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Full Text of SB3741
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SB3741 - 104th General Assembly
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Senate Amendment 001
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Senate Amendment 001
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3741
Introduced 2/5/2026, by Sen. Mattie Hunter
SYNOPSIS AS INTRODUCED:
20 ILCS 2310/2310-90
was 20 ILCS 2310/55.09
30 ILCS 500/1-10
305 ILCS 5/5-5
410 ILCS 240/Act title
410 ILCS 240/0.01
from Ch. 111 1/2, par. 4902.9
410 ILCS 240/2
from Ch. 111 1/2, par. 4904
410 ILCS 513/30
Amends the Newborn Screening Act. Changes the title of the Act and
the short title. Provides that, beginning July 1, 2026, an additional
newborn screening fee of at least $45, determined by the Department by
rule, may be collected and deposited into the Metabolic Screening and
Treatment Fund for specified purposes. Provides that nothing in the Act
shall be construed to override, replace, preempt, or supersede any
provision, requirement, or other duty or prohibition under the Early
Hearing Detection and Intervention Act. Limits the application of certain
provisions to hearing screenings and makes technical and conforming
changes. Makes conforming changes in the Department of Public Health
Powers and Duties Law of the Civil Administrative Code of Illinois, the
Illinois Procurement Code, the Illinois Public Aid Code, and the Genetic
Information Privacy Act. Effective immediately.
LRB104 20276 BDA 33727 b
A BILL FOR
SB3741
LRB104 20276 BDA 33727 b
1
AN ACT concerning State government.
2
Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:
4
Section 5.
The Department of Public Health Powers and
5
Duties Law of the Civil Administrative Code of Illinois is
6
amended by changing Section 2310-90 as follows:
7
(20 ILCS 2310/2310-90)
(was 20 ILCS 2310/55.09)
8
Sec. 2310-90.
Laboratories; fees; Public Health Laboratory
9
Services Revolving Fund.
To maintain physical, chemical,
10
bacteriological, and biological laboratories; to make
11
examinations of milk, water, atmosphere, sewage, wastes, and
12
other substances, and equipment and processes relating
13
thereto; to make diagnostic tests for diseases and tests for
14
the evaluation of health hazards considered necessary for the
15
protection of the people of the State; and to assess a
16
reasonable fee for services provided as established by
17
regulation, under the Illinois Administrative Procedure Act,
18
which shall not exceed the Department's actual costs to
19
provide these services.
20
Excepting fees collected under the Newborn
Metabolic
21
Screening Act and the Lead Poisoning Prevention Act, all fees
22
shall be deposited into the Public Health Laboratory Services
23
Revolving Fund. Other State and federal funds related to
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1
laboratory services may also be deposited into the Fund, and
2
all interest that accrues on the moneys in the Fund shall be
3
deposited into the Fund.
4
Moneys shall be appropriated from the Fund solely for the
5
purposes of testing specimens submitted in support of
6
Department programs established for the protection of human
7
health, welfare, and safety, and for testing specimens
8
submitted by physicians and other health care providers, to
9
determine whether chemically hazardous, biologically
10
infectious substances, or other disease causing conditions are
11
present.
12
(Source: P.A. 96-328, eff. 8-11-09.)
13
Section 10.
The Illinois Procurement Code is amended by
14
changing Section 1-10 as follows:
15
(30 ILCS 500/1-10)
16
(Text of Section before amendment by P.A. 104-458
)
17
Sec. 1-10.
Application.
18
(a) This Code applies only to procurements for which
19
bidders, offerors, potential contractors, or contractors were
20
first solicited on or after July 1, 1998. This Code shall not
21
be construed to affect or impair any contract, or any
22
provision of a contract, entered into based on a solicitation
23
prior to the implementation date of this Code as described in
24
Article 99, including, but not limited to, any covenant
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1
entered into with respect to any revenue bonds or similar
2
instruments. All procurements for which contracts are
3
solicited between the effective date of Articles 50 and 99 and
4
July 1, 1998 shall be substantially in accordance with this
5
Code and its intent.
6
(b) This Code shall apply regardless of the source of the
7
funds with which the contracts are paid, including federal
8
assistance moneys. This Code shall not apply to:
9
(1) Contracts between the State and its political
10
subdivisions or other governments, or between State
11
governmental bodies, except as specifically provided in
12
this Code.
13
(2) Grants, except for the filing requirements of
14
Section 20-80.
15
(3) Purchase of care, except as provided in Section
16
5-30.6 of the Illinois Public Aid Code and this Section.
17
(4) Hiring of an individual as an employee and not as
18
an independent contractor, whether pursuant to an
19
employment code or policy or by contract directly with
20
that individual.
21
(5) Collective bargaining contracts.
22
(6) Purchase of real estate, except that notice of
23
this type of contract with a value of more than $25,000
24
must be published in the Procurement Bulletin within 10
25
calendar days after the deed is recorded in the county of
26
jurisdiction. The notice shall identify the real estate
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purchased, the names of all parties to the contract, the
2
value of the contract, and the effective date of the
3
contract.
4
(7) Contracts necessary to prepare for anticipated
5
litigation, enforcement actions, or investigations,
6
provided that the chief legal counsel to the Governor
7
shall give his or her prior approval when the procuring
8
agency is one subject to the jurisdiction of the Governor,
9
and provided that the chief legal counsel of any other
10
procuring entity subject to this Code shall give his or
11
her prior approval when the procuring entity is not one
12
subject to the jurisdiction of the Governor.
13
(8) (Blank).
14
(9) Procurement expenditures by the Illinois
15
Conservation Foundation when only private funds are used.
16
(10) (Blank).
17
(11) Public-private agreements entered into according
18
to the procurement requirements of Section 20 of the
19
Public-Private Partnerships for Transportation Act and
20
design-build agreements entered into according to the
21
procurement requirements of Section 25 of the
22
Public-Private Partnerships for Transportation Act.
23
(12) (A) Contracts for legal, financial, and other
24
professional and artistic services entered into by the
25
Illinois Finance Authority in which the State of Illinois
26
is not obligated. Such contracts shall be awarded through
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a competitive process authorized by the members of the
2
Illinois Finance Authority and are subject to Sections
3
5-30, 20-160, 50-13, 50-20, 50-35, and 50-37 of this Code,
4
as well as the final approval by the members of the
5
Illinois Finance Authority of the terms of the contract.
6
(B) Contracts for legal and financial services entered
7
into by the Illinois Housing Development Authority in
8
connection with the issuance of bonds in which the State
9
of Illinois is not obligated. Such contracts shall be
10
awarded through a competitive process authorized by the
11
members of the Illinois Housing Development Authority and
12
are subject to Sections 5-30, 20-160, 50-13, 50-20, 50-35,
13
and 50-37 of this Code, as well as the final approval by
14
the members of the Illinois Housing Development Authority
15
of the terms of the contract.
16
(13) Contracts for services, commodities, and
17
equipment to support the delivery of timely forensic
18
science services in consultation with and subject to the
19
approval of the Chief Procurement Officer as provided in
20
subsection (d) of Section 5-4-3a of the Unified Code of
21
Corrections, except for the requirements of Sections
22
20-60, 20-65, 20-70, and 20-160 and Article 50 of this
23
Code; however, the Chief Procurement Officer may, in
24
writing with justification, waive any certification
25
required under Article 50 of this Code. For any contracts
26
for services which are currently provided by members of a
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collective bargaining agreement, the applicable terms of
2
the collective bargaining agreement concerning
3
subcontracting shall be followed.
4
On and after January 1, 2019, this paragraph (13),
5
except for this sentence, is inoperative.
6
(14) Contracts for participation expenditures required
7
by a domestic or international trade show or exhibition of
8
an exhibitor, member, or sponsor.
9
(15) Contracts with a railroad or utility that
10
requires the State to reimburse the railroad or utilities
11
for the relocation of utilities for construction or other
12
public purpose. Contracts included within this paragraph
13
(15) shall include, but not be limited to, those
14
associated with: relocations, crossings, installations,
15
and maintenance. For the purposes of this paragraph (15),
16
"railroad" means any form of non-highway ground
17
transportation that runs on rails or electromagnetic
18
guideways and "utility" means: (1) public utilities as
19
defined in Section 3-105 of the Public Utilities Act, (2)
20
telecommunications carriers as defined in Section 13-202
21
of the Public Utilities Act, (3) electric cooperatives as
22
defined in Section 3.4 of the Electric Supplier Act, (4)
23
telephone or telecommunications cooperatives as defined in
24
Section 13-212 of the Public Utilities Act, (5) rural
25
water or
wastewater
waste water
systems with 10,000
26
connections or less, (6) a holder as defined in Section
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21-201 of the Public Utilities Act, and (7) municipalities
2
owning or operating utility systems consisting of public
3
utilities as that term is defined in Section 11-117-2 of
4
the Illinois Municipal Code.
5
(16) Procurement expenditures necessary for the
6
Department of Public Health to provide the delivery of
7
timely newborn screening services in accordance with the
8
Newborn Metabolic Screening Act.
9
(17) Procurement expenditures necessary for the
10
Department of Agriculture, the Department of Financial and
11
Professional Regulation, the Department of Human Services,
12
and the Department of Public Health to implement the
13
Compassionate Use of Medical Cannabis Program and Opioid
14
Alternative Pilot Program requirements and ensure access
15
to medical cannabis for patients with debilitating medical
16
conditions in accordance with the Compassionate Use of
17
Medical Cannabis Program Act.
18
(18) This Code does not apply to any procurements
19
necessary for the Department of Agriculture, the
20
Department of Financial and Professional Regulation, the
21
Department of Human Services, the Department of Commerce
22
and Economic Opportunity, and the Department of Public
23
Health to implement the Cannabis Regulation and Tax Act if
24
the applicable agency has made a good faith determination
25
that it is necessary and appropriate for the expenditure
26
to fall within this exemption and if the process is
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conducted in a manner substantially in accordance with the
2
requirements of Sections 20-160, 25-60, 30-22, 50-5,
3
50-10, 50-10.5, 50-12, 50-13, 50-15, 50-20, 50-21, 50-35,
4
50-36, 50-37, 50-38, and 50-50 of this Code; however, for
5
Section 50-35, compliance applies only to contracts or
6
subcontracts over $100,000. Notice of each contract
7
entered into under this paragraph (18) that is related to
8
the procurement of goods and services identified in
9
paragraph (1) through (9) of this subsection shall be
10
published in the Procurement Bulletin within 14 calendar
11
days after contract execution. The Chief Procurement
12
Officer shall prescribe the form and content of the
13
notice. Each agency shall provide the Chief Procurement
14
Officer, on a monthly basis, in the form and content
15
prescribed by the Chief Procurement Officer, a report of
16
contracts that are related to the procurement of goods and
17
services identified in this subsection. At a minimum, this
18
report shall include the name of the contractor, a
19
description of the supply or service provided, the total
20
amount of the contract, the term of the contract, and the
21
exception to this Code utilized. A copy of any or all of
22
these contracts shall be made available to the Chief
23
Procurement Officer immediately upon request. The Chief
24
Procurement Officer shall submit a report to the Governor
25
and General Assembly no later than November 1 of each year
26
that includes, at a minimum, an annual summary of the
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monthly information reported to the Chief Procurement
2
Officer. This exemption becomes inoperative 5 years after
3
June 25, 2019 (the effective date of Public Act 101-27).
4
(19) Acquisition of modifications or adjustments,
5
limited to assistive technology devices and assistive
6
technology services, adaptive equipment, repairs, and
7
replacement parts to provide reasonable accommodations (i)
8
that enable a qualified applicant with a disability to
9
complete the job application process and be considered for
10
the position such qualified applicant desires, (ii) that
11
modify or adjust the work environment to enable a
12
qualified current employee with a disability to perform
13
the essential functions of the position held by that
14
employee, (iii) to enable a qualified current employee
15
with a disability to enjoy equal benefits and privileges
16
of employment as are enjoyed by other similarly situated
17
employees without disabilities, and (iv) that allow a
18
customer, client, claimant, or member of the public
19
seeking State services full use and enjoyment of and
20
access to its programs, services, or benefits.
21
For purposes of this paragraph (19):
22
"Assistive technology devices" means any item, piece
23
of equipment, or product system, whether acquired
24
commercially off the shelf, modified, or customized, that
25
is used to increase, maintain, or improve functional
26
capabilities of individuals with disabilities.
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1
"Assistive technology services" means any service that
2
directly assists an individual with a disability in
3
selection, acquisition, or use of an assistive technology
4
device.
5
"Qualified" has the same meaning and use as provided
6
under the federal Americans with Disabilities Act when
7
describing an individual with a disability.
8
(20) Procurement expenditures necessary for the
9
Illinois Commerce Commission to hire third-party
10
facilitators pursuant to Sections 16-105.17 and 16-108.18
11
of the Public Utilities Act or an ombudsman pursuant to
12
Section 16-107.5 of the Public Utilities Act, a
13
facilitator pursuant to Section 16-105.17 of the Public
14
Utilities Act, or a grid auditor pursuant to Section
15
16-105.10 of the Public Utilities Act.
16
(21) Procurement expenditures for the purchase,
17
renewal, and expansion of software, software licenses, or
18
software maintenance agreements that support the efforts
19
of the Illinois State Police to enforce, regulate, and
20
administer the Firearm Owners Identification Card Act, the
21
Firearm Concealed Carry Act, the Firearms Restraining
22
Order Act, the Firearm Dealer License Certification Act,
23
the Law Enforcement Agencies Data System (LEADS), the
24
Uniform Crime Reporting Act, the Criminal Identification
25
Act, the Illinois Uniform Conviction Information Act, and
26
the Gun Trafficking Information Act, or establish or
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maintain record management systems necessary to conduct
2
human trafficking investigations or gun trafficking or
3
other stolen firearm investigations. This paragraph (21)
4
applies to contracts entered into on or after January 10,
5
2023 (the effective date of Public Act 102-1116) and the
6
renewal of contracts that are in effect on January 10,
7
2023 (the effective date of Public Act 102-1116).
8
(22) Contracts for project management services and
9
system integration services required for the completion of
10
the State's enterprise resource planning project. This
11
exemption becomes inoperative 5 years after June 7, 2023
12
(the effective date of the changes made to this Section by
13
Public Act 103-8). This paragraph (22) applies to
14
contracts entered into on or after June 7, 2023 (the
15
effective date of the changes made to this Section by
16
Public Act 103-8) and the renewal of contracts that are in
17
effect on June 7, 2023 (the effective date of the changes
18
made to this Section by Public Act 103-8).
19
(23) Procurements necessary for the Department of
20
Insurance to implement the Illinois Health Benefits
21
Exchange Law if the Department of Insurance has made a
22
good faith determination that it is necessary and
23
appropriate for the expenditure to fall within this
24
exemption. The procurement process shall be conducted in a
25
manner substantially in accordance with the requirements
26
of Sections 20-160 and 25-60 and Article 50 of this Code. A
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1
copy of these contracts shall be made available to the
2
Chief Procurement Officer immediately upon request. This
3
paragraph is inoperative 5 years after June 27, 2023 (the
4
effective date of Public Act 103-103).
5
(24) Contracts for public education programming,
6
noncommercial sustaining announcements, public service
7
announcements, and public awareness and education
8
messaging with the nonprofit trade associations of the
9
providers of those services that inform the public on
10
immediate and ongoing health and safety risks and hazards.
11
(25) Procurements necessary for the Department of
12
Early Childhood to implement the Department of Early
13
Childhood Act if the Department has made a good faith
14
determination that it is necessary and appropriate for the
15
expenditure to fall within this exemption. This exemption
16
shall only be used for products and services procured
17
solely for use by the Department of Early Childhood. The
18
procurements may include those necessary to design and
19
build integrated, operational systems of programs and
20
services. The procurements may include, but are not
21
limited to, those necessary to align and update program
22
standards, integrate funding systems, design and establish
23
data and reporting systems, align and update models for
24
technical assistance and professional development, design
25
systems to manage grants and ensure compliance, design and
26
implement management and operational structures, and
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1
establish new means of engaging with families, educators,
2
providers, and stakeholders. The procurement processes
3
shall be conducted in a manner substantially in accordance
4
with the requirements of Article 50 (ethics) and Sections
5
5-5 (Procurement Policy Board), 5-7 (Commission on Equity
6
and Inclusion), 20-80 (contract files), 20-120
7
(subcontractors), 20-155 (paperwork), 20-160
8
(ethics/campaign contribution prohibitions), 25-60
9
(prevailing wage), and 25-90 (prohibited and authorized
10
cybersecurity) of this Code. Beginning January 1, 2025,
11
the Department of Early Childhood shall provide a
12
quarterly report to the General Assembly detailing a list
13
of expenditures and contracts for which the Department
14
uses this exemption. This paragraph is inoperative on and
15
after July 1, 2027.
16
(26) Procurements that are necessary for increasing
17
the recruitment and retention of State employees,
18
particularly minority candidates for employment,
19
including:
20
(A) procurements related to registration fees for
21
job fairs and other outreach and recruitment events;
22
(B) production of recruitment materials; and
23
(C) other services related to recruitment and
24
retention of State employees.
25
The exemption under this paragraph (26) applies only
26
if the State agency has made a good faith determination
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1
that it is necessary and appropriate for the expenditure
2
to fall within this paragraph (26). The procurement
3
process under this paragraph (26) shall be conducted in a
4
manner substantially in accordance with the requirements
5
of Sections 20-160 and 25-60 and Article 50 of this Code. A
6
copy of these contracts shall be made available to the
7
Chief Procurement Officer immediately upon request.
8
Nothing in this paragraph (26) authorizes the replacement
9
or diminishment of State responsibilities in hiring or the
10
positions that effectuate that hiring. This paragraph (26)
11
is inoperative on and after June 30, 2029.
12
(27) Procurements necessary for the Department of
13
Healthcare and Family Services to implement changes to the
14
State's Integrated Eligibility System to ensure the
15
system's compliance with federal implementation mandates
16
and deadlines, if the Department of Healthcare and Family
17
Services has made a good faith determination that it is
18
necessary and appropriate for the procurement to fall
19
within this exemption.
20
Notwithstanding any other provision of law, for contracts
21
with an annual value of more than $100,000 entered into on or
22
after October 1, 2017 under an exemption provided in any
23
paragraph of this subsection (b), except paragraph (1), (2),
24
or (5), each State agency shall post to the appropriate
25
procurement bulletin the name of the contractor, a description
26
of the supply or service provided, the total amount of the
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1
contract, the term of the contract, and the exception to the
2
Code utilized. The chief procurement officer shall submit a
3
report to the Governor and General Assembly no later than
4
November 1 of each year that shall include, at a minimum, an
5
annual summary of the monthly information reported to the
6
chief procurement officer.
7
(c) This Code does not apply to the electric power
8
procurement process provided for under Section 1-75 of the
9
Illinois Power Agency Act and Section 16-111.5 of the Public
10
Utilities Act. This Code does not apply to the procurement of
11
technical and policy experts pursuant to Section 1-129 of the
12
Illinois Power Agency Act.
13
(d) Except for Section 20-160 and Article 50 of this Code,
14
and as expressly required by Section 9.1 of the Illinois
15
Lottery Law, the provisions of this Code do not apply to the
16
procurement process provided for under Section 9.1 of the
17
Illinois Lottery Law.
18
(e) This Code does not apply to the process used by the
19
Capital Development Board to retain a person or entity to
20
assist the Capital Development Board with its duties related
21
to the determination of costs of a clean coal SNG brownfield
22
facility, as defined by Section 1-10 of the Illinois Power
23
Agency Act, as required in subsection (h-3) of Section 9-220
24
of the Public Utilities Act, including calculating the range
25
of capital costs, the range of operating and maintenance
26
costs, or the sequestration costs or monitoring the
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1
construction of clean coal SNG brownfield facility for the
2
full duration of construction.
3
(f) (Blank).
4
(g) (Blank).
5
(h) This Code does not apply to the process to procure or
6
contracts entered into in accordance with Sections 11-5.2 and
7
11-5.3 of the Illinois Public Aid Code.
8
(i) Each chief procurement officer may access records
9
necessary to review whether a contract, purchase, or other
10
expenditure is or is not subject to the provisions of this
11
Code, unless such records would be subject to attorney-client
12
privilege.
13
(j) This Code does not apply to the process used by the
14
Capital Development Board to retain an artist or work or works
15
of art as required in Section 14 of the Capital Development
16
Board Act.
17
(k) This Code does not apply to the process to procure
18
contracts, or contracts entered into, by the State Board of
19
Elections or the State Electoral Board for hearing officers
20
appointed pursuant to the Election Code.
21
(l) This Code does not apply to the processes used by the
22
Illinois Student Assistance Commission to procure supplies and
23
services paid for from the private funds of the Illinois
24
Prepaid Tuition Fund. As used in this subsection (l), "private
25
funds" means funds derived from deposits paid into the
26
Illinois Prepaid Tuition Trust Fund and the earnings thereon.
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(m) This Code shall apply regardless of the source of
2
funds with which contracts are paid, including federal
3
assistance moneys. Except as specifically provided in this
4
Code, this Code shall not apply to procurement expenditures
5
necessary for the Department of Public Health to conduct the
6
Healthy Illinois Survey in accordance with Section 2310-431 of
7
the Department of Public Health Powers and Duties Law of the
8
Civil Administrative Code of Illinois.
9
(Source: P.A. 103-8, eff. 6-7-23; 103-103, eff. 6-27-23;
10
103-570, eff. 1-1-24; 103-580, eff. 12-8-23; 103-594, eff.
11
6-25-24; 103-605, eff. 7-1-24; 103-865, eff. 1-1-25; 104-2,
12
eff. 6-16-25; 104-417, eff. 8-15-25)
13
(Text of Section after amendment by P.A. 104-458
)
14
Sec. 1-10.
Application.
15
(a) This Code applies only to procurements for which
16
bidders, offerors, potential contractors, or contractors were
17
first solicited on or after July 1, 1998. This Code shall not
18
be construed to affect or impair any contract, or any
19
provision of a contract, entered into based on a solicitation
20
prior to the implementation date of this Code as described in
21
Article 99, including, but not limited to, any covenant
22
entered into with respect to any revenue bonds or similar
23
instruments. All procurements for which contracts are
24
solicited between the effective date of Articles 50 and 99 and
25
July 1, 1998 shall be substantially in accordance with this
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Code and its intent.
2
(b) This Code shall apply regardless of the source of the
3
funds with which the contracts are paid, including federal
4
assistance moneys. This Code shall not apply to:
5
(1) Contracts between the State and its political
6
subdivisions or other governments, or between State
7
governmental bodies, except as specifically provided in
8
this Code.
9
(2) Grants, except for the filing requirements of
10
Section 20-80.
11
(3) Purchase of care, except as provided in Section
12
5-30.6 of the Illinois Public Aid Code and this Section.
13
(4) Hiring of an individual as an employee and not as
14
an independent contractor, whether pursuant to an
15
employment code or policy or by contract directly with
16
that individual.
17
(5) Collective bargaining contracts.
18
(6) Purchase of real estate, except that notice of
19
this type of contract with a value of more than $25,000
20
must be published in the Procurement Bulletin within 10
21
calendar days after the deed is recorded in the county of
22
jurisdiction. The notice shall identify the real estate
23
purchased, the names of all parties to the contract, the
24
value of the contract, and the effective date of the
25
contract.
26
(7) Contracts necessary to prepare for anticipated
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litigation, enforcement actions, or investigations,
2
provided that the chief legal counsel to the Governor
3
shall give his or her prior approval when the procuring
4
agency is one subject to the jurisdiction of the Governor,
5
and provided that the chief legal counsel of any other
6
procuring entity subject to this Code shall give his or
7
her prior approval when the procuring entity is not one
8
subject to the jurisdiction of the Governor.
9
(8) (Blank).
10
(9) Procurement expenditures by the Illinois
11
Conservation Foundation when only private funds are used.
12
(10) (Blank).
13
(11) Public-private agreements entered into according
14
to the procurement requirements of Section 20 of the
15
Public-Private Partnerships for Transportation Act and
16
design-build agreements entered into according to the
17
procurement requirements of Section 25 of the
18
Public-Private Partnerships for Transportation Act.
19
(12) (A) Contracts for legal, financial, and other
20
professional and artistic services entered into by the
21
Illinois Finance Authority in which the State of Illinois
22
is not obligated. Such contracts shall be awarded through
23
a competitive process authorized by the members of the
24
Illinois Finance Authority and are subject to Sections
25
5-30, 20-160, 50-13, 50-20, 50-35, and 50-37 of this Code,
26
as well as the final approval by the members of the
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Illinois Finance Authority of the terms of the contract.
2
(B) Contracts for legal and financial services entered
3
into by the Illinois Housing Development Authority in
4
connection with the issuance of bonds in which the State
5
of Illinois is not obligated. Such contracts shall be
6
awarded through a competitive process authorized by the
7
members of the Illinois Housing Development Authority and
8
are subject to Sections 5-30, 20-160, 50-13, 50-20, 50-35,
9
and 50-37 of this Code, as well as the final approval by
10
the members of the Illinois Housing Development Authority
11
of the terms of the contract.
12
(13) Contracts for services, commodities, and
13
equipment to support the delivery of timely forensic
14
science services in consultation with and subject to the
15
approval of the Chief Procurement Officer as provided in
16
subsection (d) of Section 5-4-3a of the Unified Code of
17
Corrections, except for the requirements of Sections
18
20-60, 20-65, 20-70, and 20-160 and Article 50 of this
19
Code; however, the Chief Procurement Officer may, in
20
writing with justification, waive any certification
21
required under Article 50 of this Code. For any contracts
22
for services which are currently provided by members of a
23
collective bargaining agreement, the applicable terms of
24
the collective bargaining agreement concerning
25
subcontracting shall be followed.
26
On and after January 1, 2019, this paragraph (13),
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except for this sentence, is inoperative.
2
(14) Contracts for participation expenditures required
3
by a domestic or international trade show or exhibition of
4
an exhibitor, member, or sponsor.
5
(15) Contracts with a railroad or utility that
6
requires the State to reimburse the railroad or utilities
7
for the relocation of utilities for construction or other
8
public purpose. Contracts included within this paragraph
9
(15) shall include, but not be limited to, those
10
associated with: relocations, crossings, installations,
11
and maintenance. For the purposes of this paragraph (15),
12
"railroad" means any form of non-highway ground
13
transportation that runs on rails or electromagnetic
14
guideways and "utility" means: (1) public utilities as
15
defined in Section 3-105 of the Public Utilities Act, (2)
16
telecommunications carriers as defined in Section 13-202
17
of the Public Utilities Act, (3) electric cooperatives as
18
defined in Section 3.4 of the Electric Supplier Act, (4)
19
telephone or telecommunications cooperatives as defined in
20
Section 13-212 of the Public Utilities Act, (5) rural
21
water or
wastewater
waste water
systems with 10,000
22
connections or less, (6) a holder as defined in Section
23
21-201 of the Public Utilities Act, and (7) municipalities
24
owning or operating utility systems consisting of public
25
utilities as that term is defined in Section 11-117-2 of
26
the Illinois Municipal Code.
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(16) Procurement expenditures necessary for the
2
Department of Public Health to provide the delivery of
3
timely newborn screening services in accordance with the
4
Newborn
Metabolic
Screening Act.
5
(17) Procurement expenditures necessary for the
6
Department of Agriculture, the Department of Financial and
7
Professional Regulation, the Department of Human Services,
8
and the Department of Public Health to implement the
9
Compassionate Use of Medical Cannabis Program and Opioid
10
Alternative Pilot Program requirements and ensure access
11
to medical cannabis for patients with debilitating medical
12
conditions in accordance with the Compassionate Use of
13
Medical Cannabis Program Act.
14
(18) This Code does not apply to any procurements
15
necessary for the Department of Agriculture, the
16
Department of Financial and Professional Regulation, the
17
Department of Human Services, the Department of Commerce
18
and Economic Opportunity, and the Department of Public
19
Health to implement the Cannabis Regulation and Tax Act if
20
the applicable agency has made a good faith determination
21
that it is necessary and appropriate for the expenditure
22
to fall within this exemption and if the process is
23
conducted in a manner substantially in accordance with the
24
requirements of Sections 20-160, 25-60, 30-22, 50-5,
25
50-10, 50-10.5, 50-12, 50-13, 50-15, 50-20, 50-21, 50-35,
26
50-36, 50-37, 50-38, and 50-50 of this Code; however, for
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Section 50-35, compliance applies only to contracts or
2
subcontracts over $100,000. Notice of each contract
3
entered into under this paragraph (18) that is related to
4
the procurement of goods and services identified in
5
paragraph (1) through (9) of this subsection shall be
6
published in the Procurement Bulletin within 14 calendar
7
days after contract execution. The Chief Procurement
8
Officer shall prescribe the form and content of the
9
notice. Each agency shall provide the Chief Procurement
10
Officer, on a monthly basis, in the form and content
11
prescribed by the Chief Procurement Officer, a report of
12
contracts that are related to the procurement of goods and
13
services identified in this subsection. At a minimum, this
14
report shall include the name of the contractor, a
15
description of the supply or service provided, the total
16
amount of the contract, the term of the contract, and the
17
exception to this Code utilized. A copy of any or all of
18
these contracts shall be made available to the Chief
19
Procurement Officer immediately upon request. The Chief
20
Procurement Officer shall submit a report to the Governor
21
and General Assembly no later than November 1 of each year
22
that includes, at a minimum, an annual summary of the
23
monthly information reported to the Chief Procurement
24
Officer. This exemption becomes inoperative 5 years after
25
June 25, 2019 (the effective date of Public Act 101-27).
26
(19) Acquisition of modifications or adjustments,
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limited to assistive technology devices and assistive
2
technology services, adaptive equipment, repairs, and
3
replacement parts to provide reasonable accommodations (i)
4
that enable a qualified applicant with a disability to
5
complete the job application process and be considered for
6
the position such qualified applicant desires, (ii) that
7
modify or adjust the work environment to enable a
8
qualified current employee with a disability to perform
9
the essential functions of the position held by that
10
employee, (iii) to enable a qualified current employee
11
with a disability to enjoy equal benefits and privileges
12
of employment as are enjoyed by other similarly situated
13
employees without disabilities, and (iv) that allow a
14
customer, client, claimant, or member of the public
15
seeking State services full use and enjoyment of and
16
access to its programs, services, or benefits.
17
For purposes of this paragraph (19):
18
"Assistive technology devices" means any item, piece
19
of equipment, or product system, whether acquired
20
commercially off the shelf, modified, or customized, that
21
is used to increase, maintain, or improve functional
22
capabilities of individuals with disabilities.
23
"Assistive technology services" means any service that
24
directly assists an individual with a disability in
25
selection, acquisition, or use of an assistive technology
26
device.
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"Qualified" has the same meaning and use as provided
2
under the federal Americans with Disabilities Act when
3
describing an individual with a disability.
4
(20) Procurement expenditures necessary for the
5
Illinois Commerce Commission to hire third-party
6
facilitators pursuant to Sections 16-105.17 and 16-108.18
7
of the Public Utilities Act or an ombudsman pursuant to
8
Section 16-107.5 of the Public Utilities Act, a
9
facilitator pursuant to Section 16-105.17 of the Public
10
Utilities Act, a grid auditor pursuant to Section
11
16-105.10 of the Public Utilities Act, a facilitator,
12
expert, or consultant pursuant to Sections 16-126.2 and
13
16-202 of the Public Utilities Act, a procurement monitor
14
pursuant to Section 16-111.5 of the Public Utilities Act,
15
an ombudsperson pursuant to Section 20-145 of the Public
16
Utilities Act, or consultants and experts pursuant to
17
Section 5-15 of the Utility Data Access Act.
18
(21) Procurement expenditures for the purchase,
19
renewal, and expansion of software, software licenses, or
20
software maintenance agreements that support the efforts
21
of the Illinois State Police to enforce, regulate, and
22
administer the Firearm Owners Identification Card Act, the
23
Firearm Concealed Carry Act, the Firearms Restraining
24
Order Act, the Firearm Dealer License Certification Act,
25
the Law Enforcement Agencies Data System (LEADS), the
26
Uniform Crime Reporting Act, the Criminal Identification
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Act, the Illinois Uniform Conviction Information Act, and
2
the Gun Trafficking Information Act, or establish or
3
maintain record management systems necessary to conduct
4
human trafficking investigations or gun trafficking or
5
other stolen firearm investigations. This paragraph (21)
6
applies to contracts entered into on or after January 10,
7
2023 (the effective date of Public Act 102-1116) and the
8
renewal of contracts that are in effect on January 10,
9
2023 (the effective date of Public Act 102-1116).
10
(22) Contracts for project management services and
11
system integration services required for the completion of
12
the State's enterprise resource planning project. This
13
exemption becomes inoperative 5 years after June 7, 2023
14
(the effective date of the changes made to this Section by
15
Public Act 103-8). This paragraph (22) applies to
16
contracts entered into on or after June 7, 2023 (the
17
effective date of the changes made to this Section by
18
Public Act 103-8) and the renewal of contracts that are in
19
effect on June 7, 2023 (the effective date of the changes
20
made to this Section by Public Act 103-8).
21
(23) Procurements necessary for the Department of
22
Insurance to implement the Illinois Health Benefits
23
Exchange Law if the Department of Insurance has made a
24
good faith determination that it is necessary and
25
appropriate for the expenditure to fall within this
26
exemption. The procurement process shall be conducted in a
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manner substantially in accordance with the requirements
2
of Sections 20-160 and 25-60 and Article 50 of this Code. A
3
copy of these contracts shall be made available to the
4
Chief Procurement Officer immediately upon request. This
5
paragraph is inoperative 5 years after June 27, 2023 (the
6
effective date of Public Act 103-103).
7
(24) Contracts for public education programming,
8
noncommercial sustaining announcements, public service
9
announcements, and public awareness and education
10
messaging with the nonprofit trade associations of the
11
providers of those services that inform the public on
12
immediate and ongoing health and safety risks and hazards.
13
(25) Procurements necessary for the Department of
14
Early Childhood to implement the Department of Early
15
Childhood Act if the Department has made a good faith
16
determination that it is necessary and appropriate for the
17
expenditure to fall within this exemption. This exemption
18
shall only be used for products and services procured
19
solely for use by the Department of Early Childhood. The
20
procurements may include those necessary to design and
21
build integrated, operational systems of programs and
22
services. The procurements may include, but are not
23
limited to, those necessary to align and update program
24
standards, integrate funding systems, design and establish
25
data and reporting systems, align and update models for
26
technical assistance and professional development, design
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systems to manage grants and ensure compliance, design and
2
implement management and operational structures, and
3
establish new means of engaging with families, educators,
4
providers, and stakeholders. The procurement processes
5
shall be conducted in a manner substantially in accordance
6
with the requirements of Article 50 (ethics) and Sections
7
5-5 (Procurement Policy Board), 5-7 (Commission on Equity
8
and Inclusion), 20-80 (contract files), 20-120
9
(subcontractors), 20-155 (paperwork), 20-160
10
(ethics/campaign contribution prohibitions), 25-60
11
(prevailing wage), and 25-90 (prohibited and authorized
12
cybersecurity) of this Code. Beginning January 1, 2025,
13
the Department of Early Childhood shall provide a
14
quarterly report to the General Assembly detailing a list
15
of expenditures and contracts for which the Department
16
uses this exemption. This paragraph is inoperative on and
17
after July 1, 2027.
18
(26) Procurements that are necessary for increasing
19
the recruitment and retention of State employees,
20
particularly minority candidates for employment,
21
including:
22
(A) procurements related to registration fees for
23
job fairs and other outreach and recruitment events;
24
(B) production of recruitment materials; and
25
(C) other services related to recruitment and
26
retention of State employees.
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The exemption under this paragraph (26) applies only
2
if the State agency has made a good faith determination
3
that it is necessary and appropriate for the expenditure
4
to fall within this paragraph (26). The procurement
5
process under this paragraph (26) shall be conducted in a
6
manner substantially in accordance with the requirements
7
of Sections 20-160 and 25-60 and Article 50 of this Code. A
8
copy of these contracts shall be made available to the
9
Chief Procurement Officer immediately upon request.
10
Nothing in this paragraph (26) authorizes the replacement
11
or diminishment of State responsibilities in hiring or the
12
positions that effectuate that hiring. This paragraph (26)
13
is inoperative on and after June 30, 2029.
14
(27) Procurements necessary for the Department of
15
Healthcare and Family Services to implement changes to the
16
State's Integrated Eligibility System to ensure the
17
system's compliance with federal implementation mandates
18
and deadlines, if the Department of Healthcare and Family
19
Services has made a good faith determination that it is
20
necessary and appropriate for the procurement to fall
21
within this exemption.
22
Notwithstanding any other provision of law, for contracts
23
with an annual value of more than $100,000 entered into on or
24
after October 1, 2017 under an exemption provided in any
25
paragraph of this subsection (b), except paragraph (1), (2),
26
or (5), each State agency shall post to the appropriate
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procurement bulletin the name of the contractor, a description
2
of the supply or service provided, the total amount of the
3
contract, the term of the contract, and the exception to the
4
Code utilized. The chief procurement officer shall submit a
5
report to the Governor and General Assembly no later than
6
November 1 of each year that shall include, at a minimum, an
7
annual summary of the monthly information reported to the
8
chief procurement officer.
9
(c) This Code does not apply to the electric power
10
procurement process provided for under Section 1-75 of the
11
Illinois Power Agency Act and Section 16-111.5 of the Public
12
Utilities Act. This Code does not apply to the procurement of
13
technical and policy experts pursuant to Section 1-129 of the
14
Illinois Power Agency Act.
15
(d) Except for Section 20-160 and Article 50 of this Code,
16
and as expressly required by Section 9.1 of the Illinois
17
Lottery Law, the provisions of this Code do not apply to the
18
procurement process provided for under Section 9.1 of the
19
Illinois Lottery Law.
20
(e) This Code does not apply to the process used by the
21
Capital Development Board to retain a person or entity to
22
assist the Capital Development Board with its duties related
23
to the determination of costs of a clean coal SNG brownfield
24
facility, as defined by Section 1-10 of the Illinois Power
25
Agency Act, as required in subsection (h-3) of Section 9-220
26
of the Public Utilities Act, including calculating the range
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of capital costs, the range of operating and maintenance
2
costs, or the sequestration costs or monitoring the
3
construction of clean coal SNG brownfield facility for the
4
full duration of construction.
5
(f) (Blank).
6
(g) (Blank).
7
(h) This Code does not apply to the process to procure or
8
contracts entered into in accordance with Sections 11-5.2 and
9
11-5.3 of the Illinois Public Aid Code.
10
(i) Each chief procurement officer may access records
11
necessary to review whether a contract, purchase, or other
12
expenditure is or is not subject to the provisions of this
13
Code, unless such records would be subject to attorney-client
14
privilege.
15
(j) This Code does not apply to the process used by the
16
Capital Development Board to retain an artist or work or works
17
of art as required in Section 14 of the Capital Development
18
Board Act.
19
(k) This Code does not apply to the process to procure
20
contracts, or contracts entered into, by the State Board of
21
Elections or the State Electoral Board for hearing officers
22
appointed pursuant to the Election Code.
23
(l) This Code does not apply to the processes used by the
24
Illinois Student Assistance Commission to procure supplies and
25
services paid for from the private funds of the Illinois
26
Prepaid Tuition Fund. As used in this subsection (l), "private
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funds" means funds derived from deposits paid into the
2
Illinois Prepaid Tuition Trust Fund and the earnings thereon.
3
(m) This Code shall apply regardless of the source of
4
funds with which contracts are paid, including federal
5
assistance moneys. Except as specifically provided in this
6
Code, this Code shall not apply to procurement expenditures
7
necessary for the Department of Public Health to conduct the
8
Healthy Illinois Survey in accordance with Section 2310-431 of
9
the Department of Public Health Powers and Duties Law of the
10
Civil Administrative Code of Illinois.
11
(Source: P.A. 103-8, eff. 6-7-23; 103-103, eff. 6-27-23;
12
103-570, eff. 1-1-24; 103-580, eff. 12-8-23; 103-594, eff.
13
6-25-24; 103-605, eff. 7-1-24; 103-865, eff. 1-1-25; 104-2,
14
eff. 6-16-25; 104-417, eff. 8-15-25; 104-458, eff. 6-1-26;
15
revised 1-12-26.)
16
Section 15.
The Illinois Public Aid Code is amended by
17
changing Section 5-5 as follows:
18
(305 ILCS 5/5-5)
19
Sec. 5-5.
Medical services.
The Illinois Department, by
20
rule, shall determine the quantity and quality of and the rate
21
of reimbursement for the medical assistance for which payment
22
will be authorized, and the medical services to be provided,
23
which may include all or part of the following: (1) inpatient
24
hospital services; (2) outpatient hospital services; (3) other
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laboratory and X-ray services; (4) skilled nursing home
2
services; (5) physicians' services whether furnished in the
3
office, the patient's home, a hospital, a skilled nursing
4
home, or elsewhere; (6) medical care, or any other type of
5
remedial care furnished by licensed practitioners; (7) home
6
health care services; (8) private duty nursing service; (9)
7
clinic services; (10) dental services, including prevention
8
and treatment of periodontal disease and dental caries disease
9
for pregnant individuals, provided by an individual licensed
10
to practice dentistry or dental surgery; for purposes of this
11
item (10), "dental services" means diagnostic, preventive, or
12
corrective procedures provided by or under the supervision of
13
a dentist in the practice of his or her profession; (11)
14
physical therapy and related services; (12) prescribed drugs,
15
dentures, and prosthetic devices; and eyeglasses prescribed by
16
a physician skilled in the diseases of the eye, or by an
17
optometrist, whichever the person may select; (13) other
18
diagnostic, screening, preventive, and rehabilitative
19
services, including to ensure that the individual's need for
20
intervention or treatment of mental disorders or substance use
21
disorders or co-occurring mental health and substance use
22
disorders is determined using a uniform screening, assessment,
23
and evaluation process inclusive of criteria, for children and
24
adults; for purposes of this item (13), a uniform screening,
25
assessment, and evaluation process refers to a process that
26
includes an appropriate evaluation and, as warranted, a
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referral; "uniform" does not mean the use of a singular
2
instrument, tool, or process that all must utilize; (14)
3
transportation and such other expenses as may be necessary;
4
(15) medical treatment of sexual assault survivors, as defined
5
in Section 1a of the Sexual Assault Survivors Emergency
6
Treatment Act, for injuries sustained as a result of the
7
sexual assault, including examinations and laboratory tests to
8
discover evidence which may be used in criminal proceedings
9
arising from the sexual assault; (16) the diagnosis and
10
treatment of sickle cell anemia; (16.5) services performed by
11
a chiropractic physician licensed under the Medical Practice
12
Act of 1987 and acting within the scope of his or her license,
13
including, but not limited to, chiropractic manipulative
14
treatment; and (17) any other medical care, and any other type
15
of remedial care recognized under the laws of this State. The
16
term "any other type of remedial care" shall include nursing
17
care and nursing home service for persons who rely on
18
treatment by spiritual means alone through prayer for healing.
19
Notwithstanding any other provision of this Section, a
20
comprehensive tobacco use cessation program that includes
21
purchasing prescription drugs or prescription medical devices
22
approved by the Food and Drug Administration shall be covered
23
under the medical assistance program under this Article for
24
persons who are otherwise eligible for assistance under this
25
Article.
26
Notwithstanding any other provision of this Code,
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reproductive health care that is otherwise legal in Illinois
2
shall be covered under the medical assistance program for
3
persons who are otherwise eligible for medical assistance
4
under this Article.
5
Notwithstanding any other provision of this Section, all
6
tobacco cessation medications approved by the United States
7
Food and Drug Administration and all individual and group
8
tobacco cessation counseling services and telephone-based
9
counseling services and tobacco cessation medications provided
10
through the Illinois Tobacco Quitline shall be covered under
11
the medical assistance program for persons who are otherwise
12
eligible for assistance under this Article. The Department
13
shall comply with all federal requirements necessary to obtain
14
federal financial participation, as specified in 42 CFR
15
433.15(b)(7), for telephone-based counseling services provided
16
through the Illinois Tobacco Quitline, including, but not
17
limited to: (i) entering into a memorandum of understanding or
18
interagency agreement with the Department of Public Health, as
19
administrator of the Illinois Tobacco Quitline; and (ii)
20
developing a cost allocation plan for Medicaid-allowable
21
Illinois Tobacco Quitline services in accordance with 45 CFR
22
95.507. The Department shall submit the memorandum of
23
understanding or interagency agreement, the cost allocation
24
plan, and all other necessary documentation to the Centers for
25
Medicare and Medicaid Services for review and approval.
26
Coverage under this paragraph shall be contingent upon federal
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approval.
2
Notwithstanding any other provision of this Code, the
3
Illinois Department may not require, as a condition of payment
4
for any laboratory test authorized under this Article, that a
5
physician's handwritten signature appear on the laboratory
6
test order form. The Illinois Department may, however, impose
7
other appropriate requirements regarding laboratory test order
8
documentation.
9
Upon receipt of federal approval of an amendment to the
10
Illinois Title XIX State Plan for this purpose, the Department
11
shall authorize the Chicago Public Schools (CPS) to procure a
12
vendor or vendors to manufacture eyeglasses for individuals
13
enrolled in a school within the CPS system. CPS shall ensure
14
that its vendor or vendors are enrolled as providers in the
15
medical assistance program and in any capitated Medicaid
16
managed care entity (MCE) serving individuals enrolled in a
17
school within the CPS system. Under any contract procured
18
under this provision, the vendor or vendors must serve only
19
individuals enrolled in a school within the CPS system. Claims
20
for services provided by CPS's vendor or vendors to recipients
21
of benefits in the medical assistance program under this Code,
22
the Children's Health Insurance Program, or the Covering ALL
23
KIDS Health Insurance Program shall be submitted to the
24
Department or the MCE in which the individual is enrolled for
25
payment and shall be reimbursed at the Department's or the
26
MCE's established rates or rate methodologies for eyeglasses.
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On and after July 1, 2012, the Department of Healthcare
2
and Family Services may provide the following services to
3
persons eligible for assistance under this Article who are
4
participating in education, training or employment programs
5
operated by the Department of Human Services as successor to
6
the Department of Public Aid:
7
(1) dental services provided by or under the
8
supervision of a dentist; and
9
(2) eyeglasses prescribed by a physician skilled in
10
the diseases of the eye, or by an optometrist, whichever
11
the person may select.
12
On and after July 1, 2018, the Department of Healthcare
13
and Family Services shall provide dental services to any adult
14
who is otherwise eligible for assistance under the medical
15
assistance program. As used in this paragraph, "dental
16
services" means diagnostic, preventative, restorative, or
17
corrective procedures, including procedures and services for
18
the prevention and treatment of periodontal disease and dental
19
caries disease, provided by an individual who is licensed to
20
practice dentistry or dental surgery or who is under the
21
supervision of a dentist in the practice of his or her
22
profession.
23
On and after July 1, 2018, targeted dental services, as
24
set forth in Exhibit D of the Consent Decree entered by the
25
United States District Court for the Northern District of
26
Illinois, Eastern Division, in the matter of Memisovski v.
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Maram, Case No. 92 C 1982, that are provided to adults under
2
the medical assistance program shall be established at no less
3
than the rates set forth in the "New Rate" column in Exhibit D
4
of the Consent Decree for targeted dental services that are
5
provided to persons under the age of 18 under the medical
6
assistance program.
7
Subject to federal approval, on and after January 1, 2025,
8
the rates paid for sedation evaluation and the provision of
9
deep sedation and intravenous sedation for the purpose of
10
dental services shall be increased by 33% above the rates in
11
effect on December 31, 2024. The rates paid for nitrous oxide
12
sedation shall not be impacted by this paragraph and shall
13
remain the same as the rates in effect on December 31, 2024.
14
Notwithstanding any other provision of this Code and
15
subject to federal approval, the Department may adopt rules to
16
allow a dentist who is volunteering his or her service at no
17
cost to render dental services through an enrolled
18
not-for-profit health clinic without the dentist personally
19
enrolling as a participating provider in the medical
20
assistance program. A not-for-profit health clinic shall
21
include a public health clinic or Federally Qualified Health
22
Center or other enrolled provider, as determined by the
23
Department, through which dental services covered under this
24
Section are performed. The Department shall establish a
25
process for payment of claims for reimbursement for covered
26
dental services rendered under this provision.
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Subject to appropriation and to federal approval, the
2
Department shall file administrative rules updating the
3
Handicapping Labio-Lingual Deviation orthodontic scoring tool
4
by January 1, 2025, or as soon as practicable.
5
On and after January 1, 2022, the Department of Healthcare
6
and Family Services shall administer and regulate a
7
school-based dental program that allows for the out-of-office
8
delivery of preventative dental services in a school setting
9
to children under 19 years of age. The Department shall
10
establish, by rule, guidelines for participation by providers
11
and set requirements for follow-up referral care based on the
12
requirements established in the Dental Office Reference Manual
13
published by the Department that establishes the requirements
14
for dentists participating in the All Kids Dental School
15
Program. Every effort shall be made by the Department when
16
developing the program requirements to consider the different
17
geographic differences of both urban and rural areas of the
18
State for initial treatment and necessary follow-up care. No
19
provider shall be charged a fee by any unit of local government
20
to participate in the school-based dental program administered
21
by the Department. Nothing in this paragraph shall be
22
construed to limit or preempt a home rule unit's or school
23
district's authority to establish, change, or administer a
24
school-based dental program in addition to, or independent of,
25
the school-based dental program administered by the
26
Department.
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The Illinois Department, by rule, may distinguish and
2
classify the medical services to be provided only in
3
accordance with the classes of persons designated in Section
4
5-2.
5
The Department of Healthcare and Family Services must
6
provide coverage and reimbursement for amino acid-based
7
elemental formulas, regardless of delivery method, for the
8
diagnosis and treatment of (i) eosinophilic disorders and (ii)
9
short bowel syndrome when the prescribing physician has issued
10
a written order stating that the amino acid-based elemental
11
formula is medically necessary.
12
The Illinois Department shall authorize the provision of,
13
and shall authorize payment for, screening by low-dose
14
mammography for the presence of occult breast cancer for
15
individuals 35 years of age or older who are eligible for
16
medical assistance under this Article, as follows:
17
(A) A baseline mammogram for individuals 35 to 39
18
years of age.
19
(B) An annual mammogram for individuals 40 years of
20
age or older.
21
(C) A mammogram at the age and intervals considered
22
medically necessary by the individual's health care
23
provider for individuals under 40 years of age and having
24
a family history of breast cancer, prior personal history
25
of breast cancer, positive genetic testing, or other risk
26
factors.
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(D) A comprehensive ultrasound screening and MRI of an
2
entire breast or breasts if a mammogram demonstrates
3
heterogeneous or dense breast tissue or when medically
4
necessary as determined by a physician licensed to
5
practice medicine in all of its branches.
6
(E) A screening MRI when medically necessary, as
7
determined by a physician licensed to practice medicine in
8
all of its branches.
9
(F) A diagnostic mammogram when medically necessary,
10
as determined by a physician licensed to practice medicine
11
in all its branches, advanced practice registered nurse,
12
or physician assistant.
13
(G) Molecular breast imaging (MBI) and MRI of an
14
entire breast or breasts if a mammogram demonstrates
15
heterogeneous or dense breast tissue or when medically
16
necessary as determined by a physician licensed to
17
practice medicine in all of its branches, advanced
18
practice registered nurse, or physician assistant.
19
The Department shall not impose a deductible, coinsurance,
20
copayment, or any other cost-sharing requirement on the
21
coverage provided under this paragraph; except that this
22
sentence does not apply to coverage of diagnostic mammograms
23
to the extent such coverage would disqualify a high-deductible
24
health plan from eligibility for a health savings account
25
pursuant to Section 223 of the Internal Revenue Code (26
26
U.S.C. 223).
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All screenings shall include a physical breast exam,
2
instruction on self-examination and information regarding the
3
frequency of self-examination and its value as a preventative
4
tool.
5
For purposes of this Section:
6
"Diagnostic mammogram" means a mammogram obtained using
7
diagnostic mammography.
8
"Diagnostic mammography" means a method of screening that
9
is designed to evaluate an abnormality in a breast, including
10
an abnormality seen or suspected on a screening mammogram or a
11
subjective or objective abnormality otherwise detected in the
12
breast.
13
"Low-dose mammography" means the x-ray examination of the
14
breast using equipment dedicated specifically for mammography,
15
including the x-ray tube, filter, compression device, and
16
image receptor, with an average radiation exposure delivery of
17
less than one rad per breast for 2 views of an average size
18
breast. The term also includes digital mammography and
19
includes breast tomosynthesis.
20
"Breast tomosynthesis" means a radiologic procedure that
21
involves the acquisition of projection images over the
22
stationary breast to produce cross-sectional digital
23
three-dimensional images of the breast.
24
If, at any time, the Secretary of the United States
25
Department of Health and Human Services, or its successor
26
agency, promulgates rules or regulations to be published in
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the Federal Register or publishes a comment in the Federal
2
Register or issues an opinion, guidance, or other action that
3
would require the State, pursuant to any provision of the
4
Patient Protection and Affordable Care Act (Public Law
5
111-148), including, but not limited to, 42 U.S.C.
6
18031(d)(3)(B) or any successor provision, to defray the cost
7
of any coverage for breast tomosynthesis outlined in this
8
paragraph, then the requirement that an insurer cover breast
9
tomosynthesis is inoperative other than any such coverage
10
authorized under Section 1902 of the Social Security Act, 42
11
U.S.C. 1396a, and the State shall not assume any obligation
12
for the cost of coverage for breast tomosynthesis set forth in
13
this paragraph.
14
On and after January 1, 2016, the Department shall ensure
15
that all networks of care for adult clients of the Department
16
include access to at least one breast imaging Center of
17
Imaging Excellence as certified by the American College of
18
Radiology.
19
On and after January 1, 2012, providers participating in a
20
quality improvement program approved by the Department shall
21
be reimbursed for screening and diagnostic mammography at the
22
same rate as the Medicare program's rates, including the
23
increased reimbursement for digital mammography and, after
24
January 1, 2023 (the effective date of Public Act 102-1018),
25
breast tomosynthesis.
26
The Department shall convene an expert panel including
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representatives of hospitals, free-standing mammography
2
facilities, and doctors, including radiologists, to establish
3
quality standards for mammography.
4
On and after January 1, 2017, providers participating in a
5
breast cancer treatment quality improvement program approved
6
by the Department shall be reimbursed for breast cancer
7
treatment at a rate that is no lower than 95% of the Medicare
8
program's rates for the data elements included in the breast
9
cancer treatment quality program.
10
The Department shall convene an expert panel, including
11
representatives of hospitals, free-standing breast cancer
12
treatment centers, breast cancer quality organizations, and
13
doctors, including radiologists that are trained in all forms
14
of FDA-approved breast imaging technologies, breast surgeons,
15
reconstructive breast surgeons, oncologists, and primary care
16
providers to establish quality standards for breast cancer
17
treatment.
18
Subject to federal approval, the Department shall
19
establish a rate methodology for mammography at federally
20
qualified health centers and other encounter-rate clinics.
21
These clinics or centers may also collaborate with other
22
hospital-based mammography facilities. By January 1, 2016, the
23
Department shall report to the General Assembly on the status
24
of the provision set forth in this paragraph.
25
The Department shall establish a methodology to remind
26
individuals who are age-appropriate for screening mammography,
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but who have not received a mammogram within the previous 18
2
months, of the importance and benefit of screening
3
mammography. The Department shall work with experts in breast
4
cancer outreach and patient navigation to optimize these
5
reminders and shall establish a methodology for evaluating
6
their effectiveness and modifying the methodology based on the
7
evaluation.
8
The Department shall establish a performance goal for
9
primary care providers with respect to their female patients
10
over age 40 receiving an annual mammogram. This performance
11
goal shall be used to provide additional reimbursement in the
12
form of a quality performance bonus to primary care providers
13
who meet that goal.
14
The Department shall devise a means of case-managing or
15
patient navigation for beneficiaries diagnosed with breast
16
cancer. This program shall initially operate as a pilot
17
program in areas of the State with the highest incidence of
18
mortality related to breast cancer. At least one pilot program
19
site shall be in the metropolitan Chicago area and at least one
20
site shall be outside the metropolitan Chicago area. On or
21
after July 1, 2016, the pilot program shall be expanded to
22
include one site in western Illinois, one site in southern
23
Illinois, one site in central Illinois, and 4 sites within
24
metropolitan Chicago. An evaluation of the pilot program shall
25
be carried out measuring health outcomes and cost of care for
26
those served by the pilot program compared to similarly
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situated patients who are not served by the pilot program.
2
The Department shall require all networks of care to
3
develop a means either internally or by contract with experts
4
in navigation and community outreach to navigate cancer
5
patients to comprehensive care in a timely fashion. The
6
Department shall require all networks of care to include
7
access for patients diagnosed with cancer to at least one
8
academic commission on cancer-accredited cancer program as an
9
in-network covered benefit.
10
The Department shall provide coverage and reimbursement
11
for a human papillomavirus (HPV) vaccine that is approved for
12
marketing by the federal Food and Drug Administration for all
13
persons between the ages of 9 and 45. Subject to federal
14
approval, the Department shall provide coverage and
15
reimbursement for a human papillomavirus (HPV) vaccine for
16
persons of the age of 46 and above who have been diagnosed with
17
cervical dysplasia with a high risk of recurrence or
18
progression. The Department shall disallow any
19
preauthorization requirements for the administration of the
20
human papillomavirus (HPV) vaccine.
21
On or after July 1, 2022, individuals who are otherwise
22
eligible for medical assistance under this Article shall
23
receive coverage for perinatal depression screenings for the
24
12-month period beginning on the last day of their pregnancy.
25
Medical assistance coverage under this paragraph shall be
26
conditioned on the use of a screening instrument approved by
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the Department.
2
Any medical or health care provider shall immediately
3
recommend, to any pregnant individual who is being provided
4
prenatal services and is suspected of having a substance use
5
disorder as defined in the Substance Use Disorder Act,
6
referral to a local substance use disorder treatment program
7
licensed by the Department of Human Services or to a licensed
8
hospital which provides substance abuse treatment services.
9
The Department of Healthcare and Family Services shall assure
10
coverage for the cost of treatment of the drug abuse or
11
addiction for pregnant recipients in accordance with the
12
Illinois Medicaid Program in conjunction with the Department
13
of Human Services.
14
All medical providers providing medical assistance to
15
pregnant individuals under this Code shall receive information
16
from the Department on the availability of services under any
17
program providing case management services for addicted
18
individuals, including information on appropriate referrals
19
for other social services that may be needed by addicted
20
individuals in addition to treatment for addiction.
21
The Illinois Department, in cooperation with the
22
Departments of Human Services (as successor to the Department
23
of Alcoholism and Substance Abuse) and Public Health, through
24
a public awareness campaign, may provide information
25
concerning treatment for alcoholism and drug abuse and
26
addiction, prenatal health care, and other pertinent programs
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directed at reducing the number of drug-affected infants born
2
to recipients of medical assistance.
3
Neither the Department of Healthcare and Family Services
4
nor the Department of Human Services shall sanction the
5
recipient solely on the basis of the recipient's substance
6
abuse.
7
The Illinois Department shall establish such regulations
8
governing the dispensing of health services under this Article
9
as it shall deem appropriate. The Department should seek the
10
advice of formal professional advisory committees appointed by
11
the Director of the Illinois Department for the purpose of
12
providing regular advice on policy and administrative matters,
13
information dissemination and educational activities for
14
medical and health care providers, and consistency in
15
procedures to the Illinois Department.
16
The Illinois Department may develop and contract with
17
Partnerships of medical providers to arrange medical services
18
for persons eligible under Section 5-2 of this Code.
19
Implementation of this Section may be by demonstration
20
projects in certain geographic areas. The Partnership shall be
21
represented by a sponsor organization. The Department, by
22
rule, shall develop qualifications for sponsors of
23
Partnerships. Nothing in this Section shall be construed to
24
require that the sponsor organization be a medical
25
organization.
26
The sponsor must negotiate formal written contracts with
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medical providers for physician services, inpatient and
2
outpatient hospital care, home health services, treatment for
3
alcoholism and substance abuse, and other services determined
4
necessary by the Illinois Department by rule for delivery by
5
Partnerships. Physician services must include prenatal and
6
obstetrical care. The Illinois Department shall reimburse
7
medical services delivered by Partnership providers to clients
8
in target areas according to provisions of this Article and
9
the Illinois Health Finance Reform Act, except that:
10
(1) Physicians participating in a Partnership and
11
providing certain services, which shall be determined by
12
the Illinois Department, to persons in areas covered by
13
the Partnership may receive an additional surcharge for
14
such services.
15
(2) The Department may elect to consider and negotiate
16
financial incentives to encourage the development of
17
Partnerships and the efficient delivery of medical care.
18
(3) Persons receiving medical services through
19
Partnerships may receive medical and case management
20
services above the level usually offered through the
21
medical assistance program.
22
Medical providers shall be required to meet certain
23
qualifications to participate in Partnerships to ensure the
24
delivery of high quality medical services. These
25
qualifications shall be determined by rule of the Illinois
26
Department and may be higher than qualifications for
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participation in the medical assistance program. Partnership
2
sponsors may prescribe reasonable additional qualifications
3
for participation by medical providers, only with the prior
4
written approval of the Illinois Department.
5
Nothing in this Section shall limit the free choice of
6
practitioners, hospitals, and other providers of medical
7
services by clients. In order to ensure patient freedom of
8
choice, the Illinois Department shall immediately promulgate
9
all rules and take all other necessary actions so that
10
provided services may be accessed from therapeutically
11
certified optometrists to the full extent of the Illinois
12
Optometric Practice Act of 1987 without discriminating between
13
service providers.
14
The Department shall apply for a waiver from the United
15
States Health Care Financing Administration to allow for the
16
implementation of Partnerships under this Section.
17
The Illinois Department shall require health care
18
providers to maintain records that document the medical care
19
and services provided to recipients of Medical Assistance
20
under this Article. Such records must be retained for a period
21
of not less than 6 years from the date of service or as
22
provided by applicable State law, whichever period is longer,
23
except that if an audit is initiated within the required
24
retention period then the records must be retained until the
25
audit is completed and every exception is resolved. The
26
Illinois Department shall require health care providers to
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make available, when authorized by the patient, in writing,
2
the medical records in a timely fashion to other health care
3
providers who are treating or serving persons eligible for
4
Medical Assistance under this Article. All dispensers of
5
medical services shall be required to maintain and retain
6
business and professional records sufficient to fully and
7
accurately document the nature, scope, details and receipt of
8
the health care provided to persons eligible for medical
9
assistance under this Code, in accordance with regulations
10
promulgated by the Illinois Department. The rules and
11
regulations shall require that proof of the receipt of
12
prescription drugs, dentures, prosthetic devices and
13
eyeglasses by eligible persons under this Section accompany
14
each claim for reimbursement submitted by the dispenser of
15
such medical services. No such claims for reimbursement shall
16
be approved for payment by the Illinois Department without
17
such proof of receipt, unless the Illinois Department shall
18
have put into effect and shall be operating a system of
19
post-payment audit and review which shall, on a sampling
20
basis, be deemed adequate by the Illinois Department to assure
21
that such drugs, dentures, prosthetic devices and eyeglasses
22
for which payment is being made are actually being received by
23
eligible recipients. Within 90 days after September 16, 1984
24
(the effective date of Public Act 83-1439), the Illinois
25
Department shall establish a current list of acquisition costs
26
for all prosthetic devices and any other items recognized as
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medical equipment and supplies reimbursable under this Article
2
and shall update such list on a quarterly basis, except that
3
the acquisition costs of all prescription drugs shall be
4
updated no less frequently than every 30 days as required by
5
Section 5-5.12.
6
Notwithstanding any other law to the contrary, the
7
Illinois Department shall, within 365 days after July 22, 2013
8
(the effective date of Public Act 98-104), establish
9
procedures to permit skilled care facilities licensed under
10
the Nursing Home Care Act to submit monthly billing claims for
11
reimbursement purposes. Following development of these
12
procedures, the Department shall, by July 1, 2016, test the
13
viability of the new system and implement any necessary
14
operational or structural changes to its information
15
technology platforms in order to allow for the direct
16
acceptance and payment of nursing home claims.
17
Notwithstanding any other law to the contrary, the
18
Illinois Department shall, within 365 days after August 15,
19
2014 (the effective date of Public Act 98-963), establish
20
procedures to permit ID/DD facilities licensed under the ID/DD
21
Community Care Act and MC/DD facilities licensed under the
22
MC/DD Act to submit monthly billing claims for reimbursement
23
purposes. Following development of these procedures, the
24
Department shall have an additional 365 days to test the
25
viability of the new system and to ensure that any necessary
26
operational or structural changes to its information
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technology platforms are implemented.
2
The Illinois Department shall require all dispensers of
3
medical services, other than an individual practitioner or
4
group of practitioners, desiring to participate in the Medical
5
Assistance program established under this Article to disclose
6
all financial, beneficial, ownership, equity, surety or other
7
interests in any and all firms, corporations, partnerships,
8
associations, business enterprises, joint ventures, agencies,
9
institutions or other legal entities providing any form of
10
health care services in this State under this Article.
11
The Illinois Department may require that all dispensers of
12
medical services desiring to participate in the medical
13
assistance program established under this Article disclose,
14
under such terms and conditions as the Illinois Department may
15
by rule establish, all inquiries from clients and attorneys
16
regarding medical bills paid by the Illinois Department, which
17
inquiries could indicate potential existence of claims or
18
liens for the Illinois Department.
19
Enrollment of a vendor shall be subject to a provisional
20
period and shall be conditional for one year. During the
21
period of conditional enrollment, the Department may terminate
22
the vendor's eligibility to participate in, or may disenroll
23
the vendor from, the medical assistance program without cause.
24
Unless otherwise specified, such termination of eligibility or
25
disenrollment is not subject to the Department's hearing
26
process. However, a disenrolled vendor may reapply without
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1
penalty.
2
The Department has the discretion to limit the conditional
3
enrollment period for vendors based upon the category of risk
4
of the vendor.
5
Prior to enrollment and during the conditional enrollment
6
period in the medical assistance program, all vendors shall be
7
subject to enhanced oversight, screening, and review based on
8
the risk of fraud, waste, and abuse that is posed by the
9
category of risk of the vendor. The Illinois Department shall
10
establish the procedures for oversight, screening, and review,
11
which may include, but need not be limited to: criminal and
12
financial background checks; fingerprinting; license,
13
certification, and authorization verifications; unscheduled or
14
unannounced site visits; database checks; prepayment audit
15
reviews; audits; payment caps; payment suspensions; and other
16
screening as required by federal or State law.
17
The Department shall define or specify the following: (i)
18
by provider notice, the "category of risk of the vendor" for
19
each type of vendor, which shall take into account the level of
20
screening applicable to a particular category of vendor under
21
federal law and regulations; (ii) by rule or provider notice,
22
the maximum length of the conditional enrollment period for
23
each category of risk of the vendor; and (iii) by rule, the
24
hearing rights, if any, afforded to a vendor in each category
25
of risk of the vendor that is terminated or disenrolled during
26
the conditional enrollment period.
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To be eligible for payment consideration, a vendor's
2
payment claim or bill, either as an initial claim or as a
3
resubmitted claim following prior rejection, must be received
4
by the Illinois Department, or its fiscal intermediary, no
5
later than 180 days after the latest date on the claim on which
6
medical goods or services were provided, with the following
7
exceptions:
8
(1) In the case of a provider whose enrollment is in
9
process by the Illinois Department, the 180-day period
10
shall not begin until the date on the written notice from
11
the Illinois Department that the provider enrollment is
12
complete.
13
(2) In the case of errors attributable to the Illinois
14
Department or any of its claims processing intermediaries
15
which result in an inability to receive, process, or
16
adjudicate a claim, the 180-day period shall not begin
17
until the provider has been notified of the error.
18
(3) In the case of a provider for whom the Illinois
19
Department initiates the monthly billing process.
20
(4) In the case of a provider operated by a unit of
21
local government with a population exceeding 3,000,000
22
when local government funds finance federal participation
23
for claims payments.
24
For claims for services rendered during a period for which
25
a recipient received retroactive eligibility, claims must be
26
filed within 180 days after the Department determines the
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applicant is eligible. For claims for which the Illinois
2
Department is not the primary payer, claims must be submitted
3
to the Illinois Department within 180 days after the final
4
adjudication by the primary payer.
5
In the case of long term care facilities, within 120
6
calendar days of receipt by the facility of required
7
prescreening information, new admissions with associated
8
admission documents shall be submitted through the Medical
9
Electronic Data Interchange (MEDI) or the Recipient
10
Eligibility Verification (REV) System or shall be submitted
11
directly to the Department of Human Services using required
12
admission forms. Effective September 1, 2014, admission
13
documents, including all prescreening information, must be
14
submitted through MEDI or REV. Confirmation numbers assigned
15
to an accepted transaction shall be retained by a facility to
16
verify timely submittal. Once an admission transaction has
17
been completed, all resubmitted claims following prior
18
rejection are subject to receipt no later than 180 days after
19
the admission transaction has been completed.
20
Claims that are not submitted and received in compliance
21
with the foregoing requirements shall not be eligible for
22
payment under the medical assistance program, and the State
23
shall have no liability for payment of those claims.
24
To the extent consistent with applicable information and
25
privacy, security, and disclosure laws, State and federal
26
agencies and departments shall provide the Illinois Department
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access to confidential and other information and data
2
necessary to perform eligibility and payment verifications and
3
other Illinois Department functions. This includes, but is not
4
limited to: information pertaining to licensure;
5
certification; earnings; immigration status; citizenship; wage
6
reporting; unearned and earned income; pension income;
7
employment; supplemental security income; social security
8
numbers; National Provider Identifier (NPI) numbers; the
9
National Practitioner Data Bank (NPDB); program and agency
10
exclusions; taxpayer identification numbers; tax delinquency;
11
corporate information; and death records.
12
The Illinois Department shall enter into agreements with
13
State agencies and departments, and is authorized to enter
14
into agreements with federal agencies and departments, under
15
which such agencies and departments shall share data necessary
16
for medical assistance program integrity functions and
17
oversight. The Illinois Department shall develop, in
18
cooperation with other State departments and agencies, and in
19
compliance with applicable federal laws and regulations,
20
appropriate and effective methods to share such data. At a
21
minimum, and to the extent necessary to provide data sharing,
22
the Illinois Department shall enter into agreements with State
23
agencies and departments, and is authorized to enter into
24
agreements with federal agencies and departments, including,
25
but not limited to: the Secretary of State; the Department of
26
Revenue; the Department of Public Health; the Department of
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Human Services; and the Department of Financial and
2
Professional Regulation.
3
Beginning in fiscal year 2013, the Illinois Department
4
shall set forth a request for information to identify the
5
benefits of a pre-payment, post-adjudication, and post-edit
6
claims system with the goals of streamlining claims processing
7
and provider reimbursement, reducing the number of pending or
8
rejected claims, and helping to ensure a more transparent
9
adjudication process through the utilization of: (i) provider
10
data verification and provider screening technology; and (ii)
11
clinical code editing; and (iii) pre-pay, pre-adjudicated, or
12
post-adjudicated predictive modeling with an integrated case
13
management system with link analysis. Such a request for
14
information shall not be considered as a request for proposal
15
or as an obligation on the part of the Illinois Department to
16
take any action or acquire any products or services.
17
The Illinois Department shall establish policies,
18
procedures, standards and criteria by rule for the
19
acquisition, repair and replacement of orthotic and prosthetic
20
devices and durable medical equipment. Such rules shall
21
provide, but not be limited to, the following services: (1)
22
immediate repair or replacement of such devices by recipients;
23
and (2) rental, lease, purchase or lease-purchase of durable
24
medical equipment in a cost-effective manner, taking into
25
consideration the recipient's medical prognosis, the extent of
26
the recipient's needs, and the requirements and costs for
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maintaining such equipment. Subject to prior approval, such
2
rules shall enable a recipient to temporarily acquire and use
3
alternative or substitute devices or equipment pending repairs
4
or replacements of any device or equipment previously
5
authorized for such recipient by the Department.
6
Notwithstanding any provision of Section 5-5f to the contrary,
7
the Department may, by rule, exempt certain replacement
8
wheelchair parts from prior approval and, for wheelchairs,
9
wheelchair parts, wheelchair accessories, and related seating
10
and positioning items, determine the wholesale price by
11
methods other than actual acquisition costs.
12
The Department shall require, by rule, all providers of
13
durable medical equipment to be accredited by an accreditation
14
organization approved by the federal Centers for Medicare and
15
Medicaid Services and recognized by the Department in order to
16
bill the Department for providing durable medical equipment to
17
recipients. No later than 15 months after the effective date
18
of the rule adopted pursuant to this paragraph, all providers
19
must meet the accreditation requirement.
20
In order to promote environmental responsibility, meet the
21
needs of recipients and enrollees, and achieve significant
22
cost savings, the Department, or a managed care organization
23
under contract with the Department, may provide recipients or
24
managed care enrollees who have a prescription or Certificate
25
of Medical Necessity access to refurbished durable medical
26
equipment under this Section (excluding prosthetic and
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orthotic devices as defined in the Orthotics, Prosthetics, and
2
Pedorthics Practice Act and complex rehabilitation technology
3
products and associated services) through the State's
4
assistive technology program's reutilization program, using
5
staff with the Assistive Technology Professional (ATP)
6
Certification if the refurbished durable medical equipment:
7
(i) is available; (ii) is less expensive, including shipping
8
costs, than new durable medical equipment of the same type;
9
(iii) is able to withstand at least 3 years of use; (iv) is
10
cleaned, disinfected, sterilized, and safe in accordance with
11
federal Food and Drug Administration regulations and guidance
12
governing the reprocessing of medical devices in health care
13
settings; and (v) equally meets the needs of the recipient or
14
enrollee. The reutilization program shall confirm that the
15
recipient or enrollee is not already in receipt of the same or
16
similar equipment from another service provider, and that the
17
refurbished durable medical equipment equally meets the needs
18
of the recipient or enrollee. Nothing in this paragraph shall
19
be construed to limit recipient or enrollee choice to obtain
20
new durable medical equipment or place any additional prior
21
authorization conditions on enrollees of managed care
22
organizations.
23
The Department shall execute, relative to the nursing home
24
prescreening project, written inter-agency agreements with the
25
Department of Human Services and the Department on Aging, to
26
effect the following: (i) intake procedures and common
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eligibility criteria for those persons who are receiving
2
non-institutional services; and (ii) the establishment and
3
development of non-institutional services in areas of the
4
State where they are not currently available or are
5
undeveloped; and (iii) notwithstanding any other provision of
6
law, subject to federal approval, on and after July 1, 2012, an
7
increase in the determination of need (DON) scores from 29 to
8
37 for applicants for institutional and home and
9
community-based long term care; if and only if federal
10
approval is not granted, the Department may, in conjunction
11
with other affected agencies, implement utilization controls
12
or changes in benefit packages to effectuate a similar savings
13
amount for this population; and (iv) no later than July 1,
14
2013, minimum level of care eligibility criteria for
15
institutional and home and community-based long term care; and
16
(v) no later than October 1, 2013, establish procedures to
17
permit long term care providers access to eligibility scores
18
for individuals with an admission date who are seeking or
19
receiving services from the long term care provider. In order
20
to select the minimum level of care eligibility criteria, the
21
Governor shall establish a workgroup that includes affected
22
agency representatives and stakeholders representing the
23
institutional and home and community-based long term care
24
interests. This Section shall not restrict the Department from
25
implementing lower level of care eligibility criteria for
26
community-based services in circumstances where federal
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approval has been granted.
2
The Illinois Department shall develop and operate, in
3
cooperation with other State Departments and agencies and in
4
compliance with applicable federal laws and regulations,
5
appropriate and effective systems of health care evaluation
6
and programs for monitoring of utilization of health care
7
services and facilities, as it affects persons eligible for
8
medical assistance under this Code.
9
The Illinois Department shall report annually to the
10
General Assembly, no later than the second Friday in April of
11
1979 and each year thereafter, in regard to:
12
(a) actual statistics and trends in utilization of
13
medical services by public aid recipients;
14
(b) actual statistics and trends in the provision of
15
the various medical services by medical vendors;
16
(c) current rate structures and proposed changes in
17
those rate structures for the various medical vendors; and
18
(d) efforts at utilization review and control by the
19
Illinois Department.
20
The period covered by each report shall be the 3 years
21
ending on the June 30 prior to the report. The report shall
22
include suggested legislation for consideration by the General
23
Assembly. The requirement for reporting to the General
24
Assembly shall be satisfied by filing copies of the report as
25
required by Section 3.1 of the General Assembly Organization
26
Act, and filing such additional copies with the State
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Government Report Distribution Center for the General Assembly
2
as is required under paragraph (t) of Section 7 of the State
3
Library Act.
4
Rulemaking authority to implement Public Act 95-1045, if
5
any, is conditioned on the rules being adopted in accordance
6
with all provisions of the Illinois Administrative Procedure
7
Act and all rules and procedures of the Joint Committee on
8
Administrative Rules; any purported rule not so adopted, for
9
whatever reason, is unauthorized.
10
On and after July 1, 2012, the Department shall reduce any
11
rate of reimbursement for services or other payments or alter
12
any methodologies authorized by this Code to reduce any rate
13
of reimbursement for services or other payments in accordance
14
with Section 5-5e.
15
Because kidney transplantation can be an appropriate,
16
cost-effective alternative to renal dialysis when medically
17
necessary and notwithstanding the provisions of Section 1-11
18
of this Code, beginning October 1, 2014, the Department shall
19
cover kidney transplantation for noncitizens with end-stage
20
renal disease who are not eligible for comprehensive medical
21
benefits, who meet the residency requirements of Section 5-3
22
of this Code, and who would otherwise meet the financial
23
requirements of the appropriate class of eligible persons
24
under Section 5-2 of this Code. To qualify for coverage of
25
kidney transplantation, such person must be receiving
26
emergency renal dialysis services covered by the Department.
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Providers under this Section shall be prior approved and
2
certified by the Department to perform kidney transplantation
3
and the services under this Section shall be limited to
4
services associated with kidney transplantation.
5
Notwithstanding any other provision of this Code to the
6
contrary, on or after July 1, 2015, all FDA-approved forms of
7
medication assisted treatment prescribed for the treatment of
8
alcohol dependence or treatment of opioid dependence shall be
9
covered under both fee-for-service and managed care medical
10
assistance programs for persons who are otherwise eligible for
11
medical assistance under this Article and shall not be subject
12
to any (1) utilization control, other than those established
13
under the American Society of Addiction Medicine patient
14
placement criteria, (2) prior authorization mandate, (3)
15
lifetime restriction limit mandate, or (4) limitations on
16
dosage.
17
On or after July 1, 2015, opioid antagonists prescribed
18
for the treatment of an opioid overdose, including the
19
medication product, administration devices, and any pharmacy
20
fees or hospital fees related to the dispensing, distribution,
21
and administration of the opioid antagonist, shall be covered
22
under the medical assistance program for persons who are
23
otherwise eligible for medical assistance under this Article.
24
As used in this Section, "opioid antagonist" means a drug that
25
binds to opioid receptors and blocks or inhibits the effect of
26
opioids acting on those receptors, including, but not limited
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to, naloxone hydrochloride or any other similarly acting drug
2
approved by the U.S. Food and Drug Administration. The
3
Department shall not impose a copayment on the coverage
4
provided for naloxone hydrochloride under the medical
5
assistance program.
6
Upon federal approval, the Department shall provide
7
coverage and reimbursement for all drugs that are approved for
8
marketing by the federal Food and Drug Administration and that
9
are recommended by the federal Public Health Service or the
10
United States Centers for Disease Control and Prevention for
11
pre-exposure prophylaxis and related pre-exposure prophylaxis
12
services, including, but not limited to, HIV and sexually
13
transmitted infection screening, treatment for sexually
14
transmitted infections, medical monitoring, assorted labs, and
15
counseling to reduce the likelihood of HIV infection among
16
individuals who are not infected with HIV but who are at high
17
risk of HIV infection.
18
A federally qualified health center, as defined in Section
19
1905(l)(2)(B) of the federal Social Security Act, shall be
20
reimbursed by the Department in accordance with the federally
21
qualified health center's encounter rate for services provided
22
to medical assistance recipients that are performed by a
23
dental hygienist, as defined under the Illinois Dental
24
Practice Act, working under the general supervision of a
25
dentist and employed by a federally qualified health center.
26
Within 90 days after October 8, 2021 (the effective date
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1
of Public Act 102-665), the Department shall seek federal
2
approval of a State Plan amendment to expand coverage for
3
family planning services that includes presumptive eligibility
4
to individuals whose income is at or below 208% of the federal
5
poverty level. Coverage under this Section shall be effective
6
beginning no later than December 1, 2022.
7
Subject to approval by the federal Centers for Medicare
8
and Medicaid Services of a Title XIX State Plan amendment
9
electing the Program of All-Inclusive Care for the Elderly
10
(PACE) as a State Medicaid option, as provided for by Subtitle
11
I (commencing with Section 4801) of Title IV of the Balanced
12
Budget Act of 1997 (Public Law 105-33) and Part 460
13
(commencing with Section 460.2) of Subchapter E of Title 42 of
14
the Code of Federal Regulations, PACE program services shall
15
become a covered benefit of the medical assistance program,
16
subject to criteria established in accordance with all
17
applicable laws.
18
Notwithstanding any other provision of this Code,
19
community-based pediatric palliative care from a trained
20
interdisciplinary team shall be covered under the medical
21
assistance program as provided in Section 15 of the Pediatric
22
Palliative Care Act.
23
Notwithstanding any other provision of this Code, within
24
12 months after June 2, 2022 (the effective date of Public Act
25
102-1037) and subject to federal approval, acupuncture
26
services performed by an acupuncturist licensed under the
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Acupuncture Practice Act who is acting within the scope of his
2
or her license shall be covered under the medical assistance
3
program. The Department shall apply for any federal waiver or
4
State Plan amendment, if required, to implement this
5
paragraph. The Department may adopt any rules, including
6
standards and criteria, necessary to implement this paragraph.
7
Notwithstanding any other provision of this Code, the
8
medical assistance program shall, subject to federal approval,
9
reimburse hospitals for costs associated with a newborn
10
screening test for the presence of metachromatic
11
leukodystrophy, as required under the Newborn
Metabolic
12
Screening Act, at a rate not less than the fee charged by the
13
Department of Public Health. Notwithstanding any other
14
provision of this Code, the medical assistance program shall,
15
subject to appropriation and federal approval, also reimburse
16
hospitals for costs associated with all newborn screening
17
tests added on and after August 9, 2024 (the effective date of
18
Public Act 103-909) to the Newborn
Metabolic
Screening Act and
19
required to be performed under that Act at a rate not less than
20
the fee charged by the Department of Public Health. The
21
Department shall seek federal approval before the
22
implementation of the newborn screening test fees by the
23
Department of Public Health.
24
Notwithstanding any other provision of this Code,
25
beginning on January 1, 2024, subject to federal approval,
26
cognitive assessment and care planning services provided to a
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person who experiences signs or symptoms of cognitive
2
impairment, as defined by the Diagnostic and Statistical
3
Manual of Mental Disorders, Fifth Edition, shall be covered
4
under the medical assistance program for persons who are
5
otherwise eligible for medical assistance under this Article.
6
Notwithstanding any other provision of this Code,
7
medically necessary reconstructive services that are intended
8
to restore physical appearance shall be covered under the
9
medical assistance program for persons who are otherwise
10
eligible for medical assistance under this Article. As used in
11
this paragraph, "reconstructive services" means treatments
12
performed on structures of the body damaged by trauma to
13
restore physical appearance.
14
Subject to federal approval, for dates of services on and
15
after January 1, 2026, over-the-counter choline dietary
16
supplements for pregnant persons shall be covered under the
17
medical assistance program.
18
(Source: P.A. 103-102, Article 15, Section 15-5, eff. 1-1-24;
19
103-102, Article 95, Section 95-15, eff. 1-1-24; 103-123, eff.
20
1-1-24; 103-154, eff. 6-30-23; 103-368, eff. 1-1-24; 103-593,
21
Article 5, Section 5-5, eff. 6-7-24; 103-593, Article 90,
22
Section 90-5, eff. 6-7-24; 103-605, eff. 7-1-24; 103-808, eff.
23
1-1-26; 103-909, eff. 8-9-24; 103-1040, eff. 8-9-24; 104-9,
24
eff. 6-16-25; 104-417, eff. 8-15-25
.)
25
Section 20.
The Newborn Screening Act is amended by
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changing the title of the Act and Sections 0.01 and 2 as
2
follows:
3
(410 ILCS 240/Act title)
4
An Act concerning
health
the disease of phenylketonuria
5
and other metabolic diseases, designating certain powers and
6
duties in relation thereto, providing penalties for violation
7
thereof, to repeal an Act therein named and to make an
8
appropriation in connection therewith
.
9
(410 ILCS 240/0.01)
(from Ch. 111 1/2, par. 4902.9)
10
Sec. 0.01.
Short title.
This Act may be cited as the
11
Newborn
Metabolic
Screening Act.
12
(Source: P.A. 95-695, eff. 11-5-07.)
13
(410 ILCS 240/2)
(from Ch. 111 1/2, par. 4904)
14
Sec. 2.
General provisions.
The Department of Public
15
Health shall administer the provisions of this Act and shall:
16
(a) Institute and carry on an intensive educational
17
program among physicians, hospitals, public health nurses and
18
the public concerning disorders included in newborn screening.
19
This educational program shall include information about the
20
nature of the diseases and examinations for the detection of
21
the diseases in early infancy in order that measures may be
22
taken to prevent the disabilities resulting from the diseases.
23
(a-5) Require that all newborns be screened for the
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presence of certain genetic, metabolic, and congenital
2
anomalies
, including hearing conditions,
as determined by the
3
Department, by rule.
4
(a-5.1) Require that all blood and biological specimens
5
collected pursuant to this Act or the rules adopted under this
6
Act be submitted for testing to the nearest Department
7
laboratory designated to perform such tests. The following
8
provisions shall apply concerning testing:
9
(1) Beginning July 1, 2015, the base fee for newborn
10
screening services shall be $118.
Beginning July 1, 2026,
11
the Department shall collect an additional newborn
12
screening fee in an amount determined by the Department by
13
rule but not less than an additional $45 per newborn.
The
14
Department may develop a reasonable fee structure and may
15
levy additional fees according to such structure to cover
16
the cost of providing
these
this
testing
services
service
17
and for the follow-up of infants with an abnormal
18
screening test; however, additional fees may be levied no
19
sooner than 6 months prior to the beginning of testing for
20
a new genetic, metabolic, or congenital disorder.
All fees
21
Fees
collected from the provision of this testing service
22
and all additional newborn screening fees collected under
23
this subsection
shall be
deposited into
placed in
the
24
Metabolic Screening and Treatment Fund. Other State and
25
federal funds for expenses related to metabolic
hearing or
26
congenital disorder condition
screening, follow-up, and
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1
treatment programs may also be placed in the Fund.
Nothing
2
in this Section or this Act shall be construed to
3
override, replace, preempt, or supersede any provision,
4
requirement, or other duty or prohibition enumerated in
5
the Early Hearing Detection and Intervention Act.
6
(2) Moneys shall be appropriated from the Fund to the
7
Department solely for the purposes of providing newborn
8
screening, follow-up, and treatment programs
, including
9
the Early Hearing Detection and Intervention Program
10
(EHDI) through which the Department provides
11
Cytomegalovirus education and parent-to-parent support
.
12
Nothing in this Act shall be construed to prohibit any
13
licensed medical facility from collecting additional
14
specimens for testing for metabolic or neonatal diseases
15
or any other diseases or conditions, as it deems fit. Any
16
person violating the provisions of this subsection (a-5.1)
17
is guilty of a petty offense.
18
(3) If the Department is unable to provide the
19
screening using the State Laboratory, it shall temporarily
20
provide such screening through an accredited laboratory
21
selected by the Department until the Department has the
22
capacity to provide screening through the State
23
Laboratory. If screening is provided on a temporary basis
24
through an accredited laboratory, the Department shall
25
substitute the fee charged by the accredited laboratory,
26
plus a 5% surcharge for documentation and handling, for
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1
the fee authorized in this subsection (a-5.1).
This
2
paragraph (3) does not apply to hearing screenings.
3
(a-5.2) Maintain a registry of cases, including
4
information of importance for the purpose of follow-up
5
services to assess long-term outcomes.
6
(a-5.3) Supply the necessary metabolic treatment formulas
7
where practicable for diagnosed cases of amino acid metabolism
8
disorders, including phenylketonuria, organic acid disorders,
9
and fatty acid oxidation disorders for as long as medically
10
indicated, when the product is not available through other
11
State agencies.
12
(a-5.4) Arrange for or provide public health nursing,
13
nutrition, and social services and clinical consultation as
14
indicated.
15
(a-5.5) Utilize the Genetic and Metabolic Diseases
16
Advisory Committee established under the Genetic and Metabolic
17
Diseases Advisory Committee Act to provide guidance and
18
recommendations to the Department's newborn screening program.
19
The Genetic and Metabolic Diseases Advisory Committee shall
20
review the feasibility and advisability of including
21
additional metabolic, genetic, and congenital
conditions or
22
disorders in the newborn screening panel, according to a
23
review protocol applied to each suggested addition to the
24
newborn
screening panel. The Department shall consider the
25
recommendations of the Genetic and Metabolic Diseases Advisory
26
Committee in determining whether to include an additional
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1
disorder in the
newborn
screening panel prior to proposing an
2
administrative rule concerning inclusion of an additional
3
disorder in the newborn screening panel. Notwithstanding any
4
other provision of law, no new screening may begin prior to the
5
occurrence of all the following:
6
(1) the establishment and verification of relevant and
7
appropriate performance specifications as defined under
8
the federal Clinical Laboratory Improvement Amendments and
9
regulations thereunder for U.S. Food and Drug
10
Administration-cleared or in-house developed methods,
11
performed under an institutional review board-approved
12
protocol, if required;
13
(2) the availability of quality assurance testing
14
methodology for the processes set forth in item (1) of
15
this subsection (a-5.5);
16
(3) the acquisition and installment by the Department
17
of the equipment necessary to implement the screening
18
tests;
19
(4) the establishment of precise threshold values
20
ensuring defined disorder identification for each
21
screening test;
22
(5) the authentication of pilot testing achieving each
23
milestone described in items (1) through (4) of this
24
subsection (a-5.5) for each disorder screening test; and
25
(6) the authentication of achieving the potential of
26
high throughput standards for statewide volume of each
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1
disorder screening test concomitant with each milestone
2
described in items (1) through (4) of this subsection
3
(a-5.5).
4
(a-6) (Blank).
5
(a-7) (Blank).
6
(a-8) (Blank).
7
(b) (Blank).
8
(c) (Blank).
9
(d) (Blank).
10
(e) (Blank).
11
(Source: P.A. 98-440, eff. 8-16-13; 98-756, eff. 7-16-14;
12
99-403, eff. 8-19-15.)
13
Section 25.
The Genetic Information Privacy Act is amended
14
by changing Section 30 as follows:
15
(410 ILCS 513/30)
16
Sec. 30.
Disclosure of person tested and test results.
17
(a) No person may disclose or be compelled to disclose the
18
identity of any person upon whom a genetic test is performed or
19
the results of a genetic test in a manner that permits
20
identification of the subject of the test, except to the
21
following persons:
22
(1) The subject of the test or the subject's legally
23
authorized representative. This paragraph does not create
24
a duty or obligation under which a health care provider
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1
must notify the subject's spouse or legal guardian of the
2
test results, and no such duty or obligation shall be
3
implied. No civil liability or criminal sanction under
4
this Act shall be imposed for any disclosure or
5
nondisclosure of a test result to a spouse by a physician
6
acting in good faith under this paragraph. For the purpose
7
of any proceedings, civil or criminal, the good faith of
8
any physician acting under this paragraph shall be
9
presumed.
10
(2) Any person designated in a specific written
11
legally effective authorization for release of the test
12
results executed by the subject of the test or the
13
subject's legally authorized representative.
14
(3) An authorized agent or employee of a health
15
facility or health care provider if the health facility or
16
health care provider itself is authorized to obtain the
17
test results, the agent or employee provides patient care,
18
and the agent or employee has a need to know the
19
information in order to conduct the tests or provide care
20
or treatment.
21
(4) A health facility, health care provider, or health
22
care professional that procures, processes, distributes,
23
or uses:
24
(A) a human body part from a deceased person with
25
respect to medical information regarding that person;
26
or
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(B) semen provided prior to the effective date of
2
this Act for the purpose of artificial insemination.
3
(5) Health facility staff committees for the purposes
4
of conducting program monitoring, program evaluation, or
5
service reviews.
6
(6) In the case of a minor under 18 years of age, the
7
health care provider, health care professional, or health
8
facility who ordered the test shall make a reasonable
9
effort to notify the minor's parent or legal guardian if,
10
in the professional judgment of the health care provider,
11
health care professional, or health facility, notification
12
would be in the best interest of the minor and the health
13
care provider, health care professional, or health
14
facility has first sought unsuccessfully to persuade the
15
minor to notify the parent or legal guardian or after a
16
reasonable time after the minor has agreed to notify the
17
parent or legal guardian, the health care provider, health
18
care professional, or health facility has reason to
19
believe that the minor has not made the notification. This
20
paragraph shall not create a duty or obligation under
21
which a health care provider, health care professional, or
22
health facility must notify the minor's parent or legal
23
guardian of the test results, nor shall a duty or
24
obligation be implied. No civil liability or criminal
25
sanction under this Act shall be imposed for any
26
notification or non-notification of a minor's test result
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1
by a health care provider, health care professional, or
2
health facility acting in good faith under this paragraph.
3
For the purpose of any proceeding, civil or criminal, the
4
good faith of any health care provider, health care
5
professional, or health facility acting under this
6
paragraph shall be presumed.
7
(b) All information and records held by a State agency,
8
local health authority, or health oversight agency pertaining
9
to genetic information shall be strictly confidential and
10
exempt from copying and inspection under the Freedom of
11
Information Act. The information and records shall not be
12
released or made public by the State agency, local health
13
authority, or health oversight agency and shall not be
14
admissible as evidence nor discoverable in any action of any
15
kind in any court or before any tribunal, board, agency, or
16
person and shall be treated in the same manner as the
17
information and those records subject to the provisions of
18
Part 21 of Article VIII of the Code of Civil Procedure except
19
under the following circumstances:
20
(A) when made with the written consent of all
21
persons to whom the information pertains;
22
(B) when authorized by Section 5-4-3 of the
23
Unified Code of Corrections;
24
(C) when made for the sole purpose of implementing
25
the Newborn
Metabolic
Screening Act and rules; or
26
(D) when made under the authorization of the
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1
Illinois Parentage Act of 2015.
2
Disclosure shall be limited to those who have a need to
3
know the information, and no additional disclosures may be
4
made.
5
(c) Disclosure by an insurer in accordance with the
6
requirements of the Article XL of the Illinois Insurance Code
7
shall be deemed compliance with this Section.
8
(Source: P.A. 98-1046, eff. 1-1-15; 99-85, eff. 1-1-16
.)
9
Section 95.
No acceleration or delay.
Where this Act makes
10
changes in a statute that is represented in this Act by text
11
that is not yet or no longer in effect (for example, a Section
12
represented by multiple versions), the use of that text does
13
not accelerate or delay the taking effect of (i) the changes
14
made by this Act or (ii) provisions derived from any other
15
Public Act.
16
Section 99.
Effective date.
This Act takes effect upon
17
becoming law.
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