Bill Amendment: IL SB1864 | 2019-2020 | 101st General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: HEALTH CARE AFFORD/INFO/KIDNEY
Status: 2020-07-07 - Public Act . . . . . . . . . 101-0649 [SB1864 Detail]
Download: Illinois-2019-SB1864-House_Amendment_005.html
Bill Title: HEALTH CARE AFFORD/INFO/KIDNEY
Status: 2020-07-07 - Public Act . . . . . . . . . 101-0649 [SB1864 Detail]
Download: Illinois-2019-SB1864-House_Amendment_005.html
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1 | AMENDMENT TO SENATE BILL 1864
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2 | AMENDMENT NO. ______. Amend Senate Bill 1864 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Article 5. Health Care Affordability Act | ||||||
5 | Section 5-1. Short title. This Article may be cited as the | ||||||
6 | Health Care Affordability Act. References in this Article to | ||||||
7 | "this Act" mean this Article.
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8 | Section 5-5. Findings. The General Assembly finds that: | ||||||
9 | (1) The State is committed to improving the health and | ||||||
10 | well-being of Illinois residents and families. | ||||||
11 | (2) Illinois has over 835,000 uninsured residents, | ||||||
12 | with a total uninsured rate of 7.9%. | ||||||
13 | (3) 774,500 of Illinois' uninsured residents are below | ||||||
14 | 400% of the federal poverty level, with higher uninsured | ||||||
15 | rates of more than 13% below 250% of the federal poverty |
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1 | level and an uninsured rate of 8.3% below 400% of the | ||||||
2 | federal poverty level. | ||||||
3 | (4) The cost of health insurance premiums remains a | ||||||
4 | barrier to obtaining health insurance coverage for many | ||||||
5 | Illinois residents and families. | ||||||
6 | (5) Many Illinois residents and families who have | ||||||
7 | health insurance cannot afford to use it due to high | ||||||
8 | deductibles and cost sharing. | ||||||
9 | (6) Improving health insurance affordability is key to | ||||||
10 | increasing health insurance coverage and access. | ||||||
11 | (7) Despite progress made under the Patient Protection | ||||||
12 | and Affordable Care Act, health insurance is still not | ||||||
13 | affordable enough for many Illinois residents and | ||||||
14 | families. | ||||||
15 | (8) Illinois has a lower uninsured rate than the | ||||||
16 | national average of 10.2%, but a higher uninsured rate | ||||||
17 | compared to states that have state-directed policies to | ||||||
18 | improve affordability, including Massachusetts with an | ||||||
19 | uninsured rate of 3.2%. | ||||||
20 | (9) Illinois has an opportunity to create a healthy | ||||||
21 | Illinois where health insurance coverage is more | ||||||
22 | affordable and accessible for all Illinois residents, | ||||||
23 | families, and small businesses.
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24 | Section 5-10. Feasibility study. | ||||||
25 | (a) The Department of Healthcare and Family Services, in |
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1 | consultation with the Department of Insurance, shall oversee a | ||||||
2 | feasibility study to explore options to make health insurance | ||||||
3 | more affordable for low-income and middle-income residents. | ||||||
4 | The study shall include policies targeted at increasing health | ||||||
5 | care affordability and access, including policies being | ||||||
6 | discussed in other states and nationally. The study shall | ||||||
7 | follow the best practices of other states and include an | ||||||
8 | Illinois-specific actuarial and economic analysis of | ||||||
9 | demographic and market dynamics. | ||||||
10 | (b) The study shall produce cost estimates for the policies | ||||||
11 | studied under subsection (a) along with the impact of the | ||||||
12 | policies on health insurance affordability and access and the | ||||||
13 | uninsured rates for low-income and middle-income residents, | ||||||
14 | with break-out data by geography, race, ethnicity, and income | ||||||
15 | level. The study shall evaluate how multiple policies | ||||||
16 | implemented together affect costs and outcomes and how policies | ||||||
17 | could be structured to leverage federal matching funds and | ||||||
18 | federal pass-through awards. | ||||||
19 | (c) The Department of Healthcare and Family Services, in | ||||||
20 | consultation with the Department of Insurance, shall develop | ||||||
21 | and submit no later than February 28, 2021 a report to the | ||||||
22 | General Assembly and the Governor concerning the design, costs, | ||||||
23 | benefits, and implementation of State options to increase | ||||||
24 | access to affordable health care coverage that leverage | ||||||
25 | existing State infrastructure.
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1 | Article 10. Kidney Disease Prevention and Education Task Force | ||||||
2 | Act | ||||||
3 | Section 10-1. Short title. This Article may be cited as the | ||||||
4 | Kidney Disease Prevention and Education Task Force Act. | ||||||
5 | References in this Article to "this Act" mean this Article.
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6 | Section 10-5. Findings. The General Assembly finds that: | ||||||
7 | (1) Chronic kidney disease is the 9th-leading cause of | ||||||
8 | death in the United States. An estimated 31 million people | ||||||
9 | in the United States have chronic kidney disease and over | ||||||
10 | 1.12 million people in the State of Illinois are living | ||||||
11 | with the disease. Early chronic kidney disease has no signs | ||||||
12 | or symptoms and, without early detection, can progress to | ||||||
13 | kidney failure. | ||||||
14 | (2) If a person has high blood pressure, heart disease, | ||||||
15 | diabetes, or a family history of kidney failure, the risk | ||||||
16 | of kidney disease is greater. In Illinois, 13% of all | ||||||
17 | adults have diabetes, and 32% have high blood pressure. The | ||||||
18 | prevalence of diabetes, heart disease, and hypertension is | ||||||
19 | higher for African Americans, who develop kidney failure at | ||||||
20 | a rate of nearly 4 to 1 compared to Caucasians, while | ||||||
21 | Hispanics develop kidney failure at a rate of 2 to 1. | ||||||
22 | Almost half of the people waiting for a kidney in Illinois | ||||||
23 | identify as African American, but, in 2017, less than 10% | ||||||
24 | of them received a kidney. |
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1 | (3) Although dialysis is a life-extending treatment, | ||||||
2 | the best and most cost-effective treatment for kidney | ||||||
3 | failure is a kidney transplant. Currently, the wait in | ||||||
4 | Illinois for a deceased donor kidney is 5-7 years, and 13 | ||||||
5 | people die while waiting every day. | ||||||
6 | (4) If chronic kidney disease is detected early and | ||||||
7 | managed appropriately, the individual can receive | ||||||
8 | treatment sooner to help protect the kidneys, the | ||||||
9 | deterioration in kidney function can be slowed or even | ||||||
10 | stopped, and the risk of associated cardiovascular | ||||||
11 | complications and other complications can be reduced. | ||||||
12 | (5) In light of the COVID-19 pandemic and the increased | ||||||
13 | risk of infection to patients with preexisting conditions, | ||||||
14 | it is imperative to provide those with kidney disease with | ||||||
15 | support.
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16 | Section 10-10. Kidney Disease Prevention and Education | ||||||
17 | Task Force. | ||||||
18 | (a) There is hereby established the Kidney Disease | ||||||
19 | Prevention and Education Task Force to work directly with | ||||||
20 | educational institutions to create health education programs | ||||||
21 | to increase awareness of and to examine chronic kidney disease, | ||||||
22 | transplantations, living and deceased kidney donation, and the | ||||||
23 | existing disparity in the rates of those afflicted between | ||||||
24 | Caucasians and minorities. | ||||||
25 | (b) The Task Force shall develop a sustainable plan to |
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1 | raise awareness about early detection, promote health equity, | ||||||
2 | and reduce the burden of kidney disease throughout the State, | ||||||
3 | which shall include an ongoing campaign that includes health | ||||||
4 | education workshops and seminars, relevant research, and | ||||||
5 | preventive screenings and that promotes social media campaigns | ||||||
6 | and TV and radio commercials. | ||||||
7 | (c) Membership of the Task Force shall be as follows: | ||||||
8 | (1) one member of the Senate, appointed by the Senate | ||||||
9 | President, who shall serve as Co-Chair; | ||||||
10 | (2) one member of the House of Representatives, | ||||||
11 | appointed by the Speaker of the House, who shall serve as | ||||||
12 | Co-Chair; | ||||||
13 | (3) one member of the House of Representatives, | ||||||
14 | appointed by the Minority Leader of the House; | ||||||
15 | (4) one member of the Senate, appointed by the Senate | ||||||
16 | Minority Leader; | ||||||
17 | (5) one member representing the Department of Public | ||||||
18 | Health, appointed by the Governor; | ||||||
19 | (6) one member representing the Department of | ||||||
20 | Healthcare and Family Services, appointed by the Governor; | ||||||
21 | (7) one member representing a medical center in a | ||||||
22 | county with a population of more 3 million residents, | ||||||
23 | appointed by the Co-Chairs; | ||||||
24 | (8) one member representing a physician's association | ||||||
25 | in a county with a population of more than 3 million | ||||||
26 | residents, appointed by the Co-Chairs; |
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1 | (9) one member representing a not-for-profit organ | ||||||
2 | procurement organization, appointed by the Co-Chairs; | ||||||
3 | (10) one member representing a national nonprofit | ||||||
4 | research kidney organization in the State of Illinois, | ||||||
5 | appointed by the Co-Chairs; and | ||||||
6 | (11) the Secretary of State or his or her designee. | ||||||
7 | (d) Members of the Task Force shall serve without | ||||||
8 | compensation. | ||||||
9 | (e) The Department of Public Health shall provide | ||||||
10 | administrative support to the Task Force. | ||||||
11 | (f) The Task Force shall submit its final report to the | ||||||
12 | General Assembly on or before December 31, 2021 and, upon the | ||||||
13 | filing of its final report, is dissolved.
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14 | Section 10-15. Repeal. This Act is repealed on June 1, | ||||||
15 | 2022.
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16 | Article 15. Telehealth During the COVID-19 Pandemic Act | ||||||
17 | Section 15-1. Short title. This Article may be cited as the | ||||||
18 | Telehealth During the COVID-19 Pandemic Act. References in this | ||||||
19 | Article to "this Act" mean this Article.
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20 | Section 15-5. Applicability. | ||||||
21 | (a) This Act does not apply to excepted benefits as defined | ||||||
22 | in 45 CFR 146.145(b) and 45 CFR. 148.220 but does apply to |
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1 | limited scope dental benefits, limited scope vision benefits, | ||||||
2 | long-term care benefits, coverage only for accidents, or | ||||||
3 | coverage only for specified disease or illness. | ||||||
4 | (b) This Act applies to short-term, limited-duration | ||||||
5 | health insurance coverage; fully insured student health | ||||||
6 | insurance coverage; and fully insured association health plans | ||||||
7 | except with respect to excepted benefits. | ||||||
8 | (c) Any policy, contract, or certificate of health | ||||||
9 | insurance coverage that does not distinguish between | ||||||
10 | in-network and out-of-network providers shall be subject to | ||||||
11 | this Act as though all providers were in-network.
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12 | Section 15-10. Definitions. As used in this Act: | ||||||
13 | "Health insurance coverage" has the meaning given to that | ||||||
14 | term in Section 5 of the Illinois Health Insurance Portability | ||||||
15 | and Accountability Act. | ||||||
16 | "Health insurance issuer" has the meaning given to that | ||||||
17 | term in Section 5 of the Illinois Health Insurance Portability | ||||||
18 | and Accountability Act. | ||||||
19 | "Telehealth services" means the provision of health care, | ||||||
20 | psychiatry, mental health treatment, substance use disorder | ||||||
21 | treatment, and related services to a patient, regardless of his | ||||||
22 | or her location, through electronic or telephonic methods, such | ||||||
23 | as telephone (landline or cellular), video technology commonly | ||||||
24 | available on smart phones and other devices, and | ||||||
25 | videoconferencing, as well as any method within the meaning of |
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1 | telehealth services under Section 356z.22 of the Illinois | ||||||
2 | Insurance Code.
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3 | Section 15-15. Coverage for telehealth services during the | ||||||
4 | COVID-19 pandemic. | ||||||
5 | (a) In order to protect the public's health, to permit | ||||||
6 | expedited treatment of health conditions during the COVID-19 | ||||||
7 | pandemic, and to mitigate its impact upon the residents of the | ||||||
8 | State of Illinois, all health insurance issuers regulated by | ||||||
9 | the Department of Insurance shall cover the costs of all | ||||||
10 | telehealth services rendered by in-network providers to | ||||||
11 | deliver any clinically appropriate, medically necessary | ||||||
12 | covered services and treatments to insureds, enrollees, and | ||||||
13 | members under each policy, contract, or certificate of health | ||||||
14 | insurance coverage. | ||||||
15 | (b) Health insurance issuers may establish reasonable | ||||||
16 | requirements and parameters for telehealth services, including | ||||||
17 | with respect to documentation and recordkeeping, to the extent | ||||||
18 | consistent with this Act or any company bulletin subsequently | ||||||
19 | issued by the Department of Insurance under Executive Order | ||||||
20 | 2020-09. A health insurance issuer's requirements and | ||||||
21 | parameters may not be more restrictive or less favorable toward | ||||||
22 | providers, insureds, enrollees, or members than those | ||||||
23 | contained in the emergency rulemaking undertaken by the | ||||||
24 | Department of Healthcare and Family Services at 89 Ill. Adm. | ||||||
25 | Code 140.403(e). Health insurance issuers shall notify |
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1 | providers of any instructions necessary to facilitate billing | ||||||
2 | for telehealth services.
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3 | Section 15-20. Prior authorization and utilization review | ||||||
4 | requirements. | ||||||
5 | (a) In order to ensure that health care is quickly and | ||||||
6 | efficiently provided to the public, health insurance issuers | ||||||
7 | shall not impose upon telehealth services utilization review | ||||||
8 | requirements that are unnecessary, duplicative, or unwarranted | ||||||
9 | nor impose any treatment limitations that are more stringent | ||||||
10 | than the requirements applicable to the same health care | ||||||
11 | service when rendered in-person. | ||||||
12 | (b) For telehealth services that relate to COVID-19 | ||||||
13 | delivered by in-network providers, health insurance issuers | ||||||
14 | shall not impose any prior authorization requirements.
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15 | Section 15-25. Cost-sharing prohibited. Health insurance | ||||||
16 | issuers shall not impose any cost-sharing (copayments, | ||||||
17 | deductibles, or coinsurance) for telehealth services provided | ||||||
18 | by in-network providers. However, in accordance with the | ||||||
19 | standards and definitions in 26 U.S.C. 223, if an enrollee in a | ||||||
20 | high-deductible health plan has not met the applicable | ||||||
21 | deductible under the terms of his or her coverage, the | ||||||
22 | requirements of this Section do not require an issuer to pay | ||||||
23 | for a charge for telehealth services unless the associated | ||||||
24 | health care service for that particular charge is deemed |
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1 | preventive care by the United States Department of the | ||||||
2 | Treasury. The federal Internal Revenue Service has recognized | ||||||
3 | that services for testing, treatment, and any potential | ||||||
4 | vaccination for COVID-19 fall within the scope of preventive | ||||||
5 | care.
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6 | Section 15-30. Eligible services. Services eligible under | ||||||
7 | this Act include services provided by any professional, | ||||||
8 | practitioner, clinician, or other provider who is licensed, | ||||||
9 | certified, registered, or otherwise authorized to practice in | ||||||
10 | the State where the patient receives treatment, subject to the | ||||||
11 | provisions of the Telehealth Act for any health care | ||||||
12 | professional, as defined in the Telehealth Act, who delivers | ||||||
13 | treatment through telehealth to a patient located in this | ||||||
14 | State, and substance use disorder professionals and clinicians | ||||||
15 | authorized by Illinois law to provide substance use disorder | ||||||
16 | services.
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17 | Section 15-35. Mental Health and Developmental | ||||||
18 | Disabilities Confidentiality Act. A covered health care | ||||||
19 | provider or covered entity subject to the requirements of the | ||||||
20 | Mental Health and Developmental Disabilities Confidentiality | ||||||
21 | Act that uses audio or video communication technology to | ||||||
22 | provide telehealth services to mental health and developmental | ||||||
23 | disability patients may use any non-public facing remote | ||||||
24 | communication product in accordance with this Act for the |
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1 | duration of the Gubernatorial Disaster Proclamation issued by | ||||||
2 | the Governor on March 9, 2020 concerning COVID-19 and any | ||||||
3 | subsequent Gubernatorial Disaster Proclamation issued by the | ||||||
4 | Governor concerning COVID-19. Providers and covered entities | ||||||
5 | shall, to the extent feasible, notify patients that third-party | ||||||
6 | applications potentially introduce privacy risks. Providers | ||||||
7 | shall enable all available encryption and privacy modes when | ||||||
8 | using such applications. A public facing video communication | ||||||
9 | application may not be used in the provision of telehealth | ||||||
10 | services by covered health care providers or covered entities.
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11 | Section 15-40. Rulemaking authority. The Department of | ||||||
12 | Insurance may adopt rules to implement the provisions of this | ||||||
13 | Act.
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14 | Section 15-90. Repeal. This Act is repealed on May 1, 2021.
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15 | Article 90. Amendatory Provisions | ||||||
16 | Section 90-5. The Freedom of Information Act is amended by | ||||||
17 | changing Section 7.5 as follows:
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18 | (5 ILCS 140/7.5) | ||||||
19 | Sec. 7.5. Statutory exemptions. To the extent provided for | ||||||
20 | by the statutes referenced below, the following shall be exempt | ||||||
21 | from inspection and copying: |
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1 | (a) All information determined to be confidential | ||||||
2 | under Section 4002 of the Technology Advancement and | ||||||
3 | Development Act. | ||||||
4 | (b) Library circulation and order records identifying | ||||||
5 | library users with specific materials under the Library | ||||||
6 | Records Confidentiality Act. | ||||||
7 | (c) Applications, related documents, and medical | ||||||
8 | records received by the Experimental Organ Transplantation | ||||||
9 | Procedures Board and any and all documents or other records | ||||||
10 | prepared by the Experimental Organ Transplantation | ||||||
11 | Procedures Board or its staff relating to applications it | ||||||
12 | has received. | ||||||
13 | (d) Information and records held by the Department of | ||||||
14 | Public Health and its authorized representatives relating | ||||||
15 | to known or suspected cases of sexually transmissible | ||||||
16 | disease or any information the disclosure of which is | ||||||
17 | restricted under the Illinois Sexually Transmissible | ||||||
18 | Disease Control Act. | ||||||
19 | (e) Information the disclosure of which is exempted | ||||||
20 | under Section 30 of the Radon Industry Licensing Act. | ||||||
21 | (f) Firm performance evaluations under Section 55 of | ||||||
22 | the Architectural, Engineering, and Land Surveying | ||||||
23 | Qualifications Based Selection Act. | ||||||
24 | (g) Information the disclosure of which is restricted | ||||||
25 | and exempted under Section 50 of the Illinois Prepaid | ||||||
26 | Tuition Act. |
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1 | (h) Information the disclosure of which is exempted | ||||||
2 | under the State Officials and Employees Ethics Act, and | ||||||
3 | records of any lawfully created State or local inspector | ||||||
4 | general's office that would be exempt if created or | ||||||
5 | obtained by an Executive Inspector General's office under | ||||||
6 | that Act. | ||||||
7 | (i) Information contained in a local emergency energy | ||||||
8 | plan submitted to a municipality in accordance with a local | ||||||
9 | emergency energy plan ordinance that is adopted under | ||||||
10 | Section 11-21.5-5 of the Illinois Municipal Code. | ||||||
11 | (j) Information and data concerning the distribution | ||||||
12 | of surcharge moneys collected and remitted by carriers | ||||||
13 | under the Emergency Telephone System Act. | ||||||
14 | (k) Law enforcement officer identification information | ||||||
15 | or driver identification information compiled by a law | ||||||
16 | enforcement agency or the Department of Transportation | ||||||
17 | under Section 11-212 of the Illinois Vehicle Code. | ||||||
18 | (l) Records and information provided to a residential | ||||||
19 | health care facility resident sexual assault and death | ||||||
20 | review team or the Executive Council under the Abuse | ||||||
21 | Prevention Review Team Act. | ||||||
22 | (m) Information provided to the predatory lending | ||||||
23 | database created pursuant to Article 3 of the Residential | ||||||
24 | Real Property Disclosure Act, except to the extent | ||||||
25 | authorized under that Article. | ||||||
26 | (n) Defense budgets and petitions for certification of |
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1 | compensation and expenses for court appointed trial | ||||||
2 | counsel as provided under Sections 10 and 15 of the Capital | ||||||
3 | Crimes Litigation Act. This subsection (n) shall apply | ||||||
4 | until the conclusion of the trial of the case, even if the | ||||||
5 | prosecution chooses not to pursue the death penalty prior | ||||||
6 | to trial or sentencing. | ||||||
7 | (o) Information that is prohibited from being | ||||||
8 | disclosed under Section 4 of the Illinois Health and | ||||||
9 | Hazardous Substances Registry Act. | ||||||
10 | (p) Security portions of system safety program plans, | ||||||
11 | investigation reports, surveys, schedules, lists, data, or | ||||||
12 | information compiled, collected, or prepared by or for the | ||||||
13 | Regional Transportation Authority under Section 2.11 of | ||||||
14 | the Regional Transportation Authority Act or the St. Clair | ||||||
15 | County Transit District under the Bi-State Transit Safety | ||||||
16 | Act. | ||||||
17 | (q) Information prohibited from being disclosed by the | ||||||
18 | Personnel Record Review Act. | ||||||
19 | (r) Information prohibited from being disclosed by the | ||||||
20 | Illinois School Student Records Act. | ||||||
21 | (s) Information the disclosure of which is restricted | ||||||
22 | under Section 5-108 of the Public Utilities Act.
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23 | (t) All identified or deidentified health information | ||||||
24 | in the form of health data or medical records contained in, | ||||||
25 | stored in, submitted to, transferred by, or released from | ||||||
26 | the Illinois Health Information Exchange, and identified |
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1 | or deidentified health information in the form of health | ||||||
2 | data and medical records of the Illinois Health Information | ||||||
3 | Exchange in the possession of the Illinois Health | ||||||
4 | Information Exchange Office Authority due to its | ||||||
5 | administration of the Illinois Health Information | ||||||
6 | Exchange. The terms "identified" and "deidentified" shall | ||||||
7 | be given the same meaning as in the Health Insurance | ||||||
8 | Portability and Accountability Act of 1996, Public Law | ||||||
9 | 104-191, or any subsequent amendments thereto, and any | ||||||
10 | regulations promulgated thereunder. | ||||||
11 | (u) Records and information provided to an independent | ||||||
12 | team of experts under the Developmental Disability and | ||||||
13 | Mental Health Safety Act (also known as Brian's Law). | ||||||
14 | (v) Names and information of people who have applied | ||||||
15 | for or received Firearm Owner's Identification Cards under | ||||||
16 | the Firearm Owners Identification Card Act or applied for | ||||||
17 | or received a concealed carry license under the Firearm | ||||||
18 | Concealed Carry Act, unless otherwise authorized by the | ||||||
19 | Firearm Concealed Carry Act; and databases under the | ||||||
20 | Firearm Concealed Carry Act, records of the Concealed Carry | ||||||
21 | Licensing Review Board under the Firearm Concealed Carry | ||||||
22 | Act, and law enforcement agency objections under the | ||||||
23 | Firearm Concealed Carry Act. | ||||||
24 | (w) Personally identifiable information which is | ||||||
25 | exempted from disclosure under subsection (g) of Section | ||||||
26 | 19.1 of the Toll Highway Act. |
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1 | (x) Information which is exempted from disclosure | ||||||
2 | under Section 5-1014.3 of the Counties Code or Section | ||||||
3 | 8-11-21 of the Illinois Municipal Code. | ||||||
4 | (y) Confidential information under the Adult | ||||||
5 | Protective Services Act and its predecessor enabling | ||||||
6 | statute, the Elder Abuse and Neglect Act, including | ||||||
7 | information about the identity and administrative finding | ||||||
8 | against any caregiver of a verified and substantiated | ||||||
9 | decision of abuse, neglect, or financial exploitation of an | ||||||
10 | eligible adult maintained in the Registry established | ||||||
11 | under Section 7.5 of the Adult Protective Services Act. | ||||||
12 | (z) Records and information provided to a fatality | ||||||
13 | review team or the Illinois Fatality Review Team Advisory | ||||||
14 | Council under Section 15 of the Adult Protective Services | ||||||
15 | Act. | ||||||
16 | (aa) Information which is exempted from disclosure | ||||||
17 | under Section 2.37 of the Wildlife Code. | ||||||
18 | (bb) Information which is or was prohibited from | ||||||
19 | disclosure by the Juvenile Court Act of 1987. | ||||||
20 | (cc) Recordings made under the Law Enforcement | ||||||
21 | Officer-Worn Body Camera Act, except to the extent | ||||||
22 | authorized under that Act. | ||||||
23 | (dd) Information that is prohibited from being | ||||||
24 | disclosed under Section 45 of the Condominium and Common | ||||||
25 | Interest Community Ombudsperson Act. | ||||||
26 | (ee) Information that is exempted from disclosure |
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1 | under Section 30.1 of the Pharmacy Practice Act. | ||||||
2 | (ff) Information that is exempted from disclosure | ||||||
3 | under the Revised Uniform Unclaimed Property Act. | ||||||
4 | (gg) Information that is prohibited from being | ||||||
5 | disclosed under Section 7-603.5 of the Illinois Vehicle | ||||||
6 | Code. | ||||||
7 | (hh) Records that are exempt from disclosure under | ||||||
8 | Section 1A-16.7 of the Election Code. | ||||||
9 | (ii) Information which is exempted from disclosure | ||||||
10 | under Section 2505-800 of the Department of Revenue Law of | ||||||
11 | the Civil Administrative Code of Illinois. | ||||||
12 | (jj) Information and reports that are required to be | ||||||
13 | submitted to the Department of Labor by registering day and | ||||||
14 | temporary labor service agencies but are exempt from | ||||||
15 | disclosure under subsection (a-1) of Section 45 of the Day | ||||||
16 | and Temporary Labor Services Act. | ||||||
17 | (kk) Information prohibited from disclosure under the | ||||||
18 | Seizure and Forfeiture Reporting Act. | ||||||
19 | (ll) Information the disclosure of which is restricted | ||||||
20 | and exempted under Section 5-30.8 of the Illinois Public | ||||||
21 | Aid Code. | ||||||
22 | (mm) Records that are exempt from disclosure under | ||||||
23 | Section 4.2 of the Crime Victims Compensation Act. | ||||||
24 | (nn) Information that is exempt from disclosure under | ||||||
25 | Section 70 of the Higher Education Student Assistance Act. | ||||||
26 | (oo) Communications, notes, records, and reports |
| |||||||
| |||||||
1 | arising out of a peer support counseling session prohibited | ||||||
2 | from disclosure under the First Responders Suicide | ||||||
3 | Prevention Act. | ||||||
4 | (pp) Names and all identifying information relating to | ||||||
5 | an employee of an emergency services provider or law | ||||||
6 | enforcement agency under the First Responders Suicide | ||||||
7 | Prevention Act. | ||||||
8 | (qq) Information and records held by the Department of | ||||||
9 | Public Health and its authorized representatives collected | ||||||
10 | under the Reproductive Health Act. | ||||||
11 | (rr) Information that is exempt from disclosure under | ||||||
12 | the Cannabis Regulation and Tax Act. | ||||||
13 | (ss) Data reported by an employer to the Department of | ||||||
14 | Human Rights pursuant to Section 2-108 of the Illinois | ||||||
15 | Human Rights Act. | ||||||
16 | (tt) Recordings made under the Children's Advocacy | ||||||
17 | Center Act, except to the extent authorized under that Act. | ||||||
18 | (uu) Information that is exempt from disclosure under | ||||||
19 | Section 50 of the Sexual Assault Evidence Submission Act. | ||||||
20 | (vv) Information that is exempt from disclosure under | ||||||
21 | subsections (f) and (j) of Section 5-36 of the Illinois | ||||||
22 | Public Aid Code. | ||||||
23 | (ww) Information that is exempt from disclosure under | ||||||
24 | Section 16.8 of the State Treasurer Act. | ||||||
25 | (xx) Information that is exempt from disclosure or | ||||||
26 | information that shall not be made public under the |
| |||||||
| |||||||
1 | Illinois Insurance Code. | ||||||
2 | (yy) (oo) Information prohibited from being disclosed | ||||||
3 | under the Illinois Educational Labor Relations Act. | ||||||
4 | (zz) (pp) Information prohibited from being disclosed | ||||||
5 | under the Illinois Public Labor Relations Act. | ||||||
6 | (aaa) (qq) Information prohibited from being disclosed | ||||||
7 | under Section 1-167 of the Illinois Pension Code. | ||||||
8 | (Source: P.A. 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; | ||||||
9 | 100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. | ||||||
10 | 8-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517, | ||||||
11 | eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19; | ||||||
12 | 100-863, eff. 8-14-18; 100-887, eff. 8-14-18; 101-13, eff. | ||||||
13 | 6-12-19; 101-27, eff. 6-25-19; 101-81, eff. 7-12-19; 101-221, | ||||||
14 | eff. 1-1-20; 101-236, eff. 1-1-20; 101-375, eff. 8-16-19; | ||||||
15 | 101-377, eff. 8-16-19; 101-452, eff. 1-1-20; 101-466, eff. | ||||||
16 | 1-1-20; 101-600, eff. 12-6-19; 101-620, eff 12-20-19; revised | ||||||
17 | 1-6-20.)
| ||||||
18 | Section 90-10. The Illinois Health Information Exchange | ||||||
19 | and Technology Act is amended by changing Sections 10, 20, 25, | ||||||
20 | 30, 35, and 40, as follows:
| ||||||
21 | (20 ILCS 3860/10) | ||||||
22 | (Section scheduled to be repealed on January 1, 2021)
| ||||||
23 | Sec. 10. Creation of the Health Information Exchange Office | ||||||
24 | Authority . There is hereby created the Illinois Health |
| |||||||
| |||||||
1 | Information Exchange Office ("Office") Authority | ||||||
2 | ("Authority") , which is hereby constituted as an | ||||||
3 | instrumentality and an administrative agency of the State of | ||||||
4 | Illinois. | ||||||
5 | As part of its program to promote, develop, and sustain | ||||||
6 | health information exchange at the State level, the Office | ||||||
7 | Authority shall do the following: | ||||||
8 | (1) Establish the Illinois Health Information Exchange | ||||||
9 | ("ILHIE"), to promote and facilitate the sharing of health | ||||||
10 | information among health care providers within Illinois | ||||||
11 | and in other states. ILHIE shall be an entity operated by | ||||||
12 | the Office Authority to serve as a State-level electronic | ||||||
13 | medical records exchange providing for the transfer of | ||||||
14 | health information, medical records, and other health data | ||||||
15 | in a secure environment for the benefit of patient care, | ||||||
16 | patient safety, reduction of duplicate medical tests, | ||||||
17 | reduction of administrative costs, and any other benefits | ||||||
18 | deemed appropriate by the Office Authority . | ||||||
19 | (2) Foster the widespread adoption of electronic | ||||||
20 | health records and participation in the ILHIE.
| ||||||
21 | (Source: P.A. 96-1331, eff. 7-27-10.)
| ||||||
22 | (20 ILCS 3860/20) | ||||||
23 | (Section scheduled to be repealed on January 1, 2021)
| ||||||
24 | Sec. 20. Powers and duties of the Illinois Health | ||||||
25 | Information Exchange Office Authority . The Office Authority |
| |||||||
| |||||||
1 | has the following powers, together with all powers incidental | ||||||
2 | or necessary to accomplish the purposes of this Act: | ||||||
3 | (1) The Office Authority shall create and administer | ||||||
4 | the ILHIE using information systems and processes that are | ||||||
5 | secure, are cost effective, and meet all other relevant | ||||||
6 | privacy and security requirements under State and federal | ||||||
7 | law.
| ||||||
8 | (2) The Office Authority shall establish and adopt | ||||||
9 | standards and requirements for the use of health | ||||||
10 | information and the requirements for participation in the | ||||||
11 | ILHIE by persons or entities including, but not limited to, | ||||||
12 | health care providers, payors, and local health | ||||||
13 | information exchanges.
| ||||||
14 | (3) The Office Authority shall establish minimum | ||||||
15 | standards for accessing the ILHIE to ensure that the | ||||||
16 | appropriate security and privacy protections apply to | ||||||
17 | health information, consistent with applicable federal and | ||||||
18 | State standards and laws. The Office Authority shall have | ||||||
19 | the power to suspend, limit, or terminate the right to | ||||||
20 | participate in the ILHIE for non-compliance or failure to | ||||||
21 | act, with respect to applicable standards and laws, in the | ||||||
22 | best interests of patients, users of the ILHIE, or the | ||||||
23 | public. The Office Authority may seek all remedies allowed | ||||||
24 | by law to address any violation of the terms of | ||||||
25 | participation in the ILHIE.
| ||||||
26 | (4) The Office Authority shall identify barriers to the |
| |||||||
| |||||||
1 | adoption of electronic health records systems, including | ||||||
2 | researching the rates and patterns of dissemination and use | ||||||
3 | of electronic health record systems throughout the State. | ||||||
4 | The Office Authority shall make the results of the research | ||||||
5 | available on the Department of Healthcare and Family | ||||||
6 | Services' website its website .
| ||||||
7 | (5) The Office Authority shall prepare educational | ||||||
8 | materials and educate the general public on the benefits of | ||||||
9 | electronic health records, the ILHIE, and the safeguards | ||||||
10 | available to prevent unauthorized disclosure of health | ||||||
11 | information.
| ||||||
12 | (6) The Office Authority may appoint or designate an | ||||||
13 | institutional review board in accordance with federal and | ||||||
14 | State law to review and approve requests for research in | ||||||
15 | order to ensure compliance with standards and patient | ||||||
16 | privacy and security protections as specified in paragraph | ||||||
17 | (3) of this Section.
| ||||||
18 | (7) The Office Authority may enter into all contracts | ||||||
19 | and agreements necessary or incidental to the performance | ||||||
20 | of its powers under this Act. The Office's Authority's | ||||||
21 | expenditures of private funds are exempt from the Illinois | ||||||
22 | Procurement Code, pursuant to Section 1-10 of that Act. | ||||||
23 | Notwithstanding this exception, the Office Authority shall | ||||||
24 | comply with the Business Enterprise for Minorities, Women, | ||||||
25 | and Persons with Disabilities Act.
| ||||||
26 | (8) The Office Authority may solicit and accept grants, |
| |||||||
| |||||||
1 | loans, contributions, or appropriations from any public or | ||||||
2 | private source and may expend those moneys, through | ||||||
3 | contracts, grants, loans, or agreements, on activities it | ||||||
4 | considers suitable to the performance of its duties under | ||||||
5 | this Act.
| ||||||
6 | (9) The Office Authority may determine, charge, and | ||||||
7 | collect any fees, charges, costs, and expenses from any | ||||||
8 | healthcare provider or entity in connection with its duties | ||||||
9 | under this Act. Moneys collected under this paragraph (9) | ||||||
10 | shall be deposited into the Health Information Exchange | ||||||
11 | Fund.
| ||||||
12 | (10) The Office Authority may , under the direction of | ||||||
13 | the Executive Director, employ and discharge staff, | ||||||
14 | including administrative, technical, expert, professional, | ||||||
15 | and legal staff, as is necessary or convenient to carry out | ||||||
16 | the purposes of this Act and as authorized by the Personnel | ||||||
17 | Code . The Authority may establish and administer standards | ||||||
18 | of classification regarding compensation, benefits, | ||||||
19 | duties, performance, and tenure for that staff and may | ||||||
20 | enter into contracts of employment with members of that | ||||||
21 | staff for such periods and on such terms as the Authority | ||||||
22 | deems desirable. All employees of the Authority are exempt | ||||||
23 | from the Personnel Code as provided by Section 4 of the | ||||||
24 | Personnel Code. | ||||||
25 | (10.5) Staff employed by the Illinois Health | ||||||
26 | Information Exchange Authority on the effective date of |
| |||||||
| |||||||
1 | this amendatory Act of the 101st General Assembly shall | ||||||
2 | transfer to the Office within the Department of Healthcare | ||||||
3 | and Family Services. | ||||||
4 | (10.6) The status and rights of employees transferring | ||||||
5 | from the Illinois Health Information Exchange Authority | ||||||
6 | under paragraph (10.5) shall not be affected by such | ||||||
7 | transfer except that, notwithstanding any other State law | ||||||
8 | to the contrary, those employees shall maintain their | ||||||
9 | seniority and their positions shall convert to titles of | ||||||
10 | comparable organizational level under the Personnel Code | ||||||
11 | and become subject to the Personnel Code. Other than the | ||||||
12 | changes described in this paragraph, the rights of | ||||||
13 | employees, the State of Illinois, and State agencies under | ||||||
14 | the Personnel Code or under any pension, retirement, or | ||||||
15 | annuity plan shall not be affected by this amendatory Act | ||||||
16 | of the 101st General Assembly. Transferring personnel | ||||||
17 | shall continue their service within the Office. | ||||||
18 | (11) The Office Authority shall consult and coordinate | ||||||
19 | with the Department of Public Health to further the | ||||||
20 | Office's Authority's collection of health information from | ||||||
21 | health care providers for public health purposes. The | ||||||
22 | collection of public health information shall include | ||||||
23 | identifiable information for use by the Office Authority or | ||||||
24 | other State agencies to comply with State and federal laws. | ||||||
25 | Any identifiable information so collected shall be | ||||||
26 | privileged and confidential in accordance with Sections |
| |||||||
| |||||||
1 | 8-2101, 8-2102, 8-2103, 8-2104, and 8-2105 of the Code of | ||||||
2 | Civil Procedure.
| ||||||
3 | (12) All identified or deidentified health information | ||||||
4 | in the form of health data or medical records contained in, | ||||||
5 | stored in, submitted to, transferred by, or released from | ||||||
6 | the Illinois Health Information Exchange, and identified | ||||||
7 | or deidentified health information in the form of health | ||||||
8 | data and medical records of the Illinois Health Information | ||||||
9 | Exchange in the possession of the Illinois Health | ||||||
10 | Information Exchange Office Authority due to its | ||||||
11 | administration of the Illinois Health Information | ||||||
12 | Exchange, shall be exempt from inspection and copying under | ||||||
13 | the Freedom of Information Act. The terms "identified" and | ||||||
14 | "deidentified" shall be given the same meaning as in the | ||||||
15 | Health Insurance Portability and Accountability Act of | ||||||
16 | 1996, Public Law 104-191, or any subsequent amendments | ||||||
17 | thereto, and any regulations promulgated thereunder.
| ||||||
18 | (13) To address gaps in the adoption of, workforce | ||||||
19 | preparation for, and exchange of electronic health records | ||||||
20 | that result in regional and socioeconomic disparities in | ||||||
21 | the delivery of care, the Office Authority may evaluate | ||||||
22 | such gaps and provide resources as available, giving | ||||||
23 | priority to healthcare providers serving a significant | ||||||
24 | percentage of Medicaid or uninsured patients and in | ||||||
25 | medically underserved or rural areas.
| ||||||
26 | (14) The Office shall perform its duties under this Act |
| |||||||
| |||||||
1 | in consultation with the Office of the Governor and with | ||||||
2 | the Departments of Public Health, Insurance, and Human | ||||||
3 | Services. | ||||||
4 | (Source: P.A. 99-642, eff. 7-28-16; 100-391, eff. 8-25-17.)
| ||||||
5 | (20 ILCS 3860/25) | ||||||
6 | (Section scheduled to be repealed on January 1, 2021)
| ||||||
7 | Sec. 25. Health Information Exchange Fund. | ||||||
8 | (a) The Health Information Exchange Fund (the "Fund") is | ||||||
9 | created as a separate fund outside the State treasury. Moneys | ||||||
10 | in the Fund are not subject to appropriation by the General | ||||||
11 | Assembly. The State Treasurer shall be ex-officio custodian of | ||||||
12 | the Fund. Revenues arising from the operation and | ||||||
13 | administration of the Office Authority and the ILHIE shall be | ||||||
14 | deposited into the Fund. Fees, charges, State and federal | ||||||
15 | moneys, grants, donations, gifts, interest, or other moneys | ||||||
16 | shall be deposited into the Fund. "Private funds" means gifts, | ||||||
17 | donations, and private grants. | ||||||
18 | (b) The Office Authority is authorized to spend moneys in | ||||||
19 | the Fund on activities suitable to the performance of its | ||||||
20 | duties as provided in Section 20 of this Act and authorized by | ||||||
21 | this Act. Disbursements may be made from the Fund for purposes | ||||||
22 | related to the operations and functions of the Office Authority | ||||||
23 | and the ILHIE. | ||||||
24 | (c) The Illinois General Assembly may appropriate moneys to | ||||||
25 | the Office Authority and the ILHIE, and those moneys shall be |
| |||||||
| |||||||
1 | deposited into the Fund. | ||||||
2 | (d) The Fund is not subject to administrative charges or | ||||||
3 | charge-backs, including but not limited to those authorized | ||||||
4 | under Section 8h of the State Finance Act. | ||||||
5 | (e) The Office's Authority's accounts and books shall be | ||||||
6 | set up and maintained in accordance with the Office of the | ||||||
7 | Comptroller's requirements, and the Authority's Executive | ||||||
8 | Director of the Department of Healthcare and Family Services | ||||||
9 | shall be responsible for the approval of recording of receipts, | ||||||
10 | approval of payments, and proper filing of required reports. | ||||||
11 | The moneys held and made available by the Office Authority | ||||||
12 | shall be subject to financial and compliance audits by the | ||||||
13 | Auditor General in compliance with the Illinois State Auditing | ||||||
14 | Act.
| ||||||
15 | (Source: P.A. 96-1331, eff. 7-27-10.)
| ||||||
16 | (20 ILCS 3860/30) | ||||||
17 | (Section scheduled to be repealed on January 1, 2021)
| ||||||
18 | Sec. 30. Participation in health information systems | ||||||
19 | maintained by State agencies. | ||||||
20 | (a) By no later than January 1, 2015, each State agency | ||||||
21 | that implements, acquires, or upgrades health information | ||||||
22 | technology systems shall use health information technology | ||||||
23 | systems and products that meet minimum standards adopted by the | ||||||
24 | Office Authority for accessing the ILHIE. State agencies that | ||||||
25 | have health information which supports and develops the ILHIE |
| |||||||
| |||||||
1 | shall provide access to patient-specific data to complete the | ||||||
2 | patient record at the ILHIE. Notwithstanding any other | ||||||
3 | provision of State law, the State agencies shall provide | ||||||
4 | patient-specific data to the ILHIE. | ||||||
5 | (b) Participation in the ILHIE shall have no impact on the | ||||||
6 | content of or use or disclosure of health information of | ||||||
7 | patient participants that is held in locations other than the | ||||||
8 | ILHIE. Nothing in this Act shall limit or change an entity's | ||||||
9 | obligation to exchange health information in accordance with | ||||||
10 | applicable federal and State laws and standards.
| ||||||
11 | (Source: P.A. 96-1331, eff. 7-27-10.)
| ||||||
12 | (20 ILCS 3860/35) | ||||||
13 | (Section scheduled to be repealed on January 1, 2021)
| ||||||
14 | Sec. 35. Illinois Administrative Procedure Act. The | ||||||
15 | provisions of the Illinois Administrative Procedure Act are | ||||||
16 | hereby expressly adopted and shall apply to all administrative | ||||||
17 | rules and procedures of the Office Authority , except that | ||||||
18 | Section 5-35 of the Illinois Administrative Procedure Act | ||||||
19 | relating to procedures for rulemaking does not apply to the | ||||||
20 | adoption of any rule required by federal law when the Office | ||||||
21 | Authority is precluded by that law from exercising any | ||||||
22 | discretion regarding that rule.
| ||||||
23 | (Source: P.A. 96-1331, eff. 7-27-10.)
| ||||||
24 | (20 ILCS 3860/40) |
| |||||||
| |||||||
1 | (Section scheduled to be repealed on January 1, 2021)
| ||||||
2 | Sec. 40. Reliance on data. Any health care provider who | ||||||
3 | relies in good faith upon any information provided through the | ||||||
4 | ILHIE in his, her, or its treatment of a patient shall be | ||||||
5 | immune from criminal or civil liability or professional | ||||||
6 | discipline arising from any damages caused by such good faith | ||||||
7 | reliance. This immunity does not apply to acts or omissions | ||||||
8 | constituting gross negligence or reckless, wanton, or | ||||||
9 | intentional misconduct. Notwithstanding this provision, the | ||||||
10 | Office Authority does not waive any immunities provided under | ||||||
11 | State or federal law.
| ||||||
12 | (Source: P.A. 98-1046, eff. 1-1-15 .)
| ||||||
13 | (20 ILCS 3860/15 rep.) | ||||||
14 | Section 90-15. The Illinois Health Information Exchange | ||||||
15 | and Technology Act is amended by repealing Section 15.
| ||||||
16 | Section 90-20. The Children's Health Insurance Program Act | ||||||
17 | is amended by changing Section 7 and by adding Section 8 as | ||||||
18 | follows:
| ||||||
19 | (215 ILCS 106/7) | ||||||
20 | Sec. 7. Eligibility verification. Notwithstanding any | ||||||
21 | other provision of this Act, with respect to applications for | ||||||
22 | benefits provided under the Program, eligibility shall be | ||||||
23 | determined in a manner that ensures program integrity and that |
| |||||||
| |||||||
1 | complies with federal law and regulations while minimizing | ||||||
2 | unnecessary barriers to enrollment. To this end, as soon as | ||||||
3 | practicable, and unless the Department receives written denial | ||||||
4 | from the federal government, this Section shall be implemented: | ||||||
5 | (a) The Department of Healthcare and Family Services or its | ||||||
6 | designees shall: | ||||||
7 | (1) By no later than July 1, 2011, require verification | ||||||
8 | of, at a minimum, one month's income from all sources | ||||||
9 | required for determining the eligibility of applicants to | ||||||
10 | the Program. Such verification shall take the form of pay | ||||||
11 | stubs, business or income and expense records for | ||||||
12 | self-employed persons, letters from employers, and any | ||||||
13 | other valid documentation of income including data | ||||||
14 | obtained electronically by the Department or its designees | ||||||
15 | from other sources as described in subsection (b) of this | ||||||
16 | Section. A month's income may be verified by a single pay | ||||||
17 | stub with the monthly income extrapolated from the time | ||||||
18 | period covered by the pay stub. | ||||||
19 | (2) By no later than October 1, 2011, require | ||||||
20 | verification of, at a minimum, one month's income from all | ||||||
21 | sources required for determining the continued eligibility | ||||||
22 | of recipients at their annual review of eligibility under | ||||||
23 | the Program. Such verification shall take the form of pay | ||||||
24 | stubs, business or income and expense records for | ||||||
25 | self-employed persons, letters from employers, and any | ||||||
26 | other valid documentation of income including data |
| |||||||
| |||||||
1 | obtained electronically by the Department or its designees | ||||||
2 | from other sources as described in subsection (b) of this | ||||||
3 | Section. A month's income may be verified by a single pay | ||||||
4 | stub with the monthly income extrapolated from the time | ||||||
5 | period covered by the pay stub. The Department shall send a | ||||||
6 | notice to the recipient at least 60 days prior to the end | ||||||
7 | of the period of eligibility that informs them of the | ||||||
8 | requirements for continued eligibility. Information the | ||||||
9 | Department receives prior to the annual review, including | ||||||
10 | information available to the Department as a result of the | ||||||
11 | recipient's application for other non-health care | ||||||
12 | benefits, that is sufficient to make a determination of | ||||||
13 | continued eligibility for medical assistance or for | ||||||
14 | benefits provided under the Program may be reviewed and | ||||||
15 | verified, and subsequent action taken including client | ||||||
16 | notification of continued eligibility for medical | ||||||
17 | assistance or for benefits provided under the Program. The | ||||||
18 | date of client notification establishes the date for | ||||||
19 | subsequent annual eligibility reviews. If a recipient does | ||||||
20 | not fulfill the requirements for continued eligibility by | ||||||
21 | the deadline established in the notice, a notice of | ||||||
22 | cancellation shall be issued to the recipient and coverage | ||||||
23 | shall end no later than the last day of the month following | ||||||
24 | the last day of the eligibility period. A recipient's | ||||||
25 | eligibility may be reinstated without requiring a new | ||||||
26 | application if the recipient fulfills the requirements for |
| |||||||
| |||||||
1 | continued eligibility prior to the end of the third month | ||||||
2 | following the last date of coverage (or longer period if | ||||||
3 | required by federal regulations). Nothing in this Section | ||||||
4 | shall prevent an individual whose coverage has been | ||||||
5 | cancelled from reapplying for health benefits at any time. | ||||||
6 | (3) By no later than July 1, 2011, require verification | ||||||
7 | of Illinois residency. | ||||||
8 | (b) The Department shall establish or continue cooperative
| ||||||
9 | arrangements with the Social Security Administration, the
| ||||||
10 | Illinois Secretary of State, the Department of Human Services,
| ||||||
11 | the Department of Revenue, the Department of Employment | ||||||
12 | Security, and any other appropriate entity to gain electronic
| ||||||
13 | access, to the extent allowed by law, to information available | ||||||
14 | to those entities that may be appropriate for electronically
| ||||||
15 | verifying any factor of eligibility for benefits under the
| ||||||
16 | Program. Data relevant to eligibility shall be provided for no
| ||||||
17 | other purpose than to verify the eligibility of new applicants | ||||||
18 | or current recipients of health benefits under the Program. | ||||||
19 | Data will be requested or provided for any new applicant or | ||||||
20 | current recipient only insofar as that individual's | ||||||
21 | circumstances are relevant to that individual's or another | ||||||
22 | individual's eligibility. | ||||||
23 | (c) Within 90 days of the effective date of this amendatory | ||||||
24 | Act of the 96th General Assembly, the Department of Healthcare | ||||||
25 | and Family Services shall send notice to current recipients | ||||||
26 | informing them of the changes regarding their eligibility |
| |||||||
| |||||||
1 | verification.
| ||||||
2 | (Source: P.A. 101-209, eff. 8-5-19.)
| ||||||
3 | (215 ILCS 106/8 new) | ||||||
4 | Sec. 8. COVID-19 public health emergency. Notwithstanding | ||||||
5 | any other provision of this Act, the Department may take | ||||||
6 | necessary actions to address the COVID-19 public health | ||||||
7 | emergency to the extent such actions are required, approved, or | ||||||
8 | authorized by the United States Department of Health and Human | ||||||
9 | Services, Centers for Medicare and Medicaid Services. Such | ||||||
10 | actions may continue throughout the public health emergency and | ||||||
11 | for up to 12 months after the period ends, and may include, but | ||||||
12 | are not limited to: accepting an applicant's or recipient's | ||||||
13 | attestation of income, incurred medical expenses, residency, | ||||||
14 | and insured status when electronic verification is not | ||||||
15 | available; eliminating resource tests for some eligibility | ||||||
16 | determinations; suspending redeterminations; suspending | ||||||
17 | changes that would adversely affect an applicant's or | ||||||
18 | recipient's eligibility; phone or verbal approval by an | ||||||
19 | applicant to submit an application in lieu of applicant | ||||||
20 | signature; allowing adult presumptive eligibility; allowing | ||||||
21 | presumptive eligibility for children, pregnant women, and | ||||||
22 | adults as often as twice per calendar year; paying for | ||||||
23 | additional services delivered by telehealth; and suspending | ||||||
24 | premium and co-payment requirements. | ||||||
25 | The Department's authority under this Section shall only |
| |||||||
| |||||||
1 | extend to encompass, incorporate, or effectuate the terms, | ||||||
2 | items, conditions, and other provisions approved, authorized, | ||||||
3 | or required by the United States Department of Health and Human | ||||||
4 | Services, Centers for Medicare and Medicaid Services, and shall | ||||||
5 | not extend beyond the time of the COVID-19 public health | ||||||
6 | emergency and up to 12 months after the period expires.
| ||||||
7 | Section 90-25. The Covering ALL KIDS Health Insurance Act | ||||||
8 | is amended by changing Section 7 and by adding Section 8 as | ||||||
9 | follows:
| ||||||
10 | (215 ILCS 170/7) | ||||||
11 | (Section scheduled to be repealed on October 1, 2024) | ||||||
12 | Sec. 7. Eligibility verification. Notwithstanding any | ||||||
13 | other provision of this Act, with respect to applications for | ||||||
14 | benefits provided under the Program, eligibility shall be | ||||||
15 | determined in a manner that ensures program integrity and that | ||||||
16 | complies with federal law and regulations while minimizing | ||||||
17 | unnecessary barriers to enrollment. To this end, as soon as | ||||||
18 | practicable, and unless the Department receives written denial | ||||||
19 | from the federal government, this Section shall be implemented: | ||||||
20 | (a) The Department of Healthcare and Family Services or its | ||||||
21 | designees shall: | ||||||
22 | (1) By July 1, 2011, require verification of, at a | ||||||
23 | minimum, one month's income from all sources required for | ||||||
24 | determining the eligibility of applicants to the Program.
|
| |||||||
| |||||||
1 | Such verification shall take the form of pay stubs, | ||||||
2 | business or income and expense records for self-employed | ||||||
3 | persons, letters from employers, and any other valid | ||||||
4 | documentation of income including data obtained | ||||||
5 | electronically by the Department or its designees from | ||||||
6 | other sources as described in subsection (b) of this | ||||||
7 | Section. A month's income may be verified by a single pay | ||||||
8 | stub with the monthly income extrapolated from the time | ||||||
9 | period covered by the pay stub. | ||||||
10 | (2) By October 1, 2011, require verification of, at a | ||||||
11 | minimum, one month's income from all sources required for | ||||||
12 | determining the continued eligibility of recipients at | ||||||
13 | their annual review of eligibility under the Program. Such | ||||||
14 | verification shall take the form of pay stubs, business or | ||||||
15 | income and expense records for self-employed persons, | ||||||
16 | letters from employers, and any other valid documentation | ||||||
17 | of income including data obtained electronically by the | ||||||
18 | Department or its designees from other sources as described | ||||||
19 | in subsection (b) of this Section. A month's income may be | ||||||
20 | verified by a single pay stub with the monthly income | ||||||
21 | extrapolated from the time period covered by the pay stub. | ||||||
22 | The Department shall send a notice to
recipients at least | ||||||
23 | 60 days prior to the end of their period
of eligibility | ||||||
24 | that informs them of the
requirements for continued | ||||||
25 | eligibility. Information the Department receives prior to | ||||||
26 | the annual review, including information available to the |
| |||||||
| |||||||
1 | Department as a result of the recipient's application for | ||||||
2 | other non-health care benefits, that is sufficient to make | ||||||
3 | a determination of continued eligibility for benefits | ||||||
4 | provided under this Act, the Children's Health Insurance | ||||||
5 | Program Act, or Article V of the Illinois Public Aid Code | ||||||
6 | may be reviewed and verified, and subsequent action taken | ||||||
7 | including client notification of continued eligibility for | ||||||
8 | benefits provided under this Act, the Children's Health | ||||||
9 | Insurance Program Act, or Article V of the Illinois Public | ||||||
10 | Aid Code. The date of client notification establishes the | ||||||
11 | date for subsequent annual eligibility reviews. If a | ||||||
12 | recipient
does not fulfill the requirements for continued | ||||||
13 | eligibility by the
deadline established in the notice, a | ||||||
14 | notice of cancellation shall be issued to the recipient and | ||||||
15 | coverage shall end no later than the last day of the month | ||||||
16 | following the last day of the eligibility period. A | ||||||
17 | recipient's eligibility may be reinstated without | ||||||
18 | requiring a new application if the recipient fulfills the | ||||||
19 | requirements for continued eligibility prior to the end of | ||||||
20 | the third month following the last date of coverage (or | ||||||
21 | longer period if required by federal regulations). Nothing | ||||||
22 | in this Section shall prevent an individual whose coverage | ||||||
23 | has been cancelled from reapplying for health benefits at | ||||||
24 | any time. | ||||||
25 | (3) By July 1, 2011, require verification of Illinois | ||||||
26 | residency. |
| |||||||
| |||||||
1 | (b) The Department shall establish or continue cooperative
| ||||||
2 | arrangements with the Social Security Administration, the
| ||||||
3 | Illinois Secretary of State, the Department of Human Services,
| ||||||
4 | the Department of Revenue, the Department of Employment
| ||||||
5 | Security, and any other appropriate entity to gain electronic
| ||||||
6 | access, to the extent allowed by law, to information available
| ||||||
7 | to those entities that may be appropriate for electronically
| ||||||
8 | verifying any factor of eligibility for benefits under the
| ||||||
9 | Program. Data relevant to eligibility shall be provided for no
| ||||||
10 | other purpose than to verify the eligibility of new applicants | ||||||
11 | or current recipients of health benefits under the Program. | ||||||
12 | Data will be requested or provided for any new applicant or | ||||||
13 | current recipient only insofar as that individual's | ||||||
14 | circumstances are relevant to that individual's or another | ||||||
15 | individual's eligibility. | ||||||
16 | (c) Within 90 days of the effective date of this amendatory | ||||||
17 | Act of the 96th General Assembly, the Department of Healthcare | ||||||
18 | and Family Services shall send notice to current recipients | ||||||
19 | informing them of the changes regarding their eligibility | ||||||
20 | verification.
| ||||||
21 | (Source: P.A. 101-209, eff. 8-5-19 .)
| ||||||
22 | (215 ILCS 170/8 new) | ||||||
23 | Sec. 8. COVID-19 public health emergency. Notwithstanding | ||||||
24 | any other provision of this Act, the Department may take | ||||||
25 | necessary actions to address the COVID-19 public health |
| |||||||
| |||||||
1 | emergency to the extent such actions are required, approved, or | ||||||
2 | authorized by the United States Department of Health and Human | ||||||
3 | Services, Centers for Medicare and Medicaid Services. Such | ||||||
4 | actions may continue throughout the public health emergency and | ||||||
5 | for up to 12 months after the period ends, and may include, but | ||||||
6 | are not limited to: accepting an applicant's or recipient's | ||||||
7 | attestation of income, incurred medical expenses, residency, | ||||||
8 | and insured status when electronic verification is not | ||||||
9 | available; eliminating resource tests for some eligibility | ||||||
10 | determinations; suspending redeterminations; suspending | ||||||
11 | changes that would adversely affect an applicant's or | ||||||
12 | recipient's eligibility; phone or verbal approval by an | ||||||
13 | applicant to submit an application in lieu of applicant | ||||||
14 | signature; allowing adult presumptive eligibility; allowing | ||||||
15 | presumptive eligibility for children, pregnant women, and | ||||||
16 | adults as often as twice per calendar year; paying for | ||||||
17 | additional services delivered by telehealth; and suspending | ||||||
18 | premium and co-payment requirements. | ||||||
19 | The Department's authority under this Section shall only | ||||||
20 | extend to encompass, incorporate, or effectuate the terms, | ||||||
21 | items, conditions, and other provisions approved, authorized, | ||||||
22 | or required by the United States Department of Health and Human | ||||||
23 | Services, Centers for Medicare and Medicaid Services, and shall | ||||||
24 | not extend beyond the time of the COVID-19 public health | ||||||
25 | emergency and up to 12 months after the period expires.
|
| |||||||
| |||||||
1 | Section 90-30. The Pharmacy Practice Act is amended by | ||||||
2 | adding Section 39.5 as follows:
| ||||||
3 | (225 ILCS 85/39.5 new) | ||||||
4 | Sec. 39.5. Emergency kits. | ||||||
5 | (a) As used in this Section: | ||||||
6 | "Emergency kit" means a kit containing drugs that may be | ||||||
7 | required to meet the immediate therapeutic needs of a patient | ||||||
8 | and that are not available from any other source in sufficient | ||||||
9 | time to prevent the risk of harm to a patient by delay | ||||||
10 | resulting from obtaining the drugs from another source. An | ||||||
11 | automated dispensing and storage system may be used as an | ||||||
12 | emergency kit. | ||||||
13 | "Licensed facility" means an entity licensed under the | ||||||
14 | Nursing Home Care Act, the Hospital Licensing Act, or the | ||||||
15 | University of Illinois Hospital Act or a facility licensed | ||||||
16 | under the Illinois Department of Human Services, Division of | ||||||
17 | Substance Use Prevention and Recovery, for the prevention, | ||||||
18 | intervention, treatment, and recovery support of substance use | ||||||
19 | disorders or certified by the Illinois Department of Human | ||||||
20 | Services, Division of Mental Health for the treatment of mental | ||||||
21 | health. | ||||||
22 | "Offsite institutional pharmacy" means: (1) a pharmacy | ||||||
23 | that is not located in facilities it serves and whose primary | ||||||
24 | purpose is to provide services to patients or residents of | ||||||
25 | facilities licensed under the Nursing Home Care Act, the |
| |||||||
| |||||||
1 | Hospital Licensing Act, or the University of Illinois Hospital | ||||||
2 | Act; and (2) a pharmacy that is not located in the facilities | ||||||
3 | it serves and the facilities it serves are licensed under the | ||||||
4 | Illinois Department of Human Services, Division of Substance | ||||||
5 | Use Prevention and Recovery, for the prevention, intervention, | ||||||
6 | treatment, and recovery support of substance use disorders or | ||||||
7 | for the treatment of mental health. | ||||||
8 | (b) An offsite institutional pharmacy may supply emergency | ||||||
9 | kits to a licensed facility.
| ||||||
10 | Section 90-33. The Telehealth Act is amended by changing | ||||||
11 | Section 5 as follows:
| ||||||
12 | (225 ILCS 150/5)
| ||||||
13 | Sec. 5. Definitions. As used in this Act: | ||||||
14 | "Health care professional" includes physicians, physician | ||||||
15 | assistants, optometrists, advanced practice registered nurses, | ||||||
16 | clinical psychologists licensed in Illinois, prescribing | ||||||
17 | psychologists licensed in Illinois, dentists, occupational | ||||||
18 | therapists, pharmacists, physical therapists, clinical social | ||||||
19 | workers, speech-language pathologists, audiologists, hearing | ||||||
20 | instrument dispensers, substance use disorder professionals | ||||||
21 | and clinicians, and mental health professionals and clinicians | ||||||
22 | authorized by Illinois law to provide mental health services.
| ||||||
23 | "Telehealth" means the evaluation, diagnosis, or | ||||||
24 | interpretation of electronically transmitted patient-specific |
| |||||||
| |||||||
1 | data between a remote location and a licensed health care | ||||||
2 | professional that generates interaction or treatment | ||||||
3 | recommendations. "Telehealth" includes telemedicine and the | ||||||
4 | delivery of health care services provided by way of an | ||||||
5 | interactive telecommunications system, as defined in | ||||||
6 | subsection (a) of Section 356z.22 of the Illinois Insurance | ||||||
7 | Code.
| ||||||
8 | |||||||
9 | (Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19; | ||||||
10 | 100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff. | ||||||
11 | 7-19-19.)
| ||||||
12 | Section 90-35. The Illinois Public Aid Code is amended by | ||||||
13 | changing Sections 5-2, 5-4.2, 5-5e, 5-16.8, 5B-4, and 11-5.1 | ||||||
14 | and by adding Sections 5-1.5, 5-5.27 and 12-21.21 as follows:
| ||||||
15 | (305 ILCS 5/5-1.5 new) | ||||||
16 | Sec. 5-1.5. COVID-19 public health emergency. | ||||||
17 | Notwithstanding any other provision of Articles V, XI, and XII | ||||||
18 | of this Code, the Department may take necessary actions to | ||||||
19 | address the COVID-19 public health emergency to the extent such | ||||||
20 | actions are required, approved, or authorized by the United | ||||||
21 | States Department of Health and Human Services, Centers for | ||||||
22 | Medicare and Medicaid Services. Such actions may continue | ||||||
23 | throughout the public health emergency and for up to 12 months | ||||||
24 | after the period ends, and may include, but are not limited to: |
| |||||||
| |||||||
1 | accepting an applicant's or recipient's attestation of income, | ||||||
2 | incurred medical expenses, residency, and insured status when | ||||||
3 | electronic verification is not available; eliminating resource | ||||||
4 | tests for some eligibility determinations; suspending | ||||||
5 | redeterminations; suspending changes that would adversely | ||||||
6 | affect an applicant's or recipient's eligibility; phone or | ||||||
7 | verbal approval by an applicant to submit an application in | ||||||
8 | lieu of applicant signature; allowing adult presumptive | ||||||
9 | eligibility; allowing presumptive eligibility for children, | ||||||
10 | pregnant women, and adults as often as twice per calendar year; | ||||||
11 | paying for additional services delivered by telehealth; and | ||||||
12 | suspending premium and co-payment requirements. | ||||||
13 | The Department's authority under this Section shall only | ||||||
14 | extend to encompass, incorporate, or effectuate the terms, | ||||||
15 | items, conditions, and other provisions approved, authorized, | ||||||
16 | or required by the United States Department of Health and Human | ||||||
17 | Services, Centers for Medicare and Medicaid Services, and shall | ||||||
18 | not extend beyond the time of the COVID-19 public health | ||||||
19 | emergency and up to 12 months after the period expires.
| ||||||
20 | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
| ||||||
21 | Sec. 5-2. Classes of Persons Eligible. | ||||||
22 | Medical assistance under this
Article shall be available to | ||||||
23 | any of the following classes of persons in
respect to whom a | ||||||
24 | plan for coverage has been submitted to the Governor
by the | ||||||
25 | Illinois Department and approved by him. If changes made in |
| |||||||
| |||||||
1 | this Section 5-2 require federal approval, they shall not take | ||||||
2 | effect until such approval has been received:
| ||||||
3 | 1. Recipients of basic maintenance grants under | ||||||
4 | Articles III and IV.
| ||||||
5 | 2. Beginning January 1, 2014, persons otherwise | ||||||
6 | eligible for basic maintenance under Article
III, | ||||||
7 | excluding any eligibility requirements that are | ||||||
8 | inconsistent with any federal law or federal regulation, as | ||||||
9 | interpreted by the U.S. Department of Health and Human | ||||||
10 | Services, but who fail to qualify thereunder on the basis | ||||||
11 | of need, and
who have insufficient income and resources to | ||||||
12 | meet the costs of
necessary medical care, including but not | ||||||
13 | limited to the following:
| ||||||
14 | (a) All persons otherwise eligible for basic | ||||||
15 | maintenance under Article
III but who fail to qualify | ||||||
16 | under that Article on the basis of need and who
meet | ||||||
17 | either of the following requirements:
| ||||||
18 | (i) their income, as determined by the | ||||||
19 | Illinois Department in
accordance with any federal | ||||||
20 | requirements, is equal to or less than 100% of the | ||||||
21 | federal poverty level; or
| ||||||
22 | (ii) their income, after the deduction of | ||||||
23 | costs incurred for medical
care and for other types | ||||||
24 | of remedial care, is equal to or less than 100% of | ||||||
25 | the federal poverty level.
| ||||||
26 | (b) (Blank).
|
| |||||||
| |||||||
1 | 3. (Blank).
| ||||||
2 | 4. Persons not eligible under any of the preceding | ||||||
3 | paragraphs who fall
sick, are injured, or die, not having | ||||||
4 | sufficient money, property or other
resources to meet the | ||||||
5 | costs of necessary medical care or funeral and burial
| ||||||
6 | expenses.
| ||||||
7 | 5.(a) Beginning January 1, 2020, women during | ||||||
8 | pregnancy and during the
12-month period beginning on the | ||||||
9 | last day of the pregnancy, together with
their infants,
| ||||||
10 | whose income is at or below 200% of the federal poverty | ||||||
11 | level. Until September 30, 2019, or sooner if the | ||||||
12 | maintenance of effort requirements under the Patient | ||||||
13 | Protection and Affordable Care Act are eliminated or may be | ||||||
14 | waived before then, women during pregnancy and during the | ||||||
15 | 12-month period beginning on the last day of the pregnancy, | ||||||
16 | whose countable monthly income, after the deduction of | ||||||
17 | costs incurred for medical care and for other types of | ||||||
18 | remedial care as specified in administrative rule, is equal | ||||||
19 | to or less than the Medical Assistance-No Grant(C) | ||||||
20 | (MANG(C)) Income Standard in effect on April 1, 2013 as set | ||||||
21 | forth in administrative rule.
| ||||||
22 | (b) The plan for coverage shall provide ambulatory | ||||||
23 | prenatal care to pregnant women during a
presumptive | ||||||
24 | eligibility period and establish an income eligibility | ||||||
25 | standard
that is equal to 200% of the federal poverty | ||||||
26 | level, provided that costs incurred
for medical care are |
| |||||||
| |||||||
1 | not taken into account in determining such income
| ||||||
2 | eligibility.
| ||||||
3 | (c) The Illinois Department may conduct a | ||||||
4 | demonstration in at least one
county that will provide | ||||||
5 | medical assistance to pregnant women, together
with their | ||||||
6 | infants and children up to one year of age,
where the | ||||||
7 | income
eligibility standard is set up to 185% of the | ||||||
8 | nonfarm income official
poverty line, as defined by the | ||||||
9 | federal Office of Management and Budget.
The Illinois | ||||||
10 | Department shall seek and obtain necessary authorization
| ||||||
11 | provided under federal law to implement such a | ||||||
12 | demonstration. Such
demonstration may establish resource | ||||||
13 | standards that are not more
restrictive than those | ||||||
14 | established under Article IV of this Code.
| ||||||
15 | 6. (a) Children younger than age 19 when countable | ||||||
16 | income is at or below 133% of the federal poverty level. | ||||||
17 | Until September 30, 2019, or sooner if the maintenance of | ||||||
18 | effort requirements under the Patient Protection and | ||||||
19 | Affordable Care Act are eliminated or may be waived before | ||||||
20 | then, children younger than age 19 whose countable monthly | ||||||
21 | income, after the deduction of costs incurred for medical | ||||||
22 | care and for other types of remedial care as specified in | ||||||
23 | administrative rule, is equal to or less than the Medical | ||||||
24 | Assistance-No Grant(C) (MANG(C)) Income Standard in effect | ||||||
25 | on April 1, 2013 as set forth in administrative rule. | ||||||
26 | (b) Children and youth who are under temporary custody |
| |||||||
| |||||||
1 | or guardianship of the Department of Children and Family | ||||||
2 | Services or who receive financial assistance in support of | ||||||
3 | an adoption or guardianship placement from the Department | ||||||
4 | of Children and Family Services.
| ||||||
5 | 7. (Blank).
| ||||||
6 | 8. As required under federal law, persons who are | ||||||
7 | eligible for Transitional Medical Assistance as a result of | ||||||
8 | an increase in earnings or child or spousal support | ||||||
9 | received. The plan for coverage for this class of persons | ||||||
10 | shall:
| ||||||
11 | (a) extend the medical assistance coverage to the | ||||||
12 | extent required by federal law; and
| ||||||
13 | (b) offer persons who have initially received 6 | ||||||
14 | months of the
coverage provided in paragraph (a) above, | ||||||
15 | the option of receiving an
additional 6 months of | ||||||
16 | coverage, subject to the following:
| ||||||
17 | (i) such coverage shall be pursuant to | ||||||
18 | provisions of the federal
Social Security Act;
| ||||||
19 | (ii) such coverage shall include all services | ||||||
20 | covered under Illinois' State Medicaid Plan;
| ||||||
21 | (iii) no premium shall be charged for such | ||||||
22 | coverage; and
| ||||||
23 | (iv) such coverage shall be suspended in the | ||||||
24 | event of a person's
failure without good cause to | ||||||
25 | file in a timely fashion reports required for
this | ||||||
26 | coverage under the Social Security Act and |
| |||||||
| |||||||
1 | coverage shall be reinstated
upon the filing of | ||||||
2 | such reports if the person remains otherwise | ||||||
3 | eligible.
| ||||||
4 | 9. Persons with acquired immunodeficiency syndrome | ||||||
5 | (AIDS) or with
AIDS-related conditions with respect to whom | ||||||
6 | there has been a determination
that but for home or | ||||||
7 | community-based services such individuals would
require | ||||||
8 | the level of care provided in an inpatient hospital, | ||||||
9 | skilled
nursing facility or intermediate care facility the | ||||||
10 | cost of which is
reimbursed under this Article. Assistance | ||||||
11 | shall be provided to such
persons to the maximum extent | ||||||
12 | permitted under Title
XIX of the Federal Social Security | ||||||
13 | Act.
| ||||||
14 | 10. Participants in the long-term care insurance | ||||||
15 | partnership program
established under the Illinois | ||||||
16 | Long-Term Care Partnership Program Act who meet the
| ||||||
17 | qualifications for protection of resources described in | ||||||
18 | Section 15 of that
Act.
| ||||||
19 | 11. Persons with disabilities who are employed and | ||||||
20 | eligible for Medicaid,
pursuant to Section | ||||||
21 | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | ||||||
22 | subject to federal approval, persons with a medically | ||||||
23 | improved disability who are employed and eligible for | ||||||
24 | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | ||||||
25 | the Social Security Act, as
provided by the Illinois | ||||||
26 | Department by rule. In establishing eligibility standards |
| |||||||
| |||||||
1 | under this paragraph 11, the Department shall, subject to | ||||||
2 | federal approval: | ||||||
3 | (a) set the income eligibility standard at not | ||||||
4 | lower than 350% of the federal poverty level; | ||||||
5 | (b) exempt retirement accounts that the person | ||||||
6 | cannot access without penalty before the age
of 59 1/2, | ||||||
7 | and medical savings accounts established pursuant to | ||||||
8 | 26 U.S.C. 220; | ||||||
9 | (c) allow non-exempt assets up to $25,000 as to | ||||||
10 | those assets accumulated during periods of eligibility | ||||||
11 | under this paragraph 11; and
| ||||||
12 | (d) continue to apply subparagraphs (b) and (c) in | ||||||
13 | determining the eligibility of the person under this | ||||||
14 | Article even if the person loses eligibility under this | ||||||
15 | paragraph 11.
| ||||||
16 | 12. Subject to federal approval, persons who are | ||||||
17 | eligible for medical
assistance coverage under applicable | ||||||
18 | provisions of the federal Social Security
Act and the | ||||||
19 | federal Breast and Cervical Cancer Prevention and | ||||||
20 | Treatment Act of
2000. Those eligible persons are defined | ||||||
21 | to include, but not be limited to,
the following persons:
| ||||||
22 | (1) persons who have been screened for breast or | ||||||
23 | cervical cancer under
the U.S. Centers for Disease | ||||||
24 | Control and Prevention Breast and Cervical Cancer
| ||||||
25 | Program established under Title XV of the federal | ||||||
26 | Public Health Services Act in
accordance with the |
| |||||||
| |||||||
1 | requirements of Section 1504 of that Act as | ||||||
2 | administered by
the Illinois Department of Public | ||||||
3 | Health; and
| ||||||
4 | (2) persons whose screenings under the above | ||||||
5 | program were funded in whole
or in part by funds | ||||||
6 | appropriated to the Illinois Department of Public | ||||||
7 | Health
for breast or cervical cancer screening.
| ||||||
8 | "Medical assistance" under this paragraph 12 shall be | ||||||
9 | identical to the benefits
provided under the State's | ||||||
10 | approved plan under Title XIX of the Social Security
Act. | ||||||
11 | The Department must request federal approval of the | ||||||
12 | coverage under this
paragraph 12 within 30 days after the | ||||||
13 | effective date of this amendatory Act of
the 92nd General | ||||||
14 | Assembly.
| ||||||
15 | In addition to the persons who are eligible for medical | ||||||
16 | assistance pursuant to subparagraphs (1) and (2) of this | ||||||
17 | paragraph 12, and to be paid from funds appropriated to the | ||||||
18 | Department for its medical programs, any uninsured person | ||||||
19 | as defined by the Department in rules residing in Illinois | ||||||
20 | who is younger than 65 years of age, who has been screened | ||||||
21 | for breast and cervical cancer in accordance with standards | ||||||
22 | and procedures adopted by the Department of Public Health | ||||||
23 | for screening, and who is referred to the Department by the | ||||||
24 | Department of Public Health as being in need of treatment | ||||||
25 | for breast or cervical cancer is eligible for medical | ||||||
26 | assistance benefits that are consistent with the benefits |
| |||||||
| |||||||
1 | provided to those persons described in subparagraphs (1) | ||||||
2 | and (2). Medical assistance coverage for the persons who | ||||||
3 | are eligible under the preceding sentence is not dependent | ||||||
4 | on federal approval, but federal moneys may be used to pay | ||||||
5 | for services provided under that coverage upon federal | ||||||
6 | approval. | ||||||
7 | 13. Subject to appropriation and to federal approval, | ||||||
8 | persons living with HIV/AIDS who are not otherwise eligible | ||||||
9 | under this Article and who qualify for services covered | ||||||
10 | under Section 5-5.04 as provided by the Illinois Department | ||||||
11 | by rule.
| ||||||
12 | 14. Subject to the availability of funds for this | ||||||
13 | purpose, the Department may provide coverage under this | ||||||
14 | Article to persons who reside in Illinois who are not | ||||||
15 | eligible under any of the preceding paragraphs and who meet | ||||||
16 | the income guidelines of paragraph 2(a) of this Section and | ||||||
17 | (i) have an application for asylum pending before the | ||||||
18 | federal Department of Homeland Security or on appeal before | ||||||
19 | a court of competent jurisdiction and are represented | ||||||
20 | either by counsel or by an advocate accredited by the | ||||||
21 | federal Department of Homeland Security and employed by a | ||||||
22 | not-for-profit organization in regard to that application | ||||||
23 | or appeal, or (ii) are receiving services through a | ||||||
24 | federally funded torture treatment center. Medical | ||||||
25 | coverage under this paragraph 14 may be provided for up to | ||||||
26 | 24 continuous months from the initial eligibility date so |
| |||||||
| |||||||
1 | long as an individual continues to satisfy the criteria of | ||||||
2 | this paragraph 14. If an individual has an appeal pending | ||||||
3 | regarding an application for asylum before the Department | ||||||
4 | of Homeland Security, eligibility under this paragraph 14 | ||||||
5 | may be extended until a final decision is rendered on the | ||||||
6 | appeal. The Department may adopt rules governing the | ||||||
7 | implementation of this paragraph 14.
| ||||||
8 | 15. Family Care Eligibility. | ||||||
9 | (a) On and after July 1, 2012, a parent or other | ||||||
10 | caretaker relative who is 19 years of age or older when | ||||||
11 | countable income is at or below 133% of the federal | ||||||
12 | poverty level. A person may not spend down to become | ||||||
13 | eligible under this paragraph 15. | ||||||
14 | (b) Eligibility shall be reviewed annually. | ||||||
15 | (c) (Blank). | ||||||
16 | (d) (Blank). | ||||||
17 | (e) (Blank). | ||||||
18 | (f) (Blank). | ||||||
19 | (g) (Blank). | ||||||
20 | (h) (Blank). | ||||||
21 | (i) Following termination of an individual's | ||||||
22 | coverage under this paragraph 15, the individual must | ||||||
23 | be determined eligible before the person can be | ||||||
24 | re-enrolled. | ||||||
25 | 16. Subject to appropriation, uninsured persons who | ||||||
26 | are not otherwise eligible under this Section who have been |
| |||||||
| |||||||
1 | certified and referred by the Department of Public Health | ||||||
2 | as having been screened and found to need diagnostic | ||||||
3 | evaluation or treatment, or both diagnostic evaluation and | ||||||
4 | treatment, for prostate or testicular cancer. For the | ||||||
5 | purposes of this paragraph 16, uninsured persons are those | ||||||
6 | who do not have creditable coverage, as defined under the | ||||||
7 | Health Insurance Portability and Accountability Act, or | ||||||
8 | have otherwise exhausted any insurance benefits they may | ||||||
9 | have had, for prostate or testicular cancer diagnostic | ||||||
10 | evaluation or treatment, or both diagnostic evaluation and | ||||||
11 | treatment.
To be eligible, a person must furnish a Social | ||||||
12 | Security number.
A person's assets are exempt from | ||||||
13 | consideration in determining eligibility under this | ||||||
14 | paragraph 16.
Such persons shall be eligible for medical | ||||||
15 | assistance under this paragraph 16 for so long as they need | ||||||
16 | treatment for the cancer. A person shall be considered to | ||||||
17 | need treatment if, in the opinion of the person's treating | ||||||
18 | physician, the person requires therapy directed toward | ||||||
19 | cure or palliation of prostate or testicular cancer, | ||||||
20 | including recurrent metastatic cancer that is a known or | ||||||
21 | presumed complication of prostate or testicular cancer and | ||||||
22 | complications resulting from the treatment modalities | ||||||
23 | themselves. Persons who require only routine monitoring | ||||||
24 | services are not considered to need treatment.
"Medical | ||||||
25 | assistance" under this paragraph 16 shall be identical to | ||||||
26 | the benefits provided under the State's approved plan under |
| |||||||
| |||||||
1 | Title XIX of the Social Security Act.
Notwithstanding any | ||||||
2 | other provision of law, the Department (i) does not have a | ||||||
3 | claim against the estate of a deceased recipient of | ||||||
4 | services under this paragraph 16 and (ii) does not have a | ||||||
5 | lien against any homestead property or other legal or | ||||||
6 | equitable real property interest owned by a recipient of | ||||||
7 | services under this paragraph 16. | ||||||
8 | 17. Persons who, pursuant to a waiver approved by the | ||||||
9 | Secretary of the U.S. Department of Health and Human | ||||||
10 | Services, are eligible for medical assistance under Title | ||||||
11 | XIX or XXI of the federal Social Security Act. | ||||||
12 | Notwithstanding any other provision of this Code and | ||||||
13 | consistent with the terms of the approved waiver, the | ||||||
14 | Illinois Department, may by rule: | ||||||
15 | (a) Limit the geographic areas in which the waiver | ||||||
16 | program operates. | ||||||
17 | (b) Determine the scope, quantity, duration, and | ||||||
18 | quality, and the rate and method of reimbursement, of | ||||||
19 | the medical services to be provided, which may differ | ||||||
20 | from those for other classes of persons eligible for | ||||||
21 | assistance under this Article. | ||||||
22 | (c) Restrict the persons' freedom in choice of | ||||||
23 | providers. | ||||||
24 | 18. Beginning January 1, 2014, persons aged 19 or | ||||||
25 | older, but younger than 65, who are not otherwise eligible | ||||||
26 | for medical assistance under this Section 5-2, who qualify |
| |||||||
| |||||||
1 | for medical assistance pursuant to 42 U.S.C. | ||||||
2 | 1396a(a)(10)(A)(i)(VIII) and applicable federal | ||||||
3 | regulations, and who have income at or below 133% of the | ||||||
4 | federal poverty level plus 5% for the applicable family | ||||||
5 | size as determined pursuant to 42 U.S.C. 1396a(e)(14) and | ||||||
6 | applicable federal regulations. Persons eligible for | ||||||
7 | medical assistance under this paragraph 18 shall receive | ||||||
8 | coverage for the Health Benefits Service Package as that | ||||||
9 | term is defined in subsection (m) of Section 5-1.1 of this | ||||||
10 | Code. If Illinois' federal medical assistance percentage | ||||||
11 | (FMAP) is reduced below 90% for persons eligible for | ||||||
12 | medical
assistance under this paragraph 18, eligibility | ||||||
13 | under this paragraph 18 shall cease no later than the end | ||||||
14 | of the third month following the month in which the | ||||||
15 | reduction in FMAP takes effect. | ||||||
16 | 19. Beginning January 1, 2014, as required under 42 | ||||||
17 | U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18 | ||||||
18 | and younger than age 26 who are not otherwise eligible for | ||||||
19 | medical assistance under paragraphs (1) through (17) of | ||||||
20 | this Section who (i) were in foster care under the | ||||||
21 | responsibility of the State on the date of attaining age 18 | ||||||
22 | or on the date of attaining age 21 when a court has | ||||||
23 | continued wardship for good cause as provided in Section | ||||||
24 | 2-31 of the Juvenile Court Act of 1987 and (ii) received | ||||||
25 | medical assistance under the Illinois Title XIX State Plan | ||||||
26 | or waiver of such plan while in foster care. |
| |||||||
| |||||||
1 | 20. Beginning January 1, 2018, persons who are | ||||||
2 | foreign-born victims of human trafficking, torture, or | ||||||
3 | other serious crimes as defined in Section 2-19 of this | ||||||
4 | Code and their derivative family members if such persons: | ||||||
5 | (i) reside in Illinois; (ii) are not eligible under any of | ||||||
6 | the preceding paragraphs; (iii) meet the income guidelines | ||||||
7 | of subparagraph (a) of paragraph 2; and (iv) meet the | ||||||
8 | nonfinancial eligibility requirements of Sections 16-2, | ||||||
9 | 16-3, and 16-5 of this Code. The Department may extend | ||||||
10 | medical assistance for persons who are foreign-born | ||||||
11 | victims of human trafficking, torture, or other serious | ||||||
12 | crimes whose medical assistance would be terminated | ||||||
13 | pursuant to subsection (b) of Section 16-5 if the | ||||||
14 | Department determines that the person, during the year of | ||||||
15 | initial eligibility (1) experienced a health crisis, (2) | ||||||
16 | has been unable, after reasonable attempts, to obtain | ||||||
17 | necessary information from a third party, or (3) has other | ||||||
18 | extenuating circumstances that prevented the person from | ||||||
19 | completing his or her application for status. The | ||||||
20 | Department may adopt any rules necessary to implement the | ||||||
21 | provisions of this paragraph. | ||||||
22 | 21. Persons who are not otherwise eligible for medical | ||||||
23 | assistance under this Section who may qualify for medical | ||||||
24 | assistance pursuant to 42 U.S.C. | ||||||
25 | 1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the | ||||||
26 | duration of any federal or State declared emergency due to |
| |||||||
| |||||||
1 | COVID-19. Medical assistance to persons eligible for | ||||||
2 | medical assistance solely pursuant to this paragraph 21 | ||||||
3 | shall be limited to any in vitro diagnostic product (and | ||||||
4 | the administration of such product) described in 42 U.S.C. | ||||||
5 | 1396d(a)(3)(B) on or after March 18, 2020, any visit | ||||||
6 | described in 42 U.S.C. 1396o(a)(2)(G), or any other medical | ||||||
7 | assistance that may be federally authorized for this class | ||||||
8 | of persons. The Department may also cover treatment of | ||||||
9 | COVID-19 for this class of persons, or any similar category | ||||||
10 | of uninsured individuals, to the extent authorized under a | ||||||
11 | federally approved 1115 Waiver or other federal authority. | ||||||
12 | Notwithstanding the provisions of Section 1-11 of this | ||||||
13 | Code, due to the nature of the COVID-19 public health | ||||||
14 | emergency, the Department may cover and provide the medical | ||||||
15 | assistance described in this paragraph 21 to noncitizens | ||||||
16 | who would otherwise meet the eligibility requirements for | ||||||
17 | the class of persons described in this paragraph 21 for the | ||||||
18 | duration of the State emergency period. | ||||||
19 | In implementing the provisions of Public Act 96-20, the | ||||||
20 | Department is authorized to adopt only those rules necessary, | ||||||
21 | including emergency rules. Nothing in Public Act 96-20 permits | ||||||
22 | the Department to adopt rules or issue a decision that expands | ||||||
23 | eligibility for the FamilyCare Program to a person whose income | ||||||
24 | exceeds 185% of the Federal Poverty Level as determined from | ||||||
25 | time to time by the U.S. Department of Health and Human | ||||||
26 | Services, unless the Department is provided with express |
| |||||||
| |||||||
1 | statutory authority.
| ||||||
2 | The eligibility of any such person for medical assistance | ||||||
3 | under this
Article is not affected by the payment of any grant | ||||||
4 | under the Senior
Citizens and Persons with Disabilities | ||||||
5 | Property Tax Relief Act or any distributions or items of income | ||||||
6 | described under
subparagraph (X) of
paragraph (2) of subsection | ||||||
7 | (a) of Section 203 of the Illinois Income Tax
Act. | ||||||
8 | The Department shall by rule establish the amounts of
| ||||||
9 | assets to be disregarded in determining eligibility for medical | ||||||
10 | assistance,
which shall at a minimum equal the amounts to be | ||||||
11 | disregarded under the
Federal Supplemental Security Income | ||||||
12 | Program. The amount of assets of a
single person to be | ||||||
13 | disregarded
shall not be less than $2,000, and the amount of | ||||||
14 | assets of a married couple
to be disregarded shall not be less | ||||||
15 | than $3,000.
| ||||||
16 | To the extent permitted under federal law, any person found | ||||||
17 | guilty of a
second violation of Article VIIIA
shall be | ||||||
18 | ineligible for medical assistance under this Article, as | ||||||
19 | provided
in Section 8A-8.
| ||||||
20 | The eligibility of any person for medical assistance under | ||||||
21 | this Article
shall not be affected by the receipt by the person | ||||||
22 | of donations or benefits
from fundraisers held for the person | ||||||
23 | in cases of serious illness,
as long as neither the person nor | ||||||
24 | members of the person's family
have actual control over the | ||||||
25 | donations or benefits or the disbursement
of the donations or | ||||||
26 | benefits.
|
| |||||||
| |||||||
1 | Notwithstanding any other provision of this Code, if the | ||||||
2 | United States Supreme Court holds Title II, Subtitle A, Section | ||||||
3 | 2001(a) of Public Law 111-148 to be unconstitutional, or if a | ||||||
4 | holding of Public Law 111-148 makes Medicaid eligibility | ||||||
5 | allowed under Section 2001(a) inoperable, the State or a unit | ||||||
6 | of local government shall be prohibited from enrolling | ||||||
7 | individuals in the Medical Assistance Program as the result of | ||||||
8 | federal approval of a State Medicaid waiver on or after the | ||||||
9 | effective date of this amendatory Act of the 97th General | ||||||
10 | Assembly, and any individuals enrolled in the Medical | ||||||
11 | Assistance Program pursuant to eligibility permitted as a | ||||||
12 | result of such a State Medicaid waiver shall become immediately | ||||||
13 | ineligible. | ||||||
14 | Notwithstanding any other provision of this Code, if an Act | ||||||
15 | of Congress that becomes a Public Law eliminates Section | ||||||
16 | 2001(a) of Public Law 111-148, the State or a unit of local | ||||||
17 | government shall be prohibited from enrolling individuals in | ||||||
18 | the Medical Assistance Program as the result of federal | ||||||
19 | approval of a State Medicaid waiver on or after the effective | ||||||
20 | date of this amendatory Act of the 97th General Assembly, and | ||||||
21 | any individuals enrolled in the Medical Assistance Program | ||||||
22 | pursuant to eligibility permitted as a result of such a State | ||||||
23 | Medicaid waiver shall become immediately ineligible. | ||||||
24 | Effective October 1, 2013, the determination of | ||||||
25 | eligibility of persons who qualify under paragraphs 5, 6, 8, | ||||||
26 | 15, 17, and 18 of this Section shall comply with the |
| |||||||
| |||||||
1 | requirements of 42 U.S.C. 1396a(e)(14) and applicable federal | ||||||
2 | regulations. | ||||||
3 | The Department of Healthcare and Family Services, the | ||||||
4 | Department of Human Services, and the Illinois health insurance | ||||||
5 | marketplace shall work cooperatively to assist persons who | ||||||
6 | would otherwise lose health benefits as a result of changes | ||||||
7 | made under this amendatory Act of the 98th General Assembly to | ||||||
8 | transition to other health insurance coverage. | ||||||
9 | (Source: P.A. 101-10, eff. 6-5-19.)
| ||||||
10 | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
| ||||||
11 | Sec. 5-4.2. Ambulance services payments. | ||||||
12 | (a) For
ambulance
services provided to a recipient of aid | ||||||
13 | under this Article on or after
January 1, 1993, the Illinois | ||||||
14 | Department shall reimburse ambulance service
providers at | ||||||
15 | rates calculated in accordance with this Section. It is the | ||||||
16 | intent
of the General Assembly to provide adequate | ||||||
17 | reimbursement for ambulance
services so as to ensure adequate | ||||||
18 | access to services for recipients of aid
under this Article and | ||||||
19 | to provide appropriate incentives to ambulance service
| ||||||
20 | providers to provide services in an efficient and | ||||||
21 | cost-effective manner. Thus,
it is the intent of the General | ||||||
22 | Assembly that the Illinois Department implement
a | ||||||
23 | reimbursement system for ambulance services that, to the extent | ||||||
24 | practicable
and subject to the availability of funds | ||||||
25 | appropriated by the General Assembly
for this purpose, is |
| |||||||
| |||||||
1 | consistent with the payment principles of Medicare. To
ensure | ||||||
2 | uniformity between the payment principles of Medicare and | ||||||
3 | Medicaid, the
Illinois Department shall follow, to the extent | ||||||
4 | necessary and practicable and
subject to the availability of | ||||||
5 | funds appropriated by the General Assembly for
this purpose, | ||||||
6 | the statutes, laws, regulations, policies, procedures,
| ||||||
7 | principles, definitions, guidelines, and manuals used to | ||||||
8 | determine the amounts
paid to ambulance service providers under | ||||||
9 | Title XVIII of the Social Security
Act (Medicare).
| ||||||
10 | (b) For ambulance services provided to a recipient of aid | ||||||
11 | under this Article
on or after January 1, 1996, the Illinois | ||||||
12 | Department shall reimburse ambulance
service providers based | ||||||
13 | upon the actual distance traveled if a natural
disaster, | ||||||
14 | weather conditions, road repairs, or traffic congestion | ||||||
15 | necessitates
the use of a
route other than the most direct | ||||||
16 | route.
| ||||||
17 | (c) For purposes of this Section, "ambulance services" | ||||||
18 | includes medical
transportation services provided by means of | ||||||
19 | an ambulance, medi-car, service
car, or
taxi.
| ||||||
20 | (c-1) For purposes of this Section, "ground ambulance | ||||||
21 | service" means medical transportation services that are | ||||||
22 | described as ground ambulance services by the Centers for | ||||||
23 | Medicare and Medicaid Services and provided in a vehicle that | ||||||
24 | is licensed as an ambulance by the Illinois Department of | ||||||
25 | Public Health pursuant to the Emergency Medical Services (EMS) | ||||||
26 | Systems Act. |
| |||||||
| |||||||
1 | (c-2) For purposes of this Section, "ground ambulance | ||||||
2 | service provider" means a vehicle service provider as described | ||||||
3 | in the Emergency Medical Services (EMS) Systems Act that | ||||||
4 | operates licensed ambulances for the purpose of providing | ||||||
5 | emergency ambulance services, or non-emergency ambulance | ||||||
6 | services, or both. For purposes of this Section, this includes | ||||||
7 | both ambulance providers and ambulance suppliers as described | ||||||
8 | by the Centers for Medicare and Medicaid Services. | ||||||
9 | (c-3) For purposes of this Section, "medi-car" means | ||||||
10 | transportation services provided to a patient who is confined | ||||||
11 | to a wheelchair and requires the use of a hydraulic or electric | ||||||
12 | lift or ramp and wheelchair lockdown when the patient's | ||||||
13 | condition does not require medical observation, medical | ||||||
14 | supervision, medical equipment, the administration of | ||||||
15 | medications, or the administration of oxygen. | ||||||
16 | (c-4) For purposes of this Section, "service car" means | ||||||
17 | transportation services provided to a patient by a passenger | ||||||
18 | vehicle where that patient does not require the specialized | ||||||
19 | modes described in subsection (c-1) or (c-3). | ||||||
20 | (d) This Section does not prohibit separate billing by | ||||||
21 | ambulance service
providers for oxygen furnished while | ||||||
22 | providing advanced life support
services.
| ||||||
23 | (e) Beginning with services rendered on or after July 1, | ||||||
24 | 2008, all providers of non-emergency medi-car and service car | ||||||
25 | transportation must certify that the driver and employee | ||||||
26 | attendant, as applicable, have completed a safety program |
| |||||||
| |||||||
1 | approved by the Department to protect both the patient and the | ||||||
2 | driver, prior to transporting a patient.
The provider must | ||||||
3 | maintain this certification in its records. The provider shall | ||||||
4 | produce such documentation upon demand by the Department or its | ||||||
5 | representative. Failure to produce documentation of such | ||||||
6 | training shall result in recovery of any payments made by the | ||||||
7 | Department for services rendered by a non-certified driver or | ||||||
8 | employee attendant. Medi-car and service car providers must | ||||||
9 | maintain legible documentation in their records of the driver | ||||||
10 | and, as applicable, employee attendant that actually | ||||||
11 | transported the patient. Providers must recertify all drivers | ||||||
12 | and employee attendants every 3 years.
| ||||||
13 | Notwithstanding the requirements above, any public | ||||||
14 | transportation provider of medi-car and service car | ||||||
15 | transportation that receives federal funding under 49 U.S.C. | ||||||
16 | 5307 and 5311 need not certify its drivers and employee | ||||||
17 | attendants under this Section, since safety training is already | ||||||
18 | federally mandated.
| ||||||
19 | (f) With respect to any policy or program administered by | ||||||
20 | the Department or its agent regarding approval of non-emergency | ||||||
21 | medical transportation by ground ambulance service providers, | ||||||
22 | including, but not limited to, the Non-Emergency | ||||||
23 | Transportation Services Prior Approval Program (NETSPAP), the | ||||||
24 | Department shall establish by rule a process by which ground | ||||||
25 | ambulance service providers of non-emergency medical | ||||||
26 | transportation may appeal any decision by the Department or its |
| |||||||
| |||||||
1 | agent for which no denial was received prior to the time of | ||||||
2 | transport that either (i) denies a request for approval for | ||||||
3 | payment of non-emergency transportation by means of ground | ||||||
4 | ambulance service or (ii) grants a request for approval of | ||||||
5 | non-emergency transportation by means of ground ambulance | ||||||
6 | service at a level of service that entitles the ground | ||||||
7 | ambulance service provider to a lower level of compensation | ||||||
8 | from the Department than the ground ambulance service provider | ||||||
9 | would have received as compensation for the level of service | ||||||
10 | requested. The rule shall be filed by December 15, 2012 and | ||||||
11 | shall provide that, for any decision rendered by the Department | ||||||
12 | or its agent on or after the date the rule takes effect, the | ||||||
13 | ground ambulance service provider shall have 60 days from the | ||||||
14 | date the decision is received to file an appeal. The rule | ||||||
15 | established by the Department shall be, insofar as is | ||||||
16 | practical, consistent with the Illinois Administrative | ||||||
17 | Procedure Act. The Director's decision on an appeal under this | ||||||
18 | Section shall be a final administrative decision subject to | ||||||
19 | review under the Administrative Review Law. | ||||||
20 | (f-5) Beginning 90 days after July 20, 2012 (the effective | ||||||
21 | date of Public Act 97-842), (i) no denial of a request for | ||||||
22 | approval for payment of non-emergency transportation by means | ||||||
23 | of ground ambulance service, and (ii) no approval of | ||||||
24 | non-emergency transportation by means of ground ambulance | ||||||
25 | service at a level of service that entitles the ground | ||||||
26 | ambulance service provider to a lower level of compensation |
| |||||||
| |||||||
1 | from the Department than would have been received at the level | ||||||
2 | of service submitted by the ground ambulance service provider, | ||||||
3 | may be issued by the Department or its agent unless the | ||||||
4 | Department has submitted the criteria for determining the | ||||||
5 | appropriateness of the transport for first notice publication | ||||||
6 | in the Illinois Register pursuant to Section 5-40 of the | ||||||
7 | Illinois Administrative Procedure Act. | ||||||
8 | (g) Whenever a patient covered by a medical assistance | ||||||
9 | program under this Code or by another medical program | ||||||
10 | administered by the Department, including a patient covered | ||||||
11 | under the State's Medicaid managed care program, is being | ||||||
12 | transported from a facility and requires non-emergency | ||||||
13 | transportation including ground ambulance, medi-car, or | ||||||
14 | service car transportation, a Physician Certification | ||||||
15 | Statement as described in this Section shall be required for | ||||||
16 | each patient. Facilities shall develop procedures for a | ||||||
17 | licensed medical professional to provide a written and signed | ||||||
18 | Physician Certification Statement. The Physician Certification | ||||||
19 | Statement shall specify the level of transportation services | ||||||
20 | needed and complete a medical certification establishing the | ||||||
21 | criteria for approval of non-emergency ambulance | ||||||
22 | transportation, as published by the Department of Healthcare | ||||||
23 | and Family Services, that is met by the patient. This | ||||||
24 | certification shall be completed prior to ordering the | ||||||
25 | transportation service and prior to patient discharge. The | ||||||
26 | Physician Certification Statement is not required prior to |
| |||||||
| |||||||
1 | transport if a delay in transport can be expected to negatively | ||||||
2 | affect the patient outcome. If the ground ambulance provider, | ||||||
3 | medi-car provider, or service car provider is unable to obtain | ||||||
4 | the required Physician Certification Statement within 10 | ||||||
5 | calendar days following the date of the service, the ground | ||||||
6 | ambulance provider, medi-car provider, or service car provider | ||||||
7 | must document its attempt to obtain the requested certification | ||||||
8 | and may then submit the claim for payment. Acceptable | ||||||
9 | documentation includes a signed return receipt from the U.S. | ||||||
10 | Postal Service, facsimile receipt, email receipt, or other | ||||||
11 | similar service that evidences that the ground ambulance | ||||||
12 | provider, medi-car provider, or service car provider attempted | ||||||
13 | to obtain the required Physician Certification Statement. | ||||||
14 | The medical certification specifying the level and type of | ||||||
15 | non-emergency transportation needed shall be in the form of the | ||||||
16 | Physician Certification Statement on a standardized form | ||||||
17 | prescribed by the Department of Healthcare and Family Services. | ||||||
18 | Within 75 days after July 27, 2018 (the effective date of | ||||||
19 | Public Act 100-646), the Department of Healthcare and Family | ||||||
20 | Services shall develop a standardized form of the Physician | ||||||
21 | Certification Statement specifying the level and type of | ||||||
22 | transportation services needed in consultation with the | ||||||
23 | Department of Public Health, Medicaid managed care | ||||||
24 | organizations, a statewide association representing ambulance | ||||||
25 | providers, a statewide association representing hospitals, 3 | ||||||
26 | statewide associations representing nursing homes, and other |
| |||||||
| |||||||
1 | stakeholders. The Physician Certification Statement shall | ||||||
2 | include, but is not limited to, the criteria necessary to | ||||||
3 | demonstrate medical necessity for the level of transport needed | ||||||
4 | as required by (i) the Department of Healthcare and Family | ||||||
5 | Services and (ii) the federal Centers for Medicare and Medicaid | ||||||
6 | Services as outlined in the Centers for Medicare and Medicaid | ||||||
7 | Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap. | ||||||
8 | 10, Sec. 10.2.1, et seq. The use of the Physician Certification | ||||||
9 | Statement shall satisfy the obligations of hospitals under | ||||||
10 | Section 6.22 of the Hospital Licensing Act and nursing homes | ||||||
11 | under Section 2-217 of the Nursing Home Care Act. | ||||||
12 | Implementation and acceptance of the Physician Certification | ||||||
13 | Statement shall take place no later than 90 days after the | ||||||
14 | issuance of the Physician Certification Statement by the | ||||||
15 | Department of Healthcare and Family Services. | ||||||
16 | Pursuant to subsection (E) of Section 12-4.25 of this Code, | ||||||
17 | the Department is entitled to recover overpayments paid to a | ||||||
18 | provider or vendor, including, but not limited to, from the | ||||||
19 | discharging physician, the discharging facility, and the | ||||||
20 | ground ambulance service provider, in instances where a | ||||||
21 | non-emergency ground ambulance service is rendered as the | ||||||
22 | result of improper or false certification. | ||||||
23 | Beginning October 1, 2018, the Department of Healthcare and | ||||||
24 | Family Services shall collect data from Medicaid managed care | ||||||
25 | organizations and transportation brokers, including the | ||||||
26 | Department's NETSPAP broker, regarding denials and appeals |
| |||||||
| |||||||
1 | related to the missing or incomplete Physician Certification | ||||||
2 | Statement forms and overall compliance with this subsection. | ||||||
3 | The Department of Healthcare and Family Services shall publish | ||||||
4 | quarterly results on its website within 15 days following the | ||||||
5 | end of each quarter. | ||||||
6 | (h) On and after July 1, 2012, the Department shall reduce | ||||||
7 | any rate of reimbursement for services or other payments or | ||||||
8 | alter any methodologies authorized by this Code to reduce any | ||||||
9 | rate of reimbursement for services or other payments in | ||||||
10 | accordance with Section 5-5e. | ||||||
11 | (i) On and after July 1, 2018, the Department shall | ||||||
12 | increase the base rate of reimbursement for both base charges | ||||||
13 | and mileage charges for ground ambulance service providers for | ||||||
14 | medical transportation services provided by means of a ground | ||||||
15 | ambulance to a level not lower than 112% of the base rate in | ||||||
16 | effect as of June 30, 2018. | ||||||
17 | (Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18; | ||||||
18 | 101-81, eff. 7-12-19.)
| ||||||
19 | (305 ILCS 5/5-5.27 new) | ||||||
20 | Sec. 5-5.27. Coverage for clinical trials. | ||||||
21 | (a) The medical assistance program shall provide coverage | ||||||
22 | for routine care costs that are incurred in the course of an | ||||||
23 | approved clinical trial if the medical assistance program would | ||||||
24 | provide coverage for the same routine care costs not incurred | ||||||
25 | in a clinical trial. "Routine care cost" shall be defined by |
| |||||||
| |||||||
1 | the Department by rule. | ||||||
2 | (b) The coverage that must be provided under this Section | ||||||
3 | is subject to the terms, conditions, restrictions, exclusions, | ||||||
4 | and limitations that apply generally under the medical | ||||||
5 | assistance program, including terms, conditions, restrictions, | ||||||
6 | exclusions, or limitations that apply to health care services | ||||||
7 | rendered by participating providers and nonparticipating | ||||||
8 | providers. | ||||||
9 | (c) Implementation of this Section shall be contingent upon | ||||||
10 | federal approval. Upon receipt of federal approval, if | ||||||
11 | required, the Department shall adopt any rules necessary to | ||||||
12 | implement this Section. | ||||||
13 | (d) As used in this Section: | ||||||
14 | "Approved clinical trial" means a phase I, II, III, or IV | ||||||
15 | clinical trial involving the prevention, detection, or | ||||||
16 | treatment of cancer or any other life-threatening disease or | ||||||
17 | condition if one or more of the following conditions apply: | ||||||
18 | (1) the Department makes a determination that the study | ||||||
19 | or investigation is an approved clinical trial; | ||||||
20 | (2) the study or investigation is conducted under an | ||||||
21 | investigational new drug application or an investigational | ||||||
22 | device exemption reviewed by the federal Food and Drug | ||||||
23 | Administration; | ||||||
24 | (3) the study or investigation is a drug trial that is | ||||||
25 | exempt from having an investigational new drug application | ||||||
26 | or an investigational device exemption from the federal |
| |||||||
| |||||||
1 | Food and Drug Administration; or | ||||||
2 | (4) the study or investigation is approved or funded | ||||||
3 | (which may include funding through in-kind contributions) | ||||||
4 | by: | ||||||
5 | (A) the National Institutes of Health; | ||||||
6 | (B)
the Centers for Disease Control and | ||||||
7 | Prevention; | ||||||
8 | (C)
the Agency for Healthcare Research and | ||||||
9 | Quality; | ||||||
10 | (D)
the Patient-Centered Outcomes Research | ||||||
11 | Institute; | ||||||
12 | (E)
the federal Centers for Medicare and Medicaid | ||||||
13 | Services; | ||||||
14 | (F) a cooperative group or center of any of the | ||||||
15 | entities described in subparagraphs (A) through (E) or | ||||||
16 | the United States Department of Defense or the United | ||||||
17 | States Department of Veterans Affairs; | ||||||
18 | (G)
a qualified non-governmental research entity | ||||||
19 | identified in the guidelines issued by the National | ||||||
20 | Institutes of Health for center support grants; or | ||||||
21 | (H)
the United States Department of Veterans | ||||||
22 | Affairs, the United States Department of Defense, or | ||||||
23 | the United States Department of Energy, provided that | ||||||
24 | review and approval of the study or investigation | ||||||
25 | occurs through a system of peer review that is | ||||||
26 | comparable to the peer review of studies performed by |
| |||||||
| |||||||
1 | the National Institutes of Health, including an | ||||||
2 | unbiased review of the highest scientific standards by | ||||||
3 | qualified individuals who have no interest in the | ||||||
4 | outcome of the review. | ||||||
5 | "Care method" means the use of a particular drug or device | ||||||
6 | in a particular manner. | ||||||
7 | "Life-threatening disease or condition" means a disease or | ||||||
8 | condition from which the likelihood of death is probable unless | ||||||
9 | the course of the disease or condition is interrupted.
| ||||||
10 | (305 ILCS 5/5-5e) | ||||||
11 | Sec. 5-5e. Adjusted rates of reimbursement. | ||||||
12 | (a) Rates or payments for services in effect on June 30, | ||||||
13 | 2012 shall be adjusted and
services shall be affected as | ||||||
14 | required by any other provision of Public Act 97-689. In | ||||||
15 | addition, the Department shall do the following: | ||||||
16 | (1) Delink the per diem rate paid for supportive living | ||||||
17 | facility services from the per diem rate paid for nursing | ||||||
18 | facility services, effective for services provided on or | ||||||
19 | after May 1, 2011 and before July 1, 2019. | ||||||
20 | (2) Cease payment for bed reserves in nursing | ||||||
21 | facilities and specialized mental health rehabilitation | ||||||
22 | facilities; for purposes of therapeutic home visits for | ||||||
23 | individuals scoring as TBI on the MDS 3.0, beginning June | ||||||
24 | 1, 2015, the Department shall approve payments for bed | ||||||
25 | reserves in nursing facilities and specialized mental |
| |||||||
| |||||||
1 | health rehabilitation facilities that have at least a 90% | ||||||
2 | occupancy level and at least 80% of their residents are | ||||||
3 | Medicaid eligible. Payment shall be at a daily rate of 75% | ||||||
4 | of an individual's current Medicaid per diem and shall not | ||||||
5 | exceed 10 days in a calendar month. | ||||||
6 | (2.5) Cease payment for bed reserves for purposes of | ||||||
7 | inpatient hospitalizations to intermediate care facilities | ||||||
8 | for persons with developmental development disabilities, | ||||||
9 | except in the instance of residents who are under 21 years | ||||||
10 | of age. | ||||||
11 | (3) Cease payment of the $10 per day add-on payment to | ||||||
12 | nursing facilities for certain residents with | ||||||
13 | developmental disabilities. | ||||||
14 | (b) After the application of subsection (a), | ||||||
15 | notwithstanding any other provision of this
Code to the | ||||||
16 | contrary and to the extent permitted by federal law, on and | ||||||
17 | after July 1,
2012, the rates of reimbursement for services and | ||||||
18 | other payments provided under this
Code shall further be | ||||||
19 | reduced as follows: | ||||||
20 | (1) Rates or payments for physician services, dental | ||||||
21 | services, or community health center services reimbursed | ||||||
22 | through an encounter rate, and services provided under the | ||||||
23 | Medicaid Rehabilitation Option of the Illinois Title XIX | ||||||
24 | State Plan shall not be further reduced, except as provided | ||||||
25 | in Section 5-5b.1. | ||||||
26 | (2) Rates or payments, or the portion thereof, paid to |
| |||||||
| |||||||
1 | a provider that is operated by a unit of local government | ||||||
2 | or State University that provides the non-federal share of | ||||||
3 | such services shall not be further reduced, except as | ||||||
4 | provided in Section 5-5b.1. | ||||||
5 | (3) Rates or payments for hospital services delivered | ||||||
6 | by a hospital defined as a Safety-Net Hospital under | ||||||
7 | Section 5-5e.1 of this Code shall not be further reduced, | ||||||
8 | except as provided in Section 5-5b.1. | ||||||
9 | (4) Rates or payments for hospital services delivered | ||||||
10 | by a Critical Access Hospital, which is an Illinois | ||||||
11 | hospital designated as a critical care hospital by the | ||||||
12 | Department of Public Health in accordance with 42 CFR 485, | ||||||
13 | Subpart F, shall not be further reduced, except as provided | ||||||
14 | in Section 5-5b.1. | ||||||
15 | (5) Rates or payments for Nursing Facility Services | ||||||
16 | shall only be further adjusted pursuant to Section 5-5.2 of | ||||||
17 | this Code. | ||||||
18 | (6) Rates or payments for services delivered by long | ||||||
19 | term care facilities licensed under the ID/DD Community | ||||||
20 | Care Act or the MC/DD Act and developmental training | ||||||
21 | services shall not be further reduced. | ||||||
22 | (7) Rates or payments for services provided under | ||||||
23 | capitation rates shall be adjusted taking into | ||||||
24 | consideration the rates reduction and covered services | ||||||
25 | required by Public Act 97-689. | ||||||
26 | (8) For hospitals not previously described in this |
| |||||||
| |||||||
1 | subsection, the rates or payments for hospital services | ||||||
2 | shall be further reduced by 3.5%, except for payments | ||||||
3 | authorized under Section 5A-12.4 of this Code. | ||||||
4 | (9) For all other rates or payments for services | ||||||
5 | delivered by providers not specifically referenced in | ||||||
6 | paragraphs (1) through (8), rates or payments shall be | ||||||
7 | further reduced by 2.7%. | ||||||
8 | (c) Any assessment imposed by this Code shall continue and | ||||||
9 | nothing in this Section shall be construed to cause it to | ||||||
10 | cease.
| ||||||
11 | (d) Notwithstanding any other provision of this Code to the | ||||||
12 | contrary, subject to federal approval under Title XIX of the | ||||||
13 | Social Security Act, for dates of service on and after July 1, | ||||||
14 | 2014, rates or payments for services provided for the purpose | ||||||
15 | of transitioning children from a hospital to home placement or | ||||||
16 | other appropriate setting by a children's community-based | ||||||
17 | health care center authorized under the Alternative Health Care | ||||||
18 | Delivery Act shall be $683 per day. | ||||||
19 | (e) (Blank) Notwithstanding any other provision of this | ||||||
20 | Code to the contrary, subject to federal approval under Title | ||||||
21 | XIX of the Social Security Act, for dates of service on and | ||||||
22 | after July 1, 2014, rates or payments for home health visits | ||||||
23 | shall be $72 . | ||||||
24 | (f) (Blank) Notwithstanding any other provision of this | ||||||
25 | Code to the contrary, subject to federal approval under Title | ||||||
26 | XIX of the Social Security Act, for dates of service on and |
| |||||||
| |||||||
1 | after July 1, 2014, rates or payments for the certified nursing | ||||||
2 | assistant component of the home health agency rate shall be | ||||||
3 | $20 . | ||||||
4 | (Source: P.A. 101-10, eff. 6-5-19; revised 9-12-19.)
| ||||||
5 | (305 ILCS 5/5-16.8)
| ||||||
6 | Sec. 5-16.8. Required health benefits. The medical | ||||||
7 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
8 | benefits required to be covered by a policy of
accident and | ||||||
9 | health insurance under Section 356t and the coverage required
| ||||||
10 | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, | ||||||
11 | 356z.29, and 356z.32, and 356z.33 , 356z.34, and 356z.35 of the | ||||||
12 | Illinois
Insurance Code and (ii) be subject to the provisions | ||||||
13 | of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois
| ||||||
14 | Insurance Code.
| ||||||
15 | The Department, by rule, shall adopt a model similar to the | ||||||
16 | requirements of Section 356z.39 of the Illinois Insurance Code. | ||||||
17 | On and after July 1, 2012, the Department shall reduce any | ||||||
18 | rate of reimbursement for services or other payments or alter | ||||||
19 | any methodologies authorized by this Code to reduce any rate of | ||||||
20 | reimbursement for services or other payments in accordance with | ||||||
21 | Section 5-5e. | ||||||
22 | To ensure full access to the benefits set forth in this | ||||||
23 | Section, on and after January 1, 2016, the Department shall | ||||||
24 | ensure that provider and hospital reimbursement for | ||||||
25 | post-mastectomy care benefits required under this Section are |
| |||||||
| |||||||
1 | no lower than the Medicare reimbursement rate. | ||||||
2 | (Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; | ||||||
3 | 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. | ||||||
4 | 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, | ||||||
5 | eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)
| ||||||
6 | (305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
| ||||||
7 | Sec. 5B-4. Payment of assessment; penalty.
| ||||||
8 | (a) The assessment imposed by Section 5B-2 shall be due and | ||||||
9 | payable monthly, on the last State business day of the month | ||||||
10 | for occupied bed days reported for the preceding third month | ||||||
11 | prior to the month in which the tax is payable and due. A | ||||||
12 | facility that has delayed payment due to the State's failure to | ||||||
13 | reimburse for services rendered may request an extension on the | ||||||
14 | due date for payment pursuant to subsection (b) and shall pay | ||||||
15 | the assessment within 30 days of reimbursement by the | ||||||
16 | Department.
The Illinois Department may provide that county | ||||||
17 | nursing homes directed and
maintained pursuant to Section | ||||||
18 | 5-1005 of the Counties Code may meet their
assessment | ||||||
19 | obligation by certifying to the Illinois Department that county
| ||||||
20 | expenditures have been obligated for the operation of the | ||||||
21 | county nursing
home in an amount at least equal to the amount | ||||||
22 | of the assessment.
| ||||||
23 | (a-5) The Illinois Department shall provide for an | ||||||
24 | electronic submission process for each long-term care facility | ||||||
25 | to report at a minimum the number of occupied bed days of the |
| |||||||
| |||||||
1 | long-term care facility for the reporting period and other | ||||||
2 | reasonable information the Illinois Department requires for | ||||||
3 | the administration of its responsibilities under this Code. | ||||||
4 | Beginning July 1, 2013, a separate electronic submission shall | ||||||
5 | be completed for each long-term care facility in this State | ||||||
6 | operated by a long-term care provider. The Illinois Department | ||||||
7 | shall provide a self-reporting notice of the assessment form | ||||||
8 | that the long-term care facility completes for the required | ||||||
9 | period and submits with its assessment payment to the Illinois | ||||||
10 | Department. shall prepare an assessment bill stating the amount | ||||||
11 | due and payable each month and submit it to each long-term care | ||||||
12 | facility via an electronic process. Each assessment payment | ||||||
13 | shall be accompanied by a copy of the assessment bill sent to | ||||||
14 | the long-term care facility by the Illinois Department. To the | ||||||
15 | extent practicable, the Department shall coordinate the | ||||||
16 | assessment reporting requirements with other reporting | ||||||
17 | required of long-term care facilities. | ||||||
18 | (b) The Illinois Department is authorized to establish
| ||||||
19 | delayed payment schedules for long-term care providers that are
| ||||||
20 | unable to make assessment payments when due under this Section
| ||||||
21 | due to financial difficulties, as determined by the Illinois
| ||||||
22 | Department. The Illinois Department may not deny a request for | ||||||
23 | delay of payment of the assessment imposed under this Article | ||||||
24 | if the long-term care provider has not been paid for services | ||||||
25 | provided during the month on which the assessment is levied or | ||||||
26 | the Medicaid managed care organization has not been paid by the |
| |||||||
| |||||||
1 | State.
| ||||||
2 | (c) If a long-term care provider fails to pay the full
| ||||||
3 | amount of an assessment payment when due (including any | ||||||
4 | extensions
granted under subsection (b)), there shall, unless | ||||||
5 | waived by the
Illinois Department for reasonable cause, be | ||||||
6 | added to the
assessment imposed by Section 5B-2 a
penalty | ||||||
7 | assessment equal to the lesser of (i) 5% of the amount of
the | ||||||
8 | assessment payment not paid on or before the due date plus 5% | ||||||
9 | of the
portion thereof remaining unpaid on the last day of each | ||||||
10 | month
thereafter or (ii) 100% of the assessment payment amount | ||||||
11 | not paid on or
before the due date. For purposes of this | ||||||
12 | subsection, payments
will be credited first to unpaid | ||||||
13 | assessment payment amounts (rather than
to penalty or | ||||||
14 | interest), beginning with the most delinquent assessment | ||||||
15 | payments. Payment cycles of longer than 60 days shall be one | ||||||
16 | factor the Director takes into account in granting a waiver | ||||||
17 | under this Section.
| ||||||
18 | (c-5) If a long-term care facility fails to file its | ||||||
19 | assessment bill with payment, there shall, unless waived by the | ||||||
20 | Illinois Department for reasonable cause, be added to the | ||||||
21 | assessment due a penalty assessment equal to 25% of the | ||||||
22 | assessment due. After July 1, 2013, no penalty shall be | ||||||
23 | assessed under this Section if the Illinois Department does not | ||||||
24 | provide a process for the electronic submission of the | ||||||
25 | information required by subsection (a-5). | ||||||
26 | (d) Nothing in this amendatory Act of 1993 shall be |
| |||||||
| |||||||
1 | construed to prevent
the Illinois Department from collecting | ||||||
2 | all amounts due under this Article
pursuant to an assessment | ||||||
3 | imposed before the effective date of this amendatory
Act of | ||||||
4 | 1993.
| ||||||
5 | (e) Nothing in this amendatory Act of the 96th General | ||||||
6 | Assembly shall be construed to prevent
the Illinois Department | ||||||
7 | from collecting all amounts due under this Code
pursuant to an | ||||||
8 | assessment, tax, fee, or penalty imposed before the effective | ||||||
9 | date of this amendatory
Act of the 96th General Assembly. | ||||||
10 | (f) No installment of the assessment imposed by Section | ||||||
11 | 5B-2 shall be due and payable until after the Department | ||||||
12 | notifies the long-term care providers, in writing, that the | ||||||
13 | payment methodologies to long-term care providers required | ||||||
14 | under Section 5-5.4 of this Code have been approved by the | ||||||
15 | Centers for Medicare and Medicaid Services of the U.S. | ||||||
16 | Department of Health and Human Services and the waivers under | ||||||
17 | 42 CFR 433.68 for the assessment imposed by this Section, if | ||||||
18 | necessary, have been granted by the Centers for Medicare and | ||||||
19 | Medicaid Services of the U.S. Department of Health and Human | ||||||
20 | Services. Upon notification to the Department of approval of | ||||||
21 | the payment methodologies required under Section 5-5.4 of this | ||||||
22 | Code and the waivers granted under 42 CFR 433.68, all | ||||||
23 | installments otherwise due under Section 5B-4 prior to the date | ||||||
24 | of notification shall be due and payable to the Department upon | ||||||
25 | written direction from the Department within 90 days after | ||||||
26 | issuance by the Comptroller of the payments required under |
| |||||||
| |||||||
1 | Section 5-5.4 of this Code. | ||||||
2 | (Source: P.A. 100-501, eff. 6-1-18 .)
| ||||||
3 | (305 ILCS 5/11-5.1) | ||||||
4 | Sec. 11-5.1. Eligibility verification. Notwithstanding any | ||||||
5 | other provision of this Code, with respect to applications for | ||||||
6 | medical assistance provided under Article V of this Code, | ||||||
7 | eligibility shall be determined in a manner that ensures | ||||||
8 | program integrity and complies with federal laws and | ||||||
9 | regulations while minimizing unnecessary barriers to | ||||||
10 | enrollment. To this end, as soon as practicable, and unless the | ||||||
11 | Department receives written denial from the federal | ||||||
12 | government, this Section shall be implemented: | ||||||
13 | (a) The Department of Healthcare and Family Services or its | ||||||
14 | designees shall: | ||||||
15 | (1) By no later than July 1, 2011, require verification | ||||||
16 | of, at a minimum, one month's income from all sources | ||||||
17 | required for determining the eligibility of applicants for | ||||||
18 | medical assistance under this Code. Such verification | ||||||
19 | shall take the form of pay stubs, business or income and | ||||||
20 | expense records for self-employed persons, letters from | ||||||
21 | employers, and any other valid documentation of income | ||||||
22 | including data obtained electronically by the Department | ||||||
23 | or its designees from other sources as described in | ||||||
24 | subsection (b) of this Section. A month's income may be | ||||||
25 | verified by a single pay stub with the monthly income |
| |||||||
| |||||||
1 | extrapolated from the time period covered by the pay stub. | ||||||
2 | (2) By no later than October 1, 2011, require | ||||||
3 | verification of, at a minimum, one month's income from all | ||||||
4 | sources required for determining the continued eligibility | ||||||
5 | of recipients at their annual review of eligibility for | ||||||
6 | medical assistance under this Code. Information the | ||||||
7 | Department receives prior to the annual review, including | ||||||
8 | information available to the Department as a result of the | ||||||
9 | recipient's application for other non-Medicaid benefits, | ||||||
10 | that is sufficient to make a determination of continued | ||||||
11 | Medicaid eligibility may be reviewed and verified, and | ||||||
12 | subsequent action taken including client notification of | ||||||
13 | continued Medicaid eligibility. The date of client | ||||||
14 | notification establishes the date for subsequent annual | ||||||
15 | Medicaid eligibility reviews. Such verification shall take | ||||||
16 | the form of pay stubs, business or income and expense | ||||||
17 | records for self-employed persons, letters from employers, | ||||||
18 | and any other valid documentation of income including data | ||||||
19 | obtained electronically by the Department or its designees | ||||||
20 | from other sources as described in subsection (b) of this | ||||||
21 | Section. A month's income may be verified by a single pay | ||||||
22 | stub with the monthly income extrapolated from the time | ||||||
23 | period covered by the pay stub. The
Department shall send a | ||||||
24 | notice to
recipients at least 60 days prior to the end of | ||||||
25 | their period
of eligibility that informs them of the
| ||||||
26 | requirements for continued eligibility. If a recipient
|
| |||||||
| |||||||
1 | does not fulfill the requirements for continued | ||||||
2 | eligibility by the
deadline established in the notice a | ||||||
3 | notice of cancellation shall be issued to the recipient and | ||||||
4 | coverage shall end no later than the last day of the month | ||||||
5 | following the last day of the eligibility period. A | ||||||
6 | recipient's eligibility may be reinstated without | ||||||
7 | requiring a new application if the recipient fulfills the | ||||||
8 | requirements for continued eligibility prior to the end of | ||||||
9 | the third month following the last date of coverage (or | ||||||
10 | longer period if required by federal regulations). Nothing | ||||||
11 | in this Section shall prevent an individual whose coverage | ||||||
12 | has been cancelled from reapplying for health benefits at | ||||||
13 | any time. | ||||||
14 | (3) By no later than July 1, 2011, require verification | ||||||
15 | of Illinois residency. | ||||||
16 | The Department, with federal approval, may choose to adopt | ||||||
17 | continuous financial eligibility for a full 12 months for | ||||||
18 | adults on Medicaid. | ||||||
19 | (b) The Department shall establish or continue cooperative
| ||||||
20 | arrangements with the Social Security Administration, the
| ||||||
21 | Illinois Secretary of State, the Department of Human Services,
| ||||||
22 | the Department of Revenue, the Department of Employment
| ||||||
23 | Security, and any other appropriate entity to gain electronic
| ||||||
24 | access, to the extent allowed by law, to information available
| ||||||
25 | to those entities that may be appropriate for electronically
| ||||||
26 | verifying any factor of eligibility for benefits under the
|
| |||||||
| |||||||
1 | Program. Data relevant to eligibility shall be provided for no
| ||||||
2 | other purpose than to verify the eligibility of new applicants | ||||||
3 | or current recipients of health benefits under the Program. | ||||||
4 | Data shall be requested or provided for any new applicant or | ||||||
5 | current recipient only insofar as that individual's | ||||||
6 | circumstances are relevant to that individual's or another | ||||||
7 | individual's eligibility. | ||||||
8 | (c) Within 90 days of the effective date of this amendatory | ||||||
9 | Act of the 96th General Assembly, the Department of Healthcare | ||||||
10 | and Family Services shall send notice to current recipients | ||||||
11 | informing them of the changes regarding their eligibility | ||||||
12 | verification.
| ||||||
13 | (d) As soon as practical if the data is reasonably | ||||||
14 | available, but no later than January 1, 2017, the Department | ||||||
15 | shall compile on a monthly basis data on eligibility | ||||||
16 | redeterminations of beneficiaries of medical assistance | ||||||
17 | provided under Article V of this Code. This data shall be | ||||||
18 | posted on the Department's website, and data from prior months | ||||||
19 | shall be retained and available on the Department's website. | ||||||
20 | The data compiled and reported shall include the following: | ||||||
21 | (1) The total number of redetermination decisions made | ||||||
22 | in a month and, of that total number, the number of | ||||||
23 | decisions to continue or change benefits and the number of | ||||||
24 | decisions to cancel benefits. | ||||||
25 | (2) A breakdown of enrollee language preference for the | ||||||
26 | total number of redetermination decisions made in a month |
| |||||||
| |||||||
1 | and, of that total number, a breakdown of enrollee language | ||||||
2 | preference for the number of decisions to continue or | ||||||
3 | change benefits, and a breakdown of enrollee language | ||||||
4 | preference for the number of decisions to cancel benefits. | ||||||
5 | The language breakdown shall include, at a minimum, | ||||||
6 | English, Spanish, and the next 4 most commonly used | ||||||
7 | languages. | ||||||
8 | (3) The percentage of cancellation decisions made in a | ||||||
9 | month due to each of the following: | ||||||
10 | (A) The beneficiary's ineligibility due to excess | ||||||
11 | income. | ||||||
12 | (B) The beneficiary's ineligibility due to not | ||||||
13 | being an Illinois resident. | ||||||
14 | (C) The beneficiary's ineligibility due to being | ||||||
15 | deceased. | ||||||
16 | (D) The beneficiary's request to cancel benefits. | ||||||
17 | (E) The beneficiary's lack of response after | ||||||
18 | notices mailed to the beneficiary are returned to the | ||||||
19 | Department as undeliverable by the United States | ||||||
20 | Postal Service. | ||||||
21 | (F) The beneficiary's lack of response to a request | ||||||
22 | for additional information when reliable information | ||||||
23 | in the beneficiary's account, or other more current | ||||||
24 | information, is unavailable to the Department to make a | ||||||
25 | decision on whether to continue benefits. | ||||||
26 | (G) Other reasons tracked by the Department for the |
| |||||||
| |||||||
1 | purpose of ensuring program integrity. | ||||||
2 | (4) If a vendor is utilized to provide services in | ||||||
3 | support of the Department's redetermination decision | ||||||
4 | process, the total number of redetermination decisions | ||||||
5 | made in a month and, of that total number, the number of | ||||||
6 | decisions to continue or change benefits, and the number of | ||||||
7 | decisions to cancel benefits (i) with the involvement of | ||||||
8 | the vendor and (ii) without the involvement of the vendor. | ||||||
9 | (5) Of the total number of benefit cancellations in a | ||||||
10 | month, the number of beneficiaries who return from | ||||||
11 | cancellation within one month, the number of beneficiaries | ||||||
12 | who return from cancellation within 2 months, and the | ||||||
13 | number of beneficiaries who return from cancellation | ||||||
14 | within 3 months. Of the number of beneficiaries who return | ||||||
15 | from cancellation within 3 months, the percentage of those | ||||||
16 | cancellations due to each of the reasons listed under | ||||||
17 | paragraph (3) of this subsection. | ||||||
18 | (e) The Department shall conduct a complete review of the | ||||||
19 | Medicaid redetermination process in order to identify changes | ||||||
20 | that can increase the use of ex parte redetermination | ||||||
21 | processing. This review shall be completed within 90 days after | ||||||
22 | the effective date of this amendatory Act of the 101st General | ||||||
23 | Assembly. Within 90 days of completion of the review, the | ||||||
24 | Department shall seek written federal approval of policy | ||||||
25 | changes the review recommended and implement once approved. The | ||||||
26 | review shall specifically include, but not be limited to, use |
| |||||||
| |||||||
1 | of ex parte redeterminations of the following populations: | ||||||
2 | (1) Recipients of developmental disabilities services. | ||||||
3 | (2) Recipients of benefits under the State's Aid to the | ||||||
4 | Aged, Blind, or Disabled program. | ||||||
5 | (3) Recipients of Medicaid long-term care services and | ||||||
6 | supports, including waiver services. | ||||||
7 | (4) All Modified Adjusted Gross Income (MAGI) | ||||||
8 | populations. | ||||||
9 | (5) Populations with no verifiable income. | ||||||
10 | (6) Self-employed people. | ||||||
11 | The report shall also outline populations and | ||||||
12 | circumstances in which an ex parte redetermination is not a | ||||||
13 | recommended option. | ||||||
14 | (f) The Department shall explore and implement, as | ||||||
15 | practical and technologically possible, roles that | ||||||
16 | stakeholders outside State agencies can play to assist in | ||||||
17 | expediting eligibility determinations and redeterminations | ||||||
18 | within 24 months after the effective date of this amendatory | ||||||
19 | Act of the 101st General Assembly. Such practical roles to be | ||||||
20 | explored to expedite the eligibility determination processes | ||||||
21 | shall include the implementation of hospital presumptive | ||||||
22 | eligibility, as authorized by the Patient Protection and | ||||||
23 | Affordable Care Act. | ||||||
24 | (g) The Department or its designee shall seek federal | ||||||
25 | approval to enhance the reasonable compatibility standard from | ||||||
26 | 5% to 10%. |
| |||||||
| |||||||
1 | (h) Reporting. The Department of Healthcare and Family | ||||||
2 | Services and the Department of Human Services shall publish | ||||||
3 | quarterly reports on their progress in implementing policies | ||||||
4 | and practices pursuant to this Section as modified by this | ||||||
5 | amendatory Act of the 101st General Assembly. | ||||||
6 | (1) The reports shall include, but not be limited to, | ||||||
7 | the following: | ||||||
8 | (A) Medical application processing, including a | ||||||
9 | breakdown of the number of MAGI, non-MAGI, long-term | ||||||
10 | care, and other medical cases pending for various | ||||||
11 | incremental time frames between 0 to 181 or more days. | ||||||
12 | (B) Medical redeterminations completed, including: | ||||||
13 | (i) a breakdown of the number of households that were | ||||||
14 | redetermined ex parte and those that were not; (ii) the | ||||||
15 | reasons households were not redetermined ex parte; and | ||||||
16 | (iii) the relative percentages of these reasons. | ||||||
17 | (C) A narrative discussion on issues identified in | ||||||
18 | the functioning of the State's Integrated Eligibility | ||||||
19 | System and progress on addressing those issues, as well | ||||||
20 | as progress on implementing strategies to address | ||||||
21 | eligibility backlogs, including expanding ex parte | ||||||
22 | determinations to ensure timely eligibility | ||||||
23 | determinations and renewals. | ||||||
24 | (2) Initial reports shall be issued within 90 days | ||||||
25 | after the effective date of this amendatory Act of the | ||||||
26 | 101st General Assembly. |
| |||||||
| |||||||
1 | (3) All reports shall be published on the Department's | ||||||
2 | website. | ||||||
3 | (Source: P.A. 101-209, eff. 8-5-19.)
| ||||||
4 | (305 ILCS 5/12-21.21 new) | ||||||
5 | Sec. 12-21.21. Federal waiver or State Plan amendment. The | ||||||
6 | Department of Healthcare and Family Services and the Department | ||||||
7 | of Human Services shall jointly submit the necessary | ||||||
8 | application to the federal Centers for Medicare and Medicaid | ||||||
9 | Services for a waiver or State Plan amendment to allow remote | ||||||
10 | monitoring and support services as a waiver-reimbursable | ||||||
11 | service for persons with intellectual and developmental | ||||||
12 | disabilities. The application shall be submitted no later than | ||||||
13 | January 1, 2021. | ||||||
14 | No later than July 1, 2021, the Department of Human | ||||||
15 | Services shall adopt rules to allow remote monitoring and | ||||||
16 | support services at community-integrated living arrangements.
| ||||||
17 | Section 90-40. The Medical Patient Rights Act is amended by | ||||||
18 | changing Section 3 as follows:
| ||||||
19 | (410 ILCS 50/3) (from Ch. 111 1/2, par. 5403)
| ||||||
20 | Sec. 3. The following rights are hereby established:
| ||||||
21 | (a) The right of each patient to care consistent with sound | ||||||
22 | nursing and
medical practices, to be informed of the name of | ||||||
23 | the physician responsible
for coordinating his or her care, to |
| |||||||
| |||||||
1 | receive information concerning his or
her condition and | ||||||
2 | proposed treatment, to refuse any treatment to the extent
| ||||||
3 | permitted by law, and to privacy and confidentiality of records | ||||||
4 | except as
otherwise provided by law.
| ||||||
5 | (b) The right of each patient, regardless of source of | ||||||
6 | payment, to examine
and receive a reasonable explanation of his | ||||||
7 | total bill for services rendered
by his physician or health | ||||||
8 | care provider, including the itemized charges
for specific | ||||||
9 | services received. Each physician or health care provider
shall | ||||||
10 | be responsible only for a reasonable explanation of those | ||||||
11 | specific
services provided by such physician or health care | ||||||
12 | provider.
| ||||||
13 | (c) In the event an insurance company or health services | ||||||
14 | corporation cancels
or refuses to renew an individual policy or | ||||||
15 | plan, the insured patient shall
be entitled to timely, prior | ||||||
16 | notice of the termination of such policy or plan.
| ||||||
17 | An insurance company or health services corporation that | ||||||
18 | requires any
insured patient or applicant for new or continued | ||||||
19 | insurance or coverage to
be tested for infection with human | ||||||
20 | immunodeficiency virus (HIV) or any
other identified causative | ||||||
21 | agent of acquired immunodeficiency syndrome
(AIDS) shall (1) | ||||||
22 | give the patient or applicant prior written notice of such
| ||||||
23 | requirement, (2) proceed with such testing only upon the | ||||||
24 | written
authorization of the applicant or patient, and (3) keep | ||||||
25 | the results of such
testing confidential. Notice of an adverse | ||||||
26 | underwriting or coverage
decision may be given to any |
| |||||||
| |||||||
1 | appropriately interested party, but the
insurer may only | ||||||
2 | disclose the test result itself to a physician designated
by | ||||||
3 | the applicant or patient, and any such disclosure shall be in a | ||||||
4 | manner
that assures confidentiality.
| ||||||
5 | The Department of Insurance shall enforce the provisions of | ||||||
6 | this subsection.
| ||||||
7 | (d) The right of each patient to privacy and | ||||||
8 | confidentiality in health
care. Each physician, health care | ||||||
9 | provider, health services corporation and
insurance company | ||||||
10 | shall refrain from disclosing the nature or details of
services | ||||||
11 | provided to patients, except that such information may be | ||||||
12 | disclosed: (1) to the
patient, (2) to the party making | ||||||
13 | treatment decisions if the patient is incapable
of making | ||||||
14 | decisions regarding the health services provided, (3) for | ||||||
15 | treatment in accordance with 45 CFR 164.501 and 164.506, (4) | ||||||
16 | for
payment in accordance with 45 CFR 164.501 and 164.506, (5) | ||||||
17 | to those parties responsible for peer review,
utilization | ||||||
18 | review, and quality assurance, (6) for health care operations | ||||||
19 | in accordance with 45 CFR 164.501 and 164.506, (7) to those | ||||||
20 | parties required to
be notified under the Abused and Neglected | ||||||
21 | Child Reporting Act or the
Illinois Sexually Transmissible | ||||||
22 | Disease Control Act, or (8) as otherwise permitted,
authorized, | ||||||
23 | or required by State or federal law. This right may be waived | ||||||
24 | in writing by the
patient or the patient's guardian or legal | ||||||
25 | representative, but a physician or other health care
provider | ||||||
26 | may not condition the provision of services on the patient's,
|
| |||||||
| |||||||
1 | guardian's, or legal representative's agreement to sign such a | ||||||
2 | waiver. In the interest of public health, safety, and welfare, | ||||||
3 | patient information, including, but not limited to, health | ||||||
4 | information, demographic information, and information about | ||||||
5 | the services provided to patients, may be transmitted to or | ||||||
6 | through a health information exchange, as that term is defined | ||||||
7 | in Section 2 of the Mental Health and Developmental | ||||||
8 | Disabilities Confidentiality Act, in accordance with the | ||||||
9 | disclosures permitted pursuant to this Section. Patients shall | ||||||
10 | be provided the opportunity to opt out of their health | ||||||
11 | information being transmitted to or through a health | ||||||
12 | information exchange in accordance with the regulations, | ||||||
13 | standards, or contractual obligations adopted by the Illinois | ||||||
14 | Health Information Exchange Office Authority in accordance | ||||||
15 | with Section 9.6 of the Mental Health and Developmental | ||||||
16 | Disabilities Confidentiality Act, Section 9.6 of the AIDS | ||||||
17 | Confidentiality Act, or Section 31.8 of the Genetic Information | ||||||
18 | Privacy Act, as applicable. In the case of a patient choosing | ||||||
19 | to opt out of having his or her information available on an | ||||||
20 | HIE, nothing in this Act shall cause the physician or health | ||||||
21 | care provider to be liable for the release of a patient's | ||||||
22 | health information by other entities that may possess such | ||||||
23 | information, including, but not limited to, other health | ||||||
24 | professionals, providers, laboratories, pharmacies, hospitals, | ||||||
25 | ambulatory surgical centers, and nursing homes.
| ||||||
26 | (Source: P.A. 98-1046, eff. 1-1-15 .)
|
| |||||||
| |||||||
1 | Section 90-45. The Genetic Information Privacy Act is | ||||||
2 | amended by changing Section 10 as follows:
| ||||||
3 | (410 ILCS 513/10)
| ||||||
4 | Sec. 10. Definitions. As used in this Act:
| ||||||
5 | " Office Authority " means the Illinois Health Information | ||||||
6 | Exchange Office Authority established pursuant to the Illinois | ||||||
7 | Health Information Exchange and Technology Act. | ||||||
8 | "Business associate" has the meaning ascribed to it under | ||||||
9 | HIPAA, as specified in 45 CFR 160.103. | ||||||
10 | "Covered entity" has the meaning ascribed to it under | ||||||
11 | HIPAA, as specified in 45 CFR 160.103. | ||||||
12 | "De-identified information" means health information that | ||||||
13 | is not individually identifiable as described under HIPAA, as | ||||||
14 | specified in 45 CFR 164.514(b). | ||||||
15 | "Disclosure" has the meaning ascribed to it under HIPAA, as | ||||||
16 | specified in 45 CFR 160.103. | ||||||
17 | "Employer" means the State of Illinois, any unit of local | ||||||
18 | government, and any board, commission, department, | ||||||
19 | institution, or school district, any party to a public | ||||||
20 | contract, any joint apprenticeship or training committee | ||||||
21 | within the State, and every other person employing employees | ||||||
22 | within the State. | ||||||
23 | "Employment agency" means both public and private | ||||||
24 | employment agencies and any person, labor organization, or |
| |||||||
| |||||||
1 | labor union having a hiring hall or hiring office regularly | ||||||
2 | undertaking, with or without compensation, to procure | ||||||
3 | opportunities to work, or to procure, recruit, refer, or place | ||||||
4 | employees. | ||||||
5 | "Family member" means, with respect to an individual, (i) | ||||||
6 | the spouse of the individual; (ii) a dependent child of the | ||||||
7 | individual, including a child who is born to or placed for | ||||||
8 | adoption with the individual; (iii) any other person qualifying | ||||||
9 | as a covered dependent under a managed care plan; and (iv) all | ||||||
10 | other individuals related by blood or law to the individual or | ||||||
11 | the spouse or child described in subsections (i) through (iii) | ||||||
12 | of this definition. | ||||||
13 | "Genetic information" has the meaning ascribed to it under | ||||||
14 | HIPAA, as specified in 45 CFR 160.103. | ||||||
15 | "Genetic monitoring" means the periodic examination of | ||||||
16 | employees to evaluate acquired modifications to their genetic | ||||||
17 | material, such as chromosomal damage or evidence of increased | ||||||
18 | occurrence of mutations that may have developed in the course | ||||||
19 | of employment due to exposure to toxic substances in the | ||||||
20 | workplace in order to identify, evaluate, and respond to | ||||||
21 | effects of or control adverse environmental exposures in the | ||||||
22 | workplace. | ||||||
23 | "Genetic services" has the meaning ascribed to it under | ||||||
24 | HIPAA, as specified in 45 CFR 160.103. | ||||||
25 | "Genetic testing" and "genetic test" have the meaning | ||||||
26 | ascribed to "genetic test" under HIPAA, as specified in 45 CFR |
| |||||||
| |||||||
1 | 160.103. "Genetic testing" includes direct-to-consumer | ||||||
2 | commercial genetic testing. | ||||||
3 | "Health care operations" has the meaning ascribed to it | ||||||
4 | under HIPAA, as specified in 45 CFR 164.501. | ||||||
5 | "Health care professional" means (i) a licensed physician, | ||||||
6 | (ii) a licensed physician assistant, (iii) a licensed advanced | ||||||
7 | practice registered nurse, (iv) a licensed dentist, (v) a | ||||||
8 | licensed podiatrist, (vi) a licensed genetic counselor, or | ||||||
9 | (vii) an individual certified to provide genetic testing by a | ||||||
10 | state or local public health department. | ||||||
11 | "Health care provider" has the meaning ascribed to it under | ||||||
12 | HIPAA, as specified in 45 CFR 160.103. | ||||||
13 | "Health facility" means a hospital, blood bank, blood | ||||||
14 | center, sperm bank, or other health care institution, including | ||||||
15 | any "health facility" as that term is defined in the Illinois | ||||||
16 | Finance Authority Act. | ||||||
17 | "Health information exchange" or "HIE" means a health | ||||||
18 | information exchange or health information organization that | ||||||
19 | exchanges health information electronically that (i) is | ||||||
20 | established pursuant to the Illinois Health Information | ||||||
21 | Exchange and Technology Act, or any subsequent amendments | ||||||
22 | thereto, and any administrative rules promulgated thereunder; | ||||||
23 | (ii) has established a data sharing arrangement with the Office | ||||||
24 | Authority ; or (iii) as of August 16, 2013, was designated by | ||||||
25 | the Illinois Health Information
Exchange Authority (now | ||||||
26 | Office) Board as a member of, or was represented on, the |
| |||||||
| |||||||
1 | Authority Board's Regional Health Information Exchange | ||||||
2 | Workgroup; provided that such designation
shall not require the | ||||||
3 | establishment of a data sharing arrangement or other | ||||||
4 | participation with the Illinois Health
Information Exchange or | ||||||
5 | the payment of any fee. In certain circumstances, in accordance | ||||||
6 | with HIPAA, an HIE will be a business associate. | ||||||
7 | "Health oversight agency" has the meaning ascribed to it | ||||||
8 | under HIPAA, as specified in 45 CFR 164.501. | ||||||
9 | "HIPAA" means the Health Insurance Portability and | ||||||
10 | Accountability Act of 1996, Public Law 104-191, as amended by | ||||||
11 | the Health Information Technology for Economic and Clinical | ||||||
12 | Health Act of 2009, Public Law 111-05, and any subsequent | ||||||
13 | amendments thereto and any regulations promulgated thereunder.
| ||||||
14 | "Insurer" means (i) an entity that is subject to the | ||||||
15 | jurisdiction of the Director of Insurance and (ii) a
managed | ||||||
16 | care plan.
| ||||||
17 | "Labor organization" includes any organization, labor | ||||||
18 | union, craft union, or any voluntary unincorporated | ||||||
19 | association designed to further the cause of the rights of | ||||||
20 | union labor that is constituted for the purpose, in whole or in | ||||||
21 | part, of collective bargaining or of dealing with employers | ||||||
22 | concerning grievances, terms or conditions of employment, or | ||||||
23 | apprenticeships or applications for apprenticeships, or of | ||||||
24 | other mutual aid or protection in connection with employment, | ||||||
25 | including apprenticeships or applications for apprenticeships. | ||||||
26 | "Licensing agency" means a board, commission, committee, |
| |||||||
| |||||||
1 | council, department, or officers, except a judicial officer, in | ||||||
2 | this State or any political subdivision authorized to grant, | ||||||
3 | deny, renew, revoke, suspend, annul, withdraw, or amend a | ||||||
4 | license or certificate of registration. | ||||||
5 | "Limited data set" has the meaning ascribed to it under | ||||||
6 | HIPAA, as described in 45 CFR 164.514(e)(2). | ||||||
7 | "Managed care plan" means a plan that establishes, | ||||||
8 | operates, or maintains a
network of health care providers that | ||||||
9 | have entered into agreements with the
plan to provide health | ||||||
10 | care services to enrollees where the plan has the
ultimate and | ||||||
11 | direct contractual obligation to the enrollee to arrange for | ||||||
12 | the
provision of or pay for services
through:
| ||||||
13 | (1) organizational arrangements for ongoing quality | ||||||
14 | assurance,
utilization review programs, or dispute | ||||||
15 | resolution; or
| ||||||
16 | (2) financial incentives for persons enrolled in the | ||||||
17 | plan to use the
participating providers and procedures | ||||||
18 | covered by the plan.
| ||||||
19 | A managed care plan may be established or operated by any | ||||||
20 | entity including
a licensed insurance company, hospital or | ||||||
21 | medical service plan, health
maintenance organization, limited | ||||||
22 | health service organization, preferred
provider organization, | ||||||
23 | third party administrator, or an employer or employee
| ||||||
24 | organization.
| ||||||
25 | "Minimum necessary" means HIPAA's standard for using, | ||||||
26 | disclosing, and requesting protected health information found |
| |||||||
| |||||||
1 | in 45 CFR 164.502(b) and 164.514(d). | ||||||
2 | "Nontherapeutic purpose" means a purpose that is not | ||||||
3 | intended to improve or preserve the life or health of the | ||||||
4 | individual whom the information concerns. | ||||||
5 | "Organized health care arrangement" has the meaning | ||||||
6 | ascribed to it under HIPAA, as specified in 45 CFR 160.103. | ||||||
7 | "Patient safety activities" has the meaning ascribed to it | ||||||
8 | under 42 CFR 3.20. | ||||||
9 | "Payment" has the meaning ascribed to it under HIPAA, as | ||||||
10 | specified in 45 CFR 164.501. | ||||||
11 | "Person" includes any natural person, partnership, | ||||||
12 | association, joint venture, trust, governmental entity, public | ||||||
13 | or private corporation, health facility, or other legal entity. | ||||||
14 | "Protected health information" has the meaning ascribed to | ||||||
15 | it under HIPAA, as specified in 45 CFR 164.103. | ||||||
16 | "Research" has the meaning ascribed to it under HIPAA, as | ||||||
17 | specified in 45 CFR 164.501. | ||||||
18 | "State agency" means an instrumentality of the State of | ||||||
19 | Illinois and any instrumentality of another state which | ||||||
20 | pursuant to applicable law or a written undertaking with an | ||||||
21 | instrumentality of the State of Illinois is bound to protect | ||||||
22 | the privacy of genetic information of Illinois persons. | ||||||
23 | "Treatment" has the meaning ascribed to it under HIPAA, as | ||||||
24 | specified in 45 CFR 164.501. | ||||||
25 | "Use" has the meaning ascribed to it under HIPAA, as | ||||||
26 | specified in 45 CFR 160.103, where context dictates. |
| |||||||
| |||||||
1 | (Source: P.A. 100-513, eff. 1-1-18; 101-132, eff. 1-1-20 .)
| ||||||
2 | Section 90-50. The Mental Health and Developmental | ||||||
3 | Disabilities Confidentiality Act is amended by changing | ||||||
4 | Sections 2, 9.5, 9.6, 9.8, 9.9, and 9.11 as follows:
| ||||||
5 | (740 ILCS 110/2) (from Ch. 91 1/2, par. 802)
| ||||||
6 | Sec. 2.
The terms used in this Act, unless the context | ||||||
7 | requires otherwise,
have the meanings ascribed to them in this | ||||||
8 | Section.
| ||||||
9 | "Agent" means a person who has been legally appointed as an | ||||||
10 | individual's
agent under a power of attorney for health care or | ||||||
11 | for property.
| ||||||
12 | "Business associate" has the meaning ascribed to it under | ||||||
13 | HIPAA, as specified in 45 CFR 160.103. | ||||||
14 | "Confidential communication" or "communication" means any | ||||||
15 | communication
made by a recipient or other person to a | ||||||
16 | therapist or to or in the presence of
other persons during or | ||||||
17 | in connection with providing mental health or
developmental | ||||||
18 | disability services to a recipient. Communication includes
| ||||||
19 | information which indicates that a person is a recipient. | ||||||
20 | "Communication" does not include information that has been | ||||||
21 | de-identified in accordance with HIPAA, as specified in 45 CFR | ||||||
22 | 164.514.
| ||||||
23 | "Covered entity" has the meaning ascribed to it under | ||||||
24 | HIPAA, as specified in 45 CFR 160.103. |
| |||||||
| |||||||
1 | "Guardian" means a legally appointed guardian or | ||||||
2 | conservator of the
person.
| ||||||
3 | "Health information exchange" or "HIE" means a health | ||||||
4 | information exchange or health information organization that | ||||||
5 | oversees and governs the electronic exchange of health | ||||||
6 | information that (i) is established pursuant to the Illinois | ||||||
7 | Health Information Exchange and Technology Act, or any | ||||||
8 | subsequent amendments thereto, and any administrative rules | ||||||
9 | promulgated thereunder; or
(ii) has established a data sharing | ||||||
10 | arrangement with the Illinois Health Information Exchange; or
| ||||||
11 | (iii) as of the effective date of this amendatory Act of the | ||||||
12 | 98th General Assembly, was designated by the Illinois Health | ||||||
13 | Information Exchange Office Authority Board as a member of, or | ||||||
14 | was represented on, the Office Authority Board's Regional | ||||||
15 | Health Information Exchange Workgroup; provided that such | ||||||
16 | designation shall not require the establishment of a data | ||||||
17 | sharing arrangement or other participation with the Illinois | ||||||
18 | Health Information Exchange or the payment of any fee. | ||||||
19 | "HIE purposes" means those uses and disclosures (as those | ||||||
20 | terms are defined under HIPAA, as specified in 45 CFR 160.103) | ||||||
21 | for activities of an HIE: (i) set forth in the Illinois Health | ||||||
22 | Information Exchange and Technology Act or any subsequent | ||||||
23 | amendments thereto and any administrative rules promulgated | ||||||
24 | thereunder; or (ii) which are permitted under federal law. | ||||||
25 | "HIPAA" means the Health Insurance Portability and | ||||||
26 | Accountability Act of 1996, Public Law 104-191, and any |
| |||||||
| |||||||
1 | subsequent amendments thereto and any regulations promulgated | ||||||
2 | thereunder, including the Security Rule, as specified in 45 CFR | ||||||
3 | 164.302-18, and the Privacy Rule, as specified in 45 CFR | ||||||
4 | 164.500-34. | ||||||
5 | "Integrated health system" means an organization with a | ||||||
6 | system of care which incorporates physical and behavioral | ||||||
7 | healthcare and includes care delivered in an inpatient and | ||||||
8 | outpatient setting. | ||||||
9 | "Interdisciplinary team" means a group of persons | ||||||
10 | representing different clinical disciplines, such as medicine, | ||||||
11 | nursing, social work, and psychology, providing and | ||||||
12 | coordinating the care and treatment for a recipient of mental | ||||||
13 | health or developmental disability services. The group may be | ||||||
14 | composed of individuals employed by one provider or multiple | ||||||
15 | providers. | ||||||
16 | "Mental health or developmental disabilities services" or | ||||||
17 | "services"
includes but is not limited to examination, | ||||||
18 | diagnosis, evaluation, treatment,
training, pharmaceuticals, | ||||||
19 | aftercare, habilitation or rehabilitation.
| ||||||
20 | "Personal notes" means:
| ||||||
21 | (i) information disclosed to the therapist in | ||||||
22 | confidence by
other persons on condition that such | ||||||
23 | information would never be disclosed
to the recipient or | ||||||
24 | other persons;
| ||||||
25 | (ii) information disclosed to the therapist by the | ||||||
26 | recipient
which would be injurious to the recipient's |
| |||||||
| |||||||
1 | relationships to other persons, and
| ||||||
2 | (iii) the therapist's speculations, impressions, | ||||||
3 | hunches, and reminders.
| ||||||
4 | "Parent" means a parent or, in the absence of a parent or | ||||||
5 | guardian,
a person in loco parentis.
| ||||||
6 | "Recipient" means a person who is receiving or has received | ||||||
7 | mental
health or developmental disabilities services.
| ||||||
8 | "Record" means any record kept by a therapist or by an | ||||||
9 | agency in the
course of providing mental health or | ||||||
10 | developmental disabilities service
to a recipient concerning | ||||||
11 | the recipient and the services provided.
"Records" includes all | ||||||
12 | records maintained by a court that have been created
in | ||||||
13 | connection with,
in preparation for, or as a result of the | ||||||
14 | filing of any petition or certificate
under Chapter II, Chapter | ||||||
15 | III, or Chapter IV
of the Mental Health and Developmental | ||||||
16 | Disabilities Code and includes the
petitions, certificates, | ||||||
17 | dispositional reports, treatment plans, and reports of
| ||||||
18 | diagnostic evaluations and of hearings under Article VIII of | ||||||
19 | Chapter III or under Article V of Chapter IV of that Code. | ||||||
20 | Record
does not include the therapist's personal notes, if such | ||||||
21 | notes are kept in
the therapist's sole possession for his own | ||||||
22 | personal use and are not
disclosed to any other person, except | ||||||
23 | the therapist's supervisor,
consulting therapist or attorney. | ||||||
24 | If at any time such notes are disclosed,
they shall be | ||||||
25 | considered part of the recipient's record for purposes of
this | ||||||
26 | Act. "Record" does not include information that has been |
| |||||||
| |||||||
1 | de-identified in accordance with HIPAA, as specified in 45 CFR | ||||||
2 | 164.514. "Record" does not include a reference to the receipt | ||||||
3 | of mental health or developmental disabilities services noted | ||||||
4 | during a patient history and physical or other summary of care.
| ||||||
5 | "Record custodian" means a person responsible for | ||||||
6 | maintaining a
recipient's record.
| ||||||
7 | "Therapist" means a psychiatrist, physician, psychologist, | ||||||
8 | social
worker, or nurse providing mental health or | ||||||
9 | developmental disabilities services
or any other person not | ||||||
10 | prohibited by law from providing such services or
from holding | ||||||
11 | himself out as a therapist if the recipient reasonably believes
| ||||||
12 | that such person is permitted to do so. Therapist includes any | ||||||
13 | successor
of the therapist. | ||||||
14 | "Therapeutic relationship" means the receipt by a | ||||||
15 | recipient of mental health or developmental disabilities | ||||||
16 | services from a therapist. "Therapeutic relationship" does not | ||||||
17 | include independent evaluations for a purpose other than the | ||||||
18 | provision of mental health or developmental disabilities | ||||||
19 | services.
| ||||||
20 | (Source: P.A. 98-378, eff. 8-16-13; 99-28, eff. 1-1-16 .)
| ||||||
21 | (740 ILCS 110/9.5) | ||||||
22 | Sec. 9.5. Use and disclosure of information to an HIE. | ||||||
23 | (a) An HIE, person, therapist, facility, agency, | ||||||
24 | interdisciplinary team, integrated health system, business | ||||||
25 | associate, or covered entity may, without a recipient's |
| |||||||
| |||||||
1 | consent, use or disclose information from a recipient's record | ||||||
2 | in connection with an HIE, including disclosure to the Illinois | ||||||
3 | Health Information Exchange Office Authority , an HIE, or the | ||||||
4 | business associate of either. An HIE and its business associate | ||||||
5 | may, without a recipient's consent, use or disclose and | ||||||
6 | re-disclose such information for HIE purposes or for such other | ||||||
7 | purposes as are specifically allowed under this Act. | ||||||
8 | (b) As used in this Section: | ||||||
9 | (1) "facility" means a developmental disability | ||||||
10 | facility as defined in Section 1-107 of the Mental Health | ||||||
11 | and Developmental Disabilities Code or a mental health | ||||||
12 | facility as defined in Section 1-114 of the Mental Health | ||||||
13 | and Developmental Disabilities Code; and | ||||||
14 | (2) the terms "disclosure" and "use" have the meanings | ||||||
15 | ascribed to them under HIPAA, as specified in 45 CFR | ||||||
16 | 160.103.
| ||||||
17 | (Source: P.A. 98-378, eff. 8-16-13.)
| ||||||
18 | (740 ILCS 110/9.6) | ||||||
19 | Sec. 9.6. HIE opt-out. The Illinois Health Information | ||||||
20 | Exchange Office Authority shall, through appropriate rules, | ||||||
21 | standards, or contractual obligations, which shall be binding | ||||||
22 | upon any HIE, as defined under Section 2, require that | ||||||
23 | participants of such HIE provide each recipient whose record is | ||||||
24 | accessible through the health information exchange the | ||||||
25 | reasonable opportunity to expressly decline the further |
| |||||||
| |||||||
1 | disclosure of the record by the health information exchange to | ||||||
2 | third parties, except to the extent permitted by law such as | ||||||
3 | for purposes of public health reporting. These rules, | ||||||
4 | standards, or contractual obligations shall permit a recipient | ||||||
5 | to revoke a prior decision to opt-out or a decision not to | ||||||
6 | opt-out. These rules, standards, or contractual obligations | ||||||
7 | shall provide for written notice of a recipient's right to | ||||||
8 | opt-out which directs the recipient to a health information | ||||||
9 | exchange website containing (i) an explanation of the purposes | ||||||
10 | of the health information exchange; and (ii) audio, visual, and | ||||||
11 | written instructions on how to opt-out of participation in | ||||||
12 | whole or in part to the extent possible. These rules, | ||||||
13 | standards, or contractual obligations shall be reviewed | ||||||
14 | annually and updated as the technical options develop. The | ||||||
15 | recipient shall be provided meaningful disclosure regarding | ||||||
16 | the health information exchange, and the recipient's decision | ||||||
17 | whether to opt-out should be obtained without undue inducement | ||||||
18 | or any element of force, fraud, deceit, duress, or other form | ||||||
19 | of constraint or coercion. To the extent that HIPAA, as | ||||||
20 | specified in 45 CFR 164.508(b)(4), prohibits a covered entity | ||||||
21 | from conditioning the provision of its services upon an | ||||||
22 | individual's provision of an authorization, an HIE participant | ||||||
23 | shall not condition the provision of its services upon a | ||||||
24 | recipient's decision to opt-out of further disclosure of the | ||||||
25 | record by an HIE to third parties. The Illinois Health | ||||||
26 | Information Exchange Office Authority shall, through |
| |||||||
| |||||||
1 | appropriate rules, standards, or contractual obligations, | ||||||
2 | which shall be binding upon any HIE, as defined under Section | ||||||
3 | 2, give consideration to the format and content of the | ||||||
4 | meaningful disclosure and the availability to recipients of | ||||||
5 | information regarding an HIE and the rights of recipients under | ||||||
6 | this Section to expressly decline the further disclosure of the | ||||||
7 | record by an HIE to third parties. The Illinois Health | ||||||
8 | Information Exchange Office Authority shall also give annual | ||||||
9 | consideration to enable a recipient to expressly decline the | ||||||
10 | further disclosure by an HIE to third parties of selected | ||||||
11 | portions of the recipient's record while permitting disclosure | ||||||
12 | of the recipient's remaining patient health information. In | ||||||
13 | establishing rules, standards, or contractual obligations | ||||||
14 | binding upon HIEs under this Section to give effect to | ||||||
15 | recipient disclosure preferences, the Illinois Health | ||||||
16 | Information Exchange Office Authority in its discretion may | ||||||
17 | consider the extent to which relevant health information | ||||||
18 | technologies reasonably available to therapists and HIEs in | ||||||
19 | this State reasonably enable the effective segmentation of | ||||||
20 | specific information within a recipient's electronic medical | ||||||
21 | record and reasonably enable the effective exclusion of | ||||||
22 | specific information from disclosure by an HIE to third | ||||||
23 | parties, as well as the availability of sufficient | ||||||
24 | authoritative clinical guidance to enable the practical | ||||||
25 | application of such technologies to effect recipient | ||||||
26 | disclosure preferences. The provisions of this Section 9.6 |
| |||||||
| |||||||
1 | shall not apply to the secure electronic transmission of data | ||||||
2 | which is point-to-point communication directed by the data | ||||||
3 | custodian. Any rules or standards promulgated under this | ||||||
4 | Section which apply to HIEs shall be limited to that subject | ||||||
5 | matter required by this Section and shall not include any | ||||||
6 | requirement that an HIE enter a data sharing arrangement or | ||||||
7 | otherwise participate with the Illinois Health Information | ||||||
8 | Exchange. In connection with its annual consideration | ||||||
9 | regarding the issue of segmentation of information within a | ||||||
10 | medical record and prior to the adoption of any rules or | ||||||
11 | standards regarding that issue, the Office Authority Board | ||||||
12 | shall consider information provided by affected persons or | ||||||
13 | organizations regarding the feasibility, availability, cost, | ||||||
14 | reliability, and interoperability of any technology or process | ||||||
15 | under consideration by the Board. Nothing in this Act shall be | ||||||
16 | construed to limit the authority of the Illinois Health | ||||||
17 | Information Exchange Office Authority to impose limits or | ||||||
18 | conditions on consent for disclosures to or through any HIE, as | ||||||
19 | defined under Section 2, which are more restrictive than the | ||||||
20 | requirements under this Act or under HIPAA.
| ||||||
21 | (Source: P.A. 98-378, eff. 8-16-13.)
| ||||||
22 | (740 ILCS 110/9.8) | ||||||
23 | Sec. 9.8. Business associates. An HIE, person, therapist, | ||||||
24 | facility, agency, interdisciplinary team, integrated health | ||||||
25 | system, business associate, covered entity, the Illinois |
| |||||||
| |||||||
1 | Health Information Exchange Office Authority , or entity | ||||||
2 | facilitating the establishment or operation of an HIE may, | ||||||
3 | without a recipient's consent, utilize the services of and | ||||||
4 | disclose information from a recipient's record to a business | ||||||
5 | associate, as defined by and in accordance with the | ||||||
6 | requirements set forth under HIPAA. As used in this Section, | ||||||
7 | the term "disclosure" has the meaning ascribed to it by HIPAA, | ||||||
8 | as specified in 45 CFR 160.103.
| ||||||
9 | (Source: P.A. 98-378, eff. 8-16-13.)
| ||||||
10 | (740 ILCS 110/9.9) | ||||||
11 | Sec. 9.9. Record locator service. | ||||||
12 | (a) An HIE, person, therapist, facility, agency, | ||||||
13 | interdisciplinary team, integrated health system, business | ||||||
14 | associate, covered entity, the Illinois Health Information | ||||||
15 | Exchange Office Authority , or entity facilitating the | ||||||
16 | establishment or operation of an HIE may, without a recipient's | ||||||
17 | consent, disclose the existence of a recipient's record to a | ||||||
18 | record locator service, master patient index, or other | ||||||
19 | directory or services necessary to support and enable the | ||||||
20 | establishment and operation of an HIE. | ||||||
21 | (b) As used in this Section: | ||||||
22 | (1) the term "disclosure" has the meaning ascribed to | ||||||
23 | it under HIPAA, as specified in 45 CFR 160.103; and | ||||||
24 | (2) "facility" means a developmental disability | ||||||
25 | facility as defined in Section 1-107 of the Mental Health |
| |||||||
| |||||||
1 | and Developmental Disabilities Code or a mental health | ||||||
2 | facility as defined in Section 1-114 of the Mental Health | ||||||
3 | and Developmental Disabilities Code.
| ||||||
4 | (Source: P.A. 98-378, eff. 8-16-13.)
| ||||||
5 | (740 ILCS 110/9.11) | ||||||
6 | Sec. 9.11. Establishment and disclosure of limited data | ||||||
7 | sets and de-identified information. | ||||||
8 | (a) An HIE, person, therapist, facility, agency, | ||||||
9 | interdisciplinary team, integrated health system, business | ||||||
10 | associate, covered entity, the Illinois Health Information | ||||||
11 | Exchange Office Authority , or entity facilitating the | ||||||
12 | establishment or operation of an HIE may, without a recipient's | ||||||
13 | consent, use information from a recipient's record to | ||||||
14 | establish, or disclose such information to a business associate | ||||||
15 | to establish, and further disclose information from a | ||||||
16 | recipient's record as part of a limited data set as defined by | ||||||
17 | and in accordance with the requirements set forth under HIPAA, | ||||||
18 | as specified in 45 CFR 164.514(e). An HIE, person, therapist, | ||||||
19 | facility, agency, interdisciplinary team, integrated health | ||||||
20 | system, business associate, covered entity, the Illinois | ||||||
21 | Health Information Exchange Office Authority , or entity | ||||||
22 | facilitating the establishment or operation of an HIE may, | ||||||
23 | without a recipient's consent, use information from a | ||||||
24 | recipient's record or disclose information from a recipient's | ||||||
25 | record to a business associate to de-identity the information |
| |||||||
| |||||||
1 | in accordance with HIPAA, as specified in 45 CFR 164.514. | ||||||
2 | (b) As used in this Section: | ||||||
3 | (1) the terms "disclosure" and "use" shall have the | ||||||
4 | meanings ascribed to them by HIPAA, as specified in 45 CFR | ||||||
5 | 160.103; and | ||||||
6 | (2) "facility" means a developmental disability | ||||||
7 | facility as defined in Section 1-107 of the Mental Health | ||||||
8 | and Developmental Disabilities Code or a mental health | ||||||
9 | facility as defined in Section 1-114 of the Mental Health | ||||||
10 | and Developmental Disabilities Code.
| ||||||
11 | (Source: P.A. 98-378, eff. 8-16-13.)
| ||||||
12 | Article 99. Effective Date | ||||||
13 | Section 99-99. Effective date. This Act takes effect upon | ||||||
14 | becoming law.".
|