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| Public Act 100-0135
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| HB2909 Enrolled | LRB100 08468 KTG 18586 b |
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Public Aid Code is amended by |
changing Section 5-5f as follows:
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(305 ILCS 5/5-5f)
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Sec. 5-5f. Elimination and limitations of medical |
assistance services. Notwithstanding any other provision of |
this Code to the contrary, on and after July 1, 2012: |
(a) The following services shall no longer be a covered |
service available under this Code: group psychotherapy for |
residents of any facility licensed under the Nursing Home |
Care Act or the Specialized Mental Health Rehabilitation |
Act of 2013; and adult chiropractic services. |
(b) The Department shall place the following |
limitations on services: (i) the Department shall limit |
adult eyeglasses to one pair every 2 years; however, the |
limitation does not apply to an individual who needs |
different eyeglasses following a surgical procedure such |
as cataract surgery; (ii) the Department shall set an |
annual limit of a maximum of 20 visits for each of the |
following services: adult speech, hearing, and language |
therapy services, adult occupational therapy services, and |
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physical therapy services; on or after October 1, 2014, the |
annual maximum limit of 20 visits shall expire but the |
Department shall require prior approval for all |
individuals for speech, hearing, and language therapy |
services, occupational therapy services, and physical |
therapy services; (iii) the Department shall limit adult |
podiatry services to individuals with diabetes; on or after |
October 1, 2014, podiatry services shall not be limited to |
individuals with diabetes; (iv) the Department shall pay |
for caesarean sections at the normal vaginal delivery rate |
unless a caesarean section was medically necessary; (v) the |
Department shall limit adult dental services to |
emergencies; beginning July 1, 2013, the Department shall |
ensure that the following conditions are recognized as |
emergencies: (A) dental services necessary for an |
individual in order for the individual to be cleared for a |
medical procedure, such as a transplant;
(B) extractions |
and dentures necessary for a diabetic to receive proper |
nutrition;
(C) extractions and dentures necessary as a |
result of cancer treatment; and (D) dental services |
necessary for the health of a pregnant woman prior to |
delivery of her baby; on or after July 1, 2014, adult |
dental services shall no longer be limited to emergencies, |
and dental services necessary for the health of a pregnant |
woman prior to delivery of her baby shall continue to be |
covered; and (vi) effective July 1, 2012, the Department |
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shall place limitations and require concurrent review on |
every inpatient detoxification stay to prevent repeat |
admissions to any hospital for detoxification within 60 |
days of a previous inpatient detoxification stay. The |
Department shall convene a workgroup of hospitals, |
substance abuse providers, care coordination entities, |
managed care plans, and other stakeholders to develop |
recommendations for quality standards, diversion to other |
settings, and admission criteria for patients who need |
inpatient detoxification, which shall be published on the |
Department's website no later than September 1, 2013. |
(c) The Department shall require prior approval of the |
following services: wheelchair repairs costing more than |
$400, coronary artery bypass graft, and bariatric surgery |
consistent with Medicare standards concerning patient |
responsibility. Wheelchair repair prior approval requests |
shall be adjudicated within one business day of receipt of |
complete supporting documentation. Providers may not break |
wheelchair repairs into separate claims for purposes of |
staying under the $400 threshold for requiring prior |
approval. The wholesale price of manual and power |
wheelchairs, durable medical equipment and supplies, and |
complex rehabilitation technology products and services |
shall be defined as actual acquisition cost including all |
discounts. |
(d) The Department shall establish benchmarks for |
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hospitals to measure and align payments to reduce |
potentially preventable hospital readmissions, inpatient |
complications, and unnecessary emergency room visits. In |
doing so, the Department shall consider items, including, |
but not limited to, historic and current acuity of care and |
historic and current trends in readmission. The Department |
shall publish provider-specific historical readmission |
data and anticipated potentially preventable targets 60 |
days prior to the start of the program. In the instance of |
readmissions, the Department shall adopt policies and |
rates of reimbursement for services and other payments |
provided under this Code to ensure that, by June 30, 2013, |
expenditures to hospitals are reduced by, at a minimum, |
$40,000,000. |
(e) The Department shall establish utilization |
controls for the hospice program such that it shall not pay |
for other care services when an individual is in hospice. |
(f) For home health services, the Department shall |
require Medicare certification of providers participating |
in the program and implement the Medicare face-to-face |
encounter rule. The Department shall require providers to |
implement auditable electronic service verification based |
on global positioning systems or other cost-effective |
technology. |
(g) For the Home Services Program operated by the |
Department of Human Services and the Community Care Program |
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operated by the Department on Aging, the Department of |
Human Services, in cooperation with the Department on |
Aging, shall implement an electronic service verification |
based on global positioning systems or other |
cost-effective technology. |
(h) Effective with inpatient hospital admissions on or |
after July 1, 2012, the Department shall reduce the payment |
for a claim that indicates the occurrence of a |
provider-preventable condition during the admission as |
specified by the Department in rules. The Department shall |
not pay for services related to an other |
provider-preventable condition. |
As used in this subsection (h): |
"Provider-preventable condition" means a health care |
acquired condition as defined under the federal Medicaid |
regulation found at 42 CFR 447.26 or an other |
provider-preventable condition. |
"Other provider-preventable condition" means a wrong |
surgical or other invasive procedure performed on a |
patient, a surgical or other invasive procedure performed |
on the wrong body part, or a surgical procedure or other |
invasive procedure performed on the wrong patient. |
(i) The Department shall implement cost savings |
initiatives for advanced imaging services, cardiac imaging |
services, pain management services, and back surgery. Such |
initiatives shall be designed to achieve annual costs |
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savings.
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(j) The Department shall ensure that beneficiaries |
with a diagnosis of epilepsy or seizure disorder in |
Department records will not require prior approval for |
anticonvulsants. |
(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section |
6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff. |
7-22-13; 98-651, eff. 6-16-14; 98-756, eff. 7-16-14.)
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Section 99. Effective date. This Act takes effect upon |
becoming law.
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