104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1363 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED: 210 ILCS 45/2-217210 ILCS 85/6.22305 ILCS 5/5-4.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning non-emergency transportation services for medical assistance recipients, removes a requirement that facilities complete a Physician Certification Statement prior to ordering non-emergency transportation services for a patient. Instead, requires the Department of Healthcare and Family Services to develop, subject to federal approval, a Uniform Non-Emergency Transportation Certification Form (form) for non-emergency transportation. Provides that the form shall be the only form used by and required of all facilities, physicians, transportation providers, and transportation brokers whenever a patient or person covered by the medical assistance program is being transported from a facility or personal residence and requires non-emergency transportation. Makes corresponding changes to the Nursing Home Care Act and the Hospital Licensing Act. Further amends the Medical Assistance Article with a provision authorizing transportation brokers to use a network of independent driver providers for the delivery of covered transportation services. Provides that transportation brokers and participating independent driver providers shall be subject to the same driver credentialing and licensing standards and provider registration requirements as transportation network companies (TNC) and TNC drivers enrolled in the Impact Medicaid Program Advanced Cloud Technology system. With respect to the Department's Business Enterprise Program requirements for Medicaid managed care organizations (MCO), requires each MCO to submit only one Letter of Intent that consolidates and sets forth all pending transportation services from all BEP-certified transportation providers contracted with the MCO. Requires the Department to permit a MCO's transportation broker to attest to the accuracy of all claims for services provided by a contracted transportation provider. LRB104 03271 KTG 13293 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1363 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED: 210 ILCS 45/2-217210 ILCS 85/6.22305 ILCS 5/5-4.2 210 ILCS 45/2-217 210 ILCS 85/6.22 305 ILCS 5/5-4.2 Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning non-emergency transportation services for medical assistance recipients, removes a requirement that facilities complete a Physician Certification Statement prior to ordering non-emergency transportation services for a patient. Instead, requires the Department of Healthcare and Family Services to develop, subject to federal approval, a Uniform Non-Emergency Transportation Certification Form (form) for non-emergency transportation. Provides that the form shall be the only form used by and required of all facilities, physicians, transportation providers, and transportation brokers whenever a patient or person covered by the medical assistance program is being transported from a facility or personal residence and requires non-emergency transportation. Makes corresponding changes to the Nursing Home Care Act and the Hospital Licensing Act. Further amends the Medical Assistance Article with a provision authorizing transportation brokers to use a network of independent driver providers for the delivery of covered transportation services. Provides that transportation brokers and participating independent driver providers shall be subject to the same driver credentialing and licensing standards and provider registration requirements as transportation network companies (TNC) and TNC drivers enrolled in the Impact Medicaid Program Advanced Cloud Technology system. With respect to the Department's Business Enterprise Program requirements for Medicaid managed care organizations (MCO), requires each MCO to submit only one Letter of Intent that consolidates and sets forth all pending transportation services from all BEP-certified transportation providers contracted with the MCO. Requires the Department to permit a MCO's transportation broker to attest to the accuracy of all claims for services provided by a contracted transportation provider. LRB104 03271 KTG 13293 b LRB104 03271 KTG 13293 b A BILL FOR
104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1363 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED:
210 ILCS 45/2-217210 ILCS 85/6.22305 ILCS 5/5-4.2 210 ILCS 45/2-217 210 ILCS 85/6.22 305 ILCS 5/5-4.2
210 ILCS 45/2-217
210 ILCS 85/6.22
305 ILCS 5/5-4.2
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning non-emergency transportation services for medical assistance recipients, removes a requirement that facilities complete a Physician Certification Statement prior to ordering non-emergency transportation services for a patient. Instead, requires the Department of Healthcare and Family Services to develop, subject to federal approval, a Uniform Non-Emergency Transportation Certification Form (form) for non-emergency transportation. Provides that the form shall be the only form used by and required of all facilities, physicians, transportation providers, and transportation brokers whenever a patient or person covered by the medical assistance program is being transported from a facility or personal residence and requires non-emergency transportation. Makes corresponding changes to the Nursing Home Care Act and the Hospital Licensing Act. Further amends the Medical Assistance Article with a provision authorizing transportation brokers to use a network of independent driver providers for the delivery of covered transportation services. Provides that transportation brokers and participating independent driver providers shall be subject to the same driver credentialing and licensing standards and provider registration requirements as transportation network companies (TNC) and TNC drivers enrolled in the Impact Medicaid Program Advanced Cloud Technology system. With respect to the Department's Business Enterprise Program requirements for Medicaid managed care organizations (MCO), requires each MCO to submit only one Letter of Intent that consolidates and sets forth all pending transportation services from all BEP-certified transportation providers contracted with the MCO. Requires the Department to permit a MCO's transportation broker to attest to the accuracy of all claims for services provided by a contracted transportation provider.
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A BILL FOR
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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Nursing Home Care Act is amended by
5 changing Section 2-217 as follows:
6 (210 ILCS 45/2-217)
7 Sec. 2-217. Order for transportation of resident by an
8 ambulance service provider. If a facility orders medi-car,
9 service car, or ground ambulance transportation of a resident
10 of the facility by an ambulance service provider, the facility
11 must maintain a written record that shows (i) the name of the
12 person who placed the order for that transportation and (ii)
13 the medical reason for that transportation. Additionally, the
14 facility must provide the ambulance service provider with a
15 completed Uniform Non-Emergency Transportation Certification
16 Form as Physician Certification Statement on a form prescribed
17 by the Department of Healthcare and Family Services in
18 accordance with subsection (g) of Section 5-4.2 of the
19 Illinois Public Aid Code. The facility shall provide a copy of
20 the completed Uniform Non-Emergency Transportation
21 Certification Form Physician Certification Statement to the
22 ambulance service provider prior to or at the time of
23 transport. The Uniform Non-Emergency Transportation
104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1363 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED:
210 ILCS 45/2-217210 ILCS 85/6.22305 ILCS 5/5-4.2 210 ILCS 45/2-217 210 ILCS 85/6.22 305 ILCS 5/5-4.2
210 ILCS 45/2-217
210 ILCS 85/6.22
305 ILCS 5/5-4.2
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning non-emergency transportation services for medical assistance recipients, removes a requirement that facilities complete a Physician Certification Statement prior to ordering non-emergency transportation services for a patient. Instead, requires the Department of Healthcare and Family Services to develop, subject to federal approval, a Uniform Non-Emergency Transportation Certification Form (form) for non-emergency transportation. Provides that the form shall be the only form used by and required of all facilities, physicians, transportation providers, and transportation brokers whenever a patient or person covered by the medical assistance program is being transported from a facility or personal residence and requires non-emergency transportation. Makes corresponding changes to the Nursing Home Care Act and the Hospital Licensing Act. Further amends the Medical Assistance Article with a provision authorizing transportation brokers to use a network of independent driver providers for the delivery of covered transportation services. Provides that transportation brokers and participating independent driver providers shall be subject to the same driver credentialing and licensing standards and provider registration requirements as transportation network companies (TNC) and TNC drivers enrolled in the Impact Medicaid Program Advanced Cloud Technology system. With respect to the Department's Business Enterprise Program requirements for Medicaid managed care organizations (MCO), requires each MCO to submit only one Letter of Intent that consolidates and sets forth all pending transportation services from all BEP-certified transportation providers contracted with the MCO. Requires the Department to permit a MCO's transportation broker to attest to the accuracy of all claims for services provided by a contracted transportation provider.
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A BILL FOR
210 ILCS 45/2-217
210 ILCS 85/6.22
305 ILCS 5/5-4.2
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1 Certification Form Physician Certification Statement is not
2 required prior to the transport if a delay in transport can be
3 expected to negatively affect the patient outcome; however,
4 the facility shall provide a copy of the Uniform Non-Emergency
5 Transportation Certification Form Physician Certification
6 Statement to the ambulance service provider at no charge
7 within 10 days after the request. A facility shall, upon
8 request, furnish assistance to the transportation provider in
9 the completion of the form if the form Physician Certification
10 Statement is incomplete. The facility must maintain the record
11 for a period of at least 3 years after the date of the order
12 for transportation by ambulance.
13 (Source: P.A. 100-646, eff. 7-27-18.)
14 Section 10. The Hospital Licensing Act is amended by
15 changing Section 6.22 as follows:
16 (210 ILCS 85/6.22)
17 Sec. 6.22. Arrangement for transportation of patient by an
18 ambulance service provider.
19 (a) In this Section:
20 "Ambulance service provider" means a Vehicle Service
21 Provider as defined in the Emergency Medical Services (EMS)
22 Systems Act who provides non-emergency transportation services
23 by ambulance.
24 "Patient" means a person who is transported by an
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1 ambulance service provider.
2 (b) If a hospital arranges for medi-car, service car, or
3 ground ambulance transportation of a patient of the hospital,
4 the hospital must provide the ambulance service provider, at
5 or prior to transport, a completed Uniform Non-Emergency
6 Transportation Certification Form as prescribed by the
7 Department of Healthcare and Family Services in subsection (g)
8 of Section 5-4.2 of the Illinois Public Aid Code. Physician
9 Certification Statement formatted and completed in compliance
10 with federal regulations or an equivalent form developed by
11 the hospital. Each hospital shall develop a policy requiring a
12 physician or the physician's designee to complete the Uniform
13 Non-Emergency Transportation Certification Form. The Uniform
14 Non-Emergency Transportation Certification Form Physician
15 Certification Statement. The Physician Certification Statement
16 shall be maintained as part of the patient's medical record. A
17 hospital shall, upon request, furnish assistance to the
18 ambulance service provider in the completion of the form if
19 the Uniform Non-Emergency Transportation Certification Form
20 Physician Certification Statement is incomplete. The Physician
21 Certification Statement or equivalent form is not required
22 prior to transport if a delay in transport can be expected to
23 negatively affect the patient outcome; however, a hospital
24 shall provide a copy of the form Physician Certification
25 Statement to the ambulance service provider at no charge
26 within 10 days after the request.
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1 (c) If a hospital is unable to provide a completed Uniform
2 Non-Emergency Transportation Certification Form Physician
3 Certification Statement or equivalent form, then the hospital
4 shall provide to the patient a written notice and a verbal
5 explanation of the written notice, which notice must meet all
6 of the following requirements:
7 (1) The following caption must appear at the beginning
8 of the notice in at least 14-point type: Notice to Patient
9 Regarding Non-Emergency Ambulance Services.
10 (2) The notice must contain each of the following
11 statements in at least 14-point type:
12 (A) The purpose of this notice is to help you make
13 an informed choice about whether you want to be
14 transported by ambulance because your medical
15 condition does not meet medical necessity for
16 transportation by an ambulance.
17 (B) Your insurance may not cover the charges for
18 ambulance transportation.
19 (C) You may be responsible for the cost of
20 ambulance transportation.
21 (D) The estimated cost of ambulance transportation
22 is $(amount).
23 (3) The notice must be signed by the patient or by the
24 patient's authorized representative. A copy shall be given
25 to the patient and the hospital shall retain a copy.
26 (d) The notice set forth in subsection (c) of this Section
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1 shall not be required if a delay in transport can be expected
2 to negatively affect the patient outcome.
3 (e) If a patient is physically or mentally unable to sign
4 the notice described in subsection (c) of this Section and no
5 authorized representative of the patient is available to sign
6 the notice on the patient's behalf, the hospital must be able
7 to provide documentation of the patient's inability to sign
8 the notice and the unavailability of an authorized
9 representative. In any case described in this subsection (e),
10 the hospital shall be considered to have met the requirements
11 of subsection (c) of this Section.
12 (Source: P.A. 100-646, eff. 7-27-18.)
13 Section 15. The Illinois Public Aid Code is amended by
14 changing Section 5-4.2 as follows:
15 (305 ILCS 5/5-4.2)
16 Sec. 5-4.2. Ambulance services payments.
17 (a) For ambulance services provided to a recipient of aid
18 under this Article on or after January 1, 1993, the Illinois
19 Department shall reimburse ambulance service providers at
20 rates calculated in accordance with this Section. It is the
21 intent of the General Assembly to provide adequate
22 reimbursement for ambulance services so as to ensure adequate
23 access to services for recipients of aid under this Article
24 and to provide appropriate incentives to ambulance service
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1 providers to provide services in an efficient and
2 cost-effective manner. Thus, it is the intent of the General
3 Assembly that the Illinois Department implement a
4 reimbursement system for ambulance services that, to the
5 extent practicable and subject to the availability of funds
6 appropriated by the General Assembly for this purpose, is
7 consistent with the payment principles of Medicare. To ensure
8 uniformity between the payment principles of Medicare and
9 Medicaid, the Illinois Department shall follow, to the extent
10 necessary and practicable and subject to the availability of
11 funds appropriated by the General Assembly for this purpose,
12 the statutes, laws, regulations, policies, procedures,
13 principles, definitions, guidelines, and manuals used to
14 determine the amounts paid to ambulance service providers
15 under Title XVIII of the Social Security Act (Medicare).
16 (b) For ambulance services provided to a recipient of aid
17 under this Article on or after January 1, 1996, the Illinois
18 Department shall reimburse ambulance service providers based
19 upon the actual distance traveled if a natural disaster,
20 weather conditions, road repairs, or traffic congestion
21 necessitates the use of a route other than the most direct
22 route.
23 (c) For purposes of this Section, "ambulance services"
24 includes medical transportation services provided by means of
25 an ambulance, air ambulance, medi-car, service car, or taxi.
26 (c-1) For purposes of this Section, "ground ambulance
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1 service" means medical transportation services that are
2 described as ground ambulance services by the Centers for
3 Medicare and Medicaid Services and provided in a vehicle that
4 is licensed as an ambulance by the Illinois Department of
5 Public Health pursuant to the Emergency Medical Services (EMS)
6 Systems Act.
7 (c-2) For purposes of this Section, "ground ambulance
8 service provider" means a vehicle service provider as
9 described in the Emergency Medical Services (EMS) Systems Act
10 that operates licensed ambulances for the purpose of providing
11 emergency ambulance services, or non-emergency ambulance
12 services, or both. For purposes of this Section, this includes
13 both ambulance providers and ambulance suppliers as described
14 by the Centers for Medicare and Medicaid Services.
15 (c-3) For purposes of this Section, "medi-car" means
16 transportation services provided to a patient who is confined
17 to a wheelchair and requires the use of a hydraulic or electric
18 lift or ramp and wheelchair lockdown when the patient's
19 condition does not require medical observation, medical
20 supervision, medical equipment, the administration of
21 medications, or the administration of oxygen.
22 (c-4) For purposes of this Section, "service car" means
23 transportation services provided to a patient by a passenger
24 vehicle where that patient does not require the specialized
25 modes described in subsection (c-1) or (c-3).
26 (c-5) For purposes of this Section, "air ambulance
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1 service" means medical transport by helicopter or airplane for
2 patients, as defined in 29 U.S.C. 1185f(c)(1), and any service
3 that is described as an air ambulance service by the federal
4 Centers for Medicare and Medicaid Services.
5 (d) This Section does not prohibit separate billing by
6 ambulance service providers for oxygen furnished while
7 providing advanced life support services.
8 (e) Beginning with services rendered on or after July 1,
9 2008, all providers of non-emergency medi-car and service car
10 transportation must certify that the driver and employee
11 attendant, as applicable, have completed a safety program
12 approved by the Department to protect both the patient and the
13 driver, prior to transporting a patient. The provider must
14 maintain this certification in its records. The provider shall
15 produce such documentation upon demand by the Department or
16 its representative. Failure to produce documentation of such
17 training shall result in recovery of any payments made by the
18 Department for services rendered by a non-certified driver or
19 employee attendant. Medi-car and service car providers must
20 maintain legible documentation in their records of the driver
21 and, as applicable, employee attendant that actually
22 transported the patient. Providers must recertify all drivers
23 and employee attendants every 3 years. If they meet the
24 established training components set forth by the Department,
25 providers of non-emergency medi-car and service car
26 transportation that are either directly or through an
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1 affiliated company licensed by the Department of Public Health
2 shall be approved by the Department to have in-house safety
3 programs for training their own staff.
4 Notwithstanding the requirements above, any public
5 transportation provider of medi-car and service car
6 transportation that receives federal funding under 49 U.S.C.
7 5307 and 5311 need not certify its drivers and employee
8 attendants under this Section, since safety training is
9 already federally mandated.
10 (f) With respect to any policy or program administered by
11 the Department or its agent regarding approval of
12 non-emergency medical transportation by ground ambulance
13 service providers, including, but not limited to, the
14 Non-Emergency Transportation Services Prior Approval Program
15 (NETSPAP), the Department shall establish by rule a process by
16 which ground ambulance service providers of non-emergency
17 medical transportation may appeal any decision by the
18 Department or its agent for which no denial was received prior
19 to the time of transport that either (i) denies a request for
20 approval for payment of non-emergency transportation by means
21 of ground ambulance service or (ii) grants a request for
22 approval of non-emergency transportation by means of ground
23 ambulance service at a level of service that entitles the
24 ground ambulance service provider to a lower level of
25 compensation from the Department than the ground ambulance
26 service provider would have received as compensation for the
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1 level of service requested. The rule shall be filed by
2 December 15, 2012 and shall provide that, for any decision
3 rendered by the Department or its agent on or after the date
4 the rule takes effect, the ground ambulance service provider
5 shall have 60 days from the date the decision is received to
6 file an appeal. The rule established by the Department shall
7 be, insofar as is practical, consistent with the Illinois
8 Administrative Procedure Act. The Director's decision on an
9 appeal under this Section shall be a final administrative
10 decision subject to review under the Administrative Review
11 Law.
12 (f-5) Beginning 90 days after July 20, 2012 (the effective
13 date of Public Act 97-842), (i) no denial of a request for
14 approval for payment of non-emergency transportation by means
15 of ground ambulance service, and (ii) no approval of
16 non-emergency transportation by means of ground ambulance
17 service at a level of service that entitles the ground
18 ambulance service provider to a lower level of compensation
19 from the Department than would have been received at the level
20 of service submitted by the ground ambulance service provider,
21 may be issued by the Department or its agent unless the
22 Department has submitted the criteria for determining the
23 appropriateness of the transport for first notice publication
24 in the Illinois Register pursuant to Section 5-40 of the
25 Illinois Administrative Procedure Act.
26 (f-6) Within 90 days after June 2, 2022 (the effective
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1 date of Public Act 102-1037) and subject to federal approval,
2 the Department shall file rules to allow for the approval of
3 ground ambulance services when the sole purpose of the
4 transport is for the navigation of stairs or the assisting or
5 lifting of a patient at a medical facility or during a medical
6 appointment in instances where the Department or a contracted
7 Medicaid managed care organization or their transportation
8 broker is unable to secure transportation through any other
9 transportation provider.
10 (f-7) For non-emergency ground ambulance claims properly
11 denied under Department policy at the time the claim is filed
12 due to failure to submit a valid Medical Certification for
13 Non-Emergency Ambulance on and after December 15, 2012 and
14 prior to January 1, 2021, the Department shall allot
15 $2,000,000 to a pool to reimburse such claims if the provider
16 proves medical necessity for the service by other means.
17 Providers must submit any such denied claims for which they
18 seek compensation to the Department no later than December 31,
19 2021 along with documentation of medical necessity. No later
20 than May 31, 2022, the Department shall determine for which
21 claims medical necessity was established. Such claims for
22 which medical necessity was established shall be paid at the
23 rate in effect at the time of the service, provided the
24 $2,000,000 is sufficient to pay at those rates. If the pool is
25 not sufficient, claims shall be paid at a uniform percentage
26 of the applicable rate such that the pool of $2,000,000 is
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1 exhausted. The appeal process described in subsection (f)
2 shall not be applicable to the Department's determinations
3 made in accordance with this subsection.
4 (g) Subject to federal approval, the Department of
5 Healthcare and Family Services shall develop one Uniform
6 Non-Emergency Transportation Certification Form for
7 non-emergency transportation, including ground ambulance,
8 medi-car, or service car transportation. The Department of
9 Healthcare and Family Services shall develop the form in
10 compliance with all applicable federal regulations and shall
11 work in consultation with the Department of Public Health,
12 Medicaid managed care organizations, a statewide association
13 representing ambulance providers, a statewide association
14 representing hospitals, 3 statewide associations representing
15 nursing homes, and other stakeholders. The form shall be the
16 only form used by and required of all facilities, physicians,
17 transportation providers, and transportation brokers whenever
18 Whenever a patient or person covered by a medical assistance
19 program under this Code or by another medical program
20 administered by the Department, including a patient or person
21 covered under the State's Medicaid managed care program, is
22 being transported from a facility or personal residence and
23 requires non-emergency transportation including ground
24 ambulance, medi-car, or service car transportation. The
25 Uniform Non-Emergency Transportation Certification Form shall
26 include a standard expiration date and shall provide a space
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1 for a facility, physician, transportation provider, or
2 transportation broker to specify the level and type of
3 non-emergency transportation needed and the scheduled service
4 date. The Uniform Non-Emergency Transportation Certification
5 Form shall also include, but is not limited to, the criteria
6 necessary for a facility or physician to demonstrate medical
7 necessity for the level of transport needed as required by (i)
8 the Department of Healthcare and Family Services and (ii) the
9 federal Centers for Medicare and Medicaid Services as outlined
10 in the Centers for Medicare and Medicaid Services' Medicare
11 Benefit Policy Manual, Pub. 100-02, Chap. 10, Sec. 10.2.1, et
12 seq. The use of the Uniform Non-Emergency Transportation
13 Certification Form shall satisfy the obligations of hospitals
14 under Section 6.22 of the Hospital Licensing Act and nursing
15 homes under Section 2-217 of the Nursing Home Care Act. The
16 Department of Healthcare and Family Services shall apply for
17 any federal waivers or approvals necessary to develop and
18 implement the Uniform Non-Emergency Transportation
19 Certification Form. Implementation and acceptance of the form
20 shall be contingent on the Department's receipt of all
21 necessary federal waivers or approvals, if required, and shall
22 take place no later than 90 days after the issuance of the form
23 by the Department of Healthcare and Family Services. , a
24 Physician Certification Statement as described in this Section
25 shall be required for each patient.
26 Facilities shall develop procedures for a licensed medical
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1 professional to complete provide a written and signed Uniform
2 Non-Emergency Transportation Certification Form. A written and
3 signed Uniform Non-Emergency Transportation Certification Form
4 shall Physician Certification Statement. The Physician
5 Certification Statement shall specify the level of
6 transportation services needed and complete a medical
7 certification establishing the criteria for approval of
8 non-emergency ambulance transportation, as published by the
9 Department of Healthcare and Family Services, that is met by
10 the patient. This medical certification shall be completed
11 prior to ordering the transportation service and prior to
12 patient discharge. The Uniform Non-Emergency Transportation
13 Certification Form Physician Certification Statement is not
14 required prior to transport if a delay in transport can be
15 expected to negatively affect the patient outcome. If the
16 ground ambulance provider, medi-car provider, or service car
17 provider is unable to obtain a completed Uniform Non-Emergency
18 Transportation Certification Form from the discharging
19 facility the required Physician Certification Statement within
20 10 calendar days following the date of the service, the ground
21 ambulance provider, medi-car provider, or service car provider
22 must document its attempt to obtain the requested
23 certification and may then submit the claim for payment.
24 Acceptable documentation includes a signed return receipt from
25 the U.S. Postal Service, facsimile receipt, email receipt, or
26 other similar service that evidences that the ground ambulance
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1 provider, medi-car provider, or service car provider attempted
2 to obtain the required Uniform Non-Emergency Transportation
3 Certification Form from the discharging facility. Physician
4 Certification Statement.
5 The medical certification specifying the level and type of
6 non-emergency transportation needed shall be in the form of
7 the Physician Certification Statement on a standardized form
8 prescribed by the Department of Healthcare and Family
9 Services. Within 75 days after July 27, 2018 (the effective
10 date of Public Act 100-646), the Department of Healthcare and
11 Family Services shall develop a standardized form of the
12 Physician Certification Statement specifying the level and
13 type of transportation services needed in consultation with
14 the Department of Public Health, Medicaid managed care
15 organizations, a statewide association representing ambulance
16 providers, a statewide association representing hospitals, 3
17 statewide associations representing nursing homes, and other
18 stakeholders. The Physician Certification Statement shall
19 include, but is not limited to, the criteria necessary to
20 demonstrate medical necessity for the level of transport
21 needed as required by (i) the Department of Healthcare and
22 Family Services and (ii) the federal Centers for Medicare and
23 Medicaid Services as outlined in the Centers for Medicare and
24 Medicaid Services' Medicare Benefit Policy Manual, Pub.
25 100-02, Chap. 10, Sec. 10.2.1, et seq. The use of the Physician
26 Certification Statement shall satisfy the obligations of
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1 hospitals under Section 6.22 of the Hospital Licensing Act and
2 nursing homes under Section 2-217 of the Nursing Home Care
3 Act. Implementation and acceptance of the Physician
4 Certification Statement shall take place no later than 90 days
5 after the issuance of the Physician Certification Statement by
6 the Department of Healthcare and Family Services.
7 Pursuant to subsection (E) of Section 12-4.25 of this
8 Code, the Department is entitled to recover overpayments paid
9 to a provider or vendor, including, but not limited to, from
10 the discharging physician, the discharging facility, and the
11 ground ambulance service provider, in instances where a
12 non-emergency ground ambulance service is rendered as the
13 result of improper or false certification.
14 Beginning one year after the issuance of the Uniform
15 Non-Emergency Transportation Certification Form, the Beginning
16 October 1, 2018, the Department of Healthcare and Family
17 Services shall collect data from Medicaid managed care
18 organizations and transportation brokers, including the
19 Department's NETSPAP broker, regarding denials and appeals
20 related to the missing or incomplete Uniform Non-Emergency
21 Transportation Certification Form Physician Certification
22 Statement forms and overall compliance with this subsection.
23 The Department of Healthcare and Family Services shall publish
24 quarterly results on its website within 15 days following the
25 end of each quarter.
26 (h) On and after July 1, 2012, the Department shall reduce
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1 any rate of reimbursement for services or other payments or
2 alter any methodologies authorized by this Code to reduce any
3 rate of reimbursement for services or other payments in
4 accordance with Section 5-5e.
5 (i) Subject to federal approval, on and after January 1,
6 2024, the Department shall increase the base rate of
7 reimbursement for both base charges and mileage charges for
8 ground ambulance service providers not participating in the
9 Ground Emergency Medical Transportation (GEMT) Program for
10 medical transportation services provided by means of a ground
11 ambulance to a level not lower than 140% of the base rate in
12 effect as of January 1, 2023.
13 (j) For the purpose of understanding ground ambulance
14 transportation services cost structures and their impact on
15 the Medical Assistance Program, the Department shall engage
16 stakeholders, including, but not limited to, a statewide
17 association representing private ground ambulance service
18 providers in Illinois, to develop recommendations for a plan
19 for the regular collection of cost data for all ground
20 ambulance transportation providers reimbursed under the
21 Illinois Title XIX State Plan. Cost data obtained through this
22 process shall be used to inform on and to ensure the
23 effectiveness and efficiency of Illinois Medicaid rates. The
24 Department shall establish a process to limit public
25 availability of portions of the cost report data determined to
26 be proprietary. This process shall be concluded and
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1 recommendations shall be provided no later than December 31,
2 2025.
3 (k) Subject to federal approval, beginning on January 1,
4 2024, the Department shall increase the base rate of
5 reimbursement for both base charges and mileage charges for
6 medical transportation services provided by means of an air
7 ambulance to a level not lower than 50% of the Medicare
8 ambulance fee schedule rates, by designated Medicare locality,
9 in effect on January 1, 2023.
10 (l) To ensure the availability of non-emergency
11 transportation services to medical assistance recipients, a
12 transportation broker contracted with a Medicaid managed care
13 organization shall be authorized to use a network of
14 independent driver providers for the delivery of covered
15 transportation services. A transportation broker and its
16 participating independent driver providers shall be subject to
17 the same driver credentialing and licensing standards and
18 provider registration requirements as transportation network
19 companies (TNC) and TNC drivers enrolled in the Impact
20 Medicaid Program Advanced Cloud Technology system. The
21 Department shall apply for any federal waivers or approvals
22 necessary to implement the provisions of this subsection.
23 Implementation shall be contingent upon the Department's
24 receipt of all necessary federal waivers or approvals.
25 (m) In order to minimize the administrative burden placed
26 on Medicaid managed care organizations and their contracting
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