Rep. Greg Harris

Filed: 8/5/2015

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 972

2    AMENDMENT NO. ______. Amend House Bill 972 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1limited to, any or all of the following:
2        (a) (blank);
3        (b) (blank);
4        (c) home care aide services;
5        (d) personal assistant services;
6        (e) adult day services;
7        (f) home-delivered meals;
8        (g) education in self-care;
9        (h) personal care services;
10        (i) adult day health services;
11        (j) habilitation services;
12        (k) respite care;
13        (k-5) community reintegration services;
14        (k-6) flexible senior services;
15        (k-7) medication management;
16        (k-8) emergency home response;
17        (l) other nonmedical social services that may enable
18    the person to become self-supporting; or
19        (m) clearinghouse for information provided by senior
20    citizen home owners who want to rent rooms to or share
21    living space with other senior citizens.
22    The Department shall establish eligibility standards for
23such services. In determining the amount and nature of services
24for which a person may qualify, consideration shall not be
25given to the value of cash, property or other assets held in
26the name of the person's spouse pursuant to a written agreement

 

 

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1dividing marital property into equal but separate shares or
2pursuant to a transfer of the person's interest in a home to
3his spouse, provided that the spouse's share of the marital
4property is not made available to the person seeking such
5services.
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, in conjunction with the Department of
12Public Aid (now Department of Healthcare and Family Services),
13seek appropriate amendments under Sections 1915 and 1924 of the
14Social Security Act. The purpose of the amendments shall be to
15extend eligibility for home and community based services under
16Sections 1915 and 1924 of the Social Security Act to persons
17who transfer to or for the benefit of a spouse those amounts of
18income and resources allowed under Section 1924 of the Social
19Security Act. Subject to the approval of such amendments, the
20Department shall extend the provisions of Section 5-4 of the
21Illinois Public Aid Code to persons who, but for the provision
22of home or community-based services, would require the level of
23care provided in an institution, as is provided for in federal
24law. Those persons no longer found to be eligible for receiving
25noninstitutional services due to changes in the eligibility
26criteria shall be given 45 days notice prior to actual

 

 

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1termination. Those persons receiving notice of termination may
2contact the Department and request the determination be
3appealed at any time during the 45 day notice period. The
4target population identified for the purposes of this Section
5are persons age 60 and older with an identified service need.
6Priority shall be given to those who are at imminent risk of
7institutionalization. The services shall be provided to
8eligible persons age 60 and older to the extent that the cost
9of the services together with the other personal maintenance
10expenses of the persons are reasonably related to the standards
11established for care in a group facility appropriate to the
12person's condition. These non-institutional services, pilot
13projects or experimental facilities may be provided as part of
14or in addition to those authorized by federal law or those
15funded and administered by the Department of Human Services.
16The Departments of Human Services, Healthcare and Family
17Services, Public Health, Veterans' Affairs, and Commerce and
18Economic Opportunity and other appropriate agencies of State,
19federal and local governments shall cooperate with the
20Department on Aging in the establishment and development of the
21non-institutional services. The Department shall require an
22annual audit from all personal assistant and home care aide
23vendors contracting with the Department under this Section. The
24annual audit shall assure that each audited vendor's procedures
25are in compliance with Department's financial reporting
26guidelines requiring an administrative and employee wage and

 

 

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1benefits cost split as defined in administrative rules. The
2audit is a public record under the Freedom of Information Act.
3The Department shall execute, relative to the nursing home
4prescreening project, written inter-agency agreements with the
5Department of Human Services and the Department of Healthcare
6and Family Services, to effect the following: (1) intake
7procedures and common eligibility criteria for those persons
8who are receiving non-institutional services; and (2) the
9establishment and development of non-institutional services in
10areas of the State where they are not currently available or
11are undeveloped. On and after July 1, 1996, all nursing home
12prescreenings for individuals 60 years of age or older shall be
13conducted by the Department.
14    As part of the Department on Aging's routine training of
15case managers and case manager supervisors, the Department may
16include information on family futures planning for persons who
17are age 60 or older and who are caregivers of their adult
18children with developmental disabilities. The content of the
19training shall be at the Department's discretion.
20    The Department is authorized to establish a system of
21recipient copayment for services provided under this Section,
22such copayment to be based upon the recipient's ability to pay
23but in no case to exceed the actual cost of the services
24provided. Additionally, any portion of a person's income which
25is equal to or less than the federal poverty standard shall not
26be considered by the Department in determining the copayment.

 

 

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1The level of such copayment shall be adjusted whenever
2necessary to reflect any change in the officially designated
3federal poverty standard.
4    The Department, or the Department's authorized
5representative, may recover the amount of moneys expended for
6services provided to or in behalf of a person under this
7Section by a claim against the person's estate or against the
8estate of the person's surviving spouse, but no recovery may be
9had until after the death of the surviving spouse, if any, and
10then only at such time when there is no surviving child who is
11under age 21, blind, or permanently and totally disabled. This
12paragraph, however, shall not bar recovery, at the death of the
13person, of moneys for services provided to the person or in
14behalf of the person under this Section to which the person was
15not entitled; provided that such recovery shall not be enforced
16against any real estate while it is occupied as a homestead by
17the surviving spouse or other dependent, if no claims by other
18creditors have been filed against the estate, or, if such
19claims have been filed, they remain dormant for failure of
20prosecution or failure of the claimant to compel administration
21of the estate for the purpose of payment. This paragraph shall
22not bar recovery from the estate of a spouse, under Sections
231915 and 1924 of the Social Security Act and Section 5-4 of the
24Illinois Public Aid Code, who precedes a person receiving
25services under this Section in death. All moneys for services
26paid to or in behalf of the person under this Section shall be

 

 

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1claimed for recovery from the deceased spouse's estate.
2"Homestead", as used in this paragraph, means the dwelling
3house and contiguous real estate occupied by a surviving spouse
4or relative, as defined by the rules and regulations of the
5Department of Healthcare and Family Services, regardless of the
6value of the property.
7    The Department shall increase the effectiveness of the
8existing Community Care Program by:
9        (1) ensuring that in-home services included in the care
10    plan are available on evenings and weekends;
11        (2) ensuring that care plans contain the services that
12    eligible participants need based on the number of days in a
13    month, not limited to specific blocks of time, as
14    identified by the comprehensive assessment tool selected
15    by the Department for use statewide, not to exceed the
16    total monthly service cost maximum allowed for each
17    service; the Department shall develop administrative rules
18    to implement this item (2);
19        (3) ensuring that the participants have the right to
20    choose the services contained in their care plan and to
21    direct how those services are provided, based on
22    administrative rules established by the Department;
23        (4) ensuring that the determination of need tool is
24    accurate in determining the participants' level of need; to
25    achieve this, the Department, in conjunction with the Older
26    Adult Services Advisory Committee, shall institute a study

 

 

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1    of the relationship between the Determination of Need
2    scores, level of need, service cost maximums, and the
3    development and utilization of service plans no later than
4    May 1, 2008; findings and recommendations shall be
5    presented to the Governor and the General Assembly no later
6    than January 1, 2009; recommendations shall include all
7    needed changes to the service cost maximums schedule and
8    additional covered services;
9        (5) ensuring that homemakers can provide personal care
10    services that may or may not involve contact with clients,
11    including but not limited to:
12            (A) bathing;
13            (B) grooming;
14            (C) toileting;
15            (D) nail care;
16            (E) transferring;
17            (F) respiratory services;
18            (G) exercise; or
19            (H) positioning;
20        (6) ensuring that homemaker program vendors are not
21    restricted from hiring homemakers who are family members of
22    clients or recommended by clients; the Department may not,
23    by rule or policy, require homemakers who are family
24    members of clients or recommended by clients to accept
25    assignments in homes other than the client;
26        (7) ensuring that the State may access maximum federal

 

 

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1    matching funds by seeking approval for the Centers for
2    Medicare and Medicaid Services for modifications to the
3    State's home and community based services waiver and
4    additional waiver opportunities, including applying for
5    enrollment in the Balance Incentive Payment Program by May
6    1, 2013, in order to maximize federal matching funds; this
7    shall include, but not be limited to, modification that
8    reflects all changes in the Community Care Program services
9    and all increases in the services cost maximum;
10        (8) ensuring that the determination of need tool
11    accurately reflects the service needs of individuals with
12    Alzheimer's disease and related dementia disorders;
13        (9) ensuring that services are authorized accurately
14    and consistently for the Community Care Program (CCP); the
15    Department shall implement a Service Authorization policy
16    directive; the purpose shall be to ensure that eligibility
17    and services are authorized accurately and consistently in
18    the CCP program; the policy directive shall clarify service
19    authorization guidelines to Care Coordination Units and
20    Community Care Program providers no later than May 1, 2013;
21        (10) working in conjunction with Care Coordination
22    Units, the Department of Healthcare and Family Services,
23    the Department of Human Services, Community Care Program
24    providers, and other stakeholders to make improvements to
25    the Medicaid claiming processes and the Medicaid
26    enrollment procedures or requirements as needed,

 

 

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1    including, but not limited to, specific policy changes or
2    rules to improve the up-front enrollment of participants in
3    the Medicaid program and specific policy changes or rules
4    to insure more prompt submission of bills to the federal
5    government to secure maximum federal matching dollars as
6    promptly as possible; the Department on Aging shall have at
7    least 3 meetings with stakeholders by January 1, 2014 in
8    order to address these improvements;
9        (11) requiring home care service providers to comply
10    with the rounding of hours worked provisions under the
11    federal Fair Labor Standards Act (FLSA) and as set forth in
12    29 CFR 785.48(b) by May 1, 2013;
13        (12) implementing any necessary policy changes or
14    promulgating any rules, no later than January 1, 2014, to
15    assist the Department of Healthcare and Family Services in
16    moving as many participants as possible, consistent with
17    federal regulations, into coordinated care plans if a care
18    coordination plan that covers long term care is available
19    in the recipient's area; and
20        (13) maintaining fiscal year 2014 rates at the same
21    level established on January 1, 2013.
22    Individuals with a score of 29 or higher based on the
23determination of need (DON) assessment tool shall be eligible
24to receive institutional and home and community-based long term
25care services until such time that the State receives federal
26approval and implements an updated assessment tool. The

 

 

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1Department must promulgate rules regarding the updated
2assessment tool, but shall not promulgate emergency rules
3regarding the updated assessment tool. The State shall not
4implement an updated assessment tool that causes more than 1%
5of then-current recipients to lose eligibility. Anyone
6determined to be ineligible for services due to the updated
7assessment tool shall continue to be eligible for services for
8at least one year following that determination and must be
9reassessed no earlier than 11 months after that determination.
10    By January 1, 2009 or as soon after the end of the Cash and
11Counseling Demonstration Project as is practicable, the
12Department may, based on its evaluation of the demonstration
13project, promulgate rules concerning personal assistant
14services, to include, but need not be limited to,
15qualifications, employment screening, rights under fair labor
16standards, training, fiduciary agent, and supervision
17requirements. All applicants shall be subject to the provisions
18of the Health Care Worker Background Check Act.
19    The Department shall develop procedures to enhance
20availability of services on evenings, weekends, and on an
21emergency basis to meet the respite needs of caregivers.
22Procedures shall be developed to permit the utilization of
23services in successive blocks of 24 hours up to the monthly
24maximum established by the Department. Workers providing these
25services shall be appropriately trained.
26    Beginning on the effective date of this Amendatory Act of

 

 

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11991, no person may perform chore/housekeeping and home care
2aide services under a program authorized by this Section unless
3that person has been issued a certificate of pre-service to do
4so by his or her employing agency. Information gathered to
5effect such certification shall include (i) the person's name,
6(ii) the date the person was hired by his or her current
7employer, and (iii) the training, including dates and levels.
8Persons engaged in the program authorized by this Section
9before the effective date of this amendatory Act of 1991 shall
10be issued a certificate of all pre- and in-service training
11from his or her employer upon submitting the necessary
12information. The employing agency shall be required to retain
13records of all staff pre- and in-service training, and shall
14provide such records to the Department upon request and upon
15termination of the employer's contract with the Department. In
16addition, the employing agency is responsible for the issuance
17of certifications of in-service training completed to their
18employees.
19    The Department is required to develop a system to ensure
20that persons working as home care aides and personal assistants
21receive increases in their wages when the federal minimum wage
22is increased by requiring vendors to certify that they are
23meeting the federal minimum wage statute for home care aides
24and personal assistants. An employer that cannot ensure that
25the minimum wage increase is being given to home care aides and
26personal assistants shall be denied any increase in

 

 

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

 

 

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

 

 

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1the General Assembly on or before September 30 each year.
2    The requirement for reporting to the General Assembly shall
3be satisfied by filing copies of the report with the Speaker,
4the Minority Leader and the Clerk of the House of
5Representatives and the President, the Minority Leader and the
6Secretary of the Senate and the Legislative Research Unit, as
7required by Section 3.1 of the General Assembly Organization
8Act and filing such additional copies with the State Government
9Report Distribution Center for the General Assembly as is
10required under paragraph (t) of Section 7 of the State Library
11Act.
12    Those persons previously found eligible for receiving
13non-institutional services whose services were discontinued
14under the Emergency Budget Act of Fiscal Year 1992, and who do
15not meet the eligibility standards in effect on or after July
161, 1992, shall remain ineligible on and after July 1, 1992.
17Those persons previously not required to cost-share and who
18were required to cost-share effective March 1, 1992, shall
19continue to meet cost-share requirements on and after July 1,
201992. Beginning July 1, 1992, all clients will be required to
21meet eligibility, cost-share, and other requirements and will
22have services discontinued or altered when they fail to meet
23these requirements.
24    For the purposes of this Section, "flexible senior
25services" refers to services that require one-time or periodic
26expenditures including, but not limited to, respite care, home

 

 

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1modification, assistive technology, housing assistance, and
2transportation.
3    The Department shall implement an electronic service
4verification based on global positioning systems or other
5cost-effective technology for the Community Care Program no
6later than January 1, 2014.
7    The Department shall require, as a condition of
8eligibility, enrollment in the medical assistance program
9under Article V of the Illinois Public Aid Code (i) beginning
10August 1, 2013, if the Auditor General has reported that the
11Department has failed to comply with the reporting requirements
12of Section 2-27 of the Illinois State Auditing Act; or (ii)
13beginning June 1, 2014, if the Auditor General has reported
14that the Department has not undertaken the required actions
15listed in the report required by subsection (a) of Section 2-27
16of the Illinois State Auditing Act.
17    The Department shall delay Community Care Program services
18until an applicant is determined eligible for medical
19assistance under Article V of the Illinois Public Aid Code (i)
20beginning August 1, 2013, if the Auditor General has reported
21that the Department has failed to comply with the reporting
22requirements of Section 2-27 of the Illinois State Auditing
23Act; or (ii) beginning June 1, 2014, if the Auditor General has
24reported that the Department has not undertaken the required
25actions listed in the report required by subsection (a) of
26Section 2-27 of the Illinois State Auditing Act.

 

 

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1    The Department shall implement co-payments for the
2Community Care Program at the federally allowable maximum level
3(i) beginning August 1, 2013, if the Auditor General has
4reported that the Department has failed to comply with the
5reporting requirements of Section 2-27 of the Illinois State
6Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
7General has reported that the Department has not undertaken the
8required actions listed in the report required by subsection
9(a) of Section 2-27 of the Illinois State Auditing Act.
10    The Department shall provide a bi-monthly report on the
11progress of the Community Care Program reforms set forth in
12this amendatory Act of the 98th General Assembly to the
13Governor, the Speaker of the House of Representatives, the
14Minority Leader of the House of Representatives, the President
15of the Senate, and the Minority Leader of the Senate.
16    The Department shall conduct a quarterly review of Care
17Coordination Unit performance and adherence to service
18guidelines. The quarterly review shall be reported to the
19Speaker of the House of Representatives, the Minority Leader of
20the House of Representatives, the President of the Senate, and
21the Minority Leader of the Senate. The Department shall collect
22and report longitudinal data on the performance of each care
23coordination unit. Nothing in this paragraph shall be construed
24to require the Department to identify specific care
25coordination units.
26    In regard to community care providers, failure to comply

 

 

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1with Department on Aging policies shall be cause for
2disciplinary action, including, but not limited to,
3disqualification from serving Community Care Program clients.
4Each provider, upon submission of any bill or invoice to the
5Department for payment for services rendered, shall include a
6notarized statement, under penalty of perjury pursuant to
7Section 1-109 of the Code of Civil Procedure, that the provider
8has complied with all Department policies.
9    The Director of the Department on Aging shall make
10information available to the State Board of Elections as may be
11required by an agreement the State Board of Elections has
12entered into with a multi-state voter registration list
13maintenance system.
14(Source: P.A. 97-333, eff. 8-12-11; 98-8, eff. 5-3-13; 98-1171,
15eff. 6-1-15.)
 
16    Section 10. The Disabled Persons Rehabilitation Act is
17amended by changing Section 3 as follows:
 
18    (20 ILCS 2405/3)  (from Ch. 23, par. 3434)
19    Sec. 3. Powers and duties. The Department shall have the
20powers and duties enumerated herein:
21    (a) To co-operate with the federal government in the
22administration of the provisions of the federal Rehabilitation
23Act of 1973, as amended, of the Workforce Investment Act of
241998, and of the federal Social Security Act to the extent and

 

 

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1in the manner provided in these Acts.
2    (b) To prescribe and supervise such courses of vocational
3training and provide such other services as may be necessary
4for the habilitation and rehabilitation of persons with one or
5more disabilities, including the administrative activities
6under subsection (e) of this Section, and to co-operate with
7State and local school authorities and other recognized
8agencies engaged in habilitation, rehabilitation and
9comprehensive rehabilitation services; and to cooperate with
10the Department of Children and Family Services regarding the
11care and education of children with one or more disabilities.
12    (c) (Blank).
13    (d) To report in writing, to the Governor, annually on or
14before the first day of December, and at such other times and
15in such manner and upon such subjects as the Governor may
16require. The annual report shall contain (1) a statement of the
17existing condition of comprehensive rehabilitation services,
18habilitation and rehabilitation in the State; (2) a statement
19of suggestions and recommendations with reference to the
20development of comprehensive rehabilitation services,
21habilitation and rehabilitation in the State; and (3) an
22itemized statement of the amounts of money received from
23federal, State and other sources, and of the objects and
24purposes to which the respective items of these several amounts
25have been devoted.
26    (e) (Blank).

 

 

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1    (f) To establish a program of services to prevent the
2unnecessary institutionalization of persons in need of long
3term care and who meet the criteria for blindness or disability
4as defined by the Social Security Act, thereby enabling them to
5remain in their own homes. Such preventive services include any
6or all of the following:
7        (1) personal assistant services;
8        (2) homemaker services;
9        (3) home-delivered meals;
10        (4) adult day care services;
11        (5) respite care;
12        (6) home modification or assistive equipment;
13        (7) home health services;
14        (8) electronic home response;
15        (9) brain injury behavioral/cognitive services;
16        (10) brain injury habilitation;
17        (11) brain injury pre-vocational services; or
18        (12) brain injury supported employment.
19    The Department shall establish eligibility standards for
20such services taking into consideration the unique economic and
21social needs of the population for whom they are to be
22provided. Such eligibility standards may be based on the
23recipient's ability to pay for services; provided, however,
24that any portion of a person's income that is equal to or less
25than the "protected income" level shall not be considered by
26the Department in determining eligibility. The "protected

 

 

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1income" level shall be determined by the Department, shall
2never be less than the federal poverty standard, and shall be
3adjusted each year to reflect changes in the Consumer Price
4Index For All Urban Consumers as determined by the United
5States Department of Labor. The standards must provide that a
6person may not have more than $10,000 in assets to be eligible
7for the services, and the Department may increase or decrease
8the asset limitation by rule. The Department may not decrease
9the asset level below $10,000.
10    Individuals with a score of 29 or higher based on the
11determination of need (DON) assessment tool shall be eligible
12to receive institutional and home and community-based long term
13care services until such time that the State receives federal
14approval and implements an updated assessment tool. The
15Department must promulgate rules regarding the updated
16assessment tool, but shall not promulgate emergency 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. Anyone
20determined to be ineligible for services due to the updated
21assessment tool shall continue to be eligible for services for
22at least one year following that determination and must be
23reassessed no earlier than 11 months after that determination.
24    The services shall be provided, as established by the
25Department by rule, to eligible persons to prevent unnecessary
26or premature institutionalization, to the extent that the cost

 

 

09900HB0972ham001- 22 -LRB099 04807 KTG 37436 a

1of the services, together with the other personal maintenance
2expenses of the persons, are reasonably related to the
3standards established for care in a group facility appropriate
4to their condition. These non-institutional services, pilot
5projects or experimental facilities may be provided as part of
6or in addition to those authorized by federal law or those
7funded and administered by the Illinois Department on Aging.
8The Department shall set rates and fees for services in a fair
9and equitable manner. Services identical to those offered by
10the Department on Aging shall be paid at the same rate.
11    Personal assistants shall be paid at a rate negotiated
12between the State and an exclusive representative of personal
13assistants under a collective bargaining agreement. In no case
14shall the Department pay personal assistants an hourly wage
15that is less than the federal minimum wage.
16    Solely for the purposes of coverage under the Illinois
17Public Labor Relations Act (5 ILCS 315/), personal assistants
18providing services under the Department's Home Services
19Program shall be considered to be public employees and the
20State of Illinois shall be considered to be their employer as
21of the effective date of this amendatory Act of the 93rd
22General Assembly, but not before. Solely for the purposes of
23coverage under the Illinois Public Labor Relations Act, home
24care and home health workers who function as personal
25assistants and individual maintenance home health workers and
26who also provide services under the Department's Home Services

 

 

09900HB0972ham001- 23 -LRB099 04807 KTG 37436 a

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

 

 

09900HB0972ham001- 24 -LRB099 04807 KTG 37436 a

1retirement or health insurance benefits. Home care and home
2health workers who function as personal assistants and
3individual maintenance home health workers and who also provide
4services under the Department's Home Services Program shall not
5be covered by the State Employees Group Insurance Act of 1971
6(5 ILCS 375/).
7    The Department shall execute, relative to nursing home
8prescreening, as authorized by Section 4.03 of the Illinois Act
9on the Aging, written inter-agency agreements with the
10Department on Aging and the Department of Healthcare and Family
11Services, to effect the intake procedures and eligibility
12criteria for those persons who may need long term care. On and
13after July 1, 1996, all nursing home prescreenings for
14individuals 18 through 59 years of age shall be conducted by
15the Department, or a designee of the Department.
16    The Department is authorized to establish a system of
17recipient cost-sharing for services provided under this
18Section. The cost-sharing shall be based upon the recipient's
19ability to pay for services, but in no case shall the
20recipient's share exceed the actual cost of the services
21provided. Protected income shall not be considered by the
22Department in its determination of the recipient's ability to
23pay a share of the cost of services. The level of cost-sharing
24shall be adjusted each year to reflect changes in the
25"protected income" level. The Department shall deduct from the
26recipient's share of the cost of services any money expended by

 

 

09900HB0972ham001- 25 -LRB099 04807 KTG 37436 a

1the recipient for disability-related expenses.
2    To the extent permitted under the federal Social Security
3Act, the Department, or the Department's authorized
4representative, may recover the amount of moneys expended for
5services provided to or in behalf of a person under this
6Section by a claim against the person's estate or against the
7estate of the person's surviving spouse, but no recovery may be
8had until after the death of the surviving spouse, if any, and
9then only at such time when there is no surviving child who is
10under age 21, blind, or permanently and totally disabled. This
11paragraph, however, shall not bar recovery, at the death of the
12person, of moneys for services provided to the person or in
13behalf of the person under this Section to which the person was
14not entitled; provided that such recovery shall not be enforced
15against any real estate while it is occupied as a homestead by
16the surviving spouse or other dependent, if no claims by other
17creditors have been filed against the estate, or, if such
18claims have been filed, they remain dormant for failure of
19prosecution or failure of the claimant to compel administration
20of the estate for the purpose of payment. This paragraph shall
21not bar recovery from the estate of a spouse, under Sections
221915 and 1924 of the Social Security Act and Section 5-4 of the
23Illinois Public Aid Code, who precedes a person receiving
24services under this Section in death. All moneys for services
25paid to or in behalf of the person under this Section shall be
26claimed for recovery from the deceased spouse's estate.

 

 

09900HB0972ham001- 26 -LRB099 04807 KTG 37436 a

1"Homestead", as used in this paragraph, means the dwelling
2house and contiguous real estate occupied by a surviving spouse
3or relative, as defined by the rules and regulations of the
4Department of Healthcare and Family Services, regardless of the
5value of the property.
6    The Department shall submit an annual report on programs
7and services provided under this Section. The report shall be
8filed with the Governor and the General Assembly on or before
9March 30 each year.
10    The requirement for reporting to the General Assembly shall
11be satisfied by filing copies of the report with the Speaker,
12the Minority Leader and the Clerk of the House of
13Representatives and the President, the Minority Leader and the
14Secretary of the Senate and the Legislative Research Unit, as
15required by Section 3.1 of the General Assembly Organization
16Act, and filing additional copies with the State Government
17Report Distribution Center for the General Assembly as required
18under paragraph (t) of Section 7 of the State Library Act.
19    (g) To establish such subdivisions of the Department as
20shall be desirable and assign to the various subdivisions the
21responsibilities and duties placed upon the Department by law.
22    (h) To cooperate and enter into any necessary agreements
23with the Department of Employment Security for the provision of
24job placement and job referral services to clients of the
25Department, including job service registration of such clients
26with Illinois Employment Security offices and making job

 

 

09900HB0972ham001- 27 -LRB099 04807 KTG 37436 a

1listings maintained by the Department of Employment Security
2available to such clients.
3    (i) To possess all powers reasonable and necessary for the
4exercise and administration of the powers, duties and
5responsibilities of the Department which are provided for by
6law.
7    (j) (Blank).
8    (k) (Blank).
9    (l) To establish, operate and maintain a Statewide Housing
10Clearinghouse of information on available, government
11subsidized housing accessible to disabled persons and
12available privately owned housing accessible to disabled
13persons. The information shall include but not be limited to
14the location, rental requirements, access features and
15proximity to public transportation of available housing. The
16Clearinghouse shall consist of at least a computerized database
17for the storage and retrieval of information and a separate or
18shared toll free telephone number for use by those seeking
19information from the Clearinghouse. Department offices and
20personnel throughout the State shall also assist in the
21operation of the Statewide Housing Clearinghouse. Cooperation
22with local, State and federal housing managers shall be sought
23and extended in order to frequently and promptly update the
24Clearinghouse's information.
25    (m) To assure that the names and case records of persons
26who received or are receiving services from the Department,

 

 

09900HB0972ham001- 28 -LRB099 04807 KTG 37436 a

1including persons receiving vocational rehabilitation, home
2services, or other services, and those attending one of the
3Department's schools or other supervised facility shall be
4confidential and not be open to the general public. Those case
5records and reports or the information contained in those
6records and reports shall be disclosed by the Director only to
7proper law enforcement officials, individuals authorized by a
8court, the General Assembly or any committee or commission of
9the General Assembly, and other persons and for reasons as the
10Director designates by rule. Disclosure by the Director may be
11only in accordance with other applicable law.
12(Source: P.A. 97-732, eff. 6-30-12; 97-1019, eff. 8-17-12;
1397-1158, eff. 1-29-13; 98-1004, eff. 8-18-14.)
 
14    Section 13. The Nursing Home Care Act is amended by
15changing Section 3-402 as follows:
 
16    (210 ILCS 45/3-402)  (from Ch. 111 1/2, par. 4153-402)
17    Sec. 3-402. Involuntary transfer or discharge.
18    Involuntary transfer or discharge of a resident from a
19facility shall be preceded by the discussion required under
20Section 3-408 and by a minimum written notice of 21 days,
21except in one of the following instances:
22        (a) When an emergency transfer or discharge is ordered
23    by the resident's attending physician because of the
24    resident's health care needs.

 

 

09900HB0972ham001- 29 -LRB099 04807 KTG 37436 a

1        (b) When the transfer or discharge is mandated by the
2    physical safety of other residents, the facility staff, or
3    facility visitors, as documented in the clinical record.
4    The Department shall be notified prior to any such
5    involuntary transfer or discharge. The Department shall
6    immediately offer transfer, or discharge and relocation
7    assistance to residents transferred or discharged under
8    this subparagraph (b), and the Department may place
9    relocation teams as provided in Section 3-419 of this Act.
10        (c) When an identified offender is within the
11    provisional admission period defined in Section 1-120.3.
12    If the Identified Offender Report and Recommendation
13    prepared under Section 2-201.6 shows that the identified
14    offender poses a serious threat or danger to the physical
15    safety of other residents, the facility staff, or facility
16    visitors in the admitting facility and the facility
17    determines that it is unable to provide a safe environment
18    for the other residents, the facility staff, or facility
19    visitors, the facility shall transfer or discharge the
20    identified offender within 3 days after its receipt of the
21    Identified Offender Report and Recommendation.
22    No individual receiving care in an institutional setting
23shall be involuntarily discharged as the result of the updated
24determination of need (DON) assessment tool as provided in
25Section 5-5 of the Illinois Public Aid Code until a transition
26plan has been developed by the Department on Aging or its

 

 

09900HB0972ham001- 30 -LRB099 04807 KTG 37436 a

1designee and all care identified in the transition plan is
2available to the resident immediately upon discharge.
3(Source: P.A. 96-1372, eff. 7-29-10.)
 
4    Section 15. The Illinois Public Aid Code is amended by
5changing Sections 5-5 and 5-5.01a as follows:
 
6    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
7    Sec. 5-5. Medical services. The Illinois Department, by
8rule, shall determine the quantity and quality of and the rate
9of reimbursement for the medical assistance for which payment
10will be authorized, and the medical services to be provided,
11which may include all or part of the following: (1) inpatient
12hospital services; (2) outpatient hospital services; (3) other
13laboratory and X-ray services; (4) skilled nursing home
14services; (5) physicians' services whether furnished in the
15office, the patient's home, a hospital, a skilled nursing home,
16or elsewhere; (6) medical care, or any other type of remedial
17care furnished by licensed practitioners; (7) home health care
18services; (8) private duty nursing service; (9) clinic
19services; (10) dental services, including prevention and
20treatment of periodontal disease and dental caries disease for
21pregnant women, provided by an individual licensed to practice
22dentistry or dental surgery; for purposes of this item (10),
23"dental services" means diagnostic, preventive, or corrective
24procedures provided by or under the supervision of a dentist in

 

 

09900HB0972ham001- 31 -LRB099 04807 KTG 37436 a

1the practice of his or her profession; (11) physical therapy
2and related services; (12) prescribed drugs, dentures, and
3prosthetic devices; and eyeglasses prescribed by a physician
4skilled in the diseases of the eye, or by an optometrist,
5whichever the person may select; (13) other diagnostic,
6screening, preventive, and rehabilitative services, including
7to ensure that the individual's need for intervention or
8treatment of mental disorders or substance use disorders or
9co-occurring mental health and substance use disorders is
10determined using a uniform screening, assessment, and
11evaluation process inclusive of criteria, for children and
12adults; for purposes of this item (13), a uniform screening,
13assessment, and evaluation process refers to a process that
14includes an appropriate evaluation and, as warranted, a
15referral; "uniform" does not mean the use of a singular
16instrument, tool, or process that all must utilize; (14)
17transportation and such other expenses as may be necessary;
18(15) medical treatment of sexual assault survivors, as defined
19in Section 1a of the Sexual Assault Survivors Emergency
20Treatment Act, for injuries sustained as a result of the sexual
21assault, including examinations and laboratory tests to
22discover evidence which may be used in criminal proceedings
23arising from the sexual assault; (16) the diagnosis and
24treatment of sickle cell anemia; and (17) any other medical
25care, and any other type of remedial care recognized under the
26laws of this State, but not including abortions, or induced

 

 

09900HB0972ham001- 32 -LRB099 04807 KTG 37436 a

1miscarriages or premature births, unless, in the opinion of a
2physician, such procedures are necessary for the preservation
3of the life of the woman seeking such treatment, or except an
4induced premature birth intended to produce a live viable child
5and such procedure is necessary for the health of the mother or
6her unborn child. The Illinois Department, by rule, shall
7prohibit any physician from providing medical assistance to
8anyone eligible therefor under this Code where such physician
9has been found guilty of performing an abortion procedure in a
10wilful and wanton manner upon a woman who was not pregnant at
11the time such abortion procedure was performed. The term "any
12other type of remedial care" shall include nursing care and
13nursing home service for persons who rely on treatment by
14spiritual means alone through prayer for healing.
15    Notwithstanding any other provision of this Section, a
16comprehensive tobacco use cessation program that includes
17purchasing prescription drugs or prescription medical devices
18approved by the Food and Drug Administration shall be covered
19under the medical assistance program under this Article for
20persons who are otherwise eligible for assistance under this
21Article.
22    Notwithstanding any other provision of this Code, the
23Illinois Department may not require, as a condition of payment
24for any laboratory test authorized under this Article, that a
25physician's handwritten signature appear on the laboratory
26test order form. The Illinois Department may, however, impose

 

 

09900HB0972ham001- 33 -LRB099 04807 KTG 37436 a

1other appropriate requirements regarding laboratory test order
2documentation.
3    Upon receipt of federal approval of an amendment to the
4Illinois Title XIX State Plan for this purpose, the Department
5shall authorize the Chicago Public Schools (CPS) to procure a
6vendor or vendors to manufacture eyeglasses for individuals
7enrolled in a school within the CPS system. CPS shall ensure
8that its vendor or vendors are enrolled as providers in the
9medical assistance program and in any capitated Medicaid
10managed care entity (MCE) serving individuals enrolled in a
11school within the CPS system. Under any contract procured under
12this provision, the vendor or vendors must serve only
13individuals enrolled in a school within the CPS system. Claims
14for services provided by CPS's vendor or vendors to recipients
15of benefits in the medical assistance program under this Code,
16the Children's Health Insurance Program, or the Covering ALL
17KIDS Health Insurance Program shall be submitted to the
18Department or the MCE in which the individual is enrolled for
19payment and shall be reimbursed at the Department's or the
20MCE's established rates or rate methodologies for eyeglasses.
21    On and after July 1, 2012, the Department of Healthcare and
22Family Services may provide the following services to persons
23eligible for assistance under this Article who are
24participating in education, training or employment programs
25operated by the Department of Human Services as successor to
26the Department of Public Aid:

 

 

09900HB0972ham001- 34 -LRB099 04807 KTG 37436 a

1        (1) dental services provided by or under the
2    supervision of a dentist; and
3        (2) eyeglasses prescribed by a physician skilled in the
4    diseases of the eye, or by an optometrist, whichever the
5    person may select.
6    Notwithstanding any other provision of this Code and
7subject to federal approval, the Department may adopt rules to
8allow a dentist who is volunteering his or her service at no
9cost to render dental services through an enrolled
10not-for-profit health clinic without the dentist personally
11enrolling as a participating provider in the medical assistance
12program. A not-for-profit health clinic shall include a public
13health clinic or Federally Qualified Health Center or other
14enrolled provider, as determined by the Department, through
15which dental services covered under this Section are performed.
16The Department shall establish a process for payment of claims
17for reimbursement for covered dental services rendered under
18this provision.
19    The Illinois Department, by rule, may distinguish and
20classify the medical services to be provided only in accordance
21with the classes of persons designated in Section 5-2.
22    The Department of Healthcare and Family Services must
23provide coverage and reimbursement for amino acid-based
24elemental formulas, regardless of delivery method, for the
25diagnosis and treatment of (i) eosinophilic disorders and (ii)
26short bowel syndrome when the prescribing physician has issued

 

 

09900HB0972ham001- 35 -LRB099 04807 KTG 37436 a

1a written order stating that the amino acid-based elemental
2formula is medically necessary.
3    The Illinois Department shall authorize the provision of,
4and shall authorize payment for, screening by low-dose
5mammography for the presence of occult breast cancer for women
635 years of age or older who are eligible for medical
7assistance under this Article, as follows:
8        (A) A baseline mammogram for women 35 to 39 years of
9    age.
10        (B) An annual mammogram for women 40 years of age or
11    older.
12        (C) A mammogram at the age and intervals considered
13    medically necessary by the woman's health care provider for
14    women under 40 years of age and having a family history of
15    breast cancer, prior personal history of breast cancer,
16    positive genetic testing, or other risk factors.
17        (D) A comprehensive ultrasound screening of an entire
18    breast or breasts if a mammogram demonstrates
19    heterogeneous or dense breast tissue, when medically
20    necessary as determined by a physician licensed to practice
21    medicine in all of its branches.
22    All screenings shall include a physical breast exam,
23instruction on self-examination and information regarding the
24frequency of self-examination and its value as a preventative
25tool. For purposes of this Section, "low-dose mammography"
26means the x-ray examination of the breast using equipment

 

 

09900HB0972ham001- 36 -LRB099 04807 KTG 37436 a

1dedicated specifically for mammography, including the x-ray
2tube, filter, compression device, and image receptor, with an
3average radiation exposure delivery of less than one rad per
4breast for 2 views of an average size breast. The term also
5includes digital mammography.
6    On and after January 1, 2012, providers participating in a
7quality improvement program approved by the Department shall be
8reimbursed for screening and diagnostic mammography at the same
9rate as the Medicare program's rates, including the increased
10reimbursement for digital mammography.
11    The Department shall convene an expert panel including
12representatives of hospitals, free-standing mammography
13facilities, and doctors, including radiologists, to establish
14quality standards.
15    Subject to federal approval, the Department shall
16establish a rate methodology for mammography at federally
17qualified health centers and other encounter-rate clinics.
18These clinics or centers may also collaborate with other
19hospital-based mammography facilities.
20    The Department shall establish a methodology to remind
21women who are age-appropriate for screening mammography, but
22who have not received a mammogram within the previous 18
23months, of the importance and benefit of screening mammography.
24    The Department shall establish a performance goal for
25primary care providers with respect to their female patients
26over age 40 receiving an annual mammogram. This performance

 

 

09900HB0972ham001- 37 -LRB099 04807 KTG 37436 a

1goal shall be used to provide additional reimbursement in the
2form of a quality performance bonus to primary care providers
3who meet that goal.
4    The Department shall devise a means of case-managing or
5patient navigation for beneficiaries diagnosed with breast
6cancer. This program shall initially operate as a pilot program
7in areas of the State with the highest incidence of mortality
8related to breast cancer. At least one pilot program site shall
9be in the metropolitan Chicago area and at least one site shall
10be outside the metropolitan Chicago area. An evaluation of the
11pilot program shall be carried out measuring health outcomes
12and cost of care for those served by the pilot program compared
13to similarly situated patients who are not served by the pilot
14program.
15    Any medical or health care provider shall immediately
16recommend, to any pregnant woman who is being provided prenatal
17services and is suspected of drug abuse or is addicted as
18defined in the Alcoholism and Other Drug Abuse and Dependency
19Act, referral to a local substance abuse treatment provider
20licensed by the Department of Human Services or to a licensed
21hospital which provides substance abuse treatment services.
22The Department of Healthcare and Family Services shall assure
23coverage for the cost of treatment of the drug abuse or
24addiction for pregnant recipients in accordance with the
25Illinois Medicaid Program in conjunction with the Department of
26Human Services.

 

 

09900HB0972ham001- 38 -LRB099 04807 KTG 37436 a

1    All medical providers providing medical assistance to
2pregnant women under this Code shall receive information from
3the Department on the availability of services under the Drug
4Free Families with a Future or any comparable program providing
5case management services for addicted women, including
6information on appropriate referrals for other social services
7that may be needed by addicted women in addition to treatment
8for addiction.
9    The Illinois Department, in cooperation with the
10Departments of Human Services (as successor to the Department
11of Alcoholism and Substance Abuse) and Public Health, through a
12public awareness campaign, may provide information concerning
13treatment for alcoholism and drug abuse and addiction, prenatal
14health care, and other pertinent programs directed at reducing
15the number of drug-affected infants born to recipients of
16medical assistance.
17    Neither the Department of Healthcare and Family Services
18nor the Department of Human Services shall sanction the
19recipient solely on the basis of her substance abuse.
20    The Illinois Department shall establish such regulations
21governing the dispensing of health services under this Article
22as it shall deem appropriate. The Department should seek the
23advice of formal professional advisory committees appointed by
24the Director of the Illinois Department for the purpose of
25providing regular advice on policy and administrative matters,
26information dissemination and educational activities for

 

 

09900HB0972ham001- 39 -LRB099 04807 KTG 37436 a

1medical and health care providers, and consistency in
2procedures to the Illinois Department.
3    The Illinois Department may develop and contract with
4Partnerships of medical providers to arrange medical services
5for persons eligible under Section 5-2 of this Code.
6Implementation of this Section may be by demonstration projects
7in certain geographic areas. The Partnership shall be
8represented by a sponsor organization. The Department, by rule,
9shall develop qualifications for sponsors of Partnerships.
10Nothing in this Section shall be construed to require that the
11sponsor organization be a medical organization.
12    The sponsor must negotiate formal written contracts with
13medical providers for physician services, inpatient and
14outpatient hospital care, home health services, treatment for
15alcoholism and substance abuse, and other services determined
16necessary by the Illinois Department by rule for delivery by
17Partnerships. Physician services must include prenatal and
18obstetrical care. The Illinois Department shall reimburse
19medical services delivered by Partnership providers to clients
20in target areas according to provisions of this Article and the
21Illinois Health Finance Reform Act, except that:
22        (1) Physicians participating in a Partnership and
23    providing certain services, which shall be determined by
24    the Illinois Department, to persons in areas covered by the
25    Partnership may receive an additional surcharge for such
26    services.

 

 

09900HB0972ham001- 40 -LRB099 04807 KTG 37436 a

1        (2) The Department may elect to consider and negotiate
2    financial incentives to encourage the development of
3    Partnerships and the efficient delivery of medical care.
4        (3) Persons receiving medical services through
5    Partnerships may receive medical and case management
6    services above the level usually offered through the
7    medical assistance program.
8    Medical providers shall be required to meet certain
9qualifications to participate in Partnerships to ensure the
10delivery of high quality medical services. These
11qualifications shall be determined by rule of the Illinois
12Department and may be higher than qualifications for
13participation in the medical assistance program. Partnership
14sponsors may prescribe reasonable additional qualifications
15for participation by medical providers, only with the prior
16written approval of the Illinois Department.
17    Nothing in this Section shall limit the free choice of
18practitioners, hospitals, and other providers of medical
19services by clients. In order to ensure patient freedom of
20choice, the Illinois Department shall immediately promulgate
21all rules and take all other necessary actions so that provided
22services may be accessed from therapeutically certified
23optometrists to the full extent of the Illinois Optometric
24Practice Act of 1987 without discriminating between service
25providers.
26    The Department shall apply for a waiver from the United

 

 

09900HB0972ham001- 41 -LRB099 04807 KTG 37436 a

1States Health Care Financing Administration to allow for the
2implementation of Partnerships under this Section.
3    The Illinois Department shall require health care
4providers to maintain records that document the medical care
5and services provided to recipients of Medical Assistance under
6this Article. Such records must be retained for a period of not
7less than 6 years from the date of service or as provided by
8applicable State law, whichever period is longer, except that
9if an audit is initiated within the required retention period
10then the records must be retained until the audit is completed
11and every exception is resolved. The Illinois Department shall
12require health care providers to make available, when
13authorized by the patient, in writing, the medical records in a
14timely fashion to other health care providers who are treating
15or serving persons eligible for Medical Assistance under this
16Article. All dispensers of medical services shall be required
17to maintain and retain business and professional records
18sufficient to fully and accurately document the nature, scope,
19details and receipt of the health care provided to persons
20eligible for medical assistance under this Code, in accordance
21with regulations promulgated by the Illinois Department. The
22rules and regulations shall require that proof of the receipt
23of prescription drugs, dentures, prosthetic devices and
24eyeglasses by eligible persons under this Section accompany
25each claim for reimbursement submitted by the dispenser of such
26medical services. No such claims for reimbursement shall be

 

 

09900HB0972ham001- 42 -LRB099 04807 KTG 37436 a

1approved for payment by the Illinois Department without such
2proof of receipt, unless the Illinois Department shall have put
3into effect and shall be operating a system of post-payment
4audit and review which shall, on a sampling basis, be deemed
5adequate by the Illinois Department to assure that such drugs,
6dentures, prosthetic devices and eyeglasses for which payment
7is being made are actually being received by eligible
8recipients. Within 90 days after the effective date of this
9amendatory Act of 1984, the Illinois Department shall establish
10a current list of acquisition costs for all prosthetic devices
11and any other items recognized as medical equipment and
12supplies reimbursable under this Article and shall update such
13list on a quarterly basis, except that the acquisition costs of
14all prescription drugs shall be updated no less frequently than
15every 30 days as required by Section 5-5.12.
16    The rules and regulations of the Illinois Department shall
17require that a written statement including the required opinion
18of a physician shall accompany any claim for reimbursement for
19abortions, or induced miscarriages or premature births. This
20statement shall indicate what procedures were used in providing
21such medical services.
22    Notwithstanding any other law to the contrary, the Illinois
23Department shall, within 365 days after July 22, 2013, (the
24effective date of Public Act 98-104), establish procedures to
25permit skilled care facilities licensed under the Nursing Home
26Care Act to submit monthly billing claims for reimbursement

 

 

09900HB0972ham001- 43 -LRB099 04807 KTG 37436 a

1purposes. Following development of these procedures, the
2Department shall have an additional 365 days to test the
3viability of the new system and to ensure that any necessary
4operational or structural changes to its information
5technology platforms are implemented.
6    Notwithstanding any other law to the contrary, the Illinois
7Department shall, within 365 days after August 15, 2014 (the
8effective date of Public Act 98-963) this amendatory Act of the
998th General Assembly, establish procedures to permit ID/DD
10facilities licensed under the ID/DD Community Care Act to
11submit monthly billing claims for reimbursement purposes.
12Following development of these procedures, the Department
13shall have an additional 365 days to test the viability of the
14new system and to ensure that any necessary operational or
15structural changes to its information technology platforms are
16implemented.
17    The Illinois Department shall require all dispensers of
18medical services, other than an individual practitioner or
19group of practitioners, desiring to participate in the Medical
20Assistance program established under this Article to disclose
21all financial, beneficial, ownership, equity, surety or other
22interests in any and all firms, corporations, partnerships,
23associations, business enterprises, joint ventures, agencies,
24institutions or other legal entities providing any form of
25health care services in this State under this Article.
26    The Illinois Department may require that all dispensers of

 

 

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

 

 

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

 

 

09900HB0972ham001- 46 -LRB099 04807 KTG 37436 a

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

 

 

09900HB0972ham001- 47 -LRB099 04807 KTG 37436 a

1submitted through MEDI or REV or shall be submitted directly to
2the Department of Human Services using required admission
3forms. Effective September 1, 2014, admission documents,
4including all prescreening information, must be submitted
5through MEDI or REV. Confirmation numbers assigned to an
6accepted transaction shall be retained by a facility to verify
7timely 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

 

 

09900HB0972ham001- 48 -LRB099 04807 KTG 37436 a

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)

 

 

09900HB0972ham001- 49 -LRB099 04807 KTG 37436 a

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.
22    The Department shall execute, relative to the nursing home
23prescreening project, written inter-agency agreements with the
24Department of Human Services and the Department on Aging, to
25effect the following: (i) intake procedures and common
26eligibility criteria for those persons who are receiving

 

 

09900HB0972ham001- 50 -LRB099 04807 KTG 37436 a

1non-institutional services; and (ii) the establishment and
2development of non-institutional services in areas of the State
3where they are not currently available or are undeveloped; and
4(iii) (iii) notwithstanding any other provision of law, subject
5to federal approval, on and after July 1, 2012, an increase in
6the determination of need (DON) scores from 29 to 37 for
7applicants for institutional and home and community-based long
8term care; if and only if federal approval is not granted, the
9Department may, in conjunction with other affected agencies,
10implement utilization controls or changes in benefit packages
11to effectuate a similar savings amount for this population; and
12(iv) no later than July 1, 2013, minimum level of care
13eligibility criteria for institutional and home and
14community-based long term care; and (iv) (v) no later than
15October 1, 2013, establish procedures to permit long term care
16providers access to eligibility scores for individuals with an
17admission date who are seeking or receiving services from the
18long term care provider. In order to select the minimum level
19of care eligibility criteria, the Governor shall establish a
20workgroup that includes affected agency representatives and
21stakeholders representing the institutional and home and
22community-based long term care interests. This Section shall
23not restrict the Department from implementing lower level of
24care eligibility criteria for community-based services in
25circumstances where federal approval has been granted.
26Individuals with a score of 29 or higher based on the

 

 

09900HB0972ham001- 51 -LRB099 04807 KTG 37436 a

1determination of need (DON) assessment tool shall be eligible
2to receive institutional and home and community-based long term
3care services until such time that the State receives federal
4approval and implements an updated assessment tool. The
5Department must promulgate rules regarding the updated
6assessment tool, but shall not promulgate emergency rules
7regarding the updated assessment tool. The State shall not
8implement an updated assessment tool that causes more than 1%
9of then-current recipients to lose eligibility. Anyone
10determined to be ineligible for services due to the updated
11assessment tool shall continue to be eligible for services for
12at least one year following that determination and must be
13reassessed no earlier than 11 months after that determination.
14No individual receiving care in an institutional setting shall
15be involuntarily discharged as the result of the updated
16assessment tool until a transition plan has been developed by
17the Department on Aging or its designee and all care identified
18in the transition plan is available to the resident immediately
19upon discharge.
20    The Illinois Department shall develop and operate, in
21cooperation with other State Departments and agencies and in
22compliance with applicable federal laws and regulations,
23appropriate and effective systems of health care evaluation and
24programs for monitoring of utilization of health care services
25and facilities, as it affects persons eligible for medical
26assistance under this Code.

 

 

09900HB0972ham001- 52 -LRB099 04807 KTG 37436 a

1    The Illinois Department shall report annually to the
2General Assembly, no later than the second Friday in April of
31979 and each year thereafter, in regard to:
4        (a) actual statistics and trends in utilization of
5    medical services by public aid recipients;
6        (b) actual statistics and trends in the provision of
7    the various medical services by medical vendors;
8        (c) current rate structures and proposed changes in
9    those rate structures for the various medical vendors; and
10        (d) efforts at utilization review and control by the
11    Illinois Department.
12    The period covered by each report shall be the 3 years
13ending on the June 30 prior to the report. The report shall
14include suggested legislation for consideration by the General
15Assembly. The filing of one copy of the report with the
16Speaker, one copy with the Minority Leader and one copy with
17the Clerk of the House of Representatives, one copy with the
18President, one copy with the Minority Leader and one copy with
19the Secretary of the Senate, one copy with the Legislative
20Research Unit, and such additional copies with the State
21Government Report Distribution Center for the General Assembly
22as is required under paragraph (t) of Section 7 of the State
23Library Act shall be deemed sufficient to comply with this
24Section.
25    Rulemaking authority to implement Public Act 95-1045, if
26any, is conditioned on the rules being adopted in accordance

 

 

09900HB0972ham001- 53 -LRB099 04807 KTG 37436 a

1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5    On and after July 1, 2012, the Department shall reduce any
6rate of reimbursement for services or other payments or alter
7any methodologies authorized by this Code to reduce any rate of
8reimbursement for services or other payments in accordance with
9Section 5-5e.
10    Because kidney transplantation can be an appropriate, cost
11effective alternative to renal dialysis when medically
12necessary and notwithstanding the provisions of Section 1-11 of
13this Code, beginning October 1, 2014, the Department shall
14cover kidney transplantation for noncitizens with end-stage
15renal disease who are not eligible for comprehensive medical
16benefits, who meet the residency requirements of Section 5-3 of
17this Code, and who would otherwise meet the financial
18requirements of the appropriate class of eligible persons under
19Section 5-2 of this Code. To qualify for coverage of kidney
20transplantation, such person must be receiving emergency renal
21dialysis services covered by the Department. Providers under
22this Section shall be prior approved and certified by the
23Department to perform kidney transplantation and the services
24under this Section shall be limited to services associated with
25kidney transplantation.
26(Source: P.A. 97-48, eff. 6-28-11; 97-638, eff. 1-1-12; 97-689,

 

 

09900HB0972ham001- 54 -LRB099 04807 KTG 37436 a

1eff. 6-14-12; 97-1061, eff. 8-24-12; 98-104, Article 9, Section
29-5, eff. 7-22-13; 98-104, Article 12, Section 12-20, eff.
37-22-13; 98-303, eff. 8-9-13; 98-463, eff. 8-16-13; 98-651,
4eff. 6-16-14; 98-756, eff. 7-16-14; 98-963, eff. 8-15-14;
5revised 10-2-14.)
 
6    (305 ILCS 5/5-5.01a)
7    Sec. 5-5.01a. Supportive living facilities program. The
8Department shall establish and provide oversight for a program
9of supportive living facilities that seek to promote resident
10independence, dignity, respect, and well-being in the most
11cost-effective manner.
12    A supportive living facility is either a free-standing
13facility or a distinct physical and operational entity within a
14nursing facility. A supportive living facility integrates
15housing with health, personal care, and supportive services and
16is a designated setting that offers residents their own
17separate, private, and distinct living units.
18    Sites for the operation of the program shall be selected by
19the Department based upon criteria that may include the need
20for services in a geographic area, the availability of funding,
21and the site's ability to meet the standards.
22    Beginning July 1, 2014, subject to federal approval, the
23Medicaid rates for supportive living facilities shall be equal
24to the supportive living facility Medicaid rate effective on
25June 30, 2014 increased by 8.85%. Once the assessment imposed

 

 

09900HB0972ham001- 55 -LRB099 04807 KTG 37436 a

1at Article V-G of this Code is determined to be a permissible
2tax under Title XIX of the Social Security Act, the Department
3shall increase the Medicaid rates for supportive living
4facilities effective on July 1, 2014 by 9.09%. The Department
5shall apply this increase retroactively to coincide with the
6imposition of the assessment in Article V-G of this Code in
7accordance with the approval for federal financial
8participation by the Centers for Medicare and Medicaid
9Services.
10    The Department may adopt rules to implement this Section.
11Rules that establish or modify the services, standards, and
12conditions for participation in the program shall be adopted by
13the Department in consultation with the Department on Aging,
14the Department of Rehabilitation Services, and the Department
15of Mental Health and Developmental Disabilities (or their
16successor agencies).
17    Facilities or distinct parts of facilities which are
18selected as supportive living facilities and are in good
19standing with the Department's rules are exempt from the
20provisions of the Nursing Home Care Act and the Illinois Health
21Facilities Planning Act.
22    Individuals with a score of 29 or higher based on the
23determination of need (DON) assessment tool shall be eligible
24to receive institutional and home and community-based long term
25care services until such time that the State receives federal
26approval and implements an updated assessment tool. The

 

 

09900HB0972ham001- 56 -LRB099 04807 KTG 37436 a

1Department must promulgate rules regarding the updated
2assessment tool, but shall not promulgate emergency rules
3regarding the updated assessment tool. The State shall not
4implement an updated assessment tool that causes more than 1%
5of then-current recipients to lose eligibility. Anyone
6determined to be ineligible for services due to the updated
7assessment tool shall continue to be eligible for services for
8at least one year following that determination and must be
9reassessed no earlier than 11 months after that determination.
10(Source: P.A. 98-651, eff. 6-16-14.)
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.".