SB 3668

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Full Text of SB3668
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	SB3668 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3668
Introduced 2/5/2026, by Sen. Adriane Johnson
SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to authorize coverage for screening by low-dose mammography for the presence of occult breast cancer for individuals 25 (rather than 35) years of age or older who are otherwise eligible for medical assistance. Requires the Department to convene 2 separate expert panels to review quality standards for mammography and establish quality standards for breast cancer treatment. Provides that subject to Department approval, rate methodology for screening and diagnostic mammography shall be based on the quality standards established by the expert panels and State qualified ACR Designated Comprehensive Breast Imaging Centers (formerly known as Breast Imaging Centers of Excellence). Requires the expert panels to establish a comprehensive and clinical methodology to inform women who are age-appropriate for screening mammography, but who have not received a mammogram within the previous 18 months, of the importance and benefits of screening mammography. Provides that within 2 years after the completion of a pilot program providing case-managing or patient navigation services for women diagnosed with breast cancer, the Department shall establish as a permanent initiative the Patient Assistance for Beneficiaries Diagnosed with Breast Cancer. Requires the Department to submit annual reports to the General Assembly detailing program outcomes, financial expenditures, and any recommendations for adjustments to maintain or enhance the program's effectiveness. Requires the Department to establish or facilitate training and continuing education opportunities specific to breast health and mammography for radiologists. Makes other changes. Effective immediately.
LRB104 19972 BAB 33423 b
A BILL FOR
		SB3668		LRB104 19972 BAB 33423 b
1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5 as follows:
6    (305 ILCS 5/5-5)
7    Sec. 5-5. Medical services.  The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing
16home, or elsewhere; (6) medical care, or any other type of
17remedial care furnished by licensed practitioners; (7) home
18health care services; (8) private duty nursing service; (9)
19clinic services; (10) dental services, including prevention
20and treatment of periodontal disease and dental caries disease
21for pregnant individuals, provided by an individual licensed
22to practice dentistry or dental surgery; for purposes of this
23item (10), "dental services" means diagnostic, preventive, or
		SB3668	- 2 -	LRB104 19972 BAB 33423 b
1corrective procedures provided by or under the supervision of
2a dentist in the practice of his or her profession; (11)
3physical therapy and related services; (12) prescribed drugs,
4dentures, and prosthetic devices; and eyeglasses prescribed by
5a physician skilled in the diseases of the eye, or by an
6optometrist, whichever the person may select; (13) other
7diagnostic, screening, preventive, and rehabilitative
8services, including to ensure that the individual's need for
9intervention or treatment of mental disorders or substance use
10disorders or co-occurring mental health and substance use
11disorders is determined using a uniform screening, assessment,
12and evaluation process inclusive of criteria, for children and
13adults; for purposes of this item (13), a uniform screening,
14assessment, and evaluation process refers to a process that
15includes an appropriate evaluation and, as warranted, a
16referral; "uniform" does not mean the use of a singular
17instrument, tool, or process that all must utilize; (14)
18transportation and such other expenses as may be necessary;
19(15) medical treatment of sexual assault survivors, as defined
20in Section 1a of the Sexual Assault Survivors Emergency
21Treatment Act, for injuries sustained as a result of the
22sexual assault, including examinations and laboratory tests to
23discover evidence which may be used in criminal proceedings
24arising from the sexual assault; (16) the diagnosis and
25treatment of sickle cell anemia; (16.5) services performed by
26a chiropractic physician licensed under the Medical Practice
		SB3668	- 3 -	LRB104 19972 BAB 33423 b
1Act of 1987 and acting within the scope of his or her license,
2including, but not limited to, chiropractic manipulative
3treatment; and (17) any other medical care, and any other type
4of remedial care recognized under the laws of this State. The
5term "any other type of remedial care" shall include nursing
6care and nursing home service for persons who rely on
7treatment by spiritual means alone through prayer for healing.
8    Notwithstanding any other provision of this Section, a
9comprehensive tobacco use cessation program that includes
10purchasing prescription drugs or prescription medical devices
11approved by the Food and Drug Administration shall be covered
12under the medical assistance program under this Article for
13persons who are otherwise eligible for assistance under this
14Article.
15    Notwithstanding any other provision of this Code,
16reproductive health care that is otherwise legal in Illinois
17shall be covered under the medical assistance program for
18persons who are otherwise eligible for medical assistance
19under this Article.
20    Notwithstanding any other provision of this Section, all
21tobacco cessation medications approved by the United States
22Food and Drug Administration and all individual and group
23tobacco cessation counseling services and telephone-based
24counseling services and tobacco cessation medications provided
25through the Illinois Tobacco Quitline shall be covered under
26the medical assistance program for persons who are otherwise
		SB3668	- 4 -	LRB104 19972 BAB 33423 b
1eligible for assistance under this Article. The Department
2shall comply with all federal requirements necessary to obtain
3federal financial participation, as specified in 42 CFR
4433.15(b)(7), for telephone-based counseling services provided
5through the Illinois Tobacco Quitline, including, but not
6limited to: (i) entering into a memorandum of understanding or
7interagency agreement with the Department of Public Health, as
8administrator of the Illinois Tobacco Quitline; and (ii)
9developing a cost allocation plan for Medicaid-allowable
10Illinois Tobacco Quitline services in accordance with 45 CFR
1195.507. The Department shall submit the memorandum of
12understanding or interagency agreement, the cost allocation
13plan, and all other necessary documentation to the Centers for
14Medicare and Medicaid Services for review and approval.
15Coverage under this paragraph shall be contingent upon federal
16approval.
17    Notwithstanding any other provision of this Code, the
18Illinois Department may not require, as a condition of payment
19for any laboratory test authorized under this Article, that a
20physician's handwritten signature appear on the laboratory
21test order form. The Illinois Department may, however, impose
22other appropriate requirements regarding laboratory test order
23documentation.
24    Upon receipt of federal approval of an amendment to the
25Illinois Title XIX State Plan for this purpose, the Department
26shall authorize the Chicago Public Schools (CPS) to procure a
		SB3668	- 5 -	LRB104 19972 BAB 33423 b
1vendor or vendors to manufacture eyeglasses for individuals
2enrolled in a school within the CPS system. CPS shall ensure
3that its vendor or vendors are enrolled as providers in the
4medical assistance program and in any capitated Medicaid
5managed care entity (MCE) serving individuals enrolled in a
6school within the CPS system. Under any contract procured
7under this provision, the vendor or vendors must serve only
8individuals enrolled in a school within the CPS system. Claims
9for services provided by CPS's vendor or vendors to recipients
10of benefits in the medical assistance program under this Code,
11the Children's Health Insurance Program, or the Covering ALL
12KIDS Health Insurance Program shall be submitted to the
13Department or the MCE in which the individual is enrolled for
14payment and shall be reimbursed at the Department's or the
15MCE's established rates or rate methodologies for eyeglasses.
16    On and after July 1, 2012, the Department of Healthcare
17and Family Services may provide the following services to
18persons eligible for assistance under this Article who are
19participating in education, training or employment programs
20operated by the Department of Human Services as successor to
21the Department of Public Aid:
22        (1) dental services provided by or under the
23    supervision of a dentist; and
24        (2) eyeglasses prescribed by a physician skilled in
25    the diseases of the eye, or by an optometrist, whichever
26    the person may select.
		SB3668	- 6 -	LRB104 19972 BAB 33423 b
1    On and after July 1, 2018, the Department of Healthcare
2and Family Services shall provide dental services to any adult
3who is otherwise eligible for assistance under the medical
4assistance program. As used in this paragraph, "dental
5services" means diagnostic, preventative, restorative, or
6corrective procedures, including procedures and services for
7the prevention and treatment of periodontal disease and dental
8caries disease, provided by an individual who is licensed to
9practice dentistry or dental surgery or who is under the
10supervision of a dentist in the practice of his or her
11profession.
12    On and after July 1, 2018, targeted dental services, as
13set forth in Exhibit D of the Consent Decree entered by the
14United States District Court for the Northern District of
15Illinois, Eastern Division, in the matter of Memisovski v.
16Maram, Case No. 92 C 1982, that are provided to adults under
17the medical assistance program shall be established at no less
18than the rates set forth in the "New Rate" column in Exhibit D
19of the Consent Decree for targeted dental services that are
20provided to persons under the age of 18 under the medical
21assistance program.
22    Subject to federal approval, on and after January 1, 2025,
23the rates paid for sedation evaluation and the provision of
24deep sedation and intravenous sedation for the purpose of
25dental services shall be increased by 33% above the rates in
26effect on December 31, 2024. The rates paid for nitrous oxide
		SB3668	- 7 -	LRB104 19972 BAB 33423 b
1sedation shall not be impacted by this paragraph and shall
2remain the same as the rates in effect on December 31, 2024.
3    Notwithstanding any other provision of this Code and
4subject to federal approval, the Department may adopt rules to
5allow a dentist who is volunteering his or her service at no
6cost to render dental services through an enrolled
7not-for-profit health clinic without the dentist personally
8enrolling as a participating provider in the medical
9assistance program. A not-for-profit health clinic shall
10include a public health clinic or Federally Qualified Health
11Center or other enrolled provider, as determined by the
12Department, through which dental services covered under this
13Section are performed. The Department shall establish a
14process for payment of claims for reimbursement for covered
15dental services rendered under this provision.
16    Subject to appropriation and to federal approval, the
17Department shall file administrative rules updating the
18Handicapping Labio-Lingual Deviation orthodontic scoring tool
19by January 1, 2025, or as soon as practicable.
20    On and after January 1, 2022, the Department of Healthcare
21and Family Services shall administer and regulate a
22school-based dental program that allows for the out-of-office
23delivery of preventative dental services in a school setting
24to children under 19 years of age. The Department shall
25establish, by rule, guidelines for participation by providers
26and set requirements for follow-up referral care based on the
		SB3668	- 8 -	LRB104 19972 BAB 33423 b
1requirements established in the Dental Office Reference Manual
2published by the Department that establishes the requirements
3for dentists participating in the All Kids Dental School
4Program. Every effort shall be made by the Department when
5developing the program requirements to consider the different
6geographic differences of both urban and rural areas of the
7State for initial treatment and necessary follow-up care. No
8provider shall be charged a fee by any unit of local government
9to participate in the school-based dental program administered
10by the Department. Nothing in this paragraph shall be
11construed to limit or preempt a home rule unit's or school
12district's authority to establish, change, or administer a
13school-based dental program in addition to, or independent of,
14the school-based dental program administered by the
15Department.
16    The Illinois Department, by rule, may distinguish and
17classify the medical services to be provided only in
18accordance with the classes of persons designated in Section
195-2.
20    The Department of Healthcare and Family Services must
21provide coverage and reimbursement for amino acid-based
22elemental formulas, regardless of delivery method, for the
23diagnosis and treatment of (i) eosinophilic disorders and (ii)
24short bowel syndrome when the prescribing physician has issued
25a written order stating that the amino acid-based elemental
26formula is medically necessary.
		SB3668	- 9 -	LRB104 19972 BAB 33423 b
1    The Illinois Department shall authorize the provision of,
2and shall authorize payment for, screening by low-dose
3mammography for the presence of occult breast cancer for
4individuals 25 [35] years of age or older who are eligible for
5medical assistance under this Article, as follows:
6        (A) A baseline mammogram for individuals 25 [35] to 39
7    years of age.
8        (B) An annual mammogram for individuals 40 years of
9    age or older with no family history.
10        (C) A mammogram at the age and intervals considered
11    medically necessary by the individual's health care
12    provider for individuals under 40 years of age, based on 
13    physician recommendation for familial risk, [and having a]
14    family history of breast cancer, prior personal history of
15    breast cancer, positive genetic testing, or other risk
16    factors.
17        (D) A comprehensive ultrasound screening and MRI of an
18    entire breast or breasts if a mammogram demonstrates
19    heterogeneous or dense breast tissue or when medically
20    necessary as determined by a physician licensed to
21    practice medicine in all of its branches.
22        (E) A screening MRI when medically necessary, as
23    determined by a physician licensed to practice medicine in
24    all of its branches.
25        (F) A diagnostic mammogram when medically necessary,
26    as determined by a physician licensed to practice medicine
		SB3668	- 10 -	LRB104 19972 BAB 33423 b
1    in all its branches, advanced practice registered nurse,
2    or physician assistant.
3        (G) Molecular breast imaging (MBI) and MRI of an
4    entire breast or breasts if a mammogram demonstrates
5    heterogeneous or dense breast tissue or when medically
6    necessary as determined by a physician licensed to
7    practice medicine in all of its branches, advanced
8    practice registered nurse, or physician assistant.
9    The Department shall not impose a deductible, coinsurance,
10copayment, or any other cost-sharing requirement on the
11coverage provided under this paragraph; except that this
12sentence does not apply to coverage of diagnostic mammograms
13to the extent such coverage would disqualify a high-deductible
14health plan from eligibility for a health savings account
15pursuant to Section 223 of the Internal Revenue Code (26
16U.S.C. 223).
17    All screenings shall include a physical breast exam,
18instruction on self-examination and information regarding the
19frequency of self-examination and its value as a preventative
20tool.
21    For purposes of this Section:
22    "Diagnostic mammogram" means a mammogram obtained using
23diagnostic mammography.
24    "Diagnostic mammography" means a method of screening that
25is designed to evaluate an abnormality in a breast, including
26an abnormality seen or suspected on a screening mammogram or a
		SB3668	- 11 -	LRB104 19972 BAB 33423 b
1subjective or objective abnormality otherwise detected in the
2breast.
3    "Low-dose mammography" means the x-ray examination of the
4breast using equipment dedicated specifically for mammography,
5including the x-ray tube, filter, compression device, and
6image receptor, with an average radiation exposure delivery of
7less than one rad per breast for 2 views of an average size
8breast. The term also includes digital mammography and
9includes breast tomosynthesis.
10    "Breast tomosynthesis" means a radiologic procedure that
11involves the acquisition of projection images over the
12stationary breast to produce cross-sectional digital
13three-dimensional images of the breast.
14    If, at any time, the Secretary of the United States
15Department of Health and Human Services, or its successor
16agency, promulgates rules or regulations to be published in
17the Federal Register or publishes a comment in the Federal
18Register or issues an opinion, guidance, or other action that
19would require the State, pursuant to any provision of the
20Patient Protection and Affordable Care Act (Public Law
21111-148), including, but not limited to, 42 U.S.C.
2218031(d)(3)(B) or any successor provision, to defray the cost
23of any coverage for breast tomosynthesis outlined in this
24paragraph, then the requirement that an insurer cover breast
25tomosynthesis is inoperative other than any such coverage
26authorized under Section 1902 of the Social Security Act, 42
		SB3668	- 12 -	LRB104 19972 BAB 33423 b
1U.S.C. 1396a, and the State shall not assume any obligation
2for the cost of coverage for breast tomosynthesis set forth in
3this paragraph.
4    On and after January 1, 2016, the Department shall ensure
5that all networks of care for adult clients of the Department
6include access to at least one breast imaging Center of
7Imaging Excellence as certified by the American College of
8Radiology.
9    On and after January 1, 2012, providers participating in a
10quality improvement program approved by the Department shall
11be reimbursed for screening and diagnostic mammography at the
12same rate as the Medicare program's rates, including the
13increased reimbursement for digital mammography and, after
14January 1, 2023 (the effective date of Public Act 102-1018),
15breast tomosynthesis.
16    The Department shall convene an expert panel of not more 
17than 15 members that includes [including] representatives of
18hospitals, free-standing mammography facilities, and doctors,
19including radiologists, to review [establish] quality standards
20for mammography. The panel shall be convened no later than 
21January 1, 2027, meet quarterly thereafter, and act as an 
22advisory body for developing quality standards for 
23mammography.
24    On and after January 1, 2017, providers participating in a
25breast cancer treatment quality improvement program approved
26by the Department shall be reimbursed for breast cancer
		SB3668	- 13 -	LRB104 19972 BAB 33423 b
1treatment at a rate that is no lower than 95% of the Medicare
2program's rates for the data elements included in the breast
3cancer treatment quality program.
4    The Department shall convene an expert panel, including
5representatives of hospitals, free-standing breast cancer
6treatment centers, breast cancer quality organizations, and
7doctors, including radiologists that are trained in all forms
8of FDA-approved breast imaging technologies, breast surgeons,
9reconstructive breast surgeons, oncologists, and primary care
10providers to establish quality standards for breast cancer
11treatment. This panel shall be in place by no later than 
12January 1, 2027, and meet at least quarterly thereafter either 
13in person or via remote teleconference.
14    Subject to federal approval, the Department shall
15establish a rate methodology for mammography at federally
16qualified health centers and other encounter-rate clinics.
17These clinics or centers may also collaborate with other
18hospital-based mammography facilities. By January 1, 2016, the
19Department shall report to the General Assembly on the status
20of the provision set forth in this paragraph.
21    Subject to Department approval, the rate methodology for 
22screening and diagnostic mammography shall be based on the 
23quality standards established by the 2 expert panels convened 
24by the Department and State qualified ACR Designated 
25Comprehensive Breast Imaging Centers (formerly known as Breast 
26Imaging Centers of Excellence). These centers or clinics may 
		SB3668	- 14 -	LRB104 19972 BAB 33423 b
1also collaborate with other hospital-based mammography 
2facilities. By April 1, 2027, the Department shall submit to 
3the General Assembly a progress report on the implementation 
4of this paragraph.
5    [The Department shall establish a methodology to remind ]
6[individuals who are age-appropriate for screening mammography, ]
7[but who have not received a mammogram within the previous 18 ]
8[months, of the importance and benefit of screening ]
9[mammography. The Department shall work with experts in breast ]
10[cancer outreach and patient navigation to optimize these ]
11[reminders and shall establish a methodology for evaluating ]
12[their effectiveness and modifying the methodology based on the ]
13[evaluation.]
14    The expert panels convened by the Department shall also 
15establish a comprehensive and clinical methodology to inform 
16women who are age-appropriate for screening mammography, but 
17who have not received a mammogram within the previous 18 
18months, of the importance and benefits of screening 
19mammography. The Department shall work with an independent, 
20nonprofit organization with a demonstrated history of 
21coordinating and facilitating access to breast cancer 
22screening and diagnostic services across multiple mammography 
23facilities or units. The organization must not be a hospital 
24or directly affiliated entity, and must not receive Medicaid 
25reimbursement for breast cancer screening and diagnostic 
26services across multiple mammography facilities or units. The 
		SB3668	- 15 -	LRB104 19972 BAB 33423 b
1organization shall provide navigation, outreach, and support 
2services specifically for uninsured or underinsured 
3individuals in the designated area and maintain active 
4collaborations with a network of community-based mammography 
5providers. The organization shall optimize reminders on breast 
6cancer outreach and patient navigation, and shall establish a 
7methodology for evaluating their effectiveness and modifying 
8the methodology based on the evaluation.
9    The Department shall establish a performance goal for
10primary care providers with respect to their female patients
11over age 40 receiving an annual mammogram. [This performance ]
12[goal shall be used to provide additional reimbursement in the ]
13[form of a quality performance bonus to primary care providers ]
14[who meet that goal.]
15    The Department shall devise a means of case-managing or
16patient navigation for beneficiaries diagnosed with breast
17cancer. This program shall initially operate as a pilot
18program in areas of the State with the highest incidence of
19mortality related to breast cancer. At least one pilot program
20site shall be in the metropolitan Chicago area and at least one
21site shall be outside the metropolitan Chicago area. On or
22after July 1, 2016, the pilot program shall be expanded to
23include one site in western Illinois, one site in southern
24Illinois, one site in central Illinois, and 4 sites within
25metropolitan Chicago. An evaluation of the pilot program shall
26be carried out measuring health outcomes and cost of care for
		SB3668	- 16 -	LRB104 19972 BAB 33423 b
1those served by the pilot program compared to similarly
2situated patients who are not served by the pilot program.
3    Upon the successful completion and evaluation of the pilot 
4program, the Patient Assistance for Beneficiaries Diagnosed 
5with Breast Cancer shall be established as a permanent 
6initiative, effective within 2 years of the evaluation's 
7completion. Beginning in the fiscal year immediately following 
8the program's permanent establishment, the initiative shall, 
9subject to appropriation, receive full funding to ensure that 
10resources are allocated to support its operational and 
11programmatic needs. The Department shall, on or before 
12November 1 of that first fiscal year, and every November 1 
13thereafter, submit a report to the General Assembly detailing 
14program outcomes, financial expenditures, and any 
15recommendations for adjustments to maintain or enhance the 
16program's effectiveness.
17    The Department shall require all networks of care to
18develop a means either internally or by contract with experts
19in navigation and community outreach to navigate cancer
20patients to comprehensive care in a timely fashion. The
21Department shall require all networks of care to include
22access for patients diagnosed with cancer to at least one
23academic commission on cancer-accredited cancer program as an
24in-network covered benefit.
25    The Department shall establish or facilitate training and 
26continuing education opportunities specific to breast health 
		SB3668	- 17 -	LRB104 19972 BAB 33423 b
1and mammography for radiologists, ensuring that these 
2professionals are equipped with the latest knowledge and 
3skills to accurately diagnose and assess breast cancer. 
4Similar training and continuing education opportunities shall 
5be provided for mammography technologists to ensure 
6consistent, high-quality imaging practices that support early 
7detection and accurate diagnosis.
8    The Department shall provide coverage and reimbursement
9for a human papillomavirus (HPV) vaccine that is approved for
10marketing by the federal Food and Drug Administration for all
11persons between the ages of 9 and 45. Subject to federal
12approval, the Department shall provide coverage and
13reimbursement for a human papillomavirus (HPV) vaccine for
14persons of the age of 46 and above who have been diagnosed with
15cervical dysplasia with a high risk of recurrence or
16progression. The Department shall disallow any
17preauthorization requirements for the administration of the
18human papillomavirus (HPV) vaccine.
19    On or after July 1, 2022, individuals who are otherwise
20eligible for medical assistance under this Article shall
21receive coverage for perinatal depression screenings for the
2212-month period beginning on the last day of their pregnancy.
23Medical assistance coverage under this paragraph shall be
24conditioned on the use of a screening instrument approved by
25the Department.
26    The Department shall establish a grant program to assist 
		SB3668	- 18 -	LRB104 19972 BAB 33423 b
1safety net facilities in acquiring or upgrading mammography 
2equipment to support equitable access to state-of-the-art 
3diagnostic tools. The grant program shall also, subject to 
4appropriation, include funding for the hiring of qualified 
5navigation staff, development of outreach initiatives tailored 
6to high-risk populations, and ongoing program evaluation to 
7ensure that navigation services effectively connect patients 
8with needed care.
9    Safety net facilities shall have access to free resources 
10for enhancing their quality of care, including, but not 
11limited to, staff training programs, financial support to 
12subsidize or incorporate a comprehensive mammography database, 
13and other essential quality-improvement initiatives.
14    Any medical or health care provider shall immediately
15recommend, to any pregnant individual who is being provided
16prenatal services and is suspected of having a substance use
17disorder as defined in the Substance Use Disorder Act,
18referral to a local substance use disorder treatment program
19licensed by the Department of Human Services or to a licensed
20hospital which provides substance abuse treatment services.
21The Department of Healthcare and Family Services shall assure
22coverage for the cost of treatment of the drug abuse or
23addiction for pregnant recipients in accordance with the
24Illinois Medicaid Program in conjunction with the Department
25of Human Services.
26    All medical providers providing medical assistance to
		SB3668	- 19 -	LRB104 19972 BAB 33423 b
1pregnant individuals under this Code shall receive information
2from the Department on the availability of services under any
3program providing case management services for addicted
4individuals, including information on appropriate referrals
5for other social services that may be needed by addicted
6individuals in addition to treatment for addiction.
7    The Illinois Department, in cooperation with the
8Departments of Human Services (as successor to the Department
9of Alcoholism and Substance Abuse) and Public Health, through
10a public awareness campaign, may provide information
11concerning treatment for alcoholism and drug abuse and
12addiction, prenatal health care, and other pertinent programs
13directed at reducing the number of drug-affected infants born
14to recipients of medical assistance.
15    Neither the Department of Healthcare and Family Services
16nor the Department of Human Services shall sanction the
17recipient solely on the basis of the recipient's substance
18abuse.
19    The Illinois Department shall establish such regulations
20governing the dispensing of health services under this Article
21as it shall deem appropriate. The Department should seek the
22advice of formal professional advisory committees appointed by
23the Director of the Illinois Department for the purpose of
24providing regular advice on policy and administrative matters,
25information dissemination and educational activities for
26medical and health care providers, and consistency in
		SB3668	- 20 -	LRB104 19972 BAB 33423 b
1procedures to the Illinois Department.
2    The Illinois Department may develop and contract with
3Partnerships of medical providers to arrange medical services
4for persons eligible under Section 5-2 of this Code.
5Implementation of this Section may be by demonstration
6projects in certain geographic areas. The Partnership shall be
7represented by a sponsor organization. The Department, by
8rule, shall develop qualifications for sponsors of
9Partnerships. Nothing in this Section shall be construed to
10require that the sponsor organization be a medical
11organization.
12    The sponsor must negotiate formal written contracts with
13medical providers for physician services, inpatient and
14outpatient hospital care, home health services, treatment for
15alcoholism and substance abuse, and other services determined
16necessary by the Illinois Department by rule for delivery by
17Partnerships. Physician services must include prenatal and
18obstetrical care. The Illinois Department shall reimburse
19medical services delivered by Partnership providers to clients
20in target areas according to provisions of this Article and
21the Illinois Health Finance Reform Act, except that:
22        (1) Physicians participating in a Partnership and
23    providing certain services, which shall be determined by
24    the Illinois Department, to persons in areas covered by
25    the Partnership may receive an additional surcharge for
26    such services.
		SB3668	- 21 -	LRB104 19972 BAB 33423 b
1        (2) The Department may elect to consider and negotiate
2    financial incentives to encourage the development of
3    Partnerships and the efficient delivery of medical care.
4        (3) Persons receiving medical services through
5    Partnerships may receive medical and case management
6    services above the level usually offered through the
7    medical assistance program.
8    Medical providers shall be required to meet certain
9qualifications to participate in Partnerships to ensure the
10delivery of high quality medical services. These
11qualifications shall be determined by rule of the Illinois
12Department and may be higher than qualifications for
13participation in the medical assistance program. Partnership
14sponsors may prescribe reasonable additional qualifications
15for participation by medical providers, only with the prior
16written approval of the Illinois Department.
17    Nothing in this Section shall limit the free choice of
18practitioners, hospitals, and other providers of medical
19services by clients. In order to ensure patient freedom of
20choice, the Illinois Department shall immediately promulgate
21all rules and take all other necessary actions so that
22provided services may be accessed from therapeutically
23certified optometrists to the full extent of the Illinois
24Optometric Practice Act of 1987 without discriminating between
25service providers.
26    The Department shall apply for a waiver from the United
		SB3668	- 22 -	LRB104 19972 BAB 33423 b
1States Health Care Financing Administration to allow for the
2implementation of Partnerships under this Section.
3    The Illinois Department shall require health care
4providers to maintain records that document the medical care
5and services provided to recipients of Medical Assistance
6under this Article. Such records must be retained for a period
7of not less than 6 years from the date of service or as
8provided by applicable State law, whichever period is longer,
9except that if an audit is initiated within the required
10retention period then the records must be retained until the
11audit is completed and every exception is resolved. The
12Illinois Department shall require health care providers to
13make available, when authorized by the patient, in writing,
14the medical records in a timely fashion to other health care
15providers who are treating or serving persons eligible for
16Medical Assistance under this Article. All dispensers of
17medical services shall be required to maintain and retain
18business and professional records sufficient to fully and
19accurately document the nature, scope, details and receipt of
20the health care provided to persons eligible for medical
21assistance under this Code, in accordance with regulations
22promulgated by the Illinois Department. The rules and
23regulations shall require that proof of the receipt of
24prescription drugs, dentures, prosthetic devices and
25eyeglasses by eligible persons under this Section accompany
26each claim for reimbursement submitted by the dispenser of
		SB3668	- 23 -	LRB104 19972 BAB 33423 b
1such medical services. No such claims for reimbursement shall
2be approved for payment by the Illinois Department without
3such proof of receipt, unless the Illinois Department shall
4have put into effect and shall be operating a system of
5post-payment audit and review which shall, on a sampling
6basis, be deemed adequate by the Illinois Department to assure
7that such drugs, dentures, prosthetic devices and eyeglasses
8for which payment is being made are actually being received by
9eligible recipients. Within 90 days after September 16, 1984
10(the effective date of Public Act 83-1439), the Illinois
11Department shall establish a current list of acquisition costs
12for all prosthetic devices and any other items recognized as
13medical equipment and supplies reimbursable under this Article
14and shall update such list on a quarterly basis, except that
15the acquisition costs of all prescription drugs shall be
16updated no less frequently than every 30 days as required by
17Section 5-5.12.
18    Notwithstanding any other law to the contrary, the
19Illinois Department shall, within 365 days after July 22, 2013
20(the effective date of Public Act 98-104), establish
21procedures to permit skilled care facilities licensed under
22the Nursing Home Care Act to submit monthly billing claims for
23reimbursement purposes. Following development of these
24procedures, the Department shall, by July 1, 2016, test the
25viability of the new system and implement any necessary
26operational or structural changes to its information
		SB3668	- 24 -	LRB104 19972 BAB 33423 b
1technology platforms in order to allow for the direct
2acceptance and payment of nursing home claims.
3    Notwithstanding any other law to the contrary, the
4Illinois Department shall, within 365 days after August 15,
52014 (the effective date of Public Act 98-963), establish
6procedures to permit ID/DD facilities licensed under the ID/DD
7Community Care Act and MC/DD facilities licensed under the
8MC/DD Act to submit monthly billing claims for reimbursement
9purposes. Following development of these procedures, the
10Department shall have an additional 365 days to test the
11viability of the new system and to ensure that any necessary
12operational or structural changes to its information
13technology platforms are implemented.
14    The Illinois Department shall require all dispensers of
15medical services, other than an individual practitioner or
16group of practitioners, desiring to participate in the Medical
17Assistance program established under this Article to disclose
18all financial, beneficial, ownership, equity, surety or other
19interests in any and all firms, corporations, partnerships,
20associations, business enterprises, joint ventures, agencies,
21institutions or other legal entities providing any form of
22health care services in this State under this Article.
23    The Illinois Department may require that all dispensers of
24medical services desiring to participate in the medical
25assistance program established under this Article disclose,
26under such terms and conditions as the Illinois Department may
		SB3668	- 25 -	LRB104 19972 BAB 33423 b
1by rule establish, all inquiries from clients and attorneys
2regarding medical bills paid by the Illinois Department, which
3inquiries could indicate potential existence of claims or
4liens for the Illinois Department.
5    Enrollment of a vendor shall be subject to a provisional
6period and shall be conditional for one year. During the
7period of conditional enrollment, the Department may terminate
8the vendor's eligibility to participate in, or may disenroll
9the vendor from, the medical assistance program without cause.
10Unless otherwise specified, such termination of eligibility or
11disenrollment is not subject to the Department's hearing
12process. However, a disenrolled vendor may reapply without
13penalty.
14    The Department has the discretion to limit the conditional
15enrollment period for vendors based upon the category of risk
16of the vendor.
17    Prior to enrollment and during the conditional enrollment
18period in the medical assistance program, all vendors shall be
19subject to enhanced oversight, screening, and review based on
20the risk of fraud, waste, and abuse that is posed by the
21category of risk of the vendor. The Illinois Department shall
22establish the procedures for oversight, screening, and review,
23which may include, but need not be limited to: criminal and
24financial background checks; fingerprinting; license,
25certification, and authorization verifications; unscheduled or
26unannounced site visits; database checks; prepayment audit
		SB3668	- 26 -	LRB104 19972 BAB 33423 b
1reviews; audits; payment caps; payment suspensions; and other
2screening as required by federal or State law.
3    The Department shall define or specify the following: (i)
4by provider notice, the "category of risk of the vendor" for
5each type of vendor, which shall take into account the level of
6screening applicable to a particular category of vendor under
7federal law and regulations; (ii) by rule or provider notice,
8the maximum length of the conditional enrollment period for
9each category of risk of the vendor; and (iii) by rule, the
10hearing rights, if any, afforded to a vendor in each category
11of risk of the vendor that is terminated or disenrolled during
12the conditional enrollment period.
13    To be eligible for payment consideration, a vendor's
14payment claim or bill, either as an initial claim or as a
15resubmitted claim following prior rejection, must be received
16by the Illinois Department, or its fiscal intermediary, no
17later than 180 days after the latest date on the claim on which
18medical goods or services were provided, with the following
19exceptions:
20        (1) In the case of a provider whose enrollment is in
21    process by the Illinois Department, the 180-day period
22    shall not begin until the date on the written notice from
23    the Illinois Department that the provider enrollment is
24    complete.
25        (2) In the case of errors attributable to the Illinois
26    Department or any of its claims processing intermediaries
		SB3668	- 27 -	LRB104 19972 BAB 33423 b
1    which result in an inability to receive, process, or
2    adjudicate a claim, the 180-day period shall not begin
3    until the provider has been notified of the error.
4        (3) In the case of a provider for whom the Illinois
5    Department initiates the monthly billing process.
6        (4) In the case of a provider operated by a unit of
7    local government with a population exceeding 3,000,000
8    when local government funds finance federal participation
9    for claims payments.
10    For claims for services rendered during a period for which
11a recipient received retroactive eligibility, claims must be
12filed within 180 days after the Department determines the
13applicant is eligible. For claims for which the Illinois
14Department is not the primary payer, claims must be submitted
15to the Illinois Department within 180 days after the final
16adjudication by the primary payer.
17    In the case of long term care facilities, within 120
18calendar days of receipt by the facility of required
19prescreening information, new admissions with associated
20admission documents shall be submitted through the Medical
21Electronic Data Interchange (MEDI) or the Recipient
22Eligibility Verification (REV) System or shall be submitted
23directly to the Department of Human Services using required
24admission forms. Effective September 1, 2014, admission
25documents, including all prescreening information, must be
26submitted through MEDI or REV. Confirmation numbers assigned
		SB3668	- 28 -	LRB104 19972 BAB 33423 b
1to an accepted transaction shall be retained by a facility to
2verify timely submittal. Once an admission transaction has
3been completed, all resubmitted claims following prior
4rejection are subject to receipt no later than 180 days after
5the admission transaction has been completed.
6    Claims that are not submitted and received in compliance
7with the foregoing requirements shall not be eligible for
8payment under the medical assistance program, and the State
9shall have no liability for payment of those claims.
10    To the extent consistent with applicable information and
11privacy, security, and disclosure laws, State and federal
12agencies and departments shall provide the Illinois Department
13access to confidential and other information and data
14necessary to perform eligibility and payment verifications and
15other Illinois Department functions. This includes, but is not
16limited to: information pertaining to licensure;
17certification; earnings; immigration status; citizenship; wage
18reporting; unearned and earned income; pension income;
19employment; supplemental security income; social security
20numbers; National Provider Identifier (NPI) numbers; the
21National Practitioner Data Bank (NPDB); program and agency
22exclusions; taxpayer identification numbers; tax delinquency;
23corporate information; and death records.
24    The Illinois Department shall enter into agreements with
25State agencies and departments, and is authorized to enter
26into agreements with federal agencies and departments, under
		SB3668	- 29 -	LRB104 19972 BAB 33423 b
1which such agencies and departments shall share data necessary
2for medical assistance program integrity functions and
3oversight. The Illinois Department shall develop, in
4cooperation with other State departments and agencies, and in
5compliance with applicable federal laws and regulations,
6appropriate and effective methods to share such data. At a
7minimum, and to the extent necessary to provide data sharing,
8the Illinois Department shall enter into agreements with State
9agencies and departments, and is authorized to enter into
10agreements with federal agencies and departments, including,
11but not limited to: the Secretary of State; the Department of
12Revenue; the Department of Public Health; the Department of
13Human Services; and the Department of Financial and
14Professional Regulation.
15    Beginning in fiscal year 2013, the Illinois Department
16shall set forth a request for information to identify the
17benefits of a pre-payment, post-adjudication, and post-edit
18claims system with the goals of streamlining claims processing
19and provider reimbursement, reducing the number of pending or
20rejected claims, and helping to ensure a more transparent
21adjudication process through the utilization of: (i) provider
22data verification and provider screening technology; and (ii)
23clinical code editing; and (iii) pre-pay, pre-adjudicated, or
24post-adjudicated predictive modeling with an integrated case
25management system with link analysis. Such a request for
26information shall not be considered as a request for proposal
		SB3668	- 30 -	LRB104 19972 BAB 33423 b
1or as an obligation on the part of the Illinois Department to
2take any action or acquire any products or services.
3    The Illinois Department shall establish policies,
4procedures, standards and criteria by rule for the
5acquisition, repair and replacement of orthotic and prosthetic
6devices and durable medical equipment. Such rules shall
7provide, but not be limited to, the following services: (1)
8immediate repair or replacement of such devices by recipients;
9and (2) rental, lease, purchase or lease-purchase of durable
10medical equipment in a cost-effective manner, taking into
11consideration the recipient's medical prognosis, the extent of
12the recipient's needs, and the requirements and costs for
13maintaining such equipment. Subject to prior approval, such
14rules shall enable a recipient to temporarily acquire and use
15alternative or substitute devices or equipment pending repairs
16or replacements of any device or equipment previously
17authorized for such recipient by the Department.
18Notwithstanding any provision of Section 5-5f to the contrary,
19the Department may, by rule, exempt certain replacement
20wheelchair parts from prior approval and, for wheelchairs,
21wheelchair parts, wheelchair accessories, and related seating
22and positioning items, determine the wholesale price by
23methods other than actual acquisition costs.
24    The Department shall require, by rule, all providers of
25durable medical equipment to be accredited by an accreditation
26organization approved by the federal Centers for Medicare and
		SB3668	- 31 -	LRB104 19972 BAB 33423 b
1Medicaid Services and recognized by the Department in order to
2bill the Department for providing durable medical equipment to
3recipients. No later than 15 months after the effective date
4of the rule adopted pursuant to this paragraph, all providers
5must meet the accreditation requirement.
6    In order to promote environmental responsibility, meet the
7needs of recipients and enrollees, and achieve significant
8cost savings, the Department, or a managed care organization
9under contract with the Department, may provide recipients or
10managed care enrollees who have a prescription or Certificate
11of Medical Necessity access to refurbished durable medical
12equipment under this Section (excluding prosthetic and
13orthotic devices as defined in the Orthotics, Prosthetics, and
14Pedorthics Practice Act and complex rehabilitation technology
15products and associated services) through the State's
16assistive technology program's reutilization program, using
17staff with the Assistive Technology Professional (ATP)
18Certification if the refurbished durable medical equipment:
19(i) is available; (ii) is less expensive, including shipping
20costs, than new durable medical equipment of the same type;
21(iii) is able to withstand at least 3 years of use; (iv) is
22cleaned, disinfected, sterilized, and safe in accordance with
23federal Food and Drug Administration regulations and guidance
24governing the reprocessing of medical devices in health care
25settings; and (v) equally meets the needs of the recipient or
26enrollee. The reutilization program shall confirm that the
		SB3668	- 32 -	LRB104 19972 BAB 33423 b
1recipient or enrollee is not already in receipt of the same or
2similar equipment from another service provider, and that the
3refurbished durable medical equipment equally meets the needs
4of the recipient or enrollee. Nothing in this paragraph shall
5be construed to limit recipient or enrollee choice to obtain
6new durable medical equipment or place any additional prior
7authorization conditions on enrollees of managed care
8organizations.
9    The Department shall execute, relative to the nursing home
10prescreening project, written inter-agency agreements with the
11Department of Human Services and the Department on Aging, to
12effect the following: (i) intake procedures and common
13eligibility criteria for those persons who are receiving
14non-institutional services; and (ii) the establishment and
15development of non-institutional services in areas of the
16State where they are not currently available or are
17undeveloped; and (iii) notwithstanding any other provision of
18law, subject to federal approval, on and after July 1, 2012, an
19increase in the determination of need (DON) scores from 29 to
2037 for applicants for institutional and home and
21community-based long term care; if and only if federal
22approval is not granted, the Department may, in conjunction
23with other affected agencies, implement utilization controls
24or changes in benefit packages to effectuate a similar savings
25amount for this population; and (iv) no later than July 1,
262013, minimum level of care eligibility criteria for
		SB3668	- 33 -	LRB104 19972 BAB 33423 b
1institutional and home and community-based long term care; and
2(v) no later than October 1, 2013, establish procedures to
3permit long term care providers access to eligibility scores
4for individuals with an admission date who are seeking or
5receiving services from the long term care provider. In order
6to select the minimum level of care eligibility criteria, the
7Governor shall establish a workgroup that includes affected
8agency representatives and stakeholders representing the
9institutional and home and community-based long term care
10interests. This Section shall not restrict the Department from
11implementing lower level of care eligibility criteria for
12community-based services in circumstances where federal
13approval has been granted.
14    The Illinois Department shall develop and operate, in
15cooperation with other State Departments and agencies and in
16compliance with applicable federal laws and regulations,
17appropriate and effective systems of health care evaluation
18and programs for monitoring of utilization of health care
19services and facilities, as it affects persons eligible for
20medical assistance under this Code.
21    The Illinois Department shall report annually to the
22General Assembly, no later than the second Friday in April of
231979 and each year thereafter, in regard to:
24        (a) actual statistics and trends in utilization of
25    medical services by public aid recipients;
26        (b) actual statistics and trends in the provision of
		SB3668	- 34 -	LRB104 19972 BAB 33423 b
1    the various medical services by medical vendors;
2        (c) current rate structures and proposed changes in
3    those rate structures for the various medical vendors; and
4        (d) efforts at utilization review and control by the
5    Illinois Department.
6    The period covered by each report shall be the 3 years
7ending on the June 30 prior to the report. The report shall
8include suggested legislation for consideration by the General
9Assembly. The requirement for reporting to the General
10Assembly shall be satisfied by filing copies of the report as
11required by Section 3.1 of the General Assembly Organization
12Act, and filing such additional copies with the State
13Government Report Distribution Center for the General Assembly
14as is required under paragraph (t) of Section 7 of the State
15Library Act.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22    On and after July 1, 2012, the Department shall reduce any
23rate of reimbursement for services or other payments or alter
24any methodologies authorized by this Code to reduce any rate
25of reimbursement for services or other payments in accordance
26with Section 5-5e.
		SB3668	- 35 -	LRB104 19972 BAB 33423 b
1    Because kidney transplantation can be an appropriate,
2cost-effective alternative to renal dialysis when medically
3necessary and notwithstanding the provisions of Section 1-11
4of this Code, beginning October 1, 2014, the Department shall
5cover kidney transplantation for noncitizens with end-stage
6renal disease who are not eligible for comprehensive medical
7benefits, who meet the residency requirements of Section 5-3
8of this Code, and who would otherwise meet the financial
9requirements of the appropriate class of eligible persons
10under Section 5-2 of this Code. To qualify for coverage of
11kidney transplantation, such person must be receiving
12emergency renal dialysis services covered by the Department.
13Providers under this Section shall be prior approved and
14certified by the Department to perform kidney transplantation
15and the services under this Section shall be limited to
16services associated with kidney transplantation.
17    Notwithstanding any other provision of this Code to the
18contrary, on or after July 1, 2015, all FDA-approved forms of
19medication assisted treatment prescribed for the treatment of
20alcohol dependence or treatment of opioid dependence shall be
21covered under both fee-for-service and managed care medical
22assistance programs for persons who are otherwise eligible for
23medical assistance under this Article and shall not be subject
24to any (1) utilization control, other than those established
25under the American Society of Addiction Medicine patient
26placement criteria, (2) prior authorization mandate, (3)
		SB3668	- 36 -	LRB104 19972 BAB 33423 b
1lifetime restriction limit mandate, or (4) limitations on
2dosage.
3    On or after July 1, 2015, opioid antagonists prescribed
4for the treatment of an opioid overdose, including the
5medication product, administration devices, and any pharmacy
6fees or hospital fees related to the dispensing, distribution,
7and administration of the opioid antagonist, shall be covered
8under the medical assistance program for persons who are
9otherwise eligible for medical assistance under this Article.
10As used in this Section, "opioid antagonist" means a drug that
11binds to opioid receptors and blocks or inhibits the effect of
12opioids acting on those receptors, including, but not limited
13to, naloxone hydrochloride or any other similarly acting drug
14approved by the U.S. Food and Drug Administration. The
15Department shall not impose a copayment on the coverage
16provided for naloxone hydrochloride under the medical
17assistance program.
18    Upon federal approval, the Department shall provide
19coverage and reimbursement for all drugs that are approved for
20marketing by the federal Food and Drug Administration and that
21are recommended by the federal Public Health Service or the
22United States Centers for Disease Control and Prevention for
23pre-exposure prophylaxis and related pre-exposure prophylaxis
24services, including, but not limited to, HIV and sexually
25transmitted infection screening, treatment for sexually
26transmitted infections, medical monitoring, assorted labs, and
		SB3668	- 37 -	LRB104 19972 BAB 33423 b
1counseling to reduce the likelihood of HIV infection among
2individuals who are not infected with HIV but who are at high
3risk of HIV infection.
4    A federally qualified health center, as defined in Section
51905(l)(2)(B) of the federal Social Security Act, shall be
6reimbursed by the Department in accordance with the federally
7qualified health center's encounter rate for services provided
8to medical assistance recipients that are performed by a
9dental hygienist, as defined under the Illinois Dental
10Practice Act, working under the general supervision of a
11dentist and employed by a federally qualified health center.
12    Within 90 days after October 8, 2021 (the effective date
13of Public Act 102-665), the Department shall seek federal
14approval of a State Plan amendment to expand coverage for
15family planning services that includes presumptive eligibility
16to individuals whose income is at or below 208% of the federal
17poverty level. Coverage under this Section shall be effective
18beginning no later than December 1, 2022.
19    Subject to approval by the federal Centers for Medicare
20and Medicaid Services of a Title XIX State Plan amendment
21electing the Program of All-Inclusive Care for the Elderly
22(PACE) as a State Medicaid option, as provided for by Subtitle
23I (commencing with Section 4801) of Title IV of the Balanced
24Budget Act of 1997 (Public Law 105-33) and Part 460
25(commencing with Section 460.2) of Subchapter E of Title 42 of
26the Code of Federal Regulations, PACE program services shall
		SB3668	- 38 -	LRB104 19972 BAB 33423 b
1become a covered benefit of the medical assistance program,
2subject to criteria established in accordance with all
3applicable laws.
4    Notwithstanding any other provision of this Code,
5community-based pediatric palliative care from a trained
6interdisciplinary team shall be covered under the medical
7assistance program as provided in Section 15 of the Pediatric
8Palliative Care Act.
9    Notwithstanding any other provision of this Code, within
1012 months after June 2, 2022 (the effective date of Public Act
11102-1037) and subject to federal approval, acupuncture
12services performed by an acupuncturist licensed under the
13Acupuncture Practice Act who is acting within the scope of his
14or her license shall be covered under the medical assistance
15program. The Department shall apply for any federal waiver or
16State Plan amendment, if required, to implement this
17paragraph. The Department may adopt any rules, including
18standards and criteria, necessary to implement this paragraph.
19    Notwithstanding any other provision of this Code, the
20medical assistance program shall, subject to federal approval,
21reimburse hospitals for costs associated with a newborn
22screening test for the presence of metachromatic
23leukodystrophy, as required under the Newborn Metabolic
24Screening Act, at a rate not less than the fee charged by the
25Department of Public Health. Notwithstanding any other
26provision of this Code, the medical assistance program shall,
		SB3668	- 39 -	LRB104 19972 BAB 33423 b
1subject to appropriation and federal approval, also reimburse
2hospitals for costs associated with all newborn screening
3tests added on and after August 9, 2024 (the effective date of
4Public Act 103-909) to the Newborn Metabolic Screening Act and
5required to be performed under that Act at a rate not less than
6the fee charged by the Department of Public Health. The
7Department shall seek federal approval before the
8implementation of the newborn screening test fees by the
9Department of Public Health.
10    Notwithstanding any other provision of this Code,
11beginning on January 1, 2024, subject to federal approval,
12cognitive assessment and care planning services provided to a
13person who experiences signs or symptoms of cognitive
14impairment, as defined by the Diagnostic and Statistical
15Manual of Mental Disorders, Fifth Edition, shall be covered
16under the medical assistance program for persons who are
17otherwise eligible for medical assistance under this Article.
18    Notwithstanding any other provision of this Code,
19medically necessary reconstructive services that are intended
20to restore physical appearance shall be covered under the
21medical assistance program for persons who are otherwise
22eligible for medical assistance under this Article. As used in
23this paragraph, "reconstructive services" means treatments
24performed on structures of the body damaged by trauma to
25restore physical appearance.
26    Subject to federal approval, for dates of services on and
		SB3668	- 40 -	LRB104 19972 BAB 33423 b
1after January 1, 2026, over-the-counter choline dietary
2supplements for pregnant persons shall be covered under the
3medical assistance program.
4(Source: P.A. 103-102, Article 15, Section 15-5, eff. 1-1-24;
5103-102, Article 95, Section 95-15, eff. 1-1-24; 103-123, eff.
61-1-24; 103-154, eff. 6-30-23; 103-368, eff. 1-1-24; 103-593,
7Article 5, Section 5-5, eff. 6-7-24; 103-593, Article 90,
8Section 90-5, eff. 6-7-24; 103-605, eff. 7-1-24; 103-808, eff.
91-1-26; 103-909, eff. 8-9-24; 103-1040, eff. 8-9-24; 104-9,
10eff. 6-16-25; 104-417, eff. 8-15-25.)
11    Section 99. Effective date. This Act takes effect upon
12becoming law.