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Sen. Kwame Raoul
Filed: 5/23/2012
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1 | | AMENDMENT TO HOUSE BILL 5007
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2 | | AMENDMENT NO. ______. Amend House Bill 5007 by replacing |
3 | | everything after the enacting clause with the following:
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4 | | "Section 5. If and only if Senate Bill 2840, AS AMENDED, of |
5 | | the 97th General Assembly becomes law, then the Illinois Public |
6 | | Aid Code is amended by changing Sections 5-1.4, 5-2, 5-2.03, |
7 | | 15-1, 15-2, 15-5, and 15-11 as follows: |
8 | | (305 ILCS 5/5-1.4) |
9 | | Sec. 5-1.4. Moratorium on eligibility expansions. |
10 | | Beginning on January 25, 2011 ( the effective date of Public Act |
11 | | 96-1501) this amendatory Act of the 96th General Assembly , |
12 | | there shall be a 4-year 2-year moratorium on the expansion of |
13 | | eligibility through increasing financial eligibility |
14 | | standards, or through increasing income disregards, or through |
15 | | the creation of new programs which would add new categories of |
16 | | eligible individuals under the medical assistance program in |
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1 | | addition to those categories covered on January 1, 2011 or |
2 | | above the level of any subsequent reduction in eligibility . |
3 | | This moratorium shall not apply to expansions required as a |
4 | | federal condition of State participation in the medical |
5 | | assistance program or to expansions approved by the federal |
6 | | government that are financed entirely by units of local |
7 | | government and federal matching funds. If the State of Illinois |
8 | | finds that the State has borne a cost related to such an |
9 | | expansion, the unit of local government shall reimburse the |
10 | | State. All federal funds associated with an expansion funded by |
11 | | a unit of local government shall be returned to the local |
12 | | government entity funding the expansion, pursuant to an |
13 | | intergovernmental agreement between the Department of |
14 | | Healthcare and Family Services and the local government entity. |
15 | | Within 10 calendar days of the effective date of this |
16 | | amendatory Act of the 97th General Assembly, the Department of |
17 | | Healthcare and Family Services shall formally advise the |
18 | | Centers for Medicare and Medicaid Services of the passage of |
19 | | this amendatory Act of the 97th General Assembly. The State is |
20 | | prohibited from submitting additional waiver requests that |
21 | | expand or allow for an increase in the classes of persons |
22 | | eligible for medical assistance under this Article to the |
23 | | federal government for its consideration beginning on the 20th |
24 | | calendar day following the effective date of this amendatory |
25 | | Act of the 97th General Assembly until January 25, 2015 .
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26 | | (Source: P.A. 96-1501, eff. 1-25-11.)
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1 | | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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2 | | Sec. 5-2. Classes of Persons Eligible. Medical assistance |
3 | | under this
Article shall be available to any of the following |
4 | | classes of persons in
respect to whom a plan for coverage has |
5 | | been submitted to the Governor
by the Illinois Department and |
6 | | approved by him:
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7 | | 1. Recipients of basic maintenance grants under |
8 | | Articles III and IV.
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9 | | 2. Persons otherwise eligible for basic maintenance |
10 | | under Articles
III and IV, excluding any eligibility |
11 | | requirements that are inconsistent with any federal law or |
12 | | federal regulation, as interpreted by the U.S. Department |
13 | | of Health and Human Services, but who fail to qualify |
14 | | thereunder on the basis of need or who qualify but are not |
15 | | receiving basic maintenance under Article IV, and
who have |
16 | | insufficient income and resources to meet the costs of
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17 | | necessary medical care, including but not limited to the |
18 | | following:
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19 | | (a) All persons otherwise eligible for basic |
20 | | maintenance under Article
III but who fail to qualify |
21 | | under that Article on the basis of need and who
meet |
22 | | either of the following requirements:
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23 | | (i) their income, as determined by the |
24 | | Illinois Department in
accordance with any federal |
25 | | requirements, is equal to or less than 70% in
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1 | | fiscal year 2001, equal to or less than 85% in |
2 | | fiscal year 2002 and until
a date to be determined |
3 | | by the Department by rule, and equal to or less
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4 | | than 100% beginning on the date determined by the |
5 | | Department by rule, of the nonfarm income official |
6 | | poverty
line, as defined by the federal Office of |
7 | | Management and Budget and revised
annually in |
8 | | accordance with Section 673(2) of the Omnibus |
9 | | Budget Reconciliation
Act of 1981, applicable to |
10 | | families of the same size; or
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11 | | (ii) their income, after the deduction of |
12 | | costs incurred for medical
care and for other types |
13 | | of remedial care, is equal to or less than 70% in
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14 | | fiscal year 2001, equal to or less than 85% in |
15 | | fiscal year 2002 and until
a date to be determined |
16 | | by the Department by rule, and equal to or less
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17 | | than 100% beginning on the date determined by the |
18 | | Department by rule, of the nonfarm income official |
19 | | poverty
line, as defined in item (i) of this |
20 | | subparagraph (a).
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21 | | (b) All persons who, excluding any eligibility |
22 | | requirements that are inconsistent with any federal |
23 | | law or federal regulation, as interpreted by the U.S. |
24 | | Department of Health and Human Services, would be |
25 | | determined eligible for such basic
maintenance under |
26 | | Article IV by disregarding the maximum earned income
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1 | | permitted by federal law.
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2 | | 3. Persons who would otherwise qualify for Aid to the |
3 | | Medically
Indigent under Article VII.
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4 | | 4. Persons not eligible under any of the preceding |
5 | | paragraphs who fall
sick, are injured, or die, not having |
6 | | sufficient money, property or other
resources to meet the |
7 | | costs of necessary medical care or funeral and burial
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8 | | expenses.
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9 | | 5.(a) Women during pregnancy, after the fact
of |
10 | | pregnancy has been determined by medical diagnosis, and |
11 | | during the
60-day period beginning on the last day of the |
12 | | pregnancy, together with
their infants and children born |
13 | | after September 30, 1983,
whose income and
resources are |
14 | | insufficient to meet the costs of necessary medical care to
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15 | | the maximum extent possible under Title XIX of the
Federal |
16 | | Social Security Act.
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17 | | (b) The Illinois Department and the Governor shall |
18 | | provide a plan for
coverage of the persons eligible under |
19 | | paragraph 5(a) by April 1, 1990. Such
plan shall provide |
20 | | ambulatory prenatal care to pregnant women during a
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21 | | presumptive eligibility period and establish an income |
22 | | eligibility standard
that is equal to 133%
of the nonfarm |
23 | | income official poverty line, as defined by
the federal |
24 | | Office of Management and Budget and revised annually in
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25 | | accordance with Section 673(2) of the Omnibus Budget |
26 | | Reconciliation Act of
1981, applicable to families of the |
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1 | | same size, provided that costs incurred
for medical care |
2 | | are not taken into account in determining such income
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3 | | eligibility.
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4 | | (c) The Illinois Department may conduct a |
5 | | demonstration in at least one
county that will provide |
6 | | medical assistance to pregnant women, together
with their |
7 | | infants and children up to one year of age,
where the |
8 | | income
eligibility standard is set up to 185% of the |
9 | | nonfarm income official
poverty line, as defined by the |
10 | | federal Office of Management and Budget.
The Illinois |
11 | | Department shall seek and obtain necessary authorization
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12 | | provided under federal law to implement such a |
13 | | demonstration. Such
demonstration may establish resource |
14 | | standards that are not more
restrictive than those |
15 | | established under Article IV of this Code.
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16 | | 6. Persons under the age of 18 who fail to qualify as |
17 | | dependent under
Article IV and who have insufficient income |
18 | | and resources to meet the costs
of necessary medical care |
19 | | to the maximum extent permitted under Title XIX
of the |
20 | | Federal Social Security Act.
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21 | | 7. Persons who are under 21 years of age and would
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22 | | qualify as
disabled as defined under the Federal |
23 | | Supplemental Security Income Program,
provided medical |
24 | | service for such persons would be eligible for Federal
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25 | | Financial Participation, and provided the Illinois |
26 | | Department determines that:
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1 | | (a) the person requires a level of care provided by |
2 | | a hospital, skilled
nursing facility, or intermediate |
3 | | care facility, as determined by a physician
licensed to |
4 | | practice medicine in all its branches;
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5 | | (b) it is appropriate to provide such care outside |
6 | | of an institution, as
determined by a physician |
7 | | licensed to practice medicine in all its branches;
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8 | | (c) the estimated amount which would be expended |
9 | | for care outside the
institution is not greater than |
10 | | the estimated amount which would be
expended in an |
11 | | institution.
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12 | | 8. Persons who become ineligible for basic maintenance |
13 | | assistance
under Article IV of this Code in programs |
14 | | administered by the Illinois
Department due to employment |
15 | | earnings and persons in
assistance units comprised of |
16 | | adults and children who become ineligible for
basic |
17 | | maintenance assistance under Article VI of this Code due to
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18 | | employment earnings. The plan for coverage for this class |
19 | | of persons shall:
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20 | | (a) extend the medical assistance coverage for up |
21 | | to 12 months following
termination of basic |
22 | | maintenance assistance; and
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23 | | (b) offer persons who have initially received 6 |
24 | | months of the
coverage provided in paragraph (a) above, |
25 | | the option of receiving an
additional 6 months of |
26 | | coverage, subject to the following:
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1 | | (i) such coverage shall be pursuant to |
2 | | provisions of the federal
Social Security Act;
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3 | | (ii) such coverage shall include all services |
4 | | covered while the person
was eligible for basic |
5 | | maintenance assistance;
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6 | | (iii) no premium shall be charged for such |
7 | | coverage; and
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8 | | (iv) such coverage shall be suspended in the |
9 | | event of a person's
failure without good cause to |
10 | | file in a timely fashion reports required for
this |
11 | | coverage under the Social Security Act and |
12 | | coverage shall be reinstated
upon the filing of |
13 | | such reports if the person remains otherwise |
14 | | eligible.
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15 | | 9. Persons with acquired immunodeficiency syndrome |
16 | | (AIDS) or with
AIDS-related conditions with respect to whom |
17 | | there has been a determination
that but for home or |
18 | | community-based services such individuals would
require |
19 | | the level of care provided in an inpatient hospital, |
20 | | skilled
nursing facility or intermediate care facility the |
21 | | cost of which is
reimbursed under this Article. Assistance |
22 | | shall be provided to such
persons to the maximum extent |
23 | | permitted under Title
XIX of the Federal Social Security |
24 | | Act.
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25 | | 10. Participants in the long-term care insurance |
26 | | partnership program
established under the Illinois |
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1 | | Long-Term Care Partnership Program Act who meet the
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2 | | qualifications for protection of resources described in |
3 | | Section 15 of that
Act.
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4 | | 11. Persons with disabilities who are employed and |
5 | | eligible for Medicaid,
pursuant to Section |
6 | | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, |
7 | | subject to federal approval, persons with a medically |
8 | | improved disability who are employed and eligible for |
9 | | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of |
10 | | the Social Security Act, as
provided by the Illinois |
11 | | Department by rule. In establishing eligibility standards |
12 | | under this paragraph 11, the Department shall, subject to |
13 | | federal approval: |
14 | | (a) set the income eligibility standard at not |
15 | | lower than 350% of the federal poverty level; |
16 | | (b) exempt retirement accounts that the person |
17 | | cannot access without penalty before the age
of 59 1/2, |
18 | | and medical savings accounts established pursuant to |
19 | | 26 U.S.C. 220; |
20 | | (c) allow non-exempt assets up to $25,000 as to |
21 | | those assets accumulated during periods of eligibility |
22 | | under this paragraph 11; and
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23 | | (d) continue to apply subparagraphs (b) and (c) in |
24 | | determining the eligibility of the person under this |
25 | | Article even if the person loses eligibility under this |
26 | | paragraph 11.
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1 | | 12. Subject to federal approval, persons who are |
2 | | eligible for medical
assistance coverage under applicable |
3 | | provisions of the federal Social Security
Act and the |
4 | | federal Breast and Cervical Cancer Prevention and |
5 | | Treatment Act of
2000. Those eligible persons are defined |
6 | | to include, but not be limited to,
the following persons:
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7 | | (1) persons who have been screened for breast or |
8 | | cervical cancer under
the U.S. Centers for Disease |
9 | | Control and Prevention Breast and Cervical Cancer
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10 | | Program established under Title XV of the federal |
11 | | Public Health Services Act in
accordance with the |
12 | | requirements of Section 1504 of that Act as |
13 | | administered by
the Illinois Department of Public |
14 | | Health; and
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15 | | (2) persons whose screenings under the above |
16 | | program were funded in whole
or in part by funds |
17 | | appropriated to the Illinois Department of Public |
18 | | Health
for breast or cervical cancer screening.
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19 | | "Medical assistance" under this paragraph 12 shall be |
20 | | identical to the benefits
provided under the State's |
21 | | approved plan under Title XIX of the Social Security
Act. |
22 | | The Department must request federal approval of the |
23 | | coverage under this
paragraph 12 within 30 days after the |
24 | | effective date of this amendatory Act of
the 92nd General |
25 | | Assembly.
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26 | | In addition to the persons who are eligible for medical |
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1 | | assistance pursuant to subparagraphs (1) and (2) of this |
2 | | paragraph 12, and to be paid from funds appropriated to the |
3 | | Department for its medical programs, any uninsured person |
4 | | as defined by the Department in rules residing in Illinois |
5 | | who is younger than 65 years of age, who has been screened |
6 | | for breast and cervical cancer in accordance with standards |
7 | | and procedures adopted by the Department of Public Health |
8 | | for screening, and who is referred to the Department by the |
9 | | Department of Public Health as being in need of treatment |
10 | | for breast or cervical cancer is eligible for medical |
11 | | assistance benefits that are consistent with the benefits |
12 | | provided to those persons described in subparagraphs (1) |
13 | | and (2). Medical assistance coverage for the persons who |
14 | | are eligible under the preceding sentence is not dependent |
15 | | on federal approval, but federal moneys may be used to pay |
16 | | for services provided under that coverage upon federal |
17 | | approval. |
18 | | 13. Subject to appropriation and to federal approval, |
19 | | persons living with HIV/AIDS who are not otherwise eligible |
20 | | under this Article and who qualify for services covered |
21 | | under Section 5-5.04 as provided by the Illinois Department |
22 | | by rule.
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23 | | 14. Subject to the availability of funds for this |
24 | | purpose, the Department may provide coverage under this |
25 | | Article to persons who reside in Illinois who are not |
26 | | eligible under any of the preceding paragraphs and who meet |
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1 | | the income guidelines of paragraph 2(a) of this Section and |
2 | | (i) have an application for asylum pending before the |
3 | | federal Department of Homeland Security or on appeal before |
4 | | a court of competent jurisdiction and are represented |
5 | | either by counsel or by an advocate accredited by the |
6 | | federal Department of Homeland Security and employed by a |
7 | | not-for-profit organization in regard to that application |
8 | | or appeal, or (ii) are receiving services through a |
9 | | federally funded torture treatment center. Medical |
10 | | coverage under this paragraph 14 may be provided for up to |
11 | | 24 continuous months from the initial eligibility date so |
12 | | long as an individual continues to satisfy the criteria of |
13 | | this paragraph 14. If an individual has an appeal pending |
14 | | regarding an application for asylum before the Department |
15 | | of Homeland Security, eligibility under this paragraph 14 |
16 | | may be extended until a final decision is rendered on the |
17 | | appeal. The Department may adopt rules governing the |
18 | | implementation of this paragraph 14.
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19 | | 15. Family Care Eligibility. |
20 | | (a) Through December 31, 2013, a caretaker |
21 | | relative who is 19 years of age or older when countable |
22 | | income is at or below 185% of the Federal Poverty Level |
23 | | Guidelines, as published annually in the Federal |
24 | | Register, for the appropriate family size. Beginning |
25 | | January 1, 2014, a caretaker relative who is 19 years |
26 | | of age or older when countable income is at or below |
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1 | | 133% of the Federal Poverty Level Guidelines, as |
2 | | published annually in the Federal Register, for the |
3 | | appropriate family size. A person may not spend down to |
4 | | become eligible under this paragraph 15. |
5 | | (b) Eligibility shall be reviewed annually. |
6 | | (c) Caretaker relatives enrolled under this |
7 | | paragraph 15 in families with countable income above |
8 | | 150% and at or below 185% of the Federal Poverty Level |
9 | | Guidelines shall be counted as family members and pay |
10 | | premiums as established under the Children's Health |
11 | | Insurance Program Act. |
12 | | (d) Premiums shall be billed by and payable to the |
13 | | Department or its authorized agent, on a monthly basis. |
14 | | (e) The premium due date is the last day of the |
15 | | month preceding the month of coverage. |
16 | | (f) Individuals shall have a grace period through |
17 | | 60 days of coverage to pay the premium. |
18 | | (g) Failure to pay the full monthly premium by the |
19 | | last day of the grace period shall result in |
20 | | termination of coverage. |
21 | | (h) Partial premium payments shall not be |
22 | | refunded. |
23 | | (i) Following termination of an individual's |
24 | | coverage under this paragraph 15, the following action |
25 | | is required before the individual can be re-enrolled: |
26 | | (1) A new application must be completed and the |
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1 | | individual must be determined otherwise eligible. |
2 | | (2) There must be full payment of premiums due |
3 | | under this Code, the Children's Health Insurance |
4 | | Program Act, the Covering ALL KIDS Health |
5 | | Insurance Act, or any other healthcare program |
6 | | administered by the Department for periods in |
7 | | which a premium was owed and not paid for the |
8 | | individual. |
9 | | (3) The first month's premium must be paid if |
10 | | there was an unpaid premium on the date the |
11 | | individual's previous coverage was canceled. |
12 | | The Department is authorized to implement the |
13 | | provisions of this amendatory Act of the 95th General |
14 | | Assembly by adopting the medical assistance rules in effect |
15 | | as of October 1, 2007, at 89 Ill. Admin. Code 125, and at |
16 | | 89 Ill. Admin. Code 120.32 along with only those changes |
17 | | necessary to conform to federal Medicaid requirements, |
18 | | federal laws, and federal regulations, including but not |
19 | | limited to Section 1931 of the Social Security Act (42 |
20 | | U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department |
21 | | of Health and Human Services, and the countable income |
22 | | eligibility standard authorized by this paragraph 15. The |
23 | | Department may not otherwise adopt any rule to implement |
24 | | this increase except as authorized by law, to meet the |
25 | | eligibility standards authorized by the federal government |
26 | | in the Medicaid State Plan or the Title XXI Plan, or to |
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1 | | meet an order from the federal government or any court. |
2 | | 16. Subject to appropriation, uninsured persons who |
3 | | are not otherwise eligible under this Section who have been |
4 | | certified and referred by the Department of Public Health |
5 | | as having been screened and found to need diagnostic |
6 | | evaluation or treatment, or both diagnostic evaluation and |
7 | | treatment, for prostate or testicular cancer. For the |
8 | | purposes of this paragraph 16, uninsured persons are those |
9 | | who do not have creditable coverage, as defined under the |
10 | | Health Insurance Portability and Accountability Act, or |
11 | | have otherwise exhausted any insurance benefits they may |
12 | | have had, for prostate or testicular cancer diagnostic |
13 | | evaluation or treatment, or both diagnostic evaluation and |
14 | | treatment.
To be eligible, a person must furnish a Social |
15 | | Security number.
A person's assets are exempt from |
16 | | consideration in determining eligibility under this |
17 | | paragraph 16.
Such persons shall be eligible for medical |
18 | | assistance under this paragraph 16 for so long as they need |
19 | | treatment for the cancer. A person shall be considered to |
20 | | need treatment if, in the opinion of the person's treating |
21 | | physician, the person requires therapy directed toward |
22 | | cure or palliation of prostate or testicular cancer, |
23 | | including recurrent metastatic cancer that is a known or |
24 | | presumed complication of prostate or testicular cancer and |
25 | | complications resulting from the treatment modalities |
26 | | themselves. Persons who require only routine monitoring |
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1 | | services are not considered to need treatment.
"Medical |
2 | | assistance" under this paragraph 16 shall be identical to |
3 | | the benefits provided under the State's approved plan under |
4 | | Title XIX of the Social Security Act.
Notwithstanding any |
5 | | other provision of law, the Department (i) does not have a |
6 | | claim against the estate of a deceased recipient of |
7 | | services under this paragraph 16 and (ii) does not have a |
8 | | lien against any homestead property or other legal or |
9 | | equitable real property interest owned by a recipient of |
10 | | services under this paragraph 16. |
11 | | 17. Persons who, pursuant to a waiver approved by the |
12 | | Secretary of the U.S. Department of Health and Human |
13 | | Services, are eligible for medical assistance under Title |
14 | | XIX or XXI of the federal Social Security Act. |
15 | | Notwithstanding any other provision of this Code and |
16 | | consistent with the terms of the approved waiver, the |
17 | | Illinois Department, may by rule: |
18 | | (a) Limit the geographic areas in which the waiver |
19 | | program operates. |
20 | | (b) Determine the scope, quantity, duration, and |
21 | | quality, and the rate and method of reimbursement, of |
22 | | the medical services to be provided, which may differ |
23 | | from those for other classes of persons eligible for |
24 | | assistance under this Article. |
25 | | (c) Restrict the persons' freedom in choice of |
26 | | providers. |
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1 | | In implementing the provisions of Public Act 96-20, the |
2 | | Department is authorized to adopt only those rules necessary, |
3 | | including emergency rules. Nothing in Public Act 96-20 permits |
4 | | the Department to adopt rules or issue a decision that expands |
5 | | eligibility for the FamilyCare Program to a person whose income |
6 | | exceeds 185% of the Federal Poverty Level as determined from |
7 | | time to time by the U.S. Department of Health and Human |
8 | | Services, unless the Department is provided with express |
9 | | statutory authority. |
10 | | The Illinois Department and the Governor shall provide a |
11 | | plan for
coverage of the persons eligible under paragraph 7 as |
12 | | soon as possible after
July 1, 1984.
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13 | | The eligibility of any such person for medical assistance |
14 | | under this
Article is not affected by the payment of any grant |
15 | | under the Senior
Citizens and Disabled Persons Property Tax |
16 | | Relief and Pharmaceutical
Assistance Act or any distributions |
17 | | or items of income described under
subparagraph (X) of
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18 | | paragraph (2) of subsection (a) of Section 203 of the Illinois |
19 | | Income Tax
Act. The Department shall by rule establish the |
20 | | amounts of
assets to be disregarded in determining eligibility |
21 | | for medical assistance,
which shall at a minimum equal the |
22 | | amounts to be disregarded under the
Federal Supplemental |
23 | | Security Income Program. The amount of assets of a
single |
24 | | person to be disregarded
shall not be less than $2,000, and the |
25 | | amount of assets of a married couple
to be disregarded shall |
26 | | not be less than $3,000.
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1 | | To the extent permitted under federal law, any person found |
2 | | guilty of a
second violation of Article VIIIA
shall be |
3 | | ineligible for medical assistance under this Article, as |
4 | | provided
in Section 8A-8.
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5 | | The eligibility of any person for medical assistance under |
6 | | this Article
shall not be affected by the receipt by the person |
7 | | of donations or benefits
from fundraisers held for the person |
8 | | in cases of serious illness,
as long as neither the person nor |
9 | | members of the person's family
have actual control over the |
10 | | donations or benefits or the disbursement
of the donations or |
11 | | benefits.
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12 | | Notwithstanding any other provision of this Code, if the |
13 | | United States Supreme Court holds Title II, Subtitle A, Section |
14 | | 2001(a) of Public Law 111-148 to be unconstitutional, or if a |
15 | | holding of Public Law 111-148 makes Medicaid eligibility |
16 | | allowed under Section 2001(a) inoperable, the State or a unit |
17 | | of local government shall be prohibited from enrolling |
18 | | individuals in the Medical Assistance Program as the result of |
19 | | federal approval of a State Medicaid waiver on or after the |
20 | | effective date of this amendatory Act of the 97th General |
21 | | Assembly, and any individuals enrolled in the Medical |
22 | | Assistance Program pursuant to eligibility permitted as a |
23 | | result of such a State Medicaid waiver shall become immediately |
24 | | ineligible. |
25 | | Notwithstanding any other provision of this Code, if an Act |
26 | | of Congress that becomes a Public Law eliminates Section |
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1 | | 2001(a) of Public Law 111-148, the State or a unit of local |
2 | | government shall be prohibited from enrolling individuals in |
3 | | the Medical Assistance Program as the result of federal |
4 | | approval of a State Medicaid waiver on or after the effective |
5 | | date of this amendatory Act of the 97th General Assembly, and |
6 | | any individuals enrolled in the Medical Assistance Program |
7 | | pursuant to eligibility permitted as a result of such a State |
8 | | Medicaid waiver shall become immediately ineligible. |
9 | | (Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; |
10 | | 96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. |
11 | | 7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, |
12 | | eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; |
13 | | revised 10-4-11.)
|
14 | | (305 ILCS 5/5-2.03) |
15 | | Sec. 5-2.03. Presumptive eligibility. Beginning on the |
16 | | effective date of this amendatory Act of the 96th General |
17 | | Assembly and except where federal law requires presumptive |
18 | | eligibility, no adult may be presumed eligible for medical |
19 | | assistance under this Code and the Department may not cover any |
20 | | service rendered to an adult unless the adult has completed an |
21 | | application for benefits, all required verifications have been |
22 | | received, and the Department or its designee has found the |
23 | | adult eligible for the date on which that service was provided. |
24 | | Nothing in this Section shall apply to pregnant women or to |
25 | | persons enrolled under the medical assistance program due to |
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1 | | expansions approved by the federal government that are financed |
2 | | entirely by units of local government and federal matching |
3 | | funds .
|
4 | | (Source: P.A. 96-1501, eff. 1-25-11.)
|
5 | | (305 ILCS 5/15-1) (from Ch. 23, par. 15-1)
|
6 | | Sec. 15-1. Definitions. As used in this Article, unless the |
7 | | context
requires otherwise:
|
8 | | (a) (Blank). "Base amount" means $108,800,000 multiplied |
9 | | by a
fraction, the numerator of which is the number of days |
10 | | represented by the
payments in question and the denominator of |
11 | | which is 365.
|
12 | | (a-5) "County provider" means a health care provider that |
13 | | is, or is
operated by, a county with a population greater than |
14 | | 3,000,000.
|
15 | | (b) "Fund" means the County Provider Trust Fund.
|
16 | | (c) "Hospital" or "County hospital" means a hospital, as |
17 | | defined in Section
14-1 of this Code, which is a county |
18 | | hospital located in a county of over
3,000,000 population.
|
19 | | (Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
|
20 | | (305 ILCS 5/15-2) (from Ch. 23, par. 15-2)
|
21 | | Sec. 15-2. County Provider Trust Fund.
|
22 | | (a) There is created in the State Treasury the County |
23 | | Provider
Trust Fund. Interest earned by the Fund shall be |
24 | | credited to the Fund.
The Fund shall not be used to replace any |
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1 | | funds appropriated to the
Medicaid program by the General |
2 | | Assembly.
|
3 | | (b) The Fund is created solely for the purposes of |
4 | | receiving, investing,
and distributing monies in accordance |
5 | | with this Article XV. The Fund shall
consist of:
|
6 | | (1) All monies collected or received by the Illinois |
7 | | Department under
Section 15-3 of this Code;
|
8 | | (2) All federal financial participation monies |
9 | | received by the Illinois
Department pursuant to Title XIX |
10 | | of the Social Security Act, 42 U.S.C.
1396b, attributable |
11 | | to eligible expenditures made by the Illinois Department
|
12 | | pursuant to Section 15-5 of this Code;
|
13 | | (3) All federal moneys received by the
Illinois |
14 | | Department pursuant to Title XXI of the Social Security Act
|
15 | | attributable to eligible expenditures made by the Illinois |
16 | | Department
pursuant to Section 15-5 of this Code; and
|
17 | | (4) All other monies received by the Fund from any |
18 | | source, including
interest thereon.
|
19 | | (c) Disbursements from the Fund shall be by warrants drawn |
20 | | by the State
Comptroller upon receipt of vouchers duly executed |
21 | | and certified by the
Illinois Department and shall be made |
22 | | only:
|
23 | | (1) For hospital inpatient care, hospital outpatient |
24 | | care, care
provided by other outpatient facilities |
25 | | operated by a county, and
disproportionate share hospital |
26 | | adjustment payments made under Title XIX of the Social
|
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1 | | Security Act and Article V of this Code as required by |
2 | | Section 15-5 of this
Code;
|
3 | | (1.5) For services provided or purchased by county |
4 | | providers pursuant to Section
5-11 of this Code;
|
5 | | (2) For the reimbursement of administrative expenses |
6 | | incurred by county
providers on behalf of the Illinois |
7 | | Department as permitted by Section 15-4 of
this Code;
|
8 | | (3) For the reimbursement of monies received by the |
9 | | Fund through
error or mistake;
|
10 | | (4) For the payment of administrative expenses |
11 | | necessarily incurred by the
Illinois Department or its |
12 | | agent in performing the activities required by this
Article |
13 | | XV;
|
14 | | (5) For the payment of any amounts that are |
15 | | reimbursable to the federal
government, attributable |
16 | | solely to the Fund, and required to be paid by State
|
17 | | warrant; and
|
18 | | (6) For hospital inpatient care, hospital outpatient |
19 | | care, care provided
by other outpatient facilities |
20 | | operated by a county, and disproportionate
share hospital |
21 | | adjustment payments made under Title XXI of the Social |
22 | | Security Act,
pursuant to Section 15-5 of this Code.
|
23 | | (7) For medical care and related services provided |
24 | | pursuant to a contract with a county. |
25 | | (Source: P.A. 95-859, eff. 8-19-08.)
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1 | | (305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
|
2 | | Sec. 15-5. Disbursements from the Fund.
|
3 | | (a) The monies in the Fund shall be disbursed only as |
4 | | provided in
Section 15-2 of this Code and as follows:
|
5 | | (1) To the extent that such costs are reimbursable |
6 | | under federal law, to pay the county hospitals' inpatient |
7 | | reimbursement rates based on
actual costs incurred, |
8 | | trended forward annually by an inflation index.
|
9 | | (2) To the extent that such costs are reimbursable |
10 | | under federal law, to pay county hospitals and county |
11 | | operated outpatient
facilities for outpatient services |
12 | | based on a federally approved
methodology to cover the |
13 | | maximum allowable costs.
|
14 | | (3) To pay the county hospitals disproportionate share |
15 | | hospital adjustment payments as may be specified in the |
16 | | Illinois Title XIX State plan.
|
17 | | (3.5) To pay county providers for services provided or |
18 | | purchased pursuant to Section
5-11 of this Code.
|
19 | | (4) To reimburse the county providers for expenses
|
20 | | contractually
assumed pursuant to Section 15-4 of this |
21 | | Code.
|
22 | | (5) To pay the Illinois Department its necessary |
23 | | administrative
expenses relative to the Fund and other |
24 | | amounts agreed to, if any, by the
county providers in the |
25 | | agreement provided for in subsection
(c).
|
26 | | (6) To pay the county providers any other amount due |
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1 | | according to a federally approved State plan, including
but |
2 | | not limited to payments made under the provisions of |
3 | | Section
701(d)(3)(B) of the federal Medicare, Medicaid, |
4 | | and SCHIP Benefits Improvement
and Protection Act of
2000. |
5 | | Intergovernmental transfers supporting payments under this |
6 | | paragraph
(6) shall not be subject to the
computation |
7 | | described in subsection (a) of Section 15-3 of this Code, |
8 | | but
shall be computed as the difference between
the total |
9 | | of such payments made by the Illinois Department to county
|
10 | | providers less any amount of federal
financial |
11 | | participation due the Illinois Department under Titles XIX |
12 | | and XXI
of the Social Security Act as a
result of such |
13 | | payments to county providers.
|
14 | | (b) The Illinois Department shall promptly seek all |
15 | | appropriate
amendments to the Illinois Title XIX State Plan to |
16 | | maximize reimbursement, including disproportionate share |
17 | | hospital adjustment payments, to the county providers.
|
18 | | (c) (Blank).
|
19 | | (d) The payments provided for herein are intended to cover |
20 | | services
rendered on and after July 1, 1991, and any agreement |
21 | | executed between a
qualifying county and the Illinois |
22 | | Department pursuant to this Section may
relate back to that |
23 | | date, provided the Illinois Department obtains federal
|
24 | | approval. Any changes in payment rates resulting from the |
25 | | provisions of
Article 3 of this amendatory Act of 1992 are |
26 | | intended to apply to services
rendered on or after October 1, |
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1 | | 1992, and any agreement executed between a
qualifying county |
2 | | and the Illinois Department pursuant to this Section may
be |
3 | | effective as of that date.
|
4 | | (e) If one or more hospitals file suit in any court |
5 | | challenging any part
of this Article XV, payments to hospitals |
6 | | from the Fund under this Article
XV shall be made only to the |
7 | | extent that sufficient monies are available in
the Fund and |
8 | | only to the extent that any monies in the Fund are not
|
9 | | prohibited from disbursement and may be disbursed under any |
10 | | order of the court.
|
11 | | (f) All payments under this Section are contingent upon |
12 | | federal
approval of changes to the Title XIX State plan, if |
13 | | that approval is required.
|
14 | | (Source: P.A. 95-859, eff. 8-19-08.)
|
15 | | (305 ILCS 5/15-11) |
16 | | Sec. 15-11. Uses of State funds. |
17 | | (a) At any point, if State revenues referenced in |
18 | | subsection (b) or (c) of Section 15-10 or additional State |
19 | | grants are disbursed to the Cook County Health and Hospitals |
20 | | System, all funds may be used only for the following: |
21 | | (1) medical services provided at hospitals or clinics |
22 | | owned and operated by the Cook County Health and Hospitals |
23 | | System Bureau of Health Services ; or |
24 | | (2) information technology to enhance billing |
25 | | capabilities for medical claiming and reimbursement ; or . |
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1 | | (3) services purchased by county providers pursuant to |
2 | | Section 5-11 of this Code. |
3 | | (b) State funds may not be used for the following: |
4 | | (1) non-clinical services, except services that may be |
5 | | required by accreditation bodies or State or federal |
6 | | regulatory or licensing authorities; |
7 | | (2) non-clinical support staff, except as pursuant to |
8 | | paragraph (1) of this subsection; or |
9 | | (3) capital improvements, other than investments in |
10 | | medical technology, except for capital improvements that |
11 | | may be required by accreditation bodies or State or federal |
12 | | regulatory or licensing authorities.
|
13 | | (Source: P.A. 95-859, eff. 8-19-08.)
|
14 | | Section 99. Effective date. This Act takes effect upon |
15 | | becoming law; however, no part of this Act takes effect before |
16 | | the date on which Senate Bill 2840, AS AMENDED, of the 97th |
17 | | General Assembly becomes law.".
|