Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1743 Compare Versions

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

Old	New	Differences
1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1743 Introduced 2/5/2025, by Sen. Lakesia Collins SYNOPSIS AS INTRODUCED: 225 ILCS 15/2 from Ch. 111, par. 5352225 ILCS 15/4.3305 ILCS 5/5-5720 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. LRB104 11917 AAS 22009 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1743 Introduced 2/5/2025, by Sen. Lakesia Collins SYNOPSIS AS INTRODUCED: 225 ILCS 15/2 from Ch. 111, par. 5352225 ILCS 15/4.3305 ILCS 5/5-5720 ILCS 570/303.05 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3 305 ILCS 5/5-5 720 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. LRB104 11917 AAS 22009 b LRB104 11917 AAS 22009 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1743 Introduced 2/5/2025, by Sen. Lakesia Collins SYNOPSIS AS INTRODUCED:
3	3	225 ILCS 15/2 from Ch. 111, par. 5352225 ILCS 15/4.3305 ILCS 5/5-5720 ILCS 570/303.05 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3 305 ILCS 5/5-5 720 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
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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11	11	A BILL FOR
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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	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1743 Introduced 2/5/2025, by Sen. Lakesia Collins SYNOPSIS AS INTRODUCED:
41	41	225 ILCS 15/2 from Ch. 111, par. 5352225 ILCS 15/4.3305 ILCS 5/5-5720 ILCS 570/303.05 225 ILCS 15/2 from Ch. 111, par. 5352 225 ILCS 15/4.3 305 ILCS 5/5-5 720 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
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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48	48	LRB104 11917 AAS 22009 b
49	49	A BILL FOR
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56	56	225 ILCS 15/4.3
57	57	305 ILCS 5/5-5
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)
312	312	21 (Text of Section before amendment by P.A. 103-808)
313	313	22 Sec. 5-5. Medical services. The Illinois Department, by
314	314	23 rule, shall determine the quantity and quality of and the rate
315	315	24 of reimbursement for the medical assistance for which payment
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326	326	1 will be authorized, and the medical services to be provided,
327	327	2 which may include all or part of the following: (1) inpatient
328	328	3 hospital services; (2) outpatient hospital services; (3) other
329	329	4 laboratory and X-ray services; (4) skilled nursing home
330	330	5 services; (5) physicians' services whether furnished in the
331	331	6 office, the patient's home, a hospital, a skilled nursing
332	332	7 home, or elsewhere; (6) medical care, or any other type of
333	333	8 remedial care furnished by licensed practitioners; (7) home
334	334	9 health care services; (8) private duty nursing service; (9)
335	335	10 clinic services; (10) dental services, including prevention
336	336	11 and treatment of periodontal disease and dental caries disease
337	337	12 for pregnant individuals, provided by an individual licensed
338	338	13 to practice dentistry or dental surgery; for purposes of this
339	339	14 item (10), "dental services" means diagnostic, preventive, or
340	340	15 corrective procedures provided by or under the supervision of
341	341	16 a dentist in the practice of his or her profession; (11)
342	342	17 physical therapy and related services; (12) prescribed drugs,
343	343	18 dentures, and prosthetic devices; and eyeglasses prescribed by
344	344	19 a physician skilled in the diseases of the eye, or by an
345	345	20 optometrist, whichever the person may select; (13) other
346	346	21 diagnostic, screening, preventive, and rehabilitative
347	347	22 services, including to ensure that the individual's need for
348	348	23 intervention or treatment of mental disorders or substance use
349	349	24 disorders or co-occurring mental health and substance use
350	350	25 disorders is determined using a uniform screening, assessment,
351	351	26 and evaluation process inclusive of criteria, for children and
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362	362	1 adults; for purposes of this item (13), a uniform screening,
363	363	2 assessment, and evaluation process refers to a process that
364	364	3 includes an appropriate evaluation and, as warranted, a
365	365	4 referral; "uniform" does not mean the use of a singular
366	366	5 instrument, tool, or process that all must utilize; (14)
367	367	6 transportation and such other expenses as may be necessary;
368	368	7 (15) medical treatment of sexual assault survivors, as defined
369	369	8 in Section 1a of the Sexual Assault Survivors Emergency
370	370	9 Treatment Act, for injuries sustained as a result of the
371	371	10 sexual assault, including examinations and laboratory tests to
372	372	11 discover evidence which may be used in criminal proceedings
373	373	12 arising from the sexual assault; (16) the diagnosis and
374	374	13 treatment of sickle cell anemia; (16.5) services performed by
375	375	14 a chiropractic physician licensed under the Medical Practice
376	376	15 Act of 1987 and acting within the scope of his or her license,
377	377	16 including, but not limited to, chiropractic manipulative
378	378	17 treatment; and (17) any other medical care, and any other type
379	379	18 of remedial care recognized under the laws of this State. The
380	380	19 term "any other type of remedial care" shall include nursing
381	381	20 care and nursing home service for persons who rely on
382	382	21 treatment by spiritual means alone through prayer for healing.
383	383	22 Notwithstanding any other provision of this Section, a
384	384	23 comprehensive tobacco use cessation program that includes
385	385	24 purchasing prescription drugs or prescription medical devices
386	386	25 approved by the Food and Drug Administration shall be covered
387	387	26 under the medical assistance program under this Article for
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398	398	1 persons who are otherwise eligible for assistance under this
399	399	2 Article.
400	400	3 Notwithstanding any other provision of this Code,
401	401	4 reproductive health care that is otherwise legal in Illinois
402	402	5 shall be covered under the medical assistance program for
403	403	6 persons who are otherwise eligible for medical assistance
404	404	7 under this Article.
405	405	8 Notwithstanding any other provision of this Section, all
406	406	9 tobacco cessation medications approved by the United States
407	407	10 Food and Drug Administration and all individual and group
408	408	11 tobacco cessation counseling services and telephone-based
409	409	12 counseling services and tobacco cessation medications provided
410	410	13 through the Illinois Tobacco Quitline shall be covered under
411	411	14 the medical assistance program for persons who are otherwise
412	412	15 eligible for assistance under this Article. The Department
413	413	16 shall comply with all federal requirements necessary to obtain
414	414	17 federal financial participation, as specified in 42 CFR
415	415	18 433.15(b)(7), for telephone-based counseling services provided
416	416	19 through the Illinois Tobacco Quitline, including, but not
417	417	20 limited to: (i) entering into a memorandum of understanding or
418	418	21 interagency agreement with the Department of Public Health, as
419	419	22 administrator of the Illinois Tobacco Quitline; and (ii)
420	420	23 developing a cost allocation plan for Medicaid-allowable
421	421	24 Illinois Tobacco Quitline services in accordance with 45 CFR
422	422	25 95.507. The Department shall submit the memorandum of
423	423	26 understanding or interagency agreement, the cost allocation
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434	434	1 plan, and all other necessary documentation to the Centers for
435	435	2 Medicare and Medicaid Services for review and approval.
436	436	3 Coverage under this paragraph shall be contingent upon federal
437	437	4 approval.
438	438	5 Notwithstanding any other provision of this Code, the
439	439	6 Illinois Department may not require, as a condition of payment
440	440	7 for any laboratory test authorized under this Article, that a
441	441	8 physician's handwritten signature appear on the laboratory
442	442	9 test order form. The Illinois Department may, however, impose
443	443	10 other appropriate requirements regarding laboratory test order
444	444	11 documentation.
445	445	12 Upon receipt of federal approval of an amendment to the
446	446	13 Illinois Title XIX State Plan for this purpose, the Department
447	447	14 shall authorize the Chicago Public Schools (CPS) to procure a
448	448	15 vendor or vendors to manufacture eyeglasses for individuals
449	449	16 enrolled in a school within the CPS system. CPS shall ensure
450	450	17 that its vendor or vendors are enrolled as providers in the
451	451	18 medical assistance program and in any capitated Medicaid
452	452	19 managed care entity (MCE) serving individuals enrolled in a
453	453	20 school within the CPS system. Under any contract procured
454	454	21 under this provision, the vendor or vendors must serve only
455	455	22 individuals enrolled in a school within the CPS system. Claims
456	456	23 for services provided by CPS's vendor or vendors to recipients
457	457	24 of benefits in the medical assistance program under this Code,
458	458	25 the Children's Health Insurance Program, or the Covering ALL
459	459	26 KIDS Health Insurance Program shall be submitted to the
460	460
461	461
462	462
463	463
464	464
465	465	SB1743 - 12 - LRB104 11917 AAS 22009 b
466	466
467	467
468	468	SB1743- 13 -LRB104 11917 AAS 22009 b SB1743 - 13 - LRB104 11917 AAS 22009 b
469	469	SB1743 - 13 - LRB104 11917 AAS 22009 b
470	470	1 Department or the MCE in which the individual is enrolled for
471	471	2 payment and shall be reimbursed at the Department's or the
472	472	3 MCE's established rates or rate methodologies for eyeglasses.
473	473	4 On and after July 1, 2012, the Department of Healthcare
474	474	5 and Family Services may provide the following services to
475	475	6 persons eligible for assistance under this Article who are
476	476	7 participating in education, training or employment programs
477	477	8 operated by the Department of Human Services as successor to
478	478	9 the Department of Public Aid:
479	479	10 (1) dental services provided by or under the
480	480	11 supervision of a dentist; and
481	481	12 (2) eyeglasses prescribed by a physician skilled in
482	482	13 the diseases of the eye, or by an optometrist, whichever
483	483	14 the person may select.
484	484	15 On and after July 1, 2018, the Department of Healthcare
485	485	16 and Family Services shall provide dental services to any adult
486	486	17 who is otherwise eligible for assistance under the medical
487	487	18 assistance program. As used in this paragraph, "dental
488	488	19 services" means diagnostic, preventative, restorative, or
489	489	20 corrective procedures, including procedures and services for
490	490	21 the prevention and treatment of periodontal disease and dental
491	491	22 caries disease, provided by an individual who is licensed to
492	492	23 practice dentistry or dental surgery or who is under the
493	493	24 supervision of a dentist in the practice of his or her
494	494	25 profession.
495	495	26 On and after July 1, 2018, targeted dental services, as
496	496
497	497
498	498
499	499
500	500
501	501	SB1743 - 13 - LRB104 11917 AAS 22009 b
502	502
503	503
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505	505	SB1743 - 14 - LRB104 11917 AAS 22009 b
506	506	1 set forth in Exhibit D of the Consent Decree entered by the
507	507	2 United States District Court for the Northern District of
508	508	3 Illinois, Eastern Division, in the matter of Memisovski v.
509	509	4 Maram, Case No. 92 C 1982, that are provided to adults under
510	510	5 the medical assistance program shall be established at no less
511	511	6 than the rates set forth in the "New Rate" column in Exhibit D
512	512	7 of the Consent Decree for targeted dental services that are
513	513	8 provided to persons under the age of 18 under the medical
514	514	9 assistance program.
515	515	10 Subject to federal approval, on and after January 1, 2025,
516	516	11 the rates paid for sedation evaluation and the provision of
517	517	12 deep sedation and intravenous sedation for the purpose of
518	518	13 dental services shall be increased by 33% above the rates in
519	519	14 effect on December 31, 2024. The rates paid for nitrous oxide
520	520	15 sedation shall not be impacted by this paragraph and shall
521	521	16 remain the same as the rates in effect on December 31, 2024.
522	522	17 Notwithstanding any other provision of this Code and
523	523	18 subject to federal approval, the Department may adopt rules to
524	524	19 allow a dentist who is volunteering his or her service at no
525	525	20 cost to render dental services through an enrolled
526	526	21 not-for-profit health clinic without the dentist personally
527	527	22 enrolling as a participating provider in the medical
528	528	23 assistance program. A not-for-profit health clinic shall
529	529	24 include a public health clinic or Federally Qualified Health
530	530	25 Center or other enrolled provider, as determined by the
531	531	26 Department, through which dental services covered under this
532	532
533	533
534	534
535	535
536	536
537	537	SB1743 - 14 - LRB104 11917 AAS 22009 b
538	538
539	539
540	540	SB1743- 15 -LRB104 11917 AAS 22009 b SB1743 - 15 - LRB104 11917 AAS 22009 b
541	541	SB1743 - 15 - LRB104 11917 AAS 22009 b
542	542	1 Section are performed. The Department shall establish a
543	543	2 process for payment of claims for reimbursement for covered
544	544	3 dental services rendered under this provision.
545	545	4 Subject to appropriation and to federal approval, the
546	546	5 Department shall file administrative rules updating the
547	547	6 Handicapping Labio-Lingual Deviation orthodontic scoring tool
548	548	7 by January 1, 2025, or as soon as practicable.
549	549	8 On and after January 1, 2022, the Department of Healthcare
550	550	9 and Family Services shall administer and regulate a
551	551	10 school-based dental program that allows for the out-of-office
552	552	11 delivery of preventative dental services in a school setting
553	553	12 to children under 19 years of age. The Department shall
554	554	13 establish, by rule, guidelines for participation by providers
555	555	14 and set requirements for follow-up referral care based on the
556	556	15 requirements established in the Dental Office Reference Manual
557	557	16 published by the Department that establishes the requirements
558	558	17 for dentists participating in the All Kids Dental School
559	559	18 Program. Every effort shall be made by the Department when
560	560	19 developing the program requirements to consider the different
561	561	20 geographic differences of both urban and rural areas of the
562	562	21 State for initial treatment and necessary follow-up care. No
563	563	22 provider shall be charged a fee by any unit of local government
564	564	23 to participate in the school-based dental program administered
565	565	24 by the Department. Nothing in this paragraph shall be
566	566	25 construed to limit or preempt a home rule unit's or school
567	567	26 district's authority to establish, change, or administer a
568	568
569	569
570	570
571	571
572	572
573	573	SB1743 - 15 - LRB104 11917 AAS 22009 b
574	574
575	575
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577	577	SB1743 - 16 - LRB104 11917 AAS 22009 b
578	578	1 school-based dental program in addition to, or independent of,
579	579	2 the school-based dental program administered by the
580	580	3 Department.
581	581	4 The Illinois Department, by rule, may distinguish and
582	582	5 classify the medical services to be provided only in
583	583	6 accordance with the classes of persons designated in Section
584	584	7 5-2.
585	585	8 The Department of Healthcare and Family Services must
586	586	9 provide coverage and reimbursement for amino acid-based
587	587	10 elemental formulas, regardless of delivery method, for the
588	588	11 diagnosis and treatment of (i) eosinophilic disorders and (ii)
589	589	12 short bowel syndrome when the prescribing physician has issued
590	590	13 a written order stating that the amino acid-based elemental
591	591	14 formula is medically necessary.
592	592	15 The Illinois Department shall authorize the provision of,
593	593	16 and shall authorize payment for, screening by low-dose
594	594	17 mammography for the presence of occult breast cancer for
595	595	18 individuals 35 years of age or older who are eligible for
596	596	19 medical assistance under this Article, as follows:
597	597	20 (A) A baseline mammogram for individuals 35 to 39
598	598	21 years of age.
599	599	22 (B) An annual mammogram for individuals 40 years of
600	600	23 age or older.
601	601	24 (C) A mammogram at the age and intervals considered
602	602	25 medically necessary by the individual's health care
603	603	26 provider for individuals under 40 years of age and having
604	604
605	605
606	606
607	607
608	608
609	609	SB1743 - 16 - LRB104 11917 AAS 22009 b
610	610
611	611
612	612	SB1743- 17 -LRB104 11917 AAS 22009 b SB1743 - 17 - LRB104 11917 AAS 22009 b
613	613	SB1743 - 17 - LRB104 11917 AAS 22009 b
614	614	1 a family history of breast cancer, prior personal history
615	615	2 of breast cancer, positive genetic testing, or other risk
616	616	3 factors.
617	617	4 (D) A comprehensive ultrasound screening and MRI of an
618	618	5 entire breast or breasts if a mammogram demonstrates
619	619	6 heterogeneous or dense breast tissue or when medically
620	620	7 necessary as determined by a physician licensed to
621	621	8 practice medicine in all of its branches.
622	622	9 (E) A screening MRI when medically necessary, as
623	623	10 determined by a physician licensed to practice medicine in
624	624	11 all of its branches.
625	625	12 (F) A diagnostic mammogram when medically necessary,
626	626	13 as determined by a physician licensed to practice medicine
627	627	14 in all its branches, advanced practice registered nurse,
628	628	15 or physician assistant.
629	629	16 The Department shall not impose a deductible, coinsurance,
630	630	17 copayment, or any other cost-sharing requirement on the
631	631	18 coverage provided under this paragraph; except that this
632	632	19 sentence does not apply to coverage of diagnostic mammograms
633	633	20 to the extent such coverage would disqualify a high-deductible
634	634	21 health plan from eligibility for a health savings account
635	635	22 pursuant to Section 223 of the Internal Revenue Code (26
636	636	23 U.S.C. 223).
637	637	24 All screenings shall include a physical breast exam,
638	638	25 instruction on self-examination and information regarding the
639	639	26 frequency of self-examination and its value as a preventative
640	640
641	641
642	642
643	643
644	644
645	645	SB1743 - 17 - LRB104 11917 AAS 22009 b
646	646
647	647
648	648	SB1743- 18 -LRB104 11917 AAS 22009 b SB1743 - 18 - LRB104 11917 AAS 22009 b
649	649	SB1743 - 18 - LRB104 11917 AAS 22009 b
650	650	1 tool.
651	651	2 For purposes of this Section:
652	652	3 "Diagnostic mammogram" means a mammogram obtained using
653	653	4 diagnostic mammography.
654	654	5 "Diagnostic mammography" means a method of screening that
655	655	6 is designed to evaluate an abnormality in a breast, including
656	656	7 an abnormality seen or suspected on a screening mammogram or a
657	657	8 subjective or objective abnormality otherwise detected in the
658	658	9 breast.
659	659	10 "Low-dose mammography" means the x-ray examination of the
660	660	11 breast using equipment dedicated specifically for mammography,
661	661	12 including the x-ray tube, filter, compression device, and
662	662	13 image receptor, with an average radiation exposure delivery of
663	663	14 less than one rad per breast for 2 views of an average size
664	664	15 breast. The term also includes digital mammography and
665	665	16 includes breast tomosynthesis.
666	666	17 "Breast tomosynthesis" means a radiologic procedure that
667	667	18 involves the acquisition of projection images over the
668	668	19 stationary breast to produce cross-sectional digital
669	669	20 three-dimensional images of the breast.
670	670	21 If, at any time, the Secretary of the United States
671	671	22 Department of Health and Human Services, or its successor
672	672	23 agency, promulgates rules or regulations to be published in
673	673	24 the Federal Register or publishes a comment in the Federal
674	674	25 Register or issues an opinion, guidance, or other action that
675	675	26 would require the State, pursuant to any provision of the
676	676
677	677
678	678
679	679
680	680
681	681	SB1743 - 18 - LRB104 11917 AAS 22009 b
682	682
683	683
684	684	SB1743- 19 -LRB104 11917 AAS 22009 b SB1743 - 19 - LRB104 11917 AAS 22009 b
685	685	SB1743 - 19 - LRB104 11917 AAS 22009 b
686	686	1 Patient Protection and Affordable Care Act (Public Law
687	687	2 111-148), including, but not limited to, 42 U.S.C.
688	688	3 18031(d)(3)(B) or any successor provision, to defray the cost
689	689	4 of any coverage for breast tomosynthesis outlined in this
690	690	5 paragraph, then the requirement that an insurer cover breast
691	691	6 tomosynthesis is inoperative other than any such coverage
692	692	7 authorized under Section 1902 of the Social Security Act, 42
693	693	8 U.S.C. 1396a, and the State shall not assume any obligation
694	694	9 for the cost of coverage for breast tomosynthesis set forth in
695	695	10 this paragraph.
696	696	11 On and after January 1, 2016, the Department shall ensure
697	697	12 that all networks of care for adult clients of the Department
698	698	13 include access to at least one breast imaging Center of
699	699	14 Imaging Excellence as certified by the American College of
700	700	15 Radiology.
701	701	16 On and after January 1, 2012, providers participating in a
702	702	17 quality improvement program approved by the Department shall
703	703	18 be reimbursed for screening and diagnostic mammography at the
704	704	19 same rate as the Medicare program's rates, including the
705	705	20 increased reimbursement for digital mammography and, after
706	706	21 January 1, 2023 (the effective date of Public Act 102-1018),
707	707	22 breast tomosynthesis.
708	708	23 The Department shall convene an expert panel including
709	709	24 representatives of hospitals, free-standing mammography
710	710	25 facilities, and doctors, including radiologists, to establish
711	711	26 quality standards for mammography.
712	712
713	713
714	714
715	715
716	716
717	717	SB1743 - 19 - LRB104 11917 AAS 22009 b
718	718
719	719
720	720	SB1743- 20 -LRB104 11917 AAS 22009 b SB1743 - 20 - LRB104 11917 AAS 22009 b
721	721	SB1743 - 20 - LRB104 11917 AAS 22009 b
722	722	1 On and after January 1, 2017, providers participating in a
723	723	2 breast cancer treatment quality improvement program approved
724	724	3 by the Department shall be reimbursed for breast cancer
725	725	4 treatment at a rate that is no lower than 95% of the Medicare
726	726	5 program's rates for the data elements included in the breast
727	727	6 cancer treatment quality program.
728	728	7 The Department shall convene an expert panel, including
729	729	8 representatives of hospitals, free-standing breast cancer
730	730	9 treatment centers, breast cancer quality organizations, and
731	731	10 doctors, including breast surgeons, reconstructive breast
732	732	11 surgeons, oncologists, and primary care providers to establish
733	733	12 quality standards for breast cancer treatment.
734	734	13 Subject to federal approval, the Department shall
735	735	14 establish a rate methodology for mammography at federally
736	736	15 qualified health centers and other encounter-rate clinics.
737	737	16 These clinics or centers may also collaborate with other
738	738	17 hospital-based mammography facilities. By January 1, 2016, the
739	739	18 Department shall report to the General Assembly on the status
740	740	19 of the provision set forth in this paragraph.
741	741	20 The Department shall establish a methodology to remind
742	742	21 individuals who are age-appropriate for screening mammography,
743	743	22 but who have not received a mammogram within the previous 18
744	744	23 months, of the importance and benefit of screening
745	745	24 mammography. The Department shall work with experts in breast
746	746	25 cancer outreach and patient navigation to optimize these
747	747	26 reminders and shall establish a methodology for evaluating
748	748
749	749
750	750
751	751
752	752
753	753	SB1743 - 20 - LRB104 11917 AAS 22009 b
754	754
755	755
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757	757	SB1743 - 21 - LRB104 11917 AAS 22009 b
758	758	1 their effectiveness and modifying the methodology based on the
759	759	2 evaluation.
760	760	3 The Department shall establish a performance goal for
761	761	4 primary care providers with respect to their female patients
762	762	5 over age 40 receiving an annual mammogram. This performance
763	763	6 goal shall be used to provide additional reimbursement in the
764	764	7 form of a quality performance bonus to primary care providers
765	765	8 who meet that goal.
766	766	9 The Department shall devise a means of case-managing or
767	767	10 patient navigation for beneficiaries diagnosed with breast
768	768	11 cancer. This program shall initially operate as a pilot
769	769	12 program in areas of the State with the highest incidence of
770	770	13 mortality related to breast cancer. At least one pilot program
771	771	14 site shall be in the metropolitan Chicago area and at least one
772	772	15 site shall be outside the metropolitan Chicago area. On or
773	773	16 after July 1, 2016, the pilot program shall be expanded to
774	774	17 include one site in western Illinois, one site in southern
775	775	18 Illinois, one site in central Illinois, and 4 sites within
776	776	19 metropolitan Chicago. An evaluation of the pilot program shall
777	777	20 be carried out measuring health outcomes and cost of care for
778	778	21 those served by the pilot program compared to similarly
779	779	22 situated patients who are not served by the pilot program.
780	780	23 The Department shall require all networks of care to
781	781	24 develop a means either internally or by contract with experts
782	782	25 in navigation and community outreach to navigate cancer
783	783	26 patients to comprehensive care in a timely fashion. The
784	784
785	785
786	786
787	787
788	788
789	789	SB1743 - 21 - LRB104 11917 AAS 22009 b
790	790
791	791
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793	793	SB1743 - 22 - LRB104 11917 AAS 22009 b
794	794	1 Department shall require all networks of care to include
795	795	2 access for patients diagnosed with cancer to at least one
796	796	3 academic commission on cancer-accredited cancer program as an
797	797	4 in-network covered benefit.
798	798	5 The Department shall provide coverage and reimbursement
799	799	6 for a human papillomavirus (HPV) vaccine that is approved for
800	800	7 marketing by the federal Food and Drug Administration for all
801	801	8 persons between the ages of 9 and 45. Subject to federal
802	802	9 approval, the Department shall provide coverage and
803	803	10 reimbursement for a human papillomavirus (HPV) vaccine for
804	804	11 persons of the age of 46 and above who have been diagnosed with
805	805	12 cervical dysplasia with a high risk of recurrence or
806	806	13 progression. The Department shall disallow any
807	807	14 preauthorization requirements for the administration of the
808	808	15 human papillomavirus (HPV) vaccine.
809	809	16 On or after July 1, 2022, individuals who are otherwise
810	810	17 eligible for medical assistance under this Article shall
811	811	18 receive coverage for perinatal depression screenings for the
812	812	19 12-month period beginning on the last day of their pregnancy.
813	813	20 Medical assistance coverage under this paragraph shall be
814	814	21 conditioned on the use of a screening instrument approved by
815	815	22 the Department.
816	816	23 Any medical or health care provider shall immediately
817	817	24 recommend, to any pregnant individual who is being provided
818	818	25 prenatal services and is suspected of having a substance use
819	819	26 disorder as defined in the Substance Use Disorder Act,
820	820
821	821
822	822
823	823
824	824
825	825	SB1743 - 22 - LRB104 11917 AAS 22009 b
826	826
827	827
828	828	SB1743- 23 -LRB104 11917 AAS 22009 b SB1743 - 23 - LRB104 11917 AAS 22009 b
829	829	SB1743 - 23 - LRB104 11917 AAS 22009 b
830	830	1 referral to a local substance use disorder treatment program
831	831	2 licensed by the Department of Human Services or to a licensed
832	832	3 hospital which provides substance abuse treatment services.
833	833	4 The Department of Healthcare and Family Services shall assure
834	834	5 coverage for the cost of treatment of the drug abuse or
835	835	6 addiction for pregnant recipients in accordance with the
836	836	7 Illinois Medicaid Program in conjunction with the Department
837	837	8 of Human Services.
838	838	9 All medical providers providing medical assistance to
839	839	10 pregnant individuals under this Code shall receive information
840	840	11 from the Department on the availability of services under any
841	841	12 program providing case management services for addicted
842	842	13 individuals, including information on appropriate referrals
843	843	14 for other social services that may be needed by addicted
844	844	15 individuals in addition to treatment for addiction.
845	845	16 The Illinois Department, in cooperation with the
846	846	17 Departments of Human Services (as successor to the Department
847	847	18 of Alcoholism and Substance Abuse) and Public Health, through
848	848	19 a public awareness campaign, may provide information
849	849	20 concerning treatment for alcoholism and drug abuse and
850	850	21 addiction, prenatal health care, and other pertinent programs
851	851	22 directed at reducing the number of drug-affected infants born
852	852	23 to recipients of medical assistance.
853	853	24 Neither the Department of Healthcare and Family Services
854	854	25 nor the Department of Human Services shall sanction the
855	855	26 recipient solely on the basis of the recipient's substance
856	856
857	857
858	858
859	859
860	860
861	861	SB1743 - 23 - LRB104 11917 AAS 22009 b
862	862
863	863
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865	865	SB1743 - 24 - LRB104 11917 AAS 22009 b
866	866	1 abuse.
867	867	2 The Illinois Department shall establish such regulations
868	868	3 governing the dispensing of health services under this Article
869	869	4 as it shall deem appropriate. The Department should seek the
870	870	5 advice of formal professional advisory committees appointed by
871	871	6 the Director of the Illinois Department for the purpose of
872	872	7 providing regular advice on policy and administrative matters,
873	873	8 information dissemination and educational activities for
874	874	9 medical and health care providers, and consistency in
875	875	10 procedures to the Illinois Department.
876	876	11 The Illinois Department may develop and contract with
877	877	12 Partnerships of medical providers to arrange medical services
878	878	13 for persons eligible under Section 5-2 of this Code.
879	879	14 Implementation of this Section may be by demonstration
880	880	15 projects in certain geographic areas. The Partnership shall be
881	881	16 represented by a sponsor organization. The Department, by
882	882	17 rule, shall develop qualifications for sponsors of
883	883	18 Partnerships. Nothing in this Section shall be construed to
884	884	19 require that the sponsor organization be a medical
885	885	20 organization.
886	886	21 The sponsor must negotiate formal written contracts with
887	887	22 medical providers for physician services, inpatient and
888	888	23 outpatient hospital care, home health services, treatment for
889	889	24 alcoholism and substance abuse, and other services determined
890	890	25 necessary by the Illinois Department by rule for delivery by
891	891	26 Partnerships. Physician services must include prenatal and
892	892
893	893
894	894
895	895
896	896
897	897	SB1743 - 24 - LRB104 11917 AAS 22009 b
898	898
899	899
900	900	SB1743- 25 -LRB104 11917 AAS 22009 b SB1743 - 25 - LRB104 11917 AAS 22009 b
901	901	SB1743 - 25 - LRB104 11917 AAS 22009 b
902	902	1 obstetrical care. The Illinois Department shall reimburse
903	903	2 medical services delivered by Partnership providers to clients
904	904	3 in target areas according to provisions of this Article and
905	905	4 the Illinois Health Finance Reform Act, except that:
906	906	5 (1) Physicians participating in a Partnership and
907	907	6 providing certain services, which shall be determined by
908	908	7 the Illinois Department, to persons in areas covered by
909	909	8 the Partnership may receive an additional surcharge for
910	910	9 such services.
911	911	10 (2) The Department may elect to consider and negotiate
912	912	11 financial incentives to encourage the development of
913	913	12 Partnerships and the efficient delivery of medical care.
914	914	13 (3) Persons receiving medical services through
915	915	14 Partnerships may receive medical and case management
916	916	15 services above the level usually offered through the
917	917	16 medical assistance program.
918	918	17 Medical providers shall be required to meet certain
919	919	18 qualifications to participate in Partnerships to ensure the
920	920	19 delivery of high quality medical services. These
921	921	20 qualifications shall be determined by rule of the Illinois
922	922	21 Department and may be higher than qualifications for
923	923	22 participation in the medical assistance program. Partnership
924	924	23 sponsors may prescribe reasonable additional qualifications
925	925	24 for participation by medical providers, only with the prior
926	926	25 written approval of the Illinois Department.
927	927	26 Nothing in this Section shall limit the free choice of
928	928
929	929
930	930
931	931
932	932
933	933	SB1743 - 25 - LRB104 11917 AAS 22009 b
934	934
935	935
936	936	SB1743- 26 -LRB104 11917 AAS 22009 b SB1743 - 26 - LRB104 11917 AAS 22009 b
937	937	SB1743 - 26 - LRB104 11917 AAS 22009 b
938	938	1 practitioners, hospitals, and other providers of medical
939	939	2 services by clients. In order to ensure patient freedom of
940	940	3 choice, the Illinois Department shall immediately promulgate
941	941	4 all rules and take all other necessary actions so that
942	942	5 provided services may be accessed from therapeutically
943	943	6 certified optometrists to the full extent of the Illinois
944	944	7 Optometric Practice Act of 1987 without discriminating between
945	945	8 service providers.
946	946	9 The Department shall apply for a waiver from the United
947	947	10 States Health Care Financing Administration to allow for the
948	948	11 implementation of Partnerships under this Section.
949	949	12 The Illinois Department shall require health care
950	950	13 providers to maintain records that document the medical care
951	951	14 and services provided to recipients of Medical Assistance
952	952	15 under this Article. Such records must be retained for a period
953	953	16 of not less than 6 years from the date of service or as
954	954	17 provided by applicable State law, whichever period is longer,
955	955	18 except that if an audit is initiated within the required
956	956	19 retention period then the records must be retained until the
957	957	20 audit is completed and every exception is resolved. The
958	958	21 Illinois Department shall require health care providers to
959	959	22 make available, when authorized by the patient, in writing,
960	960	23 the medical records in a timely fashion to other health care
961	961	24 providers who are treating or serving persons eligible for
962	962	25 Medical Assistance under this Article. All dispensers of
963	963	26 medical services shall be required to maintain and retain
964	964
965	965
966	966
967	967
968	968
969	969	SB1743 - 26 - LRB104 11917 AAS 22009 b
970	970
971	971
972	972	SB1743- 27 -LRB104 11917 AAS 22009 b SB1743 - 27 - LRB104 11917 AAS 22009 b
973	973	SB1743 - 27 - LRB104 11917 AAS 22009 b
974	974	1 business and professional records sufficient to fully and
975	975	2 accurately document the nature, scope, details and receipt of
976	976	3 the health care provided to persons eligible for medical
977	977	4 assistance under this Code, in accordance with regulations
978	978	5 promulgated by the Illinois Department. The rules and
979	979	6 regulations shall require that proof of the receipt of
980	980	7 prescription drugs, dentures, prosthetic devices and
981	981	8 eyeglasses by eligible persons under this Section accompany
982	982	9 each claim for reimbursement submitted by the dispenser of
983	983	10 such medical services. No such claims for reimbursement shall
984	984	11 be approved for payment by the Illinois Department without
985	985	12 such proof of receipt, unless the Illinois Department shall
986	986	13 have put into effect and shall be operating a system of
987	987	14 post-payment audit and review which shall, on a sampling
988	988	15 basis, be deemed adequate by the Illinois Department to assure
989	989	16 that such drugs, dentures, prosthetic devices and eyeglasses
990	990	17 for which payment is being made are actually being received by
991	991	18 eligible recipients. Within 90 days after September 16, 1984
992	992	19 (the effective date of Public Act 83-1439), the Illinois
993	993	20 Department shall establish a current list of acquisition costs
994	994	21 for all prosthetic devices and any other items recognized as
995	995	22 medical equipment and supplies reimbursable under this Article
996	996	23 and shall update such list on a quarterly basis, except that
997	997	24 the acquisition costs of all prescription drugs shall be
998	998	25 updated no less frequently than every 30 days as required by
999	999	26 Section 5-5.12.
1000	1000
1001	1001
1002	1002
1003	1003
1004	1004
1005	1005	SB1743 - 27 - LRB104 11917 AAS 22009 b
1006	1006
1007	1007
1008	1008	SB1743- 28 -LRB104 11917 AAS 22009 b SB1743 - 28 - LRB104 11917 AAS 22009 b
1009	1009	SB1743 - 28 - LRB104 11917 AAS 22009 b
1010	1010	1 Notwithstanding any other law to the contrary, the
1011	1011	2 Illinois Department shall, within 365 days after July 22, 2013
1012	1012	3 (the effective date of Public Act 98-104), establish
1013	1013	4 procedures to permit skilled care facilities licensed under
1014	1014	5 the Nursing Home Care Act to submit monthly billing claims for
1015	1015	6 reimbursement purposes. Following development of these
1016	1016	7 procedures, the Department shall, by July 1, 2016, test the
1017	1017	8 viability of the new system and implement any necessary
1018	1018	9 operational or structural changes to its information
1019	1019	10 technology platforms in order to allow for the direct
1020	1020	11 acceptance and payment of nursing home claims.
1021	1021	12 Notwithstanding any other law to the contrary, the
1022	1022	13 Illinois Department shall, within 365 days after August 15,
1023	1023	14 2014 (the effective date of Public Act 98-963), establish
1024	1024	15 procedures to permit ID/DD facilities licensed under the ID/DD
1025	1025	16 Community Care Act and MC/DD facilities licensed under the
1026	1026	17 MC/DD Act to submit monthly billing claims for reimbursement
1027	1027	18 purposes. Following development of these procedures, the
1028	1028	19 Department shall have an additional 365 days to test the
1029	1029	20 viability of the new system and to ensure that any necessary
1030	1030	21 operational or structural changes to its information
1031	1031	22 technology platforms are implemented.
1032	1032	23 The Illinois Department shall require all dispensers of
1033	1033	24 medical services, other than an individual practitioner or
1034	1034	25 group of practitioners, desiring to participate in the Medical
1035	1035	26 Assistance program established under this Article to disclose
1036	1036
1037	1037
1038	1038
1039	1039
1040	1040
1041	1041	SB1743 - 28 - LRB104 11917 AAS 22009 b
1042	1042
1043	1043
1044	1044	SB1743- 29 -LRB104 11917 AAS 22009 b SB1743 - 29 - LRB104 11917 AAS 22009 b
1045	1045	SB1743 - 29 - LRB104 11917 AAS 22009 b
1046	1046	1 all financial, beneficial, ownership, equity, surety or other
1047	1047	2 interests in any and all firms, corporations, partnerships,
1048	1048	3 associations, business enterprises, joint ventures, agencies,
1049	1049	4 institutions or other legal entities providing any form of
1050	1050	5 health care services in this State under this Article.
1051	1051	6 The Illinois Department may require that all dispensers of
1052	1052	7 medical services desiring to participate in the medical
1053	1053	8 assistance program established under this Article disclose,
1054	1054	9 under such terms and conditions as the Illinois Department may
1055	1055	10 by rule establish, all inquiries from clients and attorneys
1056	1056	11 regarding medical bills paid by the Illinois Department, which
1057	1057	12 inquiries could indicate potential existence of claims or
1058	1058	13 liens for the Illinois Department.
1059	1059	14 Enrollment of a vendor shall be subject to a provisional
1060	1060	15 period and shall be conditional for one year. During the
1061	1061	16 period of conditional enrollment, the Department may terminate
1062	1062	17 the vendor's eligibility to participate in, or may disenroll
1063	1063	18 the vendor from, the medical assistance program without cause.
1064	1064	19 Unless otherwise specified, such termination of eligibility or
1065	1065	20 disenrollment is not subject to the Department's hearing
1066	1066	21 process. However, a disenrolled vendor may reapply without
1067	1067	22 penalty.
1068	1068	23 The Department has the discretion to limit the conditional
1069	1069	24 enrollment period for vendors based upon the category of risk
1070	1070	25 of the vendor.
1071	1071	26 Prior to enrollment and during the conditional enrollment
1072	1072
1073	1073
1074	1074
1075	1075
1076	1076
1077	1077	SB1743 - 29 - LRB104 11917 AAS 22009 b
1078	1078
1079	1079
1080	1080	SB1743- 30 -LRB104 11917 AAS 22009 b SB1743 - 30 - LRB104 11917 AAS 22009 b
1081	1081	SB1743 - 30 - LRB104 11917 AAS 22009 b
1082	1082	1 period in the medical assistance program, all vendors shall be
1083	1083	2 subject to enhanced oversight, screening, and review based on
1084	1084	3 the risk of fraud, waste, and abuse that is posed by the
1085	1085	4 category of risk of the vendor. The Illinois Department shall
1086	1086	5 establish the procedures for oversight, screening, and review,
1087	1087	6 which may include, but need not be limited to: criminal and
1088	1088	7 financial background checks; fingerprinting; license,
1089	1089	8 certification, and authorization verifications; unscheduled or
1090	1090	9 unannounced site visits; database checks; prepayment audit
1091	1091	10 reviews; audits; payment caps; payment suspensions; and other
1092	1092	11 screening as required by federal or State law.
1093	1093	12 The Department shall define or specify the following: (i)
1094	1094	13 by provider notice, the "category of risk of the vendor" for
1095	1095	14 each type of vendor, which shall take into account the level of
1096	1096	15 screening applicable to a particular category of vendor under
1097	1097	16 federal law and regulations; (ii) by rule or provider notice,
1098	1098	17 the maximum length of the conditional enrollment period for
1099	1099	18 each category of risk of the vendor; and (iii) by rule, the
1100	1100	19 hearing rights, if any, afforded to a vendor in each category
1101	1101	20 of risk of the vendor that is terminated or disenrolled during
1102	1102	21 the conditional enrollment period.
1103	1103	22 To be eligible for payment consideration, a vendor's
1104	1104	23 payment claim or bill, either as an initial claim or as a
1105	1105	24 resubmitted claim following prior rejection, must be received
1106	1106	25 by the Illinois Department, or its fiscal intermediary, no
1107	1107	26 later than 180 days after the latest date on the claim on which
1108	1108
1109	1109
1110	1110
1111	1111
1112	1112
1113	1113	SB1743 - 30 - LRB104 11917 AAS 22009 b
1114	1114
1115	1115
1116	1116	SB1743- 31 -LRB104 11917 AAS 22009 b SB1743 - 31 - LRB104 11917 AAS 22009 b
1117	1117	SB1743 - 31 - LRB104 11917 AAS 22009 b
1118	1118	1 medical goods or services were provided, with the following
1119	1119	2 exceptions:
1120	1120	3 (1) In the case of a provider whose enrollment is in
1121	1121	4 process by the Illinois Department, the 180-day period
1122	1122	5 shall not begin until the date on the written notice from
1123	1123	6 the Illinois Department that the provider enrollment is
1124	1124	7 complete.
1125	1125	8 (2) In the case of errors attributable to the Illinois
1126	1126	9 Department or any of its claims processing intermediaries
1127	1127	10 which result in an inability to receive, process, or
1128	1128	11 adjudicate a claim, the 180-day period shall not begin
1129	1129	12 until the provider has been notified of the error.
1130	1130	13 (3) In the case of a provider for whom the Illinois
1131	1131	14 Department initiates the monthly billing process.
1132	1132	15 (4) In the case of a provider operated by a unit of
1133	1133	16 local government with a population exceeding 3,000,000
1134	1134	17 when local government funds finance federal participation
1135	1135	18 for claims payments.
1136	1136	19 For claims for services rendered during a period for which
1137	1137	20 a recipient received retroactive eligibility, claims must be
1138	1138	21 filed within 180 days after the Department determines the
1139	1139	22 applicant is eligible. For claims for which the Illinois
1140	1140	23 Department is not the primary payer, claims must be submitted
1141	1141	24 to the Illinois Department within 180 days after the final
1142	1142	25 adjudication by the primary payer.
1143	1143	26 In the case of long term care facilities, within 120
1144	1144
1145	1145
1146	1146
1147	1147
1148	1148
1149	1149	SB1743 - 31 - LRB104 11917 AAS 22009 b
1150	1150
1151	1151
1152	1152	SB1743- 32 -LRB104 11917 AAS 22009 b SB1743 - 32 - LRB104 11917 AAS 22009 b
1153	1153	SB1743 - 32 - LRB104 11917 AAS 22009 b
1154	1154	1 calendar days of receipt by the facility of required
1155	1155	2 prescreening information, new admissions with associated
1156	1156	3 admission documents shall be submitted through the Medical
1157	1157	4 Electronic Data Interchange (MEDI) or the Recipient
1158	1158	5 Eligibility Verification (REV) System or shall be submitted
1159	1159	6 directly to the Department of Human Services using required
1160	1160	7 admission forms. Effective September 1, 2014, admission
1161	1161	8 documents, including all prescreening information, must be
1162	1162	9 submitted through MEDI or REV. Confirmation numbers assigned
1163	1163	10 to an accepted transaction shall be retained by a facility to
1164	1164	11 verify timely submittal. Once an admission transaction has
1165	1165	12 been completed, all resubmitted claims following prior
1166	1166	13 rejection are subject to receipt no later than 180 days after
1167	1167	14 the admission transaction has been completed.
1168	1168	15 Claims that are not submitted and received in compliance
1169	1169	16 with the foregoing requirements shall not be eligible for
1170	1170	17 payment under the medical assistance program, and the State
1171	1171	18 shall have no liability for payment of those claims.
1172	1172	19 To the extent consistent with applicable information and
1173	1173	20 privacy, security, and disclosure laws, State and federal
1174	1174	21 agencies and departments shall provide the Illinois Department
1175	1175	22 access to confidential and other information and data
1176	1176	23 necessary to perform eligibility and payment verifications and
1177	1177	24 other Illinois Department functions. This includes, but is not
1178	1178	25 limited to: information pertaining to licensure;
1179	1179	26 certification; earnings; immigration status; citizenship; wage
1180	1180
1181	1181
1182	1182
1183	1183
1184	1184
1185	1185	SB1743 - 32 - LRB104 11917 AAS 22009 b
1186	1186
1187	1187
1188	1188	SB1743- 33 -LRB104 11917 AAS 22009 b SB1743 - 33 - LRB104 11917 AAS 22009 b
1189	1189	SB1743 - 33 - LRB104 11917 AAS 22009 b
1190	1190	1 reporting; unearned and earned income; pension income;
1191	1191	2 employment; supplemental security income; social security
1192	1192	3 numbers; National Provider Identifier (NPI) numbers; the
1193	1193	4 National Practitioner Data Bank (NPDB); program and agency
1194	1194	5 exclusions; taxpayer identification numbers; tax delinquency;
1195	1195	6 corporate information; and death records.
1196	1196	7 The Illinois Department shall enter into agreements with
1197	1197	8 State agencies and departments, and is authorized to enter
1198	1198	9 into agreements with federal agencies and departments, under
1199	1199	10 which such agencies and departments shall share data necessary
1200	1200	11 for medical assistance program integrity functions and
1201	1201	12 oversight. The Illinois Department shall develop, in
1202	1202	13 cooperation with other State departments and agencies, and in
1203	1203	14 compliance with applicable federal laws and regulations,
1204	1204	15 appropriate and effective methods to share such data. At a
1205	1205	16 minimum, and to the extent necessary to provide data sharing,
1206	1206	17 the Illinois Department shall enter into agreements with State
1207	1207	18 agencies and departments, and is authorized to enter into
1208	1208	19 agreements with federal agencies and departments, including,
1209	1209	20 but not limited to: the Secretary of State; the Department of
1210	1210	21 Revenue; the Department of Public Health; the Department of
1211	1211	22 Human Services; and the Department of Financial and
1212	1212	23 Professional Regulation.
1213	1213	24 Beginning in fiscal year 2013, the Illinois Department
1214	1214	25 shall set forth a request for information to identify the
1215	1215	26 benefits of a pre-payment, post-adjudication, and post-edit
1216	1216
1217	1217
1218	1218
1219	1219
1220	1220
1221	1221	SB1743 - 33 - LRB104 11917 AAS 22009 b
1222	1222
1223	1223
1224	1224	SB1743- 34 -LRB104 11917 AAS 22009 b SB1743 - 34 - LRB104 11917 AAS 22009 b
1225	1225	SB1743 - 34 - LRB104 11917 AAS 22009 b
1226	1226	1 claims system with the goals of streamlining claims processing
1227	1227	2 and provider reimbursement, reducing the number of pending or
1228	1228	3 rejected claims, and helping to ensure a more transparent
1229	1229	4 adjudication process through the utilization of: (i) provider
1230	1230	5 data verification and provider screening technology; and (ii)
1231	1231	6 clinical code editing; and (iii) pre-pay, pre-adjudicated, or
1232	1232	7 post-adjudicated predictive modeling with an integrated case
1233	1233	8 management system with link analysis. Such a request for
1234	1234	9 information shall not be considered as a request for proposal
1235	1235	10 or as an obligation on the part of the Illinois Department to
1236	1236	11 take any action or acquire any products or services.
1237	1237	12 The Illinois Department shall establish policies,
1238	1238	13 procedures, standards and criteria by rule for the
1239	1239	14 acquisition, repair and replacement of orthotic and prosthetic
1240	1240	15 devices and durable medical equipment. Such rules shall
1241	1241	16 provide, but not be limited to, the following services: (1)
1242	1242	17 immediate repair or replacement of such devices by recipients;
1243	1243	18 and (2) rental, lease, purchase or lease-purchase of durable
1244	1244	19 medical equipment in a cost-effective manner, taking into
1245	1245	20 consideration the recipient's medical prognosis, the extent of
1246	1246	21 the recipient's needs, and the requirements and costs for
1247	1247	22 maintaining such equipment. Subject to prior approval, such
1248	1248	23 rules shall enable a recipient to temporarily acquire and use
1249	1249	24 alternative or substitute devices or equipment pending repairs
1250	1250	25 or replacements of any device or equipment previously
1251	1251	26 authorized for such recipient by the Department.
1252	1252
1253	1253
1254	1254
1255	1255
1256	1256
1257	1257	SB1743 - 34 - LRB104 11917 AAS 22009 b
1258	1258
1259	1259
1260	1260	SB1743- 35 -LRB104 11917 AAS 22009 b SB1743 - 35 - LRB104 11917 AAS 22009 b
1261	1261	SB1743 - 35 - LRB104 11917 AAS 22009 b
1262	1262	1 Notwithstanding any provision of Section 5-5f to the contrary,
1263	1263	2 the Department may, by rule, exempt certain replacement
1264	1264	3 wheelchair parts from prior approval and, for wheelchairs,
1265	1265	4 wheelchair parts, wheelchair accessories, and related seating
1266	1266	5 and positioning items, determine the wholesale price by
1267	1267	6 methods other than actual acquisition costs.
1268	1268	7 The Department shall require, by rule, all providers of
1269	1269	8 durable medical equipment to be accredited by an accreditation
1270	1270	9 organization approved by the federal Centers for Medicare and
1271	1271	10 Medicaid Services and recognized by the Department in order to
1272	1272	11 bill the Department for providing durable medical equipment to
1273	1273	12 recipients. No later than 15 months after the effective date
1274	1274	13 of the rule adopted pursuant to this paragraph, all providers
1275	1275	14 must meet the accreditation requirement.
1276	1276	15 In order to promote environmental responsibility, meet the
1277	1277	16 needs of recipients and enrollees, and achieve significant
1278	1278	17 cost savings, the Department, or a managed care organization
1279	1279	18 under contract with the Department, may provide recipients or
1280	1280	19 managed care enrollees who have a prescription or Certificate
1281	1281	20 of Medical Necessity access to refurbished durable medical
1282	1282	21 equipment under this Section (excluding prosthetic and
1283	1283	22 orthotic devices as defined in the Orthotics, Prosthetics, and
1284	1284	23 Pedorthics Practice Act and complex rehabilitation technology
1285	1285	24 products and associated services) through the State's
1286	1286	25 assistive technology program's reutilization program, using
1287	1287	26 staff with the Assistive Technology Professional (ATP)
1288	1288
1289	1289
1290	1290
1291	1291
1292	1292
1293	1293	SB1743 - 35 - LRB104 11917 AAS 22009 b
1294	1294
1295	1295
1296	1296	SB1743- 36 -LRB104 11917 AAS 22009 b SB1743 - 36 - LRB104 11917 AAS 22009 b
1297	1297	SB1743 - 36 - LRB104 11917 AAS 22009 b
1298	1298	1 Certification if the refurbished durable medical equipment:
1299	1299	2 (i) is available; (ii) is less expensive, including shipping
1300	1300	3 costs, than new durable medical equipment of the same type;
1301	1301	4 (iii) is able to withstand at least 3 years of use; (iv) is
1302	1302	5 cleaned, disinfected, sterilized, and safe in accordance with
1303	1303	6 federal Food and Drug Administration regulations and guidance
1304	1304	7 governing the reprocessing of medical devices in health care
1305	1305	8 settings; and (v) equally meets the needs of the recipient or
1306	1306	9 enrollee. The reutilization program shall confirm that the
1307	1307	10 recipient or enrollee is not already in receipt of the same or
1308	1308	11 similar equipment from another service provider, and that the
1309	1309	12 refurbished durable medical equipment equally meets the needs
1310	1310	13 of the recipient or enrollee. Nothing in this paragraph shall
1311	1311	14 be construed to limit recipient or enrollee choice to obtain
1312	1312	15 new durable medical equipment or place any additional prior
1313	1313	16 authorization conditions on enrollees of managed care
1314	1314	17 organizations.
1315	1315	18 The Department shall execute, relative to the nursing home
1316	1316	19 prescreening project, written inter-agency agreements with the
1317	1317	20 Department of Human Services and the Department on Aging, to
1318	1318	21 effect the following: (i) intake procedures and common
1319	1319	22 eligibility criteria for those persons who are receiving
1320	1320	23 non-institutional services; and (ii) the establishment and
1321	1321	24 development of non-institutional services in areas of the
1322	1322	25 State where they are not currently available or are
1323	1323	26 undeveloped; and (iii) notwithstanding any other provision of
1324	1324
1325	1325
1326	1326
1327	1327
1328	1328
1329	1329	SB1743 - 36 - LRB104 11917 AAS 22009 b
1330	1330
1331	1331
1332	1332	SB1743- 37 -LRB104 11917 AAS 22009 b SB1743 - 37 - LRB104 11917 AAS 22009 b
1333	1333	SB1743 - 37 - LRB104 11917 AAS 22009 b
1334	1334	1 law, subject to federal approval, on and after July 1, 2012, an
1335	1335	2 increase in the determination of need (DON) scores from 29 to
1336	1336	3 37 for applicants for institutional and home and
1337	1337	4 community-based long term care; if and only if federal
1338	1338	5 approval is not granted, the Department may, in conjunction
1339	1339	6 with other affected agencies, implement utilization controls
1340	1340	7 or changes in benefit packages to effectuate a similar savings
1341	1341	8 amount for this population; and (iv) no later than July 1,
1342	1342	9 2013, minimum level of care eligibility criteria for
1343	1343	10 institutional and home and community-based long term care; and
1344	1344	11 (v) no later than October 1, 2013, establish procedures to
1345	1345	12 permit long term care providers access to eligibility scores
1346	1346	13 for individuals with an admission date who are seeking or
1347	1347	14 receiving services from the long term care provider. In order
1348	1348	15 to select the minimum level of care eligibility criteria, the
1349	1349	16 Governor shall establish a workgroup that includes affected
1350	1350	17 agency representatives and stakeholders representing the
1351	1351	18 institutional and home and community-based long term care
1352	1352	19 interests. This Section shall not restrict the Department from
1353	1353	20 implementing lower level of care eligibility criteria for
1354	1354	21 community-based services in circumstances where federal
1355	1355	22 approval has been granted.
1356	1356	23 The Illinois Department shall develop and operate, in
1357	1357	24 cooperation with other State Departments and agencies and in
1358	1358	25 compliance with applicable federal laws and regulations,
1359	1359	26 appropriate and effective systems of health care evaluation
1360	1360
1361	1361
1362	1362
1363	1363
1364	1364
1365	1365	SB1743 - 37 - LRB104 11917 AAS 22009 b
1366	1366
1367	1367
1368	1368	SB1743- 38 -LRB104 11917 AAS 22009 b SB1743 - 38 - LRB104 11917 AAS 22009 b
1369	1369	SB1743 - 38 - LRB104 11917 AAS 22009 b
1370	1370	1 and programs for monitoring of utilization of health care
1371	1371	2 services and facilities, as it affects persons eligible for
1372	1372	3 medical assistance under this Code.
1373	1373	4 The Illinois Department shall report annually to the
1374	1374	5 General Assembly, no later than the second Friday in April of
1375	1375	6 1979 and each year thereafter, in regard to:
1376	1376	7 (a) actual statistics and trends in utilization of
1377	1377	8 medical services by public aid recipients;
1378	1378	9 (b) actual statistics and trends in the provision of
1379	1379	10 the various medical services by medical vendors;
1380	1380	11 (c) current rate structures and proposed changes in
1381	1381	12 those rate structures for the various medical vendors; and
1382	1382	13 (d) efforts at utilization review and control by the
1383	1383	14 Illinois Department.
1384	1384	15 The period covered by each report shall be the 3 years
1385	1385	16 ending on the June 30 prior to the report. The report shall
1386	1386	17 include suggested legislation for consideration by the General
1387	1387	18 Assembly. The requirement for reporting to the General
1388	1388	19 Assembly shall be satisfied by filing copies of the report as
1389	1389	20 required by Section 3.1 of the General Assembly Organization
1390	1390	21 Act, and filing such additional copies with the State
1391	1391	22 Government Report Distribution Center for the General Assembly
1392	1392	23 as is required under paragraph (t) of Section 7 of the State
1393	1393	24 Library Act.
1394	1394	25 Rulemaking authority to implement Public Act 95-1045, if
1395	1395	26 any, is conditioned on the rules being adopted in accordance
1396	1396
1397	1397
1398	1398
1399	1399
1400	1400
1401	1401	SB1743 - 38 - LRB104 11917 AAS 22009 b
1402	1402
1403	1403
1404	1404	SB1743- 39 -LRB104 11917 AAS 22009 b SB1743 - 39 - LRB104 11917 AAS 22009 b
1405	1405	SB1743 - 39 - LRB104 11917 AAS 22009 b
1406	1406	1 with all provisions of the Illinois Administrative Procedure
1407	1407	2 Act and all rules and procedures of the Joint Committee on
1408	1408	3 Administrative Rules; any purported rule not so adopted, for
1409	1409	4 whatever reason, is unauthorized.
1410	1410	5 On and after July 1, 2012, the Department shall reduce any
1411	1411	6 rate of reimbursement for services or other payments or alter
1412	1412	7 any methodologies authorized by this Code to reduce any rate
1413	1413	8 of reimbursement for services or other payments in accordance
1414	1414	9 with Section 5-5e.
1415	1415	10 Because kidney transplantation can be an appropriate,
1416	1416	11 cost-effective alternative to renal dialysis when medically
1417	1417	12 necessary and notwithstanding the provisions of Section 1-11
1418	1418	13 of this Code, beginning October 1, 2014, the Department shall
1419	1419	14 cover kidney transplantation for noncitizens with end-stage
1420	1420	15 renal disease who are not eligible for comprehensive medical
1421	1421	16 benefits, who meet the residency requirements of Section 5-3
1422	1422	17 of this Code, and who would otherwise meet the financial
1423	1423	18 requirements of the appropriate class of eligible persons
1424	1424	19 under Section 5-2 of this Code. To qualify for coverage of
1425	1425	20 kidney transplantation, such person must be receiving
1426	1426	21 emergency renal dialysis services covered by the Department.
1427	1427	22 Providers under this Section shall be prior approved and
1428	1428	23 certified by the Department to perform kidney transplantation
1429	1429	24 and the services under this Section shall be limited to
1430	1430	25 services associated with kidney transplantation.
1431	1431	26 Notwithstanding any other provision of this Code to the
1432	1432
1433	1433
1434	1434
1435	1435
1436	1436
1437	1437	SB1743 - 39 - LRB104 11917 AAS 22009 b
1438	1438
1439	1439
1440	1440	SB1743- 40 -LRB104 11917 AAS 22009 b SB1743 - 40 - LRB104 11917 AAS 22009 b
1441	1441	SB1743 - 40 - LRB104 11917 AAS 22009 b
1442	1442	1 contrary, on or after July 1, 2015, all FDA-approved FDA
1443	1443	2 approved forms of medication assisted treatment prescribed for
1444	1444	3 the treatment of alcohol dependence or treatment of opioid
1445	1445	4 dependence shall be covered under both fee-for-service and
1446	1446	5 managed care medical assistance programs for persons who are
1447	1447	6 otherwise eligible for medical assistance under this Article
1448	1448	7 and shall not be subject to any (1) utilization control, other
1449	1449	8 than those established under the American Society of Addiction
1450	1450	9 Medicine patient placement criteria, (2) prior authorization
1451	1451	10 mandate, (3) lifetime restriction limit mandate, or (4)
1452	1452	11 limitations on dosage.
1453	1453	12 On or after July 1, 2015, opioid antagonists prescribed
1454	1454	13 for the treatment of an opioid overdose, including the
1455	1455	14 medication product, administration devices, and any pharmacy
1456	1456	15 fees or hospital fees related to the dispensing, distribution,
1457	1457	16 and administration of the opioid antagonist, shall be covered
1458	1458	17 under the medical assistance program for persons who are
1459	1459	18 otherwise eligible for medical assistance under this Article.
1460	1460	19 As used in this Section, "opioid antagonist" means a drug that
1461	1461	20 binds to opioid receptors and blocks or inhibits the effect of
1462	1462	21 opioids acting on those receptors, including, but not limited
1463	1463	22 to, naloxone hydrochloride or any other similarly acting drug
1464	1464	23 approved by the U.S. Food and Drug Administration. The
1465	1465	24 Department shall not impose a copayment on the coverage
1466	1466	25 provided for naloxone hydrochloride under the medical
1467	1467	26 assistance program.
1468	1468
1469	1469
1470	1470
1471	1471
1472	1472
1473	1473	SB1743 - 40 - LRB104 11917 AAS 22009 b
1474	1474
1475	1475
1476	1476	SB1743- 41 -LRB104 11917 AAS 22009 b SB1743 - 41 - LRB104 11917 AAS 22009 b
1477	1477	SB1743 - 41 - LRB104 11917 AAS 22009 b
1478	1478	1 Upon federal approval, the Department shall provide
1479	1479	2 coverage and reimbursement for all drugs that are approved for
1480	1480	3 marketing by the federal Food and Drug Administration and that
1481	1481	4 are recommended by the federal Public Health Service or the
1482	1482	5 United States Centers for Disease Control and Prevention for
1483	1483	6 pre-exposure prophylaxis and related pre-exposure prophylaxis
1484	1484	7 services, including, but not limited to, HIV and sexually
1485	1485	8 transmitted infection screening, treatment for sexually
1486	1486	9 transmitted infections, medical monitoring, assorted labs, and
1487	1487	10 counseling to reduce the likelihood of HIV infection among
1488	1488	11 individuals who are not infected with HIV but who are at high
1489	1489	12 risk of HIV infection.
1490	1490	13 A federally qualified health center, as defined in Section
1491	1491	14 1905(l)(2)(B) of the federal Social Security Act, shall be
1492	1492	15 reimbursed by the Department in accordance with the federally
1493	1493	16 qualified health center's encounter rate for services provided
1494	1494	17 to medical assistance recipients that are performed by a
1495	1495	18 dental hygienist, as defined under the Illinois Dental
1496	1496	19 Practice Act, working under the general supervision of a
1497	1497	20 dentist and employed by a federally qualified health center.
1498	1498	21 Within 90 days after October 8, 2021 (the effective date
1499	1499	22 of Public Act 102-665), the Department shall seek federal
1500	1500	23 approval of a State Plan amendment to expand coverage for
1501	1501	24 family planning services that includes presumptive eligibility
1502	1502	25 to individuals whose income is at or below 208% of the federal
1503	1503	26 poverty level. Coverage under this Section shall be effective
1504	1504
1505	1505
1506	1506
1507	1507
1508	1508
1509	1509	SB1743 - 41 - LRB104 11917 AAS 22009 b
1510	1510
1511	1511
1512	1512	SB1743- 42 -LRB104 11917 AAS 22009 b SB1743 - 42 - LRB104 11917 AAS 22009 b
1513	1513	SB1743 - 42 - LRB104 11917 AAS 22009 b
1514	1514	1 beginning no later than December 1, 2022.
1515	1515	2 Subject to approval by the federal Centers for Medicare
1516	1516	3 and Medicaid Services of a Title XIX State Plan amendment
1517	1517	4 electing the Program of All-Inclusive Care for the Elderly
1518	1518	5 (PACE) as a State Medicaid option, as provided for by Subtitle
1519	1519	6 I (commencing with Section 4801) of Title IV of the Balanced
1520	1520	7 Budget Act of 1997 (Public Law 105-33) and Part 460
1521	1521	8 (commencing with Section 460.2) of Subchapter E of Title 42 of
1522	1522	9 the Code of Federal Regulations, PACE program services shall
1523	1523	10 become a covered benefit of the medical assistance program,
1524	1524	11 subject to criteria established in accordance with all
1525	1525	12 applicable laws.
1526	1526	13 Notwithstanding any other provision of this Code,
1527	1527	14 community-based pediatric palliative care from a trained
1528	1528	15 interdisciplinary team shall be covered under the medical
1529	1529	16 assistance program as provided in Section 15 of the Pediatric
1530	1530	17 Palliative Care Act.
1531	1531	18 Notwithstanding any other provision of this Code, within
1532	1532	19 12 months after June 2, 2022 (the effective date of Public Act
1533	1533	20 102-1037) and subject to federal approval, acupuncture
1534	1534	21 services performed by an acupuncturist licensed under the
1535	1535	22 Acupuncture Practice Act who is acting within the scope of his
1536	1536	23 or her license shall be covered under the medical assistance
1537	1537	24 program. The Department shall apply for any federal waiver or
1538	1538	25 State Plan amendment, if required, to implement this
1539	1539	26 paragraph. The Department may adopt any rules, including
1540	1540
1541	1541
1542	1542
1543	1543
1544	1544
1545	1545	SB1743 - 42 - LRB104 11917 AAS 22009 b
1546	1546
1547	1547
1548	1548	SB1743- 43 -LRB104 11917 AAS 22009 b SB1743 - 43 - LRB104 11917 AAS 22009 b
1549	1549	SB1743 - 43 - LRB104 11917 AAS 22009 b
1550	1550	1 standards and criteria, necessary to implement this paragraph.
1551	1551	2 Notwithstanding any other provision of this Code, the
1552	1552	3 medical assistance program shall, subject to federal approval,
1553	1553	4 reimburse hospitals for costs associated with a newborn
1554	1554	5 screening test for the presence of metachromatic
1555	1555	6 leukodystrophy, as required under the Newborn Metabolic
1556	1556	7 Screening Act, at a rate not less than the fee charged by the
1557	1557	8 Department of Public Health. Notwithstanding any other
1558	1558	9 provision of this Code, the medical assistance program shall,
1559	1559	10 subject to appropriation and federal approval, also reimburse
1560	1560	11 hospitals for costs associated with all newborn screening
1561	1561	12 tests added on and after August 9, 2024 (the effective date of
1562	1562	13 Public Act 103-909) this amendatory Act of the 103rd General
1563	1563	14 Assembly to the Newborn Metabolic Screening Act and required
1564	1564	15 to be performed under that Act at a rate not less than the fee
1565	1565	16 charged by the Department of Public Health. The Department
1566	1566	17 shall seek federal approval before the implementation of the
1567	1567	18 newborn screening test fees by the Department of Public
1568	1568	19 Health.
1569	1569	20 Notwithstanding any other provision of this Code,
1570	1570	21 beginning on January 1, 2024, subject to federal approval,
1571	1571	22 cognitive assessment and care planning services provided to a
1572	1572	23 person who experiences signs or symptoms of cognitive
1573	1573	24 impairment, as defined by the Diagnostic and Statistical
1574	1574	25 Manual of Mental Disorders, Fifth Edition, shall be covered
1575	1575	26 under the medical assistance program for persons who are
1576	1576
1577	1577
1578	1578
1579	1579
1580	1580
1581	1581	SB1743 - 43 - LRB104 11917 AAS 22009 b
1582	1582
1583	1583
1584	1584	SB1743- 44 -LRB104 11917 AAS 22009 b SB1743 - 44 - LRB104 11917 AAS 22009 b
1585	1585	SB1743 - 44 - LRB104 11917 AAS 22009 b
1586	1586	1 otherwise eligible for medical assistance under this Article.
1587	1587	2 Notwithstanding any other provision of this Code,
1588	1588	3 medically necessary reconstructive services that are intended
1589	1589	4 to restore physical appearance shall be covered under the
1590	1590	5 medical assistance program for persons who are otherwise
1591	1591	6 eligible for medical assistance under this Article. As used in
1592	1592	7 this paragraph, "reconstructive services" means treatments
1593	1593	8 performed on structures of the body damaged by trauma to
1594	1594	9 restore physical appearance.
1595	1595	10 Notwithstanding any other provision of this Code, the
1596	1596	11 Department shall provide coverage and reimbursement for
1597	1597	12 prescription management services provided by prescribing
1598	1598	13 psychologists for persons who are otherwise eligible for
1599	1599	14 medical assistance under this Article.
1600	1600	15 (Source: P.A. 102-43, Article 30, Section 30-5, eff. 7-6-21;
1601	1601	16 102-43, Article 35, Section 35-5, eff. 7-6-21; 102-43, Article
1602	1602	17 55, Section 55-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123,
1603	1603	18 eff. 1-1-22; 102-558, eff. 8-20-21; 102-598, eff. 1-1-22;
1604	1604	19 102-655, eff. 1-1-22; 102-665, eff. 10-8-21; 102-813, eff.
1605	1605	20 5-13-22; 102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22;
1606	1606	21 102-1038, eff. 1-1-23; 103-102, Article 15, Section 15-5, eff.
1607	1607	22 1-1-24; 103-102, Article 95, Section 95-15, eff. 1-1-24;
1608	1608	23 103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-368, eff.
1609	1609	24 1-1-24; 103-593, Article 5, Section 5-5, eff. 6-7-24; 103-593,
1610	1610	25 Article 90, Section 90-5, eff. 6-7-24; 103-605, eff. 7-1-24;
1611	1611	26 103-909, eff. 8-9-24; 103-1040, eff. 8-9-24; revised
1612	1612
1613	1613
1614	1614
1615	1615
1616	1616
1617	1617	SB1743 - 44 - LRB104 11917 AAS 22009 b
1618	1618
1619	1619
1620	1620	SB1743- 45 -LRB104 11917 AAS 22009 b SB1743 - 45 - LRB104 11917 AAS 22009 b
1621	1621	SB1743 - 45 - LRB104 11917 AAS 22009 b
1622	1622	1 10-10-24.)
1623	1623	2 (Text of Section after amendment by P.A. 103-808)
1624	1624	3 Sec. 5-5. Medical services. The Illinois Department, by
1625	1625	4 rule, shall determine the quantity and quality of and the rate
1626	1626	5 of reimbursement for the medical assistance for which payment
1627	1627	6 will be authorized, and the medical services to be provided,
1628	1628	7 which may include all or part of the following: (1) inpatient
1629	1629	8 hospital services; (2) outpatient hospital services; (3) other
1630	1630	9 laboratory and X-ray services; (4) skilled nursing home
1631	1631	10 services; (5) physicians' services whether furnished in the
1632	1632	11 office, the patient's home, a hospital, a skilled nursing
1633	1633	12 home, or elsewhere; (6) medical care, or any other type of
1634	1634	13 remedial care furnished by licensed practitioners; (7) home
1635	1635	14 health care services; (8) private duty nursing service; (9)
1636	1636	15 clinic services; (10) dental services, including prevention
1637	1637	16 and treatment of periodontal disease and dental caries disease
1638	1638	17 for pregnant individuals, provided by an individual licensed
1639	1639	18 to practice dentistry or dental surgery; for purposes of this
1640	1640	19 item (10), "dental services" means diagnostic, preventive, or
1641	1641	20 corrective procedures provided by or under the supervision of
1642	1642	21 a dentist in the practice of his or her profession; (11)
1643	1643	22 physical therapy and related services; (12) prescribed drugs,
1644	1644	23 dentures, and prosthetic devices; and eyeglasses prescribed by
1645	1645	24 a physician skilled in the diseases of the eye, or by an
1646	1646	25 optometrist, whichever the person may select; (13) other
1647	1647
1648	1648
1649	1649
1650	1650
1651	1651
1652	1652	SB1743 - 45 - LRB104 11917 AAS 22009 b
1653	1653
1654	1654
1655	1655	SB1743- 46 -LRB104 11917 AAS 22009 b SB1743 - 46 - LRB104 11917 AAS 22009 b
1656	1656	SB1743 - 46 - LRB104 11917 AAS 22009 b
1657	1657	1 diagnostic, screening, preventive, and rehabilitative
1658	1658	2 services, including to ensure that the individual's need for
1659	1659	3 intervention or treatment of mental disorders or substance use
1660	1660	4 disorders or co-occurring mental health and substance use
1661	1661	5 disorders is determined using a uniform screening, assessment,
1662	1662	6 and evaluation process inclusive of criteria, for children and
1663	1663	7 adults; for purposes of this item (13), a uniform screening,
1664	1664	8 assessment, and evaluation process refers to a process that
1665	1665	9 includes an appropriate evaluation and, as warranted, a
1666	1666	10 referral; "uniform" does not mean the use of a singular
1667	1667	11 instrument, tool, or process that all must utilize; (14)
1668	1668	12 transportation and such other expenses as may be necessary;
1669	1669	13 (15) medical treatment of sexual assault survivors, as defined
1670	1670	14 in Section 1a of the Sexual Assault Survivors Emergency
1671	1671	15 Treatment Act, for injuries sustained as a result of the
1672	1672	16 sexual assault, including examinations and laboratory tests to
1673	1673	17 discover evidence which may be used in criminal proceedings
1674	1674	18 arising from the sexual assault; (16) the diagnosis and
1675	1675	19 treatment of sickle cell anemia; (16.5) services performed by
1676	1676	20 a chiropractic physician licensed under the Medical Practice
1677	1677	21 Act of 1987 and acting within the scope of his or her license,
1678	1678	22 including, but not limited to, chiropractic manipulative
1679	1679	23 treatment; and (17) any other medical care, and any other type
1680	1680	24 of remedial care recognized under the laws of this State. The
1681	1681	25 term "any other type of remedial care" shall include nursing
1682	1682	26 care and nursing home service for persons who rely on
1683	1683
1684	1684
1685	1685
1686	1686
1687	1687
1688	1688	SB1743 - 46 - LRB104 11917 AAS 22009 b
1689	1689
1690	1690
1691	1691	SB1743- 47 -LRB104 11917 AAS 22009 b SB1743 - 47 - LRB104 11917 AAS 22009 b
1692	1692	SB1743 - 47 - LRB104 11917 AAS 22009 b
1693	1693	1 treatment by spiritual means alone through prayer for healing.
1694	1694	2 Notwithstanding any other provision of this Section, a
1695	1695	3 comprehensive tobacco use cessation program that includes
1696	1696	4 purchasing prescription drugs or prescription medical devices
1697	1697	5 approved by the Food and Drug Administration shall be covered
1698	1698	6 under the medical assistance program under this Article for
1699	1699	7 persons who are otherwise eligible for assistance under this
1700	1700	8 Article.
1701	1701	9 Notwithstanding any other provision of this Code,
1702	1702	10 reproductive health care that is otherwise legal in Illinois
1703	1703	11 shall be covered under the medical assistance program for
1704	1704	12 persons who are otherwise eligible for medical assistance
1705	1705	13 under this Article.
1706	1706	14 Notwithstanding any other provision of this Section, all
1707	1707	15 tobacco cessation medications approved by the United States
1708	1708	16 Food and Drug Administration and all individual and group
1709	1709	17 tobacco cessation counseling services and telephone-based
1710	1710	18 counseling services and tobacco cessation medications provided
1711	1711	19 through the Illinois Tobacco Quitline shall be covered under
1712	1712	20 the medical assistance program for persons who are otherwise
1713	1713	21 eligible for assistance under this Article. The Department
1714	1714	22 shall comply with all federal requirements necessary to obtain
1715	1715	23 federal financial participation, as specified in 42 CFR
1716	1716	24 433.15(b)(7), for telephone-based counseling services provided
1717	1717	25 through the Illinois Tobacco Quitline, including, but not
1718	1718	26 limited to: (i) entering into a memorandum of understanding or
1719	1719
1720	1720
1721	1721
1722	1722
1723	1723
1724	1724	SB1743 - 47 - LRB104 11917 AAS 22009 b
1725	1725
1726	1726
1727	1727	SB1743- 48 -LRB104 11917 AAS 22009 b SB1743 - 48 - LRB104 11917 AAS 22009 b
1728	1728	SB1743 - 48 - LRB104 11917 AAS 22009 b
1729	1729	1 interagency agreement with the Department of Public Health, as
1730	1730	2 administrator of the Illinois Tobacco Quitline; and (ii)
1731	1731	3 developing a cost allocation plan for Medicaid-allowable
1732	1732	4 Illinois Tobacco Quitline services in accordance with 45 CFR
1733	1733	5 95.507. The Department shall submit the memorandum of
1734	1734	6 understanding or interagency agreement, the cost allocation
1735	1735	7 plan, and all other necessary documentation to the Centers for
1736	1736	8 Medicare and Medicaid Services for review and approval.
1737	1737	9 Coverage under this paragraph shall be contingent upon federal
1738	1738	10 approval.
1739	1739	11 Notwithstanding any other provision of this Code, the
1740	1740	12 Illinois Department may not require, as a condition of payment
1741	1741	13 for any laboratory test authorized under this Article, that a
1742	1742	14 physician's handwritten signature appear on the laboratory
1743	1743	15 test order form. The Illinois Department may, however, impose
1744	1744	16 other appropriate requirements regarding laboratory test order
1745	1745	17 documentation.
1746	1746	18 Upon receipt of federal approval of an amendment to the
1747	1747	19 Illinois Title XIX State Plan for this purpose, the Department
1748	1748	20 shall authorize the Chicago Public Schools (CPS) to procure a
1749	1749	21 vendor or vendors to manufacture eyeglasses for individuals
1750	1750	22 enrolled in a school within the CPS system. CPS shall ensure
1751	1751	23 that its vendor or vendors are enrolled as providers in the
1752	1752	24 medical assistance program and in any capitated Medicaid
1753	1753	25 managed care entity (MCE) serving individuals enrolled in a
1754	1754	26 school within the CPS system. Under any contract procured
1755	1755
1756	1756
1757	1757
1758	1758
1759	1759
1760	1760	SB1743 - 48 - LRB104 11917 AAS 22009 b
1761	1761
1762	1762
1763	1763	SB1743- 49 -LRB104 11917 AAS 22009 b SB1743 - 49 - LRB104 11917 AAS 22009 b
1764	1764	SB1743 - 49 - LRB104 11917 AAS 22009 b
1765	1765	1 under this provision, the vendor or vendors must serve only
1766	1766	2 individuals enrolled in a school within the CPS system. Claims
1767	1767	3 for services provided by CPS's vendor or vendors to recipients
1768	1768	4 of benefits in the medical assistance program under this Code,
1769	1769	5 the Children's Health Insurance Program, or the Covering ALL
1770	1770	6 KIDS Health Insurance Program shall be submitted to the
1771	1771	7 Department or the MCE in which the individual is enrolled for
1772	1772	8 payment and shall be reimbursed at the Department's or the
1773	1773	9 MCE's established rates or rate methodologies for eyeglasses.
1774	1774	10 On and after July 1, 2012, the Department of Healthcare
1775	1775	11 and Family Services may provide the following services to
1776	1776	12 persons eligible for assistance under this Article who are
1777	1777	13 participating in education, training or employment programs
1778	1778	14 operated by the Department of Human Services as successor to
1779	1779	15 the Department of Public Aid:
1780	1780	16 (1) dental services provided by or under the
1781	1781	17 supervision of a dentist; and
1782	1782	18 (2) eyeglasses prescribed by a physician skilled in
1783	1783	19 the diseases of the eye, or by an optometrist, whichever
1784	1784	20 the person may select.
1785	1785	21 On and after July 1, 2018, the Department of Healthcare
1786	1786	22 and Family Services shall provide dental services to any adult
1787	1787	23 who is otherwise eligible for assistance under the medical
1788	1788	24 assistance program. As used in this paragraph, "dental
1789	1789	25 services" means diagnostic, preventative, restorative, or
1790	1790	26 corrective procedures, including procedures and services for
1791	1791
1792	1792
1793	1793
1794	1794
1795	1795
1796	1796	SB1743 - 49 - LRB104 11917 AAS 22009 b
1797	1797
1798	1798
1799	1799	SB1743- 50 -LRB104 11917 AAS 22009 b SB1743 - 50 - LRB104 11917 AAS 22009 b
1800	1800	SB1743 - 50 - LRB104 11917 AAS 22009 b
1801	1801	1 the prevention and treatment of periodontal disease and dental
1802	1802	2 caries disease, provided by an individual who is licensed to
1803	1803	3 practice dentistry or dental surgery or who is under the
1804	1804	4 supervision of a dentist in the practice of his or her
1805	1805	5 profession.
1806	1806	6 On and after July 1, 2018, targeted dental services, as
1807	1807	7 set forth in Exhibit D of the Consent Decree entered by the
1808	1808	8 United States District Court for the Northern District of
1809	1809	9 Illinois, Eastern Division, in the matter of Memisovski v.
1810	1810	10 Maram, Case No. 92 C 1982, that are provided to adults under
1811	1811	11 the medical assistance program shall be established at no less
1812	1812	12 than the rates set forth in the "New Rate" column in Exhibit D
1813	1813	13 of the Consent Decree for targeted dental services that are
1814	1814	14 provided to persons under the age of 18 under the medical
1815	1815	15 assistance program.
1816	1816	16 Subject to federal approval, on and after January 1, 2025,
1817	1817	17 the rates paid for sedation evaluation and the provision of
1818	1818	18 deep sedation and intravenous sedation for the purpose of
1819	1819	19 dental services shall be increased by 33% above the rates in
1820	1820	20 effect on December 31, 2024. The rates paid for nitrous oxide
1821	1821	21 sedation shall not be impacted by this paragraph and shall
1822	1822	22 remain the same as the rates in effect on December 31, 2024.
1823	1823	23 Notwithstanding any other provision of this Code and
1824	1824	24 subject to federal approval, the Department may adopt rules to
1825	1825	25 allow a dentist who is volunteering his or her service at no
1826	1826	26 cost to render dental services through an enrolled
1827	1827
1828	1828
1829	1829
1830	1830
1831	1831
1832	1832	SB1743 - 50 - LRB104 11917 AAS 22009 b
1833	1833
1834	1834
1835	1835	SB1743- 51 -LRB104 11917 AAS 22009 b SB1743 - 51 - LRB104 11917 AAS 22009 b
1836	1836	SB1743 - 51 - LRB104 11917 AAS 22009 b
1837	1837	1 not-for-profit health clinic without the dentist personally
1838	1838	2 enrolling as a participating provider in the medical
1839	1839	3 assistance program. A not-for-profit health clinic shall
1840	1840	4 include a public health clinic or Federally Qualified Health
1841	1841	5 Center or other enrolled provider, as determined by the
1842	1842	6 Department, through which dental services covered under this
1843	1843	7 Section are performed. The Department shall establish a
1844	1844	8 process for payment of claims for reimbursement for covered
1845	1845	9 dental services rendered under this provision.
1846	1846	10 Subject to appropriation and to federal approval, the
1847	1847	11 Department shall file administrative rules updating the
1848	1848	12 Handicapping Labio-Lingual Deviation orthodontic scoring tool
1849	1849	13 by January 1, 2025, or as soon as practicable.
1850	1850	14 On and after January 1, 2022, the Department of Healthcare
1851	1851	15 and Family Services shall administer and regulate a
1852	1852	16 school-based dental program that allows for the out-of-office
1853	1853	17 delivery of preventative dental services in a school setting
1854	1854	18 to children under 19 years of age. The Department shall
1855	1855	19 establish, by rule, guidelines for participation by providers
1856	1856	20 and set requirements for follow-up referral care based on the
1857	1857	21 requirements established in the Dental Office Reference Manual
1858	1858	22 published by the Department that establishes the requirements
1859	1859	23 for dentists participating in the All Kids Dental School
1860	1860	24 Program. Every effort shall be made by the Department when
1861	1861	25 developing the program requirements to consider the different
1862	1862	26 geographic differences of both urban and rural areas of the
1863	1863
1864	1864
1865	1865
1866	1866
1867	1867
1868	1868	SB1743 - 51 - LRB104 11917 AAS 22009 b
1869	1869
1870	1870
1871	1871	SB1743- 52 -LRB104 11917 AAS 22009 b SB1743 - 52 - LRB104 11917 AAS 22009 b
1872	1872	SB1743 - 52 - LRB104 11917 AAS 22009 b
1873	1873	1 State for initial treatment and necessary follow-up care. No
1874	1874	2 provider shall be charged a fee by any unit of local government
1875	1875	3 to participate in the school-based dental program administered
1876	1876	4 by the Department. Nothing in this paragraph shall be
1877	1877	5 construed to limit or preempt a home rule unit's or school
1878	1878	6 district's authority to establish, change, or administer a
1879	1879	7 school-based dental program in addition to, or independent of,
1880	1880	8 the school-based dental program administered by the
1881	1881	9 Department.
1882	1882	10 The Illinois Department, by rule, may distinguish and
1883	1883	11 classify the medical services to be provided only in
1884	1884	12 accordance with the classes of persons designated in Section
1885	1885	13 5-2.
1886	1886	14 The Department of Healthcare and Family Services must
1887	1887	15 provide coverage and reimbursement for amino acid-based
1888	1888	16 elemental formulas, regardless of delivery method, for the
1889	1889	17 diagnosis and treatment of (i) eosinophilic disorders and (ii)
1890	1890	18 short bowel syndrome when the prescribing physician has issued
1891	1891	19 a written order stating that the amino acid-based elemental
1892	1892	20 formula is medically necessary.
1893	1893	21 The Illinois Department shall authorize the provision of,
1894	1894	22 and shall authorize payment for, screening by low-dose
1895	1895	23 mammography for the presence of occult breast cancer for
1896	1896	24 individuals 35 years of age or older who are eligible for
1897	1897	25 medical assistance under this Article, as follows:
1898	1898	26 (A) A baseline mammogram for individuals 35 to 39
1899	1899
1900	1900
1901	1901
1902	1902
1903	1903
1904	1904	SB1743 - 52 - LRB104 11917 AAS 22009 b
1905	1905
1906	1906
1907	1907	SB1743- 53 -LRB104 11917 AAS 22009 b SB1743 - 53 - LRB104 11917 AAS 22009 b
1908	1908	SB1743 - 53 - LRB104 11917 AAS 22009 b
1909	1909	1 years of age.
1910	1910	2 (B) An annual mammogram for individuals 40 years of
1911	1911	3 age or older.
1912	1912	4 (C) A mammogram at the age and intervals considered
1913	1913	5 medically necessary by the individual's health care
1914	1914	6 provider for individuals under 40 years of age and having
1915	1915	7 a family history of breast cancer, prior personal history
1916	1916	8 of breast cancer, positive genetic testing, or other risk
1917	1917	9 factors.
1918	1918	10 (D) A comprehensive ultrasound screening and MRI of an
1919	1919	11 entire breast or breasts if a mammogram demonstrates
1920	1920	12 heterogeneous or dense breast tissue or when medically
1921	1921	13 necessary as determined by a physician licensed to
1922	1922	14 practice medicine in all of its branches.
1923	1923	15 (E) A screening MRI when medically necessary, as
1924	1924	16 determined by a physician licensed to practice medicine in
1925	1925	17 all of its branches.
1926	1926	18 (F) A diagnostic mammogram when medically necessary,
1927	1927	19 as determined by a physician licensed to practice medicine
1928	1928	20 in all its branches, advanced practice registered nurse,
1929	1929	21 or physician assistant.
1930	1930	22 (G) Molecular breast imaging (MBI) and MRI of an
1931	1931	23 entire breast or breasts if a mammogram demonstrates
1932	1932	24 heterogeneous or dense breast tissue or when medically
1933	1933	25 necessary as determined by a physician licensed to
1934	1934	26 practice medicine in all of its branches, advanced
1935	1935
1936	1936
1937	1937
1938	1938
1939	1939
1940	1940	SB1743 - 53 - LRB104 11917 AAS 22009 b
1941	1941
1942	1942
1943	1943	SB1743- 54 -LRB104 11917 AAS 22009 b SB1743 - 54 - LRB104 11917 AAS 22009 b
1944	1944	SB1743 - 54 - LRB104 11917 AAS 22009 b
1945	1945	1 practice registered nurse, or physician assistant.
1946	1946	2 The Department shall not impose a deductible, coinsurance,
1947	1947	3 copayment, or any other cost-sharing requirement on the
1948	1948	4 coverage provided under this paragraph; except that this
1949	1949	5 sentence does not apply to coverage of diagnostic mammograms
1950	1950	6 to the extent such coverage would disqualify a high-deductible
1951	1951	7 health plan from eligibility for a health savings account
1952	1952	8 pursuant to Section 223 of the Internal Revenue Code (26
1953	1953	9 U.S.C. 223).
1954	1954	10 All screenings shall include a physical breast exam,
1955	1955	11 instruction on self-examination and information regarding the
1956	1956	12 frequency of self-examination and its value as a preventative
1957	1957	13 tool.
1958	1958	14 For purposes of this Section:
1959	1959	15 "Diagnostic mammogram" means a mammogram obtained using
1960	1960	16 diagnostic mammography.
1961	1961	17 "Diagnostic mammography" means a method of screening that
1962	1962	18 is designed to evaluate an abnormality in a breast, including
1963	1963	19 an abnormality seen or suspected on a screening mammogram or a
1964	1964	20 subjective or objective abnormality otherwise detected in the
1965	1965	21 breast.
1966	1966	22 "Low-dose mammography" means the x-ray examination of the
1967	1967	23 breast using equipment dedicated specifically for mammography,
1968	1968	24 including the x-ray tube, filter, compression device, and
1969	1969	25 image receptor, with an average radiation exposure delivery of
1970	1970	26 less than one rad per breast for 2 views of an average size
1971	1971
1972	1972
1973	1973
1974	1974
1975	1975
1976	1976	SB1743 - 54 - LRB104 11917 AAS 22009 b
1977	1977
1978	1978
1979	1979	SB1743- 55 -LRB104 11917 AAS 22009 b SB1743 - 55 - LRB104 11917 AAS 22009 b
1980	1980	SB1743 - 55 - LRB104 11917 AAS 22009 b
1981	1981	1 breast. The term also includes digital mammography and
1982	1982	2 includes breast tomosynthesis.
1983	1983	3 "Breast tomosynthesis" means a radiologic procedure that
1984	1984	4 involves the acquisition of projection images over the
1985	1985	5 stationary breast to produce cross-sectional digital
1986	1986	6 three-dimensional images of the breast.
1987	1987	7 If, at any time, the Secretary of the United States
1988	1988	8 Department of Health and Human Services, or its successor
1989	1989	9 agency, promulgates rules or regulations to be published in
1990	1990	10 the Federal Register or publishes a comment in the Federal
1991	1991	11 Register or issues an opinion, guidance, or other action that
1992	1992	12 would require the State, pursuant to any provision of the
1993	1993	13 Patient Protection and Affordable Care Act (Public Law
1994	1994	14 111-148), including, but not limited to, 42 U.S.C.
1995	1995	15 18031(d)(3)(B) or any successor provision, to defray the cost
1996	1996	16 of any coverage for breast tomosynthesis outlined in this
1997	1997	17 paragraph, then the requirement that an insurer cover breast
1998	1998	18 tomosynthesis is inoperative other than any such coverage
1999	1999	19 authorized under Section 1902 of the Social Security Act, 42
2000	2000	20 U.S.C. 1396a, and the State shall not assume any obligation
2001	2001	21 for the cost of coverage for breast tomosynthesis set forth in
2002	2002	22 this paragraph.
2003	2003	23 On and after January 1, 2016, the Department shall ensure
2004	2004	24 that all networks of care for adult clients of the Department
2005	2005	25 include access to at least one breast imaging Center of
2006	2006	26 Imaging Excellence as certified by the American College of
2007	2007
2008	2008
2009	2009
2010	2010
2011	2011
2012	2012	SB1743 - 55 - LRB104 11917 AAS 22009 b
2013	2013
2014	2014
2015	2015	SB1743- 56 -LRB104 11917 AAS 22009 b SB1743 - 56 - LRB104 11917 AAS 22009 b
2016	2016	SB1743 - 56 - LRB104 11917 AAS 22009 b
2017	2017	1 Radiology.
2018	2018	2 On and after January 1, 2012, providers participating in a
2019	2019	3 quality improvement program approved by the Department shall
2020	2020	4 be reimbursed for screening and diagnostic mammography at the
2021	2021	5 same rate as the Medicare program's rates, including the
2022	2022	6 increased reimbursement for digital mammography and, after
2023	2023	7 January 1, 2023 (the effective date of Public Act 102-1018),
2024	2024	8 breast tomosynthesis.
2025	2025	9 The Department shall convene an expert panel including
2026	2026	10 representatives of hospitals, free-standing mammography
2027	2027	11 facilities, and doctors, including radiologists, to establish
2028	2028	12 quality standards for mammography.
2029	2029	13 On and after January 1, 2017, providers participating in a
2030	2030	14 breast cancer treatment quality improvement program approved
2031	2031	15 by the Department shall be reimbursed for breast cancer
2032	2032	16 treatment at a rate that is no lower than 95% of the Medicare
2033	2033	17 program's rates for the data elements included in the breast
2034	2034	18 cancer treatment quality program.
2035	2035	19 The Department shall convene an expert panel, including
2036	2036	20 representatives of hospitals, free-standing breast cancer
2037	2037	21 treatment centers, breast cancer quality organizations, and
2038	2038	22 doctors, including radiologists that are trained in all forms
2039	2039	23 of FDA-approved FDA approved breast imaging technologies,
2040	2040	24 breast surgeons, reconstructive breast surgeons, oncologists,
2041	2041	25 and primary care providers to establish quality standards for
2042	2042	26 breast cancer treatment.
2043	2043
2044	2044
2045	2045
2046	2046
2047	2047
2048	2048	SB1743 - 56 - LRB104 11917 AAS 22009 b
2049	2049
2050	2050
2051	2051	SB1743- 57 -LRB104 11917 AAS 22009 b SB1743 - 57 - LRB104 11917 AAS 22009 b
2052	2052	SB1743 - 57 - LRB104 11917 AAS 22009 b
2053	2053	1 Subject to federal approval, the Department shall
2054	2054	2 establish a rate methodology for mammography at federally
2055	2055	3 qualified health centers and other encounter-rate clinics.
2056	2056	4 These clinics or centers may also collaborate with other
2057	2057	5 hospital-based mammography facilities. By January 1, 2016, the
2058	2058	6 Department shall report to the General Assembly on the status
2059	2059	7 of the provision set forth in this paragraph.
2060	2060	8 The Department shall establish a methodology to remind
2061	2061	9 individuals who are age-appropriate for screening mammography,
2062	2062	10 but who have not received a mammogram within the previous 18
2063	2063	11 months, of the importance and benefit of screening
2064	2064	12 mammography. The Department shall work with experts in breast
2065	2065	13 cancer outreach and patient navigation to optimize these
2066	2066	14 reminders and shall establish a methodology for evaluating
2067	2067	15 their effectiveness and modifying the methodology based on the
2068	2068	16 evaluation.
2069	2069	17 The Department shall establish a performance goal for
2070	2070	18 primary care providers with respect to their female patients
2071	2071	19 over age 40 receiving an annual mammogram. This performance
2072	2072	20 goal shall be used to provide additional reimbursement in the
2073	2073	21 form of a quality performance bonus to primary care providers
2074	2074	22 who meet that goal.
2075	2075	23 The Department shall devise a means of case-managing or
2076	2076	24 patient navigation for beneficiaries diagnosed with breast
2077	2077	25 cancer. This program shall initially operate as a pilot
2078	2078	26 program in areas of the State with the highest incidence of
2079	2079
2080	2080
2081	2081
2082	2082
2083	2083
2084	2084	SB1743 - 57 - LRB104 11917 AAS 22009 b
2085	2085
2086	2086
2087	2087	SB1743- 58 -LRB104 11917 AAS 22009 b SB1743 - 58 - LRB104 11917 AAS 22009 b
2088	2088	SB1743 - 58 - LRB104 11917 AAS 22009 b
2089	2089	1 mortality related to breast cancer. At least one pilot program
2090	2090	2 site shall be in the metropolitan Chicago area and at least one
2091	2091	3 site shall be outside the metropolitan Chicago area. On or
2092	2092	4 after July 1, 2016, the pilot program shall be expanded to
2093	2093	5 include one site in western Illinois, one site in southern
2094	2094	6 Illinois, one site in central Illinois, and 4 sites within
2095	2095	7 metropolitan Chicago. An evaluation of the pilot program shall
2096	2096	8 be carried out measuring health outcomes and cost of care for
2097	2097	9 those served by the pilot program compared to similarly
2098	2098	10 situated patients who are not served by the pilot program.
2099	2099	11 The Department shall require all networks of care to
2100	2100	12 develop a means either internally or by contract with experts
2101	2101	13 in navigation and community outreach to navigate cancer
2102	2102	14 patients to comprehensive care in a timely fashion. The
2103	2103	15 Department shall require all networks of care to include
2104	2104	16 access for patients diagnosed with cancer to at least one
2105	2105	17 academic commission on cancer-accredited cancer program as an
2106	2106	18 in-network covered benefit.
2107	2107	19 The Department shall provide coverage and reimbursement
2108	2108	20 for a human papillomavirus (HPV) vaccine that is approved for
2109	2109	21 marketing by the federal Food and Drug Administration for all
2110	2110	22 persons between the ages of 9 and 45. Subject to federal
2111	2111	23 approval, the Department shall provide coverage and
2112	2112	24 reimbursement for a human papillomavirus (HPV) vaccine for
2113	2113	25 persons of the age of 46 and above who have been diagnosed with
2114	2114	26 cervical dysplasia with a high risk of recurrence or
2115	2115
2116	2116
2117	2117
2118	2118
2119	2119
2120	2120	SB1743 - 58 - LRB104 11917 AAS 22009 b
2121	2121
2122	2122
2123	2123	SB1743- 59 -LRB104 11917 AAS 22009 b SB1743 - 59 - LRB104 11917 AAS 22009 b
2124	2124	SB1743 - 59 - LRB104 11917 AAS 22009 b
2125	2125	1 progression. The Department shall disallow any
2126	2126	2 preauthorization requirements for the administration of the
2127	2127	3 human papillomavirus (HPV) vaccine.
2128	2128	4 On or after July 1, 2022, individuals who are otherwise
2129	2129	5 eligible for medical assistance under this Article shall
2130	2130	6 receive coverage for perinatal depression screenings for the
2131	2131	7 12-month period beginning on the last day of their pregnancy.
2132	2132	8 Medical assistance coverage under this paragraph shall be
2133	2133	9 conditioned on the use of a screening instrument approved by
2134	2134	10 the Department.
2135	2135	11 Any medical or health care provider shall immediately
2136	2136	12 recommend, to any pregnant individual who is being provided
2137	2137	13 prenatal services and is suspected of having a substance use
2138	2138	14 disorder as defined in the Substance Use Disorder Act,
2139	2139	15 referral to a local substance use disorder treatment program
2140	2140	16 licensed by the Department of Human Services or to a licensed
2141	2141	17 hospital which provides substance abuse treatment services.
2142	2142	18 The Department of Healthcare and Family Services shall assure
2143	2143	19 coverage for the cost of treatment of the drug abuse or
2144	2144	20 addiction for pregnant recipients in accordance with the
2145	2145	21 Illinois Medicaid Program in conjunction with the Department
2146	2146	22 of Human Services.
2147	2147	23 All medical providers providing medical assistance to
2148	2148	24 pregnant individuals under this Code shall receive information
2149	2149	25 from the Department on the availability of services under any
2150	2150	26 program providing case management services for addicted
2151	2151
2152	2152
2153	2153
2154	2154
2155	2155
2156	2156	SB1743 - 59 - LRB104 11917 AAS 22009 b
2157	2157
2158	2158
2159	2159	SB1743- 60 -LRB104 11917 AAS 22009 b SB1743 - 60 - LRB104 11917 AAS 22009 b
2160	2160	SB1743 - 60 - LRB104 11917 AAS 22009 b
2161	2161	1 individuals, including information on appropriate referrals
2162	2162	2 for other social services that may be needed by addicted
2163	2163	3 individuals in addition to treatment for addiction.
2164	2164	4 The Illinois Department, in cooperation with the
2165	2165	5 Departments of Human Services (as successor to the Department
2166	2166	6 of Alcoholism and Substance Abuse) and Public Health, through
2167	2167	7 a public awareness campaign, may provide information
2168	2168	8 concerning treatment for alcoholism and drug abuse and
2169	2169	9 addiction, prenatal health care, and other pertinent programs
2170	2170	10 directed at reducing the number of drug-affected infants born
2171	2171	11 to recipients of medical assistance.
2172	2172	12 Neither the Department of Healthcare and Family Services
2173	2173	13 nor the Department of Human Services shall sanction the
2174	2174	14 recipient solely on the basis of the recipient's substance
2175	2175	15 abuse.
2176	2176	16 The Illinois Department shall establish such regulations
2177	2177	17 governing the dispensing of health services under this Article
2178	2178	18 as it shall deem appropriate. The Department should seek the
2179	2179	19 advice of formal professional advisory committees appointed by
2180	2180	20 the Director of the Illinois Department for the purpose of
2181	2181	21 providing regular advice on policy and administrative matters,
2182	2182	22 information dissemination and educational activities for
2183	2183	23 medical and health care providers, and consistency in
2184	2184	24 procedures to the Illinois Department.
2185	2185	25 The Illinois Department may develop and contract with
2186	2186	26 Partnerships of medical providers to arrange medical services
2187	2187
2188	2188
2189	2189
2190	2190
2191	2191
2192	2192	SB1743 - 60 - LRB104 11917 AAS 22009 b
2193	2193
2194	2194
2195	2195	SB1743- 61 -LRB104 11917 AAS 22009 b SB1743 - 61 - LRB104 11917 AAS 22009 b
2196	2196	SB1743 - 61 - LRB104 11917 AAS 22009 b
2197	2197	1 for persons eligible under Section 5-2 of this Code.
2198	2198	2 Implementation of this Section may be by demonstration
2199	2199	3 projects in certain geographic areas. The Partnership shall be
2200	2200	4 represented by a sponsor organization. The Department, by
2201	2201	5 rule, shall develop qualifications for sponsors of
2202	2202	6 Partnerships. Nothing in this Section shall be construed to
2203	2203	7 require that the sponsor organization be a medical
2204	2204	8 organization.
2205	2205	9 The sponsor must negotiate formal written contracts with
2206	2206	10 medical providers for physician services, inpatient and
2207	2207	11 outpatient hospital care, home health services, treatment for
2208	2208	12 alcoholism and substance abuse, and other services determined
2209	2209	13 necessary by the Illinois Department by rule for delivery by
2210	2210	14 Partnerships. Physician services must include prenatal and
2211	2211	15 obstetrical care. The Illinois Department shall reimburse
2212	2212	16 medical services delivered by Partnership providers to clients
2213	2213	17 in target areas according to provisions of this Article and
2214	2214	18 the Illinois Health Finance Reform Act, except that:
2215	2215	19 (1) Physicians participating in a Partnership and
2216	2216	20 providing certain services, which shall be determined by
2217	2217	21 the Illinois Department, to persons in areas covered by
2218	2218	22 the Partnership may receive an additional surcharge for
2219	2219	23 such services.
2220	2220	24 (2) The Department may elect to consider and negotiate
2221	2221	25 financial incentives to encourage the development of
2222	2222	26 Partnerships and the efficient delivery of medical care.
2223	2223
2224	2224
2225	2225
2226	2226
2227	2227
2228	2228	SB1743 - 61 - LRB104 11917 AAS 22009 b
2229	2229
2230	2230
2231	2231	SB1743- 62 -LRB104 11917 AAS 22009 b SB1743 - 62 - LRB104 11917 AAS 22009 b
2232	2232	SB1743 - 62 - LRB104 11917 AAS 22009 b
2233	2233	1 (3) Persons receiving medical services through
2234	2234	2 Partnerships may receive medical and case management
2235	2235	3 services above the level usually offered through the
2236	2236	4 medical assistance program.
2237	2237	5 Medical providers shall be required to meet certain
2238	2238	6 qualifications to participate in Partnerships to ensure the
2239	2239	7 delivery of high quality medical services. These
2240	2240	8 qualifications shall be determined by rule of the Illinois
2241	2241	9 Department and may be higher than qualifications for
2242	2242	10 participation in the medical assistance program. Partnership
2243	2243	11 sponsors may prescribe reasonable additional qualifications
2244	2244	12 for participation by medical providers, only with the prior
2245	2245	13 written approval of the Illinois Department.
2246	2246	14 Nothing in this Section shall limit the free choice of
2247	2247	15 practitioners, hospitals, and other providers of medical
2248	2248	16 services by clients. In order to ensure patient freedom of
2249	2249	17 choice, the Illinois Department shall immediately promulgate
2250	2250	18 all rules and take all other necessary actions so that
2251	2251	19 provided services may be accessed from therapeutically
2252	2252	20 certified optometrists to the full extent of the Illinois
2253	2253	21 Optometric Practice Act of 1987 without discriminating between
2254	2254	22 service providers.
2255	2255	23 The Department shall apply for a waiver from the United
2256	2256	24 States Health Care Financing Administration to allow for the
2257	2257	25 implementation of Partnerships under this Section.
2258	2258	26 The Illinois Department shall require health care
2259	2259
2260	2260
2261	2261
2262	2262
2263	2263
2264	2264	SB1743 - 62 - LRB104 11917 AAS 22009 b
2265	2265
2266	2266
2267	2267	SB1743- 63 -LRB104 11917 AAS 22009 b SB1743 - 63 - LRB104 11917 AAS 22009 b
2268	2268	SB1743 - 63 - LRB104 11917 AAS 22009 b
2269	2269	1 providers to maintain records that document the medical care
2270	2270	2 and services provided to recipients of Medical Assistance
2271	2271	3 under this Article. Such records must be retained for a period
2272	2272	4 of not less than 6 years from the date of service or as
2273	2273	5 provided by applicable State law, whichever period is longer,
2274	2274	6 except that if an audit is initiated within the required
2275	2275	7 retention period then the records must be retained until the
2276	2276	8 audit is completed and every exception is resolved. The
2277	2277	9 Illinois Department shall require health care providers to
2278	2278	10 make available, when authorized by the patient, in writing,
2279	2279	11 the medical records in a timely fashion to other health care
2280	2280	12 providers who are treating or serving persons eligible for
2281	2281	13 Medical Assistance under this Article. All dispensers of
2282	2282	14 medical services shall be required to maintain and retain
2283	2283	15 business and professional records sufficient to fully and
2284	2284	16 accurately document the nature, scope, details and receipt of
2285	2285	17 the health care provided to persons eligible for medical
2286	2286	18 assistance under this Code, in accordance with regulations
2287	2287	19 promulgated by the Illinois Department. The rules and
2288	2288	20 regulations shall require that proof of the receipt of
2289	2289	21 prescription drugs, dentures, prosthetic devices and
2290	2290	22 eyeglasses by eligible persons under this Section accompany
2291	2291	23 each claim for reimbursement submitted by the dispenser of
2292	2292	24 such medical services. No such claims for reimbursement shall
2293	2293	25 be approved for payment by the Illinois Department without
2294	2294	26 such proof of receipt, unless the Illinois Department shall
2295	2295
2296	2296
2297	2297
2298	2298
2299	2299
2300	2300	SB1743 - 63 - LRB104 11917 AAS 22009 b
2301	2301
2302	2302
2303	2303	SB1743- 64 -LRB104 11917 AAS 22009 b SB1743 - 64 - LRB104 11917 AAS 22009 b
2304	2304	SB1743 - 64 - LRB104 11917 AAS 22009 b
2305	2305	1 have put into effect and shall be operating a system of
2306	2306	2 post-payment audit and review which shall, on a sampling
2307	2307	3 basis, be deemed adequate by the Illinois Department to assure
2308	2308	4 that such drugs, dentures, prosthetic devices and eyeglasses
2309	2309	5 for which payment is being made are actually being received by
2310	2310	6 eligible recipients. Within 90 days after September 16, 1984
2311	2311	7 (the effective date of Public Act 83-1439), the Illinois
2312	2312	8 Department shall establish a current list of acquisition costs
2313	2313	9 for all prosthetic devices and any other items recognized as
2314	2314	10 medical equipment and supplies reimbursable under this Article
2315	2315	11 and shall update such list on a quarterly basis, except that
2316	2316	12 the acquisition costs of all prescription drugs shall be
2317	2317	13 updated no less frequently than every 30 days as required by
2318	2318	14 Section 5-5.12.
2319	2319	15 Notwithstanding any other law to the contrary, the
2320	2320	16 Illinois Department shall, within 365 days after July 22, 2013
2321	2321	17 (the effective date of Public Act 98-104), establish
2322	2322	18 procedures to permit skilled care facilities licensed under
2323	2323	19 the Nursing Home Care Act to submit monthly billing claims for
2324	2324	20 reimbursement purposes. Following development of these
2325	2325	21 procedures, the Department shall, by July 1, 2016, test the
2326	2326	22 viability of the new system and implement any necessary
2327	2327	23 operational or structural changes to its information
2328	2328	24 technology platforms in order to allow for the direct
2329	2329	25 acceptance and payment of nursing home claims.
2330	2330	26 Notwithstanding any other law to the contrary, the
2331	2331
2332	2332
2333	2333
2334	2334
2335	2335
2336	2336	SB1743 - 64 - LRB104 11917 AAS 22009 b
2337	2337
2338	2338
2339	2339	SB1743- 65 -LRB104 11917 AAS 22009 b SB1743 - 65 - LRB104 11917 AAS 22009 b
2340	2340	SB1743 - 65 - LRB104 11917 AAS 22009 b
2341	2341	1 Illinois Department shall, within 365 days after August 15,
2342	2342	2 2014 (the effective date of Public Act 98-963), establish
2343	2343	3 procedures to permit ID/DD facilities licensed under the ID/DD
2344	2344	4 Community Care Act and MC/DD facilities licensed under the
2345	2345	5 MC/DD Act to submit monthly billing claims for reimbursement
2346	2346	6 purposes. Following development of these procedures, the
2347	2347	7 Department shall have an additional 365 days to test the
2348	2348	8 viability of the new system and to ensure that any necessary
2349	2349	9 operational or structural changes to its information
2350	2350	10 technology platforms are implemented.
2351	2351	11 The Illinois Department shall require all dispensers of
2352	2352	12 medical services, other than an individual practitioner or
2353	2353	13 group of practitioners, desiring to participate in the Medical
2354	2354	14 Assistance program established under this Article to disclose
2355	2355	15 all financial, beneficial, ownership, equity, surety or other
2356	2356	16 interests in any and all firms, corporations, partnerships,
2357	2357	17 associations, business enterprises, joint ventures, agencies,
2358	2358	18 institutions or other legal entities providing any form of
2359	2359	19 health care services in this State under this Article.
2360	2360	20 The Illinois Department may require that all dispensers of
2361	2361	21 medical services desiring to participate in the medical
2362	2362	22 assistance program established under this Article disclose,
2363	2363	23 under such terms and conditions as the Illinois Department may
2364	2364	24 by rule establish, all inquiries from clients and attorneys
2365	2365	25 regarding medical bills paid by the Illinois Department, which
2366	2366	26 inquiries could indicate potential existence of claims or
2367	2367
2368	2368
2369	2369
2370	2370
2371	2371
2372	2372	SB1743 - 65 - LRB104 11917 AAS 22009 b
2373	2373
2374	2374
2375	2375	SB1743- 66 -LRB104 11917 AAS 22009 b SB1743 - 66 - LRB104 11917 AAS 22009 b
2376	2376	SB1743 - 66 - LRB104 11917 AAS 22009 b
2377	2377	1 liens for the Illinois Department.
2378	2378	2 Enrollment of a vendor shall be subject to a provisional
2379	2379	3 period and shall be conditional for one year. During the
2380	2380	4 period of conditional enrollment, the Department may terminate
2381	2381	5 the vendor's eligibility to participate in, or may disenroll
2382	2382	6 the vendor from, the medical assistance program without cause.
2383	2383	7 Unless otherwise specified, such termination of eligibility or
2384	2384	8 disenrollment is not subject to the Department's hearing
2385	2385	9 process. However, a disenrolled vendor may reapply without
2386	2386	10 penalty.
2387	2387	11 The Department has the discretion to limit the conditional
2388	2388	12 enrollment period for vendors based upon the category of risk
2389	2389	13 of the vendor.
2390	2390	14 Prior to enrollment and during the conditional enrollment
2391	2391	15 period in the medical assistance program, all vendors shall be
2392	2392	16 subject to enhanced oversight, screening, and review based on
2393	2393	17 the risk of fraud, waste, and abuse that is posed by the
2394	2394	18 category of risk of the vendor. The Illinois Department shall
2395	2395	19 establish the procedures for oversight, screening, and review,
2396	2396	20 which may include, but need not be limited to: criminal and
2397	2397	21 financial background checks; fingerprinting; license,
2398	2398	22 certification, and authorization verifications; unscheduled or
2399	2399	23 unannounced site visits; database checks; prepayment audit
2400	2400	24 reviews; audits; payment caps; payment suspensions; and other
2401	2401	25 screening as required by federal or State law.
2402	2402	26 The Department shall define or specify the following: (i)
2403	2403
2404	2404
2405	2405
2406	2406
2407	2407
2408	2408	SB1743 - 66 - LRB104 11917 AAS 22009 b
2409	2409
2410	2410
2411	2411	SB1743- 67 -LRB104 11917 AAS 22009 b SB1743 - 67 - LRB104 11917 AAS 22009 b
2412	2412	SB1743 - 67 - LRB104 11917 AAS 22009 b
2413	2413	1 by provider notice, the "category of risk of the vendor" for
2414	2414	2 each type of vendor, which shall take into account the level of
2415	2415	3 screening applicable to a particular category of vendor under
2416	2416	4 federal law and regulations; (ii) by rule or provider notice,
2417	2417	5 the maximum length of the conditional enrollment period for
2418	2418	6 each category of risk of the vendor; and (iii) by rule, the
2419	2419	7 hearing rights, if any, afforded to a vendor in each category
2420	2420	8 of risk of the vendor that is terminated or disenrolled during
2421	2421	9 the conditional enrollment period.
2422	2422	10 To be eligible for payment consideration, a vendor's
2423	2423	11 payment claim or bill, either as an initial claim or as a
2424	2424	12 resubmitted claim following prior rejection, must be received
2425	2425	13 by the Illinois Department, or its fiscal intermediary, no
2426	2426	14 later than 180 days after the latest date on the claim on which
2427	2427	15 medical goods or services were provided, with the following
2428	2428	16 exceptions:
2429	2429	17 (1) In the case of a provider whose enrollment is in
2430	2430	18 process by the Illinois Department, the 180-day period
2431	2431	19 shall not begin until the date on the written notice from
2432	2432	20 the Illinois Department that the provider enrollment is
2433	2433	21 complete.
2434	2434	22 (2) In the case of errors attributable to the Illinois
2435	2435	23 Department or any of its claims processing intermediaries
2436	2436	24 which result in an inability to receive, process, or
2437	2437	25 adjudicate a claim, the 180-day period shall not begin
2438	2438	26 until the provider has been notified of the error.
2439	2439
2440	2440
2441	2441
2442	2442
2443	2443
2444	2444	SB1743 - 67 - LRB104 11917 AAS 22009 b
2445	2445
2446	2446
2447	2447	SB1743- 68 -LRB104 11917 AAS 22009 b SB1743 - 68 - LRB104 11917 AAS 22009 b
2448	2448	SB1743 - 68 - LRB104 11917 AAS 22009 b
2449	2449	1 (3) In the case of a provider for whom the Illinois
2450	2450	2 Department initiates the monthly billing process.
2451	2451	3 (4) In the case of a provider operated by a unit of
2452	2452	4 local government with a population exceeding 3,000,000
2453	2453	5 when local government funds finance federal participation
2454	2454	6 for claims payments.
2455	2455	7 For claims for services rendered during a period for which
2456	2456	8 a recipient received retroactive eligibility, claims must be
2457	2457	9 filed within 180 days after the Department determines the
2458	2458	10 applicant is eligible. For claims for which the Illinois
2459	2459	11 Department is not the primary payer, claims must be submitted
2460	2460	12 to the Illinois Department within 180 days after the final
2461	2461	13 adjudication by the primary payer.
2462	2462	14 In the case of long term care facilities, within 120
2463	2463	15 calendar days of receipt by the facility of required
2464	2464	16 prescreening information, new admissions with associated
2465	2465	17 admission documents shall be submitted through the Medical
2466	2466	18 Electronic Data Interchange (MEDI) or the Recipient
2467	2467	19 Eligibility Verification (REV) System or shall be submitted
2468	2468	20 directly to the Department of Human Services using required
2469	2469	21 admission forms. Effective September 1, 2014, admission
2470	2470	22 documents, including all prescreening information, must be
2471	2471	23 submitted through MEDI or REV. Confirmation numbers assigned
2472	2472	24 to an accepted transaction shall be retained by a facility to
2473	2473	25 verify timely submittal. Once an admission transaction has
2474	2474	26 been completed, all resubmitted claims following prior
2475	2475
2476	2476
2477	2477
2478	2478
2479	2479
2480	2480	SB1743 - 68 - LRB104 11917 AAS 22009 b
2481	2481
2482	2482
2483	2483	SB1743- 69 -LRB104 11917 AAS 22009 b SB1743 - 69 - LRB104 11917 AAS 22009 b
2484	2484	SB1743 - 69 - LRB104 11917 AAS 22009 b
2485	2485	1 rejection are subject to receipt no later than 180 days after
2486	2486	2 the admission transaction has been completed.
2487	2487	3 Claims that are not submitted and received in compliance
2488	2488	4 with the foregoing requirements shall not be eligible for
2489	2489	5 payment under the medical assistance program, and the State
2490	2490	6 shall have no liability for payment of those claims.
2491	2491	7 To the extent consistent with applicable information and
2492	2492	8 privacy, security, and disclosure laws, State and federal
2493	2493	9 agencies and departments shall provide the Illinois Department
2494	2494	10 access to confidential and other information and data
2495	2495	11 necessary to perform eligibility and payment verifications and
2496	2496	12 other Illinois Department functions. This includes, but is not
2497	2497	13 limited to: information pertaining to licensure;
2498	2498	14 certification; earnings; immigration status; citizenship; wage
2499	2499	15 reporting; unearned and earned income; pension income;
2500	2500	16 employment; supplemental security income; social security
2501	2501	17 numbers; National Provider Identifier (NPI) numbers; the
2502	2502	18 National Practitioner Data Bank (NPDB); program and agency
2503	2503	19 exclusions; taxpayer identification numbers; tax delinquency;
2504	2504	20 corporate information; and death records.
2505	2505	21 The Illinois Department shall enter into agreements with
2506	2506	22 State agencies and departments, and is authorized to enter
2507	2507	23 into agreements with federal agencies and departments, under
2508	2508	24 which such agencies and departments shall share data necessary
2509	2509	25 for medical assistance program integrity functions and
2510	2510	26 oversight. The Illinois Department shall develop, in
2511	2511
2512	2512
2513	2513
2514	2514
2515	2515
2516	2516	SB1743 - 69 - LRB104 11917 AAS 22009 b
2517	2517
2518	2518
2519	2519	SB1743- 70 -LRB104 11917 AAS 22009 b SB1743 - 70 - LRB104 11917 AAS 22009 b
2520	2520	SB1743 - 70 - LRB104 11917 AAS 22009 b
2521	2521	1 cooperation with other State departments and agencies, and in
2522	2522	2 compliance with applicable federal laws and regulations,
2523	2523	3 appropriate and effective methods to share such data. At a
2524	2524	4 minimum, and to the extent necessary to provide data sharing,
2525	2525	5 the Illinois Department shall enter into agreements with State
2526	2526	6 agencies and departments, and is authorized to enter into
2527	2527	7 agreements with federal agencies and departments, including,
2528	2528	8 but not limited to: the Secretary of State; the Department of
2529	2529	9 Revenue; the Department of Public Health; the Department of
2530	2530	10 Human Services; and the Department of Financial and
2531	2531	11 Professional Regulation.
2532	2532	12 Beginning in fiscal year 2013, the Illinois Department
2533	2533	13 shall set forth a request for information to identify the
2534	2534	14 benefits of a pre-payment, post-adjudication, and post-edit
2535	2535	15 claims system with the goals of streamlining claims processing
2536	2536	16 and provider reimbursement, reducing the number of pending or
2537	2537	17 rejected claims, and helping to ensure a more transparent
2538	2538	18 adjudication process through the utilization of: (i) provider
2539	2539	19 data verification and provider screening technology; and (ii)
2540	2540	20 clinical code editing; and (iii) pre-pay, pre-adjudicated, or
2541	2541	21 post-adjudicated predictive modeling with an integrated case
2542	2542	22 management system with link analysis. Such a request for
2543	2543	23 information shall not be considered as a request for proposal
2544	2544	24 or as an obligation on the part of the Illinois Department to
2545	2545	25 take any action or acquire any products or services.
2546	2546	26 The Illinois Department shall establish policies,
2547	2547
2548	2548
2549	2549
2550	2550
2551	2551
2552	2552	SB1743 - 70 - LRB104 11917 AAS 22009 b
2553	2553
2554	2554
2555	2555	SB1743- 71 -LRB104 11917 AAS 22009 b SB1743 - 71 - LRB104 11917 AAS 22009 b
2556	2556	SB1743 - 71 - LRB104 11917 AAS 22009 b
2557	2557	1 procedures, standards and criteria by rule for the
2558	2558	2 acquisition, repair and replacement of orthotic and prosthetic
2559	2559	3 devices and durable medical equipment. Such rules shall
2560	2560	4 provide, but not be limited to, the following services: (1)
2561	2561	5 immediate repair or replacement of such devices by recipients;
2562	2562	6 and (2) rental, lease, purchase or lease-purchase of durable
2563	2563	7 medical equipment in a cost-effective manner, taking into
2564	2564	8 consideration the recipient's medical prognosis, the extent of
2565	2565	9 the recipient's needs, and the requirements and costs for
2566	2566	10 maintaining such equipment. Subject to prior approval, such
2567	2567	11 rules shall enable a recipient to temporarily acquire and use
2568	2568	12 alternative or substitute devices or equipment pending repairs
2569	2569	13 or replacements of any device or equipment previously
2570	2570	14 authorized for such recipient by the Department.
2571	2571	15 Notwithstanding any provision of Section 5-5f to the contrary,
2572	2572	16 the Department may, by rule, exempt certain replacement
2573	2573	17 wheelchair parts from prior approval and, for wheelchairs,
2574	2574	18 wheelchair parts, wheelchair accessories, and related seating
2575	2575	19 and positioning items, determine the wholesale price by
2576	2576	20 methods other than actual acquisition costs.
2577	2577	21 The Department shall require, by rule, all providers of
2578	2578	22 durable medical equipment to be accredited by an accreditation
2579	2579	23 organization approved by the federal Centers for Medicare and
2580	2580	24 Medicaid Services and recognized by the Department in order to
2581	2581	25 bill the Department for providing durable medical equipment to
2582	2582	26 recipients. No later than 15 months after the effective date
2583	2583
2584	2584
2585	2585
2586	2586
2587	2587
2588	2588	SB1743 - 71 - LRB104 11917 AAS 22009 b
2589	2589
2590	2590
2591	2591	SB1743- 72 -LRB104 11917 AAS 22009 b SB1743 - 72 - LRB104 11917 AAS 22009 b
2592	2592	SB1743 - 72 - LRB104 11917 AAS 22009 b
2593	2593	1 of the rule adopted pursuant to this paragraph, all providers
2594	2594	2 must meet the accreditation requirement.
2595	2595	3 In order to promote environmental responsibility, meet the
2596	2596	4 needs of recipients and enrollees, and achieve significant
2597	2597	5 cost savings, the Department, or a managed care organization
2598	2598	6 under contract with the Department, may provide recipients or
2599	2599	7 managed care enrollees who have a prescription or Certificate
2600	2600	8 of Medical Necessity access to refurbished durable medical
2601	2601	9 equipment under this Section (excluding prosthetic and
2602	2602	10 orthotic devices as defined in the Orthotics, Prosthetics, and
2603	2603	11 Pedorthics Practice Act and complex rehabilitation technology
2604	2604	12 products and associated services) through the State's
2605	2605	13 assistive technology program's reutilization program, using
2606	2606	14 staff with the Assistive Technology Professional (ATP)
2607	2607	15 Certification if the refurbished durable medical equipment:
2608	2608	16 (i) is available; (ii) is less expensive, including shipping
2609	2609	17 costs, than new durable medical equipment of the same type;
2610	2610	18 (iii) is able to withstand at least 3 years of use; (iv) is
2611	2611	19 cleaned, disinfected, sterilized, and safe in accordance with
2612	2612	20 federal Food and Drug Administration regulations and guidance
2613	2613	21 governing the reprocessing of medical devices in health care
2614	2614	22 settings; and (v) equally meets the needs of the recipient or
2615	2615	23 enrollee. The reutilization program shall confirm that the
2616	2616	24 recipient or enrollee is not already in receipt of the same or
2617	2617	25 similar equipment from another service provider, and that the
2618	2618	26 refurbished durable medical equipment equally meets the needs
2619	2619
2620	2620
2621	2621
2622	2622
2623	2623
2624	2624	SB1743 - 72 - LRB104 11917 AAS 22009 b
2625	2625
2626	2626
2627	2627	SB1743- 73 -LRB104 11917 AAS 22009 b SB1743 - 73 - LRB104 11917 AAS 22009 b
2628	2628	SB1743 - 73 - LRB104 11917 AAS 22009 b
2629	2629	1 of the recipient or enrollee. Nothing in this paragraph shall
2630	2630	2 be construed to limit recipient or enrollee choice to obtain
2631	2631	3 new durable medical equipment or place any additional prior
2632	2632	4 authorization conditions on enrollees of managed care
2633	2633	5 organizations.
2634	2634	6 The Department shall execute, relative to the nursing home
2635	2635	7 prescreening project, written inter-agency agreements with the
2636	2636	8 Department of Human Services and the Department on Aging, to
2637	2637	9 effect the following: (i) intake procedures and common
2638	2638	10 eligibility criteria for those persons who are receiving
2639	2639	11 non-institutional services; and (ii) the establishment and
2640	2640	12 development of non-institutional services in areas of the
2641	2641	13 State where they are not currently available or are
2642	2642	14 undeveloped; and (iii) notwithstanding any other provision of
2643	2643	15 law, subject to federal approval, on and after July 1, 2012, an
2644	2644	16 increase in the determination of need (DON) scores from 29 to
2645	2645	17 37 for applicants for institutional and home and
2646	2646	18 community-based long term care; if and only if federal
2647	2647	19 approval is not granted, the Department may, in conjunction
2648	2648	20 with other affected agencies, implement utilization controls
2649	2649	21 or changes in benefit packages to effectuate a similar savings
2650	2650	22 amount for this population; and (iv) no later than July 1,
2651	2651	23 2013, minimum level of care eligibility criteria for
2652	2652	24 institutional and home and community-based long term care; and
2653	2653	25 (v) no later than October 1, 2013, establish procedures to
2654	2654	26 permit long term care providers access to eligibility scores
2655	2655
2656	2656
2657	2657
2658	2658
2659	2659
2660	2660	SB1743 - 73 - LRB104 11917 AAS 22009 b
2661	2661
2662	2662
2663	2663	SB1743- 74 -LRB104 11917 AAS 22009 b SB1743 - 74 - LRB104 11917 AAS 22009 b
2664	2664	SB1743 - 74 - LRB104 11917 AAS 22009 b
2665	2665	1 for individuals with an admission date who are seeking or
2666	2666	2 receiving services from the long term care provider. In order
2667	2667	3 to select the minimum level of care eligibility criteria, the
2668	2668	4 Governor shall establish a workgroup that includes affected
2669	2669	5 agency representatives and stakeholders representing the
2670	2670	6 institutional and home and community-based long term care
2671	2671	7 interests. This Section shall not restrict the Department from
2672	2672	8 implementing lower level of care eligibility criteria for
2673	2673	9 community-based services in circumstances where federal
2674	2674	10 approval has been granted.
2675	2675	11 The Illinois Department shall develop and operate, in
2676	2676	12 cooperation with other State Departments and agencies and in
2677	2677	13 compliance with applicable federal laws and regulations,
2678	2678	14 appropriate and effective systems of health care evaluation
2679	2679	15 and programs for monitoring of utilization of health care
2680	2680	16 services and facilities, as it affects persons eligible for
2681	2681	17 medical assistance under this Code.
2682	2682	18 The Illinois Department shall report annually to the
2683	2683	19 General Assembly, no later than the second Friday in April of
2684	2684	20 1979 and each year thereafter, in regard to:
2685	2685	21 (a) actual statistics and trends in utilization of
2686	2686	22 medical services by public aid recipients;
2687	2687	23 (b) actual statistics and trends in the provision of
2688	2688	24 the various medical services by medical vendors;
2689	2689	25 (c) current rate structures and proposed changes in
2690	2690	26 those rate structures for the various medical vendors; and
2691	2691
2692	2692
2693	2693
2694	2694
2695	2695
2696	2696	SB1743 - 74 - LRB104 11917 AAS 22009 b
2697	2697
2698	2698
2699	2699	SB1743- 75 -LRB104 11917 AAS 22009 b SB1743 - 75 - LRB104 11917 AAS 22009 b
2700	2700	SB1743 - 75 - LRB104 11917 AAS 22009 b
2701	2701	1 (d) efforts at utilization review and control by the
2702	2702	2 Illinois Department.
2703	2703	3 The period covered by each report shall be the 3 years
2704	2704	4 ending on the June 30 prior to the report. The report shall
2705	2705	5 include suggested legislation for consideration by the General
2706	2706	6 Assembly. The requirement for reporting to the General
2707	2707	7 Assembly shall be satisfied by filing copies of the report as
2708	2708	8 required by Section 3.1 of the General Assembly Organization
2709	2709	9 Act, and filing such additional copies with the State
2710	2710	10 Government Report Distribution Center for the General Assembly
2711	2711	11 as is required under paragraph (t) of Section 7 of the State
2712	2712	12 Library Act.
2713	2713	13 Rulemaking authority to implement Public Act 95-1045, if
2714	2714	14 any, is conditioned on the rules being adopted in accordance
2715	2715	15 with all provisions of the Illinois Administrative Procedure
2716	2716	16 Act and all rules and procedures of the Joint Committee on
2717	2717	17 Administrative Rules; any purported rule not so adopted, for
2718	2718	18 whatever reason, is unauthorized.
2719	2719	19 On and after July 1, 2012, the Department shall reduce any
2720	2720	20 rate of reimbursement for services or other payments or alter
2721	2721	21 any methodologies authorized by this Code to reduce any rate
2722	2722	22 of reimbursement for services or other payments in accordance
2723	2723	23 with Section 5-5e.
2724	2724	24 Because kidney transplantation can be an appropriate,
2725	2725	25 cost-effective alternative to renal dialysis when medically
2726	2726	26 necessary and notwithstanding the provisions of Section 1-11
2727	2727
2728	2728
2729	2729
2730	2730
2731	2731
2732	2732	SB1743 - 75 - LRB104 11917 AAS 22009 b
2733	2733
2734	2734
2735	2735	SB1743- 76 -LRB104 11917 AAS 22009 b SB1743 - 76 - LRB104 11917 AAS 22009 b
2736	2736	SB1743 - 76 - LRB104 11917 AAS 22009 b
2737	2737	1 of this Code, beginning October 1, 2014, the Department shall
2738	2738	2 cover kidney transplantation for noncitizens with end-stage
2739	2739	3 renal disease who are not eligible for comprehensive medical
2740	2740	4 benefits, who meet the residency requirements of Section 5-3
2741	2741	5 of this Code, and who would otherwise meet the financial
2742	2742	6 requirements of the appropriate class of eligible persons
2743	2743	7 under Section 5-2 of this Code. To qualify for coverage of
2744	2744	8 kidney transplantation, such person must be receiving
2745	2745	9 emergency renal dialysis services covered by the Department.
2746	2746	10 Providers under this Section shall be prior approved and
2747	2747	11 certified by the Department to perform kidney transplantation
2748	2748	12 and the services under this Section shall be limited to
2749	2749	13 services associated with kidney transplantation.
2750	2750	14 Notwithstanding any other provision of this Code to the
2751	2751	15 contrary, on or after July 1, 2015, all FDA-approved FDA
2752	2752	16 approved forms of medication assisted treatment prescribed for
2753	2753	17 the treatment of alcohol dependence or treatment of opioid
2754	2754	18 dependence shall be covered under both fee-for-service and
2755	2755	19 managed care medical assistance programs for persons who are
2756	2756	20 otherwise eligible for medical assistance under this Article
2757	2757	21 and shall not be subject to any (1) utilization control, other
2758	2758	22 than those established under the American Society of Addiction
2759	2759	23 Medicine patient placement criteria, (2) prior authorization
2760	2760	24 mandate, (3) lifetime restriction limit mandate, or (4)
2761	2761	25 limitations on dosage.
2762	2762	26 On or after July 1, 2015, opioid antagonists prescribed
2763	2763
2764	2764
2765	2765
2766	2766
2767	2767
2768	2768	SB1743 - 76 - LRB104 11917 AAS 22009 b
2769	2769
2770	2770
2771	2771	SB1743- 77 -LRB104 11917 AAS 22009 b SB1743 - 77 - LRB104 11917 AAS 22009 b
2772	2772	SB1743 - 77 - LRB104 11917 AAS 22009 b
2773	2773	1 for the treatment of an opioid overdose, including the
2774	2774	2 medication product, administration devices, and any pharmacy
2775	2775	3 fees or hospital fees related to the dispensing, distribution,
2776	2776	4 and administration of the opioid antagonist, shall be covered
2777	2777	5 under the medical assistance program for persons who are
2778	2778	6 otherwise eligible for medical assistance under this Article.
2779	2779	7 As used in this Section, "opioid antagonist" means a drug that
2780	2780	8 binds to opioid receptors and blocks or inhibits the effect of
2781	2781	9 opioids acting on those receptors, including, but not limited
2782	2782	10 to, naloxone hydrochloride or any other similarly acting drug
2783	2783	11 approved by the U.S. Food and Drug Administration. The
2784	2784	12 Department shall not impose a copayment on the coverage
2785	2785	13 provided for naloxone hydrochloride under the medical
2786	2786	14 assistance program.
2787	2787	15 Upon federal approval, the Department shall provide
2788	2788	16 coverage and reimbursement for all drugs that are approved for
2789	2789	17 marketing by the federal Food and Drug Administration and that
2790	2790	18 are recommended by the federal Public Health Service or the
2791	2791	19 United States Centers for Disease Control and Prevention for
2792	2792	20 pre-exposure prophylaxis and related pre-exposure prophylaxis
2793	2793	21 services, including, but not limited to, HIV and sexually
2794	2794	22 transmitted infection screening, treatment for sexually
2795	2795	23 transmitted infections, medical monitoring, assorted labs, and
2796	2796	24 counseling to reduce the likelihood of HIV infection among
2797	2797	25 individuals who are not infected with HIV but who are at high
2798	2798	26 risk of HIV infection.
2799	2799
2800	2800
2801	2801
2802	2802
2803	2803
2804	2804	SB1743 - 77 - LRB104 11917 AAS 22009 b
2805	2805
2806	2806
2807	2807	SB1743- 78 -LRB104 11917 AAS 22009 b SB1743 - 78 - LRB104 11917 AAS 22009 b
2808	2808	SB1743 - 78 - LRB104 11917 AAS 22009 b
2809	2809	1 A federally qualified health center, as defined in Section
2810	2810	2 1905(l)(2)(B) of the federal Social Security Act, shall be
2811	2811	3 reimbursed by the Department in accordance with the federally
2812	2812	4 qualified health center's encounter rate for services provided
2813	2813	5 to medical assistance recipients that are performed by a
2814	2814	6 dental hygienist, as defined under the Illinois Dental
2815	2815	7 Practice Act, working under the general supervision of a
2816	2816	8 dentist and employed by a federally qualified health center.
2817	2817	9 Within 90 days after October 8, 2021 (the effective date
2818	2818	10 of Public Act 102-665), the Department shall seek federal
2819	2819	11 approval of a State Plan amendment to expand coverage for
2820	2820	12 family planning services that includes presumptive eligibility
2821	2821	13 to individuals whose income is at or below 208% of the federal
2822	2822	14 poverty level. Coverage under this Section shall be effective
2823	2823	15 beginning no later than December 1, 2022.
2824	2824	16 Subject to approval by the federal Centers for Medicare
2825	2825	17 and Medicaid Services of a Title XIX State Plan amendment
2826	2826	18 electing the Program of All-Inclusive Care for the Elderly
2827	2827	19 (PACE) as a State Medicaid option, as provided for by Subtitle
2828	2828	20 I (commencing with Section 4801) of Title IV of the Balanced
2829	2829	21 Budget Act of 1997 (Public Law 105-33) and Part 460
2830	2830	22 (commencing with Section 460.2) of Subchapter E of Title 42 of
2831	2831	23 the Code of Federal Regulations, PACE program services shall
2832	2832	24 become a covered benefit of the medical assistance program,
2833	2833	25 subject to criteria established in accordance with all
2834	2834	26 applicable laws.
2835	2835
2836	2836
2837	2837
2838	2838
2839	2839
2840	2840	SB1743 - 78 - LRB104 11917 AAS 22009 b
2841	2841
2842	2842
2843	2843	SB1743- 79 -LRB104 11917 AAS 22009 b SB1743 - 79 - LRB104 11917 AAS 22009 b
2844	2844	SB1743 - 79 - LRB104 11917 AAS 22009 b
2845	2845	1 Notwithstanding any other provision of this Code,
2846	2846	2 community-based pediatric palliative care from a trained
2847	2847	3 interdisciplinary team shall be covered under the medical
2848	2848	4 assistance program as provided in Section 15 of the Pediatric
2849	2849	5 Palliative Care Act.
2850	2850	6 Notwithstanding any other provision of this Code, within
2851	2851	7 12 months after June 2, 2022 (the effective date of Public Act
2852	2852	8 102-1037) and subject to federal approval, acupuncture
2853	2853	9 services performed by an acupuncturist licensed under the
2854	2854	10 Acupuncture Practice Act who is acting within the scope of his
2855	2855	11 or her license shall be covered under the medical assistance
2856	2856	12 program. The Department shall apply for any federal waiver or
2857	2857	13 State Plan amendment, if required, to implement this
2858	2858	14 paragraph. The Department may adopt any rules, including
2859	2859	15 standards and criteria, necessary to implement this paragraph.
2860	2860	16 Notwithstanding any other provision of this Code, the
2861	2861	17 medical assistance program shall, subject to federal approval,
2862	2862	18 reimburse hospitals for costs associated with a newborn
2863	2863	19 screening test for the presence of metachromatic
2864	2864	20 leukodystrophy, as required under the Newborn Metabolic
2865	2865	21 Screening Act, at a rate not less than the fee charged by the
2866	2866	22 Department of Public Health. Notwithstanding any other
2867	2867	23 provision of this Code, the medical assistance program shall,
2868	2868	24 subject to appropriation and federal approval, also reimburse
2869	2869	25 hospitals for costs associated with all newborn screening
2870	2870	26 tests added on and after August 9, 2024 (the effective date of
2871	2871
2872	2872
2873	2873
2874	2874
2875	2875
2876	2876	SB1743 - 79 - LRB104 11917 AAS 22009 b
2877	2877
2878	2878
2879	2879	SB1743- 80 -LRB104 11917 AAS 22009 b SB1743 - 80 - LRB104 11917 AAS 22009 b
2880	2880	SB1743 - 80 - LRB104 11917 AAS 22009 b
2881	2881	1 Public Act 103-909) this amendatory Act of the 103rd General
2882	2882	2 Assembly to the Newborn Metabolic Screening Act and required
2883	2883	3 to be performed under that Act at a rate not less than the fee
2884	2884	4 charged by the Department of Public Health. The Department
2885	2885	5 shall seek federal approval before the implementation of the
2886	2886	6 newborn screening test fees by the Department of Public
2887	2887	7 Health.
2888	2888	8 Notwithstanding any other provision of this Code,
2889	2889	9 beginning on January 1, 2024, subject to federal approval,
2890	2890	10 cognitive assessment and care planning services provided to a
2891	2891	11 person who experiences signs or symptoms of cognitive
2892	2892	12 impairment, as defined by the Diagnostic and Statistical
2893	2893	13 Manual of Mental Disorders, Fifth Edition, shall be covered
2894	2894	14 under the medical assistance program for persons who are
2895	2895	15 otherwise eligible for medical assistance under this Article.
2896	2896	16 Notwithstanding any other provision of this Code,
2897	2897	17 medically necessary reconstructive services that are intended
2898	2898	18 to restore physical appearance shall be covered under the
2899	2899	19 medical assistance program for persons who are otherwise
2900	2900	20 eligible for medical assistance under this Article. As used in
2901	2901	21 this paragraph, "reconstructive services" means treatments
2902	2902	22 performed on structures of the body damaged by trauma to
2903	2903	23 restore physical appearance.
2904	2904	24 Notwithstanding any other provision of this Code, the
2905	2905	25 Department shall provide coverage and reimbursement for
2906	2906	26 prescription management services provided by prescribing
2907	2907
2908	2908
2909	2909
2910	2910
2911	2911
2912	2912	SB1743 - 80 - LRB104 11917 AAS 22009 b
2913	2913
2914	2914
2915	2915	SB1743- 81 -LRB104 11917 AAS 22009 b SB1743 - 81 - LRB104 11917 AAS 22009 b
2916	2916	SB1743 - 81 - LRB104 11917 AAS 22009 b
2917	2917	1 psychologists for persons who are otherwise eligible for
2918	2918	2 medical assistance under this Article.
2919	2919	3 (Source: P.A. 102-43, Article 30, Section 30-5, eff. 7-6-21;
2920	2920	4 102-43, Article 35, Section 35-5, eff. 7-6-21; 102-43, Article
2921	2921	5 55, Section 55-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123,
2922	2922	6 eff. 1-1-22; 102-558, eff. 8-20-21; 102-598, eff. 1-1-22;
2923	2923	7 102-655, eff. 1-1-22; 102-665, eff. 10-8-21; 102-813, eff.
2924	2924	8 5-13-22; 102-1018, eff. 1-1-23; 102-1037, eff. 6-2-22;
2925	2925	9 102-1038, eff. 1-1-23; 103-102, Article 15, Section 15-5, eff.
2926	2926	10 1-1-24; 103-102, Article 95, Section 95-15, eff. 1-1-24;
2927	2927	11 103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-368, eff.
2928	2928	12 1-1-24; 103-593, Article 5, Section 5-5, eff. 6-7-24; 103-593,
2929	2929	13 Article 90, Section 90-5, eff. 6-7-24; 103-605, eff. 7-1-24;
2930	2930	14 103-808, eff. 1-1-26; 103-909, eff. 8-9-24; 103-1040, eff.
2931	2931	15 8-9-24; revised 10-10-24.)
2932	2932	16 Section 15. The Illinois Controlled Substances Act is
2933	2933	17 amended by changing Section 303.05 as follows:
2934	2934	18 (720 ILCS 570/303.05)
2935	2935	19 Sec. 303.05. Mid-level practitioner registration.
2936	2936	20 (a) The Department of Financial and Professional
2937	2937	21 Regulation shall register licensed physician assistants,
2938	2938	22 licensed advanced practice registered nurses, and prescribing
2939	2939	23 psychologists licensed under Section 4.2 of the Clinical
2940	2940	24 Psychologist Licensing Act to prescribe and dispense
2941	2941
2942	2942
2943	2943
2944	2944
2945	2945
2946	2946	SB1743 - 81 - LRB104 11917 AAS 22009 b
2947	2947
2948	2948
2949	2949	SB1743- 82 -LRB104 11917 AAS 22009 b SB1743 - 82 - LRB104 11917 AAS 22009 b
2950	2950	SB1743 - 82 - LRB104 11917 AAS 22009 b
2951	2951	1 controlled substances under Section 303 and euthanasia
2952	2952	2 agencies to purchase, store, or administer animal euthanasia
2953	2953	3 drugs under the following circumstances:
2954	2954	4 (1) with respect to physician assistants,
2955	2955	5 (A) the physician assistant has been delegated
2956	2956	6 written authority to prescribe any Schedule III
2957	2957	7 through V controlled substances by a physician
2958	2958	8 licensed to practice medicine in all its branches in
2959	2959	9 accordance with Section 7.5 of the Physician Assistant
2960	2960	10 Practice Act of 1987; and the physician assistant has
2961	2961	11 completed the appropriate application forms and has
2962	2962	12 paid the required fees as set by rule; or
2963	2963	13 (B) the physician assistant has been delegated
2964	2964	14 authority by a collaborating physician licensed to
2965	2965	15 practice medicine in all its branches to prescribe or
2966	2966	16 dispense Schedule II controlled substances through a
2967	2967	17 written delegation of authority and under the
2968	2968	18 following conditions:
2969	2969	19 (i) Specific Schedule II controlled substances
2970	2970	20 by oral dosage or topical or transdermal
2971	2971	21 application may be delegated, provided that the
2972	2972	22 delegated Schedule II controlled substances are
2973	2973	23 routinely prescribed by the collaborating
2974	2974	24 physician. This delegation must identify the
2975	2975	25 specific Schedule II controlled substances by
2976	2976	26 either brand name or generic name. Schedule II
2977	2977
2978	2978
2979	2979
2980	2980
2981	2981
2982	2982	SB1743 - 82 - LRB104 11917 AAS 22009 b
2983	2983
2984	2984
2985	2985	SB1743- 83 -LRB104 11917 AAS 22009 b SB1743 - 83 - LRB104 11917 AAS 22009 b
2986	2986	SB1743 - 83 - LRB104 11917 AAS 22009 b
2987	2987	1 controlled substances to be delivered by injection
2988	2988	2 or other route of administration may not be
2989	2989	3 delegated;
2990	2990	4 (ii) any delegation must be of controlled
2991	2991	5 substances prescribed by the collaborating
2992	2992	6 physician;
2993	2993	7 (iii) all prescriptions must be limited to no
2994	2994	8 more than a 30-day supply, with any continuation
2995	2995	9 authorized only after prior approval of the
2996	2996	10 collaborating physician;
2997	2997	11 (iv) the physician assistant must discuss the
2998	2998	12 condition of any patients for whom a controlled
2999	2999	13 substance is prescribed monthly with the
3000	3000	14 delegating physician;
3001	3001	15 (v) the physician assistant must have
3002	3002	16 completed the appropriate application forms and
3003	3003	17 paid the required fees as set by rule;
3004	3004	18 (vi) the physician assistant must provide
3005	3005	19 evidence of satisfactory completion of 45 contact
3006	3006	20 hours in pharmacology from any physician assistant
3007	3007	21 program accredited by the Accreditation Review
3008	3008	22 Commission on Education for the Physician
3009	3009	23 Assistant (ARC-PA), or its predecessor agency, for
3010	3010	24 any new license issued with Schedule II authority
3011	3011	25 after the effective date of this amendatory Act of
3012	3012	26 the 97th General Assembly; and
3013	3013
3014	3014
3015	3015
3016	3016
3017	3017
3018	3018	SB1743 - 83 - LRB104 11917 AAS 22009 b
3019	3019
3020	3020
3021	3021	SB1743- 84 -LRB104 11917 AAS 22009 b SB1743 - 84 - LRB104 11917 AAS 22009 b
3022	3022	SB1743 - 84 - LRB104 11917 AAS 22009 b
3023	3023	1 (vii) the physician assistant must annually
3024	3024	2 complete at least 5 hours of continuing education
3025	3025	3 in pharmacology;
3026	3026	4 (2) with respect to advanced practice registered
3027	3027	5 nurses who do not meet the requirements of Section 65-43
3028	3028	6 of the Nurse Practice Act,
3029	3029	7 (A) the advanced practice registered nurse has
3030	3030	8 been delegated authority to prescribe any Schedule III
3031	3031	9 through V controlled substances by a collaborating
3032	3032	10 physician licensed to practice medicine in all its
3033	3033	11 branches or a collaborating podiatric physician in
3034	3034	12 accordance with Section 65-40 of the Nurse Practice
3035	3035	13 Act. The advanced practice registered nurse has
3036	3036	14 completed the appropriate application forms and has
3037	3037	15 paid the required fees as set by rule; or
3038	3038	16 (B) the advanced practice registered nurse has
3039	3039	17 been delegated authority by a collaborating physician
3040	3040	18 licensed to practice medicine in all its branches to
3041	3041	19 prescribe or dispense Schedule II controlled
3042	3042	20 substances through a written delegation of authority
3043	3043	21 and under the following conditions:
3044	3044	22 (i) specific Schedule II controlled substances
3045	3045	23 by oral dosage or topical or transdermal
3046	3046	24 application may be delegated, provided that the
3047	3047	25 delegated Schedule II controlled substances are
3048	3048	26 routinely prescribed by the collaborating
3049	3049
3050	3050
3051	3051
3052	3052
3053	3053
3054	3054	SB1743 - 84 - LRB104 11917 AAS 22009 b
3055	3055
3056	3056
3057	3057	SB1743- 85 -LRB104 11917 AAS 22009 b SB1743 - 85 - LRB104 11917 AAS 22009 b
3058	3058	SB1743 - 85 - LRB104 11917 AAS 22009 b
3059	3059	1 physician. This delegation must identify the
3060	3060	2 specific Schedule II controlled substances by
3061	3061	3 either brand name or generic name. Schedule II
3062	3062	4 controlled substances to be delivered by injection
3063	3063	5 or other route of administration may not be
3064	3064	6 delegated;
3065	3065	7 (ii) any delegation must be of controlled
3066	3066	8 substances prescribed by the collaborating
3067	3067	9 physician;
3068	3068	10 (iii) all prescriptions must be limited to no
3069	3069	11 more than a 30-day supply, with any continuation
3070	3070	12 authorized only after prior approval of the
3071	3071	13 collaborating physician;
3072	3072	14 (iv) the advanced practice registered nurse
3073	3073	15 must discuss the condition of any patients for
3074	3074	16 whom a controlled substance is prescribed monthly
3075	3075	17 with the delegating physician or in the course of
3076	3076	18 review as required by Section 65-40 of the Nurse
3077	3077	19 Practice Act;
3078	3078	20 (v) the advanced practice registered nurse
3079	3079	21 must have completed the appropriate application
3080	3080	22 forms and paid the required fees as set by rule;
3081	3081	23 (vi) the advanced practice registered nurse
3082	3082	24 must provide evidence of satisfactory completion
3083	3083	25 of at least 45 graduate contact hours in
3084	3084	26 pharmacology for any new license issued with
3085	3085
3086	3086
3087	3087
3088	3088
3089	3089
3090	3090	SB1743 - 85 - LRB104 11917 AAS 22009 b
3091	3091
3092	3092
3093	3093	SB1743- 86 -LRB104 11917 AAS 22009 b SB1743 - 86 - LRB104 11917 AAS 22009 b
3094	3094	SB1743 - 86 - LRB104 11917 AAS 22009 b
3095	3095	1 Schedule II authority after the effective date of
3096	3096	2 this amendatory Act of the 97th General Assembly;
3097	3097	3 and
3098	3098	4 (vii) the advanced practice registered nurse
3099	3099	5 must annually complete 5 hours of continuing
3100	3100	6 education in pharmacology;
3101	3101	7 (2.5) with respect to advanced practice registered
3102	3102	8 nurses certified as nurse practitioners, nurse midwives,
3103	3103	9 or clinical nurse specialists who do not meet the
3104	3104	10 requirements of Section 65-43 of the Nurse Practice Act
3105	3105	11 practicing in a hospital affiliate,
3106	3106	12 (A) the advanced practice registered nurse
3107	3107	13 certified as a nurse practitioner, nurse midwife, or
3108	3108	14 clinical nurse specialist has been privileged to
3109	3109	15 prescribe any Schedule II through V controlled
3110	3110	16 substances by the hospital affiliate upon the
3111	3111	17 recommendation of the appropriate physician committee
3112	3112	18 of the hospital affiliate in accordance with Section
3113	3113	19 65-45 of the Nurse Practice Act, has completed the
3114	3114	20 appropriate application forms, and has paid the
3115	3115	21 required fees as set by rule; and
3116	3116	22 (B) an advanced practice registered nurse
3117	3117	23 certified as a nurse practitioner, nurse midwife, or
3118	3118	24 clinical nurse specialist has been privileged to
3119	3119	25 prescribe any Schedule II controlled substances by the
3120	3120	26 hospital affiliate upon the recommendation of the
3121	3121
3122	3122
3123	3123
3124	3124
3125	3125
3126	3126	SB1743 - 86 - LRB104 11917 AAS 22009 b
3127	3127
3128	3128
3129	3129	SB1743- 87 -LRB104 11917 AAS 22009 b SB1743 - 87 - LRB104 11917 AAS 22009 b
3130	3130	SB1743 - 87 - LRB104 11917 AAS 22009 b
3131	3131	1 appropriate physician committee of the hospital
3132	3132	2 affiliate, then the following conditions must be met:
3133	3133	3 (i) specific Schedule II controlled substances
3134	3134	4 by oral dosage or topical or transdermal
3135	3135	5 application may be designated, provided that the
3136	3136	6 designated Schedule II controlled substances are
3137	3137	7 routinely prescribed by advanced practice
3138	3138	8 registered nurses in their area of certification;
3139	3139	9 the privileging documents must identify the
3140	3140	10 specific Schedule II controlled substances by
3141	3141	11 either brand name or generic name; privileges to
3142	3142	12 prescribe or dispense Schedule II controlled
3143	3143	13 substances to be delivered by injection or other
3144	3144	14 route of administration may not be granted;
3145	3145	15 (ii) any privileges must be controlled
3146	3146	16 substances limited to the practice of the advanced
3147	3147	17 practice registered nurse;
3148	3148	18 (iii) any prescription must be limited to no
3149	3149	19 more than a 30-day supply;
3150	3150	20 (iv) the advanced practice registered nurse
3151	3151	21 must discuss the condition of any patients for
3152	3152	22 whom a controlled substance is prescribed monthly
3153	3153	23 with the appropriate physician committee of the
3154	3154	24 hospital affiliate or its physician designee; and
3155	3155	25 (v) the advanced practice registered nurse
3156	3156	26 must meet the education requirements of this
3157	3157
3158	3158
3159	3159
3160	3160
3161	3161
3162	3162	SB1743 - 87 - LRB104 11917 AAS 22009 b
3163	3163
3164	3164
3165	3165	SB1743- 88 -LRB104 11917 AAS 22009 b SB1743 - 88 - LRB104 11917 AAS 22009 b
3166	3166	SB1743 - 88 - LRB104 11917 AAS 22009 b
3167	3167	1 Section;
3168	3168	2 (3) with respect to animal euthanasia agencies, the
3169	3169	3 euthanasia agency has obtained a license from the
3170	3170	4 Department of Financial and Professional Regulation and
3171	3171	5 obtained a registration number from the Department; or
3172	3172	6 (4) with respect to prescribing psychologists, the
3173	3173	7 prescribing psychologist has been delegated authority to
3174	3174	8 prescribe any nonnarcotic, nonopioid Schedule II III
3175	3175	9 through V controlled substances by a collaborating
3176	3176	10 physician licensed to practice medicine in all its
3177	3177	11 branches in accordance with Section 4.3 of the Clinical
3178	3178	12 Psychologist Licensing Act, and the prescribing
3179	3179	13 psychologist has completed the appropriate application
3180	3180	14 forms and has paid the required fees as set by rule.
3181	3181	15 (b) The mid-level practitioner shall only be licensed to
3182	3182	16 prescribe those schedules of controlled substances for which a
3183	3183	17 licensed physician has delegated prescriptive authority,
3184	3184	18 except that an animal euthanasia agency does not have any
3185	3185	19 prescriptive authority. A physician assistant and an advanced
3186	3186	20 practice registered nurse are prohibited from prescribing
3187	3187	21 medications and controlled substances not set forth in the
3188	3188	22 required written delegation of authority or as authorized by
3189	3189	23 their practice Act.
3190	3190	24 (c) Upon completion of all registration requirements,
3191	3191	25 physician assistants, advanced practice registered nurses, and
3192	3192	26 animal euthanasia agencies may be issued a mid-level
3193	3193
3194	3194
3195	3195
3196	3196
3197	3197
3198	3198	SB1743 - 88 - LRB104 11917 AAS 22009 b
3199	3199
3200	3200
3201	3201	SB1743- 89 -LRB104 11917 AAS 22009 b SB1743 - 89 - LRB104 11917 AAS 22009 b
3202	3202	SB1743 - 89 - LRB104 11917 AAS 22009 b
3203	3203	1 practitioner controlled substances license for Illinois.
3204	3204	2 (d) A collaborating physician may, but is not required to,
3205	3205	3 delegate prescriptive authority to an advanced practice
3206	3206	4 registered nurse as part of a written collaborative agreement,
3207	3207	5 and the delegation of prescriptive authority shall conform to
3208	3208	6 the requirements of Section 65-40 of the Nurse Practice Act.
3209	3209	7 (e) A collaborating physician may, but is not required to,
3210	3210	8 delegate prescriptive authority to a physician assistant as
3211	3211	9 part of a written collaborative agreement, and the delegation
3212	3212	10 of prescriptive authority shall conform to the requirements of
3213	3213	11 Section 7.5 of the Physician Assistant Practice Act of 1987.
3214	3214	12 (f) Nothing in this Section shall be construed to prohibit
3215	3215	13 generic substitution.
3216	3216	14 (Source: P.A. 99-173, eff. 7-29-15; 100-453, eff. 8-25-17;
3217	3217	15 100-513, eff. 1-1-18; 100-863, eff. 8-14-18.)
3218	3218	16 Section 95. No acceleration or delay. Where this Act makes
3219	3219	17 changes in a statute that is represented in this Act by text
3220	3220	18 that is not yet or no longer in effect (for example, a Section
3221	3221	19 represented by multiple versions), the use of that text does
3222	3222	20 not accelerate or delay the taking effect of (i) the changes
3223	3223	21 made by this Act or (ii) provisions derived from any other
3224	3224	22 Public Act.
3225	3225
3226	3226
3227	3227
3228	3228
3229	3229
3230	3230	SB1743 - 89 - LRB104 11917 AAS 22009 b