101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3762

 

Introduced 2/14/2020, by Sen. Dave Syverson

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/11-5.4

    Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, the Department of Human Services, and the Department on Aging to establish a Long-Term Care Eligibility Advisory Committee to assist the State in eliminating problems surrounding long-term care eligibility determinations and enrollment in Medicaid long-term care. Contains provisions concerning the composition of the Committee, Committee meetings, and Committee reporting requirements. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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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    (a-1) On or before October 1, 2020, the Department of
14Healthcare and Family Services, with the assistance of the
15Department of Human Services and the Department on Aging, shall
16establish a Long-Term Care Eligibility Advisory Committee to
17assist the State in eliminating problems surrounding long-term
18care eligibility determinations and enrollment in Medicaid
19long-term care. The Committee shall be composed of 10 citizen
20members and 8 legislative members, all of whom shall serve in a
21voting capacity, with 2 citizen members and 2 members of the
22General Assembly appointed by each of the 4 legislative leaders
23and an additional 2 citizen members appointed by the Governor.

 

 

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1The Committee shall elect a voting member as Chair to work with
2the Department of Healthcare and Family Services, the
3Department of Human Services, and the Department on Aging to
4guide the work of the Committee. Voting members shall, by lot,
5determine whether initial appointments are for 2-year or 4-year
6terms with no more than 50% of each legislative leader's
7appointees serving an initial 2-year term. The Director of
8Healthcare and Family Services, the Director of Aging, and the
9Secretary of Human Services, or their designees, shall serve in
10a nonvoting capacity. The Committee shall meet every 6 weeks
11until backlogs of Medicaid applications and requests for
12long-term care benefits have been eliminated and shall meet
13quarterly thereafter. Voting members shall also serve on one or
14more workgroups. Additional individuals may be asked to serve
15on the workgroups. The Committee shall oversee joint reports to
16the Governor and the General Assembly. The reports shall be
17prepared by the Department of Healthcare and Family Services,
18the Department of Human Services, and the Department on Aging
19beginning January 1, 2020 and every quarter thereafter. The
20first report shall include an assessment of each of the
21provisions of this Section and all provisions of this Code that
22pertain to long-term care eligibility determination and
23enrollment issues.
24    (b) Streamlined application enrollment process; expedited
25eligibility process. The streamlined application and
26enrollment process must include, but need not be limited to,

 

 

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1the following:
2        (1) On or before July 1, 2019, a streamlined
3    application and enrollment process shall be put in place
4    which must include, but need not be limited to, the
5    following:
6            (A) Minimize the burden on applicants by
7        collecting only the data necessary to determine
8        eligibility for medical services, long-term care
9        services, and spousal impoverishment offset.
10            (B) Integrate online data sources to simplify the
11        application process by reducing the amount of
12        information needed to be entered and to expedite
13        eligibility verification.
14            (C) Provide online prompts to alert the applicant
15        that information is missing or not complete.
16            (D) Provide training and step-by-step written
17        instructions for caseworkers, applicants, and
18        providers.
19        (2) The State must expedite the eligibility process for
20    applicants meeting specified guidelines, regardless of the
21    age of the application. The guidelines, subject to federal
22    approval, must include, but need not be limited to, the
23    following individually or collectively:
24            (A) Full Medicaid benefits in the community for a
25        specified period of time.
26            (B) No transfer of assets or resources during the

 

 

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1        federally prescribed look-back period, as specified in
2        federal law.
3            (C) Receives Supplemental Security Income payments
4        or was receiving such payments at the time of admission
5        to a nursing facility.
6            (D) For applicants or recipients with verified
7        income at or below 100% of the federal poverty level
8        when the declared value of their countable resources is
9        no greater than the allowable amounts pursuant to
10        Section 5-2 of this Code for classes of eligible
11        persons for whom a resource limit applies. Such
12        simplified verification policies shall apply to
13        community cases as well as long-term care cases.
14        (3) Subject to federal approval, the Department of
15    Healthcare and Family Services must implement an ex parte
16    renewal process for Medicaid-eligible individuals residing
17    in long-term care facilities. "Renewal" has the same
18    meaning as "redetermination" in State policies,
19    administrative rule, and federal Medicaid law. The ex parte
20    renewal process must be fully operational on or before
21    January 1, 2019. If an individual has transferred to
22    another long-term care facility, any annual notice
23    concerning redetermination of eligibility must be sent to
24    the long-term care facility where the individual resides as
25    well as to the individual.
26        (4) The Department of Human Services must use the

 

 

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1    standards and distribution requirements described in this
2    subsection and in Section 11-6 for notification of missing
3    supporting documents and information during all phases of
4    the application process: initial, renewal, and appeal.
5    (c) The Department of Human Services must adopt policies
6and procedures to improve communication between long-term care
7benefits central office personnel, applicants and their
8representatives, and facilities in which the applicants
9reside. Such policies and procedures must at a minimum permit
10applicants and their representatives and the facility in which
11the applicants reside to speak directly to an individual
12trained to take telephone inquiries and provide appropriate
13responses.
14    (d) Effective 30 days after the completion of 3 regionally
15based trainings, nursing facilities shall submit all
16applications for medical assistance online via the Application
17for Benefits Eligibility (ABE) website. This requirement shall
18extend to scanning and uploading with the online application
19any required additional forms such as the Long Term Care
20Facility Notification and the Additional Financial Information
21for Long Term Care Applicants as well as scanned copies of any
22supporting documentation. Long-term care facility admission
23documents must be submitted as required in Section 5-5 of this
24Code. No local Department of Human Services office shall refuse
25to accept an electronically filed application. No Department of
26Human Services office shall request submission of any document

 

 

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1in hard copy.
2    (e) Notwithstanding any other provision of this Code, the
3Department of Human Services and the Department of Healthcare
4and Family Services' Office of the Inspector General shall,
5upon request, allow an applicant additional time to submit
6information and documents needed as part of a review of
7available resources or resources transferred during the
8look-back period. The initial extension shall not exceed 30
9days. A second extension of 30 days may be granted upon
10request. Any request for information issued by the State to an
11applicant shall include the following: an explanation of the
12information required and the date by which the information must
13be submitted; a statement that failure to respond in a timely
14manner can result in denial of the application; a statement
15that the applicant or the facility in the name of the applicant
16may seek an extension; and the name and contact information of
17a caseworker in case of questions. Any such request for
18information shall also be sent to the facility. In deciding
19whether to grant an extension, the Department of Human Services
20or the Department of Healthcare and Family Services' Office of
21the Inspector General shall take into account what is in the
22best interest of the applicant. The time limits for processing
23an application shall be tolled during the period of any
24extension granted under this subsection.
25    (f) The Department of Human Services and the Department of
26Healthcare and Family Services must jointly compile data on

 

 

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1pending applications, denials, appeals, and redeterminations
2into a monthly report, which shall be posted on each
3Department's website for the purposes of monitoring long-term
4care eligibility processing. The report must specify the number
5of applications and redeterminations pending long-term care
6eligibility determination and admission and the number of
7appeals of denials in the following categories:
8        (A) Length of time applications, redeterminations, and
9    appeals are pending - 0 to 45 days, 46 days to 90 days, 91
10    days to 180 days, 181 days to 12 months, over 12 months to
11    18 months, over 18 months to 24 months, and over 24 months.
12        (B) Percentage of applications and redeterminations
13    pending in the Department of Human Services' Family
14    Community Resource Centers, in the Department of Human
15    Services' long-term care hubs, with the Department of
16    Healthcare and Family Services' Office of Inspector
17    General, and those applications which are being tolled due
18    to requests for extension of time for additional
19    information.
20        (C) Status of pending applications, denials, appeals,
21    and redeterminations.
22    (g) Beginning on July 1, 2017, the Auditor General shall
23report every 3 years to the General Assembly on the performance
24and compliance of the Department of Healthcare and Family
25Services, the Department of Human Services, and the Department
26on Aging in meeting the requirements of this Section and the

 

 

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1federal requirements concerning eligibility determinations for
2Medicaid long-term care services and supports, and shall report
3any issues or deficiencies and make recommendations. The
4Auditor General shall, at a minimum, review, consider, and
5evaluate the following:
6        (1) compliance with federal regulations on furnishing
7    services as related to Medicaid long-term care services and
8    supports as provided under 42 CFR 435.930;
9        (2) compliance with federal regulations on the timely
10    determination of eligibility as provided under 42 CFR
11    435.912;
12        (3) the accuracy and completeness of the report
13    required under paragraph (9) of subsection (e);
14        (4) the efficacy and efficiency of the task-based
15    process used for making eligibility determinations in the
16    centralized offices of the Department of Human Services for
17    long-term care services, including the role of the State's
18    integrated eligibility system, as opposed to the
19    traditional caseworker-specific process from which these
20    central offices have converted; and
21        (5) any issues affecting eligibility determinations
22    related to the Department of Human Services' staff
23    completing Medicaid eligibility determinations instead of
24    the designated single-state Medicaid agency in Illinois,
25    the Department of Healthcare and Family Services.
26    The Auditor General's report shall include any and all

 

 

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1other areas or issues which are identified through an annual
2review. Paragraphs (1) through (5) of this subsection shall not
3be construed to limit the scope of the annual review and the
4Auditor General's authority to thoroughly and completely
5evaluate any and all processes, policies, and procedures
6concerning compliance with federal and State law requirements
7on eligibility determinations for Medicaid long-term care
8services and supports.
9    (h) The Department of Healthcare and Family Services shall
10adopt any rules necessary to administer and enforce any
11provision of this Section. Rulemaking shall not delay the full
12implementation of this Section.
13    (i) Beginning on June 29, 2018, provisional eligibility for
14medical assistance under Article V of this Code, in the form of
15a recipient identification number and any other necessary
16credentials to permit an applicant to receive covered services
17under Article V, must be issued to any applicant who has not
18received a determination on his or her application for Medicaid
19and Medicaid long-term care services filed simultaneously or,
20if already Medicaid enrolled, application for Medicaid
21long-term care services under Article V of this Code within the
22federally prescribed timeliness requirements for
23determinations on such applications. The Department of
24Healthcare and Family Services must maintain the applicant's
25provisional eligibility status until a determination is made on
26the individual's application for long-term care services. The

 

 

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1Department of Healthcare and Family Services or the managed
2care organization, if applicable, must reimburse providers for
3services rendered during an applicant's provisional
4eligibility period.
5        (1) Claims for services rendered to an applicant with
6    provisional eligibility status must be submitted and
7    processed in the same manner as those submitted on behalf
8    of beneficiaries determined to qualify for benefits.
9        (2) An applicant with provisional eligibility status
10    must have his or her long-term care benefits paid for under
11    the State's fee-for-service system during the period of
12    provisional eligibility. If an individual otherwise
13    eligible for medical assistance under Article V of this
14    Code is enrolled with a managed care organization for
15    community benefits at the time the individual's
16    provisional eligibility for long-term care services is
17    issued, the managed care organization is only responsible
18    for paying benefits covered under the capitation payment
19    received by the managed care organization for the
20    individual.
21        (3) The Department of Healthcare and Family Services,
22    within 10 business days of issuing provisional eligibility
23    to an applicant, must submit to the Office of the
24    Comptroller for payment a voucher for all retroactive
25    reimbursement due. The Department of Healthcare and Family
26    Services must clearly identify such vouchers as

 

 

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1    provisional eligibility vouchers.
2(Source: P.A. 100-380, eff. 8-25-17; 100-665, eff. 8-2-18;
3100-1141, eff. 11-28-18; 101-101, eff. 1-1-20; 101-209, eff.
48-5-19; 101-265, eff. 8-9-19; 101-559, eff. 8-23-19; revised
59-19-19.)
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.