305 ILCS 5/ Illinois Public Aid Code.

(305 ILCS 5/12-4.46)

Sec. 12-4.46. Change in legal guardianship; notification. Whenever there is a change in legal guardianship of a minor child who receives benefits under this Code, the appropriate State agency shall immediately inform the Department of Human Services of the change in legal guardianship to ensure such benefits are sent directly to the minor child's legal guardian.

For purposes of this Section, "legal guardian" means a person appointed guardian, or given custody, of a minor by a circuit court of the State, but does not include a person appointed guardian, or given custody, of a minor under the Juvenile Court Act or the Juvenile Court Act of 1987.

(Source: P.A. 98-256, eff. 8-9-13; 98-756, eff. 7-16-14.)

(305 ILCS 5/12-4.47)

Sec. 12-4.47. Continued eligibility for developmental disability services for dependents of military service members.

(a) As used in this Section:

"Dependent" means a spouse, birth child, adopted child, or stepchild of a military service member.

"Legal resident" means a person who maintains Illinois as his or her principal establishment, home of record, or permanent home and to where, whenever absent due to military obligation, he or she intends to return.

"Military service" means service in the armed forces or armed forces reserves of the United States, or membership in the Illinois National Guard.

"Military service member" means a person who is currently in military service or who has separated from military service in the previous 18 months through either retirement or military separation.

(b) A dependent, who is a legal resident of the State, having previously been determined to be eligible for developmental disability services provided by the Department of Human Services, including waiver services provided under the home and community based services programs authorized under Section 1915(c) of the Social Security Act, shall retain eligibility for those developmental disability services as long as he or she remains a legal resident of the State, regardless of having left the State due to the military service member's military assignment outside the State, and as long as he or she is otherwise eligible for such services.

(c) The Department of Human Services shall permit a dependent who resides out-of-state to be placed on the waiting list for developmental disabilities services if the dependent left the State due to the military service member's military assignment outside the State, is otherwise eligible for those services, and furnishes the following:

(1) a copy of the military service member's DD-214 or other equivalent discharge paperwork; and

(2) proof of the military service member's legal residence in the State, as prescribed by the Department.

(d) For dependents who received developmental disability services and who left the State due to the military service member's military assignment outside the State, upon the dependent's return to the State and when a request for services is made, the Department shall:

(1) determine the dependent's eligibility for services, which may include a request for waiver services provided under the home and community based services programs authorized under Section 1915(c) of the Social Security Act;

(2) provide to the dependent notification of the determination of eligibility for services, which includes notification of a denial of services if applicable;

(3) provide the dependent an opportunity to contest the Department's determination through the appeals processes established by the Department; and

(4) resume services if the individual remains eligible.

(e) As a condition of continued eligibility for services under subsection (b) of this Section, a dependent must inform the Department of his or her current address and provide updates as requested by the Department.

(f) No payment pursuant to this Section shall be made for developmental disability services authorized under the Illinois Title XIX State Plan and provided outside the State unless those services satisfy the conditions specified in 42 CFR 431.52. No payment pursuant to this Section shall be made for home and community based services provided outside the State of Illinois.

(g) The Department shall request a waiver from the appropriate federal agency if a waiver is necessary to implement the provisions of this Section.

(h) The Department may adopt rules necessary to implement the provisions of this Section.

(Source: P.A. 98-1000, eff. 8-18-14; 99-78, eff. 7-20-15.)

(305 ILCS 5/12-4.48)

Sec. 12-4.48. Long-Term Services and Supports Disparities Workgroup.

(a) The Department of Healthcare and Family Services shall establish a Long-Term Services and Supports Disparities Workgroup of the Medicaid Advisory Committee in accordance with the requirements of 42 CFR 431.12.

(b) Members of the Workgroup shall be appointed by the Director of the Department of Healthcare and Family Services and may include representatives of the following agencies, organizations, or groups:

(1) (Blank).

(2) (Blank).

(3) (Blank).

(4) (Blank).

(5) (Blank).

(6) (Blank).

(7) (Blank).

(8) Managed Care Plans.

(9) The for-profit urban nursing home or assisted living industry.

(10) The for-profit rural nursing home or assisted living industry.

(11) The not-for-profit nursing home or assisted living industry.

(12) The home care association or home care industry.

(13) The adult day care association or adult day care industry.

(14) An association representing workers who provide long-term services and supports.

(15) A representative of providers that serve the predominantly ethnic minority populations.

(16) Case Management Organizations.

(17) Three consumer representatives which may include a consumer of long-term services and supports or an individual who advocates for such consumers. For purposes of this provision, "consumer representative" means a person who is not an elected official and who has no financial interest in a health or long-term care delivery system.

(b-5) In addition, one representative from each of the following may serve ex officio: the Governor's Office; the Department of Healthcare and Family Services; the Department of Human Services; the Department on Aging; the Department of Public Health; and the Department of Human Rights.

(c) The Workgroup shall reflect diversity in race, ethnicity, and gender.

(d) The Chair of the Workgroup shall be appointed by the Director of the Department of Healthcare and Family Services.

(e) The Director of the Department of Healthcare and Family Services shall assign appropriate staff and resources to support the efforts of the Workgroup. The Workgroup shall meet as often as necessary but not less than 4 times per calendar year.

(f) The Workgroup shall promote and facilitate communication, coordination, and collaboration among relevant State agencies and communities of color, limited English-speaking communities, and the private and public entities providing services to those communities.

(g) The Workgroup shall do all of the following:

(1) Document the number and types of Long-Term Services and Supports (LTSS) providers in the State and the number of clients served in each setting.

(2) Document the number and racial profiles of residents using LTSS, including, but not limited to, residential nursing facilities, assisted living facilities, adult day care, home health services, and other home and community based long-term care services.

(3) Document the number and profiles of family or informal caregivers who provide care for minority elders.

(4) Compare data over multiple years to identify trends in the delivery of LTSS for each racial or ethnic category including: Alaskan Native or American Indian, Asian or Pacific Islander, black or African American, Hispanic, or white.

(5) Identify any racial disparities in the provision of care in various LTSS settings and determine factors that might influence the disparities found.

(6) Identify any disparities uniquely experienced in metropolitan or rural areas and make recommendations to address these areas.

(7) Assess whether the LTSS industry, including managed care plans and independent providers, is equipped to offer culturally sensitive, competent, and linguistically appropriate care to meet the needs of a diverse aging population and their informal and formal caregivers.

(8) Consider whether to recommend that the State require all home and community based services as a condition of licensure to report data similar to that gathered under the Minimum Data Set and required when a new resident is admitted to a nursing home.

(9) Identify and prioritize recommendations for actions to be taken by the State to address disparity issues identified in the course of these studies.

(10) Monitor the progress of the State in eliminating racial disparities in the delivery of LTSS.

(h) The Workgroup may conduct public hearings, inquiries, studies, and other forms of information gathering to identify how the actions of State government contribute to or reduce racial disparities in long-term care settings.

(i) The Workgroup shall report its findings and recommendations to the Governor and the General Assembly with annual reports and shall include documentation of progress made to eliminate disparities in long-term care service settings.

(Source: P.A. 103-508, eff. 8-4-23.)

(305 ILCS 5/12-4.49)

Sec. 12-4.49. Breast cancer imaging and diagnostic equipment grant program.

(a) On and after January 1, 2016 and subject to funding availability, the Department of Healthcare and Family Services shall administer a grant program the purpose of which shall be to build the public infrastructure for breast cancer imaging and diagnostic services across the State, in particular in rural, medically underserved areas and in areas with high breast cancer mortality.

(b) In order to be eligible for the program, an applicant must be a:

(1) disproportionate share hospital with high MIUR (as set by the Department by rule);

(2) mammography facility in a rural area;

(3) federally qualified health center; or

(4) rural health clinic.

(c) The grants may be used to purchase new equipment for breast imaging, image-guided biopsies, or other equipment to enhance the detection and diagnosis of breast cancer.

(d) The primary purpose of these grants is to increase access for low-income and Department of Healthcare and Family Services clients to high quality breast cancer screening and diagnostics. Medically Underserved Areas (MUAs), areas with high breast cancer mortality rates, and Health Professional Shortage Areas (HPSAs) shall receive special priority for grants under this program.

(e) The Department shall establish procedures for applying for grant funds under this Section.

(Source: P.A. 99-433, eff. 8-21-15.)

(305 ILCS 5/12-4.50)

Sec. 12-4.50. Healthy Local Food Incentives Program.

(a) Legislative findings. Diet and other lifestyle choices contribute to more than half of all deaths in Illinois. Health risk factors include smoking, obesity, stress, nutrition, high blood pressure, and alcohol and drug use. Illinois residents should be encouraged to adopt diets and lifestyles that lead to wellness. The State can help provide that encouragement by funding wellness programs that enhance the health of Illinois residents. Healthy local food incentives encourage wellness among some of the most vulnerable residents of Illinois (those whose incomes are below the poverty line and who often have limited access to fresh, healthy, and affordable foods) by doubling the purchasing power of LINK cardholders at farmers markets across the State. The benefits of such a program include: an increase in population health, Medicaid health care cost savings, decreased incidence of preventable diseases, increased revenue for Illinois small farmers, and economic stimulus for the region.

(b) Definitions. As used in this Section:

"FINI eligible fruits and vegetables" means any variety of fresh, canned, dried, or frozen whole or cut fruits and vegetables without added sugars, fats, or oils, and salt (i.e. sodium), as defined by the Food Insecurity Nutrition Incentive Grant Program administered by the United States Department of Agriculture.

"LINK card" means an electronic benefits transfer card issued by the Department of Human Services for the purpose of enabling a user of the card to obtain SNAP benefits or cash.

"SNAP" means the federal Supplemental Nutrition Assistance Program.

(c) The Department of Human Services shall establish a Healthy Local Food Incentives Program to double the purchasing power of Illinois residents with limited access to fresh fruits and vegetables. The Healthy Local Food Incentives Fund is created as a special fund in the State treasury for the purpose of implementing the Healthy Local Food Incentives Program. All moneys received pursuant to this Section shall be deposited into the Healthy Local Food Incentives Fund.

(d) Subject to appropriation, the Department of Human Services shall make an annual grant of $500,000 from the Fund to a qualified Illinois non-profit organization or agency, which shall be distributed to participating Illinois farmers markets for the purpose of providing matching dollar incentives (up to a specified amount) for the dollar value of SNAP benefits spent on FINI eligible fruits and vegetables at participating Illinois farmers markets and direct producer-to-consumer venues.

(e) The designated qualified non-profit organization or agency shall have a demonstrated track record of:

(1) building a statewide network;

(2) designing and implementing successful healthy food incentive programs that connect SNAP recipients with local producers;

(3) implementing funds distribution and reporting processes;

(4) providing training and technical assistance to farmers markets;

(5) conducting community outreach and data collection; and

(6) providing full accounting and administration of funds distributed to farmers markets.

(f) 100% of the moneys deposited into the Fund shall be distributed to participating Illinois farmers markets for healthy local food incentives.

(g) Within 90 days after the end of a grant cycle, the designated qualified non-profit organization or agency shall submit a progress report to the Department of Human Services. The progress report shall include the following information:

(1) the names and locations of Illinois farmers markets and direct producer-to-consumer venues that received funds distributed under the Program;

(2) the dollar amount of funds awarded to each participating Illinois farmers market and direct producer-to-consumer venue;

(3) the dollar amount of SNAP benefits, and funds provided under the Program, that were spent at Illinois farmers markets participating in the Program, as well as the dollar amount of any unspent funds available under the Program;

(4) the number of SNAP transactions carried out annually at participating Illinois farmers markets;

(5) the impact of the Program on increasing the quantity of fresh fruits and vegetables consumed by SNAP families, as determined by customer surveys.

(h) No later than December 31, 2017, the Department of Human Services shall adopt rules to implement the provisions of this Section.

(i) (Blank).

(Source: P.A. 99-928, eff. 1-20-17; 100-636, eff. 1-1-19.)

(305 ILCS 5/12-4.51)

Sec. 12-4.51. Workforce training and healthy families demonstration project.

(a) Subject to the availability of funds provided for this purpose by the federal government, local philanthropic or charitable sources, or other private sources, there is created a 5-year demonstration project within the Department of Human Services to provide an intensive workforce training program for entry-level workers and a multi-generational healthy family initiative. No general revenue funds may be used to fund the demonstration project created under this Section. The demonstration project shall be implemented no later than 6 months after January 1, 2019 (the effective date of Public Act 100-806) and shall terminate 5 years after the initial date of implementation. The demonstration project shall be operated and maintained by a non-profit, community-based entity that shall provide the majority of the wages earned by participants enrolled in the workforce training program as well as support services to families, including new and expectant parents, enrolled in the multi-generational healthy family initiative. The total number of participants in the 5-year demonstration project at any one time shall not exceed 500. Participants enrolled in the workforce training program or the multi-generational healthy family initiative shall qualify to have whatever financial assistance they receive from their participation excluded from consideration for purposes of determining eligibility for or the amount of assistance under this Code as provided in subsection (d) of Section 1-7. The selected entity must immediately notify the Department of Human Services or the Department of Healthcare and Family Services whenever a participant enrolled in the workforce training program or the multi-generational healthy family initiative leaves the demonstration project and ceases to participate in any of the programs under the demonstration making the participant ineligible to receive an exemption as provided in subsection (d) of Section 1-7.

(b) The entity selected to operate and maintain the demonstration project shall be a non-profit, community-based entity in good standing with the State that is located in a county with a population of less than 3,000,000. The selected entity must comply with all applicable State and federal requirements and must develop and implement a research component to determine the effectiveness of the demonstration project in promoting and instilling self-sufficiency through its intensive workforce training program and multi-generational healthy family initiative. The State shall not fund the research component outlined in the Section or any program under the demonstration project.

(c) Beginning one year after the initial implementation date of the demonstration project, and each year thereafter for the duration of the demonstration, the selected entity shall submit a report to the Department of Human Services, the Department of Healthcare and Family Services, and the General Assembly that details the progress and effectiveness of the demonstration project and the demonstration's impact on instilling the value of self-sufficiency in participants. The 4th annual report shall also provide policy recommendations on best practices for and continued research on facilitating bridges to self-sufficiency. The 4th annual report may also include a recommendation on making the demonstration project permanent upon completion of the demonstration project period.

The reports to the General Assembly shall be filed with the Clerk of the House of Representatives and the Secretary of the Senate in electronic form only, in the manner that the Clerk and the Secretary shall direct.

(Source: P.A. 100-806, eff. 1-1-19; 101-81, eff. 7-12-19.)

(305 ILCS 5/12-4.52)

Sec. 12-4.52. Prescriber education.

(a) The Department of Healthcare and Family Services shall develop, in collaboration with a public university that has a Doctor of Pharmacy Professional Program and is located in a county with a population of more than 3,000,000, a program designed to provide prescribing physicians under the medical assistance program with an evidence-based, non-commercial source of the latest objective information about pharmaceuticals. Information shall be presented to prescribing physicians by specially trained pharmacists, nurses, or other health professionals to assist prescribing physicians in making appropriate therapeutic recommendations.

(b) The prescriber education program shall consist of 2 components: a web-based curriculum and an academic educator outreach. The program shall contract with clinical pharmacists to provide scheduled visits with prescribing physicians to update them on the latest research concerning medication usage and new updates on disease states in an unbiased manner.

(c) Education provided under the prescriber education program shall include, but not be limited to, disease-based educational modules on the treatment of chronic non-cancer pain, diabetes, hypertension, hyperlipidemia, respiratory syncytial virus, and nicotine dependence. New modules may be created periodically as needed and existing module content shall be reviewed and updated on an annual or as-needed basis. Educational modules provided under the program shall provide prescribing physicians with continuing medical education credit.

(d) Additional resources provided under the prescriber education program shall include, but not be limited to, the following:

(1) a drug information response center available to prescribing physicians that provides thorough and timely in-depth answers to any questions a prescribing physician may have within 48 hours after a question is received; and

(2) information on drug utilization trends within individual and group practices.

(Source: P.A. 101-278, eff. 1-1-20.)

(305 ILCS 5/12-4.53)

Sec. 12-4.53. Prospective Payment System (PPS) rates. Effective January 1, 2021, and subsequent years, based on specific appropriation, the Prospective Payment System (PPS) rates for FQHCs shall be increased based on the cost principles found at 45 Code of Federal Regulations Part 75 or its successor. Such rates shall be increased by using any of the following methods: reducing the current minimum productivity and efficiency standards no lower than 3500 encounters per FTE physician; increasing the statewide median cost cap from 105% to 120%, a one-time re-basing of rates utilizing 2018 FQHC cost reports, or another alternative payment method acceptable to the Centers for Medicare and Medicaid Services and the FQHCs, including an across the board percentage increase to existing rates.

(Source: P.A. 101-636, eff. 6-10-20; 101-655, eff. 3-12-21.)

(305 ILCS 5/12-4.54)

Sec. 12-4.54. SNAP, WIC; diapers, menstrual hygiene products. If the United States Department of Agriculture's Food and Nutrition Service creates and makes available to the states a waiver permitting recipients of benefits provided under the Supplemental Nutrition Assistance Program or the Special Supplemental Nutrition Program for Women, Infants, and Children to use their benefits to purchase diapers or menstrual hygiene products such as tampons, sanitary napkins, and feminine wipes, then the Department of Human Services shall apply for the waiver. If the United States Department of Agriculture approves the Department of Human Services' waiver application, then the Department of Human Services shall adopt rules and make other changes as necessary to implement the approved waiver.

(Source: P.A. 102-248, eff. 1-1-22; 102-813, eff. 5-13-22.)

(305 ILCS 5/12-4.55)

Sec. 12-4.55. Community-based long-term services; application for federal funding. The Department of Healthcare and Family Services shall apply for all available federal funding to promote community inclusion and integration for persons with disabilities, regardless of age, and older adults so that those persons have the option to transition out of institutions and receive long-term care services and supports in the settings of their choice.

(Source: P.A. 102-536, eff. 8-20-21; 102-813, eff. 5-13-22.)

(305 ILCS 5/12-4.56)

Sec. 12-4.56. Managed Primary Care Demonstration Project. The Department shall establish and implement a Managed Primary Care Demonstration Project to provide primary care services that are focused on preventive rather than curative care to persons who reside in underserved communities that lack accessible health and medical services. The demonstration project shall operate for a 5-year period and provide supplemental services to medical assistance recipients. The Department shall contract with a health care organization through a competitive process that is capable of providing patient-centered, prevention-focused services, that may include, but are not limited to, the following:

(1) Patient navigators to manage patient care.

(2) Patient-tailored preventive health care plans.

(3) Administrative personal health care consultants for home health maintenance between medical office visits.

(4) Clinical personal health care consultants for telehealth (health information and advice) and wellness initiatives.

(5) A patient portal.

(6) An online virtual health hub that provides patients with access to wellness, self-guided education, health seminars, a video library, and additional health and wellness resources.

(7) Community health and human services centers to engage, educate, and empower patients to get involved in their own self-care.

(8) Mobile preventive health stations and kiosks to bring services to underserved communities that are health or medical deserts.

(9) Call centers to interact with medical homes and facilitate service offerings.

A request for proposals for the demonstration project shall be issued by December 31, 2022.

(Source: P.A. 102-699, eff. 4-19-22.)

(305 ILCS 5/12-4.57)

(Text of Section from P.A. 103-102)

Sec. 12-4.57. Prospective Payment System rates; increase for federally qualified health centers. Beginning January 1, 2024, subject to federal approval, the Department of Healthcare and Family Services shall increase the Prospective Payment System rates for federally qualified health centers to a level calculated to spend an additional $50,000,000 in the first year of application using an alternative payment method acceptable to the Centers for Medicare and Medicaid Services and a trade association representing a majority of federally qualified health centers operating in Illinois, including a rate increase that is an equal percentage increase to the rates paid to each federally qualified health center.

(Source: P.A. 103-102, eff. 1-1-24.)

(Text of Section from P.A. 103-297)

Sec. 12-4.57. Stolen SNAP benefits via card skimming; data collection and reports.

(a) As the State administrator of benefits provided under the federally funded Supplemental Nutrition Assistance Program (SNAP), the Department of Human Services shall track and collect data on the scope and frequency of SNAP benefits fraud in this State where a SNAP recipient's benefits are stolen from the recipient's electronic benefits transfer card by means of card skimming, card cloning, or some other similar fraudulent method. The Department shall specifically keep a record of every report made to the Department by a SNAP recipient alleging the theft of benefits due to no fault of the recipient, the benefit amount stolen, and, if practicable, how those stolen benefits were used and the location of those thefts.

(b) The Department shall report its findings to the General Assembly on an annual basis beginning on January 1, 2024. The Department shall file an annual report no later than the 60th day of the following year following each reporting period. A SNAP recipient's personally identifiable information shall be excluded from the reports consistent with State and federal privacy protections. Each annual report shall also be posted on the Department's official website.

(c) If the Department determines that a SNAP recipient has made a substantiated report of stolen benefits due to card skimming, card cloning, or some other similar fraudulent method, the Department shall refer the matter to the State's Attorney who has jurisdiction over the alleged theft or fraud and shall provide any assistance to that State's Attorney in the prosecution of the alleged theft or fraud.

(Source: P.A. 103-297, eff. 1-1-24.)

(305 ILCS 5/12-4.101)

Sec. 12-4.101. (Repealed).

(Source: P.A. 90-655, eff. 7-30-98. Repealed by P.A. 92-111, eff. 1-1-02.)