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1 | | rebalancing initiative. Notwithstanding any State law to the |
2 | | contrary, and subject to federal laws, regulations, and court |
3 | | decrees, the following shall apply to the long-term care |
4 | | rebalancing initiative: |
5 | | (1) "Long-term care rebalancing", as used in this |
6 | | Section, means removing barriers to community living for |
7 | | people of all ages with disabilities and long-term |
8 | | illnesses by offering individuals utilizing long-term care |
9 | | services a reasonable array of options, in particular |
10 | | adequate choices of community and institutional options, |
11 | | to achieve a balance between the proportion of total |
12 | | Medicaid long-term support expenditures used for |
13 | | institutional services and those used for community-based |
14 | | supports. |
15 | | (2) Subject to the provisions of this Section, the |
16 | | Governor shall create a unified budget report identifying |
17 | | the budgets of all State agencies offering long-term care |
18 | | services to persons in either institutional or community |
19 | | settings, including the budgets of State-operated |
20 | | facilities for persons with developmental disabilities |
21 | | that shall include, but not be limited to, the following |
22 | | service and financial data: |
23 | | (A) A breakdown of long-term care services, |
24 | | defined as institutional or community care, by the |
25 | | State agency primarily responsible for administration |
26 | | of the program. |
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1 | | (B) Actual and estimated enrollment, caseload, |
2 | | service hours, or service days provided for long-term |
3 | | care services described in a consistent format for |
4 | | those services, for each of the following age groups: |
5 | | older adults 65 years of age and older, younger adults |
6 | | 21 years of age through 64 years of age, and children |
7 | | under 21 years of age. |
8 | | (C) Funding sources for long-term care services. |
9 | | (D) Comparison of service and expenditure data, by |
10 | | services, both in aggregate and per person enrolled. |
11 | | (3) For each fiscal year, the unified budget report |
12 | | described in subdivision (2) shall be prepared with |
13 | | reference to the prioritized outcomes for that fiscal year |
14 | | contemplated by Sections 50-5 and 50-25 of this Code. |
15 | | (4) Each State agency responsible for the |
16 | | administration of long-term care services shall provide an |
17 | | analysis of the progress being made by the agency to |
18 | | transition persons from institutional to community |
19 | | settings, where appropriate, as part of the State's |
20 | | long-term care rebalancing initiative. |
21 | | (5) The Governor may designate amounts set aside for |
22 | | institutional services appropriated from the General |
23 | | Revenue Fund or any other State fund that receives monies |
24 | | for long-term care services to be transferred to all State |
25 | | agencies responsible for the administration of |
26 | | community-based long-term care programs, including, but |
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1 | | not limited to, community-based long-term care programs |
2 | | administered by the Department of Healthcare and Family |
3 | | Services, the Department of Human Services, and the |
4 | | Department on Aging, provided that the Director of |
5 | | Healthcare and Family Services first certifies that the |
6 | | amounts being transferred are necessary for the purpose of |
7 | | assisting persons in or at risk of being in institutional |
8 | | care to transition to community-based settings, including |
9 | | the financial data needed to prove the need for the |
10 | | transfer of funds. The total amounts transferred shall not |
11 | | exceed 4% in total of the amounts appropriated from the |
12 | | General Revenue Fund or any other State fund that receives |
13 | | monies for long-term care services for each fiscal year. A |
14 | | notice of the fund transfer must be made to the General |
15 | | Assembly and posted at a minimum on the Department of |
16 | | Healthcare and Family Services website, the Governor's |
17 | | Office of Management and Budget website, and any other |
18 | | website the Governor sees fit. These postings shall serve |
19 | | as notice to the General Assembly of the amounts to be |
20 | | transferred. Notice shall be given at least 30 days prior |
21 | | to transfer. |
22 | | (6) This Section shall be liberally construed and |
23 | | interpreted in a manner that allows the State to advance |
24 | | its long-term care rebalancing initiatives. |
25 | | Section 10. The State Finance Act is amended by changing |
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1 | | Sections 13.2 and 25 as follows:
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2 | | (30 ILCS 105/13.2) (from Ch. 127, par. 149.2)
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3 | | Sec. 13.2. Transfers among line item appropriations. |
4 | | (a) Transfers among line item appropriations from the same
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5 | | treasury fund for the objects specified in this Section may be |
6 | | made in
the manner provided in this Section when the balance |
7 | | remaining in one or
more such line item appropriations is |
8 | | insufficient for the purpose for
which the appropriation was |
9 | | made. |
10 | | (a-1) No transfers may be made from one
agency to another |
11 | | agency, nor may transfers be made from one institution
of |
12 | | higher education to another institution of higher education |
13 | | except as provided by subsection (a-4) .
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14 | | (a-2) Except as otherwise provided in this Section, |
15 | | transfers may be made only among the objects of expenditure |
16 | | enumerated
in this Section, except that no funds may be |
17 | | transferred from any
appropriation for personal services, from |
18 | | any appropriation for State
contributions to the State |
19 | | Employees' Retirement System, from any
separate appropriation |
20 | | for employee retirement contributions paid by the
employer, nor |
21 | | from any appropriation for State contribution for
employee |
22 | | group insurance. During State fiscal year 2005, an agency may |
23 | | transfer amounts among its appropriations within the same |
24 | | treasury fund for personal services, employee retirement |
25 | | contributions paid by employer, and State Contributions to |
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1 | | retirement systems; notwithstanding and in addition to the |
2 | | transfers authorized in subsection (c) of this Section, the |
3 | | fiscal year 2005 transfers authorized in this sentence may be |
4 | | made in an amount not to exceed 2% of the aggregate amount |
5 | | appropriated to an agency within the same treasury fund. During |
6 | | State fiscal year 2007, the Departments of Children and Family |
7 | | Services, Corrections, Human Services, and Juvenile Justice |
8 | | may transfer amounts among their respective appropriations |
9 | | within the same treasury fund for personal services, employee |
10 | | retirement contributions paid by employer, and State |
11 | | contributions to retirement systems. During State fiscal year |
12 | | 2010, the Department of Transportation may transfer amounts |
13 | | among their respective appropriations within the same treasury |
14 | | fund for personal services, employee retirement contributions |
15 | | paid by employer, and State contributions to retirement |
16 | | systems. During State fiscal year 2010 only, an agency may |
17 | | transfer amounts among its respective appropriations within |
18 | | the same treasury fund for personal services, employee |
19 | | retirement contributions paid by employer, and State |
20 | | contributions to retirement systems. Notwithstanding, and in |
21 | | addition to, the transfers authorized in subsection (c) of this |
22 | | Section, these transfers may be made in an amount not to exceed |
23 | | 2% of the aggregate amount appropriated to an agency within the |
24 | | same treasury fund.
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25 | | (a-3) Further, if an agency receives a separate
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26 | | appropriation for employee retirement contributions paid by |
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1 | | the employer,
any transfer by that agency into an appropriation |
2 | | for personal services
must be accompanied by a corresponding |
3 | | transfer into the appropriation for
employee retirement |
4 | | contributions paid by the employer, in an amount
sufficient to |
5 | | meet the employer share of the employee contributions
required |
6 | | to be remitted to the retirement system. |
7 | | (a-4) Long-Term Care Rebalancing. The Governor may |
8 | | designate amounts set aside for institutional services |
9 | | appropriated from the General Revenue Fund or any other State |
10 | | fund that receives monies for long-term care services to be |
11 | | transferred to all State agencies responsible for the |
12 | | administration of community-based long-term care programs, |
13 | | including, but not limited to, community-based long-term care |
14 | | programs administered by the Department of Healthcare and |
15 | | Family Services, the Department of Human Services, and the |
16 | | Department on Aging, provided that the Director of Healthcare |
17 | | and Family Services first certifies that the amounts being |
18 | | transferred are necessary for the purpose of assisting persons |
19 | | in or at risk of being in institutional care to transition to |
20 | | community-based settings, including the financial data needed |
21 | | to prove the need for the transfer of funds. The total amounts |
22 | | transferred shall not exceed 4% in total of the amounts |
23 | | appropriated from the General Revenue Fund or any other State |
24 | | fund that receives monies for long-term care services for each |
25 | | fiscal year. A notice of the fund transfer must be made to the |
26 | | General Assembly and posted at a minimum on the Department of |
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1 | | Healthcare and Family Services website, the Governor's Office |
2 | | of Management and Budget website, and any other website the |
3 | | Governor sees fit. These postings shall serve as notice to the |
4 | | General Assembly of the amounts to be transferred. Notice shall |
5 | | be given at least 30 days prior to transfer. |
6 | | (b) In addition to the general transfer authority provided |
7 | | under
subsection (c), the following agencies have the specific |
8 | | transfer authority
granted in this subsection: |
9 | | The Department of Healthcare and Family Services is |
10 | | authorized to make transfers
representing savings attributable |
11 | | to not increasing grants due to the
births of additional |
12 | | children from line items for payments of cash grants to
line |
13 | | items for payments for employment and social services for the |
14 | | purposes
outlined in subsection (f) of Section 4-2 of the |
15 | | Illinois Public Aid Code. |
16 | | The Department of Children and Family Services is |
17 | | authorized to make
transfers not exceeding 2% of the aggregate |
18 | | amount appropriated to it within
the same treasury fund for the |
19 | | following line items among these same line
items: Foster Home |
20 | | and Specialized Foster Care and Prevention, Institutions
and |
21 | | Group Homes and Prevention, and Purchase of Adoption and |
22 | | Guardianship
Services. |
23 | | The Department on Aging is authorized to make transfers not
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24 | | exceeding 2% of the aggregate amount appropriated to it within |
25 | | the same
treasury fund for the following Community Care Program |
26 | | line items among these
same line items: Homemaker and Senior |
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1 | | Companion Services, Alternative Senior Services, Case |
2 | | Coordination
Units, and Adult Day Care Services. |
3 | | The State Treasurer is authorized to make transfers among |
4 | | line item
appropriations
from the Capital Litigation Trust |
5 | | Fund, with respect to costs incurred in
fiscal years 2002 and |
6 | | 2003 only, when the balance remaining in one or
more such
line |
7 | | item appropriations is insufficient for the purpose for which |
8 | | the
appropriation was
made, provided that no such transfer may |
9 | | be made unless the amount transferred
is no
longer required for |
10 | | the purpose for which that appropriation was made. |
11 | | The State Board of Education is authorized to make |
12 | | transfers from line item appropriations within the same |
13 | | treasury fund for General State Aid and General State Aid - |
14 | | Hold Harmless, provided that no such transfer may be made |
15 | | unless the amount transferred is no longer required for the |
16 | | purpose for which that appropriation was made, to the line item |
17 | | appropriation for Transitional Assistance when the balance |
18 | | remaining in such line item appropriation is insufficient for |
19 | | the purpose for which the appropriation was made. |
20 | | The State Board of Education is authorized to make |
21 | | transfers between the following line item appropriations |
22 | | within the same treasury fund: Disabled Student |
23 | | Services/Materials (Section 14-13.01 of the School Code), |
24 | | Disabled Student Transportation Reimbursement (Section |
25 | | 14-13.01 of the School Code), Disabled Student Tuition - |
26 | | Private Tuition (Section 14-7.02 of the School Code), |
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1 | | Extraordinary Special Education (Section 14-7.02b of the |
2 | | School Code), Reimbursement for Free Lunch/Breakfast Program, |
3 | | Summer School Payments (Section 18-4.3 of the School Code), and |
4 | | Transportation - Regular/Vocational Reimbursement (Section |
5 | | 29-5 of the School Code). Such transfers shall be made only |
6 | | when the balance remaining in one or more such line item |
7 | | appropriations is insufficient for the purpose for which the |
8 | | appropriation was made and provided that no such transfer may |
9 | | be made unless the amount transferred is no longer required for |
10 | | the purpose for which that appropriation was made. |
11 | | During State fiscal years 2010 and 2011 only, the |
12 | | Department of Healthcare and Family Services is authorized to |
13 | | make transfers not exceeding 4% of the aggregate amount |
14 | | appropriated to it, within the same treasury fund, among the |
15 | | various line items appropriated for Medical Assistance. |
16 | | (c) The sum of such transfers for an agency in a fiscal |
17 | | year shall not
exceed 2% of the aggregate amount appropriated |
18 | | to it within the same treasury
fund for the following objects: |
19 | | Personal Services; Extra Help; Student and
Inmate |
20 | | Compensation; State Contributions to Retirement Systems; State
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21 | | Contributions to Social Security; State Contribution for |
22 | | Employee Group
Insurance; Contractual Services; Travel; |
23 | | Commodities; Printing; Equipment;
Electronic Data Processing; |
24 | | Operation of Automotive Equipment;
Telecommunications |
25 | | Services; Travel and Allowance for Committed, Paroled
and |
26 | | Discharged Prisoners; Library Books; Federal Matching Grants |
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1 | | for
Student Loans; Refunds; Workers' Compensation, |
2 | | Occupational Disease, and
Tort Claims; and, in appropriations |
3 | | to institutions of higher education,
Awards and Grants. |
4 | | Notwithstanding the above, any amounts appropriated for
|
5 | | payment of workers' compensation claims to an agency to which |
6 | | the authority
to evaluate, administer and pay such claims has |
7 | | been delegated by the
Department of Central Management Services |
8 | | may be transferred to any other
expenditure object where such |
9 | | amounts exceed the amount necessary for the
payment of such |
10 | | claims. |
11 | | (c-1) Special provisions for State fiscal year 2003. |
12 | | Notwithstanding any
other provision of this Section to the |
13 | | contrary, for State fiscal year 2003
only, transfers among line |
14 | | item appropriations to an agency from the same
treasury fund |
15 | | may be made provided that the sum of such transfers for an |
16 | | agency
in State fiscal year 2003 shall not exceed 3% of the |
17 | | aggregate amount
appropriated to that State agency for State |
18 | | fiscal year 2003 for the following
objects: personal services, |
19 | | except that no transfer may be approved which
reduces the |
20 | | aggregate appropriations for personal services within an |
21 | | agency;
extra help; student and inmate compensation; State
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22 | | contributions to retirement systems; State contributions to |
23 | | social security;
State contributions for employee group |
24 | | insurance; contractual services; travel;
commodities; |
25 | | printing; equipment; electronic data processing; operation of
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26 | | automotive equipment; telecommunications services; travel and |
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1 | | allowance for
committed, paroled, and discharged prisoners; |
2 | | library books; federal matching
grants for student loans; |
3 | | refunds; workers' compensation, occupational disease,
and tort |
4 | | claims; and, in appropriations to institutions of higher |
5 | | education,
awards and grants. |
6 | | (c-2) Special provisions for State fiscal year 2005. |
7 | | Notwithstanding subsections (a), (a-2), and (c), for State |
8 | | fiscal year 2005 only, transfers may be made among any line |
9 | | item appropriations from the same or any other treasury fund |
10 | | for any objects or purposes, without limitation, when the |
11 | | balance remaining in one or more such line item appropriations |
12 | | is insufficient for the purpose for which the appropriation was |
13 | | made, provided that the sum of those transfers by a State |
14 | | agency shall not exceed 4% of the aggregate amount appropriated |
15 | | to that State agency for fiscal year 2005.
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16 | | (d) Transfers among appropriations made to agencies of the |
17 | | Legislative
and Judicial departments and to the |
18 | | constitutionally elected officers in the
Executive branch |
19 | | require the approval of the officer authorized in Section 10
of |
20 | | this Act to approve and certify vouchers. Transfers among |
21 | | appropriations
made to the University of Illinois, Southern |
22 | | Illinois University, Chicago State
University, Eastern |
23 | | Illinois University, Governors State University, Illinois
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24 | | State University, Northeastern Illinois University, Northern |
25 | | Illinois
University, Western Illinois University, the Illinois |
26 | | Mathematics and Science
Academy and the Board of Higher |
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1 | | Education require the approval of the Board of
Higher Education |
2 | | and the Governor. Transfers among appropriations to all other
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3 | | agencies require the approval of the Governor. |
4 | | The officer responsible for approval shall certify that the
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5 | | transfer is necessary to carry out the programs and purposes |
6 | | for which
the appropriations were made by the General Assembly |
7 | | and shall transmit
to the State Comptroller a certified copy of |
8 | | the approval which shall
set forth the specific amounts |
9 | | transferred so that the Comptroller may
change his records |
10 | | accordingly. The Comptroller shall furnish the
Governor with |
11 | | information copies of all transfers approved for agencies
of |
12 | | the Legislative and Judicial departments and transfers |
13 | | approved by
the constitutionally elected officials of the |
14 | | Executive branch other
than the Governor, showing the amounts |
15 | | transferred and indicating the
dates such changes were entered |
16 | | on the Comptroller's records. |
17 | | (e) The State Board of Education, in consultation with the |
18 | | State Comptroller, may transfer line item appropriations for |
19 | | General State Aid between the Common School Fund and the |
20 | | Education Assistance Fund. With the advice and consent of the |
21 | | Governor's Office of Management and Budget, the State Board of |
22 | | Education, in consultation with the State Comptroller, may |
23 | | transfer line item appropriations between the General Revenue |
24 | | Fund and the Education Assistance Fund for the following |
25 | | programs: |
26 | | (1) Disabled Student Personnel Reimbursement (Section |
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1 | | 14-13.01 of the School Code); |
2 | | (2) Disabled Student Transportation Reimbursement |
3 | | (subsection (b) of Section 14-13.01 of the School Code); |
4 | | (3) Disabled Student Tuition - Private Tuition |
5 | | (Section 14-7.02 of the School Code); |
6 | | (4) Extraordinary Special Education (Section 14-7.02b |
7 | | of the School Code); |
8 | | (5) Reimbursement for Free Lunch/Breakfast Programs; |
9 | | (6) Summer School Payments (Section 18-4.3 of the |
10 | | School Code); |
11 | | (7) Transportation - Regular/Vocational Reimbursement |
12 | | (Section 29-5 of the School Code); |
13 | | (8) Regular Education Reimbursement (Section 18-3 of |
14 | | the School Code); and |
15 | | (9) Special Education Reimbursement (Section 14-7.03 |
16 | | of the School Code). |
17 | | (Source: P.A. 95-707, eff. 1-11-08; 96-37, eff. 7-13-09; |
18 | | 96-820, eff. 11-18-09; 96-959, eff. 7-1-10; 96-1086, eff. |
19 | | 7-16-10.)
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20 | | (30 ILCS 105/25) (from Ch. 127, par. 161)
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21 | | Sec. 25. Fiscal year limitations.
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22 | | (a) All appropriations shall be
available for expenditure |
23 | | for the fiscal year or for a lesser period if the
Act making |
24 | | that appropriation so specifies. A deficiency or emergency
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25 | | appropriation shall be available for expenditure only through |
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1 | | June 30 of
the year when the Act making that appropriation is |
2 | | enacted unless that Act
otherwise provides.
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3 | | (b) Outstanding liabilities as of June 30, payable from |
4 | | appropriations
which have otherwise expired, may be paid out of |
5 | | the expiring
appropriations during the 2-month period ending at |
6 | | the
close of business on August 31. Any service involving
|
7 | | professional or artistic skills or any personal services by an |
8 | | employee whose
compensation is subject to income tax |
9 | | withholding must be performed as of June
30 of the fiscal year |
10 | | in order to be considered an "outstanding liability as of
June |
11 | | 30" that is thereby eligible for payment out of the expiring
|
12 | | appropriation.
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13 | | (b-1) However, payment of tuition reimbursement claims |
14 | | under Section 14-7.03 or
18-3 of the School Code may be made by |
15 | | the State Board of Education from its
appropriations for those |
16 | | respective purposes for any fiscal year, even though
the claims |
17 | | reimbursed by the payment may be claims attributable to a prior
|
18 | | fiscal year, and payments may be made at the direction of the |
19 | | State
Superintendent of Education from the fund from which the |
20 | | appropriation is made
without regard to any fiscal year |
21 | | limitations , except as required by subsection (j) of this |
22 | | Section. Beginning on June 30, 2021, payment of tuition |
23 | | reimbursement claims under Section 14-7.03 or 18-3 of the |
24 | | School Code as of June 30, payable from appropriations that |
25 | | have otherwise expired, may be paid out of the expiring |
26 | | appropriation during the 4-month period ending at the close of |
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1 | | business on October 31 .
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2 | | (b-2) All outstanding liabilities as of June 30, 2010, |
3 | | payable from appropriations that would otherwise expire at the |
4 | | conclusion of the lapse period for fiscal year 2010, and |
5 | | interest penalties payable on those liabilities under the State |
6 | | Prompt Payment Act, may be paid out of the expiring |
7 | | appropriations until December 31, 2010, without regard to the |
8 | | fiscal year in which the payment is made, as long as vouchers |
9 | | for the liabilities are received by the Comptroller no later |
10 | | than August 31, 2010. |
11 | | (b-3) Medical payments may be made by the Department of |
12 | | Veterans' Affairs from
its
appropriations for those purposes |
13 | | for any fiscal year, without regard to the
fact that the |
14 | | medical services being compensated for by such payment may have
|
15 | | been rendered in a prior fiscal year , except as required by |
16 | | subsection (j) of this Section. Beginning on June 30, 2021, |
17 | | medical payments payable from appropriations that have |
18 | | otherwise expired may be paid out of the expiring appropriation |
19 | | during the 4-month period ending at the close of business on |
20 | | October 31 .
|
21 | | (b-4) Medical payments may be made by the Department of |
22 | | Healthcare and Family Services and medical payments and child |
23 | | care
payments may be made by the Department of
Human Services |
24 | | (as successor to the Department of Public Aid) from
|
25 | | appropriations for those purposes for any fiscal year,
without |
26 | | regard to the fact that the medical or child care services |
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1 | | being
compensated for by such payment may have been rendered in |
2 | | a prior fiscal
year; and payments may be made at the direction |
3 | | of the Department of
Healthcare and Family Services Central |
4 | | Management Services from the Health Insurance Reserve Fund and |
5 | | the
Local Government Health Insurance Reserve Fund without |
6 | | regard to any fiscal
year limitations , except as required by |
7 | | subsection (j) of this Section. Beginning on June 30, 2021, |
8 | | medical payments made by the Department of Healthcare and |
9 | | Family Services, child care payments made by the Department of |
10 | | Human Services, and payments made at the discretion of the |
11 | | Department of Healthcare and Family Services from the Health |
12 | | Insurance Reserve Fund and the Local Government Health |
13 | | Insurance Reserve Fund payable from appropriations that have |
14 | | otherwise expired may be paid out of the expiring appropriation |
15 | | during the 4-month period ending at the close of business on |
16 | | October 31 .
|
17 | | (b-5) Medical payments may be made by the Department of |
18 | | Human Services from its appropriations relating to substance |
19 | | abuse treatment services for any fiscal year, without regard to |
20 | | the fact that the medical services being compensated for by |
21 | | such payment may have been rendered in a prior fiscal year, |
22 | | provided the payments are made on a fee-for-service basis |
23 | | consistent with requirements established for Medicaid |
24 | | reimbursement by the Department of Healthcare and Family |
25 | | Services , except as required by subsection (j) of this Section. |
26 | | Beginning on June 30, 2021, medical payments made by the |
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1 | | Department of Human Services relating to substance abuse |
2 | | treatment services payable from appropriations that have |
3 | | otherwise expired may be paid out of the expiring appropriation |
4 | | during the 4-month period ending at the close of business on |
5 | | October 31 . |
6 | | (b-6) Additionally, payments may be made by the Department |
7 | | of Human Services from
its appropriations, or any other State |
8 | | agency from its appropriations with
the approval of the |
9 | | Department of Human Services, from the Immigration Reform
and |
10 | | Control Fund for purposes authorized pursuant to the |
11 | | Immigration Reform
and Control Act of 1986, without regard to |
12 | | any fiscal year limitations , except as required by subsection |
13 | | (j) of this Section. Beginning on June 30, 2021, payments made |
14 | | by the Department of Human Services from the Immigration Reform |
15 | | and Control Fund for purposes authorized pursuant to the |
16 | | Immigration Reform and Control Act of 1986 payable from |
17 | | appropriations that have otherwise expired may be paid out of |
18 | | the expiring appropriation during the 4-month period ending at |
19 | | the close of business on October 31 .
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20 | | Further, with respect to costs incurred in fiscal years |
21 | | 2002 and 2003 only,
payments may be made by the State Treasurer |
22 | | from its
appropriations
from the Capital Litigation Trust Fund |
23 | | without regard to any fiscal year
limitations.
|
24 | | Lease payments may be made by the Department of Central |
25 | | Management
Services under the sale and leaseback provisions of
|
26 | | Section 7.4 of
the State Property Control Act with respect to |
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1 | | the James R. Thompson Center and
the
Elgin Mental Health Center |
2 | | and surrounding land from appropriations for that
purpose |
3 | | without regard to any fiscal year
limitations.
|
4 | | Lease payments may be made under the sale and leaseback |
5 | | provisions of
Section 7.5 of the State Property Control Act |
6 | | with
respect to the
Illinois State Toll Highway Authority |
7 | | headquarters building and surrounding
land
without regard to |
8 | | any fiscal year
limitations.
|
9 | | (b-7) Payments may be made in accordance with a plan |
10 | | authorized by paragraph (11) or (12) of Section 405-105 of the |
11 | | Department of Central Management Services Law from |
12 | | appropriations for those payments without regard to fiscal year |
13 | | limitations. |
14 | | (c) Further, payments may be made by the Department of |
15 | | Public Health , and the
Department of Human Services (acting as |
16 | | successor to the Department of Public
Health under the |
17 | | Department of Human Services Act) , and the Department of |
18 | | Healthcare and Family Services
from their respective |
19 | | appropriations for grants for medical care to or on
behalf of |
20 | | persons
suffering from chronic renal disease, persons |
21 | | suffering from hemophilia, rape
victims, and premature and |
22 | | high-mortality risk infants and their mothers and
for grants |
23 | | for supplemental food supplies provided under the United States
|
24 | | Department of Agriculture Women, Infants and Children |
25 | | Nutrition Program,
for any fiscal year without regard to the |
26 | | fact that the services being
compensated for by such payment |
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1 | | may have been rendered in a prior fiscal year , except as |
2 | | required by subsection (j) of this Section. Beginning on June |
3 | | 30, 2021, payments made by the Department of Public Health, the |
4 | | Department of Human Services, and the Department of Healthcare |
5 | | and Family Services from their respective appropriations for |
6 | | grants for medical care to or on behalf of persons suffering |
7 | | from chronic renal disease, persons suffering from hemophilia, |
8 | | rape victims, and premature and high-mortality risk infants and |
9 | | their mothers and for grants for supplemental food supplies |
10 | | provided under the United States Department of Agriculture |
11 | | Women, Infants and Children Nutrition Program payable from |
12 | | appropriations that have otherwise expired may be paid out of |
13 | | the expiring appropriations during the 4-month period ending at |
14 | | the close of business on October 31 .
|
15 | | (d) The Department of Public Health and the Department of |
16 | | Human Services
(acting as successor to the Department of Public |
17 | | Health under the Department of
Human Services Act) shall each |
18 | | annually submit to the State Comptroller, Senate
President, |
19 | | Senate
Minority Leader, Speaker of the House, House Minority |
20 | | Leader, and the
respective Chairmen and Minority Spokesmen of |
21 | | the
Appropriations Committees of the Senate and the House, on |
22 | | or before
December 31, a report of fiscal year funds used to |
23 | | pay for services
provided in any prior fiscal year. This report |
24 | | shall document by program or
service category those |
25 | | expenditures from the most recently completed fiscal
year used |
26 | | to pay for services provided in prior fiscal years.
|
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1 | | (e) The Department of Healthcare and Family Services, the |
2 | | Department of Human Services
(acting as successor to the |
3 | | Department of Public Aid), and the Department of Human Services |
4 | | making fee-for-service payments relating to substance abuse |
5 | | treatment services provided during a previous fiscal year shall |
6 | | each annually
submit to the State
Comptroller, Senate |
7 | | President, Senate Minority Leader, Speaker of the House,
House |
8 | | Minority Leader, the respective Chairmen and Minority |
9 | | Spokesmen of the
Appropriations Committees of the Senate and |
10 | | the House, on or before November
30, a report that shall |
11 | | document by program or service category those
expenditures from |
12 | | the most recently completed fiscal year used to pay for (i)
|
13 | | services provided in prior fiscal years and (ii) services for |
14 | | which claims were
received in prior fiscal years.
|
15 | | (f) The Department of Human Services (as successor to the |
16 | | Department of
Public Aid) shall annually submit to the State
|
17 | | Comptroller, Senate President, Senate Minority Leader, Speaker |
18 | | of the House,
House Minority Leader, and the respective |
19 | | Chairmen and Minority Spokesmen of
the Appropriations |
20 | | Committees of the Senate and the House, on or before
December |
21 | | 31, a report
of fiscal year funds used to pay for services |
22 | | (other than medical care)
provided in any prior fiscal year. |
23 | | This report shall document by program or
service category those |
24 | | expenditures from the most recently completed fiscal
year used |
25 | | to pay for services provided in prior fiscal years.
|
26 | | (g) In addition, each annual report required to be |
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1 | | submitted by the
Department of Healthcare and Family Services |
2 | | under subsection (e) shall include the following
information |
3 | | with respect to the State's Medicaid program:
|
4 | | (1) Explanations of the exact causes of the variance |
5 | | between the previous
year's estimated and actual |
6 | | liabilities.
|
7 | | (2) Factors affecting the Department of Healthcare and |
8 | | Family Services' liabilities,
including but not limited to |
9 | | numbers of aid recipients, levels of medical
service |
10 | | utilization by aid recipients, and inflation in the cost of |
11 | | medical
services.
|
12 | | (3) The results of the Department's efforts to combat |
13 | | fraud and abuse.
|
14 | | (h) As provided in Section 4 of the General Assembly |
15 | | Compensation Act,
any utility bill for service provided to a |
16 | | General Assembly
member's district office for a period |
17 | | including portions of 2 consecutive
fiscal years may be paid |
18 | | from funds appropriated for such expenditure in
either fiscal |
19 | | year.
|
20 | | (i) An agency which administers a fund classified by the |
21 | | Comptroller as an
internal service fund may issue rules for:
|
22 | | (1) billing user agencies in advance for payments or |
23 | | authorized inter-fund transfers
based on estimated charges |
24 | | for goods or services;
|
25 | | (2) issuing credits, refunding through inter-fund |
26 | | transfers, or reducing future inter-fund transfers
during
|
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1 | | the subsequent fiscal year for all user agency payments or |
2 | | authorized inter-fund transfers received during the
prior |
3 | | fiscal year which were in excess of the final amounts owed |
4 | | by the user
agency for that period; and
|
5 | | (3) issuing catch-up billings to user agencies
during |
6 | | the subsequent fiscal year for amounts remaining due when |
7 | | payments or authorized inter-fund transfers
received from |
8 | | the user agency during the prior fiscal year were less than |
9 | | the
total amount owed for that period.
|
10 | | User agencies are authorized to reimburse internal service |
11 | | funds for catch-up
billings by vouchers drawn against their |
12 | | respective appropriations for the
fiscal year in which the |
13 | | catch-up billing was issued or by increasing an authorized |
14 | | inter-fund transfer during the current fiscal year. For the |
15 | | purposes of this Act, "inter-fund transfers" means transfers |
16 | | without the use of the voucher-warrant process, as authorized |
17 | | by Section 9.01 of the State Comptroller Act.
|
18 | | (i-1) Beginning on July 1, 2021, all outstanding |
19 | | liabilities, not payable during the 4-month lapse period as |
20 | | described in subsections (b-1), (b-3), (b-4), (b-5), (b-6), and |
21 | | (c) of this Section, that are made from appropriations for that |
22 | | purpose for any fiscal year, without regard to the fact that |
23 | | the services being compensated for by those payments may have |
24 | | been rendered in a prior fiscal year, are limited to only those |
25 | | claims that have been incurred but for which a proper bill or |
26 | | invoice as defined by the State Prompt Payment Act has not been |
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1 | | received by September 30th following the end of the fiscal year |
2 | | in which the service was rendered. |
3 | | (j) Notwithstanding any other provision of this Act, the |
4 | | aggregate amount of payments to be made without regard for |
5 | | fiscal year limitations as contained in subsections (b-1), |
6 | | (b-3), (b-4), (b-5), (b-6), and (c) of this Section, and |
7 | | determined by using Generally Accepted Accounting Principles, |
8 | | shall not exceed the following amounts: |
9 | | (1) $6,000,000,000 for outstanding liabilities related |
10 | | to fiscal year 2012; |
11 | | (2) $5,300,000,000 for outstanding liabilities related |
12 | | to fiscal year 2013; |
13 | | (3) $4,600,000,000 for outstanding liabilities related |
14 | | to fiscal year 2014; |
15 | | (4) $4,000,000,000 for outstanding liabilities related |
16 | | to fiscal year 2015; |
17 | | (5) $3,300,000,000 for outstanding liabilities related |
18 | | to fiscal year 2016; |
19 | | (6) $2,600,000,000 for outstanding liabilities related |
20 | | to fiscal year 2017; |
21 | | (7) $2,000,000,000 for outstanding liabilities related |
22 | | to fiscal year 2018; |
23 | | (8) $1,300,000,000 for outstanding liabilities related |
24 | | to fiscal year 2019; |
25 | | (9) $600,000,000 for outstanding liabilities related |
26 | | to fiscal year 2020; and |
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1 | | (10) $0 for outstanding liabilities related to fiscal |
2 | | year 2021 and fiscal years thereafter. |
3 | | (Source: P.A. 95-331, eff. 8-21-07; 96-928, eff. 6-15-10; |
4 | | 96-958, eff. 7-1-10; revised 7-22-10.)
|
5 | | Section 15. The State Prompt Payment Act is amended by |
6 | | changing Section 3-2 as follows:
|
7 | | (30 ILCS 540/3-2)
|
8 | | Sec. 3-2. Beginning July 1, 1993, in any instance where a |
9 | | State official or
agency is late in payment of a vendor's bill |
10 | | or invoice for goods or services
furnished to the State, as |
11 | | defined in Section 1, properly approved in
accordance with |
12 | | rules promulgated under Section 3-3, the State official or
|
13 | | agency shall pay interest to the vendor in accordance with the |
14 | | following:
|
15 | | (1) Any bill, except a bill submitted under Article V |
16 | | of the Illinois Public Aid Code, approved for payment under |
17 | | this Section must be paid
or the payment issued to the |
18 | | payee within 60 days of receipt
of a proper bill or |
19 | | invoice.
If payment is not issued to the payee within this |
20 | | 60 day
period, an
interest penalty of 1.0% of any amount |
21 | | approved and unpaid shall be added
for each month or |
22 | | fraction thereof after the end of this 60 day period,
until |
23 | | final payment is made. Any bill , except a bill for pharmacy |
24 | | services or goods, submitted under Article V of the |
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1 | | Illinois Public Aid Code approved for payment under this |
2 | | Section must be paid
or the payment issued to the payee |
3 | | within 60 days after receipt
of a proper bill or invoice, |
4 | | and,
if payment is not issued to the payee within this |
5 | | 60-day
period, an
interest penalty of 2.0% of any amount |
6 | | approved and unpaid shall be added
for each month or |
7 | | fraction thereof after the end of this 60-day period,
until |
8 | | final payment is made. Any bill for pharmacy services or |
9 | | goods submitted under Article V of the Illinois Public Aid |
10 | | Code, approved for payment under this Section must be paid |
11 | | or the payment issued to the payee within 60 days of |
12 | | receipt of a proper bill or invoice. If payment is not |
13 | | issued to the payee within this 60 day period, an interest |
14 | | penalty of 1.0% of any amount approved and unpaid shall be |
15 | | added for each month or fraction thereof after the end of |
16 | | this 60 day period, until final 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 agency |
19 | | determines that the bill or invoice contains a defect |
20 | | making it
unable to process the payment request, the agency
|
21 | | shall notify the vendor requesting payment as soon as |
22 | | possible after
discovering the
defect pursuant to rules |
23 | | promulgated under Section 3-3; provided, however, that the |
24 | | notice for construction related bills or invoices must be |
25 | | given not later than 30 days after the bill or invoice was |
26 | | first submitted. The notice shall
identify the defect and |
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1 | | any additional information
necessary to correct the |
2 | | defect. If one or more items on a construction related bill |
3 | | or invoice are disapproved, but not the entire bill or |
4 | | invoice, then the portion that is not disapproved shall be |
5 | | paid.
|
6 | | (2) Where a State official or agency is late in payment |
7 | | 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 more |
12 | | to the appropriate
vendor. Each agency shall be responsible |
13 | | for determining whether an interest
penalty
is
owed and
for |
14 | | paying the interest to the vendor.
Interest due to a vendor |
15 | | that amounts to less than $50 shall not be paid but shall |
16 | | be accrued until all interest due the vendor for all |
17 | | similar warrants exceeds $50, at which time the accrued |
18 | | interest shall be payable and interest will begin accruing |
19 | | again, except that interest accrued as of the end of the |
20 | | fiscal year that does not exceed $50 shall be payable at |
21 | | that time. In the event an
individual has paid a vendor for |
22 | | services in advance, the provisions of this
Section shall |
23 | | apply until payment is made to that individual.
|
24 | | (3) The provisions of this amendatory Act of the 96th |
25 | | General Assembly reducing the interest rate on pharmacy |
26 | | claims under Article V of the Illinois Public Aid Code to |
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1 | | 1.0% per month shall apply to any pharmacy bills for |
2 | | services and goods under Article V of the Illinois Public |
3 | | Aid Code received on or after the date 60 days before the |
4 | | effective date of this amendatory Act of the 96th General |
5 | | Assembly. |
6 | | (Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10; |
7 | | 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10.)
|
8 | | Section 20. The Illinois Income Tax Act is amended by |
9 | | changing Section 917 as follows:
|
10 | | (35 ILCS 5/917) (from Ch. 120, par. 9-917)
|
11 | | Sec. 917. Confidentiality and information sharing.
|
12 | | (a) Confidentiality.
Except as provided in this Section, |
13 | | all information received by the Department
from returns filed |
14 | | under this Act, or from any investigation conducted under
the |
15 | | provisions of this Act, shall be confidential, except for |
16 | | official purposes
within the Department or pursuant to official |
17 | | procedures for collection
of any State tax or pursuant to an |
18 | | investigation or audit by the Illinois
State Scholarship |
19 | | Commission of a delinquent student loan or monetary award
or |
20 | | enforcement of any civil or criminal penalty or sanction
|
21 | | imposed by this Act or by another statute imposing a State tax, |
22 | | and any
person who divulges any such information in any manner, |
23 | | except for such
purposes and pursuant to order of the Director |
24 | | or in accordance with a proper
judicial order, shall be guilty |
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1 | | of a Class A misdemeanor. However, the
provisions of this |
2 | | paragraph are not applicable to information furnished
to (i) |
3 | | the Department of Healthcare and Family Services (formerly
|
4 | | Department of Public Aid), State's Attorneys, and the Attorney |
5 | | General for child support enforcement purposes and (ii) a |
6 | | licensed attorney representing the taxpayer where an appeal or |
7 | | a protest
has been filed on behalf of the taxpayer. If it is |
8 | | necessary to file information obtained pursuant to this Act in |
9 | | a child support enforcement proceeding, the information shall |
10 | | be filed under seal.
|
11 | | (b) Public information. Nothing contained in this Act shall |
12 | | prevent
the Director from publishing or making available to the |
13 | | public the names
and addresses of persons filing returns under |
14 | | this Act, or from publishing
or making available reasonable |
15 | | statistics concerning the operation of the
tax wherein the |
16 | | contents of returns are grouped into aggregates in such a
way |
17 | | that the information contained in any individual return shall |
18 | | not be
disclosed.
|
19 | | (c) Governmental agencies. The Director may make available |
20 | | to the
Secretary of the Treasury of the United States or his |
21 | | delegate, or the
proper officer or his delegate of any other |
22 | | state imposing a tax upon or
measured by income, for |
23 | | exclusively official purposes, information received
by the |
24 | | Department in the administration of this Act, but such |
25 | | permission
shall be granted only if the United States or such |
26 | | other state, as the case
may be, grants the Department |
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1 | | substantially similar privileges. The Director
may exchange |
2 | | information with the Department of Healthcare and Family |
3 | | Services and the
Department of Human Services (acting as |
4 | | successor to the Department of Public
Aid under the Department |
5 | | of Human Services Act) for
the purpose of verifying sources and |
6 | | amounts of income and for other purposes
directly connected |
7 | | with the administration of this Act , the Illinois Public Aid |
8 | | Code, and any other health benefit program administered by the |
9 | | State and the Illinois
Public Aid Code . The Director may |
10 | | exchange information with the Director of
the Department of |
11 | | Employment Security for the purpose of verifying sources
and |
12 | | amounts of income and for other purposes directly connected |
13 | | with the
administration of this Act and Acts administered by |
14 | | the Department of
Employment
Security.
The Director may make |
15 | | available to the Illinois Workers' Compensation Commission
|
16 | | information regarding employers for the purpose of verifying |
17 | | the insurance
coverage required under the Workers' |
18 | | Compensation Act and Workers'
Occupational Diseases Act. The |
19 | | Director may exchange information with the Illinois Department |
20 | | on Aging for the purpose of verifying sources and amounts of |
21 | | income for purposes directly related to confirming eligibility |
22 | | for participation in the programs of benefits authorized by the |
23 | | Senior Citizens and Disabled Persons Property Tax Relief and |
24 | | Pharmaceutical Assistance Act.
|
25 | | The Director may make available to any State agency, |
26 | | including the
Illinois Supreme Court, which licenses persons to |
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1 | | engage in any occupation,
information that a person licensed by |
2 | | such agency has failed to file
returns under this Act or pay |
3 | | the tax, penalty and interest shown therein,
or has failed to |
4 | | pay any final assessment of tax, penalty or interest due
under |
5 | | this Act.
The Director may make available to any State agency, |
6 | | including the Illinois
Supreme
Court, information regarding |
7 | | whether a bidder, contractor, or an affiliate of a
bidder or
|
8 | | contractor has failed to file returns under this Act or pay the |
9 | | tax, penalty,
and interest
shown therein, or has failed to pay |
10 | | any final assessment of tax, penalty, or
interest due
under |
11 | | this Act, for the limited purpose of enforcing bidder and |
12 | | contractor
certifications.
For purposes of this Section, the |
13 | | term "affiliate" means any entity that (1)
directly,
|
14 | | indirectly, or constructively controls another entity, (2) is |
15 | | directly,
indirectly, or
constructively controlled by another |
16 | | entity, or (3) is subject to the control
of
a common
entity. |
17 | | For purposes of this subsection (a), an entity controls another |
18 | | entity
if
it owns,
directly or individually, more than 10% of |
19 | | the voting securities of that
entity.
As used in
this |
20 | | subsection (a), the term "voting security" means a security |
21 | | that (1)
confers upon the
holder the right to vote for the |
22 | | election of members of the board of directors
or similar
|
23 | | governing body of the business or (2) is convertible into, or |
24 | | entitles the
holder to receive
upon its exercise, a security |
25 | | that confers such a right to vote. A general
partnership
|
26 | | interest is a voting security.
|
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1 | | The Director may make available to any State agency, |
2 | | including the
Illinois
Supreme Court, units of local |
3 | | government, and school districts, information
regarding
|
4 | | whether a bidder or contractor is an affiliate of a person who |
5 | | is not
collecting
and
remitting Illinois Use taxes, for the |
6 | | limited purpose of enforcing bidder and
contractor
|
7 | | certifications.
|
8 | | The Director may also make available to the Secretary of |
9 | | State
information that a corporation which has been issued a |
10 | | certificate of
incorporation by the Secretary of State has |
11 | | failed to file returns under
this Act or pay the tax, penalty |
12 | | and interest shown therein, or has failed
to pay any final |
13 | | assessment of tax, penalty or interest due under this Act.
An |
14 | | assessment is final when all proceedings in court for
review of |
15 | | such assessment have terminated or the time for the taking
|
16 | | thereof has expired without such proceedings being instituted. |
17 | | For
taxable years ending on or after December 31, 1987, the |
18 | | Director may make
available to the Director or principal |
19 | | officer of any Department of the
State of Illinois, information |
20 | | that a person employed by such Department
has failed to file |
21 | | returns under this Act or pay the tax, penalty and
interest |
22 | | shown therein. For purposes of this paragraph, the word
|
23 | | "Department" shall have the same meaning as provided in Section |
24 | | 3 of the
State Employees Group Insurance Act of 1971.
|
25 | | (d) The Director shall make available for public
inspection |
26 | | in the Department's principal office and for publication, at |
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1 | | cost,
administrative decisions issued on or after January
1, |
2 | | 1995. These decisions are to be made available in a manner so |
3 | | that the
following
taxpayer information is not disclosed:
|
4 | | (1) The names, addresses, and identification numbers |
5 | | of the taxpayer,
related entities, and employees.
|
6 | | (2) At the sole discretion of the Director, trade |
7 | | secrets
or other confidential information identified as |
8 | | such by the taxpayer, no later
than 30 days after receipt |
9 | | of an administrative decision, by such means as the
|
10 | | Department shall provide by rule.
|
11 | | The Director shall determine the
appropriate extent of the
|
12 | | deletions allowed in paragraph (2). In the event the taxpayer |
13 | | does not submit
deletions,
the Director shall make only the |
14 | | deletions specified in paragraph (1).
|
15 | | The Director shall make available for public inspection and |
16 | | publication an
administrative decision within 180 days after |
17 | | the issuance of the
administrative
decision. The term |
18 | | "administrative decision" has the same meaning as defined in
|
19 | | Section 3-101 of Article III of the Code of Civil Procedure. |
20 | | Costs collected
under this Section shall be paid into the Tax |
21 | | Compliance and Administration
Fund.
|
22 | | (e) Nothing contained in this Act shall prevent the |
23 | | Director from
divulging
information to any person pursuant to a |
24 | | request or authorization made by the
taxpayer, by an authorized |
25 | | representative of the taxpayer, or, in the case of
information |
26 | | related to a joint return, by the spouse filing the joint |
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1 | | return
with the taxpayer.
|
2 | | (Source: P.A. 94-1074, eff. 12-26-06; 95-331, eff. 8-21-07.)
|
3 | | Section 25. The Illinois Insurance Code is amended by |
4 | | changing Section 5.5 as follows: |
5 | | (215 ILCS 5/5.5) |
6 | | Sec. 5.5. Compliance with the Department of Healthcare and |
7 | | Family Services. A company authorized to do business in this |
8 | | State or accredited by the State to issue policies of health |
9 | | insurance, including but not limited to, self-insured plans, |
10 | | group health plans (as defined in Section 607(1) of the |
11 | | Employee Retirement Income Security Act of 1974), service |
12 | | benefit plans, managed care organizations, pharmacy benefit |
13 | | managers, or other parties that are by statute, contract, or |
14 | | agreement legally responsible for payment of a claim for a |
15 | | health care item or service as a condition of doing business in |
16 | | the State must: |
17 | | (1) provide to the Department of Healthcare and Family |
18 | | Services, or any successor agency, on at least a quarterly |
19 | | basis if so requested by the Department, information upon |
20 | | request information to determine during what period any |
21 | | individual may be, or may have been, covered by a health |
22 | | insurer and the nature of the coverage that is or was |
23 | | provided by the health insurer, including the name, |
24 | | address, and identifying number of the plan; |
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1 | | (2) accept the State's right of recovery and the |
2 | | assignment to the State of any right of an individual or |
3 | | other entity to payment from the party for an item or |
4 | | service for which payment has been made under the medical |
5 | | programs of the Department of Healthcare and Family |
6 | | Services, or any successor agency, under this Code or the |
7 | | Illinois Public Aid Code; |
8 | | (3) respond to any inquiry by the Department of |
9 | | Healthcare and Family Services regarding a claim for |
10 | | payment for any health care item or service that is |
11 | | submitted not later than 3 years after the date of the |
12 | | provision of such health care item or service; and |
13 | | (4) agree not to deny a claim submitted by the |
14 | | Department of Healthcare and Family Services solely on the |
15 | | basis of the date of submission of the claim, the type or |
16 | | format of the claim form, or a failure to present proper |
17 | | documentation at the point-of-sale that is the basis of the |
18 | | claim if (i) the claim is submitted by the Department of |
19 | | Healthcare and Family Services within the 3-year period |
20 | | beginning on the date on which the item or service was |
21 | | furnished and (ii) any action by the Department of |
22 | | Healthcare and Family Services to enforce its rights with |
23 | | respect to such claim is commenced within 6 years of its |
24 | | submission of such claim.
|
25 | | In cases in which the Department of Healthcare and Family |
26 | | Services has determined that an entity that provides health |
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1 | | insurance coverage has established a pattern of failure to |
2 | | provide the information required under this Section, and has |
3 | | subsequently certified that determination, along with |
4 | | supporting documentation, to the Director of the Department of |
5 | | Insurance, the Director of the Department of Insurance, based |
6 | | upon the certification of determination made by the Department |
7 | | of Healthcare and Family Services, may commence regulatory |
8 | | proceedings in accordance with all applicable provisions of the |
9 | | Illinois Insurance Code. |
10 | | (Source: P.A. 95-632, eff. 9-25-07.) |
11 | | Section 30. The Children's Health Insurance Program Act is |
12 | | amended by changing Section 15 and by adding Sections 7, 21, |
13 | | 23, and 26 as follows: |
14 | | (215 ILCS 106/7 new) |
15 | | Sec. 7. Eligibility verification. Notwithstanding any |
16 | | other provision of this Act, with respect to applications for |
17 | | benefits provided under the Program, eligibility shall be |
18 | | determined in a manner that ensures program integrity and that |
19 | | complies with federal law and regulations while minimizing |
20 | | unnecessary barriers to enrollment. To this end, as soon as |
21 | | practicable, and unless the Department receives written denial |
22 | | from the federal government, this Section shall be implemented: |
23 | | (a) The Department of Healthcare and Family Services or its |
24 | | designees shall: |
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1 | | (1) By no later than July 1, 2011, require verification |
2 | | of, at a minimum, one month's income from all sources |
3 | | required for determining the eligibility of applicants to |
4 | | the Program. Such verification shall take the form of pay |
5 | | stubs, business or income and expense records for |
6 | | self-employed persons, letters from employers, and any |
7 | | other valid documentation of income including data |
8 | | obtained electronically by the Department or its designees |
9 | | from other sources as described in subsection (b) of this |
10 | | Section. |
11 | | (2) By no later than October 1, 2011, require |
12 | | verification of, at a minimum, one month's income from all |
13 | | sources required for determining the continued eligibility |
14 | | of recipients at their annual review of eligibility under |
15 | | the Program. Such verification shall take the form of pay |
16 | | stubs, business or income and expense records for |
17 | | self-employed persons, letters from employers, and any |
18 | | other valid documentation of income including data |
19 | | obtained electronically by the Department or its designees |
20 | | from other sources as described in subsection (b) of this |
21 | | Section. The Department shall send a notice to the |
22 | | recipient at least 60 days prior to the end of the period |
23 | | of eligibility that informs them of the requirements for |
24 | | continued eligibility. If a recipient does not fulfill the |
25 | | requirements for continued eligibility by the deadline |
26 | | established in the notice, a notice of cancellation shall |
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1 | | be issued to the recipient and coverage shall end on the |
2 | | last day of the eligibility period. A recipient's |
3 | | eligibility may be reinstated without requiring a new |
4 | | application if the recipient fulfills the requirements for |
5 | | continued eligibility prior to the end of the month |
6 | | following the last date of coverage. Nothing in this |
7 | | Section shall prevent an individual whose coverage has been |
8 | | cancelled from reapplying for health benefits at any time. |
9 | | (3) By no later than July 1, 2011, require verification |
10 | | of Illinois residency. |
11 | | (b) The Department shall establish or continue cooperative
|
12 | | arrangements with the Social Security Administration, the
|
13 | | Illinois Secretary of State, the Department of Human Services,
|
14 | | the Department of Revenue, the Department of Employment |
15 | | Security, and any other appropriate entity to gain electronic
|
16 | | access, to the extent allowed by law, to information available |
17 | | to those entities that may be appropriate for electronically
|
18 | | verifying any factor of eligibility for benefits under the
|
19 | | Program. Data relevant to eligibility shall be provided for no
|
20 | | other purpose than to verify the eligibility of new applicants |
21 | | or current recipients of health benefits under the Program. |
22 | | Data will be requested or provided for any new applicant or |
23 | | current recipient only insofar as that individual's |
24 | | circumstances are relevant to that individual's or another |
25 | | individual's eligibility. |
26 | | (c) Within 90 days of the effective date of this amendatory |
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1 | | Act of the 96th General Assembly, the Department of Healthcare |
2 | | and Family Services shall send notice to current recipients |
3 | | informing them of the changes regarding their eligibility |
4 | | verification.
|
5 | | (215 ILCS 106/15)
|
6 | | Sec. 15. Operation of the Program. There is hereby created |
7 | | a
Children's Health Insurance Program. The Program shall |
8 | | operate subject
to appropriation and shall be administered by |
9 | | the Department of Healthcare and Family Services. The |
10 | | Department shall have the powers and authority granted to the
|
11 | | Department under the Illinois Public Aid Code , including, but |
12 | | not limited to, Section 11-5.1 of the Code . The Department may |
13 | | contract
with a Third Party Administrator or other entities to |
14 | | administer and oversee
any portion of this Program.
|
15 | | (Source: P.A. 95-331, eff. 8-21-07.)
|
16 | | (215 ILCS 106/21 new) |
17 | | Sec. 21. Presumptive eligibility. Beginning on the |
18 | | effective date of this amendatory Act of the 96th General |
19 | | Assembly and except where federal law requires presumptive |
20 | | eligibility, no adult may be presumed eligible for health care |
21 | | coverage under the Program, and the Department may not cover |
22 | | any service rendered to an adult unless the adult has completed |
23 | | an application for benefits, all required verifications have |
24 | | been received and the Department or its designee has found the |
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1 | | adult eligible for the date on which that service was provided. |
2 | | Nothing in this Section shall apply to pregnant women. |
3 | | (215 ILCS 106/23 new) |
4 | | Sec. 23. Care coordination. |
5 | | (a) At least 50% of recipients eligible for comprehensive |
6 | | medical benefits in all medical assistance programs or other |
7 | | health benefit programs administered by the Department, |
8 | | including the Children's Health Insurance Program Act and the |
9 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a |
10 | | care coordination program by no later than January 1, 2015. For |
11 | | purposes of this Section, "coordinated care" or "care |
12 | | coordination" means delivery systems where recipients will |
13 | | receive their care from providers who participate under |
14 | | contract in integrated delivery systems that are responsible |
15 | | for providing or arranging the majority of care, including |
16 | | primary care physician services, referrals from primary care |
17 | | physicians, diagnostic and treatment services, behavioral |
18 | | health services, in-patient and outpatient hospital services, |
19 | | dental services, and rehabilitation and long-term care |
20 | | services. The Department shall designate or contract for such |
21 | | integrated delivery systems (i) to ensure enrollees have a |
22 | | choice of systems and of primary care providers within such |
23 | | systems; (ii) to ensure that enrollees receive quality care in |
24 | | a culturally and linguistically appropriate manner; and (iii) |
25 | | to ensure that coordinated care programs meet the diverse needs |
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1 | | of enrollees with developmental, mental health, physical, and |
2 | | age-related disabilities. |
3 | | (b) Payment for such coordinated care shall be based on |
4 | | arrangements where the State pays for performance related to |
5 | | health care outcomes, the use of evidence-based practices, the |
6 | | use of primary care delivered through comprehensive medical |
7 | | homes, the use of electronic medical records, and the |
8 | | appropriate exchange of health information electronically made |
9 | | either on a capitated basis in which a fixed monthly premium |
10 | | per recipient is paid and full financial risk is assumed for |
11 | | the delivery of services, or through other risk-based payment |
12 | | arrangements. |
13 | | (c) To qualify for compliance with this Section, the 50% |
14 | | goal shall be achieved by enrolling medical assistance |
15 | | enrollees from each medical assistance enrollment category, |
16 | | including parents, children, seniors, and people with |
17 | | disabilities to the extent that current State Medicaid payment |
18 | | laws would not limit federal matching funds for recipients in |
19 | | care coordination programs. In addition, services must be more |
20 | | comprehensively defined and more risk shall be assumed than in |
21 | | the Department's primary care case management program as of the |
22 | | effective date of this amendatory Act of the 96th General |
23 | | Assembly. |
24 | | (d) The Department shall report to the General Assembly in |
25 | | a separate part of its annual medical assistance program |
26 | | report, beginning April, 2012 until April, 2016, on the |
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1 | | progress and implementation of the care coordination program |
2 | | initiatives established by the provisions of this amendatory |
3 | | Act of the 96th General Assembly. The Department shall include |
4 | | in its April 2011 report a full analysis of federal laws or |
5 | | regulations regarding upper payment limitations to providers |
6 | | and the necessary revisions or adjustments in rate |
7 | | methodologies and payments to providers under this Code that |
8 | | would be necessary to implement coordinated care with full |
9 | | financial risk by a party other than the Department. |
10 | | (215 ILCS 106/26 new) |
11 | | Sec. 26. Moratorium on eligibility expansions. Beginning |
12 | | on the effective date of this amendatory Act of the 96th |
13 | | General Assembly, there shall be a 2-year moratorium on the |
14 | | expansion of eligibility through increasing financial |
15 | | eligibility standards, or through increasing income |
16 | | disregards, or through the creation of new programs that would |
17 | | add new categories of eligible individuals under the medical |
18 | | assistance program under the Illinois Public Aid Code in |
19 | | addition to those categories covered on January 1, 2011. This |
20 | | moratorium shall not apply to expansions required as a federal |
21 | | condition of State participation in the medical assistance |
22 | | program. |
23 | | Section 35. The Covering ALL KIDS Health Insurance Act is |
24 | | amended by changing Sections 15, 20, and 98 and by adding |
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1 | | Sections 7, 21, 26, 36, and 56 as follows: |
2 | | (215 ILCS 170/7 new) |
3 | | Sec. 7. Eligibility verification. Notwithstanding any |
4 | | other provision of this Act, with respect to applications for |
5 | | benefits provided under the Program, eligibility shall be |
6 | | determined in a manner that ensures program integrity and that |
7 | | complies with federal law and regulations while minimizing |
8 | | unnecessary barriers to enrollment. To this end, as soon as |
9 | | practicable, and unless the Department receives written denial |
10 | | from the federal government, this Section shall be implemented: |
11 | | (a) The Department of Healthcare and Family Services or its |
12 | | designees shall: |
13 | | (1) By July 1, 2011, require verification of, at a |
14 | | minimum, one month's income from all sources required for |
15 | | determining the eligibility of applicants to the Program.
|
16 | | Such verification shall take the form of pay stubs, |
17 | | business or income and expense records for self-employed |
18 | | persons, letters from employers, and any other valid |
19 | | documentation of income including data obtained |
20 | | electronically by the Department or its designees from |
21 | | other sources as described in subsection (b) of this |
22 | | Section. |
23 | | (2) By October 1, 2011, require verification of, at a |
24 | | minimum, one month's income from all sources required for |
25 | | determining the continued eligibility of recipients at |
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1 | | their annual review of eligibility under the Program. Such |
2 | | verification shall take the form of pay stubs, business or |
3 | | income and expense records for self-employed persons, |
4 | | letters from employers, and any other valid documentation |
5 | | of income including data obtained electronically by the |
6 | | Department or its designees from other sources as described |
7 | | in subsection (b) of this Section. The Department shall |
8 | | send a notice to
recipients at least 60 days prior to the |
9 | | end of their period
of eligibility that informs them of the
|
10 | | requirements for continued eligibility. If a recipient
|
11 | | does not fulfill the requirements for continued |
12 | | eligibility by the
deadline established in the notice, a |
13 | | notice of cancellation shall be issued to the recipient and |
14 | | coverage shall end on the last day of the eligibility |
15 | | period. A recipient's eligibility may be reinstated |
16 | | without requiring a new application if the recipient |
17 | | fulfills the requirements for continued eligibility prior |
18 | | to the end of the month following the last date of |
19 | | coverage. Nothing in this Section shall prevent an |
20 | | individual whose coverage has been cancelled from |
21 | | reapplying for health benefits at any time. |
22 | | (3) By July 1, 2011, require verification of Illinois |
23 | | residency. |
24 | | (b) The Department shall establish or continue cooperative
|
25 | | arrangements with the Social Security Administration, the
|
26 | | Illinois Secretary of State, the Department of Human Services,
|
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1 | | the Department of Revenue, the Department of Employment
|
2 | | Security, and any other appropriate entity to gain electronic
|
3 | | access, to the extent allowed by law, to information available
|
4 | | to those entities that may be appropriate for electronically
|
5 | | verifying any factor of eligibility for benefits under the
|
6 | | Program. Data relevant to eligibility shall be provided for no
|
7 | | other purpose than to verify the eligibility of new applicants |
8 | | or current recipients of health benefits under the Program. |
9 | | Data will be requested or provided for any new applicant or |
10 | | current recipient only insofar as that individual's |
11 | | circumstances are relevant to that individual's or another |
12 | | individual's eligibility. |
13 | | (c) Within 90 days of the effective date of this amendatory |
14 | | Act of the 96th General Assembly, the Department of Healthcare |
15 | | and Family Services shall send notice to current recipients |
16 | | informing them of the changes regarding their eligibility |
17 | | verification. |
18 | | (215 ILCS 170/15) |
19 | | (Section scheduled to be repealed on July 1, 2011)
|
20 | | Sec. 15. Operation of Program. The Covering ALL KIDS Health |
21 | | Insurance Program is created. The Program shall be administered |
22 | | by the Department of Healthcare and Family Services. The |
23 | | Department shall have the same powers and authority to |
24 | | administer the Program as are provided to the Department in |
25 | | connection with the Department's administration of the |
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1 | | Illinois Public Aid Code , including, but not limited to, the |
2 | | provisions under Section 11-5.1 of the Code, and the Children's |
3 | | Health Insurance Program Act. The Department shall coordinate |
4 | | the Program with the existing children's health programs |
5 | | operated by the Department and other State agencies.
|
6 | | (Source: P.A. 94-693, eff. 7-1-06 .) |
7 | | (215 ILCS 170/20) |
8 | | (Section scheduled to be repealed on July 1, 2011)
|
9 | | Sec. 20. Eligibility. |
10 | | (a) To be eligible for the Program, a person must be a |
11 | | child:
|
12 | | (1) who is a resident of the State of Illinois; and |
13 | | (2) who is ineligible for medical assistance under the |
14 | | Illinois Public Aid Code or benefits under the Children's |
15 | | Health Insurance Program Act; and
|
16 | | (3) either (i) who has been without health insurance |
17 | | coverage for a period set forth by the Department in rules, |
18 | | but not less than 6 months during the first month of |
19 | | operation of the Program, 7 months during the second month |
20 | | of operation, 8 months during the third month of operation, |
21 | | 9 months during the fourth month of operation, 10 months |
22 | | during the fifth month of operation, 11 months during the |
23 | | sixth month of operation, and 12 months thereafter , (ii) |
24 | | whose parent has lost employment that made available |
25 | | affordable dependent health insurance coverage, until such |
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1 | | time as affordable employer-sponsored dependent health |
2 | | insurance coverage is again available for the child as set |
3 | | forth by the Department in rules, (iii) who is a newborn |
4 | | whose responsible relative does not have available |
5 | | affordable private or employer-sponsored health insurance, |
6 | | or (iv) who, within one year of applying for coverage under |
7 | | this Act, lost medical benefits under the Illinois Public |
8 | | Aid Code or the Children's Health Insurance Program Act ; |
9 | | and . |
10 | | (3.5) whose household income, as determined by the |
11 | | Department, is at or below 300% of the federal poverty |
12 | | level. This item (3.5) is effective July 1, 2011. |
13 | | An entity that provides health insurance coverage (as |
14 | | defined in Section 2 of the Comprehensive Health Insurance Plan |
15 | | Act) to Illinois residents shall provide health insurance data |
16 | | match to the Department of Healthcare and Family Services as |
17 | | provided by and subject to Section 5.5 of the Illinois |
18 | | Insurance Code for the purpose of determining eligibility for |
19 | | the Program under this Act . |
20 | | The Department of Healthcare and Family Services, in |
21 | | collaboration with the Department of Financial and |
22 | | Professional Regulation, Division of Insurance, shall adopt |
23 | | rules governing the exchange of information under this Section. |
24 | | The rules shall be consistent with all laws relating to the |
25 | | confidentiality or privacy of personal information or medical |
26 | | records, including provisions under the Federal Health |
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1 | | Insurance Portability and Accountability Act (HIPAA). |
2 | | (b) The Department shall monitor the availability and |
3 | | retention of employer-sponsored dependent health insurance |
4 | | coverage and shall modify the period described in subdivision |
5 | | (a)(3) if necessary to promote retention of private or |
6 | | employer-sponsored health insurance and timely access to |
7 | | healthcare services, but at no time shall the period described |
8 | | in subdivision (a)(3) be less than 6 months.
|
9 | | (c) The Department, at its discretion, may take into |
10 | | account the affordability of dependent health insurance when |
11 | | determining whether employer-sponsored dependent health |
12 | | insurance coverage is available upon reemployment of a child's |
13 | | parent as provided in subdivision (a)(3). |
14 | | (d) A child who is determined to be eligible for the |
15 | | Program shall remain eligible for 12 months, provided that the |
16 | | child maintains his or her residence in this State, has not yet |
17 | | attained 19 years of age, and is not excluded under subsection |
18 | | (e). |
19 | | (e) A child is not eligible for coverage under the Program |
20 | | if: |
21 | | (1) the premium required under Section 40 has not been |
22 | | timely paid; if the required premiums are not paid, the |
23 | | liability of the Program shall be limited to benefits |
24 | | incurred under the Program for the time period for which |
25 | | premiums have been paid; re-enrollment shall be completed |
26 | | before the next covered medical visit, and the first |
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1 | | month's required premium shall be paid in advance of the |
2 | | next covered medical visit; or |
3 | | (2) the child is an inmate of a public institution or |
4 | | an institution for mental diseases.
|
5 | | (f) The Department may shall adopt eligibility rules, |
6 | | including, but not limited to: rules regarding annual renewals |
7 | | of eligibility for the Program in conformance with Section 7 of |
8 | | this Act; rules regarding annual renewals of eligibility for |
9 | | the Program; rules providing for re-enrollment, grace periods, |
10 | | notice requirements, and hearing procedures under subdivision |
11 | | (e)(1) of this Section; and rules regarding what constitutes |
12 | | availability and affordability of private or |
13 | | employer-sponsored health insurance, with consideration of |
14 | | such factors as the percentage of income needed to purchase |
15 | | children or family health insurance, the availability of |
16 | | employer subsidies, and other relevant factors.
|
17 | | (g) Each child enrolled in the Program as of July 1, 2011 |
18 | | whose family income, as established by the Department, exceeds |
19 | | 300% of the federal poverty level may remain enrolled in the |
20 | | Program for 12 additional months commencing July 1, 2011. |
21 | | Continued enrollment pursuant to this subsection shall be |
22 | | available only if the child continues to meet all eligibility |
23 | | criteria established under the Program as of the effective date |
24 | | of this amendatory Act of the 96th General Assembly without a |
25 | | break in coverage. Nothing contained in this subsection shall |
26 | | prevent a child from qualifying for any other health benefits |
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1 | | program operated by the Department. |
2 | | (Source: P.A. 96-1272, eff. 1-1-11.) |
3 | | (215 ILCS 170/21 new) |
4 | | Sec. 21. Presumptive eligibility. Beginning on the |
5 | | effective date of this amendatory Act of the 96th General |
6 | | Assembly and except where federal law or regulation requires |
7 | | presumptive eligibility, no adult may be presumed eligible for |
8 | | health care coverage under the Program and the Department may |
9 | | not cover any service rendered to an adult unless the adult has |
10 | | completed an application for benefits, all required |
11 | | verifications have been received, and the Department or its |
12 | | designee has found the adult eligible for the date on which |
13 | | that service was provided. Nothing in this Section shall apply |
14 | | to pregnant women. |
15 | | (215 ILCS 170/36 new) |
16 | | Sec. 36. Moratorium on eligibility expansions. Beginning |
17 | | on the effective date of this amendatory Act of the 96th |
18 | | General Assembly, there shall be a 2-year moratorium on the |
19 | | expansion of eligibility through increasing financial |
20 | | eligibility standards, or through increasing income |
21 | | disregards, or through the creation of new programs that would |
22 | | add new categories of eligible individuals under the medical |
23 | | assistance program under the Illinois Public Aid Code in |
24 | | addition to those categories covered on January 1, 2011. This |
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1 | | moratorium shall not apply to expansions required as a federal |
2 | | condition of State participation in the medical assistance |
3 | | program. |
4 | | (215 ILCS 170/56 new) |
5 | | Sec. 56. Care coordination. |
6 | | (a) At least 50% of recipients eligible for comprehensive |
7 | | medical benefits in all medical assistance programs or other |
8 | | health benefit programs administered by the Department, |
9 | | including the Children's Health Insurance Program Act and the |
10 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a |
11 | | care coordination program by no later than January 1, 2015. For |
12 | | purposes of this Section, "coordinated care" or "care |
13 | | coordination" means delivery systems where recipients will |
14 | | receive their care from providers who participate under |
15 | | contract in integrated delivery systems that are responsible |
16 | | for providing or arranging the majority of care, including |
17 | | primary care physician services, referrals from primary care |
18 | | physicians, diagnostic and treatment services, behavioral |
19 | | health services, in-patient and outpatient hospital services, |
20 | | dental services, and rehabilitation and long-term care |
21 | | services. The Department shall designate or contract for such |
22 | | integrated delivery systems (i) to ensure enrollees have a |
23 | | choice of systems and of primary care providers within such |
24 | | systems; (ii) to ensure that enrollees receive quality care in |
25 | | a culturally and linguistically appropriate manner; and (iii) |
|
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|
|
1 | | to ensure that coordinated care programs meet the diverse needs |
2 | | of enrollees with developmental, mental health, physical, and |
3 | | age-related disabilities. |
4 | | (b) Payment for such coordinated care shall be based on |
5 | | arrangements where the State pays for performance related to |
6 | | health care outcomes, the use of evidence-based practices, the |
7 | | use of primary care delivered through comprehensive medical |
8 | | homes, the use of electronic medical records, and the |
9 | | appropriate exchange of health information electronically made |
10 | | either on a capitated basis in which a fixed monthly premium |
11 | | per recipient is paid and full financial risk is assumed for |
12 | | the delivery of services, or through other risk-based payment |
13 | | arrangements. |
14 | | (c) To qualify for compliance with this Section, the 50% |
15 | | goal shall be achieved by enrolling medical assistance |
16 | | enrollees from each medical assistance enrollment category, |
17 | | including parents, children, seniors, and people with |
18 | | disabilities to the extent that current State Medicaid payment |
19 | | laws would not limit federal matching funds for recipients in |
20 | | care coordination programs. In addition, services must be more |
21 | | comprehensively defined and more risk shall be assumed than in |
22 | | the Department's primary care case management program as of the |
23 | | effective date of this amendatory Act of the 96th General |
24 | | Assembly. |
25 | | (d) The Department shall report to the General Assembly in |
26 | | a separate part of its annual medical assistance program |
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1 | | report, beginning April, 2012 until April, 2016, on the |
2 | | progress and implementation of the care coordination program |
3 | | initiatives established by the provisions of this amendatory |
4 | | Act of the 96th General Assembly. The Department shall include |
5 | | in its April 2011 report a full analysis of federal laws or |
6 | | regulations regarding upper payment limitations to providers |
7 | | and the necessary revisions or adjustments in rate |
8 | | methodologies and payments to providers under this Code that |
9 | | would be necessary to implement coordinated care with full |
10 | | financial risk by a party other than the Department. |
11 | | (215 ILCS 170/98) |
12 | | (Section scheduled to be repealed on July 1, 2011)
|
13 | | Sec. 98. Repealer. This Act is repealed on July 1, 2016 |
14 | | July 1, 2011 .
|
15 | | (Source: P.A. 94-693, eff. 7-1-06 .) |
16 | | Section 40. The Illinois Public Aid Code is amended by |
17 | | changing Sections 5-4.1, 5-5.12, 5-11, 8A-2.5, and 11-26 and by |
18 | | adding Sections 5-1.3, 5-1.4, 5-2.03, 5-11a, 5-29, 5-30, and |
19 | | 11-5.1 as follows: |
20 | | (305 ILCS 5/5-1.3 new) |
21 | | Sec. 5-1.3. Payer of last resort. To the extent permissible |
22 | | under federal law, the State may pay for medical services only |
23 | | after payment from all other sources of payment have been |
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1 | | exhausted, or after the Department has determined that pursuit |
2 | | of such payment is economically unfeasible. Applicants for, and |
3 | | recipients of, medical assistance under this Code shall |
4 | | disclose to the State all insurance coverage they have. To the |
5 | | extent permissible under federal law, the State shall require |
6 | | vendors of medical services to bill third-party payers for |
7 | | services that may be covered by those third-party payers prior |
8 | | to submission of a request for payment to the State. The |
9 | | Department shall, to the extent permissible under federal law, |
10 | | reject a request for payment of a medical service that should |
11 | | first have been submitted to a third-party payer. |
12 | | (305 ILCS 5/5-1.4 new) |
13 | | Sec. 5-1.4. Moratorium on eligibility expansions. |
14 | | Beginning on the effective date of this amendatory Act of the |
15 | | 96th General Assembly, there shall be a 2-year moratorium on |
16 | | the expansion of eligibility through increasing financial |
17 | | eligibility standards, or through increasing income |
18 | | disregards, or through the creation of new programs which would |
19 | | add new categories of eligible individuals under the medical |
20 | | assistance program in addition to those categories covered on |
21 | | January 1, 2011. This moratorium shall not apply to expansions |
22 | | required as a federal condition of State participation in the |
23 | | medical assistance program. |
24 | | (305 ILCS 5/5-2.03 new) |
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1 | | Sec. 5-2.03. Presumptive eligibility. Beginning on the |
2 | | effective date of this amendatory Act of the 96th General |
3 | | Assembly and except where federal law requires presumptive |
4 | | eligibility, no adult may be presumed eligible for medical |
5 | | assistance under this Code and the Department may not cover any |
6 | | service rendered to an adult unless the adult has completed an |
7 | | application for benefits, all required verifications have been |
8 | | received, and the Department or its designee has found the |
9 | | adult eligible for the date on which that service was provided. |
10 | | Nothing in this Section shall apply to pregnant women.
|
11 | | (305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
|
12 | | Sec. 5-4.1. Co-payments. The Department may by rule provide |
13 | | that recipients
under any Article of this Code shall pay a fee |
14 | | as a co-payment for services.
Co-payments shall be maximized to |
15 | | the extent permitted by federal law may not exceed $3 for brand |
16 | | name drugs, $1 for other pharmacy
services other than for |
17 | | generic drugs, and $2 for physicians services, dental
services, |
18 | | optical services and supplies, chiropractic services, podiatry
|
19 | | services, and encounter rate clinic services. There shall be no |
20 | | co-payment for
generic drugs. Co-payments may not exceed $3 for |
21 | | hospital outpatient and clinic
services . Provided, however, |
22 | | that any such rule must provide that no
co-payment requirement |
23 | | can exist
for renal dialysis, radiation therapy, cancer |
24 | | chemotherapy, or insulin, and
other products necessary on a |
25 | | recurring basis, the absence of which would
be life |
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1 | | threatening, or where co-payment expenditures for required |
2 | | services
and/or medications for chronic diseases that the |
3 | | Illinois Department shall
by rule designate shall cause an |
4 | | extensive financial burden on the
recipient, and provided no |
5 | | co-payment shall exist for emergency room
encounters which are |
6 | | for medical emergencies. The Department shall seek approval of |
7 | | a State plan amendment that allows pharmacies to refuse to |
8 | | dispense drugs in circumstances where the recipient does not |
9 | | pay the required co-payment. In the event the State plan |
10 | | amendment is rejected, co-payments may not exceed $3 for brand |
11 | | name drugs, $1 for other pharmacy
services other than for |
12 | | generic drugs, and $2 for physician services, dental
services, |
13 | | optical services and supplies, chiropractic services, podiatry
|
14 | | services, and encounter rate clinic services. There shall be no |
15 | | co-payment for
generic drugs. Co-payments may not exceed $3 for |
16 | | hospital outpatient and clinic
services.
|
17 | | (Source: P.A. 92-597, eff. 6-28-02; 93-593, eff. 8-25-03 .)
|
18 | | (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
|
19 | | Sec. 5-5.12. Pharmacy payments.
|
20 | | (a) Every request submitted by a pharmacy for reimbursement |
21 | | under this
Article for prescription drugs provided to a |
22 | | recipient of aid under this
Article shall include the name of |
23 | | the prescriber or an acceptable
identification number as |
24 | | established by the Department.
|
25 | | (b) Pharmacies providing prescription drugs under
this |
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1 | | Article shall be reimbursed at a rate which shall include
a |
2 | | professional dispensing fee as determined by the Illinois
|
3 | | Department, plus the current acquisition cost of the |
4 | | prescription
drug dispensed. The Illinois Department shall |
5 | | update its
information on the acquisition costs of all |
6 | | prescription drugs
no less frequently than every 30 days. |
7 | | However, the Illinois
Department may set the rate of |
8 | | reimbursement for the acquisition
cost, by rule, at a |
9 | | percentage of the current average wholesale
acquisition cost.
|
10 | | (c) (Blank).
|
11 | | (d) The Department shall not impose requirements for prior |
12 | | approval
based on a preferred drug list for anti-retroviral, |
13 | | anti-hemophilic factor
concentrates,
or
any atypical |
14 | | antipsychotics, conventional antipsychotics,
or |
15 | | anticonvulsants used for the treatment of serious mental
|
16 | | illnesses
until 30 days after it has conducted a study of the |
17 | | impact of such
requirements on patient care and submitted a |
18 | | report to the Speaker of the
House of Representatives and the |
19 | | President of the Senate. The Department shall review |
20 | | utilization of narcotic medications in the medical assistance |
21 | | program and impose utilization controls that protect against |
22 | | abuse.
|
23 | | (e) When making determinations as to which drugs shall be |
24 | | on a prior approval list, the Department shall include as part |
25 | | of the analysis for this determination, the degree to which a |
26 | | drug may affect individuals in different ways based on factors |
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1 | | including the gender of the person taking the medication. |
2 | | (f) (e) The Department shall cooperate with the Department |
3 | | of Public Health and the Department of Human Services Division |
4 | | of Mental Health in identifying psychotropic medications that, |
5 | | when given in a particular form, manner, duration, or frequency |
6 | | (including "as needed") in a dosage, or in conjunction with |
7 | | other psychotropic medications to a nursing home resident, may |
8 | | constitute a chemical restraint or an "unnecessary drug" as |
9 | | defined by the Nursing Home Care Act or Titles XVIII and XIX of |
10 | | the Social Security Act and the implementing rules and |
11 | | regulations. The Department shall require prior approval for |
12 | | any such medication prescribed for a nursing home resident that |
13 | | appears to be a chemical restraint or an unnecessary drug. The |
14 | | Department shall consult with the Department of Human Services |
15 | | Division of Mental Health in developing a protocol and criteria |
16 | | for deciding whether to grant such prior approval. |
17 | | (g) The Department may by rule provide for reimbursement of |
18 | | the dispensing of a 90-day supply of a generic, non-narcotic |
19 | | maintenance medication in circumstances where it is cost |
20 | | effective. |
21 | | (Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; |
22 | | revised 9-2-10.)
|
23 | | (305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
|
24 | | Sec. 5-11. Co-operative arrangements; contracts with other |
25 | | State
agencies, health care and rehabilitation organizations, |
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1 | | and fiscal
intermediaries.
|
2 | | (a) The Illinois Department may enter into co-operative |
3 | | arrangements
with
State agencies responsible for administering |
4 | | or supervising the
administration of health services and |
5 | | vocational rehabilitation services to
the end that there may be |
6 | | maximum utilization of such services in the
provision of |
7 | | medical assistance.
|
8 | | The Illinois Department shall, not later than June 30, |
9 | | 1993, enter into
one or more co-operative arrangements with the |
10 | | Department of Mental Health
and Developmental Disabilities |
11 | | providing that the Department of Mental
Health and |
12 | | Developmental Disabilities will be responsible for |
13 | | administering
or supervising all programs for services to |
14 | | persons in community care
facilities for persons with |
15 | | developmental disabilities, including but not
limited to |
16 | | intermediate care facilities, that are supported by State funds |
17 | | or
by funding under Title XIX of the federal Social Security |
18 | | Act. The
responsibilities of the Department of Mental Health |
19 | | and Developmental
Disabilities under these agreements are |
20 | | transferred to the Department of
Human Services as provided in |
21 | | the Department of Human Services Act.
|
22 | | The Department may also contract with such State health and
|
23 | | rehabilitation agencies and other public or private health care |
24 | | and
rehabilitation organizations to act for it in supplying |
25 | | designated medical
services to persons eligible therefor under |
26 | | this Article. Any contracts
with health services or health |
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1 | | maintenance organizations shall be
restricted to organizations |
2 | | which have been certified as being in
compliance with standards |
3 | | promulgated pursuant to the laws of this State
governing the |
4 | | establishment and operation of health services or health
|
5 | | maintenance organizations. The Department shall renegotiate |
6 | | the contracts with health maintenance organizations and |
7 | | managed care community
networks that took effect August 1, |
8 | | 2003, so as to produce $70,000,000 savings to the Department |
9 | | net of resulting increases to the fee-for-service program for |
10 | | State fiscal year 2006. The Department may also contract with |
11 | | insurance
companies or other corporate entities serving as |
12 | | fiscal intermediaries in
this State for the Federal Government |
13 | | in respect to Medicare payments under
Title XVIII of the |
14 | | Federal Social Security Act to act for the Department in
paying |
15 | | medical care suppliers. The provisions of Section 9 of "An Act |
16 | | in
relation to State finance", approved June 10, 1919, as |
17 | | amended,
notwithstanding, such contracts with State agencies, |
18 | | other health care and
rehabilitation organizations, or fiscal |
19 | | intermediaries may provide for
advance payments.
|
20 | | (b) For purposes of this subsection (b), "managed care |
21 | | community
network" means an entity, other than a health |
22 | | maintenance organization, that
is owned, operated, or governed |
23 | | by providers of health care services within
this State and that |
24 | | provides or arranges primary, secondary, and tertiary
managed |
25 | | health care services under contract with the Illinois |
26 | | Department
exclusively to persons participating in programs |
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1 | | administered by the Illinois
Department.
|
2 | | The Illinois Department may certify managed care community
|
3 | | networks, including managed care community networks owned, |
4 | | operated, managed,
or
governed by State-funded medical |
5 | | schools, as risk-bearing entities eligible to
contract with the |
6 | | Illinois Department as Medicaid managed care
organizations. |
7 | | The Illinois Department may contract with those managed
care |
8 | | community networks to furnish health care services to or |
9 | | arrange those
services for individuals participating in |
10 | | programs administered by the Illinois
Department. The rates for |
11 | | those provider-sponsored organizations may be
determined on a |
12 | | prepaid, capitated basis. A managed care community
network may |
13 | | choose to contract with the Illinois Department to provide only
|
14 | | pediatric
health care services.
The
Illinois Department shall |
15 | | by rule adopt the criteria, standards, and procedures
by
which |
16 | | a managed care community network may be permitted to contract |
17 | | with
the Illinois Department and shall consult with the |
18 | | Department of Insurance in
adopting these rules.
|
19 | | A county provider as defined in Section 15-1 of this Code |
20 | | may
contract with the Illinois Department to provide primary, |
21 | | secondary, or
tertiary managed health care services as a |
22 | | managed care
community network without the need to establish a |
23 | | separate entity and shall
be deemed a managed care community |
24 | | network for purposes of this Code
only to the extent it |
25 | | provides services to participating individuals. A county
|
26 | | provider is entitled to contract with the Illinois Department |
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1 | | with respect to
any contracting region located in whole or in |
2 | | part within the county. A
county provider is not required to |
3 | | accept enrollees who do not reside within
the county.
|
4 | | In order
to (i) accelerate and facilitate the development |
5 | | of integrated health care in
contracting areas outside counties |
6 | | with populations in excess of 3,000,000 and
counties adjacent |
7 | | to those counties and (ii) maintain and sustain the high
|
8 | | quality of education and residency programs coordinated and |
9 | | associated with
local area hospitals, the Illinois Department |
10 | | may develop and implement a
demonstration program from managed |
11 | | care community networks owned, operated,
managed, or
governed |
12 | | by State-funded medical schools. The Illinois Department shall
|
13 | | prescribe by rule the criteria, standards, and procedures for |
14 | | effecting this
demonstration program.
|
15 | | A managed care community network that
contracts with the |
16 | | Illinois Department to furnish health care services to or
|
17 | | arrange those services for enrollees participating in programs |
18 | | administered by
the Illinois Department shall do all of the |
19 | | following:
|
20 | | (1) Provide that any provider affiliated with the |
21 | | managed care community
network may also provide services on |
22 | | a
fee-for-service basis to Illinois Department clients not |
23 | | enrolled in such
managed care entities.
|
24 | | (2) Provide client education services as determined |
25 | | and approved by the
Illinois Department, including but not |
26 | | limited to (i) education regarding
appropriate utilization |
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1 | | of health care services in a managed care system, (ii)
|
2 | | written disclosure of treatment policies and restrictions |
3 | | or limitations on
health services, including, but not |
4 | | limited to, physical services, clinical
laboratory tests, |
5 | | hospital and surgical procedures, prescription drugs and
|
6 | | biologics, and radiological examinations, and (iii) |
7 | | written notice that the
enrollee may receive from another |
8 | | provider those covered services that are not
provided by |
9 | | the managed care community network.
|
10 | | (3) Provide that enrollees within the system may choose |
11 | | the site for
provision of services and the panel of health |
12 | | care providers.
|
13 | | (4) Not discriminate in enrollment or disenrollment |
14 | | practices among
recipients of medical services or |
15 | | enrollees based on health status.
|
16 | | (5) Provide a quality assurance and utilization review |
17 | | program that
meets
the requirements established by the |
18 | | Illinois Department in rules that
incorporate those |
19 | | standards set forth in the Health Maintenance Organization
|
20 | | Act.
|
21 | | (6) Issue a managed care community network
|
22 | | identification card to each enrollee upon enrollment. The |
23 | | card
must contain all of the following:
|
24 | | (A) The enrollee's health plan.
|
25 | | (B) The name and telephone number of the enrollee's |
26 | | primary care
physician or the site for receiving |
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1 | | primary care services.
|
2 | | (C) A telephone number to be used to confirm |
3 | | eligibility for benefits
and authorization for |
4 | | services that is available 24 hours per day, 7 days per
|
5 | | week.
|
6 | | (7) Ensure that every primary care physician and |
7 | | pharmacy in the managed
care community network meets the |
8 | | standards
established by the Illinois Department for |
9 | | accessibility and quality of care.
The Illinois Department |
10 | | shall arrange for and oversee an evaluation of the
|
11 | | standards established under this paragraph (7) and may |
12 | | recommend any necessary
changes to these standards.
|
13 | | (8) Provide a procedure for handling complaints that
|
14 | | meets the
requirements established by the Illinois |
15 | | Department in rules that incorporate
those standards set |
16 | | forth in the Health Maintenance Organization Act.
|
17 | | (9) Maintain, retain, and make available to the |
18 | | Illinois Department
records, data, and information, in a |
19 | | uniform manner determined by the Illinois
Department, |
20 | | sufficient for the Illinois Department to monitor |
21 | | utilization,
accessibility, and quality of care.
|
22 | | (10) (Blank) Provide that the pharmacy formulary used |
23 | | by the managed care
community
network and its contract |
24 | | providers be no
more restrictive than the Illinois |
25 | | Department's pharmaceutical program on the
effective date |
26 | | of this amendatory Act of 1998 and as amended after that |
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1 | | date .
|
2 | | The Illinois Department shall contract with an entity or |
3 | | entities to provide
external peer-based quality assurance |
4 | | review for the managed health care
programs administered by the |
5 | | Illinois Department. The entity shall meet all federal |
6 | | requirements for an external quality review organization be
|
7 | | representative of Illinois physicians licensed to practice |
8 | | medicine in all its
branches and have statewide geographic |
9 | | representation in all specialities of
medical care that are |
10 | | provided in managed health care programs administered by
the |
11 | | Illinois Department. The entity may not be a third party payer |
12 | | and shall
maintain offices in locations around the State in |
13 | | order to provide service and
continuing medical education to |
14 | | physician participants within those managed
health care |
15 | | programs administered by the Illinois Department. The review
|
16 | | process shall be developed and conducted by Illinois physicians |
17 | | licensed to
practice medicine in all its branches. In |
18 | | consultation with the entity, the
Illinois Department may |
19 | | contract with other entities for professional
peer-based |
20 | | quality assurance review of individual
categories of services |
21 | | other than services provided, supervised, or coordinated
by |
22 | | physicians licensed to practice medicine in all its branches. |
23 | | The Illinois
Department shall establish, by rule, criteria to |
24 | | avoid conflicts of interest in
the conduct of quality assurance |
25 | | activities consistent with professional
peer-review standards. |
26 | | All quality assurance activities shall be coordinated
by the |
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1 | | Illinois Department .
|
2 | | Each managed care community network must demonstrate its |
3 | | ability to
bear the financial risk of serving individuals under |
4 | | this program.
The Illinois Department shall by rule adopt |
5 | | standards for assessing the
solvency and financial soundness of |
6 | | each managed care community network.
Any solvency and financial |
7 | | standards adopted for managed care community
networks
shall be |
8 | | no more restrictive than the solvency and financial standards |
9 | | adopted
under
Section 1856(a) of the Social Security Act for |
10 | | provider-sponsored
organizations under Part C of Title XVIII of |
11 | | the Social Security Act.
|
12 | | The Illinois
Department may implement the amendatory |
13 | | changes to this
Code made by this amendatory Act of 1998 |
14 | | through the use of emergency
rules in accordance with Section |
15 | | 5-45 of the Illinois Administrative Procedure
Act. For purposes |
16 | | of that Act, the adoption of rules to implement these
changes |
17 | | is deemed an emergency and necessary for the public interest,
|
18 | | safety, and welfare.
|
19 | | (c) Not later than June 30, 1996, the Illinois Department |
20 | | shall
enter into one or more cooperative arrangements with the |
21 | | Department of Public
Health for the purpose of developing a |
22 | | single survey for
nursing facilities, including but not limited |
23 | | to facilities funded under Title
XVIII or Title XIX of the |
24 | | federal Social Security Act or both, which shall be
|
25 | | administered and conducted solely by the Department of Public |
26 | | Health.
The Departments shall test the single survey process on |
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1 | | a pilot basis, with
both the Departments of Public Aid and |
2 | | Public Health represented on the
consolidated survey team. The |
3 | | pilot will sunset June 30, 1997. After June 30,
1997, unless |
4 | | otherwise determined by the Governor, a single survey shall be
|
5 | | implemented by the Department of Public Health which would not |
6 | | preclude staff
from the Department of Healthcare and Family |
7 | | Services (formerly Department of Public Aid) from going on-site |
8 | | to nursing facilities to
perform necessary audits and reviews |
9 | | which shall not replicate the single State
agency survey |
10 | | required by this Act. This Section shall not apply to community
|
11 | | or intermediate care facilities for persons with developmental |
12 | | disabilities.
|
13 | | (d) Nothing in this Code in any way limits or otherwise |
14 | | impairs the
authority or power of the Illinois Department to |
15 | | enter into a negotiated
contract pursuant to this Section with |
16 | | a managed care community network or
a health maintenance |
17 | | organization, as defined in the Health Maintenance
|
18 | | Organization Act, that provides for
termination or nonrenewal |
19 | | of the contract without cause, upon notice as
provided in the |
20 | | contract, and without a hearing.
|
21 | | (Source: P.A. 94-48, eff. 7-1-05; 95-331, eff. 8-21-07.)
|
22 | | (305 ILCS 5/5-11a new) |
23 | | Sec. 5-11a. Health Benefit Information Systems. |
24 | | (a) It is the intent of the General Assembly to support |
25 | | unified electronic systems initiatives that will improve |
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1 | | management of information related to medical assistance |
2 | | programs. This will include improved management capabilities |
3 | | and new systems for Eligibility, Verification, and Enrollment |
4 | | (EVE) that will simplify and increase efficiencies in and |
5 | | access to the medical assistance programs and ensure program |
6 | | integrity. The Department of Healthcare and Family Services, in |
7 | | coordination with the Department of Human Services and other |
8 | | appropriate state agencies, shall develop a plan by July 1, |
9 | | 2011, that will: |
10 | | (1) Subject to federal and State privacy and |
11 | | confidentiality laws and regulations, meet standards for |
12 | | timely eligibility verification and enrollment, and annual |
13 | | redetermination of eligibility, of applicants for and |
14 | | recipients of means-tested health benefits sponsored by |
15 | | the State, including medical assistance under this Code. |
16 | | (2) Receive and update data electronically from the |
17 | | Social Security Administration, the U.S. Postal Service, |
18 | | the Illinois Secretary of State, the Department of Revenue, |
19 | | the Department of Employment Security, and other |
20 | | governmental entities, as appropriate and to the extent |
21 | | allowed by law, for verification of any factor of |
22 | | eligibility for medical assistance and for updating |
23 | | addresses of applicants and recipients of medical |
24 | | assistance and other health benefit programs administered |
25 | | by the Department. Data relevant to eligibility shall be |
26 | | provided for no other purpose than to verify the |
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1 | | eligibility of new applicants or current recipients of |
2 | | health benefits provided by the State. Data shall be |
3 | | requested or provided for any individual only insofar as |
4 | | that new applicant or current recipient's circumstances |
5 | | are relevant to that individual's or another individual's |
6 | | eligibility for State-sponsored health benefits. |
7 | | (3) Meet federal requirements for timely installation |
8 | | by January 1, 2014 to provide integration with a Health |
9 | | Benefits Exchange pursuant to the requirements of the |
10 | | federal Affordable Care Act and the Reconciliation Act and |
11 | | any subsequent amendments thereto and to ensure capture of |
12 | | the maximum available federal financial
participation |
13 | | (FFP). |
14 | | (4) Meet federal requirements for compliance with |
15 | | architectural standards, including, but not limited to, |
16 | | (i) the use of a module development as outlined by the |
17 | | Medicaid Information Technology Architecture standards, |
18 | | (ii) the use of federally approved open-interfaces where |
19 | | they exist, (iii) the use or the creation of |
20 | | open-interfaces where necessary, and (iv) the use of rules |
21 | | technology that can dynamically accept and modify rules in |
22 | | standard formats. |
23 | | (5) Include plans to ensure coordination with the State |
24 | | of Illinois Framework Project that will (i) expedite and |
25 | | simplify access to services provided by Illinois human |
26 | | services programs; (ii) streamline administration and data |
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1 | | sharing; (iii) enhance planning capacity, program |
2 | | evaluation, and fraud detection or prevention with access |
3 | | to cross-agency data; and (iv) simplify service reporting |
4 | | for contracted providers. |
5 | | (b) The Department of Healthcare and Family Services shall |
6 | | continue to plan for and implement a new Medicaid Management |
7 | | Information System (MMIS) and upgrade the capabilities of the |
8 | | MMIS data warehouse. Upgrades shall include, among other |
9 | | things, enhanced capabilities in data analysis including the |
10 | | ability to identify risk factors that could impact the |
11 | | treatment and resulting quality of care, and tools that perform |
12 | | predictive analytics on data applying to newborns, women with |
13 | | high risk pregnancies, and other populations served by the |
14 | | Department. |
15 | | (c) The Department of Healthcare and Family Services shall |
16 | | report in its annual Medical Assistance program report each |
17 | | April through April, 2015 on the progress and implementation of |
18 | | this plan. |
19 | | (305 ILCS 5/5-29 new) |
20 | | Sec. 5-29. Income Limits and Parental Responsibility. In |
21 | | light of the unprecedented fiscal crisis confronting the State, |
22 | | it is the intent of the General Assembly to explore whether the |
23 | | income limits and income counting methods established for |
24 | | children under the Covering ALL KIDS Health Insurance Act, |
25 | | pursuant to this amendatory Act of the 96th General Assembly, |
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1 | | should apply to medical assistance programs available to |
2 | | children made eligible under the Illinois Public Aid Code, |
3 | | including through home and community based services waiver |
4 | | programs authorized under Section 1915(c) of the Social |
5 | | Security Act, where parental income is currently not considered |
6 | | in determining a child's eligibility for medical assistance. |
7 | | The Department of Healthcare and Family Services is hereby |
8 | | directed, with the participation of the Department of Human |
9 | | Services and stakeholders, to conduct an analysis of these |
10 | | programs to determine parental cost sharing opportunities, how |
11 | | these opportunities may impact the children currently in the |
12 | | programs, waivers and on the waiting list, and any other |
13 | | factors which may increase efficiencies and decrease State |
14 | | costs. The Department is further directed to review how |
15 | | services under these programs and waivers may be provided by |
16 | | the use of a combination of skilled, unskilled, and |
17 | | uncompensated care and to advise as to what revisions to the |
18 | | Nurse Practice Act, and Acts regulating other relevant |
19 | | professions, are necessary to accomplish this combination of |
20 | | care. The Department shall submit a written analysis on the |
21 | | children's programs and waivers as part of the Department's |
22 | | annual Medicaid reports due to the General Assembly in 2011 and |
23 | | 2012. |
24 | | (305 ILCS 5/5-30 new) |
25 | | Sec. 5-30. Care coordination. |
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1 | | (a) At least 50% of recipients eligible for comprehensive |
2 | | medical benefits in all medical assistance programs or other |
3 | | health benefit programs administered by the Department, |
4 | | including the Children's Health Insurance Program Act and the |
5 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a |
6 | | care coordination program by no later than January 1, 2015. For |
7 | | purposes of this Section, "coordinated care" or "care |
8 | | coordination" means delivery systems where recipients will |
9 | | receive their care from providers who participate under |
10 | | contract in integrated delivery systems that are responsible |
11 | | for providing or arranging the majority of care, including |
12 | | primary care physician services, referrals from primary care |
13 | | physicians, diagnostic and treatment services, behavioral |
14 | | health services, in-patient and outpatient hospital services, |
15 | | dental services, and rehabilitation and long-term care |
16 | | services. The Department shall designate or contract for such |
17 | | integrated delivery systems (i) to ensure enrollees have a |
18 | | choice of systems and of primary care providers within such |
19 | | systems; (ii) to ensure that enrollees receive quality care in |
20 | | a culturally and linguistically appropriate manner; and (iii) |
21 | | to ensure that coordinated care programs meet the diverse needs |
22 | | of enrollees with developmental, mental health, physical, and |
23 | | age-related disabilities. |
24 | | (b) Payment for such coordinated care shall be based on |
25 | | arrangements where the State pays for performance related to |
26 | | health care outcomes, the use of evidence-based practices, the |
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1 | | use of primary care delivered through comprehensive medical |
2 | | homes, the use of electronic medical records, and the |
3 | | appropriate exchange of health information electronically made |
4 | | either on a capitated basis in which a fixed monthly premium |
5 | | per recipient is paid and full financial risk is assumed for |
6 | | the delivery of services, or through other risk-based payment |
7 | | arrangements. |
8 | | (c) To qualify for compliance with this Section, the 50% |
9 | | goal shall be achieved by enrolling medical assistance |
10 | | enrollees from each medical assistance enrollment category, |
11 | | including parents, children, seniors, and people with |
12 | | disabilities to the extent that current State Medicaid payment |
13 | | laws would not limit federal matching funds for recipients in |
14 | | care coordination programs. In addition, services must be more |
15 | | comprehensively defined and more risk shall be assumed than in |
16 | | the Department's primary care case management program as of the |
17 | | effective date of this amendatory Act of the 96th General |
18 | | Assembly. |
19 | | (d) The Department shall report to the General Assembly in |
20 | | a separate part of its annual medical assistance program |
21 | | report, beginning April, 2012 until April, 2016, on the |
22 | | progress and implementation of the care coordination program |
23 | | initiatives established by the provisions of this amendatory |
24 | | Act of the 96th General Assembly. The Department shall include |
25 | | in its April 2011 report a full analysis of federal laws or |
26 | | regulations regarding upper payment limitations to providers |
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1 | | and the necessary revisions or adjustments in rate |
2 | | methodologies and payments to providers under this Code that |
3 | | would be necessary to implement coordinated care with full |
4 | | financial risk by a party other than the Department.
|
5 | | (305 ILCS 5/8A-2.5)
|
6 | | Sec. 8A-2.5. Unauthorized use of medical assistance.
|
7 | | (a) Any person who knowingly uses, acquires, possesses, or |
8 | | transfers a
medical card in any manner not authorized by law or |
9 | | by rules and regulations of
the Illinois Department, or who |
10 | | knowingly alters a medical card, or who
knowingly uses, |
11 | | acquires, possesses, or transfers an altered medical card, is
|
12 | | guilty of a violation of this Article and shall be punished as |
13 | | provided in
Section 8A-6.
|
14 | | (b) Any person who knowingly obtains unauthorized medical |
15 | | benefits with or
without use of a medical card is guilty of a |
16 | | violation of this Article and
shall be punished as provided in |
17 | | Section 8A-6.
|
18 | | (c) The Department may seek to recover any and all State |
19 | | and federal monies for which it has improperly and erroneously |
20 | | paid benefits as a result of a fraudulent action and any civil |
21 | | penalties authorized in this Section. Pursuant to Section |
22 | | 11-14.5 of this Code, the Department may determine the monetary |
23 | | value of benefits improperly and erroneously received. The |
24 | | Department may recover the monies paid for such benefits and |
25 | | interest on that amount at the rate of 5% per annum for the |
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1 | | period from which payment was made to the date upon which |
2 | | repayment is made to the State. Prior to the recovery of any |
3 | | amount paid for benefits allegedly obtained by fraudulent |
4 | | means, the recipient of such benefits shall be afforded an |
5 | | opportunity for a hearing after reasonable notice. The notice |
6 | | shall be served personally or by certified or registered mail |
7 | | or as otherwise provided by law upon the parties or their |
8 | | agents appointed to receive service of process and shall |
9 | | include the following: |
10 | | (1) A statement of the time, place and nature of the |
11 | | hearing. |
12 | | (2) A statement of the legal authority and jurisdiction |
13 | | under which the hearing is to be held. |
14 | | (3) A reference to the particular Sections of the |
15 | | substantive and procedural statutes and rules involved. |
16 | | (4) Except where a more detailed statement is otherwise |
17 | | provided for by law, a short and plain statement of the |
18 | | matters asserted, the consequences of a failure to respond, |
19 | | and the official file or other reference number. |
20 | | (5) A statement of the monetary value of the benefits |
21 | | fraudulently received by the person accused. |
22 | | (6) A statement that, in addition to any other |
23 | | penalties provided by law, a civil penalty in an amount not |
24 | | to exceed $2,000 may be imposed for each fraudulent claim |
25 | | for benefits or payments. |
26 | | (7) A statement providing that the determination of the |
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1 | | monetary value may be contested by petitioning the |
2 | | Department for an administrative hearing within 30 days |
3 | | from the date of mailing the notice. |
4 | | (8) The names and mailing addresses of the |
5 | | administrative law judge, all parties, and all other |
6 | | persons to whom the agency gives notice of the hearing |
7 | | unless otherwise confidential by law. |
8 | | An opportunity shall be afforded all parties to be |
9 | | represented by legal counsel and to respond and present |
10 | | evidence and argument. |
11 | | Unless precluded by law, disposition may be made of any |
12 | | contested case by stipulation, agreed settlement, consent |
13 | | order, or default. |
14 | | Any final order, decision, or other determination made, |
15 | | issued or executed by the Director under the provisions of this |
16 | | Article whereby any person is aggrieved shall be subject to |
17 | | review in accordance with the provisions of the Administrative |
18 | | Review Law, and the rules adopted pursuant thereto, which shall |
19 | | apply to and govern all proceeding for the judicial review of |
20 | | final administrative decisions of the Director. |
21 | | Upon entry of a final administrative decision for repayment |
22 | | of any benefits obtained by fraudulent means, or for any civil |
23 | | penalties assessed, a lien shall attach to all property and |
24 | | assets of such person, firm, corporation, association, agency, |
25 | | institution, or other legal entity until the judgment is |
26 | | satisfied. |
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1 | | Within 12 months of the effective date of this amendatory |
2 | | Act of the 96th General Assembly, the Department of Healthcare |
3 | | and Family Services will report to the General Assembly on the |
4 | | number of fraud cases identified and pursued, and the fines |
5 | | assessed and collected. The report will also include the |
6 | | Department's analysis as to the use of private sector resources |
7 | | to bring action, investigate, and collect monies owed. |
8 | | (Source: P.A. 89-289, eff. 1-1-96.)
|
9 | | (305 ILCS 5/11-5.1 new) |
10 | | Sec. 11-5.1. Eligibility verification. Notwithstanding any |
11 | | other provision of this Code, with respect to applications for |
12 | | medical assistance provided under Article V of this Code, |
13 | | eligibility shall be determined in a manner that ensures |
14 | | program integrity and complies with federal laws and |
15 | | regulations while minimizing unnecessary barriers to |
16 | | enrollment. To this end, as soon as practicable, and unless the |
17 | | Department receives written denial from the federal |
18 | | government, this Section shall be implemented: |
19 | | (a) The Department of Healthcare and Family Services or its |
20 | | designees shall: |
21 | | (1) By no later than July 1, 2011, require verification |
22 | | of, at a minimum, one month's income from all sources |
23 | | required for determining the eligibility of applicants for |
24 | | medical assistance under this Code. Such verification |
25 | | shall take the form of pay stubs, business or income and |
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1 | | expense records for self-employed persons, letters from |
2 | | employers, and any other valid documentation of income |
3 | | including data obtained electronically by the Department |
4 | | or its designees from other sources as described in |
5 | | subsection (b) of this Section. |
6 | | (2) By no later than October 1, 2011, require |
7 | | verification of, at a minimum, one month's income from all |
8 | | sources required for determining the continued eligibility |
9 | | of recipients at their annual review of eligibility for |
10 | | medical assistance under this Code. Such verification |
11 | | shall take the form of pay stubs, business or income and |
12 | | expense records for self-employed persons, letters from |
13 | | employers, and any other valid documentation of income |
14 | | including data obtained electronically by the Department |
15 | | or its designees from other sources as described in |
16 | | subsection (b) of this Section. The
Department shall send a |
17 | | notice to
recipients at least 60 days prior to the end of |
18 | | their period
of eligibility that informs them of the
|
19 | | requirements for continued eligibility. If a recipient
|
20 | | does not fulfill the requirements for continued |
21 | | eligibility by the
deadline established in the notice a |
22 | | notice of cancellation shall be issued to the recipient and |
23 | | coverage shall end on the last day of the eligibility |
24 | | period. A recipient's eligibility may be reinstated |
25 | | without requiring a new application if the recipient |
26 | | fulfills the requirements for continued eligibility prior |
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1 | | to the end of the month following the last date of |
2 | | coverage. Nothing in this Section shall prevent an |
3 | | individual whose coverage has been cancelled from |
4 | | reapplying for health benefits at any time. |
5 | | (3) By no later than July 1, 2011, require verification |
6 | | of Illinois residency. |
7 | | (b) The Department shall establish or continue cooperative
|
8 | | arrangements with the Social Security Administration, the
|
9 | | Illinois Secretary of State, the Department of Human Services,
|
10 | | the Department of Revenue, the Department of Employment
|
11 | | Security, and any other appropriate entity to gain electronic
|
12 | | access, to the extent allowed by law, to information available
|
13 | | to those entities that may be appropriate for electronically
|
14 | | verifying any factor of eligibility for benefits under the
|
15 | | Program. Data relevant to eligibility shall be provided for no
|
16 | | other purpose than to verify the eligibility of new applicants |
17 | | or current recipients of health benefits under the Program. |
18 | | Data shall be requested or provided for any new applicant or |
19 | | current recipient only insofar as that individual's |
20 | | circumstances are relevant to that individual's or another |
21 | | individual's eligibility. |
22 | | (c) Within 90 days of the effective date of this amendatory |
23 | | Act of the 96th General Assembly, the Department of Healthcare |
24 | | and Family Services shall send notice to current recipients |
25 | | informing them of the changes regarding their eligibility |
26 | | verification.
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1 | | (305 ILCS 5/11-26) (from Ch. 23, par. 11-26)
|
2 | | Sec. 11-26.
Recipient's abuse of medical care; |
3 | | restrictions on access to
medical care.
|
4 | | (a) When the Department determines, on the basis of |
5 | | statistical norms and
medical judgment, that a medical care |
6 | | recipient has received medical services
in excess of need and |
7 | | with such frequency or in such a manner as to constitute
an |
8 | | abuse of the recipient's medical care privileges, the |
9 | | recipient's access to
medical care may be restricted.
|
10 | | (b) When the Department has determined that a recipient is |
11 | | abusing his or
her medical care privileges as described in this |
12 | | Section, it may require that
the recipient designate a primary |
13 | | provider type primary care provider, primary care pharmacy, or
|
14 | | health maintenance organization of the recipient's own |
15 | | choosing to assume
responsibility for the recipient's care. For |
16 | | the purposes of this subsection, "primary provider type" means |
17 | | a primary care provider, primary care pharmacy, primary |
18 | | dentist, primary podiatrist, or primary durable medical |
19 | | equipment provider. Instead of requiring a recipient to
make a |
20 | | designation as provided in this subsection, the Department, |
21 | | pursuant to
rules adopted by the Department and without regard |
22 | | to any choice of an entity
that the recipient might otherwise |
23 | | make, may initially designate a primary provider type provided |
24 | | that the primary provider type is willing to provide that care |
25 | | primary care
provider, primary care pharmacy, or health |
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1 | | maintenance organization to assume
responsibility for the |
2 | | recipient's care, provided that the primary care
provider, |
3 | | primary care pharmacy, or health maintenance organization is |
4 | | willing
to provide that care .
|
5 | | (c) When the Department has requested that a recipient |
6 | | designate a
primary provider type primary care provider, |
7 | | primary care pharmacy or health maintenance
organization and |
8 | | the recipient fails or refuses to do so, the Department
may, |
9 | | after a reasonable period of time, assign the recipient to a |
10 | | primary provider type of its own choice and determination, |
11 | | provided such primary provider type is willing to provide such |
12 | | care primary care
provider, primary care pharmacy or health |
13 | | maintenance organization of its own
choice and determination, |
14 | | provided such primary care provider, primary care
pharmacy or |
15 | | health maintenance organization is willing to provide such |
16 | | care .
|
17 | | (d) When a recipient has been restricted to a designated |
18 | | primary provider type primary care
provider, primary care |
19 | | pharmacy or health maintenance organization , the
recipient may |
20 | | change the primary provider type primary care provider, primary |
21 | | care pharmacy or
health maintenance organization :
|
22 | | (1) when the designated source becomes unavailable, as |
23 | | the Department
shall determine by rule; or
|
24 | | (2) when the designated primary provider type primary |
25 | | care provider, primary care pharmacy or
health maintenance |
26 | | organization notifies the Department that it wishes to
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1 | | withdraw from any obligation as primary provider type |
2 | | primary care provider, primary care pharmacy or health |
3 | | maintenance organization ; or
|
4 | | (3) in other situations, as the Department shall |
5 | | provide by rule.
|
6 | | The Department shall, by rule, establish procedures for |
7 | | providing medical or
pharmaceutical services when the |
8 | | designated source becomes unavailable or
wishes to withdraw |
9 | | from any obligation as primary provider type primary care |
10 | | provider, primary care
pharmacy or health maintenance |
11 | | organization , shall, by rule, take into
consideration the need |
12 | | for emergency or temporary medical assistance and shall
ensure |
13 | | that the recipient has continuous and unrestricted access to |
14 | | medical
care from the date on which such unavailability or |
15 | | withdrawal becomes effective
until such time as the recipient |
16 | | designates a primary provider type or a primary provider type |
17 | | care source or a primary
care source willing to provide such |
18 | | care is designated by the Department
consistent with |
19 | | subsections (b) and (c) and such restriction becomes effective.
|
20 | | (e) Prior to initiating any action to restrict a |
21 | | recipient's access to
medical or pharmaceutical care, the |
22 | | Department shall notify the recipient
of its intended action. |
23 | | Such notification shall be in writing and shall set
forth the |
24 | | reasons for and nature of the proposed action. In addition, the
|
25 | | notification shall:
|
26 | | (1) inform the recipient that (i) the recipient has a |
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1 | | right to
designate a primary provider type primary care |
2 | | provider, primary care pharmacy, or health maintenance
|
3 | | organization of the recipient's own choosing willing to |
4 | | accept such designation
and that the recipient's failure to |
5 | | do so within a reasonable time may result
in such |
6 | | designation being made by the Department or (ii) the |
7 | | Department has
designated a primary provider type primary |
8 | | care provider, primary care pharmacy, or health
|
9 | | maintenance organization to assume responsibility for the |
10 | | recipient's care; and
|
11 | | (2) inform the recipient that the recipient has a right |
12 | | to appeal the
Department's determination to restrict the |
13 | | recipient's access to medical care
and provide the |
14 | | recipient with an explanation of how such appeal is to be
|
15 | | made. The notification shall also inform the recipient of |
16 | | the circumstances
under which unrestricted medical |
17 | | eligibility shall continue until a decision is
made on |
18 | | appeal and that if the recipient chooses to appeal, the |
19 | | recipient will
be able to review the medical payment data |
20 | | that was utilized by the Department
to decide that the |
21 | | recipient's access to medical care should be restricted.
|
22 | | (f) The Department shall, by rule or regulation, establish |
23 | | procedures for
appealing a determination to restrict a |
24 | | recipient's access to medical care,
which procedures shall, at |
25 | | a minimum, provide for a reasonable opportunity
to be heard |
26 | | and, where the appeal is denied, for a written statement
of the |
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1 | | reason or reasons for such denial.
|
2 | | (g) Except as otherwise provided in this subsection, when a |
3 | | recipient
has had his or her medical card restricted for 4 full |
4 | | quarters (without regard
to any period of ineligibility for |
5 | | medical assistance under this Code, or any
period for which the |
6 | | recipient voluntarily terminates his or her receipt of
medical |
7 | | assistance, that may occur before the expiration of those 4 |
8 | | full
quarters), the Department shall reevaluate the |
9 | | recipient's medical usage to
determine whether it is still in |
10 | | excess of need and with such frequency or in
such a manner as |
11 | | to constitute an abuse of the receipt of medical assistance.
If |
12 | | it is still in excess of need, the restriction shall be |
13 | | continued for
another 4 full quarters. If it is no longer in |
14 | | excess of need, the restriction
shall be discontinued. If a |
15 | | recipient's access to medical care has been
restricted under |
16 | | this Section and the Department then determines, either at
|
17 | | reevaluation or after the restriction has been discontinued, to |
18 | | restrict the
recipient's access to medical care a second or |
19 | | subsequent time, the second or
subsequent restriction may be |
20 | | imposed for a period of more than 4 full
quarters. If the |
21 | | Department restricts a recipient's access to medical care for
a |
22 | | period of more than 4 full quarters, as determined by rule, the |
23 | | Department
shall reevaluate the recipient's medical usage |
24 | | after the end of the restriction
period rather than after the |
25 | | end of 4 full quarters. The Department shall
notify the |
26 | | recipient, in writing, of any decision to continue the |
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1 | | restriction
and the reason or reasons therefor. A "quarter", |
2 | | for purposes of this Section,
shall be defined as one of the |
3 | | following 3-month periods of time:
January-March, April-June, |
4 | | July-September or October-December.
|
5 | | (h) In addition to any other recipient whose acquisition of |
6 | | medical care
is determined to be in excess of need, the |
7 | | Department may restrict the medical
care privileges of the |
8 | | following persons:
|
9 | | (1) recipients found to have loaned or altered their |
10 | | cards or misused or
falsely represented medical coverage;
|
11 | | (2) recipients found in possession of blank or forged |
12 | | prescription pads;
|
13 | | (3) recipients who knowingly assist providers in |
14 | | rendering excessive
services or defrauding the medical |
15 | | assistance program.
|
16 | | The procedural safeguards in this Section shall apply to |
17 | | the above
individuals.
|
18 | | (i) Restrictions under this Section shall be in addition to |
19 | | and shall
not in any way be limited by or limit any actions |
20 | | taken under Article
VIII-A of this Code.
|
21 | | (Source: P.A. 88-554, eff. 7-26-94 .)
|
22 | | (305 ILCS 5/5-5.15 rep.)
|
23 | | Section 45. The Illinois Public Aid Code is amended by |
24 | | repealing Section 5-5.15. |
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1 | | Section 50. The Illinois Vehicle Code is amended by |
2 | | changing Section 2-123 as follows:
|
3 | | (625 ILCS 5/2-123) (from Ch. 95 1/2, par. 2-123)
|
4 | | Sec. 2-123. Sale and Distribution of Information.
|
5 | | (a) Except as otherwise provided in this Section, the |
6 | | Secretary may make the
driver's license, vehicle and title |
7 | | registration lists, in part or in whole,
and any statistical |
8 | | information derived from these lists available to local
|
9 | | governments, elected state officials, state educational |
10 | | institutions, and all
other governmental units of the State and |
11 | | Federal
Government
requesting them for governmental purposes. |
12 | | The Secretary shall require any such
applicant for services to |
13 | | pay for the costs of furnishing such services and the
use of |
14 | | the equipment involved, and in addition is empowered to |
15 | | establish prices
and charges for the services so furnished and |
16 | | for the use of the electronic
equipment utilized.
|
17 | | (b) The Secretary is further empowered to and he may, in |
18 | | his discretion,
furnish to any applicant, other than listed in |
19 | | subsection (a) of this Section,
vehicle or driver data on a |
20 | | computer tape, disk, other electronic format or
computer |
21 | | processable medium, or printout at a fixed fee of
$250 for |
22 | | orders received before October 1, 2003 and $500 for orders |
23 | | received
on or after October 1, 2003, in advance, and require |
24 | | in addition a
further sufficient
deposit based upon the |
25 | | Secretary of State's estimate of the total cost of the
|
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1 | | information requested and a charge of $25 for orders received |
2 | | before October
1, 2003 and $50 for orders received on or after |
3 | | October 1, 2003, per 1,000
units or part
thereof identified or |
4 | | the actual cost, whichever is greater. The Secretary is
|
5 | | authorized to refund any difference between the additional |
6 | | deposit and the
actual cost of the request. This service shall |
7 | | not be in lieu of an abstract
of a driver's record nor of a |
8 | | title or registration search. This service may
be limited to |
9 | | entities purchasing a minimum number of records as required by
|
10 | | administrative rule. The information
sold pursuant to this |
11 | | subsection shall be the entire vehicle or driver data
list, or |
12 | | part thereof. The information sold pursuant to this subsection
|
13 | | shall not contain personally identifying information unless |
14 | | the information is
to be used for one of the purposes |
15 | | identified in subsection (f-5) of this
Section. Commercial |
16 | | purchasers of driver and vehicle record databases shall
enter |
17 | | into a written agreement with the Secretary of State that |
18 | | includes
disclosure of the commercial use of the information to |
19 | | be purchased. |
20 | | (b-1) The Secretary is further empowered to and may, in his |
21 | | or her discretion, furnish vehicle or driver data on a computer |
22 | | tape, disk, or other electronic format or computer processible |
23 | | medium, at no fee, to any State or local governmental agency |
24 | | that uses the information provided by the Secretary to transmit |
25 | | data back to the Secretary that enables the Secretary to |
26 | | maintain accurate driving records, including dispositions of |
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1 | | traffic cases. This information may be provided without fee not |
2 | | more often than once every 6 months.
|
3 | | (c) Secretary of State may issue registration lists. The |
4 | | Secretary
of State may compile a list of all registered
|
5 | | vehicles. Each list of registered vehicles shall be arranged |
6 | | serially
according to the registration numbers assigned to |
7 | | registered vehicles and
may contain in addition the names and |
8 | | addresses of registered owners and
a brief description of each |
9 | | vehicle including the serial or other
identifying number |
10 | | thereof. Such compilation may be in such form as in the
|
11 | | discretion of the Secretary of State may seem best for the |
12 | | purposes intended.
|
13 | | (d) The Secretary of State shall furnish no more than 2 |
14 | | current available
lists of such registrations to the sheriffs |
15 | | of all counties and to the chiefs
of police of all cities and |
16 | | villages and towns of 2,000 population and over
in this State |
17 | | at no cost. Additional copies may be purchased by the sheriffs
|
18 | | or chiefs of police at the fee
of $500 each or at the cost of |
19 | | producing the list as determined
by the Secretary of State. |
20 | | Such lists are to be used for governmental
purposes only.
|
21 | | (e) (Blank).
|
22 | | (e-1) (Blank).
|
23 | | (f) The Secretary of State shall make a title or |
24 | | registration search of the
records of his office and a written |
25 | | report on the same for any person, upon
written application of |
26 | | such person, accompanied by a fee of $5 for
each registration |
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1 | | or title search. The written application shall set forth
the |
2 | | intended use of the requested information. No fee shall be |
3 | | charged for a
title or
registration search, or for the |
4 | | certification thereof requested by a government
agency. The |
5 | | report of the title or registration search shall not contain
|
6 | | personally identifying information unless the request for a |
7 | | search was made for
one of the purposes identified in |
8 | | subsection (f-5) of this Section. The report of the title or |
9 | | registration search shall not contain highly
restricted |
10 | | personal
information unless specifically authorized by this |
11 | | Code.
|
12 | | The Secretary of State shall certify a title or |
13 | | registration record upon
written request. The fee for |
14 | | certification shall be $5 in addition
to the fee required for a |
15 | | title or registration search. Certification shall
be made under |
16 | | the signature of the Secretary of State and shall be
|
17 | | authenticated by Seal of the Secretary of State.
|
18 | | The Secretary of State may notify the vehicle owner or |
19 | | registrant of
the request for purchase of his title or |
20 | | registration information as the
Secretary deems appropriate.
|
21 | | No information shall be released to the requestor until |
22 | | expiration of a
10 day period. This 10 day period shall not |
23 | | apply to requests for
information made by law enforcement |
24 | | officials, government agencies,
financial institutions, |
25 | | attorneys, insurers, employers, automobile
associated |
26 | | businesses, persons licensed as a private detective or firms
|
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1 | | licensed as a private detective agency under the Private |
2 | | Detective, Private
Alarm, Private Security, Fingerprint |
3 | | Vendor, and Locksmith Act of 2004, who are employed by or are
|
4 | | acting on
behalf of law enforcement officials, government |
5 | | agencies, financial
institutions, attorneys, insurers, |
6 | | employers, automobile associated businesses,
and other |
7 | | business entities for purposes consistent with the Illinois |
8 | | Vehicle
Code, the vehicle owner or registrant or other entities |
9 | | as the Secretary may
exempt by rule and regulation.
|
10 | | Any misrepresentation made by a requestor of title or |
11 | | vehicle information
shall be punishable as a petty offense, |
12 | | except in the case of persons
licensed as a private detective |
13 | | or firms licensed as a private detective agency
which shall be |
14 | | subject to disciplinary sanctions under Section 40-10 of the
|
15 | | Private Detective, Private Alarm, Private Security, |
16 | | Fingerprint Vendor, and Locksmith Act of 2004.
|
17 | | (f-5) The Secretary of State shall not disclose or |
18 | | otherwise make
available to
any person or entity any personally |
19 | | identifying information obtained by the
Secretary
of State in |
20 | | connection with a driver's license, vehicle, or title |
21 | | registration
record
unless the information is disclosed for one |
22 | | of the following purposes:
|
23 | | (1) For use by any government agency, including any |
24 | | court or law
enforcement agency, in carrying out its |
25 | | functions, or any private person or
entity acting on behalf |
26 | | of a federal, State, or local agency in carrying out
its
|
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1 | | functions.
|
2 | | (2) For use in connection with matters of motor vehicle |
3 | | or driver safety
and theft; motor vehicle emissions; motor |
4 | | vehicle product alterations, recalls,
or advisories; |
5 | | performance monitoring of motor vehicles, motor vehicle |
6 | | parts,
and dealers; and removal of non-owner records from |
7 | | the original owner
records of motor vehicle manufacturers.
|
8 | | (3) For use in the normal course of business by a |
9 | | legitimate business or
its agents, employees, or |
10 | | contractors, but only:
|
11 | | (A) to verify the accuracy of personal information |
12 | | submitted by
an individual to the business or its |
13 | | agents, employees, or contractors;
and
|
14 | | (B) if such information as so submitted is not |
15 | | correct or is no
longer correct, to obtain the correct |
16 | | information, but only for the
purposes of preventing |
17 | | fraud by, pursuing legal remedies against, or
|
18 | | recovering on a debt or security interest against, the |
19 | | individual.
|
20 | | (4) For use in research activities and for use in |
21 | | producing statistical
reports, if the personally |
22 | | identifying information is not published,
redisclosed, or |
23 | | used to
contact individuals.
|
24 | | (5) For use in connection with any civil, criminal, |
25 | | administrative, or
arbitral proceeding in any federal, |
26 | | State, or local court or agency or before
any
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1 | | self-regulatory body, including the service of process, |
2 | | investigation in
anticipation of litigation, and the |
3 | | execution or enforcement of judgments and
orders, or |
4 | | pursuant to an order of a federal, State, or local court.
|
5 | | (6) For use by any insurer or insurance support |
6 | | organization or by a
self-insured entity or its agents, |
7 | | employees, or contractors in connection with
claims |
8 | | investigation activities, antifraud activities, rating, or |
9 | | underwriting.
|
10 | | (7) For use in providing notice to the owners of towed |
11 | | or
impounded vehicles.
|
12 | | (8) For use by any person licensed as a private |
13 | | detective or firm licensed as a private
detective agency |
14 | | under
the Private Detective, Private Alarm, Private |
15 | | Security, Fingerprint Vendor, and Locksmith Act of
2004, |
16 | | private investigative agency or security service
licensed |
17 | | in Illinois for any purpose permitted under this |
18 | | subsection.
|
19 | | (9) For use by an employer or its agent or insurer to |
20 | | obtain or verify
information relating to a holder of a |
21 | | commercial driver's license that is
required under chapter |
22 | | 313 of title 49 of the United States Code.
|
23 | | (10) For use in connection with the operation of |
24 | | private toll
transportation facilities.
|
25 | | (11) For use by any requester, if the requester |
26 | | demonstrates it has
obtained the written consent of the |
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1 | | individual to whom the information
pertains.
|
2 | | (12) For use by members of the news media, as defined |
3 | | in
Section 1-148.5, for the purpose of newsgathering when |
4 | | the request relates to
the
operation of a motor vehicle or |
5 | | public safety.
|
6 | | (13) For any other use specifically authorized by law, |
7 | | if that use is
related to the operation of a motor vehicle |
8 | | or public safety. |
9 | | (f-6) The Secretary of State shall not disclose or |
10 | | otherwise make
available to any
person or entity any highly |
11 | | restricted personal information obtained by the
Secretary of
|
12 | | State in connection with a driver's license, vehicle, or
title |
13 | | registration
record unless
specifically authorized by this |
14 | | Code.
|
15 | | (g) 1. The Secretary of State may, upon receipt of a |
16 | | written request
and a fee of $6 before October 1, 2003 and |
17 | | a fee of $12 on and after October
1, 2003, furnish to the |
18 | | person or agency so requesting a
driver's record. Such |
19 | | document may include a record of: current driver's
license |
20 | | issuance information, except that the information on |
21 | | judicial driving
permits shall be available only as |
22 | | otherwise provided by this Code;
convictions; orders |
23 | | entered revoking, suspending or cancelling a
driver's
|
24 | | license or privilege; and notations of accident |
25 | | involvement. All other
information, unless otherwise |
26 | | permitted by
this Code, shall remain confidential. |
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1 | | Information released pursuant to a
request for a driver's |
2 | | record shall not contain personally identifying
|
3 | | information, unless the request for the driver's record was |
4 | | made for one of the
purposes set forth in subsection (f-5) |
5 | | of this Section. The Secretary of State may, without fee, |
6 | | allow a parent or guardian of a person under the age of 18 |
7 | | years, who holds an instruction permit or graduated |
8 | | driver's license, to view that person's driving record |
9 | | online, through a computer connection.
The parent or |
10 | | guardian's online access to the driving record will |
11 | | terminate when the instruction permit or graduated |
12 | | driver's license holder reaches the age of 18.
|
13 | | 2. The Secretary of State shall not disclose or |
14 | | otherwise make available
to any
person or
entity any highly |
15 | | restricted personal information obtained by the Secretary |
16 | | of
State in
connection with a driver's license, vehicle, or |
17 | | title
registration record
unless specifically
authorized |
18 | | by this Code. The Secretary of State may certify an |
19 | | abstract of a driver's record
upon written request |
20 | | therefor. Such certification
shall be made under the |
21 | | signature of the Secretary of State and shall be
|
22 | | authenticated by the Seal of his office.
|
23 | | 3. All requests for driving record information shall be |
24 | | made in a manner
prescribed by the Secretary and shall set |
25 | | forth the intended use of the
requested information.
|
26 | | The Secretary of State may notify the affected driver |
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1 | | of the request
for purchase of his driver's record as the |
2 | | Secretary deems appropriate.
|
3 | | No information shall be released to the requester until |
4 | | expiration of a
10 day period. This 10 day period shall not |
5 | | apply to requests for information
made by law enforcement |
6 | | officials, government agencies, financial institutions,
|
7 | | attorneys, insurers, employers, automobile associated |
8 | | businesses, persons
licensed as a private detective or |
9 | | firms licensed as a private detective agency
under the |
10 | | Private Detective, Private Alarm, Private Security, |
11 | | Fingerprint Vendor, and Locksmith Act
of 2004,
who are |
12 | | employed by or are acting on behalf of law enforcement |
13 | | officials,
government agencies, financial institutions, |
14 | | attorneys, insurers, employers,
automobile associated |
15 | | businesses, and other business entities for purposes
|
16 | | consistent with the Illinois Vehicle Code, the affected |
17 | | driver or other
entities as the Secretary may exempt by |
18 | | rule and regulation.
|
19 | | Any misrepresentation made by a requestor of driver |
20 | | information shall
be punishable as a petty offense, except |
21 | | in the case of persons licensed as
a private detective or |
22 | | firms licensed as a private detective agency which shall
be |
23 | | subject to disciplinary sanctions under Section 40-10 of |
24 | | the Private
Detective, Private Alarm, Private Security, |
25 | | Fingerprint Vendor, and Locksmith Act of 2004.
|
26 | | 4. The Secretary of State may furnish without fee, upon |
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1 | | the written
request of a law enforcement agency, any |
2 | | information from a driver's
record on file with the |
3 | | Secretary of State when such information is required
in the |
4 | | enforcement of this Code or any other law relating to the |
5 | | operation
of motor vehicles, including records of |
6 | | dispositions; documented
information involving the use of |
7 | | a motor vehicle; whether such individual
has, or previously |
8 | | had, a driver's license; and the address and personal
|
9 | | description as reflected on said driver's record.
|
10 | | 5. Except as otherwise provided in this Section, the |
11 | | Secretary of
State may furnish, without fee, information |
12 | | from an individual driver's
record on file, if a written |
13 | | request therefor is submitted
by any public transit system |
14 | | or authority, public defender, law enforcement
agency, a |
15 | | state or federal agency, or an Illinois local |
16 | | intergovernmental
association, if the request is for the |
17 | | purpose of a background check of
applicants for employment |
18 | | with the requesting agency, or for the purpose of
an |
19 | | official investigation conducted by the agency, or to |
20 | | determine a
current address for the driver so public funds |
21 | | can be recovered or paid to
the driver, or for any other |
22 | | purpose set forth in subsection (f-5)
of this Section.
|
23 | | The Secretary may also furnish the courts a copy of an |
24 | | abstract of a
driver's record, without fee, subsequent to |
25 | | an arrest for a violation of
Section 11-501 or a similar |
26 | | provision of a local ordinance. Such abstract
may include |
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1 | | records of dispositions; documented information involving
|
2 | | the use of a motor vehicle as contained in the current |
3 | | file; whether such
individual has, or previously had, a |
4 | | driver's license; and the address and
personal description |
5 | | as reflected on said driver's record.
|
6 | | 6. Any certified abstract issued by the Secretary of |
7 | | State or
transmitted electronically by the Secretary of |
8 | | State pursuant to this
Section,
to a court or on request of |
9 | | a law enforcement agency, for the record of a
named person |
10 | | as to the status of the person's driver's license shall be
|
11 | | prima facie evidence of the facts therein stated and if the |
12 | | name appearing
in such abstract is the same as that of a |
13 | | person named in an information or
warrant, such abstract |
14 | | shall be prima facie evidence that the person named
in such |
15 | | information or warrant is the same person as the person |
16 | | named in
such abstract and shall be admissible for any |
17 | | prosecution under this Code and
be admitted as proof of any |
18 | | prior conviction or proof of records, notices, or
orders |
19 | | recorded on individual driving records maintained by the |
20 | | Secretary of
State.
|
21 | | 7. Subject to any restrictions contained in the |
22 | | Juvenile Court Act of
1987, and upon receipt of a proper |
23 | | request and a fee of $6 before October 1,
2003 and a fee of |
24 | | $12 on or after October 1, 2003, the
Secretary of
State |
25 | | shall provide a driver's record to the affected driver, or |
26 | | the affected
driver's attorney, upon verification. Such |
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1 | | record shall contain all the
information referred to in |
2 | | paragraph 1 of this subsection (g) plus: any
recorded |
3 | | accident involvement as a driver; information recorded |
4 | | pursuant to
subsection (e) of Section 6-117 and paragraph |
5 | | (4) of subsection (a) of
Section 6-204 of this Code. All |
6 | | other information, unless otherwise permitted
by this |
7 | | Code, shall remain confidential.
|
8 | | (h) The Secretary shall not disclose social security |
9 | | numbers or any associated information obtained from the Social |
10 | | Security Administration except pursuant
to a written request |
11 | | by, or with the prior written consent of, the
individual |
12 | | except: (1) to officers and employees of the Secretary
who
have |
13 | | a need to know the social security numbers in performance of |
14 | | their
official duties, (2) to law enforcement officials for a |
15 | | lawful, civil or
criminal law enforcement investigation, and if |
16 | | the head of the law enforcement
agency has made a written |
17 | | request to the Secretary specifying the law
enforcement |
18 | | investigation for which the social security numbers are being
|
19 | | sought, (3) to the United States Department of Transportation, |
20 | | or any other
State, pursuant to the administration and |
21 | | enforcement of the Commercial
Motor Vehicle Safety Act of 1986, |
22 | | (4) pursuant to the order of a court
of competent jurisdiction, |
23 | | (5) to the Department of Healthcare and Family Services |
24 | | (formerly Department of Public Aid) for
utilization
in the |
25 | | child support enforcement duties assigned to that Department |
26 | | under
provisions of the Illinois Public Aid Code after the |
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1 | | individual has received advanced
meaningful notification of |
2 | | what redisclosure is sought by the Secretary in
accordance with |
3 | | the federal Privacy Act, (5.5) to the Department of Healthcare |
4 | | and Family Services and the Department of Human Services solely |
5 | | for the purpose of verifying Illinois residency where such |
6 | | residency is an eligibility requirement for benefits under the |
7 | | Illinois Public Aid Code or any other health benefit program |
8 | | administered by the Department of Healthcare and Family |
9 | | Services or the Department of Human Services, or (6) to the |
10 | | Illinois Department of Revenue solely for use by the Department |
11 | | in the collection of any tax or debt that the Department of |
12 | | Revenue is authorized or required by law to collect, provided |
13 | | that the Department shall not disclose the social security |
14 | | number to any person or entity outside of the Department.
|
15 | | (i) (Blank).
|
16 | | (j) Medical statements or medical reports received in the |
17 | | Secretary of
State's Office shall be confidential. No |
18 | | confidential information may be
open to public inspection or |
19 | | the contents disclosed to anyone, except
officers and employees |
20 | | of the Secretary who have a need to know the information
|
21 | | contained in the medical reports and the Driver License Medical |
22 | | Advisory
Board, unless so directed by an order of a court of |
23 | | competent jurisdiction.
|
24 | | (k) All fees collected under this Section shall be paid |
25 | | into the Road
Fund of the State Treasury, except that (i) for |
26 | | fees collected before October
1, 2003, $3 of the $6 fee for a
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1 | | driver's record shall be paid into the Secretary of State |
2 | | Special Services
Fund, (ii) for fees collected on and after |
3 | | October 1, 2003, of the $12 fee
for a driver's record, $3 shall |
4 | | be paid into the Secretary of State Special
Services Fund and |
5 | | $6 shall be paid into the General Revenue Fund, and (iii) for
|
6 | | fees collected on and after October 1, 2003, 50% of the amounts |
7 | | collected
pursuant to subsection (b) shall be paid into the |
8 | | General Revenue Fund.
|
9 | | (l) (Blank).
|
10 | | (m) Notations of accident involvement that may be disclosed |
11 | | under this
Section shall not include notations relating to |
12 | | damage to a vehicle or other
property being transported by a |
13 | | tow truck. This information shall remain
confidential, |
14 | | provided that nothing in this subsection (m) shall limit
|
15 | | disclosure of any notification of accident involvement to any |
16 | | law enforcement
agency or official.
|
17 | | (n) Requests made by the news media for driver's license, |
18 | | vehicle, or
title registration information may be furnished |
19 | | without charge or at a reduced
charge, as determined by the |
20 | | Secretary, when the specific purpose for
requesting the |
21 | | documents is deemed to be in the public interest. Waiver or
|
22 | | reduction of the fee is in the public interest if the principal |
23 | | purpose of the
request is to access and disseminate information |
24 | | regarding the health, safety,
and welfare or the legal rights |
25 | | of the general public and is not for the
principal purpose of |
26 | | gaining a personal or commercial benefit.
The information |
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1 | | provided pursuant to this subsection shall not contain
|
2 | | personally identifying information unless the information is |
3 | | to be used for one
of the
purposes identified in subsection |
4 | | (f-5) of this Section.
|
5 | | (o) The redisclosure of personally identifying information
|
6 | | obtained
pursuant
to this Section is prohibited, except to the |
7 | | extent necessary to effectuate the
purpose
for which the |
8 | | original disclosure of the information was permitted.
|
9 | | (p) The Secretary of State is empowered to adopt rules
to
|
10 | | effectuate this Section.
|
11 | | (Source: P.A. 95-201, eff. 1-1-08; 95-287, eff. 1-1-08; 95-331, |
12 | | eff. 8-21-07; 95-613, eff. 9-11-07; 95-876, eff. 8-21-08; |
13 | | 96-1383, eff. 1-1-11.)
|
14 | | Section 95. Severability. If any provision of this Act or |
15 | | application thereof to any person or circumstance is held |
16 | | invalid, such invalidity does not affect other provisions or |
17 | | applications of this Act which can be given effect without the |
18 | | invalid application or provision, and to this end the |
19 | | provisions of this Act are declared to be severable.
|
20 | | Section 99. Effective date. This Act takes effect upon |
21 | | becoming law.".
|