101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3297

 

Introduced 2/11/2020, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act. In provisions concerning income verification to determine if an applicant is eligible for the benefits provided under those Acts, provides that a month's income may be verified by a single pay stub with the monthly income extrapolated from the time period covered by the pay stub. Amends the Illinois Public Aid Code. Removes a provision that set rates or payments for home health visits at $72 for dates of service in and after July 1, 2014. Removes a provision that set rates or payments for the certified nursing assistant component of the home health agency rate at $20 for dates of service on and after July 1, 2014. Requires the Department of Healthcare and Family Services to adopt, by rule, a model similar to the psychiatric Collaborative Care Model required under the Illinois Insurance Code. In a provision concerning assessments for long-term care facilities, provides that the Department of Healthcare and Family Services shall provide a self-reporting notice of the assessment form that a long-term care facility completes for the required period and submits with its assessment payment to the Department. In a provision concerning income verification to determine if an applicant is eligible for the medical assistance benefits provided under the Code, provides that a month's income may be verified by a single pay stub with the monthly income extrapolated from the time period covered by the pay stub. Repeals a provision requiring the Department to conduct an annual audit of the County Provider Trust Fund. Amends the Illinois Health Information Exchange and Technology Act and the Regulatory Sunset Act. Provides that the Illinois Health Information Exchange and Technology Act is repealed on January 1, 2026 (rather than January 1, 2021). Effective immediately.


LRB101 18060 KTG 70135 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB3297LRB101 18060 KTG 70135 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. The Regulatory Sunset Act is amended by changing
5Sections 4.31 and 4.36 as follows:
 
6    (5 ILCS 80/4.31)
7    Sec. 4.31. Acts repealed on January 1, 2021. The following
8Acts are repealed on January 1, 2021:
9    The Crematory Regulation Act.
10    The Cemetery Oversight Act.
11    The Illinois Health Information Exchange and Technology
12Act.
13    The Radiation Protection Act of 1990.
14(Source: P.A. 96-1041, eff. 7-14-10; 96-1331, eff. 7-27-10;
15incorporates P.A. 96-863, eff. 3-1-10; 97-333, eff. 8-12-11.)
 
16    (5 ILCS 80/4.36)
17    Sec. 4.36. Acts repealed on January 1, 2026. The following
18Acts are repealed on January 1, 2026:
19    The Barber, Cosmetology, Esthetics, Hair Braiding, and
20Nail Technology Act of 1985.
21    The Collection Agency Act.
22    The Hearing Instrument Consumer Protection Act.

 

 

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1    The Illinois Athletic Trainers Practice Act.
2    The Illinois Dental Practice Act.
3    The Illinois Health Information Exchange and Technology
4Act.
5    The Illinois Roofing Industry Licensing Act.
6    The Illinois Physical Therapy Act.
7    The Professional Geologist Licensing Act.
8    The Respiratory Care Practice Act.
9(Source: P.A. 99-26, eff. 7-10-15; 99-204, eff. 7-30-15;
1099-227, eff. 8-3-15; 99-229, eff. 8-3-15; 99-230, eff. 8-3-15;
1199-427, eff. 8-21-15; 99-469, eff. 8-26-15; 99-492, eff.
1212-31-15; 99-642, eff. 7-28-16.)
 
13    Section 5. Amends the Illinois Health Information Exchange
14and Technology Act is amended by adding Section 996 as follows:
 
15    (20 ILCS 3860/996 new)
16    Sec. 996. Repeal. This Act is repealed as provided in the
17Regulatory Sunset Act.
 
18    Section 10. The Children's Health Insurance Program Act is
19amended by changing Section 7 as follows:
 
20    (215 ILCS 106/7)
21    Sec. 7. Eligibility verification. Notwithstanding any
22other provision of this Act, with respect to applications for

 

 

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1benefits provided under the Program, eligibility shall be
2determined in a manner that ensures program integrity and that
3complies with federal law and regulations while minimizing
4unnecessary barriers to enrollment. To this end, as soon as
5practicable, and unless the Department receives written denial
6from the federal government, this Section shall be implemented:
7    (a) The Department of Healthcare and Family Services or its
8designees shall:
9        (1) By no later than July 1, 2011, require verification
10    of, at a minimum, one month's income from all sources
11    required for determining the eligibility of applicants to
12    the Program. Such verification shall take the form of pay
13    stubs, business or income and expense records for
14    self-employed persons, letters from employers, and any
15    other valid documentation of income including data
16    obtained electronically by the Department or its designees
17    from other sources as described in subsection (b) of this
18    Section. A month's income may be verified by a single pay
19    stub with the monthly income extrapolated from the time
20    period covered by the pay stub.
21        (2) By no later than October 1, 2011, require
22    verification of, at a minimum, one month's income from all
23    sources required for determining the continued eligibility
24    of recipients at their annual review of eligibility under
25    the Program. Such verification shall take the form of pay
26    stubs, business or income and expense records for

 

 

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1    self-employed persons, letters from employers, and any
2    other valid documentation of income including data
3    obtained electronically by the Department or its designees
4    from other sources as described in subsection (b) of this
5    Section. A month's income may be verified by a single pay
6    stub with the monthly income extrapolated from the time
7    period covered by the pay stub. The Department shall send a
8    notice to the recipient at least 60 days prior to the end
9    of the period of eligibility that informs them of the
10    requirements for continued eligibility. Information the
11    Department receives prior to the annual review, including
12    information available to the Department as a result of the
13    recipient's application for other non-health care
14    benefits, that is sufficient to make a determination of
15    continued eligibility for medical assistance or for
16    benefits provided under the Program may be reviewed and
17    verified, and subsequent action taken including client
18    notification of continued eligibility for medical
19    assistance or for benefits provided under the Program. The
20    date of client notification establishes the date for
21    subsequent annual eligibility reviews. If a recipient does
22    not fulfill the requirements for continued eligibility by
23    the deadline established in the notice, a notice of
24    cancellation shall be issued to the recipient and coverage
25    shall end no later than the last day of the month following
26    the last day of the eligibility period. A recipient's

 

 

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1    eligibility may be reinstated without requiring a new
2    application if the recipient fulfills the requirements for
3    continued eligibility prior to the end of the third month
4    following the last date of coverage (or longer period if
5    required by federal regulations). Nothing in this Section
6    shall prevent an individual whose coverage has been
7    cancelled from reapplying for health benefits at any time.
8        (3) By no later than July 1, 2011, require verification
9    of Illinois residency.
10    (b) The Department shall establish or continue cooperative
11arrangements with the Social Security Administration, the
12Illinois Secretary of State, the Department of Human Services,
13the Department of Revenue, the Department of Employment
14Security, and any other appropriate entity to gain electronic
15access, to the extent allowed by law, to information available
16to those entities that may be appropriate for electronically
17verifying any factor of eligibility for benefits under the
18Program. Data relevant to eligibility shall be provided for no
19other purpose than to verify the eligibility of new applicants
20or current recipients of health benefits under the Program.
21Data will be requested or provided for any new applicant or
22current recipient only insofar as that individual's
23circumstances are relevant to that individual's or another
24individual's eligibility.
25    (c) Within 90 days of the effective date of this amendatory
26Act of the 96th General Assembly, the Department of Healthcare

 

 

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1and Family Services shall send notice to current recipients
2informing them of the changes regarding their eligibility
3verification.
4(Source: P.A. 101-209, eff. 8-5-19.)
 
5    Section 15. The Covering ALL KIDS Health Insurance Act is
6amended by changing Section 7 as follows:
 
7    (215 ILCS 170/7)
8    (Section scheduled to be repealed on October 1, 2024)
9    Sec. 7. Eligibility verification. Notwithstanding any
10other provision of this Act, with respect to applications for
11benefits provided under the Program, eligibility shall be
12determined in a manner that ensures program integrity and that
13complies with federal law and regulations while minimizing
14unnecessary barriers to enrollment. To this end, as soon as
15practicable, and unless the Department receives written denial
16from the federal government, this Section shall be implemented:
17    (a) The Department of Healthcare and Family Services or its
18designees shall:
19        (1) By July 1, 2011, require verification of, at a
20    minimum, one month's income from all sources required for
21    determining the eligibility of applicants to the Program.
22    Such verification shall take the form of pay stubs,
23    business or income and expense records for self-employed
24    persons, letters from employers, and any other valid

 

 

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1    documentation of income including data obtained
2    electronically by the Department or its designees from
3    other sources as described in subsection (b) of this
4    Section. A month's income may be verified by a single pay
5    stub with the monthly income extrapolated from the time
6    period covered by the pay stub.
7        (2) By October 1, 2011, require verification of, at a
8    minimum, one month's income from all sources required for
9    determining the continued eligibility of recipients at
10    their annual review of eligibility under the Program. Such
11    verification shall take the form of pay stubs, business or
12    income and expense records for self-employed persons,
13    letters from employers, and any other valid documentation
14    of income including data obtained electronically by the
15    Department or its designees from other sources as described
16    in subsection (b) of this Section. A month's income may be
17    verified by a single pay stub with the monthly income
18    extrapolated from the time period covered by the pay stub.
19    The Department shall send a notice to recipients at least
20    60 days prior to the end of their period of eligibility
21    that informs them of the requirements for continued
22    eligibility. Information the Department receives prior to
23    the annual review, including information available to the
24    Department as a result of the recipient's application for
25    other non-health care benefits, that is sufficient to make
26    a determination of continued eligibility for benefits

 

 

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1    provided under this Act, the Children's Health Insurance
2    Program Act, or Article V of the Illinois Public Aid Code
3    may be reviewed and verified, and subsequent action taken
4    including client notification of continued eligibility for
5    benefits provided under this Act, the Children's Health
6    Insurance Program Act, or Article V of the Illinois Public
7    Aid Code. The date of client notification establishes the
8    date for subsequent annual eligibility reviews. If a
9    recipient does not fulfill the requirements for continued
10    eligibility by the deadline established in the notice, a
11    notice of cancellation shall be issued to the recipient and
12    coverage shall end no later than the last day of the month
13    following the last day of the eligibility period. A
14    recipient's eligibility may be reinstated without
15    requiring a new application if the recipient fulfills the
16    requirements for continued eligibility prior to the end of
17    the third month following the last date of coverage (or
18    longer period if required by federal regulations). Nothing
19    in this Section shall prevent an individual whose coverage
20    has been cancelled from reapplying for health benefits at
21    any time.
22        (3) By July 1, 2011, require verification of Illinois
23    residency.
24    (b) The Department shall establish or continue cooperative
25arrangements with the Social Security Administration, the
26Illinois Secretary of State, the Department of Human Services,

 

 

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1the Department of Revenue, the Department of Employment
2Security, and any other appropriate entity to gain electronic
3access, to the extent allowed by law, to information available
4to those entities that may be appropriate for electronically
5verifying any factor of eligibility for benefits under the
6Program. Data relevant to eligibility shall be provided for no
7other purpose than to verify the eligibility of new applicants
8or current recipients of health benefits under the Program.
9Data will be requested or provided for any new applicant or
10current recipient only insofar as that individual's
11circumstances are relevant to that individual's or another
12individual's eligibility.
13    (c) Within 90 days of the effective date of this amendatory
14Act of the 96th General Assembly, the Department of Healthcare
15and Family Services shall send notice to current recipients
16informing them of the changes regarding their eligibility
17verification.
18(Source: P.A. 101-209, eff. 8-5-19.)
 
19    Section 20. The Illinois Public Aid Code is amended by
20changing Sections 5-5e, 5-16.8, 5B-4, and 11-5.1 as follows:
 
21    (305 ILCS 5/5-5e)
22    Sec. 5-5e. Adjusted rates of reimbursement.
23    (a) Rates or payments for services in effect on June 30,
242012 shall be adjusted and services shall be affected as

 

 

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1required by any other provision of Public Act 97-689. In
2addition, the Department shall do the following:
3        (1) Delink the per diem rate paid for supportive living
4    facility services from the per diem rate paid for nursing
5    facility services, effective for services provided on or
6    after May 1, 2011 and before July 1, 2019.
7        (2) Cease payment for bed reserves in nursing
8    facilities and specialized mental health rehabilitation
9    facilities; for purposes of therapeutic home visits for
10    individuals scoring as TBI on the MDS 3.0, beginning June
11    1, 2015, the Department shall approve payments for bed
12    reserves in nursing facilities and specialized mental
13    health rehabilitation facilities that have at least a 90%
14    occupancy level and at least 80% of their residents are
15    Medicaid eligible. Payment shall be at a daily rate of 75%
16    of an individual's current Medicaid per diem and shall not
17    exceed 10 days in a calendar month.
18        (2.5) Cease payment for bed reserves for purposes of
19    inpatient hospitalizations to intermediate care facilities
20    for persons with developmental development disabilities,
21    except in the instance of residents who are under 21 years
22    of age.
23        (3) Cease payment of the $10 per day add-on payment to
24    nursing facilities for certain residents with
25    developmental disabilities.
26    (b) After the application of subsection (a),

 

 

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1notwithstanding any other provision of this Code to the
2contrary and to the extent permitted by federal law, on and
3after July 1, 2012, the rates of reimbursement for services and
4other payments provided under this Code shall further be
5reduced as follows:
6        (1) Rates or payments for physician services, dental
7    services, or community health center services reimbursed
8    through an encounter rate, and services provided under the
9    Medicaid Rehabilitation Option of the Illinois Title XIX
10    State Plan shall not be further reduced, except as provided
11    in Section 5-5b.1.
12        (2) Rates or payments, or the portion thereof, paid to
13    a provider that is operated by a unit of local government
14    or State University that provides the non-federal share of
15    such services shall not be further reduced, except as
16    provided in Section 5-5b.1.
17        (3) Rates or payments for hospital services delivered
18    by a hospital defined as a Safety-Net Hospital under
19    Section 5-5e.1 of this Code shall not be further reduced,
20    except as provided in Section 5-5b.1.
21        (4) Rates or payments for hospital services delivered
22    by a Critical Access Hospital, which is an Illinois
23    hospital designated as a critical care hospital by the
24    Department of Public Health in accordance with 42 CFR 485,
25    Subpart F, shall not be further reduced, except as provided
26    in Section 5-5b.1.

 

 

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1        (5) Rates or payments for Nursing Facility Services
2    shall only be further adjusted pursuant to Section 5-5.2 of
3    this Code.
4        (6) Rates or payments for services delivered by long
5    term care facilities licensed under the ID/DD Community
6    Care Act or the MC/DD Act and developmental training
7    services shall not be further reduced.
8        (7) Rates or payments for services provided under
9    capitation rates shall be adjusted taking into
10    consideration the rates reduction and covered services
11    required by Public Act 97-689.
12        (8) For hospitals not previously described in this
13    subsection, the rates or payments for hospital services
14    shall be further reduced by 3.5%, except for payments
15    authorized under Section 5A-12.4 of this Code.
16        (9) For all other rates or payments for services
17    delivered by providers not specifically referenced in
18    paragraphs (1) through (8), rates or payments shall be
19    further reduced by 2.7%.
20    (c) Any assessment imposed by this Code shall continue and
21nothing in this Section shall be construed to cause it to
22cease.
23    (d) Notwithstanding any other provision of this Code to the
24contrary, subject to federal approval under Title XIX of the
25Social Security Act, for dates of service on and after July 1,
262014, rates or payments for services provided for the purpose

 

 

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1of transitioning children from a hospital to home placement or
2other appropriate setting by a children's community-based
3health care center authorized under the Alternative Health Care
4Delivery Act shall be $683 per day.
5    (e) (Blank) Notwithstanding any other provision of this
6Code to the contrary, subject to federal approval under Title
7XIX of the Social Security Act, for dates of service on and
8after July 1, 2014, rates or payments for home health visits
9shall be $72.
10    (f) (Blank) Notwithstanding any other provision of this
11Code to the contrary, subject to federal approval under Title
12XIX of the Social Security Act, for dates of service on and
13after July 1, 2014, rates or payments for the certified nursing
14assistant component of the home health agency rate shall be
15$20.
16(Source: P.A. 101-10, eff. 6-5-19; revised 9-12-19.)
 
17    (305 ILCS 5/5-16.8)
18    Sec. 5-16.8. Required health benefits. The medical
19assistance program shall (i) provide the post-mastectomy care
20benefits required to be covered by a policy of accident and
21health insurance under Section 356t and the coverage required
22under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
23356z.29, and 356z.32, and 356z.33, 356z.34, and 356z.35 of the
24Illinois Insurance Code and (ii) be subject to the provisions
25of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois

 

 

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1Insurance Code.
2    The Department, by rule, shall adopt a model similar to the
3requirements of Section 356z.39 of the Illinois Insurance Code.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate of
7reimbursement for services or other payments in accordance with
8Section 5-5e.
9    To ensure full access to the benefits set forth in this
10Section, on and after January 1, 2016, the Department shall
11ensure that provider and hospital reimbursement for
12post-mastectomy care benefits required under this Section are
13no lower than the Medicare reimbursement rate.
14(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
15100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
167-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
17eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)
 
18    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
19    Sec. 5B-4. Payment of assessment; penalty.
20    (a) The assessment imposed by Section 5B-2 shall be due and
21payable monthly, on the last State business day of the month
22for occupied bed days reported for the preceding third month
23prior to the month in which the tax is payable and due. A
24facility that has delayed payment due to the State's failure to
25reimburse for services rendered may request an extension on the

 

 

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1due date for payment pursuant to subsection (b) and shall pay
2the assessment within 30 days of reimbursement by the
3Department. The Illinois Department may provide that county
4nursing homes directed and maintained pursuant to Section
55-1005 of the Counties Code may meet their assessment
6obligation by certifying to the Illinois Department that county
7expenditures have been obligated for the operation of the
8county nursing home in an amount at least equal to the amount
9of the assessment.
10    (a-5) The Illinois Department shall provide for an
11electronic submission process for each long-term care facility
12to report at a minimum the number of occupied bed days of the
13long-term care facility for the reporting period and other
14reasonable information the Illinois Department requires for
15the administration of its responsibilities under this Code.
16Beginning July 1, 2013, a separate electronic submission shall
17be completed for each long-term care facility in this State
18operated by a long-term care provider. The Illinois Department
19shall provide a self-reporting notice of the assessment form
20that the long-term care facility completes for the required
21period and submits with its assessment payment to the Illinois
22Department. shall prepare an assessment bill stating the amount
23due and payable each month and submit it to each long-term care
24facility via an electronic process. Each assessment payment
25shall be accompanied by a copy of the assessment bill sent to
26the long-term care facility by the Illinois Department. To the

 

 

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1extent practicable, the Department shall coordinate the
2assessment reporting requirements with other reporting
3required of long-term care facilities.
4    (b) The Illinois Department is authorized to establish
5delayed payment schedules for long-term care providers that are
6unable to make assessment payments when due under this Section
7due to financial difficulties, as determined by the Illinois
8Department. The Illinois Department may not deny a request for
9delay of payment of the assessment imposed under this Article
10if the long-term care provider has not been paid for services
11provided during the month on which the assessment is levied or
12the Medicaid managed care organization has not been paid by the
13State.
14    (c) If a long-term care provider fails to pay the full
15amount of an assessment payment when due (including any
16extensions granted under subsection (b)), there shall, unless
17waived by the Illinois Department for reasonable cause, be
18added to the assessment imposed by Section 5B-2 a penalty
19assessment equal to the lesser of (i) 5% of the amount of the
20assessment payment not paid on or before the due date plus 5%
21of the portion thereof remaining unpaid on the last day of each
22month thereafter or (ii) 100% of the assessment payment amount
23not paid on or before the due date. For purposes of this
24subsection, payments will be credited first to unpaid
25assessment payment amounts (rather than to penalty or
26interest), beginning with the most delinquent assessment

 

 

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1payments. Payment cycles of longer than 60 days shall be one
2factor the Director takes into account in granting a waiver
3under this Section.
4    (c-5) If a long-term care facility fails to file its
5assessment bill with payment, there shall, unless waived by the
6Illinois Department for reasonable cause, be added to the
7assessment due a penalty assessment equal to 25% of the
8assessment due. After July 1, 2013, no penalty shall be
9assessed under this Section if the Illinois Department does not
10provide a process for the electronic submission of the
11information required by subsection (a-5).
12    (d) Nothing in this amendatory Act of 1993 shall be
13construed to prevent the Illinois Department from collecting
14all amounts due under this Article pursuant to an assessment
15imposed before the effective date of this amendatory Act of
161993.
17    (e) Nothing in this amendatory Act of the 96th General
18Assembly shall be construed to prevent the Illinois Department
19from collecting all amounts due under this Code pursuant to an
20assessment, tax, fee, or penalty imposed before the effective
21date of this amendatory Act of the 96th General Assembly.
22    (f) No installment of the assessment imposed by Section
235B-2 shall be due and payable until after the Department
24notifies the long-term care providers, in writing, that the
25payment methodologies to long-term care providers required
26under Section 5-5.4 of this Code have been approved by the

 

 

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1Centers for Medicare and Medicaid Services of the U.S.
2Department of Health and Human Services and the waivers under
342 CFR 433.68 for the assessment imposed by this Section, if
4necessary, have been granted by the Centers for Medicare and
5Medicaid Services of the U.S. Department of Health and Human
6Services. Upon notification to the Department of approval of
7the payment methodologies required under Section 5-5.4 of this
8Code and the waivers granted under 42 CFR 433.68, all
9installments otherwise due under Section 5B-4 prior to the date
10of notification shall be due and payable to the Department upon
11written direction from the Department within 90 days after
12issuance by the Comptroller of the payments required under
13Section 5-5.4 of this Code.
14(Source: P.A. 100-501, eff. 6-1-18.)
 
15    (305 ILCS 5/11-5.1)
16    Sec. 11-5.1. Eligibility verification. Notwithstanding any
17other provision of this Code, with respect to applications for
18medical assistance provided under Article V of this Code,
19eligibility shall be determined in a manner that ensures
20program integrity and complies with federal laws and
21regulations while minimizing unnecessary barriers to
22enrollment. To this end, as soon as practicable, and unless the
23Department receives written denial from the federal
24government, this Section shall be implemented:
25    (a) The Department of Healthcare and Family Services or its

 

 

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1designees shall:
2        (1) By no later than July 1, 2011, require verification
3    of, at a minimum, one month's income from all sources
4    required for determining the eligibility of applicants for
5    medical assistance under this Code. Such verification
6    shall take the form of pay stubs, business or income and
7    expense records for self-employed persons, letters from
8    employers, and any other valid documentation of income
9    including data obtained electronically by the Department
10    or its designees from other sources as described in
11    subsection (b) of this Section. A month's income may be
12    verified by a single pay stub with the monthly income
13    extrapolated from the time period covered by the pay stub.
14        (2) By no later than October 1, 2011, require
15    verification of, at a minimum, one month's income from all
16    sources required for determining the continued eligibility
17    of recipients at their annual review of eligibility for
18    medical assistance under this Code. Information the
19    Department receives prior to the annual review, including
20    information available to the Department as a result of the
21    recipient's application for other non-Medicaid benefits,
22    that is sufficient to make a determination of continued
23    Medicaid eligibility may be reviewed and verified, and
24    subsequent action taken including client notification of
25    continued Medicaid eligibility. The date of client
26    notification establishes the date for subsequent annual

 

 

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1    Medicaid eligibility reviews. Such verification shall take
2    the form of pay stubs, business or income and expense
3    records for self-employed persons, letters from employers,
4    and any other valid documentation of income including data
5    obtained electronically by the Department or its designees
6    from other sources as described in subsection (b) of this
7    Section. A month's income may be verified by a single pay
8    stub with the monthly income extrapolated from the time
9    period covered by the pay stub. The Department shall send a
10    notice to recipients at least 60 days prior to the end of
11    their period of eligibility that informs them of the
12    requirements for continued eligibility. If a recipient
13    does not fulfill the requirements for continued
14    eligibility by the deadline established in the notice a
15    notice of cancellation shall be issued to the recipient and
16    coverage shall end no later than the last day of the month
17    following the last day of the eligibility period. A
18    recipient's eligibility may be reinstated without
19    requiring a new application if the recipient fulfills the
20    requirements for continued eligibility prior to the end of
21    the third month following the last date of coverage (or
22    longer period if required by federal regulations). Nothing
23    in this Section shall prevent an individual whose coverage
24    has been cancelled from reapplying for health benefits at
25    any time.
26        (3) By no later than July 1, 2011, require verification

 

 

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1    of Illinois residency.
2    The Department, with federal approval, may choose to adopt
3continuous financial eligibility for a full 12 months for
4adults on Medicaid.
5    (b) The Department shall establish or continue cooperative
6arrangements with the Social Security Administration, the
7Illinois Secretary of State, the Department of Human Services,
8the Department of Revenue, the Department of Employment
9Security, and any other appropriate entity to gain electronic
10access, to the extent allowed by law, to information available
11to those entities that may be appropriate for electronically
12verifying any factor of eligibility for benefits under the
13Program. Data relevant to eligibility shall be provided for no
14other purpose than to verify the eligibility of new applicants
15or current recipients of health benefits under the Program.
16Data shall be requested or provided for any new applicant or
17current recipient only insofar as that individual's
18circumstances are relevant to that individual's or another
19individual's eligibility.
20    (c) Within 90 days of the effective date of this amendatory
21Act of the 96th General Assembly, the Department of Healthcare
22and Family Services shall send notice to current recipients
23informing them of the changes regarding their eligibility
24verification.
25    (d) As soon as practical if the data is reasonably
26available, but no later than January 1, 2017, the Department

 

 

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1shall compile on a monthly basis data on eligibility
2redeterminations of beneficiaries of medical assistance
3provided under Article V of this Code. This data shall be
4posted on the Department's website, and data from prior months
5shall be retained and available on the Department's website.
6The data compiled and reported shall include the following:
7        (1) The total number of redetermination decisions made
8    in a month and, of that total number, the number of
9    decisions to continue or change benefits and the number of
10    decisions to cancel benefits.
11        (2) A breakdown of enrollee language preference for the
12    total number of redetermination decisions made in a month
13    and, of that total number, a breakdown of enrollee language
14    preference for the number of decisions to continue or
15    change benefits, and a breakdown of enrollee language
16    preference for the number of decisions to cancel benefits.
17    The language breakdown shall include, at a minimum,
18    English, Spanish, and the next 4 most commonly used
19    languages.
20        (3) The percentage of cancellation decisions made in a
21    month due to each of the following:
22            (A) The beneficiary's ineligibility due to excess
23        income.
24            (B) The beneficiary's ineligibility due to not
25        being an Illinois resident.
26            (C) The beneficiary's ineligibility due to being

 

 

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1        deceased.
2            (D) The beneficiary's request to cancel benefits.
3            (E) The beneficiary's lack of response after
4        notices mailed to the beneficiary are returned to the
5        Department as undeliverable by the United States
6        Postal Service.
7            (F) The beneficiary's lack of response to a request
8        for additional information when reliable information
9        in the beneficiary's account, or other more current
10        information, is unavailable to the Department to make a
11        decision on whether to continue benefits.
12            (G) Other reasons tracked by the Department for the
13        purpose of ensuring program integrity.
14        (4) If a vendor is utilized to provide services in
15    support of the Department's redetermination decision
16    process, the total number of redetermination decisions
17    made in a month and, of that total number, the number of
18    decisions to continue or change benefits, and the number of
19    decisions to cancel benefits (i) with the involvement of
20    the vendor and (ii) without the involvement of the vendor.
21        (5) Of the total number of benefit cancellations in a
22    month, the number of beneficiaries who return from
23    cancellation within one month, the number of beneficiaries
24    who return from cancellation within 2 months, and the
25    number of beneficiaries who return from cancellation
26    within 3 months. Of the number of beneficiaries who return

 

 

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1    from cancellation within 3 months, the percentage of those
2    cancellations due to each of the reasons listed under
3    paragraph (3) of this subsection.
4    (e) The Department shall conduct a complete review of the
5Medicaid redetermination process in order to identify changes
6that can increase the use of ex parte redetermination
7processing. This review shall be completed within 90 days after
8the effective date of this amendatory Act of the 101st General
9Assembly. Within 90 days of completion of the review, the
10Department shall seek written federal approval of policy
11changes the review recommended and implement once approved. The
12review shall specifically include, but not be limited to, use
13of ex parte redeterminations of the following populations:
14        (1) Recipients of developmental disabilities services.
15        (2) Recipients of benefits under the State's Aid to the
16    Aged, Blind, or Disabled program.
17        (3) Recipients of Medicaid long-term care services and
18    supports, including waiver services.
19        (4) All Modified Adjusted Gross Income (MAGI)
20    populations.
21        (5) Populations with no verifiable income.
22        (6) Self-employed people.
23    The report shall also outline populations and
24circumstances in which an ex parte redetermination is not a
25recommended option.
26    (f) The Department shall explore and implement, as

 

 

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1practical and technologically possible, roles that
2stakeholders outside State agencies can play to assist in
3expediting eligibility determinations and redeterminations
4within 24 months after the effective date of this amendatory
5Act of the 101st General Assembly. Such practical roles to be
6explored to expedite the eligibility determination processes
7shall include the implementation of hospital presumptive
8eligibility, as authorized by the Patient Protection and
9Affordable Care Act.
10    (g) The Department or its designee shall seek federal
11approval to enhance the reasonable compatibility standard from
125% to 10%.
13    (h) Reporting. The Department of Healthcare and Family
14Services and the Department of Human Services shall publish
15quarterly reports on their progress in implementing policies
16and practices pursuant to this Section as modified by this
17amendatory Act of the 101st General Assembly.
18        (1) The reports shall include, but not be limited to,
19    the following:
20            (A) Medical application processing, including a
21        breakdown of the number of MAGI, non-MAGI, long-term
22        care, and other medical cases pending for various
23        incremental time frames between 0 to 181 or more days.
24            (B) Medical redeterminations completed, including:
25        (i) a breakdown of the number of households that were
26        redetermined ex parte and those that were not; (ii) the

 

 

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1        reasons households were not redetermined ex parte; and
2        (iii) the relative percentages of these reasons.
3            (C) A narrative discussion on issues identified in
4        the functioning of the State's Integrated Eligibility
5        System and progress on addressing those issues, as well
6        as progress on implementing strategies to address
7        eligibility backlogs, including expanding ex parte
8        determinations to ensure timely eligibility
9        determinations and renewals.
10        (2) Initial reports shall be issued within 90 days
11    after the effective date of this amendatory Act of the
12    101st General Assembly.
13        (3) All reports shall be published on the Department's
14    website.
15(Source: P.A. 101-209, eff. 8-5-19.)
 
16    (305 ILCS 5/15-6 rep.)
17    Section 25. The Illinois Public Aid Code is amended by
18repealing Section 15-6.
 
19    Section 99. Effective date. This Act takes effect upon
20becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 80/4.31
4    5 ILCS 80/4.36
5    20 ILCS 3860/996 new
6    215 ILCS 106/7
7    215 ILCS 170/7
8    305 ILCS 5/5-5e
9    305 ILCS 5/5-16.8
10    305 ILCS 5/5B-4from Ch. 23, par. 5B-4
11    305 ILCS 5/11-5.1
12    305 ILCS 5/15-6 rep.