Blue Cross and Blue Shield of Illinois

  November 1, 2013

Legislative Update

Illinois State Legislation Update – Recently Enacted Laws

During the 2013 legislative session, the Illinois General Assembly passed a variety of bills concerning health benefits, which have since been signed into law. Brief overviews of these new laws are summarized below.

Public Act 098-0104 (SB26) – Medicaid Health Benefits Services
Effective July 22, 2013, this legislation expanded the Medicaid eligibility to Illinoisans who earn up to 138 percent of the federal poverty line (approximately $15,860 per individual or $32,500 for a family of four). The legislation provides for service delivery changes through the establishment of Accountable Care Entities for care coordination; makes nursing home payment changes (Resource Utilization Groups); and provides for comprehensive changes in services and assessments for the mentally ill (accreditation of Institutes for Mental Disease – Specialized Mental Health Rehabilitation Facilities (IMDs - SMHRF Act). Changes were also made to the Save Medicaid Access and Resources Together (SMART) Act, which was approved in 2012, including the addition of anti-convulsion medication to the prior approval list for the four-script limit; relaxing requirements regarding the prescription of wheelchairs; exempting enrollees that go home for visits from an Intermediate Care Facility for the Developmentally Disabled (ICFDD) bed-hold payment; codifying rules for emergency dental procedures and hospital-acquired conditions approved by Joint Committee on Administrative Rules; exempting Cook County from the 180-day claims submittal requirement; and requiring Department of Healthcare Family Services to publish information regarding detox admission criteria on its website, among other things. Many changes were also made outside the SMART Act, as SB 26 became a human services budget implementation bill.

Public Act 098-0122 (HB1) – Medical Cannabis
The bill, which was signed Aug. 1, 2013, allows a person who has been diagnosed by a physician as having a debilitating medical condition and the person's primary caregiver to be issued a registry identification card by the Department of Public Health that permits the person or the person's primary caregiver to legally possess no more than 2.5 ounces of usable cannabis during a 14-day period that is derived solely from an intrastate source. Cannabis is not an FDA-approved drug, and the law contains no insurance mandate to provide coverage for it. This law is effective Jan. 1, 2014.

PA 098-0184 (SB1623) – Pertussis Vaccine Act - Newborns
This bill requires that parents or guardians of a newborn child in a neonatal intensive care unit shall be informed about the importance of parents, guardians and immediate family members being immunized against pertussis to minimize the chances that the disease will be communicated to the newborn child, and shall also be informed about where they may obtain the appropriate vaccine. This law went into effect on Aug. 5, 2013.

PA 098-0185 (SB1876) – Clinical Laboratory and Blood Bank Act
This bill amends the Illinois Clinical Laboratory and Blood Bank Act. It removes the definition of "therapeutic optometrist" and replaces it with a definition of "optometrist." In a provision concerning the examination of specimens, it provides that a clinical laboratory shall examine specimens only at the request of, among others, a licensed optometrist (instead of a therapeutic optometrist for diagnostic or therapeutic purposes related to the use of diagnostic topical or therapeutic ocular pharmaceutical agents). An optometrist licensed in Illinois (instead of a therapeutic optometrist) may include certain information concerning a diagnosis or other matters on a laboratory report form. This law goes into effect on Jan. 1, 2014.

Public Act 098-0189 (HB3300) – Insurance Communication Method
Effective Aug. 6, 2013, insurance companies that issue, deliver, amend, or renew a policy of accident and health insurance shall accommodate a reasonable request by a person covered by a policy issued by the company to receive communications of claim-related information from the company by alternative means or at alternative locations if the person clearly states that disclosure of all or part of the information could endanger the person. The bill also provides that if a child is covered by a policy issued by a company, then the child's parent or guardian may make a request to the company pursuant to the provision concerning alternative means of communication. The insurer can require the individual to make the request in writing. 

Public Act 098-0261 (HB2839) – Home Health Services - Physician Assistance
This law amends the Home Health, Home Services and Home Nursing Agency Licensing Act by revising the definition of “home health services.” Effective Aug. 9, 2013, the definition of home health services is limited to services provided under a plan of treatment prescribed by a physician licensed to practice medicine in all its branches, a physician assistant who has been authorized by a physician to prescribe those services, or an advanced practice nurse with a collaborating agreement with a physician that delegates that authority.

Public Act 098-0354 (HB71) – Medicaid Fraud - Obstruction
Legislation states that any vendor that knowingly assists a person (rather than any vendor that knowingly assists or knowingly or willfully fails to prevent a person) in committing specified violations concerning the unauthorized use of a medical card or the unauthorized use of medical benefits with or without a medical card, commits medical assistance fraud. This law went into effect on Aug. 16, 2013.

Public Act 098-0378 (HB1017) – Mental Health Confidentiality
This legislation amends the Mental Health and Developmental Disabilities Confidentiality Act. The provision defines “business associate,” “covered entity,” “facility,” “health information exchange” (“HIE”), “HIE purposes,” “HIPAA,” “integrated health system,” and “interdisciplinary team,” and changes the definition of “confidential communication” and “record.” It also provides that an HIE, person, therapist, facility, agency, interdisciplinary team, integrated health system, business associate, or covered entity may, without a recipient's consent, use, disclose, or re-disclose information from a recipient's record to certain entities for specified purposes. It also states that a recipient may opt-out of having his or her record disclosed. This law went into effect on Aug. 16, 2013.

Public Act 098-0440 (HB2661) – Congenital Heart Defect Screen
This mandate requires that all birth centers and hospitals must test every newborn for congenital heart defects via a screening test. The screening test should be aligned with the current standard of care, such as pulse oximetry screening, according to congenital heart defect screening protocols developed by the Department of Public Health in consultation with relevant medical practitioners and stakeholders. This law went into effect on Aug. 16, 2013.

Public Act 098-0448 (HB2760) – Home Health Services Oversight
Effective Jan. 1, 2014, the bill states that a physician licensed in another state may oversee or direct the delivery of skilled home care services provided by home health and home nursing agencies licensed in Illinois following care or treatment originally provided to the patient in the state in which the physician is licensed to practice medicine, until care is transitioned to a physician licensed to practice medicine in all its branches in Illinois under certain specified conditions.

This communication is intended for informational purposes only. It is not intended to provide, does not constitute, and cannot be relied upon as legal, tax or compliance advice. The information contained in this communication is subject to change based on future regulation and guidance.

 


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