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Sen. Donne E. Trotter
Filed: 8/14/2007
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| AMENDMENT TO HOUSE BILL 691
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| AMENDMENT NO. ______. Amend House Bill 691, AS AMENDED, by |
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| replacing everything after the enacting clause with the |
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| following:
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| "Section 1. Short title. This Act may be cited as the FY08 |
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| Human Services Budget Implementation Act. |
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| Section 3. The State Employees Group Insurance Act of 1971 |
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| is amended by changing Section 10 as follows:
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| (5 ILCS 375/10) (from Ch. 127, par. 530)
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| Sec. 10. Payments by State; premiums.
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| (a) The State shall pay the cost of basic non-contributory |
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| group life
insurance and, subject to member paid contributions |
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| set by the Department or
required by this Section, the basic |
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| program of group health benefits on each
eligible member, |
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| except a member, not otherwise
covered by this Act, who has |
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| retired as a participating member under Article 2
of the |
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| Illinois Pension Code but is ineligible for the retirement |
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| annuity under
Section 2-119 of the Illinois Pension Code, and |
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| part of each eligible member's
and retired member's premiums |
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| for health insurance coverage for enrolled
dependents as |
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| provided by Section 9. The State shall pay the cost of the |
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| basic
program of group health benefits only after benefits are |
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| reduced by the amount
of benefits covered by Medicare for all |
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| members and dependents
who are eligible for benefits under |
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| Social Security or
the Railroad Retirement system or who had |
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| sufficient Medicare-covered
government employment, except that |
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| such reduction in benefits shall apply only
to those members |
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| and dependents who (1) first become eligible
for such Medicare |
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| coverage on or after July 1, 1992; or (2) are
Medicare-eligible |
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| members or dependents of a local government unit which began
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| participation in the program on or after July 1, 1992; or (3) |
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| remain eligible
for, but no longer receive Medicare coverage |
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| which they had been receiving on
or after July 1, 1992. The |
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| Department may determine the aggregate level of the
State's |
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| contribution on the basis of actual cost of medical services |
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| adjusted
for age, sex or geographic or other demographic |
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| characteristics which affect
the costs of such programs.
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| The cost of participation in the basic program of group |
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| health benefits
for the dependent or survivor of a living or |
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| deceased retired employee who was
formerly employed by the |
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| University of Illinois in the Cooperative Extension
Service and |
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| would be an annuitant but for the fact that he or she was made
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| ineligible to participate in the State Universities Retirement |
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| System by clause
(4) of subsection (a) of Section 15-107 of the |
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| Illinois Pension Code shall not
be greater than the cost of |
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| participation that would otherwise apply to that
dependent or |
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| survivor if he or she were the dependent or survivor of an
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| annuitant under the State Universities Retirement System.
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| (a-1) Beginning January 1, 1998, for each person who |
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| becomes a new SERS
annuitant and participates in the basic |
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| program of group health benefits, the
State shall contribute |
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| toward the cost of the annuitant's
coverage under the basic |
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| program of group health benefits an amount equal
to 5% of that |
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| cost for each full year of creditable service upon which the
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| annuitant's retirement annuity is based, up to a maximum of |
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| 100% for an
annuitant with 20 or more years of creditable |
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| service.
The remainder of the cost of a new SERS annuitant's |
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| coverage under the basic
program of group health benefits shall |
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| be the responsibility of the
annuitant. In the case of a new |
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| SERS annuitant who has elected to receive an alternative |
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| retirement cancellation payment under Section 14-108.5 of the |
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| Illinois Pension Code in lieu of an annuity, for the purposes |
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| of this subsection the annuitant shall be deemed to be |
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| receiving a retirement annuity based on the number of years of |
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| creditable service that the annuitant had established at the |
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| time of his or her termination of service under SERS.
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| (a-2) Beginning January 1, 1998, for each person who |
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| becomes a new SERS
survivor and participates in the basic |
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| program of group health benefits, the
State shall contribute |
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| toward the cost of the survivor's
coverage under the basic |
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| program of group health benefits an amount equal
to 5% of that |
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| cost for each full year of the deceased employee's or deceased
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| annuitant's creditable service in the State Employees' |
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| Retirement System of
Illinois on the date of death, up to a |
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| maximum of 100% for a survivor of an
employee or annuitant with |
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| 20 or more years of creditable service. The
remainder of the |
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| cost of the new SERS survivor's coverage under the basic
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| program of group health benefits shall be the responsibility of |
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| the survivor. In the case of a new SERS survivor who was the |
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| dependent of an annuitant who elected to receive an alternative |
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| retirement cancellation payment under Section 14-108.5 of the |
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| Illinois Pension Code in lieu of an annuity, for the purposes |
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| of this subsection the deceased annuitant's creditable service |
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| shall be determined as of the date of termination of service |
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| rather than the date of death.
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| (a-3) Beginning January 1, 1998, for each person who |
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| becomes a new SURS
annuitant and participates in the basic |
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| program of group health benefits, the
State shall contribute |
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| toward the cost of the annuitant's
coverage under the basic |
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| program of group health benefits an amount equal
to 5% of that |
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| cost for each full year of creditable service upon which the
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| annuitant's retirement annuity is based, up to a maximum of |
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| 100% for an
annuitant with 20 or more years of creditable |
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| service.
The remainder of the cost of a new SURS annuitant's |
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| coverage under the basic
program of group health benefits shall |
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| be the responsibility of the
annuitant.
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| (a-4) (Blank).
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| (a-5) Beginning January 1, 1998, for each person who |
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| becomes a new SURS
survivor and participates in the basic |
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| program of group health benefits, the
State shall contribute |
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| toward the cost of the survivor's coverage under the
basic |
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| program of group health benefits an amount equal to 5% of that |
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| cost for
each full year of the deceased employee's or deceased |
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| annuitant's creditable
service in the State Universities |
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| Retirement System on the date of death, up to
a maximum of 100% |
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| for a survivor of an
employee or annuitant with 20 or more |
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| years of creditable service. The
remainder of the cost of the |
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| new SURS survivor's coverage under the basic
program of group |
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| health benefits shall be the responsibility of the survivor.
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| (a-6) Beginning July 1, 1998, for each person who becomes a |
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| new TRS
State annuitant and participates in the basic program |
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| of group health benefits,
the State shall contribute toward the |
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| cost of the annuitant's coverage under
the basic program of |
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| group health benefits an amount equal to 5% of that cost
for |
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| each full year of creditable service
as a teacher as defined in |
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| paragraph (2), (3), or (5) of Section 16-106 of the
Illinois |
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| Pension Code
upon which the annuitant's retirement annuity is |
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| based, up to a maximum of
100%;
except that
the State |
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| contribution shall be 12.5% per year (rather than 5%) for each |
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| full
year of creditable service as a regional superintendent or |
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| assistant regional
superintendent of schools. The
remainder of |
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| the cost of a new TRS State annuitant's coverage under the |
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| basic
program of group health benefits shall be the |
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| responsibility of the
annuitant.
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| (a-7) Beginning July 1, 1998, for each person who becomes a |
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| new TRS
State survivor and participates in the basic program of |
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| group health benefits,
the State shall contribute toward the |
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| cost of the survivor's coverage under the
basic program of |
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| group health benefits an amount equal to 5% of that cost for
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| each full year of the deceased employee's or deceased |
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| annuitant's creditable
service
as a teacher as defined in |
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| paragraph (2), (3), or (5) of Section 16-106 of the
Illinois |
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| Pension Code
on the date of death, up to a maximum of 100%;
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| except that the State contribution shall be 12.5% per year |
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| (rather than 5%) for
each full year of the deceased employee's |
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| or deceased annuitant's creditable
service as a regional |
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| superintendent or assistant regional superintendent of
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| schools.
The remainder of
the cost of the new TRS State |
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| survivor's coverage under the basic program of
group health |
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| benefits shall be the responsibility of the survivor.
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| (a-8) A new SERS annuitant, new SERS survivor, new SURS
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| annuitant, new SURS survivor, new TRS State
annuitant, or new |
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| TRS State survivor may waive or terminate coverage in
the |
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| program of group health benefits. Any such annuitant or |
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| survivor
who has waived or terminated coverage may enroll or |
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| re-enroll in the
program of group health benefits only during |
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| the annual benefit choice period,
as determined by the |
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| Director; except that in the event of termination of
coverage |
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| due to nonpayment of premiums, the annuitant or survivor
may |
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| not re-enroll in the program.
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| (a-9) No later than May 1 of each calendar year, the |
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| Director
of Central Management Services shall certify in |
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| writing to the Executive
Secretary of the State Employees' |
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| Retirement System of Illinois the amounts
of the Medicare |
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| supplement health care premiums and the amounts of the
health |
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| care premiums for all other retirees who are not Medicare |
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| eligible.
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| A separate calculation of the premiums based upon the |
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| actual cost of each
health care plan shall be so certified.
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| The Director of Central Management Services shall provide |
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| to the
Executive Secretary of the State Employees' Retirement |
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| System of
Illinois such information, statistics, and other data |
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| as he or she
may require to review the premium amounts |
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| certified by the Director
of Central Management Services.
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| (b) State employees who become eligible for this program on |
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| or after January
1, 1980 in positions normally requiring actual |
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| performance of duty not less
than 1/2 of a normal work period |
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| but not equal to that of a normal work period,
shall be given |
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| the option of participating in the available program. If the
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| employee elects coverage, the State shall contribute on behalf |
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| of such employee
to the cost of the employee's benefit and any |
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| applicable dependent supplement,
that sum which bears the same |
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| percentage as that percentage of time the
employee regularly |
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| works when compared to normal work period.
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| (c) The basic non-contributory coverage from the basic |
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| program of
group health benefits shall be continued for each |
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| employee not in pay status or
on active service by reason of |
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| (1) leave of absence due to illness or injury,
(2) authorized |
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| educational leave of absence or sabbatical leave, or (3)
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| military leave with pay and benefits. This coverage shall |
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| continue until
expiration of authorized leave and return to |
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| active service, but not to exceed
24 months for leaves under |
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| item (1) or (2). This 24-month limitation and the
requirement |
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| of returning to active service shall not apply to persons |
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| receiving
ordinary or accidental disability benefits or |
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| retirement benefits through the
appropriate State retirement |
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| system or benefits under the Workers' Compensation
or |
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| Occupational Disease Act.
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| (d) The basic group life insurance coverage shall continue, |
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| with
full State contribution, where such person is (1) absent |
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| from active
service by reason of disability arising from any |
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| cause other than
self-inflicted, (2) on authorized educational |
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| leave of absence or
sabbatical leave, or (3) on military leave |
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| with pay and benefits.
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| (e) Where the person is in non-pay status for a period in |
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| excess of
30 days or on leave of absence, other than by reason |
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| of disability,
educational or sabbatical leave, or military |
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| leave with pay and benefits, such
person may continue coverage |
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| only by making personal
payment equal to the amount normally |
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| contributed by the State on such person's
behalf. Such payments |
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| and coverage may be continued: (1) until such time as
the |
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| person returns to a status eligible for coverage at State |
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| expense, but not
to exceed 24 months, (2) until such person's |
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| employment or annuitant status
with the State is terminated, or |
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| (3) for a maximum period of 4 years for
members on military |
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| leave with pay and benefits and military leave without pay
and |
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| benefits (exclusive of any additional service imposed pursuant |
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| to law).
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| (f) The Department shall establish by rule the extent to |
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| which other
employee benefits will continue for persons in |
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| non-pay status or who are
not in active service.
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| (g) The State shall not pay the cost of the basic |
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| non-contributory
group life insurance, program of health |
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| benefits and other employee benefits
for members who are |
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| survivors as defined by paragraphs (1) and (2) of
subsection |
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| (q) of Section 3 of this Act. The costs of benefits for these
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| survivors shall be paid by the survivors or by the University |
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| of Illinois
Cooperative Extension Service, or any combination |
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| thereof.
However, the State shall pay the amount of the |
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| reduction in the cost of
participation, if any, resulting from |
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| the amendment to subsection (a) made
by this amendatory Act of |
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| the 91st General Assembly.
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| (h) Those persons occupying positions with any department |
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| as a result
of emergency appointments pursuant to Section 8b.8 |
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| of the Personnel Code
who are not considered employees under |
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| this Act shall be given the option
of participating in the |
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| programs of group life insurance, health benefits and
other |
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| employee benefits. Such persons electing coverage may |
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| participate only
by making payment equal to the amount normally |
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| contributed by the State for
similarly situated employees. Such |
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| amounts shall be determined by the
Director. Such payments and |
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| coverage may be continued until such time as the
person becomes |
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| an employee pursuant to this Act or such person's appointment |
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| is
terminated.
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| (i) Any unit of local government within the State of |
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| Illinois
may apply to the Director to have its employees, |
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| annuitants, and their
dependents provided group health |
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| coverage under this Act on a non-insured
basis. To participate, |
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| a unit of local government must agree to enroll
all of its |
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| employees, who may select coverage under either the State group
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| health benefits plan or a health maintenance organization that |
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| has
contracted with the State to be available as a health care |
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| provider for
employees as defined in this Act. A unit of local |
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| government must remit the
entire cost of providing coverage |
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| under the State group health benefits plan
or, for coverage |
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| under a health maintenance organization, an amount determined
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| by the Director based on an analysis of the sex, age, |
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| geographic location, or
other relevant demographic variables |
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| for its employees, except that the unit of
local government |
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| shall not be required to enroll those of its employees who are
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| covered spouses or dependents under this plan or another group |
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| policy or plan
providing health benefits as long as (1) an |
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| appropriate official from the unit
of local government attests |
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| that each employee not enrolled is a covered spouse
or |
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| dependent under this plan or another group policy or plan, and |
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| (2) at least
85% of the employees are enrolled and the unit of |
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| local government remits
the entire cost of providing coverage |
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| to those employees, except that a
participating school district |
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| must have enrolled at least 85% of its full-time
employees who |
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| have not waived coverage under the district's group health
plan |
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| by participating in a component of the district's cafeteria |
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| plan. A
participating school district is not required to enroll |
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| a full-time employee
who has waived coverage under the |
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| district's health plan, provided that an
appropriate official |
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| from the participating school district attests that the
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| full-time employee has waived coverage by participating in a |
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| component of the
district's cafeteria plan. For the purposes of |
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| this subsection, "participating
school district" includes a |
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| unit of local government whose primary purpose is
education as |
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| defined by the Department's rules.
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| Employees of a participating unit of local government who |
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| are not enrolled
due to coverage under another group health |
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| policy or plan may enroll in
the event of a qualifying change |
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| in status, special enrollment, special
circumstance as defined |
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| by the Director, or during the annual Benefit Choice
Period. A |
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| participating unit of local government may also elect to cover |
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| its
annuitants. Dependent coverage shall be offered on an |
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| optional basis, with the
costs paid by the unit of local |
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| government, its employees, or some combination
of the two as |
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| determined by the unit of local government. The unit of local
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| government shall be responsible for timely collection and |
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| transmission of
dependent premiums.
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| The Director shall annually determine monthly rates of |
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| payment, subject
to the following constraints:
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| (1) In the first year of coverage, the rates shall be |
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| equal to the
amount normally charged to State employees for |
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| elected optional coverages
or for enrolled dependents |
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| coverages or other contributory coverages, or
contributed |
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| by the State for basic insurance coverages on behalf of its
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| employees, adjusted for differences between State |
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| employees and employees
of the local government in age, |
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| sex, geographic location or other relevant
demographic |
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| variables, plus an amount sufficient to pay for the |
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| additional
administrative costs of providing coverage to |
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| employees of the unit of
local government and their |
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| dependents.
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| (2) In subsequent years, a further adjustment shall be |
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| made to reflect
the actual prior years' claims experience |
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| of the employees of the unit of
local government.
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| In the case of coverage of local government employees under |
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| a health
maintenance organization, the Director shall annually |
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| determine for each
participating unit of local government the |
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| maximum monthly amount the unit
may contribute toward that |
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| coverage, based on an analysis of (i) the age,
sex, geographic |
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| location, and other relevant demographic variables of the
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| unit's employees and (ii) the cost to cover those employees |
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| under the State
group health benefits plan. The Director may |
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| similarly determine the
maximum monthly amount each unit of |
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| local government may contribute toward
coverage of its |
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| employees' dependents under a health maintenance organization.
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| Monthly payments by the unit of local government or its |
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| employees for
group health benefits plan or health maintenance |
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| organization coverage shall
be deposited in the Local |
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| Government Health Insurance Reserve Fund.
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| The Local Government Health Insurance Reserve Fund is |
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| hereby created as a nonappropriated trust fund to be held |
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| outside the State Treasury, with the State Treasurer as |
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| custodian. The Local Government Health Insurance Reserve Fund |
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| shall be a continuing
fund not subject to fiscal year |
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| limitations. All revenues arising from the administration of |
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| the health benefits program established under this Section |
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| shall be deposited into the Local Government Health Insurance |
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| Reserve Fund. Any interest earned on moneys in the Local |
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| Government Health Insurance Reserve Fund shall be deposited |
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| into the Fund. All expenditures from this Fund
shall be used |
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| for payments for health care benefits for local government and |
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| rehabilitation facility
employees, annuitants, and dependents, |
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| and to reimburse the Department or
its administrative service |
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| organization for all expenses incurred in the
administration of |
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| benefits. No other State funds may be used for these
purposes.
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| A local government employer's participation or desire to |
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| participate
in a program created under this subsection shall |
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| not limit that employer's
duty to bargain with the |
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| representative of any collective bargaining unit
of its |
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| employees.
|
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| (j) Any rehabilitation facility within the State of |
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| Illinois may apply
to the Director to have its employees, |
11 |
| annuitants, and their eligible
dependents provided group |
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| health coverage under this Act on a non-insured
basis. To |
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| participate, a rehabilitation facility must agree to enroll all
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| of its employees and remit the entire cost of providing such |
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| coverage for
its employees, except that the rehabilitation |
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| facility shall not be
required to enroll those of its employees |
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| who are covered spouses or
dependents under this plan or |
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| another group policy or plan providing health
benefits as long |
19 |
| as (1) an appropriate official from the rehabilitation
facility |
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| attests that each employee not enrolled is a covered spouse or
|
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| dependent under this plan or another group policy or plan, and |
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| (2) at least
85% of the employees are enrolled and the |
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| rehabilitation facility remits
the entire cost of providing |
24 |
| coverage to those employees. Employees of a
participating |
25 |
| rehabilitation facility who are not enrolled due to coverage
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| under another group health policy or plan may enroll
in the |
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| event of a qualifying change in status, special enrollment, |
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| special
circumstance as defined by the Director, or during the |
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| annual Benefit Choice
Period. A participating rehabilitation |
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| facility may also elect
to cover its annuitants. Dependent |
5 |
| coverage shall be offered on an optional
basis, with the costs |
6 |
| paid by the rehabilitation facility, its employees, or
some |
7 |
| combination of the 2 as determined by the rehabilitation |
8 |
| facility. The
rehabilitation facility shall be responsible for |
9 |
| timely collection and
transmission of dependent premiums.
|
10 |
| The Director shall annually determine quarterly rates of |
11 |
| payment, subject
to the following constraints:
|
12 |
| (1) In the first year of coverage, the rates shall be |
13 |
| equal to the amount
normally charged to State employees for |
14 |
| elected optional coverages or for
enrolled dependents |
15 |
| coverages or other contributory coverages on behalf of
its |
16 |
| employees, adjusted for differences between State |
17 |
| employees and
employees of the rehabilitation facility in |
18 |
| age, sex, geographic location
or other relevant |
19 |
| demographic variables, plus an amount sufficient to pay
for |
20 |
| the additional administrative costs of providing coverage |
21 |
| to employees
of the rehabilitation facility and their |
22 |
| dependents.
|
23 |
| (2) In subsequent years, a further adjustment shall be |
24 |
| made to reflect
the actual prior years' claims experience |
25 |
| of the employees of the
rehabilitation facility.
|
26 |
| Monthly payments by the rehabilitation facility or its |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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|
1 |
| employees for
group health benefits shall be deposited in the |
2 |
| Local Government Health
Insurance Reserve Fund.
|
3 |
| (k) Any domestic violence shelter or service within the |
4 |
| State of Illinois
may apply to the Director to have its |
5 |
| employees, annuitants, and their
dependents provided group |
6 |
| health coverage under this Act on a non-insured
basis. To |
7 |
| participate, a domestic violence shelter or service must agree |
8 |
| to
enroll all of its employees and pay the entire cost of |
9 |
| providing such coverage
for its employees. A participating |
10 |
| domestic violence shelter may also elect
to cover its |
11 |
| annuitants. Dependent coverage shall be offered on an optional
|
12 |
| basis, with
employees, or some combination of the 2 as |
13 |
| determined by the domestic violence
shelter or service. The |
14 |
| domestic violence shelter or service shall be
responsible for |
15 |
| timely collection and transmission of dependent premiums.
|
16 |
| The Director shall annually determine rates of payment,
|
17 |
| subject to the following constraints:
|
18 |
| (1) In the first year of coverage, the rates shall be |
19 |
| equal to the
amount normally charged to State employees for |
20 |
| elected optional coverages
or for enrolled dependents |
21 |
| coverages or other contributory coverages on
behalf of its |
22 |
| employees, adjusted for differences between State |
23 |
| employees and
employees of the domestic violence shelter or |
24 |
| service in age, sex, geographic
location or other relevant |
25 |
| demographic variables, plus an amount sufficient
to pay for |
26 |
| the additional administrative costs of providing coverage |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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|
1 |
| to
employees of the domestic violence shelter or service |
2 |
| and their dependents.
|
3 |
| (2) In subsequent years, a further adjustment shall be |
4 |
| made to reflect
the actual prior years' claims experience |
5 |
| of the employees of the domestic
violence shelter or |
6 |
| service.
|
7 |
| Monthly payments by the domestic violence shelter or |
8 |
| service or its employees
for group health insurance shall be |
9 |
| deposited in the Local Government Health
Insurance Reserve |
10 |
| Fund.
|
11 |
| (l) A public community college or entity organized pursuant |
12 |
| to the
Public Community College Act may apply to the Director |
13 |
| initially to have
only annuitants not covered prior to July 1, |
14 |
| 1992 by the district's health
plan provided health coverage |
15 |
| under this Act on a non-insured basis. The
community college |
16 |
| must execute a 2-year contract to participate in the
Local |
17 |
| Government Health Plan.
Any annuitant may enroll in the event |
18 |
| of a qualifying change in status, special
enrollment, special |
19 |
| circumstance as defined by the Director, or during the
annual |
20 |
| Benefit Choice Period.
|
21 |
| The Director shall annually determine monthly rates of |
22 |
| payment subject to
the following constraints: for those |
23 |
| community colleges with annuitants
only enrolled, first year |
24 |
| rates shall be equal to the average cost to cover
claims for a |
25 |
| State member adjusted for demographics, Medicare
|
26 |
| participation, and other factors; and in the second year, a |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| further adjustment
of rates shall be made to reflect the actual |
2 |
| first year's claims experience
of the covered annuitants.
|
3 |
| (l-5) The provisions of subsection (l) become inoperative |
4 |
| on July 1, 1999.
|
5 |
| (m) The Director shall adopt any rules deemed necessary for
|
6 |
| implementation of this amendatory Act of 1989 (Public Act |
7 |
| 86-978).
|
8 |
| (n) Any child advocacy center within the State of Illinois |
9 |
| may apply to the Director to have its employees, annuitants, |
10 |
| and their dependants provided group health coverage under this |
11 |
| Act on a non-insured basis. To participate, a child advocacy |
12 |
| center must agree to enroll all of its employees and pay the |
13 |
| entire cost of providing coverage for its employees. A |
14 |
| participating child advocacy center may also elect to cover its |
15 |
| annuitants. Dependent coverage shall be offered on an optional |
16 |
| basis, with the costs paid by the child advocacy center, its |
17 |
| employees, or some combination of the 2 as determined by the |
18 |
| child advocacy center. The child advocacy center shall be |
19 |
| responsible for timely collection and transmission of |
20 |
| dependent premiums. |
21 |
| The Director shall annually determine rates of payment, |
22 |
| subject to the following constraints: |
23 |
| (1) In the first year of coverage, the rates shall be |
24 |
| equal to the amount normally charged to State employees for |
25 |
| elected optional coverages or for enrolled dependents |
26 |
| coverages or other contributory coverages on behalf of its |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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|
1 |
| employees, adjusted for differences between State |
2 |
| employees and employees of the child advocacy center in |
3 |
| age, sex, geographic location, or other relevant |
4 |
| demographic variables, plus an amount sufficient to pay for |
5 |
| the additional administrative costs of providing coverage |
6 |
| to employees of the child advocacy center and their |
7 |
| dependents. |
8 |
| (2) In subsequent years, a further adjustment shall be |
9 |
| made to reflect the actual prior years' claims experience |
10 |
| of the employees of the child advocacy center. |
11 |
| Monthly payments by the child advocacy center or its |
12 |
| employees for group health insurance shall be deposited into |
13 |
| the Local Government Health Insurance Reserve Fund. |
14 |
| (Source: P.A. 93-839, eff. 7-30-04; 94-839, eff. 6-6-06; |
15 |
| 94-860, eff. 6-16-06; revised 8-3-06.)
|
16 |
| Section 5. The Mental Health and Developmental |
17 |
| Disabilities Administrative Act is amended by changing Section |
18 |
| 18.5 as follows: |
19 |
| (20 ILCS 1705/18.5) |
20 |
| Sec. 18.5. Community Developmental Disability Services |
21 |
| Medicaid Trust Fund; reimbursement. |
22 |
| (a) The Community Developmental Disability Services |
23 |
| Medicaid Trust Fund is hereby created in the State treasury.
|
24 |
| (b) Except as provided in subsection (b-5), any
Any funds |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| in excess of $16,700,000 in any fiscal year paid to the State |
2 |
| by the federal government under Title XIX or Title XXI of the |
3 |
| Social Security Act for services delivered by community |
4 |
| developmental disability services providers for services |
5 |
| relating to Developmental Training and Community Integrated |
6 |
| Living Arrangements as a result of the conversion of such |
7 |
| providers from a grant payment methodology to a fee-for-service |
8 |
| payment methodology, or any other funds paid to the State for |
9 |
| any subsequent revenue maximization initiatives performed by |
10 |
| such providers, and any interest earned thereon, shall be |
11 |
| deposited directly into the Community Developmental Disability |
12 |
| Services Medicaid Trust Fund. One-third of this amount shall be |
13 |
| used only to pay for Medicaid-reimbursed community |
14 |
| developmental disability services provided to eligible |
15 |
| individuals, and the remainder shall be transferred to the |
16 |
| General Revenue Fund. |
17 |
| (b-5) Beginning in State fiscal year 2008, any funds paid |
18 |
| to the State by the federal government under Title XIX or Title |
19 |
| XXI of the Social Security Act for services delivered through |
20 |
| the Children's Residential Waiver and the Children's In-Home |
21 |
| Support Waiver shall be deposited directly into the Community |
22 |
| Developmental Disability Services Medicaid Trust Fund and |
23 |
| shall not be subject to the transfer provisions of subsection |
24 |
| (b).
|
25 |
| (c) For purposes of this Section: |
26 |
| "Medicaid-reimbursed developmental disability services" |
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| means services provided by a community developmental |
2 |
| disability provider under an agreement with the Department that |
3 |
| is eligible for reimbursement under the federal Title XIX |
4 |
| program or Title XXI program. |
5 |
| "Provider" means a qualified entity as defined in the |
6 |
| State's Home and
Community-Based Services Waiver for Persons |
7 |
| with Developmental Disabilities that is funded by the |
8 |
| Department to provide a Medicaid-reimbursed service. |
9 |
| "Revenue maximization alternatives" do not include |
10 |
| increases in
funds paid to the State as a result of growth in |
11 |
| spending through service expansion or
rate increases.
|
12 |
| (Source: P.A. 93-841, eff. 7-30-04.) |
13 |
| Section 7. The State Finance Act is amended by adding |
14 |
| Sections 5.675 and 6z-69 and changing Section 8.27 as follows: |
15 |
| (30 ILCS 105/5.675 new) |
16 |
| Sec. 5.675. The Priority Capital Grant Program Fund. |
17 |
| (30 ILCS 105/6z-69 new)
|
18 |
| Sec. 6z-69. Priority Capital Grant Program Fund. The |
19 |
| Priority Capital Grant Program Fund is created as a special |
20 |
| fund in the State treasury. Subject to appropriation, the |
21 |
| Department of Human Services shall use moneys in the Fund to |
22 |
| make grants to the Illinois Facilities Fund, a not-for-profit |
23 |
| corporation, to make long term below market rate loans and |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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|
1 |
| grants to assist nonprofit human service providers working |
2 |
| under contract to the State of Illinois to assist those |
3 |
| providers in meeting their capital needs. The loans or grants |
4 |
| shall be for the purpose of such capital needs, including but |
5 |
| not limited to special use facilities, requirements for serving |
6 |
| the disabled, mentally ill, or substance abusers, and medical |
7 |
| and technology equipment. Loan repayments shall be deposited |
8 |
| into the Priority Capital Grant Program Fund. Interest income |
9 |
| may be used to cover expenses of the program.
|
10 |
| (30 ILCS 105/8.27) (from Ch. 127, par. 144.27)
|
11 |
| Sec. 8.27. All receipts from federal financial |
12 |
| participation in the
Foster Care and Adoption Services program |
13 |
| under Title IV-E of the federal
Social Security Act, including |
14 |
| receipts
for related indirect costs,
shall be deposited in the |
15 |
| DCFS Children's Services Fund.
|
16 |
| Eighty percent of the federal funds received by the |
17 |
| Illinois Department
of Human Services under the Title IV-A |
18 |
| Emergency Assistance program as
reimbursement for expenditures |
19 |
| made from the Illinois Department of Children
and Family |
20 |
| Services appropriations for the costs of services in behalf of
|
21 |
| Department of Children and Family Services clients shall be |
22 |
| deposited into
the DCFS Children's Services Fund.
|
23 |
| All receipts from federal financial participation in the |
24 |
| Child Welfare
Services program under Title IV-B of the federal |
25 |
| Social Security Act,
including receipts for related indirect |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| costs, shall be deposited into the
DCFS Children's Services |
2 |
| Fund for those moneys received as reimbursement for
services |
3 |
| provided on or after July 1, 1994.
|
4 |
| In addition, as soon as may be practicable after the first |
5 |
| day of November,
1994, the Department of Children and Family |
6 |
| Services shall request the
Comptroller to order transferred and |
7 |
| the Treasurer shall transfer the
unexpended balance of the |
8 |
| Child Welfare Services Fund to the DCFS Children's
Services |
9 |
| Fund. Upon completion of the transfer, the Child Welfare |
10 |
| Services
Fund will be considered dissolved and any outstanding |
11 |
| obligations or
liabilities of that fund will pass to the DCFS |
12 |
| Children's Services Fund.
|
13 |
| For services provided on or after July 1, 2007, all federal |
14 |
| funds received pursuant to the John H. Chafee Foster Care |
15 |
| Independence Program shall be deposited into the DCFS |
16 |
| Children's Services Fund.
|
17 |
| Monies in the Fund may be used by the Department, pursuant |
18 |
| to
appropriation by the General Assembly, for the ordinary and |
19 |
| contingent
expenses of the Department.
|
20 |
| In fiscal year 1988 and in each fiscal year thereafter |
21 |
| through fiscal
year 2000, the Comptroller
shall order |
22 |
| transferred and the Treasurer shall transfer an amount of
|
23 |
| $16,100,000 from the DCFS Children's Services Fund to the |
24 |
| General Revenue
Fund in the following manner: As soon as may be |
25 |
| practicable after the 15th
day of September, December, March |
26 |
| and June, the Comptroller shall order
transferred and the |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| Treasurer shall transfer, to the extent that funds are
|
2 |
| available, 1/4 of $16,100,000, plus any cumulative |
3 |
| deficiencies in such
transfers for prior transfer dates during |
4 |
| such fiscal year. In no event
shall any such transfer reduce |
5 |
| the available balance in the DCFS Children's
Services Fund |
6 |
| below $350,000.
|
7 |
| In accordance with subsection (q) of Section 5 of the |
8 |
| Children and Family
Services Act, disbursements from |
9 |
| individual children's accounts shall be
deposited into the DCFS |
10 |
| Children's Services Fund.
|
11 |
| Receipts from public and unsolicited private grants, fees |
12 |
| for training, and royalties earned from the publication of |
13 |
| materials owned by or licensed to the Department of Children |
14 |
| and Family Services shall be deposited into the DCFS Children's |
15 |
| Services Fund. |
16 |
| As soon as may be practical after September 1, 2005, upon |
17 |
| the request of the Department of Children and Family Services, |
18 |
| the Comptroller shall order transferred and the Treasurer shall |
19 |
| transfer the unexpended balance of the Department of Children |
20 |
| and Family Services Training Fund into the DCFS Children's |
21 |
| Services Fund. Upon completion of the transfer, the Department |
22 |
| of Children and Family Services Training Fund is dissolved and |
23 |
| any outstanding obligations or liabilities of that Fund pass to |
24 |
| the DCFS Children's Services Fund.
|
25 |
| (Source: P.A. 94-91, eff. 7-1-05.)
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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|
1 |
| Section 9. The Hospital Licensing Act is amended by |
2 |
| changing Section 8 as follows:
|
3 |
| (210 ILCS 85/8) (from Ch. 111 1/2, par. 149)
|
4 |
| Sec. 8. Facility plan review; fees.
|
5 |
| (a) Before commencing construction of new facilities or |
6 |
| specified types
of alteration or additions to an existing |
7 |
| hospital involving major
construction, as defined by rule by |
8 |
| the Department, with an estimated
cost greater than $100,000, |
9 |
| architectural plans and
specifications therefor shall be |
10 |
| submitted by the licensee to the
Department for review and |
11 |
| approval.
A hospital may submit architectural drawings and |
12 |
| specifications for other
construction projects for Department |
13 |
| review according to subsection (b) that
shall not be subject to |
14 |
| fees under subsection (d).
The Department must give a hospital |
15 |
| that is planning to submit a construction
project for review |
16 |
| the opportunity to discuss its plans and specifications with
|
17 |
| the Department before the hospital formally submits the plans |
18 |
| and
specifications for Department review.
Review of drawings |
19 |
| and specifications shall be conducted by an employee of
the |
20 |
| Department meeting the qualifications established by the |
21 |
| Department of
Central Management Services class specifications |
22 |
| for such an individual's
position or by a person contracting |
23 |
| with the Department who meets those class
specifications.
Final |
24 |
| approval of the plans and specifications for compliance
with |
25 |
| design and construction standards shall be obtained from the
|
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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|
1 |
| Department before the alteration, addition, or new |
2 |
| construction is begun. Subject to this Section 8, and prior to |
3 |
| January 1, 2012, the Department shall consider the re-licensing |
4 |
| of an existing hospital structure according to the standards |
5 |
| for an existing hospital, as set forth in the Department's |
6 |
| rules. Re-licensing under this provision shall occur only if |
7 |
| that facility operated as a licensed hospital on July 1, 2005, |
8 |
| has had no intervening use as other than a hospital, and exists |
9 |
| in a county with a population of less than 20,000 that does not |
10 |
| have another licensed hospital on the effective date of this |
11 |
| amendatory Act of the 95th General Assembly.
|
12 |
| (b) The Department shall inform an applicant in writing |
13 |
| within 10 working
days after receiving drawings and |
14 |
| specifications and the required fee, if any,
from the applicant |
15 |
| whether the applicant's submission is complete or
incomplete. |
16 |
| Failure to provide the applicant with this notice within 10
|
17 |
| working days shall result in the submission being deemed |
18 |
| complete for purposes
of initiating the 60-day review period |
19 |
| under this Section. If the submission
is incomplete, the |
20 |
| Department shall inform the applicant of the deficiencies
with |
21 |
| the submission in writing. If the submission is complete and |
22 |
| the required
fee, if any, has been paid,
the Department shall |
23 |
| approve or disapprove drawings and specifications
submitted to |
24 |
| the Department no later than 60 days following receipt by the
|
25 |
| Department. The drawings and specifications shall be of |
26 |
| sufficient detail, as
provided by Department rule, to
enable |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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|
1 |
| the Department to
render a determination of compliance with |
2 |
| design and construction standards
under this Act.
If the |
3 |
| Department finds that the drawings are not of sufficient detail |
4 |
| for it
to render a determination of compliance, the plans shall |
5 |
| be determined to be
incomplete and shall not be considered for |
6 |
| purposes of initiating the 60 day
review period.
If a |
7 |
| submission of drawings and specifications is incomplete, the |
8 |
| applicant
may submit additional information. The 60-day review |
9 |
| period shall not commence
until the Department determines that |
10 |
| a submission of drawings and
specifications is complete or the |
11 |
| submission is deemed complete.
If the Department has not |
12 |
| approved or disapproved the
drawings and specifications within |
13 |
| 60 days, the construction, major alteration,
or addition shall |
14 |
| be deemed approved. If the drawings and specifications are
|
15 |
| disapproved, the Department shall state in writing, with |
16 |
| specificity, the
reasons for the disapproval. The entity |
17 |
| submitting the drawings and
specifications may submit |
18 |
| additional information in response to the written
comments from |
19 |
| the Department or request a reconsideration of the disapproval.
|
20 |
| A final decision of approval or disapproval shall be made |
21 |
| within 45 days of the
receipt of the additional information or |
22 |
| reconsideration request. If denied,
the Department shall state |
23 |
| the specific reasons for the denial
and the applicant may elect |
24 |
| to seek dispute resolution pursuant to Section
25 of the |
25 |
| Illinois Building Commission Act, which the Department must
|
26 |
| participate in.
|
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| (c) The Department shall provide written approval for |
2 |
| occupancy pursuant
to subsection (g) and shall not issue a |
3 |
| violation to a facility as a result of
a licensure or complaint |
4 |
| survey based upon the facility's physical structure
if:
|
5 |
| (1) the Department reviewed and approved or deemed |
6 |
| approved the drawing
and specifications for compliance |
7 |
| with design and construction standards;
|
8 |
| (2) the construction, major alteration, or addition |
9 |
| was built as
submitted;
|
10 |
| (3) the law or rules have not been amended since the |
11 |
| original approval;
and
|
12 |
| (4) the conditions at the facility indicate that there |
13 |
| is a reasonable
degree of safety provided for the patients.
|
14 |
| (c-5) The Department shall not issue a violation to a |
15 |
| facility if the
inspected aspects of the facility were |
16 |
| previously found to be in compliance
with applicable standards, |
17 |
| the relevant law or rules have not been amended,
conditions at |
18 |
| the facility
reasonably protect the safety of its patients, and |
19 |
| alterations or new hazards
have not been
identified.
|
20 |
| (d) The Department shall charge the following fees in |
21 |
| connection with its
reviews conducted before June 30, 2004 |
22 |
| under this Section:
|
23 |
| (1) (Blank).
|
24 |
| (2) (Blank).
|
25 |
| (3) If the estimated dollar value of the major
|
26 |
| construction is greater than $500,000, the fee shall be
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| established by the Department pursuant to rules that |
2 |
| reflect the reasonable
and
direct cost of the Department in |
3 |
| conducting the architectural reviews required
under this |
4 |
| Section. The estimated dollar value of the major |
5 |
| construction
subject to review under this Section shall be |
6 |
| annually readjusted to
reflect the
increase in |
7 |
| construction costs due to inflation.
|
8 |
| The fees provided in this subsection (d) shall not apply to |
9 |
| major
construction projects involving facility changes that |
10 |
| are required by
Department rule amendments or to projects |
11 |
| related to homeland security.
|
12 |
| The fees provided in this subsection (d) shall also not |
13 |
| apply to major
construction projects if 51% or more of the |
14 |
| estimated cost of the project is
attributed to capital |
15 |
| equipment. For major construction projects where 51% or
more of |
16 |
| the estimated cost of the project is attributed to capital |
17 |
| equipment,
the Department shall by rule establish a fee that is |
18 |
| reasonably related to the
cost of reviewing the project.
|
19 |
| Disproportionate share hospitals and rural hospitals shall |
20 |
| only pay
one-half of the fees
required in this subsection (d).
|
21 |
| For the purposes of this subsection (d),
(i) "disproportionate |
22 |
| share hospital" means a hospital described in items (1)
through |
23 |
| (5) of subsection (b) of Section 5-5.02 of the Illinois Public |
24 |
| Aid
Code and (ii)
"rural hospital" means a hospital that
is (A) |
25 |
| located
outside a metropolitan statistical area or (B) located |
26 |
| 15 miles or less from a
county that is
outside a metropolitan |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| statistical area and is licensed to perform
medical/surgical or
|
2 |
| obstetrical services and has a combined total bed capacity of |
3 |
| 75 or fewer beds
in these 2
service categories as of July 14, |
4 |
| 1993, as determined by the Department.
|
5 |
| The Department shall not commence the facility plan review |
6 |
| process under this
Section until the applicable fee has been |
7 |
| paid.
|
8 |
| (e) All fees received by the Department under this Section |
9 |
| shall be
deposited into the Health Facility Plan Review Fund, a |
10 |
| special fund created in
the State treasury.
All fees paid by |
11 |
| hospitals under subsection (d) shall be used only to cover
the |
12 |
| direct and reasonable costs relating to the Department's review |
13 |
| of hospital
projects under this
Section.
Moneys shall be |
14 |
| appropriated from that Fund to the
Department only to pay the |
15 |
| costs of conducting reviews under this Section.
None of the |
16 |
| moneys in the Health Facility Plan Review Fund shall be used to
|
17 |
| reduce the amount of General Revenue Fund moneys appropriated |
18 |
| to the Department
for facility plan reviews conducted pursuant |
19 |
| to this Section.
|
20 |
| (f) (Blank).
|
21 |
| (g) The Department shall conduct an on-site inspection of |
22 |
| the completed
project no later than 15 business days after |
23 |
| notification from the
applicant that the
project has been |
24 |
| completed and all certifications required by the Department
|
25 |
| have been received and accepted by the Department. The |
26 |
| Department may extend
this deadline only if a federally |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| mandated survey time frame takes
precedence. The Department |
2 |
| shall
provide written approval for occupancy to the applicant |
3 |
| within 5 working days
of the Department's final inspection, |
4 |
| provided the applicant has demonstrated
substantial compliance |
5 |
| as defined by Department rule.
Occupancy of new major |
6 |
| construction is prohibited until Department approval is
|
7 |
| received, unless the Department has not acted within the time |
8 |
| frames provided
in this subsection (g), in which case the |
9 |
| construction shall be deemed
approved. Occupancy shall be |
10 |
| authorized after any
required health inspection by the |
11 |
| Department has been conducted.
|
12 |
| (h) The Department shall establish, by rule, a procedure to |
13 |
| conduct interim
on-site review of large or complex construction |
14 |
| projects.
|
15 |
| (i) The Department shall establish, by rule, an expedited |
16 |
| process for
emergency repairs or replacement of like equipment.
|
17 |
| (j) Nothing in this Section shall be construed to apply to |
18 |
| maintenance,
upkeep, or renovation that does not affect the |
19 |
| structural integrity of the
building, does not add beds or |
20 |
| services over the number for which the facility
is licensed, |
21 |
| and provides a reasonable degree of safety for the patients.
|
22 |
| (Source: P.A. 92-563, eff. 6-24-02; 92-803, eff. 8-16-02; |
23 |
| 93-41, eff.
6-27-03.)
|
24 |
| Section 10. The Illinois Public Aid Code is amended by |
25 |
| changing Sections 5-5.4 and 5B-8 and adding Section 5-27 as |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| follows: |
2 |
| (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
|
3 |
| Sec. 5-5.4. Standards of Payment - Department of Healthcare |
4 |
| and Family Services.
The Department of Healthcare and Family |
5 |
| Services shall develop standards of payment of skilled
nursing |
6 |
| and intermediate care services in facilities providing such |
7 |
| services
under this Article which:
|
8 |
| (1) Provide for the determination of a facility's payment
|
9 |
| for skilled nursing and intermediate care services on a |
10 |
| prospective basis.
The amount of the payment rate for all |
11 |
| nursing facilities certified by the
Department of Public Health |
12 |
| under the Nursing Home Care Act as Intermediate
Care for the |
13 |
| Developmentally Disabled facilities, Long Term Care for Under |
14 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate |
15 |
| Care facilities
under the
medical assistance program shall be |
16 |
| prospectively established annually on the
basis of historical, |
17 |
| financial, and statistical data reflecting actual costs
from |
18 |
| prior years, which shall be applied to the current rate year |
19 |
| and updated
for inflation, except that the capital cost element |
20 |
| for newly constructed
facilities shall be based upon projected |
21 |
| budgets. The annually established
payment rate shall take |
22 |
| effect on July 1 in 1984 and subsequent years. No rate
increase |
23 |
| and no
update for inflation shall be provided on or after July |
24 |
| 1, 1994 and before
July 1, 2008, unless specifically provided |
25 |
| for in this
Section.
The changes made by Public Act 93-841
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| extending the duration of the prohibition against a rate |
2 |
| increase or update for inflation are effective retroactive to |
3 |
| July 1, 2004.
|
4 |
| For facilities licensed by the Department of Public Health |
5 |
| under the Nursing
Home Care Act as Intermediate Care for the |
6 |
| Developmentally Disabled facilities
or Long Term Care for Under |
7 |
| Age 22 facilities, the rates taking effect on July
1, 1998 |
8 |
| shall include an increase of 3%. For facilities licensed by the
|
9 |
| Department of Public Health under the Nursing Home Care Act as |
10 |
| Skilled Nursing
facilities or Intermediate Care facilities, |
11 |
| the rates taking effect on July 1,
1998 shall include an |
12 |
| increase of 3% plus $1.10 per resident-day, as defined by
the |
13 |
| Department. For facilities licensed by the Department of Public |
14 |
| Health under the Nursing Home Care Act as Intermediate Care |
15 |
| Facilities for the Developmentally Disabled or Long Term Care |
16 |
| for Under Age 22 facilities, the rates taking effect on January |
17 |
| 1, 2006 shall include an increase of 3%.
|
18 |
| For facilities licensed by the Department of Public Health |
19 |
| under the
Nursing Home Care Act as Intermediate Care for the |
20 |
| Developmentally Disabled
facilities or Long Term Care for Under |
21 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 |
22 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, |
23 |
| as defined by the Department. For facilities licensed by the
|
24 |
| Department of Public Health under the Nursing Home Care Act as |
25 |
| Skilled Nursing
facilities or Intermediate Care facilities, |
26 |
| the rates taking effect on July 1,
1999 shall include an |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| increase of 1.6% and, for services provided on or after
October |
2 |
| 1, 1999, shall be increased by $4.00 per resident-day, as |
3 |
| defined by
the Department.
|
4 |
| For facilities licensed by the Department of Public Health |
5 |
| under the
Nursing Home Care Act as Intermediate Care for the |
6 |
| Developmentally Disabled
facilities or Long Term Care for Under |
7 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 |
8 |
| shall include an increase of 2.5% per resident-day,
as defined |
9 |
| by the Department. For facilities licensed by the Department of
|
10 |
| Public Health under the Nursing Home Care Act as Skilled |
11 |
| Nursing facilities or
Intermediate Care facilities, the rates |
12 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% |
13 |
| per resident-day, as defined by the Department.
|
14 |
| For facilities licensed by the Department of Public Health |
15 |
| under the
Nursing Home Care Act as skilled nursing facilities |
16 |
| or intermediate care
facilities, a new payment methodology must |
17 |
| be implemented for the nursing
component of the rate effective |
18 |
| July 1, 2003. The Department of Public Aid
(now Healthcare and |
19 |
| Family Services) shall develop the new payment methodology |
20 |
| using the Minimum Data Set
(MDS) as the instrument to collect |
21 |
| information concerning nursing home
resident condition |
22 |
| necessary to compute the rate. The Department
shall develop the |
23 |
| new payment methodology to meet the unique needs of
Illinois |
24 |
| nursing home residents while remaining subject to the |
25 |
| appropriations
provided by the General Assembly.
A transition |
26 |
| period from the payment methodology in effect on June 30, 2003
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| to the payment methodology in effect on July 1, 2003 shall be |
2 |
| provided for a
period not exceeding 3 years and 184 days after |
3 |
| implementation of the new payment
methodology as follows:
|
4 |
| (A) For a facility that would receive a lower
nursing |
5 |
| component rate per patient day under the new system than |
6 |
| the facility
received
effective on the date immediately |
7 |
| preceding the date that the Department
implements the new |
8 |
| payment methodology, the nursing component rate per |
9 |
| patient
day for the facility
shall be held at
the level in |
10 |
| effect on the date immediately preceding the date that the
|
11 |
| Department implements the new payment methodology until a |
12 |
| higher nursing
component rate of
reimbursement is achieved |
13 |
| by that
facility.
|
14 |
| (B) For a facility that would receive a higher nursing |
15 |
| component rate per
patient day under the payment |
16 |
| methodology in effect on July 1, 2003 than the
facility |
17 |
| received effective on the date immediately preceding the |
18 |
| date that the
Department implements the new payment |
19 |
| methodology, the nursing component rate
per patient day for |
20 |
| the facility shall be adjusted.
|
21 |
| (C) Notwithstanding paragraphs (A) and (B), the |
22 |
| nursing component rate per
patient day for the facility |
23 |
| shall be adjusted subject to appropriations
provided by the |
24 |
| General Assembly.
|
25 |
| Notwithstanding any other provision of this Section, for |
26 |
| facilities licensed by the Department of Public Health under |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| the
Nursing Home Care Act as skilled nursing facilities or |
2 |
| intermediate care
facilities, the numerator of the ratio used |
3 |
| by the Department of Healthcare and Family Services to compute |
4 |
| the rate payable under this Section using the Minimum Data Set |
5 |
| (MDS) methodology shall incorporate the following annual |
6 |
| amounts as the additional funds appropriated to the Department |
7 |
| specifically to pay for rates based on the MDS nursing |
8 |
| component methodology in excess of the funding in effect on |
9 |
| December 31, 2006: |
10 |
| (i) For rates taking effect January 1, 2007, |
11 |
| $60,000,000. |
12 |
| (ii) For rates taking effect October 1, 2007, |
13 |
| $110,000,000. |
14 |
| Notwithstanding any other provision of this Section, for |
15 |
| facilities licensed by the Department of Public Health under |
16 |
| the Nursing Home Care Act as skilled nursing facilities or |
17 |
| intermediate care facilities, the support component of the |
18 |
| rates taking effect on October 1, 2007 shall be computed using |
19 |
| the most recent cost reports on file with the Department of |
20 |
| Healthcare and Family Services no later than April 1, 2005, |
21 |
| updated for inflation to January 1, 2006.
|
22 |
| For facilities licensed by the Department of Public Health |
23 |
| under the
Nursing Home Care Act as Intermediate Care for the |
24 |
| Developmentally Disabled
facilities or Long Term Care for Under |
25 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 |
26 |
| shall include a statewide increase of 7.85%, as
defined by the |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| Department.
|
2 |
| For facilities licensed by the Department of Public Health |
3 |
| under the
Nursing Home Care Act as Intermediate Care for the |
4 |
| Developmentally Disabled
facilities or Long Term Care for Under |
5 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 |
6 |
| shall include a statewide increase of 2.0%, as
defined by the |
7 |
| Department.
This increase terminates on July 1, 2002;
beginning |
8 |
| July 1, 2002 these rates are reduced to the level of the rates
|
9 |
| in effect on March 31, 2002, as defined by the Department.
|
10 |
| For facilities licensed by the Department of Public Health |
11 |
| under the
Nursing Home Care Act as skilled nursing facilities |
12 |
| or intermediate care
facilities, the rates taking effect on |
13 |
| July 1, 2001 shall be computed using the most recent cost |
14 |
| reports
on file with the Department of Public Aid no later than |
15 |
| April 1, 2000,
updated for inflation to January 1, 2001. For |
16 |
| rates effective July 1, 2001
only, rates shall be the greater |
17 |
| of the rate computed for July 1, 2001
or the rate effective on |
18 |
| June 30, 2001.
|
19 |
| Notwithstanding any other provision of this Section, for |
20 |
| facilities
licensed by the Department of Public Health under |
21 |
| the Nursing Home Care Act
as skilled nursing facilities or |
22 |
| intermediate care facilities, the Illinois
Department shall |
23 |
| determine by rule the rates taking effect on July 1, 2002,
|
24 |
| which shall be 5.9% less than the rates in effect on June 30, |
25 |
| 2002.
|
26 |
| Notwithstanding any other provision of this Section, for |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| facilities
licensed by the Department of Public Health under |
2 |
| the Nursing Home Care Act as
skilled nursing
facilities or |
3 |
| intermediate care facilities, if the payment methodologies |
4 |
| required under Section 5A-12 and the waiver granted under 42 |
5 |
| CFR 433.68 are approved by the United States Centers for |
6 |
| Medicare and Medicaid Services, the rates taking effect on July |
7 |
| 1, 2004 shall be 3.0% greater than the rates in effect on June |
8 |
| 30, 2004. These rates shall take
effect only upon approval and
|
9 |
| implementation of the payment methodologies required under |
10 |
| Section 5A-12.
|
11 |
| Notwithstanding any other provisions of this Section, for |
12 |
| facilities licensed by the Department of Public Health under |
13 |
| the Nursing Home Care Act as skilled nursing facilities or |
14 |
| intermediate care facilities, the rates taking effect on |
15 |
| January 1, 2005 shall be 3% more than the rates in effect on |
16 |
| December 31, 2004.
|
17 |
| Notwithstanding any other provisions of this Section, for |
18 |
| facilities licensed by the Department of Public Health under |
19 |
| the Nursing Home Care Act as intermediate care facilities that |
20 |
| are federally defined as Institutions for Mental Disease, a |
21 |
| socio-development component rate equal to 6.6% of the |
22 |
| facility's nursing component rate as of January 1, 2006 shall |
23 |
| be established and paid effective July 1, 2006. The |
24 |
| socio-development component of the rate as of July 1, 2007 |
25 |
| shall be increased by a factor of 2.53. The Illinois Department |
26 |
| may by rule adjust these socio-development component rates, but |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| in no case may such rates be diminished.
|
2 |
| For facilities
licensed
by the
Department of Public Health |
3 |
| under the Nursing Home Care Act as Intermediate
Care for
the |
4 |
| Developmentally Disabled facilities or as long-term care |
5 |
| facilities for
residents under 22 years of age, the rates |
6 |
| taking effect on July 1,
2003 shall
include a statewide |
7 |
| increase of 4%, as defined by the Department.
|
8 |
| For facilities licensed by the Department of Public Health |
9 |
| under the
Nursing Home Care Act as Intermediate Care for the |
10 |
| Developmentally Disabled
facilities or Long Term Care for Under |
11 |
| Age 22 facilities, the rates taking
effect on October 1, 2007 |
12 |
| shall include a statewide increase of 2.5%, as
defined by the |
13 |
| Department.
|
14 |
| Notwithstanding any other provision of this Section, for |
15 |
| facilities licensed by the Department of Public Health under |
16 |
| the Nursing Home Care Act as skilled nursing facilities or |
17 |
| intermediate care facilities, effective January 1, 2005, |
18 |
| facility rates shall be increased by the difference between (i) |
19 |
| a facility's per diem property, liability, and malpractice |
20 |
| insurance costs as reported in the cost report filed with the |
21 |
| Department of Public Aid and used to establish rates effective |
22 |
| July 1, 2001 and (ii) those same costs as reported in the |
23 |
| facility's 2002 cost report. These costs shall be passed |
24 |
| through to the facility without caps or limitations, except for |
25 |
| adjustments required under normal auditing procedures.
|
26 |
| Rates established effective each July 1 shall govern |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| payment
for services rendered throughout that fiscal year, |
2 |
| except that rates
established on July 1, 1996 shall be |
3 |
| increased by 6.8% for services
provided on or after January 1, |
4 |
| 1997. Such rates will be based
upon the rates calculated for |
5 |
| the year beginning July 1, 1990, and for
subsequent years |
6 |
| thereafter until June 30, 2001 shall be based on the
facility |
7 |
| cost reports
for the facility fiscal year ending at any point |
8 |
| in time during the previous
calendar year, updated to the |
9 |
| midpoint of the rate year. The cost report
shall be on file |
10 |
| with the Department no later than April 1 of the current
rate |
11 |
| year. Should the cost report not be on file by April 1, the |
12 |
| Department
shall base the rate on the latest cost report filed |
13 |
| by each skilled care
facility and intermediate care facility, |
14 |
| updated to the midpoint of the
current rate year. In |
15 |
| determining rates for services rendered on and after
July 1, |
16 |
| 1985, fixed time shall not be computed at less than zero. The
|
17 |
| Department shall not make any alterations of regulations which |
18 |
| would reduce
any component of the Medicaid rate to a level |
19 |
| below what that component would
have been utilizing in the rate |
20 |
| effective on July 1, 1984.
|
21 |
| (2) Shall take into account the actual costs incurred by |
22 |
| facilities
in providing services for recipients of skilled |
23 |
| nursing and intermediate
care services under the medical |
24 |
| assistance program.
|
25 |
| (3) Shall take into account the medical and psycho-social
|
26 |
| characteristics and needs of the patients.
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| (4) Shall take into account the actual costs incurred by |
2 |
| facilities in
meeting licensing and certification standards |
3 |
| imposed and prescribed by the
State of Illinois, any of its |
4 |
| political subdivisions or municipalities and by
the U.S. |
5 |
| Department of Health and Human Services pursuant to Title XIX |
6 |
| of the
Social Security Act.
|
7 |
| The Department of Healthcare and Family Services
shall |
8 |
| develop precise standards for
payments to reimburse nursing |
9 |
| facilities for any utilization of
appropriate rehabilitative |
10 |
| personnel for the provision of rehabilitative
services which is |
11 |
| authorized by federal regulations, including
reimbursement for |
12 |
| services provided by qualified therapists or qualified
|
13 |
| assistants, and which is in accordance with accepted |
14 |
| professional
practices. Reimbursement also may be made for |
15 |
| utilization of other
supportive personnel under appropriate |
16 |
| supervision.
|
17 |
| (Source: P.A. 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, |
18 |
| eff. 11-21-05; 94-838, eff. 6-6-06; 94-964, eff. 6-28-06; |
19 |
| 95-12, eff. 7-2-07.)
|
20 |
| (305 ILCS 5/5-27 new)
|
21 |
| Sec. 5-27. Pilot mandatory managed care program. To |
22 |
| determine the potential for savings and improved quality of |
23 |
| care in the Medicaid program, the Department shall implement in |
24 |
| State fiscal year 2008 a pilot mandatory managed care program |
25 |
| requiring recipients to enroll with a Managed Care Entity (MCE) |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| meeting the requirements of Section 1932 of the Social Security |
2 |
| Act and under contract with the Department. The program shall |
3 |
| be implemented in at least 2 contiguous counties with not less |
4 |
| than 200,000 inhabitants and not more than 2,000,000 |
5 |
| inhabitants. The program shall have the following features: |
6 |
| (1) All recipients in the selected counties who do not |
7 |
| have eligibility through the spend-down program and who are |
8 |
| not excluded from State plan based mandatory managed care |
9 |
| by the Social Security Act shall be enrolled in the |
10 |
| program. |
11 |
| (2) Only the following services may be excluded from |
12 |
| the program and shall be delivered to eligible recipients |
13 |
| through the fee-for-service system: nursing facility and |
14 |
| assisted living long term care services, services provided |
15 |
| through waivers granted pursuant to Sections 1115 and 1915 |
16 |
| of the Social Security Act, and pharmacy services. |
17 |
| (3) Up to 3 Managed Care Entities shall be selected for |
18 |
| the program. |
19 |
| (4) The Department must use the following criteria in |
20 |
| selecting MCEs to participate in the pilot program: (A) |
21 |
| network adequacy ensuring availability and access to care; |
22 |
| (B) provider payment levels; (C) quality assurance plans |
23 |
| including utilization management and peer review; (D) past |
24 |
| performance on quality outcome measures (for example, the |
25 |
| Health Plan Employer Data and Information Set (HEDIS)); (E) |
26 |
| plan for care management; (F) data system adequacy, member |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| enrollment, and communication plan; and (G) any other |
2 |
| criteria that the Department determines appropriate. |
3 |
| (5) The Department shall require that the MCEs in the |
4 |
| pilot counties keep case-specific data under the pilot |
5 |
| program and produce periodic and final reports based on |
6 |
| that data of, at a minimum, the types and frequency of care |
7 |
| provided to enrollees and the types and frequency of |
8 |
| specialty and hospital care provided. The Department shall |
9 |
| require case-specific data in a manner that does not |
10 |
| violate applicable privacy laws. |
11 |
| (6) The Department shall perform an annual analysis of |
12 |
| healthcare outcomes for the population served under the |
13 |
| pilot program compared to healthcare outcomes for the |
14 |
| medical assistance population enrolled in the primary care |
15 |
| case management program under this Article. The Department |
16 |
| shall present this analysis to the General Assembly no |
17 |
| later than 60 days after the end of the month for which |
18 |
| HEDIS measures are reported for the calendar year.
|
19 |
| (305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
|
20 |
| Sec. 5B-8. Long-Term Care Provider Fund.
|
21 |
| (a) There is created in the State Treasury the Long-Term
|
22 |
| Care Provider Fund. Interest earned by the Fund shall be
|
23 |
| credited to the Fund. The Fund shall not be used to replace any
|
24 |
| moneys appropriated to the Medicaid program by the General |
25 |
| Assembly.
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
|
1 |
| (b) The Fund is created for the purpose of receiving and
|
2 |
| disbursing moneys in accordance with this Article. |
3 |
| Disbursements
from the Fund shall be made only as follows:
|
4 |
| (1) For payments to skilled or intermediate nursing
|
5 |
| facilities, including county nursing facilities but |
6 |
| excluding
State-operated facilities, under Title XIX of |
7 |
| the Social Security
Act and Article V of this Code.
|
8 |
| (2) For the reimbursement of moneys collected by the
|
9 |
| Illinois Department through error or mistake, and for |
10 |
| making
required payments under Section 5-4.38(a)(1) if |
11 |
| there are no
moneys available for such payments in the |
12 |
| Medicaid Long Term Care
Provider Participation Fee Trust |
13 |
| Fund.
|
14 |
| (3) For payment of administrative expenses incurred by |
15 |
| the
Illinois Department or its agent in performing the |
16 |
| activities
authorized by this Article.
|
17 |
| (3.5) For reimbursement of expenses incurred by |
18 |
| long-term care facilities, and payment of administrative |
19 |
| expenses incurred by the Department of Public Health, in |
20 |
| relation to the conduct and analysis of background checks |
21 |
| for identified offenders under the Nursing Home Care Act.
|
22 |
| (4) For payments of any amounts that are reimbursable |
23 |
| to the
federal government for payments from this Fund that |
24 |
| are required
to be paid by State warrant.
|
25 |
| (5) For making transfers to the General Obligation Bond
|
26 |
| Retirement and Interest Fund, as those transfers are |
|
|
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09500HB0691sam002 |
- 45 - |
LRB095 08369 WGH 38691 a |
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|
1 |
| authorized
in the proceedings authorizing debt under the |
2 |
| Short Term Borrowing Act,
but transfers made under this |
3 |
| paragraph (5) shall not exceed the
principal amount of debt |
4 |
| issued in anticipation of the receipt by
the State of |
5 |
| moneys to be deposited into the Fund.
|
6 |
| Disbursements from the Fund, other than transfers to the
|
7 |
| General Obligation Bond Retirement and Interest Fund, shall be |
8 |
| by
warrants drawn by the State Comptroller upon receipt of |
9 |
| vouchers
duly executed and certified by the Illinois |
10 |
| Department.
|
11 |
| (c) The Fund shall consist of the following:
|
12 |
| (1) All moneys collected or received by the Illinois
|
13 |
| Department from the long-term care provider assessment |
14 |
| imposed by
this Article.
|
15 |
| (2) All federal matching funds received by the Illinois
|
16 |
| Department as a result of expenditures made by the Illinois
|
17 |
| Department that are attributable to moneys deposited in the |
18 |
| Fund.
|
19 |
| (3) Any interest or penalty levied in conjunction with |
20 |
| the
administration of this Article.
|
21 |
| (4) Any balance in the Medicaid Long Term Care Provider |
22 |
| Participation
Fee Fund in the State Treasury. The balance |
23 |
| shall be transferred to the
Fund upon certification by the |
24 |
| Illinois Department to the State Comptroller
that all of |
25 |
| the disbursements required by Section 5-4.31(b) of this |
26 |
| Code
have been made.
|