100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4277

 

Introduced , by Rep. Norine K. Hammond

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/11-5.4

    Amends the Illinois Public Aid Code. In order to protect the right of Medicaid beneficiaries to receive Medicaid long-term care services and supports (LTSS) promptly without any delay caused by administrative procedures, requires the Department of Healthcare and Family Services and other specified Departments to take the following actions: (i) for a Medicaid beneficiary aged 65 years or older who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services no later than the 46th day after the date upon which the beneficiary applied for the services; (ii) for a Medicaid beneficiary aged 64 years or younger whose Medicaid eligibility is based upon a disability and who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services no later than the 91st day after the date upon which the beneficiary applied for the services; (iii) for a Medicaid applicant who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services immediately once the applicant is determined eligible for Medicaid; (iv) by July 1, 2018, the Department of Healthcare and Family Services, in conjunction with the State Comptroller, must develop a process to expedite payment claims for Medicaid services provided during the time any application for Medicaid eligibility or LTSS services is pending beyond federally required timeliness standards; and (v) by July 1, 2018, the Department of Healthcare and Family Services and the Department of Human Services must waive all deadline requirements for applications for Medicaid eligibility or LTSS services if pending beyond federally required timeliness standards. Makes other changes. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB4277LRB100 15899 KTG 31012 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.4 as follows:
 
6    (305 ILCS 5/11-5.4)
7    Sec. 11-5.4. Expedited long-term care eligibility
8determination and enrollment.
9    (a) An expedited long-term care eligibility determination
10and enrollment system shall be established to reduce long-term
11care determinations to 90 days or fewer by July 1, 2014 and
12streamline the long-term care enrollment process.
13Establishment of the system shall be a joint venture of the
14Department of Human Services and Healthcare and Family Services
15and the Department on Aging. The Governor shall name a lead
16agency no later than 30 days after the effective date of this
17amendatory Act of the 98th General Assembly to assume
18responsibility for the full implementation of the
19establishment and maintenance of the system. Project outcomes
20shall include an enhanced eligibility determination tracking
21system accessible to providers and a centralized application
22review and eligibility determination with all applicants
23reviewed within 90 days of receipt by the State of a complete

 

 

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1application. If the Department of Healthcare and Family
2Services' Office of the Inspector General determines that there
3is a likelihood that a non-allowable transfer of assets has
4occurred, and the facility in which the applicant resides is
5notified, an extension of up to 90 days shall be permissible.
6On or before December 31, 2015, a streamlined application and
7enrollment process shall be put in place based on the following
8principles:
9        (1) Minimize the burden on applicants by collecting
10    only the data necessary to determine eligibility for
11    medical services, long-term care services, and spousal
12    impoverishment offset.
13        (2) Integrate online data sources to simplify the
14    application process by reducing the amount of information
15    needed to be entered and to expedite eligibility
16    verification.
17        (3) Provide online prompts to alert the applicant that
18    information is missing or not complete.
19    (b) The Department shall, on or before July 1, 2014, assess
20the feasibility of incorporating all information needed to
21determine eligibility for long-term care services, including
22asset transfer and spousal impoverishment financials, into the
23State's integrated eligibility system identifying all
24resources needed and reasonable timeframes for achieving the
25specified integration.
26    (c) The lead agency shall file interim reports with the

 

 

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1Chairs and Minority Spokespersons of the House and Senate Human
2Services Committees no later than September 1, 2013 and on
3February 1, 2014. The Department of Healthcare and Family
4Services shall include in the annual Medicaid report for State
5Fiscal Year 2014 and every fiscal year thereafter information
6concerning implementation of the provisions of this Section.
7    (d) No later than August 1, 2014, the Auditor General shall
8report to the General Assembly concerning the extent to which
9the timeframes specified in this Section have been met and the
10extent to which State staffing levels are adequate to meet the
11requirements of this Section.
12    (e) The Department of Healthcare and Family Services, the
13Department of Human Services, and the Department on Aging shall
14take the following steps to achieve federally established
15timeframes for eligibility determinations for Medicaid and
16long-term care benefits and shall work toward the federal goal
17of real time determinations:
18        (1) The Departments shall review, in collaboration
19    with representatives of affected providers, all forms and
20    procedures currently in use, federal guidelines either
21    suggested or mandated, and staff deployment by September
22    30, 2014 to identify additional measures that can improve
23    long-term care eligibility processing and make adjustments
24    where possible.
25        (2) No later than June 30, 2014, the Department of
26    Healthcare and Family Services shall issue vouchers for

 

 

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1    advance payments not to exceed $50,000,000 to nursing
2    facilities with significant outstanding Medicaid liability
3    associated with services provided to residents with
4    Medicaid applications pending and residents facing the
5    greatest delays. Each facility with an advance payment
6    shall state in writing whether its own recoupment schedule
7    will be in 3 or 6 equal monthly installments, as long as
8    all advances are recouped by June 30, 2015.
9        (3) The Department of Healthcare and Family Services'
10    Office of Inspector General and the Department of Human
11    Services shall immediately forgo resource review and
12    review of transfers during the relevant look-back period
13    for applications that were submitted prior to September 1,
14    2013. An applicant who applied prior to September 1, 2013,
15    who was denied for failure to cooperate in providing
16    required information, and whose application was
17    incorrectly reviewed under the wrong look-back period
18    rules may request review and correction of the denial based
19    on this subsection. If found eligible upon review, such
20    applicants shall be retroactively enrolled.
21        (4) As soon as practicable, the Department of
22    Healthcare and Family Services shall implement policies
23    and promulgate rules to simplify financial eligibility
24    verification in the following instances: (A) for
25    applicants or recipients who are receiving Supplemental
26    Security Income payments or who had been receiving such

 

 

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1    payments at the time they were admitted to a nursing
2    facility and (B) for applicants or recipients with verified
3    income at or below 100% of the federal poverty level when
4    the declared value of their countable resources is no
5    greater than the allowable amounts pursuant to Section 5-2
6    of this Code for classes of eligible persons for whom a
7    resource limit applies. Such simplified verification
8    policies shall apply to community cases as well as
9    long-term care cases.
10        (5) As soon as practicable, but not later than July 1,
11    2014, the Department of Healthcare and Family Services and
12    the Department of Human Services shall jointly begin a
13    special enrollment project by using simplified eligibility
14    verification policies and by redeploying caseworkers
15    trained to handle long-term care cases to prioritize those
16    cases, until the backlog is eliminated and processing time
17    is within 90 days. This project shall apply to applications
18    for long-term care received by the State on or before May
19    15, 2014.
20        (6) As soon as practicable, but not later than
21    September 1, 2014, the Department on Aging shall make
22    available to long-term care facilities and community
23    providers upon request, through an electronic method, the
24    information contained within the Interagency Certification
25    of Screening Results completed by the pre-screener, in a
26    form and manner acceptable to the Department of Human

 

 

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1    Services.
2        (7) Effective 30 days after the completion of 3
3    regionally based trainings, nursing facilities shall
4    submit all applications for medical assistance online via
5    the Application for Benefits Eligibility (ABE) website.
6    This requirement shall extend to scanning and uploading
7    with the online application any required additional forms
8    such as the Long Term Care Facility Notification and the
9    Additional Financial Information for Long Term Care
10    Applicants as well as scanned copies of any supporting
11    documentation. Long-term care facility admission documents
12    must be submitted as required in Section 5-5 of this Code.
13    No local Department of Human Services office shall refuse
14    to accept an electronically filed application.
15        (8) Notwithstanding any other provision of this Code,
16    the Department of Human Services and the Department of
17    Healthcare and Family Services' Office of the Inspector
18    General shall, upon request, allow an applicant additional
19    time to submit information and documents needed as part of
20    a review of available resources or resources transferred
21    during the look-back period. The initial extension shall
22    not exceed 30 days. A second extension of 30 days may be
23    granted upon request. Any request for information issued by
24    the State to an applicant shall include the following: an
25    explanation of the information required and the date by
26    which the information must be submitted; a statement that

 

 

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1    failure to respond in a timely manner can result in denial
2    of the application; a statement that the applicant or the
3    facility in the name of the applicant may seek an
4    extension; and the name and contact information of a
5    caseworker in case of questions. Any such request for
6    information shall also be sent to the facility. In deciding
7    whether to grant an extension, the Department of Human
8    Services or the Department of Healthcare and Family
9    Services' Office of the Inspector General shall take into
10    account what is in the best interest of the applicant. The
11    time limits for processing an application shall be tolled
12    during the period of any extension granted under this
13    subsection.
14        (9) The Department of Human Services and the Department
15    of Healthcare and Family Services must jointly compile data
16    on pending applications, denials, appeals, and
17    redeterminations into a monthly report, which shall be
18    posted on each Department's website for the purposes of
19    monitoring long-term care eligibility processing. The
20    report must specify the number of applications and
21    redeterminations pending long-term care eligibility
22    determination and admission and the number of appeals of
23    denials in the following categories:
24            (A) Length of time applications, redeterminations,
25        and appeals are pending - 0 to 45 days, 46 days to 90
26        days, 91 days to 180 days, 181 days to 12 months, over

 

 

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1        12 months to 18 months, over 18 months to 24 months,
2        and over 24 months.
3            (B) Percentage of applications and
4        redeterminations pending in the Department of Human
5        Services' Family Community Resource Centers, in the
6        Department of Human Services' long-term care hubs,
7        with the Department of Healthcare and Family Services'
8        Office of Inspector General, and those applications
9        which are being tolled due to requests for extension of
10        time for additional information.
11            (C) Status of pending applications, denials,
12        appeals, and redeterminations.
13    (f) Beginning on July 1, 2017, the Auditor General shall
14report every 3 years to the General Assembly on the performance
15and compliance of the Department of Healthcare and Family
16Services, the Department of Human Services, and the Department
17on Aging in meeting the requirements of this Section and the
18federal requirements concerning eligibility determinations for
19Medicaid long-term care services and supports, and shall report
20any issues or deficiencies and make recommendations. The
21Auditor General shall, at a minimum, review, consider, and
22evaluate the following:
23        (1) compliance with federal regulations on furnishing
24    services as related to Medicaid long-term care services and
25    supports as provided under 42 CFR 435.930;
26        (2) compliance with federal regulations on the timely

 

 

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1    determination of eligibility as provided under 42 CFR
2    435.912;
3        (3) the accuracy and completeness of the report
4    required under paragraph (9) of subsection (e);
5        (4) the efficacy and efficiency of the task-based
6    process used for making eligibility determinations in the
7    centralized offices of the Department of Human Services for
8    long-term care services, including the role of the State's
9    integrated eligibility system, as opposed to the
10    traditional caseworker-specific process from which these
11    central offices have converted; and
12        (5) any issues affecting eligibility determinations
13    related to the Department of Human Services' staff
14    completing Medicaid eligibility determinations instead of
15    the designated single-state Medicaid agency in Illinois,
16    the Department of Healthcare and Family Services.
17    The Auditor General's report shall include any and all
18other areas or issues which are identified through an annual
19review. Paragraphs (1) through (5) of this subsection shall not
20be construed to limit the scope of the annual review and the
21Auditor General's authority to thoroughly and completely
22evaluate any and all processes, policies, and procedures
23concerning compliance with federal and State law requirements
24on eligibility determinations for Medicaid long-term care
25services and supports.
26    (g) In order to protect the right of Medicaid beneficiaries

 

 

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1to receive Medicaid services, especially long-term care
2services and supports, promptly without any delay caused by the
3agency's administrative procedures as mandated under 42 CFR
4435.930, on and after July 1, 2018, the Department of
5Healthcare and Family Services, the Department of Human
6Services, and the Department on Aging must, at a minimum, take
7the following actions:
8        (1) For a beneficiary aged 65 years or older who is
9    enrolled in Medicaid at the time he or she applies for
10    Medicaid long-term care services and supports and who has
11    received a Determination of Need indicating the need for
12    such services, the Departments must begin paying for
13    Medicaid long-term care services and supports no later than
14    the 46th day after the date upon which the beneficiary
15    applied for such services. Payments for Medicaid long-term
16    care services and supports must begin even if the review of
17    the beneficiary's income and assets is incomplete and the
18    amount of the beneficiary's income and assets to be applied
19    to the cost of services has not been determined. The
20    Department of Healthcare and Family Services shall apply
21    the beneficiary's excess income and assets prospectively
22    to the cost of care once the final amounts are determined.
23    Delay in reviewing the available income and assets beyond
24    the 45th day after the date upon which the beneficiary
25    applied for Medicaid long-term care services and supports
26    may not delay the furnishing of such services nor the

 

 

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1    payment for such services by the Department of Healthcare
2    and Family Services.
3        (2) For a beneficiary aged 64 years or younger who is
4    enrolled in Medicaid at the time he or she applies for
5    Medicaid long-term care services and supports, whose
6    Medicaid eligibility is based upon a disability, and who
7    has received a Determination of Need indicating the need
8    for Medicaid long-term care services and supports, the
9    Departments must begin paying for Medicaid long-term care
10    services and supports no later than the 91st day after the
11    date upon which the beneficiary applied for such services.
12    Payments for Medicaid long-term care services and supports
13    must begin even if the review of the beneficiary's income
14    and assets is incomplete and the amount of the
15    beneficiary's income and assets to be applied to the cost
16    of services has not been determined. The Department of
17    Healthcare and Family Services shall apply the
18    beneficiary's excess income and assets prospectively to
19    the cost of care once the final amounts are determined.
20    Delay in reviewing the available income and assets beyond
21    the 90th day after the date upon which the beneficiary
22    applied for Medicaid long-term care services and supports
23    may not delay the furnishing of such services nor the
24    payment for such services by the Department of Healthcare
25    and Family Services. The deadlines specified in this
26    paragraph are the federally required timeliness standards

 

 

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1    set forth under 42 CFR 435.912.
2        (3) For an applicant who is not enrolled in Medicaid at
3    the time he or she applies for Medicaid long-term care
4    services and supports and who has received a Determination
5    of Need indicating the need for such services, the
6    Departments must begin paying for Medicaid long-term care
7    services and supports immediately once the applicant is
8    determined eligible for Medicaid services. Payments for
9    community services and Medicaid long-term care services
10    and supports must begin even if the review of the
11    applicant's income and assets is incomplete and the amount
12    of the applicant's income and assets to be applied to the
13    cost of services has not been determined. The Department of
14    Healthcare and Family Services shall apply the applicant's
15    excess income and assets prospectively to the cost of
16    services once the final amounts are determined. Delay in
17    reviewing the available income and assets beyond the 45th
18    day after the date upon which the applicant applied for
19    Medicaid enrollment may not delay the furnishing of such
20    services nor the payment for such services by the
21    Department of Healthcare and Family Services.
22        (4) By July 1, 2018, the Department of Healthcare and
23    Family Services and the Department of Human Services may
24    not require an applicant for Medicaid or Medicaid long-term
25    care services and supports to submit a new application for
26    benefits or services whenever a new entity or person is

 

 

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1    designated or appointed to act as the applicant's legally
2    authorized representative, representative payee, guardian,
3    agent named in a power of attorney, or as any other
4    personal representative who is authorized to make legal or
5    health care decisions for the applicant.
6        (5) By July 1, 2018, the Department of Healthcare and
7    Family Services, in conjunction with the State
8    Comptroller, must develop a process to expedite payment for
9    any claims for Medicaid services provided during the time
10    any application for Medicaid eligibility or Medicaid
11    long-term care services and supports is pending beyond
12    federally required timeliness standards set forth under 42
13    CFR 435.912. The Department must also require managed care
14    organizations contracted with the Department to follow the
15    same expedited payment process.
16        (6) By July 1, 2018, the Department of Healthcare and
17    Family Services and the Department of Human Services must
18    develop a common form that permits a Medicaid applicant's
19    legally authorized representative, representative payee,
20    agent named in a power of attorney, guardian, or any other
21    person or entity who is authorized to make legal or health
22    care decisions for the applicant to make all Medicaid
23    decisions including the right to file an appeal on the
24    applicant's behalf under this Article.
25        (7) By July 1, 2018, the Department of Healthcare and
26    Family Services and the Department of Human Services must

 

 

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1    waive all deadline requirements for applications for
2    Medicaid eligibility or Medicaid long-term care services
3    and supports if pending beyond federally required
4    timeliness standards set forth under 42 CFR 435.912.
5        (8) By July 1, 2018, the Department of Healthcare and
6    Family Services and the Department of Human Services must
7    develop a process to notify an applicant or their legally
8    authorized representative of the receipt of their
9    application and all supporting documentation. The notice
10    should indicate any documentation required but not
11    received.
12        (9) By July 1, 2018, in the case of a denial for
13    missing information, the Department of Healthcare and
14    Family Services and the Department of Human Services must
15    notify an applicant or their legally authorized
16    representative of any and all documentation or information
17    that was missing and provide information on when the
18    information was requested.
19        (10) The Department of Healthcare and Family Services
20    and the Department of Human Services may adopt rules as
21    allowed by the Illinois Administrative Procedure Act to
22    implement the requirements of this subsection (g);
23    however, the requirements under this subsection (g) must be
24    implemented by all Departments even if the proposed rules
25    are not yet adopted by the implementation date of July 1,
26    2018.

 

 

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1    As used in this subsection, "Determination of Need" means
2the current and any future assessment tool adopted by and used
3by the State to assess the amount, intensity, or level of
4services needed to properly care for the medical, physical, and
5behavioral health needs of any individual requesting Medicaid
6long-term care services and supports.
7    For the purposes of this subsection, the process of
8determining the amount of an individual's income and assets to
9be applied to the cost of the individual's care refers to the
10federal regulations concerning the post-eligibility treatment
11of income as provided under 42 CFR 435.733.
12(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.