SB 2325 – Illinois

Status: Enacted
Year Introduced: 2021
Link: https://www.ilga.gov/legislation/BillStatus.asp?DocNum=2325&GAID=16&DocTypeID=SB&LegId=134979&SessionID=110&GA=102

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for non-emergency ground ambulance claims properly denied under the policy of the Department of Healthcare and Family Services at the time the claim is filed due to failure to submit a valid Medical Certification for Non-Emergency Ambulance on and after December 15, 2012 and prior to January 1, 2021, the Department shall allot $2,000,000 to a pool to reimburse such claims if the provider proves medical necessity for the service by other means. Requires providers to submit any such denied claims for which they seek compensation to the Department no later than December 31, 2021 along with documentation of medical necessity. Provides that no later than May 31, 2022, the Department shall determine for which claims medical necessity was established. Provides that such claims for which medical necessity was established shall be paid at the rate in effect at the time of the service, provided the $2,000,000 is sufficient to pay at those rates. Provides that if the pool is not sufficient, claims shall be paid at a uniform percentage of the applicable rate such that the pool of $2,000,000 is exhausted. Provides that the appeal process described in a specified provision of the Code shall not be applicable to the Department’s determinations. Effective immediately.

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