Illinois General Assembly - Full Text of HB5007
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Full Text of HB5007  97th General Assembly

HB5007enr 97TH GENERAL ASSEMBLY

  
  
  

 


 
HB5007 EnrolledLRB097 18977 KTG 64216 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. If and only if both Senate Bill 2840, AS
5AMENDED, of the 97th General Assembly and Senate Bill 3397, AS
6AMENDED, of the 97th General Assembly become law, then the
7Illinois Public Aid Code is amended by changing Sections 5-1.4,
85-2, 5-2.03, 15-1, 15-2, 15-5, and 15-11 as follows:
 
9    (305 ILCS 5/5-1.4)
10    Sec. 5-1.4. Moratorium on eligibility expansions.
11Beginning on January 25, 2011 (the effective date of Public Act
1296-1501) this amendatory Act of the 96th General Assembly,
13there shall be a 4-year 2-year moratorium on the expansion of
14eligibility through increasing financial eligibility
15standards, or through increasing income disregards, or through
16the creation of new programs which would add new categories of
17eligible individuals under the medical assistance program in
18addition to those categories covered on January 1, 2011 or
19above the level of any subsequent reduction in eligibility.
20This moratorium shall not apply to expansions required as a
21federal condition of State participation in the medical
22assistance program or to expansions approved by the federal
23government that are financed entirely by units of local

 

 

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1government and federal matching funds. If the State of Illinois
2finds that the State has borne a cost related to such an
3expansion, the unit of local government shall reimburse the
4State. All federal funds associated with an expansion funded by
5a unit of local government shall be returned to the local
6government entity funding the expansion, pursuant to an
7intergovernmental agreement between the Department of
8Healthcare and Family Services and the local government entity.
9Within 10 calendar days of the effective date of this
10amendatory Act of the 97th General Assembly, the Department of
11Healthcare and Family Services shall formally advise the
12Centers for Medicare and Medicaid Services of the passage of
13this amendatory Act of the 97th General Assembly. The State is
14prohibited from submitting additional waiver requests that
15expand or allow for an increase in the classes of persons
16eligible for medical assistance under this Article to the
17federal government for its consideration beginning on the 20th
18calendar day following the effective date of this amendatory
19Act of the 97th General Assembly until January 25, 2015.
20(Source: P.A. 96-1501, eff. 1-25-11.)
 
21    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
22    Sec. 5-2. Classes of Persons Eligible. Medical assistance
23under this Article shall be available to any of the following
24classes of persons in respect to whom a plan for coverage has
25been submitted to the Governor by the Illinois Department and

 

 

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1approved by him:
2        1. Recipients of basic maintenance grants under
3    Articles III and IV.
4        2. Persons otherwise eligible for basic maintenance
5    under Articles III and IV, excluding any eligibility
6    requirements that are inconsistent with any federal law or
7    federal regulation, as interpreted by the U.S. Department
8    of Health and Human Services, but who fail to qualify
9    thereunder on the basis of need or who qualify but are not
10    receiving basic maintenance under Article IV, and who have
11    insufficient income and resources to meet the costs of
12    necessary medical care, including but not limited to the
13    following:
14            (a) All persons otherwise eligible for basic
15        maintenance under Article III but who fail to qualify
16        under that Article on the basis of need and who meet
17        either of the following requirements:
18                (i) their income, as determined by the
19            Illinois Department in accordance with any federal
20            requirements, is equal to or less than 70% in
21            fiscal year 2001, equal to or less than 85% in
22            fiscal year 2002 and until a date to be determined
23            by the Department by rule, and equal to or less
24            than 100% beginning on the date determined by the
25            Department by rule, of the nonfarm income official
26            poverty line, as defined by the federal Office of

 

 

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1            Management and Budget and revised annually in
2            accordance with Section 673(2) of the Omnibus
3            Budget Reconciliation Act of 1981, applicable to
4            families of the same size; or
5                (ii) their income, after the deduction of
6            costs incurred for medical care and for other types
7            of remedial care, is equal to or less than 70% in
8            fiscal year 2001, equal to or less than 85% in
9            fiscal year 2002 and until a date to be determined
10            by the Department by rule, and equal to or less
11            than 100% beginning on the date determined by the
12            Department by rule, of the nonfarm income official
13            poverty line, as defined in item (i) of this
14            subparagraph (a).
15            (b) All persons who, excluding any eligibility
16        requirements that are inconsistent with any federal
17        law or federal regulation, as interpreted by the U.S.
18        Department of Health and Human Services, would be
19        determined eligible for such basic maintenance under
20        Article IV by disregarding the maximum earned income
21        permitted by federal law.
22        3. Persons who would otherwise qualify for Aid to the
23    Medically Indigent under Article VII.
24        4. Persons not eligible under any of the preceding
25    paragraphs who fall sick, are injured, or die, not having
26    sufficient money, property or other resources to meet the

 

 

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

 

 

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

 

 

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1        licensed to practice medicine in all its branches;
2            (c) the estimated amount which would be expended
3        for care outside the institution is not greater than
4        the estimated amount which would be expended in an
5        institution.
6        8. Persons who become ineligible for basic maintenance
7    assistance under Article IV of this Code in programs
8    administered by the Illinois Department due to employment
9    earnings and persons in assistance units comprised of
10    adults and children who become ineligible for basic
11    maintenance assistance under Article VI of this Code due to
12    employment earnings. The plan for coverage for this class
13    of persons shall:
14            (a) extend the medical assistance coverage for up
15        to 12 months following termination of basic
16        maintenance assistance; and
17            (b) offer persons who have initially received 6
18        months of the coverage provided in paragraph (a) above,
19        the option of receiving an additional 6 months of
20        coverage, subject to the following:
21                (i) such coverage shall be pursuant to
22            provisions of the federal Social Security Act;
23                (ii) such coverage shall include all services
24            covered while the person was eligible for basic
25            maintenance assistance;
26                (iii) no premium shall be charged for such

 

 

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1            coverage; and
2                (iv) such coverage shall be suspended in the
3            event of a person's failure without good cause to
4            file in a timely fashion reports required for this
5            coverage under the Social Security Act and
6            coverage shall be reinstated upon the filing of
7            such reports if the person remains otherwise
8            eligible.
9        9. Persons with acquired immunodeficiency syndrome
10    (AIDS) or with AIDS-related conditions with respect to whom
11    there has been a determination that but for home or
12    community-based services such individuals would require
13    the level of care provided in an inpatient hospital,
14    skilled nursing facility or intermediate care facility the
15    cost of which is reimbursed under this Article. Assistance
16    shall be provided to such persons to the maximum extent
17    permitted under Title XIX of the Federal Social Security
18    Act.
19        10. Participants in the long-term care insurance
20    partnership program established under the Illinois
21    Long-Term Care Partnership Program Act who meet the
22    qualifications for protection of resources described in
23    Section 15 of that Act.
24        11. Persons with disabilities who are employed and
25    eligible for Medicaid, pursuant to Section
26    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,

 

 

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1    subject to federal approval, persons with a medically
2    improved disability who are employed and eligible for
3    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
4    the Social Security Act, as provided by the Illinois
5    Department by rule. In establishing eligibility standards
6    under this paragraph 11, the Department shall, subject to
7    federal approval:
8            (a) set the income eligibility standard at not
9        lower than 350% of the federal poverty level;
10            (b) exempt retirement accounts that the person
11        cannot access without penalty before the age of 59 1/2,
12        and medical savings accounts established pursuant to
13        26 U.S.C. 220;
14            (c) allow non-exempt assets up to $25,000 as to
15        those assets accumulated during periods of eligibility
16        under this paragraph 11; and
17            (d) continue to apply subparagraphs (b) and (c) in
18        determining the eligibility of the person under this
19        Article even if the person loses eligibility under this
20        paragraph 11.
21        12. Subject to federal approval, persons who are
22    eligible for medical assistance coverage under applicable
23    provisions of the federal Social Security Act and the
24    federal Breast and Cervical Cancer Prevention and
25    Treatment Act of 2000. Those eligible persons are defined
26    to include, but not be limited to, the following persons:

 

 

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1            (1) persons who have been screened for breast or
2        cervical cancer under the U.S. Centers for Disease
3        Control and Prevention Breast and Cervical Cancer
4        Program established under Title XV of the federal
5        Public Health Services Act in accordance with the
6        requirements of Section 1504 of that Act as
7        administered by the Illinois Department of Public
8        Health; and
9            (2) persons whose screenings under the above
10        program were funded in whole or in part by funds
11        appropriated to the Illinois Department of Public
12        Health for breast or cervical cancer screening.
13        "Medical assistance" under this paragraph 12 shall be
14    identical to the benefits provided under the State's
15    approved plan under Title XIX of the Social Security Act.
16    The Department must request federal approval of the
17    coverage under this paragraph 12 within 30 days after the
18    effective date of this amendatory Act of the 92nd General
19    Assembly.
20        In addition to the persons who are eligible for medical
21    assistance pursuant to subparagraphs (1) and (2) of this
22    paragraph 12, and to be paid from funds appropriated to the
23    Department for its medical programs, any uninsured person
24    as defined by the Department in rules residing in Illinois
25    who is younger than 65 years of age, who has been screened
26    for breast and cervical cancer in accordance with standards

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    services under this paragraph 16 and (ii) does not have a
2    lien against any homestead property or other legal or
3    equitable real property interest owned by a recipient of
4    services under this paragraph 16.
5        17. Persons who, pursuant to a waiver approved by the
6    Secretary of the U.S. Department of Health and Human
7    Services, are eligible for medical assistance under Title
8    XIX or XXI of the federal Social Security Act.
9    Notwithstanding any other provision of this Code and
10    consistent with the terms of the approved waiver, the
11    Illinois Department, may by rule:
12            (a) Limit the geographic areas in which the waiver
13        program operates.
14            (b) Determine the scope, quantity, duration, and
15        quality, and the rate and method of reimbursement, of
16        the medical services to be provided, which may differ
17        from those for other classes of persons eligible for
18        assistance under this Article.
19            (c) Restrict the persons' freedom in choice of
20        providers.
21    In implementing the provisions of Public Act 96-20, the
22Department is authorized to adopt only those rules necessary,
23including emergency rules. Nothing in Public Act 96-20 permits
24the Department to adopt rules or issue a decision that expands
25eligibility for the FamilyCare Program to a person whose income
26exceeds 185% of the Federal Poverty Level as determined from

 

 

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

 

 

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1of donations or benefits from fundraisers held for the person
2in cases of serious illness, as long as neither the person nor
3members of the person's family have actual control over the
4donations or benefits or the disbursement of the donations or
5benefits.
6    Notwithstanding any other provision of this Code, if the
7United States Supreme Court holds Title II, Subtitle A, Section
82001(a) of Public Law 111-148 to be unconstitutional, or if a
9holding of Public Law 111-148 makes Medicaid eligibility
10allowed under Section 2001(a) inoperable, the State or a unit
11of local government shall be prohibited from enrolling
12individuals in the Medical Assistance Program as the result of
13federal approval of a State Medicaid waiver on or after the
14effective date of this amendatory Act of the 97th General
15Assembly, and any individuals enrolled in the Medical
16Assistance Program pursuant to eligibility permitted as a
17result of such a State Medicaid waiver shall become immediately
18ineligible.
19    Notwithstanding any other provision of this Code, if an Act
20of Congress that becomes a Public Law eliminates Section
212001(a) of Public Law 111-148, the State or a unit of local
22government shall be prohibited from enrolling individuals in
23the Medical Assistance Program as the result of federal
24approval of a State Medicaid waiver on or after the effective
25date of this amendatory Act of the 97th General Assembly, and
26any individuals enrolled in the Medical Assistance Program

 

 

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1pursuant to eligibility permitted as a result of such a State
2Medicaid waiver shall become immediately ineligible.
3(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
496-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
57-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
6eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
7revised 10-4-11.)
 
8    (305 ILCS 5/5-2.03)
9    Sec. 5-2.03. Presumptive eligibility. Beginning on the
10effective date of this amendatory Act of the 96th General
11Assembly and except where federal law requires presumptive
12eligibility, no adult may be presumed eligible for medical
13assistance under this Code and the Department may not cover any
14service rendered to an adult unless the adult has completed an
15application for benefits, all required verifications have been
16received, and the Department or its designee has found the
17adult eligible for the date on which that service was provided.
18Nothing in this Section shall apply to pregnant women or to
19persons enrolled under the medical assistance program due to
20expansions approved by the federal government that are financed
21entirely by units of local government and federal matching
22funds.
23(Source: P.A. 96-1501, eff. 1-25-11.)
 
24    (305 ILCS 5/15-1)  (from Ch. 23, par. 15-1)

 

 

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1    Sec. 15-1. Definitions. As used in this Article, unless the
2context requires otherwise:
3    (a) (Blank). "Base amount" means $108,800,000 multiplied
4by a fraction, the numerator of which is the number of days
5represented by the payments in question and the denominator of
6which is 365.
7    (a-5) "County provider" means a health care provider that
8is, or is operated by, a county with a population greater than
93,000,000.
10    (b) "Fund" means the County Provider Trust Fund.
11    (c) "Hospital" or "County hospital" means a hospital, as
12defined in Section 14-1 of this Code, which is a county
13hospital located in a county of over 3,000,000 population.
14(Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
 
15    (305 ILCS 5/15-2)  (from Ch. 23, par. 15-2)
16    Sec. 15-2. County Provider Trust Fund.
17    (a) There is created in the State Treasury the County
18Provider Trust Fund. Interest earned by the Fund shall be
19credited to the Fund. The Fund shall not be used to replace any
20funds appropriated to the Medicaid program by the General
21Assembly.
22    (b) The Fund is created solely for the purposes of
23receiving, investing, and distributing monies in accordance
24with this Article XV. The Fund shall consist of:
25        (1) All monies collected or received by the Illinois

 

 

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1    Department under Section 15-3 of this Code;
2        (2) All federal financial participation monies
3    received by the Illinois Department pursuant to Title XIX
4    of the Social Security Act, 42 U.S.C. 1396b, attributable
5    to eligible expenditures made by the Illinois Department
6    pursuant to Section 15-5 of this Code;
7        (3) All federal moneys received by the Illinois
8    Department pursuant to Title XXI of the Social Security Act
9    attributable to eligible expenditures made by the Illinois
10    Department pursuant to Section 15-5 of this Code; and
11        (4) All other monies received by the Fund from any
12    source, including interest thereon.
13    (c) Disbursements from the Fund shall be by warrants drawn
14by the State Comptroller upon receipt of vouchers duly executed
15and certified by the Illinois Department and shall be made
16only:
17        (1) 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 XIX of the Social
21    Security Act and Article V of this Code as required by
22    Section 15-5 of this Code;
23        (1.5) For services provided or purchased by county
24    providers pursuant to Section 5-11 of this Code;
25        (2) For the reimbursement of administrative expenses
26    incurred by county providers on behalf of the Illinois

 

 

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

 

 

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1    reimbursement rates based on actual costs incurred,
2    trended forward annually by an inflation index.
3        (2) To the extent that such costs are reimbursable
4    under federal law, to pay county hospitals and county
5    operated outpatient facilities for outpatient services
6    based on a federally approved methodology to cover the
7    maximum allowable costs.
8        (3) To pay the county hospitals disproportionate share
9    hospital adjustment payments as may be specified in the
10    Illinois Title XIX State plan.
11        (3.5) To pay county providers for services provided or
12    purchased pursuant to Section 5-11 of this Code.
13        (4) To reimburse the county providers for expenses
14    contractually assumed pursuant to Section 15-4 of this
15    Code.
16        (5) To pay the Illinois Department its necessary
17    administrative expenses relative to the Fund and other
18    amounts agreed to, if any, by the county providers in the
19    agreement provided for in subsection (c).
20        (6) To pay the county providers any other amount due
21    according to a federally approved State plan, including but
22    not limited to payments made under the provisions of
23    Section 701(d)(3)(B) of the federal Medicare, Medicaid,
24    and SCHIP Benefits Improvement and Protection Act of 2000.
25    Intergovernmental transfers supporting payments under this
26    paragraph (6) shall not be subject to the computation

 

 

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1    described in subsection (a) of Section 15-3 of this Code,
2    but shall be computed as the difference between the total
3    of such payments made by the Illinois Department to county
4    providers less any amount of federal financial
5    participation due the Illinois Department under Titles XIX
6    and XXI of the Social Security Act as a result of such
7    payments to county providers.
8    (b) The Illinois Department shall promptly seek all
9appropriate amendments to the Illinois Title XIX State Plan to
10maximize reimbursement, including disproportionate share
11hospital adjustment payments, to the county providers.
12    (c) (Blank).
13    (d) The payments provided for herein are intended to cover
14services rendered on and after July 1, 1991, and any agreement
15executed between a qualifying county and the Illinois
16Department pursuant to this Section may relate back to that
17date, provided the Illinois Department obtains federal
18approval. Any changes in payment rates resulting from the
19provisions of Article 3 of this amendatory Act of 1992 are
20intended to apply to services rendered on or after October 1,
211992, and any agreement executed between a qualifying county
22and the Illinois Department pursuant to this Section may be
23effective as of that date.
24    (e) If one or more hospitals file suit in any court
25challenging any part of this Article XV, payments to hospitals
26from the Fund under this Article XV shall be made only to the

 

 

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

 

 

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1        (2) non-clinical support staff, except as pursuant to
2    paragraph (1) of this subsection; or
3        (3) capital improvements, other than investments in
4    medical technology, except for capital improvements that
5    may be required by accreditation bodies or State or federal
6    regulatory or licensing authorities.
7(Source: P.A. 95-859, eff. 8-19-08.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law; however, no part of this Act takes effect until
10both Senate Bill 2840, AS AMENDED, of the 97th General Assembly
11and Senate Bill 3397, AS AMENDED, of the 97th General Assembly
12have become law.