Sen. John G. Mulroe

Filed: 5/7/2018





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2    AMENDMENT NO. ______. Amend House Bill 175 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.4 and by adding Section 5-5g as follows:
6    (305 ILCS 5/5-5g new)
7    Sec. 5-5g. Long-term care patient; resident status.
8Long-term care providers shall submit all changes in resident
9status, including, but not limited to, death, discharge,
10changes in patient credit, third party liability, and Medicare
11coverage, to the Department through the Medical Electronic Data
12Interchange System, the Recipient Eligibility Verification
13System, or the Electronic Data Interchange System established
14under 89 Ill. Adm. Code 140.55(b) in compliance with the
15schedule below:
16        (1) 15 calendar days after a resident's death;



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1        (2) 15 calendar days after a resident's discharge;
2        (3) 45 calendar days after being informed of a change
3    in the resident's income;
4        (4) 45 calendar days after being informed of a change
5    in a resident's third party liability;
6        (5) 45 calendar days after a resident's move to
7    exceptional care services; and
8        (6) 45 calendar days after a resident's need for
9    services requiring reimbursement under the ventilator or
10    traumatic brain injury enhanced rate.
11    (305 ILCS 5/11-5.4)
12    Sec. 11-5.4. Expedited long-term care eligibility
13determination, renewal, and enrollment, and payment.
14    (a) The General Assembly finds that it is in the best
15interest of the State to process on an expedited basis
16applications and renewal applications for Medicaid and
17Medicaid long-term care benefits that are submitted by or on
18behalf of elderly persons in need of long-term care services.
19It is the intent of the General Assembly that the provisions of
20this Section be liberally construed to permit the maximum
21number of applicants to benefit, regardless of the age of the
22application, and for the State to complete all processing as
23required under 42 U.S.C. 1396a(a)(8) and 42 CFR 435. An
24expedited long-term care eligibility determination and
25enrollment system shall be established to reduce long-term care



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1determinations to 90 days or fewer by July 1, 2014 and
2streamline the long-term care enrollment process.
3Establishment of the system shall be a joint venture of the
4Department of Human Services and Healthcare and Family Services
5and the Department on Aging. The Governor shall name a lead
6agency no later than 30 days after the effective date of this
7amendatory Act of the 98th General Assembly to assume
8responsibility for the full implementation of the
9establishment and maintenance of the system. Project outcomes
10shall include an enhanced eligibility determination tracking
11system accessible to providers and a centralized application
12review and eligibility determination with all applicants
13reviewed within 90 days of receipt by the State of a complete
14application. If the Department of Healthcare and Family
15Services' Office of the Inspector General determines that there
16is a likelihood that a non-allowable transfer of assets has
17occurred, and the facility in which the applicant resides is
18notified, an extension of up to 90 days shall be permissible.
19On or before December 31, 2015, a streamlined application and
20enrollment process shall be put in place based on the following
22        (1) Minimize the burden on applicants by collecting
23    only the data necessary to determine eligibility for
24    medical services, long-term care services, and spousal
25    impoverishment offset.
26        (2) Integrate online data sources to simplify the



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1    application process by reducing the amount of information
2    needed to be entered and to expedite eligibility
3    verification.
4        (3) Provide online prompts to alert the applicant that
5    information is missing or not complete.
6    (a-5) As used in this Section:
7    "Department" means the Department of Healthcare and Family
9    "Managed care organization" has the meaning ascribed to
10that term in Section 5-30.1 of this Code.
11    "Renewal" has the same meaning as "redetermination" in
12State policies, administrative rules, and federal Medicaid
14    (b) The Department of Healthcare and Family Services must
15serve as the lead agency assuming primary responsibility for
16the full implementation of this Section, including the
17establishment and operation of the system. The Department
18shall, on or before July 1, 2014, assess the feasibility of
19incorporating all information needed to determine eligibility
20for long-term care services, including asset transfer and
21spousal impoverishment financials, into the State's integrated
22eligibility system identifying all resources needed and
23reasonable timeframes for achieving the specified integration.
24    (c) Beginning on June 29, 2018, provisional eligibility, in
25the form of a recipient identification number and any other
26necessary credentials to permit an applicant to receive



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1benefits, must be issued to any applicant who has not received
2a final eligibility determination on his or her application for
3Medicaid or Medicaid long-term care benefits or a notice of an
4opportunity for a hearing within the federally prescribed
5deadlines for the processing of such applications. The
6Department must maintain the applicant's provisional Medicaid
7enrollment status until a final eligibility determination is
8approved or the applicant's appeal has been adjudicated and
9eligibility is denied. The Department or the managed care
10organization, if applicable, must reimburse providers for all
11services rendered during an applicant's provisional
12eligibility period.
13        (1) The Department must immediately notify the managed
14    care organization, if applicable, in which the applicant is
15    an enrollee of the enrollee's change in status.
16        (2) The Department or the managed care organization,
17    when applicable, must begin processing claims for services
18    rendered by the end of the month in which the applicant is
19    given provisional eligibility status. Claims for services
20    rendered must be submitted and processed by the Department
21    and managed care organizations in the same manner as those
22    submitted on behalf of beneficiaries determined to qualify
23    for benefits.
24        (3) An applicant with provisional enrollment status
25    must have his or her benefits paid for under the State's
26    fee-for-service system until such time as the State makes a



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1    final determination on the applicant's Medicaid or
2    Medicaid long-term care application. If an individual is
3    enrolled with a managed care organization for community
4    benefits at the time the individual's provisional status is
5    issued, the managed care organization is only responsible
6    for paying benefits covered under the capitation payment
7    received by the managed care organization for the
8    individual.
9        (4) The Department, within 10 business days of issuing
10    provisional eligibility to an applicant not covered by a
11    managed care organization, must submit to the Office of the
12    Comptroller for payment a voucher for all retroactive
13    reimbursement due. The Department must clearly identify
14    such vouchers as provisional eligibility vouchers. The
15    lead agency shall file interim reports with the Chairs and
16    Minority Spokespersons of the House and Senate Human
17    Services Committees no later than September 1, 2013 and on
18    February 1, 2014. The Department of Healthcare and Family
19    Services shall include in the annual Medicaid report for
20    State Fiscal Year 2014 and every fiscal year thereafter
21    information concerning implementation of the provisions of
22    this Section.
23    (d) The Department must establish, by rule, policies and
24procedures to ensure prospective compliance with the federal
25deadlines for Medicaid and Medicaid long-term care benefits
26eligibility determinations required under 42 U.S.C.



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11396a(a)(8) and 42 CFR 435.912, which must include, but need
2not be limited to, the following:
3        (1) The Department, assisted by the Department of Human
4    Services and the Department on Aging, must establish, no
5    later than January 1, 2019, a streamlined application and
6    enrollment process that includes, but is not limited to,
7    the following:
8            (A) collect only the data necessary to determine
9        eligibility for medical services, long-term care
10        services, and spousal impoverishment offset;
11            (B) integrate online data and other third party
12        data sources to simplify the application process by
13        reducing the amount of information needed to be entered
14        and to expedite eligibility verification;
15            (C) provide online prompts to alert the applicant
16        that information is missing or incomplete; and
17            (D) provide training and step-by-step written
18        instructions for caseworkers, applicants, and
19        providers.
20        (2) The Department must expedite the eligibility
21    processing system for applicants meeting certain
22    guidelines, regardless of the age of the application. The
23    guidelines must be established by rule and must include,
24    but not be limited to, the following individually or
25    collectively:
26            (A) Full Medicaid benefits in the community for a



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1        specified period of time.
2            (B) No transfer of assets or resources during the
3        federally prescribed look-back time period, as
4        specified by federal law.
5            (C) Receives Supplemental Security Income payments
6        or was receiving such payments at the time the
7        applicant was admitted to a nursing facility.
8            (D) Verified income at or below 100% of the federal
9        poverty level when the declared value of the
10        applicant's countable resources is no greater than the
11        allowable amounts pursuant to Section 5-2 of this Code
12        for classes of eligible persons for whom a resource
13        limit applies.
14        (3) The Department must establish, by rule, renewal
15    policies and procedures to reduce the likelihood of
16    unnecessary interruptions in services as a result of
17    improper denials of applicants who would otherwise be
18    approved.
19            (A) Effective January 1, 2019, the Department must
20        implement a paperless passive renewal protocol that
21        provides for the electronic verification of all
22        necessary information including bank accounts.
23            (B) A beneficiary who is a resident of a facility
24        and whose previous renewal application showed an
25        income of no greater than the federal poverty level and
26        who has no discernible means of generating income



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1        greater than the federal poverty level must be deemed
2        to qualify for renewal. The beneficiary and the
3        facility must not receive an application for renewal
4        and must instead receive notification of the
5        beneficiary's renewal.
6            (C) A beneficiary for whom the processing of a
7        renewal application exceeds federally prescribed
8        timeframes must be deemed to meet renewal guidelines
9        and the Department must notify the beneficiary and the
10        facility in which the beneficiary resides. The
11        Department must also immediately notify the managed
12        care organization in which the beneficiary is
13        enrolled, if applicable. Both the Department and the
14        managed care organization must accept claims for
15        services rendered to the beneficiary without an
16        interruption in benefits to the enrollee and payment
17        for all services rendered to providers.
18        (4) The Department of Human Services must not penalize
19    an applicant for having an attorney complete a Medicaid
20    application on the applicant's behalf or for seeking to
21    understand the applicant's rights under federal and State
22    Medicaid laws and regulations. This must not include
23    targeting applications and applicants so described for
24    additional scrutiny by the Department of Healthcare and
25    Family Services' Office of the Inspector General.
26        (5) The Department of Healthcare and Family Services'



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1    Office of the Inspector General must review applications
2    for long-term care benefits when the Office obtains
3    credible evidence that an applicant has transferred assets
4    with the intent of defrauding the State. If proof of the
5    allegations does not exist, the application must be
6    released by the Office and must be assigned to the
7    appropriate caseworker for an expedited review.
8        (6) The Department of Human Services must implement a
9    process to notify an applicant, the applicant's legally
10    authorized representative, and the facility where the
11    applicant resides of the receipt of an initial or renewal
12    application and supporting documentation within 5 business
13    days of the date the application or supporting documents
14    are submitted. The notices should indicate any
15    documentation required, but not received, and provide
16    instructions for submission.
17        (7) The Department must make available one release form
18    that permits the applicant to grant permission to a third
19    party to pursue approval of Medicaid and Medicaid long-term
20    care benefits, track the status of applications, and pursue
21    a post-denial appeal on behalf of the applicant, which must
22    remain in force after the applicant's death.
23        (8) The Department must develop one eligibility system
24    for both Modified Adjusted Gross Income (MAGI) and non-MAGI
25    applicants by incorporating Affordable Care Act upgrades
26    with the goal of establishing real time approval of



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1    applications for Medicaid services and Medicaid long-term
2    care benefits, as permissible.
3        (9) The Department must have operational a fully
4    electronic application process that encompasses initial
5    applications, admission packet, renewals, and appeals no
6    later than 12 months after the effective date of this
7    amendatory Act of the 100th General Assembly. The
8    Department must not require submission of any application
9    or supporting documentation in hard copy. No later than
10    August 1, 2014, the Auditor General shall report to the
11    General Assembly concerning the extent to which the
12    timeframes specified in this Section have been met and the
13    extent to which State staffing levels are adequate to meet
14    the requirements of this Section.
15    (e) The Department must adopt policies and procedures to
16improve communication between long-term care benefits central
17office personnel, applicants, or the applicants'
18representatives, and facilities in which the applicants
19reside. The Department must establish, by rule, such policies
20and procedures that are necessary to meet the requirements of
21this Section, which must include, but need not be limited to,
22the following:
23        (1) The establishment of a centralized,
24    caseworker-based processing system with contact numbers
25    for caseworkers and supervisors that are made readily
26    available to all affected providers and are prominently



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1    displayed on all communications with applicants,
2    beneficiaries, and providers.
3        (2) Allowing facilities access to the State's
4    integrated eligibility system for tracking the status of
5    applications for applicants who have signed appropriate
6    releases, and the development and distribution of
7    applicable instructional materials and release forms. The
8    Department of Healthcare and Family Services, the
9    Department of Human Services, and the Department on Aging
10    shall take the following steps to achieve federally
11    established timeframes for eligibility determinations for
12    Medicaid and long-term care benefits and shall work toward
13    the federal goal of real time determinations:
14        (1) The Departments shall review, in collaboration
15    with representatives of affected providers, all forms and
16    procedures currently in use, federal guidelines either
17    suggested or mandated, and staff deployment by September
18    30, 2014 to identify additional measures that can improve
19    long-term care eligibility processing and make adjustments
20    where possible.
21        (2) No later than June 30, 2014, the Department of
22    Healthcare and Family Services shall issue vouchers for
23    advance payments not to exceed $50,000,000 to nursing
24    facilities with significant outstanding Medicaid liability
25    associated with services provided to residents with
26    Medicaid applications pending and residents facing the



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1    greatest delays. Each facility with an advance payment
2    shall state in writing whether its own recoupment schedule
3    will be in 3 or 6 equal monthly installments, as long as
4    all advances are recouped by June 30, 2015.
5        (3) The Department of Healthcare and Family Services'
6    Office of Inspector General and the Department of Human
7    Services shall immediately forgo resource review and
8    review of transfers during the relevant look-back period
9    for applications that were submitted prior to September 1,
10    2013. An applicant who applied prior to September 1, 2013,
11    who was denied for failure to cooperate in providing
12    required information, and whose application was
13    incorrectly reviewed under the wrong look-back period
14    rules may request review and correction of the denial based
15    on this subsection. If found eligible upon review, such
16    applicants shall be retroactively enrolled.
17        (4) As soon as practicable, the Department of
18    Healthcare and Family Services shall implement policies
19    and promulgate rules to simplify financial eligibility
20    verification in the following instances: (A) for
21    applicants or recipients who are receiving Supplemental
22    Security Income payments or who had been receiving such
23    payments at the time they were admitted to a nursing
24    facility and (B) for applicants or recipients with verified
25    income at or below 100% of the federal poverty level when
26    the declared value of their countable resources is no



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1    greater than the allowable amounts pursuant to Section 5-2
2    of this Code for classes of eligible persons for whom a
3    resource limit applies. Such simplified verification
4    policies shall apply to community cases as well as
5    long-term care cases.
6        (5) As soon as practicable, but not later than July 1,
7    2014, the Department of Healthcare and Family Services and
8    the Department of Human Services shall jointly begin a
9    special enrollment project by using simplified eligibility
10    verification policies and by redeploying caseworkers
11    trained to handle long-term care cases to prioritize those
12    cases, until the backlog is eliminated and processing time
13    is within 90 days. This project shall apply to applications
14    for long-term care received by the State on or before May
15    15, 2014.
16        (6) As soon as practicable, but not later than
17    September 1, 2014, the Department on Aging shall make
18    available to long-term care facilities and community
19    providers upon request, through an electronic method, the
20    information contained within the Interagency Certification
21    of Screening Results completed by the pre-screener, in a
22    form and manner acceptable to the Department of Human
23    Services.
24    (f) The Department must establish, by rule, policies and
25procedures to improve accountability and provide for the
26expedited payment of services rendered, which must include, but



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1need not be limited to, the following:
2        (1) The Department must apply the most current resident
3    income data entered into the Department's Medical
4    Electronic Data Interchange (MEDI) system to the payment of
5    a claim even if a caseworker has not completed a review.
6        (2) The Department and the Department of Human Services
7    must notify the applicant, or the applicant's legal
8    representative, and the facility submitting the initial,
9    renewal, or appeal application of all missing supporting
10    documentation or information and the date of the request
11    when an application, renewal, or appeal is denied for
12    failure to submit such documentation and information.
13    (g) No later than January 1, 2019, the Department of
14Healthcare and Family Services must investigate the
15public-private partnerships in use in Ohio, Michigan, and
16Minnesota aimed at redeploying caseworkers to targeted
17high-Medicaid facilities for the purpose of expediting initial
18Medicaid and Medicaid long-term care benefits applications,
19renewals, asset discovery, and all other things related to
20enrollment, reimbursement, and application processing. No
21later than March 1, 2019, the Department of Healthcare and
22Family Services must post on the long-term care pages of the
23Department's website the agencies' joint recommendations and
24must assist provider groups in educating their members on such
26    (h) The Director of Healthcare and Family Services, in



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1coordination with the Secretary of Human Services and the
2Director of Aging, must host a provider association meeting
3every 6 weeks, beginning no later than 30 days after the
4effective date of this amendatory Act of the 100th General
5Assembly, until all applications that are 45 days or older have
6been adjudicated and the application process has been reduced
7to 45 or fewer days, at which time the meetings shall be held
8quarterly, for those associations representing facilities
9licensed under the Nursing Home Care Act and certified as a
10supportive living program. Each agency must be represented by
11senior staff with hands-on knowledge of the processing of
12applications for Medicaid and Medicaid long-term care
13benefits, renewals, and such ancillary issues as income and
14address adjustments, release forms, and screening reports.
15Agenda items must be solicited from the associations.
16    (i) The Department must not delay the implementation of the
17presumptive eligibility, as ordered by Koss v. Norwood, Case
18No. 17 C 2762 (N.D. Ill. Mar. 29, 2018), in anticipation of
19this amendatory Act of the 100th General Assembly.
20    (j) As mandated by federal regulations under 42 CFR
21435.912, the Department and the Department of Human Services
22must not deny applications for Medicaid or Medicaid long-term
23care benefits to comply with the federal timeliness standards
24or avoid authorizing provisional eligibility under this
25Section. To ensure compliance, the percentage of denials in a
26given month must not increase by more than 1% of the denial



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1rate that occurred in the same month of the preceding year.
2    (k) The Department of Human Services must prioritize
3processing applications on a last-in, first-out basis. The
4Department is expressly prohibited from prioritizing the
5processing of applications from applicants who have been issued
6provisional eligibility status over other applicants.
7    (l) Unless otherwise specified, all provisions of this
8amendatory Act of the 100th General Assembly must be fully
9operational by January 1, 2019.
10    (m) Nothing in this Section shall defeat the provisions
11contained in the State Prompt Payment Act or the timely pay
12provisions contained in Section 368a of the Illinois Insurance
14    (n) The Department must offer regionally based training
15covering all aspects of this Section and must include long-term
16care provider associations in the design and presentation of
17the training. The training shall be recorded and posted on the
18Department's website to allow new employees to be trained and
19older employers to complete refresher courses.
20    (o) The Department and the Department of Human Services
21must not require an applicant for Medicaid or Medicaid
22long-term care benefits to submit a new application solely
23because there is a change in the applicant's legal
25    (p) The Department and the Department of Human Services
26must implement the requirements under this Section even if the



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1required rules are not yet adopted by the dates specified in
2this Section. If the Department is required to adopt rules
3under this Section or if the Department determines that rules
4are necessary to achieve full implementation, the Department
5must adopt policies and procedures to allow for full
6implementation by the date specified in this Section and must
7publish all policies and procedures on the Department's
8website. The Department must submit proposed permanent rules
9for public comment no later than January 1, 2019.
10    (q) (7) Effective 30 days after the completion of 3
11regionally based trainings, nursing facilities shall submit
12all applications for medical assistance online via the
13Application for Benefits Eligibility (ABE) website. This
14requirement shall extend to scanning and uploading with the
15online application any required additional forms such as the
16Long Term Care Facility Notification and the Additional
17Financial Information for Long Term Care Applicants as well as
18scanned copies of any supporting documentation. Long-term care
19facility admission documents must be submitted as required in
20Section 5-5 of this Code. No local Department of Human Services
21office shall refuse to accept an electronically filed
23    (r) (8) Notwithstanding any other provision of this Code,
24the Department of Human Services and the Department of
25Healthcare and Family Services' Office of the Inspector General
26shall, upon request, allow an applicant additional time to



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1submit information and documents needed as part of a review of
2available resources or resources transferred during the
3look-back period. The initial extension shall not exceed 30
4days. A second extension of 30 days may be granted upon
5request. Any request for information issued by the State to an
6applicant shall include the following: an explanation of the
7information required and the date by which the information must
8be submitted; a statement that failure to respond in a timely
9manner can result in denial of the application; a statement
10that the applicant or the facility in the name of the applicant
11may seek an extension; and the name and contact information of
12a caseworker in case of questions. Any such request for
13information shall also be sent to the facility. In deciding
14whether to grant an extension, the Department of Human Services
15or the Department of Healthcare and Family Services' Office of
16the Inspector General shall take into account what is in the
17best interest of the applicant. The time limits for processing
18an application shall be tolled during the period of any
19extension granted under this subsection.
20    (s) (9) The Department of Human Services and the Department
21of Healthcare and Family Services must jointly compile data on
22pending applications, denials, appeals, and renewals
23redeterminations into a monthly report, which shall be posted
24on each Department's website for the purposes of monitoring
25long-term care eligibility processing. The report must specify
26the number of applications and renewals redeterminations



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1pending long-term care eligibility determination and admission
2and the number of appeals of denials in the following
4        (1) (A) Length of time applications, renewals
5    redeterminations, and appeals are pending - 0 to 45 days,
6    46 days to 90 days, 91 days to 180 days, 181 days to 12
7    months, over 12 months to 18 months, over 18 months to 24
8    months, and over 24 months.
9        (2) (B) Percentage of applications and renewals
10    redeterminations pending in the Department of Human
11    Services' Family Community Resource Centers, in the
12    Department of Human Services' long-term care hubs, with the
13    Department of Healthcare and Family Services' Office of
14    Inspector General, and those applications which are being
15    tolled due to requests for extension of time for additional
16    information.
17        (3) (C) Status of pending applications, denials,
18    appeals, and renewals redeterminations.
19        (4) For applications, renewals, and appeals pending
20    more than 45 days, the reason for the delay as required by
21    federal regulations under 42 CFR 435.912.
22    (t) (f) Beginning on July 1, 2017, the Auditor General
23shall report every 3 years to the General Assembly on the
24performance and compliance of the Department of Healthcare and
25Family Services, the Department of Human Services, and the
26Department on Aging in meeting the requirements of this Section



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1and the federal requirements concerning eligibility
2determinations for Medicaid long-term care services and
3supports, and shall report any issues or deficiencies and make
4recommendations. The Auditor General shall, at a minimum,
5review, consider, and evaluate the following:
6        (1) compliance with federal regulations on furnishing
7    services as related to Medicaid long-term care services and
8    supports as provided under 42 CFR 435.930;
9        (2) compliance with federal regulations on the timely
10    determination of eligibility as provided under 42 CFR
11    435.912;
12        (3) the accuracy and completeness of the report
13    required under paragraph (9) of subsection (e);
14        (4) the efficacy and efficiency of the task-based
15    process used for making eligibility determinations in the
16    centralized offices of the Department of Human Services for
17    long-term care services, including the role of the State's
18    integrated eligibility system, as opposed to the
19    traditional caseworker-specific process from which these
20    central offices have converted; and
21        (5) any issues affecting eligibility determinations
22    related to the Department of Human Services' staff
23    completing Medicaid eligibility determinations instead of
24    the designated single-state Medicaid agency in Illinois,
25    the Department of Healthcare and Family Services.
26    The Auditor General's report shall include any and all



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1other areas or issues which are identified through an annual
2review. Paragraphs (1) through (5) of this subsection shall not
3be construed to limit the scope of the annual review and the
4Auditor General's authority to thoroughly and completely
5evaluate any and all processes, policies, and procedures
6concerning compliance with federal and State law requirements
7on eligibility determinations for Medicaid long-term care
8services and supports.
9(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
10    Section 99. Effective date. This Act takes effect upon
11becoming law.".