SB2913 100TH GENERAL ASSEMBLY

LRB100 18099 KTG 34358 b

100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
SB2913

Introduced 2/14/2018, by Sen. John G. Mulroe

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5g new
305 ILCS 5/11-5.4

Amends the Illinois Public Aid Code. Requires long-term care providers to submit all changes in resident status, including, but not limited to, death, discharge, changes in patient credit, third party liability, and Medicare coverage to the Department of Healthcare and Family Services through the Medical Electronic Data Interchange System, the Recipient Eligibility Verification System, or the Electronic Data Interchange System under a specified schedule. Requires the Department and other agencies to establish an expedited long-term care eligibility determination and enrollment system. Requires the Director of Healthcare and Family Services, in coordination with the Secretary of Human Services and the Director of Aging, to hold meetings for provider associations representing facilities licensed under the Nursing Home Care Act and certified as supportive living programs. Provides that the meetings shall be held every 6 weeks until all backlogged cases have been adjudicated and the application process has been reduced to the federal timeframe. Contains provisions concerning a 45-day extension of the federal eligibility application processing deadline in suspected cases of fraud; the identification of applicants who had full Medicaid benefits in the community for 6 months or more immediately before entering the long-term care facility; reporting requirements; public-private partnerships aimed at redeploying caseworkers to targeted high-Medicaid facilities for the purpose of expediting initial Medicaid and long-term care benefits applications; the establishment of a Health Insurance Portability and Accountability Act compliant database; and other matters. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

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 and by adding Section 5-5g as follows:

(305 ILCS 5/5-5g new)

Sec. 5-5g. Long-term care patient; resident status. Long-term care providers shall submit all changes in resident status, including, but not limited to, death, discharge, changes in patient credit, third party liability, and Medicare coverage to the Department through the Medical Electronic Data Interchange System, the Recipient Eligibility Verification System, or the Electronic Data Interchange System established under 89 Ill. Adm. Code 140.55(b) in compliance with the schedule below:

(1) 15 calendar days after a resident's death;

(2) 15 calendar days after a resident's discharge;

(3) 45 calendar days after being informed of a change in the resident's income;

(4) 45 calendar days after being informed of a change in a resident's third party liability;

(5) 45 calendar days after a resident's need for services requiring reimbursement under the ventilator or traumatic brain injury enhanced rate.

(305 ILCS 5/11-5.4)

Sec. 11-5.4. Expedited long-term care eligibility determination and enrollment.

(a) The General Assembly finds that it is in the best interest of the State to process on an expedited basis applications for Medicaid and Medicaid long-term care benefits that are submitted by or on behalf of elderly persons in need of long-term care services. It is the intent of the General Assembly that the provisions of this Section be liberally construed to permit the maximum number of applicants to benefit, regardless of the age of the application, and for the State to meet the federal eligibility processing deadlines. An expedited long-term care eligibility determination and enrollment system shall be established to reduce long-term care determinations to 90 days or fewer by July 1, 2014 and streamline the long-term care enrollment process. Establishment of the system shall be a joint venture of the

(1) The Department of Human Services and Healthcare and Family Services and the Department on Aging shall establish an expedited long-term care eligibility determination and enrollment system. The Department of Healthcare and Family Services shall serve as the lead agency assuming primary responsibility for the full implementation of this Section, including the establishment and maintenance of the system. The Governor shall name a lead agency no later than 30 days after the effective date of this amendatory Act of the 98th General Assembly to assume responsibility for the full implementation of the establishment and maintenance of the system. Project outcomes shall include an enhanced eligibility determination tracking system accessible to providers and a centralized application review and eligibility determination with all applicants reviewed within 90 days of receipt by the State of a complete application.

(2) The Director of Healthcare and Family Services, in coordination with the Secretary of Human Services and the Director of Aging, shall hold meetings for provider associations representing facilities licensed under the Nursing Home Care Act and certified as supportive living programs. The first meeting shall be held no later than 30 days after the effective date of this amendatory Act of the 100th General Assembly. The meetings shall be held every 6 weeks until all backlogged cases have been adjudicated and the application process has been reduced to the federal timeframe. After all backlogged cases have been adjudicated and the application process has been reduced to the federal timeframe, the meetings shall be held quarterly. Each agency shall be represented by senior staff with hands-on knowledge of the processing of applications for Medicaid, long-term care benefits, and redeterminations and such ancillary issues as income and address adjustments, release forms, and screening reports. Agenda items shall be solicited from the associations.

(3) If the Department of Healthcare and Family Services' Office of the Inspector General obtains credible evidence that an applicant has transferred assets with the intent of defrauding the State, the federal eligibility application processing deadline shall be extended by 45 days. If at the end of the extended deadline proof of the allegations does not exist, the application shall be assigned for an expedited resolve. determines that there is a likelihood that a non-allowable transfer of assets has occurred, and the facility in which the applicant resides is notified, an extension of up to 90 days shall be permissible. On or before December 31, 2015, a streamlined application and enrollment process shall be put in place based on the following principles:

(A) (1) 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) (2) 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) (3) Provide online prompts to alert the applicant that information is missing or not complete.

(D) On or before January 1, 2019, triage new applications and backlogged applications to identify applicants who had full Medicaid benefits in the community for a period of 6 months or more immediately before entering the long-term care facility.

(b) The Department shall, on or before July 1, 2014, assess the feasibility of incorporating all information needed to determine eligibility for long-term care services, including asset transfer and spousal impoverishment financials, into the State's integrated eligibility system identifying all resources needed and reasonable timeframes for achieving the specified integration.

(c) The Department of Healthcare and Family Services lead agency shall file a report with the 4 legislative leaders no later than January 1, 2019, and every January 1 thereafter, describing what each agency had accomplished in the preceding year to: reduce the backlog of Medicaid and long-term care benefits applications and redeterminations, reduce initial application processing to the federal timeframe, and eliminate the occurrence of hospital patients being discharged prior to the completion of preadmission screens. interim reports with the Chairs and Minority Spokespersons of the House and Senate Human Services Committees no later than September 1, 2013 and on February 1, 2014. The Department of Healthcare and Family Services shall include in the annual Medicaid report for State Fiscal Year 2014 and every fiscal year thereafter information concerning implementation of the provisions of this Section.

(d) (Blank). No later than August 1, 2014, the Auditor General shall report to the General Assembly concerning the extent to which the timeframes specified in this Section have been met and the extent to which State staffing levels are adequate to meet the requirements of this Section.

(e) The Department of Healthcare and Family Services, the Department of Human Services, and the Department on Aging shall take all necessary the following steps to achieve federally established timeframes for eligibility determinations for Medicaid and long-term care benefits, including, but not limited to, implementing policies and adopting rules to simplify financial eligibility verification, including, but not limited to, the following instances: and shall work toward the federal goal of real time determinations:

(1) (Blank). The Departments shall review, in collaboration with representatives of affected providers, all forms and procedures currently in use, federal guidelines either suggested or mandated, and staff deployment by September 30, 2014 to identify additional measures that can improve long-term care eligibility processing and make adjustments where possible.

(2) (Blank). No later than June 30, 2014, the Department of Healthcare and Family Services shall issue vouchers for advance payments not to exceed $50,000,000 to nursing facilities with significant outstanding Medicaid liability associated with services provided to residents with Medicaid applications pending and residents facing the greatest delays. Each facility with an advance payment shall state in writing whether its own recoupment schedule will be in 3 or 6 equal monthly installments, as long as all advances are recouped by June 30, 2015.

(3) (Blank). The Department of Healthcare and Family Services' Office of Inspector General and the Department of Human Services shall immediately forgo resource review and review of transfers during the relevant look-back period for applications that were submitted prior to September 1, 2013. An applicant who applied prior to September 1, 2013, who was denied for failure to cooperate in providing required information, and whose application was incorrectly reviewed under the wrong look-back period rules may request review and correction of the denial based on this subsection. If found eligible upon review, such applicants shall be retroactively enrolled.

(4) As soon as practicable, the Department of Healthcare and Family Services shall implement policies and promulgate rules to simplify financial eligibility verification in the following instances: (A) for applicants or recipients who are receiving Supplemental Security Income payments or who had been receiving such payments at the time they were admitted to a nursing facility, and (B) 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, (C) for applicants who have had a full Medicaid case active in the community for 6 or more months prior to entering the long-term care facility and who have not transferred assets during the preceding 60 months, regardless of the age of the application.

The provisions of this subsection (e) . Such simplified verification policies shall apply to community cases as well as long-term care cases. Rules, policies, and procedures adopted to implement this subsection shall be liberally construed to effectuate the stated purpose of this subsection.

(5) As soon as practicable, but not later than July 1, 2014, the Department of Healthcare and Family Services and the Department of Human Services shall jointly investigate the public-private partnerships in use in Ohio, Michigan, and Minnesota that are aimed at redeploying caseworkers to targeted high-Medicaid facilities for the purpose of expediting initial Medicaid and long-term care benefits applications, redeterminations, asset discovery, and all other things related to enrollment, reimbursement, and application processing. No later than January 1, 2019, the Department of Healthcare and Family Services shall post the agencies' joint recommendations on the web pages of the Department's website that contain information on long-term care benefits and shall assist provider groups in educating their members on the public-private partnerships. begin a special enrollment project by using simplified eligibility verification policies and by redeploying caseworkers trained to handle long-term care cases to prioritize those cases, until the backlog is eliminated and processing time is within 90 days. This project shall apply to applications for long-term care received by the State on or before May 15, 2014.

(6) As soon as practicable, but not later than March 1, 2019, September 1, 2014, the Department on Aging shall establish an online Health Insurance Portability and Accountability Act compliant database that allows make available to long-term care facilities and community providers to access upon request, through an electronic method, the information contained within the Interagency Certification of Screening Results completed by the pre-screener, in a form and manner acceptable to the Department of Human Services.

(6.5) No later than March 1, 2019, the Department on Aging shall initiate a public-private partnership with hospitals enrolled in the State's Medicaid program to train discharge planners to perform preadmission screenings on patients in need of long-term care placements or home and community based services. Upon successfully completing the Department's training course, the discharge planner shall be certified to perform preadmission screens and the hospital shall be offered a contract to administer the screens before the patient is discharged. The Department on Aging shall report to the Governor and the 4 legislative leaders on the number of hospitals participating in the public-private partnership, the number of trained discharge planners, and the number of patients transferred to nursing homes prior to a screening being completed within 90 days of the project being initiated and every 90 days thereafter until such time as the number of patients transferred without screens is reduced to zero and then annually thereafter.

(7) 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.

(7.5) As part of a public-private partnership with long-term care provider associations, the Department shall offer regionally based training as upgrades to the Application for Benefits Eligibility website are operationalized. The training shall be recorded and posted on the Department's website to allow new employees to be trained and older employers to complete refresher courses.

(8) 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.

(9) 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.

(f) 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.

(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)

Section 99. Effective date. This Act takes effect upon becoming law.