SB 2437 — MEDICAID-MATERNAL HLTH-DOULAS

1396d(r);

or (2) in-home shift nursing services through the home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act for persons who are medically fragile and technology dependent.

To be eligible for reimbursement as a certified family health aide, a legally responsible caregiver or a person designated by a legally responsible caregiver must meet all certification requirements as set forth in this Section, in Section 5-2.06b of Article V of the Illinois Public Aid Code, and in any applicable administrative rule.

(d) The Department of Public Health, in consultation with the Department of Healthcare and Family Services, may adopt rules necessary to implement the provisions of this Act, including, but not limited to, rules requiring background checks for the certified family health aide, establishing the scope of services a certified family health aide can perform, and establishing any utilization controls of services performed by a certified family health aide.

Section 2-100.

The Alternative Health Care Delivery Act is amended by changing Section 35 as follows:

SB2437 Enrolled - 5 - LRB104 10548 KTG 20624 b (210 ILCS 3/35) Sec.

35.

Alternative health care models authorized.

Notwithstanding any other law to the contrary, alternative health care models described in this Section may be established on a demonstration basis.

(1) (Blank).

(2) Alternative health care delivery model;

postsurgical recovery care center.

A postsurgical recovery care center is a designated site which provides postsurgical recovery care for generally healthy patients undergoing surgical procedures that potentially require overnight nursing care, pain control, or observation that would otherwise be provided in an inpatient setting.

Patients may be discharged from the postsurgical recovery care center in less than 24 hours if the attending physician or the facility's medical director believes the patient has recovered enough to be discharged.

A postsurgical recovery care center is either freestanding or a defined unit of an ambulatory surgical treatment center or hospital.

No facility, or portion of a facility, may participate in a demonstration program as a postsurgical recovery care center unless the facility has been licensed as an ambulatory surgical treatment center or hospital for at least 2 years before August 20, 1993 (the effective date of Public Act 88-441).

The maximum SB2437 Enrolled - 6 - LRB104 10548 KTG 20624 b length of stay for patients in a postsurgical recovery care center is not to exceed 48 hours unless the treating physician requests an extension of time from the recovery center's medical director on the basis of medical or clinical documentation that an additional care period is required for the recovery of a patient and the medical director approves the extension of time.

In no case, however, shall a patient's length of stay in a postsurgical recovery care center be longer than 72 hours.

If a patient requires an additional care period after the expiration of the 72-hour limit, the patient shall be transferred to an appropriate facility.

Reports on variances from the 24-hour or 48-hour limit shall be sent to the Department for its evaluation.

The reports shall, before submission to the Department, have removed from them all patient and physician identifiers.

Blood products may be administered in the postsurgical recovery care center model.

In order to handle cases of complications, emergencies, or exigent circumstances, every postsurgical recovery care center as defined in this paragraph shall maintain a contractual relationship, including a transfer agreement, with a general acute care hospital.

A postsurgical recovery care center shall be no larger than 20 beds.

A postsurgical recovery care center shall be located within 15 minutes travel time from the general acute care hospital with which the center maintains a SB2437 Enrolled - 7 - LRB104 10548 KTG 20624 b contractual relationship, including a transfer agreement, as required under this paragraph.

No postsurgical recovery care center shall discriminate against any patient requiring treatment because of the source of payment for services, including Medicare and Medicaid recipients.

The Department shall adopt rules to implement the provisions of Public Act 88-441 concerning postsurgical recovery care centers within 9 months after August 20, 1993.

Notwithstanding any other law to the contrary, a postsurgical recovery care center model may provide sleep laboratory or similar sleep studies in accordance with applicable State and federal laws and regulations.

(3) Alternative health care delivery model;

children's community-based health care center.

A children's community-based health care center model is a designated site that provides nursing care, clinical support services, and therapies for a period of one to 14 days for short-term stays and 120 days to facilitate transitions to home or other appropriate settings for medically fragile children, technology dependent children, and children with special health care needs who are deemed clinically stable by a physician and are younger than 22 years of age.

This care is to be provided in a home-like environment that serves no more than 12 children at a time, except that a children's community-based health care center in existence SB2437 Enrolled - 8 - LRB104 10548 KTG 20624 b on the effective date of this amendatory Act of the 100th General Assembly that is located in Chicago on grade level for Life Safety Code purposes may provide care to no more than 16 children at a time.

Children's community-based health care center services must be available through the model to all families, including those whose care is paid for through the Department of Healthcare and Family Services, the Department of Children and Family Services, the Department of Human Services, and insurance companies who cover home health care services or private duty nursing care in the home.

Each children's community-based health care center model location shall be physically separate and apart from any other facility licensed by the Department of Public Health under this or any other Act and shall provide the following services:

respite care, registered nursing or licensed practical nursing care, transitional care to facilitate home placement or other appropriate settings and reunite families, medical day care, weekend camps, and diagnostic studies typically done in the home setting.

A children's community-based health care center may provide initial training, prior to home placement for, and shall keep records in a manner designated by the Department regarding, the certified family health aide, as defined in the Certified Family Health Aide Program for Children and Adults Act, identified as the legally SB2437 Enrolled - 9 - LRB104 10548 KTG 20624 b responsible caregiver or designated by a legally responsible caregiver for the medical care of an individual who receives or is eligible to receive:

(i) in-home shift nursing services under the Early and Periodic Screening, Diagnostic and Treatment requirement of Medicaid under 42 U.S.C.

1396d(r);

or (ii) in-home shift nursing through the home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act for persons who are medically fragile and technology dependent.

Coverage for the services provided by the Department of Healthcare and Family Services under this paragraph (3) is contingent upon federal waiver approval and is provided only to Medicaid eligible clients participating in the home and community based services waiver designated in Section 1915(c) of the Social Security Act for medically frail and technologically dependent children or children in Department of Children and Family Services foster care who receive home health benefits.

(4) Alternative health care delivery model;

community based residential rehabilitation center.

A community-based residential rehabilitation center model is a designated site that provides rehabilitation or support, or both, for persons who have experienced severe brain injury, who are medically stable, and who no longer require acute SB2437 Enrolled - 10 - LRB104 10548 KTG 20624 b rehabilitative care or intense medical or nursing services.

The average length of stay in a community-based residential rehabilitation center shall not exceed 4 months.

As an integral part of the services provided, individuals are housed in a supervised living setting while having immediate access to the community.

The residential rehabilitation center authorized by the Department may have more than one residence included under the license.

A residence may be no larger than 12 beds and shall be located as an integral part of the community.

Day treatment or individualized outpatient services shall be provided for persons who reside in their own home.

Functional outcome goals shall be established for each individual.

Services shall include, but are not limited to, case management, training and assistance with activities of daily living, nursing consultation, traditional therapies (physical, occupational, speech), functional interventions in the residence and community (job placement, shopping, banking, recreation), counseling, self-management strategies, productive activities, and multiple opportunities for skill acquisition and practice throughout the day.

The design of individualized program plans shall be consistent with the outcome goals that are established for each resident.

The programs provided in this setting shall be accredited by the Commission on Accreditation of Rehabilitation SB2437 Enrolled - 11 - LRB104 10548 KTG 20624 b Facilities (CARF).

The program shall have been accredited by CARF as a Brain Injury Community-Integrative Program for at least 3 years.

(5) Alternative health care delivery model;

Alzheimer's disease management center.

An Alzheimer's disease management center model is a designated site that provides a safe and secure setting for care of persons diagnosed with Alzheimer's disease.

An Alzheimer's disease management center model shall be a facility separate from any other facility licensed by the Department of Public Health under this or any other Act.

An Alzheimer's disease management center shall conduct and document an assessment of each resident every 6 months.

The assessment shall include an evaluation of daily functioning, cognitive status, other medical conditions, and behavioral problems.

An Alzheimer's disease management center shall develop and implement an ongoing treatment plan for each resident.

The treatment plan shall have defined goals.

The Alzheimer's disease management center shall treat behavioral problems and mood disorders using nonpharmacologic approaches such as environmental modification, task simplification, and other appropriate activities.

All staff must have necessary training to care for all stages of Alzheimer's Disease.

An Alzheimer's disease management center shall provide education and support for residents and caregivers.

The education and support shall include SB2437 Enrolled - 12 - LRB104 10548 KTG 20624 b referrals to support organizations for educational materials on community resources, support groups, legal and financial issues, respite care, and future care needs and options.

The education and support shall also include a discussion of the resident's need to make advance directives and to identify surrogates for medical and legal decision-making.

The provisions of this paragraph establish the minimum level of services that must be provided by an Alzheimer's disease management center.

An Alzheimer's disease management center model shall have no more than 100 residents.

Nothing in this paragraph (5) shall be construed as prohibiting a person or facility from providing services and care to persons with Alzheimer's disease as otherwise authorized under State law.

(6) Alternative health care delivery model;

birth center.

A birth center shall be exclusively dedicated to serving the childbirth-related needs of women and their newborns and shall have no more than 10 beds.

A birth center is a designated site that is away from the mother's usual place of residence and in which births are planned to occur following a normal, uncomplicated, and low-risk pregnancy.

A birth center shall offer prenatal care and community education services and shall coordinate these services with other health care services available in the community.

SB2437 Enrolled - 13 - LRB104 10548 KTG 20624 b (A) A birth center shall not be separately licensed if it is one of the following:

(1) A part of a hospital;

or (2) A freestanding facility that is physically distinct from a hospital but is operated under a license issued to a hospital under the Hospital Licensing Act.

(B) A separate birth center license shall be required if the birth center is operated as:

(1) A part of the operation of a federally qualified health center as designated by the United States Department of Health and Human Services;

or (2) A facility other than one described in subparagraph (A)(1), (A)(2), or (B)(1) of this paragraph (6) whose costs are reimbursable under Title XIX of the federal Social Security Act.

In adopting rules for birth centers, the Department shall consider:

the American Association of Birth Centers' Standards for Freestanding Birth Centers;

the American Academy of Pediatrics/American College of Obstetricians and Gynecologists Guidelines for Perinatal Care;

and the Regionalized Perinatal Health Care Code.

The Department's rules shall stipulate the eligibility criteria for birth center admission.

The Department's rules shall stipulate the necessary equipment for emergency care according to SB2437 Enrolled - 14 - LRB104 10548 KTG 20624 b the American Association of Birth Centers' standards and any additional equipment deemed necessary by the Department.

The Department's rules shall provide for a time period within which each birth center not part of a hospital must become accredited by either the Commission for the Accreditation of Freestanding Birth Centers or The Joint Commission.

A birth center shall be certified to participate in the Medicare and Medicaid programs under Titles XVIII and XIX, respectively, of the federal Social Security Act.

To the extent necessary, the Illinois Department of Healthcare and Family Services shall apply for a waiver from the United States Health Care Financing Administration to allow birth centers to be reimbursed under Title XIX of the federal Social Security Act.

A birth center that is not operated under a hospital license shall be located within a ground travel time distance from the general acute care hospital with which the birth center maintains a contractual relationship, including a transfer agreement, as required under this paragraph, that allows for an emergency caesarian delivery to be started within 30 minutes of the decision a caesarian delivery is necessary.

A birth center operating under a hospital license shall be located within a ground travel time distance from the licensed hospital that allows for an emergency caesarian delivery to be started SB2437 Enrolled - 15 - LRB104 10548 KTG 20624 b within 30 minutes of the decision a caesarian delivery is necessary.

The services of a medical director physician, licensed to practice medicine in all its branches, who is certified or eligible for certification by the American College of Obstetricians and Gynecologists or the American Board of Osteopathic Obstetricians and Gynecologists or has hospital obstetrical privileges are required in birth centers.

The medical director in consultation with the Director of Nursing and Midwifery Services shall coordinate the clinical staff and overall provision of patient care.

The medical director or his or her physician designee shall be available on the premises or within a close proximity as defined by rule.

The medical director and the Director of Nursing and Midwifery Services shall jointly develop and approve policies defining the criteria to determine which pregnancies are accepted as normal, uncomplicated, and low-risk, and the anesthesia services available at the center.

No general anesthesia may be administered at the center.

If a birth center employs certified nurse midwives, a certified nurse midwife shall be the Director of Nursing and Midwifery Services who is responsible for the development of policies and procedures for services as provided by Department rules.

An obstetrician, family practitioner, or certified SB2437 Enrolled - 16 - LRB104 10548 KTG 20624 b nurse midwife shall attend each woman in labor from the time of admission through birth and throughout the immediate postpartum period.

Attendance may be delegated only to another physician or certified nurse midwife.

Additionally, a second staff person shall also be present at each birth who is licensed or certified in Illinois in a health-related field and under the supervision of the physician or certified nurse midwife in attendance, has specialized training in labor and delivery techniques and care of newborns, and receives planned and ongoing training as needed to perform assigned duties effectively.

The maximum length of stay in a birth center shall be consistent with existing State laws allowing a 48-hour stay or appropriate post-delivery care, if discharged earlier than 48 hours.

A birth center shall participate in the Illinois Perinatal System under the Developmental Disability Prevention Act.

At a minimum, this participation shall require a birth center to establish a letter of agreement with a hospital designated under the Perinatal System.

A hospital that operates or has a letter of agreement with a birth center shall include the birth center under its maternity service plan under the Hospital Licensing Act and shall include the birth center in the hospital's letter of agreement with its regional perinatal center.

A birth center may not discriminate against any SB2437 Enrolled - 17 - LRB104 10548 KTG 20624 b patient requiring treatment because of the source of payment for services, including Medicare and Medicaid recipients.

No general anesthesia and no surgery may be performed at a birth center.

The Department may by rule add birth center patient eligibility criteria or standards as it deems necessary.

The Department shall by rule require each birth center to report the information which the Department shall make publicly available, which shall include, but is not limited to, the following:

(i) Birth center ownership.

(ii) Sources of payment for services.

(iii) Utilization data involving patient length of stay.

(iv) Admissions and discharges.

(v) Complications.

(vi) Transfers.

(vii) Unusual incidents.

(viii) Deaths.

(ix) Any other publicly reported data required under the Illinois Consumer Guide.

(x) Post-discharge patient status data where patients are followed for 14 days after discharge from the birth center to determine whether the mother or baby developed a complication or infection.

Within 9 months after the effective date of this SB2437 Enrolled - 18 - LRB104 10548 KTG 20624 b amendatory Act of the 95th General Assembly, the Department shall adopt rules that are developed with consideration of:

the American Association of Birth Centers' Standards for Freestanding Birth Centers;

the American Academy of Pediatrics/American College of Obstetricians and Gynecologists Guidelines for Perinatal Care;

and the Regionalized Perinatal Health Care Code.

The Department shall adopt other rules as necessary to implement the provisions of this amendatory Act of the 95th General Assembly within 9 months after the effective date of this amendatory Act of the 95th General Assembly.

(Source:

P.A.

100-518, eff.

12-8-17 (see Section 5 of P.A.

100-558 for the effective date of changes made by P.A.

100-518).) Section 2-105.

The Home Health, Home Services, and Home Nursing Agency Licensing Act is amended by changing Section 2.11 and by adding Section 2.13 as follows:

(210 ILCS 55/2.11) Sec.

2.11.

"Home nursing agency" means an agency that provides services directly, or acts as a placement agency, in order to deliver skilled nursing and home health aide services to persons in their personal residences or a certified family health aide, as defined by the Certified Family Health Aide Program for Children and Adults Act, for individuals receiving SB2437 Enrolled - 19 - LRB104 10548 KTG 20624 b or eligible to receive:

(1) in-home shift nursing services under the Early and Periodic Screening, Diagnostic and Treatment requirement of Medicaid under 42 U.S.C.

1396d(r);

or (2) in-home shift nursing services through the home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act for persons who are medically fragile and technology dependent.

A home nursing agency provides services that would require a licensed nurse to perform.

Home health aide services are provided under the direction of a registered professional nurse or advanced practice registered nurse.

A home nursing agency does not require licensure as a home health agency under this Act.

"Home nursing agency" does not include an individually licensed nurse acting as a private contractor or a person that provides or procures temporary employment in health care facilities, as defined in the Nurse Agency Licensing Act.

(Source:

P.A.

100-513, eff.

1-1-18.) (210 ILCS 55/2.13 new) Sec.

2.13.

Certified family health aide.

A home nursing agency may provide initial and ongoing training for, and shall keep records in a manner designated by the Department regarding, the certified family health aide, as defined in the Certified Family Health Aide Program for Children and Adults Act, identified as the legally responsible caregiver or designated by the legally responsible caregiver for an SB2437 Enrolled - 20 - LRB104 10548 KTG 20624 b individual who receives or is eligible to receive:

(1) in-home shift nursing services under the Early and Periodic Screening, Diagnostic and Treatment requirement of Medicaid under 42 U.S.C.

1396d(r);

or (2) in-home shift nursing through the home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act for persons who are medically fragile and technology dependent.

Section 2-110.

The Hospital Licensing Act is amended by adding Section 17 as follows:

(210 ILCS 85/17 new) Sec.

17.

Certified family health aide.

Hospitals managing the care of an individual to be discharged under the care of a home nursing agency may provide initial training, and shall document in a manner designated by the Department, for the certified family health aide, as defined in the Certified Family Health Aide Program for Children and Adults Act, identified as the legally responsible caregiver or designated by a legally responsible caregiver for an individual who receives or is eligible to receive:

(1) in-home shift nursing services under the Early and Periodic Screening, Diagnostic and Treatment requirement of Medicaid under 42 U.S.C.

1396d(r) or (2) in-home shift nursing through the home and community-based services waiver program authorized under SB2437 Enrolled - 21 - LRB104 10548 KTG 20624 b Section 1915(c) of the Social Security Act for persons who are medically fragile and technology dependent.

Section 2-115.

The Nurse Practice Act is amended by changing Section 50-15 as follows:

(225 ILCS 65/50-15) (was 225 ILCS 65/5-15) (Section scheduled to be repealed on January 1, 2028) Sec.

50-15.

Policy;

application of Act.

(a) For the protection of life and the promotion of health, and the prevention of illness and communicable diseases, any person practicing or offering to practice advanced, professional, or practical nursing in Illinois shall submit evidence that he or she is qualified to practice, and shall be licensed as provided under this Act.

No person shall practice or offer to practice advanced, professional, or practical nursing in Illinois or use any title, sign, card or device to indicate that such a person is practicing professional or practical nursing unless such person has been licensed under the provisions of this Act.

(b) This Act does not prohibit the following:

(1) The practice of nursing in Federal employment in the discharge of the employee's duties by a person who is employed by the United States government or any bureau, division or agency thereof and is a legally qualified and licensed nurse of another state or territory and not in SB2437 Enrolled - 22 - LRB104 10548 KTG 20624 b conflict with Sections 50-50, 55-10, 60-10, and 70-5 of this Act.

(2) Nursing that is included in the program of study by students enrolled in programs of nursing or in current nurse practice update courses approved by the Department.

(3) The furnishing of nursing assistance in an emergency.

(4) The practice of nursing by a nurse who holds an active license in another state when providing services to patients in Illinois during a bonafide emergency or in immediate preparation for or during interstate transit.

(5) The incidental care of the sick by members of the family, domestic servants or housekeepers, or care of the sick where treatment is by prayer or spiritual means.

(6) Persons from being employed as unlicensed assistive personnel in private homes, long term care facilities, nurseries, hospitals or other institutions.

(7) The practice of practical nursing by one who is a licensed practical nurse under the laws of another U.S.

jurisdiction and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as a licensed practical nurse and who is qualified to receive such license under this Act, until (i) the expiration of 6 months after the filing of such written application, (ii) the withdrawal of such application, or (iii) the denial of such application by SB2437 Enrolled - 23 - LRB104 10548 KTG 20624 b the Department.

(8) The practice of advanced practice registered nursing by one who is an advanced practice registered nurse under the laws of another United States jurisdiction or a foreign jurisdiction and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as an advanced practice registered nurse and who is qualified to receive such license under this Act, until (i) the expiration of 6 months after the filing of such written application, (ii) the withdrawal of such application, or (iii) the denial of such application by the Department.

(9) The practice of professional nursing by one who is a registered professional nurse under the laws of another United States jurisdiction or a foreign jurisdiction and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as a registered professional nurse and who is qualified to receive such license under Section 55-10, until (1) the expiration of 6 months after the filing of such written application, (2) the withdrawal of such application, or (3) the denial of such application by the Department.

(10) The practice of professional nursing that is included in a program of study by one who is a registered professional nurse under the laws of another United States jurisdiction or a foreign jurisdiction and who is enrolled SB2437 Enrolled - 24 - LRB104 10548 KTG 20624 b in a graduate nursing education program or a program for the completion of a baccalaureate nursing degree in this State, which includes clinical supervision by faculty as determined by the educational institution offering the program and the health care organization where the practice of nursing occurs.

(11) Any person licensed in this State under any other Act from engaging in the practice for which she or he is licensed.

(12) Delegation to authorized direct care staff trained under Section 15.4 of the Mental Health and Developmental Disabilities Administrative Act consistent with the policies of the Department.

(13) (Blank).

(14) County correctional personnel from delivering prepackaged medication for self-administration to an individual detainee in a correctional facility.

(15) The practice of relevant care by a legally responsible caregiver or a person designated by a legally responsible caregiver who has been certified as a certified family health aide, as defined in the Certified Family Health Aide Program for Children and Adults Act, to perform for a person who receives or is eligible to receive:

(i) in-home shift nursing services under the Early and Periodic Screening, Diagnostic and Treatment requirement of Medicaid under 42 U.S.C.

1396d(r);

or (ii) SB2437 Enrolled - 25 - LRB104 10548 KTG 20624 b in-home shift nursing services through the home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act for persons who are medically fragile and technology dependent.

Nothing in this Act shall be construed to limit the delegation of tasks or duties by a physician, dentist, or podiatric physician to a licensed practical nurse, a registered professional nurse, or other persons.

(Source:

P.A.

100-513, eff.

1-1-18.) Section 2-120.

The Illinois Public Aid Code is amended by adding Section 5-2.06b as follows:

(305 ILCS 5/5-2.06b new) Sec.

5-2.06b.

Certified family health aide program for children and adults.

(a) The Department of Healthcare and Family Services may seek any federal approval from the Centers for Medicare and Medicaid Services necessary to reimburse a legally responsible caregiver or a person designated by a legally responsible caregiver, as defined in the Certified Family Health Aide Program for Children and Adults Act, who has achieved certification as a certified family health aide to perform or assist in performance of services for a person who receives or is eligible to receive:

(1) in-home shift nursing services under the Early and Periodic Screening, Diagnostic and SB2437 Enrolled - 26 - LRB104 10548 KTG 20624 b Treatment requirement of Medicaid under 42 U.S.C.

1396d(r);

or (2) the home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act for a designated person or designated persons who are medically fragile and technology dependent.

Implementation of any and all parts of the certified family health aide program is subject to the Department of Healthcare and Family Services receiving all necessary federal approval.

If the Department of Healthcare and Family Services receives all necessary federal approval the Department may adopt rules in consultation with the Department of Public Health to specify the federally approved services eligible for reimbursement under the certified family health aide certification and to adopt any other policies or procedures necessary to implement this Section.

(b) The Department of Healthcare and Family Services, in partnership with the Department of Public Health, may consult with stakeholders for expertise regarding implementation of the certified family health aide program.

Stakeholders may include, the University of Illinois at Chicago, Division of Specialized Care for Children, home nurse agencies, a physician with medical experience with the population being served by the program, children's hospitals, a legally responsible caregiver as described in item (3) of Section 10 of the Certified Family Health Aide Program for Children and Adults Act, and a Children's Community-Based Health Care SB2437 Enrolled - 27 - LRB104 10548 KTG 20624 b Clinic.

(c) Subject to federal approval, the Department of Healthcare and Family Services may adopt rules to disregard income earned by a legally responsible caregiver in the performance of or assisting in the performance of services for a person receiving or eligible to receive:

(1) in-home shift nursing services under the Early and Periodic Screening, Diagnostic and Treatment requirement of Medicaid under 42 U.S.C.

1396d(r);

or (2) the home and community-based services waiver program authorized under Section 1915(c) of the Social Security Act for a designated person or designated persons who are medically fragile and technology dependent, when determining the child's eligibility for medical assistance under the Medical Assistance-No Grant (MANG (AABD)) Income Standard.

ARTICLE 5.

Section 5-5.

(a) Recognizing the importance that doulas provide in the support and advocacy for pregnant persons, within 6 months SB2437 Enrolled - 28 - LRB104 10548 KTG 20624 b after this amendatory Act of the 104th General Assembly, all hospitals with licensed obstetric beds and birthing centers shall adopt and maintain written policies and procedures to permit a patient enrolled in the medical assistance program to have an Illinois Medicaid certified and enrolled doula of the patient's choice accompany the patient within the facility's premises for the purposes of providing support before, during, and after labor and childbirth.

(2) Each applicable facility shall post a summary of the facility's policies and procedures adopted in SB2437 Engrossed - 2 - LRB104 10548 KTG 20624 b accordance with this subsection on its website, including contact information to facilitate communication between the facility and Illinois Medicaid enrolled doulas and doula organizations.

however, no hospital shall be liable for any act or omission resulting from the provision of services by any doula solely SB2437 Enrolled - 29 - LRB104 10548 KTG 20624 b on the basis that the hospital permitted an Illinois Medicaid certified and enrolled doula of the patient's choice to accompany the patient within the facility's premises for the purposes of providing support before, during, and after labor and childbirth.

(305 ILCS 5/5-18.7 new) SB2437 Engrossed - 3 - LRB104 10548 KTG 20624 b Sec.

No employee of the Department of Healthcare and Family Services or the Department of Public Health issuing a standing recommendation in accordance with this Section shall, as a result of the employee's acts or omissions in issuing the standing recommendation, be subject to (i) any disciplinary or SB2437 Enrolled - 30 - LRB104 10548 KTG 20624 b other adverse action under the Medical Practice Act of 1987, (ii) any civil liability, or (iii) any criminal liability.

ARTICLE 10.

Section 10-5.

The Illinois Public Aid Code is amended by changing Section 5-2 as follows:

(305 ILCS 5/5-2) (from Ch.

23, par.

5-2) Sec.

5-2.

Classes of persons eligible.

Medical assistance under this Article shall be available to any of the following classes of persons in respect to whom a plan for coverage has been submitted to the Governor by the Illinois Department and approved by him.

If changes made in this Section 5-2 require federal approval, they shall not take effect until such approval has been received:

1.

Recipients of basic maintenance grants under Articles III and IV.

2.

Beginning January 1, 2014, persons otherwise eligible for basic maintenance under Article III, excluding any eligibility requirements that are inconsistent with any federal law or federal regulation, as interpreted by the U.S.

Department of Health and Human Services, but who fail to qualify thereunder on the basis of need, and who have insufficient income and resources to meet the costs of necessary medical care, including, but SB2437 Enrolled - 31 - LRB104 10548 KTG 20624 b not limited to, the following:

(a) All persons otherwise eligible for basic maintenance under Article III but who fail to qualify under that Article on the basis of need and who meet either of the following requirements:

(i) their income, as determined by the Illinois Department in accordance with any federal requirements, is equal to or less than 100% of the federal poverty level;

or (ii) their income, after the deduction of costs incurred for medical care and for other types of remedial care, is equal to or less than 100% of the federal poverty level.

(b) (Blank).

3.

(Blank).

4.

Persons not eligible under any of the preceding paragraphs who fall sick, are injured, or die, not having sufficient money, property or other resources to meet the costs of necessary medical care or funeral and burial expenses.

5.(a) Beginning January 1, 2020, individuals during pregnancy and during the 12-month period beginning on the last day of the pregnancy, together with their infants, whose income is at or below 200% of the federal poverty level.

Until September 30, 2019, or sooner if the maintenance of effort requirements under the Patient SB2437 Enrolled - 32 - LRB104 10548 KTG 20624 b Protection and Affordable Care Act are eliminated or may be waived before then, individuals during pregnancy and during the 12-month period beginning on the last day of the pregnancy, whose countable monthly income, after the deduction of costs incurred for medical care and for other types of remedial care as specified in administrative rule, is equal to or less than the Medical Assistance-No Grant(C) (MANG(C)) Income Standard in effect on April 1, 2013 as set forth in administrative rule.

(b) The plan for coverage shall provide ambulatory prenatal care to pregnant individuals during a presumptive eligibility period and establish an income eligibility standard that is equal to 200% of the federal poverty level, provided that costs incurred for medical care are not taken into account in determining such income eligibility.

(c) The Illinois Department may conduct a demonstration in at least one county that will provide medical assistance to pregnant individuals together with their infants and children up to one year of age, where the income eligibility standard is set up to 185% of the nonfarm income official poverty line, as defined by the federal Office of Management and Budget.

The Illinois Department shall seek and obtain necessary authorization provided under federal law to implement such a demonstration.

Such demonstration may establish resource SB2437 Enrolled - 33 - LRB104 10548 KTG 20624 b standards that are not more restrictive than those established under Article IV of this Code.

6.

(a) Subject to federal approval, children younger than age 19 when countable income is at or below 313% of the federal poverty level, as determined by the Department and in accordance with all applicable federal requirements.

The Department is authorized to adopt emergency rules to implement the changes made to this paragraph by Public Act 102-43.

Until September 30, 2019, or sooner if the maintenance of effort requirements under the Patient Protection and Affordable Care Act are eliminated or may be waived before then, children younger than age 19 whose countable monthly income, after the deduction of costs incurred for medical care and for other types of remedial care as specified in administrative rule, is equal to or less than the Medical Assistance-No Grant(C) (MANG(C)) Income Standard in effect on April 1, 2013 as set forth in administrative rule.

(b) Children and youth who are under temporary custody or guardianship of the Department of Children and Family Services or who receive financial assistance in support of an adoption or guardianship placement from the Department of Children and Family Services.

7.

(Blank).

8.

As required under federal law, persons who are eligible for Transitional Medical Assistance as a result SB2437 Enrolled - 34 - LRB104 10548 KTG 20624 b of an increase in earnings or child or spousal support received.

The plan for coverage for this class of persons shall:

(a) extend the medical assistance coverage to the extent required by federal law;

and (b) offer persons who have initially received 6 months of the coverage provided in paragraph (a) above, the option of receiving an additional 6 months of coverage, subject to the following:

(i) such coverage shall be pursuant to provisions of the federal Social Security Act;

(ii) such coverage shall include all services covered under Illinois' State Medicaid Plan;

(iii) no premium shall be charged for such coverage;

and (iv) such coverage shall be suspended in the event of a person's failure without good cause to file in a timely fashion reports required for this coverage under the Social Security Act and coverage shall be reinstated upon the filing of such reports if the person remains otherwise eligible.

9.

Persons with acquired immunodeficiency syndrome (AIDS) or with AIDS-related conditions with respect to whom there has been a determination that but for home or community-based services such individuals would require SB2437 Enrolled - 35 - LRB104 10548 KTG 20624 b the level of care provided in an inpatient hospital, skilled nursing facility or intermediate care facility the cost of which is reimbursed under this Article.

Assistance shall be provided to such persons to the maximum extent permitted under Title XIX of the Federal Social Security Act.

10.

Participants in the long-term care insurance partnership program established under the Illinois Long-Term Care Partnership Program Act who meet the qualifications for protection of resources described in Section 15 of that Act.

11.

Persons with disabilities who are employed and eligible for Medicaid, pursuant to Section 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, subject to federal approval, persons with a medically improved disability who are employed and eligible for Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of the Social Security Act, as provided by the Illinois Department by rule.

In establishing eligibility standards under this paragraph 11, the Department shall, subject to federal approval:

(a) set the income eligibility standard at not lower than 350% of the federal poverty level;

(b) exempt retirement accounts that the person cannot access without penalty before the age of 59 1/2, and medical savings accounts established pursuant SB2437 Enrolled - 36 - LRB104 10548 KTG 20624 b to 26 U.S.C.

220;

(c) allow non-exempt assets up to $25,000 as to those assets accumulated during periods of eligibility under this paragraph 11;

and (d) continue to apply subparagraphs (b) and (c) in determining the eligibility of the person under this Article even if the person loses eligibility under this paragraph 11.

12.

Subject to federal approval, persons who are eligible for medical assistance coverage under applicable provisions of the federal Social Security Act and the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000.

Those eligible persons are defined to include, but not be limited to, the following persons:

(1) persons who have been screened for breast or cervical cancer under the U.S.

Centers for Disease Control and Prevention Breast and Cervical Cancer Program established under Title XV of the federal Public Health Service Act in accordance with the requirements of Section 1504 of that Act as administered by the Illinois Department of Public Health;

and (2) persons whose screenings under the above program were funded in whole or in part by funds appropriated to the Illinois Department of Public Health for breast or cervical cancer screening.

SB2437 Enrolled - 37 - LRB104 10548 KTG 20624 b "Medical assistance" under this paragraph 12 shall be identical to the benefits provided under the State's approved plan under Title XIX of the Social Security Act.

The Department must request federal approval of the coverage under this paragraph 12 within 30 days after July 3, 2001 (the effective date of Public Act 92-47).

In addition to the persons who are eligible for medical assistance pursuant to subparagraphs (1) and (2) of this paragraph 12, and to be paid from funds appropriated to the Department for its medical programs, any uninsured person as defined by the Department in rules residing in Illinois who is younger than 65 years of age, who has been screened for breast and cervical cancer in accordance with standards and procedures adopted by the Department of Public Health for screening, and who is referred to the Department by the Department of Public Health as being in need of treatment for breast or cervical cancer is eligible for medical assistance benefits that are consistent with the benefits provided to those persons described in subparagraphs (1) and (2).

Medical assistance coverage for the persons who are eligible under the preceding sentence is not dependent on federal approval, but federal moneys may be used to pay for services provided under that coverage upon federal approval.

13.

Subject to appropriation and to federal approval, SB2437 Enrolled - 38 - LRB104 10548 KTG 20624 b persons living with HIV/AIDS who are not otherwise eligible under this Article and who qualify for services covered under Section 5-5.04 as provided by the Illinois Department by rule.

14.

Subject to the availability of funds for this purpose, the Department may provide coverage under this Article to persons who (a) reside in Illinois;

who (b) are not eligible under any of the preceding paragraphs of this Section;

and who (c) meet the income guidelines of paragraph 2(a) of this Section;

and (d) meet one of the following conditions:

(i) have filed an application for asylum status under 8 U.S.C.

1158 that is pending with the appropriate federal agency or have a pending appeal of such an application pending before the federal Department of Homeland Security or on appeal before a court of competent jurisdiction and are represented either by counsel or by an advocate accredited by the appropriate federal agency Department of Homeland Security and employed by a not-for-profit organization in regard to that application or appeal;

, or (ii) are receiving services through a federally funded torture treatment center;

SB2437 Enrolled - 39 - LRB104 10548 KTG 20624 b (iii) have filed a pending application for T nonimmigrant status pursuant to 8 U.S.C.

1101(a)(15)(T);

(iv) have filed a pending application for U nonimmigrant status pursuant to 8 U.S.C.

1101(a)(15)(U);

or (v) have filed as a derivative family member or are included in the application for item (i), (iii), or (iv) as provided by Department rule.

Medical coverage under this paragraph 14 may be provided for up to 24 continuous months from the initial eligibility date so long as an individual continues to satisfy the criteria of this paragraph 14.

If an individual has an application or appeal pending regarding an application for asylum, T nonimmigrant status, or U nonimmigrant status before the appropriate federal agency for such applications or appeals Department of Homeland Security, eligibility under this paragraph 14 may be extended until a final decision is rendered with respect to the application or appeal, except that an individual who is approved for a U visa continues to qualify for medical coverage under this paragraph 14 as long as the individual meets all other eligibility criteria on the appeal.

The Department shall may adopt rules governing the implementation of this paragraph 14.

15.

Family Care Eligibility.

SB2437 Enrolled - 40 - LRB104 10548 KTG 20624 b (a) On and after July 1, 2012, a parent or other caretaker relative who is 19 years of age or older when countable income is at or below 133% of the federal poverty level.

A person may not spend down to become eligible under this paragraph 15.

(b) Eligibility shall be reviewed annually.

(c) (Blank).

(d) (Blank).

(e) (Blank).

(f) (Blank).

(g) (Blank).

(h) (Blank).

(i) Following termination of an individual's coverage under this paragraph 15, the individual must be determined eligible before the person can be re-enrolled.

16.

Subject to appropriation, uninsured persons who are not otherwise eligible under this Section who have been certified and referred by the Department of Public Health as having been screened and found to need diagnostic evaluation or treatment, or both diagnostic evaluation and treatment, for prostate or testicular cancer.

For the purposes of this paragraph 16, uninsured persons are those who do not have creditable coverage, as defined under the Health Insurance Portability and Accountability Act, or have otherwise exhausted any SB2437 Enrolled - 41 - LRB104 10548 KTG 20624 b insurance benefits they may have had, for prostate or testicular cancer diagnostic evaluation or treatment, or both diagnostic evaluation and treatment.

To be eligible, a person must furnish a Social Security number.

A person's assets are exempt from consideration in determining eligibility under this paragraph 16.

Such persons shall be eligible for medical assistance under this paragraph 16 for so long as they need treatment for the cancer.

A person shall be considered to need treatment if, in the opinion of the person's treating physician, the person requires therapy directed toward cure or palliation of prostate or testicular cancer, including recurrent metastatic cancer that is a known or presumed complication of prostate or testicular cancer and complications resulting from the treatment modalities themselves.

Persons who require only routine monitoring services are not considered to need treatment.

"Medical assistance" under this paragraph 16 shall be identical to the benefits provided under the State's approved plan under Title XIX of the Social Security Act.

Notwithstanding any other provision of law, the Department (i) does not have a claim against the estate of a deceased recipient of services under this paragraph 16 and (ii) does not have a lien against any homestead property or other legal or equitable real property interest owned by a recipient of services under this paragraph 16.

SB2437 Enrolled - 42 - LRB104 10548 KTG 20624 b 17.

Persons who, pursuant to a waiver approved by the Secretary of the U.S.

Department of Health and Human Services, are eligible for medical assistance under Title XIX or XXI of the federal Social Security Act.

Notwithstanding any other provision of this Code and consistent with the terms of the approved waiver, the Illinois Department, may by rule:

(a) Limit the geographic areas in which the waiver program operates.

(b) Determine the scope, quantity, duration, and quality, and the rate and method of reimbursement, of the medical services to be provided, which may differ from those for other classes of persons eligible for assistance under this Article.

(c) Restrict the persons' freedom in choice of providers.

18.

Beginning January 1, 2014, persons aged 19 or older, but younger than 65, who are not otherwise eligible for medical assistance under this Section 5-2, who qualify for medical assistance pursuant to 42 U.S.C.

1396a(a)(10)(A)(i)(VIII) and applicable federal regulations, and who have income at or below 133% of the federal poverty level plus 5% for the applicable family size as determined pursuant to 42 U.S.C.

1396a(e)(14) and applicable federal regulations.

Persons eligible for medical assistance under this paragraph 18 shall receive SB2437 Enrolled - 43 - LRB104 10548 KTG 20624 b coverage for the Health Benefits Service Package as that term is defined in subsection (m) of Section 5-1.1 of this Code.

If Illinois' federal medical assistance percentage (FMAP) is reduced below 90% for persons eligible for medical assistance under this paragraph 18, eligibility under this paragraph 18 shall cease no later than the end of the third month following the month in which the reduction in FMAP takes effect.

19.

Beginning January 1, 2014, as required under 42 U.S.C.

1396a(a)(10)(A)(i)(IX), persons older than age 18 and younger than age 26 who are not otherwise eligible for medical assistance under paragraphs (1) through (17) of this Section who (i) were in foster care under the responsibility of the State on the date of attaining age 18 or on the date of attaining age 21 when a court has continued wardship for good cause as provided in Section 2-31 of the Juvenile Court Act of 1987 and (ii) received medical assistance under the Illinois Title XIX State Plan or waiver of such plan while in foster care.

20.

(Blank).

Beginning January 1, 2018, persons who are foreign-born victims of human trafficking, torture, or other serious crimes as defined in Section 2-19 of this Code and their derivative family members if such persons:

(i) reside in Illinois;

(ii) are not eligible under any of the preceding paragraphs;

(iii) meet the income guidelines of subparagraph (a) of paragraph 2;

and (iv) meet the SB2437 Enrolled - 44 - LRB104 10548 KTG 20624 b nonfinancial eligibility requirements of Sections 16-2, 16-3, and 16-5 of this Code.

The Department may extend medical assistance for persons who are foreign-born victims of human trafficking, torture, or other serious crimes whose medical assistance would be terminated pursuant to subsection (b) of Section 16-5 if the Department determines that the person, during the year of initial eligibility (1) experienced a health crisis, (2) has been unable, after reasonable attempts, to obtain necessary information from a third party, or (3) has other extenuating circumstances that prevented the person from completing his or her application for status.

The Department may adopt any rules necessary to implement the provisions of this paragraph.

21.

Persons who are not otherwise eligible for medical assistance under this Section who may qualify for medical assistance pursuant to 42 U.S.C.

1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C.

1396(ss) for the duration of any federal or State declared emergency due to COVID-19.

Medical assistance to persons eligible for medical assistance solely pursuant to this paragraph 21 shall be limited to any in vitro diagnostic product (and the administration of such product) described in 42 U.S.C.

1396d(a)(3)(B) on or after March 18, 2020, any visit described in 42 U.S.C.

1396o(a)(2)(G), or any other medical assistance that may be federally authorized for SB2437 Enrolled - 45 - LRB104 10548 KTG 20624 b this class of persons.

The Department may also cover treatment of COVID-19 for this class of persons, or any similar category of uninsured individuals, to the extent authorized under a federally approved 1115 Waiver or other federal authority.

Notwithstanding the provisions of Section 1-11 of this Code, due to the nature of the COVID-19 public health emergency, the Department may cover and provide the medical assistance described in this paragraph 21 to noncitizens who would otherwise meet the eligibility requirements for the class of persons described in this paragraph 21 for the duration of the State emergency period.

In implementing the provisions of Public Act 96-20, the Department is authorized to adopt only those rules necessary, including emergency rules.

Nothing in Public Act 96-20 permits the Department to adopt rules or issue a decision that expands eligibility for the FamilyCare Program to a person whose income exceeds 185% of the Federal Poverty Level as determined from time to time by the U.S.

Department of Health and Human Services, unless the Department is provided with express statutory authority.

The eligibility of any such person for medical assistance under this Article is not affected by the payment of any grant under the Senior Citizens and Persons with Disabilities Property Tax Relief Act or any distributions or items of income described under subparagraph (X) of paragraph (2) of SB2437 Enrolled - 46 - LRB104 10548 KTG 20624 b subsection (a) of Section 203 of the Illinois Income Tax Act.

The Department shall by rule establish the amounts of assets to be disregarded in determining eligibility for medical assistance, which shall at a minimum equal the amounts to be disregarded under the Federal Supplemental Security Income Program.

The amount of assets of a single person to be disregarded shall not be less than $2,000, and the amount of assets of a married couple to be disregarded shall not be less than $3,000.

To the extent permitted under federal law, any person found guilty of a second violation of Article VIIIA shall be ineligible for medical assistance under this Article, as provided in Section 8A-8.

The eligibility of any person for medical assistance under this Article shall not be affected by the receipt by the person of donations or benefits from fundraisers held for the person in cases of serious illness, as long as neither the person nor members of the person's family have actual control over the donations or benefits or the disbursement of the donations or benefits.

Notwithstanding any other provision of this Code, if the United States Supreme Court holds Title II, Subtitle A, Section 2001(a) of Public Law 111-148 to be unconstitutional, or if a holding of Public Law 111-148 makes Medicaid eligibility allowed under Section 2001(a) inoperable, the State or a unit of local government shall be prohibited from SB2437 Enrolled - 47 - LRB104 10548 KTG 20624 b enrolling individuals in the Medical Assistance Program as the result of federal approval of a State Medicaid waiver on or after June 14, 2012 (the effective date of Public Act 97-687), and any individuals enrolled in the Medical Assistance Program pursuant to eligibility permitted as a result of such a State Medicaid waiver shall become immediately ineligible.

Notwithstanding any other provision of this Code, if an Act of Congress that becomes a Public Law eliminates Section 2001(a) of Public Law 111-148, the State or a unit of local government shall be prohibited from enrolling individuals in the Medical Assistance Program as the result of federal approval of a State Medicaid waiver on or after June 14, 2012 (the effective date of Public Act 97-687), and any individuals enrolled in the Medical Assistance Program pursuant to eligibility permitted as a result of such a State Medicaid waiver shall become immediately ineligible.

Effective October 1, 2013, the determination of eligibility of persons who qualify under paragraphs 5, 6, 8, 15, 17, and 18 of this Section shall comply with the requirements of 42 U.S.C.

1396a(e)(14) and applicable federal regulations.

The Department of Healthcare and Family Services, the Department of Human Services, and the Illinois health insurance marketplace shall work cooperatively to assist persons who would otherwise lose health benefits as a result of changes made under Public Act 98-104 to transition to other SB2437 Enrolled - 48 - LRB104 10548 KTG 20624 b health insurance coverage.

(Source:

P.A.

101-10, eff.

6-5-19;

101-649, eff.

7-7-20;

102-43, eff.

7-6-21;

102-558, eff.

8-20-21;

102-665, eff.

10-8-21;

102-813, eff.

5-13-22.) ARTICLE 15.

Section 15-5.

The Illinois Public Aid Code is amended by changing Section 5-5.09a as follows:

(305 ILCS 5/5-5.09a new) Sec.

5-5.09a.

Screening for tardive dyskinesia.

(a) Notwithstanding any other provisions of law, the Department of Healthcare and Family Services shall develop, in collaboration with the Department of Human Services and the Department of Public Health, recommended screening guidelines for tardive dyskinesia for providers serving patients prescribed antipsychotic medications under the medical assistance program in State-operated residential facilities and community-based settings.

(b) The recommended screening guidelines shall be based on current, nationally accepted, evidence-based recommendations for the assessment and treatment of tardive dyskinesia, and shall include structured assessment tools, which can be both quantitative and qualitative.

(c) The Department of Healthcare and Family Services and SB2437 Enrolled - 49 - LRB104 10548 KTG 20624 b the Department of Human Services, in collaboration with the Department of Public Health, shall develop communication strategies and educational materials to be offered to health care providers regarding tardive dyskinesia, the recommended screening guidelines, and any subsequent revisions.

In developing the information to be disseminated under this Section, the Departments of Healthcare and Family Services, Human Services, and Public Health shall consult with a statewide association representing physicians licensed to practice medicine in all its branches and a statewide association representing psychiatrists.

ARTICLE 20.

Section 20-5.

The Illinois Public Aid Code is amended by changing Section 5-5.12f as follows:

(305 ILCS 5/5-5.12f) Sec.

5-5.12f.

Prescription drugs for mental illness;

no utilization or prior approval mandates.

(a) Notwithstanding any other provision of this Code to the contrary, except as otherwise provided in subsection (b), for the purpose of removing barriers to the timely treatment of serious mental illnesses, prior authorization mandates and utilization management controls shall not be imposed under the fee-for-service and managed care medical assistance programs SB2437 Enrolled - 50 - LRB104 10548 KTG 20624 b on any FDA-approved prescription drug that is recognized by a generally accepted standard medical reference as effective in the treatment of conditions specified in the most recent Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association if a preferred or non-preferred drug is prescribed to an adult patient to treat serious mental illness and one of the following applies:

(1) the patient has changed providers, including, but not limited to, a change from an inpatient to an outpatient provider, and is stable on the drug that has been previously prescribed, and received prior authorization, if required;

(2) the patient has changed Medical assistance program or managed care plan insurance coverage and is stable on the drug that has been previously prescribed and received prior authorization under the previous source of coverage;

or (3) subject to federal law on maximum dosage limits and safety edits adopted by the Department's Drug and Therapeutics Board, including those safety edits and limits needed to comply with federal requirements contained in 42 CFR 456.703, the patient has previously been prescribed and obtained prior authorization for the drug and the prescription modifies the dosage, dosage frequency, or both, of the drug as part of the same SB2437 Enrolled - 51 - LRB104 10548 KTG 20624 b treatment for which the drug was previously prescribed.

(b) The following safety edits shall be permitted for prescription drugs covered under this Section:

(1) clinically appropriate drug utilization review (DUR) edits, including, but not limited to, drug-to-drug, drug-age, and drug-dose;

(2) generic drug substitution if a generic drug is available for the prescribed medication in the same dosage and formulation;

and (3) any utilization management control that is necessary for the Department to comply with any current consent decrees or federal waivers.

(c) As used in this Section, "serious mental illness" means any one or more of the following diagnoses and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes listed by the Department of Human Services' Division of Mental Health, as amended, on its official website:

(1) Delusional Disorder (F22) (2) Brief Psychotic Disorder (F23) (3) Schizophreniform Disorder (F20.81) (4) Schizophrenia (F20.9) (5) Schizoaffective Disorder (F25.x) (6) Catatonia Associated with Another Mental Disorder (Catatonia Specifier) (F06.1) (7) Other Specified Schizophrenia Spectrum and Other SB2437 Enrolled - 52 - LRB104 10548 KTG 20624 b Psychotic Disorder (F28) (8) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (F29) (9) Bipolar I Disorder (F31.xx) (10) Bipolar II Disorder (F31.81) (11) Cyclothymic Disorder (F34.0) (12) Unspecified Bipolar and Related Disorder (F31.9) (13) Disruptive Mood Dysregulation Disorder (F34.8) (14) Major Depressive Disorder Single episode (F32.xx) (15) Major Depressive Disorder, Recurrent episode (F33.xx) (16) Obsessive-Compulsive Disorder (F42) (17) Posttraumatic Stress Disorder (F43.10) (18) Anorexia Nervosa (F50.0x) (19) Bulimia Nervosa (F50.2) (20) Postpartum Depression (F53.0) (21) Puerperal Psychosis (F53.1) (22) Factitious Disorder Imposed on Another (F68.A) (d) Notwithstanding any other provision of law, nothing in this Section shall not be construed to conflict with Section 1927(a)(1) and (b)(1)(A) of the federal Social Security Act and any implementing regulations and agreements.

(e) The Department shall publish a report semi-annually on its website on compliance with the conditions of this Section by the fee-for-service program and managed care organizations beginning with dates of service on and after July 1, 2025.

SB2437 Enrolled - 53 - LRB104 10548 KTG 20624 b These reports shall be due 12 months after the end of the period to be reported.

These reports shall include:

(1) The number of clinically denied prescriptions summarized by each of the allowed categories specified in subsection (b).

This paragraph shall include the number of prior authorization denials.

(2) The number of clinically denied prescriptions as summarized by each of the nonallowed categories specified in subsection (a), categorized by denial reason.

(3) The number of prior authorizations of prescriptions contrary to the prohibition described in subsection (a).

(4) The number of complaints filed concerning denials for prescriptions, which meet the conditions specified in subsection (a).

(5) The number of approved and paid prescriptions described in subsection (a) and the potential net cost to the State.

(6) The number of persons enrolled in the medical assistance program using emergency room services based on categories specified in subsection (c) as the primary diagnosis for the emergency room visit.

(7) The number of persons admitted into a hospital and the number of hospital readmissions, based on categories specified in subsection (c) as the primary diagnosis for the hospital admission or readmission.

SB2437 Enrolled - 54 - LRB104 10548 KTG 20624 b As used in this Section, "net cost" means the difference in total ingredient cost due to changes in product mix plus total loss in aggregate rebate revenue based on product mix realized in Fiscal Year 2025.

Nothing in this Section shall require the Department to disclose information that is exempt from disclosure under paragraph (g) of subsection (1) of Section 7 of the Freedom of Information Act.

For purposes of this Section, a hospital readmission occurs when a patient is discharged from a hospital and then admitted into the same or another hospital within 30 days of discharge for the same primary diagnosis.

(Source:

P.A.

103-593, eff.

6-7-24.) ARTICLE 30.

Section 30-5.

The Illinois Public Aid Code is amended by changing Section 5-2b as follows:

(305 ILCS 5/5-2b) Sec.

5-2b.

Medically fragile and technology dependent children eligibility and program;

provider reimbursement rates.

(a) Notwithstanding any other provision of law except as provided in Section 5-30a, on and after September 1, 2012, subject to federal approval, medical assistance under this Article shall be available to children who qualify as persons SB2437 Enrolled - 55 - LRB104 10548 KTG 20624 b with a disability, as defined under the federal Supplemental Security Income program and who are medically fragile and technology dependent.

The program shall allow eligible children to receive the medical assistance provided under this Article in the community and must maximize, to the fullest extent permissible under federal law, federal reimbursement and family cost-sharing, including co-pays, premiums, or any other family contributions, except that the Department shall be permitted to incentivize the utilization of selected services through the use of cost-sharing adjustments.

The Department shall establish the policies, procedures, standards, services, and criteria for this program by rule.

(b) Notwithstanding any other provision of this Code, subject to federal approval, on and after January 1, 2024, the reimbursement rates for nursing paid through Nursing and Personal Care Services for non-waiver customers and to providers of private duty nursing services for children eligible for medical assistance under this Section shall be 20% higher than the reimbursement rates in effect for nursing services on December 31, 2023.

(c) Notwithstanding any other provision of this Code, subject to federal approval, on and after January 1, 2025, the reimbursement rates for nursing paid through Nursing and Personal Care Services for non-waiver customers and to providers of private duty nursing services for children eligible for medical assistance under this Section shall be 7% SB2437 Enrolled - 56 - LRB104 10548 KTG 20624 b higher than the reimbursement rates in effect for nursing services on December 31, 2024.

(d) The Department shall conduct an evaluation to study the program, including service provision and design, waiver operations, and methodologies and policies for setting rates and reimbursements for services and supports that are provided to (i) individuals under the age of 21 who are approved by the Department for in-home shift nursing services and (ii) individuals over the age of 21 who are receiving in-home shift nursing services under the Home and Community-Based Services Waiver for Medically Fragile and Technology Dependent Children, including, but not limited to, in-home shift nursing services and related home and community-based services and supports, made to nursing agencies for such services.

As needed, the Department shall consult with Department-enrolled providers of in-home shift nursing services to ensure accurate information is considered in the evaluation, and the Department may, to the extent it deems necessary and appropriate, contract with an outside entity to assist or provide further analysis in the support of the evaluation.

(Source:

P.A.

103-102, eff.

1-1-24;

103-593, eff.

6-7-24.) ARTICLE 35.

Section 35-5.

The Illinois Public Aid Code is amended by adding Section 5-65 as follows:

SB2437 Enrolled - 57 - LRB104 10548 KTG 20624 b (305 ILCS 5/5-65 new) Sec.

5-65.

Reimbursement rates for long-term electrocardiogram monitoring.

(a) As used in this Section, "long-term ambulatory electrocardiogram monitoring services" means the provision of external cardiac patch monitoring devices to patients to wear for 48 hours or greater and the interpretation of data gathered by such devices to detect heart arrhythmias that can lead to stroke, cardiac arrest, or other comorbidities or medical complications if not correctly diagnosed.

(b) Subject to federal approval, for dates of service on and after January 1, 2026, the Department shall reimburse diagnostic testing facilities that provide long-term ambulatory electrocardiogram monitoring services at a rate not less than 80% of the Medicare Physician Fee Schedule rate in effect for such services on the effective date of this amendatory Act of the 104th General Assembly.

ARTICLE 40.

Section 40-5.

The Illinois Public Aid Code is amended by changing Section 5-5 as follows:

(305 ILCS 5/5-5) (Text of Section before amendment by P.A.

103-808) SB2437 Enrolled - 58 - LRB104 10548 KTG 20624 b Sec.

5-5.