Illinois 2023-2024 Regular Session

Illinois Senate Bill SB1586 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 SB1586 Introduced 2/8/2023, by Sen. Bill Cunningham SYNOPSIS AS INTRODUCED: 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3305 ILCS 5/5-5 from Ch. 23, par. 5-5 720 ILCS 570/303.05 Amends the Clinical Psychologist Licensing Act. In provisions concerning written collaborative agreements, removes a provision prohibiting a prescribing psychologist from prescribing medications to patients who are less than 17 years of age or over 65 years of age. Provides that no prescriptive authority for any Schedule II opioid shall be delegated. Provides that after the collaborating physician files a notice delegating authority to prescribe any nonnarcotic, nonopioid Schedule II through V controlled substances (rather than any nonnarcotic Schedule III through V controlled substances), the licensed clinical psychologist shall be eligible to register for a mid-level practitioner controlled substance license under the Illinois Controlled Substances Act. Defines "opioid". Makes corresponding changes in the Illinois Controlled Substances Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage and reimbursement for prescription management services provided by prescribing psychologists for persons who are otherwise eligible for medical assistance under the Article. Effective immediately. LRB103 25489 AMQ 51838 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1586 Introduced 2/8/2023, by Sen. Bill Cunningham SYNOPSIS AS INTRODUCED: 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3305 ILCS 5/5-5 from Ch. 23, par. 5-5 720 ILCS 570/303.05 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3 305 ILCS 5/5-5 from Ch. 23, par. 5-5 720 ILCS 570/303.05 Amends the Clinical Psychologist Licensing Act. In provisions concerning written collaborative agreements, removes a provision prohibiting a prescribing psychologist from prescribing medications to patients who are less than 17 years of age or over 65 years of age. Provides that no prescriptive authority for any Schedule II opioid shall be delegated. Provides that after the collaborating physician files a notice delegating authority to prescribe any nonnarcotic, nonopioid Schedule II through V controlled substances (rather than any nonnarcotic Schedule III through V controlled substances), the licensed clinical psychologist shall be eligible to register for a mid-level practitioner controlled substance license under the Illinois Controlled Substances Act. Defines "opioid". Makes corresponding changes in the Illinois Controlled Substances Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage and reimbursement for prescription management services provided by prescribing psychologists for persons who are otherwise eligible for medical assistance under the Article. Effective immediately. LRB103 25489 AMQ 51838 b LRB103 25489 AMQ 51838 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1586 Introduced 2/8/2023, by Sen. Bill Cunningham SYNOPSIS AS INTRODUCED:
3	3	225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3305 ILCS 5/5-5 from Ch. 23, par. 5-5 720 ILCS 570/303.05 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3 305 ILCS 5/5-5 from Ch. 23, par. 5-5 720 ILCS 570/303.05
4	4	225 ILCS 15/2 from Ch. 111, par. 5352
5	5	225 ILCS 15/4.3
6	6	305 ILCS 5/5-5 from Ch. 23, par. 5-5
7	7	720 ILCS 570/303.05
8	8	Amends the Clinical Psychologist Licensing Act. In provisions concerning written collaborative agreements, removes a provision prohibiting a prescribing psychologist from prescribing medications to patients who are less than 17 years of age or over 65 years of age. Provides that no prescriptive authority for any Schedule II opioid shall be delegated. Provides that after the collaborating physician files a notice delegating authority to prescribe any nonnarcotic, nonopioid Schedule II through V controlled substances (rather than any nonnarcotic Schedule III through V controlled substances), the licensed clinical psychologist shall be eligible to register for a mid-level practitioner controlled substance license under the Illinois Controlled Substances Act. Defines "opioid". Makes corresponding changes in the Illinois Controlled Substances Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage and reimbursement for prescription management services provided by prescribing psychologists for persons who are otherwise eligible for medical assistance under the Article. Effective immediately.
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14	14	1 AN ACT concerning regulation.
15	15	2 Be it enacted by the People of the State of Illinois,
16	16	3 represented in the General Assembly:
17	17	4 Section 5. The Clinical Psychologist Licensing Act is
18	18	5 amended by changing Sections 2 and 4.3 as follows:
19	19	6 (225 ILCS 15/2) (from Ch. 111, par. 5352)
20	20	7 (Section scheduled to be repealed on January 1, 2027)
21	21	8 Sec. 2. Definitions. As used in this Act:
22	22	9 (1) "Department" means the Department of Financial and
23	23	10 Professional Regulation.
24	24	11 (2) "Secretary" means the Secretary of Financial and
25	25	12 Professional Regulation.
26	26	13 (3) "Board" means the Clinical Psychologists Licensing
27	27	14 and Disciplinary Board appointed by the Secretary.
28	28	15 (4) (Blank).
29	29	16 (5) "Clinical psychology" means the independent
30	30	17 evaluation, classification, diagnosis, and treatment of
31	31	18 mental, emotional, behavioral or nervous disorders or
32	32	19 conditions, developmental disabilities, alcoholism and
33	33	20 substance abuse, disorders of habit or conduct, and the
34	34	21 psychological aspects of physical illness. The practice of
35	35	22 clinical psychology includes psychoeducational
36	36	23 evaluation, therapy, remediation and consultation, the use
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40	40	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1586 Introduced 2/8/2023, by Sen. Bill Cunningham SYNOPSIS AS INTRODUCED:
41	41	225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3305 ILCS 5/5-5 from Ch. 23, par. 5-5 720 ILCS 570/303.05 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3 305 ILCS 5/5-5 from Ch. 23, par. 5-5 720 ILCS 570/303.05
42	42	225 ILCS 15/2 from Ch. 111, par. 5352
43	43	225 ILCS 15/4.3
44	44	305 ILCS 5/5-5 from Ch. 23, par. 5-5
45	45	720 ILCS 570/303.05
46	46	Amends the Clinical Psychologist Licensing Act. In provisions concerning written collaborative agreements, removes a provision prohibiting a prescribing psychologist from prescribing medications to patients who are less than 17 years of age or over 65 years of age. Provides that no prescriptive authority for any Schedule II opioid shall be delegated. Provides that after the collaborating physician files a notice delegating authority to prescribe any nonnarcotic, nonopioid Schedule II through V controlled substances (rather than any nonnarcotic Schedule III through V controlled substances), the licensed clinical psychologist shall be eligible to register for a mid-level practitioner controlled substance license under the Illinois Controlled Substances Act. Defines "opioid". Makes corresponding changes in the Illinois Controlled Substances Act. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage and reimbursement for prescription management services provided by prescribing psychologists for persons who are otherwise eligible for medical assistance under the Article. Effective immediately.
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49	49	A BILL FOR
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55	55	225 ILCS 15/2 from Ch. 111, par. 5352
56	56	225 ILCS 15/4.3
57	57	305 ILCS 5/5-5 from Ch. 23, par. 5-5
58	58	720 ILCS 570/303.05
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77	77	1 of psychological and neuropsychological testing,
78	78	2 assessment, psychotherapy, psychoanalysis, hypnosis,
79	79	3 biofeedback, and behavioral modification when any of these
80	80	4 are used for the purpose of preventing or eliminating
81	81	5 psychopathology, or for the amelioration of psychological
82	82	6 disorders of individuals or groups. "Clinical psychology"
83	83	7 does not include the use of hypnosis by unlicensed persons
84	84	8 pursuant to Section 3.
85	85	9 (6) A person represents himself or herself to be a
86	86	10 "clinical psychologist" or "psychologist" within the
87	87	11 meaning of this Act when he or she holds himself or herself
88	88	12 out to the public by any title or description of services
89	89	13 incorporating the words "psychological", "psychologic",
90	90	14 "psychologist", "psychology", or "clinical psychologist"
91	91	15 or under such title or description offers to render or
92	92	16 renders clinical psychological services as defined in
93	93	17 paragraph (7) of this Section to individuals or the public
94	94	18 for remuneration.
95	95	19 (7) "Clinical psychological services" refers to any
96	96	20 services under paragraph (5) of this Section if the words
97	97	21 "psychological", "psychologic", "psychologist",
98	98	22 "psychology" or "clinical psychologist" are used to
99	99	23 describe such services by the person or organization
100	100	24 offering to render or rendering them.
101	101	25 (8) "Collaborating physician" means a physician
102	102	26 licensed to practice medicine in all of its branches in
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113	113	1 Illinois who generally prescribes medications for the
114	114	2 treatment of mental health disease or illness to his or
115	115	3 her patients in the normal course of his or her clinical
116	116	4 medical practice.
117	117	5 (9) "Prescribing psychologist" means a licensed,
118	118	6 doctoral level psychologist who has undergone specialized
119	119	7 training, has passed an examination as determined by rule,
120	120	8 and has received a current license granting prescriptive
121	121	9 authority under Section 4.2 of this Act that has not been
122	122	10 revoked or suspended from the Department.
123	123	11 (10) "Prescriptive authority" means the authority to
124	124	12 prescribe, administer, discontinue, or distribute drugs or
125	125	13 medicines.
126	126	14 (11) "Prescription" means an order for a drug,
127	127	15 laboratory test, or any medicines, including controlled
128	128	16 substances as defined in the Illinois Controlled
129	129	17 Substances Act.
130	130	18 (12) "Drugs" has the meaning given to that term in the
131	131	19 Pharmacy Practice Act.
132	132	20 (13) "Medicines" has the meaning given to that term in
133	133	21 the Pharmacy Practice Act.
134	134	22 (14) "Address of record" means the designated address
135	135	23 recorded by the Department in the applicant's application
136	136	24 file or the licensee's license file maintained by the
137	137	25 Department's licensure maintenance unit.
138	138	26 (15) "Opioid" means a narcotic drug or substance that
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149	149	1 is a Schedule II controlled substance under paragraph (1),
150	150	2 (2), (3), or (5) of subsection (b) or under subsection (c)
151	151	3 of Section 206 of the Illinois Controlled Substances Act.
152	152	4 This Act shall not apply to persons lawfully carrying on
153	153	5 their particular profession or business under any valid
154	154	6 existing regulatory Act of the State.
155	155	7 (Source: P.A. 98-668, eff. 6-25-14; 99-572, eff. 7-15-16.)
156	156	8 (225 ILCS 15/4.3)
157	157	9 (Section scheduled to be repealed on January 1, 2027)
158	158	10 Sec. 4.3. Written collaborative agreements.
159	159	11 (a) A written collaborative agreement is required for all
160	160	12 prescribing psychologists practicing under a prescribing
161	161	13 psychologist license issued pursuant to Section 4.2 of this
162	162	14 Act.
163	163	15 (b) A written delegation of prescriptive authority by a
164	164	16 collaborating physician may only include medications for the
165	165	17 treatment of mental health disease or illness the
166	166	18 collaborating physician generally provides to his or her
167	167	19 patients in the normal course of his or her clinical practice
168	168	20 with the exception of the following:
169	169	21 (1) (blank); patients who are less than 17 years of
170	170	22 age or over 65 years of age;
171	171	23 (2) patients during pregnancy;
172	172	24 (3) patients with serious medical conditions, such as
173	173	25 heart disease, cancer, stroke, or seizures, and with
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184	184	1 developmental disabilities and intellectual disabilities;
185	185	2 and
186	186	3 (4) prescriptive authority for benzodiazepine Schedule
187	187	4 III controlled substances; and .
188	188	5 (5) prescriptive authority for any Schedule II opioid.
189	189	6 (c) The collaborating physician shall file with the
190	190	7 Department notice of delegation of prescriptive authority and
191	191	8 termination of the delegation, in accordance with rules of the
192	192	9 Department. Upon receipt of this notice delegating authority
193	193	10 to prescribe any nonnarcotic, nonopioid Schedule II III
194	194	11 through V controlled substances, the licensed clinical
195	195	12 psychologist shall be eligible to register for a mid-level
196	196	13 practitioner controlled substance license under Section 303.05
197	197	14 of the Illinois Controlled Substances Act.
198	198	15 (d) All of the following shall apply to delegation of
199	199	16 prescriptive authority:
200	200	17 (1) Any delegation of Schedule II III through V
201	201	18 controlled substances shall identify the specific
202	202	19 controlled substance by brand name or generic name. No
203	203	20 controlled substance to be delivered by injection may be
204	204	21 delegated. No Schedule II opioid controlled substance
205	205	22 shall be delegated.
206	206	23 (2) A prescribing psychologist shall not prescribe
207	207	24 narcotic drugs, as defined in Section 102 of the Illinois
208	208	25 Controlled Substances Act.
209	209	26 Any prescribing psychologist who writes a prescription for
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220	220	1 a controlled substance without having valid and appropriate
221	221	2 authority may be fined by the Department not more than $50 per
222	222	3 prescription and the Department may take any other
223	223	4 disciplinary action provided for in this Act.
224	224	5 All prescriptions written by a prescribing psychologist
225	225	6 must contain the name of the prescribing psychologist and his
226	226	7 or her signature. The prescribing psychologist shall sign his
227	227	8 or her own name.
228	228	9 (e) The written collaborative agreement shall describe the
229	229	10 working relationship of the prescribing psychologist with the
230	230	11 collaborating physician and shall delegate prescriptive
231	231	12 authority as provided in this Act. Collaboration does not
232	232	13 require an employment relationship between the collaborating
233	233	14 physician and prescribing psychologist. Absent an employment
234	234	15 relationship, an agreement may not restrict third-party
235	235	16 payment sources accepted by the prescribing psychologist. For
236	236	17 the purposes of this Section, "collaboration" means the
237	237	18 relationship between a prescribing psychologist and a
238	238	19 collaborating physician with respect to the delivery of
239	239	20 prescribing services in accordance with (1) the prescribing
240	240	21 psychologist's training, education, and experience and (2)
241	241	22 collaboration and consultation as documented in a jointly
242	242	23 developed written collaborative agreement.
243	243	24 (f) The agreement shall promote the exercise of
244	244	25 professional judgment by the prescribing psychologist
245	245	26 corresponding to his or her education and experience.
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256	256	1 (g) The collaborative agreement shall not be construed to
257	257	2 require the personal presence of a physician at the place
258	258	3 where services are rendered. Methods of communication shall be
259	259	4 available for consultation with the collaborating physician in
260	260	5 person or by telecommunications in accordance with established
261	261	6 written guidelines as set forth in the written agreement.
262	262	7 (h) Collaboration and consultation pursuant to all
263	263	8 collaboration agreements shall be adequate if a collaborating
264	264	9 physician does each of the following:
265	265	10 (1) participates in the joint formulation and joint
266	266	11 approval of orders or guidelines with the prescribing
267	267	12 psychologist and he or she periodically reviews the
268	268	13 prescribing psychologist's orders and the services
269	269	14 provided patients under the orders in accordance with
270	270	15 accepted standards of medical practice and prescribing
271	271	16 psychologist practice;
272	272	17 (2) provides collaboration and consultation with the
273	273	18 prescribing psychologist in person at least once a month
274	274	19 for review of safety and quality clinical care or
275	275	20 treatment;
276	276	21 (3) is available through telecommunications for
277	277	22 consultation on medical problems, complications,
278	278	23 emergencies, or patient referral; and
279	279	24 (4) reviews medication orders of the prescribing
280	280	25 psychologist no less than monthly, including review of
281	281	26 laboratory tests and other tests as available.
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292	292	1 (i) The written collaborative agreement shall contain
293	293	2 provisions detailing notice for termination or change of
294	294	3 status involving a written collaborative agreement, except
295	295	4 when the notice is given for just cause.
296	296	5 (j) A copy of the signed written collaborative agreement
297	297	6 shall be available to the Department upon request to either
298	298	7 the prescribing psychologist or the collaborating physician.
299	299	8 (k) Nothing in this Section shall be construed to limit
300	300	9 the authority of a prescribing psychologist to perform all
301	301	10 duties authorized under this Act.
302	302	11 (l) A prescribing psychologist shall inform each
303	303	12 collaborating physician of all collaborative agreements he or
304	304	13 she has signed and provide a copy of these to any collaborating
305	305	14 physician.
306	306	15 (m) No collaborating physician shall enter into more than
307	307	16 3 collaborative agreements with prescribing psychologists.
308	308	17 (Source: P.A. 101-84, eff. 7-19-19.)
309	309	18 Section 10. The Illinois Public Aid Code is amended by
310	310	19 changing Section 5-5 as follows:
311	311	20 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
312	312	21 Sec. 5-5. Medical services. The Illinois Department, by
313	313	22 rule, shall determine the quantity and quality of and the rate
314	314	23 of reimbursement for the medical assistance for which payment
315	315	24 will be authorized, and the medical services to be provided,
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326	326	1 which may include all or part of the following: (1) inpatient
327	327	2 hospital services; (2) outpatient hospital services; (3) other
328	328	3 laboratory and X-ray services; (4) skilled nursing home
329	329	4 services; (5) physicians' services whether furnished in the
330	330	5 office, the patient's home, a hospital, a skilled nursing
331	331	6 home, or elsewhere; (6) medical care, or any other type of
332	332	7 remedial care furnished by licensed practitioners; (7) home
333	333	8 health care services; (8) private duty nursing service; (9)
334	334	9 clinic services; (10) dental services, including prevention
335	335	10 and treatment of periodontal disease and dental caries disease
336	336	11 for pregnant individuals, provided by an individual licensed
337	337	12 to practice dentistry or dental surgery; for purposes of this
338	338	13 item (10), "dental services" means diagnostic, preventive, or
339	339	14 corrective procedures provided by or under the supervision of
340	340	15 a dentist in the practice of his or her profession; (11)
341	341	16 physical therapy and related services; (12) prescribed drugs,
342	342	17 dentures, and prosthetic devices; and eyeglasses prescribed by
343	343	18 a physician skilled in the diseases of the eye, or by an
344	344	19 optometrist, whichever the person may select; (13) other
345	345	20 diagnostic, screening, preventive, and rehabilitative
346	346	21 services, including to ensure that the individual's need for
347	347	22 intervention or treatment of mental disorders or substance use
348	348	23 disorders or co-occurring mental health and substance use
349	349	24 disorders is determined using a uniform screening, assessment,
350	350	25 and evaluation process inclusive of criteria, for children and
351	351	26 adults; for purposes of this item (13), a uniform screening,
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362	362	1 assessment, and evaluation process refers to a process that
363	363	2 includes an appropriate evaluation and, as warranted, a
364	364	3 referral; "uniform" does not mean the use of a singular
365	365	4 instrument, tool, or process that all must utilize; (14)
366	366	5 transportation and such other expenses as may be necessary;
367	367	6 (15) medical treatment of sexual assault survivors, as defined
368	368	7 in Section 1a of the Sexual Assault Survivors Emergency
369	369	8 Treatment Act, for injuries sustained as a result of the
370	370	9 sexual assault, including examinations and laboratory tests to
371	371	10 discover evidence which may be used in criminal proceedings
372	372	11 arising from the sexual assault; (16) the diagnosis and
373	373	12 treatment of sickle cell anemia; (16.5) services performed by
374	374	13 a chiropractic physician licensed under the Medical Practice
375	375	14 Act of 1987 and acting within the scope of his or her license,
376	376	15 including, but not limited to, chiropractic manipulative
377	377	16 treatment; and (17) any other medical care, and any other type
378	378	17 of remedial care recognized under the laws of this State. The
379	379	18 term "any other type of remedial care" shall include nursing
380	380	19 care and nursing home service for persons who rely on
381	381	20 treatment by spiritual means alone through prayer for healing.
382	382	21 Notwithstanding any other provision of this Section, a
383	383	22 comprehensive tobacco use cessation program that includes
384	384	23 purchasing prescription drugs or prescription medical devices
385	385	24 approved by the Food and Drug Administration shall be covered
386	386	25 under the medical assistance program under this Article for
387	387	26 persons who are otherwise eligible for assistance under this
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398	398	1 Article.
399	399	2 Notwithstanding any other provision of this Code,
400	400	3 reproductive health care that is otherwise legal in Illinois
401	401	4 shall be covered under the medical assistance program for
402	402	5 persons who are otherwise eligible for medical assistance
403	403	6 under this Article.
404	404	7 Notwithstanding any other provision of this Section, all
405	405	8 tobacco cessation medications approved by the United States
406	406	9 Food and Drug Administration and all individual and group
407	407	10 tobacco cessation counseling services and telephone-based
408	408	11 counseling services and tobacco cessation medications provided
409	409	12 through the Illinois Tobacco Quitline shall be covered under
410	410	13 the medical assistance program for persons who are otherwise
411	411	14 eligible for assistance under this Article. The Department
412	412	15 shall comply with all federal requirements necessary to obtain
413	413	16 federal financial participation, as specified in 42 CFR
414	414	17 433.15(b)(7), for telephone-based counseling services provided
415	415	18 through the Illinois Tobacco Quitline, including, but not
416	416	19 limited to: (i) entering into a memorandum of understanding or
417	417	20 interagency agreement with the Department of Public Health, as
418	418	21 administrator of the Illinois Tobacco Quitline; and (ii)
419	419	22 developing a cost allocation plan for Medicaid-allowable
420	420	23 Illinois Tobacco Quitline services in accordance with 45 CFR
421	421	24 95.507. The Department shall submit the memorandum of
422	422	25 understanding or interagency agreement, the cost allocation
423	423	26 plan, and all other necessary documentation to the Centers for
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434	434	1 Medicare and Medicaid Services for review and approval.
435	435	2 Coverage under this paragraph shall be contingent upon federal
436	436	3 approval.
437	437	4 Notwithstanding any other provision of this Code, the
438	438	5 Illinois Department may not require, as a condition of payment
439	439	6 for any laboratory test authorized under this Article, that a
440	440	7 physician's handwritten signature appear on the laboratory
441	441	8 test order form. The Illinois Department may, however, impose
442	442	9 other appropriate requirements regarding laboratory test order
443	443	10 documentation.
444	444	11 Upon receipt of federal approval of an amendment to the
445	445	12 Illinois Title XIX State Plan for this purpose, the Department
446	446	13 shall authorize the Chicago Public Schools (CPS) to procure a
447	447	14 vendor or vendors to manufacture eyeglasses for individuals
448	448	15 enrolled in a school within the CPS system. CPS shall ensure
449	449	16 that its vendor or vendors are enrolled as providers in the
450	450	17 medical assistance program and in any capitated Medicaid
451	451	18 managed care entity (MCE) serving individuals enrolled in a
452	452	19 school within the CPS system. Under any contract procured
453	453	20 under this provision, the vendor or vendors must serve only
454	454	21 individuals enrolled in a school within the CPS system. Claims
455	455	22 for services provided by CPS's vendor or vendors to recipients
456	456	23 of benefits in the medical assistance program under this Code,
457	457	24 the Children's Health Insurance Program, or the Covering ALL
458	458	25 KIDS Health Insurance Program shall be submitted to the
459	459	26 Department or the MCE in which the individual is enrolled for
460	460
461	461
462	462
463	463
464	464
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470	470	1 payment and shall be reimbursed at the Department's or the
471	471	2 MCE's established rates or rate methodologies for eyeglasses.
472	472	3 On and after July 1, 2012, the Department of Healthcare
473	473	4 and Family Services may provide the following services to
474	474	5 persons eligible for assistance under this Article who are
475	475	6 participating in education, training or employment programs
476	476	7 operated by the Department of Human Services as successor to
477	477	8 the Department of Public Aid:
478	478	9 (1) dental services provided by or under the
479	479	10 supervision of a dentist; and
480	480	11 (2) eyeglasses prescribed by a physician skilled in
481	481	12 the diseases of the eye, or by an optometrist, whichever
482	482	13 the person may select.
483	483	14 On and after July 1, 2018, the Department of Healthcare
484	484	15 and Family Services shall provide dental services to any adult
485	485	16 who is otherwise eligible for assistance under the medical
486	486	17 assistance program. As used in this paragraph, "dental
487	487	18 services" means diagnostic, preventative, restorative, or
488	488	19 corrective procedures, including procedures and services for
489	489	20 the prevention and treatment of periodontal disease and dental
490	490	21 caries disease, provided by an individual who is licensed to
491	491	22 practice dentistry or dental surgery or who is under the
492	492	23 supervision of a dentist in the practice of his or her
493	493	24 profession.
494	494	25 On and after July 1, 2018, targeted dental services, as
495	495	26 set forth in Exhibit D of the Consent Decree entered by the
496	496
497	497
498	498
499	499
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506	506	1 United States District Court for the Northern District of
507	507	2 Illinois, Eastern Division, in the matter of Memisovski v.
508	508	3 Maram, Case No. 92 C 1982, that are provided to adults under
509	509	4 the medical assistance program shall be established at no less
510	510	5 than the rates set forth in the "New Rate" column in Exhibit D
511	511	6 of the Consent Decree for targeted dental services that are
512	512	7 provided to persons under the age of 18 under the medical
513	513	8 assistance program.
514	514	9 Notwithstanding any other provision of this Code and
515	515	10 subject to federal approval, the Department may adopt rules to
516	516	11 allow a dentist who is volunteering his or her service at no
517	517	12 cost to render dental services through an enrolled
518	518	13 not-for-profit health clinic without the dentist personally
519	519	14 enrolling as a participating provider in the medical
520	520	15 assistance program. A not-for-profit health clinic shall
521	521	16 include a public health clinic or Federally Qualified Health
522	522	17 Center or other enrolled provider, as determined by the
523	523	18 Department, through which dental services covered under this
524	524	19 Section are performed. The Department shall establish a
525	525	20 process for payment of claims for reimbursement for covered
526	526	21 dental services rendered under this provision.
527	527	22 On and after January 1, 2022, the Department of Healthcare
528	528	23 and Family Services shall administer and regulate a
529	529	24 school-based dental program that allows for the out-of-office
530	530	25 delivery of preventative dental services in a school setting
531	531	26 to children under 19 years of age. The Department shall
532	532
533	533
534	534
535	535
536	536
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538	538
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542	542	1 establish, by rule, guidelines for participation by providers
543	543	2 and set requirements for follow-up referral care based on the
544	544	3 requirements established in the Dental Office Reference Manual
545	545	4 published by the Department that establishes the requirements
546	546	5 for dentists participating in the All Kids Dental School
547	547	6 Program. Every effort shall be made by the Department when
548	548	7 developing the program requirements to consider the different
549	549	8 geographic differences of both urban and rural areas of the
550	550	9 State for initial treatment and necessary follow-up care. No
551	551	10 provider shall be charged a fee by any unit of local government
552	552	11 to participate in the school-based dental program administered
553	553	12 by the Department. Nothing in this paragraph shall be
554	554	13 construed to limit or preempt a home rule unit's or school
555	555	14 district's authority to establish, change, or administer a
556	556	15 school-based dental program in addition to, or independent of,
557	557	16 the school-based dental program administered by the
558	558	17 Department.
559	559	18 The Illinois Department, by rule, may distinguish and
560	560	19 classify the medical services to be provided only in
561	561	20 accordance with the classes of persons designated in Section
562	562	21 5-2.
563	563	22 The Department of Healthcare and Family Services must
564	564	23 provide coverage and reimbursement for amino acid-based
565	565	24 elemental formulas, regardless of delivery method, for the
566	566	25 diagnosis and treatment of (i) eosinophilic disorders and (ii)
567	567	26 short bowel syndrome when the prescribing physician has issued
568	568
569	569
570	570
571	571
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578	578	1 a written order stating that the amino acid-based elemental
579	579	2 formula is medically necessary.
580	580	3 The Illinois Department shall authorize the provision of,
581	581	4 and shall authorize payment for, screening by low-dose
582	582	5 mammography for the presence of occult breast cancer for
583	583	6 individuals 35 years of age or older who are eligible for
584	584	7 medical assistance under this Article, as follows:
585	585	8 (A) A baseline mammogram for individuals 35 to 39
586	586	9 years of age.
587	587	10 (B) An annual mammogram for individuals 40 years of
588	588	11 age or older.
589	589	12 (C) A mammogram at the age and intervals considered
590	590	13 medically necessary by the individual's health care
591	591	14 provider for individuals under 40 years of age and having
592	592	15 a family history of breast cancer, prior personal history
593	593	16 of breast cancer, positive genetic testing, or other risk
594	594	17 factors.
595	595	18 (D) A comprehensive ultrasound screening and MRI of an
596	596	19 entire breast or breasts if a mammogram demonstrates
597	597	20 heterogeneous or dense breast tissue or when medically
598	598	21 necessary as determined by a physician licensed to
599	599	22 practice medicine in all of its branches.
600	600	23 (E) A screening MRI when medically necessary, as
601	601	24 determined by a physician licensed to practice medicine in
602	602	25 all of its branches.
603	603	26 (F) A diagnostic mammogram when medically necessary,
604	604
605	605
606	606
607	607
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610	610
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614	614	1 as determined by a physician licensed to practice medicine
615	615	2 in all its branches, advanced practice registered nurse,
616	616	3 or physician assistant.
617	617	4 The Department shall not impose a deductible, coinsurance,
618	618	5 copayment, or any other cost-sharing requirement on the
619	619	6 coverage provided under this paragraph; except that this
620	620	7 sentence does not apply to coverage of diagnostic mammograms
621	621	8 to the extent such coverage would disqualify a high-deductible
622	622	9 health plan from eligibility for a health savings account
623	623	10 pursuant to Section 223 of the Internal Revenue Code (26
624	624	11 U.S.C. 223).
625	625	12 All screenings shall include a physical breast exam,
626	626	13 instruction on self-examination and information regarding the
627	627	14 frequency of self-examination and its value as a preventative
628	628	15 tool.
629	629	16 For purposes of this Section:
630	630	17 "Diagnostic mammogram" means a mammogram obtained using
631	631	18 diagnostic mammography.
632	632	19 "Diagnostic mammography" means a method of screening that
633	633	20 is designed to evaluate an abnormality in a breast, including
634	634	21 an abnormality seen or suspected on a screening mammogram or a
635	635	22 subjective or objective abnormality otherwise detected in the
636	636	23 breast.
637	637	24 "Low-dose mammography" means the x-ray examination of the
638	638	25 breast using equipment dedicated specifically for mammography,
639	639	26 including the x-ray tube, filter, compression device, and
640	640
641	641
642	642
643	643
644	644
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646	646
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650	650	1 image receptor, with an average radiation exposure delivery of
651	651	2 less than one rad per breast for 2 views of an average size
652	652	3 breast. The term also includes digital mammography and
653	653	4 includes breast tomosynthesis.
654	654	5 "Breast tomosynthesis" means a radiologic procedure that
655	655	6 involves the acquisition of projection images over the
656	656	7 stationary breast to produce cross-sectional digital
657	657	8 three-dimensional images of the breast.
658	658	9 If, at any time, the Secretary of the United States
659	659	10 Department of Health and Human Services, or its successor
660	660	11 agency, promulgates rules or regulations to be published in
661	661	12 the Federal Register or publishes a comment in the Federal
662	662	13 Register or issues an opinion, guidance, or other action that
663	663	14 would require the State, pursuant to any provision of the
664	664	15 Patient Protection and Affordable Care Act (Public Law
665	665	16 111-148), including, but not limited to, 42 U.S.C.
666	666	17 18031(d)(3)(B) or any successor provision, to defray the cost
667	667	18 of any coverage for breast tomosynthesis outlined in this
668	668	19 paragraph, then the requirement that an insurer cover breast
669	669	20 tomosynthesis is inoperative other than any such coverage
670	670	21 authorized under Section 1902 of the Social Security Act, 42
671	671	22 U.S.C. 1396a, and the State shall not assume any obligation
672	672	23 for the cost of coverage for breast tomosynthesis set forth in
673	673	24 this paragraph.
674	674	25 On and after January 1, 2016, the Department shall ensure
675	675	26 that all networks of care for adult clients of the Department
676	676
677	677
678	678
679	679
680	680
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682	682
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686	686	1 include access to at least one breast imaging Center of
687	687	2 Imaging Excellence as certified by the American College of
688	688	3 Radiology.
689	689	4 On and after January 1, 2012, providers participating in a
690	690	5 quality improvement program approved by the Department shall
691	691	6 be reimbursed for screening and diagnostic mammography at the
692	692	7 same rate as the Medicare program's rates, including the
693	693	8 increased reimbursement for digital mammography and, after
694	694	9 January 1, 2023 (the effective date of Public Act 102-1018)
695	695	10 this amendatory Act of the 102nd General Assembly, breast
696	696	11 tomosynthesis.
697	697	12 The Department shall convene an expert panel including
698	698	13 representatives of hospitals, free-standing mammography
699	699	14 facilities, and doctors, including radiologists, to establish
700	700	15 quality standards for mammography.
701	701	16 On and after January 1, 2017, providers participating in a
702	702	17 breast cancer treatment quality improvement program approved
703	703	18 by the Department shall be reimbursed for breast cancer
704	704	19 treatment at a rate that is no lower than 95% of the Medicare
705	705	20 program's rates for the data elements included in the breast
706	706	21 cancer treatment quality program.
707	707	22 The Department shall convene an expert panel, including
708	708	23 representatives of hospitals, free-standing breast cancer
709	709	24 treatment centers, breast cancer quality organizations, and
710	710	25 doctors, including breast surgeons, reconstructive breast
711	711	26 surgeons, oncologists, and primary care providers to establish
712	712
713	713
714	714
715	715
716	716
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718	718
719	719
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722	722	1 quality standards for breast cancer treatment.
723	723	2 Subject to federal approval, the Department shall
724	724	3 establish a rate methodology for mammography at federally
725	725	4 qualified health centers and other encounter-rate clinics.
726	726	5 These clinics or centers may also collaborate with other
727	727	6 hospital-based mammography facilities. By January 1, 2016, the
728	728	7 Department shall report to the General Assembly on the status
729	729	8 of the provision set forth in this paragraph.
730	730	9 The Department shall establish a methodology to remind
731	731	10 individuals who are age-appropriate for screening mammography,
732	732	11 but who have not received a mammogram within the previous 18
733	733	12 months, of the importance and benefit of screening
734	734	13 mammography. The Department shall work with experts in breast
735	735	14 cancer outreach and patient navigation to optimize these
736	736	15 reminders and shall establish a methodology for evaluating
737	737	16 their effectiveness and modifying the methodology based on the
738	738	17 evaluation.
739	739	18 The Department shall establish a performance goal for
740	740	19 primary care providers with respect to their female patients
741	741	20 over age 40 receiving an annual mammogram. This performance
742	742	21 goal shall be used to provide additional reimbursement in the
743	743	22 form of a quality performance bonus to primary care providers
744	744	23 who meet that goal.
745	745	24 The Department shall devise a means of case-managing or
746	746	25 patient navigation for beneficiaries diagnosed with breast
747	747	26 cancer. This program shall initially operate as a pilot
748	748
749	749
750	750
751	751
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758	758	1 program in areas of the State with the highest incidence of
759	759	2 mortality related to breast cancer. At least one pilot program
760	760	3 site shall be in the metropolitan Chicago area and at least one
761	761	4 site shall be outside the metropolitan Chicago area. On or
762	762	5 after July 1, 2016, the pilot program shall be expanded to
763	763	6 include one site in western Illinois, one site in southern
764	764	7 Illinois, one site in central Illinois, and 4 sites within
765	765	8 metropolitan Chicago. An evaluation of the pilot program shall
766	766	9 be carried out measuring health outcomes and cost of care for
767	767	10 those served by the pilot program compared to similarly
768	768	11 situated patients who are not served by the pilot program.
769	769	12 The Department shall require all networks of care to
770	770	13 develop a means either internally or by contract with experts
771	771	14 in navigation and community outreach to navigate cancer
772	772	15 patients to comprehensive care in a timely fashion. The
773	773	16 Department shall require all networks of care to include
774	774	17 access for patients diagnosed with cancer to at least one
775	775	18 academic commission on cancer-accredited cancer program as an
776	776	19 in-network covered benefit.
777	777	20 The Department shall provide coverage and reimbursement
778	778	21 for a human papillomavirus (HPV) vaccine that is approved for
779	779	22 marketing by the federal Food and Drug Administration for all
780	780	23 persons between the ages of 9 and 45 and persons of the age of
781	781	24 46 and above who have been diagnosed with cervical dysplasia
782	782	25 with a high risk of recurrence or progression. The Department
783	783	26 shall disallow any preauthorization requirements for the
784	784
785	785
786	786
787	787
788	788
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790	790
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794	794	1 administration of the human papillomavirus (HPV) vaccine.
795	795	2 On or after July 1, 2022, individuals who are otherwise
796	796	3 eligible for medical assistance under this Article shall
797	797	4 receive coverage for perinatal depression screenings for the
798	798	5 12-month period beginning on the last day of their pregnancy.
799	799	6 Medical assistance coverage under this paragraph shall be
800	800	7 conditioned on the use of a screening instrument approved by
801	801	8 the Department.
802	802	9 Any medical or health care provider shall immediately
803	803	10 recommend, to any pregnant individual who is being provided
804	804	11 prenatal services and is suspected of having a substance use
805	805	12 disorder as defined in the Substance Use Disorder Act,
806	806	13 referral to a local substance use disorder treatment program
807	807	14 licensed by the Department of Human Services or to a licensed
808	808	15 hospital which provides substance abuse treatment services.
809	809	16 The Department of Healthcare and Family Services shall assure
810	810	17 coverage for the cost of treatment of the drug abuse or
811	811	18 addiction for pregnant recipients in accordance with the
812	812	19 Illinois Medicaid Program in conjunction with the Department
813	813	20 of Human Services.
814	814	21 All medical providers providing medical assistance to
815	815	22 pregnant individuals under this Code shall receive information
816	816	23 from the Department on the availability of services under any
817	817	24 program providing case management services for addicted
818	818	25 individuals, including information on appropriate referrals
819	819	26 for other social services that may be needed by addicted
820	820
821	821
822	822
823	823
824	824
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826	826
827	827
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830	830	1 individuals in addition to treatment for addiction.
831	831	2 The Illinois Department, in cooperation with the
832	832	3 Departments of Human Services (as successor to the Department
833	833	4 of Alcoholism and Substance Abuse) and Public Health, through
834	834	5 a public awareness campaign, may provide information
835	835	6 concerning treatment for alcoholism and drug abuse and
836	836	7 addiction, prenatal health care, and other pertinent programs
837	837	8 directed at reducing the number of drug-affected infants born
838	838	9 to recipients of medical assistance.
839	839	10 Neither the Department of Healthcare and Family Services
840	840	11 nor the Department of Human Services shall sanction the
841	841	12 recipient solely on the basis of the recipient's substance
842	842	13 abuse.
843	843	14 The Illinois Department shall establish such regulations
844	844	15 governing the dispensing of health services under this Article
845	845	16 as it shall deem appropriate. The Department should seek the
846	846	17 advice of formal professional advisory committees appointed by
847	847	18 the Director of the Illinois Department for the purpose of
848	848	19 providing regular advice on policy and administrative matters,
849	849	20 information dissemination and educational activities for
850	850	21 medical and health care providers, and consistency in
851	851	22 procedures to the Illinois Department.
852	852	23 The Illinois Department may develop and contract with
853	853	24 Partnerships of medical providers to arrange medical services
854	854	25 for persons eligible under Section 5-2 of this Code.
855	855	26 Implementation of this Section may be by demonstration
856	856
857	857
858	858
859	859
860	860
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863	863
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866	866	1 projects in certain geographic areas. The Partnership shall be
867	867	2 represented by a sponsor organization. The Department, by
868	868	3 rule, shall develop qualifications for sponsors of
869	869	4 Partnerships. Nothing in this Section shall be construed to
870	870	5 require that the sponsor organization be a medical
871	871	6 organization.
872	872	7 The sponsor must negotiate formal written contracts with
873	873	8 medical providers for physician services, inpatient and
874	874	9 outpatient hospital care, home health services, treatment for
875	875	10 alcoholism and substance abuse, and other services determined
876	876	11 necessary by the Illinois Department by rule for delivery by
877	877	12 Partnerships. Physician services must include prenatal and
878	878	13 obstetrical care. The Illinois Department shall reimburse
879	879	14 medical services delivered by Partnership providers to clients
880	880	15 in target areas according to provisions of this Article and
881	881	16 the Illinois Health Finance Reform Act, except that:
882	882	17 (1) Physicians participating in a Partnership and
883	883	18 providing certain services, which shall be determined by
884	884	19 the Illinois Department, to persons in areas covered by
885	885	20 the Partnership may receive an additional surcharge for
886	886	21 such services.
887	887	22 (2) The Department may elect to consider and negotiate
888	888	23 financial incentives to encourage the development of
889	889	24 Partnerships and the efficient delivery of medical care.
890	890	25 (3) Persons receiving medical services through
891	891	26 Partnerships may receive medical and case management
892	892
893	893
894	894
895	895
896	896
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898	898
899	899
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902	902	1 services above the level usually offered through the
903	903	2 medical assistance program.
904	904	3 Medical providers shall be required to meet certain
905	905	4 qualifications to participate in Partnerships to ensure the
906	906	5 delivery of high quality medical services. These
907	907	6 qualifications shall be determined by rule of the Illinois
908	908	7 Department and may be higher than qualifications for
909	909	8 participation in the medical assistance program. Partnership
910	910	9 sponsors may prescribe reasonable additional qualifications
911	911	10 for participation by medical providers, only with the prior
912	912	11 written approval of the Illinois Department.
913	913	12 Nothing in this Section shall limit the free choice of
914	914	13 practitioners, hospitals, and other providers of medical
915	915	14 services by clients. In order to ensure patient freedom of
916	916	15 choice, the Illinois Department shall immediately promulgate
917	917	16 all rules and take all other necessary actions so that
918	918	17 provided services may be accessed from therapeutically
919	919	18 certified optometrists to the full extent of the Illinois
920	920	19 Optometric Practice Act of 1987 without discriminating between
921	921	20 service providers.
922	922	21 The Department shall apply for a waiver from the United
923	923	22 States Health Care Financing Administration to allow for the
924	924	23 implementation of Partnerships under this Section.
925	925	24 The Illinois Department shall require health care
926	926	25 providers to maintain records that document the medical care
927	927	26 and services provided to recipients of Medical Assistance
928	928
929	929
930	930
931	931
932	932
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934	934
935	935
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938	938	1 under this Article. Such records must be retained for a period
939	939	2 of not less than 6 years from the date of service or as
940	940	3 provided by applicable State law, whichever period is longer,
941	941	4 except that if an audit is initiated within the required
942	942	5 retention period then the records must be retained until the
943	943	6 audit is completed and every exception is resolved. The
944	944	7 Illinois Department shall require health care providers to
945	945	8 make available, when authorized by the patient, in writing,
946	946	9 the medical records in a timely fashion to other health care
947	947	10 providers who are treating or serving persons eligible for
948	948	11 Medical Assistance under this Article. All dispensers of
949	949	12 medical services shall be required to maintain and retain
950	950	13 business and professional records sufficient to fully and
951	951	14 accurately document the nature, scope, details and receipt of
952	952	15 the health care provided to persons eligible for medical
953	953	16 assistance under this Code, in accordance with regulations
954	954	17 promulgated by the Illinois Department. The rules and
955	955	18 regulations shall require that proof of the receipt of
956	956	19 prescription drugs, dentures, prosthetic devices and
957	957	20 eyeglasses by eligible persons under this Section accompany
958	958	21 each claim for reimbursement submitted by the dispenser of
959	959	22 such medical services. No such claims for reimbursement shall
960	960	23 be approved for payment by the Illinois Department without
961	961	24 such proof of receipt, unless the Illinois Department shall
962	962	25 have put into effect and shall be operating a system of
963	963	26 post-payment audit and review which shall, on a sampling
964	964
965	965
966	966
967	967
968	968
969	969	SB1586 - 26 - LRB103 25489 AMQ 51838 b
970	970
971	971
972	972	SB1586- 27 -LRB103 25489 AMQ 51838 b SB1586 - 27 - LRB103 25489 AMQ 51838 b
973	973	SB1586 - 27 - LRB103 25489 AMQ 51838 b
974	974	1 basis, be deemed adequate by the Illinois Department to assure
975	975	2 that such drugs, dentures, prosthetic devices and eyeglasses
976	976	3 for which payment is being made are actually being received by
977	977	4 eligible recipients. Within 90 days after September 16, 1984
978	978	5 (the effective date of Public Act 83-1439), the Illinois
979	979	6 Department shall establish a current list of acquisition costs
980	980	7 for all prosthetic devices and any other items recognized as
981	981	8 medical equipment and supplies reimbursable under this Article
982	982	9 and shall update such list on a quarterly basis, except that
983	983	10 the acquisition costs of all prescription drugs shall be
984	984	11 updated no less frequently than every 30 days as required by
985	985	12 Section 5-5.12.
986	986	13 Notwithstanding any other law to the contrary, the
987	987	14 Illinois Department shall, within 365 days after July 22, 2013
988	988	15 (the effective date of Public Act 98-104), establish
989	989	16 procedures to permit skilled care facilities licensed under
990	990	17 the Nursing Home Care Act to submit monthly billing claims for
991	991	18 reimbursement purposes. Following development of these
992	992	19 procedures, the Department shall, by July 1, 2016, test the
993	993	20 viability of the new system and implement any necessary
994	994	21 operational or structural changes to its information
995	995	22 technology platforms in order to allow for the direct
996	996	23 acceptance and payment of nursing home claims.
997	997	24 Notwithstanding any other law to the contrary, the
998	998	25 Illinois Department shall, within 365 days after August 15,
999	999	26 2014 (the effective date of Public Act 98-963), establish
1000	1000
1001	1001
1002	1002
1003	1003
1004	1004
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1006	1006
1007	1007
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1009	1009	SB1586 - 28 - LRB103 25489 AMQ 51838 b
1010	1010	1 procedures to permit ID/DD facilities licensed under the ID/DD
1011	1011	2 Community Care Act and MC/DD facilities licensed under the
1012	1012	3 MC/DD Act to submit monthly billing claims for reimbursement
1013	1013	4 purposes. Following development of these procedures, the
1014	1014	5 Department shall have an additional 365 days to test the
1015	1015	6 viability of the new system and to ensure that any necessary
1016	1016	7 operational or structural changes to its information
1017	1017	8 technology platforms are implemented.
1018	1018	9 The Illinois Department shall require all dispensers of
1019	1019	10 medical services, other than an individual practitioner or
1020	1020	11 group of practitioners, desiring to participate in the Medical
1021	1021	12 Assistance program established under this Article to disclose
1022	1022	13 all financial, beneficial, ownership, equity, surety or other
1023	1023	14 interests in any and all firms, corporations, partnerships,
1024	1024	15 associations, business enterprises, joint ventures, agencies,
1025	1025	16 institutions or other legal entities providing any form of
1026	1026	17 health care services in this State under this Article.
1027	1027	18 The Illinois Department may require that all dispensers of
1028	1028	19 medical services desiring to participate in the medical
1029	1029	20 assistance program established under this Article disclose,
1030	1030	21 under such terms and conditions as the Illinois Department may
1031	1031	22 by rule establish, all inquiries from clients and attorneys
1032	1032	23 regarding medical bills paid by the Illinois Department, which
1033	1033	24 inquiries could indicate potential existence of claims or
1034	1034	25 liens for the Illinois Department.
1035	1035	26 Enrollment of a vendor shall be subject to a provisional
1036	1036
1037	1037
1038	1038
1039	1039
1040	1040
1041	1041	SB1586 - 28 - LRB103 25489 AMQ 51838 b
1042	1042
1043	1043
1044	1044	SB1586- 29 -LRB103 25489 AMQ 51838 b SB1586 - 29 - LRB103 25489 AMQ 51838 b
1045	1045	SB1586 - 29 - LRB103 25489 AMQ 51838 b
1046	1046	1 period and shall be conditional for one year. During the
1047	1047	2 period of conditional enrollment, the Department may terminate
1048	1048	3 the vendor's eligibility to participate in, or may disenroll
1049	1049	4 the vendor from, the medical assistance program without cause.
1050	1050	5 Unless otherwise specified, such termination of eligibility or
1051	1051	6 disenrollment is not subject to the Department's hearing
1052	1052	7 process. However, a disenrolled vendor may reapply without
1053	1053	8 penalty.
1054	1054	9 The Department has the discretion to limit the conditional
1055	1055	10 enrollment period for vendors based upon category of risk of
1056	1056	11 the vendor.
1057	1057	12 Prior to enrollment and during the conditional enrollment
1058	1058	13 period in the medical assistance program, all vendors shall be
1059	1059	14 subject to enhanced oversight, screening, and review based on
1060	1060	15 the risk of fraud, waste, and abuse that is posed by the
1061	1061	16 category of risk of the vendor. The Illinois Department shall
1062	1062	17 establish the procedures for oversight, screening, and review,
1063	1063	18 which may include, but need not be limited to: criminal and
1064	1064	19 financial background checks; fingerprinting; license,
1065	1065	20 certification, and authorization verifications; unscheduled or
1066	1066	21 unannounced site visits; database checks; prepayment audit
1067	1067	22 reviews; audits; payment caps; payment suspensions; and other
1068	1068	23 screening as required by federal or State law.
1069	1069	24 The Department shall define or specify the following: (i)
1070	1070	25 by provider notice, the "category of risk of the vendor" for
1071	1071	26 each type of vendor, which shall take into account the level of
1072	1072
1073	1073
1074	1074
1075	1075
1076	1076
1077	1077	SB1586 - 29 - LRB103 25489 AMQ 51838 b
1078	1078
1079	1079
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1081	1081	SB1586 - 30 - LRB103 25489 AMQ 51838 b
1082	1082	1 screening applicable to a particular category of vendor under
1083	1083	2 federal law and regulations; (ii) by rule or provider notice,
1084	1084	3 the maximum length of the conditional enrollment period for
1085	1085	4 each category of risk of the vendor; and (iii) by rule, the
1086	1086	5 hearing rights, if any, afforded to a vendor in each category
1087	1087	6 of risk of the vendor that is terminated or disenrolled during
1088	1088	7 the conditional enrollment period.
1089	1089	8 To be eligible for payment consideration, a vendor's
1090	1090	9 payment claim or bill, either as an initial claim or as a
1091	1091	10 resubmitted claim following prior rejection, must be received
1092	1092	11 by the Illinois Department, or its fiscal intermediary, no
1093	1093	12 later than 180 days after the latest date on the claim on which
1094	1094	13 medical goods or services were provided, with the following
1095	1095	14 exceptions:
1096	1096	15 (1) In the case of a provider whose enrollment is in
1097	1097	16 process by the Illinois Department, the 180-day period
1098	1098	17 shall not begin until the date on the written notice from
1099	1099	18 the Illinois Department that the provider enrollment is
1100	1100	19 complete.
1101	1101	20 (2) In the case of errors attributable to the Illinois
1102	1102	21 Department or any of its claims processing intermediaries
1103	1103	22 which result in an inability to receive, process, or
1104	1104	23 adjudicate a claim, the 180-day period shall not begin
1105	1105	24 until the provider has been notified of the error.
1106	1106	25 (3) In the case of a provider for whom the Illinois
1107	1107	26 Department initiates the monthly billing process.
1108	1108
1109	1109
1110	1110
1111	1111
1112	1112
1113	1113	SB1586 - 30 - LRB103 25489 AMQ 51838 b
1114	1114
1115	1115
1116	1116	SB1586- 31 -LRB103 25489 AMQ 51838 b SB1586 - 31 - LRB103 25489 AMQ 51838 b
1117	1117	SB1586 - 31 - LRB103 25489 AMQ 51838 b
1118	1118	1 (4) In the case of a provider operated by a unit of
1119	1119	2 local government with a population exceeding 3,000,000
1120	1120	3 when local government funds finance federal participation
1121	1121	4 for claims payments.
1122	1122	5 For claims for services rendered during a period for which
1123	1123	6 a recipient received retroactive eligibility, claims must be
1124	1124	7 filed within 180 days after the Department determines the
1125	1125	8 applicant is eligible. For claims for which the Illinois
1126	1126	9 Department is not the primary payer, claims must be submitted
1127	1127	10 to the Illinois Department within 180 days after the final
1128	1128	11 adjudication by the primary payer.
1129	1129	12 In the case of long term care facilities, within 120
1130	1130	13 calendar days of receipt by the facility of required
1131	1131	14 prescreening information, new admissions with associated
1132	1132	15 admission documents shall be submitted through the Medical
1133	1133	16 Electronic Data Interchange (MEDI) or the Recipient
1134	1134	17 Eligibility Verification (REV) System or shall be submitted
1135	1135	18 directly to the Department of Human Services using required
1136	1136	19 admission forms. Effective September 1, 2014, admission
1137	1137	20 documents, including all prescreening information, must be
1138	1138	21 submitted through MEDI or REV. Confirmation numbers assigned
1139	1139	22 to an accepted transaction shall be retained by a facility to
1140	1140	23 verify timely submittal. Once an admission transaction has
1141	1141	24 been completed, all resubmitted claims following prior
1142	1142	25 rejection are subject to receipt no later than 180 days after
1143	1143	26 the admission transaction has been completed.
1144	1144
1145	1145
1146	1146
1147	1147
1148	1148
1149	1149	SB1586 - 31 - LRB103 25489 AMQ 51838 b
1150	1150
1151	1151
1152	1152	SB1586- 32 -LRB103 25489 AMQ 51838 b SB1586 - 32 - LRB103 25489 AMQ 51838 b
1153	1153	SB1586 - 32 - LRB103 25489 AMQ 51838 b
1154	1154	1 Claims that are not submitted and received in compliance
1155	1155	2 with the foregoing requirements shall not be eligible for
1156	1156	3 payment under the medical assistance program, and the State
1157	1157	4 shall have no liability for payment of those claims.
1158	1158	5 To the extent consistent with applicable information and
1159	1159	6 privacy, security, and disclosure laws, State and federal
1160	1160	7 agencies and departments shall provide the Illinois Department
1161	1161	8 access to confidential and other information and data
1162	1162	9 necessary to perform eligibility and payment verifications and
1163	1163	10 other Illinois Department functions. This includes, but is not
1164	1164	11 limited to: information pertaining to licensure;
1165	1165	12 certification; earnings; immigration status; citizenship; wage
1166	1166	13 reporting; unearned and earned income; pension income;
1167	1167	14 employment; supplemental security income; social security
1168	1168	15 numbers; National Provider Identifier (NPI) numbers; the
1169	1169	16 National Practitioner Data Bank (NPDB); program and agency
1170	1170	17 exclusions; taxpayer identification numbers; tax delinquency;
1171	1171	18 corporate information; and death records.
1172	1172	19 The Illinois Department shall enter into agreements with
1173	1173	20 State agencies and departments, and is authorized to enter
1174	1174	21 into agreements with federal agencies and departments, under
1175	1175	22 which such agencies and departments shall share data necessary
1176	1176	23 for medical assistance program integrity functions and
1177	1177	24 oversight. The Illinois Department shall develop, in
1178	1178	25 cooperation with other State departments and agencies, and in
1179	1179	26 compliance with applicable federal laws and regulations,
1180	1180
1181	1181
1182	1182
1183	1183
1184	1184
1185	1185	SB1586 - 32 - LRB103 25489 AMQ 51838 b
1186	1186
1187	1187
1188	1188	SB1586- 33 -LRB103 25489 AMQ 51838 b SB1586 - 33 - LRB103 25489 AMQ 51838 b
1189	1189	SB1586 - 33 - LRB103 25489 AMQ 51838 b
1190	1190	1 appropriate and effective methods to share such data. At a
1191	1191	2 minimum, and to the extent necessary to provide data sharing,
1192	1192	3 the Illinois Department shall enter into agreements with State
1193	1193	4 agencies and departments, and is authorized to enter into
1194	1194	5 agreements with federal agencies and departments, including,
1195	1195	6 but not limited to: the Secretary of State; the Department of
1196	1196	7 Revenue; the Department of Public Health; the Department of
1197	1197	8 Human Services; and the Department of Financial and
1198	1198	9 Professional Regulation.
1199	1199	10 Beginning in fiscal year 2013, the Illinois Department
1200	1200	11 shall set forth a request for information to identify the
1201	1201	12 benefits of a pre-payment, post-adjudication, and post-edit
1202	1202	13 claims system with the goals of streamlining claims processing
1203	1203	14 and provider reimbursement, reducing the number of pending or
1204	1204	15 rejected claims, and helping to ensure a more transparent
1205	1205	16 adjudication process through the utilization of: (i) provider
1206	1206	17 data verification and provider screening technology; and (ii)
1207	1207	18 clinical code editing; and (iii) pre-pay, pre- or
1208	1208	19 post-adjudicated predictive modeling with an integrated case
1209	1209	20 management system with link analysis. Such a request for
1210	1210	21 information shall not be considered as a request for proposal
1211	1211	22 or as an obligation on the part of the Illinois Department to
1212	1212	23 take any action or acquire any products or services.
1213	1213	24 The Illinois Department shall establish policies,
1214	1214	25 procedures, standards and criteria by rule for the
1215	1215	26 acquisition, repair and replacement of orthotic and prosthetic
1216	1216
1217	1217
1218	1218
1219	1219
1220	1220
1221	1221	SB1586 - 33 - LRB103 25489 AMQ 51838 b
1222	1222
1223	1223
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1225	1225	SB1586 - 34 - LRB103 25489 AMQ 51838 b
1226	1226	1 devices and durable medical equipment. Such rules shall
1227	1227	2 provide, but not be limited to, the following services: (1)
1228	1228	3 immediate repair or replacement of such devices by recipients;
1229	1229	4 and (2) rental, lease, purchase or lease-purchase of durable
1230	1230	5 medical equipment in a cost-effective manner, taking into
1231	1231	6 consideration the recipient's medical prognosis, the extent of
1232	1232	7 the recipient's needs, and the requirements and costs for
1233	1233	8 maintaining such equipment. Subject to prior approval, such
1234	1234	9 rules shall enable a recipient to temporarily acquire and use
1235	1235	10 alternative or substitute devices or equipment pending repairs
1236	1236	11 or replacements of any device or equipment previously
1237	1237	12 authorized for such recipient by the Department.
1238	1238	13 Notwithstanding any provision of Section 5-5f to the contrary,
1239	1239	14 the Department may, by rule, exempt certain replacement
1240	1240	15 wheelchair parts from prior approval and, for wheelchairs,
1241	1241	16 wheelchair parts, wheelchair accessories, and related seating
1242	1242	17 and positioning items, determine the wholesale price by
1243	1243	18 methods other than actual acquisition costs.
1244	1244	19 The Department shall require, by rule, all providers of
1245	1245	20 durable medical equipment to be accredited by an accreditation
1246	1246	21 organization approved by the federal Centers for Medicare and
1247	1247	22 Medicaid Services and recognized by the Department in order to
1248	1248	23 bill the Department for providing durable medical equipment to
1249	1249	24 recipients. No later than 15 months after the effective date
1250	1250	25 of the rule adopted pursuant to this paragraph, all providers
1251	1251	26 must meet the accreditation requirement.
1252	1252
1253	1253
1254	1254
1255	1255
1256	1256
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1258	1258
1259	1259
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1262	1262	1 In order to promote environmental responsibility, meet the
1263	1263	2 needs of recipients and enrollees, and achieve significant
1264	1264	3 cost savings, the Department, or a managed care organization
1265	1265	4 under contract with the Department, may provide recipients or
1266	1266	5 managed care enrollees who have a prescription or Certificate
1267	1267	6 of Medical Necessity access to refurbished durable medical
1268	1268	7 equipment under this Section (excluding prosthetic and
1269	1269	8 orthotic devices as defined in the Orthotics, Prosthetics, and
1270	1270	9 Pedorthics Practice Act and complex rehabilitation technology
1271	1271	10 products and associated services) through the State's
1272	1272	11 assistive technology program's reutilization program, using
1273	1273	12 staff with the Assistive Technology Professional (ATP)
1274	1274	13 Certification if the refurbished durable medical equipment:
1275	1275	14 (i) is available; (ii) is less expensive, including shipping
1276	1276	15 costs, than new durable medical equipment of the same type;
1277	1277	16 (iii) is able to withstand at least 3 years of use; (iv) is
1278	1278	17 cleaned, disinfected, sterilized, and safe in accordance with
1279	1279	18 federal Food and Drug Administration regulations and guidance
1280	1280	19 governing the reprocessing of medical devices in health care
1281	1281	20 settings; and (v) equally meets the needs of the recipient or
1282	1282	21 enrollee. The reutilization program shall confirm that the
1283	1283	22 recipient or enrollee is not already in receipt of the same or
1284	1284	23 similar equipment from another service provider, and that the
1285	1285	24 refurbished durable medical equipment equally meets the needs
1286	1286	25 of the recipient or enrollee. Nothing in this paragraph shall
1287	1287	26 be construed to limit recipient or enrollee choice to obtain
1288	1288
1289	1289
1290	1290
1291	1291
1292	1292
1293	1293	SB1586 - 35 - LRB103 25489 AMQ 51838 b
1294	1294
1295	1295
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1297	1297	SB1586 - 36 - LRB103 25489 AMQ 51838 b
1298	1298	1 new durable medical equipment or place any additional prior
1299	1299	2 authorization conditions on enrollees of managed care
1300	1300	3 organizations.
1301	1301	4 The Department shall execute, relative to the nursing home
1302	1302	5 prescreening project, written inter-agency agreements with the
1303	1303	6 Department of Human Services and the Department on Aging, to
1304	1304	7 effect the following: (i) intake procedures and common
1305	1305	8 eligibility criteria for those persons who are receiving
1306	1306	9 non-institutional services; and (ii) the establishment and
1307	1307	10 development of non-institutional services in areas of the
1308	1308	11 State where they are not currently available or are
1309	1309	12 undeveloped; and (iii) notwithstanding any other provision of
1310	1310	13 law, subject to federal approval, on and after July 1, 2012, an
1311	1311	14 increase in the determination of need (DON) scores from 29 to
1312	1312	15 37 for applicants for institutional and home and
1313	1313	16 community-based long term care; if and only if federal
1314	1314	17 approval is not granted, the Department may, in conjunction
1315	1315	18 with other affected agencies, implement utilization controls
1316	1316	19 or changes in benefit packages to effectuate a similar savings
1317	1317	20 amount for this population; and (iv) no later than July 1,
1318	1318	21 2013, minimum level of care eligibility criteria for
1319	1319	22 institutional and home and community-based long term care; and
1320	1320	23 (v) no later than October 1, 2013, establish procedures to
1321	1321	24 permit long term care providers access to eligibility scores
1322	1322	25 for individuals with an admission date who are seeking or
1323	1323	26 receiving services from the long term care provider. In order
1324	1324
1325	1325
1326	1326
1327	1327
1328	1328
1329	1329	SB1586 - 36 - LRB103 25489 AMQ 51838 b
1330	1330
1331	1331
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1333	1333	SB1586 - 37 - LRB103 25489 AMQ 51838 b
1334	1334	1 to select the minimum level of care eligibility criteria, the
1335	1335	2 Governor shall establish a workgroup that includes affected
1336	1336	3 agency representatives and stakeholders representing the
1337	1337	4 institutional and home and community-based long term care
1338	1338	5 interests. This Section shall not restrict the Department from
1339	1339	6 implementing lower level of care eligibility criteria for
1340	1340	7 community-based services in circumstances where federal
1341	1341	8 approval has been granted.
1342	1342	9 The Illinois Department shall develop and operate, in
1343	1343	10 cooperation with other State Departments and agencies and in
1344	1344	11 compliance with applicable federal laws and regulations,
1345	1345	12 appropriate and effective systems of health care evaluation
1346	1346	13 and programs for monitoring of utilization of health care
1347	1347	14 services and facilities, as it affects persons eligible for
1348	1348	15 medical assistance under this Code.
1349	1349	16 The Illinois Department shall report annually to the
1350	1350	17 General Assembly, no later than the second Friday in April of
1351	1351	18 1979 and each year thereafter, in regard to:
1352	1352	19 (a) actual statistics and trends in utilization of
1353	1353	20 medical services by public aid recipients;
1354	1354	21 (b) actual statistics and trends in the provision of
1355	1355	22 the various medical services by medical vendors;
1356	1356	23 (c) current rate structures and proposed changes in
1357	1357	24 those rate structures for the various medical vendors; and
1358	1358	25 (d) efforts at utilization review and control by the
1359	1359	26 Illinois Department.
1360	1360
1361	1361
1362	1362
1363	1363
1364	1364
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1366	1366
1367	1367
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1369	1369	SB1586 - 38 - LRB103 25489 AMQ 51838 b
1370	1370	1 The period covered by each report shall be the 3 years
1371	1371	2 ending on the June 30 prior to the report. The report shall
1372	1372	3 include suggested legislation for consideration by the General
1373	1373	4 Assembly. The requirement for reporting to the General
1374	1374	5 Assembly shall be satisfied by filing copies of the report as
1375	1375	6 required by Section 3.1 of the General Assembly Organization
1376	1376	7 Act, and filing such additional copies with the State
1377	1377	8 Government Report Distribution Center for the General Assembly
1378	1378	9 as is required under paragraph (t) of Section 7 of the State
1379	1379	10 Library Act.
1380	1380	11 Rulemaking authority to implement Public Act 95-1045, if
1381	1381	12 any, is conditioned on the rules being adopted in accordance
1382	1382	13 with all provisions of the Illinois Administrative Procedure
1383	1383	14 Act and all rules and procedures of the Joint Committee on
1384	1384	15 Administrative Rules; any purported rule not so adopted, for
1385	1385	16 whatever reason, is unauthorized.
1386	1386	17 On and after July 1, 2012, the Department shall reduce any
1387	1387	18 rate of reimbursement for services or other payments or alter
1388	1388	19 any methodologies authorized by this Code to reduce any rate
1389	1389	20 of reimbursement for services or other payments in accordance
1390	1390	21 with Section 5-5e.
1391	1391	22 Because kidney transplantation can be an appropriate,
1392	1392	23 cost-effective alternative to renal dialysis when medically
1393	1393	24 necessary and notwithstanding the provisions of Section 1-11
1394	1394	25 of this Code, beginning October 1, 2014, the Department shall
1395	1395	26 cover kidney transplantation for noncitizens with end-stage
1396	1396
1397	1397
1398	1398
1399	1399
1400	1400
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1402	1402
1403	1403
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1405	1405	SB1586 - 39 - LRB103 25489 AMQ 51838 b
1406	1406	1 renal disease who are not eligible for comprehensive medical
1407	1407	2 benefits, who meet the residency requirements of Section 5-3
1408	1408	3 of this Code, and who would otherwise meet the financial
1409	1409	4 requirements of the appropriate class of eligible persons
1410	1410	5 under Section 5-2 of this Code. To qualify for coverage of
1411	1411	6 kidney transplantation, such person must be receiving
1412	1412	7 emergency renal dialysis services covered by the Department.
1413	1413	8 Providers under this Section shall be prior approved and
1414	1414	9 certified by the Department to perform kidney transplantation
1415	1415	10 and the services under this Section shall be limited to
1416	1416	11 services associated with kidney transplantation.
1417	1417	12 Notwithstanding any other provision of this Code to the
1418	1418	13 contrary, on or after July 1, 2015, all FDA approved forms of
1419	1419	14 medication assisted treatment prescribed for the treatment of
1420	1420	15 alcohol dependence or treatment of opioid dependence shall be
1421	1421	16 covered under both fee for service and managed care medical
1422	1422	17 assistance programs for persons who are otherwise eligible for
1423	1423	18 medical assistance under this Article and shall not be subject
1424	1424	19 to any (1) utilization control, other than those established
1425	1425	20 under the American Society of Addiction Medicine patient
1426	1426	21 placement criteria, (2) prior authorization mandate, or (3)
1427	1427	22 lifetime restriction limit mandate.
1428	1428	23 On or after July 1, 2015, opioid antagonists prescribed
1429	1429	24 for the treatment of an opioid overdose, including the
1430	1430	25 medication product, administration devices, and any pharmacy
1431	1431	26 fees or hospital fees related to the dispensing, distribution,
1432	1432
1433	1433
1434	1434
1435	1435
1436	1436
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1438	1438
1439	1439
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1442	1442	1 and administration of the opioid antagonist, shall be covered
1443	1443	2 under the medical assistance program for persons who are
1444	1444	3 otherwise eligible for medical assistance under this Article.
1445	1445	4 As used in this Section, "opioid antagonist" means a drug that
1446	1446	5 binds to opioid receptors and blocks or inhibits the effect of
1447	1447	6 opioids acting on those receptors, including, but not limited
1448	1448	7 to, naloxone hydrochloride or any other similarly acting drug
1449	1449	8 approved by the U.S. Food and Drug Administration. The
1450	1450	9 Department shall not impose a copayment on the coverage
1451	1451	10 provided for naloxone hydrochloride under the medical
1452	1452	11 assistance program.
1453	1453	12 Upon federal approval, the Department shall provide
1454	1454	13 coverage and reimbursement for all drugs that are approved for
1455	1455	14 marketing by the federal Food and Drug Administration and that
1456	1456	15 are recommended by the federal Public Health Service or the
1457	1457	16 United States Centers for Disease Control and Prevention for
1458	1458	17 pre-exposure prophylaxis and related pre-exposure prophylaxis
1459	1459	18 services, including, but not limited to, HIV and sexually
1460	1460	19 transmitted infection screening, treatment for sexually
1461	1461	20 transmitted infections, medical monitoring, assorted labs, and
1462	1462	21 counseling to reduce the likelihood of HIV infection among
1463	1463	22 individuals who are not infected with HIV but who are at high
1464	1464	23 risk of HIV infection.
1465	1465	24 A federally qualified health center, as defined in Section
1466	1466	25 1905(l)(2)(B) of the federal Social Security Act, shall be
1467	1467	26 reimbursed by the Department in accordance with the federally
1468	1468
1469	1469
1470	1470
1471	1471
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1478	1478	1 qualified health center's encounter rate for services provided
1479	1479	2 to medical assistance recipients that are performed by a
1480	1480	3 dental hygienist, as defined under the Illinois Dental
1481	1481	4 Practice Act, working under the general supervision of a
1482	1482	5 dentist and employed by a federally qualified health center.
1483	1483	6 Within 90 days after October 8, 2021 (the effective date
1484	1484	7 of Public Act 102-665), the Department shall seek federal
1485	1485	8 approval of a State Plan amendment to expand coverage for
1486	1486	9 family planning services that includes presumptive eligibility
1487	1487	10 to individuals whose income is at or below 208% of the federal
1488	1488	11 poverty level. Coverage under this Section shall be effective
1489	1489	12 beginning no later than December 1, 2022.
1490	1490	13 Subject to approval by the federal Centers for Medicare
1491	1491	14 and Medicaid Services of a Title XIX State Plan amendment
1492	1492	15 electing the Program of All-Inclusive Care for the Elderly
1493	1493	16 (PACE) as a State Medicaid option, as provided for by Subtitle
1494	1494	17 I (commencing with Section 4801) of Title IV of the Balanced
1495	1495	18 Budget Act of 1997 (Public Law 105-33) and Part 460
1496	1496	19 (commencing with Section 460.2) of Subchapter E of Title 42 of
1497	1497	20 the Code of Federal Regulations, PACE program services shall
1498	1498	21 become a covered benefit of the medical assistance program,
1499	1499	22 subject to criteria established in accordance with all
1500	1500	23 applicable laws.
1501	1501	24 Notwithstanding any other provision of this Code,
1502	1502	25 community-based pediatric palliative care from a trained
1503	1503	26 interdisciplinary team shall be covered under the medical
1504	1504
1505	1505
1506	1506
1507	1507
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1514	1514	1 assistance program as provided in Section 15 of the Pediatric
1515	1515	2 Palliative Care Act.
1516	1516	3 Notwithstanding any other provision of this Code, within
1517	1517	4 12 months after June 2, 2022 (the effective date of Public Act
1518	1518	5 102-1037) this amendatory Act of the 102nd General Assembly
1519	1519	6 and subject to federal approval, acupuncture services
1520	1520	7 performed by an acupuncturist licensed under the Acupuncture
1521	1521	8 Practice Act who is acting within the scope of his or her
1522	1522	9 license shall be covered under the medical assistance program.
1523	1523	10 The Department shall apply for any federal waiver or State
1524	1524	11 Plan amendment, if required, to implement this paragraph. The
1525	1525	12 Department may adopt any rules, including standards and
1526	1526	13 criteria, necessary to implement this paragraph.
1527	1527	14 Notwithstanding any other provision of this Code, the
1528	1528	15 Department shall provide coverage and reimbursement for
1529	1529	16 prescription management services provided by prescribing
1530	1530	17 psychologists for persons who are otherwise eligible for
1531	1531	18 medical assistance under this Article.
1532	1532	19 (Source: P.A. 101-209, eff. 8-5-19; 101-580, eff. 1-1-20;
1533	1533	20 102-43, Article 30, Section 30-5, eff. 7-6-21; 102-43, Article
1534	1534	21 35, Section 35-5, eff. 7-6-21; 102-43, Article 55, Section
1535	1535	22 55-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123, eff. 1-1-22;
1536	1536	23 102-558, eff. 8-20-21; 102-598, eff. 1-1-22; 102-655, eff.
1537	1537	24 1-1-22; 102-665, eff. 10-8-21; 102-813, eff. 5-13-22;
1538	1538	25 102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22; 102-1038 eff.
1539	1539	26 1-1-23; revised 12-14-22.)
1540	1540
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1550	1550	1 Section 15. The Illinois Controlled Substances Act is
1551	1551	2 amended by changing Section 303.05 as follows:
1552	1552	3 (720 ILCS 570/303.05)
1553	1553	4 Sec. 303.05. Mid-level practitioner registration.
1554	1554	5 (a) The Department of Financial and Professional
1555	1555	6 Regulation shall register licensed physician assistants,
1556	1556	7 licensed advanced practice registered nurses, and prescribing
1557	1557	8 psychologists licensed under Section 4.2 of the Clinical
1558	1558	9 Psychologist Licensing Act to prescribe and dispense
1559	1559	10 controlled substances under Section 303 and euthanasia
1560	1560	11 agencies to purchase, store, or administer animal euthanasia
1561	1561	12 drugs under the following circumstances:
1562	1562	13 (1) with respect to physician assistants,
1563	1563	14 (A) the physician assistant has been delegated
1564	1564	15 written authority to prescribe any Schedule III
1565	1565	16 through V controlled substances by a physician
1566	1566	17 licensed to practice medicine in all its branches in
1567	1567	18 accordance with Section 7.5 of the Physician Assistant
1568	1568	19 Practice Act of 1987; and the physician assistant has
1569	1569	20 completed the appropriate application forms and has
1570	1570	21 paid the required fees as set by rule; or
1571	1571	22 (B) the physician assistant has been delegated
1572	1572	23 authority by a collaborating physician licensed to
1573	1573	24 practice medicine in all its branches to prescribe or
1574	1574
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1584	1584	1 dispense Schedule II controlled substances through a
1585	1585	2 written delegation of authority and under the
1586	1586	3 following conditions:
1587	1587	4 (i) Specific Schedule II controlled substances
1588	1588	5 by oral dosage or topical or transdermal
1589	1589	6 application may be delegated, provided that the
1590	1590	7 delegated Schedule II controlled substances are
1591	1591	8 routinely prescribed by the collaborating
1592	1592	9 physician. This delegation must identify the
1593	1593	10 specific Schedule II controlled substances by
1594	1594	11 either brand name or generic name. Schedule II
1595	1595	12 controlled substances to be delivered by injection
1596	1596	13 or other route of administration may not be
1597	1597	14 delegated;
1598	1598	15 (ii) any delegation must be of controlled
1599	1599	16 substances prescribed by the collaborating
1600	1600	17 physician;
1601	1601	18 (iii) all prescriptions must be limited to no
1602	1602	19 more than a 30-day supply, with any continuation
1603	1603	20 authorized only after prior approval of the
1604	1604	21 collaborating physician;
1605	1605	22 (iv) the physician assistant must discuss the
1606	1606	23 condition of any patients for whom a controlled
1607	1607	24 substance is prescribed monthly with the
1608	1608	25 delegating physician;
1609	1609	26 (v) the physician assistant must have
1610	1610
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1620	1620	1 completed the appropriate application forms and
1621	1621	2 paid the required fees as set by rule;
1622	1622	3 (vi) the physician assistant must provide
1623	1623	4 evidence of satisfactory completion of 45 contact
1624	1624	5 hours in pharmacology from any physician assistant
1625	1625	6 program accredited by the Accreditation Review
1626	1626	7 Commission on Education for the Physician
1627	1627	8 Assistant (ARC-PA), or its predecessor agency, for
1628	1628	9 any new license issued with Schedule II authority
1629	1629	10 after the effective date of this amendatory Act of
1630	1630	11 the 97th General Assembly; and
1631	1631	12 (vii) the physician assistant must annually
1632	1632	13 complete at least 5 hours of continuing education
1633	1633	14 in pharmacology;
1634	1634	15 (2) with respect to advanced practice registered
1635	1635	16 nurses who do not meet the requirements of Section 65-43
1636	1636	17 of the Nurse Practice Act,
1637	1637	18 (A) the advanced practice registered nurse has
1638	1638	19 been delegated authority to prescribe any Schedule III
1639	1639	20 through V controlled substances by a collaborating
1640	1640	21 physician licensed to practice medicine in all its
1641	1641	22 branches or a collaborating podiatric physician in
1642	1642	23 accordance with Section 65-40 of the Nurse Practice
1643	1643	24 Act. The advanced practice registered nurse has
1644	1644	25 completed the appropriate application forms and has
1645	1645	26 paid the required fees as set by rule; or
1646	1646
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1656	1656	1 (B) the advanced practice registered nurse has
1657	1657	2 been delegated authority by a collaborating physician
1658	1658	3 licensed to practice medicine in all its branches to
1659	1659	4 prescribe or dispense Schedule II controlled
1660	1660	5 substances through a written delegation of authority
1661	1661	6 and under the following conditions:
1662	1662	7 (i) specific Schedule II controlled substances
1663	1663	8 by oral dosage or topical or transdermal
1664	1664	9 application may be delegated, provided that the
1665	1665	10 delegated Schedule II controlled substances are
1666	1666	11 routinely prescribed by the collaborating
1667	1667	12 physician. This delegation must identify the
1668	1668	13 specific Schedule II controlled substances by
1669	1669	14 either brand name or generic name. Schedule II
1670	1670	15 controlled substances to be delivered by injection
1671	1671	16 or other route of administration may not be
1672	1672	17 delegated;
1673	1673	18 (ii) any delegation must be of controlled
1674	1674	19 substances prescribed by the collaborating
1675	1675	20 physician;
1676	1676	21 (iii) all prescriptions must be limited to no
1677	1677	22 more than a 30-day supply, with any continuation
1678	1678	23 authorized only after prior approval of the
1679	1679	24 collaborating physician;
1680	1680	25 (iv) the advanced practice registered nurse
1681	1681	26 must discuss the condition of any patients for
1682	1682
1683	1683
1684	1684
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1692	1692	1 whom a controlled substance is prescribed monthly
1693	1693	2 with the delegating physician or in the course of
1694	1694	3 review as required by Section 65-40 of the Nurse
1695	1695	4 Practice Act;
1696	1696	5 (v) the advanced practice registered nurse
1697	1697	6 must have completed the appropriate application
1698	1698	7 forms and paid the required fees as set by rule;
1699	1699	8 (vi) the advanced practice registered nurse
1700	1700	9 must provide evidence of satisfactory completion
1701	1701	10 of at least 45 graduate contact hours in
1702	1702	11 pharmacology for any new license issued with
1703	1703	12 Schedule II authority after the effective date of
1704	1704	13 this amendatory Act of the 97th General Assembly;
1705	1705	14 and
1706	1706	15 (vii) the advanced practice registered nurse
1707	1707	16 must annually complete 5 hours of continuing
1708	1708	17 education in pharmacology;
1709	1709	18 (2.5) with respect to advanced practice registered
1710	1710	19 nurses certified as nurse practitioners, nurse midwives,
1711	1711	20 or clinical nurse specialists who do not meet the
1712	1712	21 requirements of Section 65-43 of the Nurse Practice Act
1713	1713	22 practicing in a hospital affiliate,
1714	1714	23 (A) the advanced practice registered nurse
1715	1715	24 certified as a nurse practitioner, nurse midwife, or
1716	1716	25 clinical nurse specialist has been privileged to
1717	1717	26 prescribe any Schedule II through V controlled
1718	1718
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1728	1728	1 substances by the hospital affiliate upon the
1729	1729	2 recommendation of the appropriate physician committee
1730	1730	3 of the hospital affiliate in accordance with Section
1731	1731	4 65-45 of the Nurse Practice Act, has completed the
1732	1732	5 appropriate application forms, and has paid the
1733	1733	6 required fees as set by rule; and
1734	1734	7 (B) an advanced practice registered nurse
1735	1735	8 certified as a nurse practitioner, nurse midwife, or
1736	1736	9 clinical nurse specialist has been privileged to
1737	1737	10 prescribe any Schedule II controlled substances by the
1738	1738	11 hospital affiliate upon the recommendation of the
1739	1739	12 appropriate physician committee of the hospital
1740	1740	13 affiliate, then the following conditions must be met:
1741	1741	14 (i) specific Schedule II controlled substances
1742	1742	15 by oral dosage or topical or transdermal
1743	1743	16 application may be designated, provided that the
1744	1744	17 designated Schedule II controlled substances are
1745	1745	18 routinely prescribed by advanced practice
1746	1746	19 registered nurses in their area of certification;
1747	1747	20 the privileging documents must identify the
1748	1748	21 specific Schedule II controlled substances by
1749	1749	22 either brand name or generic name; privileges to
1750	1750	23 prescribe or dispense Schedule II controlled
1751	1751	24 substances to be delivered by injection or other
1752	1752	25 route of administration may not be granted;
1753	1753	26 (ii) any privileges must be controlled
1754	1754
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1764	1764	1 substances limited to the practice of the advanced
1765	1765	2 practice registered nurse;
1766	1766	3 (iii) any prescription must be limited to no
1767	1767	4 more than a 30-day supply;
1768	1768	5 (iv) the advanced practice registered nurse
1769	1769	6 must discuss the condition of any patients for
1770	1770	7 whom a controlled substance is prescribed monthly
1771	1771	8 with the appropriate physician committee of the
1772	1772	9 hospital affiliate or its physician designee; and
1773	1773	10 (v) the advanced practice registered nurse
1774	1774	11 must meet the education requirements of this
1775	1775	12 Section;
1776	1776	13 (3) with respect to animal euthanasia agencies, the
1777	1777	14 euthanasia agency has obtained a license from the
1778	1778	15 Department of Financial and Professional Regulation and
1779	1779	16 obtained a registration number from the Department; or
1780	1780	17 (4) with respect to prescribing psychologists, the
1781	1781	18 prescribing psychologist has been delegated authority to
1782	1782	19 prescribe any nonnarcotic, nonopioid Schedule II III
1783	1783	20 through V controlled substances by a collaborating
1784	1784	21 physician licensed to practice medicine in all its
1785	1785	22 branches in accordance with Section 4.3 of the Clinical
1786	1786	23 Psychologist Licensing Act, and the prescribing
1787	1787	24 psychologist has completed the appropriate application
1788	1788	25 forms and has paid the required fees as set by rule.
1789	1789	26 (b) The mid-level practitioner shall only be licensed to
1790	1790
1791	1791
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1793	1793
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1800	1800	1 prescribe those schedules of controlled substances for which a
1801	1801	2 licensed physician has delegated prescriptive authority,
1802	1802	3 except that an animal euthanasia agency does not have any
1803	1803	4 prescriptive authority. A physician assistant and an advanced
1804	1804	5 practice registered nurse are prohibited from prescribing
1805	1805	6 medications and controlled substances not set forth in the
1806	1806	7 required written delegation of authority or as authorized by
1807	1807	8 their practice Act.
1808	1808	9 (c) Upon completion of all registration requirements,
1809	1809	10 physician assistants, advanced practice registered nurses, and
1810	1810	11 animal euthanasia agencies may be issued a mid-level
1811	1811	12 practitioner controlled substances license for Illinois.
1812	1812	13 (d) A collaborating physician may, but is not required to,
1813	1813	14 delegate prescriptive authority to an advanced practice
1814	1814	15 registered nurse as part of a written collaborative agreement,
1815	1815	16 and the delegation of prescriptive authority shall conform to
1816	1816	17 the requirements of Section 65-40 of the Nurse Practice Act.
1817	1817	18 (e) A collaborating physician may, but is not required to,
1818	1818	19 delegate prescriptive authority to a physician assistant as
1819	1819	20 part of a written collaborative agreement, and the delegation
1820	1820	21 of prescriptive authority shall conform to the requirements of
1821	1821	22 Section 7.5 of the Physician Assistant Practice Act of 1987.
1822	1822	23 (f) Nothing in this Section shall be construed to prohibit
1823	1823	24 generic substitution.
1824	1824	25 (Source: P.A. 99-173, eff. 7-29-15; 100-453, eff. 8-25-17;
1825	1825	26 100-513, eff. 1-1-18; 100-863, eff. 8-14-18.)
1826	1826
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