Rep. Gregory Harris
Filed: 5/28/2018
 
 


 




10000SB1851ham002LRB100 10394 KTG 41023 a



1
AMENDMENT TO SENATE BILL 1851




2 AMENDMENT NO. ______. Amend Senate Bill 1851, AS AMENDED, 
3by replacing everything after the enacting clause with the 
4following:


5 "Section 1. Findings; intent. According to the 
6Congressional Research Service reporting, approximately 35% to 
760% of children placed in foster care have at least one chronic 
8or acute physical health condition that requires treatment, 
9including growth failure, asthma, obesity, vision impairment, 
10hearing loss, neurological problems, and complex chronic 
11illnesses; as many as 50% to 75% show behavioral or social 
12competency issues that may warrant mental health services; many 
13of these physical and mental health care issues persist and, 
14relative to their peers in the general population, children who 
15leave foster care for adoption and those who age out of care 
16continue to have greater health needs.
17 Federal child welfare policy requires states to develop 
 
 
10000SB1851ham002- 2 -LRB100 10394 KTG 41023 a


1strategies to address the health care needs of each child in 
2foster care and mandates coordination of state child welfare 
3and Medicaid agencies to ensure that the health care needs of 
4children in foster care are properly identified and treated.
5 The Department of Children and Family Services is 
6responsible for ensuring safety, family permanence, and 
7well-being for the children placed in its custody and 
8protecting these children from further trauma by ensuring 
9timely access to appropriate placements and services, 
10especially those children with complex emotional and 
11behavioral needs who are at much greater risk for not achieving 
12the fundamental child welfare goals of safety, permanence, and 
13well-being.
14 The Department remains under federal court oversight 
15pursuant to the B.H. Consent Decree, in part, for failure to 
16provide constitutionally sufficient services and placements 
17for children with psychological, behavioral, or emotional 
18challenges; the 2015 court-appointed Expert Panel found too 
19many children in the class experience multiple disruptions of 
20placement, services, and relationships; these children and 
21their families endure indeterminate waits, month upon month, 
22for services the child and family need, without a concrete plan 
23or timeframe; these disruptions and delays and the inaction of 
24Department officials exacerbate children's already serious and 
25chronic mental health problems; the Department's approach to 
26treatment and its system of practice have been shaped by 
 
 
10000SB1851ham002- 3 -LRB100 10394 KTG 41023 a


1crises, practitioner preferences, tradition, and system 
2expediency.
3 The American Academy of Pediatrics cautions that the 
4effects of managed care on children's access to services and 
5actual health outcomes are not yet clear; it outlines design 
6and implementation principles if managed care is to be 
7implemented for children. 
8 It is the intent of the General Assembly to ensure that 
9children are provided a system of health care with full and 
10inclusive access to physical and behavioral health services 
11necessary for them to thrive.
12 The General Assembly finds it necessary to protect youth in 
13care by requiring the Department to plan the use of managed 
14care services transparently, collaboratively, and deliberately 
15to ensure quality outcomes and accountable oversight.

16 Section 5. The Open Meetings Act is amended by changing 
17Section 2 as follows:




18 (5 ILCS 120/2) (from Ch. 102, par. 42)



19 Sec. 2. Open meetings. 

20 (a) Openness required. All meetings of public
bodies shall 
21be open to the public unless excepted in subsection (c)
and 
22closed in accordance with Section 2a.

23 (b) Construction of exceptions. The exceptions contained 
24in subsection
(c) are in derogation of the requirement that 
 
 
10000SB1851ham002- 4 -LRB100 10394 KTG 41023 a


1public bodies
meet in the open, and therefore, the exceptions 
2are to be strictly
construed, extending only to subjects 
3clearly within their scope.
The exceptions authorize but do not 
4require the holding of
a closed meeting to discuss a subject 
5included within an enumerated exception.

6 (c) Exceptions. A public body may hold closed meetings to 
7consider the
following subjects:

8  (1) The appointment, employment, compensation, 
9 discipline, performance,
or dismissal of specific 
10 employees of the public body or legal counsel for
the 
11 public body, including hearing
testimony on a complaint 
12 lodged against an employee of the public body or
against 
13 legal counsel for the public body to determine its 
14 validity. However, a meeting to consider an increase in 
15 compensation to a specific employee of a public body that 
16 is subject to the Local Government Wage Increase 
17 Transparency Act may not be closed and shall be open to the 
18 public and posted and held in accordance with this Act.

19  (2) Collective negotiating matters between the public 
20 body and its
employees or their representatives, or 
21 deliberations concerning salary
schedules for one or more 
22 classes of employees.

23  (3) The selection of a person to fill a public office,

24 as defined in this Act, including a vacancy in a public 
25 office, when the public
body is given power to appoint 
26 under law or ordinance, or the discipline,
performance or 
 
 
10000SB1851ham002- 5 -LRB100 10394 KTG 41023 a


1 removal of the occupant of a public office, when the public 
2 body
is given power to remove the occupant under law or 
3 ordinance. 

4  (4) Evidence or testimony presented in open hearing, or 
5 in closed
hearing where specifically authorized by law, to

6 a quasi-adjudicative body, as defined in this Act, provided 
7 that the body
prepares and makes available for public 
8 inspection a written decision
setting forth its 
9 determinative reasoning.

10  (5) The purchase or lease of real property for the use 
11 of
the public body, including meetings held for the purpose 
12 of discussing
whether a particular parcel should be 
13 acquired.

14  (6) The setting of a price for sale or lease of 
15 property owned
by the public body.

16  (7) The sale or purchase of securities, investments, or 
17 investment
contracts. This exception shall not apply to the 
18 investment of assets or income of funds deposited into the 
19 Illinois Prepaid Tuition Trust Fund. 

20  (8) Security procedures, school building safety and 
21 security, and the use of personnel and
equipment to respond 
22 to an actual, a threatened, or a reasonably
potential 
23 danger to the safety of employees, students, staff, the 
24 public, or
public
property.

25  (9) Student disciplinary cases.

26  (10) The placement of individual students in special 
 
 
10000SB1851ham002- 6 -LRB100 10394 KTG 41023 a


1 education
programs and other matters relating to 
2 individual students.

3  (11) Litigation, when an action against, affecting or 
4 on behalf of the
particular public body has been filed and 
5 is pending before a court or
administrative tribunal, or 
6 when the public body finds that an action is
probable or 
7 imminent, in which case the basis for the finding shall be

8 recorded and entered into the minutes of the closed 
9 meeting.

10  (12) The establishment of reserves or settlement of 
11 claims as provided
in the Local Governmental and 
12 Governmental Employees Tort Immunity Act, if
otherwise the 
13 disposition of a claim or potential claim might be

14 prejudiced, or the review or discussion of claims, loss or 
15 risk management
information, records, data, advice or 
16 communications from or with respect
to any insurer of the 
17 public body or any intergovernmental risk management

18 association or self insurance pool of which the public body 
19 is a member.

20  (13) Conciliation of complaints of discrimination in 
21 the sale or rental
of housing, when closed meetings are 
22 authorized by the law or ordinance
prescribing fair housing 
23 practices and creating a commission or
administrative 
24 agency for their enforcement.

25  (14) Informant sources, the hiring or assignment of 
26 undercover personnel
or equipment, or ongoing, prior or 
 
 
10000SB1851ham002- 7 -LRB100 10394 KTG 41023 a


1 future criminal investigations, when
discussed by a public 
2 body with criminal investigatory responsibilities.

3  (15) Professional ethics or performance when 
4 considered by an advisory
body appointed to advise a 
5 licensing or regulatory agency on matters
germane to the 
6 advisory body's field of competence.

7  (16) Self evaluation, practices and procedures or 
8 professional ethics,
when meeting with a representative of 
9 a statewide association of which the
public body is a 
10 member.

11  (17) The recruitment, credentialing, discipline or 
12 formal peer review
of physicians or other
health care 
13 professionals, or for the discussion of matters protected 
14 under the federal Patient Safety and Quality Improvement 
15 Act of 2005, and the regulations promulgated thereunder, 
16 including 42 C.F.R. Part 3 (73 FR 70732), or the federal 
17 Health Insurance Portability and Accountability Act of 
18 1996, and the regulations promulgated thereunder, 
19 including 45 C.F.R. Parts 160, 162, and 164, by a hospital, 
20 or
other institution providing medical care, that is 
21 operated by the public body.

22  (18) Deliberations for decisions of the Prisoner 
23 Review Board.

24  (19) Review or discussion of applications received 
25 under the
Experimental Organ Transplantation Procedures 
26 Act.

 
 
10000SB1851ham002- 8 -LRB100 10394 KTG 41023 a


1  (20) The classification and discussion of matters 
2 classified as
confidential or continued confidential by 
3 the State Government Suggestion Award
Board.

4  (21) Discussion of minutes of meetings lawfully closed 
5 under this Act,
whether for purposes of approval by the 
6 body of the minutes or semi-annual
review of the minutes as 
7 mandated by Section 2.06.

8  (22) Deliberations for decisions of the State

9 Emergency Medical Services Disciplinary
Review Board.

10  (23) The operation by a municipality of a municipal 
11 utility or the
operation of a
municipal power agency or 
12 municipal natural gas agency when the
discussion involves 
13 (i) contracts relating to the
purchase, sale, or delivery 
14 of electricity or natural gas or (ii) the results
or 
15 conclusions of load forecast studies.

16  (24) Meetings of a residential health care facility 
17 resident sexual
assault and death review
team or
the 
18 Executive
Council under the Abuse Prevention Review
Team 
19 Act.

20  (25) Meetings of an independent team of experts under 
21 Brian's Law. 
22  (26) Meetings of a mortality review team appointed 
23 under the Department of Juvenile Justice Mortality Review 
24 Team Act. 
25  (27) (Blank). 
26  (28) Correspondence and records (i) that may not be 
 
 
10000SB1851ham002- 9 -LRB100 10394 KTG 41023 a


1 disclosed under Section 11-9 of the Illinois Public Aid 
2 Code or (ii) that pertain to appeals under Section 11-8 of 
3 the Illinois Public Aid Code. 
4  (29) Meetings between internal or external auditors 
5 and governmental audit committees, finance committees, and 
6 their equivalents, when the discussion involves internal 
7 control weaknesses, identification of potential fraud risk 
8 areas, known or suspected frauds, and fraud interviews 
9 conducted in accordance with generally accepted auditing 
10 standards of the United States of America.
11  (30) Those meetings or portions of meetings of a 
12 fatality review team or the Illinois Fatality Review Team 
13 Advisory Council during which a review of the death of an 
14 eligible adult in which abuse or neglect is suspected, 
15 alleged, or substantiated is conducted pursuant to Section 
16 15 of the Adult Protective Services Act. 
17  (31) Meetings and deliberations for decisions of the 
18 Concealed Carry Licensing Review Board under the Firearm 
19 Concealed Carry Act. 
20  (32) Meetings between the Regional Transportation 
21 Authority Board and its Service Boards when the discussion 
22 involves review by the Regional Transportation Authority 
23 Board of employment contracts under Section 28d of the 
24 Metropolitan Transit Authority Act and Sections 3A.18 and 
25 3B.26 of the Regional Transportation Authority Act.
26  (33) Those meetings or portions of meetings of the 
 
 
10000SB1851ham002- 10 -LRB100 10394 KTG 41023 a


1 advisory committee and peer review subcommittee created 
2 under Section 320 of the Illinois Controlled Substances Act 
3 during which specific controlled substance prescriber, 
4 dispenser, or patient information is discussed.
5  (34) Meetings of the Tax Increment Financing Reform 
6 Task Force under Section 2505-800 of the Department of 
7 Revenue Law of the Civil Administrative Code of Illinois. 
8  (35) Meetings of the group established to discuss 
9 Medicaid capitation rates under Section 5-30.8 of the 
10 Illinois Public Aid Code. 
11 (d) Definitions. For purposes of this Section:

12 "Employee" means a person employed by a public body whose 
13relationship
with the public body constitutes an 
14employer-employee relationship under
the usual common law 
15rules, and who is not an independent contractor.

16 "Public office" means a position created by or under the

17Constitution or laws of this State, the occupant of which is 
18charged with
the exercise of some portion of the sovereign 
19power of this State. The term
"public office" shall include 
20members of the public body, but it shall not
include 
21organizational positions filled by members thereof, whether

22established by law or by a public body itself, that exist to 
23assist the
body in the conduct of its business.

24 "Quasi-adjudicative body" means an administrative body 
25charged by law or
ordinance with the responsibility to conduct 
26hearings, receive evidence or
testimony and make 
 
 
10000SB1851ham002- 11 -LRB100 10394 KTG 41023 a


1determinations based
thereon, but does not include
local 
2electoral boards when such bodies are considering petition 
3challenges.

4 (e) Final action. No final action may be taken at a closed 
5meeting.
Final action shall be preceded by a public recital of 
6the nature of the
matter being considered and other information 
7that will inform the
public of the business being conducted. 

8(Source: P.A. 99-78, eff. 7-20-15; 99-235, eff. 1-1-16; 99-480, 
9eff. 9-9-15; 99-642, eff. 7-28-16; 99-646, eff. 7-28-16; 
1099-687, eff. 1-1-17; 100-201, eff. 8-18-17; 100-465, eff. 
118-31-17.)


12 Section 10. The Freedom of Information Act is amended by 
13changing Section 7.5 as follows:

14 (5 ILCS 140/7.5)
15 (Text of Section before amendment by P.A. 100-512 and 
16100-517)
17 Sec. 7.5. Statutory exemptions. To the extent provided for 
18by the statutes referenced below, the following shall be exempt 
19from inspection and copying:
20  (a) All information determined to be confidential 
21 under Section 4002 of the Technology Advancement and 
22 Development Act.
23  (b) Library circulation and order records identifying 
24 library users with specific materials under the Library 
 
 
10000SB1851ham002- 12 -LRB100 10394 KTG 41023 a


1 Records Confidentiality Act.
2  (c) Applications, related documents, and medical 
3 records received by the Experimental Organ Transplantation 
4 Procedures Board and any and all documents or other records 
5 prepared by the Experimental Organ Transplantation 
6 Procedures Board or its staff relating to applications it 
7 has received.
8  (d) Information and records held by the Department of 
9 Public Health and its authorized representatives relating 
10 to known or suspected cases of sexually transmissible 
11 disease or any information the disclosure of which is 
12 restricted under the Illinois Sexually Transmissible 
13 Disease Control Act.
14  (e) Information the disclosure of which is exempted 
15 under Section 30 of the Radon Industry Licensing Act.
16  (f) Firm performance evaluations under Section 55 of 
17 the Architectural, Engineering, and Land Surveying 
18 Qualifications Based Selection Act.
19  (g) Information the disclosure of which is restricted 
20 and exempted under Section 50 of the Illinois Prepaid 
21 Tuition Act.
22  (h) Information the disclosure of which is exempted 
23 under the State Officials and Employees Ethics Act, and 
24 records of any lawfully created State or local inspector 
25 general's office that would be exempt if created or 
26 obtained by an Executive Inspector General's office under 
 
 
10000SB1851ham002- 13 -LRB100 10394 KTG 41023 a


1 that Act.
2  (i) Information contained in a local emergency energy 
3 plan submitted to a municipality in accordance with a local 
4 emergency energy plan ordinance that is adopted under 
5 Section 11-21.5-5 of the Illinois Municipal Code.
6  (j) Information and data concerning the distribution 
7 of surcharge moneys collected and remitted by carriers 
8 under the Emergency Telephone System Act.
9  (k) Law enforcement officer identification information 
10 or driver identification information compiled by a law 
11 enforcement agency or the Department of Transportation 
12 under Section 11-212 of the Illinois Vehicle Code.
13  (l) Records and information provided to a residential 
14 health care facility resident sexual assault and death 
15 review team or the Executive Council under the Abuse 
16 Prevention Review Team Act.
17  (m) Information provided to the predatory lending 
18 database created pursuant to Article 3 of the Residential 
19 Real Property Disclosure Act, except to the extent 
20 authorized under that Article.
21  (n) Defense budgets and petitions for certification of 
22 compensation and expenses for court appointed trial 
23 counsel as provided under Sections 10 and 15 of the Capital 
24 Crimes Litigation Act. This subsection (n) shall apply 
25 until the conclusion of the trial of the case, even if the 
26 prosecution chooses not to pursue the death penalty prior 
 
 
10000SB1851ham002- 14 -LRB100 10394 KTG 41023 a


1 to trial or sentencing.
2  (o) Information that is prohibited from being 
3 disclosed under Section 4 of the Illinois Health and 
4 Hazardous Substances Registry Act.
5  (p) Security portions of system safety program plans, 
6 investigation reports, surveys, schedules, lists, data, or 
7 information compiled, collected, or prepared by or for the 
8 Regional Transportation Authority under Section 2.11 of 
9 the Regional Transportation Authority Act or the St. Clair 
10 County Transit District under the Bi-State Transit Safety 
11 Act. 
12  (q) Information prohibited from being disclosed by the 
13 Personnel Records Review Act. 
14  (r) Information prohibited from being disclosed by the 
15 Illinois School Student Records Act. 
16  (s) Information the disclosure of which is restricted 
17 under Section 5-108 of the Public Utilities Act. 

18  (t) All identified or deidentified health information 
19 in the form of health data or medical records contained in, 
20 stored in, submitted to, transferred by, or released from 
21 the Illinois Health Information Exchange, and identified 
22 or deidentified health information in the form of health 
23 data and medical records of the Illinois Health Information 
24 Exchange in the possession of the Illinois Health 
25 Information Exchange Authority due to its administration 
26 of the Illinois Health Information Exchange. The terms 
 
 
10000SB1851ham002- 15 -LRB100 10394 KTG 41023 a


1 "identified" and "deidentified" shall be given the same 
2 meaning as in the Health Insurance Portability and 
3 Accountability Act of 1996, Public Law 104-191, or any 
4 subsequent amendments thereto, and any regulations 
5 promulgated thereunder. 
6  (u) Records and information provided to an independent 
7 team of experts under Brian's Law. 
8  (v) Names and information of people who have applied 
9 for or received Firearm Owner's Identification Cards under 
10 the Firearm Owners Identification Card Act or applied for 
11 or received a concealed carry license under the Firearm 
12 Concealed Carry Act, unless otherwise authorized by the 
13 Firearm Concealed Carry Act; and databases under the 
14 Firearm Concealed Carry Act, records of the Concealed Carry 
15 Licensing Review Board under the Firearm Concealed Carry 
16 Act, and law enforcement agency objections under the 
17 Firearm Concealed Carry Act. 
18  (w) Personally identifiable information which is 
19 exempted from disclosure under subsection (g) of Section 
20 19.1 of the Toll Highway Act.
21  (x) Information which is exempted from disclosure 
22 under Section 5-1014.3 of the Counties Code or Section 
23 8-11-21 of the Illinois Municipal Code. 
24  (y) Confidential information under the Adult 
25 Protective Services Act and its predecessor enabling 
26 statute, the Elder Abuse and Neglect Act, including 
 
 
10000SB1851ham002- 16 -LRB100 10394 KTG 41023 a


1 information about the identity and administrative finding 
2 against any caregiver of a verified and substantiated 
3 decision of abuse, neglect, or financial exploitation of an 
4 eligible adult maintained in the Registry established 
5 under Section 7.5 of the Adult Protective Services Act. 
6  (z) Records and information provided to a fatality 
7 review team or the Illinois Fatality Review Team Advisory 
8 Council under Section 15 of the Adult Protective Services 
9 Act. 
10  (aa) Information which is exempted from disclosure 
11 under Section 2.37 of the Wildlife Code. 
12  (bb) Information which is or was prohibited from 
13 disclosure by the Juvenile Court Act of 1987. 
14  (cc) Recordings made under the Law Enforcement 
15 Officer-Worn Body Camera Act, except to the extent 
16 authorized under that Act.
17  (dd) Information that is prohibited from being 
18 disclosed under Section 45 of the Condominium and Common 
19 Interest Community Ombudsperson Act. 
20  (ee) Information that is exempted from disclosure 
21 under Section 30.1 of the Pharmacy Practice Act. 
22  (ff) Information that is exempted from disclosure 
23 under the Revised Uniform Unclaimed Property Act. 
24  (gg) (ff) Information that is prohibited from being 
25 disclosed under Section 7-603.5 of the Illinois Vehicle 
26 Code. 
 
 
10000SB1851ham002- 17 -LRB100 10394 KTG 41023 a


1  (hh) (ff) Records that are exempt from disclosure under 
2 Section 1A-16.7 of the Election Code. 
3  (ii) (ff) Information which is exempted from 
4 disclosure under Section 2505-800 of the Department of 
5 Revenue Law of the Civil Administrative Code of Illinois. 
6  (ll) Information the disclosure of which is restricted 
7 and exempted under Section 5-30.8 of the Illinois Public 
8 Aid Code. 
9(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, 
10eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; 
1199-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; 
12100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. 
138-28-17; 100-465, eff. 8-31-17; revised 11-2-17.)

14 (Text of Section after amendment by P.A. 100-517 but before 
15amendment by P.A. 100-512)
16 Sec. 7.5. Statutory exemptions. To the extent provided for 
17by the statutes referenced below, the following shall be exempt 
18from inspection and copying:
19  (a) All information determined to be confidential 
20 under Section 4002 of the Technology Advancement and 
21 Development Act.
22  (b) Library circulation and order records identifying 
23 library users with specific materials under the Library 
24 Records Confidentiality Act.
25  (c) Applications, related documents, and medical 
 
 
10000SB1851ham002- 18 -LRB100 10394 KTG 41023 a


1 records received by the Experimental Organ Transplantation 
2 Procedures Board and any and all documents or other records 
3 prepared by the Experimental Organ Transplantation 
4 Procedures Board or its staff relating to applications it 
5 has received.
6  (d) Information and records held by the Department of 
7 Public Health and its authorized representatives relating 
8 to known or suspected cases of sexually transmissible 
9 disease or any information the disclosure of which is 
10 restricted under the Illinois Sexually Transmissible 
11 Disease Control Act.
12  (e) Information the disclosure of which is exempted 
13 under Section 30 of the Radon Industry Licensing Act.
14  (f) Firm performance evaluations under Section 55 of 
15 the Architectural, Engineering, and Land Surveying 
16 Qualifications Based Selection Act.
17  (g) Information the disclosure of which is restricted 
18 and exempted under Section 50 of the Illinois Prepaid 
19 Tuition Act.
20  (h) Information the disclosure of which is exempted 
21 under the State Officials and Employees Ethics Act, and 
22 records of any lawfully created State or local inspector 
23 general's office that would be exempt if created or 
24 obtained by an Executive Inspector General's office under 
25 that Act.
26  (i) Information contained in a local emergency energy 
 
 
10000SB1851ham002- 19 -LRB100 10394 KTG 41023 a


1 plan submitted to a municipality in accordance with a local 
2 emergency energy plan ordinance that is adopted under 
3 Section 11-21.5-5 of the Illinois Municipal Code.
4  (j) Information and data concerning the distribution 
5 of surcharge moneys collected and remitted by carriers 
6 under the Emergency Telephone System Act.
7  (k) Law enforcement officer identification information 
8 or driver identification information compiled by a law 
9 enforcement agency or the Department of Transportation 
10 under Section 11-212 of the Illinois Vehicle Code.
11  (l) Records and information provided to a residential 
12 health care facility resident sexual assault and death 
13 review team or the Executive Council under the Abuse 
14 Prevention Review Team Act.
15  (m) Information provided to the predatory lending 
16 database created pursuant to Article 3 of the Residential 
17 Real Property Disclosure Act, except to the extent 
18 authorized under that Article.
19  (n) Defense budgets and petitions for certification of 
20 compensation and expenses for court appointed trial 
21 counsel as provided under Sections 10 and 15 of the Capital 
22 Crimes Litigation Act. This subsection (n) shall apply 
23 until the conclusion of the trial of the case, even if the 
24 prosecution chooses not to pursue the death penalty prior 
25 to trial or sentencing.
26  (o) Information that is prohibited from being 
 
 
10000SB1851ham002- 20 -LRB100 10394 KTG 41023 a


1 disclosed under Section 4 of the Illinois Health and 
2 Hazardous Substances Registry Act.
3  (p) Security portions of system safety program plans, 
4 investigation reports, surveys, schedules, lists, data, or 
5 information compiled, collected, or prepared by or for the 
6 Regional Transportation Authority under Section 2.11 of 
7 the Regional Transportation Authority Act or the St. Clair 
8 County Transit District under the Bi-State Transit Safety 
9 Act. 
10  (q) Information prohibited from being disclosed by the 
11 Personnel Records Review Act. 
12  (r) Information prohibited from being disclosed by the 
13 Illinois School Student Records Act. 
14  (s) Information the disclosure of which is restricted 
15 under Section 5-108 of the Public Utilities Act. 

16  (t) All identified or deidentified health information 
17 in the form of health data or medical records contained in, 
18 stored in, submitted to, transferred by, or released from 
19 the Illinois Health Information Exchange, and identified 
20 or deidentified health information in the form of health 
21 data and medical records of the Illinois Health Information 
22 Exchange in the possession of the Illinois Health 
23 Information Exchange Authority due to its administration 
24 of the Illinois Health Information Exchange. The terms 
25 "identified" and "deidentified" shall be given the same 
26 meaning as in the Health Insurance Portability and 
 
 
10000SB1851ham002- 21 -LRB100 10394 KTG 41023 a


1 Accountability Act of 1996, Public Law 104-191, or any 
2 subsequent amendments thereto, and any regulations 
3 promulgated thereunder. 
4  (u) Records and information provided to an independent 
5 team of experts under Brian's Law. 
6  (v) Names and information of people who have applied 
7 for or received Firearm Owner's Identification Cards under 
8 the Firearm Owners Identification Card Act or applied for 
9 or received a concealed carry license under the Firearm 
10 Concealed Carry Act, unless otherwise authorized by the 
11 Firearm Concealed Carry Act; and databases under the 
12 Firearm Concealed Carry Act, records of the Concealed Carry 
13 Licensing Review Board under the Firearm Concealed Carry 
14 Act, and law enforcement agency objections under the 
15 Firearm Concealed Carry Act. 
16  (w) Personally identifiable information which is 
17 exempted from disclosure under subsection (g) of Section 
18 19.1 of the Toll Highway Act.
19  (x) Information which is exempted from disclosure 
20 under Section 5-1014.3 of the Counties Code or Section 
21 8-11-21 of the Illinois Municipal Code. 
22  (y) Confidential information under the Adult 
23 Protective Services Act and its predecessor enabling 
24 statute, the Elder Abuse and Neglect Act, including 
25 information about the identity and administrative finding 
26 against any caregiver of a verified and substantiated 
 
 
10000SB1851ham002- 22 -LRB100 10394 KTG 41023 a


1 decision of abuse, neglect, or financial exploitation of an 
2 eligible adult maintained in the Registry established 
3 under Section 7.5 of the Adult Protective Services Act. 
4  (z) Records and information provided to a fatality 
5 review team or the Illinois Fatality Review Team Advisory 
6 Council under Section 15 of the Adult Protective Services 
7 Act. 
8  (aa) Information which is exempted from disclosure 
9 under Section 2.37 of the Wildlife Code. 
10  (bb) Information which is or was prohibited from 
11 disclosure by the Juvenile Court Act of 1987. 
12  (cc) Recordings made under the Law Enforcement 
13 Officer-Worn Body Camera Act, except to the extent 
14 authorized under that Act.
15  (dd) Information that is prohibited from being 
16 disclosed under Section 45 of the Condominium and Common 
17 Interest Community Ombudsperson Act. 
18  (ee) Information that is exempted from disclosure 
19 under Section 30.1 of the Pharmacy Practice Act. 
20  (ff) Information that is exempted from disclosure 
21 under the Revised Uniform Unclaimed Property Act. 
22  (gg) (ff) Information that is prohibited from being 
23 disclosed under Section 7-603.5 of the Illinois Vehicle 
24 Code. 
25  (hh) (ff) Records that are exempt from disclosure under 
26 Section 1A-16.7 of the Election Code. 
 
 
10000SB1851ham002- 23 -LRB100 10394 KTG 41023 a


1  (ii) (ff) Information which is exempted from 
2 disclosure under Section 2505-800 of the Department of 
3 Revenue Law of the Civil Administrative Code of Illinois. 
4  (jj) (ff) Information and reports that are required to 
5 be submitted to the Department of Labor by registering day 
6 and temporary labor service agencies but are exempt from 
7 disclosure under subsection (a-1) of Section 45 of the Day 
8 and Temporary Labor Services Act. 
9  (ll) Information the disclosure of which is restricted 
10 and exempted under Section 5-30.8 of the Illinois Public 
11 Aid Code. 
12(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, 
13eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; 
1499-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; 
15100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. 
168-28-17; 100-465, eff. 8-31-17; 100-517, eff. 6-1-18; revised 
1711-2-17.)

18 (Text of Section after amendment by P.A. 100-512)
19 Sec. 7.5. Statutory exemptions. To the extent provided for 
20by the statutes referenced below, the following shall be exempt 
21from inspection and copying:
22  (a) All information determined to be confidential 
23 under Section 4002 of the Technology Advancement and 
24 Development Act.
25  (b) Library circulation and order records identifying 
 
 
10000SB1851ham002- 24 -LRB100 10394 KTG 41023 a


1 library users with specific materials under the Library 
2 Records Confidentiality Act.
3  (c) Applications, related documents, and medical 
4 records received by the Experimental Organ Transplantation 
5 Procedures Board and any and all documents or other records 
6 prepared by the Experimental Organ Transplantation 
7 Procedures Board or its staff relating to applications it 
8 has received.
9  (d) Information and records held by the Department of 
10 Public Health and its authorized representatives relating 
11 to known or suspected cases of sexually transmissible 
12 disease or any information the disclosure of which is 
13 restricted under the Illinois Sexually Transmissible 
14 Disease Control Act.
15  (e) Information the disclosure of which is exempted 
16 under Section 30 of the Radon Industry Licensing Act.
17  (f) Firm performance evaluations under Section 55 of 
18 the Architectural, Engineering, and Land Surveying 
19 Qualifications Based Selection Act.
20  (g) Information the disclosure of which is restricted 
21 and exempted under Section 50 of the Illinois Prepaid 
22 Tuition Act.
23  (h) Information the disclosure of which is exempted 
24 under the State Officials and Employees Ethics Act, and 
25 records of any lawfully created State or local inspector 
26 general's office that would be exempt if created or 
 
 
10000SB1851ham002- 25 -LRB100 10394 KTG 41023 a


1 obtained by an Executive Inspector General's office under 
2 that Act.
3  (i) Information contained in a local emergency energy 
4 plan submitted to a municipality in accordance with a local 
5 emergency energy plan ordinance that is adopted under 
6 Section 11-21.5-5 of the Illinois Municipal Code.
7  (j) Information and data concerning the distribution 
8 of surcharge moneys collected and remitted by carriers 
9 under the Emergency Telephone System Act.
10  (k) Law enforcement officer identification information 
11 or driver identification information compiled by a law 
12 enforcement agency or the Department of Transportation 
13 under Section 11-212 of the Illinois Vehicle Code.
14  (l) Records and information provided to a residential 
15 health care facility resident sexual assault and death 
16 review team or the Executive Council under the Abuse 
17 Prevention Review Team Act.
18  (m) Information provided to the predatory lending 
19 database created pursuant to Article 3 of the Residential 
20 Real Property Disclosure Act, except to the extent 
21 authorized under that Article.
22  (n) Defense budgets and petitions for certification of 
23 compensation and expenses for court appointed trial 
24 counsel as provided under Sections 10 and 15 of the Capital 
25 Crimes Litigation Act. This subsection (n) shall apply 
26 until the conclusion of the trial of the case, even if the 
 
 
10000SB1851ham002- 26 -LRB100 10394 KTG 41023 a


1 prosecution chooses not to pursue the death penalty prior 
2 to trial or sentencing.
3  (o) Information that is prohibited from being 
4 disclosed under Section 4 of the Illinois Health and 
5 Hazardous Substances Registry Act.
6  (p) Security portions of system safety program plans, 
7 investigation reports, surveys, schedules, lists, data, or 
8 information compiled, collected, or prepared by or for the 
9 Regional Transportation Authority under Section 2.11 of 
10 the Regional Transportation Authority Act or the St. Clair 
11 County Transit District under the Bi-State Transit Safety 
12 Act. 
13  (q) Information prohibited from being disclosed by the 
14 Personnel Records Review Act. 
15  (r) Information prohibited from being disclosed by the 
16 Illinois School Student Records Act. 
17  (s) Information the disclosure of which is restricted 
18 under Section 5-108 of the Public Utilities Act. 

19  (t) All identified or deidentified health information 
20 in the form of health data or medical records contained in, 
21 stored in, submitted to, transferred by, or released from 
22 the Illinois Health Information Exchange, and identified 
23 or deidentified health information in the form of health 
24 data and medical records of the Illinois Health Information 
25 Exchange in the possession of the Illinois Health 
26 Information Exchange Authority due to its administration 
 
 
10000SB1851ham002- 27 -LRB100 10394 KTG 41023 a


1 of the Illinois Health Information Exchange. The terms 
2 "identified" and "deidentified" shall be given the same 
3 meaning as in the Health Insurance Portability and 
4 Accountability Act of 1996, Public Law 104-191, or any 
5 subsequent amendments thereto, and any regulations 
6 promulgated thereunder. 
7  (u) Records and information provided to an independent 
8 team of experts under Brian's Law. 
9  (v) Names and information of people who have applied 
10 for or received Firearm Owner's Identification Cards under 
11 the Firearm Owners Identification Card Act or applied for 
12 or received a concealed carry license under the Firearm 
13 Concealed Carry Act, unless otherwise authorized by the 
14 Firearm Concealed Carry Act; and databases under the 
15 Firearm Concealed Carry Act, records of the Concealed Carry 
16 Licensing Review Board under the Firearm Concealed Carry 
17 Act, and law enforcement agency objections under the 
18 Firearm Concealed Carry Act. 
19  (w) Personally identifiable information which is 
20 exempted from disclosure under subsection (g) of Section 
21 19.1 of the Toll Highway Act.
22  (x) Information which is exempted from disclosure 
23 under Section 5-1014.3 of the Counties Code or Section 
24 8-11-21 of the Illinois Municipal Code. 
25  (y) Confidential information under the Adult 
26 Protective Services Act and its predecessor enabling 
 
 
10000SB1851ham002- 28 -LRB100 10394 KTG 41023 a


1 statute, the Elder Abuse and Neglect Act, including 
2 information about the identity and administrative finding 
3 against any caregiver of a verified and substantiated 
4 decision of abuse, neglect, or financial exploitation of an 
5 eligible adult maintained in the Registry established 
6 under Section 7.5 of the Adult Protective Services Act. 
7  (z) Records and information provided to a fatality 
8 review team or the Illinois Fatality Review Team Advisory 
9 Council under Section 15 of the Adult Protective Services 
10 Act. 
11  (aa) Information which is exempted from disclosure 
12 under Section 2.37 of the Wildlife Code. 
13  (bb) Information which is or was prohibited from 
14 disclosure by the Juvenile Court Act of 1987. 
15  (cc) Recordings made under the Law Enforcement 
16 Officer-Worn Body Camera Act, except to the extent 
17 authorized under that Act.
18  (dd) Information that is prohibited from being 
19 disclosed under Section 45 of the Condominium and Common 
20 Interest Community Ombudsperson Act. 
21  (ee) Information that is exempted from disclosure 
22 under Section 30.1 of the Pharmacy Practice Act. 
23  (ff) Information that is exempted from disclosure 
24 under the Revised Uniform Unclaimed Property Act. 
25  (gg) (ff) Information that is prohibited from being 
26 disclosed under Section 7-603.5 of the Illinois Vehicle 
 
 
10000SB1851ham002- 29 -LRB100 10394 KTG 41023 a


1 Code. 
2  (hh) (ff) Records that are exempt from disclosure under 
3 Section 1A-16.7 of the Election Code. 
4  (ii) (ff) Information which is exempted from 
5 disclosure under Section 2505-800 of the Department of 
6 Revenue Law of the Civil Administrative Code of Illinois. 
7  (jj) (ff) Information and reports that are required to 
8 be submitted to the Department of Labor by registering day 
9 and temporary labor service agencies but are exempt from 
10 disclosure under subsection (a-1) of Section 45 of the Day 
11 and Temporary Labor Services Act. 
12  (kk) (ff) Information prohibited from disclosure under 
13 the Seizure and Forfeiture Reporting Act. 
14  (ll) Information the disclosure of which is restricted 
15 and exempted under Section 5-30.8 of the Illinois Public 
16 Aid Code. 
17(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, 
18eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; 
1999-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; 
20100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. 
218-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517, 
22eff. 6-1-18; revised 11-2-17.)

23 Section 15. The Children and Family Services Act is amended 
24by adding Section 5.45 as follows:

 
 
10000SB1851ham002- 30 -LRB100 10394 KTG 41023 a


1 (20 ILCS 505/5.45 new)
2 Sec. 5.45. Managed care plan services.
3 (a) As used in this Section:
4 "Caregiver" means an individual or entity directly 
5providing the day-to-day care of a child ensuring the child's 
6safety and well-being. 
7 "Child" means a child placed in the care of the Department 
8pursuant to the Juvenile Court Act of 1987.
9 "Department" means the Department of Children and Family 
10Services, or any successor State agency.
11 "Director" means the Director of Children and Family 
12Services.
13 "Managed care organization" has the meaning ascribed to 
14that term in Section 5-30.1 of the Illinois Public Aid Code.
15 "Medicaid managed care plan" means a health care plan 
16operated by a managed care organization under the Medical 
17Assistance Program established in Article V of the Illinois 
18Public Aid Code. 
19 "Workgroup" means the Child Welfare Medicaid Managed Care 
20Implementation Advisory Workgroup. 
21 (b) Every child who is in the care of the Department 
22pursuant to the Juvenile Court Act of 1987 shall receive the 
23necessary services required by this Act and the Juvenile Court 
24Act of 1987, including any child enrolled in a Medicaid managed 
25care plan.
26 (c) The Department shall not relinquish its authority or 
 
 
10000SB1851ham002- 31 -LRB100 10394 KTG 41023 a


1diminish its responsibility to determine and provide necessary 
2services that are in the best interest of a child even if those 
3services are directly or indirectly:
4  (1) provided by a managed care organization, another 
5 State agency, or other third parties;
6  (2) coordinated through a managed care organization, 
7 another State agency, or other third parties; or
8  (3) paid for by a managed care organization, another 
9 State agency, or other third parties.
10 (d) The Department shall:
11  (1) implement and enforce measures to ensure that a 
12 child's enrollment in Medicaid managed care supports 
13 continuity of treatment and does not hinder service 
14 delivery;
15  (2) establish a single point of contact for health care 
16 coverage inquiries and dispute resolution systemwide 
17 without transferring this responsibility to a third party 
18 such as a managed care coordinator;
19  (3) not require any child to participate in Medicaid 
20 managed care if the child would otherwise be exempt from 
21 enrolling in a Medicaid managed care plan under any rule or 
22 statute of this State; and
23  (4) make recommendations regarding managed care 
24 contract measures, quality assurance activities, and 
25 performance delivery evaluations in consultation with the 
26 Workgroup; and
 
 
10000SB1851ham002- 32 -LRB100 10394 KTG 41023 a


1  (5) post on its website:
2   (A) a link to any rule adopted or procedures 
3 changed to address the provisions of this Section, if 
4 applicable;
5   (B) each managed care organization's contract, 
6 enrollee handbook, and directory;
7   (C) the notification process and timeframe 
8 requirements used to inform managed care plan 
9 enrollees, enrollees' caregivers, and enrollees' legal 
10 representation of any changes in health care coverage 
11 or change in a child's managed care provider; 
12   (D) defined prior authorization requirements for 
13 prescriptions, goods, and services in emergency and 
14 non-emergency situations; 
15   (E) the State's current Health Care Oversight and 
16 Coordination Plan developed in accordance with federal 
17 requirements; and 
18   (F) the transition plan required under subsection 
19 (f), including:
20    (i) the public comments submitted to the 
21 Department, the Department of Healthcare and 
22 Family Services, and the Workgroup for 
23 consideration in development of the transition 
24 plan;
25    (ii) a list and summary of recommendations of 
26 the Workgroup that the Director or Director of 
 
 
10000SB1851ham002- 33 -LRB100 10394 KTG 41023 a


1 Healthcare and Family Services declined to adopt 
2 or implement; and
3    (iii) the Department's attestation that the 
4 transition plan will not impede the Department's 
5 ability to timely identify the service needs of 
6 youth in care and the timely and appropriate 
7 provision of services to address those identified 
8 needs. 
9 (e) The Child Welfare Medicaid Managed Care Implementation 
10Advisory Workgroup is established to advise the Department on 
11the transition and implementation of managed care for children. 
12The Director of Children and Family Services and the Director 
13of Healthcare and Family Services shall serve as 
14co-chairpersons of the Workgroup. The Directors shall jointly 
15appoint members to the Workgroup who are stakeholders from the 
16child welfare community, including:
17  (1) employees of the Department of Children and Family 
18 Services who have responsibility in the areas of (i) 
19 managed care services, (ii) performance monitoring and 
20 oversight, (iii) placement operations, and (iv) budget 
21 revenue maximization; 
22  (2) employees of the Department of Healthcare and 
23 Family Services who have responsibility in the areas of (i) 
24 managed care contracting, (ii) performance monitoring and 
25 oversight, (iii) children's behavioral health, and (iv) 
26 budget revenue maximization; 
 
 
10000SB1851ham002- 34 -LRB100 10394 KTG 41023 a


1  (3) 2 representatives of youth in care;
2  (4) one representative of managed care organizations 
3 serving youth in care;
4  (5) 4 representatives of child welfare providers;
5  (6) one representative of parents of children in 
6 out-of-home care;
7  (7) one representative of universities or research 
8 institutions;
9  (8) one representative of pediatric physicians;
10  (9) one representative of the juvenile court;
11  (10) one representative of caregivers of youth in care;
12  (11) one practitioner with expertise in child and 
13 adolescent psychiatry;
14  (12) one representative of substance abuse and
mental 
15 health providers with expertise in serving children 
16 involved in child welfare and their families;
17  (13) at least one member of the Medicaid Advisory 
18 Committee; 
19  (14) one representative of a statewide organization 
20 representing hospitals; 
21  (15) one representative of a statewide organization 
22 representing child welfare providers; 
23  (16) one representative of a statewide organization 
24 representing substance abuse and mental health providers; 
25 and 
26  (17) other child advocates as deemed appropriate by the 
 
 
10000SB1851ham002- 35 -LRB100 10394 KTG 41023 a


1 Directors. 
2 To the greatest extent possible, the co-chairpersons shall 
3appoint members who reflect the geographic diversity of the 
4State and include members who represent rural service areas. 
5Members shall serve 2-year terms or until the Workgroup 
6dissolves. If a vacancy occurs in the Workgroup membership, the 
7vacancy shall be filled in the same manner as the original 
8appointment for the remainder of the unexpired term. The 
9Workgroup shall hold meetings, as it deems appropriate, in the 
10northern, central, and southern regions of the State to solicit 
11public comments to develop its recommendations. To ensure the 
12Department of Children and Family Services and the Department 
13of Healthcare and Family Services are provided time to confer 
14and determine their use of pertinent Workgroup recommendations 
15in the transition plan required under subsection (f), the 
16co-chairpersons shall convene at least 3 meetings. The 
17Department of Children and Family Services and the Department 
18of Healthcare and Family Services shall provide administrative 
19support to the Workgroup. Workgroup members shall serve without 
20compensation. The Workgroup shall dissolve 5 years after the 
21Department of Children and Family Services' implementation of 
22managed care. 
23 (f) Prior to transitioning any child to managed care, the 
24Department of Children and Family Services and the Department 
25of Healthcare and Family Services, in consultation with the 
26Workgroup, must develop and post publicly, a transition plan 
 
 
10000SB1851ham002- 36 -LRB100 10394 KTG 41023 a


1for the provision of health care services to children enrolled 
2in Medicaid managed care plans. Interim transition plans must 
3be posted to the Department's website by July 15, 2018. The 
4transition plan shall be posted at least 28 days before the 
5Department's implementation of managed care. The transition 
6plan shall address, but is not limited to, the following:
7  (1) an assessment of existing network adequacy, plans 
8 to address gaps in network, and ongoing network evaluation;
9  (2) a framework for preparing and training 
10 organizations, caregivers, frontline staff, and managed 
11 care organizations;
12  (3) the identification of administrative changes 
13 necessary for successful transition to managed care, and 
14 the timeframes to make changes;
15  (4) defined roles, responsibilities, and lines of 
16 authority for care coordination, placement providers, 
17 service providers, and each State agency involved in 
18 management and oversight of managed care services;
19  (5) data used to establish baseline performance and 
20 quality of care, which shall be utilized to assess quality 
21 outcomes and identify ongoing areas for improvement;
22  (6) a process for stakeholder input into managed care 
23 planning and implementation;
24  (7) a dispute resolution process, including the rights 
25 of enrollees and representatives of enrollees under the 
26 dispute process and timeframes for dispute resolution 
 
 
10000SB1851ham002- 37 -LRB100 10394 KTG 41023 a


1 determinations and remedies;
2  (8) the process for health care transition for youth 
3 exiting the Department's care through emancipation or 
4 achieving permanency; and
5  (9) protections to ensure the continued provision of 
6 health care services if a child's residence or legal 
7 guardian changes.
8 (g) Reports.
9  (1) On or before February 1, 2019, and on or before 
10 each February 1 thereafter, the Department shall submit a 
11 report to the House and Senate Human Services Committees, 
12 or to any successor committees, on measures of access to 
13 and the quality of health care services for children 
14 enrolled in Medicaid managed care plans, including, but not 
15 limited to, data showing whether:
16   (A) children enrolled in Medicaid managed care 
17 plans have continuity of care across placement types, 
18 geographic regions, and specialty service needs;
19   (B) each child is receiving the early periodic 
20 screening, diagnosis, and treatment services as 
21 required by federal law, including, but not limited to, 
22 regular preventative care and timely specialty care;
23   (C) children are assigned to health homes;
24   (D) each child has a health care oversight and 
25 coordination plan as required by federal law;
26   (E) there exist complaints and grievances 
 
 
10000SB1851ham002- 38 -LRB100 10394 KTG 41023 a


1 indicating gaps or barriers in service delivery; and
2   (F) the Workgroup and other stakeholders have and 
3 continue to be engaged in quality improvement 
4 initiatives.
5  The report shall be prepared in consultation with the 
6 Workgroup and other agencies, organizations, or 
7 individuals the Director deems appropriate in order to 
8 obtain comprehensive and objective information about the 
9 managed care plan operation.
10  (2) During each legislative session, the House and 
11 Senate Human Services Committees shall hold hearings to 
12 take public testimony about managed care implementation 
13 for children in the care of, adopted from, or placed in 
14 guardianship by the Department. The Department shall 
15 present testimony, including information provided in the 
16 report required under paragraph (1), the Department's 
17 compliance with the provisions of this Section, and any 
18 recommendations for statutory changes to improve health 
19 care for children in the Department's care.
20 (h) If any provision of this Section or its application to 
21any person or circumstance is held invalid, the invalidity of 
22that provision or application does not affect other provisions 
23or applications of this Section that can be given effect 
24without the invalid provision or application. 

25 Section 16. The Nursing Home Care Act is amended by 
 
 
10000SB1851ham002- 39 -LRB100 10394 KTG 41023 a


1changing Section 2-217 as follows:

2 (210 ILCS 45/2-217)
3 Sec. 2-217. Order for transportation of resident by an 
4ambulance service provider. If a facility orders medi-car, 
5service car, or ground ambulance transportation of a resident 
6of the facility by an ambulance service provider, the facility 
7must maintain a written record that shows (i) the name of the 
8person who placed the order for that transportation and (ii) 
9the medical reason for that transportation. Additionally, the 
10facility must provide the ambulance service provider with a 
11Physician Certification Statement on a form prescribed by the 
12Department of Healthcare and Family Services in accordance with 
13subsection (g) of Section 5-4.2 of the Illinois Public Aid 
14Code. The facility shall provide a copy of the Physician 
15Certification Statement to the ambulance service provider 
16prior to or at the time of transport. The Physician 
17Certification Statement is not required prior to the transport 
18if a delay in transport can be expected to negatively affect 
19the patient outcome; however, the facility shall provide a copy 
20of the Physician Certification Statement to the ambulance 
21service provider at no charge within 10 days after the request. 
22A facility shall, upon request, furnish assistance to the 
23transportation provider in the completion of the form if the 
24Physician Certification Statement is incomplete. The facility 
25must maintain the record for a period of at least 3 years after 
 
 
10000SB1851ham002- 40 -LRB100 10394 KTG 41023 a


1the date of the order for transportation by ambulance.

2(Source: P.A. 94-1063, eff. 1-31-07.)

3 Section 17. The Specialized Mental Health Rehabilitation 
4Act of 2013 is amended by adding Section 5-104 as follows:

5 (210 ILCS 49/5-104 new)
6 Sec. 5-104. Therapeutic visit rates. For a facility 
7licensed under this Act by June 1, 2018 or provisionally 
8licensed under this Act by June 1, 2018, a payment shall be 
9made for therapeutic visits that have been indicated by an 
10interdisciplinary team as therapeutically beneficial. Payment 
11under this Section shall be at a rate of 75% of the facility's 
12rate on the effective date of this amendatory Act of the 100th 
13General Assembly and may not exceed 20 days in a fiscal year 
14and shall not exceed 10 days consecutively.

15 Section 18. The Hospital Licensing Act is amended by 
16changing Section 6.22 as follows:

17 (210 ILCS 85/6.22)
18 Sec. 6.22. Arrangement for transportation of patient by an 
19ambulance service provider.

20 (a) In this Section:
21  "Ambulance service provider" means a Vehicle Service 
22 Provider as defined in the Emergency Medical Services (EMS) 
 
 
10000SB1851ham002- 41 -LRB100 10394 KTG 41023 a


1 Systems Act who provides non-emergency transportation 
2 services by ambulance.
3  "Patient" means a person who is transported by an 
4 ambulance service provider.

5 (b) If a hospital arranges for medi-car, service car, or 
6ground ambulance transportation of a patient of the hospital by 
7ambulance, the hospital must provide the ambulance service 
8provider, at or prior to transport, a Physician Certification 
9Statement formatted and completed in compliance with federal 
10regulations or an equivalent form developed by the hospital. 
11Each hospital shall develop a policy requiring a physician or 
12the physician's designee to complete the Physician 
13Certification
Statement. The Physician Certification
Statement 
14shall be maintained as part of the patient's medical record. A 
15hospital shall, upon request, furnish assistance to the 
16ambulance service provider in the completion of the form if the 
17Physician Certification
Statement is incomplete. The Physician 
18Certification Statement or equivalent form is not required 
19prior to transport if a delay in transport can be expected to 
20negatively affect the patient outcome; however, a hospital 
21shall provide a copy of the Physician Certification
Statement 
22to the ambulance service provider at no charge within 10 days 
23after the request.
24 (c) If a hospital is unable to provide a Physician 
25Certification Statement or equivalent form, then the hospital 
26shall provide to the patient a written notice and a verbal 
 
 
10000SB1851ham002- 42 -LRB100 10394 KTG 41023 a


1explanation of the written notice, which notice must meet all 
2of the following requirements:

3  (1) The following caption must appear at the beginning 
4 of the notice in at least 14-point type: Notice to Patient 
5 Regarding Non-Emergency Ambulance Services.
6  (2) The notice must contain each of the following 
7 statements in at least 14-point type:
8   (A) The purpose of this notice is to help you make 
9 an informed choice about whether you want to be 
10 transported by ambulance because your medical 
11 condition does not meet medical necessity for 
12 transportation by an ambulance.
13   (B) Your insurance may not cover the charges for 
14 ambulance transportation.
15   (C) You may be responsible for the cost of 
16 ambulance transportation.
17   (D) The estimated cost of ambulance transportation 
18 is $(amount).
19  (3) The notice must be signed by the patient or by the 
20 patient's authorized representative. A copy shall be given 
21 to the patient and the hospital shall retain a copy.
22 (d) The notice set forth in subsection (c) of this Section 
23shall not be required if a delay in transport can be expected 
24to negatively affect the patient outcome.
25 (e) If a patient is physically or mentally unable to sign 
26the notice described in subsection (c) of this Section and no 
 
 
10000SB1851ham002- 43 -LRB100 10394 KTG 41023 a


1authorized representative of the patient is available to sign 
2the notice on the patient's behalf, the hospital must be able 
3to provide documentation of the patient's inability to sign the 
4notice and the unavailability of an authorized representative. 
5In any case described in this subsection (e), the hospital 
6shall be considered to have met the requirements of subsection 
7(c) of this Section.


8(Source: P.A. 94-1063, eff. 1-31-07.)

9 Section 20. The Illinois Public Aid Code is amended by 
10changing Sections 5-4.2, 5-5.4h, and 5A-16 and by adding 
11Sections 5-5.07 and 5-30.8 as follows:




12 (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)



13 Sec. 5-4.2. Ambulance services payments. 
14 (a) For
ambulance
services provided to a recipient of aid 
15under this Article on or after
January 1, 1993, the Illinois 
16Department shall reimburse ambulance service
providers at 
17rates calculated in accordance with this Section. It is the 
18intent
of the General Assembly to provide adequate 
19reimbursement for ambulance
services so as to ensure adequate 
20access to services for recipients of aid
under this Article and 
21to provide appropriate incentives to ambulance service

22providers to provide services in an efficient and 
23cost-effective manner. Thus,
it is the intent of the General 
24Assembly that the Illinois Department implement
a 
 
 
10000SB1851ham002- 44 -LRB100 10394 KTG 41023 a


1reimbursement system for ambulance services that, to the extent 
2practicable
and subject to the availability of funds 
3appropriated by the General Assembly
for this purpose, is 
4consistent with the payment principles of Medicare. To
ensure 
5uniformity between the payment principles of Medicare and 
6Medicaid, the
Illinois Department shall follow, to the extent 
7necessary and practicable and
subject to the availability of 
8funds appropriated by the General Assembly for
this purpose, 
9the statutes, laws, regulations, policies, procedures,

10principles, definitions, guidelines, and manuals used to 
11determine the amounts
paid to ambulance service providers under 
12Title XVIII of the Social Security
Act (Medicare).

13 (b) For ambulance services provided to a recipient of aid 
14under this Article
on or after January 1, 1996, the Illinois 
15Department shall reimburse ambulance
service providers based 
16upon the actual distance traveled if a natural
disaster, 
17weather conditions, road repairs, or traffic congestion 
18necessitates
the use of a
route other than the most direct 
19route.

20 (c) For purposes of this Section, "ambulance services" 
21includes medical
transportation services provided by means of 
22an ambulance, medi-car, service
car, or
taxi.

23 (c-1) For purposes of this Section, "ground ambulance 
24service" means medical transportation services that are 
25described as ground ambulance services by the Centers for 
26Medicare and Medicaid Services and provided in a vehicle that 
 
 
10000SB1851ham002- 45 -LRB100 10394 KTG 41023 a


1is licensed as an ambulance by the Illinois Department of 
2Public Health pursuant to the Emergency Medical Services (EMS) 
3Systems Act.
4 (c-2) For purposes of this Section, "ground ambulance 
5service provider" means a vehicle service provider as described 
6in the Emergency Medical Services (EMS) Systems Act that 
7operates licensed ambulances for the purpose of providing 
8emergency ambulance services, or non-emergency ambulance 
9services, or both. For purposes of this Section, this includes 
10both ambulance providers and ambulance suppliers as described 
11by the Centers for Medicare and Medicaid Services.
12 (c-3) For purposes of this Section, "medi-car" means 
13transportation services provided to a patient who is confined 
14to a wheelchair and requires the use of a hydraulic or electric 
15lift or ramp and wheelchair lockdown when the patient's 
16condition does not require medical observation, medical 
17supervision, medical equipment, the administration of 
18medications, or the administration of oxygen. 
19 (c-4) For purposes of this Section, "service car" means 
20transportation services provided to a patient by a passenger 
21vehicle where that patient does not require the specialized 
22modes described in subsection (c-1) or (c-3). 
23 (d) This Section does not prohibit separate billing by 
24ambulance service
providers for oxygen furnished while 
25providing advanced life support
services.

26 (e) Beginning with services rendered on or after July 1, 
 
 
10000SB1851ham002- 46 -LRB100 10394 KTG 41023 a


12008, all providers of non-emergency medi-car and service car 
2transportation must certify that the driver and employee 
3attendant, as applicable, have completed a safety program 
4approved by the Department to protect both the patient and the 
5driver, prior to transporting a patient.
The provider must 
6maintain this certification in its records. The provider shall 
7produce such documentation upon demand by the Department or its 
8representative. Failure to produce documentation of such 
9training shall result in recovery of any payments made by the 
10Department for services rendered by a non-certified driver or 
11employee attendant. Medi-car and service car providers must 
12maintain legible documentation in their records of the driver 
13and, as applicable, employee attendant that actually 
14transported the patient. Providers must recertify all drivers 
15and employee attendants every 3 years.

16 Notwithstanding the requirements above, any public 
17transportation provider of medi-car and service car 
18transportation that receives federal funding under 49 U.S.C. 
195307 and 5311 need not certify its drivers and employee 
20attendants under this Section, since safety training is already 
21federally mandated.

22 (f) With respect to any policy or program administered by 
23the Department or its agent regarding approval of non-emergency 
24medical transportation by ground ambulance service providers, 
25including, but not limited to, the Non-Emergency 
26Transportation Services Prior Approval Program (NETSPAP), the 
 
 
10000SB1851ham002- 47 -LRB100 10394 KTG 41023 a


1Department shall establish by rule a process by which ground 
2ambulance service providers of non-emergency medical 
3transportation may appeal any decision by the Department or its 
4agent for which no denial was received prior to the time of 
5transport that either (i) denies a request for approval for 
6payment of non-emergency transportation by means of ground 
7ambulance service or (ii) grants a request for approval of 
8non-emergency transportation by means of ground ambulance 
9service at a level of service that entitles the ground 
10ambulance service provider to a lower level of compensation 
11from the Department than the ground ambulance service provider 
12would have received as compensation for the level of service 
13requested. The rule shall be filed by December 15, 2012 and 
14shall provide that, for any decision rendered by the Department 
15or its agent on or after the date the rule takes effect, the 
16ground ambulance service provider shall have 60 days from the 
17date the decision is received to file an appeal. The rule 
18established by the Department shall be, insofar as is 
19practical, consistent with the Illinois Administrative 
20Procedure Act. The Director's decision on an appeal under this 
21Section shall be a final administrative decision subject to 
22review under the Administrative Review Law. 
23 (f-5) Beginning 90 days after July 20, 2012 (the effective 
24date of Public Act 97-842), (i) no denial of a request for 
25approval for payment of non-emergency transportation by means 
26of ground ambulance service, and (ii) no approval of 
 
 
10000SB1851ham002- 48 -LRB100 10394 KTG 41023 a


1non-emergency transportation by means of ground ambulance 
2service at a level of service that entitles the ground 
3ambulance service provider to a lower level of compensation 
4from the Department than would have been received at the level 
5of service submitted by the ground ambulance service provider, 
6may be issued by the Department or its agent unless the 
7Department has submitted the criteria for determining the 
8appropriateness of the transport for first notice publication 
9in the Illinois Register pursuant to Section 5-40 of the 
10Illinois Administrative Procedure Act. 
11 (g) Whenever a patient covered by a medical assistance 
12program under this Code or by another medical program 
13administered by the Department, including a patient covered 
14under the State's Medicaid managed care program, is being 
15transported discharged from a facility and requires 
16non-emergency transportation including ground ambulance, 
17medi-car, or service car transportation, a Physician 
18Certification Statement , a physician discharge order as 
19described in this Section shall be required for each patient 
20whose discharge requires medically supervised ground ambulance 
21services. Facilities shall develop procedures for a licensed 
22medical professional physician with medical staff privileges 
23to provide a written and signed Physician Certification 
24Statement physician discharge order. The Physician 
25Certification Statement physician discharge order shall 
26specify the level of transportation ground ambulance services 
 
 
10000SB1851ham002- 49 -LRB100 10394 KTG 41023 a


1needed and complete a medical certification establishing the 
2criteria for approval of non-emergency ambulance 
3transportation, as published by the Department of Healthcare 
4and Family Services, that is met by the patient. This order and 
5the medical certification shall be completed prior to ordering 
6the transportation an ambulance service and prior to patient 
7discharge. The Physician Certification Statement is not 
8required prior to transport if a delay in transport can be 
9expected to negatively affect the patient outcome. discharge.
10 The medical certification specifying the level and type of 
11non-emergency transportation needed shall be in the form of the 
12Physician Certification Statement on a standardized form 
13prescribed by the Department of Healthcare and Family Services. 
14Within 75 days after the effective date of this amendatory Act 
15of the 100th General Assembly, the Department of Healthcare and 
16Family Services shall develop a standardized form of the 
17Physician Certification Statement specifying the level and 
18type of transportation services needed in consultation with the 
19Department of Public Health, Medicaid managed care 
20organizations, a statewide association representing ambulance 
21providers, a statewide association representing hospitals, 3 
22statewide associations representing nursing homes, and other 
23stakeholders. The Physician Certification Statement shall 
24include, but is not limited to, the criteria necessary to 
25demonstrate medical necessity for the level of transport needed 
26as required by (i) the Department of Healthcare and Family 
 
 
10000SB1851ham002- 50 -LRB100 10394 KTG 41023 a


1Services and (ii) the federal Centers for Medicare and Medicaid 
2Services as outlined in the Centers for Medicare and Medicaid 
3Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap. 
410, Sec. 10.2.1, et seq. The use of the Physician Certification 
5Statement shall satisfy the obligations of hospitals under 
6Section 6.22 of the Hospital Licensing Act and nursing homes 
7under Section 2-217 of the Nursing Home Care Act. 
8Implementation and acceptance of the Physician Certification 
9Statement shall take place no later than 90 days after the 
10issuance of the Physician Certification Statement by the 
11Department of Healthcare and Family Services. 
12 Pursuant to subsection (E) of Section 12-4.25 of this Code, 
13the Department is entitled to recover overpayments paid to a 
14provider or vendor, including, but not limited to, from the 
15discharging physician, the discharging facility, and the 
16ground ambulance service provider, in instances where a 
17non-emergency ground ambulance service is rendered as the 
18result of improper or false certification. 
19 Beginning October 1, 2018, the Department of Healthcare and 
20Family Services shall collect data from Medicaid managed care 
21organizations and transportation brokers, including the 
22Department's NETSPAP broker, regarding denials and appeals 
23related to the missing or incomplete Physician Certification 
24Statement forms and overall compliance with this subsection. 
25The Department of Healthcare and Family Services shall publish 
26quarterly results on its website within 15 days following the 
 
 
10000SB1851ham002- 51 -LRB100 10394 KTG 41023 a


1end of each quarter. 
2 (h) On and after July 1, 2012, the Department shall reduce 
3any rate of reimbursement for services or other payments or 
4alter any methodologies authorized by this Code to reduce any 
5rate of reimbursement for services or other payments in 
6accordance with Section 5-5e. 
7(Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12; 
897-842, eff. 7-20-12; 98-463, eff. 8-16-13.)


9 (305 ILCS 5/5-5.4h)
10 Sec. 5-5.4h. Medicaid reimbursement for medically complex 
11for the developmentally disabled facilities licensed under the 
12MC/DD Act long-term care facilities for persons under 22 years 
13of age.
14 (a) Facilities licensed as medically complex for the 
15developmentally disabled facilities long-term care facilities 
16for persons under 22 years of age that serve severely and 
17chronically ill pediatric patients shall have a specific 
18reimbursement system designed to recognize the characteristics 
19and needs of the patients they serve. 
20 (b) For dates of services starting July 1, 2013 and until a 
21new reimbursement system is designed, medically complex for the 
22developmentally disabled facilities long-term care facilities 
23for persons under 22 years of age that meet the following 
24criteria: 
25  (1) serve exceptional care patients; and 
 
 
10000SB1851ham002- 52 -LRB100 10394 KTG 41023 a


1  (2) have 30% or more of their patients receiving 
2 ventilator care;
3shall receive Medicaid reimbursement on a 30-day expedited 
4schedule. 

5 (c) Subject to federal approval of changes to the Title XIX 
6State Plan, for dates of services starting July 1, 2014 through 
7March 31, 2019, medically complex for the developmentally 
8disabled facilities and until a new reimbursement system is 
9designed, long-term care facilities for persons under 22 years 
10of age which meet the criteria in subsection (b) of this 
11Section shall receive a per diem rate for clinically complex 
12residents of $304. Clinically complex residents on a ventilator 
13shall receive a per diem rate of $669. Subject to federal 
14approval of changes to the Title XIX State Plan, for dates of 
15services starting April 1, 2019, medically complex for the 
16developmentally disabled facilities must be reimbursed an 
17exceptional care per diem rate, instead of the base rate, for 
18services to residents with complex or extensive medical needs. 
19Exceptional care per diem rates must be paid for the conditions 
20or services specified under subsection (f) at the following per 
21diem rates: Tier 1 $326, Tier 2 $546, and Tier 3 $735. 
22 (d) For To qualify for the per diem rate of $669 for 
23clinically complex residents on a ventilator pursuant to 
24subsection (c) or subsection (f), facilities shall have a 
25policy documenting their method of routine assessment of a 
26resident's weaning potential with interventions implemented 
 
 
10000SB1851ham002- 53 -LRB100 10394 KTG 41023 a


1noted in the resident's medical record. 
2 (e) For services provided prior to April 1, 2019 and for 
3For the purposes of this Section, a resident is considered 
4clinically complex if the resident requires at least one of the 
5following medical services: 
6  (1) Tracheostomy care with dependence on mechanical 
7 ventilation for a minimum of 6 hours each day. 
8  (2) Tracheostomy care requiring suctioning at least 
9 every 6 hours, room air mist or oxygen as needed, and 
10 dependence on one of the treatment procedures listed under 
11 paragraph (4) excluding the procedure listed in 
12 subparagraph (A) of paragraph (4). 
13  (3) Total parenteral nutrition or other intravenous 
14 nutritional support and one of the treatment procedures 
15 listed under paragraph (4). 
16  (4) The following treatment procedures apply to the 
17 conditions in paragraphs (2) and (3) of this subsection: 
18   (A) Intermittent suctioning at least every 8 hours 
19 and room air mist or oxygen as needed. 
20   (B) Continuous intravenous therapy including 
21 administration of therapeutic agents necessary for 
22 hydration or of intravenous pharmaceuticals; or 
23 intravenous pharmaceutical administration of more than 
24 one agent via a peripheral or central line, without 
25 continuous infusion. 
26   (C) Peritoneal dialysis treatments requiring at 
 
 
10000SB1851ham002- 54 -LRB100 10394 KTG 41023 a


1 least 4 exchanges every 24 hours. 
2   (D) Tube feeding via nasogastric or gastrostomy 
3 tube. 
4   (E) Other medical technologies required 
5 continuously, which in the opinion of the attending 
6 physician require the services of a professional 
7 nurse. 
8 (f) Complex or extensive medical needs for exceptional care 
9reimbursement. The conditions and services used for the 
10purposes of this Section have the same meanings as ascribed to 
11those conditions and services under the Minimum Data Set (MDS) 
12Resident Assessment Instrument (RAI) and specified in the most 
13recent manual. Instead of submitting minimum data set 
14assessments to the Department, medically complex for the 
15developmentally disabled facilities must document within each 
16resident's medical record the conditions or services using the 
17minimum data set documentation standards and requirements to 
18qualify for exceptional care reimbursement.
19  (1) Tier 1 reimbursement is for residents who are 
20 receiving at least 51% of their caloric intake via a 
21 feeding tube.
22  (2) Tier 2 reimbursement is for residents who are 
23 receiving tracheostomy care without a ventilator.
24  (3) Tier 3 reimbursement is for residents who are 
25 receiving tracheostomy care and ventilator care.
26 (g) For dates of services starting April 1, 2019, 
 
 
10000SB1851ham002- 55 -LRB100 10394 KTG 41023 a


1reimbursement calculations and direct payment for services 
2provided by medically complex for the developmentally disabled 
3facilities are the responsibility of the Department of 
4Healthcare and Family Services instead of the Department of 
5Human Services. Appropriations for medically complex for the 
6developmentally disabled facilities must be shifted from the 
7Department of Human Services to the Department of Healthcare 
8and Family Services. Nothing in this Section prohibits the 
9Department of Healthcare and Family Services from paying more 
10than the rates specified in this Section. The rates in this 
11Section must be interpreted as a minimum amount. Any 
12reimbursement increases applied to providers licensed under 
13the ID/DD Community Care Act must also be applied in an 
14equivalent manner to medically complex for the developmentally 
15disabled facilities. 
16 (h) The Department of Healthcare and Family Services shall 
17pay the rates in effect on March 31, 2019 until the changes 
18made to this Section by this amendatory Act of the 100th 
19General Assembly have been approved by the Centers for Medicare 
20and Medicaid Services of the U.S. Department of Health and 
21Human Services. 
22 (i) The Department of Healthcare and Family Services may 
23adopt rules as allowed by the Illinois Administrative Procedure 
24Act to implement this Section; however, the requirements of 
25this Section must be implemented by the Department of 
26Healthcare and Family Services even if the Department of 
 
 
10000SB1851ham002- 56 -LRB100 10394 KTG 41023 a


1Healthcare and Family Services has not adopted rules by the 
2implementation date of April 1, 2019. 
3(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)

4 (305 ILCS 5/5-5.07 new)
5 Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem 
6rate. The Department of Children and Family Services shall pay 
7the DCFS per diem rate for inpatient psychiatric stay at a 
8free-standing psychiatric hospital effective the 11th day when 
9a child is in the hospital beyond medical necessity, and the 
10parent or caregiver has denied the child access to the home and 
11has refused or failed to make provisions for another living 
12arrangement for the child or the child's discharge is being 
13delayed due to a pending inquiry or investigation by the 
14Department of Children and Family Services. This Section is 
15repealed 6 months after the effective date of this amendatory 
16Act of the 100th General Assembly.

17 (305 ILCS 5/5-30.8 new)
18 Sec. 5-30.8. Managed care organization rate transparency.
19 (a) For the establishment of Managed care
organization 
20(MCO) capitated base rate payments from the State,
including, 
21but not limited to: (i) hospital fee schedule
reforms and 
22updates, (ii) rates related to a single
State-mandated 
23preferred drug list, (iii) rate updates related
to the State's 
24preferred drug list, (iv) inclusion of coverage
for children 
 
 
10000SB1851ham002- 57 -LRB100 10394 KTG 41023 a


1with special needs, (v) inclusion of coverage for
children 
2within the child welfare system, (vi) annual MCO
capitated 
3rates, and (vii) any retroactive provider fee
schedule 
4adjustments or other changes required by legislation
or other 
5actions, the Department of Healthcare and Family
Services shall 
6implement a capitation base rate setting process beginning
on 
7the effective date of this amendatory Act of the 100th
General 
8Assembly which shall include all of the following
elements of 
9transparency:
10  (1) The Department shall include participating MCOs 
11 and a statewide trade association representing a majority 
12 of participating MCOs in meetings to discuss the impact to 
13 base capitation rates as a result of any new or updated 
14 hospital fee schedules or
other provider fee schedules. 
15 Additionally, the Department
shall share any data or 
16 reports used to develop MCO capitation rates
with 
17 participating MCOs. This data shall be comprehensive

18 enough for MCO actuaries to recreate and verify the

19 accuracy of the capitation base rate build-up. 
20  (2) The Department shall not limit the number of

21 experts that each MCO is allowed to bring to the draft 
22 capitation base rate
meeting or the final capitation base 
23 rate review meeting. Draft and final capitation base rate 
24 review meetings shall be held in at least 2 locations. 
25  (3) The Department and its contracted actuary shall

26 meet with all participating MCOs simultaneously and

 
 
10000SB1851ham002- 58 -LRB100 10394 KTG 41023 a


1 together along with consulting actuaries contracted with

2 statewide trade association representing a majority of 
3 Medicaid health plans at the request of the plans.

4 Participating MCOs shall additionally, at their request,

5 be granted individual capitation rate development meetings 
6 with the
Department. 
7  (4) Any quality incentive or other incentive

8 withholding of any portion of the actuarially certified

9 capitation rates must be budget-neutral. The entirety of 
10 any aggregate
withheld amounts must be returned to the MCOs 
11 in proportion
to their performance on the relevant 
12 performance metric. No
amounts shall be returned to the 
13 Department if
all performance measures are not achieved to 
14 the extent allowable by federal law and regulations. 
15  (5) Upon request, the Department shall provide written 
16 responses to
questions regarding MCO capitation base 
17 rates, the capitation base development
methodology, and 
18 MCO capitation rate data, and all other requests regarding

19 capitation rates from MCOs. Upon request, the Department 
20 shall also provide to the MCOs materials used in 
21 incorporating provider fee schedules into base capitation 
22 rates.
23 (b) For the development of capitation base rates for new 
24capitation rate years: 
25  (1) The Department shall take into account emerging

26 experience in the development of the annual MCO capitation 
 
 
10000SB1851ham002- 59 -LRB100 10394 KTG 41023 a


1 base rates,
including, but not limited to, current-year 
2 cost and
utilization trends observed by MCOs in an 
3 actuarially sound manner and in accordance with federal law 
4 and regulations. 
5  (2) No later than January 1 of each year, the 
6 Department shall release an agreed upon annual calendar 
7 that outlines dates for capitation rate setting meetings 
8 for that year. The calendar shall include at least the 
9 following meetings and deadlines: 
10   (A) An initial meeting for the Department to review 
11 MCO data and draft rate assumptions to be used in the 
12 development of capitation base rates for the following 
13 year. 
14   (B) A draft rate meeting after the Department 
15 provides the MCOs with the
draft capitated base
rates

16 to discuss, review, and seek feedback regarding the 
17 draft capitation base
rates. 
18  (3) Prior to the submission of final capitation rates 
19 to the federal Centers for
Medicare and Medicaid Services, 
20 the Department shall
provide the MCOs with a final 
21 actuarial report including
the final capitation base rates 
22 for the following year and
subsequently conduct a final 
23 capitation base review meeting.
Final capitation rates 
24 shall be marked final. 
25 (c) For the development of capitation base rates reflecting 
26policy changes: 
 
 
10000SB1851ham002- 60 -LRB100 10394 KTG 41023 a


1  (1) Unless contrary to federal law and regulation,
the 
2 Department must provide notice to MCOs
of any significant 
3 operational policy change no later than 60 days
prior to 
4 the effective date of an operational policy change in order 
5 to give MCOs time to prepare for and implement the 
6 operational policy change and to ensure that the quality 
7 and delivery of enrollee health care is not disrupted. 
8 "Operational policy change" means a change to operational 
9 requirements such as reporting formats, encounter 
10 submission definitional changes, or required provider 
11 interfaces
made at the sole discretion of the Department

12 and not required by legislation with a retroactive

13 effective date. Nothing in this Section shall be construed 
14 as a requirement to delay or prohibit implementation of 
15 policy changes that impact enrollee benefits as determined 
16 in the sole discretion of the Department. 
17  (2) No later than 60 days after the effective date of 
18 the policy change or
program implementation, the 
19 Department shall meet with the
MCOs regarding the initial 
20 data collection needed to
establish capitation base rates 
21 for the policy change. Additionally,
the Department shall 
22 share with the participating MCOs what
other data is needed 
23 to estimate the change and the processes for collection of 
24 that data that shall be
utilized to develop capitation base 
25 rates. 
26  (3) No later than 60 days after the effective date of 
 
 
10000SB1851ham002- 61 -LRB100 10394 KTG 41023 a


1 the policy change or
program implementation, the 
2 Department shall meet with
MCOs to review data and the 
3 Department's written draft
assumptions to be used in 
4 development of capitation base rates for the
policy change, 
5 and shall provide opportunities for
questions to be asked 
6 and answered. 
7  (4) No later than 60 days after the effective date of 
8 the policy change or
program implementation, the 
9 Department shall provide the
MCOs with draft capitation 
10 base rates and shall also conduct
a draft capitation base 
11 rate meeting with MCOs to discuss, review, and seek

12 feedback regarding the draft capitation base rates. 
13 (d) For the development of capitation base rates for 
14retroactive policy or
fee schedule changes: 
15  (1) The Department shall meet with the MCOs regarding

16 the initial data collection needed to establish capitation 
17 base rates for
the policy change. Additionally, the 
18 Department shall
share with the participating MCOs what 
19 other data is needed to estimate the change and the

20 processes for collection of the data that shall be utilized 
21 to develop capitation base
rates. 
22  (2) The Department shall meet with MCOs to review data

23 and the Department's written draft assumptions to be used

24 in development of capitation base rates for the policy 
25 change. The Department shall
provide opportunities for 
26 questions to be asked and
answered. 
 
 
10000SB1851ham002- 62 -LRB100 10394 KTG 41023 a


1  (3) The Department shall provide the MCOs with draft

2 capitated rates and shall also conduct a draft rate meeting

3 with MCOs to discuss, review, and seek feedback regarding

4 the draft capitation base rates. 
5  (4) The Department shall inform MCOs no less than 
6 quarterly of upcoming benefit and policy changes to the 
7 Medicaid program. 
8 (e) Meetings of the group established to discuss Medicaid 
9capitation rates under this Section shall be closed to the 
10public and shall not be subject to the Open Meetings Act. 
11Records and information produced by the group established to 
12discuss Medicaid capitation rates under this Section shall be 
13confidential and not subject to the Freedom of Information Act.

14 (305 ILCS 5/5A-16)
15 Sec. 5A-16. State fiscal year 2019 implementation 
16protection. 
17 (a) To preserve access to hospital services and to ensure 
18continuity of payments and stability of access to hospital 
19services, it is the intent of the General Assembly that there 
20not be a gap in payments to hospitals while the changes 
21authorized under Public Act 100-581 this amendatory Act of the 
22100th General Assembly are being reviewed by the federal 
23Centers for Medicare and Medicaid Services and implemented by 
24the Department. Therefore, pending the review and approval of 
25the changes to the assessment and hospital reimbursement 
 
 
10000SB1851ham002- 63 -LRB100 10394 KTG 41023 a


1methodologies authorized under Public Act 100-581 this 
2amendatory Act of the 100th General Assembly by the federal 
3Centers for Medicare and Medicaid Services and the final 
4implementation of such program by the Department, the 
5Department shall take all actions necessary to continue the 
6reimbursement methodologies and payments to hospitals that are 
7changed under Public Act 100-581 this amendatory Act of the 
8100th General Assembly, as they are in effect on June 30, 2018, 
9until the first day of the second month after the new and 
10revised methodologies and payments authorized under Public Act 
11100-581 this amendatory Act of the 100th General Assembly are 
12effective and implemented by the Department. Such actions by 
13the Department shall include, but not be limited to, requesting 
14prior to June 15, 2018 the extension of any federal approval of 
15the currently approved payment methodologies contained in 
16Illinois' Medicaid State Plan while the federal Centers for 
17Medicare and Medicaid Services reviews the proposed changes 
18authorized under Public Act 100-581 this amendatory Act of the 
19100th General Assembly.
20 (b) Notwithstanding any other provision of this Code, if 
21the federal Centers for Medicare and Medicaid Services should 
22approve the continuation of the reimbursement methodologies 
23and payments to hospitals under Sections 5A-12.2, 5A-12.4, 
245A-12.5 and , and Section 14-12, as they are in effect on June 
2530, 2018, until the new and revised methodologies and payments 
26authorized under Sections 5A-12.6 and Section 14-12 of this 
 
 
10000SB1851ham002- 64 -LRB100 10394 KTG 41023 a


1Code amendatory Act of the 100th General Assembly are federally 
2approved, then the reimbursement methodologies and payments to 
3hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12, 
4and the assessments imposed under Section 5A-2, as they are in 
5effect on June 30, 2018, shall continue until the effective 
6date of the new and revised methodologies and payments, which 
7shall be the first day of the second month following the date 
8of approval by the federal Centers for Medicare and Medicaid 
9Services.

10 (c) Notwithstanding any other provision of this Code, if by 
11July 11, 2018 the federal Centers for Medicare and Medicaid 
12Services has neither approved the changes authorized under 
13Public Act 100-581 nor has formally approved an extension of 
14the reimbursement methodologies and payments to hospitals 
15under Sections 5A-12.5 and 14-12 as they are in effect on June 
1630, 2018, then the following shall apply: 
17  (1) all reimbursement methodologies and payments for 
18 hospital services authorized under Sections 5A-12.2, 
19 5A-12.4, and 5A-12.5 in effect on June 30, 2018 shall 
20 continue subject to the availability of federal matching 
21 funds for such expenditures and subject to the provisions 
22 of subsection (c) of Section 5A-15; and 
23  (2) all supplemental payments to hospitals authorized 
24 in Illinois' Medicaid State
Plan in effect on June 30, 
25 2018, which are scheduled to terminate under Illinois' 
26 Medicaid State
Plan on June 30, 2018, shall continue 
 
 
10000SB1851ham002- 65 -LRB100 10394 KTG 41023 a


1 subject to the availability of federal matching funds for 
2 such expenditures; and 
3  (3) all assessments imposed under Section 5A-2, as they 
4 are in effect on June 30, 2018, shall continue.
5 Notwithstanding any other provision in this subsection, 
6the Department shall make monthly advance payments to any 
7safety-net hospital or critical access hospital requesting 
8such advance payments in an amount, as requested by the 
9hospital, provided that the total monthly payments to the 
10hospital under this subsection shall not exceed 1/12th of the 
11payments the hospital would have received under Sections 
125A-12.2, 5A-12.4, and 5A-12.5 and subsections (d) and (f) of 
13Section 14-12. 
14 Notwithstanding any other provision in this subsection, 
15the Department may make monthly advance payments to a hospital 
16requesting such advance payments in an amount, as requested by 
17the hospital, provided that the total monthly payments to the 
18hospital under this subsection shall not exceed 1/12th of the 
19payments the hospital would have received under Sections 
205A-12.2, 5A-12.4, and 5A-12.5 and subsections (d) and (f) of 
21Section 14-12. 
22 Payments under this subsection shall be made regardless of 
23federal approval for federal financial participation under 
24Title XIX or XXI of the federal Social Security Act. 
25 As used in this subsection, "safety-net hospital" means a 
26hospital as defined in Section 5-5e.1 for Rate Year 2017 or an 
 
 
10000SB1851ham002- 66 -LRB100 10394 KTG 41023 a


1Illinois hospital that meets the criteria in paragraphs (2) and 
2(3) of subsection (a) of Section 5-5e.1 for Rate Year 2017.
3 As used in this subsection, "critical access hospital" 
4means a hospital that has such status as of June 30, 2018. 
5 The changes authorized under this subsection shall 
6continue, on the same time schedule as otherwise authorized 
7under this Article, until the effective date of the new and 
8revised methodologies and payments under Public Act 100-581, 
9which shall be the first day of the second month following the 
10date of approval by the federal Centers for Medicare and 
11Medicaid Services. 
12(Source: P.A. 100-581, eff. 3-12-18.)


13 Section 95. No acceleration or delay. Where this Act makes 
14changes in a statute that is represented in this Act by text 
15that is not yet or no longer in effect (for example, a Section 
16represented by multiple versions), the use of that text does 
17not accelerate or delay the taking effect of (i) the changes 
18made by this Act or (ii) provisions derived from any other 
19Public Act.

20 Section 999. Effective date. This Act takes effect upon 
21becoming law.".