HB4771 EngrossedLRB100 18554 KTG 33773 b

1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.4 and by adding Section 5-5g as follows:
6    (305 ILCS 5/5-5g new)
7    Sec. 5-5g. Long-term care patient; resident status.
8Long-term care providers shall submit all changes in resident
9status, including, but not limited to, death, discharge,
10changes in patient credit, third party liability, and Medicare
11coverage, to the Department through the Medical Electronic Data
12Interchange System, the Recipient Eligibility Verification
13System, or the Electronic Data Interchange System established
14under 89 Ill. Adm. Code 140.55(b) in compliance with the
15schedule below:
16        (1) 15 calendar days after a resident's death;
17        (2) 15 calendar days after a resident's discharge;
18        (3) 45 calendar days after being informed of a change
19    in the resident's income;
20        (4) 45 calendar days after being informed of a change
21    in a resident's third party liability;
22        (5) 45 calendar days after a resident's move to
23    exceptional care services; and



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1        (6) 45 calendar days after a resident's need for
2    services requiring reimbursement under the ventilator or
3    traumatic brain injury enhanced rate.
4    (305 ILCS 5/11-5.4)
5    Sec. 11-5.4. Expedited long-term care eligibility
6determination, renewal, and enrollment, and payment.
7    (a) The General Assembly finds that it is in the best
8interest of the State to process on an expedited basis
9applications and renewal applications for Medicaid and
10Medicaid long-term care benefits that are submitted by or on
11behalf of elderly persons in need of long-term care services.
12It is the intent of the General Assembly that the provisions of
13this Section be liberally construed to permit the maximum
14number of applicants to benefit, regardless of the age of the
15application, and for the State to complete all processing as
16required under 42 U.S.C. 1396a(a)(8) and 42 CFR 435. An
17expedited long-term care eligibility determination and
18enrollment system shall be established to reduce long-term care
19determinations to 90 days or fewer by July 1, 2014 and
20streamline the long-term care enrollment process.
21Establishment of the system shall be a joint venture of the
22Department of Human Services and Healthcare and Family Services
23and the Department on Aging. The Governor shall name a lead
24agency no later than 30 days after the effective date of this
25amendatory Act of the 98th General Assembly to assume



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1responsibility for the full implementation of the
2establishment and maintenance of the system. Project outcomes
3shall include an enhanced eligibility determination tracking
4system accessible to providers and a centralized application
5review and eligibility determination with all applicants
6reviewed within 90 days of receipt by the State of a complete
7application. If the Department of Healthcare and Family
8Services' Office of the Inspector General determines that there
9is a likelihood that a non-allowable transfer of assets has
10occurred, and the facility in which the applicant resides is
11notified, an extension of up to 90 days shall be permissible.
12On or before December 31, 2015, a streamlined application and
13enrollment process shall be put in place based on the following
15        (1) Minimize the burden on applicants by collecting
16    only the data necessary to determine eligibility for
17    medical services, long-term care services, and spousal
18    impoverishment offset.
19        (2) Integrate online data sources to simplify the
20    application process by reducing the amount of information
21    needed to be entered and to expedite eligibility
22    verification.
23        (3) Provide online prompts to alert the applicant that
24    information is missing or not complete.
25    (a-5) As used in this Section:
26    "Department" means the Department of Healthcare and Family



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2    "Managed care organization" has the meaning ascribed to
3that term in Section 5-30.1 of this Code.
4    (b) The Department of Healthcare and Family Services must
5serve as the lead agency assuming primary responsibility for
6the full implementation of this Section, including the
7establishment and operation of the system. The Department
8shall, on or before July 1, 2014, assess the feasibility of
9incorporating all information needed to determine eligibility
10for long-term care services, including asset transfer and
11spousal impoverishment financials, into the State's integrated
12eligibility system identifying all resources needed and
13reasonable timeframes for achieving the specified integration.
14    (c) Beginning on June 29, 2018, provisional eligibility, in
15the form of a recipient identification number and any other
16necessary credentials to permit an individual to receive
17benefits, must be issued to any individual who has not received
18a final eligibility determination on the individual's
19application for Medicaid or Medicaid long-term care benefits or
20a notice of an opportunity for a hearing within the federally
21prescribed deadlines for the processing of such applications.
22The Department must maintain the individual's provisional
23Medicaid enrollment status until a final eligibility
24determination is approved or the individual's appeal has been
25adjudicated and eligibility is denied. The Department or the
26managed care organization, if applicable, must reimburse



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1providers for all services rendered during an individual's
2provisional eligibility period.
3        (1) The Department must immediately notify the managed
4    care organization, if applicable, in which the individual
5    is an enrollee of the enrollee's change in status.
6        (2) The Department or the managed care organization,
7    when applicable, must begin processing claims for services
8    rendered by the end of the month in which the individual is
9    given provisional eligibility status. Claims for services
10    rendered must be submitted and processed by the Department
11    and managed care organizations in the same manner as those
12    submitted on behalf of individuals determined to qualify
13    for benefits.
14        (3) An individual with provisional enrollment status,
15    who is not enrolled in a managed care organization at the
16    time the individual's provisional status is issued, must
17    continue to have his or her benefits paid for under the
18    State's fee-for-service system until such time as the State
19    makes a final determination on the individual's Medicaid
20    application.
21        (4) The Department, within 10 business days of issuing
22    provisional eligibility to an individual not covered by a
23    managed care organization, must submit to the Office of the
24    Comptroller for payment a voucher for all retroactive
25    reimbursement due and the State Comptroller must place such
26    vouchers on expedited payment status. However, if the



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1    provisional enrollee is enrolled with a managed care
2    organization, the Department must submit the same to the
3    managed care organization and the managed care
4    organization must pay the provider on an expedited basis.
5    The lead agency shall file interim reports with the Chairs
6    and Minority Spokespersons of the House and Senate Human
7    Services Committees no later than September 1, 2013 and on
8    February 1, 2014. The Department of Healthcare and Family
9    Services shall include in the annual Medicaid report for
10    State Fiscal Year 2014 and every fiscal year thereafter
11    information concerning implementation of the provisions of
12    this Section.
13    (d) The Department must establish, by rule, policies and
14procedures to ensure prospective compliance with the federal
15deadlines for Medicaid and Medicaid long-term care benefits
16eligibility determinations required under 42 U.S.C.
171396a(a)(8) and 42 CFR 435.912, which must include, but need
18not be limited to, the following:
19        (1) The Department, assisted by the Department of Human
20    Services and the Department on Aging, must establish, no
21    later than January 1, 2019, a streamlined application and
22    enrollment process that includes, but is not limited to,
23    the following:
24            (A) collect only the data necessary to determine
25        eligibility for medical services, long-term care
26        services, and spousal impoverishment offset;



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1            (B) integrate online data and other third party
2        data sources to simplify the application process by
3        reducing the amount of information needed to be entered
4        and to expedite eligibility verification;
5            (C) provide online prompts to alert the applicant
6        that information is missing or incomplete; and
7            (D) provide training and step-by-step written
8        instructions for caseworkers, applicants, and
9        providers.
10        (2) The Department must expedite the eligibility
11    processing system for applicants meeting certain
12    guidelines, regardless of the age of the application. The
13    guidelines must be established by rule and shall include,
14    but not be limited to, the following individually or
15    collectively:
16            (A) Full Medicaid benefits in the community for a
17        specified period of time.
18            (B) No transfer of assets or resources during the
19        federally prescribed look-back time period, as
20        specified by federal law.
21            (C) Receives Supplemental Security Income payments
22        or was receiving such payments at the time the
23        applicant was admitted to a nursing facility.
24            (D) Verified income at or below 100% of the federal
25        poverty level when the declared value of the
26        applicant's countable resources is no greater than the



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1        allowable amounts pursuant to Section 5-2 of this Code
2        for classes of eligible persons for whom a resource
3        limit applies.
4        (3) The Department must establish, by rule, renewal
5    policies and procedures to reduce the likelihood of
6    unnecessary interruptions in services as a result of
7    improper denials of individuals who would otherwise be
8    approved.
9            (A) Effective January 1, 2019, the Department must
10        implement a paperless passive redetermination protocol
11        that provides for the electronic verification of all
12        necessary information including bank accounts.
13            (B) A resident of a facility whose previous renewal
14        application showed an income of no greater than the
15        federal poverty level and who has no discernible means
16        of generating income greater than the federal poverty
17        level must be deemed to qualify for renewal. The
18        resident and the facility must not receive an
19        application for renewal and must instead receive
20        notification of the resident's renewal.
21            (C) An individual for whom the processing of a
22        renewal application exceeds federally prescribed
23        timeframes must be deemed to meet renewal guidelines
24        and the Department must notify the individual and the
25        facility in which the individual resides. The
26        Department must also immediately notify the managed



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1        care organization in which the individual is enrolled,
2        if applicable. Both the Department and the managed care
3        organization must accept claims for services rendered
4        to the individual without an interruption in benefits
5        to the enrollee and payment for all services rendered
6        to providers.
7        (4) The Department of Human Services must not penalize
8    an applicant for having an attorney complete a Medicaid
9    application on the applicant's behalf or for seeking to
10    understand the applicant's rights under federal and State
11    Medicaid laws and regulations. This must include targeting
12    applications and applicants so described for additional
13    scrutiny by the Department of Healthcare and Family
14    Services' Office of the Inspector General.
15        (5) The Department of Healthcare and Family Services'
16    Office of the Inspector General must review applications
17    for long-term care benefits when the Office obtains
18    credible evidence that an applicant has transferred assets
19    with the intent of defrauding the State. If proof of the
20    allegations does not exist, the application must be
21    released by the Office and must be assigned to the
22    appropriate caseworker for an expedited review.
23        (6) The Department of Human Services must implement a
24    process to notify an applicant, the applicant's legally
25    authorized representative, and the facility where the
26    applicant resides of the receipt of an initial or renewal



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1    application and supporting documentation within 5 business
2    days of the date the application or supporting documents
3    are submitted. The notices must indicate any documentation
4    required, but not received, and provide instructions for
5    submission.
6        (7) The Department must make available one release form
7    that permits the applicant to grant permission to a third
8    party to pursue approval of Medicaid and Medicaid long-term
9    care benefits, track the status of applications, and pursue
10    a post-denial appeal on behalf of the applicant, which must
11    remain in force after the applicant's death.
12        (8) The Department must develop one eligibility system
13    for both Modified Adjusted Gross Income (MAGI) and non-MAGI
14    applicants by incorporating Affordable Care Act upgrades
15    with the goal of establishing real time approval of
16    applications for Medicaid services and Medicaid long-term
17    care benefits, as permissible.
18        (9) The Department must have operational a fully
19    electronic application process that encompasses initial
20    applications, admission packets, renewals, and appeals no
21    later than 12 months after the effective date of this
22    amendatory Act of the 100th General Assembly. The
23    Department must not require submission of any application
24    or supporting documentation in hard copy. No later than
25    August 1, 2014, the Auditor General shall report to the
26    General Assembly concerning the extent to which the



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1    timeframes specified in this Section have been met and the
2    extent to which State staffing levels are adequate to meet
3    the requirements of this Section.
4    (e) Within 6 months after the effective date of this
5amendatory Act of the 100th General Assembly, the Department
6must adopt policies and procedures to improve communication
7between long-term care benefits central office personnel,
8applicants, or the applicants' representatives, and facilities
9in which the applicants reside. The Department must establish,
10by rule, policies and procedures that are necessary to meet the
11requirements of this Section, which must include, but need not
12be limited to, the following:
13        (1) The establishment of a centralized,
14    caseworker-based processing system with contact numbers
15    for caseworkers and supervisors that are made readily
16    available to all affected providers and are prominently
17    displayed on all communications with applicants,
18    beneficiaries, and providers.
19        (2) Allowing facilities access to the State's
20    integrated eligibility system for tracking the status of
21    applications for applicants who have signed appropriate
22    releases, and the development and distribution of
23    applicable instructional materials and release forms. The
24    Department of Healthcare and Family Services, the
25    Department of Human Services, and the Department on Aging
26    shall take the following steps to achieve federally



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1    established timeframes for eligibility determinations for
2    Medicaid and long-term care benefits and shall work toward
3    the federal goal of real time determinations:
4        (1) The Departments shall review, in collaboration
5    with representatives of affected providers, all forms and
6    procedures currently in use, federal guidelines either
7    suggested or mandated, and staff deployment by September
8    30, 2014 to identify additional measures that can improve
9    long-term care eligibility processing and make adjustments
10    where possible.
11        (2) No later than June 30, 2014, the Department of
12    Healthcare and Family Services shall issue vouchers for
13    advance payments not to exceed $50,000,000 to nursing
14    facilities with significant outstanding Medicaid liability
15    associated with services provided to residents with
16    Medicaid applications pending and residents facing the
17    greatest delays. Each facility with an advance payment
18    shall state in writing whether its own recoupment schedule
19    will be in 3 or 6 equal monthly installments, as long as
20    all advances are recouped by June 30, 2015.
21        (3) The Department of Healthcare and Family Services'
22    Office of Inspector General and the Department of Human
23    Services shall immediately forgo resource review and
24    review of transfers during the relevant look-back period
25    for applications that were submitted prior to September 1,
26    2013. An applicant who applied prior to September 1, 2013,



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1    who was denied for failure to cooperate in providing
2    required information, and whose application was
3    incorrectly reviewed under the wrong look-back period
4    rules may request review and correction of the denial based
5    on this subsection. If found eligible upon review, such
6    applicants shall be retroactively enrolled.
7        (4) As soon as practicable, the Department of
8    Healthcare and Family Services shall implement policies
9    and promulgate rules to simplify financial eligibility
10    verification in the following instances: (A) for
11    applicants or recipients who are receiving Supplemental
12    Security Income payments or who had been receiving such
13    payments at the time they were admitted to a nursing
14    facility and (B) for applicants or recipients with verified
15    income at or below 100% of the federal poverty level when
16    the declared value of their countable resources is no
17    greater than the allowable amounts pursuant to Section 5-2
18    of this Code for classes of eligible persons for whom a
19    resource limit applies. Such simplified verification
20    policies shall apply to community cases as well as
21    long-term care cases.
22        (5) As soon as practicable, but not later than July 1,
23    2014, the Department of Healthcare and Family Services and
24    the Department of Human Services shall jointly begin a
25    special enrollment project by using simplified eligibility
26    verification policies and by redeploying caseworkers



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1    trained to handle long-term care cases to prioritize those
2    cases, until the backlog is eliminated and processing time
3    is within 90 days. This project shall apply to applications
4    for long-term care received by the State on or before May
5    15, 2014.
6        (6) As soon as practicable, but not later than
7    September 1, 2014, the Department on Aging shall make
8    available to long-term care facilities and community
9    providers upon request, through an electronic method, the
10    information contained within the Interagency Certification
11    of Screening Results completed by the pre-screener, in a
12    form and manner acceptable to the Department of Human
13    Services.
14    (f) The Department must establish policies and procedures
15to improve accountability and provide for the expedited payment
16of services rendered, which must include, but need not be
17limited to, the following:
18        (1) The Department must apply the most current resident
19    income data entered into the Department's Medical
20    Electronic Data Interchange (MEDI) system to the payment of
21    a claim even if a caseworker has not completed a review.
22        (2) The Department and the Department of Human Services
23    must notify the applicant, or the applicant's legal
24    representative, and the facility submitting the initial,
25    renewal, or appeal application of all missing supporting
26    documentation or information and the date of the request



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1    when an application, renewal, or appeal is denied for
2    failure to submit such documentation and information.
3    (g) No later than January 1, 2019, the Department of
4Healthcare and Family Services must investigate the
5public-private partnerships in use in Ohio, Michigan, and
6Minnesota aimed at redeploying caseworkers to targeted
7high-Medicaid facilities for the purpose of expediting initial
8Medicaid and Medicaid long-term care benefits applications,
9renewals, asset discovery, and all other things related to
10enrollment, reimbursement, and application processing. No
11later than March 1, 2019, the Department of Healthcare and
12Family Services must post on the long-term care pages of the
13Department's website the agencies' joint recommendations and
14must assist provider groups in educating their members on such
16    (h) The Director of Healthcare and Family Services, in
17coordination with the Secretary of Human Services and the
18Director of Aging, must host a provider association meeting
19every 6 weeks, beginning no later than 30 days after the
20effective date of this amendatory Act of the 100th General
21Assembly, until all applications that are 45 days or older have
22been adjudicated and the application process has been reduced
23to 45 or fewer days, at which time the meetings shall be held
24quarterly, for those associations representing facilities
25licensed under the Nursing Home Care Act and certified as a
26supportive living program. Each agency must be represented by



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1senior staff with hands-on knowledge of the processing of
2applications for Medicaid and Medicaid long-term care
3benefits, renewals, and such ancillary issues as income and
4address adjustments, release forms, and screening reports.
5Agenda items must be solicited from the associations.
6    (i) The Department must not delay the implementation of the
7presumptive eligibility, as ordered by Koss v. Norwood, Case
8No. 17 C 2762 (N.D. Ill. Mar. 29, 2018), in anticipation of
9this amendatory Act of the 100th General Assembly.
10    (j) As mandated by federal regulations under 42 CFR
11435.912, the Department and the Department of Human Services
12must not deny applications for Medicaid or Medicaid long-term
13care benefits to comply with the federal timeliness standards
14or avoid authorizing provisional eligibility under this
15Section. To ensure compliance, the percentage of denials in a
16given month must not increase by more than 1% of the denial
17rate that occurred in the same month of the preceding year.
18    (k) The Department of Human Services must prioritize
19processing applications on a last-in, first-out basis. The
20Department is expressly prohibited from prioritizing the
21processing of applications from individuals who have been
22issued provisional eligibility status over other applicants.
23    (l) Unless otherwise specified, all provisions of this
24amendatory Act of the 100th General Assembly must be fully
25operational by January 1, 2019.
26    (m) Nothing in this Section shall defeat the provisions



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1contained in the State Prompt Payment Act or the timely pay
2provisions contained in Section 368a of the Illinois Insurance
4    (n) The Department must offer regionally based training
5covering all aspects of this Section and must include long-term
6care provider associations in the design and presentation of
7the training. The training shall be recorded and posted on the
8Department's website to allow new employees to be trained and
9older employers to complete refresher courses.
10    (o) The Department and the Department of Human Services
11must not require an applicant for Medicaid or Medicaid
12long-term care benefits to submit a new application solely
13because there is a change in the applicant's legal
15    (p) The Department and the Department of Human Services
16must implement the requirements of this Section even if the
17proposed rules are not yet adopted by the dates specified in
18this Section. If The Department is required to adopt rules
19under this Section or if the Department determines that rules
20are necessary to achieve full implementation, the Department
21must adopt policies and procedures to allow for full
22implementation by the date specified in this Section and must
23publish all policies and procedures on the Department's
24website. The Department must submit proposed permanent rules
25for public comment no later than January 1, 2019.
26    (q) (7) Effective 30 days after the completion of 3



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1regionally based trainings, nursing facilities shall submit
2all applications for medical assistance online via the
3Application for Benefits Eligibility (ABE) website. This
4requirement shall extend to scanning and uploading with the
5online application any required additional forms such as the
6Long Term Care Facility Notification and the Additional
7Financial Information for Long Term Care Applicants as well as
8scanned copies of any supporting documentation. Long-term care
9facility admission documents must be submitted as required in
10Section 5-5 of this Code. No local Department of Human Services
11office shall refuse to accept an electronically filed
13    (r) (8) Notwithstanding any other provision of this Code,
14the Department of Human Services and the Department of
15Healthcare and Family Services' Office of the Inspector General
16shall, upon request, allow an applicant additional time to
17submit information and documents needed as part of a review of
18available resources or resources transferred during the
19look-back period. The initial extension shall not exceed 30
20days. A second extension of 30 days may be granted upon
21request. Any request for information issued by the State to an
22applicant shall include the following: an explanation of the
23information required and the date by which the information must
24be submitted; a statement that failure to respond in a timely
25manner can result in denial of the application; a statement
26that the applicant or the facility in the name of the applicant



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1may seek an extension; and the name and contact information of
2a caseworker in case of questions. Any such request for
3information shall also be sent to the facility. In deciding
4whether to grant an extension, the Department of Human Services
5or the Department of Healthcare and Family Services' Office of
6the Inspector General shall take into account what is in the
7best interest of the applicant. The time limits for processing
8an application shall be tolled during the period of any
9extension granted under this subsection.
10    (s) (9) The Department of Human Services and the Department
11of Healthcare and Family Services must jointly compile data on
12pending applications, denials, appeals, and redeterminations
13into a monthly report, which shall be posted on each
14Department's website for the purposes of monitoring long-term
15care eligibility processing. The report must specify the number
16of applications and redeterminations pending long-term care
17eligibility determination and admission and the number of
18appeals of denials in the following categories:
19        (1) (A) Length of time applications, redeterminations,
20    and appeals are pending - 0 to 45 days, 46 days to 90 days,
21    91 days to 180 days, 181 days to 12 months, over 12 months
22    to 18 months, over 18 months to 24 months, and over 24
23    months.
24        (2) (B) Percentage of applications and
25    redeterminations pending in the Department of Human
26    Services' Family Community Resource Centers, in the



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1    Department of Human Services' long-term care hubs, with the
2    Department of Healthcare and Family Services' Office of
3    Inspector General, and those applications which are being
4    tolled due to requests for extension of time for additional
5    information.
6        (3) (C) Status of pending applications, denials,
7    appeals, and redeterminations.
8        (4) For applications, redeterminations, and appeals
9    pending more than 45 days, the reason for the delay as
10    required by federal regulations under 42 CFR 435.912.
11    (t) (f) Beginning on July 1, 2017, the Auditor General
12shall report every 3 years to the General Assembly on the
13performance and compliance of the Department of Healthcare and
14Family Services, the Department of Human Services, and the
15Department on Aging in meeting the requirements of this Section
16and the federal requirements concerning eligibility
17determinations for Medicaid long-term care services and
18supports, and shall report any issues or deficiencies and make
19recommendations. The Auditor General shall, at a minimum,
20review, consider, and evaluate the following:
21        (1) compliance with federal regulations on furnishing
22    services as related to Medicaid long-term care services and
23    supports as provided under 42 CFR 435.930;
24        (2) compliance with federal regulations on the timely
25    determination of eligibility as provided under 42 CFR
26    435.912;



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1        (3) the accuracy and completeness of the report
2    required under paragraph (9) of subsection (e);
3        (4) the efficacy and efficiency of the task-based
4    process used for making eligibility determinations in the
5    centralized offices of the Department of Human Services for
6    long-term care services, including the role of the State's
7    integrated eligibility system, as opposed to the
8    traditional caseworker-specific process from which these
9    central offices have converted; and
10        (5) any issues affecting eligibility determinations
11    related to the Department of Human Services' staff
12    completing Medicaid eligibility determinations instead of
13    the designated single-state Medicaid agency in Illinois,
14    the Department of Healthcare and Family Services.
15    The Auditor General's report shall include any and all
16other areas or issues which are identified through an annual
17review. Paragraphs (1) through (5) of this subsection shall not
18be construed to limit the scope of the annual review and the
19Auditor General's authority to thoroughly and completely
20evaluate any and all processes, policies, and procedures
21concerning compliance with federal and State law requirements
22on eligibility determinations for Medicaid long-term care
23services and supports.
24(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)