Sen. Kwame Raoul

Filed: 5/21/2012

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 5007

2    AMENDMENT NO. ______. Amend House Bill 5007 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-1.4, 5-2.03, 5-2, 15-1, 15-2, 15-5, and
615-11 as follows:
 
7    (305 ILCS 5/5-1.4)
8    Sec. 5-1.4. Moratorium on eligibility expansions.
9Beginning on the effective date of this amendatory Act of the
1096th General Assembly, there shall be a 2-year moratorium on
11the expansion of eligibility through increasing financial
12eligibility standards, or through increasing income
13disregards, or through the creation of new programs which would
14add new categories of eligible individuals under the medical
15assistance program in addition to those categories covered on
16January 1, 2011. This moratorium shall not apply to expansions

 

 

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1required as a federal condition of State participation in the
2medical assistance program or to expansions approved by the
3federal government that are financed entirely by units of local
4government and federal matching funds. If the State of Illinois
5finds that the State has borne a cost related to such an
6expansion, the unit of local government shall reimburse the
7State. All federal funds associated with an expansion funded by
8a unit of local government shall be returned to the local
9government entity funding the expansion, pursuant to an
10intergovernmental agreement between the Department of
11Healthcare and Family Services and the local government entity.
12Within 10 calendar days of the effective date of this
13amendatory Act of the 97th General Assembly, the Department of
14Healthcare and Family Services shall formally advise the
15Centers for Medicare and Medicaid Services of the passage of
16this amendatory Act of the 97th General Assembly. The State is
17prohibited from submitting additional waiver requests that
18expand or allow for an increase in the classes of persons
19eligible for medical assistance under this Article to the
20federal government for its consideration beginning on the 20th
21calendar day following the effective date of this amendatory
22Act of the 97th General Assembly until January 25, 2013.
23(Source: P.A. 96-1501, eff. 1-25-11.)
 
24    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
25    Sec. 5-2. Classes of Persons Eligible. Medical assistance

 

 

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1under this Article shall be available to any of the following
2classes of persons in respect to whom a plan for coverage has
3been submitted to the Governor by the Illinois Department and
4approved by him:
5        1. Recipients of basic maintenance grants under
6    Articles III and IV.
7        2. Persons otherwise eligible for basic maintenance
8    under Articles III and IV, excluding any eligibility
9    requirements that are inconsistent with any federal law or
10    federal regulation, as interpreted by the U.S. Department
11    of Health and Human Services, but who fail to qualify
12    thereunder on the basis of need or who qualify but are not
13    receiving basic maintenance under Article IV, and who have
14    insufficient income and resources to meet the costs of
15    necessary medical care, including but not limited to the
16    following:
17            (a) All persons otherwise eligible for basic
18        maintenance under Article III but who fail to qualify
19        under that Article on the basis of need and who meet
20        either of the following requirements:
21                (i) their income, as determined by the
22            Illinois Department in accordance with any federal
23            requirements, is equal to or less than 70% in
24            fiscal year 2001, equal to or less than 85% in
25            fiscal year 2002 and until a date to be determined
26            by the Department by rule, and equal to or less

 

 

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1            than 100% beginning on the date determined by the
2            Department by rule, of the nonfarm income official
3            poverty line, as defined by the federal Office of
4            Management and Budget and revised annually in
5            accordance with Section 673(2) of the Omnibus
6            Budget Reconciliation Act of 1981, applicable to
7            families of the same size; or
8                (ii) their income, after the deduction of
9            costs incurred for medical care and for other types
10            of remedial care, is equal to or less than 70% in
11            fiscal year 2001, equal to or less than 85% in
12            fiscal year 2002 and until a date to be determined
13            by the Department by rule, and equal to or less
14            than 100% beginning on the date determined by the
15            Department by rule, of the nonfarm income official
16            poverty line, as defined in item (i) of this
17            subparagraph (a).
18            (b) All persons who, excluding any eligibility
19        requirements that are inconsistent with any federal
20        law or federal regulation, as interpreted by the U.S.
21        Department of Health and Human Services, would be
22        determined eligible for such basic maintenance under
23        Article IV by disregarding the maximum earned income
24        permitted by federal law.
25        3. Persons who would otherwise qualify for Aid to the
26    Medically Indigent under Article VII.

 

 

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1        4. Persons not eligible under any of the preceding
2    paragraphs who fall sick, are injured, or die, not having
3    sufficient money, property or other resources to meet the
4    costs of necessary medical care or funeral and burial
5    expenses.
6        5.(a) Women during pregnancy, after the fact of
7    pregnancy has been determined by medical diagnosis, and
8    during the 60-day period beginning on the last day of the
9    pregnancy, together with their infants and children born
10    after September 30, 1983, whose income and resources are
11    insufficient to meet the costs of necessary medical care to
12    the maximum extent possible under Title XIX of the Federal
13    Social Security Act.
14        (b) The Illinois Department and the Governor shall
15    provide a plan for coverage of the persons eligible under
16    paragraph 5(a) by April 1, 1990. Such plan shall provide
17    ambulatory prenatal care to pregnant women during a
18    presumptive eligibility period and establish an income
19    eligibility standard that is equal to 133% of the nonfarm
20    income official poverty line, as defined by the federal
21    Office of Management and Budget and revised annually in
22    accordance with Section 673(2) of the Omnibus Budget
23    Reconciliation Act of 1981, applicable to families of the
24    same size, provided that costs incurred for medical care
25    are not taken into account in determining such income
26    eligibility.

 

 

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1        (c) The Illinois Department may conduct a
2    demonstration in at least one county that will provide
3    medical assistance to pregnant women, together with their
4    infants and children up to one year of age, where the
5    income eligibility standard is set up to 185% of the
6    nonfarm income official poverty line, as defined by the
7    federal Office of Management and Budget. The Illinois
8    Department shall seek and obtain necessary authorization
9    provided under federal law to implement such a
10    demonstration. Such demonstration may establish resource
11    standards that are not more restrictive than those
12    established under Article IV of this Code.
13        6. Persons under the age of 18 who fail to qualify as
14    dependent under Article IV and who have insufficient income
15    and resources to meet the costs of necessary medical care
16    to the maximum extent permitted under Title XIX of the
17    Federal Social Security Act.
18        7. Persons who are under 21 years of age and would
19    qualify as disabled as defined under the Federal
20    Supplemental Security Income Program, provided medical
21    service for such persons would be eligible for Federal
22    Financial Participation, and provided the Illinois
23    Department determines that:
24            (a) the person requires a level of care provided by
25        a hospital, skilled nursing facility, or intermediate
26        care facility, as determined by a physician licensed to

 

 

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1        practice medicine in all its branches;
2            (b) it is appropriate to provide such care outside
3        of an institution, as determined by a physician
4        licensed to practice medicine in all its branches;
5            (c) the estimated amount which would be expended
6        for care outside the institution is not greater than
7        the estimated amount which would be expended in an
8        institution.
9        8. Persons who become ineligible for basic maintenance
10    assistance under Article IV of this Code in programs
11    administered by the Illinois Department due to employment
12    earnings and persons in assistance units comprised of
13    adults and children who become ineligible for basic
14    maintenance assistance under Article VI of this Code due to
15    employment earnings. The plan for coverage for this class
16    of persons shall:
17            (a) extend the medical assistance coverage for up
18        to 12 months following termination of basic
19        maintenance assistance; and
20            (b) offer persons who have initially received 6
21        months of the coverage provided in paragraph (a) above,
22        the option of receiving an additional 6 months of
23        coverage, subject to the following:
24                (i) such coverage shall be pursuant to
25            provisions of the federal Social Security Act;
26                (ii) such coverage shall include all services

 

 

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1            covered while the person was eligible for basic
2            maintenance assistance;
3                (iii) no premium shall be charged for such
4            coverage; and
5                (iv) such coverage shall be suspended in the
6            event of a person's failure without good cause to
7            file in a timely fashion reports required for this
8            coverage under the Social Security Act and
9            coverage shall be reinstated upon the filing of
10            such reports if the person remains otherwise
11            eligible.
12        9. Persons with acquired immunodeficiency syndrome
13    (AIDS) or with AIDS-related conditions with respect to whom
14    there has been a determination that but for home or
15    community-based services such individuals would require
16    the level of care provided in an inpatient hospital,
17    skilled nursing facility or intermediate care facility the
18    cost of which is reimbursed under this Article. Assistance
19    shall be provided to such persons to the maximum extent
20    permitted under Title XIX of the Federal Social Security
21    Act.
22        10. Participants in the long-term care insurance
23    partnership program established under the Illinois
24    Long-Term Care Partnership Program Act who meet the
25    qualifications for protection of resources described in
26    Section 15 of that Act.

 

 

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1        11. Persons with disabilities who are employed and
2    eligible for Medicaid, pursuant to Section
3    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
4    subject to federal approval, persons with a medically
5    improved disability who are employed and eligible for
6    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
7    the Social Security Act, as provided by the Illinois
8    Department by rule. In establishing eligibility standards
9    under this paragraph 11, the Department shall, subject to
10    federal approval:
11            (a) set the income eligibility standard at not
12        lower than 350% of the federal poverty level;
13            (b) exempt retirement accounts that the person
14        cannot access without penalty before the age of 59 1/2,
15        and medical savings accounts established pursuant to
16        26 U.S.C. 220;
17            (c) allow non-exempt assets up to $25,000 as to
18        those assets accumulated during periods of eligibility
19        under this paragraph 11; and
20            (d) continue to apply subparagraphs (b) and (c) in
21        determining the eligibility of the person under this
22        Article even if the person loses eligibility under this
23        paragraph 11.
24        12. Subject to federal approval, persons who are
25    eligible for medical assistance coverage under applicable
26    provisions of the federal Social Security Act and the

 

 

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1    federal Breast and Cervical Cancer Prevention and
2    Treatment Act of 2000. Those eligible persons are defined
3    to include, but not be limited to, the following persons:
4            (1) persons who have been screened for breast or
5        cervical cancer under the U.S. Centers for Disease
6        Control and Prevention Breast and Cervical Cancer
7        Program established under Title XV of the federal
8        Public Health Services Act in accordance with the
9        requirements of Section 1504 of that Act as
10        administered by the Illinois Department of Public
11        Health; and
12            (2) persons whose screenings under the above
13        program were funded in whole or in part by funds
14        appropriated to the Illinois Department of Public
15        Health for breast or cervical cancer screening.
16        "Medical assistance" under this paragraph 12 shall be
17    identical to the benefits provided under the State's
18    approved plan under Title XIX of the Social Security Act.
19    The Department must request federal approval of the
20    coverage under this paragraph 12 within 30 days after the
21    effective date of this amendatory Act of the 92nd General
22    Assembly.
23        In addition to the persons who are eligible for medical
24    assistance pursuant to subparagraphs (1) and (2) of this
25    paragraph 12, and to be paid from funds appropriated to the
26    Department for its medical programs, any uninsured person

 

 

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1    as defined by the Department in rules residing in Illinois
2    who is younger than 65 years of age, who has been screened
3    for breast and cervical cancer in accordance with standards
4    and procedures adopted by the Department of Public Health
5    for screening, and who is referred to the Department by the
6    Department of Public Health as being in need of treatment
7    for breast or cervical cancer is eligible for medical
8    assistance benefits that are consistent with the benefits
9    provided to those persons described in subparagraphs (1)
10    and (2). Medical assistance coverage for the persons who
11    are eligible under the preceding sentence is not dependent
12    on federal approval, but federal moneys may be used to pay
13    for services provided under that coverage upon federal
14    approval.
15        13. Subject to appropriation and to federal approval,
16    persons living with HIV/AIDS who are not otherwise eligible
17    under this Article and who qualify for services covered
18    under Section 5-5.04 as provided by the Illinois Department
19    by rule.
20        14. Subject to the availability of funds for this
21    purpose, the Department may provide coverage under this
22    Article to persons who reside in Illinois who are not
23    eligible under any of the preceding paragraphs and who meet
24    the income guidelines of paragraph 2(a) of this Section and
25    (i) have an application for asylum pending before the
26    federal Department of Homeland Security or on appeal before

 

 

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1    a court of competent jurisdiction and are represented
2    either by counsel or by an advocate accredited by the
3    federal Department of Homeland Security and employed by a
4    not-for-profit organization in regard to that application
5    or appeal, or (ii) are receiving services through a
6    federally funded torture treatment center. Medical
7    coverage under this paragraph 14 may be provided for up to
8    24 continuous months from the initial eligibility date so
9    long as an individual continues to satisfy the criteria of
10    this paragraph 14. If an individual has an appeal pending
11    regarding an application for asylum before the Department
12    of Homeland Security, eligibility under this paragraph 14
13    may be extended until a final decision is rendered on the
14    appeal. The Department may adopt rules governing the
15    implementation of this paragraph 14.
16        15. Family Care Eligibility.
17            (a) Through December 31, 2013, a caretaker
18        relative who is 19 years of age or older when countable
19        income is at or below 185% of the Federal Poverty Level
20        Guidelines, as published annually in the Federal
21        Register, for the appropriate family size. Beginning
22        January 1, 2014, a caretaker relative who is 19 years
23        of age or older when countable income is at or below
24        133% of the Federal Poverty Level Guidelines, as
25        published annually in the Federal Register, for the
26        appropriate family size. A person may not spend down to

 

 

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1        become eligible under this paragraph 15.
2            (b) Eligibility shall be reviewed annually.
3            (c) Caretaker relatives enrolled under this
4        paragraph 15 in families with countable income above
5        150% and at or below 185% of the Federal Poverty Level
6        Guidelines shall be counted as family members and pay
7        premiums as established under the Children's Health
8        Insurance Program Act.
9            (d) Premiums shall be billed by and payable to the
10        Department or its authorized agent, on a monthly basis.
11            (e) The premium due date is the last day of the
12        month preceding the month of coverage.
13            (f) Individuals shall have a grace period through
14        60 days of coverage to pay the premium.
15            (g) Failure to pay the full monthly premium by the
16        last day of the grace period shall result in
17        termination of coverage.
18            (h) Partial premium payments shall not be
19        refunded.
20            (i) Following termination of an individual's
21        coverage under this paragraph 15, the following action
22        is required before the individual can be re-enrolled:
23                (1) A new application must be completed and the
24            individual must be determined otherwise eligible.
25                (2) There must be full payment of premiums due
26            under this Code, the Children's Health Insurance

 

 

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1            Program Act, the Covering ALL KIDS Health
2            Insurance Act, or any other healthcare program
3            administered by the Department for periods in
4            which a premium was owed and not paid for the
5            individual.
6                (3) The first month's premium must be paid if
7            there was an unpaid premium on the date the
8            individual's previous coverage was canceled.
9        The Department is authorized to implement the
10    provisions of this amendatory Act of the 95th General
11    Assembly by adopting the medical assistance rules in effect
12    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
13    89 Ill. Admin. Code 120.32 along with only those changes
14    necessary to conform to federal Medicaid requirements,
15    federal laws, and federal regulations, including but not
16    limited to Section 1931 of the Social Security Act (42
17    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
18    of Health and Human Services, and the countable income
19    eligibility standard authorized by this paragraph 15. The
20    Department may not otherwise adopt any rule to implement
21    this increase except as authorized by law, to meet the
22    eligibility standards authorized by the federal government
23    in the Medicaid State Plan or the Title XXI Plan, or to
24    meet an order from the federal government or any court.
25        16. Subject to appropriation, uninsured persons who
26    are not otherwise eligible under this Section who have been

 

 

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1    certified and referred by the Department of Public Health
2    as having been screened and found to need diagnostic
3    evaluation or treatment, or both diagnostic evaluation and
4    treatment, for prostate or testicular cancer. For the
5    purposes of this paragraph 16, uninsured persons are those
6    who do not have creditable coverage, as defined under the
7    Health Insurance Portability and Accountability Act, or
8    have otherwise exhausted any insurance benefits they may
9    have had, for prostate or testicular cancer diagnostic
10    evaluation or treatment, or both diagnostic evaluation and
11    treatment. To be eligible, a person must furnish a Social
12    Security number. A person's assets are exempt from
13    consideration in determining eligibility under this
14    paragraph 16. Such persons shall be eligible for medical
15    assistance under this paragraph 16 for so long as they need
16    treatment for the cancer. A person shall be considered to
17    need treatment if, in the opinion of the person's treating
18    physician, the person requires therapy directed toward
19    cure or palliation of prostate or testicular cancer,
20    including recurrent metastatic cancer that is a known or
21    presumed complication of prostate or testicular cancer and
22    complications resulting from the treatment modalities
23    themselves. Persons who require only routine monitoring
24    services are not considered to need treatment. "Medical
25    assistance" under this paragraph 16 shall be identical to
26    the benefits provided under the State's approved plan under

 

 

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1    Title XIX of the Social Security Act. Notwithstanding any
2    other provision of law, the Department (i) does not have a
3    claim against the estate of a deceased recipient of
4    services under this paragraph 16 and (ii) does not have a
5    lien against any homestead property or other legal or
6    equitable real property interest owned by a recipient of
7    services under this paragraph 16.
8        17. Persons who, pursuant to a waiver approved by the
9    Secretary of the U.S. Department of Health and Human
10    Services, are eligible for medical assistance under Title
11    XIX or XXI of the federal Social Security Act.
12    Notwithstanding any other provision of this Code and
13    consistent with the terms of the approved waiver, the
14    Illinois Department, may by rule:
15            (a) Limit the geographic areas in which the waiver
16        program operates.
17            (b) Determine the scope, quantity, duration, and
18        quality, and the rate and method of reimbursement, of
19        the medical services to be provided, which may differ
20        from those for other classes of persons eligible for
21        assistance under this Article.
22            (c) Restrict the persons' freedom in choice of
23        providers.
24    In implementing the provisions of Public Act 96-20, the
25Department is authorized to adopt only those rules necessary,
26including emergency rules. Nothing in Public Act 96-20 permits

 

 

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1the Department to adopt rules or issue a decision that expands
2eligibility for the FamilyCare Program to a person whose income
3exceeds 185% of the Federal Poverty Level as determined from
4time to time by the U.S. Department of Health and Human
5Services, unless the Department is provided with express
6statutory authority.
7    The Illinois Department and the Governor shall provide a
8plan for coverage of the persons eligible under paragraph 7 as
9soon as possible after July 1, 1984.
10    The eligibility of any such person for medical assistance
11under this Article is not affected by the payment of any grant
12under the Senior Citizens and Disabled Persons Property Tax
13Relief and Pharmaceutical Assistance Act or any distributions
14or items of income described under subparagraph (X) of
15paragraph (2) of subsection (a) of Section 203 of the Illinois
16Income Tax Act. The Department shall by rule establish the
17amounts of assets to be disregarded in determining eligibility
18for medical assistance, which shall at a minimum equal the
19amounts to be disregarded under the Federal Supplemental
20Security Income Program. The amount of assets of a single
21person to be disregarded shall not be less than $2,000, and the
22amount of assets of a married couple to be disregarded shall
23not be less than $3,000.
24    To the extent permitted under federal law, any person found
25guilty of a second violation of Article VIIIA shall be
26ineligible for medical assistance under this Article, as

 

 

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1provided in Section 8A-8.
2    The eligibility of any person for medical assistance under
3this Article shall not be affected by the receipt by the person
4of donations or benefits from fundraisers held for the person
5in cases of serious illness, as long as neither the person nor
6members of the person's family have actual control over the
7donations or benefits or the disbursement of the donations or
8benefits.
9    Notwithstanding any other provision of this Code, if the
10United States Supreme Court holds Title II, Subtitle A, Section
112001(a) of Public Law 111-148 to be unconstitutional, or if a
12holding of Public Law 111-148 makes Medicaid eligibility
13allowed under Section 2001(a) inoperable, the State or a unit
14of local government shall be prohibited from enrolling
15individuals in the Medical Assistance Program as the result of
16federal approval of a State Medicaid waiver on or after the
17effective date of this amendatory Act of the 97th General
18Assembly, and any individuals enrolled in the Medical
19Assistance Program pursuant to eligibility permitted as a
20result of such a State Medicaid waiver shall become immediately
21ineligible.
22    Notwithstanding any other provision of this Code, if an Act
23of Congress that becomes a Public Law eliminates Section
242001(a) of Public Law 111-148, the State or a unit of local
25government shall be prohibited from enrolling individuals in
26the Medical Assistance Program as the result of federal

 

 

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1approval of a State Medicaid waiver on or after the effective
2date of this amendatory Act of the 97th General Assembly, and
3any individuals enrolled in the Medical Assistance Program
4pursuant to eligibility permitted as a result of such a State
5Medicaid waiver shall become immediately ineligible.
6(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
796-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
87-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
9eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
10revised 10-4-11.)
 
11    (305 ILCS 5/5-2.03)
12    Sec. 5-2.03. Presumptive eligibility. Beginning on the
13effective date of this amendatory Act of the 96th General
14Assembly and except where federal law requires presumptive
15eligibility, no adult may be presumed eligible for medical
16assistance under this Code and the Department may not cover any
17service rendered to an adult unless the adult has completed an
18application for benefits, all required verifications have been
19received, and the Department or its designee has found the
20adult eligible for the date on which that service was provided.
21Nothing in this Section shall apply to pregnant women or to
22persons enrolled under the medical assistance program due to
23expansions approved by the federal government that are financed
24entirely by units of local government and federal matching
25funds.

 

 

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1(Source: P.A. 96-1501, eff. 1-25-11.)
 
2    (305 ILCS 5/15-1)  (from Ch. 23, par. 15-1)
3    Sec. 15-1. Definitions. As used in this Article, unless the
4context requires otherwise:
5    (a) (Blank). "Base amount" means $108,800,000 multiplied
6by a fraction, the numerator of which is the number of days
7represented by the payments in question and the denominator of
8which is 365.
9    (a-5) "County provider" means a health care provider that
10is, or is operated by, a county with a population greater than
113,000,000.
12    (b) "Fund" means the County Provider Trust Fund.
13    (c) "Hospital" or "County hospital" means a hospital, as
14defined in Section 14-1 of this Code, which is a county
15hospital located in a county of over 3,000,000 population.
16(Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
 
17    (305 ILCS 5/15-2)  (from Ch. 23, par. 15-2)
18    Sec. 15-2. County Provider Trust Fund.
19    (a) There is created in the State Treasury the County
20Provider Trust Fund. Interest earned by the Fund shall be
21credited to the Fund. The Fund shall not be used to replace any
22funds appropriated to the Medicaid program by the General
23Assembly.
24    (b) The Fund is created solely for the purposes of

 

 

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1receiving, investing, and distributing monies in accordance
2with this Article XV. The Fund shall consist of:
3        (1) All monies collected or received by the Illinois
4    Department under Section 15-3 of this Code;
5        (2) All federal financial participation monies
6    received by the Illinois Department pursuant to Title XIX
7    of the Social Security Act, 42 U.S.C. 1396b, attributable
8    to eligible expenditures made by the Illinois Department
9    pursuant to Section 15-5 of this Code;
10        (3) All federal moneys received by the Illinois
11    Department pursuant to Title XXI of the Social Security Act
12    attributable to eligible expenditures made by the Illinois
13    Department pursuant to Section 15-5 of this Code; and
14        (4) All other monies received by the Fund from any
15    source, including interest thereon.
16    (c) Disbursements from the Fund shall be by warrants drawn
17by the State Comptroller upon receipt of vouchers duly executed
18and certified by the Illinois Department and shall be made
19only:
20        (1) For hospital inpatient care, hospital outpatient
21    care, care provided by other outpatient facilities
22    operated by a county, and disproportionate share hospital
23    adjustment payments made under Title XIX of the Social
24    Security Act and Article V of this Code as required by
25    Section 15-5 of this Code;
26        (1.5) For services provided or purchased by county

 

 

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1    providers pursuant to Section 5-11 of this Code;
2        (2) For the reimbursement of administrative expenses
3    incurred by county providers on behalf of the Illinois
4    Department as permitted by Section 15-4 of this Code;
5        (3) For the reimbursement of monies received by the
6    Fund through error or mistake;
7        (4) For the payment of administrative expenses
8    necessarily incurred by the Illinois Department or its
9    agent in performing the activities required by this Article
10    XV;
11        (5) For the payment of any amounts that are
12    reimbursable to the federal government, attributable
13    solely to the Fund, and required to be paid by State
14    warrant; and
15        (6) For hospital inpatient care, hospital outpatient
16    care, care provided by other outpatient facilities
17    operated by a county, and disproportionate share hospital
18    adjustment payments made under Title XXI of the Social
19    Security Act, pursuant to Section 15-5 of this Code.
20        (7) For medical care and related services provided
21    pursuant to a contract with a county.
22(Source: P.A. 95-859, eff. 8-19-08.)
 
23    (305 ILCS 5/15-5)  (from Ch. 23, par. 15-5)
24    Sec. 15-5. Disbursements from the Fund.
25    (a) The monies in the Fund shall be disbursed only as

 

 

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1provided in Section 15-2 of this Code and as follows:
2        (1) To the extent that such costs are reimbursable
3    under federal law, to pay the county hospitals' inpatient
4    reimbursement rates based on actual costs incurred,
5    trended forward annually by an inflation index.
6        (2) To the extent that such costs are reimbursable
7    under federal law, to pay county hospitals and county
8    operated outpatient facilities for outpatient services
9    based on a federally approved methodology to cover the
10    maximum allowable costs.
11        (3) To pay the county hospitals disproportionate share
12    hospital adjustment payments as may be specified in the
13    Illinois Title XIX State plan.
14        (3.5) To pay county providers for services provided or
15    purchased pursuant to Section 5-11 of this Code.
16        (4) To reimburse the county providers for expenses
17    contractually assumed pursuant to Section 15-4 of this
18    Code.
19        (5) To pay the Illinois Department its necessary
20    administrative expenses relative to the Fund and other
21    amounts agreed to, if any, by the county providers in the
22    agreement provided for in subsection (c).
23        (6) To pay the county providers any other amount due
24    according to a federally approved State plan, including but
25    not limited to payments made under the provisions of
26    Section 701(d)(3)(B) of the federal Medicare, Medicaid,

 

 

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1    and SCHIP Benefits Improvement and Protection Act of 2000.
2    Intergovernmental transfers supporting payments under this
3    paragraph (6) shall not be subject to the computation
4    described in subsection (a) of Section 15-3 of this Code,
5    but shall be computed as the difference between the total
6    of such payments made by the Illinois Department to county
7    providers less any amount of federal financial
8    participation due the Illinois Department under Titles XIX
9    and XXI of the Social Security Act as a result of such
10    payments to county providers.
11    (b) The Illinois Department shall promptly seek all
12appropriate amendments to the Illinois Title XIX State Plan to
13maximize reimbursement, including disproportionate share
14hospital adjustment payments, to the county providers.
15    (c) (Blank).
16    (d) The payments provided for herein are intended to cover
17services rendered on and after July 1, 1991, and any agreement
18executed between a qualifying county and the Illinois
19Department pursuant to this Section may relate back to that
20date, provided the Illinois Department obtains federal
21approval. Any changes in payment rates resulting from the
22provisions of Article 3 of this amendatory Act of 1992 are
23intended to apply to services rendered on or after October 1,
241992, and any agreement executed between a qualifying county
25and the Illinois Department pursuant to this Section may be
26effective as of that date.

 

 

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1    (e) If one or more hospitals file suit in any court
2challenging any part of this Article XV, payments to hospitals
3from the Fund under this Article XV shall be made only to the
4extent that sufficient monies are available in the Fund and
5only to the extent that any monies in the Fund are not
6prohibited from disbursement and may be disbursed under any
7order of the court.
8    (f) All payments under this Section are contingent upon
9federal approval of changes to the Title XIX State plan, if
10that approval is required.
11(Source: P.A. 95-859, eff. 8-19-08.)
 
12    (305 ILCS 5/15-11)
13    Sec. 15-11. Uses of State funds.
14    (a) At any point, if State revenues referenced in
15subsection (b) or (c) of Section 15-10 or additional State
16grants are disbursed to the Cook County Health and Hospitals
17System, all funds may be used only for the following:
18        (1) medical services provided at hospitals or clinics
19    owned and operated by the Cook County Health and Hospitals
20    System Bureau of Health Services; or
21        (2) information technology to enhance billing
22    capabilities for medical claiming and reimbursement; or .
23        (3) services purchased by county providers pursuant to
24    Section 5-11 of this Code.
25    (b) State funds may not be used for the following:

 

 

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1        (1) non-clinical services, except services that may be
2    required by accreditation bodies or State or federal
3    regulatory or licensing authorities;
4        (2) non-clinical support staff, except as pursuant to
5    paragraph (1) of this subsection; or
6        (3) capital improvements, other than investments in
7    medical technology, except for capital improvements that
8    may be required by accreditation bodies or State or federal
9    regulatory or licensing authorities.
10(Source: P.A. 95-859, eff. 8-19-08.)
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.".