Rep. Gregory Harris

Filed: 5/21/2020

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1 AMENDMENT TO SENATE BILL 1864

2 AMENDMENT NO. ______. Amend Senate Bill 1864 by replacing

3 everything after the enacting clause with the following:

4 "Article 5. Health Care Affordability Act

5 Section 5-1. Short title. This Article may be cited as the

6 Health Care Affordability Act. References in this Article to

7 "this Act" mean this Article.

8 Section 5-5. Findings. The General Assembly finds that:

9 (1) The State is committed to improving the health and

10 well-being of Illinois residents and families.

11 (2) Illinois has over 835,000 uninsured residents,

12 with a total uninsured rate of 7.9%.

13 (3) 774,500 of Illinois' uninsured residents are below

14 400% of the federal poverty level, with higher uninsured

15 rates of more than 13% below 250% of the federal poverty

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1 level and an uninsured rate of 8.3% below 400% of the

2 federal poverty level.

3 (4) The cost of health insurance premiums remains a

4 barrier to obtaining health insurance coverage for many

5 Illinois residents and families.

6 (5) Many Illinois residents and families who have

7 health insurance cannot afford to use it due to high

8 deductibles and cost sharing.

9 (6) Improving health insurance affordability is key to

10 increasing health insurance coverage and access.

11 (7) Despite progress made under the Patient Protection

12 and Affordable Care Act, health insurance is still not

13 affordable enough for many Illinois residents and

14 families.

15 (8) Illinois has a lower uninsured rate than the

16 national average of 10.2%, but a higher uninsured rate

17 compared to states that have state-directed policies to

18 improve affordability, including Massachusetts with an

19 uninsured rate of 3.2%.

20 (9) Illinois has an opportunity to create a healthy

21 Illinois where health insurance coverage is more

22 affordable and accessible for all Illinois residents,

23 families, and small businesses.

24 Section 5-10. Feasibility study.

25 (a) The Department of Healthcare and Family Services, in

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1 consultation with the Department of Insurance, shall oversee a

2 feasibility study to explore options to make health insurance

3 more affordable for low-income and middle-income residents.

4 The study shall include policies targeted at increasing health

5 care affordability and access, including policies being

6 discussed in other states and nationally. The study shall

7 follow the best practices of other states and include an

8 Illinois-specific actuarial and economic analysis of

9 demographic and market dynamics.

10 (b) The study shall produce cost estimates for the policies

11 studied under subsection (a) along with the impact of the

12 policies on health insurance affordability and access and the

13 uninsured rates for low-income and middle-income residents,

14 with break-out data by geography, race, ethnicity, and income

15 level. The study shall evaluate how multiple policies

16 implemented together affect costs and outcomes and how policies

17 could be structured to leverage federal matching funds and

18 federal pass-through awards.

19 (c) The Department of Healthcare and Family Services, in

20 consultation with the Department of Insurance, shall develop

21 and submit no later than February 28, 2021 a report to the

22 General Assembly and the Governor concerning the design, costs,

23 benefits, and implementation of State options to increase

24 access to affordable health care coverage that leverage

25 existing State infrastructure.

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1 Article 10. Kidney Disease Prevention and Education Task Force

2 Act

3 Section 10-1. Short title. This Article may be cited as the

4 Kidney Disease Prevention and Education Task Force Act.

5 References in this Article to "this Act" mean this Article.

6 Section 10-5. Findings. The General Assembly finds that:

7 (1) Chronic kidney disease is the 9th-leading cause of

8 death in the United States. An estimated 31 million people

9 in the United States have chronic kidney disease and over

10 1.12 million people in the State of Illinois are living

11 with the disease. Early chronic kidney disease has no signs

12 or symptoms and, without early detection, can progress to

13 kidney failure.

14 (2) If a person has high blood pressure, heart disease,

15 diabetes, or a family history of kidney failure, the risk

16 of kidney disease is greater. In Illinois, 13% of all

17 adults have diabetes, and 32% have high blood pressure. The

18 prevalence of diabetes, heart disease, and hypertension is

19 higher for African Americans, who develop kidney failure at

20 a rate of nearly 4 to 1 compared to Caucasians, while

21 Hispanics develop kidney failure at a rate of 2 to 1.

22 Almost half of the people waiting for a kidney in Illinois

23 identify as African American, but, in 2017, less than 10%

24 of them received a kidney.

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1 (3) Although dialysis is a life-extending treatment,

2 the best and most cost-effective treatment for kidney

3 failure is a kidney transplant. Currently, the wait in

4 Illinois for a deceased donor kidney is 5-7 years, and 13

5 people die while waiting every day.

6 (4) If chronic kidney disease is detected early and

7 managed appropriately, the individual can receive

8 treatment sooner to help protect the kidneys, the

9 deterioration in kidney function can be slowed or even

10 stopped, and the risk of associated cardiovascular

11 complications and other complications can be reduced.

12 (5) In light of the COVID-19 pandemic and the increased

13 risk of infection to patients with preexisting conditions,

14 it is imperative to provide those with kidney disease with

15 support.

16 Section 10-10. Kidney Disease Prevention and Education

17 Task Force.

18 (a) There is hereby established the Kidney Disease

19 Prevention and Education Task Force to work directly with

20 educational institutions to create health education programs

21 to increase awareness of and to examine chronic kidney disease,

22 transplantations, living and deceased kidney donation, and the

23 existing disparity in the rates of those afflicted between

24 Caucasians and minorities.

25 (b) The Task Force shall develop a sustainable plan to

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1 raise awareness about early detection, promote health equity,

2 and reduce the burden of kidney disease throughout the State,

3 which shall include an ongoing campaign that includes health

4 education workshops and seminars, relevant research, and

5 preventive screenings and that promotes social media campaigns

6 and TV and radio commercials.

7 (c) Membership of the Task Force shall be as follows:

8 (1) one member of the Senate, appointed by the Senate

9 President, who shall serve as Co-Chair;

10 (2) one member of the House of Representatives,

11 appointed by the Speaker of the House, who shall serve as

12 Co-Chair;

13 (3) one member of the House of Representatives,

14 appointed by the Minority Leader of the House;

15 (4) one member of the Senate, appointed by the Senate

16 Minority Leader;

17 (5) one member representing the Department of Public

18 Health, appointed by the Governor;

19 (6) one member representing the Department of

20 Healthcare and Family Services, appointed by the Governor;

21 (7) one member representing a medical center in a

22 county with a population of more 3 million residents,

23 appointed by the Co-Chairs;

24 (8) one member representing a physician's association

25 in a county with a population of more than 3 million

26 residents, appointed by the Co-Chairs;

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1 (9) one member representing a not-for-profit organ

2 procurement organization, appointed by the Co-Chairs;

3 (10) one member representing a national nonprofit

4 research kidney organization in the State of Illinois,

5 appointed by the Co-Chairs; and

6 (11) the Secretary of State or his or her designee.

7 (d) Members of the Task Force shall serve without

8 compensation.

9 (e) The Department of Public Health shall provide

10 administrative support to the Task Force.

11 (f) The Task Force shall submit its final report to the

12 General Assembly on or before December 31, 2021 and, upon the

13 filing of its final report, is dissolved.

14 Section 10-15. Repeal. This Act is repealed on June 1,

15 2022.

16 Article 15. Telehealth During the COVID-19 Pandemic Act

17 Section 15-1. Short title. This Article may be cited as the

18 Telehealth During the COVID-19 Pandemic Act. References in this

19 Article to "this Act" mean this Article.

20 Section 15-5. Applicability.

21 (a) This Act does not apply to excepted benefits as defined

22 in 45 CFR 146.145(b) and 45 CFR. 148.220 but does apply to

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1 limited scope dental benefits, limited scope vision benefits,

2 long-term care benefits, coverage only for accidents, or

3 coverage only for specified disease or illness.

4 (b) This Act applies to short-term, limited-duration

5 health insurance coverage; fully insured student health

6 insurance coverage; and fully insured association health plans

7 except with respect to excepted benefits.

8 (c) Any policy, contract, or certificate of health

9 insurance coverage that does not distinguish between

10 in-network and out-of-network providers shall be subject to

11 this Act as though all providers were in-network.

12 Section 15-10. Definitions. As used in this Act:

13 "Health insurance coverage" has the meaning given to that

14 term in Section 5 of the Illinois Health Insurance Portability

15 and Accountability Act.

16 "Health insurance issuer" has the meaning given to that

17 term in Section 5 of the Illinois Health Insurance Portability

18 and Accountability Act.

19 "Telehealth services" means the provision of health care,

20 psychiatry, mental health treatment, substance use disorder

21 treatment, and related services to a patient, regardless of his

22 or her location, through electronic or telephonic methods, such

23 as telephone (landline or cellular), video technology commonly

24 available on smart phones and other devices, and

25 videoconferencing, as well as any method within the meaning of

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1 telehealth services under Section 356z.22 of the Illinois

2 Insurance Code.

3 Section 15-15. Coverage for telehealth services during the

4 COVID-19 pandemic.

5 (a) In order to protect the public's health, to permit

6 expedited treatment of health conditions during the COVID-19

7 pandemic, and to mitigate its impact upon the residents of the

8 State of Illinois, all health insurance issuers regulated by

9 the Department of Insurance shall cover the costs of all

10 telehealth services rendered by in-network providers to

11 deliver any clinically appropriate, medically necessary

12 covered services and treatments to insureds, enrollees, and

13 members under each policy, contract, or certificate of health

14 insurance coverage.

15 (b) Health insurance issuers may establish reasonable

16 requirements and parameters for telehealth services, including

17 with respect to documentation and recordkeeping, to the extent

18 consistent with this Act or any company bulletin subsequently

19 issued by the Department of Insurance under Executive Order

20 2020-09. A health insurance issuer's requirements and

21 parameters may not be more restrictive or less favorable toward

22 providers, insureds, enrollees, or members than those

23 contained in the emergency rulemaking undertaken by the

24 Department of Healthcare and Family Services at 89 Ill. Adm.

25 Code 140.403(e). Health insurance issuers shall notify

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1 providers of any instructions necessary to facilitate billing

2 for telehealth services.

3 Section 15-20. Prior authorization and utilization review

4 requirements.

5 (a) In order to ensure that health care is quickly and

6 efficiently provided to the public, health insurance issuers

7 shall not impose upon telehealth services utilization review

8 requirements that are unnecessary, duplicative, or unwarranted

9 nor impose any treatment limitations that are more stringent

10 than the requirements applicable to the same health care

11 service when rendered in-person.

12 (b) For telehealth services that relate to COVID-19

13 delivered by in-network providers, health insurance issuers

14 shall not impose any prior authorization requirements.

15 Section 15-25. Cost-sharing prohibited. Health insurance

16 issuers shall not impose any cost-sharing (copayments,

17 deductibles, or coinsurance) for telehealth services provided

18 by in-network providers. However, in accordance with the

19 standards and definitions in 26 U.S.C. 223, if an enrollee in a

20 high-deductible health plan has not met the applicable

21 deductible under the terms of his or her coverage, the

22 requirements of this Section do not require an issuer to pay

23 for a charge for telehealth services unless the associated

24 health care service for that particular charge is deemed

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1 preventive care by the United States Department of the

2 Treasury. The federal Internal Revenue Service has recognized

3 that services for testing, treatment, and any potential

4 vaccination for COVID-19 fall within the scope of preventive

5 care.

6 Section 15-30. Eligible services. Services eligible under

7 this Act include services provided by any professional,

8 practitioner, clinician, or other provider who is licensed,

9 certified, registered, or otherwise authorized to practice in

10 the State where the patient receives treatment, subject to the

11 provisions of the Telehealth Act for any health care

12 professional, as defined in the Telehealth Act, who delivers

13 treatment through telehealth to a patient located in this

14 State, and substance use disorder professionals and clinicians

15 authorized by Illinois law to provide substance use disorder

16 services.

17 Section 15-35. Mental Health and Developmental

18 Disabilities Confidentiality Act. A covered health care

19 provider or covered entity subject to the requirements of the

20 Mental Health and Developmental Disabilities Confidentiality

21 Act that uses audio or video communication technology to

22 provide telehealth services to mental health and developmental

23 disability patients may use any non-public facing remote

24 communication product in accordance with this Act for the

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1 duration of the Gubernatorial Disaster Proclamation issued by

2 the Governor on March 9, 2020 concerning COVID-19 and any

3 subsequent Gubernatorial Disaster Proclamation issued by the

4 Governor concerning COVID-19. Providers and covered entities

5 shall, to the extent feasible, notify patients that third-party

6 applications potentially introduce privacy risks. Providers

7 shall enable all available encryption and privacy modes when

8 using such applications. A public facing video communication

9 application may not be used in the provision of telehealth

10 services by covered health care providers or covered entities.

11 Section 15-40. Rulemaking authority. The Department of

12 Insurance may adopt rules to implement the provisions of this

13 Act.

14 Section 15-90. Repeal. This Act is repealed on May 1, 2021.

15 Article 90. Amendatory Provisions

16 Section 90-5. The Freedom of Information Act is amended by

17 changing Section 7.5 as follows:

18 (5 ILCS 140/7.5)

19 Sec. 7.5. Statutory exemptions. To the extent provided for

20 by the statutes referenced below, the following shall be exempt

21 from inspection and copying:

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1 (a) All information determined to be confidential

2 under Section 4002 of the Technology Advancement and

3 Development Act.

4 (b) Library circulation and order records identifying

5 library users with specific materials under the Library

6 Records Confidentiality Act.

7 (c) Applications, related documents, and medical

8 records received by the Experimental Organ Transplantation

9 Procedures Board and any and all documents or other records

10 prepared by the Experimental Organ Transplantation

11 Procedures Board or its staff relating to applications it

12 has received.

13 (d) Information and records held by the Department of

14 Public Health and its authorized representatives relating

15 to known or suspected cases of sexually transmissible

16 disease or any information the disclosure of which is

17 restricted under the Illinois Sexually Transmissible

18 Disease Control Act.

19 (e) Information the disclosure of which is exempted

20 under Section 30 of the Radon Industry Licensing Act.

21 (f) Firm performance evaluations under Section 55 of

22 the Architectural, Engineering, and Land Surveying

23 Qualifications Based Selection Act.

24 (g) Information the disclosure of which is restricted

25 and exempted under Section 50 of the Illinois Prepaid

26 Tuition Act.

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1 (h) Information the disclosure of which is exempted

2 under the State Officials and Employees Ethics Act, and

3 records of any lawfully created State or local inspector

4 general's office that would be exempt if created or

5 obtained by an Executive Inspector General's office under

6 that Act.

7 (i) Information contained in a local emergency energy

8 plan submitted to a municipality in accordance with a local

9 emergency energy plan ordinance that is adopted under

10 Section 11-21.5-5 of the Illinois Municipal Code.

11 (j) Information and data concerning the distribution

12 of surcharge moneys collected and remitted by carriers

13 under the Emergency Telephone System Act.

14 (k) Law enforcement officer identification information

15 or driver identification information compiled by a law

16 enforcement agency or the Department of Transportation

17 under Section 11-212 of the Illinois Vehicle Code.

18 (l) Records and information provided to a residential

19 health care facility resident sexual assault and death

20 review team or the Executive Council under the Abuse

21 Prevention Review Team Act.

22 (m) Information provided to the predatory lending

23 database created pursuant to Article 3 of the Residential

24 Real Property Disclosure Act, except to the extent

25 authorized under that Article.

26 (n) Defense budgets and petitions for certification of

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1 compensation and expenses for court appointed trial

2 counsel as provided under Sections 10 and 15 of the Capital

3 Crimes Litigation Act. This subsection (n) shall apply

4 until the conclusion of the trial of the case, even if the

5 prosecution chooses not to pursue the death penalty prior

6 to trial or sentencing.

7 (o) Information that is prohibited from being

8 disclosed under Section 4 of the Illinois Health and

9 Hazardous Substances Registry Act.

10 (p) Security portions of system safety program plans,

11 investigation reports, surveys, schedules, lists, data, or

12 information compiled, collected, or prepared by or for the

13 Regional Transportation Authority under Section 2.11 of

14 the Regional Transportation Authority Act or the St. Clair

15 County Transit District under the Bi-State Transit Safety

16 Act.

17 (q) Information prohibited from being disclosed by the

18 Personnel Record Review Act.

19 (r) Information prohibited from being disclosed by the

20 Illinois School Student Records Act.

21 (s) Information the disclosure of which is restricted

22 under Section 5-108 of the Public Utilities Act.

23 (t) All identified or deidentified health information

24 in the form of health data or medical records contained in,

25 stored in, submitted to, transferred by, or released from

26 the Illinois Health Information Exchange, and identified

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1 or deidentified health information in the form of health

2 data and medical records of the Illinois Health Information

3 Exchange in the possession of the Illinois Health

4 Information Exchange Office ~~Authority~~ due to its

5 administration of the Illinois Health Information

6 Exchange. The terms "identified" and "deidentified" shall

7 be given the same meaning as in the Health Insurance

8 Portability and Accountability Act of 1996, Public Law

9 104-191, or any subsequent amendments thereto, and any

10 regulations promulgated thereunder.

11 (u) Records and information provided to an independent

12 team of experts under the Developmental Disability and

13 Mental Health Safety Act (also known as Brian's Law).

14 (v) Names and information of people who have applied

15 for or received Firearm Owner's Identification Cards under

16 the Firearm Owners Identification Card Act or applied for

17 or received a concealed carry license under the Firearm

18 Concealed Carry Act, unless otherwise authorized by the

19 Firearm Concealed Carry Act; and databases under the

20 Firearm Concealed Carry Act, records of the Concealed Carry

21 Licensing Review Board under the Firearm Concealed Carry

22 Act, and law enforcement agency objections under the

23 Firearm Concealed Carry Act.

24 (w) Personally identifiable information which is

25 exempted from disclosure under subsection (g) of Section

26 19.1 of the Toll Highway Act.

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1 (x) Information which is exempted from disclosure

2 under Section 5-1014.3 of the Counties Code or Section

3 8-11-21 of the Illinois Municipal Code.

4 (y) Confidential information under the Adult

5 Protective Services Act and its predecessor enabling

6 statute, the Elder Abuse and Neglect Act, including

7 information about the identity and administrative finding

8 against any caregiver of a verified and substantiated

9 decision of abuse, neglect, or financial exploitation of an

10 eligible adult maintained in the Registry established

11 under Section 7.5 of the Adult Protective Services Act.

12 (z) Records and information provided to a fatality

13 review team or the Illinois Fatality Review Team Advisory

14 Council under Section 15 of the Adult Protective Services

15 Act.

16 (aa) Information which is exempted from disclosure

17 under Section 2.37 of the Wildlife Code.

18 (bb) Information which is or was prohibited from

19 disclosure by the Juvenile Court Act of 1987.

20 (cc) Recordings made under the Law Enforcement

21 Officer-Worn Body Camera Act, except to the extent

22 authorized under that Act.

23 (dd) Information that is prohibited from being

24 disclosed under Section 45 of the Condominium and Common

25 Interest Community Ombudsperson Act.

26 (ee) Information that is exempted from disclosure

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1 under Section 30.1 of the Pharmacy Practice Act.

2 (ff) Information that is exempted from disclosure

3 under the Revised Uniform Unclaimed Property Act.

4 (gg) Information that is prohibited from being

5 disclosed under Section 7-603.5 of the Illinois Vehicle

6 Code.

7 (hh) Records that are exempt from disclosure under

8 Section 1A-16.7 of the Election Code.

9 (ii) Information which is exempted from disclosure

10 under Section 2505-800 of the Department of Revenue Law of

11 the Civil Administrative Code of Illinois.

12 (jj) Information and reports that are required to be

13 submitted to the Department of Labor by registering day and

14 temporary labor service agencies but are exempt from

15 disclosure under subsection (a-1) of Section 45 of the Day

16 and Temporary Labor Services Act.

17 (kk) Information prohibited from disclosure under the

18 Seizure and Forfeiture Reporting Act.

19 (ll) Information the disclosure of which is restricted

20 and exempted under Section 5-30.8 of the Illinois Public

21 Aid Code.

22 (mm) Records that are exempt from disclosure under

23 Section 4.2 of the Crime Victims Compensation Act.

24 (nn) Information that is exempt from disclosure under

25 Section 70 of the Higher Education Student Assistance Act.

26 (oo) Communications, notes, records, and reports

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1 arising out of a peer support counseling session prohibited

2 from disclosure under the First Responders Suicide

3 Prevention Act.

4 (pp) Names and all identifying information relating to

5 an employee of an emergency services provider or law

6 enforcement agency under the First Responders Suicide

7 Prevention Act.

8 (qq) Information and records held by the Department of

9 Public Health and its authorized representatives collected

10 under the Reproductive Health Act.

11 (rr) Information that is exempt from disclosure under

12 the Cannabis Regulation and Tax Act.

13 (ss) Data reported by an employer to the Department of

14 Human Rights pursuant to Section 2-108 of the Illinois

15 Human Rights Act.

16 (tt) Recordings made under the Children's Advocacy

17 Center Act, except to the extent authorized under that Act.

18 (uu) Information that is exempt from disclosure under

19 Section 50 of the Sexual Assault Evidence Submission Act.

20 (vv) Information that is exempt from disclosure under

21 subsections (f) and (j) of Section 5-36 of the Illinois

22 Public Aid Code.

23 (ww) Information that is exempt from disclosure under

24 Section 16.8 of the State Treasurer Act.

25 (xx) Information that is exempt from disclosure or

26 information that shall not be made public under the

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1 Illinois Insurance Code.

2 (yy) ~~(oo)~~ Information prohibited from being disclosed

3 under the Illinois Educational Labor Relations Act.

4 (zz) ~~(pp)~~ Information prohibited from being disclosed

5 under the Illinois Public Labor Relations Act.

6 (aaa) ~~(qq)~~ Information prohibited from being disclosed

7 under Section 1-167 of the Illinois Pension Code.

8 (Source: P.A. 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;

9 100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.

10 8-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517,

11 eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19;

12 100-863, eff. 8-14-18; 100-887, eff. 8-14-18; 101-13, eff.

13 6-12-19; 101-27, eff. 6-25-19; 101-81, eff. 7-12-19; 101-221,

14 eff. 1-1-20; 101-236, eff. 1-1-20; 101-375, eff. 8-16-19;

15 101-377, eff. 8-16-19; 101-452, eff. 1-1-20; 101-466, eff.

16 1-1-20; 101-600, eff. 12-6-19; 101-620, eff 12-20-19; revised

17 1-6-20.)

18 Section 90-10. The Illinois Health Information Exchange

19 and Technology Act is amended by changing Sections 10, 20, 25,

20 30, 35, and 40, as follows:

21 (20 ILCS 3860/10)

22 (Section scheduled to be repealed on January 1, 2021)

23 Sec. 10. Creation of the Health Information Exchange Office

24 ~~Authority~~. There is hereby created the Illinois Health

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1 Information Exchange Office ("Office") ~~Authority~~

2 ~~("Authority")~~, which is hereby constituted as an

3 instrumentality and an administrative agency of the State of

4 Illinois.

5 As part of its program to promote, develop, and sustain

6 health information exchange at the State level, the Office

7 ~~Authority~~ shall do the following:

8 (1) Establish the Illinois Health Information Exchange

9 ("ILHIE"), to promote and facilitate the sharing of health

10 information among health care providers within Illinois

11 and in other states. ILHIE shall be an entity operated by

12 the Office ~~Authority~~ to serve as a State-level electronic

13 medical records exchange providing for the transfer of

14 health information, medical records, and other health data

15 in a secure environment for the benefit of patient care,

16 patient safety, reduction of duplicate medical tests,

17 reduction of administrative costs, and any other benefits

18 deemed appropriate by the Office ~~Authority~~.

19 (2) Foster the widespread adoption of electronic

20 health records and participation in the ILHIE.

21 (Source: P.A. 96-1331, eff. 7-27-10.)

22 (20 ILCS 3860/20)

23 (Section scheduled to be repealed on January 1, 2021)

24 Sec. 20. Powers and duties of the Illinois Health

25 Information Exchange Office ~~Authority~~. The Office ~~Authority~~

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1 has the following powers, together with all powers incidental

2 or necessary to accomplish the purposes of this Act:

3 (1) The Office ~~Authority~~ shall create and administer

4 the ILHIE using information systems and processes that are

5 secure, are cost effective, and meet all other relevant

6 privacy and security requirements under State and federal

7 law.

8 (2) The Office ~~Authority~~ shall establish and adopt

9 standards and requirements for the use of health

10 information and the requirements for participation in the

11 ILHIE by persons or entities including, but not limited to,

12 health care providers, payors, and local health

13 information exchanges.

14 (3) The Office ~~Authority~~ shall establish minimum

15 standards for accessing the ILHIE to ensure that the

16 appropriate security and privacy protections apply to

17 health information, consistent with applicable federal and

18 State standards and laws. The Office ~~Authority~~ shall have

19 the power to suspend, limit, or terminate the right to

20 participate in the ILHIE for non-compliance or failure to

21 act, with respect to applicable standards and laws, in the

22 best interests of patients, users of the ILHIE, or the

23 public. The Office ~~Authority~~ may seek all remedies allowed

24 by law to address any violation of the terms of

25 participation in the ILHIE.

26 (4) The Office ~~Authority~~ shall identify barriers to the

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1 adoption of electronic health records systems, including

2 researching the rates and patterns of dissemination and use

3 of electronic health record systems throughout the State.

4 The Office ~~Authority~~ shall make the results of the research

5 available on the Department of Healthcare and Family

6 Services' website ~~its website~~.

7 (5) The Office ~~Authority~~ shall prepare educational

8 materials and educate the general public on the benefits of

9 electronic health records, the ILHIE, and the safeguards

10 available to prevent unauthorized disclosure of health

11 information.

12 (6) The Office ~~Authority~~ may appoint or designate an

13 institutional review board in accordance with federal and

14 State law to review and approve requests for research in

15 order to ensure compliance with standards and patient

16 privacy and security protections as specified in paragraph

17 (3) of this Section.

18 (7) The Office ~~Authority~~ may enter into all contracts

19 and agreements necessary or incidental to the performance

20 of its powers under this Act. The Office's ~~Authority's~~

21 expenditures of private funds are exempt from the Illinois

22 Procurement Code, pursuant to Section 1-10 of that Act.

23 Notwithstanding this exception, the Office ~~Authority~~ shall

24 comply with the Business Enterprise for Minorities, Women,

25 and Persons with Disabilities Act.

26 (8) The Office ~~Authority~~ may solicit and accept grants,

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1 loans, contributions, or appropriations from any public or

2 private source and may expend those moneys, through

3 contracts, grants, loans, or agreements, on activities it

4 considers suitable to the performance of its duties under

5 this Act.

6 (9) The Office ~~Authority~~ may determine, charge, and

7 collect any fees, charges, costs, and expenses from any

8 healthcare provider or entity in connection with its duties

9 under this Act. Moneys collected under this paragraph (9)

10 shall be deposited into the Health Information Exchange

11 Fund.

12 (10) The Office ~~Authority~~ may~~, under the direction of~~

13 ~~the Executive Director,~~ employ and discharge staff,

14 including administrative, technical, expert, professional,

15 and legal staff, as is necessary or convenient to carry out

16 the purposes of this Act and as authorized by the Personnel

17 Code. ~~The Authority may establish and administer standards~~

18 ~~of classification regarding compensation, benefits,~~

19 ~~duties, performance, and tenure for that staff and may~~

20 ~~enter into contracts of employment with members of that~~

21 ~~staff for such periods and on such terms as the Authority~~

22 ~~deems desirable. All employees of the Authority are exempt~~

23 ~~from the Personnel Code as provided by Section 4 of the~~

24 ~~Personnel Code.~~

25 (10.5) Staff employed by the Illinois Health

26 Information Exchange Authority on the effective date of

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LRB101 10924 KTG 72284 a

1 this amendatory Act of the 101st General Assembly shall

2 transfer to the Office within the Department of Healthcare

3 and Family Services.

4 (10.6) The status and rights of employees transferring

5 from the Illinois Health Information Exchange Authority

6 under paragraph (10.5) shall not be affected by such

7 transfer except that, notwithstanding any other State law

8 to the contrary, those employees shall maintain their

9 seniority and their positions shall convert to titles of

10 comparable organizational level under the Personnel Code

11 and become subject to the Personnel Code. Other than the

12 changes described in this paragraph, the rights of

13 employees, the State of Illinois, and State agencies under

14 the Personnel Code or under any pension, retirement, or

15 annuity plan shall not be affected by this amendatory Act

16 of the 101st General Assembly. Transferring personnel

17 shall continue their service within the Office.

18 (11) The Office ~~Authority~~ shall consult and coordinate

19 with the Department of Public Health to further the

20 Office's ~~Authority's~~ collection of health information from

21 health care providers for public health purposes. The

22 collection of public health information shall include

23 identifiable information for use by the Office ~~Authority~~ or

24 other State agencies to comply with State and federal laws.

25 Any identifiable information so collected shall be

26 privileged and confidential in accordance with Sections

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LRB101 10924 KTG 72284 a

1 8-2101, 8-2102, 8-2103, 8-2104, and 8-2105 of the Code of

2 Civil Procedure.

3 (12) All identified or deidentified health information

4 in the form of health data or medical records contained in,

5 stored in, submitted to, transferred by, or released from

6 the Illinois Health Information Exchange, and identified

7 or deidentified health information in the form of health

8 data and medical records of the Illinois Health Information

9 Exchange in the possession of the Illinois Health

10 Information Exchange Office ~~Authority~~ due to its

11 administration of the Illinois Health Information

12 Exchange, shall be exempt from inspection and copying under

13 the Freedom of Information Act. The terms "identified" and

14 "deidentified" shall be given the same meaning as in the

15 Health Insurance Portability and Accountability Act of

16 1996, Public Law 104-191, or any subsequent amendments

17 thereto, and any regulations promulgated thereunder.

18 (13) To address gaps in the adoption of, workforce

19 preparation for, and exchange of electronic health records

20 that result in regional and socioeconomic disparities in

21 the delivery of care, the Office ~~Authority~~ may evaluate

22 such gaps and provide resources as available, giving

23 priority to healthcare providers serving a significant

24 percentage of Medicaid or uninsured patients and in

25 medically underserved or rural areas.

26 (14) The Office shall perform its duties under this Act

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1 in consultation with the Office of the Governor and with

2 the Departments of Public Health, Insurance, and Human

3 Services.

4 (Source: P.A. 99-642, eff. 7-28-16; 100-391, eff. 8-25-17.)

5 (20 ILCS 3860/25)

6 (Section scheduled to be repealed on January 1, 2021)

7 Sec. 25. Health Information Exchange Fund.

8 (a) The Health Information Exchange Fund (the "Fund") is

9 created as a separate fund outside the State treasury. Moneys

10 in the Fund are not subject to appropriation by the General

11 Assembly. The State Treasurer shall be ex-officio custodian of

12 the Fund. Revenues arising from the operation and

13 administration of the Office ~~Authority~~ and the ILHIE shall be

14 deposited into the Fund. Fees, charges, State and federal

15 moneys, grants, donations, gifts, interest, or other moneys

16 shall be deposited into the Fund. "Private funds" means gifts,

17 donations, and private grants.

18 (b) The Office ~~Authority~~ is authorized to spend moneys in

19 the Fund on activities suitable to the performance of its

20 duties as provided in Section 20 of this Act and authorized by

21 this Act. Disbursements may be made from the Fund for purposes

22 related to the operations and functions of the Office ~~Authority~~

23 and the ILHIE.

24 (c) The Illinois General Assembly may appropriate moneys to

25 the Office ~~Authority~~ and the ILHIE, and those moneys shall be

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1 deposited into the Fund.

2 (d) The Fund is not subject to administrative charges or

3 charge-backs, including but not limited to those authorized

4 under Section 8h of the State Finance Act.

5 (e) The Office's ~~Authority's~~ accounts and books shall be

6 set up and maintained in accordance with the Office of the

7 Comptroller's requirements, and the ~~Authority's Executive~~

8 Director of the Department of Healthcare and Family Services

9 shall be responsible for the approval of recording of receipts,

10 approval of payments, and proper filing of required reports.

11 The moneys held and made available by the Office ~~Authority~~

12 shall be subject to financial and compliance audits by the

13 Auditor General in compliance with the Illinois State Auditing

14 Act.

15 (Source: P.A. 96-1331, eff. 7-27-10.)

16 (20 ILCS 3860/30)

17 (Section scheduled to be repealed on January 1, 2021)

18 Sec. 30. Participation in health information systems

19 maintained by State agencies.

20 (a) By no later than January 1, 2015, each State agency

21 that implements, acquires, or upgrades health information

22 technology systems shall use health information technology

23 systems and products that meet minimum standards adopted by the

24 Office ~~Authority~~ for accessing the ILHIE. State agencies that

25 have health information which supports and develops the ILHIE

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1 shall provide access to patient-specific data to complete the

2 patient record at the ILHIE. Notwithstanding any other

3 provision of State law, the State agencies shall provide

4 patient-specific data to the ILHIE.

5 (b) Participation in the ILHIE shall have no impact on the

6 content of or use or disclosure of health information of

7 patient participants that is held in locations other than the

8 ILHIE. Nothing in this Act shall limit or change an entity's

9 obligation to exchange health information in accordance with

10 applicable federal and State laws and standards.

11 (Source: P.A. 96-1331, eff. 7-27-10.)

12 (20 ILCS 3860/35)

13 (Section scheduled to be repealed on January 1, 2021)

14 Sec. 35. Illinois Administrative Procedure Act. The

15 provisions of the Illinois Administrative Procedure Act are

16 hereby expressly adopted and shall apply to all administrative

17 rules and procedures of the Office ~~Authority~~, except that

18 Section 5-35 of the Illinois Administrative Procedure Act

19 relating to procedures for rulemaking does not apply to the

20 adoption of any rule required by federal law when the Office

21 ~~Authority~~ is precluded by that law from exercising any

22 discretion regarding that rule.

23 (Source: P.A. 96-1331, eff. 7-27-10.)

24 (20 ILCS 3860/40)

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1 (Section scheduled to be repealed on January 1, 2021)

2 Sec. 40. Reliance on data. Any health care provider who

3 relies in good faith upon any information provided through the

4 ILHIE in his, her, or its treatment of a patient shall be

5 immune from criminal or civil liability or professional

6 discipline arising from any damages caused by such good faith

7 reliance. This immunity does not apply to acts or omissions

8 constituting gross negligence or reckless, wanton, or

9 intentional misconduct. Notwithstanding this provision, the

10 Office ~~Authority~~ does not waive any immunities provided under

11 State or federal law.

12 (Source: P.A. 98-1046, eff. 1-1-15.)

13 (20 ILCS 3860/15 rep.)

14 Section 90-15. The Illinois Health Information Exchange

15 and Technology Act is amended by repealing Section 15.

16 Section 90-20. The Children's Health Insurance Program Act

17 is amended by changing Section 7 and by adding Section 8 as

18 follows:

19 (215 ILCS 106/7)

20 Sec. 7. Eligibility verification. Notwithstanding any

21 other provision of this Act, with respect to applications for

22 benefits provided under the Program, eligibility shall be

23 determined in a manner that ensures program integrity and that

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1 complies with federal law and regulations while minimizing

2 unnecessary barriers to enrollment. To this end, as soon as

3 practicable, and unless the Department receives written denial

4 from the federal government, this Section shall be implemented:

5 (a) The Department of Healthcare and Family Services or its

6 designees shall:

7 (1) By no later than July 1, 2011, require verification

8 of, at a minimum, one month's income from all sources

9 required for determining the eligibility of applicants to

10 the Program. Such verification shall take the form of pay

11 stubs, business or income and expense records for

12 self-employed persons, letters from employers, and any

13 other valid documentation of income including data

14 obtained electronically by the Department or its designees

15 from other sources as described in subsection (b) of this

16 Section. A month's income may be verified by a single pay

17 stub with the monthly income extrapolated from the time

18 period covered by the pay stub.

19 (2) By no later than October 1, 2011, require

20 verification of, at a minimum, one month's income from all

21 sources required for determining the continued eligibility

22 of recipients at their annual review of eligibility under

23 the Program. Such verification shall take the form of pay

24 stubs, business or income and expense records for

25 self-employed persons, letters from employers, and any

26 other valid documentation of income including data

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1 obtained electronically by the Department or its designees

2 from other sources as described in subsection (b) of this

3 Section. A month's income may be verified by a single pay

4 stub with the monthly income extrapolated from the time

5 period covered by the pay stub. The Department shall send a

6 notice to the recipient at least 60 days prior to the end

7 of the period of eligibility that informs them of the

8 requirements for continued eligibility. Information the

9 Department receives prior to the annual review, including

10 information available to the Department as a result of the

11 recipient's application for other non-health care

12 benefits, that is sufficient to make a determination of

13 continued eligibility for medical assistance or for

14 benefits provided under the Program may be reviewed and

15 verified, and subsequent action taken including client

16 notification of continued eligibility for medical

17 assistance or for benefits provided under the Program. The

18 date of client notification establishes the date for

19 subsequent annual eligibility reviews. If a recipient does

20 not fulfill the requirements for continued eligibility by

21 the deadline established in the notice, a notice of

22 cancellation shall be issued to the recipient and coverage

23 shall end no later than the last day of the month following

24 the last day of the eligibility period. A recipient's

25 eligibility may be reinstated without requiring a new

26 application if the recipient fulfills the requirements for

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1 continued eligibility prior to the end of the third month

2 following the last date of coverage (or longer period if

3 required by federal regulations). Nothing in this Section

4 shall prevent an individual whose coverage has been

5 cancelled from reapplying for health benefits at any time.

6 (3) By no later than July 1, 2011, require verification

7 of Illinois residency.

8 (b) The Department shall establish or continue cooperative

9 arrangements with the Social Security Administration, the

10 Illinois Secretary of State, the Department of Human Services,

11 the Department of Revenue, the Department of Employment

12 Security, and any other appropriate entity to gain electronic

13 access, to the extent allowed by law, to information available

14 to those entities that may be appropriate for electronically

15 verifying any factor of eligibility for benefits under the

16 Program. Data relevant to eligibility shall be provided for no

17 other purpose than to verify the eligibility of new applicants

18 or current recipients of health benefits under the Program.

19 Data will be requested or provided for any new applicant or

20 current recipient only insofar as that individual's

21 circumstances are relevant to that individual's or another

22 individual's eligibility.

23 (c) Within 90 days of the effective date of this amendatory

24 Act of the 96th General Assembly, the Department of Healthcare

25 and Family Services shall send notice to current recipients

26 informing them of the changes regarding their eligibility

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1 verification.

2 (Source: P.A. 101-209, eff. 8-5-19.)

3 (215 ILCS 106/8 new)

4 Sec. 8. COVID-19 public health emergency. Notwithstanding

5 any other provision of this Act, the Department may take

6 necessary actions to address the COVID-19 public health

7 emergency to the extent such actions are required, approved, or

8 authorized by the United States Department of Health and Human

9 Services, Centers for Medicare and Medicaid Services. Such

10 actions may continue throughout the public health emergency and

11 for up to 12 months after the period ends, and may include, but

12 are not limited to: accepting an applicant's or recipient's

13 attestation of income, incurred medical expenses, residency,

14 and insured status when electronic verification is not

15 available; eliminating resource tests for some eligibility

16 determinations; suspending redeterminations; suspending

17 changes that would adversely affect an applicant's or

18 recipient's eligibility; phone or verbal approval by an

19 applicant to submit an application in lieu of applicant

20 signature; allowing adult presumptive eligibility; allowing

21 presumptive eligibility for children, pregnant women, and

22 adults as often as twice per calendar year; paying for

23 additional services delivered by telehealth; and suspending

24 premium and co-payment requirements.

25 The Department's authority under this Section shall only

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1 extend to encompass, incorporate, or effectuate the terms,

2 items, conditions, and other provisions approved, authorized,

3 or required by the United States Department of Health and Human

4 Services, Centers for Medicare and Medicaid Services, and shall

5 not extend beyond the time of the COVID-19 public health

6 emergency and up to 12 months after the period expires.

7 Section 90-25. The Covering ALL KIDS Health Insurance Act

8 is amended by changing Section 7 and by adding Section 8 as

9 follows:

10 (215 ILCS 170/7)

11 (Section scheduled to be repealed on October 1, 2024)

12 Sec. 7. Eligibility verification. Notwithstanding any

13 other provision of this Act, with respect to applications for

14 benefits provided under the Program, eligibility shall be

15 determined in a manner that ensures program integrity and that

16 complies with federal law and regulations while minimizing

17 unnecessary barriers to enrollment. To this end, as soon as

18 practicable, and unless the Department receives written denial

19 from the federal government, this Section shall be implemented:

20 (a) The Department of Healthcare and Family Services or its

21 designees shall:

22 (1) By July 1, 2011, require verification of, at a

23 minimum, one month's income from all sources required for

24 determining the eligibility of applicants to the Program.

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1 Such verification shall take the form of pay stubs,

2 business or income and expense records for self-employed

3 persons, letters from employers, and any other valid

4 documentation of income including data obtained

5 electronically by the Department or its designees from

6 other sources as described in subsection (b) of this

7 Section. A month's income may be verified by a single pay

8 stub with the monthly income extrapolated from the time

9 period covered by the pay stub.

10 (2) By October 1, 2011, require verification of, at a

11 minimum, one month's income from all sources required for

12 determining the continued eligibility of recipients at

13 their annual review of eligibility under the Program. Such

14 verification shall take the form of pay stubs, business or

15 income and expense records for self-employed persons,

16 letters from employers, and any other valid documentation

17 of income including data obtained electronically by the

18 Department or its designees from other sources as described

19 in subsection (b) of this Section. A month's income may be

20 verified by a single pay stub with the monthly income

21 extrapolated from the time period covered by the pay stub.

22 The Department shall send a notice to recipients at least

23 60 days prior to the end of their period of eligibility

24 that informs them of the requirements for continued

25 eligibility. Information the Department receives prior to

26 the annual review, including information available to the

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1 Department as a result of the recipient's application for

2 other non-health care benefits, that is sufficient to make

3 a determination of continued eligibility for benefits

4 provided under this Act, the Children's Health Insurance

5 Program Act, or Article V of the Illinois Public Aid Code

6 may be reviewed and verified, and subsequent action taken

7 including client notification of continued eligibility for

8 benefits provided under this Act, the Children's Health

9 Insurance Program Act, or Article V of the Illinois Public

10 Aid Code. The date of client notification establishes the

11 date for subsequent annual eligibility reviews. If a

12 recipient does not fulfill the requirements for continued

13 eligibility by the deadline established in the notice, a

14 notice of cancellation shall be issued to the recipient and

15 coverage shall end no later than the last day of the month

16 following the last day of the eligibility period. A

17 recipient's eligibility may be reinstated without

18 requiring a new application if the recipient fulfills the

19 requirements for continued eligibility prior to the end of

20 the third month following the last date of coverage (or

21 longer period if required by federal regulations). Nothing

22 in this Section shall prevent an individual whose coverage

23 has been cancelled from reapplying for health benefits at

24 any time.

25 (3) By July 1, 2011, require verification of Illinois

26 residency.

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1 (b) The Department shall establish or continue cooperative

2 arrangements with the Social Security Administration, the

3 Illinois Secretary of State, the Department of Human Services,

4 the Department of Revenue, the Department of Employment

5 Security, and any other appropriate entity to gain electronic

6 access, to the extent allowed by law, to information available

7 to those entities that may be appropriate for electronically

8 verifying any factor of eligibility for benefits under the

9 Program. Data relevant to eligibility shall be provided for no

10 other purpose than to verify the eligibility of new applicants

11 or current recipients of health benefits under the Program.

12 Data will be requested or provided for any new applicant or

13 current recipient only insofar as that individual's

14 circumstances are relevant to that individual's or another

15 individual's eligibility.

16 (c) Within 90 days of the effective date of this amendatory

17 Act of the 96th General Assembly, the Department of Healthcare

18 and Family Services shall send notice to current recipients

19 informing them of the changes regarding their eligibility

20 verification.

21 (Source: P.A. 101-209, eff. 8-5-19.)

22 (215 ILCS 170/8 new)

23 Sec. 8. COVID-19 public health emergency. Notwithstanding

24 any other provision of this Act, the Department may take

25 necessary actions to address the COVID-19 public health

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1 emergency to the extent such actions are required, approved, or

2 authorized by the United States Department of Health and Human

3 Services, Centers for Medicare and Medicaid Services. Such

4 actions may continue throughout the public health emergency and

5 for up to 12 months after the period ends, and may include, but

6 are not limited to: accepting an applicant's or recipient's

7 attestation of income, incurred medical expenses, residency,

8 and insured status when electronic verification is not

9 available; eliminating resource tests for some eligibility

10 determinations; suspending redeterminations; suspending

11 changes that would adversely affect an applicant's or

12 recipient's eligibility; phone or verbal approval by an

13 applicant to submit an application in lieu of applicant

14 signature; allowing adult presumptive eligibility; allowing

15 presumptive eligibility for children, pregnant women, and

16 adults as often as twice per calendar year; paying for

17 additional services delivered by telehealth; and suspending

18 premium and co-payment requirements.

19 The Department's authority under this Section shall only

20 extend to encompass, incorporate, or effectuate the terms,

21 items, conditions, and other provisions approved, authorized,

22 or required by the United States Department of Health and Human

23 Services, Centers for Medicare and Medicaid Services, and shall

24 not extend beyond the time of the COVID-19 public health

25 emergency and up to 12 months after the period expires.

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1 Section 90-30. The Pharmacy Practice Act is amended by

2 adding Section 39.5 as follows:

3 (225 ILCS 85/39.5 new)

4 Sec. 39.5. Emergency kits.

5 (a) As used in this Section:

6 "Emergency kit" means a kit containing drugs that may be

7 required to meet the immediate therapeutic needs of a patient

8 and that are not available from any other source in sufficient

9 time to prevent the risk of harm to a patient by delay

10 resulting from obtaining the drugs from another source. An

11 automated dispensing and storage system may be used as an

12 emergency kit.

13 "Licensed facility" means an entity licensed under the

14 Nursing Home Care Act, the Hospital Licensing Act, or the

15 University of Illinois Hospital Act or a facility licensed

16 under the Illinois Department of Human Services, Division of

17 Substance Use Prevention and Recovery, for the prevention,

18 intervention, treatment, and recovery support of substance use

19 disorders or certified by the Illinois Department of Human

20 Services, Division of Mental Health for the treatment of mental

21 health.

22 "Offsite institutional pharmacy" means: (1) a pharmacy

23 that is not located in facilities it serves and whose primary

24 purpose is to provide services to patients or residents of

25 facilities licensed under the Nursing Home Care Act, the

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1 Hospital Licensing Act, or the University of Illinois Hospital

2 Act; and (2) a pharmacy that is not located in the facilities

3 it serves and the facilities it serves are licensed under the

4 Illinois Department of Human Services, Division of Substance

5 Use Prevention and Recovery, for the prevention, intervention,

6 treatment, and recovery support of substance use disorders or

7 for the treatment of mental health.

8 (b) An offsite institutional pharmacy may supply emergency

9 kits to a licensed facility.

10 Section 90-33. The Telehealth Act is amended by changing

11 Section 5 as follows:

12 (225 ILCS 150/5)

13 Sec. 5. Definitions. As used in this Act:

14 "Health care professional" includes physicians, physician

15 assistants, optometrists, advanced practice registered nurses,

16 clinical psychologists licensed in Illinois, prescribing

17 psychologists licensed in Illinois, dentists, occupational

18 therapists, pharmacists, physical therapists, clinical social

19 workers, speech-language pathologists, audiologists, hearing

20 instrument dispensers, substance use disorder professionals

21 and clinicians, and mental health professionals and clinicians

22 authorized by Illinois law to provide mental health services.

23 "Telehealth" means the evaluation, diagnosis, or

24 interpretation of electronically transmitted patient-specific

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1 data between a remote location and a licensed health care

2 professional that generates interaction or treatment

3 recommendations. "Telehealth" includes telemedicine and the

4 delivery of health care services provided by way of an

5 interactive telecommunications system, as defined in

6 subsection (a) of Section 356z.22 of the Illinois Insurance

7 Code.

9 (Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;

10 100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.

11 7-19-19.)

12 Section 90-35. The Illinois Public Aid Code is amended by

13 changing Sections 5-2, 5-4.2, 5-5e, 5-16.8, 5B-4, and 11-5.1

14 and by adding Sections 5-1.5, 5-5.27 and 12-21.21 as follows:

15 (305 ILCS 5/5-1.5 new)

16 Sec. 5-1.5. COVID-19 public health emergency.

17 Notwithstanding any other provision of Articles V, XI, and XII

18 of this Code, the Department may take necessary actions to

19 address the COVID-19 public health emergency to the extent such

20 actions are required, approved, or authorized by the United

21 States Department of Health and Human Services, Centers for

22 Medicare and Medicaid Services. Such actions may continue

23 throughout the public health emergency and for up to 12 months

24 after the period ends, and may include, but are not limited to:

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1 accepting an applicant's or recipient's attestation of income,

2 incurred medical expenses, residency, and insured status when

3 electronic verification is not available; eliminating resource

4 tests for some eligibility determinations; suspending

5 redeterminations; suspending changes that would adversely

6 affect an applicant's or recipient's eligibility; phone or

7 verbal approval by an applicant to submit an application in

8 lieu of applicant signature; allowing adult presumptive

9 eligibility; allowing presumptive eligibility for children,

10 pregnant women, and adults as often as twice per calendar year;

11 paying for additional services delivered by telehealth; and

12 suspending premium and co-payment requirements.

13 The Department's authority under this Section shall only

14 extend to encompass, incorporate, or effectuate the terms,

15 items, conditions, and other provisions approved, authorized,

16 or required by the United States Department of Health and Human

17 Services, Centers for Medicare and Medicaid Services, and shall

18 not extend beyond the time of the COVID-19 public health

19 emergency and up to 12 months after the period expires.

20 (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)

21 Sec. 5-2. Classes of Persons Eligible.

22 Medical assistance under this Article shall be available to

23 any of the following classes of persons in respect to whom a

24 plan for coverage has been submitted to the Governor by the

25 Illinois Department and approved by him. If changes made in

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1 this Section 5-2 require federal approval, they shall not take

2 effect until such approval has been received:

3 1. Recipients of basic maintenance grants under

4 Articles III and IV.

5 2. Beginning January 1, 2014, persons otherwise

6 eligible for basic maintenance under Article III,

7 excluding any eligibility requirements that are

8 inconsistent with any federal law or federal regulation, as

9 interpreted by the U.S. Department of Health and Human

10 Services, but who fail to qualify thereunder on the basis

11 of need, and who have insufficient income and resources to

12 meet the costs of necessary medical care, including but not

13 limited to the following:

14 (a) All persons otherwise eligible for basic

15 maintenance under Article III but who fail to qualify

16 under that Article on the basis of need and who meet

17 either of the following requirements:

18 (i) their income, as determined by the

19 Illinois Department in accordance with any federal

20 requirements, is equal to or less than 100% of the

21 federal poverty level; or

22 (ii) their income, after the deduction of

23 costs incurred for medical care and for other types

24 of remedial care, is equal to or less than 100% of

25 the federal poverty level.

26 (b) (Blank).

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LRB101 10924 KTG 72284 a

1 3. (Blank).

2 4. Persons not eligible under any of the preceding

3 paragraphs who fall sick, are injured, or die, not having

4 sufficient money, property or other resources to meet the

5 costs of necessary medical care or funeral and burial

6 expenses.

7 5.(a) Beginning January 1, 2020, women during

8 pregnancy and during the 12-month period beginning on the

9 last day of the pregnancy, together with their infants,

10 whose income is at or below 200% of the federal poverty

11 level. Until September 30, 2019, or sooner if the

12 maintenance of effort requirements under the Patient

13 Protection and Affordable Care Act are eliminated or may be

14 waived before then, women during pregnancy and during the

15 12-month period beginning on the last day of the pregnancy,

16 whose countable monthly income, after the deduction of

17 costs incurred for medical care and for other types of

18 remedial care as specified in administrative rule, is equal

19 to or less than the Medical Assistance-No Grant(C)

20 (MANG(C)) Income Standard in effect on April 1, 2013 as set

21 forth in administrative rule.

22 (b) The plan for coverage shall provide ambulatory

23 prenatal care to pregnant women during a presumptive

24 eligibility period and establish an income eligibility

25 standard that is equal to 200% of the federal poverty

26 level, provided that costs incurred for medical care are

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1 not taken into account in determining such income

2 eligibility.

3 (c) The Illinois Department may conduct a

4 demonstration in at least one county that will provide

5 medical assistance to pregnant women, together with their

6 infants and children up to one year of age, where the

7 income eligibility standard is set up to 185% of the

8 nonfarm income official poverty line, as defined by the

9 federal Office of Management and Budget. The Illinois

10 Department shall seek and obtain necessary authorization

11 provided under federal law to implement such a

12 demonstration. Such demonstration may establish resource

13 standards that are not more restrictive than those

14 established under Article IV of this Code.

15 6. (a) Children younger than age 19 when countable

16 income is at or below 133% of the federal poverty level.

17 Until September 30, 2019, or sooner if the maintenance of

18 effort requirements under the Patient Protection and

19 Affordable Care Act are eliminated or may be waived before

20 then, children younger than age 19 whose countable monthly

21 income, after the deduction of costs incurred for medical

22 care and for other types of remedial care as specified in

23 administrative rule, is equal to or less than the Medical

24 Assistance-No Grant(C) (MANG(C)) Income Standard in effect

25 on April 1, 2013 as set forth in administrative rule.

26 (b) Children and youth who are under temporary custody

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1 or guardianship of the Department of Children and Family

2 Services or who receive financial assistance in support of

3 an adoption or guardianship placement from the Department

4 of Children and Family Services.

5 7. (Blank).

6 8. As required under federal law, persons who are

7 eligible for Transitional Medical Assistance as a result of

8 an increase in earnings or child or spousal support

9 received. The plan for coverage for this class of persons

10 shall:

11 (a) extend the medical assistance coverage to the

12 extent required by federal law; and

13 (b) offer persons who have initially received 6

14 months of the coverage provided in paragraph (a) above,

15 the option of receiving an additional 6 months of

16 coverage, subject to the following:

17 (i) such coverage shall be pursuant to

18 provisions of the federal Social Security Act;

19 (ii) such coverage shall include all services

20 covered under Illinois' State Medicaid Plan;

21 (iii) no premium shall be charged for such

22 coverage; and

23 (iv) such coverage shall be suspended in the

24 event of a person's failure without good cause to

25 file in a timely fashion reports required for this

26 coverage under the Social Security Act and

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1 coverage shall be reinstated upon the filing of

2 such reports if the person remains otherwise

3 eligible.

4 9. Persons with acquired immunodeficiency syndrome

5 (AIDS) or with AIDS-related conditions with respect to whom

6 there has been a determination that but for home or

7 community-based services such individuals would require

8 the level of care provided in an inpatient hospital,

9 skilled nursing facility or intermediate care facility the

10 cost of which is reimbursed under this Article. Assistance

11 shall be provided to such persons to the maximum extent

12 permitted under Title XIX of the Federal Social Security

13 Act.

14 10. Participants in the long-term care insurance

15 partnership program established under the Illinois

16 Long-Term Care Partnership Program Act who meet the

17 qualifications for protection of resources described in

18 Section 15 of that Act.

19 11. Persons with disabilities who are employed and

20 eligible for Medicaid, pursuant to Section

21 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,

22 subject to federal approval, persons with a medically

23 improved disability who are employed and eligible for

24 Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of

25 the Social Security Act, as provided by the Illinois

26 Department by rule. In establishing eligibility standards

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1 under this paragraph 11, the Department shall, subject to

2 federal approval:

3 (a) set the income eligibility standard at not

4 lower than 350% of the federal poverty level;

5 (b) exempt retirement accounts that the person

6 cannot access without penalty before the age of 59 1/2,

7 and medical savings accounts established pursuant to

8 26 U.S.C. 220;

9 (c) allow non-exempt assets up to $25,000 as to

10 those assets accumulated during periods of eligibility

11 under this paragraph 11; and

12 (d) continue to apply subparagraphs (b) and (c) in

13 determining the eligibility of the person under this

14 Article even if the person loses eligibility under this

15 paragraph 11.

16 12. Subject to federal approval, persons who are

17 eligible for medical assistance coverage under applicable

18 provisions of the federal Social Security Act and the

19 federal Breast and Cervical Cancer Prevention and

20 Treatment Act of 2000. Those eligible persons are defined

21 to include, but not be limited to, the following persons:

22 (1) persons who have been screened for breast or

23 cervical cancer under the U.S. Centers for Disease

24 Control and Prevention Breast and Cervical Cancer

25 Program established under Title XV of the federal

26 Public Health Services Act in accordance with the

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1 requirements of Section 1504 of that Act as

2 administered by the Illinois Department of Public

3 Health; and

4 (2) persons whose screenings under the above

5 program were funded in whole or in part by funds

6 appropriated to the Illinois Department of Public

7 Health for breast or cervical cancer screening.

8 "Medical assistance" under this paragraph 12 shall be

9 identical to the benefits provided under the State's

10 approved plan under Title XIX of the Social Security Act.

11 The Department must request federal approval of the

12 coverage under this paragraph 12 within 30 days after the

13 effective date of this amendatory Act of the 92nd General

14 Assembly.

15 In addition to the persons who are eligible for medical

16 assistance pursuant to subparagraphs (1) and (2) of this

17 paragraph 12, and to be paid from funds appropriated to the

18 Department for its medical programs, any uninsured person

19 as defined by the Department in rules residing in Illinois

20 who is younger than 65 years of age, who has been screened

21 for breast and cervical cancer in accordance with standards

22 and procedures adopted by the Department of Public Health

23 for screening, and who is referred to the Department by the

24 Department of Public Health as being in need of treatment

25 for breast or cervical cancer is eligible for medical

26 assistance benefits that are consistent with the benefits

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1 provided to those persons described in subparagraphs (1)

2 and (2). Medical assistance coverage for the persons who

3 are eligible under the preceding sentence is not dependent

4 on federal approval, but federal moneys may be used to pay

5 for services provided under that coverage upon federal

6 approval.

7 13. Subject to appropriation and to federal approval,

8 persons living with HIV/AIDS who are not otherwise eligible

9 under this Article and who qualify for services covered

10 under Section 5-5.04 as provided by the Illinois Department

11 by rule.

12 14. Subject to the availability of funds for this

13 purpose, the Department may provide coverage under this

14 Article to persons who reside in Illinois who are not

15 eligible under any of the preceding paragraphs and who meet

16 the income guidelines of paragraph 2(a) of this Section and

17 (i) have an application for asylum pending before the

18 federal Department of Homeland Security or on appeal before

19 a court of competent jurisdiction and are represented

20 either by counsel or by an advocate accredited by the

21 federal Department of Homeland Security and employed by a

22 not-for-profit organization in regard to that application

23 or appeal, or (ii) are receiving services through a

24 federally funded torture treatment center. Medical

25 coverage under this paragraph 14 may be provided for up to

26 24 continuous months from the initial eligibility date so

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1 long as an individual continues to satisfy the criteria of

2 this paragraph 14. If an individual has an appeal pending

3 regarding an application for asylum before the Department

4 of Homeland Security, eligibility under this paragraph 14

5 may be extended until a final decision is rendered on the

6 appeal. The Department may adopt rules governing the

7 implementation of this paragraph 14.

8 15. Family Care Eligibility.

9 (a) On and after July 1, 2012, a parent or other

10 caretaker relative who is 19 years of age or older when

11 countable income is at or below 133% of the federal

12 poverty level. A person may not spend down to become

13 eligible under this paragraph 15.

14 (b) Eligibility shall be reviewed annually.

15 (c) (Blank).

16 (d) (Blank).

17 (e) (Blank).

18 (f) (Blank).

19 (g) (Blank).

20 (h) (Blank).

21 (i) Following termination of an individual's

22 coverage under this paragraph 15, the individual must

23 be determined eligible before the person can be

24 re-enrolled.

25 16. Subject to appropriation, uninsured persons who

26 are not otherwise eligible under this Section who have been

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1 certified and referred by the Department of Public Health

2 as having been screened and found to need diagnostic

3 evaluation or treatment, or both diagnostic evaluation and

4 treatment, for prostate or testicular cancer. For the

5 purposes of this paragraph 16, uninsured persons are those

6 who do not have creditable coverage, as defined under the

7 Health Insurance Portability and Accountability Act, or

8 have otherwise exhausted any insurance benefits they may

9 have had, for prostate or testicular cancer diagnostic

10 evaluation or treatment, or both diagnostic evaluation and

11 treatment. To be eligible, a person must furnish a Social

12 Security number. A person's assets are exempt from

13 consideration in determining eligibility under this

14 paragraph 16. Such persons shall be eligible for medical

15 assistance under this paragraph 16 for so long as they need

16 treatment for the cancer. A person shall be considered to

17 need treatment if, in the opinion of the person's treating

18 physician, the person requires therapy directed toward

19 cure or palliation of prostate or testicular cancer,

20 including recurrent metastatic cancer that is a known or

21 presumed complication of prostate or testicular cancer and

22 complications resulting from the treatment modalities

23 themselves. Persons who require only routine monitoring

24 services are not considered to need treatment. "Medical

25 assistance" under this paragraph 16 shall be identical to

26 the benefits provided under the State's approved plan under

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1 Title XIX of the Social Security Act. Notwithstanding any

2 other provision of law, the Department (i) does not have a

3 claim against the estate of a deceased recipient of

4 services under this paragraph 16 and (ii) does not have a

5 lien against any homestead property or other legal or

6 equitable real property interest owned by a recipient of

7 services under this paragraph 16.

8 17. Persons who, pursuant to a waiver approved by the

9 Secretary of the U.S. Department of Health and Human

10 Services, are eligible for medical assistance under Title

11 XIX or XXI of the federal Social Security Act.

12 Notwithstanding any other provision of this Code and

13 consistent with the terms of the approved waiver, the

14 Illinois Department, may by rule:

15 (a) Limit the geographic areas in which the waiver

16 program operates.

17 (b) Determine the scope, quantity, duration, and

18 quality, and the rate and method of reimbursement, of

19 the medical services to be provided, which may differ

20 from those for other classes of persons eligible for

21 assistance under this Article.

22 (c) Restrict the persons' freedom in choice of

23 providers.

24 18. Beginning January 1, 2014, persons aged 19 or

25 older, but younger than 65, who are not otherwise eligible

26 for medical assistance under this Section 5-2, who qualify

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1 for medical assistance pursuant to 42 U.S.C.

2 1396a(a)(10)(A)(i)(VIII) and applicable federal

3 regulations, and who have income at or below 133% of the

4 federal poverty level plus 5% for the applicable family

5 size as determined pursuant to 42 U.S.C. 1396a(e)(14) and

6 applicable federal regulations. Persons eligible for

7 medical assistance under this paragraph 18 shall receive

8 coverage for the Health Benefits Service Package as that

9 term is defined in subsection (m) of Section 5-1.1 of this

10 Code. If Illinois' federal medical assistance percentage

11 (FMAP) is reduced below 90% for persons eligible for

12 medical assistance under this paragraph 18, eligibility

13 under this paragraph 18 shall cease no later than the end

14 of the third month following the month in which the

15 reduction in FMAP takes effect.

16 19. Beginning January 1, 2014, as required under 42

17 U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18

18 and younger than age 26 who are not otherwise eligible for

19 medical assistance under paragraphs (1) through (17) of

20 this Section who (i) were in foster care under the

21 responsibility of the State on the date of attaining age 18

22 or on the date of attaining age 21 when a court has

23 continued wardship for good cause as provided in Section

24 2-31 of the Juvenile Court Act of 1987 and (ii) received

25 medical assistance under the Illinois Title XIX State Plan

26 or waiver of such plan while in foster care.

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1 20. Beginning January 1, 2018, persons who are

2 foreign-born victims of human trafficking, torture, or

3 other serious crimes as defined in Section 2-19 of this

4 Code and their derivative family members if such persons:

5 (i) reside in Illinois; (ii) are not eligible under any of

6 the preceding paragraphs; (iii) meet the income guidelines

7 of subparagraph (a) of paragraph 2; and (iv) meet the

8 nonfinancial eligibility requirements of Sections 16-2,

9 16-3, and 16-5 of this Code. The Department may extend

10 medical assistance for persons who are foreign-born

11 victims of human trafficking, torture, or other serious

12 crimes whose medical assistance would be terminated

13 pursuant to subsection (b) of Section 16-5 if the

14 Department determines that the person, during the year of

15 initial eligibility (1) experienced a health crisis, (2)

16 has been unable, after reasonable attempts, to obtain

17 necessary information from a third party, or (3) has other

18 extenuating circumstances that prevented the person from

19 completing his or her application for status. The

20 Department may adopt any rules necessary to implement the

21 provisions of this paragraph.

22 21. Persons who are not otherwise eligible for medical

23 assistance under this Section who may qualify for medical

24 assistance pursuant to 42 U.S.C.

25 1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the

26 duration of any federal or State declared emergency due to

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1 COVID-19. Medical assistance to persons eligible for

2 medical assistance solely pursuant to this paragraph 21

3 shall be limited to any in vitro diagnostic product (and

4 the administration of such product) described in 42 U.S.C.

5 1396d(a)(3)(B) on or after March 18, 2020, any visit

6 described in 42 U.S.C. 1396o(a)(2)(G), or any other medical

7 assistance that may be federally authorized for this class

8 of persons. The Department may also cover treatment of

9 COVID-19 for this class of persons, or any similar category

10 of uninsured individuals, to the extent authorized under a

11 federally approved 1115 Waiver or other federal authority.

12 Notwithstanding the provisions of Section 1-11 of this

13 Code, due to the nature of the COVID-19 public health

14 emergency, the Department may cover and provide the medical

15 assistance described in this paragraph 21 to noncitizens

16 who would otherwise meet the eligibility requirements for

17 the class of persons described in this paragraph 21 for the

18 duration of the State emergency period.

19 In implementing the provisions of Public Act 96-20, the

20 Department is authorized to adopt only those rules necessary,

21 including emergency rules. Nothing in Public Act 96-20 permits

22 the Department to adopt rules or issue a decision that expands

23 eligibility for the FamilyCare Program to a person whose income

24 exceeds 185% of the Federal Poverty Level as determined from

25 time to time by the U.S. Department of Health and Human

26 Services, unless the Department is provided with express

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1 statutory authority.

2 The eligibility of any such person for medical assistance

3 under this Article is not affected by the payment of any grant

4 under the Senior Citizens and Persons with Disabilities

5 Property Tax Relief Act or any distributions or items of income

6 described under subparagraph (X) of paragraph (2) of subsection

7 (a) of Section 203 of the Illinois Income Tax Act.

8 The Department shall by rule establish the amounts of

9 assets to be disregarded in determining eligibility for medical

10 assistance, which shall at a minimum equal the amounts to be

11 disregarded under the Federal Supplemental Security Income

12 Program. The amount of assets of a single person to be

13 disregarded shall not be less than $2,000, and the amount of

14 assets of a married couple to be disregarded shall not be less

15 than $3,000.

16 To the extent permitted under federal law, any person found

17 guilty of a second violation of Article VIIIA shall be

18 ineligible for medical assistance under this Article, as

19 provided in Section 8A-8.

20 The eligibility of any person for medical assistance under

21 this Article shall not be affected by the receipt by the person

22 of donations or benefits from fundraisers held for the person

23 in cases of serious illness, as long as neither the person nor

24 members of the person's family have actual control over the

25 donations or benefits or the disbursement of the donations or

26 benefits.

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1 Notwithstanding any other provision of this Code, if the

2 United States Supreme Court holds Title II, Subtitle A, Section

3 2001(a) of Public Law 111-148 to be unconstitutional, or if a

4 holding of Public Law 111-148 makes Medicaid eligibility

5 allowed under Section 2001(a) inoperable, the State or a unit

6 of local government shall be prohibited from enrolling

7 individuals in the Medical Assistance Program as the result of

8 federal approval of a State Medicaid waiver on or after the

9 effective date of this amendatory Act of the 97th General

10 Assembly, and any individuals enrolled in the Medical

11 Assistance Program pursuant to eligibility permitted as a

12 result of such a State Medicaid waiver shall become immediately

13 ineligible.

14 Notwithstanding any other provision of this Code, if an Act

15 of Congress that becomes a Public Law eliminates Section

16 2001(a) of Public Law 111-148, the State or a unit of local

17 government shall be prohibited from enrolling individuals in

18 the Medical Assistance Program as the result of federal

19 approval of a State Medicaid waiver on or after the effective

20 date of this amendatory Act of the 97th General Assembly, and

21 any individuals enrolled in the Medical Assistance Program

22 pursuant to eligibility permitted as a result of such a State

23 Medicaid waiver shall become immediately ineligible.

24 Effective October 1, 2013, the determination of

25 eligibility of persons who qualify under paragraphs 5, 6, 8,

26 15, 17, and 18 of this Section shall comply with the

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1 requirements of 42 U.S.C. 1396a(e)(14) and applicable federal

2 regulations.

3 The Department of Healthcare and Family Services, the

4 Department of Human Services, and the Illinois health insurance

5 marketplace shall work cooperatively to assist persons who

6 would otherwise lose health benefits as a result of changes

7 made under this amendatory Act of the 98th General Assembly to

8 transition to other health insurance coverage.

9 (Source: P.A. 101-10, eff. 6-5-19.)

10 (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)

11 Sec. 5-4.2. Ambulance services payments.

12 (a) For ambulance services provided to a recipient of aid

13 under this Article on or after January 1, 1993, the Illinois

14 Department shall reimburse ambulance service providers at

15 rates calculated in accordance with this Section. It is the

16 intent of the General Assembly to provide adequate

17 reimbursement for ambulance services so as to ensure adequate

18 access to services for recipients of aid under this Article and

19 to provide appropriate incentives to ambulance service

20 providers to provide services in an efficient and

21 cost-effective manner. Thus, it is the intent of the General

22 Assembly that the Illinois Department implement a

23 reimbursement system for ambulance services that, to the extent

24 practicable and subject to the availability of funds

25 appropriated by the General Assembly for this purpose, is

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1 consistent with the payment principles of Medicare. To ensure

2 uniformity between the payment principles of Medicare and

3 Medicaid, the Illinois Department shall follow, to the extent

4 necessary and practicable and subject to the availability of

5 funds appropriated by the General Assembly for this purpose,

6 the statutes, laws, regulations, policies, procedures,

7 principles, definitions, guidelines, and manuals used to

8 determine the amounts paid to ambulance service providers under

9 Title XVIII of the Social Security Act (Medicare).

10 (b) For ambulance services provided to a recipient of aid

11 under this Article on or after January 1, 1996, the Illinois

12 Department shall reimburse ambulance service providers based

13 upon the actual distance traveled if a natural disaster,

14 weather conditions, road repairs, or traffic congestion

15 necessitates the use of a route other than the most direct

16 route.

17 (c) For purposes of this Section, "ambulance services"

18 includes medical transportation services provided by means of

19 an ambulance, medi-car, service car, or taxi.

20 (c-1) For purposes of this Section, "ground ambulance

21 service" means medical transportation services that are

22 described as ground ambulance services by the Centers for

23 Medicare and Medicaid Services and provided in a vehicle that

24 is licensed as an ambulance by the Illinois Department of

25 Public Health pursuant to the Emergency Medical Services (EMS)

26 Systems Act.

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1 (c-2) For purposes of this Section, "ground ambulance

2 service provider" means a vehicle service provider as described

3 in the Emergency Medical Services (EMS) Systems Act that

4 operates licensed ambulances for the purpose of providing

5 emergency ambulance services, or non-emergency ambulance

6 services, or both. For purposes of this Section, this includes

7 both ambulance providers and ambulance suppliers as described

8 by the Centers for Medicare and Medicaid Services.

9 (c-3) For purposes of this Section, "medi-car" means

10 transportation services provided to a patient who is confined

11 to a wheelchair and requires the use of a hydraulic or electric

12 lift or ramp and wheelchair lockdown when the patient's

13 condition does not require medical observation, medical

14 supervision, medical equipment, the administration of

15 medications, or the administration of oxygen.

16 (c-4) For purposes of this Section, "service car" means

17 transportation services provided to a patient by a passenger

18 vehicle where that patient does not require the specialized

19 modes described in subsection (c-1) or (c-3).

20 (d) This Section does not prohibit separate billing by

21 ambulance service providers for oxygen furnished while

22 providing advanced life support services.

23 (e) Beginning with services rendered on or after July 1,

24 2008, all providers of non-emergency medi-car and service car

25 transportation must certify that the driver and employee

26 attendant, as applicable, have completed a safety program

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1 approved by the Department to protect both the patient and the

2 driver, prior to transporting a patient. The provider must

3 maintain this certification in its records. The provider shall

4 produce such documentation upon demand by the Department or its

5 representative. Failure to produce documentation of such

6 training shall result in recovery of any payments made by the

7 Department for services rendered by a non-certified driver or

8 employee attendant. Medi-car and service car providers must

9 maintain legible documentation in their records of the driver

10 and, as applicable, employee attendant that actually

11 transported the patient. Providers must recertify all drivers

12 and employee attendants every 3 years.

13 Notwithstanding the requirements above, any public

14 transportation provider of medi-car and service car

15 transportation that receives federal funding under 49 U.S.C.

16 5307 and 5311 need not certify its drivers and employee

17 attendants under this Section, since safety training is already

18 federally mandated.

19 (f) With respect to any policy or program administered by

20 the Department or its agent regarding approval of non-emergency

21 medical transportation by ground ambulance service providers,

22 including, but not limited to, the Non-Emergency

23 Transportation Services Prior Approval Program (NETSPAP), the

24 Department shall establish by rule a process by which ground

25 ambulance service providers of non-emergency medical

26 transportation may appeal any decision by the Department or its

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1 agent for which no denial was received prior to the time of

2 transport that either (i) denies a request for approval for

3 payment of non-emergency transportation by means of ground

4 ambulance service or (ii) grants a request for approval of

5 non-emergency transportation by means of ground ambulance

6 service at a level of service that entitles the ground

7 ambulance service provider to a lower level of compensation

8 from the Department than the ground ambulance service provider

9 would have received as compensation for the level of service

10 requested. The rule shall be filed by December 15, 2012 and

11 shall provide that, for any decision rendered by the Department

12 or its agent on or after the date the rule takes effect, the

13 ground ambulance service provider shall have 60 days from the

14 date the decision is received to file an appeal. The rule

15 established by the Department shall be, insofar as is

16 practical, consistent with the Illinois Administrative

17 Procedure Act. The Director's decision on an appeal under this

18 Section shall be a final administrative decision subject to

19 review under the Administrative Review Law.

20 (f-5) Beginning 90 days after July 20, 2012 (the effective

21 date of Public Act 97-842), (i) no denial of a request for

22 approval for payment of non-emergency transportation by means

23 of ground ambulance service, and (ii) no approval of

24 non-emergency transportation by means of ground ambulance

25 service at a level of service that entitles the ground

26 ambulance service provider to a lower level of compensation

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1 from the Department than would have been received at the level

2 of service submitted by the ground ambulance service provider,

3 may be issued by the Department or its agent unless the

4 Department has submitted the criteria for determining the

5 appropriateness of the transport for first notice publication

6 in the Illinois Register pursuant to Section 5-40 of the

7 Illinois Administrative Procedure Act.

8 (g) Whenever a patient covered by a medical assistance

9 program under this Code or by another medical program

10 administered by the Department, including a patient covered

11 under the State's Medicaid managed care program, is being

12 transported from a facility and requires non-emergency

13 transportation including ground ambulance, medi-car, or

14 service car transportation, a Physician Certification

15 Statement as described in this Section shall be required for

16 each patient. Facilities shall develop procedures for a

17 licensed medical professional to provide a written and signed

18 Physician Certification Statement. The Physician Certification

19 Statement shall specify the level of transportation services

20 needed and complete a medical certification establishing the

21 criteria for approval of non-emergency ambulance

22 transportation, as published by the Department of Healthcare

23 and Family Services, that is met by the patient. This

24 certification shall be completed prior to ordering the

25 transportation service and prior to patient discharge. The

26 Physician Certification Statement is not required prior to

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1 transport if a delay in transport can be expected to negatively

2 affect the patient outcome. If the ground ambulance provider,

3 medi-car provider, or service car provider is unable to obtain

4 the required Physician Certification Statement within 10

5 calendar days following the date of the service, the ground

6 ambulance provider, medi-car provider, or service car provider

7 must document its attempt to obtain the requested certification

8 and may then submit the claim for payment. Acceptable

9 documentation includes a signed return receipt from the U.S.

10 Postal Service, facsimile receipt, email receipt, or other

11 similar service that evidences that the ground ambulance

12 provider, medi-car provider, or service car provider attempted

13 to obtain the required Physician Certification Statement.

14 The medical certification specifying the level and type of

15 non-emergency transportation needed shall be in the form of the

16 Physician Certification Statement on a standardized form

17 prescribed by the Department of Healthcare and Family Services.

18 Within 75 days after July 27, 2018 (the effective date of

19 Public Act 100-646), the Department of Healthcare and Family

20 Services shall develop a standardized form of the Physician

21 Certification Statement specifying the level and type of

22 transportation services needed in consultation with the

23 Department of Public Health, Medicaid managed care

24 organizations, a statewide association representing ambulance

25 providers, a statewide association representing hospitals, 3

26 statewide associations representing nursing homes, and other

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1 stakeholders. The Physician Certification Statement shall

2 include, but is not limited to, the criteria necessary to

3 demonstrate medical necessity for the level of transport needed

4 as required by (i) the Department of Healthcare and Family

5 Services and (ii) the federal Centers for Medicare and Medicaid

6 Services as outlined in the Centers for Medicare and Medicaid

7 Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap.

8 10, Sec. 10.2.1, et seq. The use of the Physician Certification

9 Statement shall satisfy the obligations of hospitals under

10 Section 6.22 of the Hospital Licensing Act and nursing homes

11 under Section 2-217 of the Nursing Home Care Act.

12 Implementation and acceptance of the Physician Certification

13 Statement shall take place no later than 90 days after the

14 issuance of the Physician Certification Statement by the

15 Department of Healthcare and Family Services.

16 Pursuant to subsection (E) of Section 12-4.25 of this Code,

17 the Department is entitled to recover overpayments paid to a

18 provider or vendor, including, but not limited to, from the

19 discharging physician, the discharging facility, and the

20 ground ambulance service provider, in instances where a

21 non-emergency ground ambulance service is rendered as the

22 result of improper or false certification.

23 Beginning October 1, 2018, the Department of Healthcare and

24 Family Services shall collect data from Medicaid managed care

25 organizations and transportation brokers, including the

26 Department's NETSPAP broker, regarding denials and appeals

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1 related to the missing or incomplete Physician Certification

2 Statement forms and overall compliance with this subsection.

3 The Department of Healthcare and Family Services shall publish

4 quarterly results on its website within 15 days following the

5 end of each quarter.

6 (h) On and after July 1, 2012, the Department shall reduce

7 any rate of reimbursement for services or other payments or

8 alter any methodologies authorized by this Code to reduce any

9 rate of reimbursement for services or other payments in

10 accordance with Section 5-5e.

11 (i) On and after July 1, 2018, the Department shall

12 increase the base rate of reimbursement for both base charges

13 and mileage charges for ground ambulance service providers for

14 medical transportation services provided by means of a ground

15 ambulance to a level not lower than 112% of the base rate in

16 effect as of June 30, 2018.

17 (Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18;

18 101-81, eff. 7-12-19.)

19 (305 ILCS 5/5-5.27 new)

20 Sec. 5-5.27. Coverage for clinical trials.

21 (a) The medical assistance program shall provide coverage

22 for routine care costs that are incurred in the course of an

23 approved clinical trial if the medical assistance program would

24 provide coverage for the same routine care costs not incurred

25 in a clinical trial. "Routine care cost" shall be defined by

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1 the Department by rule.

2 (b) The coverage that must be provided under this Section

3 is subject to the terms, conditions, restrictions, exclusions,

4 and limitations that apply generally under the medical

5 assistance program, including terms, conditions, restrictions,

6 exclusions, or limitations that apply to health care services

7 rendered by participating providers and nonparticipating

8 providers.

9 (c) Implementation of this Section shall be contingent upon

10 federal approval. Upon receipt of federal approval, if

11 required, the Department shall adopt any rules necessary to

12 implement this Section.

13 (d) As used in this Section:

14 "Approved clinical trial" means a phase I, II, III, or IV

15 clinical trial involving the prevention, detection, or

16 treatment of cancer or any other life-threatening disease or

17 condition if one or more of the following conditions apply:

18 (1) the Department makes a determination that the study

19 or investigation is an approved clinical trial;

20 (2) the study or investigation is conducted under an

21 investigational new drug application or an investigational

22 device exemption reviewed by the federal Food and Drug

23 Administration;

24 (3) the study or investigation is a drug trial that is

25 exempt from having an investigational new drug application

26 or an investigational device exemption from the federal

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1 Food and Drug Administration; or

2 (4) the study or investigation is approved or funded

3 (which may include funding through in-kind contributions)

4 by:

5 (A) the National Institutes of Health;

6 (B) the Centers for Disease Control and

7 Prevention;

8 (C) the Agency for Healthcare Research and

9 Quality;

10 (D) the Patient-Centered Outcomes Research

11 Institute;

12 (E) the federal Centers for Medicare and Medicaid

13 Services;

14 (F) a cooperative group or center of any of the

15 entities described in subparagraphs (A) through (E) or

16 the United States Department of Defense or the United

17 States Department of Veterans Affairs;

18 (G) a qualified non-governmental research entity

19 identified in the guidelines issued by the National

20 Institutes of Health for center support grants; or

21 (H) the United States Department of Veterans

22 Affairs, the United States Department of Defense, or

23 the United States Department of Energy, provided that

24 review and approval of the study or investigation

25 occurs through a system of peer review that is

26 comparable to the peer review of studies performed by

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1 the National Institutes of Health, including an

2 unbiased review of the highest scientific standards by

3 qualified individuals who have no interest in the

4 outcome of the review.

5 "Care method" means the use of a particular drug or device

6 in a particular manner.

7 "Life-threatening disease or condition" means a disease or

8 condition from which the likelihood of death is probable unless

9 the course of the disease or condition is interrupted.

10 (305 ILCS 5/5-5e)

11 Sec. 5-5e. Adjusted rates of reimbursement.

12 (a) Rates or payments for services in effect on June 30,

13 2012 shall be adjusted and services shall be affected as

14 required by any other provision of Public Act 97-689. In

15 addition, the Department shall do the following:

16 (1) Delink the per diem rate paid for supportive living

17 facility services from the per diem rate paid for nursing

18 facility services, effective for services provided on or

19 after May 1, 2011 and before July 1, 2019.

20 (2) Cease payment for bed reserves in nursing

21 facilities and specialized mental health rehabilitation

22 facilities; for purposes of therapeutic home visits for

23 individuals scoring as TBI on the MDS 3.0, beginning June

24 1, 2015, the Department shall approve payments for bed

25 reserves in nursing facilities and specialized mental

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1 health rehabilitation facilities that have at least a 90%

2 occupancy level and at least 80% of their residents are

3 Medicaid eligible. Payment shall be at a daily rate of 75%

4 of an individual's current Medicaid per diem and shall not

5 exceed 10 days in a calendar month.

6 (2.5) Cease payment for bed reserves for purposes of

7 inpatient hospitalizations to intermediate care facilities

8 for persons with developmental ~~development~~ disabilities,

9 except in the instance of residents who are under 21 years

10 of age.

11 (3) Cease payment of the $10 per day add-on payment to

12 nursing facilities for certain residents with

13 developmental disabilities.

14 (b) After the application of subsection (a),

15 notwithstanding any other provision of this Code to the

16 contrary and to the extent permitted by federal law, on and

17 after July 1, 2012, the rates of reimbursement for services and

18 other payments provided under this Code shall further be

19 reduced as follows:

20 (1) Rates or payments for physician services, dental

21 services, or community health center services reimbursed

22 through an encounter rate, and services provided under the

23 Medicaid Rehabilitation Option of the Illinois Title XIX

24 State Plan shall not be further reduced, except as provided

25 in Section 5-5b.1.

26 (2) Rates or payments, or the portion thereof, paid to

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1 a provider that is operated by a unit of local government

2 or State University that provides the non-federal share of

3 such services shall not be further reduced, except as

4 provided in Section 5-5b.1.

5 (3) Rates or payments for hospital services delivered

6 by a hospital defined as a Safety-Net Hospital under

7 Section 5-5e.1 of this Code shall not be further reduced,

8 except as provided in Section 5-5b.1.

9 (4) Rates or payments for hospital services delivered

10 by a Critical Access Hospital, which is an Illinois

11 hospital designated as a critical care hospital by the

12 Department of Public Health in accordance with 42 CFR 485,

13 Subpart F, shall not be further reduced, except as provided

14 in Section 5-5b.1.

15 (5) Rates or payments for Nursing Facility Services

16 shall only be further adjusted pursuant to Section 5-5.2 of

17 this Code.

18 (6) Rates or payments for services delivered by long

19 term care facilities licensed under the ID/DD Community

20 Care Act or the MC/DD Act and developmental training

21 services shall not be further reduced.

22 (7) Rates or payments for services provided under

23 capitation rates shall be adjusted taking into

24 consideration the rates reduction and covered services

25 required by Public Act 97-689.

26 (8) For hospitals not previously described in this

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1 subsection, the rates or payments for hospital services

2 shall be further reduced by 3.5%, except for payments

3 authorized under Section 5A-12.4 of this Code.

4 (9) For all other rates or payments for services

5 delivered by providers not specifically referenced in

6 paragraphs (1) through (8), rates or payments shall be

7 further reduced by 2.7%.

8 (c) Any assessment imposed by this Code shall continue and

9 nothing in this Section shall be construed to cause it to

10 cease.

11 (d) Notwithstanding any other provision of this Code to the

12 contrary, subject to federal approval under Title XIX of the

13 Social Security Act, for dates of service on and after July 1,

14 2014, rates or payments for services provided for the purpose

15 of transitioning children from a hospital to home placement or

16 other appropriate setting by a children's community-based

17 health care center authorized under the Alternative Health Care

18 Delivery Act shall be $683 per day.

19 (e) (Blank) ~~Notwithstanding any other provision of this~~

20 ~~Code to the contrary, subject to federal approval under Title~~

21 ~~XIX of the Social Security Act, for dates of service on and~~

22 ~~after July 1, 2014, rates or payments for home health visits~~

23 ~~shall be $72~~.

24 (f) (Blank) ~~Notwithstanding any other provision of this~~

25 ~~Code to the contrary, subject to federal approval under Title~~

26 ~~XIX of the Social Security Act, for dates of service on and~~

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1 ~~after July 1, 2014, rates or payments for the certified nursing~~

2 ~~assistant component of the home health agency rate shall be~~

3 ~~$20~~.

4 (Source: P.A. 101-10, eff. 6-5-19; revised 9-12-19.)

5 (305 ILCS 5/5-16.8)

6 Sec. 5-16.8. Required health benefits. The medical

7 assistance program shall (i) provide the post-mastectomy care

8 benefits required to be covered by a policy of accident and

9 health insurance under Section 356t and the coverage required

10 under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,

11 356z.29, ~~and~~ 356z.32, ~~and~~ 356z.33, 356z.34, and 356z.35 of the

12 Illinois Insurance Code and (ii) be subject to the provisions

13 of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois

14 Insurance Code.

15 The Department, by rule, shall adopt a model similar to the

16 requirements of Section 356z.39 of the Illinois Insurance Code.

17 On and after July 1, 2012, the Department shall reduce any

18 rate of reimbursement for services or other payments or alter

19 any methodologies authorized by this Code to reduce any rate of

20 reimbursement for services or other payments in accordance with

21 Section 5-5e.

22 To ensure full access to the benefits set forth in this

23 Section, on and after January 1, 2016, the Department shall

24 ensure that provider and hospital reimbursement for

25 post-mastectomy care benefits required under this Section are

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1 no lower than the Medicare reimbursement rate.

2 (Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;

3 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.

4 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,

5 eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)

6 (305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)

7 Sec. 5B-4. Payment of assessment; penalty.

8 (a) The assessment imposed by Section 5B-2 shall be due and

9 payable monthly, on the last State business day of the month

10 for occupied bed days reported for the preceding third month

11 prior to the month in which the tax is payable and due. A

12 facility that has delayed payment due to the State's failure to

13 reimburse for services rendered may request an extension on the

14 due date for payment pursuant to subsection (b) and shall pay

15 the assessment within 30 days of reimbursement by the

16 Department. The Illinois Department may provide that county

17 nursing homes directed and maintained pursuant to Section

18 5-1005 of the Counties Code may meet their assessment

19 obligation by certifying to the Illinois Department that county

20 expenditures have been obligated for the operation of the

21 county nursing home in an amount at least equal to the amount

22 of the assessment.

23 (a-5) The Illinois Department shall provide for an

24 electronic submission process for each long-term care facility

25 to report at a minimum the number of occupied bed days of the

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1 long-term care facility for the reporting period and other

2 reasonable information the Illinois Department requires for

3 the administration of its responsibilities under this Code.

4 Beginning July 1, 2013, a separate electronic submission shall

5 be completed for each long-term care facility in this State

6 operated by a long-term care provider. The Illinois Department

7 shall provide a self-reporting notice of the assessment form

8 that the long-term care facility completes for the required

9 period and submits with its assessment payment to the Illinois

10 Department. ~~shall prepare an assessment bill stating the amount~~

11 ~~due and payable each month and submit it to each long-term care~~

12 ~~facility via an electronic process. Each assessment payment~~

13 ~~shall be accompanied by a copy of the assessment bill sent to~~

14 ~~the long-term care facility by the Illinois Department.~~ To the

15 extent practicable, the Department shall coordinate the

16 assessment reporting requirements with other reporting

17 required of long-term care facilities.

18 (b) The Illinois Department is authorized to establish

19 delayed payment schedules for long-term care providers that are

20 unable to make assessment payments when due under this Section

21 due to financial difficulties, as determined by the Illinois

22 Department. The Illinois Department may not deny a request for

23 delay of payment of the assessment imposed under this Article

24 if the long-term care provider has not been paid for services

25 provided during the month on which the assessment is levied or

26 the Medicaid managed care organization has not been paid by the

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1 State.

2 (c) If a long-term care provider fails to pay the full

3 amount of an assessment payment when due (including any

4 extensions granted under subsection (b)), there shall, unless

5 waived by the Illinois Department for reasonable cause, be

6 added to the assessment imposed by Section 5B-2 a penalty

7 assessment equal to the lesser of (i) 5% of the amount of the

8 assessment payment not paid on or before the due date plus 5%

9 of the portion thereof remaining unpaid on the last day of each

10 month thereafter or (ii) 100% of the assessment payment amount

11 not paid on or before the due date. For purposes of this

12 subsection, payments will be credited first to unpaid

13 assessment payment amounts (rather than to penalty or

14 interest), beginning with the most delinquent assessment

15 payments. Payment cycles of longer than 60 days shall be one

16 factor the Director takes into account in granting a waiver

17 under this Section.

18 (c-5) If a long-term care facility fails to file its

19 assessment bill with payment, there shall, unless waived by the

20 Illinois Department for reasonable cause, be added to the

21 assessment due a penalty assessment equal to 25% of the

22 assessment due. After July 1, 2013, no penalty shall be

23 assessed under this Section if the Illinois Department does not

24 provide a process for the electronic submission of the

25 information required by subsection (a-5).

26 (d) Nothing in this amendatory Act of 1993 shall be

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1 construed to prevent the Illinois Department from collecting

2 all amounts due under this Article pursuant to an assessment

3 imposed before the effective date of this amendatory Act of

4 1993.

5 (e) Nothing in this amendatory Act of the 96th General

6 Assembly shall be construed to prevent the Illinois Department

7 from collecting all amounts due under this Code pursuant to an

8 assessment, tax, fee, or penalty imposed before the effective

9 date of this amendatory Act of the 96th General Assembly.

10 (f) No installment of the assessment imposed by Section

11 5B-2 shall be due and payable until after the Department

12 notifies the long-term care providers, in writing, that the

13 payment methodologies to long-term care providers required

14 under Section 5-5.4 of this Code have been approved by the

15 Centers for Medicare and Medicaid Services of the U.S.

16 Department of Health and Human Services and the waivers under

17 42 CFR 433.68 for the assessment imposed by this Section, if

18 necessary, have been granted by the Centers for Medicare and

19 Medicaid Services of the U.S. Department of Health and Human

20 Services. Upon notification to the Department of approval of

21 the payment methodologies required under Section 5-5.4 of this

22 Code and the waivers granted under 42 CFR 433.68, all

23 installments otherwise due under Section 5B-4 prior to the date

24 of notification shall be due and payable to the Department upon

25 written direction from the Department within 90 days after

26 issuance by the Comptroller of the payments required under

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1 Section 5-5.4 of this Code.

2 (Source: P.A. 100-501, eff. 6-1-18.)

3 (305 ILCS 5/11-5.1)

4 Sec. 11-5.1. Eligibility verification. Notwithstanding any

5 other provision of this Code, with respect to applications for

6 medical assistance provided under Article V of this Code,

7 eligibility shall be determined in a manner that ensures

8 program integrity and complies with federal laws and

9 regulations while minimizing unnecessary barriers to

10 enrollment. To this end, as soon as practicable, and unless the

11 Department receives written denial from the federal

12 government, this Section shall be implemented:

13 (a) The Department of Healthcare and Family Services or its

14 designees shall:

15 (1) By no later than July 1, 2011, require verification

16 of, at a minimum, one month's income from all sources

17 required for determining the eligibility of applicants for

18 medical assistance under this Code. Such verification

19 shall take the form of pay stubs, business or income and

20 expense records for self-employed persons, letters from

21 employers, and any other valid documentation of income

22 including data obtained electronically by the Department

23 or its designees from other sources as described in

24 subsection (b) of this Section. A month's income may be

25 verified by a single pay stub with the monthly income

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1 extrapolated from the time period covered by the pay stub.

2 (2) By no later than October 1, 2011, require

3 verification of, at a minimum, one month's income from all

4 sources required for determining the continued eligibility

5 of recipients at their annual review of eligibility for

6 medical assistance under this Code. Information the

7 Department receives prior to the annual review, including

8 information available to the Department as a result of the

9 recipient's application for other non-Medicaid benefits,

10 that is sufficient to make a determination of continued

11 Medicaid eligibility may be reviewed and verified, and

12 subsequent action taken including client notification of

13 continued Medicaid eligibility. The date of client

14 notification establishes the date for subsequent annual

15 Medicaid eligibility reviews. Such verification shall take

16 the form of pay stubs, business or income and expense

17 records for self-employed persons, letters from employers,

18 and any other valid documentation of income including data

19 obtained electronically by the Department or its designees

20 from other sources as described in subsection (b) of this

21 Section. A month's income may be verified by a single pay

22 stub with the monthly income extrapolated from the time

23 period covered by the pay stub. The Department shall send a

24 notice to recipients at least 60 days prior to the end of

25 their period of eligibility that informs them of the

26 requirements for continued eligibility. If a recipient

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1 does not fulfill the requirements for continued

2 eligibility by the deadline established in the notice a

3 notice of cancellation shall be issued to the recipient and

4 coverage shall end no later than the last day of the month

5 following the last day of the eligibility period. A

6 recipient's eligibility may be reinstated without

7 requiring a new application if the recipient fulfills the

8 requirements for continued eligibility prior to the end of

9 the third month following the last date of coverage (or

10 longer period if required by federal regulations). Nothing

11 in this Section shall prevent an individual whose coverage

12 has been cancelled from reapplying for health benefits at

13 any time.

14 (3) By no later than July 1, 2011, require verification

15 of Illinois residency.

16 The Department, with federal approval, may choose to adopt

17 continuous financial eligibility for a full 12 months for

18 adults on Medicaid.

19 (b) The Department shall establish or continue cooperative

20 arrangements with the Social Security Administration, the

21 Illinois Secretary of State, the Department of Human Services,

22 the Department of Revenue, the Department of Employment

23 Security, and any other appropriate entity to gain electronic

24 access, to the extent allowed by law, to information available

25 to those entities that may be appropriate for electronically

26 verifying any factor of eligibility for benefits under the

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1 Program. Data relevant to eligibility shall be provided for no

2 other purpose than to verify the eligibility of new applicants

3 or current recipients of health benefits under the Program.

4 Data shall be requested or provided for any new applicant or

5 current recipient only insofar as that individual's

6 circumstances are relevant to that individual's or another

7 individual's eligibility.

8 (c) Within 90 days of the effective date of this amendatory

9 Act of the 96th General Assembly, the Department of Healthcare

10 and Family Services shall send notice to current recipients

11 informing them of the changes regarding their eligibility

12 verification.

13 (d) As soon as practical if the data is reasonably

14 available, but no later than January 1, 2017, the Department

15 shall compile on a monthly basis data on eligibility

16 redeterminations of beneficiaries of medical assistance

17 provided under Article V of this Code. This data shall be

18 posted on the Department's website, and data from prior months

19 shall be retained and available on the Department's website.

20 The data compiled and reported shall include the following:

21 (1) The total number of redetermination decisions made

22 in a month and, of that total number, the number of

23 decisions to continue or change benefits and the number of

24 decisions to cancel benefits.

25 (2) A breakdown of enrollee language preference for the

26 total number of redetermination decisions made in a month

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1 and, of that total number, a breakdown of enrollee language

2 preference for the number of decisions to continue or

3 change benefits, and a breakdown of enrollee language

4 preference for the number of decisions to cancel benefits.

5 The language breakdown shall include, at a minimum,

6 English, Spanish, and the next 4 most commonly used

7 languages.

8 (3) The percentage of cancellation decisions made in a

9 month due to each of the following:

10 (A) The beneficiary's ineligibility due to excess

11 income.

12 (B) The beneficiary's ineligibility due to not

13 being an Illinois resident.

14 (C) The beneficiary's ineligibility due to being

15 deceased.

16 (D) The beneficiary's request to cancel benefits.

17 (E) The beneficiary's lack of response after

18 notices mailed to the beneficiary are returned to the

19 Department as undeliverable by the United States

20 Postal Service.

21 (F) The beneficiary's lack of response to a request

22 for additional information when reliable information

23 in the beneficiary's account, or other more current

24 information, is unavailable to the Department to make a

25 decision on whether to continue benefits.

26 (G) Other reasons tracked by the Department for the

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1 purpose of ensuring program integrity.

2 (4) If a vendor is utilized to provide services in

3 support of the Department's redetermination decision

4 process, the total number of redetermination decisions

5 made in a month and, of that total number, the number of

6 decisions to continue or change benefits, and the number of

7 decisions to cancel benefits (i) with the involvement of

8 the vendor and (ii) without the involvement of the vendor.

9 (5) Of the total number of benefit cancellations in a

10 month, the number of beneficiaries who return from

11 cancellation within one month, the number of beneficiaries

12 who return from cancellation within 2 months, and the

13 number of beneficiaries who return from cancellation

14 within 3 months. Of the number of beneficiaries who return

15 from cancellation within 3 months, the percentage of those

16 cancellations due to each of the reasons listed under

17 paragraph (3) of this subsection.

18 (e) The Department shall conduct a complete review of the

19 Medicaid redetermination process in order to identify changes

20 that can increase the use of ex parte redetermination

21 processing. This review shall be completed within 90 days after

22 the effective date of this amendatory Act of the 101st General

23 Assembly. Within 90 days of completion of the review, the

24 Department shall seek written federal approval of policy

25 changes the review recommended and implement once approved. The

26 review shall specifically include, but not be limited to, use

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1 of ex parte redeterminations of the following populations:

2 (1) Recipients of developmental disabilities services.

3 (2) Recipients of benefits under the State's Aid to the

4 Aged, Blind, or Disabled program.

5 (3) Recipients of Medicaid long-term care services and

6 supports, including waiver services.

7 (4) All Modified Adjusted Gross Income (MAGI)

8 populations.

9 (5) Populations with no verifiable income.

10 (6) Self-employed people.

11 The report shall also outline populations and

12 circumstances in which an ex parte redetermination is not a

13 recommended option.

14 (f) The Department shall explore and implement, as

15 practical and technologically possible, roles that

16 stakeholders outside State agencies can play to assist in

17 expediting eligibility determinations and redeterminations

18 within 24 months after the effective date of this amendatory

19 Act of the 101st General Assembly. Such practical roles to be

20 explored to expedite the eligibility determination processes

21 shall include the implementation of hospital presumptive

22 eligibility, as authorized by the Patient Protection and

23 Affordable Care Act.

24 (g) The Department or its designee shall seek federal

25 approval to enhance the reasonable compatibility standard from

26 5% to 10%.

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1 (h) Reporting. The Department of Healthcare and Family

2 Services and the Department of Human Services shall publish

3 quarterly reports on their progress in implementing policies

4 and practices pursuant to this Section as modified by this

5 amendatory Act of the 101st General Assembly.

6 (1) The reports shall include, but not be limited to,

7 the following:

8 (A) Medical application processing, including a

9 breakdown of the number of MAGI, non-MAGI, long-term

10 care, and other medical cases pending for various

11 incremental time frames between 0 to 181 or more days.

12 (B) Medical redeterminations completed, including:

13 (i) a breakdown of the number of households that were

14 redetermined ex parte and those that were not; (ii) the

15 reasons households were not redetermined ex parte; and

16 (iii) the relative percentages of these reasons.

17 (C) A narrative discussion on issues identified in

18 the functioning of the State's Integrated Eligibility

19 System and progress on addressing those issues, as well

20 as progress on implementing strategies to address

21 eligibility backlogs, including expanding ex parte

22 determinations to ensure timely eligibility

23 determinations and renewals.

24 (2) Initial reports shall be issued within 90 days

25 after the effective date of this amendatory Act of the

26 101st General Assembly.

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1 (3) All reports shall be published on the Department's

2 website.

3 (Source: P.A. 101-209, eff. 8-5-19.)

4 (305 ILCS 5/12-21.21 new)

5 Sec. 12-21.21. Federal waiver or State Plan amendment. The

6 Department of Healthcare and Family Services and the Department

7 of Human Services shall jointly submit the necessary

8 application to the federal Centers for Medicare and Medicaid

9 Services for a waiver or State Plan amendment to allow remote

10 monitoring and support services as a waiver-reimbursable

11 service for persons with intellectual and developmental

12 disabilities. The application shall be submitted no later than

13 January 1, 2021.

14 No later than July 1, 2021, the Department of Human

15 Services shall adopt rules to allow remote monitoring and

16 support services at community-integrated living arrangements.

17 Section 90-40. The Medical Patient Rights Act is amended by

18 changing Section 3 as follows:

19 (410 ILCS 50/3) (from Ch. 111 1/2, par. 5403)

20 Sec. 3. The following rights are hereby established:

21 (a) The right of each patient to care consistent with sound

22 nursing and medical practices, to be informed of the name of

23 the physician responsible for coordinating his or her care, to

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1 receive information concerning his or her condition and

2 proposed treatment, to refuse any treatment to the extent

3 permitted by law, and to privacy and confidentiality of records

4 except as otherwise provided by law.

5 (b) The right of each patient, regardless of source of

6 payment, to examine and receive a reasonable explanation of his

7 total bill for services rendered by his physician or health

8 care provider, including the itemized charges for specific

9 services received. Each physician or health care provider shall

10 be responsible only for a reasonable explanation of those

11 specific services provided by such physician or health care

12 provider.

13 (c) In the event an insurance company or health services

14 corporation cancels or refuses to renew an individual policy or

15 plan, the insured patient shall be entitled to timely, prior

16 notice of the termination of such policy or plan.

17 An insurance company or health services corporation that

18 requires any insured patient or applicant for new or continued

19 insurance or coverage to be tested for infection with human

20 immunodeficiency virus (HIV) or any other identified causative

21 agent of acquired immunodeficiency syndrome (AIDS) shall (1)

22 give the patient or applicant prior written notice of such

23 requirement, (2) proceed with such testing only upon the

24 written authorization of the applicant or patient, and (3) keep

25 the results of such testing confidential. Notice of an adverse

26 underwriting or coverage decision may be given to any

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1 appropriately interested party, but the insurer may only

2 disclose the test result itself to a physician designated by

3 the applicant or patient, and any such disclosure shall be in a

4 manner that assures confidentiality.

5 The Department of Insurance shall enforce the provisions of

6 this subsection.

7 (d) The right of each patient to privacy and

8 confidentiality in health care. Each physician, health care

9 provider, health services corporation and insurance company

10 shall refrain from disclosing the nature or details of services

11 provided to patients, except that such information may be

12 disclosed: (1) to the patient, (2) to the party making

13 treatment decisions if the patient is incapable of making

14 decisions regarding the health services provided, (3) for

15 treatment in accordance with 45 CFR 164.501 and 164.506, (4)

16 for payment in accordance with 45 CFR 164.501 and 164.506, (5)

17 to those parties responsible for peer review, utilization

18 review, and quality assurance, (6) for health care operations

19 in accordance with 45 CFR 164.501 and 164.506, (7) to those

20 parties required to be notified under the Abused and Neglected

21 Child Reporting Act or the Illinois Sexually Transmissible

22 Disease Control Act, or (8) as otherwise permitted, authorized,

23 or required by State or federal law. This right may be waived

24 in writing by the patient or the patient's guardian or legal

25 representative, but a physician or other health care provider

26 may not condition the provision of services on the patient's,

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1 guardian's, or legal representative's agreement to sign such a

2 waiver. In the interest of public health, safety, and welfare,

3 patient information, including, but not limited to, health

4 information, demographic information, and information about

5 the services provided to patients, may be transmitted to or

6 through a health information exchange, as that term is defined

7 in Section 2 of the Mental Health and Developmental

8 Disabilities Confidentiality Act, in accordance with the

9 disclosures permitted pursuant to this Section. Patients shall

10 be provided the opportunity to opt out of their health

11 information being transmitted to or through a health

12 information exchange in accordance with the regulations,

13 standards, or contractual obligations adopted by the Illinois

14 Health Information Exchange Office ~~Authority~~ in accordance

15 with Section 9.6 of the Mental Health and Developmental

16 Disabilities Confidentiality Act, Section 9.6 of the AIDS

17 Confidentiality Act, or Section 31.8 of the Genetic Information

18 Privacy Act, as applicable. In the case of a patient choosing

19 to opt out of having his or her information available on an

20 HIE, nothing in this Act shall cause the physician or health

21 care provider to be liable for the release of a patient's

22 health information by other entities that may possess such

23 information, including, but not limited to, other health

24 professionals, providers, laboratories, pharmacies, hospitals,

25 ambulatory surgical centers, and nursing homes.

26 (Source: P.A. 98-1046, eff. 1-1-15.)

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1 Section 90-45. The Genetic Information Privacy Act is

2 amended by changing Section 10 as follows:

3 (410 ILCS 513/10)

4 Sec. 10. Definitions. As used in this Act:

5 "Office ~~Authority~~" means the Illinois Health Information

6 Exchange Office ~~Authority~~ established pursuant to the Illinois

7 Health Information Exchange and Technology Act.

8 "Business associate" has the meaning ascribed to it under

9 HIPAA, as specified in 45 CFR 160.103.

10 "Covered entity" has the meaning ascribed to it under

11 HIPAA, as specified in 45 CFR 160.103.

12 "De-identified information" means health information that

13 is not individually identifiable as described under HIPAA, as

14 specified in 45 CFR 164.514(b).

15 "Disclosure" has the meaning ascribed to it under HIPAA, as

16 specified in 45 CFR 160.103.

17 "Employer" means the State of Illinois, any unit of local

18 government, and any board, commission, department,

19 institution, or school district, any party to a public

20 contract, any joint apprenticeship or training committee

21 within the State, and every other person employing employees

22 within the State.

23 "Employment agency" means both public and private

24 employment agencies and any person, labor organization, or

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1 labor union having a hiring hall or hiring office regularly

2 undertaking, with or without compensation, to procure

3 opportunities to work, or to procure, recruit, refer, or place

4 employees.

5 "Family member" means, with respect to an individual, (i)

6 the spouse of the individual; (ii) a dependent child of the

7 individual, including a child who is born to or placed for

8 adoption with the individual; (iii) any other person qualifying

9 as a covered dependent under a managed care plan; and (iv) all

10 other individuals related by blood or law to the individual or

11 the spouse or child described in subsections (i) through (iii)

12 of this definition.

13 "Genetic information" has the meaning ascribed to it under

14 HIPAA, as specified in 45 CFR 160.103.

15 "Genetic monitoring" means the periodic examination of

16 employees to evaluate acquired modifications to their genetic

17 material, such as chromosomal damage or evidence of increased

18 occurrence of mutations that may have developed in the course

19 of employment due to exposure to toxic substances in the

20 workplace in order to identify, evaluate, and respond to

21 effects of or control adverse environmental exposures in the

22 workplace.

23 "Genetic services" has the meaning ascribed to it under

24 HIPAA, as specified in 45 CFR 160.103.

25 "Genetic testing" and "genetic test" have the meaning

26 ascribed to "genetic test" under HIPAA, as specified in 45 CFR

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1 160.103. "Genetic testing" includes direct-to-consumer

2 commercial genetic testing.

3 "Health care operations" has the meaning ascribed to it

4 under HIPAA, as specified in 45 CFR 164.501.

5 "Health care professional" means (i) a licensed physician,

6 (ii) a licensed physician assistant, (iii) a licensed advanced

7 practice registered nurse, (iv) a licensed dentist, (v) a

8 licensed podiatrist, (vi) a licensed genetic counselor, or

9 (vii) an individual certified to provide genetic testing by a

10 state or local public health department.

11 "Health care provider" has the meaning ascribed to it under

12 HIPAA, as specified in 45 CFR 160.103.

13 "Health facility" means a hospital, blood bank, blood

14 center, sperm bank, or other health care institution, including

15 any "health facility" as that term is defined in the Illinois

16 Finance Authority Act.

17 "Health information exchange" or "HIE" means a health

18 information exchange or health information organization that

19 exchanges health information electronically that (i) is

20 established pursuant to the Illinois Health Information

21 Exchange and Technology Act, or any subsequent amendments

22 thereto, and any administrative rules promulgated thereunder;

23 (ii) has established a data sharing arrangement with the Office

24 ~~Authority~~; or (iii) as of August 16, 2013, was designated by

25 the Illinois Health Information Exchange Authority (now

26 Office) Board as a member of, or was represented on, the

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1 Authority Board's Regional Health Information Exchange

2 Workgroup; provided that such designation shall not require the

3 establishment of a data sharing arrangement or other

4 participation with the Illinois Health Information Exchange or

5 the payment of any fee. In certain circumstances, in accordance

6 with HIPAA, an HIE will be a business associate.

7 "Health oversight agency" has the meaning ascribed to it

8 under HIPAA, as specified in 45 CFR 164.501.

9 "HIPAA" means the Health Insurance Portability and

10 Accountability Act of 1996, Public Law 104-191, as amended by

11 the Health Information Technology for Economic and Clinical

12 Health Act of 2009, Public Law 111-05, and any subsequent

13 amendments thereto and any regulations promulgated thereunder.

14 "Insurer" means (i) an entity that is subject to the

15 jurisdiction of the Director of Insurance and (ii) a managed

16 care plan.

17 "Labor organization" includes any organization, labor

18 union, craft union, or any voluntary unincorporated

19 association designed to further the cause of the rights of

20 union labor that is constituted for the purpose, in whole or in

21 part, of collective bargaining or of dealing with employers

22 concerning grievances, terms or conditions of employment, or

23 apprenticeships or applications for apprenticeships, or of

24 other mutual aid or protection in connection with employment,

25 including apprenticeships or applications for apprenticeships.

26 "Licensing agency" means a board, commission, committee,

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1 council, department, or officers, except a judicial officer, in

2 this State or any political subdivision authorized to grant,

3 deny, renew, revoke, suspend, annul, withdraw, or amend a

4 license or certificate of registration.

5 "Limited data set" has the meaning ascribed to it under

6 HIPAA, as described in 45 CFR 164.514(e)(2).

7 "Managed care plan" means a plan that establishes,

8 operates, or maintains a network of health care providers that

9 have entered into agreements with the plan to provide health

10 care services to enrollees where the plan has the ultimate and

11 direct contractual obligation to the enrollee to arrange for

12 the provision of or pay for services through:

13 (1) organizational arrangements for ongoing quality

14 assurance, utilization review programs, or dispute

15 resolution; or

16 (2) financial incentives for persons enrolled in the

17 plan to use the participating providers and procedures

18 covered by the plan.

19 A managed care plan may be established or operated by any

20 entity including a licensed insurance company, hospital or

21 medical service plan, health maintenance organization, limited

22 health service organization, preferred provider organization,

23 third party administrator, or an employer or employee

24 organization.

25 "Minimum necessary" means HIPAA's standard for using,

26 disclosing, and requesting protected health information found

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1 in 45 CFR 164.502(b) and 164.514(d).

2 "Nontherapeutic purpose" means a purpose that is not

3 intended to improve or preserve the life or health of the

4 individual whom the information concerns.

5 "Organized health care arrangement" has the meaning

6 ascribed to it under HIPAA, as specified in 45 CFR 160.103.

7 "Patient safety activities" has the meaning ascribed to it

8 under 42 CFR 3.20.

9 "Payment" has the meaning ascribed to it under HIPAA, as

10 specified in 45 CFR 164.501.

11 "Person" includes any natural person, partnership,

12 association, joint venture, trust, governmental entity, public

13 or private corporation, health facility, or other legal entity.

14 "Protected health information" has the meaning ascribed to

15 it under HIPAA, as specified in 45 CFR 164.103.

16 "Research" has the meaning ascribed to it under HIPAA, as

17 specified in 45 CFR 164.501.

18 "State agency" means an instrumentality of the State of

19 Illinois and any instrumentality of another state which

20 pursuant to applicable law or a written undertaking with an

21 instrumentality of the State of Illinois is bound to protect

22 the privacy of genetic information of Illinois persons.

23 "Treatment" has the meaning ascribed to it under HIPAA, as

24 specified in 45 CFR 164.501.

25 "Use" has the meaning ascribed to it under HIPAA, as

26 specified in 45 CFR 160.103, where context dictates.

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1 (Source: P.A. 100-513, eff. 1-1-18; 101-132, eff. 1-1-20.)

2 Section 90-50. The Mental Health and Developmental

3 Disabilities Confidentiality Act is amended by changing

4 Sections 2, 9.5, 9.6, 9.8, 9.9, and 9.11 as follows:

5 (740 ILCS 110/2) (from Ch. 91 1/2, par. 802)

6 Sec. 2. The terms used in this Act, unless the context

7 requires otherwise, have the meanings ascribed to them in this

8 Section.

9 "Agent" means a person who has been legally appointed as an

10 individual's agent under a power of attorney for health care or

11 for property.

12 "Business associate" has the meaning ascribed to it under

13 HIPAA, as specified in 45 CFR 160.103.

14 "Confidential communication" or "communication" means any

15 communication made by a recipient or other person to a

16 therapist or to or in the presence of other persons during or

17 in connection with providing mental health or developmental

18 disability services to a recipient. Communication includes

19 information which indicates that a person is a recipient.

20 "Communication" does not include information that has been

21 de-identified in accordance with HIPAA, as specified in 45 CFR

22 164.514.

23 "Covered entity" has the meaning ascribed to it under

24 HIPAA, as specified in 45 CFR 160.103.

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1 "Guardian" means a legally appointed guardian or

2 conservator of the person.

3 "Health information exchange" or "HIE" means a health

4 information exchange or health information organization that

5 oversees and governs the electronic exchange of health

6 information that (i) is established pursuant to the Illinois

7 Health Information Exchange and Technology Act, or any

8 subsequent amendments thereto, and any administrative rules

9 promulgated thereunder; or (ii) has established a data sharing

10 arrangement with the Illinois Health Information Exchange; or

11 (iii) as of the effective date of this amendatory Act of the

12 98th General Assembly, was designated by the Illinois Health

13 Information Exchange Office ~~Authority~~ Board as a member of, or

14 was represented on, the Office ~~Authority~~ Board's Regional

15 Health Information Exchange Workgroup; provided that such

16 designation shall not require the establishment of a data

17 sharing arrangement or other participation with the Illinois

18 Health Information Exchange or the payment of any fee.

19 "HIE purposes" means those uses and disclosures (as those

20 terms are defined under HIPAA, as specified in 45 CFR 160.103)

21 for activities of an HIE: (i) set forth in the Illinois Health

22 Information Exchange and Technology Act or any subsequent

23 amendments thereto and any administrative rules promulgated

24 thereunder; or (ii) which are permitted under federal law.

25 "HIPAA" means the Health Insurance Portability and

26 Accountability Act of 1996, Public Law 104-191, and any

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1 subsequent amendments thereto and any regulations promulgated

2 thereunder, including the Security Rule, as specified in 45 CFR

3 164.302-18, and the Privacy Rule, as specified in 45 CFR

4 164.500-34.

5 "Integrated health system" means an organization with a

6 system of care which incorporates physical and behavioral

7 healthcare and includes care delivered in an inpatient and

8 outpatient setting.

9 "Interdisciplinary team" means a group of persons

10 representing different clinical disciplines, such as medicine,

11 nursing, social work, and psychology, providing and

12 coordinating the care and treatment for a recipient of mental

13 health or developmental disability services. The group may be

14 composed of individuals employed by one provider or multiple

15 providers.

16 "Mental health or developmental disabilities services" or

17 "services" includes but is not limited to examination,

18 diagnosis, evaluation, treatment, training, pharmaceuticals,

19 aftercare, habilitation or rehabilitation.

20 "Personal notes" means:

21 (i) information disclosed to the therapist in

22 confidence by other persons on condition that such

23 information would never be disclosed to the recipient or

24 other persons;

25 (ii) information disclosed to the therapist by the

26 recipient which would be injurious to the recipient's

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1 relationships to other persons, and

2 (iii) the therapist's speculations, impressions,

3 hunches, and reminders.

4 "Parent" means a parent or, in the absence of a parent or

5 guardian, a person in loco parentis.

6 "Recipient" means a person who is receiving or has received

7 mental health or developmental disabilities services.

8 "Record" means any record kept by a therapist or by an

9 agency in the course of providing mental health or

10 developmental disabilities service to a recipient concerning

11 the recipient and the services provided. "Records" includes all

12 records maintained by a court that have been created in

13 connection with, in preparation for, or as a result of the

14 filing of any petition or certificate under Chapter II, Chapter

15 III, or Chapter IV of the Mental Health and Developmental

16 Disabilities Code and includes the petitions, certificates,

17 dispositional reports, treatment plans, and reports of

18 diagnostic evaluations and of hearings under Article VIII of

19 Chapter III or under Article V of Chapter IV of that Code.

20 Record does not include the therapist's personal notes, if such

21 notes are kept in the therapist's sole possession for his own

22 personal use and are not disclosed to any other person, except

23 the therapist's supervisor, consulting therapist or attorney.

24 If at any time such notes are disclosed, they shall be

25 considered part of the recipient's record for purposes of this

26 Act. "Record" does not include information that has been

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1 de-identified in accordance with HIPAA, as specified in 45 CFR

2 164.514. "Record" does not include a reference to the receipt

3 of mental health or developmental disabilities services noted

4 during a patient history and physical or other summary of care.

5 "Record custodian" means a person responsible for

6 maintaining a recipient's record.

7 "Therapist" means a psychiatrist, physician, psychologist,

8 social worker, or nurse providing mental health or

9 developmental disabilities services or any other person not

10 prohibited by law from providing such services or from holding

11 himself out as a therapist if the recipient reasonably believes

12 that such person is permitted to do so. Therapist includes any

13 successor of the therapist.

14 "Therapeutic relationship" means the receipt by a

15 recipient of mental health or developmental disabilities

16 services from a therapist. "Therapeutic relationship" does not

17 include independent evaluations for a purpose other than the

18 provision of mental health or developmental disabilities

19 services.

20 (Source: P.A. 98-378, eff. 8-16-13; 99-28, eff. 1-1-16.)

21 (740 ILCS 110/9.5)

22 Sec. 9.5. Use and disclosure of information to an HIE.

23 (a) An HIE, person, therapist, facility, agency,

24 interdisciplinary team, integrated health system, business

25 associate, or covered entity may, without a recipient's

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1 consent, use or disclose information from a recipient's record

2 in connection with an HIE, including disclosure to the Illinois

3 Health Information Exchange Office ~~Authority~~, an HIE, or the

4 business associate of either. An HIE and its business associate

5 may, without a recipient's consent, use or disclose and

6 re-disclose such information for HIE purposes or for such other

7 purposes as are specifically allowed under this Act.

8 (b) As used in this Section:

9 (1) "facility" means a developmental disability

10 facility as defined in Section 1-107 of the Mental Health

11 and Developmental Disabilities Code or a mental health

12 facility as defined in Section 1-114 of the Mental Health

13 and Developmental Disabilities Code; and

14 (2) the terms "disclosure" and "use" have the meanings

15 ascribed to them under HIPAA, as specified in 45 CFR

16 160.103.

17 (Source: P.A. 98-378, eff. 8-16-13.)

18 (740 ILCS 110/9.6)

19 Sec. 9.6. HIE opt-out. The Illinois Health Information

20 Exchange Office ~~Authority~~ shall, through appropriate rules,

21 standards, or contractual obligations, which shall be binding

22 upon any HIE, as defined under Section 2, require that

23 participants of such HIE provide each recipient whose record is

24 accessible through the health information exchange the

25 reasonable opportunity to expressly decline the further

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1 disclosure of the record by the health information exchange to

2 third parties, except to the extent permitted by law such as

3 for purposes of public health reporting. These rules,

4 standards, or contractual obligations shall permit a recipient

5 to revoke a prior decision to opt-out or a decision not to

6 opt-out. These rules, standards, or contractual obligations

7 shall provide for written notice of a recipient's right to

8 opt-out which directs the recipient to a health information

9 exchange website containing (i) an explanation of the purposes

10 of the health information exchange; and (ii) audio, visual, and

11 written instructions on how to opt-out of participation in

12 whole or in part to the extent possible. These rules,

13 standards, or contractual obligations shall be reviewed

14 annually and updated as the technical options develop. The

15 recipient shall be provided meaningful disclosure regarding

16 the health information exchange, and the recipient's decision

17 whether to opt-out should be obtained without undue inducement

18 or any element of force, fraud, deceit, duress, or other form

19 of constraint or coercion. To the extent that HIPAA, as

20 specified in 45 CFR 164.508(b)(4), prohibits a covered entity

21 from conditioning the provision of its services upon an

22 individual's provision of an authorization, an HIE participant

23 shall not condition the provision of its services upon a

24 recipient's decision to opt-out of further disclosure of the

25 record by an HIE to third parties. The Illinois Health

26 Information Exchange Office ~~Authority~~ shall, through

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1 appropriate rules, standards, or contractual obligations,

2 which shall be binding upon any HIE, as defined under Section

3 2, give consideration to the format and content of the

4 meaningful disclosure and the availability to recipients of

5 information regarding an HIE and the rights of recipients under

6 this Section to expressly decline the further disclosure of the

7 record by an HIE to third parties. The Illinois Health

8 Information Exchange Office ~~Authority~~ shall also give annual

9 consideration to enable a recipient to expressly decline the

10 further disclosure by an HIE to third parties of selected

11 portions of the recipient's record while permitting disclosure

12 of the recipient's remaining patient health information. In

13 establishing rules, standards, or contractual obligations

14 binding upon HIEs under this Section to give effect to

15 recipient disclosure preferences, the Illinois Health

16 Information Exchange Office ~~Authority~~ in its discretion may

17 consider the extent to which relevant health information

18 technologies reasonably available to therapists and HIEs in

19 this State reasonably enable the effective segmentation of

20 specific information within a recipient's electronic medical

21 record and reasonably enable the effective exclusion of

22 specific information from disclosure by an HIE to third

23 parties, as well as the availability of sufficient

24 authoritative clinical guidance to enable the practical

25 application of such technologies to effect recipient

26 disclosure preferences. The provisions of this Section 9.6

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1 shall not apply to the secure electronic transmission of data

2 which is point-to-point communication directed by the data

3 custodian. Any rules or standards promulgated under this

4 Section which apply to HIEs shall be limited to that subject

5 matter required by this Section and shall not include any

6 requirement that an HIE enter a data sharing arrangement or

7 otherwise participate with the Illinois Health Information

8 Exchange. In connection with its annual consideration

9 regarding the issue of segmentation of information within a

10 medical record and prior to the adoption of any rules or

11 standards regarding that issue, the Office ~~Authority~~ Board

12 shall consider information provided by affected persons or

13 organizations regarding the feasibility, availability, cost,

14 reliability, and interoperability of any technology or process

15 under consideration by the Board. Nothing in this Act shall be

16 construed to limit the authority of the Illinois Health

17 Information Exchange Office ~~Authority~~ to impose limits or

18 conditions on consent for disclosures to or through any HIE, as

19 defined under Section 2, which are more restrictive than the

20 requirements under this Act or under HIPAA.

21 (Source: P.A. 98-378, eff. 8-16-13.)

22 (740 ILCS 110/9.8)

23 Sec. 9.8. Business associates. An HIE, person, therapist,

24 facility, agency, interdisciplinary team, integrated health

25 system, business associate, covered entity, the Illinois

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1 Health Information Exchange Office ~~Authority~~, or entity

2 facilitating the establishment or operation of an HIE may,

3 without a recipient's consent, utilize the services of and

4 disclose information from a recipient's record to a business

5 associate, as defined by and in accordance with the

6 requirements set forth under HIPAA. As used in this Section,

7 the term "disclosure" has the meaning ascribed to it by HIPAA,

8 as specified in 45 CFR 160.103.

9 (Source: P.A. 98-378, eff. 8-16-13.)

10 (740 ILCS 110/9.9)

11 Sec. 9.9. Record locator service.

12 (a) An HIE, person, therapist, facility, agency,

13 interdisciplinary team, integrated health system, business

14 associate, covered entity, the Illinois Health Information

15 Exchange Office ~~Authority~~, or entity facilitating the

16 establishment or operation of an HIE may, without a recipient's

17 consent, disclose the existence of a recipient's record to a

18 record locator service, master patient index, or other

19 directory or services necessary to support and enable the

20 establishment and operation of an HIE.

21 (b) As used in this Section:

22 (1) the term "disclosure" has the meaning ascribed to

23 it under HIPAA, as specified in 45 CFR 160.103; and

24 (2) "facility" means a developmental disability

25 facility as defined in Section 1-107 of the Mental Health

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1 and Developmental Disabilities Code or a mental health

2 facility as defined in Section 1-114 of the Mental Health

3 and Developmental Disabilities Code.

4 (Source: P.A. 98-378, eff. 8-16-13.)

5 (740 ILCS 110/9.11)

6 Sec. 9.11. Establishment and disclosure of limited data

7 sets and de-identified information.

8 (a) An HIE, person, therapist, facility, agency,

9 interdisciplinary team, integrated health system, business

10 associate, covered entity, the Illinois Health Information

11 Exchange Office ~~Authority~~, or entity facilitating the

12 establishment or operation of an HIE may, without a recipient's

13 consent, use information from a recipient's record to

14 establish, or disclose such information to a business associate

15 to establish, and further disclose information from a

16 recipient's record as part of a limited data set as defined by

17 and in accordance with the requirements set forth under HIPAA,

18 as specified in 45 CFR 164.514(e). An HIE, person, therapist,

19 facility, agency, interdisciplinary team, integrated health

20 system, business associate, covered entity, the Illinois

21 Health Information Exchange Office ~~Authority~~, or entity

22 facilitating the establishment or operation of an HIE may,

23 without a recipient's consent, use information from a

24 recipient's record or disclose information from a recipient's

25 record to a business associate to de-identity the information

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1 in accordance with HIPAA, as specified in 45 CFR 164.514.

2 (b) As used in this Section:

3 (1) the terms "disclosure" and "use" shall have the

4 meanings ascribed to them by HIPAA, as specified in 45 CFR

5 160.103; and

6 (2) "facility" means a developmental disability

7 facility as defined in Section 1-107 of the Mental Health

8 and Developmental Disabilities Code or a mental health

9 facility as defined in Section 1-114 of the Mental Health

10 and Developmental Disabilities Code.

11 (Source: P.A. 98-378, eff. 8-16-13.)

12 Article 99. Effective Date

13 Section 99-99. Effective date. This Act takes effect upon

14 becoming law.".