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1		AN ACT concerning health.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Article 5. Health Care Affordability Act
5		Section 5-1. Short title. This Article may be cited as the
6		Health Care Affordability Act. References in this Article to
7		"this Act" mean this Article.
8		Section 5-5. Findings. The General Assembly finds that:
9		(1) The State is committed to improving the health and
10		well-being of Illinois residents and families.
11		(2) Illinois has over 835,000 uninsured residents,
12		with a total uninsured rate of 7.9%.
13		(3) 774,500 of Illinois' uninsured residents are below
14		400% of the federal poverty level, with higher uninsured
15		rates of more than 13% below 250% of the federal poverty
16		level and an uninsured rate of 8.3% below 400% of the
17		federal poverty level.
18		(4) The cost of health insurance premiums remains a
19		barrier to obtaining health insurance coverage for many
20		Illinois residents and families.
21		(5) Many Illinois residents and families who have
22		health insurance cannot afford to use it due to high

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1		deductibles and cost sharing.
2		(6) Improving health insurance affordability is key to
3		increasing health insurance coverage and access.
4		(7) Despite progress made under the Patient Protection
5		and Affordable Care Act, health insurance is still not
6		affordable enough for many Illinois residents and
7		families.
8		(8) Illinois has a lower uninsured rate than the
9		national average of 10.2%, but a higher uninsured rate
10		compared to states that have state-directed policies to
11		improve affordability, including Massachusetts with an
12		uninsured rate of 3.2%.
13		(9) Illinois has an opportunity to create a healthy
14		Illinois where health insurance coverage is more
15		affordable and accessible for all Illinois residents,
16		families, and small businesses.
17		Section 5-10. Feasibility study.
18		(a) The Department of Healthcare and Family Services, in
19		consultation with the Department of Insurance, shall oversee a
20		feasibility study to explore options to make health insurance
21		more affordable for low-income and middle-income residents.
22		The study shall include policies targeted at increasing health
23		care affordability and access, including policies being
24		discussed in other states and nationally. The study shall
25		follow the best practices of other states and include an

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1		Illinois-specific actuarial and economic analysis of
2		demographic and market dynamics.
3		(b) The study shall produce cost estimates for the policies
4		studied under subsection (a) along with the impact of the
5		policies on health insurance affordability and access and the
6		uninsured rates for low-income and middle-income residents,
7		with break-out data by geography, race, ethnicity, and income
8		level. The study shall evaluate how multiple policies
9		implemented together affect costs and outcomes and how policies
10		could be structured to leverage federal matching funds and
11		federal pass-through awards.
12		(c) The Department of Healthcare and Family Services, in
13		consultation with the Department of Insurance, shall develop
14		and submit no later than February 28, 2021 a report to the
15		General Assembly and the Governor concerning the design, costs,
16		benefits, and implementation of State options to increase
17		access to affordable health care coverage that leverage
18		existing State infrastructure.
19		Article 10. Kidney Disease Prevention and Education Task Force
20		Act
21		Section 10-1. Short title. This Article may be cited as the
22		Kidney Disease Prevention and Education Task Force Act.
23		References in this Article to "this Act" mean this Article.

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1		Section 10-5. Findings. The General Assembly finds that:
2		(1) Chronic kidney disease is the 9th-leading cause of
3		death in the United States. An estimated 31 million people
4		in the United States have chronic kidney disease and over
5		1.12 million people in the State of Illinois are living
6		with the disease. Early chronic kidney disease has no signs
7		or symptoms and, without early detection, can progress to
8		kidney failure.
9		(2) If a person has high blood pressure, heart disease,
10		diabetes, or a family history of kidney failure, the risk
11		of kidney disease is greater. In Illinois, 13% of all
12		adults have diabetes, and 32% have high blood pressure. The
13		prevalence of diabetes, heart disease, and hypertension is
14		higher for African Americans, who develop kidney failure at
15		a rate of nearly 4 to 1 compared to Caucasians, while
16		Hispanics develop kidney failure at a rate of 2 to 1.
17		Almost half of the people waiting for a kidney in Illinois
18		identify as African American, but, in 2017, less than 10%
19		of them received a kidney.
20		(3) Although dialysis is a life-extending treatment,
21		the best and most cost-effective treatment for kidney
22		failure is a kidney transplant. Currently, the wait in
23		Illinois for a deceased donor kidney is 5-7 years, and 13
24		people die while waiting every day.
25		(4) If chronic kidney disease is detected early and
26		managed appropriately, the individual can receive

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1		treatment sooner to help protect the kidneys, the
2		deterioration in kidney function can be slowed or even
3		stopped, and the risk of associated cardiovascular
4		complications and other complications can be reduced.
5		(5) In light of the COVID-19 pandemic and the increased
6		risk of infection to patients with preexisting conditions,
7		it is imperative to provide those with kidney disease with
8		support.
9		Section 10-10. Kidney Disease Prevention and Education
10		Task Force.
11		(a) There is hereby established the Kidney Disease
12		Prevention and Education Task Force to work directly with
13		educational institutions to create health education programs
14		to increase awareness of and to examine chronic kidney disease,
15		transplantations, living and deceased kidney donation, and the
16		existing disparity in the rates of those afflicted between
17		Caucasians and minorities.
18		(b) The Task Force shall develop a sustainable plan to
19		raise awareness about early detection, promote health equity,
20		and reduce the burden of kidney disease throughout the State,
21		which shall include an ongoing campaign that includes health
22		education workshops and seminars, relevant research, and
23		preventive screenings and that promotes social media campaigns
24		and TV and radio commercials.
25		(c) Membership of the Task Force shall be as follows:

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1		(1) one member of the Senate, appointed by the Senate
2		President, who shall serve as Co-Chair;
3		(2) one member of the House of Representatives,
4		appointed by the Speaker of the House, who shall serve as
5		Co-Chair;
6		(3) one member of the House of Representatives,
7		appointed by the Minority Leader of the House;
8		(4) one member of the Senate, appointed by the Senate
9		Minority Leader;
10		(5) one member representing the Department of Public
11		Health, appointed by the Governor;
12		(6) one member representing the Department of
13		Healthcare and Family Services, appointed by the Governor;
14		(7) one member representing a medical center in a
15		county with a population of more 3 million residents,
16		appointed by the Co-Chairs;
17		(8) one member representing a physician's association
18		in a county with a population of more than 3 million
19		residents, appointed by the Co-Chairs;
20		(9) one member representing a not-for-profit organ
21		procurement organization, appointed by the Co-Chairs;
22		(10) one member representing a national nonprofit
23		research kidney organization in the State of Illinois,
24		appointed by the Co-Chairs; and
25		(11) the Secretary of State or his or her designee.
26		(d) Members of the Task Force shall serve without

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1		compensation.
2		(e) The Department of Public Health shall provide
3		administrative support to the Task Force.
4		(f) The Task Force shall submit its final report to the
5		General Assembly on or before December 31, 2021 and, upon the
6		filing of its final report, is dissolved.
7		Section 10-15. Repeal. This Act is repealed on June 1,
8		2022.
9		Article 90. Amendatory Provisions
10		Section 90-5. The Freedom of Information Act is amended by
11		changing Section 7.5 as follows:
12		(5 ILCS 140/7.5)
13		Sec. 7.5. Statutory exemptions. To the extent provided for
14		by the statutes referenced below, the following shall be exempt
15		from inspection and copying:
16		(a) All information determined to be confidential
17		under Section 4002 of the Technology Advancement and
18		Development Act.
19		(b) Library circulation and order records identifying
20		library users with specific materials under the Library
21		Records Confidentiality Act.
22		(c) Applications, related documents, and medical

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1		records received by the Experimental Organ Transplantation
2		Procedures Board and any and all documents or other records
3		prepared by the Experimental Organ Transplantation
4		Procedures Board or its staff relating to applications it
5		has received.
6		(d) Information and records held by the Department of
7		Public Health and its authorized representatives relating
8		to known or suspected cases of sexually transmissible
9		disease or any information the disclosure of which is
10		restricted under the Illinois Sexually Transmissible
11		Disease Control Act.
12		(e) Information the disclosure of which is exempted
13		under Section 30 of the Radon Industry Licensing Act.
14		(f) Firm performance evaluations under Section 55 of
15		the Architectural, Engineering, and Land Surveying
16		Qualifications Based Selection Act.
17		(g) Information the disclosure of which is restricted
18		and exempted under Section 50 of the Illinois Prepaid
19		Tuition Act.
20		(h) Information the disclosure of which is exempted
21		under the State Officials and Employees Ethics Act, and
22		records of any lawfully created State or local inspector
23		general's office that would be exempt if created or
24		obtained by an Executive Inspector General's office under
25		that Act.
26		(i) Information contained in a local emergency energy

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1		plan submitted to a municipality in accordance with a local
2		emergency energy plan ordinance that is adopted under
3		Section 11-21.5-5 of the Illinois Municipal Code.
4		(j) Information and data concerning the distribution
5		of surcharge moneys collected and remitted by carriers
6		under the Emergency Telephone System Act.
7		(k) Law enforcement officer identification information
8		or driver identification information compiled by a law
9		enforcement agency or the Department of Transportation
10		under Section 11-212 of the Illinois Vehicle Code.
11		(l) Records and information provided to a residential
12		health care facility resident sexual assault and death
13		review team or the Executive Council under the Abuse
14		Prevention Review Team Act.
15		(m) Information provided to the predatory lending
16		database created pursuant to Article 3 of the Residential
17		Real Property Disclosure Act, except to the extent
18		authorized under that Article.
19		(n) Defense budgets and petitions for certification of
20		compensation and expenses for court appointed trial
21		counsel as provided under Sections 10 and 15 of the Capital
22		Crimes Litigation Act. This subsection (n) shall apply
23		until the conclusion of the trial of the case, even if the
24		prosecution chooses not to pursue the death penalty prior
25		to trial or sentencing.
26		(o) Information that is prohibited from being

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1		disclosed under Section 4 of the Illinois Health and
2		Hazardous Substances Registry Act.
3		(p) Security portions of system safety program plans,
4		investigation reports, surveys, schedules, lists, data, or
5		information compiled, collected, or prepared by or for the
6		Regional Transportation Authority under Section 2.11 of
7		the Regional Transportation Authority Act or the St. Clair
8		County Transit District under the Bi-State Transit Safety
9		Act.
10		(q) Information prohibited from being disclosed by the
11		Personnel Record Review Act.
12		(r) Information prohibited from being disclosed by the
13		Illinois School Student Records Act.
14		(s) Information the disclosure of which is restricted
15		under Section 5-108 of the Public Utilities Act.
16		(t) All identified or deidentified health information
17		in the form of health data or medical records contained in,
18		stored in, submitted to, transferred by, or released from
19		the Illinois Health Information Exchange, and identified
20		or deidentified health information in the form of health
21		data and medical records of the Illinois Health Information
22		Exchange in the possession of the Illinois Health
23		Information Exchange Office Authority due to its
24		administration of the Illinois Health Information
25		Exchange. The terms "identified" and "deidentified" shall
26		be given the same meaning as in the Health Insurance

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1		Portability and Accountability Act of 1996, Public Law
2		104-191, or any subsequent amendments thereto, and any
3		regulations promulgated thereunder.
4		(u) Records and information provided to an independent
5		team of experts under the Developmental Disability and
6		Mental Health Safety Act (also known as Brian's Law).
7		(v) Names and information of people who have applied
8		for or received Firearm Owner's Identification Cards under
9		the Firearm Owners Identification Card Act or applied for
10		or received a concealed carry license under the Firearm
11		Concealed Carry Act, unless otherwise authorized by the
12		Firearm Concealed Carry Act; and databases under the
13		Firearm Concealed Carry Act, records of the Concealed Carry
14		Licensing Review Board under the Firearm Concealed Carry
15		Act, and law enforcement agency objections under the
16		Firearm Concealed Carry Act.
17		(w) Personally identifiable information which is
18		exempted from disclosure under subsection (g) of Section
19		19.1 of the Toll Highway Act.
20		(x) Information which is exempted from disclosure
21		under Section 5-1014.3 of the Counties Code or Section
22		8-11-21 of the Illinois Municipal Code.
23		(y) Confidential information under the Adult
24		Protective Services Act and its predecessor enabling
25		statute, the Elder Abuse and Neglect Act, including
26		information about the identity and administrative finding

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1		against any caregiver of a verified and substantiated
2		decision of abuse, neglect, or financial exploitation of an
3		eligible adult maintained in the Registry established
4		under Section 7.5 of the Adult Protective Services Act.
5		(z) Records and information provided to a fatality
6		review team or the Illinois Fatality Review Team Advisory
7		Council under Section 15 of the Adult Protective Services
8		Act.
9		(aa) Information which is exempted from disclosure
10		under Section 2.37 of the Wildlife Code.
11		(bb) Information which is or was prohibited from
12		disclosure by the Juvenile Court Act of 1987.
13		(cc) Recordings made under the Law Enforcement
14		Officer-Worn Body Camera Act, except to the extent
15		authorized under that Act.
16		(dd) Information that is prohibited from being
17		disclosed under Section 45 of the Condominium and Common
18		Interest Community Ombudsperson Act.
19		(ee) Information that is exempted from disclosure
20		under Section 30.1 of the Pharmacy Practice Act.
21		(ff) Information that is exempted from disclosure
22		under the Revised Uniform Unclaimed Property Act.
23		(gg) Information that is prohibited from being
24		disclosed under Section 7-603.5 of the Illinois Vehicle
25		Code.
26		(hh) Records that are exempt from disclosure under

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1		Section 1A-16.7 of the Election Code.
2		(ii) Information which is exempted from disclosure
3		under Section 2505-800 of the Department of Revenue Law of
4		the Civil Administrative Code of Illinois.
5		(jj) Information and reports that are required to be
6		submitted to the Department of Labor by registering day and
7		temporary labor service agencies but are exempt from
8		disclosure under subsection (a-1) of Section 45 of the Day
9		and Temporary Labor Services Act.
10		(kk) Information prohibited from disclosure under the
11		Seizure and Forfeiture Reporting Act.
12		(ll) Information the disclosure of which is restricted
13		and exempted under Section 5-30.8 of the Illinois Public
14		Aid Code.
15		(mm) Records that are exempt from disclosure under
16		Section 4.2 of the Crime Victims Compensation Act.
17		(nn) Information that is exempt from disclosure under
18		Section 70 of the Higher Education Student Assistance Act.
19		(oo) Communications, notes, records, and reports
20		arising out of a peer support counseling session prohibited
21		from disclosure under the First Responders Suicide
22		Prevention Act.
23		(pp) Names and all identifying information relating to
24		an employee of an emergency services provider or law
25		enforcement agency under the First Responders Suicide
26		Prevention Act.

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1		(qq) Information and records held by the Department of
2		Public Health and its authorized representatives collected
3		under the Reproductive Health Act.
4		(rr) Information that is exempt from disclosure under
5		the Cannabis Regulation and Tax Act.
6		(ss) Data reported by an employer to the Department of
7		Human Rights pursuant to Section 2-108 of the Illinois
8		Human Rights Act.
9		(tt) Recordings made under the Children's Advocacy
10		Center Act, except to the extent authorized under that Act.
11		(uu) Information that is exempt from disclosure under
12		Section 50 of the Sexual Assault Evidence Submission Act.
13		(vv) Information that is exempt from disclosure under
14		subsections (f) and (j) of Section 5-36 of the Illinois
15		Public Aid Code.
16		(ww) Information that is exempt from disclosure under
17		Section 16.8 of the State Treasurer Act.
18		(xx) Information that is exempt from disclosure or
19		information that shall not be made public under the
20		Illinois Insurance Code.
21		(yy) (oo) Information prohibited from being disclosed
22		under the Illinois Educational Labor Relations Act.
23		(zz) (pp) Information prohibited from being disclosed
24		under the Illinois Public Labor Relations Act.
25		(aaa) (qq) Information prohibited from being disclosed
26		under Section 1-167 of the Illinois Pension Code.

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1		(Source: P.A. 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
2		100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
3		8-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517,
4		eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19;
5		100-863, eff. 8-14-18; 100-887, eff. 8-14-18; 101-13, eff.
6		6-12-19; 101-27, eff. 6-25-19; 101-81, eff. 7-12-19; 101-221,
7		eff. 1-1-20; 101-236, eff. 1-1-20; 101-375, eff. 8-16-19;
8		101-377, eff. 8-16-19; 101-452, eff. 1-1-20; 101-466, eff.
9		1-1-20; 101-600, eff. 12-6-19; 101-620, eff 12-20-19; revised
10		1-6-20.)
11		Section 90-10. The Illinois Health Information Exchange
12		and Technology Act is amended by changing Sections 10, 20, 25,
13		30, 35, and 40, as follows:
14		(20 ILCS 3860/10)
15		(Section scheduled to be repealed on January 1, 2021)
16		Sec. 10. Creation of the Health Information Exchange Office
17		Authority. There is hereby created the Illinois Health
18		Information Exchange Office ("Office") Authority
19		("Authority"), which is hereby constituted as an
20		instrumentality and an administrative agency of the State of
21		Illinois.
22		As part of its program to promote, develop, and sustain
23		health information exchange at the State level, the Office
24		Authority shall do the following:

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1		(1) Establish the Illinois Health Information Exchange
2		("ILHIE"), to promote and facilitate the sharing of health
3		information among health care providers within Illinois
4		and in other states. ILHIE shall be an entity operated by
5		the Office Authority to serve as a State-level electronic
6		medical records exchange providing for the transfer of
7		health information, medical records, and other health data
8		in a secure environment for the benefit of patient care,
9		patient safety, reduction of duplicate medical tests,
10		reduction of administrative costs, and any other benefits
11		deemed appropriate by the Office Authority.
12		(2) Foster the widespread adoption of electronic
13		health records and participation in the ILHIE.
14		(Source: P.A. 96-1331, eff. 7-27-10.)
15		(20 ILCS 3860/20)
16		(Section scheduled to be repealed on January 1, 2021)
17		Sec. 20. Powers and duties of the Illinois Health
18		Information Exchange Office Authority. The Office Authority
19		has the following powers, together with all powers incidental
20		or necessary to accomplish the purposes of this Act:
21		(1) The Office Authority shall create and administer
22		the ILHIE using information systems and processes that are
23		secure, are cost effective, and meet all other relevant
24		privacy and security requirements under State and federal
25		law.

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1		(2) The Office Authority shall establish and adopt
2		standards and requirements for the use of health
3		information and the requirements for participation in the
4		ILHIE by persons or entities including, but not limited to,
5		health care providers, payors, and local health
6		information exchanges.
7		(3) The Office Authority shall establish minimum
8		standards for accessing the ILHIE to ensure that the
9		appropriate security and privacy protections apply to
10		health information, consistent with applicable federal and
11		State standards and laws. The Office Authority shall have
12		the power to suspend, limit, or terminate the right to
13		participate in the ILHIE for non-compliance or failure to
14		act, with respect to applicable standards and laws, in the
15		best interests of patients, users of the ILHIE, or the
16		public. The Office Authority may seek all remedies allowed
17		by law to address any violation of the terms of
18		participation in the ILHIE.
19		(4) The Office Authority shall identify barriers to the
20		adoption of electronic health records systems, including
21		researching the rates and patterns of dissemination and use
22		of electronic health record systems throughout the State.
23		The Office Authority shall make the results of the research
24		available on the Department of Healthcare and Family
25		Services' website its website.
26		(5) The Office Authority shall prepare educational

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1		materials and educate the general public on the benefits of
2		electronic health records, the ILHIE, and the safeguards
3		available to prevent unauthorized disclosure of health
4		information.
5		(6) The Office Authority may appoint or designate an
6		institutional review board in accordance with federal and
7		State law to review and approve requests for research in
8		order to ensure compliance with standards and patient
9		privacy and security protections as specified in paragraph
10		(3) of this Section.
11		(7) The Office Authority may enter into all contracts
12		and agreements necessary or incidental to the performance
13		of its powers under this Act. The Office's Authority's
14		expenditures of private funds are exempt from the Illinois
15		Procurement Code, pursuant to Section 1-10 of that Act.
16		Notwithstanding this exception, the Office Authority shall
17		comply with the Business Enterprise for Minorities, Women,
18		and Persons with Disabilities Act.
19		(8) The Office Authority may solicit and accept grants,
20		loans, contributions, or appropriations from any public or
21		private source and may expend those moneys, through
22		contracts, grants, loans, or agreements, on activities it
23		considers suitable to the performance of its duties under
24		this Act.
25		(9) The Office Authority may determine, charge, and
26		collect any fees, charges, costs, and expenses from any

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1		healthcare provider or entity in connection with its duties
2		under this Act. Moneys collected under this paragraph (9)
3		shall be deposited into the Health Information Exchange
4		Fund.
5		(10) The Office Authority may, under the direction of
6		the Executive Director, employ and discharge staff,
7		including administrative, technical, expert, professional,
8		and legal staff, as is necessary or convenient to carry out
9		the purposes of this Act and as authorized by the Personnel
10		Code. The Authority may establish and administer standards
11		of classification regarding compensation, benefits,
12		duties, performance, and tenure for that staff and may
13		enter into contracts of employment with members of that
14		staff for such periods and on such terms as the Authority
15		deems desirable. All employees of the Authority are exempt
16		from the Personnel Code as provided by Section 4 of the
17		Personnel Code.
18		(10.5) Staff employed by the Illinois Health
19		Information Exchange Authority on the effective date of
20		this amendatory Act of the 101st General Assembly shall
21		transfer to the Office within the Department of Healthcare
22		and Family Services.
23		(10.6) The status and rights of employees transferring
24		from the Illinois Health Information Exchange Authority
25		under paragraph (10.5) shall not be affected by such
26		transfer except that, notwithstanding any other State law

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1		to the contrary, those employees shall maintain their
2		seniority and their positions shall convert to titles of
3		comparable organizational level under the Personnel Code
4		and become subject to the Personnel Code. Other than the
5		changes described in this paragraph, the rights of
6		employees, the State of Illinois, and State agencies under
7		the Personnel Code or under any pension, retirement, or
8		annuity plan shall not be affected by this amendatory Act
9		of the 101st General Assembly. Transferring personnel
10		shall continue their service within the Office.
11		(11) The Office Authority shall consult and coordinate
12		with the Department of Public Health to further the
13		Office's Authority's collection of health information from
14		health care providers for public health purposes. The
15		collection of public health information shall include
16		identifiable information for use by the Office Authority or
17		other State agencies to comply with State and federal laws.
18		Any identifiable information so collected shall be
19		privileged and confidential in accordance with Sections
20		8-2101, 8-2102, 8-2103, 8-2104, and 8-2105 of the Code of
21		Civil Procedure.
22		(12) All identified or deidentified health information
23		in the form of health data or medical records contained in,
24		stored in, submitted to, transferred by, or released from
25		the Illinois Health Information Exchange, and identified
26		or deidentified health information in the form of health

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1		data and medical records of the Illinois Health Information
2		Exchange in the possession of the Illinois Health
3		Information Exchange Office Authority due to its
4		administration of the Illinois Health Information
5		Exchange, shall be exempt from inspection and copying under
6		the Freedom of Information Act. The terms "identified" and
7		"deidentified" shall be given the same meaning as in the
8		Health Insurance Portability and Accountability Act of
9		1996, Public Law 104-191, or any subsequent amendments
10		thereto, and any regulations promulgated thereunder.
11		(13) To address gaps in the adoption of, workforce
12		preparation for, and exchange of electronic health records
13		that result in regional and socioeconomic disparities in
14		the delivery of care, the Office Authority may evaluate
15		such gaps and provide resources as available, giving
16		priority to healthcare providers serving a significant
17		percentage of Medicaid or uninsured patients and in
18		medically underserved or rural areas.
19		(14) The Office shall perform its duties under this Act
20		in consultation with the Office of the Governor and with
21		the Departments of Public Health, Insurance, and Human
22		Services.
23		(Source: P.A. 99-642, eff. 7-28-16; 100-391, eff. 8-25-17.)
24		(20 ILCS 3860/25)
25		(Section scheduled to be repealed on January 1, 2021)

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

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1		Director of the Department of Healthcare and Family Services
2		shall be responsible for the approval of recording of receipts,
3		approval of payments, and proper filing of required reports.
4		The moneys held and made available by the Office Authority
5		shall be subject to financial and compliance audits by the
6		Auditor General in compliance with the Illinois State Auditing
7		Act.
8		(Source: P.A. 96-1331, eff. 7-27-10.)
9		(20 ILCS 3860/30)
10		(Section scheduled to be repealed on January 1, 2021)
11		Sec. 30. Participation in health information systems
12		maintained by State agencies.
13		(a) By no later than January 1, 2015, each State agency
14		that implements, acquires, or upgrades health information
15		technology systems shall use health information technology
16		systems and products that meet minimum standards adopted by the
17		Office Authority for accessing the ILHIE. State agencies that
18		have health information which supports and develops the ILHIE
19		shall provide access to patient-specific data to complete the
20		patient record at the ILHIE. Notwithstanding any other
21		provision of State law, the State agencies shall provide
22		patient-specific data to the ILHIE.
23		(b) Participation in the ILHIE shall have no impact on the
24		content of or use or disclosure of health information of
25		patient participants that is held in locations other than the

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1		ILHIE. Nothing in this Act shall limit or change an entity's
2		obligation to exchange health information in accordance with
3		applicable federal and State laws and standards.
4		(Source: P.A. 96-1331, eff. 7-27-10.)
5		(20 ILCS 3860/35)
6		(Section scheduled to be repealed on January 1, 2021)
7		Sec. 35. Illinois Administrative Procedure Act. The
8		provisions of the Illinois Administrative Procedure Act are
9		hereby expressly adopted and shall apply to all administrative
10		rules and procedures of the Office Authority, except that
11		Section 5-35 of the Illinois Administrative Procedure Act
12		relating to procedures for rulemaking does not apply to the
13		adoption of any rule required by federal law when the Office
14		Authority is precluded by that law from exercising any
15		discretion regarding that rule.
16		(Source: P.A. 96-1331, eff. 7-27-10.)
17		(20 ILCS 3860/40)
18		(Section scheduled to be repealed on January 1, 2021)
19		Sec. 40. Reliance on data. Any health care provider who
20		relies in good faith upon any information provided through the
21		ILHIE in his, her, or its treatment of a patient shall be
22		immune from criminal or civil liability or professional
23		discipline arising from any damages caused by such good faith
24		reliance. This immunity does not apply to acts or omissions

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1		constituting gross negligence or reckless, wanton, or
2		intentional misconduct. Notwithstanding this provision, the
3		Office Authority does not waive any immunities provided under
4		State or federal law.
5		(Source: P.A. 98-1046, eff. 1-1-15.)
6		(20 ILCS 3860/15 rep.)
7		Section 90-15. The Illinois Health Information Exchange
8		and Technology Act is amended by repealing Section 15.
9		Section 90-20. The Children's Health Insurance Program Act
10		is amended by changing Section 7 and by adding Section 8 as
11		follows:
12		(215 ILCS 106/7)
13		Sec. 7. Eligibility verification. Notwithstanding any
14		other provision of this Act, with respect to applications for
15		benefits provided under the Program, eligibility shall be
16		determined in a manner that ensures program integrity and that
17		complies with federal law and regulations while minimizing
18		unnecessary barriers to enrollment. To this end, as soon as
19		practicable, and unless the Department receives written denial
20		from the federal government, this Section shall be implemented:
21		(a) The Department of Healthcare and Family Services or its
22		designees shall:
23		(1) By no later than July 1, 2011, require verification

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1		of, at a minimum, one month's income from all sources
2		required for determining the eligibility of applicants to
3		the Program. Such verification shall take the form of pay
4		stubs, business or income and expense records for
5		self-employed persons, letters from employers, and any
6		other valid documentation of income including data
7		obtained electronically by the Department or its designees
8		from other sources as described in subsection (b) of this
9		Section. A month's income may be verified by a single pay
10		stub with the monthly income extrapolated from the time
11		period covered by the pay stub.
12		(2) By no later than October 1, 2011, require
13		verification of, at a minimum, one month's income from all
14		sources required for determining the continued eligibility
15		of recipients at their annual review of eligibility under
16		the Program. Such verification shall take the form of pay
17		stubs, business or income and expense records for
18		self-employed persons, letters from employers, and any
19		other valid documentation of income including data
20		obtained electronically by the Department or its designees
21		from other sources as described in subsection (b) of this
22		Section. A month's income may be verified by a single pay
23		stub with the monthly income extrapolated from the time
24		period covered by the pay stub. The Department shall send a
25		notice to the recipient at least 60 days prior to the end
26		of the period of eligibility that informs them of the

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

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1		(b) The Department shall establish or continue cooperative
2		arrangements with the Social Security Administration, the
3		Illinois Secretary of State, the Department of Human Services,
4		the Department of Revenue, the Department of Employment
5		Security, and any other appropriate entity to gain electronic
6		access, to the extent allowed by law, to information available
7		to those entities that may be appropriate for electronically
8		verifying any factor of eligibility for benefits under the
9		Program. Data relevant to eligibility shall be provided for no
10		other purpose than to verify the eligibility of new applicants
11		or current recipients of health benefits under the Program.
12		Data will be requested or provided for any new applicant or
13		current recipient only insofar as that individual's
14		circumstances are relevant to that individual's or another
15		individual's eligibility.
16		(c) Within 90 days of the effective date of this amendatory
17		Act of the 96th General Assembly, the Department of Healthcare
18		and Family Services shall send notice to current recipients
19		informing them of the changes regarding their eligibility
20		verification.
21		(Source: P.A. 101-209, eff. 8-5-19.)
22		(215 ILCS 106/8 new)
23		Sec. 8. COVID-19 public health emergency. Notwithstanding
24		any other provision of this Act, the Department may take
25		necessary actions to address the COVID-19 public health

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

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1		Section 90-25. The Covering ALL KIDS Health Insurance Act
2		is amended by changing Section 7 and by adding Section 8 as
3		follows:
4		(215 ILCS 170/7)
5		(Section scheduled to be repealed on October 1, 2024)
6		Sec. 7. Eligibility verification. Notwithstanding any
7		other provision of this Act, with respect to applications for
8		benefits provided under the Program, eligibility shall be
9		determined in a manner that ensures program integrity and that
10		complies with federal law and regulations while minimizing
11		unnecessary barriers to enrollment. To this end, as soon as
12		practicable, and unless the Department receives written denial
13		from the federal government, this Section shall be implemented:
14		(a) The Department of Healthcare and Family Services or its
15		designees shall:
16		(1) By July 1, 2011, require verification of, at a
17		minimum, one month's income from all sources required for
18		determining the eligibility of applicants to the Program.
19		Such verification shall take the form of pay stubs,
20		business or income and expense records for self-employed
21		persons, letters from employers, and any other valid
22		documentation of income including data obtained
23		electronically by the Department or its designees from
24		other sources as described in subsection (b) of this
25		Section. A month's income may be verified by a single pay

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1		stub with the monthly income extrapolated from the time
2		period covered by the pay stub.
3		(2) By October 1, 2011, require verification of, at a
4		minimum, one month's income from all sources required for
5		determining the continued eligibility of recipients at
6		their annual review of eligibility under the Program. Such
7		verification shall take the form of pay stubs, business or
8		income and expense records for self-employed persons,
9		letters from employers, and any other valid documentation
10		of income including data obtained electronically by the
11		Department or its designees from other sources as described
12		in subsection (b) of this Section. A month's income may be
13		verified by a single pay stub with the monthly income
14		extrapolated from the time period covered by the pay stub.
15		The Department shall send a notice to recipients at least
16		60 days prior to the end of their period of eligibility
17		that informs them of the requirements for continued
18		eligibility. Information the Department receives prior to
19		the annual review, including information available to the
20		Department as a result of the recipient's application for
21		other non-health care benefits, that is sufficient to make
22		a determination of continued eligibility for benefits
23		provided under this Act, the Children's Health Insurance
24		Program Act, or Article V of the Illinois Public Aid Code
25		may be reviewed and verified, and subsequent action taken
26		including client notification of continued eligibility for

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1		benefits provided under this Act, the Children's Health
2		Insurance Program Act, or Article V of the Illinois Public
3		Aid Code. The date of client notification establishes the
4		date for subsequent annual eligibility reviews. If a
5		recipient does not fulfill the requirements for continued
6		eligibility by the deadline established in the notice, a
7		notice of cancellation shall be issued to the recipient and
8		coverage shall end no later than the last day of the month
9		following the last day of the eligibility period. A
10		recipient's eligibility may be reinstated without
11		requiring a new application if the recipient fulfills the
12		requirements for continued eligibility prior to the end of
13		the third month following the last date of coverage (or
14		longer period if required by federal regulations). Nothing
15		in this Section shall prevent an individual whose coverage
16		has been cancelled from reapplying for health benefits at
17		any time.
18		(3) By July 1, 2011, require verification of Illinois
19		residency.
20		(b) The Department shall establish or continue cooperative
21		arrangements with the Social Security Administration, the
22		Illinois Secretary of State, the Department of Human Services,
23		the Department of Revenue, the Department of Employment
24		Security, and any other appropriate entity to gain electronic
25		access, to the extent allowed by law, to information available
26		to those entities that may be appropriate for electronically

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1		verifying any factor of eligibility for benefits under the
2		Program. Data relevant to eligibility shall be provided for no
3		other purpose than to verify the eligibility of new applicants
4		or current recipients of health benefits under the Program.
5		Data will be requested or provided for any new applicant or
6		current recipient only insofar as that individual's
7		circumstances are relevant to that individual's or another
8		individual's eligibility.
9		(c) Within 90 days of the effective date of this amendatory
10		Act of the 96th General Assembly, the Department of Healthcare
11		and Family Services shall send notice to current recipients
12		informing them of the changes regarding their eligibility
13		verification.
14		(Source: P.A. 101-209, eff. 8-5-19.)
15		(215 ILCS 170/8 new)
16		Sec. 8. COVID-19 public health emergency. Notwithstanding
17		any other provision of this Act, the Department may take
18		necessary actions to address the COVID-19 public health
19		emergency to the extent such actions are required, approved, or
20		authorized by the United States Department of Health and Human
21		Services, Centers for Medicare and Medicaid Services. Such
22		actions may continue throughout the public health emergency and
23		for up to 12 months after the period ends, and may include, but
24		are not limited to: accepting an applicant's or recipient's
25		attestation of income, incurred medical expenses, residency,

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1		and insured status when electronic verification is not
2		available; eliminating resource tests for some eligibility
3		determinations; suspending redeterminations; suspending
4		changes that would adversely affect an applicant's or
5		recipient's eligibility; phone or verbal approval by an
6		applicant to submit an application in lieu of applicant
7		signature; allowing adult presumptive eligibility; allowing
8		presumptive eligibility for children, pregnant women, and
9		adults as often as twice per calendar year; paying for
10		additional services delivered by telehealth; and suspending
11		premium and co-payment requirements.
12		The Department's authority under this Section shall only
13		extend to encompass, incorporate, or effectuate the terms,
14		items, conditions, and other provisions approved, authorized,
15		or required by the United States Department of Health and Human
16		Services, Centers for Medicare and Medicaid Services, and shall
17		not extend beyond the time of the COVID-19 public health
18		emergency and up to 12 months after the period expires.
19		Section 90-30. The Pharmacy Practice Act is amended by
20		adding Section 39.5 as follows:
21		(225 ILCS 85/39.5 new)
22		Sec. 39.5. Emergency kits.
23		(a) As used in this Section:
24		"Emergency kit" means a kit containing drugs that may be

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

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1		(b) An offsite institutional pharmacy may supply emergency
2		kits to a licensed facility.
3		Section 90-35. The Illinois Public Aid Code is amended by
4		changing Sections 5-2, 5-4.2, 5-5e, 5-16.8, 5B-4, and 11-5.1
5		and by adding Sections 5-1.5, 5-5.27 and 12-21.21 as follows:
6		(305 ILCS 5/5-1.5 new)
7		Sec. 5-1.5. COVID-19 public health emergency.
8		Notwithstanding any other provision of Articles V, XI, and XII
9		of this Code, the Department may take necessary actions to
10		address the COVID-19 public health emergency to the extent such
11		actions are required, approved, or authorized by the United
12		States Department of Health and Human Services, Centers for
13		Medicare and Medicaid Services. Such actions may continue
14		throughout the public health emergency and for up to 12 months
15		after the period ends, and may include, but are not limited to:
16		accepting an applicant's or recipient's attestation of income,
17		incurred medical expenses, residency, and insured status when
18		electronic verification is not available; eliminating resource
19		tests for some eligibility determinations; suspending
20		redeterminations; suspending changes that would adversely
21		affect an applicant's or recipient's eligibility; phone or
22		verbal approval by an applicant to submit an application in
23		lieu of applicant signature; allowing adult presumptive
24		eligibility; allowing presumptive eligibility for children,

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1		pregnant women, and adults as often as twice per calendar year;
2		paying for additional services delivered by telehealth; and
3		suspending premium and co-payment requirements.
4		The Department's authority under this Section shall only
5		extend to encompass, incorporate, or effectuate the terms,
6		items, conditions, and other provisions approved, authorized,
7		or required by the United States Department of Health and Human
8		Services, Centers for Medicare and Medicaid Services, and shall
9		not extend beyond the time of the COVID-19 public health
10		emergency and up to 12 months after the period expires.
11		(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
12		Sec. 5-2. Classes of Persons Eligible.
13		Medical assistance under this Article shall be available to
14		any of the following classes of persons in respect to whom a
15		plan for coverage has been submitted to the Governor by the
16		Illinois Department and approved by him. If changes made in
17		this Section 5-2 require federal approval, they shall not take
18		effect until such approval has been received:
19		1. Recipients of basic maintenance grants under
20		Articles III and IV.
21		2. Beginning January 1, 2014, persons otherwise
22		eligible for basic maintenance under Article III,
23		excluding any eligibility requirements that are
24		inconsistent with any federal law or federal regulation, as
25		interpreted by the U.S. Department of Health and Human

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1		Services, but who fail to qualify thereunder on the basis
2		of need, and who have insufficient income and resources to
3		meet the costs of necessary medical care, including but not
4		limited to the following:
5		(a) All persons otherwise eligible for basic
6		maintenance under Article III but who fail to qualify
7		under that Article on the basis of need and who meet
8		either of the following requirements:
9		(i) their income, as determined by the
10		Illinois Department in accordance with any federal
11		requirements, is equal to or less than 100% of the
12		federal poverty level; or
13		(ii) their income, after the deduction of
14		costs incurred for medical care and for other types
15		of remedial care, is equal to or less than 100% of
16		the federal poverty level.
17		(b) (Blank).
18		3. (Blank).
19		4. Persons not eligible under any of the preceding
20		paragraphs who fall sick, are injured, or die, not having
21		sufficient money, property or other resources to meet the
22		costs of necessary medical care or funeral and burial
23		expenses.
24		5.(a) Beginning January 1, 2020, women during
25		pregnancy and during the 12-month period beginning on the
26		last day of the pregnancy, together with their infants,

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1		whose income is at or below 200% of the federal poverty
2		level. Until September 30, 2019, or sooner if the
3		maintenance of effort requirements under the Patient
4		Protection and Affordable Care Act are eliminated or may be
5		waived before then, women during pregnancy and during the
6		12-month period beginning on the last day of the pregnancy,
7		whose countable monthly income, after the deduction of
8		costs incurred for medical care and for other types of
9		remedial care as specified in administrative rule, is equal
10		to or less than the Medical Assistance-No Grant(C)
11		(MANG(C)) Income Standard in effect on April 1, 2013 as set
12		forth in administrative rule.
13		(b) The plan for coverage shall provide ambulatory
14		prenatal care to pregnant women during a presumptive
15		eligibility period and establish an income eligibility
16		standard that is equal to 200% of the federal poverty
17		level, provided that costs incurred for medical care are
18		not taken into account in determining such income
19		eligibility.
20		(c) The Illinois Department may conduct a
21		demonstration in at least one county that will provide
22		medical assistance to pregnant women, together with their
23		infants and children up to one year of age, where the
24		income eligibility standard is set up to 185% of the
25		nonfarm income official poverty line, as defined by the
26		federal Office of Management and Budget. The Illinois

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1		Department shall seek and obtain necessary authorization
2		provided under federal law to implement such a
3		demonstration. Such demonstration may establish resource
4		standards that are not more restrictive than those
5		established under Article IV of this Code.
6		6. (a) Children younger than age 19 when countable
7		income is at or below 133% of the federal poverty level.
8		Until September 30, 2019, or sooner if the maintenance of
9		effort requirements under the Patient Protection and
10		Affordable Care Act are eliminated or may be waived before
11		then, children younger than age 19 whose countable monthly
12		income, after the deduction of costs incurred for medical
13		care and for other types of remedial care as specified in
14		administrative rule, is equal to or less than the Medical
15		Assistance-No Grant(C) (MANG(C)) Income Standard in effect
16		on April 1, 2013 as set forth in administrative rule.
17		(b) Children and youth who are under temporary custody
18		or guardianship of the Department of Children and Family
19		Services or who receive financial assistance in support of
20		an adoption or guardianship placement from the Department
21		of Children and Family Services.
22		7. (Blank).
23		8. As required under federal law, persons who are
24		eligible for Transitional Medical Assistance as a result of
25		an increase in earnings or child or spousal support
26		received. The plan for coverage for this class of persons

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1		shall:
2		(a) extend the medical assistance coverage to the
3		extent required by federal law; and
4		(b) offer persons who have initially received 6
5		months of the coverage provided in paragraph (a) above,
6		the option of receiving an additional 6 months of
7		coverage, subject to the following:
8		(i) such coverage shall be pursuant to
9		provisions of the federal Social Security Act;
10		(ii) such coverage shall include all services
11		covered under Illinois' State Medicaid Plan;
12		(iii) no premium shall be charged for such
13		coverage; and
14		(iv) such coverage shall be suspended in the
15		event of a person's failure without good cause to
16		file in a timely fashion reports required for this
17		coverage under the Social Security Act and
18		coverage shall be reinstated upon the filing of
19		such reports if the person remains otherwise
20		eligible.
21		9. Persons with acquired immunodeficiency syndrome
22		(AIDS) or with AIDS-related conditions with respect to whom
23		there has been a determination that but for home or
24		community-based services such individuals would require
25		the level of care provided in an inpatient hospital,
26		skilled nursing facility or intermediate care facility the

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1		cost of which is reimbursed under this Article. Assistance
2		shall be provided to such persons to the maximum extent
3		permitted under Title XIX of the Federal Social Security
4		Act.
5		10. Participants in the long-term care insurance
6		partnership program established under the Illinois
7		Long-Term Care Partnership Program Act who meet the
8		qualifications for protection of resources described in
9		Section 15 of that Act.
10		11. Persons with disabilities who are employed and
11		eligible for Medicaid, pursuant to Section
12		1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
13		subject to federal approval, persons with a medically
14		improved disability who are employed and eligible for
15		Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
16		the Social Security Act, as provided by the Illinois
17		Department by rule. In establishing eligibility standards
18		under this paragraph 11, the Department shall, subject to
19		federal approval:
20		(a) set the income eligibility standard at not
21		lower than 350% of the federal poverty level;
22		(b) exempt retirement accounts that the person
23		cannot access without penalty before the age of 59 1/2,
24		and medical savings accounts established pursuant to
25		26 U.S.C. 220;
26		(c) allow non-exempt assets up to $25,000 as to

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1		those assets accumulated during periods of eligibility
2		under this paragraph 11; and
3		(d) continue to apply subparagraphs (b) and (c) in
4		determining the eligibility of the person under this
5		Article even if the person loses eligibility under this
6		paragraph 11.
7		12. Subject to federal approval, persons who are
8		eligible for medical assistance coverage under applicable
9		provisions of the federal Social Security Act and the
10		federal Breast and Cervical Cancer Prevention and
11		Treatment Act of 2000. Those eligible persons are defined
12		to include, but not be limited to, the following persons:
13		(1) persons who have been screened for breast or
14		cervical cancer under the U.S. Centers for Disease
15		Control and Prevention Breast and Cervical Cancer
16		Program established under Title XV of the federal
17		Public Health Services Act in accordance with the
18		requirements of Section 1504 of that Act as
19		administered by the Illinois Department of Public
20		Health; and
21		(2) persons whose screenings under the above
22		program were funded in whole or in part by funds
23		appropriated to the Illinois Department of Public
24		Health for breast or cervical cancer screening.
25		"Medical assistance" under this paragraph 12 shall be
26		identical to the benefits provided under the State's

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1		approved plan under Title XIX of the Social Security Act.
2		The Department must request federal approval of the
3		coverage under this paragraph 12 within 30 days after the
4		effective date of this amendatory Act of the 92nd General
5		Assembly.
6		In addition to the persons who are eligible for medical
7		assistance pursuant to subparagraphs (1) and (2) of this
8		paragraph 12, and to be paid from funds appropriated to the
9		Department for its medical programs, any uninsured person
10		as defined by the Department in rules residing in Illinois
11		who is younger than 65 years of age, who has been screened
12		for breast and cervical cancer in accordance with standards
13		and procedures adopted by the Department of Public Health
14		for screening, and who is referred to the Department by the
15		Department of Public Health as being in need of treatment
16		for breast or cervical cancer is eligible for medical
17		assistance benefits that are consistent with the benefits
18		provided to those persons described in subparagraphs (1)
19		and (2). Medical assistance coverage for the persons who
20		are eligible under the preceding sentence is not dependent
21		on federal approval, but federal moneys may be used to pay
22		for services provided under that coverage upon federal
23		approval.
24		13. Subject to appropriation and to federal approval,
25		persons living with HIV/AIDS who are not otherwise eligible
26		under this Article and who qualify for services covered

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1		under Section 5-5.04 as provided by the Illinois Department
2		by rule.
3		14. Subject to the availability of funds for this
4		purpose, the Department may provide coverage under this
5		Article to persons who reside in Illinois who are not
6		eligible under any of the preceding paragraphs and who meet
7		the income guidelines of paragraph 2(a) of this Section and
8		(i) have an application for asylum pending before the
9		federal Department of Homeland Security or on appeal before
10		a court of competent jurisdiction and are represented
11		either by counsel or by an advocate accredited by the
12		federal Department of Homeland Security and employed by a
13		not-for-profit organization in regard to that application
14		or appeal, or (ii) are receiving services through a
15		federally funded torture treatment center. Medical
16		coverage under this paragraph 14 may be provided for up to
17		24 continuous months from the initial eligibility date so
18		long as an individual continues to satisfy the criteria of
19		this paragraph 14. If an individual has an appeal pending
20		regarding an application for asylum before the Department
21		of Homeland Security, eligibility under this paragraph 14
22		may be extended until a final decision is rendered on the
23		appeal. The Department may adopt rules governing the
24		implementation of this paragraph 14.
25		15. Family Care Eligibility.
26		(a) On and after July 1, 2012, a parent or other

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1		caretaker relative who is 19 years of age or older when
2		countable income is at or below 133% of the federal
3		poverty level. A person may not spend down to become
4		eligible under this paragraph 15.
5		(b) Eligibility shall be reviewed annually.
6		(c) (Blank).
7		(d) (Blank).
8		(e) (Blank).
9		(f) (Blank).
10		(g) (Blank).
11		(h) (Blank).
12		(i) Following termination of an individual's
13		coverage under this paragraph 15, the individual must
14		be determined eligible before the person can be
15		re-enrolled.
16		16. Subject to appropriation, uninsured persons who
17		are not otherwise eligible under this Section who have been
18		certified and referred by the Department of Public Health
19		as having been screened and found to need diagnostic
20		evaluation or treatment, or both diagnostic evaluation and
21		treatment, for prostate or testicular cancer. For the
22		purposes of this paragraph 16, uninsured persons are those
23		who do not have creditable coverage, as defined under the
24		Health Insurance Portability and Accountability Act, or
25		have otherwise exhausted any insurance benefits they may
26		have had, for prostate or testicular cancer diagnostic

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1		evaluation or treatment, or both diagnostic evaluation and
2		treatment. To be eligible, a person must furnish a Social
3		Security number. A person's assets are exempt from
4		consideration in determining eligibility under this
5		paragraph 16. Such persons shall be eligible for medical
6		assistance under this paragraph 16 for so long as they need
7		treatment for the cancer. A person shall be considered to
8		need treatment if, in the opinion of the person's treating
9		physician, the person requires therapy directed toward
10		cure or palliation of prostate or testicular cancer,
11		including recurrent metastatic cancer that is a known or
12		presumed complication of prostate or testicular cancer and
13		complications resulting from the treatment modalities
14		themselves. Persons who require only routine monitoring
15		services are not considered to need treatment. "Medical
16		assistance" under this paragraph 16 shall be identical to
17		the benefits provided under the State's approved plan under
18		Title XIX of the Social Security Act. Notwithstanding any
19		other provision of law, the Department (i) does not have a
20		claim against the estate of a deceased recipient of
21		services under this paragraph 16 and (ii) does not have a
22		lien against any homestead property or other legal or
23		equitable real property interest owned by a recipient of
24		services under this paragraph 16.
25		17. Persons who, pursuant to a waiver approved by the
26		Secretary of the U.S. Department of Health and Human

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1		Services, are eligible for medical assistance under Title
2		XIX or XXI of the federal Social Security Act.
3		Notwithstanding any other provision of this Code and
4		consistent with the terms of the approved waiver, the
5		Illinois Department, may by rule:
6		(a) Limit the geographic areas in which the waiver
7		program operates.
8		(b) Determine the scope, quantity, duration, and
9		quality, and the rate and method of reimbursement, of
10		the medical services to be provided, which may differ
11		from those for other classes of persons eligible for
12		assistance under this Article.
13		(c) Restrict the persons' freedom in choice of
14		providers.
15		18. Beginning January 1, 2014, persons aged 19 or
16		older, but younger than 65, who are not otherwise eligible
17		for medical assistance under this Section 5-2, who qualify
18		for medical assistance pursuant to 42 U.S.C.
19		1396a(a)(10)(A)(i)(VIII) and applicable federal
20		regulations, and who have income at or below 133% of the
21		federal poverty level plus 5% for the applicable family
22		size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
23		applicable federal regulations. Persons eligible for
24		medical assistance under this paragraph 18 shall receive
25		coverage for the Health Benefits Service Package as that
26		term is defined in subsection (m) of Section 5-1.1 of this

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1		Code. If Illinois' federal medical assistance percentage
2		(FMAP) is reduced below 90% for persons eligible for
3		medical assistance under this paragraph 18, eligibility
4		under this paragraph 18 shall cease no later than the end
5		of the third month following the month in which the
6		reduction in FMAP takes effect.
7		19. Beginning January 1, 2014, as required under 42
8		U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
9		and younger than age 26 who are not otherwise eligible for
10		medical assistance under paragraphs (1) through (17) of
11		this Section who (i) were in foster care under the
12		responsibility of the State on the date of attaining age 18
13		or on the date of attaining age 21 when a court has
14		continued wardship for good cause as provided in Section
15		2-31 of the Juvenile Court Act of 1987 and (ii) received
16		medical assistance under the Illinois Title XIX State Plan
17		or waiver of such plan while in foster care.
18		20. Beginning January 1, 2018, persons who are
19		foreign-born victims of human trafficking, torture, or
20		other serious crimes as defined in Section 2-19 of this
21		Code and their derivative family members if such persons:
22		(i) reside in Illinois; (ii) are not eligible under any of
23		the preceding paragraphs; (iii) meet the income guidelines
24		of subparagraph (a) of paragraph 2; and (iv) meet the
25		nonfinancial eligibility requirements of Sections 16-2,
26		16-3, and 16-5 of this Code. The Department may extend

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1		medical assistance for persons who are foreign-born
2		victims of human trafficking, torture, or other serious
3		crimes whose medical assistance would be terminated
4		pursuant to subsection (b) of Section 16-5 if the
5		Department determines that the person, during the year of
6		initial eligibility (1) experienced a health crisis, (2)
7		has been unable, after reasonable attempts, to obtain
8		necessary information from a third party, or (3) has other
9		extenuating circumstances that prevented the person from
10		completing his or her application for status. The
11		Department may adopt any rules necessary to implement the
12		provisions of this paragraph.
13		21. Persons who are not otherwise eligible for medical
14		assistance under this Section who may qualify for medical
15		assistance pursuant to 42 U.S.C.
16		1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
17		duration of any federal or State declared emergency due to
18		COVID-19. Medical assistance to persons eligible for
19		medical assistance solely pursuant to this paragraph 21
20		shall be limited to any in vitro diagnostic product (and
21		the administration of such product) described in 42 U.S.C.
22		1396d(a)(3)(B) on or after March 18, 2020, any visit
23		described in 42 U.S.C. 1396o(a)(2)(G), or any other medical
24		assistance that may be federally authorized for this class
25		of persons. The Department may also cover treatment of
26		COVID-19 for this class of persons, or any similar category

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1		of uninsured individuals, to the extent authorized under a
2		federally approved 1115 Waiver or other federal authority.
3		Notwithstanding the provisions of Section 1-11 of this
4		Code, due to the nature of the COVID-19 public health
5		emergency, the Department may cover and provide the medical
6		assistance described in this paragraph 21 to noncitizens
7		who would otherwise meet the eligibility requirements for
8		the class of persons described in this paragraph 21 for the
9		duration of the State emergency period.
10		In implementing the provisions of Public Act 96-20, the
11		Department is authorized to adopt only those rules necessary,
12		including emergency rules. Nothing in Public Act 96-20 permits
13		the Department to adopt rules or issue a decision that expands
14		eligibility for the FamilyCare Program to a person whose income
15		exceeds 185% of the Federal Poverty Level as determined from
16		time to time by the U.S. Department of Health and Human
17		Services, unless the Department is provided with express
18		statutory authority.
19		The eligibility of any such person for medical assistance
20		under this Article is not affected by the payment of any grant
21		under the Senior Citizens and Persons with Disabilities
22		Property Tax Relief Act or any distributions or items of income
23		described under subparagraph (X) of paragraph (2) of subsection
24		(a) of Section 203 of the Illinois Income Tax Act.
25		The Department shall by rule establish the amounts of
26		assets to be disregarded in determining eligibility for medical

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1		assistance, which shall at a minimum equal the amounts to be
2		disregarded under the Federal Supplemental Security Income
3		Program. The amount of assets of a single person to be
4		disregarded shall not be less than $2,000, and the amount of
5		assets of a married couple to be disregarded shall not be less
6		than $3,000.
7		To the extent permitted under federal law, any person found
8		guilty of a second violation of Article VIIIA shall be
9		ineligible for medical assistance under this Article, as
10		provided in Section 8A-8.
11		The eligibility of any person for medical assistance under
12		this Article shall not be affected by the receipt by the person
13		of donations or benefits from fundraisers held for the person
14		in cases of serious illness, as long as neither the person nor
15		members of the person's family have actual control over the
16		donations or benefits or the disbursement of the donations or
17		benefits.
18		Notwithstanding any other provision of this Code, if the
19		United States Supreme Court holds Title II, Subtitle A, Section
20		2001(a) of Public Law 111-148 to be unconstitutional, or if a
21		holding of Public Law 111-148 makes Medicaid eligibility
22		allowed under Section 2001(a) inoperable, the State or a unit
23		of local government shall be prohibited from enrolling
24		individuals in the Medical Assistance Program as the result of
25		federal approval of a State Medicaid waiver on or after the
26		effective date of this amendatory Act of the 97th General

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1		Assembly, and any individuals enrolled in the Medical
2		Assistance Program pursuant to eligibility permitted as a
3		result of such a State Medicaid waiver shall become immediately
4		ineligible.
5		Notwithstanding any other provision of this Code, if an Act
6		of Congress that becomes a Public Law eliminates Section
7		2001(a) of Public Law 111-148, the State or a unit of local
8		government shall be prohibited from enrolling individuals in
9		the Medical Assistance Program as the result of federal
10		approval of a State Medicaid waiver on or after the effective
11		date of this amendatory Act of the 97th General Assembly, and
12		any individuals enrolled in the Medical Assistance Program
13		pursuant to eligibility permitted as a result of such a State
14		Medicaid waiver shall become immediately ineligible.
15		Effective October 1, 2013, the determination of
16		eligibility of persons who qualify under paragraphs 5, 6, 8,
17		15, 17, and 18 of this Section shall comply with the
18		requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
19		regulations.
20		The Department of Healthcare and Family Services, the
21		Department of Human Services, and the Illinois health insurance
22		marketplace shall work cooperatively to assist persons who
23		would otherwise lose health benefits as a result of changes
24		made under this amendatory Act of the 98th General Assembly to
25		transition to other health insurance coverage.
26		(Source: P.A. 101-10, eff. 6-5-19.)

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1		(305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
2		Sec. 5-4.2. Ambulance services payments.
3		(a) For ambulance services provided to a recipient of aid
4		under this Article on or after January 1, 1993, the Illinois
5		Department shall reimburse ambulance service providers at
6		rates calculated in accordance with this Section. It is the
7		intent of the General Assembly to provide adequate
8		reimbursement for ambulance services so as to ensure adequate
9		access to services for recipients of aid under this Article and
10		to provide appropriate incentives to ambulance service
11		providers to provide services in an efficient and
12		cost-effective manner. Thus, it is the intent of the General
13		Assembly that the Illinois Department implement a
14		reimbursement system for ambulance services that, to the extent
15		practicable and subject to the availability of funds
16		appropriated by the General Assembly for this purpose, is
17		consistent with the payment principles of Medicare. To ensure
18		uniformity between the payment principles of Medicare and
19		Medicaid, the Illinois Department shall follow, to the extent
20		necessary and practicable and subject to the availability of
21		funds appropriated by the General Assembly for this purpose,
22		the statutes, laws, regulations, policies, procedures,
23		principles, definitions, guidelines, and manuals used to
24		determine the amounts paid to ambulance service providers under
25		Title XVIII of the Social Security Act (Medicare).

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1		(b) For ambulance services provided to a recipient of aid
2		under this Article on or after January 1, 1996, the Illinois
3		Department shall reimburse ambulance service providers based
4		upon the actual distance traveled if a natural disaster,
5		weather conditions, road repairs, or traffic congestion
6		necessitates the use of a route other than the most direct
7		route.
8		(c) For purposes of this Section, "ambulance services"
9		includes medical transportation services provided by means of
10		an ambulance, medi-car, service car, or taxi.
11		(c-1) For purposes of this Section, "ground ambulance
12		service" means medical transportation services that are
13		described as ground ambulance services by the Centers for
14		Medicare and Medicaid Services and provided in a vehicle that
15		is licensed as an ambulance by the Illinois Department of
16		Public Health pursuant to the Emergency Medical Services (EMS)
17		Systems Act.
18		(c-2) For purposes of this Section, "ground ambulance
19		service provider" means a vehicle service provider as described
20		in the Emergency Medical Services (EMS) Systems Act that
21		operates licensed ambulances for the purpose of providing
22		emergency ambulance services, or non-emergency ambulance
23		services, or both. For purposes of this Section, this includes
24		both ambulance providers and ambulance suppliers as described
25		by the Centers for Medicare and Medicaid Services.
26		(c-3) For purposes of this Section, "medi-car" means

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1		transportation services provided to a patient who is confined
2		to a wheelchair and requires the use of a hydraulic or electric
3		lift or ramp and wheelchair lockdown when the patient's
4		condition does not require medical observation, medical
5		supervision, medical equipment, the administration of
6		medications, or the administration of oxygen.
7		(c-4) For purposes of this Section, "service car" means
8		transportation services provided to a patient by a passenger
9		vehicle where that patient does not require the specialized
10		modes described in subsection (c-1) or (c-3).
11		(d) This Section does not prohibit separate billing by
12		ambulance service providers for oxygen furnished while
13		providing advanced life support services.
14		(e) Beginning with services rendered on or after July 1,
15		2008, all providers of non-emergency medi-car and service car
16		transportation must certify that the driver and employee
17		attendant, as applicable, have completed a safety program
18		approved by the Department to protect both the patient and the
19		driver, prior to transporting a patient. The provider must
20		maintain this certification in its records. The provider shall
21		produce such documentation upon demand by the Department or its
22		representative. Failure to produce documentation of such
23		training shall result in recovery of any payments made by the
24		Department for services rendered by a non-certified driver or
25		employee attendant. Medi-car and service car providers must
26		maintain legible documentation in their records of the driver

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1		and, as applicable, employee attendant that actually
2		transported the patient. Providers must recertify all drivers
3		and employee attendants every 3 years.
4		Notwithstanding the requirements above, any public
5		transportation provider of medi-car and service car
6		transportation that receives federal funding under 49 U.S.C.
7		5307 and 5311 need not certify its drivers and employee
8		attendants under this Section, since safety training is already
9		federally mandated.
10		(f) With respect to any policy or program administered by
11		the Department or its agent regarding approval of non-emergency
12		medical transportation by ground ambulance service providers,
13		including, but not limited to, the Non-Emergency
14		Transportation Services Prior Approval Program (NETSPAP), the
15		Department shall establish by rule a process by which ground
16		ambulance service providers of non-emergency medical
17		transportation may appeal any decision by the Department or its
18		agent for which no denial was received prior to the time of
19		transport that either (i) denies a request for approval for
20		payment of non-emergency transportation by means of ground
21		ambulance service or (ii) grants a request for approval of
22		non-emergency transportation by means of ground ambulance
23		service at a level of service that entitles the ground
24		ambulance service provider to a lower level of compensation
25		from the Department than the ground ambulance service provider
26		would have received as compensation for the level of service

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1		requested. The rule shall be filed by December 15, 2012 and
2		shall provide that, for any decision rendered by the Department
3		or its agent on or after the date the rule takes effect, the
4		ground ambulance service provider shall have 60 days from the
5		date the decision is received to file an appeal. The rule
6		established by the Department shall be, insofar as is
7		practical, consistent with the Illinois Administrative
8		Procedure Act. The Director's decision on an appeal under this
9		Section shall be a final administrative decision subject to
10		review under the Administrative Review Law.
11		(f-5) Beginning 90 days after July 20, 2012 (the effective
12		date of Public Act 97-842), (i) no denial of a request for
13		approval for payment of non-emergency transportation by means
14		of ground ambulance service, and (ii) no approval of
15		non-emergency transportation by means of ground ambulance
16		service at a level of service that entitles the ground
17		ambulance service provider to a lower level of compensation
18		from the Department than would have been received at the level
19		of service submitted by the ground ambulance service provider,
20		may be issued by the Department or its agent unless the
21		Department has submitted the criteria for determining the
22		appropriateness of the transport for first notice publication
23		in the Illinois Register pursuant to Section 5-40 of the
24		Illinois Administrative Procedure Act.
25		(g) Whenever a patient covered by a medical assistance
26		program under this Code or by another medical program

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1		administered by the Department, including a patient covered
2		under the State's Medicaid managed care program, is being
3		transported from a facility and requires non-emergency
4		transportation including ground ambulance, medi-car, or
5		service car transportation, a Physician Certification
6		Statement as described in this Section shall be required for
7		each patient. Facilities shall develop procedures for a
8		licensed medical professional to provide a written and signed
9		Physician Certification Statement. The Physician Certification
10		Statement shall specify the level of transportation services
11		needed and complete a medical certification establishing the
12		criteria for approval of non-emergency ambulance
13		transportation, as published by the Department of Healthcare
14		and Family Services, that is met by the patient. This
15		certification shall be completed prior to ordering the
16		transportation service and prior to patient discharge. The
17		Physician Certification Statement is not required prior to
18		transport if a delay in transport can be expected to negatively
19		affect the patient outcome. If the ground ambulance provider,
20		medi-car provider, or service car provider is unable to obtain
21		the required Physician Certification Statement within 10
22		calendar days following the date of the service, the ground
23		ambulance provider, medi-car provider, or service car provider
24		must document its attempt to obtain the requested certification
25		and may then submit the claim for payment. Acceptable
26		documentation includes a signed return receipt from the U.S.

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1		Postal Service, facsimile receipt, email receipt, or other
2		similar service that evidences that the ground ambulance
3		provider, medi-car provider, or service car provider attempted
4		to obtain the required Physician Certification Statement.
5		The medical certification specifying the level and type of
6		non-emergency transportation needed shall be in the form of the
7		Physician Certification Statement on a standardized form
8		prescribed by the Department of Healthcare and Family Services.
9		Within 75 days after July 27, 2018 (the effective date of
10		Public Act 100-646), the Department of Healthcare and Family
11		Services shall develop a standardized form of the Physician
12		Certification Statement specifying the level and type of
13		transportation services needed in consultation with the
14		Department of Public Health, Medicaid managed care
15		organizations, a statewide association representing ambulance
16		providers, a statewide association representing hospitals, 3
17		statewide associations representing nursing homes, and other
18		stakeholders. The Physician Certification Statement shall
19		include, but is not limited to, the criteria necessary to
20		demonstrate medical necessity for the level of transport needed
21		as required by (i) the Department of Healthcare and Family
22		Services and (ii) the federal Centers for Medicare and Medicaid
23		Services as outlined in the Centers for Medicare and Medicaid
24		Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap.
25		10, Sec. 10.2.1, et seq. The use of the Physician Certification
26		Statement shall satisfy the obligations of hospitals under

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1		Section 6.22 of the Hospital Licensing Act and nursing homes
2		under Section 2-217 of the Nursing Home Care Act.
3		Implementation and acceptance of the Physician Certification
4		Statement shall take place no later than 90 days after the
5		issuance of the Physician Certification Statement by the
6		Department of Healthcare and Family Services.
7		Pursuant to subsection (E) of Section 12-4.25 of this Code,
8		the Department is entitled to recover overpayments paid to a
9		provider or vendor, including, but not limited to, from the
10		discharging physician, the discharging facility, and the
11		ground ambulance service provider, in instances where a
12		non-emergency ground ambulance service is rendered as the
13		result of improper or false certification.
14		Beginning October 1, 2018, the Department of Healthcare and
15		Family Services shall collect data from Medicaid managed care
16		organizations and transportation brokers, including the
17		Department's NETSPAP broker, regarding denials and appeals
18		related to the missing or incomplete Physician Certification
19		Statement forms and overall compliance with this subsection.
20		The Department of Healthcare and Family Services shall publish
21		quarterly results on its website within 15 days following the
22		end of each quarter.
23		(h) On and after July 1, 2012, the Department shall reduce
24		any rate of reimbursement for services or other payments or
25		alter any methodologies authorized by this Code to reduce any
26		rate of reimbursement for services or other payments in

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1		accordance with Section 5-5e.
2		(i) On and after July 1, 2018, the Department shall
3		increase the base rate of reimbursement for both base charges
4		and mileage charges for ground ambulance service providers for
5		medical transportation services provided by means of a ground
6		ambulance to a level not lower than 112% of the base rate in
7		effect as of June 30, 2018.
8		(Source: P.A. 100-587, eff. 6-4-18; 100-646, eff. 7-27-18;
9		101-81, eff. 7-12-19.)
10		(305 ILCS 5/5-5.27 new)
11		Sec. 5-5.27. Coverage for clinical trials.
12		(a) The medical assistance program shall provide coverage
13		for routine care costs that are incurred in the course of an
14		approved clinical trial if the medical assistance program would
15		provide coverage for the same routine care costs not incurred
16		in a clinical trial. "Routine care cost" shall be defined by
17		the Department by rule.
18		(b) The coverage that must be provided under this Section
19		is subject to the terms, conditions, restrictions, exclusions,
20		and limitations that apply generally under the medical
21		assistance program, including terms, conditions, restrictions,
22		exclusions, or limitations that apply to health care services
23		rendered by participating providers and nonparticipating
24		providers.
25		(c) Implementation of this Section shall be contingent upon

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1		federal approval. Upon receipt of federal approval, if
2		required, the Department shall adopt any rules necessary to
3		implement this Section.
4		(d) As used in this Section:
5		"Approved clinical trial" means a phase I, II, III, or IV
6		clinical trial involving the prevention, detection, or
7		treatment of cancer or any other life-threatening disease or
8		condition if one or more of the following conditions apply:
9		(1) the Department makes a determination that the study
10		or investigation is an approved clinical trial;
11		(2) the study or investigation is conducted under an
12		investigational new drug application or an investigational
13		device exemption reviewed by the federal Food and Drug
14		Administration;
15		(3) the study or investigation is a drug trial that is
16		exempt from having an investigational new drug application
17		or an investigational device exemption from the federal
18		Food and Drug Administration; or
19		(4) the study or investigation is approved or funded
20		(which may include funding through in-kind contributions)
21		by:
22		(A) the National Institutes of Health;
23		(B) the Centers for Disease Control and
24		Prevention;
25		(C) the Agency for Healthcare Research and
26		Quality;

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1		(D) the Patient-Centered Outcomes Research
2		Institute;
3		(E) the federal Centers for Medicare and Medicaid
4		Services;
5		(F) a cooperative group or center of any of the
6		entities described in subparagraphs (A) through (E) or
7		the United States Department of Defense or the United
8		States Department of Veterans Affairs;
9		(G) a qualified non-governmental research entity
10		identified in the guidelines issued by the National
11		Institutes of Health for center support grants; or
12		(H) the United States Department of Veterans
13		Affairs, the United States Department of Defense, or
14		the United States Department of Energy, provided that
15		review and approval of the study or investigation
16		occurs through a system of peer review that is
17		comparable to the peer review of studies performed by
18		the National Institutes of Health, including an
19		unbiased review of the highest scientific standards by
20		qualified individuals who have no interest in the
21		outcome of the review.
22		"Care method" means the use of a particular drug or device
23		in a particular manner.
24		"Life-threatening disease or condition" means a disease or
25		condition from which the likelihood of death is probable unless
26		the course of the disease or condition is interrupted.

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1		(305 ILCS 5/5-5e)
2		Sec. 5-5e. Adjusted rates of reimbursement.
3		(a) Rates or payments for services in effect on June 30,
4		2012 shall be adjusted and services shall be affected as
5		required by any other provision of Public Act 97-689. In
6		addition, the Department shall do the following:
7		(1) Delink the per diem rate paid for supportive living
8		facility services from the per diem rate paid for nursing
9		facility services, effective for services provided on or
10		after May 1, 2011 and before July 1, 2019.
11		(2) Cease payment for bed reserves in nursing
12		facilities and specialized mental health rehabilitation
13		facilities; for purposes of therapeutic home visits for
14		individuals scoring as TBI on the MDS 3.0, beginning June
15		1, 2015, the Department shall approve payments for bed
16		reserves in nursing facilities and specialized mental
17		health rehabilitation facilities that have at least a 90%
18		occupancy level and at least 80% of their residents are
19		Medicaid eligible. Payment shall be at a daily rate of 75%
20		of an individual's current Medicaid per diem and shall not
21		exceed 10 days in a calendar month.
22		(2.5) Cease payment for bed reserves for purposes of
23		inpatient hospitalizations to intermediate care facilities
24		for persons with developmental development disabilities,
25		except in the instance of residents who are under 21 years

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1		of age.
2		(3) Cease payment of the $10 per day add-on payment to
3		nursing facilities for certain residents with
4		developmental disabilities.
5		(b) After the application of subsection (a),
6		notwithstanding any other provision of this Code to the
7		contrary and to the extent permitted by federal law, on and
8		after July 1, 2012, the rates of reimbursement for services and
9		other payments provided under this Code shall further be
10		reduced as follows:
11		(1) Rates or payments for physician services, dental
12		services, or community health center services reimbursed
13		through an encounter rate, and services provided under the
14		Medicaid Rehabilitation Option of the Illinois Title XIX
15		State Plan shall not be further reduced, except as provided
16		in Section 5-5b.1.
17		(2) Rates or payments, or the portion thereof, paid to
18		a provider that is operated by a unit of local government
19		or State University that provides the non-federal share of
20		such services shall not be further reduced, except as
21		provided in Section 5-5b.1.
22		(3) Rates or payments for hospital services delivered
23		by a hospital defined as a Safety-Net Hospital under
24		Section 5-5e.1 of this Code shall not be further reduced,
25		except as provided in Section 5-5b.1.
26		(4) Rates or payments for hospital services delivered

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1		by a Critical Access Hospital, which is an Illinois
2		hospital designated as a critical care hospital by the
3		Department of Public Health in accordance with 42 CFR 485,
4		Subpart F, shall not be further reduced, except as provided
5		in Section 5-5b.1.
6		(5) Rates or payments for Nursing Facility Services
7		shall only be further adjusted pursuant to Section 5-5.2 of
8		this Code.
9		(6) Rates or payments for services delivered by long
10		term care facilities licensed under the ID/DD Community
11		Care Act or the MC/DD Act and developmental training
12		services shall not be further reduced.
13		(7) Rates or payments for services provided under
14		capitation rates shall be adjusted taking into
15		consideration the rates reduction and covered services
16		required by Public Act 97-689.
17		(8) For hospitals not previously described in this
18		subsection, the rates or payments for hospital services
19		shall be further reduced by 3.5%, except for payments
20		authorized under Section 5A-12.4 of this Code.
21		(9) For all other rates or payments for services
22		delivered by providers not specifically referenced in
23		paragraphs (1) through (8), rates or payments shall be
24		further reduced by 2.7%.
25		(c) Any assessment imposed by this Code shall continue and
26		nothing in this Section shall be construed to cause it to

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1		cease.
2		(d) Notwithstanding any other provision of this Code to the
3		contrary, subject to federal approval under Title XIX of the
4		Social Security Act, for dates of service on and after July 1,
5		2014, rates or payments for services provided for the purpose
6		of transitioning children from a hospital to home placement or
7		other appropriate setting by a children's community-based
8		health care center authorized under the Alternative Health Care
9		Delivery Act shall be $683 per day.
10		(e) (Blank) Notwithstanding any other provision of this
11		Code to the contrary, subject to federal approval under Title
12		XIX of the Social Security Act, for dates of service on and
13		after July 1, 2014, rates or payments for home health visits
14		shall be $72.
15		(f) (Blank) Notwithstanding any other provision of this
16		Code to the contrary, subject to federal approval under Title
17		XIX of the Social Security Act, for dates of service on and
18		after July 1, 2014, rates or payments for the certified nursing
19		assistant component of the home health agency rate shall be
20		$20.
21		(Source: P.A. 101-10, eff. 6-5-19; revised 9-12-19.)
22		(305 ILCS 5/5-16.8)
23		Sec. 5-16.8. Required health benefits. The medical
24		assistance program shall (i) provide the post-mastectomy care
25		benefits required to be covered by a policy of accident and

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1		health insurance under Section 356t and the coverage required
2		under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
3		356z.29, and 356z.32, and 356z.33, 356z.34, and 356z.35 of the
4		Illinois Insurance Code and (ii) be subject to the provisions
5		of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois
6		Insurance Code.
7		The Department, by rule, shall adopt a model similar to the
8		requirements of Section 356z.39 of the Illinois Insurance Code.
9		On and after July 1, 2012, the Department shall reduce any
10		rate of reimbursement for services or other payments or alter
11		any methodologies authorized by this Code to reduce any rate of
12		reimbursement for services or other payments in accordance with
13		Section 5-5e.
14		To ensure full access to the benefits set forth in this
15		Section, on and after January 1, 2016, the Department shall
16		ensure that provider and hospital reimbursement for
17		post-mastectomy care benefits required under this Section are
18		no lower than the Medicare reimbursement rate.
19		(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
20		100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
21		7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
22		eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)
23		(305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
24		Sec. 5B-4. Payment of assessment; penalty.
25		(a) The assessment imposed by Section 5B-2 shall be due and

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1		payable monthly, on the last State business day of the month
2		for occupied bed days reported for the preceding third month
3		prior to the month in which the tax is payable and due. A
4		facility that has delayed payment due to the State's failure to
5		reimburse for services rendered may request an extension on the
6		due date for payment pursuant to subsection (b) and shall pay
7		the assessment within 30 days of reimbursement by the
8		Department. The Illinois Department may provide that county
9		nursing homes directed and maintained pursuant to Section
10		5-1005 of the Counties Code may meet their assessment
11		obligation by certifying to the Illinois Department that county
12		expenditures have been obligated for the operation of the
13		county nursing home in an amount at least equal to the amount
14		of the assessment.
15		(a-5) The Illinois Department shall provide for an
16		electronic submission process for each long-term care facility
17		to report at a minimum the number of occupied bed days of the
18		long-term care facility for the reporting period and other
19		reasonable information the Illinois Department requires for
20		the administration of its responsibilities under this Code.
21		Beginning July 1, 2013, a separate electronic submission shall
22		be completed for each long-term care facility in this State
23		operated by a long-term care provider. The Illinois Department
24		shall provide a self-reporting notice of the assessment form
25		that the long-term care facility completes for the required
26		period and submits with its assessment payment to the Illinois

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1		Department. shall prepare an assessment bill stating the amount
2		due and payable each month and submit it to each long-term care
3		facility via an electronic process. Each assessment payment
4		shall be accompanied by a copy of the assessment bill sent to
5		the long-term care facility by the Illinois Department. To the
6		extent practicable, the Department shall coordinate the
7		assessment reporting requirements with other reporting
8		required of long-term care facilities.
9		(b) The Illinois Department is authorized to establish
10		delayed payment schedules for long-term care providers that are
11		unable to make assessment payments when due under this Section
12		due to financial difficulties, as determined by the Illinois
13		Department. The Illinois Department may not deny a request for
14		delay of payment of the assessment imposed under this Article
15		if the long-term care provider has not been paid for services
16		provided during the month on which the assessment is levied or
17		the Medicaid managed care organization has not been paid by the
18		State.
19		(c) If a long-term care provider fails to pay the full
20		amount of an assessment payment when due (including any
21		extensions granted under subsection (b)), there shall, unless
22		waived by the Illinois Department for reasonable cause, be
23		added to the assessment imposed by Section 5B-2 a penalty
24		assessment equal to the lesser of (i) 5% of the amount of the
25		assessment payment not paid on or before the due date plus 5%
26		of the portion thereof remaining unpaid on the last day of each

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1		month thereafter or (ii) 100% of the assessment payment amount
2		not paid on or before the due date. For purposes of this
3		subsection, payments will be credited first to unpaid
4		assessment payment amounts (rather than to penalty or
5		interest), beginning with the most delinquent assessment
6		payments. Payment cycles of longer than 60 days shall be one
7		factor the Director takes into account in granting a waiver
8		under this Section.
9		(c-5) If a long-term care facility fails to file its
10		assessment bill with payment, there shall, unless waived by the
11		Illinois Department for reasonable cause, be added to the
12		assessment due a penalty assessment equal to 25% of the
13		assessment due. After July 1, 2013, no penalty shall be
14		assessed under this Section if the Illinois Department does not
15		provide a process for the electronic submission of the
16		information required by subsection (a-5).
17		(d) Nothing in this amendatory Act of 1993 shall be
18		construed to prevent the Illinois Department from collecting
19		all amounts due under this Article pursuant to an assessment
20		imposed before the effective date of this amendatory Act of
21		1993.
22		(e) Nothing in this amendatory Act of the 96th General
23		Assembly shall be construed to prevent the Illinois Department
24		from collecting all amounts due under this Code pursuant to an
25		assessment, tax, fee, or penalty imposed before the effective
26		date of this amendatory Act of the 96th General Assembly.

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1		(f) No installment of the assessment imposed by Section
2		5B-2 shall be due and payable until after the Department
3		notifies the long-term care providers, in writing, that the
4		payment methodologies to long-term care providers required
5		under Section 5-5.4 of this Code have been approved by the
6		Centers for Medicare and Medicaid Services of the U.S.
7		Department of Health and Human Services and the waivers under
8		42 CFR 433.68 for the assessment imposed by this Section, if
9		necessary, have been granted by the Centers for Medicare and
10		Medicaid Services of the U.S. Department of Health and Human
11		Services. Upon notification to the Department of approval of
12		the payment methodologies required under Section 5-5.4 of this
13		Code and the waivers granted under 42 CFR 433.68, all
14		installments otherwise due under Section 5B-4 prior to the date
15		of notification shall be due and payable to the Department upon
16		written direction from the Department within 90 days after
17		issuance by the Comptroller of the payments required under
18		Section 5-5.4 of this Code.
19		(Source: P.A. 100-501, eff. 6-1-18.)
20		(305 ILCS 5/11-5.1)
21		Sec. 11-5.1. Eligibility verification. Notwithstanding any
22		other provision of this Code, with respect to applications for
23		medical assistance provided under Article V of this Code,
24		eligibility shall be determined in a manner that ensures
25		program integrity and complies with federal laws and

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

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1		that is sufficient to make a determination of continued
2		Medicaid eligibility may be reviewed and verified, and
3		subsequent action taken including client notification of
4		continued Medicaid eligibility. The date of client
5		notification establishes the date for subsequent annual
6		Medicaid eligibility reviews. Such verification shall take
7		the form of pay stubs, business or income and expense
8		records for self-employed persons, letters from employers,
9		and any other valid documentation of income including data
10		obtained electronically by the Department or its designees
11		from other sources as described in subsection (b) of this
12		Section. A month's income may be verified by a single pay
13		stub with the monthly income extrapolated from the time
14		period covered by the pay stub. The Department shall send a
15		notice to recipients at least 60 days prior to the end of
16		their period of eligibility that informs them of the
17		requirements for continued eligibility. If a recipient
18		does not fulfill the requirements for continued
19		eligibility by the deadline established in the notice a
20		notice of cancellation shall be issued to the recipient and
21		coverage shall end no later than the last day of the month
22		following the last day of the eligibility period. A
23		recipient's eligibility may be reinstated without
24		requiring a new application if the recipient fulfills the
25		requirements for continued eligibility prior to the end of
26		the third month following the last date of coverage (or

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1		longer period if required by federal regulations). Nothing
2		in this Section shall prevent an individual whose coverage
3		has been cancelled from reapplying for health benefits at
4		any time.
5		(3) By no later than July 1, 2011, require verification
6		of Illinois residency.
7		The Department, with federal approval, may choose to adopt
8		continuous financial eligibility for a full 12 months for
9		adults on Medicaid.
10		(b) The Department shall establish or continue cooperative
11		arrangements with the Social Security Administration, the
12		Illinois Secretary of State, the Department of Human Services,
13		the Department of Revenue, the Department of Employment
14		Security, and any other appropriate entity to gain electronic
15		access, to the extent allowed by law, to information available
16		to those entities that may be appropriate for electronically
17		verifying any factor of eligibility for benefits under the
18		Program. Data relevant to eligibility shall be provided for no
19		other purpose than to verify the eligibility of new applicants
20		or current recipients of health benefits under the Program.
21		Data shall be requested or provided for any new applicant or
22		current recipient only insofar as that individual's
23		circumstances are relevant to that individual's or another
24		individual's eligibility.
25		(c) Within 90 days of the effective date of this amendatory
26		Act of the 96th General Assembly, the Department of Healthcare

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1		and Family Services shall send notice to current recipients
2		informing them of the changes regarding their eligibility
3		verification.
4		(d) As soon as practical if the data is reasonably
5		available, but no later than January 1, 2017, the Department
6		shall compile on a monthly basis data on eligibility
7		redeterminations of beneficiaries of medical assistance
8		provided under Article V of this Code. This data shall be
9		posted on the Department's website, and data from prior months
10		shall be retained and available on the Department's website.
11		The data compiled and reported shall include the following:
12		(1) The total number of redetermination decisions made
13		in a month and, of that total number, the number of
14		decisions to continue or change benefits and the number of
15		decisions to cancel benefits.
16		(2) A breakdown of enrollee language preference for the
17		total number of redetermination decisions made in a month
18		and, of that total number, a breakdown of enrollee language
19		preference for the number of decisions to continue or
20		change benefits, and a breakdown of enrollee language
21		preference for the number of decisions to cancel benefits.
22		The language breakdown shall include, at a minimum,
23		English, Spanish, and the next 4 most commonly used
24		languages.
25		(3) The percentage of cancellation decisions made in a
26		month due to each of the following:

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1		(A) The beneficiary's ineligibility due to excess
2		income.
3		(B) The beneficiary's ineligibility due to not
4		being an Illinois resident.
5		(C) The beneficiary's ineligibility due to being
6		deceased.
7		(D) The beneficiary's request to cancel benefits.
8		(E) The beneficiary's lack of response after
9		notices mailed to the beneficiary are returned to the
10		Department as undeliverable by the United States
11		Postal Service.
12		(F) The beneficiary's lack of response to a request
13		for additional information when reliable information
14		in the beneficiary's account, or other more current
15		information, is unavailable to the Department to make a
16		decision on whether to continue benefits.
17		(G) Other reasons tracked by the Department for the
18		purpose of ensuring program integrity.
19		(4) If a vendor is utilized to provide services in
20		support of the Department's redetermination decision
21		process, the total number of redetermination decisions
22		made in a month and, of that total number, the number of
23		decisions to continue or change benefits, and the number of
24		decisions to cancel benefits (i) with the involvement of
25		the vendor and (ii) without the involvement of the vendor.
26		(5) Of the total number of benefit cancellations in a

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1		month, the number of beneficiaries who return from
2		cancellation within one month, the number of beneficiaries
3		who return from cancellation within 2 months, and the
4		number of beneficiaries who return from cancellation
5		within 3 months. Of the number of beneficiaries who return
6		from cancellation within 3 months, the percentage of those
7		cancellations due to each of the reasons listed under
8		paragraph (3) of this subsection.
9		(e) The Department shall conduct a complete review of the
10		Medicaid redetermination process in order to identify changes
11		that can increase the use of ex parte redetermination
12		processing. This review shall be completed within 90 days after
13		the effective date of this amendatory Act of the 101st General
14		Assembly. Within 90 days of completion of the review, the
15		Department shall seek written federal approval of policy
16		changes the review recommended and implement once approved. The
17		review shall specifically include, but not be limited to, use
18		of ex parte redeterminations of the following populations:
19		(1) Recipients of developmental disabilities services.
20		(2) Recipients of benefits under the State's Aid to the
21		Aged, Blind, or Disabled program.
22		(3) Recipients of Medicaid long-term care services and
23		supports, including waiver services.
24		(4) All Modified Adjusted Gross Income (MAGI)
25		populations.
26		(5) Populations with no verifiable income.

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1		(6) Self-employed people.
2		The report shall also outline populations and
3		circumstances in which an ex parte redetermination is not a
4		recommended option.
5		(f) The Department shall explore and implement, as
6		practical and technologically possible, roles that
7		stakeholders outside State agencies can play to assist in
8		expediting eligibility determinations and redeterminations
9		within 24 months after the effective date of this amendatory
10		Act of the 101st General Assembly. Such practical roles to be
11		explored to expedite the eligibility determination processes
12		shall include the implementation of hospital presumptive
13		eligibility, as authorized by the Patient Protection and
14		Affordable Care Act.
15		(g) The Department or its designee shall seek federal
16		approval to enhance the reasonable compatibility standard from
17		5% to 10%.
18		(h) Reporting. The Department of Healthcare and Family
19		Services and the Department of Human Services shall publish
20		quarterly reports on their progress in implementing policies
21		and practices pursuant to this Section as modified by this
22		amendatory Act of the 101st General Assembly.
23		(1) The reports shall include, but not be limited to,
24		the following:
25		(A) Medical application processing, including a
26		breakdown of the number of MAGI, non-MAGI, long-term

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1		care, and other medical cases pending for various
2		incremental time frames between 0 to 181 or more days.
3		(B) Medical redeterminations completed, including:
4		(i) a breakdown of the number of households that were
5		redetermined ex parte and those that were not; (ii) the
6		reasons households were not redetermined ex parte; and
7		(iii) the relative percentages of these reasons.
8		(C) A narrative discussion on issues identified in
9		the functioning of the State's Integrated Eligibility
10		System and progress on addressing those issues, as well
11		as progress on implementing strategies to address
12		eligibility backlogs, including expanding ex parte
13		determinations to ensure timely eligibility
14		determinations and renewals.
15		(2) Initial reports shall be issued within 90 days
16		after the effective date of this amendatory Act of the
17		101st General Assembly.
18		(3) All reports shall be published on the Department's
19		website.
20		(Source: P.A. 101-209, eff. 8-5-19.)
21		(305 ILCS 5/12-21.21 new)
22		Sec. 12-21.21. Federal waiver or State Plan amendment. The
23		Department of Healthcare and Family Services and the Department
24		of Human Services shall jointly submit the necessary
25		application to the federal Centers for Medicare and Medicaid

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1		Services for a waiver or State Plan amendment to allow remote
2		monitoring and support services as a waiver-reimbursable
3		service for persons with intellectual and developmental
4		disabilities. The application shall be submitted no later than
5		January 1, 2021.
6		No later than July 1, 2021, the Department of Human
7		Services shall adopt rules to allow remote monitoring and
8		support services at community-integrated living arrangements.
9		Section 90-40. The Medical Patient Rights Act is amended by
10		changing Section 3 as follows:
11		(410 ILCS 50/3) (from Ch. 111 1/2, par. 5403)
12		Sec. 3. The following rights are hereby established:
13		(a) The right of each patient to care consistent with sound
14		nursing and medical practices, to be informed of the name of
15		the physician responsible for coordinating his or her care, to
16		receive information concerning his or her condition and
17		proposed treatment, to refuse any treatment to the extent
18		permitted by law, and to privacy and confidentiality of records
19		except as otherwise provided by law.
20		(b) The right of each patient, regardless of source of
21		payment, to examine and receive a reasonable explanation of his
22		total bill for services rendered by his physician or health
23		care provider, including the itemized charges for specific
24		services received. Each physician or health care provider shall

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1		be responsible only for a reasonable explanation of those
2		specific services provided by such physician or health care
3		provider.
4		(c) In the event an insurance company or health services
5		corporation cancels or refuses to renew an individual policy or
6		plan, the insured patient shall be entitled to timely, prior
7		notice of the termination of such policy or plan.
8		An insurance company or health services corporation that
9		requires any insured patient or applicant for new or continued
10		insurance or coverage to be tested for infection with human
11		immunodeficiency virus (HIV) or any other identified causative
12		agent of acquired immunodeficiency syndrome (AIDS) shall (1)
13		give the patient or applicant prior written notice of such
14		requirement, (2) proceed with such testing only upon the
15		written authorization of the applicant or patient, and (3) keep
16		the results of such testing confidential. Notice of an adverse
17		underwriting or coverage decision may be given to any
18		appropriately interested party, but the insurer may only
19		disclose the test result itself to a physician designated by
20		the applicant or patient, and any such disclosure shall be in a
21		manner that assures confidentiality.
22		The Department of Insurance shall enforce the provisions of
23		this subsection.
24		(d) The right of each patient to privacy and
25		confidentiality in health care. Each physician, health care
26		provider, health services corporation and insurance company

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1		shall refrain from disclosing the nature or details of services
2		provided to patients, except that such information may be
3		disclosed: (1) to the patient, (2) to the party making
4		treatment decisions if the patient is incapable of making
5		decisions regarding the health services provided, (3) for
6		treatment in accordance with 45 CFR 164.501 and 164.506, (4)
7		for payment in accordance with 45 CFR 164.501 and 164.506, (5)
8		to those parties responsible for peer review, utilization
9		review, and quality assurance, (6) for health care operations
10		in accordance with 45 CFR 164.501 and 164.506, (7) to those
11		parties required to be notified under the Abused and Neglected
12		Child Reporting Act or the Illinois Sexually Transmissible
13		Disease Control Act, or (8) as otherwise permitted, authorized,
14		or required by State or federal law. This right may be waived
15		in writing by the patient or the patient's guardian or legal
16		representative, but a physician or other health care provider
17		may not condition the provision of services on the patient's,
18		guardian's, or legal representative's agreement to sign such a
19		waiver. In the interest of public health, safety, and welfare,
20		patient information, including, but not limited to, health
21		information, demographic information, and information about
22		the services provided to patients, may be transmitted to or
23		through a health information exchange, as that term is defined
24		in Section 2 of the Mental Health and Developmental
25		Disabilities Confidentiality Act, in accordance with the
26		disclosures permitted pursuant to this Section. Patients shall

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1		be provided the opportunity to opt out of their health
2		information being transmitted to or through a health
3		information exchange in accordance with the regulations,
4		standards, or contractual obligations adopted by the Illinois
5		Health Information Exchange Office Authority in accordance
6		with Section 9.6 of the Mental Health and Developmental
7		Disabilities Confidentiality Act, Section 9.6 of the AIDS
8		Confidentiality Act, or Section 31.8 of the Genetic Information
9		Privacy Act, as applicable. In the case of a patient choosing
10		to opt out of having his or her information available on an
11		HIE, nothing in this Act shall cause the physician or health
12		care provider to be liable for the release of a patient's
13		health information by other entities that may possess such
14		information, including, but not limited to, other health
15		professionals, providers, laboratories, pharmacies, hospitals,
16		ambulatory surgical centers, and nursing homes.
17		(Source: P.A. 98-1046, eff. 1-1-15.)
18		Section 90-45. The Genetic Information Privacy Act is
19		amended by changing Section 10 as follows:
20		(410 ILCS 513/10)
21		Sec. 10. Definitions. As used in this Act:
22		"Office Authority" means the Illinois Health Information
23		Exchange Office Authority established pursuant to the Illinois
24		Health Information Exchange and Technology Act.

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1		"Business associate" has the meaning ascribed to it under
2		HIPAA, as specified in 45 CFR 160.103.
3		"Covered entity" has the meaning ascribed to it under
4		HIPAA, as specified in 45 CFR 160.103.
5		"De-identified information" means health information that
6		is not individually identifiable as described under HIPAA, as
7		specified in 45 CFR 164.514(b).
8		"Disclosure" has the meaning ascribed to it under HIPAA, as
9		specified in 45 CFR 160.103.
10		"Employer" means the State of Illinois, any unit of local
11		government, and any board, commission, department,
12		institution, or school district, any party to a public
13		contract, any joint apprenticeship or training committee
14		within the State, and every other person employing employees
15		within the State.
16		"Employment agency" means both public and private
17		employment agencies and any person, labor organization, or
18		labor union having a hiring hall or hiring office regularly
19		undertaking, with or without compensation, to procure
20		opportunities to work, or to procure, recruit, refer, or place
21		employees.
22		"Family member" means, with respect to an individual, (i)
23		the spouse of the individual; (ii) a dependent child of the
24		individual, including a child who is born to or placed for
25		adoption with the individual; (iii) any other person qualifying
26		as a covered dependent under a managed care plan; and (iv) all

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1		other individuals related by blood or law to the individual or
2		the spouse or child described in subsections (i) through (iii)
3		of this definition.
4		"Genetic information" has the meaning ascribed to it under
5		HIPAA, as specified in 45 CFR 160.103.
6		"Genetic monitoring" means the periodic examination of
7		employees to evaluate acquired modifications to their genetic
8		material, such as chromosomal damage or evidence of increased
9		occurrence of mutations that may have developed in the course
10		of employment due to exposure to toxic substances in the
11		workplace in order to identify, evaluate, and respond to
12		effects of or control adverse environmental exposures in the
13		workplace.
14		"Genetic services" has the meaning ascribed to it under
15		HIPAA, as specified in 45 CFR 160.103.
16		"Genetic testing" and "genetic test" have the meaning
17		ascribed to "genetic test" under HIPAA, as specified in 45 CFR
18		160.103. "Genetic testing" includes direct-to-consumer
19		commercial genetic testing.
20		"Health care operations" has the meaning ascribed to it
21		under HIPAA, as specified in 45 CFR 164.501.
22		"Health care professional" means (i) a licensed physician,
23		(ii) a licensed physician assistant, (iii) a licensed advanced
24		practice registered nurse, (iv) a licensed dentist, (v) a
25		licensed podiatrist, (vi) a licensed genetic counselor, or
26		(vii) an individual certified to provide genetic testing by a

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1		state or local public health department.
2		"Health care provider" has the meaning ascribed to it under
3		HIPAA, as specified in 45 CFR 160.103.
4		"Health facility" means a hospital, blood bank, blood
5		center, sperm bank, or other health care institution, including
6		any "health facility" as that term is defined in the Illinois
7		Finance Authority Act.
8		"Health information exchange" or "HIE" means a health
9		information exchange or health information organization that
10		exchanges health information electronically that (i) is
11		established pursuant to the Illinois Health Information
12		Exchange and Technology Act, or any subsequent amendments
13		thereto, and any administrative rules promulgated thereunder;
14		(ii) has established a data sharing arrangement with the Office
15		Authority; or (iii) as of August 16, 2013, was designated by
16		the Illinois Health Information Exchange Authority (now
17		Office) Board as a member of, or was represented on, the
18		Authority Board's Regional Health Information Exchange
19		Workgroup; provided that such designation shall not require the
20		establishment of a data sharing arrangement or other
21		participation with the Illinois Health Information Exchange or
22		the payment of any fee. In certain circumstances, in accordance
23		with HIPAA, an HIE will be a business associate.
24		"Health oversight agency" has the meaning ascribed to it
25		under HIPAA, as specified in 45 CFR 164.501.
26		"HIPAA" means the Health Insurance Portability and

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1		Accountability Act of 1996, Public Law 104-191, as amended by
2		the Health Information Technology for Economic and Clinical
3		Health Act of 2009, Public Law 111-05, and any subsequent
4		amendments thereto and any regulations promulgated thereunder.
5		"Insurer" means (i) an entity that is subject to the
6		jurisdiction of the Director of Insurance and (ii) a managed
7		care plan.
8		"Labor organization" includes any organization, labor
9		union, craft union, or any voluntary unincorporated
10		association designed to further the cause of the rights of
11		union labor that is constituted for the purpose, in whole or in
12		part, of collective bargaining or of dealing with employers
13		concerning grievances, terms or conditions of employment, or
14		apprenticeships or applications for apprenticeships, or of
15		other mutual aid or protection in connection with employment,
16		including apprenticeships or applications for apprenticeships.
17		"Licensing agency" means a board, commission, committee,
18		council, department, or officers, except a judicial officer, in
19		this State or any political subdivision authorized to grant,
20		deny, renew, revoke, suspend, annul, withdraw, or amend a
21		license or certificate of registration.
22		"Limited data set" has the meaning ascribed to it under
23		HIPAA, as described in 45 CFR 164.514(e)(2).
24		"Managed care plan" means a plan that establishes,
25		operates, or maintains a network of health care providers that
26		have entered into agreements with the plan to provide health

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1		care services to enrollees where the plan has the ultimate and
2		direct contractual obligation to the enrollee to arrange for
3		the provision of or pay for services through:
4		(1) organizational arrangements for ongoing quality
5		assurance, utilization review programs, or dispute
6		resolution; or
7		(2) financial incentives for persons enrolled in the
8		plan to use the participating providers and procedures
9		covered by the plan.
10		A managed care plan may be established or operated by any
11		entity including a licensed insurance company, hospital or
12		medical service plan, health maintenance organization, limited
13		health service organization, preferred provider organization,
14		third party administrator, or an employer or employee
15		organization.
16		"Minimum necessary" means HIPAA's standard for using,
17		disclosing, and requesting protected health information found
18		in 45 CFR 164.502(b) and 164.514(d).
19		"Nontherapeutic purpose" means a purpose that is not
20		intended to improve or preserve the life or health of the
21		individual whom the information concerns.
22		"Organized health care arrangement" has the meaning
23		ascribed to it under HIPAA, as specified in 45 CFR 160.103.
24		"Patient safety activities" has the meaning ascribed to it
25		under 42 CFR 3.20.
26		"Payment" has the meaning ascribed to it under HIPAA, as

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1		specified in 45 CFR 164.501.
2		"Person" includes any natural person, partnership,
3		association, joint venture, trust, governmental entity, public
4		or private corporation, health facility, or other legal entity.
5		"Protected health information" has the meaning ascribed to
6		it under HIPAA, as specified in 45 CFR 164.103.
7		"Research" has the meaning ascribed to it under HIPAA, as
8		specified in 45 CFR 164.501.
9		"State agency" means an instrumentality of the State of
10		Illinois and any instrumentality of another state which
11		pursuant to applicable law or a written undertaking with an
12		instrumentality of the State of Illinois is bound to protect
13		the privacy of genetic information of Illinois persons.
14		"Treatment" has the meaning ascribed to it under HIPAA, as
15		specified in 45 CFR 164.501.
16		"Use" has the meaning ascribed to it under HIPAA, as
17		specified in 45 CFR 160.103, where context dictates.
18		(Source: P.A. 100-513, eff. 1-1-18; 101-132, eff. 1-1-20.)
19		Section 90-50. The Mental Health and Developmental
20		Disabilities Confidentiality Act is amended by changing
21		Sections 2, 9.5, 9.6, 9.8, 9.9, and 9.11 as follows:
22		(740 ILCS 110/2) (from Ch. 91 1/2, par. 802)
23		Sec. 2. The terms used in this Act, unless the context
24		requires otherwise, have the meanings ascribed to them in this

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1		Section.
2		"Agent" means a person who has been legally appointed as an
3		individual's agent under a power of attorney for health care or
4		for property.
5		"Business associate" has the meaning ascribed to it under
6		HIPAA, as specified in 45 CFR 160.103.
7		"Confidential communication" or "communication" means any
8		communication made by a recipient or other person to a
9		therapist or to or in the presence of other persons during or
10		in connection with providing mental health or developmental
11		disability services to a recipient. Communication includes
12		information which indicates that a person is a recipient.
13		"Communication" does not include information that has been
14		de-identified in accordance with HIPAA, as specified in 45 CFR
15		164.514.
16		"Covered entity" has the meaning ascribed to it under
17		HIPAA, as specified in 45 CFR 160.103.
18		"Guardian" means a legally appointed guardian or
19		conservator of the person.
20		"Health information exchange" or "HIE" means a health
21		information exchange or health information organization that
22		oversees and governs the electronic exchange of health
23		information that (i) is established pursuant to the Illinois
24		Health Information Exchange and Technology Act, or any
25		subsequent amendments thereto, and any administrative rules
26		promulgated thereunder; or (ii) has established a data sharing

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1		arrangement with the Illinois Health Information Exchange; or
2		(iii) as of the effective date of this amendatory Act of the
3		98th General Assembly, was designated by the Illinois Health
4		Information Exchange Office Authority Board as a member of, or
5		was represented on, the Office Authority Board's Regional
6		Health Information Exchange Workgroup; provided that such
7		designation shall not require the establishment of a data
8		sharing arrangement or other participation with the Illinois
9		Health Information Exchange or the payment of any fee.
10		"HIE purposes" means those uses and disclosures (as those
11		terms are defined under HIPAA, as specified in 45 CFR 160.103)
12		for activities of an HIE: (i) set forth in the Illinois Health
13		Information Exchange and Technology Act or any subsequent
14		amendments thereto and any administrative rules promulgated
15		thereunder; or (ii) which are permitted under federal law.
16		"HIPAA" means the Health Insurance Portability and
17		Accountability Act of 1996, Public Law 104-191, and any
18		subsequent amendments thereto and any regulations promulgated
19		thereunder, including the Security Rule, as specified in 45 CFR
20		164.302-18, and the Privacy Rule, as specified in 45 CFR
21		164.500-34.
22		"Integrated health system" means an organization with a
23		system of care which incorporates physical and behavioral
24		healthcare and includes care delivered in an inpatient and
25		outpatient setting.
26		"Interdisciplinary team" means a group of persons

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1		representing different clinical disciplines, such as medicine,
2		nursing, social work, and psychology, providing and
3		coordinating the care and treatment for a recipient of mental
4		health or developmental disability services. The group may be
5		composed of individuals employed by one provider or multiple
6		providers.
7		"Mental health or developmental disabilities services" or
8		"services" includes but is not limited to examination,
9		diagnosis, evaluation, treatment, training, pharmaceuticals,
10		aftercare, habilitation or rehabilitation.
11		"Personal notes" means:
12		(i) information disclosed to the therapist in
13		confidence by other persons on condition that such
14		information would never be disclosed to the recipient or
15		other persons;
16		(ii) information disclosed to the therapist by the
17		recipient which would be injurious to the recipient's
18		relationships to other persons, and
19		(iii) the therapist's speculations, impressions,
20		hunches, and reminders.
21		"Parent" means a parent or, in the absence of a parent or
22		guardian, a person in loco parentis.
23		"Recipient" means a person who is receiving or has received
24		mental health or developmental disabilities services.
25		"Record" means any record kept by a therapist or by an
26		agency in the course of providing mental health or

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1		developmental disabilities service to a recipient concerning
2		the recipient and the services provided. "Records" includes all
3		records maintained by a court that have been created in
4		connection with, in preparation for, or as a result of the
5		filing of any petition or certificate under Chapter II, Chapter
6		III, or Chapter IV of the Mental Health and Developmental
7		Disabilities Code and includes the petitions, certificates,
8		dispositional reports, treatment plans, and reports of
9		diagnostic evaluations and of hearings under Article VIII of
10		Chapter III or under Article V of Chapter IV of that Code.
11		Record does not include the therapist's personal notes, if such
12		notes are kept in the therapist's sole possession for his own
13		personal use and are not disclosed to any other person, except
14		the therapist's supervisor, consulting therapist or attorney.
15		If at any time such notes are disclosed, they shall be
16		considered part of the recipient's record for purposes of this
17		Act. "Record" does not include information that has been
18		de-identified in accordance with HIPAA, as specified in 45 CFR
19		164.514. "Record" does not include a reference to the receipt
20		of mental health or developmental disabilities services noted
21		during a patient history and physical or other summary of care.
22		"Record custodian" means a person responsible for
23		maintaining a recipient's record.
24		"Therapist" means a psychiatrist, physician, psychologist,
25		social worker, or nurse providing mental health or
26		developmental disabilities services or any other person not

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1		prohibited by law from providing such services or from holding
2		himself out as a therapist if the recipient reasonably believes
3		that such person is permitted to do so. Therapist includes any
4		successor of the therapist.
5		"Therapeutic relationship" means the receipt by a
6		recipient of mental health or developmental disabilities
7		services from a therapist. "Therapeutic relationship" does not
8		include independent evaluations for a purpose other than the
9		provision of mental health or developmental disabilities
10		services.
11		(Source: P.A. 98-378, eff. 8-16-13; 99-28, eff. 1-1-16.)
12		(740 ILCS 110/9.5)
13		Sec. 9.5. Use and disclosure of information to an HIE.
14		(a) An HIE, person, therapist, facility, agency,
15		interdisciplinary team, integrated health system, business
16		associate, or covered entity may, without a recipient's
17		consent, use or disclose information from a recipient's record
18		in connection with an HIE, including disclosure to the Illinois
19		Health Information Exchange Office Authority, an HIE, or the
20		business associate of either. An HIE and its business associate
21		may, without a recipient's consent, use or disclose and
22		re-disclose such information for HIE purposes or for such other
23		purposes as are specifically allowed under this Act.
24		(b) As used in this Section:
25		(1) "facility" means a developmental disability

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1		facility as defined in Section 1-107 of the Mental Health
2		and Developmental Disabilities Code or a mental health
3		facility as defined in Section 1-114 of the Mental Health
4		and Developmental Disabilities Code; and
5		(2) the terms "disclosure" and "use" have the meanings
6		ascribed to them under HIPAA, as specified in 45 CFR
7		160.103.
8		(Source: P.A. 98-378, eff. 8-16-13.)
9		(740 ILCS 110/9.6)
10		Sec. 9.6. HIE opt-out. The Illinois Health Information
11		Exchange Office Authority shall, through appropriate rules,
12		standards, or contractual obligations, which shall be binding
13		upon any HIE, as defined under Section 2, require that
14		participants of such HIE provide each recipient whose record is
15		accessible through the health information exchange the
16		reasonable opportunity to expressly decline the further
17		disclosure of the record by the health information exchange to
18		third parties, except to the extent permitted by law such as
19		for purposes of public health reporting. These rules,
20		standards, or contractual obligations shall permit a recipient
21		to revoke a prior decision to opt-out or a decision not to
22		opt-out. These rules, standards, or contractual obligations
23		shall provide for written notice of a recipient's right to
24		opt-out which directs the recipient to a health information
25		exchange website containing (i) an explanation of the purposes

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1		of the health information exchange; and (ii) audio, visual, and
2		written instructions on how to opt-out of participation in
3		whole or in part to the extent possible. These rules,
4		standards, or contractual obligations shall be reviewed
5		annually and updated as the technical options develop. The
6		recipient shall be provided meaningful disclosure regarding
7		the health information exchange, and the recipient's decision
8		whether to opt-out should be obtained without undue inducement
9		or any element of force, fraud, deceit, duress, or other form
10		of constraint or coercion. To the extent that HIPAA, as
11		specified in 45 CFR 164.508(b)(4), prohibits a covered entity
12		from conditioning the provision of its services upon an
13		individual's provision of an authorization, an HIE participant
14		shall not condition the provision of its services upon a
15		recipient's decision to opt-out of further disclosure of the
16		record by an HIE to third parties. The Illinois Health
17		Information Exchange Office Authority shall, through
18		appropriate rules, standards, or contractual obligations,
19		which shall be binding upon any HIE, as defined under Section
20		2, give consideration to the format and content of the
21		meaningful disclosure and the availability to recipients of
22		information regarding an HIE and the rights of recipients under
23		this Section to expressly decline the further disclosure of the
24		record by an HIE to third parties. The Illinois Health
25		Information Exchange Office Authority shall also give annual
26		consideration to enable a recipient to expressly decline the

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1		further disclosure by an HIE to third parties of selected
2		portions of the recipient's record while permitting disclosure
3		of the recipient's remaining patient health information. In
4		establishing rules, standards, or contractual obligations
5		binding upon HIEs under this Section to give effect to
6		recipient disclosure preferences, the Illinois Health
7		Information Exchange Office Authority in its discretion may
8		consider the extent to which relevant health information
9		technologies reasonably available to therapists and HIEs in
10		this State reasonably enable the effective segmentation of
11		specific information within a recipient's electronic medical
12		record and reasonably enable the effective exclusion of
13		specific information from disclosure by an HIE to third
14		parties, as well as the availability of sufficient
15		authoritative clinical guidance to enable the practical
16		application of such technologies to effect recipient
17		disclosure preferences. The provisions of this Section 9.6
18		shall not apply to the secure electronic transmission of data
19		which is point-to-point communication directed by the data
20		custodian. Any rules or standards promulgated under this
21		Section which apply to HIEs shall be limited to that subject
22		matter required by this Section and shall not include any
23		requirement that an HIE enter a data sharing arrangement or
24		otherwise participate with the Illinois Health Information
25		Exchange. In connection with its annual consideration
26		regarding the issue of segmentation of information within a

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1		medical record and prior to the adoption of any rules or
2		standards regarding that issue, the Office Authority Board
3		shall consider information provided by affected persons or
4		organizations regarding the feasibility, availability, cost,
5		reliability, and interoperability of any technology or process
6		under consideration by the Board. Nothing in this Act shall be
7		construed to limit the authority of the Illinois Health
8		Information Exchange Office Authority to impose limits or
9		conditions on consent for disclosures to or through any HIE, as
10		defined under Section 2, which are more restrictive than the
11		requirements under this Act or under HIPAA.
12		(Source: P.A. 98-378, eff. 8-16-13.)
13		(740 ILCS 110/9.8)
14		Sec. 9.8. Business associates. An HIE, person, therapist,
15		facility, agency, interdisciplinary team, integrated health
16		system, business associate, covered entity, the Illinois
17		Health Information Exchange Office Authority, or entity
18		facilitating the establishment or operation of an HIE may,
19		without a recipient's consent, utilize the services of and
20		disclose information from a recipient's record to a business
21		associate, as defined by and in accordance with the
22		requirements set forth under HIPAA. As used in this Section,
23		the term "disclosure" has the meaning ascribed to it by HIPAA,
24		as specified in 45 CFR 160.103.
25		(Source: P.A. 98-378, eff. 8-16-13.)

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1		(740 ILCS 110/9.9)
2		Sec. 9.9. Record locator service.
3		(a) An HIE, person, therapist, facility, agency,
4		interdisciplinary team, integrated health system, business
5		associate, covered entity, the Illinois Health Information
6		Exchange Office Authority, or entity facilitating the
7		establishment or operation of an HIE may, without a recipient's
8		consent, disclose the existence of a recipient's record to a
9		record locator service, master patient index, or other
10		directory or services necessary to support and enable the
11		establishment and operation of an HIE.
12		(b) As used in this Section:
13		(1) the term "disclosure" has the meaning ascribed to
14		it under HIPAA, as specified in 45 CFR 160.103; and
15		(2) "facility" means a developmental disability
16		facility as defined in Section 1-107 of the Mental Health
17		and Developmental Disabilities Code or a mental health
18		facility as defined in Section 1-114 of the Mental Health
19		and Developmental Disabilities Code.
20		(Source: P.A. 98-378, eff. 8-16-13.)
21		(740 ILCS 110/9.11)
22		Sec. 9.11. Establishment and disclosure of limited data
23		sets and de-identified information.
24		(a) An HIE, person, therapist, facility, agency,

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

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1		and Developmental Disabilities Code.
2		(Source: P.A. 98-378, eff. 8-16-13.)
3		Article 99. Effective Date