99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB2929

 

Introduced 2/18/2016, by Sen. John G. Mulroe

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Hospital Licensing Act. Provides that a patient discharged to a skilled nursing facility who is not assessed prior to discharge or whose pre-screening information does not accompany the patient to the skilled nursing facility shall (i) be admitted to the skilled nursing facility pending the case coordination unit completing a post-screening evaluation or the delivery of the pre-screening information to the skilled nursing facility and (ii) be eligible for Medicaid funded care from the date of admission if the patient meets all eligibility criteria for medical assistance under the Illinois Public Aid Code. Amends the Illinois Public Aid Code. Provides that a nursing home resident determined to be eligible for medical assistance for long term care services shall be entitled to have his or her care paid retroactive to the date of admission to a nursing home or the date the resident converted from Medicare or private funds as a payer source if it is determined that the resident met the financial eligibility standards for medical assistance on the date of admission or conversion and the admission or conversion date is within the retroactive window established under the Code. Provides that an outstanding application for medical assistance for long term care services shall not be closed or denied based solely on the applicant's death or the absence of certain documentation if services authorized under the Code were provided pending a determination of eligibility. Provides that a nursing home resident who is unable to comply in securing financial documents requested by the Department of Healthcare and Family Services to prove financial eligibility shall be assigned a long term care ombudsman to assist the resident in securing medical assistance.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB2929LRB099 20556 KTG 45107 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 Hospital Licensing Act is amended by
5changing Section 6.09 as follows:
 
6    (210 ILCS 85/6.09)  (from Ch. 111 1/2, par. 147.09)
7    Sec. 6.09. (a) In order to facilitate the orderly
8transition of aged patients and patients with disabilities from
9hospitals to post-hospital care, whenever a patient who
10qualifies for the federal Medicare program is hospitalized, the
11patient shall be notified of discharge at least 24 hours prior
12to discharge from the hospital. With regard to pending
13discharges to a skilled nursing facility, the hospital must
14notify the case coordination unit, as defined in 89 Ill. Adm.
15Code 240.260, at least 24 hours prior to discharge. When the
16assessment is completed in the hospital, the case coordination
17unit shall provide the discharge planner with a copy of the
18prescreening information and accompanying materials, which the
19discharge planner shall transmit when the patient is discharged
20to a skilled nursing facility. Notwithstanding any other
21provision of law to the contrary, a patient discharged to a
22skilled nursing facility who is not assessed prior to discharge
23or whose pre-screening information does not accompany the

 

 

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1patient to the skilled nursing facility shall be admitted to
2the skilled nursing facility pending the case coordination unit
3completing a post-screening evaluation or the delivery of the
4pre-screening information to the skilled nursing facility by
5the case coordination unit and shall be eligible for Medicaid
6funded care from the date of admission if the patient meets all
7eligibility criteria for medical assistance set forth under
8Article V of the Illinois Public Aid Code. If home health
9services are ordered, the hospital must inform its designated
10case coordination unit, as defined in 89 Ill. Adm. Code
11240.260, of the pending discharge and must provide the patient
12with the case coordination unit's telephone number and other
13contact information.
14    (b) Every hospital shall develop procedures for a physician
15with medical staff privileges at the hospital or any
16appropriate medical staff member to provide the discharge
17notice prescribed in subsection (a) of this Section. The
18procedures must include prohibitions against discharging or
19referring a patient to any of the following if unlicensed,
20uncertified, or unregistered: (i) a board and care facility, as
21defined in the Board and Care Home Act; (ii) an assisted living
22and shared housing establishment, as defined in the Assisted
23Living and Shared Housing Act; (iii) a facility licensed under
24the Nursing Home Care Act, the Specialized Mental Health
25Rehabilitation Act of 2013, the ID/DD Community Care Act, or
26the MC/DD Act; (iv) a supportive living facility, as defined in

 

 

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1Section 5-5.01a of the Illinois Public Aid Code; or (v) a
2free-standing hospice facility licensed under the Hospice
3Program Licensing Act if licensure, certification, or
4registration is required. The Department of Public Health shall
5annually provide hospitals with a list of licensed, certified,
6or registered board and care facilities, assisted living and
7shared housing establishments, nursing homes, supportive
8living facilities, facilities licensed under the ID/DD
9Community Care Act, the MC/DD Act, or the Specialized Mental
10Health Rehabilitation Act of 2013, and hospice facilities.
11Reliance upon this list by a hospital shall satisfy compliance
12with this requirement. The procedure may also include a waiver
13for any case in which a discharge notice is not feasible due to
14a short length of stay in the hospital by the patient, or for
15any case in which the patient voluntarily desires to leave the
16hospital before the expiration of the 24 hour period.
17    (c) At least 24 hours prior to discharge from the hospital,
18the patient shall receive written information on the patient's
19right to appeal the discharge pursuant to the federal Medicare
20program, including the steps to follow to appeal the discharge
21and the appropriate telephone number to call in case the
22patient intends to appeal the discharge.
23    (d) Before transfer of a patient to a long term care
24facility licensed under the Nursing Home Care Act where elderly
25persons reside, a hospital shall as soon as practicable
26initiate a name-based criminal history background check by

 

 

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1electronic submission to the Department of State Police for all
2persons between the ages of 18 and 70 years; provided, however,
3that a hospital shall be required to initiate such a background
4check only with respect to patients who:
5        (1) are transferring to a long term care facility for
6    the first time;
7        (2) have been in the hospital more than 5 days;
8        (3) are reasonably expected to remain at the long term
9    care facility for more than 30 days;
10        (4) have a known history of serious mental illness or
11    substance abuse; and
12        (5) are independently ambulatory or mobile for more
13    than a temporary period of time.
14    A hospital may also request a criminal history background
15check for a patient who does not meet any of the criteria set
16forth in items (1) through (5).
17    A hospital shall notify a long term care facility if the
18hospital has initiated a criminal history background check on a
19patient being discharged to that facility. In all circumstances
20in which the hospital is required by this subsection to
21initiate the criminal history background check, the transfer to
22the long term care facility may proceed regardless of the
23availability of criminal history results. Upon receipt of the
24results, the hospital shall promptly forward the results to the
25appropriate long term care facility. If the results of the
26background check are inconclusive, the hospital shall have no

 

 

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1additional duty or obligation to seek additional information
2from, or about, the patient.
3(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;
499-143, eff. 7-27-15; 99-180, eff. 7-29-15; revised 10-14-15.)
 
5    Section 10. The Illinois Public Aid Code is amended by
6changing Sections 5-2.1d and 5-6 and by adding Section 5-6a as
7follows:
 
8    (305 ILCS 5/5-2.1d)
9    Sec. 5-2.1d. Retroactive eligibility.
10    (a) An applicant for medical assistance may be eligible for
11up to 3 months prior to the date of application if the person
12would have been eligible for medical assistance at the time he
13or she received the services if he or she had applied,
14regardless of whether the individual is alive when the
15application for medical assistance is made. In determining
16financial eligibility for medical assistance for retroactive
17months, the Department shall consider the amount of income and
18resources and exemptions available to a person as of the first
19day of each of the backdated months for which eligibility is
20sought.
21    (b) A nursing home resident determined to be eligible for
22medical assistance for long term care services shall be
23entitled to have his or her care paid retroactive to the date
24of admission to a nursing home or the date the resident

 

 

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1converted from Medicare or private funds as a payer source if
2it is determined that the resident met the financial
3eligibility standards set forth in this Code on the date of
4admission or conversion and the admission or conversion date is
5within the retroactive window established in subsection (a)
6regardless of whether a case coordination unit had completed a
7screening in advance of admission or the facility submitted
8admission materials on the date of admission or conversion.
9(Source: P.A. 97-689, eff. 6-14-12.)
 
10    (305 ILCS 5/5-6)  (from Ch. 23, par. 5-6)
11    Sec. 5-6. Obligations incurred prior to death of a
12recipient.
13    (a) Obligations incurred but not paid for at the time of a
14recipient's death for services authorized under Section 5-5,
15including medical and other care in facilities as defined in
16the Nursing Home Care Act, the Specialized Mental Health
17Rehabilitation Act of 2013, the ID/DD Community Care Act, or
18the MC/DD Act, or in like facilities not required to be
19licensed under that Act, may be paid, subject to the rules and
20regulations of the Illinois Department, after the death of the
21recipient.
22    (b) An outstanding application for medical assistance for
23long term care services shall not be closed or denied based
24solely on the applicant's death or the absence of documentation
25the applicant failed to provide prior to the applicant's death

 

 

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1if services authorized under Section 5-5 were provided pending
2a determination of eligibility. In the case of missing
3documentation, the Department shall request the information
4from the financial institution. If the financial institution
5fails to comply with the request, the Department shall notify
6the Secretary of the Department of Financial and Professional
7Regulation, who shall take all steps necessary to ensure
8compliance. Before an application is closed or denied on an
9applicant's death, the Department shall determine if
10outstanding obligations for authorized services exist. The
11provider of the services shall have 12 months from the date the
12application was closed or denied to request payment for
13services rendered in good faith and the Department shall make
14every attempt to accommodate the request, unless the Department
15has proof that the services were not rendered or were not
16rendered in good faith. The provider shall have 36 months from
17the date of the resident's death to seek compensation through
18the Court of Claims.
19(Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)
 
20    (305 ILCS 5/5-6a new)
21    Sec. 5-6a. Long term care ombudsman; nursing home resident.
22A nursing home resident who is unable to comply in securing
23financial documents requested by the Department to prove
24financial eligibility and whose family is unable or unwilling
25to secure the requested documents on the resident's behalf

 

 

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1shall be assigned a long term care ombudsman from the Long Term
2Care Ombudsman Program established under Section 4.04 of the
3Illinois Act on the Aging to assist the resident in securing
4medical assistance for long term care services. The long term
5care ombudsman shall work with: (i) the resident; (ii) the
6resident's family, to the extent they are willing to
7participate; (iii) the facility; and (iv) the Department of
8Human Services and the Department of Healthcare and Family
9Services' Office of the Inspector General to successfully
10secure long term care benefits for the resident. The Department
11of Human Services and the Department of Healthcare and Family
12Services' Office of the Inspector General shall be responsible
13for requesting missing financial documentation from financial
14institutions on behalf of the resident. The Secretary or
15Director of the requesting Department shall report to the
16Secretary of the Department of Financial and Professional
17Regulation any financial institution that fails to comply with
18a request for missing financial documentation. The Secretary of
19the Department of Financial and Professional Regulation shall
20take all steps necessary to ensure compliance. The Long Term
21Care Ombudsman Program shall be reimbursed for services
22provided pursuant to this Section on a per client basis at a
23rate established by the Department on Aging from federal Civil
24Monetary Funds overseen by the Department of Public Health.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    210 ILCS 85/6.09from Ch. 111 1/2, par. 147.09
4    305 ILCS 5/5-2.1d
5    305 ILCS 5/5-6from Ch. 23, par. 5-6
6    305 ILCS 5/5-6a new