102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3119

 

Introduced 2/19/2021, by Rep. Robyn Gabel

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Public Aid Code. Provides that, subject to federal approval, children younger than age 19 shall be eligible for medical assistance when countable income is at or below 313% (rather than 133%) of the federal poverty level as determined by the Department of Healthcare and Family Services and in accordance with applicable federal requirements. Provides that any individual determined eligible for medical assistance as of or during the COVID-19 public health emergency may be treated as eligible for such medical assistance benefits during the COVID-19 public health emergency, and up to 12 months after the period expires, regardless of whether federally required or whether the individual's eligibility may be State or federally funded, unless the individual requests a voluntary termination of eligibility or ceases to be a resident. Provides that the amendatory Act shall not restrict any determination of medical need or appropriateness for any particular service and shall not require continued coverage of any particular service that may be no longer necessary, appropriate, or otherwise authorized for an individual. Provides that nothing shall prevent the Department from determining and properly establishing an individual's eligibility under a different category of eligibility. Repeals the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act. Makes conforming changes to various Acts.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3119LRB102 14580 KTG 19933 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Finance Act is amended by changing
5Sections 6z-52, 6z-81, and 25 as follows:
 
6    (30 ILCS 105/6z-52)
7    Sec. 6z-52. Drug Rebate Fund.
8    (a) There is created in the State Treasury a special fund
9to be known as the Drug Rebate Fund.
10    (b) The Fund is created for the purpose of receiving and
11disbursing moneys in accordance with this Section.
12Disbursements from the Fund shall be made, subject to
13appropriation, only as follows:
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.
20        (1.5) For payments to managed care organizations as
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.
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:
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
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
15to be known as the Healthcare Provider Relief Fund.
16    (b) The Fund is created for the purpose of receiving and
17disbursing moneys in accordance with this Section.
18Disbursements 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

 

 

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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
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
8provided for by law, on the effective date of Public Act 97-44,
9or as soon thereafter as practical, the State Comptroller
10shall direct and the State Treasurer shall transfer the sum of
11$365,000,000 from the General Revenue Fund into the Healthcare
12Provider Relief Fund.
13    (e) In addition to any other transfers that may be
14provided for by law, on July 1, 2011, or as soon thereafter as
15practical, the State Comptroller shall direct and the State
16Treasurer shall transfer the sum of $160,000,000 from the
17General Revenue Fund to the Healthcare Provider Relief Fund.
18    (f) Notwithstanding any other State law to the contrary,
19and in addition to any other transfers that may be provided for
20by law, the State Comptroller shall order transferred and the
21State Treasurer shall transfer $500,000,000 to the Healthcare
22Provider Relief Fund from the General Revenue Fund in equal
23monthly installments of $100,000,000, with the first transfer
24to be made on July 1, 2012, or as soon thereafter as practical,
25and with each of the remaining transfers to be made on August
261, 2012, September 1, 2012, October 1, 2012, and November 1,

 

 

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12012, or as soon thereafter as practical. This transfer may
2assist the Department of Healthcare and Family Services in
3improving Medical Assistance bill processing timeframes or in
4meeting the possible requirements of Senate Bill 3397, or
5other similar legislation, of the 97th General Assembly should
6it become law.
7    (g) Notwithstanding any other State law to the contrary,
8and in addition to any other transfers that may be provided for
9by law, on July 1, 2013, or as soon thereafter as may be
10practical, the State Comptroller shall direct and the State
11Treasurer shall transfer the sum of $601,000,000 from the
12General Revenue Fund to the Healthcare Provider Relief Fund.
13(Source: P.A. 100-587, eff. 6-4-18; 101-9, eff. 6-5-19;
14101-650, 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
18for the fiscal year or for a lesser period if the Act making
19that appropriation so specifies. A deficiency or emergency
20appropriation shall be available for expenditure only through
21June 30 of the year when the Act making that appropriation is
22enacted unless that Act otherwise provides.
23    (b) Outstanding liabilities as of June 30, payable from
24appropriations which have otherwise expired, may be paid out
25of the expiring appropriations during the 2-month period

 

 

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1ending at the close of business on August 31. Any service
2involving professional or artistic skills or any personal
3services by an employee whose compensation is subject to
4income tax withholding must be performed as of June 30 of the
5fiscal year in order to be considered an "outstanding
6liability as of June 30" that is thereby eligible for payment
7out of the expiring appropriation.
8    (b-1) However, payment of tuition reimbursement claims
9under Section 14-7.03 or 18-3 of the School Code may be made by
10the State Board of Education from its appropriations for those
11respective purposes for any fiscal year, even though the
12claims reimbursed by the payment may be claims attributable to
13a prior fiscal year, and payments may be made at the direction
14of the State Superintendent of Education from the fund from
15which the appropriation is made without regard to any fiscal
16year limitations, except as required by subsection (j) of this
17Section. Beginning on June 30, 2021, payment of tuition
18reimbursement claims under Section 14-7.03 or 18-3 of the
19School Code as of June 30, payable from appropriations that
20have otherwise expired, may be paid out of the expiring
21appropriation during the 4-month period ending at the close of
22business 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,
4payable from appropriations that would otherwise expire at the
5conclusion of the lapse period for fiscal year 2020, and
6interest penalties payable on those liabilities under the
7State Prompt Payment Act, may be paid out of the expiring
8appropriations until December 31, 2020, without regard to the
9fiscal year in which the payment is made, as long as vouchers
10for the liabilities are received by the Comptroller no later
11than September 30, 2020.
12    (b-2.7) For fiscal years 2012, 2013, 2014, 2018, 2019,
132020, and 2021, interest penalties payable under the State
14Prompt Payment Act associated with a voucher for which payment
15is issued after June 30 may be paid out of the next fiscal
16year's appropriation. The future year appropriation must be
17for the same purpose and from the same fund as the original
18payment. An interest penalty voucher submitted against a
19future year appropriation must be submitted within 60 days
20after the issuance of the associated voucher, except that, for
21fiscal year 2018 only, an interest penalty voucher submitted
22against a future year appropriation must be submitted within
2360 days of June 5, 2019 (the effective date of Public Act
24101-10). The Comptroller must issue the interest payment
25within 60 days after acceptance of the interest voucher.
26    (b-3) Medical payments may be made by the Department of

 

 

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1Veterans' Affairs from its appropriations for those purposes
2for any fiscal year, without regard to the fact that the
3medical services being compensated for by such payment may
4have been rendered in a prior fiscal year, except as required
5by subsection (j) of this Section. Beginning on June 30, 2021,
6medical payments payable from appropriations that have
7otherwise expired may be paid out of the expiring
8appropriation during the 4-month period ending at the close of
9business on October 31.
10    (b-4) Medical payments and child care payments may be made
11by the Department of Human Services (as successor to the
12Department of Public Aid) from appropriations for those
13purposes for any fiscal year, without regard to the fact that
14the medical or child care services being compensated for by
15such payment may have been rendered in a prior fiscal year; and
16payments may be made at the direction of the Department of
17Healthcare and Family Services (or successor agency) from the
18Health Insurance Reserve Fund without regard to any fiscal
19year limitations, except as required by subsection (j) of this
20Section. Beginning on June 30, 2021, medical and child care
21payments made by the Department of Human Services and payments
22made at the discretion of the Department of Healthcare and
23Family Services (or successor agency) from the Health
24Insurance Reserve Fund and payable from appropriations that
25have otherwise expired may be paid out of the expiring
26appropriation during the 4-month period ending at the close of

 

 

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1business on October 31.
2    (b-5) Medical payments may be made by the Department of
3Human Services from its appropriations relating to substance
4abuse treatment services for any fiscal year, without regard
5to the fact that the medical services being compensated for by
6such payment may have been rendered in a prior fiscal year,
7provided the payments are made on a fee-for-service basis
8consistent with requirements established for Medicaid
9reimbursement by the Department of Healthcare and Family
10Services, except as required by subsection (j) of this
11Section. Beginning on June 30, 2021, medical payments made by
12the Department of Human Services relating to substance abuse
13treatment services payable from appropriations that have
14otherwise expired may be paid out of the expiring
15appropriation during the 4-month period ending at the close of
16business on October 31.
17    (b-6) (Blank).
18    (b-7) Payments may be made in accordance with a plan
19authorized by paragraph (11) or (12) of Section 405-105 of the
20Department of Central Management Services Law from
21appropriations for those payments without regard to fiscal
22year limitations.
23    (b-8) Reimbursements to eligible airport sponsors for the
24construction or upgrading of Automated Weather Observation
25Systems may be made by the Department of Transportation from
26appropriations for those purposes for any fiscal year, without

 

 

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1regard to the fact that the qualification or obligation may
2have occurred in a prior fiscal year, provided that at the time
3the expenditure was made the project had been approved by the
4Department of Transportation prior to June 1, 2012 and, as a
5result of recent changes in federal funding formulas, can no
6longer receive federal reimbursement.
7    (b-9) (Blank).
8    (c) Further, payments may be made by the Department of
9Public Health and the Department of Human Services (acting as
10successor to the Department of Public Health under the
11Department of Human Services Act) from their respective
12appropriations for grants for medical care to or on behalf of
13premature and high-mortality risk infants and their mothers
14and for grants for supplemental food supplies provided under
15the United States Department of Agriculture Women, Infants and
16Children Nutrition Program, for any fiscal year without regard
17to the fact that the services being compensated for by such
18payment may have been rendered in a prior fiscal year, except
19as required by subsection (j) of this Section. Beginning on
20June 30, 2021, payments made by the Department of Public
21Health and the Department of Human Services from their
22respective appropriations for grants for medical care to or on
23behalf of premature and high-mortality risk infants and their
24mothers and for grants for supplemental food supplies provided
25under the United States Department of Agriculture Women,
26Infants and Children Nutrition Program payable from

 

 

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1appropriations that have otherwise expired may be paid out of
2the expiring appropriations during the 4-month period ending
3at the close of business on October 31.
4    (d) The Department of Public Health and the Department of
5Human Services (acting as successor to the Department of
6Public Health under the Department of Human Services Act)
7shall each annually submit to the State Comptroller, Senate
8President, Senate Minority Leader, Speaker of the House, House
9Minority Leader, and the respective Chairmen and Minority
10Spokesmen of the Appropriations Committees of the Senate and
11the House, on or before December 31, a report of fiscal year
12funds used to pay for services provided in any prior fiscal
13year. This report shall document by program or service
14category those expenditures from the most recently completed
15fiscal year used to pay for services provided in prior fiscal
16years.
17    (e) The Department of Healthcare and Family Services, the
18Department of Human Services (acting as successor to the
19Department of Public Aid), and the Department of Human
20Services making fee-for-service payments relating to substance
21abuse treatment services provided during a previous fiscal
22year shall each annually submit to the State Comptroller,
23Senate President, Senate Minority Leader, Speaker of the
24House, House Minority Leader, the respective Chairmen and
25Minority Spokesmen of the Appropriations Committees of the
26Senate and the House, on or before November 30, a report that

 

 

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1shall document by program or service category those
2expenditures from the most recently completed fiscal year used
3to pay for (i) services provided in prior fiscal years and (ii)
4services for which claims were received in prior fiscal years.
5    (f) The Department of Human Services (as successor to the
6Department of Public Aid) shall annually submit to the State
7Comptroller, Senate President, Senate Minority Leader, Speaker
8of the House, House Minority Leader, and the respective
9Chairmen and Minority Spokesmen of the Appropriations
10Committees of the Senate and the House, on or before December
1131, a report of fiscal year funds used to pay for services
12(other than medical care) provided in any prior fiscal year.
13This report shall document by program or service category
14those expenditures from the most recently completed fiscal
15year used to pay for services provided in prior fiscal years.
16    (g) In addition, each annual report required to be
17submitted by the Department of Healthcare and Family Services
18under subsection (e) shall include the following information
19with 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

 

 

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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
5Compensation Act, any utility bill for service provided to a
6General Assembly member's district office for a period
7including portions of 2 consecutive fiscal years may be paid
8from funds appropriated for such expenditure in either fiscal
9year.
10    (i) An agency which administers a fund classified by the
11Comptroller 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.
26User agencies are authorized to reimburse internal service

 

 

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1funds for catch-up billings by vouchers drawn against their
2respective appropriations for the fiscal year in which the
3catch-up billing was issued or by increasing an authorized
4inter-fund transfer during the current fiscal year. For the
5purposes of this Act, "inter-fund transfers" means transfers
6without the use of the voucher-warrant process, as authorized
7by Section 9.01 of the State Comptroller Act.
8    (i-1) Beginning on July 1, 2021, all outstanding
9liabilities, not payable during the 4-month lapse period as
10described in subsections (b-1), (b-3), (b-4), (b-5), and (c)
11of this Section, that are made from appropriations for that
12purpose for any fiscal year, without regard to the fact that
13the services being compensated for by those payments may have
14been rendered in a prior fiscal year, are limited to only those
15claims that have been incurred but for which a proper bill or
16invoice as defined by the State Prompt Payment Act has not been
17received by September 30th following the end of the fiscal
18year in which the service was rendered.
19    (j) Notwithstanding any other provision of this Act, the
20aggregate amount of payments to be made without regard for
21fiscal year limitations as contained in subsections (b-1),
22(b-3), (b-4), (b-5), and (c) of this Section, and determined
23by using Generally Accepted Accounting Principles, shall not
24exceed the following amounts:
25        (1) $6,000,000,000 for outstanding liabilities related
26    to fiscal year 2012;

 

 

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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
20Assistance 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

 

 

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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.

 

 

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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.

 

 

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1    (l) The changes to this Section made by Public Act 97-691
2shall be effective for payment of Medical Assistance bills
3incurred in fiscal year 2013 and future fiscal years. The
4changes to this Section made by Public Act 97-691 shall not be
5applied to Medical Assistance bills incurred in fiscal year
62012 or prior fiscal years.
7    (m) The Comptroller must issue payments against
8outstanding liabilities that were received prior to the lapse
9period deadlines set forth in this Section as soon thereafter
10as practical, but no payment may be issued after the 4 months
11following the lapse period deadline without the signed
12authorization of the Comptroller and the Governor.
13(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18;
14101-10, eff. 6-5-19; 101-275, eff. 8-9-19; 101-636, eff.
156-10-20.)
 
16    Section 10. The State Prompt Payment Act is amended by
17changing Section 3-2 as follows:
 
18    (30 ILCS 540/3-2)
19    Sec. 3-2. Beginning July 1, 1993, in any instance where a
20State official or agency is late in payment of a vendor's bill
21or invoice for goods or services furnished to the State, as
22defined in Section 1, properly approved in accordance with
23rules promulgated under Section 3-3, the State official or
24agency shall pay interest to the vendor in accordance with the

 

 

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1following:
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

 

 

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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

 

 

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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.

 

 

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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
19may not be paid under this Act when: (1) a Chief Procurement
20Officer has voided the underlying contract for goods or
21services under Article 50 of the Illinois Procurement Code; or
22(2) the Auditor General is conducting a performance or program
23audit and the Comptroller has held or is holding for review a
24related contract or vouchers for payment of goods or services
25in the exercise of duties under Section 9 of the State
26Comptroller Act. In such event, interest shall not accrue

 

 

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1during 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
43-8 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
8or used by a hospital owner that owns one or more hospitals
9licensed under the Hospital Licensing Act or operated under
10the University of Illinois Hospital Act, or a hospital
11affiliate that is not already exempt under another provision
12of this Act and meets the criteria for an exemption under this
13Section, is exempt from taxation under this Act.
14    (b) A hospital owner or hospital affiliate satisfies the
15conditions for an exemption under this Section if the value of
16qualified services or activities listed in subsection (c) of
17this Section for the hospital year equals or exceeds the
18relevant hospital entity's estimated property tax liability,
19without regard to any property tax exemption granted under
20Section 15-86 of the Property Tax Code, for the calendar year
21in which exemption or renewal of exemption is sought. For
22purposes of making the calculations required by this
23subsection (b), if the relevant hospital entity is a hospital
24owner that owns more than one hospital, the value of the

 

 

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1services or activities listed in subsection (c) shall be
2calculated on the basis of only those services and activities
3relating to the hospital that includes the subject property,
4and the relevant hospital entity's estimated property tax
5liability shall be calculated only with respect to the
6properties comprising that hospital. In the case of a
7multi-state hospital system or hospital affiliate, the value
8of the services or activities listed in subsection (c) shall
9be calculated on the basis of only those services and
10activities that occur in Illinois and the relevant hospital
11entity's estimated property tax liability shall be calculated
12only with respect to its property located in Illinois.
13    (c) The following services and activities shall be
14considered for purposes of making the calculations required by
15subsection (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

 

 

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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

 

 

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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

 

 

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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

 

 

HB3119- 29 -LRB102 14580 KTG 19933 b

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
12its exemption application establishing that it satisfies the
13requirements of subsection (b). For purposes of making the
14calculations required by subsection (b), the hospital
15applicant may for each year elect to use either (1) the value
16of the services or activities listed in subsection (e) for the
17hospital year or (2) the average value of those services or
18activities for the 3 fiscal years ending with the hospital
19year. If the relevant hospital entity has been in operation
20for less than 3 completed fiscal years, then the latter
21calculation, if elected, shall be performed on a pro rata
22basis.
23    (e) For purposes of making the calculations required by
24this Section:
25        (1) particular services or activities eligible for
26    consideration under any of the paragraphs (1) through (7)

 

 

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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
10estimated property tax liability used for the determination in
11subsection (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

 

 

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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

 

 

HB3119- 32 -LRB102 14580 KTG 19933 b

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.

 

 

HB3119- 33 -LRB102 14580 KTG 19933 b

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
7shall 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

 

 

HB3119- 34 -LRB102 14580 KTG 19933 b

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.

 

 

HB3119- 35 -LRB102 14580 KTG 19933 b

1    (i) It is the intent of the General Assembly that any
2exemptions taken, granted, or renewed under this Section prior
3to the effective date of this amendatory Act of the 100th
4General 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
7Section 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
11or used by a hospital owner that owns one or more hospitals
12licensed under the Hospital Licensing Act or operated under
13the University of Illinois Hospital Act, or a hospital
14affiliate that is not already exempt under another provision
15of this Act and meets the criteria for an exemption under this
16Section, is exempt from taxation under this Act.
17    (b) A hospital owner or hospital affiliate satisfies the
18conditions for an exemption under this Section if the value of
19qualified services or activities listed in subsection (c) of
20this Section for the hospital year equals or exceeds the
21relevant hospital entity's estimated property tax liability,
22without regard to any property tax exemption granted under
23Section 15-86 of the Property Tax Code, for the calendar year
24in which exemption or renewal of exemption is sought. For

 

 

HB3119- 36 -LRB102 14580 KTG 19933 b

1purposes of making the calculations required by this
2subsection (b), if the relevant hospital entity is a hospital
3owner that owns more than one hospital, the value of the
4services or activities listed in subsection (c) shall be
5calculated on the basis of only those services and activities
6relating to the hospital that includes the subject property,
7and the relevant hospital entity's estimated property tax
8liability shall be calculated only with respect to the
9properties comprising that hospital. In the case of a
10multi-state hospital system or hospital affiliate, the value
11of the services or activities listed in subsection (c) shall
12be calculated on the basis of only those services and
13activities that occur in Illinois and the relevant hospital
14entity's estimated property tax liability shall be calculated
15only with respect to its property located in Illinois.
16    (c) The following services and activities shall be
17considered for purposes of making the calculations required by
18subsection (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,

 

 

HB3119- 37 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 38 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 39 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 40 -LRB102 14580 KTG 19933 b

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
15its exemption application establishing that it satisfies the
16requirements of subsection (b). For purposes of making the
17calculations required by subsection (b), the hospital
18applicant may for each year elect to use either (1) the value
19of the services or activities listed in subsection (e) for the
20hospital year or (2) the average value of those services or
21activities for the 3 fiscal years ending with the hospital
22year. If the relevant hospital entity has been in operation
23for less than 3 completed fiscal years, then the latter
24calculation, if elected, shall be performed on a pro rata
25basis.
26    (e) For purposes of making the calculations required by

 

 

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1this 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
13estimated property tax liability used for the determination in
14subsection (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

 

 

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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

 

 

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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

 

 

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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
10shall 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'

 

 

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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

 

 

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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
5exemptions taken, granted, or renewed under this Section prior
6to the effective date of this amendatory Act of the 100th
7General 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
10by 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
14or used by a hospital owner that owns one or more hospitals
15licensed under the Hospital Licensing Act or operated under
16the University of Illinois Hospital Act, or a hospital
17affiliate that is not already exempt under another provision
18of this Act and meets the criteria for an exemption under this
19Section, is exempt from taxation under this Act.
20    (b) A hospital owner or hospital affiliate satisfies the
21conditions for an exemption under this Section if the value of
22qualified services or activities listed in subsection (c) of
23this Section for the hospital year equals or exceeds the
24relevant hospital entity's estimated property tax liability,

 

 

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1without regard to any property tax exemption granted under
2Section 15-86 of the Property Tax Code, for the calendar year
3in which exemption or renewal of exemption is sought. For
4purposes of making the calculations required by this
5subsection (b), if the relevant hospital entity is a hospital
6owner that owns more than one hospital, the value of the
7services or activities listed in subsection (c) shall be
8calculated on the basis of only those services and activities
9relating to the hospital that includes the subject property,
10and the relevant hospital entity's estimated property tax
11liability shall be calculated only with respect to the
12properties comprising that hospital. In the case of a
13multi-state hospital system or hospital affiliate, the value
14of the services or activities listed in subsection (c) shall
15be calculated on the basis of only those services and
16activities that occur in Illinois and the relevant hospital
17entity's estimated property tax liability shall be calculated
18only with respect to its property located in Illinois.
19    (c) The following services and activities shall be
20considered for purposes of making the calculations required by
21subsection (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.

 

 

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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

 

 

HB3119- 49 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 50 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 51 -LRB102 14580 KTG 19933 b

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
18its exemption application establishing that it satisfies the
19requirements of subsection (b). For purposes of making the
20calculations required by subsection (b), the hospital
21applicant may for each year elect to use either (1) the value
22of the services or activities listed in subsection (e) for the
23hospital year or (2) the average value of those services or
24activities for the 3 fiscal years ending with the hospital
25year. If the relevant hospital entity has been in operation
26for less than 3 completed fiscal years, then the latter

 

 

HB3119- 52 -LRB102 14580 KTG 19933 b

1calculation, if elected, shall be performed on a pro rata
2basis.
3    (e) For purposes of making the calculations required by
4this 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
16estimated property tax liability used for the determination in
17subsection (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:

 

 

HB3119- 53 -LRB102 14580 KTG 19933 b

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.

 

 

HB3119- 54 -LRB102 14580 KTG 19933 b

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,

 

 

HB3119- 55 -LRB102 14580 KTG 19933 b

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
13shall 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

 

 

HB3119- 56 -LRB102 14580 KTG 19933 b

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.

 

 

HB3119- 57 -LRB102 14580 KTG 19933 b

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
8exemptions taken, granted, or renewed under this Section prior
9to the effective date of this amendatory Act of the 100th
10General 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
13Section 15-86 as follows:
 
14    (35 ILCS 200/15-86)
15    Sec. 15-86. Exemptions related to access to hospital and
16health care services by low-income and underserved
17individuals.
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

 

 

HB3119- 58 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 59 -LRB102 14580 KTG 19933 b

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

 

 

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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
10following 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'

 

 

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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

 

 

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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
7exemption under this Section with respect to the subject
8property, and shall be issued a charitable exemption for that
9property, if the value of services or activities listed in
10subsection (e) for the hospital year equals or exceeds the
11relevant hospital entity's estimated property tax liability,
12as determined under subsection (g), for the year for which
13exemption is sought. For purposes of making the calculations
14required by this subsection (c), if the relevant hospital
15entity is a hospital owner that owns more than one hospital,
16the value of the services or activities listed in subsection
17(e) shall be calculated on the basis of only those services and
18activities relating to the hospital that includes the subject
19property, and the relevant hospital entity's estimated
20property tax liability shall be calculated only with respect
21to the properties comprising that hospital. In the case of a
22multi-state hospital system or hospital affiliate, the value
23of the services or activities listed in subsection (e) shall
24be calculated on the basis of only those services and
25activities that occur in Illinois and the relevant hospital
26entity's estimated property tax liability shall be calculated

 

 

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1only with respect to its property located in Illinois.
2    Notwithstanding any other provisions of this Act, any
3parcel or portion thereof, that is owned by a for-profit
4entity whether part of the hospital system or not, or that is
5leased, licensed or operated by a for-profit entity regardless
6of whether healthcare services are provided on that parcel
7shall not qualify for exemption. If a parcel has both exempt
8and non-exempt uses, an exemption may be granted for the
9qualifying portion of that parcel. In the case of parking lots
10and common areas serving both exempt and non-exempt uses those
11parcels or portions thereof may qualify for an exemption in
12proportion to the amount of qualifying use.
13    (d) The hospital applicant shall include information in
14its exemption application establishing that it satisfies the
15requirements of subsection (c). For purposes of making the
16calculations required by subsection (c), the hospital
17applicant may for each year elect to use either (1) the value
18of the services or activities listed in subsection (e) for the
19hospital year or (2) the average value of those services or
20activities for the 3 fiscal years ending with the hospital
21year. If the relevant hospital entity has been in operation
22for less than 3 completed fiscal years, then the latter
23calculation, if elected, shall be performed on a pro rata
24basis.
25    (e) Services that address the health care needs of
26low-income or underserved individuals or relieve the burden of

 

 

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1government with regard to health care services. The following
2services and activities shall be considered for purposes of
3making 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.

 

 

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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

 

 

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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

 

 

HB3119- 67 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 68 -LRB102 14580 KTG 19933 b

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
5subsections (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
16estimated property tax liability used for the determination in
17subsection (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:

 

 

HB3119- 69 -LRB102 14580 KTG 19933 b

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.

 

 

HB3119- 70 -LRB102 14580 KTG 19933 b

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,

 

 

HB3119- 71 -LRB102 14580 KTG 19933 b

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
13property tax exemption pursuant to Section 15-5 and this
14Section shall use an application form provided by the
15Department. The application form shall specify the records
16required in support of the application and those records shall
17be submitted to the Department with the application form. Each
18application or affidavit shall contain a verification by the
19Chief Executive Officer of the hospital applicant under oath
20or affirmation stating that each statement in the application
21or affidavit and each document submitted with the application
22or affidavit are true and correct. The records submitted with
23the application pursuant to this Section shall include an
24exhibit prepared by the relevant hospital entity showing (A)
25the value of the relevant hospital entity's services and
26activities, if any, under paragraphs (1) through (7) of

 

 

HB3119- 72 -LRB102 14580 KTG 19933 b

1subsection (e) of this Section stated separately for each
2paragraph, and (B) the value relating to the relevant hospital
3entity's estimated property tax liability under subsections
4(g)(1)(A), (B), and (C), subsections (g)(2)(A), (B), and (C),
5and subsection (g)(3) of this Section stated separately for
6each item. Such exhibit will be made available to the public by
7the chief county assessment officer. Nothing in this Section
8shall be construed as limiting the Attorney General's
9authority under the Illinois False Claims Act.
10    (i) Nothing in this Section shall be construed to limit
11the ability of otherwise eligible hospitals, hospital owners,
12hospital affiliates, or hospital systems to obtain or maintain
13property tax exemptions pursuant to a provision of the
14Property 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
17changing 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
20person, including a person elected, appointed or under
21contract, receiving compensation from the State or a unit of
22local government or school district for personal services
23rendered, including salaried persons. A health care provider
24who elects to participate in the State Employees Deferred

 

 

HB3119- 73 -LRB102 14580 KTG 19933 b

1Compensation Plan established under Section 24-104 of this
2Code 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
5dentist, physician, optometrist, pharmacist, or podiatric
6physician that participates and receives compensation as a
7provider under the Illinois Public Aid Code, the Children's
8Health Insurance Act, or the Covering ALL KIDS Health
9Insurance Act.
10    As used in this Article, "compensation" includes
11compensation received in a lump sum for accumulated unused
12vacation, personal leave or sick leave, with the exception of
13health care providers. "Compensation" with respect to health
14care providers is defined under the Illinois Public Aid Code,
15the Children's Health Insurance Act, or the Covering ALL KIDS
16Health Insurance Act.
17    Where applicable, in no event shall the total of the
18amount of deferred compensation of an employee set aside in
19relation to a particular year under the Illinois State
20Employees Deferred Compensation Plan and the employee's
21nondeferred compensation for that year exceed the total annual
22salary or compensation under the existing salary schedule or
23classification plan applicable to such employee in such year;
24except that any compensation received in a lump sum for
25accumulated unused vacation, personal leave or sick leave
26shall not be included in the calculation of such totals.

 

 

HB3119- 74 -LRB102 14580 KTG 19933 b

1(Source: P.A. 98-214, eff. 8-9-13.)
 
2    Section 40. The Loan Repayment Assistance for Dentists Act
3is 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
6otherwise requires:
7    "Dental hygienist" means a person who holds a license
8under the Illinois Dental Practice Act to perform dental
9services as authorized by Section 18 of the Illinois Dental
10Practice Act.
11    "Dental payments" means compensation provided to dentists
12and dental specialists for services rendered under Article V
13of the Illinois Public Aid Code, the Covering ALL KIDS Health
14Insurance Act, or the Children's Health Insurance Program Act.
15    "Dental specialist" means a person who has received a
16license as a dentist in this State and who is trained and
17qualified to practice in one or more of the following
18specialties of dentistry: endodontics, oral and maxillofacial
19surgery, orthodontics, pedodontics, periodontics, and
20prosthodontics.
21    "Dentist" means a person who has received a general
22license pursuant to paragraph (a) of Section 11 of the
23Illinois Dental Practice Act, who may perform any intraoral
24and extraoral procedure required in the practice of dentistry,

 

 

HB3119- 75 -LRB102 14580 KTG 19933 b

1and to whom is reserved the responsibilities specified in
2Section 17 of the Illinois Dental Practice Act.
3    "Department" means the Department of Public Health.
4    "Designated shortage area" means a medically underserved
5area or health manpower shortage area as defined by the United
6States Department of Health and Human Services or as otherwise
7designated by the Department of Public Health.
8    "Educational loans" means higher education student loans
9that a person has incurred in attending a registered
10professional dental education program.
11    "Program" means the educational loan repayment assistance
12program for dentists and dental specialists or dental
13hygienists 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
17the program, an applicant must meet all of the following
18qualifications:
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

 

 

HB3119- 76 -LRB102 14580 KTG 19933 b

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
15applicant practices full time in this State in a designated
16shortage area as a dentist or dental specialist, the
17Department shall, subject to appropriation, award a grant to
18that person in an amount equal to the amount in educational
19loans that the person must repay that year. However, the total
20amount in grants that a person may be awarded under the program
21must not exceed $25,000 per year for a 4-year period.
22    The grant award for a dental hygienist shall be set by rule
23of the Department.
24    (b) The Department shall require recipients to use the
25grants to pay off their educational loans.

 

 

HB3119- 77 -LRB102 14580 KTG 19933 b

1    (c) The initial grant awarded to a dentist or dental
2specialist under this Act shall be for a 2-year period. Based
3on the successful completion of the initial 2-year grant, the
4grantees may be awarded up to 2 subsequent one-year grants.
5Grantees are eligible to receive grant funds for no more than a
64-year period. Previous grant recipients shall be given
7priority for years 3 and 4 grant funding, provided that the
8grantee continues to meet the eligibility requirements set
9forth in Section 25 of this Act. Grantees shall practice full
10time in a designated shortage area for the period of each grant
11awarded.
12    The grant award for a dental hygienist shall be for a
13maximum of 2 years.
14    (d) Successful applicants shall be eligible for a grant
15award upon execution of the grant agreement and shall then
16begin to receive grant award payments on a quarterly basis.
17    (e) The Department shall award grants to otherwise
18eligible 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

 

 

HB3119- 78 -LRB102 14580 KTG 19933 b

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
6changing 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
11this State the kinds of business enumerated in clause (b) of
12Class 1 and clause (a) of Class 2 of Section 4. Nothing in this
13Article shall apply to, or in any way affect policies or
14contracts described in clause (a) of Class 1 of Section 4;
15however, this Article shall apply to policies and contracts
16which contain benefits providing reimbursement for the
17expenses of long term health care which are certified or
18ordered by a physician including but not limited to
19professional nursing care, custodial nursing care, and
20non-nursing custodial care provided in a nursing home or at a
21residence of the insured.
22    (b) (Blank).
23    (c) A policy issued and delivered in this State that
24provides coverage under that policy for certificate holders

 

 

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1who are neither residents of nor employed in this State does
2not need to provide to those nonresident certificate holders
3who are not employed in this State the coverages or services
4mandated by this Article.
5    (d) Stop-loss insurance is exempt from all Sections of
6this Article, except this Section and Sections 353a, 354,
7357.30, and 370. For purposes of this exemption, stop-loss
8insurance 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
17Department of Healthcare and Family Services (formerly
18Illinois Department of Public Aid) and providing coverage,
19under clause (b) of Class 1 or clause (a) of Class 2 as
20described in Section 4, to persons who are enrolled under
21Article V of the Illinois Public Aid Code or under the
22Children's Health Insurance Program Act is exempt from all
23restrictions, limitations, standards, rules, or regulations
24respecting benefits imposed by or under authority of this
25Code, except those specified by subsection (1) of Section 143,
26Section 370c, and Section 370c.1. Nothing in this subsection,

 

 

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1however, affects the total medical services available to
2persons eligible for medical assistance under the Illinois
3Public Aid Code.
4    (f) An in-office membership care agreement provided under
5the In-Office Membership Care Act is not insurance for the
6purposes of this Code.
7(Source: P.A. 101-190, eff. 8-2-19.)
 
8    Section 50. The Health Maintenance Organization Act is
9amended 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
12context otherwise requires, the following terms shall have the
13meanings ascribed to them:
14    (1) "Advertisement" means any printed or published
15material, audiovisual material and descriptive literature of
16the health care plan used in direct mail, newspapers,
17magazines, radio scripts, television scripts, billboards and
18similar displays; and any descriptive literature or sales aids
19of all kinds disseminated by a representative of the health
20care plan for presentation to the public including, but not
21limited to, circulars, leaflets, booklets, depictions,
22illustrations, form letters and prepared sales presentations.
23    (2) "Director" means the Director of Insurance.
24    (3) "Basic health care services" means emergency care, and

 

 

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1inpatient hospital and physician care, outpatient medical
2services, mental health services and care for alcohol and drug
3abuse, including any reasonable deductibles and co-payments,
4all of which are subject to the limitations described in
5Section 4-20 of this Act and as determined by the Director
6pursuant to rule.
7    (4) "Enrollee" means an individual who has been enrolled
8in a health care plan.
9    (5) "Evidence of coverage" means any certificate,
10agreement, or contract issued to an enrollee setting out the
11coverage to which he is entitled in exchange for a per capita
12prepaid sum.
13    (6) "Group contract" means a contract for health care
14services which by its terms limits eligibility to members of a
15specified group.
16    (7) "Health care plan" means any arrangement whereby any
17organization undertakes to provide or arrange for and pay for
18or reimburse the cost of basic health care services, excluding
19any reasonable deductibles and copayments, from providers
20selected by the Health Maintenance Organization and such
21arrangement consists of arranging for or the provision of such
22health care services, as distinguished from mere
23indemnification against the cost of such services, except as
24otherwise authorized by Section 2-3 of this Act, on a per
25capita prepaid basis, through insurance or otherwise. A
26"health care plan" also includes any arrangement whereby an

 

 

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1organization undertakes to provide or arrange for or pay for
2or reimburse the cost of any health care service for persons
3who are enrolled under Article V of the Illinois Public Aid
4Code or under the Children's Health Insurance Program Act
5through providers selected by the organization and the
6arrangement consists of making provision for the delivery of
7health care services, as distinguished from mere
8indemnification. A "health care plan" also includes any
9arrangement pursuant to Section 4-17. Nothing in this
10definition, however, affects the total medical services
11available to persons eligible for medical assistance under the
12Illinois Public Aid Code.
13    (8) "Health care services" means any services included in
14the furnishing to any individual of medical or dental care, or
15the hospitalization or incident to the furnishing of such care
16or hospitalization as well as the furnishing to any person of
17any and all other services for the purpose of preventing,
18alleviating, curing or healing human illness or injury.
19    (9) "Health Maintenance Organization" means any
20organization formed under the laws of this or another state to
21provide or arrange for one or more health care plans under a
22system which causes any part of the risk of health care
23delivery to be borne by the organization or its providers.
24    (10) "Net worth" means admitted assets, as defined in
25Section 1-3 of this Act, minus liabilities.
26    (11) "Organization" means any insurance company, a

 

 

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1nonprofit corporation authorized under the Dental Service Plan
2Act or the Voluntary Health Services Plans Act, or a
3corporation organized under the laws of this or another state
4for the purpose of operating one or more health care plans and
5doing no business other than that of a Health Maintenance
6Organization or an insurance company. "Organization" shall
7also mean the University of Illinois Hospital as defined in
8the University of Illinois Hospital Act or a unit of local
9government health system operating within a county with a
10population of 3,000,000 or more.
11    (12) "Provider" means any physician, hospital facility,
12facility licensed under the Nursing Home Care Act, or facility
13or long-term care facility as those terms are defined in the
14Nursing Home Care Act or other person which is licensed or
15otherwise authorized to furnish health care services and also
16includes any other entity that arranges for the delivery or
17furnishing of health care service.
18    (13) "Producer" means a person directly or indirectly
19associated with a health care plan who engages in solicitation
20or enrollment.
21    (14) "Per capita prepaid" means a basis of prepayment by
22which a fixed amount of money is prepaid per individual or any
23other enrollment unit to the Health Maintenance Organization
24or for health care services which are provided during a
25definite time period regardless of the frequency or extent of
26the services rendered by the Health Maintenance Organization,

 

 

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1except for copayments and deductibles and except as provided
2in subsection (f) of Section 5-3 of this Act.
3    (15) "Subscriber" means a person who has entered into a
4contractual relationship with the Health Maintenance
5Organization for the provision of or arrangement of at least
6basic health care services to the beneficiaries of such
7contract.
8(Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14;
999-78, eff. 7-20-15.)
 
10    Section 55. The Illinois Public Aid Code is amended by
11changing Sections 5-1.5, 5-2, 5-5, 5-30, 5A-8, 5G-35, 5H-1,
1211-22, 11-22a, 11-22b, 11-22c, 12-4.35, 12-4.45, 12-9, and
1312-10.4 as follows:
 
14    (305 ILCS 5/5-1.5)
15    Sec. 5-1.5. COVID-19 public health emergency.
16Notwithstanding any other provision of Articles V, XI, and XII
17of this Code, the Department may take necessary actions to
18address the COVID-19 public health emergency to the extent
19such actions are required, approved, or authorized by the
20United States Department of Health and Human Services, Centers
21for Medicare and Medicaid Services. Such actions may continue
22throughout the public health emergency and for up to 12 months
23after the period ends, and may include, but are not limited to:
24accepting an applicant's or recipient's attestation of income,

 

 

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1incurred medical expenses, residency, and insured status when
2electronic verification is not available; eliminating resource
3tests for some eligibility determinations; suspending
4redeterminations; suspending changes that would adversely
5affect an applicant's or recipient's eligibility; phone or
6verbal approval by an applicant to submit an application in
7lieu of applicant signature; allowing adult presumptive
8eligibility; allowing presumptive eligibility for children,
9pregnant women, and adults as often as twice per calendar
10year; paying for additional services delivered by telehealth;
11and suspending premium and co-payment requirements.
12    The Department's authority under this Section shall only
13extend to encompass, incorporate, or effectuate the terms,
14items, conditions, and other provisions approved, authorized,
15or required by the United States Department of Health and
16Human Services, Centers for Medicare and Medicaid Services,
17and shall not extend beyond the time of the COVID-19 public
18health emergency and up to 12 months after the period expires.
19    Any individual determined eligible for medical assistance
20under this Code as of or during the COVID-19 public health
21emergency may be treated as eligible for such medical
22assistance benefits during the COVID-19 public health
23emergency, and up to 12 months after the period expires,
24regardless of whether federally required or whether the
25individual's eligibility may be State or federally funded,
26unless the individual requests a voluntary termination of

 

 

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1eligibility or ceases to be a resident. This paragraph shall
2not restrict any determination of medical need or
3appropriateness for any particular service and shall not
4require continued coverage of any particular service that may
5be no longer necessary, appropriate, or otherwise authorized
6for an individual. Nothing shall prevent the Department from
7determining and properly establishing an individual's
8eligibility 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
12under this Article shall be available to any of the following
13classes of persons in respect to whom a plan for coverage has
14been submitted to the Governor by the Illinois Department and
15approved by him. If changes made in this Section 5-2 require
16federal approval, they shall not take effect until such
17approval 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

 

 

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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

 

 

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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

 

 

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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

 

 

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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

 

 

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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

 

 

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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.

 

 

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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.

 

 

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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

 

 

HB3119- 95 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 96 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 97 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 98 -LRB102 14580 KTG 19933 b

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:

 

 

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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.

 

 

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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
17Department is authorized to adopt only those rules necessary,
18including emergency rules. Nothing in Public Act 96-20 permits
19the Department to adopt rules or issue a decision that expands
20eligibility for the FamilyCare Program to a person whose
21income exceeds 185% of the Federal Poverty Level as determined
22from time to time by the U.S. Department of Health and Human
23Services, unless the Department is provided with express
24statutory authority.
25    The eligibility of any such person for medical assistance
26under this Article is not affected by the payment of any grant

 

 

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1under the Senior Citizens and Persons with Disabilities
2Property Tax Relief Act or any distributions or items of
3income described under subparagraph (X) of paragraph (2) of
4subsection (a) of Section 203 of the Illinois Income Tax Act.
5    The Department shall by rule establish the amounts of
6assets to be disregarded in determining eligibility for
7medical assistance, which shall at a minimum equal the amounts
8to be disregarded under the Federal Supplemental Security
9Income Program. The amount of assets of a single person to be
10disregarded shall not be less than $2,000, and the amount of
11assets of a married couple to be disregarded shall not be less
12than $3,000.
13    To the extent permitted under federal law, any person
14found guilty of a second violation of Article VIIIA shall be
15ineligible for medical assistance under this Article, as
16provided in Section 8A-8.
17    The eligibility of any person for medical assistance under
18this Article shall not be affected by the receipt by the person
19of donations or benefits from fundraisers held for the person
20in cases of serious illness, as long as neither the person nor
21members of the person's family have actual control over the
22donations or benefits or the disbursement of the donations or
23benefits.
24    Notwithstanding any other provision of this Code, if the
25United States Supreme Court holds Title II, Subtitle A,
26Section 2001(a) of Public Law 111-148 to be unconstitutional,

 

 

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1or if a holding of Public Law 111-148 makes Medicaid
2eligibility allowed under Section 2001(a) inoperable, the
3State or a unit of local government shall be prohibited from
4enrolling individuals in the Medical Assistance Program as the
5result of federal approval of a State Medicaid waiver on or
6after June 14, 2012 (the effective date of Public Act 97-687)
7this amendatory Act of the 97th General Assembly, and any
8individuals enrolled in the Medical Assistance Program
9pursuant to eligibility permitted as a result of such a State
10Medicaid waiver shall become immediately ineligible.
11    Notwithstanding any other provision of this Code, if an
12Act of Congress that becomes a Public Law eliminates Section
132001(a) of Public Law 111-148, the State or a unit of local
14government shall be prohibited from enrolling individuals in
15the Medical Assistance Program as the result of federal
16approval of a State Medicaid waiver on or after June 14, 2012
17(the effective date of Public Act 97-687) this amendatory Act
18of the 97th General Assembly, and any individuals enrolled in
19the Medical Assistance Program pursuant to eligibility
20permitted as a result of such a State Medicaid waiver shall
21become immediately ineligible.
22    Effective October 1, 2013, the determination of
23eligibility of persons who qualify under paragraphs 5, 6, 8,
2415, 17, and 18 of this Section shall comply with the
25requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
26regulations.

 

 

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1    The Department of Healthcare and Family Services, the
2Department of Human Services, and the Illinois health
3insurance marketplace shall work cooperatively to assist
4persons who would otherwise lose health benefits as a result
5of changes made under Public Act 98-104 this amendatory Act of
6the 98th General Assembly to transition to other health
7insurance coverage.
8(Source: P.A. 101-10, eff. 6-5-19; 101-649, eff. 7-7-20;
9revised 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
12rule, shall determine the quantity and quality of and the rate
13of reimbursement for the medical assistance for which payment
14will be authorized, and the medical services to be provided,
15which may include all or part of the following: (1) inpatient
16hospital services; (2) outpatient hospital services; (3) other
17laboratory and X-ray services; (4) skilled nursing home
18services; (5) physicians' services whether furnished in the
19office, the patient's home, a hospital, a skilled nursing
20home, or elsewhere; (6) medical care, or any other type of
21remedial care furnished by licensed practitioners; (7) home
22health care services; (8) private duty nursing service; (9)
23clinic services; (10) dental services, including prevention
24and treatment of periodontal disease and dental caries disease
25for pregnant women, provided by an individual licensed to

 

 

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1practice dentistry or dental surgery; for purposes of this
2item (10), "dental services" means diagnostic, preventive, or
3corrective procedures provided by or under the supervision of
4a dentist in the practice of his or her profession; (11)
5physical therapy and related services; (12) prescribed drugs,
6dentures, and prosthetic devices; and eyeglasses prescribed by
7a physician skilled in the diseases of the eye, or by an
8optometrist, whichever the person may select; (13) other
9diagnostic, screening, preventive, and rehabilitative
10services, including to ensure that the individual's need for
11intervention or treatment of mental disorders or substance use
12disorders or co-occurring mental health and substance use
13disorders is determined using a uniform screening, assessment,
14and evaluation process inclusive of criteria, for children and
15adults; for purposes of this item (13), a uniform screening,
16assessment, and evaluation process refers to a process that
17includes an appropriate evaluation and, as warranted, a
18referral; "uniform" does not mean the use of a singular
19instrument, tool, or process that all must utilize; (14)
20transportation and such other expenses as may be necessary;
21(15) medical treatment of sexual assault survivors, as defined
22in Section 1a of the Sexual Assault Survivors Emergency
23Treatment Act, for injuries sustained as a result of the
24sexual assault, including examinations and laboratory tests to
25discover evidence which may be used in criminal proceedings
26arising from the sexual assault; (16) the diagnosis and

 

 

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1treatment of sickle cell anemia; and (17) any other medical
2care, and any other type of remedial care recognized under the
3laws of this State. The term "any other type of remedial care"
4shall include nursing care and nursing home service for
5persons who rely on treatment by spiritual means alone through
6prayer for healing.
7    Notwithstanding any other provision of this Section, a
8comprehensive tobacco use cessation program that includes
9purchasing prescription drugs or prescription medical devices
10approved by the Food and Drug Administration shall be covered
11under the medical assistance program under this Article for
12persons who are otherwise eligible for assistance under this
13Article.
14    Notwithstanding any other provision of this Code,
15reproductive health care that is otherwise legal in Illinois
16shall be covered under the medical assistance program for
17persons who are otherwise eligible for medical assistance
18under this Article.
19    Notwithstanding any other provision of this Code, the
20Illinois Department may not require, as a condition of payment
21for any laboratory test authorized under this Article, that a
22physician's handwritten signature appear on the laboratory
23test order form. The Illinois Department may, however, impose
24other appropriate requirements regarding laboratory test order
25documentation.
26    Upon receipt of federal approval of an amendment to the

 

 

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1Illinois Title XIX State Plan for this purpose, the Department
2shall authorize the Chicago Public Schools (CPS) to procure a
3vendor or vendors to manufacture eyeglasses for individuals
4enrolled in a school within the CPS system. CPS shall ensure
5that its vendor or vendors are enrolled as providers in the
6medical assistance program and in any capitated Medicaid
7managed care entity (MCE) serving individuals enrolled in a
8school within the CPS system. Under any contract procured
9under this provision, the vendor or vendors must serve only
10individuals enrolled in a school within the CPS system. Claims
11for services provided by CPS's vendor or vendors to recipients
12of benefits in the medical assistance program under this Code,
13the Children's Health Insurance Program, or the Covering ALL
14KIDS Health Insurance Program shall be submitted to the
15Department or the MCE in which the individual is enrolled for
16payment and shall be reimbursed at the Department's or the
17MCE's established rates or rate methodologies for eyeglasses.
18    On and after July 1, 2012, the Department of Healthcare
19and Family Services may provide the following services to
20persons eligible for assistance under this Article who are
21participating in education, training or employment programs
22operated by the Department of Human Services as successor to
23the 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

 

 

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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
4and Family Services shall provide dental services to any adult
5who is otherwise eligible for assistance under the medical
6assistance program. As used in this paragraph, "dental
7services" means diagnostic, preventative, restorative, or
8corrective procedures, including procedures and services for
9the prevention and treatment of periodontal disease and dental
10caries disease, provided by an individual who is licensed to
11practice dentistry or dental surgery or who is under the
12supervision of a dentist in the practice of his or her
13profession.
14    On and after July 1, 2018, targeted dental services, as
15set forth in Exhibit D of the Consent Decree entered by the
16United States District Court for the Northern District of
17Illinois, Eastern Division, in the matter of Memisovski v.
18Maram, Case No. 92 C 1982, that are provided to adults under
19the medical assistance program shall be established at no less
20than the rates set forth in the "New Rate" column in Exhibit D
21of the Consent Decree for targeted dental services that are
22provided to persons under the age of 18 under the medical
23assistance program.
24    Notwithstanding any other provision of this Code and
25subject to federal approval, the Department may adopt rules to
26allow a dentist who is volunteering his or her service at no

 

 

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1cost to render dental services through an enrolled
2not-for-profit health clinic without the dentist personally
3enrolling as a participating provider in the medical
4assistance program. A not-for-profit health clinic shall
5include a public health clinic or Federally Qualified Health
6Center or other enrolled provider, as determined by the
7Department, through which dental services covered under this
8Section are performed. The Department shall establish a
9process for payment of claims for reimbursement for covered
10dental services rendered under this provision.
11    The Illinois Department, by rule, may distinguish and
12classify the medical services to be provided only in
13accordance with the classes of persons designated in Section
145-2.
15    The Department of Healthcare and Family Services must
16provide coverage and reimbursement for amino acid-based
17elemental formulas, regardless of delivery method, for the
18diagnosis and treatment of (i) eosinophilic disorders and (ii)
19short bowel syndrome when the prescribing physician has issued
20a written order stating that the amino acid-based elemental
21formula is medically necessary.
22    The Illinois Department shall authorize the provision of,
23and shall authorize payment for, screening by low-dose
24mammography for the presence of occult breast cancer for women
2535 years of age or older who are eligible for medical
26assistance under this Article, as follows:

 

 

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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,
23copayment, or any other cost-sharing requirement on the
24coverage provided under this paragraph; except that this
25sentence does not apply to coverage of diagnostic mammograms
26to the extent such coverage would disqualify a high-deductible

 

 

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1health plan from eligibility for a health savings account
2pursuant to Section 223 of the Internal Revenue Code (26
3U.S.C. 223).
4    All screenings shall include a physical breast exam,
5instruction on self-examination and information regarding the
6frequency of self-examination and its value as a preventative
7tool.
8     For purposes of this Section:
9    "Diagnostic mammogram" means a mammogram obtained using
10diagnostic mammography.
11    "Diagnostic mammography" means a method of screening that
12is designed to evaluate an abnormality in a breast, including
13an abnormality seen or suspected on a screening mammogram or a
14subjective or objective abnormality otherwise detected in the
15breast.
16    "Low-dose mammography" means the x-ray examination of the
17breast using equipment dedicated specifically for mammography,
18including the x-ray tube, filter, compression device, and
19image receptor, with an average radiation exposure delivery of
20less than one rad per breast for 2 views of an average size
21breast. The term also includes digital mammography and
22includes breast tomosynthesis.
23    "Breast tomosynthesis" means a radiologic procedure that
24involves the acquisition of projection images over the
25stationary breast to produce cross-sectional digital
26three-dimensional images of the breast.

 

 

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1    If, at any time, the Secretary of the United States
2Department of Health and Human Services, or its successor
3agency, promulgates rules or regulations to be published in
4the Federal Register or publishes a comment in the Federal
5Register or issues an opinion, guidance, or other action that
6would require the State, pursuant to any provision of the
7Patient Protection and Affordable Care Act (Public Law
8111-148), including, but not limited to, 42 U.S.C.
918031(d)(3)(B) or any successor provision, to defray the cost
10of any coverage for breast tomosynthesis outlined in this
11paragraph, then the requirement that an insurer cover breast
12tomosynthesis is inoperative other than any such coverage
13authorized under Section 1902 of the Social Security Act, 42
14U.S.C. 1396a, and the State shall not assume any obligation
15for the cost of coverage for breast tomosynthesis set forth in
16this paragraph.
17    On and after January 1, 2016, the Department shall ensure
18that all networks of care for adult clients of the Department
19include access to at least one breast imaging Center of
20Imaging Excellence as certified by the American College of
21Radiology.
22    On and after January 1, 2012, providers participating in a
23quality improvement program approved by the Department shall
24be reimbursed for screening and diagnostic mammography at the
25same rate as the Medicare program's rates, including the
26increased reimbursement for digital mammography.

 

 

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1    The Department shall convene an expert panel including
2representatives of hospitals, free-standing mammography
3facilities, and doctors, including radiologists, to establish
4quality standards for mammography.
5    On and after January 1, 2017, providers participating in a
6breast cancer treatment quality improvement program approved
7by the Department shall be reimbursed for breast cancer
8treatment at a rate that is no lower than 95% of the Medicare
9program's rates for the data elements included in the breast
10cancer treatment quality program.
11    The Department shall convene an expert panel, including
12representatives of hospitals, free-standing breast cancer
13treatment centers, breast cancer quality organizations, and
14doctors, including breast surgeons, reconstructive breast
15surgeons, oncologists, and primary care providers to establish
16quality standards for breast cancer treatment.
17    Subject to federal approval, the Department shall
18establish a rate methodology for mammography at federally
19qualified health centers and other encounter-rate clinics.
20These clinics or centers may also collaborate with other
21hospital-based mammography facilities. By January 1, 2016, the
22Department shall report to the General Assembly on the status
23of the provision set forth in this paragraph.
24    The Department shall establish a methodology to remind
25women who are age-appropriate for screening mammography, but
26who have not received a mammogram within the previous 18

 

 

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1months, of the importance and benefit of screening
2mammography. The Department shall work with experts in breast
3cancer outreach and patient navigation to optimize these
4reminders and shall establish a methodology for evaluating
5their effectiveness and modifying the methodology based on the
6evaluation.
7    The Department shall establish a performance goal for
8primary care providers with respect to their female patients
9over age 40 receiving an annual mammogram. This performance
10goal shall be used to provide additional reimbursement in the
11form of a quality performance bonus to primary care providers
12who meet that goal.
13    The Department shall devise a means of case-managing or
14patient navigation for beneficiaries diagnosed with breast
15cancer. This program shall initially operate as a pilot
16program in areas of the State with the highest incidence of
17mortality related to breast cancer. At least one pilot program
18site shall be in the metropolitan Chicago area and at least one
19site shall be outside the metropolitan Chicago area. On or
20after July 1, 2016, the pilot program shall be expanded to
21include one site in western Illinois, one site in southern
22Illinois, one site in central Illinois, and 4 sites within
23metropolitan Chicago. An evaluation of the pilot program shall
24be carried out measuring health outcomes and cost of care for
25those served by the pilot program compared to similarly
26situated patients who are not served by the pilot program.

 

 

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1    The Department shall require all networks of care to
2develop a means either internally or by contract with experts
3in navigation and community outreach to navigate cancer
4patients to comprehensive care in a timely fashion. The
5Department shall require all networks of care to include
6access for patients diagnosed with cancer to at least one
7academic commission on cancer-accredited cancer program as an
8in-network covered benefit.
9    Any medical or health care provider shall immediately
10recommend, to any pregnant woman who is being provided
11prenatal services and is suspected of having a substance use
12disorder as defined in the Substance Use Disorder Act,
13referral to a local substance use disorder treatment program
14licensed by the Department of Human Services or to a licensed
15hospital which provides substance abuse treatment services.
16The Department of Healthcare and Family Services shall assure
17coverage for the cost of treatment of the drug abuse or
18addiction for pregnant recipients in accordance with the
19Illinois Medicaid Program in conjunction with the Department
20of Human Services.
21    All medical providers providing medical assistance to
22pregnant women under this Code shall receive information from
23the Department on the availability of services under any
24program providing case management services for addicted women,
25including information on appropriate referrals for other
26social services that may be needed by addicted women in

 

 

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1addition to treatment for addiction.
2    The Illinois Department, in cooperation with the
3Departments of Human Services (as successor to the Department
4of Alcoholism and Substance Abuse) and Public Health, through
5a public awareness campaign, may provide information
6concerning treatment for alcoholism and drug abuse and
7addiction, prenatal health care, and other pertinent programs
8directed at reducing the number of drug-affected infants born
9to recipients of medical assistance.
10    Neither the Department of Healthcare and Family Services
11nor the Department of Human Services shall sanction the
12recipient solely on the basis of her substance abuse.
13    The Illinois Department shall establish such regulations
14governing the dispensing of health services under this Article
15as it shall deem appropriate. The Department should seek the
16advice of formal professional advisory committees appointed by
17the Director of the Illinois Department for the purpose of
18providing regular advice on policy and administrative matters,
19information dissemination and educational activities for
20medical and health care providers, and consistency in
21procedures to the Illinois Department.
22    The Illinois Department may develop and contract with
23Partnerships of medical providers to arrange medical services
24for persons eligible under Section 5-2 of this Code.
25Implementation of this Section may be by demonstration
26projects in certain geographic areas. The Partnership shall be

 

 

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1represented by a sponsor organization. The Department, by
2rule, shall develop qualifications for sponsors of
3Partnerships. Nothing in this Section shall be construed to
4require that the sponsor organization be a medical
5organization.
6    The sponsor must negotiate formal written contracts with
7medical providers for physician services, inpatient and
8outpatient hospital care, home health services, treatment for
9alcoholism and substance abuse, and other services determined
10necessary by the Illinois Department by rule for delivery by
11Partnerships. Physician services must include prenatal and
12obstetrical care. The Illinois Department shall reimburse
13medical services delivered by Partnership providers to clients
14in target areas according to provisions of this Article and
15the 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

 

 

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1    medical assistance program.
2    Medical providers shall be required to meet certain
3qualifications to participate in Partnerships to ensure the
4delivery of high quality medical services. These
5qualifications shall be determined by rule of the Illinois
6Department and may be higher than qualifications for
7participation in the medical assistance program. Partnership
8sponsors may prescribe reasonable additional qualifications
9for participation by medical providers, only with the prior
10written approval of the Illinois Department.
11    Nothing in this Section shall limit the free choice of
12practitioners, hospitals, and other providers of medical
13services by clients. In order to ensure patient freedom of
14choice, the Illinois Department shall immediately promulgate
15all rules and take all other necessary actions so that
16provided services may be accessed from therapeutically
17certified optometrists to the full extent of the Illinois
18Optometric Practice Act of 1987 without discriminating between
19service providers.
20    The Department shall apply for a waiver from the United
21States Health Care Financing Administration to allow for the
22implementation of Partnerships under this Section.
23    The Illinois Department shall require health care
24providers to maintain records that document the medical care
25and services provided to recipients of Medical Assistance
26under this Article. Such records must be retained for a period

 

 

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1of not less than 6 years from the date of service or as
2provided by applicable State law, whichever period is longer,
3except that if an audit is initiated within the required
4retention period then the records must be retained until the
5audit is completed and every exception is resolved. The
6Illinois Department shall require health care providers to
7make available, when authorized by the patient, in writing,
8the medical records in a timely fashion to other health care
9providers who are treating or serving persons eligible for
10Medical Assistance under this Article. All dispensers of
11medical services shall be required to maintain and retain
12business and professional records sufficient to fully and
13accurately document the nature, scope, details and receipt of
14the health care provided to persons eligible for medical
15assistance under this Code, in accordance with regulations
16promulgated by the Illinois Department. The rules and
17regulations shall require that proof of the receipt of
18prescription drugs, dentures, prosthetic devices and
19eyeglasses by eligible persons under this Section accompany
20each claim for reimbursement submitted by the dispenser of
21such medical services. No such claims for reimbursement shall
22be approved for payment by the Illinois Department without
23such proof of receipt, unless the Illinois Department shall
24have put into effect and shall be operating a system of
25post-payment audit and review which shall, on a sampling
26basis, be deemed adequate by the Illinois Department to assure

 

 

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1that such drugs, dentures, prosthetic devices and eyeglasses
2for which payment is being made are actually being received by
3eligible recipients. Within 90 days after September 16, 1984
4(the effective date of Public Act 83-1439), the Illinois
5Department shall establish a current list of acquisition costs
6for all prosthetic devices and any other items recognized as
7medical equipment and supplies reimbursable under this Article
8and shall update such list on a quarterly basis, except that
9the acquisition costs of all prescription drugs shall be
10updated no less frequently than every 30 days as required by
11Section 5-5.12.
12    Notwithstanding any other law to the contrary, the
13Illinois Department shall, within 365 days after July 22, 2013
14(the effective date of Public Act 98-104), establish
15procedures to permit skilled care facilities licensed under
16the Nursing Home Care Act to submit monthly billing claims for
17reimbursement purposes. Following development of these
18procedures, the Department shall, by July 1, 2016, test the
19viability of the new system and implement any necessary
20operational or structural changes to its information
21technology platforms in order to allow for the direct
22acceptance and payment of nursing home claims.
23    Notwithstanding any other law to the contrary, the
24Illinois Department shall, within 365 days after August 15,
252014 (the effective date of Public Act 98-963), establish
26procedures to permit ID/DD facilities licensed under the ID/DD

 

 

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1Community Care Act and MC/DD facilities licensed under the
2MC/DD Act to submit monthly billing claims for reimbursement
3purposes. Following development of these procedures, the
4Department shall have an additional 365 days to test the
5viability of the new system and to ensure that any necessary
6operational or structural changes to its information
7technology platforms are implemented.
8    The Illinois Department shall require all dispensers of
9medical services, other than an individual practitioner or
10group of practitioners, desiring to participate in the Medical
11Assistance program established under this Article to disclose
12all financial, beneficial, ownership, equity, surety or other
13interests in any and all firms, corporations, partnerships,
14associations, business enterprises, joint ventures, agencies,
15institutions or other legal entities providing any form of
16health care services in this State under this Article.
17    The Illinois Department may require that all dispensers of
18medical services desiring to participate in the medical
19assistance program established under this Article disclose,
20under such terms and conditions as the Illinois Department may
21by rule establish, all inquiries from clients and attorneys
22regarding medical bills paid by the Illinois Department, which
23inquiries could indicate potential existence of claims or
24liens for the Illinois Department.
25    Enrollment of a vendor shall be subject to a provisional
26period and shall be conditional for one year. During the

 

 

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1period of conditional enrollment, the Department may terminate
2the vendor's eligibility to participate in, or may disenroll
3the vendor from, the medical assistance program without cause.
4Unless otherwise specified, such termination of eligibility or
5disenrollment is not subject to the Department's hearing
6process. However, a disenrolled vendor may reapply without
7penalty.
8    The Department has the discretion to limit the conditional
9enrollment period for vendors based upon category of risk of
10the vendor.
11    Prior to enrollment and during the conditional enrollment
12period in the medical assistance program, all vendors shall be
13subject to enhanced oversight, screening, and review based on
14the risk of fraud, waste, and abuse that is posed by the
15category of risk of the vendor. The Illinois Department shall
16establish the procedures for oversight, screening, and review,
17which may include, but need not be limited to: criminal and
18financial background checks; fingerprinting; license,
19certification, and authorization verifications; unscheduled or
20unannounced site visits; database checks; prepayment audit
21reviews; audits; payment caps; payment suspensions; and other
22screening as required by federal or State law.
23    The Department shall define or specify the following: (i)
24by provider notice, the "category of risk of the vendor" for
25each type of vendor, which shall take into account the level of
26screening applicable to a particular category of vendor under

 

 

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1federal law and regulations; (ii) by rule or provider notice,
2the maximum length of the conditional enrollment period for
3each category of risk of the vendor; and (iii) by rule, the
4hearing rights, if any, afforded to a vendor in each category
5of risk of the vendor that is terminated or disenrolled during
6the conditional enrollment period.
7    To be eligible for payment consideration, a vendor's
8payment claim or bill, either as an initial claim or as a
9resubmitted claim following prior rejection, must be received
10by the Illinois Department, or its fiscal intermediary, no
11later than 180 days after the latest date on the claim on which
12medical goods or services were provided, with the following
13exceptions:
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

 

 

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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
5a recipient received retroactive eligibility, claims must be
6filed within 180 days after the Department determines the
7applicant is eligible. For claims for which the Illinois
8Department is not the primary payer, claims must be submitted
9to the Illinois Department within 180 days after the final
10adjudication by the primary payer.
11    In the case of long term care facilities, within 45
12calendar days of receipt by the facility of required
13prescreening information, new admissions with associated
14admission documents shall be submitted through the Medical
15Electronic Data Interchange (MEDI) or the Recipient
16Eligibility Verification (REV) System or shall be submitted
17directly to the Department of Human Services using required
18admission forms. Effective September 1, 2014, admission
19documents, including all prescreening information, must be
20submitted through MEDI or REV. Confirmation numbers assigned
21to an accepted transaction shall be retained by a facility to
22verify timely submittal. Once an admission transaction has
23been completed, all resubmitted claims following prior
24rejection are subject to receipt no later than 180 days after
25the admission transaction has been completed.
26    Claims that are not submitted and received in compliance

 

 

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1with the foregoing requirements shall not be eligible for
2payment under the medical assistance program, and the State
3shall have no liability for payment of those claims.
4    To the extent consistent with applicable information and
5privacy, security, and disclosure laws, State and federal
6agencies and departments shall provide the Illinois Department
7access to confidential and other information and data
8necessary to perform eligibility and payment verifications and
9other Illinois Department functions. This includes, but is not
10limited to: information pertaining to licensure;
11certification; earnings; immigration status; citizenship; wage
12reporting; unearned and earned income; pension income;
13employment; supplemental security income; social security
14numbers; National Provider Identifier (NPI) numbers; the
15National Practitioner Data Bank (NPDB); program and agency
16exclusions; taxpayer identification numbers; tax delinquency;
17corporate information; and death records.
18    The Illinois Department shall enter into agreements with
19State agencies and departments, and is authorized to enter
20into agreements with federal agencies and departments, under
21which such agencies and departments shall share data necessary
22for medical assistance program integrity functions and
23oversight. The Illinois Department shall develop, in
24cooperation with other State departments and agencies, and in
25compliance with applicable federal laws and regulations,
26appropriate and effective methods to share such data. At a

 

 

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1minimum, and to the extent necessary to provide data sharing,
2the Illinois Department shall enter into agreements with State
3agencies and departments, and is authorized to enter into
4agreements with federal agencies and departments, including,
5but not limited to: the Secretary of State; the Department of
6Revenue; the Department of Public Health; the Department of
7Human Services; and the Department of Financial and
8Professional Regulation.
9    Beginning in fiscal year 2013, the Illinois Department
10shall set forth a request for information to identify the
11benefits of a pre-payment, post-adjudication, and post-edit
12claims system with the goals of streamlining claims processing
13and provider reimbursement, reducing the number of pending or
14rejected claims, and helping to ensure a more transparent
15adjudication process through the utilization of: (i) provider
16data verification and provider screening technology; and (ii)
17clinical code editing; and (iii) pre-pay, pre- or
18post-adjudicated predictive modeling with an integrated case
19management system with link analysis. Such a request for
20information shall not be considered as a request for proposal
21or as an obligation on the part of the Illinois Department to
22take any action or acquire any products or services.
23    The Illinois Department shall establish policies,
24procedures, standards and criteria by rule for the
25acquisition, repair and replacement of orthotic and prosthetic
26devices and durable medical equipment. Such rules shall

 

 

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1provide, but not be limited to, the following services: (1)
2immediate repair or replacement of such devices by recipients;
3and (2) rental, lease, purchase or lease-purchase of durable
4medical equipment in a cost-effective manner, taking into
5consideration the recipient's medical prognosis, the extent of
6the recipient's needs, and the requirements and costs for
7maintaining such equipment. Subject to prior approval, such
8rules shall enable a recipient to temporarily acquire and use
9alternative or substitute devices or equipment pending repairs
10or replacements of any device or equipment previously
11authorized for such recipient by the Department.
12Notwithstanding any provision of Section 5-5f to the contrary,
13the Department may, by rule, exempt certain replacement
14wheelchair parts from prior approval and, for wheelchairs,
15wheelchair parts, wheelchair accessories, and related seating
16and positioning items, determine the wholesale price by
17methods other than actual acquisition costs.
18    The Department shall require, by rule, all providers of
19durable medical equipment to be accredited by an accreditation
20organization approved by the federal Centers for Medicare and
21Medicaid Services and recognized by the Department in order to
22bill the Department for providing durable medical equipment to
23recipients. No later than 15 months after the effective date
24of the rule adopted pursuant to this paragraph, all providers
25must meet the accreditation requirement.
26    In order to promote environmental responsibility, meet the

 

 

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1needs of recipients and enrollees, and achieve significant
2cost savings, the Department, or a managed care organization
3under contract with the Department, may provide recipients or
4managed care enrollees who have a prescription or Certificate
5of Medical Necessity access to refurbished durable medical
6equipment under this Section (excluding prosthetic and
7orthotic devices as defined in the Orthotics, Prosthetics, and
8Pedorthics Practice Act and complex rehabilitation technology
9products and associated services) through the State's
10assistive technology program's reutilization program, using
11staff with the Assistive Technology Professional (ATP)
12Certification if the refurbished durable medical equipment:
13(i) is available; (ii) is less expensive, including shipping
14costs, than new durable medical equipment of the same type;
15(iii) is able to withstand at least 3 years of use; (iv) is
16cleaned, disinfected, sterilized, and safe in accordance with
17federal Food and Drug Administration regulations and guidance
18governing the reprocessing of medical devices in health care
19settings; and (v) equally meets the needs of the recipient or
20enrollee. The reutilization program shall confirm that the
21recipient or enrollee is not already in receipt of same or
22similar equipment from another service provider, and that the
23refurbished durable medical equipment equally meets the needs
24of the recipient or enrollee. Nothing in this paragraph shall
25be construed to limit recipient or enrollee choice to obtain
26new durable medical equipment or place any additional prior

 

 

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1authorization conditions on enrollees of managed care
2organizations.
3    The Department shall execute, relative to the nursing home
4prescreening project, written inter-agency agreements with the
5Department of Human Services and the Department on Aging, to
6effect the following: (i) intake procedures and common
7eligibility criteria for those persons who are receiving
8non-institutional services; and (ii) the establishment and
9development of non-institutional services in areas of the
10State where they are not currently available or are
11undeveloped; and (iii) notwithstanding any other provision of
12law, subject to federal approval, on and after July 1, 2012, an
13increase in the determination of need (DON) scores from 29 to
1437 for applicants for institutional and home and
15community-based long term care; if and only if federal
16approval is not granted, the Department may, in conjunction
17with other affected agencies, implement utilization controls
18or changes in benefit packages to effectuate a similar savings
19amount for this population; and (iv) no later than July 1,
202013, minimum level of care eligibility criteria for
21institutional and home and community-based long term care; and
22(v) no later than October 1, 2013, establish procedures to
23permit long term care providers access to eligibility scores
24for individuals with an admission date who are seeking or
25receiving services from the long term care provider. In order
26to select the minimum level of care eligibility criteria, the

 

 

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1Governor shall establish a workgroup that includes affected
2agency representatives and stakeholders representing the
3institutional and home and community-based long term care
4interests. This Section shall not restrict the Department from
5implementing lower level of care eligibility criteria for
6community-based services in circumstances where federal
7approval has been granted.
8    The Illinois Department shall develop and operate, in
9cooperation with other State Departments and agencies and in
10compliance with applicable federal laws and regulations,
11appropriate and effective systems of health care evaluation
12and programs for monitoring of utilization of health care
13services and facilities, as it affects persons eligible for
14medical assistance under this Code.
15    The Illinois Department shall report annually to the
16General Assembly, no later than the second Friday in April of
171979 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

 

 

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1ending on the June 30 prior to the report. The report shall
2include suggested legislation for consideration by the General
3Assembly. The requirement for reporting to the General
4Assembly shall be satisfied by filing copies of the report as
5required by Section 3.1 of the General Assembly Organization
6Act, and filing such additional copies with the State
7Government Report Distribution Center for the General Assembly
8as is required under paragraph (t) of Section 7 of the State
9Library Act.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16    On and after July 1, 2012, the Department shall reduce any
17rate of reimbursement for services or other payments or alter
18any methodologies authorized by this Code to reduce any rate
19of reimbursement for services or other payments in accordance
20with Section 5-5e.
21    Because kidney transplantation can be an appropriate,
22cost-effective alternative to renal dialysis when medically
23necessary and notwithstanding the provisions of Section 1-11
24of this Code, beginning October 1, 2014, the Department shall
25cover kidney transplantation for noncitizens with end-stage
26renal disease who are not eligible for comprehensive medical

 

 

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1benefits, who meet the residency requirements of Section 5-3
2of this Code, and who would otherwise meet the financial
3requirements of the appropriate class of eligible persons
4under Section 5-2 of this Code. To qualify for coverage of
5kidney transplantation, such person must be receiving
6emergency renal dialysis services covered by the Department.
7Providers under this Section shall be prior approved and
8certified by the Department to perform kidney transplantation
9and the services under this Section shall be limited to
10services associated with kidney transplantation.
11    Notwithstanding any other provision of this Code to the
12contrary, on or after July 1, 2015, all FDA approved forms of
13medication assisted treatment prescribed for the treatment of
14alcohol dependence or treatment of opioid dependence shall be
15covered under both fee for service and managed care medical
16assistance programs for persons who are otherwise eligible for
17medical assistance under this Article and shall not be subject
18to any (1) utilization control, other than those established
19under the American Society of Addiction Medicine patient
20placement criteria, (2) prior authorization mandate, or (3)
21lifetime restriction limit mandate.
22    On or after July 1, 2015, opioid antagonists prescribed
23for the treatment of an opioid overdose, including the
24medication product, administration devices, and any pharmacy
25fees related to the dispensing and administration of the
26opioid antagonist, shall be covered under the medical

 

 

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1assistance program for persons who are otherwise eligible for
2medical assistance under this Article. As used in this
3Section, "opioid antagonist" means a drug that binds to opioid
4receptors and blocks or inhibits the effect of opioids acting
5on those receptors, including, but not limited to, naloxone
6hydrochloride or any other similarly acting drug approved by
7the U.S. Food and Drug Administration.
8    Upon federal approval, the Department shall provide
9coverage and reimbursement for all drugs that are approved for
10marketing by the federal Food and Drug Administration and that
11are recommended by the federal Public Health Service or the
12United States Centers for Disease Control and Prevention for
13pre-exposure prophylaxis and related pre-exposure prophylaxis
14services, including, but not limited to, HIV and sexually
15transmitted infection screening, treatment for sexually
16transmitted infections, medical monitoring, assorted labs, and
17counseling to reduce the likelihood of HIV infection among
18individuals who are not infected with HIV but who are at high
19risk of HIV infection.
20    A federally qualified health center, as defined in Section
211905(l)(2)(B) of the federal Social Security Act, shall be
22reimbursed by the Department in accordance with the federally
23qualified health center's encounter rate for services provided
24to medical assistance recipients that are performed by a
25dental hygienist, as defined under the Illinois Dental
26Practice Act, working under the general supervision of a

 

 

HB3119- 133 -LRB102 14580 KTG 19933 b

1dentist and employed by a federally qualified health center.
2(Source: P.A. 100-201, eff. 8-18-17; 100-395, eff. 1-1-18;
3100-449, eff. 1-1-18; 100-538, eff. 1-1-18; 100-587, eff.
46-4-18; 100-759, eff. 1-1-19; 100-863, eff. 8-14-18; 100-974,
5eff. 8-19-18; 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19;
6100-1148, eff. 12-10-18; 101-209, eff. 8-5-19; 101-580, eff.
71-1-20; 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
11medical benefits in all medical assistance programs or other
12health benefit programs administered by the Department,
13including the Children's Health Insurance Program Act and the
14Covering ALL KIDS Health Insurance Act, shall be enrolled in a
15care coordination program by no later than January 1, 2015.
16For purposes of this Section, "coordinated care" or "care
17coordination" means delivery systems where recipients will
18receive their care from providers who participate under
19contract in integrated delivery systems that are responsible
20for providing or arranging the majority of care, including
21primary care physician services, referrals from primary care
22physicians, diagnostic and treatment services, behavioral
23health services, in-patient and outpatient hospital services,
24dental services, and rehabilitation and long-term care
25services. The Department shall designate or contract for such

 

 

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1integrated delivery systems (i) to ensure enrollees have a
2choice of systems and of primary care providers within such
3systems; (ii) to ensure that enrollees receive quality care in
4a culturally and linguistically appropriate manner; and (iii)
5to ensure that coordinated care programs meet the diverse
6needs of enrollees with developmental, mental health,
7physical, and age-related disabilities.
8    (b) Payment for such coordinated care shall be based on
9arrangements where the State pays for performance related to
10health care outcomes, the use of evidence-based practices, the
11use of primary care delivered through comprehensive medical
12homes, the use of electronic medical records, and the
13appropriate exchange of health information electronically made
14either on a capitated basis in which a fixed monthly premium
15per recipient is paid and full financial risk is assumed for
16the delivery of services, or through other risk-based payment
17arrangements.
18    (c) To qualify for compliance with this Section, the 50%
19goal shall be achieved by enrolling medical assistance
20enrollees from each medical assistance enrollment category,
21including parents, children, seniors, and people with
22disabilities to the extent that current State Medicaid payment
23laws would not limit federal matching funds for recipients in
24care coordination programs. In addition, services must be more
25comprehensively defined and more risk shall be assumed than in
26the Department's primary care case management program as of

 

 

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1January 25, 2011 (the effective date of Public Act 96-1501).
2    (d) The Department shall report to the General Assembly in
3a separate part of its annual medical assistance program
4report, beginning April, 2012 until April, 2016, on the
5progress and implementation of the care coordination program
6initiatives established by the provisions of Public Act
796-1501. The Department shall include in its April 2011 report
8a full analysis of federal laws or regulations regarding upper
9payment limitations to providers and the necessary revisions
10or adjustments in rate methodologies and payments to providers
11under this Code that would be necessary to implement
12coordinated care with full financial risk by a party other
13than the Department.
14    (e) Integrated Care Program for individuals with chronic
15mental 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

 

 

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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
24which the Department mandates some or all of the beneficiaries
25of the Medical Assistance Program residing in the county to
26enroll in a Care Coordination Program, as set forth in Section

 

 

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15-30 of this Code, shall not be eligible for any non-claims
2based payments not mandated by Article V-A of this Code for
3which it would otherwise be qualified to receive, unless the
4hospital is a Coordinated Care Participating Hospital no later
5than 60 days after June 14, 2012 (the effective date of Public
6Act 97-689) or 60 days after the first mandatory enrollment of
7a beneficiary in a Coordinated Care program. For purposes of
8this subsection, "Coordinated Care Participating Hospital"
9means 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
24which contracts with the Department to provide services where
25payment for medical services is made on a capitated basis.
26    (g) No later than August 1, 2013, the Department shall

 

 

HB3119- 138 -LRB102 14580 KTG 19933 b

1issue a purchase of care solicitation for Accountable Care
2Entities (ACE) to serve any children and parents or caretaker
3relatives of children eligible for medical assistance under
4this Article. An ACE may be a single corporate structure or a
5network of providers organized through contractual
6relationships with a single corporate entity. The solicitation
7shall 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).

 

 

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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

 

 

HB3119- 140 -LRB102 14580 KTG 19933 b

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
10from the date of the posting of the solicitation to submit
11proposals. After the solicitation is released, in addition to
12the MCO rate development data available on the Department's
13website, subject to federal and State confidentiality and
14privacy laws and regulations, the Department shall provide 2
15years of de-identified summary service data on the targeted
16population, split between children and adults, showing the
17historical type and volume of services received and the cost
18of those services to those potential bidders that sign a data
19use agreement. The Department may add up to 2 non-state
20government employees with expertise in creating integrated
21delivery systems to its review team for the purchase of care
22solicitation described in this subsection. Any such
23individuals must sign a no-conflict disclosure and
24confidentiality agreement and agree to act in accordance with
25all applicable State laws.
26    During the first 2 years of an ACE's operation, the

 

 

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1Department shall provide claims data to the ACE on its
2enrollees on a periodic basis no less frequently than monthly.
3    Nothing in this subsection shall be construed to limit the
4Department's mandate to enroll 50% of its beneficiaries into
5care coordination systems by January 1, 2015, using all
6available care coordination delivery systems, including Care
7Coordination Entities (CCE), MCCNs, or MCOs, nor be construed
8to affect the current CCEs, MCCNs, and MCOs selected to serve
9seniors and persons with disabilities prior to that date.
10    Nothing in this subsection precludes the Department from
11considering future proposals for new ACEs or expansion of
12existing ACEs at the discretion of the Department.
13    (h) Department contracts with MCOs and other entities
14reimbursed by risk based capitation shall have a minimum
15medical loss ratio of 85%, shall require the entity to
16establish an appeals and grievances process for consumers and
17providers, and shall require the entity to provide a quality
18assurance and utilization review program. Entities contracted
19with the Department to coordinate healthcare regardless of
20risk shall be measured utilizing the same quality metrics. The
21quality metrics may be population specific. Any contracted
22entity serving at least 5,000 seniors or people with
23disabilities or 15,000 individuals in other populations
24covered by the Medical Assistance Program that has been
25receiving full-risk capitation for a year shall be accredited
26by a national accreditation organization authorized by the

 

 

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1Department within 2 years after the date it is eligible to
2become accredited. The requirements of this subsection shall
3apply to contracts with MCOs entered into or renewed or
4extended after June 1, 2013.
5    (h-5) The Department shall monitor and enforce compliance
6by MCOs with agreements they have entered into with providers
7on issues that include, but are not limited to, timeliness of
8payment, payment rates, and processes for obtaining prior
9approval. The Department may impose sanctions on MCOs for
10violating provisions of those agreements that include, but are
11not limited to, financial penalties, suspension of enrollment
12of new enrollees, and termination of the MCO's contract with
13the Department. As used in this subsection (h-5), "MCO" has
14the meaning ascribed to that term in Section 5-30.1 of this
15Code.
16    (i) Unless otherwise required by federal law, Medicaid
17Managed Care Entities and their respective business associates
18shall not disclose, directly or indirectly, including by
19sending a bill or explanation of benefits, information
20concerning the sensitive health services received by enrollees
21of the Medicaid Managed Care Entity to any person other than
22covered entities and business associates, which may receive,
23use, and further disclose such information solely for the
24purposes permitted under applicable federal and State laws and
25regulations if such use and further disclosure satisfies all
26applicable requirements of such laws and regulations. The

 

 

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1Medicaid Managed Care Entity or its respective business
2associates may disclose information concerning the sensitive
3health services if the enrollee who received the sensitive
4health services requests the information from the Medicaid
5Managed Care Entity or its respective business associates and
6authorized the sending of a bill or explanation of benefits.
7Communications including, but not limited to, statements of
8care received or appointment reminders either directly or
9indirectly to the enrollee from the health care provider,
10health care professional, and care coordinators, remain
11permissible. Medicaid Managed Care Entities or their
12respective business associates may communicate directly with
13their enrollees regarding care coordination activities for
14those enrollees.
15    For the purposes of this subsection, the term "Medicaid
16Managed Care Entity" includes Care Coordination Entities,
17Accountable Care Entities, Managed Care Organizations, and
18Managed Care Community Networks.
19    For purposes of this subsection, the term "sensitive
20health services" means mental health services, substance abuse
21treatment services, reproductive health services, family
22planning services, services for sexually transmitted
23infections and sexually transmitted diseases, and services for
24sexual assault or domestic abuse. Services include prevention,
25screening, consultation, examination, treatment, or follow-up.
26    For purposes of this subsection, "business associate",

 

 

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1"covered entity", "disclosure", and "use" have the meanings
2ascribed to those terms in 45 CFR 160.103.
3    Nothing in this subsection shall be construed to relieve a
4Medicaid Managed Care Entity or the Department of any duty to
5report incidents of sexually transmitted infections to the
6Department of Public Health or to the local board of health in
7accordance with regulations adopted under a statute or
8ordinance or to report incidents of sexually transmitted
9infections as necessary to comply with the requirements under
10Section 5 of the Abused and Neglected Child Reporting Act or as
11otherwise required by State or federal law.
12    The Department shall create policy in order to implement
13the requirements in this subsection.
14    (j) Managed Care Entities (MCEs), including MCOs and all
15other care coordination organizations, shall develop and
16maintain a written language access policy that sets forth the
17standards, guidelines, and operational plan to ensure language
18appropriate services and that is consistent with the standard
19of meaningful access for populations with limited English
20proficiency. The language access policy shall describe how the
21MCEs 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

 

 

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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
12relationship between Managed Care Organizations (MCOs) and any
13dental administrator contracted by an MCO to provide dental
14services. The Department shall adopt appropriate dental
15Healthcare Effectiveness Data and Information Set (HEDIS)
16measures and shall include the Annual Dental Visit (ADV) HEDIS
17measure in its Health Plan Comparison Tool and Illinois
18Medicaid Plan Report Card that is available on the
19Department's website for enrolled individuals.
20    The Department shall collect from each MCO specific
21information about the types of contracted, broad-based care
22coordination occurring between the MCO and any dental
23administrator, including, but not limited to, pregnant women
24and diabetic patients in need of oral care.
25(Source: P.A. 99-106, eff. 1-1-16; 99-181, eff. 7-29-15;
2699-566, eff. 1-1-17; 99-642, eff. 7-28-16; 100-587, eff.

 

 

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16-4-18.)
 
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
5Provider Fund. Interest earned by the Fund shall be credited
6to the Fund. The Fund shall not be used to replace any moneys
7appropriated to the Medicaid program by the General Assembly.
8    (b) The Fund is created for the purpose of receiving
9moneys in accordance with Section 5A-6 and disbursing moneys
10only for the following purposes, notwithstanding any other
11provision 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

 

 

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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

 

 

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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

 

 

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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

 

 

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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

 

 

HB3119- 151 -LRB102 14580 KTG 19933 b

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.

 

 

HB3119- 152 -LRB102 14580 KTG 19933 b

1    Disbursements from the Fund, other than transfers
2authorized under paragraphs (5) and (6) of this subsection,
3shall be by warrants drawn by the State Comptroller upon
4receipt of vouchers duly executed and certified by the
5Illinois 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;
25101-650, eff. 7-7-20.)
 

 

 

HB3119- 153 -LRB102 14580 KTG 19933 b

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
4Living Facility Fund. Interest earned by the Fund shall be
5credited to the Fund. The Fund shall not be used to replace any
6moneys appropriated to the Medicaid program by the General
7Assembly.
8    (b) The Fund is created for the purpose of receiving and
9disbursing moneys in accordance with this Article.
10Disbursements from the Fund, other than transfers authorized
11under paragraphs (5) and (6) of this subsection, shall be by
12warrants drawn by the State Comptroller upon receipt of
13vouchers duly executed and certified by the Department.
14Disbursements 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

 

 

HB3119- 154 -LRB102 14580 KTG 19933 b

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

 

 

HB3119- 155 -LRB102 14580 KTG 19933 b

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
13to December 31, 2018.
14    "Department" means the Department of Healthcare and Family
15Services.
16    "Federal employee health benefit" means the program of
17health benefits plans, as defined in 5 U.S.C. 8901, available
18to 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
21under a certificate of authority issued pursuant to the Health
22Maintenance Organization Act or as a Managed Care Community
23Network pursuant to Section 5-11 of this the Public Aid Code.
24    "Medicaid managed care organization" means a managed care
25organization under contract with the Department to provide

 

 

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1services to recipients of benefits in the medical assistance
2program pursuant to Article V of this the Public Aid Code, the
3Children's Health Insurance Program Act, or the Covering ALL
4KIDS Health Insurance Act. It does not include contracts the
5same entity or an affiliated entity has for other business.
6    "Medicare" means the federal Medicare program established
7under Title XVIII of the federal Social Security Act.
8    "Member months" means the aggregate total number of months
9all individuals are enrolled for coverage in a Managed Care
10Organization during the base year. Member months are
11determined by the Department for Medicaid Managed Care
12Organizations based on enrollment data in its Medicaid
13Management Information System and by the Department of
14Insurance for other Managed Care Organizations based on
15required filings with the Department of Insurance. Member
16months do not include months individuals are enrolled in a
17Limited Health Services Organization, including stand-alone
18dental or vision plans, a Medicare Advantage Plan, a Medicare
19Supplement Plan, a Medicaid Medicare Alignment Initiate Plan
20pursuant to a Memorandum of Understanding between the
21Department and the Federal Centers for Medicare and Medicaid
22Services 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

 

 

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1injuries. The Illinois Department shall have a charge upon all
2claims, demands and causes of action for injuries to an
3applicant for or recipient of (i) financial aid under Articles
4III, IV, and V or (ii) , (ii) health care benefits provided
5under the Covering ALL KIDS Health Insurance Act, or (iii)
6health care benefits provided under the Veterans' Health
7Insurance Program Act or the Veterans' Health Insurance
8Program Act of 2008 for the total amount of medical assistance
9provided the recipient from the time of injury to the date of
10recovery upon such claim, demand or cause of action. In
11addition, if the applicant or recipient was employable, as
12defined by the Department, at the time of the injury, the
13Department shall also have a charge upon any such claims,
14demands and causes of action for the total amount of aid
15provided to the recipient and his dependents, including all
16cash assistance and medical assistance only to the extent
17includable in the claimant's action, from the time of injury
18to the date of recovery upon such claim, demand or cause of
19action. Any definition of "employable" adopted by the
20Department shall apply only to persons above the age of
21compulsory school attendance.
22    If the injured person was employable at the time of the
23injury and is provided aid under Articles III, IV, or V and any
24dependent or member of his family is provided aid under
25Article VI, or vice versa, both the Illinois Department and
26the local governmental unit shall have a charge upon such

 

 

HB3119- 158 -LRB102 14580 KTG 19933 b

1claims, demands and causes of action for the aid provided to
2the injured person and any dependent member of his family,
3including all cash assistance, medical assistance and food
4stamps, from the time of the injury to the date of recovery.
5    "Recipient", as used herein, means (i) in the case of
6financial aid provided under this Code, the grantee of record
7and any persons whose needs are included in the financial aid
8provided to the grantee of record or otherwise met by grants
9under the appropriate Article of this Code for which such
10person is eligible and (ii) , (ii) in the case of health care
11benefits provided under the Covering ALL KIDS Health Insurance
12Act, the child to whom those benefits are provided, and (iii)
13in the case of health care benefits provided under the
14Veterans' Health Insurance Program Act or the Veterans' Health
15Insurance Program Act of 2008, the veteran to whom benefits
16are provided.
17    In each case, the notice shall be served by certified mail
18or registered mail, or by facsimile or electronic messaging
19when requested by the party or parties against whom the
20applicant or recipient has a claim, demand, or cause of
21action, upon the party or parties against whom the applicant
22or recipient has a claim, demand or cause of action. The notice
23shall claim the charge and describe the interest the Illinois
24Department, the local governmental unit, or the county, has in
25the claim, demand, or cause of action. The charge shall attach
26to any verdict or judgment entered and to any money or property

 

 

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1which may be recovered on account of such claim, demand, cause
2of action or suit from and after the time of the service of the
3notice.
4    On petition filed by the Illinois Department, or by the
5local governmental unit or county if either is claiming a
6charge, or by the recipient, or by the defendant, the court, on
7written notice to all interested parties, may adjudicate the
8rights of the parties and enforce the charge. The court may
9approve the settlement of any claim, demand or cause of action
10either before or after a verdict, and nothing in this Section
11shall be construed as requiring the actual trial or final
12adjudication of any claim, demand or cause of action upon
13which the Illinois Department, the local governmental unit or
14county has charge. The court may determine what portion of the
15recovery shall be paid to the injured person and what portion
16shall be paid to the Illinois Department, the local
17governmental unit or county having a charge against the
18recovery. In making this determination, the court shall
19conduct an evidentiary hearing and shall consider competent
20evidence 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

 

 

HB3119- 160 -LRB102 14580 KTG 19933 b

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

 

 

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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
18exercise by the court of its discretion to reduce the amount of
19a proven charge sought to be enforced against the recovery
20shall rest with the party seeking such reduction.
21    The court may reduce and apportion the Illinois
22Department's lien proportionate to the recovery of the
23claimant. The court may consider the nature and extent of the
24injury, economic and noneconomic loss, settlement offers,
25comparative negligence as it applies to the case at hand,
26hospital costs, physician costs, and all other appropriate

 

 

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1costs. The Illinois Department shall pay its pro rata share of
2the attorney fees based on the Illinois Department's lien as
3it compares to the total settlement agreed upon. This Section
4shall not affect the priority of an attorney's lien under the
5Attorneys Lien Act. The charges of the Illinois Department
6described in this Section, however, shall take priority over
7all other liens and charges existing under the laws of the
8State of Illinois with the exception of the attorney's lien
9under said statute.
10    Whenever the Department or any unit of local government
11has a statutory charge under this Section against a recovery
12for damages incurred by a recipient because of its advancement
13of any assistance, such charge shall not be satisfied out of
14any recovery until the attorney's claim for fees is satisfied,
15irrespective of whether or not an action based on recipient's
16claim has been filed in court.
17    This Section shall be inapplicable to any claim, demand or
18cause of action arising under (a) the Workers' Compensation
19Act or the predecessor Workers' Compensation Act of June 28,
201913, (b) the Workers' Occupational Diseases Act or the
21predecessor Workers' Occupational Diseases Act of March 16,
221936; 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

 

 

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1amount of (i) medical assistance provided by the Department to
2or on behalf of a recipient under Article V or VI or (ii) ,
3(ii) health care benefits provided for a child under the
4Covering ALL KIDS Health Insurance Act, or (iii) health care
5benefits provided to a veteran under the Veterans' Health
6Insurance Program Act or the Veterans' Health Insurance
7Program Act of 2008, the Department shall be subrogated to any
8right of recovery such recipient may have under the terms of
9any private or public health care coverage or casualty
10coverage, including coverage under the "Workers' Compensation
11Act", approved July 9, 1951, as amended, or the "Workers'
12Occupational Diseases Act", approved July 9, 1951, as amended,
13without the necessity of assignment of claim or other
14authorization to secure the right of recovery to the
15Department. To enforce its subrogation right, the Department
16may (i) intervene or join in an action or proceeding brought by
17the recipient, his or her guardian, personal representative,
18estate, dependents, or survivors against any person or public
19or private entity that may be liable; (ii) institute and
20prosecute legal proceedings against any person or public or
21private entity that may be liable for the cost of such
22services; or (iii) institute and prosecute legal proceedings,
23to the extent necessary to reimburse the Illinois Department
24for its costs, against any noncustodial parent who (A) is
25required by court or administrative order to provide insurance
26or other coverage of the cost of health care services for a

 

 

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1child eligible for medical assistance under this Code and (B)
2has received payment from a third party for the costs of those
3services but has not used the payments to reimburse either the
4other parent or the guardian of the child or the provider of
5the services.
6(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06;
795-755, 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

 

 

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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
5beneficiary under this Code, under the Covering ALL KIDS
6Health Insurance Act, or under the Veterans' Health Insurance
7Program Act or the Veterans' Health Insurance Program Act of
82008 because of an injury for which another person is liable,
9or for which a carrier is liable in accordance with the
10provisions of any policy of insurance issued pursuant to the
11Illinois Insurance Code, the Illinois Department shall have a
12right to recover from such person or carrier the reasonable
13value of benefits so provided. The Attorney General may, to
14enforce such right, institute and prosecute legal proceedings
15against the third person or carrier who may be liable for the
16injury in an appropriate court, either in the name of the
17Illinois Department or in the name of the injured person, his
18guardian, 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

 

 

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1    the heirs of the deceased.
2    (3) No action taken on behalf of the Department pursuant
3to this Section or any judgment rendered in such action shall
4be a bar to any action upon the claim or cause of action of the
5beneficiary, his guardian, conservator, personal
6representative, estate, dependents or survivors against the
7third person who may be liable for the injury, or shall operate
8to deny to the beneficiary the recovery for that portion of any
9damages not covered hereunder.
10    (c)(1) When an action is brought by the Department
11pursuant to subsection (b), it shall be commenced within the
12period prescribed by Article XIII of the Code of Civil
13Procedure.
14    However, the Department may not commence the action prior
15to 5 months before the end of the applicable period prescribed
16by Article XIII of the Code of Civil Procedure. Thirty days
17prior to commencing an action, the Department shall notify the
18beneficiary of the Department's intent to commence such an
19action.
20    (2) The death of the beneficiary does not abate any right
21of action established by subsection (b).
22    (3) When an action or claim is brought by persons entitled
23to bring such actions or assert such claims against a third
24person who may be liable for causing the death of a
25beneficiary, any settlement, judgment or award obtained is
26subject to the Department's claim for reimbursement of the

 

 

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1benefits provided to the beneficiary under this Code, under
2the Covering ALL KIDS Health Insurance Act, or under the
3Veterans' Health Insurance Program Act or the Veterans' Health
4Insurance Program Act of 2008.
5    (4) When the action or claim is brought by the beneficiary
6alone and the beneficiary incurs a personal liability to pay
7attorney's fees and costs of litigation, the Department's
8claim for reimbursement of the benefits provided to the
9beneficiary shall be the full amount of benefits paid on
10behalf of the beneficiary under this Code, under the Covering
11ALL KIDS Health Insurance Act, or under the Veterans' Health
12Insurance Program Act or the Veterans' Health Insurance
13Program Act of 2008 less a pro rata share which represents the
14Department's reasonable share of attorney's fees paid by the
15beneficiary and that portion of the cost of litigation
16expenses determined by multiplying by the ratio of the full
17amount of the expenditures of the full amount of the judgment,
18award or settlement.
19    (d)(1) If either the beneficiary or the Department brings
20an action or claim against such third party or carrier, the
21beneficiary or the Department shall within 30 days of filing
22the action give to the other written notice by personal
23service or registered mail of the action or claim and of the
24name of the court in which the action or claim is brought.
25Proof of such notice shall be filed in such action or claim. If
26an action or claim is brought by either the Department or the

 

 

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1beneficiary, the other may, at any time before trial on the
2facts, become a party to such action or claim or shall
3consolidate his action or claim with the other if brought
4independently.
5    (2) If an action or claim is brought by the Department
6pursuant to subsection (b)(1), written notice to the
7beneficiary, guardian, personal representative, estate or
8survivor given pursuant to this Section shall advise him of
9his right to intervene in the proceeding, his right to obtain a
10private attorney of his choice and the Department's right to
11recover the reasonable value of the benefits provided.
12    (e) In the event of judgment or award in a suit or claim
13against 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

 

 

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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
18before the judgment or award is satisfied, allow as a further
19lien the amount of any expenditures of the Department in
20payment of additional benefits arising out of the same cause
21of action or claim provided on behalf of the beneficiary under
22this Code, under the Covering ALL KIDS Health Insurance Act,
23or under the Veterans' Health Insurance Program Act or the
24Veterans' Health Insurance Program Act of 2008, when such
25benefits were provided or became payable subsequent to the
26original order.

 

 

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1    (g) No judgment, award, or settlement in any action or
2claim by a beneficiary to recover damages for injuries, when
3the Department has an interest, shall be satisfied without
4first giving the Department notice and a reasonable
5opportunity to perfect and satisfy its lien.
6    (h) When the Department has perfected a lien upon a
7judgment or award in favor of a beneficiary against any third
8party for an injury for which the beneficiary has received
9benefits under this Code, under the Covering ALL KIDS Health
10Insurance Act, or under the Veterans' Health Insurance Program
11Act or the Veterans' Health Insurance Program Act of 2008, the
12Department shall be entitled to a writ of execution as lien
13claimant to enforce payment of said lien against such third
14party with interest and other accruing costs as in the case of
15other executions. In the event the amount of such judgment or
16award so recovered has been paid to the beneficiary, the
17Department shall be entitled to a writ of execution against
18such beneficiary to the extent of the Department's lien, with
19interest and other accruing costs as in the case of other
20executions.
21    (i) Except as otherwise provided in this Section,
22notwithstanding any other provision of law, the entire amount
23of any settlement of the injured beneficiary's action or
24claim, with or without suit, is subject to the Department's
25claim for reimbursement of the benefits provided and any lien
26filed pursuant thereto to the same extent and subject to the

 

 

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1same 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;
395-755, 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
7receiving financial assistance under Article IV or Article VI
8of this Code, receiving health care benefits under the
9Covering ALL KIDS Health Insurance Act, or receiving health
10care benefits under the Veterans' Health Insurance Program Act
11or the Veterans' Health Insurance Program Act of 2008.
12    (b) If a recipient maintains any suit, charge or other
13court or administrative action against an employer seeking
14back pay for a period during which the recipient received
15financial assistance under Article IV or Article VI of this
16Code, health care benefits under the Covering ALL KIDS Health
17Insurance Act, or health care benefits under the Veterans'
18Health Insurance Program Act or the Veterans' Health Insurance
19Program Act of 2008, the recipient shall report such fact to
20the Department. To the extent of the amount of assistance
21provided to or on behalf of the recipient under Article IV or
22Article VI, health care benefits provided under the Covering
23ALL KIDS Health Insurance Act, or health care benefits
24provided under the Veterans' Health Insurance Program Act or
25the Veterans' Health Insurance Program Act of 2008, the

 

 

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1Department may by intervention or otherwise without the
2necessity of assignment of claim, attach a lien on the
3recovery of back wages equal to the amount of assistance
4provided by the Department to the recipient under Article IV
5or Article VI, under the Covering ALL KIDS Health Insurance
6Act, or under the Veterans' Health Insurance Program Act or
7the Veterans' Health Insurance Program Act of 2008.
8(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06;
995-755, 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
1320(a) of the Children's Health Insurance Program Act, the
14Department of Healthcare and Family Services may provide
15medical services to noncitizens who have not yet attained 19
16years of age and who are not eligible for medical assistance
17under Article V of this Code or under the Children's Health
18Insurance Program created by the Children's Health Insurance
19Program Act due to their not meeting the otherwise applicable
20provisions of Section 1-11 of this Code or Section 20(a) of the
21Children's Health Insurance Program Act. The medical services
22available, standards for eligibility, and other conditions of
23participation under this Section shall be established by rule
24by the Department; however, any such rule shall be at least as
25restrictive as the rules for medical assistance under Article

 

 

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1V of this Code or the Children's Health Insurance Program
2created by the Children's Health Insurance Program Act.
3    (a-5) Notwithstanding Section 1-11 of this Code, the
4Department of Healthcare and Family Services may provide
5medical assistance in accordance with Article V of this Code
6to noncitizens over the age of 65 years of age who are not
7eligible for medical assistance under Article V of this Code
8due to their not meeting the otherwise applicable provisions
9of Section 1-11 of this Code, whose income is at or below 100%
10of the federal poverty level after deducting the costs of
11medical or other remedial care, and who would otherwise meet
12the eligibility requirements in Section 5-2 of this Code. The
13medical services available, standards for eligibility, and
14other conditions of participation under this Section shall be
15established by rule by the Department; however, any such rule
16shall be at least as restrictive as the rules for medical
17assistance under Article V of this Code.
18    (b) The Department is authorized to take any action that
19would not otherwise be prohibited by applicable law, including
20without limitation cessation or limitation of enrollment,
21reduction of available medical services, and changing
22standards for eligibility, that is deemed necessary by the
23Department during a State fiscal year to assure that payments
24under this Section do not exceed available funds.
25    (c) (Blank). Continued enrollment of individuals into the
26program created under subsection (a) of this Section in any

 

 

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1fiscal year is contingent upon continued enrollment of
2individuals into the Children's Health Insurance Program
3during 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
9Department of Healthcare and Family Services shall identify
10individuals receiving services under medical assistance
11programs funded or partially funded by the State who may be or
12may have been covered by a third party health insurer, the
13period of coverage for such individuals, and the nature of
14coverage. A company, as defined in Section 5.5 of the Illinois
15Insurance Code and Section 2 of the Comprehensive Health
16Insurance Plan Act, must provide the Department eligibility
17information in a federally recommended or mutually agreed-upon
18format 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

 

 

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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
6a company that does not comply with the request for
7information made under Section 5.5 of the Illinois Insurance
8Code and paragraph (3) of subsection (a) of Section 20 of the
9Covering ALL KIDS Health Insurance Act. The amount of the
10penalty shall not exceed $10,000 per day for each day of
11noncompliance that occurs after the 180th day after the date
12of the request. The first day of the 180-day period commences
13on the business day following the date of the correspondence
14requesting the information sent by the Department to the
15company. 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
25the time the order is under administrative review if the
26company files an appeal.

 

 

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1    (d) The Attorney General may bring suit on behalf of the
2Department to collect the penalty.
3    (e) Recoveries made by the Department in connection with
4the imposition of an administrative penalty as provided under
5this Section shall be deposited into the Public Aid Recoveries
6Trust 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
10Public Aid Recoveries Trust Fund shall consist of (1)
11recoveries by the Department of Healthcare and Family Services
12(formerly Illinois Department of Public Aid) authorized by
13this Code in respect to applicants or recipients under
14Articles III, IV, V, and VI, including recoveries made by the
15Department of Healthcare and Family Services (formerly
16Illinois Department of Public Aid) from the estates of
17deceased recipients, (2) recoveries made by the Department of
18Healthcare and Family Services (formerly Illinois Department
19of Public Aid) in respect to applicants and recipients under
20the Children's Health Insurance Program Act, and the Covering
21ALL KIDS Health Insurance Act, (2.5) recoveries made by the
22Department of Healthcare and Family Services in connection
23with the imposition of an administrative penalty as provided
24under Section 12-4.45, (3) federal funds received on behalf of
25and earned by State universities and local governmental

 

 

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1entities for services provided to applicants or recipients
2covered under this Code, the Children's Health Insurance
3Program Act, and the Covering ALL KIDS Health Insurance Act,
4(3.5) federal financial participation revenue related to
5eligible disbursements made by the Department of Healthcare
6and Family Services from appropriations required by this
7Section, and (4) all other moneys received to the Fund,
8including interest thereon. The Fund shall be held as a
9special fund in the State Treasury.
10    Disbursements from this Fund shall be only (1) for the
11reimbursement of claims collected by the Department of
12Healthcare and Family Services (formerly Illinois Department
13of Public Aid) through error or mistake, (2) for payment to
14persons or agencies designated as payees or co-payees on any
15instrument, whether or not negotiable, delivered to the
16Department of Healthcare and Family Services (formerly
17Illinois Department of Public Aid) as a recovery under this
18Section, such payment to be in proportion to the respective
19interests of the payees in the amount so collected, (3) for
20payments to the Department of Human Services for collections
21made by the Department of Healthcare and Family Services
22(formerly Illinois Department of Public Aid) on behalf of the
23Department of Human Services under this Code, the Children's
24Health Insurance Program Act, and the Covering ALL KIDS Health
25Insurance Act, (4) for payment of administrative expenses
26incurred in performing the activities authorized under this

 

 

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1Code, the Children's Health Insurance Program Act, and the
2Covering ALL KIDS Health Insurance Act, (5) for payment of
3fees to persons or agencies in the performance of activities
4pursuant to the collection of monies owed the State that are
5collected under this Code, the Children's Health Insurance
6Program Act, and the Covering ALL KIDS Health Insurance Act,
7(6) for payments of any amounts which are reimbursable to the
8federal government which are required to be paid by State
9warrant by either the State or federal government, and (7) for
10payments to State universities and local governmental entities
11of federal funds for services provided to applicants or
12recipients covered under this Code, the Children's Health
13Insurance Program Act, and the Covering ALL KIDS Health
14Insurance Act. Disbursements from this Fund for purposes of
15items (4) and (5) of this paragraph shall be subject to
16appropriations from the Fund to the Department of Healthcare
17and Family Services (formerly Illinois Department of Public
18Aid).
19    The balance in this Fund after payment therefrom of any
20amounts reimbursable to the federal government, and minus the
21amount reasonably anticipated to be needed to make the
22disbursements authorized by this Section during the current
23and following 3 calendar months, shall be certified by the
24Director of Healthcare and Family Services and transferred by
25the State Comptroller to the Drug Rebate Fund or the
26Healthcare Provider Relief Fund in the State Treasury, as

 

 

HB3119- 179 -LRB102 14580 KTG 19933 b

1appropriate, on at least an annual basis by June 30th of each
2fiscal year. The Director of Healthcare and Family Services
3may certify and the State Comptroller shall transfer to the
4Drug Rebate Fund or the Healthcare Provider Relief Fund
5amounts on a more frequent basis.
6    On July 1, 1999, the State Comptroller shall transfer the
7sum of $5,000,000 from the Public Aid Recoveries Trust Fund
8(formerly the Public Assistance Recoveries Trust Fund) into
9the DHS Recoveries Trust Fund.
10(Source: P.A. 97-647, eff. 1-1-12; 97-689, eff. 6-14-12;
1198-130, 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
14Matching Fund. There is created in the State Treasury the
15Juvenile Rehabilitation Services Medicaid Matching Fund.
16Deposits to this Fund shall consist of all moneys received
17from the federal government for behavioral health services
18secured by counties pursuant to an agreement with the
19Department of Healthcare and Family Services with respect to
20Title XIX of the Social Security Act or under the Children's
21Health Insurance Program pursuant to the Children's Health
22Insurance Program Act and Title XXI of the Social Security Act
23for minors who are committed to mental health facilities by
24the Illinois court system and for residential placements
25secured by the Department of Juvenile Justice for minors as a

 

 

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1condition of their aftercare release.
2    Disbursements from the Fund shall be made, subject to
3appropriation, by the Department of Healthcare and Family
4Services for grants to the Department of Juvenile Justice and
5those counties which secure behavioral health services ordered
6by the courts and which have an interagency agreement with the
7Department and submit detailed bills according to standards
8determined 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
12repealing Section 5-29.
 
13    Section 65. The Early Intervention Services System Act is
14amended 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
18early intervention services is made, and at any eligibility
19redetermination thereafter, the family shall be asked if it is
20currently enrolled in any federally funded, Department of
21Healthcare and Family Services administered, medical programs,
22or the Title V program administered by the University of
23Illinois Division of Specialized Care for Children. If the

 

 

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1family is enrolled in any of these programs, that information
2shall be put on the individualized family service plan and
3entered into the computerized case management system, and
4shall require that the individualized family services plan of
5a child who has been found eligible for services through the
6Division of Specialized Care for Children state that the child
7is enrolled in that program. For those programs in which the
8family is not enrolled, a preliminary eligibility screen shall
9be 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
12funded, Department of Healthcare and Family Services
13administered, medical programs) benefits under the Children's
14Health Insurance Program Act, and (iii) Title V maternal and
15child health services provided through the Division of
16Specialized Care for Children of the University of Illinois.
17    (b) For purposes of determining family fees under
18subsection (f) of Section 13 and determining eligibility for
19the other programs and services specified in items (i) through
20(iii) of subsection (a), the lead agency shall develop and
21use, within 60 days after the effective date of this
22amendatory Act of the 92nd General Assembly, with the
23cooperation of the Department of Public Aid (now Healthcare
24and Family Services) and the Division of Specialized Care for
25Children of the University of Illinois, a screening device
26that provides sufficient information for the early

 

 

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1intervention regional intake entities or other agencies to
2establish eligibility for those other programs and shall, in
3cooperation with the Illinois Department of Public Aid (now
4Healthcare and Family Services) and the Division of
5Specialized Care for Children, train the regional intake
6entities on using the screening device.
7    (c) When a child is determined eligible for and enrolled
8in the early intervention program and has been found to at
9least meet the threshold income eligibility requirements for
10any federally funded, Department of Healthcare and Family
11Services administered, medical programs, the regional intake
12entity shall complete an application for any federally funded,
13Department of Healthcare and Family Services administered,
14medical programs with the family and forward it to the
15Department of Healthcare and Family Services for a
16determination of eligibility. A parent shall not be required
17to enroll in any federally funded, Department of Healthcare
18and Family Services administered, medical programs as a
19condition of receiving services provided pursuant to Part C of
20the Individuals with Disabilities Education Act.
21    (d) With the cooperation of the Department of Healthcare
22and Family Services, the lead agency shall establish
23procedures that ensure the timely and maximum allowable
24recovery of payments for all early intervention services and
25allowable administrative costs under Article V of the Illinois
26Public Aid Code and the Children's Health Insurance Program

 

 

HB3119- 183 -LRB102 14580 KTG 19933 b

1Act and shall include those procedures in the interagency
2agreement required under subsection (e) of Section 5 of this
3Act.
4    (e) (Blank). For purposes of making referrals for final
5determinations of eligibility for any federally funded,
6Department of Healthcare and Family Services administered,
7medical programs benefits under the Children's Health
8Insurance Program Act and for medical assistance under Article
9V of the Illinois Public Aid Code, the lead agency shall
10require each early intervention regional intake entity to
11enroll as an application agent in order for the entity to
12complete any federally funded, Department of Healthcare and
13Family Services administered, medical programs application as
14authorized under Section 22 of the Children's Health Insurance
15Program Act.
16    (f) For purposes of early intervention services that may
17be provided by the Division of Specialized Care for Children
18of the University of Illinois (DSCC), the lead agency shall
19establish procedures whereby the early intervention regional
20intake entities may determine whether children enrolled in the
21early intervention program may also be eligible for those
22services, and shall develop, within 60 days after the
23effective date of this amendatory Act of the 92nd General
24Assembly, (i) the inter-agency agreement required under
25subsection (e) of Section 5 of this Act, establishing that
26early intervention funds are to be used as the payor of last

 

 

HB3119- 184 -LRB102 14580 KTG 19933 b

1resort when services required under an individualized family
2services plan may be provided to an eligible child through the
3DSCC, and (ii) training guidelines for the regional intake
4entities and providers that explain eligibility and billing
5procedures for services through DSCC.
6    (g) The lead agency shall require that an individual
7applying for or renewing enrollment as a provider of services
8in the early intervention program state whether or not he or
9she is also enrolled as a DSCC provider. This information
10shall be noted next to the name of the provider on the
11computerized roster of Illinois early intervention providers,
12and regional intake entities shall make every effort to refer
13families 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
162008 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

 

 

HB3119- 185 -LRB102 14580 KTG 19933 b

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
23Program shall remain eligible for 12 months, provided the
24veteran or spouse remains a resident of the State and is not
25excluded under subsection (c) of this Section and provided the
26Department has not limited the enrollment period as set forth

 

 

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1in subsection (b) of Section 10.
2    (c) A veteran or spouse is not eligible for coverage under
3the 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,
16including, but not limited to, rules relating to eligibility,
17re-enrollment, grace periods, notice requirements, hearing
18procedures, cost-sharing, covered services, and provider
19requirements.
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
23repealed.
 
24    (215 ILCS 170/Act rep.)

 

 

HB3119- 187 -LRB102 14580 KTG 19933 b

1    Section 80. The Covering ALL KIDS Health Insurance Act is
2repealed.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    30 ILCS 105/6z-52
4    30 ILCS 105/6z-81
5    30 ILCS 105/25from Ch. 127, par. 161
6    30 ILCS 540/3-2
7    35 ILCS 105/3-8
8    35 ILCS 110/3-8
9    35 ILCS 120/2-9
10    35 ILCS 200/15-86
11    40 ILCS 5/24-102from Ch. 108 1/2, par. 24-102
12    110 ILCS 948/10
13    110 ILCS 948/25
14    110 ILCS 948/30
15    215 ILCS 5/352from Ch. 73, par. 964
16    215 ILCS 125/1-2from Ch. 111 1/2, par. 1402
17    305 ILCS 5/5-1.5
18    305 ILCS 5/5-2from Ch. 23, par. 5-2
19    305 ILCS 5/5-5from Ch. 23, par. 5-5
20    305 ILCS 5/5-30
21    305 ILCS 5/5A-8from Ch. 23, par. 5A-8
22    305 ILCS 5/5G-35
23    305 ILCS 5/5H-1
24    305 ILCS 5/11-22from Ch. 23, par. 11-22
25    305 ILCS 5/11-22afrom Ch. 23, par. 11-22a

 

 

HB3119- 189 -LRB102 14580 KTG 19933 b

1    305 ILCS 5/11-22bfrom Ch. 23, par. 11-22b
2    305 ILCS 5/11-22cfrom Ch. 23, par. 11-22c
3    305 ILCS 5/12-4.35
4    305 ILCS 5/12-4.45
5    305 ILCS 5/12-9from Ch. 23, par. 12-9
6    305 ILCS 5/12-10.4
7    305 ILCS 5/5-29 rep.
8    325 ILCS 20/13.5
9    330 ILCS 126/15
10    215 ILCS 106/Act rep.
11    215 ILCS 170/Act rep.