Full Text of HB2353 101st General Assembly
HB2353ham001 101ST GENERAL ASSEMBLY | Rep. Kathleen Willis Filed: 3/25/2019
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| 1 | | AMENDMENT TO HOUSE BILL 2353
| 2 | | AMENDMENT NO. ______. Amend House Bill 2353 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be referred to as the | 5 | | Medicaid Eligibility Determination and Renewal Reform Act. | 6 | | Section 5. Purpose. The processes currently in place for | 7 | | eligibility determination and renewal (also known as | 8 | | redetermination) under the State's medical assistance programs | 9 | | lead to delayed access to benefits, disruptions in care | 10 | | delivery, decreased quality of care, waste in spending on | 11 | | unnecessary administrative costs, and worse overall health and | 12 | | well-being for enrollees. To improve continuity of care for | 13 | | beneficiaries and remedy significant administrative | 14 | | challenges, to the benefit of both the State and beneficiaries, | 15 | | this Act implements improvements and efficiencies to increase | 16 | | accountability and transparency, minimize delay and procedural |
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| 1 | | terminations, and improve the overall integrity of the State's | 2 | | medical assistance programs. | 3 | | Section 10. Medicaid eligibility determination and renewal | 4 | | goals. | 5 | | (a) The Department of Healthcare and Family Services shall | 6 | | work with the Department of Human Services, as well as other | 7 | | stakeholders, to achieve the following goals related to | 8 | | eligibility determinations and renewals under the Medical | 9 | | Assistance Program established under Article V of the Illinois | 10 | | Public Aid Code: | 11 | | (1) Reduce procedural terminations under the Medical | 12 | | Assistance Program so that no more than 10% of medical | 13 | | assistance beneficiaries who remain eligible for medical | 14 | | assistance experience any lapse in contemporaneous medical | 15 | | coverage. | 16 | | (2) Use technology to lower administrative burdens and | 17 | | increase beneficiary continuity of coverage by providing | 18 | | real-time eligibility determination decisions under the | 19 | | Medical Assistance Program for at least 75% of all medical | 20 | | assistance applicants, increasing automatic renewals for | 21 | | medical assistance beneficiaries, and offering an | 22 | | electronic means by which a broad array of medical | 23 | | assistance beneficiaries can track and maintain their | 24 | | benefits. | 25 | | (b) The Department of Healthcare and Family Services and |
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| 1 | | the Department of Human Services shall work together with | 2 | | stakeholders, including, but not limited to, beneficiaries of | 3 | | medical assistance, consumer advocates, governmental staff, | 4 | | provider, and managed care organizations, to achieve the goals | 5 | | described in subsection (a) by December 31, 2020. The | 6 | | Department of Healthcare and Family Services shall provide a | 7 | | report to the General Assembly on the Department's progress | 8 | | toward achieving those goals by December 31, 2019. The report | 9 | | shall be posted on the Department of Healthcare and Family | 10 | | Services' website and shall describe the policy changes the | 11 | | Department has made, any challenges the Department has faced, | 12 | | the Department's plan to achieve the goals by the deadline, and | 13 | | the current rate of procedural termination, data-driven | 14 | | renewals, and electronic portal use. | 15 | | Section 15. Express lane eligibility State Plan amendment; | 16 | | implementation timeline. | 17 | | (a) As used in this Section: | 18 | | "CHIP" means the Children's Health Insurance Program | 19 | | established under the Children's Health Insurance Program | 20 | | Act. | 21 | | "Medicaid" means medical assistance authorized under
| 22 | | Section 1902 of the Social Security Act. | 23 | | (b) Federal approval for express lane eligibility. The | 24 | | Department of Healthcare and Family Services shall submit | 25 | | Medicaid and CHIP State Plan amendments to the federal Centers |
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| 1 | | for Medicare and Medicaid Services to implement express lane | 2 | | eligibility for all Medicaid and CHIP beneficiaries as | 3 | | permitted by Section 203 of the Children's Health Insurance | 4 | | Program Reauthorization Act of 2009 (Public Law 111-3), no | 5 | | later than 90 days after the effective date of this Act. The | 6 | | Department of Healthcare and Family Services shall cooperate | 7 | | with the federal Centers for Medicare and Medicaid Services to | 8 | | obtain approval, if necessary, to implement an express lane | 9 | | eligibility option to ensure that children eligible for | 10 | | Medicaid or CHIP have a fast and simplified process for having | 11 | | their eligibility determined or renewed to facilitate | 12 | | enrollment in Medicaid and CHIP. | 13 | | (c) Content of State Plan amendment. At a minimum, the | 14 | | State Plan amendment shall specify that express lane | 15 | | eligibility shall apply to all Medicaid and CHIP beneficiaries. | 16 | | If federal approval is granted, the Department of Healthcare | 17 | | and Family Services shall seek an 1115 waiver to apply the | 18 | | express lane eligibility option to beneficiaries age 21 or | 19 | | older no later than 90 days after approval. The State Plan | 20 | | amendment shall identify, at a minimum, the Supplemental | 21 | | Nutrition Assistance Program as its express lane agency. The | 22 | | State Plan amendment shall also specify that the express lane | 23 | | eligibility option will be used for both applications and | 24 | | renewals. The Department of Healthcare and Family Services may | 25 | | select more than one express lane agency, consistent with the | 26 | | Centers for Medicare and Medicaid Services' rules governing |
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| 1 | | express lane eligibility. The Department of Healthcare and | 2 | | Family Services may also elect to obtain and use information | 3 | | directly from State income tax records or returns, consistent | 4 | | with the Centers for Medicare and Medicaid Services' rules | 5 | | governing express lane eligibility. | 6 | | (d) Implementation. After the Department of Healthcare and | 7 | | Family Services secures federal approval (if required) from the | 8 | | Centers for Medicare and Medicaid Services, the Department | 9 | | shall implement express lane eligibility within 90 days after | 10 | | the date of federal approval. | 11 | | Section 20. Reinstatement upon renewal. | 12 | | (a) If an individual who failed to cooperate during the | 13 | | renewal process cooperates and submits all required | 14 | | verifications prior to the end of the third month (or 90 days | 15 | | if longer) following the last day of coverage, and the case | 16 | | remains eligible, the Department of Healthcare and Family | 17 | | Services shall restore assistance immediately, with no loss of | 18 | | coverage and back to the date of cancellation, without | 19 | | requiring a new application from the individual. In restoring | 20 | | assistance, the Department shall act to ensure that an eligible | 21 | | individual has the shortest time possible, if any, when his or | 22 | | her case shows as inactive to providers. Retroactive coverage | 23 | | alone does not satisfy the objective of this Section if | 24 | | eligible individuals still experience real-time periods of an | 25 | | inactive case. |
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| 1 | | (b) Individuals who are reinstated and who are enrolled in | 2 | | a managed care organization prior to initial cancellation of | 3 | | coverage shall be reinstated to the same managed care | 4 | | organization, regardless of when the individual's coverage is | 5 | | reinstated, and the annual HealthChoice Illinois open | 6 | | enrollment period for the individual shall remain the same. | 7 | | Managed care organizations shall be paid the appropriate per | 8 | | member per month payment retroactively for reinstated members. | 9 | | (c) Providers serving individuals in the State's | 10 | | fee-for-service system may submit prior approval requests to | 11 | | the Department of Healthcare and Family Services for review and | 12 | | retroactive processing for medical assistance provided during | 13 | | the reinstatement period. Providers serving individuals | 14 | | enrolled in managed care may have their prior approval requests | 15 | | submitted and processed retroactively for medical assistance | 16 | | provided during the reinstatement period, provided that | 17 | | appropriate member attribution and associated payment are also | 18 | | made to the managed care organization for the reinstated | 19 | | coverage period. | 20 | | Section 25. Community-based enrollment and redetermination | 21 | | assistance. | 22 | | (a) The Department of Healthcare and Family Services shall | 23 | | create and support agency-associated permission and enhanced | 24 | | user permission within the Department's integrated eligibility | 25 | | system to provide authorized access to client cases to better |
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| 1 | | enable providers and community-based organizations to support | 2 | | applicants and clients enrolling in, renewing, or otherwise | 3 | | maintaining their benefits. | 4 | | (b) Creation of agency-associated permission. | 5 | | (1) The Department of Healthcare and Family Services | 6 | | shall authorize, create, support, and administer a process | 7 | | by which a provider or community-based organization can | 8 | | access each client case that is associated with that | 9 | | provider or community-based organization in the | 10 | | Department's integrated eligibility system for each | 11 | | client, provider, and community-based organization that | 12 | | seeks such access, and cooperates with the Department's | 13 | | screening, training, and security protocols. Such access | 14 | | shall enable the provider or community-based organization | 15 | | to assist its clients with their benefits cases. | 16 | | (2) A client must authorize the Department of | 17 | | Healthcare and Family Services to associate his or her case | 18 | | with one or more particular providers or community-based | 19 | | organizations before the provider or organization may | 20 | | access the client's case. Such authorization must be given | 21 | | in writing and may be revoked in writing by the client, | 22 | | provider, or community-based organization at any time. The | 23 | | permission to access the case shall be granted to the | 24 | | provider or community-based organization as a whole and not | 25 | | specific to any particular employee or staff member. The | 26 | | Department of Healthcare and Family Services shall process |
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| 1 | | all requests to associate a case or revoke an association | 2 | | with particular providers or community-based organizations | 3 | | promptly. | 4 | | (3) For each provider and community-based organization | 5 | | that seeks such access, the Department of Healthcare and | 6 | | Family Services shall authorize and create | 7 | | agency-associated permission within the Department's | 8 | | integrated eligibility system to view the specific case for | 9 | | each client associated with the provider or | 10 | | community-based organization. This agency-associated | 11 | | permission shall permit staff authorized by the provider or | 12 | | community-based organization to access and interact with | 13 | | all client cases associated with the provider or | 14 | | community-based organization in ways that are otherwise | 15 | | accessible to the client. The provider or community-based | 16 | | organization shall identify and supervise authorized | 17 | | staff. Such agency-associated permission shall enable the | 18 | | provider or community-based organization to access all | 19 | | client-facing aspects of the case for each client | 20 | | associated with the provider or community-based | 21 | | organization who has authorized such access. | 22 | | (4) The Department of Healthcare and Family Services | 23 | | shall ensure that the provider or community-based | 24 | | organization has been granted permission within the | 25 | | Department's integrated eligibility system (or other | 26 | | electronic systems) to receive and view notifications and |
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| 1 | | alerts for all associated client cases, and to perform | 2 | | certain actions in associated client cases. Permitted | 3 | | actions shall include, but are not limited to: (i) viewing | 4 | | notifications, (ii) uploading documentation such as | 5 | | spend-down verifications and renewal forms, and (iii) | 6 | | initiating contact with and continuing communication with | 7 | | Department staff. | 8 | | (c) Administration of agency-associated permission. | 9 | | (1) The Department of Healthcare and Family Services | 10 | | shall develop criteria and policies for granting | 11 | | permission to providers and community-based organizations | 12 | | that seek agency-associated permission. | 13 | | (2) The Department of Healthcare and Family Services | 14 | | shall create criteria and policies to ensure that | 15 | | agency-associated permission is granted only for accounts | 16 | | where the authorized user has agreed to (i) obtain the | 17 | | written consent of the individual, (ii) act in the best | 18 | | interest of the individual, (iii) maintain the integrity of | 19 | | the Department's programs, and (iv) act in compliance with | 20 | | applicable State and federal law. | 21 | | (3) Agency-associated permission shall be authorized | 22 | | by the Department of Healthcare and Family Services in | 23 | | accordance with the criteria and policies to be developed | 24 | | by the Department under this Act. | 25 | | (4) The Department of Healthcare and Family Services | 26 | | shall not unreasonably restrict or limit agency-associated |
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| 1 | | permission. | 2 | | (d) Creation of enhanced user permission. | 3 | | (1) The Department of Healthcare and Family Services | 4 | | shall authorize, create, support, and administer an | 5 | | enhanced user permission under which particular | 6 | | individuals have authority to manually verify information | 7 | | and work around error messages in the Department's | 8 | | integrated eligibility system. Individuals who are | 9 | | associated with navigators, providers, or community-based | 10 | | organizations may apply for such access, and the Department | 11 | | shall grant enhanced user permission in compliance with | 12 | | this Section to those who cooperate with the Department's | 13 | | screening, training, and security protocols. | 14 | | (2) Enhanced user permissions shall permit individuals | 15 | | to work in the integrated eligibility system with enhanced | 16 | | permissions beyond the consumer-facing portal. Such | 17 | | enhanced permissions shall include, but not be limited to, | 18 | | addressing common challenges, including (i) resolving | 19 | | common error codes, (ii) manually verifying data in the | 20 | | integrated eligibility system, and (iii) performing | 21 | | identity verification for the purposes of eligibility | 22 | | determination in accordance with requirements set forth by | 23 | | State and federal law. Nothing in this Act shall be | 24 | | interpreted as changing program eligibility or renewal | 25 | | criteria. | 26 | | (e) Administration of enhanced user permission. |
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| 1 | | (1) Providers and community-based organizations shall | 2 | | nominate and supervise individual staff that serve as | 3 | | assisters, navigators, or who are otherwise proficient | 4 | | with Manage My Case to be granted enhanced user permissions | 5 | | by the Department of Healthcare and Family Services. | 6 | | (2) The Department of Healthcare and Family Services | 7 | | shall develop criteria and policies for granting enhanced | 8 | | user permission. | 9 | | (3) The Department of Healthcare and Family Services | 10 | | shall provide support and training to individuals granted | 11 | | enhanced user permission. | 12 | | (4) The Department of Healthcare and Family Services | 13 | | shall maintain and publish online a list of providers and | 14 | | community-based organizations that employ staff who have | 15 | | been granted enhanced user permission, to help individuals | 16 | | and families looking for assistance enrolling in and | 17 | | maintaining benefits. | 18 | | (5) The Department of Healthcare and Family Services | 19 | | shall create criteria and policies to ensure that | 20 | | individuals with enhanced user permission agree to (i) | 21 | | obtain the written consent of the individual, (ii) act in | 22 | | the best interest of the individual, (iii) maintain the | 23 | | integrity of the Department's programs, and (iv) act in | 24 | | compliance with applicable State and federal law. | 25 | | (6) Enhanced user permission shall be authorized by the | 26 | | Department of Healthcare and Family Services in accordance |
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| 1 | | with the criteria and policies to be developed by the | 2 | | Department under this Act. | 3 | | (7) The Department of Healthcare and Family Services | 4 | | shall not unreasonably restrict or limit enhanced user | 5 | | permission. | 6 | | Section 30. The Department shall adopt any rules or | 7 | | policies necessary to implement this Act. | 8 | | Section 35. The Illinois Public Aid Code is amended by | 9 | | changing Section 11-5.2 as follows: | 10 | | (305 ILCS 5/11-5.2) | 11 | | Sec. 11-5.2. Income, Residency, and Identity Verification | 12 | | System. | 13 | | (a) The Department shall ensure that its proposed | 14 | | integrated eligibility system shall include the computerized | 15 | | functions of income, residency, and identity eligibility | 16 | | verification to verify eligibility, eliminate duplication of | 17 | | medical assistance, and deter fraud , reduce administrative | 18 | | burdens on the Department and the applicant or recipient, and | 19 | | minimize delay . Until the integrated eligibility system is | 20 | | operational, the Department may enter into a contract with the | 21 | | vendor selected pursuant to Section 11-5.3 as necessary to | 22 | | obtain the electronic data matching described in this Section. | 23 | | This contract shall be exempt from the Illinois Procurement |
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| 1 | | Code pursuant to subsection (h) of Section 1-10 of that Code. | 2 | | (b) Prior to awarding medical assistance at application | 3 | | under Article V of this Code, the Department shall, to the | 4 | | extent such databases are available to the Department, conduct | 5 | | data matches using the name, date of birth, address, and Social | 6 | | Security Number of each applicant or recipient or responsible | 7 | | relative of an applicant or recipient through one or more | 8 | | federal or State electronic data sources including against the | 9 | | following: | 10 | | (1) Income tax information. | 11 | | (2) Employer reports of income and unemployment | 12 | | insurance payment information maintained by the Department | 13 | | of Employment Security. | 14 | | (3) Earned and unearned income, citizenship and death, | 15 | | and other relevant information maintained by the Social | 16 | | Security Administration. | 17 | | (4) Immigration status information maintained by the | 18 | | United States Citizenship and Immigration Services. | 19 | | (5) Wage reporting and similar information maintained | 20 | | by states contiguous to this State. | 21 | | (6) Employment information maintained by the | 22 | | Department of Employment Security in its New Hire Directory | 23 | | database. | 24 | | (7) Employment information maintained by the United | 25 | | States Department of Health and Human Services in its | 26 | | National Directory of New Hires database. |
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| 1 | | (8) Veterans' benefits information maintained by the | 2 | | United States Department of Health and Human Services, in | 3 | | coordination with the Department of Health and Human | 4 | | Services and the Department of Veterans' Affairs, in the | 5 | | federal Public Assistance Reporting Information System | 6 | | (PARIS) database. | 7 | | (9) Residency information maintained by the Illinois | 8 | | Secretary of State. | 9 | | (10) A database which is substantially similar to or a | 10 | | successor of a database described in this Section that | 11 | | contains information relevant for verifying eligibility | 12 | | for medical assistance. | 13 | | (c) (Blank). | 14 | | (c-5) Financial information shall be data matched by first | 15 | | using the electronic data source with the most recent data. The | 16 | | most recent data source shall be accepted as a reliable | 17 | | electronic data source for determining reasonable | 18 | | compatibility with the applicant's or recipient's attestation | 19 | | or records. The Department may use a less recent data source | 20 | | only if it will maximize accuracy, minimize delay, and meet | 21 | | other applicable requirements. | 22 | | (d) If information provided by or on behalf of an | 23 | | individual (on the application or renewal form or otherwise) is | 24 | | reasonably compatible with the information obtained by the | 25 | | Department in accordance with subsection (b), the Department | 26 | | must determine or renew eligibility based on such information |
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| 1 | | without making additional requests for verification, | 2 | | information, or documentation to the individual. "Reasonable | 3 | | compatibility" means an allowable difference or discrepancy | 4 | | between the income reported by an applicant or recipient and | 5 | | the income reported by an electronic data source. a discrepancy | 6 | | results between information provided by an applicant, | 7 | | recipient, or responsible relative and information contained | 8 | | in one or more of the databases or information tools listed | 9 | | under subsection (b) of this Section or subsection (c) of | 10 | | Section 11-5.3 and that discrepancy calls into question the | 11 | | accuracy of information relevant to a condition of eligibility | 12 | | provided by the applicant, recipient, or responsible relative, | 13 | | the Department or its contractor shall review the applicant's | 14 | | or recipient's case using the following procedures: | 15 | | (1) Income information obtained through an electronic | 16 | | data source shall be considered reasonably compatible with | 17 | | income information provided by or on behalf of the | 18 | | individual if both are either above or at or below the | 19 | | applicable income threshold. If the information discovered | 20 | | under subsection (b) of this Section or subsection (c) of | 21 | | Section 11-5.3 does not result in the Department finding | 22 | | the applicant or recipient ineligible for assistance under | 23 | | Article V of this Code, the Department shall finalize the | 24 | | determination or redetermination of eligibility. | 25 | | (1.5) Income information is reasonably compatible if | 26 | | the discrepancy between the information provided by or on |
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| 1 | | behalf of the individual is within 10% of the federal | 2 | | poverty level (above or below) of the information from the | 3 | | electronic data source. "Federal poverty level" means the | 4 | | poverty guidelines updated periodically in the Federal | 5 | | Register by the U.S. Department of Health and Human | 6 | | Services. These guidelines set poverty levels by family | 7 | | size. | 8 | | (1.6) The reasonable compatibility standard for | 9 | | financial information shall also be met when the | 10 | | information provided by or on behalf of the individual is | 11 | | zero income or income that is below the program's | 12 | | applicable income standard, or when no income data is | 13 | | available from electronic data sources. | 14 | | (1.7) If information provided by or on behalf of the | 15 | | individual is not reasonably compatible with information | 16 | | obtained through an electronic data match, the Department | 17 | | shall provide written notice to the applicant or recipient | 18 | | which shall describe in sufficient detail the | 19 | | circumstances and sources of the discrepancy, the | 20 | | information or documentation required, the manner in which | 21 | | the applicant or recipient may respond, and the | 22 | | consequences of failing to take action. The applicant or | 23 | | recipient shall have 10 business days to respond. | 24 | | (2) If the information from both the electronic data | 25 | | source and the applicant or recipient discovered results in | 26 | | the Department finding the applicant or recipient |
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| 1 | | ineligible for assistance, the Department shall provide | 2 | | notice as set forth in Section 11-7 of this Article. | 3 | | (3) (Blank). If the information discovered is | 4 | | insufficient to determine that the applicant or recipient | 5 | | is eligible or ineligible, the Department shall provide | 6 | | written notice to the applicant or recipient which shall | 7 | | describe in sufficient detail the circumstances of the | 8 | | discrepancy, the information or documentation required, | 9 | | the manner in which the applicant or recipient may respond, | 10 | | and the consequences of failing to take action. The | 11 | | applicant or recipient shall have 10 business days to | 12 | | respond. | 13 | | (4) If the applicant or recipient does not respond to | 14 | | the notice, the Department shall deny assistance for | 15 | | failure to cooperate, in which case the Department shall | 16 | | provide notice as set forth in Section 11-7. Eligibility | 17 | | for assistance shall not be established until the | 18 | | discrepancy has been resolved. | 19 | | (5) If an applicant or recipient responds to the | 20 | | notice, the Department shall determine the effect of the | 21 | | information or documentation provided on the applicant's | 22 | | or recipient's case and shall take appropriate action. | 23 | | Written notice of the Department's action shall be provided | 24 | | as set forth in Section 11-7 of this Article. | 25 | | (6) Suspected cases of fraud shall be referred to the | 26 | | Department's Inspector General. |
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| 1 | | (e) Excepting citizenship and satisfactory immigration | 2 | | status, the Department may waive its verification requirements | 3 | | for exceptional circumstances, including: The Department shall | 4 | | adopt any rules necessary to implement this Section.
| 5 | | (1) homelessness; | 6 | | (2) domestic violence; | 7 | | (3) instances where a noncustodial parent refuses to | 8 | | release documentation germane to verification of one or | 9 | | more eligibility factors; | 10 | | (4) natural disaster; and | 11 | | (5) other circumstances as identified on a | 12 | | case-by-case basis and approved by the Department, | 13 | | including, but not limited to, when documentation does not | 14 | | exist at the time of application or renewal or is not | 15 | | reasonably available. | 16 | | (f) The Department shall ensure the integrated eligibility | 17 | | system shall include an applicant portal that allows electronic | 18 | | submission of eligibility documentation, updating of family | 19 | | and demographic information, tracking application status, and | 20 | | receiving electronic notifications from the Department. The | 21 | | Department shall actively promote the use of this portal | 22 | | through materials provided at Family and Community Resource | 23 | | Centers, staff communications with applicants, and electronic | 24 | | and print media. The portal and materials used to promote the | 25 | | portal must be available, at a minimum, in English, Spanish, | 26 | | and the next 4 most commonly used languages. The portal shall |
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| 1 | | be available to all applicants and recipients of medical | 2 | | assistance provided they satisfy electronic identity | 3 | | verification requirements through one of the following | 4 | | processes: | 5 | | (1) Providing personally identifying credit history | 6 | | information. | 7 | | (2) Providing requested personally identifying | 8 | | documentation to the Department. | 9 | | (3) Completing an email, text, or mobile phone | 10 | | verification where a message is sent to the email or phone | 11 | | associated with the account and the applicant or recipient | 12 | | must respond to that message. | 13 | | (4) Completing any alternative process developed by | 14 | | the Department for ensuring the electronic security of | 15 | | applicants and recipients. | 16 | | (g) The Department shall adopt any rules necessary to | 17 | | implement this Section. | 18 | | (Source: P.A. 97-689, eff. 6-14-12; 98-756, eff. 7-16-14.)
| 19 | | Section 99. Effective date. This Act takes effect upon | 20 | | becoming law.".
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