(305 ILCS 5/11-1) (from Ch. 23, par. 11-1)
Sec. 11-1.
No discrimination).
There shall be no discrimination or denial
of financial aid and social services on account of the race, religion, color,
national origin, sex, marital status, or political affiliation of any
applicant or recipient. This paragraph shall not prevent the Department from
treating individuals differently as a result of the rights and responsibilities
that arise under law from marital status.
Participation in any marriage promotion or family formation activity is
voluntary.
Non-participation shall not affect any person's eligibility for or receipt of
financial aid or
social services in any program under this Code.
Where financial aid or social services are granted to certain classes of
persons under a program for which federal funds are available, nothing in
this Section shall require granting of financial aid or social services
to other persons where federal funds would not be available as to those other
persons.
(Source: P.A. 93-598, eff. 8-26-03.)
|
(305 ILCS 5/11-2) (from Ch. 23, par. 11-2)
Sec. 11-2.
Conduct
of administrative staff.
Every person administering any provision of this Code shall conduct
himself or herself with courtesy, consideration and respect toward all
applicants and
recipients and perform duties in such manner as to secure for every
applicant and recipient the aid and services to which the person
may be entitled.
Any applicant or recipient who feels he or she has not been treated properly
by administrative staff or the Department in regard to the aforementioned
conduct provisions shall be afforded the right to complain to the Department
about such treatment. The Department shall advise applicants and recipients
of this right through informational brochures and publicly posted information.
Such complaints shall be treated confidentially and the Department and its
employees shall not otherwise discriminate against any applicant or recipient
because such individual complains about the conduct of Department staff.
(Source: P.A. 82-555.)
|
(305 ILCS 5/11-2.1) (from Ch. 23, par. 11-2.1)
Sec. 11-2.1.
No private business and vocational school, as defined in
the Private Business and Vocational Schools Act of 2012,
may solicit an
applicant or recipient within a public aid office or within 100 feet of a
public aid office, for the purpose of enrolling the applicant or recipient
in a work or training program, without the express written consent of the
Illinois Department.
Any person violating this Section shall be guilty of a Class A misdemeanor.
"Public aid office" for the purpose of this Section includes any
business office of the Department where a person may apply for or receive
benefits or services under this Code, the building in which such office is
located, and any parking area connected to such office that is owned or
leased by the State for the benefit of the Department for use by personnel
of the Department or by applicants or recipients.
(Source: P.A. 97-650, eff. 2-1-12.)
|
(305 ILCS 5/11-3) (from Ch. 23, par. 11-3)
Sec. 11-3. Assignment and attachment of aid prohibited. Except as provided
below in this
Section and in Section 11-3.3, all financial aid given under
Articles III, IV, V, and VI and money payments for child care
services
provided by a child care provider under Articles
IX
and IXA shall not be subject to
assignment,
sale,
attachment, garnishment, or otherwise. Provided, however, that a medical
vendor may use his right to receive vendor payments as collateral for loans
from financial institutions so long as such arrangements do not constitute
any activity prohibited under Section 1902(a)(32) of the Social Security
Act and regulations promulgated thereunder, or any other applicable laws or
regulations. Provided further, however, that a medical or other vendor or a
service provider may assign, reassign, sell, pledge or grant a security
interest in any such financial aid, vendor payments or money payments or
grants which he has a right to receive to the Illinois
Finance Authority, in connection with any financing program undertaken by
the Illinois Finance Authority. Each Authority may utilize a
trustee or agent to accept, accomplish, effectuate or realize upon any such
assignment, reassignment, sale, pledge or grant on that Authority's behalf.
Provided further, however, that nothing herein shall prevent the Illinois
Department from collecting any assessment, fee, interest or penalty due under
Article V-A, V-B, V-C, or V-E by withholding financial aid as payment of such
assessment, fee, interest, or penalty. Any alienation in contravention of this
statute does not diminish and does not affect the validity, legality or
enforceability of any underlying obligations for which such alienation may
have been made as collateral between the parties to the alienation. This
amendatory Act shall be retroactive in application and shall pertain to
obligations existing prior to its enactment.
(Source: P.A. 95-331, eff. 8-21-07.)
|
(305 ILCS 5/11-3.1) (from Ch. 23, par. 11-3.1)
Sec. 11-3.1. Any recipient of financial aid which is payable to the
recipient at regular intervals may elect to have the aid deposited, and the
Illinois Department of Human Services is authorized to deposit the aid,
directly in the
recipient's savings account or checking account or in any electronic
benefits transfer account or accounts in a financial institution approved
by the Illinois Department of Human Services and in accordance with the rules
and regulations
of the Department of Human Services. The Illinois Department of Human Services
and any electronic benefits
transfer financial institutions or contractor shall encourage financial
institutions to provide checking account and savings account services to
recipients of public aid.
Any recipient of financial aid or benefits distributed by means other
than electronic benefits transfer under Articles III, IV, and VI of this
Code may elect to receive the aid by means of direct deposit transmittals
to his or her account maintained at a bank, savings and loan association,
or credit union or by means of electronic benefits transfer in a financial
institution approved by the Illinois Department of Human Services and in accordance with
rules and regulations of the Illinois Department of Human Services. The Illinois Department of Human Services
may distribute financial aid or food stamp benefits by means of electronic
benefits transfer and may require recipients to receive financial aid or
food stamp benefits by means of electronic benefits transfer, provided that
any electronic benefits transfer made under this Section shall be
accomplished in compliance with the Electronic Fund Transfer Act and any relevant rules promulgated thereunder. The Illinois
Department of Human Services may provide for a method of compensation for services in
accordance with the rules and regulations of the Illinois Department of Human Services, the
United States Department of Agriculture, the United States Department of
Health and Human Services, and the State Comptroller and the State
Treasurer. The Illinois Department of Human Services shall require a
convenient density of
distribution points for recipients of public aid to have adequate options
to access aid held in an electronic benefits transfer account. No fee may
be charged to recipients for reasonable access to public aid benefits held
in such an account. Deposits into a financial institution for electronic
benefits transfer accounts shall be subject to community reinvestment and
to serving public benefits recipients pursuant to relevant criteria of the
State Treasurer, Comptroller, and the Illinois Department of Human
Services.
The Electronic Benefits Transfer Fund is hereby created for the purpose of
electronically disbursing public aid benefits.
The electronic benefits transfer contractor shall inform the Department of
Human Services
whenever it has distributed financial aid to individuals by means of electronic
benefits transfer. The Illinois Department of Human Services shall determine
the amount to be
reimbursed to the contractor and shall direct the State Treasurer to transfer
this
portion of the amount previously vouchered by the Department of Human Services
and approved by
the Comptroller pursuant to Section 9.05(c) of the State Comptroller Act to the
contractor from the Electronic Benefits Transfer Fund created
under Section 9.05(b) of the State Comptroller Act in accordance with the rules
and regulations of the Illinois Department of Human Services, the United
States Department of
Agriculture, the United States Department of Health and Human Services, the
State Comptroller, and the State Treasurer.
(Source: P.A. 95-331, eff. 8-21-07.)
|
(305 ILCS 5/11-3.2) (from Ch. 23, par. 11-3.2)
Sec. 11-3.2.
Upon the request of a penal or correctional facility,
the Illinois Department shall cooperate in providing informational material
and application forms concerning financial aid or social services under
this Act to the facility and in providing an interview with the appropriate
Public Aid office for persons incarcerated in such facility upon their
release from the facility.
In consideration of any application for financial aid or social
services of persons released from a penal or correctional institution,
a permanent address shall not be required to establish residence in the
determination of eligibility. Other requirements necessary to establish
eligibility for assistance under this code shall apply.
(Source: P.A. 82-497.)
|
(305 ILCS 5/11-3.3) (from Ch. 23, par. 11-3.3)
Sec. 11-3.3. Payment to provider or governmental agency or entity.
Payments under this Code shall be made to the provider, except that the
Department may issue or may agree to issue the payment directly to
the Illinois
Finance
Authority or any other governmental agency or entity, including any bond
trustee for that agency or entity, to whom the provider has assigned,
reassigned, sold, pledged or granted a security interest in the payments
that the provider has a right to receive, provided that the issuance or
agreement to issue is not prohibited under Section 1902(a)(32) of the Social
Security Act.
(Source: P.A. 95-331, eff. 8-21-07.)
|
(305 ILCS 5/11-4) (from Ch. 23, par. 11-4)
Sec. 11-4.
Applications; assistance in making applications.
An application for public assistance shall be deemed an application for
all such benefits to which any person may be entitled except to the
extent that the applicant expressly declines
in writing to apply for particular benefits. The Illinois Department shall
provide information in writing about all benefits provided under this Code
to any person seeking public assistance.
The Illinois Department shall also provide information in writing and orally
to all applicants about an election to have financial aid deposited directly in
a recipient's savings account or checking account or in any electronic benefits
account or accounts as provided in Section 11-3.1, to the extent that those
elections are actually available, including information on any programs
administered by the State Treasurer to facilitate or encourage the distribution
of financial aid by direct deposit or electronic benefits transfer.
The Illinois Department shall
determine the applicant's eligibility for cash assistance, medical
assistance and food stamps unless the applicant expressly declines in
writing to apply for particular benefits.
The Illinois Department shall adopt policies and procedures to facilitate
timely changes between programs that result from changes in categorical
eligibility factors.
The County departments, local governmental units and the Illinois
Department shall
assist applicants for public assistance to properly complete their
applications. Such assistance shall include, but not be limited to, assistance
in securing
evidence in support of their eligibility.
(Source: P.A. 88-232.)
|
(305 ILCS 5/11-4.1) Sec. 11-4.1. Medical providers assisting with applications for medical assistance. A provider enrolled to provide medical assistance services may, upon the request of an individual, accompany, represent, and assist the individual in applying for medical assistance under Article V of this Code. If an individual is unable to request such assistance due to incapacity or mental incompetence and has no other representative willing or able to assist in the application process, a facility licensed under the Nursing Home Care Act, the ID/DD Community Care Act, or the MC/DD Act or certified under this Code is authorized to assist the individual in applying for long-term care services. Subject to the provisions of the Free Healthcare Benefits Application Assistance Act, nothing in this Section shall be construed as prohibiting any individual or entity from assisting another individual in applying for medical assistance under Article V of this Code.
(Source: P.A. 99-180, eff. 7-29-15.) |
(305 ILCS 5/11-4.2) Sec. 11-4.2. Application assistance for enrolling individuals in the medical assistance program. (a) The Department shall have procedures to allow application agents to assist in enrolling individuals in the medical assistance program. As used in this Section, "application agent" means an organization or individual, such as a licensed health care provider, school, youth service agency, employer, labor union, local chamber of commerce, community-based organization, or other organization, approved by the Department to assist in enrolling individuals in the medical assistance program. (b) At the Department's discretion, technical assistance payments may be made available for approved applications facilitated by an application agent. The Department shall permit day and temporary labor service agencies, as defined in the Day and Temporary Labor Services Act, doing business in Illinois to enroll as unpaid application agents. As established in the Free Healthcare Benefits Application Assistance Act, it shall be unlawful for any person to charge another person or family for assisting in completing and submitting an application for enrollment in the medical assistance program. (c) Existing enrollment agreements or contracts for all application agents, technical assistance payments, and outreach grants that were authorized under Section 22 of the Children's Health Insurance Program Act and Sections 25 and 30 of the Covering ALL KIDS Health Insurance Act prior to those Acts becoming inoperative shall continue to be authorized under this Section per the terms of the agreement or contract until modified, amended, or terminated.
(Source: P.A. 102-43, eff. 7-6-21.) |
(305 ILCS 5/11-5) (from Ch. 23, par. 11-5)
Sec. 11-5. Investigation of applications.
The County Department or local governmental unit shall promptly, upon
receipt of an application, make the necessary investigation, as
prescribed by rule of the Illinois Department, for determining the
eligibility of the applicant for aid.
A report of every investigation shall be made in writing and become a
part of the record in each case.
The Illinois Department may by
rule prescribe the circumstances under which information furnished by
applicants in respect to their eligibility may be presumed prima facie
correct, subject to all civil and criminal penalties and recoveries
provided in this Code if the additional investigation establishes that
the applicant made false statements or was otherwise ineligible for
aid.
(Source: P.A. 93-632, eff. 2-1-04.)
|
(305 ILCS 5/11-5.1) Sec. 11-5.1. Eligibility verification. Notwithstanding any other provision of this Code, with respect to applications for medical assistance provided under Article V of this Code, eligibility shall be determined in a manner that ensures program integrity and complies with federal laws and regulations while minimizing unnecessary barriers to enrollment. To this end, as soon as practicable, and unless the Department receives written denial from the federal government, this Section shall be implemented: (a) The Department of Healthcare and Family Services or its designees shall: (1) By no later than July 1, 2011, require | ||
| ||
(2) By no later than October 1, 2011, require | ||
| ||
(3) By no later than July 1, 2011, require | ||
| ||
The Department, with federal approval, may choose to adopt continuous financial eligibility for a full 12 months for adults on Medicaid. (b) The Department shall establish or continue cooperative
arrangements with the Social Security Administration, the
Illinois Secretary of State, the Department of Human Services,
the Department of Revenue, the Department of Employment
Security, and any other appropriate entity to gain electronic
access, to the extent allowed by law, to information available
to those entities that may be appropriate for electronically
verifying any factor of eligibility for benefits under the
Program. Data relevant to eligibility shall be provided for no
other purpose than to verify the eligibility of new applicants or current recipients of health benefits under the Program. Data shall be requested or provided for any new applicant or current recipient only insofar as that individual's circumstances are relevant to that individual's or another individual's eligibility. (c) Within 90 days of the effective date of this amendatory Act of the 96th General Assembly, the Department of Healthcare and Family Services shall send notice to current recipients informing them of the changes regarding their eligibility verification.
(d) As soon as practical if the data is reasonably available, but no later than January 1, 2017, the Department shall compile on a monthly basis data on eligibility redeterminations of beneficiaries of medical assistance provided under Article V of this Code. In addition to the
other data required under this subsection, the Department
shall compile on a monthly basis data on the percentage of
beneficiaries whose eligibility is renewed through ex parte
redeterminations as described in subsection (b) of Section
5-1.6 of this Code, subject to federal approval of the changes
made in subsection (b) of Section 5-1.6 by this amendatory Act
of the 102nd General Assembly. This data shall be posted on the Department's website, and data from prior months shall be retained and available on the Department's website. The data compiled and reported shall include the following: (1) The total number of redetermination decisions | ||
| ||
(2) A breakdown of enrollee language preference for | ||
| ||
(3) The percentage of cancellation decisions made in | ||
| ||
(A) The beneficiary's ineligibility due to excess | ||
| ||
(B) The beneficiary's ineligibility due to not | ||
| ||
(C) The beneficiary's ineligibility due to being | ||
| ||
(D) The beneficiary's request to cancel benefits. (E) The beneficiary's lack of response after | ||
| ||
(F) The beneficiary's lack of response to a | ||
| ||
(G) Other reasons tracked by the Department for | ||
| ||
(4) If a vendor is utilized to provide services in | ||
| ||
(5) Of the total number of benefit cancellations in a | ||
| ||
(e) The Department shall conduct a complete review of the Medicaid redetermination process in order to identify changes that can increase the use of ex parte redetermination processing. This review shall be completed within 90 days after the effective date of this amendatory Act of the 101st General Assembly. Within 90 days of completion of the review, the Department shall seek written federal approval of policy changes the review recommended and implement once approved. The review shall specifically include, but not be limited to, use of ex parte redeterminations of the following populations: (1) Recipients of developmental disabilities | ||
| ||
(2) Recipients of benefits under the State's Aid to | ||
| ||
(3) Recipients of Medicaid long-term care services | ||
| ||
(4) All Modified Adjusted Gross Income (MAGI) | ||
| ||
(5) Populations with no verifiable income. (6) Self-employed people. The report shall also outline populations and circumstances in which an ex parte redetermination is not a recommended option. (f) The Department shall explore and implement, as practical and technologically possible, roles that stakeholders outside State agencies can play to assist in expediting eligibility determinations and redeterminations within 24 months after the effective date of this amendatory Act of the 101st General Assembly. Such practical roles to be explored to expedite the eligibility determination processes shall include the implementation of hospital presumptive eligibility, as authorized by the Patient Protection and Affordable Care Act. (g) The Department or its designee shall seek federal approval to enhance the reasonable compatibility standard from 5% to 10%. (h) Reporting. The Department of Healthcare and Family Services and the Department of Human Services shall publish quarterly reports on their progress in implementing policies and practices pursuant to this Section as modified by this amendatory Act of the 101st General Assembly. (1) The reports shall include, but not be limited to, | ||
| ||
(A) Medical application processing, including a | ||
| ||
(B) Medical redeterminations completed, | ||
| ||
(C) A narrative discussion on issues identified | ||
| ||
(2) Initial reports shall be issued within 90 days | ||
| ||
(3) All reports shall be published on the | ||
| ||
(i) It is the determination of the General Assembly that the Department must include seniors and persons with disabilities in ex parte renewals. It is the determination of the General Assembly that the Department must use its asset verification system to assist in the determination of whether an individual's coverage can be renewed using the ex parte process. If a State Plan amendment is required, the Department shall pursue such State Plan amendment by July 1, 2022. Within 60 days after receiving federal approval or guidance, the Department of Healthcare and Family Services and the Department of Human Services shall make necessary technical and rule changes to implement these changes to the redetermination process. (Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20; 102-1037, eff. 6-2-22.) |
(305 ILCS 5/11-5.2) Sec. 11-5.2. Income, Residency, and Identity Verification System. (a) The Department shall ensure that its proposed integrated eligibility system shall include the computerized functions of income, residency, and identity eligibility verification to verify eligibility, eliminate duplication of medical assistance, and deter fraud. Until the integrated eligibility system is operational, the Department may enter into a contract with the vendor selected pursuant to Section 11-5.3 as necessary to obtain the electronic data matching described in this Section. This contract shall be exempt from the Illinois Procurement Code pursuant to subsection (h) of Section 1-10 of that Code. (b) Prior to awarding medical assistance at application under Article V of this Code, the Department shall, to the extent such databases are available to the Department, conduct data matches using the name, date of birth, address, and Social Security Number of each applicant or recipient or responsible relative of an applicant or recipient against the following: (1) Income tax information. (2) Employer reports of income and unemployment | ||
| ||
(3) Earned and unearned income, citizenship and | ||
| ||
(4) Immigration status information maintained by the | ||
| ||
(5) Wage reporting and similar information maintained | ||
| ||
(6) Employment information maintained by the | ||
| ||
(7) Employment information maintained by the United | ||
| ||
(8) Veterans' benefits information maintained by the | ||
| ||
(9) Residency information maintained by the Illinois | ||
| ||
(10) A database which is substantially similar to or | ||
| ||
(c) (Blank). (d) If a discrepancy results between information provided by an applicant, recipient, or responsible relative and information contained in one or more of the databases or information tools listed under subsection (b) of this Section or subsection (c) of Section 11-5.3 and that discrepancy calls into question the accuracy of information relevant to a condition of eligibility provided by the applicant, recipient, or responsible relative, the Department or its contractor shall review the applicant's or recipient's case using the following procedures: (1) If the information discovered under subsection | ||
| ||
(2) If the information discovered results in the | ||
| ||
(3) If the information discovered is insufficient to | ||
| ||
(4) If the applicant or recipient does not respond to | ||
| ||
(5) If an applicant or recipient responds to the | ||
| ||
(6) Suspected cases of fraud shall be referred to the | ||
| ||
(e) The Department shall adopt any rules necessary to implement this Section.
(Source: P.A. 97-689, eff. 6-14-12; 98-756, eff. 7-16-14.) |
(305 ILCS 5/11-5.3) Sec. 11-5.3. Procurement of vendor to verify eligibility for assistance under Article V. (a) No later than 60 days after the effective date of this amendatory Act of the 97th General Assembly, the Chief Procurement Officer for General Services, in consultation with the Department of Healthcare and Family Services, shall conduct and complete any procurement necessary to procure a vendor to verify eligibility for assistance under Article V of this Code. Such authority shall include procuring a vendor to assist the Chief Procurement Officer in conducting the procurement. The Chief Procurement Officer and the Department shall jointly negotiate final contract terms with a vendor selected by the Chief Procurement Officer. Within 30 days of selection of an eligibility verification vendor, the Department of Healthcare and Family Services shall enter into a contract with the selected vendor. The Department of Healthcare and Family Services and the Department of Human Services shall cooperate with and provide any information requested by the Chief Procurement Officer to conduct the procurement. (b) Notwithstanding any other provision of law, any procurement or contract necessary to comply with this Section shall be exempt from: (i) the Illinois Procurement Code pursuant to Section 1-10(h) of the Illinois Procurement Code, except that bidders shall comply with the disclosure requirement in Sections 50-10.5(a) through (d), 50-13, 50-35, and 50-37 of the Illinois Procurement Code and a vendor awarded a contract under this Section shall comply with Section 50-37 of the Illinois Procurement Code; (ii) any administrative rules of this State pertaining to procurement or contract formation; and (iii) any State or Department policies or procedures pertaining to procurement, contract formation, contract award, and Business Enterprise Program approval. (c) Upon becoming operational, the contractor shall conduct data matches using the name, date of birth, address, and Social Security Number of each applicant and recipient against public records to verify eligibility. The contractor, upon preliminary determination that an enrollee is eligible or ineligible, shall notify the Department, except that the contractor shall not make preliminary determinations regarding the eligibility of persons residing in long term care facilities whose income and resources were at or below the applicable financial eligibility standards at the time of their last review. Within 20 business days of such notification, the Department shall accept the recommendation or reject it with a stated reason. The Department shall retain final authority over eligibility determinations. The contractor shall keep a record of all preliminary determinations of ineligibility communicated to the Department. Within 30 days of the end of each calendar quarter, the Department and contractor shall file a joint report on a quarterly basis to the Governor, the Speaker of the House of Representatives, the Minority Leader of the House of Representatives, the Senate President, and the Senate Minority Leader. The report shall include, but shall not be limited to, monthly recommendations of preliminary determinations of eligibility or ineligibility communicated by the contractor, the actions taken on those preliminary determinations by the Department, and the stated reasons for those recommendations that the Department rejected. (d) An eligibility verification vendor contract shall be awarded for an initial 2-year period with up to a maximum of 2 one-year renewal options. Nothing in this Section shall compel the award of a contract to a vendor that fails to meet the needs of the Department. A contract with a vendor to assist in the procurement shall be awarded for a period of time not to exceed 6 months.
(e) The provisions of this Section shall be administered in compliance with federal law. (Source: P.A. 101-10, eff. 6-5-19; 101-209, eff. 8-5-19.) |
(305 ILCS 5/11-5.4) Sec. 11-5.4. Expedited long-term care eligibility determination and enrollment. (a) Establishment of the expedited long-term care eligibility determination and enrollment system shall be a joint venture of the Departments of Human Services and Healthcare and Family Services and the Department on Aging. (b) Streamlined application enrollment process; expedited eligibility process. The streamlined application and enrollment process must include, but need not be limited to, the following: (1) On or before July 1, 2019, a streamlined | ||
| ||
(A) Minimize the burden on applicants by | ||
| ||
(B) Integrate online data sources to simplify the | ||
| ||
(C) Provide online prompts to alert the applicant | ||
| ||
(D) Provide training and step-by-step written | ||
| ||
(2) The State must expedite the eligibility process | ||
| ||
(A) Full Medicaid benefits in the community for a | ||
| ||
(B) No transfer of assets or resources during the | ||
| ||
(C) Receives Supplemental Security Income | ||
| ||
(D) For applicants or recipients with verified | ||
| ||
(3) Subject to federal approval, the Department of | ||
| ||
(4) The Department of Human Services must use the | ||
| ||
(c) The Department of Human Services must adopt policies and procedures to improve communication between long-term care benefits central office personnel, applicants and their representatives, and facilities in which the applicants reside. Such policies and procedures must at a minimum permit applicants and their representatives and the facility in which the applicants reside to speak directly to an individual trained to take telephone inquiries and provide appropriate responses.
(d) Effective 30 days after the completion of 3 regionally based trainings, nursing facilities shall submit all applications for medical assistance online via the Application for Benefits Eligibility (ABE) website. This requirement shall extend to scanning and uploading with the online application any required additional forms such as the Long Term Care Facility Notification and the Additional Financial Information for Long Term Care Applicants as well as scanned copies of any supporting documentation. Long-term care facility admission documents must be submitted as required in Section 5-5 of this Code. No local Department of Human Services office shall refuse to accept an electronically filed application. No Department of Human Services office shall request submission of any document in hard copy. (e) Notwithstanding any other provision of this Code, the Department of Human Services and the Department of Healthcare and Family Services' Office of the Inspector General shall, upon request, allow an applicant additional time to submit information and documents needed as part of a review of available resources or resources transferred during the look-back period. The initial extension shall not exceed 30 days. A second extension of 30 days may be granted upon request. Any request for information issued by the State to an applicant shall include the following: an explanation of the information required and the date by which the information must be submitted; a statement that failure to respond in a timely manner can result in denial of the application; a statement that the applicant or the facility in the name of the applicant may seek an extension; and the name and contact information of a caseworker in case of questions. Any such request for information shall also be sent to the facility. In deciding whether to grant an extension, the Department of Human Services or the Department of Healthcare and Family Services' Office of the Inspector General shall take into account what is in the best interest of the applicant. The time limits for processing an application shall be tolled during the period of any extension granted under this subsection. (f) The Department of Human Services and the Department of Healthcare and Family Services must jointly compile data on pending applications, denials, appeals, and redeterminations into a monthly report, which shall be posted on each Department's website for the purposes of monitoring long-term care eligibility processing. The report must specify the number of applications and redeterminations pending long-term care eligibility determination and admission and the number of appeals of denials in the following categories: (A) Length of time applications, redeterminations, | ||
| ||
(B) Percentage of applications and redeterminations | ||
| ||
(C) Status of pending applications, denials, appeals, | ||
| ||
(g) Beginning on July 1, 2017, the Auditor General shall report every 3 years to the General Assembly on the performance and compliance of the Department of Healthcare and Family Services, the Department of Human Services, and the Department on Aging in meeting the requirements of this Section and the federal requirements concerning eligibility determinations for Medicaid long-term care services and supports, and shall report any issues or deficiencies and make recommendations. The Auditor General shall, at a minimum, review, consider, and evaluate the following: (1) compliance with federal regulations on furnishing | ||
| ||
(2) compliance with federal regulations on the timely | ||
| ||
(3) the accuracy and completeness of the report | ||
| ||
(4) the efficacy and efficiency of the task-based | ||
| ||
(5) any issues affecting eligibility determinations | ||
| ||
The Auditor General's report shall include any and all other areas or issues which are identified through an annual review. Paragraphs (1) through (5) of this subsection shall not be construed to limit the scope of the annual review and the Auditor General's authority to thoroughly and completely evaluate any and all processes, policies, and procedures concerning compliance with federal and State law requirements on eligibility determinations for Medicaid long-term care services and supports. (h) The Department of Healthcare and Family Services shall adopt any rules necessary to administer and enforce any provision of this Section. Rulemaking shall not delay the full implementation of this Section. (i) Beginning on June 29, 2018, provisional eligibility for medical assistance under Article V of this Code, in
the form of a recipient identification number and any other necessary credentials to permit an applicant to receive covered services under Article V, must be issued to any applicant who has not received a determination on his or her application for Medicaid and Medicaid long-term care services filed simultaneously or, if already Medicaid enrolled, application for Medicaid long-term care services under Article V of this Code within the federally prescribed timeliness requirements for determinations on such applications. The Department of Healthcare and Family Services must maintain the applicant's provisional eligibility status until a determination is made on the individual's application for long-term care services. The Department of Healthcare and Family Services or the managed care organization, if applicable, must reimburse providers for services rendered during an applicant's provisional eligibility period. (1) Claims for services rendered to an applicant with | ||
| ||
(2) An applicant with provisional eligibility status | ||
| ||
(3) The Department of Healthcare and Family Services, | ||
| ||
(Source: P.A. 101-101, eff. 1-1-20; 101-209, eff. 8-5-19; 101-265, eff. 8-9-19; 101-559, eff. 8-23-19; 102-558, eff. 8-20-21.) |
(305 ILCS 5/11-5.5) Sec. 11-5.5. Streamlining enrollment into the Medicare Savings Program. (a) The Department shall investigate how to align the Medicare Part D Low-Income Subsidy and Medicare Savings Program eligibility criteria. (b) The Department shall issue a report making recommendations on how to streamline enrollment into Medicare Savings Program benefits by July 1, 2022. (c) Within 90 days after issuing its report, the Department shall seek public feedback on those recommendations and plans. (d) By July 1, 2023, the Department shall implement the necessary changes to streamline enrollment into the Medicare Savings Program. The Department may adopt any rules necessary to implement the provisions of this paragraph.
(Source: P.A. 102-1037, eff. 6-2-22.) |
(305 ILCS 5/11-6) (from Ch. 23, par. 11-6)
Sec. 11-6. Decisions on applications. Within 10 days after a decision is
reached on an application, the applicant
shall be notified in writing of the decision. If the applicant resides in a facility licensed under the Nursing Home Care Act or a supportive living facility authorized under Section 5-5.01a, the facility shall also receive written notice of the decision, provided that the notification is related to a Department payment for services received by the applicant in the facility. Only facilities enrolled in and subject to a provider agreement under the medical assistance program under Article V may receive such notices of decisions. The Department shall
consider eligibility for, and the notice shall contain a decision on, each
of the following assistance programs for which the client may be
eligible based on the information contained in the application: Temporary
Assistance for Needy Families, Medical Assistance, Aid to the Aged, Blind
and Disabled, General Assistance (in the City of Chicago), and food stamps. No
decision shall be required for any
assistance program for which the applicant has expressly declined in
writing to apply. If the applicant is determined to
be eligible, the notice shall include a statement of the
amount of financial aid to be provided and a statement of the reasons for
any partial grant amounts. If the applicant is determined
ineligible for any public assistance the notice shall include the reason
why the applicant is ineligible. If the application for any public
assistance is denied, the notice shall include a statement defining the
applicant's right to appeal the decision.
The Illinois Department, by rule, shall determine the date on which
assistance shall begin for applicants determined eligible. That date may be
no later than 30 days after the date of the application.
Under no circumstances may any application be denied solely to meet an
application-processing deadline. As used in this Section, "application" also refers to requests for admission approval to facilities licensed under the Nursing Home Care Act or to supportive living facilities authorized under Section 5-5.01a.
(Source: P.A. 100-665, eff. 8-2-18; 100-863, eff. 8-14-18.)
|
(305 ILCS 5/11-6.1) (from Ch. 23, par. 11-6.1)
Sec. 11-6.1.
Report of loss.
(a) (Blank).
(b) (Blank).
(c) The payee of a grant under this Code shall immediately report to the
Illinois Department the theft or other loss of any instrument used in
making a grant payment.
(Source: P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-6.2)
Sec. 11-6.2.
Electronic fingerprinting.
(a) The Illinois Department may implement a program to
prevent multiple enrollments of aid
recipients through the use of an electronic automated 2-digit fingerprint
matching
identification system in local offices.
The Illinois Department shall apply for any federal waivers or approvals
necessary to conduct this program.
(b) The fingerprints or their electronic representations collected and
maintained through the use of an automated
fingerprint matching identification system as authorized by this Section may
not be used, disclosed, or redisclosed for any purpose other than the
prevention of multiple enrollments of aid recipients, may not be used or
admitted in any criminal or civil investigation, prosecution, or proceeding,
other than a proceeding pursuant to Article VIII-A, and may not be disclosed in
response to a subpoena or other compulsory legal process or warrant or upon the
request or order of any agency, authority, division, office, or other private
or public entity or person, except that nothing contained in this subsection
prohibits disclosure in response to a subpoena issued by or on behalf of the
applicant or recipient who is the subject of
the record maintained as a part of the system. A person who knowingly makes
or obtains any unauthorized disclosure of data collected and maintained under
this Section through the use of an automated fingerprint matching
identification system is guilty of a Class A misdemeanor.
Data collected and maintained on the automated fingerprint matching
identification system shall be subject to the provisions of this Code relating
to unauthorized disclosure of confidential client information.
(c)
The system shall include the use of a photographic identification for every aid
recipient. The Illinois Department shall
insure that adequate training for county department
staff involved with the program will be provided.
(d) The assistance programs affected by the electronic fingerprinting
program shall be determined by rule. By applying or
maintaining
eligibility for those assistance programs,
applicants
and recipients must submit
to the electronic collection of their fingerprints as an additional method of
establishing eligibility. Applicants for and recipients of aid who fail to
submit to electronic fingerprinting shall be declared ineligible for those
assistance programs.
(e) This Section does not authorize or permit the termination, suspension,
or
diminution of aid except as elsewhere specifically authorized in this Code. If a proposed sanction is based on the use of an automated fingerprint matching
identification
system authorized pursuant to this Section, the sanction may not be imposed
unless the Illinois Department has verified the multiple
enrollment through an independent investigation.
(f) The Illinois Department shall conduct periodic audits to monitor
compliance with all laws and regulations regarding the automated fingerprint
matching identification system to insure that: (i) any records maintained
as part of the system are accurate and complete; (ii) effective software and
hardware designs
have been instituted with security features to prevent unauthorized access to
records; (iii) access to record information system facilities, systems
operating
environments, and data file contents, whether while in use or when stored in
a media library, is restricted to authorized personnel; (iv) operational
programs are used that will prohibit inquiry, record updates, or destruction of
records from any terminal
other than automated fingerprint matching identification system terminals that
are so designated; (v) operational programs are used to detect and store for
the output of designated Illinois Department and county department employees
all
unauthorized attempts to penetrate any electronic automated fingerprint
matching
identification system, program, or file; and (vi) adequate and timely
procedures exist
to insure
the recipient's or applicant's right to access and review of records for the
purpose of accuracy and completeness, including procedures for review of
information maintained about those individuals and for administrative review
(including procedures for administrative appeal) and necessary correction of
any claim by the individual to whom the information relates that the
information is inaccurate or incomplete.
(Source: P.A. 90-17, eff. 6-19-97; 91-599, eff. 8-14-99.)
|
(305 ILCS 5/11-7) (from Ch. 23, par. 11-7)
Sec. 11-7. Notice of decisions to terminate aid - determination and
notice of other medical assistance available - additional notice in cases
of blind persons.
Whenever decision is made to terminate aid, the recipient shall be
notified in writing within 10 days following the decision. The notice shall
set out the specific reasons for the termination. In the case of a blind
person, the notice and statement of reasons shall be sent whenever aid is
withdrawn, suspended, revoked, or in any way changed. In the case of a recipient who resides at a long-term care facility, the notice and statement of reasons shall be sent to the recipient and to the long-term care facility.
The notice shall include a statement defining the recipient's right to
appeal.
Before any notice to terminate medical assistance is issued, the
Illinois Department shall determine whether the recipient is newly eligible
for any other medical assistance offered by the Illinois Department. For
all recipients found eligible as a result of this determination for other
medical assistance offered by the Illinois Department, the Illinois
Department shall provide other medical assistance effective as of the date
of the termination of the prior medical assistance.
(Source: P.A. 101-100, eff. 1-1-20 .)
|
(305 ILCS 5/11-8) (from Ch. 23, par. 11-8)
Sec. 11-8. Appeals - to whom taken. Applicants or recipients of aid
may, at any time within 60 days after the decision of the County
Department or local governmental unit, as the case may be, appeal a
decision denying or terminating aid, or granting aid in an amount which
is deemed inadequate, or changing, cancelling, revoking or suspending
grants as provided in Section 11-16, or determining to make a protective
payment under the provisions of Sections 3-5a or 4-9, or a decision by an
administrative review board to impose administrative safeguards as provided
in Section 8A-8. An appeal shall also lie when an application is not acted
upon within the time period after filing of the application as provided by rule
of the Illinois Department.
If an appeal is not made, the action of the County Department or
local governmental unit shall be final.
Appeals by applicants or recipients under Articles III, IV, or V
shall be taken to the Illinois Department.
Appeals by applicants or recipients under Article VI shall be taken
as follows:
(1) In counties under township organization (except | ||
| ||
(2) In counties in excess of 3,000,000 population and | ||
| ||
(3) In counties described in paragraph (2) appeals of | ||
| ||
(4) In counties not under township organization, | ||
| ||
In counties designated in paragraph (1) the Chairman or President of
the County Board shall appoint, with the advice and consent of the
county board, one or more alternate members of the Public Aid Committee.
All regular and alternate members shall be Supervisors of General
Assistance. In any appeal involving a local governmental unit whose
Supervisor of General Assistance is a member of the Committee, he shall
be replaced for that appeal by an alternate member designated by the
Chairman or President of the County Board, with the advice and consent
of the county board. In these counties not more than 3 of the 5 regular
appointees shall be members of the same political party unless the
political composition of the Supervisors of the General Assistance
precludes such a limitation. In these counties at least one member of the
Public Aid Committee shall be a person knowledgeable in the area of general
assistance and the regulations of the Illinois Department pertaining
thereto. If no member of the Committee possesses such knowledge, the
Illinois Department shall designate an employee of the Illinois Department
having such knowledge to be present at the Committee hearings to advise
the Committee.
In every county the County Board shall provide facilities for the
conduct of hearings on appeals under Article VI. All expenses incident
to such hearings shall be borne by the county except that in counties
under township organization in which the governing authority is a Board
of Commissioners (1) the salary and other expenses of the Commissioner
of Appeals shall be paid from General Assistance funds available for
administrative purposes, and (2) all expenses incident to such hearings
shall be borne by the township and the per diem and traveling expenses
of the township supervisors serving on the Public Aid Committee shall be
fixed and paid by their respective townships. In all other counties the
members of the Public Aid Committee shall receive the compensation and
expenses provided by law for attendance at meetings of the County Board.
In appeals under Article VI involving a governmental unit receiving
State funds, the Public Aid Committee and the Commissioner of Appeals
shall be bound by the rules and regulations of the Illinois Department
which are relevant to the issues on appeal, and shall file such reports
concerning appeals as the Illinois Department requests.
The members of each Public Aid Committee and the members of the Cook
County Townships Public Aid Committee are immune from personal liability in connection with their service on the committee to the same extent as an elected or appointed judge in this State is immune from personal liability in connection with the performance of his or her duties as judge. This immunity applies only to causes of action accruing on or after the effective date of this amendatory Act of the 94th General Assembly.
An appeal shall be without cost to the appellant and shall be made, at
the option of the appellant, either upon forms provided and prescribed by
the Illinois Department or, for appeals to a Public Aid Committee, upon
forms prescribed by the County Board; or an appeal may be made by calling a
toll-free number provided for that purpose by the Illinois Department and
providing the necessary information. The Illinois Department may assist
County Boards or a Commissioner of Appeals in the preparation of appeal
forms, or upon request of a County Board or Commissioner of Appeals may
furnish such forms. County Departments and local governmental units shall
render all possible aid to persons desiring to make an appeal. The
provisions of Sections 11-8.1 to 11-8.7, inclusive, shall apply to all
such appeals.
(Source: P.A. 93-295, eff. 7-22-03; 94-524, eff. 8-10-05.)
|
(305 ILCS 5/11-8.1) (from Ch. 23, par. 11-8.1)
Sec. 11-8.1.
Appellants' rights.
(a) Upon receipt of an appeal the Illinois Department, Public Aid
Committee, or Commissioner of Appeals, as the case may be, shall review the
case. The appellant shall be entitled to appear in person and to be
represented by counsel. He shall be afforded an opportunity to present all
relevant matter in support of his claim for aid, or his objection to (a)
termination of aid, or (b) the amount of aid, or (c) a determination to
make a protective payment.
(b) Whenever any applicant appeals the denial of any application for
assistance and the reason for denial is due to the failure of the
applicant to comply with procedural requirements, including but not limited
to, failure to keep an appointment, failure to produce acceptable proof of
eligibility, or failure to request more time or assistance in obtaining
acceptable proof of eligibility, the denial shall be rescinded if at any
time before the decision on the appeal is made, the appellant complies with the
procedural requirements that caused the denial and all other requirements
necessary to process the application. When the denial is rescinded under
this subsection, the Illinois Department shall grant or deny the application
based upon all relevant substantive eligibility factors and issue a new
decision. If the application is approved, cash assistance shall begin
effective 30 calendar days after the original application date and the
starting date of all other assistance shall begin based on the original
application date.
(Source: P.A. 87-630.)
|
(305 ILCS 5/11-8.2) (from Ch. 23, par. 11-8.2)
Sec. 11-8.2.
Venue; depositions.
The appeal shall be heard in the county where the appellant resides.
However, if the appellant is outside the State, the Illinois Department,
Public Aid Committee, or Commissioner of Appeals, as the case may be, may
take depositions from him and his witnesses or permit the appellant to present
all relevant matter in support of his claim through witnesses acting in his
behalf, or both by deposition or by testimony of witnesses, depending upon
the circumstances in each case.
Hearings under this Section and Section 11-8.1 may be conducted with
some or all of the parties, including the hearing officer, at different
locations connected with each other by telephone.
(Source: P.A. 87-860.)
|
(305 ILCS 5/11-8.3) (from Ch. 23, par. 11-8.3)
Sec. 11-8.3.
Hearing officers - Subpoenas.
Any qualified officer or employee
of the Illinois Department, a
County Board, or member of the staff of a Commissioner of Appeals, as
the case may be, designated in writing to so act by the Director of the
Department, Chairman or President of the County Board, or Commissioner
of Appeals, may conduct hearings on appeals and may compel, by subpoena,
the attendance and testimony of witnesses and the production of books
and papers, and administer oaths to witnesses. Wherever feasible, the
Public Aid Committee shall itself conduct hearings on appeals by
applicants for or recipients of aid under Article VI. No person
shall be compelled to attend a hearing at a place outside the county in
which he resides. Subpoenas may be served as provided for in civil
actions. The fees of witnesses for attendance and travel shall be the
same as the fees of witnesses before the circuit court and shall be paid
as an expense of administration of the County Department or the local
governmental unit, as the case may be.
If a witness refuses to attend or testify, or to produce books or
papers, concerning any matter upon which he might be lawfully examined,
the circuit court of the county wherein the hearing is held, upon
application of the Illinois Department, Public Aid Committee, or
Commissioner of Appeals, as the case may be, may compel obedience by
proceedings as for contempt as in case of a like refusal to obey a
similar order of the court.
(Source: P.A. 81-1085.)
|
(305 ILCS 5/11-8.4) (from Ch. 23, par. 11-8.4)
Sec. 11-8.4.
Hearings not bound by technical rules of evidence or procedure.
The Illinois Department, Public Aid Committees and Commissioner of
Appeals shall not be bound by common law or statutory rules of evidence, or
by technical or formal rules of procedure, but shall conduct their hearings
in such manner as seems best calculated to conform to substantial justice
and the spirit of this Code. They may make such additional investigation as
they may deem necessary, and shall make such decision as to the granting of
aid and the amounts thereof as in their opinion is justified and in
conformity with this Code.
(Source: Laws 1967, p. 2302.)
|
(305 ILCS 5/11-8.5) (from Ch. 23, par. 11-8.5)
Sec. 11-8.5.
(Repealed).
(Source: Laws 1967, p. 122. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-8.6) (from Ch. 23, par. 11-8.6)
Sec. 11-8.6.
Decision - time and effect.
A decision on appeal shall be
given to the interested parties within 90 days from the date of the filing of
the appeal, unless additional time is required for a proper disposition of the
appeal. All decisions on appeals shall be binding upon and complied with by
the County Departments and local governmental units.
(Source: P.A. 90-17, eff. 7-1-97.)
|
(305 ILCS 5/11-8.7) (from Ch. 23, par. 11-8.7)
Sec. 11-8.7.
Judicial review.
The provisions of the Administrative Review
Law, as amended, and the rules
adopted pursuant thereto, shall apply to
and govern all proceedings for the judicial review of final
administrative decisions of the Illinois Department on appeals by
applicants or recipients under Articles III, IV, or V. The term
"administrative decision" is defined as in Section 3-101 of the Code of Civil
Procedure.
(Source: P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-9) (from Ch. 23, par. 11-9)
Sec. 11-9. Protection of records; exceptions. For the protection of applicants and recipients, the Illinois Department,
the county departments and local governmental units and their respective
officers and employees are prohibited, except as hereinafter provided, from
disclosing the contents of any records, files, papers and communications,
except for purposes directly connected with the administration of public
aid under this Code.
In any judicial proceeding, except a proceeding directly concerned with
the administration of programs provided for in this Code, such records,
files, papers and communications, and their contents shall be deemed
privileged communications and shall be disclosed only upon the order of the
court, where the court finds such to be necessary in the interest of justice.
The Illinois Department shall establish and enforce reasonable rules and
regulations governing the custody, use and preservation of the records,
papers, files, and communications of the Illinois Department, the county
departments and local governmental units receiving State or Federal funds
or aid. The governing body of other local governmental units shall in like
manner establish and enforce rules and regulations governing the same matters.
The contents of case files pertaining to recipients under Articles IV, V,
and VI shall be made available without subpoena or formal notice to the
officers of any court, to all law enforcement agencies, and to such other persons
or
agencies as from time to time may be authorized by any court.
In particular, the contents of those case files shall be made available upon
request to a law enforcement agency for the purpose of determining the current
address of a recipient with respect to whom an arrest warrant is outstanding,
and
the current address of a recipient who was a victim of a felony or a
witness to a felony shall be made available upon
request to a State's Attorney of this State or a State's Attorney's
investigator. Information shall also be disclosed to
the Illinois State Scholarship
Commission pursuant to an investigation or audit by the Illinois State
Scholarship Commission of a delinquent student loan or monetary award.
This Section does not prevent the Illinois Department and local governmental
units from reporting to appropriate law enforcement officials the desertion
or abandonment by a parent of a child, as a result of which financial aid
has been necessitated under Articles IV, V, or VI, or reporting
to
appropriate law enforcement officials instances in which a mother under
age 18 has a child out of wedlock and is an applicant for or recipient of
aid under any Article of this Code. The Illinois Department may provide
by rule for the county departments and local governmental units to initiate
proceedings under the Juvenile Court Act of 1987 to have children declared
to be neglected when they deem
such action necessary to protect the children from immoral influences
present in their home or surroundings.
This Section does not preclude the full exercise of the powers of the Board
of Public Aid Commissioners to inspect records and documents, as provided
for all advisory boards pursuant to Section 5-505 of the
Departments of State Government Law (20 ILCS 5/5-505).
This Section does not preclude exchanges of information among the Department of Healthcare and Family Services (formerly Illinois
Department of Public Aid), the Department of Human Services (as successor to the
Department of Public Aid), and the Illinois Department of Revenue for the
purpose of verifying sources and amounts of income and for other purposes
directly connected with the administration of this Code and of the Illinois
Income Tax Act.
The provisions of this Section and of Section 11-11 as they apply to
applicants and recipients of public aid under Article V shall
be operative only to the extent that they do not conflict with any Federal
law or regulation governing Federal grants to this State for such programs.
The Department of Healthcare and Family Services and the Department of Human Services
(as successor to the Illinois Department of Public Aid) shall enter into an
inter-agency agreement with the
Department of Children and Family Services to establish a procedure by which
employees of the Department of Children and Family Services may have immediate
access to records,
files, papers, and communications (except medical, alcohol or drug assessment
or treatment, mental health, or any other medical records) of the Illinois
Department, county
departments, and local governmental units receiving State or federal funds or
aid, if the Department of Children and Family Services determines the
information is necessary to perform its duties under the Abused and Neglected
Child Reporting Act, the Child Care Act of 1969, and the Children and Family
Services Act.
(Source: P.A. 100-201, eff. 8-18-17.)
|
(305 ILCS 5/11-10) (from Ch. 23, par. 11-10)
Sec. 11-10.
Names
furnished other agencies.
Whenever, under provisions of law, names and addresses of recipients of
public aid are furnished to or held by any other agency or department of
government, the agency or department of government shall adopt regulations
necessary to prevent the publication of lists thereof or their use for
purposes not directly connected with the administration of this Code, except
that lists of that information shall be made available upon request to a law
enforcement agency for the purpose of determining the current address of a
recipient with respect to whom an arrest warrant is outstanding as provided in
Section 11-9.
(Source: P.A. 89-583, eff. 1-1-97.)
|
(305 ILCS 5/11-12) (from Ch. 23, par. 11-12)
Sec. 11-12.
Penalty for publication, use for political or commercial purposes.
It is unlawful to use or publish any names or list of names of
recipients secured from records maintained in the offices of the county
departments or local governmental units except in conformity with
regulations adopted by the Illinois Department.
It is unlawful, for commercial or political purposes of any nature, for
any person, body, association, firm, corporation, or other agency to
solicit, receive, make use of, or to authorize, knowingly permit,
participate in or acquiesce in the use of, any lists of names of, or any
information concerning, persons applying for or receiving public aid,
directly or indirectly derived from the records, papers, files, or
communications of the Illinois Department, the county departments, or local
governmental units, or acquired in the course of performance of official
duties. A violation of this Section shall constitute a Class B misdemeanor.
(Source: P.A. 77-2344.)
|
(305 ILCS 5/11-13) (from Ch. 23, par. 11-13)
Sec. 11-13. Conditions For Receipt of Vendor Payments - Limitation Period
For Vendor Action - Penalty For Violation. A vendor payment, as defined in
Section 2-5 of Article II, shall constitute payment in full for the goods
or services covered thereby. Acceptance of the payment by or in behalf of
the vendor shall bar him from obtaining, or attempting to obtain,
additional payment therefor from the recipient or any other person. A
vendor payment shall not, however, bar recovery of the value of goods and
services the obligation for which, under the rules and regulations of the
Illinois Department, is to be met from the income and resources available
to the recipient, and in respect to which the vendor payment of the
Illinois Department or the local governmental unit represents
supplementation of such available income and resources.
Vendors seeking to enforce obligations of a governmental unit or the
Illinois Department for goods or services (1) furnished to or in behalf of
recipients and (2) subject to a vendor payment as defined in Section 2-5,
shall commence their actions in the appropriate Circuit Court or the Court
of Claims, as the case may require, within one year next after the cause of
action accrued.
A cause of action accrues within the meaning of this Section upon the following date:
(1) If the vendor can prove that he submitted a bill | ||
| ||
(2) If the vendor cannot prove that he submitted a | ||
| ||
In the case of long term care facilities, where the Illinois Department initiates the monthly billing process for the vendor, the cause of action shall accrue 12 months after the last day of the month the service was rendered. This paragraph governs only vendor payments as
defined in this Code and as limited by regulations of the Illinois
Department; it does not apply to goods or services purchased or contracted
for by a recipient under circumstances in which the payment is to be made
directly by the recipient.
Any vendor who accepts a vendor payment and who knowingly obtains or
attempts to obtain additional payment for the goods or services covered by
the vendor payment from the recipient or any other person shall be guilty
of a Class B misdemeanor.
(Source: P.A. 97-689, eff. 6-14-12.)
|
(305 ILCS 5/11-14) (from Ch. 23, par. 11-14)
Sec. 11-14.
Voluntary repayments.
A recipient or former recipient of financial aid under this Code, or a
responsible relative or other person in behalf of the recipient or former
recipient may voluntarily repay all or part of the financial aid rendered
to him and in respect to which repayment was not required by this Code or
other laws of this State.
Repayments may be made to the County Department or to the local
governmental unit which rendered the financial aid. If there is more than
one such local governmental unit, the repayment may be made to any one of
such governmental units and the local governmental unit to which the
repayment is made shall transmit to the other unit or units a proportionate
share of the repayment which shall be in the ratio of the assistance
rendered by each unit to the total assistance rendered by all units.
The fact of such voluntary repayment and the amount thereof shall be
duly entered on the public aid disbursement record, and in the case record
of the recipient if available, and designated in such manner as will
clearly distinguish such repayment as made voluntarily and without
compulsion.
Voluntary repayments to County Departments shall be paid into the
general fund in the State Treasury, or into such other fund as may be
established by law for such voluntary repayments. Repayments to local
governmental units shall be paid into the general assistance fund of the
governmental unit or other special fund into which general assistance
moneys of the local governmental unit are paid.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/11-14.5)
Sec. 11-14.5.
Overpayment; recovery.
If an applicant or recipient receives
any form of public aid from the Illinois Department or a local governmental
unit to which he or she is not
entitled, the Illinois Department or local governmental unit may determine
that the applicant or recipient
has received an overpayment of public aid. The Illinois Department may
determine that an overpayment has been received regardless of any determination
of the cause of the overpayment, including but not limited to a determination
that the overpayment was caused by an error of the Illinois Department or
local governmental unit. The
Illinois Department or local governmental unit may attempt to recover the
overpayment by recoupment from
future assistance payments or food stamps or any other legal means consistent
with State and federal law.
(Source: P.A. 89-673, eff. 8-14-96; 90-517, eff. 8-22-97.)
|
(305 ILCS 5/11-15) (from Ch. 23, par. 11-15) Sec. 11-15. Application requirements. (1) An application for financial aid shall be filed in writing by the person requesting aid and, in the case of a request for family aid, by the head of that family, except as otherwise permitted in paragraph (2). Applications for aid under Articles III, IV, and V shall be filed in writing with any local office of the Department of Human Services in the manner prescribed by the Department. Applications for aid under Article VI shall be filed in writing with the local governmental unit upon forms approved by the Department. Each applicant shall provide information as to the amount of property, real and personal, owned by him or her within the period of time preceding the application as required under Sections 3-1.3, 4-1.11, and 5-2.1 of this Code. The applicant shall also furnish information concerning all income, money contributions, and other support from any source, and the beneficiary and the amount or cash surrender or loan value of all insurance policies held by himself or herself or any member of his family for whom aid is requested. (2) An application, in all instances to be in writing, may be filed in behalf of a person considered to be in need of financial aid under Articles III, IV, V, or VI only if the person (a) has been adjudged to be under legal disability; or (b) is unable because of minority or physical or | ||
| ||
(c) in the case of need for funeral and burial, died | ||
| ||
Applications in behalf of persons specified in (a) and (b) shall be filed by the applicant's legal guardian or, if a guardian has not been appointed or the applicant has no legal guardian or the guardian is not available, by a relative or other person, acceptable under the rules of the Illinois Department, who is able to furnish the required information. Applications in behalf of persons specified in (c) shall be filed by any next of kin of the deceased who is not under legal disability or, if there are no such next of kin or they are unknown or unavailable, by a person, acceptable under the rules of the Illinois Department, who is able to furnish the required information. Notwithstanding any other provision of this paragraph (2), a minor may sign and file an application on the minor's own behalf if the application is for the Article V family planning program established under Section 5-5 by Public Act 102-665. (3) The application shall contain a written declaration to be signed by the applicant, or in behalf of the applicant by a person qualified under paragraph (2), in substantially the following form, the parenthetical references being applicable to an application filed by a person in behalf of the applicant: "I declare under penalties of perjury that I have examined this form and all accompanying statements or documents pertaining to the income and resources of myself (the applicant) or any member of my family (the applicant's family) included in this application for aid, or pertaining to any other matter having bearing upon my (the applicant's) eligibility for aid, and to the best of my knowledge and belief the information supplied is true, correct, and complete". (4) If an application for financial aid is filed for a family, and any person in that family is under 18 years of age, the application shall be accompanied by the following for each such person under 18 years of age: (i) a copy of the person's birth certificate, or (ii) other reliable proof, as determined by the | ||
| ||
The Illinois Department shall provide information to all families, orally by an intake worker and in writing when the application is filed, about the availability and location of immunization services. (5) Once an applicant is determined eligible for aid, he or she has the right to request to have the case transferred to another local office of the Department of Human Services for his or her convenience based on one of the following factors: the location of his or her employer; the location of his or her child care provider; access to reliable transportation; or the location of a social service provider that he or she sees on a regular basis. Within 5 business days after the request for transfer, the Department shall transfer the case, assign a caseworker, make appropriate entries in the computer system, and issue a written notice to the recipient that includes the name of and contact information for the caseworker. The location of the recipient's case may be reconsidered on the recipient's request or at the time of redetermination of eligibility. (Source: P.A. 103-786, eff. 8-7-24.) |
(305 ILCS 5/11-16) (from Ch. 23, par. 11-16)
Sec. 11-16. Changes in grants; cancellations, revocations, suspensions.
(a) All grants of financial aid under this Code shall be considered as
frequently as may be required by the rules of the Illinois Department.
The Department of Healthcare and Family Services shall consider grants of financial aid to
children who are eligible under Article V of this Code at least annually and
shall take into account those reports filed, or required to be filed, pursuant
to Sections 11-18 and 11-19.
After such investigation as may be necessary, the amount and manner of
giving aid may be changed or the aid may be entirely withdrawn if the
County Department, local governmental unit, or Illinois Department finds
that the recipient's circumstances have altered sufficiently to warrant
such action. Financial aid may at any time be canceled or revoked for cause
or suspended for such period as may be proper.
(b) Whenever any such grant of financial aid is cancelled, revoked,
reduced, or terminated because of the failure of the recipient to cooperate
with the Department, including but not limited to the failure to keep an
appointment, attend a meeting, or produce proof or verification of
eligibility or need, the grant shall be reinstated in full, retroactive to
the date of the change in or termination of the grant, provided that within
10 working days after the first day the financial aid would have been
available, the recipient cooperates with the Department and is not
otherwise ineligible for benefits for the period in question. This
subsection (b) does not apply to sanctions imposed for the failure of any
recipient to participate as required in the child support enforcement
program or in any educational, training, or employment program under this
Code or any other sanction under Section 4-21, nor does this subsection (b)
apply to any cancellation, revocation,
reduction, termination, or sanction imposed for the failure of any recipient to
cooperate in the monthly reporting process or the quarterly reporting
process.
(Source: P.A. 95-331, eff. 8-21-07.)
|
(305 ILCS 5/11-17) (from Ch. 23, par. 11-17)
Sec. 11-17.
Duplication or supplementation of aid prohibited-Exceptions.
Except (1) for Medical Assistance provided under Article V, or (2)
when necessary to accomplish the purposes of this Code, where not
inconsistent therewith, and subject to the rules of the Illinois
Department, a person receiving aid under any one of Articles III, IV, or VI of
this Code shall not at the same time receive aid under any other
of such Articles or any other financial aid from the State, any political
subdivision thereof, or any municipal corporation therein.
(Source: P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-18) (from Ch. 23, par. 11-18)
Sec. 11-18.
Duty
to report changes in circumstances.
It is the duty of every applicant and recipient to notify promptly the
county department or the supervisor of general assistance, as the case may
be, of any change of status with respect to his property, or need, or
family composition, amount of income, money contributions and other
support, from whatever source, occurring, in the case of an applicant,
between the time of his filing an application for financial aid and the
issuance of the grant, and, in the case of a recipient, occurring at any
time during the period that he receives financial aid.
If an applicant or recipient fails to give prompt notice of changes in
his circumstances, and as a result financial aid is given to which he is
not entitled, he shall be liable to the county department or to the local
governmental unit, as the case may be, for refunding a sum of money up to
but not in excess of the entire amount of financial aid provided. Unless
the refund is made the amount may be recovered in a civil action.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/11-19) (from Ch. 23, par. 11-19)
Sec. 11-19.
Reports by recipients.
Every recipient who is of legal age, and every grantee of record of aid
provided for a minor recipient, shall file
with the county department or the local governmental unit, as the case may
be, a statement in respect to any change occurring in his status since his
application was made or the filing of his last such report, whichever is
applicable. The report shall set out any changes occurring in respect to
his property or need, family composition, amount of income, money
contributions or other support, from whatever source.
Such reports shall be required to be filed as often as may be specified
by rule, and the required frequency of such reports may vary by program,
geographic area, condition of employment, or such other differentiation as
may be specified by rule.
The Illinois Department may require that information in the reports filed
under this Section include a child immunization history for recipients age 6
and under not attending school. For recipients who report that they have not
obtained the immunizations in accordance with recommended schedules, the
Illinois Department shall respond by providing information about the
availability and location of immunization services and shall transmit the
immunization history information to the Healthy Kids Program administered under
Section 5-19 of this Code.
(Source: P.A. 88-342.)
|
(305 ILCS 5/11-20) (from Ch. 23, par. 11-20)
Sec. 11-20. Employment registration; duty to accept employment. This
Section applies to employment and training
programs other than those for recipients of assistance under Article IV.
(1) Each applicant or recipient and dependent member of
the family age 16 or over who is able to engage in employment and who is
unemployed, or employed for less than the full working time for the occupation
in which he or she is engaged, shall maintain a current registration for
employment or additional employment with the system of free public employment
offices maintained in this State by the State Department of Employment
Security under the Public Employment Office Act and shall utilize the job
placement
services and other facilities of such offices unless the Illinois
Department otherwise provides by rule for programs administered by the
Illinois Department.
(2) Every person age 16 or over shall be deemed "able to engage in
employment", as that term is used herein, unless (a) the person has an
illness certified by the attending practitioner as precluding his or her
engagement in employment of any type for a time period stated in the
practitioner's certification; or (b) the person has a medically determinable
physical or mental impairment, disease or loss of indefinite duration and
of such severity that he or she cannot perform labor or services in any
type of gainful work which exists in the national economy, including work
adjusted for persons with physical or mental disabilities; or (c) the person
is among the classes of persons exempted by paragraph 5 of this Section.
A person described in clauses (a), (b) or (c) of the preceding sentence
shall be classified as "temporarily unemployable". The Illinois Department
shall provide by rule for periodic review of the circumstances of persons
classified as "temporarily unemployable".
(3) The Illinois Department shall provide through rules and regulations
for sanctions against applicants and recipients of aid under this Code
who fail or refuse to cooperate, without good cause, as defined by rule of
the Illinois Department, to accept a bona fide offer of employment in which
he or she is able to engage either in the community of the person's
residence or within reasonable commuting distance therefrom.
The Illinois Department may provide by rule for the grant or continuation
of aid for a temporary period, if federal law or regulation so permits or
requires, to a person who refuses employment without good cause if he or
she accepts counseling or other services designed to increase motivation
and incentives for accepting employment.
(4) Without limiting other criteria which the Illinois Department may
establish, it shall be good cause of refusal if
(a) the wage does not meet applicable minimum wage | ||
| ||
(b) there being no applicable minimum wage as | ||
| ||
(c) acceptance of the offer involves a substantial | ||
| ||
(5) The requirements of registration and acceptance of employment shall
not apply (a) to a parent or other person needed at home
to provide personal care and supervision to a child or children unless,
in accordance with the rules and regulations of the Illinois Department,
suitable arrangements have been or can be made for such care and
supervision
during the hours of the day the parent or other person is out of the home
because of employment; (b) to a person age 16 or over in regular attendance
in school, as defined in Section 4-1.1; or (c) to a person whose presence
in the home on a substantially continuous basis is required because of the
illness or incapacity of another member of the household.
(Source: P.A. 99-143, eff. 7-27-15.)
|
(305 ILCS 5/11-20.1) (from Ch. 23, par. 11-20.1)
Sec. 11-20.1. Employment; Rights of recipient and obligations of
Illinois Department when recipients become employed; Assistance when
a recipient has employment or earned income or both. (a) When a recipient reports employment or earned income, or both, or
the Illinois Department otherwise learns of a recipient's employment or
earned income, or both, the Illinois Department shall provide the recipient
with:
(1) An explanation of how the earned income will | ||
| ||
(2) An explanation of the Work Pays budgeting | ||
| ||
(3) An explanation of how the earned income will | ||
| ||
(4) The names and telephone numbers of all | ||
| ||
(5) An explanation of the recipient's | ||
| ||
(6) If the recipient will continue to receive a | ||
| ||
(7) An explanation of Kidcare, Family Assist, Family | ||
| ||
(8) An explanation of the medical assistance the | ||
| ||
(9) An explanation of the availability of a child | ||
| ||
(10) (Blank).
(11) (Blank).
(11a) (Blank).
(12) (Blank).
(13) An explanation of the availability of payment | ||
| ||
(14) An explanation of the job retention component | ||
| ||
(15) A statement of the types of assistance that will | ||
| ||
(16) If the recipient will not continue to receive a | ||
| ||
(17) An explanation of the availability of payments | ||
| ||
(18) If the recipient will not continue to receive a | ||
| ||
(19) An explanation of the earned income tax credit | ||
| ||
(20) An explanation of the education and training | ||
| ||
(b) The information listed in subsection (a) shall be provided to the
recipient on an individual basis during an in-person meeting with a
representative of the Illinois Department. The individual in-person
meeting shall be held at a time which does not conflict with the
recipient's work schedule within 30 days of the date the recipient begins
working. If the recipient informs the Illinois Department that an
in-person meeting would be inconvenient, the Illinois Department may
provide the information during a home visit, by telephone, or by mail
within 30 days of the date the recipient begins working, whichever the
client prefers.
(c) At the conclusion of the meeting described in subsection (b), the
Illinois Department shall ensure that all case transfers and calculations
of benefits necessitated by the recipient's employment or receipt of earned
income have been performed, that applications have been made or provided
for all benefits for which the person must apply or reapply, and that the
person has received payment for initial expenses of employment.
(d) In food stamp cases in which an applicant or recipient reports earned income, the applicant's or recipient's employment shall be presumed to be a hardship for purposes of scheduling an in-person meeting with a
representative of the Illinois Department and an in-person meeting shall be waived. (Source: P.A. 96-867, eff. 1-1-11 .)
|
(305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
Sec. 11-22. Charge upon claims and causes of action for injuries. The Illinois Department shall have a charge upon all claims, demands and
causes of action for injuries to an applicant for or recipient of (i)
financial aid under Articles III, IV, and V, (ii) health care benefits provided under the Covering ALL KIDS Health Insurance Act, or (iii) health care benefits provided under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008 for the total
amount of
medical assistance provided the recipient from the time of injury to the
date of recovery upon such claim, demand or cause of action. In addition, if
the applicant or recipient was employable, as defined by the Department, at
the time of the injury, the Department shall also have a charge upon any
such claims, demands and causes of action for the total amount of aid
provided to the recipient and his
dependents, including all cash assistance and medical assistance
only to the extent includable in the claimant's action, from the
time of injury to the date of recovery upon such
claim, demand or cause of action. Any definition of "employable"
adopted by the Department shall apply only to persons above the age of
compulsory school attendance.
If the injured person was employable at the time of the injury and is
provided aid under Articles III, IV, or V and any dependent or
member of his family is provided aid under Article VI, or vice versa,
both the Illinois Department and the local governmental unit shall have
a charge upon such claims, demands and causes of action for the aid
provided to the injured person and any
dependent member of his family, including all cash assistance, medical
assistance and food stamps, from the time of the injury to the date
of recovery.
"Recipient", as used herein, means (i) in the case of financial aid provided under this Code, the grantee of record and any
persons whose needs are included in the financial aid provided to the
grantee of record or otherwise met by grants under the appropriate
Article of this Code for which such person is eligible, (ii) in the case of health care benefits provided under the Covering ALL KIDS Health Insurance Act, the child to whom those benefits are provided, and (iii) in the case of health care benefits provided under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, the veteran to whom benefits are provided.
In each case, the notice shall be served by certified mail or
registered mail, or by facsimile or electronic messaging when requested by the party or parties against whom the applicant or recipient has a claim, demand, or cause of action, upon the party or parties against whom the applicant or
recipient has a claim, demand or cause of action. The notice shall
claim the charge and describe the interest the Illinois Department, the
local governmental unit, or the county, has in the claim, demand, or
cause of action. The charge shall attach to any verdict or judgment
entered and to any money or property which may be recovered on account
of such claim, demand, cause of action or suit from and after the time
of the service of the notice.
On petition filed by the Illinois Department, or by the local
governmental unit or county if either is claiming a charge, or by the
recipient, or by the defendant, the court, on written notice to all
interested parties, may adjudicate the rights of the parties and enforce
the charge. The court may approve the settlement of any claim, demand
or cause of action either before or after a verdict, and nothing in this
Section shall be construed as requiring the actual trial or final
adjudication of any claim, demand or cause of action upon which the
Illinois Department, the local governmental unit or county has charge.
The court may determine what portion of the recovery shall be paid to
the injured person and what portion shall be paid to the Illinois
Department, the local governmental unit or county having a charge
against the recovery.
In making this determination, the court shall conduct an evidentiary hearing
and shall consider competent evidence pertaining
to the following matters:
(1) the amount of the charge sought to be enforced | ||
| ||
(2) the amount, if any, of the attorney's fees and | ||
| ||
(3) the total hospital, doctor and other medical | ||
| ||
(4) whether the recovery represents less than | ||
| ||
(5) the age of the recipient and of persons dependent | ||
| ||
(6) the realistic ability of the recipient to repay | ||
| ||
The burden of producing evidence sufficient to support the exercise by
the court of its discretion to reduce the amount of a proven charge sought
to be enforced against the recovery shall rest with the party seeking such reduction.
The court may reduce and apportion the Illinois
Department's lien proportionate to the recovery of the claimant. The court may
consider the nature and extent of the injury, economic and noneconomic
loss, settlement offers, comparative negligence as it applies to the case
at hand, hospital costs, physician costs, and all other appropriate costs.
The Illinois Department shall pay its pro rata share of the attorney fees
based on the Illinois Department's lien as it compares to the total
settlement agreed upon. This Section shall not affect the priority of an
attorney's lien under the Attorneys Lien Act. The charges of
the Illinois Department described in this Section, however, shall take
priority over all other liens and charges existing under the laws of the
State of Illinois with the exception of the attorney's lien under said statute.
Whenever the Department or any unit of local government
has a statutory charge under this Section against a recovery for damages
incurred by a recipient because of its advancement of any assistance, such
charge shall not be satisfied out of any recovery until the attorney's claim
for fees is satisfied, irrespective of whether or not an action based on
recipient's claim has been filed in court.
This Section shall be inapplicable to any claim, demand or cause of
action arising under (a) the Workers' Compensation Act or the predecessor
Workers' Compensation Act
of
June 28, 1913, (b) the Workers' Occupational Diseases Act or the predecessor
Workers' Occupational
Diseases Act of March 16, 1936; and (c) the Wrongful Death Act.
(Source: P.A. 98-73, eff. 7-15-13.)
|
(305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
Sec. 11-22a. Right of Subrogation. To the extent of the amount of (i) medical
assistance provided by the Department to or on behalf of a recipient under
Article V or VI, (ii) health care benefits provided for a child under the Covering ALL KIDS Health Insurance Act, or (iii) health care benefits provided to a veteran under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, the Department shall be
subrogated
to any right of
recovery such recipient may have under the terms of any private or public
health care coverage or casualty coverage, including coverage under the
"Workers' Compensation Act", approved July 9, 1951, as amended, or the
"Workers' Occupational Diseases Act", approved July 9, 1951, as amended,
without the necessity of assignment of claim or other authorization to secure
the right of recovery to the Department. To enforce its subrogation right, the
Department may (i) intervene or join in an action or proceeding brought by the
recipient, his or her guardian, personal representative, estate, dependents, or
survivors against any person or public or private entity that may be liable;
(ii) institute and prosecute legal proceedings against any person or public or
private entity that may be liable for the cost of such services; or (iii)
institute and prosecute legal proceedings, to the extent necessary to reimburse
the Illinois Department for its costs, against any noncustodial parent who (A)
is required by court or administrative order to provide insurance or other
coverage of the cost of health care services for a child eligible for medical
assistance under this Code and (B) has received payment from a third party for
the costs of those services but has not used the payments to reimburse either
the other parent or the guardian of the child or the provider of the services.
(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; 95-755, eff. 7-25-08.)
|
(305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
Sec. 11-22b. Recoveries.
(a) As used in this Section:
(1) "Carrier" means any insurer, including any | ||
| ||
(2) "Beneficiary" means any person or their | ||
| ||
(b)(1) When benefits are provided or will be provided to a beneficiary
under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008 because of an injury for which another person is liable, or
for which a carrier is liable in accordance with the provisions of any
policy of insurance issued pursuant to the Illinois Insurance Code, the
Illinois Department shall have a right to recover from such person or carrier
the reasonable value of benefits so provided. The Attorney General may, to
enforce such right, institute and prosecute legal proceedings against the
third person or carrier who may be liable for the injury in an appropriate
court, either in the name of the Illinois Department or in the name of the
injured person, his guardian, personal representative, estate, or survivors.
(2) The Department may:
(A) compromise or settle and release any such claim | ||
| ||
(B) waive any such claims for benefits provided under | ||
| ||
(3) No action taken on behalf of the Department pursuant to this Section
or any judgment rendered in such action shall be a bar to any action upon
the claim or cause of action of the beneficiary, his guardian, conservator,
personal representative, estate, dependents or survivors against the third
person who may be liable for the injury, or shall operate to deny to the
beneficiary the recovery for that portion of any damages not covered hereunder.
(c)(1) When an action is brought by the Department pursuant to
subsection (b), it shall be commenced within the period prescribed by
Article XIII of the Code of Civil Procedure.
However, the Department may not commence the action prior to 5 months
before the end of the applicable period prescribed by Article XIII of the
Code of Civil Procedure. Thirty days prior to commencing an action, the
Department shall notify the beneficiary of the Department's intent to
commence such an action.
(2) The death of the beneficiary does not abate any right of action
established by subsection (b).
(3) When an action or claim is brought by persons entitled to bring such
actions or assert such claims against a third person who may be liable for
causing the death of a beneficiary, any settlement, judgment or award
obtained is subject to the Department's claim for reimbursement of the
benefits provided to the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008.
(4) When the action or claim is brought by the beneficiary alone and
the beneficiary incurs a personal liability to pay attorney's fees and
costs of litigation, the Department's claim for reimbursement of the
benefits provided to the beneficiary shall be the full amount of benefits
paid on behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008 less a pro rata
share which represents the Department's reasonable share of attorney's fees
paid by the beneficiary and that portion of the cost of litigation expenses
determined by multiplying by the ratio of the full amount of the
expenditures of the full amount of the judgment, award or settlement.
(d)(1) If either the beneficiary or the Department brings an action or
claim against such third party or carrier, the beneficiary or the
Department shall within 30 days of filing the action give to the other
written notice by personal service or registered mail of the action or
claim and of the name of the court in which the
action or claim is brought. Proof of such notice shall be filed in such
action or claim. If an action or claim is brought by either the Department
or the beneficiary, the other may, at any time before trial on the facts,
become a party to such action or claim or shall consolidate his action or
claim with the other if brought independently.
(2) If an action or claim is brought by the Department pursuant to
subsection (b)(1), written notice to the beneficiary, guardian, personal
representative, estate or survivor given pursuant to this Section shall
advise him of his right to intervene in the proceeding, his right to obtain
a private attorney of his choice and the Department's right to recover the
reasonable value of the benefits provided.
(e) In the event of judgment or award in a suit or claim against such
third person or carrier:
(1) If the action or claim is prosecuted by the | ||
| ||
(2) If the action or claim is prosecuted both by the | ||
| ||
(f) The court shall, upon further application at any time
before the judgment or award is satisfied, allow as a further lien the
amount of any expenditures of the Department in payment of additional
benefits arising out of the same cause of action or claim provided on
behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, when such benefits were
provided or became payable subsequent to the original order.
(g) No judgment, award, or settlement in any action or claim by a
beneficiary to recover damages for injuries, when the Department has an
interest, shall be satisfied without first giving the Department notice and
a reasonable opportunity to perfect and satisfy its lien.
(h) When the Department has perfected a lien upon a judgment or award in
favor of a beneficiary against any third party for an injury for which the
beneficiary has received benefits under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, the Department shall be
entitled to a writ of execution as lien claimant to enforce payment of said
lien against such third party with interest and other accruing costs as in
the case of other executions. In the event the amount of such judgment or
award so recovered has been paid to the beneficiary, the Department shall
be entitled to a writ of execution against such beneficiary to the extent of
the Department's lien, with interest and other accruing costs as in the case
of other executions.
(i) Except as otherwise provided in this Section, notwithstanding any
other provision of law, the entire amount of any settlement of the injured
beneficiary's action or claim, with or without suit, is subject to the
Department's claim for reimbursement of the benefits provided and any lien
filed pursuant thereto to the same extent and subject to the same
limitations as in Section 11-22 of this Code.
(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; 95-755, eff. 7-25-08.)
|
(305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
Sec. 11-22c. Recovery of back wages. (a) As used in this Section, "recipient" means any person
receiving financial assistance under Article IV or Article VI of this Code, receiving health care benefits under the Covering ALL KIDS Health Insurance Act, or receiving health care benefits under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008.
(b) If a recipient maintains any suit, charge or other court or
administrative action against an employer seeking back pay for a period
during which the recipient received financial assistance under Article IV
or Article VI of this Code, health care benefits under the Covering ALL KIDS Health Insurance Act, or health care benefits under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, the recipient shall report such fact to the
Department. To the extent of the amount of assistance provided to or on
behalf of the recipient under Article IV or Article VI, health care benefits provided under the Covering ALL KIDS Health Insurance Act, or health care benefits provided under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, the Department may
by intervention or otherwise without the necessity of assignment of claim,
attach a lien on the recovery of back wages equal to the amount of
assistance provided by the Department to the recipient under Article IV or
Article VI, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008.
(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; 95-755, eff. 7-25-08.)
|
(305 ILCS 5/11-22d) Sec. 11-22d. Savings provisions. (a) Notwithstanding any amendments or provisions in this amendatory Act of the 102nd General Assembly which would make the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act inoperative, Sections 11-22a, 11-22b, and 11-22c of this Code shall remain in force for the commencement or continuation of any cause of action that (i) accrued prior to the effective date of this amendatory Act of the 102nd General Assembly or the date upon which the Department receives federal approval of the changes made to paragraph (6) of Section 5-2 by this amendatory Act of the 102nd General Assembly, whichever is later, and (ii) concerns the recovery of any amount expended by the State for health care benefits provided under the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act prior to those Acts becoming inoperative. Any timely action brought under Sections 11-22a, 11-22b, and 11-22c shall be decided in accordance with those Sections as they existed when the cause of action accrued. (b) Notwithstanding any amendments or provisions in this amendatory Act of the 102nd General Assembly which would make the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act inoperative, paragraph (2) of Section 12-9 of this Code shall remain in force as to recoveries made by the Department of Healthcare and Family Services from any cause of action commenced or continued in accordance with subsection (a).
(Source: P.A. 102-43, eff. 7-6-21.) |
(305 ILCS 5/11-23) (from Ch. 23, par. 11-23)
Sec. 11-23.
(Repealed).
(Source: P.A. 76-523. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-23.1) (from Ch. 23, par. 11-23.1)
Sec. 11-23.1.
(Repealed).
(Source: P.A. 89-507, eff. 7-1-97. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-25) (from Ch. 23, par. 11-25)
Sec. 11-25.
(Repealed).
(Source: P.A. 84-855. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-26) (from Ch. 23, par. 11-26)
Sec. 11-26. Recipient's abuse of medical care; restrictions on access to
medical care. (a) When the Department determines, on the basis of statistical norms and
medical judgment, that a medical care recipient has received medical services
in excess of need and with such frequency or in such a manner as to constitute
an abuse of the recipient's medical care privileges, the recipient's access to
medical care may be restricted.
(b) When the Department has determined that a recipient is abusing his or
her medical care privileges as described in this Section, it may require that
the recipient designate a primary provider type of the recipient's own choosing to assume
responsibility for the recipient's care. For the purposes of this subsection, "primary provider type" means a provider type
as determined by the Department. Instead of requiring a recipient to
make a designation as provided in this subsection, the Department, pursuant to
rules adopted by the Department and without regard to any choice of an entity
that the recipient might otherwise make, may initially designate a primary provider type provided that the primary provider type is willing to provide that care.
(c) When the Department has requested that a recipient designate a
primary provider type and the recipient fails or refuses to do so, the Department
may, after a reasonable period of time, assign the recipient to a primary provider type of its own choice and determination, provided such primary provider type is willing to provide such care.
(d) When a recipient has been restricted to a designated primary provider type, the
recipient may change the primary provider type:
(1) when the designated source becomes unavailable, | ||
| ||
(2) when the designated primary provider type | ||
| ||
(3) in other situations, as the Department shall | ||
| ||
The Department shall, by rule, establish procedures for providing medical or
pharmaceutical services when the designated source becomes unavailable or
wishes to withdraw from any obligation as primary provider type, shall, by rule, take into
consideration the need for emergency or temporary medical assistance and shall
ensure that the recipient has continuous and unrestricted access to medical
care from the date on which such unavailability or withdrawal becomes effective
until such time as the recipient designates a primary provider type or a primary provider type willing to provide such care is designated by the Department
consistent with subsections (b) and (c) and such restriction becomes effective.
(e) Prior to initiating any action to restrict a recipient's access to
medical or pharmaceutical care, the Department shall notify the recipient
of its intended action. Such notification shall be in writing and shall set
forth the reasons for and nature of the proposed action. In addition, the
notification shall:
(1) inform the recipient that (i) the recipient has a | ||
| ||
(2) inform the recipient that the recipient has a | ||
| ||
(f) The Department shall, by rule or regulation, establish procedures for
appealing a determination to restrict a recipient's access to medical care,
which procedures shall, at a minimum, provide for a reasonable opportunity
to be heard and, where the appeal is denied, for a written statement
of the reason or reasons for such denial.
(g) Except as otherwise provided in this subsection, when a recipient
has had his or her medical card restricted for 4 full quarters (without regard
to any period of ineligibility for medical assistance under this Code, or any
period for which the recipient voluntarily terminates his or her receipt of
medical assistance, that may occur before the expiration of those 4 full
quarters), the Department shall reevaluate the recipient's medical usage to
determine whether it is still in excess of need and with such frequency or in
such a manner as to constitute an abuse of the receipt of medical assistance.
If it is still in excess of need, the restriction shall be continued for
another 4 full quarters. If it is no longer in excess of need, the restriction
shall be discontinued. If a recipient's access to medical care has been
restricted under this Section and the Department then determines, either at
reevaluation or after the restriction has been discontinued, to restrict the
recipient's access to medical care a second or subsequent time, the second or
subsequent restriction may be imposed for a period of more than 4 full
quarters. If the Department restricts a recipient's access to medical care for
a period of more than 4 full quarters, as determined by rule, the Department
shall reevaluate the recipient's medical usage after the end of the restriction
period rather than after the end of 4 full quarters. The Department shall
notify the recipient, in writing, of any decision to continue the restriction
and the reason or reasons therefor. A "quarter", for purposes of this Section,
shall be defined as one of the following 3-month periods of time:
January-March, April-June, July-September or October-December.
(h) In addition to any other recipient whose acquisition of medical care
is determined to be in excess of need, the Department may restrict the medical
care privileges of the following persons:
(1) recipients found to have loaned or altered their | ||
| ||
(2) recipients found in possession of blank or forged | ||
| ||
(3) recipients who knowingly assist providers in | ||
| ||
The procedural safeguards in this Section shall apply to the above
individuals.
(i) Restrictions under this Section shall be in addition to and shall
not in any way be limited by or limit any actions taken under Article VIIIA
of this Code.
(Source: P.A. 97-689, eff. 6-14-12; 98-463, eff. 8-16-13.)
|
(305 ILCS 5/11-26.1) (from Ch. 23, par. 11-26.1)
Sec. 11-26.1.
Drug Utilization Review.
(a) The Illinois Department shall, within the time frames mandated by
federal law, implement a Drug Utilization Review Program (DUR), designed to
decrease overutilization of drugs through both prospective and
retrospective utilization review. The Illinois Department shall determine
the content of the DUR by rule.
(b) The Illinois Department may implement this Section as added by this
amendatory Act of 1991 through the use of emergency rules in accordance
with the provisions of Section 5.02 of the Illinois Administrative
Procedure Act. For purposes of the Illinois Administrative Procedure Act,
the adoption of rules to implement this Section as added by this amendatory
Act of 1991 shall be deemed an emergency and necessary for the public
interest, safety and welfare.
(Source: P.A. 87-14.)
|
(305 ILCS 5/11-27) (from Ch. 23, par. 11-27)
Sec. 11-27.
Obtaining benefits after termination.
(a)
For the purpose of this Section, the term "entity" includes persons,
firms, corporations, associations and agencies.
(b) Subject to the provisions of Sections 8A-7, 8A-8 and 12-4.25, no
entity which has had its receipt of benefits or payments under this Code
terminated or suspended or its future receipt
barred by the Department shall,
while such disability
remains in effect, directly or indirectly:
(1) serve as a technical or other advisor to any entity which obtains,
attempts to obtain or seeks to obtain benefits or payments under this Code; or
(2) be an incorporator or member of the board of directors of any entity
which obtains, attempts to
obtain or seeks to obtain benefits or payments under this Code; or
(3) be an investor with or in any entity which obtains, attempts
to obtain or seeks to obtain benefits or payments under this Code.
(c) The Director may, by rule, establish procedures for any entity
aggrieved by the application of this Section to seek special permission to
continue receiving benefits or
payments under this Code or to seek reinstatement of benefits or
payments under this Code. Such entity must be otherwise eligible to
receive benefits or payments under this Code and in compliance with any
applicable requirement of this Code for reinstatement. If the Director
determines that the entity seeking such permission or reinstatement had no
part in the actions or conduct upon which the decision to suspend,
terminate or bar benefits was based, he may authorize the continued
participation by or reinstatement of the entity in such program or programs
as he may deem appropriate under all the circumstances and upon such terms
and conditions and under such probationary or other restrictions as he or
other provisions of this Code may require.
(d) Any entity which knowingly violates the provisions of this Section
or knowingly attempts or
conspires to violate the provisions of this Section shall be civilly liable
in a court of law for damages in an amount 3 times the value of all benefits or payments
obtained by such entity or $10,000, whichever sum is greater.
(e) The civil liability imposed under this Section shall be joint and
several and shall extend to any entity knowingly
seeking or attempting to obtain benefits under this
Code which, having the authority to refuse, knowingly associates with or
permits the association of a suspended, terminated or barred
entity as prohibited herein. Such liability
shall also extend to any
entity found guilty in a court of law of such unlawful association,
including the suspended, terminated or
barred entity. Liability shall arise when any such
entity knew, or under all of the circumstances reasonably should
have known, that it was engaging in or authorizing any activity prohibited herein.
(f) The Attorney General, or the State's Attorney in actions involving a
local governmental unit, may initiate court proceedings to recover benefits
or payments obtained in violation of this Section and shall, in addition to
any judgment obtained, be entitled to recover all court costs.
(g) Notwithstanding any provision of The Freedom of Information Act
or other State law, the Department shall make public the identity and
business address of every entity which has had its receipt of benefits or
payments under this Code suspended or terminated or its future receipt barred by the
Department. Each month, the Department shall publish a list of such
identities and addresses, which shall be mailed by the Department without
charge to associations and societies, including their affiliates and
components, of vendors providing goods, services or both to recipients of
medical assistance under this Code. The Department shall also mail such
list without charge to any other person or organization upon request.
(h) Nothing in this Section shall prohibit the Department from
pursuing and implementing any other remedy provided by this Code in
connection with the suspension, termination or reinstatement of receipt of
benefits or payments under this Code or the barring of receipt of future
benefits or payments under this Code.
(Source: P.A. 84-1254; 84-1438.)
|
(305 ILCS 5/11-28) (from Ch. 23, par. 11-28)
Sec. 11-28.
Recipient Bill of Rights.
The Illinois Department shall
promulgate a Bill of Rights for Public Aid recipients which provides basic
information about financial and medical assistance and other social
services which are available through the Illinois Department and the rights
of recipients of and applicants for assistance or social services to due
process in reviewing and contesting decisions or actions of the Illinois
Department or a County Department. The Bill of Rights also shall contain
provisions to insure that all recipients and applicants are treated with
dignity and fairness. Copies of the Bill of Rights shall be prominently
posted in each County Department and other local service office maintained
by the Illinois Department or a County Department so that it will be
legible to recipients and applicants.
(Source: P.A. 87-528.)
|
(305 ILCS 5/11-29) (from Ch. 23, par. 11-29)
Sec. 11-29.
Notification of Eligibility for Earned Income Tax Credit.
(a) The Illinois Department shall include the notice
regarding the availability of the federal earned income tax credit, in the
language provided under Section 20 of the Earned Income Tax Credit
Information Act, in any one scheduled mailing disbursed during the month of
January to: (1) any person receiving cash assistance under Article IV of
this Code; (2) any person receiving benefits under Article V of this Code who
does not also receive cash assistance; (3) any person receiving benefits
under Article VI of this Code who resides in the city of Chicago; and (4)
any person receiving benefits under the federal food stamp program who does
not also receive cash assistance under any Article of this Code.
(b) Before the annual mailing of the notice under subsection (a) of this
Section the Illinois Department shall update the language of
the notice provided under Section 20 of the Earned Income Tax Credit
Information Act in the appropriate blanks to reflect the maximum earned
income tax credit and the maximum earnings to which that credit shall
apply, as determined by the federal government.
(Source: P.A. 89-507, eff. 7-1-97.)
|
(305 ILCS 5/11-30) (from Ch. 23, par. 11-30)
Sec. 11-30.
(Repealed).
(Source: P.A. 87-860. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/11-31)
Sec. 11-31.
Recovery of amounts spent on child medical care.
The
Illinois Department may provide by rule for certification to the Comptroller of
amounts spent on child medical care. The purpose of the certification shall be
to intercept, to the extent necessary to reimburse the Illinois Department for
its costs, State income tax refunds and other payments due to any noncustodial
parent who
(i) is required by court or administrative order to provide insurance or other
coverage of the
cost of health care services for a child eligible for medical assistance under
this
Code and (ii) has received payment from a third party for the costs of those
services but has not used the payments to reimburse either the other parent or
the guardian of the child or the provider of the services.
The rule shall provide for notice to the person and an opportunity to be
heard. A final administrative decision rendered by the Illinois Department
under this Section may
be reviewed only under the Administrative Review Law.
(Source: P.A. 89-183, eff. 1-1-96.)
|
(305 ILCS 5/11-32) Sec. 11-32. Premium debts; forgiveness, compromise, reduction. The Department may forgive, compromise, or reduce any debt owed by a former or current recipient of medical assistance under this Code or health care benefits under the Children's Health Insurance Program or the Covering ALL KIDS Health Insurance Program that is related to any premium that was determined or imposed in accordance with (i) the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act prior to those Acts becoming inoperative or (ii) any corresponding administrative rule.
(Source: P.A. 102-43, eff. 7-6-21.) |
(305 ILCS 5/Art. XII heading) ARTICLE XII.
ADMINISTRATION
|
(305 ILCS 5/12-1) (from Ch. 23, par. 12-1)
Sec. 12-1. Administration of Code; Department of Healthcare and Family Services.
(a) This Code shall be administered by the Department of Human
Services and the Department of Healthcare and Family Services (formerly Illinois Department of Public
Aid)
as provided in the Department of Human Services Act.
(b) The Department of Healthcare and Family Services shall be under the supervision and
direction of the
Director of Healthcare and Family Services, as provided in Section 5-20 of the
Departments of State Government Law (20 ILCS 5/5-20). The Director shall be appointed pursuant
to the
provisions of Section 5-605 and meet the qualifications of Section
5-230 of
that Law.
The Assistant Director of Healthcare and Family Services, created by Section 5-165
of the
Departments of State Government Law (20 ILCS 5/5-165), shall be appointed pursuant to the
provisions
of Section 5-605 of that Law and shall meet the
qualifications
prescribed in
Section 5-230 of that Law.
The salaries of the Director and the Assistant Director shall be those
specified in Section 5-395 of the Departments of State
Government Law (20 ILCS 5/5-395).
The Department of Healthcare and Family Services and the Director of Healthcare and Family Services
shall comply with
other provisions of the Civil Administrative Code of Illinois which are
generally
applicable to the several departments of the State Government created by
that Code.
(Source: P.A. 95-331, eff. 8-21-07.)
|
(305 ILCS 5/12-2) (from Ch. 23, par. 12-2)
Sec. 12-2.
County departments.
The County Departments, under the supervision
and direction of the Illinois
Department and subject to its rules and regulations, shall locally
administer the programs
provided by Articles III, IV, and V of this Code
and shall provide the social services and utilize the rehabilitative
facilities authorized in Articles IX and IXA in respect to
persons served through
Articles III, IV, and V. They shall also
discharge such other duties as may be required by other provisions of
this Code or other laws of this State.
(Source: P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/12-3) (from Ch. 23, par. 12-3)
Sec. 12-3.
Local governmental units.
As provided in Article VI, local
governmental units shall provide funds for and administer the programs
provided in that Article subject, where so provided, to the supervision of
the Illinois Department. Local governmental units shall also provide the
social services and utilize the rehabilitative facilities authorized in
Article IX for persons served through Article VI, and shall discharge such
other duties as may be required by this Code or other laws of this State.
In counties not under township organization, the county shall provide
funds for and administer such programs.
In counties under township organization (including any such counties
in which the governing authority is a board of commissioners) the
various towns other than those towns lying entirely within the corporate
limits of any city, village or incorporated town having a population of
more than 500,000 inhabitants shall provide funds for and administer
such programs.
Cities, villages, and incorporated towns having a population of more
than 500,000 inhabitants shall provide funds for public aid purposes
under Article VI but the Department of Human Services shall administer the
program for such municipality.
For the fiscal year beginning July 1, 2003, however, the municipality shall
decrease by $5,000,000 the amount of funds it provides for public aid purposes
under Article VI. For each fiscal year thereafter, the municipality shall
decrease the amount of funds it provides for public aid purposes under Article
VI in that fiscal year by an additional amount equal to (i) $5,000,000 or (ii)
the amount provided by the municipality in the preceding fiscal year, whichever
is less, until the municipality does not provide any funds for public aid
purposes under Article VI.
Incorporated towns which have superseded civil townships shall
provide funds for and administer the public aid program provided by
Article VI.
In counties of less than 3 million population having a County
Veterans Assistance Commission in which there has been levied a tax as
authorized by Section 5-2006 of the Counties Code for the purpose of
providing assistance to military veterans and their families, the
County Veterans Assistance Commission shall administer the programs
provided by Article VI for such military veterans and their families
as seek aid through the County Veterans Assistance Commission.
(Source: P.A. 92-111, eff. 1-1-02; 92-597, eff. 6-28-02.)
|
(305 ILCS 5/12-3.1) Sec. 12-3.1. Discontinuance of a coterminous township. Upon discontinuance of a coterminous township under Articles 27 and 28 of the Township Code, the coterminous municipality shall provide funds for and administer the public aid program provided for under Article VI of this Code.
(Source: P.A. 98-127, eff. 8-2-13; 99-474, eff. 8-27-15.) |
(305 ILCS 5/12-4) (from Ch. 23, par. 12-4)
Sec. 12-4.
Powers and duties of the Illinois department.
In addition to the powers, duties and functions vested in it by other
provisions of this Code or by other laws of this State, the Illinois
Department shall have the powers enumerated in Sections 12-4.1 to
12-4.30, inclusive, subject to the conditions therein stated.
(Source: P.A. 85-1209.)
|
(305 ILCS 5/12-4.1) (from Ch. 23, par. 12-4.1)
Sec. 12-4.1.
Appointment of administrative staff.
Appoint, in accordance with the "Personnel Code", approved July 18,
1955, as amended, such administrative staff as may be necessary. The
enactment of this Code shall not impair the merit services status of
persons employed by the Illinois Department on the effective date thereof.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.3) (from Ch. 23, par. 12-4.3)
Sec. 12-4.3.
Child and Spouse Support Unit.)
Establish within the administrative staff a Child and Spouse Support unit, as provided
in Section 10-3.1 of Article X.
(Source: P.A. 79-474.)
|
(305 ILCS 5/12-4.4) (from Ch. 23, par. 12-4.4)
Sec. 12-4.4. Administration of federally-aided programs. Direct
County Departments of Public Aid in the administration of
the federally
funded Supplemental Nutrition Assistance (SNAP) Program, programs to aid refugees and Articles III,
IV, and V of this Code.
The
Illinois Department of Human Services
shall operate a SNAP Employment and Training (SNAP E&T) program in
compliance with federal law. The SNAP E&T program may only be mandatory in counties where the Department can show that there are sufficient program slots for at least the majority of the county's current non-exempt work registrants as described in Section 11-20 of this Code. Nothing in this Section shall prevent the Department from operating a fully voluntary SNAP E&T program. The SNAP E&T program will have an Earnfare
component. The Earnfare component shall be available in selected geographic
areas based on criteria established by the Illinois Department of Human
Services by rule.
Participants in Earnfare will, to the extent resources allow, earn their
assistance. Participation in the Earnfare program is voluntary, except when
ordered by a court of competent jurisdiction. Eligibility for Earnfare may
be limited to only 6 months out of any 12 consecutive month period. Clients are
not entitled to be placed in an Earnfare slot. Earnfare slots shall be made
available only as resources permit. Earnfare shall be available to persons
receiving SNAP benefits who meet eligibility criteria established by the Illinois
Department of Human Services by rule.
The Illinois Department may, by rule, extend the Earnfare Program to clients
who do not receive SNAP benefits.
Receipt of SNAP benefits is not an
eligibility requirement of
Earnfare when a court of competent jurisdiction orders an individual to
participate in the Earnfare Program. To
the extent resources permit, the Earnfare program will allow participants
to engage in work-related activities to earn monthly financial assistance
payments and to improve participants' employability in order for them to
succeed in obtaining employment. The Illinois Department of Human Services may enter into
contracts with other public agencies including State agencies, with local
governmental units, and with not-for-profit community based organizations
to carry out the elements of the Program that the Department of Human Services deems appropriate.
The Earnfare Program shall contain the following elements:
(1) To the extent resources allow and slots exist, | ||
| ||
(2) Persons participating in Earnfare shall engage in | ||
| ||
(3) To the extent appropriate slots are available, | ||
| ||
(4) The Department of Human Services shall consider | ||
| ||
(5) The Department of Human Services may enter into | ||
| ||
(6) To the extent resources permit, the Department of | ||
| ||
(7) All income and asset limitations of the Federal | ||
| ||
(8) Earnfare participants shall not displace or | ||
| ||
(9) Persons who fail to cooperate with the SNAP E&T | ||
| ||
(Source: P.A. 101-566, eff. 8-23-19.)
|
(305 ILCS 5/12-4.5) (from Ch. 23, par. 12-4.5)
Sec. 12-4.5. Co-operation with Federal Government. Co-operate with the Federal Department of Health and Human Services,
or with any successor agency thereof, or with any other agency of
the Federal Government providing federal funds, commodities, or aid, for
public aid and other purposes, in any reasonable manner not contrary to
this Code, as may be necessary to qualify for federal aid for the several
public aid and welfare service programs established under this Code,
including the costs of administration and personnel training incurred
thereunder, and for such other aid, welfare and related programs for which
federal aid may be available.
The Department of Human Services may supervise the administration of food
and shelter
assistance under this Section for which the Department of Human Services is
authorized to
receive funds from federal, State and private sources. Under such terms as
the Department of Human Services may establish, such monies may be
distributed to units of
local government and non-profit agencies for the purpose of provision of
temporary shelter and food assistance. Temporary shelter means
emergency and transitional living arrangements, including related
ancillary services. Allowable costs shall include remodeling costs but
shall not include other costs not directly related to direct service
provision.
The Department of Human Services may provide low income families and individuals appropriate
supportive services on site to enhance their ability to maintain independent
living arrangements or may contract for the provision of those services on site
with entities that develop or operate housing developments, governmental units,
community based organizations, or not for profit organizations. Those living
arrangements may include transitional housing, single-room occupancy (SRO)
housing developments, or family housing developments. Supportive services may
include any service authorized under this Code including, but not
limited to, services relating to substance abuse, mental health,
transportation, child care, or case management. When appropriate, the
Department of Human Services shall work with other State agencies in order to coordinate services
and to maximize funding. The
Department of Human Services shall give priority for services to residents
of housing
developments
which have been funded by or have a commitment of funds from the Illinois
Housing Development Authority.
The Department of Human Services shall promulgate specific rules
governing the
selection of Distribution Network Agencies under the Federal Surplus
Commodity Program including, but not limited to, policies relative to the
termination of contracts, policies relative to fraud and abuse, appeals
processes, and information relative to application and selection processes.
The Department of Human Services shall also promulgate specific rules that set forth the
information required to be contained in the cost reports to be submitted by
each Distribution Network Agency to the Department of Human Services.
The Department of Human Services shall cooperate with units of local government and
non-profit agencies in the development and implementation of plans to
assure the availability of temporary shelter for persons without a home and/or
food assistance.
The Department of Human Services shall report annually to the House and Senate
Appropriations Committees of the General Assembly regarding the provision
of monies for such assistance as provided in this Section, including the
number of persons served, the level and cost of food provided and the level
and cost of each type of shelter provided and any unmet need as to food and
shelter.
The Illinois Department of Human Services shall make such
reports to the Federal Department or other Federal agencies in such form
and containing such information as may be required, and shall comply with
such provisions as may be necessary to assure the correctness and
verification of such reports if funds are contributed by the Federal
Government. In cooperating with any federal agency providing federal funds,
commodities, or aid for public aid and other purposes, the Department of
Human Services,
with the consent of the Governor, may make necessary expenditures from
moneys appropriated for such purposes for any of the subdivisions of
public aid, for related purposes, or for administration.
(Source: P.A. 97-333, eff. 8-12-11.)
|
(305 ILCS 5/12-4.6) (from Ch. 23, par. 12-4.6)
Sec. 12-4.6.
Receipt and use of federal funds, commodities, or other aid.
Receive, expend and use for all purposes of this Code, and for other
public aid, welfare and related purposes, funds, commodities and other aid
made available by the Federal Government.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.7) (from Ch. 23, par. 12-4.7)
Sec. 12-4.7. Co-operation with other agencies. Make use of, aid and
co-operate with State and local governmental agencies, and co-operate with and
assist other governmental and private agencies and organizations engaged in
welfare functions.
This grant of authority includes the powers necessary for the Department of Healthcare and Family Services to administer the Illinois Health and Human Services Innovation Incubator (HHSi2) project. The Department of Healthcare and Family Services shall cochair with the Governor's Office of Management and Budget an Executive Steering Committee of partner State agencies to coordinate the HHSi2 project. The powers and duties of the Executive Steering Committee shall be established by intergovernmental agreement. In addition, the Department of Healthcare and Family Services is authorized, without limitation, to enter into agreements with federal agencies, to create and implement the HHSi2 Shared Interoperability Platform, and to create all Implementation Advance Planning documents for the HHSi2 project. (Source: P.A. 103-8, eff. 7-1-23.)
|
(305 ILCS 5/12-4.7a) (from Ch. 23, par. 12-4.7a)
Sec. 12-4.7a.
(Repealed).
(Source: P.A. 90-372, eff. 7-1-98. Repealed internally, eff. 7-1-98.)
|
(305 ILCS 5/12-4.7b)
(Text of Section before amendment by P.A. 103-688 )
Sec. 12-4.7b. Exchanges of information; inmates. The Department shall enter
into intergovernmental agreements
to conduct monthly exchanges of information with
the
Illinois Department of Corrections, the Cook County Department of
Corrections, and the office of the sheriff of every other
county to determine whether any individual included in an assistance unit
receiving public aid
under any Article of this Code is an
inmate in a facility operated by the Illinois Department of Corrections, the
Cook County Department of
Corrections, or a county sheriff. The Illinois Department of Corrections, the Cook County Department of Corrections, and the office of the sheriff of every other county shall honor all intergovernmental agreements with the Department under this Section and shall provide all required information in a timely manner. The Department shall review each month
the entire list of individuals generated by the
monthly exchange and shall verify the eligibility for benefits under this
Code for each individual on the list. The Department shall terminate benefits
under this Code
for any individual determined to be ineligible by this monthly review.
The Department shall use any legal means available to recoup as an overpayment
any assistance
provided to an individual for any period during which he or she was ineligible
to receive the
assistance.
(Source: P.A. 101-115, eff. 7-22-19.)
(Text of Section after amendment by P.A. 103-688 ) Sec. 12-4.7b. Exchanges of information; inmates. The Department shall enter into intergovernmental agreements to conduct exchanges of information with the Illinois Department of Corrections, the Cook County Department of Corrections, and the office of the sheriff to the extent available to determine whether any individual included in an assistance unit receiving public aid under any Article of this Code is an inmate in a facility operated by the Illinois Department of Corrections, the Cook County Department of Corrections, or a county sheriff. Alternatively, the Department may utilize the option of purchasing incarceration data through a third-party resource in order to conduct data matches of incarcerated individuals. The Illinois Department of Corrections, the Cook County Department of Corrections, and the office of the sheriff of every other county shall honor all intergovernmental agreements with the Department under this Section and shall provide all required information in a timely manner. The Department shall review each individual prior to authorizing benefits at application and redetermination to verify eligibility for benefits under this Code. The Department shall terminate benefits under this Code for any individual determined to be ineligible by this review. The Department shall use any legal means available to recoup as an overpayment any assistance provided to an individual for any period during which he or she was ineligible to receive the assistance. (Source: P.A. 103-688, eff. 1-1-25.) |
(305 ILCS 5/12-4.7c)
Sec. 12-4.7c. Exchange of information after July 1, 1997.
(a) The Department of Human Services shall exchange with the
Department of Healthcare and Family Services information
that may be necessary for the enforcement of child support orders
entered pursuant to Sections 10-10 and 10-11 of this Code or pursuant to
the Illinois Marriage and Dissolution of Marriage Act, the Non-Support
of Spouse and Children Act, the Non-Support Punishment Act, the Revised
Uniform Reciprocal Enforcement of
Support Act, the Uniform Interstate Family Support Act,
the Illinois Parentage Act of 1984, or the Illinois Parentage Act of 2015.
(b) Notwithstanding any provisions in this Code to the contrary,
the Department of Human Services shall not be liable
to any person for any disclosure of information to the
Department of Healthcare and Family Services (formerly
Illinois Department of Public Aid) under subsection (a)
or for any other
action taken in good faith to comply with the requirements of subsection
(a).
(Source: P.A. 99-85, eff. 1-1-16 .)
|
(305 ILCS 5/12-4.7d)
Sec. 12-4.7d.
Interagency agreement regarding investigation of child care
providers. The Department shall enter into a written agreement with the
Department of Children and Family Services which shall provide for interagency
procedures regarding requests by the Department that the Department of Children
and Family Services conduct an investigation of the Central Register, as
defined in the Abused and Neglected Child Reporting Act, to ascertain if a
child care provider who is not required to be licensed
under the Child Care Act of 1969 and who is participating in the child care
assistance program under this Code has been determined to be a perpetrator in
an indicated report of child abuse or neglect.
(Source: P.A. 90-684, eff. 7-31-98.)
|
(305 ILCS 5/12-4.7e) Sec. 12-4.7e. (Repealed).
(Source: P.A. 96-878, eff. 2-2-10. Repealed internally, eff. 1-1-12.) |
(305 ILCS 5/12-4.7f) Sec. 12-4.7f. Death records information. At least once each calendar month, the Department of Human Services shall cross-reference its roster of public aid recipients with the death records information from the Department of Public Health residing on the Electronic Data Warehouse at the Department of Healthcare and Family Services. A public aid recipient who is found to have a death record shall be subject to an immediate cancelation of his or her public aid benefits, including the deactivation of his or her LINK card, in instances where there are no other individuals receiving benefits in that assistance unit and upon
certification that the identity of the public aid recipient matches the identity
of the person named in the death certificate. As used in this Section, "LINK
card" means the electronic benefits transfer card issued by the Department of Human Services for the purpose of enabling a user of the card to obtain Supplemental Nutrition Assistance Program (SNAP) benefits or cash.
(Source: P.A. 99-87, eff. 7-21-15.) |
(305 ILCS 5/12-4.8) (from Ch. 23, par. 12-4.8)
Sec. 12-4.8.
Supervision of administration of general assistance.
Supervise
the administration of
General Assistance under Article VI by local governmental units
receiving State funds for the purposes of such Article.
(Source: P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/12-4.8a)
Sec. 12-4.8a.
General assistance record keeping.
The
Illinois Department shall establish procedures
designed to ensure that a person who receives a general assistance grant from
the Illinois Department does not receive a duplicate grant from a township
general assistance program that receives State funds.
(Source: P.A. 88-412.)
|
(305 ILCS 5/12-4.9) (from Ch. 23, par. 12-4.9)
Sec. 12-4.9.
Hearings and investigations.
Conduct hearings and investigations in connection with the
administration of public aid; compel by subpoena, the attendance and
testimony of witnesses and the production of books and papers; and
administer oaths to witnesses. No person shall be compelled to attend an
investigation or hearing at a place outside the county in which he resides.
Subpoenas may be served as provided for in civil actions. The fees of
witnesses for attendance and travel shall be the same as the fees of
witnesses before the Circuit Court and shall be paid as an expense of
administration.
Any qualified officer or employee of the Department designated in
writing by the Director may conduct the hearings and investigations.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.10) (from Ch. 23, par. 12-4.10)
Sec. 12-4.10.
Forms and supplies.
Prescribe the form of and print and supply to the County Departments and
local governmental units official blanks for applications and reports and
such other forms as it deems advisable in relation to the administration of
public aid.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.11) (from Ch. 23, par. 12-4.11)
Sec. 12-4.11. Grant amounts. The Department,
with due regard for and subject to budgetary limitations, shall establish
grant amounts for each of the programs, by regulation. The grant amounts may
vary by program, size of assistance unit and geographic area. Grant amounts under the Temporary Assistance for Needy Families (TANF) program may not vary on the basis of a TANF recipient's county of residence.
Aid payments shall not be reduced except: (1) for changes in the cost of
items included in the grant amounts, or (2) for changes in the expenses of the
recipient, or (3) for changes in the income or resources available to the
recipient, or (4) for changes in grants resulting from adoption of a
consolidated grant amount.
The maximum benefit levels provided to TANF recipients shall increase as follows: beginning October 1, 2023, the Department of Human Services shall increase TANF grant amounts in effect on September 30, 2023 to at least 35% of the most recent United States Department of Health and Human Services Federal Poverty Guidelines for each family size. Beginning October 1, 2024, and each October 1 thereafter, the maximum benefit levels shall be annually adjusted to remain equal to at least 35% of the most recent poverty guidelines updated periodically in the Federal Register by the U.S. Department
of Health and Human Services under the authority of 42 U.S.C. 9902(2) for each family size. TANF grants for child-only assistance units shall be at least 75% of TANF grants for assistance units of the same size that consist of a caretaker relative with children. In fixing standards to govern payments or reimbursements for funeral
and burial expenses, the Department shall establish a minimum allowable
amount of
not less than
$1,000 for Department payment of funeral services and not less than $500 for
Department payment of burial or cremation services. On January 1, 2006, July 1, 2006, and July 1, 2007, the Department shall increase the minimum reimbursement amount for funeral and burial expenses under this Section by a percentage equal to the percentage increase in the Consumer Price Index for All Urban Consumers, if any, during the 12 months immediately preceding that January 1 or July 1. In establishing the minimum
allowable
amount, the Department shall take into account the services
essential to a dignified, low-cost (i) funeral and (ii) burial or
cremation, including reasonable
amounts that may be necessary for
burial space and cemetery charges, and any applicable taxes or other
required governmental fees or charges. If no
person has agreed to pay the total cost of the (i) funeral and
(ii) burial or cremation
charges, the Department shall pay the vendor the actual costs of the (i)
funeral
and
(ii) burial or cremation, or the minimum allowable amount for each service as
established by
the Department, whichever is less, provided that the Department reduces its
payments by
the amount available from the following sources: the decedent's assets
and
available resources and the anticipated amounts of any death benefits available
to the
decedent's estate, and amounts paid and arranged to be paid by the
decedent's legally
responsible relatives. A legally responsible relative is expected to pay
(i) funeral and (ii) burial
or cremation expenses unless financially unable to do so.
Nothing contained in this Section or in any other Section of this
Code shall be construed to prohibit the Illinois Department (1) from
consolidating existing standards on the basis of any standards which are
or were in effect on, or subsequent to July 1, 1969, or (2) from
employing any consolidated standards in determining need for public
aid and the amount of money payment or grant for individual recipients
or recipient families.
(Source: P.A. 103-8, eff. 6-7-23.)
|
(305 ILCS 5/12-4.11-5) Sec. 12-4.11-5. Murdered Children Funeral and Burial Assistance Program. The Department of Human Services shall by rule administer the Murdered Children Funeral and Burial Assistance Program. Eligibility for the Murdered Children Funeral and Burial Assistance Program shall be limited to those individuals as described in the Murdered Children Funeral and Burial Assistance Act. Beginning July 1, 2023, the Department of Human Services shall make eligibility determinations for the Murdered Children Funeral and Burial Assistance Program and, subject to appropriation, shall make disbursements for eligible cases to a funeral establishment or cemetery authority as provided under the Murdered Children Funeral and Burial Assistance Act.
(Source: P.A. 102-754, eff. 5-10-22.) |
(305 ILCS 5/12-4.12) (from Ch. 23, par. 12-4.12)
Sec. 12-4.12.
Insurance Policies in Determination of Need.
To the extent authorized by the rules and regulations of the Illinois
Department, all or a portion of the loan or cash value of insurance
policies may be disregarded in the determination of need under Sections
3-1.2, 4-1.6, 5-4, 6-1.2 and 7-1.2. The Department may also provide, by
rule, (1) for the continuation of life insurance policies at face, cash, or
loan value amounts in excess of funeral and burial expenses, as such
expenses are governed by standards established under Section 12-4.11, and
(2) whether or not provision for continuation is made under (1), for the
taking of assignments of life insurance policies to cover an amount not in
excess of the amount of financial aid which has been, or may be, provided.
In making the determination under (1), the Department shall consider the
physical condition of the insured, the needs of the insured and his
dependents for financial aid, whether those needs will be of a temporary or
continuing nature, and the existence of any unusual circumstances which may
warrant a decision to permit such continuation.
(Source: P.A. 76-1416.)
|
(305 ILCS 5/12-4.13) (from Ch. 23, par. 12-4.13)
Sec. 12-4.13.
Extension of federal commodity and food stamp programs to
non-recipients; Standards of eligibility. The Department of Human
Services shall provide, by rule, for the
extension of Federal surplus foods, food
stamps, or other commodities made available by the Federal Government to
persons who are not recipients of public aid, and establish standards for
determining the eligibility of such persons.
(Source: P.A. 89-507, eff. 7-1-97.)
|
(305 ILCS 5/12-4.13a) Sec. 12-4.13a. Gross income eligibility standard; SNAP. Subject to federal approval if required, a household that includes an elderly, blind, or disabled person shall be considered categorically eligible for Supplemental Nutrition Assistance Program (SNAP) benefits if the gross income of such household is at or below 200% of the nonfarm income poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and
Human Services under the authority of 42 U.S.C. 9902(2); and a household that does not include an elderly, blind, or disabled person shall be considered categorically eligible for Supplemental Nutrition Assistance Program (SNAP) benefits if the gross income of such household is at or below 165% of those nonfarm income poverty guidelines.
(Source: P.A. 99-170, eff. 1-1-16 .) |
(305 ILCS 5/12-4.13b) Sec. 12-4.13b. College student eligibility for supplemental nutrition assistance benefits. (a) For the purposes of Section 273.5(b)(11)(ii) of Title 7 of the Code of Federal Regulations, a career and technical educational program offered at a community college and approved by the Illinois Community College Board that could be a component of a SNAP Employment and Training (E&T) program, as identified by the Department of Human Services, shall be considered an employment and training program under Section 273.7 of Title 7 of the Code of Federal Regulations, unless prohibited by federal law. (b) The Department of Human Services, in consultation with representatives of the Illinois Community College Board, the Illinois Student Assistance Commission, the Illinois Workforce Innovation Board, and advocates for students and SNAP recipients, shall establish a protocol to identify and verify all potential exemptions to the eligibility rule described in Section 273.5(a) of Title 7 of the Code of Federal Regulations, and to identify and verify a student's participation in educational programs, including, but not limited to, self-initiated placements, that would exempt a student from the eligibility rule described in Section 273.5(a) of Title 7 of the Code of Federal Regulations. To the extent possible, this consultation shall take place through existing workgroups convened by the Department of Human Services. (c) If the United States Department of Agriculture requires federal approval of the exemption designation established pursuant to subsection (a) and the protocol established pursuant to subsection (b), the Department of Human Services shall seek and obtain that approval before publishing the guidance or regulation required by subsection (e). (d)(1) This Section does not require the Department of Human Services to offer a particular component, support services, or workers' compensation to a college student found eligible for an exemption pursuant to this Section. (2) This Section does not restrict or require the use of federal funds for the financing of SNAP E&T programs. (3) This Section does not require an institution of higher education to verify eligibility for SNAP. (e) The Department of Human Services shall adopt any rules necessary to implement the provisions of subsections (a), (b), (c), and (d).
(Source: P.A. 100-620, eff. 7-20-18; 101-560, eff. 8-23-19.) |
(305 ILCS 5/12-4.13c) Sec. 12-4.13c. SNAP Restaurant Meals Program. (a) Subject to federal approval of the plan for operating the Program, the Department of Human Services shall establish a Restaurant Meals Program as part of the federal Supplemental Nutrition Assistance Program (SNAP). Under the Restaurant Meals Program, households containing elderly or disabled members, and their spouses, as defined in 7 U.S.C. 2012(j), or homeless individuals, as defined in 7 U.S.C. 2012(l), shall have the option in accordance with 7 U.S.C. 2012(k) to redeem their SNAP benefits at private establishments that contract with the Department to offer meals for eligible individuals at concessional prices subject to 7 U.S.C. 2018(h). The Restaurant Meals Program shall be operational no later than July 1, 2021. (b) The Department of Human Services shall adopt any rules necessary to implement the provisions of this Section.
(Source: P.A. 101-10, eff. 6-5-19; 101-110, eff. 7-19-19; 102-558, eff. 8-20-21.) |
(305 ILCS 5/12-4.13d)
Sec. 12-4.13d. SNAP eligibility notification; college students. (a) To complement student financial assistance programs and to enhance their effectiveness for students with financial need, the Illinois Student Assistance Commission (ISAC) shall annually include information about the Supplemental Nutrition Assistance Program (SNAP) in the language that schools are required to provide to students eligible for the Monetary Award Program grant. The language shall, at a minimum, direct students to information about college student eligibility criteria for SNAP, and it shall direct students to the Department of Human Services and to the Illinois Hunger Coalition's Hunger Hotline for additional information. (b) Illinois institutions of higher education that participate in the Monetary Award Program (MAP) shall provide the notice described in subsection (a) to all students who are enrolled, or who are accepted for enrollment and intending to enroll, and who have been identified by ISAC as MAP-eligible at the institution. If possible, the institution may designate a public benefits liaison or single point person to assist students in taking the necessary steps to obtain public benefits if eligible. (c) ISAC shall adopt any rules necessary to implement the provisions of this Section on or before October 1, 2020.
(Source: P.A. 101-560, eff. 8-23-19; 102-558, eff. 8-20-21.)
|
(305 ILCS 5/12-4.13e) Sec. 12-4.13e. Summer EBT Program. (a) Subject to federal approval, the Department of Human Services may establish and participate in the federal Summer Electronic Benefit Transfer Program for Children, which may be referred to as the Summer EBT Program. (b) The Summer EBT Program Fund is established as a federal trust fund in the State treasury. The fund is established to receive moneys from the federal government for the Summer EBT Program. Subject to appropriation, moneys in the Summer EBT Program Fund shall be expended by the Department of Human Services only for those purposes permitted under the federal Summer Electronic Benefit Transfer Program for Children. (c) The Department of Human Services is authorized to adopt any rules, including emergency rules, necessary to implement the provisions of this Section.
(Source: P.A. 103-588, eff. 6-5-24.) |
(305 ILCS 5/12-4.14) (from Ch. 23, par. 12-4.14)
Sec. 12-4.14.
Investigation of resources of applicants, recipients, and responsible
relatives.
Investigate the financial condition of applicants, recipients, and
responsible relatives as defined in Section 2-11 of Article II, in order
to determine whether an applicant or recipient has or can obtain property,
income, resources, or other sources of support sufficient to provide him
with a standard of living compatible with health and well-being.
(Source: Laws 1967, p. 122 .)
|
(305 ILCS 5/12-4.15) (from Ch. 23, par. 12-4.15)
Sec. 12-4.15.
(Repealed).
(Source: P.A. 86-651. Repealed by P.A. 90-17, eff. 7-1-97.)
|
(305 ILCS 5/12-4.16) (from Ch. 23, par. 12-4.16)
Sec. 12-4.16.
Economic and social investigations.
Investigate causes of dependency and economic distress, develop plans
and programs for the elimination and prevention of such causes, and
recommend the execution of such programs to appropriate agencies.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.17) (from Ch. 23, par. 12-4.17)
Sec. 12-4.17.
Training personnel for employment in public aid programs.
Establish within the administrative staff a staff development unit to
provide orientation and job-related training for new employees and
continued development and improvement of job skills of all staff of the
Department and County Departments; establish
criteria for and administer and maintain a program for granting employees
educational leave for specialized professional or technical study; and
co-ordinate such training, development, and educational activities with the
training program of the Illinois Department of Central Management Services
and with other
programs for training personnel established under this Section. The
Department may also make grants to public or other non-profit institutions
of higher learning for training personnel employed or preparing for
employment in the public aid programs and conduct special courses of study
or seminars for personnel by experts hired temporarily by the Illinois
Department.
(Source: P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/12-4.18) (from Ch. 23, par. 12-4.18)
Sec. 12-4.18.
Grants and gifts for public aid and related welfare purposes.
Accept, hold and administer in behalf of the State any grant, gift or legacy
of money, securities, or property to the Illinois
Department or to the State of Illinois for public aid or any related
welfare purpose.
From appropriations from the Assistance to the Homeless Fund, a special
fund in the State treasury, which is hereby created, provide grants to
not-for-profit organizations for the purpose of providing assistance to
homeless persons.
Grants, gifts, and legacies for employment and training programs for public
assistance clients shall be deposited into the Employment and Training Fund.
Grants, gifts, donations, and legacies for functions connected with the
administration of any medical program administered by the Illinois Department
shall be deposited into the Medical Special Purposes Trust
Fund created under Section 12-10.5.
(Source: P.A. 92-37, eff. 7-1-01.)
|
(305 ILCS 5/12-4.19) (from Ch. 23, par. 12-4.19)
Sec. 12-4.19.
Grants for Pilot Studies and Research.
Co-operate with the Federal Government, private foundations, persons,
corporations or other entities making grants of funds or offering the
services of technical assistants for pilot studies and other research
programs relating to effective methods of rehabilitation or the adequacy of
public aid and welfare programs, policies and procedures, and accept, hold
and administer grants made in connection therewith.
Grants for functions connected with the administration of any medical program
administered by the Illinois Department shall be deposited into the
Medical Special Purposes Trust Fund created under Section 12-10.5.
(Source: P.A. 92-37, eff. 7-1-01.)
|
(305 ILCS 5/12-4.20) (from Ch. 23, par. 12-4.20)
Sec. 12-4.20.
Appointment of statewide advisory committees.
Appoint, when and as it may deem necessary, statewide advisory
committees to provide professional or technical consultation in respect to
medical or dental or hospital care, general assistance, home economics, or
other special aspects of public aid and related welfare functions. The
members of the committees shall receive no compensation for their services,
other than expenses actually incurred in the performance of their official
duties. The number of members of each advisory committee shall be
determined by the Illinois Department. The committees shall consult with
and advise the Illinois Department in respect to problems and policies
incident to the administration of the particular Article or Articles of
this Code germane to their respective fields of competence.
The Illinois Department shall include a balanced representation of
recipients, service providers, representatives of community and welfare
advocacy groups, representatives of local governments dealing with public
aid, and representatives of the general public on all statewide advisory
committees appointed by it, except that Professional Advisory Committees created
under Section 5-5 of this Code to provide technical and
professional advice to the Department shall consist entirely of persons
practicing a particular profession.
(Source: P.A. 86-1475.)
|
(305 ILCS 5/12-4.20a) (from Ch. 23, par. 12-4.20a)
Sec. 12-4.20a.
(Repealed).
(Source: P.A. 92-84, eff. 7-1-02. Repealed internally, eff. 7-1-02.)
|
(305 ILCS 5/12-4.20b) (from Ch. 23, par. 12-4.20b)
Sec. 12-4.20b.
(Repealed).
(Source: P.A. 90-372, eff. 7-1-98. Repealed internally, eff. 7-1-98.)
|
(305 ILCS 5/12-4.20c) (from Ch. 23, par. 12-4.20c)
Sec. 12-4.20c.
Appointment of Child Support Advisory Committee.
Appoint
the Child Support Advisory Committee to be composed of members of the
General Assembly, the judiciary, the private bar, and others with expertise
specific to child support establishment and enforcement. Among the tasks of
the Committee shall be the periodic review of the State's child support
guidelines as required by the federal Family Support Act of 1988. Members
shall be appointed for one year terms commencing on January 1 of each year.
Each newly appointed Committee shall elect a chairperson from among its
members. Members shall serve without compensation, but shall be reimbursed
for expenses incurred in the performance of their duties. The Committee
shall meet at least quarterly and at other times at the call of the
chairperson or at the request of the Director.
(Source: P.A. 86-1347; 86-1432.)
|
(305 ILCS 5/12-4.20d) (from Ch. 23, par. 12-4.20d)
Sec. 12-4.20d.
Appointment of Social Services Advisory Council.
Appoint the Social Services Advisory Council, to be composed of 30
members, which shall include a balanced representation of recipients,
services providers, local governmental units, community and welfare
advocacy groups, academia and the general public. The Council shall advise
the Illinois Department regarding all aspects of assistance
delivered or contracted for under Articles III, IV, VI and IX of this Code
and other areas as deemed appropriate by the Director. In
appointing the first Council, the Director shall name 15 members to 2 year
terms and 15 members to 4 year terms, all of whom shall be appointed within
6 months of the effective date of this amendatory Act of 1991. All members
appointed thereafter shall serve 4 year terms. Members shall serve without
compensation other than reimbursement of expenses actually incurred in the
performance of their official duties. At its first meeting, the Council
shall select a chair from among its members. The Council shall meet at
least quarterly and at other times at the call of the chair.
(Source: P.A. 87-685.)
|
(305 ILCS 5/12-4.21) (from Ch. 23, par. 12-4.21)
Sec. 12-4.21.
Appointment of county welfare services committee.
Appoint, in the manner provided in Section 12-19, the members of the
County Welfare Services Committee in each county of the State.
(Source: Laws 1967, p. 122 .)
|
(305 ILCS 5/12-4.22) (from Ch. 23, par. 12-4.22)
Sec. 12-4.22.
Utilization of volunteers.
Adopt, in cooperation with the County Welfare Services Committee of each
county, a plan for the recruitment and full utilization of volunteers to
assist caseworkers and other staff in the performance of their
responsibilities in administering the public aid programs.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.23) (from Ch. 23, par. 12-4.23)
Sec. 12-4.23.
Disposition of obsolete equipment and supplies.
Sell, destroy, or otherwise dispose of office equipment and supplies of
the Illinois Department or the County Departments which have become
worthless by reason of obsolescence or condition of disrepair. If the
Illinois Department orders the sale of all or any portion of such equipment
or supplies, such sale may be either public or private and for cash, and
the proceeds thereof shall be paid into the General Revenue Fund.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.24) (from Ch. 23, par. 12-4.24)
Sec. 12-4.24.
Reports and recommendations.
Recommend to the Governor and General Assembly the enactment of such
legislation as it may deem necessary to improve public aid administration
in this State; submit to the Governor and the General Assembly such reports
as may be requested or as it may deem necessary; and make such other
reports as may be required to supply necessary information concerning
problems and policies relating to the administration of the public aid
programs.
(Source: Laws 1967, p. 122.)
|
(305 ILCS 5/12-4.24a) (from Ch. 23, par. 12-4.24a)
Sec. 12-4.24a. Report and recommendations concerning designated
shortage area. The Illinois Department shall analyze payments made to
providers of medical services under Article V of
this Code to
determine whether any special compensatory standard should be applied to
payments to such providers in designated shortage areas as defined in
Section 3.04 of the Underserved Health Care Provider Workforce Act. The Illinois Department shall, not later than June 30, 1990,
report to the Governor and the General Assembly concerning the results of
its analysis, and may provide by rule for adjustments in its payment rates
to medical service providers in such areas.
(Source: P.A. 101-118, eff. 7-22-19; 102-888, eff. 5-17-22.)
|
(305 ILCS 5/12-4.25) (from Ch. 23, par. 12-4.25)
Sec. 12-4.25. Medical assistance program; vendor participation.
(A) The Illinois Department may deny, suspend, or
terminate the eligibility of any person, firm, corporation, association,
agency, institution or other legal entity to participate as a vendor of
goods or services to recipients under the medical assistance program
under Article V, or may exclude any such
person or entity from participation as such a vendor, and may
deny, suspend, or recover payments, if after reasonable notice and opportunity for a
hearing the Illinois Department finds:
(a) Such vendor is not complying with the | ||
| ||
(b) Such vendor has failed to keep or make available | ||
| ||
(c) Such vendor has failed to furnish any information | ||
| ||
(d) Such vendor has knowingly made, or caused to be | ||
| ||
(e) Such vendor has furnished goods or services to a | ||
| ||
(f) The vendor; a person with management | ||
| ||
(1) was previously terminated, suspended, or | ||
| ||
(2) was a person with management responsibility | ||
| ||
(3) was an officer, or person owning, either | ||
| ||
(4) was an owner of a sole proprietorship or | ||
| ||
(f-1) Such vendor has a delinquent debt owed to the | ||
| ||
(g) The vendor; a person with management | ||
| ||
(1) has engaged in practices prohibited by | ||
| ||
(2) was a person with management responsibility | ||
| ||
(3) was an officer, or person owning, either | ||
| ||
(4) was an owner of a sole proprietorship or | ||
| ||
(h) The direct or indirect ownership of the vendor | ||
| ||
(A-5) The Illinois Department may deny, suspend, or terminate the
eligibility
of any person, firm, corporation, association, agency, institution, or other
legal entity to participate as a vendor of goods or services to recipients
under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor, if, after reasonable
notice and opportunity for a hearing, the Illinois Department finds that the
vendor; a person with management responsibility for a vendor; an officer or
person owning, either directly or indirectly, 5% or more of the shares of stock
or other evidences of ownership in a corporate vendor; an owner of a sole
proprietorship that is a vendor; or a partner in a partnership that is a vendor
has been convicted of an offense based on fraud or willful
misrepresentation related to any of
the following:
(1) The medical assistance program under Article V of | ||
| ||
(2) A medical assistance or health care program in | ||
| ||
(3) The Medicare program under Title XVIII of the | ||
| ||
(4) The provision of health care services.
(5) A violation of this Code, as provided in Article | ||
| ||
(A-10) The Illinois Department may deny, suspend, or terminate the eligibility of any person, firm, corporation, association, agency, institution, or other legal entity to participate as a vendor of goods or services to recipients under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor, if, after reasonable notice and opportunity for a hearing, the Illinois Department finds that (i) the vendor, (ii) a person with management responsibility for a vendor, (iii) an officer or person owning, either directly or indirectly, 5% or more of the shares of stock or other evidences of ownership in a corporate vendor, (iv) an owner of a sole proprietorship that is a vendor, or (v) a partner in a partnership that is a vendor has been convicted of an offense related to any of the following:
(1) Murder.
(2) A Class X felony under the Criminal Code of 1961 | ||
| ||
(3) Sexual misconduct that may subject recipients to | ||
| ||
(4) A criminal offense that may subject recipients to | ||
| ||
(5) A crime of fraud or dishonesty. (6) A crime involving a controlled substance. (7) A misdemeanor relating to fraud, theft, | ||
| ||
(A-15) The Illinois Department may deny the eligibility of any person, firm, corporation, association, agency, institution, or other legal entity to participate as a vendor of goods or services to recipients under the medical assistance program under Article V if, after reasonable notice and opportunity for a hearing, the Illinois Department finds: (1) The applicant or any person with management | ||
| ||
(2) The applicant or any person with management | ||
| ||
(3) There is a credible allegation of the use, | ||
| ||
(4) There is a credible allegation of a transfer of | ||
| ||
(5) There is a credible allegation of the use, | ||
| ||
(6) There is a credible allegation that the | ||
| ||
As used in this subsection, "credible allegation" is defined to include an allegation from any source, including, but not limited to, fraud hotline complaints, claims data mining, patterns identified through provider audits, civil actions filed under the Illinois False Claims Act, and law enforcement investigations. An allegation is considered to be credible when it has indicia of reliability. (B) The Illinois Department shall deny, suspend or terminate the
eligibility of any person, firm, corporation, association, agency,
institution or other legal entity to participate as a vendor of goods or
services to recipients under the medical assistance program under
Article V, or may
exclude any such person or entity from participation as such a
vendor:
(1) immediately, if such vendor is not properly | ||
| ||
(2) within 30 days of the date when such vendor's | ||
| ||
(3) if such vendor has been convicted of a violation | ||
| ||
(C) Upon termination, suspension, or exclusion of a vendor of goods or services from
participation in the medical assistance program authorized by this
Article, a person with management responsibility for such vendor during
the time of any conduct which served as the basis for that vendor's
termination, suspension, or exclusion is barred from participation in the medical assistance
program.
Upon termination, suspension, or exclusion of a corporate vendor, the officers and persons
owning, directly or indirectly, 5% or more of the shares of stock or
other evidences of ownership in the vendor during the time of any
conduct which served as the basis for that vendor's termination, suspension, or exclusion are
barred from participation in the medical assistance program. A person who
owns, directly or indirectly, 5% or more of the shares of stock or other
evidences of ownership in a terminated, suspended, or excluded vendor may not transfer his or
her ownership interest in that vendor to his or her spouse, child, brother,
sister, parent, grandparent, grandchild, uncle, aunt, niece, nephew, cousin, or
relative by marriage.
Upon termination, suspension, or exclusion of a sole proprietorship or partnership, the owner
or partners during the time of any conduct which served as the basis for
that vendor's termination, suspension, or exclusion are barred from participation in the medical
assistance program. The owner of a terminated, suspended, or excluded vendor that is a sole
proprietorship, and a partner in a terminated, suspended, or excluded vendor that is a partnership, may
not transfer his or her ownership or partnership interest in that vendor to his
or her spouse, child, brother, sister, parent, grandparent, grandchild, uncle,
aunt, niece, nephew, cousin, or relative by marriage.
A person who owns, directly or indirectly, 5% or more of the shares of stock or other evidences of ownership in a corporate or limited liability company vendor who owes a debt to the Department, if that vendor has not made payment arrangements acceptable to the Department, shall not transfer his or her ownership interest in that vendor, or vendor assets of any kind, to his or her spouse, child, brother, sister, parent, grandparent, grandchild, uncle, aunt, niece, nephew, cousin, or relative by marriage. Rules adopted by the Illinois Department to implement these
provisions shall specifically include a definition of the term
"management responsibility" as used in this Section. Such definition
shall include, but not be limited to, typical job titles, and duties and
descriptions which will be considered as within the definition of
individuals with management responsibility for a provider.
A vendor or a prior vendor who has been terminated, excluded, or suspended from the medical assistance program, or from another state or federal medical assistance or health care program, and any individual currently or previously barred from the medical assistance program, or from another state or federal medical assistance or health care program, as a result of being an officer or a person owning, directly or indirectly, 5% or more of the shares of stock or other evidences of ownership in a corporate or limited liability company vendor during the time of any conduct which served as the basis for that vendor's termination, suspension, or exclusion, may be required to post a surety bond as part of a condition of enrollment or participation in the medical assistance program. The Illinois Department shall establish, by rule, the criteria and requirements for determining when a surety bond must be posted and the value of the bond. A vendor or a prior vendor who has a debt owed to the Illinois Department and any individual currently or previously barred from the medical assistance program, or from another state or federal medical assistance or health care program, as a result of being an officer or a person owning, directly or indirectly, 5% or more of the shares of stock or other evidences of ownership in that corporate or limited liability company vendor during the time of any conduct which served as the basis for the debt, may be required to post a surety bond as part of a condition of enrollment or participation in the medical assistance program. The Illinois Department shall establish, by rule, the criteria and requirements for determining when a surety bond must be posted and the value of the bond. (D) If a vendor has been suspended from the medical assistance
program under Article V of the Code, the Director may require that such
vendor correct any deficiencies which served as the basis for the
suspension. The Director shall specify in the suspension order a specific
period of time, which shall not exceed one year from the date of the
order, during which a suspended vendor shall not be eligible to
participate. At the conclusion of the period of suspension the Director
shall reinstate such vendor, unless he finds that such vendor has not
corrected deficiencies upon which the suspension was based.
If a vendor has been terminated, suspended, or excluded from the medical assistance program
under Article V, such vendor shall be barred from participation for at
least one year, except that if a vendor has been terminated, suspended, or excluded based on a
conviction of a
violation of Article VIIIA or a conviction of a felony based on fraud or a
willful misrepresentation related to (i) the medical assistance program under
Article V, (ii) a federal or another state's medical assistance or health care program, or (iii) the provision of health care services, then
the vendor shall be barred from participation for 5 years or for the length of
the vendor's sentence for that conviction, whichever is longer. At the end of
one year a vendor who has been terminated, suspended, or excluded
may apply for reinstatement to the program. Upon proper application to
be reinstated such vendor may be deemed eligible by the Director
providing that such vendor meets the requirements for eligibility under
this Code. If such vendor is deemed not eligible for
reinstatement, he
shall be barred from again applying for reinstatement for one year from the
date his application for reinstatement is denied.
A vendor whose termination, suspension, or exclusion from participation in the Illinois medical
assistance program under Article V was based solely on an action by a
governmental entity other than the Illinois Department may, upon reinstatement
by that governmental entity or upon reversal of the termination, suspension, or exclusion, apply for
rescission of the termination, suspension, or exclusion from participation in the Illinois medical
assistance program. Upon proper application for rescission, the vendor may be
deemed eligible by the Director if the vendor meets the requirements for
eligibility under this Code.
If a vendor has been terminated, suspended, or excluded and reinstated to the medical assistance
program under Article V and the vendor is terminated, suspended, or excluded a second or subsequent
time from the medical assistance program, the vendor shall be barred from
participation for at least 2 years, except that if a vendor has been
terminated, suspended, or excluded a second time based on a
conviction of a violation of Article VIIIA or a conviction of a felony based on
fraud or a willful misrepresentation related to (i) the medical assistance
program under Article V, (ii) a federal or another state's medical assistance or health care program, or (iii) the provision of health care
services, then the vendor shall be barred from participation for life. At
the end of 2 years, a vendor who has
been terminated, suspended, or excluded may apply for reinstatement to the program. Upon application
to be reinstated, the vendor may be deemed eligible if the vendor meets the
requirements for eligibility under this Code. If the vendor is deemed not
eligible for reinstatement, the vendor shall be barred from again applying for
reinstatement for 2 years from the date the vendor's application for
reinstatement is denied.
(E) The Illinois Department may recover money improperly or
erroneously paid, or overpayments, either by setoff, crediting against
future billings or by requiring direct repayment to the Illinois
Department. The Illinois Department may suspend or deny payment, in whole or in part, if such payment would be improper or erroneous or would otherwise result in overpayment. (1) Payments may be suspended, denied, or recovered | ||
| ||
(2) Notwithstanding any other provision of law, if a | ||
| ||
(E-5) Civil monetary penalties. (1) As used in this subsection (E-5): (a) "Knowingly" means that a person, with respect | ||
| ||
(b) "Overpayment" means any funds that a person | ||
| ||
(c) "Remuneration" means the offer or transfer of | ||
| ||
(d) "Should know" means that a person, with | ||
| ||
(2) Any person (including a vendor, provider, | ||
| ||
(a) knowingly presents or causes to be presented | ||
| ||
(i) is for a medical or other item or service | ||
| ||
(ii) is for a medical or other item or | ||
| ||
(iii) is presented for a vendor physician's | ||
| ||
(AA) was not licensed as a physician; (BB) was licensed as a physician but such | ||
| ||
(CC) represented to the patient at the | ||
| ||
(iv) is for a medical or other item or | ||
| ||
(v) is for a pattern of medical or other | ||
| ||
(b) knowingly presents or causes to be presented | ||
| ||
(c) knowingly gives or causes to be given to any | ||
| ||
(d) in the case of a person who is not an | ||
| ||
(i) retains a direct or indirect ownership or | ||
| ||
(ii) is an officer or managing employee of | ||
| ||
(e) offers or transfers remuneration to any | ||
| ||
(f) arranges or contracts (by employment or | ||
| ||
(g) commits an act described in subsection (b) or | ||
| ||
(h) knowingly makes, uses, or causes to be made | ||
| ||
(i) fails to grant timely access, upon reasonable | ||
| ||
(j) orders or prescribes a medical or other item | ||
| ||
(k) knowingly makes or causes to be made any | ||
| ||
(l) knows of an overpayment and does not report | ||
| ||
shall be subject, in addition to any other penalties that | ||
| ||
(3) In addition, the Director or his or her designee | ||
| ||
(4) The Illinois Department may seek the civil | ||
| ||
(5) Any final order, decision, or other determination | ||
| ||
(6)(a) If a person has received an overpayment, the | ||
| ||
(i) report and return the overpayment to the | ||
| ||
(ii) notify the Department in writing of the | ||
| ||
(b) An overpayment must be reported and returned | ||
| ||
(i) the date which is 60 days after the date on | ||
| ||
(ii) the date any corresponding cost report is | ||
| ||
(E-10) A vendor who disputes an overpayment identified as part of a Department audit shall utilize the Department's self-referral disclosure protocol as set forth under this Code to identify, investigate, and return to the Department any undisputed audit overpayment amount. Unless the disputed overpayment amount is subject to a fraud payment suspension, or involves a termination sanction, the Department shall defer the recovery of the disputed overpayment amount up to one year after the date of the Department's final audit determination, or earlier, or as required by State or federal law. If the administrative hearing extends beyond one year, and such delay was not caused by the request of the vendor, then the Department shall not recover the disputed overpayment amount until the date of the final administrative decision. If a final administrative decision establishes that the disputed overpayment amount is owed to the Department, then the amount shall be immediately due to the Department. The Department shall be entitled to recover interest from the vendor on the overpayment amount from the date of the overpayment through the date the vendor returns the overpayment to the Department at a rate not to exceed the Wall Street Journal Prime Rate, as published from time to time, but not to exceed 5%. Any interest billed by the Department shall be due immediately upon receipt of the Department's billing statement. (F) The Illinois Department may withhold payments to any vendor
or alternate payee prior to or during the pendency of any audit or proceeding under this Section, and through the pendency of any administrative appeal or administrative review by any court proceeding. The Illinois Department shall
state by rule with as much specificity as practicable the conditions
under which payments will not be withheld under this Section. Payments may be denied for bills
submitted with service dates occurring during the pendency of a
proceeding, after a final decision has been rendered, or after the conclusion of any administrative appeal, where the final administrative decision is to terminate, exclude, or suspend
eligibility to participate in the medical assistance program. The
Illinois Department shall state by rule with as much specificity as
practicable the conditions under which payments will not be denied for
such bills.
The Illinois
Department shall state by rule a process and criteria by
which a vendor or alternate payee may request full or partial release of payments withheld under
this subsection. The Department must complete a proceeding under this Section
in a timely manner.
Notwithstanding recovery allowed under subsection (E) or this subsection (F), the Illinois Department may withhold payments to any vendor or alternate payee who is not properly licensed, certified, or in compliance with State or federal agency regulations. Payments may be denied for bills submitted with service dates occurring during the period of time that a vendor is not properly licensed, certified, or in compliance with State or federal regulations. Facilities licensed under
the Nursing Home Care Act shall have payments denied or
withheld pursuant to subsection (I) of this Section. (F-5) The Illinois Department may temporarily withhold payments to
a vendor or alternate payee if any of the following individuals have been indicted or
otherwise charged under a law of the United States or this or any other state
with an offense that is based on alleged fraud or willful
misrepresentation on the part of the individual related to (i) the medical
assistance program under Article V of this Code, (ii) a federal or another state's medical assistance
or health care program, or (iii) the provision of health care services:
(1) If the vendor or alternate payee is a | ||
| ||
(2) If the vendor is a sole proprietorship: the owner | ||
| ||
(3) If the vendor or alternate payee is a | ||
| ||
(4) If the vendor or alternate payee is any other | ||
| ||
If the Illinois Department withholds payments to a vendor or alternate payee under this
subsection, the Department shall not release those payments to the vendor
or alternate payee
while any criminal proceeding related to the indictment or charge is pending
unless the Department determines that there is good cause to release the
payments before completion of the proceeding. If the indictment or charge
results in the individual's conviction, the Illinois Department shall retain
all withheld
payments, which shall be considered forfeited to the Department. If the
indictment or charge does not result in the individual's conviction, the
Illinois Department
shall release to the vendor or alternate payee all withheld payments.
(F-10) If the Illinois Department establishes that the vendor or alternate payee owes a debt to the Illinois Department, and the vendor or alternate payee subsequently fails to pay or make satisfactory payment arrangements with the Illinois Department for the debt owed, the Illinois Department may seek all remedies available under the law of this State to recover the debt, including, but not limited to, wage garnishment or the filing of claims or liens against the vendor or alternate payee. (F-15) Enforcement of judgment. (1) Any fine, recovery amount, other sanction, or | ||
| ||
(2) After expiration of the period in which judicial | ||
| ||
(3) In any case in which any person or entity has | ||
| ||
(4) Upon being recorded in the manner required by | ||
| ||
(5) The Director may set aside any judgment entered | ||
| ||
(G) The provisions of the Administrative Review Law, as now or hereafter
amended, and the rules adopted pursuant
thereto, shall apply to and govern all proceedings for the judicial
review of final administrative decisions of the Illinois Department
under this Section. The term "administrative decision" is defined as in
Section 3-101 of the Code of Civil Procedure.
(G-5) Vendors who pose a risk of fraud, waste, abuse, or harm.
(1) Notwithstanding any other provision in this | ||
| ||
(2) Vendors who pose a risk of fraud, waste, abuse, | ||
| ||
(A) In the case of a vendor that is a | ||
| ||
(B) In the case of a vendor that is a | ||
| ||
(C) In the case of a vendor that is a sole | ||
| ||
(D) Each officer or manager of the vendor.
Each such vendor shall be responsible for payment of | ||
| ||
(3) Vendors who pose a risk of fraud, waste, abuse, | ||
| ||
(4) The Department, or its agents, may refuse to | ||
| ||
(A) the Department has initiated a notice of | ||
| ||
(B) the Department has issued notification of its | ||
| ||
(C) the Department has issued a notification of | ||
| ||
(5) As used in this subsection, the following terms | ||
| ||
(A) "Fraud" means an intentional deception or | ||
| ||
(B) "Abuse" means provider practices that are | ||
| ||
(C) "Waste" means the unintentional misuse of | ||
| ||
(D) "Harm" means physical, mental, or monetary | ||
| ||
(G-6) The Illinois Department, upon making a determination based upon information in the possession of the Illinois Department that continuation of participation in the medical assistance program by a vendor would constitute an immediate danger to the public, may immediately suspend such vendor's participation in the medical assistance program without a hearing. In instances in which the Illinois Department immediately suspends the medical assistance program participation of a vendor under this Section, a hearing upon the vendor's participation must be convened by the Illinois Department within 15 days after such suspension and completed without appreciable delay. Such hearing shall be held to determine whether to recommend to the Director that the vendor's medical assistance program participation be denied, terminated, suspended, placed on provisional status, or reinstated. In the hearing, any evidence relevant to the vendor constituting an immediate danger to the public may be introduced against such vendor; provided, however, that the vendor, or his or her counsel, shall have the opportunity to discredit, impeach, and submit evidence rebutting such evidence. (H) Nothing contained in this Code shall in any way limit or
otherwise impair the authority or power of any State agency responsible
for licensing of vendors.
(I) Based on a finding of noncompliance on the part of a nursing home with
any requirement for certification under Title XVIII or XIX of the Social
Security Act (42 U.S.C. Sec. 1395 et seq. or 42 U.S.C. Sec. 1396 et seq.), the
Illinois Department may impose one or more of the following remedies after
notice to the facility:
(1) Termination of the provider agreement.
(2) Temporary management.
(3) Denial of payment for new admissions.
(4) Civil money penalties.
(5) Closure of the facility in emergency situations | ||
| ||
(6) State monitoring.
(7) Denial of all payments when the U.S. Department | ||
| ||
The Illinois Department shall by rule establish criteria governing continued
payments to a nursing facility subsequent to termination of the facility's
provider agreement if, in the sole discretion of the Illinois Department,
circumstances affecting the health, safety, and welfare of the facility's
residents require those continued payments. The Illinois Department may
condition those continued payments on the appointment of temporary management,
sale of the facility to new owners or operators, or other
arrangements that the Illinois Department determines best serve the needs of
the facility's residents.
Except in the case of a facility that has a right to a hearing on the finding
of noncompliance before an agency of the federal government, a facility may
request a hearing before a State agency on any finding of noncompliance within
60 days after the notice of the intent to impose a remedy. Except in the case
of civil money penalties, a request for a hearing shall not delay imposition of
the penalty. The choice of remedies is not appealable at a hearing. The level
of noncompliance may be challenged only in the case of a civil money penalty.
The Illinois Department shall provide by rule for the State agency that will
conduct the evidentiary hearings.
The Illinois Department may collect interest on unpaid civil money penalties.
The Illinois Department may adopt all rules necessary to implement this
subsection (I).
(J) The Illinois Department, by rule, may permit individual practitioners to designate that Department payments that may be due the practitioner be made to an alternate payee or alternate payees. (a) Such alternate payee or alternate payees shall be | ||
| ||
(b) If a practitioner designates an alternate payee, | ||
| ||
(c) Registration as an alternate payee or alternate | ||
| ||
(d) The Illinois Department may seek a revocation of | ||
| ||
(1) the alternate payee is not complying with the | ||
| ||
(2) the alternate payee has failed to keep or | ||
| ||
(3) the alternate payee has failed to furnish any | ||
| ||
(4) the alternate payee has knowingly made, or | ||
| ||
(5) the alternate payee, a person with management | ||
| ||
(a) was previously terminated, suspended, or | ||
| ||
(b) was a person with management | ||
| ||
(c) was an officer, or person owning, either | ||
| ||
(d) was an owner of a sole proprietorship or | ||
| ||
(6) the alternate payee, a person with management | ||
| ||
(a) has engaged in conduct prohibited by | ||
| ||
(b) was a person with management | ||
| ||
(c) was an officer, or person owning, either | ||
| ||
(d) was an owner of a sole proprietorship or | ||
| ||
(7) the direct or indirect ownership of the | ||
| ||
(K) The Illinois Department of Healthcare and Family Services may withhold payments, in whole or in part, to a provider or alternate payee where there is credible evidence, received from State or federal law enforcement or federal oversight agencies or from the results of a preliminary Department audit, that the circumstances giving rise to the need for a withholding of payments may involve fraud or willful misrepresentation under the Illinois Medical Assistance program. The Department shall by rule define what constitutes "credible" evidence for purposes of this subsection. The Department may withhold payments without first notifying the provider or alternate payee of its intention to withhold such payments. A provider or alternate payee may request a reconsideration of payment withholding, and the Department must grant such a request. The Department shall state by rule a process and criteria by which a provider or alternate payee may request full or partial release of payments withheld under this subsection. This request may be made at any time after the Department first withholds such payments. (a) The Illinois Department must send notice of its | ||
| ||
(1) State that payments are being withheld in | ||
| ||
(2) State that the withholding is for a temporary | ||
| ||
(3) Specify, when appropriate, which type or | ||
| ||
(4) Inform the provider or alternate payee of the | ||
| ||
(5) Inform the provider or alternate payee that a | ||
| ||
(b) All withholding-of-payment actions under this | ||
| ||
(1) The Illinois Department or the prosecuting | ||
| ||
(2) Legal proceedings related to the provider's | ||
| ||
(3) The withholding of payments for a period of 3 | ||
| ||
(c) The Illinois Department may adopt all rules | ||
| ||
(K-5) The Illinois Department may withhold payments, in whole or in part, to a provider or alternate payee upon initiation of an audit, quality of care review, investigation when there is a credible allegation of fraud, or the provider or alternate payee demonstrating a clear failure to cooperate with the Illinois Department such that the circumstances give rise to the need for a withholding of payments. As used in this subsection, "credible allegation" is defined to include an allegation from any source, including, but not limited to, fraud hotline complaints, claims data mining, patterns identified through provider audits, civil actions filed under the Illinois False Claims Act, and law enforcement investigations. An allegation is considered to be credible when it has indicia of reliability. The Illinois Department may withhold payments without first notifying the provider or alternate payee of its intention to withhold such payments. A provider or alternate payee may request a hearing or a reconsideration of payment withholding, and the Illinois Department must grant such a request. The Illinois Department shall state by rule a process and criteria by which a provider or alternate payee may request a hearing or a reconsideration for the full or partial release of payments withheld under this subsection. This request may be made at any time after the Illinois Department first withholds such payments. (a) The Illinois Department must send notice of its | ||
| ||
(1) State that payments are being withheld in | ||
| ||
(2) State that the withholding is for a temporary | ||
| ||
(3) Specify, when appropriate, which type or | ||
| ||
(4) Inform the provider or alternate payee of the | ||
| ||
(5) Inform the provider or alternate payee that a | ||
| ||
(b) All withholding of payment actions under this | ||
| ||
(1) The Illinois Department determines that there | ||
| ||
(2) The withholding of payments has lasted for a | ||
| ||
(c) The Illinois Department may adopt all rules | ||
| ||
(L) The Illinois Department shall establish a protocol to enable health care providers to disclose an actual or potential violation of this Section pursuant to a self-referral disclosure protocol, referred to in this subsection as "the protocol". The protocol shall include direction for health care providers on a specific person, official, or office to whom such disclosures shall be made. The Illinois Department shall post information on the protocol on the Illinois Department's public website. The Illinois Department may adopt rules necessary to implement this subsection (L). In addition to other factors that the Illinois Department finds appropriate, the Illinois Department may consider a health care provider's timely use or failure to use the protocol in considering the provider's failure to comply with this Code. (M) Notwithstanding any other provision of this Code, the Illinois Department, at its discretion, may exempt an entity licensed under the Nursing Home Care Act, the ID/DD Community Care Act, or the MC/DD Act from the provisions of subsections (A-15), (B), and (C) of this Section if the licensed entity is in receivership. (Source: P.A. 102-538, eff. 8-20-21.)
|
(305 ILCS 5/12-4.25a) (from Ch. 23, par. 12-4.25a)
Sec. 12-4.25a.
Any vendor of physician services who shall be the
subject of a medical quality review by the Illinois Department shall have
the right to consult with another physician or physicians to assist in
understanding the procedures and interpretations of the Illinois
Department and to assist in interpreting, as an experienced or expert
consultant or witness, the quality of care, its relation to a prevailing
standard of care, and standards of documentation of the Illinois
Department. The consulting physician or physicians may be present at the
review meeting where the provider is present. The assistance offered by
the consulting physician or physicians shall respect the
confidentiality of recipient patient relations with the treating physician
in relation to consultation on treatment matters. Nothing in this
subsection shall be deemed to waive the requirements of the Medical Patient
Rights Act as it relates to patient privacy and confidentiality.
(Source: P.A. 87-399.)
|
(305 ILCS 5/12-4.25b) (from Ch. 23, par. 12-4.25b)
Sec. 12-4.25b.
A vendor of physician services who is the subject of
medical quality review by the Illinois Department shall have the right to
record that portion of any Medical Quality Review Committee meeting or
hearing with the Illinois Department, at which the vendor is present and
participates. The recording shall be privileged and confidential
and shall not be disclosed, except however if the Illinois Department
initiates action to deny, suspend or terminate the vendor's participation
in the Medicaid program, the recording may be disclosed to an attorney or
physician consultant to prepare a defense.
(Source: P.A. 87-399.)
|
(305 ILCS 5/12-4.25c) (from Ch. 23, par. 12-4.25c)
Sec. 12-4.25c.
Where a medical provider's medical practices are under
review by the Illinois Department and the provider is board certified in a
specialty by a nationally recognized specialty board and practicing in the
specialty, the Illinois Department should attempt to utilize a medical
practitioner with like qualifications to assist in reviewing the medical
practices of the provider under review in the areas of practice within the
specialty.
(Source: P.A. 87-399.)
|
(305 ILCS 5/12-4.26) (from Ch. 23, par. 12-4.26)
Sec. 12-4.26.
Scope of Application.) The Illinois Department may terminate
or suspend a vendor pursuant to the authority and powers conferred in Section
12-4.25, only subsequent to the effective date of this amendatory Act.
However the authority and powers are expressly declared to be retroactive
to the extent that conduct and activities of vendors engaged in prior to
the effective date of this amendatory Act may be relied upon as the basis
for terminating or suspending eligibility to participate in the Medical
Assistance Program, where the vendor had actual or constructive knowledge
of the requirements which applied to his conduct or activities.
(Source: P.A. 80-2nd SS-2.)
|
(305 ILCS 5/12-4.27) (from Ch. 23, par. 12-4.27)
Sec. 12-4.27.
Factual Determinations.) Factual determinations made by
the Department in administrative hearings initiated prior to the effective
date of this amendatory Act and which involve issues of fact relating to
activities which constitute grounds for termination pursuant to this amendatory
Act, shall be reviewed by the Director and may be used as grounds for approval
or denial of applications to participate, for termination of eligibility,
or for recovery of money, without conducting a new administrative proceeding.
(Source: P.A. 80-2nd SS-2.)
|
(305 ILCS 5/12-4.28) (from Ch. 23, par. 12-4.28)
Sec. 12-4.28.
(Repealed).
(Source: P.A. 83-1362. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/12-4.29) (from Ch. 23, par. 12-4.29)
Sec. 12-4.29.
Youth employability and career development programs.
The
Illinois Department may establish and administer community-based programs
providing comprehensive, long-term intervention strategies to increase
future employability and career development among high risk youth, as
required by "An Act in relation to the provision of assistance to certain
persons, amending Acts named therein", certified December 2, 1987.
The Illinois Department may contract with private nonprofit
organizations or units of local government to administer and deliver
services pursuant to the above-named Act.
(Source: P.A. 85-1209.)
|
(305 ILCS 5/12-4.30) (from Ch. 23, par. 12-4.30)
Sec. 12-4.30. Demonstration programs. Establish
demonstration programs, authorized by federal law and pursuant to State
regulations. Such demonstration programs may
include, but shall not be limited to: cashing out welfare benefits such as,
but not limited to, food stamps, energy assistance payments and medical
benefits; providing medical benefits through the purchase of health
insurance; and capping grant amounts at certain levels regardless of the
number of persons in the case. Such demonstration programs may be limited
to particular geographic areas.
(Source: P.A. 93-632, eff. 2-1-04.)
|
(305 ILCS 5/12-4.31)
Sec. 12-4.31.
(Repealed).
(Source: P.A. 90-655, eff. 7-30-98. Repealed by P.A. 90-790, eff.
8-14-98.)
|
(305 ILCS 5/12-4.32)
Sec. 12-4.32.
(Repealed).
(Source: P.A. 90-9, eff. 7-1-97. Repealed by P.A. 90-564, eff. 12-22-97.)
|
(305 ILCS 5/12-4.33)
Sec. 12-4.33. Welfare reform research and accountability.
(a) The Illinois Department shall collect and report
upon all data in connection with federally funded or assisted welfare programs
as federal law may require, including, but not limited to, Section 411 of the
Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and its
implementing regulations and any amendments thereto as may from time to time be
enacted.
(b) In addition to and on the same schedule as the data collection required
by federal law and subsection (a), the Department shall collect and report on
further information with respect to the Temporary Assistance for Needy Families
("TANF") program, as follows:
(1) With respect to denials of applications for | ||
| ||
(2) With respect to all terminations of benefits, all | ||
| ||
(c) The Department shall collect all of the same data as set forth in
subsections (a) and (b), and report it on the same schedule, with respect to
all cash assistance benefits provided to families that are not funded from the
TANF program
federal block grant or are not otherwise required to be included in the data
collection and reporting in subsections (a) and (b).
(d) Whether or not reports under this Section must be submitted to the
federal government, they shall be considered public and they shall be promptly
made available to
the public at the end of
each fiscal year, free of charge upon request. The data underlying the reports
shall be made available to
academic institutions and public policy organizations
involved in the study of welfare issues or programs
and redacted to conform with applicable privacy
laws. The cost shall be no more than that incurred by the Department in
assembling and delivering the data.
(e) (Blank).
(f) (Blank).
(Source: P.A. 95-322, eff. 1-1-08.)
|
(305 ILCS 5/12-4.34)
Sec. 12-4.34.
Services to noncitizens.
(a) Subject to specific appropriation for this purpose and notwithstanding
Sections 1-11 and 3-1 of this Code, the Department of Human Services is
authorized to provide services to legal immigrants, including but not limited
to naturalization and nutrition services and financial assistance. The nature
of these services, payment levels, and eligibility conditions shall be
determined by rule.
(b) The Illinois Department is authorized to lower the payment levels
established under this subsection or take such other actions during the
fiscal year as are necessary to ensure that payments under this subsection
do not exceed the amounts appropriated for this purpose. These changes
may be accomplished by emergency rule under Section 5-45 of the Illinois
Administrative Procedure Act, except that the limitation on the number of
emergency rules that may be adopted in a 24-month period shall not apply.
(Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10, eff.
6-11-01; 92-597, eff. 6-28-02.)
|
(305 ILCS 5/12-4.35)
Sec. 12-4.35. Medical services for certain noncitizens.
(a) Notwithstanding
Section 1-11 of this Code or Section 20(a) of the Children's Health Insurance
Program Act, the Department of Healthcare and Family Services may provide medical services to
noncitizens who have not yet attained 19 years of age and who are not eligible
for medical assistance under Article V of this Code or under the Children's
Health Insurance Program created by the Children's Health Insurance Program Act
due to their not meeting the otherwise applicable provisions of Section 1-11
of this Code or Section 20(a) of the Children's Health Insurance Program Act.
The medical services available, standards for eligibility, and other conditions
of participation under this Section shall be established by rule by the
Department; however, any such rule shall be at least as restrictive as the
rules for medical assistance under Article V of this Code or the Children's
Health Insurance Program created by the Children's Health Insurance Program
Act.
(a-5) Notwithstanding Section 1-11 of this Code, the Department of Healthcare and Family Services may provide medical assistance in accordance with Article V of this Code to noncitizens over the age of 65 years of age who are not eligible for medical assistance under Article V of this Code due to their not meeting the otherwise applicable provisions of Section 1-11 of this Code, whose income is at or below 100% of the federal poverty level after deducting the costs of medical or other remedial care, and who would otherwise meet the eligibility requirements in Section 5-2 of this Code. The medical services available, standards for eligibility, and other conditions of participation under this Section shall be established by rule by the Department; however, any such rule shall be at least as restrictive as the rules for medical assistance under Article V of this Code. (a-6) By May 30, 2022, notwithstanding Section 1-11 of this Code, the Department of Healthcare and Family Services may provide medical services to noncitizens 55 years of age through 64 years of age who (i) are not eligible for medical assistance under Article V of this Code due to their not meeting the otherwise applicable provisions of Section 1-11 of this Code and (ii) have income at or below 133% of the federal poverty level plus 5% for the applicable family size as determined under applicable federal law and regulations. Persons eligible for medical services under Public Act 102-16 shall receive benefits identical to the benefits provided under the Health Benefits Service Package as that term is defined in subsection (m) of Section 5-1.1 of this Code. (a-7) By July 1, 2022, notwithstanding Section 1-11 of this Code, the Department of Healthcare and Family Services may provide medical services to noncitizens 42 years of age through 54 years of age who (i) are not eligible for medical assistance under Article V of this Code due to their not meeting the otherwise applicable provisions of Section 1-11 of this Code and (ii) have income at or below 133% of the federal poverty level plus 5% for the applicable family size as determined under applicable federal law and regulations. The medical services available, standards for eligibility, and other conditions of participation under this Section shall be established by rule by the Department; however, any such rule shall be at least as restrictive as the rules for medical assistance under Article V of this Code. In order to provide for the timely and expeditious implementation of this subsection, the Department may adopt rules necessary to establish and implement this subsection through the use of emergency rulemaking in accordance with Section 5-45 of the Illinois Administrative Procedure Act. For purposes of the Illinois Administrative Procedure Act, the General Assembly finds that the adoption of rules to implement this subsection is deemed necessary for the public interest, safety, and welfare. (a-10) Notwithstanding the provisions of Section 1-11, the Department shall cover immunosuppressive drugs and related services associated with post-kidney transplant management, excluding long-term care costs, for noncitizens who: (i) are not eligible for comprehensive medical benefits; (ii) meet the residency requirements of Section 5-3; and (iii) would meet the financial eligibility requirements of Section 5-2. (b) The Department is authorized to take any action that would not otherwise be prohibited by applicable law, including, without
limitation, cessation or limitation of enrollment, reduction of available medical services,
and changing standards for eligibility, that is deemed necessary by the
Department during a State fiscal year to assure that payments under this
Section do not exceed available funds.
(c) (Blank).
(d) (Blank).
(e) In order to provide for the expeditious and effective ongoing implementation of this Section, the Department may adopt rules through the use of emergency rulemaking in accordance with Section 5-45 of the Illinois Administrative Procedure Act, except that the limitation on the number of emergency rules that may be adopted in a 24-month period shall not apply. For purposes of the Illinois Administrative Procedure Act, the General Assembly finds that the adoption of rules to implement this Section is deemed necessary for the public interest, safety, and welfare. This subsection (e) is inoperative on and after July 1, 2025. (Source: P.A. 102-16, eff. 6-17-21; 102-43, Article 25, Section 25-15, eff. 7-6-21; 102-43, Article 45, Section 45-5, eff. 7-6-21; 102-813, eff. 5-13-22; 102-1037, eff. 6-2-22; 103-102, eff. 6-16-23.)
|
(305 ILCS 5/12-4.36)
Sec. 12-4.36. (Repealed).
(Source: P.A. 95-622, eff. 9-17-07. Repealed by P.A. 97-689, eff. 6-14-12.)
|
(305 ILCS 5/12-4.37) Sec. 12-4.37. Children's Healthcare Partnership Pilot Program. (a) The Department of Healthcare and Family Services, in cooperation with the Department of Human Services, shall establish a Children's Healthcare Partnership Pilot Program in Sangamon County to fund the provision of various health care services by a single provider, or a group of providers that have entered into an agreement for that purpose, at a single location in the county. Services covered under the pilot program shall include, but need not be limited to, family practice, pediatric, nursing (including advanced practice registered nursing), psychiatric, dental, and vision services. The Departments shall fund the provision of all services provided under the pilot program using a rate structure that is cost-based. To be selected by the Departments as the provider of health care services under the pilot program, a provider or group of providers must serve a disproportionate share of low-income or indigent patients, including recipients of medical assistance under Article V of this Code. The Departments shall adopt rules as necessary to implement this Section. (b) Implementation of this Section is contingent on federal approval. The Department of Healthcare and Family Services shall take appropriate action by January 1, 2010 to seek federal approval. (c) This Section is inoperative if the provider of health care services under the pilot program receives designation as a Federally Qualified Health Center (FQHC) or FQHC Look-Alike.
(Source: P.A. 100-513, eff. 1-1-18 .) |
(305 ILCS 5/12-4.38)
Sec. 12-4.38. Special FamilyCare provisions. The Department of Healthcare and Family Services may submit to the Comptroller, and the Comptroller is authorized to pay, on behalf of persons enrolled in the FamilyCare Program, claims for services rendered to an enrollee during the period beginning October 1, 2007, and ending on the effective date of any rules adopted to implement the provisions of this amendatory Act of the 96th General Assembly. The authorization for payment of claims applies only to bona fide claims for payment for services rendered. Any claim for payment which is authorized pursuant to the provisions of this amendatory Act of the 96th General Assembly must adhere to all other applicable rules, regulations, and requirements.
(Source: P.A. 96-20, eff. 6-30-09; 97-689, eff. 6-14-12.) |
(305 ILCS 5/12-4.39) Sec. 12-4.39. Dental clinic grant program. (a) Grant program. On and after July 1, 2012, and subject to funding availability, the Department of Healthcare and Family Services may administer a grant program. The purpose of this grant program shall be to build the public infrastructure for dental care and to make grants to local health departments, federally qualified health clinics (FQHCs), and rural health clinics (RHCs) for development of comprehensive dental clinics for dental care services. The primary purpose of these new dental clinics will be to increase dental access for low-income and Department of Healthcare and Family Services clients who have no dental arrangements with a dental provider in a project's service area. The dental clinic must be willing to accept out-of-area clients who need dental services, including emergency services for adults and Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-referral children. Medically Underserved Areas (MUAs) and Health Professional Shortage Areas (HPSAs) shall receive special priority for grants under this program. (b) Eligible applicants. The following entities are eligible to apply for grants: (1) Local health departments. (2) Federally Qualified Health Centers (FQHCs). (3) Rural health clinics (RHCs). (c) Use of grant moneys. Grant moneys must be used to support projects that develop dental services to meet the dental health care needs of Department of Healthcare and Family Services Dental Program clients.
Grant moneys must be used for operating expenses, including, but not limited to: insurance; dental supplies and equipment; dental support services; and renovation expenses.
Grant moneys may not be used to offset existing indebtedness, supplant existing funds, purchase real property, or pay for personnel service salaries for dental employees. (d) Application process. The Department shall establish procedures for applying for dental clinic grants.
(Source: P.A. 96-67, eff. 7-23-09; 96-1000, eff. 7-2-10; 97-689, eff. 6-14-12.) |
(305 ILCS 5/12-4.40) Sec. 12-4.40. Payment Recapture Audits. The Department of Healthcare and Family Services is authorized to contract with third-party entities to conduct Payment Recapture Audits to detect and recapture payments made in error or as a result of fraud or abuse. Payment Recapture Audits under this Section may be performed in conjunction with similar audits performed under federal authorization. A Payment Recapture Audit shall include the process of identifying improper payments paid to providers or other entities whereby accounting specialists and fraud examination specialists examine payment records and uncover such problems as duplicate payments, payments for services not rendered, overpayments, payments for unauthorized services, and fictitious vendors. This audit may include the use of professional and specialized auditors on a contingency basis, with compensation tied to the identification of misspent funds. The use of Payment Recapture Audits does not preclude the Office of the Inspector General or any other authorized agency employee from performing activities to identify and prevent improper payments.
(Source: P.A. 96-942, eff. 6-25-10; 97-333, eff. 8-12-11.) |
(305 ILCS 5/12-4.41) Sec. 12-4.41. Public Benefits Fraud Protection Task Force. (a) Purpose. The purpose of the Public Benefits Fraud Protection Task Force is to conduct a thorough review of the nature of public assistance fraud in the State of Illinois; to ascertain the feasibility of implementing a mechanism to determine the pervasiveness and frequency of public assistance fraud; to calculate the detriment of public assistance fraud to the financial status and socio-economic status of public aid recipients specifically and Illinois taxpayers generally; and to determine if more stringent penalties or compassionate procedures are necessary. (b) Definitions. As used in this Section: "Task Force" means the Public Benefits Fraud Protection Task Force. "Public assistance" or "public aid" includes, without limitation, Medicaid, TANF, the Illinois LINK Program, General Assistance, Transitional Assistance, the Supplemental Nutrition Assistance Program, and the Child Care Assistance Program. (c) The Public Benefits Fraud Protection Task Force. The Public Benefits Fraud Protection Task Force is created. The Task Force shall be composed of 17 members appointed as follows: (1) One member of the Illinois Senate appointed by | ||
| ||
(2) One member of the Illinois Senate appointed by | ||
| ||
(3) One member of the Illinois House of | ||
| ||
(4) One member of the Illinois House of | ||
| ||
(5) The following persons, or their designees: the | ||
| ||
(6) The Director of the Illinois Department on Aging, | ||
| ||
(7) The Executive Inspector General appointed by the | ||
| ||
(8) The Inspector General of the Illinois Department | ||
| ||
(9) A representative from the Office of the Attorney | ||
| ||
(10) Three persons, who are not currently employed by | ||
| ||
(11) The Attorney General, or his or her designee; (12) A representative of a union representing front | ||
| ||
(13) A representative of a statewide business | ||
| ||
(d) Compensation and qualifications. Members shall serve without compensation and shall be adults and residents of Illinois. (e) Appointments. Appointments shall be made 90 days from the effective date of this amendatory Act of the 96th General Assembly. (f) Hearings. The Task Force shall solicit comments from stakeholders and hold public hearings before filing any report required by this Section. At the public hearings, the Task Force shall allow interested persons to present their views and comments. The Task Force shall submit all reports required by this Section to the Governor and the General Assembly. In addition to the reports required by this Section, the Task Force may provide, at its discretion, interim reports and recommendations. The Department of Human Services shall provide administrative support to the Task Force. (g) Task Force duties. The Task Force shall gather information and make recommendations relating to at least the following topics in relation to public assistance fraud: (1) Reviews of provider billing of public aid claims. (2) Reviews of recipient utilization of public aid. (3) Protocols for investigating recipient public aid | ||
| ||
(4) Protocols for investigating provider public aid | ||
| ||
(5) Reporting of alleged fraud by private citizens | ||
| ||
(6) Examination of current fraud prevention measures | ||
| ||
(7) Coordination between relevant agencies in fraud | ||
| ||
(8) Financial audit of the current costs borne by aid | ||
| ||
(9) Examination of enhanced penalties for fraudulent | ||
| ||
(10) Enhanced whistleblower protections. (11) Voluntary assistance from businesses and | ||
| ||
(h) Task Force recommendations. Any of the findings, recommendations, public postings, and other relevant information regarding the Task Force shall be made available on the Department of Human Services' website. (i) Reporting requirements. The Task Force shall submit findings and recommendations to the Governor and the General Assembly by December 31, 2011, including any necessary implementing legislation, and recommendations for changes to policies, rules, or procedures that are not incorporated in the implementing legislation. (j) Dissolution of Task Force. The Task Force shall be dissolved 90 days after its report has been submitted to the Governor's Office and the General Assembly. (Source: P.A. 103-145, eff. 10-1-23 .) |
(305 ILCS 5/12-4.42)
Sec. 12-4.42. Medicaid Revenue Maximization. (a) Purpose. The General Assembly finds that there is a need to make changes to the administration of services provided by State and local governments in order to maximize federal financial participation. (b) Definitions. As used in this Section: "Community Medicaid mental health services" means all mental health services outlined in Part 132 of Title 59 of the Illinois Administrative Code that are funded through DHS, eligible for federal financial participation, and provided by a community-based provider. "Community-based provider" means an entity enrolled as a provider pursuant to Sections 140.11 and 140.12 of Title 89 of the Illinois Administrative Code and certified to provide community Medicaid mental health services in accordance with Part 132 of Title 59 of the Illinois Administrative Code. "DCFS" means the Department of Children and Family Services. "Department" means the Illinois Department of Healthcare and Family Services. "Care facility for persons with a developmental disability" means an intermediate care facility for persons with an intellectual disability within the meaning of Title XIX of the Social Security Act, whether public or private and whether organized for profit or not-for-profit, but shall not include any facility operated by the State. "Care provider for persons with a developmental disability" means a person conducting, operating, or maintaining a care facility for persons with a developmental disability. For purposes of this definition, "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. "DHS" means the Illinois Department of Human Services. "Hospital" means an institution, place, building, or agency located in this State that is licensed as a general acute hospital by the Illinois Department of Public Health under the Hospital Licensing Act, whether public or private and whether organized for profit or not-for-profit. "Long term care facility" 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, 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 "long term care facility" 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. "Long term care 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 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. For purposes of this definition, "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. "State-operated facility for persons with a developmental disability" means an intermediate care facility for persons with an intellectual disability within the meaning of Title XIX of the Social Security Act operated by the State. (c) Administration and deposit of Revenues. The Department shall coordinate the implementation of changes required by Public Act 96-1405 amongst the various State and local government bodies that administer programs referred to in this Section. Revenues generated by program changes mandated by any provision in this Section, less reasonable administrative costs associated with the implementation of these program changes, which would otherwise be deposited into the General Revenue Fund shall be deposited into the Healthcare Provider Relief Fund. The Department shall issue a report to the General Assembly detailing the implementation progress of Public Act 96-1405 as a part of the Department's Medical Programs annual report for fiscal years 2010 and 2011. (d) Acceleration of payment vouchers. To the extent practicable and permissible under federal law, the Department shall create all vouchers for long term care facilities and facilities for persons with a developmental disability for dates of service in the month in which the enhanced federal medical assistance percentage (FMAP) originally set forth in the American Recovery and Reinvestment Act (ARRA) expires and for dates of service in the month prior to that month and shall, no later than the 15th of the month in which the enhanced FMAP expires, submit these vouchers to the Comptroller for payment. The Department of Human Services shall create the necessary documentation for State-operated facilities for persons with a developmental disability so that the necessary data for all dates of service before the expiration of the enhanced FMAP originally set forth in the ARRA can be adjudicated by the Department no later than the 15th of the month in which the enhanced FMAP expires. (e) Billing of DHS community Medicaid mental health services. No later than July 1, 2011, community Medicaid mental health services provided by a community-based provider must be billed directly to the Department. (f) DCFS Medicaid services. The Department shall work with DCFS to identify existing programs, pending qualifying services, that can be converted in an economically feasible manner to Medicaid in order to secure federal financial revenue. (g) (Blank). (h) Public health departments.
The Department shall identify unreimbursed costs for persons covered by Medicaid who are served by the Chicago Department of Public Health. The Department shall assist the Chicago Department of Public Health in determining total unreimbursed costs associated with the provision of healthcare services to Medicaid enrollees. The Department shall determine and draw the maximum allowable federal matching dollars associated with the cost of Chicago Department of Public Health services provided to Medicaid enrollees. (i) Acceleration of hospital-based payments.
The Department shall, by the 10th day of the month in which the enhanced FMAP originally set forth in the ARRA expires, create vouchers for all State fiscal year 2011 hospital payments exempt from the prompt payment requirements of the ARRA. The Department shall submit these vouchers to the Comptroller for payment.
(Source: P.A. 100-201, eff. 8-18-17; 101-209, eff. 8-5-19.)
|
(305 ILCS 5/12-4.44) Sec. 12-4.44. Report on centralizing administrative functions. The Department of Healthcare and Family Services, with the cooperation of the Department of Human Services, shall provide a report to the General Assembly by January 1, 2012, regarding the feasibility and potential consequences of centralizing administrative functions, to the extent allowable under federal law, for applicants applying only for medical assistance. The report shall include, but need not be limited to, an analysis of centralizing administrative functions in a statewide or regional centers administered by either public or private entities, and an analysis of the impact of removing medical assistance only cases from the caseload assigned to employees in local Department of Human Services field offices that accept and process applications for benefits.
(Source: P.A. 97-172, eff. 7-22-11.) |
(305 ILCS 5/12-4.45) Sec. 12-4.45. Third party liability. (a) To the extent authorized under federal law, the Department of Healthcare and Family Services shall identify individuals receiving services under medical assistance programs funded or partially funded by the State who may be or may have been covered by a third party health insurer, the period of coverage for such individuals, and the nature of coverage. A company, as defined in Section 5.5 of the Illinois Insurance Code and Section 2 of the Comprehensive Health Insurance Plan Act, must provide the Department eligibility information in a federally recommended or mutually agreed-upon format that includes at a minimum: (1) The names, addresses, dates, and sex of primary | ||
| ||
(2) The policy group numbers of the covered persons. (3) The names, dates of birth, and sex of covered | ||
| ||
(4) The effective dates of coverage for each covered | ||
| ||
(5) The generally defined covered services | ||
| ||
(b) The Department may impose an administrative penalty on a company that does not comply with the request for information made under Section 5.5 of the Illinois Insurance Code and paragraph (3) of subsection (a) of Section 20 of the Covering ALL KIDS Health Insurance Act. The amount of the penalty shall not exceed $10,000 per day for each day of noncompliance that occurs after the 180th day after the date of the request. The first day of the 180-day period commences on the business day following the date of the correspondence requesting the information sent by the Department to the company. The amount shall be based on: (1) The seriousness of the violation, including the | ||
| ||
(2) The economic harm caused by the violation. (3) The history of previous violations. (4) The amount necessary to deter a future violation. (5) Efforts to correct the violation. (6) Any other matter that justice may require. (c) The enforcement of the penalty may be stayed during the time the order is under administrative review if the company files an appeal. (d) The Attorney General may bring suit on behalf of the Department to collect the penalty. (e) Recoveries made by the Department in connection with the imposition of an administrative penalty as provided under this Section shall be deposited into the Public Aid Recoveries Trust Fund created under Section 12-9.
(Source: P.A. 98-130, eff. 8-2-13; 98-756, eff. 7-16-14.) |
(305 ILCS 5/12-4.46) Sec. 12-4.46. Change in legal guardianship; notification. Whenever there is a change in legal guardianship of a minor child who receives benefits under this Code, the appropriate State agency shall immediately inform the Department of Human Services of the change in legal guardianship to ensure such benefits are sent directly to the minor child's legal guardian. For purposes of this Section, "legal guardian" means a person appointed guardian, or given custody, of a minor by a circuit court of the State, but does not include a person appointed guardian, or given custody, of a minor under the Juvenile Court Act or the Juvenile Court Act of 1987.
(Source: P.A. 98-256, eff. 8-9-13; 98-756, eff. 7-16-14.) |
(305 ILCS 5/12-4.47) Sec. 12-4.47. Continued eligibility for developmental disability services for dependents of military service members. (a) As used in this Section: "Dependent" means a spouse, birth child, adopted child, or
stepchild of a military service member. "Legal resident" means a person who maintains Illinois as his
or her principal establishment, home of record, or permanent home and
to where, whenever absent due to military obligation, he or she intends
to return. "Military service" means service in the armed forces or armed
forces reserves of the United States, or membership in the Illinois National Guard. "Military service member" means a person who is currently in military service or who
has separated from military service in the previous 18 months through
either retirement or military separation. (b) A dependent, who is a legal resident of the State, having
previously been determined to be eligible for developmental disability
services provided by the Department of Human Services, including waiver services provided under the home and community based services programs authorized under Section 1915(c) of the Social Security Act, shall retain eligibility for those developmental disability services as long as he
or she remains a legal resident of the State, regardless of having left the State due to the military service member's military assignment
outside the State, and as long as he or she is otherwise eligible for such services. (c) The Department of Human Services shall permit a dependent who resides out-of-state to be placed on the waiting list for developmental disabilities services if the dependent left the State due to the military service member's military assignment outside the State, is otherwise eligible for those services, and furnishes the following: (1) a copy of the military service member's DD-214 or | ||
| ||
(2) proof of the military service member's legal | ||
| ||
(d) For dependents who received developmental disability services
and who left the State due to the military service member's military
assignment outside the State, upon the dependent's return to the State and when a request for services is made, the Department shall: (1) determine the dependent's eligibility for | ||
| ||
(2) provide to the dependent notification of the | ||
| ||
(3) provide the dependent an opportunity to contest | ||
| ||
(4) resume services if the individual remains | ||
| ||
(e) As a condition of continued eligibility for services under subsection (b) of this Section,
a dependent must inform the Department of his or her
current address and provide updates as requested by the Department. (f) No payment pursuant to this Section shall be made for developmental disability services authorized under the Illinois Title XIX State Plan and provided outside the State unless those services satisfy the conditions specified in 42 CFR 431.52. No payment pursuant to this Section shall be made for home and community based services provided outside the State of Illinois. (g) The Department shall request a waiver from the appropriate
federal agency if a waiver is necessary to implement the provisions of this
Section. (h) The Department may adopt rules necessary to implement the
provisions of this Section.
(Source: P.A. 98-1000, eff. 8-18-14; 99-78, eff. 7-20-15.) |
(305 ILCS 5/12-4.48) Sec. 12-4.48. Long-Term Services and Supports Disparities Workgroup. (a) The Department of Healthcare and Family Services shall establish a Long-Term Services and Supports Disparities Workgroup of the Medicaid Advisory Committee in accordance with the requirements of 42 CFR 431.12. (b) Members of the Workgroup shall be appointed by the Director of the Department of Healthcare and Family Services and may include representatives of the following agencies, organizations, or groups: (1) (Blank). (2) (Blank). (3) (Blank). (4) (Blank). (5) (Blank). (6) (Blank). (7) (Blank). (8) Managed Care Plans. (9) The for-profit urban nursing home or assisted | ||
| ||
(10) The for-profit rural nursing home or assisted | ||
| ||
(11) The not-for-profit nursing home or assisted | ||
| ||
(12) The home care association or home care industry. (13) The adult day care association or adult day care | ||
| ||
(14) An association representing workers who provide | ||
| ||
(15) A representative of providers that serve the | ||
| ||
(16) Case Management Organizations. (17) Three consumer representatives which may include | ||
| ||
(b-5) In addition, one representative from each of the following may serve ex officio: the Governor's Office; the Department of Healthcare and Family Services; the Department of Human Services; the Department on Aging; the Department of Public Health; and the Department of Human Rights. (c) The Workgroup shall reflect diversity in race, ethnicity, and gender. (d) The Chair of the Workgroup shall be appointed by the Director of the Department of Healthcare and Family Services. (e) The Director of the Department of Healthcare and Family Services shall assign appropriate staff and resources to support the efforts of the Workgroup. The Workgroup shall meet as often as necessary but not less than 4 times per calendar year. (f) The Workgroup shall promote and facilitate communication, coordination, and collaboration among relevant State agencies and communities of color, limited English-speaking communities, and the private and public entities providing services to those communities. (g) The Workgroup shall do all of the following: (1) Document the number and types of Long-Term | ||
| ||
(2) Document the number and racial profiles of | ||
| ||
(3) Document the number and profiles of family or | ||
| ||
(4) Compare data over multiple years to identify | ||
| ||
(5) Identify any racial disparities in the provision | ||
| ||
(6) Identify any disparities uniquely experienced in | ||
| ||
(7) Assess whether the LTSS industry, including | ||
| ||
(8) Consider whether to recommend that the State | ||
| ||
(9) Identify and prioritize recommendations for | ||
| ||
(10) Monitor the progress of the State in eliminating | ||
| ||
(h) The Workgroup may conduct public hearings, inquiries, studies, and other forms of information gathering to identify how the actions of State government contribute to or reduce racial disparities in long-term care settings. (i) The Workgroup shall report its findings and recommendations to the Governor and the General Assembly with annual reports and shall include documentation of progress made to eliminate disparities in long-term care service settings.
(Source: P.A. 103-508, eff. 8-4-23.) |
(305 ILCS 5/12-4.49) Sec. 12-4.49. Breast cancer imaging and diagnostic equipment grant program. (a) On and after January 1, 2016 and subject to funding availability, the Department of Healthcare and Family Services shall administer a grant program the purpose of which shall be to build the public infrastructure for breast cancer imaging and diagnostic services across the State, in particular in rural, medically underserved areas and in areas with high breast cancer mortality. (b) In order to be eligible for the program, an applicant must be a: (1) disproportionate share hospital with high MIUR | ||
| ||
(2) mammography facility in a rural area; (3) federally qualified health center; or (4) rural health clinic. (c) The grants may be used to purchase new equipment for breast imaging, image-guided biopsies, or other equipment to enhance the detection and diagnosis of breast cancer. (d) The primary purpose of these grants is to increase access for low-income and Department of Healthcare and Family Services clients to high quality breast cancer screening and diagnostics. Medically Underserved Areas (MUAs), areas with high breast cancer mortality rates, and Health Professional Shortage Areas (HPSAs) shall receive special priority for grants under this program. (e) The Department shall establish procedures for applying for grant funds under this Section.
(Source: P.A. 99-433, eff. 8-21-15.) |
(305 ILCS 5/12-4.50) Sec. 12-4.50. Healthy Local Food Incentives Program. (a) Legislative findings. Diet and other lifestyle choices contribute to more than half of all deaths in Illinois. Health risk factors include smoking, obesity, stress, nutrition, high blood pressure, and alcohol and drug use. Illinois residents should be encouraged to adopt diets and lifestyles that lead to wellness. The State can help provide that encouragement by funding wellness programs that enhance the health of Illinois residents. Healthy local food incentives encourage wellness among some of the most vulnerable residents of Illinois (those whose incomes are below the poverty line and who often have limited access to fresh, healthy, and affordable foods) by doubling the purchasing power of LINK cardholders at farmers markets across the State. The benefits of such a program include: an increase in population health, Medicaid health care cost savings, decreased incidence of preventable diseases, increased revenue for Illinois small farmers, and economic stimulus for the region. (b) Definitions. As used in this Section: "FINI eligible fruits and vegetables" means any variety of fresh, canned, dried, or frozen whole or cut fruits and vegetables without added sugars, fats, or oils, and salt (i.e. sodium), as defined by the Food Insecurity Nutrition Incentive Grant Program administered by the United States Department of Agriculture. "LINK card" means an electronic benefits transfer card issued by the Department of Human Services for the purpose of enabling a user of the card to obtain SNAP benefits or cash. "SNAP" means the federal Supplemental Nutrition Assistance Program. (c) The Department of Human Services shall establish a Healthy Local Food Incentives Program to double the purchasing power of Illinois residents with limited access to fresh fruits and vegetables. The Healthy Local Food Incentives Fund is created as a special fund in the State treasury for the purpose of implementing the Healthy Local Food Incentives Program. All moneys received pursuant to this Section shall be deposited into the Healthy Local Food Incentives Fund. (d) Subject to appropriation, the Department of Human Services shall make an annual grant of $500,000 from the Fund to a qualified Illinois non-profit organization or agency, which shall be distributed to participating Illinois farmers markets for the purpose of providing matching dollar incentives (up to a specified amount) for the dollar value of SNAP benefits spent on FINI eligible fruits and vegetables at participating Illinois farmers markets and direct producer-to-consumer venues. (e) The designated qualified non-profit organization or agency shall have a demonstrated track record of: (1) building a statewide network; (2) designing and implementing successful healthy | ||
| ||
(3) implementing funds distribution and reporting | ||
| ||
(4) providing training and technical assistance to | ||
| ||
(5) conducting community outreach and data | ||
| ||
(6) providing full accounting and administration of | ||
| ||
(f) 100% of the moneys deposited into the Fund shall be distributed to participating Illinois farmers markets for healthy local food incentives. (g) Within 90 days after the end of a grant cycle, the designated qualified non-profit organization or agency shall submit a progress report to the Department of Human Services. The progress report shall include the following information: (1) the names and locations of Illinois farmers | ||
| ||
(2) the dollar amount of funds awarded to each | ||
| ||
(3) the dollar amount of SNAP benefits, and funds | ||
| ||
(4) the number of SNAP transactions carried out | ||
| ||
(5) the impact of the Program on increasing the | ||
| ||
(h) No later than December 31, 2017, the Department of Human Services shall adopt rules to implement the provisions of this Section. (i) (Blank).
(Source: P.A. 99-928, eff. 1-20-17; 100-636, eff. 1-1-19 .) |
(305 ILCS 5/12-4.51) Sec. 12-4.51. Workforce training and healthy families demonstration project. (a) Subject to the availability of funds provided for this purpose by the federal government, local philanthropic or charitable sources, or other private sources, there is created a 5-year demonstration project within the Department of Human Services to provide an intensive workforce training program for entry-level workers and a multi-generational healthy family initiative. No general revenue funds may be used to fund the demonstration project created under this Section. The demonstration project shall be implemented no later than 6 months after January 1, 2019 (the effective date of Public Act 100-806) and shall terminate 5 years after the initial date of implementation. The demonstration project shall be operated and maintained by a non-profit, community-based entity that shall provide the majority of the wages earned by participants enrolled in the workforce training program as well as support services to families, including new and expectant parents, enrolled in the multi-generational healthy family initiative. The total number of participants in the 5-year demonstration project at any one time shall not exceed 500. Participants enrolled in the workforce training program or the multi-generational healthy family initiative shall qualify to have whatever financial assistance they receive from their participation excluded from consideration for purposes of determining eligibility for or the amount of assistance under this Code as provided in subsection (d) of Section 1-7. The selected entity must immediately notify the Department of Human Services or the Department of Healthcare and Family Services whenever a participant enrolled in the workforce training program or the multi-generational healthy family initiative leaves the demonstration project and ceases to participate in any of the programs under the demonstration making the participant ineligible to receive an exemption as provided in subsection (d) of Section 1-7. (b) The entity selected to operate and maintain the demonstration project shall be a non-profit, community-based entity in good standing with the State that is located in a county with a population of less than 3,000,000. The selected entity must comply with all applicable State and federal requirements and must develop and implement a research component to determine the effectiveness of the demonstration project in promoting and instilling self-sufficiency through its intensive workforce training program and multi-generational healthy family initiative. The State shall not fund the research component outlined in the Section or any program under the demonstration project. (c) Beginning one year after the initial implementation date of the demonstration project, and each year thereafter for the duration of the demonstration, the selected entity shall submit a report to the Department of Human Services, the Department of Healthcare and Family Services, and the General Assembly that details the progress and effectiveness of the demonstration project and the demonstration's impact on instilling the value of self-sufficiency in participants. The 4th annual report shall also provide policy recommendations on best practices for and continued research on facilitating bridges to self-sufficiency. The 4th annual report may also include a recommendation on making the demonstration project permanent upon completion of the demonstration project period. The reports to the General Assembly shall be filed with the Clerk of the House of Representatives and the Secretary of the Senate in electronic form only, in the manner that the Clerk and the Secretary shall direct.
(Source: P.A. 100-806, eff. 1-1-19; 101-81, eff. 7-12-19.) |
(305 ILCS 5/12-4.52) Sec. 12-4.52. Prescriber education. (a) The Department of Healthcare and Family Services shall develop, in collaboration with a public university that has a Doctor of Pharmacy Professional Program and is located in a county with a population of more than 3,000,000, a program designed to provide
prescribing physicians under the medical assistance program with an evidence-based, non-commercial source of the latest
objective information about pharmaceuticals. Information shall be
presented to prescribing physicians by specially trained pharmacists, nurses, or
other health professionals to assist prescribing physicians in making
appropriate therapeutic recommendations. (b) The prescriber education program shall consist of 2 components: a web-based curriculum and an academic educator outreach. The program shall contract with clinical pharmacists to provide scheduled visits with prescribing physicians to update them on the latest research concerning medication usage and new updates on disease states in an unbiased manner. (c) Education provided under the prescriber education program shall include, but not be limited to, disease-based educational modules on the treatment of chronic non-cancer pain, diabetes, hypertension, hyperlipidemia, respiratory syncytial virus, and nicotine dependence. New modules may be created periodically as needed and existing module content shall be reviewed and updated on an annual or as-needed basis. Educational modules provided under the program shall provide prescribing physicians with continuing medical education credit. (d) Additional resources provided under the prescriber education program shall include, but not be limited to, the following: (1) a drug information response center available to | ||
| ||
(2) information on drug utilization trends within | ||
| ||
(Source: P.A. 101-278, eff. 1-1-20 .) |
(305 ILCS 5/12-4.53) Sec. 12-4.53. Prospective Payment System (PPS) rates. Effective January 1, 2021, and subsequent years, based on specific appropriation, the Prospective Payment System (PPS) rates for FQHCs shall be increased based on the cost principles found at 45 Code of Federal Regulations Part 75 or its successor. Such rates shall be increased by using any of the following methods: reducing the current minimum productivity and efficiency standards no lower than 3500 encounters per FTE physician; increasing the statewide median cost cap from 105% to 120%, a one-time re-basing of rates utilizing 2018 FQHC cost reports, or another alternative payment method acceptable to the Centers for Medicare and Medicaid Services and the FQHCs, including an across the board percentage increase to existing rates.
(Source: P.A. 101-636, eff. 6-10-20; 101-655, eff. 3-12-21.) |
(305 ILCS 5/12-4.54) Sec. 12-4.54. SNAP, WIC; diapers, menstrual hygiene products. If the United States Department of Agriculture's Food and Nutrition Service creates and makes available to the states a waiver permitting recipients of benefits provided under the Supplemental Nutrition Assistance Program or the Special Supplemental Nutrition Program for Women, Infants, and Children to use their benefits to purchase diapers or menstrual hygiene products such as tampons, sanitary napkins, and feminine wipes, then the Department of Human Services shall apply for the waiver. If the United States Department of Agriculture approves the Department of Human Services' waiver application, then the Department of Human Services shall adopt rules and make other changes as necessary to implement the approved waiver.
(Source: P.A. 102-248, eff. 1-1-22; 102-813, eff. 5-13-22.) |
(305 ILCS 5/12-4.55)
Sec. 12-4.55. Community-based long-term services; application for federal funding. The Department of Healthcare and Family Services shall apply for all available federal funding to promote community inclusion and integration for persons with disabilities, regardless of age, and older adults so that those persons have the option to transition out of institutions and receive long-term care services and supports in the settings of their choice.
(Source: P.A. 102-536, eff. 8-20-21; 102-813, eff. 5-13-22.)
|
(305 ILCS 5/12-4.56) Sec. 12-4.56. Managed Primary Care Demonstration Project. The Department shall establish and implement a Managed Primary Care Demonstration Project to provide primary care services that are focused on preventive rather than curative care to persons who reside in underserved communities that lack accessible health and medical services. The demonstration project shall operate for a 5-year period and provide supplemental services to medical assistance recipients. The Department shall contract with a health care organization through a competitive process that is capable of providing patient-centered, prevention-focused services, that may include, but are not limited to, the following: (1) Patient navigators to manage patient care. (2) Patient-tailored preventive health care plans. (3) Administrative personal health care consultants | ||
| ||
(4) Clinical personal health care consultants for | ||
| ||
(5) A patient portal. (6) An online virtual health hub that provides | ||
| ||
(7) Community health and human services centers to | ||
| ||
(8) Mobile preventive health stations and kiosks to | ||
| ||
(9) Call centers to interact with medical homes and | ||
| ||
A request for proposals for the demonstration project shall be issued by December 31, 2022.
(Source: P.A. 102-699, eff. 4-19-22.) |
(305 ILCS 5/12-4.57) Sec. 12-4.57. Prospective Payment System rates; increase for federally qualified health centers. Beginning January 1, 2024, subject to federal approval, the Department of Healthcare and Family Services shall increase the Prospective Payment System rates for federally qualified health centers to a level calculated to spend an additional $50,000,000 in the first year of application using an alternative payment method acceptable to the Centers for Medicare and Medicaid Services and a trade association representing a majority of federally qualified health centers operating in Illinois, including a rate increase that is an equal percentage increase to the rates paid to each federally qualified health center. (Source: P.A. 103-102, eff. 1-1-24; 103-605, eff. 7-1-24.) |
(305 ILCS 5/12-4.58) Sec. 12-4.58. Stolen SNAP benefits via card skimming; data collection and reports. (a) As the State administrator of benefits provided under the federally funded Supplemental Nutrition Assistance Program (SNAP), the Department of Human Services shall track and collect data on the scope and frequency of SNAP benefits fraud in this State where a SNAP recipient's benefits are stolen from the recipient's electronic benefits transfer card by means of card skimming, card cloning, or some other similar fraudulent method. The Department shall specifically keep a record of every report made to the Department by a SNAP recipient alleging the theft of benefits due to no fault of the recipient, the benefit amount stolen, and, if practicable, how those stolen benefits were used and the location of those thefts. (b) The Department shall report its findings to the General Assembly on an annual basis beginning on January 1, 2024. The Department shall file an annual report no later than the 60th day of the following year following each reporting period. A SNAP recipient's personally identifiable information shall be excluded from the reports consistent with State and federal privacy protections. Each annual report shall also be posted on the Department's official website. (c) If the Department determines that a SNAP recipient has made a substantiated report of stolen benefits due to card skimming, card cloning, or some other similar fraudulent method, the Department shall refer the matter to the State's Attorney who has jurisdiction over the alleged theft or fraud and shall provide any assistance to that State's Attorney in the prosecution of the alleged theft or fraud. (Source: P.A. 103-297, eff. 1-1-24; 103-605, eff. 7-1-24.) |
(305 ILCS 5/12-4.101)
Sec. 12-4.101.
(Repealed).
(Source: P.A. 90-655, eff. 7-30-98. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/12-4.102)
Sec. 12-4.102.
(Repealed).
(Source: P.A. 88-412. Repealed by P.A. 92-111, eff. 1-1-02.)
|
(305 ILCS 5/12-4.103)
Sec. 12-4.103.
Individual Development Accounts.
Subject to funding availability, the Illinois Department shall
establish a program that allows eligible low-income
individuals to open and maintain Individual Development Accounts for the
purpose of enabling the individual to accumulate funds for a qualified purpose.
A qualified purpose for establishing an Individual Development Account shall
be one or more of the following:
(1) to pay for postsecondary education expenses if the expenses are paid
directly to an eligible educational institution;
(2) to acquire a principal residence if the individual is buying a home for
the first time and if the funds are paid directly to the person to whom the
amounts required for the purchase are due; or
(3) to finance business capitalization expenses if the funds are paid
directly into a business capitalization account at a federally insured
financial institution and are restricted to use solely for qualified business
capitalization expenses.
An individual may make contributions to his or her
Individual Development Account only from earned income as
defined in Section 911(d)(2) of the Internal Revenue Code of 1986.
An Individual Development Account program shall be established in
accordance with subsection (h) of Section 404 of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996. State funds made available
for this program and federal funds, to the extent they may be used for this
purpose, shall be used (i) to match, dollar for dollar, contributions made by
individuals participating in an Individual Development Account program approved
by the Illinois Department, (ii) to fund or supplement other funds available
for the costs of the administration of an Individual Development Account
program by a not-for-profit organization, and (iii) for a grant or grants to
not-for-profit organizations to provide technical assistance and training to
other not-for-profit organizations in the State that wish to establish an
Individual Development Account program consistent with this Section. No
Individual Development Account program shall qualify for State funds under this
Section unless the administering not-for-profit organization verifies that it
has secured at least a dollar for dollar match from
other sources for contributions made by participating individuals.
The Illinois Department shall by rule establish qualifications for a
not-for-profit organization to administer an Individual Development Account
program.
The Illinois Department shall establish eligibility criteria for individuals
seeking to participate in an Individual Development Account program. The
Illinois Department shall promulgate rules regarding the administration of
Individual Development Account programs by approved not-for-profit
organizations administering the programs.
Notwithstanding any other provision of State law, funds in an Individual
Development Account, including accrued interest and matching deposits, shall be
disregarded for the purpose of determining the eligibility and benefit levels
under this Code of the individual establishing the Individual Development
Account with respect to any period during which such individual maintains or
makes contributions into such an account.
Nothing in this Section shall prohibit a not-for-profit organization which does
not
receive State matching funds from administering an approved Individual
Development Account under this Section.
(Source: P.A. 90-783, eff. 8-14-98.)
|
(305 ILCS 5/12-4.103a) Sec. 12-4.103a. Assets for Independence Program. (a) Program established. Subject to available funding and receipt of a federal Assets for Independence grant award, the Department of Human Services shall establish and administer an Assets for Independence Program (Program). The Program shall be established in accordance with the terms of the Assets for Independence Act (AFIA) as now and hereafter amended (Title IV Community Opportunities, Accountability, and Training and Educational Services Act as amended, Public Law 105-285, 42 U.S.C. 604 note). (b) Assets for Independence Fund. The Assets for Independence Fund is established. The Fund shall be held by the Secretary or his or her designee as ex-officio custodian thereof separate and apart from all other State funds. The Assets for Independence Fund is authorized to receive grants under AFIA, State moneys appropriated for the Program, and moneys from voluntary donations from individuals, foundations, corporations, and other sources. Moneys in the Assets for Independence Fund shall not be commingled with other State funds, but they shall be deposited as required by law and maintained in a separate account on the books of a savings and loan association, bank, or other qualified financial institution. All interest earnings on amounts within the Assets for Independence Fund shall accrue to the Assets for Independence Fund and shall be used in accordance with the terms of the AFIA. Administrative expenses related to the Program, including the provision of financial education to Program participants, shall be paid from the Assets for Independence Fund in accordance with the terms of AFIA Section 707(c)(3). (c) Program purpose. The purpose of the Program is to allow eligible low-income Illinois citizens, subject to the availability of State and federal funds and authorization from the Department, to open and maintain an Individual Development Account (IDA) at a federally insured financial institution. Deposits into an IDA that are used for subsequent qualified purchases shall be matched dollar-for-dollar by moneys from the Assets for Independence Fund. Not more than $2,000 of moneys from the Assets for Independence Fund shall be provided to any one individual. Not more than $4,000 of moneys from the Assets for Independence Fund shall be provided to any one household. Assets for Independence Fund moneys not being used to administer the Program shall be used only for qualified purchases, shall be distributed only directly to the vendor of a qualified purchase, and shall require the authorization by signature of the Department's chief financial officer. (d) Contributions to IDA and use of moneys. An individual may make contributions to his or her IDA only from earned income as defined in Section 911(d)(2) of the Internal Revenue Code of 1986. The moneys deposited into an IDA shall not be commingled with any Assets for Independence Fund moneys. An IDA holder shall have a 36-month period, beginning on the date the Department authorizes the holder to open the IDA, within which to make a qualified purchase. If a qualified purchase is not made within that 36-month period, Assets for Independence Fund moneys earmarked for that individual shall be released, and the Department shall authorize another eligible person to open an IDA. Under no circumstances, and at no time, shall an IDA holder lose the ability to withdraw moneys from his or her IDA. (e) Qualified purchases. A qualified asset purchase using moneys from an IDA shall be defined in accordance with AFIA Section 404(8) and shall be one or more of the following: (1) Payment of post-secondary education expenses, if | ||
| ||
(2) Acquisition of a principal residence, if the | ||
| ||
(3) Financing of business capitalization expenses, if | ||
| ||
(f) Program eligibility. Program eligibility shall be established by the Department in accordance with AFIA Section 408. Persons eligible to open an IDA and to receive Assets for Independence Fund moneys are Illinois citizens currently residing in Illinois who are (i) able to demonstrate that they are currently eligible for assistance under the State's Temporary Assistance for Needy Families program or (ii) able to demonstrate that the adjusted gross income of their household in the calendar year preceding the determination of eligibility was equal to or less than 200% of the poverty line, as determined by the Federal Office of Management and Budget. An individual must further demonstrate that the net worth of his or her household, as of the end of the calendar year preceding the determination of eligibility, does not exceed $10,000, as determined by AFIA Section 408(2)(B). Notwithstanding any other provision of State law, moneys in an Individual Development Account, including accrued interest and matching deposits, shall be disregarded for the purpose of determining the eligibility and benefit levels under this Code in the case of the individual establishing the IDA with respect to any period during which the individual maintains or makes contributions into the IDA. The Department shall approve an individual to open an IDA at a federally insured financial institution upon determining, based on the individual's application, that all eligibility criteria are met and subject to the availability of $2,000 in Assets for Independence Fund moneys.
(Source: P.A. 94-1043, eff. 7-24-06.) |
(305 ILCS 5/12-4.104)
Sec. 12-4.104.
Family and Community Development Grant Program.
(a) Subject to funding availability, a family and community development
grant
program shall be administered by the Department
of
Human Services. The program shall be designed to make services
available to families who are at risk of long-term economic
dependency and to work with communities to provide economic opportunities. The
purpose of the program is to fund, evaluate, and provide
recommendations on not less than 8 nor more than 10 projects to
move 100 families at risk of
long-term economic dependency to self-sufficiency through the family and
community development program.
(b) As used in this Section only:
"Applicant" means a public or private organization that makes application
for a grant through the request for proposals process.
"Council" means the Social Services Advisory Council.
"Department" means the Department of Human Services.
"Grant" means an award to fund a project approved by the
Department with the advice of the Council.
"Grantee" means the recipient of a grant approved by the Department.
(c) The Social Services Advisory Council as established within
the Department of Human Services shall,
with
respect to the family and community development
grants
administered by the Department,
involve a representative of the Human Resource
Investment Council in considering proposed projects and monitoring approved
projects.
(d) The Council shall:
(1) Identify the factors and conditions that place | ||
| ||
(2) Identify the factors and conditions that place | ||
| ||
(3) Report those findings to the Secretary of Human | ||
| ||
(4) Recommend grants to public or private | ||
| ||
(5) In cooperation with the Illinois Community Action | ||
| ||
(6) Seek the support of an Illinois accredited | ||
| ||
(7) Seek additional support for the funding of family | ||
| ||
(8) Make recommendations to the Governor, the General | ||
| ||
(9) Evaluate and make recommendations regarding the | ||
| ||
(e) In cooperation with the Illinois Community Action Association,
the grantees shall identify families that
receive TANF (formerly AFDC)
payments that may place families at
risk of long-term economic
dependency.
(f) The Department shall adopt rules for the operation of this program.
(Source: P.A. 90-783, eff. 8-14-98.)
|
(305 ILCS 5/12-4.105) Sec. 12-4.105. Human poison control center; payment program. Subject to funding availability resulting from transfers made from the Hospital Provider Fund to the Healthcare Provider Relief Fund as authorized under this Code, for State fiscal year 2017 and State fiscal year 2018, and for each State fiscal year thereafter in which the assessment under Section 5A-2 is imposed, the Department of Healthcare and Family Services shall pay to the human poison control center designated under the Poison Control System Act an amount of not less than $3,000,000 for each of State fiscal years 2017 through 2020, and for State fiscal years 2021 through 2023 an amount of not less than $3,750,000 and for State fiscal years 2024 through 2026 an amount of not less than $4,000,000 and for the period July 1, 2026 through December 31, 2026 an amount
of not less than $2,000,000, if the human poison control center is in operation.
(Source: P.A. 102-886, eff. 5-17-22; 103-102, eff. 6-16-23.) |
(305 ILCS 5/12-4.201)
Sec. 12-4.201. Data warehouse concerning medical and related
services. (a) The Department of Healthcare and Family Services may purchase services and
materials associated with the costs of developing and implementing a data
warehouse comprised of management and decision making information in
regard to the liability associated with, and utilization of, medical and
related services, out of moneys available for that purpose. (b) The Department of Healthcare and Family Services shall perform all necessary administrative functions to expand its linearly-scalable data warehouse to encompass other healthcare data sources at both the Department of Human Services and the Department of Public Health. The Department of Healthcare and Family Services shall leverage the inherent capabilities of the data warehouse to accomplish this expansion with marginal additional technical administration. The purpose of
this expansion is to allow for programmatic review and analysis including the interrelatedness among the various healthcare programs in order to ascertain effectiveness toward, and ultimate impact on, clients. Beginning
July 1, 2005, the Department of Healthcare and Family Services (formerly Department of Public Aid) shall supply quarterly reports to the Commission on Government Forecasting and Accountability detailing progress toward this mandate.
(c) The Department of Healthcare and Family Services (HFS), the Illinois Department of Public Health, the Illinois Department of Human Services, and the Division of Specialized Care for Children, University of Illinois at Chicago, with necessary support from the Department of Central Management Services, shall integrate into the medical data warehouse individual record level data owned by one of these agencies that pertains to maternal and child health, including the following data sets:
(1) Vital Records as they relate to births, birth | ||
| ||
(2) Adverse Pregnancy Outcomes Reporting System | ||
| ||
(3) Genetics/Newborn Screenings/SIDS. (4) Cornerstone (WIC, FCM, Teen Parents, | ||
| ||
(5) HFS medical claims data. (6) I-CARE. (7) Children with Special Healthcare Needs Data. By September 1, 2009, the departments of Healthcare and Family Services, Public Health, and Human Services and the Division of Specialized Care for Children shall jointly prepare a work plan for fully integrating these data sets into the medical data warehouse. The work plan shall provide an overall project design, including defining a mutually acceptable transfer format for each discrete data set, the data update frequency, and a single method of data transfer for each data set. By October 1, 2009, the Department of Public Health shall grant to the Department of Healthcare and Family Services complete access to all vital records data. The Department of Public Health shall prepare a report detailing that this task has been accomplished and submit this report to the Commission on Government Forecasting and Accountability by October 15, 2009. By March 1, 2010, the data sets shall be completely loaded into the medical data warehouse. By July 1, 2010, data from the various sources shall be processed so as to be compatible with other data in the medical data warehouse and available for analysis in an integrated manner. With the cooperation of the other agencies, HFS shall submit status reports on the progress of these efforts to the Governor and the General Assembly no later than October 1, 2009 and April 1, 2010, with a final report due no later than November 1, 2010. On an ongoing basis, the 4 agencies shall review the feasibility of adding data from additional sources to the warehouse. Such review may take into account the cost effectiveness of adding the data, the utility of adding data that is not available as identifiable individual record level data, the requirements related to adding data owned by another entity or not available in electronic form, whether sharing of the data is otherwise prohibited by law and the resources required and available for effecting the addition. The departments shall use analysis of the data in the medical data warehouse to improve maternal and child health outcomes, and in particular improve birth outcomes, and to reduce racial health disparities in this area. All access and use of the data shall be in compliance with all applicable federal and State laws, regulations, and mandates. Notwithstanding anything in this Section, data incorporated into the data warehouse shall remain subject to the same provisions of law regarding confidentiality and use restrictions as they are subject to in the control of the contributing agency. The Department of Healthcare and Family Services shall develop measures to ensure that the interplay of the several data sets contributed to the data warehouse does not lead to the use or release of data from the data warehouse that would not otherwise be subject to use or release under State or federal law. (Source: P.A. 95-331, eff. 8-21-07; 96-799, eff. 10-28-09; 96-1000, eff. 7-2-10.)
|
(305 ILCS 5/12-4.202)
Sec. 12-4.202. (Repealed).
(P.A. 94-267, eff. 7-19-05. Repealed internally, eff. 1-1-06.)
|
(305 ILCS 5/12-5) (from Ch. 23, par. 12-5)
Sec. 12-5. Appropriations; uses; federal grants; report to
General Assembly. From the sums appropriated by the General Assembly,
the Illinois Department shall order for payment by warrant from the State
Treasury grants for public aid under Articles III, IV, and V,
including
grants for funeral and burial expenses, and all costs of administration of
the Illinois Department and the County Departments relating thereto. Moneys
appropriated to the Illinois Department for public aid under Article VI may
be used, with the consent of the Governor, to co-operate
with federal, State, and local agencies in the development of work
projects designed to provide suitable employment for persons receiving
public aid under Article VI. The Illinois Department, with the consent
of the Governor, may be the agent of the State for the receipt and
disbursement of federal funds or commodities for public aid purposes
under Article VI and for related purposes in which the
co-operation of the Illinois Department is sought by the federal
government, and, in connection therewith, may make necessary
expenditures from moneys appropriated for public aid under any Article
of this Code and for administration. The Illinois Department may make necessary expenditures from monies
appropriated to it for operations, administration, and grants, including
payment to the Health Insurance Reserve Fund for group insurance costs at
the rate certified by the Department of Central Management Services.
All grants received by the Illinois Department for programs funded by the
Federal Social Services Block Grant shall be deposited in the Social Services
Block Grant Fund. All funds received into the Social Services Block Grant Fund
as reimbursement for expenditures from the General Revenue Fund shall be
transferred to the General Revenue Fund. All funds received into the Social
Services Block Grant fund for reimbursement for expenditure out of the Local
Initiative Fund shall be transferred into the Local Initiative Fund. Any other
federal funds received into the Social Services Block Grant Fund shall be
transferred to the DHS Special Purposes Trust Fund. All federal funds received by
the Illinois Department as reimbursement for Employment and Training Programs
for expenditures made by the Illinois Department from grants, gifts, or
legacies as provided in Section 12-4.18 or made by an entity other than the
Illinois Department and all federal funds received from the Emergency Contingency Fund for State Temporary Assistance for Needy Families Programs established by the American Recovery and Reinvestment Act of 2009 shall be deposited into the Employment and Training Fund.
During each State fiscal year, an amount not exceeding a total of $68,800,000 of the federal funds received by the
Illinois Department under the provisions of Title IV-A of the federal Social Security Act shall be deposited
into the DCFS Children's Services
Fund.
All federal funds, except those covered by the foregoing 3
paragraphs, received as reimbursement for expenditures from the General Revenue
Fund shall be deposited in the General Revenue Fund for administrative and
distributive expenditures properly chargeable by federal law or regulation to
aid programs established under Articles III through XII and Titles IV, XVI, XIX
and XX of the Federal Social Security Act. Any other federal funds received by
the Illinois Department under Sections 12-4.6, 12-4.18 and
12-4.19 that are required by Section 12-10 of this Code to be paid into the
DHS Special Purposes Trust Fund shall be deposited into the DHS Special Purposes Trust
Fund. Any other federal funds received by the Illinois Department pursuant to
the Child Support Enforcement Program established by Title IV-D of the Social
Security Act shall be deposited in the Child Support Enforcement Trust Fund
as required under Section 12-10.2 or in the Child Support Administrative Fund as required under Section 12-10.2a of this Code. Any other federal funds received by the Illinois Department for
expenditures made under Title XIX of the Social Security Act and Articles
V and VI of this Code that are required by Section 15-2 of this Code
to be paid into the County Provider Trust Fund shall be deposited
into the County Provider Trust Fund. Any other federal funds received
by the Illinois Department for hospital
inpatient, hospital ambulatory care, and disproportionate share hospital
expenditures made under Title XIX of the Social Security Act and Article V of
this Code that are required by Section 5A-8 of this Code to be paid into the
Hospital Provider Fund shall be deposited into the Hospital Provider Fund. Any
other federal funds received by the Illinois Department for medical
assistance program expenditures made under Title XIX of the Social Security
Act and Article V of this Code that are required by Section 5B-8 of this
Code to be paid into the Long-Term Care Provider Fund shall be deposited
into the Long-Term Care Provider Fund. Any other federal funds received by
the Illinois Department for medical assistance program expenditures made
under Title XIX of the Social Security Act and Article V of this Code that
are required by Section 5C-7 of this Code to be paid into the
Care Provider Fund for Persons with a Developmental Disability shall be deposited into the
Care Provider Fund for Persons with a Developmental Disability. Any other federal funds received
by the Illinois Department for trauma center
adjustment payments that are required by Section 5-5.03 of this Code and made
under Title XIX of the Social Security Act and Article V of this Code shall be
deposited into the Trauma Center Fund. Any other federal funds received by
the Illinois Department as reimbursement for expenses for early intervention
services paid from the Early Intervention Services Revolving Fund shall be
deposited into that Fund.
The Illinois Department shall report to the General Assembly at the
end of each fiscal quarter the amount of all funds received and paid into
the Social Services Block Grant Fund and the Local Initiative Fund and the
expenditures and transfers of such funds for services, programs and other
purposes authorized by law. Such report shall be filed with the Speaker,
Minority Leader and Clerk of the House, with the President, Minority Leader
and Secretary of the Senate, with the Chairmen of the House and Senate
Appropriations Committees, the House Human Resources Committee and the
Senate Public Health, Welfare and Corrections Committee, or the successor
standing Committees of each as provided by the rules of the House and
Senate, respectively, with the Commission on Government Forecasting and Accountability and with the State
Government Report Distribution Center for the General Assembly as is
required under paragraph (t) of Section 7 of the State Library Act
shall be deemed sufficient to comply with this Section.
(Source: P.A. 100-587, eff. 6-4-18; 100-863, eff. 8-14-18; 100-1148, eff. 12-10-18; 101-275, eff. 8-9-19.) |
(305 ILCS 5/12-6) (from Ch. 23, par. 12-6)
Sec. 12-6.
(Repealed).
(Source: P.A. 90-372, eff. 7-1-98. Repealed internally, eff. 7-1-98.)
|
(305 ILCS 5/12-8) (from Ch. 23, par. 12-8)
Sec. 12-8. Public Assistance Emergency Revolving Fund - Uses. The
Public Assistance Emergency Revolving Fund, established by Act approved
July 8, 1955 shall be held by the Illinois Department and shall be used
for the following purposes:
1. To provide immediate financial aid to applicants | ||
| ||
2. To provide emergency aid to recipients under said | ||
| ||
3. To provide emergency aid for transportation, meals | ||
| ||
4. To provide emergency transportation expense | ||
| ||
5. To assist public aid applicants in obtaining | ||
| ||
6. To provide immediate payments to current or former | ||
| ||
7. To provide payments to individuals or providers of | ||
| ||
8. To provide immediate payment of fees, as follows: (A) To sheriffs and other public officials | ||
| ||
(B) To county clerks, recorders of deeds, and | ||
| ||
(C) To State and local officials in connection | ||
| ||
(D) To the State Registrar of Vital Records, | ||
| ||
Disbursements from the Public Assistance Emergency Revolving Fund
shall be made by the Illinois Department.
Expenditures from the Public Assistance Emergency Revolving Fund
shall be for purposes which are properly chargeable to appropriations
made to the Illinois Department, or, in the case of payments under subparagraphs 6 and 8, to the Child Support Enforcement Trust Fund or the Child Support Administrative Fund, except that no expenditure, other than payment of the fees provided for under subparagraph 8 of this Section,
shall be made for purposes which are properly chargeable to appropriations
for the following objects: personal services; extra help; state contributions
to retirement system; state contributions to Social Security; state
contributions for employee group insurance; contractual services; travel;
commodities; printing; equipment; electronic data processing; operation of
auto equipment; telecommunications services; library books; and refunds.
The Illinois Department shall reimburse the Public Assistance Emergency
Revolving Fund by warrants drawn by the State Comptroller on the
appropriation or appropriations which are so chargeable, or, in the case of
payments under subparagraphs 6 and 8, by warrants drawn on the Child Support
Enforcement Trust Fund or the Child Support Administrative Fund, payable to the Revolving Fund.
(Source: P.A. 103-102, eff. 1-1-24 .)
|
(305 ILCS 5/12-8.1)
Sec. 12-8.1.
State Disbursement Unit Revolving Fund.
(a) There is created a revolving fund to be known as the State Disbursement
Unit Revolving Fund, to be held by the Director of the Illinois Department,
outside the State treasury,
for the following purposes:
(1) the deposit of all support payments received by | ||
| ||
(2) the deposit of other funds including, but not | ||
| ||
(3) the deposit of any interest accrued by the | ||
| ||
(4) the disbursement of such payments to obligees or | ||
| ||
(5) the disbursement of funds to payors or obligors | ||
| ||
(b) (Blank).
(Source: P.A. 92-44, eff. 7-1-01; 93-20, eff. 6-20-03.)
|
(305 ILCS 5/12-8.2) Sec. 12-8.2. Medical Assistance Dental Reimbursement Revolving Fund. There is created a revolving fund to be known as the Medical Assistance Dental Reimbursement Revolving Fund, to be held by the Director of the Department of Healthcare and Family Services, outside of the State treasury, for the following purposes: (1) The deposit of all funds to pay for dental | ||
| ||
(2) The deposit of any interest accrued by the | ||
| ||
(3) The payment of amounts to enrolled dental service | ||
| ||
(Source: P.A. 96-1123, eff. 1-1-11.) |
(305 ILCS 5/12-9) (from Ch. 23, par. 12-9) Sec. 12-9. Public Aid Recoveries Trust Fund; uses. The Public Aid Recoveries Trust Fund shall consist of (1) recoveries by the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid) authorized by this Code in respect to applicants or recipients under Articles III, IV, V, and VI, including recoveries made by the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid) from the estates of deceased recipients, (2) recoveries made by the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid) in respect to applicants and recipients under the Children's Health Insurance Program Act, and the Covering ALL KIDS Health Insurance Act, (2.5) recoveries made by the Department of Healthcare and Family Services in connection with the imposition of an administrative penalty as provided under Section 12-4.45, (3) federal funds received on behalf of and earned by State universities, other State agencies or departments, and local governmental entities for services provided to applicants or recipients covered under this Code, the Children's Health Insurance Program Act, and the Covering ALL KIDS Health Insurance Act, (3.5) federal financial participation revenue related to eligible disbursements made by the Department of Healthcare and Family Services from appropriations required by this Section, and (4) all other moneys received to the Fund, including interest thereon. The Fund shall be held as a special fund in the State Treasury. Disbursements from this Fund shall be only (1) for the reimbursement of claims collected by the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid) through error or mistake, (2) for payment to persons or agencies designated as payees or co-payees on any instrument, whether or not negotiable, delivered to the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid) as a recovery under this Section, such payment to be in proportion to the respective interests of the payees in the amount so collected, (3) for payments to the Department of Human Services for collections made by the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid) on behalf of the Department of Human Services under this Code, the Children's Health Insurance Program Act, and the Covering ALL KIDS Health Insurance Act, (4) for payment of administrative expenses incurred in performing the activities authorized under this Code, the Children's Health Insurance Program Act, and the Covering ALL KIDS Health Insurance Act, (5) for payment of fees to persons or agencies in the performance of activities pursuant to the collection of monies owed the State that are collected under this Code, the Children's Health Insurance Program Act, and the Covering ALL KIDS Health Insurance Act, (6) for payments of any amounts which are reimbursable to the federal government which are required to be paid by State warrant by either the State or federal government, and (7) for payments to State universities, other State agencies or departments, and local governmental entities of federal funds for services provided to applicants or recipients covered under this Code, the Children's Health Insurance Program Act, and the Covering ALL KIDS Health Insurance Act. Disbursements from this Fund for purposes of items (4) and (5) of this paragraph shall be subject to appropriations from the Fund to the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid). The balance in this Fund after payment therefrom of any amounts reimbursable to the federal government, and minus the amount anticipated to be needed to make the disbursements authorized by this Section, shall be certified by the Director of Healthcare and Family Services and transferred by the State Comptroller to the Drug Rebate Fund or the Healthcare Provider Relief Fund in the State Treasury, as appropriate, on at least an annual basis by June 30th of each fiscal year. The Director of Healthcare and Family Services may certify and the State Comptroller shall transfer to the Drug Rebate Fund or the Healthcare Provider Relief Fund amounts on a more frequent basis. (Source: P.A. 103-593, eff. 6-7-24.) |
(305 ILCS 5/12-9.1)
Sec. 12-9.1. DHS Recoveries Trust Fund; uses. The DHS Recoveries Trust
Fund shall consist of (1) recoveries authorized by this Code in respect to
applicants or recipients under Articles III, IV, and VI, including recoveries
from the estates of deceased recipients, (2) payments received by the Illinois
Department of Human Services under Sections 10-3.1, 10-8, 10-10, 10-16, 10-19,
and 12-9 that are required by those Sections to be paid into the DHS Recoveries
Trust Fund, (3) federal financial participation revenue related to eligible disbursements made by the Illinois Department of Human Services from appropriations required by this Section, and (4) amounts received by the Illinois Department of Human Services directly from federal or State grants and intended to be used to pay a portion of the Department's administrative expenses associated with those grants. This Fund shall be held as a special fund in the State Treasury.
Disbursements from the Fund shall be only (1) for the reimbursement of
claims collected by the Illinois Department of Human Services through error
or mistake, (2) for payment to persons or agencies designated as payees or
co-payees on any instrument, whether or not negotiable, delivered to the
Illinois Department of Human Services as a recovery under this Section, such
payment to be in proportion to the respective interests of the payees in the
amount so collected, (3) for payments to non-recipients, or to former
recipients of financial aid of the collections which are made in their behalf
under Article X, (4) for payment to local governmental units of support
payments collected by the Illinois Department of Human Services pursuant to
an agreement under Section 10-3.1, (5) for payment of administrative expenses
incurred in performing the activities authorized by Article X, (6) for payment of administrative expenses associated with the administration of federal or State grants, (7) for payment
of fees to person or agencies in the performance of activities pursuant to the
collection of moneys owed the State, (8) for payments of any amounts which are
reimbursable to the federal government which are required to be paid by State
warrant by either the State or federal government, and (9) for disbursements to
attorneys or advocates for legal representation in an appeal of any claim for
federal Supplemental Security Income benefits before an administrative law
judge as provided for in Section 3-13 of this Code. Disbursements from the
Fund for purposes of items (5), (6), (7), and (9) of this paragraph shall be subject
to appropriations from the Fund to the Illinois Department of Human Services.
Any transfers from the Fund that were required to be made prior to June 19, 2013 (the effective date of Public Act 98-24) shall not be made. (Source: P.A. 100-59, eff. 1-1-18 .)
|
(305 ILCS 5/12-10) (from Ch. 23, par. 12-10)
Sec. 12-10. DHS Special Purposes Trust Fund; uses. The DHS Special
Purposes Trust Fund, to be held outside the State Treasury by the State
Treasurer as ex-officio custodian, shall consist of (1) any federal grants
received under Section 12-4.6 that are not required by Section 12-5 to be paid
into the General Revenue Fund or transferred into the Local Initiative Fund
under Section 12-10.1 or deposited in the Employment and Training Fund under
Section 12-10.3; (2) grants, gifts or legacies of moneys or securities
received under Section 12-4.18; (3) grants received under Section 12-4.19; and
(4) funds for child care and development services that are not deposited into the Employment and Training Fund under Section 12-10.3. Disbursements from this
Fund shall be only for the purposes authorized by the aforementioned Sections.
Disbursements from this Fund shall be by warrants drawn by the State
Comptroller on receipt of vouchers duly executed and certified by the Illinois
Department of Human Services, including payment to the Health Insurance
Reserve Fund for group insurance costs at the rate certified by the Department
of Central Management Services. In addition to any other transfers that may be provided for by law, the State Comptroller shall direct and the State Treasurer shall transfer from the DHS Special Purposes Trust Fund into the Governor's Grant Fund such amounts as may be directed in writing by the Secretary of Human Services.
In addition to any other transfers that may be provided for by law, the State Comptroller shall direct and the State Treasurer shall transfer from the DHS Special Purposes Trust Fund into the Employment and Training fund such amounts as may be directed in writing by the Secretary of Human Services.
(Source: P.A. 102-16, eff. 6-17-21; 103-363, eff. 7-28-23.)
|
(305 ILCS 5/12-10.1) (from Ch. 23, par. 12-10.1)
Sec. 12-10.1.
Local Initiative Fund - Uses.
There is hereby created the Local Initiative Fund in the
State Treasury. The Local Initiative Fund is created for the purpose of
receiving and disbursing monies in accordance with the provisions of the
Social Services Block Grant of the federal Social Security Act and related
rules and regulations,
as now or hereafter amended, governing the use of such monies.
Expenditures from the Local Initiative Fund shall be made for services
contained in the Projected Expenditure Report required of the State
under the Social Services Block Grant of the federal
Social Security Act. The Local Initiative
Fund shall be administered by the Illinois Department, which
shall expend monies appropriated from such fund by the Illinois General
Assembly for the purchase and provision of social services. The Illinois
Department shall execute a written contract for the purchase
of social services from persons qualified to provide such
services. Such contract
shall be filed with the Illinois Department and the State
Comptroller.
There shall be paid into the Local Initiative Fund the following monies:
1. Federal funds paid to the State as reimbursement for expenditures
from the Local Initiative Fund made according to the provisions of the
federal Social Services Block Grant.
2. Payments by the Illinois Department for the purpose of
reimbursing the Local Initiative Fund for expenditures for services not
approved for federal reimbursement under the Social Security Block Grant of
the federal Social Security Act either by the Illinois Department or by the
federal Department of Health and Human Services. Such
payments shall be made by the Illinois Department in the
amount that the Director of the Illinois Department has
determined was not caused by the failure of a provider of services to comply
with the provisions of a service contract or the provisions of the Social
Services Block Grant of the federal Social Security Act and related rules
and regulations as now or hereafter amended. Any such expenditures for
services not approved for federal reimbursement which are subsequently paid
into the Social Services Block Grant Fund shall be transferred into
the General Revenue Fund.
(Source: P.A. 89-507, eff. 7-1-97.)
|
(305 ILCS 5/12-10.2) (from Ch. 23, par. 12-10.2)
Sec. 12-10.2.
The Child Support Enforcement Trust Fund.
(a) The Child Support Enforcement Trust Fund, to be held by
the State Treasurer as ex-officio custodian outside the State Treasury,
pursuant to the Child Support Enforcement Program established by Title
IV-D of the Social Security Act, shall consist of the following, through June
30, 2002:
(1) all support payments assigned to the Illinois | ||
| ||
(2) all support payments received by the Illinois | ||
| ||
(3) all federal grants received by the Illinois | ||
| ||
(4) incentive payments received by the Illinois | ||
| ||
(5) incentive payments retained by the Illinois | ||
| ||
(6) all fees charged by the Department for child | ||
| ||
(7) all amounts appropriated by the General Assembly | ||
| ||
(8) any gifts, grants, donations, or awards from | ||
| ||
(a-5) On and after July 1, 2002, the Child Support Enforcement Trust Fund
shall
consist of the following:
(1) all support payments assigned to the Illinois | ||
| ||
(2) all support payments received by the Illinois | ||
| ||
(3) all federal grants received by the Illinois | ||
| ||
(4) incentive payments received by the Illinois | ||
| ||
(5) incentive payments retained by the Illinois | ||
| ||
(6) all fees charged by the Department for child | ||
| ||
(7) all amounts appropriated by the General Assembly | ||
| ||
(8) any gifts, grants, donations, or awards from | ||
| ||
(b) Disbursements from this Fund shall be only for the following
purposes:
(1) for the reimbursement of funds received by the | ||
| ||
(2) for payments to non-recipients, current | ||
| ||
(3) for any other payments required by law to be paid | ||
| ||
(4) for payment of any administrative expenses | ||
| ||
(5) for the reimbursement of the Public Assistance | ||
| ||
(6) for the payment of incentive amounts owed to | ||
| ||
(7) for the payment of incentive amounts owed to | ||
| ||
(8) for payments of any amounts which are | ||
| ||
Disbursements from this Fund shall be by warrants drawn by the State
Comptroller on receipt of vouchers duly executed and certified by the Illinois
Department or any other State agency that receives an appropriation from the
Fund.
(c) The Illinois Department's child support administrative expenses, as
defined in Section 12-10.2a, that are incurred after fiscal year 2002 shall be
paid only as provided in that Section.
(Source: P.A. 91-212, eff. 7-20-99; 91-400, eff. 7-30-99; 91-712, eff.
7-1-00; 92-44, eff. 7-1-01; 92-570, eff. 6-26-02; 92-651, eff. 7-11-02.)
|
(305 ILCS 5/12-10.2a)
Sec. 12-10.2a. Child Support Administrative Fund.
(a) Beginning July 1, 2002, the Child Support Administrative Fund is created
as a special fund in
the State treasury. Moneys in the Fund may be used, subject to appropriation,
only for the Department of Healthcare and Family Services' (formerly Department of Public Aid's) child support administrative expenses,
as defined in this Section.
(a-5) Moneys in the Child Support Administrative Fund shall consist of the
following:
(1) all federal grants received by the Illinois | ||
| ||
(2) incentive payments received by the Illinois | ||
| ||
(3) incentive payments retained by the Illinois | ||
| ||
(4) all fees charged by the Department for child | ||
| ||
(5) all amounts appropriated by the General Assembly | ||
| ||
(6) any gifts, grants, donations, or awards from | ||
| ||
(a-10) The moneys identified in subsection (a-5) of this Section shall
include
moneys receipted on or after July 1, 2002, regardless of the fiscal year in
which the
moneys were earned.
(b) As used in this Section, "child support administrative expenses" means
administrative expenses, including payment to the Health Insurance Reserve Fund
for group insurance costs at the rate certified by the Department of Central
Management Services, except those required to be paid from the General Revenue
Fund, including personal and contractual services, incurred by the Department of Healthcare and Family Services (formerly Department
of Public Aid), either directly or under its contracts with SDU contractors as
defined in Section 10-26.2, in performing activities authorized
by Article X of this Code, and including appropriations to other State
agencies or offices. The term includes expenses incurred by the
Department of Healthcare and Family Services (formerly
Department of Public Aid) in administering the Child Support Enforcement Trust
Fund and the State Disbursement Unit Revolving Fund.
(c) Child support administrative expenses incurred in fiscal year 2003 or
thereafter shall be paid only from moneys appropriated
from
the Child Support Administrative Fund.
(d) Before April 1, 2003 and before April 1 of each year thereafter, the
Department of Healthcare and Family Services (formerly Department of Public Aid) shall provide notification to the General Assembly of
the
amount of
the Department's child support administrative expenses expected to be incurred
during the fiscal year beginning on the next July 1, including the estimated
amount required for the operation of the State
Disbursement Unit, which shall be separately identified in the annual
administrative appropriation.
(e) For the fiscal year beginning July 1, 2002 and for each fiscal year
thereafter, the State Comptroller and the State Treasurer shall transfer from
the Child Support Enforcement Trust Fund to the Child Support Administrative
Fund amounts as determined by the Department necessary to enable the Department
to meet its child support
administrative expenses for the then-current fiscal year. For any fiscal year,
the State Comptroller and the State Treasurer may not transfer more than the
total amount appropriated for the Department's child support
administrative expenses for that fiscal year.
(f) By December 1, 2001, the Illinois Department shall provide a corrective
action plan to the General Assembly regarding the establishment of accurate
accounts in the Child Support Enforcement Trust Fund. The plan shall include
those tasks that may be required to establish accurate accounts, the estimated
time for completion of each of those tasks and the plan, and the estimated cost
for completion of each of the tasks and the plan.
(Source: P.A. 95-331, eff. 8-21-07.)
|