Illinois 96th Regular Session Status: Passed House

HB 5331 — MEDICAID-AMBULANCE SRVCS RATES

Last action — Session Sine Die

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 96th Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Amends the Illinois Public Aid Code. Provides formulas for Medicaid reimbursement of ambulance service providers for emergency ambulance services, non-emergency ambulance services, mileage, advanced life support services, and specialty care transport services. Provides that the requirement for payment of ground ambulance services by the Illinois Department of Healthcare and Family Services is met if the services are provided pursuant to a request for evaluation, treatment, and transport for an individual with a condition of such a nature that a prudent layperson would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to life or health. Requires the Department to annually update the ambulance fee schedule rates on July 1 of each year. Makes other changes.

Bill Text

What changed in the latest version

1017 added · 173 removed

Plain-language change summary

The recent amendments to HB 5331 clarify the definitions and categories related to ground ambulance services, particularly distinguishing between emergency and non-emergency services. This helps ensure that reimbursement formulas for Medicaid reflect the realities of ambulance operations and patient needs. Additionally, it requires the Illinois Department of Healthcare and Family Services to update its ambulance fee schedule annually, which is important for keeping reimbursement rates in line with current costs and services. These changes are designed to enhance funding for ambulance providers and improve overall patient care in Illinois.

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*LRB09618929KTG34317b* HB5331 96TH GENERAL ASSEMBLY State of Illinois and 2010 HB5331 Introduced 2/5/2010, by Rep.
HB5331 Engrossed LRB096 18929 KTG 34317 b AN ACT concerning public aid.
Dan Reitz SYNOPSIS AS INTRODUCED:
ILCS 5/5-4.2 from Ch.
23, par.
5-4.2 Amends the Illinois Public Aid Code.
Provides formulas for Medicaid reimbursement of ambulance service providers for emergency ambulance services, non-emergency ambulance services, mileage, advanced life support services, and specialty care transport services.
Provides that the requirement for payment of ground ambulance services by the Illinois Department of Healthcare and Family Services is met if the services are provided pursuant to a request for evaluation, treatment, and transport for an individual with a condition of such a nature that a prudent layperson would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to life or health.
Requires the Department to annually update the ambulance fee schedule rates on July 1 of each year.
Makes other changes.
LRB096 18929 KTG 34317 b FISCAL NOTE ACT MAY APPLY A BILL FOR HB5331 LRB096 18929 KTG 34317 b AN ACT concerning public aid.
The Illinois Public Aid Code is amended by changing Section 5-4.2 as follows:
The Illinois Public Aid Code is amended by changing Sections 5-4.2 and 5-5 as follows:
Ambulance services payments.
Ground ambulance Ambulance services payments.
(a) It is the intent of the General Assembly to provide adequate reimbursement for ambulance services so as to ensure adequate access to services for both recipients of aid under this Article and for the general population of Illinois.
(a) For purposes of this Section, the following terms have the following meanings:
Unless otherwise indicated in this Section, the practices of the Illinois Department where it concerns ambulance service payments shall be consistent with the payment principles of Medicare to include the statutes, laws, regulations, policies, procedures, principles, definitions, guidelines, coding systems, including the ambulance condition coding system, and manuals used to determine the payment system to ambulance service providers under Title XVIII of the Social Security Act.
"Department" means the Illinois Department of Healthcare and Family Services.
(b) For ambulance services provided to a recipient of aid under this Article on or after July 1, 2010 January 1, 1993, the Illinois Department shall reimburse ambulance service providers at rates calculated in accordance with this Section.
"Ground ambulance services" means medical transportation services that are described as ground ambulance services by the Centers for Medicare and Medicaid Services and provided in a vehicle that is licensed as an ambulance by the Illinois Department of Public Health pursuant to the Emergency Medical Services (EMS) Systems Act.
HB5331 - 2 - LRB096 18929 KTG 34317 b (1) Payment for non-emergency ambulance services base rates shall be at a rate that is the lesser of the provider's charge, as reflected on the provider's claim form, or 60% of the Medicare Ambulance Fee Schedule amount for the designated Medicare Locality, except that any non-emergency base rate previously approved by the Illinois Department that exceeds 60% of the Medicare Ambulance Fee Schedule amount for the designated Medicare Locality shall remain in force.
"Ground ambulance services provider" means a vehicle service provider as described in the Emergency Medical Services (EMS) Systems Act that operates licensed ambulances for the purpose of providing emergency ambulance services, or non-emergency ambulance services, or both.
(2) Payment for emergency ambulance services base rates shall be at a rate that is the lesser of the provider's charge, as reflected on the provider's claim form, or 80% of the Medicare Ambulance Fee Schedule amount for the designated Medicare Locality, except that any emergency base rate previously approved by the Illinois Department that exceeds 80% of the Medicare Ambulance Fee Schedule amount for the designated Medicare Locality shall remain in force.
For purposes of this Section, this includes both ambulance providers and ambulance HB5331 Engrossed - 2 - LRB096 18929 KTG 34317 b suppliers as described by the Centers for Medicare and Medicaid Services.
(3) Payment for mileage shall be per loaded mile with no loaded mileage included in the base rate.
"Rural county" means:
If a natural disaster, weather, or other conditions necessitate a route other than the most direct route, reimbursement shall be based upon the actual distance traveled.
any county not located in a U.S.
For mileage associated to emergency base rates, payment shall be at a rate that is the lesser of the provider's charge, as reflected on the provider's claim form, or 80% of the HB5331 - 3 - LRB096 18929 KTG 34317 b Medicare Ambulance Fee Schedule rate for the designated Medicare Locality, except that any mileage rate previously approved by the Illinois Department that exceeds 80% of the Medicare Ambulance Fee Schedule rate for the designated Medicare Locality shall remain in force.
Bureau of the Census Metropolitan Statistical Area (MSA);
For mileage associated with non-emergency base rates, payment shall be at a rate that is the lesser of the provider's charge, as reflected on the provider's claim form, or 60% of the Medicare Ambulance Fee Schedule rate for the designated Medicare Locality, except that any mileage rate previously approved by the Illinois Department that exceeds 60% of the Medicare Ambulance Fee Schedule rate for the designated Medicare Locality shall remain in force.
or any county located within a U.S.
(4) For advanced life support services and specialty care transport services provided during transport of a patient between hospitals in an emergency situation for a higher level of care, payments shall be made at the emergency base rate and all other such services shall be paid at the non-emergency base rate.
Bureau of the Census Metropolitan Statistical Area but having a population of 60,000 or less.
(c) The requirement for payment of ground ambulance services by the Illinois Department is deemed to be met if the services are provided pursuant to a request for evaluation, treatment, and transport for an individual with a condition of such a nature that a prudent layperson would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to life or health.
(b) It is the intent of the General Assembly to provide for the payment for ground ambulance services as part of the State Medicaid plan and to provide adequate payment for ground ambulance services under the State Medicaid plan so as to ensure adequate access to ground ambulance services for both recipients of aid under this Article and for the general population of Illinois.
This standard is HB5331 - 4 - LRB096 18929 KTG 34317 b deemed to be met if there is an emergency medical condition manifesting itself by acute symptoms of sufficient severity, including but not limited to severe pain, such that a prudent layperson who possesses an average of knowledge of medicine and health can reasonably expect the absence of immediate medical attention could result in placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy, cause serious impairment to bodily functions, or cause serious dysfunction of any bodily organ or part.
Unless otherwise indicated in this Section, the practices of the Department concerning payments for ground ambulance services provided to recipients of aid under this Article shall be consistent with the payment principles of Medicare, including the statutes, regulations, policies, procedures, principles, definitions, guidelines, coding systems, including the ambulance condition coding system, and manuals used by the Centers for Medicare and Medicaid Services and the Medicare Part B Carrier or the Medicare Administrative Contractor for the State of Illinois to determine the payment system to ground ambulance services providers under Title XVIII of the Social Security Act.
(d) The Illinois Department shall update the Medicaid ambulance fee schedule rates annually on July 1 to be in compliance with the Medicare ambulance fee schedule rates in effect at the time of the update.
(c) For ground ambulance services provided to a recipient HB5331 Engrossed - 3 - LRB096 18929 KTG 34317 b of aid under this Article on or after July 1, 2010, the Department shall provide payment to ground ambulance services providers for base charges and mileage charges based upon the lesser of the provider's charge, as reflected on the provider's claim form, or the Illinois Medicaid Ambulance Fee Schedule payment rates calculated in accordance with this Section.
Effective July 1, 2010, the Illinois Medicaid Ambulance Fee Schedule shall be established and shall include only the ground ambulance services payment rates outlined in the Medicare Ambulance Fee Schedule as promulgated by the Centers for Medicare and Medicaid Services in effect as of July 1, 2010 and adjusted for the 4 Medicare Localities in Illinois, with an adjustment of 100% of the Medicare Ambulance Fee Schedule payment rates, by Medicare Locality, for both base rates and mileage for rural counties, and an adjustment of 80% of the Medicare Ambulance Fee Schedule payment rates, by Medicare Locality, for both base rates and mileage for all other counties.
The transition from the current payment system to the Illinois Medicaid Ambulance Fee Schedule shall be by a 2-year phase-in as follows:
(1) Effective for dates of service from July 1, 2010 through June 30, 2011, for each individual base rate and mileage rate, the payment rate for ground ambulance services shall be based on 50% of the Medicaid payment rate in effect as of January 1, 2010 and 50% of the Illinois Medicaid Ambulance Fee Schedule amount in effect on July 1, HB5331 Engrossed - 4 - LRB096 18929 KTG 34317 b 2010 for the designated Medicare Locality, except that any payment rate that was previously approved by the Department that exceeds this amount shall remain in force.
(2) Effective for dates of service on or after July 1, 2011, for each individual base rate and mileage rate, the payment rate for ground ambulance services shall be based on 100% of the Illinois Medicaid Ambulance Fee Schedule amount in effect on July 1, 2011 for the designated Medicare Locality, except that any payment rate that was previously approved by the Department that exceeds this amount shall remain in force.
Effective for dates of service on or after July 1, 2011, the Department shall update the Illinois Medicaid Ambulance Fee Schedule payment rates so that they comply with the Medicare Ambulance Fee Schedule payment rates for ground ambulance services in effect at the time of the update, in the manner prescribed in the second paragraph of this subsection (c).
(d) Payment for mileage shall be per loaded mile with no loaded mileage included in the base rate.
If a natural disaster, weather, road repairs, traffic congestion, or other conditions necessitate a route other than the most direct route, payment shall be based upon the actual distance traveled.
Notwithstanding the payment principles in subsection (b) of this Section, the Department shall develop the Illinois Medicaid Ambulance Fee Schedule using the ground mileage payment rate, as defined by the Centers for Medicare and HB5331 Engrossed - 5 - LRB096 18929 KTG 34317 b Medicaid Services, and no other mileage rates which act as enhancements to the ground mileage rate, whether permanent or temporary, shall be recognized by the Department.
When a ground ambulance services provider provides transport pursuant to an emergency call as defined by the Centers for Medicare and Medicaid Services, no reduction in the mileage payment shall be made based upon the fact that a closer facility may have been available, so long as the ground ambulance services provider provided transport to the recipient's facility of choice within the scope of the Illinois Emergency Medical Services (EMS) Systems Act and associated rules and the policies and procedures of the EMS System of which the provider is a member.
(e) The Department shall provide payment for emergency ground ambulance services provided to a recipient of aid under this Article according to the requirements provided in subsection (b) of this Section when those services are provided pursuant to a request made through a 9-1-1 or equivalent emergency telephone number for evaluation, treatment, and transport from or on behalf of an individual with a condition of such a nature that a prudent layperson would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to life or health.
This standard is deemed to be met if there is an emergency medical condition manifesting itself by acute symptoms of sufficient severity, including but not limited to severe pain, such that a prudent layperson who possesses an average knowledge of medicine and HB5331 Engrossed - 6 - LRB096 18929 KTG 34317 b health can reasonably expect that the absence of immediate medical attention could result in placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy, cause serious impairment to bodily functions, or cause serious dysfunction of any bodily organ or part.
(f) For ground ambulance services provided to a recipient enrolled in a Medicaid managed care plan by a ground ambulance services provider that is not a contracted provider to the Medicaid managed care plan in question, the amount of the payment for ground ambulance services by the Medicaid managed care plan shall be the lesser of the provider's charge, as reflected on the provider's claim form, or the Illinois Medicaid Ambulance Fee Schedule payment rates calculated in accordance with this Section.
(g) Nothing in this Section prohibits the Department from setting payment rates for out-of-State ground ambulance services providers by administrative rule.
(h) Effective for dates of service on or after July 1, 2010, payments for stretcher van services provided by ground ambulance services providers shall be as follows:
(1) For each individual base rate, the amount of the payment shall be the lesser of the provider's charge, as reflected on the provider's claim form, or 80% of the Illinois Medicaid Ambulance Fee Schedule payment rate for the basic life support non-emergency base rate.
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HB5331 Engrossed - 7 - LRB096 18929 KTG 34317 b (2) For each loaded mile, the amount of the payment shall be the lesser of the provider's charge, as reflected on the provider's claim form, or 80% of the Illinois Medicaid Ambulance Fee Schedule payment rate for mileage.
(i) All payments under subsections (a) through (h) of this Section are subject to the availability of appropriations for those purposes.
For ambulance services provided to a recipient of aid under this Article on or after January 1, 1993, the Illinois Department shall reimburse ambulance service providers at rates calculated in accordance with this Section.
To ensure uniformity between the payment principles of Medicare and Medicaid, the Illinois HB5331 - 5 - LRB096 18929 KTG 34317 b Department shall follow, to the extent necessary and practicable and subject to the availability of funds appropriated by the General Assembly for this purpose, the statutes, laws, regulations, policies, procedures, principles, definitions, guidelines, and manuals used to determine the amounts paid to ambulance service providers under Title XVIII of the Social Security Act (Medicare).
To ensure uniformity between the payment principles of Medicare and Medicaid, the Illinois Department shall follow, to the extent necessary and practicable and subject to the availability of funds appropriated by the General Assembly for this purpose, HB5331 Engrossed - 8 - LRB096 18929 KTG 34317 b the statutes, laws, regulations, policies, procedures, principles, definitions, guidelines, and manuals used to determine the amounts paid to ambulance service providers under Title XVIII of the Social Security Act (Medicare).
(e) For purposes of this Section, "ambulance services" includes medical transportation services provided by means of a licensed ambulance and does not include transportation services provided by a an ambulance, medi-car, service car, or taxi, or other form of transportation not defined as an ambulance service by Medicare or the Emergency Medical Services (EMS) Systems Act.
For purposes of this Section, "ambulance services" includes medical transportation services provided by means of an ambulance, medi-car, service car, or taxi.
Beginning with services rendered on or after July 1, 2008, all providers of non-emergency medi-car and service car HB5331 - 6 - LRB096 18929 KTG 34317 b transportation must certify that the driver and employee attendant, as applicable, have completed a safety program approved by the Department to protect both the patient and the driver, prior to transporting a patient.
(j) Beginning with services rendered on or after July 1, 2008, all providers of non-emergency medi-car and service car transportation must certify that the driver and employee attendant, as applicable, have completed a safety program approved by the Department to protect both the patient and the driver, prior to transporting a patient.
Failure to produce documentation of such training shall result in recovery of any payments made by the Department for services rendered by a non-certified driver or employee attendant.
Failure to produce documentation of such HB5331 Engrossed - 9 - LRB096 18929 KTG 34317 b training shall result in recovery of any payments made by the Department for services rendered by a non-certified driver or employee attendant.
8-28-07.)
8-28-07.) (305 ILCS 5/5-5) (from Ch.
23, par.
5-5) (Text of Section before amendment by P.A.
96-806) Sec.
5-5.
Medical services.
The Illinois Department, by rule, shall determine the quantity and quality of and the rate of reimbursement for the medical assistance for which payment will be authorized, and the medical services to be provided, which may include all or part of the following:
(1) inpatient hospital services;
(2) outpatient hospital services;
(3) other laboratory and X-ray services;
(4) skilled nursing home services;
(5) physicians' services whether furnished in the office, the patient's home, a hospital, a skilled nursing home, HB5331 Engrossed - 10 - LRB096 18929 KTG 34317 b or elsewhere;
(6) medical care, or any other type of remedial care furnished by licensed practitioners;
(7) home health care services;
(8) private duty nursing service;
(9) clinic services;
(10) dental services, including prevention and treatment of periodontal disease and dental caries disease for pregnant women, provided by an individual licensed to practice dentistry or dental surgery;
for purposes of this item (10), "dental services" means diagnostic, preventive, or corrective procedures provided by or under the supervision of a dentist in the practice of his or her profession;
(11) physical therapy and related services;
(12) prescribed drugs, dentures, and prosthetic devices;
and eyeglasses prescribed by a physician skilled in the diseases of the eye, or by an optometrist, whichever the person may select;
(13) other diagnostic, screening, preventive, and rehabilitative services;
(14) transportation and such other expenses as may be necessary, provided that payment for ground ambulance services shall be as provided in Section 5-4.2;
(15) medical treatment of sexual assault survivors, as defined in Section 1a of the Sexual Assault Survivors Emergency Treatment Act, for injuries sustained as a result of the sexual assault, including examinations and laboratory tests to discover evidence which may be used in criminal proceedings arising from the sexual assault;
(16) the diagnosis and treatment of sickle cell anemia;
and (17) any other medical care, and any other type of remedial care recognized under the laws of this State, but not HB5331 Engrossed - 11 - LRB096 18929 KTG 34317 b including abortions, or induced miscarriages or premature births, unless, in the opinion of a physician, such procedures are necessary for the preservation of the life of the woman seeking such treatment, or except an induced premature birth intended to produce a live viable child and such procedure is necessary for the health of the mother or her unborn child.
The Illinois Department, by rule, shall prohibit any physician from providing medical assistance to anyone eligible therefor under this Code where such physician has been found guilty of performing an abortion procedure in a wilful and wanton manner upon a woman who was not pregnant at the time such abortion procedure was performed.
The term "any other type of remedial care" shall include nursing care and nursing home service for persons who rely on treatment by spiritual means alone through prayer for healing.
Notwithstanding any other provision of this Section, a 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 Code, the Illinois Department may not require, as a condition of payment for any laboratory test authorized under this Article, that a physician's handwritten signature appear on the laboratory HB5331 Engrossed - 12 - LRB096 18929 KTG 34317 b test order form.
The Illinois Department may, however, impose other appropriate requirements regarding laboratory test order documentation.
The Department of Healthcare and Family Services shall provide the following services to persons eligible for assistance under this Article who are participating in education, training or employment programs operated by the Department of Human Services as successor to the Department of Public Aid:
(1) dental services provided by or under the supervision of a dentist;
and (2) eyeglasses prescribed by a physician skilled in the diseases of the eye, or by an optometrist, whichever the person may select.
The Illinois Department, by rule, may distinguish and classify the medical services to be provided only in accordance with the classes of persons designated in Section 5-2.
The Department of Healthcare and Family Services must provide coverage and reimbursement for amino acid-based elemental formulas, regardless of delivery method, for the diagnosis and treatment of (i) eosinophilic disorders and (ii) short bowel syndrome when the prescribing physician has issued a written order stating that the amino acid-based elemental formula is medically necessary.
The Illinois Department shall authorize the provision of, and shall authorize payment for, screening by low-dose HB5331 Engrossed - 13 - LRB096 18929 KTG 34317 b mammography for the presence of occult breast cancer for women 35 years of age or older who are eligible for medical assistance under this Article, as follows:
(A) A baseline mammogram for women 35 to 39 years of age.
(B) An annual mammogram for women 40 years of age or older.
(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, positive genetic testing, or other risk factors.
(D) A comprehensive ultrasound screening 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.
All screenings shall include a physical breast exam, instruction on self-examination and information regarding the frequency of self-examination and its value as a preventative tool.
For purposes of this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and image receptor, with an average radiation exposure delivery of less than one rad per breast for 2 views of an average size breast.
The term also HB5331 Engrossed - 14 - LRB096 18929 KTG 34317 b includes digital mammography.
On and after July 1, 2008, screening and diagnostic mammography shall be reimbursed at the same rate as the Medicare program's rates, including the increased reimbursement for digital mammography.
The Department shall convene an expert panel including representatives of hospitals, free-standing mammography facilities, and doctors, including radiologists, to establish quality standards.
Based on these quality standards, the Department shall provide for bonus payments to mammography facilities meeting the standards for screening and diagnosis.
The bonus payments shall be at least 15% higher than the Medicare rates for mammography.
Subject to federal approval, the Department shall establish a rate methodology for mammography at federally qualified health centers and other encounter-rate clinics.
These clinics or centers may also collaborate with other hospital-based mammography facilities.
The Department shall establish a methodology to remind women who are age-appropriate for screening mammography, but who have not received a mammogram within the previous 18 months, of the importance and benefit of screening mammography.
The Department shall establish a performance goal for primary care providers with respect to their female patients over age 40 receiving an annual mammogram.
This performance goal shall be used to provide additional reimbursement in the HB5331 Engrossed - 15 - LRB096 18929 KTG 34317 b form of a quality performance bonus to primary care providers who meet that goal.
The Department shall devise a means of case-managing or patient navigation for beneficiaries diagnosed with breast cancer.
This program shall initially operate as a pilot program in areas of the State with the highest incidence of mortality related to breast cancer.
At least one pilot program site shall be in the metropolitan Chicago area and at least one site shall be outside the metropolitan Chicago area.
An evaluation of the pilot program shall be carried out measuring health outcomes and cost of care for those served by the pilot program compared to similarly situated patients who are not served by the pilot program.
Any medical or health care provider shall immediately recommend, to any pregnant woman who is being provided prenatal services and is suspected of drug abuse or is addicted as defined in the Alcoholism and Other Drug Abuse and Dependency Act, referral to a local substance abuse treatment provider licensed by the Department of Human Services or to a licensed hospital which provides substance abuse treatment services.
The Department of Healthcare and Family Services shall assure coverage for the cost of treatment of the drug abuse or addiction for pregnant recipients in accordance with the Illinois Medicaid Program in conjunction with the Department of Human Services.
All medical providers providing medical assistance to HB5331 Engrossed - 16 - LRB096 18929 KTG 34317 b pregnant women under this Code shall receive information from the Department on the availability of services under the Drug Free Families with a Future or any comparable program providing case management services for addicted women, including information on appropriate referrals for other social services that may be needed by addicted women in addition to treatment for addiction.
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 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.
Neither the Department of Healthcare and Family Services nor the Department of Human Services shall sanction the recipient solely on the basis of her substance abuse.
The Illinois Department shall establish such regulations governing the dispensing of health services under this Article as it shall deem appropriate.
The Department should seek the advice of formal professional advisory committees appointed by the Director of the Illinois Department for the purpose of providing regular advice on policy and administrative matters, information dissemination and educational activities for medical and health care providers, and consistency in HB5331 Engrossed - 17 - LRB096 18929 KTG 34317 b procedures to the Illinois Department.
The Illinois Department may develop and contract with Partnerships of medical providers to arrange medical services for persons eligible under Section 5-2 of this Code.
Implementation of this Section may be by demonstration projects in certain geographic areas.
The Partnership shall be represented by a sponsor organization.
The Department, by rule, shall develop qualifications for sponsors of Partnerships.
Nothing in this Section shall be construed to require that the sponsor organization be a medical organization.
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.
Physician services must include prenatal and obstetrical care.
The Illinois Department shall reimburse medical services delivered by Partnership providers to clients in target areas according to provisions of this Article and the Illinois Health Finance Reform Act, except that:
(1) Physicians participating in a Partnership and providing certain services, which shall be determined by the Illinois Department, to persons in areas covered by the Partnership may receive an additional surcharge for such services.
(2) The Department may elect to consider and negotiate HB5331 Engrossed - 18 - LRB096 18929 KTG 34317 b financial incentives to encourage the development of Partnerships and the efficient delivery of medical care.
(3) Persons receiving medical services through Partnerships may receive medical and case management services above the level usually offered through the medical assistance program.
Medical providers shall be required to meet certain qualifications to participate in Partnerships to ensure the delivery of high quality medical services.
These qualifications shall be determined by rule of the Illinois Department and may be higher than qualifications for participation in the medical assistance program.
Partnership sponsors may prescribe reasonable additional qualifications for participation by medical providers, only with the prior written approval of the Illinois Department.
Nothing in this Section shall limit the free choice of practitioners, hospitals, and other providers of medical services by clients.
In order to ensure patient freedom of choice, the Illinois Department shall immediately promulgate all rules and take all other necessary actions so that provided services may be accessed from therapeutically certified optometrists to the full extent of the Illinois Optometric Practice Act of 1987 without discriminating between service providers.
The Department shall apply for a waiver from the United States Health Care Financing Administration to allow for the HB5331 Engrossed - 19 - LRB096 18929 KTG 34317 b implementation of Partnerships under this Section.
The Illinois Department shall require health care providers to maintain records that document the medical care and services provided to recipients of Medical Assistance under this Article.
The Illinois Department shall 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.
All dispensers of medical services shall be required to maintain and retain business and professional records sufficient to fully and accurately document the nature, scope, details and receipt of the health care provided to persons eligible for medical assistance under this Code, in accordance with regulations promulgated by the Illinois Department.
The rules and regulations shall require that proof of the receipt of prescription drugs, dentures, prosthetic devices and eyeglasses by eligible persons under this Section accompany each claim for reimbursement submitted by the dispenser of such medical services.
No such claims for reimbursement shall be approved for payment by the Illinois Department without such proof of receipt, unless the Illinois Department shall have put into effect and shall be operating a system of post-payment audit and review which shall, on a sampling basis, be deemed adequate by the Illinois Department to assure that such drugs, dentures, prosthetic devices and eyeglasses for which payment HB5331 Engrossed - 20 - LRB096 18929 KTG 34317 b is being made are actually being received by eligible recipients.
Within 90 days after the effective date of this amendatory Act of 1984, the Illinois Department shall establish a current list of acquisition costs for all prosthetic devices and any other items recognized as medical 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.
The rules and regulations of the Illinois Department shall require that a written statement including the required opinion of a physician shall accompany any claim for reimbursement for abortions, or induced miscarriages or premature births.
This statement shall indicate what procedures were used in providing such medical services.
The Illinois Department shall require all dispensers of medical services, other than an individual practitioner or group of practitioners, desiring to participate in the Medical Assistance program established under this Article to disclose all financial, beneficial, ownership, equity, surety or other interests in any and all firms, corporations, partnerships, associations, business enterprises, joint ventures, agencies, institutions or other legal entities providing any form of health care services in this State under this Article.
The Illinois Department may require that all dispensers of medical services desiring to participate in the medical HB5331 Engrossed - 21 - LRB096 18929 KTG 34317 b assistance program established under this Article disclose, under such terms and conditions as the Illinois Department may by rule establish, all inquiries from clients and attorneys regarding medical bills paid by the Illinois Department, which inquiries could indicate potential existence of claims or liens for the Illinois Department.
Enrollment of a vendor that provides non-emergency medical transportation, defined by the Department by rule, shall be conditional for 180 days.
During that time, the Department of Healthcare and Family Services may terminate the vendor's eligibility to participate in the medical assistance program without cause.
That termination of eligibility is not subject to the Department's hearing process.
The Illinois Department shall establish policies, procedures, standards and criteria by rule for the acquisition, repair and replacement of orthotic and prosthetic devices and durable medical equipment.
Such rules shall provide, but not be limited to, the following services:
(1) immediate repair or replacement of such devices by recipients without medical authorization;
and (2) rental, lease, purchase or lease-purchase of durable medical equipment in a cost-effective manner, taking into consideration the recipient's medical prognosis, the extent of the recipient's needs, and the requirements and costs for maintaining such equipment.
Such rules shall enable a recipient to temporarily acquire and use alternative or substitute devices or equipment HB5331 Engrossed - 22 - LRB096 18929 KTG 34317 b pending repairs or replacements of any device or equipment previously authorized for such recipient by the Department.
The Department shall execute, relative to the nursing home prescreening project, written inter-agency agreements with the Department of Human Services and the Department on Aging, to effect the following:
(i) intake procedures and common eligibility criteria for those persons who are receiving non-institutional services;
and (ii) the establishment and development of non-institutional services in areas of the State where they are not currently available or are undeveloped.
The Illinois Department shall develop and operate, in cooperation with other State Departments and agencies and in compliance with applicable federal laws and regulations, appropriate and effective systems of health care evaluation and programs for monitoring of utilization of health care services and facilities, as it affects persons eligible for medical assistance under this Code.
The Illinois Department shall report annually to the General Assembly, no later than the second Friday in April of 1979 and each year thereafter, in regard to:
(a) actual statistics and trends in utilization of medical services by public aid recipients;
(b) actual statistics and trends in the provision of the various medical services by medical vendors;
(c) current rate structures and proposed changes in those rate structures for the various medical vendors;
and HB5331 Engrossed - 23 - LRB096 18929 KTG 34317 b (d) efforts at utilization review and control by the Illinois Department.
The period covered by each report shall be the 3 years ending on the June 30 prior to the report.
The report shall include suggested legislation for consideration by the General Assembly.
The filing of one copy of the report with the Speaker, one copy with the Minority Leader and one copy with 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.
Rulemaking authority to implement Public Act 95-1045 this amendatory Act of the 95th General Assembly, if any, is conditioned on the rules being adopted in accordance with all provisions of the Illinois Administrative Procedure Act and all rules and procedures of the Joint Committee on Administrative Rules;
any purported rule not so adopted, for whatever reason, is unauthorized.
(Source:
P.A.
95-331, eff.
8-21-07;
95-520, eff.
8-28-07;
95-1045, eff.
3-27-09;
96-156, eff.
1-1-10;
revised 11-4-09.) (Text of Section after amendment by P.A.
96-806) HB5331 Engrossed - 24 - LRB096 18929 KTG 34317 b Sec.
5-5.
Medical services.
The Illinois Department, by rule, shall determine the quantity and quality of and the rate of reimbursement for the medical assistance for which payment will be authorized, and the medical services to be provided, which may include all or part of the following:
(1) inpatient hospital services;
(2) outpatient hospital services;
(3) other laboratory and X-ray services;
(4) skilled nursing home services;
(5) physicians' services whether furnished in the office, the patient's home, a hospital, a skilled nursing home, or elsewhere;
(6) medical care, or any other type of remedial care furnished by licensed practitioners;
(7) home health care services;
(8) private duty nursing service;
(9) clinic services;
(10) dental services, including prevention and treatment of periodontal disease and dental caries disease for pregnant women, provided by an individual licensed to practice dentistry or dental surgery;
for purposes of this item (10), "dental services" means diagnostic, preventive, or corrective procedures provided by or under the supervision of a dentist in the practice of his or her profession;
(11) physical therapy and related services;
(12) prescribed drugs, dentures, and prosthetic devices;
and eyeglasses prescribed by a physician skilled in the diseases of the eye, or by an optometrist, whichever the person may select;
(13) other diagnostic, screening, preventive, and rehabilitative services;
(14) transportation and such other expenses as may be necessary , provided that payment for ground ambulance services shall be as HB5331 Engrossed - 25 - LRB096 18929 KTG 34317 b provided in Section 5-4.2;
(15) medical treatment of sexual assault survivors, as defined in Section 1a of the Sexual Assault Survivors Emergency Treatment Act, for injuries sustained as a result of the sexual assault, including examinations and laboratory tests to discover evidence which may be used in criminal proceedings arising from the sexual assault;
(16) the diagnosis and treatment of sickle cell anemia;
and (17) any other medical care, and any other type of remedial care recognized under the laws of this State, but not including abortions, or induced miscarriages or premature births, unless, in the opinion of a physician, such procedures are necessary for the preservation of the life of the woman seeking such treatment, or except an induced premature birth intended to produce a live viable child and such procedure is necessary for the health of the mother or her unborn child.
The Illinois Department, by rule, shall prohibit any physician from providing medical assistance to anyone eligible therefor under this Code where such physician has been found guilty of performing an abortion procedure in a wilful and wanton manner upon a woman who was not pregnant at the time such abortion procedure was performed.
The term "any other type of remedial care" shall include nursing care and nursing home service for persons who rely on treatment by spiritual means alone through prayer for healing.
Notwithstanding any other provision of this Section, a comprehensive tobacco use cessation program that includes HB5331 Engrossed - 26 - LRB096 18929 KTG 34317 b 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 Code, the Illinois Department may not require, as a condition of payment for any laboratory test authorized under this Article, that a physician's handwritten signature appear on the laboratory test order form.
The Illinois Department may, however, impose other appropriate requirements regarding laboratory test order documentation.
The Department of Healthcare and Family Services shall provide the following services to persons eligible for assistance under this Article who are participating in education, training or employment programs operated by the Department of Human Services as successor to the Department of Public Aid:
(1) dental services provided by or under the supervision of a dentist;
and (2) eyeglasses prescribed by a physician skilled in the diseases of the eye, or by an optometrist, whichever the person may select.
The Illinois Department, by rule, may distinguish and classify the medical services to be provided only in accordance with the classes of persons designated in Section 5-2.
HB5331 Engrossed - 27 - LRB096 18929 KTG 34317 b The Department of Healthcare and Family Services must provide coverage and reimbursement for amino acid-based elemental formulas, regardless of delivery method, for the diagnosis and treatment of (i) eosinophilic disorders and (ii) short bowel syndrome when the prescribing physician has issued a written order stating that the amino acid-based elemental formula is medically necessary.
The Illinois Department shall authorize the provision of, and shall authorize payment for, screening by low-dose mammography for the presence of occult breast cancer for women 35 years of age or older who are eligible for medical assistance under this Article, as follows:
(A) A baseline mammogram for women 35 to 39 years of age.
(B) An annual mammogram for women 40 years of age or older.
(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, positive genetic testing, or other risk factors.
(D) A comprehensive ultrasound screening 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.
HB5331 Engrossed - 28 - LRB096 18929 KTG 34317 b All screenings shall include a physical breast exam, instruction on self-examination and information regarding the frequency of self-examination and its value as a preventative tool.
For purposes of this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and image receptor, with an average radiation exposure delivery of less than one rad per breast for 2 views of an average size breast.
The term also includes digital mammography.
On and after July 1, 2008, screening and diagnostic mammography shall be reimbursed at the same rate as the Medicare program's rates, including the increased reimbursement for digital mammography.
The Department shall convene an expert panel including representatives of hospitals, free-standing mammography facilities, and doctors, including radiologists, to establish quality standards.
Based on these quality standards, the Department shall provide for bonus payments to mammography facilities meeting the standards for screening and diagnosis.
The bonus payments shall be at least 15% higher than the Medicare rates for mammography.
Subject to federal approval, the Department shall establish a rate methodology for mammography at federally qualified health centers and other encounter-rate clinics.
These clinics or centers may also collaborate with other HB5331 Engrossed - 29 - LRB096 18929 KTG 34317 b hospital-based mammography facilities.
The Department shall establish a methodology to remind women who are age-appropriate for screening mammography, but who have not received a mammogram within the previous 18 months, of the importance and benefit of screening mammography.
The Department shall establish a performance goal for primary care providers with respect to their female patients over age 40 receiving an annual mammogram.
This performance goal shall be used to provide additional reimbursement in the form of a quality performance bonus to primary care providers who meet that goal.
The Department shall devise a means of case-managing or patient navigation for beneficiaries diagnosed with breast cancer.
This program shall initially operate as a pilot program in areas of the State with the highest incidence of mortality related to breast cancer.
At least one pilot program site shall be in the metropolitan Chicago area and at least one site shall be outside the metropolitan Chicago area.
An evaluation of the pilot program shall be carried out measuring health outcomes and cost of care for those served by the pilot program compared to similarly situated patients who are not served by the pilot program.
Any medical or health care provider shall immediately recommend, to any pregnant woman who is being provided prenatal services and is suspected of drug abuse or is addicted as defined in the Alcoholism and Other Drug Abuse and Dependency HB5331 Engrossed - 30 - LRB096 18929 KTG 34317 b Act, referral to a local substance abuse treatment provider licensed by the Department of Human Services or to a licensed hospital which provides substance abuse treatment services.
The Department of Healthcare and Family Services shall assure coverage for the cost of treatment of the drug abuse or addiction for pregnant recipients in accordance with the Illinois Medicaid Program in conjunction with the Department of Human Services.
All medical providers providing medical assistance to pregnant women under this Code shall receive information from the Department on the availability of services under the Drug Free Families with a Future or any comparable program providing case management services for addicted women, including information on appropriate referrals for other social services that may be needed by addicted women in addition to treatment for addiction.
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 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.
Neither the Department of Healthcare and Family Services nor the Department of Human Services shall sanction the HB5331 Engrossed - 31 - LRB096 18929 KTG 34317 b recipient solely on the basis of her substance abuse.
The Illinois Department shall establish such regulations governing the dispensing of health services under this Article as it shall deem appropriate.
The Department should seek the advice of formal professional advisory committees appointed by the Director of the Illinois Department for the purpose of providing regular advice on policy and administrative matters, information dissemination and educational activities for medical and health care providers, and consistency in procedures to the Illinois Department.
Notwithstanding any other provision of law, a health care provider under the medical assistance program may elect, in lieu of receiving direct payment for services provided under that program, to participate in the State Employees Deferred Compensation Plan adopted under Article 24 of the Illinois Pension Code.
A health care provider who elects to participate in the plan does not have a cause of action against the State for any damages allegedly suffered by the provider as a result of any delay by the State in crediting the amount of any contribution to the provider's plan account.
The Illinois Department may develop and contract with Partnerships of medical providers to arrange medical services for persons eligible under Section 5-2 of this Code.
Implementation of this Section may be by demonstration projects in certain geographic areas.
The Partnership shall be represented by a sponsor organization.
The Department, by rule, HB5331 Engrossed - 32 - LRB096 18929 KTG 34317 b shall develop qualifications for sponsors of Partnerships.
Nothing in this Section shall be construed to require that the sponsor organization be a medical organization.
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.
Physician services must include prenatal and obstetrical care.
The Illinois Department shall reimburse medical services delivered by Partnership providers to clients in target areas according to provisions of this Article and the Illinois Health Finance Reform Act, except that:
(1) Physicians participating in a Partnership and providing certain services, which shall be determined by the Illinois Department, to persons in areas covered by the Partnership may receive an additional surcharge for such services.
(2) The Department may elect to consider and negotiate financial incentives to encourage the development of Partnerships and the efficient delivery of medical care.
(3) Persons receiving medical services through Partnerships may receive medical and case management services above the level usually offered through the medical assistance program.
Medical providers shall be required to meet certain HB5331 Engrossed - 33 - LRB096 18929 KTG 34317 b qualifications to participate in Partnerships to ensure the delivery of high quality medical services.
These qualifications shall be determined by rule of the Illinois Department and may be higher than qualifications for participation in the medical assistance program.
Partnership sponsors may prescribe reasonable additional qualifications for participation by medical providers, only with the prior written approval of the Illinois Department.
Nothing in this Section shall limit the free choice of practitioners, hospitals, and other providers of medical services by clients.
In order to ensure patient freedom of choice, the Illinois Department shall immediately promulgate all rules and take all other necessary actions so that provided services may be accessed from therapeutically certified optometrists to the full extent of the Illinois Optometric Practice Act of 1987 without discriminating between service providers.
The Department shall apply for a waiver from the United States Health Care Financing Administration to allow for the implementation of Partnerships under this Section.
The Illinois Department shall require health care providers to maintain records that document the medical care and services provided to recipients of Medical Assistance under this Article.
The Illinois Department shall require health care providers to make available, when authorized by the patient, in writing, the medical records in a timely fashion to other HB5331 Engrossed - 34 - LRB096 18929 KTG 34317 b health care providers who are treating or serving persons eligible for Medical Assistance under this Article.
All dispensers of medical services shall be required to maintain and retain business and professional records sufficient to fully and accurately document the nature, scope, details and receipt of the health care provided to persons eligible for medical assistance under this Code, in accordance with regulations promulgated by the Illinois Department.
The rules and regulations shall require that proof of the receipt of prescription drugs, dentures, prosthetic devices and eyeglasses by eligible persons under this Section accompany each claim for reimbursement submitted by the dispenser of such medical services.
No such claims for reimbursement shall be approved for payment by the Illinois Department without such proof of receipt, unless the Illinois Department shall have put into effect and shall be operating a system of post-payment audit and review which shall, on a sampling basis, be deemed adequate by the Illinois Department to assure that such drugs, dentures, prosthetic devices and eyeglasses for which payment is being made are actually being received by eligible recipients.
Within 90 days after the effective date of this amendatory Act of 1984, the Illinois Department shall establish a current list of acquisition costs for all prosthetic devices and any other items recognized as medical equipment and supplies reimbursable under this Article and shall update such list on a quarterly basis, except that the acquisition costs of HB5331 Engrossed - 35 - LRB096 18929 KTG 34317 b all prescription drugs shall be updated no less frequently than every 30 days as required by Section 5-5.12.
The rules and regulations of the Illinois Department shall require that a written statement including the required opinion of a physician shall accompany any claim for reimbursement for abortions, or induced miscarriages or premature births.
This statement shall indicate what procedures were used in providing such medical services.
The Illinois Department shall require all dispensers of medical services, other than an individual practitioner or group of practitioners, desiring to participate in the Medical Assistance program established under this Article to disclose all financial, beneficial, ownership, equity, surety or other interests in any and all firms, corporations, partnerships, associations, business enterprises, joint ventures, agencies, institutions or other legal entities providing any form of health care services in this State under this Article.
The Illinois Department may require that all dispensers of medical services desiring to participate in the medical assistance program established under this Article disclose, under such terms and conditions as the Illinois Department may by rule establish, all inquiries from clients and attorneys regarding medical bills paid by the Illinois Department, which inquiries could indicate potential existence of claims or liens for the Illinois Department.
Enrollment of a vendor that provides non-emergency medical HB5331 Engrossed - 36 - LRB096 18929 KTG 34317 b transportation, defined by the Department by rule, shall be conditional for 180 days.
During that time, the Department of Healthcare and Family Services may terminate the vendor's eligibility to participate in the medical assistance program without cause.
That termination of eligibility is not subject to the Department's hearing process.
The Illinois Department shall establish policies, procedures, standards and criteria by rule for the acquisition, repair and replacement of orthotic and prosthetic devices and durable medical equipment.
Such rules shall provide, but not be limited to, the following services:
(1) immediate repair or replacement of such devices by recipients without medical authorization;
and (2) rental, lease, purchase or lease-purchase of durable medical equipment in a cost-effective manner, taking into consideration the recipient's medical prognosis, the extent of the recipient's needs, and the requirements and costs for maintaining such equipment.
Such rules shall enable a recipient to temporarily acquire and use alternative or substitute devices or equipment pending repairs or replacements of any device or equipment previously authorized for such recipient by the Department.
The Department shall execute, relative to the nursing home prescreening project, written inter-agency agreements with the Department of Human Services and the Department on Aging, to effect the following:
(i) intake procedures and common eligibility criteria for those persons who are receiving HB5331 Engrossed - 37 - LRB096 18929 KTG 34317 b non-institutional services;
and (ii) the establishment and development of non-institutional services in areas of the State where they are not currently available or are undeveloped.
The Illinois Department shall develop and operate, in cooperation with other State Departments and agencies and in compliance with applicable federal laws and regulations, appropriate and effective systems of health care evaluation and programs for monitoring of utilization of health care services and facilities, as it affects persons eligible for medical assistance under this Code.
The Illinois Department shall report annually to the General Assembly, no later than the second Friday in April of 1979 and each year thereafter, in regard to:
(a) actual statistics and trends in utilization of medical services by public aid recipients;
(b) actual statistics and trends in the provision of the various medical services by medical vendors;
(c) current rate structures and proposed changes in those rate structures for the various medical vendors;
and (d) efforts at utilization review and control by the Illinois Department.
The period covered by each report shall be the 3 years ending on the June 30 prior to the report.
The report shall include suggested legislation for consideration by the General Assembly.
The filing of one copy of the report with the Speaker, one copy with the Minority Leader and one copy with HB5331 Engrossed - 38 - LRB096 18929 KTG 34317 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.
Rulemaking authority to implement Public Act 95-1045 this amendatory Act of the 95th General Assembly, if any, is conditioned on the rules being adopted in accordance with all provisions of the Illinois Administrative Procedure Act and all rules and procedures of the Joint Committee on Administrative Rules;
any purported rule not so adopted, for whatever reason, is unauthorized.
(Source:
P.A.
95-331, eff.
8-21-07;
95-520, eff.
8-28-07;
95-1045, eff.
3-27-09;
96-156, eff.
1-1-10;
96-806, eff.
7-1-10;
revised 11-4-09.) Section 95.
No acceleration or delay.
Where this Act makes changes in a statute that is represented in this Act by text that is not yet or no longer in effect (for example, a Section represented by multiple versions), the use of that text does not accelerate or delay the taking effect of (i) the changes made by this Act or (ii) provisions derived from any other Public Act.
HB5331 Engrossed - 39 - LRB096 18929 KTG 34317 b Section 99.
Effective date.
This Act takes effect upon becoming law.
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Action History

  1. Session Sine Die

  2. Rule 19(b) / Re-referred to Rules Committee

  3. Senate Floor Amendment No. 2 Motion to Concur Referred to Rules Committee

  4. Senate Floor Amendment No. 2 Motion Filed Concur Rep. Dan Reitz

  5. Placed on Calendar Order of Concurrence Senate Amendment(s) 2

  6. Arrived in House

  7. Third Reading - Passed; 054-002-000

  8. Added as Alternate Co-Sponsor Sen. Donne E. Trotter

  9. Placed on Calendar Order of 3rd Reading May 3, 2010

  10. Senate Floor Amendment No. 2 Adopted; Sullivan

  11. Second Reading

  12. Senate Floor Amendment No. 2 Recommend Do Adopt Human Services; 009-000-000

  13. Senate Floor Amendment No. 2 Assignments Refers to Human Services

  14. Senate Floor Amendment No. 2 Referred to Assignments

  15. Senate Floor Amendment No. 2 Filed with Secretary by Sen. John M. Sullivan

  16. Placed on Calendar Order of 2nd Reading April 21, 2010

  17. Do Pass Human Services; 008-001-000

  18. Senate Committee Amendment No. 1 Tabled in Human Services; Sullivan

  19. Senate Committee Amendment No. 1 Assignments Refers to Human Services

  20. Senate Committee Amendment No. 1 Referred to Assignments

  21. Senate Committee Amendment No. 1 Filed with Secretary by Sen. John M. Sullivan

  22. Added as Alternate Chief Co-Sponsor Sen. Pamela J. Althoff

  23. Assigned to Human Services

  24. Added as Alternate Co-Sponsor Sen. Martin A. Sandoval

  25. Added as Alternate Chief Co-Sponsor Sen. David Luechtefeld

  26. Referred to Assignments

  27. First Reading

  28. Chief Senate Sponsor Sen. John M. Sullivan

  29. Placed on Calendar Order of First Reading March 15, 2010

  30. Arrive in Senate

  31. Added Co-Sponsor Rep. Eddie Lee Jackson, Sr.

  32. Added Co-Sponsor Rep. John E. Bradley

  33. Added Co-Sponsor Rep. Brandon W. Phelps

  34. Added Co-Sponsor Rep. Dan Brady

  35. Third Reading - Short Debate - Passed 100-009-001

  36. Added Co-Sponsor Rep. Patrick J. Verschoore

  37. Placed on Calendar Order of 3rd Reading - Short Debate

  38. House Floor Amendment No. 2 Adopted by Voice Vote

  39. Second Reading - Short Debate

  40. Remove Chief Co-Sponsor Rep. Jim Durkin

  41. House Floor Amendment No. 2 Recommends Be Adopted Rules Committee; 004-000-000

  42. Added Co-Sponsor Rep. Franco Coladipietro

  43. Added Chief Co-Sponsor Rep. Thomas Holbrook

  44. Chief Co-Sponsor Changed to Rep. Jim Durkin

  45. Added Chief Co-Sponsor Rep. Jim Durkin

  46. House Floor Amendment No. 2 Referred to Rules Committee

  47. House Floor Amendment No. 2 Filed with Clerk by Rep. Dan Reitz

  48. Added Chief Co-Sponsor Rep. Dennis M. Reboletti

  49. Added Co-Sponsor Rep. Randy Ramey, Jr.

  50. Placed on Calendar 2nd Reading - Short Debate

  51. Do Pass as Amended / Short Debate Human Services Committee; 005-002-000

  52. House Committee Amendment No. 1 Adopted in Human Services Committee; by Voice Vote

  53. House Committee Amendment No. 1 Filed with Clerk by Human Services Committee

  54. Assigned to Human Services Committee

  55. Referred to Rules Committee

  56. First Reading

  57. Filed with the Clerk by Rep. Dan Reitz

Sponsors

  • Dan Reitz · Cosponsor
  • Martin A. Sandoval · Cosponsor
  • Donne E. Trotter · Cosponsor

Sponsorship breakdown

Export CSV (upgrade) →

0 sponsors · 3 co-sponsors · 180 not signed on

Sponsors (0)

None.

Co-sponsors (3)

  • Dan Reitz
  • Martin A. Sandoval
  • Donne E. Trotter

Not signed on (180)

180 members have not signed on to this bill.

Show all 180 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Third Reading

Passed 54 Yea · 2 Nay · 3 Other
Party YeaNayPresentNot Voting
Unaffiliated 47200
Democrat 7002
Republican 0001
Total 54203
% of votes cast 92%3%0%5%
How each member voted (59)
Member Party Vote
Martinez — Yea
McCarter — Yea
Millner — Yea
Muñoz — Yea
Schoenberg — Yea
Silverstein — Yea
Steans — Yea
Demuzio — Yea
Jacobs — Yea
Jones, J. — Yea
Brady — Yea
Sullivan — Yea
Dillard — Yea
Forby — Yea
Hutchinson — Yea
Kotowski — Yea
Link — Yea
Luechtefeld — Yea
Maloney — Yea
Cullerton — Yea
Noland — Yea
Radogno — Yea
Raoul — Yea
Trotter — Yea
Wilhelmi — Yea
Clayborne — Yea
Cronin — Yea
Crotty — Yea
Dahl — Yea
DeLeo — Yea
Duffy — Nay
Frerichs — Yea
Garrett — Yea
Haine — Yea
Hendon — Yea
Hultgren — Yea
Pankau — Yea
Righter — Yea
Risinger — Yea
Rutherford — Yea
Sandoval — Yea
Viverito — Yea
Lauzen — Yea
Althoff — Yea
Bivins — Yea
Bomke — Yea
Bond — Yea
Burzynski — Nay
Meeks — Yea
David Koehler Democrat Yea
Don Harmon Democrat Yea
Emil Jones, III Democrat Yea
Eva-Dina Delgado Democrat Yea
Kimberly A. Lightford Democrat Not Voting
Lakesia Collins Democrat Yea
Laura M. Murphy Democrat Not Voting
Linda Holmes Democrat Yea
Mattie Hunter Democrat Yea
Dave Syverson Republican Not Voting

Official roll call →

Third Reading

Passed 100 Yea · 9 Nay · 8 Other
Party YeaNayPresentNot Voting
Democrat 10001
Unaffiliated 87906
Republican 3001
Total 100908
% of votes cast 85%8%0%7%
How each member voted (117)
Member Party Vote
Jakobsson — Yea
Jefferson — Yea
Lang — Yea
Mathias — Yea
McAuliffe — Yea
McCarthy — Yea
Mell — Yea
Reitz — Yea
Mendoza — Yea
Senger — Yea
Sente — Yea
Lyons — Yea
Thapedi — Yea
Madigan — Yea
Moffitt — Yea
Myers — Not Voting
Hannig — Yea
Harris — Yea
Nekritz — Yea
Osterman — Yea
Phelps — Yea
Watson — Yea
Soto — Not Voting
Tryon — Yea
Howard — Yea
Turner — Yea
Verschoore — Yea
Wait — Yea
Davis, Monique — Yea
Washington — Yea
Winters — Yea
Mitchell, Bill — Nay
Yarbrough — Yea
Zalewski — Yea
Hernandez — Not Voting
Cavaletto — Nay
Coladipietro — Yea
Cole — Nay
Colvin — Yea
Connelly — Nay
Cross — Yea
Cultra — Not Voting
Currie — Yea
D'Amico — Yea
Durkin — Not Voting
Eddy — Nay
Graham — Yea
Hamos — Yea
Hatcher — Yea
Holbrook — Yea
Jackson — Yea
Bradley — Yea
McGuire — Yea
Brady — Yea
Burke — Yea
Sullivan — Yea
Gordon, Careen — Yea
Mitchell, Jerry — Yea
Gordon, Jehan — Yea
Dugan — Yea
Dunkin — Yea
Farnham — Yea
Flider — Yea
Flowers — Yea
Fortner — Yea
Franks — Yea
Fritchey — Yea
Froehlich — Yea
Golar — Yea
Kosel — Yea
Osmond — Yea
Pihos — Nay
Poe — Yea
Pritchard — Yea
Ramey — Yea
Reboletti — Yea
Reis — Nay
Riley — Yea
Sacia — Yea
Saviano — Yea
Schmitz — Yea
Sommer — Yea
Leitch — Yea
Acevedo — Yea
Arroyo — Yea
Bassi — Not Voting
Beaubien — Yea
Beiser — Yea
Bellock — Nay
Berrios — Yea
Biggins — Yea
Mautino — Yea
Black — Nay
Boland — Yea
May — Yea
Bost — Yea
Brauer — Yea
Burns — Yea
McAsey — Yea
Coulson — Yea
Mulligan — Yea
Chapa LaVia — Yea
Anthony DeLuca Democrat Yea
Fred Crespo Democrat Yea
Jay Hoffman Democrat Not Voting
La Shawn K. Ford Democrat Yea
Lakesia Collins Democrat Yea
Mark L. Walker Democrat Yea
Nicholas K. Smith Democrat Yea
Patrick J. Joyce Democrat Yea
Robert "Bob" Rita Democrat Yea
Sara Feigenholtz Democrat Yea
William "Will" Davis Democrat Yea
Brad Stephens Republican Yea
Chapin Rose Republican Yea
Chris Miller Republican Yea
Jil Tracy Republican Not Voting

Official roll call →

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HB 5331 do?
Amends the Illinois Public Aid Code. Provides formulas for Medicaid reimbursement of ambulance service providers for emergency ambulance services, non-emergency ambulance services, mileage, advanced life support services, and specialty care transport services. Provides that the requirement for payment of ground ambulance services by the Illinois Department of Healthcare and Family Services is met if the services are provided pursuant to a request for evaluation, treatment, and transport for an individual with a condition of such a nature that a prudent layperson would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to life or health. Requires the Department to annually update the ambulance fee schedule rates on July 1 of each year. Makes other changes.
Who sponsors HB 5331?
HB 5331 is sponsored by Dan Reitz, Martin A. Sandoval, and Donne E. Trotter.
What is the current status of HB 5331?
This bill died with 96th Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HB 5331?
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