Full Text of SB1544 100th General Assembly
SB1544sam001 100TH GENERAL ASSEMBLY | Sen. John G. Mulroe Filed: 3/10/2017
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| 1 | | AMENDMENT TO SENATE BILL 1544
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1544 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 11-5.4 as follows: | 6 | | (305 ILCS 5/11-5.4) | 7 | | Sec. 11-5.4. Expedited long-term care eligibility | 8 | | determination and enrollment. | 9 | | (a) An expedited long-term care eligibility determination | 10 | | and enrollment system shall be established to reduce long-term | 11 | | care determinations to 90 days or fewer by July 1, 2014 and | 12 | | streamline the long-term care enrollment process. | 13 | | Establishment of the system shall be a joint venture of the | 14 | | Department of Human Services and Healthcare and Family Services | 15 | | and the Department on Aging. The Governor shall name a lead | 16 | | agency no later than 30 days after the effective date of this |
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| 1 | | amendatory Act of the 98th General Assembly to assume | 2 | | responsibility for the full implementation of the | 3 | | establishment and maintenance of the system. Project outcomes | 4 | | shall include an enhanced eligibility determination tracking | 5 | | system accessible to providers and a centralized application | 6 | | review and eligibility determination with all applicants | 7 | | reviewed within 90 days of receipt by the State of a complete | 8 | | application. If the Department of Healthcare and Family | 9 | | Services' Office of the Inspector General determines that there | 10 | | is a likelihood that a non-allowable transfer of assets has | 11 | | occurred, and the facility in which the applicant resides is | 12 | | notified, an extension of up to 90 days shall be permissible. | 13 | | On or before December 31, 2015, a streamlined application and | 14 | | enrollment process shall be put in place based on the following | 15 | | principles: | 16 | | (1) Minimize the burden on applicants by collecting | 17 | | only the data necessary to determine eligibility for | 18 | | medical services, long-term care services, and spousal | 19 | | impoverishment offset. | 20 | | (2) Integrate online data sources to simplify the | 21 | | application process by reducing the amount of information | 22 | | needed to be entered and to expedite eligibility | 23 | | verification. | 24 | | (3) Provide online prompts to alert the applicant that | 25 | | information is missing or not complete. | 26 | | (b) The Department shall, on or before July 1, 2014, assess |
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| 1 | | the feasibility of incorporating all information needed to | 2 | | determine eligibility for long-term care services, including | 3 | | asset transfer and spousal impoverishment financials, into the | 4 | | State's integrated eligibility system identifying all | 5 | | resources needed and reasonable timeframes for achieving the | 6 | | specified integration. | 7 | | (c) The lead agency shall file interim reports with the | 8 | | Chairs and Minority Spokespersons of the House and Senate Human | 9 | | Services Committees no later than September 1, 2013 and on | 10 | | February 1, 2014. The Department of Healthcare and Family | 11 | | Services shall include in the annual Medicaid report for State | 12 | | Fiscal Year 2014 and every fiscal year thereafter information | 13 | | concerning implementation of the provisions of this Section. | 14 | | (d) No later than August 1, 2014, the Auditor General shall | 15 | | report to the General Assembly concerning the extent to which | 16 | | the timeframes specified in this Section have been met and the | 17 | | extent to which State staffing levels are adequate to meet the | 18 | | requirements of this Section.
| 19 | | (e) The Department of Healthcare and Family Services, the | 20 | | Department of Human Services, and the Department on Aging shall | 21 | | take the following steps to achieve federally established | 22 | | timeframes for eligibility determinations for Medicaid and | 23 | | long-term care benefits and shall work toward the federal goal | 24 | | of real time determinations: | 25 | | (1) The Departments shall review, in collaboration | 26 | | with representatives of affected providers, all forms and |
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| 1 | | procedures currently in use, federal guidelines either | 2 | | suggested or mandated, and staff deployment by September | 3 | | 30, 2014 to identify additional measures that can improve | 4 | | long-term care eligibility processing and make adjustments | 5 | | where possible. | 6 | | (2) No later than June 30, 2014, the Department of | 7 | | Healthcare and Family Services shall issue vouchers for | 8 | | advance payments not to exceed $50,000,000 to nursing | 9 | | facilities with significant outstanding Medicaid liability | 10 | | associated with services provided to residents with | 11 | | Medicaid applications pending and residents facing the | 12 | | greatest delays. Each facility with an advance payment | 13 | | shall state in writing whether its own recoupment schedule | 14 | | will be in 3 or 6 equal monthly installments, as long as | 15 | | all advances are recouped by June 30, 2015. | 16 | | (3) The Department of Healthcare and Family Services' | 17 | | Office of Inspector General and the Department of Human | 18 | | Services shall immediately forgo resource review and | 19 | | review of transfers during the relevant look-back period | 20 | | for applications that were submitted prior to September 1, | 21 | | 2013. An applicant who applied prior to September 1, 2013, | 22 | | who was denied for failure to cooperate in providing | 23 | | required information, and whose application was | 24 | | incorrectly reviewed under the wrong look-back period | 25 | | rules may request review and correction of the denial based | 26 | | on this subsection. If found eligible upon review, such |
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| 1 | | applicants shall be retroactively enrolled. | 2 | | (4) As soon as practicable, the Department of | 3 | | Healthcare and Family Services shall implement policies | 4 | | and promulgate rules to simplify financial eligibility | 5 | | verification in the following instances: (A) for | 6 | | applicants or recipients who are receiving Supplemental | 7 | | Security Income payments or who had been receiving such | 8 | | payments at the time they were admitted to a nursing | 9 | | facility and (B) for applicants or recipients with verified | 10 | | income at or below 100% of the federal poverty level when | 11 | | the declared value of their countable resources is no | 12 | | greater than the allowable amounts pursuant to Section 5-2 | 13 | | of this Code for classes of eligible persons for whom a | 14 | | resource limit applies. Such simplified verification | 15 | | policies shall apply to community cases as well as | 16 | | long-term care cases. | 17 | | (5) As soon as practicable, but not later than July 1, | 18 | | 2014, the Department of Healthcare and Family Services and | 19 | | the Department of Human Services shall jointly begin a | 20 | | special enrollment project by using simplified eligibility | 21 | | verification policies and by redeploying caseworkers | 22 | | trained to handle long-term care cases to prioritize those | 23 | | cases, until the backlog is eliminated and processing time | 24 | | is within 90 days. This project shall apply to applications | 25 | | for long-term care received by the State on or before May | 26 | | 15, 2014. |
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| 1 | | (6) As soon as practicable, but not later than | 2 | | September 1, 2014, the Department on Aging shall make | 3 | | available to long-term care facilities and community | 4 | | providers upon request, through an electronic method, the | 5 | | information contained within the Interagency Certification | 6 | | of Screening Results completed by the pre-screener, in a | 7 | | form and manner acceptable to the Department of Human | 8 | | Services. | 9 | | (7) Effective 30 days after the completion of 3 | 10 | | regionally based trainings, nursing facilities shall | 11 | | submit all applications for medical assistance online via | 12 | | the Application for Benefits Eligibility (ABE) website. | 13 | | This requirement shall extend to scanning and uploading | 14 | | with the online application any required additional forms | 15 | | such as the Long Term Care Facility Notification and the | 16 | | Additional Financial Information for Long Term Care | 17 | | Applicants as well as scanned copies of any supporting | 18 | | documentation. Long-term care facility admission documents | 19 | | must be submitted as required in Section 5-5 of this Code. | 20 | | No local Department of Human Services office shall refuse | 21 | | to accept an electronically filed application. | 22 | | (8) Notwithstanding any other provision of this Code, | 23 | | the Department of Human Services and the Department of | 24 | | Healthcare and Family Services' Office of the Inspector | 25 | | General shall, upon request, allow an applicant additional | 26 | | time to submit information and documents needed as part of |
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| 1 | | a review of available resources or resources transferred | 2 | | during the look-back period. The initial extension shall | 3 | | not exceed 30 days. A second extension of 30 days may be | 4 | | granted upon request. Any request for information issued by | 5 | | the State to an applicant shall include the following: an | 6 | | explanation of the information required and the date by | 7 | | which the information must be submitted; a statement that | 8 | | failure to respond in a timely manner can result in denial | 9 | | of the application; a statement that the applicant or the | 10 | | facility in the name of the applicant may seek an | 11 | | extension; and the name and contact information of a | 12 | | caseworker in case of questions. Any such request for | 13 | | information shall also be sent to the facility. In deciding | 14 | | whether to grant an extension, the Department of Human | 15 | | Services or the Department of Healthcare and Family | 16 | | Services' Office of the Inspector General shall take into | 17 | | account what is in the best interest of the applicant. The | 18 | | time limits for processing an application shall be tolled | 19 | | during the period of any extension granted under this | 20 | | subsection. | 21 | | (9) The Department of Human Services and the Department | 22 | | of Healthcare and Family Services must jointly compile data | 23 | | on pending applications, denials, appeals, and | 24 | | redeterminations into a monthly report, which shall be | 25 | | posted on each Department's website for the purposes of | 26 | | monitoring long-term care eligibility processing. The |
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| 1 | | report must specify the number of applications and | 2 | | redeterminations pending long-term care eligibility | 3 | | determination and admission and the number of appeals of | 4 | | denials in the following categories: | 5 | | (A) Length of time applications, redeterminations, | 6 | | and appeals are pending - 0 to 90 days, 91 days to 180 | 7 | | days, 181 days to 12 months, over 12 months to 18 | 8 | | months, over 18 months to 24 months, and over 24 | 9 | | months. | 10 | | (B) Percentage of applications and | 11 | | redeterminations pending in the Department of Human | 12 | | Services' Family Community Resource Centers, in the | 13 | | Department of Human Services' long-term care hubs, | 14 | | with the Department of Healthcare and Family Services' | 15 | | Office of Inspector General, and those applications | 16 | | which are being tolled due to requests for extension of | 17 | | time for additional information. | 18 | | (C) Status of pending applications, denials, | 19 | | appeals, and redeterminations , including the number of | 20 | | pending applications and redeterminations denied for | 21 | | failure to submit the required documentation . | 22 | | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; | 23 | | 99-153, eff. 7-28-15.)
| 24 | | Section 99. Effective date. This Act takes effect upon | 25 | | becoming law.".
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