Illinois General Assembly - Full Text of SB0815
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Full Text of SB0815  99th General Assembly




State of Illinois
2015 and 2016


Introduced 2/5/2015, by Sen. Dale A. Righter


305 ILCS 5/11-5.2
305 ILCS 5/11-5.3

    Amends the Illinois Public Aid Code. In a provision concerning the Department of Healthcare and Family Services' proposed Medicaid integrated eligibility system, provides that until the system is operational the Department shall (rather than may) enter into a contract with the vendor selected as necessary to obtain certain electronic data matching. Provides that no later than 70 days (rather than 60 days) after the effective date of the amendatory Act, the Chief Procurement Officer for General Services, in consultation with the Department of Healthcare and Family Services, shall conduct and complete any procurement necessary to procure a vendor to verify eligibility for assistance under the Code. Effective immediately.

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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 Sections 11-5.2 and 11-5.3 as follows:
6    (305 ILCS 5/11-5.2)
7    Sec. 11-5.2. Income, Residency, and Identity Verification
8System. The General Assembly finds that the Department of Human
9Services has made every reasonable effort to utilize State
10employees to perform eligibility determinations and
11redeterminations on applicants and recipients of assistance
12provided under Article V of this Code. However, the General
13Assembly declares that there exist conditions in the State that
14require the Department of Healthcare and Family Services to
15procure a vendor to verify eligibility.
16    (a) The Department shall ensure that its proposed
17integrated eligibility system shall include the computerized
18functions of income, residency, and identity eligibility
19verification to verify eligibility, eliminate duplication of
20medical assistance, and deter fraud. Until the integrated
21eligibility system is operational, the Department shall may
22enter into a contract with the vendor selected pursuant to
23Section 11-5.3 as necessary to obtain the electronic data



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1matching described in this Section. This contract shall be
2exempt from the Illinois Procurement Code pursuant to
3subsection (h) of Section 1-10 of that Code.
4    (b) Prior to awarding medical assistance at application
5under Article V of this Code, the Department shall, to the
6extent such databases are available to the Department, conduct
7data matches using the name, date of birth, address, and Social
8Security Number of each applicant or recipient or responsible
9relative of an applicant or recipient against the following:
10        (1) Income tax information.
11        (2) Employer reports of income and unemployment
12    insurance payment information maintained by the Department
13    of Employment Security.
14        (3) Earned and unearned income, citizenship and death,
15    and other relevant information maintained by the Social
16    Security Administration.
17        (4) Immigration status information maintained by the
18    United States Citizenship and Immigration Services.
19        (5) Wage reporting and similar information maintained
20    by states contiguous to this State.
21        (6) Employment information maintained by the
22    Department of Employment Security in its New Hire Directory
23    database.
24        (7) Employment information maintained by the United
25    States Department of Health and Human Services in its
26    National Directory of New Hires database.



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1        (8) Veterans' benefits information maintained by the
2    United States Department of Health and Human Services, in
3    coordination with the Department of Health and Human
4    Services and the Department of Veterans' Affairs, in the
5    federal Public Assistance Reporting Information System
6    (PARIS) database.
7        (9) Residency information maintained by the Illinois
8    Secretary of State.
9        (10) A database which is substantially similar to or a
10    successor of a database described in this Section that
11    contains information relevant for verifying eligibility
12    for medical assistance.
13    (c) (Blank).
14    (d) If a discrepancy results between information provided
15by an applicant, recipient, or responsible relative and
16information contained in one or more of the databases or
17information tools listed under subsection (b) of this Section
18or subsection (c) of Section 11-5.3 and that discrepancy calls
19into question the accuracy of information relevant to a
20condition of eligibility provided by the applicant, recipient,
21or responsible relative, the Department or its contractor shall
22review the applicant's or recipient's case using the following
24        (1) If the information discovered under subsection (b)
25    of this Section or subsection (c) of Section 11-5.3 does
26    not result in the Department finding the applicant or



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1    recipient ineligible for assistance under Article V of this
2    Code, the Department shall finalize the determination or
3    redetermination of eligibility.
4        (2) If the information discovered results in the
5    Department finding the applicant or recipient ineligible
6    for assistance, the Department shall provide notice as set
7    forth in Section 11-7 of this Article.
8        (3) If the information discovered is insufficient to
9    determine that the applicant or recipient is eligible or
10    ineligible, the Department shall provide written notice to
11    the applicant or recipient which shall describe in
12    sufficient detail the circumstances of the discrepancy,
13    the information or documentation required, the manner in
14    which the applicant or recipient may respond, and the
15    consequences of failing to take action. The applicant or
16    recipient shall have 10 business days to respond.
17        (4) If the applicant or recipient does not respond to
18    the notice, the Department shall deny assistance for
19    failure to cooperate, in which case the Department shall
20    provide notice as set forth in Section 11-7. Eligibility
21    for assistance shall not be established until the
22    discrepancy has been resolved.
23        (5) If an applicant or recipient responds to the
24    notice, the Department shall determine the effect of the
25    information or documentation provided on the applicant's
26    or recipient's case and shall take appropriate action.



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1    Written notice of the Department's action shall be provided
2    as set forth in Section 11-7 of this Article.
3        (6) Suspected cases of fraud shall be referred to the
4    Department's Inspector General.
5    (e) The Department shall adopt any rules necessary to
6implement this Section.
7(Source: P.A. 97-689, eff. 6-14-12; 98-756, eff. 7-16-14.)
8    (305 ILCS 5/11-5.3)
9    Sec. 11-5.3. Procurement of vendor to verify eligibility
10for assistance under Article V.
11    (a) No later than 70 60 days after the effective date of
12this amendatory Act of the 99th 97th General Assembly, the
13Chief Procurement Officer for General Services, in
14consultation with the Department of Healthcare and Family
15Services, shall conduct and complete any procurement necessary
16to procure a vendor to verify eligibility for assistance under
17Article V of this Code. Such authority shall include procuring
18a vendor to assist the Chief Procurement Officer in conducting
19the procurement. The Chief Procurement Officer and the
20Department shall jointly negotiate final contract terms with a
21vendor selected by the Chief Procurement Officer. Within 30
22days of selection of an eligibility verification vendor, the
23Department of Healthcare and Family Services shall enter into a
24contract with the selected vendor. The Department of Healthcare
25and Family Services and the Department of Human Services shall



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1cooperate with and provide any information requested by the
2Chief Procurement Officer to conduct the procurement.
3    (b) Notwithstanding any other provision of law, any
4procurement or contract necessary to comply with this Section
5shall be exempt from: (i) the Illinois Procurement Code
6pursuant to Section 1-10(h) of the Illinois Procurement Code,
7except that bidders shall comply with the disclosure
8requirement in Sections 50-10.5(a) through (d), 50-13, 50-35,
9and 50-37 of the Illinois Procurement Code and a vendor awarded
10a contract under this Section shall comply with Section 50-37
11of the Illinois Procurement Code; (ii) any administrative rules
12of this State pertaining to procurement or contract formation;
13and (iii) any State or Department policies or procedures
14pertaining to procurement, contract formation, contract award,
15and Business Enterprise Program approval.
16    (c) Upon becoming operational, the contractor shall
17conduct data matches using the name, date of birth, address,
18and Social Security Number of each applicant and recipient
19against public records to verify eligibility. The contractor,
20upon preliminary determination that an enrollee is eligible or
21ineligible, shall notify the Department, except that the
22contractor shall not make preliminary determinations regarding
23the eligibility of persons residing in long term care
24facilities whose income and resources were at or below the
25applicable financial eligibility standards at the time of their
26last review. Within 20 business days of such notification, the



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1Department shall accept the recommendation or reject it with a
2stated reason. The Department shall retain final authority over
3eligibility determinations. The contractor shall keep a record
4of all preliminary determinations of ineligibility
5communicated to the Department. Within 30 days of the end of
6each calendar quarter, the Department and contractor shall file
7a joint report on a quarterly basis to the Governor, the
8Speaker of the House of Representatives, the Minority Leader of
9the House of Representatives, the Senate President, and the
10Senate Minority Leader. The report shall include, but shall not
11be limited to, monthly recommendations of preliminary
12determinations of eligibility or ineligibility communicated by
13the contractor, the actions taken on those preliminary
14determinations by the Department, and the stated reasons for
15those recommendations that the Department rejected.
16    (d) An eligibility verification vendor contract shall be
17awarded for an initial 2-year period with up to a maximum of 2
18one-year renewal options. Nothing in this Section shall compel
19the award of a contract to a vendor that fails to meet the
20needs of the Department. A contract with a vendor to assist in
21the procurement shall be awarded for a period of time not to
22exceed 6 months.
23    (e) The provisions of this Section shall be administered in
24compliance with federal law.
25(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
26    Section 99. Effective date. This Act takes effect upon



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1becoming law.