(305 ILCS 5/5C-1) (from Ch. 23, par. 5C-1)
Sec. 5C-1. Definitions. As used in this Article, unless the context
requires otherwise:
"Fund" means the Care Provider Fund for Persons with a Developmental Disability.
"Care facility for persons with a developmental disability" means an intermediate care
facility for the intellectually disabled within the meaning of Title XIX of the
Social Security Act, whether public or private and whether organized for
profit or not-for-profit, but shall not include any facility operated by
the State.
"Care provider for persons with a developmental disability" means a person conducting,
operating, or maintaining a facility for persons with a developmental disability. For
this purpose, "person" means any political subdivision of the State,
municipal corporation, individual, firm, partnership, corporation, company,
limited liability company, association, joint stock association, or trust,
or a receiver, executor, trustee, guardian or other representative
appointed by order of any court.
"Adjusted gross developmentally disabled care revenue" shall be computed
separately for each facility for persons with a developmental disability conducted,
operated, or maintained by a care provider for persons with a developmental disability, and
means the total revenue of the care provider for persons with a developmental disability for
inpatient residential services less contractual allowances and discounts on
patients' accounts, but does not include non-patient revenue from sources
such as contributions, donations or bequests, investments, day training
services, television and telephone service, and rental of facility space.
"Long-term care facility for persons under 22 years of age serving clinically complex residents" means a facility licensed by the Department of Public Health as a long-term care facility for persons under 22 meeting the qualifications of Section 5-5.4h of this Code. (Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-143, eff. 7-27-15.)
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(305 ILCS 5/5C-2) (from Ch. 23, par. 5C-2)
Sec. 5C-2. Assessment; no local authorization to tax.
(a) For the privilege of engaging in the occupation of care provider for persons with a developmental disability, an assessment is imposed upon each care provider for persons with a developmental disability in an amount equal to 6%, or the maximum allowed under federal regulation, whichever is less, of its adjusted
gross developmentally disabled care revenue for the prior State fiscal
year. Notwithstanding any provision of any other Act to the contrary, this
assessment shall be construed as a tax, but may not be added to the charges
of an individual's nursing home care that is paid for in whole, or in part,
by a federal, State, or combined federal-state medical care program, except
those individuals receiving Medicare Part B benefits solely.
(b) Nothing in this amendatory Act of 1995 shall be construed
to authorize any home rule unit or other unit of local government to license
for revenue or impose a tax or assessment upon a care provider for persons with a developmental disability or the occupation of care provider for persons with a developmental disability, or a tax
or assessment measured by the income or earnings of a care provider for persons with a developmental disability.
(c) Effective July 1, 2013, for the privilege of engaging in the occupation of long-term care facility for persons under 22 years of age serving clinically complex residents provider, an assessment is imposed upon each long-term care facility for persons under 22 years of age serving clinically complex residents provider in the same amount and upon the same conditions and requirements as imposed in Article V-B of this Code and a license fee is imposed in the same amount and upon the same conditions and requirements as imposed in Article V-E of this Code. Notwithstanding any provision of any other Act to the contrary, the assessment and license fee imposed by this subsection (c) shall be construed as a tax, but may not be added to the charges of an individual's nursing home care that is paid for in whole, or in part, by a federal, State, or combined federal-State medical care program, except for those individuals receiving Medicare Part B benefits solely. (Source: P.A. 98-651, eff. 6-16-14; 99-143, eff. 7-27-15.)
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(305 ILCS 5/5C-4) (from Ch. 23, par. 5C-4)
Sec. 5C-4. Reporting; penalty; maintenance of records.
(a) After June 30 of each State fiscal year, and on or before
September 30 of the succeeding State fiscal year, every care provider for persons with a developmental disability subject to assessment under this Article shall file
a return with the Illinois Department. The return shall report the
adjusted gross developmentally disabled care revenue from the State fiscal
year just ended and shall be utilized by the Illinois Department to
calculate the assessment for the State fiscal year commencing on the
preceding July 1. The return shall be on a form prepared by the Illinois
Department and shall state the following:
(1) The name of the care provider for persons with a |
| developmental disability.
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(2) The address of the care provider's principal
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| place of business from which the provider engages in the occupation of care provider for persons with a developmental disability in this State, and the name and address of all care facilities for persons with a developmental disability operated or maintained by the provider in this State.
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(3) The adjusted gross developmentally disabled care
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| revenue for the State fiscal year just ended, the amount of assessment imposed under Section 5C-2 for the State fiscal year for which the return is filed, and the amount of each quarterly installment to be paid during the State fiscal year.
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(4) The amount of penalty due, if any.
(5) Other reasonable information the Illinois
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(b) If a care provider for persons with a developmental disability operates
or maintains more than one care facility for persons with a developmental disability
in this State, the provider may not file a single return covering
all those care facilities for persons with a developmental disability, but shall file
a separate return for each care facility for persons with a developmental disability and shall compute and pay the assessment for each
care facility for persons with a developmental disability separately.
(c) Notwithstanding any other provision in this Article, a
person who ceases to conduct, operate, or maintain a
care facility for persons with a developmental disability in respect of which the
person is subject to assessment under this Article as a care provider for persons with a developmental disability, the assessment for the State fiscal year
in which the cessation occurs shall be adjusted by multiplying
the assessment computed under Section 5C-2 by a fraction, the
numerator of which is the number of months in the year during
which the provider conducts, operates, or maintains the
care facility for persons with a developmental disability and the denominator of
which is 12. The person shall file a final, amended return
with the Illinois Department not more than 90 days after the
cessation reflecting the adjustment and shall pay with the
final return the assessment for the year as so adjusted (to the
extent not previously paid).
(d) Notwithstanding any other provision of this Article, a
provider who commences conducting, operating, or maintaining a
care facility for persons with a developmental disability shall file an initial
return for the State fiscal year in which the commencement
occurs within 90 days thereafter and shall pay the assessment
computed under Section 5C-2 and subsection (e) in equal
installments on the due date of the return and on the regular
installment due dates for the State fiscal year occurring after
the due date of the initial return.
(e) Notwithstanding any other provision of this Article, in
the case of a care provider for persons with a developmental disability that did not
conduct, operate, or maintain a care facility for persons with a developmental disability throughout the prior State fiscal year, the assessment
for that State fiscal year shall be computed on the basis of
hypothetical adjusted gross developmentally disabled care revenue
for the prior year as determined by rules adopted by
the Illinois Department (which may be based on annualization of
the provider's actual revenues for a portion of the State fiscal
year, or revenues of a comparable facility for such year,
including revenues realized by a prior provider from the same
facility during such year).
(f) In the case of a care provider for persons with a developmental disability
existing as a corporation or legal entity other than an
individual, the return filed by it shall be signed by its
president, vice-president, secretary, or treasurer or by its
properly authorized agent.
(g) If a care provider for persons with a developmental disability fails to
file its return for a State fiscal year on or before the due date
of the return, there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5C-2 for the State fiscal year a penalty
assessment equal to 25% of the assessment imposed for the year.
(h) Every care provider for persons with a developmental disability subject to
assessment under this Article shall keep records and books
that will permit the determination of adjusted gross developmentally disabled care revenue on a State fiscal year
basis. All such books and records shall be kept in the English
language and shall, at all times during business hours of the
day, be subject to inspection by the Illinois Department or its
duly authorized agents and employees.
(Source: P.A. 99-143, eff. 7-27-15.)
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(305 ILCS 5/5C-6) (from Ch. 23, par. 5C-6)
Sec. 5C-6. Administration; enforcement provisions.
(a) To the extent practicable, the Illinois Department shall administer and
enforce this Article and collect the assessments, interest, and
penalty assessments imposed under this Article, using procedures
employed in its administration of this Code generally and, as it deems
appropriate, in a manner similar to that in which the Department
of Revenue administers and collects the retailers' occupation tax
pursuant to the Retailers' Occupation Tax Act ("ROTA"). Instead
of certificates of registration, the Illinois Department shall
establish and maintain a listing of all care providers for persons with a developmental disability appearing in the licensing records of the
Department of Public Health, which shall show each provider's
name, principal place of business, and the name and address of
each care facility for persons with a developmental disability operated or maintained by the
provider in this State. In addition, the following Retailers' Occupation
Tax Act provisions are incorporated by reference into this Section, except
that the Illinois Department and its Director (rather than the Department
of Revenue and its Director) and every care provider for persons with a developmental disability subject to assessment measured by adjusted gross developmentally
disabled care revenue and to the return filing requirements of this Article
(rather than persons subject to retailers' occupation tax measured by gross
receipts from the sale of tangible personal property at retail and to the
return filing requirements of ROTA) shall have the powers, duties, and
rights specified in these ROTA provisions, as modified in this Section or
by the Illinois Department in a manner consistent with this Article and
except as manifestly inconsistent with the other provisions of this Article:
(1) ROTA, Section 4 (examination of return; notice of |
| correction; evidence; limitations; protest and hearing), except that (i) the Illinois Department shall issue notices of assessment liability (rather than notices of tax liability as provided in ROTA, Section 4); (ii) in the case of a fraudulent return or in the case of an extended period agreed to by the Illinois Department and the care provider for persons with a developmental disability before the expiration of the limitation period, no notice of assessment liability shall be issued more than 3 years after the later of the due date of the return required by Section 5C-5 or the date the return (or an amended return) was filed (rather within the period stated in ROTA, Section 4); and (iii) the penalty provisions of ROTA, Section 4 shall not apply.
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(2) ROTA, Section 5 (failure to make return; failure
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| to pay assessment), except that the penalty and interest provisions of ROTA, Section 5 shall not apply.
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(3) ROTA, Section 5a (lien; attachment; termination;
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| notice; protest; review; release of lien; status of lien).
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(4) ROTA, Section 5b (State lien notices; State lien
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| index; duties of recorder and registrar of titles).
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(5) ROTA, Section 5c (liens; certificate of release).
(6) ROTA, Section 5d (Department not required to
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| furnish bond; claim to property attached or levied upon).
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(7) ROTA, Section 5e (foreclosure on liens;
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(8) ROTA, Section 5f (demand for payment; levy and
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| sale of property; limitation).
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(9) ROTA, Section 5g (sale of property; redemption).
(10) ROTA, Section 5j (sales on transfers outside
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| usual course of business; report; payment of assessment; rights and duties of purchaser; penalty).
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(11) ROTA, Section 6 (erroneous payments; credit or
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| refund), provided that (i) the Illinois Department may only apply an amount otherwise subject to credit or refund to a liability arising under this Article; (ii) except in the case of an extended period agreed to by the Illinois Department and the care provider for persons with a developmental disability prior to the expiration of this limitation period, a claim for credit or refund must be filed no more than 3 years after the due date of the return required by Section 5C-5 (rather than the time limitation stated in ROTA, Section 6); and (iii) credits or refunds shall not bear interest.
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(12) ROTA, Section 6a (claims for credit or refund).
(13) ROTA, Section 6b (tentative determination of
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| claim; notice; hearing; review), provided that a care provider for persons with a developmental disability or its representative shall have 60 days (rather than 20 days) within which to file a protest and request for hearing in response to a tentative determination of claim.
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(14) ROTA, Section 6c (finality of tentative
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(15) ROTA, Section 8 (investigations and hearings).
(16) ROTA, Section 9 (witness; immunity).
(17) ROTA, Section 10 (issuance of subpoenas;
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| attendance of witnesses; production of books and records).
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(18) ROTA, Section 11 (information confidential;
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(19) ROTA, Section 12 (rules and regulations;
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| hearing; appeals), except that a care provider for persons with a developmental disability shall not be required to file a bond or be subject to a lien in lieu thereof in order to seek court review under the Administrative Review Law of a final assessment or revised final assessment or the equivalent thereof issued by the Illinois Department under this Article.
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(b) In addition to any other remedy provided for and without sending a
notice of assessment liability, the Illinois Department may collect an
unpaid assessment by withholding, as payment of the assessment,
reimbursements or other amounts otherwise payable by the Illinois
Department to the provider.
(Source: P.A. 99-143, eff. 7-27-15.)
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(305 ILCS 5/5C-7) (from Ch. 23, par. 5C-7)
Sec. 5C-7. Care Provider Fund for Persons with a Developmental Disability.
(a) There is created in the State Treasury the
Care Provider Fund for Persons with a Developmental Disability. Interest earned by the Fund shall be credited to the
Fund. The Fund shall not be used to replace any moneys appropriated to the
Medicaid program by the General Assembly.
(b) The Fund is created for the purpose of receiving and
disbursing assessment moneys in accordance with this Article.
Disbursements from the Fund shall be made only as follows:
(1) For payments to intermediate care facilities for |
| persons with a developmental disability under Title XIX of the Social Security Act and Article V of this Code.
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(2) For the reimbursement of moneys collected by the
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| Illinois Department through error or mistake, and to make required payments under Section 5-4.28(a)(1) of this Code if there are no moneys available for such payments in the Medicaid Provider for Persons with a Developmental Disability Participation Fee Trust Fund.
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(3) For payment of administrative expenses incurred
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| by the Department of Human Services or its agent or the Illinois Department or its agent in performing the activities authorized by this Article.
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(4) For payments of any amounts which are
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| reimbursable to the federal government for payments from this Fund which are required to be paid by State warrant.
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(5) For making transfers to the General Obligation
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| Bond Retirement and Interest Fund as those transfers are authorized in the proceedings authorizing debt under the Short Term Borrowing Act, but transfers made under this paragraph (5) shall not exceed the principal amount of debt issued in anticipation of the receipt by the State of moneys to be deposited into the Fund.
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(6) For making refunds as required under Section
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Disbursements from the Fund, other than transfers to the
General Obligation Bond Retirement and Interest Fund, shall be by
warrants drawn by the State Comptroller upon receipt of vouchers
duly executed and certified by the Illinois Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois
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| Department from the care provider for persons with a developmental disability assessment imposed by this Article.
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(2) All federal matching funds received by the
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| Illinois Department as a result of expenditures made by the Illinois Department that are attributable to moneys deposited in the Fund.
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(3) Any interest or penalty levied in conjunction
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| with the administration of this Article.
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(4) Any balance in the Medicaid Care Provider for
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| Persons With a Developmental Disability Participation Fee Trust Fund in the State Treasury. The balance shall be transferred to the Fund upon certification by the Illinois Department to the State Comptroller that all of the disbursements required by Section 5-4.21(b) of this Code have been made.
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(5) All other moneys received for the Fund from any
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| other source, including interest earned thereon.
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(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-143, eff. 7-27-15.)
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(305 ILCS 5/5F-15) Sec. 5F-15. Definitions. As used in this Article: "Appeal" means any of the procedures that deal with the review of adverse organization determinations on the health care services the enrollee believes he or she is entitled to receive, including delay in providing, arranging for, or approving the health care services, such that a delay would adversely affect the health of the enrollee or on any amounts the enrollee must pay for a service, as defined under 42 CFR 422.566(b). These procedures include reconsiderations by the managed care organization and, if necessary, an independent review entity as provided by the Health Carrier External Review Act, hearings before administrative law judges, review by the Medicare Appeals Council, and judicial review. "Demonstration Project" means the nursing home component of the Medicare-Medicaid Alignment Initiative Demonstration Project. "Department" means the Department of Healthcare and Family Services. "Enrollee" means an individual who resides in a nursing home or is qualified to be admitted to a nursing home and is enrolled with a managed care organization participating in the Demonstration Project. "Health care services" means the diagnosis, treatment, and prevention of disease and includes medication, primary care, nursing or medical care, mental health treatment, psychiatric rehabilitation, memory loss services, physical, occupational, and speech rehabilitation, enhanced care, medical supplies and equipment and the repair of such equipment, and assistance with activities of daily living. "Managed care organization" or "MCO" means an entity that meets the definition of health maintenance organization as defined in the Health Maintenance Organization Act, is licensed, regulated and in good standing with the Department of Insurance, and is authorized to participate in the nursing home component of the Medicare-Medicaid Alignment Initiative Demonstration Project by a 3-way contract with the Department of Healthcare and Family Services and the Centers for Medicare and Medicaid Services. "Medical professional" means a physician, physician assistant, or nurse practitioner. "Medically necessary" means health care services that a medical professional, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or its symptoms, and that are: (i) in accordance with the generally accepted standards of medical practice; (ii) clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or disease; and (iii) not primarily for the convenience of the patient, a medical professional, other health care provider, caregiver, family member, or other interested party. "Nursing home" means a facility licensed under the Nursing Home Care Act. "Nurse practitioner" means an individual properly licensed as a nurse practitioner under the Nurse Practice Act. "Physician" means an individual licensed to practice in all branches of medicine under the Medical Practice Act of 1987. "Physician assistant" means an individual properly licensed under the Physician Assistant Practice Act of 1987. "Resident" means an enrollee who is receiving personal or medical care, including, but not limited to, mental health treatment, psychiatric rehabilitation, physical rehabilitation, and assistance with activities of daily living, from a nursing home. "RAI Manual" means the most recent Resident Assessment Instrument Manual, published by the Centers for Medicare and Medicaid Services. "Resident's representative" means a person designated in writing by a resident to be the resident's representative or the resident's guardian, as described by the Nursing Home Care Act. "SNFist" means a medical professional specializing in the care of individuals residing in nursing homes employed by or under contract with a MCO. "Transition period" means a period of time immediately following enrollment into the Demonstration Project or an enrollee's movement from one managed care organization to another managed care organization or one care setting to another care setting.
(Source: P.A. 98-651, eff. 6-16-14.) |
(305 ILCS 5/5F-20) Sec. 5F-20. Network adequacy. (a) Every managed care organization shall allow every nursing home in its service area an opportunity to be a network contracted facility at the plan's standard terms, conditions, and rates. Either party may opt to limit the contract to existing residents only. (b) With the exception of subsection (c) of this Section, a managed care organization shall only terminate or refuse to renew a contract with a nursing home if the nursing home fails to meet quality standards if the following conditions are met: (1) the quality standards are made known to the |
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(2) the quality standards can be objectively
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(3) the nursing home is measured on at least a
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| year's worth of performance;
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(4) a nursing home that the MCO has determined did
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| not meet a quality standard has the opportunity to contest that determination by challenging the accuracy or the measurement of the data through an arbitration process agreed to by contract; and
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(5) the Department may attempt to mediate a dispute
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(c) A managed care organization may terminate or refuse to renew a contract with a nursing home for a material breach of the contract, including, but not limited to, failure to grant reasonable and timely access to the MCO's care coordinators, SNFists and other providers, termination from the Medicare or Medicaid program, or revocation of license.
(Source: P.A. 98-651, eff. 6-16-14.)
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(305 ILCS 5/5F-32) Sec. 5F-32. Non-emergency prior approval and appeal. (a) MCOs must have a method of receiving prior approval requests 24 hours a day, 7 days a week, 365 days a year from nursing home residents, physicians, or providers. If a response is not provided within 24 hours of the request and the nursing home is required by regulation to provide a service because a physician ordered it, the MCO must pay for the service if it is a covered service under the MCO's contract in the Demonstration Project, provided that the request is consistent with the policies and procedures of the MCO. In a non-emergency situation, notwithstanding any provisions in State law to the contrary, in the event a resident's physician orders a service, treatment, or test that is not approved by the MCO, the enrollee, physician, or provider may utilize an expedited appeal to the MCO. If an enrollee, physician, or provider requests an expedited appeal pursuant to 42 CFR 438.410, the MCO shall notify the individual filing the appeal, whether it is the enrollee, physician, or provider, within 24 hours after the submission of the appeal of all information from the enrollee, physician, or provider that the MCO requires to evaluate the appeal. The MCO shall notify the individual filing the appeal of the MCO's decision on an expedited appeal within 24 hours after receipt of the required information. (b) While the appeal is pending or if the ordered service, treatment, or test is denied after appeal, the Department of Public Health may not cite the nursing home for failure to provide the ordered service, treatment, or test. The nursing home shall not be liable or responsible for an injury in any regulatory proceeding for the following: (1) failure to follow the appealed or denied order; |
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(2) injury to the extent it was caused by the delay
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| or failure to perform the appealed or denied service, treatment, or test.
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Provided however, a nursing home shall continue to monitor, document, and ensure the patient's safety. Nothing in this subsection (b) is intended to otherwise change the nursing home's existing obligations under State and federal law to appropriately care for its residents.
(Source: P.A. 98-651, eff. 6-16-14; 99-719, eff. 1-1-17.)
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(305 ILCS 5/5H-3) Sec. 5H-3. Managed care assessment. (a) There is imposed upon managed care organization member months an assessment, calculated on base year data, as set forth below for the appropriate tier: (1) Tier 1: $78.90 per member month. (2) Tier 2: $1.40 per member month. (3) Tier 3: $2.40 per member month. (b) The tiers are established as follows: (1) Tier 1 includes the first 4,195,000 member months |
| in a Medicaid managed care organization for the base year;
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(2) Tier 2 includes member months over 4,195,000 in a
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| Medicaid managed care organization during the base year; and
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(3) Tier 3 includes member months during the base
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| year in a managed care organization that is not a Medicaid managed care organization.
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(c) For State fiscal year 2020, and for each State fiscal year thereafter, the Department may adjust rates or tier parameters or both in order to maximize the revenue generated by the assessment consistent with federal regulations and to meet federal statistical tests necessary for federal financial participation. Any upward adjustment to the Tier 3 rate shall be the minimum necessary to meet federal statistical tests.
(Source: P.A. 103-593, eff. 6-7-24.)
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(305 ILCS 5/6-1.2) (from Ch. 23, par. 6-1.2)
Sec. 6-1.2. Need. Income available to the person, when added to
contributions in money, substance, or services from other sources,
including contributions from legally responsible relatives, must be
insufficient to equal the grant amount established by Department regulation
(or by local governmental unit in units which do not receive State funds)
for such a person.
In determining income to be taken into account:
(1) The first $75 of earned income in income |
| assistance units comprised exclusively of one adult person shall be disregarded, and for not more than 3 months in any 12 consecutive months that portion of earned income beyond the first $75 that is the difference between the standard of assistance and the grant amount, shall be disregarded.
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(2) For income assistance units not comprised
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| exclusively of one adult person, when authorized by rules and regulations of the Illinois Department, a portion of earned income, not to exceed the first $25 a month plus 50% of the next $75, may be disregarded for the purpose of stimulating and aiding rehabilitative effort and self-support activity.
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"Earned income" means money earned in self-employment or wages, salary,
or commission for personal services performed as an employee. The eligibility
of any applicant for or recipient of public aid under this Article is not
affected by the payment of any grant under the "Senior Citizens and Persons with Disabilities Property Tax Relief Act", any
refund
or payment of the federal Earned Income Tax Credit, any rebate authorized under Section 2201(a) of the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116-136) or under any other federal economic stimulus program created in response to the COVID-19 emergency, or any distributions or
items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois Income Tax
Act.
(Source: P.A. 101-632, eff. 6-5-20.)
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(305 ILCS 5/6-1.7) (from Ch. 23, par. 6-1.7)
Sec. 6-1.7. A recipient of financial aid under this Article, which money
or vendor payment is made by a local governmental unit which administers aid
under this Article and is not a County Department, who is required under
Section 6-1.4 to register for and accept bona fide offers of employment
as provided in Section 11-20 but is not required to participate in a job
search, training and work program under Section 9-6, must also register
for work with such local governmental unit and must perform work without
compensation for a taxing district or private not-for-profit
organization as provided in this Section.
A local governmental unit which administers aid under this Article shall
maintain a roster of the persons who have registered for work in such local
governmental unit, and shall assure that such roster is available for the
inspection of the governing authorities of all taxing districts or
private not-for-profit organizations, or the
duly authorized agents thereof, for the selection of possible workers. Each
such local governmental unit shall cause persons, who are selected by a
taxing district or private not-for-profit organization to perform work,
to be notified at least 24 hours in
advance of the time the work is to begin.
Each such local governmental unit shall assure that the following additional
requirements are complied with:
(a) The taxing district or private not-for-profit organization may
not use a person selected to work under this
Section to replace a regular employee.
(b) The work to be performed for the taxing district or private
not-for-profit organization must be reasonably
related to the skills or interests of the recipient.
(c) The maximum number of hours such work may be performed is 8 hours
per day and 40 hours per week.
(d) The recipient shall be provided or compensated for transportation
to and from the work location.
(e) The person selected to work under this Section shall receive credit
against his or her monthly benefits under this Article, based on the State or federal
minimum wage rate, whichever is higher, for the work performed.
However, a taxing district or private not-for-profit organization
using the services of such recipient must pay
the recipient at least the State or federal minimum wage, whichever is higher, after such recipient has
received credit by the Illinois Department equal to the amount of financial
aid received under this Article, or the recipient shall be discharged.
Moneys made available for public aid purposes under this Article may be
expended to purchase worker's compensation insurance or to pay worker's
compensation claims.
For the purposes of this Section, "taxing district" means any unit of local
government, as defined in Section 1 of Article VII of the Constitution, with
the power to tax, and any school district or community college district.
(Source: P.A. 94-533, eff. 8-10-05.)
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(305 ILCS 5/6-2) (from Ch. 23, par. 6-2)
Sec. 6-2. Amount of aid. The amount and nature of General Assistance
for basic maintenance requirements shall be determined in accordance
with local budget standards for local governmental units which do not receive
State funds. For local governmental units which do receive State funds,
the amount and nature of General Assistance for basic maintenance requirements
shall be determined in accordance with the standards, rules and regulations
of the Illinois Department. However,
the amount and nature of any
financial aid is not affected by the payment of any grant under the
Senior Citizens and Persons with Disabilities Property Tax Relief Act, any rebate authorized under Section 2201(a) of the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116-136) or under any other federal economic stimulus program created in response to the COVID-19 emergency,
or any distributions or items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois Income Tax
Act. Due regard shall be given to the
requirements and the conditions existing in each case, and to the income,
money contributions and other support and resources available, from
whatever source. In local governmental units which do not receive State
funds, the grant shall be sufficient when added to all other income, money
contributions and support in excess of any excluded income or resources, to
provide the person with a grant in the amount established for such a person
by the local governmental unit based upon standards meeting basic
maintenance requirements. In local governmental units which
do receive State funds, the grant shall be sufficient when added to all
other income, money contributions and support in excess of any excluded
income or resources, to provide the person with a grant in the amount
established for such a person by Department regulation based upon standards
providing a livelihood compatible with health and well-being, as directed
by Section 12-4.11 of this Code.
The Illinois Department may conduct special projects, which may be
known as Grant Diversion Projects, under which recipients of financial aid
under this Article are placed in jobs and their grants are diverted to the
employer who in turn makes payments to the recipients in the form of salary
or other employment benefits. The Illinois Department shall by rule specify
the terms and conditions of such Grant Diversion Projects. Such projects
shall take into consideration and be coordinated with the programs
administered under the Illinois Emergency Employment Development Act.
The allowances provided under Article IX for recipients participating in
the training and rehabilitation programs shall be in addition to such
maximum payment.
Payments may also be made to provide persons receiving basic
maintenance support with necessary treatment, care and supplies required
because of illness or disability or with acute medical treatment, care,
and supplies.
Payments for necessary or acute medical
care under
this paragraph may be made to or in behalf of the person. Obligations
incurred for such services but not paid for at the time of a recipient's
death may be paid, subject to the rules and regulations of the Illinois
Department, after the death of the recipient.
(Source: P.A. 101-632, eff. 6-5-20.)
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(305 ILCS 5/6-2.1) (from Ch. 23, par. 6-2.1)
Sec. 6-2.1.
Assets of homeless persons.
(a) For the purpose of assisting homeless persons in securing housing,
all assistance units that include a homeless person shall have an asset
disregard no less than that applicable to recipients of benefits under
Article 4 of this Code. For purposes of this Section, "homeless" or
"homeless person" means either of the following:
(1) An individual who lacks a fixed, regular, and |
| adequate nighttime residence; or
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(2) An individual who has a primary nighttime
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| residence that is any of the following:
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(A) A supervised publicly or privately operated
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| shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelters, and transitional housing for the mentally ill).
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(B) An institution that provides a temporary
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| residence for individuals intended to be institutionalized.
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(C) A public or private place not designed for,
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| or ordinarily used as, a regular sleeping accommodation for human beings.
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(b) While the Illinois Department shall consider other indicia of
homelessness in determining whether a person is homeless, a letter from a
shelter provider stating that a person is homeless or residing in its
shelter shall create a rebuttable presumption that the person is homeless.
(Source: P.A. 87-1185.)
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(305 ILCS 5/6-9) (from Ch. 23, par. 6-9) Sec. 6-9. (a)(1) A local governmental unit may provide assistance to households under its General Assistance program following a declaration by the President of the United States of a major disaster or emergency pursuant to the Federal Disaster Relief Act of 1974, as now or hereafter amended, if the local governmental unit is within the area designated under the declaration. A local governmental unit may also provide assistance to households under its General Assistance program following a disaster proclamation issued by the Governor if the local governmental unit is within the area designated under the proclamation. Assistance under this Section may be provided to households which have suffered damage, loss, or hardships as a result of the major disaster or emergency. Assistance under this Section may be provided to households without regard to the eligibility requirements and other requirements of this Code. Assistance under this Section may be provided only during the 90-day period following the date of declaration of a major disaster or emergency. (2) A local governmental unit shall not use State funds to provide assistance under this Section. If a local governmental unit receives State funds to provide General Assistance under this Article, assistance provided by the local governmental unit under this Section shall not be considered in determining whether a local governmental unit has qualified to receive State funds under Article XII. A local governmental unit which provides assistance under this Section shall not, as a result of payment of such assistance, change the nature or amount of assistance provided to any other individual or family under this Article. (3) This Section shall not apply to any municipality of more than 500,000 population in which a separate program has been established by the Illinois Department under Section 6-1. (b)(1) A local governmental unit may provide assistance to households for food and temporary shelter. To qualify for assistance a household shall submit to the local governmental unit: (A) such application as the local governmental unit may require; (B) a copy of an application to the Federal Emergency Management Agency (hereinafter "FEMA") or the Small Business Administration (hereinafter "SBA") for assistance; (C) such other proof of damage, loss, or hardship as the local governmental unit may require; and (D) an agreement to reimburse the local governmental unit for the amount of any assistance received by the household under this subsection (b). (2) Assistance under this subsection (b) may be in the form of cash or vouchers. The amount of assistance provided to a household in any month under this subsection (b) shall not exceed the maximum amount payable under Section 6-2. (3) No assistance shall be provided to a household after it receives a determination of its application to FEMA or SBA for assistance. (4) A household which has received assistance under this subsection (b) shall reimburse the local governmental unit in full for any assistance received under this subsection. If the household receives assistance from FEMA or SBA in the form of loans or grants, the household shall reimburse the local governmental unit from those funds. If the household's request for assistance is denied or rejected by the FEMA or SBA, the household shall repay the local governmental unit in accordance with a repayment schedule prescribed by the local governmental unit. (c)(1) A local governmental unit may provide assistance to households for structural repairs to homes or for repair or replacement of home electrical or heating systems, bedding, and food refrigeration equipment. To qualify for assistance a household shall submit to the local governmental unit: (A) such application as the local governmental unit may require; (B) a copy of claim to an insurance company for reimbursement for the damage or loss for which assistance is sought; (C) such other proof of damage, loss, or hardship as the local governmental unit may require; and (D) an agreement to reimburse the local governmental unit for the amount of any assistance received by the household under this subsection (c). (2) Any assistance provided under this subsection (c) shall be in the form of direct payments to vendors, and shall not be made directly to a household. The total amount of assistance provided to a household under this subsection (c) shall not exceed $1,500. (3) No assistance shall be provided to a household after it receives a determination of its insurance claims. (4) A household which has received assistance under this subsection (c) shall reimburse the local governmental unit in full for any assistance received under this subsection. If the household's insurance claim is approved, the household shall reimburse the local governmental unit from the proceeds. If the household's insurance claim is denied, the household shall repay the local governmental unit in accordance with a repayment schedule prescribed by the local governmental unit.(Source: P.A. 103-192, eff. 1-1-24; 103-605, eff. 7-1-24.) |
(305 ILCS 5/6-11) (from Ch. 23, par. 6-11)
Sec. 6-11. General Assistance.
(a) Effective July 1, 1992, all State funded General Assistance and related
medical benefits shall be governed by this Section, provided that, notwithstanding any other provisions of this Code to the contrary, on and after July 1, 2012, the State shall not fund the programs outlined in this Section. Other parts of this Code
or other laws related to General Assistance shall remain in effect to the
extent they do not conflict with the provisions of this Section. If any other
part of this Code or other laws of this State conflict with the provisions of
this Section, the provisions of this Section shall control.
(b) General Assistance may consist of 2 separate
programs. One program shall be for adults with no children and shall be
known as Transitional Assistance. The other program may be for
families with children and for pregnant women and shall be known as
Family and Children Assistance.
(c) (1) To be eligible for Transitional Assistance on or after July
1, 1992, an individual must be ineligible for assistance under any other
Article of this Code, must be determined chronically needy, and must be one of
the following:
(A) age 18 or over or
(B) married and living with a spouse, regardless of |
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(2) The local governmental unit shall determine
whether individuals are chronically needy as follows:
(A) Individuals who have applied for Supplemental
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| Security Income (SSI) and are awaiting a decision on eligibility for SSI who are determined to be a person with a disability by the Illinois Department using the SSI standard shall be considered chronically needy, except that individuals whose disability is based solely on substance use disorders and whose disability would cease were their addictions to end shall be eligible only for medical assistance and shall not be eligible for cash assistance under the Transitional Assistance program.
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(B) (Blank).
(C) The unit of local government may specify other
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| categories of individuals as chronically needy; nothing in this Section, however, shall be deemed to require the inclusion of any specific category other than as specified in paragraph (A).
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(3) For individuals in Transitional Assistance, medical assistance may
be provided by the unit of local government in an amount and nature determined by the unit of local government. Nothing in this paragraph (3) shall be construed to require the coverage of
any particular medical service. In addition, the amount and nature of medical
assistance provided may be different for different categories of individuals
determined chronically needy.
(4) (Blank).
(5) (Blank).
(d) (1) To be eligible for Family and Children Assistance, a
family unit must be ineligible for assistance under any other Article of
this Code and must contain a child who is:
(A) under age 18 or
(B) age 18 and a full-time student in a secondary
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| school or the equivalent level of vocational or technical training, and who may reasonably be expected to complete the program before reaching age 19.
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Those children shall be eligible for Family and Children Assistance.
(2) The natural or adoptive parents of the child living in the same
household may be eligible for Family and Children Assistance.
(3) A pregnant woman whose pregnancy has been verified shall be
eligible for income maintenance assistance under the Family and
Children Assistance program.
(4) The amount and nature of medical assistance provided under the
Family and Children Assistance program shall be determined by the unit of local government. The amount and nature of medical
assistance provided
need not be the same as that provided under paragraph (3) of
subsection (c) of this Section, and nothing in this paragraph (4) shall be
construed to require the coverage of any particular medical service.
(5) (Blank).
(e) A local governmental unit that chooses to participate in a
General Assistance program under this Section shall provide
funding in accordance with Section 12-21.13 of this Act.
Local governmental funds used to qualify for State funding may only be
expended for clients eligible for assistance under this Section 6-11 and
related administrative expenses.
(f) (Blank).
(g) (Blank).
(Source: P.A. 99-143, eff. 7-27-15; 100-759, eff. 1-1-19.)
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(305 ILCS 5/8A-2.5)
Sec. 8A-2.5. Unauthorized use of medical assistance.
(a) Any person who knowingly uses, acquires, possesses, or transfers a
medical card in any manner not authorized by law or by rules and regulations of
the Illinois Department, or who knowingly alters a medical card, or who
knowingly uses, acquires, possesses, or transfers an altered medical card, is
guilty of a violation of this Article and shall be punished as provided in
Section 8A-6.
(b) Any person who knowingly obtains unauthorized medical benefits or causes to be obtained unauthorized medical benefits with or
without use of a medical card is guilty of a violation of this Article and
shall be punished as provided in Section 8A-6.
(b-5) Any vendor that knowingly assists a person in committing a violation under subsection (a) or (b) of this Section is guilty of a violation of this Article and shall be punished as provided in Section 8A-6. (b-6) Any person (including a vendor, organization, agency, or other entity) that, in any matter related to the medical assistance program, knowingly or willfully falsifies, conceals, or omits by any trick, scheme, artifice, or device a material fact, or makes any false, fictitious, or fraudulent statement or representation, or makes or uses any false writing or document, knowing the same to contain any false, fictitious, or fraudulent statement or entry in connection with the provision of health care or related services, is guilty of a violation of this Article and shall be punished as provided in Section 8A-6. (c) The Department may seek to recover any and all State and federal monies for which it has improperly and erroneously paid benefits as a result of a fraudulent action and any civil penalties authorized in this Section. Pursuant to Section 11-14.5 of this Code, the Department may determine the monetary value of benefits improperly and erroneously received. The Department may recover the monies paid for such benefits and interest on that amount at the rate of 5% per annum for the period from which payment was made to the date upon which repayment is made to the State. Prior to the recovery of any amount paid for benefits allegedly obtained by fraudulent means, the recipient or payee of such benefits shall be afforded an opportunity for a hearing after reasonable notice. The notice shall be served personally or by certified or registered mail or as otherwise provided by law upon the parties or their agents appointed to receive service of process and shall include the following: (1) A statement of the time, place and nature of the |
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(2) A statement of the legal authority and
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| jurisdiction under which the hearing is to be held.
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(3) A reference to the particular Sections of the
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(4) Except where a more detailed statement is
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| otherwise provided for by law, a short and plain statement of the matters asserted, the consequences of a failure to respond, and the official file or other reference number.
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(5) A statement of the monetary value of the benefits
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| fraudulently received by the person accused.
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(6) A statement that, in addition to any other
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| penalties provided by law, a civil penalty in an amount not to exceed $2,000 may be imposed for each fraudulent claim for benefits or payments.
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(7) A statement providing that the determination of
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| the monetary value may be contested by petitioning the Department for an administrative hearing within 30 days from the date of mailing the notice.
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(8) The names and mailing addresses of the
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| administrative law judge, all parties, and all other persons to whom the agency gives notice of the hearing unless otherwise confidential by law.
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An opportunity shall be afforded all parties to be represented by legal counsel and to respond and present evidence and argument.
Unless precluded by law, disposition may be made of any contested case by stipulation, agreed settlement, consent order, or default.
Any final order, decision, or other determination made, issued or executed by the Director under the provisions of this Article whereby any person is aggrieved shall be subject to review in accordance with the provisions of the Administrative Review Law, and the rules adopted pursuant thereto, which shall apply to and govern all proceedings for the judicial review of final administrative decisions of the Director.
Upon entry of a final administrative decision for repayment of any benefits obtained by fraudulent means, or for any civil penalties assessed, a lien shall attach to all property and assets of such person, firm, corporation, association, agency, institution, vendor, or other legal entity until the judgment is satisfied.
Within 18 months of the effective date of this amendatory Act of the 96th General Assembly, the Department of Healthcare and Family Services will report to the General Assembly on the number of fraud cases identified and pursued, and the fines assessed and collected. The report will also include the Department's analysis as to the use of private sector resources to bring action, investigate, and collect monies owed.
(d) In subsections (a), (b), (b-5) and (b-6), "knowledge" has the meaning ascribed to that term in Section 4-5 of the Criminal Code of 2012. For any administrative action brought under subsection (c) pursuant to a violation of this Section, the Department shall define "knowing" by rule.
(Source: P.A. 97-23, eff. 1-1-12; 98-354, eff. 8-16-13.)
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(305 ILCS 5/8A-3) (from Ch. 23, par. 8A-3)
Sec. 8A-3.
Vendor Fraud and Kickbacks.
(a) Any person, firm, corporation,
association, agency, institution or other legal entity that willfully, by
means of a false statement or representation, or by concealment of any material
fact or by other fraudulent scheme or device on behalf of himself or others,
obtains or attempts to obtain benefits or payments under this Code to which
he or it is not entitled, or in a greater amount than that to which he or
it is entitled, is guilty of a violation of this Article and shall be punished
as provided in Section 8A-6.
(b) A person shall be guilty of a violation of this Article and shall
be punished as provided in Section 8A-6 if he solicits or receives any
remuneration, including any kickback,
bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind:
(1) in return for referring an individual to a person for the
furnishing or arranging for the furnishing of any item or service for which
payment may be made in whole or in part under this Code; or
(2) in return for purchasing, leasing, ordering, or arranging for or
recommending purchasing, leasing, or ordering any good, facility, service
or item for which payment may be made in whole or in part under this Code.
(c) A person shall be guilty of a violation of this Article and shall
be punished as provided in Section 8A-6 if he offers or pays any
remuneration, including any kickback,
bribe, or rebate, directly or indirectly, overtly or covertly, in cash or
in kind to any person to induce such person:
(1) to refer an individual to a person for the furnishing or arranging
for the furnishing of any item or service for which payment may be made in
whole or in part under this Code; or
(2) to purchase, lease, order, or arrange for or recommend purchasing,
leasing, or ordering any good, facility, service, or item for which payment
may be made in whole or in part under this Code.
(d) Subsections (b) and (c) shall not apply to:
(1) a discount or other reduction in price obtained by a provider of
services or other entity under this Code if the reduction in price is
properly disclosed and appropriately reflected in the costs claimed or
charges made by the provider or entity under this Code;
(2) any amount paid by an employer to an employee who has a bona fide
employment relationship with such employer for employment in the provision
of covered items or services; or
(3) any amount
paid to or received by a physician for professional
services rendered if a physician, pursuant to a bona fide contract with
a health maintenance organization, as defined by the Health
Maintenance Organization Act, has referred a patient to another physician
for rendering professional services not covered by the health maintenance
organization.
(Source: P.A. 85-818.)
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