(305 ILCS 5/5F-40) Sec. 5F-40. Contractual requirements. (a) Every contract shall contain a clause for termination consistent with the Managed Care Reform and Patient Rights Act providing nursing homes the ability to terminate the contract. (b) All changes to the contract by the MCO shall be preceded by 30 days' written notice sent to the nursing home.
(Source: P.A. 98-651, eff. 6-16-14.) |
(305 ILCS 5/5F-45) Sec. 5F-45. Prohibition. No managed care organization or contract shall contain any provision, policy, or procedure that limits, restricts, or waives any rights set forth in this Article or is expressly prohibited by this Article. Any such policy or procedure is void and unenforceable.
(Source: P.A. 98-651, eff. 6-16-14.) |
(305 ILCS 5/Art. V-G heading) ARTICLE V-G. SUPPORTIVE LIVING FACILITY FUNDING(Repealed by P.A. 103-593)(Source: P.A. 103-154, eff. 6-30-23. Repealed by P.A. 103-593, eff. 6-7-24.) |
(305 ILCS 5/Art. V-H heading) ARTICLE V-H. MANAGED CARE ORGANIZATION PROVIDER ASSESSMENT
(Source: P.A. 103-154, eff. 6-30-23.) |
(305 ILCS 5/5H-1) Sec. 5H-1. Definitions. As used in this Article: "Base year" means the 12-month period from January 1, 2023 to December 31, 2023. "Department" means the Department of Healthcare and Family Services. "Federal employee health benefit" means the program of health benefits plans, as defined in 5 U.S.C. 8901, available to federal employees under 5 U.S.C. 8901 to 8914. "Fund" means the Healthcare Provider Relief Fund. "Managed care organization" means an entity operating under a certificate of authority issued pursuant to the Health Maintenance Organization Act or as a Managed Care Community Network pursuant to Section 5-11 of this Code. "Medicaid managed care organization" means a managed care organization under contract with the Department to provide services to recipients of benefits in the medical assistance program pursuant to Article V of this Code, the Children's Health Insurance Program Act, or the Covering ALL KIDS Health Insurance Act. It does not include contracts the same entity or an affiliated entity has for other business. "Medicare" means the federal Medicare program established under Title XVIII of the federal Social Security Act. "Member months" means the aggregate total number of months all individuals are enrolled for coverage in a Managed Care Organization during the base year. Member months are determined by the Department for Medicaid Managed Care Organizations based on enrollment data in its Medicaid Management Information System and by the Department of Insurance for other Managed Care Organizations based on required filings with the Department of Insurance. Member months do not include months individuals are enrolled in a Limited Health Services Organization, including stand-alone dental or vision plans, a Medicare Advantage Plan, a Medicare Supplement Plan, a Medicaid Medicare Alignment Initiate Plan pursuant to a Memorandum of Understanding between the Department and the Federal Centers for Medicare and Medicaid Services or a Federal Employee Health Benefits Plan.(Source: P.A. 102-558, eff. 8-20-21; 103-593, eff. 6-7-24.) |
(305 ILCS 5/5H-2) Sec. 5H-2. Federal waivers. The Department shall request a waiver from the federal Centers for Medicare and Medicaid Services of the broad-based and uniformity provisions of Section 1903(w)(3)(B) and (C) of Title XIX of the Social Security Act, 42 U.S.C. 1396b, relating to the assessment imposed under this Article. The assessment required pursuant to Section 5H-3 shall not be due and payable until such waiver has been approved and all other federal requirements necessary to obtain federal financial participation have been approved by the Centers for Medicare and Medicaid Services.
(Source: P.A. 101-9, eff. 6-5-19.) |
(305 ILCS 5/5H-3) Sec. 5H-3. Managed care assessment. (a) There is imposed upon managed care organization member months an assessment, calculated on base year data, as set forth below for the appropriate tier: (1) Tier 1: $78.90 per member month. (2) Tier 2: $1.40 per member month. (3) Tier 3: $2.40 per member month. (b) The tiers are established as follows: (1) Tier 1 includes the first 4,195,000 member months | ||
| ||
(2) Tier 2 includes member months over 4,195,000 in a | ||
| ||
(3) Tier 3 includes member months during the base | ||
| ||
(c) For State fiscal year 2020, and for each State fiscal year thereafter, the Department may adjust rates or tier parameters or both in order to maximize the revenue generated by the assessment consistent with federal regulations and to meet federal statistical tests necessary for federal financial participation. Any upward adjustment to the Tier 3 rate shall be the minimum necessary to meet federal statistical tests.(Source: P.A. 103-593, eff. 6-7-24.) |
(305 ILCS 5/5H-4) Sec. 5H-4. Payment of assessment. (a) The assessment payable pursuant to Section 5H-3 shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the first State business day of each month. (b) If the approval of the waivers required under Section 5H-2 is delayed beyond the start of State fiscal year 2020, then the first installment shall be due on the first business day of the first month that begins more than 15 days after the date of such approval. In the event approval results in installments beginning after July 1, 2019, the amount of each installment for that fiscal year shall equal the full amount of the annual assessment divided by the number of payments that will be paid in fiscal year 2020. (c) The Department shall notify each managed care organization of its annual fiscal year 2020 assessment and the installment due dates no later than 30 days prior to the first installment due date and the annual assessment and due dates for each subsequent year at least 30 days prior to the start of each fiscal year. (d) Proceeds from the assessment levied pursuant to Section 5H-3 shall be deposited into the Fund; provided, however, that proceeds from the assessment levied pursuant to Section 5H-3 upon a county provider as defined in Section 15-1 of this Code shall instead be deposited directly into the County Provider Trust Fund.
(Source: P.A. 101-9, eff. 6-5-19; 101-636, eff. 6-10-20.) |
(305 ILCS 5/5H-5) Sec. 5H-5. Liability or resultant entities. In the event of a merger, acquisition, or any similar transaction involving entities subject to the assessment under this Article, the resultant entity shall be responsible for the full amount of the assessment for all entities involved in the transaction with the member months allotted to tiers as they were prior to the transaction and no member months shall change tiers as a result of any transaction. A managed care organization that ceases doing business in the State during any fiscal year shall be liable only for the monthly installments due in months that it operated in the State. The Department shall by rule establish a methodology to set the assessment base member months for a managed care organization that begins operating in the State at any time after 2018. Nothing in this Section shall be construed to limit authority granted in subsection (c) of Section 5H-3.
(Source: P.A. 101-9, eff. 6-5-19; 102-558, eff. 8-20-21.) |
(305 ILCS 5/5H-6) Sec. 5H-6. Recordkeeping; penalties. (a) A managed care organization that is liable for the assessment under this Article shall keep accurate and complete records and pertinent documents as may be required by the Department. Records required by the Department shall be retained for a period of 4 years after the assessment imposed under this Act to which the records apply is due or as otherwise provided by law. The Department or the Department of Insurance may audit all records necessary to ensure compliance with this Article and make adjustments to assessment amounts previously calculated based on the results of any such audit. (b) If a managed care organization fails to make a payment due under this Article in a timely fashion, it shall pay an additional penalty of 5% of the amount of the installment not paid on or before the due date, or any grace period granted, plus 5% of the portion thereof remaining unpaid on the last day of each 30-day period thereafter. The Department is authorized to grant grace periods of up to 30 days upon request of a managed care organization for good cause due to financial or other difficulties, as determined by the Department. If a managed care organization fails to make a payment within 60 days after the due date the Department shall additionally impose a contractual sanction allowed against a Medicaid managed care organization and may terminate any such contract. The Department of Insurance shall take action against the certificate of authority of a non-Medicaid managed care organization that fails to pay an installment within 60 days after the due date.
(Source: P.A. 101-9, eff. 6-5-19; 102-558, eff. 8-20-21.) |
(305 ILCS 5/5H-7) Sec. 5H-7. Rulemaking. The Department may by rule modify or make adjustments to any methodology, assessment amount, assessment tier, or other similar provision specified in this Article, including broadening the tax base in subsection (a) of Section 5H-3, to the extent necessary to meet the requirements of federal law or regulations, obtain federal approval, or to ensure federal financial participation is available. However, upward adjustments to Tier 3 rates shall be the minimum necessary to meet federal statistical tests to receive federal financial participation. The Department shall adopt rules to implement this Article under the Illinois Administrative Procedure Act.
(Source: P.A. 101-9, eff. 6-5-19.) |
(305 ILCS 5/5H-8) Sec. 5H-8. Duties of the Department. (a) The Department shall ensure that rates to Medicaid managed care organizations are actuarially sound including appropriate incorporation of assessments under this Article, other taxes and administrative expenses, including standardization of processes, and cost of medical care. (b) The Department shall pay to each Medicaid managed care organization the amount required to be included in its rates due to the assessment under this Article in order to ensure actuarial soundness within 10 business days of receipt of each assessment payment from the Medicaid managed care organization. The Department shall extend the deadline for any assessment payment due after the initial assessment payment if the payment to the managed care organizations under this subsection for the previous assessment payment has not been paid. Such extension shall extend until 7 business days after receipt by the managed care organization of the late payment under this subsection. (c) Reimbursement of assessments paid under this Article shall not be required to count as revenue towards any calculation of the managed care organization's medical loss ratio, net worth, risk based capital or other deposit requirements as may otherwise be required under the Insurance Code. Such reimbursements will be considered revenue in calculating the 6% limit under 42 U.S.C. 433.68(f)(3). (d) The Department shall include in its annual report, beginning with its fiscal year 2020 report, and every year thereafter, information on the revenues collected from this assessment, the federal funds drawn based on those revenues, the rates set in Section 5H-3 or any alterations thereof by administrative rule, and other impacts this gross revenue has had on the Medicaid program.
(Source: P.A. 101-9, eff. 6-5-19.) |
(305 ILCS 5/Art. VI heading) ARTICLE VI.
GENERAL ASSISTANCE
|
(305 ILCS 5/6-1) (from Ch. 23, par. 6-1)
Sec. 6-1. Eligibility requirements. Financial aid in meeting basic
maintenance requirements shall be given under this Article to
or in behalf of persons who meet the eligibility conditions of Sections
6-1.1 through 6-1.10.
In addition, each unit of local government subject to this Article shall
provide persons receiving financial aid in meeting basic maintenance
requirements with financial aid for either (a) necessary treatment, care, and
supplies required because of illness or disability, or (b) acute medical
treatment, care, and supplies only. If a local governmental unit elects to
provide financial aid for acute medical treatment, care, and supplies only, the
general types of acute medical treatment, care, and supplies for which
financial
aid is provided shall be specified in the general assistance rules of the local
governmental unit, which rules shall provide that financial aid is provided, at
a minimum, for acute medical treatment, care, or supplies necessitated by a
medical condition for which prior approval or authorization of medical
treatment, care, or supplies is not required by the general assistance rules
of the Illinois Department.
(Source: P.A. 100-538, eff. 1-1-18.)
|
(305 ILCS 5/6-1.1) (from Ch. 23, par. 6-1.1)
Sec. 6-1.1.
Residence.)
If it appears that an applicant is not a resident of this State but that
he will suffer great
hardship and privation unless general assistance is provided, general assistance
may be given for such
temporary period of time as the need therefor exists. If the applicant
is a resident of some place
within the United States charged by law with the support of its needy residents,
upon the request
of the applicant, transportation to such place may be provided, together
with support during the
journey and temporary support pending transportation.
If the person is a resident of this State but has not resided in the governmental
unit in
which he makes application for a continuous period of 6 months, the governmental
unit in which he last so
resided shall be charged with providing the necessary aid until the person
has resided in the governmental
unit to which he has moved for a continuous period of 6 months. The governmental
unit to which he has
moved shall thereupon become responsible for providing the necessary aid,
whether or not he has
received general assistance during the 6 months period. The local governmental
unit to which application
is made shall determine promptly whether or not the applicant meets the
6 months residence requirement. Pending
the determination, general assistance shall be provided if the person is
otherwise eligible as a needy
person. If it is determined that he is a resident of another governmental
unit, notice shall be given
that unit. Upon receipt of such notice that unit shall furnish the necessary
aid until the person
has established a residence in the governmental unit in which he has made
application. On failure or refusal
of the unit of residence to provide aid, the unit to which application is
made shall provide the aid
which shall be recoverable against the unit of residence by appropriate civil action.
(Source: P.A. 79-353.)
|
(305 ILCS 5/6-1.2) (from Ch. 23, par. 6-1.2)
Sec. 6-1.2. Need. Income available to the person, when added to
contributions in money, substance, or services from other sources,
including contributions from legally responsible relatives, must be
insufficient to equal the grant amount established by Department regulation
(or by local governmental unit in units which do not receive State funds)
for such a person.
In determining income to be taken into account:
(1) The first $75 of earned income in income | ||
| ||
(2) For income assistance units not comprised | ||
| ||
"Earned income" means money earned in self-employment or wages, salary,
or commission for personal services performed as an employee. The eligibility
of any applicant for or recipient of public aid under this Article is not
affected by the payment of any grant under the "Senior Citizens and Persons with Disabilities Property Tax Relief Act", any
refund
or payment of the federal Earned Income Tax Credit, any rebate authorized under Section 2201(a) of the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116-136) or under any other federal economic stimulus program created in response to the COVID-19 emergency, or any distributions or
items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois Income Tax
Act.
(Source: P.A. 101-632, eff. 6-5-20.)
|