Chapter 305, PUBLIC AID

(305 ILCS 5/5-36.5) Sec. 5-36.5. Education on mental health and substance use treatment services for children and young adults. The Department of Healthcare and Family Services shall develop a layman's guide to the mental health and substance use treatment services available in I…

(305 ILCS 5/5-37) Sec. 5-37. Billing mechanism for preventive mental health services delivered to children. (a) The General Assembly finds: (1) It is common for children to have mental health needs but to not have a full-blown diagnosis of a mental illness. Examples include, but …

(305 ILCS 5/5-38) Sec. 5-38. Alignment of children's mental health treatment systems. The Governor's Office shall establish, convene, and lead a working group that includes the Director of Healthcare and Family Services, the Secretary of Human Services, the Director of Public Hea…

(305 ILCS 5/5-39) Sec. 5-39. Behavioral health services for children; diagnostic assessment system. Beginning on July 1, 2022, if it is necessary to provide a diagnostic code for behavioral health services for children ages 5 and under, providers shall utilize a developmentally a…

(305 ILCS 5/5-4) (from Ch. 23, par. 5-4) Sec. 5-4. Amount and nature of medical assistance. (a) The amount and nature of medical assistance shall be determined in accordance with the standards, rules, and regulations of the Department of Healthcare and Family Services, with due r…

(305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1) Sec. 5-4.1. Co-payments. The Department may by rule provide that recipients under any Article of this Code shall pay a federally approved fee as a co-payment for services. No co-payment requirement can exist for renal dialysis, radiati…

(305 ILCS 5/5-4.2) Sec. 5-4.2. Ambulance services payments. (a) For ambulance services provided to a recipient of aid under this Article on or after January 1, 1993, the Illinois Department shall reimburse ambulance service providers at rates calculated in accordance with this Se…

(305 ILCS 5/5-40) Sec. 5-40. Human breast milk coverage. (a) Notwithstanding any other provision of this Act, pasteurized donated human breast milk, which may include human milk fortifiers if indicated by a prescribing licensed medical practitioner, shall be covered under a healt…

(305 ILCS 5/5-41) Sec. 5-41. Inpatient hospitalization for opioid-related overdose or withdrawal patients. Due to the disproportionately high opioid-related fatality rates among African Americans in under-resourced communities in Illinois, the lack of community resources, the com…

(305 ILCS 5/5-42) Sec. 5-42. Tobacco cessation coverage; managed care. Notwithstanding any other provision of this Article, a managed care organization under contract with the Department to provide services to recipients of medical assistance shall provide coverage for all tobacc…

(305 ILCS 5/5-43) Sec. 5-43. Supports Waiver Program for Young Adults with Developmental Disabilities. (a) The Department of Human Services' Division of Developmental Disabilities, in partnership with the Department of Healthcare and Family Services and stakeholders, shall study …

(305 ILCS 5/5-44) (Text of Section before amendment by P.A. 104-742) Sec. 5-44. Screening, Brief Intervention, and Referral to Treatment. As used in this Section, "SBIRT" means a comprehensive, integrated, public health approach to the delivery of early intervention and treatment…

(305 ILCS 5/5-45) (Text of Section before amendment by P.A. 104-742) Sec. 5-45. Reimbursement rates; substance use disorder treatment providers and facilities. Beginning on July 1, 2022, the Department of Human Services' Division of Substance Use Prevention and Recovery in conjun…

(305 ILCS 5/5-46) Sec. 5-46. General acute care hospitals. A general acute care hospital is authorized to file a notice with the Department of Public Health and the Health Facilities and Services Review Board to establish an acute mental illness category of service in accordance …

(305 ILCS 5/5-47) (Text of Section before amendment by P.A. 104-742) Sec. 5-47. Medicaid reimbursement rates; substance use disorder treatment providers and facilities. (a) Beginning on January 1, 2024, subject to federal approval, the Department of Healthcare and Family Services…

(305 ILCS 5/5-48) Sec. 5-48. Increasing behavioral health service capacity in federally qualified health centers. The Department of Healthcare and Family Services shall develop policies and procedures with the goal of increasing the capacity of behavioral health services provided…

(305 ILCS 5/5-49) Sec. 5-49. Long-acting reversible contraception. Subject to federal approval, the Department shall adopt policies and rates for long-acting reversible contraception by January 1, 2024 to ensure that reimbursement is not reduced by 4.4% below list price. The Depa…

(305 ILCS 5/5-5) Sec. 5-5. Medical services. The Illinois Department, by rule, shall determine the quantity and quality of and the rate of reimbursement for the medical assistance for which payment will be authorized, and the medical services to be provided, which may include all…

(305 ILCS 5/5-5.01) (from Ch. 23, par. 5-5.01) Sec. 5-5.01. The Department of Healthcare and Family Services may establish and implement a pilot project for determining the feasibility of authorizing medical assistance payments for the costs of diagnosis and treatment of Alzheime…

(305 ILCS 5/5-5.01a) Sec. 5-5.01a. Supportive living facilities program. (a) The Department shall establish and provide oversight for a program of supportive living facilities that seek to promote resident independence, dignity, respect, and well-being in the most cost-effective …

(305 ILCS 5/5-5.01b) Sec. 5-5.01b. Certified Nursing Assistant Intern Program. (a) The Department shall establish or approve a Certified Nursing Assistant Intern Program to address the increasing need for trained health care workers for the supporting living facilities program es…

(305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02) Sec. 5-5.02. Hospital reimbursements. (a) Reimbursement to hospitals; July 1, 1992 through September 30, 1992. Notwithstanding any other provisions of this Code or the Illinois Department's Rules promulgated under the Illinois Admini…

(305 ILCS 5/5-5.03) Sec. 5-5.03. Trauma center adjustment. (a) For inpatient admissions on or after October 1, 1992 for trauma injuries as defined in the Emergency Medical Services (EMS) Systems Act, in addition to any other payments made under this Code, the Illinois Department …

(305 ILCS 5/5-5.04) Sec. 5-5.04. Persons living with HIV/AIDS. The Department of Public Aid may seek federal approval to expand access to health care for persons living with HIV/AIDS. Implementation of this Section is subject to appropriation. (Source: P.A. 94-629, eff. 1-1-06.)…

(305 ILCS 5/5-5.05) Sec. 5-5.05. Hospitals; psychiatric services. (a) On and after January 1, 2024, the inpatient, per diem rate to be paid to a hospital for inpatient psychiatric services shall be not less than 90% of the per diem rate established in accordance with subsection (…

(305 ILCS 5/5-5.05a) Sec. 5-5.05a. Reimbursement rates; community mental health centers. Notwithstanding the provisions of any other law, reimbursement rates, including enhanced payment rates and rate add-ons, for psychiatric and behavioral health services provided in or by commu…

(305 ILCS 5/5-5.05b) Sec. 5-5.05b. Access to psychiatric treatment. Effective July 1, 2019, or as soon thereafter as practical and subject to federal approval, the Department shall allocate an amount of up to $40,000,000 to enhance access psychiatric treatment, including both rei…

(305 ILCS 5/5-5.05c) Sec. 5-5.05c. Access to physician services. The Department shall increase rates of reimbursement for physician services to as close to 60% of Medicare rates in effect as of January 1, 2020 utilizing the rates of Illinois Locality 99 facility rates. (Source: P…

(305 ILCS 5/5-5.05d) Sec. 5-5.05d. Academic detailing for behavioral health providers. The Department shall develop, in collaboration with associations representing behavioral health providers, a program designed to provide behavioral health providers and providers in academic me…

(305 ILCS 5/5-5.05e) Sec. 5-5.05e. Tracking availability of beds for withdrawal management services. The Department of Human Services shall track, or contract with an organization to track, the availability of beds for withdrawal management services that are licensed by the Depar…

(305 ILCS 5/5-5.05f) (Text of Section before amendment by P.A. 104-742) Sec. 5-5.05f. Medicaid coverage for peer recovery support services. On or before January 1, 2023, the Department shall seek approval from the federal Centers for Medicare and Medicaid Services to cover peer r…

(305 ILCS 5/5-5.05h) Sec. 5-5.05h. Reimbursement rates for psychiatric evaluations and medication monitoring. Subject to federal approval, for dates of service on and after January 1, 2025, the Department shall make a one-time adjustment to the add-on rates for services delivered…

(305 ILCS 5/5-5.06) Sec. 5-5.06. Dental home initiative. The Department, in cooperation with the dental community and other affected organizations such as Head Start, shall work to develop and promote the concept of a dental home for children covered under this Article. Included …

(305 ILCS 5/5-5.06a) Sec. 5-5.06a. Increased funding for dental services. Beginning January 1, 2022, the amount allocated to fund rates for dental services provided to adults and children under the medical assistance program shall be increased by an approximate amount of $10,000,…

(305 ILCS 5/5-5.06b) Sec. 5-5.06b. Dental services. On and after July 1, 2021, dental services provided to adults and children under the medical assistance program may be established and paid at no less than the rates published by the Department and effective January 1, 2020 for …

(305 ILCS 5/5-5.06c) Sec. 5-5.06c. Access to prenatal and postpartum care. To ensure access to high quality prenatal and postpartum care and to promote continuity of care for pregnant individuals, the Department shall increase the rate for prenatal and postpartum visits to no les…

(305 ILCS 5/5-5.06d) Sec. 5-5.06d. External cephalic version rate. To encourage provider use of external cephalic versions and decrease the rates of caesarean sections in Illinois, the Department shall evaluate the rate for external cephalic versions and increase the rate by an a…

(305 ILCS 5/5-5.06e) Sec. 5-5.06e. Increased funding for dental services. Beginning January 1, 2023, the amount allocated to fund rates for dental services provided to adults and children under the medical assistance program shall be increased by an approximate amount of $10,000,…

(305 ILCS 5/5-5.07) Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem rate. The Department of Children and Family Services shall pay the DCFS per diem rate for inpatient psychiatric stay at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inp…

(305 ILCS 5/5-5.08) Sec. 5-5.08. Dialysis center funding. Notwithstanding any other provision of law, the add-on Medicaid payments to hospitals and freestanding chronic dialysis centers established under 89 Illinois Administrative Code 148.140(g)(4) for dates of service July 1, 2…

(305 ILCS 5/5-5.08a) Sec. 5-5.08a. Renal dialysis; add-on payments for home dialysis providers in skilled nursing facilities. (a) Findings. The General Assembly finds the following: (1) Home dialysis services provided on-site at skilled nursing facilities are beneficial to nursin…

(305 ILCS 5/5-5.09) Sec. 5-5.09. Mental health professionals; veterans. (a) The General Assembly is proud of and grateful to members of all branches of the United States Armed Forces. The General Assembly recognizes that returning veterans may have unique and specific needs that …

(305 ILCS 5/5-5.09a) Sec. 5-5.09a. Screening for tardive dyskinesia. (a) Notwithstanding any other provisions of law, the Department of Healthcare and Family Services shall develop, in collaboration with the Department of Human Services and the Department of Public Health, recomm…

(305 ILCS 5/5-5.1) (from Ch. 23, par. 5-5.1) Sec. 5-5.1. Grouping of facilities. The Department of Healthcare and Family Services shall, for purposes of payment, provide for groupings of nursing facilities. Factors to be considered in grouping facilities may include, but are not …

(305 ILCS 5/5-5.10) Sec. 5-5.10. Value-based purchasing. (a) The Department of Healthcare and Family Services, and, as appropriate, divisions within the Department of Human Services, shall confer with stakeholders to discuss development of alternative value-based payment models t…

(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12) (Text of Section before amendment by P.A. 104-742) Sec. 5-5.12. Pharmacy payments. (a) Every request submitted by a pharmacy for reimbursement under this Article for prescription drugs provided to a recipient of aid under this Articl…

(305 ILCS 5/5-5.12a) Sec. 5-5.12a. Title XIX waiver; pharmacy assistance program. The Illinois Department may seek a waiver of otherwise applicable requirements of Title XIX of the federal Social Security Act in order to claim federal financial participation for a pharmacy assist…

(305 ILCS 5/5-5.12b) Sec. 5-5.12b. Critical access care pharmacy program. (a) As used in this Section: "Critical access care pharmacy" means an Illinois-based brick and mortar retail pharmacy located in Illinois that is owned by a person or entity with an ownership or control int…

(305 ILCS 5/5-5.12c) Sec. 5-5.12c. Managed care organization uniform electronic prior authorization form; prescription benefits. (a) As used in this Section, "prescribing provider" includes a provider authorized to write a prescription, as described in subsection (e) of Section 3…

(305 ILCS 5/5-5.12d) Sec. 5-5.12d. Coverage for patient care services for contraceptives, human immunodeficiency virus pre-exposure prophylaxis, and human immunodeficiency virus post-exposure prophylaxis provided by a pharmacist. (a) Subject to approval by the federal Centers for…