Sen. Kwame Raoul

Filed: 5/22/2012

 

 


 

 


 
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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. If and only if Senate Bill 2840 of the 97th
5General Assembly becomes law, then the State Finance Act is
6amended by changing Section 25 as follows:
 
7    (30 ILCS 105/25)  (from Ch. 127, par. 161)
8    Sec. 25. Fiscal year limitations.
9    (a) All appropriations shall be available for expenditure
10for the fiscal year or for a lesser period if the Act making
11that appropriation so specifies. A deficiency or emergency
12appropriation shall be available for expenditure only through
13June 30 of the year when the Act making that appropriation is
14enacted unless that Act otherwise provides.
15    (b) Outstanding liabilities as of June 30, payable from
16appropriations which have otherwise expired, may be paid out of

 

 

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1the expiring appropriations during the 2-month period ending at
2the close of business on August 31. Any service involving
3professional or artistic skills or any personal services by an
4employee whose compensation is subject to income tax
5withholding must be performed as of June 30 of the fiscal year
6in order to be considered an "outstanding liability as of June
730" that is thereby eligible for payment out of the expiring
8appropriation.
9    (b-1) However, payment of tuition reimbursement claims
10under Section 14-7.03 or 18-3 of the School Code may be made by
11the State Board of Education from its appropriations for those
12respective purposes for any fiscal year, even though the claims
13reimbursed by the payment may be claims attributable to a prior
14fiscal year, and payments may be made at the direction of the
15State Superintendent of Education from the fund from which the
16appropriation is made without regard to any fiscal year
17limitations, except as required by subsection (j) of this
18Section. Beginning on June 30, 2021, payment of tuition
19reimbursement claims under Section 14-7.03 or 18-3 of the
20School Code as of June 30, payable from appropriations that
21have otherwise expired, may be paid out of the expiring
22appropriation during the 4-month period ending at the close of
23business on October 31.
24    (b-2) All outstanding liabilities as of June 30, 2010,
25payable from appropriations that would otherwise expire at the
26conclusion of the lapse period for fiscal year 2010, and

 

 

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1interest penalties payable on those liabilities under the State
2Prompt Payment Act, may be paid out of the expiring
3appropriations until December 31, 2010, without regard to the
4fiscal year in which the payment is made, as long as vouchers
5for the liabilities are received by the Comptroller no later
6than August 31, 2010.
7    (b-2.5) All outstanding liabilities as of June 30, 2011,
8payable from appropriations that would otherwise expire at the
9conclusion of the lapse period for fiscal year 2011, and
10interest penalties payable on those liabilities under the State
11Prompt Payment Act, may be paid out of the expiring
12appropriations until December 31, 2011, without regard to the
13fiscal year in which the payment is made, as long as vouchers
14for the liabilities are received by the Comptroller no later
15than August 31, 2011.
16    (b-3) Medical payments may be made by the Department of
17Veterans' Affairs from its appropriations for those purposes
18for any fiscal year, without regard to the fact that the
19medical services being compensated for by such payment may have
20been rendered in a prior fiscal year, except as required by
21subsection (j) of this Section. Beginning on June 30, 2021,
22medical payments payable from appropriations that have
23otherwise expired may be paid out of the expiring appropriation
24during the 4-month period ending at the close of business on
25October 31.
26    (b-4) Medical payments may be made by the Department of

 

 

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1Healthcare and Family Services and medical payments and child
2care payments may be made by the Department of Human Services
3(as successor to the Department of Public Aid) from
4appropriations for those purposes for any fiscal year, without
5regard to the fact that the medical or child care services
6being compensated for by such payment may have been rendered in
7a prior fiscal year; and payments may be made at the direction
8of the Department of Healthcare and Family Services (or
9successor agency) from the Health Insurance Reserve Fund and
10the Local Government Health Insurance Reserve Fund without
11regard to any fiscal year limitations, except as required by
12subsection (j) of this Section. Beginning on June 30, 2021,
13medical and payments made by the Department of Healthcare and
14Family Services, child care payments made by the Department of
15Human Services, and payments made at the discretion of the
16Department of Healthcare and Family Services (or successor
17agency) from the Health Insurance Reserve Fund and the Local
18Government Health Insurance Reserve Fund payable from
19appropriations that have otherwise expired may be paid out of
20the expiring appropriation during the 4-month period ending at
21the close of business on October 31.
22    (b-5) Medical payments may be made by the Department of
23Human Services from its appropriations relating to substance
24abuse treatment services for any fiscal year, without regard to
25the fact that the medical services being compensated for by
26such payment may have been rendered in a prior fiscal year,

 

 

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1provided the payments are made on a fee-for-service basis
2consistent with requirements established for Medicaid
3reimbursement by the Department of Healthcare and Family
4Services, except as required by subsection (j) of this Section.
5Beginning on June 30, 2021, medical payments made by the
6Department of Human Services relating to substance abuse
7treatment services payable from appropriations that have
8otherwise expired may be paid out of the expiring appropriation
9during the 4-month period ending at the close of business on
10October 31.
11    (b-6) Additionally, payments may be made by the Department
12of Human Services from its appropriations, or any other State
13agency from its appropriations with the approval of the
14Department of Human Services, from the Immigration Reform and
15Control Fund for purposes authorized pursuant to the
16Immigration Reform and Control Act of 1986, without regard to
17any fiscal year limitations, except as required by subsection
18(j) of this Section. Beginning on June 30, 2021, payments made
19by the Department of Human Services from the Immigration Reform
20and Control Fund for purposes authorized pursuant to the
21Immigration Reform and Control Act of 1986 payable from
22appropriations that have otherwise expired may be paid out of
23the expiring appropriation during the 4-month period ending at
24the close of business on October 31.
25    (b-7) Payments may be made in accordance with a plan
26authorized by paragraph (11) or (12) of Section 405-105 of the

 

 

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1Department of Central Management Services Law from
2appropriations for those payments without regard to fiscal year
3limitations.
4    (c) Further, payments may be made by the Department of
5Public Health and , the Department of Human Services (acting as
6successor to the Department of Public Health under the
7Department of Human Services Act), and the Department of
8Healthcare and Family Services from their respective
9appropriations for grants for medical care to or on behalf of
10persons suffering from chronic renal disease, persons
11suffering from hemophilia, rape victims, and premature and
12high-mortality risk infants and their mothers and for grants
13for supplemental food supplies provided under the United States
14Department of Agriculture Women, Infants and Children
15Nutrition Program, for any fiscal year without regard to the
16fact that the services being compensated for by such payment
17may have been rendered in a prior fiscal year, except as
18required by subsection (j) of this Section. Beginning on June
1930, 2021, payments made by the Department of Public Health and
20, the Department of Human Services, and the Department of
21Healthcare and Family Services from their respective
22appropriations for grants for medical care to or on behalf of
23persons suffering from chronic renal disease, persons
24suffering from hemophilia, rape victims, and premature and
25high-mortality risk infants and their mothers and for grants
26for supplemental food supplies provided under the United States

 

 

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1Department of Agriculture Women, Infants and Children
2Nutrition Program payable from appropriations that have
3otherwise expired may be paid out of the expiring
4appropriations during the 4-month period ending at the close of
5business on October 31.
6    (d) The Department of Public Health and the Department of
7Human Services (acting as successor to the Department of Public
8Health under the Department of Human Services Act) shall each
9annually submit to the State Comptroller, Senate President,
10Senate Minority Leader, Speaker of the House, House Minority
11Leader, and the respective Chairmen and Minority Spokesmen of
12the Appropriations Committees of the Senate and the House, on
13or before December 31, a report of fiscal year funds used to
14pay for services provided in any prior fiscal year. This report
15shall document by program or service category those
16expenditures from the most recently completed fiscal year used
17to pay for services provided in prior fiscal years.
18    (e) The Department of Healthcare and Family Services, the
19Department of Human Services (acting as successor to the
20Department of Public Aid), and the Department of Human Services
21making fee-for-service payments relating to substance abuse
22treatment services provided during a previous fiscal year shall
23each annually submit to the State Comptroller, Senate
24President, Senate Minority Leader, Speaker of the House, House
25Minority Leader, the respective Chairmen and Minority
26Spokesmen of the Appropriations Committees of the Senate and

 

 

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1the House, on or before November 30, a report that shall
2document by program or service category those expenditures from
3the most recently completed fiscal year used to pay for (i)
4services provided in prior fiscal years and (ii) services for
5which claims were received in prior fiscal years.
6    (f) The Department of Human Services (as successor to the
7Department of Public Aid) shall annually submit to the State
8Comptroller, Senate President, Senate Minority Leader, Speaker
9of the House, House Minority Leader, and the respective
10Chairmen and Minority Spokesmen of the Appropriations
11Committees of the Senate and the House, on or before December
1231, a report of fiscal year funds used to pay for services
13(other than medical care) provided in any prior fiscal year.
14This report shall document by program or service category those
15expenditures from the most recently completed fiscal year used
16to pay for services provided in prior fiscal years.
17    (g) In addition, each annual report required to be
18submitted by the Department of Healthcare and Family Services
19under subsection (e) shall include the following information
20with respect to the State's Medicaid program:
21        (1) Explanations of the exact causes of the variance
22    between the previous year's estimated and actual
23    liabilities.
24        (2) Factors affecting the Department of Healthcare and
25    Family Services' liabilities, including but not limited to
26    numbers of aid recipients, levels of medical service

 

 

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1    utilization by aid recipients, and inflation in the cost of
2    medical services.
3        (3) The results of the Department's efforts to combat
4    fraud and abuse.
5    (h) As provided in Section 4 of the General Assembly
6Compensation Act, any utility bill for service provided to a
7General Assembly member's district office for a period
8including portions of 2 consecutive fiscal years may be paid
9from funds appropriated for such expenditure in either fiscal
10year.
11    (i) An agency which administers a fund classified by the
12Comptroller as an internal service fund may issue rules for:
13        (1) billing user agencies in advance for payments or
14    authorized inter-fund transfers based on estimated charges
15    for goods or services;
16        (2) issuing credits, refunding through inter-fund
17    transfers, or reducing future inter-fund transfers during
18    the subsequent fiscal year for all user agency payments or
19    authorized inter-fund transfers received during the prior
20    fiscal year which were in excess of the final amounts owed
21    by the user agency for that period; and
22        (3) issuing catch-up billings to user agencies during
23    the subsequent fiscal year for amounts remaining due when
24    payments or authorized inter-fund transfers received from
25    the user agency during the prior fiscal year were less than
26    the total amount owed for that period.

 

 

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1User agencies are authorized to reimburse internal service
2funds for catch-up billings by vouchers drawn against their
3respective appropriations for the fiscal year in which the
4catch-up billing was issued or by increasing an authorized
5inter-fund transfer during the current fiscal year. For the
6purposes of this Act, "inter-fund transfers" means transfers
7without the use of the voucher-warrant process, as authorized
8by Section 9.01 of the State Comptroller Act.
9    (i-1) Beginning on July 1, 2021, all outstanding
10liabilities, not payable during the 4-month lapse period as
11described in subsections (b-1), (b-3), (b-4), (b-5), (b-6), and
12(c) of this Section, that are made from appropriations for that
13purpose for any fiscal year, without regard to the fact that
14the services being compensated for by those payments may have
15been rendered in a prior fiscal year, are limited to only those
16claims that have been incurred but for which a proper bill or
17invoice as defined by the State Prompt Payment Act has not been
18received by September 30th following the end of the fiscal year
19in which the service was rendered.
20    (j) Notwithstanding any other provision of this Act, the
21aggregate amount of payments to be made without regard for
22fiscal year limitations as contained in subsections (b-1),
23(b-3), (b-4), (b-5), (b-6), and (c) of this Section, and
24determined by using Generally Accepted Accounting Principles,
25shall not exceed the following amounts:
26        (1) $6,000,000,000 for outstanding liabilities related

 

 

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1    to fiscal year 2012;
2        (2) $5,300,000,000 for outstanding liabilities related
3    to fiscal year 2013;
4        (3) $4,600,000,000 for outstanding liabilities related
5    to fiscal year 2014;
6        (4) $4,000,000,000 for outstanding liabilities related
7    to fiscal year 2015;
8        (5) $3,300,000,000 for outstanding liabilities related
9    to fiscal year 2016;
10        (6) $2,600,000,000 for outstanding liabilities related
11    to fiscal year 2017;
12        (7) $2,000,000,000 for outstanding liabilities related
13    to fiscal year 2018;
14        (8) $1,300,000,000 for outstanding liabilities related
15    to fiscal year 2019;
16        (9) $600,000,000 for outstanding liabilities related
17    to fiscal year 2020; and
18        (10) $0 for outstanding liabilities related to fiscal
19    year 2021 and fiscal years thereafter.
20    (k) Department of Healthcare and Family Services Medical
21Assistance Payments.
22        (1) Definition of Medical Assistance.
23            For purposes of this subsection, the term "Medical
24        Assistance" shall include, but not necessarily be
25        limited to, medical programs and services authorized
26        under Titles XIX and XXI of the Social Security Act,

 

 

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1        the Illinois Public Aid Code, the Children's Health
2        Insurance Program Act, the Covering ALL KIDS Health
3        Insurance Act, the Long Term Acute Care Hospital
4        Quality Improvement Transfer Program Act, and medical
5        care to or on behalf of persons suffering from chronic
6        renal disease, persons suffering from hemophilia and
7        victims of sexual assault.
8        (2) Limitations on Medical Assistance payments that
9    may be paid from future fiscal year appropriations.
10            (A) The maximum amounts of annual unpaid Medical
11        Assistance bills received and recorded by the
12        Department of Healthcare and Family Services on or
13        before June 30th of a particular fiscal year
14        attributable in aggregate to the General Revenue Fund,
15        Healthcare Provider Relief Fund, Tobacco Settlement
16        Recovery Fund, Long-Term Care Provider Fund, and the
17        Drug Rebate Fund that may be paid in total by the
18        Department from future fiscal year Medical Assistance
19        appropriations to those funds are: $700,000,000 for
20        fiscal year 2013 and $100,000,000 for fiscal year 2014
21        and each fiscal year thereafter.
22            (B) Bills for Medical Assistance services rendered
23        in a particular fiscal year, but received and recorded
24        by the Department of Healthcare and Family Services
25        after June 30th of that fiscal year, may be paid from
26        either appropriations for that fiscal year or future

 

 

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1        fiscal year appropriations for Medical Assistance.
2        Such payments shall not be subject to the requirements
3        of subparagraph (A).
4            (C) Medical Assistance bills received by the
5        Department of Healthcare and Family Services in a
6        particular fiscal year, but subject to payment amount
7        adjustments in a future fiscal year may be paid from a
8        future fiscal year's appropriation for Medical
9        Assistance. Such payments shall not be subject to the
10        requirements of subparagraph (A).
11            (D) Medical Assistance payments made by the
12        Department of Healthcare and Family Services from
13        funds other than those specifically referenced in
14        subparagraph (A) may be made from appropriations for
15        those purposes for any fiscal year without regard to
16        the fact that the Medical Assistance services being
17        compensated for by such payment may have been rendered
18        in a prior fiscal year. Such payments shall not be
19        subject to the requirements of subparagraph (A).
20        (3) Extended lapse period for Department of Healthcare
21    and Family Services Medical Assistance payments.
22    Notwithstanding any other State law to the contrary,
23    outstanding Department of Healthcare and Family Services
24    Medical Assistance liabilities, as of June 30th, payable
25    from appropriations which have otherwise expired, may be
26    paid out of the expiring appropriations during the 6-month

 

 

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1    period ending at the close of business on December 31st.
2    (l) The changes to this Section made by this amendatory Act
3of the 97th General Assembly shall be effective for payment of
4Medical Assistance bills incurred in fiscal year 2013 and
5future fiscal years. The changes to this Section made by this
6amendatory Act of the 97th General Assembly shall not be
7applied to Medical Assistance bills incurred in fiscal year
82012 or prior fiscal years.
9(Source: P.A. 96-928, eff. 6-15-10; 96-958, eff. 7-1-10;
1096-1501, eff. 1-25-11; 97-75, eff. 6-30-11; 97-333, eff.
118-12-11.)
 
12    Section 10. If and only if Senate Bill 2840 of the 97th
13General Assembly becomes law, then the Illinois Public Aid Code
14is amended by changing Sections 5-1.4, 5-2, 5-2.03, 15-1, 15-2,
1515-5, and 15-11 as follows:
 
16    (305 ILCS 5/5-1.4)
17    Sec. 5-1.4. Moratorium on eligibility expansions.
18Beginning on January 25, 2011 (the effective date of Public Act
1996-1501) this amendatory Act of the 96th General Assembly,
20there shall be a 4-year 2-year moratorium on the expansion of
21eligibility through increasing financial eligibility
22standards, or through increasing income disregards, or through
23the creation of new programs which would add new categories of
24eligible individuals under the medical assistance program in

 

 

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1addition to those categories covered on January 1, 2011. This
2moratorium shall not apply to expansions required as a federal
3condition of State participation in the medical assistance
4program or to expansions approved by the federal government
5that are financed entirely by units of local government and
6federal matching funds. If the State of Illinois finds that the
7State has borne a cost related to such an expansion, the unit
8of local government shall reimburse the State. All federal
9funds associated with an expansion funded by a unit of local
10government shall be returned to the local government entity
11funding the expansion, pursuant to an intergovernmental
12agreement between the Department of Healthcare and Family
13Services and the local government entity. Within 10 calendar
14days of the effective date of this amendatory Act of the 97th
15General Assembly, the Department of Healthcare and Family
16Services shall formally advise the Centers for Medicare and
17Medicaid Services of the passage of this amendatory Act of the
1897th General Assembly. The State is prohibited from submitting
19additional waiver requests that expand or allow for an increase
20in the classes of persons eligible for medical assistance under
21this Article to the federal government for its consideration
22beginning on the 20th calendar day following the effective date
23of this amendatory Act of the 97th General Assembly until
24January 25, 2013.
25(Source: P.A. 96-1501, eff. 1-25-11.)
 

 

 

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1    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
2    Sec. 5-2. Classes of Persons Eligible. Medical assistance
3under this Article shall be available to any of the following
4classes of persons in respect to whom a plan for coverage has
5been submitted to the Governor by the Illinois Department and
6approved by him:
7        1. Recipients of basic maintenance grants under
8    Articles III and IV.
9        2. Persons otherwise eligible for basic maintenance
10    under Articles III and IV, excluding any eligibility
11    requirements that are inconsistent with any federal law or
12    federal regulation, as interpreted by the U.S. Department
13    of Health and Human Services, but who fail to qualify
14    thereunder on the basis of need or who qualify but are not
15    receiving basic maintenance under Article IV, and who have
16    insufficient income and resources to meet the costs of
17    necessary medical care, including but not limited to the
18    following:
19            (a) All persons otherwise eligible for basic
20        maintenance under Article III but who fail to qualify
21        under that Article on the basis of need and who meet
22        either of the following requirements:
23                (i) their income, as determined by the
24            Illinois Department in accordance with any federal
25            requirements, is equal to or less than 70% in
26            fiscal year 2001, equal to or less than 85% in

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

09700HB5007sam003- 23 -LRB097 18977 JLS 69999 a

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

 

 

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

 

 

09700HB5007sam003- 25 -LRB097 18977 JLS 69999 a

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

 

 

09700HB5007sam003- 26 -LRB097 18977 JLS 69999 a

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

 

 

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

 

 

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

 

 

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1    assistance" under this paragraph 16 shall be identical to
2    the benefits provided under the State's approved plan under
3    Title XIX of the Social Security Act. Notwithstanding any
4    other provision of law, the Department (i) does not have a
5    claim against the estate of a deceased recipient of
6    services under this paragraph 16 and (ii) does not have a
7    lien against any homestead property or other legal or
8    equitable real property interest owned by a recipient of
9    services under this paragraph 16.
10        17. Persons who, pursuant to a waiver approved by the
11    Secretary of the U.S. Department of Health and Human
12    Services, are eligible for medical assistance under Title
13    XIX or XXI of the federal Social Security Act.
14    Notwithstanding any other provision of this Code and
15    consistent with the terms of the approved waiver, the
16    Illinois Department, may by rule:
17            (a) Limit the geographic areas in which the waiver
18        program operates.
19            (b) Determine the scope, quantity, duration, and
20        quality, and the rate and method of reimbursement, of
21        the medical services to be provided, which may differ
22        from those for other classes of persons eligible for
23        assistance under this Article.
24            (c) Restrict the persons' freedom in choice of
25        providers.
26    In implementing the provisions of Public Act 96-20, the

 

 

09700HB5007sam003- 30 -LRB097 18977 JLS 69999 a

1Department is authorized to adopt only those rules necessary,
2including emergency rules. Nothing in Public Act 96-20 permits
3the Department to adopt rules or issue a decision that expands
4eligibility for the FamilyCare Program to a person whose income
5exceeds 185% of the Federal Poverty Level as determined from
6time to time by the U.S. Department of Health and Human
7Services, unless the Department is provided with express
8statutory authority.
9    The Illinois Department and the Governor shall provide a
10plan for coverage of the persons eligible under paragraph 7 as
11soon as possible after July 1, 1984.
12    The eligibility of any such person for medical assistance
13under this Article is not affected by the payment of any grant
14under the Senior Citizens and Disabled Persons Property Tax
15Relief and Pharmaceutical Assistance Act or any distributions
16or items of income described under subparagraph (X) of
17paragraph (2) of subsection (a) of Section 203 of the Illinois
18Income Tax Act. The Department shall by rule establish the
19amounts of assets to be disregarded in determining eligibility
20for medical assistance, which shall at a minimum equal the
21amounts to be disregarded under the Federal Supplemental
22Security Income Program. The amount of assets of a single
23person to be disregarded shall not be less than $2,000, and the
24amount of assets of a married couple to be disregarded shall
25not be less than $3,000.
26    To the extent permitted under federal law, any person found

 

 

09700HB5007sam003- 31 -LRB097 18977 JLS 69999 a

1guilty of a second violation of Article VIIIA shall be
2ineligible for medical assistance under this Article, as
3provided in Section 8A-8.
4    The eligibility of any person for medical assistance under
5this Article shall not be affected by the receipt by the person
6of donations or benefits from fundraisers held for the person
7in cases of serious illness, as long as neither the person nor
8members of the person's family have actual control over the
9donations or benefits or the disbursement of the donations or
10benefits.
11    Notwithstanding any other provision of this Code, if the
12United States Supreme Court holds Title II, Subtitle A, Section
132001(a) of Public Law 111-148 to be unconstitutional, or if a
14holding of Public Law 111-148 makes Medicaid eligibility
15allowed under Section 2001(a) inoperable, the State or a unit
16of local government shall be prohibited from enrolling
17individuals in the Medical Assistance Program as the result of
18federal approval of a State Medicaid waiver on or after the
19effective date of this amendatory Act of the 97th General
20Assembly, and any individuals enrolled in the Medical
21Assistance Program pursuant to eligibility permitted as a
22result of such a State Medicaid waiver shall become immediately
23ineligible.
24    Notwithstanding any other provision of this Code, if an Act
25of Congress that becomes a Public Law eliminates Section
262001(a) of Public Law 111-148, the State or a unit of local

 

 

09700HB5007sam003- 32 -LRB097 18977 JLS 69999 a

1government shall be prohibited from enrolling individuals in
2the Medical Assistance Program as the result of federal
3approval of a State Medicaid waiver on or after the effective
4date of this amendatory Act of the 97th General Assembly, and
5any individuals enrolled in the Medical Assistance Program
6pursuant to eligibility permitted as a result of such a State
7Medicaid waiver shall become immediately ineligible.
8(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
996-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
107-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
11eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
12revised 10-4-11.)
 
13    (305 ILCS 5/5-2.03)
14    Sec. 5-2.03. Presumptive eligibility. Beginning on the
15effective date of this amendatory Act of the 96th General
16Assembly and except where federal law requires presumptive
17eligibility, no adult may be presumed eligible for medical
18assistance under this Code and the Department may not cover any
19service rendered to an adult unless the adult has completed an
20application for benefits, all required verifications have been
21received, and the Department or its designee has found the
22adult eligible for the date on which that service was provided.
23Nothing in this Section shall apply to pregnant women or to
24persons enrolled under the medical assistance program due to
25expansions approved by the federal government that are financed

 

 

09700HB5007sam003- 33 -LRB097 18977 JLS 69999 a

1entirely by units of local government and federal matching
2funds.
3(Source: P.A. 96-1501, eff. 1-25-11.)
 
4    (305 ILCS 5/15-1)  (from Ch. 23, par. 15-1)
5    Sec. 15-1. Definitions. As used in this Article, unless the
6context requires otherwise:
7    (a) (Blank). "Base amount" means $108,800,000 multiplied
8by a fraction, the numerator of which is the number of days
9represented by the payments in question and the denominator of
10which is 365.
11    (a-5) "County provider" means a health care provider that
12is, or is operated by, a county with a population greater than
133,000,000.
14    (b) "Fund" means the County Provider Trust Fund.
15    (c) "Hospital" or "County hospital" means a hospital, as
16defined in Section 14-1 of this Code, which is a county
17hospital located in a county of over 3,000,000 population.
18(Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
 
19    (305 ILCS 5/15-2)  (from Ch. 23, par. 15-2)
20    Sec. 15-2. County Provider Trust Fund.
21    (a) There is created in the State Treasury the County
22Provider Trust Fund. Interest earned by the Fund shall be
23credited to the Fund. The Fund shall not be used to replace any
24funds appropriated to the Medicaid program by the General

 

 

09700HB5007sam003- 34 -LRB097 18977 JLS 69999 a

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

 

 

09700HB5007sam003- 35 -LRB097 18977 JLS 69999 a

1    Section 15-5 of this Code;
2        (1.5) For services provided or purchased by county
3    providers pursuant to Section 5-11 of this Code;
4        (2) For the reimbursement of administrative expenses
5    incurred by county providers on behalf of the Illinois
6    Department as permitted by Section 15-4 of this Code;
7        (3) For the reimbursement of monies received by the
8    Fund through error or mistake;
9        (4) For the payment of administrative expenses
10    necessarily incurred by the Illinois Department or its
11    agent in performing the activities required by this Article
12    XV;
13        (5) For the payment of any amounts that are
14    reimbursable to the federal government, attributable
15    solely to the Fund, and required to be paid by State
16    warrant; and
17        (6) For hospital inpatient care, hospital outpatient
18    care, care provided by other outpatient facilities
19    operated by a county, and disproportionate share hospital
20    adjustment payments made under Title XXI of the Social
21    Security Act, pursuant to Section 15-5 of this Code.
22        (7) For medical care and related services provided
23    pursuant to a contract with a county.
24(Source: P.A. 95-859, eff. 8-19-08.)
 
25    (305 ILCS 5/15-5)  (from Ch. 23, par. 15-5)

 

 

09700HB5007sam003- 36 -LRB097 18977 JLS 69999 a

1    Sec. 15-5. Disbursements from the Fund.
2    (a) The monies in the Fund shall be disbursed only as
3provided in Section 15-2 of this Code and as follows:
4        (1) To the extent that such costs are reimbursable
5    under federal law, to pay the county hospitals' inpatient
6    reimbursement rates based on actual costs incurred,
7    trended forward annually by an inflation index.
8        (2) To the extent that such costs are reimbursable
9    under federal law, to pay county hospitals and county
10    operated outpatient facilities for outpatient services
11    based on a federally approved methodology to cover the
12    maximum allowable costs.
13        (3) To pay the county hospitals disproportionate share
14    hospital adjustment payments as may be specified in the
15    Illinois Title XIX State plan.
16        (3.5) To pay county providers for services provided or
17    purchased pursuant to Section 5-11 of this Code.
18        (4) To reimburse the county providers for expenses
19    contractually assumed pursuant to Section 15-4 of this
20    Code.
21        (5) To pay the Illinois Department its necessary
22    administrative expenses relative to the Fund and other
23    amounts agreed to, if any, by the county providers in the
24    agreement provided for in subsection (c).
25        (6) To pay the county providers any other amount due
26    according to a federally approved State plan, including but

 

 

09700HB5007sam003- 37 -LRB097 18977 JLS 69999 a

1    not limited to payments made under the provisions of
2    Section 701(d)(3)(B) of the federal Medicare, Medicaid,
3    and SCHIP Benefits Improvement and Protection Act of 2000.
4    Intergovernmental transfers supporting payments under this
5    paragraph (6) shall not be subject to the computation
6    described in subsection (a) of Section 15-3 of this Code,
7    but shall be computed as the difference between the total
8    of such payments made by the Illinois Department to county
9    providers less any amount of federal financial
10    participation due the Illinois Department under Titles XIX
11    and XXI of the Social Security Act as a result of such
12    payments to county providers.
13    (b) The Illinois Department shall promptly seek all
14appropriate amendments to the Illinois Title XIX State Plan to
15maximize reimbursement, including disproportionate share
16hospital adjustment payments, to the county providers.
17    (c) (Blank).
18    (d) The payments provided for herein are intended to cover
19services rendered on and after July 1, 1991, and any agreement
20executed between a qualifying county and the Illinois
21Department pursuant to this Section may relate back to that
22date, provided the Illinois Department obtains federal
23approval. Any changes in payment rates resulting from the
24provisions of Article 3 of this amendatory Act of 1992 are
25intended to apply to services rendered on or after October 1,
261992, and any agreement executed between a qualifying county

 

 

09700HB5007sam003- 38 -LRB097 18977 JLS 69999 a

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

 

 

09700HB5007sam003- 39 -LRB097 18977 JLS 69999 a

1    Section 5-11 of this Code.
2    (b) State funds may not be used for the following:
3        (1) non-clinical services, except services that may be
4    required by accreditation bodies or State or federal
5    regulatory or licensing authorities;
6        (2) non-clinical support staff, except as pursuant to
7    paragraph (1) of this subsection; or
8        (3) capital improvements, other than investments in
9    medical technology, except for capital improvements that
10    may be required by accreditation bodies or State or federal
11    regulatory or licensing authorities.
12(Source: P.A. 95-859, eff. 8-19-08.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law, except that Section 5 takes effect on July 1,
152012; however, no part of this Act takes effect before the date
16on which Senate Bill 2840 of the 97th General Assembly becomes
17law.".