Rep. Gregory Harris
Filed: 5/23/2020
 
 


 




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1
AMENDMENT TO SENATE BILL 1864




2 AMENDMENT NO. ______. Amend Senate Bill 1864, AS AMENDED, 
3by replacing everything after the enacting clause with the 
4following:


5
"Article 5.  Health Care Affordability Act


6 Section 5-1. Short title. This Article may be cited as the 
7Health Care Affordability Act. References in this Article to 
8"this Act" mean this Article.

9 Section 5-5. Findings. The General Assembly finds that:
10  (1) The State is committed to improving the health and 
11 well-being of Illinois residents and families.
12  (2) Illinois has over 835,000 uninsured residents, 
13 with a total uninsured rate of 7.9%.
14  (3) 774,500 of Illinois' uninsured residents are below 
15 400% of the federal poverty level, with higher uninsured 
 
 
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1 rates of more than 13% below 250% of the federal poverty 
2 level and an uninsured rate of 8.3% below 400% of the 
3 federal poverty level.
4  (4) The cost of health insurance premiums remains a 
5 barrier to obtaining health insurance coverage for many 
6 Illinois residents and families.
7  (5) Many Illinois residents and families who have 
8 health insurance cannot afford to use it due to high 
9 deductibles and cost sharing.
10  (6) Improving health insurance affordability is key to 
11 increasing health insurance coverage and access.
12  (7) Despite progress made under the Patient Protection 
13 and Affordable Care Act, health insurance is still not 
14 affordable enough for many Illinois residents and 
15 families.
16  (8) Illinois has a lower uninsured rate than the 
17 national average of 10.2%, but a higher uninsured rate 
18 compared to states that have state-directed policies to 
19 improve affordability, including Massachusetts with an 
20 uninsured rate of 3.2%.
21  (9) Illinois has an opportunity to create a healthy 
22 Illinois where health insurance coverage is more 
23 affordable and accessible for all Illinois residents, 
24 families, and small businesses.

25 Section 5-10. Feasibility study. 
 
 
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1 (a) The Department of Healthcare and Family Services, in 
2consultation with the Department of Insurance, shall oversee a 
3feasibility study to explore options to make health insurance 
4more affordable for low-income and middle-income residents. 
5The study shall include policies targeted at increasing health 
6care affordability and access, including policies being 
7discussed in other states and nationally. The study shall 
8follow the best practices of other states and include an 
9Illinois-specific actuarial and economic analysis of 
10demographic and market dynamics.
11 (b) The study shall produce cost estimates for the policies 
12studied under subsection (a) along with the impact of the 
13policies on health insurance affordability and access and the 
14uninsured rates for low-income and middle-income residents, 
15with break-out data by geography, race, ethnicity, and income 
16level. The study shall evaluate how multiple policies 
17implemented together affect costs and outcomes and how policies 
18could be structured to leverage federal matching funds and 
19federal pass-through awards.
20 (c) The Department of Healthcare and Family Services, in 
21consultation with the Department of Insurance, shall develop 
22and submit no later than February 28, 2021 a report to the 
23General Assembly and the Governor concerning the design, costs, 
24benefits, and implementation of State options to increase 
25access to affordable health care coverage that leverage 
26existing 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 
4Kidney Disease Prevention and Education Task Force Act. 
5References 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% 
 
 
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1 of them received a kidney.
2  (3) Although dialysis is a life-extending treatment, 
3 the best and most cost-effective treatment for kidney 
4 failure is a kidney transplant. Currently, the wait in 
5 Illinois for a deceased donor kidney is 5-7 years, and 13 
6 people die while waiting every day.
7  (4) If chronic kidney disease is detected early and 
8 managed appropriately, the individual can receive 
9 treatment sooner to help protect the kidneys, the 
10 deterioration in kidney function can be slowed or even 
11 stopped, and the risk of associated cardiovascular 
12 complications and other complications can be reduced.
13  (5) In light of the COVID-19 pandemic and the increased 
14 risk of infection to patients with preexisting conditions, 
15 it is imperative to provide those with kidney disease with 
16 support.

17 Section 10-10. Kidney Disease Prevention and Education 
18Task Force.
19 (a) There is hereby established the Kidney Disease 
20Prevention and Education Task Force to work directly with 
21educational institutions to create health education programs 
22to increase awareness of and to examine chronic kidney disease, 
23transplantations, living and deceased kidney donation, and the 
24existing disparity in the rates of those afflicted between 
25Caucasians and minorities.
 
 
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1 (b) The Task Force shall develop a sustainable plan to 
2raise awareness about early detection, promote health equity, 
3and reduce the burden of kidney disease throughout the State, 
4which shall include an ongoing campaign that includes health 
5education workshops and seminars, relevant research, and 
6preventive screenings and that promotes social media campaigns 
7and TV and radio commercials.
8 (c) Membership of the Task Force shall be as follows:
9  (1) one member of the Senate, appointed by the Senate 
10 President, who shall serve as Co-Chair;
11  (2) one member of the House of Representatives, 
12 appointed by the Speaker of the House, who shall serve as 
13 Co-Chair;
14  (3) one member of the House of Representatives, 
15 appointed by the Minority Leader of the House;
16  (4) one member of the Senate, appointed by the Senate 
17 Minority Leader;
18  (5) one member representing the Department of Public 
19 Health, appointed by the Governor;
20  (6) one member representing the Department of 
21 Healthcare and Family Services, appointed by the Governor;
22  (7) one member representing a medical center in a 
23 county with a population of more 3 million residents, 
24 appointed by the Co-Chairs;
25  (8) one member representing a physician's association 
26 in a county with a population of more than 3 million 
 
 
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1 residents, appointed by the Co-Chairs;
2  (9) one member representing a not-for-profit organ 
3 procurement organization, appointed by the Co-Chairs;
4  (10) one member representing a national nonprofit 
5 research kidney organization in the State of Illinois, 
6 appointed by the Co-Chairs; and
7  (11) the Secretary of State or his or her designee.
8 (d) Members of the Task Force shall serve without 
9compensation.
10 (e) The Department of Public Health shall provide 
11administrative support to the Task Force.
12 (f) The Task Force shall submit its final report to the 
13General Assembly on or before December 31, 2021 and, upon the 
14filing of its final report, is dissolved.

15 Section 10-15. Repeal. This Act is repealed on June 1, 
162022.

17
Article 90.  Amendatory Provisions


18 Section 90-5. The Freedom of Information Act is amended by 
19changing Section 7.5 as follows:

20 (5 ILCS 140/7.5)
21 Sec. 7.5. Statutory exemptions. To the extent provided for 
22by the statutes referenced below, the following shall be exempt 
 
 
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1from inspection and copying:
2  (a) All information determined to be confidential 
3 under Section 4002 of the Technology Advancement and 
4 Development Act.
5  (b) Library circulation and order records identifying 
6 library users with specific materials under the Library 
7 Records Confidentiality Act.
8  (c) Applications, related documents, and medical 
9 records received by the Experimental Organ Transplantation 
10 Procedures Board and any and all documents or other records 
11 prepared by the Experimental Organ Transplantation 
12 Procedures Board or its staff relating to applications it 
13 has received.
14  (d) Information and records held by the Department of 
15 Public Health and its authorized representatives relating 
16 to known or suspected cases of sexually transmissible 
17 disease or any information the disclosure of which is 
18 restricted under the Illinois Sexually Transmissible 
19 Disease Control Act.
20  (e) Information the disclosure of which is exempted 
21 under Section 30 of the Radon Industry Licensing Act.
22  (f) Firm performance evaluations under Section 55 of 
23 the Architectural, Engineering, and Land Surveying 
24 Qualifications Based Selection Act.
25  (g) Information the disclosure of which is restricted 
26 and exempted under Section 50 of the Illinois Prepaid 
 
 
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1 Tuition Act.
2  (h) Information the disclosure of which is exempted 
3 under the State Officials and Employees Ethics Act, and 
4 records of any lawfully created State or local inspector 
5 general's office that would be exempt if created or 
6 obtained by an Executive Inspector General's office under 
7 that Act.
8  (i) Information contained in a local emergency energy 
9 plan submitted to a municipality in accordance with a local 
10 emergency energy plan ordinance that is adopted under 
11 Section 11-21.5-5 of the Illinois Municipal Code.
12  (j) Information and data concerning the distribution 
13 of surcharge moneys collected and remitted by carriers 
14 under the Emergency Telephone System Act.
15  (k) Law enforcement officer identification information 
16 or driver identification information compiled by a law 
17 enforcement agency or the Department of Transportation 
18 under Section 11-212 of the Illinois Vehicle Code.
19  (l) Records and information provided to a residential 
20 health care facility resident sexual assault and death 
21 review team or the Executive Council under the Abuse 
22 Prevention Review Team Act.
23  (m) Information provided to the predatory lending 
24 database created pursuant to Article 3 of the Residential 
25 Real Property Disclosure Act, except to the extent 
26 authorized under that Article.
 
 
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1  (n) Defense budgets and petitions for certification of 
2 compensation and expenses for court appointed trial 
3 counsel as provided under Sections 10 and 15 of the Capital 
4 Crimes Litigation Act. This subsection (n) shall apply 
5 until the conclusion of the trial of the case, even if the 
6 prosecution chooses not to pursue the death penalty prior 
7 to trial or sentencing.
8  (o) Information that is prohibited from being 
9 disclosed under Section 4 of the Illinois Health and 
10 Hazardous Substances Registry Act.
11  (p) Security portions of system safety program plans, 
12 investigation reports, surveys, schedules, lists, data, or 
13 information compiled, collected, or prepared by or for the 
14 Regional Transportation Authority under Section 2.11 of 
15 the Regional Transportation Authority Act or the St. Clair 
16 County Transit District under the Bi-State Transit Safety 
17 Act. 
18  (q) Information prohibited from being disclosed by the 
19 Personnel Record Review Act. 
20  (r) Information prohibited from being disclosed by the 
21 Illinois School Student Records Act. 
22  (s) Information the disclosure of which is restricted 
23 under Section 5-108 of the Public Utilities Act. 

24  (t) All identified or deidentified health information 
25 in the form of health data or medical records contained in, 
26 stored in, submitted to, transferred by, or released from 
 
 
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1 the Illinois Health Information Exchange, and identified 
2 or deidentified health information in the form of health 
3 data and medical records of the Illinois Health Information 
4 Exchange in the possession of the Illinois Health 
5 Information Exchange Office Authority due to its 
6 administration of the Illinois Health Information 
7 Exchange. The terms "identified" and "deidentified" shall 
8 be given the same meaning as in the Health Insurance 
9 Portability and Accountability Act of 1996, Public Law 
10 104-191, or any subsequent amendments thereto, and any 
11 regulations promulgated thereunder. 
12  (u) Records and information provided to an independent 
13 team of experts under the Developmental Disability and 
14 Mental Health Safety Act (also known as Brian's Law). 
15  (v) Names and information of people who have applied 
16 for or received Firearm Owner's Identification Cards under 
17 the Firearm Owners Identification Card Act or applied for 
18 or received a concealed carry license under the Firearm 
19 Concealed Carry Act, unless otherwise authorized by the 
20 Firearm Concealed Carry Act; and databases under the 
21 Firearm Concealed Carry Act, records of the Concealed Carry 
22 Licensing Review Board under the Firearm Concealed Carry 
23 Act, and law enforcement agency objections under the 
24 Firearm Concealed Carry Act. 
25  (w) Personally identifiable information which is 
26 exempted from disclosure under subsection (g) of Section 
 
 
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1 19.1 of the Toll Highway Act.
2  (x) Information which is exempted from disclosure 
3 under Section 5-1014.3 of the Counties Code or Section 
4 8-11-21 of the Illinois Municipal Code. 
5  (y) Confidential information under the Adult 
6 Protective Services Act and its predecessor enabling 
7 statute, the Elder Abuse and Neglect Act, including 
8 information about the identity and administrative finding 
9 against any caregiver of a verified and substantiated 
10 decision of abuse, neglect, or financial exploitation of an 
11 eligible adult maintained in the Registry established 
12 under Section 7.5 of the Adult Protective Services Act. 
13  (z) Records and information provided to a fatality 
14 review team or the Illinois Fatality Review Team Advisory 
15 Council under Section 15 of the Adult Protective Services 
16 Act. 
17  (aa) Information which is exempted from disclosure 
18 under Section 2.37 of the Wildlife Code. 
19  (bb) Information which is or was prohibited from 
20 disclosure by the Juvenile Court Act of 1987. 
21  (cc) Recordings made under the Law Enforcement 
22 Officer-Worn Body Camera Act, except to the extent 
23 authorized under that Act.
24  (dd) Information that is prohibited from being 
25 disclosed under Section 45 of the Condominium and Common 
26 Interest Community Ombudsperson Act. 
 
 
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1  (ee) Information that is exempted from disclosure 
2 under Section 30.1 of the Pharmacy Practice Act. 
3  (ff) Information that is exempted from disclosure 
4 under the Revised Uniform Unclaimed Property Act. 
5  (gg) Information that is prohibited from being 
6 disclosed under Section 7-603.5 of the Illinois Vehicle 
7 Code. 
8  (hh) Records that are exempt from disclosure under 
9 Section 1A-16.7 of the Election Code. 
10  (ii) Information which is exempted from disclosure 
11 under Section 2505-800 of the Department of Revenue Law of 
12 the Civil Administrative Code of Illinois. 
13  (jj) Information and reports that are required to be 
14 submitted to the Department of Labor by registering day and 
15 temporary labor service agencies but are exempt from 
16 disclosure under subsection (a-1) of Section 45 of the Day 
17 and Temporary Labor Services Act. 
18  (kk) Information prohibited from disclosure under the 
19 Seizure and Forfeiture Reporting Act. 
20  (ll) Information the disclosure of which is restricted 
21 and exempted under Section 5-30.8 of the Illinois Public 
22 Aid Code. 
23  (mm) Records that are exempt from disclosure under 
24 Section 4.2 of the Crime Victims Compensation Act. 
25  (nn) Information that is exempt from disclosure under 
26 Section 70 of the Higher Education Student Assistance Act. 
 
 
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1  (oo) Communications, notes, records, and reports 
2 arising out of a peer support counseling session prohibited 
3 from disclosure under the First Responders Suicide 
4 Prevention Act. 
5  (pp) Names and all identifying information relating to 
6 an employee of an emergency services provider or law 
7 enforcement agency under the First Responders Suicide 
8 Prevention Act. 
9  (qq) Information and records held by the Department of 
10 Public Health and its authorized representatives collected 
11 under the Reproductive Health Act. 
12  (rr) Information that is exempt from disclosure under 
13 the Cannabis Regulation and Tax Act. 
14  (ss) Data reported by an employer to the Department of 
15 Human Rights pursuant to Section 2-108 of the Illinois 
16 Human Rights Act.
17  (tt) Recordings made under the Children's Advocacy 
18 Center Act, except to the extent authorized under that Act. 
19  (uu) Information that is exempt from disclosure under 
20 Section 50 of the Sexual Assault Evidence Submission Act. 
21  (vv) Information that is exempt from disclosure under 
22 subsections (f) and (j) of Section 5-36 of the Illinois 
23 Public Aid Code. 
24  (ww) Information that is exempt from disclosure under 
25 Section 16.8 of the State Treasurer Act. 
26  (xx) Information that is exempt from disclosure or 
 
 
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1 information that shall not be made public under the 
2 Illinois Insurance Code. 
3  (yy) (oo) Information prohibited from being disclosed 
4 under the Illinois Educational Labor Relations Act.
5  (zz) (pp) Information prohibited from being disclosed 
6 under the Illinois Public Labor Relations Act. 
7  (aaa) (qq) Information prohibited from being disclosed 
8 under Section 1-167 of the Illinois Pension Code. 
9(Source: P.A. 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; 
10100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. 
118-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517, 
12eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19; 
13100-863, eff. 8-14-18; 100-887, eff. 8-14-18; 101-13, eff. 
146-12-19; 101-27, eff. 6-25-19; 101-81, eff. 7-12-19; 101-221, 
15eff. 1-1-20; 101-236, eff. 1-1-20; 101-375, eff. 8-16-19; 
16101-377, eff. 8-16-19; 101-452, eff. 1-1-20; 101-466, eff. 
171-1-20; 101-600, eff. 12-6-19; 101-620, eff 12-20-19; revised 
181-6-20.)

19 Section 90-10. The Illinois Health Information Exchange 
20and Technology Act is amended by changing Sections 10, 20, 25, 
2130, 35, and 40, as follows:

22 (20 ILCS 3860/10)
23 (Section scheduled to be repealed on January 1, 2021)

24 Sec. 10. Creation of the Health Information Exchange Office 
 
 
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1Authority. There is hereby created the Illinois Health 
2Information Exchange Office ("Office") Authority 
3("Authority"), which is hereby constituted as an 
4instrumentality and an administrative agency of the State of 
5Illinois.
6 As part of its program to promote, develop, and sustain 
7health information exchange at the State level, the Office 
8Authority shall do the following:
9  (1) Establish the Illinois Health Information Exchange 
10 ("ILHIE"), to promote and facilitate the sharing of health 
11 information among health care providers within Illinois 
12 and in other states. ILHIE shall be an entity operated by 
13 the Office Authority to serve as a State-level electronic 
14 medical records exchange providing for the transfer of 
15 health information, medical records, and other health data 
16 in a secure environment for the benefit of patient care, 
17 patient safety, reduction of duplicate medical tests, 
18 reduction of administrative costs, and any other benefits 
19 deemed appropriate by the Office Authority.
20  (2) Foster the widespread adoption of electronic 
21 health records and participation in the ILHIE.


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

23 (20 ILCS 3860/20)
24 (Section scheduled to be repealed on January 1, 2021)

25 Sec. 20. Powers and duties of the Illinois Health 
 
 
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1Information Exchange Office Authority. The Office Authority 
2has the following powers, together with all powers incidental 
3or necessary to accomplish the purposes of this Act: 
4  (1) The Office Authority shall create and administer 
5 the ILHIE using information systems and processes that are 
6 secure, are cost effective, and meet all other relevant 
7 privacy and security requirements under State and federal 
8 law.

9  (2) The Office Authority shall establish and adopt 
10 standards and requirements for the use of health 
11 information and the requirements for participation in the 
12 ILHIE by persons or entities including, but not limited to, 
13 health care providers, payors, and local health 
14 information exchanges.

15  (3) The Office Authority shall establish minimum 
16 standards for accessing the ILHIE to ensure that the 
17 appropriate security and privacy protections apply to 
18 health information, consistent with applicable federal and 
19 State standards and laws. The Office Authority shall have 
20 the power to suspend, limit, or terminate the right to 
21 participate in the ILHIE for non-compliance or failure to 
22 act, with respect to applicable standards and laws, in the 
23 best interests of patients, users of the ILHIE, or the 
24 public. The Office Authority may seek all remedies allowed 
25 by law to address any violation of the terms of 
26 participation in the ILHIE.

 
 
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1  (4) The Office Authority shall identify barriers to the 
2 adoption of electronic health records systems, including 
3 researching the rates and patterns of dissemination and use 
4 of electronic health record systems throughout the State. 
5 The Office Authority shall make the results of the research 
6 available on the Department of Healthcare and Family 
7 Services' website its website.

8  (5) The Office Authority shall prepare educational 
9 materials and educate the general public on the benefits of 
10 electronic health records, the ILHIE, and the safeguards 
11 available to prevent unauthorized disclosure of health 
12 information.

13  (6) The Office Authority may appoint or designate an 
14 institutional review board in accordance with federal and 
15 State law to review and approve requests for research in 
16 order to ensure compliance with standards and patient 
17 privacy and security protections as specified in paragraph 
18 (3) of this Section.

19  (7) The Office Authority may enter into all contracts 
20 and agreements necessary or incidental to the performance 
21 of its powers under this Act. The Office's Authority's 
22 expenditures of private funds are exempt from the Illinois 
23 Procurement Code, pursuant to Section 1-10 of that Act. 
24 Notwithstanding this exception, the Office Authority shall 
25 comply with the Business Enterprise for Minorities, Women, 
26 and Persons with Disabilities Act.

 
 
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1  (8) The Office Authority may solicit and accept grants, 
2 loans, contributions, or appropriations from any public or 
3 private source and may expend those moneys, through 
4 contracts, grants, loans, or agreements, on activities it 
5 considers suitable to the performance of its duties under 
6 this Act.

7  (9) The Office Authority may determine, charge, and 
8 collect any fees, charges, costs, and expenses from any 
9 healthcare provider or entity in connection with its duties 
10 under this Act. Moneys collected under this paragraph (9) 
11 shall be deposited into the Health Information Exchange 
12 Fund.

13  (10) The Office Authority may, under the direction of 
14 the Executive Director, employ and discharge staff, 
15 including administrative, technical, expert, professional, 
16 and legal staff, as is necessary or convenient to carry out 
17 the purposes of this Act and as authorized by the Personnel 
18 Code. The Authority may establish and administer standards 
19 of classification regarding compensation, benefits, 
20 duties, performance, and tenure for that staff and may 
21 enter into contracts of employment with members of that 
22 staff for such periods and on such terms as the Authority 
23 deems desirable. All employees of the Authority are exempt 
24 from the Personnel Code as provided by Section 4 of the 
25 Personnel Code.
26  (10.5) Staff employed by the Illinois Health 
 
 
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1 Information Exchange Authority on the effective date of 
2 this amendatory Act of the 101st General Assembly shall 
3 transfer to the Office within the Department of Healthcare 
4 and Family Services. 
5  (10.6) The status and rights of employees transferring 
6 from the Illinois Health Information Exchange Authority 
7 under paragraph (10.5) shall not be affected by such 
8 transfer except that, notwithstanding any other State law 
9 to the contrary, those employees shall maintain their 
10 seniority and their positions shall convert to titles of 
11 comparable organizational level under the Personnel Code 
12 and become subject to the Personnel Code. Other than the 
13 changes described in this paragraph, the rights of 
14 employees, the State of Illinois, and State agencies under 
15 the Personnel Code or under any pension, retirement, or 
16 annuity plan shall not be affected by this amendatory Act 
17 of the 101st General Assembly. Transferring personnel 
18 shall continue their service within the Office. 
19  (11) The Office Authority shall consult and coordinate 
20 with the Department of Public Health to further the 
21 Office's Authority's collection of health information from 
22 health care providers for public health purposes. The 
23 collection of public health information shall include 
24 identifiable information for use by the Office Authority or 
25 other State agencies to comply with State and federal laws. 
26 Any identifiable information so collected shall be 
 
 
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1 privileged and confidential in accordance with Sections 
2 8-2101, 8-2102, 8-2103, 8-2104, and 8-2105 of the Code of 
3 Civil Procedure.

4  (12) All identified or deidentified health information 
5 in the form of health data or medical records contained in, 
6 stored in, submitted to, transferred by, or released from 
7 the Illinois Health Information Exchange, and identified 
8 or deidentified health information in the form of health 
9 data and medical records of the Illinois Health Information 
10 Exchange in the possession of the Illinois Health 
11 Information Exchange Office Authority due to its 
12 administration of the Illinois Health Information 
13 Exchange, shall be exempt from inspection and copying under 
14 the Freedom of Information Act. The terms "identified" and 
15 "deidentified" shall be given the same meaning as in the 
16 Health Insurance Portability and Accountability Act of 
17 1996, Public Law 104-191, or any subsequent amendments 
18 thereto, and any regulations promulgated thereunder.

19  (13) To address gaps in the adoption of, workforce 
20 preparation for, and exchange of electronic health records 
21 that result in regional and socioeconomic disparities in 
22 the delivery of care, the Office Authority may evaluate 
23 such gaps and provide resources as available, giving 
24 priority to healthcare providers serving a significant 
25 percentage of Medicaid or uninsured patients and in 
26 medically underserved or rural areas.


 
 
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1  (14) The Office shall perform its duties under this Act 
2 in consultation with the Office of the Governor and with 
3 the Departments of Public Health, Insurance, and Human 
4 Services. 
5(Source: P.A. 99-642, eff. 7-28-16; 100-391, eff. 8-25-17.)

6 (20 ILCS 3860/25)
7 (Section scheduled to be repealed on January 1, 2021)

8 Sec. 25. Health Information Exchange Fund. 
9 (a) The Health Information Exchange Fund (the "Fund") is 
10created as a separate fund outside the State treasury. Moneys 
11in the Fund are not subject to appropriation by the General 
12Assembly. The State Treasurer shall be ex-officio custodian of 
13the Fund. Revenues arising from the operation and 
14administration of the Office Authority and the ILHIE shall be 
15deposited into the Fund. Fees, charges, State and federal 
16moneys, grants, donations, gifts, interest, or other moneys 
17shall be deposited into the Fund. "Private funds" means gifts, 
18donations, and private grants.
19 (b) The Office Authority is authorized to spend moneys in 
20the Fund on activities suitable to the performance of its 
21duties as provided in Section 20 of this Act and authorized by 
22this Act. Disbursements may be made from the Fund for purposes 
23related to the operations and functions of the Office Authority 
24and the ILHIE. 
25 (c) The Illinois General Assembly may appropriate moneys to 
 
 
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1the Office Authority and the ILHIE, and those moneys shall be 
2deposited into the Fund. 
3 (d) The Fund is not subject to administrative charges or 
4charge-backs, including but not limited to those authorized 
5under Section 8h of the State Finance Act.
6 (e) The Office's Authority's accounts and books shall be 
7set up and maintained in accordance with the Office of the 
8Comptroller's requirements, and the Authority's Executive 
9Director of the Department of Healthcare and Family Services 
10shall be responsible for the approval of recording of receipts, 
11approval of payments, and proper filing of required reports. 
12The moneys held and made available by the Office Authority 
13shall be subject to financial and compliance audits by the 
14Auditor General in compliance with the Illinois State Auditing 
15Act. 

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

17 (20 ILCS 3860/30)
18 (Section scheduled to be repealed on January 1, 2021)

19 Sec. 30. Participation in health information systems 
20maintained by State agencies. 
21 (a) By no later than January 1, 2015, each State agency 
22that implements, acquires, or upgrades health information 
23technology systems shall use health information technology 
24systems and products that meet minimum standards adopted by the 
25Office Authority for accessing the ILHIE. State agencies that 
 
 
10100SB1864ham006- 24 -LRB101 10924 SMS 72418 a


1have health information which supports and develops the ILHIE 
2shall provide access to patient-specific data to complete the 
3patient record at the ILHIE. Notwithstanding any other 
4provision of State law, the State agencies shall provide 
5patient-specific data to the ILHIE.
6 (b) Participation in the ILHIE shall have no impact on the 
7content of or use or disclosure of health information of 
8patient participants that is held in locations other than the 
9ILHIE. Nothing in this Act shall limit or change an entity's 
10obligation to exchange health information in accordance with 
11applicable federal and State laws and standards. 

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

13 (20 ILCS 3860/35)
14 (Section scheduled to be repealed on January 1, 2021)

15 Sec. 35. Illinois Administrative Procedure Act. The 
16provisions of the Illinois Administrative Procedure Act are 
17hereby expressly adopted and shall apply to all administrative 
18rules and procedures of the Office Authority, except that 
19Section 5-35 of the Illinois Administrative Procedure Act 
20relating to procedures for rulemaking does not apply to the 
21adoption of any rule required by federal law when the Office 
22Authority is precluded by that law from exercising any 
23discretion regarding that rule.

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

 
 
10100SB1864ham006- 25 -LRB101 10924 SMS 72418 a


1 (20 ILCS 3860/40)
2 (Section scheduled to be repealed on January 1, 2021)

3 Sec. 40. Reliance on data. Any health care provider who 
4relies in good faith upon any information provided through the 
5ILHIE in his, her, or its treatment of a patient shall be 
6immune from criminal or civil liability or professional 
7discipline arising from any damages caused by such good faith 
8reliance. This immunity does not apply to acts or omissions 
9constituting gross negligence or reckless, wanton, or 
10intentional misconduct. Notwithstanding this provision, the 
11Office Authority does not waive any immunities provided under 
12State or federal law.

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

14 (20 ILCS 3860/15 rep.)
15 Section 90-15. The Illinois Health Information Exchange 
16and Technology Act is amended by repealing Section 15.

17 Section 90-20. The Children's Health Insurance Program Act 
18is amended by changing Section 7 and by adding Section 8 as 
19follows:

20 (215 ILCS 106/7)
21 Sec. 7. Eligibility verification. Notwithstanding any 
22other provision of this Act, with respect to applications for 
23benefits provided under the Program, eligibility shall be 
 
 
10100SB1864ham006- 26 -LRB101 10924 SMS 72418 a


1determined in a manner that ensures program integrity and that 
2complies with federal law and regulations while minimizing 
3unnecessary barriers to enrollment. To this end, as soon as 
4practicable, and unless the Department receives written denial 
5from the federal government, this Section shall be implemented:
6 (a) The Department of Healthcare and Family Services or its 
7designees shall: 
8  (1) By no later than July 1, 2011, require verification 
9 of, at a minimum, one month's income from all sources 
10 required for determining the eligibility of applicants to 
11 the Program. Such verification shall take the form of pay 
12 stubs, business or income and expense records for 
13 self-employed persons, letters from employers, and any 
14 other valid documentation of income including data 
15 obtained electronically by the Department or its designees 
16 from other sources as described in subsection (b) of this 
17 Section. A month's income may be verified by a single pay 
18 stub with the monthly income extrapolated from the time 
19 period covered by the pay stub. 
20  (2) By no later than October 1, 2011, require 
21 verification of, at a minimum, one month's income from all 
22 sources required for determining the continued eligibility 
23 of recipients at their annual review of eligibility under 
24 the Program. Such verification shall take the form of pay 
25 stubs, business or income and expense records for 
26 self-employed persons, letters from employers, and any 
 
 
10100SB1864ham006- 27 -LRB101 10924 SMS 72418 a


1 other valid documentation of income including data 
2 obtained electronically by the Department or its designees 
3 from other sources as described in subsection (b) of this 
4 Section. A month's income may be verified by a single pay 
5 stub with the monthly income extrapolated from the time 
6 period covered by the pay stub. The Department shall send a 
7 notice to the recipient at least 60 days prior to the end 
8 of the period of eligibility that informs them of the 
9 requirements for continued eligibility. Information the 
10 Department receives prior to the annual review, including 
11 information available to the Department as a result of the 
12 recipient's application for other non-health care 
13 benefits, that is sufficient to make a determination of 
14 continued eligibility for medical assistance or for 
15 benefits provided under the Program may be reviewed and 
16 verified, and subsequent action taken including client 
17 notification of continued eligibility for medical 
18 assistance or for benefits provided under the Program. The 
19 date of client notification establishes the date for 
20 subsequent annual eligibility reviews. If a recipient does 
21 not fulfill the requirements for continued eligibility by 
22 the deadline established in the notice, a notice of 
23 cancellation shall be issued to the recipient and coverage 
24 shall end no later than the last day of the month following 
25 the last day of the eligibility period. A recipient's 
26 eligibility may be reinstated without requiring a new 
 
 
10100SB1864ham006- 28 -LRB101 10924 SMS 72418 a


1 application if the recipient fulfills the requirements for 
2 continued eligibility prior to the end of the third month 
3 following the last date of coverage (or longer period if 
4 required by federal regulations). Nothing in this Section 
5 shall prevent an individual whose coverage has been 
6 cancelled from reapplying for health benefits at any time. 
7  (3) By no later than July 1, 2011, require verification 
8 of Illinois residency. 
9 (b) The Department shall establish or continue cooperative

10arrangements with the Social Security Administration, the

11Illinois Secretary of State, the Department of Human Services,

12the Department of Revenue, the Department of Employment 
13Security, and any other appropriate entity to gain electronic

14access, to the extent allowed by law, to information available 
15to those entities that may be appropriate for electronically

16verifying any factor of eligibility for benefits under the

17Program. Data relevant to eligibility shall be provided for no

18other purpose than to verify the eligibility of new applicants 
19or current recipients of health benefits under the Program. 
20Data will be requested or provided for any new applicant or 
21current recipient only insofar as that individual's 
22circumstances are relevant to that individual's or another 
23individual's eligibility. 
24 (c) Within 90 days of the effective date of this amendatory 
25Act of the 96th General Assembly, the Department of Healthcare 
26and Family Services shall send notice to current recipients 
 
 
10100SB1864ham006- 29 -LRB101 10924 SMS 72418 a


1informing them of the changes regarding their eligibility 
2verification.

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

4 (215 ILCS 106/8 new)
5 Sec. 8. COVID-19 public health emergency. Notwithstanding 
6any other provision of this Act, the Department may take 
7necessary actions to address the COVID-19 public health 
8emergency to the extent such actions are required, approved, or 
9authorized by the United States Department of Health and Human 
10Services, Centers for Medicare and Medicaid Services. Such 
11actions may continue throughout the public health emergency and 
12for up to 12 months after the period ends, and may include, but 
13are not limited to: accepting an applicant's or recipient's 
14attestation of income, incurred medical expenses, residency, 
15and insured status when electronic verification is not 
16available; eliminating resource tests for some eligibility 
17determinations; suspending redeterminations; suspending 
18changes that would adversely affect an applicant's or 
19recipient's eligibility; phone or verbal approval by an 
20applicant to submit an application in lieu of applicant 
21signature; allowing adult presumptive eligibility; allowing 
22presumptive eligibility for children, pregnant women, and 
23adults as often as twice per calendar year; paying for 
24additional services delivered by telehealth; and suspending 
25premium and co-payment requirements.
 
 
10100SB1864ham006- 30 -LRB101 10924 SMS 72418 a


1 The Department's authority under this Section shall only 
2extend to encompass, incorporate, or effectuate the terms, 
3items, conditions, and other provisions approved, authorized, 
4or required by the United States Department of Health and Human 
5Services, Centers for Medicare and Medicaid Services, and shall 
6not extend beyond the time of the COVID-19 public health 
7emergency and up to 12 months after the period expires. 

8 Section 90-25. The Covering ALL KIDS Health Insurance Act 
9is amended by changing Section 7 and by adding Section 8 as 
10follows:

11 (215 ILCS 170/7)
12 (Section scheduled to be repealed on October 1, 2024)
13 Sec. 7. Eligibility verification. Notwithstanding any 
14other provision of this Act, with respect to applications for 
15benefits provided under the Program, eligibility shall be 
16determined in a manner that ensures program integrity and that 
17complies with federal law and regulations while minimizing 
18unnecessary barriers to enrollment. To this end, as soon as 
19practicable, and unless the Department receives written denial 
20from the federal government, this Section shall be implemented:
21 (a) The Department of Healthcare and Family Services or its 
22designees shall: 
23  (1) By July 1, 2011, require verification of, at a 
24 minimum, one month's income from all sources required for 
 
 
10100SB1864ham006- 31 -LRB101 10924 SMS 72418 a


1 determining the eligibility of applicants to the Program.

2 Such verification shall take the form of pay stubs, 
3 business or income and expense records for self-employed 
4 persons, letters from employers, and any other valid 
5 documentation of income including data obtained 
6 electronically by the Department or its designees from 
7 other sources as described in subsection (b) of this 
8 Section. A month's income may be verified by a single pay 
9 stub with the monthly income extrapolated from the time 
10 period covered by the pay stub. 
11  (2) By October 1, 2011, require verification of, at a 
12 minimum, one month's income from all sources required for 
13 determining the continued eligibility of recipients at 
14 their annual review of eligibility under the Program. Such 
15 verification shall take the form of pay stubs, business or 
16 income and expense records for self-employed persons, 
17 letters from employers, and any other valid documentation 
18 of income including data obtained electronically by the 
19 Department or its designees from other sources as described 
20 in subsection (b) of this Section. A month's income may be 
21 verified by a single pay stub with the monthly income 
22 extrapolated from the time period covered by the pay stub. 
23 The Department shall send a notice to
recipients at least 
24 60 days prior to the end of their period
of eligibility 
25 that informs them of the
requirements for continued 
26 eligibility. Information the Department receives prior to 
 
 
10100SB1864ham006- 32 -LRB101 10924 SMS 72418 a


1 the annual review, including information available to the 
2 Department as a result of the recipient's application for 
3 other non-health care benefits, that is sufficient to make 
4 a determination of continued eligibility for benefits 
5 provided under this Act, the Children's Health Insurance 
6 Program Act, or Article V of the Illinois Public Aid Code 
7 may be reviewed and verified, and subsequent action taken 
8 including client notification of continued eligibility for 
9 benefits provided under this Act, the Children's Health 
10 Insurance Program Act, or Article V of the Illinois Public 
11 Aid Code. The date of client notification establishes the 
12 date for subsequent annual eligibility reviews. If a 
13 recipient
does not fulfill the requirements for continued 
14 eligibility by the
deadline established in the notice, a 
15 notice of cancellation shall be issued to the recipient and 
16 coverage shall end no later than the last day of the month 
17 following the last day of the eligibility period. A 
18 recipient's eligibility may be reinstated without 
19 requiring a new application if the recipient fulfills the 
20 requirements for continued eligibility prior to the end of 
21 the third month following the last date of coverage (or 
22 longer period if required by federal regulations). Nothing 
23 in this Section shall prevent an individual whose coverage 
24 has been cancelled from reapplying for health benefits at 
25 any time. 
26  (3) By July 1, 2011, require verification of Illinois 
 
 
10100SB1864ham006- 33 -LRB101 10924 SMS 72418 a


1 residency. 
2 (b) The Department shall establish or continue cooperative

3arrangements with the Social Security Administration, the

4Illinois Secretary of State, the Department of Human Services,

5the Department of Revenue, the Department of Employment

6Security, and any other appropriate entity to gain electronic

7access, to the extent allowed by law, to information available

8to those entities that may be appropriate for electronically

9verifying any factor of eligibility for benefits under the

10Program. Data relevant to eligibility shall be provided for no

11other purpose than to verify the eligibility of new applicants 
12or current recipients of health benefits under the Program. 
13Data will be requested or provided for any new applicant or 
14current recipient only insofar as that individual's 
15circumstances are relevant to that individual's or another 
16individual's eligibility. 
17 (c) Within 90 days of the effective date of this amendatory 
18Act of the 96th General Assembly, the Department of Healthcare 
19and Family Services shall send notice to current recipients 
20informing them of the changes regarding their eligibility 
21verification. 

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

23 (215 ILCS 170/8 new)
24 Sec. 8. COVID-19 public health emergency. Notwithstanding 
25any other provision of this Act, the Department may take 
 
 
10100SB1864ham006- 34 -LRB101 10924 SMS 72418 a


1necessary actions to address the COVID-19 public health 
2emergency to the extent such actions are required, approved, or 
3authorized by the United States Department of Health and Human 
4Services, Centers for Medicare and Medicaid Services. Such 
5actions may continue throughout the public health emergency and 
6for up to 12 months after the period ends, and may include, but 
7are not limited to: accepting an applicant's or recipient's 
8attestation of income, incurred medical expenses, residency, 
9and insured status when electronic verification is not 
10available; eliminating resource tests for some eligibility 
11determinations; suspending redeterminations; suspending 
12changes that would adversely affect an applicant's or 
13recipient's eligibility; phone or verbal approval by an 
14applicant to submit an application in lieu of applicant 
15signature; allowing adult presumptive eligibility; allowing 
16presumptive eligibility for children, pregnant women, and 
17adults as often as twice per calendar year; paying for 
18additional services delivered by telehealth; and suspending 
19premium and co-payment requirements.
20 The Department's authority under this Section shall only 
21extend to encompass, incorporate, or effectuate the terms, 
22items, conditions, and other provisions approved, authorized, 
23or required by the United States Department of Health and Human 
24Services, Centers for Medicare and Medicaid Services, and shall 
25not extend beyond the time of the COVID-19 public health 
26emergency and up to 12 months after the period expires. 

 
 
10100SB1864ham006- 35 -LRB101 10924 SMS 72418 a


1 Section 90-30. The Pharmacy Practice Act is amended by 
2adding 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 
7required to meet the immediate therapeutic needs of a patient 
8and that are not available from any other source in sufficient 
9time to prevent the risk of harm to a patient by delay 
10resulting from obtaining the drugs from another source. An 
11automated dispensing and storage system may be used as an 
12emergency kit.
13 "Licensed facility" means an entity licensed under the 
14Nursing Home Care Act, the Hospital Licensing Act, or the 
15University of Illinois Hospital Act or a facility licensed 
16under the Illinois Department of Human Services, Division of 
17Substance Use Prevention and Recovery, for the prevention, 
18intervention, treatment, and recovery support of substance use 
19disorders or certified by the Illinois Department of Human 
20Services, Division of Mental Health for the treatment of mental 
21health.
22 "Offsite institutional pharmacy" means: (1) a pharmacy 
23that is not located in facilities it serves and whose primary 
24purpose is to provide services to patients or residents of 
 
 
10100SB1864ham006- 36 -LRB101 10924 SMS 72418 a


1facilities licensed under the Nursing Home Care Act, the 
2Hospital Licensing Act, or the University of Illinois Hospital 
3Act; and (2) a pharmacy that is not located in the facilities 
4it serves and the facilities it serves are licensed under the 
5Illinois Department of Human Services, Division of Substance 
6Use Prevention and Recovery, for the prevention, intervention, 
7treatment, and recovery support of substance use disorders or 
8for the treatment of mental health.
9 (b) An offsite institutional pharmacy may supply emergency 
10kits to a licensed facility. 

11 Section 90-35. The Illinois Public Aid Code is amended by 
12changing Sections 5-2, 5-4.2, 5-5e, 5-16.8, 5B-4, and 11-5.1 
13and by adding Sections 5-1.5, 5-5.27 and 12-21.21 as follows:

14 (305 ILCS 5/5-1.5 new)
15 Sec. 5-1.5. COVID-19 public health emergency. 
16Notwithstanding any other provision of Articles V, XI, and XII 
17of this Code, the Department may take necessary actions to 
18address the COVID-19 public health emergency to the extent such 
19actions are required, approved, or authorized by the United 
20States Department of Health and Human Services, Centers for 
21Medicare and Medicaid Services. Such actions may continue 
22throughout the public health emergency and for up to 12 months 
23after the period ends, and may include, but are not limited to: 
24accepting an applicant's or recipient's attestation of income, 
 
 
10100SB1864ham006- 37 -LRB101 10924 SMS 72418 a


1incurred medical expenses, residency, and insured status when 
2electronic verification is not available; eliminating resource 
3tests for some eligibility determinations; suspending 
4redeterminations; suspending changes that would adversely 
5affect an applicant's or recipient's eligibility; phone or 
6verbal approval by an applicant to submit an application in 
7lieu of applicant signature; allowing adult presumptive 
8eligibility; allowing presumptive eligibility for children, 
9pregnant women, and adults as often as twice per calendar year; 
10paying for additional services delivered by telehealth; and 
11suspending premium and co-payment requirements.
12 The Department's authority under this Section shall only 
13extend to encompass, incorporate, or effectuate the terms, 
14items, conditions, and other provisions approved, authorized, 
15or required by the United States Department of Health and Human 
16Services, Centers for Medicare and Medicaid Services, and shall 
17not extend beyond the time of the COVID-19 public health 
18emergency and up to 12 months after the period expires. 




19 (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)


20 Sec. 5-2. Classes of Persons Eligible.  
21 Medical assistance under this
Article shall be available to 
22any of the following classes of persons in
respect to whom a 
23plan for coverage has been submitted to the Governor
by the 
24Illinois Department and approved by him. If changes made in 
25this Section 5-2 require federal approval, they shall not take 
 
 
10100SB1864ham006- 38 -LRB101 10924 SMS 72418 a


1effect until such approval has been received:

2  1. Recipients of basic maintenance grants under 
3 Articles III and IV.

4  2. Beginning January 1, 2014, persons otherwise 
5 eligible for basic maintenance under Article
III, 
6 excluding any eligibility requirements that are 
7 inconsistent with any federal law or federal regulation, as 
8 interpreted by the U.S. Department of Health and Human 
9 Services, but who fail to qualify thereunder on the basis 
10 of need, and
who have insufficient income and resources to 
11 meet the costs of
necessary medical care, including but not 
12 limited to the following:


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


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


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


25   (b) (Blank).

26  3. (Blank).

 
 
10100SB1864ham006- 39 -LRB101 10924 SMS 72418 a


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

5 expenses.


6  5.(a) Beginning January 1, 2020, women during 
7 pregnancy and during the
12-month period beginning on the 
8 last day of the pregnancy, together with
their infants,

9 whose income is at or below 200% of the federal poverty 
10 level. Until September 30, 2019, or sooner if the 
11 maintenance of effort requirements under the Patient 
12 Protection and Affordable Care Act are eliminated or may be 
13 waived before then, women during pregnancy and during the 
14 12-month period beginning on the last day of the pregnancy, 
15 whose countable monthly income, after the deduction of 
16 costs incurred for medical care and for other types of 
17 remedial care as specified in administrative rule, is equal 
18 to or less than the Medical Assistance-No Grant(C) 
19 (MANG(C)) Income Standard in effect on April 1, 2013 as set 
20 forth in administrative rule.


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

 
 
10100SB1864ham006- 40 -LRB101 10924 SMS 72418 a


1 eligibility.


2  (c) The Illinois Department may conduct a 
3 demonstration in at least one
county that will provide 
4 medical assistance to pregnant women, together
with their 
5 infants and children up to one year of age,
where the 
6 income
eligibility standard is set up to 185% of the 
7 nonfarm income official
poverty line, as defined by the 
8 federal Office of Management and Budget.
The Illinois 
9 Department shall seek and obtain necessary authorization

10 provided under federal law to implement such a 
11 demonstration. Such
demonstration may establish resource 
12 standards that are not more
restrictive than those 
13 established under Article IV of this Code.

14  6. (a) Children younger than age 19 when countable 
15 income is at or below 133% of the federal poverty level. 
16 Until September 30, 2019, or sooner if the maintenance of 
17 effort requirements under the Patient Protection and 
18 Affordable Care Act are eliminated or may be waived before 
19 then, children younger than age 19 whose countable monthly 
20 income, after the deduction of costs incurred for medical 
21 care and for other types of remedial care as specified in 
22 administrative rule, is equal to or less than the Medical 
23 Assistance-No Grant(C) (MANG(C)) Income Standard in effect 
24 on April 1, 2013 as set forth in administrative rule.
25  (b) Children and youth who are under temporary custody 
26 or guardianship of the Department of Children and Family 
 
 
10100SB1864ham006- 41 -LRB101 10924 SMS 72418 a


1 Services or who receive financial assistance in support of 
2 an adoption or guardianship placement from the Department 
3 of Children and Family Services. 

4  7. (Blank).

5  8. As required under federal law, persons who are 
6 eligible for Transitional Medical Assistance as a result of 
7 an increase in earnings or child or spousal support 
8 received. The plan for coverage for this class of persons 
9 shall:


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


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


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


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


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


22    (iv) such coverage shall be suspended in the 
23 event of a person's
failure without good cause to 
24 file in a timely fashion reports required for
this 
25 coverage under the Social Security Act and 
26 coverage shall be reinstated
upon the filing of 
 
 
10100SB1864ham006- 42 -LRB101 10924 SMS 72418 a


1 such reports if the person remains otherwise 
2 eligible.

3  9. Persons with acquired immunodeficiency syndrome 
4 (AIDS) or with
AIDS-related conditions with respect to whom 
5 there has been a determination
that but for home or 
6 community-based services such individuals would
require 
7 the level of care provided in an inpatient hospital, 
8 skilled
nursing facility or intermediate care facility the 
9 cost of which is
reimbursed under this Article. Assistance 
10 shall be provided to such
persons to the maximum extent 
11 permitted under Title
XIX of the Federal Social Security 
12 Act.

13  10. Participants in the long-term care insurance 
14 partnership program
established under the Illinois 
15 Long-Term Care Partnership Program Act who meet the

16 qualifications for protection of resources described in 
17 Section 15 of that
Act.

18  11. Persons with disabilities who are employed and 
19 eligible for Medicaid,
pursuant to Section 
20 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, 
21 subject to federal approval, persons with a medically 
22 improved disability who are employed and eligible for 
23 Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of 
24 the Social Security Act, as
provided by the Illinois 
25 Department by rule. In establishing eligibility standards 
26 under this paragraph 11, the Department shall, subject to 
 
 
10100SB1864ham006- 43 -LRB101 10924 SMS 72418 a


1 federal approval:
2   (a) set the income eligibility standard at not 
3 lower than 350% of the federal poverty level;
4   (b) exempt retirement accounts that the person 
5 cannot access without penalty before the age
of 59 1/2, 
6 and medical savings accounts established pursuant to 
7 26 U.S.C. 220;
8   (c) allow non-exempt assets up to $25,000 as to 
9 those assets accumulated during periods of eligibility 
10 under this paragraph 11; and

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

15  12. Subject to federal approval, persons who are 
16 eligible for medical
assistance coverage under applicable 
17 provisions of the federal Social Security
Act and the 
18 federal Breast and Cervical Cancer Prevention and 
19 Treatment Act of
2000. Those eligible persons are defined 
20 to include, but not be limited to,
the following persons:


21   (1) persons who have been screened for breast or 
22 cervical cancer under
the U.S. Centers for Disease 
23 Control and Prevention Breast and Cervical Cancer

24 Program established under Title XV of the federal 
25 Public Health Services Act in
accordance with the 
26 requirements of Section 1504 of that Act as 
 
 
10100SB1864ham006- 44 -LRB101 10924 SMS 72418 a


1 administered by
the Illinois Department of Public 
2 Health; and


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

7  "Medical assistance" under this paragraph 12 shall be 
8 identical to the benefits
provided under the State's 
9 approved plan under Title XIX of the Social Security
Act. 
10 The Department must request federal approval of the 
11 coverage under this
paragraph 12 within 30 days after the 
12 effective date of this amendatory Act of
the 92nd General 
13 Assembly.

14  In addition to the persons who are eligible for medical 
15 assistance pursuant to subparagraphs (1) and (2) of this 
16 paragraph 12, and to be paid from funds appropriated to the 
17 Department for its medical programs, any uninsured person 
18 as defined by the Department in rules residing in Illinois 
19 who is younger than 65 years of age, who has been screened 
20 for breast and cervical cancer in accordance with standards 
21 and procedures adopted by the Department of Public Health 
22 for screening, and who is referred to the Department by the 
23 Department of Public Health as being in need of treatment 
24 for breast or cervical cancer is eligible for medical 
25 assistance benefits that are consistent with the benefits 
26 provided to those persons described in subparagraphs (1) 
 
 
10100SB1864ham006- 45 -LRB101 10924 SMS 72418 a


1 and (2). Medical assistance coverage for the persons who 
2 are eligible under the preceding sentence is not dependent 
3 on federal approval, but federal moneys may be used to pay 
4 for services provided under that coverage upon federal 
5 approval. 
6  13. Subject to appropriation and to federal approval, 
7 persons living with HIV/AIDS who are not otherwise eligible 
8 under this Article and who qualify for services covered 
9 under Section 5-5.04 as provided by the Illinois Department 
10 by rule.

11  14. Subject to the availability of funds for this 
12 purpose, the Department may provide coverage under this 
13 Article to persons who reside in Illinois who are not 
14 eligible under any of the preceding paragraphs and who meet 
15 the income guidelines of paragraph 2(a) of this Section and 
16 (i) have an application for asylum pending before the 
17 federal Department of Homeland Security or on appeal before 
18 a court of competent jurisdiction and are represented 
19 either by counsel or by an advocate accredited by the 
20 federal Department of Homeland Security and employed by a 
21 not-for-profit organization in regard to that application 
22 or appeal, or (ii) are receiving services through a 
23 federally funded torture treatment center. Medical 
24 coverage under this paragraph 14 may be provided for up to 
25 24 continuous months from the initial eligibility date so 
26 long as an individual continues to satisfy the criteria of 
 
 
10100SB1864ham006- 46 -LRB101 10924 SMS 72418 a


1 this paragraph 14. If an individual has an appeal pending 
2 regarding an application for asylum before the Department 
3 of Homeland Security, eligibility under this paragraph 14 
4 may be extended until a final decision is rendered on the 
5 appeal. The Department may adopt rules governing the 
6 implementation of this paragraph 14.

7  15. Family Care Eligibility.
8   (a) On and after July 1, 2012, a parent or other 
9 caretaker relative who is 19 years of age or older when 
10 countable income is at or below 133% of the federal 
11 poverty level. A person may not spend down to become 
12 eligible under this paragraph 15. 
13   (b) Eligibility shall be reviewed annually.
14   (c) (Blank).
15   (d) (Blank).
16   (e) (Blank).
17   (f) (Blank).
18   (g) (Blank).
19   (h) (Blank).
20   (i) Following termination of an individual's 
21 coverage under this paragraph 15, the individual must 
22 be determined eligible before the person can be 
23 re-enrolled.
24  16. Subject to appropriation, uninsured persons who 
25 are not otherwise eligible under this Section who have been 
26 certified and referred by the Department of Public Health 
 
 
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1 as having been screened and found to need diagnostic 
2 evaluation or treatment, or both diagnostic evaluation and 
3 treatment, for prostate or testicular cancer. For the 
4 purposes of this paragraph 16, uninsured persons are those 
5 who do not have creditable coverage, as defined under the 
6 Health Insurance Portability and Accountability Act, or 
7 have otherwise exhausted any insurance benefits they may 
8 have had, for prostate or testicular cancer diagnostic 
9 evaluation or treatment, or both diagnostic evaluation and 
10 treatment.
To be eligible, a person must furnish a Social 
11 Security number.
A person's assets are exempt from 
12 consideration in determining eligibility under this 
13 paragraph 16.
Such persons shall be eligible for medical 
14 assistance under this paragraph 16 for so long as they need 
15 treatment for the cancer. A person shall be considered to 
16 need treatment if, in the opinion of the person's treating 
17 physician, the person requires therapy directed toward 
18 cure or palliation of prostate or testicular cancer, 
19 including recurrent metastatic cancer that is a known or 
20 presumed complication of prostate or testicular cancer and 
21 complications resulting from the treatment modalities 
22 themselves. Persons who require only routine monitoring 
23 services are not considered to need treatment.
"Medical 
24 assistance" under this paragraph 16 shall be identical to 
25 the benefits provided under the State's approved plan under 
26 Title XIX of the Social Security Act.
Notwithstanding any 
 
 
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1 other provision of law, the Department (i) does not have a 
2 claim against the estate of a deceased recipient of 
3 services under this paragraph 16 and (ii) does not have a 
4 lien against any homestead property or other legal or 
5 equitable real property interest owned by a recipient of 
6 services under this paragraph 16.
7  17. Persons who, pursuant to a waiver approved by the 
8 Secretary of the U.S. Department of Health and Human 
9 Services, are eligible for medical assistance under Title 
10 XIX or XXI of the federal Social Security Act. 
11 Notwithstanding any other provision of this Code and 
12 consistent with the terms of the approved waiver, the 
13 Illinois Department, may by rule: 
14   (a) Limit the geographic areas in which the waiver 
15 program operates. 
16   (b) Determine the scope, quantity, duration, and 
17 quality, and the rate and method of reimbursement, of 
18 the medical services to be provided, which may differ 
19 from those for other classes of persons eligible for 
20 assistance under this Article. 
21   (c) Restrict the persons' freedom in choice of 
22 providers. 
23  18. Beginning January 1, 2014, persons aged 19 or 
24 older, but younger than 65, who are not otherwise eligible 
25 for medical assistance under this Section 5-2, who qualify 
26 for medical assistance pursuant to 42 U.S.C. 
 
 
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1 1396a(a)(10)(A)(i)(VIII) and applicable federal 
2 regulations, and who have income at or below 133% of the 
3 federal poverty level plus 5% for the applicable family 
4 size as determined pursuant to 42 U.S.C. 1396a(e)(14) and 
5 applicable federal regulations. Persons eligible for 
6 medical assistance under this paragraph 18 shall receive 
7 coverage for the Health Benefits Service Package as that 
8 term is defined in subsection (m) of Section 5-1.1 of this 
9 Code. If Illinois' federal medical assistance percentage 
10 (FMAP) is reduced below 90% for persons eligible for 
11 medical
assistance under this paragraph 18, eligibility 
12 under this paragraph 18 shall cease no later than the end 
13 of the third month following the month in which the 
14 reduction in FMAP takes effect. 
15  19. Beginning January 1, 2014, as required under 42 
16 U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18 
17 and younger than age 26 who are not otherwise eligible for 
18 medical assistance under paragraphs (1) through (17) of 
19 this Section who (i) were in foster care under the 
20 responsibility of the State on the date of attaining age 18 
21 or on the date of attaining age 21 when a court has 
22 continued wardship for good cause as provided in Section 
23 2-31 of the Juvenile Court Act of 1987 and (ii) received 
24 medical assistance under the Illinois Title XIX State Plan 
25 or waiver of such plan while in foster care. 
26  20. Beginning January 1, 2018, persons who are 
 
 
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1 foreign-born victims of human trafficking, torture, or 
2 other serious crimes as defined in Section 2-19 of this 
3 Code and their derivative family members if such persons: 
4 (i) reside in Illinois; (ii) are not eligible under any of 
5 the preceding paragraphs; (iii) meet the income guidelines 
6 of subparagraph (a) of paragraph 2; and (iv) meet the 
7 nonfinancial eligibility requirements of Sections 16-2, 
8 16-3, and 16-5 of this Code. The Department may extend 
9 medical assistance for persons who are foreign-born 
10 victims of human trafficking, torture, or other serious 
11 crimes whose medical assistance would be terminated 
12 pursuant to subsection (b) of Section 16-5 if the 
13 Department determines that the person, during the year of 
14 initial eligibility (1) experienced a health crisis, (2) 
15 has been unable, after reasonable attempts, to obtain 
16 necessary information from a third party, or (3) has other 
17 extenuating circumstances that prevented the person from 
18 completing his or her application for status. The 
19 Department may adopt any rules necessary to implement the 
20 provisions of this paragraph.
21  21. Persons who are not otherwise eligible for medical 
22 assistance under this Section who may qualify for medical 
23 assistance pursuant to 42 U.S.C. 
24 1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the 
25 duration of any federal or State declared emergency due to 
26 COVID-19. Medical assistance to persons eligible for 
 
 
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1 medical assistance solely pursuant to this paragraph 21 
2 shall be limited to any in vitro diagnostic product (and 
3 the administration of such product) described in 42 U.S.C. 
4 1396d(a)(3)(B) on or after March 18, 2020, any visit 
5 described in 42 U.S.C. 1396o(a)(2)(G), or any other medical 
6 assistance that may be federally authorized for this class 
7 of persons. The Department may also cover treatment of 
8 COVID-19 for this class of persons, or any similar category 
9 of uninsured individuals, to the extent authorized under a 
10 federally approved 1115 Waiver or other federal authority. 
11 Notwithstanding the provisions of Section 1-11 of this 
12 Code, due to the nature of the COVID-19 public health 
13 emergency, the Department may cover and provide the medical 
14 assistance described in this paragraph 21 to noncitizens 
15 who would otherwise meet the eligibility requirements for 
16 the class of persons described in this paragraph 21 for the 
17 duration of the State emergency period. 
18 In implementing the provisions of Public Act 96-20, the 
19Department is authorized to adopt only those rules necessary, 
20including emergency rules. Nothing in Public Act 96-20 permits 
21the Department to adopt rules or issue a decision that expands 
22eligibility for the FamilyCare Program to a person whose income 
23exceeds 185% of the Federal Poverty Level as determined from 
24time to time by the U.S. Department of Health and Human 
25Services, unless the Department is provided with express 
26statutory authority. 

 
 
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1 The eligibility of any such person for medical assistance 
2under this
Article is not affected by the payment of any grant 
3under the Senior
Citizens and Persons with Disabilities 
4Property Tax Relief Act or any distributions or items of income 
5described under
subparagraph (X) of
paragraph (2) of subsection 
6(a) of Section 203 of the Illinois Income Tax
Act.
7 The Department shall by rule establish the amounts of

8assets to be disregarded in determining eligibility for medical 
9assistance,
which shall at a minimum equal the amounts to be 
10disregarded under the
Federal Supplemental Security Income 
11Program. The amount of assets of a
single person to be 
12disregarded
shall not be less than $2,000, and the amount of 
13assets of a married couple
to be disregarded shall not be less 
14than $3,000.

15 To the extent permitted under federal law, any person found 
16guilty of a
second violation of Article VIIIA
shall be 
17ineligible for medical assistance under this Article, as 
18provided
in Section 8A-8.

19 The eligibility of any person for medical assistance under 
20this Article
shall not be affected by the receipt by the person 
21of donations or benefits
from fundraisers held for the person 
22in cases of serious illness,
as long as neither the person nor 
23members of the person's family
have actual control over the 
24donations or benefits or the disbursement
of the donations or 
25benefits.

26 Notwithstanding any other provision of this Code, if the 
 
 
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1United States Supreme Court holds Title II, Subtitle A, Section 
22001(a) of Public Law 111-148 to be unconstitutional, or if a 
3holding of Public Law 111-148 makes Medicaid eligibility 
4allowed under Section 2001(a) inoperable, the State or a unit 
5of local government shall be prohibited from enrolling 
6individuals in the Medical Assistance Program as the result of 
7federal approval of a State Medicaid waiver on or after the 
8effective date of this amendatory Act of the 97th General 
9Assembly, and any individuals enrolled in the Medical 
10Assistance Program pursuant to eligibility permitted as a 
11result of such a State Medicaid waiver shall become immediately 
12ineligible. 
13 Notwithstanding any other provision of this Code, if an Act 
14of Congress that becomes a Public Law eliminates Section 
152001(a) of Public Law 111-148, the State or a unit of local 
16government shall be prohibited from enrolling individuals in 
17the Medical Assistance Program as the result of federal 
18approval of a State Medicaid waiver on or after the effective 
19date of this amendatory Act of the 97th General Assembly, and 
20any individuals enrolled in the Medical Assistance Program 
21pursuant to eligibility permitted as a result of such a State 
22Medicaid waiver shall become immediately ineligible. 
23 Effective October 1, 2013, the determination of 
24eligibility of persons who qualify under paragraphs 5, 6, 8, 
2515, 17, and 18 of this Section shall comply with the 
26requirements of 42 U.S.C. 1396a(e)(14) and applicable federal 
 
 
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1regulations. 
2 The Department of Healthcare and Family Services, the 
3Department of Human Services, and the Illinois health insurance 
4marketplace shall work cooperatively to assist persons who 
5would otherwise lose health benefits as a result of changes 
6made under this amendatory Act of the 98th General Assembly to 
7transition to other health insurance coverage. 
8(Source: P.A. 101-10, eff. 6-5-19.)





9 (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)



10 Sec. 5-4.2. Ambulance services payments. 
11 (a) For
ambulance
services provided to a recipient of aid 
12under this Article on or after
January 1, 1993, the Illinois 
13Department shall reimburse ambulance service
providers at 
14rates calculated in accordance with this Section. It is the 
15intent
of the General Assembly to provide adequate 
16reimbursement for ambulance
services so as to ensure adequate 
17access to services for recipients of aid
under this Article and 
18to provide appropriate incentives to ambulance service

19providers to provide services in an efficient and 
20cost-effective manner. Thus,
it is the intent of the General 
21Assembly that the Illinois Department implement
a 
22reimbursement system for ambulance services that, to the extent 
23practicable
and subject to the availability of funds 
24appropriated by the General Assembly
for this purpose, is 
25consistent with the payment principles of Medicare. To
ensure 
 
 
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1uniformity between the payment principles of Medicare and 
2Medicaid, the
Illinois Department shall follow, to the extent 
3necessary and practicable and
subject to the availability of 
4funds appropriated by the General Assembly for
this purpose, 
5the statutes, laws, regulations, policies, procedures,

6principles, definitions, guidelines, and manuals used to 
7determine the amounts
paid to ambulance service providers under 
8Title XVIII of the Social Security
Act (Medicare).

9 (b) For ambulance services provided to a recipient of aid 
10under this Article
on or after January 1, 1996, the Illinois 
11Department shall reimburse ambulance
service providers based 
12upon the actual distance traveled if a natural
disaster, 
13weather conditions, road repairs, or traffic congestion 
14necessitates
the use of a
route other than the most direct 
15route.

16 (c) For purposes of this Section, "ambulance services" 
17includes medical
transportation services provided by means of 
18an ambulance, medi-car, service
car, or
taxi.

19 (c-1) For purposes of this Section, "ground ambulance 
20service" means medical transportation services that are 
21described as ground ambulance services by the Centers for 
22Medicare and Medicaid Services and provided in a vehicle that 
23is licensed as an ambulance by the Illinois Department of 
24Public Health pursuant to the Emergency Medical Services (EMS) 
25Systems Act.
26 (c-2) For purposes of this Section, "ground ambulance 
 
 
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1service provider" means a vehicle service provider as described 
2in the Emergency Medical Services (EMS) Systems Act that 
3operates licensed ambulances for the purpose of providing 
4emergency ambulance services, or non-emergency ambulance 
5services, or both. For purposes of this Section, this includes 
6both ambulance providers and ambulance suppliers as described 
7by the Centers for Medicare and Medicaid Services.
8 (c-3) For purposes of this Section, "medi-car" means 
9transportation services provided to a patient who is confined 
10to a wheelchair and requires the use of a hydraulic or electric 
11lift or ramp and wheelchair lockdown when the patient's 
12condition does not require medical observation, medical 
13supervision, medical equipment, the administration of 
14medications, or the administration of oxygen. 
15 (c-4) For purposes of this Section, "service car" means 
16transportation services provided to a patient by a passenger 
17vehicle where that patient does not require the specialized 
18modes described in subsection (c-1) or (c-3). 
19 (d) This Section does not prohibit separate billing by 
20ambulance service
providers for oxygen furnished while 
21providing advanced life support
services.

22 (e) Beginning with services rendered on or after July 1, 
232008, all providers of non-emergency medi-car and service car 
24transportation must certify that the driver and employee 
25attendant, as applicable, have completed a safety program 
26approved by the Department to protect both the patient and the 
 
 
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1driver, prior to transporting a patient.
The provider must 
2maintain this certification in its records. The provider shall 
3produce such documentation upon demand by the Department or its 
4representative. Failure to produce documentation of such 
5training shall result in recovery of any payments made by the 
6Department for services rendered by a non-certified driver or 
7employee attendant. Medi-car and service car providers must 
8maintain legible documentation in their records of the driver 
9and, as applicable, employee attendant that actually 
10transported the patient. Providers must recertify all drivers 
11and employee attendants every 3 years.

12 Notwithstanding the requirements above, any public 
13transportation provider of medi-car and service car 
14transportation that receives federal funding under 49 U.S.C. 
155307 and 5311 need not certify its drivers and employee 
16attendants under this Section, since safety training is already 
17federally mandated.

18 (f) With respect to any policy or program administered by 
19the Department or its agent regarding approval of non-emergency 
20medical transportation by ground ambulance service providers, 
21including, but not limited to, the Non-Emergency 
22Transportation Services Prior Approval Program (NETSPAP), the 
23Department shall establish by rule a process by which ground 
24ambulance service providers of non-emergency medical 
25transportation may appeal any decision by the Department or its 
26agent for which no denial was received prior to the time of 
 
 
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1transport that either (i) denies a request for approval for 
2payment of non-emergency transportation by means of ground 
3ambulance service or (ii) grants a request for approval of 
4non-emergency transportation by means of ground ambulance 
5service at a level of service that entitles the ground 
6ambulance service provider to a lower level of compensation 
7from the Department than the ground ambulance service provider 
8would have received as compensation for the level of service 
9requested. The rule shall be filed by December 15, 2012 and 
10shall provide that, for any decision rendered by the Department 
11or its agent on or after the date the rule takes effect, the 
12ground ambulance service provider shall have 60 days from the 
13date the decision is received to file an appeal. The rule 
14established by the Department shall be, insofar as is 
15practical, consistent with the Illinois Administrative 
16Procedure Act. The Director's decision on an appeal under this 
17Section shall be a final administrative decision subject to 
18review under the Administrative Review Law. 
19 (f-5) Beginning 90 days after July 20, 2012 (the effective 
20date of Public Act 97-842), (i) no denial of a request for 
21approval for payment of non-emergency transportation by means 
22of ground ambulance service, and (ii) no approval of 
23non-emergency transportation by means of ground ambulance 
24service at a level of service that entitles the ground 
25ambulance service provider to a lower level of compensation 
26from the Department than would have been received at the level 
 
 
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1of service submitted by the ground ambulance service provider, 
2may be issued by the Department or its agent unless the 
3Department has submitted the criteria for determining the 
4appropriateness of the transport for first notice publication 
5in the Illinois Register pursuant to Section 5-40 of the 
6Illinois Administrative Procedure Act. 
7 (g) Whenever a patient covered by a medical assistance 
8program under this Code or by another medical program 
9administered by the Department, including a patient covered 
10under the State's Medicaid managed care program, is being 
11transported from a facility and requires non-emergency 
12transportation including ground ambulance, medi-car, or 
13service car transportation, a Physician Certification 
14Statement as described in this Section shall be required for 
15each patient. Facilities shall develop procedures for a 
16licensed medical professional to provide a written and signed 
17Physician Certification Statement. The Physician Certification 
18Statement shall specify the level of transportation services 
19needed and complete a medical certification establishing the 
20criteria for approval of non-emergency ambulance 
21transportation, as published by the Department of Healthcare 
22and Family Services, that is met by the patient. This 
23certification shall be completed prior to ordering the 
24transportation service and prior to patient discharge. The 
25Physician Certification Statement is not required prior to 
26transport if a delay in transport can be expected to negatively 
 
 
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1affect the patient outcome. If the ground ambulance provider, 
2medi-car provider, or service car provider is unable to obtain 
3the required Physician Certification Statement within 10 
4calendar days following the date of the service, the ground 
5ambulance provider, medi-car provider, or service car provider 
6must document its attempt to obtain the requested certification 
7and may then submit the claim for payment. Acceptable 
8documentation includes a signed return receipt from the U.S. 
9Postal Service, facsimile receipt, email receipt, or other 
10similar service that evidences that the ground ambulance 
11provider, medi-car provider, or service car provider attempted 
12to obtain the required Physician Certification Statement. 
13 The medical certification specifying the level and type of 
14non-emergency transportation needed shall be in the form of the 
15Physician Certification Statement on a standardized form 
16prescribed by the Department of Healthcare and Family Services. 
17Within 75 days after July 27, 2018 (the effective date of 
18Public Act 100-646), the Department of Healthcare and Family 
19Services shall develop a standardized form of the Physician 
20Certification Statement specifying the level and type of 
21transportation services needed in consultation with the 
22Department of Public Health, Medicaid managed care 
23organizations, a statewide association representing ambulance 
24providers, a statewide association representing hospitals, 3 
25statewide associations representing nursing homes, and other 
26stakeholders. The Physician Certification Statement shall 
 
 
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1include, but is not limited to, the criteria necessary to 
2demonstrate medical necessity for the level of transport needed 
3as required by (i) the Department of Healthcare and Family 
4Services and (ii) the federal Centers for Medicare and Medicaid 
5Services as outlined in the Centers for Medicare and Medicaid 
6Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap. 
710, Sec. 10.2.1, et seq. The use of the Physician Certification 
8Statement shall satisfy the obligations of hospitals under 
9Section 6.22 of the Hospital Licensing Act and nursing homes 
10under Section 2-217 of the Nursing Home Care Act. 
11Implementation and acceptance of the Physician Certification 
12Statement shall take place no later than 90 days after the 
13issuance of the Physician Certification Statement by the 
14Department of Healthcare and Family Services. 
15 Pursuant to subsection (E) of Section 12-4.25 of this Code, 
16the Department is entitled to recover overpayments paid to a 
17provider or vendor, including, but not limited to, from the 
18discharging physician, the discharging facility, and the 
19ground ambulance service provider, in instances where a 
20non-emergency ground ambulance service is rendered as the 
21result of improper or false certification. 
22 Beginning October 1, 2018, the Department of Healthcare and 
23Family Services shall collect data from Medicaid managed care 
24organizations and transportation brokers, including the 
25Department's NETSPAP broker, regarding denials and appeals 
26related to the missing or incomplete Physician Certification 
 
 
10100SB1864ham006- 62 -LRB101 10924 SMS 72418 a


1Statement forms and overall compliance with this subsection. 
2The Department of Healthcare and Family Services shall publish 
3quarterly results on its website within 15 days following the 
4end of each quarter. 
5 (h) On and after July 1, 2012, the Department shall reduce 
6any rate of reimbursement for services or other payments or 
7alter any methodologies authorized by this Code to reduce any 
8rate of reimbursement for services or other payments in 
9accordance with Section 5-5e. 
10 (i) On and after July 1, 2018, the Department shall 
11increase the base rate of reimbursement for both base charges 
12and mileage charges for ground ambulance service providers for 
13medical transportation services provided by means of a ground 
14ambulance to a level not lower than 112% of the base rate in 
15effect as of June 30, 2018.
16(Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18; 
17101-81, eff. 7-12-19.)


18 (305 ILCS 5/5-5.27 new)
19 Sec. 5-5.27. Coverage for clinical trials. 
20 (a) The medical assistance program shall provide coverage 
21for routine care costs that are incurred in the course of an 
22approved clinical trial if the medical assistance program would 
23provide coverage for the same routine care costs not incurred 
24in a clinical trial. "Routine care cost" shall be defined by 
25the Department by rule. 
 
 
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1 (b) The coverage that must be provided under this Section 
2is subject to the terms, conditions, restrictions, exclusions, 
3and limitations that apply generally under the medical 
4assistance program, including terms, conditions, restrictions, 
5exclusions, or limitations that apply to health care services 
6rendered by participating providers and nonparticipating 
7providers. 
8 (c) Implementation of this Section shall be contingent upon 
9federal approval. Upon receipt of federal approval, if 
10required, the Department shall adopt any rules necessary to 
11implement this Section. 
12 (d) As used in this Section:
13 "Approved clinical trial" means a phase I, II, III, or IV 
14clinical trial involving the prevention, detection, or 
15treatment of cancer or any other life-threatening disease or 
16condition if one or more of the following conditions apply:
17  (1) the Department makes a determination that the study 
18 or investigation is an approved clinical trial; 
19  (2) the study or investigation is conducted under an 
20 investigational new drug application or an investigational 
21 device exemption reviewed by the federal Food and Drug 
22 Administration; 
23  (3) the study or investigation is a drug trial that is 
24 exempt from having an investigational new drug application 
25 or an investigational device exemption from the federal 
26 Food and Drug Administration; or 
 
 
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1  (4) the study or investigation is approved or funded 
2 (which may include funding through in-kind contributions) 
3 by: 
4   (A) the National Institutes of Health;
5   (B)
the Centers for Disease Control and 
6 Prevention;
7   (C)
the Agency for Healthcare Research and 
8 Quality;
9   (D)
the Patient-Centered Outcomes Research 
10 Institute;
11   (E)
the federal Centers for Medicare and Medicaid 
12 Services; 
13   (F) a cooperative group or center of any of the 
14 entities described in subparagraphs (A) through (E) or 
15 the United States Department of Defense or the United 
16 States Department of Veterans Affairs;
17   (G)
a qualified non-governmental research entity 
18 identified in the guidelines issued by the National 
19 Institutes of Health for center support grants; or
20   (H)
the United States Department of Veterans 
21 Affairs, the United States Department of Defense, or 
22 the United States Department of Energy, provided that 
23 review and approval of the study or investigation 
24 occurs through a system of peer review that is 
25 comparable to the peer review of studies performed by 
26 the National Institutes of Health, including an 
 
 
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1 unbiased review of the highest scientific standards by 
2 qualified individuals who have no interest in the 
3 outcome of the review. 
4 "Care method" means the use of a particular drug or device 
5in a particular manner. 
6 "Life-threatening disease or condition" means a disease or 
7condition from which the likelihood of death is probable unless 
8the course of the disease or condition is interrupted. 

9 (305 ILCS 5/5-5e)
10 Sec. 5-5e. Adjusted rates of reimbursement. 
11 (a) Rates or payments for services in effect on June 30, 
122012 shall be adjusted and
services shall be affected as 
13required by any other provision of Public Act 97-689. In 
14addition, the Department shall do the following: 
15  (1) Delink the per diem rate paid for supportive living 
16 facility services from the per diem rate paid for nursing 
17 facility services, effective for services provided on or 
18 after May 1, 2011 and before July 1, 2019.
19  (2) Cease payment for bed reserves in nursing 
20 facilities and specialized mental health rehabilitation 
21 facilities; for purposes of therapeutic home visits for 
22 individuals scoring as TBI on the MDS 3.0, beginning June 
23 1, 2015, the Department shall approve payments for bed 
24 reserves in nursing facilities and specialized mental 
25 health rehabilitation facilities that have at least a 90% 
 
 
10100SB1864ham006- 66 -LRB101 10924 SMS 72418 a


1 occupancy level and at least 80% of their residents are 
2 Medicaid eligible. Payment shall be at a daily rate of 75% 
3 of an individual's current Medicaid per diem and shall not 
4 exceed 10 days in a calendar month.
5  (2.5) Cease payment for bed reserves for purposes of 
6 inpatient hospitalizations to intermediate care facilities 
7 for persons with developmental development disabilities, 
8 except in the instance of residents who are under 21 years 
9 of age. 
10  (3) Cease payment of the $10 per day add-on payment to 
11 nursing facilities for certain residents with 
12 developmental disabilities.
13 (b) After the application of subsection (a), 
14notwithstanding any other provision of this
Code to the 
15contrary and to the extent permitted by federal law, on and 
16after July 1,
2012, the rates of reimbursement for services and 
17other payments provided under this
Code shall further be 
18reduced as follows: 
19  (1) Rates or payments for physician services, dental 
20 services, or community health center services reimbursed 
21 through an encounter rate, and services provided under the 
22 Medicaid Rehabilitation Option of the Illinois Title XIX 
23 State Plan shall not be further reduced, except as provided 
24 in Section 5-5b.1. 
25  (2) Rates or payments, or the portion thereof, paid to 
26 a provider that is operated by a unit of local government 
 
 
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1 or State University that provides the non-federal share of 
2 such services shall not be further reduced, except as 
3 provided in Section 5-5b.1. 
4  (3) Rates or payments for hospital services delivered 
5 by a hospital defined as a Safety-Net Hospital under 
6 Section 5-5e.1 of this Code shall not be further reduced, 
7 except as provided in Section 5-5b.1. 
8  (4) Rates or payments for hospital services delivered 
9 by a Critical Access Hospital, which is an Illinois 
10 hospital designated as a critical care hospital by the 
11 Department of Public Health in accordance with 42 CFR 485, 
12 Subpart F, shall not be further reduced, except as provided 
13 in Section 5-5b.1. 
14  (5) Rates or payments for Nursing Facility Services 
15 shall only be further adjusted pursuant to Section 5-5.2 of 
16 this Code. 
17  (6) Rates or payments for services delivered by long 
18 term care facilities licensed under the ID/DD Community 
19 Care Act or the MC/DD Act and developmental training 
20 services shall not be further reduced. 
21  (7) Rates or payments for services provided under 
22 capitation rates shall be adjusted taking into 
23 consideration the rates reduction and covered services 
24 required by Public Act 97-689. 
25  (8) For hospitals not previously described in this 
26 subsection, the rates or payments for hospital services 
 
 
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1 shall be further reduced by 3.5%, except for payments 
2 authorized under Section 5A-12.4 of this Code. 
3  (9) For all other rates or payments for services 
4 delivered by providers not specifically referenced in 
5 paragraphs (1) through (8), rates or payments shall be 
6 further reduced by 2.7%. 
7 (c) Any assessment imposed by this Code shall continue and 
8nothing in this Section shall be construed to cause it to 
9cease. 

10 (d) Notwithstanding any other provision of this Code to the 
11contrary, subject to federal approval under Title XIX of the 
12Social Security Act, for dates of service on and after July 1, 
132014, rates or payments for services provided for the purpose 
14of transitioning children from a hospital to home placement or 
15other appropriate setting by a children's community-based 
16health care center authorized under the Alternative Health Care 
17Delivery Act shall be $683 per day. 
18 (e) (Blank) Notwithstanding any other provision of this 
19Code to the contrary, subject to federal approval under Title 
20XIX of the Social Security Act, for dates of service on and 
21after July 1, 2014, rates or payments for home health visits 
22shall be $72. 
23 (f) (Blank) Notwithstanding any other provision of this 
24Code to the contrary, subject to federal approval under Title 
25XIX of the Social Security Act, for dates of service on and 
26after July 1, 2014, rates or payments for the certified nursing 
 
 
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1assistant component of the home health agency rate shall be 
2$20. 
3(Source: P.A. 101-10, eff. 6-5-19; revised 9-12-19.)



4 (305 ILCS 5/5-16.8)


5 Sec. 5-16.8. Required health benefits. The medical 
6assistance program
shall
(i) provide the post-mastectomy care 
7benefits required to be covered by a policy of
accident and 
8health insurance under Section 356t and the coverage required

9under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, 
10356z.29, and 356z.32, and 356z.33, 356z.34, and 356z.35 of the 
11Illinois
Insurance Code and (ii) be subject to the provisions 
12of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois

13Insurance Code.

14 The Department, by rule, shall adopt a model similar to the 
15requirements of Section 356z.39 of the Illinois Insurance Code. 
16 On and after July 1, 2012, the Department shall reduce any 
17rate of reimbursement for services or other payments or alter 
18any methodologies authorized by this Code to reduce any rate of 
19reimbursement for services or other payments in accordance with 
20Section 5-5e. 
21 To ensure full access to the benefits set forth in this 
22Section, on and after January 1, 2016, the Department shall 
23ensure that provider and hospital reimbursement for 
24post-mastectomy care benefits required under this Section are 
25no lower than the Medicare reimbursement rate. 
 
 
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1(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 
2100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 
37-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, 
4eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)




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



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

7 (a) The assessment imposed by Section 5B-2 shall be due and 
8payable monthly, on the last State business day of the month 
9for occupied bed days reported for the preceding third month 
10prior to the month in which the tax is payable and due. A 
11facility that has delayed payment due to the State's failure to 
12reimburse for services rendered may request an extension on the 
13due date for payment pursuant to subsection (b) and shall pay 
14the assessment within 30 days of reimbursement by the 
15Department.
The Illinois Department may provide that county 
16nursing homes directed and
maintained pursuant to Section 
175-1005 of the Counties Code may meet their
assessment 
18obligation by certifying to the Illinois Department that county

19expenditures have been obligated for the operation of the 
20county nursing
home in an amount at least equal to the amount 
21of the assessment.

22 (a-5) The Illinois Department shall provide for an 
23electronic submission process for each long-term care facility 
24to report at a minimum the number of occupied bed days of the 
25long-term care facility for the reporting period and other 
 
 
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1reasonable information the Illinois Department requires for 
2the administration of its responsibilities under this Code. 
3Beginning July 1, 2013, a separate electronic submission shall 
4be completed for each long-term care facility in this State 
5operated by a long-term care provider. The Illinois Department 
6shall provide a self-reporting notice of the assessment form 
7that the long-term care facility completes for the required 
8period and submits with its assessment payment to the Illinois 
9Department. shall prepare an assessment bill stating the amount 
10due and payable each month and submit it to each long-term care 
11facility via an electronic process. Each assessment payment 
12shall be accompanied by a copy of the assessment bill sent to 
13the long-term care facility by the Illinois Department. To the 
14extent practicable, the Department shall coordinate the 
15assessment reporting requirements with other reporting 
16required of long-term care facilities.
17 (b) The Illinois Department is authorized to establish

18delayed payment schedules for long-term care providers that are

19unable to make assessment payments when due under this Section

20due to financial difficulties, as determined by the Illinois

21Department. The Illinois Department may not deny a request for 
22delay of payment of the assessment imposed under this Article 
23if the long-term care provider has not been paid for services 
24provided during the month on which the assessment is levied or 
25the Medicaid managed care organization has not been paid by the 
26State. 

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

2amount of an assessment payment when due (including any 
3extensions
granted under subsection (b)), there shall, unless 
4waived by the
Illinois Department for reasonable cause, be 
5added to the
assessment imposed by Section 5B-2 a
penalty 
6assessment equal to the lesser of (i) 5% of the amount of
the 
7assessment payment not paid on or before the due date plus 5% 
8of the
portion thereof remaining unpaid on the last day of each 
9month
thereafter or (ii) 100% of the assessment payment amount 
10not paid on or
before the due date. For purposes of this 
11subsection, payments
will be credited first to unpaid 
12assessment payment amounts (rather than
to penalty or 
13interest), beginning with the most delinquent assessment 
14payments. Payment cycles of longer than 60 days shall be one 
15factor the Director takes into account in granting a waiver 
16under this Section. 

17 (c-5) If a long-term care facility fails to file its 
18assessment bill with payment, there shall, unless waived by the 
19Illinois Department for reasonable cause, be added to the 
20assessment due a penalty assessment equal to 25% of the 
21assessment due. After July 1, 2013, no penalty shall be 
22assessed under this Section if the Illinois Department does not 
23provide a process for the electronic submission of the 
24information required by subsection (a-5). 
25 (d) Nothing in this amendatory Act of 1993 shall be 
26construed to prevent
the Illinois Department from collecting 
 
 
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1all amounts due under this Article
pursuant to an assessment 
2imposed before the effective date of this amendatory
Act of 
31993.

4 (e) Nothing in this amendatory Act of the 96th General 
5Assembly shall be construed to prevent
the Illinois Department 
6from collecting all amounts due under this Code
pursuant to an 
7assessment, tax, fee, or penalty imposed before the effective 
8date of this amendatory
Act of the 96th General Assembly. 
9 (f) No installment of the assessment imposed by Section 
105B-2 shall be due and payable until after the Department 
11notifies the long-term care providers, in writing, that the 
12payment methodologies to long-term care providers required 
13under Section 5-5.4 of this Code have been approved by the 
14Centers for Medicare and Medicaid Services of the U.S. 
15Department of Health and Human Services and the waivers under 
1642 CFR 433.68 for the assessment imposed by this Section, if 
17necessary, have been granted by the Centers for Medicare and 
18Medicaid Services of the U.S. Department of Health and Human 
19Services. Upon notification to the Department of approval of 
20the payment methodologies required under Section 5-5.4 of this 
21Code and the waivers granted under 42 CFR 433.68, all 
22installments otherwise due under Section 5B-4 prior to the date 
23of notification shall be due and payable to the Department upon 
24written direction from the Department within 90 days after 
25issuance by the Comptroller of the payments required under 
26Section 5-5.4 of this Code. 
 
 
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1(Source: P.A. 100-501, eff. 6-1-18.)


2 (305 ILCS 5/11-5.1)
3 Sec. 11-5.1. Eligibility verification. Notwithstanding any 
4other provision of this Code, with respect to applications for 
5medical assistance provided under Article V of this Code, 
6eligibility shall be determined in a manner that ensures 
7program integrity and complies with federal laws and 
8regulations while minimizing unnecessary barriers to 
9enrollment. To this end, as soon as practicable, and unless the 
10Department receives written denial from the federal 
11government, this Section shall be implemented:
12 (a) The Department of Healthcare and Family Services or its 
13designees shall: 
14  (1) By no later than July 1, 2011, require verification 
15 of, at a minimum, one month's income from all sources 
16 required for determining the eligibility of applicants for 
17 medical assistance under this Code. Such verification 
18 shall take the form of pay stubs, business or income and 
19 expense records for self-employed persons, letters from 
20 employers, and any other valid documentation of income 
21 including data obtained electronically by the Department 
22 or its designees from other sources as described in 
23 subsection (b) of this Section. A month's income may be 
24 verified by a single pay stub with the monthly income 
25 extrapolated from the time period covered by the pay stub. 
 
 
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1  (2) By no later than October 1, 2011, require 
2 verification of, at a minimum, one month's income from all 
3 sources required for determining the continued eligibility 
4 of recipients at their annual review of eligibility for 
5 medical assistance under this Code. Information the 
6 Department receives prior to the annual review, including 
7 information available to the Department as a result of the 
8 recipient's application for other non-Medicaid benefits, 
9 that is sufficient to make a determination of continued 
10 Medicaid eligibility may be reviewed and verified, and 
11 subsequent action taken including client notification of 
12 continued Medicaid eligibility. The date of client 
13 notification establishes the date for subsequent annual 
14 Medicaid eligibility reviews. Such verification shall take 
15 the form of pay stubs, business or income and expense 
16 records for self-employed persons, letters from employers, 
17 and any other valid documentation of income including data 
18 obtained electronically by the Department or its designees 
19 from other sources as described in subsection (b) of this 
20 Section. A month's income may be verified by a single pay 
21 stub with the monthly income extrapolated from the time 
22 period covered by the pay stub. The
Department shall send a 
23 notice to
recipients at least 60 days prior to the end of 
24 their period
of eligibility that informs them of the

25 requirements for continued eligibility. If a recipient

26 does not fulfill the requirements for continued 
 
 
10100SB1864ham006- 76 -LRB101 10924 SMS 72418 a


1 eligibility by the
deadline established in the notice a 
2 notice of cancellation shall be issued to the recipient and 
3 coverage shall end no later than the last day of the month 
4 following the last day of the eligibility period. A 
5 recipient's eligibility may be reinstated without 
6 requiring a new application if the recipient fulfills the 
7 requirements for continued eligibility prior to the end of 
8 the third month following the last date of coverage (or 
9 longer period if required by federal regulations). Nothing 
10 in this Section shall prevent an individual whose coverage 
11 has been cancelled from reapplying for health benefits at 
12 any time.
13  (3) By no later than July 1, 2011, require verification 
14 of Illinois residency. 
15 The Department, with federal approval, may choose to adopt 
16continuous financial eligibility for a full 12 months for 
17adults on Medicaid. 
18 (b) The Department shall establish or continue cooperative

19arrangements with the Social Security Administration, the

20Illinois Secretary of State, the Department of Human Services,

21the Department of Revenue, the Department of Employment

22Security, and any other appropriate entity to gain electronic

23access, to the extent allowed by law, to information available

24to those entities that may be appropriate for electronically

25verifying any factor of eligibility for benefits under the

26Program. Data relevant to eligibility shall be provided for no

 
 
10100SB1864ham006- 77 -LRB101 10924 SMS 72418 a


1other purpose than to verify the eligibility of new applicants 
2or current recipients of health benefits under the Program. 
3Data shall be requested or provided for any new applicant or 
4current recipient only insofar as that individual's 
5circumstances are relevant to that individual's or another 
6individual's eligibility. 
7 (c) Within 90 days of the effective date of this amendatory 
8Act of the 96th General Assembly, the Department of Healthcare 
9and Family Services shall send notice to current recipients 
10informing them of the changes regarding their eligibility 
11verification. 

12 (d) As soon as practical if the data is reasonably 
13available, but no later than January 1, 2017, the Department 
14shall compile on a monthly basis data on eligibility 
15redeterminations of beneficiaries of medical assistance 
16provided under Article V of this Code. This data shall be 
17posted on the Department's website, and data from prior months 
18shall be retained and available on the Department's website. 
19The data compiled and reported shall include the following: 
20  (1) The total number of redetermination decisions made 
21 in a month and, of that total number, the number of 
22 decisions to continue or change benefits and the number of 
23 decisions to cancel benefits. 
24  (2) A breakdown of enrollee language preference for the 
25 total number of redetermination decisions made in a month 
26 and, of that total number, a breakdown of enrollee language 
 
 
10100SB1864ham006- 78 -LRB101 10924 SMS 72418 a


1 preference for the number of decisions to continue or 
2 change benefits, and a breakdown of enrollee language 
3 preference for the number of decisions to cancel benefits. 
4 The language breakdown shall include, at a minimum, 
5 English, Spanish, and the next 4 most commonly used 
6 languages. 
7  (3) The percentage of cancellation decisions made in a 
8 month due to each of the following: 
9   (A) The beneficiary's ineligibility due to excess 
10 income. 
11   (B) The beneficiary's ineligibility due to not 
12 being an Illinois resident. 
13   (C) The beneficiary's ineligibility due to being 
14 deceased. 
15   (D) The beneficiary's request to cancel benefits. 
16   (E) The beneficiary's lack of response after 
17 notices mailed to the beneficiary are returned to the 
18 Department as undeliverable by the United States 
19 Postal Service. 
20   (F) The beneficiary's lack of response to a request 
21 for additional information when reliable information 
22 in the beneficiary's account, or other more current 
23 information, is unavailable to the Department to make a 
24 decision on whether to continue benefits. 
25   (G) Other reasons tracked by the Department for the 
26 purpose of ensuring program integrity. 
 
 
10100SB1864ham006- 79 -LRB101 10924 SMS 72418 a


1  (4) If a vendor is utilized to provide services in 
2 support of the Department's redetermination decision 
3 process, the total number of redetermination decisions 
4 made in a month and, of that total number, the number of 
5 decisions to continue or change benefits, and the number of 
6 decisions to cancel benefits (i) with the involvement of 
7 the vendor and (ii) without the involvement of the vendor. 
8  (5) Of the total number of benefit cancellations in a 
9 month, the number of beneficiaries who return from 
10 cancellation within one month, the number of beneficiaries 
11 who return from cancellation within 2 months, and the 
12 number of beneficiaries who return from cancellation 
13 within 3 months. Of the number of beneficiaries who return 
14 from cancellation within 3 months, the percentage of those 
15 cancellations due to each of the reasons listed under 
16 paragraph (3) of this subsection. 
17 (e) The Department shall conduct a complete review of the 
18Medicaid redetermination process in order to identify changes 
19that can increase the use of ex parte redetermination 
20processing. This review shall be completed within 90 days after 
21the effective date of this amendatory Act of the 101st General 
22Assembly. Within 90 days of completion of the review, the 
23Department shall seek written federal approval of policy 
24changes the review recommended and implement once approved. The 
25review shall specifically include, but not be limited to, use 
26of ex parte redeterminations of the following populations: 
 
 
10100SB1864ham006- 80 -LRB101 10924 SMS 72418 a


1  (1) Recipients of developmental disabilities services. 
2  (2) Recipients of benefits under the State's Aid to the 
3 Aged, Blind, or Disabled program.
4  (3) Recipients of Medicaid long-term care services and 
5 supports, including waiver services.
6  (4) All Modified Adjusted Gross Income (MAGI) 
7 populations.
8  (5) Populations with no verifiable income.
9  (6) Self-employed people.
10 The report shall also outline populations and 
11circumstances in which an ex parte redetermination is not a 
12recommended option. 
13 (f) The Department shall explore and implement, as 
14practical and technologically possible, roles that 
15stakeholders outside State agencies can play to assist in 
16expediting eligibility determinations and redeterminations 
17within 24 months after the effective date of this amendatory 
18Act of the 101st General Assembly. Such practical roles to be 
19explored to expedite the eligibility determination processes 
20shall include the implementation of hospital presumptive 
21eligibility, as authorized by the Patient Protection and 
22Affordable Care Act. 
23 (g) The Department or its designee shall seek federal 
24approval to enhance the reasonable compatibility standard from 
255% to 10%. 
26 (h) Reporting. The Department of Healthcare and Family 
 
 
10100SB1864ham006- 81 -LRB101 10924 SMS 72418 a


1Services and the Department of Human Services shall publish 
2quarterly reports on their progress in implementing policies 
3and practices pursuant to this Section as modified by this 
4amendatory Act of the 101st General Assembly. 
5  (1) The reports shall include, but not be limited to, 
6 the following: 
7   (A) Medical application processing, including a 
8 breakdown of the number of MAGI, non-MAGI, long-term 
9 care, and other medical cases pending for various 
10 incremental time frames between 0 to 181 or more days.
11   (B) Medical redeterminations completed, including: 
12 (i) a breakdown of the number of households that were 
13 redetermined ex parte and those that were not; (ii) the 
14 reasons households were not redetermined ex parte; and 
15 (iii) the relative percentages of these reasons.
16   (C) A narrative discussion on issues identified in 
17 the functioning of the State's Integrated Eligibility 
18 System and progress on addressing those issues, as well 
19 as progress on implementing strategies to address 
20 eligibility backlogs, including expanding ex parte 
21 determinations to ensure timely eligibility 
22 determinations and renewals. 
23  (2) Initial reports shall be issued within 90 days 
24 after the effective date of this amendatory Act of the 
25 101st General Assembly. 
26  (3) All reports shall be published on the Department's 
 
 
10100SB1864ham006- 82 -LRB101 10924 SMS 72418 a


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

3 (305 ILCS 5/12-21.21 new)
4 Sec. 12-21.21. Federal waiver or State Plan amendment. The 
5Department of Healthcare and Family Services and the Department 
6of Human Services shall jointly submit the necessary 
7application to the federal Centers for Medicare and Medicaid 
8Services for a waiver or State Plan amendment to allow remote 
9monitoring and support services as a waiver-reimbursable 
10service for persons with intellectual and developmental 
11disabilities. The application shall be submitted no later than 
12January 1, 2021.
13 No later than July 1, 2021, the Department of Human 
14Services shall adopt rules to allow remote monitoring and 
15support services at community-integrated living arrangements.


16 Section 90-40. The Medical Patient Rights Act is amended by 
17changing Section 3 as follows:



18 (410 ILCS 50/3) (from Ch. 111 1/2, par. 5403)



19 Sec. 3. The following rights are hereby established: 

20 (a) The right of each patient to care consistent with sound 
21nursing and
medical practices, to be informed of the name of 
22the physician responsible
for coordinating his or her care, to 
23receive information concerning his or
her condition and 
 
 
10100SB1864ham006- 83 -LRB101 10924 SMS 72418 a


1proposed treatment, to refuse any treatment to the extent

2permitted by law, and to privacy and confidentiality of records 
3except as
otherwise provided by law.

4 (b) The right of each patient, regardless of source of 
5payment, to examine
and receive a reasonable explanation of his 
6total bill for services rendered
by his physician or health 
7care provider, including the itemized charges
for specific 
8services received. Each physician or health care provider
shall 
9be responsible only for a reasonable explanation of those 
10specific
services provided by such physician or health care 
11provider.

12 (c) In the event an insurance company or health services 
13corporation cancels
or refuses to renew an individual policy or 
14plan, the insured patient shall
be entitled to timely, prior 
15notice of the termination of such policy or plan.

16 An insurance company or health services corporation that 
17requires any
insured patient or applicant for new or continued 
18insurance or coverage to
be tested for infection with human 
19immunodeficiency virus (HIV) or any
other identified causative 
20agent of acquired immunodeficiency syndrome
(AIDS) shall (1) 
21give the patient or applicant prior written notice of such

22requirement, (2) proceed with such testing only upon the 
23written
authorization of the applicant or patient, and (3) keep 
24the results of such
testing confidential. Notice of an adverse 
25underwriting or coverage
decision may be given to any 
26appropriately interested party, but the
insurer may only 
 
 
10100SB1864ham006- 84 -LRB101 10924 SMS 72418 a


1disclose the test result itself to a physician designated
by 
2the applicant or patient, and any such disclosure shall be in a 
3manner
that assures confidentiality.

4 The Department of Insurance shall enforce the provisions of 
5this subsection.

6 (d) The right of each patient to privacy and 
7confidentiality in health
care. Each physician, health care 
8provider, health services corporation and
insurance company 
9shall refrain from disclosing the nature or details of
services 
10provided to patients, except that such information may be 
11disclosed: (1) to the
patient, (2) to the party making 
12treatment decisions if the patient is incapable
of making 
13decisions regarding the health services provided, (3) for 
14treatment in accordance with 45 CFR 164.501 and 164.506, (4) 
15for
payment in accordance with 45 CFR 164.501 and 164.506, (5) 
16to those parties responsible for peer review,
utilization 
17review, and quality assurance, (6) for health care operations 
18in accordance with 45 CFR 164.501 and 164.506, (7) to those 
19parties required to
be notified under the Abused and Neglected 
20Child Reporting Act or the
Illinois Sexually Transmissible 
21Disease Control Act, or (8) as otherwise permitted,
authorized, 
22or required by State or federal law. This right may be waived 
23in writing by the
patient or the patient's guardian or legal 
24representative, but a physician or other health care
provider 
25may not condition the provision of services on the patient's,

26guardian's, or legal representative's agreement to sign such a 
 
 
10100SB1864ham006- 85 -LRB101 10924 SMS 72418 a


1waiver. In the interest of public health, safety, and welfare, 
2patient information, including, but not limited to, health 
3information, demographic information, and information about 
4the services provided to patients, may be transmitted to or 
5through a health information exchange, as that term is defined 
6in Section 2 of the Mental Health and Developmental 
7Disabilities Confidentiality Act, in accordance with the 
8disclosures permitted pursuant to this Section. Patients shall 
9be provided the opportunity to opt out of their health 
10information being transmitted to or through a health 
11information exchange in accordance with the regulations, 
12standards, or contractual obligations adopted by the Illinois 
13Health Information Exchange Office Authority in accordance 
14with Section 9.6 of the Mental Health and Developmental 
15Disabilities Confidentiality Act, Section 9.6 of the AIDS 
16Confidentiality Act, or Section 31.8 of the Genetic Information 
17Privacy Act, as applicable. In the case of a patient choosing 
18to opt out of having his or her information available on an 
19HIE, nothing in this Act shall cause the physician or health 
20care provider to be liable for the release of a patient's 
21health information by other entities that may possess such 
22information, including, but not limited to, other health 
23professionals, providers, laboratories, pharmacies, hospitals, 
24ambulatory surgical centers, and nursing homes. 

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


 
 
10100SB1864ham006- 86 -LRB101 10924 SMS 72418 a


1 Section 90-45. The Genetic Information Privacy Act is 
2amended 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 
6Exchange Office Authority established pursuant to the Illinois 
7Health Information Exchange and Technology Act.
8 "Business associate" has the meaning ascribed to it under 
9HIPAA, as specified in 45 CFR 160.103.
10 "Covered entity" has the meaning ascribed to it under 
11HIPAA, as specified in 45 CFR 160.103.
12 "De-identified information" means health information that 
13is not individually identifiable as described under HIPAA, as 
14specified in 45 CFR 164.514(b). 
15 "Disclosure" has the meaning ascribed to it under HIPAA, as 
16specified in 45 CFR 160.103. 
17 "Employer" means the State of Illinois, any unit of local 
18government, and any board, commission, department, 
19institution, or school district, any party to a public 
20contract, any joint apprenticeship or training committee 
21within the State, and every other person employing employees 
22within the State.
23 "Employment agency" means both public and private 
24employment agencies and any person, labor organization, or 
25labor union having a hiring hall or hiring office regularly 
 
 
10100SB1864ham006- 87 -LRB101 10924 SMS 72418 a


1undertaking, with or without compensation, to procure 
2opportunities to work, or to procure, recruit, refer, or place 
3employees.
4 "Family member" means, with respect to an individual, (i) 
5the spouse of the individual; (ii) a dependent child of the 
6individual, including a child who is born to or placed for 
7adoption with the individual; (iii) any other person qualifying 
8as a covered dependent under a managed care plan; and (iv) all 
9other individuals related by blood or law to the individual or 
10the spouse or child described in subsections (i) through (iii) 
11of this definition.
12 "Genetic information" has the meaning ascribed to it under 
13HIPAA, as specified in 45 CFR 160.103.
14 "Genetic monitoring" means the periodic examination of 
15employees to evaluate acquired modifications to their genetic 
16material, such as chromosomal damage or evidence of increased 
17occurrence of mutations that may have developed in the course 
18of employment due to exposure to toxic substances in the 
19workplace in order to identify, evaluate, and respond to 
20effects of or control adverse environmental exposures in the 
21workplace.
22 "Genetic services" has the meaning ascribed to it under 
23HIPAA, as specified in 45 CFR 160.103. 
24 "Genetic testing" and "genetic test" have the meaning 
25ascribed to "genetic test" under HIPAA, as specified in 45 CFR 
26160.103. "Genetic testing" includes direct-to-consumer 
 
 
10100SB1864ham006- 88 -LRB101 10924 SMS 72418 a


1commercial genetic testing. 
2 "Health care operations" has the meaning ascribed to it 
3under HIPAA, as specified in 45 CFR 164.501.
4 "Health care professional" means (i) a licensed physician, 
5(ii) a licensed physician assistant, (iii) a licensed advanced 
6practice registered nurse, (iv) a licensed dentist, (v) a 
7licensed podiatrist, (vi) a licensed genetic counselor, or 
8(vii) an individual certified to provide genetic testing by a 
9state or local public health department.
10 "Health care provider" has the meaning ascribed to it under 
11HIPAA, as specified in 45 CFR 160.103.
12 "Health facility" means a hospital, blood bank, blood 
13center, sperm bank, or other health care institution, including 
14any "health facility" as that term is defined in the Illinois 
15Finance Authority Act.
16 "Health information exchange" or "HIE" means a health 
17information exchange or health information organization that 
18exchanges health information electronically that (i) is 
19established pursuant to the Illinois Health Information 
20Exchange and Technology Act, or any subsequent amendments 
21thereto, and any administrative rules promulgated thereunder; 
22(ii) has established a data sharing arrangement with the Office 
23Authority; or (iii) as of August 16, 2013, was designated by 
24the Illinois Health Information
Exchange Authority (now 
25Office) Board as a member of, or was represented on, the 
26Authority Board's Regional Health Information Exchange 
 
 
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1Workgroup; provided that such designation
shall not require the 
2establishment of a data sharing arrangement or other 
3participation with the Illinois Health
Information Exchange or 
4the payment of any fee. In certain circumstances, in accordance 
5with HIPAA, an HIE will be a business associate.
6 "Health oversight agency" has the meaning ascribed to it 
7under HIPAA, as specified in 45 CFR 164.501.
8 "HIPAA" means the Health Insurance Portability and 
9Accountability Act of 1996, Public Law 104-191, as amended by 
10the Health Information Technology for Economic and Clinical 
11Health Act of 2009, Public Law 111-05, and any subsequent 
12amendments thereto and any regulations promulgated thereunder. 

13 "Insurer" means (i) an entity that is subject to the 
14jurisdiction of the Director of Insurance and (ii) a
managed 
15care plan.

16 "Labor organization" includes any organization, labor 
17union, craft union, or any voluntary unincorporated 
18association designed to further the cause of the rights of 
19union labor that is constituted for the purpose, in whole or in 
20part, of collective bargaining or of dealing with employers 
21concerning grievances, terms or conditions of employment, or 
22apprenticeships or applications for apprenticeships, or of 
23other mutual aid or protection in connection with employment, 
24including apprenticeships or applications for apprenticeships. 
25 "Licensing agency" means a board, commission, committee, 
26council, department, or officers, except a judicial officer, in 
 
 
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1this State or any political subdivision authorized to grant, 
2deny, renew, revoke, suspend, annul, withdraw, or amend a 
3license or certificate of registration.
4 "Limited data set" has the meaning ascribed to it under 
5HIPAA, as described in 45 CFR 164.514(e)(2). 
6 "Managed care plan" means a plan that establishes, 
7operates, or maintains a
network of health care providers that 
8have entered into agreements with the
plan to provide health 
9care services to enrollees where the plan has the
ultimate and 
10direct contractual obligation to the enrollee to arrange for 
11the
provision of or pay for services
through:

12  (1) organizational arrangements for ongoing quality 
13 assurance,
utilization review programs, or dispute 
14 resolution; or

15  (2) financial incentives for persons enrolled in the 
16 plan to use the
participating providers and procedures 
17 covered by the plan.

18 A managed care plan may be established or operated by any 
19entity including
a licensed insurance company, hospital or 
20medical service plan, health
maintenance organization, limited 
21health service organization, preferred
provider organization, 
22third party administrator, or an employer or employee

23organization.

24 "Minimum necessary" means HIPAA's standard for using, 
25disclosing, and requesting protected health information found 
26in 45 CFR 164.502(b) and 164.514(d).
 
 
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1 "Nontherapeutic purpose" means a purpose that is not 
2intended to improve or preserve the life or health of the 
3individual whom the information concerns.
4 "Organized health care arrangement" has the meaning 
5ascribed to it under HIPAA, as specified in 45 CFR 160.103.
6 "Patient safety activities" has the meaning ascribed to it 
7under 42 CFR 3.20.
8 "Payment" has the meaning ascribed to it under HIPAA, as 
9specified in 45 CFR 164.501.
10 "Person" includes any natural person, partnership, 
11association, joint venture, trust, governmental entity, public 
12or private corporation, health facility, or other legal entity.
13 "Protected health information" has the meaning ascribed to 
14it under HIPAA, as specified in 45 CFR 164.103.
15 "Research" has the meaning ascribed to it under HIPAA, as 
16specified in 45 CFR 164.501.
17 "State agency" means an instrumentality of the State of 
18Illinois and any instrumentality of another state which 
19pursuant to applicable law or a written undertaking with an 
20instrumentality of the State of Illinois is bound to protect 
21the privacy of genetic information of Illinois persons.
22 "Treatment" has the meaning ascribed to it under HIPAA, as 
23specified in 45 CFR 164.501. 
24 "Use" has the meaning ascribed to it under HIPAA, as 
25specified in 45 CFR 160.103, where context dictates. 
26(Source: P.A. 100-513, eff. 1-1-18; 101-132, eff. 1-1-20.)


 
 
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1 Section 90-50. The Mental Health and Developmental 
2Disabilities Confidentiality Act is amended by changing 
3Sections 2, 9.5, 9.6, 9.8, 9.9, and 9.11 as follows:



4 (740 ILCS 110/2) (from Ch. 91 1/2, par. 802)



5 Sec. 2. 
The terms used in this Act, unless the context 
6requires otherwise,
have the meanings ascribed to them in this 
7Section.

8 "Agent" means a person who has been legally appointed as an 
9individual's
agent under a power of attorney for health care or 
10for property.

11 "Business associate" has the meaning ascribed to it under 
12HIPAA, as specified in 45 CFR 160.103. 
13 "Confidential communication" or "communication" means any 
14communication
made by a recipient or other person to a 
15therapist or to or in the presence of
other persons during or 
16in connection with providing mental health or
developmental 
17disability services to a recipient. Communication includes

18information which indicates that a person is a recipient. 
19"Communication" does not include information that has been 
20de-identified in accordance with HIPAA, as specified in 45 CFR 
21164.514. 

22 "Covered entity" has the meaning ascribed to it under 
23HIPAA, as specified in 45 CFR 160.103. 
24 "Guardian" means a legally appointed guardian or 
 
 
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1conservator of the
person.

2 "Health information exchange" or "HIE" means a health 
3information exchange or health information organization that 
4oversees and governs the electronic exchange of health 
5information that (i) is established pursuant to the Illinois 
6Health Information Exchange and Technology Act, or any 
7subsequent amendments thereto, and any administrative rules 
8promulgated thereunder; or
(ii) has established a data sharing 
9arrangement with the Illinois Health Information Exchange; or

10(iii) as of the effective date of this amendatory Act of the 
1198th General Assembly, was designated by the Illinois Health 
12Information Exchange Office Authority Board as a member of, or 
13was represented on, the Office Authority Board's Regional 
14Health Information Exchange Workgroup; provided that such 
15designation shall not require the establishment of a data 
16sharing arrangement or other participation with the Illinois 
17Health Information Exchange or the payment of any fee. 
18 "HIE purposes" means those uses and disclosures (as those 
19terms are defined under HIPAA, as specified in 45 CFR 160.103) 
20for activities of an HIE: (i) set forth in the Illinois Health 
21Information Exchange and Technology Act or any subsequent 
22amendments thereto and any administrative rules promulgated 
23thereunder; or (ii) which are permitted under federal law. 
24 "HIPAA" means the Health Insurance Portability and 
25Accountability Act of 1996, Public Law 104-191, and any 
26subsequent amendments thereto and any regulations promulgated 
 
 
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1thereunder, including the Security Rule, as specified in 45 CFR 
2164.302-18, and the Privacy Rule, as specified in 45 CFR 
3164.500-34. 
4 "Integrated health system" means an organization with a 
5system of care which incorporates physical and behavioral 
6healthcare and includes care delivered in an inpatient and 
7outpatient setting. 
8 "Interdisciplinary team" means a group of persons 
9representing different clinical disciplines, such as medicine, 
10nursing, social work, and psychology, providing and 
11coordinating the care and treatment for a recipient of mental 
12health or developmental disability services. The group may be 
13composed of individuals employed by one provider or multiple 
14providers. 
15 "Mental health or developmental disabilities services" or 
16"services"
includes but is not limited to examination, 
17diagnosis, evaluation, treatment,
training, pharmaceuticals, 
18aftercare, habilitation or rehabilitation.

19 "Personal notes" means:

20  (i) information disclosed to the therapist in 
21 confidence by
other persons on condition that such 
22 information would never be disclosed
to the recipient or 
23 other persons;

24  (ii) information disclosed to the therapist by the 
25 recipient
which would be injurious to the recipient's 
26 relationships to other persons, and

 
 
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1  (iii) the therapist's speculations, impressions, 
2 hunches, and reminders.

3 "Parent" means a parent or, in the absence of a parent or 
4guardian,
a person in loco parentis.

5 "Recipient" means a person who is receiving or has received 
6mental
health or developmental disabilities services.

7 "Record" means any record kept by a therapist or by an 
8agency in the
course of providing mental health or 
9developmental disabilities service
to a recipient concerning 
10the recipient and the services provided.
"Records" includes all 
11records maintained by a court that have been created
in 
12connection with,
in preparation for, or as a result of the 
13filing of any petition or certificate
under Chapter II, Chapter 
14III, or Chapter IV
of the Mental Health and Developmental 
15Disabilities Code and includes the
petitions, certificates, 
16dispositional reports, treatment plans, and reports of

17diagnostic evaluations and of hearings under Article VIII of 
18Chapter III or under Article V of Chapter IV of that Code. 
19Record
does not include the therapist's personal notes, if such 
20notes are kept in
the therapist's sole possession for his own 
21personal use and are not
disclosed to any other person, except 
22the therapist's supervisor,
consulting therapist or attorney. 
23If at any time such notes are disclosed,
they shall be 
24considered part of the recipient's record for purposes of
this 
25Act. "Record" does not include information that has been 
26de-identified in accordance with HIPAA, as specified in 45 CFR 
 
 
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1164.514. "Record" does not include a reference to the receipt 
2of mental health or developmental disabilities services noted 
3during a patient history and physical or other summary of care. 

4 "Record custodian" means a person responsible for 
5maintaining a
recipient's record.

6 "Therapist" means a psychiatrist, physician, psychologist, 
7social
worker, or nurse providing mental health or 
8developmental disabilities services
or any other person not 
9prohibited by law from providing such services or
from holding 
10himself out as a therapist if the recipient reasonably believes

11that such person is permitted to do so. Therapist includes any 
12successor
of the therapist.
13 "Therapeutic relationship" means the receipt by a 
14recipient of mental health or developmental disabilities 
15services from a therapist. "Therapeutic relationship" does not 
16include independent evaluations for a purpose other than the 
17provision of mental health or developmental disabilities 
18services.

19(Source: P.A. 98-378, eff. 8-16-13; 99-28, eff. 1-1-16.)


20 (740 ILCS 110/9.5)
21 Sec. 9.5. Use and disclosure of information to an HIE.
22 (a) An HIE, person, therapist, facility, agency, 
23interdisciplinary team, integrated health system, business 
24associate, or covered entity may, without a recipient's 
25consent, use or disclose information from a recipient's record 
 
 
10100SB1864ham006- 97 -LRB101 10924 SMS 72418 a


1in connection with an HIE, including disclosure to the Illinois 
2Health Information Exchange Office Authority, an HIE, or the 
3business associate of either. An HIE and its business associate 
4may, without a recipient's consent, use or disclose and 
5re-disclose such information for HIE purposes or for such other 
6purposes as are specifically allowed under this Act.
7 (b) As used in this Section:
8  (1) "facility" means a developmental disability 
9 facility as defined in Section 1-107 of the Mental Health 
10 and Developmental Disabilities Code or a mental health 
11 facility as defined in Section 1-114 of the Mental Health 
12 and Developmental Disabilities Code; and
13  (2) the terms "disclosure" and "use" have the meanings 
14 ascribed to them under HIPAA, as specified in 45 CFR 
15 160.103.

16(Source: P.A. 98-378, eff. 8-16-13.)

17 (740 ILCS 110/9.6)
18 Sec. 9.6. HIE opt-out. The Illinois Health Information 
19Exchange Office Authority shall, through appropriate rules, 
20standards, or contractual obligations, which shall be binding 
21upon any HIE, as defined under Section 2, require that 
22participants of such HIE provide each recipient whose record is 
23accessible through the health information exchange the 
24reasonable opportunity to expressly decline the further 
25disclosure of the record by the health information exchange to 
 
 
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1third parties, except to the extent permitted by law such as 
2for purposes of public health reporting. These rules, 
3standards, or contractual obligations shall permit a recipient 
4to revoke a prior decision to opt-out or a decision not to 
5opt-out. These rules, standards, or contractual obligations 
6shall provide for written notice of a recipient's right to 
7opt-out which directs the recipient to a health information 
8exchange website containing (i) an explanation of the purposes 
9of the health information exchange; and (ii) audio, visual, and 
10written instructions on how to opt-out of participation in 
11whole or in part to the extent possible. These rules, 
12standards, or contractual obligations shall be reviewed 
13annually and updated as the technical options develop. The 
14recipient shall be provided meaningful disclosure regarding 
15the health information exchange, and the recipient's decision 
16whether to opt-out should be obtained without undue inducement 
17or any element of force, fraud, deceit, duress, or other form 
18of constraint or coercion. To the extent that HIPAA, as 
19specified in 45 CFR 164.508(b)(4), prohibits a covered entity 
20from conditioning the provision of its services upon an 
21individual's provision of an authorization, an HIE participant 
22shall not condition the provision of its services upon a 
23recipient's decision to opt-out of further disclosure of the 
24record by an HIE to third parties. The Illinois Health 
25Information Exchange Office Authority shall, through 
26appropriate rules, standards, or contractual obligations, 
 
 
10100SB1864ham006- 99 -LRB101 10924 SMS 72418 a


1which shall be binding upon any HIE, as defined under Section 
22, give consideration to the format and content of the 
3meaningful disclosure and the availability to recipients of 
4information regarding an HIE and the rights of recipients under 
5this Section to expressly decline the further disclosure of the 
6record by an HIE to third parties. The Illinois Health 
7Information Exchange Office Authority shall also give annual 
8consideration to enable a recipient to expressly decline the 
9further disclosure by an HIE to third parties of selected 
10portions of the recipient's record while permitting disclosure 
11of the recipient's remaining patient health information. In 
12establishing rules, standards, or contractual obligations 
13binding upon HIEs under this Section to give effect to 
14recipient disclosure preferences, the Illinois Health 
15Information Exchange Office Authority in its discretion may 
16consider the extent to which relevant health information 
17technologies reasonably available to therapists and HIEs in 
18this State reasonably enable the effective segmentation of 
19specific information within a recipient's electronic medical 
20record and reasonably enable the effective exclusion of 
21specific information from disclosure by an HIE to third 
22parties, as well as the availability of sufficient 
23authoritative clinical guidance to enable the practical 
24application of such technologies to effect recipient 
25disclosure preferences. The provisions of this Section 9.6 
26shall not apply to the secure electronic transmission of data 
 
 
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1which is point-to-point communication directed by the data 
2custodian. Any rules or standards promulgated under this 
3Section which apply to HIEs shall be limited to that subject 
4matter required by this Section and shall not include any 
5requirement that an HIE enter a data sharing arrangement or 
6otherwise participate with the Illinois Health Information 
7Exchange. In connection with its annual consideration 
8regarding the issue of segmentation of information within a 
9medical record and prior to the adoption of any rules or 
10standards regarding that issue, the Office Authority Board 
11shall consider information provided by affected persons or 
12organizations regarding the feasibility, availability, cost, 
13reliability, and interoperability of any technology or process 
14under consideration by the Board. Nothing in this Act shall be 
15construed to limit the authority of the Illinois Health 
16Information Exchange Office Authority to impose limits or 
17conditions on consent for disclosures to or through any HIE, as 
18defined under Section 2, which are more restrictive than the 
19requirements under this Act or under HIPAA.

20(Source: P.A. 98-378, eff. 8-16-13.)

21 (740 ILCS 110/9.8)
22 Sec. 9.8. Business associates. An HIE, person, therapist, 
23facility, agency, interdisciplinary team, integrated health 
24system, business associate, covered entity, the Illinois 
25Health Information Exchange Office Authority, or entity 
 
 
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1facilitating the establishment or operation of an HIE may, 
2without a recipient's consent, utilize the services of and 
3disclose information from a recipient's record to a business 
4associate, as defined by and in accordance with the 
5requirements set forth under HIPAA. As used in this Section, 
6the term "disclosure" has the meaning ascribed to it by HIPAA, 
7as specified in 45 CFR 160.103.

8(Source: P.A. 98-378, eff. 8-16-13.)

9 (740 ILCS 110/9.9)
10 Sec. 9.9. Record locator service.
11 (a) An HIE, person, therapist, facility, agency, 
12interdisciplinary team, integrated health system, business 
13associate, covered entity, the Illinois Health Information 
14Exchange Office Authority, or entity facilitating the 
15establishment or operation of an HIE may, without a recipient's 
16consent, disclose the existence of a recipient's record to a 
17record locator service, master patient index, or other 
18directory or services necessary to support and enable the 
19establishment and operation of an HIE.
20 (b) As used in this Section:
21  (1) the term "disclosure" has the meaning ascribed to 
22 it under HIPAA, as specified in 45 CFR 160.103; and
23  (2) "facility" means a developmental disability 
24 facility as defined in Section 1-107 of the Mental Health 
25 and Developmental Disabilities Code or a mental health 
 
 
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1 facility as defined in Section 1-114 of the Mental Health 
2 and Developmental Disabilities Code.

3(Source: P.A. 98-378, eff. 8-16-13.)

4 (740 ILCS 110/9.11)
5 Sec. 9.11. Establishment and disclosure of limited data 
6sets and de-identified information.
7 (a) An HIE, person, therapist, facility, agency, 
8interdisciplinary team, integrated health system, business 
9associate, covered entity, the Illinois Health Information 
10Exchange Office Authority, or entity facilitating the 
11establishment or operation of an HIE may, without a recipient's 
12consent, use information from a recipient's record to 
13establish, or disclose such information to a business associate 
14to establish, and further disclose information from a 
15recipient's record as part of a limited data set as defined by 
16and in accordance with the requirements set forth under HIPAA, 
17as specified in 45 CFR 164.514(e). An HIE, person, therapist, 
18facility, agency, interdisciplinary team, integrated health 
19system, business associate, covered entity, the Illinois 
20Health Information Exchange Office Authority, or entity 
21facilitating the establishment or operation of an HIE may, 
22without a recipient's consent, use information from a 
23recipient's record or disclose information from a recipient's 
24record to a business associate to de-identity the information 
25in accordance with HIPAA, as specified in 45 CFR 164.514.
 
 
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1 (b) As used in this Section:
2  (1) the terms "disclosure" and "use" shall have the 
3 meanings ascribed to them by HIPAA, as specified in 45 CFR 
4 160.103; and 
5  (2) "facility" means a developmental disability 
6 facility as defined in Section 1-107 of the Mental Health 
7 and Developmental Disabilities Code or a mental health 
8 facility as defined in Section 1-114 of the Mental Health 
9 and Developmental Disabilities Code.

10(Source: P.A. 98-378, eff. 8-16-13.)

11
Article 99.  Effective Date


12 Section 99-99. Effective date. This Act takes effect upon 
13becoming law.".