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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.1 and by adding Section 5-30.2 as
6follows:
 
7    (305 ILCS 5/5-30.2 new)
8    Sec. 5-30.2. Monthly reports; managed care enrollment.
9    (a) As used in this Section, "Medicaid Managed Care Entity"
10means a Managed Care Organization (MCO), a Managed Care
11Community Network (MCCN), an Accountable Care Entity (ACE), or
12a Care Coordination Entity (CCE) contracted by the Department.
13    (b) As soon as practical if the data is reasonably
14available, but no later than January 1, 2017, the Department
15shall publish monthly reports on its website on the enrollment
16of persons in the State's medical assistance program. In
17addition, as soon as practical if the data is reasonably
18available, but no later than January 1, 2017, the Department
19shall publish monthly reports on its website on the enrollment
20of recipients of medical assistance into a Medicaid Managed
21Care Entity contracted by the Department. As soon as practical
22if the data is reasonably available, but no later than January
231, 2017, the monthly reports shall include all of the following

 

 

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1information for the medical assistance program generally and,
2separately, for each Medicaid Managed Care Entity contracted by
3the Department:
4        (1) Total enrollment.
5        (2) The number of persons enrolled in the medical
6    assistance program under items 18 and 19 of Section 5-2.
7        (3) The number of children enrolled.
8        (4) The number of parents and caretakers of minor
9    children enrolled.
10        (5) The number of women enrolled on the basis of
11    pregnancy.
12        (6) The number of seniors enrolled.
13        (7) The number of persons enrolled on the basis of
14    disability.
15    (c) As soon as practical if the data is reasonably
16available, but no later than January 1, 2017, the Department
17shall publish monthly reports on its website detailing the
18percentage of persons enrolled in each Medicaid Managed Care
19Entity that was assigned using an auto-assignment algorithm.
20This percentage should also report the type of enrollee who was
21assigned using an auto-assignment algorithm, including, but
22not limited to, persons enrolled in the medical assistance
23program in each of the groups listed in subsection (b) of this
24Section.
25    (d) As soon as practical if the data is reasonably
26available, but no later than January 1, 2017, monthly

 

 

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1enrollment reports for each Medicaid Managed Care Entity shall
2include data on the 2 most recently available months and data
3comparing the most recently available month to that month in
4the prior year.
5    (e) As soon as practical if the data is reasonably
6available, but no later than January 1, 2017, monthly
7enrollment reports for each Medicaid Managed Care Entity shall
8include a breakdown of language preference for enrollees by
9English, Spanish, and the next 4 most commonly used languages.
10    (f) The Department must annually publish on its website
11each Medicaid Managed Care Entity's quality metrics outcomes
12and must make public an independent annual quality review
13report on the State's Medicaid managed care delivery system.
 
14    (305 ILCS 5/11-5.1)
15    Sec. 11-5.1. Eligibility verification. Notwithstanding any
16other provision of this Code, with respect to applications for
17medical assistance provided under Article V of this Code,
18eligibility shall be determined in a manner that ensures
19program integrity and complies with federal laws and
20regulations while minimizing unnecessary barriers to
21enrollment. To this end, as soon as practicable, and unless the
22Department receives written denial from the federal
23government, this Section shall be implemented:
24    (a) The Department of Healthcare and Family Services or its
25designees shall:

 

 

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1        (1) By no later than July 1, 2011, require verification
2    of, at a minimum, one month's income from all sources
3    required for determining the eligibility of applicants for
4    medical assistance under this Code. Such verification
5    shall take the form of pay stubs, business or income and
6    expense records for self-employed persons, letters from
7    employers, and any other valid documentation of income
8    including data obtained electronically by the Department
9    or its designees from other sources as described in
10    subsection (b) of this Section.
11        (2) By no later than October 1, 2011, require
12    verification of, at a minimum, one month's income from all
13    sources required for determining the continued eligibility
14    of recipients at their annual review of eligibility for
15    medical assistance under this Code. Such verification
16    shall take the form of pay stubs, business or income and
17    expense records for self-employed persons, letters from
18    employers, and any other valid documentation of income
19    including data obtained electronically by the Department
20    or its designees from other sources as described in
21    subsection (b) of this Section. The Department shall send a
22    notice to recipients at least 60 days prior to the end of
23    their period of eligibility that informs them of the
24    requirements for continued eligibility. If a recipient
25    does not fulfill the requirements for continued
26    eligibility by the deadline established in the notice a

 

 

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1    notice of cancellation shall be issued to the recipient and
2    coverage shall end on the last day of the eligibility
3    period. A recipient's eligibility may be reinstated
4    without requiring a new application if the recipient
5    fulfills the requirements for continued eligibility prior
6    to the end of the third month following the last date of
7    coverage (or longer period if required by federal
8    regulations). Nothing in this Section shall prevent an
9    individual whose coverage has been cancelled from
10    reapplying for health benefits at any time.
11        (3) By no later than July 1, 2011, require verification
12    of Illinois residency.
13    (b) The Department shall establish or continue cooperative
14arrangements with the Social Security Administration, the
15Illinois Secretary of State, the Department of Human Services,
16the Department of Revenue, the Department of Employment
17Security, and any other appropriate entity to gain electronic
18access, to the extent allowed by law, to information available
19to those entities that may be appropriate for electronically
20verifying any factor of eligibility for benefits under the
21Program. Data relevant to eligibility shall be provided for no
22other purpose than to verify the eligibility of new applicants
23or current recipients of health benefits under the Program.
24Data shall be requested or provided for any new applicant or
25current recipient only insofar as that individual's
26circumstances are relevant to that individual's or another

 

 

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1individual's eligibility.
2    (c) Within 90 days of the effective date of this amendatory
3Act of the 96th General Assembly, the Department of Healthcare
4and Family Services shall send notice to current recipients
5informing them of the changes regarding their eligibility
6verification.
7    (d) As soon as practical if the data is reasonably
8available, but no later than January 1, 2017, the Department
9shall compile on a monthly basis data on eligibility
10redeterminations of beneficiaries of medical assistance
11provided under Article V of this Code. This data shall be
12posted on the Department's website, and data from prior months
13shall be retained and available on the Department's website.
14The data compiled and reported shall include the following:
15        (1) The total number of redetermination decisions made
16    in a month and, of that total number, the number of
17    decisions to continue or change benefits and the number of
18    decisions to cancel benefits.
19        (2) A breakdown of enrollee language preference for the
20    total number of redetermination decisions made in a month
21    and, of that total number, a breakdown of enrollee language
22    preference for the number of decisions to continue or
23    change benefits, and a breakdown of enrollee language
24    preference for the number of decisions to cancel benefits.
25    The language breakdown shall include, at a minimum,
26    English, Spanish, and the next 4 most commonly used

 

 

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1    languages.
2        (3) The percentage of cancellation decisions made in a
3    month due to each of the following:
4            (A) The beneficiary's ineligibility due to excess
5        income.
6            (B) The beneficiary's ineligibility due to not
7        being an Illinois resident.
8            (C) The beneficiary's ineligibility due to being
9        deceased.
10            (D) The beneficiary's request to cancel benefits.
11            (E) The beneficiary's lack of response after
12        notices mailed to the beneficiary are returned to the
13        Department as undeliverable by the United States
14        Postal Service.
15            (F) The beneficiary's lack of response to a request
16        for additional information when reliable information
17        in the beneficiary's account, or other more current
18        information, is unavailable to the Department to make a
19        decision on whether to continue benefits.
20            (G) Other reasons tracked by the Department for the
21        purpose of ensuring program integrity.
22        (4) If a vendor is utilized to provide services in
23    support of the Department's redetermination decision
24    process, the total number of redetermination decisions
25    made in a month and, of that total number, the number of
26    decisions to continue or change benefits, and the number of

 

 

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1    decisions to cancel benefits (i) with the involvement of
2    the vendor and (ii) without the involvement of the vendor.
3        (5) Of the total number of benefit cancellations in a
4    month, the number of beneficiaries who return from
5    cancellation within one month, the number of beneficiaries
6    who return from cancellation within 2 months, and the
7    number of beneficiaries who return from cancellation
8    within 3 months. Of the number of beneficiaries who return
9    from cancellation within 3 months, the percentage of those
10    cancellations due to each of the reasons listed under
11    paragraph (3) of this subsection.
12(Source: P.A. 98-651, eff. 6-16-14.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    305 ILCS 5/5-30.2 new
4    305 ILCS 5/11-5.1