reglab/housing_qa huggingface dataset:
305 ILCS 5/5-5.4j
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.4j. ID/DD targeted Medicaid rate enhancement. Within 30 days after the effective date of this amendatory Act of the 100th General Assembly, the Department shall increase the Medicaid per diem rate by $21.15 for facilities with more than 16 beds licensed by the Department of Public Health under the ID/DD Community Care Act located in the Department of Public Health's Planning Area 7-B.  (Source: P.A. 100-587, eff. 6-4-18.)
305 ILCS 5/5-5.5a
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

 (from Ch. 23, par. 5-5.5a)Sec. 5-5.5a. Kosher kitchen and food service.(a) The Department of Healthcare and Family Services may develop in its rate structure for   nursing facilities an accommodation  for fully kosher kitchen and food service operations, rabbinically  approved or certified on an annual basis for a facility in which the only  kitchen or all kitchens are fully kosher (a fully kosher facility).  Beginning in the fiscal year after the fiscal year when this amendatory Act  of 1990 becomes effective, the rate structure may provide for an additional  payment to such facility not to exceed 50 cents per resident per day if 60%  or more of the residents in the facility request kosher foods or food  products prepared in accordance with Jewish religious dietary requirements  for religious purposes in a fully kosher facility.  Based upon food cost  reports of the Illinois Department of Agriculture regarding kosher and  non-kosher food available in the various regions of the State, this rate  structure may be periodically adjusted by the Department but may not exceed  the maximum authorized under this subsection (a).(b) The Department shall by rule determine how a facility with a fully  kosher kitchen and food service may be determined to be eligible and apply  for the rate accommodation specified in subsection (a).  (Source: P.A. 95-331, eff. 8-21-07; 96-1530, eff. 2-16-11.)
305 ILCS 5/5-5.6
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

 (from Ch. 23, par. 5-5.6)Sec. 5-5.6.     Federal Requirements.     All reimbursement  rates established pursuant to this Act must be consistent  with the criteria for nursing facility reimbursement  established by the Federal government for approval of  matching funds under Title XIX of the Federal  Social Security Act.    (Source: P.A. 80-1142.)
305 ILCS 5/5-5.6a
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.6a. (Repealed).        (Source: P.A. 85-1440. Repealed by P.A. 96-1530, eff. 2-16-11.)
305 ILCS 5/5-5.6b
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

 (from Ch. 23, par. 5-5.6b)Sec. 5-5.6b. Prohibition against double payment. If any resident of a   nursing facility or ICF/DD is admitted to such  facility on the basis that the charges for such resident's care will be  paid from private funds, and the source of payment for such care thereafter  changes from private funds to payments under this Article, the facility  shall, upon receiving the first such payment under this Article, notify the  Illinois Department of such source of private funds for such recipient and  repay to the source of private funds any amounts received from such source  as payment for care for which payment also was made under this Article.  Private funds shall not include third party resources such as  insurance or Medicare benefits or payments made by responsible relatives.  (Source: P.A. 96-1530, eff. 2-16-11.)
305 ILCS 5/5-5.7
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

 (from Ch. 23, par. 5-5.7)Sec. 5-5.7. Cost reports - audits. The Department of Healthcare and Family Services shall  work with the Department of Public Health to use cost report information  currently being collected under provisions of the Nursing Home Care  Act, the Specialized Mental Health Rehabilitation Act of 2013, the ID/DD Community Care Act, and the MC/DD Act.  The Department of Healthcare and Family Services may, in conjunction with the Department of Public Health,  develop in accordance with generally accepted accounting principles a  uniform chart of accounts which each facility providing services under the  medical assistance program shall adopt, after a reasonable period.Facilities licensed under the Nursing Home Care Act, the Specialized Mental Health Rehabilitation Act of 2013, the ID/DD Community Care Act, or the MC/DD Act  and providers of adult developmental training services certified by the  Department of Human Services pursuant to  Section 15.2 of the Mental Health and Developmental Disabilities Administrative  Act which provide  services to clients eligible for  medical assistance under this Article are responsible for submitting the  required annual cost report to the Department of Healthcare and Family Services.The Department of Healthcare and Family Services    shall audit the financial and statistical  records of each provider participating in the medical assistance program  as a nursing facility, a specialized mental health rehabilitation facility, or an ICF/DD over a 3 year period,  beginning with the close of the first cost reporting year.  Following the  end of this 3-year term, audits of the financial and statistical records  will be performed each year in at least 20% of the facilities participating  in the medical assistance program with at least 10% being selected on a  random sample basis, and the remainder selected on the basis of exceptional  profiles.  All audits shall be conducted in accordance with generally accepted  auditing standards.The Department of Healthcare and Family Services    shall establish prospective payment rates  for categories or levels of services within each licensure class, in order to more appropriately recognize the  individual needs of patients in nursing facilities.The Department of Healthcare and Family Services    shall provide, during the process of  establishing the payment rate for nursing facility, specialized mental health rehabilitation facility, or ICF/DD  services, or when a substantial change in rates is proposed, an opportunity  for public review and comment on the proposed rates prior to their becoming  effective.  (Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)
305 ILCS 5/5-5.8
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

 (from Ch. 23, par. 5-5.8)Sec. 5-5.8. Report on nursing home reimbursement. The Illinois  Department shall report annually to the General Assembly, no later than the  first Monday in April of 1982, and each year thereafter, in regard to:(a) the rate structure used by the Illinois     Department to reimburse nursing facilities;(b) changes in the rate structure for reimbursing     nursing facilities;(c) the administrative and program costs of     reimbursing nursing facilities;(d) the availability of beds in nursing facilities     for public aid recipients; and(e) the number of closings of nursing facilities, and     the reasons for those closings.The requirement for reporting to the General Assembly shall be satisfied  by filing copies of the report   as required by Section 3.1 of the General Assembly Organization Act, and filing 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.  (Source: P.A. 100-1148, eff. 12-10-18.)
305 ILCS 5/5-5.8a
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.8a. (Repealed).        (Source: P.A. 95-331, eff. 8-21-07. Repealed by P.A. 96-1123, eff. 1-1-11.)
305 ILCS 5/5-5.8b
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

 (from Ch. 23, par. 5-5.8b)Sec. 5-5.8b. Payment to Campus Facilities. There is hereby established  a separate payment category for campus facilities.  A "campus facility" is  defined as an entity which consists of a long term care facility (or group  of facilities if the facilities are on the same contiguous parcel of real  estate) which meets all of the following criteria as of May 1,  1987:  the  entity provides care for both children and adults; residents of the entity  reside in three or more separate buildings with congregate and small group  living arrangements on a single campus; the entity provides three or more  separate licensed levels of care; the entity (or a part of the entity) is  enrolled with the Department of Healthcare and Family Services as a provider of long term care  services and receives payments from that Department; the  entity (or a part of the entity) receives funding from the Department of   Human  Services; and the entity (or a part of  the entity) holds a current license as a child care institution issued by  the Department of Children and Family Services.The Department of Healthcare and Family Services, the Department of Human Services, and the Department of Children and Family  Services shall develop jointly a rate methodology or methodologies for  campus facilities.  Such methodology or methodologies may establish a  single rate to be paid by all the agencies, or a separate rate to be paid  by each agency, or separate components to be paid to  different parts of the campus facility.  All campus facilities shall  receive the same rate of payment for similar services.  Any methodology  developed pursuant to this section shall take into account the actual costs  to the facility of providing services to residents, and shall be adequate  to reimburse the allowable costs of a campus facility which is economically  and efficiently operated.  Any methodology shall be established on the  basis of historical, financial, and statistical data submitted by campus  facilities, and shall take into account the actual costs incurred by campus  facilities in providing services, and in meeting licensing and  certification standards imposed and prescribed by the State of Illinois,  any of its political subdivisions or municipalities and by the United  States Department of Health and Human Services.  Rates may be established  on a prospective or retrospective basis.  Any methodology shall provide  reimbursement for appropriate payment elements, including the following:  standard services, patient services, real estate taxes, and capital costs.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. (Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
305 ILCS 5/5-5.09
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.09. Mental health professionals; veterans.(a) The General Assembly is proud of and grateful to members of all branches of the United States Armed Forces.  The General Assembly recognizes that returning veterans may have unique and specific needs that are better understood and addressed by persons with military exposure.   The Department of Healthcare and Family Services shall seek federal approval of an amendment to the Illinois Title XIX State Plan for the purpose of allowing a person who has completed a psychiatric training certification program from any branch of the United States Armed Forces and who has at least one year of experience in a mental health setting to be recognized as a mental health professional.(b) Upon receipt of federal approval of an amendment to the Illinois Title XIX State Plan for this purpose, the Department of Healthcare and Family Services, in collaboration with all necessary partners including the Department of Human Services, shall adopt within 180 days after the date upon which federal approval is received any necessary rules that would allow a person who has completed a psychiatric training certification program from any branch of the United States Armed Forces and who has at least one year of experience in a mental health setting to be recognized as a mental health professional for purposes of programs authorized or funded by the Department of Healthcare and Family Services under the standards of practice as authorized by the Department.  (Source: P.A. 100-908, eff. 1-1-19.)
305 ILCS 5/5-5.10
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.10. Value-based purchasing.(a) The Department of Healthcare and Family Services, and, as appropriate, divisions within the Department of Human Services, shall confer with stakeholders to discuss development of alternative value-based payment models that move away from fee-for-service and reward health outcomes and improved quality and provide flexibility in how providers meet the needs of the individuals they serve.  Stakeholders include providers, managed care organizations, and community-based and advocacy organizations. The approaches explored may be different for different types of services.(b) The Department of Healthcare and Family Services  and the Department of Human Services shall initiate discussions with mental health providers, substance abuse providers, managed care organizations, advocacy groups for individuals with behavioral health issues, and others, as appropriate, no later than July 1, 2019.  A model for value-based purchasing for behavioral health providers shall be presented to the General Assembly by January 31, 2020. In developing this model, the Department of Healthcare and Family Services shall develop projections of the funding necessary for the model.   (Source: P.A. 101-209, eff. 8-5-19.)
305 ILCS 5/5-5.11
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.11. (Repealed).        (Source: P.A. 83-748. Repealed by P.A. 96-1530, eff. 2-16-11.)
305 ILCS 5/5-5.12a
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.12a.     Title XIX waiver; pharmacy assistance program.     The  Illinois Department may seek a waiver of otherwise applicable requirements  of Title XIX of the federal Social Security Act in order to claim federal  financial participation for a pharmacy assistance program for persons aged  65 and over with income levels at or less than 250% of the federal poverty  level.  The Illinois Department may provide by rule for all other requirements  of the program, including cost sharing, as permitted by an approved waiver and  without regard to any provision of this Code to the contrary.  The benefits may  be no more restrictive than the Pharmacy Assistance Program in effect on May  31, 2001.  Benefits provided under the waiver are subject to appropriation.The Illinois Department may not implement the waiver until cost neutrality is  demonstrated for the State relative to the final Pharmacy Assistance Program  appropriation for the fiscal year beginning July 1, 2001.  Implementation of  the waiver shall terminate on June 30, 2007.    (Source: P.A. 92-10, eff. 6-11-01.)
305 ILCS 5/5-5.12b
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.12b. Critical access care pharmacy program.(a) As used in this Section:"Critical access care pharmacy" means an Illinois-based brick and mortar pharmacy that is located in a county with fewer than 50,000 residents  and that owns fewer than 10 pharmacies."Critical access care pharmacy program payment" means the number of individual prescriptions a critical access care pharmacy fills during that quarter multiplied by the lesser of the individual payment amount or the dispensing reimbursement rate made by the Department under the medical assistance program as of April 1, 2018."Individual payment amount" means the dividend of 1/4 of the annual amount appropriated for the critical access care pharmacy program by the number of prescriptions filled by all critical access care pharmacies reimbursed by Medicaid managed care organizations that quarter.(b) Subject to appropriations, the Department shall establish a critical access care pharmacy program to ensure the sustainability of critical access pharmacies throughout the State of Illinois.(c) The critical access care pharmacy program shall not exceed $10,000,000 annually and individual payment amounts per prescription shall not exceed the dispensing rate that the Department would have reimbursed under the Medical Assistance Program as of April 1, 2018.(d) Quarterly, the Department shall determine the number of prescriptions filled by critical access care pharmacies reimbursed by Medicaid managed care organizations utilizing encounter data available to the Department.  The Department shall determine the individual payment amount per prescription by dividing 1/4 of the annual amount appropriated for the critical access care pharmacy program by the number of prescriptions filled by all critical access care pharmacies reimbursed by Medicaid managed care organizations that quarter. If the individual payment amount per prescription as calculated using quarterly prescription amounts exceeds the reimbursement rate under the medical assistance program as of April 1, 2018, then the individual payment amount per prescription shall be the dispensing reimbursement rate under the medical assistance program as of April 1, 2018.(e) Quarterly, the Department shall distribute to critical access care pharmacies a critical access care pharmacy program payment. The first payment shall be calculated utilizing the encounter data from the last quarter of State fiscal year 2018.(f) The Department may adopt rules permitting an Illinois-based brick and mortar pharmacy that owns fewer than 10 pharmacies to receive critical access care pharmacy program payments in the same manner as a critical access care pharmacy, regardless of whether the pharmacy is located in a county with a population of less than 50,000.   (Source: P.A. 100-587, eff. 6-4-18.)
305 ILCS 5/5-5.12c
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

Sec. 5-5.12c. Managed care organization uniform electronic prior authorization form; prescription benefits.(a) As used in this Section, "prescribing provider" includes a provider authorized to write a prescription, as described in subsection (e) of Section 3 of the Pharmacy Practice Act, to treat a medical condition of an insured.(b) Notwithstanding any other provision of law to the contrary, on and after July 1, 2021, a managed care organization that provides prescription drug benefits shall utilize and accept the uniform electronic prior authorization form developed pursuant to subsection (c) when requiring prior authorization for prescription drug benefits.(c) On or before July 1, 2020, the Department of Healthcare and Family Services shall develop a uniform electronic prior authorization form that shall be used by managed care organizations.  Notwithstanding any other provision of law to the contrary, on and after July 1, 2021, every prescribing provider must use the uniform electronic prior authorization form to request prior authorization for coverage of prescription drug benefits, and every managed care organization shall accept the uniform electronic prior authorization form as sufficient to request prior authorization for prescription drug benefits.(d)  The Department of Healthcare and Family Services shall develop the uniform electronic prior authorization form with input from interested parties, including, but not limited to, the following individuals appointed by the Director of Healthcare and Family Services:  2 psychiatrists recommended by a State organization that represents psychiatrists, 2 pharmacists recommended by a State organization that represents pharmacists, 2 physicians recommended by a State organization that represents physicians, 2 family physicians recommended by a State organization that represents family physicians, 2 pediatricians recommended by a State organization that represents pediatricians, and 2 representatives of the association that represents managed care organizations, from at least one public meeting.(e) The Department of Healthcare and Family Services, in development of the uniform electronic prior authorization form, shall take into consideration the following:(1) existing prior authorization forms established by     the federal Centers for Medicare and Medicaid Services and the Department of Healthcare and Family Services; and(2) national standards pertaining to electronic prior     authorization.(f) If, upon receipt of a completed and accurate electronic prior authorization request from a prescribing provider pursuant to the submission of a uniform electronic prior authorization form, a managed care organization fails to use or accept the uniform electronic prior authorization form or fails to respond within 24 hours, then the prior authorization request shall be deemed to have been granted.  (Source: P.A. 101-463, eff. 1-1-20.)
305 ILCS 5/5-5.12d
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

(Text of Section from P.A. 102-103)Sec. 5-5.12d. Coverage for patient care services for hormonal contraceptives provided by a pharmacist.(a) Subject to approval by the federal Centers for Medicare and Medicaid Services, the medical assistance program, including both the fee-for-service and managed care medical assistance programs established under this Article, shall cover patient care services provided by a pharmacist for hormonal contraceptives assessment and consultation.(b) The Department shall establish a fee schedule for patient care services provided by a pharmacist for hormonal contraceptives assessment and consultation.(c) The rate of reimbursement for patient care services provided by a pharmacist for hormonal contraceptives assessment and consultation shall be at 85% of the fee schedule for physician services by the medical assistance program.(d) A pharmacist must be enrolled in the medical assistance program as an ordering and referring provider prior to providing hormonal contraceptives assessment and consultation that is submitted by a pharmacy or pharmacist provider for reimbursement pursuant to this Section.(e) The Department shall apply for any necessary federal waivers or approvals to implement this Section by January 1, 2022.(f) This Section does not restrict or prohibit any services currently provided by pharmacists as authorized by law, including, but not limited to, pharmacist services provided under this Code or authorized under the Illinois Title XIX State Plan.(g) The Department shall submit to the Joint Committee on Administrative Rules administrative rules for this Section as soon as practicable but no later than 6 months after federal approval is received.  (Source: P.A. 102-103, eff. 1-1-22.)(Text of Section from P.A. 102-409)Sec. 5-5.12d. Managed care organization prior authorization of health care services.(a)   As used in this Section, "health care service" has the meaning given to that term in the Prior Authorization Reform Act.(b)   Notwithstanding any other provision of law to the contrary, all managed care organizations shall comply with the requirements of the Prior Authorization Reform Act.  (Source: P.A. 102-409, eff. 1-1-22.)