Full Text of SB2913 100th General Assembly
SB2913enr 100TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Sections 11-5.4 and 11-6 and by adding Section 5-5g as | 6 | | follows: | 7 | | (305 ILCS 5/5-5g new) | 8 | | Sec. 5-5g. Long-term care patient; resident status. | 9 | | Long-term care providers shall submit all changes in resident | 10 | | status, including, but not limited to, death, discharge, | 11 | | changes in patient credit, third party liability, and Medicare | 12 | | coverage, to the Department through the Medical Electronic Data | 13 | | Interchange System, the Recipient Eligibility Verification | 14 | | System, or the Electronic Data Interchange System established | 15 | | under 89 Ill. Adm. Code 140.55(b) in compliance with the | 16 | | schedule below: | 17 | | (1) 15 calendar days after a resident's death; | 18 | | (2) 15 calendar days after a resident's discharge; | 19 | | (3) 45 calendar days after being informed of a change | 20 | | in the resident's income; | 21 | | (4) 45 calendar days after being informed of a change | 22 | | in a resident's third party liability; | 23 | | (5) 45 calendar days after a resident's move to |
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| 1 | | exceptional care services; and | 2 | | (6) 45 calendar days after a resident's need for | 3 | | services requiring reimbursement under the ventilator or | 4 | | traumatic brain injury enhanced rate. | 5 | | (305 ILCS 5/11-5.4) | 6 | | Sec. 11-5.4. Expedited long-term care eligibility | 7 | | determination and enrollment. | 8 | | (a) Establishment of the expedited long-term care | 9 | | eligibility determination and enrollment system shall be a | 10 | | joint venture of the Departments of Human Services and | 11 | | Healthcare and Family Services and the Department on Aging. An | 12 | | expedited long-term care eligibility determination and | 13 | | enrollment system shall be established to reduce long-term care | 14 | | determinations to 90 days or fewer by July 1, 2014 and | 15 | | streamline the long-term care enrollment process. | 16 | | Establishment of the system shall be a joint venture of the | 17 | | Department of Human Services and Healthcare and Family Services | 18 | | and the Department on Aging. The Governor shall name a lead | 19 | | agency no later than 30 days after the effective date of this | 20 | | amendatory Act of the 98th General Assembly to assume | 21 | | responsibility for the full implementation of the | 22 | | establishment and maintenance of the system. Project outcomes | 23 | | shall include an enhanced eligibility determination tracking | 24 | | system accessible to providers and a centralized application | 25 | | review and eligibility determination with all applicants |
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| 1 | | reviewed within 90 days of receipt by the State of a complete | 2 | | application. If the Department of Healthcare and Family | 3 | | Services' Office of the Inspector General determines that there | 4 | | is a likelihood that a non-allowable transfer of assets has | 5 | | occurred, and the facility in which the applicant resides is | 6 | | notified, an extension of up to 90 days shall be permissible. | 7 | | (b) Streamlined application enrollment process; expedited | 8 | | eligibility process. The streamlined application and | 9 | | enrollment process must include, but need not be limited to, | 10 | | the following: | 11 | | (1) On or before July 1, 2019, December 31, 2015, a | 12 | | streamlined application and enrollment process shall be | 13 | | put in place which must include, but need not be limited | 14 | | to, the following: based on the following principles: | 15 | | (A) (1) Minimize the burden on applicants by | 16 | | collecting only the data necessary to determine | 17 | | eligibility for medical services, long-term care | 18 | | services, and spousal impoverishment offset. | 19 | | (B) (2) Integrate online data sources to simplify | 20 | | the application process by reducing the amount of | 21 | | information needed to be entered and to expedite | 22 | | eligibility verification. | 23 | | (C) (3) Provide online prompts to alert the | 24 | | applicant that information is missing or not complete. | 25 | | (D) Provide training and step-by-step written | 26 | | instructions for caseworkers, applicants, and |
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| 1 | | providers. | 2 | | (2) The State must expedite the eligibility process for | 3 | | applicants meeting specified guidelines, regardless of the | 4 | | age of the application. The guidelines, subject to federal | 5 | | approval, must include, but need not be limited to, the | 6 | | following individually or collectively: | 7 | | (A) Full Medicaid benefits in the community for a | 8 | | specified period of time. | 9 | | (B) No transfer of assets or resources during the | 10 | | federally prescribed look-back period, as specified in | 11 | | federal law. | 12 | | (C) Receives
Supplemental Security Income payments | 13 | | or was receiving such payments at the time of admission | 14 | | to a nursing facility. | 15 | | (D) For applicants or recipients with verified | 16 | | income at or below 100% of the federal poverty level | 17 | | when the declared value of their countable resources is | 18 | | no greater than the allowable amounts pursuant to | 19 | | Section 5-2 of this Code for classes of eligible | 20 | | persons for whom a resource limit applies. Such | 21 | | simplified verification policies shall apply to | 22 | | community cases as well as long-term care cases. | 23 | | (3) Subject to federal approval, the Department of | 24 | | Healthcare and Family Services must implement an ex parte | 25 | | renewal process for Medicaid-eligible individuals residing | 26 | | in long-term care facilities. "Renewal" has the same |
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| 1 | | meaning as "redetermination" in State policies, | 2 | | administrative rule, and federal Medicaid law. The ex parte | 3 | | renewal process must be fully operational on or before | 4 | | January 1, 2019. | 5 | | (4) The Department of Human Services must use the | 6 | | standards and distribution requirements described in this | 7 | | subsection and in Section 11-6 for notification of missing | 8 | | supporting documents and information during all phases of | 9 | | the application process: initial, renewal, and appeal. | 10 | | (c) The Department of Human Services must adopt policies | 11 | | and procedures to improve communication between long-term care | 12 | | benefits central office personnel, applicants and their | 13 | | representatives, and facilities in which the applicants | 14 | | reside. Such policies and procedures must at a minimum permit | 15 | | applicants and their representatives and the facility in which | 16 | | the applicants reside to speak directly to an individual | 17 | | trained to take telephone inquiries and provide appropriate | 18 | | responses. | 19 | | (b) The Department shall, on or before July 1, 2014, assess | 20 | | the feasibility of incorporating all information needed to | 21 | | determine eligibility for long-term care services, including | 22 | | asset transfer and spousal impoverishment financials, into the | 23 | | State's integrated eligibility system identifying all | 24 | | resources needed and reasonable timeframes for achieving the | 25 | | specified integration. | 26 | | (c) The lead agency shall file interim reports with the |
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| 1 | | Chairs and Minority Spokespersons of the House and Senate Human | 2 | | Services Committees no later than September 1, 2013 and on | 3 | | February 1, 2014. The Department of Healthcare and Family | 4 | | Services shall include in the annual Medicaid report for State | 5 | | Fiscal Year 2014 and every fiscal year thereafter information | 6 | | concerning implementation of the provisions of this Section. | 7 | | (d) No later than August 1, 2014, the Auditor General shall | 8 | | report to the General Assembly concerning the extent to which | 9 | | the timeframes specified in this Section have been met and the | 10 | | extent to which State staffing levels are adequate to meet the | 11 | | requirements of this Section.
| 12 | | (e) The Department of Healthcare and Family Services, the | 13 | | Department of Human Services, and the Department on Aging shall | 14 | | take the following steps to achieve federally established | 15 | | timeframes for eligibility determinations for Medicaid and | 16 | | long-term care benefits and shall work toward the federal goal | 17 | | of real time determinations: | 18 | | (1) The Departments shall review, in collaboration | 19 | | with representatives of affected providers, all forms and | 20 | | procedures currently in use, federal guidelines either | 21 | | suggested or mandated, and staff deployment by September | 22 | | 30, 2014 to identify additional measures that can improve | 23 | | long-term care eligibility processing and make adjustments | 24 | | where possible. | 25 | | (2) No later than June 30, 2014, the Department of | 26 | | Healthcare and Family Services shall issue vouchers for |
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| 1 | | advance payments not to exceed $50,000,000 to nursing | 2 | | facilities with significant outstanding Medicaid liability | 3 | | associated with services provided to residents with | 4 | | Medicaid applications pending and residents facing the | 5 | | greatest delays. Each facility with an advance payment | 6 | | shall state in writing whether its own recoupment schedule | 7 | | will be in 3 or 6 equal monthly installments, as long as | 8 | | all advances are recouped by June 30, 2015. | 9 | | (3) The Department of Healthcare and Family Services' | 10 | | Office of Inspector General and the Department of Human | 11 | | Services shall immediately forgo resource review and | 12 | | review of transfers during the relevant look-back period | 13 | | for applications that were submitted prior to September 1, | 14 | | 2013. An applicant who applied prior to September 1, 2013, | 15 | | who was denied for failure to cooperate in providing | 16 | | required information, and whose application was | 17 | | incorrectly reviewed under the wrong look-back period | 18 | | rules may request review and correction of the denial based | 19 | | on this subsection. If found eligible upon review, such | 20 | | applicants shall be retroactively enrolled. | 21 | | (4) As soon as practicable, the Department of | 22 | | Healthcare and Family Services shall implement policies | 23 | | and promulgate rules to simplify financial eligibility | 24 | | verification in the following instances: (A) for | 25 | | applicants or recipients who are receiving Supplemental | 26 | | Security Income payments or who had been receiving such |
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| 1 | | payments at the time they were admitted to a nursing | 2 | | facility and (B) for applicants or recipients with verified | 3 | | income at or below 100% of the federal poverty level when | 4 | | the declared value of their countable resources is no | 5 | | greater than the allowable amounts pursuant to Section 5-2 | 6 | | of this Code for classes of eligible persons for whom a | 7 | | resource limit applies. Such simplified verification | 8 | | policies shall apply to community cases as well as | 9 | | long-term care cases. | 10 | | (5) As soon as practicable, but not later than July 1, | 11 | | 2014, the Department of Healthcare and Family Services and | 12 | | the Department of Human Services shall jointly begin a | 13 | | special enrollment project by using simplified eligibility | 14 | | verification policies and by redeploying caseworkers | 15 | | trained to handle long-term care cases to prioritize those | 16 | | cases, until the backlog is eliminated and processing time | 17 | | is within 90 days. This project shall apply to applications | 18 | | for long-term care received by the State on or before May | 19 | | 15, 2014. | 20 | | (6) As soon as practicable, but not later than | 21 | | September 1, 2014, the Department on Aging shall make | 22 | | available to long-term care facilities and community | 23 | | providers upon request, through an electronic method, the | 24 | | information contained within the Interagency Certification | 25 | | of Screening Results completed by the pre-screener, in a | 26 | | form and manner acceptable to the Department of Human |
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| 1 | | Services. | 2 | | (d) (7) Effective 30 days after the completion of 3 | 3 | | regionally based trainings, nursing facilities shall submit | 4 | | all applications for medical assistance online via the | 5 | | Application for Benefits Eligibility (ABE) website. This | 6 | | requirement shall extend to scanning and uploading with the | 7 | | online application any required additional forms such as the | 8 | | Long Term Care Facility Notification and the Additional | 9 | | Financial Information for Long Term Care Applicants as well as | 10 | | scanned copies of any supporting documentation. Long-term care | 11 | | facility admission documents must be submitted as required in | 12 | | Section 5-5 of this Code. No local Department of Human Services | 13 | | office shall refuse to accept an electronically filed | 14 | | application. No Department of Human Services office shall | 15 | | request submission of any document in hard copy. | 16 | | (e) (8) Notwithstanding any other provision of this Code, | 17 | | the Department of Human Services and the Department of | 18 | | Healthcare and Family Services' Office of the Inspector General | 19 | | shall, upon request, allow an applicant additional time to | 20 | | submit information and documents needed as part of a review of | 21 | | available resources or resources transferred during the | 22 | | look-back period. The initial extension shall not exceed 30 | 23 | | days. A second extension of 30 days may be granted upon | 24 | | request. Any request for information issued by the State to an | 25 | | applicant shall include the following: an explanation of the | 26 | | information required and the date by which the information must |
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| 1 | | be submitted; a statement that failure to respond in a timely | 2 | | manner can result in denial of the application; a statement | 3 | | that the applicant or the facility in the name of the applicant | 4 | | may seek an extension; and the name and contact information of | 5 | | a caseworker in case of questions. Any such request for | 6 | | information shall also be sent to the facility. In deciding | 7 | | whether to grant an extension, the Department of Human Services | 8 | | or the Department of Healthcare and Family Services' Office of | 9 | | the Inspector General shall take into account what is in the | 10 | | best interest of the applicant. The time limits for processing | 11 | | an application shall be tolled during the period of any | 12 | | extension granted under this subsection. | 13 | | (f) (9) The Department of Human Services and the Department | 14 | | of Healthcare and Family Services must jointly compile data on | 15 | | pending applications, denials, appeals, and redeterminations | 16 | | into a monthly report, which shall be posted on each | 17 | | Department's website for the purposes of monitoring long-term | 18 | | care eligibility processing. The report must specify the number | 19 | | of applications and redeterminations pending long-term care | 20 | | eligibility determination and admission and the number of | 21 | | appeals of denials in the following categories: | 22 | | (A) Length of time applications, redeterminations, and | 23 | | appeals are pending - 0 to 45 days, 46 days to 90 days, 91 | 24 | | days to 180 days, 181 days to 12 months, over 12 months to | 25 | | 18 months, over 18 months to 24 months, and over 24 months. | 26 | | (B) Percentage of applications and redeterminations |
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| 1 | | pending in the Department of Human Services' Family | 2 | | Community Resource Centers, in the Department of Human | 3 | | Services' long-term care hubs, with the Department of | 4 | | Healthcare and Family Services' Office of Inspector | 5 | | General, and those applications which are being tolled due | 6 | | to requests for extension of time for additional | 7 | | information. | 8 | | (C) Status of pending applications, denials, appeals, | 9 | | and redeterminations. | 10 | | (g) (f) Beginning on July 1, 2017, the Auditor General | 11 | | shall report every 3 years to the General Assembly on the | 12 | | performance and compliance of the Department of Healthcare and | 13 | | Family Services, the Department of Human Services, and the | 14 | | Department on Aging in meeting the requirements of this Section | 15 | | and the federal requirements concerning eligibility | 16 | | determinations for Medicaid long-term care services and | 17 | | supports, and shall report any issues or deficiencies and make | 18 | | recommendations. The Auditor General shall, at a minimum, | 19 | | review, consider, and evaluate the following: | 20 | | (1) compliance with federal regulations on furnishing | 21 | | services as related to Medicaid long-term care services and | 22 | | supports as provided under 42 CFR 435.930; | 23 | | (2) compliance with federal regulations on the timely | 24 | | determination of eligibility as provided under 42 CFR | 25 | | 435.912; | 26 | | (3) the accuracy and completeness of the report |
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| 1 | | required under paragraph (9) of subsection (e); | 2 | | (4) the efficacy and efficiency of the task-based | 3 | | process used for making eligibility determinations in the | 4 | | centralized offices of the Department of Human Services for | 5 | | long-term care services, including the role of the State's | 6 | | integrated eligibility system, as opposed to the | 7 | | traditional caseworker-specific process from which these | 8 | | central offices have converted; and | 9 | | (5) any issues affecting eligibility determinations | 10 | | related to the Department of Human Services' staff | 11 | | completing Medicaid eligibility determinations instead of | 12 | | the designated single-state Medicaid agency in Illinois, | 13 | | the Department of Healthcare and Family Services. | 14 | | The Auditor General's report shall include any and all | 15 | | other areas or issues which are identified through an annual | 16 | | review. Paragraphs (1) through (5) of this subsection shall not | 17 | | be construed to limit the scope of the annual review and the | 18 | | Auditor General's authority to thoroughly and completely | 19 | | evaluate any and all processes, policies, and procedures | 20 | | concerning compliance with federal and State law requirements | 21 | | on eligibility determinations for Medicaid long-term care | 22 | | services and supports. | 23 | | (h) The Department of Healthcare and Family Services shall | 24 | | adopt any rules necessary to administer and enforce any | 25 | | provision of this Section. Rulemaking shall not delay the full | 26 | | implementation of this Section. |
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| 1 | | (Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
| 2 | | (305 ILCS 5/11-6) (from Ch. 23, par. 11-6)
| 3 | | Sec. 11-6. Decisions on applications. Within 10 days after | 4 | | a decision is
reached on an application, the applicant
shall be | 5 | | notified in writing of the decision. If the applicant resides | 6 | | in a facility licensed under the Nursing Home Care Act or a | 7 | | supportive living facility authorized under Section 5-5.01a, | 8 | | the facility shall also receive written notice of the decision, | 9 | | provided that the notification is related to a Department | 10 | | payment for services received by the applicant in the facility. | 11 | | Only facilities enrolled in and subject to a provider agreement | 12 | | under the medical assistance program under Article V may | 13 | | receive such notices of decisions. The Department shall
| 14 | | consider eligibility for, and the notice shall contain a | 15 | | decision on, each
of the following assistance programs for | 16 | | which the client may be
eligible based on the information | 17 | | contained in the application: Temporary
Assistance for to Needy | 18 | | Families, Medical Assistance, Aid to the Aged, Blind
and | 19 | | Disabled, General Assistance (in the City of Chicago), and food | 20 | | stamps. No
decision shall be required for any
assistance | 21 | | program for which the applicant has expressly declined in
| 22 | | writing to apply. If the applicant is determined to
be | 23 | | eligible, the notice shall include a statement of the
amount of | 24 | | financial aid to be provided and a statement of the reasons for
| 25 | | any partial grant amounts. If the applicant is determined
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| 1 | | ineligible for any public assistance the notice shall include | 2 | | the reason
why the applicant is ineligible. If the application | 3 | | for any public
assistance is denied, the notice shall include a | 4 | | statement defining the
applicant's right to appeal the | 5 | | decision.
The Illinois Department, by rule, shall determine the | 6 | | date on which
assistance shall begin for applicants determined | 7 | | eligible. That date may be
no later than 30 days after the date | 8 | | of the application.
| 9 | | Under no circumstances may any application be denied solely | 10 | | to meet an
application-processing deadline. As used in this | 11 | | Section, "application" also refers to requests for admission | 12 | | approval to facilities licensed under the Nursing Home Care Act | 13 | | or to supportive living facilities authorized under Section | 14 | | 5-5.01a.
| 15 | | (Source: P.A. 96-206, eff. 1-1-10; revised 10-4-17.)
| 16 | | Section 99. Effective date. This Act takes effect upon | 17 | | becoming law.
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