Full Text of SB3762 101st General Assembly
SB3762 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 SB3762 Introduced 2/14/2020, by Sen. Dave Syverson SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services, the Department of Human Services, and the Department on Aging to establish a Long-Term Care Eligibility Advisory Committee to assist the State in eliminating problems surrounding long-term care eligibility determinations and enrollment in Medicaid long-term care. Contains provisions concerning the composition of the Committee, Committee meetings, and Committee reporting requirements. Effective immediately.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 11-5.4 as follows: | 6 | | (305 ILCS 5/11-5.4) | 7 | | Sec. 11-5.4. Expedited long-term care eligibility | 8 | | determination and enrollment. | 9 | | (a) Establishment of the expedited long-term care | 10 | | eligibility determination and enrollment system shall be a | 11 | | joint venture of the Departments of Human Services and | 12 | | Healthcare and Family Services and the Department on Aging. | 13 | | (a-1) On or before October 1, 2020, the Department of | 14 | | Healthcare and Family Services, with the assistance of the | 15 | | Department of Human Services and the Department on Aging, shall | 16 | | establish a Long-Term Care Eligibility Advisory Committee to | 17 | | assist the State in eliminating problems surrounding long-term | 18 | | care eligibility determinations and enrollment in Medicaid | 19 | | long-term care. The Committee shall be composed of 10 citizen | 20 | | members and 8 legislative members, all of whom shall serve in a | 21 | | voting capacity, with 2 citizen members and 2 members of the | 22 | | General Assembly appointed by each of the 4 legislative leaders | 23 | | and an additional 2 citizen members appointed by the Governor. |
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| 1 | | The Committee shall elect a voting member as Chair to work with | 2 | | the Department of Healthcare and Family Services, the | 3 | | Department of Human Services, and the Department on Aging to | 4 | | guide the work of the Committee. Voting members shall, by lot, | 5 | | determine whether initial appointments are for 2-year or 4-year | 6 | | terms with no more than 50% of each legislative leader's | 7 | | appointees serving an initial 2-year term. The Director of | 8 | | Healthcare and Family Services, the Director of Aging, and the | 9 | | Secretary of Human Services, or their designees, shall serve in | 10 | | a nonvoting capacity. The Committee shall meet every 6 weeks | 11 | | until backlogs of Medicaid applications and requests for | 12 | | long-term care benefits have been eliminated and shall meet | 13 | | quarterly thereafter. Voting members shall also serve on one or | 14 | | more workgroups. Additional individuals may be asked to serve | 15 | | on the workgroups. The Committee shall oversee joint reports to | 16 | | the Governor and the General Assembly. The reports shall be | 17 | | prepared by the Department of Healthcare and Family Services, | 18 | | the Department of Human Services, and the Department on Aging | 19 | | beginning January 1, 2020 and every quarter thereafter. The | 20 | | first report shall include an assessment of each of the | 21 | | provisions of this Section and all provisions of this Code that | 22 | | pertain to long-term care eligibility determination and | 23 | | enrollment issues. | 24 | | (b) Streamlined application enrollment process; expedited | 25 | | eligibility process. The streamlined application and | 26 | | enrollment process must include, but need not be limited to, |
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| 1 | | the following: | 2 | | (1) On or before July 1, 2019, a streamlined | 3 | | application and enrollment process shall be put in place | 4 | | which must include, but need not be limited to, the | 5 | | following: | 6 | | (A) Minimize the burden on applicants by | 7 | | collecting only the data necessary to determine | 8 | | eligibility for medical services, long-term care | 9 | | services, and spousal impoverishment offset. | 10 | | (B) Integrate online data sources to simplify the | 11 | | application process by reducing the amount of | 12 | | information needed to be entered and to expedite | 13 | | eligibility verification. | 14 | | (C) Provide online prompts to alert the applicant | 15 | | that information is missing or not complete. | 16 | | (D) Provide training and step-by-step written | 17 | | instructions for caseworkers, applicants, and | 18 | | providers. | 19 | | (2) The State must expedite the eligibility process for | 20 | | applicants meeting specified guidelines, regardless of the | 21 | | age of the application. The guidelines, subject to federal | 22 | | approval, must include, but need not be limited to, the | 23 | | following individually or collectively: | 24 | | (A) Full Medicaid benefits in the community for a | 25 | | specified period of time. | 26 | | (B) No transfer of assets or resources during the |
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| 1 | | federally prescribed look-back period, as specified in | 2 | | federal law. | 3 | | (C) Receives
Supplemental Security Income payments | 4 | | or was receiving such payments at the time of admission | 5 | | to a nursing facility. | 6 | | (D) For applicants or recipients with verified | 7 | | income at or below 100% of the federal poverty level | 8 | | when the declared value of their countable resources is | 9 | | no greater than the allowable amounts pursuant to | 10 | | Section 5-2 of this Code for classes of eligible | 11 | | persons for whom a resource limit applies. Such | 12 | | simplified verification policies shall apply to | 13 | | community cases as well as long-term care cases. | 14 | | (3) Subject to federal approval, the Department of | 15 | | Healthcare and Family Services must implement an ex parte | 16 | | renewal process for Medicaid-eligible individuals residing | 17 | | in long-term care facilities. "Renewal" has the same | 18 | | meaning as "redetermination" in State policies, | 19 | | administrative rule, and federal Medicaid law. The ex parte | 20 | | renewal process must be fully operational on or before | 21 | | January 1, 2019. If an individual has transferred to | 22 | | another long-term care facility, any annual notice | 23 | | concerning redetermination of eligibility must be sent to | 24 | | the long-term care facility where the individual resides as | 25 | | well as to the individual. | 26 | | (4) The Department of Human Services must use the |
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| 1 | | standards and distribution requirements described in this | 2 | | subsection and in Section 11-6 for notification of missing | 3 | | supporting documents and information during all phases of | 4 | | the application process: initial, renewal, and appeal. | 5 | | (c) The Department of Human Services must adopt policies | 6 | | and procedures to improve communication between long-term care | 7 | | benefits central office personnel, applicants and their | 8 | | representatives, and facilities in which the applicants | 9 | | reside. Such policies and procedures must at a minimum permit | 10 | | applicants and their representatives and the facility in which | 11 | | the applicants reside to speak directly to an individual | 12 | | trained to take telephone inquiries and provide appropriate | 13 | | responses.
| 14 | | (d) Effective 30 days after the completion of 3 regionally | 15 | | based trainings, nursing facilities shall submit all | 16 | | applications for medical assistance online via the Application | 17 | | for Benefits Eligibility (ABE) website. This requirement shall | 18 | | extend to scanning and uploading with the online application | 19 | | any required additional forms such as the Long Term Care | 20 | | Facility Notification and the Additional Financial Information | 21 | | for Long Term Care Applicants as well as scanned copies of any | 22 | | supporting documentation. Long-term care facility admission | 23 | | documents must be submitted as required in Section 5-5 of this | 24 | | Code. No local Department of Human Services office shall refuse | 25 | | to accept an electronically filed application. No Department of | 26 | | Human Services office shall request submission of any document |
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| 1 | | in hard copy. | 2 | | (e) Notwithstanding any other provision of this Code, the | 3 | | Department of Human Services and the Department of Healthcare | 4 | | and Family Services' Office of the Inspector General shall, | 5 | | upon request, allow an applicant additional time to submit | 6 | | information and documents needed as part of a review of | 7 | | available resources or resources transferred during the | 8 | | look-back period. The initial extension shall not exceed 30 | 9 | | days. A second extension of 30 days may be granted upon | 10 | | request. Any request for information issued by the State to an | 11 | | applicant shall include the following: an explanation of the | 12 | | information required and the date by which the information must | 13 | | be submitted; a statement that failure to respond in a timely | 14 | | manner can result in denial of the application; a statement | 15 | | that the applicant or the facility in the name of the applicant | 16 | | may seek an extension; and the name and contact information of | 17 | | a caseworker in case of questions. Any such request for | 18 | | information shall also be sent to the facility. In deciding | 19 | | whether to grant an extension, the Department of Human Services | 20 | | or the Department of Healthcare and Family Services' Office of | 21 | | the Inspector General shall take into account what is in the | 22 | | best interest of the applicant. The time limits for processing | 23 | | an application shall be tolled during the period of any | 24 | | extension granted under this subsection. | 25 | | (f) The Department of Human Services and the Department of | 26 | | Healthcare and Family Services must jointly compile data on |
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| 1 | | pending applications, denials, appeals, and redeterminations | 2 | | into a monthly report, which shall be posted on each | 3 | | Department's website for the purposes of monitoring long-term | 4 | | care eligibility processing. The report must specify the number | 5 | | of applications and redeterminations pending long-term care | 6 | | eligibility determination and admission and the number of | 7 | | appeals of denials in the following categories: | 8 | | (A) Length of time applications, redeterminations, and | 9 | | appeals are pending - 0 to 45 days, 46 days to 90 days, 91 | 10 | | days to 180 days, 181 days to 12 months, over 12 months to | 11 | | 18 months, over 18 months to 24 months, and over 24 months. | 12 | | (B) Percentage of applications and redeterminations | 13 | | pending in the Department of Human Services' Family | 14 | | Community Resource Centers, in the Department of Human | 15 | | Services' long-term care hubs, with the Department of | 16 | | Healthcare and Family Services' Office of Inspector | 17 | | General, and those applications which are being tolled due | 18 | | to requests for extension of time for additional | 19 | | information. | 20 | | (C) Status of pending applications, denials, appeals, | 21 | | and redeterminations. | 22 | | (g) Beginning on July 1, 2017, the Auditor General shall | 23 | | report every 3 years to the General Assembly on the performance | 24 | | and compliance of the Department of Healthcare and Family | 25 | | Services, the Department of Human Services, and the Department | 26 | | on Aging in meeting the requirements of this Section and the |
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| 1 | | federal requirements concerning eligibility determinations for | 2 | | Medicaid long-term care services and supports, and shall report | 3 | | any issues or deficiencies and make recommendations. The | 4 | | Auditor General shall, at a minimum, review, consider, and | 5 | | evaluate the following: | 6 | | (1) compliance with federal regulations on furnishing | 7 | | services as related to Medicaid long-term care services and | 8 | | supports as provided under 42 CFR 435.930; | 9 | | (2) compliance with federal regulations on the timely | 10 | | determination of eligibility as provided under 42 CFR | 11 | | 435.912; | 12 | | (3) the accuracy and completeness of the report | 13 | | required under paragraph (9) of subsection (e); | 14 | | (4) the efficacy and efficiency of the task-based | 15 | | process used for making eligibility determinations in the | 16 | | centralized offices of the Department of Human Services for | 17 | | long-term care services, including the role of the State's | 18 | | integrated eligibility system, as opposed to the | 19 | | traditional caseworker-specific process from which these | 20 | | central offices have converted; and | 21 | | (5) any issues affecting eligibility determinations | 22 | | related to the Department of Human Services' staff | 23 | | completing Medicaid eligibility determinations instead of | 24 | | the designated single-state Medicaid agency in Illinois, | 25 | | the Department of Healthcare and Family Services. | 26 | | The Auditor General's report shall include any and all |
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| 1 | | other areas or issues which are identified through an annual | 2 | | review. Paragraphs (1) through (5) of this subsection shall not | 3 | | be construed to limit the scope of the annual review and the | 4 | | Auditor General's authority to thoroughly and completely | 5 | | evaluate any and all processes, policies, and procedures | 6 | | concerning compliance with federal and State law requirements | 7 | | on eligibility determinations for Medicaid long-term care | 8 | | services and supports. | 9 | | (h) The Department of Healthcare and Family Services shall | 10 | | adopt any rules necessary to administer and enforce any | 11 | | provision of this Section. Rulemaking shall not delay the full | 12 | | implementation of this Section. | 13 | | (i) Beginning on June 29, 2018, provisional eligibility for | 14 | | medical assistance under Article V of this Code, in
the form of | 15 | | a recipient identification number and any other necessary | 16 | | credentials to permit an applicant to receive covered services | 17 | | under Article V, must be issued to any applicant who has not | 18 | | received a determination on his or her application for Medicaid | 19 | | and Medicaid long-term care services filed simultaneously or, | 20 | | if already Medicaid enrolled, application for Medicaid | 21 | | long-term care services under Article V of this Code within the | 22 | | federally prescribed timeliness requirements for | 23 | | determinations on such applications. The Department of | 24 | | Healthcare and Family Services must maintain the applicant's | 25 | | provisional eligibility status until a determination is made on | 26 | | the individual's application for long-term care services. The |
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| 1 | | Department of Healthcare and Family Services or the managed | 2 | | care organization, if applicable, must reimburse providers for | 3 | | services rendered during an applicant's provisional | 4 | | eligibility period. | 5 | | (1) Claims for services rendered to an applicant with | 6 | | provisional eligibility status must be submitted and | 7 | | processed in the same manner as those submitted on behalf | 8 | | of beneficiaries determined to qualify for benefits. | 9 | | (2) An applicant with provisional eligibility status | 10 | | must have his or her long-term care benefits paid for under | 11 | | the State's fee-for-service system during the period of | 12 | | provisional eligibility. If an individual otherwise | 13 | | eligible for medical assistance under Article V of this | 14 | | Code is enrolled with a managed care organization for | 15 | | community benefits at the time the individual's | 16 | | provisional eligibility for long-term care services is | 17 | | issued, the managed care organization is only responsible | 18 | | for paying benefits covered under the capitation payment | 19 | | received by the managed care organization for the | 20 | | individual. | 21 | | (3) The Department of Healthcare and Family Services, | 22 | | within 10 business days of issuing provisional eligibility | 23 | | to an applicant, must submit to the Office of the | 24 | | Comptroller for payment a voucher for all retroactive | 25 | | reimbursement due. The Department of Healthcare and Family | 26 | | Services must clearly identify such vouchers as |
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| 1 | | provisional eligibility vouchers. | 2 | | (Source: P.A. 100-380, eff. 8-25-17; 100-665, eff. 8-2-18; | 3 | | 100-1141, eff. 11-28-18; 101-101, eff. 1-1-20; 101-209, eff. | 4 | | 8-5-19; 101-265, eff. 8-9-19; 101-559, eff. 8-23-19; revised | 5 | | 9-19-19.)
| 6 | | Section 99. Effective date. This Act takes effect upon | 7 | | becoming law.
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