Sen. Daniel Biss

Filed: 5/30/2017

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 238

2    AMENDMENT NO. ______. Amend House Bill 238 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Act on the Aging is amended by
5changing Section 4.02 as follows:
 
6    (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
7    Sec. 4.02. Community Care Program. The Department shall
8establish a program of services to prevent unnecessary
9institutionalization of persons age 60 and older in need of
10long term care or who are established as persons who suffer
11from Alzheimer's disease or a related disorder under the
12Alzheimer's Disease Assistance Act, thereby enabling them to
13remain in their own homes or in other living arrangements. Such
14preventive services, which may be coordinated with other
15programs for the aged and monitored by area agencies on aging
16in cooperation with the Department, may include, but are not

 

 

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1limited to, any or all of the following:
2        (a) (blank);
3        (b) (blank);
4        (c) home care aide services;
5        (d) personal assistant services;
6        (e) adult day services;
7        (f) home-delivered meals;
8        (g) education in self-care;
9        (h) personal care services;
10        (i) adult day health services;
11        (j) habilitation services;
12        (k) respite care;
13        (k-5) community reintegration services;
14        (k-6) flexible senior services;
15        (k-7) medication management;
16        (k-8) emergency home response;
17        (l) other nonmedical social services that may enable
18    the person to become self-supporting; or
19        (m) clearinghouse for information provided by senior
20    citizen home owners who want to rent rooms to or share
21    living space with other senior citizens.
22    Individuals who meet the following criteria shall have
23equal access to services under the Community Care Program: The
24Department shall establish eligibility standards for such
25services.
26        (a) are 60 years old or older;

 

 

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1        (b) are U.S. citizens or legal aliens;
2        (c) are residents of Illinois;
3        (d) have non-exempt assets of $17,500 or less;
4    non-exempt assets do not include home, car, or personal
5    furnishings; and
6        (e) have an assessed need for long term care, as
7    provided in this Section, and are at risk for nursing
8    facility placement as measured by the determination of need
9    assessment tool or a future updated assessment tool.
10In determining the amount and nature of services for which a
11person may qualify, consideration shall not be given to the
12value of cash, property or other assets held in the name of the
13person's spouse pursuant to a written agreement dividing
14marital property into equal but separate shares or pursuant to
15a transfer of the person's interest in a home to his spouse,
16provided that the spouse's share of the marital property is not
17made available to the person seeking such services.
18    Need for long term care shall be determined as follows:
19Individuals with a score of 29 or higher based on the
20determination of need (DON) assessment tool shall be eligible
21to receive institutional and home and community-based long term
22care services until the State receives federal approval and
23implements an updated assessment tool, and those individuals
24are found to be ineligible under that updated assessment tool.
25Anyone determined to be ineligible for services due to the
26updated assessment tool shall continue to be eligible for

 

 

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1services for at least one year following that determination and
2must be reassessed no earlier than 11 months after that
3determination. The Department must adopt rules through the
4regular rulemaking process regarding the updated assessment
5tool, and shall not adopt emergency or peremptory rules
6regarding the updated assessment tool. The State shall not
7implement an updated assessment tool that causes more than 1%
8of then-current recipients to lose eligibility.
9    Service cost maximums shall be set at levels no lower than
10the service cost maximums that were in effect as of January 1,
112016. Service cost maximums shall be increased accordingly to
12reflect any rate increases.
13    Beginning January 1, 2008, the Department shall require as
14a condition of eligibility that all new financially eligible
15applicants apply for and enroll in medical assistance under
16Article V of the Illinois Public Aid Code in accordance with
17rules promulgated by the Department.
18    The Department shall not: (i) adopt any rule that restricts
19eligibility under the Community Care Program to persons who
20qualify for medical assistance under Article V of the Illinois
21Public Aid Code; or (ii) establish, by rule, a separate program
22of home and community-based long term care services for persons
23who are otherwise eligible for services under the Community
24Care Program but who do not qualify for medical assistance
25under Article V of the Illinois Public Aid Code.
26    The Department shall, in conjunction with the Department of

 

 

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1Public Aid (now Department of Healthcare and Family Services),
2seek appropriate amendments under Sections 1915 and 1924 of the
3Social Security Act. The purpose of the amendments shall be to
4extend eligibility for home and community based services under
5Sections 1915 and 1924 of the Social Security Act to persons
6who transfer to or for the benefit of a spouse those amounts of
7income and resources allowed under Section 1924 of the Social
8Security Act. Subject to the approval of such amendments, the
9Department shall extend the provisions of Section 5-4 of the
10Illinois Public Aid Code to persons who, but for the provision
11of home or community-based services, would require the level of
12care provided in an institution, as is provided for in federal
13law. Those persons no longer found to be eligible for receiving
14noninstitutional services due to changes in the eligibility
15criteria shall be given 45 days notice prior to actual
16termination. Those persons receiving notice of termination may
17contact the Department and request the determination be
18appealed at any time during the 45 day notice period. The
19target population identified for the purposes of this Section
20are persons age 60 and older with an identified service need.
21Priority shall be given to those who are at imminent risk of
22institutionalization. The services shall be provided to
23eligible persons age 60 and older to the extent that the cost
24of the services together with the other personal maintenance
25expenses of the persons are reasonably related to the standards
26established for care in a group facility appropriate to the

 

 

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1person's condition. These non-institutional services, pilot
2projects or experimental facilities may be provided as part of
3or in addition to those authorized by federal law or those
4funded and administered by the Department of Human Services.
5The Departments of Human Services, Healthcare and Family
6Services, Public Health, Veterans' Affairs, and Commerce and
7Economic Opportunity and other appropriate agencies of State,
8federal and local governments shall cooperate with the
9Department on Aging in the establishment and development of the
10non-institutional services. The Department shall require an
11annual audit from all personal assistant and home care aide
12vendors contracting with the Department under this Section. The
13annual audit shall assure that each audited vendor's procedures
14are in compliance with Department's financial reporting
15guidelines requiring an administrative and employee wage and
16benefits cost split as defined in administrative rules. The
17audit is a public record under the Freedom of Information Act.
18The Department shall execute, relative to the nursing home
19prescreening project, written inter-agency agreements with the
20Department of Human Services and the Department of Healthcare
21and Family Services, to effect the following: (1) intake
22procedures and common eligibility criteria for those persons
23who are receiving non-institutional services; and (2) the
24establishment and development of non-institutional services in
25areas of the State where they are not currently available or
26are undeveloped. On and after July 1, 1996, all nursing home

 

 

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1prescreenings for individuals 60 years of age or older shall be
2conducted by the Department.
3    As part of the Department on Aging's routine training of
4case managers and case manager supervisors, the Department may
5include information on family futures planning for persons who
6are age 60 or older and who are caregivers of their adult
7children with developmental disabilities. The content of the
8training shall be at the Department's discretion.
9    The Department is authorized to establish a system of
10recipient copayment for services provided under this Section,
11such copayment to be based upon the recipient's ability to pay
12but in no case to exceed the actual cost of the services
13provided. Additionally, any portion of a person's income which
14is equal to or less than the federal poverty standard shall not
15be considered by the Department in determining the copayment.
16The level of such copayment shall be adjusted whenever
17necessary to reflect any change in the officially designated
18federal poverty standard. The Department shall not increase
19copayment levels to the levels that were in effect on January
201, 2016, except to make an adjustment for inflation.
21    The Department, or the Department's authorized
22representative, may recover the amount of moneys expended for
23services provided to or in behalf of a person under this
24Section by a claim against the person's estate or against the
25estate of the person's surviving spouse, but no recovery may be
26had until after the death of the surviving spouse, if any, and

 

 

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1then only at such time when there is no surviving child who is
2under age 21 or blind or who has a permanent and total
3disability. This paragraph, however, shall not bar recovery, at
4the death of the person, of moneys for services provided to the
5person or in behalf of the person under this Section to which
6the person was not entitled; provided that such recovery shall
7not be enforced against any real estate while it is occupied as
8a homestead by the surviving spouse or other dependent, if no
9claims by other creditors have been filed against the estate,
10or, if such claims have been filed, they remain dormant for
11failure of prosecution or failure of the claimant to compel
12administration of the estate for the purpose of payment. This
13paragraph shall not bar recovery from the estate of a spouse,
14under Sections 1915 and 1924 of the Social Security Act and
15Section 5-4 of the Illinois Public Aid Code, who precedes a
16person receiving services under this Section in death. All
17moneys for services paid to or in behalf of the person under
18this Section shall be claimed for recovery from the deceased
19spouse's estate. "Homestead", as used in this paragraph, means
20the dwelling house and contiguous real estate occupied by a
21surviving spouse or relative, as defined by the rules and
22regulations of the Department of Healthcare and Family
23Services, regardless of the value of the property.
24    The Department shall increase the effectiveness of the
25existing Community Care Program by:
26        (1) ensuring that in-home services included in the care

 

 

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1    plan are available on evenings and weekends;
2        (2) ensuring that care plans contain the services that
3    eligible participants need based on the number of days in a
4    month, not limited to specific blocks of time, as
5    identified by the comprehensive assessment tool selected
6    by the Department for use statewide, not to exceed the
7    total monthly service cost maximum allowed for each
8    service; the Department shall develop administrative rules
9    to implement this item (2);
10        (3) ensuring that the participants have the right to
11    choose the services contained in their care plan and to
12    direct how those services are provided, based on
13    administrative rules established by the Department;
14        (4) ensuring that the determination of need tool is
15    accurate in determining the participants' level of need; to
16    achieve this, the Department, in conjunction with the Older
17    Adult Services Advisory Committee, shall institute a study
18    of the relationship between the Determination of Need
19    scores, level of need, service cost maximums, and the
20    development and utilization of service plans no later than
21    May 1, 2008; findings and recommendations shall be
22    presented to the Governor and the General Assembly no later
23    than January 1, 2009; recommendations shall include all
24    needed changes to the service cost maximums schedule and
25    additional covered services;
26        (5) ensuring that homemakers can provide personal care

 

 

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1    services that may or may not involve contact with clients,
2    including but not limited to:
3            (A) bathing;
4            (B) grooming;
5            (C) toileting;
6            (D) nail care;
7            (E) transferring;
8            (F) respiratory services;
9            (G) exercise; or
10            (H) positioning;
11        (6) ensuring that homemaker program vendors are not
12    restricted from hiring homemakers who are family members of
13    clients or recommended by clients; the Department may not,
14    by rule or policy, require homemakers who are family
15    members of clients or recommended by clients to accept
16    assignments in homes other than the client;
17        (7) ensuring that the State may access maximum federal
18    matching funds by seeking approval for the Centers for
19    Medicare and Medicaid Services for modifications to the
20    State's home and community based services waiver and
21    additional waiver opportunities, including applying for
22    enrollment in the Balance Incentive Payment Program by May
23    1, 2013, in order to maximize federal matching funds; this
24    shall include, but not be limited to, modification that
25    reflects all changes in the Community Care Program services
26    and all increases in the services cost maximum;

 

 

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1        (8) ensuring that the determination of need tool
2    accurately reflects the service needs of individuals with
3    Alzheimer's disease and related dementia disorders;
4        (9) ensuring that services are authorized accurately
5    and consistently for the Community Care Program (CCP); the
6    Department shall implement a Service Authorization policy
7    directive; the purpose shall be to ensure that eligibility
8    and services are authorized accurately and consistently in
9    the CCP program; the policy directive shall clarify service
10    authorization guidelines to Care Coordination Units and
11    Community Care Program providers no later than May 1, 2013;
12        (10) working in conjunction with Care Coordination
13    Units, the Department of Healthcare and Family Services,
14    the Department of Human Services, Community Care Program
15    providers, and other stakeholders to make improvements to
16    the Medicaid claiming processes and the Medicaid
17    enrollment procedures or requirements as needed,
18    including, but not limited to, specific policy changes or
19    rules to improve the up-front enrollment of participants in
20    the Medicaid program and specific policy changes or rules
21    to insure more prompt submission of bills to the federal
22    government to secure maximum federal matching dollars as
23    promptly as possible; the Department on Aging shall have at
24    least 3 meetings with stakeholders by January 1, 2014 in
25    order to address these improvements;
26        (11) requiring home care service providers to comply

 

 

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1    with the rounding of hours worked provisions under the
2    federal Fair Labor Standards Act (FLSA) and as set forth in
3    29 CFR 785.48(b) by May 1, 2013;
4        (12) implementing any necessary policy changes or
5    promulgating any rules, no later than January 1, 2014, to
6    assist the Department of Healthcare and Family Services in
7    moving as many participants as possible, consistent with
8    federal regulations, into coordinated care plans if a care
9    coordination plan that covers long term care is available
10    in the recipient's area; and
11        (13) maintaining fiscal year 2014 rates at the same
12    level established on January 1, 2013.
13    By January 1, 2009 or as soon after the end of the Cash and
14Counseling Demonstration Project as is practicable, the
15Department may, based on its evaluation of the demonstration
16project, promulgate rules concerning personal assistant
17services, to include, but need not be limited to,
18qualifications, employment screening, rights under fair labor
19standards, training, fiduciary agent, and supervision
20requirements. All applicants shall be subject to the provisions
21of the Health Care Worker Background Check Act.
22    The Department shall develop procedures to enhance
23availability of services on evenings, weekends, and on an
24emergency basis to meet the respite needs of caregivers.
25Procedures shall be developed to permit the utilization of
26services in successive blocks of 24 hours up to the monthly

 

 

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1maximum established by the Department. Workers providing these
2services shall be appropriately trained.
3    Beginning on the effective date of this amendatory Act of
41991, no person may perform chore/housekeeping and home care
5aide services under a program authorized by this Section unless
6that person has been issued a certificate of pre-service to do
7so by his or her employing agency. Information gathered to
8effect such certification shall include (i) the person's name,
9(ii) the date the person was hired by his or her current
10employer, and (iii) the training, including dates and levels.
11Persons engaged in the program authorized by this Section
12before the effective date of this amendatory Act of 1991 shall
13be issued a certificate of all pre- and in-service training
14from his or her employer upon submitting the necessary
15information. The employing agency shall be required to retain
16records of all staff pre- and in-service training, and shall
17provide such records to the Department upon request and upon
18termination of the employer's contract with the Department. In
19addition, the employing agency is responsible for the issuance
20of certifications of in-service training completed to their
21employees.
22    The Department is required to develop a system to ensure
23that persons working as home care aides and personal assistants
24receive increases in their wages when the federal minimum wage
25is increased by requiring vendors to certify that they are
26meeting the federal minimum wage statute for home care aides

 

 

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1and personal assistants. An employer that cannot ensure that
2the minimum wage increase is being given to home care aides and
3personal assistants shall be denied any increase in
4reimbursement costs.
5    The Community Care Program Advisory Committee is created in
6the Department on Aging. The Director shall appoint individuals
7to serve in the Committee, who shall serve at their own
8expense. Members of the Committee must abide by all applicable
9ethics laws. The Committee shall advise the Department on
10issues related to the Department's program of services to
11prevent unnecessary institutionalization. The Committee shall
12meet on a bi-monthly basis and shall serve to identify and
13advise the Department on present and potential issues affecting
14the service delivery network, the program's clients, and the
15Department and to recommend solution strategies. Persons
16appointed to the Committee shall be appointed on, but not
17limited to, their own and their agency's experience with the
18program, geographic representation, and willingness to serve.
19The Director shall appoint members to the Committee to
20represent provider, advocacy, policy research, and other
21constituencies committed to the delivery of high quality home
22and community-based services to older adults. Representatives
23shall be appointed to ensure representation from community care
24providers including, but not limited to, adult day service
25providers, homemaker providers, case coordination and case
26management units, emergency home response providers, statewide

 

 

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1trade or labor unions that represent home care aides and direct
2care staff, area agencies on aging, adults over age 60,
3membership organizations representing older adults, and other
4organizational entities, providers of care, or individuals
5with demonstrated interest and expertise in the field of home
6and community care as determined by the Director.
7    Nominations may be presented from any agency or State
8association with interest in the program. The Director, or his
9or her designee, shall serve as the permanent co-chair of the
10advisory committee. One other co-chair shall be nominated and
11approved by the members of the committee on an annual basis.
12Committee members' terms of appointment shall be for 4 years
13with one-quarter of the appointees' terms expiring each year. A
14member shall continue to serve until his or her replacement is
15named. The Department shall fill vacancies that have a
16remaining term of over one year, and this replacement shall
17occur through the annual replacement of expiring terms. The
18Director shall designate Department staff to provide technical
19assistance and staff support to the committee. Department
20representation shall not constitute membership of the
21committee. All Committee papers, issues, recommendations,
22reports, and meeting memoranda are advisory only. The Director,
23or his or her designee, shall make a written report, as
24requested by the Committee, regarding issues before the
25Committee.
26    The Department on Aging and the Department of Human

 

 

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1Services shall cooperate in the development and submission of
2an annual report on programs and services provided under this
3Section. Such joint report shall be filed with the Governor and
4the General Assembly on or before September 30 each year.
5    The requirement for reporting to the General Assembly shall
6be satisfied by filing copies of the report with the Speaker,
7the Minority Leader and the Clerk of the House of
8Representatives and the President, the Minority Leader and the
9Secretary of the Senate and the Legislative Research Unit, as
10required by Section 3.1 of the General Assembly Organization
11Act and filing such additional copies with the State Government
12Report Distribution Center for the General Assembly as is
13required under paragraph (t) of Section 7 of the State Library
14Act.
15    Those persons previously found eligible for receiving
16non-institutional services whose services were discontinued
17under the Emergency Budget Act of Fiscal Year 1992, and who do
18not meet the eligibility standards in effect on or after July
191, 1992, shall remain ineligible on and after July 1, 1992.
20Those persons previously not required to cost-share and who
21were required to cost-share effective March 1, 1992, shall
22continue to meet cost-share requirements on and after July 1,
231992. Beginning July 1, 1992, all clients will be required to
24meet eligibility, cost-share, and other requirements and will
25have services discontinued or altered when they fail to meet
26these requirements.

 

 

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1    For the purposes of this Section, "flexible senior
2services" refers to services that require one-time or periodic
3expenditures including, but not limited to, respite care, home
4modification, assistive technology, housing assistance, and
5transportation.
6    The Department shall implement an electronic service
7verification based on global positioning systems or other
8cost-effective technology for the Community Care Program no
9later than January 1, 2014.
10    The Department shall require, as a condition of
11eligibility, enrollment in the medical assistance program
12under Article V of the Illinois Public Aid Code (i) beginning
13August 1, 2013, if the Auditor General has reported that the
14Department has failed to comply with the reporting requirements
15of Section 2-27 of the Illinois State Auditing Act; or (ii)
16beginning June 1, 2014, if the Auditor General has reported
17that the Department has not undertaken the required actions
18listed in the report required by subsection (a) of Section 2-27
19of the Illinois State Auditing Act.
20    The Department shall delay Community Care Program services
21until an applicant is determined eligible for medical
22assistance under Article V of the Illinois Public Aid Code (i)
23beginning August 1, 2013, if the Auditor General has reported
24that the Department has failed to comply with the reporting
25requirements of Section 2-27 of the Illinois State Auditing
26Act; or (ii) beginning June 1, 2014, if the Auditor General has

 

 

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1reported that the Department has not undertaken the required
2actions listed in the report required by subsection (a) of
3Section 2-27 of the Illinois State Auditing Act.
4    The Department shall implement co-payments for the
5Community Care Program at the federally allowable maximum level
6(i) beginning August 1, 2013, if the Auditor General has
7reported that the Department has failed to comply with the
8reporting requirements of Section 2-27 of the Illinois State
9Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
10General has reported that the Department has not undertaken the
11required actions listed in the report required by subsection
12(a) of Section 2-27 of the Illinois State Auditing Act.
13    The Department shall provide a bi-monthly report on the
14progress of the Community Care Program reforms set forth in
15this amendatory Act of the 98th General Assembly to the
16Governor, the Speaker of the House of Representatives, the
17Minority Leader of the House of Representatives, the President
18of the Senate, and the Minority Leader of the Senate.
19    The Department shall conduct a quarterly review of Care
20Coordination Unit performance and adherence to service
21guidelines. The quarterly review shall be reported to the
22Speaker of the House of Representatives, the Minority Leader of
23the House of Representatives, the President of the Senate, and
24the Minority Leader of the Senate. The Department shall collect
25and report longitudinal data on the performance of each care
26coordination unit. Nothing in this paragraph shall be construed

 

 

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1to require the Department to identify specific care
2coordination units.
3    In regard to community care providers, failure to comply
4with Department on Aging policies shall be cause for
5disciplinary action, including, but not limited to,
6disqualification from serving Community Care Program clients.
7Each provider, upon submission of any bill or invoice to the
8Department for payment for services rendered, shall include a
9notarized statement, under penalty of perjury pursuant to
10Section 1-109 of the Code of Civil Procedure, that the provider
11has complied with all Department policies.
12    The Director of the Department on Aging shall make
13information available to the State Board of Elections as may be
14required by an agreement the State Board of Elections has
15entered into with a multi-state voter registration list
16maintenance system.
17(Source: P.A. 98-8, eff. 5-3-13; 98-1171, eff. 6-1-15; 99-143,
18eff. 7-27-15.)
 
19    Section 10. The Rehabilitation of Persons with
20Disabilities Act is amended by changing Section 3 as follows:
 
21    (20 ILCS 2405/3)  (from Ch. 23, par. 3434)
22    Sec. 3. Powers and duties. The Department shall have the
23powers and duties enumerated herein:
24    (a) To co-operate with the federal government in the

 

 

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1administration of the provisions of the federal Rehabilitation
2Act of 1973, as amended, of the Workforce Investment Act of
31998, and of the federal Social Security Act to the extent and
4in the manner provided in these Acts.
5    (b) To prescribe and supervise such courses of vocational
6training and provide such other services as may be necessary
7for the habilitation and rehabilitation of persons with one or
8more disabilities, including the administrative activities
9under subsection (e) of this Section, and to co-operate with
10State and local school authorities and other recognized
11agencies engaged in habilitation, rehabilitation and
12comprehensive rehabilitation services; and to cooperate with
13the Department of Children and Family Services regarding the
14care and education of children with one or more disabilities.
15    (c) (Blank).
16    (d) To report in writing, to the Governor, annually on or
17before the first day of December, and at such other times and
18in such manner and upon such subjects as the Governor may
19require. The annual report shall contain (1) a statement of the
20existing condition of comprehensive rehabilitation services,
21habilitation and rehabilitation in the State; (2) a statement
22of suggestions and recommendations with reference to the
23development of comprehensive rehabilitation services,
24habilitation and rehabilitation in the State; and (3) an
25itemized statement of the amounts of money received from
26federal, State and other sources, and of the objects and

 

 

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1purposes to which the respective items of these several amounts
2have been devoted.
3    (e) (Blank).
4    (f) To establish a program of services to prevent the
5unnecessary institutionalization of persons in need of long
6term care and who meet the criteria for blindness or disability
7as defined by the Social Security Act, thereby enabling them to
8remain in their own homes. Such preventive services include any
9or all of the following:
10        (1) personal assistant services;
11        (2) homemaker services;
12        (3) home-delivered meals;
13        (4) adult day care services;
14        (5) respite care;
15        (6) home modification or assistive equipment;
16        (7) home health services;
17        (8) electronic home response;
18        (9) brain injury behavioral/cognitive services;
19        (10) brain injury habilitation;
20        (11) brain injury pre-vocational services; or
21        (12) brain injury supported employment.
22    The Department shall establish eligibility standards for
23such services taking into consideration the unique economic and
24social needs of the population for whom they are to be
25provided. Such eligibility standards may be based on the
26recipient's ability to pay for services; provided, however,

 

 

10000HB0238sam001- 22 -LRB100 00066 KTG 27369 a

1that any portion of a person's income that is equal to or less
2than the "protected income" level shall not be considered by
3the Department in determining eligibility. The "protected
4income" level shall be determined by the Department, shall
5never be less than the federal poverty standard, and shall be
6adjusted each year to reflect changes in the Consumer Price
7Index For All Urban Consumers as determined by the United
8States Department of Labor. The standards must provide that a
9person may not have more than $10,000 in assets to be eligible
10for the services, and the Department may increase or decrease
11the asset limitation by rule. The Department may not decrease
12the asset level below $10,000.
13    Individuals with a score of 29 or higher based on the
14determination of need (DON) assessment tool shall be eligible
15to receive institutional and home and community-based long term
16care services until the State receives federal approval and
17implements an updated assessment tool, and those individuals
18are found to be ineligible under that updated assessment tool.
19Anyone determined to be ineligible for services due to the
20updated assessment tool shall continue to be eligible for
21services for at least one year following that determination and
22must be reassessed no earlier than 11 months after that
23determination. The Department must adopt rules through the
24regular rulemaking process regarding the updated assessment
25tool, and shall not adopt emergency or peremptory rules
26regarding the updated assessment tool. The State shall not

 

 

10000HB0238sam001- 23 -LRB100 00066 KTG 27369 a

1implement an updated assessment tool that causes more than 1%
2of then-current recipients to lose eligibility.
3    Service cost maximums shall be set at levels no lower than
4the service cost maximums that were in effect as of January 1,
52016. Service cost maximums shall be increased accordingly to
6reflect any rate increases.
7    The services shall be provided, as established by the
8Department by rule, to eligible persons to prevent unnecessary
9or premature institutionalization, to the extent that the cost
10of the services, together with the other personal maintenance
11expenses of the persons, are reasonably related to the
12standards established for care in a group facility appropriate
13to their condition. These non-institutional services, pilot
14projects or experimental facilities may be provided as part of
15or in addition to those authorized by federal law or those
16funded and administered by the Illinois Department on Aging.
17The Department shall set rates and fees for services in a fair
18and equitable manner. Services identical to those offered by
19the Department on Aging shall be paid at the same rate.
20    Personal assistants shall be paid at a rate negotiated
21between the State and an exclusive representative of personal
22assistants under a collective bargaining agreement. In no case
23shall the Department pay personal assistants an hourly wage
24that is less than the federal minimum wage.
25    Solely for the purposes of coverage under the Illinois
26Public Labor Relations Act (5 ILCS 315/), personal assistants

 

 

10000HB0238sam001- 24 -LRB100 00066 KTG 27369 a

1providing services under the Department's Home Services
2Program shall be considered to be public employees and the
3State of Illinois shall be considered to be their employer as
4of the effective date of this amendatory Act of the 93rd
5General Assembly, but not before. Solely for the purposes of
6coverage under the Illinois Public Labor Relations Act, home
7care and home health workers who function as personal
8assistants and individual maintenance home health workers and
9who also provide services under the Department's Home Services
10Program shall be considered to be public employees, no matter
11whether the State provides such services through direct
12fee-for-service arrangements, with the assistance of a managed
13care organization or other intermediary, or otherwise, and the
14State of Illinois shall be considered to be the employer of
15those persons as of January 29, 2013 (the effective date of
16Public Act 97-1158), but not before except as otherwise
17provided under this subsection (f). The State shall engage in
18collective bargaining with an exclusive representative of home
19care and home health workers who function as personal
20assistants and individual maintenance home health workers
21working under the Home Services Program concerning their terms
22and conditions of employment that are within the State's
23control. Nothing in this paragraph shall be understood to limit
24the right of the persons receiving services defined in this
25Section to hire and fire home care and home health workers who
26function as personal assistants and individual maintenance

 

 

10000HB0238sam001- 25 -LRB100 00066 KTG 27369 a

1home health workers working under the Home Services Program or
2to supervise them within the limitations set by the Home
3Services Program. The State shall not be considered to be the
4employer of home care and home health workers who function as
5personal assistants and individual maintenance home health
6workers working under the Home Services Program for any
7purposes not specifically provided in Public Act 93-204 or
8Public Act 97-1158, including but not limited to, purposes of
9vicarious liability in tort and purposes of statutory
10retirement or health insurance benefits. Home care and home
11health workers who function as personal assistants and
12individual maintenance home health workers and who also provide
13services under the Department's Home Services Program shall not
14be covered by the State Employees Group Insurance Act of 1971
15(5 ILCS 375/).
16    The Department shall execute, relative to nursing home
17prescreening, as authorized by Section 4.03 of the Illinois Act
18on the Aging, written inter-agency agreements with the
19Department on Aging and the Department of Healthcare and Family
20Services, to effect the intake procedures and eligibility
21criteria for those persons who may need long term care. On and
22after July 1, 1996, all nursing home prescreenings for
23individuals 18 through 59 years of age shall be conducted by
24the Department, or a designee of the Department.
25    The Department is authorized to establish a system of
26recipient cost-sharing for services provided under this

 

 

10000HB0238sam001- 26 -LRB100 00066 KTG 27369 a

1Section. The cost-sharing shall be based upon the recipient's
2ability to pay for services, but in no case shall the
3recipient's share exceed the actual cost of the services
4provided. Protected income shall not be considered by the
5Department in its determination of the recipient's ability to
6pay a share of the cost of services. The level of cost-sharing
7shall be adjusted each year to reflect changes in the
8"protected income" level. The Department shall deduct from the
9recipient's share of the cost of services any money expended by
10the recipient for disability-related expenses.
11    To the extent permitted under the federal Social Security
12Act, the Department, or the Department's authorized
13representative, may recover the amount of moneys expended for
14services provided to or in behalf of a person under this
15Section by a claim against the person's estate or against the
16estate of the person's surviving spouse, but no recovery may be
17had until after the death of the surviving spouse, if any, and
18then only at such time when there is no surviving child who is
19under age 21 or blind or who has a permanent and total
20disability. This paragraph, however, shall not bar recovery, at
21the death of the person, of moneys for services provided to the
22person or in behalf of the person under this Section to which
23the person was not entitled; provided that such recovery shall
24not be enforced against any real estate while it is occupied as
25a homestead by the surviving spouse or other dependent, if no
26claims by other creditors have been filed against the estate,

 

 

10000HB0238sam001- 27 -LRB100 00066 KTG 27369 a

1or, if such claims have been filed, they remain dormant for
2failure of prosecution or failure of the claimant to compel
3administration of the estate for the purpose of payment. This
4paragraph shall not bar recovery from the estate of a spouse,
5under Sections 1915 and 1924 of the Social Security Act and
6Section 5-4 of the Illinois Public Aid Code, who precedes a
7person receiving services under this Section in death. All
8moneys for services paid to or in behalf of the person under
9this Section shall be claimed for recovery from the deceased
10spouse's estate. "Homestead", as used in this paragraph, means
11the dwelling house and contiguous real estate occupied by a
12surviving spouse or relative, as defined by the rules and
13regulations of the Department of Healthcare and Family
14Services, regardless of the value of the property.
15    The Department shall submit an annual report on programs
16and services provided under this Section. The report shall be
17filed with the Governor and the General Assembly on or before
18March 30 each year.
19    The requirement for reporting to the General Assembly shall
20be satisfied by filing copies of the report with the Speaker,
21the Minority Leader and the Clerk of the House of
22Representatives and the President, the Minority Leader and the
23Secretary of the Senate and the Legislative Research Unit, as
24required by Section 3.1 of the General Assembly Organization
25Act, and filing additional copies with the State Government
26Report Distribution Center for the General Assembly as required

 

 

10000HB0238sam001- 28 -LRB100 00066 KTG 27369 a

1under paragraph (t) of Section 7 of the State Library Act.
2    (g) To establish such subdivisions of the Department as
3shall be desirable and assign to the various subdivisions the
4responsibilities and duties placed upon the Department by law.
5    (h) To cooperate and enter into any necessary agreements
6with the Department of Employment Security for the provision of
7job placement and job referral services to clients of the
8Department, including job service registration of such clients
9with Illinois Employment Security offices and making job
10listings maintained by the Department of Employment Security
11available to such clients.
12    (i) To possess all powers reasonable and necessary for the
13exercise and administration of the powers, duties and
14responsibilities of the Department which are provided for by
15law.
16    (j) (Blank).
17    (k) (Blank).
18    (l) To establish, operate and maintain a Statewide Housing
19Clearinghouse of information on available, government
20subsidized housing accessible to persons with disabilities and
21available privately owned housing accessible to persons with
22disabilities. The information shall include but not be limited
23to the location, rental requirements, access features and
24proximity to public transportation of available housing. The
25Clearinghouse shall consist of at least a computerized database
26for the storage and retrieval of information and a separate or

 

 

10000HB0238sam001- 29 -LRB100 00066 KTG 27369 a

1shared toll free telephone number for use by those seeking
2information from the Clearinghouse. Department offices and
3personnel throughout the State shall also assist in the
4operation of the Statewide Housing Clearinghouse. Cooperation
5with local, State and federal housing managers shall be sought
6and extended in order to frequently and promptly update the
7Clearinghouse's information.
8    (m) To assure that the names and case records of persons
9who received or are receiving services from the Department,
10including persons receiving vocational rehabilitation, home
11services, or other services, and those attending one of the
12Department's schools or other supervised facility shall be
13confidential and not be open to the general public. Those case
14records and reports or the information contained in those
15records and reports shall be disclosed by the Director only to
16proper law enforcement officials, individuals authorized by a
17court, the General Assembly or any committee or commission of
18the General Assembly, and other persons and for reasons as the
19Director designates by rule. Disclosure by the Director may be
20only in accordance with other applicable law.
21(Source: P.A. 98-1004, eff. 8-18-14; 99-143, eff. 7-27-15.)
 
22    Section 13. The Nursing Home Care Act is amended by
23changing Section 3-402 as follows:
 
24    (210 ILCS 45/3-402)  (from Ch. 111 1/2, par. 4153-402)

 

 

10000HB0238sam001- 30 -LRB100 00066 KTG 27369 a

1    Sec. 3-402. Involuntary transfer or discharge.
2    Involuntary transfer or discharge of a resident from a
3facility shall be preceded by the discussion required under
4Section 3-408 and by a minimum written notice of 21 days,
5except in one of the following instances:
6        (a) When an emergency transfer or discharge is ordered
7    by the resident's attending physician because of the
8    resident's health care needs.
9        (b) When the transfer or discharge is mandated by the
10    physical safety of other residents, the facility staff, or
11    facility visitors, as documented in the clinical record.
12    The Department shall be notified prior to any such
13    involuntary transfer or discharge. The Department shall
14    immediately offer transfer, or discharge and relocation
15    assistance to residents transferred or discharged under
16    this subparagraph (b), and the Department may place
17    relocation teams as provided in Section 3-419 of this Act.
18        (c) When an identified offender is within the
19    provisional admission period defined in Section 1-120.3.
20    If the Identified Offender Report and Recommendation
21    prepared under Section 2-201.6 shows that the identified
22    offender poses a serious threat or danger to the physical
23    safety of other residents, the facility staff, or facility
24    visitors in the admitting facility and the facility
25    determines that it is unable to provide a safe environment
26    for the other residents, the facility staff, or facility

 

 

10000HB0238sam001- 31 -LRB100 00066 KTG 27369 a

1    visitors, the facility shall transfer or discharge the
2    identified offender within 3 days after its receipt of the
3    Identified Offender Report and Recommendation.
4    No individual receiving care in an institutional setting
5shall be involuntarily discharged as the result of the updated
6determination of need (DON) assessment tool as provided in
7Section 5-5 of the Illinois Public Aid Code until a transition
8plan has been developed by the Department on Aging or its
9designee and all care identified in the transition plan is
10available to the resident immediately upon discharge.
11(Source: P.A. 96-1372, eff. 7-29-10.)
 
12    Section 15. The Illinois Public Aid Code is amended by
13changing Sections 5-5 and 5-5.01a as follows:
 
14    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
15    Sec. 5-5. Medical services. The Illinois Department, by
16rule, shall determine the quantity and quality of and the rate
17of reimbursement for the medical assistance for which payment
18will be authorized, and the medical services to be provided,
19which may include all or part of the following: (1) inpatient
20hospital services; (2) outpatient hospital services; (3) other
21laboratory and X-ray services; (4) skilled nursing home
22services; (5) physicians' services whether furnished in the
23office, the patient's home, a hospital, a skilled nursing home,
24or elsewhere; (6) medical care, or any other type of remedial

 

 

10000HB0238sam001- 32 -LRB100 00066 KTG 27369 a

1care furnished by licensed practitioners; (7) home health care
2services; (8) private duty nursing service; (9) clinic
3services; (10) dental services, including prevention and
4treatment of periodontal disease and dental caries disease for
5pregnant women, provided by an individual licensed to practice
6dentistry or dental surgery; for purposes of this item (10),
7"dental services" means diagnostic, preventive, or corrective
8procedures provided by or under the supervision of a dentist in
9the practice of his or her profession; (11) physical therapy
10and related services; (12) prescribed drugs, dentures, and
11prosthetic devices; and eyeglasses prescribed by a physician
12skilled in the diseases of the eye, or by an optometrist,
13whichever the person may select; (13) other diagnostic,
14screening, preventive, and rehabilitative services, including
15to ensure that the individual's need for intervention or
16treatment of mental disorders or substance use disorders or
17co-occurring mental health and substance use disorders is
18determined using a uniform screening, assessment, and
19evaluation process inclusive of criteria, for children and
20adults; for purposes of this item (13), a uniform screening,
21assessment, and evaluation process refers to a process that
22includes an appropriate evaluation and, as warranted, a
23referral; "uniform" does not mean the use of a singular
24instrument, tool, or process that all must utilize; (14)
25transportation and such other expenses as may be necessary;
26(15) medical treatment of sexual assault survivors, as defined

 

 

10000HB0238sam001- 33 -LRB100 00066 KTG 27369 a

1in Section 1a of the Sexual Assault Survivors Emergency
2Treatment Act, for injuries sustained as a result of the sexual
3assault, including examinations and laboratory tests to
4discover evidence which may be used in criminal proceedings
5arising from the sexual assault; (16) the diagnosis and
6treatment of sickle cell anemia; and (17) any other medical
7care, and any other type of remedial care recognized under the
8laws of this State, but not including abortions, or induced
9miscarriages or premature births, unless, in the opinion of a
10physician, such procedures are necessary for the preservation
11of the life of the woman seeking such treatment, or except an
12induced premature birth intended to produce a live viable child
13and such procedure is necessary for the health of the mother or
14her unborn child. The Illinois Department, by rule, shall
15prohibit any physician from providing medical assistance to
16anyone eligible therefor under this Code where such physician
17has been found guilty of performing an abortion procedure in a
18wilful and wanton manner upon a woman who was not pregnant at
19the time such abortion procedure was performed. The term "any
20other type of remedial care" shall include nursing care and
21nursing home service for persons who rely on treatment by
22spiritual means alone through prayer for healing.
23    Notwithstanding any other provision of this Section, a
24comprehensive tobacco use cessation program that includes
25purchasing prescription drugs or prescription medical devices
26approved by the Food and Drug Administration shall be covered

 

 

10000HB0238sam001- 34 -LRB100 00066 KTG 27369 a

1under the medical assistance program under this Article for
2persons who are otherwise eligible for assistance under this
3Article.
4    Notwithstanding any other provision of this Code, the
5Illinois Department may not require, as a condition of payment
6for any laboratory test authorized under this Article, that a
7physician's handwritten signature appear on the laboratory
8test order form. The Illinois Department may, however, impose
9other appropriate requirements regarding laboratory test order
10documentation.
11    Upon receipt of federal approval of an amendment to the
12Illinois Title XIX State Plan for this purpose, the Department
13shall authorize the Chicago Public Schools (CPS) to procure a
14vendor or vendors to manufacture eyeglasses for individuals
15enrolled in a school within the CPS system. CPS shall ensure
16that its vendor or vendors are enrolled as providers in the
17medical assistance program and in any capitated Medicaid
18managed care entity (MCE) serving individuals enrolled in a
19school within the CPS system. Under any contract procured under
20this provision, the vendor or vendors must serve only
21individuals enrolled in a school within the CPS system. Claims
22for services provided by CPS's vendor or vendors to recipients
23of benefits in the medical assistance program under this Code,
24the Children's Health Insurance Program, or the Covering ALL
25KIDS Health Insurance Program shall be submitted to the
26Department or the MCE in which the individual is enrolled for

 

 

10000HB0238sam001- 35 -LRB100 00066 KTG 27369 a

1payment and shall be reimbursed at the Department's or the
2MCE's established rates or rate methodologies for eyeglasses.
3    On and after July 1, 2012, the Department of Healthcare and
4Family Services may provide the following services to persons
5eligible for assistance under this Article who are
6participating in education, training or employment programs
7operated by the Department of Human Services as successor to
8the Department of Public Aid:
9        (1) dental services provided by or under the
10    supervision of a dentist; and
11        (2) eyeglasses prescribed by a physician skilled in the
12    diseases of the eye, or by an optometrist, whichever the
13    person may select.
14    Notwithstanding any other provision of this Code and
15subject to federal approval, the Department may adopt rules to
16allow a dentist who is volunteering his or her service at no
17cost to render dental services through an enrolled
18not-for-profit health clinic without the dentist personally
19enrolling as a participating provider in the medical assistance
20program. A not-for-profit health clinic shall include a public
21health clinic or Federally Qualified Health Center or other
22enrolled provider, as determined by the Department, through
23which dental services covered under this Section are performed.
24The Department shall establish a process for payment of claims
25for reimbursement for covered dental services rendered under
26this provision.

 

 

10000HB0238sam001- 36 -LRB100 00066 KTG 27369 a

1    The Illinois Department, by rule, may distinguish and
2classify the medical services to be provided only in accordance
3with the classes of persons designated in Section 5-2.
4    The Department of Healthcare and Family Services must
5provide coverage and reimbursement for amino acid-based
6elemental formulas, regardless of delivery method, for the
7diagnosis and treatment of (i) eosinophilic disorders and (ii)
8short bowel syndrome when the prescribing physician has issued
9a written order stating that the amino acid-based elemental
10formula is medically necessary.
11    The Illinois Department shall authorize the provision of,
12and shall authorize payment for, screening by low-dose
13mammography for the presence of occult breast cancer for women
1435 years of age or older who are eligible for medical
15assistance under this Article, as follows:
16        (A) A baseline mammogram for women 35 to 39 years of
17    age.
18        (B) An annual mammogram for women 40 years of age or
19    older.
20        (C) A mammogram at the age and intervals considered
21    medically necessary by the woman's health care provider for
22    women under 40 years of age and having a family history of
23    breast cancer, prior personal history of breast cancer,
24    positive genetic testing, or other risk factors.
25        (D) A comprehensive ultrasound screening of an entire
26    breast or breasts if a mammogram demonstrates

 

 

10000HB0238sam001- 37 -LRB100 00066 KTG 27369 a

1    heterogeneous or dense breast tissue, when medically
2    necessary as determined by a physician licensed to practice
3    medicine in all of its branches.
4        (E) A screening MRI when medically necessary, as
5    determined by a physician licensed to practice medicine in
6    all of its branches.
7    All screenings shall include a physical breast exam,
8instruction on self-examination and information regarding the
9frequency of self-examination and its value as a preventative
10tool. For purposes of this Section, "low-dose mammography"
11means the x-ray examination of the breast using equipment
12dedicated specifically for mammography, including the x-ray
13tube, filter, compression device, and image receptor, with an
14average radiation exposure delivery of less than one rad per
15breast for 2 views of an average size breast. The term also
16includes digital mammography and includes breast
17tomosynthesis. As used in this Section, the term "breast
18tomosynthesis" means a radiologic procedure that involves the
19acquisition of projection images over the stationary breast to
20produce cross-sectional digital three-dimensional images of
21the breast. If, at any time, the Secretary of the United States
22Department of Health and Human Services, or its successor
23agency, promulgates rules or regulations to be published in the
24Federal Register or publishes a comment in the Federal Register
25or issues an opinion, guidance, or other action that would
26require the State, pursuant to any provision of the Patient

 

 

10000HB0238sam001- 38 -LRB100 00066 KTG 27369 a

1Protection and Affordable Care Act (Public Law 111-148),
2including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
3successor provision, to defray the cost of any coverage for
4breast tomosynthesis outlined in this paragraph, then the
5requirement that an insurer cover breast tomosynthesis is
6inoperative other than any such coverage authorized under
7Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
8the State shall not assume any obligation for the cost of
9coverage for breast tomosynthesis set forth in this paragraph.
10    On and after January 1, 2016, the Department shall ensure
11that all networks of care for adult clients of the Department
12include access to at least one breast imaging Center of Imaging
13Excellence as certified by the American College of Radiology.
14    On and after January 1, 2012, providers participating in a
15quality improvement program approved by the Department shall be
16reimbursed for screening and diagnostic mammography at the same
17rate as the Medicare program's rates, including the increased
18reimbursement for digital mammography.
19    The Department shall convene an expert panel including
20representatives of hospitals, free-standing mammography
21facilities, and doctors, including radiologists, to establish
22quality standards for mammography.
23    On and after January 1, 2017, providers participating in a
24breast cancer treatment quality improvement program approved
25by the Department shall be reimbursed for breast cancer
26treatment at a rate that is no lower than 95% of the Medicare

 

 

10000HB0238sam001- 39 -LRB100 00066 KTG 27369 a

1program's rates for the data elements included in the breast
2cancer treatment quality program.
3    The Department shall convene an expert panel, including
4representatives of hospitals, free standing breast cancer
5treatment centers, breast cancer quality organizations, and
6doctors, including breast surgeons, reconstructive breast
7surgeons, oncologists, and primary care providers to establish
8quality standards for breast cancer treatment.
9    Subject to federal approval, the Department shall
10establish a rate methodology for mammography at federally
11qualified health centers and other encounter-rate clinics.
12These clinics or centers may also collaborate with other
13hospital-based mammography facilities. By January 1, 2016, the
14Department shall report to the General Assembly on the status
15of the provision set forth in this paragraph.
16    The Department shall establish a methodology to remind
17women who are age-appropriate for screening mammography, but
18who have not received a mammogram within the previous 18
19months, of the importance and benefit of screening mammography.
20The Department shall work with experts in breast cancer
21outreach and patient navigation to optimize these reminders and
22shall establish a methodology for evaluating their
23effectiveness and modifying the methodology based on the
24evaluation.
25    The Department shall establish a performance goal for
26primary care providers with respect to their female patients

 

 

10000HB0238sam001- 40 -LRB100 00066 KTG 27369 a

1over age 40 receiving an annual mammogram. This performance
2goal shall be used to provide additional reimbursement in the
3form of a quality performance bonus to primary care providers
4who meet that goal.
5    The Department shall devise a means of case-managing or
6patient navigation for beneficiaries diagnosed with breast
7cancer. This program shall initially operate as a pilot program
8in areas of the State with the highest incidence of mortality
9related to breast cancer. At least one pilot program site shall
10be in the metropolitan Chicago area and at least one site shall
11be outside the metropolitan Chicago area. On or after July 1,
122016, the pilot program shall be expanded to include one site
13in western Illinois, one site in southern Illinois, one site in
14central Illinois, and 4 sites within metropolitan Chicago. An
15evaluation of the pilot program shall be carried out measuring
16health outcomes and cost of care for those served by the pilot
17program compared to similarly situated patients who are not
18served by the pilot program.
19    The Department shall require all networks of care to
20develop a means either internally or by contract with experts
21in navigation and community outreach to navigate cancer
22patients to comprehensive care in a timely fashion. The
23Department shall require all networks of care to include access
24for patients diagnosed with cancer to at least one academic
25commission on cancer-accredited cancer program as an
26in-network covered benefit.

 

 

10000HB0238sam001- 41 -LRB100 00066 KTG 27369 a

1    Any medical or health care provider shall immediately
2recommend, to any pregnant woman who is being provided prenatal
3services and is suspected of drug abuse or is addicted as
4defined in the Alcoholism and Other Drug Abuse and Dependency
5Act, referral to a local substance abuse treatment provider
6licensed by the Department of Human Services or to a licensed
7hospital which provides substance abuse treatment services.
8The Department of Healthcare and Family Services shall assure
9coverage for the cost of treatment of the drug abuse or
10addiction for pregnant recipients in accordance with the
11Illinois Medicaid Program in conjunction with the Department of
12Human Services.
13    All medical providers providing medical assistance to
14pregnant women under this Code shall receive information from
15the Department on the availability of services under the Drug
16Free Families with a Future or any comparable program providing
17case management services for addicted women, including
18information on appropriate referrals for other social services
19that may be needed by addicted women in addition to treatment
20for addiction.
21    The Illinois Department, in cooperation with the
22Departments of Human Services (as successor to the Department
23of Alcoholism and Substance Abuse) and Public Health, through a
24public awareness campaign, may provide information concerning
25treatment for alcoholism and drug abuse and addiction, prenatal
26health care, and other pertinent programs directed at reducing

 

 

10000HB0238sam001- 42 -LRB100 00066 KTG 27369 a

1the number of drug-affected infants born to recipients of
2medical assistance.
3    Neither the Department of Healthcare and Family Services
4nor the Department of Human Services shall sanction the
5recipient solely on the basis of her substance abuse.
6    The Illinois Department shall establish such regulations
7governing the dispensing of health services under this Article
8as it shall deem appropriate. The Department should seek the
9advice of formal professional advisory committees appointed by
10the Director of the Illinois Department for the purpose of
11providing regular advice on policy and administrative matters,
12information dissemination and educational activities for
13medical and health care providers, and consistency in
14procedures to the Illinois Department.
15    The Illinois Department may develop and contract with
16Partnerships of medical providers to arrange medical services
17for persons eligible under Section 5-2 of this Code.
18Implementation of this Section may be by demonstration projects
19in certain geographic areas. The Partnership shall be
20represented by a sponsor organization. The Department, by rule,
21shall develop qualifications for sponsors of Partnerships.
22Nothing in this Section shall be construed to require that the
23sponsor organization be a medical organization.
24    The sponsor must negotiate formal written contracts with
25medical providers for physician services, inpatient and
26outpatient hospital care, home health services, treatment for

 

 

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1alcoholism and substance abuse, and other services determined
2necessary by the Illinois Department by rule for delivery by
3Partnerships. Physician services must include prenatal and
4obstetrical care. The Illinois Department shall reimburse
5medical services delivered by Partnership providers to clients
6in target areas according to provisions of this Article and the
7Illinois Health Finance Reform Act, except that:
8        (1) Physicians participating in a Partnership and
9    providing certain services, which shall be determined by
10    the Illinois Department, to persons in areas covered by the
11    Partnership may receive an additional surcharge for such
12    services.
13        (2) The Department may elect to consider and negotiate
14    financial incentives to encourage the development of
15    Partnerships and the efficient delivery of medical care.
16        (3) Persons receiving medical services through
17    Partnerships may receive medical and case management
18    services above the level usually offered through the
19    medical assistance program.
20    Medical providers shall be required to meet certain
21qualifications to participate in Partnerships to ensure the
22delivery of high quality medical services. These
23qualifications shall be determined by rule of the Illinois
24Department and may be higher than qualifications for
25participation in the medical assistance program. Partnership
26sponsors may prescribe reasonable additional qualifications

 

 

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1for participation by medical providers, only with the prior
2written approval of the Illinois Department.
3    Nothing in this Section shall limit the free choice of
4practitioners, hospitals, and other providers of medical
5services by clients. In order to ensure patient freedom of
6choice, the Illinois Department shall immediately promulgate
7all rules and take all other necessary actions so that provided
8services may be accessed from therapeutically certified
9optometrists to the full extent of the Illinois Optometric
10Practice Act of 1987 without discriminating between service
11providers.
12    The Department shall apply for a waiver from the United
13States Health Care Financing Administration to allow for the
14implementation of Partnerships under this Section.
15    The Illinois Department shall require health care
16providers to maintain records that document the medical care
17and services provided to recipients of Medical Assistance under
18this Article. Such records must be retained for a period of not
19less than 6 years from the date of service or as provided by
20applicable State law, whichever period is longer, except that
21if an audit is initiated within the required retention period
22then the records must be retained until the audit is completed
23and every exception is resolved. The Illinois Department shall
24require health care providers to make available, when
25authorized by the patient, in writing, the medical records in a
26timely fashion to other health care providers who are treating

 

 

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1or serving persons eligible for Medical Assistance under this
2Article. All dispensers of medical services shall be required
3to maintain and retain business and professional records
4sufficient to fully and accurately document the nature, scope,
5details and receipt of the health care provided to persons
6eligible for medical assistance under this Code, in accordance
7with regulations promulgated by the Illinois Department. The
8rules and regulations shall require that proof of the receipt
9of prescription drugs, dentures, prosthetic devices and
10eyeglasses by eligible persons under this Section accompany
11each claim for reimbursement submitted by the dispenser of such
12medical services. No such claims for reimbursement shall be
13approved for payment by the Illinois Department without such
14proof of receipt, unless the Illinois Department shall have put
15into effect and shall be operating a system of post-payment
16audit and review which shall, on a sampling basis, be deemed
17adequate by the Illinois Department to assure that such drugs,
18dentures, prosthetic devices and eyeglasses for which payment
19is being made are actually being received by eligible
20recipients. Within 90 days after September 16, 1984 (the
21effective date of Public Act 83-1439), the Illinois Department
22shall establish a current list of acquisition costs for all
23prosthetic devices and any other items recognized as medical
24equipment and supplies reimbursable under this Article and
25shall update such list on a quarterly basis, except that the
26acquisition costs of all prescription drugs shall be updated no

 

 

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1less frequently than every 30 days as required by Section
25-5.12.
3    The rules and regulations of the Illinois Department shall
4require that a written statement including the required opinion
5of a physician shall accompany any claim for reimbursement for
6abortions, or induced miscarriages or premature births. This
7statement shall indicate what procedures were used in providing
8such medical services.
9    Notwithstanding any other law to the contrary, the Illinois
10Department shall, within 365 days after July 22, 2013 (the
11effective date of Public Act 98-104), establish procedures to
12permit skilled care facilities licensed under the Nursing Home
13Care Act to submit monthly billing claims for reimbursement
14purposes. Following development of these procedures, the
15Department shall, by July 1, 2016, test the viability of the
16new system and implement any necessary operational or
17structural changes to its information technology platforms in
18order to allow for the direct acceptance and payment of nursing
19home claims.
20    Notwithstanding any other law to the contrary, the Illinois
21Department shall, within 365 days after August 15, 2014 (the
22effective date of Public Act 98-963), establish procedures to
23permit ID/DD facilities licensed under the ID/DD Community Care
24Act and MC/DD facilities licensed under the MC/DD Act to submit
25monthly billing claims for reimbursement purposes. Following
26development of these procedures, the Department shall have an

 

 

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1additional 365 days to test the viability of the new system and
2to ensure that any necessary operational or structural changes
3to its information technology platforms are implemented.
4    The Illinois Department shall require all dispensers of
5medical services, other than an individual practitioner or
6group of practitioners, desiring to participate in the Medical
7Assistance program established under this Article to disclose
8all financial, beneficial, ownership, equity, surety or other
9interests in any and all firms, corporations, partnerships,
10associations, business enterprises, joint ventures, agencies,
11institutions or other legal entities providing any form of
12health care services in this State under this Article.
13    The Illinois Department may require that all dispensers of
14medical services desiring to participate in the medical
15assistance program established under this Article disclose,
16under such terms and conditions as the Illinois Department may
17by rule establish, all inquiries from clients and attorneys
18regarding medical bills paid by the Illinois Department, which
19inquiries could indicate potential existence of claims or liens
20for the Illinois Department.
21    Enrollment of a vendor shall be subject to a provisional
22period and shall be conditional for one year. During the period
23of conditional enrollment, the Department may terminate the
24vendor's eligibility to participate in, or may disenroll the
25vendor from, the medical assistance program without cause.
26Unless otherwise specified, such termination of eligibility or

 

 

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1disenrollment is not subject to the Department's hearing
2process. However, a disenrolled vendor may reapply without
3penalty.
4    The Department has the discretion to limit the conditional
5enrollment period for vendors based upon category of risk of
6the vendor.
7    Prior to enrollment and during the conditional enrollment
8period in the medical assistance program, all vendors shall be
9subject to enhanced oversight, screening, and review based on
10the risk of fraud, waste, and abuse that is posed by the
11category of risk of the vendor. The Illinois Department shall
12establish the procedures for oversight, screening, and review,
13which may include, but need not be limited to: criminal and
14financial background checks; fingerprinting; license,
15certification, and authorization verifications; unscheduled or
16unannounced site visits; database checks; prepayment audit
17reviews; audits; payment caps; payment suspensions; and other
18screening as required by federal or State law.
19    The Department shall define or specify the following: (i)
20by provider notice, the "category of risk of the vendor" for
21each type of vendor, which shall take into account the level of
22screening applicable to a particular category of vendor under
23federal law and regulations; (ii) by rule or provider notice,
24the maximum length of the conditional enrollment period for
25each category of risk of the vendor; and (iii) by rule, the
26hearing rights, if any, afforded to a vendor in each category

 

 

10000HB0238sam001- 49 -LRB100 00066 KTG 27369 a

1of risk of the vendor that is terminated or disenrolled during
2the conditional enrollment period.
3    To be eligible for payment consideration, a vendor's
4payment claim or bill, either as an initial claim or as a
5resubmitted claim following prior rejection, must be received
6by the Illinois Department, or its fiscal intermediary, no
7later than 180 days after the latest date on the claim on which
8medical goods or services were provided, with the following
9exceptions:
10        (1) In the case of a provider whose enrollment is in
11    process by the Illinois Department, the 180-day period
12    shall not begin until the date on the written notice from
13    the Illinois Department that the provider enrollment is
14    complete.
15        (2) In the case of errors attributable to the Illinois
16    Department or any of its claims processing intermediaries
17    which result in an inability to receive, process, or
18    adjudicate a claim, the 180-day period shall not begin
19    until the provider has been notified of the error.
20        (3) In the case of a provider for whom the Illinois
21    Department initiates the monthly billing process.
22        (4) In the case of a provider operated by a unit of
23    local government with a population exceeding 3,000,000
24    when local government funds finance federal participation
25    for claims payments.
26    For claims for services rendered during a period for which

 

 

10000HB0238sam001- 50 -LRB100 00066 KTG 27369 a

1a recipient received retroactive eligibility, claims must be
2filed within 180 days after the Department determines the
3applicant is eligible. For claims for which the Illinois
4Department is not the primary payer, claims must be submitted
5to the Illinois Department within 180 days after the final
6adjudication by the primary payer.
7    In the case of long term care facilities, within 5 days of
8receipt by the facility of required prescreening information,
9data for new admissions shall be entered into the Medical
10Electronic Data Interchange (MEDI) or the Recipient
11Eligibility Verification (REV) System or successor system, and
12within 15 days of receipt by the facility of required
13prescreening information, admission documents shall be
14submitted through MEDI or REV or shall be submitted directly to
15the Department of Human Services using required admission
16forms. Effective September 1, 2014, admission documents,
17including all prescreening information, must be submitted
18through MEDI or REV. Confirmation numbers assigned to an
19accepted transaction shall be retained by a facility to verify
20timely submittal. Once an admission transaction has been
21completed, all resubmitted claims following prior rejection
22are subject to receipt no later than 180 days after the
23admission transaction has been completed.
24    Claims that are not submitted and received in compliance
25with the foregoing requirements shall not be eligible for
26payment under the medical assistance program, and the State

 

 

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1shall have no liability for payment of those claims.
2    To the extent consistent with applicable information and
3privacy, security, and disclosure laws, State and federal
4agencies and departments shall provide the Illinois Department
5access to confidential and other information and data necessary
6to perform eligibility and payment verifications and other
7Illinois Department functions. This includes, but is not
8limited to: information pertaining to licensure;
9certification; earnings; immigration status; citizenship; wage
10reporting; unearned and earned income; pension income;
11employment; supplemental security income; social security
12numbers; National Provider Identifier (NPI) numbers; the
13National Practitioner Data Bank (NPDB); program and agency
14exclusions; taxpayer identification numbers; tax delinquency;
15corporate information; and death records.
16    The Illinois Department shall enter into agreements with
17State agencies and departments, and is authorized to enter into
18agreements with federal agencies and departments, under which
19such agencies and departments shall share data necessary for
20medical assistance program integrity functions and oversight.
21The Illinois Department shall develop, in cooperation with
22other State departments and agencies, and in compliance with
23applicable federal laws and regulations, appropriate and
24effective methods to share such data. At a minimum, and to the
25extent necessary to provide data sharing, the Illinois
26Department shall enter into agreements with State agencies and

 

 

10000HB0238sam001- 52 -LRB100 00066 KTG 27369 a

1departments, and is authorized to enter into agreements with
2federal agencies and departments, including but not limited to:
3the Secretary of State; the Department of Revenue; the
4Department of Public Health; the Department of Human Services;
5and the Department of Financial and Professional Regulation.
6    Beginning in fiscal year 2013, the Illinois Department
7shall set forth a request for information to identify the
8benefits of a pre-payment, post-adjudication, and post-edit
9claims system with the goals of streamlining claims processing
10and provider reimbursement, reducing the number of pending or
11rejected claims, and helping to ensure a more transparent
12adjudication process through the utilization of: (i) provider
13data verification and provider screening technology; and (ii)
14clinical code editing; and (iii) pre-pay, pre- or
15post-adjudicated predictive modeling with an integrated case
16management system with link analysis. Such a request for
17information shall not be considered as a request for proposal
18or as an obligation on the part of the Illinois Department to
19take any action or acquire any products or services.
20    The Illinois Department shall establish policies,
21procedures, standards and criteria by rule for the acquisition,
22repair and replacement of orthotic and prosthetic devices and
23durable medical equipment. Such rules shall provide, but not be
24limited to, the following services: (1) immediate repair or
25replacement of such devices by recipients; and (2) rental,
26lease, purchase or lease-purchase of durable medical equipment

 

 

10000HB0238sam001- 53 -LRB100 00066 KTG 27369 a

1in a cost-effective manner, taking into consideration the
2recipient's medical prognosis, the extent of the recipient's
3needs, and the requirements and costs for maintaining such
4equipment. Subject to prior approval, such rules shall enable a
5recipient to temporarily acquire and use alternative or
6substitute devices or equipment pending repairs or
7replacements of any device or equipment previously authorized
8for such recipient by the Department. Notwithstanding any
9provision of Section 5-5f to the contrary, the Department may,
10by rule, exempt certain replacement wheelchair parts from prior
11approval and, for wheelchairs, wheelchair parts, wheelchair
12accessories, and related seating and positioning items,
13determine the wholesale price by methods other than actual
14acquisition costs.
15    The Department shall require, by rule, all providers of
16durable medical equipment to be accredited by an accreditation
17organization approved by the federal Centers for Medicare and
18Medicaid Services and recognized by the Department in order to
19bill the Department for providing durable medical equipment to
20recipients. No later than 15 months after the effective date of
21the rule adopted pursuant to this paragraph, all providers must
22meet the accreditation requirement.
23    The Department shall execute, relative to the nursing home
24prescreening project, written inter-agency agreements with the
25Department of Human Services and the Department on Aging, to
26effect the following: (i) intake procedures and common

 

 

10000HB0238sam001- 54 -LRB100 00066 KTG 27369 a

1eligibility criteria for those persons who are receiving
2non-institutional services; and (ii) the establishment and
3development of non-institutional services in areas of the State
4where they are not currently available or are undeveloped; and
5(iii) notwithstanding any other provision of law, subject to
6federal approval, on and after July 1, 2012, an increase in the
7determination of need (DON) scores from 29 to 37 for applicants
8for institutional and home and community-based long term care;
9if and only if federal approval is not granted, the Department
10may, in conjunction with other affected agencies, implement
11utilization controls or changes in benefit packages to
12effectuate a similar savings amount for this population; and
13(iv) no later than July 1, 2013, minimum level of care
14eligibility criteria for institutional and home and
15community-based long term care; and (iv) (v) no later than
16October 1, 2013, establish procedures to permit long term care
17providers access to eligibility scores for individuals with an
18admission date who are seeking or receiving services from the
19long term care provider. In order to select the minimum level
20of care eligibility criteria, the Governor shall establish a
21workgroup that includes affected agency representatives and
22stakeholders representing the institutional and home and
23community-based long term care interests. This Section shall
24not restrict the Department from implementing lower level of
25care eligibility criteria for community-based services in
26circumstances where federal approval has been granted.

 

 

10000HB0238sam001- 55 -LRB100 00066 KTG 27369 a

1Individuals with a score of 29 or higher based on the
2determination of need (DON) assessment tool shall be eligible
3to receive institutional and home and community-based long term
4care services until the State receives federal approval and
5implements an updated assessment tool, and those individuals
6are found to be ineligible under that updated assessment tool.
7Anyone determined to be ineligible for services due to the
8updated assessment tool shall continue to be eligible for
9services for at least one year following that determination and
10must be reassessed no earlier than 11 months after that
11determination. The Department must adopt rules through the
12regular rulemaking process regarding the updated assessment
13tool, and shall not adopt emergency or peremptory rules
14regarding the updated assessment tool. The State shall not
15implement an updated assessment tool that causes more than 1%
16of then-current recipients to lose eligibility. No individual
17receiving care in an institutional setting shall be
18involuntarily discharged as the result of the updated
19assessment tool until a transition plan has been developed by
20the Department on Aging or its designee and all care identified
21in the transition plan is available to the resident immediately
22upon discharge.
23    The Illinois Department shall develop and operate, in
24cooperation with other State Departments and agencies and in
25compliance with applicable federal laws and regulations,
26appropriate and effective systems of health care evaluation and

 

 

10000HB0238sam001- 56 -LRB100 00066 KTG 27369 a

1programs for monitoring of utilization of health care services
2and facilities, as it affects persons eligible for medical
3assistance under this Code.
4    The Illinois Department shall report annually to the
5General Assembly, no later than the second Friday in April of
61979 and each year thereafter, in regard to:
7        (a) actual statistics and trends in utilization of
8    medical services by public aid recipients;
9        (b) actual statistics and trends in the provision of
10    the various medical services by medical vendors;
11        (c) current rate structures and proposed changes in
12    those rate structures for the various medical vendors; and
13        (d) efforts at utilization review and control by the
14    Illinois Department.
15    The period covered by each report shall be the 3 years
16ending on the June 30 prior to the report. The report shall
17include suggested legislation for consideration by the General
18Assembly. The filing of one copy of the report with the
19Speaker, one copy with the Minority Leader and one copy with
20the Clerk of the House of Representatives, one copy with the
21President, one copy with the Minority Leader and one copy with
22the Secretary of the Senate, one copy with the Legislative
23Research Unit, and such additional copies with the State
24Government Report Distribution Center for the General Assembly
25as is required under paragraph (t) of Section 7 of the State
26Library Act shall be deemed sufficient to comply with this

 

 

10000HB0238sam001- 57 -LRB100 00066 KTG 27369 a

1Section.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8    On and after July 1, 2012, the Department shall reduce any
9rate of reimbursement for services or other payments or alter
10any methodologies authorized by this Code to reduce any rate of
11reimbursement for services or other payments in accordance with
12Section 5-5e.
13    Because kidney transplantation can be an appropriate, cost
14effective alternative to renal dialysis when medically
15necessary and notwithstanding the provisions of Section 1-11 of
16this Code, beginning October 1, 2014, the Department shall
17cover kidney transplantation for noncitizens with end-stage
18renal disease who are not eligible for comprehensive medical
19benefits, who meet the residency requirements of Section 5-3 of
20this Code, and who would otherwise meet the financial
21requirements of the appropriate class of eligible persons under
22Section 5-2 of this Code. To qualify for coverage of kidney
23transplantation, such person must be receiving emergency renal
24dialysis services covered by the Department. Providers under
25this Section shall be prior approved and certified by the
26Department to perform kidney transplantation and the services

 

 

10000HB0238sam001- 58 -LRB100 00066 KTG 27369 a

1under this Section shall be limited to services associated with
2kidney transplantation.
3    Notwithstanding any other provision of this Code to the
4contrary, on or after July 1, 2015, all FDA approved forms of
5medication assisted treatment prescribed for the treatment of
6alcohol dependence or treatment of opioid dependence shall be
7covered under both fee for service and managed care medical
8assistance programs for persons who are otherwise eligible for
9medical assistance under this Article and shall not be subject
10to any (1) utilization control, other than those established
11under the American Society of Addiction Medicine patient
12placement criteria, (2) prior authorization mandate, or (3)
13lifetime restriction limit mandate.
14    On or after July 1, 2015, opioid antagonists prescribed for
15the treatment of an opioid overdose, including the medication
16product, administration devices, and any pharmacy fees related
17to the dispensing and administration of the opioid antagonist,
18shall be covered under the medical assistance program for
19persons who are otherwise eligible for medical assistance under
20this Article. As used in this Section, "opioid antagonist"
21means a drug that binds to opioid receptors and blocks or
22inhibits the effect of opioids acting on those receptors,
23including, but not limited to, naloxone hydrochloride or any
24other similarly acting drug approved by the U.S. Food and Drug
25Administration.
26    Upon federal approval, the Department shall provide

 

 

10000HB0238sam001- 59 -LRB100 00066 KTG 27369 a

1coverage and reimbursement for all drugs that are approved for
2marketing by the federal Food and Drug Administration and that
3are recommended by the federal Public Health Service or the
4United States Centers for Disease Control and Prevention for
5pre-exposure prophylaxis and related pre-exposure prophylaxis
6services, including, but not limited to, HIV and sexually
7transmitted infection screening, treatment for sexually
8transmitted infections, medical monitoring, assorted labs, and
9counseling to reduce the likelihood of HIV infection among
10individuals who are not infected with HIV but who are at high
11risk of HIV infection.
12(Source: P.A. 98-104, Article 9, Section 9-5, eff. 7-22-13;
1398-104, Article 12, Section 12-20, eff. 7-22-13; 98-303, eff.
148-9-13; 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 98-756,
15eff. 7-16-14; 98-963, eff. 8-15-14; 99-78, eff. 7-20-15;
1699-180, eff. 7-29-15; 99-236, eff. 8-3-15; 99-407 (see Section
1720 of P.A. 99-588 for the effective date of P.A. 99-407);
1899-433, eff. 8-21-15; 99-480, eff. 9-9-15; 99-588, eff.
197-20-16; 99-642, eff. 7-28-16; 99-772, eff. 1-1-17; 99-895,
20eff. 1-1-17; revised 9-20-16.)
 
21    (305 ILCS 5/5-5.01a)
22    Sec. 5-5.01a. Supportive living facilities program. The
23Department shall establish and provide oversight for a program
24of supportive living facilities that seek to promote resident
25independence, dignity, respect, and well-being in the most

 

 

10000HB0238sam001- 60 -LRB100 00066 KTG 27369 a

1cost-effective manner.
2    A supportive living facility is either a free-standing
3facility or a distinct physical and operational entity within a
4nursing facility. A supportive living facility integrates
5housing with health, personal care, and supportive services and
6is a designated setting that offers residents their own
7separate, private, and distinct living units.
8    Sites for the operation of the program shall be selected by
9the Department based upon criteria that may include the need
10for services in a geographic area, the availability of funding,
11and the site's ability to meet the standards.
12    Beginning July 1, 2014, subject to federal approval, the
13Medicaid rates for supportive living facilities shall be equal
14to the supportive living facility Medicaid rate effective on
15June 30, 2014 increased by 8.85%. Once the assessment imposed
16at Article V-G of this Code is determined to be a permissible
17tax under Title XIX of the Social Security Act, the Department
18shall increase the Medicaid rates for supportive living
19facilities effective on July 1, 2014 by 9.09%. The Department
20shall apply this increase retroactively to coincide with the
21imposition of the assessment in Article V-G of this Code in
22accordance with the approval for federal financial
23participation by the Centers for Medicare and Medicaid
24Services.
25    The Department may adopt rules to implement this Section.
26Rules that establish or modify the services, standards, and

 

 

10000HB0238sam001- 61 -LRB100 00066 KTG 27369 a

1conditions for participation in the program shall be adopted by
2the Department in consultation with the Department on Aging,
3the Department of Rehabilitation Services, and the Department
4of Mental Health and Developmental Disabilities (or their
5successor agencies).
6    Facilities or distinct parts of facilities which are
7selected as supportive living facilities and are in good
8standing with the Department's rules are exempt from the
9provisions of the Nursing Home Care Act and the Illinois Health
10Facilities Planning Act.
11    Individuals with a score of 29 or higher based on the
12determination of need (DON) assessment tool shall be eligible
13to receive institutional and home and community-based long term
14care services until the State receives federal approval and
15implements an updated assessment tool, and those individuals
16are found to be ineligible under that updated assessment tool.
17Anyone determined to be ineligible for services due to the
18updated assessment tool shall continue to be eligible for
19services for at least one year following that determination and
20must be reassessed no earlier than 11 months after that
21determination. The Department must adopt rules through the
22regular rulemaking process regarding the updated assessment
23tool, and shall not adopt emergency or peremptory rules
24regarding the updated assessment tool. The State shall not
25implement an updated assessment tool that causes more than 1%
26of then-current recipients to lose eligibility. No individual

 

 

10000HB0238sam001- 62 -LRB100 00066 KTG 27369 a

1receiving care in an institutional setting shall be
2involuntarily discharged as the result of the updated
3assessment tool until a transition plan has been developed by
4the Department on Aging or its designee and all care identified
5in the transition plan is available to the resident immediately
6upon discharge.
7(Source: P.A. 98-651, eff. 6-16-14.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.".