Illinois General Assembly - Full Text of HB4771
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Full Text of HB4771  100th General Assembly


Sen. John G. Mulroe

Filed: 5/22/2018





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2    AMENDMENT NO. ______. Amend House Bill 4771, AS AMENDED, by
3replacing everything after the enacting clause with the
5    "Section 5. The Illinois Public Aid Code is amended by
6changing Section 11-5.4 as follows:
7    (305 ILCS 5/11-5.4)
8    Sec. 11-5.4. Expedited long-term care eligibility
9determination and enrollment.
10    (a) An expedited long-term care eligibility determination
11and enrollment system shall be established to reduce long-term
12care determinations to 90 days or fewer by July 1, 2014 and
13streamline the long-term care enrollment process.
14Establishment of the system shall be a joint venture of the
15Department of Human Services and Healthcare and Family Services
16and the Department on Aging. The Governor shall name a lead



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1agency no later than 30 days after the effective date of this
2amendatory Act of the 98th General Assembly to assume
3responsibility for the full implementation of the
4establishment and maintenance of the system. Project outcomes
5shall include an enhanced eligibility determination tracking
6system accessible to providers and a centralized application
7review and eligibility determination with all applicants
8reviewed within 90 days of receipt by the State of a complete
9application. If the Department of Healthcare and Family
10Services' Office of the Inspector General determines that there
11is a likelihood that a non-allowable transfer of assets has
12occurred, and the facility in which the applicant resides is
13notified, an extension of up to 90 days shall be permissible.
14On or before December 31, 2015, a streamlined application and
15enrollment process shall be put in place based on the following
17        (1) Minimize the burden on applicants by collecting
18    only the data necessary to determine eligibility for
19    medical services, long-term care services, and spousal
20    impoverishment offset.
21        (2) Integrate online data sources to simplify the
22    application process by reducing the amount of information
23    needed to be entered and to expedite eligibility
24    verification.
25        (3) Provide online prompts to alert the applicant that
26    information is missing or not complete.



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1    (b) The Department shall, on or before July 1, 2014, assess
2the feasibility of incorporating all information needed to
3determine eligibility for long-term care services, including
4asset transfer and spousal impoverishment financials, into the
5State's integrated eligibility system identifying all
6resources needed and reasonable timeframes for achieving the
7specified integration.
8    (c) The lead agency shall file interim reports with the
9Chairs and Minority Spokespersons of the House and Senate Human
10Services Committees no later than September 1, 2013 and on
11February 1, 2014. The Department of Healthcare and Family
12Services shall include in the annual Medicaid report for State
13Fiscal Year 2014 and every fiscal year thereafter information
14concerning implementation of the provisions of this Section.
15    (d) No later than August 1, 2014, the Auditor General shall
16report to the General Assembly concerning the extent to which
17the timeframes specified in this Section have been met and the
18extent to which State staffing levels are adequate to meet the
19requirements of this Section.
20    (e) The Department of Healthcare and Family Services, the
21Department of Human Services, and the Department on Aging shall
22take the following steps to achieve federally established
23timeframes for eligibility determinations for Medicaid and
24long-term care benefits and shall work toward the federal goal
25of real time determinations:
26        (1) The Departments shall review, in collaboration



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1    with representatives of affected providers, all forms and
2    procedures currently in use, federal guidelines either
3    suggested or mandated, and staff deployment by September
4    30, 2014 to identify additional measures that can improve
5    long-term care eligibility processing and make adjustments
6    where possible.
7        (2) No later than June 30, 2014, the Department of
8    Healthcare and Family Services shall issue vouchers for
9    advance payments not to exceed $50,000,000 to nursing
10    facilities with significant outstanding Medicaid liability
11    associated with services provided to residents with
12    Medicaid applications pending and residents facing the
13    greatest delays. Each facility with an advance payment
14    shall state in writing whether its own recoupment schedule
15    will be in 3 or 6 equal monthly installments, as long as
16    all advances are recouped by June 30, 2015.
17        (3) The Department of Healthcare and Family Services'
18    Office of Inspector General and the Department of Human
19    Services shall immediately forgo resource review and
20    review of transfers during the relevant look-back period
21    for applications that were submitted prior to September 1,
22    2013. An applicant who applied prior to September 1, 2013,
23    who was denied for failure to cooperate in providing
24    required information, and whose application was
25    incorrectly reviewed under the wrong look-back period
26    rules may request review and correction of the denial based



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1    on this subsection. If found eligible upon review, such
2    applicants shall be retroactively enrolled.
3        (4) As soon as practicable, the Department of
4    Healthcare and Family Services shall implement policies
5    and promulgate rules to simplify financial eligibility
6    verification in the following instances: (A) for
7    applicants or recipients who are receiving Supplemental
8    Security Income payments or who had been receiving such
9    payments at the time they were admitted to a nursing
10    facility and (B) for applicants or recipients with verified
11    income at or below 100% of the federal poverty level when
12    the declared value of their countable resources is no
13    greater than the allowable amounts pursuant to Section 5-2
14    of this Code for classes of eligible persons for whom a
15    resource limit applies. Such simplified verification
16    policies shall apply to community cases as well as
17    long-term care cases.
18        (5) As soon as practicable, but not later than July 1,
19    2014, the Department of Healthcare and Family Services and
20    the Department of Human Services shall jointly begin a
21    special enrollment project by using simplified eligibility
22    verification policies and by redeploying caseworkers
23    trained to handle long-term care cases to prioritize those
24    cases, until the backlog is eliminated and processing time
25    is within 90 days. This project shall apply to applications
26    for long-term care received by the State on or before May



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1    15, 2014.
2        (6) As soon as practicable, but not later than
3    September 1, 2014, the Department on Aging shall make
4    available to long-term care facilities and community
5    providers upon request, through an electronic method, the
6    information contained within the Interagency Certification
7    of Screening Results completed by the pre-screener, in a
8    form and manner acceptable to the Department of Human
9    Services.
10        (7) Effective 30 days after the completion of 3
11    regionally based trainings, nursing facilities shall
12    submit all applications for medical assistance online via
13    the Application for Benefits Eligibility (ABE) website.
14    This requirement shall extend to scanning and uploading
15    with the online application any required additional forms
16    such as the Long Term Care Facility Notification and the
17    Additional Financial Information for Long Term Care
18    Applicants as well as scanned copies of any supporting
19    documentation. Long-term care facility admission documents
20    must be submitted as required in Section 5-5 of this Code.
21    No local Department of Human Services office shall refuse
22    to accept an electronically filed application.
23        (8) Notwithstanding any other provision of this Code,
24    the Department of Human Services and the Department of
25    Healthcare and Family Services' Office of the Inspector
26    General shall, upon request, allow an applicant additional



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1    time to submit information and documents needed as part of
2    a review of available resources or resources transferred
3    during the look-back period. The initial extension shall
4    not exceed 30 days. A second extension of 30 days may be
5    granted upon request. Any request for information issued by
6    the State to an applicant shall include the following: an
7    explanation of the information required and the date by
8    which the information must be submitted; a statement that
9    failure to respond in a timely manner can result in denial
10    of the application; a statement that the applicant or the
11    facility in the name of the applicant may seek an
12    extension; and the name and contact information of a
13    caseworker in case of questions. Any such request for
14    information shall also be sent to the facility. In deciding
15    whether to grant an extension, the Department of Human
16    Services or the Department of Healthcare and Family
17    Services' Office of the Inspector General shall take into
18    account what is in the best interest of the applicant. The
19    time limits for processing an application shall be tolled
20    during the period of any extension granted under this
21    subsection.
22        (9) The Department of Human Services and the Department
23    of Healthcare and Family Services must jointly compile data
24    on pending applications, denials, appeals, and
25    redeterminations into a monthly report, which shall be
26    posted on each Department's website for the purposes of



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1    monitoring long-term care eligibility processing. The
2    report must specify the number of applications and
3    redeterminations pending long-term care eligibility
4    determination and admission and the number of appeals of
5    denials in the following categories:
6            (A) Length of time applications, redeterminations,
7        and appeals are pending - 0 to 45 days, 46 days to 90
8        days, 91 days to 180 days, 181 days to 12 months, over
9        12 months to 18 months, over 18 months to 24 months,
10        and over 24 months.
11            (B) Percentage of applications and
12        redeterminations pending in the Department of Human
13        Services' Family Community Resource Centers, in the
14        Department of Human Services' long-term care hubs,
15        with the Department of Healthcare and Family Services'
16        Office of Inspector General, and those applications
17        which are being tolled due to requests for extension of
18        time for additional information.
19            (C) Status of pending applications, denials,
20        appeals, and redeterminations.
21    (f) Beginning on July 1, 2017, the Auditor General shall
22report every 3 years to the General Assembly on the performance
23and compliance of the Department of Healthcare and Family
24Services, the Department of Human Services, and the Department
25on Aging in meeting the requirements of this Section and the
26federal requirements concerning eligibility determinations for



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1Medicaid long-term care services and supports, and shall report
2any issues or deficiencies and make recommendations. The
3Auditor General shall, at a minimum, review, consider, and
4evaluate the following:
5        (1) compliance with federal regulations on furnishing
6    services as related to Medicaid long-term care services and
7    supports as provided under 42 CFR 435.930;
8        (2) compliance with federal regulations on the timely
9    determination of eligibility as provided under 42 CFR
10    435.912;
11        (3) the accuracy and completeness of the report
12    required under paragraph (9) of subsection (e);
13        (4) the efficacy and efficiency of the task-based
14    process used for making eligibility determinations in the
15    centralized offices of the Department of Human Services for
16    long-term care services, including the role of the State's
17    integrated eligibility system, as opposed to the
18    traditional caseworker-specific process from which these
19    central offices have converted; and
20        (5) any issues affecting eligibility determinations
21    related to the Department of Human Services' staff
22    completing Medicaid eligibility determinations instead of
23    the designated single-state Medicaid agency in Illinois,
24    the Department of Healthcare and Family Services.
25    The Auditor General's report shall include any and all
26other areas or issues which are identified through an annual



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1review. Paragraphs (1) through (5) of this subsection shall not
2be construed to limit the scope of the annual review and the
3Auditor General's authority to thoroughly and completely
4evaluate any and all processes, policies, and procedures
5concerning compliance with federal and State law requirements
6on eligibility determinations for Medicaid long-term care
7services and supports.
8    (g) The Department shall adopt rules necessary to
9administer and enforce any provision of this Section.
10Rulemaking shall not delay the full implementation of this
12    (h) Beginning on June 29, 2018, provisional eligibility, in
13the form of a recipient identification number and any other
14necessary credentials to permit an applicant to receive
15benefits, must be issued to any applicant who has not received
16a final eligibility determination on his or her application for
17Medicaid or Medicaid long-term care benefits or a notice of an
18opportunity for a hearing within the federally prescribed
19deadlines for the processing of such applications. The
20Department must maintain the applicant's provisional Medicaid
21enrollment status until a final eligibility determination is
22approved or the applicant's appeal has been adjudicated and
23eligibility is denied. The Department or the managed care
24organization, if applicable, must reimburse providers for
25services rendered during an applicant's provisional
26eligibility period.



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1        (1) Claims for services rendered to an applicant with
2    provisional eligibility status must be submitted and
3    processed in the same manner as those submitted on behalf
4    of beneficiaries determined to qualify for benefits.
5        (2) An applicant with provisional enrollment status
6    must have his or her benefits paid for under the State's
7    fee-for-service system until the State makes a final
8    determination on the applicant's Medicaid or Medicaid
9    long-term care application. If an individual is enrolled
10    with a managed care organization for community benefits at
11    the time the individual's provisional status is issued, the
12    managed care organization is only responsible for paying
13    benefits covered under the capitation payment received by
14    the managed care organization for the individual.
15        (3) The Department, within 10 business days of issuing
16    provisional eligibility to an applicant, must submit to the
17    Office of the Comptroller for payment a voucher for all
18    retroactive reimbursement due. The Department must clearly
19    identify such vouchers as provisional eligibility
20    vouchers.
21(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
22    Section 99. Effective date. This Act takes effect upon
23becoming law.".