Chapter 305 — PUBLIC AID

(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) (Text of Section from P.A. 104-9) 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…

(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) 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 recovery support services under the medical assistan…

(305 ILCS 5/5-5.05g) Sec. 5-5.05g. (Repealed). (Source: P.A. 102-1037, eff. 6-2-22. Repealed by P.A. 104-122, eff. 1-1-26.)

(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 5/5-5.11) Sec. 5-5.11. (Repealed). (Source: P.A. 83-748. Repealed by P.A. 96-1530, eff. 2-16-11.)

(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12) 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 Article shall include the name of the prescriber or an ac…

(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…

(305 ILCS 5/5-5.12e) Sec. 5-5.12e. Managed care organization prior authorization of health care services. (a) As used in this Section, "health care service" has the meaning given to that term in the Prior Authorization Reform Act. (b) Notwithstanding any other provision of law to…

(305 ILCS 5/5-5.12f) Sec. 5-5.12f. Prescription drugs for mental illness; no utilization or prior approval mandates. (a) Notwithstanding any other provision of this Code to the contrary, except as otherwise provided in subsection (b), for the purpose of removing barriers to the t…

(305 ILCS 5/5-5.13) (from Ch. 23, par. 5-5.13) Sec. 5-5.13. The Illinois Department shall establish procedures for the expedited review, for purposes of inclusion in the Illinois Public Aid formulary, of any drug for the treatment of acquired immunodeficiency syndrome (AIDS) whic…

(305 ILCS 5/5-5.14) Sec. 5-5.14. (Repealed). (Source: Repealed by P.A. 88-85.)

(305 ILCS 5/5-5.14.5) Sec. 5-5.14.5. (Repealed). (Source: P.A. 101-10, eff. 6-5-19. Repealed by P.A. 104-122, eff. 1-1-26.)

(305 ILCS 5/5-5.15) Sec. 5-5.15. (Repealed). (Source: P.A. 83-1509. Repealed by P.A. 96-1501, eff. 1-25-11.)

(305 ILCS 5/5-5.16) (from Ch. 23, par. 5-5.16) Sec. 5-5.16. (Repealed). (Source: P.A. 90-372, eff. 7-1-98. Repealed internally, eff. 7-1-98.)

(305 ILCS 5/5-5.17) (from Ch. 23, par. 5-5.17) Sec. 5-5.17. Separate reimbursement rate. The Illinois Department may by rule establish a separate reimbursement rate to be paid to long term care facilities for adult developmental training services as defined in Section 15.2 of the…

(305 ILCS 5/5-5.18) Sec. 5-5.18. Diagnosis accompanying request for reimbursement. Every request submitted by a physician for reimbursement under this Article for services provided to a recipient of aid under this Article shall include the physician's diagnosis of the recipient's…

(305 ILCS 5/5-5.19) Sec. 5-5.19. Reimbursement request records. The Illinois Department shall file all requests for reimbursement for medical services provided under this Article according to both (i) the name of the service provider and (ii) the name of the recipient of aid unde…

(305 ILCS 5/5-5.2) Sec. 5-5.2. Payment. (a) All nursing facilities that are grouped pursuant to Section 5-5.1 of this Act shall receive the same rate of payment for similar services. (b) It shall be a matter of State policy that the Illinois Department shall utilize a uniform bil…

(305 ILCS 5/5-5.20) Sec. 5-5.20. Clinic payments. For services provided by federally qualified health centers as defined in Section 1905 (l)(2)(B) of the federal Social Security Act, on or after April 1, 1989, and as long as required by federal law, the Illinois Department shall …

(305 ILCS 5/5-5.21) Sec. 5-5.21. (Repealed). (Source: P.A. 89-415, eff. 1-1-96. Repealed by P.A. 96-1530, eff. 2-16-11.)

(305 ILCS 5/5-5.22) Sec. 5-5.22. (Repealed). (Source: P.A. 92-725, eff. 7-25-02. Repealed by P.A. 94-838, eff. 6-6-06.)

(305 ILCS 5/5-5.23) Sec. 5-5.23. Children's mental health services. (a) The Department of Healthcare and Family Services, by rule, shall require the screening and assessment of a child prior to any Medicaid-funded admission to an inpatient hospital for psychiatric services to be …

(305 ILCS 5/5-5.24) Sec. 5-5.24. Prenatal and perinatal care. (a) The Department of Healthcare and Family Services may provide reimbursement under this Article for all prenatal and perinatal health care services that are provided for the purpose of preventing low-birthweight infa…