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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||||||||||||||||||||||||
5 | changing Sections 3-1 and 3-4 and by adding Section 5-2.4 as | ||||||||||||||||||||||||||||
6 | follows:
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7 | (305 ILCS 5/3-1) (from Ch. 23, par. 3-1)
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8 | Sec. 3-1. Eligibility Requirements. Financial aid in | ||||||||||||||||||||||||||||
9 | meeting basic
maintenance requirements for a livelihood | ||||||||||||||||||||||||||||
10 | compatible with health and
well-being shall be given under this | ||||||||||||||||||||||||||||
11 | Article to or in behalf of aged,
blind, or disabled persons who | ||||||||||||||||||||||||||||
12 | meet the eligibility conditions of Sections
3-1.1 through | ||||||||||||||||||||||||||||
13 | 3-1.7. Financial aid under this Article shall be available only
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14 | for persons who are receiving Supplemental Security Income | ||||||||||||||||||||||||||||
15 | (SSI) or who have
been found ineligible for SSI on the basis of | ||||||||||||||||||||||||||||
16 | income.
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17 | "Aged person" means a person who has attained age 65, as | ||||||||||||||||||||||||||||
18 | demonstrated by
such evidence of age as the Illinois Department | ||||||||||||||||||||||||||||
19 | may by rule prescribe.
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20 | "Blind person" means a person who has no vision or whose | ||||||||||||||||||||||||||||
21 | vision with
corrective glasses is so defective as to prevent | ||||||||||||||||||||||||||||
22 | the performance of
ordinary duties or tasks for which eyesight | ||||||||||||||||||||||||||||
23 | is essential. The Illinois
Department shall define blindness in | ||||||||||||||||||||||||||||
24 | terms of ophthalmic measurements or
ocular conditions. For | ||||||||||||||||||||||||||||
25 | purposes of this Act, an Illinois Disabled Person
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26 | Identification Card issued pursuant to The Illinois | ||||||||||||||||||||||||||||
27 | Identification Card
Act, indicating that the person thereon | ||||||||||||||||||||||||||||
28 | named has a Type 3 disability shall
be evidence that such | ||||||||||||||||||||||||||||
29 | person is a blind person within the meaning of this
Section; | ||||||||||||||||||||||||||||
30 | however, such a card shall not qualify such person for aid as a
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31 | blind person under this Act, and eligibility for aid as a blind | ||||||||||||||||||||||||||||
32 | person
shall be determined as provided in this Act.
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1 | "Disabled person" means , as defined by the Social Security | ||||||
2 | Act and implementing federal regulations, a person over the age | ||||||
3 | of 18 who is unable to do any substantial gainful activity by | ||||||
4 | reason of any medically determinable physical or mental | ||||||
5 | impairment which can be expected to result in death or which | ||||||
6 | has lasted or can be expected to last for a continuous period | ||||||
7 | of not less than 12 months. To meet this definition, the person | ||||||
8 | must have a severe impairment that makes the person unable to | ||||||
9 | do his or her previous work or any other substantial gainful | ||||||
10 | activity that exists in the national economy. To determine | ||||||
11 | whether the person is able to do any other work, the person's | ||||||
12 | residual functional capacity, age, education, and work | ||||||
13 | experience must be considered under the guidelines used to | ||||||
14 | determine disability under the Social Security Act as set forth | ||||||
15 | in 20 CFR 416, Subpart I.
a person age 18 or over who has a | ||||||
16 | physical or
mental impairment, disease, or loss which is of a | ||||||
17 | permanent nature and
which substantially impairs his ability to | ||||||
18 | perform labor or services or to
engage in useful occupations | ||||||
19 | for which he is qualified, as determined by
rule and regulation | ||||||
20 | of the Illinois Department. For purposes of this
Act, an | ||||||
21 | Illinois Disabled Person Identification Card issued pursuant | ||||||
22 | to The
Illinois Identification Card Act, indicating that the | ||||||
23 | person thereon named
has a Type 1 or 2, Class 2 disability | ||||||
24 | shall be evidence that such person is
a disabled person under | ||||||
25 | this Section; however, such a card shall not
qualify such | ||||||
26 | person for aid as a disabled person under this Act, and
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27 | eligibility for aid as a disabled person shall be determined as | ||||||
28 | provided in
this Act. If federal law or regulation permit or | ||||||
29 | require the inclusion of
blind or disabled persons whose | ||||||
30 | blindness or disability is not of the
degree specified in the | ||||||
31 | foregoing definitions, or permit or require the
inclusion of | ||||||
32 | disabled persons under age 18 or aged persons under age 65,
the | ||||||
33 | Illinois Department, upon written approval of the Governor, may | ||||||
34 | provide
by rule that all aged, blind or disabled persons toward | ||||||
35 | whose aid federal
funds are available be eligible for | ||||||
36 | assistance under this Article as is
given to those who meet the |
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1 | foregoing definitions of blind person and
disabled person or | ||||||
2 | aged person.
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3 | (Source: P.A. 89-21, eff. 7-1-95.)
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4 | (305 ILCS 5/3-4) (from Ch. 23, par. 3-4)
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5 | Sec. 3-4. Examination as to disability. | ||||||
6 | (a) For all purposes, in determining whether an applicant | ||||||
7 | is a "disabled person", the Client Assessment Unit or its | ||||||
8 | successor office shall rely on all regulations and other | ||||||
9 | guidance that are used by the Illinois Bureau of Disability | ||||||
10 | Determination Services in the Office of Rehabilitation | ||||||
11 | Services in determining disability under the Social Security | ||||||
12 | Act. | ||||||
13 | (b) As part of making a disability determination, the | ||||||
14 | Client Assessment Unit or its successor office shall determine | ||||||
15 | whether an applicant (i) has applied for Supplemental Security | ||||||
16 | Income (SSI) or Old-Age, Survivors, and Disability Insurance | ||||||
17 | (OASDI) disability benefits from the Social Security | ||||||
18 | Administration and received a decision on that application | ||||||
19 | within the last 12 months or (ii) has a pending application for | ||||||
20 | such benefits. In the case of a person who has received a | ||||||
21 | decision on such an application within the last 12 months or is | ||||||
22 | receiving SSI or OASDI benefits at the time of application | ||||||
23 | based on disability, the Client Assessment Unit or its | ||||||
24 | successor office shall follow the procedures set forth in | ||||||
25 | subsection (c). In the case of a person who has such an | ||||||
26 | application pending with the Social Security Administration or | ||||||
27 | the Bureau of Disability Determination Services, the Client | ||||||
28 | Assessment Unit or its successor office shall request copies of | ||||||
29 | medical and other records held by the Social Security | ||||||
30 | Administration or the Bureau of Disability Determination | ||||||
31 | Services for use in determining disability for purposes of | ||||||
32 | Article III or Article V of this Code. | ||||||
33 | (c) The Client Assessment Unit or its successor office must | ||||||
34 | do all of the following: | ||||||
35 | (1) Accept as binding a finding of disability made by |
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1 | the Social Security Administration if an applicant is | ||||||
2 | receiving SSI or primary OASDI benefits. | ||||||
3 | (2) Make a determination of disability if the applicant | ||||||
4 | has been denied SSI on the basis of too much income or if | ||||||
5 | the applicant is applying for medical assistance only and | ||||||
6 | not receiving SSI or OASDI. | ||||||
7 | If an individual applying for or receiving medical | ||||||
8 | assistance is determined currently "not disabled" by the Social | ||||||
9 | Security Administration under the SSI or OASDI program, the | ||||||
10 | Client Assessment Unit or its successor office shall accept the | ||||||
11 | Social Security Administration's determination of disability | ||||||
12 | and deny or cancel the case, no matter which agency made the | ||||||
13 | original determination of eligibility. Notwithstanding the | ||||||
14 | preceding sentence, however: | ||||||
15 | (A) If the individual appeals the Social Security | ||||||
16 | Administration's determination of disability to the Social | ||||||
17 | Security Administration, medical assistance under Article | ||||||
18 | V shall be continued for recipients through the level of a | ||||||
19 | determination by an Administrative Law Judge. | ||||||
20 | (B) If medical assistance has been canceled, but the | ||||||
21 | client later appeals to the Social Security | ||||||
22 | Administration, the case shall be reinstated through the | ||||||
23 | level of a determination by an Administrative Law Judge. | ||||||
24 | (C) If an Administrative Law Judge finds the individual | ||||||
25 | "not disabled", the Client Assessment Unit or its successor | ||||||
26 | office shall accept that finding as final. The individual | ||||||
27 | does not have the right to appeal the determination of | ||||||
28 | disability to the Client Assessment Unit or its successor | ||||||
29 | office at any time during this process. | ||||||
30 | (d) As part of making disability determinations, the Client | ||||||
31 | Assessment Unit or its successor office shall do the following: | ||||||
32 | (1) Identify and assist persons who are receiving | ||||||
33 | mental health treatment and services from Office of Mental | ||||||
34 | Health facilities, county health departments, and | ||||||
35 | community mental health agencies pursuant to a Serious | ||||||
36 | Mental Illness (SMI) finding in applying for medical |
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1 | assistance under Article V. | ||||||
2 | (2) Provide uniform policies and forms for submission | ||||||
3 | of mental health records from Office of Mental Health | ||||||
4 | facilities, county health departments, and community | ||||||
5 | mental health agencies that include completion of a mental | ||||||
6 | health treatment packet that contains the following | ||||||
7 | documents to be used by the Client Assessment Unit or its | ||||||
8 | successor office in determining disability status: | ||||||
9 | (A) the SMI determination; | ||||||
10 | (B) the medical evidence underlying the SMI | ||||||
11 | determination; | ||||||
12 | (C) the treatment plan; and | ||||||
13 | (D) a residual functional capacity form completed | ||||||
14 | by the treating mental health professional. | ||||||
15 | (3) Train staff of the Client Assessment Unit or its | ||||||
16 | successor office on the programs provided by the Office of | ||||||
17 | Mental Health, county departments of health, and community | ||||||
18 | mental health agencies and the process and significance of | ||||||
19 | findings of SMI in these settings; and require that a | ||||||
20 | finding of SMI status, with the corresponding receipt of | ||||||
21 | mental health treatment and services, constitutes a | ||||||
22 | presumption of disability that may be overridden only in | ||||||
23 | those cases in which actual medical evidence exists that | ||||||
24 | satisfactorily overrides the SMI designation. | ||||||
25 | (4) Monitor, on an ongoing basis, the resolution of | ||||||
26 | disability determinations for medical assistance | ||||||
27 | applicants receiving treatment and services from the | ||||||
28 | Office of Mental Health, county departments of health, and | ||||||
29 | community mental health agencies. | ||||||
30 | (e) As part of making disability determinations, the Client | ||||||
31 | Assessment Unit or its successor office shall do the following: | ||||||
32 | (1) Identify and assist persons who have had a | ||||||
33 | Determination of Need (DON) assessment with a score of 30 | ||||||
34 | or higher done by staff from the Department on Aging, the | ||||||
35 | Department of Human Services, or the Department of Public | ||||||
36 | Aid in applying for medical assistance under Article V. |
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1 | (2) Provide uniform policies and forms for submission | ||||||
2 | of health records by staff involved in doing the DON | ||||||
3 | assessment that include completion of a treatment packet | ||||||
4 | that contains the following documents to be used by the | ||||||
5 | Client Assessment Unit or its successor office in | ||||||
6 | determining disability status: | ||||||
7 | (A) the DON determination; | ||||||
8 | (B) the medical evidence underlying the DON | ||||||
9 | determination; | ||||||
10 | (C) the treatment plan, if any; and | ||||||
11 | (D) a residual functional capacity form completed | ||||||
12 | by the staff who completed the DON assessment. | ||||||
13 | (3) Train staff of the Client Assessment Unit or its | ||||||
14 | successor office on the DON assessment and programs | ||||||
15 | provided by State agencies for persons with DON assessment | ||||||
16 | scores of 30 or higher; and require that a DON score of 30 | ||||||
17 | or higher, with the corresponding receipt of services from | ||||||
18 | a State agency, constitutes a presumption of disability | ||||||
19 | that may be overridden only in those cases in which actual | ||||||
20 | medical evidence exists that satisfactorily overrides the | ||||||
21 | DON assessment. | ||||||
22 | (4) Monitor, on an ongoing basis, the resolution of | ||||||
23 | disability determinations for medical assistance | ||||||
24 | applicants who have DON assessment scores of 30 or higher. | ||||||
25 | (f) Redetermination of disability is a condition of | ||||||
26 | continuing eligibility for individuals who are not applying for | ||||||
27 | or receiving SSI or OASDI benefits. | ||||||
28 | (g) When appropriate, the Client Assessment Unit or its | ||||||
29 | successor office shall obtain and arrange for payment of a | ||||||
30 | medical examination to determine disability.
For all purposes, | ||||||
31 | the Illinois Department may accept determinations
as to | ||||||
32 | disability performed under the auspices of the Federal Social
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33 | Security Administration and properly certified to the | ||||||
34 | Department.
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35 | (Source: P.A. 89-21, eff. 7-1-95.)
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1 | (305 ILCS 5/5-2.4 new) | ||||||
2 | Sec. 5-2.4. Non-citizen; emergency medical condition. | ||||||
3 | (a) For purposes of this Section, "emergency medical | ||||||
4 | condition" means a medical condition (including labor and | ||||||
5 | delivery and including treatment of end stage renal disease, | ||||||
6 | other than organ transplants and related services) of | ||||||
7 | sufficient severity (including severe pain) such that the | ||||||
8 | absence of immediate medical attention could result in: | ||||||
9 | (1) placing the non-citizen's health in serious | ||||||
10 | jeopardy; | ||||||
11 | (2) serious impairments to bodily functions; or | ||||||
12 | (3) serious dysfunction of any organ or part (42 U.S.C. | ||||||
13 | 1396(b)(v)). | ||||||
14 | (b) A non-citizen who is not otherwise eligible for medical | ||||||
15 | assistance because he or she is not within a group eligible for | ||||||
16 | medical assistance, as defined by the Department of Public Aid, | ||||||
17 | is eligible for coverage of medical care and services if (i) | ||||||
18 | the medical care and services are necessary for the treatment | ||||||
19 | of an emergency medical condition of the non-citizen and (ii) | ||||||
20 | the non-citizen otherwise meets the income, asset, and | ||||||
21 | categorical requirements of the AABD MAG program or Family Care | ||||||
22 | program. | ||||||
23 | (c) For purposes of determining whether a non-citizen has | ||||||
24 | an emergency medical condition, the Client Assessment Unit or | ||||||
25 | its successor office must do the following: | ||||||
26 | (1) Consider all relevant evidence that is submitted in | ||||||
27 | support of the application for assistance. | ||||||
28 | This evidence may contain medical opinions. For | ||||||
29 | purposes of this item (1), "medical opinions" means | ||||||
30 | statements from physicians and psychologists or other | ||||||
31 | medical sources that reflect judgments about the nature and | ||||||
32 | severity of the applicant's medical condition, including | ||||||
33 | symptoms, diagnosis, and medical care and treatment | ||||||
34 | provided or to be provided. In deciding whether an | ||||||
35 | applicant has an emergency medical condition, the Client | ||||||
36 | Assessment Unit or its successor office must always |
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1 | consider the medical opinions that have been submitted that | ||||||
2 | underlie the medical care and treatment that was provided | ||||||
3 | or is to be provided. | ||||||
4 | After the Client Assessment Unit or its successor | ||||||
5 | office reviews all of the evidence relevant to the | ||||||
6 | application, including medical opinions, the Client | ||||||
7 | Assessment Unit or its successor office shall make findings | ||||||
8 | about what the evidence shows. | ||||||
9 | If all of the evidence received by the Client | ||||||
10 | Assessment Unit or its successor office, including all | ||||||
11 | medical opinions stating that emergency medical care and | ||||||
12 | treatment is required, is consistent, and if there is | ||||||
13 | sufficient evidence for the Client Assessment Unit or its | ||||||
14 | successor office to determine whether the applicant has an | ||||||
15 | emergency medical condition, the Client Assessment Unit or | ||||||
16 | its successor office shall make its determination based on | ||||||
17 | that evidence and shall find that the applicant has an | ||||||
18 | emergency medical condition. | ||||||
19 | If any of the evidence submitted, including any medical | ||||||
20 | opinions, is inconsistent with other evidence submitted, | ||||||
21 | or if any such evidence is internally inconsistent, the | ||||||
22 | Client Assessment Unit or its successor office shall weigh | ||||||
23 | all of the evidence and determine whether it is able to | ||||||
24 | determine whether the applicant has an emergency medical | ||||||
25 | condition based on the evidence that the Client Assessment | ||||||
26 | Unit or its successor office has. | ||||||
27 | If the evidence is consistent but the Client Assessment | ||||||
28 | Unit or its successor office does not have sufficient | ||||||
29 | evidence to determine whether the applicant has an | ||||||
30 | emergency medical condition, or if after weighing the | ||||||
31 | evidence the Client Assessment Unit or its successor office | ||||||
32 | is unable to reach a conclusion as to whether the applicant | ||||||
33 | has an emergency medical condition, the Client Assessment | ||||||
34 | Unit or its successor office shall try to obtain additional | ||||||
35 | evidence by recontacting the medical staff who treated the | ||||||
36 | applicant for the emergency medical condition and consider |
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1 | any additional evidence that is received, together with the | ||||||
2 | evidence already received. | ||||||
3 | If there are inconsistencies in the evidence that | ||||||
4 | cannot be resolved or if, despite efforts to obtain | ||||||
5 | additional evidence, the evidence is not complete, the | ||||||
6 | Client Assessment Unit or its successor office shall make a | ||||||
7 | determination or decision based on the evidence it has. | ||||||
8 | (2) Evaluate every medical opinion it receives. | ||||||
9 | Unless the Client Assessment Unit or its successor | ||||||
10 | office gives a treating source's opinion controlling | ||||||
11 | weight under item (1) of this subsection, the Client | ||||||
12 | Assessment Unit or its successor office shall consider all | ||||||
13 | of the following factors in deciding the weight that it | ||||||
14 | gives to any medical opinion: | ||||||
15 | (A) Examining relationship. The Client Assessment | ||||||
16 | Unit or its successor office shall give more weight to | ||||||
17 | the opinion of a source who has examined and treated | ||||||
18 | the applicant than to the opinion of a source who has | ||||||
19 | not examined or treated the applicant. | ||||||
20 | (B) Treatment relationship. The Client Assessment | ||||||
21 | Unit or its successor office shall give more weight to | ||||||
22 | opinions from treating sources, because these sources | ||||||
23 | are likely to be the medical professionals most able to | ||||||
24 | provide a detailed, longitudinal picture of the | ||||||
25 | applicant's medical impairment or impairments and may | ||||||
26 | bring a unique perspective to the medical evidence that | ||||||
27 | cannot be obtained from the objective medical findings | ||||||
28 | alone or from reports of individual examinations. If a | ||||||
29 | treating source's opinion on the issue of whether an | ||||||
30 | emergency medical condition exists is well-supported | ||||||
31 | by medically acceptable clinical and laboratory | ||||||
32 | diagnostic techniques and is not inconsistent with the | ||||||
33 | other substantial evidence submitted, the Client | ||||||
34 | Assessment Unit or its successor office shall give it | ||||||
35 | controlling weight. If the Client Assessment Unit or | ||||||
36 | its successor office does not give the treating |
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1 | source's opinion controlling weight, the Client | ||||||
2 | Assessment Unit or its successor office must explain in | ||||||
3 | its notice of determination the weight that it gave the | ||||||
4 | treating source's opinion. | ||||||
5 | (C) Supportability. The more a medical source | ||||||
6 | presents relevant evidence to support an opinion, | ||||||
7 | particularly medical signs and laboratory findings, | ||||||
8 | the more weight the Client Assessment Unit or its | ||||||
9 | successor office shall give that opinion. Because | ||||||
10 | nonexamining sources have no examining or treating | ||||||
11 | relationship with the applicant, the weight to be given | ||||||
12 | their opinions shall depend on the degree to which they | ||||||
13 | provide supporting explanations for the ir opinions. | ||||||
14 | The Client Assessment Unit or its successor office | ||||||
15 | shall evaluate the degree to which these opinions | ||||||
16 | consider all of the pertinent evidence in the claim, | ||||||
17 | including opinions of treating and other examining | ||||||
18 | sources. | ||||||
19 | (D) Consistency. The more consistent an opinion is | ||||||
20 | with the record as a whole, the more weight the Client | ||||||
21 | Assessment Unit or its successor office shall give to | ||||||
22 | that opinion. | ||||||
23 | (E) Specialization. The Client Assessment Unit or | ||||||
24 | its successor office shall give more weight to the | ||||||
25 | opinion of a specialist about medical issues related to | ||||||
26 | his or her area of specialty than to the opinion of a | ||||||
27 | source who is not a specialist. | ||||||
28 | (d) For purposes of determining whether a non-citizen has | ||||||
29 | an emergency medical condition, the Client Assessment Unit or | ||||||
30 | its successor office may not require a showing that the medical | ||||||
31 | condition either (i) occurs suddenly and unexpectedly or (ii) | ||||||
32 | is caused by injury or illness.
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33 | Section 99. Effective date. This Act takes effect upon | ||||||
34 | becoming law.
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