Public Act 099-0236

HB1876 Enrolled LRB099 06677 KTG 26750 b

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois,

represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by

changing Section 5-5 as follows:

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

Sec. 5-5. Medical services. The Illinois Department, by

rule, shall determine the quantity and quality of and the rate

of reimbursement for the medical assistance for which payment

will be authorized, and the medical services to be provided,

which may include all or part of the following: (1) inpatient

hospital services; (2) outpatient hospital services; (3) other

laboratory and X-ray services; (4) skilled nursing home

services; (5) physicians' services whether furnished in the

office, the patient's home, a hospital, a skilled nursing home,

or elsewhere; (6) medical care, or any other type of remedial

care furnished by licensed practitioners; (7) home health care

services; (8) private duty nursing service; (9) clinic

services; (10) dental services, including prevention and

treatment of periodontal disease and dental caries disease for

pregnant women, provided by an individual licensed to practice

dentistry or dental surgery; for purposes of this item (10),

"dental services" means diagnostic, preventive, or corrective

procedures provided by or under the supervision of a dentist in

the practice of his or her profession; (11) physical therapy

and related services; (12) prescribed drugs, dentures, and

prosthetic devices; and eyeglasses prescribed by a physician

skilled in the diseases of the eye, or by an optometrist,

whichever the person may select; (13) other diagnostic,

screening, preventive, and rehabilitative services, including

to ensure that the individual's need for intervention or

treatment of mental disorders or substance use disorders or

co-occurring mental health and substance use disorders is

determined using a uniform screening, assessment, and

evaluation process inclusive of criteria, for children and

adults; for purposes of this item (13), a uniform screening,

assessment, and evaluation process refers to a process that

includes an appropriate evaluation and, as warranted, a

referral; "uniform" does not mean the use of a singular

instrument, tool, or process that all must utilize; (14)

transportation and such other expenses as may be necessary;

(15) medical treatment of sexual assault survivors, as defined

in Section 1a of the Sexual Assault Survivors Emergency

Treatment Act, for injuries sustained as a result of the sexual

assault, including examinations and laboratory tests to

discover evidence which may be used in criminal proceedings

arising from the sexual assault; (16) the diagnosis and

treatment of sickle cell anemia; and (17) any other medical

care, and any other type of remedial care recognized under the

laws of this State, but not including abortions, or induced

miscarriages or premature births, unless, in the opinion of a

physician, such procedures are necessary for the preservation

of the life of the woman seeking such treatment, or except an

induced premature birth intended to produce a live viable child

and such procedure is necessary for the health of the mother or

her unborn child. The Illinois Department, by rule, shall

prohibit any physician from providing medical assistance to

anyone eligible therefor under this Code where such physician

has been found guilty of performing an abortion procedure in a

wilful and wanton manner upon a woman who was not pregnant at

the time such abortion procedure was performed. The term "any

other type of remedial care" shall include nursing care and

nursing home service for persons who rely on treatment by

spiritual means alone through prayer for healing.

Notwithstanding any other provision of this Section, a

comprehensive tobacco use cessation program that includes

purchasing prescription drugs or prescription medical devices

approved by the Food and Drug Administration shall be covered

under the medical assistance program under this Article for

persons who are otherwise eligible for assistance under this

Article.

Notwithstanding any other provision of this Code, the

Illinois Department may not require, as a condition of payment

for any laboratory test authorized under this Article, that a

physician's handwritten signature appear on the laboratory

test order form. The Illinois Department may, however, impose

other appropriate requirements regarding laboratory test order

documentation.

Upon receipt of federal approval of an amendment to the

Illinois Title XIX State Plan for this purpose, the Department

shall authorize the Chicago Public Schools (CPS) to procure a

vendor or vendors to manufacture eyeglasses for individuals

enrolled in a school within the CPS system. CPS shall ensure

that its vendor or vendors are enrolled as providers in the

medical assistance program and in any capitated Medicaid

managed care entity (MCE) serving individuals enrolled in a

school within the CPS system. Under any contract procured under

this provision, the vendor or vendors must serve only

individuals enrolled in a school within the CPS system. Claims

for services provided by CPS's vendor or vendors to recipients

of benefits in the medical assistance program under this Code,

the Children's Health Insurance Program, or the Covering ALL

KIDS Health Insurance Program shall be submitted to the

Department or the MCE in which the individual is enrolled for

payment and shall be reimbursed at the Department's or the

MCE's established rates or rate methodologies for eyeglasses.

On and after July 1, 2012, the Department of Healthcare and

Family Services may provide the following services to persons

eligible for assistance under this Article who are

participating in education, training or employment programs

operated by the Department of Human Services as successor to

the Department of Public Aid:

(1) dental services provided by or under the

supervision of a dentist; and

(2) eyeglasses prescribed by a physician skilled in the

diseases of the eye, or by an optometrist, whichever the

person may select.

Notwithstanding any other provision of this Code and

subject to federal approval, the Department may adopt rules to

allow a dentist who is volunteering his or her service at no

cost to render dental services through an enrolled

not-for-profit health clinic without the dentist personally

enrolling as a participating provider in the medical assistance

program. A not-for-profit health clinic shall include a public

health clinic or Federally Qualified Health Center or other

enrolled provider, as determined by the Department, through

which dental services covered under this Section are performed.

The Department shall establish a process for payment of claims

for reimbursement for covered dental services rendered under

this provision.

The Illinois Department, by rule, may distinguish and

classify the medical services to be provided only in accordance

with the classes of persons designated in Section 5-2.

The Department of Healthcare and Family Services must

provide coverage and reimbursement for amino acid-based

elemental formulas, regardless of delivery method, for the

diagnosis and treatment of (i) eosinophilic disorders and (ii)

short bowel syndrome when the prescribing physician has issued

a written order stating that the amino acid-based elemental

formula is medically necessary.

The Illinois Department shall authorize the provision of,

and shall authorize payment for, screening by low-dose

mammography for the presence of occult breast cancer for women

35 years of age or older who are eligible for medical

assistance under this Article, as follows:

(A) A baseline mammogram for women 35 to 39 years of

age.

(B) An annual mammogram for women 40 years of age or

older.

(C) A mammogram at the age and intervals considered

medically necessary by the woman's health care provider for

women under 40 years of age and having a family history of

breast cancer, prior personal history of breast cancer,

positive genetic testing, or other risk factors.

(D) A comprehensive ultrasound screening of an entire

breast or breasts if a mammogram demonstrates

heterogeneous or dense breast tissue, when medically

necessary as determined by a physician licensed to practice

medicine in all of its branches.

All screenings shall include a physical breast exam,

instruction on self-examination and information regarding the

frequency of self-examination and its value as a preventative

tool. For purposes of this Section, "low-dose mammography"

means the x-ray examination of the breast using equipment

dedicated specifically for mammography, including the x-ray

tube, filter, compression device, and image receptor, with an

average radiation exposure delivery of less than one rad per

breast for 2 views of an average size breast. The term also

includes digital mammography.

On and after January 1, 2012, providers participating in a

quality improvement program approved by the Department shall be

reimbursed for screening and diagnostic mammography at the same

rate as the Medicare program's rates, including the increased

reimbursement for digital mammography.

The Department shall convene an expert panel including

representatives of hospitals, free-standing mammography

facilities, and doctors, including radiologists, to establish

quality standards.

Subject to federal approval, the Department shall

establish a rate methodology for mammography at federally

qualified health centers and other encounter-rate clinics.

These clinics or centers may also collaborate with other

hospital-based mammography facilities.

The Department shall establish a methodology to remind

women who are age-appropriate for screening mammography, but

who have not received a mammogram within the previous 18

months, of the importance and benefit of screening mammography.

The Department shall establish a performance goal for

primary care providers with respect to their female patients

over age 40 receiving an annual mammogram. This performance

goal shall be used to provide additional reimbursement in the

form of a quality performance bonus to primary care providers

who meet that goal.

The Department shall devise a means of case-managing or

patient navigation for beneficiaries diagnosed with breast

cancer. This program shall initially operate as a pilot program

in areas of the State with the highest incidence of mortality

related to breast cancer. At least one pilot program site shall

be in the metropolitan Chicago area and at least one site shall

be outside the metropolitan Chicago area. An evaluation of the

pilot program shall be carried out measuring health outcomes

and cost of care for those served by the pilot program compared

to similarly situated patients who are not served by the pilot

program.

Any medical or health care provider shall immediately

recommend, to any pregnant woman who is being provided prenatal

services and is suspected of drug abuse or is addicted as

defined in the Alcoholism and Other Drug Abuse and Dependency

Act, referral to a local substance abuse treatment provider

licensed by the Department of Human Services or to a licensed

hospital which provides substance abuse treatment services.

The Department of Healthcare and Family Services shall assure

coverage for the cost of treatment of the drug abuse or

addiction for pregnant recipients in accordance with the

Illinois Medicaid Program in conjunction with the Department of

Human Services.

All medical providers providing medical assistance to

pregnant women under this Code shall receive information from

the Department on the availability of services under the Drug

Free Families with a Future or any comparable program providing

case management services for addicted women, including

information on appropriate referrals for other social services

that may be needed by addicted women in addition to treatment

for addiction.

The Illinois Department, in cooperation with the

Departments of Human Services (as successor to the Department

of Alcoholism and Substance Abuse) and Public Health, through a

public awareness campaign, may provide information concerning

treatment for alcoholism and drug abuse and addiction, prenatal

health care, and other pertinent programs directed at reducing

the number of drug-affected infants born to recipients of

medical assistance.

Neither the Department of Healthcare and Family Services

nor the Department of Human Services shall sanction the

recipient solely on the basis of her substance abuse.

The Illinois Department shall establish such regulations

governing the dispensing of health services under this Article

as it shall deem appropriate. The Department should seek the

advice of formal professional advisory committees appointed by

the Director of the Illinois Department for the purpose of

providing regular advice on policy and administrative matters,

information dissemination and educational activities for

medical and health care providers, and consistency in

procedures to the Illinois Department.

The Illinois Department may develop and contract with

Partnerships of medical providers to arrange medical services

for persons eligible under Section 5-2 of this Code.

Implementation of this Section may be by demonstration projects

in certain geographic areas. The Partnership shall be

represented by a sponsor organization. The Department, by rule,

shall develop qualifications for sponsors of Partnerships.

Nothing in this Section shall be construed to require that the

sponsor organization be a medical organization.

The sponsor must negotiate formal written contracts with

medical providers for physician services, inpatient and

outpatient hospital care, home health services, treatment for

alcoholism and substance abuse, and other services determined

necessary by the Illinois Department by rule for delivery by

Partnerships. Physician services must include prenatal and

obstetrical care. The Illinois Department shall reimburse

medical services delivered by Partnership providers to clients

in target areas according to provisions of this Article and the

Illinois Health Finance Reform Act, except that:

(1) Physicians participating in a Partnership and

providing certain services, which shall be determined by

the Illinois Department, to persons in areas covered by the

Partnership may receive an additional surcharge for such

services.

(2) The Department may elect to consider and negotiate

financial incentives to encourage the development of

Partnerships and the efficient delivery of medical care.

(3) Persons receiving medical services through

Partnerships may receive medical and case management

services above the level usually offered through the

medical assistance program.

Medical providers shall be required to meet certain

qualifications to participate in Partnerships to ensure the

delivery of high quality medical services. These

qualifications shall be determined by rule of the Illinois

Department and may be higher than qualifications for

participation in the medical assistance program. Partnership

sponsors may prescribe reasonable additional qualifications

for participation by medical providers, only with the prior

written approval of the Illinois Department.

Nothing in this Section shall limit the free choice of

practitioners, hospitals, and other providers of medical

services by clients. In order to ensure patient freedom of

choice, the Illinois Department shall immediately promulgate

all rules and take all other necessary actions so that provided

services may be accessed from therapeutically certified

optometrists to the full extent of the Illinois Optometric

Practice Act of 1987 without discriminating between service

providers.

The Department shall apply for a waiver from the United

States Health Care Financing Administration to allow for the

implementation of Partnerships under this Section.

The Illinois Department shall require health care

providers to maintain records that document the medical care

and services provided to recipients of Medical Assistance under

this Article. Such records must be retained for a period of not

less than 6 years from the date of service or as provided by

applicable State law, whichever period is longer, except that

if an audit is initiated within the required retention period

then the records must be retained until the audit is completed

and every exception is resolved. The Illinois Department shall

require health care providers to make available, when

authorized by the patient, in writing, the medical records in a

timely fashion to other health care providers who are treating

or serving persons eligible for Medical Assistance under this

Article. All dispensers of medical services shall be required

to maintain and retain business and professional records

sufficient to fully and accurately document the nature, scope,

details and receipt of the health care provided to persons

eligible for medical assistance under this Code, in accordance

with regulations promulgated by the Illinois Department. The

rules and regulations shall require that proof of the receipt

of prescription drugs, dentures, prosthetic devices and

eyeglasses by eligible persons under this Section accompany

each claim for reimbursement submitted by the dispenser of such

medical services. No such claims for reimbursement shall be

approved for payment by the Illinois Department without such

proof of receipt, unless the Illinois Department shall have put

into effect and shall be operating a system of post-payment

audit and review which shall, on a sampling basis, be deemed

adequate by the Illinois Department to assure that such drugs,

dentures, prosthetic devices and eyeglasses for which payment

is being made are actually being received by eligible

recipients. Within 90 days after the effective date of this

amendatory Act of 1984, the Illinois Department shall establish

a current list of acquisition costs for all prosthetic devices

and any other items recognized as medical equipment and

supplies reimbursable under this Article and shall update such

list on a quarterly basis, except that the acquisition costs of

all prescription drugs shall be updated no less frequently than

every 30 days as required by Section 5-5.12.

The rules and regulations of the Illinois Department shall

require that a written statement including the required opinion

of a physician shall accompany any claim for reimbursement for

abortions, or induced miscarriages or premature births. This

statement shall indicate what procedures were used in providing

such medical services.

Notwithstanding any other law to the contrary, the Illinois

Department shall, within 365 days after July 22, 2013, (the

effective date of Public Act 98-104), establish procedures to

permit skilled care facilities licensed under the Nursing Home

Care Act to submit monthly billing claims for reimbursement

purposes. Following development of these procedures, the

Department shall, by July 1, 2016, have an additional 365 days

to test the viability of the new system and implement to ensure

that any necessary operational or structural changes to its

information technology platforms in order to allow for the

direct acceptance and payment of nursing home claims are

implemented.

Notwithstanding any other law to the contrary, the Illinois

Department shall, within 365 days after August 15, 2014 (the

effective date of Public Act 98-963) this amendatory Act of the

98th General Assembly, establish procedures to permit ID/DD

facilities licensed under the ID/DD Community Care Act to

submit monthly billing claims for reimbursement purposes.

Following development of these procedures, the Department

shall have an additional 365 days to test the viability of the

new system and to ensure that any necessary operational or

structural changes to its information technology platforms are

implemented.

The Illinois Department shall require all dispensers of

medical services, other than an individual practitioner or

group of practitioners, desiring to participate in the Medical

Assistance program established under this Article to disclose

all financial, beneficial, ownership, equity, surety or other

interests in any and all firms, corporations, partnerships,

associations, business enterprises, joint ventures, agencies,

institutions or other legal entities providing any form of

health care services in this State under this Article.

The Illinois Department may require that all dispensers of

medical services desiring to participate in the medical

assistance program established under this Article disclose,

under such terms and conditions as the Illinois Department may

by rule establish, all inquiries from clients and attorneys

regarding medical bills paid by the Illinois Department, which

inquiries could indicate potential existence of claims or liens

for the Illinois Department.

Enrollment of a vendor shall be subject to a provisional

period and shall be conditional for one year. During the period

of conditional enrollment, the Department may terminate the

vendor's eligibility to participate in, or may disenroll the

vendor from, the medical assistance program without cause.

Unless otherwise specified, such termination of eligibility or

disenrollment is not subject to the Department's hearing

process. However, a disenrolled vendor may reapply without

penalty.

The Department has the discretion to limit the conditional

enrollment period for vendors based upon category of risk of

the vendor.

Prior to enrollment and during the conditional enrollment

period in the medical assistance program, all vendors shall be

subject to enhanced oversight, screening, and review based on

the risk of fraud, waste, and abuse that is posed by the

category of risk of the vendor. The Illinois Department shall

establish the procedures for oversight, screening, and review,

which may include, but need not be limited to: criminal and

financial background checks; fingerprinting; license,

certification, and authorization verifications; unscheduled or

unannounced site visits; database checks; prepayment audit

reviews; audits; payment caps; payment suspensions; and other

screening as required by federal or State law.

The Department shall define or specify the following: (i)

by provider notice, the "category of risk of the vendor" for

each type of vendor, which shall take into account the level of

screening applicable to a particular category of vendor under

federal law and regulations; (ii) by rule or provider notice,

the maximum length of the conditional enrollment period for

each category of risk of the vendor; and (iii) by rule, the

hearing rights, if any, afforded to a vendor in each category

of risk of the vendor that is terminated or disenrolled during

the conditional enrollment period.

To be eligible for payment consideration, a vendor's

payment claim or bill, either as an initial claim or as a

resubmitted claim following prior rejection, must be received

by the Illinois Department, or its fiscal intermediary, no

later than 180 days after the latest date on the claim on which

medical goods or services were provided, with the following

exceptions:

(1) In the case of a provider whose enrollment is in

process by the Illinois Department, the 180-day period

shall not begin until the date on the written notice from

the Illinois Department that the provider enrollment is

complete.

(2) In the case of errors attributable to the Illinois

Department or any of its claims processing intermediaries

which result in an inability to receive, process, or

adjudicate a claim, the 180-day period shall not begin

until the provider has been notified of the error.

(3) In the case of a provider for whom the Illinois

Department initiates the monthly billing process.

(4) In the case of a provider operated by a unit of

local government with a population exceeding 3,000,000

when local government funds finance federal participation

for claims payments.

For claims for services rendered during a period for which

a recipient received retroactive eligibility, claims must be

filed within 180 days after the Department determines the

applicant is eligible. For claims for which the Illinois

Department is not the primary payer, claims must be submitted

to the Illinois Department within 180 days after the final

adjudication by the primary payer.

In the case of long term care facilities, within 5 days of

receipt by the facility of required prescreening information,

data for new admissions shall be entered into the Medical

Electronic Data Interchange (MEDI) or the Recipient

Eligibility Verification (REV) System or successor system, and

within 15 days of receipt by the facility of required

prescreening information, admission documents shall be

submitted through MEDI or REV or shall be submitted directly to

the Department of Human Services using required admission

forms. Effective September 1, 2014, admission documents,

including all prescreening information, must be submitted

through MEDI or REV. Confirmation numbers assigned to an

accepted transaction shall be retained by a facility to verify

timely submittal. Once an admission transaction has been

completed, all resubmitted claims following prior rejection

are subject to receipt no later than 180 days after the

admission transaction has been completed.

Claims that are not submitted and received in compliance

with the foregoing requirements shall not be eligible for

payment under the medical assistance program, and the State

shall have no liability for payment of those claims.

To the extent consistent with applicable information and

privacy, security, and disclosure laws, State and federal

agencies and departments shall provide the Illinois Department

access to confidential and other information and data necessary

to perform eligibility and payment verifications and other

Illinois Department functions. This includes, but is not

limited to: information pertaining to licensure;

certification; earnings; immigration status; citizenship; wage

reporting; unearned and earned income; pension income;

employment; supplemental security income; social security

numbers; National Provider Identifier (NPI) numbers; the

National Practitioner Data Bank (NPDB); program and agency

exclusions; taxpayer identification numbers; tax delinquency;

corporate information; and death records.

The Illinois Department shall enter into agreements with

State agencies and departments, and is authorized to enter into

agreements with federal agencies and departments, under which

such agencies and departments shall share data necessary for

medical assistance program integrity functions and oversight.

The Illinois Department shall develop, in cooperation with

other State departments and agencies, and in compliance with

applicable federal laws and regulations, appropriate and

effective methods to share such data. At a minimum, and to the

extent necessary to provide data sharing, the Illinois

Department shall enter into agreements with State agencies and

departments, and is authorized to enter into agreements with

federal agencies and departments, including but not limited to:

the Secretary of State; the Department of Revenue; the

Department of Public Health; the Department of Human Services;

and the Department of Financial and Professional Regulation.

Beginning in fiscal year 2013, the Illinois Department

shall set forth a request for information to identify the

benefits of a pre-payment, post-adjudication, and post-edit

claims system with the goals of streamlining claims processing

and provider reimbursement, reducing the number of pending or

rejected claims, and helping to ensure a more transparent

adjudication process through the utilization of: (i) provider

data verification and provider screening technology; and (ii)

clinical code editing; and (iii) pre-pay, pre- or

post-adjudicated predictive modeling with an integrated case

management system with link analysis. Such a request for

information shall not be considered as a request for proposal

or as an obligation on the part of the Illinois Department to

take any action or acquire any products or services.

The Illinois Department shall establish policies,

procedures, standards and criteria by rule for the acquisition,

repair and replacement of orthotic and prosthetic devices and

durable medical equipment. Such rules shall provide, but not be

limited to, the following services: (1) immediate repair or

replacement of such devices by recipients; and (2) rental,

lease, purchase or lease-purchase of durable medical equipment

in a cost-effective manner, taking into consideration the

recipient's medical prognosis, the extent of the recipient's

needs, and the requirements and costs for maintaining such

equipment. Subject to prior approval, such rules shall enable a

recipient to temporarily acquire and use alternative or

substitute devices or equipment pending repairs or

replacements of any device or equipment previously authorized

for such recipient by the Department.

The Department shall execute, relative to the nursing home

prescreening project, written inter-agency agreements with the

Department of Human Services and the Department on Aging, to

effect the following: (i) intake procedures and common

eligibility criteria for those persons who are receiving

non-institutional services; and (ii) the establishment and

development of non-institutional services in areas of the State

where they are not currently available or are undeveloped; and

(iii) notwithstanding any other provision of law, subject to

federal approval, on and after July 1, 2012, an increase in the

determination of need (DON) scores from 29 to 37 for applicants

for institutional and home and community-based long term care;

if and only if federal approval is not granted, the Department

may, in conjunction with other affected agencies, implement

utilization controls or changes in benefit packages to

effectuate a similar savings amount for this population; and

(iv) no later than July 1, 2013, minimum level of care

eligibility criteria for institutional and home and

community-based long term care; and (v) no later than October

1, 2013, establish procedures to permit long term care

providers access to eligibility scores for individuals with an

admission date who are seeking or receiving services from the

long term care provider. In order to select the minimum level

of care eligibility criteria, the Governor shall establish a

workgroup that includes affected agency representatives and

stakeholders representing the institutional and home and

community-based long term care interests. This Section shall

not restrict the Department from implementing lower level of

care eligibility criteria for community-based services in

circumstances where federal approval has been granted.

The Illinois Department shall develop and operate, in

cooperation with other State Departments and agencies and in

compliance with applicable federal laws and regulations,

appropriate and effective systems of health care evaluation and

programs for monitoring of utilization of health care services

and facilities, as it affects persons eligible for medical

assistance under this Code.

The Illinois Department shall report annually to the

General Assembly, no later than the second Friday in April of

1979 and each year thereafter, in regard to:

(a) actual statistics and trends in utilization of

medical services by public aid recipients;

(b) actual statistics and trends in the provision of

the various medical services by medical vendors;

(c) current rate structures and proposed changes in

those rate structures for the various medical vendors; and

(d) efforts at utilization review and control by the

Illinois Department.

The period covered by each report shall be the 3 years

ending on the June 30 prior to the report. The report shall

include suggested legislation for consideration by the General

Assembly. The filing of one copy of the report with the

Speaker, one copy with the Minority Leader and one copy with

the Clerk of the House of Representatives, one copy with the

President, one copy with the Minority Leader and one copy with

the Secretary of the Senate, one copy with the Legislative

Research Unit, and such additional copies with the State

Government Report Distribution Center for the General Assembly

as is required under paragraph (t) of Section 7 of the State

Library Act shall be deemed sufficient to comply with this

Section.

Rulemaking authority to implement Public Act 95-1045, if

any, is conditioned on the rules being adopted in accordance

with all provisions of the Illinois Administrative Procedure

Act and all rules and procedures of the Joint Committee on

Administrative Rules; any purported rule not so adopted, for

whatever reason, is unauthorized.

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

rate of reimbursement for services or other payments or alter

any methodologies authorized by this Code to reduce any rate of

reimbursement for services or other payments in accordance with

Section 5-5e.

Because kidney transplantation can be an appropriate, cost

effective alternative to renal dialysis when medically

necessary and notwithstanding the provisions of Section 1-11 of

this Code, beginning October 1, 2014, the Department shall

cover kidney transplantation for noncitizens with end-stage

renal disease who are not eligible for comprehensive medical

benefits, who meet the residency requirements of Section 5-3 of

this Code, and who would otherwise meet the financial

requirements of the appropriate class of eligible persons under

Section 5-2 of this Code. To qualify for coverage of kidney

transplantation, such person must be receiving emergency renal

dialysis services covered by the Department. Providers under

this Section shall be prior approved and certified by the

Department to perform kidney transplantation and the services

under this Section shall be limited to services associated with

kidney transplantation.

(Source: P.A. 97-48, eff. 6-28-11; 97-638, eff. 1-1-12; 97-689,

eff. 6-14-12; 97-1061, eff. 8-24-12; 98-104, Article 9, Section

9-5, eff. 7-22-13; 98-104, Article 12, Section 12-20, eff.

7-22-13; 98-303, eff. 8-9-13; 98-463, eff. 8-16-13; 98-651,

eff. 6-16-14; 98-756, eff. 7-16-14; 98-963, eff. 8-15-14;

revised 10-2-14.)