(305 ILCS 5/5-1.2)
Recipient eligibility verification.
(a) The Illinois Department shall initiate a statewide system by which
providers and sites of medical care can electronically verify recipient
eligibility for aid under this Article.
High-volume providers and sites of medical care, as defined by the Illinois
Department by rule, shall be required to participate in the eligibility
Every non-high-volume provider and site of medical
care shall be afforded the opportunity to participate in the eligibility
The Illinois Department shall provide by rule for
implementation of the system, which may be accomplished in phases over time and
by geographic region, recipient classification, and provider type.
The system shall initially be implemented in, but not limited to, the
following zip codes in Cook County: 60601, 60602, 60603, 60604, 60605, 60606,
60607, 60608, 60609, 60612, and 60616. The system shall be implemented within
months after approval by the federal government. The Illinois Department shall
report to the General Assembly by December 31, 1994 on the status of the
Illinois Department's application to the federal government for approval of
The recipient eligibility verification system may be coordinated with the
Electronic Benefits Transfer system established by Section 11-3.1 of this Code
and compatible with any of the methods for the delivery of medical care and
services authorized by this Article.
The system shall make available to providers the history of claims for
medical services submitted to the Illinois Department for those services
provided to the recipient. The Illinois Department shall develop safeguards to
protect each recipient's health information from misuse or unauthorized
(b) The Illinois Department shall conduct a demonstration project in at
least 2 geographic locations for the purpose of assessing the effectiveness of
a recipient photo identification card in reducing abuses in the provision of
services under this Article. In order to receive medical care, recipients
included in this demonstration project must present a Medicaid card and photo
identification card. The Illinois Department shall apply for any federal
waivers or approvals necessary to conduct this demonstration project. The
demonstration project shall become operational (i) 12 months after the
date of this amendatory Act of 1994 or (ii) after the Illinois Department's
of all necessary federal waivers and approvals, whichever occurs later, and
shall operate for 12 months.
(c) Effective October 1, 2007, all changes in status of Medicaid recipients
residing in Illinois nursing facilities after initial eligibility for
Medicaid has been established shall be reported to the Department, using an
Internet-based electronic data interchange system, by the nursing facilities,
except for those changes made by personnel of the Department. Changes reported
using the Internet-based electronic data interchange system shall be deemed
valid and shall be used as the basis for future Medicaid payments unless
Department approval of the transaction is required, or until such time as
any review or audit conducted by the State establishes that the
information is incorrect.
(Source: P.A. 95-458, eff. 8-27-07.)