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Public Act 101-0265


 

Public Act 0265 101ST GENERAL ASSEMBLY

  
  
  

 


 
Public Act 101-0265
 
HB2659 EnrolledLRB101 09331 KTG 54427 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Public Aid Code is amended by
changing Section 11-5.4 as follows:
 
    (305 ILCS 5/11-5.4)
    Sec. 11-5.4. Expedited long-term care eligibility
determination and enrollment.
    (a) Establishment of the expedited long-term care
eligibility determination and enrollment system shall be a
joint venture of the Departments of Human Services and
Healthcare and Family Services and the Department on Aging.
    (b) Streamlined application enrollment process; expedited
eligibility process. The streamlined application and
enrollment process must include, but need not be limited to,
the following:
        (1) On or before July 1, 2019, a streamlined
    application and enrollment process shall be put in place
    which must include, but need not be limited to, the
    following:
            (A) Minimize the burden on applicants by
        collecting only the data necessary to determine
        eligibility for medical services, long-term care
        services, and spousal impoverishment offset.
            (B) Integrate online data sources to simplify the
        application process by reducing the amount of
        information needed to be entered and to expedite
        eligibility verification.
            (C) Provide online prompts to alert the applicant
        that information is missing or not complete.
            (D) Provide training and step-by-step written
        instructions for caseworkers, applicants, and
        providers.
        (2) The State must expedite the eligibility process for
    applicants meeting specified guidelines, regardless of the
    age of the application. The guidelines, subject to federal
    approval, must include, but need not be limited to, the
    following individually or collectively:
            (A) Full Medicaid benefits in the community for a
        specified period of time.
            (B) No transfer of assets or resources during the
        federally prescribed look-back period, as specified in
        federal law.
            (C) Receives Supplemental Security Income payments
        or was receiving such payments at the time of admission
        to a nursing facility.
            (D) For applicants or recipients with verified
        income at or below 100% of the federal poverty level
        when the declared value of their countable resources is
        no greater than the allowable amounts pursuant to
        Section 5-2 of this Code for classes of eligible
        persons for whom a resource limit applies. Such
        simplified verification policies shall apply to
        community cases as well as long-term care cases.
        (3) Subject to federal approval, the Department of
    Healthcare and Family Services must implement an ex parte
    renewal process for Medicaid-eligible individuals residing
    in long-term care facilities. "Renewal" has the same
    meaning as "redetermination" in State policies,
    administrative rule, and federal Medicaid law. The ex parte
    renewal process must be fully operational on or before
    January 1, 2019.
        (4) The Department of Human Services must use the
    standards and distribution requirements described in this
    subsection and in Section 11-6 for notification of missing
    supporting documents and information during all phases of
    the application process: initial, renewal, and appeal.
    (c) The Department of Human Services must adopt policies
and procedures to improve communication between long-term care
benefits central office personnel, applicants and their
representatives, and facilities in which the applicants
reside. Such policies and procedures must at a minimum permit
applicants and their representatives and the facility in which
the applicants reside to speak directly to an individual
trained to take telephone inquiries and provide appropriate
responses.
    (d) Effective 30 days after the completion of 3 regionally
based trainings, nursing facilities shall submit all
applications for medical assistance online via the Application
for Benefits Eligibility (ABE) website. This requirement shall
extend to scanning and uploading with the online application
any required additional forms such as the Long Term Care
Facility Notification and the Additional Financial Information
for Long Term Care Applicants as well as scanned copies of any
supporting documentation. Long-term care facility admission
documents must be submitted as required in Section 5-5 of this
Code. No local Department of Human Services office shall refuse
to accept an electronically filed application. No Department of
Human Services office shall request submission of any document
in hard copy.
    (e) Notwithstanding any other provision of this Code, the
Department of Human Services and the Department of Healthcare
and Family Services' Office of the Inspector General shall,
upon request, allow an applicant additional time to submit
information and documents needed as part of a review of
available resources or resources transferred during the
look-back period. The initial extension shall not exceed 30
days. A second extension of 30 days may be granted upon
request. Any request for information issued by the State to an
applicant shall include the following: an explanation of the
information required and the date by which the information must
be submitted; a statement that failure to respond in a timely
manner can result in denial of the application; a statement
that the applicant or the facility in the name of the applicant
may seek an extension; and the name and contact information of
a caseworker in case of questions. Any such request for
information shall also be sent to the facility. In deciding
whether to grant an extension, the Department of Human Services
or the Department of Healthcare and Family Services' Office of
the Inspector General shall take into account what is in the
best interest of the applicant. The time limits for processing
an application shall be tolled during the period of any
extension granted under this subsection.
    (f) The Department of Human Services and the Department of
Healthcare and Family Services must jointly compile data on
pending applications, denials, appeals, and redeterminations
into a monthly report, which shall be posted on each
Department's website for the purposes of monitoring long-term
care eligibility processing. The report must specify the number
of applications and redeterminations pending long-term care
eligibility determination and admission and the number of
appeals of denials in the following categories:
        (A) Length of time applications, redeterminations, and
    appeals are pending - 0 to 45 days, 46 days to 90 days, 91
    days to 180 days, 181 days to 12 months, over 12 months to
    18 months, over 18 months to 24 months, and over 24 months.
        (B) Percentage of applications and redeterminations
    pending in the Department of Human Services' Family
    Community Resource Centers, in the Department of Human
    Services' long-term care hubs, with the Department of
    Healthcare and Family Services' Office of Inspector
    General, and those applications which are being tolled due
    to requests for extension of time for additional
    information.
        (C) Status of pending applications, denials, appeals,
    and redeterminations.
    (g) Beginning on July 1, 2017, the Auditor General shall
report every 3 years to the General Assembly on the performance
and compliance of the Department of Healthcare and Family
Services, the Department of Human Services, and the Department
on Aging in meeting the requirements of this Section and the
federal requirements concerning eligibility determinations for
Medicaid long-term care services and supports, and shall report
any issues or deficiencies and make recommendations. The
Auditor General shall, at a minimum, review, consider, and
evaluate the following:
        (1) compliance with federal regulations on furnishing
    services as related to Medicaid long-term care services and
    supports as provided under 42 CFR 435.930;
        (2) compliance with federal regulations on the timely
    determination of eligibility as provided under 42 CFR
    435.912;
        (3) the accuracy and completeness of the report
    required under paragraph (9) of subsection (e);
        (4) the efficacy and efficiency of the task-based
    process used for making eligibility determinations in the
    centralized offices of the Department of Human Services for
    long-term care services, including the role of the State's
    integrated eligibility system, as opposed to the
    traditional caseworker-specific process from which these
    central offices have converted; and
        (5) any issues affecting eligibility determinations
    related to the Department of Human Services' staff
    completing Medicaid eligibility determinations instead of
    the designated single-state Medicaid agency in Illinois,
    the Department of Healthcare and Family Services.
    The Auditor General's report shall include any and all
other areas or issues which are identified through an annual
review. Paragraphs (1) through (5) of this subsection shall not
be construed to limit the scope of the annual review and the
Auditor General's authority to thoroughly and completely
evaluate any and all processes, policies, and procedures
concerning compliance with federal and State law requirements
on eligibility determinations for Medicaid long-term care
services and supports.
    (h) The Department of Healthcare and Family Services shall
adopt any rules necessary to administer and enforce any
provision of this Section. Rulemaking shall not delay the full
implementation of this Section.
    (g) The Department shall adopt rules necessary to
administer and enforce any provision of this Section.
Rulemaking shall not delay the full implementation of this
Section.
    (i) (h) Beginning on June 29, 2018, provisional
eligibility, in the form of a recipient identification number
and any other necessary credentials to permit an applicant to
receive benefits, must be issued to any applicant who has not
received a final eligibility determination on his or her
application for Medicaid or Medicaid long-term care benefits or
a notice of an opportunity for a hearing within the federally
prescribed deadlines for the processing of such applications.
The Department must maintain the applicant's provisional
Medicaid enrollment status until a final eligibility
determination is approved or the applicant's appeal has been
adjudicated and eligibility is denied. The Department or the
managed care organization, if applicable, must reimburse
providers for services rendered during an applicant's
provisional eligibility period.
        (1) Claims for services rendered to an applicant with
    provisional eligibility status must be submitted and
    processed in the same manner as those submitted on behalf
    of beneficiaries determined to qualify for benefits.
        (2) An applicant with provisional enrollment status
    must have his or her benefits paid for under the State's
    fee-for-service system until the State makes a final
    determination on the applicant's Medicaid or Medicaid
    long-term care application. If an individual is enrolled
    with a managed care organization for community benefits at
    the time the individual's provisional status is issued, the
    managed care organization is only responsible for paying
    benefits covered under the capitation payment received by
    the managed care organization for the individual.
        (3) The Department, within 10 business days of issuing
    provisional eligibility to an applicant, must submit to the
    Office of the Comptroller for payment a voucher for all
    retroactive reimbursement due. The Department must clearly
    identify such vouchers as provisional eligibility
    vouchers.
(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17;
100-665, eff. 8-2-18; 100-1141, eff. 11-28-18.)
 
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 8/9/2019