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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The State Finance Act is amended by changing | ||||||||||||||||||||||||
5 | Sections 6z-52, 6z-81, and 25 as follows:
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6 | (30 ILCS 105/6z-52)
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7 | Sec. 6z-52. Drug Rebate Fund.
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8 | (a) There is created in the State Treasury a special fund | ||||||||||||||||||||||||
9 | to be known as
the Drug Rebate Fund.
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10 | (b) The Fund is created for the purpose of receiving and | ||||||||||||||||||||||||
11 | disbursing moneys
in accordance with this Section. | ||||||||||||||||||||||||
12 | Disbursements from the Fund shall be made,
subject to | ||||||||||||||||||||||||
13 | appropriation, only as follows:
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14 | (1) For payments for reimbursement or coverage for | ||||||||||||||||||||||||
15 | prescription drugs and other pharmacy products
provided to | ||||||||||||||||||||||||
16 | a recipient of medical assistance under the Illinois | ||||||||||||||||||||||||
17 | Public Aid Code , the Children's Health Insurance Program | ||||||||||||||||||||||||
18 | Act, the Covering ALL KIDS Health Insurance Act, and the | ||||||||||||||||||||||||
19 | Veterans' Health Insurance Program Act of 2008.
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20 | (1.5) For payments to managed care organizations as
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21 | defined in Section 5-30.1 of the Illinois Public Aid Code. | ||||||||||||||||||||||||
22 | (2) For reimbursement of moneys collected by the | ||||||||||||||||||||||||
23 | Department of Healthcare and Family Services (formerly
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1 | Illinois Department of
Public Aid) through error or | ||||||
2 | mistake.
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3 | (3) For payments of any amounts that are reimbursable | ||||||
4 | to the federal
government resulting from a payment into | ||||||
5 | this Fund.
| ||||||
6 | (4) For payments of operational and administrative | ||||||
7 | expenses related to providing and managing coverage for | ||||||
8 | prescription drugs and other pharmacy products provided to | ||||||
9 | a recipient of medical assistance under the Illinois | ||||||
10 | Public Aid Code , the Children's Health Insurance Program | ||||||
11 | Act, the Covering ALL KIDS Health Insurance Act, and the | ||||||
12 | Veterans' Health Insurance Program Act of 2008. | ||||||
13 | (c) The Fund shall consist of the following:
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14 | (1) Upon notification from the Director of Healthcare | ||||||
15 | and Family Services, the Comptroller
shall direct and the | ||||||
16 | Treasurer shall transfer the net State share (disregarding | ||||||
17 | the reduction in net State share attributable to the | ||||||
18 | American Recovery and Reinvestment Act of 2009 or any | ||||||
19 | other federal economic stimulus program) of all moneys
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20 | received by the Department of Healthcare and Family | ||||||
21 | Services (formerly Illinois Department of Public Aid) from | ||||||
22 | drug rebate agreements
with pharmaceutical manufacturers | ||||||
23 | pursuant to Title XIX of the federal Social
Security Act, | ||||||
24 | including any portion of the balance in the Public Aid | ||||||
25 | Recoveries
Trust Fund on July 1, 2001 that is attributable | ||||||
26 | to such receipts.
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1 | (2) All federal matching funds received by the | ||||||
2 | Illinois Department as a
result of expenditures made by | ||||||
3 | the Department that are attributable to moneys
deposited | ||||||
4 | in the Fund.
| ||||||
5 | (3) Any premium collected by the Illinois Department | ||||||
6 | from participants
under a waiver approved by the federal | ||||||
7 | government relating to provision of
pharmaceutical | ||||||
8 | services.
| ||||||
9 | (4) All other moneys received for the Fund from any | ||||||
10 | other source,
including interest earned thereon.
| ||||||
11 | (Source: P.A. 100-23, eff. 7-6-17.)
| ||||||
12 | (30 ILCS 105/6z-81) | ||||||
13 | Sec. 6z-81. Healthcare Provider Relief Fund. | ||||||
14 | (a) There is created in the State treasury a special fund | ||||||
15 | to be known as the Healthcare Provider Relief Fund. | ||||||
16 | (b) The Fund is created for the purpose of receiving and | ||||||
17 | disbursing moneys in accordance with this Section. | ||||||
18 | Disbursements from the Fund shall be made only as follows: | ||||||
19 | (1) Subject to appropriation, for payment by the | ||||||
20 | Department of Healthcare and
Family Services or by the | ||||||
21 | Department of Human Services of medical bills and related | ||||||
22 | expenses, including administrative expenses, for which the | ||||||
23 | State is responsible under Titles XIX and XXI of the | ||||||
24 | Social Security Act, the Illinois Public Aid Code, the | ||||||
25 | Children's Health Insurance Program Act, the Covering ALL |
| |||||||
| |||||||
1 | KIDS Health Insurance Act, and the Long Term Acute Care | ||||||
2 | Hospital Quality Improvement Transfer Program Act. | ||||||
3 | (2) For repayment of funds borrowed from other State
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4 | funds or from outside sources, including interest thereon. | ||||||
5 | (3) For making payments to the human poison control | ||||||
6 | center pursuant to Section 12-4.105 of the Illinois Public | ||||||
7 | Aid Code. | ||||||
8 | (c) The Fund shall consist of the following: | ||||||
9 | (1) Moneys received by the State from short-term
| ||||||
10 | borrowing pursuant to the Short Term Borrowing Act on or | ||||||
11 | after the effective date of Public Act 96-820. | ||||||
12 | (2) All federal matching funds received by the
| ||||||
13 | Illinois Department of Healthcare and Family Services as a | ||||||
14 | result of expenditures made by the Department that are | ||||||
15 | attributable to moneys deposited in the Fund. | ||||||
16 | (3) All federal matching funds received by the
| ||||||
17 | Illinois Department of Healthcare and Family Services as a | ||||||
18 | result of federal approval of Title XIX State plan | ||||||
19 | amendment transmittal number 07-09. | ||||||
20 | (3.5) Proceeds from the assessment authorized under | ||||||
21 | Article V-H of the Illinois Public Aid Code. | ||||||
22 | (4) All other moneys received for the Fund from any
| ||||||
23 | other source, including interest earned thereon. | ||||||
24 | (5) All federal matching funds received by the
| ||||||
25 | Illinois Department of Healthcare and Family Services as a | ||||||
26 | result of expenditures made by the Department for Medical |
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| |||||||
1 | Assistance from the General Revenue Fund, the Tobacco | ||||||
2 | Settlement Recovery Fund, the Long-Term Care Provider | ||||||
3 | Fund, and the Drug Rebate Fund related to individuals | ||||||
4 | eligible for medical assistance pursuant to the Patient | ||||||
5 | Protection and Affordable Care Act (P.L. 111-148) and | ||||||
6 | Section 5-2 of the Illinois Public Aid Code. | ||||||
7 | (d) In addition to any other transfers that may be | ||||||
8 | provided for by law, on the effective date of Public Act 97-44, | ||||||
9 | or as soon thereafter as practical, the State Comptroller | ||||||
10 | shall direct and the State Treasurer shall transfer the sum of | ||||||
11 | $365,000,000 from the General Revenue Fund into the Healthcare | ||||||
12 | Provider Relief Fund.
| ||||||
13 | (e) In addition to any other transfers that may be | ||||||
14 | provided for by law, on July 1, 2011, or as soon thereafter as | ||||||
15 | practical, the State Comptroller shall direct and the State | ||||||
16 | Treasurer shall transfer the sum of $160,000,000 from the | ||||||
17 | General Revenue Fund to the Healthcare Provider Relief Fund. | ||||||
18 | (f) Notwithstanding any other State law to the contrary, | ||||||
19 | and in addition to any other transfers that may be provided for | ||||||
20 | by law, the State Comptroller shall order transferred and the | ||||||
21 | State Treasurer shall transfer $500,000,000 to the Healthcare | ||||||
22 | Provider Relief Fund from the General Revenue Fund in equal | ||||||
23 | monthly installments of $100,000,000, with the first transfer | ||||||
24 | to be made on July 1, 2012, or as soon thereafter as practical, | ||||||
25 | and with each of the remaining transfers to be made on August | ||||||
26 | 1, 2012, September 1, 2012, October 1, 2012, and November 1, |
| |||||||
| |||||||
1 | 2012, or as soon thereafter as practical. This transfer may | ||||||
2 | assist the Department of Healthcare and Family Services in | ||||||
3 | improving Medical Assistance bill processing timeframes or in | ||||||
4 | meeting the possible requirements of Senate Bill 3397, or | ||||||
5 | other similar legislation, of the 97th General Assembly should | ||||||
6 | it become law. | ||||||
7 | (g) Notwithstanding any other State law to the contrary, | ||||||
8 | and in addition to any other transfers that may be provided for | ||||||
9 | by law, on July 1, 2013, or as soon thereafter as may be | ||||||
10 | practical, the State Comptroller shall direct and the State | ||||||
11 | Treasurer shall transfer the sum of $601,000,000 from the | ||||||
12 | General Revenue Fund to the Healthcare Provider Relief Fund. | ||||||
13 | (Source: P.A. 100-587, eff. 6-4-18; 101-9, eff. 6-5-19; | ||||||
14 | 101-650, eff. 7-7-20.)
| ||||||
15 | (30 ILCS 105/25) (from Ch. 127, par. 161)
| ||||||
16 | Sec. 25. Fiscal year limitations.
| ||||||
17 | (a) All appropriations shall be
available for expenditure | ||||||
18 | for the fiscal year or for a lesser period if the
Act making | ||||||
19 | that appropriation so specifies. A deficiency or emergency
| ||||||
20 | appropriation shall be available for expenditure only through | ||||||
21 | June 30 of
the year when the Act making that appropriation is | ||||||
22 | enacted unless that Act
otherwise provides.
| ||||||
23 | (b) Outstanding liabilities as of June 30, payable from | ||||||
24 | appropriations
which have otherwise expired, may be paid out | ||||||
25 | of the expiring
appropriations during the 2-month period |
| |||||||
| |||||||
1 | ending at the
close of business on August 31. Any service | ||||||
2 | involving
professional or artistic skills or any personal | ||||||
3 | services by an employee whose
compensation is subject to | ||||||
4 | income tax withholding must be performed as of June
30 of the | ||||||
5 | fiscal year in order to be considered an "outstanding | ||||||
6 | liability as of
June 30" that is thereby eligible for payment | ||||||
7 | out of the expiring
appropriation.
| ||||||
8 | (b-1) However, payment of tuition reimbursement claims | ||||||
9 | under Section 14-7.03 or
18-3 of the School Code may be made by | ||||||
10 | the State Board of Education from its
appropriations for those | ||||||
11 | respective purposes for any fiscal year, even though
the | ||||||
12 | claims reimbursed by the payment may be claims attributable to | ||||||
13 | a prior
fiscal year, and payments may be made at the direction | ||||||
14 | of the State
Superintendent of Education from the fund from | ||||||
15 | which the appropriation is made
without regard to any fiscal | ||||||
16 | year limitations, except as required by subsection (j) of this | ||||||
17 | Section. Beginning on June 30, 2021, payment of tuition | ||||||
18 | reimbursement claims under Section 14-7.03 or 18-3 of the | ||||||
19 | School Code as of June 30, payable from appropriations that | ||||||
20 | have otherwise expired, may be paid out of the expiring | ||||||
21 | appropriation during the 4-month period ending at the close of | ||||||
22 | business on October 31.
| ||||||
23 | (b-2) (Blank). | ||||||
24 | (b-2.5) (Blank). | ||||||
25 | (b-2.6) (Blank). | ||||||
26 | (b-2.6a) (Blank). |
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| |||||||
1 | (b-2.6b) (Blank). | ||||||
2 | (b-2.6c) (Blank). | ||||||
3 | (b-2.6d) All outstanding liabilities as of June 30, 2020, | ||||||
4 | payable from appropriations that would otherwise expire at the | ||||||
5 | conclusion of the lapse period for fiscal year 2020, and | ||||||
6 | interest penalties payable on those liabilities under the | ||||||
7 | State Prompt Payment Act, may be paid out of the expiring | ||||||
8 | appropriations until December 31, 2020, without regard to the | ||||||
9 | fiscal year in which the payment is made, as long as vouchers | ||||||
10 | for the liabilities are received by the Comptroller no later | ||||||
11 | than September 30, 2020. | ||||||
12 | (b-2.7) For fiscal years 2012, 2013, 2014, 2018, 2019, | ||||||
13 | 2020, and 2021, interest penalties payable under the State | ||||||
14 | Prompt Payment Act associated with a voucher for which payment | ||||||
15 | is issued after June 30 may be paid out of the next fiscal | ||||||
16 | year's appropriation. The future year appropriation must be | ||||||
17 | for the same purpose and from the same fund as the original | ||||||
18 | payment. An interest penalty voucher submitted against a | ||||||
19 | future year appropriation must be submitted within 60 days | ||||||
20 | after the issuance of the associated voucher, except that, for | ||||||
21 | fiscal year 2018 only, an interest penalty voucher submitted | ||||||
22 | against a future year appropriation must be submitted within | ||||||
23 | 60 days of June 5, 2019 (the effective date of Public Act | ||||||
24 | 101-10). The Comptroller must issue the interest payment | ||||||
25 | within 60 days after acceptance of the interest voucher. | ||||||
26 | (b-3) Medical payments may be made by the Department of |
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1 | Veterans' Affairs from
its
appropriations for those purposes | ||||||
2 | for any fiscal year, without regard to the
fact that the | ||||||
3 | medical services being compensated for by such payment may | ||||||
4 | have
been rendered in a prior fiscal year, except as required | ||||||
5 | by subsection (j) of this Section. Beginning on June 30, 2021, | ||||||
6 | medical payments payable from appropriations that have | ||||||
7 | otherwise expired may be paid out of the expiring | ||||||
8 | appropriation during the 4-month period ending at the close of | ||||||
9 | business on October 31.
| ||||||
10 | (b-4) Medical payments and child care
payments may be made | ||||||
11 | by the Department of
Human Services (as successor to the | ||||||
12 | Department of Public Aid) from
appropriations for those | ||||||
13 | purposes for any fiscal year,
without regard to the fact that | ||||||
14 | the medical or child care services being
compensated for by | ||||||
15 | such payment may have been rendered in a prior fiscal
year; and | ||||||
16 | payments may be made at the direction of the Department of
| ||||||
17 | Healthcare and Family Services (or successor agency) from the | ||||||
18 | Health Insurance Reserve Fund without regard to any fiscal
| ||||||
19 | year limitations, except as required by subsection (j) of this | ||||||
20 | Section. Beginning on June 30, 2021, medical and child care | ||||||
21 | payments made by the Department of Human Services and payments | ||||||
22 | made at the discretion of the Department of Healthcare and | ||||||
23 | Family Services (or successor agency) from the Health | ||||||
24 | Insurance Reserve Fund and payable from appropriations that | ||||||
25 | have otherwise expired may be paid out of the expiring | ||||||
26 | appropriation during the 4-month period ending at the close of |
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1 | business on October 31.
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2 | (b-5) Medical payments may be made by the Department of | ||||||
3 | Human Services from its appropriations relating to substance | ||||||
4 | abuse treatment services for any fiscal year, without regard | ||||||
5 | to the fact that the medical services being compensated for by | ||||||
6 | such payment may have been rendered in a prior fiscal year, | ||||||
7 | provided the payments are made on a fee-for-service basis | ||||||
8 | consistent with requirements established for Medicaid | ||||||
9 | reimbursement by the Department of Healthcare and Family | ||||||
10 | Services, except as required by subsection (j) of this | ||||||
11 | Section. Beginning on June 30, 2021, medical payments made by | ||||||
12 | the Department of Human Services relating to substance abuse | ||||||
13 | treatment services payable from appropriations that have | ||||||
14 | otherwise expired may be paid out of the expiring | ||||||
15 | appropriation during the 4-month period ending at the close of | ||||||
16 | business on October 31. | ||||||
17 | (b-6) (Blank).
| ||||||
18 | (b-7) Payments may be made in accordance with a plan | ||||||
19 | authorized by paragraph (11) or (12) of Section 405-105 of the | ||||||
20 | Department of Central Management Services Law from | ||||||
21 | appropriations for those payments without regard to fiscal | ||||||
22 | year limitations. | ||||||
23 | (b-8) Reimbursements to eligible airport sponsors for the | ||||||
24 | construction or upgrading of Automated Weather Observation | ||||||
25 | Systems may be made by the Department of Transportation from | ||||||
26 | appropriations for those purposes for any fiscal year, without |
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| |||||||
1 | regard to the fact that the qualification or obligation may | ||||||
2 | have occurred in a prior fiscal year, provided that at the time | ||||||
3 | the expenditure was made the project had been approved by the | ||||||
4 | Department of Transportation prior to June 1, 2012 and, as a | ||||||
5 | result of recent changes in federal funding formulas, can no | ||||||
6 | longer receive federal reimbursement. | ||||||
7 | (b-9) (Blank). | ||||||
8 | (c) Further, payments may be made by the Department of | ||||||
9 | Public Health and the
Department of Human Services (acting as | ||||||
10 | successor to the Department of Public
Health under the | ||||||
11 | Department of Human Services Act)
from their respective | ||||||
12 | appropriations for grants for medical care to or on
behalf of | ||||||
13 | premature and high-mortality risk infants and their mothers | ||||||
14 | and
for grants for supplemental food supplies provided under | ||||||
15 | the United States
Department of Agriculture Women, Infants and | ||||||
16 | Children Nutrition Program,
for any fiscal year without regard | ||||||
17 | to the fact that the services being
compensated for by such | ||||||
18 | payment may have been rendered in a prior fiscal year, except | ||||||
19 | as required by subsection (j) of this Section. Beginning on | ||||||
20 | June 30, 2021, payments made by the Department of Public | ||||||
21 | Health and the Department of Human Services from their | ||||||
22 | respective appropriations for grants for medical care to or on | ||||||
23 | behalf of premature and high-mortality risk infants and their | ||||||
24 | mothers and for grants for supplemental food supplies provided | ||||||
25 | under the United States Department of Agriculture Women, | ||||||
26 | Infants and Children Nutrition Program payable from |
| |||||||
| |||||||
1 | appropriations that have otherwise expired may be paid out of | ||||||
2 | the expiring appropriations during the 4-month period ending | ||||||
3 | at the close of business on October 31.
| ||||||
4 | (d) The Department of Public Health and the Department of | ||||||
5 | Human Services
(acting as successor to the Department of | ||||||
6 | Public Health under the Department of
Human Services Act) | ||||||
7 | shall each annually submit to the State Comptroller, Senate
| ||||||
8 | President, Senate
Minority Leader, Speaker of the House, House | ||||||
9 | Minority Leader, and the
respective Chairmen and Minority | ||||||
10 | Spokesmen of the
Appropriations Committees of the Senate and | ||||||
11 | the House, on or before
December 31, a report of fiscal year | ||||||
12 | funds used to pay for services
provided in any prior fiscal | ||||||
13 | year. This report shall document by program or
service | ||||||
14 | category those expenditures from the most recently completed | ||||||
15 | fiscal
year used to pay for services provided in prior fiscal | ||||||
16 | years.
| ||||||
17 | (e) The Department of Healthcare and Family Services, the | ||||||
18 | Department of Human Services
(acting as successor to the | ||||||
19 | Department of Public Aid), and the Department of Human | ||||||
20 | Services making fee-for-service payments relating to substance | ||||||
21 | abuse treatment services provided during a previous fiscal | ||||||
22 | year shall each annually
submit to the State
Comptroller, | ||||||
23 | Senate President, Senate Minority Leader, Speaker of the | ||||||
24 | House,
House Minority Leader, the respective Chairmen and | ||||||
25 | Minority Spokesmen of the
Appropriations Committees of the | ||||||
26 | Senate and the House, on or before November
30, a report that |
| |||||||
| |||||||
1 | shall document by program or service category those
| ||||||
2 | expenditures from the most recently completed fiscal year used | ||||||
3 | to pay for (i)
services provided in prior fiscal years and (ii) | ||||||
4 | services for which claims were
received in prior fiscal years.
| ||||||
5 | (f) The Department of Human Services (as successor to the | ||||||
6 | Department of
Public Aid) shall annually submit to the State
| ||||||
7 | Comptroller, Senate President, Senate Minority Leader, Speaker | ||||||
8 | of the House,
House Minority Leader, and the respective | ||||||
9 | Chairmen and Minority Spokesmen of
the Appropriations | ||||||
10 | Committees of the Senate and the House, on or before
December | ||||||
11 | 31, a report
of fiscal year funds used to pay for services | ||||||
12 | (other than medical care)
provided in any prior fiscal year. | ||||||
13 | This report shall document by program or
service category | ||||||
14 | those expenditures from the most recently completed fiscal
| ||||||
15 | year used to pay for services provided in prior fiscal years.
| ||||||
16 | (g) In addition, each annual report required to be | ||||||
17 | submitted by the
Department of Healthcare and Family Services | ||||||
18 | under subsection (e) shall include the following
information | ||||||
19 | with respect to the State's Medicaid program:
| ||||||
20 | (1) Explanations of the exact causes of the variance | ||||||
21 | between the previous
year's estimated and actual | ||||||
22 | liabilities.
| ||||||
23 | (2) Factors affecting the Department of Healthcare and | ||||||
24 | Family Services' liabilities,
including, but not limited | ||||||
25 | to, numbers of aid recipients, levels of medical
service | ||||||
26 | utilization by aid recipients, and inflation in the cost |
| |||||||
| |||||||
1 | of medical
services.
| ||||||
2 | (3) The results of the Department's efforts to combat | ||||||
3 | fraud and abuse.
| ||||||
4 | (h) As provided in Section 4 of the General Assembly | ||||||
5 | Compensation Act,
any utility bill for service provided to a | ||||||
6 | General Assembly
member's district office for a period | ||||||
7 | including portions of 2 consecutive
fiscal years may be paid | ||||||
8 | from funds appropriated for such expenditure in
either fiscal | ||||||
9 | year.
| ||||||
10 | (i) An agency which administers a fund classified by the | ||||||
11 | Comptroller as an
internal service fund may issue rules for:
| ||||||
12 | (1) billing user agencies in advance for payments or | ||||||
13 | authorized inter-fund transfers
based on estimated charges | ||||||
14 | for goods or services;
| ||||||
15 | (2) issuing credits, refunding through inter-fund | ||||||
16 | transfers, or reducing future inter-fund transfers
during
| ||||||
17 | the subsequent fiscal year for all user agency payments or | ||||||
18 | authorized inter-fund transfers received during the
prior | ||||||
19 | fiscal year which were in excess of the final amounts owed | ||||||
20 | by the user
agency for that period; and
| ||||||
21 | (3) issuing catch-up billings to user agencies
during | ||||||
22 | the subsequent fiscal year for amounts remaining due when | ||||||
23 | payments or authorized inter-fund transfers
received from | ||||||
24 | the user agency during the prior fiscal year were less | ||||||
25 | than the
total amount owed for that period.
| ||||||
26 | User agencies are authorized to reimburse internal service |
| |||||||
| |||||||
1 | funds for catch-up
billings by vouchers drawn against their | ||||||
2 | respective appropriations for the
fiscal year in which the | ||||||
3 | catch-up billing was issued or by increasing an authorized | ||||||
4 | inter-fund transfer during the current fiscal year. For the | ||||||
5 | purposes of this Act, "inter-fund transfers" means transfers | ||||||
6 | without the use of the voucher-warrant process, as authorized | ||||||
7 | by Section 9.01 of the State Comptroller Act.
| ||||||
8 | (i-1) Beginning on July 1, 2021, all outstanding | ||||||
9 | liabilities, not payable during the 4-month lapse period as | ||||||
10 | described in subsections (b-1), (b-3), (b-4), (b-5), and (c) | ||||||
11 | of this Section, that are made from appropriations for that | ||||||
12 | purpose for any fiscal year, without regard to the fact that | ||||||
13 | the services being compensated for by those payments may have | ||||||
14 | been rendered in a prior fiscal year, are limited to only those | ||||||
15 | claims that have been incurred but for which a proper bill or | ||||||
16 | invoice as defined by the State Prompt Payment Act has not been | ||||||
17 | received by September 30th following the end of the fiscal | ||||||
18 | year in which the service was rendered. | ||||||
19 | (j) Notwithstanding any other provision of this Act, the | ||||||
20 | aggregate amount of payments to be made without regard for | ||||||
21 | fiscal year limitations as contained in subsections (b-1), | ||||||
22 | (b-3), (b-4), (b-5), and (c) of this Section, and determined | ||||||
23 | by using Generally Accepted Accounting Principles, shall not | ||||||
24 | exceed the following amounts: | ||||||
25 | (1) $6,000,000,000 for outstanding liabilities related | ||||||
26 | to fiscal year 2012; |
| |||||||
| |||||||
1 | (2) $5,300,000,000 for outstanding liabilities related | ||||||
2 | to fiscal year 2013; | ||||||
3 | (3) $4,600,000,000 for outstanding liabilities related | ||||||
4 | to fiscal year 2014; | ||||||
5 | (4) $4,000,000,000 for outstanding liabilities related | ||||||
6 | to fiscal year 2015; | ||||||
7 | (5) $3,300,000,000 for outstanding liabilities related | ||||||
8 | to fiscal year 2016; | ||||||
9 | (6) $2,600,000,000 for outstanding liabilities related | ||||||
10 | to fiscal year 2017; | ||||||
11 | (7) $2,000,000,000 for outstanding liabilities related | ||||||
12 | to fiscal year 2018; | ||||||
13 | (8) $1,300,000,000 for outstanding liabilities related | ||||||
14 | to fiscal year 2019; | ||||||
15 | (9) $600,000,000 for outstanding liabilities related | ||||||
16 | to fiscal year 2020; and | ||||||
17 | (10) $0 for outstanding liabilities related to fiscal | ||||||
18 | year 2021 and fiscal years thereafter. | ||||||
19 | (k) Department of Healthcare and Family Services Medical | ||||||
20 | Assistance Payments. | ||||||
21 | (1) Definition of Medical Assistance. | ||||||
22 | For purposes of this subsection, the term "Medical | ||||||
23 | Assistance" shall include, but not necessarily be | ||||||
24 | limited to, medical programs and services authorized | ||||||
25 | under Titles XIX and XXI of the Social Security Act, | ||||||
26 | the Illinois Public Aid Code, the Children's Health |
| |||||||
| |||||||
1 | Insurance Program Act, the Covering ALL KIDS Health | ||||||
2 | Insurance Act, the Long Term Acute Care Hospital | ||||||
3 | Quality Improvement Transfer Program Act, and medical | ||||||
4 | care to or on behalf of persons suffering from chronic | ||||||
5 | renal disease, persons suffering from hemophilia, and | ||||||
6 | victims of sexual assault. | ||||||
7 | (2) Limitations on Medical Assistance payments that | ||||||
8 | may be paid from future fiscal year appropriations. | ||||||
9 | (A) The maximum amounts of annual unpaid Medical | ||||||
10 | Assistance bills received and recorded by the | ||||||
11 | Department of Healthcare and Family Services on or | ||||||
12 | before June 30th of a particular fiscal year | ||||||
13 | attributable in aggregate to the General Revenue Fund, | ||||||
14 | Healthcare Provider Relief Fund, Tobacco Settlement | ||||||
15 | Recovery Fund, Long-Term Care Provider Fund, and the | ||||||
16 | Drug Rebate Fund that may be paid in total by the | ||||||
17 | Department from future fiscal year Medical Assistance | ||||||
18 | appropriations to those funds are:
$700,000,000 for | ||||||
19 | fiscal year 2013 and $100,000,000 for fiscal year 2014 | ||||||
20 | and each fiscal year thereafter. | ||||||
21 | (B) Bills for Medical Assistance services rendered | ||||||
22 | in a particular fiscal year, but received and recorded | ||||||
23 | by the Department of Healthcare and Family Services | ||||||
24 | after June 30th of that fiscal year, may be paid from | ||||||
25 | either appropriations for that fiscal year or future | ||||||
26 | fiscal year appropriations for Medical Assistance. |
| |||||||
| |||||||
1 | Such payments shall not be subject to the requirements | ||||||
2 | of subparagraph (A). | ||||||
3 | (C) Medical Assistance bills received by the | ||||||
4 | Department of Healthcare and Family Services in a | ||||||
5 | particular fiscal year, but subject to payment amount | ||||||
6 | adjustments in a future fiscal year may be paid from a | ||||||
7 | future fiscal year's appropriation for Medical | ||||||
8 | Assistance. Such payments shall not be subject to the | ||||||
9 | requirements of subparagraph (A). | ||||||
10 | (D) Medical Assistance payments made by the | ||||||
11 | Department of Healthcare and Family Services from | ||||||
12 | funds other than those specifically referenced in | ||||||
13 | subparagraph (A) may be made from appropriations for | ||||||
14 | those purposes for any fiscal year without regard to | ||||||
15 | the fact that the Medical Assistance services being | ||||||
16 | compensated for by such payment may have been rendered | ||||||
17 | in a prior fiscal year. Such payments shall not be | ||||||
18 | subject to the requirements of subparagraph (A). | ||||||
19 | (3) Extended lapse period for Department of Healthcare | ||||||
20 | and Family Services Medical Assistance payments. | ||||||
21 | Notwithstanding any other State law to the contrary, | ||||||
22 | outstanding Department of Healthcare and Family Services | ||||||
23 | Medical Assistance liabilities, as of June 30th, payable | ||||||
24 | from appropriations which have otherwise expired, may be | ||||||
25 | paid out of the expiring appropriations during the 6-month | ||||||
26 | period ending at the close of business on December 31st. |
| |||||||
| |||||||
1 | (l) The changes to this Section made by Public Act 97-691 | ||||||
2 | shall be effective for payment of Medical Assistance bills | ||||||
3 | incurred in fiscal year 2013 and future fiscal years. The | ||||||
4 | changes to this Section made by Public Act 97-691 shall not be | ||||||
5 | applied to Medical Assistance bills incurred in fiscal year | ||||||
6 | 2012 or prior fiscal years. | ||||||
7 | (m) The Comptroller must issue payments against | ||||||
8 | outstanding liabilities that were received prior to the lapse | ||||||
9 | period deadlines set forth in this Section as soon thereafter | ||||||
10 | as practical, but no payment may be issued after the 4 months | ||||||
11 | following the lapse period deadline without the signed | ||||||
12 | authorization of the Comptroller and the Governor. | ||||||
13 | (Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18; | ||||||
14 | 101-10, eff. 6-5-19; 101-275, eff. 8-9-19; 101-636, eff. | ||||||
15 | 6-10-20.)
| ||||||
16 | Section 10. The State Prompt Payment Act is amended by | ||||||
17 | changing Section 3-2 as follows:
| ||||||
18 | (30 ILCS 540/3-2)
| ||||||
19 | Sec. 3-2. Beginning July 1, 1993, in any instance where a | ||||||
20 | State official or
agency is late in payment of a vendor's bill | ||||||
21 | or invoice for goods or services
furnished to the State, as | ||||||
22 | defined in Section 1, properly approved in
accordance with | ||||||
23 | rules promulgated under Section 3-3, the State official or
| ||||||
24 | agency shall pay interest to the vendor in accordance with the |
| |||||||
| |||||||
1 | following:
| ||||||
2 | (1) Any bill, except a bill submitted under Article V | ||||||
3 | of the Illinois Public Aid Code and except as provided | ||||||
4 | under paragraph (1.05) of this Section, approved for | ||||||
5 | payment under this Section must be paid
or the payment | ||||||
6 | issued to the payee within 60 days of receipt
of a proper | ||||||
7 | bill or invoice.
If payment is not issued to the payee | ||||||
8 | within this 60-day
period, an
interest penalty of 1.0% of | ||||||
9 | any amount approved and unpaid shall be added
for each | ||||||
10 | month or fraction thereof after the end of this 60-day | ||||||
11 | period,
until final payment is made. Any bill, except a | ||||||
12 | bill for pharmacy
or nursing facility services or goods, | ||||||
13 | and except as provided under paragraph (1.05) of this | ||||||
14 | Section, submitted under Article V of the Illinois Public | ||||||
15 | Aid Code approved for payment under this Section must be | ||||||
16 | paid
or the payment issued to the payee within 60 days | ||||||
17 | after receipt
of a proper bill or invoice, and,
if payment | ||||||
18 | is not issued to the payee within this 60-day
period, an
| ||||||
19 | interest penalty of 2.0% of any amount approved and unpaid | ||||||
20 | shall be added
for each month or fraction thereof after | ||||||
21 | the end of this 60-day period,
until final payment is | ||||||
22 | made. Any bill for pharmacy or nursing facility services | ||||||
23 | or
goods submitted under Article V of the Illinois Public | ||||||
24 | Aid
Code, except as provided under paragraph (1.05) of | ||||||
25 | this Section, and approved for payment under this Section | ||||||
26 | must be paid
or the payment issued to the payee within 60 |
| |||||||
| |||||||
1 | days of
receipt of a proper bill or invoice. If payment is | ||||||
2 | not
issued to the payee within this 60-day period, an | ||||||
3 | interest
penalty of 1.0% of any amount approved and unpaid | ||||||
4 | shall be
added for each month or fraction thereof after | ||||||
5 | the end of this 60-day period, until final payment is | ||||||
6 | made.
| ||||||
7 | (1.05) For State fiscal year 2012 and future fiscal | ||||||
8 | years, any bill approved for payment under this Section | ||||||
9 | must be paid
or the payment issued to the payee within 90 | ||||||
10 | days of receipt
of a proper bill or invoice.
If payment is | ||||||
11 | not issued to the payee within this 90-day
period, an
| ||||||
12 | interest penalty of 1.0% of any amount approved and unpaid | ||||||
13 | shall be added
for each month, or 0.033% (one-thirtieth of | ||||||
14 | one percent) of any amount approved and unpaid for each | ||||||
15 | day, after the end of this 90-day period,
until final | ||||||
16 | payment is made. | ||||||
17 | (1.1) A State agency shall review in a timely manner | ||||||
18 | each bill or
invoice after its receipt. If the
State | ||||||
19 | agency determines that the bill or invoice contains a | ||||||
20 | defect making it
unable to process the payment request, | ||||||
21 | the agency
shall notify the vendor requesting payment as | ||||||
22 | soon as possible after
discovering the
defect pursuant to | ||||||
23 | rules promulgated under Section 3-3; provided, however, | ||||||
24 | that the notice for construction related bills or invoices | ||||||
25 | must be given not later than 30 days after the bill or | ||||||
26 | invoice was first submitted. The notice shall
identify the |
| |||||||
| |||||||
1 | defect and any additional information
necessary to correct | ||||||
2 | the defect. If one or more items on a construction related | ||||||
3 | bill or invoice are disapproved, but not the entire bill | ||||||
4 | or invoice, then the portion that is not disapproved shall | ||||||
5 | be paid.
| ||||||
6 | (2) Where a State official or agency is late in | ||||||
7 | payment of a
vendor's bill or invoice properly approved in | ||||||
8 | accordance with this Act, and
different late payment terms | ||||||
9 | are not reduced to writing as a contractual
agreement, the | ||||||
10 | State official or agency shall automatically pay interest
| ||||||
11 | penalties required by this Section amounting to $50 or | ||||||
12 | more to the appropriate
vendor. Each agency shall be | ||||||
13 | responsible for determining whether an interest
penalty
is
| ||||||
14 | owed and
for paying the interest to the vendor. Except as | ||||||
15 | provided in paragraph (4), an individual interest payment | ||||||
16 | amounting to $5 or less shall not be paid by the State.
| ||||||
17 | Interest due to a vendor that amounts to greater than $5 | ||||||
18 | and less than $50 shall not be paid but shall be accrued | ||||||
19 | until all interest due the vendor for all similar warrants | ||||||
20 | exceeds $50, at which time the accrued interest shall be | ||||||
21 | payable and interest will begin accruing again, except | ||||||
22 | that interest accrued as of the end of the fiscal year that | ||||||
23 | does not exceed $50 shall be payable at that time. In the | ||||||
24 | event an
individual has paid a vendor for services in | ||||||
25 | advance, the provisions of this
Section shall apply until | ||||||
26 | payment is made to that individual.
|
| |||||||
| |||||||
1 | (3) The provisions of Public Act 96-1501 reducing the | ||||||
2 | interest rate on pharmacy claims under Article V of the | ||||||
3 | Illinois Public Aid Code to 1.0% per month shall apply to | ||||||
4 | any pharmacy bills for services and goods under Article V | ||||||
5 | of the Illinois Public Aid Code received on or after the | ||||||
6 | date 60 days before January 25, 2011 (the effective date | ||||||
7 | of Public Act 96-1501) except as provided under paragraph | ||||||
8 | (1.05) of this Section. | ||||||
9 | (4) Interest amounting to less than $5 shall not be | ||||||
10 | paid by the State, except for claims (i) to the Department | ||||||
11 | of Healthcare and Family Services or the Department of | ||||||
12 | Human Services, (ii) pursuant to Article V of the Illinois | ||||||
13 | Public Aid Code, the Covering ALL KIDS Health Insurance | ||||||
14 | Act, or the Children's Health Insurance Program Act, and | ||||||
15 | (iii) made (A) by pharmacies for prescriptive services or | ||||||
16 | (B) by any federally qualified health center for | ||||||
17 | prescriptive services or any other services. | ||||||
18 | Notwithstanding any provision to the contrary, interest | ||||||
19 | may not be paid under this Act when: (1) a Chief Procurement | ||||||
20 | Officer has voided the underlying contract for goods or | ||||||
21 | services under Article 50 of the Illinois Procurement Code; or | ||||||
22 | (2) the Auditor General is conducting a performance or program | ||||||
23 | audit and the Comptroller has held or is holding for review a | ||||||
24 | related contract or vouchers for payment of goods or services | ||||||
25 | in the exercise of duties under Section 9 of the State | ||||||
26 | Comptroller Act. In such event, interest shall not accrue |
| |||||||
| |||||||
1 | during the pendency of the Auditor General's review. | ||||||
2 | (Source: P.A. 100-1064, eff. 8-24-18.)
| ||||||
3 | Section 15. The Use Tax Act is amended by changing Section | ||||||
4 | 3-8 as follows: | ||||||
5 | (35 ILCS 105/3-8) | ||||||
6 | Sec. 3-8. Hospital exemption. | ||||||
7 | (a) Until July 1, 2022, tangible personal property sold to | ||||||
8 | or used by a hospital owner that owns one or more hospitals | ||||||
9 | licensed under the Hospital Licensing Act or operated under | ||||||
10 | the University of Illinois Hospital Act, or a hospital | ||||||
11 | affiliate that is not already exempt under another provision | ||||||
12 | of this Act and meets the criteria for an exemption under this | ||||||
13 | Section, is exempt from taxation under this Act. | ||||||
14 | (b) A hospital owner or hospital affiliate satisfies the | ||||||
15 | conditions for an exemption under this Section if the value of | ||||||
16 | qualified services or activities listed in subsection (c) of | ||||||
17 | this Section for the hospital year equals or exceeds the | ||||||
18 | relevant hospital entity's estimated property tax liability, | ||||||
19 | without regard to any property tax exemption granted under | ||||||
20 | Section 15-86 of the Property Tax Code, for the calendar year | ||||||
21 | in which exemption or renewal of exemption is sought. For | ||||||
22 | purposes of making the calculations required by this | ||||||
23 | subsection (b), if the relevant hospital entity is a hospital | ||||||
24 | owner that owns more than one hospital, the value of the |
| |||||||
| |||||||
1 | services or activities listed in subsection (c) shall be | ||||||
2 | calculated on the basis of only those services and activities | ||||||
3 | relating to the hospital that includes the subject property, | ||||||
4 | and the relevant hospital entity's estimated property tax | ||||||
5 | liability shall be calculated only with respect to the | ||||||
6 | properties comprising that hospital. In the case of a | ||||||
7 | multi-state hospital system or hospital affiliate, the value | ||||||
8 | of the services or activities listed in subsection (c) shall | ||||||
9 | be calculated on the basis of only those services and | ||||||
10 | activities that occur in Illinois and the relevant hospital | ||||||
11 | entity's estimated property tax liability shall be calculated | ||||||
12 | only with respect to its property located in Illinois. | ||||||
13 | (c) The following services and activities shall be | ||||||
14 | considered for purposes of making the calculations required by | ||||||
15 | subsection (b): | ||||||
16 | (1) Charity care. Free or discounted services provided | ||||||
17 | pursuant to the relevant hospital entity's financial | ||||||
18 | assistance policy, measured at cost, including discounts | ||||||
19 | provided under the Hospital Uninsured Patient Discount | ||||||
20 | Act. | ||||||
21 | (2) Health services to low-income and underserved | ||||||
22 | individuals. Other unreimbursed costs of the relevant | ||||||
23 | hospital entity for providing without charge, paying for, | ||||||
24 | or subsidizing goods, activities, or services for the | ||||||
25 | purpose of addressing the health of low-income or | ||||||
26 | underserved individuals. Those activities or services may |
| |||||||
| |||||||
1 | include, but are not limited to: financial or in-kind | ||||||
2 | support to affiliated or unaffiliated hospitals, hospital | ||||||
3 | affiliates, community clinics, or programs that treat | ||||||
4 | low-income or underserved individuals; paying for or | ||||||
5 | subsidizing health care professionals who care for | ||||||
6 | low-income or underserved individuals; providing or | ||||||
7 | subsidizing outreach or educational services to low-income | ||||||
8 | or underserved individuals for disease management and | ||||||
9 | prevention; free or subsidized goods, supplies, or | ||||||
10 | services needed by low-income or underserved individuals | ||||||
11 | because of their medical condition; and prenatal or | ||||||
12 | childbirth outreach to low-income or underserved persons. | ||||||
13 | (3) Subsidy of State or local governments. Direct or | ||||||
14 | indirect financial or in-kind subsidies of State or local | ||||||
15 | governments by the relevant hospital entity that pay for | ||||||
16 | or subsidize activities or programs related to health care | ||||||
17 | for low-income or underserved individuals. | ||||||
18 | (4) Support for State health care programs for | ||||||
19 | low-income individuals. At the election of the hospital | ||||||
20 | applicant for each applicable year, either (A) 10% of | ||||||
21 | payments to the relevant hospital entity and any hospital | ||||||
22 | affiliate designated by the relevant hospital entity | ||||||
23 | (provided that such hospital affiliate's operations | ||||||
24 | provide financial or operational support for or receive | ||||||
25 | financial or operational support from the relevant | ||||||
26 | hospital entity) under Medicaid or other means-tested |
| |||||||
| |||||||
1 | programs, including, but not limited to, General | ||||||
2 | Assistance , the Covering ALL KIDS Health Insurance Act, | ||||||
3 | and the State Children's Health Insurance Program or (B) | ||||||
4 | the amount of subsidy provided by the relevant hospital | ||||||
5 | entity and any hospital affiliate designated by the | ||||||
6 | relevant hospital entity (provided that such hospital | ||||||
7 | affiliate's operations provide financial or operational | ||||||
8 | support for or receive financial or operational support | ||||||
9 | from the relevant hospital entity) to State or local | ||||||
10 | government in treating Medicaid recipients and recipients | ||||||
11 | of means-tested programs, including but not limited to | ||||||
12 | General Assistance , the Covering ALL KIDS Health Insurance | ||||||
13 | Act, and the State Children's Health Insurance Program . | ||||||
14 | The amount of subsidy for purpose of this item (4) is | ||||||
15 | calculated in the same manner as unreimbursed costs are | ||||||
16 | calculated for Medicaid and other means-tested government | ||||||
17 | programs in the Schedule H of IRS Form 990 in effect on the | ||||||
18 | effective date of this amendatory Act of the 97th General | ||||||
19 | Assembly. | ||||||
20 | (5) Dual-eligible subsidy. The amount of subsidy | ||||||
21 | provided to government by treating dual-eligible | ||||||
22 | Medicare/Medicaid patients. The amount of subsidy for | ||||||
23 | purposes of this item (5) is calculated by multiplying the | ||||||
24 | relevant hospital entity's unreimbursed costs for | ||||||
25 | Medicare, calculated in the same manner as determined in | ||||||
26 | the Schedule H of IRS Form 990 in effect on the effective |
| |||||||
| |||||||
1 | date of this amendatory Act of the 97th General Assembly, | ||||||
2 | by the relevant hospital entity's ratio of dual-eligible | ||||||
3 | patients to total Medicare patients. | ||||||
4 | (6) Relief of the burden of government related to | ||||||
5 | health care. Except to the extent otherwise taken into | ||||||
6 | account in this subsection, the portion of unreimbursed | ||||||
7 | costs of the relevant hospital entity attributable to | ||||||
8 | providing, paying for, or subsidizing goods, activities, | ||||||
9 | or services that relieve the burden of government related | ||||||
10 | to health care for low-income individuals. Such activities | ||||||
11 | or services shall include, but are not limited to, | ||||||
12 | providing emergency, trauma, burn, neonatal, psychiatric, | ||||||
13 | rehabilitation, or other special services; providing | ||||||
14 | medical education; and conducting medical research or | ||||||
15 | training of health care professionals. The portion of | ||||||
16 | those unreimbursed costs attributable to benefiting | ||||||
17 | low-income individuals shall be determined using the ratio | ||||||
18 | calculated by adding the relevant hospital entity's costs | ||||||
19 | attributable to charity care, Medicaid, other means-tested | ||||||
20 | government programs, Medicare patients with disabilities | ||||||
21 | under age 65, and dual-eligible Medicare/Medicaid patients | ||||||
22 | and dividing that total by the relevant hospital entity's | ||||||
23 | total costs. Such costs for the numerator and denominator | ||||||
24 | shall be determined by multiplying gross charges by the | ||||||
25 | cost to charge ratio taken from the hospital's most | ||||||
26 | recently filed Medicare cost report (CMS 2252-10 |
| |||||||
| |||||||
1 | Worksheet, Part I). In the case of emergency services, the | ||||||
2 | ratio shall be calculated using costs (gross charges | ||||||
3 | multiplied by the cost to charge ratio taken from the | ||||||
4 | hospital's most recently filed Medicare cost report (CMS | ||||||
5 | 2252-10 Worksheet, Part I)) of patients treated in the | ||||||
6 | relevant hospital entity's emergency department. | ||||||
7 | (7) Any other activity by the relevant hospital entity | ||||||
8 | that the Department determines relieves the burden of | ||||||
9 | government or addresses the health of low-income or | ||||||
10 | underserved individuals. | ||||||
11 | (d) The hospital applicant shall include information in | ||||||
12 | its exemption application establishing that it satisfies the | ||||||
13 | requirements of subsection (b). For purposes of making the | ||||||
14 | calculations required by subsection (b), the hospital | ||||||
15 | applicant may for each year elect to use either (1) the value | ||||||
16 | of the services or activities listed in subsection (e) for the | ||||||
17 | hospital year or (2) the average value of those services or | ||||||
18 | activities for the 3 fiscal years ending with the hospital | ||||||
19 | year. If the relevant hospital entity has been in operation | ||||||
20 | for less than 3 completed fiscal years, then the latter | ||||||
21 | calculation, if elected, shall be performed on a pro rata | ||||||
22 | basis. | ||||||
23 | (e) For purposes of making the calculations required by | ||||||
24 | this Section: | ||||||
25 | (1) particular services or activities eligible for | ||||||
26 | consideration under any of the paragraphs (1) through (7) |
| |||||||
| |||||||
1 | of subsection (c) may not be counted under more than one of | ||||||
2 | those paragraphs; and | ||||||
3 | (2) the amount of unreimbursed costs and the amount of | ||||||
4 | subsidy shall not be reduced by restricted or unrestricted | ||||||
5 | payments received by the relevant hospital entity as | ||||||
6 | contributions deductible under Section 170(a) of the | ||||||
7 | Internal Revenue Code. | ||||||
8 | (f) (Blank). | ||||||
9 | (g) Estimation of Exempt Property Tax Liability. The | ||||||
10 | estimated property tax liability used for the determination in | ||||||
11 | subsection (b) shall be calculated as follows: | ||||||
12 | (1) "Estimated property tax liability" means the | ||||||
13 | estimated dollar amount of property tax that would be | ||||||
14 | owed, with respect to the exempt portion of each of the | ||||||
15 | relevant hospital entity's properties that are already | ||||||
16 | fully or partially exempt, or for which an exemption in | ||||||
17 | whole or in part is currently being sought, and then | ||||||
18 | aggregated as applicable, as if the exempt portion of | ||||||
19 | those properties were subject to tax, calculated with | ||||||
20 | respect to each such property by multiplying: | ||||||
21 | (A) the lesser of (i) the actual assessed value, | ||||||
22 | if any, of the portion of the property for which an | ||||||
23 | exemption is sought or (ii) an estimated assessed | ||||||
24 | value of the exempt portion of such property as | ||||||
25 | determined in item (2) of this subsection (g), by | ||||||
26 | (B) the applicable State equalization rate |
| |||||||
| |||||||
1 | (yielding the equalized assessed value), by | ||||||
2 | (C) the applicable tax rate. | ||||||
3 | (2) The estimated assessed value of the exempt portion | ||||||
4 | of the property equals the sum of (i) the estimated fair | ||||||
5 | market value of buildings on the property, as determined | ||||||
6 | in accordance with subparagraphs (A) and (B) of this item | ||||||
7 | (2), multiplied by the applicable assessment factor, and | ||||||
8 | (ii) the estimated assessed value of the land portion of | ||||||
9 | the property, as determined in accordance with | ||||||
10 | subparagraph (C). | ||||||
11 | (A) The "estimated fair market value of buildings | ||||||
12 | on the property" means the replacement value of any | ||||||
13 | exempt portion of buildings on the property, minus | ||||||
14 | depreciation, determined utilizing the cost | ||||||
15 | replacement method whereby the exempt square footage | ||||||
16 | of all such buildings is multiplied by the replacement | ||||||
17 | cost per square foot for Class A Average building | ||||||
18 | found in the most recent edition of the Marshall & | ||||||
19 | Swift Valuation Services Manual, adjusted by any | ||||||
20 | appropriate current cost and local multipliers. | ||||||
21 | (B) Depreciation, for purposes of calculating the | ||||||
22 | estimated fair market value of buildings on the | ||||||
23 | property, is applied by utilizing a weighted mean life | ||||||
24 | for the buildings based on original construction and | ||||||
25 | assuming a 40-year life for hospital buildings and the | ||||||
26 | applicable life for other types of buildings as |
| |||||||
| |||||||
1 | specified in the American Hospital Association | ||||||
2 | publication "Estimated Useful Lives of Depreciable | ||||||
3 | Hospital Assets". In the case of hospital buildings, | ||||||
4 | the remaining life is divided by 40 and this ratio is | ||||||
5 | multiplied by the replacement cost of the buildings to | ||||||
6 | obtain an estimated fair market value of buildings. If | ||||||
7 | a hospital building is older than 35 years, a | ||||||
8 | remaining life of 5 years for residual value is | ||||||
9 | assumed; and if a building is less than 8 years old, a | ||||||
10 | remaining life of 32 years is assumed. | ||||||
11 | (C) The estimated assessed value of the land | ||||||
12 | portion of the property shall be determined by | ||||||
13 | multiplying (i) the per square foot average of the | ||||||
14 | assessed values of three parcels of land (not | ||||||
15 | including farm land, and excluding the assessed value | ||||||
16 | of the improvements thereon) reasonably comparable to | ||||||
17 | the property, by (ii) the number of square feet | ||||||
18 | comprising the exempt portion of the property's land | ||||||
19 | square footage. | ||||||
20 | (3) The assessment factor, State equalization rate, | ||||||
21 | and tax rate (including any special factors such as | ||||||
22 | Enterprise Zones) used in calculating the estimated | ||||||
23 | property tax liability shall be for the most recent year | ||||||
24 | that is publicly available from the applicable chief | ||||||
25 | county assessment officer or officers at least 90 days | ||||||
26 | before the end of the hospital year. |
| |||||||
| |||||||
1 | (4) The method utilized to calculate estimated | ||||||
2 | property tax liability for purposes of this Section 15-86 | ||||||
3 | shall not be utilized for the actual valuation, | ||||||
4 | assessment, or taxation of property pursuant to the | ||||||
5 | Property Tax Code. | ||||||
6 | (h) For the purpose of this Section, the following terms | ||||||
7 | shall have the meanings set forth below: | ||||||
8 | (1) "Hospital" means any institution, place, building, | ||||||
9 | buildings on a campus, or other health care facility | ||||||
10 | located in Illinois that is licensed under the Hospital | ||||||
11 | Licensing Act and has a hospital owner. | ||||||
12 | (2) "Hospital owner" means a not-for-profit | ||||||
13 | corporation that is the titleholder of a hospital, or the | ||||||
14 | owner of the beneficial interest in an Illinois land trust | ||||||
15 | that is the titleholder of a hospital. | ||||||
16 | (3) "Hospital affiliate" means any corporation, | ||||||
17 | partnership, limited partnership, joint venture, limited | ||||||
18 | liability company, association or other organization, | ||||||
19 | other than a hospital owner, that directly or indirectly | ||||||
20 | controls, is controlled by, or is under common control | ||||||
21 | with one or more hospital owners and that supports, is | ||||||
22 | supported by, or acts in furtherance of the exempt health | ||||||
23 | care purposes of at least one of those hospital owners' | ||||||
24 | hospitals. | ||||||
25 | (4) "Hospital system" means a hospital and one or more | ||||||
26 | other hospitals or hospital affiliates related by common |
| |||||||
| |||||||
1 | control or ownership. | ||||||
2 | (5) "Control" relating to hospital owners, hospital | ||||||
3 | affiliates, or hospital systems means possession, direct | ||||||
4 | or indirect, of the power to direct or cause the direction | ||||||
5 | of the management and policies of the entity, whether | ||||||
6 | through ownership of assets, membership interest, other | ||||||
7 | voting or governance rights, by contract or otherwise. | ||||||
8 | (6) "Hospital applicant" means a hospital owner or | ||||||
9 | hospital affiliate that files an application for an | ||||||
10 | exemption or renewal of exemption under this Section. | ||||||
11 | (7) "Relevant hospital entity" means (A) the hospital | ||||||
12 | owner, in the case of a hospital applicant that is a | ||||||
13 | hospital owner, and (B) at the election of a hospital | ||||||
14 | applicant that is a hospital affiliate, either (i) the | ||||||
15 | hospital affiliate or (ii) the hospital system to which | ||||||
16 | the hospital applicant belongs, including any hospitals or | ||||||
17 | hospital affiliates that are related by common control or | ||||||
18 | ownership. | ||||||
19 | (8) "Subject property" means property used for the | ||||||
20 | calculation under subsection (b) of this Section. | ||||||
21 | (9) "Hospital year" means the fiscal year of the | ||||||
22 | relevant hospital entity, or the fiscal year of one of the | ||||||
23 | hospital owners in the hospital system if the relevant | ||||||
24 | hospital entity is a hospital system with members with | ||||||
25 | different fiscal years, that ends in the year for which | ||||||
26 | the exemption is sought.
|
| |||||||
| |||||||
1 | (i) It is the intent of the General Assembly that any | ||||||
2 | exemptions taken, granted, or renewed under this Section prior | ||||||
3 | to the effective date of this amendatory Act of the 100th | ||||||
4 | General Assembly are hereby validated. | ||||||
5 | (Source: P.A. 99-143, eff. 7-27-15; 100-1181, eff. 3-8-19.) | ||||||
6 | Section 20. The Service Use Tax Act is amended by changing | ||||||
7 | Section 3-8 as follows: | ||||||
8 | (35 ILCS 110/3-8) | ||||||
9 | Sec. 3-8. Hospital exemption. | ||||||
10 | (a) Until July 1, 2022, tangible personal property sold to | ||||||
11 | or used by a hospital owner that owns one or more hospitals | ||||||
12 | licensed under the Hospital Licensing Act or operated under | ||||||
13 | the University of Illinois Hospital Act, or a hospital | ||||||
14 | affiliate that is not already exempt under another provision | ||||||
15 | of this Act and meets the criteria for an exemption under this | ||||||
16 | Section, is exempt from taxation under this Act. | ||||||
17 | (b) A hospital owner or hospital affiliate satisfies the | ||||||
18 | conditions for an exemption under this Section if the value of | ||||||
19 | qualified services or activities listed in subsection (c) of | ||||||
20 | this Section for the hospital year equals or exceeds the | ||||||
21 | relevant hospital entity's estimated property tax liability, | ||||||
22 | without regard to any property tax exemption granted under | ||||||
23 | Section 15-86 of the Property Tax Code, for the calendar year | ||||||
24 | in which exemption or renewal of exemption is sought. For |
| |||||||
| |||||||
1 | purposes of making the calculations required by this | ||||||
2 | subsection (b), if the relevant hospital entity is a hospital | ||||||
3 | owner that owns more than one hospital, the value of the | ||||||
4 | services or activities listed in subsection (c) shall be | ||||||
5 | calculated on the basis of only those services and activities | ||||||
6 | relating to the hospital that includes the subject property, | ||||||
7 | and the relevant hospital entity's estimated property tax | ||||||
8 | liability shall be calculated only with respect to the | ||||||
9 | properties comprising that hospital. In the case of a | ||||||
10 | multi-state hospital system or hospital affiliate, the value | ||||||
11 | of the services or activities listed in subsection (c) shall | ||||||
12 | be calculated on the basis of only those services and | ||||||
13 | activities that occur in Illinois and the relevant hospital | ||||||
14 | entity's estimated property tax liability shall be calculated | ||||||
15 | only with respect to its property located in Illinois. | ||||||
16 | (c) The following services and activities shall be | ||||||
17 | considered for purposes of making the calculations required by | ||||||
18 | subsection (b): | ||||||
19 | (1) Charity care. Free or discounted services provided | ||||||
20 | pursuant to the relevant hospital entity's financial | ||||||
21 | assistance policy, measured at cost, including discounts | ||||||
22 | provided under the Hospital Uninsured Patient Discount | ||||||
23 | Act. | ||||||
24 | (2) Health services to low-income and underserved | ||||||
25 | individuals. Other unreimbursed costs of the relevant | ||||||
26 | hospital entity for providing without charge, paying for, |
| |||||||
| |||||||
1 | or subsidizing goods, activities, or services for the | ||||||
2 | purpose of addressing the health of low-income or | ||||||
3 | underserved individuals. Those activities or services may | ||||||
4 | include, but are not limited to: financial or in-kind | ||||||
5 | support to affiliated or unaffiliated hospitals, hospital | ||||||
6 | affiliates, community clinics, or programs that treat | ||||||
7 | low-income or underserved individuals; paying for or | ||||||
8 | subsidizing health care professionals who care for | ||||||
9 | low-income or underserved individuals; providing or | ||||||
10 | subsidizing outreach or educational services to low-income | ||||||
11 | or underserved individuals for disease management and | ||||||
12 | prevention; free or subsidized goods, supplies, or | ||||||
13 | services needed by low-income or underserved individuals | ||||||
14 | because of their medical condition; and prenatal or | ||||||
15 | childbirth outreach to low-income or underserved persons. | ||||||
16 | (3) Subsidy of State or local governments. Direct or | ||||||
17 | indirect financial or in-kind subsidies of State or local | ||||||
18 | governments by the relevant hospital entity that pay for | ||||||
19 | or subsidize activities or programs related to health care | ||||||
20 | for low-income or underserved individuals. | ||||||
21 | (4) Support for State health care programs for | ||||||
22 | low-income individuals. At the election of the hospital | ||||||
23 | applicant for each applicable year, either (A) 10% of | ||||||
24 | payments to the relevant hospital entity and any hospital | ||||||
25 | affiliate designated by the relevant hospital entity | ||||||
26 | (provided that such hospital affiliate's operations |
| |||||||
| |||||||
1 | provide financial or operational support for or receive | ||||||
2 | financial or operational support from the relevant | ||||||
3 | hospital entity) under Medicaid or other means-tested | ||||||
4 | programs, including, but not limited to, General | ||||||
5 | Assistance , the Covering ALL KIDS Health Insurance Act, | ||||||
6 | and the State Children's Health Insurance Program or (B) | ||||||
7 | the amount of subsidy provided by the relevant hospital | ||||||
8 | entity and any hospital affiliate designated by the | ||||||
9 | relevant hospital entity (provided that such hospital | ||||||
10 | affiliate's operations provide financial or operational | ||||||
11 | support for or receive financial or operational support | ||||||
12 | from the relevant hospital entity) to State or local | ||||||
13 | government in treating Medicaid recipients and recipients | ||||||
14 | of means-tested programs, including but not limited to | ||||||
15 | General Assistance , the Covering ALL KIDS Health Insurance | ||||||
16 | Act, and the State Children's Health Insurance Program . | ||||||
17 | The amount of subsidy for purposes of this item (4) is | ||||||
18 | calculated in the same manner as unreimbursed costs are | ||||||
19 | calculated for Medicaid and other means-tested government | ||||||
20 | programs in the Schedule H of IRS Form 990 in effect on the | ||||||
21 | effective date of this amendatory Act of the 97th General | ||||||
22 | Assembly. | ||||||
23 | (5) Dual-eligible subsidy. The amount of subsidy | ||||||
24 | provided to government by treating dual-eligible | ||||||
25 | Medicare/Medicaid patients. The amount of subsidy for | ||||||
26 | purposes of this item (5) is calculated by multiplying the |
| |||||||
| |||||||
1 | relevant hospital entity's unreimbursed costs for | ||||||
2 | Medicare, calculated in the same manner as determined in | ||||||
3 | the Schedule H of IRS Form 990 in effect on the effective | ||||||
4 | date of this amendatory Act of the 97th General Assembly, | ||||||
5 | by the relevant hospital entity's ratio of dual-eligible | ||||||
6 | patients to total Medicare patients. | ||||||
7 | (6) Relief of the burden of government related to | ||||||
8 | health care. Except to the extent otherwise taken into | ||||||
9 | account in this subsection, the portion of unreimbursed | ||||||
10 | costs of the relevant hospital entity attributable to | ||||||
11 | providing, paying for, or subsidizing goods, activities, | ||||||
12 | or services that relieve the burden of government related | ||||||
13 | to health care for low-income individuals. Such activities | ||||||
14 | or services shall include, but are not limited to, | ||||||
15 | providing emergency, trauma, burn, neonatal, psychiatric, | ||||||
16 | rehabilitation, or other special services; providing | ||||||
17 | medical education; and conducting medical research or | ||||||
18 | training of health care professionals. The portion of | ||||||
19 | those unreimbursed costs attributable to benefiting | ||||||
20 | low-income individuals shall be determined using the ratio | ||||||
21 | calculated by adding the relevant hospital entity's costs | ||||||
22 | attributable to charity care, Medicaid, other means-tested | ||||||
23 | government programs, Medicare patients with disabilities | ||||||
24 | under age 65, and dual-eligible Medicare/Medicaid patients | ||||||
25 | and dividing that total by the relevant hospital entity's | ||||||
26 | total costs. Such costs for the numerator and denominator |
| |||||||
| |||||||
1 | shall be determined by multiplying gross charges by the | ||||||
2 | cost to charge ratio taken from the hospital's most | ||||||
3 | recently filed Medicare cost report (CMS 2252-10 | ||||||
4 | Worksheet, Part I). In the case of emergency services, the | ||||||
5 | ratio shall be calculated using costs (gross charges | ||||||
6 | multiplied by the cost to charge ratio taken from the | ||||||
7 | hospital's most recently filed Medicare cost report (CMS | ||||||
8 | 2252-10 Worksheet, Part I)) of patients treated in the | ||||||
9 | relevant hospital entity's emergency department. | ||||||
10 | (7) Any other activity by the relevant hospital entity | ||||||
11 | that the Department determines relieves the burden of | ||||||
12 | government or addresses the health of low-income or | ||||||
13 | underserved individuals. | ||||||
14 | (d) The hospital applicant shall include information in | ||||||
15 | its exemption application establishing that it satisfies the | ||||||
16 | requirements of subsection (b). For purposes of making the | ||||||
17 | calculations required by subsection (b), the hospital | ||||||
18 | applicant may for each year elect to use either (1) the value | ||||||
19 | of the services or activities listed in subsection (e) for the | ||||||
20 | hospital year or (2) the average value of those services or | ||||||
21 | activities for the 3 fiscal years ending with the hospital | ||||||
22 | year. If the relevant hospital entity has been in operation | ||||||
23 | for less than 3 completed fiscal years, then the latter | ||||||
24 | calculation, if elected, shall be performed on a pro rata | ||||||
25 | basis. | ||||||
26 | (e) For purposes of making the calculations required by |
| |||||||
| |||||||
1 | this Section: | ||||||
2 | (1) particular services or activities eligible for | ||||||
3 | consideration under any of the paragraphs (1) through (7) | ||||||
4 | of subsection (c) may not be counted under more than one of | ||||||
5 | those paragraphs; and | ||||||
6 | (2) the amount of unreimbursed costs and the amount of | ||||||
7 | subsidy shall not be reduced by restricted or unrestricted | ||||||
8 | payments received by the relevant hospital entity as | ||||||
9 | contributions deductible under Section 170(a) of the | ||||||
10 | Internal Revenue Code. | ||||||
11 | (f) (Blank). | ||||||
12 | (g) Estimation of Exempt Property Tax Liability. The | ||||||
13 | estimated property tax liability used for the determination in | ||||||
14 | subsection (b) shall be calculated as follows: | ||||||
15 | (1) "Estimated property tax liability" means the | ||||||
16 | estimated dollar amount of property tax that would be | ||||||
17 | owed, with respect to the exempt portion of each of the | ||||||
18 | relevant hospital entity's properties that are already | ||||||
19 | fully or partially exempt, or for which an exemption in | ||||||
20 | whole or in part is currently being sought, and then | ||||||
21 | aggregated as applicable, as if the exempt portion of | ||||||
22 | those properties were subject to tax, calculated with | ||||||
23 | respect to each such property by multiplying: | ||||||
24 | (A) the lesser of (i) the actual assessed value, | ||||||
25 | if any, of the portion of the property for which an | ||||||
26 | exemption is sought or (ii) an estimated assessed |
| |||||||
| |||||||
1 | value of the exempt portion of such property as | ||||||
2 | determined in item (2) of this subsection (g), by | ||||||
3 | (B) the applicable State equalization rate | ||||||
4 | (yielding the equalized assessed value), by | ||||||
5 | (C) the applicable tax rate. | ||||||
6 | (2) The estimated assessed value of the exempt portion | ||||||
7 | of the property equals the sum of (i) the estimated fair | ||||||
8 | market value of buildings on the property, as determined | ||||||
9 | in accordance with subparagraphs (A) and (B) of this item | ||||||
10 | (2), multiplied by the applicable assessment factor, and | ||||||
11 | (ii) the estimated assessed value of the land portion of | ||||||
12 | the property, as determined in accordance with | ||||||
13 | subparagraph (C). | ||||||
14 | (A) The "estimated fair market value of buildings | ||||||
15 | on the property" means the replacement value of any | ||||||
16 | exempt portion of buildings on the property, minus | ||||||
17 | depreciation, determined utilizing the cost | ||||||
18 | replacement method whereby the exempt square footage | ||||||
19 | of all such buildings is multiplied by the replacement | ||||||
20 | cost per square foot for Class A Average building | ||||||
21 | found in the most recent edition of the Marshall & | ||||||
22 | Swift Valuation Services Manual, adjusted by any | ||||||
23 | appropriate current cost and local multipliers. | ||||||
24 | (B) Depreciation, for purposes of calculating the | ||||||
25 | estimated fair market value of buildings on the | ||||||
26 | property, is applied by utilizing a weighted mean life |
| |||||||
| |||||||
1 | for the buildings based on original construction and | ||||||
2 | assuming a 40-year life for hospital buildings and the | ||||||
3 | applicable life for other types of buildings as | ||||||
4 | specified in the American Hospital Association | ||||||
5 | publication "Estimated Useful Lives of Depreciable | ||||||
6 | Hospital Assets". In the case of hospital buildings, | ||||||
7 | the remaining life is divided by 40 and this ratio is | ||||||
8 | multiplied by the replacement cost of the buildings to | ||||||
9 | obtain an estimated fair market value of buildings. If | ||||||
10 | a hospital building is older than 35 years, a | ||||||
11 | remaining life of 5 years for residual value is | ||||||
12 | assumed; and if a building is less than 8 years old, a | ||||||
13 | remaining life of 32 years is assumed. | ||||||
14 | (C) The estimated assessed value of the land | ||||||
15 | portion of the property shall be determined by | ||||||
16 | multiplying (i) the per square foot average of the | ||||||
17 | assessed values of three parcels of land (not | ||||||
18 | including farm land, and excluding the assessed value | ||||||
19 | of the improvements thereon) reasonably comparable to | ||||||
20 | the property, by (ii) the number of square feet | ||||||
21 | comprising the exempt portion of the property's land | ||||||
22 | square footage. | ||||||
23 | (3) The assessment factor, State equalization rate, | ||||||
24 | and tax rate (including any special factors such as | ||||||
25 | Enterprise Zones) used in calculating the estimated | ||||||
26 | property tax liability shall be for the most recent year |
| |||||||
| |||||||
1 | that is publicly available from the applicable chief | ||||||
2 | county assessment officer or officers at least 90 days | ||||||
3 | before the end of the hospital year. | ||||||
4 | (4) The method utilized to calculate estimated | ||||||
5 | property tax liability for purposes of this Section 15-86 | ||||||
6 | shall not be utilized for the actual valuation, | ||||||
7 | assessment, or taxation of property pursuant to the | ||||||
8 | Property Tax Code. | ||||||
9 | (h) For the purpose of this Section, the following terms | ||||||
10 | shall have the meanings set forth below: | ||||||
11 | (1) "Hospital" means any institution, place, building, | ||||||
12 | buildings on a campus, or other health care facility | ||||||
13 | located in Illinois that is licensed under the Hospital | ||||||
14 | Licensing Act and has a hospital owner. | ||||||
15 | (2) "Hospital owner" means a not-for-profit | ||||||
16 | corporation that is the titleholder of a hospital, or the | ||||||
17 | owner of the beneficial interest in an Illinois land trust | ||||||
18 | that is the titleholder of a hospital. | ||||||
19 | (3) "Hospital affiliate" means any corporation, | ||||||
20 | partnership, limited partnership, joint venture, limited | ||||||
21 | liability company, association or other organization, | ||||||
22 | other than a hospital owner, that directly or indirectly | ||||||
23 | controls, is controlled by, or is under common control | ||||||
24 | with one or more hospital owners and that supports, is | ||||||
25 | supported by, or acts in furtherance of the exempt health | ||||||
26 | care purposes of at least one of those hospital owners' |
| |||||||
| |||||||
1 | hospitals. | ||||||
2 | (4) "Hospital system" means a hospital and one or more | ||||||
3 | other hospitals or hospital affiliates related by common | ||||||
4 | control or ownership. | ||||||
5 | (5) "Control" relating to hospital owners, hospital | ||||||
6 | affiliates, or hospital systems means possession, direct | ||||||
7 | or indirect, of the power to direct or cause the direction | ||||||
8 | of the management and policies of the entity, whether | ||||||
9 | through ownership of assets, membership interest, other | ||||||
10 | voting or governance rights, by contract or otherwise. | ||||||
11 | (6) "Hospital applicant" means a hospital owner or | ||||||
12 | hospital affiliate that files an application for an | ||||||
13 | exemption or renewal of exemption under this Section. | ||||||
14 | (7) "Relevant hospital entity" means (A) the hospital | ||||||
15 | owner, in the case of a hospital applicant that is a | ||||||
16 | hospital owner, and (B) at the election of a hospital | ||||||
17 | applicant that is a hospital affiliate, either (i) the | ||||||
18 | hospital affiliate or (ii) the hospital system to which | ||||||
19 | the hospital applicant belongs, including any hospitals or | ||||||
20 | hospital affiliates that are related by common control or | ||||||
21 | ownership. | ||||||
22 | (8) "Subject property" means property used for the | ||||||
23 | calculation under subsection (b) of this Section. | ||||||
24 | (9) "Hospital year" means the fiscal year of the | ||||||
25 | relevant hospital entity, or the fiscal year of one of the | ||||||
26 | hospital owners in the hospital system if the relevant |
| |||||||
| |||||||
1 | hospital entity is a hospital system with members with | ||||||
2 | different fiscal years, that ends in the year for which | ||||||
3 | the exemption is sought.
| ||||||
4 | (i) It is the intent of the General Assembly that any | ||||||
5 | exemptions taken, granted, or renewed under this Section prior | ||||||
6 | to the effective date of this amendatory Act of the 100th | ||||||
7 | General Assembly are hereby validated. | ||||||
8 | (Source: P.A. 99-143, eff. 7-27-15; 100-1181, eff. 3-8-19.) | ||||||
9 | Section 25. The Retailers' Occupation Tax Act is amended | ||||||
10 | by changing Section 2-9 as follows: | ||||||
11 | (35 ILCS 120/2-9) | ||||||
12 | Sec. 2-9. Hospital exemption. | ||||||
13 | (a) Until July 1, 2022, tangible personal property sold to | ||||||
14 | or used by a hospital owner that owns one or more hospitals | ||||||
15 | licensed under the Hospital Licensing Act or operated under | ||||||
16 | the University of Illinois Hospital Act, or a hospital | ||||||
17 | affiliate that is not already exempt under another provision | ||||||
18 | of this Act and meets the criteria for an exemption under this | ||||||
19 | Section, is exempt from taxation under this Act. | ||||||
20 | (b) A hospital owner or hospital affiliate satisfies the | ||||||
21 | conditions for an exemption under this Section if the value of | ||||||
22 | qualified services or activities listed in subsection (c) of | ||||||
23 | this Section for the hospital year equals or exceeds the | ||||||
24 | relevant hospital entity's estimated property tax liability, |
| |||||||
| |||||||
1 | without regard to any property tax exemption granted under | ||||||
2 | Section 15-86 of the Property Tax Code, for the calendar year | ||||||
3 | in which exemption or renewal of exemption is sought. For | ||||||
4 | purposes of making the calculations required by this | ||||||
5 | subsection (b), if the relevant hospital entity is a hospital | ||||||
6 | owner that owns more than one hospital, the value of the | ||||||
7 | services or activities listed in subsection (c) shall be | ||||||
8 | calculated on the basis of only those services and activities | ||||||
9 | relating to the hospital that includes the subject property, | ||||||
10 | and the relevant hospital entity's estimated property tax | ||||||
11 | liability shall be calculated only with respect to the | ||||||
12 | properties comprising that hospital. In the case of a | ||||||
13 | multi-state hospital system or hospital affiliate, the value | ||||||
14 | of the services or activities listed in subsection (c) shall | ||||||
15 | be calculated on the basis of only those services and | ||||||
16 | activities that occur in Illinois and the relevant hospital | ||||||
17 | entity's estimated property tax liability shall be calculated | ||||||
18 | only with respect to its property located in Illinois. | ||||||
19 | (c) The following services and activities shall be | ||||||
20 | considered for purposes of making the calculations required by | ||||||
21 | subsection (b): | ||||||
22 | (1) Charity care. Free or discounted services provided | ||||||
23 | pursuant to the relevant hospital entity's financial | ||||||
24 | assistance policy, measured at cost, including discounts | ||||||
25 | provided under the Hospital Uninsured Patient Discount | ||||||
26 | Act. |
| |||||||
| |||||||
1 | (2) Health services to low-income and underserved | ||||||
2 | individuals. Other unreimbursed costs of the relevant | ||||||
3 | hospital entity for providing without charge, paying for, | ||||||
4 | or subsidizing goods, activities, or services for the | ||||||
5 | purpose of addressing the health of low-income or | ||||||
6 | underserved individuals. Those activities or services may | ||||||
7 | include, but are not limited to: financial or in-kind | ||||||
8 | support to affiliated or unaffiliated hospitals, hospital | ||||||
9 | affiliates, community clinics, or programs that treat | ||||||
10 | low-income or underserved individuals; paying for or | ||||||
11 | subsidizing health care professionals who care for | ||||||
12 | low-income or underserved individuals; providing or | ||||||
13 | subsidizing outreach or educational services to low-income | ||||||
14 | or underserved individuals for disease management and | ||||||
15 | prevention; free or subsidized goods, supplies, or | ||||||
16 | services needed by low-income or underserved individuals | ||||||
17 | because of their medical condition; and prenatal or | ||||||
18 | childbirth outreach to low-income or underserved persons. | ||||||
19 | (3) Subsidy of State or local governments. Direct or | ||||||
20 | indirect financial or in-kind subsidies of State or local | ||||||
21 | governments by the relevant hospital entity that pay for | ||||||
22 | or subsidize activities or programs related to health care | ||||||
23 | for low-income or underserved individuals. | ||||||
24 | (4) Support for State health care programs for | ||||||
25 | low-income individuals. At the election of the hospital | ||||||
26 | applicant for each applicable year, either (A) 10% of |
| |||||||
| |||||||
1 | payments to the relevant hospital entity and any hospital | ||||||
2 | affiliate designated by the relevant hospital entity | ||||||
3 | (provided that such hospital affiliate's operations | ||||||
4 | provide financial or operational support for or receive | ||||||
5 | financial or operational support from the relevant | ||||||
6 | hospital entity) under Medicaid or other means-tested | ||||||
7 | programs, including, but not limited to, General | ||||||
8 | Assistance , the Covering ALL KIDS Health Insurance Act, | ||||||
9 | and the State Children's Health Insurance Program or (B) | ||||||
10 | the amount of subsidy provided by the relevant hospital | ||||||
11 | entity and any hospital affiliate designated by the | ||||||
12 | relevant hospital entity (provided that such hospital | ||||||
13 | affiliate's operations provide financial or operational | ||||||
14 | support for or receive financial or operational support | ||||||
15 | from the relevant hospital entity) to State or local | ||||||
16 | government in treating Medicaid recipients and recipients | ||||||
17 | of means-tested programs, including but not limited to | ||||||
18 | General Assistance , the Covering ALL KIDS Health Insurance | ||||||
19 | Act, and the State Children's Health Insurance Program . | ||||||
20 | The amount of subsidy for purposes of this item (4) is | ||||||
21 | calculated in the same manner as unreimbursed costs are | ||||||
22 | calculated for Medicaid and other means-tested government | ||||||
23 | programs in the Schedule H of IRS Form 990 in effect on the | ||||||
24 | effective date of this amendatory Act of the 97th General | ||||||
25 | Assembly. | ||||||
26 | (5) Dual-eligible subsidy. The amount of subsidy |
| |||||||
| |||||||
1 | provided to government by treating dual-eligible | ||||||
2 | Medicare/Medicaid patients. The amount of subsidy for | ||||||
3 | purposes of this item (5) is calculated by multiplying the | ||||||
4 | relevant hospital entity's unreimbursed costs for | ||||||
5 | Medicare, calculated in the same manner as determined in | ||||||
6 | the Schedule H of IRS Form 990 in effect on the effective | ||||||
7 | date of this amendatory Act of the 97th General Assembly, | ||||||
8 | by the relevant hospital entity's ratio of dual-eligible | ||||||
9 | patients to total Medicare patients. | ||||||
10 | (6) Relief of the burden of government related to | ||||||
11 | health care. Except to the extent otherwise taken into | ||||||
12 | account in this subsection, the portion of unreimbursed | ||||||
13 | costs of the relevant hospital entity attributable to | ||||||
14 | providing, paying for, or subsidizing goods, activities, | ||||||
15 | or services that relieve the burden of government related | ||||||
16 | to health care for low-income individuals. Such activities | ||||||
17 | or services shall include, but are not limited to, | ||||||
18 | providing emergency, trauma, burn, neonatal, psychiatric, | ||||||
19 | rehabilitation, or other special services; providing | ||||||
20 | medical education; and conducting medical research or | ||||||
21 | training of health care professionals. The portion of | ||||||
22 | those unreimbursed costs attributable to benefiting | ||||||
23 | low-income individuals shall be determined using the ratio | ||||||
24 | calculated by adding the relevant hospital entity's costs | ||||||
25 | attributable to charity care, Medicaid, other means-tested | ||||||
26 | government programs, Medicare patients with disabilities |
| |||||||
| |||||||
1 | under age 65, and dual-eligible Medicare/Medicaid patients | ||||||
2 | and dividing that total by the relevant hospital entity's | ||||||
3 | total costs. Such costs for the numerator and denominator | ||||||
4 | shall be determined by multiplying gross charges by the | ||||||
5 | cost to charge ratio taken from the hospital's most | ||||||
6 | recently filed Medicare cost report (CMS 2252-10 | ||||||
7 | Worksheet, Part I). In the case of emergency services, the | ||||||
8 | ratio shall be calculated using costs (gross charges | ||||||
9 | multiplied by the cost to charge ratio taken from the | ||||||
10 | hospital's most recently filed Medicare cost report (CMS | ||||||
11 | 2252-10 Worksheet, Part I)) of patients treated in the | ||||||
12 | relevant hospital entity's emergency department. | ||||||
13 | (7) Any other activity by the relevant hospital entity | ||||||
14 | that the Department determines relieves the burden of | ||||||
15 | government or addresses the health of low-income or | ||||||
16 | underserved individuals. | ||||||
17 | (d) The hospital applicant shall include information in | ||||||
18 | its exemption application establishing that it satisfies the | ||||||
19 | requirements of subsection (b). For purposes of making the | ||||||
20 | calculations required by subsection (b), the hospital | ||||||
21 | applicant may for each year elect to use either (1) the value | ||||||
22 | of the services or activities listed in subsection (e) for the | ||||||
23 | hospital year or (2) the average value of those services or | ||||||
24 | activities for the 3 fiscal years ending with the hospital | ||||||
25 | year. If the relevant hospital entity has been in operation | ||||||
26 | for less than 3 completed fiscal years, then the latter |
| |||||||
| |||||||
1 | calculation, if elected, shall be performed on a pro rata | ||||||
2 | basis. | ||||||
3 | (e) For purposes of making the calculations required by | ||||||
4 | this Section: | ||||||
5 | (1) particular services or activities eligible for | ||||||
6 | consideration under any of the paragraphs (1) through (7) | ||||||
7 | of subsection (c) may not be counted under more than one of | ||||||
8 | those paragraphs; and | ||||||
9 | (2) the amount of unreimbursed costs and the amount of | ||||||
10 | subsidy shall not be reduced by restricted or unrestricted | ||||||
11 | payments received by the relevant hospital entity as | ||||||
12 | contributions deductible under Section 170(a) of the | ||||||
13 | Internal Revenue Code. | ||||||
14 | (f) (Blank). | ||||||
15 | (g) Estimation of Exempt Property Tax Liability. The | ||||||
16 | estimated property tax liability used for the determination in | ||||||
17 | subsection (b) shall be calculated as follows: | ||||||
18 | (1) "Estimated property tax liability" means the | ||||||
19 | estimated dollar amount of property tax that would be | ||||||
20 | owed, with respect to the exempt portion of each of the | ||||||
21 | relevant hospital entity's properties that are already | ||||||
22 | fully or partially exempt, or for which an exemption in | ||||||
23 | whole or in part is currently being sought, and then | ||||||
24 | aggregated as applicable, as if the exempt portion of | ||||||
25 | those properties were subject to tax, calculated with | ||||||
26 | respect to each such property by multiplying: |
| |||||||
| |||||||
1 | (A) the lesser of (i) the actual assessed value, | ||||||
2 | if any, of the portion of the property for which an | ||||||
3 | exemption is sought or (ii) an estimated assessed | ||||||
4 | value of the exempt portion of such property as | ||||||
5 | determined in item (2) of this subsection (g), by | ||||||
6 | (B) the applicable State equalization rate | ||||||
7 | (yielding the equalized assessed value), by | ||||||
8 | (C) the applicable tax rate. | ||||||
9 | (2) The estimated assessed value of the exempt portion | ||||||
10 | of the property equals the sum of (i) the estimated fair | ||||||
11 | market value of buildings on the property, as determined | ||||||
12 | in accordance with subparagraphs (A) and (B) of this item | ||||||
13 | (2), multiplied by the applicable assessment factor, and | ||||||
14 | (ii) the estimated assessed value of the land portion of | ||||||
15 | the property, as determined in accordance with | ||||||
16 | subparagraph (C). | ||||||
17 | (A) The "estimated fair market value of buildings | ||||||
18 | on the property" means the replacement value of any | ||||||
19 | exempt portion of buildings on the property, minus | ||||||
20 | depreciation, determined utilizing the cost | ||||||
21 | replacement method whereby the exempt square footage | ||||||
22 | of all such buildings is multiplied by the replacement | ||||||
23 | cost per square foot for Class A Average building | ||||||
24 | found in the most recent edition of the Marshall & | ||||||
25 | Swift Valuation Services Manual, adjusted by any | ||||||
26 | appropriate current cost and local multipliers. |
| |||||||
| |||||||
1 | (B) Depreciation, for purposes of calculating the | ||||||
2 | estimated fair market value of buildings on the | ||||||
3 | property, is applied by utilizing a weighted mean life | ||||||
4 | for the buildings based on original construction and | ||||||
5 | assuming a 40-year life for hospital buildings and the | ||||||
6 | applicable life for other types of buildings as | ||||||
7 | specified in the American Hospital Association | ||||||
8 | publication "Estimated Useful Lives of Depreciable | ||||||
9 | Hospital Assets". In the case of hospital buildings, | ||||||
10 | the remaining life is divided by 40 and this ratio is | ||||||
11 | multiplied by the replacement cost of the buildings to | ||||||
12 | obtain an estimated fair market value of buildings. If | ||||||
13 | a hospital building is older than 35 years, a | ||||||
14 | remaining life of 5 years for residual value is | ||||||
15 | assumed; and if a building is less than 8 years old, a | ||||||
16 | remaining life of 32 years is assumed. | ||||||
17 | (C) The estimated assessed value of the land | ||||||
18 | portion of the property shall be determined by | ||||||
19 | multiplying (i) the per square foot average of the | ||||||
20 | assessed values of three parcels of land (not | ||||||
21 | including farm land, and excluding the assessed value | ||||||
22 | of the improvements thereon) reasonably comparable to | ||||||
23 | the property, by (ii) the number of square feet | ||||||
24 | comprising the exempt portion of the property's land | ||||||
25 | square footage. | ||||||
26 | (3) The assessment factor, State equalization rate, |
| |||||||
| |||||||
1 | and tax rate (including any special factors such as | ||||||
2 | Enterprise Zones) used in calculating the estimated | ||||||
3 | property tax liability shall be for the most recent year | ||||||
4 | that is publicly available from the applicable chief | ||||||
5 | county assessment officer or officers at least 90 days | ||||||
6 | before the end of the hospital year. | ||||||
7 | (4) The method utilized to calculate estimated | ||||||
8 | property tax liability for purposes of this Section 15-86 | ||||||
9 | shall not be utilized for the actual valuation, | ||||||
10 | assessment, or taxation of property pursuant to the | ||||||
11 | Property Tax Code. | ||||||
12 | (h) For the purpose of this Section, the following terms | ||||||
13 | shall have the meanings set forth below: | ||||||
14 | (1) "Hospital" means any institution, place, building, | ||||||
15 | buildings on a campus, or other health care facility | ||||||
16 | located in Illinois that is licensed under the Hospital | ||||||
17 | Licensing Act and has a hospital owner. | ||||||
18 | (2) "Hospital owner" means a not-for-profit | ||||||
19 | corporation that is the titleholder of a hospital, or the | ||||||
20 | owner of the beneficial interest in an Illinois land trust | ||||||
21 | that is the titleholder of a hospital. | ||||||
22 | (3) "Hospital affiliate" means any corporation, | ||||||
23 | partnership, limited partnership, joint venture, limited | ||||||
24 | liability company, association or other organization, | ||||||
25 | other than a hospital owner, that directly or indirectly | ||||||
26 | controls, is controlled by, or is under common control |
| |||||||
| |||||||
1 | with one or more hospital owners and that supports, is | ||||||
2 | supported by, or acts in furtherance of the exempt health | ||||||
3 | care purposes of at least one of those hospital owners' | ||||||
4 | hospitals. | ||||||
5 | (4) "Hospital system" means a hospital and one or more | ||||||
6 | other hospitals or hospital affiliates related by common | ||||||
7 | control or ownership. | ||||||
8 | (5) "Control" relating to hospital owners, hospital | ||||||
9 | affiliates, or hospital systems means possession, direct | ||||||
10 | or indirect, of the power to direct or cause the direction | ||||||
11 | of the management and policies of the entity, whether | ||||||
12 | through ownership of assets, membership interest, other | ||||||
13 | voting or governance rights, by contract or otherwise. | ||||||
14 | (6) "Hospital applicant" means a hospital owner or | ||||||
15 | hospital affiliate that files an application for an | ||||||
16 | exemption or renewal of exemption under this Section. | ||||||
17 | (7) "Relevant hospital entity" means (A) the hospital | ||||||
18 | owner, in the case of a hospital applicant that is a | ||||||
19 | hospital owner, and (B) at the election of a hospital | ||||||
20 | applicant that is a hospital affiliate, either (i) the | ||||||
21 | hospital affiliate or (ii) the hospital system to which | ||||||
22 | the hospital applicant belongs, including any hospitals or | ||||||
23 | hospital affiliates that are related by common control or | ||||||
24 | ownership. | ||||||
25 | (8) "Subject property" means property used for the | ||||||
26 | calculation under subsection (b) of this Section. |
| |||||||
| |||||||
1 | (9) "Hospital year" means the fiscal year of the | ||||||
2 | relevant hospital entity, or the fiscal year of one of the | ||||||
3 | hospital owners in the hospital system if the relevant | ||||||
4 | hospital entity is a hospital system with members with | ||||||
5 | different fiscal years, that ends in the year for which | ||||||
6 | the exemption is sought.
| ||||||
7 | (i) It is the intent of the General Assembly that any | ||||||
8 | exemptions taken, granted, or renewed under this Section prior | ||||||
9 | to the effective date of this amendatory Act of the 100th | ||||||
10 | General Assembly are hereby validated. | ||||||
11 | (Source: P.A. 99-143, eff. 7-27-15; 100-1181, eff. 3-8-19.) | ||||||
12 | Section 30. The Property Tax Code is amended by changing | ||||||
13 | Section 15-86 as follows: | ||||||
14 | (35 ILCS 200/15-86) | ||||||
15 | Sec. 15-86. Exemptions related to access to hospital and | ||||||
16 | health care services by low-income and underserved | ||||||
17 | individuals. | ||||||
18 | (a) The General Assembly finds: | ||||||
19 | (1) Despite the Supreme Court's decision in Provena | ||||||
20 | Covenant Medical Center v. Dept. of Revenue , 236 Ill.2d | ||||||
21 | 368, there is considerable uncertainty surrounding the | ||||||
22 | test for charitable property tax exemption, especially | ||||||
23 | regarding the application of a quantitative or monetary | ||||||
24 | threshold. In Provena , the Department stated that the |
| |||||||
| |||||||
1 | primary basis for its decision was the hospital's | ||||||
2 | inadequate amount of charitable activity, but the | ||||||
3 | Department has not articulated what constitutes an | ||||||
4 | adequate amount of charitable activity. After Provena , the | ||||||
5 | Department denied property tax exemption applications of 3 | ||||||
6 | more hospitals, and, on the effective date of this | ||||||
7 | amendatory Act of the 97th General Assembly, at least 20 | ||||||
8 | other hospitals are awaiting rulings on applications for | ||||||
9 | property tax exemption. | ||||||
10 | (2) In Provena , two Illinois Supreme Court justices | ||||||
11 | opined that "setting a monetary or quantum standard is a | ||||||
12 | complex decision which should be left to our legislature, | ||||||
13 | should it so choose". The Appellate Court in Provena | ||||||
14 | stated: "The language we use in the State of Illinois to | ||||||
15 | determine whether real property is used for a charitable | ||||||
16 | purpose has its genesis in our 1870 Constitution. It is | ||||||
17 | obvious that such language may be difficult to apply to | ||||||
18 | the modern face of our nation's health care delivery | ||||||
19 | systems". The court noted the many significant changes in | ||||||
20 | the health care system since that time, but concluded that | ||||||
21 | taking these changes into account is a matter of public | ||||||
22 | policy, and "it is the legislature's job, not ours, to | ||||||
23 | make public policy". | ||||||
24 | (3) It is essential to ensure that tax exemption law | ||||||
25 | relating to hospitals accounts for the complexities of the | ||||||
26 | modern health care delivery system. Health care is moving |
| |||||||
| |||||||
1 | beyond the walls of the hospital. In addition to treating | ||||||
2 | individual patients, hospitals are assuming responsibility | ||||||
3 | for improving the health status of communities and | ||||||
4 | populations. Low-income and underserved communities | ||||||
5 | benefit disproportionately by these activities. | ||||||
6 | (4) The Supreme Court has explained that: "the | ||||||
7 | fundamental ground upon which all exemptions in favor of | ||||||
8 | charitable institutions are based is the benefit conferred | ||||||
9 | upon the public by them, and a consequent relief, to some | ||||||
10 | extent, of the burden upon the state to care for and | ||||||
11 | advance the interests of its citizens". Hospitals relieve | ||||||
12 | the burden of government in many ways, but most | ||||||
13 | significantly through their participation in and | ||||||
14 | substantial financial subsidization of the Illinois | ||||||
15 | Medicaid program, which could not operate without the | ||||||
16 | participation and partnership of Illinois hospitals. | ||||||
17 | (5) Working with the Illinois hospital community and | ||||||
18 | other interested parties, the General Assembly has | ||||||
19 | developed a comprehensive combination of related | ||||||
20 | legislation that addresses hospital property tax | ||||||
21 | exemption, significantly increases access to free health | ||||||
22 | care for indigent persons, and strengthens the Medical | ||||||
23 | Assistance program. It is the intent of the General | ||||||
24 | Assembly to establish a new category of ownership for | ||||||
25 | charitable property tax exemption to be applied to | ||||||
26 | not-for-profit hospitals and hospital affiliates in lieu |
| |||||||
| |||||||
1 | of the existing ownership category of "institutions of | ||||||
2 | public charity". It is also the intent of the General | ||||||
3 | Assembly to establish quantifiable standards for the | ||||||
4 | issuance of charitable exemptions for such property. It is | ||||||
5 | not the intent of the General Assembly to declare any | ||||||
6 | property exempt ipso facto, but rather to establish | ||||||
7 | criteria to be applied to the facts on a case-by-case | ||||||
8 | basis. | ||||||
9 | (b) For the purpose of this Section and Section 15-10, the | ||||||
10 | following terms shall have the meanings set forth below: | ||||||
11 | (1) "Hospital" means any institution, place, building, | ||||||
12 | buildings on a campus, or other health care facility | ||||||
13 | located in Illinois that is licensed under the Hospital | ||||||
14 | Licensing Act and has a hospital owner. | ||||||
15 | (2) "Hospital owner" means a not-for-profit | ||||||
16 | corporation that is the titleholder of a hospital, or the | ||||||
17 | owner of the beneficial interest in an Illinois land trust | ||||||
18 | that is the titleholder of a hospital. | ||||||
19 | (3) "Hospital affiliate" means any corporation, | ||||||
20 | partnership, limited partnership, joint venture, limited | ||||||
21 | liability company, association or other organization, | ||||||
22 | other than a hospital owner, that directly or indirectly | ||||||
23 | controls, is controlled by, or is under common control | ||||||
24 | with one or more hospital owners and that supports, is | ||||||
25 | supported by, or acts in furtherance of the exempt health | ||||||
26 | care purposes of at least one of those hospital owners' |
| |||||||
| |||||||
1 | hospitals. | ||||||
2 | (4) "Hospital system" means a hospital and one or more | ||||||
3 | other hospitals or hospital affiliates related by common | ||||||
4 | control or ownership. | ||||||
5 | (5) "Control" relating to hospital owners, hospital | ||||||
6 | affiliates, or hospital systems means possession, direct | ||||||
7 | or indirect, of the power to direct or cause the direction | ||||||
8 | of the management and policies of the entity, whether | ||||||
9 | through ownership of assets, membership interest, other | ||||||
10 | voting or governance rights, by contract or otherwise. | ||||||
11 | (6) "Hospital applicant" means a hospital owner or | ||||||
12 | hospital affiliate that files an application for a | ||||||
13 | property tax exemption pursuant to Section 15-5 and this | ||||||
14 | Section. | ||||||
15 | (7) "Relevant hospital entity" means (A) the hospital | ||||||
16 | owner, in the case of a hospital applicant that is a | ||||||
17 | hospital owner, and (B) at the election of a hospital | ||||||
18 | applicant that is a hospital affiliate, either (i) the | ||||||
19 | hospital affiliate or (ii) the hospital system to which | ||||||
20 | the hospital applicant belongs, including any hospitals or | ||||||
21 | hospital affiliates that are related by common control or | ||||||
22 | ownership. | ||||||
23 | (8) "Subject property" means property for which a | ||||||
24 | hospital applicant files an application for an exemption | ||||||
25 | pursuant to Section 15-5 and this Section. | ||||||
26 | (9) "Hospital year" means the fiscal year of the |
| |||||||
| |||||||
1 | relevant hospital entity, or the fiscal year of one of the | ||||||
2 | hospital owners in the hospital system if the relevant | ||||||
3 | hospital entity is a hospital system with members with | ||||||
4 | different fiscal years, that ends in the year for which | ||||||
5 | the exemption is sought. | ||||||
6 | (c) A hospital applicant satisfies the conditions for an | ||||||
7 | exemption under this Section with respect to the subject | ||||||
8 | property, and shall be issued a charitable exemption for that | ||||||
9 | property, if the value of services or activities listed in | ||||||
10 | subsection (e) for the hospital year equals or exceeds the | ||||||
11 | relevant hospital entity's estimated property tax liability, | ||||||
12 | as determined under subsection (g), for the year for which | ||||||
13 | exemption is sought. For purposes of making the calculations | ||||||
14 | required by this subsection (c), if the relevant hospital | ||||||
15 | entity is a hospital owner that owns more than one hospital, | ||||||
16 | the value of the services or activities listed in subsection | ||||||
17 | (e) shall be calculated on the basis of only those services and | ||||||
18 | activities relating to the hospital that includes the subject | ||||||
19 | property, and the relevant hospital entity's estimated | ||||||
20 | property tax liability shall be calculated only with respect | ||||||
21 | to the properties comprising that hospital. In the case of a | ||||||
22 | multi-state hospital system or hospital affiliate, the value | ||||||
23 | of the services or activities listed in subsection (e) shall | ||||||
24 | be calculated on the basis of only those services and | ||||||
25 | activities that occur in Illinois and the relevant hospital | ||||||
26 | entity's estimated property tax liability shall be calculated |
| |||||||
| |||||||
1 | only with respect to its property located in Illinois. | ||||||
2 | Notwithstanding any other provisions of this Act, any | ||||||
3 | parcel or portion thereof, that is owned by a for-profit | ||||||
4 | entity whether part of the hospital system or not, or that is | ||||||
5 | leased, licensed or operated by a for-profit entity regardless | ||||||
6 | of whether healthcare services are provided on that parcel | ||||||
7 | shall not qualify for exemption. If a parcel has both exempt | ||||||
8 | and non-exempt uses, an exemption may be granted for the | ||||||
9 | qualifying portion of that parcel. In the case of parking lots | ||||||
10 | and common areas serving both exempt and non-exempt uses those | ||||||
11 | parcels or portions thereof may qualify for an exemption in | ||||||
12 | proportion to the amount of qualifying use. | ||||||
13 | (d) The hospital applicant shall include information in | ||||||
14 | its exemption application establishing that it satisfies the | ||||||
15 | requirements of subsection (c). For purposes of making the | ||||||
16 | calculations required by subsection (c), the hospital | ||||||
17 | applicant may for each year elect to use either (1) the value | ||||||
18 | of the services or activities listed in subsection (e) for the | ||||||
19 | hospital year or (2) the average value of those services or | ||||||
20 | activities for the 3 fiscal years ending with the hospital | ||||||
21 | year. If the relevant hospital entity has been in operation | ||||||
22 | for less than 3 completed fiscal years, then the latter | ||||||
23 | calculation, if elected, shall be performed on a pro rata | ||||||
24 | basis. | ||||||
25 | (e) Services that address the health care needs of | ||||||
26 | low-income or underserved individuals or relieve the burden of |
| |||||||
| |||||||
1 | government with regard to health care services. The following | ||||||
2 | services and activities shall be considered for purposes of | ||||||
3 | making the calculations required by subsection (c): | ||||||
4 | (1) Charity care. Free or discounted services provided | ||||||
5 | pursuant to the relevant hospital entity's financial | ||||||
6 | assistance policy, measured at cost, including discounts | ||||||
7 | provided under the Hospital Uninsured Patient Discount | ||||||
8 | Act. | ||||||
9 | (2) Health services to low-income and underserved | ||||||
10 | individuals. Other unreimbursed costs of the relevant | ||||||
11 | hospital entity for providing without charge, paying for, | ||||||
12 | or subsidizing goods, activities, or services for the | ||||||
13 | purpose of addressing the health of low-income or | ||||||
14 | underserved individuals. Those activities or services may | ||||||
15 | include, but are not limited to: financial or in-kind | ||||||
16 | support to affiliated or unaffiliated hospitals, hospital | ||||||
17 | affiliates, community clinics, or programs that treat | ||||||
18 | low-income or underserved individuals; paying for or | ||||||
19 | subsidizing health care professionals who care for | ||||||
20 | low-income or underserved individuals; providing or | ||||||
21 | subsidizing outreach or educational services to low-income | ||||||
22 | or underserved individuals for disease management and | ||||||
23 | prevention; free or subsidized goods, supplies, or | ||||||
24 | services needed by low-income or underserved individuals | ||||||
25 | because of their medical condition; and prenatal or | ||||||
26 | childbirth outreach to low-income or underserved persons. |
| |||||||
| |||||||
1 | (3) Subsidy of State or local governments. Direct or | ||||||
2 | indirect financial or in-kind subsidies of State or local | ||||||
3 | governments by the relevant hospital entity that pay for | ||||||
4 | or subsidize activities or programs related to health care | ||||||
5 | for low-income or underserved individuals. | ||||||
6 | (4) Support for State health care programs for | ||||||
7 | low-income individuals. At the election of the hospital | ||||||
8 | applicant for each applicable year, either (A) 10% of | ||||||
9 | payments to the relevant hospital entity and any hospital | ||||||
10 | affiliate designated by the relevant hospital entity | ||||||
11 | (provided that such hospital affiliate's operations | ||||||
12 | provide financial or operational support for or receive | ||||||
13 | financial or operational support from the relevant | ||||||
14 | hospital entity) under Medicaid or other means-tested | ||||||
15 | programs, including, but not limited to, General | ||||||
16 | Assistance , the Covering ALL KIDS Health Insurance Act, | ||||||
17 | and the State Children's Health Insurance Program or (B) | ||||||
18 | the amount of subsidy provided by the relevant hospital | ||||||
19 | entity and any hospital affiliate designated by the | ||||||
20 | relevant hospital entity (provided that such hospital | ||||||
21 | affiliate's operations provide financial or operational | ||||||
22 | support for or receive financial or operational support | ||||||
23 | from the relevant hospital entity) to State or local | ||||||
24 | government in treating Medicaid recipients and recipients | ||||||
25 | of means-tested programs, including but not limited to | ||||||
26 | General Assistance , the Covering ALL KIDS Health Insurance |
| |||||||
| |||||||
1 | Act, and the State Children's Health Insurance Program . | ||||||
2 | The amount of subsidy for purposes of this item (4) is | ||||||
3 | calculated in the same manner as unreimbursed costs are | ||||||
4 | calculated for Medicaid and other means-tested government | ||||||
5 | programs in the Schedule H of IRS Form 990 in effect on the | ||||||
6 | effective date of this amendatory Act of the 97th General | ||||||
7 | Assembly; provided, however, that in any event | ||||||
8 | unreimbursed costs shall be net of fee-for-services | ||||||
9 | payments, payments pursuant to an assessment, quarterly | ||||||
10 | payments, and all other payments included on the schedule | ||||||
11 | H of the IRS form 990. | ||||||
12 | (5) Dual-eligible subsidy. The amount of subsidy | ||||||
13 | provided to government by treating dual-eligible | ||||||
14 | Medicare/Medicaid patients. The amount of subsidy for | ||||||
15 | purposes of this item (5) is calculated by multiplying the | ||||||
16 | relevant hospital entity's unreimbursed costs for | ||||||
17 | Medicare, calculated in the same manner as determined in | ||||||
18 | the Schedule H of IRS Form 990 in effect on the effective | ||||||
19 | date of this amendatory Act of the 97th General Assembly, | ||||||
20 | by the relevant hospital entity's ratio of dual-eligible | ||||||
21 | patients to total Medicare patients. | ||||||
22 | (6) Relief of the burden of government related to | ||||||
23 | health care of low-income individuals. Except to the | ||||||
24 | extent otherwise taken into account in this subsection, | ||||||
25 | the portion of unreimbursed costs of the relevant hospital | ||||||
26 | entity attributable to providing, paying for, or |
| |||||||
| |||||||
1 | subsidizing goods, activities, or services that relieve | ||||||
2 | the burden of government related to health care for | ||||||
3 | low-income individuals. Such activities or services shall | ||||||
4 | include, but are not limited to, providing emergency, | ||||||
5 | trauma, burn, neonatal, psychiatric, rehabilitation, or | ||||||
6 | other special services; providing medical education; and | ||||||
7 | conducting medical research or training of health care | ||||||
8 | professionals. The portion of those unreimbursed costs | ||||||
9 | attributable to benefiting low-income individuals shall be | ||||||
10 | determined using the ratio calculated by adding the | ||||||
11 | relevant hospital entity's costs attributable to charity | ||||||
12 | care, Medicaid, other means-tested government programs, | ||||||
13 | Medicare patients with disabilities under age 65, and | ||||||
14 | dual-eligible Medicare/Medicaid patients and dividing that | ||||||
15 | total by the relevant hospital entity's total costs. Such | ||||||
16 | costs for the numerator and denominator shall be | ||||||
17 | determined by multiplying gross charges by the cost to | ||||||
18 | charge ratio taken from the hospitals' most recently filed | ||||||
19 | Medicare cost report (CMS 2252-10 Worksheet C, Part I). In | ||||||
20 | the case of emergency services, the ratio shall be | ||||||
21 | calculated using costs (gross charges multiplied by the | ||||||
22 | cost to charge ratio taken from the hospitals' most | ||||||
23 | recently filed Medicare cost report (CMS 2252-10 Worksheet | ||||||
24 | C, Part I)) of patients treated in the relevant hospital | ||||||
25 | entity's emergency department. | ||||||
26 | (7) Any other activity by the relevant hospital entity |
| |||||||
| |||||||
1 | that the Department determines relieves the burden of | ||||||
2 | government or addresses the health of low-income or | ||||||
3 | underserved individuals. | ||||||
4 | (f) For purposes of making the calculations required by | ||||||
5 | subsections (c) and (e): | ||||||
6 | (1) particular services or activities eligible for | ||||||
7 | consideration under any of the paragraphs (1) through (7) | ||||||
8 | of subsection (e) may not be counted under more than one of | ||||||
9 | those paragraphs; and | ||||||
10 | (2) the amount of unreimbursed costs and the amount of | ||||||
11 | subsidy shall not be reduced by restricted or unrestricted | ||||||
12 | payments received by the relevant hospital entity as | ||||||
13 | contributions deductible under Section 170(a) of the | ||||||
14 | Internal Revenue Code. | ||||||
15 | (g) Estimation of Exempt Property Tax Liability. The | ||||||
16 | estimated property tax liability used for the determination in | ||||||
17 | subsection (c) shall be calculated as follows: | ||||||
18 | (1) "Estimated property tax liability" means the | ||||||
19 | estimated dollar amount of property tax that would be | ||||||
20 | owed, with respect to the exempt portion of each of the | ||||||
21 | relevant hospital entity's properties that are already | ||||||
22 | fully or partially exempt, or for which an exemption in | ||||||
23 | whole or in part is currently being sought, and then | ||||||
24 | aggregated as applicable, as if the exempt portion of | ||||||
25 | those properties were subject to tax, calculated with | ||||||
26 | respect to each such property by multiplying: |
| |||||||
| |||||||
1 | (A) the lesser of (i) the actual assessed value, | ||||||
2 | if any, of the portion of the property for which an | ||||||
3 | exemption is sought or (ii) an estimated assessed | ||||||
4 | value of the exempt portion of such property as | ||||||
5 | determined in item (2) of this subsection (g), by: | ||||||
6 | (B) the applicable State equalization rate | ||||||
7 | (yielding the equalized assessed value), by | ||||||
8 | (C) the applicable tax rate. | ||||||
9 | (2) The estimated assessed value of the exempt portion | ||||||
10 | of the property equals the sum of (i) the estimated fair | ||||||
11 | market value of buildings on the property, as determined | ||||||
12 | in accordance with subparagraphs (A) and (B) of this item | ||||||
13 | (2), multiplied by the applicable assessment factor, and | ||||||
14 | (ii) the estimated assessed value of the land portion of | ||||||
15 | the property, as determined in accordance with | ||||||
16 | subparagraph (C). | ||||||
17 | (A) The "estimated fair market value of buildings | ||||||
18 | on the property" means the replacement value of any | ||||||
19 | exempt portion of buildings on the property, minus | ||||||
20 | depreciation, determined utilizing the cost | ||||||
21 | replacement method whereby the exempt square footage | ||||||
22 | of all such buildings is multiplied by the replacement | ||||||
23 | cost per square foot for Class A Average building | ||||||
24 | found in the most recent edition of the Marshall & | ||||||
25 | Swift Valuation Services Manual, adjusted by any | ||||||
26 | appropriate current cost and local multipliers. |
| |||||||
| |||||||
1 | (B) Depreciation, for purposes of calculating the | ||||||
2 | estimated fair market value of buildings on the | ||||||
3 | property, is applied by utilizing a weighted mean life | ||||||
4 | for the buildings based on original construction and | ||||||
5 | assuming a 40-year life for hospital buildings and the | ||||||
6 | applicable life for other types of buildings as | ||||||
7 | specified in the American Hospital Association | ||||||
8 | publication "Estimated Useful Lives of Depreciable | ||||||
9 | Hospital Assets". In the case of hospital buildings, | ||||||
10 | the remaining life is divided by 40 and this ratio is | ||||||
11 | multiplied by the replacement cost of the buildings to | ||||||
12 | obtain an estimated fair market value of buildings. If | ||||||
13 | a hospital building is older than 35 years, a | ||||||
14 | remaining life of 5 years for residual value is | ||||||
15 | assumed; and if a building is less than 8 years old, a | ||||||
16 | remaining life of 32 years is assumed. | ||||||
17 | (C) The estimated assessed value of the land | ||||||
18 | portion of the property shall be determined by | ||||||
19 | multiplying (i) the per square foot average of the | ||||||
20 | assessed values of three parcels of land (not | ||||||
21 | including farm land, and excluding the assessed value | ||||||
22 | of the improvements thereon) reasonably comparable to | ||||||
23 | the property, by (ii) the number of square feet | ||||||
24 | comprising the exempt portion of the property's land | ||||||
25 | square footage. | ||||||
26 | (3) The assessment factor, State equalization rate, |
| |||||||
| |||||||
1 | and tax rate (including any special factors such as | ||||||
2 | Enterprise Zones) used in calculating the estimated | ||||||
3 | property tax liability shall be for the most recent year | ||||||
4 | that is publicly available from the applicable chief | ||||||
5 | county assessment officer or officers at least 90 days | ||||||
6 | before the end of the hospital year. | ||||||
7 | (4) The method utilized to calculate estimated | ||||||
8 | property tax liability for purposes of this Section 15-86 | ||||||
9 | shall not be utilized for the actual valuation, | ||||||
10 | assessment, or taxation of property pursuant to the | ||||||
11 | Property Tax Code. | ||||||
12 | (h) Application. Each hospital applicant applying for a | ||||||
13 | property tax exemption pursuant to Section 15-5 and this | ||||||
14 | Section shall use an application form provided by the | ||||||
15 | Department. The application form shall specify the records | ||||||
16 | required in support of the application and those records shall | ||||||
17 | be submitted to the Department with the application form. Each | ||||||
18 | application or affidavit shall contain a verification by the | ||||||
19 | Chief Executive Officer of the hospital applicant under oath | ||||||
20 | or affirmation stating that each statement in the application | ||||||
21 | or affidavit and each document submitted with the application | ||||||
22 | or affidavit are true and correct. The records submitted with | ||||||
23 | the application pursuant to this Section shall include an | ||||||
24 | exhibit prepared by the relevant hospital entity showing (A) | ||||||
25 | the value of the relevant hospital entity's services and | ||||||
26 | activities, if any, under paragraphs (1) through (7) of |
| |||||||
| |||||||
1 | subsection (e) of this Section stated separately for each | ||||||
2 | paragraph, and (B) the value relating to the relevant hospital | ||||||
3 | entity's estimated property tax liability under subsections | ||||||
4 | (g)(1)(A), (B), and (C), subsections (g)(2)(A), (B), and (C), | ||||||
5 | and subsection (g)(3) of this Section stated separately for | ||||||
6 | each item. Such exhibit will be made available to the public by | ||||||
7 | the chief county assessment officer. Nothing in this Section | ||||||
8 | shall be construed as limiting the Attorney General's | ||||||
9 | authority under the Illinois False Claims Act. | ||||||
10 | (i) Nothing in this Section shall be construed to limit | ||||||
11 | the ability of otherwise eligible hospitals, hospital owners, | ||||||
12 | hospital affiliates, or hospital systems to obtain or maintain | ||||||
13 | property tax exemptions pursuant to a provision of the | ||||||
14 | Property Tax Code other than this Section.
| ||||||
15 | (Source: P.A. 99-143, eff. 7-27-15.) | ||||||
16 | Section 35. The Illinois Pension Code is amended by | ||||||
17 | changing Section 24-102 as follows:
| ||||||
18 | (40 ILCS 5/24-102) (from Ch. 108 1/2, par. 24-102)
| ||||||
19 | Sec. 24-102.
As used in this Article, "employee" means any | ||||||
20 | person,
including a person elected, appointed or under | ||||||
21 | contract, receiving
compensation from the State or a unit of | ||||||
22 | local government or school
district for personal services | ||||||
23 | rendered, including salaried persons. A health care provider | ||||||
24 | who elects to participate in the State Employees Deferred |
| |||||||
| |||||||
1 | Compensation Plan established under Section 24-104 of this | ||||||
2 | Code shall, for purposes of that participation, be deemed an | ||||||
3 | "employee" as defined in this Section.
| ||||||
4 | As used in this Article, "health care provider" means a | ||||||
5 | dentist, physician, optometrist, pharmacist, or podiatric | ||||||
6 | physician that participates and receives compensation as a | ||||||
7 | provider under the Illinois Public Aid Code , the Children's | ||||||
8 | Health Insurance Act, or the Covering ALL KIDS Health | ||||||
9 | Insurance Act . | ||||||
10 | As used in this Article, "compensation" includes | ||||||
11 | compensation received
in a lump sum for accumulated unused | ||||||
12 | vacation, personal leave or sick leave, with the exception of | ||||||
13 | health care providers. "Compensation" with respect to health | ||||||
14 | care providers is defined under the Illinois Public Aid Code , | ||||||
15 | the Children's Health Insurance Act, or the Covering ALL KIDS | ||||||
16 | Health Insurance Act .
| ||||||
17 | Where applicable, in no event shall the total of the | ||||||
18 | amount of deferred compensation of an
employee set aside in | ||||||
19 | relation to a particular year under the Illinois
State | ||||||
20 | Employees Deferred Compensation Plan and the employee's
| ||||||
21 | nondeferred compensation for that year exceed the total annual | ||||||
22 | salary or
compensation under the existing salary schedule or | ||||||
23 | classification plan
applicable to such employee in such year; | ||||||
24 | except that any compensation
received in a lump sum for | ||||||
25 | accumulated unused vacation, personal leave or sick
leave | ||||||
26 | shall not be included in the calculation of such totals.
|
| |||||||
| |||||||
1 | (Source: P.A. 98-214, eff. 8-9-13.)
| ||||||
2 | Section 40. The Loan Repayment Assistance for Dentists Act | ||||||
3 | is amended by changing Sections 10, 25, and 30 as follows: | ||||||
4 | (110 ILCS 948/10)
| ||||||
5 | Sec. 10. Definitions. In this Act, unless the context | ||||||
6 | otherwise requires: | ||||||
7 | "Dental hygienist" means a person who holds a license | ||||||
8 | under the Illinois Dental Practice Act to perform dental | ||||||
9 | services as authorized by Section 18 of the Illinois Dental | ||||||
10 | Practice Act. | ||||||
11 | "Dental payments" means compensation provided to dentists | ||||||
12 | and dental specialists for services rendered under Article V | ||||||
13 | of the Illinois Public Aid Code , the Covering ALL KIDS Health | ||||||
14 | Insurance Act, or the Children's Health Insurance Program Act . | ||||||
15 | "Dental specialist" means a person who has received a | ||||||
16 | license as a dentist in this State and who is trained and | ||||||
17 | qualified to practice in one or more of the following | ||||||
18 | specialties of dentistry: endodontics, oral and maxillofacial | ||||||
19 | surgery, orthodontics, pedodontics, periodontics, and | ||||||
20 | prosthodontics. | ||||||
21 | "Dentist" means a person who has received a general | ||||||
22 | license pursuant to paragraph (a) of Section 11 of the | ||||||
23 | Illinois Dental Practice Act, who may perform any intraoral | ||||||
24 | and extraoral procedure required in the practice of dentistry, |
| |||||||
| |||||||
1 | and to whom is reserved the responsibilities specified in | ||||||
2 | Section 17 of the Illinois Dental Practice Act. | ||||||
3 | "Department" means the Department of Public Health. | ||||||
4 | "Designated shortage area" means a medically underserved | ||||||
5 | area or health manpower shortage area as defined by the United | ||||||
6 | States Department of Health and Human Services or as otherwise | ||||||
7 | designated by the Department of Public Health. | ||||||
8 | "Educational loans" means higher education student loans | ||||||
9 | that a person has incurred in attending a registered | ||||||
10 | professional dental education program. | ||||||
11 | "Program" means the educational loan repayment assistance | ||||||
12 | program for dentists and dental specialists or dental | ||||||
13 | hygienists established by the Department under this Act.
| ||||||
14 | (Source: P.A. 95-297, eff. 8-20-07; 96-757, eff. 8-25-09.) | ||||||
15 | (110 ILCS 948/25)
| ||||||
16 | Sec. 25. Eligibility. To be eligible for assistance under | ||||||
17 | the program, an applicant must meet all of the following | ||||||
18 | qualifications: | ||||||
19 | (1) He or she must be a citizen or permanent resident
| ||||||
20 | of the United States.
| ||||||
21 | (2) He or she must be a resident of this State. | ||||||
22 | (3) He or she must be practicing full time in
this | ||||||
23 | State as a dentist, dental specialist, or dental | ||||||
24 | hygienist.
| ||||||
25 | (4) He or she must currently be repaying educational
|
| |||||||
| |||||||
1 | loans.
| ||||||
2 | (5) He or she must accept dental payments as defined | ||||||
3 | in this Act. | ||||||
4 | (6) He or she must practice or commit to practice full | ||||||
5 | time in this State in a designated shortage area.
| ||||||
6 | (7) He or she must allocate at least 20% of all patient | ||||||
7 | appointments to patients covered by Article V of the | ||||||
8 | Illinois Public Aid Code , the Covering ALL KIDS Health | ||||||
9 | Insurance Act, or the Children's Health Insurance Program | ||||||
10 | Act . | ||||||
11 | (Source: P.A. 95-297, eff. 8-20-07; 96-757, eff. 8-25-09.) | ||||||
12 | (110 ILCS 948/30)
| ||||||
13 | Sec. 30. The award of grants. | ||||||
14 | (a) Under the program, for each year that a qualified | ||||||
15 | applicant practices full time in this State in a designated | ||||||
16 | shortage area as a dentist or dental specialist, the | ||||||
17 | Department shall, subject to appropriation, award a grant to | ||||||
18 | that person in an amount equal to the amount in educational | ||||||
19 | loans that the person must repay that year. However, the total | ||||||
20 | amount in grants that a person may be awarded under the program | ||||||
21 | must not exceed $25,000 per year for a 4-year period. | ||||||
22 | The grant award for a dental hygienist shall be set by rule | ||||||
23 | of the Department. | ||||||
24 | (b) The Department shall require recipients to use the | ||||||
25 | grants to pay off their educational loans.
|
| |||||||
| |||||||
1 | (c) The initial grant awarded to a dentist or dental | ||||||
2 | specialist under this Act shall be for a 2-year period. Based | ||||||
3 | on the successful completion of the initial 2-year grant, the | ||||||
4 | grantees may be awarded up to 2 subsequent one-year grants. | ||||||
5 | Grantees are eligible to receive grant funds for no more than a | ||||||
6 | 4-year period. Previous grant recipients shall be given | ||||||
7 | priority for years 3 and 4 grant funding, provided that the | ||||||
8 | grantee continues to meet the eligibility requirements set | ||||||
9 | forth in Section 25 of this Act. Grantees shall practice full | ||||||
10 | time in a designated shortage area for the period of each grant | ||||||
11 | awarded. | ||||||
12 | The grant award for a dental hygienist shall be for a | ||||||
13 | maximum of 2 years. | ||||||
14 | (d) Successful applicants shall be eligible for a grant | ||||||
15 | award upon execution of the grant agreement and shall then | ||||||
16 | begin to receive grant award payments on a quarterly basis. | ||||||
17 | (e) The Department shall award grants to otherwise | ||||||
18 | eligible dental applicants by using the following criteria: | ||||||
19 | (1) Dental specialist willing to practice in any | ||||||
20 | designated shortage area. | ||||||
21 | (2) Dentist willing to practice in a designated | ||||||
22 | shortage area with the highest Health Professional | ||||||
23 | Shortage Area (HPSA) score. | ||||||
24 | (3) Dentist willing to practice in a designated | ||||||
25 | shortage area with the highest HPSA score and agreeing to | ||||||
26 | allocate the highest percentage of patient appointments to |
| |||||||
| |||||||
1 | those that are covered by Article V of the Illinois Public | ||||||
2 | Aid Code , the Covering ALL KIDS Health Insurance Act, or | ||||||
3 | the Children's Health Insurance Program Act . | ||||||
4 | (Source: P.A. 95-297, eff. 8-20-07; 96-757, eff. 8-25-09.) | ||||||
5 | Section 45. The Illinois Insurance Code is amended by | ||||||
6 | changing Section 352 as follows:
| ||||||
7 | (215 ILCS 5/352) (from Ch. 73, par. 964)
| ||||||
8 | Sec. 352. Scope of Article.
| ||||||
9 | (a) Except as provided in subsections (b), (c), (d), and | ||||||
10 | (e),
this Article shall
apply to all companies transacting in | ||||||
11 | this State the kinds of business
enumerated in clause (b) of | ||||||
12 | Class 1 and clause (a) of Class 2 of Section 4.
Nothing in this | ||||||
13 | Article shall apply to, or in any way affect policies or
| ||||||
14 | contracts described in clause (a) of Class 1 of Section 4; | ||||||
15 | however, this
Article shall apply to policies and contracts | ||||||
16 | which contain benefits
providing reimbursement for the | ||||||
17 | expenses of long term health care which are
certified or | ||||||
18 | ordered by a physician including but not limited to
| ||||||
19 | professional nursing care, custodial nursing care, and | ||||||
20 | non-nursing
custodial care provided in a nursing home or at a | ||||||
21 | residence of the insured.
| ||||||
22 | (b) (Blank).
| ||||||
23 | (c) A policy issued and delivered in this State
that | ||||||
24 | provides coverage under that policy for
certificate holders |
| |||||||
| |||||||
1 | who are neither residents of nor employed in this State
does | ||||||
2 | not need to provide to those nonresident
certificate holders | ||||||
3 | who are not employed in this State the coverages or
services | ||||||
4 | mandated by this Article.
| ||||||
5 | (d) Stop-loss insurance is exempt from all Sections
of | ||||||
6 | this Article, except this Section and Sections 353a, 354, | ||||||
7 | 357.30, and
370. For purposes of this exemption, stop-loss | ||||||
8 | insurance is further defined as
follows:
| ||||||
9 | (1) The policy must be issued to and insure an | ||||||
10 | employer, trustee, or other
sponsor of the plan, or the | ||||||
11 | plan itself, but not employees, members, or
participants.
| ||||||
12 | (2) Payments by the insurer must be made to the | ||||||
13 | employer, trustee, or
other sponsors of the plan, or the | ||||||
14 | plan itself, but not to the employees,
members, | ||||||
15 | participants, or health care providers.
| ||||||
16 | (e) A policy issued or delivered in this State to the | ||||||
17 | Department of Healthcare and Family Services (formerly
| ||||||
18 | Illinois Department
of Public Aid) and providing coverage, | ||||||
19 | under clause (b) of Class 1 or clause (a)
of Class 2 as | ||||||
20 | described in Section 4, to persons who are enrolled under | ||||||
21 | Article V of the Illinois
Public Aid Code or under the | ||||||
22 | Children's Health Insurance Program Act is
exempt from all | ||||||
23 | restrictions, limitations,
standards, rules, or regulations | ||||||
24 | respecting benefits imposed by or under
authority of this | ||||||
25 | Code, except those specified by subsection (1) of Section
143, | ||||||
26 | Section 370c, and Section 370c.1. Nothing in this subsection, |
| |||||||
| |||||||
1 | however, affects the total medical services
available to | ||||||
2 | persons eligible for medical assistance under the Illinois | ||||||
3 | Public
Aid Code.
| ||||||
4 | (f) An in-office membership care agreement provided under | ||||||
5 | the In-Office Membership Care Act is not insurance for the | ||||||
6 | purposes of this Code. | ||||||
7 | (Source: P.A. 101-190, eff. 8-2-19.)
| ||||||
8 | Section 50. The Health Maintenance Organization Act is | ||||||
9 | amended by changing Section 1-2 as follows:
| ||||||
10 | (215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)
| ||||||
11 | Sec. 1-2. Definitions. As used in this Act, unless the | ||||||
12 | context otherwise
requires, the following terms shall have the | ||||||
13 | meanings ascribed to them:
| ||||||
14 | (1) "Advertisement" means any printed or published | ||||||
15 | material,
audiovisual material and descriptive literature of | ||||||
16 | the health care plan
used in direct mail, newspapers, | ||||||
17 | magazines, radio scripts, television
scripts, billboards and | ||||||
18 | similar displays; and any descriptive literature or
sales aids | ||||||
19 | of all kinds disseminated by a representative of the health | ||||||
20 | care
plan for presentation to the public including, but not | ||||||
21 | limited to, circulars,
leaflets, booklets, depictions, | ||||||
22 | illustrations, form letters and prepared
sales presentations.
| ||||||
23 | (2) "Director" means the Director of Insurance.
| ||||||
24 | (3) "Basic health care services" means emergency care, and |
| |||||||
| |||||||
1 | inpatient
hospital and physician care, outpatient medical | ||||||
2 | services, mental
health services and care for alcohol and drug | ||||||
3 | abuse, including any
reasonable deductibles and co-payments, | ||||||
4 | all of which are subject to the
limitations described in | ||||||
5 | Section 4-20 of this Act and as determined by the Director | ||||||
6 | pursuant to rule.
| ||||||
7 | (4) "Enrollee" means an individual who has been enrolled | ||||||
8 | in a health
care plan.
| ||||||
9 | (5) "Evidence of coverage" means any certificate, | ||||||
10 | agreement,
or contract issued to an enrollee setting out the | ||||||
11 | coverage to which he is
entitled in exchange for a per capita | ||||||
12 | prepaid sum.
| ||||||
13 | (6) "Group contract" means a contract for health care | ||||||
14 | services which
by its terms limits eligibility to members of a | ||||||
15 | specified group.
| ||||||
16 | (7) "Health care plan" means any arrangement whereby any | ||||||
17 | organization
undertakes to provide or arrange for and pay for | ||||||
18 | or reimburse the
cost of basic health care services, excluding | ||||||
19 | any reasonable deductibles and copayments, from providers | ||||||
20 | selected by
the Health Maintenance Organization and such | ||||||
21 | arrangement
consists of arranging for or the provision of such | ||||||
22 | health care services, as
distinguished from mere | ||||||
23 | indemnification against the cost of such services,
except as | ||||||
24 | otherwise authorized by Section 2-3 of this Act,
on a per | ||||||
25 | capita prepaid basis, through insurance or otherwise. A | ||||||
26 | "health
care plan" also includes any arrangement whereby an |
| |||||||
| |||||||
1 | organization undertakes to
provide or arrange for or pay for | ||||||
2 | or reimburse the cost of any health care
service for persons | ||||||
3 | who are enrolled under Article V of the Illinois Public Aid
| ||||||
4 | Code or under the Children's Health Insurance Program Act | ||||||
5 | through
providers selected by the organization and the | ||||||
6 | arrangement consists of making
provision for the delivery of | ||||||
7 | health care services, as distinguished from mere
| ||||||
8 | indemnification. A "health care plan" also includes any | ||||||
9 | arrangement pursuant
to Section 4-17. Nothing in this | ||||||
10 | definition, however, affects the total
medical services | ||||||
11 | available to persons eligible for medical assistance under the
| ||||||
12 | Illinois Public Aid Code.
| ||||||
13 | (8) "Health care services" means any services included in | ||||||
14 | the furnishing
to any individual of medical or dental care, or | ||||||
15 | the hospitalization or
incident to the furnishing of such care | ||||||
16 | or hospitalization as well as the
furnishing to any person of | ||||||
17 | any and all other services for the purpose of
preventing, | ||||||
18 | alleviating, curing or healing human illness or injury.
| ||||||
19 | (9) "Health Maintenance Organization" means any | ||||||
20 | organization formed
under the laws of this or another state to | ||||||
21 | provide or arrange for one or
more health care plans under a | ||||||
22 | system which causes any part of the risk of
health care | ||||||
23 | delivery to be borne by the organization or its providers.
| ||||||
24 | (10) "Net worth" means admitted assets, as defined in | ||||||
25 | Section 1-3 of
this Act, minus liabilities.
| ||||||
26 | (11) "Organization" means any insurance company, a |
| |||||||
| |||||||
1 | nonprofit
corporation authorized under the Dental
Service Plan | ||||||
2 | Act or the Voluntary
Health Services Plans Act,
or a | ||||||
3 | corporation organized under the laws of this or another state | ||||||
4 | for the
purpose of operating one or more health care plans and | ||||||
5 | doing no business other
than that of a Health Maintenance | ||||||
6 | Organization or an insurance company.
"Organization" shall | ||||||
7 | also mean the University of Illinois Hospital as
defined in | ||||||
8 | the University of Illinois Hospital Act or a unit of local | ||||||
9 | government health system operating within a county with a | ||||||
10 | population of 3,000,000 or more.
| ||||||
11 | (12) "Provider" means any physician, hospital facility,
| ||||||
12 | facility licensed under the Nursing Home Care Act, or facility | ||||||
13 | or long-term care facility as those terms are defined in the | ||||||
14 | Nursing Home Care Act or other person which is licensed or | ||||||
15 | otherwise authorized
to furnish health care services and also | ||||||
16 | includes any other entity that
arranges for the delivery or | ||||||
17 | furnishing of health care service.
| ||||||
18 | (13) "Producer" means a person directly or indirectly | ||||||
19 | associated with a
health care plan who engages in solicitation | ||||||
20 | or enrollment.
| ||||||
21 | (14) "Per capita prepaid" means a basis of prepayment by | ||||||
22 | which a fixed
amount of money is prepaid per individual or any | ||||||
23 | other enrollment unit to
the Health Maintenance Organization | ||||||
24 | or for health care services which are
provided during a | ||||||
25 | definite time period regardless of the frequency or
extent of | ||||||
26 | the services rendered
by the Health Maintenance Organization, |
| |||||||
| |||||||
1 | except for copayments and deductibles
and except as provided | ||||||
2 | in subsection (f) of Section 5-3 of this Act.
| ||||||
3 | (15) "Subscriber" means a person who has entered into a | ||||||
4 | contractual
relationship with the Health Maintenance | ||||||
5 | Organization for the provision of
or arrangement of at least | ||||||
6 | basic health care services to the beneficiaries
of such | ||||||
7 | contract.
| ||||||
8 | (Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14; | ||||||
9 | 99-78, eff. 7-20-15.)
| ||||||
10 | Section 55. The Illinois Public Aid Code is amended by | ||||||
11 | changing Sections 5-1.5, 5-2, 5-5, 5-30, 5A-8, 5G-35, 5H-1, | ||||||
12 | 11-22, 11-22a, 11-22b, 11-22c, 12-4.35, 12-4.45, 12-9, and | ||||||
13 | 12-10.4 as follows: | ||||||
14 | (305 ILCS 5/5-1.5) | ||||||
15 | Sec. 5-1.5. COVID-19 public health emergency. | ||||||
16 | Notwithstanding any other provision of Articles V, XI, and XII | ||||||
17 | of this Code, the Department may take necessary actions to | ||||||
18 | address the COVID-19 public health emergency to the extent | ||||||
19 | such actions are required, approved, or authorized by the | ||||||
20 | United States Department of Health and Human Services, Centers | ||||||
21 | for Medicare and Medicaid Services. Such actions may continue | ||||||
22 | throughout the public health emergency and for up to 12 months | ||||||
23 | after the period ends, and may include, but are not limited to: | ||||||
24 | accepting an applicant's or recipient's attestation of income, |
| |||||||
| |||||||
1 | incurred medical expenses, residency, and insured status when | ||||||
2 | electronic verification is not available; eliminating resource | ||||||
3 | tests for some eligibility determinations; suspending | ||||||
4 | redeterminations; suspending changes that would adversely | ||||||
5 | affect an applicant's or recipient's eligibility; phone or | ||||||
6 | verbal approval by an applicant to submit an application in | ||||||
7 | lieu of applicant signature; allowing adult presumptive | ||||||
8 | eligibility; allowing presumptive eligibility for children, | ||||||
9 | pregnant women, and adults as often as twice per calendar | ||||||
10 | year; paying for additional services delivered by telehealth; | ||||||
11 | and suspending premium and co-payment requirements. | ||||||
12 | The Department's authority under this Section shall only | ||||||
13 | extend to encompass, incorporate, or effectuate the terms, | ||||||
14 | items, conditions, and other provisions approved, authorized, | ||||||
15 | or required by the United States Department of Health and | ||||||
16 | Human Services, Centers for Medicare and Medicaid Services, | ||||||
17 | and shall not extend beyond the time of the COVID-19 public | ||||||
18 | health emergency and up to 12 months after the period expires.
| ||||||
19 | Any individual determined eligible for medical assistance | ||||||
20 | under this Code as of or during the COVID-19 public health | ||||||
21 | emergency may be treated as eligible for such medical | ||||||
22 | assistance benefits during the COVID-19 public health | ||||||
23 | emergency, and up to 12 months after the period expires, | ||||||
24 | regardless of whether federally required or whether the | ||||||
25 | individual's eligibility may be State or federally funded, | ||||||
26 | unless the individual requests a voluntary termination of |
| |||||||
| |||||||
1 | eligibility or ceases to be a resident. This paragraph shall | ||||||
2 | not restrict any determination of medical need or | ||||||
3 | appropriateness for any particular service and shall not | ||||||
4 | require continued coverage of any particular service that may | ||||||
5 | be no longer necessary, appropriate, or otherwise authorized | ||||||
6 | for an individual. Nothing shall prevent the Department from | ||||||
7 | determining and properly establishing an individual's | ||||||
8 | eligibility under a different category of eligibility. | ||||||
9 | (Source: P.A. 101-649, eff. 7-7-20.)
| ||||||
10 | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
| ||||||
11 | Sec. 5-2. Classes of persons eligible. Medical assistance | ||||||
12 | under this
Article shall be available to any of the following | ||||||
13 | classes of persons in
respect to whom a plan for coverage has | ||||||
14 | been submitted to the Governor
by the Illinois Department and | ||||||
15 | approved by him. If changes made in this Section 5-2 require | ||||||
16 | federal approval, they shall not take effect until such | ||||||
17 | approval has been received:
| ||||||
18 | 1. Recipients of basic maintenance grants under | ||||||
19 | Articles III and IV.
| ||||||
20 | 2. Beginning January 1, 2014, persons otherwise | ||||||
21 | eligible for basic maintenance under Article
III, | ||||||
22 | excluding any eligibility requirements that are | ||||||
23 | inconsistent with any federal law or federal regulation, | ||||||
24 | as interpreted by the U.S. Department of Health and Human | ||||||
25 | Services, but who fail to qualify thereunder on the basis |
| |||||||
| |||||||
1 | of need, and
who have insufficient income and resources to | ||||||
2 | meet the costs of
necessary medical care, including , but | ||||||
3 | not limited to , the following:
| ||||||
4 | (a) All persons otherwise eligible for basic | ||||||
5 | maintenance under Article
III but who fail to qualify | ||||||
6 | under that Article on the basis of need and who
meet | ||||||
7 | either of the following requirements:
| ||||||
8 | (i) their income, as determined by the | ||||||
9 | Illinois Department in
accordance with any federal | ||||||
10 | requirements, is equal to or less than 100% of the | ||||||
11 | federal poverty level; or
| ||||||
12 | (ii) their income, after the deduction of | ||||||
13 | costs incurred for medical
care and for other | ||||||
14 | types of remedial care, is equal to or less than | ||||||
15 | 100% of the federal poverty level.
| ||||||
16 | (b) (Blank).
| ||||||
17 | 3. (Blank).
| ||||||
18 | 4. Persons not eligible under any of the preceding | ||||||
19 | paragraphs who fall
sick, are injured, or die, not having | ||||||
20 | sufficient money, property or other
resources to meet the | ||||||
21 | costs of necessary medical care or funeral and burial
| ||||||
22 | expenses.
| ||||||
23 | 5.(a) Beginning January 1, 2020, women during | ||||||
24 | pregnancy and during the
12-month period beginning on the | ||||||
25 | last day of the pregnancy, together with
their infants,
| ||||||
26 | whose income is at or below 200% of the federal poverty |
| |||||||
| |||||||
1 | level. Until September 30, 2019, or sooner if the | ||||||
2 | maintenance of effort requirements under the Patient | ||||||
3 | Protection and Affordable Care Act are eliminated or may | ||||||
4 | be waived before then, women during pregnancy and during | ||||||
5 | the 12-month period beginning on the last day of the | ||||||
6 | pregnancy, whose countable monthly income, after the | ||||||
7 | deduction of costs incurred for medical care and for other | ||||||
8 | types of remedial care as specified in administrative | ||||||
9 | rule, is equal to or less than the Medical Assistance-No | ||||||
10 | Grant(C) (MANG(C)) Income Standard in effect on April 1, | ||||||
11 | 2013 as set forth in administrative rule.
| ||||||
12 | (b) The plan for coverage shall provide ambulatory | ||||||
13 | prenatal care to pregnant women during a
presumptive | ||||||
14 | eligibility period and establish an income eligibility | ||||||
15 | standard
that is equal to 200% of the federal poverty | ||||||
16 | level, provided that costs incurred
for medical care are | ||||||
17 | not taken into account in determining such income
| ||||||
18 | eligibility.
| ||||||
19 | (c) The Illinois Department may conduct a | ||||||
20 | demonstration in at least one
county that will provide | ||||||
21 | medical assistance to pregnant women, together
with their | ||||||
22 | infants and children up to one year of age,
where the | ||||||
23 | income
eligibility standard is set up to 185% of the | ||||||
24 | nonfarm income official
poverty line, as defined by the | ||||||
25 | federal Office of Management and Budget.
The Illinois | ||||||
26 | Department shall seek and obtain necessary authorization
|
| |||||||
| |||||||
1 | provided under federal law to implement such a | ||||||
2 | demonstration. Such
demonstration may establish resource | ||||||
3 | standards that are not more
restrictive than those | ||||||
4 | established under Article IV of this Code.
| ||||||
5 | 6. (a) Subject to federal approval, children Children | ||||||
6 | younger than age 19 when countable income is at or below | ||||||
7 | 313% 133% of the federal poverty level , as determined by | ||||||
8 | the Department and in accordance with all applicable | ||||||
9 | federal requirements . Until September 30, 2019, or sooner | ||||||
10 | if the maintenance of effort requirements under the | ||||||
11 | Patient Protection and Affordable Care Act are eliminated | ||||||
12 | or may be waived before then, children younger than age 19 | ||||||
13 | whose countable monthly income, after the deduction of | ||||||
14 | costs incurred for medical care and for other types of | ||||||
15 | remedial care as specified in administrative rule, is | ||||||
16 | equal to or less than the Medical Assistance-No Grant(C) | ||||||
17 | (MANG(C)) Income Standard in effect on April 1, 2013 as | ||||||
18 | set forth in administrative rule. | ||||||
19 | (b) Children and youth who are under temporary custody | ||||||
20 | or guardianship of the Department of Children and Family | ||||||
21 | Services or who receive financial assistance in support of | ||||||
22 | an adoption or guardianship placement from the Department | ||||||
23 | of Children and Family Services.
| ||||||
24 | 7. (Blank).
| ||||||
25 | 8. As required under federal law, persons who are | ||||||
26 | eligible for Transitional Medical Assistance as a result |
| |||||||
| |||||||
1 | of an increase in earnings or child or spousal support | ||||||
2 | received. The plan for coverage for this class of persons | ||||||
3 | shall:
| ||||||
4 | (a) extend the medical assistance coverage to the | ||||||
5 | extent required by federal law; and
| ||||||
6 | (b) offer persons who have initially received 6 | ||||||
7 | months of the
coverage provided in paragraph (a) | ||||||
8 | above, the option of receiving an
additional 6 months | ||||||
9 | of coverage, subject to the following:
| ||||||
10 | (i) such coverage shall be pursuant to | ||||||
11 | provisions of the federal
Social Security Act;
| ||||||
12 | (ii) such coverage shall include all services | ||||||
13 | covered under Illinois' State Medicaid Plan;
| ||||||
14 | (iii) no premium shall be charged for such | ||||||
15 | coverage; and
| ||||||
16 | (iv) such coverage shall be suspended in the | ||||||
17 | event of a person's
failure without good cause to | ||||||
18 | file in a timely fashion reports required for
this | ||||||
19 | coverage under the Social Security Act and | ||||||
20 | coverage shall be reinstated
upon the filing of | ||||||
21 | such reports if the person remains otherwise | ||||||
22 | eligible.
| ||||||
23 | 9. Persons with acquired immunodeficiency syndrome | ||||||
24 | (AIDS) or with
AIDS-related conditions with respect to | ||||||
25 | whom there has been a determination
that but for home or | ||||||
26 | community-based services such individuals would
require |
| |||||||
| |||||||
1 | the level of care provided in an inpatient hospital, | ||||||
2 | skilled
nursing facility or intermediate care facility the | ||||||
3 | cost of which is
reimbursed under this Article. Assistance | ||||||
4 | shall be provided to such
persons to the maximum extent | ||||||
5 | permitted under Title
XIX of the Federal Social Security | ||||||
6 | Act.
| ||||||
7 | 10. Participants in the long-term care insurance | ||||||
8 | partnership program
established under the Illinois | ||||||
9 | Long-Term Care Partnership Program Act who meet the
| ||||||
10 | qualifications for protection of resources described in | ||||||
11 | Section 15 of that
Act.
| ||||||
12 | 11. Persons with disabilities who are employed and | ||||||
13 | eligible for Medicaid,
pursuant to Section | ||||||
14 | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | ||||||
15 | subject to federal approval, persons with a medically | ||||||
16 | improved disability who are employed and eligible for | ||||||
17 | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | ||||||
18 | the Social Security Act, as
provided by the Illinois | ||||||
19 | Department by rule. In establishing eligibility standards | ||||||
20 | under this paragraph 11, the Department shall, subject to | ||||||
21 | federal approval: | ||||||
22 | (a) set the income eligibility standard at not | ||||||
23 | lower than 350% of the federal poverty level; | ||||||
24 | (b) exempt retirement accounts that the person | ||||||
25 | cannot access without penalty before the age
of 59 | ||||||
26 | 1/2, and medical savings accounts established pursuant |
| |||||||
| |||||||
1 | to 26 U.S.C. 220; | ||||||
2 | (c) allow non-exempt assets up to $25,000 as to | ||||||
3 | those assets accumulated during periods of eligibility | ||||||
4 | under this paragraph 11; and
| ||||||
5 | (d) continue to apply subparagraphs (b) and (c) in | ||||||
6 | determining the eligibility of the person under this | ||||||
7 | Article even if the person loses eligibility under | ||||||
8 | this paragraph 11.
| ||||||
9 | 12. Subject to federal approval, persons who are | ||||||
10 | eligible for medical
assistance coverage under applicable | ||||||
11 | provisions of the federal Social Security
Act and the | ||||||
12 | federal Breast and Cervical Cancer Prevention and | ||||||
13 | Treatment Act of
2000. Those eligible persons are defined | ||||||
14 | to include, but not be limited to,
the following persons:
| ||||||
15 | (1) persons who have been screened for breast or | ||||||
16 | cervical cancer under
the U.S. Centers for Disease | ||||||
17 | Control and Prevention Breast and Cervical Cancer
| ||||||
18 | Program established under Title XV of the federal | ||||||
19 | Public Health Service Services Act in
accordance with | ||||||
20 | the requirements of Section 1504 of that Act as | ||||||
21 | administered by
the Illinois Department of Public | ||||||
22 | Health; and
| ||||||
23 | (2) persons whose screenings under the above | ||||||
24 | program were funded in whole
or in part by funds | ||||||
25 | appropriated to the Illinois Department of Public | ||||||
26 | Health
for breast or cervical cancer screening.
|
| |||||||
| |||||||
1 | "Medical assistance" under this paragraph 12 shall be | ||||||
2 | identical to the benefits
provided under the State's | ||||||
3 | approved plan under Title XIX of the Social Security
Act. | ||||||
4 | The Department must request federal approval of the | ||||||
5 | coverage under this
paragraph 12 within 30 days after July | ||||||
6 | 3, 2001 ( the effective date of Public Act 92-47) this | ||||||
7 | amendatory Act of
the 92nd General Assembly .
| ||||||
8 | In addition to the persons who are eligible for | ||||||
9 | medical assistance pursuant to subparagraphs (1) and (2) | ||||||
10 | of this paragraph 12, and to be paid from funds | ||||||
11 | appropriated to the Department for its medical programs, | ||||||
12 | any uninsured person as defined by the Department in rules | ||||||
13 | residing in Illinois who is younger than 65 years of age, | ||||||
14 | who has been screened for breast and cervical cancer in | ||||||
15 | accordance with standards and procedures adopted by the | ||||||
16 | Department of Public Health for screening, and who is | ||||||
17 | referred to the Department by the Department of Public | ||||||
18 | Health as being in need of treatment for breast or | ||||||
19 | cervical cancer is eligible for medical assistance | ||||||
20 | benefits that are consistent with the benefits provided to | ||||||
21 | those persons described in subparagraphs (1) and (2). | ||||||
22 | Medical assistance coverage for the persons who are | ||||||
23 | eligible under the preceding sentence is not dependent on | ||||||
24 | federal approval, but federal moneys may be used to pay | ||||||
25 | for services provided under that coverage upon federal | ||||||
26 | approval. |
| |||||||
| |||||||
1 | 13. Subject to appropriation and to federal approval, | ||||||
2 | persons living with HIV/AIDS who are not otherwise | ||||||
3 | eligible under this Article and who qualify for services | ||||||
4 | covered under Section 5-5.04 as provided by the Illinois | ||||||
5 | Department by rule.
| ||||||
6 | 14. Subject to the availability of funds for this | ||||||
7 | purpose, the Department may provide coverage under this | ||||||
8 | Article to persons who reside in Illinois who are not | ||||||
9 | eligible under any of the preceding paragraphs and who | ||||||
10 | meet the income guidelines of paragraph 2(a) of this | ||||||
11 | Section and (i) have an application for asylum pending | ||||||
12 | before the federal Department of Homeland Security or on | ||||||
13 | appeal before a court of competent jurisdiction and are | ||||||
14 | represented either by counsel or by an advocate accredited | ||||||
15 | by the federal Department of Homeland Security and | ||||||
16 | employed by a not-for-profit organization in regard to | ||||||
17 | that application or appeal, or (ii) are receiving services | ||||||
18 | through a federally funded torture treatment center. | ||||||
19 | Medical coverage under this paragraph 14 may be provided | ||||||
20 | for up to 24 continuous months from the initial | ||||||
21 | eligibility date so long as an individual continues to | ||||||
22 | satisfy the criteria of this paragraph 14. If an | ||||||
23 | individual has an appeal pending regarding an application | ||||||
24 | for asylum before the Department of Homeland Security, | ||||||
25 | eligibility under this paragraph 14 may be extended until | ||||||
26 | a final decision is rendered on the appeal. The Department |
| |||||||
| |||||||
1 | may adopt rules governing the implementation of this | ||||||
2 | paragraph 14.
| ||||||
3 | 15. Family Care Eligibility. | ||||||
4 | (a) On and after July 1, 2012, a parent or other | ||||||
5 | caretaker relative who is 19 years of age or older when | ||||||
6 | countable income is at or below 133% of the federal | ||||||
7 | poverty level. A person may not spend down to become | ||||||
8 | eligible under this paragraph 15. | ||||||
9 | (b) Eligibility shall be reviewed annually. | ||||||
10 | (c) (Blank). | ||||||
11 | (d) (Blank). | ||||||
12 | (e) (Blank). | ||||||
13 | (f) (Blank). | ||||||
14 | (g) (Blank). | ||||||
15 | (h) (Blank). | ||||||
16 | (i) Following termination of an individual's | ||||||
17 | coverage under this paragraph 15, the individual must | ||||||
18 | be determined eligible before the person can be | ||||||
19 | re-enrolled. | ||||||
20 | 16. Subject to appropriation, uninsured persons who | ||||||
21 | are not otherwise eligible under this Section who have | ||||||
22 | been certified and referred by the Department of Public | ||||||
23 | Health as having been screened and found to need | ||||||
24 | diagnostic evaluation or treatment, or both diagnostic | ||||||
25 | evaluation and treatment, for prostate or testicular | ||||||
26 | cancer. For the purposes of this paragraph 16, uninsured |
| |||||||
| |||||||
1 | persons are those who do not have creditable coverage, as | ||||||
2 | defined under the Health Insurance Portability and | ||||||
3 | Accountability Act, or have otherwise exhausted any | ||||||
4 | insurance benefits they may have had, for prostate or | ||||||
5 | testicular cancer diagnostic evaluation or treatment, or | ||||||
6 | both diagnostic evaluation and treatment.
To be eligible, | ||||||
7 | a person must furnish a Social Security number.
A person's | ||||||
8 | assets are exempt from consideration in determining | ||||||
9 | eligibility under this paragraph 16.
Such persons shall be | ||||||
10 | eligible for medical assistance under this paragraph 16 | ||||||
11 | for so long as they need treatment for the cancer. A person | ||||||
12 | shall be considered to need treatment if, in the opinion | ||||||
13 | of the person's treating physician, the person requires | ||||||
14 | therapy directed toward cure or palliation of prostate or | ||||||
15 | testicular cancer, including recurrent metastatic cancer | ||||||
16 | that is a known or presumed complication of prostate or | ||||||
17 | testicular cancer and complications resulting from the | ||||||
18 | treatment modalities themselves. Persons who require only | ||||||
19 | routine monitoring services are not considered to need | ||||||
20 | treatment.
"Medical assistance" under this paragraph 16 | ||||||
21 | shall be identical to the benefits provided under the | ||||||
22 | State's approved plan under Title XIX of the Social | ||||||
23 | Security Act.
Notwithstanding any other provision of law, | ||||||
24 | the Department (i) does not have a claim against the | ||||||
25 | estate of a deceased recipient of services under this | ||||||
26 | paragraph 16 and (ii) does not have a lien against any |
| |||||||
| |||||||
1 | homestead property or other legal or equitable real | ||||||
2 | property interest owned by a recipient of services under | ||||||
3 | this paragraph 16. | ||||||
4 | 17. Persons who, pursuant to a waiver approved by the | ||||||
5 | Secretary of the U.S. Department of Health and Human | ||||||
6 | Services, are eligible for medical assistance under Title | ||||||
7 | XIX or XXI of the federal Social Security Act. | ||||||
8 | Notwithstanding any other provision of this Code and | ||||||
9 | consistent with the terms of the approved waiver, the | ||||||
10 | Illinois Department, may by rule: | ||||||
11 | (a) Limit the geographic areas in which the waiver | ||||||
12 | program operates. | ||||||
13 | (b) Determine the scope, quantity, duration, and | ||||||
14 | quality, and the rate and method of reimbursement, of | ||||||
15 | the medical services to be provided, which may differ | ||||||
16 | from those for other classes of persons eligible for | ||||||
17 | assistance under this Article. | ||||||
18 | (c) Restrict the persons' freedom in choice of | ||||||
19 | providers. | ||||||
20 | 18. Beginning January 1, 2014, persons aged 19 or | ||||||
21 | older, but younger than 65, who are not otherwise eligible | ||||||
22 | for medical assistance under this Section 5-2, who qualify | ||||||
23 | for medical assistance pursuant to 42 U.S.C. | ||||||
24 | 1396a(a)(10)(A)(i)(VIII) and applicable federal | ||||||
25 | regulations, and who have income at or below 133% of the | ||||||
26 | federal poverty level plus 5% for the applicable family |
| |||||||
| |||||||
1 | size as determined pursuant to 42 U.S.C. 1396a(e)(14) and | ||||||
2 | applicable federal regulations. Persons eligible for | ||||||
3 | medical assistance under this paragraph 18 shall receive | ||||||
4 | coverage for the Health Benefits Service Package as that | ||||||
5 | term is defined in subsection (m) of Section 5-1.1 of this | ||||||
6 | Code. If Illinois' federal medical assistance percentage | ||||||
7 | (FMAP) is reduced below 90% for persons eligible for | ||||||
8 | medical
assistance under this paragraph 18, eligibility | ||||||
9 | under this paragraph 18 shall cease no later than the end | ||||||
10 | of the third month following the month in which the | ||||||
11 | reduction in FMAP takes effect. | ||||||
12 | 19. Beginning January 1, 2014, as required under 42 | ||||||
13 | U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18 | ||||||
14 | and younger than age 26 who are not otherwise eligible for | ||||||
15 | medical assistance under paragraphs (1) through (17) of | ||||||
16 | this Section who (i) were in foster care under the | ||||||
17 | responsibility of the State on the date of attaining age | ||||||
18 | 18 or on the date of attaining age 21 when a court has | ||||||
19 | continued wardship for good cause as provided in Section | ||||||
20 | 2-31 of the Juvenile Court Act of 1987 and (ii) received | ||||||
21 | medical assistance under the Illinois Title XIX State Plan | ||||||
22 | or waiver of such plan while in foster care. | ||||||
23 | 20. Beginning January 1, 2018, persons who are | ||||||
24 | foreign-born victims of human trafficking, torture, or | ||||||
25 | other serious crimes as defined in Section 2-19 of this | ||||||
26 | Code and their derivative family members if such persons: |
| |||||||
| |||||||
1 | (i) reside in Illinois; (ii) are not eligible under any of | ||||||
2 | the preceding paragraphs; (iii) meet the income guidelines | ||||||
3 | of subparagraph (a) of paragraph 2; and (iv) meet the | ||||||
4 | nonfinancial eligibility requirements of Sections 16-2, | ||||||
5 | 16-3, and 16-5 of this Code. The Department may extend | ||||||
6 | medical assistance for persons who are foreign-born | ||||||
7 | victims of human trafficking, torture, or other serious | ||||||
8 | crimes whose medical assistance would be terminated | ||||||
9 | pursuant to subsection (b) of Section 16-5 if the | ||||||
10 | Department determines that the person, during the year of | ||||||
11 | initial eligibility (1) experienced a health crisis, (2) | ||||||
12 | has been unable, after reasonable attempts, to obtain | ||||||
13 | necessary information from a third party, or (3) has other | ||||||
14 | extenuating circumstances that prevented the person from | ||||||
15 | completing his or her application for status. The | ||||||
16 | Department may adopt any rules necessary to implement the | ||||||
17 | provisions of this paragraph. | ||||||
18 | 21. Persons who are not otherwise eligible for medical | ||||||
19 | assistance under this Section who may qualify for medical | ||||||
20 | assistance pursuant to 42 U.S.C. | ||||||
21 | 1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the | ||||||
22 | duration of any federal or State declared emergency due to | ||||||
23 | COVID-19. Medical assistance to persons eligible for | ||||||
24 | medical assistance solely pursuant to this paragraph 21 | ||||||
25 | shall be limited to any in vitro diagnostic product (and | ||||||
26 | the administration of such product) described in 42 U.S.C. |
| |||||||
| |||||||
1 | 1396d(a)(3)(B) on or after March 18, 2020, any visit | ||||||
2 | described in 42 U.S.C. 1396o(a)(2)(G), or any other | ||||||
3 | medical assistance that may be federally authorized for | ||||||
4 | this class of persons. The Department may also cover | ||||||
5 | treatment of COVID-19 for this class of persons, or any | ||||||
6 | similar category of uninsured individuals, to the extent | ||||||
7 | authorized under a federally approved 1115 Waiver or other | ||||||
8 | federal authority. Notwithstanding the provisions of | ||||||
9 | Section 1-11 of this Code, due to the nature of the | ||||||
10 | COVID-19 public health emergency, the Department may cover | ||||||
11 | and provide the medical assistance described in this | ||||||
12 | paragraph 21 to noncitizens who would otherwise meet the | ||||||
13 | eligibility requirements for the class of persons | ||||||
14 | described in this paragraph 21 for the duration of the | ||||||
15 | State emergency period. | ||||||
16 | In implementing the provisions of Public Act 96-20, the | ||||||
17 | Department is authorized to adopt only those rules necessary, | ||||||
18 | including emergency rules. Nothing in Public Act 96-20 permits | ||||||
19 | the Department to adopt rules or issue a decision that expands | ||||||
20 | eligibility for the FamilyCare Program to a person whose | ||||||
21 | income exceeds 185% of the Federal Poverty Level as determined | ||||||
22 | from time to time by the U.S. Department of Health and Human | ||||||
23 | Services, unless the Department is provided with express | ||||||
24 | statutory authority.
| ||||||
25 | The eligibility of any such person for medical assistance | ||||||
26 | under this
Article is not affected by the payment of any grant |
| |||||||
| |||||||
1 | under the Senior
Citizens and Persons with Disabilities | ||||||
2 | Property Tax Relief Act or any distributions or items of | ||||||
3 | income described under
subparagraph (X) of
paragraph (2) of | ||||||
4 | subsection (a) of Section 203 of the Illinois Income Tax
Act. | ||||||
5 | The Department shall by rule establish the amounts of
| ||||||
6 | assets to be disregarded in determining eligibility for | ||||||
7 | medical assistance,
which shall at a minimum equal the amounts | ||||||
8 | to be disregarded under the
Federal Supplemental Security | ||||||
9 | Income Program. The amount of assets of a
single person to be | ||||||
10 | disregarded
shall not be less than $2,000, and the amount of | ||||||
11 | assets of a married couple
to be disregarded shall not be less | ||||||
12 | than $3,000.
| ||||||
13 | To the extent permitted under federal law, any person | ||||||
14 | found guilty of a
second violation of Article VIIIA
shall be | ||||||
15 | ineligible for medical assistance under this Article, as | ||||||
16 | provided
in Section 8A-8.
| ||||||
17 | The eligibility of any person for medical assistance under | ||||||
18 | this Article
shall not be affected by the receipt by the person | ||||||
19 | of donations or benefits
from fundraisers held for the person | ||||||
20 | in cases of serious illness,
as long as neither the person nor | ||||||
21 | members of the person's family
have actual control over the | ||||||
22 | donations or benefits or the disbursement
of the donations or | ||||||
23 | benefits.
| ||||||
24 | Notwithstanding any other provision of this Code, if the | ||||||
25 | United States Supreme Court holds Title II, Subtitle A, | ||||||
26 | Section 2001(a) of Public Law 111-148 to be unconstitutional, |
| |||||||
| |||||||
1 | or if a holding of Public Law 111-148 makes Medicaid | ||||||
2 | eligibility allowed under Section 2001(a) inoperable, the | ||||||
3 | State or a unit of local government shall be prohibited from | ||||||
4 | enrolling individuals in the Medical Assistance Program as the | ||||||
5 | result of federal approval of a State Medicaid waiver on or | ||||||
6 | after June 14, 2012 ( the effective date of Public Act 97-687) | ||||||
7 | this amendatory Act of the 97th General Assembly , and any | ||||||
8 | individuals enrolled in the Medical Assistance Program | ||||||
9 | pursuant to eligibility permitted as a result of such a State | ||||||
10 | Medicaid waiver shall become immediately ineligible. | ||||||
11 | Notwithstanding any other provision of this Code, if an | ||||||
12 | Act of Congress that becomes a Public Law eliminates Section | ||||||
13 | 2001(a) of Public Law 111-148, the State or a unit of local | ||||||
14 | government shall be prohibited from enrolling individuals in | ||||||
15 | the Medical Assistance Program as the result of federal | ||||||
16 | approval of a State Medicaid waiver on or after June 14, 2012 | ||||||
17 | ( the effective date of Public Act 97-687) this amendatory Act | ||||||
18 | of the 97th General Assembly , and any individuals enrolled in | ||||||
19 | the Medical Assistance Program pursuant to eligibility | ||||||
20 | permitted as a result of such a State Medicaid waiver shall | ||||||
21 | become immediately ineligible. | ||||||
22 | Effective October 1, 2013, the determination of | ||||||
23 | eligibility of persons who qualify under paragraphs 5, 6, 8, | ||||||
24 | 15, 17, and 18 of this Section shall comply with the | ||||||
25 | requirements of 42 U.S.C. 1396a(e)(14) and applicable federal | ||||||
26 | regulations. |
| |||||||
| |||||||
1 | The Department of Healthcare and Family Services, the | ||||||
2 | Department of Human Services, and the Illinois health | ||||||
3 | insurance marketplace shall work cooperatively to assist | ||||||
4 | persons who would otherwise lose health benefits as a result | ||||||
5 | of changes made under Public Act 98-104 this amendatory Act of | ||||||
6 | the 98th General Assembly to transition to other health | ||||||
7 | insurance coverage. | ||||||
8 | (Source: P.A. 101-10, eff. 6-5-19; 101-649, eff. 7-7-20; | ||||||
9 | revised 8-24-20.)
| ||||||
10 | (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
| ||||||
11 | Sec. 5-5. Medical services. The Illinois Department, by | ||||||
12 | rule, shall
determine the quantity and quality of and the rate | ||||||
13 | of reimbursement for the
medical assistance for which
payment | ||||||
14 | will be authorized, and the medical services to be provided,
| ||||||
15 | which may include all or part of the following: (1) inpatient | ||||||
16 | hospital
services; (2) outpatient hospital services; (3) other | ||||||
17 | laboratory and
X-ray services; (4) skilled nursing home | ||||||
18 | services; (5) physicians'
services whether furnished in the | ||||||
19 | office, the patient's home, a
hospital, a skilled nursing | ||||||
20 | home, or elsewhere; (6) medical care, or any
other type of | ||||||
21 | remedial care furnished by licensed practitioners; (7)
home | ||||||
22 | health care services; (8) private duty nursing service; (9) | ||||||
23 | clinic
services; (10) dental services, including prevention | ||||||
24 | and treatment of periodontal disease and dental caries disease | ||||||
25 | for pregnant women, provided by an individual licensed to |
| |||||||
| |||||||
1 | practice dentistry or dental surgery; for purposes of this | ||||||
2 | item (10), "dental services" means diagnostic, preventive, or | ||||||
3 | corrective procedures provided by or under the supervision of | ||||||
4 | a dentist in the practice of his or her profession; (11) | ||||||
5 | physical therapy and related
services; (12) prescribed drugs, | ||||||
6 | dentures, and prosthetic devices; and
eyeglasses prescribed by | ||||||
7 | a physician skilled in the diseases of the eye,
or by an | ||||||
8 | optometrist, whichever the person may select; (13) other
| ||||||
9 | diagnostic, screening, preventive, and rehabilitative | ||||||
10 | services, including to ensure that the individual's need for | ||||||
11 | intervention or treatment of mental disorders or substance use | ||||||
12 | disorders or co-occurring mental health and substance use | ||||||
13 | disorders is determined using a uniform screening, assessment, | ||||||
14 | and evaluation process inclusive of criteria, for children and | ||||||
15 | adults; for purposes of this item (13), a uniform screening, | ||||||
16 | assessment, and evaluation process refers to a process that | ||||||
17 | includes an appropriate evaluation and, as warranted, a | ||||||
18 | referral; "uniform" does not mean the use of a singular | ||||||
19 | instrument, tool, or process that all must utilize; (14)
| ||||||
20 | transportation and such other expenses as may be necessary; | ||||||
21 | (15) medical
treatment of sexual assault survivors, as defined | ||||||
22 | in
Section 1a of the Sexual Assault Survivors Emergency | ||||||
23 | Treatment Act, for
injuries sustained as a result of the | ||||||
24 | sexual assault, including
examinations and laboratory tests to | ||||||
25 | discover evidence which may be used in
criminal proceedings | ||||||
26 | arising from the sexual assault; (16) the
diagnosis and |
| |||||||
| |||||||
1 | treatment of sickle cell anemia; and (17)
any other medical | ||||||
2 | care, and any other type of remedial care recognized
under the | ||||||
3 | laws of this State. The term "any other type of remedial care" | ||||||
4 | shall
include nursing care and nursing home service for | ||||||
5 | persons who rely on
treatment by spiritual means alone through | ||||||
6 | prayer for healing.
| ||||||
7 | Notwithstanding any other provision of this Section, a | ||||||
8 | comprehensive
tobacco use cessation program that includes | ||||||
9 | purchasing prescription drugs or
prescription medical devices | ||||||
10 | approved by the Food and Drug Administration shall
be covered | ||||||
11 | under the medical assistance
program under this Article for | ||||||
12 | persons who are otherwise eligible for
assistance under this | ||||||
13 | Article.
| ||||||
14 | Notwithstanding any other provision of this Code, | ||||||
15 | reproductive health care that is otherwise legal in Illinois | ||||||
16 | shall be covered under the medical assistance program for | ||||||
17 | persons who are otherwise eligible for medical assistance | ||||||
18 | under this Article. | ||||||
19 | Notwithstanding any other provision of this Code, the | ||||||
20 | Illinois
Department may not require, as a condition of payment | ||||||
21 | for any laboratory
test authorized under this Article, that a | ||||||
22 | physician's handwritten signature
appear on the laboratory | ||||||
23 | test order form. The Illinois Department may,
however, impose | ||||||
24 | other appropriate requirements regarding laboratory test
order | ||||||
25 | documentation.
| ||||||
26 | Upon receipt of federal approval of an amendment to the |
| |||||||
| |||||||
1 | Illinois Title XIX State Plan for this purpose, the Department | ||||||
2 | shall authorize the Chicago Public Schools (CPS) to procure a | ||||||
3 | vendor or vendors to manufacture eyeglasses for individuals | ||||||
4 | enrolled in a school within the CPS system. CPS shall ensure | ||||||
5 | that its vendor or vendors are enrolled as providers in the | ||||||
6 | medical assistance program and in any capitated Medicaid | ||||||
7 | managed care entity (MCE) serving individuals enrolled in a | ||||||
8 | school within the CPS system. Under any contract procured | ||||||
9 | under this provision, the vendor or vendors must serve only | ||||||
10 | individuals enrolled in a school within the CPS system. Claims | ||||||
11 | for services provided by CPS's vendor or vendors to recipients | ||||||
12 | of benefits in the medical assistance program under this Code , | ||||||
13 | the Children's Health Insurance Program, or the Covering ALL | ||||||
14 | KIDS Health Insurance Program shall be submitted to the | ||||||
15 | Department or the MCE in which the individual is enrolled for | ||||||
16 | payment and shall be reimbursed at the Department's or the | ||||||
17 | MCE's established rates or rate methodologies for eyeglasses. | ||||||
18 | On and after July 1, 2012, the Department of Healthcare | ||||||
19 | and Family Services may provide the following services to
| ||||||
20 | persons
eligible for assistance under this Article who are | ||||||
21 | participating in
education, training or employment programs | ||||||
22 | operated by the Department of Human
Services as successor to | ||||||
23 | the Department of Public Aid:
| ||||||
24 | (1) dental services provided by or under the | ||||||
25 | supervision of a dentist; and
| ||||||
26 | (2) eyeglasses prescribed by a physician skilled in |
| |||||||
| |||||||
1 | the diseases of the
eye, or by an optometrist, whichever | ||||||
2 | the person may select.
| ||||||
3 | On and after July 1, 2018, the Department of Healthcare | ||||||
4 | and Family Services shall provide dental services to any adult | ||||||
5 | who is otherwise eligible for assistance under the medical | ||||||
6 | assistance program. As used in this paragraph, "dental | ||||||
7 | services" means diagnostic, preventative, restorative, or | ||||||
8 | corrective procedures, including procedures and services for | ||||||
9 | the prevention and treatment of periodontal disease and dental | ||||||
10 | caries disease, provided by an individual who is licensed to | ||||||
11 | practice dentistry or dental surgery or who is under the | ||||||
12 | supervision of a dentist in the practice of his or her | ||||||
13 | profession. | ||||||
14 | On and after July 1, 2018, targeted dental services, as | ||||||
15 | set forth in Exhibit D of the Consent Decree entered by the | ||||||
16 | United States District Court for the Northern District of | ||||||
17 | Illinois, Eastern Division, in the matter of Memisovski v. | ||||||
18 | Maram, Case No. 92 C 1982, that are provided to adults under | ||||||
19 | the medical assistance program shall be established at no less | ||||||
20 | than the rates set forth in the "New Rate" column in Exhibit D | ||||||
21 | of the Consent Decree for targeted dental services that are | ||||||
22 | provided to persons under the age of 18 under the medical | ||||||
23 | assistance program. | ||||||
24 | Notwithstanding any other provision of this Code and | ||||||
25 | subject to federal approval, the Department may adopt rules to | ||||||
26 | allow a dentist who is volunteering his or her service at no |
| |||||||
| |||||||
1 | cost to render dental services through an enrolled | ||||||
2 | not-for-profit health clinic without the dentist personally | ||||||
3 | enrolling as a participating provider in the medical | ||||||
4 | assistance program. A not-for-profit health clinic shall | ||||||
5 | include a public health clinic or Federally Qualified Health | ||||||
6 | Center or other enrolled provider, as determined by the | ||||||
7 | Department, through which dental services covered under this | ||||||
8 | Section are performed. The Department shall establish a | ||||||
9 | process for payment of claims for reimbursement for covered | ||||||
10 | dental services rendered under this provision. | ||||||
11 | The Illinois Department, by rule, may distinguish and | ||||||
12 | classify the
medical services to be provided only in | ||||||
13 | accordance with the classes of
persons designated in Section | ||||||
14 | 5-2.
| ||||||
15 | The Department of Healthcare and Family Services must | ||||||
16 | provide coverage and reimbursement for amino acid-based | ||||||
17 | elemental formulas, regardless of delivery method, for the | ||||||
18 | diagnosis and treatment of (i) eosinophilic disorders and (ii) | ||||||
19 | short bowel syndrome when the prescribing physician has issued | ||||||
20 | a written order stating that the amino acid-based elemental | ||||||
21 | formula is medically necessary.
| ||||||
22 | The Illinois Department shall authorize the provision of, | ||||||
23 | and shall
authorize payment for, screening by low-dose | ||||||
24 | mammography for the presence of
occult breast cancer for women | ||||||
25 | 35 years of age or older who are eligible
for medical | ||||||
26 | assistance under this Article, as follows: |
| |||||||
| |||||||
1 | (A) A baseline
mammogram for women 35 to 39 years of | ||||||
2 | age.
| ||||||
3 | (B) An annual mammogram for women 40 years of age or | ||||||
4 | older. | ||||||
5 | (C) A mammogram at the age and intervals considered | ||||||
6 | medically necessary by the woman's health care provider | ||||||
7 | for women under 40 years of age and having a family history | ||||||
8 | of breast cancer, prior personal history of breast cancer, | ||||||
9 | positive genetic testing, or other risk factors. | ||||||
10 | (D) A comprehensive ultrasound screening and MRI of an | ||||||
11 | entire breast or breasts if a mammogram demonstrates | ||||||
12 | heterogeneous or dense breast tissue or when medically | ||||||
13 | necessary as determined by a physician licensed to | ||||||
14 | practice medicine in all of its branches. | ||||||
15 | (E) A screening MRI when medically necessary, as | ||||||
16 | determined by a physician licensed to practice medicine in | ||||||
17 | all of its branches. | ||||||
18 | (F) A diagnostic mammogram when medically necessary, | ||||||
19 | as determined by a physician licensed to practice medicine | ||||||
20 | in all its branches, advanced practice registered nurse, | ||||||
21 | or physician assistant. | ||||||
22 | The Department shall not impose a deductible, coinsurance, | ||||||
23 | copayment, or any other cost-sharing requirement on the | ||||||
24 | coverage provided under this paragraph; except that this | ||||||
25 | sentence does not apply to coverage of diagnostic mammograms | ||||||
26 | to the extent such coverage would disqualify a high-deductible |
| |||||||
| |||||||
1 | health plan from eligibility for a health savings account | ||||||
2 | pursuant to Section 223 of the Internal Revenue Code (26 | ||||||
3 | U.S.C. 223). | ||||||
4 | All screenings
shall
include a physical breast exam, | ||||||
5 | instruction on self-examination and
information regarding the | ||||||
6 | frequency of self-examination and its value as a
preventative | ||||||
7 | tool. | ||||||
8 | For purposes of this Section: | ||||||
9 | "Diagnostic
mammogram" means a mammogram obtained using | ||||||
10 | diagnostic mammography. | ||||||
11 | "Diagnostic
mammography" means a method of screening that | ||||||
12 | is designed to
evaluate an abnormality in a breast, including | ||||||
13 | an abnormality seen
or suspected on a screening mammogram or a | ||||||
14 | subjective or objective
abnormality otherwise detected in the | ||||||
15 | breast. | ||||||
16 | "Low-dose mammography" means
the x-ray examination of the | ||||||
17 | breast using equipment dedicated specifically
for mammography, | ||||||
18 | including the x-ray tube, filter, compression device,
and | ||||||
19 | image receptor, with an average radiation exposure delivery
of | ||||||
20 | less than one rad per breast for 2 views of an average size | ||||||
21 | breast.
The term also includes digital mammography and | ||||||
22 | includes breast tomosynthesis. | ||||||
23 | "Breast tomosynthesis" means a radiologic procedure that | ||||||
24 | involves the acquisition of projection images over the | ||||||
25 | stationary breast to produce cross-sectional digital | ||||||
26 | three-dimensional images of the breast. |
| |||||||
| |||||||
1 | If, at any time, the Secretary of the United States | ||||||
2 | Department of Health and Human Services, or its successor | ||||||
3 | agency, promulgates rules or regulations to be published in | ||||||
4 | the Federal Register or publishes a comment in the Federal | ||||||
5 | Register or issues an opinion, guidance, or other action that | ||||||
6 | would require the State, pursuant to any provision of the | ||||||
7 | Patient Protection and Affordable Care Act (Public Law | ||||||
8 | 111-148), including, but not limited to, 42 U.S.C. | ||||||
9 | 18031(d)(3)(B) or any successor provision, to defray the cost | ||||||
10 | of any coverage for breast tomosynthesis outlined in this | ||||||
11 | paragraph, then the requirement that an insurer cover breast | ||||||
12 | tomosynthesis is inoperative other than any such coverage | ||||||
13 | authorized under Section 1902 of the Social Security Act, 42 | ||||||
14 | U.S.C. 1396a, and the State shall not assume any obligation | ||||||
15 | for the cost of coverage for breast tomosynthesis set forth in | ||||||
16 | this paragraph.
| ||||||
17 | On and after January 1, 2016, the Department shall ensure | ||||||
18 | that all networks of care for adult clients of the Department | ||||||
19 | include access to at least one breast imaging Center of | ||||||
20 | Imaging Excellence as certified by the American College of | ||||||
21 | Radiology. | ||||||
22 | On and after January 1, 2012, providers participating in a | ||||||
23 | quality improvement program approved by the Department shall | ||||||
24 | be reimbursed for screening and diagnostic mammography at the | ||||||
25 | same rate as the Medicare program's rates, including the | ||||||
26 | increased reimbursement for digital mammography. |
| |||||||
| |||||||
1 | The Department shall convene an expert panel including | ||||||
2 | representatives of hospitals, free-standing mammography | ||||||
3 | facilities, and doctors, including radiologists, to establish | ||||||
4 | quality standards for mammography. | ||||||
5 | On and after January 1, 2017, providers participating in a | ||||||
6 | breast cancer treatment quality improvement program approved | ||||||
7 | by the Department shall be reimbursed for breast cancer | ||||||
8 | treatment at a rate that is no lower than 95% of the Medicare | ||||||
9 | program's rates for the data elements included in the breast | ||||||
10 | cancer treatment quality program. | ||||||
11 | The Department shall convene an expert panel, including | ||||||
12 | representatives of hospitals, free-standing breast cancer | ||||||
13 | treatment centers, breast cancer quality organizations, and | ||||||
14 | doctors, including breast surgeons, reconstructive breast | ||||||
15 | surgeons, oncologists, and primary care providers to establish | ||||||
16 | quality standards for breast cancer treatment. | ||||||
17 | Subject to federal approval, the Department shall | ||||||
18 | establish a rate methodology for mammography at federally | ||||||
19 | qualified health centers and other encounter-rate clinics. | ||||||
20 | These clinics or centers may also collaborate with other | ||||||
21 | hospital-based mammography facilities. By January 1, 2016, the | ||||||
22 | Department shall report to the General Assembly on the status | ||||||
23 | of the provision set forth in this paragraph. | ||||||
24 | The Department shall establish a methodology to remind | ||||||
25 | women who are age-appropriate for screening mammography, but | ||||||
26 | who have not received a mammogram within the previous 18 |
| |||||||
| |||||||
1 | months, of the importance and benefit of screening | ||||||
2 | mammography. The Department shall work with experts in breast | ||||||
3 | cancer outreach and patient navigation to optimize these | ||||||
4 | reminders and shall establish a methodology for evaluating | ||||||
5 | their effectiveness and modifying the methodology based on the | ||||||
6 | evaluation. | ||||||
7 | The Department shall establish a performance goal for | ||||||
8 | primary care providers with respect to their female patients | ||||||
9 | over age 40 receiving an annual mammogram. This performance | ||||||
10 | goal shall be used to provide additional reimbursement in the | ||||||
11 | form of a quality performance bonus to primary care providers | ||||||
12 | who meet that goal. | ||||||
13 | The Department shall devise a means of case-managing or | ||||||
14 | patient navigation for beneficiaries diagnosed with breast | ||||||
15 | cancer. This program shall initially operate as a pilot | ||||||
16 | program in areas of the State with the highest incidence of | ||||||
17 | mortality related to breast cancer. At least one pilot program | ||||||
18 | site shall be in the metropolitan Chicago area and at least one | ||||||
19 | site shall be outside the metropolitan Chicago area. On or | ||||||
20 | after July 1, 2016, the pilot program shall be expanded to | ||||||
21 | include one site in western Illinois, one site in southern | ||||||
22 | Illinois, one site in central Illinois, and 4 sites within | ||||||
23 | metropolitan Chicago. An evaluation of the pilot program shall | ||||||
24 | be carried out measuring health outcomes and cost of care for | ||||||
25 | those served by the pilot program compared to similarly | ||||||
26 | situated patients who are not served by the pilot program. |
| |||||||
| |||||||
1 | The Department shall require all networks of care to | ||||||
2 | develop a means either internally or by contract with experts | ||||||
3 | in navigation and community outreach to navigate cancer | ||||||
4 | patients to comprehensive care in a timely fashion. The | ||||||
5 | Department shall require all networks of care to include | ||||||
6 | access for patients diagnosed with cancer to at least one | ||||||
7 | academic commission on cancer-accredited cancer program as an | ||||||
8 | in-network covered benefit. | ||||||
9 | Any medical or health care provider shall immediately | ||||||
10 | recommend, to
any pregnant woman who is being provided | ||||||
11 | prenatal services and is suspected
of having a substance use | ||||||
12 | disorder as defined in the Substance Use Disorder Act, | ||||||
13 | referral to a local substance use disorder treatment program | ||||||
14 | licensed by the Department of Human Services or to a licensed
| ||||||
15 | hospital which provides substance abuse treatment services. | ||||||
16 | The Department of Healthcare and Family Services
shall assure | ||||||
17 | coverage for the cost of treatment of the drug abuse or
| ||||||
18 | addiction for pregnant recipients in accordance with the | ||||||
19 | Illinois Medicaid
Program in conjunction with the Department | ||||||
20 | of Human Services.
| ||||||
21 | All medical providers providing medical assistance to | ||||||
22 | pregnant women
under this Code shall receive information from | ||||||
23 | the Department on the
availability of services under any
| ||||||
24 | program providing case management services for addicted women,
| ||||||
25 | including information on appropriate referrals for other | ||||||
26 | social services
that may be needed by addicted women in |
| |||||||
| |||||||
1 | addition to treatment for addiction.
| ||||||
2 | The Illinois Department, in cooperation with the | ||||||
3 | Departments of Human
Services (as successor to the Department | ||||||
4 | of Alcoholism and Substance
Abuse) and Public Health, through | ||||||
5 | a public awareness campaign, may
provide information | ||||||
6 | concerning treatment for alcoholism and drug abuse and
| ||||||
7 | addiction, prenatal health care, and other pertinent programs | ||||||
8 | directed at
reducing the number of drug-affected infants born | ||||||
9 | to recipients of medical
assistance.
| ||||||
10 | Neither the Department of Healthcare and Family Services | ||||||
11 | nor the Department of Human
Services shall sanction the | ||||||
12 | recipient solely on the basis of
her substance abuse.
| ||||||
13 | The Illinois Department shall establish such regulations | ||||||
14 | governing
the dispensing of health services under this Article | ||||||
15 | as it shall deem
appropriate. The Department
should
seek the | ||||||
16 | advice of formal professional advisory committees appointed by
| ||||||
17 | the Director of the Illinois Department for the purpose of | ||||||
18 | providing regular
advice on policy and administrative matters, | ||||||
19 | information dissemination and
educational activities for | ||||||
20 | medical and health care providers, and
consistency in | ||||||
21 | procedures to the Illinois Department.
| ||||||
22 | The Illinois Department may develop and contract with | ||||||
23 | Partnerships of
medical providers to arrange medical services | ||||||
24 | for persons eligible under
Section 5-2 of this Code. | ||||||
25 | Implementation of this Section may be by
demonstration | ||||||
26 | projects in certain geographic areas. The Partnership shall
be |
| |||||||
| |||||||
1 | represented by a sponsor organization. The Department, by | ||||||
2 | rule, shall
develop qualifications for sponsors of | ||||||
3 | Partnerships. Nothing in this
Section shall be construed to | ||||||
4 | require that the sponsor organization be a
medical | ||||||
5 | organization.
| ||||||
6 | The sponsor must negotiate formal written contracts with | ||||||
7 | medical
providers for physician services, inpatient and | ||||||
8 | outpatient hospital care,
home health services, treatment for | ||||||
9 | alcoholism and substance abuse, and
other services determined | ||||||
10 | necessary by the Illinois Department by rule for
delivery by | ||||||
11 | Partnerships. Physician services must include prenatal and
| ||||||
12 | obstetrical care. The Illinois Department shall reimburse | ||||||
13 | medical services
delivered by Partnership providers to clients | ||||||
14 | in target areas according to
provisions of this Article and | ||||||
15 | the Illinois Health Finance Reform Act,
except that:
| ||||||
16 | (1) Physicians participating in a Partnership and | ||||||
17 | providing certain
services, which shall be determined by | ||||||
18 | the Illinois Department, to persons
in areas covered by | ||||||
19 | the Partnership may receive an additional surcharge
for | ||||||
20 | such services.
| ||||||
21 | (2) The Department may elect to consider and negotiate | ||||||
22 | financial
incentives to encourage the development of | ||||||
23 | Partnerships and the efficient
delivery of medical care.
| ||||||
24 | (3) Persons receiving medical services through | ||||||
25 | Partnerships may receive
medical and case management | ||||||
26 | services above the level usually offered
through the |
| |||||||
| |||||||
1 | medical assistance program.
| ||||||
2 | Medical providers shall be required to meet certain | ||||||
3 | qualifications to
participate in Partnerships to ensure the | ||||||
4 | delivery of high quality medical
services. These | ||||||
5 | qualifications shall be determined by rule of the Illinois
| ||||||
6 | Department and may be higher than qualifications for | ||||||
7 | participation in the
medical assistance program. Partnership | ||||||
8 | sponsors may prescribe reasonable
additional qualifications | ||||||
9 | for participation by medical providers, only with
the prior | ||||||
10 | written approval of the Illinois Department.
| ||||||
11 | Nothing in this Section shall limit the free choice of | ||||||
12 | practitioners,
hospitals, and other providers of medical | ||||||
13 | services by clients.
In order to ensure patient freedom of | ||||||
14 | choice, the Illinois Department shall
immediately promulgate | ||||||
15 | all rules and take all other necessary actions so that
| ||||||
16 | provided services may be accessed from therapeutically | ||||||
17 | certified optometrists
to the full extent of the Illinois | ||||||
18 | Optometric Practice Act of 1987 without
discriminating between | ||||||
19 | service providers.
| ||||||
20 | The Department shall apply for a waiver from the United | ||||||
21 | States Health
Care Financing Administration to allow for the | ||||||
22 | implementation of
Partnerships under this Section.
| ||||||
23 | The Illinois Department shall require health care | ||||||
24 | providers to maintain
records that document the medical care | ||||||
25 | and services provided to recipients
of Medical Assistance | ||||||
26 | under this Article. Such records must be retained for a period |
| |||||||
| |||||||
1 | of not less than 6 years from the date of service or as | ||||||
2 | provided by applicable State law, whichever period is longer, | ||||||
3 | except that if an audit is initiated within the required | ||||||
4 | retention period then the records must be retained until the | ||||||
5 | audit is completed and every exception is resolved. The | ||||||
6 | Illinois Department shall
require health care providers to | ||||||
7 | make available, when authorized by the
patient, in writing, | ||||||
8 | the medical records in a timely fashion to other
health care | ||||||
9 | providers who are treating or serving persons eligible for
| ||||||
10 | Medical Assistance under this Article. All dispensers of | ||||||
11 | medical services
shall be required to maintain and retain | ||||||
12 | business and professional records
sufficient to fully and | ||||||
13 | accurately document the nature, scope, details and
receipt of | ||||||
14 | the health care provided to persons eligible for medical
| ||||||
15 | assistance under this Code, in accordance with regulations | ||||||
16 | promulgated by
the Illinois Department. The rules and | ||||||
17 | regulations shall require that proof
of the receipt of | ||||||
18 | prescription drugs, dentures, prosthetic devices and
| ||||||
19 | eyeglasses by eligible persons under this Section accompany | ||||||
20 | each claim
for reimbursement submitted by the dispenser of | ||||||
21 | such medical services.
No such claims for reimbursement shall | ||||||
22 | be approved for payment by the Illinois
Department without | ||||||
23 | such proof of receipt, unless the Illinois Department
shall | ||||||
24 | have put into effect and shall be operating a system of | ||||||
25 | post-payment
audit and review which shall, on a sampling | ||||||
26 | basis, be deemed adequate by
the Illinois Department to assure |
| |||||||
| |||||||
1 | that such drugs, dentures, prosthetic
devices and eyeglasses | ||||||
2 | for which payment is being made are actually being
received by | ||||||
3 | eligible recipients. Within 90 days after September 16, 1984 | ||||||
4 | (the effective date of Public Act 83-1439), the Illinois | ||||||
5 | Department shall establish a
current list of acquisition costs | ||||||
6 | for all prosthetic devices and any
other items recognized as | ||||||
7 | medical equipment and supplies reimbursable under
this Article | ||||||
8 | and shall update such list on a quarterly basis, except that
| ||||||
9 | the acquisition costs of all prescription drugs shall be | ||||||
10 | updated no
less frequently than every 30 days as required by | ||||||
11 | Section 5-5.12.
| ||||||
12 | Notwithstanding any other law to the contrary, the | ||||||
13 | Illinois Department shall, within 365 days after July 22, 2013 | ||||||
14 | (the effective date of Public Act 98-104), establish | ||||||
15 | procedures to permit skilled care facilities licensed under | ||||||
16 | the Nursing Home Care Act to submit monthly billing claims for | ||||||
17 | reimbursement purposes. Following development of these | ||||||
18 | procedures, the Department shall, by July 1, 2016, test the | ||||||
19 | viability of the new system and implement any necessary | ||||||
20 | operational or structural changes to its information | ||||||
21 | technology platforms in order to allow for the direct | ||||||
22 | acceptance and payment of nursing home claims. | ||||||
23 | Notwithstanding any other law to the contrary, the | ||||||
24 | Illinois Department shall, within 365 days after August 15, | ||||||
25 | 2014 (the effective date of Public Act 98-963), establish | ||||||
26 | procedures to permit ID/DD facilities licensed under the ID/DD |
| |||||||
| |||||||
1 | Community Care Act and MC/DD facilities licensed under the | ||||||
2 | MC/DD Act to submit monthly billing claims for reimbursement | ||||||
3 | purposes. Following development of these procedures, the | ||||||
4 | Department shall have an additional 365 days to test the | ||||||
5 | viability of the new system and to ensure that any necessary | ||||||
6 | operational or structural changes to its information | ||||||
7 | technology platforms are implemented. | ||||||
8 | The Illinois Department shall require all dispensers of | ||||||
9 | medical
services, other than an individual practitioner or | ||||||
10 | group of practitioners,
desiring to participate in the Medical | ||||||
11 | Assistance program
established under this Article to disclose | ||||||
12 | all financial, beneficial,
ownership, equity, surety or other | ||||||
13 | interests in any and all firms,
corporations, partnerships, | ||||||
14 | associations, business enterprises, joint
ventures, agencies, | ||||||
15 | institutions or other legal entities providing any
form of | ||||||
16 | health care services in this State under this Article.
| ||||||
17 | The Illinois Department may require that all dispensers of | ||||||
18 | medical
services desiring to participate in the medical | ||||||
19 | assistance program
established under this Article disclose, | ||||||
20 | under such terms and conditions as
the Illinois Department may | ||||||
21 | by rule establish, all inquiries from clients
and attorneys | ||||||
22 | regarding medical bills paid by the Illinois Department, which
| ||||||
23 | inquiries could indicate potential existence of claims or | ||||||
24 | liens for the
Illinois Department.
| ||||||
25 | Enrollment of a vendor
shall be
subject to a provisional | ||||||
26 | period and shall be conditional for one year. During the |
| |||||||
| |||||||
1 | period of conditional enrollment, the Department may
terminate | ||||||
2 | the vendor's eligibility to participate in, or may disenroll | ||||||
3 | the vendor from, the medical assistance
program without cause. | ||||||
4 | Unless otherwise specified, such termination of eligibility or | ||||||
5 | disenrollment is not subject to the
Department's hearing | ||||||
6 | process.
However, a disenrolled vendor may reapply without | ||||||
7 | penalty.
| ||||||
8 | The Department has the discretion to limit the conditional | ||||||
9 | enrollment period for vendors based upon category of risk of | ||||||
10 | the vendor. | ||||||
11 | Prior to enrollment and during the conditional enrollment | ||||||
12 | period in the medical assistance program, all vendors shall be | ||||||
13 | subject to enhanced oversight, screening, and review based on | ||||||
14 | the risk of fraud, waste, and abuse that is posed by the | ||||||
15 | category of risk of the vendor. The Illinois Department shall | ||||||
16 | establish the procedures for oversight, screening, and review, | ||||||
17 | which may include, but need not be limited to: criminal and | ||||||
18 | financial background checks; fingerprinting; license, | ||||||
19 | certification, and authorization verifications; unscheduled or | ||||||
20 | unannounced site visits; database checks; prepayment audit | ||||||
21 | reviews; audits; payment caps; payment suspensions; and other | ||||||
22 | screening as required by federal or State law. | ||||||
23 | The Department shall define or specify the following: (i) | ||||||
24 | by provider notice, the "category of risk of the vendor" for | ||||||
25 | each type of vendor, which shall take into account the level of | ||||||
26 | screening applicable to a particular category of vendor under |
| |||||||
| |||||||
1 | federal law and regulations; (ii) by rule or provider notice, | ||||||
2 | the maximum length of the conditional enrollment period for | ||||||
3 | each category of risk of the vendor; and (iii) by rule, the | ||||||
4 | hearing rights, if any, afforded to a vendor in each category | ||||||
5 | of risk of the vendor that is terminated or disenrolled during | ||||||
6 | the conditional enrollment period. | ||||||
7 | To be eligible for payment consideration, a vendor's | ||||||
8 | payment claim or bill, either as an initial claim or as a | ||||||
9 | resubmitted claim following prior rejection, must be received | ||||||
10 | by the Illinois Department, or its fiscal intermediary, no | ||||||
11 | later than 180 days after the latest date on the claim on which | ||||||
12 | medical goods or services were provided, with the following | ||||||
13 | exceptions: | ||||||
14 | (1) In the case of a provider whose enrollment is in | ||||||
15 | process by the Illinois Department, the 180-day period | ||||||
16 | shall not begin until the date on the written notice from | ||||||
17 | the Illinois Department that the provider enrollment is | ||||||
18 | complete. | ||||||
19 | (2) In the case of errors attributable to the Illinois | ||||||
20 | Department or any of its claims processing intermediaries | ||||||
21 | which result in an inability to receive, process, or | ||||||
22 | adjudicate a claim, the 180-day period shall not begin | ||||||
23 | until the provider has been notified of the error. | ||||||
24 | (3) In the case of a provider for whom the Illinois | ||||||
25 | Department initiates the monthly billing process. | ||||||
26 | (4) In the case of a provider operated by a unit of |
| |||||||
| |||||||
1 | local government with a population exceeding 3,000,000 | ||||||
2 | when local government funds finance federal participation | ||||||
3 | for claims payments. | ||||||
4 | For claims for services rendered during a period for which | ||||||
5 | a recipient received retroactive eligibility, claims must be | ||||||
6 | filed within 180 days after the Department determines the | ||||||
7 | applicant is eligible. For claims for which the Illinois | ||||||
8 | Department is not the primary payer, claims must be submitted | ||||||
9 | to the Illinois Department within 180 days after the final | ||||||
10 | adjudication by the primary payer. | ||||||
11 | In the case of long term care facilities, within 45 | ||||||
12 | calendar days of receipt by the facility of required | ||||||
13 | prescreening information, new admissions with associated | ||||||
14 | admission documents shall be submitted through the Medical | ||||||
15 | Electronic Data Interchange (MEDI) or the Recipient | ||||||
16 | Eligibility Verification (REV) System or shall be submitted | ||||||
17 | directly to the Department of Human Services using required | ||||||
18 | admission forms. Effective September
1, 2014, admission | ||||||
19 | documents, including all prescreening
information, must be | ||||||
20 | submitted through MEDI or REV. Confirmation numbers assigned | ||||||
21 | to an accepted transaction shall be retained by a facility to | ||||||
22 | verify timely submittal. Once an admission transaction has | ||||||
23 | been completed, all resubmitted claims following prior | ||||||
24 | rejection are subject to receipt no later than 180 days after | ||||||
25 | the admission transaction has been completed. | ||||||
26 | Claims that are not submitted and received in compliance |
| |||||||
| |||||||
1 | with the foregoing requirements shall not be eligible for | ||||||
2 | payment under the medical assistance program, and the State | ||||||
3 | shall have no liability for payment of those claims. | ||||||
4 | To the extent consistent with applicable information and | ||||||
5 | privacy, security, and disclosure laws, State and federal | ||||||
6 | agencies and departments shall provide the Illinois Department | ||||||
7 | access to confidential and other information and data | ||||||
8 | necessary to perform eligibility and payment verifications and | ||||||
9 | other Illinois Department functions. This includes, but is not | ||||||
10 | limited to: information pertaining to licensure; | ||||||
11 | certification; earnings; immigration status; citizenship; wage | ||||||
12 | reporting; unearned and earned income; pension income; | ||||||
13 | employment; supplemental security income; social security | ||||||
14 | numbers; National Provider Identifier (NPI) numbers; the | ||||||
15 | National Practitioner Data Bank (NPDB); program and agency | ||||||
16 | exclusions; taxpayer identification numbers; tax delinquency; | ||||||
17 | corporate information; and death records. | ||||||
18 | The Illinois Department shall enter into agreements with | ||||||
19 | State agencies and departments, and is authorized to enter | ||||||
20 | into agreements with federal agencies and departments, under | ||||||
21 | which such agencies and departments shall share data necessary | ||||||
22 | for medical assistance program integrity functions and | ||||||
23 | oversight. The Illinois Department shall develop, in | ||||||
24 | cooperation with other State departments and agencies, and in | ||||||
25 | compliance with applicable federal laws and regulations, | ||||||
26 | appropriate and effective methods to share such data. At a |
| |||||||
| |||||||
1 | minimum, and to the extent necessary to provide data sharing, | ||||||
2 | the Illinois Department shall enter into agreements with State | ||||||
3 | agencies and departments, and is authorized to enter into | ||||||
4 | agreements with federal agencies and departments, including , | ||||||
5 | but not limited to: the Secretary of State; the Department of | ||||||
6 | Revenue; the Department of Public Health; the Department of | ||||||
7 | Human Services; and the Department of Financial and | ||||||
8 | Professional Regulation. | ||||||
9 | Beginning in fiscal year 2013, the Illinois Department | ||||||
10 | shall set forth a request for information to identify the | ||||||
11 | benefits of a pre-payment, post-adjudication, and post-edit | ||||||
12 | claims system with the goals of streamlining claims processing | ||||||
13 | and provider reimbursement, reducing the number of pending or | ||||||
14 | rejected claims, and helping to ensure a more transparent | ||||||
15 | adjudication process through the utilization of: (i) provider | ||||||
16 | data verification and provider screening technology; and (ii) | ||||||
17 | clinical code editing; and (iii) pre-pay, pre- or | ||||||
18 | post-adjudicated predictive modeling with an integrated case | ||||||
19 | management system with link analysis. Such a request for | ||||||
20 | information shall not be considered as a request for proposal | ||||||
21 | or as an obligation on the part of the Illinois Department to | ||||||
22 | take any action or acquire any products or services. | ||||||
23 | The Illinois Department shall establish policies, | ||||||
24 | procedures,
standards and criteria by rule for the | ||||||
25 | acquisition, repair and replacement
of orthotic and prosthetic | ||||||
26 | devices and durable medical equipment. Such
rules shall |
| |||||||
| |||||||
1 | provide, but not be limited to, the following services: (1)
| ||||||
2 | immediate repair or replacement of such devices by recipients; | ||||||
3 | and (2) rental, lease, purchase or lease-purchase of
durable | ||||||
4 | medical equipment in a cost-effective manner, taking into
| ||||||
5 | consideration the recipient's medical prognosis, the extent of | ||||||
6 | the
recipient's needs, and the requirements and costs for | ||||||
7 | maintaining such
equipment. Subject to prior approval, such | ||||||
8 | rules shall enable a recipient to temporarily acquire and
use | ||||||
9 | alternative or substitute devices or equipment pending repairs | ||||||
10 | or
replacements of any device or equipment previously | ||||||
11 | authorized for such
recipient by the Department. | ||||||
12 | Notwithstanding any provision of Section 5-5f to the contrary, | ||||||
13 | the Department may, by rule, exempt certain replacement | ||||||
14 | wheelchair parts from prior approval and, for wheelchairs, | ||||||
15 | wheelchair parts, wheelchair accessories, and related seating | ||||||
16 | and positioning items, determine the wholesale price by | ||||||
17 | methods other than actual acquisition costs. | ||||||
18 | The Department shall require, by rule, all providers of | ||||||
19 | durable medical equipment to be accredited by an accreditation | ||||||
20 | organization approved by the federal Centers for Medicare and | ||||||
21 | Medicaid Services and recognized by the Department in order to | ||||||
22 | bill the Department for providing durable medical equipment to | ||||||
23 | recipients. No later than 15 months after the effective date | ||||||
24 | of the rule adopted pursuant to this paragraph, all providers | ||||||
25 | must meet the accreditation requirement.
| ||||||
26 | In order to promote environmental responsibility, meet the |
| |||||||
| |||||||
1 | needs of recipients and enrollees, and achieve significant | ||||||
2 | cost savings, the Department, or a managed care organization | ||||||
3 | under contract with the Department, may provide recipients or | ||||||
4 | managed care enrollees who have a prescription or Certificate | ||||||
5 | of Medical Necessity access to refurbished durable medical | ||||||
6 | equipment under this Section (excluding prosthetic and | ||||||
7 | orthotic devices as defined in the Orthotics, Prosthetics, and | ||||||
8 | Pedorthics Practice Act and complex rehabilitation technology | ||||||
9 | products and associated services) through the State's | ||||||
10 | assistive technology program's reutilization program, using | ||||||
11 | staff with the Assistive Technology Professional (ATP) | ||||||
12 | Certification if the refurbished durable medical equipment: | ||||||
13 | (i) is available; (ii) is less expensive, including shipping | ||||||
14 | costs, than new durable medical equipment of the same type; | ||||||
15 | (iii) is able to withstand at least 3 years of use; (iv) is | ||||||
16 | cleaned, disinfected, sterilized, and safe in accordance with | ||||||
17 | federal Food and Drug Administration regulations and guidance | ||||||
18 | governing the reprocessing of medical devices in health care | ||||||
19 | settings; and (v) equally meets the needs of the recipient or | ||||||
20 | enrollee. The reutilization program shall confirm that the | ||||||
21 | recipient or enrollee is not already in receipt of same or | ||||||
22 | similar equipment from another service provider, and that the | ||||||
23 | refurbished durable medical equipment equally meets the needs | ||||||
24 | of the recipient or enrollee. Nothing in this paragraph shall | ||||||
25 | be construed to limit recipient or enrollee choice to obtain | ||||||
26 | new durable medical equipment or place any additional prior |
| |||||||
| |||||||
1 | authorization conditions on enrollees of managed care | ||||||
2 | organizations. | ||||||
3 | The Department shall execute, relative to the nursing home | ||||||
4 | prescreening
project, written inter-agency agreements with the | ||||||
5 | Department of Human
Services and the Department on Aging, to | ||||||
6 | effect the following: (i) intake
procedures and common | ||||||
7 | eligibility criteria for those persons who are receiving
| ||||||
8 | non-institutional services; and (ii) the establishment and | ||||||
9 | development of
non-institutional services in areas of the | ||||||
10 | State where they are not currently
available or are | ||||||
11 | undeveloped; and (iii) notwithstanding any other provision of | ||||||
12 | law, subject to federal approval, on and after July 1, 2012, an | ||||||
13 | increase in the determination of need (DON) scores from 29 to | ||||||
14 | 37 for applicants for institutional and home and | ||||||
15 | community-based long term care; if and only if federal | ||||||
16 | approval is not granted, the Department may, in conjunction | ||||||
17 | with other affected agencies, implement utilization controls | ||||||
18 | or changes in benefit packages to effectuate a similar savings | ||||||
19 | amount for this population; and (iv) no later than July 1, | ||||||
20 | 2013, minimum level of care eligibility criteria for | ||||||
21 | institutional and home and community-based long term care; and | ||||||
22 | (v) no later than October 1, 2013, establish procedures to | ||||||
23 | permit long term care providers access to eligibility scores | ||||||
24 | for individuals with an admission date who are seeking or | ||||||
25 | receiving services from the long term care provider. In order | ||||||
26 | to select the minimum level of care eligibility criteria, the |
| |||||||
| |||||||
1 | Governor shall establish a workgroup that includes affected | ||||||
2 | agency representatives and stakeholders representing the | ||||||
3 | institutional and home and community-based long term care | ||||||
4 | interests. This Section shall not restrict the Department from | ||||||
5 | implementing lower level of care eligibility criteria for | ||||||
6 | community-based services in circumstances where federal | ||||||
7 | approval has been granted.
| ||||||
8 | The Illinois Department shall develop and operate, in | ||||||
9 | cooperation
with other State Departments and agencies and in | ||||||
10 | compliance with
applicable federal laws and regulations, | ||||||
11 | appropriate and effective
systems of health care evaluation | ||||||
12 | and programs for monitoring of
utilization of health care | ||||||
13 | services and facilities, as it affects
persons eligible for | ||||||
14 | medical assistance under this Code.
| ||||||
15 | The Illinois Department shall report annually to the | ||||||
16 | General Assembly,
no later than the second Friday in April of | ||||||
17 | 1979 and each year
thereafter, in regard to:
| ||||||
18 | (a) actual statistics and trends in utilization of | ||||||
19 | medical services by
public aid recipients;
| ||||||
20 | (b) actual statistics and trends in the provision of | ||||||
21 | the various medical
services by medical vendors;
| ||||||
22 | (c) current rate structures and proposed changes in | ||||||
23 | those rate structures
for the various medical vendors; and
| ||||||
24 | (d) efforts at utilization review and control by the | ||||||
25 | Illinois Department.
| ||||||
26 | The period covered by each report shall be the 3 years |
| |||||||
| |||||||
1 | ending on the June
30 prior to the report. The report shall | ||||||
2 | include suggested legislation
for consideration by the General | ||||||
3 | Assembly. The requirement for reporting to the General | ||||||
4 | Assembly shall be satisfied
by filing copies of the report as | ||||||
5 | required by Section 3.1 of the General Assembly Organization | ||||||
6 | Act, and filing such additional
copies
with the State | ||||||
7 | Government Report Distribution Center for the General
Assembly | ||||||
8 | as is required under paragraph (t) of Section 7 of the State
| ||||||
9 | Library Act.
| ||||||
10 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
11 | any, is conditioned on the rules being adopted in accordance | ||||||
12 | with all provisions of the Illinois Administrative Procedure | ||||||
13 | Act and all rules and procedures of the Joint Committee on | ||||||
14 | Administrative Rules; any purported rule not so adopted, for | ||||||
15 | whatever reason, is unauthorized. | ||||||
16 | On and after July 1, 2012, the Department shall reduce any | ||||||
17 | rate of reimbursement for services or other payments or alter | ||||||
18 | any methodologies authorized by this Code to reduce any rate | ||||||
19 | of reimbursement for services or other payments in accordance | ||||||
20 | with Section 5-5e. | ||||||
21 | Because kidney transplantation can be an appropriate, | ||||||
22 | cost-effective
alternative to renal dialysis when medically | ||||||
23 | necessary and notwithstanding the provisions of Section 1-11 | ||||||
24 | of this Code, beginning October 1, 2014, the Department shall | ||||||
25 | cover kidney transplantation for noncitizens with end-stage | ||||||
26 | renal disease who are not eligible for comprehensive medical |
| |||||||
| |||||||
1 | benefits, who meet the residency requirements of Section 5-3 | ||||||
2 | of this Code, and who would otherwise meet the financial | ||||||
3 | requirements of the appropriate class of eligible persons | ||||||
4 | under Section 5-2 of this Code. To qualify for coverage of | ||||||
5 | kidney transplantation, such person must be receiving | ||||||
6 | emergency renal dialysis services covered by the Department. | ||||||
7 | Providers under this Section shall be prior approved and | ||||||
8 | certified by the Department to perform kidney transplantation | ||||||
9 | and the services under this Section shall be limited to | ||||||
10 | services associated with kidney transplantation. | ||||||
11 | Notwithstanding any other provision of this Code to the | ||||||
12 | contrary, on or after July 1, 2015, all FDA approved forms of | ||||||
13 | medication assisted treatment prescribed for the treatment of | ||||||
14 | alcohol dependence or treatment of opioid dependence shall be | ||||||
15 | covered under both fee for service and managed care medical | ||||||
16 | assistance programs for persons who are otherwise eligible for | ||||||
17 | medical assistance under this Article and shall not be subject | ||||||
18 | to any (1) utilization control, other than those established | ||||||
19 | under the American Society of Addiction Medicine patient | ||||||
20 | placement criteria,
(2) prior authorization mandate, or (3) | ||||||
21 | lifetime restriction limit
mandate. | ||||||
22 | On or after July 1, 2015, opioid antagonists prescribed | ||||||
23 | for the treatment of an opioid overdose, including the | ||||||
24 | medication product, administration devices, and any pharmacy | ||||||
25 | fees related to the dispensing and administration of the | ||||||
26 | opioid antagonist, shall be covered under the medical |
| |||||||
| |||||||
1 | assistance program for persons who are otherwise eligible for | ||||||
2 | medical assistance under this Article. As used in this | ||||||
3 | Section, "opioid antagonist" means a drug that binds to opioid | ||||||
4 | receptors and blocks or inhibits the effect of opioids acting | ||||||
5 | on those receptors, including, but not limited to, naloxone | ||||||
6 | hydrochloride or any other similarly acting drug approved by | ||||||
7 | the U.S. Food and Drug Administration. | ||||||
8 | Upon federal approval, the Department shall provide | ||||||
9 | coverage and reimbursement for all drugs that are approved for | ||||||
10 | marketing by the federal Food and Drug Administration and that | ||||||
11 | are recommended by the federal Public Health Service or the | ||||||
12 | United States Centers for Disease Control and Prevention for | ||||||
13 | pre-exposure prophylaxis and related pre-exposure prophylaxis | ||||||
14 | services, including, but not limited to, HIV and sexually | ||||||
15 | transmitted infection screening, treatment for sexually | ||||||
16 | transmitted infections, medical monitoring, assorted labs, and | ||||||
17 | counseling to reduce the likelihood of HIV infection among | ||||||
18 | individuals who are not infected with HIV but who are at high | ||||||
19 | risk of HIV infection. | ||||||
20 | A federally qualified health center, as defined in Section | ||||||
21 | 1905(l)(2)(B) of the federal
Social Security Act, shall be | ||||||
22 | reimbursed by the Department in accordance with the federally | ||||||
23 | qualified health center's encounter rate for services provided | ||||||
24 | to medical assistance recipients that are performed by a | ||||||
25 | dental hygienist, as defined under the Illinois Dental | ||||||
26 | Practice Act, working under the general supervision of a |
| |||||||
| |||||||
1 | dentist and employed by a federally qualified health center. | ||||||
2 | (Source: P.A. 100-201, eff. 8-18-17; 100-395, eff. 1-1-18; | ||||||
3 | 100-449, eff. 1-1-18; 100-538, eff. 1-1-18; 100-587, eff. | ||||||
4 | 6-4-18; 100-759, eff. 1-1-19; 100-863, eff. 8-14-18; 100-974, | ||||||
5 | eff. 8-19-18; 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19; | ||||||
6 | 100-1148, eff. 12-10-18; 101-209, eff. 8-5-19; 101-580, eff. | ||||||
7 | 1-1-20; revised 9-18-19.) | ||||||
8 | (305 ILCS 5/5-30) | ||||||
9 | Sec. 5-30. Care coordination. | ||||||
10 | (a) At least 50% of recipients eligible for comprehensive | ||||||
11 | medical benefits in all medical assistance programs or other | ||||||
12 | health benefit programs administered by the Department , | ||||||
13 | including the Children's Health Insurance Program Act and the | ||||||
14 | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | ||||||
15 | care coordination program by no later than January 1, 2015. | ||||||
16 | For purposes of this Section, "coordinated care" or "care | ||||||
17 | coordination" means delivery systems where recipients will | ||||||
18 | receive their care from providers who participate under | ||||||
19 | contract in integrated delivery systems that are responsible | ||||||
20 | for providing or arranging the majority of care, including | ||||||
21 | primary care physician services, referrals from primary care | ||||||
22 | physicians, diagnostic and treatment services, behavioral | ||||||
23 | health services, in-patient and outpatient hospital services, | ||||||
24 | dental services, and rehabilitation and long-term care | ||||||
25 | services. The Department shall designate or contract for such |
| |||||||
| |||||||
1 | integrated delivery systems (i) to ensure enrollees have a | ||||||
2 | choice of systems and of primary care providers within such | ||||||
3 | systems; (ii) to ensure that enrollees receive quality care in | ||||||
4 | a culturally and linguistically appropriate manner; and (iii) | ||||||
5 | to ensure that coordinated care programs meet the diverse | ||||||
6 | needs of enrollees with developmental, mental health, | ||||||
7 | physical, and age-related disabilities. | ||||||
8 | (b) Payment for such coordinated care shall be based on | ||||||
9 | arrangements where the State pays for performance related to | ||||||
10 | health care outcomes, the use of evidence-based practices, the | ||||||
11 | use of primary care delivered through comprehensive medical | ||||||
12 | homes, the use of electronic medical records, and the | ||||||
13 | appropriate exchange of health information electronically made | ||||||
14 | either on a capitated basis in which a fixed monthly premium | ||||||
15 | per recipient is paid and full financial risk is assumed for | ||||||
16 | the delivery of services, or through other risk-based payment | ||||||
17 | arrangements. | ||||||
18 | (c) To qualify for compliance with this Section, the 50% | ||||||
19 | goal shall be achieved by enrolling medical assistance | ||||||
20 | enrollees from each medical assistance enrollment category, | ||||||
21 | including parents, children, seniors, and people with | ||||||
22 | disabilities to the extent that current State Medicaid payment | ||||||
23 | laws would not limit federal matching funds for recipients in | ||||||
24 | care coordination programs. In addition, services must be more | ||||||
25 | comprehensively defined and more risk shall be assumed than in | ||||||
26 | the Department's primary care case management program as of |
| |||||||
| |||||||
1 | January 25, 2011 (the effective date of Public Act 96-1501). | ||||||
2 | (d) The Department shall report to the General Assembly in | ||||||
3 | a separate part of its annual medical assistance program | ||||||
4 | report, beginning April, 2012 until April, 2016, on the | ||||||
5 | progress and implementation of the care coordination program | ||||||
6 | initiatives established by the provisions of Public Act | ||||||
7 | 96-1501. The Department shall include in its April 2011 report | ||||||
8 | a full analysis of federal laws or regulations regarding upper | ||||||
9 | payment limitations to providers and the necessary revisions | ||||||
10 | or adjustments in rate methodologies and payments to providers | ||||||
11 | under this Code that would be necessary to implement | ||||||
12 | coordinated care with full financial risk by a party other | ||||||
13 | than the Department.
| ||||||
14 | (e) Integrated Care Program for individuals with chronic | ||||||
15 | mental health conditions. | ||||||
16 | (1) The Integrated Care Program shall encompass | ||||||
17 | services administered to recipients of medical assistance | ||||||
18 | under this Article to prevent exacerbations and | ||||||
19 | complications using cost-effective, evidence-based | ||||||
20 | practice guidelines and mental health management | ||||||
21 | strategies. | ||||||
22 | (2) The Department may utilize and expand upon | ||||||
23 | existing contractual arrangements with integrated care | ||||||
24 | plans under the Integrated Care Program for providing the | ||||||
25 | coordinated care provisions of this Section. | ||||||
26 | (3) Payment for such coordinated care shall be based |
| |||||||
| |||||||
1 | on arrangements where the State pays for performance | ||||||
2 | related to mental health outcomes on a capitated basis in | ||||||
3 | which a fixed monthly premium per recipient is paid and | ||||||
4 | full financial risk is assumed for the delivery of | ||||||
5 | services, or through other risk-based payment arrangements | ||||||
6 | such as provider-based care coordination. | ||||||
7 | (4) The Department shall examine whether chronic | ||||||
8 | mental health management programs and services for | ||||||
9 | recipients with specific chronic mental health conditions | ||||||
10 | do any or all of the following: | ||||||
11 | (A) Improve the patient's overall mental health in | ||||||
12 | a more expeditious and cost-effective manner. | ||||||
13 | (B) Lower costs in other aspects of the medical | ||||||
14 | assistance program, such as hospital admissions, | ||||||
15 | emergency room visits, or more frequent and | ||||||
16 | inappropriate psychotropic drug use. | ||||||
17 | (5) The Department shall work with the facilities and | ||||||
18 | any integrated care plan participating in the program to | ||||||
19 | identify and correct barriers to the successful | ||||||
20 | implementation of this subsection (e) prior to and during | ||||||
21 | the implementation to best facilitate the goals and | ||||||
22 | objectives of this subsection (e). | ||||||
23 | (f) A hospital that is located in a county of the State in | ||||||
24 | which the Department mandates some or all of the beneficiaries | ||||||
25 | of the Medical Assistance Program residing in the county to | ||||||
26 | enroll in a Care Coordination Program, as set forth in Section |
| |||||||
| |||||||
1 | 5-30 of this Code, shall not be eligible for any non-claims | ||||||
2 | based payments not mandated by Article V-A of this Code for | ||||||
3 | which it would otherwise be qualified to receive, unless the | ||||||
4 | hospital is a Coordinated Care Participating Hospital no later | ||||||
5 | than 60 days after June 14, 2012 (the effective date of Public | ||||||
6 | Act 97-689) or 60 days after the first mandatory enrollment of | ||||||
7 | a beneficiary in a Coordinated Care program. For purposes of | ||||||
8 | this subsection, "Coordinated Care Participating Hospital" | ||||||
9 | means a hospital that meets one of the following criteria: | ||||||
10 | (1) The hospital has entered into a contract to | ||||||
11 | provide hospital services with one or more MCOs to | ||||||
12 | enrollees of the care coordination program. | ||||||
13 | (2) The hospital has not been offered a contract by a | ||||||
14 | care coordination plan that the Department has determined | ||||||
15 | to be a good faith offer and that pays at least as much as | ||||||
16 | the Department would pay, on a fee-for-service basis, not | ||||||
17 | including disproportionate share hospital adjustment | ||||||
18 | payments or any other supplemental adjustment or add-on | ||||||
19 | payment to the base fee-for-service rate, except to the | ||||||
20 | extent such adjustments or add-on payments are | ||||||
21 | incorporated into the development of the applicable MCO | ||||||
22 | capitated rates. | ||||||
23 | As used in this subsection (f), "MCO" means any entity | ||||||
24 | which contracts with the Department to provide services where | ||||||
25 | payment for medical services is made on a capitated basis. | ||||||
26 | (g) No later than August 1, 2013, the Department shall |
| |||||||
| |||||||
1 | issue a purchase of care solicitation for Accountable Care | ||||||
2 | Entities (ACE) to serve any children and parents or caretaker | ||||||
3 | relatives of children eligible for medical assistance under | ||||||
4 | this Article. An ACE may be a single corporate structure or a | ||||||
5 | network of providers organized through contractual | ||||||
6 | relationships with a single corporate entity. The solicitation | ||||||
7 | shall require that: | ||||||
8 | (1) An ACE operating in Cook County be capable of | ||||||
9 | serving at least 40,000 eligible individuals in that | ||||||
10 | county; an ACE operating in Lake, Kane, DuPage, or Will | ||||||
11 | Counties be capable of serving at least 20,000 eligible | ||||||
12 | individuals in those counties and an ACE operating in | ||||||
13 | other regions of the State be capable of serving at least | ||||||
14 | 10,000 eligible individuals in the region in which it | ||||||
15 | operates. During initial periods of mandatory enrollment, | ||||||
16 | the Department shall require its enrollment services | ||||||
17 | contractor to use a default assignment algorithm that | ||||||
18 | ensures if possible an ACE reaches the minimum enrollment | ||||||
19 | levels set forth in this paragraph. | ||||||
20 | (2) An ACE must include at a minimum the following | ||||||
21 | types of providers: primary care, specialty care, | ||||||
22 | hospitals, and behavioral healthcare. | ||||||
23 | (3) An ACE shall have a governance structure that | ||||||
24 | includes the major components of the health care delivery | ||||||
25 | system, including one representative from each of the | ||||||
26 | groups listed in paragraph (2). |
| |||||||
| |||||||
1 | (4) An ACE must be an integrated delivery system, | ||||||
2 | including a network able to provide the full range of | ||||||
3 | services needed by Medicaid beneficiaries and system | ||||||
4 | capacity to securely pass clinical information across | ||||||
5 | participating entities and to aggregate and analyze that | ||||||
6 | data in order to coordinate care. | ||||||
7 | (5) An ACE must be capable of providing both care | ||||||
8 | coordination and complex case management, as necessary, to | ||||||
9 | beneficiaries. To be responsive to the solicitation, a | ||||||
10 | potential ACE must outline its care coordination and | ||||||
11 | complex case management model and plan to reduce the cost | ||||||
12 | of care. | ||||||
13 | (6) In the first 18 months of operation, unless the | ||||||
14 | ACE selects a shorter period, an ACE shall be paid care | ||||||
15 | coordination fees on a per member per month basis that are | ||||||
16 | projected to be cost neutral to the State during the term | ||||||
17 | of their payment and, subject to federal approval, be | ||||||
18 | eligible to share in additional savings generated by their | ||||||
19 | care coordination. | ||||||
20 | (7) In months 19 through 36 of operation, unless the | ||||||
21 | ACE selects a shorter period, an ACE shall be paid on a | ||||||
22 | pre-paid capitation basis for all medical assistance | ||||||
23 | covered services, under contract terms similar to Managed | ||||||
24 | Care Organizations (MCO), with the Department sharing the | ||||||
25 | risk through either stop-loss insurance for extremely high | ||||||
26 | cost individuals or corridors of shared risk based on the |
| |||||||
| |||||||
1 | overall cost of the total enrollment in the ACE. The ACE | ||||||
2 | shall be responsible for claims processing, encounter data | ||||||
3 | submission, utilization control, and quality assurance. | ||||||
4 | (8) In the fourth and subsequent years of operation, | ||||||
5 | an ACE shall convert to a Managed Care Community Network | ||||||
6 | (MCCN), as defined in this Article, or Health Maintenance | ||||||
7 | Organization pursuant to the Illinois Insurance Code, | ||||||
8 | accepting full-risk capitation payments. | ||||||
9 | The Department shall allow potential ACE entities 5 months | ||||||
10 | from the date of the posting of the solicitation to submit | ||||||
11 | proposals. After the solicitation is released, in addition to | ||||||
12 | the MCO rate development data available on the Department's | ||||||
13 | website, subject to federal and State confidentiality and | ||||||
14 | privacy laws and regulations, the Department shall provide 2 | ||||||
15 | years of de-identified summary service data on the targeted | ||||||
16 | population, split between children and adults, showing the | ||||||
17 | historical type and volume of services received and the cost | ||||||
18 | of those services to those potential bidders that sign a data | ||||||
19 | use agreement. The Department may add up to 2 non-state | ||||||
20 | government employees with expertise in creating integrated | ||||||
21 | delivery systems to its review team for the purchase of care | ||||||
22 | solicitation described in this subsection. Any such | ||||||
23 | individuals must sign a no-conflict disclosure and | ||||||
24 | confidentiality agreement and agree to act in accordance with | ||||||
25 | all applicable State laws. | ||||||
26 | During the first 2 years of an ACE's operation, the |
| |||||||
| |||||||
1 | Department shall provide claims data to the ACE on its | ||||||
2 | enrollees on a periodic basis no less frequently than monthly. | ||||||
3 | Nothing in this subsection shall be construed to limit the | ||||||
4 | Department's mandate to enroll 50% of its beneficiaries into | ||||||
5 | care coordination systems by January 1, 2015, using all | ||||||
6 | available care coordination delivery systems, including Care | ||||||
7 | Coordination Entities (CCE), MCCNs, or MCOs, nor be construed | ||||||
8 | to affect the current CCEs, MCCNs, and MCOs selected to serve | ||||||
9 | seniors and persons with disabilities prior to that date. | ||||||
10 | Nothing in this subsection precludes the Department from | ||||||
11 | considering future proposals for new ACEs or expansion of | ||||||
12 | existing ACEs at the discretion of the Department. | ||||||
13 | (h) Department contracts with MCOs and other entities | ||||||
14 | reimbursed by risk based capitation shall have a minimum | ||||||
15 | medical loss ratio of 85%, shall require the entity to | ||||||
16 | establish an appeals and grievances process for consumers and | ||||||
17 | providers, and shall require the entity to provide a quality | ||||||
18 | assurance and utilization review program. Entities contracted | ||||||
19 | with the Department to coordinate healthcare regardless of | ||||||
20 | risk shall be measured utilizing the same quality metrics. The | ||||||
21 | quality metrics may be population specific. Any contracted | ||||||
22 | entity serving at least 5,000 seniors or people with | ||||||
23 | disabilities or 15,000 individuals in other populations | ||||||
24 | covered by the Medical Assistance Program that has been | ||||||
25 | receiving full-risk capitation for a year shall be accredited | ||||||
26 | by a national accreditation organization authorized by the |
| |||||||
| |||||||
1 | Department within 2 years after the date it is eligible to | ||||||
2 | become accredited. The requirements of this subsection shall | ||||||
3 | apply to contracts with MCOs entered into or renewed or | ||||||
4 | extended after June 1, 2013. | ||||||
5 | (h-5) The Department shall monitor and enforce compliance | ||||||
6 | by MCOs with agreements they have entered into with providers | ||||||
7 | on issues that include, but are not limited to, timeliness of | ||||||
8 | payment, payment rates, and processes for obtaining prior | ||||||
9 | approval. The Department may impose sanctions on MCOs for | ||||||
10 | violating provisions of those agreements that include, but are | ||||||
11 | not limited to, financial penalties, suspension of enrollment | ||||||
12 | of new enrollees, and termination of the MCO's contract with | ||||||
13 | the Department. As used in this subsection (h-5), "MCO" has | ||||||
14 | the meaning ascribed to that term in Section 5-30.1 of this | ||||||
15 | Code. | ||||||
16 | (i) Unless otherwise required by federal law, Medicaid | ||||||
17 | Managed Care Entities and their respective business associates | ||||||
18 | shall not disclose, directly or indirectly, including by | ||||||
19 | sending a bill or explanation of benefits, information | ||||||
20 | concerning the sensitive health services received by enrollees | ||||||
21 | of the Medicaid Managed Care Entity to any person other than | ||||||
22 | covered entities and business associates, which may receive, | ||||||
23 | use, and further disclose such information solely for the | ||||||
24 | purposes permitted under applicable federal and State laws and | ||||||
25 | regulations if such use and further disclosure satisfies all | ||||||
26 | applicable requirements of such laws and regulations. The |
| |||||||
| |||||||
1 | Medicaid Managed Care Entity or its respective business | ||||||
2 | associates may disclose information concerning the sensitive | ||||||
3 | health services if the enrollee who received the sensitive | ||||||
4 | health services requests the information from the Medicaid | ||||||
5 | Managed Care Entity or its respective business associates and | ||||||
6 | authorized the sending of a bill or explanation of benefits. | ||||||
7 | Communications including, but not limited to, statements of | ||||||
8 | care received or appointment reminders either directly or | ||||||
9 | indirectly to the enrollee from the health care provider, | ||||||
10 | health care professional, and care coordinators, remain | ||||||
11 | permissible. Medicaid Managed Care Entities or their | ||||||
12 | respective business associates may communicate directly with | ||||||
13 | their enrollees regarding care coordination activities for | ||||||
14 | those enrollees. | ||||||
15 | For the purposes of this subsection, the term "Medicaid | ||||||
16 | Managed Care Entity" includes Care Coordination Entities, | ||||||
17 | Accountable Care Entities, Managed Care Organizations, and | ||||||
18 | Managed Care Community Networks. | ||||||
19 | For purposes of this subsection, the term "sensitive | ||||||
20 | health services" means mental health services, substance abuse | ||||||
21 | treatment services, reproductive health services, family | ||||||
22 | planning services, services for sexually transmitted | ||||||
23 | infections and sexually transmitted diseases, and services for | ||||||
24 | sexual assault or domestic abuse. Services include prevention, | ||||||
25 | screening, consultation, examination, treatment, or follow-up. | ||||||
26 | For purposes of this subsection, "business associate", |
| |||||||
| |||||||
1 | "covered entity", "disclosure", and "use" have the meanings | ||||||
2 | ascribed to those terms in 45 CFR 160.103. | ||||||
3 | Nothing in this subsection shall be construed to relieve a | ||||||
4 | Medicaid Managed Care Entity or the Department of any duty to | ||||||
5 | report incidents of sexually transmitted infections to the | ||||||
6 | Department of Public Health or to the local board of health in | ||||||
7 | accordance with regulations adopted under a statute or | ||||||
8 | ordinance or to report incidents of sexually transmitted | ||||||
9 | infections as necessary to comply with the requirements under | ||||||
10 | Section 5 of the Abused and Neglected Child Reporting Act or as | ||||||
11 | otherwise required by State or federal law. | ||||||
12 | The Department shall create policy in order to implement | ||||||
13 | the requirements in this subsection. | ||||||
14 | (j) Managed Care Entities (MCEs), including MCOs and all | ||||||
15 | other care coordination organizations, shall develop and | ||||||
16 | maintain a written language access policy that sets forth the | ||||||
17 | standards, guidelines, and operational plan to ensure language | ||||||
18 | appropriate services and that is consistent with the standard | ||||||
19 | of meaningful access for populations with limited English | ||||||
20 | proficiency. The language access policy shall describe how the | ||||||
21 | MCEs will provide all of the following required services: | ||||||
22 | (1) Translation (the written replacement of text from | ||||||
23 | one language into another) of all vital documents and | ||||||
24 | forms as identified by the Department. | ||||||
25 | (2) Qualified interpreter services (the oral | ||||||
26 | communication of a message from one language into another |
| |||||||
| |||||||
1 | by a qualified interpreter). | ||||||
2 | (3) Staff training on the language access policy, | ||||||
3 | including how to identify language needs, access and | ||||||
4 | provide language assistance services, work with | ||||||
5 | interpreters, request translations, and track the use of | ||||||
6 | language assistance services. | ||||||
7 | (4) Data tracking that identifies the language need. | ||||||
8 | (5) Notification to participants on the availability | ||||||
9 | of language access services and on how to access such | ||||||
10 | services. | ||||||
11 | (k) The Department shall actively monitor the contractual | ||||||
12 | relationship between Managed Care Organizations (MCOs) and any | ||||||
13 | dental administrator contracted by an MCO to provide dental | ||||||
14 | services. The Department shall adopt appropriate dental | ||||||
15 | Healthcare Effectiveness Data and Information Set (HEDIS) | ||||||
16 | measures and shall include the Annual Dental Visit (ADV) HEDIS | ||||||
17 | measure in its Health Plan Comparison Tool and Illinois | ||||||
18 | Medicaid Plan Report Card that is available on the | ||||||
19 | Department's website for enrolled individuals. | ||||||
20 | The Department shall collect from each MCO specific | ||||||
21 | information about the types of contracted, broad-based care | ||||||
22 | coordination occurring between the MCO and any dental | ||||||
23 | administrator, including, but not limited to, pregnant women | ||||||
24 | and diabetic patients in need of oral care. | ||||||
25 | (Source: P.A. 99-106, eff. 1-1-16; 99-181, eff. 7-29-15; | ||||||
26 | 99-566, eff. 1-1-17; 99-642, eff. 7-28-16; 100-587, eff. |
| |||||||
| |||||||
1 | 6-4-18.) | ||||||
2 | (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
| ||||||
3 | Sec. 5A-8. Hospital Provider Fund.
| ||||||
4 | (a) There is created in the State Treasury the Hospital | ||||||
5 | Provider Fund.
Interest earned by the Fund shall be credited | ||||||
6 | to the Fund. The
Fund shall not be used to replace any moneys | ||||||
7 | appropriated to the
Medicaid program by the General Assembly.
| ||||||
8 | (b) The Fund is created for the purpose of receiving | ||||||
9 | moneys
in accordance with Section 5A-6 and disbursing moneys | ||||||
10 | only for the following
purposes, notwithstanding any other | ||||||
11 | provision of law:
| ||||||
12 | (1) For making payments to hospitals as required under | ||||||
13 | this Code , under the Children's Health Insurance Program | ||||||
14 | Act, under the Covering ALL KIDS Health Insurance Act, and | ||||||
15 | under the Long Term Acute Care Hospital Quality | ||||||
16 | Improvement Transfer Program Act.
| ||||||
17 | (2) For the reimbursement of moneys collected by the
| ||||||
18 | Illinois Department from hospitals or hospital providers | ||||||
19 | through error or
mistake in performing the
activities | ||||||
20 | authorized under this Code.
| ||||||
21 | (3) For payment of administrative expenses incurred by | ||||||
22 | the
Illinois Department or its agent in performing | ||||||
23 | activities
under this Code , under the Children's Health | ||||||
24 | Insurance Program Act, under the Covering ALL KIDS Health | ||||||
25 | Insurance Act, and under the Long Term Acute Care Hospital |
| |||||||
| |||||||
1 | Quality Improvement Transfer Program Act.
| ||||||
2 | (4) For payments of any amounts which are reimbursable | ||||||
3 | to
the federal government for payments from this Fund | ||||||
4 | which are
required to be paid by State warrant.
| ||||||
5 | (5) For making transfers, as those transfers are | ||||||
6 | authorized
in the proceedings authorizing debt under the | ||||||
7 | Short Term Borrowing Act,
but transfers made under this | ||||||
8 | paragraph (5) shall not exceed the
principal amount of | ||||||
9 | debt issued in anticipation of the receipt by
the State of | ||||||
10 | moneys to be deposited into the Fund.
| ||||||
11 | (6) For making transfers to any other fund in the | ||||||
12 | State treasury, but
transfers made under this paragraph | ||||||
13 | (6) shall not exceed the amount transferred
previously | ||||||
14 | from that other fund into the Hospital Provider Fund plus | ||||||
15 | any interest that would have been earned by that fund on | ||||||
16 | the monies that had been transferred.
| ||||||
17 | (6.5) For making transfers to the Healthcare Provider | ||||||
18 | Relief Fund, except that transfers made under this | ||||||
19 | paragraph (6.5) shall not exceed $60,000,000 in the | ||||||
20 | aggregate. | ||||||
21 | (7) For making transfers not exceeding the following | ||||||
22 | amounts, related to State fiscal years 2013 through 2018, | ||||||
23 | to the following designated funds: | ||||||
24 | Health and Human Services Medicaid Trust | ||||||
25 | Fund ..............................$20,000,000 | ||||||
26 | Long-Term Care Provider Fund ..........$30,000,000 |
| |||||||
| |||||||
1 | General Revenue Fund .................$80,000,000. | ||||||
2 | Transfers under this paragraph shall be made within 7 days | ||||||
3 | after the payments have been received pursuant to the | ||||||
4 | schedule of payments provided in subsection (a) of Section | ||||||
5 | 5A-4. | ||||||
6 | (7.1) (Blank).
| ||||||
7 | (7.5) (Blank). | ||||||
8 | (7.8) (Blank). | ||||||
9 | (7.9) (Blank). | ||||||
10 | (7.10) For State fiscal year 2014, for making | ||||||
11 | transfers of the moneys resulting from the assessment | ||||||
12 | under subsection (b-5) of Section 5A-2 and received from | ||||||
13 | hospital providers under Section 5A-4 and transferred into | ||||||
14 | the Hospital Provider Fund under Section 5A-6 to the | ||||||
15 | designated funds not exceeding the following amounts in | ||||||
16 | that State fiscal year: | ||||||
17 | Healthcare Provider Relief Fund ......$100,000,000 | ||||||
18 | Transfers under this paragraph shall be made within 7 | ||||||
19 | days after the payments have been received pursuant to the | ||||||
20 | schedule of payments provided in subsection (a) of Section | ||||||
21 | 5A-4. | ||||||
22 | The additional amount of transfers in this paragraph | ||||||
23 | (7.10), authorized by Public Act 98-651, shall be made | ||||||
24 | within 10 State business days after June 16, 2014 (the | ||||||
25 | effective date of Public Act 98-651). That authority shall | ||||||
26 | remain in effect even if Public Act 98-651 does not become |
| |||||||
| |||||||
1 | law until State fiscal year 2015. | ||||||
2 | (7.10a) For State fiscal years 2015 through 2018, for | ||||||
3 | making transfers of the moneys resulting from the | ||||||
4 | assessment under subsection (b-5) of Section 5A-2 and | ||||||
5 | received from hospital providers under Section 5A-4 and | ||||||
6 | transferred into the Hospital Provider Fund under Section | ||||||
7 | 5A-6 to the designated funds not exceeding the following | ||||||
8 | amounts related to each State fiscal year: | ||||||
9 | Healthcare Provider Relief Fund ......$50,000,000 | ||||||
10 | Transfers under this paragraph shall be made within 7 | ||||||
11 | days after the payments have been received pursuant to the | ||||||
12 | schedule of payments provided in subsection (a) of Section | ||||||
13 | 5A-4. | ||||||
14 | (7.11) (Blank). | ||||||
15 | (7.12) For State fiscal year 2013, for increasing by | ||||||
16 | 21/365ths the transfer of the moneys resulting from the | ||||||
17 | assessment under subsection (b-5) of Section 5A-2 and | ||||||
18 | received from hospital providers under Section 5A-4 for | ||||||
19 | the portion of State fiscal year 2012 beginning June 10, | ||||||
20 | 2012 through June 30, 2012 and transferred into the | ||||||
21 | Hospital Provider Fund under Section 5A-6 to the | ||||||
22 | designated funds not exceeding the following amounts in | ||||||
23 | that State fiscal year: | ||||||
24 | Healthcare Provider Relief Fund .......$2,870,000 | ||||||
25 | Since the federal Centers for Medicare and Medicaid | ||||||
26 | Services approval of the assessment authorized under |
| |||||||
| |||||||
1 | subsection (b-5) of Section 5A-2, received from hospital | ||||||
2 | providers under Section 5A-4 and the payment methodologies | ||||||
3 | to hospitals required under Section 5A-12.4 was not | ||||||
4 | received by the Department until State fiscal year 2014 | ||||||
5 | and since the Department made retroactive payments during | ||||||
6 | State fiscal year 2014 related to the referenced period of | ||||||
7 | June 2012, the transfer authority granted in this | ||||||
8 | paragraph (7.12) is extended through the date that is 10 | ||||||
9 | State business days after June 16, 2014 (the effective | ||||||
10 | date of Public Act 98-651). | ||||||
11 | (7.13) In addition to any other transfers authorized | ||||||
12 | under this Section, for State fiscal years 2017 and 2018, | ||||||
13 | for making transfers to the Healthcare Provider Relief | ||||||
14 | Fund of moneys collected from the ACA Assessment | ||||||
15 | Adjustment authorized under subsections (a) and (b-5) of | ||||||
16 | Section 5A-2 and paid by hospital providers under Section | ||||||
17 | 5A-4 into the Hospital Provider Fund under Section 5A-6 | ||||||
18 | for each State fiscal year. Timing of transfers to the | ||||||
19 | Healthcare Provider Relief Fund under this paragraph shall | ||||||
20 | be at the discretion of the Department, but no less | ||||||
21 | frequently than quarterly. | ||||||
22 | (7.14) For making transfers not exceeding the | ||||||
23 | following amounts, related to State fiscal years 2019 and | ||||||
24 | 2020, to the following designated funds: | ||||||
25 | Health and Human Services Medicaid Trust | ||||||
26 | Fund ..............................$20,000,000 |
| |||||||
| |||||||
1 | Long-Term Care Provider Fund ..........$30,000,000 | ||||||
2 | Healthcare Provider Relief Fund .....$325,000,000. | ||||||
3 | Transfers under this paragraph shall be made within 7 | ||||||
4 | days after the payments have been received pursuant to the | ||||||
5 | schedule of payments provided in subsection (a) of Section | ||||||
6 | 5A-4. | ||||||
7 | (7.15) For making transfers not exceeding the | ||||||
8 | following amounts, related to State fiscal years 2021 and | ||||||
9 | 2022, to the following designated funds: | ||||||
10 | Health and Human Services Medicaid Trust | ||||||
11 | Fund .............................$20,000,000 | ||||||
12 | Long-Term Care Provider Fund .........$30,000,000 | ||||||
13 | Healthcare Provider Relief Fund .....$365,000,000 | ||||||
14 | (7.16) For making transfers not exceeding the | ||||||
15 | following amounts, related to July 1, 2022 to December 31, | ||||||
16 | 2022, to the following designated funds: | ||||||
17 | Health and Human Services Medicaid Trust | ||||||
18 | Fund .............................$10,000,000 | ||||||
19 | Long-Term Care Provider Fund .........$15,000,000 | ||||||
20 | Healthcare Provider Relief Fund .....$182,500,000 | ||||||
21 | (8) For making refunds to hospital providers pursuant | ||||||
22 | to Section 5A-10.
| ||||||
23 | (9) For making payment to capitated managed care | ||||||
24 | organizations as described in subsections (s) and (t) of | ||||||
25 | Section 5A-12.2, subsection (r) of Section 5A-12.6, and | ||||||
26 | Section 5A-12.7 of this Code. |
| |||||||
| |||||||
1 | Disbursements from the Fund, other than transfers | ||||||
2 | authorized under
paragraphs (5) and (6) of this subsection, | ||||||
3 | shall be by
warrants drawn by the State Comptroller upon | ||||||
4 | receipt of vouchers
duly executed and certified by the | ||||||
5 | Illinois Department.
| ||||||
6 | (c) The Fund shall consist of the following:
| ||||||
7 | (1) All moneys collected or received by the Illinois
| ||||||
8 | Department from the hospital provider assessment imposed | ||||||
9 | by this
Article.
| ||||||
10 | (2) All federal matching funds received by the | ||||||
11 | Illinois
Department as a result of expenditures made by | ||||||
12 | the Illinois
Department that are attributable to moneys | ||||||
13 | deposited in the Fund.
| ||||||
14 | (3) Any interest or penalty levied in conjunction with | ||||||
15 | the
administration of this Article.
| ||||||
16 | (3.5) As applicable, proceeds from surety bond | ||||||
17 | payments payable to the Department as referenced in | ||||||
18 | subsection (s) of Section 5A-12.2 of this Code. | ||||||
19 | (4) Moneys transferred from another fund in the State | ||||||
20 | treasury.
| ||||||
21 | (5) All other moneys received for the Fund from any | ||||||
22 | other
source, including interest earned thereon.
| ||||||
23 | (d) (Blank).
| ||||||
24 | (Source: P.A. 100-581, eff. 3-12-18; 100-863, eff. 8-14-19; | ||||||
25 | 101-650, eff. 7-7-20.)
|
| |||||||
| |||||||
1 | (305 ILCS 5/5G-35) | ||||||
2 | Sec. 5G-35. Supportive Living Facility Fund. | ||||||
3 | (a) There is created in the State treasury the Supportive | ||||||
4 | Living Facility Fund. Interest earned by the Fund shall be | ||||||
5 | credited to the Fund. The Fund shall not be used to replace any | ||||||
6 | moneys appropriated to the Medicaid program by the General | ||||||
7 | Assembly. | ||||||
8 | (b) The Fund is created for the purpose of receiving and | ||||||
9 | disbursing moneys in accordance with this Article. | ||||||
10 | Disbursements from the Fund, other than transfers authorized | ||||||
11 | under paragraphs (5) and (6) of this subsection, shall be by | ||||||
12 | warrants drawn by the State Comptroller upon receipt of | ||||||
13 | vouchers duly executed and certified by the Department. | ||||||
14 | Disbursements from the Fund shall be made only as follows: | ||||||
15 | (1) For making payments to supportive living | ||||||
16 | facilities as required under this Code , under the | ||||||
17 | Children's Health Insurance Program Act, under the | ||||||
18 | Covering ALL KIDS Health Insurance Act, and under the Long | ||||||
19 | Term Acute Care Hospital Quality Improvement Transfer | ||||||
20 | Program Act. | ||||||
21 | (2) For the reimbursement of moneys collected by the | ||||||
22 | Department from supportive living facilities through error | ||||||
23 | or mistake in performing the activities authorized under | ||||||
24 | this Code. | ||||||
25 | (3) For payment of administrative expenses incurred by | ||||||
26 | the Department or its agent in performing administrative |
| |||||||
| |||||||
1 | oversight activities for the supportive living program or | ||||||
2 | review of new supportive living facility applications. | ||||||
3 | (4) For payments of any amounts which are reimbursable | ||||||
4 | to the federal government for payments from this Fund | ||||||
5 | which are required to be paid by State warrant. | ||||||
6 | (5) For making transfers, as those transfers are | ||||||
7 | authorized in the proceedings authorizing debt under the | ||||||
8 | Short Term Borrowing Act, but transfers made under this | ||||||
9 | paragraph (5) shall not exceed the principal amount of | ||||||
10 | debt issued in anticipation of the receipt by the State of | ||||||
11 | moneys to be deposited into the Fund. | ||||||
12 | (6) For making transfers to any other fund in the | ||||||
13 | State treasury, but transfers made under this paragraph | ||||||
14 | (6) shall not exceed the amount transferred previously | ||||||
15 | from that other fund into the Supportive Living Facility | ||||||
16 | Fund plus any interest that would have been earned by that | ||||||
17 | fund on the money that had been transferred. | ||||||
18 | (c) The Fund shall consist of the following: | ||||||
19 | (1) All moneys collected or received by the Department | ||||||
20 | from the supportive living facility assessment imposed by | ||||||
21 | this Article. | ||||||
22 | (2) All moneys collected or received by the Department | ||||||
23 | from the supportive living facility certification fee | ||||||
24 | imposed by this Article. | ||||||
25 | (3) All federal matching funds received by the | ||||||
26 | Department as a result of expenditures made by the |
| |||||||
| |||||||
1 | Department that are attributable to moneys deposited in | ||||||
2 | the Fund. | ||||||
3 | (4) Any interest or penalty levied in conjunction with | ||||||
4 | the administration of this Article. | ||||||
5 | (5) Moneys transferred from another fund in the State | ||||||
6 | treasury. | ||||||
7 | (6) All other moneys received for the Fund from any | ||||||
8 | other source, including interest earned thereon.
| ||||||
9 | (Source: P.A. 98-651, eff. 6-16-14.) | ||||||
10 | (305 ILCS 5/5H-1) | ||||||
11 | Sec. 5H-1. Definitions. As used in this Article: | ||||||
12 | "Base year" means the 12-month period from January 1, 2018 | ||||||
13 | to December 31, 2018. | ||||||
14 | "Department" means the Department of Healthcare and Family | ||||||
15 | Services. | ||||||
16 | "Federal employee health benefit" means the program of | ||||||
17 | health benefits plans, as defined in 5 U.S.C. 8901, available | ||||||
18 | to federal employees under 5 U.S.C. 8901 to 8914. | ||||||
19 | "Fund" means the Healthcare Provider Relief Fund. | ||||||
20 | "Managed care organization" means an entity operating | ||||||
21 | under a certificate of authority issued pursuant to the Health | ||||||
22 | Maintenance Organization Act or as a Managed Care Community | ||||||
23 | Network pursuant to Section 5-11 of this the Public Aid Code. | ||||||
24 | "Medicaid managed care organization" means a managed care | ||||||
25 | organization under contract with the Department to provide |
| |||||||
| |||||||
1 | services to recipients of benefits in the medical assistance | ||||||
2 | program pursuant to Article V of this the Public Aid Code , the | ||||||
3 | Children's Health Insurance Program Act, or the Covering ALL | ||||||
4 | KIDS Health Insurance Act . It does not include contracts the | ||||||
5 | same entity or an affiliated entity has for other business. | ||||||
6 | "Medicare" means the federal Medicare program established | ||||||
7 | under Title XVIII of the federal Social Security Act. | ||||||
8 | "Member months" means the aggregate total number of months | ||||||
9 | all individuals are enrolled for coverage in a Managed Care | ||||||
10 | Organization during the base year. Member months are | ||||||
11 | determined by the Department for Medicaid Managed Care | ||||||
12 | Organizations based on enrollment data in its Medicaid | ||||||
13 | Management Information System and by the Department of | ||||||
14 | Insurance for other Managed Care Organizations based on | ||||||
15 | required filings with the Department of Insurance. Member | ||||||
16 | months do not include months individuals are enrolled in a | ||||||
17 | Limited Health Services Organization, including stand-alone | ||||||
18 | dental or vision plans, a Medicare Advantage Plan, a Medicare | ||||||
19 | Supplement Plan, a Medicaid Medicare Alignment Initiate Plan | ||||||
20 | pursuant to a Memorandum of Understanding between the | ||||||
21 | Department and the Federal Centers for Medicare and Medicaid | ||||||
22 | Services or a Federal Employee Health Benefits Plan.
| ||||||
23 | (Source: P.A. 101-9, eff. 6-5-19; revised 7-12-19.)
| ||||||
24 | (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
| ||||||
25 | Sec. 11-22. Charge upon claims and causes of action for |
| |||||||
| |||||||
1 | injuries. The Illinois Department shall have a charge upon all | ||||||
2 | claims, demands and
causes of action for injuries to an | ||||||
3 | applicant for or recipient of (i)
financial aid under Articles | ||||||
4 | III, IV, and V or (ii) , (ii) health care benefits provided | ||||||
5 | under the Covering ALL KIDS Health Insurance Act, or (iii) | ||||||
6 | health care benefits provided under the Veterans' Health | ||||||
7 | Insurance Program Act or the Veterans' Health Insurance | ||||||
8 | Program Act of 2008 for the total
amount of
medical assistance | ||||||
9 | provided the recipient from the time of injury to the
date of | ||||||
10 | recovery upon such claim, demand or cause of action. In | ||||||
11 | addition, if
the applicant or recipient was employable, as | ||||||
12 | defined by the Department, at
the time of the injury, the | ||||||
13 | Department shall also have a charge upon any
such claims, | ||||||
14 | demands and causes of action for the total amount of aid
| ||||||
15 | provided to the recipient and his
dependents, including all | ||||||
16 | cash assistance and medical assistance
only to the extent | ||||||
17 | includable in the claimant's action, from the
time of injury | ||||||
18 | to the date of recovery upon such
claim, demand or cause of | ||||||
19 | action. Any definition of "employable"
adopted by the | ||||||
20 | Department shall apply only to persons above the age of
| ||||||
21 | compulsory school attendance.
| ||||||
22 | If the injured person was employable at the time of the | ||||||
23 | injury and is
provided aid under Articles III, IV, or V and any | ||||||
24 | dependent or
member of his family is provided aid under | ||||||
25 | Article VI, or vice versa,
both the Illinois Department and | ||||||
26 | the local governmental unit shall have
a charge upon such |
| |||||||
| |||||||
1 | claims, demands and causes of action for the aid
provided to | ||||||
2 | the injured person and any
dependent member of his family, | ||||||
3 | including all cash assistance, medical
assistance and food | ||||||
4 | stamps, from the time of the injury to the date
of recovery.
| ||||||
5 | "Recipient", as used herein, means (i) in the case of | ||||||
6 | financial aid provided under this Code, the grantee of record | ||||||
7 | and any
persons whose needs are included in the financial aid | ||||||
8 | provided to the
grantee of record or otherwise met by grants | ||||||
9 | under the appropriate
Article of this Code for which such | ||||||
10 | person is eligible and (ii) , (ii) in the case of health care | ||||||
11 | benefits provided under the Covering ALL KIDS Health Insurance | ||||||
12 | Act, the child to whom those benefits are provided, and (iii) | ||||||
13 | in the case of health care benefits provided under the | ||||||
14 | Veterans' Health Insurance Program Act or the Veterans' Health | ||||||
15 | Insurance Program Act of 2008, the veteran to whom benefits | ||||||
16 | are provided.
| ||||||
17 | In each case, the notice shall be served by certified mail | ||||||
18 | or
registered mail, or by facsimile or electronic messaging | ||||||
19 | when requested by the party or parties against whom the | ||||||
20 | applicant or recipient has a claim, demand, or cause of | ||||||
21 | action, upon the party or parties against whom the applicant | ||||||
22 | or
recipient has a claim, demand or cause of action. The notice | ||||||
23 | shall
claim the charge and describe the interest the Illinois | ||||||
24 | Department, the
local governmental unit, or the county, has in | ||||||
25 | the claim, demand, or
cause of action. The charge shall attach | ||||||
26 | to any verdict or judgment
entered and to any money or property |
| |||||||
| |||||||
1 | which may be recovered on account
of such claim, demand, cause | ||||||
2 | of action or suit from and after the time
of the service of the | ||||||
3 | notice.
| ||||||
4 | On petition filed by the Illinois Department, or by the | ||||||
5 | local
governmental unit or county if either is claiming a | ||||||
6 | charge, or by the
recipient, or by the defendant, the court, on | ||||||
7 | written notice to all
interested parties, may adjudicate the | ||||||
8 | rights of the parties and enforce
the charge. The court may | ||||||
9 | approve the settlement of any claim, demand
or cause of action | ||||||
10 | either before or after a verdict, and nothing in this
Section | ||||||
11 | shall be construed as requiring the actual trial or final
| ||||||
12 | adjudication of any claim, demand or cause of action upon | ||||||
13 | which the
Illinois Department, the local governmental unit or | ||||||
14 | county has charge.
The court may determine what portion of the | ||||||
15 | recovery shall be paid to
the injured person and what portion | ||||||
16 | shall be paid to the Illinois
Department, the local | ||||||
17 | governmental unit or county having a charge
against the | ||||||
18 | recovery.
In making this determination, the court shall | ||||||
19 | conduct an evidentiary hearing
and shall consider competent | ||||||
20 | evidence pertaining
to the following matters:
| ||||||
21 | (1) the amount of the charge sought to be enforced | ||||||
22 | against the recovery
when expressed as a percentage of the | ||||||
23 | gross amount of the recovery; the
amount of the charge | ||||||
24 | sought to be enforced against the recovery when expressed
| ||||||
25 | as a percentage of the amount obtained by subtracting from | ||||||
26 | the gross amount
of the recovery the total attorney's fees |
| |||||||
| |||||||
1 | and other costs incurred by the
recipient incident to the | ||||||
2 | recovery; and whether the Department, unit of
local | ||||||
3 | government or county seeking to enforce the charge against | ||||||
4 | the recovery
should as a matter of fairness and equity | ||||||
5 | bear its proportionate share of
the fees and costs | ||||||
6 | incurred to generate the recovery from which the charge
is | ||||||
7 | sought to be satisfied;
| ||||||
8 | (2) the amount, if any, of the attorney's fees and | ||||||
9 | other costs incurred
by the recipient incident to the | ||||||
10 | recovery and paid by the recipient up to the
time of | ||||||
11 | recovery, and the amount of such fees and costs remaining | ||||||
12 | unpaid
at the time of recovery;
| ||||||
13 | (3) the total hospital, doctor and other medical | ||||||
14 | expenses incurred for
care and treatment of the injury to | ||||||
15 | the date of recovery therefor, the portion
of such | ||||||
16 | expenses theretofore paid by the recipient, by insurance | ||||||
17 | provided
by the recipient, and by the Department, unit of | ||||||
18 | local government and county
seeking to enforce a charge | ||||||
19 | against the recovery, and the amount of such
previously | ||||||
20 | incurred expenses which remain unpaid at the time of | ||||||
21 | recovery
and by whom such incurred, unpaid expenses are to | ||||||
22 | be paid;
| ||||||
23 | (4) whether the recovery represents less than | ||||||
24 | substantially full
recompense
for the injury and the | ||||||
25 | hospital, doctor and other medical expenses incurred
to | ||||||
26 | the date of recovery for the care and treatment of the |
| |||||||
| |||||||
1 | injury, so that
reduction of the charge sought to be | ||||||
2 | enforced against the recovery would
not likely result in a | ||||||
3 | double recovery or unjust enrichment to the recipient;
| ||||||
4 | (5) the age of the recipient and of persons dependent | ||||||
5 | for support upon
the recipient, the nature and permanency | ||||||
6 | of the recipient's injuries as
they affect not only the | ||||||
7 | future employability and education of the recipient
but | ||||||
8 | also the reasonably necessary and foreseeable future | ||||||
9 | material, maintenance,
medical, rehabilitative and | ||||||
10 | training needs of the recipient, the cost of
such | ||||||
11 | reasonably necessary and foreseeable future needs, and the | ||||||
12 | resources
available to meet such needs and pay such costs;
| ||||||
13 | (6) the realistic ability of the recipient to repay in | ||||||
14 | whole or in part
the charge sought to be enforced against | ||||||
15 | the recovery when judged in light
of the factors | ||||||
16 | enumerated above.
| ||||||
17 | The burden of producing evidence sufficient to support the | ||||||
18 | exercise by
the court of its discretion to reduce the amount of | ||||||
19 | a proven charge sought
to be enforced against the recovery | ||||||
20 | shall rest with the party seeking such reduction.
| ||||||
21 | The court may reduce and apportion the Illinois
| ||||||
22 | Department's lien proportionate to the recovery of the | ||||||
23 | claimant. The court may
consider the nature and extent of the | ||||||
24 | injury, economic and noneconomic
loss, settlement offers, | ||||||
25 | comparative negligence as it applies to the case
at hand, | ||||||
26 | hospital costs, physician costs, and all other appropriate |
| |||||||
| |||||||
1 | costs.
The Illinois Department shall pay its pro rata share of | ||||||
2 | the attorney fees
based on the Illinois Department's lien as | ||||||
3 | it compares to the total
settlement agreed upon. This Section | ||||||
4 | shall not affect the priority of an
attorney's lien under the | ||||||
5 | Attorneys Lien Act. The charges of
the Illinois Department | ||||||
6 | described in this Section, however, shall take
priority over | ||||||
7 | all other liens and charges existing under the laws of the
| ||||||
8 | State of Illinois with the exception of the attorney's lien | ||||||
9 | under said statute.
| ||||||
10 | Whenever the Department or any unit of local government
| ||||||
11 | has a statutory charge under this Section against a recovery | ||||||
12 | for damages
incurred by a recipient because of its advancement | ||||||
13 | of any assistance, such
charge shall not be satisfied out of | ||||||
14 | any recovery until the attorney's claim
for fees is satisfied, | ||||||
15 | irrespective of whether or not an action based on
recipient's | ||||||
16 | claim has been filed in court.
| ||||||
17 | This Section shall be inapplicable to any claim, demand or | ||||||
18 | cause of
action arising under (a) the Workers' Compensation | ||||||
19 | Act or the predecessor
Workers' Compensation Act
of
June 28, | ||||||
20 | 1913, (b) the Workers' Occupational Diseases Act or the | ||||||
21 | predecessor
Workers' Occupational
Diseases Act of March 16, | ||||||
22 | 1936; and (c) the Wrongful Death Act.
| ||||||
23 | (Source: P.A. 98-73, eff. 7-15-13.)
| ||||||
24 | (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
| ||||||
25 | Sec. 11-22a. Right of Subrogation. To the extent of the |
| |||||||
| |||||||
1 | amount of (i) medical
assistance provided by the Department to | ||||||
2 | or on behalf of a recipient under
Article V or VI or (ii) , | ||||||
3 | (ii) health care benefits provided for a child under the | ||||||
4 | Covering ALL KIDS Health Insurance Act, or (iii) health care | ||||||
5 | benefits provided to a veteran under the Veterans' Health | ||||||
6 | Insurance Program Act or the Veterans' Health Insurance | ||||||
7 | Program Act of 2008, the Department shall be
subrogated
to any | ||||||
8 | right of
recovery such recipient may have under the terms of | ||||||
9 | any private or public
health care coverage or casualty | ||||||
10 | coverage, including coverage under the
"Workers' Compensation | ||||||
11 | Act", approved July 9, 1951, as amended, or the
"Workers' | ||||||
12 | Occupational Diseases Act", approved July 9, 1951, as amended,
| ||||||
13 | without the necessity of assignment of claim or other | ||||||
14 | authorization to secure
the right of recovery to the | ||||||
15 | Department. To enforce its subrogation right, the
Department | ||||||
16 | may (i) intervene or join in an action or proceeding brought by | ||||||
17 | the
recipient, his or her guardian, personal representative, | ||||||
18 | estate, dependents, or
survivors against any person or public | ||||||
19 | or private entity that may be liable;
(ii) institute and | ||||||
20 | prosecute legal proceedings against any person or public or
| ||||||
21 | private entity that may be liable for the cost of such | ||||||
22 | services; or (iii)
institute and prosecute legal proceedings, | ||||||
23 | to the extent necessary to reimburse
the Illinois Department | ||||||
24 | for its costs, against any noncustodial parent who (A)
is | ||||||
25 | required by court or administrative order to provide insurance | ||||||
26 | or other
coverage of the cost of health care services for a |
| |||||||
| |||||||
1 | child eligible for medical
assistance under this Code and (B) | ||||||
2 | has received payment from a third party for
the costs of those | ||||||
3 | services but has not used the payments to reimburse either
the | ||||||
4 | other parent or the guardian of the child or the provider of | ||||||
5 | the services.
| ||||||
6 | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | ||||||
7 | 95-755, eff. 7-25-08.)
| ||||||
8 | (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
| ||||||
9 | Sec. 11-22b. Recoveries.
| ||||||
10 | (a) As used in this Section:
| ||||||
11 | (1) "Carrier" means any insurer, including any private | ||||||
12 | company,
corporation, mutual association, trust fund, | ||||||
13 | reciprocal or interinsurance
exchange authorized under the | ||||||
14 | laws of this State to insure persons against
liability or | ||||||
15 | injuries caused to another and any insurer providing
| ||||||
16 | benefits under a policy of bodily injury liability | ||||||
17 | insurance covering
liability arising out of the ownership, | ||||||
18 | maintenance or use of a motor
vehicle which provides | ||||||
19 | uninsured motorist endorsement or coverage.
| ||||||
20 | (2) "Beneficiary" means any person or their dependents | ||||||
21 | who has received
benefits or will be provided benefits | ||||||
22 | under this Code , under the Covering ALL KIDS Health | ||||||
23 | Insurance Act, or under the Veterans' Health Insurance | ||||||
24 | Program Act or the Veterans' Health Insurance Program Act | ||||||
25 | of 2008
because of an injury for
which another person may |
| |||||||
| |||||||
1 | be liable. It includes such beneficiary's guardian,
| ||||||
2 | conservator or other personal representative, his estate | ||||||
3 | or survivors.
| ||||||
4 | (b)(1) When benefits are provided or will be provided to a | ||||||
5 | beneficiary
under this Code , under the Covering ALL KIDS | ||||||
6 | Health Insurance Act, or under the Veterans' Health Insurance | ||||||
7 | Program Act or the Veterans' Health Insurance Program Act of | ||||||
8 | 2008 because of an injury for which another person is liable, | ||||||
9 | or
for which a carrier is liable in accordance with the | ||||||
10 | provisions of any
policy of insurance issued pursuant to the | ||||||
11 | Illinois Insurance Code, the
Illinois Department shall have a | ||||||
12 | right to recover from such person or carrier
the reasonable | ||||||
13 | value of benefits so provided. The Attorney General may, to
| ||||||
14 | enforce such right, institute and prosecute legal proceedings | ||||||
15 | against the
third person or carrier who may be liable for the | ||||||
16 | injury in an appropriate
court, either in the name of the | ||||||
17 | Illinois Department or in the name of the
injured person, his | ||||||
18 | guardian, personal representative, estate, or survivors.
| ||||||
19 | (2) The Department may:
| ||||||
20 | (A) compromise or settle and release any such claim | ||||||
21 | for benefits
provided under this Code, or
| ||||||
22 | (B) waive any such claims for benefits provided under | ||||||
23 | this Code, in
whole or in part, for the convenience of the | ||||||
24 | Department or if the Department
determines that collection | ||||||
25 | would result in undue hardship upon the person who
| ||||||
26 | suffered the injury or, in a wrongful death action, upon |
| |||||||
| |||||||
1 | the heirs of the
deceased.
| ||||||
2 | (3) No action taken on behalf of the Department pursuant | ||||||
3 | to this Section
or any judgment rendered in such action shall | ||||||
4 | be a bar to any action upon
the claim or cause of action of the | ||||||
5 | beneficiary, his guardian, conservator,
personal | ||||||
6 | representative, estate, dependents or survivors against the | ||||||
7 | third
person who may be liable for the injury, or shall operate | ||||||
8 | to deny to the
beneficiary the recovery for that portion of any | ||||||
9 | damages not covered hereunder.
| ||||||
10 | (c)(1) When an action is brought by the Department | ||||||
11 | pursuant to
subsection (b), it shall be commenced within the | ||||||
12 | period prescribed by
Article XIII of the Code of Civil | ||||||
13 | Procedure.
| ||||||
14 | However, the Department may not commence the action prior | ||||||
15 | to 5 months
before the end of the applicable period prescribed | ||||||
16 | by Article XIII of the
Code of Civil Procedure. Thirty days | ||||||
17 | prior to commencing an action, the
Department shall notify the | ||||||
18 | beneficiary of the Department's intent to
commence such an | ||||||
19 | action.
| ||||||
20 | (2) The death of the beneficiary does not abate any right | ||||||
21 | of action
established by subsection (b).
| ||||||
22 | (3) When an action or claim is brought by persons entitled | ||||||
23 | to bring such
actions or assert such claims against a third | ||||||
24 | person who may be liable for
causing the death of a | ||||||
25 | beneficiary, any settlement, judgment or award
obtained is | ||||||
26 | subject to the Department's claim for reimbursement of the
|
| |||||||
| |||||||
1 | benefits provided to the beneficiary under this Code , under | ||||||
2 | the Covering ALL KIDS Health Insurance Act, or under the | ||||||
3 | Veterans' Health Insurance Program Act or the Veterans' Health | ||||||
4 | Insurance Program Act of 2008.
| ||||||
5 | (4) When the action or claim is brought by the beneficiary | ||||||
6 | alone and
the beneficiary incurs a personal liability to pay | ||||||
7 | attorney's fees and
costs of litigation, the Department's | ||||||
8 | claim for reimbursement of the
benefits provided to the | ||||||
9 | beneficiary shall be the full amount of benefits
paid on | ||||||
10 | behalf of the beneficiary under this Code , under the Covering | ||||||
11 | ALL KIDS Health Insurance Act, or under the Veterans' Health | ||||||
12 | Insurance Program Act or the Veterans' Health Insurance | ||||||
13 | Program Act of 2008 less a pro rata
share which represents the | ||||||
14 | Department's reasonable share of attorney's fees
paid by the | ||||||
15 | beneficiary and that portion of the cost of litigation | ||||||
16 | expenses
determined by multiplying by the ratio of the full | ||||||
17 | amount of the
expenditures of the full amount of the judgment, | ||||||
18 | award or settlement.
| ||||||
19 | (d)(1) If either the beneficiary or the Department brings | ||||||
20 | an action or
claim against such third party or carrier, the | ||||||
21 | beneficiary or the
Department shall within 30 days of filing | ||||||
22 | the action give to the other
written notice by personal | ||||||
23 | service or registered mail of the action or
claim and of the | ||||||
24 | name of the court in which the
action or claim is brought. | ||||||
25 | Proof of such notice shall be filed in such
action or claim. If | ||||||
26 | an action or claim is brought by either the Department
or the |
| |||||||
| |||||||
1 | beneficiary, the other may, at any time before trial on the | ||||||
2 | facts,
become a party to such action or claim or shall | ||||||
3 | consolidate his action or
claim with the other if brought | ||||||
4 | independently.
| ||||||
5 | (2) If an action or claim is brought by the Department | ||||||
6 | pursuant to
subsection (b)(1), written notice to the | ||||||
7 | beneficiary, guardian, personal
representative, estate or | ||||||
8 | survivor given pursuant to this Section shall
advise him of | ||||||
9 | his right to intervene in the proceeding, his right to obtain
a | ||||||
10 | private attorney of his choice and the Department's right to | ||||||
11 | recover the
reasonable value of the benefits provided.
| ||||||
12 | (e) In the event of judgment or award in a suit or claim | ||||||
13 | against such
third person or carrier:
| ||||||
14 | (1) If the action or claim is prosecuted by the | ||||||
15 | beneficiary alone, the
court shall first order paid from | ||||||
16 | any judgment or award the
reasonable litigation expenses | ||||||
17 | incurred in preparation and prosecution of
such action or | ||||||
18 | claim, together with reasonable attorney's fees, when an
| ||||||
19 | attorney has been retained. After payment of such expenses | ||||||
20 | and attorney's
fees the court shall, on the application of | ||||||
21 | the Department, allow
as a first lien against the amount | ||||||
22 | of such judgment or award the amount of
the Department's | ||||||
23 | expenditures for the benefit of the beneficiary under this
| ||||||
24 | Code , under the Covering ALL KIDS Health Insurance Act, or | ||||||
25 | under the Veterans' Health Insurance Program Act or the | ||||||
26 | Veterans' Health Insurance Program Act of 2008, as |
| |||||||
| |||||||
1 | provided in subsection (c)(4).
| ||||||
2 | (2) If the action or claim is prosecuted both by the | ||||||
3 | beneficiary and the
Department, the court shall first | ||||||
4 | order paid from any judgment or
award the reasonable | ||||||
5 | litigation expenses incurred in preparation and
| ||||||
6 | prosecution of such action or claim, together with | ||||||
7 | reasonable attorney's
fees for plaintiffs attorneys based | ||||||
8 | solely on the services rendered for the
benefit of the | ||||||
9 | beneficiary. After payment of such expenses and attorney's
| ||||||
10 | fees, the court shall apply out of the balance of such | ||||||
11 | judgment or award an
amount sufficient to reimburse the | ||||||
12 | Department the full amount of benefits
paid on behalf of | ||||||
13 | the beneficiary under this Code , under the Covering ALL | ||||||
14 | KIDS Health Insurance Act, or under the Veterans' Health | ||||||
15 | Insurance Program Act or the Veterans' Health Insurance | ||||||
16 | Program Act of 2008.
| ||||||
17 | (f) The court shall, upon further application at any time
| ||||||
18 | before the judgment or award is satisfied, allow as a further | ||||||
19 | lien the
amount of any expenditures of the Department in | ||||||
20 | payment of additional
benefits arising out of the same cause | ||||||
21 | of action or claim provided on
behalf of the beneficiary under | ||||||
22 | this Code , under the Covering ALL KIDS Health Insurance Act, | ||||||
23 | or under the Veterans' Health Insurance Program Act or the | ||||||
24 | Veterans' Health Insurance Program Act of 2008, when such | ||||||
25 | benefits were
provided or became payable subsequent to the | ||||||
26 | original order.
|
| |||||||
| |||||||
1 | (g) No judgment, award, or settlement in any action or | ||||||
2 | claim by a
beneficiary to recover damages for injuries, when | ||||||
3 | the Department has an
interest, shall be satisfied without | ||||||
4 | first giving the Department notice and
a reasonable | ||||||
5 | opportunity to perfect and satisfy its lien.
| ||||||
6 | (h) When the Department has perfected a lien upon a | ||||||
7 | judgment or award in
favor of a beneficiary against any third | ||||||
8 | party for an injury for which the
beneficiary has received | ||||||
9 | benefits under this Code , under the Covering ALL KIDS Health | ||||||
10 | Insurance Act, or under the Veterans' Health Insurance Program | ||||||
11 | Act or the Veterans' Health Insurance Program Act of 2008, the | ||||||
12 | Department shall be
entitled to a writ of execution as lien | ||||||
13 | claimant to enforce payment of said
lien against such third | ||||||
14 | party with interest and other accruing costs as in
the case of | ||||||
15 | other executions. In the event the amount of such judgment or
| ||||||
16 | award so recovered has been paid to the beneficiary, the | ||||||
17 | Department shall
be entitled to a writ of execution against | ||||||
18 | such beneficiary to the extent of
the Department's lien, with | ||||||
19 | interest and other accruing costs as in the case
of other | ||||||
20 | executions.
| ||||||
21 | (i) Except as otherwise provided in this Section, | ||||||
22 | notwithstanding any
other provision of law, the entire amount | ||||||
23 | of any settlement of the injured
beneficiary's action or | ||||||
24 | claim, with or without suit, is subject to the
Department's | ||||||
25 | claim for reimbursement of the benefits provided and any lien
| ||||||
26 | filed pursuant thereto to the same extent and subject to the |
| |||||||
| |||||||
1 | same
limitations as in Section 11-22 of this Code.
| ||||||
2 | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | ||||||
3 | 95-755, eff. 7-25-08.)
| ||||||
4 | (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
| ||||||
5 | Sec. 11-22c. Recovery of back wages. | ||||||
6 | (a) As used in this Section, "recipient" means any person
| ||||||
7 | receiving financial assistance under Article IV or Article VI | ||||||
8 | of this Code , receiving health care benefits under the | ||||||
9 | Covering ALL KIDS Health Insurance Act, or receiving health | ||||||
10 | care benefits under the Veterans' Health Insurance Program Act | ||||||
11 | or the Veterans' Health Insurance Program Act of 2008.
| ||||||
12 | (b) If a recipient maintains any suit, charge or other | ||||||
13 | court or
administrative action against an employer seeking | ||||||
14 | back pay for a period
during which the recipient received | ||||||
15 | financial assistance under Article IV
or Article VI of this | ||||||
16 | Code , health care benefits under the Covering ALL KIDS Health | ||||||
17 | Insurance Act, or health care benefits under the Veterans' | ||||||
18 | Health Insurance Program Act or the Veterans' Health Insurance | ||||||
19 | Program Act of 2008, the recipient shall report such fact to | ||||||
20 | the
Department. To the extent of the amount of assistance | ||||||
21 | provided to or on
behalf of the recipient under Article IV or | ||||||
22 | Article VI , health care benefits provided under the Covering | ||||||
23 | ALL KIDS Health Insurance Act, or health care benefits | ||||||
24 | provided under the Veterans' Health Insurance Program Act or | ||||||
25 | the Veterans' Health Insurance Program Act of 2008, the |
| |||||||
| |||||||
1 | Department may
by intervention or otherwise without the | ||||||
2 | necessity of assignment of claim,
attach a lien on the | ||||||
3 | recovery of back wages equal to the amount of
assistance | ||||||
4 | provided by the Department to the recipient under Article IV | ||||||
5 | or
Article VI , under the Covering ALL KIDS Health Insurance | ||||||
6 | Act, or under the Veterans' Health Insurance Program Act or | ||||||
7 | the Veterans' Health Insurance Program Act of 2008.
| ||||||
8 | (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; | ||||||
9 | 95-755, eff. 7-25-08.)
| ||||||
10 | (305 ILCS 5/12-4.35)
| ||||||
11 | Sec. 12-4.35. Medical services for certain noncitizens.
| ||||||
12 | (a) Notwithstanding
Section 1-11 of this Code or Section | ||||||
13 | 20(a) of the Children's Health Insurance
Program Act , the | ||||||
14 | Department of Healthcare and Family Services may provide | ||||||
15 | medical services to
noncitizens who have not yet attained 19 | ||||||
16 | years of age and who are not eligible
for medical assistance | ||||||
17 | under Article V of this Code or under the Children's
Health | ||||||
18 | Insurance Program created by the Children's Health Insurance | ||||||
19 | Program Act
due to their not meeting the otherwise applicable | ||||||
20 | provisions of Section 1-11
of this Code or Section 20(a) of the | ||||||
21 | Children's Health Insurance Program Act .
The medical services | ||||||
22 | available, standards for eligibility, and other conditions
of | ||||||
23 | participation under this Section shall be established by rule | ||||||
24 | by the
Department; however, any such rule shall be at least as | ||||||
25 | restrictive as the
rules for medical assistance under Article |
| |||||||
| |||||||
1 | V of this Code or the Children's
Health Insurance Program | ||||||
2 | created by the Children's Health Insurance Program
Act .
| ||||||
3 | (a-5) Notwithstanding Section 1-11 of this Code, the | ||||||
4 | Department of Healthcare and Family Services may provide | ||||||
5 | medical assistance in accordance with Article V of this Code | ||||||
6 | to noncitizens over the age of 65 years of age who are not | ||||||
7 | eligible for medical assistance under Article V of this Code | ||||||
8 | due to their not meeting the otherwise applicable provisions | ||||||
9 | of Section 1-11 of this Code, whose income is at or below 100% | ||||||
10 | of the federal poverty level after deducting the costs of | ||||||
11 | medical or other remedial care, and who would otherwise meet | ||||||
12 | the eligibility requirements in Section 5-2 of this Code. The | ||||||
13 | medical services available, standards for eligibility, and | ||||||
14 | other conditions of participation under this Section shall be | ||||||
15 | established by rule by the Department; however, any such rule | ||||||
16 | shall be at least as restrictive as the rules for medical | ||||||
17 | assistance under Article V of this Code. | ||||||
18 | (b) The Department is authorized to take any action that | ||||||
19 | would not otherwise be prohibited by applicable law , including | ||||||
20 | without
limitation cessation or limitation of enrollment, | ||||||
21 | reduction of available medical services,
and changing | ||||||
22 | standards for eligibility, that is deemed necessary by the
| ||||||
23 | Department during a State fiscal year to assure that payments | ||||||
24 | under this
Section do not exceed available funds.
| ||||||
25 | (c) (Blank). Continued enrollment of
individuals into the | ||||||
26 | program created under subsection (a) of this Section in any |
| |||||||
| |||||||
1 | fiscal year is
contingent upon continued enrollment of | ||||||
2 | individuals into the Children's Health
Insurance Program | ||||||
3 | during that fiscal year.
| ||||||
4 | (d) (Blank).
| ||||||
5 | (Source: P.A. 101-636, eff. 6-10-20.)
| ||||||
6 | (305 ILCS 5/12-4.45) | ||||||
7 | Sec. 12-4.45. Third party liability. | ||||||
8 | (a) To the extent authorized under federal law, the | ||||||
9 | Department of Healthcare and Family Services shall identify | ||||||
10 | individuals receiving services under medical assistance | ||||||
11 | programs funded or partially funded by the State who may be or | ||||||
12 | may have been covered by a third party health insurer, the | ||||||
13 | period of coverage for such individuals, and the nature of | ||||||
14 | coverage. A company, as defined in Section 5.5 of the Illinois | ||||||
15 | Insurance Code and Section 2 of the Comprehensive Health | ||||||
16 | Insurance Plan Act, must provide the Department eligibility | ||||||
17 | information in a federally recommended or mutually agreed-upon | ||||||
18 | format that includes at a minimum: | ||||||
19 | (1) The names, addresses, dates, and sex of primary | ||||||
20 | covered persons. | ||||||
21 | (2) The policy group numbers of the covered persons. | ||||||
22 | (3) The names, dates of birth, and sex of covered | ||||||
23 | dependents, and the relationship of dependents to the | ||||||
24 | primary covered person. | ||||||
25 | (4) The effective dates of coverage for each covered |
| |||||||
| |||||||
1 | person. | ||||||
2 | (5) The generally defined covered services | ||||||
3 | information, such as drugs, medical, or any other similar | ||||||
4 | description of services covered. | ||||||
5 | (b) The Department may impose an administrative penalty on | ||||||
6 | a company that does not comply with the request for | ||||||
7 | information made under Section 5.5 of the Illinois Insurance | ||||||
8 | Code and paragraph (3) of subsection (a) of Section 20 of the | ||||||
9 | Covering ALL KIDS Health Insurance Act . The amount of the | ||||||
10 | penalty shall not exceed $10,000 per day for each day of | ||||||
11 | noncompliance that occurs after the 180th day after the date | ||||||
12 | of the request. The first day of the 180-day period commences | ||||||
13 | on the business day following the date of the correspondence | ||||||
14 | requesting the information sent by the Department to the | ||||||
15 | company. The amount shall be based on: | ||||||
16 | (1) The seriousness of the violation, including the | ||||||
17 | nature, circumstances, extent, and gravity of the | ||||||
18 | violation. | ||||||
19 | (2) The economic harm caused by the violation. | ||||||
20 | (3) The history of previous violations. | ||||||
21 | (4) The amount necessary to deter a future violation. | ||||||
22 | (5) Efforts to correct the violation. | ||||||
23 | (6) Any other matter that justice may require. | ||||||
24 | (c) The enforcement of the penalty may be stayed during | ||||||
25 | the time the order is under administrative review if the | ||||||
26 | company files an appeal. |
| |||||||
| |||||||
1 | (d) The Attorney General may bring suit on behalf of the | ||||||
2 | Department to collect the penalty. | ||||||
3 | (e) Recoveries made by the Department in connection with | ||||||
4 | the imposition of an administrative penalty as provided under | ||||||
5 | this Section shall be deposited into the Public Aid Recoveries | ||||||
6 | Trust Fund created under Section 12-9.
| ||||||
7 | (Source: P.A. 98-130, eff. 8-2-13; 98-756, eff. 7-16-14.)
| ||||||
8 | (305 ILCS 5/12-9) (from Ch. 23, par. 12-9)
| ||||||
9 | Sec. 12-9. Public Aid Recoveries Trust Fund; uses. The | ||||||
10 | Public Aid Recoveries Trust Fund shall consist of (1)
| ||||||
11 | recoveries by the Department of Healthcare and Family Services | ||||||
12 | (formerly Illinois Department of Public Aid) authorized by | ||||||
13 | this Code
in respect to applicants or recipients under | ||||||
14 | Articles III, IV, V, and VI,
including recoveries made by the | ||||||
15 | Department of Healthcare and Family Services (formerly | ||||||
16 | Illinois Department of Public
Aid) from the estates of | ||||||
17 | deceased recipients, (2) recoveries made by the
Department of | ||||||
18 | Healthcare and Family Services (formerly Illinois Department | ||||||
19 | of Public Aid) in respect to applicants and recipients under
| ||||||
20 | the Children's Health Insurance Program Act, and the Covering | ||||||
21 | ALL KIDS Health Insurance Act, (2.5) recoveries made by the | ||||||
22 | Department of Healthcare and Family Services in connection | ||||||
23 | with the imposition of an administrative penalty as provided | ||||||
24 | under Section 12-4.45, (3) federal funds received on
behalf of | ||||||
25 | and earned by State universities and local governmental |
| |||||||
| |||||||
1 | entities
for services provided to
applicants or recipients | ||||||
2 | covered under this Code, the Children's Health Insurance | ||||||
3 | Program Act, and the Covering ALL KIDS Health Insurance Act, | ||||||
4 | (3.5) federal financial participation revenue related to | ||||||
5 | eligible disbursements made by the Department of Healthcare | ||||||
6 | and Family Services from appropriations required by this | ||||||
7 | Section, and (4) all other moneys received to the Fund, | ||||||
8 | including interest thereon. The Fund shall be held
as a | ||||||
9 | special fund in the State Treasury.
| ||||||
10 | Disbursements from this Fund shall be only (1) for the | ||||||
11 | reimbursement of
claims collected by the Department of | ||||||
12 | Healthcare and Family Services (formerly Illinois Department | ||||||
13 | of Public Aid) through error
or mistake, (2) for payment to | ||||||
14 | persons or agencies designated as payees or
co-payees on any | ||||||
15 | instrument, whether or not negotiable, delivered to the
| ||||||
16 | Department of Healthcare and Family Services (formerly
| ||||||
17 | Illinois Department of Public Aid) as a recovery under this | ||||||
18 | Section, such
payment to be in proportion to the respective | ||||||
19 | interests of the payees in the
amount so collected, (3) for | ||||||
20 | payments to the Department of Human Services
for collections | ||||||
21 | made by the Department of Healthcare and Family Services | ||||||
22 | (formerly Illinois Department of Public Aid) on behalf of
the | ||||||
23 | Department of Human Services under this Code, the Children's | ||||||
24 | Health Insurance Program Act, and the Covering ALL KIDS Health | ||||||
25 | Insurance Act, (4) for payment of
administrative expenses | ||||||
26 | incurred in performing the
activities authorized under this |
| |||||||
| |||||||
1 | Code, the Children's Health Insurance Program Act, and the | ||||||
2 | Covering ALL KIDS Health Insurance Act, (5)
for payment of | ||||||
3 | fees to persons or agencies in the performance of activities
| ||||||
4 | pursuant to the collection of monies owed the State that are | ||||||
5 | collected
under this Code, the Children's Health Insurance | ||||||
6 | Program Act, and the Covering ALL KIDS Health Insurance Act, | ||||||
7 | (6) for payments of any amounts which are
reimbursable to the | ||||||
8 | federal government which are required to be paid by State
| ||||||
9 | warrant by either the State or federal government, and (7) for | ||||||
10 | payments
to State universities and local governmental entities | ||||||
11 | of federal funds for
services provided to
applicants or | ||||||
12 | recipients covered under this Code , the Children's Health | ||||||
13 | Insurance Program Act, and the Covering ALL KIDS Health | ||||||
14 | Insurance Act . Disbursements
from this Fund for purposes of | ||||||
15 | items (4) and (5) of this
paragraph shall be subject to | ||||||
16 | appropriations from the Fund to the Department of Healthcare | ||||||
17 | and Family Services (formerly Illinois
Department of Public | ||||||
18 | Aid).
| ||||||
19 | The balance in this Fund after
payment therefrom of any | ||||||
20 | amounts reimbursable to the federal government, and
minus the | ||||||
21 | amount reasonably anticipated to be needed to make the | ||||||
22 | disbursements
authorized by this Section during the current | ||||||
23 | and following 3 calendar months, shall be certified by the
| ||||||
24 | Director of Healthcare and Family Services and transferred by | ||||||
25 | the
State Comptroller to the Drug Rebate Fund or the | ||||||
26 | Healthcare Provider Relief Fund in
the State Treasury, as |
| |||||||
| |||||||
1 | appropriate, on at least an annual basis by June 30th of each | ||||||
2 | fiscal year. The Director of Healthcare and Family Services | ||||||
3 | may certify and the State Comptroller shall transfer to the | ||||||
4 | Drug Rebate Fund or the Healthcare Provider Relief Fund | ||||||
5 | amounts on a more frequent basis.
| ||||||
6 | On July 1, 1999, the State Comptroller shall transfer the | ||||||
7 | sum of $5,000,000
from the Public Aid Recoveries Trust Fund | ||||||
8 | (formerly the Public Assistance
Recoveries Trust Fund) into | ||||||
9 | the DHS Recoveries Trust Fund.
| ||||||
10 | (Source: P.A. 97-647, eff. 1-1-12; 97-689, eff. 6-14-12; | ||||||
11 | 98-130, eff. 8-2-13; 98-651, eff. 6-16-14.)
| ||||||
12 | (305 ILCS 5/12-10.4)
| ||||||
13 | Sec. 12-10.4. Juvenile Rehabilitation Services Medicaid | ||||||
14 | Matching Fund.
There is created in the State Treasury the | ||||||
15 | Juvenile Rehabilitation Services
Medicaid Matching Fund. | ||||||
16 | Deposits to this Fund shall consist of all moneys
received | ||||||
17 | from the federal government for behavioral health services | ||||||
18 | secured by
counties pursuant to an agreement with the | ||||||
19 | Department of Healthcare and Family Services with respect to | ||||||
20 | Title XIX of the
Social Security Act or under the Children's | ||||||
21 | Health Insurance Program pursuant
to the Children's Health | ||||||
22 | Insurance Program Act and Title XXI of the Social
Security Act | ||||||
23 | for minors who are committed to mental health facilities by | ||||||
24 | the
Illinois court system and for residential placements | ||||||
25 | secured by the
Department of Juvenile Justice for minors as a |
| |||||||
| |||||||
1 | condition of their aftercare release.
| ||||||
2 | Disbursements from the Fund shall be made, subject to | ||||||
3 | appropriation, by the
Department of Healthcare and Family | ||||||
4 | Services for grants to the Department of Juvenile Justice
and | ||||||
5 | those counties which secure behavioral health services ordered | ||||||
6 | by the
courts and which have an interagency agreement with the | ||||||
7 | Department and submit
detailed bills according to standards | ||||||
8 | determined by the Department.
| ||||||
9 | (Source: P.A. 98-558, eff. 1-1-14.)
| ||||||
10 | (305 ILCS 5/5-29 rep.) | ||||||
11 | Section 60. The Illinois Public Aid Code is amended by | ||||||
12 | repealing Section 5-29. | ||||||
13 | Section 65. The Early Intervention Services System Act is | ||||||
14 | amended by changing Section 13.5 as follows:
| ||||||
15 | (325 ILCS 20/13.5)
| ||||||
16 | Sec. 13.5. Other programs.
| ||||||
17 | (a) When an application or a review of
eligibility for | ||||||
18 | early
intervention services is made, and at any
eligibility | ||||||
19 | redetermination
thereafter, the family shall be asked if it
is | ||||||
20 | currently enrolled in
any federally funded, Department of | ||||||
21 | Healthcare and Family Services administered, medical programs, | ||||||
22 | or the Title V program
administered by the University of | ||||||
23 | Illinois
Division of
Specialized Care for Children. If the
|
| |||||||
| |||||||
1 | family is enrolled in any of these
programs, that information | ||||||
2 | shall be put on
the individualized family service
plan and | ||||||
3 | entered into the computerized case
management system, and | ||||||
4 | shall
require that the individualized family
services plan of | ||||||
5 | a child who has been
found eligible for services through the
| ||||||
6 | Division of Specialized Care for
Children state that the child | ||||||
7 | is enrolled
in that program. For those
programs in which the | ||||||
8 | family is not
enrolled, a preliminary eligibility
screen shall | ||||||
9 | be
conducted simultaneously
for (i) medical assistance
| ||||||
10 | (Medicaid) under
Article V of the Illinois Public Aid Code and | ||||||
11 | (ii) , (ii)
children's
health insurance program (any federally | ||||||
12 | funded, Department of Healthcare and Family Services | ||||||
13 | administered, medical programs) benefits
under the
Children's | ||||||
14 | Health Insurance Program Act, and (iii)
Title V
maternal and | ||||||
15 | child health services provided
through the
Division of | ||||||
16 | Specialized Care for Children of the
University
of Illinois.
| ||||||
17 | (b) For purposes of determining family fees
under
| ||||||
18 | subsection (f) of Section 13 and determining
eligibility for
| ||||||
19 | the other programs and services specified in
items (i)
through | ||||||
20 | (iii) of subsection (a), the lead agency
shall
develop and | ||||||
21 | use, within 60 days after the effective
date of
this | ||||||
22 | amendatory Act of the 92nd General Assembly,
with the
| ||||||
23 | cooperation of the Department of Public Aid (now Healthcare | ||||||
24 | and Family Services)
and the
Division
of Specialized Care for | ||||||
25 | Children of the
University of
Illinois, a screening device | ||||||
26 | that provides
sufficient
information for the early |
| |||||||
| |||||||
1 | intervention regional
intake
entities or other agencies to | ||||||
2 | establish eligibility for
those
other programs
and shall, in | ||||||
3 | cooperation with the Illinois
Department of Public Aid (now | ||||||
4 | Healthcare and Family Services) and the Division
of | ||||||
5 | Specialized Care for Children, train the
regional intake | ||||||
6 | entities
on using the screening device.
| ||||||
7 | (c) When a child is
determined eligible for and enrolled
| ||||||
8 | in the early intervention
program and has been found to at | ||||||
9 | least meet
the threshold income
eligibility requirements for | ||||||
10 | any federally funded, Department of Healthcare and Family | ||||||
11 | Services administered, medical programs, the regional intake | ||||||
12 | entity
shall complete an application for any federally funded, | ||||||
13 | Department of Healthcare and Family Services administered, | ||||||
14 | medical programs with the family and forward it
to the
| ||||||
15 | Department of Healthcare and Family Services for a | ||||||
16 | determination of
eligibility. A parent shall not be required | ||||||
17 | to enroll in any federally funded, Department of Healthcare | ||||||
18 | and Family Services administered, medical programs as a | ||||||
19 | condition of receiving services provided pursuant to Part C of | ||||||
20 | the Individuals with Disabilities Education Act.
| ||||||
21 | (d) With the cooperation of the Department of Healthcare | ||||||
22 | and Family Services, the lead agency shall establish | ||||||
23 | procedures that
ensure
the timely and maximum allowable | ||||||
24 | recovery of payments
for all
early intervention services and | ||||||
25 | allowable
administrative
costs under Article V of the Illinois | ||||||
26 | Public Aid
Code and the
Children's Health Insurance Program |
| |||||||
| |||||||
1 | Act and shall include
those procedures in the interagency | ||||||
2 | agreement required under subsection (e) of
Section 5 of this | ||||||
3 | Act.
| ||||||
4 | (e) (Blank). For purposes of making referrals for final
| ||||||
5 | determinations of eligibility for any federally funded, | ||||||
6 | Department of Healthcare and Family Services administered, | ||||||
7 | medical programs benefits
under the Children's Health | ||||||
8 | Insurance Program Act and for medical assistance
under Article | ||||||
9 | V of the Illinois Public Aid Code,
the lead agency shall | ||||||
10 | require each early intervention regional intake entity to
| ||||||
11 | enroll as an application agent in order for the entity to | ||||||
12 | complete any federally funded, Department of Healthcare and | ||||||
13 | Family Services administered, medical programs
application as | ||||||
14 | authorized under Section 22 of the Children's Health Insurance
| ||||||
15 | Program Act.
| ||||||
16 | (f) For purposes of early intervention services that may | ||||||
17 | be provided
by the Division of Specialized Care for Children | ||||||
18 | of the University of Illinois
(DSCC), the lead agency shall | ||||||
19 | establish procedures whereby the early
intervention regional
| ||||||
20 | intake entities may determine whether children enrolled in the | ||||||
21 | early
intervention program may also be eligible for those | ||||||
22 | services, and shall
develop, within 60 days after the | ||||||
23 | effective date of this amendatory Act of the
92nd General | ||||||
24 | Assembly, (i) the inter-agency agreement required under | ||||||
25 | subsection
(e) of Section 5 of this Act, establishing that | ||||||
26 | early intervention funds are to
be used as the payor of last |
| |||||||
| |||||||
1 | resort when services required under an
individualized family | ||||||
2 | services plan may be provided to an eligible child
through the | ||||||
3 | DSCC, and (ii) training
guidelines for the regional intake | ||||||
4 | entities
and providers that explain eligibility and billing | ||||||
5 | procedures for
services through DSCC.
| ||||||
6 | (g) The lead agency shall require that an
individual | ||||||
7 | applying for or renewing
enrollment as a provider of services | ||||||
8 | in the
early intervention program state whether or
not he or | ||||||
9 | she is also enrolled as a DSCC
provider. This information | ||||||
10 | shall be noted
next to the name of the provider on the
| ||||||
11 | computerized roster of Illinois early
intervention providers, | ||||||
12 | and regional intake
entities shall make every effort to refer
| ||||||
13 | families eligible for DSCC services to
these providers.
| ||||||
14 | (Source: P.A. 98-41, eff. 6-28-13.)
| ||||||
15 | Section 70. The Veterans' Health Insurance Program Act of | ||||||
16 | 2008 is amended by changing Section 15 as follows: | ||||||
17 | (330 ILCS 126/15)
| ||||||
18 | Sec. 15. Eligibility. | ||||||
19 | (a) To be eligible for the Program, a person must: | ||||||
20 | (1) be a veteran who is not on active duty and who has | ||||||
21 | not been dishonorably discharged from service or the | ||||||
22 | spouse of such a veteran; | ||||||
23 | (2) be a resident of the State of Illinois; | ||||||
24 | (3) be at least 19 years of age and no older than 64 |
| |||||||
| |||||||
1 | years of age; | ||||||
2 | (4) be uninsured, as defined by the Department by | ||||||
3 | rule, for a period of time established by the Department | ||||||
4 | by rule, which shall be no less than 3 months; | ||||||
5 | (5) not be eligible for medical assistance under the | ||||||
6 | Illinois Public Aid Code or healthcare benefits under the | ||||||
7 | Children's Health Insurance Program Act or the Covering | ||||||
8 | ALL KIDS Health Insurance Act ; | ||||||
9 | (6) not be eligible for medical benefits through the | ||||||
10 | Veterans Health Administration; and | ||||||
11 | (7) have a household income no greater than the sum of | ||||||
12 | (i) an amount equal to 25% of the federal poverty level | ||||||
13 | plus (ii) an amount equal to the Veterans Administration | ||||||
14 | means test income threshold at the initiation of the | ||||||
15 | Program; depending on the availability of funds, this | ||||||
16 | level may be increased to an amount equal to the sum of | ||||||
17 | (iii) an amount equal to 50% of the federal poverty level | ||||||
18 | plus (iv) an amount equal to the Veterans Administration | ||||||
19 | means test income threshold. This means test income | ||||||
20 | threshold is subject to alteration by the Department as | ||||||
21 | set forth in subsection (b) of Section 10. | ||||||
22 | (b) A veteran or spouse who is determined eligible for the | ||||||
23 | Program shall remain eligible for 12 months, provided the | ||||||
24 | veteran or spouse remains a resident of the State and is not | ||||||
25 | excluded under subsection (c) of this Section and provided the | ||||||
26 | Department has not limited the enrollment period as set forth |
| |||||||
| |||||||
1 | in subsection (b) of Section 10. | ||||||
2 | (c) A veteran or spouse is not eligible for coverage under | ||||||
3 | the Program if: | ||||||
4 | (1) the premium required under Section 35 of this Act | ||||||
5 | has not been timely paid; if the required premiums are not | ||||||
6 | paid, the liability of the Program shall be limited to | ||||||
7 | benefits incurred under the Program for the time period | ||||||
8 | for which premiums have been paid and for grace periods as | ||||||
9 | established under subsection (d); if the required monthly | ||||||
10 | premium is not paid, the veteran or spouse is ineligible | ||||||
11 | for re-enrollment for a minimum period of 3 months; or | ||||||
12 | (2) the veteran or spouse is a resident of a nursing | ||||||
13 | facility or an inmate of a public institution, as defined | ||||||
14 | by 42 CFR 435.1009. | ||||||
15 | (d) The Department shall adopt rules for the Program, | ||||||
16 | including, but not limited to, rules relating to eligibility, | ||||||
17 | re-enrollment, grace periods, notice requirements, hearing | ||||||
18 | procedures, cost-sharing, covered services, and provider | ||||||
19 | requirements.
| ||||||
20 | (Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09 .)
| ||||||
21 | (215 ILCS 106/Act rep.)
| ||||||
22 | Section 75. The Children's Health Insurance Program Act is | ||||||
23 | repealed. | ||||||
24 | (215 ILCS 170/Act rep.)
|
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1 | Section 80. The Covering ALL KIDS Health Insurance Act is | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
2 | repealed.
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