(305 ILCS 5/5C-4) (from Ch. 23, par. 5C-4)
Sec. 5C-4. Reporting; penalty; maintenance of records.
(a) After June 30 of each State fiscal year, and on or before
September 30 of the succeeding State fiscal year, every care provider for persons with a developmental disability subject to assessment under this Article shall file
a return with the Illinois Department. The return shall report the
adjusted gross developmentally disabled care revenue from the State fiscal
year just ended and shall be utilized by the Illinois Department to
calculate the assessment for the State fiscal year commencing on the
preceding July 1. The return shall be on a form prepared by the Illinois
Department and shall state the following:
(1) The name of the care provider for persons with a |
| developmental disability.
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(2) The address of the care provider's principal
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| place of business from which the provider engages in the occupation of care provider for persons with a developmental disability in this State, and the name and address of all care facilities for persons with a developmental disability operated or maintained by the provider in this State.
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(3) The adjusted gross developmentally disabled care
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| revenue for the State fiscal year just ended, the amount of assessment imposed under Section 5C-2 for the State fiscal year for which the return is filed, and the amount of each quarterly installment to be paid during the State fiscal year.
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(4) The amount of penalty due, if any.
(5) Other reasonable information the Illinois
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(b) If a care provider for persons with a developmental disability operates
or maintains more than one care facility for persons with a developmental disability
in this State, the provider may not file a single return covering
all those care facilities for persons with a developmental disability, but shall file
a separate return for each care facility for persons with a developmental disability and shall compute and pay the assessment for each
care facility for persons with a developmental disability separately.
(c) Notwithstanding any other provision in this Article, a
person who ceases to conduct, operate, or maintain a
care facility for persons with a developmental disability in respect of which the
person is subject to assessment under this Article as a care provider for persons with a developmental disability, the assessment for the State fiscal year
in which the cessation occurs shall be adjusted by multiplying
the assessment computed under Section 5C-2 by a fraction, the
numerator of which is the number of months in the year during
which the provider conducts, operates, or maintains the
care facility for persons with a developmental disability and the denominator of
which is 12. The person shall file a final, amended return
with the Illinois Department not more than 90 days after the
cessation reflecting the adjustment and shall pay with the
final return the assessment for the year as so adjusted (to the
extent not previously paid).
(d) Notwithstanding any other provision of this Article, a
provider who commences conducting, operating, or maintaining a
care facility for persons with a developmental disability shall file an initial
return for the State fiscal year in which the commencement
occurs within 90 days thereafter and shall pay the assessment
computed under Section 5C-2 and subsection (e) in equal
installments on the due date of the return and on the regular
installment due dates for the State fiscal year occurring after
the due date of the initial return.
(e) Notwithstanding any other provision of this Article, in
the case of a care provider for persons with a developmental disability that did not
conduct, operate, or maintain a care facility for persons with a developmental disability throughout the prior State fiscal year, the assessment
for that State fiscal year shall be computed on the basis of
hypothetical adjusted gross developmentally disabled care revenue
for the prior year as determined by rules adopted by
the Illinois Department (which may be based on annualization of
the provider's actual revenues for a portion of the State fiscal
year, or revenues of a comparable facility for such year,
including revenues realized by a prior provider from the same
facility during such year).
(f) In the case of a care provider for persons with a developmental disability
existing as a corporation or legal entity other than an
individual, the return filed by it shall be signed by its
president, vice-president, secretary, or treasurer or by its
properly authorized agent.
(g) If a care provider for persons with a developmental disability fails to
file its return for a State fiscal year on or before the due date
of the return, there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5C-2 for the State fiscal year a penalty
assessment equal to 25% of the assessment imposed for the year.
(h) Every care provider for persons with a developmental disability subject to
assessment under this Article shall keep records and books
that will permit the determination of adjusted gross developmentally disabled care revenue on a State fiscal year
basis. All such books and records shall be kept in the English
language and shall, at all times during business hours of the
day, be subject to inspection by the Illinois Department or its
duly authorized agents and employees.
(Source: P.A. 99-143, eff. 7-27-15.)
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(305 ILCS 5/5C-6) (from Ch. 23, par. 5C-6)
Sec. 5C-6. Administration; enforcement provisions.
(a) To the extent practicable, the Illinois Department shall administer and
enforce this Article and collect the assessments, interest, and
penalty assessments imposed under this Article, using procedures
employed in its administration of this Code generally and, as it deems
appropriate, in a manner similar to that in which the Department
of Revenue administers and collects the retailers' occupation tax
pursuant to the Retailers' Occupation Tax Act ("ROTA"). Instead
of certificates of registration, the Illinois Department shall
establish and maintain a listing of all care providers for persons with a developmental disability appearing in the licensing records of the
Department of Public Health, which shall show each provider's
name, principal place of business, and the name and address of
each care facility for persons with a developmental disability operated or maintained by the
provider in this State. In addition, the following Retailers' Occupation
Tax Act provisions are incorporated by reference into this Section, except
that the Illinois Department and its Director (rather than the Department
of Revenue and its Director) and every care provider for persons with a developmental disability subject to assessment measured by adjusted gross developmentally
disabled care revenue and to the return filing requirements of this Article
(rather than persons subject to retailers' occupation tax measured by gross
receipts from the sale of tangible personal property at retail and to the
return filing requirements of ROTA) shall have the powers, duties, and
rights specified in these ROTA provisions, as modified in this Section or
by the Illinois Department in a manner consistent with this Article and
except as manifestly inconsistent with the other provisions of this Article:
(1) ROTA, Section 4 (examination of return; notice of |
| correction; evidence; limitations; protest and hearing), except that (i) the Illinois Department shall issue notices of assessment liability (rather than notices of tax liability as provided in ROTA, Section 4); (ii) in the case of a fraudulent return or in the case of an extended period agreed to by the Illinois Department and the care provider for persons with a developmental disability before the expiration of the limitation period, no notice of assessment liability shall be issued more than 3 years after the later of the due date of the return required by Section 5C-5 or the date the return (or an amended return) was filed (rather within the period stated in ROTA, Section 4); and (iii) the penalty provisions of ROTA, Section 4 shall not apply.
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(2) ROTA, Section 5 (failure to make return; failure
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| to pay assessment), except that the penalty and interest provisions of ROTA, Section 5 shall not apply.
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(3) ROTA, Section 5a (lien; attachment; termination;
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| notice; protest; review; release of lien; status of lien).
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(4) ROTA, Section 5b (State lien notices; State lien
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| index; duties of recorder and registrar of titles).
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(5) ROTA, Section 5c (liens; certificate of release).
(6) ROTA, Section 5d (Department not required to
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| furnish bond; claim to property attached or levied upon).
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(7) ROTA, Section 5e (foreclosure on liens;
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(8) ROTA, Section 5f (demand for payment; levy and
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| sale of property; limitation).
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(9) ROTA, Section 5g (sale of property; redemption).
(10) ROTA, Section 5j (sales on transfers outside
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| usual course of business; report; payment of assessment; rights and duties of purchaser; penalty).
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(11) ROTA, Section 6 (erroneous payments; credit or
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| refund), provided that (i) the Illinois Department may only apply an amount otherwise subject to credit or refund to a liability arising under this Article; (ii) except in the case of an extended period agreed to by the Illinois Department and the care provider for persons with a developmental disability prior to the expiration of this limitation period, a claim for credit or refund must be filed no more than 3 years after the due date of the return required by Section 5C-5 (rather than the time limitation stated in ROTA, Section 6); and (iii) credits or refunds shall not bear interest.
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(12) ROTA, Section 6a (claims for credit or refund).
(13) ROTA, Section 6b (tentative determination of
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| claim; notice; hearing; review), provided that a care provider for persons with a developmental disability or its representative shall have 60 days (rather than 20 days) within which to file a protest and request for hearing in response to a tentative determination of claim.
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(14) ROTA, Section 6c (finality of tentative
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(15) ROTA, Section 8 (investigations and hearings).
(16) ROTA, Section 9 (witness; immunity).
(17) ROTA, Section 10 (issuance of subpoenas;
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| attendance of witnesses; production of books and records).
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(18) ROTA, Section 11 (information confidential;
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(19) ROTA, Section 12 (rules and regulations;
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| hearing; appeals), except that a care provider for persons with a developmental disability shall not be required to file a bond or be subject to a lien in lieu thereof in order to seek court review under the Administrative Review Law of a final assessment or revised final assessment or the equivalent thereof issued by the Illinois Department under this Article.
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(b) In addition to any other remedy provided for and without sending a
notice of assessment liability, the Illinois Department may collect an
unpaid assessment by withholding, as payment of the assessment,
reimbursements or other amounts otherwise payable by the Illinois
Department to the provider.
(Source: P.A. 99-143, eff. 7-27-15.)
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(305 ILCS 5/5C-7) (from Ch. 23, par. 5C-7)
Sec. 5C-7. Care Provider Fund for Persons with a Developmental Disability.
(a) There is created in the State Treasury the
Care Provider Fund for Persons with a Developmental Disability. Interest earned by the Fund shall be credited to the
Fund. The Fund shall not be used to replace any moneys appropriated to the
Medicaid program by the General Assembly.
(b) The Fund is created for the purpose of receiving and
disbursing assessment moneys in accordance with this Article.
Disbursements from the Fund shall be made only as follows:
(1) For payments to intermediate care facilities for |
| persons with a developmental disability under Title XIX of the Social Security Act and Article V of this Code.
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(2) For the reimbursement of moneys collected by the
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| Illinois Department through error or mistake, and to make required payments under Section 5-4.28(a)(1) of this Code if there are no moneys available for such payments in the Medicaid Provider for Persons with a Developmental Disability Participation Fee Trust Fund.
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(3) For payment of administrative expenses incurred
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| by the Department of Human Services or its agent or the Illinois Department or its agent in performing the activities authorized by this Article.
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(4) For payments of any amounts which are
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| reimbursable to the federal government for payments from this Fund which are required to be paid by State warrant.
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(5) For making transfers to the General Obligation
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| Bond Retirement and Interest Fund as those transfers are authorized in the proceedings authorizing debt under the Short Term Borrowing Act, but transfers made under this paragraph (5) shall not exceed the principal amount of debt issued in anticipation of the receipt by the State of moneys to be deposited into the Fund.
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(6) For making refunds as required under Section
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Disbursements from the Fund, other than transfers to the
General Obligation Bond Retirement and Interest Fund, shall be by
warrants drawn by the State Comptroller upon receipt of vouchers
duly executed and certified by the Illinois Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois
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| Department from the care provider for persons with a developmental disability assessment imposed by this Article.
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(2) All federal matching funds received by the
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| Illinois Department as a result of expenditures made by the Illinois Department that are attributable to moneys deposited in the Fund.
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(3) Any interest or penalty levied in conjunction
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| with the administration of this Article.
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(4) Any balance in the Medicaid Care Provider for
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| Persons With a Developmental Disability Participation Fee Trust Fund in the State Treasury. The balance shall be transferred to the Fund upon certification by the Illinois Department to the State Comptroller that all of the disbursements required by Section 5-4.21(b) of this Code have been made.
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(5) All other moneys received for the Fund from any
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| other source, including interest earned thereon.
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(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-143, eff. 7-27-15.)
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(305 ILCS 5/5E-5)
(Section scheduled to be repealed on July 1, 2024) Sec. 5E-5. Definitions. As used in this Article, unless the
context requires otherwise:
"Nursing home" means (i) a skilled nursing or intermediate long-term care
facility, whether public or private and whether organized for profit or
not-for-profit, that is subject to licensure by the Illinois Department
of Public Health under the Nursing Home Care Act, the ID/DD Community Care Act, or the MC/DD Act, including a
county nursing home directed and maintained under Section
5-1005 of the Counties Code, and (ii) a part of a hospital in
which skilled or intermediate long-term care services within the
meaning of Title XVIII or XIX of the Social Security Act are
provided; except that the term "nursing home" does not include a facility
operated solely as an intermediate care facility for the intellectually disabled
within the meaning of Title XIX of the Social Security Act or a specialized mental health rehabilitation facility.
"Nursing home provider" means (i) a person licensed
by the Department of Public Health to operate and maintain a
skilled nursing or intermediate long-term care facility which charges its
residents, a third party payor, Medicaid, or Medicare for skilled nursing or
intermediate long-term care services, or (ii) a hospital provider that
provides skilled or intermediate long-term care services within
the meaning of Title XVIII or XIX of the Social Security Act.
"Nursing home provider" does not include a person who operates or a provider who provides services within a specialized mental health rehabilitation facility. For purposes of this paragraph, "person" means any political
subdivision of the State, municipal corporation, individual,
firm, partnership, corporation, company, limited liability
company, association, joint stock association, or trust, or a
receiver, executor, trustee, guardian, or other representative
appointed by order of any court. "Hospital provider" means a
person licensed by the Department of Public Health to conduct,
operate, or maintain a hospital.
"Licensed bed days" shall be computed separately for each nursing home
operated or maintained by a nursing home provider and means, with respect to a
nursing home provider, the sum for all nursing home beds of the number of days
during a calendar quarter on which each bed is covered by a license issued to
that provider under the Nursing Home Care Act or the Hospital Licensing Act.
(Source: P.A. 99-180, eff. 7-29-15.)
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(305 ILCS 5/5F-15) Sec. 5F-15. Definitions. As used in this Article: "Appeal" means any of the procedures that deal with the review of adverse organization determinations on the health care services the enrollee believes he or she is entitled to receive, including delay in providing, arranging for, or approving the health care services, such that a delay would adversely affect the health of the enrollee or on any amounts the enrollee must pay for a service, as defined under 42 CFR 422.566(b). These procedures include reconsiderations by the managed care organization and, if necessary, an independent review entity as provided by the Health Carrier External Review Act, hearings before administrative law judges, review by the Medicare Appeals Council, and judicial review. "Demonstration Project" means the nursing home component of the Medicare-Medicaid Alignment Initiative Demonstration Project. "Department" means the Department of Healthcare and Family Services. "Enrollee" means an individual who resides in a nursing home or is qualified to be admitted to a nursing home and is enrolled with a managed care organization participating in the Demonstration Project. "Health care services" means the diagnosis, treatment, and prevention of disease and includes medication, primary care, nursing or medical care, mental health treatment, psychiatric rehabilitation, memory loss services, physical, occupational, and speech rehabilitation, enhanced care, medical supplies and equipment and the repair of such equipment, and assistance with activities of daily living. "Managed care organization" or "MCO" means an entity that meets the definition of health maintenance organization as defined in the Health Maintenance Organization Act, is licensed, regulated and in good standing with the Department of Insurance, and is authorized to participate in the nursing home component of the Medicare-Medicaid Alignment Initiative Demonstration Project by a 3-way contract with the Department of Healthcare and Family Services and the Centers for Medicare and Medicaid Services. "Medical professional" means a physician, physician assistant, or nurse practitioner. "Medically necessary" means health care services that a medical professional, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or its symptoms, and that are: (i) in accordance with the generally accepted standards of medical practice; (ii) clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or disease; and (iii) not primarily for the convenience of the patient, a medical professional, other health care provider, caregiver, family member, or other interested party. "Nursing home" means a facility licensed under the Nursing Home Care Act. "Nurse practitioner" means an individual properly licensed as a nurse practitioner under the Nurse Practice Act. "Physician" means an individual licensed to practice in all branches of medicine under the Medical Practice Act of 1987. "Physician assistant" means an individual properly licensed under the Physician Assistant Practice Act of 1987. "Resident" means an enrollee who is receiving personal or medical care, including, but not limited to, mental health treatment, psychiatric rehabilitation, physical rehabilitation, and assistance with activities of daily living, from a nursing home. "RAI Manual" means the most recent Resident Assessment Instrument Manual, published by the Centers for Medicare and Medicaid Services. "Resident's representative" means a person designated in writing by a resident to be the resident's representative or the resident's guardian, as described by the Nursing Home Care Act. "SNFist" means a medical professional specializing in the care of individuals residing in nursing homes employed by or under contract with a MCO. "Transition period" means a period of time immediately following enrollment into the Demonstration Project or an enrollee's movement from one managed care organization to another managed care organization or one care setting to another care setting.
(Source: P.A. 98-651, eff. 6-16-14.) |
(305 ILCS 5/5F-20) Sec. 5F-20. Network adequacy. (a) Every managed care organization shall allow every nursing home in its service area an opportunity to be a network contracted facility at the plan's standard terms, conditions, and rates. Either party may opt to limit the contract to existing residents only. (b) With the exception of subsection (c) of this Section, a managed care organization shall only terminate or refuse to renew a contract with a nursing home if the nursing home fails to meet quality standards if the following conditions are met: (1) the quality standards are made known to the |
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(2) the quality standards can be objectively
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(3) the nursing home is measured on at least a
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| year's worth of performance;
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(4) a nursing home that the MCO has determined did
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| not meet a quality standard has the opportunity to contest that determination by challenging the accuracy or the measurement of the data through an arbitration process agreed to by contract; and
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(5) the Department may attempt to mediate a dispute
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(c) A managed care organization may terminate or refuse to renew a contract with a nursing home for a material breach of the contract, including, but not limited to, failure to grant reasonable and timely access to the MCO's care coordinators, SNFists and other providers, termination from the Medicare or Medicaid program, or revocation of license.
(Source: P.A. 98-651, eff. 6-16-14.)
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