103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4076

 

Introduced 5/9/2023, by Rep. Camille Y. Lilly

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/11-5.3a new

     Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application.


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A BILL FOR

 

HB4076LRB103 32309 KTG 61622 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 11-5.3a as follows:
 
6    (305 ILCS 5/11-5.3a new)
7    Sec. 11-5.3a. Business Enterprise Program certified vendor
8for redetermination system.
9    (a) The General Assembly finds that there is a real and
10current need for automation of the process of determination,
11redetermination (generally "determination"), certification,
12or recertification of entry into any type of regulated program
13while also providing for an automatic system of facilitating
14the determination process where recalcitrance or reticence is
15detected. Further, there is a need for a system that includes
16finding, informing, recruiting, and securing an individual's
17participation in programs such as the medical assistance
18program under Article V to the benefit of the individual.
19    (b) The Department of Innovation and Technology, in
20conjunction with the Department of Healthcare and Family
21Services, shall select a State vendor to redetermine the
22eligibility of medical assistance enrollees not covered by the
23federal waivers provided under Section 1902(e)(14)(A) of the

 

 

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1Social Security Act. The selected vendor must be certified by
2the Business Enterprise Program and have no less than 60% of
3its owners with established residency in Illinois as of the
4effective date of this amendatory Act of the 103rd General
5Assembly. The selected vendor shall conduct redeterminations
6utilizing a system that meets the following requirements:
7        (1) The redetermination system must be hosted on a
8    cloud-based platform that is secure and compliant with
9    standards under the federal Health Insurance Portability
10    and Accountability Act of 1996.
11        (2) The redetermination system must also use a cloud
12    communication platform to programmatically perform calls,
13    text messages, and other communication functions using web
14    services or application programming interface services.
15        (3) The redetermination system must be able to make
16    contact with a medical assistance enrollee in an automated
17    fashion, using the last known contact information to
18    contact the medical assistance enrollee, and if the
19    redetermination contact process is advised that contact
20    was not made, the process must use public and private
21    databases to find and test newly found contact information
22    until the medical assistance enrollee is reached and
23    redetermination is started, or the medical assistance
24    enrollee opts out of the redetermination contact process.
25    The redetermination system must be designed to continue
26    until contact is made and confirmed and contact

 

 

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1    information is updated to facilitate the following year's
2    redetermination contact process. A relentless search to
3    find medical assistance enrollees and complete the
4    redetermination process must be made, such that no
5    eligible medical assistance enrollee or applicant is left
6    behind.
7        (4) The redetermination system must also have the
8    ability to reward a medical assistance enrollee who
9    successfully completes the redetermination process, such
10    as with a gift card or other rewards that can be provided
11    to the medical assistance enrollee when the process is
12    completed. The amount of the gift card may be conditioned
13    on the responsiveness of the medical assistance enrollee
14    or dependent on other factors such as age, living
15    conditions, or abode as well as other factors or criteria.
16        (5) The redetermination system must have the ability
17    to simplify and greatly facilitate medical assistance
18    enrollees to engage in the redetermination process and
19    easily enter, update, and transmit their required
20    information and data by being able to go from using a voice
21    virtual agent or text virtual agent to an online web form
22    and back to a human assistant seamlessly and without
23    losing any data input.
24        (6) The redetermination system must allow the medical
25    assistance enrollee to start the process through one of
26    the means available, stop at some point, and then resume

 

 

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1    using the same means or transferring the process to
2    another means available through the system without missing
3    a beat.
4        (7) The redetermination system must allow the medical
5    assistance enrollee to switch between the voice virtual
6    agent (using artificial intelligence), the text virtual
7    agent, and an online web form.
8        (8) The redetermination system must also perform the
9    function of pre-populating forms with the information
10    confirmed by the medical assistance enrollee, which can be
11    uploaded during the redetermination process as the medical
12    assistance enrollee proceeds through the data fields so as
13    to confirm or update the medical assistance recipient's
14    information.
15        (9) The redetermination system must be designed to be
16    compliant with the Americans with Disabilities Act (ADA).
17    ADA compliance must be found regardless of which of the
18    different ways a medical assistance enrollee enters the
19    data, and then, any of the other means to which the medical
20    assistance enrollee can switch, continues to be ADA
21    compliant regardless of the stage of the redetermination
22    process that the enrollee is in and regardless of the
23    number of transitions from one data entry means to
24    another.
25        (10) The redetermination system must provide an
26    out-of-the-box analytics dashboard that is tethered to the

 

 

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1    cloud-based system with no additional software
2    installation on the user's computer or mobile devices.
3        (11) The redetermination system must allow for a
4    scouring of the laws, rules, and regulations to review any
5    changes to the medical assistance program and institute
6    those changes in the questionnaires and forms utilized to
7    assess the candidate and enroll the applicant.
8        (12) Using the redetermination system shall not be
9    considered "assistance" but rather a different modality of
10    applying for redetermination.
11        (13) The redetermination system must have a cloud data
12    processing platform to accumulate enrollee data to begin
13    the process in an automated fashion. This includes data
14    validation, rejection, and preparation for communication
15    such as call or text.
16        (14) The redetermination system must have a cloud data
17    processing platform to be able to provide data submitted
18    by medical assistance enrollees to managed care
19    organizations at a predefined frequency, such as daily,
20    weekly, or monthly.
21    (c) All vendors applying for consideration as the State
22vendor to conduct medical assistance eligibility
23redeterminations as provided in subsection (b) shall submit a
24letter of intent to the Department of Innovation and
25Technology in a form and manner required by the Department of
26Innovation and Technology. The Department of Innovation and

 

 

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1Technology shall allow 7 days for a letter of intent and shall
2issue a grant award to the selected vendor within 2 weeks after
3the end of the 7-day period. To qualify for a grant award under
4this Section, the selected vendor must already have all
5contracts in place with any relevant subvendors no later than
65 business days after the effective date of this amendatory
7Act of the 103rd General Assembly.
8    (d) Nothing in this amendatory Act of the 103rd General
9Assembly shall be construed to contravene any federal
10regulation, policy, or requirement of the Centers for Medicare
11and Medicaid Services. If any provision of this amendatory Act
12of the 103rd General Assembly or its application is found to be
13in violation of any federal regulation, policy, or requirement
14of the Centers for Medicare and Medicaid Services, that
15provision is declared invalid but does not affect any other
16provision or application of this amendatory Act that can be
17given effect without the invalid provision or application. The
18provisions of this amendatory Act of the 103rd General
19Assembly are declared to be severable.