SB2929 99TH GENERAL ASSEMBLY

LRB099 20556 KTG 45107 b

99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB2929

Introduced 2/18/2016, by Sen. John G. Mulroe

SYNOPSIS AS INTRODUCED:

See Index

Amends the Hospital Licensing Act. Provides that a patient discharged to a skilled nursing facility who is not assessed prior to discharge or whose pre-screening information does not accompany the patient to the skilled nursing facility shall (i) be admitted to the skilled nursing facility pending the case coordination unit completing a post-screening evaluation or the delivery of the pre-screening information to the skilled nursing facility and (ii) be eligible for Medicaid funded care from the date of admission if the patient meets all eligibility criteria for medical assistance under the Illinois Public Aid Code. Amends the Illinois Public Aid Code. Provides that a nursing home resident determined to be eligible for medical assistance for long term care services shall be entitled to have his or her care paid retroactive to the date of admission to a nursing home or the date the resident converted from Medicare or private funds as a payer source if it is determined that the resident met the financial eligibility standards for medical assistance on the date of admission or conversion and the admission or conversion date is within the retroactive window established under the Code. Provides that an outstanding application for medical assistance for long term care services shall not be closed or denied based solely on the applicant's death or the absence of certain documentation if services authorized under the Code were provided pending a determination of eligibility. Provides that a nursing home resident who is unable to comply in securing financial documents requested by the Department of Healthcare and Family Services to prove financial eligibility shall be assigned a long term care ombudsman to assist the resident in securing medical assistance.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Hospital Licensing Act is amended by changing Section 6.09 as follows:

(210 ILCS 85/6.09) (from Ch. 111 1/2, par. 147.09)

Sec. 6.09. (a) In order to facilitate the orderly transition of aged patients and patients with disabilities from hospitals to post-hospital care, whenever a patient who qualifies for the federal Medicare program is hospitalized, the patient shall be notified of discharge at least 24 hours prior to discharge from the hospital. With regard to pending discharges to a skilled nursing facility, the hospital must notify the case coordination unit, as defined in 89 Ill. Adm. Code 240.260, at least 24 hours prior to discharge. When the assessment is completed in the hospital, the case coordination unit shall provide the discharge planner with a copy of the prescreening information and accompanying materials, which the discharge planner shall transmit when the patient is discharged to a skilled nursing facility. Notwithstanding any other provision of law to the contrary, a patient discharged to a skilled nursing facility who is not assessed prior to discharge or whose pre-screening information does not accompany the patient to the skilled nursing facility shall be admitted to the skilled nursing facility pending the case coordination unit completing a post-screening evaluation or the delivery of the pre-screening information to the skilled nursing facility by the case coordination unit and shall be eligible for Medicaid funded care from the date of admission if the patient meets all eligibility criteria for medical assistance set forth under Article V of the Illinois Public Aid Code. If home health services are ordered, the hospital must inform its designated case coordination unit, as defined in 89 Ill. Adm. Code 240.260, of the pending discharge and must provide the patient with the case coordination unit's telephone number and other contact information.

(b) Every hospital shall develop procedures for a physician with medical staff privileges at the hospital or any appropriate medical staff member to provide the discharge notice prescribed in subsection (a) of this Section. The procedures must include prohibitions against discharging or referring a patient to any of the following if unlicensed, uncertified, or unregistered: (i) a board and care facility, as defined in the Board and Care Home Act; (ii) an assisted living and shared housing establishment, as defined in the Assisted Living and Shared Housing Act; (iii) a facility licensed under the Nursing Home Care Act, the Specialized Mental Health Rehabilitation Act of 2013, the ID/DD Community Care Act, or the MC/DD Act; (iv) a supportive living facility, as defined in Section 5-5.01a of the Illinois Public Aid Code; or (v) a free-standing hospice facility licensed under the Hospice Program Licensing Act if licensure, certification, or registration is required. The Department of Public Health shall annually provide hospitals with a list of licensed, certified, or registered board and care facilities, assisted living and shared housing establishments, nursing homes, supportive living facilities, facilities licensed under the ID/DD Community Care Act, the MC/DD Act, or the Specialized Mental Health Rehabilitation Act of 2013, and hospice facilities. Reliance upon this list by a hospital shall satisfy compliance with this requirement. The procedure may also include a waiver for any case in which a discharge notice is not feasible due to a short length of stay in the hospital by the patient, or for any case in which the patient voluntarily desires to leave the hospital before the expiration of the 24 hour period.

(c) At least 24 hours prior to discharge from the hospital, the patient shall receive written information on the patient's right to appeal the discharge pursuant to the federal Medicare program, including the steps to follow to appeal the discharge and the appropriate telephone number to call in case the patient intends to appeal the discharge.

(d) Before transfer of a patient to a long term care facility licensed under the Nursing Home Care Act where elderly persons reside, a hospital shall as soon as practicable initiate a name-based criminal history background check by electronic submission to the Department of State Police for all persons between the ages of 18 and 70 years; provided, however, that a hospital shall be required to initiate such a background check only with respect to patients who:

(1) are transferring to a long term care facility for the first time;

(2) have been in the hospital more than 5 days;

(3) are reasonably expected to remain at the long term care facility for more than 30 days;

(4) have a known history of serious mental illness or substance abuse; and

(5) are independently ambulatory or mobile for more than a temporary period of time.

A hospital may also request a criminal history background check for a patient who does not meet any of the criteria set forth in items (1) through (5).

A hospital shall notify a long term care facility if the hospital has initiated a criminal history background check on a patient being discharged to that facility. In all circumstances in which the hospital is required by this subsection to initiate the criminal history background check, the transfer to the long term care facility may proceed regardless of the availability of criminal history results. Upon receipt of the results, the hospital shall promptly forward the results to the appropriate long term care facility. If the results of the background check are inconclusive, the hospital shall have no additional duty or obligation to seek additional information from, or about, the patient.

(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-143, eff. 7-27-15; 99-180, eff. 7-29-15; revised 10-14-15.)

Section 10. The Illinois Public Aid Code is amended by changing Sections 5-2.1d and 5-6 and by adding Section 5-6a as follows:

(305 ILCS 5/5-2.1d)

Sec. 5-2.1d. Retroactive eligibility.

(a) An applicant for medical assistance may be eligible for up to 3 months prior to the date of application if the person would have been eligible for medical assistance at the time he or she received the services if he or she had applied, regardless of whether the individual is alive when the application for medical assistance is made. In determining financial eligibility for medical assistance for retroactive months, the Department shall consider the amount of income and resources and exemptions available to a person as of the first day of each of the backdated months for which eligibility is sought.

(b) A nursing home resident determined to be eligible for medical assistance for long term care services shall be entitled to have his or her care paid retroactive to the date of admission to a nursing home or the date the resident converted from Medicare or private funds as a payer source if it is determined that the resident met the financial eligibility standards set forth in this Code on the date of admission or conversion and the admission or conversion date is within the retroactive window established in subsection (a) regardless of whether a case coordination unit had completed a screening in advance of admission or the facility submitted admission materials on the date of admission or conversion.

(Source: P.A. 97-689, eff. 6-14-12.)

(305 ILCS 5/5-6) (from Ch. 23, par. 5-6)

Sec. 5-6. Obligations incurred prior to death of a recipient.

(a) Obligations incurred but not paid for at the time of a recipient's death for services authorized under Section 5-5, including medical and other care in facilities as defined in the Nursing Home Care Act, the Specialized Mental Health Rehabilitation Act of 2013, the ID/DD Community Care Act, or the MC/DD Act, or in like facilities not required to be licensed under that Act, may be paid, subject to the rules and regulations of the Illinois Department, after the death of the recipient.

(b) An outstanding application for medical assistance for long term care services shall not be closed or denied based solely on the applicant's death or the absence of documentation the applicant failed to provide prior to the applicant's death if services authorized under Section 5-5 were provided pending a determination of eligibility. In the case of missing documentation, the Department shall request the information from the financial institution. If the financial institution fails to comply with the request, the Department shall notify the Secretary of the Department of Financial and Professional Regulation, who shall take all steps necessary to ensure compliance. Before an application is closed or denied on an applicant's death, the Department shall determine if outstanding obligations for authorized services exist. The provider of the services shall have 12 months from the date the application was closed or denied to request payment for services rendered in good faith and the Department shall make every attempt to accommodate the request, unless the Department has proof that the services were not rendered or were not rendered in good faith. The provider shall have 36 months from the date of the resident's death to seek compensation through the Court of Claims.

(Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)

(305 ILCS 5/5-6a new)

Sec. 5-6a. Long term care ombudsman; nursing home resident. A nursing home resident who is unable to comply in securing financial documents requested by the Department to prove financial eligibility and whose family is unable or unwilling to secure the requested documents on the resident's behalf shall be assigned a long term care ombudsman from the Long Term Care Ombudsman Program established under Section 4.04 of the Illinois Act on the Aging to assist the resident in securing medical assistance for long term care services. The long term care ombudsman shall work with: (i) the resident; (ii) the resident's family, to the extent they are willing to participate; (iii) the facility; and (iv) the Department of Human Services and the Department of Healthcare and Family Services' Office of the Inspector General to successfully secure long term care benefits for the resident. The Department of Human Services and the Department of Healthcare and Family Services' Office of the Inspector General shall be responsible for requesting missing financial documentation from financial institutions on behalf of the resident. The Secretary or Director of the requesting Department shall report to the Secretary of the Department of Financial and Professional Regulation any financial institution that fails to comply with a request for missing financial documentation. The Secretary of the Department of Financial and Professional Regulation shall take all steps necessary to ensure compliance. The Long Term Care Ombudsman Program shall be reimbursed for services provided pursuant to this Section on a per client basis at a rate established by the Department on Aging from federal Civil Monetary Funds overseen by the Department of Public Health.