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92_SB1855
LRB9209402DJgc
1 AN ACT to revise the Illinois Public Aid Code.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 ARTICLE 1. REVISORY PROVISIONS
5 Section 1-5. Purpose. The purpose of this Act is to
6 revise the Illinois Public Aid Code by making the references
7 to certain terms used in that Code more specific, by
8 resectioning certain Sections of that Code, and by
9 incorporating into that Code certain provisions of the
10 Department of Public Aid Law of the Civil Administrative Code
11 of Illinois, making only nonsubstantive and technical
12 changes.
13 Section 1-10. Prior law.
14 (a) A provision revised and continued in the Illinois
15 Public Aid Code by the amendatory provisions of this Act
16 shall be construed as a continuation of the prior law and not
17 as a new or different law.
18 (b) A citation in an Act other than the Illinois Public
19 Aid Code to a Section of that Code that is resectioned and
20 continued in that Code by the amendatory provisions of this
21 Act shall be construed to be a citation to that renumbered
22 and continued provision in that Code.
23 Section 1-15. Other Acts of the General Assembly. If
24 any other Act of the General Assembly changes, adds, or
25 repeals a provision of prior law that is resectioned and
26 continued in the Illinois Public Aid Code or incorporated
27 into the Illinois Public Aid Code by the amendatory
28 provisions of this Act, then that change, addition, or repeal
29 in the other Act shall be construed together with the
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1 Illinois Public Aid Code as amended by this Act.
2 Section 1-20. Matters of form.
3 (a) The parenthetical citation before a new Section in
4 the form "(XX ILCS XX/XX new)" (i) is an informational
5 reference to the citation of the new Section in the Illinois
6 Compiled Statutes and (ii) is not part of the text of the
7 law.
8 (b) The parenthetical citation before a new Section in
9 the form "(was XX ILCS XX/XX)" (i) is an informational
10 reference to the prior law from which the new Section is
11 derived and (ii) is not part of the text of the law.
12 (c) In the text of a new Section, (i) matter that is
13 stricken indicates a deletion from the prior law and (ii)
14 matter that is underscored indicates an addition to the prior
15 law. The purpose of striking and underscoring in this manner
16 is to clearly indicate all changes to prior laws that are
17 being resectioned and continued in the Illinois Public Aid
18 Code or that are being incorporated into the Illinois Public
19 Aid Code. Matter in the text of a new Section that is not
20 underscored or stricken is matter being continued in the
21 Illinois Public Aid Code, or being added to the Illinois
22 Public Aid Code from the prior law, with no changes.
23 (d) The parenthetical citation after a Section in the
24 form "(Source: Laws 19XX, p. XX)" or "(Source: P.A. XX-XXXX)"
25 (i) is an informational reference to the most recent sources
26 of the continued text in the Session Laws of Illinois and
27 (ii) is not part of the text of the law.
28 Section 1-25. Home rule; mandates. No provision
29 incorporated into the Illinois Public Aid Code by the
30 amendatory provisions of this Act (i) is a denial of or
31 limitation on home rule powers if no denial or limitation
32 existed under prior law or (ii) creates a State mandate under
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1 the State Mandates Act if no mandate existed under prior law.
2 Section 1-30. Captions. The language contained in the
3 Section and subsection captions in the Illinois Public Aid
4 Code:
5 (1) is intended only as a general description that
6 is not a part of the substantive provisions of that Code;
7 (2) does not take precedence over the content of
8 the substantive provisions of that Code; and
9 (3) shall not be used in construing the meaning of
10 the substantive provisions of that Code.
11 ARTICLE 5. AMENDATORY PROVISIONS
12 Section 5-5. The Illinois Public Aid Code is amended by
13 changing and, in part, by resectioning Sections 1-1, 1-6,
14 1-7, 1-8, 1-11, 2-11, 2-16, 3-1, 3-1a, 3-1.2, 3-1.4, 3-2,
15 3-3, 3-4, 3-5, 3-5a, 3-8, 3-9, 3-10.1, 3-10.4, 3-10.5,
16 3-10.6, 3-10.7, 3-10.9, 3-10.10, 3-11, 3-13, 3-14, 4-0.5,
17 4-1, 4-1.2, 4-1.2a, 4-1.2c, 4-1.6, 4-1.7, 4-1.10, 4-1.12,
18 4-2, 4-3a, 4-4.1, 4-7, 4-8, 4-9, 4-10, 4-12, 4-17, 4-21,
19 4-22, 5-1.1, 5-1.2, 5-2, 5-2.1a, 5-2.2, 5-2.3, 5-4, 5-4.1,
20 5-4.2, 5-4.20, 5-4.21, 5-4.22, 5-4.23, 5-4.24, 5-4.25,
21 5-4.26, 5-4.27, 5-4.28, 5-4.30, 5-4.31, 5-4.32, 5-4.33,
22 5-4.34, 5-4.35, 5-4.36, 5-4.37, 5-4.38, 5-5, 5-5.01a, 5-5.02,
23 5-5.03, 5-5.1, 5-5.2, 5-5.3, 5-5.4, 5-5.5, 5-5.5a, 5-5.6a,
24 5-5.6b, 5-5.8, 5-5.8a, 5-5.11, 5-5.12, 5-5.12a, 5-5.13,
25 5-5.15, 5-5.17, 5-5.18, 5-5.19, 5-5.20, 5-5.21, 5-5a, 5-5b,
26 5-5c, 5-6, 5-7, 5-8, 5-9, 5-11, 5-11.1, 5-12, 5-13, 5-13.2,
27 5-14, 5-15, 5-15.5, 5-16, 5-16.1, 5-16.2, 5-16.4, 5-16.5,
28 5-16.6, 5-16.9, 5-16.10, 5-16.11, 5-16.12, 5-17, 5-19, 5-20,
29 5-21, 5-22, 5A-2, 5A-3, 5A-4, 5A-5, 5A-6, 5A-7, 5A-8, 5A-9,
30 5B-4, 5B-5, 5B-6, 5B-7, 5B-8, 5C-3, 5C-4, 5C-5, 5C-6, 5C-7,
31 5E-10, 6-1, 6-1.2, 6-1.3, 6-1.3a, 6-1.6, 6-1.7, 6-2, 6-2.1,
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1 6-6, 6-7, 6-9, 6-10, 6-11, 6-12, 8A-2.5, 8A-4, 8A-4A, 8A-5,
2 8A-5A, 8A-7, 8A-7.1, 8A-8, 8A-9, 8A-11, 8A-12, 8A-16, 9-1,
3 9-2, 9-3, 9-4, 9-5, 9-6, 9-6.1, 9-7, 9-8, 9-9, 9-11, 9A-3,
4 9A-4, 9A-7, 9A-8, 9A-8.1, 9A-9, 9A-10, 9A-11, 9A-11.5, 9A-14,
5 10-1, 10-3, 10-3.1, 10-3.2, 10-3.3, 10-3.4, 10-4, 10-5, 10-6,
6 10-7, 10-8, 10-8.1, 10-9, 10-10, 10-10.1, 10-10.2, 10-10.3,
7 10-10.4, 10-10.5, 10-11, 10-11.1, 10-11.2, 10-12, 10-12.1,
8 10-13, 10-13.1, 10-13.2, 10-13.3, 10-13.4, 10-13.5, 10-13.6,
9 10-13.7, 10-13.8, 10-13.9, 10-13.10, 10-14, 10-14.1, 10-15,
10 10-16, 10-16.4, 10-16.6, 10-17.1, 10-17.2, 10-17.3, 10-17.4,
11 10-17.5, 10-17.6, 10-17.7, 10-17.8, 10-17.9, 10-17.11, 10-18,
12 10-19, 10-20, 10-21, 10-23, 10-24.5, 10-24.45, 10-25,
13 10-25.5, 10-26, 10-26.2, 10-26.5, 10-27, 11-2, 11-2.1, 11-3,
14 11-3.2, 11-3.3, 11-4, 11-5, 11-6, 11-6.1, 11-6.2, 11-7, 11-8,
15 11-8.1, 11-8.2, 11-8.3, 11-8.4, 11-8.7, 11-9, 11-12, 11-13,
16 11-14.5, 11-15, 11-16, 11-17, 11-19, 11-20, 11-20.1, 11-22,
17 11-22a, 11-22b, 11-22c, 11-26, 11-26.1, 11-27, 11-28, 11-29,
18 11-31, 12-2, 12-3, 12-4, 12-4.1, 12-4.3, 12-4.4, 12-4.5,
19 12-4.6, 12-4.7, 12-4.7b, 12-4.7c, 12-4.7d, 12-4.8, 12-4.8a,
20 12-4.9, 12-4.10, 12-4.11, 12-4.12, 12-4.14, 12-4.16, 12-4.17,
21 12-4.18, 12-4.19, 12-4.20, 12-4.20a, 12-4.20c, 12-4.20d,
22 12-4.21, 12-4.22, 12-4.23, 12-4.24, 12-4.24a, 12-4.25,
23 12-4.25a, 12-4.25b, 12-4.25c, 12-4.26, 12-4.27, 12-4.29,
24 12-4.30, 12-4.33, 12-4.34, 12-4.35, 12-4.103, 12-5, 12-8,
25 12-8.1, 12-9, 12-9.1, 12-10, 12-10.1, 12-10.2, 12-10.2a,
26 12-10.3, 12-10.5, 12-10.6, 12-12, 12-12.1, 12-13, 12-13.05,
27 12-13.2, 12-19, 12-19.1, 12-19.3, 12-19.5, 12-21, 12-21.6,
28 12-21.7, 12-21.8, 12-21.10, 12-21.11, 12-21.12, 12-21.14,
29 12-21.16, 12-21.17, 12-21.18, 14-1, 14-2, 14-3, 14-4, 14-5,
30 14-6, 14-7, 14-8, 14-9, 14-10, 15-2, 15-3, 15-4, 15-5, 15-6,
31 15-7, and 15-8 and by adding Sections 2-6.5 and 2-18 as
32 follows:
33 (305 ILCS 5/1-1) (from Ch. 23, par. 1-1)
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1 Sec. 1-1. Public purpose Aims in providing financial aid
2 and services. The purpose of this Code is to assist in the
3 alleviation and prevention of poverty and thereby to protect
4 and promote the health and welfare of all the people of this
5 State.
6 To accomplish this purpose, this Code authorizes
7 financial aid and social welfare services for persons in need
8 thereof by reason of unemployment, illness, or other cause
9 depriving them of the means of a livelihood compatible with
10 health and well-being, and provides for the development, use
11 and coordination of all resources in this State, governmental
12 and private.
13 The Illinois Department of Public Aid and the Department
14 of Human Services shall establish such standards of financial
15 aid and services as will encourage and assist applicants and
16 recipients to maintain a livelihood compatible with health
17 and well being and to develop their self-reliance and realize
18 their capacities for self-care, self-support, and responsible
19 citizenship.
20 The maintenance and strengthening of the family unit
21 shall be a principal consideration in the administration of
22 this Code. All public aid policies shall be formulated and
23 administered to achieve this end.
24 (Source: P.A. 89-507, eff. 7-1-97.)
25 (305 ILCS 5/1-6) (from Ch. 23, par. 1-6)
26 Sec. 1-6. Eligibility; unemployment benefits.
27 Notwithstanding any provisions of this Code to the contrary,
28 a person, if eligible, shall be required to file for
29 unemployment compensation benefits as a condition for
30 qualifying for public assistance benefits under programs of
31 aid to the aged, blind, or disabled, aid to families with
32 dependent children, and aid to families with dependent
33 children--unemployed, which are administered by the Illinois
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1 Department of Human Services, or general assistance programs
2 administered by some other public agency.
3 (Source: P.A. 89-507, eff. 7-1-97.)
4 (305 ILCS 5/1-7) (from Ch. 23, par. 1-7)
5 Sec. 1-7. Items excluded from consideration in
6 determining eligibility for or level of aid.
7 (a) For purposes of determining eligibility for
8 assistance under this Code, the Illinois Department of Public
9 Aid, the Department of Human Services, county departments,
10 and local governmental units shall exclude from consideration
11 restitution payments, including all income and resources
12 derived therefrom, made to persons of Japanese or Aleutian
13 ancestry pursuant to the federal Civil Liberties Act of 1988
14 and the Aleutian and Pribilof Island Restitution Act, P.L.
15 100-383.
16 (b) For purposes of any program or form of assistance
17 where a person's income or assets are considered in
18 determining eligibility or level of assistance, whether under
19 this Code or another authority, neither the State of Illinois
20 nor any entity or person administering a program wholly or
21 partially financed by the State of Illinois or any of its
22 political subdivisions shall include restitution payments,
23 including all income and resources derived therefrom, made
24 pursuant to the federal Civil Liberties Act of 1988 and the
25 Aleutian and Pribilof Island Restitution Act, P.L. 100-383,
26 in the calculation of income or assets for determining
27 eligibility or level of assistance.
28 (c) For purposes of determining eligibility for or the
29 amount of assistance under this Code, except for the
30 determination of eligibility for payments or programs under
31 the TANF employment, education, and training programs and the
32 Food Stamp Employment and Training Program, the Illinois
33 Department of Public Aid, the Department of Human Services,
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1 county departments, and local governmental units shall
2 exclude from consideration any financial assistance received
3 under any student aid program administered by an agency of
4 this State or the federal government, by a person who is
5 enrolled as a full-time or part-time student of any public or
6 private university, college, or community college in this
7 State.
8 (Source: P.A. 92-111, eff. 1-1-02.)
9 (305 ILCS 5/1-8)
10 Sec. 1-8. Fugitives ineligible.
11 (a) The following persons are not eligible for aid under
12 this Code, or federal food stamps or federal food stamp
13 benefits:
14 (1) A person who has fled from the jurisdiction of
15 any court of record of this or any other state or of the
16 United States to avoid prosecution for a felony or to
17 avoid giving testimony in any criminal proceeding
18 involving the alleged commission of a felony.
19 (2) A person who has fled to avoid imprisonment in
20 a correctional facility of this or any other state or the
21 United States for having committed a felony.
22 (3) A person who has escaped from a correctional
23 facility of this or any other state or the United States
24 if the person was incarcerated for having committed a
25 felony.
26 (4) A person who is violating a condition of
27 probation or parole imposed under federal or State law.
28 In this Section, "felony" means a violation of a penal
29 statute of this or any other state or the United States for
30 which a sentence to death or to a term of imprisonment in a
31 penitentiary for one year or more is provided.
32 To implement this Section, the Illinois Department of
33 Public Aid and the Department of Human Services may exchange
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1 necessary information with an appropriate law enforcement
2 agency of this or any other state, a political subdivision of
3 this or any other state, or the United States.
4 (b) (Blank).
5 (Source: P.A. 92-111, eff. 1-1-02.)
6 (305 ILCS 5/1-11)
7 Sec. 1-11. Citizenship. To the extent not otherwise
8 provided in this Code or federal law, all clients who receive
9 cash or medical assistance under Article III, IV, V, or VI of
10 this Code must meet the citizenship requirements as
11 established in this Section. To be eligible for assistance an
12 individual, who is otherwise eligible, must be either a
13 United States citizen or included in one of the following
14 categories of non-citizens:
15 (1) United States veterans honorably discharged and
16 persons on active military duty, and the spouse and
17 unmarried dependent children of these persons;
18 (2) Refugees under Section 207 of the Immigration
19 and Nationality Act;
20 (3) Asylees under Section 208 of the Immigration
21 and Nationality Act;
22 (4) Persons for whom deportation has been withheld
23 under Section 243(h) of the Immigration and Nationality
24 Act;
25 (5) Persons granted conditional entry under Section
26 203(a)(7) of the Immigration and Nationality Act as in
27 effect prior to April 1, 1980;
28 (6) Persons lawfully admitted for permanent
29 residence under the Immigration and Nationality Act; and
30 (7) Parolees, for at least one year, under Section
31 212(d)(5) of the Immigration and Nationality Act.
32 Those persons who are in the categories set forth in
33 subdivisions 6 and 7 of this Section, who enter the United
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1 States on or after August 22, 1996, shall not be eligible for
2 5 years beginning on the date the person entered the United
3 States.
4 The Illinois Department of Public Aid may, by rule, cover
5 prenatal care or emergency medical care for non-citizens who
6 are not otherwise eligible under this Section. Local
7 governmental units which do not receive State funds may
8 impose their own citizenship requirements and are authorized
9 to provide any benefits and impose any citizenship
10 requirements as are allowed under the Personal Responsibility
11 and Work Opportunity Reconciliation Act of 1996 (P.L.
12 104-193).
13 (Source: P.A. 90-17, eff. 7-1-97.)
14 (305 ILCS 5/2-6.5 new)
15 Sec. 2-6.5. "Medicaid". Unless the context requires
16 otherwise, "Medicaid" means the program of medical assistance
17 under Article V.
18 (305 ILCS 5/2-11) (from Ch. 23, par. 2-11)
19 Sec. 2-11. "Family unit": Husband and wife and a child
20 or children under age 21. Spouses and parents of children
21 under age 21 constitute "legally responsible relatives" or
22 "responsible relatives" wherever those terms may be used in
23 this Code in respect to their support obligation enforceable
24 by court action or an administrative order of the Illinois
25 Department of Public Aid, as provided in Article X, or
26 enforceable through other State or Federal laws.
27 The support obligation of other persons defined as
28 "legally responsible relatives" in this Section prior to
29 October 6, 1969 for aid extended to their dependents prior to
30 that date shall remain unimpaired.
31 (Source: P.A. 79-474.)
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1 (305 ILCS 5/2-16) (from Ch. 23, par. 2-16)
2 Sec. 2-16. "Service provider": A person or corporation
3 who furnishes medical, educational, psychiatric, vocational
4 or rehabilitative services to a recipient under this Code,
5 but excluding an employee of the Illinois Department of
6 Public Aid or the Department of Human Services or a county
7 department.
8 (Source: P.A. 82-555.)
9 (305 ILCS 5/2-18 new)
10 Sec. 2-18. Terms used in connection with determination
11 and enforcement of support responsibility. Unless the
12 context requires otherwise or unless otherwise provided in
13 this Code:
14 "Arrearage", "delinquency", "obligee", "obligor", "order
15 for support", and "payor" are defined as in the Income
16 Withholding for Support Act.
17 "Support order" means an order for support.
18 (305 ILCS 5/3-1) (from Ch. 23, par. 3-1)
19 Sec. 3-1. Eligibility requirements. Financial aid in
20 meeting basic maintenance requirements for a livelihood
21 compatible with health and well-being shall be given under
22 this Article to or in behalf of aged, blind, or disabled
23 persons who meet the eligibility conditions of Sections 3-1.1
24 through 3-1.7. Financial aid under this Article shall be
25 available only for persons who are receiving Supplemental
26 Security Income (SSI) or who have been found ineligible for
27 SSI on the basis of income.
28 "Aged person" means a person who has attained age 65, as
29 demonstrated by such evidence of age as the Illinois
30 Department of Human Services may by rule prescribe.
31 "Blind person" means a person who has no vision or whose
32 vision with corrective glasses is so defective as to prevent
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1 the performance of ordinary duties or tasks for which
2 eyesight is essential. The Illinois Department of Human
3 Services shall define blindness in terms of ophthalmic
4 measurements or ocular conditions. For purposes of this Act,
5 an Illinois Disabled Person Identification Card issued
6 pursuant to the Illinois Identification Card Act, indicating
7 that the person thereon named has a Type 3 disability shall
8 be evidence that such person is a blind person within the
9 meaning of this Section; however, such a card shall not
10 qualify such person for aid as a blind person under this Act,
11 and eligibility for aid as a blind person shall be determined
12 as provided in this Act.
13 "Disabled person" means a person age 18 or over who has a
14 physical or mental impairment, disease, or loss which is of a
15 permanent nature and which substantially impairs his ability
16 to perform labor or services or to engage in useful
17 occupations for which he is qualified, as determined by rule
18 and regulation of the Illinois Department of Human Services.
19 For purposes of this Act, an Illinois Disabled Person
20 Identification Card issued pursuant to The Illinois
21 Identification Card Act, indicating that the person thereon
22 named has a Type 1 or 2, Class 2 disability shall be evidence
23 that such person is a disabled person under this Section;
24 however, such a card shall not qualify such person for aid as
25 a disabled person under this Act, and eligibility for aid as
26 a disabled person shall be determined as provided in this
27 Act. If federal law or regulation permit or require the
28 inclusion of blind or disabled persons whose blindness or
29 disability is not of the degree specified in the foregoing
30 definitions, or permit or require the inclusion of disabled
31 persons under age 18 or aged persons under age 65, the
32 Illinois Department of Human Services, upon written approval
33 of the Governor, may provide by rule that all aged, blind or
34 disabled persons toward whose aid federal funds are available
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1 be eligible for assistance under this Article as is given to
2 those who meet the foregoing definitions of blind person and
3 disabled person or aged person.
4 (Source: P.A. 89-21, eff. 7-1-95.)
5 (305 ILCS 5/3-1a) (from Ch. 23, par. 3-1a)
6 Sec. 3-1a. Interim Assistance.
7 (a) (Blank).
8 (b) The Illinois Department of Human Services may
9 establish, by rule, an advocacy program to help clients
10 pursue Supplemental Security Income applications and, if the
11 client is found ineligible for Supplemental Security Income
12 initially, to help the client pursue the Supplemental
13 Security Income reconsideration and appeal process. This
14 program may be limited to specific geographic areas.
15 (Source: P.A. 92-111, eff. 1-1-02.)
16 (305 ILCS 5/3-1.2) (from Ch. 23, par. 3-1.2)
17 Sec. 3-1.2. Need. Income available to the person, when
18 added to contributions in money, substance, or services from
19 other sources, including contributions from legally
20 responsible relatives, must be insufficient to equal the
21 grant amount established by Department of Human Services
22 regulation for such person.
23 In determining earned income to be taken into account,
24 consideration shall be given to any expenses reasonably
25 attributable to the earning of such income. If federal law or
26 regulations permit or require exemption of earned or other
27 income and resources, the Illinois Department of Human
28 Services shall provide by rule and regulation that the amount
29 of income to be disregarded be increased (1) to the maximum
30 extent so required and (2) to the maximum extent permitted by
31 federal law or regulation in effect as of the date this
32 Amendatory Act becomes law. The Illinois Department may also
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1 provide by rule and regulation that the amount of resources
2 to be disregarded be increased to the maximum extent so
3 permitted or required.
4 In determining the resources of an individual or any
5 dependents, the Department of Human Services shall exclude
6 from consideration the value of funeral and burial spaces,
7 grave markers and other funeral and burial merchandise,
8 funeral and burial insurance the proceeds of which can only
9 be used to pay the funeral and burial expenses of the insured
10 and funds specifically set aside for the funeral and burial
11 arrangements of the individual or his or her dependents,
12 including prepaid funeral and burial plans, to the same
13 extent that such items are excluded from consideration under
14 the federal Supplemental Security Income program.
15 The homestead shall be exempt from consideration except
16 to the extent that it meets the income and shelter needs of
17 the person. "Homestead" means the dwelling house and
18 contiguous real estate owned and occupied by the person,
19 regardless of its value.
20 Occasional or irregular gifts in cash, goods or services
21 from persons who are not legally responsible relatives which
22 are of nominal value or which do not have significant effect
23 in meeting essential requirements shall be disregarded. The
24 eligibility of any applicant for or recipient of public aid
25 under this Article is not affected by the payment of any
26 grant under the "Senior Citizens and Disabled Persons
27 Property Tax Relief and Pharmaceutical Assistance Act" or any
28 distributions or items of income described under subparagraph
29 (X) of paragraph (2) of subsection (a) of Section 203 of the
30 Illinois Income Tax Act.
31 The Illinois Department of Human Services may, after
32 appropriate investigation, establish and implement a
33 consolidated standard to determine need and eligibility for
34 and amount of benefits under this Article or a uniform cash
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1 supplement to the federal Supplemental Security Income
2 program for all or any part of the then current recipients
3 under this Article; provided, however, that the establishment
4 or implementation of such a standard or supplement shall not
5 result in reductions in benefits under this Article for the
6 then current recipients of such benefits.
7 (Source: P.A. 91-676, eff. 12-23-99.)
8 (305 ILCS 5/3-1.4) (from Ch. 23, par. 3-1.4)
9 Sec. 3-1.4. Residents of public institutions. Residents
10 of municipal, county, state or national institutions for
11 persons with mental illness or persons with a developmental
12 disability or for the tuberculous, or residents of a home or
13 other institution maintained by such governmental bodies when
14 not in need of institutional care because of sickness,
15 convalescence, infirmity, or chronic illness, and inmates of
16 penal or correctional institutions maintained by such
17 governmental bodies, may qualify for aid under this Article
18 only after they have ceased to be residents or inmates, but
19 they may apply in advance of their discharge. Applications
20 received from residents scheduled for discharge from such
21 institutions shall be processed by the Department of Human
22 Services in an expeditious manner. For persons whose
23 applications are approved, the date of eligibility shall be
24 the date of release from the institution.
25 A person shall not be deemed a resident of a State
26 institution for persons with mental illness or persons with a
27 developmental disability within the meaning of this Section
28 if he or she has been conditionally discharged by the
29 Department of Mental Health and Developmental Disabilities or
30 the Department of Human Services (acting as successor to the
31 Department of Mental Health and Developmental Disabilities)
32 and is no longer residing in the institution.
33 Recipients of benefits under this Article who become
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1 residents of such institutions shall be permitted a period of
2 up to 30 days in such institutions without suspension or
3 termination of eligibility; if residency in an institution
4 extends beyond 30 days the eligibility for all benefits
5 except Aid to Families with Dependent Children shall be
6 suspended. Benefits shall be restored, effective on the date
7 of discharge or release, for persons who are residents of
8 institutions. Within a reasonable time after the discharge
9 of a person who was a resident of an institution, the
10 Department of Human Services shall redetermine the
11 eligibility of such person.
12 The Department of Human Services shall provide for
13 procedures to expedite the determination of disability of
14 persons scheduled to be discharged from facilities operated
15 by the Department.
16 If federal law or regulations governing grants under this
17 Article permit the inclusion of persons who are residents of
18 institutions designated in this Section beyond the period
19 authorized herein, the Illinois Department of Human Services,
20 upon a determination that the appropriations for public aid
21 are sufficient for such purpose, and upon approval of the
22 Governor, may provide by general and uniform rule for the
23 waiver of the provisions of this Section which would
24 otherwise disqualify such person for aid under this Article.
25 (Source: P.A. 88-380; 89-507, eff. 7-1-97.)
26 (305 ILCS 5/3-2) (from Ch. 23, par. 3-2)
27 Sec. 3-2. Conditions for basic maintenance grants to
28 persons receiving institutional care. A resident of a public
29 or private home or institution maintained for the care of
30 persons who are sick, convalescent, infirm or chronically
31 ill, may, if otherwise qualified, be granted financial aid
32 for basic maintenance, subject to the rules and regulations
33 of the Illinois Department of Human Services, if the
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1 facilities of the home or institution are in conformity with
2 standards prescribed by the Department of Public Health for
3 safeguarding the health, safety, and comfort of the residents
4 thereof, and provide such services as may be prescribed by
5 the Illinois Department of Human Services for enhancing their
6 rehabilitation or increasing their capacity for self-care.
7 (Source: Laws 1967, p. 122.)
8 (305 ILCS 5/3-3) (from Ch. 23, par. 3-3)
9 Sec. 3-3. Examination as to blindness. For all purposes,
10 the Illinois Department of Human Services may accept
11 determinations as to blindness performed under the auspices
12 of the federal Social Security Administration and properly
13 certified to the Department.
14 (Source: P.A. 89-21, eff. 7-1-95.)
15 (305 ILCS 5/3-4) (from Ch. 23, par. 3-4)
16 Sec. 3-4. Examination as to disability. For all purposes,
17 the Illinois Department of Human Services may accept
18 determinations as to disability performed under the auspices
19 of the federal Social Security Administration and properly
20 certified to the Department.
21 (Source: P.A. 89-21, eff. 7-1-95.)
22 (305 ILCS 5/3-5) (from Ch. 23, par. 3-5)
23 Sec. 3-5. Amount of aid. The amount and nature of
24 financial aid granted to or in behalf of aged, blind, or
25 disabled persons shall be determined in accordance with the
26 standards, grant amounts, rules and regulations of the
27 Illinois Department of Human Services. Due regard shall be
28 given to the requirements and conditions existing in each
29 case, and to the amount of property owned and the income,
30 money contributions, and other support, and resources
31 received or obtainable by the person, from whatever source.
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1 However, the amount and nature of any financial aid is not
2 affected by the payment of any grant under the "Senior
3 Citizens and Disabled Persons Property Tax Relief and
4 Pharmaceutical Assistance Act" or any distributions or items
5 of income described under subparagraph (X) of paragraph (2)
6 of subsection (a) of Section 203 of the Illinois Income Tax
7 Act. The aid shall be sufficient, when added to all other
8 income, money contributions and support, to provide the
9 person with a grant in the amount established by Department
10 of Human Services regulation for such a person, based upon
11 standards providing a livelihood compatible with health and
12 well-being.
13 (Source: P.A. 91-676, eff. 12-23-99.)
14 (305 ILCS 5/3-5a) (from Ch. 23, par. 3-5a)
15 Sec. 3-5a. Protective payments to substitute payee. If
16 the person, by reason of his physical or mental condition, is
17 unable to manage funds, or if, for any reason, he
18 persistently mismanages the grant to the detriment of his
19 best interests, the county department, in accordance with the
20 rules and regulations of the Illinois Department of Human
21 Services, may make a protective payment by designating a
22 person who is interested in or concerned with the person's
23 welfare to receive the grant in his behalf.
24 The substitute payee shall serve without compensation and
25 assume the obligation of seeing that the grant is expended
26 for the recipient's benefit. He may spend the grant for the
27 recipient, or supervise the recipient in its use, depending
28 upon the circumstances in the case, and shall make such
29 monthly reports to the county department as the county
30 department and the Illinois Department of Human Services may
31 require.
32 The county department shall terminate the protective
33 payment when it has made a determination that the grant will
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1 be used for the recipient's welfare.
2 A substitute payee may be removed, in accordance with the
3 rules and regulations of the Illinois Department of Human
4 Services, for unsatisfactory service. Such removal may be
5 effected without hearing. The decision shall not be
6 appealable to the Illinois Department of Human Services nor
7 shall it be reviewable in the courts.
8 The county department shall conduct such periodic reviews
9 as may be required by the Illinois Department of Human
10 Services to determine whether there is a continuing need for
11 a protective payment. If it appears that the need for such
12 payment is likely to continue beyond a reasonable period, the
13 county department shall take action for appointment by the
14 circuit court of a guardian or legal representative for the
15 purpose of receiving and managing the public aid grant.
16 The person shall be advised, in advance of a
17 determination to make a protective payment, that he may
18 appeal the decision to the Illinois Department of Human
19 Services under the provisions of Section 11-8 of Article XI.
20 (Source: Laws 1967, p. 2324.)
21 (305 ILCS 5/3-8) (from Ch. 23, par. 3-8)
22 Sec. 3-8. Funeral and burial. If the estate of a
23 deceased recipient is insufficient to pay for funeral and
24 burial expenses, and if no other resources, including
25 assistance from legally responsible relatives, are available
26 for such purposes, there shall be paid, in accordance with
27 the standards, rules and regulations of the Illinois
28 Department of Human Services, such reasonable amounts as may
29 be necessary to meet costs of the funeral, burial space, and
30 cemetery charges, or to reimburse any person not financially
31 responsible for the deceased who has voluntarily made
32 expenditures for such costs.
33 (Source: P.A. 90-372, eff. 7-1-98.)
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1 (305 ILCS 5/3-9) (from Ch. 23, par. 3-9)
2 Sec. 3-9. Claim against the estate of a deceased
3 recipient. On the death of a person who has been a recipient,
4 the total amount paid under this Article shall be filed and
5 allowed as a claim against that person's estate or as a claim
6 against the estate of that person's surviving spouse. No
7 claim of the State, however, shall be enforced against any
8 real estate while it is occupied as a homestead by the
9 recipient's surviving spouse, or a relative of the recipient
10 as defined by the rules and regulations of the Illinois
11 Department of Human Services, if no claims by other creditors
12 have been filed against the estate, or, if such claims have
13 been filed, they remain dormant for failure of prosecution or
14 failure of the claimant to compel administration of the
15 estate for the purpose of payment. "Homestead", as used in
16 this Section, means the dwelling house and contiguous real
17 estate occupied by a surviving spouse, or defined relative of
18 the recipient, regardless of the value of the property.
19 The transfer of money, personal property or other
20 personal assets, or any interest therein, by a present or
21 former recipient into a joint tenancy account in a bank or
22 other institution or depository shall be prima facie evidence
23 of an intent to defeat the claim against his estate. The
24 transfer may be voided in an appropriate legal action, or the
25 Illinois Department of Human Services may consider the
26 recipient's interest in the joint tenancy account as an asset
27 of his estate for the purpose of the claim provided by this
28 Section.
29 The Illinois Department of Human Services may, by rule,
30 defer or waive the enforcement of its claim hereunder if the
31 deceased recipient is survived by a dependent spouse and
32 minor child or children, or if rehabilitative training for
33 employment or other means of self-support for the surviving
34 spouse or children is feasible and the deferment or waiver of
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1 the claim would facilitate achievement of self-support status
2 and prevent or reduce the likelihood of return to dependency
3 upon public aid.
4 The estate claim herein provided is in addition to the
5 lien claim established in Section 3-10.
6 (Source: P.A. 88-85.)
7 (305 ILCS 5/3-10.1) (from Ch. 23, par. 3-10.1)
8 Sec. 3-10.1. Execution of notice of lien. The county
9 department of the county in which the recipient resides shall
10 execute a notice of lien which shall contain the name and
11 address of the recipient, a legal description of the
12 property, the fact that a lien is being claimed for aid paid
13 under this Article, and such other information as the
14 Illinois Department of Human Services may by rule prescribe.
15 The notice shall designate the County Superintendent of
16 Public Aid in his official capacity, and his successors in
17 office, as the holder of the lien and shall be executed by
18 the County Superintendent, in his official capacity, and
19 shall be acknowledged substantially in the following form:
20 "State of Illinois, County of (name of county): I (give
21 name of the officer and his official title) certify that
22 (name and official title of superintendent of public aid)
23 personally known to me to be the same person whose name is
24 subscribed to the foregoing instrument, appeared before me
25 this day in person and acknowledged that he signed the
26 instrument as required of him by law, for the uses therein
27 set forth."
28 "Dated (insert date).
29 ...............................
30 Signature of officer (Seal)."
31 (Source: P.A. 91-357, eff. 7-29-99.)
32 (305 ILCS 5/3-10.4) (from Ch. 23, par. 3-10.4)
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1 Sec. 3-10.4. Court costs waived. The Illinois Department
2 of Human Service and county departments shall not be required
3 to furnish bond or make a deposit for or pay any costs or
4 fees of any court or officer thereof in any legal proceeding
5 involving the lien.
6 (Source: P.A. 83-889.)
7 (305 ILCS 5/3-10.5) (from Ch. 23, par. 3-10.5)
8 Sec. 3-10.5. Payment to preserve lien. To protect the
9 lien of the State for reimbursement of aid paid under this
10 Article, the Illinois Department of Human Services may, from
11 funds which are available for that purpose, pay or provide
12 for the payment of necessary or essential repairs, purchase
13 tax certificates, pay balances due on land contracts, or pay
14 or cause to be satisfied any prior liens on the property to
15 which the lien hereunder applies.
16 (Source: Laws 1967, p. 122.)
17 (305 ILCS 5/3-10.6) (from Ch. 23, par. 3-10.6)
18 Sec. 3-10.6. Release of lien. The county department,
19 under the rules and regulations of the Illinois Department of
20 Human Services, shall issue a certificate of release of lien
21 upon payment by the recipient, his spouse, heirs at law, next
22 of kin, or personal representatives, of the total amount of
23 aid to which the lien applies, or upon submission of a bond
24 with surety or sureties satisfactory to the Illinois
25 Department of Human Services, conditioned upon payment of
26 such amount. A certificate of release may also be issued upon
27 payment of the value of the property to which the lien
28 applies; in such case, the release shall reserve the
29 Department of Human Services' Illinois Department's claim for
30 the balance against subsequently discovered assets of the
31 recipient.
32 The Illinois Department of Human Services may also by
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1 rule provide for release of the lien in the case of
2 recipients who have dependent spouses and minor children or
3 for whom rehabilitative training for employment or other
4 means of self-support is feasible where release of the lien
5 would facilitate achievement of self-support status and
6 prevent or reduce the likelihood of return to dependency.
7 (Source: Laws 1967, p. 122.)
8 (305 ILCS 5/3-10.7) (from Ch. 23, par. 3-10.7)
9 Sec. 3-10.7. Foreclosure of lien. Upon the death of the
10 recipient, or prior thereto in cases of fraud if the Illinois
11 Department of Human Services deems such action necessary to
12 preserve the security of the lien, the Illinois Department of
13 Human Services, acting in behalf of the State, may foreclose
14 the lien in a judicial proceeding to the same extent and in
15 the same manner as in the enforcement of other liens. The
16 process, practice and procedure for such foreclosure shall be
17 the same as provided in the Civil Practice Law, as amended.
18 If the amount bid for the property at the sale is less
19 than the amount of the lien, or if there are no bidders, the
20 Illinois Department of Human Services may purchase the
21 property for the use of the People of the State of Illinois.
22 Property so acquired may be sold to the highest bidder, after
23 advertisement in the State official newspaper, the sale to be
24 not less than 10 days after the advertisement. Upon a sale,
25 the deed shall be executed by the Illinois Department of
26 Human Services for the use of the People of the State of
27 Illinois, and shall be signed by the Secretary of Human
28 Services Director.
29 Except in cases of fraud, the Illinois Department of
30 Human Services shall defer foreclosure proceedings on
31 property occupied as a homestead by the recipient, his
32 surviving spouse, or a relative of the recipient as defined
33 by the rules and regulations of the Illinois Department.
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1 (Source: P.A. 89-507, eff. 7-1-97.)
2 (305 ILCS 5/3-10.9) (from Ch. 23, par. 3-10.9)
3 Sec. 3-10.9. Redemption. Except as to any sale had by
4 virtue of a judgment of foreclosure in accordance with
5 Article XV of the Code of Civil Procedure, whenever real
6 estate has been or is sold at judicial or judgment sale and
7 the lien thereon in favor of the Illinois Department of Human
8 Services is junior or inferior to the lien so enforced or
9 foreclosed by or through that sale, the right to redeem in
10 any manner under or by virtue of such lien from such sale or
11 from the lien so foreclosed or enforced shall terminate at
12 the end of 12 months from the date upon which there is filed
13 for record in the office of the Recorder for the County in
14 which the lands so sold are situated, if such lands are
15 unregistered, or in the office of the Registrar of Titles for
16 such County, if such lands are registered, a certified copy
17 of the original or duplicate recorded or registered
18 certificate of such sale, such certified copy being endorsed
19 by the Secretary of Human Services Director showing service
20 of a copy of such certificate upon him or her, and upon such
21 service such officer shall make such endorsement. Such
22 service may be by United States registered or certified mail.
23 (Source: P.A. 89-507, eff. 7-1-97.)
24 (305 ILCS 5/3-10.10) (from Ch. 23, par. 3-10.10)
25 Sec. 3-10.10. Sale of property of deceased recipient
26 Order for amount of lien Preservation of lien. Whenever the
27 court having jurisdiction of the estate of a decedent
28 determines that it is necessary or desirable for the proper
29 administration of the estate to sell real property upon which
30 the State has a lien imposed by this Article, the Court shall
31 enter an order for the total amount of which the State has a
32 lien, as determined by evidence submitted to it by the
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1 Illinois Department of Human Services through the appropriate
2 county department or departments.
3 The superiority of such lien shall not be affected
4 thereby and shall be satisfied from the proceeds of sale in
5 the same manner as specified in Section 3-10.7 for
6 foreclosure of the lien. The Illinois Department of Human
7 Services shall have the same power of purchase and subsequent
8 sale as set forth in the second paragraph of Section 3-10.7.
9 The lien may be released by the county department in
10 accordance with the provisions of Section 3-10.6.
11 (Source: Laws 1967, p. 122.)
12 (305 ILCS 5/3-11) (from Ch. 23, par. 3-11)
13 Sec. 3-11. Fraudulent transfer of real property. A
14 transfer of any legal or equitable interest in real property,
15 whether vested, contingent, or inchoate, by a person who is
16 or has been a recipient, including any such transfers prior
17 to application which would have initially disqualified the
18 person as provided in Section 3-1.3, shall, under any of the
19 following conditions, be deemed prima facie fraudulent as to
20 the Illinois Department of Human Services.
21 (1.) Where the deed or assignment has not been
22 recorded or registered by the grantee, trustee, or
23 assignee
24 (2.) When the deed or assignment, even though
25 recorded or registered, fails to state the consideration
26 (3.) When the consideration for the deed or
27 assignment, even though recorded or registered, is not
28 paid
29 (4.) When the consideration for the deed or
30 assignment, even though recorded or registered, does not
31 approximate the fair, cash market value.
32 The Attorney General, upon request of the Illinois
33 Department of Human Services, shall file suit to rescind any
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1 such transfer or assignment of real property. Any aid
2 furnished under this Article shall be recoverable in any such
3 proceeding from such person or from his estate.
4 (Source: P.A. 92-111, eff. 1-1-02.)
5 (305 ILCS 5/3-13) (from Ch. 23, par. 3-13)
6 Sec. 3-13. Federal program; declaration of
7 responsibilities.: It is the position of this State that the
8 Federal Government should meet its obligation to provide
9 financial aid to those aged, blind or disabled persons
10 eligible under Article III hereof so as to assure those
11 persons a standard of living compatible with health and
12 well-being, including any supplementary aid program provided
13 to meet special or emergency needs, and it is the position of
14 this State that the Federal Government should meet its
15 obligation to provide continuing supplemental nutritional aid
16 for such persons through the federal Food Stamp Program or
17 through full reimbursement for expenditures made in lieu of
18 such Food Stamp Program.
19 (a) The Illinois Department of Human Services may, from
20 federal reimbursements received under this Section, make
21 disbursements to any attorney, or advocate working under the
22 supervision of an attorney, who represents a recipient of
23 assistance under Article VI of this Code in a program
24 administered by the Illinois Department, in an appeal of any
25 claim for federal Supplemental Security Income benefits
26 before an administrative law judge which is decided in favor
27 of such recipient. The amount of such disbursement shall be
28 equal to 25% of the maximum federal Supplemental Security
29 Income grant payable to an individual for a period of one
30 year. No such disbursement shall be made unless a petition
31 and a copy of the favorable decision is submitted by such
32 attorney or advocate to the Illinois Department of Human
33 Services within 60 days of the date of such decision. The
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1 disbursement shall be made within 30 days after the petition
2 is received. The Illinois Department of Human Services shall
3 promulgate rules and regulations necessary to implement this
4 subsection.
5 (b) The Illinois Department of Human Services shall
6 institute a State program to fully supplement the federal
7 Supplemental Security Income grants of all persons in the
8 aged, blind, or disabled categories who meet the eligibility
9 and need requirements of this Code, after having given prior
10 notice to and having consulted with the Citizens
11 Assembly/Council on Public Aid under the procedures
12 established by Section 12-4.11 hereof. The amount or amounts
13 of such supplementary payments shall be established by the
14 Secretary of Human Services Director of the Illinois
15 Department in a manner consistent with the other provisions
16 of this Article III.
17 (c) The Illinois Department of Human Services, the
18 Comptroller and the Treasurer, are authorized to disburse to
19 the Federal Government amounts appropriated to the Illinois
20 Department of Human Services for use in furnishing aid to
21 persons eligible under Article III of this Code, to receive
22 reimbursements from the Federal Government therefor, and to
23 establish administrative procedures necessary for the
24 accomplishment of such a payment system.
25 (Source: P.A. 89-21, eff. 7-1-95.)
26 (305 ILCS 5/3-14) (from Ch. 23, par. 3-14)
27 Sec. 3-14. Authorization for federal administration of
28 supplement.: The Illinois Department of Human Services is
29 authorized to enter into an agreement with the Secretary of
30 Health and Human Services, Education and Welfare for the
31 Secretary to administer, as provided in Section 1616 of the
32 Social Security Act, any or all portions of a State program
33 to supplement grants.
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1 (Source: P.A. 78-3rd S.S.-22.)
2 (305 ILCS 5/4-0.5)
3 Sec. 4-0.5. Aid to Families with Dependent Children
4 Program inoperative after June 30, 1997. The Aid to Families
5 with Dependent Children (AFDC) Program shall be inoperative
6 after June 30, 1997. Under the federal Temporary Assistance
7 for Needy Children Program the Illinois Department of Human
8 Services shall develop an alternative program of mutual
9 responsibility between the Illinois Department and the client
10 to allow the family to become self-sufficient or employed as
11 quickly as possible through (i) the provision of transitional
12 assistance to families in the form of emergency one-time
13 payments to prevent job loss, temporary assistance while
14 searching for or being trained for work, or paternity
15 establishment and child support enforcement or (ii) the
16 provision for continued work.
17 (Source: P.A. 89-6, eff. 3-6-95; 90-17, eff. 7-1-97.)
18 (305 ILCS 5/4-1) (from Ch. 23, par. 4-1)
19 Sec. 4-1. Eligibility requirements. Financial aid in
20 meeting basic maintenance requirements for a livelihood
21 compatible with health and well-being shall be given under
22 this Article to or in behalf of families with dependent
23 children who meet the eligibility conditions of Sections
24 4-1.1 through 4-1.11. Persons who meet the eligibility
25 criteria authorized under this Article shall be treated
26 equally, provided that nothing in this Article shall be
27 construed to create an entitlement to a particular grant or
28 service level or to aid in amounts not authorized under this
29 Code, nor construed to limit the authority of the General
30 Assembly to change the eligibility requirements or provisions
31 respecting assistance amounts.
32 The Illinois Department of Human Services shall advise
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1 every applicant for and recipient of aid under this Article
2 of (i) the requirement that all recipients move toward
3 self-sufficiency and (ii) the value and benefits of
4 employment. As a condition of eligibility for that aid,
5 every person who applies for aid under this Article on or
6 after the effective date of this amendatory Act of 1995 shall
7 prepare and submit, as part of the application or subsequent
8 redetermination, a personal plan for achieving employment and
9 self-sufficiency. The plan shall incorporate the
10 individualized assessment and employability plan set out in
11 subsections (a) and (b) of Section 9A-8.05 and subsections
12 (a), (b), and (c) of Section 9A-8.010 (d), (f), and (g) of
13 Section 9A-8. The plan may be amended as the recipient's
14 needs change. The assessment process to develop the plan
15 shall include questions that screen for domestic violence
16 issues and steps needed to address these issues may be part
17 of the plan. If the individual indicates that he or she is a
18 victim of domestic violence, he or she may also be referred
19 to an available domestic violence program. Failure of the
20 client to follow through on the personal plan for employment
21 and self-sufficiency may be a basis for sanction under
22 Section 4-21.
23 (Source: P.A. 92-111, eff. 1-1-02.)
24 (305 ILCS 5/4-1.2) (from Ch. 23, par. 4-1.2)
25 Sec. 4-1.2. Living arrangements; parents; relatives;
26 foster care.
27 (a) The child or children must (1) be living with his or
28 their father, mother, grandfather, grandmother, brother,
29 sister, stepfather, stepmother, stepbrother, stepsister,
30 uncle or aunt, or other relative approved by the Illinois
31 Department of Human Services, in a place of residence
32 maintained by one or more of such relatives as his or their
33 own home, or (2) have been (a) removed from the home of the
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1 parents or other relatives by judicial order under the
2 Juvenile Court Act or the Juvenile Court Act of 1987, as
3 amended, (b) placed under the guardianship of the Department
4 of Children and Family Services, and (c) under such
5 guardianship, placed in a foster family home, group home or
6 child care institution licensed pursuant to the "Child Care
7 Act of 1969", approved May 15, 1969, as amended, or approved
8 by the that Department of Children and Family Services as
9 meeting standards established for licensing under that Act,
10 or (3) have been relinquished in accordance with the
11 Abandoned Newborn Infant Protection Act. A child so placed in
12 foster care who was not receiving aid under this Article in
13 or for the month in which the court proceedings leading to
14 that placement were initiated may qualify only if he lived in
15 the home of his parents or other relatives at the time the
16 proceedings were initiated, or within 6 months prior to the
17 month of initiation, and would have received aid in and for
18 that month if application had been made therefor.
19 (b) The Illinois Department of Human Services may, by
20 rule, establish those persons who are living together who
21 must be included in the same assistance unit in order to
22 receive cash assistance under this Article and the income and
23 assets of those persons in an assistance unit which must be
24 considered in determining eligibility.
25 (c) The conditions of qualification herein specified
26 shall not prejudice aid granted under this Code for foster
27 care prior to the effective date of this 1969 Amendatory Act.
28 (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01.)
29 (305 ILCS 5/4-1.2a) (from Ch. 23, par. 4-1.2a)
30 Sec. 4-1.2a. Residents of public institutions.
31 Residents of municipal, county, state or national
32 institutions for persons with mental illness or persons with
33 a developmental disability or for the tuberculous, or
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1 residents of a home or other institution maintained by such
2 governmental bodies when not in need of institutional care
3 because of sickness, convalescence, infirmity, or chronic
4 illness, and inmates of penal or correctional institutions
5 maintained by such governmental bodies, may qualify for aid
6 under this Article only after they have ceased to be
7 residents or inmates.
8 A person shall not be deemed a resident of a State
9 institution for persons with mental illness or persons with a
10 developmental disability within the meaning of this Section
11 if he or she has been conditionally discharged by the
12 Department of Mental Health and Developmental Disabilities or
13 the Department of Human Services (acting as successor to the
14 Department of Mental Health and Developmental Disabilities)
15 and is no longer residing in the institution.
16 Recipients of benefits under this Article who become
17 residents of such institutions shall be permitted a period of
18 up to 30 days in such institutions without suspension or
19 termination of eligibility. Benefits for which such person is
20 eligible shall be restored, effective on the date of
21 discharge or release, for persons who are residents of
22 institutions. Within a reasonable time after the discharge of
23 a person who was a resident of an institution, the Department
24 of Human Services shall redetermine the eligibility of such
25 person.
26 The Department of Human Services shall provide for
27 procedures to expedite the determination of incapacity or
28 ability to engage in employment of persons scheduled to be
29 discharged from facilities operated by the Department.
30 (Source: P.A. 92-111, eff. 1-1-02.)
31 (305 ILCS 5/4-1.2c)
32 Sec. 4-1.2c. Residence of child who is pregnant or a
33 parent.
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1 (a) Notwithstanding any other provision of this Code, no
2 aid shall be paid under this Article on behalf of a person
3 under age 18 who has never married and who has a child or is
4 pregnant, unless that person resides with a parent, legal
5 guardian, or other adult relative or in a foster home,
6 maternity home, or other adult-supervised living arrangement.
7 (b) The Illinois Department of Human Services may make
8 an exception to the requirement of subsection (a) in any of
9 the following circumstances:
10 (1) The person has no living parent or legal
11 guardian, or the parent's or legal guardian's whereabouts
12 are unknown.
13 (2) The Illinois Department determines that the
14 physical health or safety of the person or the person's
15 child would be jeopardized.
16 (3) The person has lived apart from the parent or
17 legal guardian for a period of at least one year before
18 the child's birth or before applying for aid under this
19 Article.
20 (c) (Blank).
21 (Source: P.A. 92-111, eff. 1-1-02.)
22 (305 ILCS 5/4-1.6) (from Ch. 23, par. 4-1.6)
23 Sec. 4-1.6. Need. Income available to the family as
24 defined by the Illinois Department of Human Services by rule,
25 or to the child in the case of a child removed from his or
26 her home, when added to contributions in money, substance or
27 services from other sources, including income available from
28 parents absent from the home or from a stepparent,
29 contributions made for the benefit of the parent or other
30 persons necessary to provide care and supervision to the
31 child, and contributions from legally responsible relatives,
32 must be insufficient to equal the grant amount established by
33 Department regulation for such a person.
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1 In considering income to be taken into account,
2 consideration shall be given to any expenses reasonably
3 attributable to the earning of such income. The Illinois
4 Department of Human Services may also permit all or any
5 portion of earned or other income to be set aside for the
6 future identifiable needs of a child. The Illinois Department
7 may provide by rule and regulation for the exemptions thus
8 permitted or required. The eligibility of any applicant for
9 or recipient of public aid under this Article is not affected
10 by the payment of any grant under the "Senior Citizens and
11 Disabled Persons Property Tax Relief and Pharmaceutical
12 Assistance Act" or any distributions or items of income
13 described under subparagraph (X) of paragraph (2) of
14 subsection (a) of Section 203 of the Illinois Income Tax Act.
15 The Illinois Department of Human Services may, by rule,
16 set forth criteria under which an assistance unit is
17 ineligible for cash assistance under this Article for a
18 specified number of months due to the receipt of a lump sum
19 payment.
20 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
21 (305 ILCS 5/4-1.7) (from Ch. 23, par. 4-1.7)
22 Sec. 4-1.7. Enforcement of parental child support
23 obligation.) If the parent or parents of the child are
24 failing to meet or are delinquent in their legal obligation
25 to support the child, the parent or other person having
26 custody of the child or the Illinois Department of Public Aid
27 may request the law enforcement officer authorized or
28 directed by law to so act to file action for the enforcement
29 of such remedies as the law provides for the fulfillment of
30 the child support obligation.
31 If a parent has a judicial remedy against the other
32 parent to compel child support, or if, as the result of an
33 action initiated by or in behalf of one parent against the
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1 other, a child support order has been entered in respect to
2 which there is noncompliance or delinquency, or where the
3 order so entered may be changed upon petition to the court to
4 provide additional support, the parent or other person having
5 custody of the child or the Illinois Department of Public Aid
6 may request the appropriate law enforcement officer to seek
7 enforcement of the remedy, or of the support order, or a
8 change therein to provide additional support. If the law
9 enforcement officer is not authorized by law to so act in
10 these instances, the parent, or if so authorized by law the
11 other person having custody of the child, or the Illinois
12 Department of Public Aid may initiate an action to enforce
13 these remedies.
14 A parent or other person having custody of the child must
15 comply with the requirements of Title IV of the federal
16 Social Security Act, and the regulations duly promulgated
17 thereunder, and any rules promulgated by the Illinois
18 Department of Public Aid regarding enforcement of the child
19 support obligation. The Illinois Department of Public Aid
20 and the Department of Human Services may provide by rule for
21 the grant or continuation of aid to the person for a
22 temporary period if he or she accepts counseling or other
23 services designed to increase his or her motivation to seek
24 enforcement of the child support obligation.
25 In addition to any other definition of failure or refusal
26 to comply with the requirements of Title IV of the federal
27 Social Security Act, or Illinois Department of Public Aid
28 rule, in the case of failure to attend court hearings, the
29 parent or other person can show cooperation by attending a
30 court hearing or, if a court hearing cannot be scheduled
31 within 14 days following the court hearing that was missed,
32 by signing a statement that the parent or other person is now
33 willing to cooperate in the child support enforcement process
34 and will appear at any later scheduled court date. The
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1 parent or other person can show cooperation by signing such a
2 statement only once. If failure to attend the court hearing
3 or other failure to cooperate results in the case being
4 dismissed, such a statement may be signed after 2 months.
5 No denial or termination of medical assistance pursuant
6 to this Section shall commence during pregnancy of the parent
7 or other person having custody of the child or for 30 days
8 after the termination of such pregnancy. The termination of
9 medical assistance may commence thereafter if the Illinois
10 Department of Public Aid determines that the failure or
11 refusal to comply with this Section persists. Postponement
12 of denial or termination of medical assistance during
13 pregnancy under this paragraph shall be effective only to the
14 extent it does not conflict with federal law or regulation.
15 Any evidence a parent or other person having custody of
16 the child gives in order to comply with the requirements of
17 this Section shall not render him or her liable to
18 prosecution under Sections 11-7 or 11-8 of the "Criminal Code
19 of 1961", approved July 28, 1961, as amended.
20 When so requested, the Illinois Department of Public Aid
21 and the Department of Human Services shall provide such
22 services and assistance as the law enforcement officer may
23 require in connection with the filing of any action
24 hereunder.
25 The Illinois Department of Public Aid and the Department
26 of Human Services, and as an expense of administration, may
27 also provide applicants for and recipients of aid with such
28 services and assistance, including assumption of the
29 reasonable costs of prosecuting any action or proceeding, as
30 may be necessary to enable them to enforce the child support
31 liability required hereunder.
32 Nothing in this Section shall be construed as a
33 requirement that an applicant or recipient file an action for
34 dissolution of marriage against his or her spouse.
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1 (Source: P.A. 89-507, eff. 7-1-97; 90-17, eff. 7-1-97;
2 revised 12-13-01.)
3 (305 ILCS 5/4-1.10) (from Ch. 23, par. 4-1.10)
4 Sec. 4-1.10. Acceptance of assignment to job search,
5 training and work programs. An individual for whom the job
6 search, training and work programs established under Article
7 IXA are applicable must accept assignment to such programs.
8 The Illinois Department of Human Services and the local
9 governmental unit shall determine, pursuant to rules and
10 regulations, sanctions for persons failing to comply with the
11 requirements under this Section. However, no participant
12 shall be sanctioned for failure to satisfy job search
13 requirements before a full assessment of the participant's
14 job readiness and employability, except that for those
15 persons subject to the job search program operated under this
16 Section an assessment as defined by rule at the time of
17 intake will meet the assessment requirement. No participant
18 shall be sanctioned for failure to satisfy the minimum number
19 of employer contacts if the participant made a good faith
20 effort.
21 (Source: P.A. 92-111, eff. 1-1-02.)
22 (305 ILCS 5/4-1.12)
23 Sec. 4-1.12. Five year limitation. No assistance unit
24 shall be eligible for a cash grant under this Article if it
25 includes an adult who has received cash assistance as an
26 adult for 60 months, whether or not consecutive, after the
27 effective date of this amendatory Act of 1997. The Illinois
28 Department of Human Services may exempt individual assistance
29 units from the 60-month limitation or determine circumstances
30 under which a month or months would not count towards the
31 60-month limitation even though the assistance unit did
32 receive cash assistance under this Article.
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1 (Source: P.A. 90-17, eff. 7-1-97.)
2 (305 ILCS 5/4-2) (was 305 ILCS 5/4-2, subsec. (a))
3 Sec. 4-2. Amount of aid, generally. (a) The amount and
4 nature of financial aid shall be determined in accordance
5 with the grant amounts, rules and regulations of the Illinois
6 Department of Human Services. Due regard shall be given to
7 the self-sufficiency requirements of the family and to the
8 income, money contributions and other support and resources
9 available, from whatever source. However, the amount and
10 nature of any financial aid is not affected by the payment of
11 any grant under the "Senior Citizens and Disabled Persons
12 Property Tax Relief and Pharmaceutical Assistance Act" or any
13 distributions or items of income described under subparagraph
14 (X) of paragraph (2) of subsection (a) of Section 203 of the
15 Illinois Income Tax Act. The aid shall be sufficient, when
16 added to all other income, money contributions and support to
17 provide the family with a grant in the amount established by
18 Department of Human Services regulation.
19 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
20 (305 ILCS 5/4-2.5 new) (was 305 ILCS 5/4-2, subsec. (c))
21 Sec. 4-2.5. Amount of aid; child requiring care outside
22 home. (c) The amount and nature of the financial aid for a
23 child requiring care outside his own home shall be determined
24 in accordance with the rules and regulations of the Illinois
25 Department of Human Services, with due regard to the needs
26 and requirements of the child in the foster home or
27 institution in which he has been placed.
28 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
29 (305 ILCS 5/4-2.10 new) (was 305 ILCS 5/4-2, subsec. (d))
30 Sec. 4-2.10. Amount of aid; pregnant woman with no
31 dependent child.
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1 (a) (d) If the Department of Human Services establishes
2 grants for family units consisting exclusively of a pregnant
3 woman with no dependent child or including her husband if
4 living with her, the grant amount for such a unit shall be
5 equal to the grant amount for an assistance unit consisting
6 of one adult, or 2 persons if the husband is included. Other
7 than as herein described, an unborn child shall not be
8 counted in determining the size of an assistance unit or for
9 calculating grants.
10 (b) Payments for basic maintenance requirements of a
11 child or children and the relative with whom the child or
12 children are living shall be prescribed, by rule, by the
13 Illinois Department of Human Services.
14 (c) Grants under this Article shall not be supplemented
15 by General Assistance provided under Article VI.
16 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
17 (305 ILCS 5/4-2.15 new) (was 305 ILCS 5/4-2, subsecs. (f)
18 and (g))
19 Sec. 4-2.15. Grant increase after birth of child.
20 (a) (f) An assistance unit, receiving financial aid
21 under this Article or temporarily ineligible to receive aid
22 under this Article under a penalty imposed by the Illinois
23 Department of Human Services for failure to comply with the
24 eligibility requirements or that voluntarily requests
25 termination of financial assistance under this Article and
26 becomes subsequently eligible for assistance within 9 months,
27 shall not receive any increase in the amount of aid solely on
28 account of the birth of a child; except that an increase is
29 not prohibited when the birth is (i) of a child of a pregnant
30 woman who became eligible for aid under this Article during
31 the pregnancy, or (ii) of a child born within 10 months after
32 the date of implementation of this Section subsection, or
33 (iii) of a child conceived after a family became ineligible
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1 for assistance due to income or marriage and at least 3
2 months of ineligibility expired before any reapplication for
3 assistance. This Section subsection does not, however,
4 prevent a unit from receiving a general increase in the
5 amount of aid that is provided to all recipients of aid under
6 this Article.
7 (b) The Illinois Department of Human Services is
8 authorized to transfer funds, and shall use any budgetary
9 savings attributable to not increasing the grants due to the
10 births of additional children, to supplement existing funding
11 for employment and training services for recipients of aid
12 under this Article IV. The Illinois Department shall target,
13 to the extent the supplemental funding allows, employment and
14 training services to the families who do not receive a grant
15 increase after the birth of a child. In addition, the
16 Illinois Department shall provide, to the extent the
17 supplemental funding allows, such families with up to 24
18 months of transitional child care pursuant to Illinois
19 Department rules. All remaining supplemental funds shall be
20 used for employment and training services or transitional
21 child care support.
22 (c) In making the transfers authorized by this
23 subsection (b), the Illinois Department of Human Services
24 shall first determine, pursuant to regulations adopted by the
25 Illinois Department for this purpose, the amount of savings
26 attributable to not increasing the grants due to the births
27 of additional children. Transfers may be made from General
28 Revenue Fund appropriations for distributive purposes
29 authorized by Article IV of this Code only to General Revenue
30 Fund appropriations for employability development services
31 including operating and administrative costs and related
32 distributive purposes under Article IXA of this Code. The
33 Secretary of Human Services Director, with the approval of
34 the Governor, shall certify the amount and affected line item
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1 appropriations to the State Comptroller.
2 (d) Nothing in this Section subsection shall be
3 construed to prohibit the Illinois Department of Human
4 Services from using funds under this Article IV to provide
5 assistance in the form of vouchers that may be used to pay
6 for goods and services deemed by the Illinois Department, by
7 rule, as suitable for the care of the child such as diapers,
8 clothing, school supplies, and cribs.
9 (g) (Blank).
10 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
11 (305 ILCS 5/4-2.20 new) (was 305 ILCS 5/4-2, subsec. (h))
12 Sec. 4-2.20. Reductions and increases in payment levels.
13 (a) (h) Notwithstanding any other provision of this
14 Code, the Illinois Department of Human Services is authorized
15 to reduce payment levels used to determine cash grants under
16 this Article after December 31 of any fiscal year if the
17 Illinois Department determines that the caseload upon which
18 the appropriations for the current fiscal year are based have
19 increased by more than 5% and the appropriation is not
20 sufficient to ensure that cash benefits under this Article do
21 not exceed the amounts appropriated for those cash benefits.
22 (b) Reductions in payment levels may be accomplished by
23 emergency rule under Section 5-45 of the Illinois
24 Administrative Procedure Act, except that the limitation on
25 the number of emergency rules that may be adopted in a
26 24-month period shall not apply and the provisions of
27 Sections 5-115 and 5-125 of the Illinois Administrative
28 Procedure Act shall not apply.
29 (c) Increases in payment levels shall be accomplished
30 only in accordance with Section 5-40 of the Illinois
31 Administrative Procedure Act. Before any rule to increase
32 payment levels promulgated under Sections 4-2 through this
33 Section shall become effective, a joint resolution approving
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1 the rule must be adopted by a roll call vote by a majority of
2 the members elected to each chamber of the General Assembly.
3 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
4 (305 ILCS 5/4-2.25 new) (was 305 ILCS 5/4-2, subsec. (e))
5 Sec. 4-2.25. Person to whom grant is paid. (e) Grants
6 shall be paid to the parent or other person with whom the
7 child or children are living, except for such amount as is
8 paid in behalf of the child or his parent or other relative
9 to other persons or agencies pursuant to this Code or the
10 rules and regulations of the Illinois Department of Human
11 Services.
12 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
13 (305 ILCS 5/4-2.30 new) (was 305 ILCS 5/4-2, subsec. (b))
14 Sec. 4-2.30. Grant diversion projects. (b) The Illinois
15 Department of Human Services may conduct special projects,
16 which may be known as Grant Diversion Projects, under which
17 recipients of financial aid under this Article are placed in
18 jobs and their grants are diverted to the employer who in
19 turn makes payments to the recipients in the form of salary
20 or other employment benefits. The Illinois Department shall
21 by rule specify the terms and conditions of such Grant
22 Diversion Projects. Such projects shall take into
23 consideration and be coordinated with the programs
24 administered under the Illinois Emergency Employment
25 Development Act. insert
26 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
27 (305 ILCS 5/4-3a) (from Ch. 23, par. 4-3a)
28 Sec. 4-3a. Handicapped children; special education. No
29 otherwise qualified handicapped child receiving special
30 education and related services under Article 14 of the School
31 Code shall solely by reason of his or her handicap be
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1 excluded from the participation in or be denied the benefits
2 of or be subjected to discrimination under any program or
3 activity provided by the Department of Human Services.
4 (Source: P.A. 80-1403.)
5 (305 ILCS 5/4-4.1)
6 Sec. 4-4.1. Immunizations.
7 (a) The Illinois Department of Public Aid shall develop
8 and implement and that Department and the Department of Human
9 Services shall jointly continue by rule a program to ensure
10 that children under 5 years of age living in assistance units
11 that receive benefits under this Code are immunized. The
12 Illinois Department of Public Aid shall report to the
13 Governor and the General Assembly on the progress of the
14 program on April 1, 1994 and 1995.
15 (b) Nothing in this Section shall be construed to
16 require immunization of any child in contravention of the
17 stated objections of a parent, guardian, or relative with
18 custody of a child that the administration of immunizing
19 agents conflicts with his or her religious tenets and
20 practices.
21 (Source: P.A. 88-342; 89-507, eff. 7-1-97.)
22 (305 ILCS 5/4-7) (from Ch. 23, par. 4-7)
23 Sec. 4-7. Home visits, interviews or communications. Each
24 family receiving aid shall be interviewed in person or
25 communicated with in investigations of applications for aid
26 and at least once in each subsequent 12 month period to
27 ascertain continuing need for such aid and to provide the
28 child and his parents or relatives with such service and
29 guidance as will strengthen family life and aid them in
30 utilizing to the maximum their capacities for self-care,
31 self-support, and responsible citizenship. However, the
32 Department of Human Services shall determine those assistance
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1 units where the possibility for public assistance fraud or
2 abuse is greatest, or where there is the possibility of
3 frequent changes in need or circumstances, or where any child
4 in the home may be an abused or neglected child as determined
5 by the Department of Children and Family Services under the
6 Abused and Neglected Child Reporting Act, as now or hereafter
7 amended, and shall by rule provide for more frequent
8 interviews of or communications with those assistance units
9 and for the implementation of necessary remedies under
10 Sections 4-8 through 4-8.20 and Section 4-9 for those
11 assistance units. Written reports of such interviews or
12 communications and any related remedies shall become a part
13 of the record in every case.
14 (Source: P.A. 85-1209.)
15 (305 ILCS 5/4-8) (was 305 ILCS 5/4-8, subsec. (a), in
16 part)
17 Sec. 4-8. Mismanagement of assistance grant. (a) If the
18 county department has reason to believe that the money
19 payment for basic maintenance is not being used, or may not
20 be used, in the best interests of the child and the family
21 and that there is present or potential damage to the
22 standards of health and well-being that the grant is intended
23 to assure, the county department shall provide the parent or
24 other relative with the counseling and guidance services with
25 respect to the use of the grant and the management of other
26 funds available to the family as may be required to assure
27 use of the grant in the best interests of the child and
28 family.
29 (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
30 (305 ILCS 5/4-8.5 new) (was 305 ILCS 5/4-8, subsec. (a),
31 in part)
32 Sec. 4-8.5. Evidence of grant mismanagement. The Illinois
-43- LRB9209402DJgc
1 Department of Human Services shall by rule prescribe criteria
2 which shall constitute evidence of grant mismanagement. The
3 criteria shall include but not be limited to the following:
4 (1) A determination that a child in the assistance
5 unit is not receiving proper and necessary support or
6 other care for which assistance is being provided under
7 this Code.
8 (2) A record establishing that the parent or
9 relative has been found guilty of public assistance fraud
10 under Article VIIIA.
11 (3) A determination by an appropriate person,
12 entity, or agency that the parent or other relative
13 requires treatment for alcohol or substance abuse, mental
14 health services, or other special care or treatment.
15 The Department of Human Services shall at least consider
16 non-payment of rent for two consecutive months as evidence of
17 grant mismanagement by a parent or relative of a recipient
18 who is responsible for making rental payments for the housing
19 or shelter of the child or family, unless the Department
20 determines that the non-payment is necessary for the
21 protection of the health and well-being of the recipient. The
22 county department shall advise the parent or other relative
23 grantee that continued mismanagement will result in the
24 application of one of the sanctions specified in Sections 4-8
25 through 4-8.20 this Section.
26 (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
27 (305 ILCS 5/4-8.10 new) (was 305 ILCS 5/4-8, subsec. (a),
28 in part)
29 Sec. 4-8.10. Irregular school attendance.
30 (a) The Illinois Department of Human Services shall
31 consider irregular school attendance by children of school
32 age grades 1 through 8, as evidence of lack of proper and
33 necessary support or care. The Department may extend this
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1 consideration to children in grades higher than 8.
2 (b) The Illinois Department of Human Services shall
3 develop preventive programs in collaboration with school and
4 social service networks to encourage school attendance of
5 children receiving assistance under Article IV. To the
6 extent that Illinois Department of Human Services and
7 community resources are available, the programs shall serve
8 families whose children in grades 1 through 8 are not
9 attending school regularly, as defined by the school. The
10 Department may extend these programs to families whose
11 children are in grades higher than 8. The programs shall
12 include referrals from the school to a social service
13 network, assessment and development of a service plan by one
14 or more network representatives, and the Illinois
15 Department's encouragement of the family to follow through
16 with the service plan. Families that fail to follow the
17 service plan as determined by the service provider, shall be
18 subject to the protective payment provisions of Sections 4-8
19 through 4-8.20 this Section and Section 4-9 of this Code.
20 (c) Families for whom a protective payment plan has been
21 in effect for at least 3 months and whose school children
22 continue to regularly miss school shall be subject to
23 sanction under Section 4-21. The sanction shall continue
24 until the children demonstrate satisfactory attendance, as
25 defined by the school. To the extent necessary to implement
26 this Section, the Illinois Department of Human Services shall
27 seek appropriate waivers of federal requirements from the
28 U.S. Department of Health and Human Services.
29 (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
30 (305 ILCS 5/4-8.15 new) (was 305 ILCS 5/4-8, subsec. (b))
31 Sec. 4-8.15. Substance abuse; assessment and treatment.
32 (a) (b) In areas of the State where clinically
33 appropriate substance abuse treatment capacity is available,
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1 if the Department of Human Services local office has reason
2 to believe that a caretaker relative is experiencing
3 substance abuse, the local office shall refer the caretaker
4 relative to a licensed treatment provider for assessment. If
5 the assessment indicates that the caretaker relative is
6 experiencing substance abuse, the local office shall require
7 the caretaker relative to comply with all treatment
8 recommended by the assessment.
9 (b) If the caretaker relative refuses without good
10 cause, as determined by rules of the Illinois Department of
11 Human Services, to submit to the assessment or treatment, the
12 caretaker relative shall be ineligible for assistance, and
13 the Department of Human Services local office shall take one
14 or more of the following actions:
15 (1) (i) If there is another family member or friend
16 who is ensuring that the family's needs are being met,
17 that person, if willing, shall be assigned as protective
18 payee.
19 (2) (ii) If there is no family member or close
20 friend to serve as protective payee, the local office
21 shall provide for a protective payment to a substitute
22 payee as provided in Section 4-9. The Department also
23 shall determine whether a referral to the Department of
24 Children and Family Services is warranted and, if
25 appropriate, shall make the referral.
26 (3) (iii) The Department shall contact the
27 individual who is thought to be experiencing substance
28 abuse and explain why the protective payee has been
29 assigned and refer the individual to treatment.
30 (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
31 (305 ILCS 5/4-8.20 new) (was 305 ILCS 5/4-8, subsec. (c))
32 Sec. 4-8.20. Failure of efforts to correct
33 mismanagement.
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1 (c) This Section subsection (c) applies to cases other
2 than those described in Section 4-8.15 subsection (b). If
3 the efforts to correct the mismanagement of the grant have
4 failed, the county department, in accordance with the rules
5 and regulations of the Illinois Department of Human Services,
6 shall initiate one or more of the following actions:
7 (1) 1. Provide for a protective payment to a
8 substitute payee, as provided in Section 4-9. This
9 action may be initiated for any assistance unit
10 containing a child determined to be neglected by the
11 Department of Children and Family Services under the
12 Abused and Neglected Child Reporting Act, and in any case
13 involving a record of public assistance fraud.
14 (2) 2. Provide for issuance of all or part of the
15 grant in the form of disbursing orders. This action may
16 be initiated in any case involving a record of public
17 assistance fraud, or upon the request of a substitute
18 payee designated under Section 4-9.
19 (3) 3. File a petition under the Juvenile Court Act
20 of 1987 for an Order of Protection under Section 2-25,
21 2-26, 3-26, 3-27, 4-23, 4-24, 5-730, or 5-735 of that
22 Act.
23 (4) 4. Institute a proceeding under the Juvenile
24 Court Act of 1987 for the appointment of a guardian or
25 legal representative for the purpose of receiving and
26 managing the public aid grant.
27 (5) 5. If the mismanagement of the grant, together
28 with other factors, has rendered the home unsuitable for
29 the best welfare of the child, file a neglect petition
30 under the Juvenile Court Act of 1987, requesting the
31 removal of the child or children.
32 (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
33 (305 ILCS 5/4-9) (from Ch. 23, par. 4-9)
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1 Sec. 4-9. Protective payment to substitute payee. If the
2 parent or other grantee relative persistently mismanages the
3 grant to the detriment of the child and the family but there
4 is reason to believe that, with specialized counseling and
5 guidance services, the parent or relative may develop ability
6 to manage the funds properly, the county department, in
7 accordance with the rules and regulations of the Illinois
8 Department of Human Services, may designate a person who is
9 interested in or concerned with the welfare of the child and
10 its family to receive the aid payment on behalf of the
11 family. The county department may designate private welfare
12 or social service agencies to serve as substitute payees in
13 appropriate cases.
14 The substitute payee shall serve without compensation and
15 assume the obligation of seeing that the aid payment is
16 expended for the benefit of the child and the family. He may
17 spend the grant for the family, or supervise the parent or
18 other relative in the use of the grant, depending upon the
19 circumstances in each case, and shall make monthly reports to
20 the county department as the county department and the
21 Illinois Department of Human services may require.
22 The county department shall terminate the protective
23 payment when it is no longer necessary to assure that the
24 grant is being used for the welfare of the child and family,
25 or when the parent or other relative is no longer receiving
26 and no longer requires treatment for alcohol or substance
27 abuse, mental health services, or other special care or
28 treatment.
29 A substitute payee may be removed, in accordance with the
30 rules and regulations of the Illinois Department of Human
31 Services, for unsatisfactory service. The removal may be
32 effected without hearing. The decision shall not be
33 appealable to the Illinois Department of Human Services nor
34 shall it be reviewable in the courts.
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1 The county department shall conduct periodic reviews as
2 may be required by the Illinois Department of Human Services
3 to determine whether there is a continuing need for a
4 protective payment. If it appears that the need for the
5 payment is likely to continue beyond a reasonable period, the
6 county department shall take one of the other actions set out
7 in Sections Section 4-8 through 4-8.20.
8 The parent or other relative shall be advised, in advance
9 of a determination to make a protective payment, that he may
10 appeal the decision to the Illinois Department of Human
11 Services under the provisions of Section 11-8 of Article XI.
12 (Source: P.A. 87-528; 87-895.)
13 (305 ILCS 5/4-10) (from Ch. 23, par. 4-10)
14 Sec. 4-10. Funeral and burial. If the estate of a
15 deceased recipient is insufficient to pay for funeral and
16 burial expenses, and if no other resources, including
17 assistance from legally responsible relatives, are available
18 for such purposes, there shall be paid, in accordance with
19 the standards, rules and regulations of the Illinois
20 Department of Human Services, such reasonable amounts as may
21 be necessary to meet costs of the funeral, burial space, and
22 cemetery charges or to reimburse any person not financially
23 responsible for the deceased who has voluntarily made
24 expenditures for such costs.
25 (Source: P.A. 90-372, eff. 7-1-98.)
26 (305 ILCS 5/4-12) (from Ch. 23, par. 4-12)
27 Sec. 4-12. Crisis assistance.
28 (a) Where a family has been (1) rendered homeless or
29 threatened with homelessness by fire, flood, other natural
30 disaster, eviction or court order to vacate the premises for
31 reasons other than nonpayment of rent, or where a spouse and
32 child have become homeless because they have left the
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1 residence occupied by a spouse who was physically abusing the
2 now homeless spouse or child; (2) deprived of essential items
3 of furniture or essential clothing by fire or flood or other
4 natural disaster; (3) deprived of food as a result of actions
5 other than loss or theft of cash and where the deprivation
6 cannot be promptly alleviated through the federal food stamp
7 program; (4) as a result of a documented theft or documented
8 loss of cash, deprived of food or essential clothing or
9 deprived of shelter or immediately threatened with
10 deprivation of shelter as evidenced by a court order
11 requiring immediate eviction due to nonpayment of rent; or
12 (5) rendered the victim of such other hardships as the
13 Illinois Department of Human Services shall by rule define,
14 the Illinois Department of Human Services may provide
15 assistance to alleviate such needs.
16 (b) The Illinois Department of Human Services shall
17 verify need and determine eligibility for crisis assistance
18 for families already receiving grants from the Illinois
19 Department within 5 working days following application for
20 such assistance and shall determine eligibility for all other
21 families and afford such assistance for families found
22 eligible within such time limits as the Illinois Department
23 shall by rule provide.
24 (c) The Illinois Department of Human Services may, by
25 rule, limit crisis assistance to an eligible family to once
26 in any 12 consecutive months. This limitation may be made
27 for some or all items of crisis assistance.
28 (d) The Illinois Department of Human Services by
29 regulation shall specify the criteria for determining
30 eligibility and the amount and nature of assistance to be
31 provided. Where deprivation of shelter exists or is
32 threatened, the Illinois Department may provide reasonable
33 moving expenses, short term rental costs, including one
34 month's rent and a security deposit where such expenses are
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1 needed for relocation, and, where the Department determines
2 appropriate, provide assistance to prevent an imminent
3 eviction or foreclosure. These amounts may be described in
4 established amounts or maximums. The Illinois Department may
5 also describe, for each form of assistance authorized, the
6 method by which the assistance shall be delivered, including
7 but not limited to warrants or disbursing orders.
8 (e) Annual expenditures under this Section shall not
9 exceed $2,000,000. The Illinois Department of Human Services
10 shall review such expenditures quarterly and shall, if
11 necessary, reduce the amounts or nature of assistance
12 authorized in order to assure that the limit is not exceeded.
13 (Source: P.A. 90-17, eff. 7-1-97.)
14 (305 ILCS 5/4-17)
15 Sec. 4-17. Targeted jobs TANF project.
16 (a) The Illinois Department of Human Services shall
17 operate a targeted jobs TANF project under which individuals
18 whose youngest child is 13 years of age or older shall be
19 required to seek and accept employment. Cash assistance for
20 these individuals shall be limited to 24 months unless the
21 individual is working, as defined by rule, or is
22 participating in a pay-after-performance program. The
23 addition to the household of a child under 13 years of age or
24 the birth of a child more than 10 months after enrollment
25 into the targeted jobs TANF project shall not extend the
26 period of eligibility.
27 (b) (Blank).
28 (c) (Blank).
29 (Source: P.A. 92-111, eff. 1-1-02.)
30 (305 ILCS 5/4-21)
31 Sec. 4-21. Sanctions.
32 (a) The Illinois Department of Human Services shall, by
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1 rule, establish a system of sanctions for persons who fail to
2 cooperate, without good cause, with employment and training
3 programs or other programs under this Article or Article IXA
4 or who fail to cooperate with child support programs under
5 this Article, Article X, or Title IV of the federal Social
6 Security Act. The sanctions may discontinue all or part of
7 the cash grant provided under this Article. The sanctions
8 may be time limited or continue until the person cooperates
9 in the program. The sanctions may be progressive in that a
10 second, third, or further sanction may be progressively more
11 severe or last longer.
12 (b) The Illinois Department of Human Services shall, by
13 rule, define what constitutes failure to cooperate and what
14 constitutes good cause which would excuse that failure.
15 (Source: P.A. 90-17, eff. 7-1-97.)
16 (305 ILCS 5/4-22)
17 Sec. 4-22. Domestic violence.
18 (a) The assessment process to develop the personal plan
19 for achieving self-sufficiency shall include questions that
20 screen for domestic violence issues. If the individual
21 indicates that he or she is the victim of domestic violence
22 and indicates a need to address domestic violence issues in
23 order to reach self-sufficiency, the plan shall take this
24 factor into account in determining the work, education, and
25 training activities suitable to the client for achieving
26 self-sufficiency. In addition, in such a case, specific
27 steps needed to directly address the domestic violence issues
28 may also be made part of the plan, including referral to an
29 available domestic violence program.
30 (b) The Illinois Department of Human Services shall
31 develop and monitor compliance procedures for its employees,
32 contractors, and subcontractors to ensure that any
33 information pertaining to any client who claims to be a past
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1 or present victim of domestic violence or an individual at
2 risk of further domestic violence, whether provided by the
3 victim or by a third party, will remain confidential.
4 (c) The Illinois Department of Human Services shall
5 develop and implement a domestic violence training curriculum
6 for Illinois Department employees who serve applicants for
7 and recipients of aid under this Article. The curriculum
8 shall be designed to better equip those employees to identify
9 and serve domestic violence victims. The Illinois Department
10 may enter into a contract for the development of the
11 curriculum with one or more organizations providing services
12 to domestic violence victims. The Illinois Department shall
13 adopt rules necessary to implement this subsection.
14 (Source: P.A. 90-17, eff. 7-1-97; 91-759, eff. 1-1-01.)
15 (305 ILCS 5/5-1.1) (from Ch. 23, par. 5-1.1)
16 Sec. 5-1.1. Definitions. The terms defined in this
17 Section shall have the meanings ascribed to them, except when
18 the context otherwise requires.
19 (a) "Skilled nursing facility" means a nursing home
20 eligible to participate as a skilled nursing facility under
21 Title XIX of the federal Social Security Act.
22 (b) "Intermediate care facility" means a nursing home
23 eligible to participate as an intermediate care facility
24 under Title XIX of the federal Social Security Act.
25 (c) "Standard services" means those services required
26 for the care of all patients in the facility and shall as a
27 minimum include the following: (1) administration; (2)
28 dietary (standard); (3) housekeeping; (4) laundry and linen;
29 (5) maintenance of property and equipment, including
30 utilities; (6) medical records; (7) training of employees;
31 (8) utilization review; (9) activities services; (10) social
32 services; (11) disability services; and all other similar
33 services required by either the laws of the State of Illinois
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1 or one of its political subdivisions or municipalities or by
2 Title XIX of the Social Security Act.
3 (d) "Patient services" means those which vary with the
4 number of personnel; professional and para-professional
5 skills of the personnel; specialized equipment, and reflect
6 the intensity of the medical and psycho-social needs of the
7 patients. Patient services shall as a minimum include: (1)
8 physical services; (2) nursing services, including
9 restorative nursing; (3) medical direction and patient care
10 planning; (4) health related supportive and habilitative
11 services and all similar services required by either the laws
12 of the State of Illinois or one of its political subdivisions
13 or municipalities or by Title XIX of the Social Security Act.
14 (e) "Ancillary services" means those services which
15 require a specific physician's order and defined as under the
16 medical assistance program as not being routine in nature for
17 skilled nursing and intermediate care facilities. Such
18 services generally must be authorized prior to delivery and
19 payment as provided for under the rules of the Department of
20 Public Aid.
21 (f) "Capital" means the investment in a facility's
22 assets for both debt and non-debt funds. Non-debt capital is
23 the difference between an adjusted replacement value of the
24 assets and the actual amount of debt capital.
25 (g) "Profit" means the amount which shall accrue to a
26 facility as a result of its revenues exceeding its expenses
27 as determined in accordance with generally accepted
28 accounting principles.
29 (h) "Non-institutional services" means those services
30 provided under paragraph (f) of Section 3 of the Disabled
31 Persons Rehabilitation Act and those services provided under
32 Section 4.02 of the Illinois Act on the Aging.
33 (i) "Exceptional medical care" means the level of
34 medical care required by persons who are medically stable for
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1 discharge from a hospital but who require acute intensity
2 hospital level care for physician, nurse and ancillary
3 specialist services, including persons with acquired
4 immunodeficiency syndrome (AIDS) or a related condition.
5 Such care shall consist of those services which the
6 Department of Public Aid shall determine by rule.
7 (j) "Institutionalized person" means an individual who
8 is an inpatient in an intermediate care or skilled nursing
9 facility, or who is an inpatient in a medical institution
10 receiving a level of care equivalent to that of an
11 intermediate care or skilled nursing facility, or who is
12 receiving services under Section 1915(c) of the Social
13 Security Act.
14 (k) "Institutionalized spouse" means an
15 institutionalized person who is expected to receive services
16 at the same level of care for at least 30 days and is married
17 to a spouse who is not an institutionalized person.
18 (l) "Community spouse" is the spouse of an
19 institutionalized spouse.
20 (Source: P.A. 89-626, eff. 8-9-96.)
21 (305 ILCS 5/5-1.2)
22 Sec. 5-1.2. Recipient eligibility verification.
23 (a) The Illinois Department of Public Aid shall initiate
24 a statewide system by which providers and sites of medical
25 care can electronically verify recipient eligibility for aid
26 under this Article. High-volume providers and sites of
27 medical care, as defined by the Illinois Department by rule,
28 shall be required to participate in the eligibility
29 verification system. Every non-high-volume provider and site
30 of medical care shall be afforded the opportunity to
31 participate in the eligibility verification system. The
32 Illinois Department shall provide by rule for implementation
33 of the system, which may be accomplished in phases over time
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1 and by geographic region, recipient classification, and
2 provider type. The system shall initially be implemented in,
3 but not limited to, the following zip codes in Cook County:
4 60601, 60602, 60603, 60604, 60605, 60606, 60607, 60608,
5 60609, 60612, and 60616. The system shall be implemented
6 within 6 months after approval by the federal government.
7 The Illinois Department of Public Aid shall report to the
8 General Assembly by December 31, 1994 on the status of the
9 Illinois Department's application to the federal government
10 for approval of this system. The recipient eligibility
11 verification system may be coordinated with the Electronic
12 Benefits Transfer system established by Section 11-3.1 of
13 this Code and compatible with any of the methods for the
14 delivery of medical care and services authorized by this
15 Article. The system shall make available to providers the
16 history of claims for medical services submitted to the
17 Illinois Department of Public Aid for those services provided
18 to the recipient. The Illinois Department of Public Aid
19 shall develop safeguards to protect each recipient's health
20 information from misuse or unauthorized disclosure.
21 (b) The Illinois Department of Public Aid shall conduct
22 a demonstration project in at least 2 geographic locations
23 for the purpose of assessing the effectiveness of a recipient
24 photo identification card in reducing abuses in the provision
25 of services under this Article. In order to receive medical
26 care, recipients included in this demonstration project must
27 present a Medicaid card and photo identification card. The
28 Illinois Department shall apply for any federal waivers or
29 approvals necessary to conduct this demonstration project.
30 The demonstration project shall become operational (i) 12
31 months after the effective date of this amendatory Act of
32 1994 or (ii) after the Illinois Department's receipt of all
33 necessary federal waivers and approvals, whichever occurs
34 later, and shall operate for 12 months.
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1 (Source: P.A. 88-554, eff. 7-26-94.)
2 (305 ILCS 5/5-2) (was 305 ILCS 5/5-2, in part)
3 Sec. 5-2. Classes of Persons Eligible. Medical
4 assistance under this Article shall be available to any of
5 the following classes of persons described in the Sections
6 following this Section and preceding Section 5-2.0100 in
7 respect to whom a plan for coverage has been submitted to the
8 Governor by the Illinois Department of Public Aid and
9 approved by him.:
10 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
11 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
12 7-3-01.)
13 (305 ILCS 5/5-2.05 new) (was 305 ILCS 5/5-2, par. 1)
14 Sec. 5-2.05. Recipients of basic maintenance grants.
15 Medical assistance under this Article shall be available to
16 the following class of persons in respect to whom a plan for
17 coverage has been submitted to the Governor by the Department
18 of Public Aid and approved by him: 1. recipients of basic
19 maintenance grants under Articles III and IV.
20 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
21 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
22 7-3-01.)
23 (305 ILCS 5/5-2.010 new) (was 305 ILCS 5/5-2, par. 2)
24 Sec. 5-2.010. Persons failing to qualify for basic
25 maintenance on the basis of need. Medical assistance under
26 this Article shall be available to the following class of
27 persons in respect to whom a plan for coverage has been
28 submitted to the Governor by the Department of Public Aid and
29 approved by him: 2. persons otherwise eligible for basic
30 maintenance under Articles III and IV but who fail to qualify
31 thereunder on the basis of need, and who have insufficient
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1 income and resources to meet the costs of necessary medical
2 care, including but not limited to the following:
3 (1) (a) All persons otherwise eligible for basic
4 maintenance under Article III but who fail to qualify
5 under that Article on the basis of need and who meet
6 either of the following requirements:
7 (A) (i) their income, as determined by the
8 Illinois Department of Public Aid in accordance with
9 any federal requirements, is equal to or less than
10 70% in fiscal year 2001, equal to or less than 85%
11 in fiscal year 2002, and equal to or less than 100%
12 in fiscal year 2003 and thereafter of the nonfarm
13 income official poverty line, as defined by the
14 federal Office of Management and Budget and revised
15 annually in accordance with Section 673(2) of the
16 Omnibus Budget Reconciliation Act of 1981,
17 applicable to families of the same size; or
18 (B) (ii) their income, after the deduction of
19 costs incurred for medical care and for other types
20 of remedial care, is equal to or less than 70% in
21 fiscal year 2001, equal to or less than 85% in
22 fiscal year 2002, and equal to r less than 100% in
23 fiscal year 2003 and thereafter of the nonfarm
24 income official poverty line, as defined in item (A)
25 (i) of this paragraph (1) subparagraph (a).
26 (2) (b) All persons who would be determined
27 eligible for such basic maintenance under Article IV by
28 disregarding the maximum earned income permitted by
29 federal law.
30 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
31 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
32 7-3-01.)
33 (305 ILCS 5/5-2.015 new) (was 305 ILCS 5/5-2, par. 3)
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1 Sec. 5-2.015. Aid to the Medically Indigent. Medical
2 assistance under this Article shall be available to the
3 following class of persons in respect to whom a plan for
4 coverage has been submitted to the Governor by the Department
5 of Public Aid and approved by him: 3. persons who would
6 otherwise qualify for Aid to the Medically Indigent under
7 Article VII.
8 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
9 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
10 7-3-01.)
11 (305 ILCS 5/5-2.020 new) (was 305 ILCS 5/5-2, par. 4)
12 Sec. 5-2.020. Persons without sufficient resources.
13 Medical assistance under this Article shall be available to
14 the following class of persons in respect to whom a plan for
15 coverage has been submitted to the Governor by the Department
16 of Public Aid and approved by him: 4. persons not eligible
17 under Section 5-2.05, 5-2.010, or 5-2.015 any of the
18 preceding paragraphs who fall sick, are injured, or die, not
19 having sufficient money, property or other resources to meet
20 the costs of necessary medical care or funeral and burial
21 expenses.
22 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
23 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
24 7-3-01.)
25 (305 ILCS 5/5-2.025 new) (was 305 ILCS 5/5-2, par. 5)
26 Sec. 5-2.025. Pregnant women and their infants and
27 children.
28 5. (a) Medical assistance under this Article shall be
29 available to the following class of persons in respect to
30 whom a plan for coverage has been submitted to the Governor
31 by the Department of Public Aid and approved by him: women
32 during pregnancy, after the fact of pregnancy has been
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1 determined by medical diagnosis, and during the 60-day period
2 beginning on the last day of the pregnancy, together with
3 their infants and children born after September 30, 1983,
4 whose income and resources are insufficient to meet the costs
5 of necessary medical care to the maximum extent possible
6 under Title XIX of the Federal Social Security Act.
7 (b) The Illinois Department of Public Aid and the
8 Governor shall provide a plan for coverage of the persons
9 eligible under paragraph 5(a) by April 1, 1990. Such plan
10 shall provide ambulatory prenatal care to pregnant women
11 during a presumptive eligibility period and establish an
12 income eligibility standard that is equal to 133% of the
13 nonfarm income official poverty line, as defined by the
14 federal Office of Management and Budget and revised annually
15 in accordance with Section 673(2) of the Omnibus Budget
16 Reconciliation Act of 1981, applicable to families of the
17 same size, provided that costs incurred for medical care are
18 not taken into account in determining such income
19 eligibility.
20 (c) The Illinois Department of Public Aid may conduct a
21 demonstration in at least one county that will provide
22 medical assistance to pregnant women, together with their
23 infants and children up to one year of age, where the income
24 eligibility standard is set up to 185% of the nonfarm income
25 official poverty line, as defined by the federal Office of
26 Management and Budget. The Illinois Department of Public Aid
27 shall seek and obtain necessary authorization provided under
28 federal law to implement such a demonstration. Such
29 demonstration may establish resource standards that are not
30 more restrictive than those established under Article IV of
31 this Code.
32 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
33 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
34 7-3-01.)
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1 (305 ILCS 5/5-2.030 new) (was 305 ILCS 5/5-2, par. 6)
2 Sec. 5-2.030. Persons under age 18. Medical assistance
3 under this Article shall be available to the following class
4 of persons in respect to whom a plan for coverage has been
5 submitted to the Governor by the Department of Public Aid and
6 approved by him: 6. persons under the age of 18 who fail to
7 qualify as dependent under Article IV and who have
8 insufficient income and resources to meet the costs of
9 necessary medical care to the maximum extent permitted under
10 Title XIX of the federal Social Security Act.
11 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
12 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
13 7-3-01.)
14 (305 ILCS 5/5-2.035 new) (was 305 ILCS 5/5-2, in part,
15 and par. 7)
16 Sec. 5-2.035. Disabled persons age 18 or younger.
17 (a) Medical assistance under this Article shall be
18 available to the following class of persons in respect to
19 whom a plan for coverage has been submitted to the Governor
20 by the Department of Public Aid and approved by him: 7.
21 persons who are 18 years of age or younger and would qualify
22 as disabled as defined under the Federal Supplemental
23 Security Income Program, provided medical service for such
24 persons would be eligible for Federal Financial
25 Participation, and provided the Illinois Department of Public
26 Aid determines that:
27 (1) (a) the person requires a level of care
28 provided by a hospital, skilled nursing facility, or
29 intermediate care facility, as determined by a physician
30 licensed to practice medicine in all its branches;
31 (2) (b) it is appropriate to provide such care
32 outside of an institution, as determined by a physician
33 licensed to practice medicine in all its branches;
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1 (3) (c) the estimated amount which would be
2 expended for care outside the institution is not greater
3 than the estimated amount which would be expended in an
4 institution.
5 (b) The Illinois Department of Public Aid and the
6 Governor shall provide a plan for coverage of the persons
7 eligible under this Section paragraph 7 as soon as possible
8 after July 1, 1984.
9 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
10 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
11 7-3-01.)
12 (305 ILCS 5/5-2.040 new) (was 305 ILCS 5/5-2, par. 8)
13 Sec. 5-2.040. Persons ineligible for basic maintenance
14 due to employment earnings.
15 (a) Medical assistance under this Article shall be
16 available to the following class of persons in respect to
17 whom a plan for coverage has been submitted to the Governor
18 by the Department of Public Aid and approved by him: 8.
19 persons who become ineligible for basic maintenance
20 assistance under Article IV of this Code in programs
21 administered by the Illinois Department of Human Services due
22 to employment earnings and persons in assistance units
23 comprised of adults and children who become ineligible for
24 basic maintenance assistance under Article VI of this Code
25 due to employment earnings.
26 (b) The plan for coverage for this class of persons
27 shall:
28 (1) (a) extend the medical assistance coverage for
29 up to 12 months following termination of basic
30 maintenance assistance; and
31 (2) (b) offer persons who have initially received 6
32 months of the coverage provided in paragraph (1) (a)
33 above, the option of receiving an additional 6 months of
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1 coverage, subject to the following:
2 (A) (i) Such coverage shall be pursuant to
3 provisions of the federal Social Security Act;
4 (B) (ii) such coverage shall include all
5 services covered while the person was eligible for
6 basic maintenance assistance;
7 (C) (iii) no premium shall be charged for such
8 coverage; and
9 (D) (iv) such coverage shall be suspended in
10 the event of a person's failure without good cause
11 to file in a timely fashion reports required for
12 this coverage under the Social Security Act and
13 coverage shall be reinstated upon the filing of such
14 reports if the person remains otherwise eligible.
15 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
16 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
17 7-3-01.)
18 (305 ILCS 5/5-2.045 new) (was 305 ILCS 5/5-2, par. 9)
19 Sec. 5-2.045. Persons with AIDS. Medical assistance
20 under this Article shall be available to the following class
21 of persons in respect to whom a plan for coverage has been
22 submitted to the Governor by the Department of Public Aid and
23 approved by him: 9. persons with acquired immunodeficiency
24 syndrome (AIDS) or with AIDS-related conditions with respect
25 to whom there has been a determination that but for home or
26 community-based services such individuals would require the
27 level of care provided in an inpatient hospital, skilled
28 nursing facility or intermediate care facility the cost of
29 which is reimbursed under this Article. Assistance shall be
30 provided to such persons to the maximum extent permitted
31 under Title XIX of the federal Social Security Act.
32 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
33 91-712, eff. 92-16, eff. 6-28-01; 92-47, eff. 7-3-01.)
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1 (305 ILCS 5/5-2.050 new) (was 305 ILCS 5/5-2, par. 10)
2 Sec. 5-2.050. Participants in long-term care insurance
3 partnership program. Medical assistance under this Article
4 shall be available to the following class of persons in
5 respect to whom a plan for coverage has been submitted to the
6 Governor by the Department of Public Aid and approved by him:
7 10. participants in the long-term care insurance partnership
8 program established under the Partnership for Long-Term Care
9 Act who meet the qualifications for protection of resources
10 described in Section 25 of that Act.
11 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
12 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
13 7-3-01.)
14 (305 ILCS 5/5-2.055 new) (was 305 ILCS 5/5-2, par. 11)
15 Sec. 5-2.055. Persons eligible for "Medicaid Buy-In"
16 program. Medical assistance under this Article shall be
17 available to the following class of persons in respect to
18 whom a plan for coverage has been submitted to the Governor
19 by the Department of Public Aid and approved by him: 11.
20 persons with disabilities who are employed and eligible for
21 Medicaid, pursuant to Section 1902(a)(10)(A)(ii)(xv) of the
22 Social Security Act, as provided by the Illinois Department
23 of Public Aid by rule.
24 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
25 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
26 7-3-01.)
27 (305 ILCS 5/5-2.060 new) (was 305 ILCS 5/5-2, par. 12)
28 Sec. 5-2.060. Persons eligible under the Breast and
29 Cervical Cancer Prevention and Treatment Act of 2000.
30 (a) Medical assistance under this Article shall be
31 available to the following class of persons in respect to
32 whom a plan for coverage has been submitted to the Governor
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1 by the Department of Public Aid and approved by him: 12.
2 subject to federal approval, persons who are eligible for
3 medical assistance coverage under applicable provisions of
4 the federal Social Security Act and the federal Breast and
5 Cervical Cancer Prevention and Treatment Act of 2000. Those
6 eligible persons are defined to include, but not be limited
7 to, the following persons:
8 (1) persons who have been screened for breast or
9 cervical cancer under the U.S. Centers for Disease
10 Control and Prevention Breast and Cervical Cancer Program
11 established under Title XV of the federal Public Health
12 Services Act in accordance with the requirements of
13 Section 1504 of that Act as administered by the Illinois
14 Department of Public Health; and
15 (2) persons whose screenings under the above
16 program were funded in whole or in part by funds
17 appropriated to the Illinois Department of Public Health
18 for breast or cervical cancer screening.
19 (b) "Medical assistance" under this Section paragraph 12
20 shall be identical to the benefits provided under the State's
21 approved plan under Title XIX of the Social Security Act.
22 The Department of Public Aid must request federal approval of
23 the coverage under this Section paragraph 12 within 30 days
24 after the effective date of this amendatory Act of the 92nd
25 General Assembly.
26 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
27 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
28 7-3-01.)
29 (305 ILCS 5/5-2.0100 new) (was 305 ILCS 5/5-2, in part)
30 Sec. 5-2.0100. Factors affecting eligibility for medical
31 assistance.
32 (a) The eligibility of any such person for medical
33 assistance under this Article is not affected by the payment
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1 of any grant under the Senior Citizens and Disabled Persons
2 Property Tax Relief and Pharmaceutical Assistance Act or any
3 distributions or items of income described under subparagraph
4 (X) of paragraph (2) of subsection (a) of Section 203 of the
5 Illinois Income Tax Act.
6 (b) The Department of Public Aid shall by rule establish
7 the amounts of assets to be disregarded in determining
8 eligibility for medical assistance, which shall at a minimum
9 equal the amounts to be disregarded under the federal
10 Supplemental Security Income Program. The amount of assets
11 of a single person to be disregarded shall not be less than
12 $2,000, and the amount of assets of a married couple to be
13 disregarded shall not be less than $3,000.
14 (c) To the extent permitted under federal law, any
15 person found guilty of a second violation of Article VIIIA
16 shall be ineligible for medical assistance under this
17 Article, as provided in Section 8A-8.
18 (d) The eligibility of any person for medical assistance
19 under this Article shall not be affected by the receipt by
20 the person of donations or benefits from fundraisers held for
21 the person in cases of serious illness, as long as neither
22 the person nor members of the person's family have actual
23 control over the donations or benefits or the disbursement of
24 the donations or benefits.
25 (Source: P.A. 91-676, eff. 12-23-99; 91-699, eff. 7-1-00;
26 91-712, eff. 7-1-00; 92-16, eff. 6-28-01; 92-47, eff.
27 7-3-01.)
28 (305 ILCS 5/5-2.1a)
29 Sec. 5-2.1a. Treatment of trust amounts. To the extent
30 required by federal law, the Illinois Department shall
31 provide by rule for the consideration of trusts and similar
32 legal instruments or devices established by a person in the
33 Illinois Department's determination of the person's
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1 eligibility for and the amount of assistance provided under
2 this Article. This Section shall be enforced by the
3 Department of Human Services, acting as successor to the
4 Department of Public Aid under the Department of Human
5 Services Act.
6 (Source: P.A. 88-554, eff. 7-26-94; 89-507, eff. 7-1-97.)
7 (305 ILCS 5/5-2.2) (from Ch. 23, par. 5-2.2)
8 Sec. 5-2.2. Cooperation in establishing support
9 obligation. A parent or other person having custody of the
10 child or a spouse who fails or refuses to comply with the
11 requirements of Title XIX of the federal Social Security Act,
12 and the regulations duly promulgated thereunder, regarding
13 establishment and enforcement of the child or spousal support
14 obligation shall be ineligible for medical assistance and
15 shall remain ineligible for medical assistance for as long as
16 the failure or refusal persists.
17 In addition to any other definition of failure or refusal
18 to comply with the requirements of Title XIX of the federal
19 Social Security Act, in the case of failure to attend court
20 hearings, the parent or other person can show cooperation by
21 attending a court hearing or, if a court hearing cannot be
22 scheduled within 30 days following the court hearing that was
23 missed, by signing a statement that the parent or other
24 person is now willing to cooperate in the child support
25 enforcement process and will appear at any later scheduled
26 court date. The parent or other person can show cooperation
27 by signing such a statement only once. If failure to attend
28 the court hearing or other failure to cooperate results in
29 the case being dismissed, such a statement may be signed
30 after 2 months.
31 No denial or termination of medical assistance pursuant
32 to this Section shall commence during pregnancy of the parent
33 or other person having custody of the child or for 30 days
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1 after the termination of such pregnancy. The termination of
2 medical assistance may commence thereafter if the Illinois
3 Department of Public Aid determines that the failure or
4 refusal to comply with this Section persists. Postponement
5 of denial or termination of medical assistance during
6 pregnancy under this paragraph shall be effective only to the
7 extent it does not conflict with federal law or regulation.
8 (Source: P.A. 85-1155.)
9 (305 ILCS 5/5-2.3)
10 Sec. 5-2.3. Notice of rights concerning
11 institutionalization. The Illinois Department of Public Aid
12 shall prepare a notice to be given to every applicant for and
13 recipient of medical assistance under this Article when the
14 applicant or recipient, or the spouse of the applicant or
15 recipient, or a person for whom the applicant or recipient is
16 the primary caretaker, becomes an institutionalized person.
17 The notice shall fully and completely inform the
18 institutionalized person (and that person's spouse or primary
19 caretaker, if applicable) of each individual's rights and
20 obligations under this Code with respect to that
21 institutionalization.
22 (Source: P.A. 88-162.)
23 (305 ILCS 5/5-4) (from Ch. 23, par. 5-4)
24 Sec. 5-4. Amount and nature of medical assistance. The
25 amount and nature of medical assistance shall be determined
26 by the county departments in accordance with the standards,
27 rules, and regulations of the Illinois Department of Public
28 Aid, with due regard to the requirements and conditions in
29 each case, including contributions available from legally
30 responsible relatives. However, the amount and nature of
31 such medical assistance shall not be affected by the payment
32 of any grant under the Senior Citizens and Disabled Persons
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1 Property Tax Relief and Pharmaceutical Assistance Act or any
2 distributions or items of income described under subparagraph
3 (X) of paragraph (2) of subsection (a) of Section 203 of the
4 Illinois Income Tax Act. The amount and nature of medical
5 assistance shall not be affected by the receipt of donations
6 or benefits from fundraisers in cases of serious illness, as
7 long as neither the person nor members of the person's family
8 have actual control over the donations or benefits or the
9 disbursement of the donations or benefits.
10 In determining the income and assets available to the
11 institutionalized spouse and to the community spouse, the
12 Illinois Department of Public Aid shall follow the procedures
13 established by federal law. The community spouse resource
14 allowance shall be established and maintained at the maximum
15 level permitted pursuant to Section 1924(f)(2) of the Social
16 Security Act, as now or hereafter amended, or an amount set
17 after a fair hearing, whichever is greater. The monthly
18 maintenance allowance for the community spouse shall be
19 established and maintained at the maximum level permitted
20 pursuant to Section 1924(d)(3)(C) of the Social Security Act,
21 as now or hereafter amended. Subject to the approval of the
22 Secretary of the United States Department of Health and Human
23 Services, the provisions of this Section shall be extended to
24 persons who but for the provision of home or community-based
25 services under Section 4.02 of the Illinois Act on the Aging,
26 would require the level of care provided in an institution,
27 as is provided for in federal law.
28 The Department of Human Services shall notify in writing
29 each institutionalized spouse who is a recipient of medical
30 assistance under this Article, and each such person's
31 community spouse, of the changes in treatment of income and
32 resources, including provisions for protecting income for a
33 community spouse and permitting the transfer of resources to
34 a community spouse, required by enactment of the federal
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1 Medicare Catastrophic Coverage Act of 1988 (Public Law
2 100-360). The notification shall be in language likely to be
3 easily understood by those persons. The Department of Human
4 Services also shall reassess the amount of medical assistance
5 for which each such recipient is eligible as a result of the
6 enactment of that federal Act, whether or not a recipient
7 requests such a reassessment.
8 (Source: P.A. 90-655, eff. 7-30-98; 91-676, eff. 12-23-99.)
9 (305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
10 Sec. 5-4.1. Co-payments. The Department of Public Aid
11 may by rule provide that recipients under any Article of this
12 Code (other than group care recipients) shall pay a fee as a
13 co-payment for services. Co-payments may not exceed one
14 dollar for pharmacy services, physicians services, dental
15 services, optical services and supplies, chiropractic
16 services, podiatry services, and encounter rate clinic
17 services. Co-payments may not exceed three dollars for
18 hospital outpatient and clinic services. Provided, however,
19 that any such rule must provide that no co-payment
20 requirement can exist for renal dialysis, radiation therapy,
21 cancer chemotherapy, or insulin, and other products necessary
22 on a recurring basis, the absence of which would be life
23 threatening, or where co-payment expenditures for required
24 services and/or medications for chronic diseases that the
25 Illinois Department of Public Aid shall by rule designate
26 shall cause an extensive financial burden on the recipient,
27 and provided no co-payment shall exist for emergency room
28 encounters which are for medical emergencies.
29 (Source: P.A. 82-664.)
30 (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
31 Sec. 5-4.2. Ambulance services payments. For ambulance
32 services provided to a recipient of aid under this Article on
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1 or after January 1, 1993, the Illinois Department of Public
2 Aid shall reimburse ambulance service providers at rates
3 calculated in accordance with this Section. It is the intent
4 of the General Assembly to provide adequate reimbursement for
5 ambulance services so as to ensure adequate access to
6 services for recipients of aid under this Article and to
7 provide appropriate incentives to ambulance service providers
8 to provide services in an efficient and cost-effective
9 manner. Thus, it is the intent of the General Assembly that
10 the Illinois Department of Public Aid implement a
11 reimbursement system for ambulance services that, to the
12 extent practicable and subject to the availability of funds
13 appropriated by the General Assembly for this purpose, is
14 consistent with the payment principles of Medicare. To
15 ensure uniformity between the payment principles of Medicare
16 and Medicaid, the Illinois Department of Public Aid shall
17 follow, to the extent necessary and practicable and subject
18 to the availability of funds appropriated by the General
19 Assembly for this purpose, the statutes, laws, regulations,
20 policies, procedures, principles, definitions, guidelines,
21 and manuals used to determine the amounts paid to ambulance
22 service providers under Title XVIII of the Social Security
23 Act (Medicare).
24 For ambulance services provided to a recipient of aid
25 under this Article on or after January 1, 1996, the Illinois
26 Department of Public Aid shall reimburse ambulance service
27 providers based upon the actual distance traveled if a
28 natural disaster, weather conditions, road repairs, or
29 traffic congestion necessitates the use of a route other than
30 the most direct route.
31 For purposes of this Section, "ambulance services"
32 includes medical transportation services provided by means of
33 an ambulance, medi-car, service car, or taxi.
34 This Section does not prohibit separate billing by
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1 ambulance service providers for oxygen furnished while
2 providing advanced life support services.
3 (Source: P.A. 88-104; 89-43, eff. 1-1-96.)
4 (305 ILCS 5/5-4.20) (from Ch. 23, par. 5-4.20)
5 Sec. 5-4.20. Definitions. As used in this Section and
6 in Sections 5-4.21 through 5-4.29:
7 "Fund" means the Medicaid Developmentally Disabled
8 Provider Participation Fee Trust Fund.
9 "Fee" means a provider participation fee paid by
10 facilities under Sections 5-4.21 through 5-4.29.
11 "Facility" means a medicaid certified intermediate care
12 facility for persons with a developmental disability or
13 intermediate care facility for persons with a developmental
14 disability of 16 beds or less, but shall not include
15 State-operated facilities.
16 "Gross receipts" means all payments for medical services
17 delivered under Title XIX of the Social Security Act and
18 Article V of this Code and shall mean any and all payments
19 made by the Illinois Department of Public Aid, or a Division
20 thereof, to a Medical Assistance Program provider certified
21 to participate in the Illinois Medical Assistance Program,
22 for services rendered eligible for Medical Assistance under
23 Article V of this Code, State regulations and the federal
24 Medicaid Program as defined in Title XIX of the Social
25 Security Act and federal regulations.
26 (Source: P.A. 87-13; 88-380.)
27 (305 ILCS 5/5-4.21) (from Ch. 23, par. 5-4.21)
28 Sec. 5-4.21. Medicaid Provider Participation Fee Trust
29 Fund for Persons With a Developmental Disability.
30 (a) There is created in the State treasury the Medicaid
31 Provider Participation Fee Trust Fund for Persons With a
32 Developmental Disability. Interest earned by the Fund shall
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1 be credited to the Fund. The monies in the Fund shall be
2 matched with federal Medicaid program dollars in accordance
3 with the provisions of this Section and shall be exempt from
4 any State budget reduction Acts. The Fund shall not be used
5 to replace any funds appropriated to the Medicaid program by
6 the General Assembly.
7 (b) The Fund is created for the purpose of receiving and
8 disbursing monies in accordance with Sections 5-4.20 through
9 5-4.29 of this Code. Disbursements from the Fund shall be
10 made only:
11 (1) for payments to intermediate care facilities
12 for persons with a developmental disability under Title
13 XIX of the Social Security Act and Article V of this
14 Code;
15 (2) for the reimbursement of monies collected by
16 the Illinois Department of Public Aid through error or
17 mistake;
18 (3) for payment of administrative expenses incurred
19 by the Illinois Department of Public Aid or its agent in
20 performing the activities authorized by Sections 5-4.20
21 through 5-4.29 of this Code;
22 (4) for maintaining contingency reserves of no more
23 than 3% of the total monies collected in any one year;
24 (5) for payments of any amounts which are
25 reimbursable to the federal government for payments from
26 this Fund which are required to be paid by State warrant;
27 and
28 (6) (Blank).
29 Disbursements from this Fund shall be by warrants drawn
30 by the State Comptroller upon receipt of vouchers duly
31 executed and certified by the Illinois Department of Public
32 Aid.
33 (c) The Fund shall consist of:
34 (1) all monies collected or received by the
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1 Illinois Department of Public Aid under Section 5-4.22 of
2 this Code;
3 (2) all federal matching funds received by the
4 Illinois Department of Public Aid as a result of
5 expenditures made by the Illinois Department as required
6 by Section 5-4.27 of this Code, that are attributable to
7 monies deposited in the Fund;
8 (3) any interest or penalty levied in conjunction
9 with the administration of the Fund; and
10 (4) all other monies received for the Fund from any
11 other source, including interest earned thereon.
12 (d) All payments received by the Illinois Department of
13 Public Aid shall be credited first to any interest or
14 penalty, and then to the fee due.
15 (Source: P.A. 89-626, eff. 8-9-96; 90-372, eff. 7-1-98.)
16 (305 ILCS 5/5-4.22) (from Ch. 23, par. 5-4.22)
17 Sec. 5-4.22. Provider participation fees. For the
18 period July 1, 1991 through June 30, 1992, a fee is imposed
19 upon each facility in an amount equal to 15% of the
20 provider's gross receipts for services provided for the
21 previous State fiscal year as determined and reported by the
22 Illinois Department of Public Aid. This fee is imposed
23 pursuant to the authority granted by Sections 1 and 2 of
24 Article IX of the Illinois Constitution of 1970.
25 (Source: P.A. 87-13; 87-861.)
26 (305 ILCS 5/5-4.23) (from Ch. 23, par. 5-4.23)
27 Sec. 5-4.23. Payment of fees due.
28 (a) The fees described in Section 5-4.22 shall be due
29 and payable on a calendar quarterly basis.
30 (b) The fee shall be payable to and collected by the
31 Illinois Department of Public Aid in equal quarterly amounts
32 due on the first business day of each calendar quarter. All
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1 monies collected under Section 5-4.22 shall be deposited into
2 the Fund.
3 (c) The Director of Public Aid the Illinois Department
4 is authorized to establish delayed payment schedules for
5 facilities that are unable to make timely payments under this
6 subsection due to financial difficulties. The delayed
7 payments shall include interest at a rate not to exceed the
8 State of Illinois borrowing rate. The interest may be waived
9 by the Director for good cause shown.
10 (Source: P.A. 87-13.)
11 (305 ILCS 5/5-4.24) (from Ch. 23, par. 5-4.24)
12 Sec. 5-4.24. Notification. The Illinois Department of
13 Public Aid shall notify each provider of the results of its
14 calculations under Section 5-4.22 of this Code. If a
15 facility, so notified, does not submit a request for
16 reconsideration, the calculations shall be considered final.
17 The notification shall be in writing.
18 (Source: P.A. 87-13.)
19 (305 ILCS 5/5-4.25) (from Ch. 23, par. 5-4.25)
20 Sec. 5-4.25. Procedures for reconsideration and final
21 reconciliation. Each facility shall have the right to
22 reconsideration of the amount of its fee. The Illinois
23 Department of Public Aid shall conduct a final
24 reconciliation. Each facility shall be entitled to receive
25 enhanced reimbursement through disbursements made under
26 Section 5-4.27 in an amount at least equal to the amount of
27 the fee imposed on the facility under Section 5-4.22.
28 (Source: P.A. 87-13.)
29 (305 ILCS 5/5-4.26) (from Ch. 23, par. 5-4.26)
30 Sec. 5-4.26. Penalties.
31 (a) Any facility that fails to pay the fee when due or
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1 pays less than the full amount due, shall be assessed a
2 penalty of 10% of the delinquency or deficiency for each
3 month, or any fraction thereof, computed on the full amount
4 of the delinquency or deficiency, from the time the fee was
5 due.
6 (b) In addition, the Illinois Department of Public Aid
7 may take action to notify the Office of the Comptroller to
8 collect any amount of monies owed under Sections 5-4.20
9 through 5-4.29 of this Code, pursuant to Section 10.05 of the
10 State Comptroller Act, or may suspend payments to, or cancel
11 or refuse to issue, extend, or reinstate a Provider Agreement
12 to, any facility which has failed to pay any delinquent fee
13 or penalty.
14 (Source: P.A. 87-13.)
15 (305 ILCS 5/5-4.27) (from Ch. 23, par. 5-4.27)
16 Sec. 5-4.27. Disbursements to facilities.
17 (a) The Illinois Department of Public Aid shall develop
18 a reimbursement methodology which shall enhance reimbursement
19 to facilities sufficiently to expend the fee monies described
20 in Section 5-4.22 of this Code, and the federal matching
21 funds received by the Illinois Department as a result of
22 expenditures made by the Illinois Department as required by
23 this Section and Section 5-4.21 that are attributable to fee
24 monies deposited in the Fund.
25 (b) All payments to facilities under this Section are
26 conditional on:
27 (1) expiration of the time limitations for
28 reconsiderations under Section 5-4.25 of this Code; and
29 (2) the availability of sufficient monies in the
30 Fund to make the payments required by this Section after
31 the final reconciliation determined under Section 5-4.25
32 of this Code.
33 (c) If amounts in the Fund are insufficient to make the
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1 total amount of payments for which facilities are eligible,
2 the Illinois Department of Public Aid shall reduce the amount
3 of each payment by the percentage by which the amounts are
4 insufficient. Any amounts not paid when due shall be paid to
5 facilities as soon as monies are available in the Fund.
6 (d) If one or more facilities files suit in any court
7 challenging any part of Sections 5-4.20 through 5-4.29 of
8 this Code, payments to facilities under these Sections shall
9 be made only to the extent that sufficient monies are
10 available in the Fund and only to the extent that any monies
11 in the Fund are not prohibited from disbursement under any
12 order of the Court.
13 (Source: P.A. 87-13.)
14 (305 ILCS 5/5-4.28) (from Ch. 23, par. 5-4.28)
15 Sec. 5-4.28. Annual audit.
16 (a) The Illinois Department of Public Aid shall conduct
17 an annual audit of the Fund to determine that amounts
18 received from or paid to facilities were correct. If such an
19 audit identifies amounts that a facility should not have been
20 required to pay but did pay, a facility should have been
21 required to pay but did not pay, a facility should not have
22 received but did receive, or a facility should have received
23 but did not receive, the Illinois Department of Public Aid
24 shall:
25 (1) Make required payments to any such facility, or
26 (2) Take action to recover required amounts from
27 any such facility, including recoupment from future
28 payments.
29 (b) Amounts recovered from a facility shall be credited
30 to the Fund. A facility is entitled to recover amounts paid
31 to the Department of Public Aid and to receive refunds and
32 payments from the Department under this Section only to the
33 extent that monies are available in the Fund.
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1 (Source: P.A. 87-13.)
2 (305 ILCS 5/5-4.30) (from Ch. 23, par. 5-4.30)
3 Sec. 5-4.30. Definitions. As used in this Section and
4 in Sections 5-4.31 through 5-4.39:
5 "Fund" means the Medicaid Long Term Care Provider
6 Participation Fee Trust Fund.
7 "Fee" means a provider participation fee paid by
8 facilities under Sections 5-4.31 through 5-4.39.
9 "Facility" means a skilled or intermediate nursing
10 facility, including county nursing homes directed and
11 maintained pursuant to Section 5-1005 of the Counties Code,
12 but shall not include State-operated facilities and shall not
13 include an intermediate care facility for persons with a
14 developmental disability.
15 "Gross receipts" means all payments for medical services
16 delivered under Title XIX of the Social Security Act and
17 Article V of this Code and shall mean any and all payments
18 made by the Illinois Department of Public Aid, or a Division
19 thereof, to a Medical Assistance Program provider certified
20 to participate in the Illinois Medical Assistance Program,
21 for services rendered eligible for Medical Assistance under
22 Article V of this Code, State regulations and the federal
23 Medicaid Program as defined in Title XIX of the Social
24 Security Act and federal regulations.
25 (Source: P.A. 87-13; 88-380.)
26 (305 ILCS 5/5-4.31) (from Ch. 23, par. 5-4.31)
27 Sec. 5-4.31. Medicaid Long Term Care Provider
28 Participation Fee Trust Fund.
29 (a) There is created in the State treasury the Medicaid
30 Long Term Care Provider Participation Fee Trust Fund.
31 Interest earned by the Fund shall be credited to the Fund.
32 The monies in the Fund shall be matched with federal Medicaid
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1 program dollars in accordance with the provisions of this
2 Section and shall be exempt from any State budget reduction
3 Acts. The Fund shall not be used to replace any funds
4 appropriated to the Medicaid program by the General Assembly.
5 (b) The Fund is created for the purpose of receiving and
6 disbursing monies in accordance with Sections 5-4.30 through
7 5-4.39 of this Code. Disbursements from the Fund shall be
8 made only:
9 (1) for payments to skilled or intermediate nursing
10 facilities, including county nursing facilities,
11 excluding State-operated facilities, under Title XIX of
12 the Social Security Act and Article V of this Code;
13 (2) for the reimbursement of monies collected by
14 the Illinois Department of Public Aid through error or
15 mistake;
16 (3) for payment of administrative expenses incurred
17 by the Illinois Department of Public Aid or its agent in
18 performing the activities authorized by Sections 5-4.30
19 through 5-4.39 of this Code;
20 (4) for maintaining contingency reserves of no more
21 than 3% of the total monies collected in any one year;
22 (5) for payments of any amounts which are
23 reimbursable to the federal government for payments from
24 this Fund which are required to be paid by State warrant;
25 and
26 (6) (Blank).
27 Disbursements from this Fund shall be by warrants drawn
28 by the State Comptroller upon receipt of vouchers duly
29 executed and certified by the Illinois Department of Public
30 Aid.
31 (c) The Fund shall consist of:
32 (1) all monies collected or received by the
33 Illinois Department of Public Aid under Section 5-4.32 of
34 this Code;
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1 (2) all federal matching funds received by the
2 Illinois Department of Public Aid as a result of
3 expenditures made by the Illinois Department as required
4 by Section 5-4.37 of this Code, that are attributable to
5 monies deposited in the Fund;
6 (3) any interest or penalty levied in conjunction
7 with the administration of the Fund; and
8 (4) all other monies received for the Fund from any
9 other source, including interest earned thereon.
10 (d) All payments received by the Illinois Department of
11 Public Aid shall be credited first to any interest or
12 penalty, and then to the fee due.
13 (Source: P.A. 89-626, eff. 8-9-96; 90-372, eff. 7-1-98.)
14 (305 ILCS 5/5-4.32) (from Ch. 23, par. 5-4.32)
15 Sec. 5-4.32. Provider participation fee. For the period
16 July 1, 1991, through June 30, 1992, a fee is imposed upon
17 each facility in an amount equal to 15% of the facility's
18 gross receipts for services provided for the previous State
19 fiscal year as determined and reported by the Illinois
20 Department of Public Aid. This fee is imposed pursuant to
21 the authority granted by Sections 1 and 2 of Article IX of
22 the Illinois Constitution of 1970.
23 (Source: P.A. 87-13; 87-861.)
24 (305 ILCS 5/5-4.33) (from Ch. 23, par. 5-4.33)
25 Sec. 5-4.33. Payment of fees due.
26 (a) The fees described in Section 5-4.32 shall be due
27 and payable on a calendar quarterly basis. The Illinois
28 Department of Public Aid may provide that county nursing
29 homes directed and maintained pursuant to Section 5-1005 of
30 the Counties Code may meet their fee obligation by certifying
31 to the Illinois Department that county expenditures have been
32 obligated for the operation of the county nursing home in an
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1 amount at least equal to the amount of the fee.
2 (b) The fee shall be payable to and collected by the
3 Illinois Department of Public Aid in equal quarterly amounts
4 due on the first business day of each calendar quarter. All
5 monies collected under Section 5-4.32 shall be deposited into
6 the Fund.
7 (c) The Director of Public Aid the Illinois Department
8 is authorized to establish delayed payment schedules for
9 facilities that are unable to make timely payments under this
10 subsection due to financial difficulties. The delayed
11 payments shall include interest at a rate not to exceed the
12 State of Illinois borrowing rate. The interest may be waived
13 by the Director for good cause shown.
14 (Source: P.A. 87-13.)
15 (305 ILCS 5/5-4.34) (from Ch. 23, par. 5-4.34)
16 Sec. 5-4.34. Notification. The Illinois Department of
17 Public Aid shall notify each provider of the results of its
18 calculations under Section 5-4.32 of this Code. If a
19 facility, so notified, does not submit a request for
20 reconsideration, the calculations shall be considered final.
21 The notification shall be in writing.
22 (Source: P.A. 87-13.)
23 (305 ILCS 5/5-4.35) (from Ch. 23, par. 5-4.35)
24 Sec. 5-4.35. Procedures for reconsideration and final
25 reconciliation. Each facility shall have the right to
26 reconsideration of the amount of its fee. The Illinois
27 Department of Public Aid shall conduct a final
28 reconciliation.
29 Each facility shall be entitled to receive enhanced
30 reimbursement through disbursements made under Section 5-4.37
31 in an amount at least equal to the amount of the fee imposed
32 on the facility under Section 5-4.32.
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1 (Source: P.A. 87-13.)
2 (305 ILCS 5/5-4.36) (from Ch. 23, par. 5-4.36)
3 Sec. 5-4.36. Penalties.
4 (a) Any facility that fails to pay the fee when due or
5 pays less than the full amount due, shall be assessed a
6 penalty of 10% of the delinquency or deficiency for each
7 month, or any fraction thereof, computed on the full amount
8 of the delinquency or deficiency, from the time the fee was
9 due.
10 (b) In addition, the Illinois Department of Public Aid
11 may take action to notify the Office of the Comptroller to
12 collect any amount of monies owed under Sections 5-4.30
13 through 5-4.39 of this Code, pursuant to Section 10.05 of the
14 State Comptroller Act, or may suspend payments to, or cancel
15 or refuse to issue, extend, or reinstate a Provider Agreement
16 to, any facility which has failed to pay any delinquent fee
17 or penalty.
18 (Source: P.A. 87-13.)
19 (305 ILCS 5/5-4.37) (from Ch. 23, par. 5-4.37)
20 Sec. 5-4.37. Disbursements to facilities.
21 (a) The Illinois Department of Public Aid shall develop
22 a reimbursement methodology which shall enhance reimbursement
23 to facilities sufficiently to expend the fee monies described
24 in Section 5-4.32 of this Code, and the federal matching
25 funds received by the Illinois Department as a result of
26 expenditures made by the Illinois Department as required by
27 this Section and Section 5-4.31 that are attributable to fee
28 monies deposited in the Fund.
29 (b) All payments to facilities under this Section are
30 conditional on:
31 (1) expiration of the time limitations for
32 reconsiderations under Section 5-4.35 of this Code; and
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1 (2) the availability of sufficient monies in the
2 Fund to make the payments required by this Section after
3 the final reconciliation determined under Section 5-4.35
4 of this Code.
5 (c) If amounts in the Fund are insufficient to make the
6 total amount of payments for which facilities are eligible,
7 the Illinois Department of Public Aid shall reduce the amount
8 of each payment by the percentage by which the amounts are
9 insufficient. Any amounts not paid when due shall be paid to
10 facilities as soon as monies are available in the Fund.
11 (d) If one or more facilities files suit in any court
12 challenging any part of Sections 5-4.30 through 5-4.39 of
13 this Code, payments to facilities under these Sections shall
14 be made only to the extent that sufficient monies are
15 available in the Fund and only to the extent that any monies
16 in the Fund are not prohibited from disbursement under any
17 order of the Court.
18 (Source: P.A. 87-13.)
19 (305 ILCS 5/5-4.38) (from Ch. 23, par. 5-4.38)
20 Sec. 5-4.38. Annual audit.
21 (a) The Illinois Department of Public Aid shall conduct
22 an annual audit of the Fund to determine that amounts
23 received from or paid to facilities were correct. If such an
24 audit identifies amounts that a facility should not have been
25 required to pay but did pay, a facility should have been
26 required to pay but did not pay, a facility should not have
27 received but did receive, or a facility should have received
28 but did not receive, the Illinois Department of Public Aid
29 shall:
30 (1) Make required payments to any such facility, or
31 (2) Take action to recover required amounts from
32 any such facility, including recoupment from future
33 payments.
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1 (b) Amounts recovered from a facility shall be credited
2 to the Fund. A facility is entitled to recover amounts paid
3 to the Department of Public Aid and to receive refunds and
4 payments from the Department under this Section only to the
5 extent that monies are available in the Fund.
6 (Source: P.A. 87-13.)
7 (305 ILCS 5/5-5) (was 305 ILCS 5/5-5, in part)
8 Sec. 5-5. Medical services.
9 (a) The Illinois Department of Public Aid, by rule,
10 shall determine the quantity and quality of and the rate of
11 reimbursement for the medical assistance for which payment
12 will be authorized, and the medical services to be provided,
13 which may include all or part of the following:
14 (1) inpatient hospital services;
15 (2) outpatient hospital services;
16 (3) other laboratory and X-ray services;
17 (4) skilled nursing home services;
18 (5) physicians' services whether furnished in the
19 office, the patient's home, a hospital, a skilled nursing
20 home, or elsewhere;
21 (6) medical care, or any other type of remedial
22 care furnished by licensed practitioners;
23 (7) home health care services;
24 (8) private duty nursing service;
25 (9) clinic services;
26 (10) dental services;
27 (11) physical therapy and related services;
28 (12) prescribed drugs, dentures, and prosthetic
29 devices; and eyeglasses prescribed by a physician skilled
30 in the diseases of the eye, or by an optometrist,
31 whichever the person may select;
32 (13) other diagnostic, screening, preventive, and
33 rehabilitative services;
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1 (14) transportation and such other expenses as may
2 be necessary;
3 (15) medical treatment of sexual assault survivors,
4 as defined in Section 1a of the Sexual Assault Survivors
5 Emergency Treatment Act, for injuries sustained as a
6 result of the sexual assault, including examinations and
7 laboratory tests to discover evidence which may be used
8 in criminal proceedings arising from the sexual assault;
9 (16) the diagnosis and treatment of sickle cell
10 anemia; and
11 (17) any other medical care, and any other type of
12 remedial care recognized under the laws of this State,
13 but not including abortions, or induced miscarriages or
14 premature births, unless, in the opinion of a physician,
15 such procedures are necessary for the preservation of the
16 life of the woman seeking such treatment, or except an
17 induced premature birth intended to produce a live viable
18 child and such procedure is necessary for the health of
19 the mother or her unborn child.
20 (b) The Illinois Department of Public Aid, by rule,
21 shall prohibit any physician from providing medical
22 assistance to anyone eligible therefor under this Code where
23 such physician has been found guilty of performing an
24 abortion procedure in a wilful and wanton manner upon a woman
25 who was not pregnant at the time such abortion procedure was
26 performed.
27 (c) The term "any other type of remedial care" shall
28 include nursing care and nursing home service for persons who
29 rely on treatment by spiritual means alone through prayer for
30 healing.
31 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
32 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
33 (305 ILCS 5/5-5.005 new) (was 305 ILCS 5/5-5, in part)
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1 Sec. 5-5.005. Tobacco use cessation program.
2 Notwithstanding any other provision of Sections 5-5 through
3 5-5.0075 this Section, a comprehensive tobacco use cessation
4 program that includes purchasing prescription drugs or
5 prescription medical devices approved by the Food and Drug
6 administration shall be covered under the medical assistance
7 program under this Article for persons who are otherwise
8 eligible for assistance under this Article.
9 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
10 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
11 (305 ILCS 5/5-5.0010 new) (was 305 ILCS 5/5-5, in part)
12 Sec. 5-5.0010. Laboratory tests; documentation.
13 Notwithstanding any other provision of this Code, the
14 Illinois Department of Public Aid may not require, as a
15 condition of payment for any laboratory test authorized under
16 this Article, that a physician's handwritten signature appear
17 on the laboratory test order form. The Illinois Department
18 may, however, impose other appropriate requirements regarding
19 laboratory test order documentation.
20 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
21 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
22 (305 ILCS 5/5-5.0015 new) (was 305 ILCS 5/5-5, in part)
23 Sec. 5-5.0015. Persons participating in education,
24 training, or employment programs. The Illinois
25 Department of Public Aid shall provide the following services
26 to persons eligible for assistance under this Article who are
27 participating in education, training or employment programs
28 operated by the Department of Human Services as successor to
29 the Department of Public Aid:
30 (1) dental services, which shall include but not be
31 limited to prosthodontics; and
32 (2) eyeglasses prescribed by a physician skilled in
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1 the diseases of the eye, or by an optometrist, whichever
2 the person may select.
3 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
4 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
5 (305 ILCS 5/5-5.0020 new) (was 305 ILCS 5/5-5, in part)
6 Sec. 5-5.0020. Classification of medical services. The
7 Illinois Department of Public Aid, by rule, may distinguish
8 and classify the medical services to be provided only in
9 accordance with the classes of persons designated in the
10 Sections following Section 5-2 and preceding Section
11 5-2.0100.
12 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
13 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
14 (305 ILCS 5/5-5.0025 new) (was 305 ILCS 5/5-5, in part)
15 Sec. 5-5.0025. Breast cancer screening.
16 (a) The Illinois Department of Public Aid shall
17 authorize the provision of, and shall authorize payment for,
18 screening by low-dose mammography for the presence of occult
19 breast cancer for women 35 years of age or older who are
20 eligible for medical assistance under this Article, as
21 follows: a baseline mammogram for women 35 to 39 years of
22 age and an annual mammogram for women 40 years of age or
23 older. All screenings shall include a physical breast exam,
24 instruction on self-examination and information regarding the
25 frequency of self-examination and its value as a preventative
26 tool.
27 (b) As used in this Section, "low-dose mammography"
28 means the x-ray examination of the breast using equipment
29 dedicated specifically for mammography, including the x-ray
30 tube, filter, compression device, image receptor, and
31 cassettes, with an average radiation exposure delivery of
32 less than one rad mid-breast, with 2 views for each breast.
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1 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
2 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
3 (305 ILCS 5/5-5.0030 new) (was 305 ILCS 5/5-5, in part)
4 Sec. 5-5.0030. Pregnant women; substance abuse.
5 (a) Any medical or health care provider shall
6 immediately recommend, to any pregnant woman who is being
7 provided prenatal services and is suspected of drug abuse or
8 is addicted as defined in the Alcoholism and Other Drug Abuse
9 and Dependency Act, referral to a local substance abuse
10 treatment provider licensed by the Department of Human
11 Services or to a licensed hospital which provides substance
12 abuse treatment services. The Department of Public Aid shall
13 assure coverage for the cost of treatment of the drug abuse
14 or addiction for pregnant recipients in accordance with the
15 Illinois Medicaid Program in conjunction with the Department
16 of Human Services.
17 (b) All medical providers providing medical assistance
18 to pregnant women under this Code shall receive information
19 from the Department of Public Aid on the availability of
20 services under the Drug Free Families with a Future or any
21 comparable program providing case management services for
22 addicted women, including information on appropriate
23 referrals for other social services that may be needed by
24 addicted women in addition to treatment for addiction.
25 (c) The Illinois Department of Public Aid, in
26 cooperation with the Departments of Human Services (as
27 successor to the Department of Alcoholism and Substance
28 Abuse) and Public Health, through a public awareness
29 campaign, may provide information concerning treatment for
30 alcoholism and drug abuse and addiction, prenatal health
31 care, and other pertinent programs directed at reducing the
32 number of drug-affected infants born to recipients of medical
33 assistance.
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1 (d) Neither the Illinois Department of Public Aid nor
2 the Department of Human Services shall sanction the recipient
3 solely on the basis of her substance abuse.
4 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
5 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
6 (305 ILCS 5/5-5.0035 new) (was 305 ILCS 5/5-5, in part)
7 Sec. 5-5.0035. Regulations for dispensing of health
8 services; advisory bodies. The Illinois Department of Public
9 Aid shall establish such regulations governing the dispensing
10 of health services under this Article as it shall deem
11 appropriate. In formulating these regulations the Illinois
12 Department shall consult with and give substantial weight to
13 the recommendations offered by the Citizens Assembly/Council
14 on Public Aid. The Department should seek the advice of
15 formal professional advisory committees appointed by the
16 Director of Public Aid the Illinois Department for the
17 purpose of providing regular advice on policy and
18 administrative matters, information dissemination and
19 educational activities for medical and health care providers,
20 and consistency in procedures to the Illinois Department.
21 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
22 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
23 (305 ILCS 5/5-5.0040 new) (was 305 ILCS 5/5-5, in part)
24 Sec. 5-5.0040. Contracts with partnerships of medical
25 providers.
26 (a) The Illinois Department of Public Aid may develop
27 and contract with Partnerships of medical providers to
28 arrange medical services for persons eligible under Sections
29 Section 5-2 through 5-2.0100 of this Code. Implementation of
30 this Section may be by demonstration projects in certain
31 geographic areas. The Partnership shall be represented by a
32 sponsor organization. The Department, by rule, shall develop
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1 qualifications for sponsors of Partnerships. Nothing in this
2 Section shall be construed to require that the sponsor
3 organization be a medical organization.
4 (b) The sponsor must negotiate formal written contracts
5 with medical providers for physician services, inpatient and
6 outpatient hospital care, home health services, treatment for
7 alcoholism and substance abuse, and other services determined
8 necessary by the Illinois Department of Public Aid by rule
9 for delivery by Partnerships. Physician services must
10 include prenatal and obstetrical care. The Illinois
11 Department of Public Aid shall reimburse medical services
12 delivered by Partnership providers to clients in target areas
13 according to provisions of this Article and the Illinois
14 Health Finance Reform Act, except that:
15 (1) Physicians participating in a Partnership and
16 providing certain services, which shall be determined by
17 the Illinois Department of Public Aid, to persons in
18 areas covered by the Partnership may receive an
19 additional surcharge for such services.
20 (2) The Department of Public Aid may elect to
21 consider and negotiate financial incentives to encourage
22 the development of Partnerships and the efficient
23 delivery of medical care.
24 (3) Persons receiving medical services through
25 Partnerships may receive medical and case management
26 services above the level usually offered through the
27 medical assistance program.
28 (c) Medical providers shall be required to meet certain
29 qualifications to participate in Partnerships to ensure the
30 delivery of high quality medical services. These
31 qualifications shall be determined by rule of the Illinois
32 Department of Public Aid and may be higher than
33 qualifications for participation in the medical assistance
34 program. Partnership sponsors may prescribe reasonable
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1 additional qualifications for participation by medical
2 providers, only with the prior written approval of the
3 Illinois Department of Public Aid.
4 (d) Nothing in Sections 5-5 through 5-5.0075 this
5 Section shall limit the free choice of practitioners,
6 hospitals, and other providers of medical services by
7 clients. In order to ensure patient freedom of choice, the
8 Illinois Department of Public Aid shall immediately
9 promulgate all rules and take all other necessary actions so
10 that provided services may be accessed from therapeutically
11 certified optometrists to the full extent of the Illinois
12 Optometric Practice Act of 1987 without discriminating
13 between service providers.
14 (e) The Department of Public Aid shall apply for a
15 waiver from the United States Health Care Financing
16 Administration to allow for the implementation of
17 Partnerships under this Section.
18 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
19 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
20 (305 ILCS 5/5-5.0045 new) (was 305 ILCS 5/5-5, in part)
21 Sec. 5-5.0045. Providers' records.
22 (a) The Illinois Department of Public Aid shall require
23 health care providers to maintain records that document the
24 medical care and services provided to recipients of Medical
25 Assistance under this Article. The Illinois Department shall
26 require health care providers to make available, when
27 authorized by the patient, in writing, the medical records in
28 a timely fashion to other health care providers who are
29 treating or serving persons eligible for Medical Assistance
30 under this Article.
31 (b) All dispensers of medical services shall be required
32 to maintain and retain business and professional records
33 sufficient to fully and accurately document the nature,
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1 scope, details and receipt of the health care provided to
2 persons eligible for medical assistance under this Code, in
3 accordance with regulations promulgated by the Illinois
4 Department of Public Aid.
5 (c) The rules and regulations shall require that proof
6 of the receipt of prescription drugs, dentures, prosthetic
7 devices and eyeglasses by eligible persons under this Section
8 accompany each claim for reimbursement submitted by the
9 dispenser of such medical services. No such claims for
10 reimbursement shall be approved for payment by the Illinois
11 Department of Public Aid without such proof of receipt,
12 unless the Illinois Department shall have put into effect and
13 shall be operating a system of post-payment audit and review
14 which shall, on a sampling basis, be deemed adequate by the
15 Illinois Department to assure that such drugs, dentures,
16 prosthetic devices and eyeglasses for which payment is being
17 made are actually being received by eligible recipients.
18 (d) Within 90 days after the effective date of this
19 amendatory Act of 1984, the Illinois Department of Public Aid
20 shall establish a current list of acquisition costs for all
21 prosthetic devices and any other items recognized as medical
22 equipment and supplies reimbursable under this Article and
23 shall update such list on a quarterly basis, except that the
24 acquisition costs of all prescription drugs shall be updated
25 no less frequently than every 30 days as required by Section
26 5-5.12.
27 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
28 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
29 (305 ILCS 5/5-5.0050 new) (was 305 ILCS 5/5-5, in part)
30 Sec. 5-5.0050. Abortions, induced miscarriages, and
31 premature births. The rules and regulations of the Illinois
32 Department of Public Aid shall require that a written
33 statement including the required opinion of a physician shall
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1 accompany any claim for reimbursement for abortions, or
2 induced miscarriages or premature births. This statement
3 shall indicate what procedures were used in providing such
4 medical services.
5 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
6 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
7 (305 ILCS 5/5-5.0055 new) (was 305 ILCS 5/5-5, in part)
8 Sec. 5-5.0055. Providers' disclosure of economic
9 interests. The Illinois Department of Public Aid shall
10 require that all dispensers of medical services, other than
11 an individual practitioner or group of practitioners,
12 desiring to participate in the Medical Assistance program
13 established under this Article to disclose all financial,
14 beneficial, ownership, equity, surety or other interests in
15 any and all firms, corporations, partnerships, associations,
16 business enterprises, joint ventures, agencies, institutions
17 or other legal entities providing any form of health care
18 services in this State under this Article.
19 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
20 91-666, eff. 12-22-99; 92-16, eff. 6-28-01; revised
21 12-13-01.)
22 (305 ILCS 5/5-5.0060 new) (was 305 ILCS 5/5-5, in part)
23 Sec. 5-5.0060. Providers' disclosure of inquiries. The
24 Illinois Department of Public Aid may require that all
25 dispensers of medical services desiring to participate in the
26 medical assistance program established under this Article
27 disclose, under such terms and conditions as the Illinois
28 Department may by rule establish, all inquiries from clients
29 and attorneys regarding medical bills paid by the Illinois
30 Department, which inquiries could indicate potential
31 existence of claims or liens for the Illinois Department.
32 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
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1 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
2 (305 ILCS 5/5-5.0065 new) (was 305 ILCS 5/5-5, in part)
3 Sec. 5-5.0065. Orthotic and prosthetic devices; durable
4 medical equipment.
5 (a) The Illinois Department of Public Aid shall
6 establish policies, procedures, standards and criteria by
7 rule for the acquisition, repair and replacement of orthotic
8 and prosthetic devices and durable medical equipment. Such
9 rules shall provide, but not be limited to, the following
10 services:
11 (1) immediate repair or replacement of such devices
12 by recipients without medical authorization; and
13 (2) rental, lease, purchase or lease-purchase of
14 durable medical equipment in a cost-effective manner,
15 taking into consideration the recipient's medical
16 prognosis, the extent of the recipient's needs, and the
17 requirements and costs for maintaining such equipment.
18 Such rules shall enable a recipient to temporarily
19 acquire and use alternative or substitute devices or
20 equipment pending repairs or replacements of any device or
21 equipment previously authorized for such recipient by the
22 Department.
23 (b) Rules under paragraph clause (2) of subsection (a)
24 above shall not provide for purchase or lease-purchase of
25 durable medical equipment or supplies used for the purpose of
26 oxygen delivery and respiratory care.
27 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
28 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
29 (305 ILCS 5/5-5.0070 new) (was 305 ILCS 5/5-5, in part)
30 Sec. 5-5.0070. Nursing home prescreening; interagency
31 agreements. The Department of Public Aid shall execute,
32 relative to the nursing home prescreening project, written
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1 inter-agency agreements with the Department of Human Services
2 and the Department on Aging, to effect the following: (i)
3 intake procedures and common eligibility criteria for those
4 persons who are receiving non-institutional services; and
5 (ii) the establishment and development of non-institutional
6 services in areas of the State where they are not currently
7 available or are undeveloped.
8 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
9 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
10 (305 ILCS 5/5-5.0075 new) (was 305 ILCS 5/5-5, in part)
11 Sec. 5-5.0075. Evaluation; monitoring of utilization of
12 services and facilities.
13 (a) The Illinois Department of Public Aid shall develop
14 and operate, in cooperation with other State departments and
15 agencies and in compliance with applicable federal laws and
16 regulations, appropriate and effective systems of health care
17 evaluation and programs for monitoring of utilization of
18 health care services and facilities, as it affects persons
19 eligible for medical assistance under this Code.
20 (b) The Illinois Department of Public Aid shall report
21 regularly the results of the operation of such systems and
22 programs to the Citizens Assembly/Council on Public Aid to
23 enable the Committee to ensure, from time to time, that these
24 programs are effective and meaningful.
25 (c) The Illinois Department of Public Aid shall report
26 annually to the General Assembly, no later than the second
27 Friday in April of 1979 and each year thereafter, in regard
28 to:
29 (1) (a) actual statistics and trends in utilization
30 of medical services by public aid recipients;
31 (2) (b) actual statistics and trends in the
32 provision of the various medical services by medical
33 vendors;
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1 (3) (c) current rate structures and proposed
2 changes in those rate structures for the various medical
3 vendors; and
4 (4) (d) efforts at utilization review and control
5 by the Illinois Department.
6 The period covered by each report shall be the 3 years
7 ending on the June 30 prior to the report. The report shall
8 include suggested legislation for consideration by the
9 General Assembly. The filing of one copy of the report with
10 the Speaker, one copy with the Minority Leader and one copy
11 with the Clerk of the House of Representatives, one copy with
12 the President, one copy with the Minority Leader and one copy
13 with the Secretary of the Senate, one copy with the
14 Legislative Research Unit, such additional copies with the
15 State Government Report Distribution Center for the General
16 Assembly as is required under paragraph (t) of Section 7 of
17 the State Library Act and one copy with the Citizens
18 Assembly/Council on Public Aid or its successor shall be
19 deemed sufficient to comply with this Section.
20 (Source: P.A. 91-344, eff. 1-1-00; 91-462, eff. 8-6-99;
21 91-666, eff. 12-22-99; 92-16, eff. 6-28-01.)
22 (305 ILCS 5/5-5.01a)
23 Sec. 5-5.01a. Supportive living facilities demonstration
24 project. For the purpose of studying alternative settings
25 for long term care, the Department of Public Aid may
26 establish and provide oversight for a demonstration project
27 to determine the viability of supportive living facilities
28 that seek to promote resident independence, dignity, respect,
29 and well-being in the most cost-effective manner.
30 A supportive living facility is either a free-standing
31 facility or a distinct physical and operational entity within
32 a nursing facility. A supportive living facility integrates
33 housing with health, personal care, and supportive services
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1 and is a designated setting that offers residents their own
2 separate, private, and distinct living units.
3 Demonstration sites shall be selected by the Department
4 of Public Aid based upon criteria that may include the need
5 for services in a geographic area, the availability of
6 funding, and the site's ability to meet the standards.
7 The Department of Public Aid may adopt rules to implement
8 this Section. Rules that establish or modify the services,
9 standards, and conditions for participation in the
10 demonstration project shall be adopted by the Department in
11 consultation with the Department on Aging, the Department of
12 Rehabilitation Services, and the Department of Mental Health
13 and Developmental Disabilities (or their successor agencies).
14 Facilities or distinct parts of facilities which are
15 selected as supportive living facilities and are in good
16 standing with the Department of Public Aid's Department's
17 rules are exempt from the provisions of the Nursing Home Care
18 Act and the Illinois Health Facilities Planning Act.
19 (Source: P.A. 89-499, eff. 6-28-96.)
20 (305 ILCS 5/5-5.02) (was 305 ILCS 5/5-5.02, subsec. (h))
21 Sec. 5-5.02. Hospital reimbursements; definitions.
22 (h) For the purposes of this Section through Section
23 5-5.02j, the following terms shall be defined as follows:
24 (1) "Medicaid inpatient utilization rate" means a
25 fraction, the numerator of which is the number of a
26 hospital's inpatient days provided in a given 12-month period
27 to patients who, for such days, were eligible for Medicaid
28 under Title XIX of the federal Social Security Act, and the
29 denominator of which is the total number of the hospital's
30 inpatient days in that same period.
31 (2) "Mean Medicaid inpatient utilization rate" means the
32 total number of Medicaid inpatient days provided by all
33 Illinois Medicaid-participating hospitals divided by the
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1 total number of inpatient days provided by those same
2 hospitals.
3 (3) "Medicaid obstetrical inpatient utilization rate"
4 means the ratio of Medicaid obstetrical inpatient days to
5 total Medicaid inpatient days for all Illinois hospitals
6 receiving Medicaid payments from the Illinois Department of
7 Public Aid.
8 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
9 (305 ILCS 5/5-5.02a new) (was 305 ILCS 5/5-5.02, subsec.
10 (a))
11 Sec. 5-5.02a. (a) Reimbursement to hospitals; July 1,
12 1992 through September 30, 1992. Notwithstanding any other
13 provisions of this Code or the Department of Public Aid's
14 Illinois Department's rules promulgated under the Illinois
15 Administrative Procedure Act, reimbursement to hospitals for
16 services provided during the period July 1, 1992 through
17 September 30, 1992, shall be as follows:
18 (1) For inpatient hospital services rendered, or if
19 applicable, for inpatient hospital discharges occurring,
20 on or after July 1, 1992 and on or before September 30,
21 1992, the Illinois Department of Public Aid shall
22 reimburse hospitals for inpatient services under the
23 reimbursement methodologies in effect for each hospital,
24 and at the inpatient payment rate calculated for each
25 hospital, as of June 30, 1992. For purposes of this
26 paragraph, "reimbursement methodologies" means all
27 reimbursement methodologies that pertain to the provision
28 of inpatient hospital services, including, but not
29 limited to, any adjustments for disproportionate share,
30 targeted access, critical care access and uncompensated
31 care, as defined by the Illinois Department of Public Aid
32 on June 30, 1992.
33 (2) For the purpose of calculating the inpatient
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1 payment rate for each hospital eligible to receive
2 quarterly adjustment payments for targeted access and
3 critical care, as defined by the Illinois Department of
4 Public Aid on June 30, 1992, the adjustment payment for
5 the period July 1, 1992 through September 30, 1992, shall
6 be 25% of the annual adjustment payments calculated for
7 each eligible hospital, as of June 30, 1992. The
8 Illinois Department of Public Aid shall determine by rule
9 the adjustment payments for targeted access and critical
10 care beginning October 1, 1992.
11 (3) For the purpose of calculating the inpatient
12 payment rate for each hospital eligible to receive
13 quarterly adjustment payments for uncompensated care, as
14 defined by the Illinois Department of Public Aid on June
15 30, 1992, the adjustment payment for the period August 1,
16 1992 through September 30, 1992, shall be one-sixth of
17 the total uncompensated care adjustment payments
18 calculated for each eligible hospital for the
19 uncompensated care rate year, as defined by the Illinois
20 Department of Public Aid, ending on July 31, 1992. The
21 Illinois Department of Public Aid shall determine by rule
22 the adjustment payments for uncompensated care beginning
23 October 1, 1992.
24 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
25 (305 ILCS 5/5-5.02b new) (was 305 ILCS 5/5-5.02, subsec.
26 (b))
27 Sec. 5-5.02b. (b) Inpatient payments. For inpatient
28 services provided on or after October 1, 1993, in addition to
29 rates paid for hospital inpatient services pursuant to the
30 Illinois Health Finance Reform Act, as now or hereafter
31 amended, or the Department of Public Aid's Illinois
32 Department's prospective reimbursement methodology, or any
33 other methodology used by the Illinois Department for
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1 inpatient services, the Illinois Department of Public Aid
2 shall make adjustment payments, in an amount calculated
3 pursuant to the methodology described in paragraph (c) of
4 this Section 5-5.02c, to hospitals that the Illinois
5 Department determines satisfy any one of the following
6 requirements:
7 (1) Hospitals that are described in Section 1923 of
8 the federal Social Security Act, as now or hereafter
9 amended; or
10 (2) Illinois hospitals that have a Medicaid
11 inpatient utilization rate which is at least one-half a
12 standard deviation above the mean Medicaid inpatient
13 utilization rate for all hospitals in Illinois receiving
14 Medicaid payments from the Illinois Department of Public
15 Aid; or
16 (3) Illinois hospitals that on July 1, 1991 had a
17 Medicaid inpatient utilization rate, as defined in
18 paragraph (h) of this Section 5-5.02, that was at least
19 the mean Medicaid inpatient utilization rate for all
20 hospitals in Illinois receiving Medicaid payments from
21 the Illinois Department of Public Aid and which were
22 located in a planning area with one-third or fewer excess
23 beds as determined by the Illinois Health Facilities
24 Planning Board, and that, as of June 30, 1992, were
25 located in a federally designated Health Manpower
26 Shortage Area; or
27 (4) Illinois hospitals that:
28 (A) have a Medicaid inpatient utilization rate
29 that is at least equal to the mean Medicaid
30 inpatient utilization rate for all hospitals in
31 Illinois receiving Medicaid payments from the
32 Department of Public Aid; and
33 (B) also have a Medicaid obstetrical inpatient
34 utilization rate that is at least one standard
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1 deviation above the mean Medicaid obstetrical
2 inpatient utilization rate for all hospitals in
3 Illinois receiving Medicaid payments from the
4 Department of Public Aid for obstetrical services;
5 or
6 (5) Any children's hospital, which means a hospital
7 devoted exclusively to caring for children. A hospital
8 which includes a facility devoted exclusively to caring
9 for children that is separately licensed as a hospital by
10 a municipality prior to September 30, 1998 shall be
11 considered a children's hospital to the degree that the
12 hospital's Medicaid care is provided to children.
13 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
14 (305 ILCS 5/5-5.02c new) (was 305 ILCS 5/5-5.02, subsec.
15 (c))
16 Sec. 5-5.02c. (c) Inpatient adjustment payments. The
17 adjustment payments required by Section 5-5.02b paragraph (b)
18 shall be calculated based upon the hospital's Medicaid
19 inpatient utilization rate as follows:
20 (1) Hospitals with a Medicaid inpatient utilization
21 rate below the mean shall receive a per day adjustment
22 payment equal to $25.;
23 (2) Hospitals with a Medicaid inpatient
24 utilization rate that is equal to or greater than the
25 mean Medicaid inpatient utilization rate but less than
26 one standard deviation above the mean Medicaid inpatient
27 utilization rate shall receive a per day adjustment
28 payment equal to the sum of $25 plus $1 for each one
29 percent that the hospital's Medicaid inpatient
30 utilization rate exceeds the mean Medicaid inpatient
31 utilization rate.;
32 (3) Hospitals with a Medicaid inpatient utilization
33 rate that is equal to or greater than one standard
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1 deviation above the mean Medicaid inpatient utilization
2 rate but less than 1.5 standard deviations above the mean
3 Medicaid inpatient utilization rate shall receive a per
4 day adjustment payment equal to the sum of $40 plus $7
5 for each one percent that the hospital's Medicaid
6 inpatient utilization rate exceeds one standard deviation
7 above the mean Medicaid inpatient utilization rate.; and
8 (4) Hospitals with a Medicaid inpatient utilization
9 rate that is equal to or greater than 1.5 standard
10 deviations above the mean Medicaid inpatient utilization
11 rate shall receive a per day adjustment payment equal to
12 the sum of $90 plus $2 for each one percent that the
13 hospital's Medicaid inpatient utilization rate exceeds
14 1.5 standard deviations above the mean Medicaid inpatient
15 utilization rate.
16 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
17 (305 ILCS 5/5-5.02d new) (was 305 ILCS 5/5-5.02, subsec.
18 (d))
19 Sec. 5-5.02d. (d) Supplemental adjustment payments. In
20 addition to the adjustment payments described in Section
21 5-5.02c paragraph (c), hospitals as defined in clauses (1)
22 through (5) of Section 5-5.02b paragraph (b), excluding
23 county hospitals (as defined in subsection (c) of Section
24 15-1 of this Code) and a hospital organized under the
25 University of Illinois Hospital Act, shall be paid
26 supplemental inpatient adjustment payments of $60 per day.
27 For purposes of Title XIX of the federal Social Security Act,
28 these supplemental adjustment payments shall not be
29 classified as adjustment payments to disproportionate share
30 hospitals.
31 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
32 (305 ILCS 5/5-5.02e new) (was 305 ILCS 5/5-5.02, subsec.
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1 (e))
2 Sec. 5-5.02e. Inpatient adjustment payments; annual
3 increase; daily maximum.
4 (a) (e) The inpatient adjustment payments described in
5 Sections 5-5.02c and 5-5.02d paragraphs (c) and (d) shall be
6 increased on October 1, 1993 and annually thereafter by a
7 percentage equal to the lesser of (i) the increase in the DRI
8 hospital cost index for the most recent 12 month period for
9 which data are available, or (ii) the percentage increase in
10 the statewide average hospital payment rate over the previous
11 year's statewide average hospital payment rate.
12 (b) The sum of the inpatient adjustment payments under
13 Sections 5-5.02c and 5-5.02d paragraphs (c) and (d) to a
14 hospital, other than a county hospital (as defined in
15 subsection (c) of Section 15-1 of this Code) or a hospital
16 organized under the University of Illinois Hospital Act,
17 however, shall not exceed $275 per day; that limit shall be
18 increased on October 1, 1993 and annually thereafter by a
19 percentage equal to the lesser of (i) the increase in the DRI
20 hospital cost index for the most recent 12-month period for
21 which data are available or (ii) the percentage increase in
22 the statewide average hospital payment rate over the previous
23 year's statewide average hospital payment rate.
24 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
25 (305 ILCS 5/5-5.02f new) (was 305 ILCS 5/5-5.02, subsec.
26 (f))
27 Sec. 5-5.02f. (f) Children's hospital inpatient
28 adjustment payments. For children's hospitals, as defined in
29 clause (5) of Section 5-5.02b paragraph (b), the adjustment
30 payments required pursuant to Sections 5-5.02c and 5-5.02d
31 paragraphs (c) and (d) shall be multiplied by 2.0.
32 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
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1 (305 ILCS 5/5-5.02g new) (was 305 ILCS 5/5-5.02, subsec.
2 (g))
3 Sec. 5-5.02g. (g) County hospital inpatient adjustment
4 payments. For county hospitals, as defined in subsection (c)
5 of Section 15-1 of this Code, there shall be an adjustment
6 payment as determined by rules issued by the Illinois
7 Department of Public Aid.
8 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
9 (305 ILCS 5/5-5.02h new) (was 305 ILCS 5/5-5.02, subsec.
10 (i))
11 Sec. 5-5.02h. (i) Inpatient adjustment payment limit. In
12 order to meet the limits of Public Law 102-234 and Public Law
13 103-66, the Illinois Department of Public Aid shall by rule
14 adjust disproportionate share adjustment payments.
15 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
16 (305 ILCS 5/5-5.02i new) (was 305 ILCS 5/5-5.02, subsec.
17 (j))
18 Sec. 5-5.02i. (j) University of Illinois Hospital
19 inpatient adjustment payments. For hospitals organized under
20 the University of Illinois Hospital Act, there shall be an
21 adjustment payment as determined by rules adopted by the
22 Illinois Department of Public Aid.
23 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
24 (305 ILCS 5/5-5.02j new) (was 305 ILCS 5/5-5.02, subsec.
25 (k))
26 Sec. 5-5.02j. Adjustment payments; criteria and
27 methodologies. (k) The Illinois Department of Public Aid may
28 by rule establish criteria for and develop methodologies for
29 adjustment payments to hospitals participating under this
30 Article.
31 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)
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1 (305 ILCS 5/5-5.03)
2 Sec. 5-5.03. Trauma center adjustment.
3 (a) For inpatient admissions on or after October 1, 1992
4 for trauma injuries as defined in the Emergency Medical
5 Services (EMS) Systems Act, in addition to any other payments
6 made under this Code, the Illinois Department of Public Aid
7 shall make adjustment payments, in an amount calculated under
8 subsection (b) of this Section, to hospitals located in the
9 State of Illinois that are recognized as Level I trauma
10 centers (adult or pediatric) and to certain Level II trauma
11 centers as determined by the Illinois Department.
12 (b) Trauma center adjustment calculation.
13 (1) The funds used to make trauma center adjustment
14 payments to qualifying trauma centers shall consist of:
15 (A) At least 50% of the amount of moneys
16 deposited each State fiscal year into the Trauma
17 Center Fund created in the State treasury; and
18 (B) All federal matching funds received by the
19 Illinois Department of Public Aid as a result of
20 expenditures made by the Illinois Department as
21 required by this Section.
22 (2) The trauma center adjustment payments shall be
23 made to qualifying trauma centers on a quarterly basis.
24 In determining the payment methodology for trauma center
25 adjustment payments, the Illinois Department of Public
26 Aid shall divide the available funds from the Trauma
27 Center Fund for each quarter by the total number of the
28 Medicaid trauma admissions as determined by the Illinois
29 Department for the same quarter of the Trauma Center base
30 year. The result of that calculation shall be the amount
31 of the quarterly trauma center adjustment payment to be
32 paid to qualifying trauma centers.
33 (3) Disbursements from the Trauma Center Fund shall
34 be by warrants drawn by the State Comptroller upon
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1 receipt of vouchers duly executed and certified by the
2 Illinois Department of Public Aid.
3 (4) Trauma center adjustment payments shall not be
4 treated as payments for hospital services under Title XIX
5 of the Social Security Act for purposes of the
6 calculation of the intergovernmental transfer provided
7 for in Section 15-3(a) of the Code.
8 (c) Definitions. As used in this Section, unless the
9 context requires otherwise:
10 "Trauma center adjustment year" means, beginning October
11 1, 1992, the 12 month period beginning on October 1 of the
12 year and ending September 30 of the following year.
13 "Trauma center base year" means State Fiscal Year 1991
14 for trauma center adjustment payments calculated for the
15 October 1, 1992 trauma center adjustment year, State Fiscal
16 Year 1992 for trauma center adjustment payments calculated
17 for the October 1, 1993 trauma center adjustment year, and so
18 on for each succeeding State Fiscal Year for trauma center
19 adjustment payments calculated for the trauma center
20 adjustment year beginning October 1 of that State Fiscal
21 Year.
22 (Source: P.A. 87-1229.)
23 (305 ILCS 5/5-5.1) (from Ch. 23, par. 5-5.1)
24 Sec. 5-5.1. Grouping of facilities. The Department of
25 Public Aid shall, for purposes of payment, provide for
26 groupings of nursing facilities. Factors to be considered in
27 grouping facilities may include, but are not limited to,
28 size, age, patient mix or geographical area.
29 The groupings developed under this Section shall be
30 considered in determining reasonable cost reimbursement
31 formulas. However, this Section shall not preclude the
32 Department of Public Aid from recognizing and evaluating the
33 cost of capital on a facility-by-facility basis.
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1 (Source: P.A. 80-1142.)
2 (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
3 Sec. 5-5.2. Payment.
4 (a) All Skilled Nursing Facilities that are grouped
5 pursuant to Section 5-5.1 of this Act shall receive the same
6 rate of payment for similar services. All Intermediate Care
7 Facilities that are grouped pursuant to Section 5-5.1 of this
8 Act shall receive the same rate of payment for similar
9 services.
10 (b) It shall be a matter of State policy that the
11 Illinois Department of Public Aid shall utilize a uniform
12 billing cycle throughout the State for the following
13 long-term care providers: skilled nursing facilities,
14 intermediate care facilities, and intermediate care
15 facilities for persons with a developmental disability. The
16 Illinois Department shall establish billing cycles on a
17 calendar month basis for all long-term care providers no
18 later than July 1, 1992.
19 (Source: P.A. 87-809; 88-380.)
20 (305 ILCS 5/5-5.3) (from Ch. 23, par. 5-5.3)
21 Sec. 5-5.3. Annual determination Conditions of payment
22 Prospective rates Accounting Principles. This amendatory Act
23 establishes certain conditions for the Department of Public
24 Aid in instituting rates for the care of recipients of
25 medical assistance in skilled nursing facilities and
26 intermediate care facilities. Such conditions shall assure a
27 method under which the payment for skilled nursing and
28 intermediate care services, provided to recipients under the
29 Medical Assistance Program shall be on a reasonable cost
30 related basis, which is prospectively determined annually by
31 the Department of Public Aid. The annually established
32 payment rate shall take effect on July 1 in 1984 and
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1 subsequent years. There shall be no rate increase during
2 calendar year 1983 and the first six months of calendar year
3 1984.
4 The determination of the payment shall be made on the
5 basis of generally accepted accounting principles that shall
6 take into account the actual costs to the facility of
7 providing skilled nursing and intermediate care services to
8 recipients under the medical assistance program.
9 The resultant total rate for a specified type of service
10 shall be an amount which shall have been determined to be
11 adequate to reimburse allowable costs of a facility that is
12 economically and efficiently operated. The Department of
13 Public Aid shall establish an effective date for each
14 facility or group of facilities after which rates shall be
15 paid on a reasonable cost related basis which shall be no
16 sooner than the effective date of this amendatory Act of
17 1977.
18 (Source: P.A. 91-357, eff. 7-29-99.)
19 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
20 Sec. 5-5.4. Standards of payment Department of Public
21 Aid. The Department of Public Aid shall develop standards of
22 payment of skilled nursing and intermediate care services in
23 facilities providing such services under this Article which:
24 (1) Provide Provides for the determination of a
25 facility's payment for skilled nursing and intermediate care
26 services on a prospective basis. The amount of the payment
27 rate for all nursing facilities certified under the medical
28 assistance program shall be prospectively established
29 annually on the basis of historical, financial, and
30 statistical data reflecting actual costs from prior years,
31 which shall be applied to the current rate year and updated
32 for inflation, except that the capital cost element for newly
33 constructed facilities shall be based upon projected budgets.
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1 The annually established payment rate shall take effect on
2 July 1 in 1984 and subsequent years. Rate increases shall be
3 provided annually thereafter on July 1 in 1984 and on each
4 subsequent July 1 in the following years, except that no rate
5 increase and no update for inflation shall be provided on or
6 after July 1, 1994 and before July 1, 2002, unless
7 specifically provided for in this Section.
8 For facilities licensed by the Department of Public
9 Health under the Nursing Home Care Act as Intermediate Care
10 for the Developmentally Disabled facilities or Long Term Care
11 for Under Age 22 facilities, the rates taking effect on July
12 1, 1998 shall include an increase of 3%. For facilities
13 licensed by the Department of Public Health under the Nursing
14 Home Care Act as Skilled Nursing facilities or Intermediate
15 Care facilities, the rates taking effect on July 1, 1998
16 shall include an increase of 3% plus $1.10 per resident-day,
17 as defined by the Department.
18 For facilities licensed by the Department of Public
19 Health under the Nursing Home Care Act as Intermediate Care
20 for the Developmentally Disabled facilities or Long Term Care
21 for Under Age 22 facilities, the rates taking effect on July
22 1, 1999 shall include an increase of 1.6% plus $3.00 per
23 resident-day, as defined by the Department. For facilities
24 licensed by the Department of Public Health under the Nursing
25 Home Care Act as Skilled Nursing facilities or Intermediate
26 Care facilities, the rates taking effect on July 1, 1999
27 shall include an increase of 1.6% and, for services provided
28 on or after October 1, 1999, shall be increased by $4.00 per
29 resident-day, as defined by the Department.
30 For facilities licensed by the Department of Public
31 Health under the Nursing Home Care Act as Intermediate Care
32 for the Developmentally Disabled facilities or Long Term Care
33 for Under Age 22 facilities, the rates taking effect on July
34 1, 2000 shall include an increase of 2.5% per resident-day,
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1 as defined by the Department. For facilities licensed by the
2 Department of Public Health under the Nursing Home Care Act
3 as Skilled Nursing facilities or Intermediate Care
4 facilities, the rates taking effect on July 1, 2000 shall
5 include an increase of 2.5% per resident-day, as defined by
6 the Department.
7 For facilities licensed by the Department of Public
8 Health under the Nursing Home Care Act as Intermediate Care
9 for the Developmentally Disabled facilities or Long Term Care
10 for Under Age 22 facilities, the rates taking effect on March
11 1, 2001 shall include a statewide increase of 7.85%, as
12 defined by the Department.
13 For facilities licensed by the Department of Public
14 Health under the Nursing Home Care Act as Intermediate Care
15 for the Developmentally Disabled facilities or Long Term Care
16 for Under Age 22 facilities, the rates taking effect on April
17 1, 2002 shall include a statewide increase of 2.0%, as
18 defined by the Department.
19 For facilities licensed by the Department of Public
20 Health under the Nursing Home Care Act as skilled nursing
21 facilities or intermediate care facilities, the rates taking
22 effect on July 1, 2001, and each subsequent year thereafter,
23 shall be computed using the most recent cost reports on file
24 with the Department of Public Aid no later than April 1, 2000
25 updated for inflation to January 1, 2001. For rates
26 effective July 1, 2001 only, rates shall be the greater of
27 the rate computed for July 1, 2001 or the rate effective on
28 June 30, 2001.
29 Rates established effective each July 1 shall govern
30 payment for services rendered throughout that fiscal year,
31 except that rates established on July 1, 1996 shall be
32 increased by 6.8% for services provided on or after January
33 1, 1997. Such rates will be based upon the rates calculated
34 for the year beginning July 1, 1990, and for subsequent years
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1 thereafter until June 30, 2001 shall be based on the facility
2 cost reports for the facility fiscal year ending at any point
3 in time during the previous calendar year, updated to the
4 midpoint of the rate year. The cost report shall be on file
5 with the Department of Public Aid no later than April 1 of
6 the current rate year. Should the cost report not be on file
7 by April 1, the Department of Public Aid shall base the rate
8 on the latest cost report filed by each skilled care facility
9 and intermediate care facility, updated to the midpoint of
10 the current rate year. In determining rates for services
11 rendered on and after July 1, 1985, fixed time shall not be
12 computed at less than zero. The Department of Public Aid
13 shall not make any alterations of regulations which would
14 reduce any component of the Medicaid rate to a level below
15 what that component would have been utilizing in the rate
16 effective on July 1, 1984.
17 (2) Shall take into account the actual costs incurred by
18 facilities in providing services for recipients of skilled
19 nursing and intermediate care services under the medical
20 assistance program.
21 (3) Shall take into account the medical and
22 psycho-social characteristics and needs of the patients.
23 (4) Shall take into account the actual costs incurred by
24 facilities in meeting licensing and certification standards
25 imposed and prescribed by the State of Illinois, any of its
26 political subdivisions or municipalities and by the U.S.
27 Department of Health and Human Services pursuant to Title XIX
28 of the Social Security Act.
29 The Department of Public Aid shall develop precise
30 standards for payments to reimburse nursing facilities for
31 any utilization of appropriate rehabilitative personnel for
32 the provision of rehabilitative services which is authorized
33 by federal regulations, including reimbursement for services
34 provided by qualified therapists or qualified assistants, and
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1 which is in accordance with accepted professional practices.
2 Reimbursement also may be made for utilization of other
3 supportive personnel under appropriate supervision.
4 (Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10,
5 eff. 6-11-01; 92-31, eff. 6-28-01; revised 12-13-01.)
6 (305 ILCS 5/5-5.5) (from Ch. 23, par. 5-5.5)
7 Sec. 5-5.5. Elements of payment rate.
8 (a) The Department of Public Aid shall develop a
9 prospective method for determining payment rates for skilled
10 nursing and intermediate care services in nursing facilities
11 composed of the following cost elements:
12 (1) Standard Services, with the cost of this
13 component being determined by taking into account the
14 actual costs to the facilities of these services subject
15 to cost ceilings to be defined in the Department of
16 Public Aid's Department's rules.
17 (2) Resident Services, with the cost of this
18 component being determined by taking into account the
19 actual costs, needs and utilization of these services, as
20 derived from an assessment of the resident needs in the
21 nursing facilities. The Department of Public Aid shall
22 adopt rules governing reimbursement for resident services
23 as listed in Section 5-1.1. Surveys or assessments of
24 resident needs under this Section shall include a review
25 by the facility of the results of such assessments and a
26 discussion of issues in dispute with authorized survey
27 staff, unless the facility elects not to participate in
28 such a review process. Surveys or assessments of
29 resident needs under this Section may be conducted
30 semi-annually and payment rates relating to resident
31 services may be changed on a semi-annual basis. The
32 Illinois Department of Public Aid shall initiate a
33 project, either on a pilot basis or Statewide, to
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1 reimburse the cost of resident services based on a
2 methodology which utilizes an assessment of resident
3 needs to determine the level of reimbursement. This
4 methodology shall be different from the payment criteria
5 for resident services utilized by the Illinois Department
6 of Public Aid on July 1, 1981. On March 1, 1982, and
7 each year thereafter, until such time when the Illinois
8 Department of Public Aid adopts the methodology used in
9 such project for use statewide or the Illinois Department
10 reports to the Citizens Assembly/Council on Public Aid
11 that the methodology did not meet the Department's goals
12 and objectives and therefore is ceasing such project, the
13 Illinois Department of Public Aid shall report to the
14 General Assembly on the implementation and progress of
15 such project. The report shall include:
16 (A) A statement of the Illinois Department's
17 goals and objectives for such project;
18 (B) A description of such project, including
19 the number and type of nursing facilities involved
20 in the project;
21 (C) A description of the methodology used in
22 such project;
23 (D) A description of the Illinois Department's
24 application of the methodology;
25 (E) A statement on the methodology's effect on
26 the quality of care given to residents in the sample
27 nursing facilities; and
28 (F) A statement on the cost of the methodology
29 used in such project and a comparison of this cost
30 with the cost of the current payment criteria.
31 (3) Ancillary Services, with the payment rate being
32 developed for each individual type of service. Payment
33 shall be made only when authorized under procedures
34 developed by the Department of Public Aid.
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1 (4) Nurse's Aide Training, with the cost of this
2 component being determined by taking into account the
3 actual cost to the facilities of such training.
4 (5) Real Estate Taxes, with the cost of this
5 component being determined by taking into account the
6 figures contained in the most currently available cost
7 reports (with no imposition of maximums) updated to the
8 midpoint of the current rate year for long term care
9 services rendered between July 1, 1984 and June 30, 1985,
10 and with the cost of this component being determined by
11 taking into account the actual 1983 taxes for which the
12 nursing homes were assessed (with no imposition of
13 maximums) updated to the midpoint of the current rate
14 year for long term care services rendered between July 1,
15 1985 and June 30, 1986.
16 (b) In developing a prospective method for determining
17 payment rates for skilled nursing and intermediate care
18 services in nursing facilities, the Department of Public Aid
19 shall consider the following cost elements:
20 (1) Reasonable capital cost determined by utilizing
21 incurred interest rate and the current value of the
22 investment, including land, utilizing composite rates, or
23 by utilizing such other reasonable cost related methods
24 determined by the Department. However, beginning with the
25 rate reimbursement period effective July 1, 1987, the
26 Department shall be prohibited from establishing,
27 including, and implementing any depreciation factor in
28 calculating the capital cost element.
29 (2) Profit, with the actual amount being produced
30 and accruing to the providers in the form of a return on
31 their total investment, on the basis of their ability to
32 economically and efficiently deliver a type of service.
33 The method of payment may assure the opportunity for a
34 profit, but shall not guarantee or establish a specific
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1 amount as a cost.
2 (c) The Illinois Department of Public Aid may implement
3 the amendatory changes to this Section made by this
4 amendatory Act of 1991 through the use of emergency rules in
5 accordance with the provisions of Section 5.02 of the
6 Illinois Administrative Procedure Act. For purposes of the
7 Illinois Administrative Procedure Act, the adoption of rules
8 to implement the amendatory changes to this Section made by
9 this amendatory Act of 1991 shall be deemed an emergency and
10 necessary for the public interest, safety and welfare.
11 (d) No later than January 1, 2001, the Department of
12 Public Aid shall file with the Joint Committee on
13 Administrative Rules, pursuant to the Illinois Administrative
14 Procedure Act, a proposed rule, or a proposed amendment to an
15 existing rule, regarding payment for appropriate services,
16 including assessment, care planning, discharge planning, and
17 treatment provided by nursing facilities to residents who
18 have a serious mental illness.
19 (Source: P.A. 91-799, eff. 6-13-00.)
20 (305 ILCS 5/5-5.5a) (from Ch. 23, par. 5-5.5a)
21 Sec. 5-5.5a. Kosher kitchen and food service.
22 (a) The Department of Public Aid may develop in its rate
23 structure for skilled nursing facilities and intermediate
24 care facilities an accommodation for fully kosher kitchen and
25 food service operations, rabbinically approved or certified
26 on an annual basis for a facility in which the only kitchen
27 or all kitchens are fully kosher (a fully kosher facility).
28 Beginning in the fiscal year after the fiscal year when this
29 amendatory Act of 1990 becomes effective, the rate structure
30 may provide for an additional payment to such facility not to
31 exceed 50 cents per resident per day if 60% or more of the
32 residents in the facility request kosher foods or food
33 products prepared in accordance with Jewish religious dietary
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1 requirements for religious purposes in a fully kosher
2 facility. Based upon food cost reports of the Illinois
3 Department of Agriculture regarding kosher and non-kosher
4 food available in the various regions of the State, this rate
5 structure may be periodically adjusted by the Department of
6 Public Aid but may not exceed the maximum authorized under
7 this subsection (a).
8 (b) The Department of Public Aid shall by rule determine
9 how a facility with a fully kosher kitchen and food service
10 may be determined to be eligible and apply for the rate
11 accommodation specified in subsection (a).
12 (Source: P.A. 86-1464.)
13 (305 ILCS 5/5-5.6a) (from Ch. 23, par. 5-5.6a)
14 Sec. 5-5.6a. Promulgation of payment conditions,
15 standards and elements.
16 (a) Conditions of payment for skilled nursing and
17 intermediate care services in nursing facilities under
18 Section 5-5.3, standards of payment to such facilities under
19 Section 5-5.4 and the cost elements of payments to such
20 facilities under Section 5-5.5, promulgated and effective on
21 June 30, 1981, shall be null and void on July 1, 1982. The
22 Illinois Department of Public Aid shall promulgate new
23 conditions, standards and elements to be effective no later
24 than July 1, 1982, for payment for the care of recipients of
25 medical assistance in skilled or intermediate care
26 facilities, excluding skilled nursing facilities for
27 pediatrics and intermediate care facilities for the mentally
28 retarded, that are consistent with the criteria for nursing
29 facility reimbursement under Title XIX of the federal Social
30 Security Act, as determined by the federal Department of
31 Health and Human Services.
32 (b) Conditions of payment for skilled nursing facilities
33 for pediatrics and intermediate care facilities for the
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1 mentally retarded under Section 5-5.3, standards of payment
2 to such facilities under Section 5-5.4, and the cost elements
3 of payments to such facilities under Section 5-5.5,
4 promulgated and effective on December 31, 1984, shall be null
5 and void on January 1, 1985. The Illinois Department of
6 Public Aid shall promulgate conditions, standards and
7 elements to be effective no later than January 1, 1985, for
8 payment for the care of recipients of medical assistance in
9 skilled nursing facilities for pediatrics and intermediate
10 care facilities for the mentally retarded, that are
11 consistent with the criteria for nursing facility
12 reimbursement under Title XIX of the federal Social Security
13 Act, as determined by the federal Department of Health and
14 Human Services.
15 (Source: P.A. 85-1440.)
16 (305 ILCS 5/5-5.6b) (from Ch. 23, par. 5-5.6b)
17 Sec. 5-5.6b. Prohibition against double payment. If any
18 resident of a skilled nursing facility or intermediate care
19 facility is admitted to such facility on the basis that the
20 charges for such resident's care will be paid from private
21 funds, and the source of payment for such care thereafter
22 changes from private funds to payments under this Article,
23 the facility shall, upon receiving the first such payment
24 under this Article, notify the Illinois Department of Public
25 Aid of such source of private funds for such recipient and
26 repay to the source of private funds any amounts received
27 from such source as payment for care for which payment also
28 was made under this Article. Private funds shall not include
29 third party resources such as insurance or Medicare benefits
30 or payments made by responsible relatives.
31 (Source: P.A. 85-824.)
32 (305 ILCS 5/5-5.8) (from Ch. 23, par. 5-5.8)
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1 Sec. 5-5.8. Report on nursing home reimbursement. The
2 Illinois Department of Public Aid shall report annually to
3 the General Assembly, no later than the first Monday in April
4 of 1982, and each year thereafter, in regard to:
5 (a) the rate structure used by the Illinois
6 Department to reimburse nursing facilities;
7 (b) changes in the rate structure for reimbursing
8 nursing facilities;
9 (c) the administrative and program costs of
10 reimbursing nursing facilities;
11 (d) the availability of beds in nursing facilities
12 for public aid recipients; and
13 (e) the number of closings of nursing facilities,
14 and the reasons for those closings.
15 The requirement for reporting to the General Assembly
16 shall be satisfied by filing copies of the report with the
17 Speaker, the Minority Leader and the Clerk of the House of
18 Representatives and the President, the Minority Leader and
19 the Secretary of the Senate and the Legislative Research
20 Unit, as required by Section 3.1 of "An Act to revise the law
21 in relation to the General Assembly", approved February 25,
22 1874, as amended, and filing such additional copies with the
23 State Government Report Distribution Center for the General
24 Assembly as is required under paragraph (t) of Section 7 of
25 the State Library Act.
26 (Source: P.A. 84-1438.)
27 (305 ILCS 5/5-5.8a) (from Ch. 23, par. 5-5.8a)
28 Sec. 5-5.8a. Payment for exceptional care.
29 (a) For the provision of exceptional medical care, the
30 Illinois Department of Public Aid may make payments only to
31 skilled nursing facilities that substantially meet the
32 licensure and certification requirements prescribed by the
33 Department of Public Health. Only the Department of Public
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1 Health shall be responsible for determining whether licensure
2 and certification requirements for skilled nursing care
3 facilities have been substantially met. The rate of payment
4 shall be negotiated with the facilities offering to provide
5 the exceptional medical care. A facility's costs of
6 providing exceptional care shall not be considered in
7 determining the rate of payment to skilled nursing facilities
8 under Sections 5-5.3 through 5-5.5. Payment for exceptional
9 medical care shall not exceed the rate that the Illinois
10 Department of Public Aid would be required to pay under the
11 Medical Assistance Program for the same care in a hospital.
12 (b) The Illinois Department of Public Aid shall adopt
13 rules and regulations under the Illinois Administrative
14 Procedure Act to implement this Section. Those rules and
15 regulations shall set forth the procedures to be followed by
16 facilities when submitting an initial exceptional medical
17 care certification request and exceptional medical care
18 payment requests. The rules and regulations shall also
19 include the procedures and criteria used by the Illinois
20 Department of Public Aid in determining whether to approve a
21 skilled nursing facility's initial exceptional medical care
22 certification request and exceptional medical care payment
23 requests. The rules shall provide that the Illinois
24 Department, upon receipt of a facility's request for payment
25 for exceptional medical care and all necessary documentation,
26 shall, after negotiations between the Illinois Department and
27 the facility are completed, determine and notify the facility
28 whether the request has been approved or denied.
29 (Source: P.A. 88-412.)
30 (305 ILCS 5/5-5.11) (from Ch. 23, par. 5-5.11)
31 Sec. 5-5.11. Payments for fiscal year 1983 services.
32 Interim rate payments for fiscal year 1983 services made from
33 the available fiscal year 1983 appropriation shall be
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1 reconciled to each hospital's rates. Said reconciliation
2 shall be made from the fiscal year 1984 appropriation;
3 preliminary settlement shall be made on or before July 15,
4 1983 or 60 days after a hospital files its cost report with
5 the Department of Public Aid or its fiscal intermediary
6 covering any part of fiscal year 1983, whichever is later and
7 final settlement shall be made on or before 90 days after
8 said cost report is filed or July 15, 1983, whichever is
9 later. In no event shall any hospital be paid more than the
10 amount to be calculated by multiplying the hospital's rates
11 by the number of outpatient visits and clinic visits, and by
12 the lesser of the actual number of inpatient days or
13 allowable inpatient days of care provided by such hospital.
14 Total reconciliation payments in fiscal year 1984 shall not
15 exceed $170 million.
16 The Auditor General shall conduct a post audit to
17 determine if the Illinois Department of Public Aid has
18 complied with the requirements of Public Act 82-787.
19 (Source: P.A. 83-748.)
20 (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
21 Sec. 5-5.12. Pharmacy payments.
22 (a) Every request submitted by a pharmacy for
23 reimbursement under this Article for prescription drugs
24 provided to a recipient of aid under this Article shall
25 include the name of the prescriber or an acceptable
26 identification number as established by the Department of
27 Public Aid.
28 (b) Pharmacies providing prescription drugs under this
29 Article shall be reimbursed at a rate which shall include a
30 professional dispensing fee as determined by the Illinois
31 Department of Public Aid, plus the current acquisition cost
32 of the prescription drug dispensed. The Illinois Department
33 of Public Aid shall update its information on the acquisition
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1 costs of all prescription drugs no less frequently than every
2 30 days. However, the Illinois Department may set the rate of
3 reimbursement for the acquisition cost, by rule, at a
4 percentage of the current average wholesale acquisition cost.
5 (Source: P.A. 88-554, eff. 7-26-94; 89-673, eff. 8-14-96.)
6 (305 ILCS 5/5-5.12a)
7 Sec. 5-5.12a. Title XIX waiver; pharmacy assistance
8 program. The Illinois Department of Public Aid may seek a
9 waiver of otherwise applicable requirements of Title XIX of
10 the federal Social Security Act in order to claim federal
11 financial participation for a pharmacy assistance program for
12 persons aged 65 and over with income levels at or less than
13 250% of the federal poverty level. The Illinois Department
14 may provide by rule for all other requirements of the
15 program, including cost sharing, as permitted by an approved
16 waiver and without regard to any provision of this Code to
17 the contrary. The benefits may be no more restrictive than
18 the Pharmacy Assistance Program in effect on May 31, 2001.
19 Benefits provided under the waiver are subject to
20 appropriation.
21 The Illinois Department of Public Aid may not implement
22 the waiver until cost neutrality is demonstrated for the
23 State relative to the final Pharmacy Assistance Program
24 appropriation for the fiscal year beginning July 1, 2001.
25 Implementation of the waiver shall terminate on June 30,
26 2007.
27 (Source: P.A. 92-10, eff. 6-11-01.)
28 (305 ILCS 5/5-5.13) (from Ch. 23, par. 5-5.13)
29 Sec. 5-5.13. AIDS drugs. The Illinois Department of
30 Public Aid shall establish procedures for the expedited
31 review, for purposes of inclusion in the Illinois Public Aid
32 formulary, of any drug for the treatment of acquired
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1 immunodeficiency syndrome (AIDS) which the federal Food and
2 Drug Administration has indicated is subject to a treatment
3 investigational new drug application.
4 (Source: P.A. 88-85.)
5 (305 ILCS 5/5-5.15) (from Ch. 23, par. 5-5.15)
6 Sec. 5-5.15. Prescription pharmaceuticals; prepaid
7 capitation plans. The Illinois Department of Public Aid
8 shall not implement any additional plan or program which
9 provides for any form of prepaid capitation for prescription
10 pharmaceuticals when the percentage of public aid recipients
11 who receive prescription pharmaceuticals through prepaid
12 capitation plans exceeds 30% of the number of all public aid
13 recipients who receive prescription pharmaceuticals, unless
14 the Department receives the results of an evaluation of
15 delivery of prescription pharmaceuticals through prepaid
16 capitation plans, performed by an ad hoc committee appointed
17 by the Illinois Department. If the ad hoc committee shall
18 fail to deliver to the Illinois Department its evaluation
19 within 90 days of the Department's request to the ad hoc
20 committee for such an evaluation, the ad hoc committee shall
21 be deemed to have had no objection to the implementation of
22 such additional plan or program. The ad hoc committee shall
23 include representatives of the Illinois Department of Public
24 Aid, the Illinois State Medical Society, the Illinois
25 Hospital Association, the Illinois Pharmacists Association,
26 the Illinois Nurses Association, the Illinois Retail
27 Merchants Association, the Illinois Arthritis Foundation, the
28 Illinois Pharmaceutical Manufacturing Group, and the Council
29 of Medical Specialty Societies.
30 The Department of Public Aid shall report the results of
31 the evaluation to the House and Senate Appropriations
32 Committees of the General Assembly.
33 This Section shall apply to all programs for which the
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1 Illinois Department of Public Aid provides reimbursement for
2 prescription pharmaceuticals.
3 (Source: P.A. 83-1509.)
4 (305 ILCS 5/5-5.17) (from Ch. 23, par. 5-5.17)
5 Sec. 5-5.17. Separate reimbursement rate. The Illinois
6 Department of Public Aid may by rule establish a separate
7 reimbursement rate to be paid to long term care facilities
8 for adult developmental training services as defined in
9 Section 15.2 of the Mental Health and Developmental
10 Disabilities Administrative Act which are provided to
11 mentally retarded residents of such facilities who receive
12 aid under this Article. Any such reimbursement shall be
13 based upon cost reports submitted by the providers of such
14 services and shall be paid by the long term care facility to
15 the provider within such time as the Illinois Department of
16 Public Aid shall prescribe by rule, but in no case less than
17 3 business days after receipt of the reimbursement by such
18 facility from the Illinois Department. The Illinois
19 Department of Public Aid may impose a penalty upon a facility
20 which does not make payment to the provider of adult
21 developmental training services within the time so
22 prescribed, up to the amount of payment not made to the
23 provider.
24 (Source: P.A. 89-507, eff. 7-1-97.)
25 (305 ILCS 5/5-5.18)
26 Sec. 5-5.18. Diagnosis accompanying request for
27 reimbursement. Every request submitted by a physician for
28 reimbursement under this Article for services provided to a
29 recipient of aid under this Article shall include the
30 physician's diagnosis of the recipient's illness or other
31 condition requiring those services. The diagnosis shall be
32 either written out or expressed in a code approved by the
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1 Illinois Department of Public Aid.
2 (Source: P.A. 88-554, eff. 7-26-94.)
3 (305 ILCS 5/5-5.19)
4 Sec. 5-5.19. Reimbursement request records. The
5 Illinois Department of Public Aid shall file all requests for
6 reimbursement for medical services provided under this
7 Article according to both (i) the name of the service
8 provider and (ii) the name of the recipient of aid under this
9 Article to whom the medical services were provided.
10 (Source: P.A. 88-554, eff. 7-26-94.)
11 (305 ILCS 5/5-5.20)
12 Sec. 5-5.20. Clinic payments. For services provided by
13 federally qualified health centers as defined in Section 1905
14 (l)(2)(B) of the federal Social Security Act, on or after
15 April 1, 1989, and as long as required by federal law, the
16 Illinois Department of Public Aid shall reimburse those
17 health centers for those services according to a prospective
18 cost-reimbursement methodology.
19 (Source: P.A. 89-38, eff. 1-1-96.)
20 (305 ILCS 5/5-5.21)
21 Sec. 5-5.21. Reimbursement methodology. The Department
22 of Public Aid shall form a workgroup comprised of
23 representatives of the Department of Public Aid, the Illinois
24 Department of Public Health, and members of the long-term
25 care provider community to implement a reimbursement
26 methodology based upon the federally mandated resident
27 assessment instrument. No later than January 1, 1997, the
28 Illinois Department of Public Aid in conjunction with the
29 work group will recommend to the Governor a methodology for
30 determining payment rates for services in nursing facilities
31 based upon the federally mandated resident assessment
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1 instrument. No later than June 30, 1997, the Illinois
2 Department of Public Aid shall implement a methodology for
3 determining payment rates for services in nursing facilities
4 based upon federal requirements.
5 (Source: P.A. 89-415, eff. 1-1-96.)
6 (305 ILCS 5/5-5a) (from Ch. 23, par. 5-5a)
7 Sec. 5-5a. Waiver for home and community-based services.
8 The Department of Public Aid shall apply for a waiver from
9 the United States Health Care Financing Administration to
10 allow payment for home and community-based services under
11 this Article.
12 The Department of Public Aid, in cooperation with the
13 Department on Aging, the Department of Human Services and any
14 other relevant State, local or federal government agency, may
15 establish a nursing home pre-screening program to determine
16 whether the applicant, eligible for medical assistance under
17 this Article, may use home and community-based services as a
18 reasonable, lower-cost alternative form of care. For the
19 purpose of this Section, "home and community-based services"
20 may include, but are not limited to, those services provided
21 under subsection (f) of Section 3 of the Disabled Persons
22 Rehabilitation Act and Section 4 of the Illinois Act on the
23 Aging.
24 (Source: P.A. 89-507, eff. 7-1-97; 89-626, eff. 8-9-96.)
25 (305 ILCS 5/5-5b) (from Ch. 23, par. 5-5b)
26 Sec. 5-5b. Payment reductions.
27 (a) Notwithstanding any other Section in this Code
28 establishing a methodology for determining payment rates or
29 dispensing fees for non-institutional services provided under
30 this Code, the Illinois Department of Public Aid is
31 authorized to reduce those payment rates or dispensing fees
32 with due regard for and subject to budgetary limitations to
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1 the extent permitted by federal law.
2 (b) The Illinois Department of Public Aid may implement
3 this Section as added by this amendatory Act of 1991 through
4 the use of emergency rules in accordance with the provisions
5 of Section 5.02 of the Illinois Administrative Procedure Act.
6 For purposes of the Illinois Administrative Procedure Act,
7 the adoption of rules to implement this Section as added by
8 this amendatory Act of 1991 shall be deemed an emergency and
9 necessary for the public interest, safety and welfare.
10 (Source: P.A. 87-14.)
11 (305 ILCS 5/5-5c)
12 Sec. 5-5c. Waiver for home and community-based services
13 for traumatic brain injury (TBI) patients. The Department of
14 Public Aid shall apply for a waiver from the United States
15 Health Care Financing Administration to allow payment for
16 home and community-based services under this Article for
17 traumatic brain injury patients.
18 The Department of Public Aid shall submit a Home and
19 Community-Based Services TBI Waiver request to the United
20 States Health Care Financing Administration by January 1,
21 1998. The waiver shall be requested pursuant to Section
22 1915(c) of the Social Security Act. The Department shall
23 request a waiver of Section 1902(a)(10)(B) of the Social
24 Security Act in order to target home and community-based
25 services to individuals with a traumatic brain injury meeting
26 the Medicaid eligibility criteria set forth in appendices to
27 the Prototype Waiver request.
28 Under the waiver, the Department of Public Aid, in
29 cooperation with the Department of Human Services and any
30 other relevant State, local, or federal government agency,
31 may establish a nursing facility pre-screening program to
32 determine whether an applicant who is eligible for medical
33 assistance under this Article and has a traumatic brain
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1 injury may use home and community-based services as a
2 reasonable, lower-cost alternative form of care. If a waiver
3 request has not been submitted by January 1, 1998 the
4 Department of Public Aid shall submit the TBI Prototype
5 Waiver request to the United States Health Care Financing
6 Administration.
7 (Source: P.A. 90-335, eff. 8-8-97.)
8 (305 ILCS 5/5-6) (from Ch. 23, par. 5-6)
9 Sec. 5-6. Obligations incurred prior to death of a
10 recipient. Obligations incurred but not paid for at the time
11 of a recipient's death for services authorized under Sections
12 Section 5-5 through 5-5.0075, including medical and other
13 care in group care facilities as defined in the "Nursing Home
14 Care Act", approved August 23, 1979, as amended, or in like
15 facilities not required to be licensed under that Act, may be
16 paid, subject to the rules and regulations of the Illinois
17 Department of Public Aid, after the death of the recipient.
18 (Source: P.A. 86-820.)
19 (305 ILCS 5/5-7) (from Ch. 23, par. 5-7)
20 Sec. 5-7. Fees and charges; reimbursements to counties).
21 The Illinois Department of Public Aid shall negotiate with
22 the various dispensers of medical services the fees or rates
23 which shall govern payment for medical assistance provided
24 under this Article and in such negotiations the Illinois
25 Department shall consider but is not mandated to pay other
26 fees or rates charged in the community to persons not
27 eligible for medical assistance provided under this Article.
28 The Illinois Department of Public Aid shall pay each
29 claim for medical assistance provided under this Article
30 within 90 days after it receives the claim for such payment;
31 provided, that such claim is not contested as to form or
32 substance.
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1 If the Department of Public Aid contests the claim it
2 shall provide written notice to the dispenser of medical
3 services within 90 days after receipt of the claim, which
4 notice shall include the specific reasons for contesting the
5 claim.
6 (Source: P.A. 81-487.)
7 (305 ILCS 5/5-8) (from Ch. 23, par. 5-8)
8 Sec. 5-8. Practitioners. In supplying medical assistance,
9 the Illinois Department of Public aid may provide for the
10 legally authorized services of persons licensed under the
11 Medical Practice Act of 1987, as amended, except as hereafter
12 in this Section stated, whether under a general or limited
13 license, and of persons licensed or registered under other
14 laws of this State to provide dental, medical,
15 pharmaceutical, optometric, podiatric, or nursing services,
16 or other remedial care recognized under State law. The
17 Department may not provide for legally authorized services of
18 any physician who has been convicted of having performed an
19 abortion procedure in a wilful and wanton manner on a woman
20 who was not pregnant at the time such abortion procedure was
21 performed. The utilization of the services of persons
22 engaged in the treatment or care of the sick, which persons
23 are not required to be licensed or registered under the laws
24 of this State, is not prohibited by this Section.
25 (Source: P.A. 85-1209.)
26 (305 ILCS 5/5-9) (from Ch. 23, par. 5-9)
27 Sec. 5-9. Choice of medical dispensers. Applicants and
28 recipients shall be entitled to free choice of those
29 qualified practitioners, hospitals, nursing homes, and other
30 dispensers of medical services meeting the requirements and
31 complying with the rules and regulations of the Illinois
32 Department of Public Aid. However, the Director of Public Aid
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1 may, after providing reasonable notice and opportunity for
2 hearing, deny, suspend or terminate any otherwise qualified
3 person, firm, corporation, association, agency, institution,
4 or other legal entity, from participation as a vendor of
5 goods or services under the medical assistance program
6 authorized by this Article if the Director finds such vendor
7 of medical services in violation of this Act or the policy or
8 rules and regulations issued pursuant to this Act. Any
9 physician who has been convicted of performing an abortion
10 procedure in a wilful and wanton manner upon a woman who was
11 not pregnant at the time such abortion procedure was
12 performed shall be automatically removed from the list of
13 physicians qualified to participate as a vendor of medical
14 services under the medical assistance program authorized by
15 this Article.
16 (Source: P.A. 82-263.)
17 (305 ILCS 5/5-11) (was 305 ILCS 5/5-11, subsec. (a), in
18 part)
19 Sec. 5-11. Co-operative arrangements; contracts with
20 other State agencies, health care and rehabilitation
21 organizations, and fiscal intermediaries.
22 (a) The Illinois Department of Public Aid may enter into
23 co-operative arrangements with State agencies responsible for
24 administering or supervising the administration of health
25 services and vocational rehabilitation services to the end
26 that there may be maximum utilization of such services in the
27 provision of medical assistance.
28 (b) The Illinois Department of Public Aid shall, not
29 later than June 30, 1993, enter into one or more co-operative
30 arrangements with the Department of Mental Health and
31 Developmental Disabilities providing that the Department of
32 Mental Health and Developmental Disabilities will be
33 responsible for administering or supervising all programs for
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1 services to persons in community care facilities for persons
2 with developmental disabilities, including but not limited to
3 intermediate care facilities, that are supported by State
4 funds or by funding under Title XIX of the federal Social
5 Security Act. The responsibilities of the Department of
6 Mental Health and Developmental Disabilities under these
7 agreements are transferred to the Department of Human
8 Services as provided in the Department of Human Services Act.
9 (Source: P.A. 92-370, eff. 8-15-01.)
10 (305 ILCS 5/5-11.05 new) (was 305 ILCS 5/5-11, subsec.
11 (a), in part)
12 Sec. 5-11.05. Contracts with health and rehabilitation
13 agencies and organizations. The Department of Public Aid may
14 also contract with such State health and rehabilitation
15 agencies described in Section 5-11 and with other public or
16 private health care and rehabilitation organizations to act
17 for it in supplying designated medical services to persons
18 eligible therefor under this Article. Any contracts with
19 health services or health maintenance organizations shall be
20 restricted to organizations which have been certified as
21 being in compliance with standards promulgated pursuant to
22 the laws of this State governing the establishment and
23 operation of health services or health maintenance
24 organizations.
25 (Source: P.A. 92-370, eff. 8-15-01.)
26 (305 ILCS 5/5-11.010 new) (was 305 ILCS 5/5-11, subsec.
27 (a), in part)
28 Sec. 5-11.010. Contracts with insurance companies. The
29 Department of Public Aid may also contract with insurance
30 companies or other corporate entities serving as fiscal
31 intermediaries in this State for the Federal Government in
32 respect to Medicare payments under Title XVIII of the Federal
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1 Social Security Act to act for the Department in paying
2 medical care suppliers.
3 (Source: P.A. 92-370, eff. 8-15-01.)
4 (305 ILCS 5/5-11.015 new) (was 305 ILCS 5/5-11, subsec.
5 (a), in part)
6 Sec. 5-11.015. Advance payments. The provisions of
7 Section 9 of "An Act in relation to State finance", approved
8 June 10, 1919, as amended, notwithstanding, such contracts
9 with State agencies, other health care and rehabilitation
10 organizations, or fiscal intermediaries under Section 5-11,
11 5-11.05, or 5-11.010 may provide for advance payments.
12 (Source: P.A. 92-370, eff. 8-15-01.)
13 (305 ILCS 5/5-11.020 new) (was 305 ILCS 5/5-11, subsec.
14 (b), in part)
15 Sec. 5-11.020. Managed care community network;
16 definition. (b) For purposes of this Section and Sections
17 5-11.025 through 5-11.055 subsection (b), "managed care
18 community network" means an entity, other than a health
19 maintenance organization, that is owned, operated, or
20 governed by providers of health care services within this
21 State and that provides or arranges primary, secondary, and
22 tertiary managed health care services under contract with the
23 Illinois Department of Public Aid exclusively to persons
24 participating in programs administered by the Illinois
25 Department.
26 (Source: P.A. 92-370, eff. 8-15-01.)
27 (305 ILCS 5/5-11.025 new) (was 305 ILCS 5/5-11, subsec.
28 (b), in part)
29 Sec. 5-11.025. Contracts with managed care community
30 networks.
31 (a) The Illinois Department of Public Aid may certify
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1 managed care community networks, including managed care
2 community networks owned, operated, managed, or governed by
3 State-funded medical schools, as risk-bearing entities
4 eligible to contract with the Illinois Department as Medicaid
5 managed care organizations. The Illinois Department may
6 contract with those managed care community networks to
7 furnish health care services to or arrange those services for
8 individuals participating in programs administered by the
9 Illinois Department.
10 (b) The rates for those provider-sponsored organizations
11 may be determined on a prepaid, capitated basis.
12 (c) A managed care community network may choose to
13 contract with the Illinois Department of Public Aid to
14 provide only pediatric health care services.
15 (d) The Illinois Department of Public Aid shall by rule
16 adopt the criteria, standards, and procedures by which a
17 managed care community network may be permitted to contract
18 with the Illinois Department and shall consult with the
19 Department of Insurance in adopting these rules.
20 (Source: P.A. 92-370, eff. 8-15-01.)
21 (305 ILCS 5/5-11.030 new) (was 305 ILCS 5/5-11, subsec.
22 (b), in part)
23 Sec. 5-11.030. Contracts with county providers. A county
24 provider as defined in Section 15-1 of this Code may contract
25 with the Illinois Department of Public Aid to provide
26 primary, secondary, or tertiary managed health care services
27 as a managed care community network without the need to
28 establish a separate entity and shall be deemed a managed
29 care community network for purposes of this Code only to the
30 extent it provides services to participating individuals. A
31 county provider is entitled to contract with the Illinois
32 Department with respect to any contracting region located in
33 whole or in part within the county. A county provider is not
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1 required to accept enrollees who do not reside within the
2 county.
3 (Source: P.A. 92-370, eff. 8-15-01.)
4 (305 ILCS 5/5-11.035 new) (was 305 ILCS 5/5-11, subsec.
5 (b), in part)
6 Sec. 5-11.035. State-funded medical schools;
7 demonstration program. In order to (i) accelerate and
8 facilitate the development of integrated health care in
9 contracting areas outside counties with populations in excess
10 of 3,000,000 and counties adjacent to those counties and (ii)
11 maintain and sustain the high quality of education and
12 residency programs coordinated and associated with local area
13 hospitals, the Illinois Department of Public Aid may develop
14 and implement a demonstration program from managed care
15 community networks owned, operated, managed, or governed by
16 State-funded medical schools. The Illinois Department shall
17 prescribe by rule the criteria, standards, and procedures for
18 effecting this demonstration program.
19 (Source: P.A. 92-370, eff. 8-15-01.)
20 (305 ILCS 5/5-11.040 new) (was 305 ILCS 5/5-11, subsec.
21 (b), in part)
22 Sec. 5-11.040. Duties of managed care community network.
23 A managed care community network that contracts with the
24 Illinois Department of Public Aid to furnish health care
25 services to or arrange those services for enrollees
26 participating in programs administered by the Illinois
27 Department shall do all of the following:
28 (1) Provide that any provider affiliated with the
29 managed care community network may also provide services
30 on a fee-for-service basis to Illinois Department of
31 Public Aid clients not enrolled in such managed care
32 entities.
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1 (2) Provide client education services as determined
2 and approved by the Illinois Department of Public Aid,
3 including but not limited to (i) education regarding
4 appropriate utilization of health care services in a
5 managed care system, (ii) written disclosure of treatment
6 policies and restrictions or limitations on health
7 services, including, but not limited to, physical
8 services, clinical laboratory tests, hospital and
9 surgical procedures, prescription drugs and biologics,
10 and radiological examinations, and (iii) written notice
11 that the enrollee may receive from another provider those
12 covered services that are not provided by the managed
13 care community network.
14 (3) Provide that enrollees within the system may
15 choose the site for provision of services and the panel
16 of health care providers.
17 (4) Not discriminate in enrollment or disenrollment
18 practices among recipients of medical services or
19 enrollees based on health status.
20 (5) Provide a quality assurance and utilization
21 review program that meets the requirements established by
22 the Illinois Department of Public Aid in rules that
23 incorporate those standards set forth in the Health
24 Maintenance Organization Act.
25 (6) Issue a managed care community network
26 identification card to each enrollee upon enrollment.
27 The card must contain all of the following:
28 (A) The enrollee's health plan.
29 (B) The name and telephone number of the
30 enrollee's primary care physician or the site for
31 receiving primary care services.
32 (C) A telephone number to be used to confirm
33 eligibility for benefits and authorization for
34 services that is available 24 hours per day, 7 days
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1 per week.
2 (7) Ensure that every primary care physician and
3 pharmacy in the managed care community network meets the
4 standards established by the Illinois Department of
5 Public Aid for accessibility and quality of care. The
6 Illinois Department of Public Aid shall arrange for and
7 oversee an evaluation of the standards established under
8 this paragraph (7) and may recommend any necessary
9 changes to these standards.
10 (8) Provide a procedure for handling complaints
11 that meets the requirements established by the Illinois
12 Department of Public Aid in rules that incorporate those
13 standards set forth in the Health Maintenance
14 Organization Act.
15 (9) Maintain, retain, and make available to the
16 Illinois Department of Public Aid records, data, and
17 information, in a uniform manner determined by the
18 Illinois Department, sufficient for the Illinois
19 Department to monitor utilization, accessibility, and
20 quality of care.
21 (10) Provide that the pharmacy formulary used by
22 the managed care community network and its contract
23 providers be no more restrictive than the Department of
24 Public Aid's Illinois Department's pharmaceutical program
25 on the effective date of this amendatory Act of 1998 and
26 as amended after that date.
27 (Source: P.A. 92-370, eff. 8-15-01.)
28 (305 ILCS 5/5-11.045 new) (was 305 ILCS 5/5-11, subsec.
29 (b), in part)
30 Sec. 5-11.045. Quality assurance review.
31 (a) The Illinois Department of Public Aid shall contract
32 with an entity or entities to provide external peer-based
33 quality assurance review for the managed health care programs
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1 administered by the Illinois Department. The entity shall be
2 representative of Illinois physicians licensed to practice
3 medicine in all its branches and have statewide geographic
4 representation in all specialities of medical care that are
5 provided in managed health care programs administered by the
6 Illinois Department. The entity may not be a third party
7 payer and shall maintain offices in locations around the
8 State in order to provide service and continuing medical
9 education to physician participants within those managed
10 health care programs administered by the Illinois Department.
11 (b) The review process shall be developed and conducted
12 by Illinois physicians licensed to practice medicine in all
13 its branches.
14 (c) In consultation with the entity, the Illinois
15 Department of Public Aid may contract with other entities for
16 professional peer-based quality assurance review of
17 individual categories of services other than services
18 provided, supervised, or coordinated by physicians licensed
19 to practice medicine in all its branches.
20 (d) The Illinois Department of Public Aid shall
21 establish, by rule, criteria to avoid conflicts of interest
22 in the conduct of quality assurance activities consistent
23 with professional peer-review standards.
24 (e) All quality assurance activities shall be
25 coordinated by the Illinois Department of Public Aid.
26 (Source: P.A. 92-370, eff. 8-15-01.)
27 (305 ILCS 5/5-11.050 new) (was 305 ILCS 5/5-11, subsec.
28 (b), in part)
29 Sec. 5-11.050. Ability to bear financial risk. Each
30 managed care community network must demonstrate its ability
31 to bear the financial risk of serving individuals under this
32 program. The Illinois Department of Public Aid shall by rule
33 adopt standards for assessing the solvency and financial
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1 soundness of each managed care community network. Any
2 solvency and financial standards adopted for managed care
3 community networks shall be no more restrictive than the
4 solvency and financial standards adopted under Section
5 1856(a) of the Social Security Act for provider-sponsored
6 organizations under Part C of Title XVIII of the Social
7 Security Act.
8 (Source: P.A. 92-370, eff. 8-15-01.)
9 (305 ILCS 5/5-11.055 new) (was 305 ILCS 5/5-11, subsec.
10 (b), in part)
11 Sec. 5-11.055. Emergency rulemaking. The Illinois
12 Department of Public Aid may implement the amendatory changes
13 to this Code made by this amendatory Act of 1998 through the
14 use of emergency rules in accordance with Section 5-45 of the
15 Illinois Administrative Procedure Act. For purposes of that
16 Act, the adoption of rules to implement these changes is
17 deemed an emergency and necessary for the public interest,
18 safety, and welfare.
19 (Source: P.A. 92-370, eff. 8-15-01.)
20 (305 ILCS 5/5-11.060 new) (was 305 ILCS 5/5-11, subsec.
21 (c))
22 Sec. 5-11.060. Survey for nursing facilities; Department
23 of Public Health.
24 (a) (c) Not later than June 30, 1996, the Illinois
25 Department of Public Aid shall enter into one or more
26 cooperative arrangements with the Department of Public Health
27 for the purpose of developing a single survey for nursing
28 facilities, including but not limited to facilities funded
29 under Title XVIII or Title XIX of the federal Social Security
30 Act or both, which shall be administered and conducted solely
31 by the Department of Public Health. The Departments shall
32 test the single survey process on a pilot basis, with both
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1 the Departments of Public Aid and Public Health represented
2 on the consolidated survey team. The pilot will sunset June
3 30, 1997. After June 30, 1997, unless otherwise determined
4 by the Governor, a single survey shall be implemented by the
5 Department of Public Health which would not preclude staff
6 from the Department of Public Aid from going on-site to
7 nursing facilities to perform necessary audits and reviews
8 which shall not replicate the single State agency survey
9 required by this Act.
10 (b) Sections 5-11 through 5-11.065 This Section shall
11 not apply to community or intermediate care facilities for
12 persons with developmental disabilities.
13 (Source: P.A. 92-370, eff. 8-15-01.)
14 (305 ILCS 5/5-11.065 new) (was 305 ILCS 5/5-11, subsec.
15 (d))
16 Sec. 5-11.065. Negotiated contract with managed care
17 community network or HMO. (d) Nothing in this Code in any way
18 limits or otherwise impairs the authority or power of the
19 Illinois Department to enter into a negotiated contract
20 pursuant to this Section with a managed care community
21 network or a health maintenance organization, as defined in
22 the Health Maintenance Organization Act, that provides for
23 termination or nonrenewal of the contract without cause, upon
24 notice as provided in the contract, and without a hearing.
25 (Source: P.A. 92-370, eff. 8-15-01.)
26 (305 ILCS 5/5-11.1)
27 Sec. 5-11.1. Cooperative arrangements; contracts. The
28 Illinois Department of Public Aid may enter into cooperative
29 arrangements with State agencies responsible for
30 administering or supervising the administration of health
31 services and vocational rehabilitation services to maximize
32 utilization of these services in the provision of medical
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1 assistance.
2 The Illinois Department of Public Aid shall, not later
3 than June 30, 1994, enter into one or more cooperative
4 arrangements with the Department of Mental Health and
5 Developmental Disabilities providing that the Department of
6 Mental Health and Developmental Disabilities will be
7 responsible for administering or supervising all programs for
8 services to persons in community care facilities for persons
9 with mental illness, including but not limited to
10 intermediate care facilities, that are supported by State
11 funds or by funding under Title XIX of the federal Social
12 Security Act. The responsibilities of the Department of
13 Mental Health and Developmental Disabilities under these
14 agreements are transferred to the Department of Human
15 Services as provided in the Department of Human Services Act.
16 The Department of Public Aid may also contract with State
17 health and rehabilitation agencies and other public or
18 private health care and rehabilitation organizations to act
19 for it in supplying designated medical services to persons
20 eligible under this Section. Any contracts with health
21 services or health maintenance organizations shall be
22 restricted to organizations which have been certified as
23 being in compliance with standards promulgated under the laws
24 of this State governing the establishment and operation of
25 health services or health maintenance organizations. The
26 Department of Public Aid may also contract with insurance
27 companies or other corporate entities serving as fiscal
28 intermediaries in this State for the federal government in
29 respect to Medicare payments under Title XVIII of the federal
30 Social Security Act to act for the Department in paying
31 medical care suppliers. Nothing in this Section shall be
32 construed to abrogate any existing doctor/patient
33 relationships with Illinois Department of Public Aid
34 recipients or the free choice of clients or their guardians
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1 to select a physician to provide medical care. The
2 provisions of Section 9 of the State Finance Act
3 notwithstanding, such contracts with State agencies, other
4 health care and rehabilitation organizations, or fiscal
5 intermediaries may provide for advance payments.
6 (Source: P.A. 91-357, eff. 7-29-99.)
7 (305 ILCS 5/5-12) (from Ch. 23, par. 5-12)
8 Sec. 5-12. Funeral and burial. Upon the death of a
9 recipient who qualified under class 2, 3 or 4 of Section
10 5-2.010, 5-2.015, or 5-2.020 5-2, if his estate is
11 insufficient to pay his funeral and burial expenses and if no
12 other resources, including assistance from legally
13 responsible relatives, are available for such purposes, there
14 shall be paid, in accordance with the standards, rules and
15 regulations of the Illinois Department of Human Services,
16 such reasonable amounts as may be necessary to meet costs of
17 the funeral, burial space, and cemetery charges, or to
18 reimburse any person not financially responsible for the
19 deceased who have voluntarily made expenditures for such
20 costs.
21 (Source: P.A. 89-507, eff. 7-1-97; 90-372, eff. 7-1-98.)
22 (305 ILCS 5/5-13) (from Ch. 23, par. 5-13)
23 Sec. 5-13. Claim against estate of recipients. To the
24 extent permitted under the federal Social Security Act, the
25 amount expended under this Article (1) for a person of any
26 age who is an inpatient in a nursing facility, an
27 intermediate care facility for the mentally retarded, or
28 other medical institution, or (2) for a person aged 55 or
29 more, shall be a claim against the person's estate or a claim
30 against the estate of the person's spouse, regardless of the
31 order of death, but no recovery may be had thereon until
32 after the death of the surviving spouse, if any, and then
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1 only at such time when there is no surviving child who is
2 under age 21, or blind, or permanently and totally disabled.
3 This Section, however, shall not bar recovery at the death of
4 the person of amounts of medical assistance paid to or in his
5 behalf to which he was not entitled; provided that such
6 recovery shall not be enforced against any real estate while
7 it is occupied as a homestead by the surviving spouse or
8 other dependent, if no claims by other creditors have been
9 filed against the estate, or if such claims have been filed,
10 they remain dormant for failure of prosecution or failure of
11 the claimant to compel administration of the estate for the
12 purpose of payment. The term "estate", as used in this
13 Section, with respect to a deceased person, means all real
14 and personal property and other assets included within the
15 person's estate, as that term is used in the Probate Act of
16 1975; however, in the case of a deceased person who has
17 received (or is entitled to receive) benefits under a
18 long-term care insurance policy in connection with which
19 assets or resources are disregarded to the extent that
20 payments are made or because the deceased person received (or
21 was entitled to receive) benefits under a long-term care
22 insurance policy, "estate" also includes any other real and
23 personal property and other assets in which the deceased
24 person had any legal title or interest at the time of his or
25 her death (to the extent of that interest), including assets
26 conveyed to a survivor, heir, or assignee of the deceased
27 person through joint tenancy, tenancy in common,
28 survivorship, life estate, living trust, or other
29 arrangement. The term "homestead", as used in this Section,
30 means the dwelling house and contiguous real estate occupied
31 by a surviving spouse or relative, as defined by the rules
32 and regulations of the Illinois Department of Public Aid,
33 regardless of the value of the property.
34 A claim arising under this Section against assets
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1 conveyed to a survivor, heir, or assignee of the deceased
2 person through joint tenancy, tenancy in common,
3 survivorship, life estate, living trust, or other arrangement
4 is not effective until the claim is recorded or filed in the
5 manner provided for a notice of lien in Section 3-10.2. The
6 claim is subject to the same requirements and conditions to
7 which liens on real property interests are subject under
8 Sections 3-10.1 through 3-10.10. A claim arising under this
9 Section attaches to interests owned or subsequently acquired
10 by the estate of a recipient or the estate of a recipient's
11 surviving spouse. The transfer or conveyance of any real or
12 personal property of the estate as defined in this Section
13 shall be subject to the fraudulent transfer conditions that
14 apply to real property in Section 3-11 of this Code.
15 The provisions of this Section shall not affect the
16 validity of claims against estates for medical assistance
17 provided prior to January 1, 1966 to aged, blind, or disabled
18 persons receiving aid under Articles V, VII and VII-A of the
19 1949 Code.
20 (Source: P.A. 88-85; 88-554, eff. 7-26-94; 89-21, eff.
21 7-1-95; 89-437, eff. 12-15-95; 89-686, eff. 12-31-96.)
22 (305 ILCS 5/5-13.2)
23 Sec. 5-13.2. Notice of claim for payment or against
24 estate. If the Illinois Department of Public Aid determines,
25 more than 120 days after a person becomes an
26 institutionalized person, that (i) the institutionalized
27 person, the institutionalized person's spouse, or any other
28 person is required under this Code to reimburse the Illinois
29 Department for any part of the amount of medical assistance
30 provided under this Article to or on behalf of the
31 institutionalized person or (ii) the institutionalized
32 person's estate is liable for any amount of medical
33 assistance provided to or on behalf of the institutionalized
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1 person, the Illinois Department shall not make any claim for
2 payment of that amount on demand, but rather shall establish,
3 in cooperation with the institutionalized person (and that
4 person's spouse or primary caretaker, if applicable), a
5 schedule for payment of the amount owed to the Illinois
6 Department.
7 (Source: P.A. 88-162; 88-670, eff. 12-2-94.)
8 (305 ILCS 5/5-14) (from Ch. 23, par. 5-14)
9 Sec. 5-14. Exemption for townships. Nothing in this
10 Article shall be construed as requiring townships to provide,
11 in whole or in part, medical assistance to persons who are
12 not residents of the State of Illinois.
13 In all instances under this Article where medical aid or
14 assistance to a person who is not a resident of this State
15 would otherwise be in whole or in part, the responsibility of
16 a township, the Illinois Department of Public Aid shall be
17 responsible for such aid or assistance.
18 The Illinois Department of Public Aid shall, by rule or
19 regulation, insure that provision of such aid or assistance
20 to a non-resident is identical to the uniform standard of
21 eligibility established by the Illinois Department.
22 (Source: P.A. 81-519.)
23 (305 ILCS 5/5-15) (from Ch. 23, par. 5-15)
24 Sec. 5-15. Contracts with community based organizations.
25 (a) The Illinois Department of Public Aid is authorized
26 to contract with community based organizations serving low
27 income communities for a three year period to demonstrate how
28 and the extent to which preventive health programs can
29 decrease utilization of medical care services and/or improve
30 health status.
31 (b) As used in this Section (1) a community based
32 organization is an organization established as a
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1 not-for-profit corporation under laws of the State of
2 Illinois which serves a defined geographic community and is
3 governed by members of that community; and (2) a preventive
4 health program is any program, service or intervention the
5 purpose of which is to identify, resolve, or ameliorate
6 problems which contribute to the utilization of medical
7 services.
8 (c) The Illinois Department of Public Aid is authorized,
9 for evaluation purposes, to release names of recipients and
10 other pertinent identification and medical utilization
11 information to the community organizations under contract.
12 (d) Contractors shall maintain strict confidentiality of
13 information released by the Illinois Department of Public Aid
14 by following guidelines established by the Illinois
15 Department, which shall require that recipients sign a
16 release for any further use or disclosure of such
17 information.
18 (e) The Illinois Department of Public Aid shall report
19 to the Citizens Assembly/Council on Public Aid annually on
20 the costs and benefits of preventive health care projects.
21 (Source: P.A. 86-651.)
22 (305 ILCS 5/5-15.5)
23 Sec. 5-15.5. Preventive physical examinations;
24 demonstration program.
25 (a) The Illinois Department of Public Aid may establish
26 and implement a demonstration program of preventive physical
27 examinations over a 3-year period commencing on January 1,
28 1994, for persons receiving assistance under Article IV of
29 this Code and persons eligible for assistance under this
30 Article who are otherwise eligible for assistance under
31 Article IV but who fail to qualify for cash assistance under
32 Article IV on the basis of need. Notwithstanding any other
33 provision of this Section, however, persons who are pregnant
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1 or who are less than 21 years of age shall not be eligible to
2 participate in the demonstration program. The demonstration
3 program may be implemented for recipients in at least 2
4 counties, one with a population of not more than 650,000 as
5 determined by the 1990 federal census, and one with a
6 population of not more than 100,000 as determined by the 1990
7 federal census. The Illinois Department of Public Aid may
8 establish by rule the nature and scope of the preventive
9 physical examinations required under this Section, except
10 that the services may include, as appropriate, blood pressure
11 reading, complete blood test appropriate to the population
12 and risk factors, family planning, nutrition counselling,
13 smoking evaluation, temperature, urinalysis, chest x-ray,
14 tuberculosis screening, and appropriate referrals.
15 (b) Participation in the demonstration program shall be
16 voluntary, and eligible recipients shall not be subject to
17 sanctions for refusing or failing to submit to a preventive
18 physical examination or any portion of such an examination.
19 The Illinois Department of Public Aid may by rule limit each
20 eligible recipient to one examination during the
21 demonstration period.
22 (c) For the purpose of carrying out its responsibilities
23 under this Section, the Illinois Department of Public Aid is
24 authorized to enter into cooperative arrangements with
25 for-profit and non-profit medical clinics and hospitals,
26 local health departments, and other providers of medical
27 services. The Illinois Department of Public Health shall
28 cooperate in the development and establishment of this
29 demonstration program. During the period of the demonstration
30 program, the Illinois Department of Public Aid shall study
31 the cost benefit of providing preventive physical
32 examinations to the targeted group of recipients of public
33 aid.
34 (d) Implementation of the demonstration program shall be
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1 contingent on the receipt of all necessary federal waivers.
2 (Source: P.A. 88-396.)
3 (305 ILCS 5/5-16) (from Ch. 23, par. 5-16)
4 Sec. 5-16. Managed care. The Illinois Department of
5 Public Aid may develop and implement a Primary Care Sponsor
6 System consistent with the provisions of this Section. The
7 purpose of this managed care delivery system shall be to
8 contain the costs of providing medical care to Medicaid
9 recipients by having one provider responsible for managing
10 all aspects of a recipient's medical care. This managed care
11 system shall have the following characteristics:
12 (a) The Department of Public Aid, by rule, shall
13 establish criteria to determine which clients must
14 participate in this program.;
15 (b) Providers participating in the program may be
16 paid an amount per patient per month, to be set by the
17 Illinois Department of Public Aid, for managing each
18 recipient's medical care.;
19 (c) Providers eligible to participate in the
20 program shall be physicians licensed to practice medicine
21 in all its branches, and the Illinois Department of
22 Public Aid may terminate a provider's participation if
23 the provider is determined to have failed to comply with
24 any applicable program standard or procedure established
25 by the Illinois Department.;
26 (d) Each recipient required to participate in the
27 program must select from a panel of primary care
28 providers or networks established by the Department of
29 Public Aid in their communities.;
30 (e) A recipient may change his designated primary
31 care provider:
32 (1) when the designated source becomes
33 unavailable, as the Illinois Department of Public
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1 Aid shall determine by rule; or
2 (2) when the designated primary care provider
3 notifies the Illinois Department of Public Aid that
4 it wishes to withdraw from any obligation as primary
5 care provider; or
6 (3) in other situations, as the Illinois
7 Department of Public Aid shall provide by rule.;
8 (f) The Illinois Department of Public Aid shall, by
9 rule, establish procedures for providing medical services
10 when the designated source becomes unavailable or wishes
11 to withdraw from any obligation as primary care provider
12 taking into consideration the need for emergency or
13 temporary medical assistance and ensuring that the
14 recipient has continuous and unrestricted access to
15 medical care from the date on which such unavailability
16 or withdrawal becomes effective until such time as the
17 recipient designates a primary care source.;
18 (g) Only medical care services authorized by a
19 recipient's designated provider, except for emergency
20 services, services performed by a provider that is owned
21 or operated by a county and that provides non-emergency
22 services without regard to ability to pay and such other
23 services as provided by the Illinois Department of Public
24 Aid, shall be subject to payment by the Illinois
25 Department of Public Aid. The Illinois Department of
26 Public Aid shall enter into an intergovernmental
27 agreement with each county that owns or operates such a
28 provider to develop and implement policies to minimize
29 the provision of medical care services provided by county
30 owned or operated providers pursuant to the foregoing
31 exception.
32 The Illinois Department of Public Aid shall seek and
33 obtain necessary authorization provided under federal law to
34 implement such a program including the waiver of any federal
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1 regulations.
2 The Illinois Department of Public Aid may implement the
3 amendatory changes to this Section made by this amendatory
4 Act of 1991 through the use of emergency rules in accordance
5 with the provisions of Section 5.02 of the Illinois
6 Administrative Procedure Act. For purposes of the Illinois
7 Administrative Procedure Act, the adoption of rules to
8 implement the amendatory changes to this Section made by this
9 amendatory Act of 1991 shall be deemed an emergency and
10 necessary for the public interest, safety and welfare.
11 The Illinois Department of Public Aid may establish a
12 managed care system demonstration program, on a limited
13 basis, as described in this Section. The demonstration
14 program shall terminate on June 30, 1997. Within 30 days
15 after the end of each year of the demonstration program's
16 operation, the Illinois Department shall report to the
17 Governor and the General Assembly concerning the operation of
18 the demonstration program.
19 (Source: P.A. 87-14; 88-490.)
20 (305 ILCS 5/5-16.1) (from Ch. 23, par. 5-16.1)
21 Sec. 5-16.1. Case management services. The Illinois
22 Department of Public Aid may develop, implement and evaluate
23 a Case Management Services Program which provides services
24 consistent with the provisions of this Section, and the
25 Inter-Agency Agreement between the Department of Public Aid
26 and the Department of Public Health, for a targeted
27 population on a less than Statewide basis in the State of
28 Illinois. The purpose of this Case Management Services
29 Program shall be to assist eligible participants in gaining
30 access to needed medical, social, educational and other
31 services thereby reducing the likelihood of long-term welfare
32 dependency. The Case Management Services Program shall have
33 the following characteristics:
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1 (a) It shall be conducted for a period of no less
2 than 5 consecutive fiscal years in one urban area
3 containing a high proportion, as determined by Department
4 of Public Aid and Department of Public Health records, of
5 Medicaid eligible pregnant or parenting girls under 17
6 years of age at the time of the initial assessment and in
7 one rural area containing a high proportion, as
8 determined by Department of Public Aid and Department of
9 Public Health records, of Medicaid eligible pregnant or
10 parenting girls under 17 years of age at the time of the
11 initial assessment.
12 (b) Providers participating in the program shall be
13 paid an amount per patient per month, to be set by the
14 Illinois Department of Public Aid, for the case
15 management services provided.
16 (c) Providers eligible to participate in the
17 program shall be nurses or social workers, licensed to
18 practice in Illinois, who comply with the rules and
19 regulations established by the Illinois Department of
20 Public Aid and the Inter-Agency Agreement between the
21 Department of Public Aid and the Department of Public
22 Health. The Illinois Department of Public Aid may
23 terminate a provider's participation in the program if
24 the provider is determined to have failed to comply with
25 any applicable program standard or procedure established
26 by the Illinois Department.
27 (d) Each eligible participant in an area where the
28 Case Management Services Program is being conducted may
29 voluntarily designate a case manager, of her own choosing
30 to assume responsibility for her care.
31 (e) A participant may change her designated case
32 manager provided that she informs the Illinois Department
33 of Public Aid by the 20th day of the month in order for
34 the change to be effective in the following month.
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1 (f) The Illinois Department of Public Aid shall, by
2 rule, establish procedures for providing case management
3 services when the designated source becomes unavailable
4 or wishes to withdraw from any obligation as case
5 management services provider.
6 (g) In accordance with rules adopted by the
7 Illinois Department of Public Aid, a participant may
8 discontinue participation in the program upon timely
9 notice to the Illinois Department of Public Aid, in which
10 case the participant shall remain eligible for assistance
11 under all applicable provisions of Article V of this
12 Code.
13 The Illinois Department of Public Aid shall take any
14 necessary steps to obtain authorization or waiver under
15 federal law to implement a Case Management Services Program.
16 Participation shall be voluntary for the provider and the
17 recipient.
18 (Source: P.A. 87-685.)
19 (305 ILCS 5/5-16.2)
20 Sec. 5-16.2. Long range plan for case management. The
21 Illinois Department of Public Aid shall develop a long range
22 plan for the implementation of case management services, as
23 defined in Section 5-16.1 of this Act, throughout Illinois.
24 The long range plan shall include: (i) a geographic overview
25 of the State and the proportion, as determined by the
26 Department of Public Aid and the Department of Public Health
27 records, of Medicaid eligible pregnant or parenting girls
28 under 17 years of age at the time of the initial assessment;
29 (ii) identification of high proportion areas; (iii) goals for
30 reducing the likelihood of long-term welfare dependency; (iv)
31 the time frames for accomplishing the identified goals; and
32 (v) specific recommendations for administrative or
33 legislative policies and programs necessary to complete the
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1 identified goals. The long range plan shall take into
2 consideration other resources currently serving the
3 identified population. The long range plan shall be
4 completed no later than July 1, 1994, and provided to the
5 Governor and the General Assembly in the form of a written
6 report.
7 (Source: P.A. 88-70.)
8 (305 ILCS 5/5-16.4)
9 Sec. 5-16.4. Medical Assistance Provider Payment Fund.
10 (a) There is created in the State treasury the Medical
11 Assistance Provider Payment Fund. Interest earned by the
12 Fund shall be credited to the Fund.
13 (b) The Fund is created for the purpose of disbursing
14 moneys as follows:
15 (1) For medical services provided to recipients of
16 aid under Articles V, VI, and XII.
17 (2) For payment of administrative expenses incurred
18 by the Illinois Department of Public Aid or its agent in
19 performing the activities authorized by this Section.
20 (3) For making transfers to the General Obligation
21 Bond Retirement and Interest Fund, as those transfers are
22 authorized in the proceedings authorizing debt under the
23 Medicaid Liability Liquidity Borrowing Act, but transfers
24 made under this paragraph (3) may not exceed the
25 principal amount of debt issued under that Act.
26 Disbursements from the Fund, other than transfers to the
27 General Obligation Bond Retirement and Interest Fund (which
28 shall be made in accordance with the provisions of the
29 Medicaid Liability Liquidity Borrowing Act), shall be by
30 warrants drawn by the State Comptroller upon receipt of
31 vouchers duly executed and certified by the Illinois
32 Department of Public Aid.
33 (c) The Fund shall consist of the following:
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1 (1) All federal matching funds received by the
2 Illinois Department of Public Aid as a result of
3 expenditures made by the Illinois Department of Public
4 Aid that are attributable to moneys deposited into the
5 Fund.
6 (2) Proceeds from any short-term borrowing directed
7 to the Fund by the Governor pursuant to the Medicaid
8 Liability Liquidity Borrowing Act.
9 (3) Amounts transferred into the Fund under
10 subsection (d) of this Section.
11 (4) All other moneys received for the Fund from any
12 other source, including interest earned on those moneys.
13 (d) Beginning July 1, 1995, on the 13th and 26th days of
14 each month the State Comptroller and Treasurer shall transfer
15 from the General Revenue Fund to the Medical Assistance
16 Provider Payment Fund an amount equal to 1/48th of the annual
17 Medical Assistance appropriation to the Illinois Department
18 of Public Aid from the Medical Assistance Provider Payment
19 Fund, plus cumulative deficiencies from those prior
20 transfers. In addition to those transfers, the State
21 Comptroller and Treasurer may transfer from the General
22 Revenue Fund to the Medical Assistance Provider Payment Fund
23 as much as is necessary to pay claims pursuant to the new
24 twice-monthly payment schedule established in Section 5-16.5
25 and to avoid interest liabilities under the State Prompt
26 Payment Act. No transfers made pursuant to this subsection
27 shall interfere with the timely payment of the general State
28 aid payment made pursuant to Section 18-11 of the School
29 Code.
30 (Source: P.A. 88-554, eff. 7-26-94.)
31 (305 ILCS 5/5-16.5)
32 Sec. 5-16.5. Expedited payments.
33 (a) (Blank).
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1 (b) In a county with a population of 3,000,000 or more,
2 a managed care community network shall receive expedited
3 payment of its capitated reimbursement for each of its
4 managed care enrollees if both of the following criteria are
5 met:
6 (1) At least 75% of its membership is composed of
7 hospitals that are qualified on or after July 1, 1994 as
8 disproportionate share hospitals.
9 (2) At least 75% of its managed care enrollees
10 receive services at the disproportionate share hospitals
11 or those hospitals' affiliated sites.
12 (c) For counties whose population is less than
13 3,000,000, the Illinois Department of Public Aid shall
14 establish by rule the terms and conditions under which a
15 managed care community network shall receive expedited
16 payment, including a determination of the qualifying
17 percentage criteria for disproportionate share hospitals and
18 managed care enrollees within a network receiving services at
19 disproportionate share hospitals or their affiliated sites.
20 (Source: P.A. 88-554, eff. 7-26-94; 89-21, eff. 7-1-95.)
21 (305 ILCS 5/5-16.6)
22 Sec. 5-16.6. Provider compliance with certain
23 requirements. The Illinois Department of Public Aid shall
24 inquire of appropriate State agencies concerning the status
25 of all providers' compliance with State income tax
26 requirements, child support payments in accordance with
27 Article X of this Code, and educational loans guaranteed by
28 the Illinois State Scholarship Commission. The Illinois
29 Department of Public Aid may suspend from participation in
30 the medical assistance program, after reasonable notice and
31 opportunity for a hearing in accordance with Sections Section
32 12-4.25 through 12-4.25.35 of this Code, those providers not
33 in compliance with these requirements, unless payment
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1 arrangements acceptable to the appropriate State agency are
2 made.
3 (Source: P.A. 90-655, eff. 7-30-98.)
4 (305 ILCS 5/5-16.9)
5 Sec. 5-16.9. Woman's health care provider. The medical
6 assistance program is subject to the provisions of Section
7 356r of the Illinois Insurance Code. The Illinois Department
8 of Public Aid shall adopt rules to implement the requirements
9 of Section 356r of the Illinois Insurance Code in the medical
10 assistance program including managed care components.
11 (Source: P.A. 92-370, eff. 8-15-01.)
12 (305 ILCS 5/5-16.10)
13 Sec. 5-16.10. Managed care entities; marketing. A
14 managed health care entity providing services under this
15 Article V may not engage in door-to-door marketing activities
16 or marketing activities at an office of the Illinois
17 Department of Public Aid or a county department in order to
18 enroll recipients in the entity's health care delivery
19 system. The Department of Public Aid shall adopt rules
20 defining "marketing activities" prohibited by this Section.
21 Before a managed health care entity providing services
22 under this Article V may market its health care delivery
23 system to recipients, the Illinois Department of Public Aid
24 must approve a marketing plan submitted by the entity to the
25 Illinois Department. The Illinois Department shall adopt
26 guidelines for approving marketing plans submitted by managed
27 health care entities under this Section. Besides prohibiting
28 door-to-door marketing activities and marketing activities at
29 public aid offices, the guidelines shall include at least the
30 following:
31 (1) A managed health care entity may not offer or
32 provide any gift, favor, or other inducement in marketing
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1 its health care delivery system to integrated health care
2 program enrollees. A managed health care entity may
3 provide health care related items that are of nominal
4 value and pre-approved by the Department of Public Aid to
5 prospective enrollees. A managed health care entity may
6 also provide to enrollees health care related items that
7 have been pre-approved by the Department of Public Aid as
8 an incentive to manage their health care appropriately.
9 (2) All persons employed or otherwise engaged by a
10 managed health care entity to market the entity's health
11 care delivery system to recipients or to supervise that
12 marketing shall register with the Illinois Department of
13 Public Aid.
14 The Inspector General appointed under Section 12-13.1 may
15 conduct investigations to determine whether the marketing
16 practices of managed health care entities providing services
17 under this Article V comply with the guidelines.
18 (Source: P.A. 90-538, eff. 12-1-97.)
19 (305 ILCS 5/5-16.11)
20 Sec. 5-16.11. Uniform standards applied to managed care
21 entities. Any managed care entity providing services under
22 this Code shall use a pharmacy formulary that is no more
23 restrictive than the Department of Public Aid's Illinois
24 Department's pharmaceutical program.
25 (Source: P.A. 92-370, eff. 8-15-01.)
26 (305 ILCS 5/5-16.12)
27 Sec. 5-16.12. Managed Care Reform and Patient Rights
28 Act. The medical assistance program and other programs
29 administered by the Department of Public Aid are subject to
30 the provisions of the Managed Care Reform and Patient Rights
31 Act. The Department of Public Aid may adopt rules to
32 implement those provisions. These rules shall require
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1 compliance with that Act in the medical assistance managed
2 care programs and other programs administered by the
3 Department. The medical assistance fee-for-service program
4 is not subject to the provisions of the Managed Care Reform
5 and Patient Rights Act.
6 Nothing in the Managed Care Reform and Patient Rights Act
7 shall be construed to mean that the Department of Public Aid
8 is a health care plan as defined in that Act simply because
9 the Department enters into contractual relationships with
10 health care plans.
11 (Source: P.A. 91-617, eff. 1-1-00.)
12 (305 ILCS 5/5-17) (from Ch. 23, par. 5-17)
13 Sec. 5-17. Programs to improve access to hospital care.
14 (a) (1) The General Assembly finds:
15 (A) That while hospitals have traditionally
16 provided charitable care to indigent patients, this
17 burden is not equally borne by all hospitals
18 operating in this State. Some hospitals continue to
19 provide significant amounts of care to low-income
20 persons while others provide very little such care;
21 and
22 (B) That access to hospital care in this State
23 by the indigent citizens of Illinois would be
24 seriously impaired by the closing of hospitals that
25 provide significant amounts of care to low-income
26 persons.
27 (2) To help expand the availability of hospital
28 care for all citizens of this State, it is the policy of
29 the State to implement programs that more equitably
30 distribute the burden of providing hospital care to
31 Illinois' low-income population and that improve access
32 to health care in Illinois.
33 (3) The Illinois Department of Public Aid may
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1 develop and implement a program that lessens the burden
2 of providing hospital care to Illinois' low-income
3 population, taking into account the costs that must be
4 incurred by hospitals providing significant amounts of
5 care to low-income persons, and may develop adjustments
6 to increase rates to improve access to health care in
7 Illinois. The Illinois Department of Public Aid shall
8 prescribe by rule the criteria, standards and procedures
9 for effecting such adjustments in the rates of hospital
10 payments for services provided to eligible low-income
11 persons (under Articles V, VI and VII of this Code) under
12 this Article.
13 (b) The Illinois Department of Public Aid shall require
14 hospitals certified to participate in the federal Medicaid
15 program to:
16 (1) provide equal access to available services to
17 low-income persons who are eligible for assistance under
18 Articles V, VI and VII of this Code;
19 (2) provide data and reports on the provision of
20 uncompensated care.
21 (c) From the effective date of this amendatory Act of
22 1992 until July 1, 1992, nothing in this Section 5-17 shall
23 be construed as creating a private right of action on behalf
24 of any individual.
25 (Source: P.A. 87-13; 87-838.)
26 (305 ILCS 5/5-19) (from Ch. 23, par. 5-19)
27 Sec. 5-19. Healthy Kids Program.
28 (a) Eligibility for program. Any child under the age of
29 21 eligible to receive Medical Assistance from the Illinois
30 Department of Public Aid under Article V of this Code shall
31 be eligible for Early and Periodic Screening, Diagnosis and
32 Treatment services provided by the Healthy Kids Program of
33 the Illinois Department under the Social Security Act, 42
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1 U.S.C. 1396d(r).
2 (b) Enrollment of children in Medicaid. The Illinois
3 Department of Public Aid shall provide for receipt and
4 initial processing of applications for Medical Assistance for
5 all pregnant women and children under the age of 21 at
6 locations in addition to those used for processing
7 applications for cash assistance, including disproportionate
8 share hospitals, federally qualified health centers and other
9 sites as selected by the Illinois Department.
10 (c) Healthy Kids examinations. The Illinois Department
11 of Public Aid shall consider any examination of a child
12 eligible for the Healthy Kids services provided by a medical
13 provider meeting the requirements and complying with the
14 rules and regulations of the Illinois Department to be
15 reimbursed as a Healthy Kids examination.
16 (d) Medical screening examinations.
17 (1) The Illinois Department of Public Aid shall
18 insure Medicaid coverage for periodic health, vision,
19 hearing, and dental screenings for children eligible for
20 Healthy Kids services scheduled from a child's birth up
21 until the child turns 21 years. The Illinois Department
22 of Public Aid shall pay for vision, hearing, dental and
23 health screening examinations for any child eligible for
24 Healthy Kids services by qualified providers at intervals
25 established by Department rules.
26 (2) The Illinois Department of Public Aid shall pay
27 for an interperiodic health, vision, hearing, or dental
28 screening examination for any child eligible for Healthy
29 Kids services whenever an examination is:
30 (A) requested by a child's parent, guardian,
31 or custodian, or is determined to be necessary or
32 appropriate by social services, developmental,
33 health, or educational personnel; or
34 (B) necessary for enrollment in school; or
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1 (C) necessary for enrollment in a licensed day
2 care program, including Head Start; or
3 (D) necessary for placement in a licensed
4 child welfare facility, including a foster home,
5 group home or child care institution; or
6 (E) necessary for attendance at a camping
7 program; or
8 (F) necessary for participation in an
9 organized athletic program; or
10 (G) necessary for enrollment in an early
11 childhood education program recognized by the
12 Illinois State Board of Education; or
13 (H) necessary for participation in a Women,
14 Infant, and Children (WIC) program; or
15 (I) deemed appropriate by the Illinois
16 Department of Public Aid.
17 (e) Minimum screening protocols for periodic health
18 screening examinations. Health screening examinations must
19 include the following services:
20 (1) Comprehensive health and development assessment
21 including:
22 (A) Development/mental health/psychosocial
23 assessment; and
24 (B) Assessment of nutritional status including
25 tests for iron deficiency and anemia for children at
26 the following ages: 9 months, 2 years, 8 years, and
27 18 years;
28 (2) Comprehensive unclothed physical exam;
29 (3) Appropriate immunizations at a minimum, as
30 required by the Secretary of the U.S. Department of
31 Health and Human Services under 42 U.S.C. 1396d(r).
32 (4) Appropriate laboratory tests including blood
33 lead levels appropriate for age and risk factors.
34 (A) Anemia test.
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1 (B) Sickle cell test.
2 (C) Tuberculin test at 12 months of age and
3 every 1-2 years thereafter unless the treating
4 health care professional determines that testing is
5 medically contraindicated.
6 (D) Other -- The Illinois Department of Public
7 Aid shall insure that testing for HIV, drug
8 exposure, and sexually transmitted diseases is
9 provided for as clinically indicated.
10 (5) Health education. The Illinois Department of
11 Public Aid shall require providers to provide
12 anticipatory guidance as recommended by the American
13 Academy of Pediatrics.
14 (6) Vision screening. The Illinois Department of
15 Public Aid shall require providers to provide vision
16 screenings consistent with those set forth in the
17 Department of Public Health's Administrative Rules.
18 (7) Hearing screening. The Illinois Department of
19 Public Aid shall require providers to provide hearing
20 screenings consistent with those set forth in the
21 Department of Public Health's Administrative Rules.
22 (8) Dental screening. The Illinois Department of
23 Public Aid shall require providers to provide dental
24 screenings consistent with those set forth in the
25 Department of Public Health's Administrative Rules.
26 (f) Covered medical services. The Illinois Department
27 of Public Aid shall provide coverage for all necessary health
28 care, diagnostic services, treatment and other measures to
29 correct or ameliorate defects, physical and mental illnesses,
30 and conditions whether discovered by the screening services
31 or not for all children eligible for Medical Assistance under
32 Article V of this Code.
33 (g) Notice of Healthy Kids services.
34 (1) The Illinois Department of Public Aid shall
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1 inform any child eligible for Healthy Kids services and
2 the child's family about the benefits provided under the
3 Healthy Kids Program, including, but not limited to, the
4 following: what services are available under Healthy
5 Kids, including discussion of the periodicity schedules
6 and immunization schedules, that services are provided at
7 no cost to eligible children, the benefits of preventive
8 health care, where the services are available, how to
9 obtain them, and that necessary transportation and
10 scheduling assistance is available.
11 (2) The Illinois Department of Public Aid shall
12 widely disseminate information regarding the availability
13 of the Healthy Kids Program throughout the State by
14 outreach activities which shall include, but not be
15 limited to, (i) the development of cooperation agreements
16 with local school districts, public health agencies,
17 clinics, hospitals and other health care providers,
18 including developmental disability and mental health
19 providers, and with charities, to notify the constituents
20 of each of the Program and assist individuals, as
21 feasible, with applying for the Program, (ii) using the
22 media for public service announcements and advertisements
23 of the Program, and (iii) developing posters advertising
24 the Program for display in hospital and clinic waiting
25 rooms.
26 (3) The Illinois Department of Public Aid shall
27 utilize accepted methods for informing persons who are
28 illiterate, blind, deaf, or cannot understand the English
29 language, including but not limited to public services
30 announcements and advertisements in the foreign language
31 media of radio, television and newspapers.
32 (4) The Illinois Department of Public Aid shall
33 provide notice of the Healthy Kids Program to every child
34 eligible for Healthy Kids services and his or her family
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1 at the following times:
2 (A) orally by the intake worker and in writing
3 at the time of application for Medical Assistance;
4 (B) at the time the applicant is informed that
5 he or she is eligible for Medical Assistance
6 benefits; and
7 (C) at least 20 days before the date of any
8 periodic health, vision, hearing, and dental
9 examination for any child eligible for Healthy Kids
10 services. Notice given under this subparagraph (C)
11 must state that a screening examination is due under
12 the periodicity schedules and must advise the
13 eligible child and his or her family that the
14 Illinois Department of Public Aid will provide
15 assistance in scheduling an appointment and
16 arranging medical transportation.
17 (h) Data collection. The Illinois Department of Public
18 Aid shall collect data in a usable form to track utilization
19 of Healthy Kids screening examinations by children eligible
20 for Healthy Kids services, including but not limited to data
21 showing screening examinations and immunizations received, a
22 summary of follow-up treatment received by children eligible
23 for Healthy Kids services and the number of children
24 receiving dental, hearing and vision services.
25 (Source: P.A. 87-630; 87-895.)
26 (305 ILCS 5/5-20)
27 Sec. 5-20. Electronic health care card. By December 31,
28 1994, the Illinois Department of Public Aid may develop and
29 implement by rule an electronic health information system to
30 process claims electronically and to electronically store
31 Medicare and Medicaid patient records, medical histories, and
32 billing information. The Illinois Department of Public Aid
33 may issue each Medicare and Medicaid recipient a health card
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1 containing electronically coded information that will access
2 the system, verify their Medicare or Medicaid status, and
3 display how much the patient must pay in deductibles or
4 copayments for a medical procedure. The Illinois Department
5 of Public Aid may also develop safeguards to protect
6 recipients' health information from misuse or unauthorized
7 disclosure.
8 (Source: P.A. 88-308; 88-670, eff. 12-2-94.)
9 (305 ILCS 5/5-21)
10 Sec. 5-21. Immunization. By July 1, 1994, the Illinois
11 Department of Public Aid shall, in cooperation with the
12 Department of Public Health, establish and implement a pilot
13 program that will provide immunization services for children
14 on a walk-in basis at local public aid offices. The Director
15 of Public Aid shall determine the number and location of the
16 local public aid offices that will participate in the pilot
17 program. The Illinois Department of Public Aid shall submit
18 a report on the effectiveness of the program to the General
19 Assembly on or before December 31, 1995. The Department of
20 Public Aid and the Department of Human Services, in
21 cooperation with the Department of Public Health, shall
22 continue to implement the pilot program after the effective
23 date of this amendatory Act of 1996.
24 (Source: P.A. 88-493; 88-670, eff. 12-2-94; 89-507, eff.
25 7-1-97.)
26 (305 ILCS 5/5-22)
27 Sec. 5-22. Healthy Moms/Healthy Kids reporting
28 requirement. The Illinois Department of Public Aid shall
29 submit a report concerning the Healthy Moms/Healthy Kids
30 Program on July 31, 1994 and on that day each year
31 thereafter. The report shall contain the following
32 information:
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1 (1) A list of each Primary Care Provider participating
2 in the Healthy Moms/Healthy Kids Managed Care Program and the
3 following information for each listed provider:
4 (A) zip code;
5 (B) specialty (as indicated on their HMHK Managed
6 Care Provider Agreement);
7 (C) total number of patients that the provider has
8 agreed to enroll each month under the signed agreement
9 including the total number of pregnant women and the
10 total number of children each provider has agreed to
11 serve; and
12 (D) total number of unduplicated patients the
13 provider has enrolled (by month and for the year) under
14 the signed agreement including the number of pregnant
15 women and the total number of children.
16 (2) The unduplicated number of children who are Medicaid
17 enrolled in the Healthy Moms/Healthy Kids Managed Care
18 Program's target area during the year.
19 (3) The unduplicated number of children who were
20 enrolled in the Healthy Moms/Healthy Kids Managed Care
21 Program during the year:
22 (A) The unduplicated number of children who were
23 assigned to a Primary Care Provider enrolled physician.
24 (B) The unduplicated number of children who were
25 assigned to a Federally Qualified Health Center (number
26 of FQHC name).
27 (C) The unduplicated number of children who were
28 assigned to a hospital outpatient or other clinic type
29 (number of hospital outpatient or other clinic name).
30 (D) The unduplicated number of children who were
31 assigned to an HMO (number of HMO name).
32 (4) The unduplicated number of known pregnant women who
33 are Medicaid enrolled during their pregnancy in the Healthy
34 Moms/Healthy Kids Managed Care Program's target area during
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1 the year.
2 (5) The unduplicated number of pregnant women who were
3 enrolled in the Healthy Moms/Healthy Kids Managed Care
4 Program during the year:
5 (A) The unduplicated number of pregnant women who
6 were assigned to a Primary Care Provider enrolled
7 physician.
8 (B) The unduplicated number of pregnant women who
9 were assigned to a Federally Qualified Health Center
10 (number by FQHC name).
11 (C) The unduplicated number of pregnant women who
12 were assigned to a hospital outpatient or other clinic
13 type (number of hospital outpatient or other clinic
14 name).
15 (D) The unduplicated number of women who were
16 pregnant at the time of assignment to an HMO (number of
17 HMO name).
18 (6) The number of unduplicated children who were
19 Medicaid enrolled in the Healthy Moms/Healthy Kids Managed
20 Care Program's target area, but who were not enrolled with
21 one of the Primary Care Provider types or an HMO during the
22 year.
23 (7) The number of known unduplicated pregnant women who
24 were Medicaid enrolled in the Healthy Moms/Healthy Kids
25 Managed Care Program's target area but who were not enrolled
26 with one of the Primary Care Provider types or an HMO during
27 the year.
28 (8) The number of unduplicated children enrolled in the
29 Healthy Moms/Healthy Kids Managed Care Program who were
30 referred to a specialist, indicating the number of children
31 by specialty, as identified in the Medicaid Provider
32 Enrollment system.
33 (9) The number of unduplicated pregnant women enrolled
34 in the Healthy Moms/Healthy Kids Managed Care Program who
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1 were referred to a specialist, indicating the number of
2 pregnant women by specialty, as identified in the Medicaid
3 Provider Enrollment system.
4 (10) A list of each case management agency participating
5 in the Healthy Moms/Healthy Kids Managed Care Program and the
6 following information for each listed agency:
7 (A) name;
8 (B) address and zip code;
9 (C) the number of cases assigned by category (i.e.
10 families with pregnant women; families with infants;
11 families with children over age one) by month and an
12 unduplicated total for the year; and
13 (D) the amount of payment for case management
14 services by month and a total for the year.
15 (11) A list of each case management agency participating
16 in the Healthy Moms/Healthy Kids Program (outside of the
17 target Healthy Moms/Healthy Kids Managed Care Program area)
18 and the following information for each listed agency:
19 (A) name;
20 (B) address and zip code;
21 (B-5) county/area served;
22 (C) the number of cases assigned by category (i.e.
23 families with pregnant women; families with infants;
24 families with children over age one) by month and an
25 unduplicated total for the year; and
26 (D) the amount of payment for case management
27 services by month and an unduplicated total for the year.
28 (12) The total number of physicians by county, who have
29 signed Healthy Moms/Healthy Kids Provider Agreements (outside
30 of the target Healthy Moms/Healthy Kids Managed Care Program
31 area).
32 (Source: P.A. 90-655, eff. 7-30-98.)
33 (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
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1 Sec. 5A-2. Assessment; no local authorization to tax.
2 (a) For the privilege of engaging in the occupation of
3 hospital provider, an assessment is imposed upon each
4 hospital provider for the State fiscal year beginning on July
5 1, 1993 and ending on June 30, 1994, in an amount equal to
6 1.88% of the provider's adjusted gross hospital revenue for
7 the most recent calendar year ending before the beginning of
8 that State fiscal year.
9 Effective July 1, 1994 through June 30, 1996, an annual
10 assessment is imposed upon each hospital provider in an
11 amount equal to the provider's adjusted gross hospital
12 revenue for the most recent calendar year ending before the
13 beginning of that State fiscal year multiplied by the
14 Provider's Savings Rate.
15 Effective July 1, 1996 through March 31, 1997, an
16 assessment is imposed upon each hospital provider in an
17 amount equal to three-fourths of the provider's adjusted
18 gross hospital revenue for calendar year 1995 multiplied by
19 the Provider's Savings Rate. No assessment shall be imposed
20 on or after April 1, 1997.
21 Before July 1, 1995, the Provider's Savings Rate is 1.88%
22 multiplied by a fraction, the numerator of which is the
23 Maximum Section 5A-2 Contribution minus the Cigarette Tax
24 Contribution, and the denominator of which is the Maximum
25 Section 5A-2 Contribution. Effective July 1, 1995, the
26 Provider's Savings Rate is 1.25% multiplied by a fraction,
27 the numerator of which is the Maximum Section 5A-2
28 Contribution minus the Cigarette Tax Contribution, and the
29 denominator of which is the Maximum Section 5A-2
30 Contribution.
31 The Cigarette Tax Contribution is the sum of the total
32 amount deposited in the Hospital Provider Fund in the
33 previous State fiscal year pursuant to Section 2(a) of the
34 Cigarette Tax Act, plus the total amount deposited in the
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1 Hospital Provider Fund in the previous State fiscal year
2 pursuant to Section 5A-3(c) of this Code.
3 The Maximum Section 5A-2 Contribution is the total amount
4 of tax imposed by this Section in the previous State fiscal
5 year on providers subject to this Act, multiplied by a
6 fraction the numerator of which is adjusted gross hospital
7 revenues reported to the Department of Public Aid by
8 providers subject to this Act for the previous State fiscal
9 year and the denominator of which is adjusted gross hospital
10 revenues reported to the Department by providers subject to
11 this Act for the State fiscal year immediately preceding the
12 previous State fiscal year.
13 The Department of Public Aid shall notify hospital
14 providers of the Provider's Savings Rate by mailing a notice
15 to each provider's last known address as reflected by the
16 records of the Illinois Department.
17 (b) Nothing in this amendatory Act of 1995 shall be
18 construed to authorize any home rule unit or other unit of
19 local government to license for revenue or to impose a tax or
20 assessment upon hospital providers or the occupation of
21 hospital provider, or a tax or assessment measured by the
22 income or earnings of a hospital provider.
23 (Source: P.A. 88-88; 89-21, eff. 7-1-95; 89-499, eff.
24 6-28-96.)
25 (305 ILCS 5/5A-3) (from Ch. 23, par. 5A-3)
26 Sec. 5A-3. Exemptions; intergovernmental transfers.
27 (a) A hospital provider which is a county with a
28 population of more than 3,000,000 that makes
29 intergovernmental transfer payments as provided in Section
30 15-3 of this Code shall be exempt from the assessment imposed
31 by Section 5A-2, unless the exemption is adjudged to be
32 unconstitutional or otherwise invalid, in which case the
33 county shall pay the assessment imposed by Section 5A-2 for
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1 all assessment periods beginning on or after July 1, 1992,
2 and the assessment so paid shall be creditable against the
3 intergovernmental transfer payments.
4 (b) A hospital organized under the University of
5 Illinois Hospital Act and exempt from the assessment imposed
6 by Section 5A-2 is hereby authorized to enter into an
7 interagency agreement with the Illinois Department of Public
8 Aid to make intergovernmental transfer payments to the
9 Illinois Department. These payments shall be deposited into
10 the University of Illinois Hospital Services Fund or, if that
11 Fund ceases to exist, into the General Revenue Fund.
12 (b-5) A hospital operated by the Department of Human
13 Services in the course of performing its mental health and
14 developmental disabilities functions is exempt from the
15 assessment imposed by Section 5A-2.
16 (c) The Illinois Department of Public Aid is hereby
17 authorized to enter into agreements with publicly owned or
18 operated hospitals to make intergovernmental transfer
19 payments to the Illinois Department. These payments shall be
20 deposited into the Hospital Provider Fund, except that any
21 payments arising under an agreement with a hospital organized
22 under the University of Illinois Hospital Act shall be
23 deposited into the University of Illinois Hospital Services
24 Fund, if that Fund exists.
25 (Source: P.A. 88-88; 88-554, eff. 7-26-94; 89-21, eff.
26 7-1-95; 89-507, eff. 7-1-97.)
27 (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4)
28 Sec. 5A-4. Payment of assessment; penalty.
29 (a) The assessment imposed by Section 5A-2 for a State
30 fiscal year shall be due and payable in quarterly
31 installments, each equalling one-fourth of the assessment for
32 the year, on September 30, December 31, March 31, and May 31
33 of the year; except that for the period July 1, 1996 through
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1 March 31, 1997, the assessment imposed by Section 5A-2 for
2 that period shall be due and payable in 3 equal installments
3 on September 30, December 31, and March 31 of that period.
4 (b) The Illinois Department of Public Aid is authorized
5 to establish delayed payment schedules for hospital providers
6 that are unable to make installment payments when due under
7 this Section due to financial difficulties, as determined by
8 the Illinois Department.
9 (c) If a hospital provider fails to pay the full amount
10 of an installment when due (including any extensions granted
11 under subsection (b)), there shall, unless waived by the
12 Illinois Department of Public Aid for reasonable cause, be
13 added to the assessment imposed by Section 5A-2 a penalty
14 assessment equal to the lesser of (i) 5% of the amount of the
15 installment not paid on or before the due date plus 5% of the
16 portion thereof remaining unpaid on the last day of each
17 month thereafter or (ii) 100% of the installment amount not
18 paid on or before the due date. For purposes of this
19 subsection, payments will be credited first to unpaid
20 installment amounts (rather than to penalty or interest),
21 beginning with the most delinquent installments.
22 (Source: P.A. 88-88; 89-499, eff. 6-28-96.)
23 (305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
24 Sec. 5A-5. Reporting; penalty; maintenance of records.
25 (a) After December 31 of each year, and on or before
26 March 31 of the succeeding year, every hospital provider
27 subject to assessment under this Article shall file a return
28 with the Illinois Department of Public Aid. The return shall
29 report the adjusted gross hospital revenue from the calendar
30 year just ended and shall be utilized by the Illinois
31 Department of Public Aid to calculate the assessment for the
32 State fiscal year commencing on the next July 1, except that
33 the return for the State fiscal year commencing July 1, 1992
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1 and the report of revenue for calendar year 1991 shall be
2 filed on or before September 30, 1992. The return shall be
3 on a form prepared by the Illinois Department of Public Aid
4 and shall state the following:
5 (1) The name of the hospital provider.
6 (2) The address of the hospital provider's
7 principal place of business from which the provider
8 engages in the occupation of hospital provider in this
9 State, and the name and address of each hospital
10 operated, conducted, or maintained by the provider in
11 this State.
12 (3) The adjusted gross hospital revenue of the
13 hospital provider for the calendar year just ended, the
14 amount of assessment imposed under Section 5A-2 for the
15 State fiscal year for which the return is filed, and the
16 amount of each quarterly installment to be paid during
17 the State fiscal year.
18 (4) The amount of penalty due, if any.
19 (5) Other reasonable information the Illinois
20 Department of Public Aid requires.
21 (b) If a hospital provider conducts, operates, or
22 maintains more than one hospital licensed by the Illinois
23 Department of Public Health, the provider may not file a
24 single return covering all those hospitals, but shall file a
25 separate return for each hospital and shall compute and pay
26 the assessment for each hospital separately.
27 (c) Notwithstanding any other provision in this Article,
28 in the case of a person who ceases to conduct, operate, or
29 maintain a hospital in respect of which the person is subject
30 to assessment under this Article as a hospital provider, the
31 assessment for the State fiscal year in which the cessation
32 occurs shall be adjusted by multiplying the assessment
33 computed under Section 5A-2 by a fraction, the numerator of
34 which is the number of months in the year during which the
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1 provider conducts, operates, or maintains the hospital and
2 the denominator of which is 12. The person shall file a
3 final, amended return with the Illinois Department of Public
4 Aid not more than 90 days after the cessation reflecting the
5 adjustment and shall pay with the final return the assessment
6 for the year as so adjusted (to the extent not previously
7 paid).
8 (d) Notwithstanding any other provision in this Article,
9 a provider who commences conducting, operating, or
10 maintaining a hospital shall file an initial return for the
11 State fiscal year in which the commencement occurs within 90
12 days thereafter and shall pay the assessment computed under
13 Section 5A-2 and subsection (e) in equal installments on the
14 due date of the return and on the regular installment due
15 dates for the State fiscal year occurring after the due date
16 of the initial return.
17 (e) Notwithstanding any other provision in this Article,
18 in the case of a hospital provider that did not conduct,
19 operate, or maintain a hospital throughout the calendar year
20 preceding a State fiscal year, the assessment for that State
21 fiscal year shall be computed on the basis of hypothetical
22 adjusted gross hospital revenue for the full calendar year as
23 determined by rules adopted by the Illinois Department of
24 Public Aid (which may be based on annualization of the
25 provider's actual revenues for a portion of the calendar
26 year, or revenues of a comparable hospital for the year,
27 including revenues realized by a prior provider from the same
28 hospital during the year).
29 (f) In the case of a hospital provider existing as a
30 corporation or legal entity other than an individual, the
31 return filed by it shall be signed by its president,
32 vice-president, secretary, or treasurer or by its properly
33 authorized agent.
34 (g) If a hospital provider fails to file its return for
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1 a State fiscal year on or before the due date of the return,
2 there shall, unless waived by the Illinois Department of
3 Public Aid for reasonable cause, be added to the assessment
4 imposed by Section 5A-2 for the State fiscal year a penalty
5 assessment equal to 25% of the assessment imposed for the
6 year.
7 (h) Every hospital provider subject to assessment under
8 this Article shall keep sufficient records to permit the
9 determination of adjusted gross hospital revenue on a
10 calendar year basis. All such records shall be kept in the
11 English language and shall, at all times during business
12 hours of the day, be subject to inspection by the Illinois
13 Department of Public Aid or its duly authorized agents and
14 employees.
15 (Source: P.A. 87-861.)
16 (305 ILCS 5/5A-6) (from Ch. 23, par. 5A-6)
17 Sec. 5A-6. Disposition of proceeds. The Illinois
18 Department of Public Aid shall pay all moneys received from
19 hospital providers under this Article into the Hospital
20 Provider Fund. Upon certification by the Illinois Department
21 of Public Aid to the State Comptroller of its intent to
22 withhold from a provider under Section 5A-7(b), the State
23 Comptroller shall draw a warrant on the treasury or other
24 fund held by the State Treasurer, as appropriate. The
25 warrant shall state the amount for which the provider is
26 entitled to a warrant, the amount of the deduction, and the
27 reason therefor and shall direct the State Treasurer to pay
28 the balance to the provider, all in accordance with Section
29 10.05 of the State Comptroller Act. The warrant also shall
30 direct the State Treasurer to transfer the amount of the
31 deduction so ordered from the treasury or other fund into the
32 Hospital Provider Fund.
33 (Source: P.A. 87-861.)
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1 (305 ILCS 5/5A-7) (from Ch. 23, par. 5A-7)
2 Sec. 5A-7. Administration; enforcement provisions.
3 (a) To the extent practicable, the Illinois Department
4 of Public Aid shall administer and enforce this Article and
5 collect the assessments, interest, and penalty assessments
6 imposed under this Article using procedures employed in its
7 administration of this Code generally and, as it deems
8 appropriate, in a manner similar to that in which the
9 Department of Revenue administers and collects the retailers'
10 occupation tax under the Retailers' Occupation Tax Act
11 ("ROTA"). Instead of certificates of registration, the
12 Illinois Department of Public Aid shall establish and
13 maintain a listing of all hospital providers appearing in the
14 licensing records of the Department of Public Health, which
15 shall show each provider's name, principal place of business,
16 and the name and address of each hospital operated,
17 conducted, or maintained by the provider in this State. In
18 addition, the following specified provisions of the
19 Retailers' Occupation Tax Act are incorporated by reference
20 into this Section except that the Illinois Department of
21 Public Aid and the its Director of Public Aid (rather than
22 the Department of Revenue and the its Director of Revenue)
23 and every hospital provider subject to assessment measured by
24 adjusted gross hospital revenue and to the return filing
25 requirements of this Article (rather than persons subject to
26 retailers' occupation tax measured by gross receipts from the
27 sale of tangible personal property at retail and to the
28 return filing requirements of ROTA) shall have the powers,
29 duties, and rights specified in these ROTA provisions, as
30 modified in this Section or by the Illinois Department of
31 Public Aid in a manner consistent with this Article and
32 except as manifestly inconsistent with the other provisions
33 of this Article:
34 (1) ROTA, Section 4 (examination of return; notice
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1 of correction; evidence; limitations; protest and
2 hearing), except that (i) the Illinois Department of
3 Public Aid shall issue notices of assessment liability
4 (rather than notices of tax liability as provided in
5 ROTA, Section 4); (ii) in the case of a fraudulent return
6 or in the case of an extended period agreed to by the
7 Illinois Department of Public Aid and the hospital
8 provider before the expiration of the limitation period,
9 no notice of assessment liability shall be issued more
10 than 3 years after the later of the due date of the
11 return required by Section 5A-5 or the date the return
12 (or an amended return) was filed (rather within the
13 period stated in ROTA, Section 4); and (iii) the penalty
14 provisions of ROTA, Section 4 shall not apply.
15 (2) ROTA, Sec. 5 (failure to make return; failure
16 to pay assessment), except that the penalty and interest
17 provisions of ROTA, Section 5 shall not apply.
18 (3) ROTA, Section 5a (lien; attachment;
19 termination; notice; protest; review; release of lien;
20 status of lien).
21 (4) ROTA, Section 5b (State lien notices; State
22 lien index; duties of recorder and registrar of titles).
23 (5) ROTA, Section 5c (liens; certificate of
24 release).
25 (6) ROTA, Section 5d (Department not required to
26 furnish bond; claim to property attached or levied upon).
27 (7) ROTA, Section 5e (foreclosure on liens;
28 enforcement).
29 (8) ROTA, Section 5f (demand for payment; levy and
30 sale of property; limitation).
31 (9) ROTA, Section 5g (sale of property;
32 redemption).
33 (10) ROTA, Section 5j (sales on transfers outside
34 usual course of business; report; payment of assessment;
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1 rights and duties of purchaser; penalty).
2 (11) ROTA, Section 6 (erroneous payments; credit or
3 refund), provided that (i) the Illinois Department of
4 Public Aid may only apply an amount otherwise subject to
5 credit or refund to a liability arising under this
6 Article; (ii) except in the case of an extended period
7 agreed to by the Illinois Department of Public Aid and
8 the hospital provider before the expiration of this
9 limitation period, a claim for credit or refund must be
10 filed no more than 3 years after the due date of the
11 return required by Section 5A-5 (rather than the time
12 limitation stated in ROTA, Section 6); and (iii) credits
13 or refunds shall not bear interest.
14 (12) ROTA, Section 6a (claims for credit or
15 refund).
16 (13) ROTA, Section 6b (tentative determination of
17 claim; notice; hearing; review), provided that a hospital
18 provider or its representative shall have 60 days (rather
19 than 20 days) within which to file a protest and request
20 for hearing in response to a tentative determination of
21 claim.
22 (14) ROTA, Section 6c (finality of tentative
23 determinations).
24 (15) ROTA, Section 8 (investigations and
25 hearings).
26 (16) ROTA, Section 9 (witness; immunity).
27 (17) ROTA, Section 10 (issuance of subpoenas;
28 attendance of witnesses; production of books and
29 records).
30 (18) ROTA, Section 11 (information confidential;
31 exceptions).
32 (19) ROTA, Section 12 (rules and regulations;
33 hearing; appeals), except that a hospital provider shall
34 not be required to file a bond or be subject to a lien in
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1 lieu thereof in order to seek court review under the
2 Administrative Review Law of a final assessment or
3 revised final assessment or the equivalent thereof issued
4 by the Illinois Department of Public Aid under this
5 Article.
6 (b) In addition to any other remedy provided for and
7 without sending a notice of assessment liability, the
8 Illinois Department of Public Aid may collect an unpaid
9 assessment by withholding, as payment of the assessment,
10 reimbursements or other amounts otherwise payable by the
11 Illinois Department to the provider.
12 (Source: P.A. 87-861.)
13 (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
14 Sec. 5A-8. Hospital Provider Fund.
15 (a) There is created in the State treasury the Hospital
16 Provider Fund. Interest earned by the Fund shall be credited
17 to the Fund. The Fund shall not be used to replace any
18 moneys appropriated to the Medicaid program by the General
19 Assembly.
20 (b) The Fund is created for the purpose of receiving
21 moneys in accordance with Section 5A-6 and disbursing moneys
22 as follows:
23 (1) For hospital inpatient care, hospital
24 ambulatory care, and disproportionate share hospital
25 distributive expenditures made under Title XIX of the
26 Social Security Act and Article V of this Code.
27 (2) For the reimbursement of moneys collected by
28 the Illinois Department of Public Aid from hospitals
29 through error or mistake and for making required payments
30 under Section 14-9 of this Code if there are no moneys
31 available for those payments in the Hospital Services
32 Trust Fund.
33 (3) For payment of administrative expenses incurred
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1 by the Illinois Department of Public Aid or its agent in
2 performing the activities authorized by this Article.
3 (4) For payments of any amounts which are
4 reimbursable to the federal government for payments from
5 this Fund which are required to be paid by State warrant.
6 (5) For making transfers to the General Obligation
7 Bond Retirement and Interest Fund, as those transfers are
8 authorized in the proceedings authorizing debt under the
9 Short Term Borrowing Act, but transfers made under this
10 paragraph (5) shall not exceed the principal amount of
11 debt issued in anticipation of the receipt by the State
12 of moneys to be deposited into the Fund.
13 Disbursements from the Fund, other than transfers to the
14 General Obligation Bond Retirement and Interest Fund, shall
15 be by warrants drawn by the State Comptroller upon receipt of
16 vouchers duly executed and certified by the Illinois
17 Department of Public Aid.
18 (c) The Fund shall consist of the following:
19 (1) All moneys collected or received by the
20 Illinois Department of Public Aid from the hospital
21 provider assessment imposed by this Article.
22 (2) All federal matching funds received by the
23 Illinois Department of Public Aid as a result of
24 expenditures made by the Illinois Department that are
25 attributable to moneys deposited in the Fund.
26 (3) Any interest or penalty levied in conjunction
27 with the administration of this Article.
28 (4) Any balance in the Hospital Services Trust Fund
29 in the State treasury. The balance shall be transferred
30 to the Fund upon certification by the Illinois Department
31 of Public Aid to the State Comptroller that all of the
32 disbursements required by Section 14-2(b) of this Code
33 have been made.
34 (5) All other moneys received for the Fund from any
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1 other source, including interest earned thereon.
2 (d) The Fund shall cease to exist on October 1, 1999.
3 Any balance in the Fund as of that date shall be transferred
4 to the General Revenue Fund. Any moneys that otherwise would
5 be paid into the Fund on or after that date shall be
6 deposited into the General Revenue Fund. Any disbursements
7 on or after that date that otherwise would be made from the
8 Fund may be appropriated by the General Assembly from the
9 General Revenue Fund.
10 (Source: P.A. 89-626, eff. 8-9-96; 90-587, eff. 7-1-98.)
11 (305 ILCS 5/5A-9) (from Ch. 23, par. 5A-9)
12 Sec. 5A-9. Emergency services audits. The Illinois
13 Department of Public Aid may audit hospital claims for
14 payment for emergency services provided to a recipient who
15 does not require admission as an inpatient. The Illinois
16 Department shall adopt rules that describe how the emergency
17 services audit process will be conducted. These rules shall
18 include, but need not be limited to, the following
19 provisions:
20 (1) The determination that an emergency medical
21 condition exists shall be based upon the symptoms and
22 condition of the recipient at the time the recipient is
23 initially examined by the hospital emergency department
24 and not upon the final determination of the recipient's
25 actual medical condition.
26 (2) The Illinois Department of Public Aid or its
27 authorized representative shall meet with the chief
28 executive officer of the hospital, or a person designated
29 by the chief executive officer, upon arrival at the
30 hospital to conduct the audit and before leaving the
31 hospital at the conclusion of the audit. The purpose of
32 the pre-audit meeting shall be to inform the hospital
33 concerning the scope of the audit. The purpose of the
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1 post-audit meeting shall be to provide the hospital with
2 the preliminary findings of the audit.
3 (3) An emergency services audit shall be limited to
4 a review of records related to services rendered within 3
5 years of the date of the audit. The hospital's business
6 and professional records for at least 12 previous
7 calendar months shall be maintained and available for
8 inspection by authorized Illinois Department of Public
9 Aid personnel on the premises of the hospital. Illinois
10 Department of Public Aid personnel shall make requests in
11 writing to inspect records more than 12 months old at
12 least 2 business days in advance of the date they must be
13 produced.
14 (4) Where the purpose of the audit is to determine
15 the appropriateness of the emergency services provided,
16 any final determination that would result in a denial of
17 or reduction in payment to the hospital shall be made by
18 a physician licensed to practice medicine in all of its
19 branches who is board certified in emergency medicine or
20 by the appropriate health care professionals under the
21 supervision of the physician.
22 (5) The preliminary audit findings shall be
23 provided to the hospital within 120 days of the date on
24 which the audit conducted on the hospital premises was
25 completed.
26 (6) The Illinois Department of Public Aid or its
27 designated review agent shall use statistically valid
28 sampling techniques when conducting audits.
29 (Source: P.A. 87-861.)
30 (305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
31 Sec. 5B-4. Payment of assessment; penalty.
32 (a) The assessment imposed by Section 5B-2 for a State
33 fiscal year shall be due and payable in quarterly
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1 installments, each equalling one-fourth of the assessment for
2 the year, on September 30, December 31, March 31, and June 30
3 of the year. The Illinois Department of Public Aid may
4 provide that county nursing homes directed and maintained
5 pursuant to Section 5-1005 of the Counties Code may meet
6 their assessment obligation by certifying to the Illinois
7 Department that county expenditures have been obligated for
8 the operation of the county nursing home in an amount at
9 least equal to the amount of the assessment.
10 (b) The Illinois Department of Public Aid is authorized
11 to establish delayed payment schedules for long-term care
12 providers that are unable to make installment payments when
13 due under this Section due to financial difficulties, as
14 determined by the Illinois Department.
15 (c) If a long-term care provider fails to pay the full
16 amount of an installment when due (including any extensions
17 granted under subsection (b)), there shall, unless waived by
18 the Illinois Department of Public Aid for reasonable cause,
19 be added to the assessment imposed by Section 5B-2 for the
20 State fiscal year a penalty assessment equal to the lesser of
21 (i) 5% of the amount of the installment not paid on or before
22 the due date plus 5% of the portion thereof remaining unpaid
23 on the last day of each month thereafter or (ii) 100% of the
24 installment amount not paid on or before the due date. For
25 purposes of this subsection, payments will be credited first
26 to unpaid installment amounts (rather than to penalty or
27 interest), beginning with the most delinquent installments.
28 (d) Nothing in this amendatory Act of 1993 shall be
29 construed to prevent the Illinois Department of Public Aid
30 from collecting all amounts due under this Article pursuant
31 to an assessment imposed before the effective date of this
32 amendatory Act of 1993.
33 (Source: P.A. 87-861; 88-88.)
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1 (305 ILCS 5/5B-5) (from Ch. 23, par. 5B-5)
2 Sec. 5B-5. Reporting; penalty; maintenance of records.
3 (a) After December 31 of each year, and on or before
4 March 31 of the succeeding year, every long-term care
5 provider subject to assessment under this Article shall file
6 a return with the Illinois Department of Public Aid. The
7 return shall report the occupied bed days for the calendar
8 year just ended and shall be utilized by the Illinois
9 Department of Public Aid to calculate the assessment for the
10 State fiscal year commencing on the next July 1, except that
11 the return for the State fiscal year commencing July 1, 1992
12 and the report of occupied bed days for calendar year 1991
13 shall be filed on or before September 30, 1992. The return
14 shall be on a form prepared by the Illinois Department of
15 Public Aid and shall state the following:
16 (1) The name of the long-term care provider.
17 (2) The address of the long-term care provider's
18 principal place of business from which the provider
19 engages in the occupation of long-term care provider in
20 this State, and the name and address of each long-term
21 care facility operated or maintained by the provider in
22 this State.
23 (3) The number of occupied bed days of the
24 long-term care provider for the calendar year just ended,
25 the amount of assessment imposed under Section 5B-2 for
26 the State fiscal year for which the return is filed, and
27 the amount of each quarterly installment to be paid
28 during the State fiscal year.
29 (4) The amount of penalty due, if any.
30 (5) Other reasonable information the Illinois
31 Department of Public Aid requires.
32 (b) If a long-term care provider operates or maintains
33 more than one long-term care facility in this State, the
34 provider may not file a single return covering all those
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1 long-term care facilities, but shall file a separate return
2 for each long-term care facility and shall compute and pay
3 the assessment for each long-term care facility separately.
4 (c) Notwithstanding any other provision in this Article,
5 in the case of a person who ceases to operate or maintain a
6 long-term care facility in respect of which the person is
7 subject to assessment under this Article as a long-term care
8 provider, the assessment for the State fiscal year in which
9 the cessation occurs shall be adjusted by multiplying the
10 assessment computed under Section 5B-2 by a fraction, the
11 numerator of which is the number of months in the year during
12 which the provider operates or maintains the long-term care
13 facility and the denominator of which is 12. The person
14 shall file a final, amended return with the Illinois
15 Department of Public Aid not more than 90 days after the
16 cessation reflecting the adjustment and shall pay with the
17 final return the assessment for the year as so adjusted (to
18 the extent not previously paid).
19 (d) Notwithstanding any other provision of this Article,
20 a provider who commences operating or maintaining a long-term
21 care facility shall file an initial return for the State
22 fiscal year in which the commencement occurs within 90 days
23 thereafter and shall pay the assessment computed under
24 Section 5B-2 and subsection (e) in equal installments on the
25 due date of the return and on the regular installment due
26 dates for the State fiscal year occurring after the due date
27 of the initial return.
28 (e) Notwithstanding any other provision of this Article,
29 in the case of a long-term care provider that did not operate
30 or maintain a long-term care facility throughout the calendar
31 year preceding a State fiscal year, the assessment for that
32 State fiscal year shall be computed on the basis of
33 hypothetical occupied bed days for the full calendar year as
34 determined by rules adopted by the Illinois Department of
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1 Public Aid (which may be based on annualization of the
2 provider's actual occupied bed days for a portion of the
3 calendar year, or the occupied bed days of a comparable
4 facility for the year, including the same facility while
5 operated by a prior provider).
6 (f) In the case of a long-term care provider existing as
7 a corporation or legal entity other than an individual, the
8 return filed by it shall be signed by its president,
9 vice-president, secretary, or treasurer or by its properly
10 authorized agent.
11 (g) If a long-term care provider fails to file its
12 return for a State fiscal year on or before the due date of
13 the return, there shall, unless waived by the Illinois
14 Department of Public Aid for reasonable cause, be added to
15 the assessment imposed by Section 5B-2 for the State fiscal
16 year a penalty assessment equal to 25% of the assessment
17 imposed for the year.
18 (h) Every long-term care provider subject to assessment
19 under this Article shall keep records and books that will
20 permit the determination of occupied bed days on a calendar
21 year basis. All such books and records shall be kept in the
22 English language and shall, at all times during business
23 hours of the day, be subject to inspection by the Illinois
24 Department of Public Aid or its duly authorized agents and
25 employees.
26 (Source: P.A. 87-861.)
27 (305 ILCS 5/5B-6) (from Ch. 23, par. 5B-6)
28 Sec. 5B-6. Disposition of proceeds. The Illinois
29 Department of Public Aid shall pay all moneys received from
30 long-term care providers under this Article into the
31 Long-Term Care Provider Fund. Upon certification by the
32 Illinois Department of Public Aid to the State Comptroller of
33 its intent to withhold from a provider under Section 5B-7(b),
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1 the State Comptroller shall draw a warrant on the treasury or
2 other fund held by the State Treasurer, as appropriate. The
3 warrant shall state the amount for which the provider is
4 entitled to a warrant, the amount of the deduction, and the
5 reason therefor and shall direct the State Treasurer to pay
6 the balance to the provider, all in accordance with Section
7 10.05 of the State Comptroller Act. The warrant also shall
8 direct the State Treasurer to transfer the amount of the
9 deduction so ordered from the treasury or other fund into the
10 Long-Term Care Provider Fund.
11 (Source: P.A. 87-861.)
12 (305 ILCS 5/5B-7) (from Ch. 23, par. 5B-7)
13 Sec. 5B-7. Administration; enforcement provisions.
14 (a) To the extent practicable, the Illinois Department
15 of Public Aid shall administer and enforce this Article and
16 collect the assessments, interest, and penalty assessments
17 imposed under this Article, using procedures employed in its
18 administration of this Code generally and, as it deems
19 appropriate, in a manner similar to that in which the
20 Department of Revenue administers and collects the retailers'
21 occupation tax under the Retailers' Occupation Tax Act
22 ("ROTA"). Instead of certificates of registration, the
23 Illinois Department of Public Aid shall establish and
24 maintain a listing of all long-term care providers appearing
25 in the licensing records of the Department of Public Health,
26 which shall show each provider's name, principal place of
27 business, and the name and address of each long-term care
28 facility operated or maintained by the provider in this
29 State. In addition, the following provisions of the
30 Retailers' Occupation Tax Act are incorporated by reference
31 into this Section, except that the Illinois Department of
32 Public Aid and the its Director of Public Aid (rather than
33 the Department of Revenue and the its Director of Revenue)
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1 and every long-term care provider subject to assessment
2 measured by occupied bed days and to the return filing
3 requirements of this Article (rather than persons subject to
4 retailers' occupation tax measured by gross receipts from the
5 sale of tangible personal property at retail and to the
6 return filing requirements of ROTA) shall have the powers,
7 duties, and rights specified in these ROTA provisions, as
8 modified in this Section or by the Illinois Department of
9 Public Aid in a manner consistent with this Article and
10 except as manifestly inconsistent with the other provisions
11 of this Article:
12 (1) ROTA, Section 4 (examination of return; notice
13 of correction; evidence; limitations; protest and
14 hearing), except that (i) the Illinois Department of
15 Public Aid shall issue notices of assessment liability
16 (rather than notices of tax liability as provided in
17 ROTA, Section 4); (ii) in the case of a fraudulent return
18 or in the case of an extended period agreed to by the
19 Illinois Department of Public Aid and the long-term care
20 provider before the expiration of the limitation period,
21 no notice of assessment liability shall be issued more
22 than 3 years after the later of the due date of the
23 return required by Section 5B-5 or the date the return
24 (or an amended return) was filed (rather within the
25 period stated in ROTA, Section 4); and (iii) the penalty
26 provisions of ROTA, Section 4 shall not apply.
27 (2) ROTA, Section 5 (failure to make return;
28 failure to pay assessment), except that the penalty and
29 interest provisions of ROTA, Section 5 shall not apply.
30 (3) ROTA, Section 5a (lien; attachment;
31 termination; notice; protest; review; release of lien;
32 status of lien).
33 (4) ROTA, Section 5b (State lien notices; State
34 lien index; duties of recorder and registrar of titles).
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1 (5) ROTA, Section 5c (liens; certificate of
2 release).
3 (6) ROTA, Section 5d (Department not required to
4 furnish bond; claim to property attached or levied upon).
5 (7) ROTA, Section 5e (foreclosure on liens;
6 enforcement).
7 (8) ROTA, Section 5f (demand for payment; levy and
8 sale of property; limitation).
9 (9) ROTA, Section 5g (sale of property;
10 redemption).
11 (10) ROTA, Section 5j (sales on transfers outside
12 usual course of business; report; payment of assessment;
13 rights and duties of purchaser; penalty).
14 (11) ROTA, Section 6 (erroneous payments; credit or
15 refund), provided that (i) the Illinois Department of
16 Public Aid may only apply an amount otherwise subject to
17 credit or refund to a liability arising under this
18 Article; (ii) except in the case of an extended period
19 agreed to by the Illinois Department of Public Aid and
20 the long term care provider prior to the expiration of
21 this limitation period, a claim for credit or refund must
22 be filed no more than 3 years after the due date of the
23 return required by Section 5B-5 (rather than the time
24 limitation stated in ROTA, Section 6); and (iii) credits
25 or refunds shall not bear interest.
26 (12) ROTA, Section 6a (claims for credit or
27 refund).
28 (13) ROTA, Section 6b (tentative determination of
29 claim; notice; hearing; review), provided that a
30 long-term care provider or its representative shall have
31 60 days (rather than 20 days) within which to file a
32 protest and request for hearing in response to a
33 tentative determination of claim.
34 (14) ROTA, Section 6c (finality of tentative
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1 determinations).
2 (15) ROTA, Section 8 (investigations and
3 hearings).
4 (16) ROTA, Section 9 (witness; immunity).
5 (17) ROTA, Section 10 (issuance of subpoenas;
6 attendance of witnesses; production of books and
7 records).
8 (18) ROTA, Section 11 (information confidential;
9 exceptions).
10 (19) ROTA, Section 12 (rules and regulations;
11 hearing; appeals), except that a long-term care provider
12 shall not be required to file a bond or be subject to a
13 lien in lieu thereof in order to seek court review under
14 the Administrative Review Law of a final assessment or
15 revised final assessment or the equivalent thereof issued
16 by the Illinois Department of Public Aid under this
17 Article.
18 (b) In addition to any other remedy provided for and
19 without sending a notice of assessment liability, the
20 Illinois Department of Public Aid may collect an unpaid
21 assessment by withholding, as payment of the assessment,
22 reimbursements or other amounts otherwise payable by the
23 Illinois Department to the provider.
24 (Source: P.A. 87-861.)
25 (305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
26 Sec. 5B-8. Long-Term Care Provider Fund.
27 (a) There is created in the State treasury the Long-Term
28 Care Provider Fund. Interest earned by the Fund shall be
29 credited to the Fund. The Fund shall not be used to replace
30 any moneys appropriated to the Medicaid program by the
31 General Assembly.
32 (b) The Fund is created for the purpose of receiving and
33 disbursing moneys in accordance with this Article.
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1 Disbursements from the Fund shall be made only as follows:
2 (1) For payments to skilled or intermediate nursing
3 facilities, including county nursing facilities but
4 excluding State-operated facilities, under Title XIX of
5 the Social Security Act and Article V of this Code.
6 (2) For the reimbursement of moneys collected by
7 the Illinois Department of Public Aid through error or
8 mistake, and for making required payments under Section
9 5-4.38(a)(1) if there are no moneys available for such
10 payments in the Medicaid Long Term Care Provider
11 Participation Fee Trust Fund.
12 (3) For payment of administrative expenses incurred
13 by the Illinois Department of Public Aid or its agent in
14 performing the activities authorized by this Article.
15 (4) For payments of any amounts that are
16 reimbursable to the federal government for payments from
17 this Fund that are required to be paid by State warrant.
18 (5) For making transfers to the General Obligation
19 Bond Retirement and Interest Fund, as those transfers are
20 authorized in the proceedings authorizing debt under the
21 Short Term Borrowing Act, but transfers made under this
22 paragraph (5) shall not exceed the principal amount of
23 debt issued in anticipation of the receipt by the State
24 of moneys to be deposited into the Fund.
25 Disbursements from the Fund, other than transfers to the
26 General Obligation Bond Retirement and Interest Fund, shall
27 be by warrants drawn by the State Comptroller upon receipt of
28 vouchers duly executed and certified by the Illinois
29 Department of Public Aid.
30 (c) The Fund shall consist of the following:
31 (1) All moneys collected or received by the
32 Illinois Department of Public Aid from the long-term care
33 provider assessment imposed by this Article.
34 (2) All federal matching funds received by the
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1 Illinois Department of Public Aid as a result of
2 expenditures made by the Illinois Department that are
3 attributable to moneys deposited in the Fund.
4 (3) Any interest or penalty levied in conjunction
5 with the administration of this Article.
6 (4) Any balance in the Medicaid Long Term Care
7 Provider Participation Fee Fund in the State treasury.
8 The balance shall be transferred to the Fund upon
9 certification by the Illinois Department of Public Aid to
10 the State Comptroller that all of the disbursements
11 required by Section 5-4.31(b) of this Code have been
12 made.
13 (5) All other monies received for the Fund from any
14 other source, including interest earned thereon.
15 (Source: P.A. 89-626, eff. 8-9-96.)
16 (305 ILCS 5/5C-3) (from Ch. 23, par. 5C-3)
17 Sec. 5C-3. Payment of assessment; penalty.
18 (a) The assessment imposed by Section 5C-2 for a State
19 fiscal year shall be due and payable in quarterly
20 installments, each equalling one-fourth of the assessment for
21 the year, on September 30, December 31, March 31, and May 31
22 of the year.
23 (b) The Illinois Department of Public Aid authorized to
24 establish delayed payment schedules for developmentally
25 disabled care providers that are unable to make installment
26 payments when due under this Section due to financial
27 difficulties, as determined by the Illinois Department.
28 (c) If a developmentally disabled care provider fails to
29 pay the full amount of an installment when due (including any
30 extensions granted under subsection (b)), there shall, unless
31 waived by the Illinois Department of Public Aid for
32 reasonable cause, be added to the assessment imposed by
33 Section 5C-2 for the State fiscal year a penalty assessment
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1 equal to the lesser of (i) 5% of the amount of the
2 installment not paid on or before the due date plus 5% of the
3 portion thereof remaining unpaid on the last day of each
4 month thereafter or (ii) 100% of the installment amount not
5 paid on or before the due date. For purposes of this
6 subsection, payments will be credited first to unpaid
7 installment amounts (rather than to penalty or interest),
8 beginning with the most delinquent installments.
9 (Source: P.A. 87-861; 88-88.)
10 (305 ILCS 5/5C-4) (from Ch. 23, par. 5C-4)
11 Sec. 5C-4. Reporting; penalty; maintenance of records.
12 (a) After June 30 of each State fiscal year, and on or
13 before September 30 of the succeeding State fiscal year,
14 every developmentally disabled care provider subject to
15 assessment under this Article shall file a return with the
16 Illinois Department of Public Aid. The return shall report
17 the adjusted gross developmentally disabled care revenue from
18 the State fiscal year just ended and shall be utilized by the
19 Illinois Department of Public Aid to calculate the assessment
20 for the State fiscal year commencing on the preceding July 1.
21 The return shall be on a form prepared by the Illinois
22 Department of Public Aid and shall state the following:
23 (1) The name of the developmentally disabled care
24 provider.
25 (2) The address of the developmentally disabled
26 care provider's principal place of business from which
27 the provider engages in the occupation of developmentally
28 disabled care provider in this State, and the name and
29 address of all developmentally disabled care facilities
30 operated or maintained by the provider in this State.
31 (3) The adjusted gross developmentally disabled
32 care revenue for the State fiscal year just ended, the
33 amount of assessment imposed under Section 5C-2 for the
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1 State fiscal year for which the return is filed, and the
2 amount of each quarterly installment to be paid during
3 the State fiscal year.
4 (4) The amount of penalty due, if any.
5 (5) Other reasonable information the Illinois
6 Department of Public Aid requires.
7 (b) If a developmentally disabled care provider operates
8 or maintains more than one developmentally disabled care
9 facility in this State, the provider may not file a single
10 return covering all those developmentally disabled care
11 facilities, but shall file a separate return for each
12 developmentally disabled care facility and shall compute and
13 pay the assessment for each developmentally disabled care
14 facility separately.
15 (c) Notwithstanding any other provision in this Article,
16 a person who ceases to conduct, operate, or maintain a
17 developmentally disabled care facility in respect of which
18 the person is subject to assessment under this Article as a
19 developmentally disabled care provider, the assessment for
20 the State fiscal year in which the cessation occurs shall be
21 adjusted by multiplying the assessment computed under Section
22 5C-2 by a fraction, the numerator of which is the number of
23 months in the year during which the provider conducts,
24 operates, or maintains the developmentally disabled care
25 facility and the denominator of which is 12. The person
26 shall file a final, amended return with the Illinois
27 Department of Public Aid not more than 90 days after the
28 cessation reflecting the adjustment and shall pay with the
29 final return the assessment for the year as so adjusted (to
30 the extent not previously paid).
31 (d) Notwithstanding any other provision of this Article,
32 a provider who commences conducting, operating, or
33 maintaining a developmentally disabled care facility shall
34 file an initial return for the State fiscal year in which the
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1 commencement occurs within 90 days thereafter and shall pay
2 the assessment computed under Section 5C-2 and subsection
3 (e) in equal installments on the due date of the return and
4 on the regular installment due dates for the State fiscal
5 year occurring after the due date of the initial return.
6 (e) Notwithstanding any other provision of this Article,
7 in the case of a developmentally disabled care provider that
8 did not conduct, operate, or maintain a developmentally
9 disabled care facility throughout the prior State fiscal
10 year, the assessment for that State fiscal year shall be
11 computed on the basis of hypothetical adjusted gross
12 developmentally disabled care revenue for the prior year as
13 determined by rules adopted by the Illinois Department of
14 Public Aid (which may be based on annualization of the
15 provider's actual revenues for a portion of the State fiscal
16 year, or revenues of a comparable facility for such year,
17 including revenues realized by a prior provider from the same
18 facility during such year).
19 (f) In the case of a developmentally disabled care
20 provider existing as a corporation or legal entity other than
21 an individual, the return filed by it shall be signed by its
22 president, vice-president, secretary, or treasurer or by its
23 properly authorized agent.
24 (g) If a developmentally disabled care provider fails to
25 file its return for a State fiscal year on or before the due
26 date of the return, there shall, unless waived by the
27 Illinois Department of Public Aid for reasonable cause, be
28 added to the assessment imposed by Section 5C-2 for the State
29 fiscal year a penalty assessment equal to 25% of the
30 assessment imposed for the year.
31 (h) Every developmentally disabled care provider subject
32 to assessment under this Article shall keep records and books
33 that will permit the determination of adjusted gross
34 developmentally disabled care revenue on a State fiscal year
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1 basis. All such books and records shall be kept in the
2 English language and shall, at all times during business
3 hours of the day, be subject to inspection by the Illinois
4 Department of Public Aid or its duly authorized agents and
5 employees.
6 (Source: P.A. 87-861.)
7 (305 ILCS 5/5C-5) (from Ch. 23, par. 5C-5)
8 Sec. 5C-5. Disposition of proceeds. The Illinois
9 Department of Public Aid shall pay all moneys received from
10 developmentally disabled care providers under this Article
11 into the Developmentally Disabled Care Provider Fund. Upon
12 certification by the Illinois Department of Public Aid to the
13 State Comptroller of its intent to withhold from a provider
14 under Section 5C-6(b), the State Comptroller shall draw a
15 warrant on the treasury or other fund held by the State
16 Treasurer, as appropriate. The warrant shall state the
17 amount for which the provider is entitled to a warrant, the
18 amount of the deduction, and the reason therefor and shall
19 direct the State Treasurer to pay the balance to the
20 provider, all in accordance with Section 10.05 of the State
21 Comptroller Act. The warrant also shall direct the State
22 Treasurer to transfer the amount of the deduction so ordered
23 from the treasury or other fund into the Developmentally
24 Disabled Care Provider Fund.
25 (Source: P.A. 87-861.)
26 (305 ILCS 5/5C-6) (from Ch. 23, par. 5C-6)
27 Sec. 5C-6. Administration; enforcement provisions.
28 (a) To the extent practicable, the Illinois Department
29 of Public Aid shall administer and enforce this Article and
30 collect the assessments, interest, and penalty assessments
31 imposed under this Article, using procedures employed in its
32 administration of this Code generally and, as it deems
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1 appropriate, in a manner similar to that in which the
2 Department of Revenue administers and collects the retailers'
3 occupation tax pursuant to the Retailers' Occupation Tax Act
4 ("ROTA"). Instead of certificates of registration, the
5 Illinois Department of Public Aid shall establish and
6 maintain a listing of all developmentally disabled care
7 providers appearing in the licensing records of the
8 Department of Public Health, which shall show each provider's
9 name, principal place of business, and the name and address
10 of each developmentally disabled care facility operated or
11 maintained by the provider in this State. In addition, the
12 following Retailers' Occupation Tax Act provisions are
13 incorporated by reference into this Section, except that the
14 Illinois Department of Public Aid and the its Director of
15 Public Aid (rather than the Department of Revenue and the its
16 Director of Revenue) and every developmentally disabled care
17 provider subject to assessment measured by adjusted gross
18 developmentally disabled care revenue and to the return
19 filing requirements of this Article (rather than persons
20 subject to retailers' occupation tax measured by gross
21 receipts from the sale of tangible personal property at
22 retail and to the return filing requirements of ROTA) shall
23 have the powers, duties, and rights specified in these ROTA
24 provisions, as modified in this Section or by the Illinois
25 Department of Public Aid in a manner consistent with this
26 Article and except as manifestly inconsistent with the other
27 provisions of this Article:
28 (1) ROTA, Section 4 (examination of return; notice
29 of correction; evidence; limitations; protest and
30 hearing), except that (i) the Illinois Department of
31 Public Aid shall issue notices of assessment liability
32 (rather than notices of tax liability as provided in
33 ROTA, Section 4); (ii) in the case of a fraudulent return
34 or in the case of an extended period agreed to by the
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1 Illinois Department of Public Aid and the developmentally
2 disabled care provider before the expiration of the
3 limitation period, no notice of assessment liability
4 shall be issued more than 3 years after the later of the
5 due date of the return required by Section 5C-5 or the
6 date the return (or an amended return) was filed (rather
7 within the period stated in ROTA, Section 4); and (iii)
8 the penalty provisions of ROTA, Section 4 shall not
9 apply.
10 (2) ROTA, Section 5 (failure to make return;
11 failure to pay assessment), except that the penalty and
12 interest provisions of ROTA, Section 5 shall not apply.
13 (3) ROTA, Section 5a (lien; attachment;
14 termination; notice; protest; review; release of lien;
15 status of lien).
16 (4) ROTA, Section 5b (State lien notices; State
17 lien index; duties of recorder and registrar of titles).
18 (5) ROTA, Section 5c (liens; certificate of
19 release).
20 (6) ROTA, Section 5d (Department not required to
21 furnish bond; claim to property attached or levied upon).
22 (7) ROTA, Section 5e (foreclosure on liens;
23 enforcement).
24 (8) ROTA, Section 5f (demand for payment; levy and
25 sale of property; limitation).
26 (9) ROTA, Section 5g (sale of property;
27 redemption).
28 (10) ROTA, Section 5j (sales on transfers outside
29 usual course of business; report; payment of assessment;
30 rights and duties of purchaser; penalty).
31 (11) ROTA, Section 6 (erroneous payments; credit or
32 refund), provided that (i) the Illinois Department of
33 Public Aid may only apply an amount otherwise subject to
34 credit or refund to a liability arising under this
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1 Article; (ii) except in the case of an extended period
2 agreed to by the Illinois Department of Public Aid and
3 the developmentally disabled care provider prior to the
4 expiration of this limitation period, a claim for credit
5 or refund must be filed no more than 3 years after the
6 due date of the return required by Section 5C-5 (rather
7 than the time limitation stated in ROTA, Section 6); and
8 (iii) credits or refunds shall not bear interest.
9 (12) ROTA, Section 6a (claims for credit or
10 refund).
11 (13) ROTA, Section 6b (tentative determination of
12 claim; notice; hearing; review), provided that a
13 developmentally disabled care provider or its
14 representative shall have 60 days (rather than 20
15 days) within which to file a protest and request for
16 hearing in response to a tentative determination of
17 claim.
18 (14) ROTA, Section 6c (finality of tentative
19 determinations).
20 (15) ROTA, Section 8 (investigations and
21 hearings).
22 (16) ROTA, Section 9 (witness; immunity).
23 (17) ROTA, Section 10 (issuance of subpoenas;
24 attendance of witnesses; production of books and
25 records).
26 (18) ROTA, Section 11 (information confidential;
27 exceptions).
28 (19) ROTA, Section 12 (rules and regulations;
29 hearing; appeals), except that a developmentally disabled
30 care provider shall not be required to file a bond or be
31 subject to a lien in lieu thereof in order to seek court
32 review under the Administrative Review Law of a final
33 assessment or revised final assessment or the equivalent
34 thereof issued by the Illinois Department of Public Aid
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1 under this Article.
2 (b) In addition to any other remedy provided for and
3 without sending a notice of assessment liability, the
4 Illinois Department of Public Aid may collect an unpaid
5 assessment by withholding, as payment of the assessment,
6 reimbursements or other amounts otherwise payable by the
7 Illinois Department to the provider.
8 (Source: P.A. 87-861.)
9 (305 ILCS 5/5C-7) (from Ch. 23, par. 5C-7)
10 Sec. 5C-7. Developmentally Disabled Care Provider Fund.
11 (a) There is created in the State treasury the
12 Developmentally Disabled Care Provider Fund. Interest earned
13 by the Fund shall be credited to the Fund. The Fund shall
14 not be used to replace any moneys appropriated to the
15 Medicaid program by the General Assembly.
16 (b) The Fund is created for the purpose of receiving and
17 disbursing assessment moneys in accordance with this Article.
18 Disbursements from the Fund shall be made only as follows:
19 (1) For payments to intermediate care facilities
20 for the developmentally disabled under Title XIX of the
21 Social Security Act and Article V of this Code.
22 (2) For the reimbursement of moneys collected by
23 the Illinois Department of Public Aid through error or
24 mistake, and to make required payments under Section
25 5-4.28(a)(1) of this Code if there are no moneys
26 available for such payments in the Medicaid
27 Developmentally Disabled Provider Participation Fee Trust
28 Fund.
29 (3) For payment of administrative expenses incurred
30 by the Department of Human Services or its agent or the
31 Illinois Department of Public Aid or its agent in
32 performing the activities authorized by this Article.
33 (4) For payments of any amounts which are
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1 reimbursable to the federal government for payments from
2 this Fund which are required to be paid by State warrant.
3 (5) For making transfers to the General Obligation
4 Bond Retirement and Interest Fund as those transfers are
5 authorized in the proceedings authorizing debt under the
6 Short Term Borrowing Act, but transfers made under this
7 paragraph (5) shall not exceed the principal amount of
8 debt issued in anticipation of the receipt by the State
9 of moneys to be deposited into the Fund.
10 Disbursements from the Fund, other than transfers to the
11 General Obligation Bond Retirement and Interest Fund, shall
12 be by warrants drawn by the State Comptroller upon receipt of
13 vouchers duly executed and certified by the Illinois
14 Department of Public Aid.
15 (c) The Fund shall consist of the following:
16 (1) All moneys collected or received by the
17 Illinois Department of Public Aid from the
18 developmentally disabled care provider assessment imposed
19 by this Article.
20 (2) All federal matching funds received by the
21 Illinois Department of Public Aid as a result of
22 expenditures made by the Illinois Department that are
23 attributable to moneys deposited in the Fund.
24 (3) Any interest or penalty levied in conjunction
25 with the administration of this Article.
26 (4) Any balance in the Medicaid Developmentally
27 Disabled Care Provider Participation Fee Trust Fund in
28 the State treasury. The balance shall be transferred to
29 the Fund upon certification by the Illinois Department of
30 Public Aid to the State Comptroller that all of the
31 disbursements required by Section 5-4.21(b) of this Code
32 have been made.
33 (5) All other moneys received for the Fund from any
34 other source, including interest earned thereon.
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1 (Source: P.A. 89-21, eff. 7-1-95; 89-507, eff. 7-1-97.)
2 (305 ILCS 5/5E-10)
3 Sec. 5E-10. Fee. Every nursing home provider shall pay
4 to the Illinois Department of Public Aid, on or before
5 September 10, December 10, March 10, and June 10, a fee in
6 the amount of $1.50 for each licensed nursing bed day for the
7 calendar quarter in which the payment is due. This fee shall
8 not be billed or passed on to any resident of a nursing home
9 operated by the nursing home provider. All fees received by
10 the Illinois Department of Public Aid under this Section
11 shall be deposited into the Long-Term Care Provider Fund.
12 (Source: P.A. 88-88; 89-21, eff. 7-1-95.)
13 (305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
14 Sec. 6-1. Eligibility requirements. Financial aid in
15 meeting basic maintenance requirements shall be given under
16 this Article to or in behalf of persons who meet the
17 eligibility conditions of Sections 6-1.1 through 6-1.10. In
18 addition, each unit of local government subject to this
19 Article shall provide persons receiving financial aid in
20 meeting basic maintenance requirements with financial aid for
21 either (a) necessary treatment, care, and supplies required
22 because of illness or disability, or (b) acute medical
23 treatment, care, and supplies only. If a local governmental
24 unit elects to provide financial aid for acute medical
25 treatment, care, and supplies only, the general types of
26 acute medical treatment, care, and supplies for which
27 financial aid is provided shall be specified in the general
28 assistance rules of the local governmental unit, which rules
29 shall provide that financial aid is provided, at a minimum,
30 for acute medical treatment, care, or supplies necessitated
31 by a medical condition for which prior approval or
32 authorization of medical treatment, care, or supplies is not
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1 required by the general assistance rules of the Illinois
2 Department of Human Services. Nothing in this Article shall
3 be construed to permit the granting of financial aid where
4 the purpose of such aid is to obtain an abortion, induced
5 miscarriage or induced premature birth unless, in the opinion
6 of a physician, such procedures are necessary for the
7 preservation of the life of the woman seeking such treatment,
8 or except an induced premature birth intended to produce a
9 live viable child and such procedure is necessary for the
10 health of the mother or her unborn child.
11 (Source: P.A. 92-111, eff. 1-1-02.)
12 (305 ILCS 5/6-1.2) (from Ch. 23, par. 6-1.2)
13 Sec. 6-1.2. Need. Income available to the person, when
14 added to contributions in money, substance, or services from
15 other sources, including contributions from legally
16 responsible relatives, must be insufficient to equal the
17 grant amount established by Department of Human Services
18 regulation (or by local governmental unit in units which do
19 not receive State funds) for such a person.
20 In determining income to be taken into account:
21 (1) The first $75 of earned income in income
22 assistance units comprised exclusively of one adult
23 person shall be disregarded, and for not more than 3
24 months in any 12 consecutive months that portion of
25 earned income beyond the first $75 that is the difference
26 between the standard of assistance and the grant amount,
27 shall be disregarded.
28 (2) For income assistance units not comprised
29 exclusively of one adult person, when authorized by rules
30 and regulations of the Illinois Department of Human
31 Services, a portion of earned income, not to exceed the
32 first $25 a month plus 50% of the next $75, may be
33 disregarded for the purpose of stimulating and aiding
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1 rehabilitative effort and self-support activity.
2 "Earned income" means money earned in self-employment or
3 wages, salary, or commission for personal services performed
4 as an employee. The eligibility of any applicant for or
5 recipient of public aid under this Article is not affected by
6 the payment of any grant under the "Senior Citizens and
7 Disabled Persons Property Tax Relief and Pharmaceutical
8 Assistance Act", any refund or payment of the federal Earned
9 Income Tax Credit, or any distributions or items of income
10 described under subparagraph (X) of paragraph (2) of
11 subsection (a) of Section 203 of the Illinois Income Tax Act.
12 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
13 (305 ILCS 5/6-1.3) (from Ch. 23, par. 6-1.3)
14 Sec. 6-1.3. Utilization of aid available under other
15 provisions of Code. The person must have been determined
16 ineligible for aid under the federally funded programs to aid
17 refugees and Articles III, IV or V. Nothing in this Section
18 shall prevent the use of General Assistance funds to pay any
19 portion of the costs of care and maintenance in a residential
20 drug abuse treatment program licensed by the Department of
21 Human Services, or in a County Nursing Home, or in a private
22 nursing home, retirement home or other facility for the care
23 of the elderly, of a person otherwise eligible to receive
24 General Assistance except for the provisions of this
25 paragraph.
26 A person otherwise eligible for aid under the federally
27 funded programs to aid refugees or Articles III, IV or V who
28 fails or refuses to comply with provisions of this Code or
29 other laws, or rules and regulations of the Illinois
30 Department of Human Services, which would qualify him for aid
31 under those programs or Articles, shall not receive General
32 Assistance under this Article nor shall any of his dependents
33 whose eligibility is contingent upon such compliance receive
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1 General Assistance.
2 Persons and families who are ineligible for aid under
3 Article IV due to having received benefits under Article IV
4 for any maximum time limits set under the Illinois Temporary
5 Assistance to Needy Families (TANF) Plan shall not be
6 eligible for General Assistance under this Article unless the
7 Illinois Department of Human Services or the local
8 governmental unit, by rule, specifies that those persons or
9 families may be eligible.
10 (Source: P.A. 89-507, eff. 7-1-97; 90-17, eff. 7-1-97.)
11 (305 ILCS 5/6-1.3a) (from Ch. 23, par. 6-1.3a)
12 Sec. 6-1.3a. Residents of public institutions.
13 Residents of municipal, county, State or national
14 institutions for persons with mental illness or persons with
15 a developmental disability or for the tuberculous, or
16 residents of a home or other institution maintained by such
17 governmental bodies when not in need of institutional care
18 because of sickness, convalescence, infirmity, or chronic
19 illness, and inmates of penal or correctional institutions
20 maintained by such governmental bodies, may qualify for aid
21 under this Article only after they have ceased to be
22 residents or inmates.
23 A person shall not be deemed a resident of a State
24 institution for persons with mental illness or persons with a
25 developmental disability within the meaning of this Section
26 if he has been conditionally discharged by the Department of
27 Mental Health and Developmental Disabilities or the
28 Department of Human Services (acting as successor to the
29 Department of Mental Health and Developmental Disabilities)
30 and is no longer residing in the institution.
31 Recipients of benefits under this Article who become
32 residents of such institutions shall be permitted a period of
33 up to 30 days in such institutions without suspension or
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1 termination of eligibility. Benefits for which such person is
2 eligible shall be restored, effective on the date of
3 discharge or release, for persons who are residents of
4 institutions. Within a reasonable time after the discharge
5 of a person who was a resident of an institution, the
6 Department of Human Services shall redetermine the
7 eligibility of such person.
8 The Department of Human Services shall provide for
9 procedures to expedite the determination of ability to engage
10 in employment of persons scheduled to be discharged from
11 facilities operated by the Department.
12 (Source: P.A. 92-111, eff. 1-1-02.)
13 (305 ILCS 5/6-1.6) (from Ch. 23, par. 6-1.6)
14 Sec. 6-1.6. Acceptance of assignment to job search,
15 training and work programs. A person for whom the job search,
16 training and work programs established under Sections Section
17 9-6 through 9-6.0050 of Article IX are applicable must accept
18 assignment to such programs. In conducting job search
19 programs, the Illinois Department of Human Services and the
20 local governmental unit shall by rule specify a reasonable
21 minimum number of employer contacts, and methods of
22 documentation, to be made by program participants each month
23 and shall determine, pursuant to rules and regulations,
24 sanctions for persons failing to comply with the requirements
25 under Sections Section 9-6 through 9-6.0050. However, no
26 participant shall be sanctioned for failure to satisfy job
27 search requirements prior to a full assessment of his job
28 readiness and employability. No participant shall be
29 sanctioned for failure to satisfy the minimum number of
30 employer contacts if he has made a good faith effort to
31 comply. The Illinois Department of Human Services and local
32 governmental units shall provide payment for transportation
33 and other necessary expenses to comply with the requirements
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1 of such programs, as defined by rule. Sanctions shall not
2 apply to participants who are not provided with such
3 payments. Such payments to participants shall be provided in
4 advance of participant program compliance by the Illinois
5 Department of Human Services and may be provided in advance
6 of such compliance by the local governmental unit.
7 Sanctions may include the loss of eligibility to receive aid
8 under this Article for a period of time of up to 3 months.
9 (Source: P.A. 85-114.)
10 (305 ILCS 5/6-1.7) (from Ch. 23, par. 6-1.7)
11 Sec. 6-1.7. Registration for work with local
12 governmental unit. A recipient of financial aid under this
13 Article, which money or vendor payment is made by a local
14 governmental unit which administers aid under this Article
15 and is not a County Department, who is required under Section
16 6-1.4 to register for and accept bona fide offers of
17 employment as provided in Section 11-20 but is not required
18 to participate in a job search, training and work program
19 under Sections Section 9-6 through 9-6.0050, must also
20 register for work with such local governmental unit and must
21 perform work without compensation for a taxing district or
22 private not-for-profit organization as provided in this
23 Section.
24 A local governmental unit which administers aid under
25 this Article shall maintain a roster of the persons who have
26 registered for work in such local governmental unit, and
27 shall assure that such roster is available for the inspection
28 of the governing authorities of all taxing districts or
29 private not-for-profit organizations, or the duly authorized
30 agents thereof, for the selection of possible workers. Each
31 such local governmental unit shall cause persons, who are
32 selected by a taxing district or private not-for-profit
33 organization to perform work, to be notified at least 24
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1 hours in advance of the time the work is to begin.
2 Each such local governmental unit shall assure that the
3 following additional requirements are complied with:
4 (a) The taxing district or private not-for-profit
5 organization may not use a person selected to work under
6 this Section to replace a regular employee.
7 (b) The work to be performed for the taxing
8 district or private not-for-profit organization must be
9 reasonably related to the skills or interests of the
10 recipient.
11 (c) The maximum number of hours such work may be
12 performed is 8 hours per day and 40 hours per week.
13 (d) The recipient shall be provided or compensated
14 for transportation to and from the work location.
15 (e) The person selected to work under this Section
16 shall receive credit against his or her monthly benefits
17 under this Article, based on the State minimum wage rate,
18 for the work performed.
19 However, a taxing district or private not-for-profit
20 organization using the services of such recipient must pay
21 the recipient at least the State minimum wage after such
22 recipient has received credit by the Illinois Department of
23 Human Services equal to the amount of financial aid received
24 under this Article, or the recipient shall be discharged.
25 Moneys made available for public aid purposes under this
26 Article may be expended to purchase worker's compensation
27 insurance or to pay worker's compensation claims.
28 For the purposes of this Section, "taxing district" means
29 any unit of local government, as defined in Section 1 of
30 Article VII of the Constitution, with the power to tax, and
31 any school district or community college district.
32 (Source: P.A. 85-114.)
33 (305 ILCS 5/6-2) (from Ch. 23, par. 6-2)
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1 Sec. 6-2. Amount of aid. The amount and nature of
2 General Assistance for basic maintenance requirements shall
3 be determined in accordance with local budget standards for
4 local governmental units which do not receive State funds.
5 For local governmental units which do receive State funds,
6 the amount and nature of General Assistance for basic
7 maintenance requirements shall be determined in accordance
8 with the standards, rules and regulations of the Illinois
9 Department of Human Services. However, the amount and
10 nature of any financial aid is not affected by the payment of
11 any grant under the Senior Citizens and Disabled Persons
12 Property Tax Relief and Pharmaceutical Assistance Act or any
13 distributions or items of income described under subparagraph
14 (X) of paragraph (2) of subsection (a) of Section 203 of the
15 Illinois Income Tax Act. Due regard shall be given to the
16 requirements and the conditions existing in each case, and to
17 the income, money contributions and other support and
18 resources available, from whatever source. In local
19 governmental units which do not receive State funds, the
20 grant shall be sufficient when added to all other income,
21 money contributions and support in excess of any excluded
22 income or resources, to provide the person with a grant in
23 the amount established for such a person by the local
24 governmental unit based upon standards meeting basic
25 maintenance requirements. In local governmental units which
26 do receive State funds, the grant shall be sufficient when
27 added to all other income, money contributions and support in
28 excess of any excluded income or resources, to provide the
29 person with a grant in the amount established for such a
30 person by Department of Human Services regulation based upon
31 standards providing a livelihood compatible with health and
32 well-being, as directed by Section 12-4.11 of this Code.
33 The Illinois Department of Human Services may conduct
34 special projects, which may be known as Grant Diversion
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1 Projects, under which recipients of financial aid under this
2 Article are placed in jobs and their grants are diverted to
3 the employer who in turn makes payments to the recipients in
4 the form of salary or other employment benefits. The
5 Illinois Department shall by rule specify the terms and
6 conditions of such Grant Diversion Projects. Such projects
7 shall take into consideration and be coordinated with the
8 programs administered under the Illinois Emergency Employment
9 Development Act.
10 The allowances provided under Article IX for recipients
11 participating in the training and rehabilitation programs
12 shall be in addition to such maximum payment.
13 Payments may also be made to provide persons receiving
14 basic maintenance support with necessary treatment, care and
15 supplies required because of illness or disability or with
16 acute medical treatment, care, and supplies. Payments for
17 necessary or acute medical care under this paragraph may be
18 made to or in behalf of the person. Obligations incurred for
19 such services but not paid for at the time of a recipient's
20 death may be paid, subject to the rules and regulations of
21 the Illinois Department of Human Services, after the death of
22 the recipient.
23 (Source: P.A. 91-676, eff. 12-23-99; 92-111, eff. 1-1-02.)
24 (305 ILCS 5/6-2.1) (from Ch. 23, par. 6-2.1)
25 Sec. 6-2.1. Assets of homeless persons.
26 (a) For the purpose of assisting homeless persons in
27 securing housing, all assistance units that include a
28 homeless person shall have an asset disregard no less than
29 that applicable to recipients of benefits under Article 4 of
30 this Code. For purposes of this Section, "homeless" or
31 "homeless person" means either of the following:
32 (1) An individual who lacks a fixed, regular, and
33 adequate nighttime residence; or
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1 (2) An individual who has a primary nighttime
2 residence that is any of the following:
3 (A) A supervised publicly or privately
4 operated shelter designed to provide temporary
5 living accommodations (including welfare hotels,
6 congregate shelters, and transitional housing for
7 the mentally ill).
8 (B) An institution that provides a temporary
9 residence for individuals intended to be
10 institutionalized.
11 (C) A public or private place not designed
12 for, or ordinarily used as, a regular sleeping
13 accommodation for human beings.
14 (b) While the Illinois Department of Human Services
15 shall consider other indicia of homelessness in determining
16 whether a person is homeless, a letter from a shelter
17 provider stating that a person is homeless or residing in its
18 shelter shall create a rebuttable presumption that the person
19 is homeless.
20 (Source: P.A. 87-1185.)
21 (305 ILCS 5/6-6) (from Ch. 23, par. 6-6)
22 Sec. 6-6. Funeral and burial. If the estate of a
23 deceased recipient is insufficient to pay for funeral and
24 burial expenses and if no other resources including
25 assistance from legally responsible relatives or the United
26 States Veterans Administration, are available for such
27 purposes, there shall be paid, in accordance with the
28 standards, rules and regulations of the Illinois Department
29 of Human Services, such amounts as may be necessary to meet
30 costs of the funeral, burial space, and cemetery charges, or
31 to reimburse any person not financially responsible for the
32 deceased who has voluntarily made expenditures for such
33 costs.
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1 (Source: P.A. 90-372, eff. 7-1-98.)
2 (305 ILCS 5/6-7) (from Ch. 23, par. 6-7)
3 Sec. 6-7. Exemption for townships. Nothing in this
4 Article shall be construed as requiring townships to provide,
5 in whole or in part, medical assistance to persons who are
6 not residents of the State of Illinois.
7 In all instances under this Article where medical aid or
8 assistance to a person who is not a resident of this State
9 would otherwise be, in whole or in part, the responsibility
10 of a township, the Illinois Department shall be responsible
11 for such provision.
12 The Illinois Department shall, by rule or regulation,
13 insure that provision of such aid or assistance to a
14 non-resident is identical to the uniform standard of
15 eligibility established by the Illinois Department.
16 (Source: P.A. 81-519.)
17 (305 ILCS 5/6-9) (from Ch. 23, par. 6-9)
18 Sec. 6-9. Major disasters or emergencies.
19 (a) (1) A local governmental unit may provide assistance
20 to households under its General Assistance program following
21 a declaration by the President of the United States of a
22 major disaster or emergency pursuant to the Federal Disaster
23 Relief Act of 1974, as now or hereafter amended, if the local
24 governmental unit is within the area designated under the
25 declaration. Assistance under this Section may be provided to
26 households which have suffered damage, loss or hardships as a
27 result of the major disaster or emergency. Assistance under
28 this Section may be provided to households without regard to
29 the eligibility requirements and other requirements of this
30 Code. Assistance under this Section may be provided only
31 during the 90-day period following the date of declaration of
32 a major disaster or emergency.
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1 (2) A local governmental unit shall not use State funds
2 to provide assistance under this Section. If a local
3 governmental unit receives State funds to provide General
4 Assistance under this Article, assistance provided by the
5 local governmental unit under this Section shall not be
6 considered in determining whether a local governmental unit
7 has qualified to receive State funds under Article XII. A
8 local governmental unit which provides assistance under this
9 Section shall not, as a result of payment of such assistance,
10 change the nature or amount of assistance provided to any
11 other individual or family under this Article.
12 (3) This Section shall not apply to any municipality of
13 more than 500,000 population in which a separate program has
14 been established by the Illinois Department of Human Services
15 under Section 6-1.
16 (b) (1) A local governmental unit may provide assistance
17 to households for food and temporary shelter. To qualify for
18 assistance a household shall submit to the local governmental
19 unit: (A) such application as the local governmental unit
20 may require; (B) a copy of an application to the Federal
21 Emergency Management Agency (hereinafter "FEMA") or the Small
22 Business Administration (hereinafter "SBA") for assistance;
23 (C) such other proof of damage, loss or hardship as the
24 local governmental unit may require; and (D) an agreement to
25 reimburse the local governmental unit for the amount of any
26 assistance received by the household under this subsection
27 (b).
28 (2) Assistance under this subsection (b) may be in the
29 form of cash or vouchers. The amount of assistance provided
30 to a household in any month under this subsection (b) shall
31 not exceed the maximum amount payable under Section 6-2.
32 (3) No assistance shall be provided to a household after
33 it receives a determination of its application to FEMA or SBA
34 for assistance.
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1 (4) A household which has received assistance under this
2 subsection (b) shall reimburse the local governmental unit in
3 full for any assistance received under this subsection. If
4 the household receives assistance from FEMA or SBA in the
5 form of loans or grants, the household shall reimburse the
6 local governmental unit from those funds. If the household's
7 request for assistance is denied or rejected by the FEMA or
8 SBA, the household shall repay the local governmental unit in
9 accordance with a repayment schedule prescribed by the local
10 governmental unit.
11 (c) (1) A local governmental unit may provide assistance
12 to households for structural repairs to homes or for repair
13 or replacement of home electrical or heating systems, bedding
14 and food refrigeration equipment. To qualify for assistance
15 a household shall submit to the local governmental unit:
16 (A) such application as the local governmental unit may
17 require; (B) a copy of claim to an insurance company for
18 reimbursement for the damage or loss for which assistance is
19 sought; (C) such other proof of damage, loss or hardship as
20 the local governmental unit may require; and (D) an
21 agreement to reimburse the local governmental unit for the
22 amount of any assistance received by the household under this
23 subsection (c).
24 (2) Any assistance provided under this subsection
25 (c) shall be in the form of direct payments to vendors, and
26 shall not be made directly to a household. The total amount
27 of assistance provided to a household under this subsection
28 (c) shall not exceed $1,500.
29 (3) No assistance shall be provided to a household after
30 it receives a determination of its insurance claims.
31 (4) A household which has received assistance under this
32 subsection (c) shall reimburse the local governmental unit in
33 full for any assistance received under this subsection. If
34 the household's insurance claim is approved, the household
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1 shall reimburse the local governmental unit from the
2 proceeds. If the household's insurance claim is denied, the
3 household shall repay the local governmental unit in
4 accordance with a repayment schedule prescribed by the local
5 governmental unit.
6 (Source: P.A. 85-1233.)
7 (305 ILCS 5/6-10) (from Ch. 23, par. 6-10)
8 Sec. 6-10. Emergency financial assistance.
9 (a) Except in a city, village or incorporated town of
10 more than 500,000 population, when an applicant resides in
11 the local governmental unit in which he makes application,
12 emergency financial assistance to alleviate life-threatening
13 circumstances or to assist the individual in attaining
14 self-sufficiency may be given to or in behalf of the
15 applicant. The emergency assistance so given shall be by
16 vendor payment in an amount necessary to meet the need, up to
17 the maximum established by the local governmental unit.
18 Emergency assistance shall not be granted under this Section
19 more than once to any applicant during any 12 consecutive
20 month period.
21 (b) Persons currently receiving financial assistance
22 under this Article or under any other Article of this Code
23 shall not be eligible for emergency financial assistance
24 under this Section. Persons receiving only medical
25 assistance from the Illinois Department of Public Aid may,
26 however, receive emergency financial assistance under this
27 Section. Emergency financial assistance may be provided
28 under this Section to persons who are applicants for public
29 aid from the Illinois Department of Public Aid or the
30 Department of Human Services in order to cover time periods
31 prior to receipt of public aid from either or both of those
32 departments the Illinois Department.
33 (c) A local governmental unit may use General Assistance
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1 moneys to provide emergency financial assistance under this
2 Section but shall not use State funds to provide assistance
3 under this Section. If a local governmental unit receives
4 State funds to provide General Assistance under this Article,
5 assistance provided by the local governmental unit under
6 this Section shall not be considered in determining whether a
7 local governmental unit has qualified to receive State funds
8 under Article XII. A local governmental unit which provides
9 assistance under this Section shall not, as a result of
10 payment of such assistance, change the nature or amount of
11 assistance provided to any other individual or family under
12 this Article.
13 (Source: P.A. 88-412.)
14 (305 ILCS 5/6-11) (was 305 ILCS 5/6-11, subsecs. (a) and
15 (b))
16 Sec. 6-11. State funded General Assistance.
17 (a) Effective July 1, 1992, all State funded General
18 Assistance and related medical benefits shall be governed by
19 this Section through Section 6-11.15. Other parts of this
20 Code or other laws related to General Assistance shall remain
21 in effect to the extent they do not conflict with the
22 provisions of this Section through Section 6-11.15. If any
23 other part of this Code or other laws of this State conflict
24 with the provisions of this Section through Section 6-11.15,
25 the provisions of this Section through Section 6-11.15 shall
26 control.
27 (b) State funded General Assistance shall consist of 2
28 separate programs. One program shall be for adults with no
29 children and shall be known as State Transitional Assistance.
30 The other program shall be for families with children and for
31 pregnant women and shall be known as State Family and
32 Children Assistance.
33 (Source: P.A. 92-111, eff. 1-1-02.)
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1 (305 ILCS 5/6-11.5 new) (was 305 ILCS 5/6-11, subsecs.
2 (c) and (g))
3 Sec. 6-11.5. State Transitional Assistance.
4 (a) (c) (1) To be eligible for State Transitional
5 Assistance on or after July 1, 1992, an individual must be
6 ineligible for assistance under any other Article of this
7 Code, must be determined chronically needy, and must be one
8 of the following:
9 (1) (A) age 18 or over; or
10 (2) (B) married and living with a spouse,
11 regardless of age.
12 (b) (2) The Illinois Department of Human Services or the
13 local governmental unit shall determine whether individuals
14 are chronically needy as follows:
15 (1) (A) Individuals who have applied for
16 Supplemental Security Income (SSI) and are awaiting a
17 decision on eligibility for SSI who are determined
18 disabled by the Illinois Department of Human Services
19 using the SSI standard shall be considered chronically
20 needy, except that individuals whose disability is based
21 solely on substance addictions (drug abuse and
22 alcoholism) and whose disability would cease were their
23 addictions to end shall be eligible only for medical
24 assistance and shall not be eligible for cash assistance
25 under the State Transitional Assistance program.
26 (2) (B) If an individual has been denied SSI due to
27 a finding of "not disabled" (either at the Administrative
28 Law Judge level or above, or at a lower level if that
29 determination was not appealed), the Illinois Department
30 of Human Services shall adopt that finding and the
31 individual shall not be eligible for State Transitional
32 Assistance or any related medical benefits. Such an
33 individual may not be determined disabled by the Illinois
34 Department for a period of 12 months, unless the
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1 individual shows that there has been a substantial change
2 in his or her medical condition or that there has been a
3 substantial change in other factors, such as age or work
4 experience, that might change the determination of
5 disability.
6 (3) (C) The Illinois Department of Human Services,
7 by rule, may specify other categories of individuals as
8 chronically needy; nothing in Sections 6-11 through
9 6-11.15 this Section, however, shall be deemed to require
10 the inclusion of any specific category other than as
11 specified in paragraphs (1) (A) and (2) of this
12 subsection (B).
13 (c) (3) For individuals in State Transitional
14 Assistance, medical assistance shall be provided in an amount
15 and nature determined by the Illinois Department of Public
16 Aid by rule. The amount and nature of medical assistance
17 provided need not be the same as that provided under
18 paragraph (4) of subsection (d) of this Section 6-11.10, and
19 nothing in this subsection (c) paragraph (3) shall be
20 construed to require the coverage of any particular medical
21 service. In addition, the amount and nature of medical
22 assistance provided may be different for different categories
23 of individuals determined chronically needy.
24 (d) (4) The Illinois Department of Human Services shall
25 determine, by rule, those assistance recipients under Article
26 VI who shall be subject to employment, training, or education
27 programs including Earnfare, the content of those programs,
28 and the penalties for failure to cooperate in those programs.
29 (e) (5) The Illinois Department of Human Services shall,
30 by rule, establish further eligibility requirements,
31 including but not limited to residence, need, and the level
32 of payments.
33 (f) (g) Notwithstanding any other provision in this
34 Code, the Illinois Department of Human Services is authorized
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1 to reduce payment levels used to determine cash grants
2 provided to recipients of State Transitional Assistance at
3 any time within a Fiscal Year in order to ensure that cash
4 benefits for State Transitional Assistance do not exceed the
5 amounts appropriated for those cash benefits. Changes in
6 payment levels may be accomplished by emergency rule under
7 Section 5-45 of the Illinois Administrative Procedure Act,
8 except that the limitation on the number of emergency rules
9 that may be adopted in a 24-month period shall not apply and
10 the provisions of Sections 5-115 and 5-125 of the Illinois
11 Administrative Procedure Act shall not apply. This provision
12 shall also be applicable to any reduction in payment levels
13 made upon implementation of this amendatory Act of 1995.
14 (Source: P.A. 92-111, eff. 1-1-02.)
15 (305 ILCS 5/6-11.10 new) (was 305 ILCS 5/6-11, subsec.
16 (d))
17 Sec. 6-11.10. State Family and Children Assistance.
18 (a) (d) (1) To be eligible for State Family and Children
19 Assistance, a family unit must be ineligible for assistance
20 under any other Article of this Code and must contain a child
21 who is:
22 (1) (A) under age 18; or
23 (2) (B) age 18 and a full-time student in a
24 secondary school or the equivalent level of vocational or
25 technical training, and who may reasonably be expected to
26 complete the program before reaching age 19.
27 Those children shall be eligible for State Family and
28 Children Assistance.
29 (b) (2) The natural or adoptive parents of the child
30 living in the same household may be eligible for State Family
31 and Children Assistance.
32 (c) (3) A pregnant woman whose pregnancy has been
33 verified shall be eligible for income maintenance assistance
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1 under the State Family and Children Assistance program.
2 (d) (4) The amount and nature of medical assistance
3 provided under the State Family and Children Assistance
4 program shall be determined by the Illinois Department of
5 Public Aid by rule. The amount and nature of medical
6 assistance provided need not be the same as that provided
7 under paragraph (3) of subsection (c) of this Section 6-11.5,
8 and nothing in this subsection (d) paragraph (4) shall be
9 construed to require the coverage of any particular medical
10 service.
11 (e) (5) The Illinois Department of Human Services shall,
12 by rule, establish further eligibility requirements,
13 including but not limited to residence, need, and the level
14 of payments.
15 (Source: P.A. 92-111, eff. 1-1-02.)
16 (305 ILCS 5/6-11.15 new) (was 305 ILCS 5/6-11, subsecs.
17 (e) and (f))
18 Sec. 6-11.15. Local governmental units; funding.
19 (a) (e) A local governmental unit that chooses to
20 participate in a General Assistance program under Sections
21 6-11 through this Section shall provide funding in accordance
22 with Section 12-21.13 of this Act. Local governmental funds
23 used to qualify for State funding may only be expended for
24 clients eligible for assistance under Sections 6-11 through
25 this Section 6-11 and related administrative expenses.
26 (b) (f) In order to qualify for State funding under this
27 Section, a local governmental unit shall be subject to the
28 supervision and the rules and regulations of the Illinois
29 Department of Human Services.
30 (Source: P.A. 92-111, eff. 1-1-02.)
31 (305 ILCS 5/6-12) (from Ch. 23, par. 6-12)
32 Sec. 6-12. General Assistance not funded by State.
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1 General Assistance programs in local governments that do not
2 receive State funds shall continue to be governed by Sections
3 6-1 through 6-10, as applicable, as well as other relevant
4 parts of this Code and other laws. However, notwithstanding
5 any other provision of this Code, any unit of local
6 government that does not receive State funds may implement a
7 General Assistance program that complies with Sections
8 Section 6-11 through 6-11.15. So long as that program
9 complies with Sections Section 6-11 through 6-11.15, the
10 program shall not be deemed out of compliance with or in
11 violation of this Code.
12 (Source: P.A. 87-860.)
13 (305 ILCS 5/8A-2.5)
14 Sec. 8A-2.5. Unauthorized use of medical assistance.
15 (a) Any person who knowingly uses, acquires, possesses,
16 or transfers a medical card in any manner not authorized by
17 law or by rules and regulations of the Illinois Department of
18 Public Aid, or who knowingly alters a medical card, or who
19 knowingly uses, acquires, possesses, or transfers an altered
20 medical card, is guilty of a violation of this Article and
21 shall be punished as provided in Section 8A-6.
22 (b) Any person who knowingly obtains unauthorized
23 medical benefits with or without use of a medical card is
24 guilty of a violation of this Article and shall be punished
25 as provided in Section 8A-6.
26 (Source: P.A. 89-289, eff. 1-1-96.)
27 (305 ILCS 5/8A-4) (from Ch. 23, par. 8A-4)
28 Sec. 8A-4. Penalty for unauthorized use of federal food
29 stamps or federal food stamp benefits. Any person who
30 knowingly uses, acquires, possesses, or transfers federal
31 food stamps, or federal food stamp benefits, or Electronic
32 Benefit Transfer card for federal food stamp benefits, or
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1 authorizations to participate in the federal food stamp
2 program in any manner not authorized by law or the rules and
3 regulations of the Illinois Department of Human Services, or
4 who knowingly alters or uses, acquires, possesses or
5 transfers altered federal food stamps, or federal food stamp
6 benefits, or Electronic Benefit Transfer card for federal
7 food stamp benefits, or authorizations to participate in the
8 federal food stamp program, or who knowingly alters or
9 falsifies electronic federal food stamp benefit data or
10 possesses or uses altered or falsified electronic federal
11 food stamp benefit data for the purpose of making claims for
12 or receiving redemption of food stamp benefits or for the
13 substantiation of redemptions received, is guilty of a
14 violation of this Article and shall be punished as provided
15 in Section 8A-6.
16 (Source: P.A. 89-489, eff. 1-1-97.)
17 (305 ILCS 5/8A-4A) (from Ch. 23, par. 8A-4A)
18 Sec. 8A-4A. Penalty for unauthorized use of federal
19 surplus commodities. Any person who knowingly uses,
20 acquires, possesses, or transfers federal surplus food
21 commodities or authorizations to participate in the federal
22 surplus food commodities program, in original or altered
23 form, in any manner not authorized by law or the rules and
24 regulations of the Illinois Department of Human Services, or
25 who knowingly alters authorizations to participate in the
26 federal surplus food commodities program, is guilty of a
27 violation of this Article and shall be punished as provided
28 in Section 8A-6.
29 (Source: P.A. 85-555.)
30 (305 ILCS 5/8A-5) (from Ch. 23, par. 8A-5)
31 Sec. 8A-5. Administrative malfeasance.
32 (a) Any person who shall misappropriate, misuse or
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1 unlawfully withhold or convert to his own use or to the use
2 of another, any public funds made available for public aid
3 purposes under this Code is guilty of a violation of this
4 Article and shall be punished as provided in Section 8A-6.
5 (b) Any official or employee of the Illinois Department
6 of Public Aid or the Department of Human Services or of a,
7 county department or local governmental unit who willfully
8 fails to report a known violation of Sections 8A-2, 8A-3,
9 8A-4 or 8A-5 to the designated administrative personnel as
10 identified in the policy and procedures of the Illinois
11 Department of Public Aid or the Department of Human Services
12 for employees of either of those departments the Illinois
13 Department or of a county department, or to the State's
14 Attorney for employees of a local governmental unit, shall be
15 subject to disciplinary proceedings pursuant to regulations
16 of the Illinois Department of Public Aid or the Department of
17 Human Services or the local governmental unit.
18 (Source: P.A. 82-440.)
19 (305 ILCS 5/8A-5A) (from Ch. 23, par. 8A-5A)
20 Sec. 8A-5A. Unauthorized possession of identification
21 document. Any person who possesses for an unlawful purpose
22 another person's identification document issued by the
23 Illinois Department of Public Aid or the Department of Human
24 Services shall be guilty of a Class 4 felony. For purposes
25 of this Section, "identification document" includes but is
26 not limited to an authorization to participate in the federal
27 food stamp program or the federal surplus food commodities
28 program, or a card or other document which identifies a
29 person as being entitled to public aid under this Code.
30 (Source: P.A. 86-1012.)
31 (305 ILCS 5/8A-7) (was 305 ILCS 5/8A-7, subsecs. (a),
32 (b), and (c))
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1 Sec. 8A-7. Civil remedies.
2 (a) A person who receives financial aid by means of a
3 false statement, willful misrepresentation or by his failure
4 to notify the county department or local governmental unit,
5 as the case may be, of a change in his status as required by
6 Sections 11-18 and 11-19, for the purpose of preventing the
7 denial, cancellation or suspension of his grant, or a
8 variation in the amount thereof, or by other fraudulent
9 device, or a person who knowingly aids or abets any person in
10 obtaining financial aid for which he is not eligible, shall
11 be answerable to the county department or the local
12 governmental unit, as the case may be, for refunding the
13 entire amount of aid received. If the refund is not made, it
14 shall be recoverable in a civil action from the person who
15 received the aid, or from anyone who willfully aided such
16 person to obtain the aid.
17 If an act which would be unlawful under Section 8A-2 is
18 proven, the court may as a penalty assess an additional sum
19 of money, not to exceed the entire amount of aid provided,
20 against the recipient or against any person who willfully
21 aided the recipient. If assessed, the penalty shall be
22 included in any judgment entered for the aid received, and
23 paid to the county department or the local governmental unit,
24 as the case may be.
25 Upon entry of the judgment a lien shall attach to all
26 property and assets of such person until the judgment is
27 satisfied.
28 (b) Any person, firm, corporation, association, agency,
29 institution or other legal entity, other than an individual
30 recipient, that willfully, by means of a false statement or
31 representation, or by concealment of any material fact or by
32 other fraudulent scheme or device on behalf of himself or
33 others, obtains or attempts to obtain benefits or payments
34 under this Code to which he or it is not entitled, or in a
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1 greater amount than that to which he or it is entitled, shall
2 be liable for repayment of any excess benefits or payments
3 received and, in addition to any other penalties provided by
4 law, civil penalties consisting of (1) the interest on the
5 amount of excess benefits or payments at the maximum legal
6 rate in effect on the date the payment was made to such
7 person, firm, corporation, association, agency, institution
8 or other legal entity for the period from the date upon which
9 payment was made to the date upon which repayment is made to
10 the State, (2) an amount not to exceed 3 times the amount of
11 such excess benefits or payments, and (3) the sum of $2,000
12 for each excessive claim for benefits or payments.
13 Upon entry of a judgment for repayment of any excess
14 benefits or payments, or for any civil penalties assessed by
15 the court, a lien shall attach to all property and assets of
16 such person, firm, corporation, association, agency,
17 institution or other legal entity until the judgment is
18 satisfied.
19 (c) Civil recoveries provided for in this Section
20 through Section 8A-7.025 may be recoverable in court
21 proceedings initiated by the Attorney General or, in actions
22 involving a local governmental unit, by the State's Attorney.
23 (Source: P.A. 85-707.)
24 (305 ILCS 5/8A-7.05 new) (was 305 ILCS 8A-7, subsec. (d),
25 in part)
26 Sec. 8A-7.05. Forfeiture of money or other property.
27 (a) (d) Any person who commits the offense of vendor
28 fraud or recipient fraud as defined in Section 8A-2 and
29 Section 8A-3 of this Article shall forfeit, according to the
30 provisions of this Section through Section 8A-7.025
31 subsection, any monies, profits or proceeds, and any interest
32 or property which the sentencing court determines he has
33 acquired or maintained, directly or indirectly, in whole or
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1 in part as a result of such offense. Such person shall also
2 forfeit any interest in, securities of, claim against, or
3 contractual right of any kind which affords him a source of
4 influence over, any enterprise which he has established,
5 operated, controlled, conducted, or participated in
6 conducting, where his relationship to or connection with any
7 such thing or activity directly or indirectly, in whole or in
8 part, is traceable to any thing or benefit which he has
9 obtained or acquired through vendor fraud or recipient fraud.
10 (b) Proceedings instituted pursuant to this Section
11 through Section 8A-7.025 subsection shall be subject to and
12 conducted in accordance with the following procedures set
13 forth in Sections 8A-7.010 through 8A-7.025.:
14 (Source: P.A. 85-707.)
15 (305 ILCS 5/8A-7.010 new) (was 305 ILCS 5/8A-7, subsec.
16 (d), in part)
17 Sec. 8A-7.010. Forfeiture hearing. (1) The sentencing
18 court shall, upon petition by the Attorney General or State's
19 Attorney at any time following sentencing, conduct a hearing
20 to determine whether any property or property interest is
21 subject to forfeiture under Sections 8A-7.05 through 8A-7.025
22 this subsection. At the forfeiture hearing the People shall
23 have the burden of establishing, by a preponderance of the
24 evidence, that the property or property interests are subject
25 to such forfeiture.
26 (Source: P.A. 85-707.)
27 (305 ILCS 5/8A-7.015 new) (was 305 ILCS 5/8A-7, subsec.
28 (d), in part)
29 Sec. 8A-7.015. Restraining order, injunction, or
30 prohibition.
31 (a) (2) In any action brought by the People of the State
32 of Illinois under Sections 8A-7 through 8A-7.025 this
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1 Section, in which any restraining order, injunction or
2 prohibition or any other action in connection with any
3 property or interest subject to forfeiture under Sections
4 8A-7.05 through 8A-7.025 this subsection is sought, the
5 circuit court presiding over the trial of the person charged
6 with recipient fraud or vendor fraud as defined in Sections
7 8A-2 or 8A-3 of this Article shall first determine whether
8 there is probable cause to believe that the person so charged
9 has committed the offense of recipient fraud or vendor fraud
10 and whether the property or interest is subject to forfeiture
11 under Sections 8A-7.05 through 8A-7.025 this subsection.
12 (b) To make such a determination, prior to entering any
13 such order, the court shall conduct a hearing without a jury,
14 at which the People shall establish that there is (i)
15 probable cause that the person so charged has committed the
16 offense of recipient fraud or vendor fraud and (ii) probable
17 cause that any property or interest may be subject to
18 forfeiture pursuant to Sections 8A-7.05 through 8A-7.025 this
19 subsection. Such hearing may be conducted simultaneously
20 with a preliminary hearing, if the prosecution is commenced
21 by information or complaint, or by motion of the People at
22 any stage in the proceedings.
23 (c) The court may accept a finding of probable cause at
24 a preliminary hearing following the filing of an information
25 charging the offense of recipient fraud or vendor fraud as
26 defined in Sections 8A-2 or 8A-3 or the return of an
27 indictment by a grand jury charging the offense of recipient
28 fraud or vendor fraud as defined in Sections 8A-2 or 8A-3 of
29 this Article as sufficient evidence of probable cause as
30 provided in item (i) above. Upon such a finding, the circuit
31 court shall enter such restraining order, injunction or
32 prohibition, or shall take such other action in connection
33 with any such property or other interest subject to
34 forfeiture under this Act as is necessary to insure that such
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1 property is not removed from the jurisdiction of the court,
2 concealed, destroyed or otherwise disposed of by the owner of
3 that property or interest prior to a forfeiture hearing under
4 Section 8A-7.010 this subsection.
5 (d) The Attorney General or State's Attorney shall file
6 a certified copy of such restraining order, injunction or
7 other prohibition with the recorder of deeds or registrar of
8 titles of each county where any such property of the
9 defendant may be located. No such injunction, restraining
10 order or other prohibition shall affect the rights of any
11 bonafide purchaser, mortgagee, judgement creditor or other
12 lien holder arising prior to the date of such filing.
13 (e) The court may, at any time, upon verified petition
14 by the defendant, conduct a hearing to determine whether all
15 or portions of any such property or interest which the court
16 previously determined to be subject to forfeiture or subject
17 to any restraining order, injunction, or prohibition or other
18 action, should be released. The court may in its discretion
19 release such property to the defendant for good cause shown.
20 (Source: P.A. 85-707.)
21 (305 ILCS 5/8A-7.020 new) (was 305 ILCS 5/8A-7, subsec.
22 (d), in part)
23 Sec. 8A-7.020. Seizure of property. (3) Upon conviction
24 of a person under this Article, the court shall authorize the
25 Director of the Illinois Department of State Police to seize
26 all property or other interest declared forfeited under
27 Sections 8A-7.05 through 8A-7.025 this subsection upon such
28 terms and conditions as the court shall deem proper.
29 (Source: P.A. 85-707.)
30 (305 ILCS 5/8A-7.025 new) (was 305 ILCS 5/8A-7, subsec.
31 (d), in part)
32 Sec. 8A-7.025. Sale of forfeited property; distribution
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1 of proceeds.
2 (a) (4) The Director of the Illinois Department of State
3 Police is authorized to sell all property forfeited and
4 seized pursuant to Section 8A-7.05 through this Section
5 subsection, unless such property is required by law to be
6 destroyed or is harmful to the public.
7 (b) After the deduction of all requisite expenses of
8 administration and sale, the court shall order the Director
9 of State Police to distribute to the Illinois Department of
10 Public Aid or the Department of Human Services, or both, an
11 amount from the proceeds of the forfeited property, or monies
12 forfeited or seized, which will satisfy any unsatisfied court
13 order of restitution entered pursuant to a conviction under
14 this Article. If the proceeds are less than the amount
15 necessary to satisfy the order of restitution, the Director
16 of State Police shall distribute to the Illinois Department
17 of Public Aid or the Department of Human Services, or both,
18 the entire amount of the remaining proceeds.
19 (c) The Director of State Police shall distribute any
20 remaining proceeds of such sale, along with any monies
21 forfeited or seized, in accordance with the following
22 schedules:
23 (A) 25% shall be distributed to the unit of local
24 government whose officers or employees conducted the
25 investigation into recipient fraud or vendor fraud and
26 caused the arrest or arrests and prosecution leading to
27 the forfeiture. Amounts distributed to units of local
28 government shall be used solely for enforcement matters
29 relating to detection, investigation or prosecution of
30 recipient fraud or vendor fraud as defined in Section
31 8A-2 or 8A-3 of this Article.
32 Where the investigation, arrest or arrests leading
33 to the prosecution and forfeiture is undertaken solely by
34 the Illinois Department of State Police, the portion
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1 provided hereunder shall be paid into the Medicaid Fraud
2 and Abuse Prevention Fund, which is hereby created in the
3 State treasury. Monies from this fund shall be used by
4 the Department of State Police for the furtherance of
5 enforcement matters relating to detection, investigation
6 or prosecution of recipient fraud or vendor fraud.
7 Monies directed to this fund shall be used in addition
8 to, and not as a substitute for, funds annually
9 appropriated to the Department of State Police for
10 medicaid fraud enforcement.
11 (B) 25% shall be distributed to the county in which
12 the prosecution and petition for forfeiture resulting in
13 the forfeiture was instituted, and deposited in a special
14 fund in the county treasury and appropriated to the
15 State's Attorney for use solely in enforcement matters
16 relating to detection, investigation or prosecution of
17 recipient fraud or vendor fraud; however, if the Attorney
18 General brought the prosecution resulting in the
19 forfeiture, the portion provided hereunder shall be paid
20 into the Medicaid Fraud and Abuse Prevention Fund, to be
21 used by the Medicaid Fraud Control Unit of the Illinois
22 Department of State Police for enforcement matters
23 relating to detection, investigation or prosecution of
24 recipient fraud or vendor fraud. Where the Attorney
25 General and a State's Attorney have jointly participated
26 in any portion of the proceedings, 12.5% shall be
27 distributed to the county in which the prosecution
28 resulting in the forfeiture was instituted, and used as
29 specified herein, and 12.5% shall be paid into the
30 Medicaid Fraud and Abuse Prevention Fund, and used as
31 specified herein.
32 (C) 50% shall be transmitted to the State Treasurer
33 for deposit in the General Revenue Fund.
34 (Source: P.A. 85-707.)
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1 (305 ILCS 5/8A-7.1) (from Ch. 23, par. 8A-7.1)
2 Sec. 8A-7.1. Health care professional; danger to the
3 public. The Director, upon making a determination based upon
4 information in the possession of the Illinois Department,
5 that continuation in practice of a licensed health care
6 professional would constitute an immediate danger to the
7 public, shall submit a written communication to the Director
8 of Professional Regulation indicating such determination and
9 additionally providing a complete summary of the information
10 upon which such determination is based, and recommending that
11 the Director of Professional Regulation immediately suspend
12 such person's license. All relevant evidence, or copies
13 thereof, in the Illinois Department's possession may also be
14 submitted in conjunction with the written communication. A
15 copy of such written communication, which is exempt from the
16 copying and inspection provisions of the Freedom of
17 Information Act, shall at the time of submittal to the
18 Director of Professional Regulation be simultaneously mailed
19 to the last known business address of such licensed health
20 care professional by certified or registered postage, United
21 States Mail, return receipt requested. Any evidence, or
22 copies thereof, which is submitted in conjunction with the
23 written communication is also exempt from the copying and
24 inspection provisions of the Freedom of Information Act.
25 The Director, upon making a determination based upon
26 information in the possession of the Illinois Department,
27 that a licensed health care professional is willfully
28 committing fraud upon the Illinois Department's medical
29 assistance program, shall submit a written communication to
30 the Director of Professional Regulation indicating such
31 determination and additionally providing a complete summary
32 of the information upon which such determination is based.
33 All relevant evidence, or copies thereof, in the Illinois
34 Department's possession may also be submitted in conjunction
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1 with the written communication.
2 Upon receipt of such written communication, the Director
3 of Professional Regulation shall promptly investigate the
4 allegations contained in such written communication. A copy
5 of such written communication, which is exempt from the
6 copying and inspection provisions of the Freedom of
7 Information Act, shall at the time of submission to the
8 Director of Professional Regulation, be simultaneously mailed
9 to the last known address of such licensed health care
10 professional by certified or registered postage, United
11 States Mail, return receipt requested. Any evidence, or
12 copies thereof, which is submitted in conjunction with the
13 written communication is also exempt from the copying and
14 inspection provisions of the Freedom of Information Act.
15 For the purposes of this Section, "licensed health care
16 professional" means any person licensed under the Illinois
17 Dental Practice Act, the Nursing and Advanced Practice
18 Nursing Act, the Medical Practice Act of 1987, the Pharmacy
19 Practice Act of 1987, the Podiatric Medical Practice Act of
20 1987, or and the Illinois Optometric Practice Act of 1987.
21 (Source: P.A. 90-742, eff. 8-13-98; revised 12-13-01.)
22 (305 ILCS 5/8A-8) (from Ch. 23, par. 8A-8)
23 Sec. 8A-8. Future participation in the public assistance
24 program.
25 (a) Any person applying for public assistance under this
26 Code who has been found guilty of a violation of this Article
27 or of any law of the United States or of any state which is
28 substantially similar to Sections 8A-2 through 8A-5 for
29 violations related to public assistance or medical assistance
30 programs of the kind provided under this Code and who has not
31 been previously convicted for a violation of this Article or
32 of any law of the United States or of any state which is
33 substantially similar to Sections 8A-2 through 8A-5 for
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1 violations related to public assistance or medical assistance
2 programs of the kind provided under this Code shall have
3 applications for public assistance under this Code reviewed
4 by an administrative review board to determine the person's
5 eligibility and the need for administrative safeguards to
6 prevent any such further violations. The administrative
7 review board shall be composed of not less than two persons
8 who are selected in accordance with regulations of the
9 Illinois Department or the local governmental unit. Hearings
10 conducted by the board shall:
11 (1) be of an informal nature, permitting the
12 applicant to attend at his option;
13 (2) be open to the public, unless the applicant and
14 the administrative review board determine otherwise;
15 (3) be subject to reasonable time and notification
16 requirements as determined by regulations of the Illinois
17 Department or local governmental units; and
18 (4) be held at a location convenient to the
19 applicant.
20 At the hearing, the administrative review board may deny
21 the application based on an investigation of the person's
22 eligibility, or the board may appoint a substitute payee,
23 require more frequent visits or consultations, more frequent
24 financial reports or require any other action to the extent
25 permitted by State and federal law and regulations. A
26 decision by the administrative review board to deny a
27 person's application shall only be based on the person's
28 failure to qualify under the eligibility criteria applicable
29 to all applicants for the public assistance program in
30 question. Any decision by the administrative review board may
31 be appealed pursuant to the provisions of this Code. In no
32 instance shall the administrative review board delay the
33 hearing or its decision beyond the time allowed under State
34 or federal law and regulations for determining an applicant's
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1 eligibility for public assistance.
2 If the person has been determined eligible, the Illinois
3 Department or the local governmental unit may recoup prior
4 payments obtained in violation of this Article from the
5 current cash assistance grants, unless such payments have
6 previously been repaid. The Illinois Department or the local
7 governmental unit, on a case by case basis, shall limit the
8 amount deducted from the current cash assistance grant so as
9 not to cause undue hardship to the person.
10 (b) To the extent permitted under federal law, any person
11 found guilty of a first violation of this Article or of any
12 law of the United States or of any state which is
13 substantially similar to Sections 8A-2 through 8A-5 for
14 violations related to public assistance or medical assistance
15 programs of the kind provided under this Code may be
16 suspended from eligibility for public aid under this Code.
17 Any person found guilty of a second or subsequent violation
18 of this Article or of any law of the United States or of any
19 state which is substantially similar to Sections 8A-2 through
20 8A-5 for violations related to public assistance or medical
21 assistance programs of the kind provided under this Code
22 shall be ineligible for public aid under this Code.
23 (c) In no instance shall this Section adversely affect
24 the eligibility of children who are in need of public aid
25 under this Code, or the amount of the grant received by such
26 children. If a child's caretaker relative is adversely
27 affected by this Section, a substitute payee may be appointed
28 until the Illinois Department can determine, by rule, that
29 the caretaker relative can manage the public aid in the best
30 interest of the child.
31 (d) Any person, firm, corporation, association, agency,
32 institution or other legal entity that has been convicted of
33 a violation of this Article shall be prohibited from
34 participating as a vendor of goods or services to recipients
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1 of public aid under this Code. Such prohibition shall extend
2 to any person with management responsibility in a firm,
3 corporation, association, agency, institution, or other legal
4 entity that has been convicted of any such violation and to
5 an officer or person owning, either directly or indirectly,
6 5% or more of the shares of stock or other evidences of
7 ownership in a corporation.
8 (e) Any employee of the Illinois Department, county
9 department or local governmental unit who has been found
10 guilty of a violation of this Article shall be terminated
11 from employment.
12 (Source: P.A. 89-489, eff. 1-1-97; 90-725, eff. 8-7-98.)
13 (305 ILCS 5/8A-9) (from Ch. 23, par. 8A-9)
14 Sec. 8A-9. Special Investigations Unit. There shall be
15 established within the administrative staff a unit to
16 investigate all matters pertaining to the fraudulent
17 acquisition of public aid, including administrative funds.
18 The investigation may be conducted without prior notice to
19 the recipients, to the personnel administering the cases or
20 to vendors or other persons involved. The unit shall also
21 investigate any other matter relating to the administration
22 of public aid assigned to it by the Director of the Illinois
23 Department. The Illinois Department may make the facts
24 revealed by any investigation available to the Attorney
25 General or to the appropriate State's Attorney.
26 (Source: P.A. 82-440.)
27 (305 ILCS 5/8A-11) (from Ch. 23, par. 8A-11)
28 Sec. 8A-11. Medical assistance; prohibited acts.
29 (a) No person shall:
30 (1) Knowingly charge a resident of a nursing home
31 for any services provided pursuant to Article V of the
32 Illinois Public Aid Code, money or other consideration at
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1 a rate in excess of the rates established for covered
2 services by the Illinois Department of Public Aid
3 pursuant to Article V of the Illinois Public Aid Code; or
4 (2) Knowingly charge, solicit, accept or receive,
5 in addition to any amount otherwise authorized or
6 required to be paid pursuant to Article V of the Illinois
7 Public Aid Code, any gift, money, donation or other
8 consideration:
9 (i) As a precondition to admitting or
10 expediting the admission of a recipient or
11 applicant, pursuant to Article V of the Illinois
12 Public Aid Code, to a long-term care facility as
13 defined in Section 1-113 of the Nursing Home Care
14 Act; and
15 (ii) As a requirement for the recipient's or
16 applicant's continued stay in such facility when the
17 cost of the services provided therein to the
18 recipient is paid for, in whole or in part, pursuant
19 to Article V of the Illinois Public Aid Code.
20 (b) Nothing herein shall prohibit a person from making a
21 voluntary contribution, gift or donation to a long-term care
22 facility.
23 (c) This paragraph shall not apply to agreements to
24 provide continuing care or life care between a life care
25 facility as defined by the Life Care Facilities Act, and a
26 person financially eligible for benefits pursuant to Article
27 V of the Illinois Public Aid Code.
28 (d) Any person who violates this Section shall be guilty
29 of a business offense and fined not less than $5,000 nor more
30 than $25,000.
31 (e) "Person", as used in this Section, means an
32 individual, corporation, partnership, or unincorporated
33 association.
34 (f) The State's Attorney of the county in which the
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1 facility is located and the Attorney General shall be
2 notified by the Illinois Department of Public Aid of any
3 alleged violations of this Section known to the Department.
4 (g) The Illinois Department of Public Aid shall adopt
5 rules and regulations to carry out the provisions of this
6 Section.
7 (Source: P.A. 86-820.)
8 (305 ILCS 5/8A-12)
9 Sec. 8A-12. Early fraud prevention and detection
10 program. The Illinois Department may conduct an early fraud
11 prevention and detection program as provided in this Section.
12 If conducted, the program shall apply to all categories of
13 assistance and all applicants for aid. The program may be
14 conducted in appropriate counties as determined by the
15 Department. The program shall have the following features:
16 (1) No intimidation of applicants or recipients may
17 occur, either by referral or threat of referral for a
18 fraud prevention investigation.
19 (2) An applicant may not be referred for a fraud
20 prevention investigation until an application for aid is
21 completed and signed by the applicant or any authorized
22 representative.
23 (3) An applicant may be referred to the Inspector
24 General for a fraud prevention investigation if there are
25 reasonable grounds to question the accuracy of any
26 information, statements, documents, or other
27 representations by the applicant or any authorized
28 representative. Referrals for fraud prevention
29 investigations shall be made in accordance with
30 guidelines to be jointly determined by the Inspector
31 General and the Department.
32 (Source: P.A. 89-118, eff. 7-7-95.)
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1 (305 ILCS 5/8A-16)
2 Sec. 8A-16. Unfair or deceptive marketing practices.
3 (a) As used in this Section, "health plan" has the
4 meaning attributed to that term in Section 8A-13.
5 (b) It is unlawful to knowingly and willfully engage in
6 any unfair or deceptive marketing practice in connection with
7 proposing, offering, selling, soliciting, or providing any
8 health care service or any health plan. Unfair or deceptive
9 marketing practices include the following:
10 (1) Making a false and misleading oral or written
11 statement, visual description, advertisement, or other
12 representation of any kind that has the capacity,
13 tendency, or effect of deceiving or misleading health
14 care consumers with respect to any health care service,
15 health plan, or health care provider.
16 (2) Making a representation that a health care plan
17 or a health care provider offers any service, benefit,
18 access to care, or choice that it does not in fact offer.
19 (3) Making a representation that a health plan or
20 health care provider has any status, certification,
21 qualification, sponsorship, affiliation, or licensure
22 that it does not have.
23 (4) A failure to state a material fact if the
24 failure deceives or tends to deceive.
25 (5) Offering any kickback, bribe, reward, or
26 benefit to any person as an inducement to select or to
27 refrain from s