Illinois General Assembly - Full Text of SB1821
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Full Text of SB1821  99th General Assembly




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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
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 and post a monthly report on each
17    Department's website for the purposes of monitoring
18    long-term care eligibility processing. The report must
19    specify the number of applications pending long-term care
20    eligibility determination and admission in the following
21    categories:
22            (A) Length of time application is pending - 0 to 90
23        days, 91 days to 180 days, 181 days to 12 months, over
24        12 months to 18 months, over 18 months to 24 months,
25        and over 24 months.
26            (B) Percentage of applications pending in the



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1        Department of Human Services' Family Community
2        Resource Centers, in the Department of Human Services'
3        long-term care hubs, with the Department of Healthcare
4        and Family Services' Office of Inspector General, and
5        those applications which are being tolled due to
6        requests for extension of time for additional
7        information.
8            (C) Status of pending applications.
9    (f) An applicant for long-term care services under the
10medical assistance program whose application remains open at
11least 15 days past the federally established guideline for
12processing applications shall be entitled to a temporary
13medical assistance card which shall be issued upon the
14applicant's request. The Department of Healthcare and Family
15Services shall immediately add the person to the facility's
16roster for payment and notify the managed care organization of
17the resident's change in payment status, if the resident is
18enrolled in a managed care organization.
19(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
20    Section 99. Effective date. This Act takes effect upon
21becoming law.