→
Previous
Latest
SB0314 Engrossed LRB100 05099 SMS 15109 b AN ACT concerning regulation.
SB0314 Enrolled LRB100 05099 SMS 15109 b AN ACT concerning regulation.
SB0314 Engrossed - 2 - LRB100 05099 SMS 15109 b (4) A comprehensive ultrasound screening and MRI of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, when medically necessary as determined by a physician licensed to practice medicine in all of its branches.
SB0314 Enrolled - 2 - LRB100 05099 SMS 15109 b (4) A comprehensive ultrasound screening and MRI of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, when medically necessary as determined by a physician licensed to practice medicine in all of its branches.
If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), SB0314 Engrossed - 3 - LRB100 05099 SMS 15109 b including, but not limited to, 42 U.S.C.
If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), SB0314 Enrolled - 3 - LRB100 05099 SMS 15109 b including, but not limited to, 42 U.S.C.
Coverage SB0314 Engrossed - 4 - LRB100 05099 SMS 15109 b for breast reconstruction in connection with a mastectomy shall include:
Coverage SB0314 Enrolled - 4 - LRB100 05099 SMS 15109 b for breast reconstruction in connection with a mastectomy shall include:
An insurer may not deny to an insured eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of SB0314 Engrossed - 5 - LRB100 05099 SMS 15109 b avoiding the requirements of this Section.
An insurer may not deny to an insured eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of SB0314 Enrolled - 5 - LRB100 05099 SMS 15109 b avoiding the requirements of this Section.
SB0314 Engrossed - 6 - LRB100 05099 SMS 15109 b (1) A baseline mammogram for women 35 to 39 years of age.
SB0314 Enrolled - 6 - LRB100 05099 SMS 15109 b (1) A baseline mammogram for women 35 to 39 years of age.
If, at any time, the Secretary of the United States SB0314 Engrossed - 7 - LRB100 05099 SMS 15109 b Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C.
If, at any time, the Secretary of the United States SB0314 Enrolled - 7 - LRB100 05099 SMS 15109 b Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C.
Coverage for breast reconstruction in SB0314 Engrossed - 8 - LRB100 05099 SMS 15109 b connection with a mastectomy shall include:
Coverage for breast reconstruction in SB0314 Enrolled - 8 - LRB100 05099 SMS 15109 b connection with a mastectomy shall include:
A SB0314 Engrossed - 9 - LRB100 05099 SMS 15109 b health maintenance organization may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with this Section.
A SB0314 Enrolled - 9 - LRB100 05099 SMS 15109 b health maintenance organization may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with this Section.
(4) skilled nursing home SB0314 Engrossed - 10 - LRB100 05099 SMS 15109 b services;
(4) skilled nursing home SB0314 Enrolled - 10 - LRB100 05099 SMS 15109 b services;
"uniform" does not mean the use of a singular SB0314 Engrossed - 11 - LRB100 05099 SMS 15109 b instrument, tool, or process that all must utilize;
"uniform" does not mean the use of a singular SB0314 Enrolled - 11 - LRB100 05099 SMS 15109 b instrument, tool, or process that all must utilize;
Notwithstanding any other provision of this Section, a SB0314 Engrossed - 12 - LRB100 05099 SMS 15109 b comprehensive tobacco use cessation program that includes purchasing prescription drugs or prescription medical devices approved by the Food and Drug Administration shall be covered under the medical assistance program under this Article for persons who are otherwise eligible for assistance under this Article.
Notwithstanding any other provision of this Section, a SB0314 Enrolled - 12 - LRB100 05099 SMS 15109 b comprehensive tobacco use cessation program that includes purchasing prescription drugs or prescription medical devices approved by the Food and Drug Administration shall be covered under the medical assistance program under this Article for persons who are otherwise eligible for assistance under this Article.
Claims for services provided by CPS's vendor or vendors to recipients of benefits in the medical assistance program under this Code, SB0314 Engrossed - 13 - LRB100 05099 SMS 15109 b the Children's Health Insurance Program, or the Covering ALL KIDS Health Insurance Program shall be submitted to the Department or the MCE in which the individual is enrolled for payment and shall be reimbursed at the Department's or the MCE's established rates or rate methodologies for eyeglasses.
Claims for services provided by CPS's vendor or vendors to recipients of benefits in the medical assistance program under this Code, SB0314 Enrolled - 13 - LRB100 05099 SMS 15109 b the Children's Health Insurance Program, or the Covering ALL KIDS Health Insurance Program shall be submitted to the Department or the MCE in which the individual is enrolled for payment and shall be reimbursed at the Department's or the MCE's established rates or rate methodologies for eyeglasses.
SB0314 Engrossed - 14 - LRB100 05099 SMS 15109 b The Department shall establish a process for payment of claims for reimbursement for covered dental services rendered under this provision.
SB0314 Enrolled - 14 - LRB100 05099 SMS 15109 b The Department shall establish a process for payment of claims for reimbursement for covered dental services rendered under this provision.
(C) A mammogram at the age and intervals considered medically necessary by the woman's health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, SB0314 Engrossed - 15 - LRB100 05099 SMS 15109 b positive genetic testing, or other risk factors.
(C) A mammogram at the age and intervals considered medically necessary by the woman's health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, SB0314 Enrolled - 15 - LRB100 05099 SMS 15109 b positive genetic testing, or other risk factors.
If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the SB0314 Engrossed - 16 - LRB100 05099 SMS 15109 b Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C.
If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the SB0314 Enrolled - 16 - LRB100 05099 SMS 15109 b Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C.
On and after January 1, 2017, providers participating in a SB0314 Engrossed - 17 - LRB100 05099 SMS 15109 b breast cancer treatment quality improvement program approved by the Department shall be reimbursed for breast cancer treatment at a rate that is no lower than 95% of the Medicare program's rates for the data elements included in the breast cancer treatment quality program.
On and after January 1, 2017, providers participating in a SB0314 Enrolled - 17 - LRB100 05099 SMS 15109 b breast cancer treatment quality improvement program approved by the Department shall be reimbursed for breast cancer treatment at a rate that is no lower than 95% of the Medicare program's rates for the data elements included in the breast cancer treatment quality program.
The Department shall work with experts in breast cancer outreach and patient navigation to optimize these reminders and shall establish a methodology for evaluating their effectiveness and modifying the methodology based on the SB0314 Engrossed - 18 - LRB100 05099 SMS 15109 b evaluation.
The Department shall work with experts in breast cancer outreach and patient navigation to optimize these reminders and shall establish a methodology for evaluating their effectiveness and modifying the methodology based on the SB0314 Enrolled - 18 - LRB100 05099 SMS 15109 b evaluation.
The Department shall require all networks of care to include access SB0314 Engrossed - 19 - LRB100 05099 SMS 15109 b for patients diagnosed with cancer to at least one academic commission on cancer-accredited cancer program as an in-network covered benefit.
The Department shall require all networks of care to include access SB0314 Enrolled - 19 - LRB100 05099 SMS 15109 b for patients diagnosed with cancer to at least one academic commission on cancer-accredited cancer program as an in-network covered benefit.
The Illinois Department, in cooperation with the Departments of Human Services (as successor to the Department of Alcoholism and Substance Abuse) and Public Health, through a SB0314 Engrossed - 20 - LRB100 05099 SMS 15109 b public awareness campaign, may provide information concerning treatment for alcoholism and drug abuse and addiction, prenatal health care, and other pertinent programs directed at reducing the number of drug-affected infants born to recipients of medical assistance.
The Illinois Department, in cooperation with the Departments of Human Services (as successor to the Department of Alcoholism and Substance Abuse) and Public Health, through a SB0314 Enrolled - 20 - LRB100 05099 SMS 15109 b public awareness campaign, may provide information concerning treatment for alcoholism and drug abuse and addiction, prenatal health care, and other pertinent programs directed at reducing the number of drug-affected infants born to recipients of medical assistance.
SB0314 Engrossed - 21 - LRB100 05099 SMS 15109 b The sponsor must negotiate formal written contracts with medical providers for physician services, inpatient and outpatient hospital care, home health services, treatment for alcoholism and substance abuse, and other services determined necessary by the Illinois Department by rule for delivery by Partnerships.
SB0314 Enrolled - 21 - LRB100 05099 SMS 15109 b The sponsor must negotiate formal written contracts with medical providers for physician services, inpatient and outpatient hospital care, home health services, treatment for alcoholism and substance abuse, and other services determined necessary by the Illinois Department by rule for delivery by Partnerships.
These qualifications shall be determined by rule of the Illinois SB0314 Engrossed - 22 - LRB100 05099 SMS 15109 b Department and may be higher than qualifications for participation in the medical assistance program.
These qualifications shall be determined by rule of the Illinois SB0314 Enrolled - 22 - LRB100 05099 SMS 15109 b Department and may be higher than qualifications for participation in the medical assistance program.
The Illinois Department shall SB0314 Engrossed - 23 - LRB100 05099 SMS 15109 b require health care providers to make available, when authorized by the patient, in writing, the medical records in a timely fashion to other health care providers who are treating or serving persons eligible for Medical Assistance under this Article.
The Illinois Department shall SB0314 Enrolled - 23 - LRB100 05099 SMS 15109 b require health care providers to make available, when authorized by the patient, in writing, the medical records in a timely fashion to other health care providers who are treating or serving persons eligible for Medical Assistance under this Article.
Within 90 days after September 16, 1984 (the effective date of Public Act 83-1439), the Illinois Department shall establish a current list of acquisition costs for all prosthetic devices and any other items recognized as medical SB0314 Engrossed - 24 - LRB100 05099 SMS 15109 b equipment and supplies reimbursable under this Article and shall update such list on a quarterly basis, except that the acquisition costs of all prescription drugs shall be updated no less frequently than every 30 days as required by Section 5-5.12.
Within 90 days after September 16, 1984 (the effective date of Public Act 83-1439), the Illinois Department shall establish a current list of acquisition costs for all prosthetic devices and any other items recognized as medical SB0314 Enrolled - 24 - LRB100 05099 SMS 15109 b equipment and supplies reimbursable under this Article and shall update such list on a quarterly basis, except that the acquisition costs of all prescription drugs shall be updated no less frequently than every 30 days as required by Section 5-5.12.
Notwithstanding any other law to the contrary, the Illinois Department shall, within 365 days after August 15, 2014 (the effective date of Public Act 98-963), establish procedures to permit ID/DD facilities licensed under the ID/DD Community Care SB0314 Engrossed - 25 - LRB100 05099 SMS 15109 b Act and MC/DD facilities licensed under the MC/DD Act to submit monthly billing claims for reimbursement purposes.
Notwithstanding any other law to the contrary, the Illinois Department shall, within 365 days after August 15, 2014 (the effective date of Public Act 98-963), establish procedures to permit ID/DD facilities licensed under the ID/DD Community Care SB0314 Enrolled - 25 - LRB100 05099 SMS 15109 b Act and MC/DD facilities licensed under the MC/DD Act to submit monthly billing claims for reimbursement purposes.
During the period of conditional enrollment, the Department may terminate the SB0314 Engrossed - 26 - LRB100 05099 SMS 15109 b vendor's eligibility to participate in, or may disenroll the vendor from, the medical assistance program without cause.
During the period of conditional enrollment, the Department may terminate the SB0314 Enrolled - 26 - LRB100 05099 SMS 15109 b vendor's eligibility to participate in, or may disenroll the vendor from, the medical assistance program without cause.
(ii) by rule or provider notice, SB0314 Engrossed - 27 - LRB100 05099 SMS 15109 b the maximum length of the conditional enrollment period for each category of risk of the vendor;
(ii) by rule or provider notice, SB0314 Enrolled - 27 - LRB100 05099 SMS 15109 b the maximum length of the conditional enrollment period for each category of risk of the vendor;
(4) In the case of a provider operated by a unit of local government with a population exceeding 3,000,000 SB0314 Engrossed - 28 - LRB100 05099 SMS 15109 b when local government funds finance federal participation for claims payments.
(4) In the case of a provider operated by a unit of local government with a population exceeding 3,000,000 SB0314 Enrolled - 28 - LRB100 05099 SMS 15109 b when local government funds finance federal participation for claims payments.
SB0314 Engrossed - 29 - LRB100 05099 SMS 15109 b Claims that are not submitted and received in compliance with the foregoing requirements shall not be eligible for payment under the medical assistance program, and the State shall have no liability for payment of those claims.
SB0314 Enrolled - 29 - LRB100 05099 SMS 15109 b Claims that are not submitted and received in compliance with the foregoing requirements shall not be eligible for payment under the medical assistance program, and the State shall have no liability for payment of those claims.
The Illinois Department shall develop, in cooperation with other State departments and agencies, and in compliance with applicable federal laws and regulations, appropriate and SB0314 Engrossed - 30 - LRB100 05099 SMS 15109 b effective methods to share such data.
The Illinois Department shall develop, in cooperation with other State departments and agencies, and in compliance with applicable federal laws and regulations, appropriate and SB0314 Enrolled - 30 - LRB100 05099 SMS 15109 b effective methods to share such data.
Such rules shall provide, but not be SB0314 Engrossed - 31 - LRB100 05099 SMS 15109 b limited to, the following services:
Such rules shall provide, but not be SB0314 Enrolled - 31 - LRB100 05099 SMS 15109 b limited to, the following services:
The Department shall execute, relative to the nursing home SB0314 Engrossed - 32 - LRB100 05099 SMS 15109 b prescreening project, written inter-agency agreements with the Department of Human Services and the Department on Aging, to effect the following:
The Department shall execute, relative to the nursing home SB0314 Enrolled - 32 - LRB100 05099 SMS 15109 b prescreening project, written inter-agency agreements with the Department of Human Services and the Department on Aging, to effect the following:
This Section shall SB0314 Engrossed - 33 - LRB100 05099 SMS 15109 b not restrict the Department from implementing lower level of care eligibility criteria for community-based services in circumstances where federal approval has been granted.
This Section shall SB0314 Enrolled - 33 - LRB100 05099 SMS 15109 b not restrict the Department from implementing lower level of care eligibility criteria for community-based services in circumstances where federal approval has been granted.
The filing of one copy of the report with the Speaker, one copy with the Minority Leader and one copy with SB0314 Engrossed - 34 - LRB100 05099 SMS 15109 b the Clerk of the House of Representatives, one copy with the President, one copy with the Minority Leader and one copy with the Secretary of the Senate, one copy with the Legislative Research Unit, and such additional copies with the State Government Report Distribution Center for the General Assembly as is required under paragraph (t) of Section 7 of the State Library Act shall be deemed sufficient to comply with this Section.
The filing of one copy of the report with the Speaker, one copy with the Minority Leader and one copy with SB0314 Enrolled - 34 - LRB100 05099 SMS 15109 b the Clerk of the House of Representatives, one copy with the President, one copy with the Minority Leader and one copy with the Secretary of the Senate, one copy with the Legislative Research Unit, and such additional copies with the State Government Report Distribution Center for the General Assembly as is required under paragraph (t) of Section 7 of the State Library Act shall be deemed sufficient to comply with this Section.
Because kidney transplantation can be an appropriate, cost effective alternative to renal dialysis when medically necessary and notwithstanding the provisions of Section 1-11 of this Code, beginning October 1, 2014, the Department shall cover kidney transplantation for noncitizens with end-stage renal disease who are not eligible for comprehensive medical benefits, who meet the residency requirements of Section 5-3 of SB0314 Engrossed - 35 - LRB100 05099 SMS 15109 b this Code, and who would otherwise meet the financial requirements of the appropriate class of eligible persons under Section 5-2 of this Code.
Because kidney transplantation can be an appropriate, cost effective alternative to renal dialysis when medically necessary and notwithstanding the provisions of Section 1-11 of this Code, beginning October 1, 2014, the Department shall cover kidney transplantation for noncitizens with end-stage renal disease who are not eligible for comprehensive medical benefits, who meet the residency requirements of Section 5-3 of SB0314 Enrolled - 35 - LRB100 05099 SMS 15109 b this Code, and who would otherwise meet the financial requirements of the appropriate class of eligible persons under Section 5-2 of this Code.
On or after July 1, 2015, opioid antagonists prescribed for the treatment of an opioid overdose, including the medication product, administration devices, and any pharmacy fees related to the dispensing and administration of the opioid antagonist, shall be covered under the medical assistance program for persons who are otherwise eligible for medical assistance under SB0314 Engrossed - 36 - LRB100 05099 SMS 15109 b this Article.
On or after July 1, 2015, opioid antagonists prescribed for the treatment of an opioid overdose, including the medication product, administration devices, and any pharmacy fees related to the dispensing and administration of the opioid antagonist, shall be covered under the medical assistance program for persons who are otherwise eligible for medical assistance under SB0314 Enrolled - 36 - LRB100 05099 SMS 15109 b this Article.
99-895, SB0314 Engrossed - 37 - LRB100 05099 SMS 15109 b eff.
99-895, SB0314 Enrolled - 37 - LRB100 05099 SMS 15109 b eff.
⬇ Download PDF