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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.4 as follows:
 
6    (305 ILCS 5/11-5.4)
7    Sec. 11-5.4. Expedited long-term care eligibility
8determination and enrollment.
9    (a) Establishment of the expedited long-term care
10eligibility determination and enrollment system shall be a
11joint venture of the Departments of Human Services and
12Healthcare and Family Services and the Department on Aging.
13    (b) Streamlined application enrollment process; expedited
14eligibility process. The streamlined application and
15enrollment process must include, but need not be limited to,
16the following:
17        (1) On or before July 1, 2019, a streamlined
18    application and enrollment process shall be put in place
19    which must include, but need not be limited to, the
20    following:
21            (A) Minimize the burden on applicants by
22        collecting only the data necessary to determine
23        eligibility for medical services, long-term care

 

 

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1        services, and spousal impoverishment offset.
2            (B) Integrate online data sources to simplify the
3        application process by reducing the amount of
4        information needed to be entered and to expedite
5        eligibility verification.
6            (C) Provide online prompts to alert the applicant
7        that information is missing or not complete.
8            (D) Provide training and step-by-step written
9        instructions for caseworkers, applicants, and
10        providers.
11        (2) The State must expedite the eligibility process for
12    applicants meeting specified guidelines, regardless of the
13    age of the application. The guidelines, subject to federal
14    approval, must include, but need not be limited to, the
15    following individually or collectively:
16            (A) Full Medicaid benefits in the community for a
17        specified period of time.
18            (B) No transfer of assets or resources during the
19        federally prescribed look-back period, as specified in
20        federal law.
21            (C) Receives Supplemental Security Income payments
22        or was receiving such payments at the time of admission
23        to a nursing facility.
24            (D) For applicants or recipients with verified
25        income at or below 100% of the federal poverty level
26        when the declared value of their countable resources is

 

 

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1        no greater than the allowable amounts pursuant to
2        Section 5-2 of this Code for classes of eligible
3        persons for whom a resource limit applies. Such
4        simplified verification policies shall apply to
5        community cases as well as long-term care cases.
6        (3) Subject to federal approval, the Department of
7    Healthcare and Family Services must implement an ex parte
8    renewal process for Medicaid-eligible individuals residing
9    in long-term care facilities. "Renewal" has the same
10    meaning as "redetermination" in State policies,
11    administrative rule, and federal Medicaid law. The ex parte
12    renewal process must be fully operational on or before
13    January 1, 2019. If an individual has transferred to
14    another long-term care facility, any annual notice
15    concerning redetermination of eligibility must be sent to
16    the long-term care facility where the individual resides as
17    well as to the individual.
18        (4) The Department of Human Services must use the
19    standards and distribution requirements described in this
20    subsection and in Section 11-6 for notification of missing
21    supporting documents and information during all phases of
22    the application process: initial, renewal, and appeal.
23    (c) The Department of Human Services must adopt policies
24and procedures to improve communication between long-term care
25benefits central office personnel, applicants and their
26representatives, and facilities in which the applicants

 

 

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1reside. Such policies and procedures must at a minimum permit
2applicants and their representatives and the facility in which
3the applicants reside to speak directly to an individual
4trained to take telephone inquiries and provide appropriate
5responses.
6    (d) Effective 30 days after the completion of 3 regionally
7based trainings, nursing facilities shall submit all
8applications for medical assistance online via the Application
9for Benefits Eligibility (ABE) website. This requirement shall
10extend to scanning and uploading with the online application
11any required additional forms such as the Long Term Care
12Facility Notification and the Additional Financial Information
13for Long Term Care Applicants as well as scanned copies of any
14supporting documentation. Long-term care facility admission
15documents must be submitted as required in Section 5-5 of this
16Code. No local Department of Human Services office shall refuse
17to accept an electronically filed application. No Department of
18Human Services office shall request submission of any document
19in hard copy.
20    (e) Notwithstanding any other provision of this Code, the
21Department of Human Services and the Department of Healthcare
22and Family Services' Office of the Inspector General shall,
23upon request, allow an applicant additional time to submit
24information and documents needed as part of a review of
25available resources or resources transferred during the
26look-back period. The initial extension shall not exceed 30

 

 

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1days. A second extension of 30 days may be granted upon
2request. Any request for information issued by the State to an
3applicant shall include the following: an explanation of the
4information required and the date by which the information must
5be submitted; a statement that failure to respond in a timely
6manner can result in denial of the application; a statement
7that the applicant or the facility in the name of the applicant
8may seek an extension; and the name and contact information of
9a caseworker in case of questions. Any such request for
10information shall also be sent to the facility. In deciding
11whether to grant an extension, the Department of Human Services
12or the Department of Healthcare and Family Services' Office of
13the Inspector General shall take into account what is in the
14best interest of the applicant. The time limits for processing
15an application shall be tolled during the period of any
16extension granted under this subsection.
17    (f) The Department of Human Services and the Department of
18Healthcare and Family Services must jointly compile data on
19pending applications, denials, appeals, and redeterminations
20into a monthly report, which shall be posted on each
21Department's website for the purposes of monitoring long-term
22care eligibility processing. The report must specify the number
23of applications and redeterminations pending long-term care
24eligibility determination and admission and the number of
25appeals of denials in the following categories:
26        (A) Length of time applications, redeterminations, and

 

 

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1    appeals are pending - 0 to 45 days, 46 days to 90 days, 91
2    days to 180 days, 181 days to 12 months, over 12 months to
3    18 months, over 18 months to 24 months, and over 24 months.
4        (B) Percentage of applications and redeterminations
5    pending in the Department of Human Services' Family
6    Community Resource Centers, in the Department of Human
7    Services' long-term care hubs, with the Department of
8    Healthcare and Family Services' Office of Inspector
9    General, and those applications which are being tolled due
10    to requests for extension of time for additional
11    information.
12        (C) Status of pending applications, denials, appeals,
13    and redeterminations.
14    (g) Beginning on July 1, 2017, the Auditor General shall
15report every 3 years to the General Assembly on the performance
16and compliance of the Department of Healthcare and Family
17Services, the Department of Human Services, and the Department
18on Aging in meeting the requirements of this Section and the
19federal requirements concerning eligibility determinations for
20Medicaid long-term care services and supports, and shall report
21any issues or deficiencies and make recommendations. The
22Auditor General shall, at a minimum, review, consider, and
23evaluate the following:
24        (1) compliance with federal regulations on furnishing
25    services as related to Medicaid long-term care services and
26    supports as provided under 42 CFR 435.930;

 

 

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1        (2) compliance with federal regulations on the timely
2    determination of eligibility as provided under 42 CFR
3    435.912;
4        (3) the accuracy and completeness of the report
5    required under paragraph (9) of subsection (e);
6        (4) the efficacy and efficiency of the task-based
7    process used for making eligibility determinations in the
8    centralized offices of the Department of Human Services for
9    long-term care services, including the role of the State's
10    integrated eligibility system, as opposed to the
11    traditional caseworker-specific process from which these
12    central offices have converted; and
13        (5) any issues affecting eligibility determinations
14    related to the Department of Human Services' staff
15    completing Medicaid eligibility determinations instead of
16    the designated single-state Medicaid agency in Illinois,
17    the Department of Healthcare and Family Services.
18    The Auditor General's report shall include any and all
19other areas or issues which are identified through an annual
20review. Paragraphs (1) through (5) of this subsection shall not
21be construed to limit the scope of the annual review and the
22Auditor General's authority to thoroughly and completely
23evaluate any and all processes, policies, and procedures
24concerning compliance with federal and State law requirements
25on eligibility determinations for Medicaid long-term care
26services and supports.

 

 

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1    (h) The Department of Healthcare and Family Services shall
2adopt any rules necessary to administer and enforce any
3provision of this Section. Rulemaking shall not delay the full
4implementation of this Section.
5(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17;
6100-665, eff. 8-2-18.)