior to transporting a patient. The provider must
152	152	12 maintain this certification in its records. The provider shall
153	153	13 produce such documentation upon demand by the Department or
154	154	14 its representative. Failure to produce documentation of such
155	155	15 training shall result in recovery of any payments made by the
156	156	16 Department for services rendered by a non-certified driver or
157	157	17 employee attendant. Medi-car and service car providers must
158	158	18 maintain legible documentation in their records of the driver
159	159	19 and, as applicable, employee attendant that actually
160	160	20 transported the patient. Providers must recertify all drivers
161	161	21 and employee attendants every 3 years. If they meet the
162	162	22 established training components set forth by the Department,
163	163	23 providers of non-emergency medi-car and service car
164	164	24 transportation that are either directly or through an
165	165	25 affiliated company licensed by the Department of Public Health
166	166	26 shall be approved by the Department to have in-house safety
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177	177	1 programs for training their own staff.
178	178	2 Notwithstanding the requirements above, any public
179	179	3 transportation provider of medi-car and service car
180	180	4 transportation that receives federal funding under 49 U.S.C.
181	181	5 5307 and 5311 need not certify its drivers and employee
182	182	6 attendants under this Section, since safety training is
183	183	7 already federally mandated.
184	184	8 (f) With respect to any policy or program administered by
185	185	9 the Department or its agent regarding approval of
186	186	10 non-emergency medical transportation by ground ambulance
187	187	11 service providers, including, but not limited to, the
188	188	12 Non-Emergency Transportation Services Prior Approval Program
189	189	13 (NETSPAP), the Department shall establish by rule a process by
190	190	14 which ground ambulance service providers of non-emergency
191	191	15 medical transportation may appeal any decision by the
192	192	16 Department or its agent for which no denial was received prior
193	193	17 to the time of transport that either (i) denies a request for
194	194	18 approval for payment of non-emergency transportation by means
195	195	19 of ground ambulance service or (ii) grants a request for
196	196	20 approval of non-emergency transportation by means of ground
197	197	21 ambulance service at a level of service that entitles the
198	198	22 ground ambulance service provider to a lower level of
199	199	23 compensation from the Department than the ground ambulance
200	200	24 service provider would have received as compensation for the
201	201	25 level of service requested. The rule shall be filed by
202	202	26 December 15, 2012 and shall provide that, for any decision
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213	213	1 rendered by the Department or its agent on or after the date
214	214	2 the rule takes effect, the ground ambulance service provider
215	215	3 shall have 60 days from the date the decision is received to
216	216	4 file an appeal. The rule established by the Department shall
217	217	5 be, insofar as is practical, consistent with the Illinois
218	218	6 Administrative Procedure Act. The Director's decision on an
219	219	7 appeal under this Section shall be a final administrative
220	220	8 decision subject to review under the Administrative Review
221	221	9 Law.
222	222	10 (f-5) Beginning 90 days after July 20, 2012 (the effective
223	223	11 date of Public Act 97-842), (i) no denial of a request for
224	224	12 approval for payment of non-emergency transportation by means
225	225	13 of ground ambulance service, and (ii) no approval of
226	226	14 non-emergency transportation by means of ground ambulance
227	227	15 service at a level of service that entitles the ground
228	228	16 ambulance service provider to a lower level of compensation
229	229	17 from the Department than would have been received at the level
230	230	18 of service submitted by the ground ambulance service provider,
231	231	19 may be issued by the Department or its agent unless the
232	232	20 Department has submitted the criteria for determining the
233	233	21 appropriateness of the transport for first notice publication
234	234	22 in the Illinois Register pursuant to Section 5-40 of the
235	235	23 Illinois Administrative Procedure Act.
236	236	24 (f-6) Within 90 days after June 2, 2022 (the effective
237	237	25 date of Public Act 102-1037) this amendatory Act of the 102nd
238	238	26 General Assembly and subject to federal approval, the
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249	249	1 Department shall file rules to allow for the approval of
250	250	2 ground ambulance services when the sole purpose of the
251	251	3 transport is for the navigation of stairs or the assisting or
252	252	4 lifting of a patient at a medical facility or during a medical
253	253	5 appointment in instances where the Department or a contracted
254	254	6 Medicaid managed care organization or their transportation
255	255	7 broker is unable to secure transportation through any other
256	256	8 transportation provider.
257	257	9 (f-7) For non-emergency ground ambulance claims properly
258	258	10 denied under Department policy at the time the claim is filed
259	259	11 due to failure to submit a valid Medical Certification for
260	260	12 Non-Emergency Ambulance on and after December 15, 2012 and
261	261	13 prior to January 1, 2021, the Department shall allot
262	262	14 $2,000,000 to a pool to reimburse such claims if the provider
263	263	15 proves medical necessity for the service by other means.
264	264	16 Providers must submit any such denied claims for which they
265	265	17 seek compensation to the Department no later than December 31,
266	266	18 2021 along with documentation of medical necessity. No later
267	267	19 than May 31, 2022, the Department shall determine for which
268	268	20 claims medical necessity was established. Such claims for
269	269	21 which medical necessity was established shall be paid at the
270	270	22 rate in effect at the time of the service, provided the
271	271	23 $2,000,000 is sufficient to pay at those rates. If the pool is
272	272	24 not sufficient, claims shall be paid at a uniform percentage
273	273	25 of the applicable rate such that the pool of $2,000,000 is
274	274	26 exhausted. The appeal process described in subsection (f)
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285	285	1 shall not be applicable to the Department's determinations
286	286	2 made in accordance with this subsection.
287	287	3 (g) Whenever a patient covered by a medical assistance
288	288	4 program under this Code or by another medical program
289	289	5 administered by the Department, including a patient covered
290	290	6 under the State's Medicaid managed care program, is being
291	291	7 transported from a facility and requires non-emergency
292	292	8 transportation including ground ambulance, medi-car, or
293	293	9 service car transportation, a Physician Certification
294	294	10 Statement as described in this Section shall be required for
295	295	11 each patient. Facilities shall develop procedures for a
296	296	12 licensed medical professional to provide a written and signed
297	297	13 Physician Certification Statement. The Physician Certification
298	298	14 Statement shall specify the level of transportation services
299	299	15 needed and complete a medical certification establishing the
300	300	16 criteria for approval of non-emergency ambulance
301	301	17 transportation, as published by the Department of Healthcare
302	302	18 and Family Services, that is met by the patient. This
303	303	19 certification shall be completed prior to ordering the
304	304	20 transportation service and prior to patient discharge. The
305	305	21 Physician Certification Statement is not required prior to
306	306	22 transport if a delay in transport can be expected to
307	307	23 negatively affect the patient outcome. If the ground ambulance
308	308	24 provider, medi-car provider, or service car provider is unable
309	309	25 to obtain the required Physician Certification Statement
310	310	26 within 10 calendar days following the date of the service, the
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321	321	1 ground ambulance provider, medi-car provider, or service car
322	322	2 provider must document its attempt to obtain the requested
323	323	3 certification and may then submit the claim for payment.
324	324	4 Acceptable documentation includes a signed return receipt from
325	325	5 the U.S. Postal Service, facsimile receipt, email receipt, or
326	326	6 other similar service that evidences that the ground ambulance
327	327	7 provider, medi-car provider, or service car provider attempted
328	328	8 to obtain the required Physician Certification Statement.
329	329	9 The medical certification specifying the level and type of
330	330	10 non-emergency transportation needed shall be in the form of
331	331	11 the Physician Certification Statement on a standardized form
332	332	12 prescribed by the Department of Healthcare and Family
333	333	13 Services. Within 75 days after July 27, 2018 (the effective
334	334	14 date of Public Act 100-646), the Department of Healthcare and
335	335	15 Family Services shall develop a standardized form of the
336	336	16 Physician Certification Statement specifying the level and
337	337	17 type of transportation services needed in consultation with
338	338	18 the Department of Public Health, Medicaid managed care
339	339	19 organizations, a statewide association representing ambulance
340	340	20 providers, a statewide association representing hospitals, 3
341	341	21 statewide associations representing nursing homes, and other
342	342	22 stakeholders. The Physician Certification Statement shall
343	343	23 include, but is not limited to, the criteria necessary to
344	344	24 demonstrate medical necessity for the level of transport
345	345	25 needed as required by (i) the Department of Healthcare and
346	346	26 Family Services and (ii) the federal Centers for Medicare and
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357	357	1 Medicaid Services as outlined in the Centers for Medicare and
358	358	2 Medicaid Services' Medicare Benefit Policy Manual, Pub.
359	359	3 100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician
360	360	4 Certification Statement shall satisfy the obligations of
361	361	5 hospitals under Section 6.22 of the Hospital Licensing Act and
362	362	6 nursing homes under Section 2-217 of the Nursing Home Care
363	363	7 Act. Implementation and acceptance of the Physician
364	364	8 Certification Statement shall take place no later than 90 days
365	365	9 after the issuance of the Physician Certification Statement by
366	366	10 the Department of Healthcare and Family Services.
367	367	11 Pursuant to subsection (E) of Section 12-4.25 of this
368	368	12 Code, the Department is entitled to recover overpayments paid
369	369	13 to a provider or vendor, including, but not limited to, from
370	370	14 the discharging physician, the discharging facility, and the
371	371	15 ground ambulance service provider, in instances where a
372	372	16 non-emergency ground ambulance service is rendered as the
373	373	17 result of improper or false certification.
374	374	18 Beginning October 1, 2018, the Department of Healthcare
375	375	19 and Family Services shall collect data from Medicaid managed
376	376	20 care organizations and transportation brokers, including the
377	377	21 Department's NETSPAP broker, regarding denials and appeals
378	378	22 related to the missing or incomplete Physician Certification
379	379	23 Statement forms and overall compliance with this subsection.
380	380	24 The Department of Healthcare and Family Services shall publish
381	381	25 quarterly results on its website within 15 days following the
382	382	26 end of each quarter.
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393	393	1 (h) On and after July 1, 2012, the Department shall reduce
394	394	2 any rate of reimbursement for services or other payments or
395	395	3 alter any methodologies authorized by this Code to reduce any
396	396	4 rate of reimbursement for services or other payments in
397	397	5 accordance with Section 5-5e.
398	398	6 (i) Subject to federal approval, on and after January 1,
399	399	7 2024 through June 30, 2026, the Department shall increase the
400	400	8 base rate of reimbursement for both base charges and mileage
401	401	9 charges for ground ambulance service providers not
402	402	10 participating in the Ground Emergency Medical Transportation
403	403	11 (GEMT) Program for medical transportation services provided by
404	404	12 means of a ground ambulance to a level not lower than 140% of
405	405	13 the base rate in effect as of January 1, 2023.
406	406	14 (j) For the purpose of understanding ground ambulance
407	407	15 transportation services cost structures and their impact on
408	408	16 the Medical Assistance Program, the Department shall engage
409	409	17 stakeholders, including, but not limited to, a statewide
410	410	18 association representing private ground ambulance service
411	411	19 providers in Illinois, to develop recommendations for a plan
412	412	20 for the regular collection of cost data for all ground
413	413	21 ambulance transportation providers reimbursed under the
414	414	22 Illinois Title XIX State Plan. Cost data obtained through this
415	415	23 process shall be used to inform on and to ensure the
416	416	24 effectiveness and efficiency of Illinois Medicaid rates. The
417	417	25 Department shall establish a process to limit public
418	418	26 availability of portions of the cost report data determined to
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429	429	1 be proprietary. This process shall be concluded and
430	430	2 recommendations shall be provided no later than April 1, 2024.
431	431	3 (k) (j) Subject to federal approval, beginning on January
432	432	4 1, 2024, the Department shall increase the base rate of
433	433	5 reimbursement for both base charges and mileage charges for
434	434	6 medical transportation services provided by means of an air
435	435	7 ambulance to a level not lower than 50% of the Medicare
436	436	8 ambulance fee schedule rates, by designated Medicare locality,
437	437	9 in effect on January 1, 2023.
438	438	10 (l) The General Assembly finds that access to ground
439	439	11 ambulance services improves health equity, increases access to
440	440	12 quality care, and reduces health disparities in underserved
441	441	13 communities. Due to the underfunding of these critical
442	442	14 services by the federal Medicare and Medicaid programs, there
443	443	15 is a growing scarcity of non-emergency ground ambulance
444	444	16 services in underserved, minority communities in this State,
445	445	17 including and particularly in those communities with
446	446	18 safety-net hospitals. To address this scarcity, the General
447	447	19 Assembly finds that the State has an interest in providing
448	448	20 funding to nongovernmental ground ambulance providers in
449	449	21 affected communities. The Safety-Net Ambulance Sustainability
450	450	22 Fund is created as a special fund in the State treasury. The
451	451	23 purpose of the Fund is to receive and disburse funds in
452	452	24 accordance with this subsection and for no other purpose. The
453	453	25 Fund shall consist of any federal, State, or private moneys
454	454	26 designated for deposit into the Fund and all interest earned
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