Full Text of HB4343 102nd General Assembly
HB4343ham002 102ND GENERAL ASSEMBLY | Rep. Greg Harris Filed: 2/28/2022
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| 1 | | AMENDMENT TO HOUSE BILL 4343
| 2 | | AMENDMENT NO. ______. Amend House Bill 4343, AS AMENDED, | 3 | | by replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 5. The Illinois Public Aid Code is amended by | 6 | | changing Section 11-5.1 and by adding Sections 5-1.6, 5-13.1 | 7 | | and 11-5.5 as follows: | 8 | | (305 ILCS 5/5-1.6 new) | 9 | | Sec. 5-1.6. Continuous eligibility; ex parte | 10 | | redeterminations. | 11 | | (a) By July 1, 2022, the Department of Healthcare and | 12 | | Family Services shall seek a State Plan amendment or any | 13 | | federal waivers necessary to make changes to the medical | 14 | | assistance program. The Department shall apply for federal | 15 | | approval to implement 12 months of continuous eligibility for | 16 | | adults participating in the medical assistance program. The |
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| 1 | | Department shall secure federal financial participation in | 2 | | accordance with this Section for expenditures made by the | 3 | | Department in State Fiscal Year 2023 and every State fiscal | 4 | | year thereafter. | 5 | | (b) By July 1, 2022, the Department of Healthcare and | 6 | | Family Services shall seek a State Plan amendment or any | 7 | | federal waivers or approvals necessary to make changes to the | 8 | | medical assistance redetermination process for people without | 9 | | any income at the time of redetermination. These changes shall | 10 | | seek to allow all people without income to be considered for ex | 11 | | parte redetermination. If there is no non-income related | 12 | | disqualifying information for medical assistance recipients | 13 | | without any income, then a person without any income shall be | 14 | | redetermined ex parte. Within 60 days after receiving federal | 15 | | approval or guidance, the Department of Healthcare and Family | 16 | | Services and the Department of Human Services shall make | 17 | | necessary technical and rule changes to implement changes to | 18 | | the redetermination process. The percentage of medical | 19 | | assistance recipients whose eligibility is renewed through the | 20 | | ex parte redetermination process shall be reported monthly by | 21 | | the Department of Healthcare and Family Services on its | 22 | | website in accordance with subsection (d) of Section 11-5.1 of | 23 | | this Code as well as shared in all Medicaid Advisory Committee | 24 | | meetings and Medicaid Advisory Committee Public Education | 25 | | Subcommittee meetings. |
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| 1 | | (305 ILCS 5/5-13.1 new) | 2 | | Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers, | 3 | | and making information about waivers more accessible. | 4 | | (a) It is the intent of the General Assembly to ease the | 5 | | burden of liens and estate recovery for correctly paid | 6 | | benefits for participants, applicants, and their families and | 7 | | heirs, and to make information about waivers more widely | 8 | | available. | 9 | | (b) The Department shall waive estate recovery under | 10 | | Sections 3-9 and 5-13 where recovery would not be | 11 | | cost-effective, would work an undue hardship, or for any other | 12 | | just reason, and shall make information about waivers and | 13 | | estate recovery easily accessible. | 14 | | (1) Cost-effectiveness waiver. Subject to federal | 15 | | approval, the Department shall waive any claim against the | 16 | | first $25,0000 of any estate to prevent substantial and | 17 | | unreasonable hardship. The Department shall consider the | 18 | | gross assets in the estate, including, but not limited to, | 19 | | the net value of real estate less mortgages or liens with | 20 | | priority over the Department's claims. The Department may | 21 | | increase the cost-effectiveness threshold in the future. | 22 | | (2) Undue hardship waiver. The Department may develop | 23 | | additional hardship waiver standards in addition to those | 24 | | already employed, including, but not limited to, waivers | 25 | | aimed at preserving income-producing real property or a | 26 | | modest home as defined by rule. |
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| 1 | | (3) Accessible information. The Department shall make | 2 | | information about estate recovery and hardship waivers | 3 | | easily accessible. The Department shall maintain | 4 | | information about how to request a hardship waiver on its | 5 | | website in English, Spanish, and the next 4 most commonly | 6 | | used languages, including a short guide and simple form to | 7 | | facilitate requesting hardship exemptions in each | 8 | | language. On an annual basis, the Department shall | 9 | | publicly report on the number of estate recovery cases | 10 | | that are pursued and the number of undue hardship | 11 | | exemptions granted, including demographic data of the | 12 | | deceased beneficiaries where available. | 13 | | (305 ILCS 5/11-5.1) | 14 | | Sec. 11-5.1. Eligibility verification. Notwithstanding any | 15 | | other provision of this Code, with respect to applications for | 16 | | medical assistance provided under Article V of this Code, | 17 | | eligibility shall be determined in a manner that ensures | 18 | | program integrity and complies with federal laws and | 19 | | regulations while minimizing unnecessary barriers to | 20 | | enrollment. To this end, as soon as practicable, and unless | 21 | | the Department receives written denial from the federal | 22 | | government, this Section shall be implemented: | 23 | | (a) The Department of Healthcare and Family Services or | 24 | | its designees shall: | 25 | | (1) By no later than July 1, 2011, require |
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| 1 | | verification of, at a minimum, one month's income from all | 2 | | sources required for determining the eligibility of | 3 | | applicants for medical assistance under this Code. Such | 4 | | verification shall take the form of pay stubs, business or | 5 | | income and expense records for self-employed persons, | 6 | | letters from employers, and any other valid documentation | 7 | | of income including data obtained electronically by the | 8 | | Department or its designees from other sources as | 9 | | described in subsection (b) of this Section. A month's | 10 | | income may be verified by a single pay stub with the | 11 | | monthly income extrapolated from the time period covered | 12 | | by the pay stub. | 13 | | (2) By no later than October 1, 2011, require | 14 | | verification of, at a minimum, one month's income from all | 15 | | sources required for determining the continued eligibility | 16 | | of recipients at their annual review of eligibility for | 17 | | medical assistance under this Code. Information the | 18 | | Department receives prior to the annual review, including | 19 | | information available to the Department as a result of the | 20 | | recipient's application for other non-Medicaid benefits, | 21 | | that is sufficient to make a determination of continued | 22 | | Medicaid eligibility may be reviewed and verified, and | 23 | | subsequent action taken including client notification of | 24 | | continued Medicaid eligibility. The date of client | 25 | | notification establishes the date for subsequent annual | 26 | | Medicaid eligibility reviews. Such verification shall take |
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| 1 | | the form of pay stubs, business or income and expense | 2 | | records for self-employed persons, letters from employers, | 3 | | and any other valid documentation of income including data | 4 | | obtained electronically by the Department or its designees | 5 | | from other sources as described in subsection (b) of this | 6 | | Section. A month's income may be verified by a single pay | 7 | | stub with the monthly income extrapolated from the time | 8 | | period covered by the pay stub. The
Department shall send | 9 | | a notice to
recipients at least 60 days prior to the end of | 10 | | their period
of eligibility that informs them of the
| 11 | | requirements for continued eligibility. If a recipient
| 12 | | does not fulfill the requirements for continued | 13 | | eligibility by the
deadline established in the notice a | 14 | | notice of cancellation shall be issued to the recipient | 15 | | and coverage shall end no later than the last day of the | 16 | | month following the last day of the eligibility period. A | 17 | | recipient's eligibility may be reinstated without | 18 | | requiring a new application if the recipient fulfills the | 19 | | requirements for continued eligibility prior to the end of | 20 | | the third month following the last date of coverage (or | 21 | | longer period if required by federal regulations). Nothing | 22 | | in this Section shall prevent an individual whose coverage | 23 | | has been cancelled from reapplying for health benefits at | 24 | | any time. | 25 | | (3) By no later than July 1, 2011, require | 26 | | verification of Illinois residency. |
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| 1 | | The Department, with federal approval, may choose to adopt | 2 | | continuous financial eligibility for a full 12 months for | 3 | | adults on Medicaid. | 4 | | (b) The Department shall establish or continue cooperative
| 5 | | arrangements with the Social Security Administration, the
| 6 | | Illinois Secretary of State, the Department of Human Services,
| 7 | | the Department of Revenue, the Department of Employment
| 8 | | Security, and any other appropriate entity to gain electronic
| 9 | | access, to the extent allowed by law, to information available
| 10 | | to those entities that may be appropriate for electronically
| 11 | | verifying any factor of eligibility for benefits under the
| 12 | | Program. Data relevant to eligibility shall be provided for no
| 13 | | other purpose than to verify the eligibility of new applicants | 14 | | or current recipients of health benefits under the Program. | 15 | | Data shall be requested or provided for any new applicant or | 16 | | current recipient only insofar as that individual's | 17 | | circumstances are relevant to that individual's or another | 18 | | individual's eligibility. | 19 | | (c) Within 90 days of the effective date of this | 20 | | amendatory Act of the 96th General Assembly, the Department of | 21 | | Healthcare and Family Services shall send notice to current | 22 | | recipients informing them of the changes regarding their | 23 | | eligibility verification.
| 24 | | (d) As soon as practical if the data is reasonably | 25 | | available, but no later than January 1, 2017, the Department | 26 | | shall compile on a monthly basis data on eligibility |
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| 1 | | redeterminations of beneficiaries of medical assistance | 2 | | provided under Article V of this Code. In addition to the
other | 3 | | data required under this subsection, the Department
shall | 4 | | compile on a monthly basis data on the percentage of
| 5 | | beneficiaries whose eligibility is renewed through ex parte
| 6 | | redeterminations as described in subsection (b) of Section
| 7 | | 5-1.6 of this Code, subject to federal approval of the changes
| 8 | | made in subsection (b) of Section 5-1.6 by this amendatory Act
| 9 | | of the 102nd General Assembly. This data shall be posted on the | 10 | | Department's website, and data from prior months shall be | 11 | | retained and available on the Department's website. The data | 12 | | compiled and reported shall include the following: | 13 | | (1) The total number of redetermination decisions made | 14 | | in a month and, of that total number, the number of | 15 | | decisions to continue or change benefits and the number of | 16 | | decisions to cancel benefits. | 17 | | (2) A breakdown of enrollee language preference for | 18 | | the total number of redetermination decisions made in a | 19 | | month and, of that total number, a breakdown of enrollee | 20 | | language preference for the number of decisions to | 21 | | continue or change benefits, and a breakdown of enrollee | 22 | | language preference for the number of decisions to cancel | 23 | | benefits. The language breakdown shall include, at a | 24 | | minimum, English, Spanish, and the next 4 most commonly | 25 | | used languages. | 26 | | (3) The percentage of cancellation decisions made in a |
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| 1 | | month due to each of the following: | 2 | | (A) The beneficiary's ineligibility due to excess | 3 | | income. | 4 | | (B) The beneficiary's ineligibility due to not | 5 | | being an Illinois resident. | 6 | | (C) The beneficiary's ineligibility due to being | 7 | | deceased. | 8 | | (D) The beneficiary's request to cancel benefits. | 9 | | (E) The beneficiary's lack of response after | 10 | | notices mailed to the beneficiary are returned to the | 11 | | Department as undeliverable by the United States | 12 | | Postal Service. | 13 | | (F) The beneficiary's lack of response to a | 14 | | request for additional information when reliable | 15 | | information in the beneficiary's account, or other | 16 | | more current information, is unavailable to the | 17 | | Department to make a decision on whether to continue | 18 | | benefits. | 19 | | (G) Other reasons tracked by the Department for | 20 | | the purpose of ensuring program integrity. | 21 | | (4) If a vendor is utilized to provide services in | 22 | | support of the Department's redetermination decision | 23 | | process, the total number of redetermination decisions | 24 | | made in a month and, of that total number, the number of | 25 | | decisions to continue or change benefits, and the number | 26 | | of decisions to cancel benefits (i) with the involvement |
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| 1 | | of the vendor and (ii) without the involvement of the | 2 | | vendor. | 3 | | (5) Of the total number of benefit cancellations in a | 4 | | month, the number of beneficiaries who return from | 5 | | cancellation within one month, the number of beneficiaries | 6 | | who return from cancellation within 2 months, and the | 7 | | number of beneficiaries who return from cancellation | 8 | | within 3 months. Of the number of beneficiaries who return | 9 | | from cancellation within 3 months, the percentage of those | 10 | | cancellations due to each of the reasons listed under | 11 | | paragraph (3) of this subsection. | 12 | | (e) The Department shall conduct a complete review of the | 13 | | Medicaid redetermination process in order to identify changes | 14 | | that can increase the use of ex parte redetermination | 15 | | processing. This review shall be completed within 90 days | 16 | | after the effective date of this amendatory Act of the 101st | 17 | | General Assembly. Within 90 days of completion of the review, | 18 | | the Department shall seek written federal approval of policy | 19 | | changes the review recommended and implement once approved. | 20 | | The review shall specifically include, but not be limited to, | 21 | | use of ex parte redeterminations of the following populations: | 22 | | (1) Recipients of developmental disabilities services. | 23 | | (2) Recipients of benefits under the State's Aid to | 24 | | the Aged, Blind, or Disabled program. | 25 | | (3) Recipients of Medicaid long-term care services and | 26 | | supports, including waiver services. |
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| 1 | | (4) All Modified Adjusted Gross Income (MAGI) | 2 | | populations. | 3 | | (5) Populations with no verifiable income. | 4 | | (6) Self-employed people. | 5 | | The report shall also outline populations and | 6 | | circumstances in which an ex parte redetermination is not a | 7 | | recommended option. | 8 | | (f) The Department shall explore and implement, as | 9 | | practical and technologically possible, roles that | 10 | | stakeholders outside State agencies can play to assist in | 11 | | expediting eligibility determinations and redeterminations | 12 | | within 24 months after the effective date of this amendatory | 13 | | Act of the 101st General Assembly. Such practical roles to be | 14 | | explored to expedite the eligibility determination processes | 15 | | shall include the implementation of hospital presumptive | 16 | | eligibility, as authorized by the Patient Protection and | 17 | | Affordable Care Act. | 18 | | (g) The Department or its designee shall seek federal | 19 | | approval to enhance the reasonable compatibility standard from | 20 | | 5% to 10%. | 21 | | (h) Reporting. The Department of Healthcare and Family | 22 | | Services and the Department of Human Services shall publish | 23 | | quarterly reports on their progress in implementing policies | 24 | | and practices pursuant to this Section as modified by this | 25 | | amendatory Act of the 101st General Assembly. | 26 | | (1) The reports shall include, but not be limited to, |
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| 1 | | the following: | 2 | | (A) Medical application processing, including a | 3 | | breakdown of the number of MAGI, non-MAGI, long-term | 4 | | care, and other medical cases pending for various | 5 | | incremental time frames between 0 to 181 or more days. | 6 | | (B) Medical redeterminations completed, including: | 7 | | (i) a breakdown of the number of households that were | 8 | | redetermined ex parte and those that were not; (ii) | 9 | | the reasons households were not redetermined ex parte; | 10 | | and (iii) the relative percentages of these reasons. | 11 | | (C) A narrative discussion on issues identified in | 12 | | the functioning of the State's Integrated Eligibility | 13 | | System and progress on addressing those issues, as | 14 | | well as progress on implementing strategies to address | 15 | | eligibility backlogs, including expanding ex parte | 16 | | determinations to ensure timely eligibility | 17 | | determinations and renewals. | 18 | | (2) Initial reports shall be issued within 90 days | 19 | | after the effective date of this amendatory Act of the | 20 | | 101st General Assembly. | 21 | | (3) All reports shall be published on the Department's | 22 | | website. | 23 | | (i) It is the determination of the General Assembly that | 24 | | the Department must include seniors and persons with | 25 | | disabilities in ex parte renewals. It is the determination of | 26 | | the General Assembly that the Department must use its asset |
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| 1 | | verification system to assist in the determination of whether | 2 | | an individual's coverage can be renewed using the ex parte | 3 | | process. If a State Plan amendment is required, the Department | 4 | | shall pursue such State Plan amendment by July 1, 2022. Within | 5 | | 60 days after receiving federal approval or guidance, the | 6 | | Department of Healthcare and Family Services and the | 7 | | Department of Human Services shall make necessary technical | 8 | | and rule changes to implement these changes to the | 9 | | redetermination process. | 10 | | (Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20.) | 11 | | (305 ILCS 5/11-5.5 new) | 12 | | Sec. 11-5.5. Streamlining enrollment into the Medicare | 13 | | Savings Program. | 14 | | (a) The Department shall investigate how to align the | 15 | | Medicare Part D Low-Income Subsidy and Medicare Savings | 16 | | Program eligibility criteria. | 17 | | (b) The Department shall issue a report making | 18 | | recommendations on how to streamline enrollment into Medicare | 19 | | Savings Program benefits by July 1, 2022. | 20 | | (c) Within 90 days after issuing its report, the | 21 | | Department shall seek public feedback on those recommendations | 22 | | and plans. | 23 | | (d) By July 1, 2023, the Department shall implement the | 24 | | necessary changes to streamline enrollment into the Medicare | 25 | | Savings Program. The Department may adopt any rules necessary |
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| 1 | | to implement the provisions of this paragraph.
| 2 | | (305 ILCS 5/3-10 rep.)
| 3 | | (305 ILCS 5/3-10.1 rep.)
| 4 | | (305 ILCS 5/3-10.2 rep.)
| 5 | | (305 ILCS 5/3-10.3 rep.)
| 6 | | (305 ILCS 5/3-10.4 rep.)
| 7 | | (305 ILCS 5/3-10.5 rep.)
| 8 | | (305 ILCS 5/3-10.6 rep.)
| 9 | | (305 ILCS 5/3-10.7 rep.)
| 10 | | (305 ILCS 5/3-10.8 rep.)
| 11 | | (305 ILCS 5/3-10.9 rep.)
| 12 | | (305 ILCS 5/3-10.10 rep.)
| 13 | | (305 ILCS 5/5-13.5 rep.) | 14 | | Section 10. The Illinois Public Aid Code is amended by | 15 | | repealing Sections 3-10, 3-10.1, 3-10.2, 3-10.3, 3-10.4, | 16 | | 3-10.5, 3-10.6, 3-10.7, 3-10.8, 3-10.9, and 3-10.10, and | 17 | | 5-13.5.
| 18 | | Section 99. Effective date. This Act takes effect upon | 19 | | becoming law.".
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