Illinois General Assembly - Full Text of HB0175
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Full Text of HB0175  100th General Assembly


Rep. Jay Hoffman

Filed: 4/24/2018





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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    (b) The Department of Healthcare and Family Services must
12serve as the lead agency assuming primary responsibility for
13the full implementation of this Section, including the
14establishment and operation of the system. The Department
15shall, on or before July 1, 2014, assess the feasibility of
16incorporating all information needed to determine eligibility
17for long-term care services, including asset transfer and
18spousal impoverishment financials, into the State's integrated
19eligibility system identifying all resources needed and
20reasonable timeframes for achieving the specified integration.
21    (c) Beginning on June 29, 2018, provisional eligibility, in
22the form of a recipient identification number and any other
23necessary credentials to permit an applicant to receive
24benefits, must be issued to any applicant who has not received
25a final eligibility determination on his or her application for
26Medicaid or Medicaid long-term care benefits or a notice of an



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



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1    Medicaid long-term care application .
2        (4) The Department, within 10 business days of issuing
3    provisional eligibility to an applicant not covered by a
4    managed care organization, must submit to the Office of the
5    Comptroller for payment a voucher for all retroactive
6    reimbursement due and the State Comptroller must place such
7    vouchers on expedited payment status. However, if the
8    provisional beneficiary is enrolled with a managed care
9    organization, the Department must submit the same to the
10    managed care organization and the managed care
11    organization must pay the provider on an expedited basis.
12    The lead agency shall file interim reports with the Chairs
13    and Minority Spokespersons of the House and Senate Human
14    Services Committees no later than September 1, 2013 and on
15    February 1, 2014. The Department of Healthcare and Family
16    Services shall include in the annual Medicaid report for
17    State Fiscal Year 2014 and every fiscal year thereafter
18    information concerning implementation of the provisions of
19    this Section.
20    (d) The Department must establish, by rule, policies and
21procedures to ensure prospective compliance with the federal
22deadlines for Medicaid and Medicaid long-term care benefits
23eligibility determinations required under 42 U.S.C.
241396a(a)(8) and 42 CFR 435.912, which must include, but need
25not be limited to, the following:
26        (1) The Department, assisted by the Department of Human



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



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1        specified by federal law.
2            (C) Receives Supplemental Security Income payments
3        or was receiving such payments at the time the
4        applicant was admitted to a nursing facility.
5            (D) Verified income at or below 100% of the federal
6        poverty level when the declared value of the
7        applicant's countable resources is no greater than the
8        allowable amounts pursuant to Section 5-2 of this Code
9        for classes of eligible persons for whom a resource
10        limit applies.
11        (3) The Department must establish, by rule, renewal
12    policies and procedures to reduce the likelihood of
13    unnecessary interruptions in services as a result of
14    improper denials of applicants who would otherwise be
15    approved.
16            (A) Effective January 1, 2019, the Department must
17        implement a paperless passive renewal protocol that
18        provides for the electronic verification of all
19        necessary information including bank accounts.
20            (B) A beneficiary who is a resident of a facility
21        and whose previous renewal application showed an
22        income of no greater than the federal poverty level and
23        who has no discernible means of generating income
24        greater than the federal poverty level must be deemed
25        to qualify for renewal. The beneficiary and the
26        facility must not receive an application for renewal



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



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



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



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1    applications for applicants who have signed appropriate
2    releases, and the development and distribution of
3    applicable instructional materials and release forms. The
4    Department of Healthcare and Family Services, the
5    Department of Human Services, and the Department on Aging
6    shall take the following steps to achieve federally
7    established timeframes for eligibility determinations for
8    Medicaid and long-term care benefits and shall work toward
9    the federal goal of real time determinations:
10        (1) The Departments shall review, in collaboration
11    with representatives of affected providers, all forms and
12    procedures currently in use, federal guidelines either
13    suggested or mandated, and staff deployment by September
14    30, 2014 to identify additional measures that can improve
15    long-term care eligibility processing and make adjustments
16    where possible.
17        (2) No later than June 30, 2014, the Department of
18    Healthcare and Family Services shall issue vouchers for
19    advance payments not to exceed $50,000,000 to nursing
20    facilities with significant outstanding Medicaid liability
21    associated with services provided to residents with
22    Medicaid applications pending and residents facing the
23    greatest delays. Each facility with an advance payment
24    shall state in writing whether its own recoupment schedule
25    will be in 3 or 6 equal monthly installments, as long as
26    all advances are recouped by June 30, 2015.



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1        (3) The Department of Healthcare and Family Services'
2    Office of Inspector General and the Department of Human
3    Services shall immediately forgo resource review and
4    review of transfers during the relevant look-back period
5    for applications that were submitted prior to September 1,
6    2013. An applicant who applied prior to September 1, 2013,
7    who was denied for failure to cooperate in providing
8    required information, and whose application was
9    incorrectly reviewed under the wrong look-back period
10    rules may request review and correction of the denial based
11    on this subsection. If found eligible upon review, such
12    applicants shall be retroactively enrolled.
13        (4) As soon as practicable, the Department of
14    Healthcare and Family Services shall implement policies
15    and promulgate rules to simplify financial eligibility
16    verification in the following instances: (A) for
17    applicants or recipients who are receiving Supplemental
18    Security Income payments or who had been receiving such
19    payments at the time they were admitted to a nursing
20    facility and (B) for applicants or recipients with verified
21    income at or below 100% of the federal poverty level when
22    the declared value of their countable resources is no
23    greater than the allowable amounts pursuant to Section 5-2
24    of this Code for classes of eligible persons for whom a
25    resource limit applies. Such simplified verification
26    policies shall apply to community cases as well as



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1    long-term care cases.
2        (5) As soon as practicable, but not later than July 1,
3    2014, the Department of Healthcare and Family Services and
4    the Department of Human Services shall jointly begin a
5    special enrollment project by using simplified eligibility
6    verification policies and by redeploying caseworkers
7    trained to handle long-term care cases to prioritize those
8    cases, until the backlog is eliminated and processing time
9    is within 90 days. This project shall apply to applications
10    for long-term care received by the State on or before May
11    15, 2014.
12        (6) As soon as practicable, but not later than
13    September 1, 2014, the Department on Aging shall make
14    available to long-term care facilities and community
15    providers upon request, through an electronic method, the
16    information contained within the Interagency Certification
17    of Screening Results completed by the pre-screener, in a
18    form and manner acceptable to the Department of Human
19    Services.
20    (f) The Department must establish, by rule, policies and
21procedures to improve accountability and provide for the
22expedited payment of services rendered, which must include, but
23need not be limited to, the following:
24        (1) The Department must apply the most current resident
25    income data entered into the Department's Medical
26    Electronic Data Interchange (MEDI) system to the payment of



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1    a claim even if a caseworker has not completed a review.
2        (2) The Department and the Department of Human Services
3    must notify the applicant, or the applicant's legal
4    representative, and the facility submitting the initial,
5    renewal, or appeal application of all missing supporting
6    documentation or information and the date of the request
7    when an application, renewal, or appeal is denied for
8    failure to submit such documentation and information.
9    (g) No later than January 1, 2019, the Department of
10Healthcare and Family Services must investigate the
11public-private partnerships in use in Ohio, Michigan, and
12Minnesota aimed at redeploying caseworkers to targeted
13high-Medicaid facilities for the purpose of expediting initial
14Medicaid and Medicaid long-term care benefits applications,
15renewals, asset discovery, and all other things related to
16enrollment, reimbursement, and application processing. No
17later than March 1, 2019, the Department of Healthcare and
18Family Services must post on the long-term care pages of the
19Department's website the agencies' joint recommendations and
20must assist provider groups in educating their members on such
22    (h) The Director of Healthcare and Family Services, in
23coordination with the Secretary of Human Services and the
24Director of Aging, must host a provider association meeting
25every 6 weeks, beginning no later than 30 days after the
26effective date of this amendatory Act of the 100th General



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1Assembly, until all applications that are 45 days or older have
2been adjudicated and the application process has been reduced
3to 45 or fewer days, at which time the meetings shall be held
4quarterly, for those associations representing facilities
5licensed under the Nursing Home Care Act and certified as a
6supportive living program. Each agency must be represented by
7senior staff with hands-on knowledge of the processing of
8applications for Medicaid and Medicaid long-term care
9benefits, renewals, and such ancillary issues as income and
10address adjustments, release forms, and screening reports.
11Agenda items must be solicited from the associations.
12    (i) The Department must not delay the implementation of the
13presumptive eligibility, as ordered by Koss v. Norwood, Case
14No. 17 C 2762 (N.D. Ill. Mar. 29, 2018), in anticipation of
15this amendatory Act of the 100th General Assembly.
16    (j) As mandated by federal regulations under 42 CFR
17435.912, the Department and the Department of Human Services
18must not deny applications for Medicaid or Medicaid long-term
19care benefits to comply with the federal timeliness standards
20or avoid authorizing provisional eligibility under this
21Section. To ensure compliance, the percentage of denials in a
22given month must not increase by more than 1% of the denial
23rate that occurred in the same month of the preceding year.
24    (k) The Department of Human Services must prioritize
25processing applications on a last-in, first-out basis. The
26Department is expressly prohibited from prioritizing the



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1processing of applications from applicants who have been issued
2provisional eligibility status over other applicants.
3    (l) Unless otherwise specified, all provisions of this
4amendatory Act of the 100th General Assembly must be fully
5operational by January 1, 2019.
6    (m) Nothing in this Section shall defeat the provisions
7contained in the State Prompt Payment Act or the timely pay
8provisions contained in Section 368a of the Illinois Insurance
10    (n) The Department must offer regionally based training
11covering all aspects of this Section and must include long-term
12care provider associations in the design and presentation of
13the training. The training shall be recorded and posted on the
14Department's website to allow new employees to be trained and
15older employers to complete refresher courses.
16    (o) The Department and the Department of Human Services
17must not require an applicant for Medicaid or Medicaid
18long-term care benefits to submit a new application solely
19because there is a change in the applicant's legal
21    (p) The Department and the Department of Human Services
22must implement the requirements under this Section even if the
23required rules are not yet adopted by the dates specified in
24this Section. If the Department is required to adopt rules
25under this Section or if the Department determines that rules
26are necessary to achieve full implementation, the Department



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1must adopt policies and procedures to allow for full
2implementation by the date specified in this Section and must
3publish all policies and procedures on the Department's
4website. The Department must submit proposed permanent rules
5for public comment no later than January 1, 2019.
6    (q) (7) Effective 30 days after the completion of 3
7regionally based trainings, nursing facilities shall submit
8all applications for medical assistance online via the
9Application for Benefits Eligibility (ABE) website. This
10requirement shall extend to scanning and uploading with the
11online application any required additional forms such as the
12Long Term Care Facility Notification and the Additional
13Financial Information for Long Term Care Applicants as well as
14scanned copies of any supporting documentation. Long-term care
15facility admission documents must be submitted as required in
16Section 5-5 of this Code. No local Department of Human Services
17office shall refuse to accept an electronically filed
19    (r) (8) Notwithstanding any other provision of this Code,
20the Department of Human Services and the Department of
21Healthcare and Family Services' Office of the Inspector General
22shall, upon request, allow an applicant additional time to
23submit information and documents needed as part of a review of
24available resources or resources transferred during the
25look-back period. The initial extension shall not exceed 30
26days. A second extension of 30 days may be granted upon



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



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



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1review, consider, and evaluate the following:
2        (1) compliance with federal regulations on furnishing
3    services as related to Medicaid long-term care services and
4    supports as provided under 42 CFR 435.930;
5        (2) compliance with federal regulations on the timely
6    determination of eligibility as provided under 42 CFR
7    435.912;
8        (3) the accuracy and completeness of the report
9    required under paragraph (9) of subsection (e);
10        (4) the efficacy and efficiency of the task-based
11    process used for making eligibility determinations in the
12    centralized offices of the Department of Human Services for
13    long-term care services, including the role of the State's
14    integrated eligibility system, as opposed to the
15    traditional caseworker-specific process from which these
16    central offices have converted; and
17        (5) any issues affecting eligibility determinations
18    related to the Department of Human Services' staff
19    completing Medicaid eligibility determinations instead of
20    the designated single-state Medicaid agency in Illinois,
21    the Department of Healthcare and Family Services.
22    The Auditor General's report shall include any and all
23other areas or issues which are identified through an annual
24review. Paragraphs (1) through (5) of this subsection shall not
25be construed to limit the scope of the annual review and the
26Auditor General's authority to thoroughly and completely



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1evaluate any and all processes, policies, and procedures
2concerning compliance with federal and State law requirements
3on eligibility determinations for Medicaid long-term care
4services and supports.
5(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
6    Section 99. Effective date. This Act takes effect upon
7becoming law.".