101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB2496

 

Introduced , by Rep. LaToya Greenwood

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Act on the Aging, the Disabled Persons Rehabilitation Act, and the Illinois Public Aid Code. Regarding services under the Community Care Program (CCP), the Home Services Program, the supportive living facilities program, and the nursing home prescreening project, provides that individuals with a score of 29 or higher based on the determination of need assessment tool shall be eligible to receive institutional and home and community-based long term care services until the State receives federal approval and implements an updated assessment tool, and those individuals are found to be ineligible under that updated assessment tool. Requires the Department on Aging and the Departments of Human Services and Healthcare and Family Services to adopt rules, but not emergency rules, regarding the updated assessment tool. Contains provisions concerning continued eligibility for persons made ineligible for services under the updated assessment tool. Amends the Illinois Act on the Aging. Prohibits the Department on Aging from adopting any rule that: (i) restricts eligibility under CCP to persons who qualify for medical assistance; or (ii) establishes a separate program of home and community-based long term care services for persons eligible for CCP services but not eligible for medical assistance. Prohibits the Department from increasing copayment levels under CCP to those levels in effect on January 1, 2016. Amends the Illinois Public Aid Code. Deletes a provision concerning an increase in the determination of need scores, on and after July 1, 2012, from 29 to 37. Amends the Nursing Home Care Act. Prohibits the involuntary discharge of an individual receiving care in an institutional setting as the result of the updated assessment tool until a transition plan has been developed. Effective immediately.


LRB101 10944 KTG 56118 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB2496LRB101 10944 KTG 56118 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Act on the Aging is amended by
5changing Section 4.02 as follows:
 
6    (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
7    Sec. 4.02. Community Care Program. The Department shall
8establish a program of services to prevent unnecessary
9institutionalization of persons age 60 and older in need of
10long term care or who are established as persons who suffer
11from Alzheimer's disease or a related disorder under the
12Alzheimer's Disease Assistance Act, thereby enabling them to
13remain in their own homes or in other living arrangements. Such
14preventive services, which may be coordinated with other
15programs for the aged and monitored by area agencies on aging
16in cooperation with the Department, may include, but are not
17limited to, any or all of the following:
18        (a) (blank);
19        (b) (blank);
20        (c) home care aide services;
21        (d) personal assistant services;
22        (e) adult day services;
23        (f) home-delivered meals;

 

 

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1        (g) education in self-care;
2        (h) personal care services;
3        (i) adult day health services;
4        (j) habilitation services;
5        (k) respite care;
6        (k-5) community reintegration services;
7        (k-6) flexible senior services;
8        (k-7) medication management;
9        (k-8) emergency home response;
10        (l) other nonmedical social services that may enable
11    the person to become self-supporting; or
12        (m) clearinghouse for information provided by senior
13    citizen home owners who want to rent rooms to or share
14    living space with other senior citizens.
15    Individuals who meet the following criteria shall have
16equal access to services under the Community Care Program: The
17Department shall establish eligibility standards for such
18services.
19        (a) are 60 years old or older;
20        (b) are U.S. citizens or legal aliens;
21        (c) are residents of Illinois;
22        (d) have nonexempt assets of $17,500 or less; nonexempt
23    assets do not include home, car, or personal furnishings;
24    and
25        (e) have an assessed need for long term care, as
26    provided in this Section, and are at risk for nursing

 

 

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1    facility placement as measured by the determination of need
2    assessment tool or a future updated assessment tool.
3In determining the amount and nature of services for which a
4person may qualify, consideration shall not be given to the
5value of cash, property or other assets held in the name of the
6person's spouse pursuant to a written agreement dividing
7marital property into equal but separate shares or pursuant to
8a transfer of the person's interest in a home to his spouse,
9provided that the spouse's share of the marital property is not
10made available to the person seeking such services.
11    Need for long term care shall be determined as follows:
12Individuals with a score of 29 or higher based on the
13determination of need (DON) assessment tool shall be eligible
14to receive institutional and home and community-based long term
15care services until the State receives federal approval and
16implements an updated assessment tool, and those individuals
17are found to be ineligible under that updated assessment tool.
18Anyone determined to be ineligible for services due to the
19updated assessment tool shall continue to be eligible for
20services for at least one year following that determination and
21must be reassessed no earlier than 11 months after that
22determination. The Department must adopt rules through the
23regular rulemaking process regarding the updated assessment
24tool, and shall not adopt emergency or peremptory rules
25regarding the updated assessment tool. The State shall not
26implement an updated assessment tool that causes more than 1%

 

 

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1of then-current recipients to lose eligibility.
2    Service cost maximums shall be set at levels no lower than
3the service cost maximums that were in effect as of January 1,
42016. Service cost maximums shall be increased accordingly to
5reflect any rate increases.
6    Beginning January 1, 2008, the Department shall require as
7a condition of eligibility that all new financially eligible
8applicants apply for and enroll in medical assistance under
9Article V of the Illinois Public Aid Code in accordance with
10rules promulgated by the Department.
11    The Department shall not: (i) adopt any rule that restricts
12eligibility under the Community Care Program to persons who
13qualify for medical assistance under Article V of the Illinois
14Public Aid Code; or (ii) establish, by rule, a separate program
15of home and community-based long term care services for persons
16who are otherwise eligible for services under the Community
17Care Program but who do not qualify for medical assistance
18under Article V of the Illinois Public Aid Code.
19    The Department shall, in conjunction with the Department of
20Public Aid (now Department of Healthcare and Family Services),
21seek appropriate amendments under Sections 1915 and 1924 of the
22Social Security Act. The purpose of the amendments shall be to
23extend eligibility for home and community based services under
24Sections 1915 and 1924 of the Social Security Act to persons
25who transfer to or for the benefit of a spouse those amounts of
26income and resources allowed under Section 1924 of the Social

 

 

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1Security Act. Subject to the approval of such amendments, the
2Department shall extend the provisions of Section 5-4 of the
3Illinois Public Aid Code to persons who, but for the provision
4of home or community-based services, would require the level of
5care provided in an institution, as is provided for in federal
6law. Those persons no longer found to be eligible for receiving
7noninstitutional services due to changes in the eligibility
8criteria shall be given 45 days notice prior to actual
9termination. Those persons receiving notice of termination may
10contact the Department and request the determination be
11appealed at any time during the 45 day notice period. The
12target population identified for the purposes of this Section
13are persons age 60 and older with an identified service need.
14Priority shall be given to those who are at imminent risk of
15institutionalization. The services shall be provided to
16eligible persons age 60 and older to the extent that the cost
17of the services together with the other personal maintenance
18expenses of the persons are reasonably related to the standards
19established for care in a group facility appropriate to the
20person's condition. These non-institutional services, pilot
21projects or experimental facilities may be provided as part of
22or in addition to those authorized by federal law or those
23funded and administered by the Department of Human Services.
24The Departments of Human Services, Healthcare and Family
25Services, Public Health, Veterans' Affairs, and Commerce and
26Economic Opportunity and other appropriate agencies of State,

 

 

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1federal and local governments shall cooperate with the
2Department on Aging in the establishment and development of the
3non-institutional services. The Department shall require an
4annual audit from all personal assistant and home care aide
5vendors contracting with the Department under this Section. The
6annual audit shall assure that each audited vendor's procedures
7are in compliance with Department's financial reporting
8guidelines requiring an administrative and employee wage and
9benefits cost split as defined in administrative rules. The
10audit is a public record under the Freedom of Information Act.
11The Department shall execute, relative to the nursing home
12prescreening project, written inter-agency agreements with the
13Department of Human Services and the Department of Healthcare
14and Family Services, to effect the following: (1) intake
15procedures and common eligibility criteria for those persons
16who are receiving non-institutional services; and (2) the
17establishment and development of non-institutional services in
18areas of the State where they are not currently available or
19are undeveloped. On and after July 1, 1996, all nursing home
20prescreenings for individuals 60 years of age or older shall be
21conducted by the Department.
22    As part of the Department on Aging's routine training of
23case managers and case manager supervisors, the Department may
24include information on family futures planning for persons who
25are age 60 or older and who are caregivers of their adult
26children with developmental disabilities. The content of the

 

 

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1training shall be at the Department's discretion.
2    The Department is authorized to establish a system of
3recipient copayment for services provided under this Section,
4such copayment to be based upon the recipient's ability to pay
5but in no case to exceed the actual cost of the services
6provided. Additionally, any portion of a person's income which
7is equal to or less than the federal poverty standard shall not
8be considered by the Department in determining the copayment.
9The level of such copayment shall be adjusted whenever
10necessary to reflect any change in the officially designated
11federal poverty standard. The Department shall not increase
12copayment levels to the levels that were in effect on January
131, 2016, except to make an adjustment for inflation.
14    The Department, or the Department's authorized
15representative, may recover the amount of moneys expended for
16services provided to or in behalf of a person under this
17Section by a claim against the person's estate or against the
18estate of the person's surviving spouse, but no recovery may be
19had until after the death of the surviving spouse, if any, and
20then only at such time when there is no surviving child who is
21under age 21 or blind or who has a permanent and total
22disability. This paragraph, however, shall not bar recovery, at
23the death of the person, of moneys for services provided to the
24person or in behalf of the person under this Section to which
25the person was not entitled; provided that such recovery shall
26not be enforced against any real estate while it is occupied as

 

 

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1a homestead by the surviving spouse or other dependent, if no
2claims by other creditors have been filed against the estate,
3or, if such claims have been filed, they remain dormant for
4failure of prosecution or failure of the claimant to compel
5administration of the estate for the purpose of payment. This
6paragraph shall not bar recovery from the estate of a spouse,
7under Sections 1915 and 1924 of the Social Security Act and
8Section 5-4 of the Illinois Public Aid Code, who precedes a
9person receiving services under this Section in death. All
10moneys for services paid to or in behalf of the person under
11this Section shall be claimed for recovery from the deceased
12spouse's estate. "Homestead", as used in this paragraph, means
13the dwelling house and contiguous real estate occupied by a
14surviving spouse or relative, as defined by the rules and
15regulations of the Department of Healthcare and Family
16Services, regardless of the value of the property.
17    The Department shall increase the effectiveness of the
18existing Community Care Program by:
19        (1) ensuring that in-home services included in the care
20    plan are available on evenings and weekends;
21        (2) ensuring that care plans contain the services that
22    eligible participants need based on the number of days in a
23    month, not limited to specific blocks of time, as
24    identified by the comprehensive assessment tool selected
25    by the Department for use statewide, not to exceed the
26    total monthly service cost maximum allowed for each

 

 

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1    service; the Department shall develop administrative rules
2    to implement this item (2);
3        (3) ensuring that the participants have the right to
4    choose the services contained in their care plan and to
5    direct how those services are provided, based on
6    administrative rules established by the Department;
7        (4) ensuring that the determination of need tool is
8    accurate in determining the participants' level of need; to
9    achieve this, the Department, in conjunction with the Older
10    Adult Services Advisory Committee, shall institute a study
11    of the relationship between the Determination of Need
12    scores, level of need, service cost maximums, and the
13    development and utilization of service plans no later than
14    May 1, 2008; findings and recommendations shall be
15    presented to the Governor and the General Assembly no later
16    than January 1, 2009; recommendations shall include all
17    needed changes to the service cost maximums schedule and
18    additional covered services;
19        (5) ensuring that homemakers can provide personal care
20    services that may or may not involve contact with clients,
21    including but not limited to:
22            (A) bathing;
23            (B) grooming;
24            (C) toileting;
25            (D) nail care;
26            (E) transferring;

 

 

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1            (F) respiratory services;
2            (G) exercise; or
3            (H) positioning;
4        (6) ensuring that homemaker program vendors are not
5    restricted from hiring homemakers who are family members of
6    clients or recommended by clients; the Department may not,
7    by rule or policy, require homemakers who are family
8    members of clients or recommended by clients to accept
9    assignments in homes other than the client;
10        (7) ensuring that the State may access maximum federal
11    matching funds by seeking approval for the Centers for
12    Medicare and Medicaid Services for modifications to the
13    State's home and community based services waiver and
14    additional waiver opportunities, including applying for
15    enrollment in the Balance Incentive Payment Program by May
16    1, 2013, in order to maximize federal matching funds; this
17    shall include, but not be limited to, modification that
18    reflects all changes in the Community Care Program services
19    and all increases in the services cost maximum;
20        (8) ensuring that the determination of need tool
21    accurately reflects the service needs of individuals with
22    Alzheimer's disease and related dementia disorders;
23        (9) ensuring that services are authorized accurately
24    and consistently for the Community Care Program (CCP); the
25    Department shall implement a Service Authorization policy
26    directive; the purpose shall be to ensure that eligibility

 

 

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1    and services are authorized accurately and consistently in
2    the CCP program; the policy directive shall clarify service
3    authorization guidelines to Care Coordination Units and
4    Community Care Program providers no later than May 1, 2013;
5        (10) working in conjunction with Care Coordination
6    Units, the Department of Healthcare and Family Services,
7    the Department of Human Services, Community Care Program
8    providers, and other stakeholders to make improvements to
9    the Medicaid claiming processes and the Medicaid
10    enrollment procedures or requirements as needed,
11    including, but not limited to, specific policy changes or
12    rules to improve the up-front enrollment of participants in
13    the Medicaid program and specific policy changes or rules
14    to insure more prompt submission of bills to the federal
15    government to secure maximum federal matching dollars as
16    promptly as possible; the Department on Aging shall have at
17    least 3 meetings with stakeholders by January 1, 2014 in
18    order to address these improvements;
19        (11) requiring home care service providers to comply
20    with the rounding of hours worked provisions under the
21    federal Fair Labor Standards Act (FLSA) and as set forth in
22    29 CFR 785.48(b) by May 1, 2013;
23        (12) implementing any necessary policy changes or
24    promulgating any rules, no later than January 1, 2014, to
25    assist the Department of Healthcare and Family Services in
26    moving as many participants as possible, consistent with

 

 

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1    federal regulations, into coordinated care plans if a care
2    coordination plan that covers long term care is available
3    in the recipient's area; and
4        (13) maintaining fiscal year 2014 rates at the same
5    level established on January 1, 2013.
6    By January 1, 2009 or as soon after the end of the Cash and
7Counseling Demonstration Project as is practicable, the
8Department may, based on its evaluation of the demonstration
9project, promulgate rules concerning personal assistant
10services, to include, but need not be limited to,
11qualifications, employment screening, rights under fair labor
12standards, training, fiduciary agent, and supervision
13requirements. All applicants shall be subject to the provisions
14of the Health Care Worker Background Check Act.
15    The Department shall develop procedures to enhance
16availability of services on evenings, weekends, and on an
17emergency basis to meet the respite needs of caregivers.
18Procedures shall be developed to permit the utilization of
19services in successive blocks of 24 hours up to the monthly
20maximum established by the Department. Workers providing these
21services shall be appropriately trained.
22    Beginning on the effective date of this amendatory Act of
231991, no person may perform chore/housekeeping and home care
24aide services under a program authorized by this Section unless
25that person has been issued a certificate of pre-service to do
26so by his or her employing agency. Information gathered to

 

 

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1effect such certification shall include (i) the person's name,
2(ii) the date the person was hired by his or her current
3employer, and (iii) the training, including dates and levels.
4Persons engaged in the program authorized by this Section
5before the effective date of this amendatory Act of 1991 shall
6be issued a certificate of all pre- and in-service training
7from his or her employer upon submitting the necessary
8information. The employing agency shall be required to retain
9records of all staff pre- and in-service training, and shall
10provide such records to the Department upon request and upon
11termination of the employer's contract with the Department. In
12addition, the employing agency is responsible for the issuance
13of certifications of in-service training completed to their
14employees.
15    The Department is required to develop a system to ensure
16that persons working as home care aides and personal assistants
17receive increases in their wages when the federal minimum wage
18is increased by requiring vendors to certify that they are
19meeting the federal minimum wage statute for home care aides
20and personal assistants. An employer that cannot ensure that
21the minimum wage increase is being given to home care aides and
22personal assistants shall be denied any increase in
23reimbursement costs.
24    The Community Care Program Advisory Committee is created in
25the Department on Aging. The Director shall appoint individuals
26to serve in the Committee, who shall serve at their own

 

 

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1expense. Members of the Committee must abide by all applicable
2ethics laws. The Committee shall advise the Department on
3issues related to the Department's program of services to
4prevent unnecessary institutionalization. The Committee shall
5meet on a bi-monthly basis and shall serve to identify and
6advise the Department on present and potential issues affecting
7the service delivery network, the program's clients, and the
8Department and to recommend solution strategies. Persons
9appointed to the Committee shall be appointed on, but not
10limited to, their own and their agency's experience with the
11program, geographic representation, and willingness to serve.
12The Director shall appoint members to the Committee to
13represent provider, advocacy, policy research, and other
14constituencies committed to the delivery of high quality home
15and community-based services to older adults. Representatives
16shall be appointed to ensure representation from community care
17providers including, but not limited to, adult day service
18providers, homemaker providers, case coordination and case
19management units, emergency home response providers, statewide
20trade or labor unions that represent home care aides and direct
21care staff, area agencies on aging, adults over age 60,
22membership organizations representing older adults, and other
23organizational entities, providers of care, or individuals
24with demonstrated interest and expertise in the field of home
25and community care as determined by the Director.
26    Nominations may be presented from any agency or State

 

 

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1association with interest in the program. The Director, or his
2or her designee, shall serve as the permanent co-chair of the
3advisory committee. One other co-chair shall be nominated and
4approved by the members of the committee on an annual basis.
5Committee members' terms of appointment shall be for 4 years
6with one-quarter of the appointees' terms expiring each year. A
7member shall continue to serve until his or her replacement is
8named. The Department shall fill vacancies that have a
9remaining term of over one year, and this replacement shall
10occur through the annual replacement of expiring terms. The
11Director shall designate Department staff to provide technical
12assistance and staff support to the committee. Department
13representation shall not constitute membership of the
14committee. All Committee papers, issues, recommendations,
15reports, and meeting memoranda are advisory only. The Director,
16or his or her designee, shall make a written report, as
17requested by the Committee, regarding issues before the
18Committee.
19    The Department on Aging and the Department of Human
20Services shall cooperate in the development and submission of
21an annual report on programs and services provided under this
22Section. Such joint report shall be filed with the Governor and
23the General Assembly on or before September 30 each year.
24    The requirement for reporting to the General Assembly shall
25be satisfied by filing copies of the report as required by
26Section 3.1 of the General Assembly Organization Act and filing

 

 

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1such additional copies with the State Government Report
2Distribution Center for the General Assembly as is required
3under paragraph (t) of Section 7 of the State Library Act.
4    Those persons previously found eligible for receiving
5non-institutional services whose services were discontinued
6under the Emergency Budget Act of Fiscal Year 1992, and who do
7not meet the eligibility standards in effect on or after July
81, 1992, shall remain ineligible on and after July 1, 1992.
9Those persons previously not required to cost-share and who
10were required to cost-share effective March 1, 1992, shall
11continue to meet cost-share requirements on and after July 1,
121992. Beginning July 1, 1992, all clients will be required to
13meet eligibility, cost-share, and other requirements and will
14have services discontinued or altered when they fail to meet
15these requirements.
16    For the purposes of this Section, "flexible senior
17services" refers to services that require one-time or periodic
18expenditures including, but not limited to, respite care, home
19modification, assistive technology, housing assistance, and
20transportation.
21    The Department shall implement an electronic service
22verification based on global positioning systems or other
23cost-effective technology for the Community Care Program no
24later than January 1, 2014.
25    The Department shall require, as a condition of
26eligibility, enrollment in the medical assistance program

 

 

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1under Article V of the Illinois Public Aid Code (i) beginning
2August 1, 2013, if the Auditor General has reported that the
3Department has failed to comply with the reporting requirements
4of Section 2-27 of the Illinois State Auditing Act; or (ii)
5beginning June 1, 2014, if the Auditor General has reported
6that the Department has not undertaken the required actions
7listed in the report required by subsection (a) of Section 2-27
8of the Illinois State Auditing Act.
9    The Department shall delay Community Care Program services
10until an applicant is determined eligible for medical
11assistance under Article V of the Illinois Public Aid Code (i)
12beginning August 1, 2013, if the Auditor General has reported
13that the Department has failed to comply with the reporting
14requirements of Section 2-27 of the Illinois State Auditing
15Act; or (ii) beginning June 1, 2014, if the Auditor General has
16reported that the Department has not undertaken the required
17actions listed in the report required by subsection (a) of
18Section 2-27 of the Illinois State Auditing Act.
19    The Department shall implement co-payments for the
20Community Care Program at the federally allowable maximum level
21(i) beginning August 1, 2013, if the Auditor General has
22reported that the Department has failed to comply with the
23reporting requirements of Section 2-27 of the Illinois State
24Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
25General has reported that the Department has not undertaken the
26required actions listed in the report required by subsection

 

 

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1(a) of Section 2-27 of the Illinois State Auditing Act.
2    The Department shall provide a bi-monthly report on the
3progress of the Community Care Program reforms set forth in
4this amendatory Act of the 98th General Assembly to the
5Governor, the Speaker of the House of Representatives, the
6Minority Leader of the House of Representatives, the President
7of the Senate, and the Minority Leader of the Senate.
8    The Department shall conduct a quarterly review of Care
9Coordination Unit performance and adherence to service
10guidelines. The quarterly review shall be reported to the
11Speaker of the House of Representatives, the Minority Leader of
12the House of Representatives, the President of the Senate, and
13the Minority Leader of the Senate. The Department shall collect
14and report longitudinal data on the performance of each care
15coordination unit. Nothing in this paragraph shall be construed
16to require the Department to identify specific care
17coordination units.
18    In regard to community care providers, failure to comply
19with Department on Aging policies shall be cause for
20disciplinary action, including, but not limited to,
21disqualification from serving Community Care Program clients.
22Each provider, upon submission of any bill or invoice to the
23Department for payment for services rendered, shall include a
24notarized statement, under penalty of perjury pursuant to
25Section 1-109 of the Code of Civil Procedure, that the provider
26has complied with all Department policies.

 

 

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1    The Director of the Department on Aging shall make
2information available to the State Board of Elections as may be
3required by an agreement the State Board of Elections has
4entered into with a multi-state voter registration list
5maintenance system.
6    Within 30 days after July 6, 2017 (the effective date of
7Public Act 100-23), rates shall be increased to $18.29 per
8hour, for the purpose of increasing, by at least $.72 per hour,
9the wages paid by those vendors to their employees who provide
10homemaker services. The Department shall pay an enhanced rate
11under the Community Care Program to those in-home service
12provider agencies that offer health insurance coverage as a
13benefit to their direct service worker employees consistent
14with the mandates of Public Act 95-713. For State fiscal years
152018 and 2019, the enhanced rate shall be $1.77 per hour. The
16rate shall be adjusted using actuarial analysis based on the
17cost of care, but shall not be set below $1.77 per hour. The
18Department shall adopt rules, including emergency rules under
19subsections (y) and (bb) of Section 5-45 of the Illinois
20Administrative Procedure Act, to implement the provisions of
21this paragraph.
22    The General Assembly finds it necessary to authorize an
23aggressive Medicaid enrollment initiative designed to maximize
24federal Medicaid funding for the Community Care Program which
25produces significant savings for the State of Illinois. The
26Department on Aging shall establish and implement a Community

 

 

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1Care Program Medicaid Initiative. Under the Initiative, the
2Department on Aging shall, at a minimum: (i) provide an
3enhanced rate to adequately compensate care coordination units
4to enroll eligible Community Care Program clients into
5Medicaid; (ii) use recommendations from a stakeholder
6committee on how best to implement the Initiative; and (iii)
7establish requirements for State agencies to make enrollment in
8the State's Medical Assistance program easier for seniors.
9    The Community Care Program Medicaid Enrollment Oversight
10Subcommittee is created as a subcommittee of the Older Adult
11Services Advisory Committee established in Section 35 of the
12Older Adult Services Act to make recommendations on how best to
13increase the number of medical assistance recipients who are
14enrolled in the Community Care Program. The Subcommittee shall
15consist of all of the following persons who must be appointed
16within 30 days after the effective date of this amendatory Act
17of the 100th General Assembly:
18        (1) The Director of Aging, or his or her designee, who
19    shall serve as the chairperson of the Subcommittee.
20        (2) One representative of the Department of Healthcare
21    and Family Services, appointed by the Director of
22    Healthcare and Family Services.
23        (3) One representative of the Department of Human
24    Services, appointed by the Secretary of Human Services.
25        (4) One individual representing a care coordination
26    unit, appointed by the Director of Aging.

 

 

HB2496- 21 -LRB101 10944 KTG 56118 b

1        (5) One individual from a non-governmental statewide
2    organization that advocates for seniors, appointed by the
3    Director of Aging.
4        (6) One individual representing Area Agencies on
5    Aging, appointed by the Director of Aging.
6        (7) One individual from a statewide association
7    dedicated to Alzheimer's care, support, and research,
8    appointed by the Director of Aging.
9        (8) One individual from an organization that employs
10    persons who provide services under the Community Care
11    Program, appointed by the Director of Aging.
12        (9) One member of a trade or labor union representing
13    persons who provide services under the Community Care
14    Program, appointed by the Director of Aging.
15        (10) One member of the Senate, who shall serve as
16    co-chairperson, appointed by the President of the Senate.
17        (11) One member of the Senate, who shall serve as
18    co-chairperson, appointed by the Minority Leader of the
19    Senate.
20        (12) One member of the House of Representatives, who
21    shall serve as co-chairperson, appointed by the Speaker of
22    the House of Representatives.
23        (13) One member of the House of Representatives, who
24    shall serve as co-chairperson, appointed by the Minority
25    Leader of the House of Representatives.
26        (14) One individual appointed by a labor organization

 

 

HB2496- 22 -LRB101 10944 KTG 56118 b

1    representing frontline employees at the Department of
2    Human Services.
3    The Subcommittee shall provide oversight to the Community
4Care Program Medicaid Initiative and shall meet quarterly. At
5each Subcommittee meeting the Department on Aging shall provide
6the following data sets to the Subcommittee: (A) the number of
7Illinois residents, categorized by planning and service area,
8who are receiving services under the Community Care Program and
9are enrolled in the State's Medical Assistance Program; (B) the
10number of Illinois residents, categorized by planning and
11service area, who are receiving services under the Community
12Care Program, but are not enrolled in the State's Medical
13Assistance Program; and (C) the number of Illinois residents,
14categorized by planning and service area, who are receiving
15services under the Community Care Program and are eligible for
16benefits under the State's Medical Assistance Program, but are
17not enrolled in the State's Medical Assistance Program. In
18addition to this data, the Department on Aging shall provide
19the Subcommittee with plans on how the Department on Aging will
20reduce the number of Illinois residents who are not enrolled in
21the State's Medical Assistance Program but who are eligible for
22medical assistance benefits. The Department on Aging shall
23enroll in the State's Medical Assistance Program those Illinois
24residents who receive services under the Community Care Program
25and are eligible for medical assistance benefits but are not
26enrolled in the State's Medicaid Assistance Program. The data

 

 

HB2496- 23 -LRB101 10944 KTG 56118 b

1provided to the Subcommittee shall be made available to the
2public via the Department on Aging's website.
3    The Department on Aging, with the involvement of the
4Subcommittee, shall collaborate with the Department of Human
5Services and the Department of Healthcare and Family Services
6on how best to achieve the responsibilities of the Community
7Care Program Medicaid Initiative.
8    The Department on Aging, the Department of Human Services,
9and the Department of Healthcare and Family Services shall
10coordinate and implement a streamlined process for seniors to
11access benefits under the State's Medical Assistance Program.
12    The Subcommittee shall collaborate with the Department of
13Human Services on the adoption of a uniform application
14submission process. The Department of Human Services and any
15other State agency involved with processing the medical
16assistance application of any person enrolled in the Community
17Care Program shall include the appropriate care coordination
18unit in all communications related to the determination or
19status of the application.
20    The Community Care Program Medicaid Initiative shall
21provide targeted funding to care coordination units to help
22seniors complete their applications for medical assistance
23benefits. On and after July 1, 2019, care coordination units
24shall receive no less than $200 per completed application.
25    The Community Care Program Medicaid Initiative shall cease
26operation 5 years after the effective date of this amendatory

 

 

HB2496- 24 -LRB101 10944 KTG 56118 b

1Act of the 100th General Assembly, after which the Subcommittee
2shall dissolve.
3(Source: P.A. 99-143, eff. 7-27-15; 100-23, eff. 7-6-17;
4100-587, eff. 6-4-18; 100-1148, eff. 12-10-18.)
 
5    Section 10. The Rehabilitation of Persons with
6Disabilities Act is amended by changing Section 3 as follows:
 
7    (20 ILCS 2405/3)  (from Ch. 23, par. 3434)
8    Sec. 3. Powers and duties. The Department shall have the
9powers and duties enumerated herein:
10        (a) To co-operate with the federal government in the
11    administration of the provisions of the federal
12    Rehabilitation Act of 1973, as amended, of the Workforce
13    Innovation and Opportunity Act, and of the federal Social
14    Security Act to the extent and in the manner provided in
15    these Acts.
16        (b) To prescribe and supervise such courses of
17    vocational training and provide such other services as may
18    be necessary for the habilitation and rehabilitation of
19    persons with one or more disabilities, including the
20    administrative activities under subsection (e) of this
21    Section, and to co-operate with State and local school
22    authorities and other recognized agencies engaged in
23    habilitation, rehabilitation and comprehensive
24    rehabilitation services; and to cooperate with the

 

 

HB2496- 25 -LRB101 10944 KTG 56118 b

1    Department of Children and Family Services regarding the
2    care and education of children with one or more
3    disabilities.
4        (c) (Blank).
5        (d) To report in writing, to the Governor, annually on
6    or before the first day of December, and at such other
7    times and in such manner and upon such subjects as the
8    Governor may require. The annual report shall contain (1) a
9    statement of the existing condition of comprehensive
10    rehabilitation services, habilitation and rehabilitation
11    in the State; (2) a statement of suggestions and
12    recommendations with reference to the development of
13    comprehensive rehabilitation services, habilitation and
14    rehabilitation in the State; and (3) an itemized statement
15    of the amounts of money received from federal, State and
16    other sources, and of the objects and purposes to which the
17    respective items of these several amounts have been
18    devoted.
19        (e) (Blank).
20        (f) To establish a program of services to prevent the
21    unnecessary institutionalization of persons in need of
22    long term care and who meet the criteria for blindness or
23    disability as defined by the Social Security Act, thereby
24    enabling them to remain in their own homes. Such preventive
25    services include any or all of the following:
26            (1) personal assistant services;

 

 

HB2496- 26 -LRB101 10944 KTG 56118 b

1            (2) homemaker services;
2            (3) home-delivered meals;
3            (4) adult day care services;
4            (5) respite care;
5            (6) home modification or assistive equipment;
6            (7) home health services;
7            (8) electronic home response;
8            (9) brain injury behavioral/cognitive services;
9            (10) brain injury habilitation;
10            (11) brain injury pre-vocational services; or
11            (12) brain injury supported employment.
12        The Department shall establish eligibility standards
13    for such services taking into consideration the unique
14    economic and social needs of the population for whom they
15    are to be provided. Such eligibility standards may be based
16    on the recipient's ability to pay for services; provided,
17    however, that any portion of a person's income that is
18    equal to or less than the "protected income" level shall
19    not be considered by the Department in determining
20    eligibility. The "protected income" level shall be
21    determined by the Department, shall never be less than the
22    federal poverty standard, and shall be adjusted each year
23    to reflect changes in the Consumer Price Index For All
24    Urban Consumers as determined by the United States
25    Department of Labor. The standards must provide that a
26    person may not have more than $10,000 in assets to be

 

 

HB2496- 27 -LRB101 10944 KTG 56118 b

1    eligible for the services, and the Department may increase
2    or decrease the asset limitation by rule. The Department
3    may not decrease the asset level below $10,000.
4    Individuals with a score of 29 or higher based on the
5determination of need (DON) assessment tool shall be eligible
6to receive institutional and home and community-based long term
7care services until the State receives federal approval and
8implements an updated assessment tool, and those individuals
9are found to be ineligible under that updated assessment tool.
10Anyone determined to be ineligible for services due to the
11updated assessment tool shall continue to be eligible for
12services for at least one year following that determination and
13must be reassessed no earlier than 11 months after that
14determination. The Department must adopt rules through the
15regular rulemaking process regarding the updated assessment
16tool, and shall not adopt emergency or peremptory rules
17regarding the updated assessment tool. The State shall not
18implement an updated assessment tool that causes more than 1%
19of then-current recipients to lose eligibility.
20    Service cost maximums shall be set at levels no lower than
21the service cost maximums that were in effect as of January 1,
222016. Service cost maximums shall be increased accordingly to
23reflect any rate increases.
24        The services shall be provided, as established by the
25    Department by rule, to eligible persons to prevent
26    unnecessary or premature institutionalization, to the

 

 

HB2496- 28 -LRB101 10944 KTG 56118 b

1    extent that the cost of the services, together with the
2    other personal maintenance expenses of the persons, are
3    reasonably related to the standards established for care in
4    a group facility appropriate to their condition. These
5    non-institutional services, pilot projects or experimental
6    facilities may be provided as part of or in addition to
7    those authorized by federal law or those funded and
8    administered by the Illinois Department on Aging. The
9    Department shall set rates and fees for services in a fair
10    and equitable manner. Services identical to those offered
11    by the Department on Aging shall be paid at the same rate.
12        Except as otherwise provided in this paragraph,
13    personal assistants shall be paid at a rate negotiated
14    between the State and an exclusive representative of
15    personal assistants under a collective bargaining
16    agreement. In no case shall the Department pay personal
17    assistants an hourly wage that is less than the federal
18    minimum wage. Within 30 days after July 6, 2017 (the
19    effective date of Public Act 100-23), the hourly wage paid
20    to personal assistants and individual maintenance home
21    health workers shall be increased by $0.48 per hour.
22        Solely for the purposes of coverage under the Illinois
23    Public Labor Relations Act, personal assistants providing
24    services under the Department's Home Services Program
25    shall be considered to be public employees and the State of
26    Illinois shall be considered to be their employer as of

 

 

HB2496- 29 -LRB101 10944 KTG 56118 b

1    July 16, 2003 (the effective date of Public Act 93-204),
2    but not before. Solely for the purposes of coverage under
3    the Illinois Public Labor Relations Act, home care and home
4    health workers who function as personal assistants and
5    individual maintenance home health workers and who also
6    provide services under the Department's Home Services
7    Program shall be considered to be public employees, no
8    matter whether the State provides such services through
9    direct fee-for-service arrangements, with the assistance
10    of a managed care organization or other intermediary, or
11    otherwise, and the State of Illinois shall be considered to
12    be the employer of those persons as of January 29, 2013
13    (the effective date of Public Act 97-1158), but not before
14    except as otherwise provided under this subsection (f). The
15    State shall engage in collective bargaining with an
16    exclusive representative of home care and home health
17    workers who function as personal assistants and individual
18    maintenance home health workers working under the Home
19    Services Program concerning their terms and conditions of
20    employment that are within the State's control. Nothing in
21    this paragraph shall be understood to limit the right of
22    the persons receiving services defined in this Section to
23    hire and fire home care and home health workers who
24    function as personal assistants and individual maintenance
25    home health workers working under the Home Services Program
26    or to supervise them within the limitations set by the Home

 

 

HB2496- 30 -LRB101 10944 KTG 56118 b

1    Services Program. The State shall not be considered to be
2    the employer of home care and home health workers who
3    function as personal assistants and individual maintenance
4    home health workers working under the Home Services Program
5    for any purposes not specifically provided in Public Act
6    93-204 or Public Act 97-1158, including but not limited to,
7    purposes of vicarious liability in tort and purposes of
8    statutory retirement or health insurance benefits. Home
9    care and home health workers who function as personal
10    assistants and individual maintenance home health workers
11    and who also provide services under the Department's Home
12    Services Program shall not be covered by the State
13    Employees Group Insurance Act of 1971.
14        The Department shall execute, relative to nursing home
15    prescreening, as authorized by Section 4.03 of the Illinois
16    Act on the Aging, written inter-agency agreements with the
17    Department on Aging and the Department of Healthcare and
18    Family Services, to effect the intake procedures and
19    eligibility criteria for those persons who may need long
20    term care. On and after July 1, 1996, all nursing home
21    prescreenings for individuals 18 through 59 years of age
22    shall be conducted by the Department, or a designee of the
23    Department.
24        The Department is authorized to establish a system of
25    recipient cost-sharing for services provided under this
26    Section. The cost-sharing shall be based upon the

 

 

HB2496- 31 -LRB101 10944 KTG 56118 b

1    recipient's ability to pay for services, but in no case
2    shall the recipient's share exceed the actual cost of the
3    services provided. Protected income shall not be
4    considered by the Department in its determination of the
5    recipient's ability to pay a share of the cost of services.
6    The level of cost-sharing shall be adjusted each year to
7    reflect changes in the "protected income" level. The
8    Department shall deduct from the recipient's share of the
9    cost of services any money expended by the recipient for
10    disability-related expenses.
11        To the extent permitted under the federal Social
12    Security Act, the Department, or the Department's
13    authorized representative, may recover the amount of
14    moneys expended for services provided to or in behalf of a
15    person under this Section by a claim against the person's
16    estate or against the estate of the person's surviving
17    spouse, but no recovery may be had until after the death of
18    the surviving spouse, if any, and then only at such time
19    when there is no surviving child who is under age 21 or
20    blind or who has a permanent and total disability. This
21    paragraph, however, shall not bar recovery, at the death of
22    the person, of moneys for services provided to the person
23    or in behalf of the person under this Section to which the
24    person was not entitled; provided that such recovery shall
25    not be enforced against any real estate while it is
26    occupied as a homestead by the surviving spouse or other

 

 

HB2496- 32 -LRB101 10944 KTG 56118 b

1    dependent, if no claims by other creditors have been filed
2    against the estate, or, if such claims have been filed,
3    they remain dormant for failure of prosecution or failure
4    of the claimant to compel administration of the estate for
5    the purpose of payment. This paragraph shall not bar
6    recovery from the estate of a spouse, under Sections 1915
7    and 1924 of the Social Security Act and Section 5-4 of the
8    Illinois Public Aid Code, who precedes a person receiving
9    services under this Section in death. All moneys for
10    services paid to or in behalf of the person under this
11    Section shall be claimed for recovery from the deceased
12    spouse's estate. "Homestead", as used in this paragraph,
13    means the dwelling house and contiguous real estate
14    occupied by a surviving spouse or relative, as defined by
15    the rules and regulations of the Department of Healthcare
16    and Family Services, regardless of the value of the
17    property.
18        The Department shall submit an annual report on
19    programs and services provided under this Section. The
20    report shall be filed with the Governor and the General
21    Assembly on or before March 30 each year.
22        The requirement for reporting to the General Assembly
23    shall be satisfied by filing copies of the report as
24    required by Section 3.1 of the General Assembly
25    Organization Act, and filing additional copies with the
26    State Government Report Distribution Center for the

 

 

HB2496- 33 -LRB101 10944 KTG 56118 b

1    General Assembly as required under paragraph (t) of Section
2    7 of the State Library Act.
3        (g) To establish such subdivisions of the Department as
4    shall be desirable and assign to the various subdivisions
5    the responsibilities and duties placed upon the Department
6    by law.
7        (h) To cooperate and enter into any necessary
8    agreements with the Department of Employment Security for
9    the provision of job placement and job referral services to
10    clients of the Department, including job service
11    registration of such clients with Illinois Employment
12    Security offices and making job listings maintained by the
13    Department of Employment Security available to such
14    clients.
15        (i) To possess all powers reasonable and necessary for
16    the exercise and administration of the powers, duties and
17    responsibilities of the Department which are provided for
18    by law.
19        (j) (Blank).
20        (k) (Blank).
21        (l) To establish, operate, and maintain a Statewide
22    Housing Clearinghouse of information on available
23    government subsidized housing accessible to persons with
24    disabilities and available privately owned housing
25    accessible to persons with disabilities. The information
26    shall include, but not be limited to, the location, rental

 

 

HB2496- 34 -LRB101 10944 KTG 56118 b

1    requirements, access features and proximity to public
2    transportation of available housing. The Clearinghouse
3    shall consist of at least a computerized database for the
4    storage and retrieval of information and a separate or
5    shared toll free telephone number for use by those seeking
6    information from the Clearinghouse. Department offices and
7    personnel throughout the State shall also assist in the
8    operation of the Statewide Housing Clearinghouse.
9    Cooperation with local, State, and federal housing
10    managers shall be sought and extended in order to
11    frequently and promptly update the Clearinghouse's
12    information.
13        (m) To assure that the names and case records of
14    persons who received or are receiving services from the
15    Department, including persons receiving vocational
16    rehabilitation, home services, or other services, and
17    those attending one of the Department's schools or other
18    supervised facility shall be confidential and not be open
19    to the general public. Those case records and reports or
20    the information contained in those records and reports
21    shall be disclosed by the Director only to proper law
22    enforcement officials, individuals authorized by a court,
23    the General Assembly or any committee or commission of the
24    General Assembly, and other persons and for reasons as the
25    Director designates by rule. Disclosure by the Director may
26    be only in accordance with other applicable law.

 

 

HB2496- 35 -LRB101 10944 KTG 56118 b

1(Source: P.A. 99-143, eff. 7-27-15; 100-23, eff. 7-6-17;
2100-477, eff. 9-8-17; 100-587, eff. 6-4-18; 100-863, eff.
38-14-18; 100-1148, eff. 12-10-18.)
 
4    Section 13. The Nursing Home Care Act is amended by
5changing Section 3-402 as follows:
 
6    (210 ILCS 45/3-402)  (from Ch. 111 1/2, par. 4153-402)
7    Sec. 3-402. Involuntary transfer or discharge.
8    Involuntary transfer or discharge of a resident from a
9facility shall be preceded by the discussion required under
10Section 3-408 and by a minimum written notice of 21 days,
11except in one of the following instances:
12        (a) When an emergency transfer or discharge is ordered
13    by the resident's attending physician because of the
14    resident's health care needs.
15        (b) When the transfer or discharge is mandated by the
16    physical safety of other residents, the facility staff, or
17    facility visitors, as documented in the clinical record.
18    The Department shall be notified prior to any such
19    involuntary transfer or discharge. The Department shall
20    immediately offer transfer, or discharge and relocation
21    assistance to residents transferred or discharged under
22    this subparagraph (b), and the Department may place
23    relocation teams as provided in Section 3-419 of this Act.
24        (c) When an identified offender is within the

 

 

HB2496- 36 -LRB101 10944 KTG 56118 b

1    provisional admission period defined in Section 1-120.3.
2    If the Identified Offender Report and Recommendation
3    prepared under Section 2-201.6 shows that the identified
4    offender poses a serious threat or danger to the physical
5    safety of other residents, the facility staff, or facility
6    visitors in the admitting facility and the facility
7    determines that it is unable to provide a safe environment
8    for the other residents, the facility staff, or facility
9    visitors, the facility shall transfer or discharge the
10    identified offender within 3 days after its receipt of the
11    Identified Offender Report and Recommendation.
12    No individual receiving care in an institutional setting
13shall be involuntarily discharged as the result of the updated
14determination of need (DON) assessment tool as provided in
15Section 5-5 of the Illinois Public Aid Code until a transition
16plan has been developed by the Department on Aging or its
17designee and all care identified in the transition plan is
18available to the resident immediately upon discharge.
19(Source: P.A. 96-1372, eff. 7-29-10.)
 
20    Section 15. The Illinois Public Aid Code is amended by
21changing Sections 5-5 and 5-5.01a as follows:
 
22    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
23    Sec. 5-5. Medical services. The Illinois Department, by
24rule, shall determine the quantity and quality of and the rate

 

 

HB2496- 37 -LRB101 10944 KTG 56118 b

1of reimbursement for the medical assistance for which payment
2will be authorized, and the medical services to be provided,
3which may include all or part of the following: (1) inpatient
4hospital services; (2) outpatient hospital services; (3) other
5laboratory and X-ray services; (4) skilled nursing home
6services; (5) physicians' services whether furnished in the
7office, the patient's home, a hospital, a skilled nursing home,
8or elsewhere; (6) medical care, or any other type of remedial
9care furnished by licensed practitioners; (7) home health care
10services; (8) private duty nursing service; (9) clinic
11services; (10) dental services, including prevention and
12treatment of periodontal disease and dental caries disease for
13pregnant women, provided by an individual licensed to practice
14dentistry or dental surgery; for purposes of this item (10),
15"dental services" means diagnostic, preventive, or corrective
16procedures provided by or under the supervision of a dentist in
17the practice of his or her profession; (11) physical therapy
18and related services; (12) prescribed drugs, dentures, and
19prosthetic devices; and eyeglasses prescribed by a physician
20skilled in the diseases of the eye, or by an optometrist,
21whichever the person may select; (13) other diagnostic,
22screening, preventive, and rehabilitative services, including
23to ensure that the individual's need for intervention or
24treatment of mental disorders or substance use disorders or
25co-occurring mental health and substance use disorders is
26determined using a uniform screening, assessment, and

 

 

HB2496- 38 -LRB101 10944 KTG 56118 b

1evaluation process inclusive of criteria, for children and
2adults; for purposes of this item (13), a uniform screening,
3assessment, and evaluation process refers to a process that
4includes an appropriate evaluation and, as warranted, a
5referral; "uniform" does not mean the use of a singular
6instrument, tool, or process that all must utilize; (14)
7transportation and such other expenses as may be necessary;
8(15) medical treatment of sexual assault survivors, as defined
9in Section 1a of the Sexual Assault Survivors Emergency
10Treatment Act, for injuries sustained as a result of the sexual
11assault, including examinations and laboratory tests to
12discover evidence which may be used in criminal proceedings
13arising from the sexual assault; (16) the diagnosis and
14treatment of sickle cell anemia; and (17) any other medical
15care, and any other type of remedial care recognized under the
16laws of this State. The term "any other type of remedial care"
17shall include nursing care and nursing home service for persons
18who rely on treatment by spiritual means alone through prayer
19for healing.
20    Notwithstanding any other provision of this Section, a
21comprehensive tobacco use cessation program that includes
22purchasing prescription drugs or prescription medical devices
23approved by the Food and Drug Administration shall be covered
24under the medical assistance program under this Article for
25persons who are otherwise eligible for assistance under this
26Article.

 

 

HB2496- 39 -LRB101 10944 KTG 56118 b

1    Notwithstanding any other provision of this Code,
2reproductive health care that is otherwise legal in Illinois
3shall be covered under the medical assistance program for
4persons who are otherwise eligible for medical assistance under
5this Article.
6    Notwithstanding any other provision of this Code, the
7Illinois Department may not require, as a condition of payment
8for any laboratory test authorized under this Article, that a
9physician's handwritten signature appear on the laboratory
10test order form. The Illinois Department may, however, impose
11other appropriate requirements regarding laboratory test order
12documentation.
13    Upon receipt of federal approval of an amendment to the
14Illinois Title XIX State Plan for this purpose, the Department
15shall authorize the Chicago Public Schools (CPS) to procure a
16vendor or vendors to manufacture eyeglasses for individuals
17enrolled in a school within the CPS system. CPS shall ensure
18that its vendor or vendors are enrolled as providers in the
19medical assistance program and in any capitated Medicaid
20managed care entity (MCE) serving individuals enrolled in a
21school within the CPS system. Under any contract procured under
22this provision, the vendor or vendors must serve only
23individuals enrolled in a school within the CPS system. Claims
24for services provided by CPS's vendor or vendors to recipients
25of benefits in the medical assistance program under this Code,
26the Children's Health Insurance Program, or the Covering ALL

 

 

HB2496- 40 -LRB101 10944 KTG 56118 b

1KIDS Health Insurance Program shall be submitted to the
2Department or the MCE in which the individual is enrolled for
3payment and shall be reimbursed at the Department's or the
4MCE's established rates or rate methodologies for eyeglasses.
5    On and after July 1, 2012, the Department of Healthcare and
6Family Services may provide the following services to persons
7eligible for assistance under this Article who are
8participating in education, training or employment programs
9operated by the Department of Human Services as successor to
10the Department of Public Aid:
11        (1) dental services provided by or under the
12    supervision of a dentist; and
13        (2) eyeglasses prescribed by a physician skilled in the
14    diseases of the eye, or by an optometrist, whichever the
15    person may select.
16    On and after July 1, 2018, the Department of Healthcare and
17Family Services shall provide dental services to any adult who
18is otherwise eligible for assistance under the medical
19assistance program. As used in this paragraph, "dental
20services" means diagnostic, preventative, restorative, or
21corrective procedures, including procedures and services for
22the prevention and treatment of periodontal disease and dental
23caries disease, provided by an individual who is licensed to
24practice dentistry or dental surgery or who is under the
25supervision of a dentist in the practice of his or her
26profession.

 

 

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1    On and after July 1, 2018, targeted dental services, as set
2forth in Exhibit D of the Consent Decree entered by the United
3States District Court for the Northern District of Illinois,
4Eastern Division, in the matter of Memisovski v. Maram, Case
5No. 92 C 1982, that are provided to adults under the medical
6assistance program shall be established at no less than the
7rates set forth in the "New Rate" column in Exhibit D of the
8Consent Decree for targeted dental services that are provided
9to persons under the age of 18 under the medical assistance
10program.
11    Notwithstanding any other provision of this Code and
12subject to federal approval, the Department may adopt rules to
13allow a dentist who is volunteering his or her service at no
14cost to render dental services through an enrolled
15not-for-profit health clinic without the dentist personally
16enrolling as a participating provider in the medical assistance
17program. A not-for-profit health clinic shall include a public
18health clinic or Federally Qualified Health Center or other
19enrolled provider, as determined by the Department, through
20which dental services covered under this Section are performed.
21The Department shall establish a process for payment of claims
22for reimbursement for covered dental services rendered under
23this provision.
24    The Illinois Department, by rule, may distinguish and
25classify the medical services to be provided only in accordance
26with the classes of persons designated in Section 5-2.

 

 

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1    The Department of Healthcare and Family Services must
2provide coverage and reimbursement for amino acid-based
3elemental formulas, regardless of delivery method, for the
4diagnosis and treatment of (i) eosinophilic disorders and (ii)
5short bowel syndrome when the prescribing physician has issued
6a written order stating that the amino acid-based elemental
7formula is medically necessary.
8    The Illinois Department shall authorize the provision of,
9and shall authorize payment for, screening by low-dose
10mammography for the presence of occult breast cancer for women
1135 years of age or older who are eligible for medical
12assistance under this Article, as follows:
13        (A) A baseline mammogram for women 35 to 39 years of
14    age.
15        (B) An annual mammogram for women 40 years of age or
16    older.
17        (C) A mammogram at the age and intervals considered
18    medically necessary by the woman's health care provider for
19    women under 40 years of age and having a family history of
20    breast cancer, prior personal history of breast cancer,
21    positive genetic testing, or other risk factors.
22        (D) A comprehensive ultrasound screening and MRI of an
23    entire breast or breasts if a mammogram demonstrates
24    heterogeneous or dense breast tissue, when medically
25    necessary as determined by a physician licensed to practice
26    medicine in all of its branches.

 

 

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1        (E) A screening MRI when medically necessary, as
2    determined by a physician licensed to practice medicine in
3    all of its branches.
4    All screenings shall include a physical breast exam,
5instruction on self-examination and information regarding the
6frequency of self-examination and its value as a preventative
7tool. For purposes of this Section, "low-dose mammography"
8means the x-ray examination of the breast using equipment
9dedicated specifically for mammography, including the x-ray
10tube, filter, compression device, and image receptor, with an
11average radiation exposure delivery of less than one rad per
12breast for 2 views of an average size breast. The term also
13includes digital mammography and includes breast
14tomosynthesis. As used in this Section, the term "breast
15tomosynthesis" means a radiologic procedure that involves the
16acquisition of projection images over the stationary breast to
17produce cross-sectional digital three-dimensional images of
18the breast. If, at any time, the Secretary of the United States
19Department of Health and Human Services, or its successor
20agency, promulgates rules or regulations to be published in the
21Federal Register or publishes a comment in the Federal Register
22or issues an opinion, guidance, or other action that would
23require the State, pursuant to any provision of the Patient
24Protection and Affordable Care Act (Public Law 111-148),
25including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
26successor provision, to defray the cost of any coverage for

 

 

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1breast tomosynthesis outlined in this paragraph, then the
2requirement that an insurer cover breast tomosynthesis is
3inoperative other than any such coverage authorized under
4Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
5the State shall not assume any obligation for the cost of
6coverage for breast tomosynthesis set forth in this paragraph.
7    On and after January 1, 2016, the Department shall ensure
8that all networks of care for adult clients of the Department
9include access to at least one breast imaging Center of Imaging
10Excellence as certified by the American College of Radiology.
11    On and after January 1, 2012, providers participating in a
12quality improvement program approved by the Department shall be
13reimbursed for screening and diagnostic mammography at the same
14rate as the Medicare program's rates, including the increased
15reimbursement for digital mammography.
16    The Department shall convene an expert panel including
17representatives of hospitals, free-standing mammography
18facilities, and doctors, including radiologists, to establish
19quality standards for mammography.
20    On and after January 1, 2017, providers participating in a
21breast cancer treatment quality improvement program approved
22by the Department shall be reimbursed for breast cancer
23treatment at a rate that is no lower than 95% of the Medicare
24program's rates for the data elements included in the breast
25cancer treatment quality program.
26    The Department shall convene an expert panel, including

 

 

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1representatives of hospitals, free-standing breast cancer
2treatment centers, breast cancer quality organizations, and
3doctors, including breast surgeons, reconstructive breast
4surgeons, oncologists, and primary care providers to establish
5quality standards for breast cancer treatment.
6    Subject to federal approval, the Department shall
7establish a rate methodology for mammography at federally
8qualified health centers and other encounter-rate clinics.
9These clinics or centers may also collaborate with other
10hospital-based mammography facilities. By January 1, 2016, the
11Department shall report to the General Assembly on the status
12of the provision set forth in this paragraph.
13    The Department shall establish a methodology to remind
14women who are age-appropriate for screening mammography, but
15who have not received a mammogram within the previous 18
16months, of the importance and benefit of screening mammography.
17The Department shall work with experts in breast cancer
18outreach and patient navigation to optimize these reminders and
19shall establish a methodology for evaluating their
20effectiveness and modifying the methodology based on the
21evaluation.
22    The Department shall establish a performance goal for
23primary care providers with respect to their female patients
24over age 40 receiving an annual mammogram. This performance
25goal shall be used to provide additional reimbursement in the
26form of a quality performance bonus to primary care providers

 

 

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1who meet that goal.
2    The Department shall devise a means of case-managing or
3patient navigation for beneficiaries diagnosed with breast
4cancer. This program shall initially operate as a pilot program
5in areas of the State with the highest incidence of mortality
6related to breast cancer. At least one pilot program site shall
7be in the metropolitan Chicago area and at least one site shall
8be outside the metropolitan Chicago area. On or after July 1,
92016, the pilot program shall be expanded to include one site
10in western Illinois, one site in southern Illinois, one site in
11central Illinois, and 4 sites within metropolitan Chicago. An
12evaluation of the pilot program shall be carried out measuring
13health outcomes and cost of care for those served by the pilot
14program compared to similarly situated patients who are not
15served by the pilot program.
16    The Department shall require all networks of care to
17develop a means either internally or by contract with experts
18in navigation and community outreach to navigate cancer
19patients to comprehensive care in a timely fashion. The
20Department shall require all networks of care to include access
21for patients diagnosed with cancer to at least one academic
22commission on cancer-accredited cancer program as an
23in-network covered benefit.
24    Any medical or health care provider shall immediately
25recommend, to any pregnant woman who is being provided prenatal
26services and is suspected of having a substance use disorder as

 

 

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1defined in the Substance Use Disorder Act, referral to a local
2substance use disorder treatment program licensed by the
3Department of Human Services or to a licensed hospital which
4provides substance abuse treatment services. The Department of
5Healthcare and Family Services shall assure coverage for the
6cost of treatment of the drug abuse or addiction for pregnant
7recipients in accordance with the Illinois Medicaid Program in
8conjunction with the Department of Human Services.
9    All medical providers providing medical assistance to
10pregnant women under this Code shall receive information from
11the Department on the availability of services under any
12program providing case management services for addicted women,
13including information on appropriate referrals for other
14social services that may be needed by addicted women in
15addition to treatment for addiction.
16    The Illinois Department, in cooperation with the
17Departments of Human Services (as successor to the Department
18of Alcoholism and Substance Abuse) and Public Health, through a
19public awareness campaign, may provide information concerning
20treatment for alcoholism and drug abuse and addiction, prenatal
21health care, and other pertinent programs directed at reducing
22the number of drug-affected infants born to recipients of
23medical assistance.
24    Neither the Department of Healthcare and Family Services
25nor the Department of Human Services shall sanction the
26recipient solely on the basis of her substance abuse.

 

 

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1    The Illinois Department shall establish such regulations
2governing the dispensing of health services under this Article
3as it shall deem appropriate. The Department should seek the
4advice of formal professional advisory committees appointed by
5the Director of the Illinois Department for the purpose of
6providing regular advice on policy and administrative matters,
7information dissemination and educational activities for
8medical and health care providers, and consistency in
9procedures to the Illinois Department.
10    The Illinois Department may develop and contract with
11Partnerships of medical providers to arrange medical services
12for persons eligible under Section 5-2 of this Code.
13Implementation of this Section may be by demonstration projects
14in certain geographic areas. The Partnership shall be
15represented by a sponsor organization. The Department, by rule,
16shall develop qualifications for sponsors of Partnerships.
17Nothing in this Section shall be construed to require that the
18sponsor organization be a medical organization.
19    The sponsor must negotiate formal written contracts with
20medical providers for physician services, inpatient and
21outpatient hospital care, home health services, treatment for
22alcoholism and substance abuse, and other services determined
23necessary by the Illinois Department by rule for delivery by
24Partnerships. Physician services must include prenatal and
25obstetrical care. The Illinois Department shall reimburse
26medical services delivered by Partnership providers to clients

 

 

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1in target areas according to provisions of this Article and the
2Illinois Health Finance Reform Act, except that:
3        (1) Physicians participating in a Partnership and
4    providing certain services, which shall be determined by
5    the Illinois Department, to persons in areas covered by the
6    Partnership may receive an additional surcharge for such
7    services.
8        (2) The Department may elect to consider and negotiate
9    financial incentives to encourage the development of
10    Partnerships and the efficient delivery of medical care.
11        (3) Persons receiving medical services through
12    Partnerships may receive medical and case management
13    services above the level usually offered through the
14    medical assistance program.
15    Medical providers shall be required to meet certain
16qualifications to participate in Partnerships to ensure the
17delivery of high quality medical services. These
18qualifications shall be determined by rule of the Illinois
19Department and may be higher than qualifications for
20participation in the medical assistance program. Partnership
21sponsors may prescribe reasonable additional qualifications
22for participation by medical providers, only with the prior
23written approval of the Illinois Department.
24    Nothing in this Section shall limit the free choice of
25practitioners, hospitals, and other providers of medical
26services by clients. In order to ensure patient freedom of

 

 

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1choice, the Illinois Department shall immediately promulgate
2all rules and take all other necessary actions so that provided
3services may be accessed from therapeutically certified
4optometrists to the full extent of the Illinois Optometric
5Practice Act of 1987 without discriminating between service
6providers.
7    The Department shall apply for a waiver from the United
8States Health Care Financing Administration to allow for the
9implementation of Partnerships under this Section.
10    The Illinois Department shall require health care
11providers to maintain records that document the medical care
12and services provided to recipients of Medical Assistance under
13this Article. Such records must be retained for a period of not
14less than 6 years from the date of service or as provided by
15applicable State law, whichever period is longer, except that
16if an audit is initiated within the required retention period
17then the records must be retained until the audit is completed
18and every exception is resolved. The Illinois Department shall
19require health care providers to make available, when
20authorized by the patient, in writing, the medical records in a
21timely fashion to other health care providers who are treating
22or serving persons eligible for Medical Assistance under this
23Article. All dispensers of medical services shall be required
24to maintain and retain business and professional records
25sufficient to fully and accurately document the nature, scope,
26details and receipt of the health care provided to persons

 

 

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1eligible for medical assistance under this Code, in accordance
2with regulations promulgated by the Illinois Department. The
3rules and regulations shall require that proof of the receipt
4of prescription drugs, dentures, prosthetic devices and
5eyeglasses by eligible persons under this Section accompany
6each claim for reimbursement submitted by the dispenser of such
7medical services. No such claims for reimbursement shall be
8approved for payment by the Illinois Department without such
9proof of receipt, unless the Illinois Department shall have put
10into effect and shall be operating a system of post-payment
11audit and review which shall, on a sampling basis, be deemed
12adequate by the Illinois Department to assure that such drugs,
13dentures, prosthetic devices and eyeglasses for which payment
14is being made are actually being received by eligible
15recipients. Within 90 days after September 16, 1984 (the
16effective date of Public Act 83-1439), the Illinois Department
17shall establish a current list of acquisition costs for all
18prosthetic devices and any other items recognized as medical
19equipment and supplies reimbursable under this Article and
20shall update such list on a quarterly basis, except that the
21acquisition costs of all prescription drugs shall be updated no
22less frequently than every 30 days as required by Section
235-5.12.
24    Notwithstanding any other law to the contrary, the Illinois
25Department shall, within 365 days after July 22, 2013 (the
26effective date of Public Act 98-104), establish procedures to

 

 

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1permit skilled care facilities licensed under the Nursing Home
2Care Act to submit monthly billing claims for reimbursement
3purposes. Following development of these procedures, the
4Department shall, by July 1, 2016, test the viability of the
5new system and implement any necessary operational or
6structural changes to its information technology platforms in
7order to allow for the direct acceptance and payment of nursing
8home claims.
9    Notwithstanding any other law to the contrary, the Illinois
10Department shall, within 365 days after August 15, 2014 (the
11effective date of Public Act 98-963), establish procedures to
12permit ID/DD facilities licensed under the ID/DD Community Care
13Act and MC/DD facilities licensed under the MC/DD Act to submit
14monthly billing claims for reimbursement purposes. Following
15development of these procedures, the Department shall have an
16additional 365 days to test the viability of the new system and
17to ensure that any necessary operational or structural changes
18to its information technology platforms are implemented.
19    The Illinois Department shall require all dispensers of
20medical services, other than an individual practitioner or
21group of practitioners, desiring to participate in the Medical
22Assistance program established under this Article to disclose
23all financial, beneficial, ownership, equity, surety or other
24interests in any and all firms, corporations, partnerships,
25associations, business enterprises, joint ventures, agencies,
26institutions or other legal entities providing any form of

 

 

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1health care services in this State under this Article.
2    The Illinois Department may require that all dispensers of
3medical services desiring to participate in the medical
4assistance program established under this Article disclose,
5under such terms and conditions as the Illinois Department may
6by rule establish, all inquiries from clients and attorneys
7regarding medical bills paid by the Illinois Department, which
8inquiries could indicate potential existence of claims or liens
9for the Illinois Department.
10    Enrollment of a vendor shall be subject to a provisional
11period and shall be conditional for one year. During the period
12of conditional enrollment, the Department may terminate the
13vendor's eligibility to participate in, or may disenroll the
14vendor from, the medical assistance program without cause.
15Unless otherwise specified, such termination of eligibility or
16disenrollment is not subject to the Department's hearing
17process. However, a disenrolled vendor may reapply without
18penalty.
19    The Department has the discretion to limit the conditional
20enrollment period for vendors based upon category of risk of
21the vendor.
22    Prior to enrollment and during the conditional enrollment
23period in the medical assistance program, all vendors shall be
24subject to enhanced oversight, screening, and review based on
25the risk of fraud, waste, and abuse that is posed by the
26category of risk of the vendor. The Illinois Department shall

 

 

HB2496- 54 -LRB101 10944 KTG 56118 b

1establish the procedures for oversight, screening, and review,
2which may include, but need not be limited to: criminal and
3financial background checks; fingerprinting; license,
4certification, and authorization verifications; unscheduled or
5unannounced site visits; database checks; prepayment audit
6reviews; audits; payment caps; payment suspensions; and other
7screening as required by federal or State law.
8    The Department shall define or specify the following: (i)
9by provider notice, the "category of risk of the vendor" for
10each type of vendor, which shall take into account the level of
11screening applicable to a particular category of vendor under
12federal law and regulations; (ii) by rule or provider notice,
13the maximum length of the conditional enrollment period for
14each category of risk of the vendor; and (iii) by rule, the
15hearing rights, if any, afforded to a vendor in each category
16of risk of the vendor that is terminated or disenrolled during
17the conditional enrollment period.
18    To be eligible for payment consideration, a vendor's
19payment claim or bill, either as an initial claim or as a
20resubmitted claim following prior rejection, must be received
21by the Illinois Department, or its fiscal intermediary, no
22later than 180 days after the latest date on the claim on which
23medical goods or services were provided, with the following
24exceptions:
25        (1) In the case of a provider whose enrollment is in
26    process by the Illinois Department, the 180-day period

 

 

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1    shall not begin until the date on the written notice from
2    the Illinois Department that the provider enrollment is
3    complete.
4        (2) In the case of errors attributable to the Illinois
5    Department or any of its claims processing intermediaries
6    which result in an inability to receive, process, or
7    adjudicate a claim, the 180-day period shall not begin
8    until the provider has been notified of the error.
9        (3) In the case of a provider for whom the Illinois
10    Department initiates the monthly billing process.
11        (4) In the case of a provider operated by a unit of
12    local government with a population exceeding 3,000,000
13    when local government funds finance federal participation
14    for claims payments.
15    For claims for services rendered during a period for which
16a recipient received retroactive eligibility, claims must be
17filed within 180 days after the Department determines the
18applicant is eligible. For claims for which the Illinois
19Department is not the primary payer, claims must be submitted
20to the Illinois Department within 180 days after the final
21adjudication by the primary payer.
22    In the case of long term care facilities, within 45
23calendar days of receipt by the facility of required
24prescreening information, new admissions with associated
25admission documents shall be submitted through the Medical
26Electronic Data Interchange (MEDI) or the Recipient

 

 

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1Eligibility Verification (REV) System or shall be submitted
2directly to the Department of Human Services using required
3admission forms. Effective September 1, 2014, admission
4documents, including all prescreening information, must be
5submitted through MEDI or REV. Confirmation numbers assigned to
6an accepted transaction shall be retained by a facility to
7verify timely submittal. Once an admission transaction has been
8completed, all resubmitted claims following prior rejection
9are subject to receipt no later than 180 days after the
10admission transaction has been completed.
11    Claims that are not submitted and received in compliance
12with the foregoing requirements shall not be eligible for
13payment under the medical assistance program, and the State
14shall have no liability for payment of those claims.
15    To the extent consistent with applicable information and
16privacy, security, and disclosure laws, State and federal
17agencies and departments shall provide the Illinois Department
18access to confidential and other information and data necessary
19to perform eligibility and payment verifications and other
20Illinois Department functions. This includes, but is not
21limited to: information pertaining to licensure;
22certification; earnings; immigration status; citizenship; wage
23reporting; unearned and earned income; pension income;
24employment; supplemental security income; social security
25numbers; National Provider Identifier (NPI) numbers; the
26National Practitioner Data Bank (NPDB); program and agency

 

 

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1exclusions; taxpayer identification numbers; tax delinquency;
2corporate information; and death records.
3    The Illinois Department shall enter into agreements with
4State agencies and departments, and is authorized to enter into
5agreements with federal agencies and departments, under which
6such agencies and departments shall share data necessary for
7medical assistance program integrity functions and oversight.
8The Illinois Department shall develop, in cooperation with
9other State departments and agencies, and in compliance with
10applicable federal laws and regulations, appropriate and
11effective methods to share such data. At a minimum, and to the
12extent necessary to provide data sharing, the Illinois
13Department shall enter into agreements with State agencies and
14departments, and is authorized to enter into agreements with
15federal agencies and departments, including but not limited to:
16the Secretary of State; the Department of Revenue; the
17Department of Public Health; the Department of Human Services;
18and the Department of Financial and Professional Regulation.
19    Beginning in fiscal year 2013, the Illinois Department
20shall set forth a request for information to identify the
21benefits of a pre-payment, post-adjudication, and post-edit
22claims system with the goals of streamlining claims processing
23and provider reimbursement, reducing the number of pending or
24rejected claims, and helping to ensure a more transparent
25adjudication process through the utilization of: (i) provider
26data verification and provider screening technology; and (ii)

 

 

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1clinical code editing; and (iii) pre-pay, pre- or
2post-adjudicated predictive modeling with an integrated case
3management system with link analysis. Such a request for
4information shall not be considered as a request for proposal
5or as an obligation on the part of the Illinois Department to
6take any action or acquire any products or services.
7    The Illinois Department shall establish policies,
8procedures, standards and criteria by rule for the acquisition,
9repair and replacement of orthotic and prosthetic devices and
10durable medical equipment. Such rules shall provide, but not be
11limited to, the following services: (1) immediate repair or
12replacement of such devices by recipients; and (2) rental,
13lease, purchase or lease-purchase of durable medical equipment
14in a cost-effective manner, taking into consideration the
15recipient's medical prognosis, the extent of the recipient's
16needs, and the requirements and costs for maintaining such
17equipment. Subject to prior approval, such rules shall enable a
18recipient to temporarily acquire and use alternative or
19substitute devices or equipment pending repairs or
20replacements of any device or equipment previously authorized
21for such recipient by the Department. Notwithstanding any
22provision of Section 5-5f to the contrary, the Department may,
23by rule, exempt certain replacement wheelchair parts from prior
24approval and, for wheelchairs, wheelchair parts, wheelchair
25accessories, and related seating and positioning items,
26determine the wholesale price by methods other than actual

 

 

HB2496- 59 -LRB101 10944 KTG 56118 b

1acquisition costs.
2    The Department shall require, by rule, all providers of
3durable medical equipment to be accredited by an accreditation
4organization approved by the federal Centers for Medicare and
5Medicaid Services and recognized by the Department in order to
6bill the Department for providing durable medical equipment to
7recipients. No later than 15 months after the effective date of
8the rule adopted pursuant to this paragraph, all providers must
9meet the accreditation requirement.
10    In order to promote environmental responsibility, meet the
11needs of recipients and enrollees, and achieve significant cost
12savings, the Department, or a managed care organization under
13contract with the Department, may provide recipients or managed
14care enrollees who have a prescription or Certificate of
15Medical Necessity access to refurbished durable medical
16equipment under this Section (excluding prosthetic and
17orthotic devices as defined in the Orthotics, Prosthetics, and
18Pedorthics Practice Act and complex rehabilitation technology
19products and associated services) through the State's
20assistive technology program's reutilization program, using
21staff with the Assistive Technology Professional (ATP)
22Certification if the refurbished durable medical equipment:
23(i) is available; (ii) is less expensive, including shipping
24costs, than new durable medical equipment of the same type;
25(iii) is able to withstand at least 3 years of use; (iv) is
26cleaned, disinfected, sterilized, and safe in accordance with

 

 

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1federal Food and Drug Administration regulations and guidance
2governing the reprocessing of medical devices in health care
3settings; and (v) equally meets the needs of the recipient or
4enrollee. The reutilization program shall confirm that the
5recipient or enrollee is not already in receipt of same or
6similar equipment from another service provider, and that the
7refurbished durable medical equipment equally meets the needs
8of the recipient or enrollee. Nothing in this paragraph shall
9be construed to limit recipient or enrollee choice to obtain
10new durable medical equipment or place any additional prior
11authorization conditions on enrollees of managed care
12organizations.
13    The Department shall execute, relative to the nursing home
14prescreening project, written inter-agency agreements with the
15Department of Human Services and the Department on Aging, to
16effect the following: (i) intake procedures and common
17eligibility criteria for those persons who are receiving
18non-institutional services; and (ii) the establishment and
19development of non-institutional services in areas of the State
20where they are not currently available or are undeveloped; and
21(iii) notwithstanding any other provision of law, subject to
22federal approval, on and after July 1, 2012, an increase in the
23determination of need (DON) scores from 29 to 37 for applicants
24for institutional and home and community-based long term care;
25if and only if federal approval is not granted, the Department
26may, in conjunction with other affected agencies, implement

 

 

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1utilization controls or changes in benefit packages to
2effectuate a similar savings amount for this population; and
3(iv) no later than July 1, 2013, minimum level of care
4eligibility criteria for institutional and home and
5community-based long term care; and (iv) (v) no later than
6October 1, 2013, establish procedures to permit long term care
7providers access to eligibility scores for individuals with an
8admission date who are seeking or receiving services from the
9long term care provider. In order to select the minimum level
10of care eligibility criteria, the Governor shall establish a
11workgroup that includes affected agency representatives and
12stakeholders representing the institutional and home and
13community-based long term care interests. This Section shall
14not restrict the Department from implementing lower level of
15care eligibility criteria for community-based services in
16circumstances where federal approval has been granted.
17Individuals with a score of 29 or higher based on the
18determination of need (DON) assessment tool shall be eligible
19to receive institutional and home and community-based long term
20care services until the State receives federal approval and
21implements an updated assessment tool, and those individuals
22are found to be ineligible under that updated assessment tool.
23Anyone determined to be ineligible for services due to the
24updated assessment tool shall continue to be eligible for
25services for at least one year following that determination and
26must be reassessed no earlier than 11 months after that

 

 

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1determination. The Department must adopt rules through the
2regular rulemaking process regarding the updated assessment
3tool, and shall not adopt emergency or peremptory rules
4regarding the updated assessment tool. The State shall not
5implement an updated assessment tool that causes more than 1%
6of then-current recipients to lose eligibility. No individual
7receiving care in an institutional setting shall be
8involuntarily discharged as the result of the updated
9assessment tool until a transition plan has been developed by
10the Department on Aging or its designee and all care identified
11in the transition plan is available to the resident immediately
12upon discharge.
13    The Illinois Department shall develop and operate, in
14cooperation with other State Departments and agencies and in
15compliance with applicable federal laws and regulations,
16appropriate and effective systems of health care evaluation and
17programs for monitoring of utilization of health care services
18and facilities, as it affects persons eligible for medical
19assistance under this Code.
20    The Illinois Department shall report annually to the
21General Assembly, no later than the second Friday in April of
221979 and each year thereafter, in regard to:
23        (a) actual statistics and trends in utilization of
24    medical services by public aid recipients;
25        (b) actual statistics and trends in the provision of
26    the various medical services by medical vendors;

 

 

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1        (c) current rate structures and proposed changes in
2    those rate structures for the various medical vendors; and
3        (d) efforts at utilization review and control by the
4    Illinois Department.
5    The period covered by each report shall be the 3 years
6ending on the June 30 prior to the report. The report shall
7include suggested legislation for consideration by the General
8Assembly. The requirement for reporting to the General Assembly
9shall be satisfied by filing copies of the report as required
10by Section 3.1 of the General Assembly Organization Act, and
11filing such additional copies with the State Government Report
12Distribution Center for the General Assembly as is required
13under paragraph (t) of Section 7 of the State Library Act.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20    On and after July 1, 2012, the Department shall reduce any
21rate of reimbursement for services or other payments or alter
22any methodologies authorized by this Code to reduce any rate of
23reimbursement for services or other payments in accordance with
24Section 5-5e.
25    Because kidney transplantation can be an appropriate,
26cost-effective alternative to renal dialysis when medically

 

 

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1necessary and notwithstanding the provisions of Section 1-11 of
2this Code, beginning October 1, 2014, the Department shall
3cover kidney transplantation for noncitizens with end-stage
4renal disease who are not eligible for comprehensive medical
5benefits, who meet the residency requirements of Section 5-3 of
6this Code, and who would otherwise meet the financial
7requirements of the appropriate class of eligible persons under
8Section 5-2 of this Code. To qualify for coverage of kidney
9transplantation, such person must be receiving emergency renal
10dialysis services covered by the Department. Providers under
11this Section shall be prior approved and certified by the
12Department to perform kidney transplantation and the services
13under this Section shall be limited to services associated with
14kidney transplantation.
15    Notwithstanding any other provision of this Code to the
16contrary, on or after July 1, 2015, all FDA approved forms of
17medication assisted treatment prescribed for the treatment of
18alcohol dependence or treatment of opioid dependence shall be
19covered under both fee for service and managed care medical
20assistance programs for persons who are otherwise eligible for
21medical assistance under this Article and shall not be subject
22to any (1) utilization control, other than those established
23under the American Society of Addiction Medicine patient
24placement criteria, (2) prior authorization mandate, or (3)
25lifetime restriction limit mandate.
26    On or after July 1, 2015, opioid antagonists prescribed for

 

 

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1the treatment of an opioid overdose, including the medication
2product, administration devices, and any pharmacy fees related
3to the dispensing and administration of the opioid antagonist,
4shall be covered under the medical assistance program for
5persons who are otherwise eligible for medical assistance under
6this Article. As used in this Section, "opioid antagonist"
7means a drug that binds to opioid receptors and blocks or
8inhibits the effect of opioids acting on those receptors,
9including, but not limited to, naloxone hydrochloride or any
10other similarly acting drug approved by the U.S. Food and Drug
11Administration.
12    Upon federal approval, the Department shall provide
13coverage and reimbursement for all drugs that are approved for
14marketing by the federal Food and Drug Administration and that
15are recommended by the federal Public Health Service or the
16United States Centers for Disease Control and Prevention for
17pre-exposure prophylaxis and related pre-exposure prophylaxis
18services, including, but not limited to, HIV and sexually
19transmitted infection screening, treatment for sexually
20transmitted infections, medical monitoring, assorted labs, and
21counseling to reduce the likelihood of HIV infection among
22individuals who are not infected with HIV but who are at high
23risk of HIV infection.
24    A federally qualified health center, as defined in Section
251905(l)(2)(B) of the federal Social Security Act, shall be
26reimbursed by the Department in accordance with the federally

 

 

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1qualified health center's encounter rate for services provided
2to medical assistance recipients that are performed by a dental
3hygienist, as defined under the Illinois Dental Practice Act,
4working under the general supervision of a dentist and employed
5by a federally qualified health center.
6    Notwithstanding any other provision of this Code, the
7Illinois Department shall authorize licensed dietitian
8nutritionists and certified diabetes educators to counsel
9senior diabetes patients in the senior diabetes patients' homes
10to remove the hurdle of transportation for senior diabetes
11patients to receive treatment.
12(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1399-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for
14the effective date of P.A. 99-407); 99-433, eff. 8-21-15;
1599-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff.
167-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201,
17eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18;
18100-538, eff. 1-1-18; 100-587, eff. 6-4-18; 100-759, eff.
191-1-19; 100-863, eff. 8-14-18; 100-974, eff. 8-19-18;
20100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19; 100-1148, eff.
2112-10-18.)
 
22    (305 ILCS 5/5-5.01a)
23    Sec. 5-5.01a. Supportive living facilities program.
24    (a) The Department shall establish and provide oversight
25for a program of supportive living facilities that seek to

 

 

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1promote resident independence, dignity, respect, and
2well-being in the most cost-effective manner.
3    A supportive living facility is (i) a free-standing
4facility or (ii) a distinct physical and operational entity
5within a mixed-use building that meets the criteria established
6in subsection (d). A supportive living facility integrates
7housing with health, personal care, and supportive services and
8is a designated setting that offers residents their own
9separate, private, and distinct living units.
10    Sites for the operation of the program shall be selected by
11the Department based upon criteria that may include the need
12for services in a geographic area, the availability of funding,
13and the site's ability to meet the standards.
14    (b) Beginning July 1, 2014, subject to federal approval,
15the Medicaid rates for supportive living facilities shall be
16equal to the supportive living facility Medicaid rate effective
17on June 30, 2014 increased by 8.85%. Once the assessment
18imposed at Article V-G of this Code is determined to be a
19permissible tax under Title XIX of the Social Security Act, the
20Department shall increase the Medicaid rates for supportive
21living facilities effective on July 1, 2014 by 9.09%. The
22Department shall apply this increase retroactively to coincide
23with the imposition of the assessment in Article V-G of this
24Code in accordance with the approval for federal financial
25participation by the Centers for Medicare and Medicaid
26Services.

 

 

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1    The Medicaid rates for supportive living facilities
2effective on July 1, 2017 must be equal to the rates in effect
3for supportive living facilities on June 30, 2017 increased by
42.8%.
5    The Medicaid rates for supportive living facilities
6effective on July 1, 2018 must be equal to the rates in effect
7for supportive living facilities on June 30, 2018.
8    (c) The Department may adopt rules to implement this
9Section. Rules that establish or modify the services,
10standards, and conditions for participation in the program
11shall be adopted by the Department in consultation with the
12Department on Aging, the Department of Rehabilitation
13Services, and the Department of Mental Health and Developmental
14Disabilities (or their successor agencies).
15    (d) Subject to federal approval by the Centers for Medicare
16and Medicaid Services, the Department shall accept for
17consideration of certification under the program any
18application for a site or building where distinct parts of the
19site or building are designated for purposes other than the
20provision of supportive living services, but only if:
21        (1) those distinct parts of the site or building are
22    not designated for the purpose of providing assisted living
23    services as required under the Assisted Living and Shared
24    Housing Act;
25        (2) those distinct parts of the site or building are
26    completely separate from the part of the building used for

 

 

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1    the provision of supportive living program services,
2    including separate entrances;
3        (3) those distinct parts of the site or building do not
4    share any common spaces with the part of the building used
5    for the provision of supportive living program services;
6    and
7        (4) those distinct parts of the site or building do not
8    share staffing with the part of the building used for the
9    provision of supportive living program services.
10    (e) Facilities or distinct parts of facilities which are
11selected as supportive living facilities and are in good
12standing with the Department's rules are exempt from the
13provisions of the Nursing Home Care Act and the Illinois Health
14Facilities Planning Act.
15    Individuals with a score of 29 or higher based on the
16determination of need (DON) assessment tool shall be eligible
17to receive institutional and home and community-based long term
18care services until the State receives federal approval and
19implements an updated assessment tool, and those individuals
20are found to be ineligible under that updated assessment tool.
21Anyone determined to be ineligible for services due to the
22updated assessment tool shall continue to be eligible for
23services for at least one year following that determination and
24must be reassessed no earlier than 11 months after that
25determination. The Department must adopt rules through the
26regular rulemaking process regarding the updated assessment

 

 

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1tool, and shall not adopt emergency or peremptory rules
2regarding the updated assessment tool. The State shall not
3implement an updated assessment tool that causes more than 1%
4of then-current recipients to lose eligibility. No individual
5receiving care in an institutional setting shall be
6involuntarily discharged as the result of the updated
7assessment tool until a transition plan has been developed by
8the Department on Aging or its designee and all care identified
9in the transition plan is available to the resident immediately
10upon discharge.
11(Source: P.A. 100-23, eff. 7-6-17; 100-583, eff. 4-6-18;
12100-587, eff. 6-4-18.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    20 ILCS 105/4.02from Ch. 23, par. 6104.02
4    20 ILCS 2405/3from Ch. 23, par. 3434
5    210 ILCS 45/3-402from Ch. 111 1/2, par. 4153-402
6    305 ILCS 5/5-5from Ch. 23, par. 5-5
7    305 ILCS 5/5-5.01a