Rep. Greg Harris
Filed: 3/1/2022
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1 | AMENDMENT TO HOUSE BILL 4343
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2 | AMENDMENT NO. ______. Amend House Bill 4343, AS AMENDED, | ||||||
3 | by replacing everything after the enacting clause with the | ||||||
4 | following:
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5 | "Section 5. The Illinois Public Aid Code is amended by | ||||||
6 | changing Section 11-5.1 and by adding Sections 5-1.6, 5-13.1 | ||||||
7 | and 11-5.5 as follows: | ||||||
8 | (305 ILCS 5/5-1.6 new) | ||||||
9 | Sec. 5-1.6. Continuous eligibility; ex parte | ||||||
10 | redeterminations. | ||||||
11 | (a) By July 1, 2022, the Department of Healthcare and | ||||||
12 | Family Services shall seek a State Plan amendment or any | ||||||
13 | federal waivers necessary to make changes to the medical | ||||||
14 | assistance program. The Department shall apply for federal | ||||||
15 | approval to implement 12 months of continuous eligibility for | ||||||
16 | adults participating in the medical assistance program. The |
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1 | Department shall secure federal financial participation in | ||||||
2 | accordance with this Section for expenditures made by the | ||||||
3 | Department in State Fiscal Year 2023 and every State fiscal | ||||||
4 | year thereafter. | ||||||
5 | (b) By July 1, 2022, the Department of Healthcare and | ||||||
6 | Family Services shall seek a State Plan amendment or any | ||||||
7 | federal waivers or approvals necessary to make changes to the | ||||||
8 | medical assistance redetermination process for people without | ||||||
9 | any income at the time of redetermination. These changes shall | ||||||
10 | seek to allow all people without income to be considered for ex | ||||||
11 | parte redetermination. If there is no non-income related | ||||||
12 | disqualifying information for medical assistance recipients | ||||||
13 | without any income, then a person without any income shall be | ||||||
14 | redetermined ex parte. Within 60 days after receiving federal | ||||||
15 | approval or guidance, the Department of Healthcare and Family | ||||||
16 | Services and the Department of Human Services shall make | ||||||
17 | necessary technical and rule changes to implement changes to | ||||||
18 | the redetermination process. The percentage of medical | ||||||
19 | assistance recipients whose eligibility is renewed through the | ||||||
20 | ex parte redetermination process shall be reported monthly by | ||||||
21 | the Department of Healthcare and Family Services on its | ||||||
22 | website in accordance with subsection (d) of Section 11-5.1 of | ||||||
23 | this Code as well as shared in all Medicaid Advisory Committee | ||||||
24 | meetings and Medicaid Advisory Committee Public Education | ||||||
25 | Subcommittee meetings. |
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1 | (305 ILCS 5/5-13.1 new) | ||||||
2 | Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers, | ||||||
3 | and making information about waivers more accessible. | ||||||
4 | (a) It is the intent of the General Assembly to ease the | ||||||
5 | burden of liens and estate recovery for correctly paid | ||||||
6 | benefits for participants, applicants, and their families and | ||||||
7 | heirs, and to make information about waivers more widely | ||||||
8 | available. | ||||||
9 | (b) The Department shall waive estate recovery under | ||||||
10 | Sections 3-9 and 5-13 where recovery would not be | ||||||
11 | cost-effective, would work an undue hardship, or for any other | ||||||
12 | just reason, and shall make information about waivers and | ||||||
13 | estate recovery easily accessible. | ||||||
14 | (1) Cost-effectiveness waiver. Subject to federal | ||||||
15 | approval, the Department shall waive any claim against the | ||||||
16 | first $25,000 of any estate to prevent substantial and | ||||||
17 | unreasonable hardship. The Department shall consider the | ||||||
18 | gross assets in the estate, including, but not limited to, | ||||||
19 | the net value of real estate less mortgages or liens with | ||||||
20 | priority over the Department's claims. The Department may | ||||||
21 | increase the cost-effectiveness threshold in the future. | ||||||
22 | (2) Undue hardship waiver. The Department may develop | ||||||
23 | additional hardship waiver standards in addition to those | ||||||
24 | already employed, including, but not limited to, waivers | ||||||
25 | aimed at preserving income-producing real property or a | ||||||
26 | modest home as defined by rule. |
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1 | (3) Accessible information. The Department shall make | ||||||
2 | information about estate recovery and hardship waivers | ||||||
3 | easily accessible. The Department shall maintain | ||||||
4 | information about how to request a hardship waiver on its | ||||||
5 | website in English, Spanish, and the next 4 most commonly | ||||||
6 | used languages, including a short guide and simple form to | ||||||
7 | facilitate requesting hardship exemptions in each | ||||||
8 | language. On an annual basis, the Department shall | ||||||
9 | publicly report on the number of estate recovery cases | ||||||
10 | that are pursued and the number of undue hardship | ||||||
11 | exemptions granted, including demographic data of the | ||||||
12 | deceased beneficiaries where available. | ||||||
13 | (305 ILCS 5/11-5.1) | ||||||
14 | Sec. 11-5.1. Eligibility verification. Notwithstanding any | ||||||
15 | other provision of this Code, with respect to applications for | ||||||
16 | medical assistance provided under Article V of this Code, | ||||||
17 | eligibility shall be determined in a manner that ensures | ||||||
18 | program integrity and complies with federal laws and | ||||||
19 | regulations while minimizing unnecessary barriers to | ||||||
20 | enrollment. To this end, as soon as practicable, and unless | ||||||
21 | the Department receives written denial from the federal | ||||||
22 | government, this Section shall be implemented: | ||||||
23 | (a) The Department of Healthcare and Family Services or | ||||||
24 | its designees shall: | ||||||
25 | (1) By no later than July 1, 2011, require |
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1 | verification of, at a minimum, one month's income from all | ||||||
2 | sources required for determining the eligibility of | ||||||
3 | applicants for medical assistance under this Code. Such | ||||||
4 | verification shall take the form of pay stubs, business or | ||||||
5 | income and expense records for self-employed persons, | ||||||
6 | letters from employers, and any other valid documentation | ||||||
7 | of income including data obtained electronically by the | ||||||
8 | Department or its designees from other sources as | ||||||
9 | described in subsection (b) of this Section. A month's | ||||||
10 | income may be verified by a single pay stub with the | ||||||
11 | monthly income extrapolated from the time period covered | ||||||
12 | by the pay stub. | ||||||
13 | (2) By no later than October 1, 2011, require | ||||||
14 | verification of, at a minimum, one month's income from all | ||||||
15 | sources required for determining the continued eligibility | ||||||
16 | of recipients at their annual review of eligibility for | ||||||
17 | medical assistance under this Code. Information the | ||||||
18 | Department receives prior to the annual review, including | ||||||
19 | information available to the Department as a result of the | ||||||
20 | recipient's application for other non-Medicaid benefits, | ||||||
21 | that is sufficient to make a determination of continued | ||||||
22 | Medicaid eligibility may be reviewed and verified, and | ||||||
23 | subsequent action taken including client notification of | ||||||
24 | continued Medicaid eligibility. The date of client | ||||||
25 | notification establishes the date for subsequent annual | ||||||
26 | Medicaid eligibility reviews. Such verification shall take |
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1 | the form of pay stubs, business or income and expense | ||||||
2 | records for self-employed persons, letters from employers, | ||||||
3 | and any other valid documentation of income including data | ||||||
4 | obtained electronically by the Department or its designees | ||||||
5 | from other sources as described in subsection (b) of this | ||||||
6 | Section. A month's income may be verified by a single pay | ||||||
7 | stub with the monthly income extrapolated from the time | ||||||
8 | period covered by the pay stub. The
Department shall send | ||||||
9 | a notice to
recipients at least 60 days prior to the end of | ||||||
10 | their period
of eligibility that informs them of the
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11 | requirements for continued eligibility. If a recipient
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12 | does not fulfill the requirements for continued | ||||||
13 | eligibility by the
deadline established in the notice a | ||||||
14 | notice of cancellation shall be issued to the recipient | ||||||
15 | and coverage shall end no later than the last day of the | ||||||
16 | month following the last day of the eligibility period. A | ||||||
17 | recipient's eligibility may be reinstated without | ||||||
18 | requiring a new application if the recipient fulfills the | ||||||
19 | requirements for continued eligibility prior to the end of | ||||||
20 | the third month following the last date of coverage (or | ||||||
21 | longer period if required by federal regulations). Nothing | ||||||
22 | in this Section shall prevent an individual whose coverage | ||||||
23 | has been cancelled from reapplying for health benefits at | ||||||
24 | any time. | ||||||
25 | (3) By no later than July 1, 2011, require | ||||||
26 | verification of Illinois residency. |
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1 | The Department, with federal approval, may choose to adopt | ||||||
2 | continuous financial eligibility for a full 12 months for | ||||||
3 | adults on Medicaid. | ||||||
4 | (b) The Department shall establish or continue cooperative
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5 | arrangements with the Social Security Administration, the
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6 | Illinois Secretary of State, the Department of Human Services,
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7 | the Department of Revenue, the Department of Employment
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8 | Security, and any other appropriate entity to gain electronic
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9 | access, to the extent allowed by law, to information available
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10 | to those entities that may be appropriate for electronically
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11 | verifying any factor of eligibility for benefits under the
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12 | Program. Data relevant to eligibility shall be provided for no
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13 | other purpose than to verify the eligibility of new applicants | ||||||
14 | or current recipients of health benefits under the Program. | ||||||
15 | Data shall be requested or provided for any new applicant or | ||||||
16 | current recipient only insofar as that individual's | ||||||
17 | circumstances are relevant to that individual's or another | ||||||
18 | individual's eligibility. | ||||||
19 | (c) Within 90 days of the effective date of this | ||||||
20 | amendatory Act of the 96th General Assembly, the Department of | ||||||
21 | Healthcare and Family Services shall send notice to current | ||||||
22 | recipients informing them of the changes regarding their | ||||||
23 | eligibility verification.
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24 | (d) As soon as practical if the data is reasonably | ||||||
25 | available, but no later than January 1, 2017, the Department | ||||||
26 | shall compile on a monthly basis data on eligibility |
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1 | redeterminations of beneficiaries of medical assistance | ||||||
2 | provided under Article V of this Code. In addition to the
other | ||||||
3 | data required under this subsection, the Department
shall | ||||||
4 | compile on a monthly basis data on the percentage of
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5 | beneficiaries whose eligibility is renewed through ex parte
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6 | redeterminations as described in subsection (b) of Section
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7 | 5-1.6 of this Code, subject to federal approval of the changes
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8 | made in subsection (b) of Section 5-1.6 by this amendatory Act
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9 | of the 102nd General Assembly. This data shall be posted on the | ||||||
10 | Department's website, and data from prior months shall be | ||||||
11 | retained and available on the Department's website. The data | ||||||
12 | compiled and reported shall include the following: | ||||||
13 | (1) The total number of redetermination decisions made | ||||||
14 | in a month and, of that total number, the number of | ||||||
15 | decisions to continue or change benefits and the number of | ||||||
16 | decisions to cancel benefits. | ||||||
17 | (2) A breakdown of enrollee language preference for | ||||||
18 | the total number of redetermination decisions made in a | ||||||
19 | month and, of that total number, a breakdown of enrollee | ||||||
20 | language preference for the number of decisions to | ||||||
21 | continue or change benefits, and a breakdown of enrollee | ||||||
22 | language preference for the number of decisions to cancel | ||||||
23 | benefits. The language breakdown shall include, at a | ||||||
24 | minimum, English, Spanish, and the next 4 most commonly | ||||||
25 | used languages. | ||||||
26 | (3) The percentage of cancellation decisions made in a |
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1 | month due to each of the following: | ||||||
2 | (A) The beneficiary's ineligibility due to excess | ||||||
3 | income. | ||||||
4 | (B) The beneficiary's ineligibility due to not | ||||||
5 | being an Illinois resident. | ||||||
6 | (C) The beneficiary's ineligibility due to being | ||||||
7 | deceased. | ||||||
8 | (D) The beneficiary's request to cancel benefits. | ||||||
9 | (E) The beneficiary's lack of response after | ||||||
10 | notices mailed to the beneficiary are returned to the | ||||||
11 | Department as undeliverable by the United States | ||||||
12 | Postal Service. | ||||||
13 | (F) The beneficiary's lack of response to a | ||||||
14 | request for additional information when reliable | ||||||
15 | information in the beneficiary's account, or other | ||||||
16 | more current information, is unavailable to the | ||||||
17 | Department to make a decision on whether to continue | ||||||
18 | benefits. | ||||||
19 | (G) Other reasons tracked by the Department for | ||||||
20 | the purpose of ensuring program integrity. | ||||||
21 | (4) If a vendor is utilized to provide services in | ||||||
22 | support of the Department's redetermination decision | ||||||
23 | process, the total number of redetermination decisions | ||||||
24 | made in a month and, of that total number, the number of | ||||||
25 | decisions to continue or change benefits, and the number | ||||||
26 | of decisions to cancel benefits (i) with the involvement |
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1 | of the vendor and (ii) without the involvement of the | ||||||
2 | vendor. | ||||||
3 | (5) Of the total number of benefit cancellations in a | ||||||
4 | month, the number of beneficiaries who return from | ||||||
5 | cancellation within one month, the number of beneficiaries | ||||||
6 | who return from cancellation within 2 months, and the | ||||||
7 | number of beneficiaries who return from cancellation | ||||||
8 | within 3 months. Of the number of beneficiaries who return | ||||||
9 | from cancellation within 3 months, the percentage of those | ||||||
10 | cancellations due to each of the reasons listed under | ||||||
11 | paragraph (3) of this subsection. | ||||||
12 | (e) The Department shall conduct a complete review of the | ||||||
13 | Medicaid redetermination process in order to identify changes | ||||||
14 | that can increase the use of ex parte redetermination | ||||||
15 | processing. This review shall be completed within 90 days | ||||||
16 | after the effective date of this amendatory Act of the 101st | ||||||
17 | General Assembly. Within 90 days of completion of the review, | ||||||
18 | the Department shall seek written federal approval of policy | ||||||
19 | changes the review recommended and implement once approved. | ||||||
20 | The review shall specifically include, but not be limited to, | ||||||
21 | use of ex parte redeterminations of the following populations: | ||||||
22 | (1) Recipients of developmental disabilities services. | ||||||
23 | (2) Recipients of benefits under the State's Aid to | ||||||
24 | the Aged, Blind, or Disabled program. | ||||||
25 | (3) Recipients of Medicaid long-term care services and | ||||||
26 | supports, including waiver services. |
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1 | (4) All Modified Adjusted Gross Income (MAGI) | ||||||
2 | populations. | ||||||
3 | (5) Populations with no verifiable income. | ||||||
4 | (6) Self-employed people. | ||||||
5 | The report shall also outline populations and | ||||||
6 | circumstances in which an ex parte redetermination is not a | ||||||
7 | recommended option. | ||||||
8 | (f) The Department shall explore and implement, as | ||||||
9 | practical and technologically possible, roles that | ||||||
10 | stakeholders outside State agencies can play to assist in | ||||||
11 | expediting eligibility determinations and redeterminations | ||||||
12 | within 24 months after the effective date of this amendatory | ||||||
13 | Act of the 101st General Assembly. Such practical roles to be | ||||||
14 | explored to expedite the eligibility determination processes | ||||||
15 | shall include the implementation of hospital presumptive | ||||||
16 | eligibility, as authorized by the Patient Protection and | ||||||
17 | Affordable Care Act. | ||||||
18 | (g) The Department or its designee shall seek federal | ||||||
19 | approval to enhance the reasonable compatibility standard from | ||||||
20 | 5% to 10%. | ||||||
21 | (h) Reporting. The Department of Healthcare and Family | ||||||
22 | Services and the Department of Human Services shall publish | ||||||
23 | quarterly reports on their progress in implementing policies | ||||||
24 | and practices pursuant to this Section as modified by this | ||||||
25 | amendatory Act of the 101st General Assembly. | ||||||
26 | (1) The reports shall include, but not be limited to, |
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1 | the following: | ||||||
2 | (A) Medical application processing, including a | ||||||
3 | breakdown of the number of MAGI, non-MAGI, long-term | ||||||
4 | care, and other medical cases pending for various | ||||||
5 | incremental time frames between 0 to 181 or more days. | ||||||
6 | (B) Medical redeterminations completed, including: | ||||||
7 | (i) a breakdown of the number of households that were | ||||||
8 | redetermined ex parte and those that were not; (ii) | ||||||
9 | the reasons households were not redetermined ex parte; | ||||||
10 | and (iii) the relative percentages of these reasons. | ||||||
11 | (C) A narrative discussion on issues identified in | ||||||
12 | the functioning of the State's Integrated Eligibility | ||||||
13 | System and progress on addressing those issues, as | ||||||
14 | well as progress on implementing strategies to address | ||||||
15 | eligibility backlogs, including expanding ex parte | ||||||
16 | determinations to ensure timely eligibility | ||||||
17 | determinations and renewals. | ||||||
18 | (2) Initial reports shall be issued within 90 days | ||||||
19 | after the effective date of this amendatory Act of the | ||||||
20 | 101st General Assembly. | ||||||
21 | (3) All reports shall be published on the Department's | ||||||
22 | website. | ||||||
23 | (i) It is the determination of the General Assembly that | ||||||
24 | the Department must include seniors and persons with | ||||||
25 | disabilities in ex parte renewals. It is the determination of | ||||||
26 | the General Assembly that the Department must use its asset |
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1 | verification system to assist in the determination of whether | ||||||
2 | an individual's coverage can be renewed using the ex parte | ||||||
3 | process. If a State Plan amendment is required, the Department | ||||||
4 | shall pursue such State Plan amendment by July 1, 2022. Within | ||||||
5 | 60 days after receiving federal approval or guidance, the | ||||||
6 | Department of Healthcare and Family Services and the | ||||||
7 | Department of Human Services shall make necessary technical | ||||||
8 | and rule changes to implement these changes to the | ||||||
9 | redetermination process. | ||||||
10 | (Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20.) | ||||||
11 | (305 ILCS 5/11-5.5 new) | ||||||
12 | Sec. 11-5.5. Streamlining enrollment into the Medicare | ||||||
13 | Savings Program. | ||||||
14 | (a) The Department shall investigate how to align the | ||||||
15 | Medicare Part D Low-Income Subsidy and Medicare Savings | ||||||
16 | Program eligibility criteria. | ||||||
17 | (b) The Department shall issue a report making | ||||||
18 | recommendations on how to streamline enrollment into Medicare | ||||||
19 | Savings Program benefits by July 1, 2022. | ||||||
20 | (c) Within 90 days after issuing its report, the | ||||||
21 | Department shall seek public feedback on those recommendations | ||||||
22 | and plans. | ||||||
23 | (d) By July 1, 2023, the Department shall implement the | ||||||
24 | necessary changes to streamline enrollment into the Medicare | ||||||
25 | Savings Program. The Department may adopt any rules necessary |
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1 | to implement the provisions of this paragraph.
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2 | (305 ILCS 5/3-10 rep.)
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3 | (305 ILCS 5/3-10.1 rep.)
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4 | (305 ILCS 5/3-10.2 rep.)
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5 | (305 ILCS 5/3-10.3 rep.)
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6 | (305 ILCS 5/3-10.4 rep.)
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7 | (305 ILCS 5/3-10.5 rep.)
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8 | (305 ILCS 5/3-10.6 rep.)
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9 | (305 ILCS 5/3-10.7 rep.)
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10 | (305 ILCS 5/3-10.8 rep.)
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11 | (305 ILCS 5/3-10.9 rep.)
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12 | (305 ILCS 5/3-10.10 rep.)
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13 | (305 ILCS 5/5-13.5 rep.) | ||||||
14 | Section 10. The Illinois Public Aid Code is amended by | ||||||
15 | repealing Sections 3-10, 3-10.1, 3-10.2, 3-10.3, 3-10.4, | ||||||
16 | 3-10.5, 3-10.6, 3-10.7, 3-10.8, 3-10.9, and 3-10.10, and | ||||||
17 | 5-13.5.
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18 | Section 99. Effective date. This Act takes effect upon | ||||||
19 | becoming law.".
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