|
Public Act 096-1501 |
HB5420 Enrolled | LRB096 18878 JDS 34265 b |
|
|
AN ACT concerning State government.
|
Be it enacted by the People of the State of Illinois,
|
represented in the General Assembly:
|
Section 5. The State Budget Law of the Civil Administrative |
Code of Illinois is amended by adding Section 50-30 as follows: |
(15 ILCS 20/50-30 new) |
Sec. 50-30. Long-term care rebalancing. In light of the |
increasing demands confronting the State in meeting the needs |
of individuals utilizing long-term care services under the |
medical assistance program and any other long-term care related |
benefit program administered by the State, it is the intent of |
the General Assembly to address the needs of both the State and |
the individuals eligible for such services by cost effective |
and efficient means through the advancement of a long-term care |
rebalancing initiative. Notwithstanding any State law to the |
contrary, and subject to federal laws, regulations, and court |
decrees, the following shall apply to the long-term care |
rebalancing initiative: |
(1) "Long-term care rebalancing", as used in this |
Section, means removing barriers to community living for |
people of all ages with disabilities and long-term |
illnesses by offering individuals utilizing long-term care |
services a reasonable array of options, in particular |
|
adequate choices of community and institutional options, |
to achieve a balance between the proportion of total |
Medicaid long-term support expenditures used for |
institutional services and those used for community-based |
supports. |
(2) Subject to the provisions of this Section, the |
Governor shall create a unified budget report identifying |
the budgets of all State agencies offering long-term care |
services to persons in either institutional or community |
settings, including the budgets of State-operated |
facilities for persons with developmental disabilities |
that shall include, but not be limited to, the following |
service and financial data: |
(A) A breakdown of long-term care services, |
defined as institutional or community care, by the |
State agency primarily responsible for administration |
of the program. |
(B) Actual and estimated enrollment, caseload, |
service hours, or service days provided for long-term |
care services described in a consistent format for |
those services, for each of the following age groups: |
older adults 65 years of age and older, younger adults |
21 years of age through 64 years of age, and children |
under 21 years of age. |
(C) Funding sources for long-term care services. |
(D) Comparison of service and expenditure data, by |
|
services, both in aggregate and per person enrolled. |
(3) For each fiscal year, the unified budget report |
described in subdivision (2) shall be prepared with |
reference to the prioritized outcomes for that fiscal year |
contemplated by Sections 50-5 and 50-25 of this Code. |
(4) Each State agency responsible for the |
administration of long-term care services shall provide an |
analysis of the progress being made by the agency to |
transition persons from institutional to community |
settings, where appropriate, as part of the State's |
long-term care rebalancing initiative. |
(5) The Governor may designate amounts set aside for |
institutional services appropriated from the General |
Revenue Fund or any other State fund that receives monies |
for long-term care services to be transferred to all State |
agencies responsible for the administration of |
community-based long-term care programs, including, but |
not limited to, community-based long-term care programs |
administered by the Department of Healthcare and Family |
Services, the Department of Human Services, and the |
Department on Aging, provided that the Director of |
Healthcare and Family Services first certifies that the |
amounts being transferred are necessary for the purpose of |
assisting persons in or at risk of being in institutional |
care to transition to community-based settings, including |
the financial data needed to prove the need for the |
|
transfer of funds. The total amounts transferred shall not |
exceed 4% in total of the amounts appropriated from the |
General Revenue Fund or any other State fund that receives |
monies for long-term care services for each fiscal year. A |
notice of the fund transfer must be made to the General |
Assembly and posted at a minimum on the Department of |
Healthcare and Family Services website, the Governor's |
Office of Management and Budget website, and any other |
website the Governor sees fit. These postings shall serve |
as notice to the General Assembly of the amounts to be |
transferred. Notice shall be given at least 30 days prior |
to transfer. |
(6) This Section shall be liberally construed and |
interpreted in a manner that allows the State to advance |
its long-term care rebalancing initiatives. |
Section 10. The State Finance Act is amended by changing |
Sections 13.2 and 25 as follows:
|
(30 ILCS 105/13.2) (from Ch. 127, par. 149.2)
|
Sec. 13.2. Transfers among line item appropriations. |
(a) Transfers among line item appropriations from the same
|
treasury fund for the objects specified in this Section may be |
made in
the manner provided in this Section when the balance |
remaining in one or
more such line item appropriations is |
insufficient for the purpose for
which the appropriation was |
|
made. |
(a-1) No transfers may be made from one
agency to another |
agency, nor may transfers be made from one institution
of |
higher education to another institution of higher education |
except as provided by subsection (a-4) .
|
(a-2) Except as otherwise provided in this Section, |
transfers may be made only among the objects of expenditure |
enumerated
in this Section, except that no funds may be |
transferred from any
appropriation for personal services, from |
any appropriation for State
contributions to the State |
Employees' Retirement System, from any
separate appropriation |
for employee retirement contributions paid by the
employer, nor |
from any appropriation for State contribution for
employee |
group insurance. During State fiscal year 2005, an agency may |
transfer amounts among its appropriations within the same |
treasury fund for personal services, employee retirement |
contributions paid by employer, and State Contributions to |
retirement systems; notwithstanding and in addition to the |
transfers authorized in subsection (c) of this Section, the |
fiscal year 2005 transfers authorized in this sentence may be |
made in an amount not to exceed 2% of the aggregate amount |
appropriated to an agency within the same treasury fund. During |
State fiscal year 2007, the Departments of Children and Family |
Services, Corrections, Human Services, and Juvenile Justice |
may transfer amounts among their respective appropriations |
within the same treasury fund for personal services, employee |
|
retirement contributions paid by employer, and State |
contributions to retirement systems. During State fiscal year |
2010, the Department of Transportation may transfer amounts |
among their respective appropriations within the same treasury |
fund for personal services, employee retirement contributions |
paid by employer, and State contributions to retirement |
systems. During State fiscal year 2010 only, an agency may |
transfer amounts among its respective appropriations within |
the same treasury fund for personal services, employee |
retirement contributions paid by employer, and State |
contributions to retirement systems. Notwithstanding, and in |
addition to, the transfers authorized in subsection (c) of this |
Section, these transfers may be made in an amount not to exceed |
2% of the aggregate amount appropriated to an agency within the |
same treasury fund.
|
(a-3) Further, if an agency receives a separate
|
appropriation for employee retirement contributions paid by |
the employer,
any transfer by that agency into an appropriation |
for personal services
must be accompanied by a corresponding |
transfer into the appropriation for
employee retirement |
contributions paid by the employer, in an amount
sufficient to |
meet the employer share of the employee contributions
required |
to be remitted to the retirement system. |
(a-4) Long-Term Care Rebalancing. The Governor may |
designate amounts set aside for institutional services |
appropriated from the General Revenue Fund or any other State |
|
fund that receives monies for long-term care services to be |
transferred to all State agencies responsible for the |
administration of community-based long-term care programs, |
including, but not limited to, community-based long-term care |
programs administered by the Department of Healthcare and |
Family Services, the Department of Human Services, and the |
Department on Aging, provided that the Director of Healthcare |
and Family Services first certifies that the amounts being |
transferred are necessary for the purpose of assisting persons |
in or at risk of being in institutional care to transition to |
community-based settings, including the financial data needed |
to prove the need for the transfer of funds. The total amounts |
transferred shall not exceed 4% in total of the amounts |
appropriated from the General Revenue Fund or any other State |
fund that receives monies for long-term care services for each |
fiscal year. A notice of the fund transfer must be made to the |
General Assembly and posted at a minimum on the Department of |
Healthcare and Family Services website, the Governor's Office |
of Management and Budget website, and any other website the |
Governor sees fit. These postings shall serve as notice to the |
General Assembly of the amounts to be transferred. Notice shall |
be given at least 30 days prior to transfer. |
(b) In addition to the general transfer authority provided |
under
subsection (c), the following agencies have the specific |
transfer authority
granted in this subsection: |
The Department of Healthcare and Family Services is |
|
authorized to make transfers
representing savings attributable |
to not increasing grants due to the
births of additional |
children from line items for payments of cash grants to
line |
items for payments for employment and social services for the |
purposes
outlined in subsection (f) of Section 4-2 of the |
Illinois Public Aid Code. |
The Department of Children and Family Services is |
authorized to make
transfers not exceeding 2% of the aggregate |
amount appropriated to it within
the same treasury fund for the |
following line items among these same line
items: Foster Home |
and Specialized Foster Care and Prevention, Institutions
and |
Group Homes and Prevention, and Purchase of Adoption and |
Guardianship
Services. |
The Department on Aging is authorized to make transfers not
|
exceeding 2% of the aggregate amount appropriated to it within |
the same
treasury fund for the following Community Care Program |
line items among these
same line items: Homemaker and Senior |
Companion Services, Alternative Senior Services, Case |
Coordination
Units, and Adult Day Care Services. |
The State Treasurer is authorized to make transfers among |
line item
appropriations
from the Capital Litigation Trust |
Fund, with respect to costs incurred in
fiscal years 2002 and |
2003 only, when the balance remaining in one or
more such
line |
item appropriations is insufficient for the purpose for which |
the
appropriation was
made, provided that no such transfer may |
be made unless the amount transferred
is no
longer required for |
|
the purpose for which that appropriation was made. |
The State Board of Education is authorized to make |
transfers from line item appropriations within the same |
treasury fund for General State Aid and General State Aid - |
Hold Harmless, provided that no such transfer may be made |
unless the amount transferred is no longer required for the |
purpose for which that appropriation was made, to the line item |
appropriation for Transitional Assistance when the balance |
remaining in such line item appropriation is insufficient for |
the purpose for which the appropriation was made. |
The State Board of Education is authorized to make |
transfers between the following line item appropriations |
within the same treasury fund: Disabled Student |
Services/Materials (Section 14-13.01 of the School Code), |
Disabled Student Transportation Reimbursement (Section |
14-13.01 of the School Code), Disabled Student Tuition - |
Private Tuition (Section 14-7.02 of the School Code), |
Extraordinary Special Education (Section 14-7.02b of the |
School Code), Reimbursement for Free Lunch/Breakfast Program, |
Summer School Payments (Section 18-4.3 of the School Code), and |
Transportation - Regular/Vocational Reimbursement (Section |
29-5 of the School Code). Such transfers shall be made only |
when the balance remaining in one or more such line item |
appropriations is insufficient for the purpose for which the |
appropriation was made and provided that no such transfer may |
be made unless the amount transferred is no longer required for |
|
the purpose for which that appropriation was made. |
During State fiscal years 2010 and 2011 only, the |
Department of Healthcare and Family Services is authorized to |
make transfers not exceeding 4% of the aggregate amount |
appropriated to it, within the same treasury fund, among the |
various line items appropriated for Medical Assistance. |
(c) The sum of such transfers for an agency in a fiscal |
year shall not
exceed 2% of the aggregate amount appropriated |
to it within the same treasury
fund for the following objects: |
Personal Services; Extra Help; Student and
Inmate |
Compensation; State Contributions to Retirement Systems; State
|
Contributions to Social Security; State Contribution for |
Employee Group
Insurance; Contractual Services; Travel; |
Commodities; Printing; Equipment;
Electronic Data Processing; |
Operation of Automotive Equipment;
Telecommunications |
Services; Travel and Allowance for Committed, Paroled
and |
Discharged Prisoners; Library Books; Federal Matching Grants |
for
Student Loans; Refunds; Workers' Compensation, |
Occupational Disease, and
Tort Claims; and, in appropriations |
to institutions of higher education,
Awards and Grants. |
Notwithstanding the above, any amounts appropriated for
|
payment of workers' compensation claims to an agency to which |
the authority
to evaluate, administer and pay such claims has |
been delegated by the
Department of Central Management Services |
may be transferred to any other
expenditure object where such |
amounts exceed the amount necessary for the
payment of such |
|
claims. |
(c-1) Special provisions for State fiscal year 2003. |
Notwithstanding any
other provision of this Section to the |
contrary, for State fiscal year 2003
only, transfers among line |
item appropriations to an agency from the same
treasury fund |
may be made provided that the sum of such transfers for an |
agency
in State fiscal year 2003 shall not exceed 3% of the |
aggregate amount
appropriated to that State agency for State |
fiscal year 2003 for the following
objects: personal services, |
except that no transfer may be approved which
reduces the |
aggregate appropriations for personal services within an |
agency;
extra help; student and inmate compensation; State
|
contributions to retirement systems; State contributions to |
social security;
State contributions for employee group |
insurance; contractual services; travel;
commodities; |
printing; equipment; electronic data processing; operation of
|
automotive equipment; telecommunications services; travel and |
allowance for
committed, paroled, and discharged prisoners; |
library books; federal matching
grants for student loans; |
refunds; workers' compensation, occupational disease,
and tort |
claims; and, in appropriations to institutions of higher |
education,
awards and grants. |
(c-2) Special provisions for State fiscal year 2005. |
Notwithstanding subsections (a), (a-2), and (c), for State |
fiscal year 2005 only, transfers may be made among any line |
item appropriations from the same or any other treasury fund |
|
for any objects or purposes, without limitation, when the |
balance remaining in one or more such line item appropriations |
is insufficient for the purpose for which the appropriation was |
made, provided that the sum of those transfers by a State |
agency shall not exceed 4% of the aggregate amount appropriated |
to that State agency for fiscal year 2005.
|
(d) Transfers among appropriations made to agencies of the |
Legislative
and Judicial departments and to the |
constitutionally elected officers in the
Executive branch |
require the approval of the officer authorized in Section 10
of |
this Act to approve and certify vouchers. Transfers among |
appropriations
made to the University of Illinois, Southern |
Illinois University, Chicago State
University, Eastern |
Illinois University, Governors State University, Illinois
|
State University, Northeastern Illinois University, Northern |
Illinois
University, Western Illinois University, the Illinois |
Mathematics and Science
Academy and the Board of Higher |
Education require the approval of the Board of
Higher Education |
and the Governor. Transfers among appropriations to all other
|
agencies require the approval of the Governor. |
The officer responsible for approval shall certify that the
|
transfer is necessary to carry out the programs and purposes |
for which
the appropriations were made by the General Assembly |
and shall transmit
to the State Comptroller a certified copy of |
the approval which shall
set forth the specific amounts |
transferred so that the Comptroller may
change his records |
|
accordingly. The Comptroller shall furnish the
Governor with |
information copies of all transfers approved for agencies
of |
the Legislative and Judicial departments and transfers |
approved by
the constitutionally elected officials of the |
Executive branch other
than the Governor, showing the amounts |
transferred and indicating the
dates such changes were entered |
on the Comptroller's records. |
(e) The State Board of Education, in consultation with the |
State Comptroller, may transfer line item appropriations for |
General State Aid between the Common School Fund and the |
Education Assistance Fund. With the advice and consent of the |
Governor's Office of Management and Budget, the State Board of |
Education, in consultation with the State Comptroller, may |
transfer line item appropriations between the General Revenue |
Fund and the Education Assistance Fund for the following |
programs: |
(1) Disabled Student Personnel Reimbursement (Section |
14-13.01 of the School Code); |
(2) Disabled Student Transportation Reimbursement |
(subsection (b) of Section 14-13.01 of the School Code); |
(3) Disabled Student Tuition - Private Tuition |
(Section 14-7.02 of the School Code); |
(4) Extraordinary Special Education (Section 14-7.02b |
of the School Code); |
(5) Reimbursement for Free Lunch/Breakfast Programs; |
(6) Summer School Payments (Section 18-4.3 of the |
|
School Code); |
(7) Transportation - Regular/Vocational Reimbursement |
(Section 29-5 of the School Code); |
(8) Regular Education Reimbursement (Section 18-3 of |
the School Code); and |
(9) Special Education Reimbursement (Section 14-7.03 |
of the School Code). |
(Source: P.A. 95-707, eff. 1-11-08; 96-37, eff. 7-13-09; |
96-820, eff. 11-18-09; 96-959, eff. 7-1-10; 96-1086, eff. |
7-16-10.)
|
(30 ILCS 105/25) (from Ch. 127, par. 161)
|
Sec. 25. Fiscal year limitations.
|
(a) All appropriations shall be
available for expenditure |
for the fiscal year or for a lesser period if the
Act making |
that appropriation so specifies. A deficiency or emergency
|
appropriation shall be available for expenditure only through |
June 30 of
the year when the Act making that appropriation is |
enacted unless that Act
otherwise provides.
|
(b) Outstanding liabilities as of June 30, payable from |
appropriations
which have otherwise expired, may be paid out of |
the expiring
appropriations during the 2-month period ending at |
the
close of business on August 31. Any service involving
|
professional or artistic skills or any personal services by an |
employee whose
compensation is subject to income tax |
withholding must be performed as of June
30 of the fiscal year |
|
in order to be considered an "outstanding liability as of
June |
30" that is thereby eligible for payment out of the expiring
|
appropriation.
|
(b-1) However, payment of tuition reimbursement claims |
under Section 14-7.03 or
18-3 of the School Code may be made by |
the State Board of Education from its
appropriations for those |
respective purposes for any fiscal year, even though
the claims |
reimbursed by the payment may be claims attributable to a prior
|
fiscal year, and payments may be made at the direction of the |
State
Superintendent of Education from the fund from which the |
appropriation is made
without regard to any fiscal year |
limitations , except as required by subsection (j) of this |
Section. Beginning on June 30, 2021, payment of tuition |
reimbursement claims under Section 14-7.03 or 18-3 of the |
School Code as of June 30, payable from appropriations that |
have otherwise expired, may be paid out of the expiring |
appropriation during the 4-month period ending at the close of |
business on October 31 .
|
(b-2) All outstanding liabilities as of June 30, 2010, |
payable from appropriations that would otherwise expire at the |
conclusion of the lapse period for fiscal year 2010, and |
interest penalties payable on those liabilities under the State |
Prompt Payment Act, may be paid out of the expiring |
appropriations until December 31, 2010, without regard to the |
fiscal year in which the payment is made, as long as vouchers |
for the liabilities are received by the Comptroller no later |
|
than August 31, 2010. |
(b-3) Medical payments may be made by the Department of |
Veterans' Affairs from
its
appropriations for those purposes |
for any fiscal year, without regard to the
fact that the |
medical services being compensated for by such payment may have
|
been rendered in a prior fiscal year , except as required by |
subsection (j) of this Section. Beginning on June 30, 2021, |
medical payments payable from appropriations that have |
otherwise expired may be paid out of the expiring appropriation |
during the 4-month period ending at the close of business on |
October 31 .
|
(b-4) Medical payments may be made by the Department of |
Healthcare and Family Services and medical payments and child |
care
payments may be made by the Department of
Human Services |
(as successor to the Department of Public Aid) from
|
appropriations for those purposes for any fiscal year,
without |
regard to the fact that the medical or child care services |
being
compensated for by such payment may have been rendered in |
a prior fiscal
year; and payments may be made at the direction |
of the Department of
Healthcare and Family Services Central |
Management Services from the Health Insurance Reserve Fund and |
the
Local Government Health Insurance Reserve Fund without |
regard to any fiscal
year limitations , except as required by |
subsection (j) of this Section. Beginning on June 30, 2021, |
medical payments made by the Department of Healthcare and |
Family Services, child care payments made by the Department of |
|
Human Services, and payments made at the discretion of the |
Department of Healthcare and Family Services from the Health |
Insurance Reserve Fund and the Local Government Health |
Insurance Reserve Fund payable from appropriations that have |
otherwise expired may be paid out of the expiring appropriation |
during the 4-month period ending at the close of business on |
October 31 .
|
(b-5) Medical payments may be made by the Department of |
Human Services from its appropriations relating to substance |
abuse treatment services for any fiscal year, without regard to |
the fact that the medical services being compensated for by |
such payment may have been rendered in a prior fiscal year, |
provided the payments are made on a fee-for-service basis |
consistent with requirements established for Medicaid |
reimbursement by the Department of Healthcare and Family |
Services , except as required by subsection (j) of this Section. |
Beginning on June 30, 2021, medical payments made by the |
Department of Human Services relating to substance abuse |
treatment services payable from appropriations that have |
otherwise expired may be paid out of the expiring appropriation |
during the 4-month period ending at the close of business on |
October 31 . |
(b-6) Additionally, payments may be made by the Department |
of Human Services from
its appropriations, or any other State |
agency from its appropriations with
the approval of the |
Department of Human Services, from the Immigration Reform
and |
|
Control Fund for purposes authorized pursuant to the |
Immigration Reform
and Control Act of 1986, without regard to |
any fiscal year limitations , except as required by subsection |
(j) of this Section. Beginning on June 30, 2021, payments made |
by the Department of Human Services from the Immigration Reform |
and Control Fund for purposes authorized pursuant to the |
Immigration Reform and Control Act of 1986 payable from |
appropriations that have otherwise expired may be paid out of |
the expiring appropriation during the 4-month period ending at |
the close of business on October 31 .
|
Further, with respect to costs incurred in fiscal years |
2002 and 2003 only,
payments may be made by the State Treasurer |
from its
appropriations
from the Capital Litigation Trust Fund |
without regard to any fiscal year
limitations.
|
Lease payments may be made by the Department of Central |
Management
Services under the sale and leaseback provisions of
|
Section 7.4 of
the State Property Control Act with respect to |
the James R. Thompson Center and
the
Elgin Mental Health Center |
and surrounding land from appropriations for that
purpose |
without regard to any fiscal year
limitations.
|
Lease payments may be made under the sale and leaseback |
provisions of
Section 7.5 of the State Property Control Act |
with
respect to the
Illinois State Toll Highway Authority |
headquarters building and surrounding
land
without regard to |
any fiscal year
limitations.
|
(b-7) Payments may be made in accordance with a plan |
|
authorized by paragraph (11) or (12) of Section 405-105 of the |
Department of Central Management Services Law from |
appropriations for those payments without regard to fiscal year |
limitations. |
(c) Further, payments may be made by the Department of |
Public Health , and the
Department of Human Services (acting as |
successor to the Department of Public
Health under the |
Department of Human Services Act) , and the Department of |
Healthcare and Family Services
from their respective |
appropriations for grants for medical care to or on
behalf of |
persons
suffering from chronic renal disease, persons |
suffering from hemophilia, rape
victims, and premature and |
high-mortality risk infants and their mothers and
for grants |
for supplemental food supplies provided under the United States
|
Department of Agriculture Women, Infants and Children |
Nutrition Program,
for any fiscal year without regard to the |
fact that the services being
compensated for by such payment |
may have been rendered in a prior fiscal year , except as |
required by subsection (j) of this Section. Beginning on June |
30, 2021, payments made by the Department of Public Health, the |
Department of Human Services, and the Department of Healthcare |
and Family Services from their respective appropriations for |
grants for medical care to or on behalf of persons suffering |
from chronic renal disease, persons suffering from hemophilia, |
rape victims, and premature and high-mortality risk infants and |
their mothers and for grants for supplemental food supplies |
|
provided under the United States Department of Agriculture |
Women, Infants and Children Nutrition Program payable from |
appropriations that have otherwise expired may be paid out of |
the expiring appropriations during the 4-month period ending at |
the close of business on October 31 .
|
(d) The Department of Public Health and the Department of |
Human Services
(acting as successor to the Department of Public |
Health under the Department of
Human Services Act) shall each |
annually submit to the State Comptroller, Senate
President, |
Senate
Minority Leader, Speaker of the House, House Minority |
Leader, and the
respective Chairmen and Minority Spokesmen of |
the
Appropriations Committees of the Senate and the House, on |
or before
December 31, a report of fiscal year funds used to |
pay for services
provided in any prior fiscal year. This report |
shall document by program or
service category those |
expenditures from the most recently completed fiscal
year used |
to pay for services provided in prior fiscal years.
|
(e) The Department of Healthcare and Family Services, the |
Department of Human Services
(acting as successor to the |
Department of Public Aid), and the Department of Human Services |
making fee-for-service payments relating to substance abuse |
treatment services provided during a previous fiscal year shall |
each annually
submit to the State
Comptroller, Senate |
President, Senate Minority Leader, Speaker of the House,
House |
Minority Leader, the respective Chairmen and Minority |
Spokesmen of the
Appropriations Committees of the Senate and |
|
the House, on or before November
30, a report that shall |
document by program or service category those
expenditures from |
the most recently completed fiscal year used to pay for (i)
|
services provided in prior fiscal years and (ii) services for |
which claims were
received in prior fiscal years.
|
(f) The Department of Human Services (as successor to the |
Department of
Public Aid) shall annually submit to the State
|
Comptroller, Senate President, Senate Minority Leader, Speaker |
of the House,
House Minority Leader, and the respective |
Chairmen and Minority Spokesmen of
the Appropriations |
Committees of the Senate and the House, on or before
December |
31, a report
of fiscal year funds used to pay for services |
(other than medical care)
provided in any prior fiscal year. |
This report shall document by program or
service category those |
expenditures from the most recently completed fiscal
year used |
to pay for services provided in prior fiscal years.
|
(g) In addition, each annual report required to be |
submitted by the
Department of Healthcare and Family Services |
under subsection (e) shall include the following
information |
with respect to the State's Medicaid program:
|
(1) Explanations of the exact causes of the variance |
between the previous
year's estimated and actual |
liabilities.
|
(2) Factors affecting the Department of Healthcare and |
Family Services' liabilities,
including but not limited to |
numbers of aid recipients, levels of medical
service |
|
utilization by aid recipients, and inflation in the cost of |
medical
services.
|
(3) The results of the Department's efforts to combat |
fraud and abuse.
|
(h) As provided in Section 4 of the General Assembly |
Compensation Act,
any utility bill for service provided to a |
General Assembly
member's district office for a period |
including portions of 2 consecutive
fiscal years may be paid |
from funds appropriated for such expenditure in
either fiscal |
year.
|
(i) An agency which administers a fund classified by the |
Comptroller as an
internal service fund may issue rules for:
|
(1) billing user agencies in advance for payments or |
authorized inter-fund transfers
based on estimated charges |
for goods or services;
|
(2) issuing credits, refunding through inter-fund |
transfers, or reducing future inter-fund transfers
during
|
the subsequent fiscal year for all user agency payments or |
authorized inter-fund transfers received during the
prior |
fiscal year which were in excess of the final amounts owed |
by the user
agency for that period; and
|
(3) issuing catch-up billings to user agencies
during |
the subsequent fiscal year for amounts remaining due when |
payments or authorized inter-fund transfers
received from |
the user agency during the prior fiscal year were less than |
the
total amount owed for that period.
|
|
User agencies are authorized to reimburse internal service |
funds for catch-up
billings by vouchers drawn against their |
respective appropriations for the
fiscal year in which the |
catch-up billing was issued or by increasing an authorized |
inter-fund transfer during the current fiscal year. For the |
purposes of this Act, "inter-fund transfers" means transfers |
without the use of the voucher-warrant process, as authorized |
by Section 9.01 of the State Comptroller Act.
|
(i-1) Beginning on July 1, 2021, all outstanding |
liabilities, not payable during the 4-month lapse period as |
described in subsections (b-1), (b-3), (b-4), (b-5), (b-6), and |
(c) of this Section, that are made from appropriations for that |
purpose for any fiscal year, without regard to the fact that |
the services being compensated for by those payments may have |
been rendered in a prior fiscal year, are limited to only those |
claims that have been incurred but for which a proper bill or |
invoice as defined by the State Prompt Payment Act has not been |
received by September 30th following the end of the fiscal year |
in which the service was rendered. |
(j) Notwithstanding any other provision of this Act, the |
aggregate amount of payments to be made without regard for |
fiscal year limitations as contained in subsections (b-1), |
(b-3), (b-4), (b-5), (b-6), and (c) of this Section, and |
determined by using Generally Accepted Accounting Principles, |
shall not exceed the following amounts: |
(1) $6,000,000,000 for outstanding liabilities related |
|
to fiscal year 2012; |
(2) $5,300,000,000 for outstanding liabilities related |
to fiscal year 2013; |
(3) $4,600,000,000 for outstanding liabilities related |
to fiscal year 2014; |
(4) $4,000,000,000 for outstanding liabilities related |
to fiscal year 2015; |
(5) $3,300,000,000 for outstanding liabilities related |
to fiscal year 2016; |
(6) $2,600,000,000 for outstanding liabilities related |
to fiscal year 2017; |
(7) $2,000,000,000 for outstanding liabilities related |
to fiscal year 2018; |
(8) $1,300,000,000 for outstanding liabilities related |
to fiscal year 2019; |
(9) $600,000,000 for outstanding liabilities related |
to fiscal year 2020; and |
(10) $0 for outstanding liabilities related to fiscal |
year 2021 and fiscal years thereafter. |
(Source: P.A. 95-331, eff. 8-21-07; 96-928, eff. 6-15-10; |
96-958, eff. 7-1-10; revised 7-22-10.)
|
Section 15. The State Prompt Payment Act is amended by |
changing Section 3-2 as follows:
|
(30 ILCS 540/3-2)
|
|
Sec. 3-2. Beginning July 1, 1993, in any instance where a |
State official or
agency is late in payment of a vendor's bill |
or invoice for goods or services
furnished to the State, as |
defined in Section 1, properly approved in
accordance with |
rules promulgated under Section 3-3, the State official or
|
agency shall pay interest to the vendor in accordance with the |
following:
|
(1) Any bill, except a bill submitted under Article V |
of the Illinois Public Aid Code, approved for payment under |
this Section must be paid
or the payment issued to the |
payee within 60 days of receipt
of a proper bill or |
invoice.
If payment is not issued to the payee within this |
60 day
period, an
interest penalty of 1.0% of any amount |
approved and unpaid shall be added
for each month or |
fraction thereof after the end of this 60 day period,
until |
final payment is made. Any bill , except a bill for pharmacy |
services or goods, submitted under Article V of the |
Illinois Public Aid Code approved for payment under this |
Section must be paid
or the payment issued to the payee |
within 60 days after receipt
of a proper bill or invoice, |
and,
if payment is not issued to the payee within this |
60-day
period, an
interest penalty of 2.0% of any amount |
approved and unpaid shall be added
for each month or |
fraction thereof after the end of this 60-day period,
until |
final payment is made. Any bill for pharmacy services or |
goods submitted under Article V of the Illinois Public Aid |
|
Code, approved for payment under this Section must be paid |
or the payment issued to the payee within 60 days of |
receipt of a proper bill or invoice. If payment is not |
issued to the payee within this 60 day period, an interest |
penalty of 1.0% of any amount approved and unpaid shall be |
added for each month or fraction thereof after the end of |
this 60 day period, until final payment is made.
|
(1.1) A State agency shall review in a timely manner |
each bill or
invoice after its receipt. If the
State agency |
determines that the bill or invoice contains a defect |
making it
unable to process the payment request, the agency
|
shall notify the vendor requesting payment as soon as |
possible after
discovering the
defect pursuant to rules |
promulgated under Section 3-3; provided, however, that the |
notice for construction related bills or invoices must be |
given not later than 30 days after the bill or invoice was |
first submitted. The notice shall
identify the defect and |
any additional information
necessary to correct the |
defect. If one or more items on a construction related bill |
or invoice are disapproved, but not the entire bill or |
invoice, then the portion that is not disapproved shall be |
paid.
|
(2) Where a State official or agency is late in payment |
of a
vendor's bill or invoice properly approved in |
accordance with this Act, and
different late payment terms |
are not reduced to writing as a contractual
agreement, the |
|
State official or agency shall automatically pay interest
|
penalties required by this Section amounting to $50 or more |
to the appropriate
vendor. Each agency shall be responsible |
for determining whether an interest
penalty
is
owed and
for |
paying the interest to the vendor.
Interest due to a vendor |
that amounts to less than $50 shall not be paid but shall |
be accrued until all interest due the vendor for all |
similar warrants exceeds $50, at which time the accrued |
interest shall be payable and interest will begin accruing |
again, except that interest accrued as of the end of the |
fiscal year that does not exceed $50 shall be payable at |
that time. In the event an
individual has paid a vendor for |
services in advance, the provisions of this
Section shall |
apply until payment is made to that individual.
|
(3) The provisions of this amendatory Act of the 96th |
General Assembly reducing the interest rate on pharmacy |
claims under Article V of the Illinois Public Aid Code to |
1.0% per month shall apply to any pharmacy bills for |
services and goods under Article V of the Illinois Public |
Aid Code received on or after the date 60 days before the |
effective date of this amendatory Act of the 96th General |
Assembly. |
(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10; |
96-959, eff. 7-1-10; 96-1000, eff. 7-2-10.)
|
Section 20. The Illinois Income Tax Act is amended by |
|
changing Section 917 as follows:
|
(35 ILCS 5/917) (from Ch. 120, par. 9-917)
|
Sec. 917. Confidentiality and information sharing.
|
(a) Confidentiality.
Except as provided in this Section, |
all information received by the Department
from returns filed |
under this Act, or from any investigation conducted under
the |
provisions of this Act, shall be confidential, except for |
official purposes
within the Department or pursuant to official |
procedures for collection
of any State tax or pursuant to an |
investigation or audit by the Illinois
State Scholarship |
Commission of a delinquent student loan or monetary award
or |
enforcement of any civil or criminal penalty or sanction
|
imposed by this Act or by another statute imposing a State tax, |
and any
person who divulges any such information in any manner, |
except for such
purposes and pursuant to order of the Director |
or in accordance with a proper
judicial order, shall be guilty |
of a Class A misdemeanor. However, the
provisions of this |
paragraph are not applicable to information furnished
to (i) |
the Department of Healthcare and Family Services (formerly
|
Department of Public Aid), State's Attorneys, and the Attorney |
General for child support enforcement purposes and (ii) a |
licensed attorney representing the taxpayer where an appeal or |
a protest
has been filed on behalf of the taxpayer. If it is |
necessary to file information obtained pursuant to this Act in |
a child support enforcement proceeding, the information shall |
|
be filed under seal.
|
(b) Public information. Nothing contained in this Act shall |
prevent
the Director from publishing or making available to the |
public the names
and addresses of persons filing returns under |
this Act, or from publishing
or making available reasonable |
statistics concerning the operation of the
tax wherein the |
contents of returns are grouped into aggregates in such a
way |
that the information contained in any individual return shall |
not be
disclosed.
|
(c) Governmental agencies. The Director may make available |
to the
Secretary of the Treasury of the United States or his |
delegate, or the
proper officer or his delegate of any other |
state imposing a tax upon or
measured by income, for |
exclusively official purposes, information received
by the |
Department in the administration of this Act, but such |
permission
shall be granted only if the United States or such |
other state, as the case
may be, grants the Department |
substantially similar privileges. The Director
may exchange |
information with the Department of Healthcare and Family |
Services and the
Department of Human Services (acting as |
successor to the Department of Public
Aid under the Department |
of Human Services Act) for
the purpose of verifying sources and |
amounts of income and for other purposes
directly connected |
with the administration of this Act , the Illinois Public Aid |
Code, and any other health benefit program administered by the |
State and the Illinois
Public Aid Code . The Director may |
|
exchange information with the Director of
the Department of |
Employment Security for the purpose of verifying sources
and |
amounts of income and for other purposes directly connected |
with the
administration of this Act and Acts administered by |
the Department of
Employment
Security.
The Director may make |
available to the Illinois Workers' Compensation Commission
|
information regarding employers for the purpose of verifying |
the insurance
coverage required under the Workers' |
Compensation Act and Workers'
Occupational Diseases Act. The |
Director may exchange information with the Illinois Department |
on Aging for the purpose of verifying sources and amounts of |
income for purposes directly related to confirming eligibility |
for participation in the programs of benefits authorized by the |
Senior Citizens and Disabled Persons Property Tax Relief and |
Pharmaceutical Assistance Act.
|
The Director may make available to any State agency, |
including the
Illinois Supreme Court, which licenses persons to |
engage in any occupation,
information that a person licensed by |
such agency has failed to file
returns under this Act or pay |
the tax, penalty and interest shown therein,
or has failed to |
pay any final assessment of tax, penalty or interest due
under |
this Act.
The Director may make available to any State agency, |
including the Illinois
Supreme
Court, information regarding |
whether a bidder, contractor, or an affiliate of a
bidder or
|
contractor has failed to file returns under this Act or pay the |
tax, penalty,
and interest
shown therein, or has failed to pay |
|
any final assessment of tax, penalty, or
interest due
under |
this Act, for the limited purpose of enforcing bidder and |
contractor
certifications.
For purposes of this Section, the |
term "affiliate" means any entity that (1)
directly,
|
indirectly, or constructively controls another entity, (2) is |
directly,
indirectly, or
constructively controlled by another |
entity, or (3) is subject to the control
of
a common
entity. |
For purposes of this subsection (a), an entity controls another |
entity
if
it owns,
directly or individually, more than 10% of |
the voting securities of that
entity.
As used in
this |
subsection (a), the term "voting security" means a security |
that (1)
confers upon the
holder the right to vote for the |
election of members of the board of directors
or similar
|
governing body of the business or (2) is convertible into, or |
entitles the
holder to receive
upon its exercise, a security |
that confers such a right to vote. A general
partnership
|
interest is a voting security.
|
The Director may make available to any State agency, |
including the
Illinois
Supreme Court, units of local |
government, and school districts, information
regarding
|
whether a bidder or contractor is an affiliate of a person who |
is not
collecting
and
remitting Illinois Use taxes, for the |
limited purpose of enforcing bidder and
contractor
|
certifications.
|
The Director may also make available to the Secretary of |
State
information that a corporation which has been issued a |
|
certificate of
incorporation by the Secretary of State has |
failed to file returns under
this Act or pay the tax, penalty |
and interest shown therein, or has failed
to pay any final |
assessment of tax, penalty or interest due under this Act.
An |
assessment is final when all proceedings in court for
review of |
such assessment have terminated or the time for the taking
|
thereof has expired without such proceedings being instituted. |
For
taxable years ending on or after December 31, 1987, the |
Director may make
available to the Director or principal |
officer of any Department of the
State of Illinois, information |
that a person employed by such Department
has failed to file |
returns under this Act or pay the tax, penalty and
interest |
shown therein. For purposes of this paragraph, the word
|
"Department" shall have the same meaning as provided in Section |
3 of the
State Employees Group Insurance Act of 1971.
|
(d) The Director shall make available for public
inspection |
in the Department's principal office and for publication, at |
cost,
administrative decisions issued on or after January
1, |
1995. These decisions are to be made available in a manner so |
that the
following
taxpayer information is not disclosed:
|
(1) The names, addresses, and identification numbers |
of the taxpayer,
related entities, and employees.
|
(2) At the sole discretion of the Director, trade |
secrets
or other confidential information identified as |
such by the taxpayer, no later
than 30 days after receipt |
of an administrative decision, by such means as the
|
|
Department shall provide by rule.
|
The Director shall determine the
appropriate extent of the
|
deletions allowed in paragraph (2). In the event the taxpayer |
does not submit
deletions,
the Director shall make only the |
deletions specified in paragraph (1).
|
The Director shall make available for public inspection and |
publication an
administrative decision within 180 days after |
the issuance of the
administrative
decision. The term |
"administrative decision" has the same meaning as defined in
|
Section 3-101 of Article III of the Code of Civil Procedure. |
Costs collected
under this Section shall be paid into the Tax |
Compliance and Administration
Fund.
|
(e) Nothing contained in this Act shall prevent the |
Director from
divulging
information to any person pursuant to a |
request or authorization made by the
taxpayer, by an authorized |
representative of the taxpayer, or, in the case of
information |
related to a joint return, by the spouse filing the joint |
return
with the taxpayer.
|
(Source: P.A. 94-1074, eff. 12-26-06; 95-331, eff. 8-21-07.)
|
Section 25. The Illinois Insurance Code is amended by |
changing Section 5.5 as follows: |
(215 ILCS 5/5.5) |
Sec. 5.5. Compliance with the Department of Healthcare and |
Family Services. A company authorized to do business in this |
|
State or accredited by the State to issue policies of health |
insurance, including but not limited to, self-insured plans, |
group health plans (as defined in Section 607(1) of the |
Employee Retirement Income Security Act of 1974), service |
benefit plans, managed care organizations, pharmacy benefit |
managers, or other parties that are by statute, contract, or |
agreement legally responsible for payment of a claim for a |
health care item or service as a condition of doing business in |
the State must: |
(1) provide to the Department of Healthcare and Family |
Services, or any successor agency, on at least a quarterly |
basis if so requested by the Department, information upon |
request information to determine during what period any |
individual may be, or may have been, covered by a health |
insurer and the nature of the coverage that is or was |
provided by the health insurer, including the name, |
address, and identifying number of the plan; |
(2) accept the State's right of recovery and the |
assignment to the State of any right of an individual or |
other entity to payment from the party for an item or |
service for which payment has been made under the medical |
programs of the Department of Healthcare and Family |
Services, or any successor agency, under this Code or the |
Illinois Public Aid Code; |
(3) respond to any inquiry by the Department of |
Healthcare and Family Services regarding a claim for |
|
payment for any health care item or service that is |
submitted not later than 3 years after the date of the |
provision of such health care item or service; and |
(4) agree not to deny a claim submitted by the |
Department of Healthcare and Family Services solely on the |
basis of the date of submission of the claim, the type or |
format of the claim form, or a failure to present proper |
documentation at the point-of-sale that is the basis of the |
claim if (i) the claim is submitted by the Department of |
Healthcare and Family Services within the 3-year period |
beginning on the date on which the item or service was |
furnished and (ii) any action by the Department of |
Healthcare and Family Services to enforce its rights with |
respect to such claim is commenced within 6 years of its |
submission of such claim.
|
In cases in which the Department of Healthcare and Family |
Services has determined that an entity that provides health |
insurance coverage has established a pattern of failure to |
provide the information required under this Section, and has |
subsequently certified that determination, along with |
supporting documentation, to the Director of the Department of |
Insurance, the Director of the Department of Insurance, based |
upon the certification of determination made by the Department |
of Healthcare and Family Services, may commence regulatory |
proceedings in accordance with all applicable provisions of the |
Illinois Insurance Code. |
|
(Source: P.A. 95-632, eff. 9-25-07.) |
Section 30. The Children's Health Insurance Program Act is |
amended by changing Section 15 and by adding Sections 7, 21, |
23, and 26 as follows: |
(215 ILCS 106/7 new) |
Sec. 7. Eligibility verification. Notwithstanding any |
other provision of this Act, with respect to applications for |
benefits provided under the Program, eligibility shall be |
determined in a manner that ensures program integrity and that |
complies with federal law and regulations while minimizing |
unnecessary barriers to enrollment. To this end, as soon as |
practicable, and unless the Department receives written denial |
from the federal government, this Section shall be implemented: |
(a) The Department of Healthcare and Family Services or its |
designees shall: |
(1) By no later than July 1, 2011, require verification |
of, at a minimum, one month's income from all sources |
required for determining the eligibility of applicants to |
the Program. Such verification shall take the form of pay |
stubs, business or income and expense records for |
self-employed persons, letters from employers, and any |
other valid documentation of income including data |
obtained electronically by the Department or its designees |
from other sources as described in subsection (b) of this |
|
Section. |
(2) By no later than October 1, 2011, require |
verification of, at a minimum, one month's income from all |
sources required for determining the continued eligibility |
of recipients at their annual review of eligibility under |
the Program. Such verification shall take the form of pay |
stubs, business or income and expense records for |
self-employed persons, letters from employers, and any |
other valid documentation of income including data |
obtained electronically by the Department or its designees |
from other sources as described in subsection (b) of this |
Section. The Department shall send a notice to the |
recipient at least 60 days prior to the end of the period |
of eligibility that informs them of the requirements for |
continued eligibility. If a recipient does not fulfill the |
requirements for continued eligibility by the deadline |
established in the notice, a notice of cancellation shall |
be issued to the recipient and coverage shall end on the |
last day of the eligibility period. A recipient's |
eligibility may be reinstated without requiring a new |
application if the recipient fulfills the requirements for |
continued eligibility prior to the end of the month |
following the last date of coverage. Nothing in this |
Section shall prevent an individual whose coverage has been |
cancelled from reapplying for health benefits at any time. |
(3) By no later than July 1, 2011, require verification |
|
of Illinois residency. |
(b) The Department shall establish or continue cooperative
|
arrangements with the Social Security Administration, the
|
Illinois Secretary of State, the Department of Human Services,
|
the Department of Revenue, the Department of Employment |
Security, and any other appropriate entity to gain electronic
|
access, to the extent allowed by law, to information available |
to those entities that may be appropriate for electronically
|
verifying any factor of eligibility for benefits under the
|
Program. Data relevant to eligibility shall be provided for no
|
other purpose than to verify the eligibility of new applicants |
or current recipients of health benefits under the Program. |
Data will be requested or provided for any new applicant or |
current recipient only insofar as that individual's |
circumstances are relevant to that individual's or another |
individual's eligibility. |
(c) Within 90 days of the effective date of this amendatory |
Act of the 96th General Assembly, the Department of Healthcare |
and Family Services shall send notice to current recipients |
informing them of the changes regarding their eligibility |
verification.
|
(215 ILCS 106/15)
|
Sec. 15. Operation of the Program. There is hereby created |
a
Children's Health Insurance Program. The Program shall |
operate subject
to appropriation and shall be administered by |
|
the Department of Healthcare and Family Services. The |
Department shall have the powers and authority granted to the
|
Department under the Illinois Public Aid Code , including, but |
not limited to, Section 11-5.1 of the Code . The Department may |
contract
with a Third Party Administrator or other entities to |
administer and oversee
any portion of this Program.
|
(Source: P.A. 95-331, eff. 8-21-07.)
|
(215 ILCS 106/21 new) |
Sec. 21. Presumptive eligibility. Beginning on the |
effective date of this amendatory Act of the 96th General |
Assembly and except where federal law requires presumptive |
eligibility, no adult may be presumed eligible for health care |
coverage under the Program, and the Department may not cover |
any service rendered to an adult unless the adult has completed |
an application for benefits, all required verifications have |
been received and the Department or its designee has found the |
adult eligible for the date on which that service was provided. |
Nothing in this Section shall apply to pregnant women. |
(215 ILCS 106/23 new) |
Sec. 23. Care coordination. |
(a) At least 50% of recipients eligible for comprehensive |
medical benefits in all medical assistance programs or other |
health benefit programs administered by the Department, |
including the Children's Health Insurance Program Act and the |
|
Covering ALL KIDS Health Insurance Act, shall be enrolled in a |
care coordination program by no later than January 1, 2015. For |
purposes of this Section, "coordinated care" or "care |
coordination" means delivery systems where recipients will |
receive their care from providers who participate under |
contract in integrated delivery systems that are responsible |
for providing or arranging the majority of care, including |
primary care physician services, referrals from primary care |
physicians, diagnostic and treatment services, behavioral |
health services, in-patient and outpatient hospital services, |
dental services, and rehabilitation and long-term care |
services. The Department shall designate or contract for such |
integrated delivery systems (i) to ensure enrollees have a |
choice of systems and of primary care providers within such |
systems; (ii) to ensure that enrollees receive quality care in |
a culturally and linguistically appropriate manner; and (iii) |
to ensure that coordinated care programs meet the diverse needs |
of enrollees with developmental, mental health, physical, and |
age-related disabilities. |
(b) Payment for such coordinated care shall be based on |
arrangements where the State pays for performance related to |
health care outcomes, the use of evidence-based practices, the |
use of primary care delivered through comprehensive medical |
homes, the use of electronic medical records, and the |
appropriate exchange of health information electronically made |
either on a capitated basis in which a fixed monthly premium |
|
per recipient is paid and full financial risk is assumed for |
the delivery of services, or through other risk-based payment |
arrangements. |
(c) To qualify for compliance with this Section, the 50% |
goal shall be achieved by enrolling medical assistance |
enrollees from each medical assistance enrollment category, |
including parents, children, seniors, and people with |
disabilities to the extent that current State Medicaid payment |
laws would not limit federal matching funds for recipients in |
care coordination programs. In addition, services must be more |
comprehensively defined and more risk shall be assumed than in |
the Department's primary care case management program as of the |
effective date of this amendatory Act of the 96th General |
Assembly. |
(d) The Department shall report to the General Assembly in |
a separate part of its annual medical assistance program |
report, beginning April, 2012 until April, 2016, on the |
progress and implementation of the care coordination program |
initiatives established by the provisions of this amendatory |
Act of the 96th General Assembly. The Department shall include |
in its April 2011 report a full analysis of federal laws or |
regulations regarding upper payment limitations to providers |
and the necessary revisions or adjustments in rate |
methodologies and payments to providers under this Code that |
would be necessary to implement coordinated care with full |
financial risk by a party other than the Department. |
|
(215 ILCS 106/26 new) |
Sec. 26. Moratorium on eligibility expansions. Beginning |
on the effective date of this amendatory Act of the 96th |
General Assembly, there shall be a 2-year moratorium on the |
expansion of eligibility through increasing financial |
eligibility standards, or through increasing income |
disregards, or through the creation of new programs that would |
add new categories of eligible individuals under the medical |
assistance program under the Illinois Public Aid Code in |
addition to those categories covered on January 1, 2011. This |
moratorium shall not apply to expansions required as a federal |
condition of State participation in the medical assistance |
program. |
Section 35. The Covering ALL KIDS Health Insurance Act is |
amended by changing Sections 15, 20, and 98 and by adding |
Sections 7, 21, 36, and 56 as follows: |
(215 ILCS 170/7 new) |
Sec. 7. Eligibility verification. Notwithstanding any |
other provision of this Act, with respect to applications for |
benefits provided under the Program, eligibility shall be |
determined in a manner that ensures program integrity and that |
complies with federal law and regulations while minimizing |
unnecessary barriers to enrollment. To this end, as soon as |
|
practicable, and unless the Department receives written denial |
from the federal government, this Section shall be implemented: |
(a) The Department of Healthcare and Family Services or its |
designees shall: |
(1) By July 1, 2011, require verification of, at a |
minimum, one month's income from all sources required for |
determining the eligibility of applicants to the Program.
|
Such verification shall take the form of pay stubs, |
business or income and expense records for self-employed |
persons, letters from employers, and any other valid |
documentation of income including data obtained |
electronically by the Department or its designees from |
other sources as described in subsection (b) of this |
Section. |
(2) By October 1, 2011, require verification of, at a |
minimum, one month's income from all sources required for |
determining the continued eligibility of recipients at |
their annual review of eligibility under the Program. Such |
verification shall take the form of pay stubs, business or |
income and expense records for self-employed persons, |
letters from employers, and any other valid documentation |
of income including data obtained electronically by the |
Department or its designees from other sources as described |
in subsection (b) of this Section. The Department shall |
send a notice to
recipients at least 60 days prior to the |
end of their period
of eligibility that informs them of the
|
|
requirements for continued eligibility. If a recipient
|
does not fulfill the requirements for continued |
eligibility by the
deadline established in the notice, a |
notice of cancellation shall be issued to the recipient and |
coverage shall end on the last day of the eligibility |
period. A recipient's eligibility may be reinstated |
without requiring a new application if the recipient |
fulfills the requirements for continued eligibility prior |
to the end of the month following the last date of |
coverage. Nothing in this Section shall prevent an |
individual whose coverage has been cancelled from |
reapplying for health benefits at any time. |
(3) By July 1, 2011, require verification of Illinois |
residency. |
(b) The Department shall establish or continue cooperative
|
arrangements with the Social Security Administration, the
|
Illinois Secretary of State, the Department of Human Services,
|
the Department of Revenue, the Department of Employment
|
Security, and any other appropriate entity to gain electronic
|
access, to the extent allowed by law, to information available
|
to those entities that may be appropriate for electronically
|
verifying any factor of eligibility for benefits under the
|
Program. Data relevant to eligibility shall be provided for no
|
other purpose than to verify the eligibility of new applicants |
or current recipients of health benefits under the Program. |
Data will be requested or provided for any new applicant or |
|
current recipient only insofar as that individual's |
circumstances are relevant to that individual's or another |
individual's eligibility. |
(c) Within 90 days of the effective date of this amendatory |
Act of the 96th General Assembly, the Department of Healthcare |
and Family Services shall send notice to current recipients |
informing them of the changes regarding their eligibility |
verification. |
(215 ILCS 170/15) |
(Section scheduled to be repealed on July 1, 2011)
|
Sec. 15. Operation of Program. The Covering ALL KIDS Health |
Insurance Program is created. The Program shall be administered |
by the Department of Healthcare and Family Services. The |
Department shall have the same powers and authority to |
administer the Program as are provided to the Department in |
connection with the Department's administration of the |
Illinois Public Aid Code , including, but not limited to, the |
provisions under Section 11-5.1 of the Code, and the Children's |
Health Insurance Program Act. The Department shall coordinate |
the Program with the existing children's health programs |
operated by the Department and other State agencies.
|
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/20) |
(Section scheduled to be repealed on July 1, 2011)
|
|
Sec. 20. Eligibility. |
(a) To be eligible for the Program, a person must be a |
child:
|
(1) who is a resident of the State of Illinois; and |
(2) who is ineligible for medical assistance under the |
Illinois Public Aid Code or benefits under the Children's |
Health Insurance Program Act; and
|
(3) either (i) who has been without health insurance |
coverage for a period set forth by the Department in rules, |
but not less than 6 months during the first month of |
operation of the Program, 7 months during the second month |
of operation, 8 months during the third month of operation, |
9 months during the fourth month of operation, 10 months |
during the fifth month of operation, 11 months during the |
sixth month of operation, and 12 months thereafter , (ii) |
whose parent has lost employment that made available |
affordable dependent health insurance coverage, until such |
time as affordable employer-sponsored dependent health |
insurance coverage is again available for the child as set |
forth by the Department in rules, (iii) who is a newborn |
whose responsible relative does not have available |
affordable private or employer-sponsored health insurance, |
or (iv) who, within one year of applying for coverage under |
this Act, lost medical benefits under the Illinois Public |
Aid Code or the Children's Health Insurance Program Act ; |
and . |
|
(3.5) whose household income, as determined by the |
Department, is at or below 300% of the federal poverty |
level. This item (3.5) is effective July 1, 2011. |
An entity that provides health insurance coverage (as |
defined in Section 2 of the Comprehensive Health Insurance Plan |
Act) to Illinois residents shall provide health insurance data |
match to the Department of Healthcare and Family Services as |
provided by and subject to Section 5.5 of the Illinois |
Insurance Code for the purpose of determining eligibility for |
the Program under this Act . |
The Department of Healthcare and Family Services, in |
collaboration with the Department of Financial and |
Professional Regulation, Division of Insurance, shall adopt |
rules governing the exchange of information under this Section. |
The rules shall be consistent with all laws relating to the |
confidentiality or privacy of personal information or medical |
records, including provisions under the Federal Health |
Insurance Portability and Accountability Act (HIPAA). |
(b) The Department shall monitor the availability and |
retention of employer-sponsored dependent health insurance |
coverage and shall modify the period described in subdivision |
(a)(3) if necessary to promote retention of private or |
employer-sponsored health insurance and timely access to |
healthcare services, but at no time shall the period described |
in subdivision (a)(3) be less than 6 months.
|
(c) The Department, at its discretion, may take into |
|
account the affordability of dependent health insurance when |
determining whether employer-sponsored dependent health |
insurance coverage is available upon reemployment of a child's |
parent as provided in subdivision (a)(3). |
(d) A child who is determined to be eligible for the |
Program shall remain eligible for 12 months, provided that the |
child maintains his or her residence in this State, has not yet |
attained 19 years of age, and is not excluded under subsection |
(e). |
(e) A child is not eligible for coverage under the Program |
if: |
(1) the premium required under Section 40 has not been |
timely paid; if the required premiums are not paid, the |
liability of the Program shall be limited to benefits |
incurred under the Program for the time period for which |
premiums have been paid; re-enrollment shall be completed |
before the next covered medical visit, and the first |
month's required premium shall be paid in advance of the |
next covered medical visit; or |
(2) the child is an inmate of a public institution or |
an institution for mental diseases.
|
(f) The Department may shall adopt eligibility rules, |
including, but not limited to: rules regarding annual renewals |
of eligibility for the Program in conformance with Section 7 of |
this Act; rules regarding annual renewals of eligibility for |
the Program; rules providing for re-enrollment, grace periods, |
|
notice requirements, and hearing procedures under subdivision |
(e)(1) of this Section; and rules regarding what constitutes |
availability and affordability of private or |
employer-sponsored health insurance, with consideration of |
such factors as the percentage of income needed to purchase |
children or family health insurance, the availability of |
employer subsidies, and other relevant factors.
|
(g) Each child enrolled in the Program as of July 1, 2011 |
whose family income, as established by the Department, exceeds |
300% of the federal poverty level may remain enrolled in the |
Program for 12 additional months commencing July 1, 2011. |
Continued enrollment pursuant to this subsection shall be |
available only if the child continues to meet all eligibility |
criteria established under the Program as of the effective date |
of this amendatory Act of the 96th General Assembly without a |
break in coverage. Nothing contained in this subsection shall |
prevent a child from qualifying for any other health benefits |
program operated by the Department. |
(Source: P.A. 96-1272, eff. 1-1-11.) |
(215 ILCS 170/21 new) |
Sec. 21. Presumptive eligibility. Beginning on the |
effective date of this amendatory Act of the 96th General |
Assembly and except where federal law or regulation requires |
presumptive eligibility, no adult may be presumed eligible for |
health care coverage under the Program and the Department may |
|
not cover any service rendered to an adult unless the adult has |
completed an application for benefits, all required |
verifications have been received, and the Department or its |
designee has found the adult eligible for the date on which |
that service was provided. Nothing in this Section shall apply |
to pregnant women. |
(215 ILCS 170/36 new) |
Sec. 36. Moratorium on eligibility expansions. Beginning |
on the effective date of this amendatory Act of the 96th |
General Assembly, there shall be a 2-year moratorium on the |
expansion of eligibility through increasing financial |
eligibility standards, or through increasing income |
disregards, or through the creation of new programs that would |
add new categories of eligible individuals under the medical |
assistance program under the Illinois Public Aid Code in |
addition to those categories covered on January 1, 2011. This |
moratorium shall not apply to expansions required as a federal |
condition of State participation in the medical assistance |
program. |
(215 ILCS 170/56 new) |
Sec. 56. Care coordination. |
(a) At least 50% of recipients eligible for comprehensive |
medical benefits in all medical assistance programs or other |
health benefit programs administered by the Department, |
|
including the Children's Health Insurance Program Act and the |
Covering ALL KIDS Health Insurance Act, shall be enrolled in a |
care coordination program by no later than January 1, 2015. For |
purposes of this Section, "coordinated care" or "care |
coordination" means delivery systems where recipients will |
receive their care from providers who participate under |
contract in integrated delivery systems that are responsible |
for providing or arranging the majority of care, including |
primary care physician services, referrals from primary care |
physicians, diagnostic and treatment services, behavioral |
health services, in-patient and outpatient hospital services, |
dental services, and rehabilitation and long-term care |
services. The Department shall designate or contract for such |
integrated delivery systems (i) to ensure enrollees have a |
choice of systems and of primary care providers within such |
systems; (ii) to ensure that enrollees receive quality care in |
a culturally and linguistically appropriate manner; and (iii) |
to ensure that coordinated care programs meet the diverse needs |
of enrollees with developmental, mental health, physical, and |
age-related disabilities. |
(b) Payment for such coordinated care shall be based on |
arrangements where the State pays for performance related to |
health care outcomes, the use of evidence-based practices, the |
use of primary care delivered through comprehensive medical |
homes, the use of electronic medical records, and the |
appropriate exchange of health information electronically made |
|
either on a capitated basis in which a fixed monthly premium |
per recipient is paid and full financial risk is assumed for |
the delivery of services, or through other risk-based payment |
arrangements. |
(c) To qualify for compliance with this Section, the 50% |
goal shall be achieved by enrolling medical assistance |
enrollees from each medical assistance enrollment category, |
including parents, children, seniors, and people with |
disabilities to the extent that current State Medicaid payment |
laws would not limit federal matching funds for recipients in |
care coordination programs. In addition, services must be more |
comprehensively defined and more risk shall be assumed than in |
the Department's primary care case management program as of the |
effective date of this amendatory Act of the 96th General |
Assembly. |
(d) The Department shall report to the General Assembly in |
a separate part of its annual medical assistance program |
report, beginning April, 2012 until April, 2016, on the |
progress and implementation of the care coordination program |
initiatives established by the provisions of this amendatory |
Act of the 96th General Assembly. The Department shall include |
in its April 2011 report a full analysis of federal laws or |
regulations regarding upper payment limitations to providers |
and the necessary revisions or adjustments in rate |
methodologies and payments to providers under this Code that |
would be necessary to implement coordinated care with full |
|
financial risk by a party other than the Department. |
(215 ILCS 170/98) |
(Section scheduled to be repealed on July 1, 2011)
|
Sec. 98. Repealer. This Act is repealed on July 1, 2016 |
July 1, 2011 .
|
(Source: P.A. 94-693, eff. 7-1-06 .) |
Section 40. The Illinois Public Aid Code is amended by |
changing Sections 5-4.1, 5-5.12, 5-11, 8A-2.5, and 11-26 and by |
adding Sections 5-1.3, 5-1.4, 5-2.03, 5-11a, 5-29, 5-30, and |
11-5.1 as follows: |
(305 ILCS 5/5-1.3 new) |
Sec. 5-1.3. Payer of last resort. To the extent permissible |
under federal law, the State may pay for medical services only |
after payment from all other sources of payment have been |
exhausted, or after the Department has determined that pursuit |
of such payment is economically unfeasible. Applicants for, and |
recipients of, medical assistance under this Code shall |
disclose to the State all insurance coverage they have. To the |
extent permissible under federal law, the State shall require |
vendors of medical services to bill third-party payers for |
services that may be covered by those third-party payers prior |
to submission of a request for payment to the State. The |
Department shall, to the extent permissible under federal law, |
|
reject a request for payment of a medical service that should |
first have been submitted to a third-party payer. |
(305 ILCS 5/5-1.4 new) |
Sec. 5-1.4. Moratorium on eligibility expansions. |
Beginning on the effective date of this amendatory Act of the |
96th General Assembly, there shall be a 2-year moratorium on |
the expansion of eligibility through increasing financial |
eligibility standards, or through increasing income |
disregards, or through the creation of new programs which would |
add new categories of eligible individuals under the medical |
assistance program in addition to those categories covered on |
January 1, 2011. This moratorium shall not apply to expansions |
required as a federal condition of State participation in the |
medical assistance program. |
(305 ILCS 5/5-2.03 new) |
Sec. 5-2.03. Presumptive eligibility. Beginning on the |
effective date of this amendatory Act of the 96th General |
Assembly and except where federal law requires presumptive |
eligibility, no adult may be presumed eligible for medical |
assistance under this Code and the Department may not cover any |
service rendered to an adult unless the adult has completed an |
application for benefits, all required verifications have been |
received, and the Department or its designee has found the |
adult eligible for the date on which that service was provided. |
|
Nothing in this Section shall apply to pregnant women.
|
(305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
|
Sec. 5-4.1. Co-payments. The Department may by rule provide |
that recipients
under any Article of this Code shall pay a fee |
as a co-payment for services.
Co-payments shall be maximized to |
the extent permitted by federal law may not exceed $3 for brand |
name drugs, $1 for other pharmacy
services other than for |
generic drugs, and $2 for physicians services, dental
services, |
optical services and supplies, chiropractic services, podiatry
|
services, and encounter rate clinic services. There shall be no |
co-payment for
generic drugs. Co-payments may not exceed $3 for |
hospital outpatient and clinic
services . Provided, however, |
that any such rule must provide that no
co-payment requirement |
can exist
for renal dialysis, radiation therapy, cancer |
chemotherapy, or insulin, and
other products necessary on a |
recurring basis, the absence of which would
be life |
threatening, or where co-payment expenditures for required |
services
and/or medications for chronic diseases that the |
Illinois Department shall
by rule designate shall cause an |
extensive financial burden on the
recipient, and provided no |
co-payment shall exist for emergency room
encounters which are |
for medical emergencies. The Department shall seek approval of |
a State plan amendment that allows pharmacies to refuse to |
dispense drugs in circumstances where the recipient does not |
pay the required co-payment. In the event the State plan |
|
amendment is rejected, co-payments may not exceed $3 for brand |
name drugs, $1 for other pharmacy
services other than for |
generic drugs, and $2 for physician services, dental
services, |
optical services and supplies, chiropractic services, podiatry
|
services, and encounter rate clinic services. There shall be no |
co-payment for
generic drugs. Co-payments may not exceed $3 for |
hospital outpatient and clinic
services.
|
(Source: P.A. 92-597, eff. 6-28-02; 93-593, eff. 8-25-03 .)
|
(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
|
Sec. 5-5.12. Pharmacy payments.
|
(a) Every request submitted by a pharmacy for reimbursement |
under this
Article for prescription drugs provided to a |
recipient of aid under this
Article shall include the name of |
the prescriber or an acceptable
identification number as |
established by the Department.
|
(b) Pharmacies providing prescription drugs under
this |
Article shall be reimbursed at a rate which shall include
a |
professional dispensing fee as determined by the Illinois
|
Department, plus the current acquisition cost of the |
prescription
drug dispensed. The Illinois Department shall |
update its
information on the acquisition costs of all |
prescription drugs
no less frequently than every 30 days. |
However, the Illinois
Department may set the rate of |
reimbursement for the acquisition
cost, by rule, at a |
percentage of the current average wholesale
acquisition cost.
|
|
(c) (Blank).
|
(d) The Department shall not impose requirements for prior |
approval
based on a preferred drug list for anti-retroviral, |
anti-hemophilic factor
concentrates,
or
any atypical |
antipsychotics, conventional antipsychotics,
or |
anticonvulsants used for the treatment of serious mental
|
illnesses
until 30 days after it has conducted a study of the |
impact of such
requirements on patient care and submitted a |
report to the Speaker of the
House of Representatives and the |
President of the Senate. The Department shall review |
utilization of narcotic medications in the medical assistance |
program and impose utilization controls that protect against |
abuse.
|
(e) When making determinations as to which drugs shall be |
on a prior approval list, the Department shall include as part |
of the analysis for this determination, the degree to which a |
drug may affect individuals in different ways based on factors |
including the gender of the person taking the medication. |
(f) (e) The Department shall cooperate with the Department |
of Public Health and the Department of Human Services Division |
of Mental Health in identifying psychotropic medications that, |
when given in a particular form, manner, duration, or frequency |
(including "as needed") in a dosage, or in conjunction with |
other psychotropic medications to a nursing home resident, may |
constitute a chemical restraint or an "unnecessary drug" as |
defined by the Nursing Home Care Act or Titles XVIII and XIX of |
|
the Social Security Act and the implementing rules and |
regulations. The Department shall require prior approval for |
any such medication prescribed for a nursing home resident that |
appears to be a chemical restraint or an unnecessary drug. The |
Department shall consult with the Department of Human Services |
Division of Mental Health in developing a protocol and criteria |
for deciding whether to grant such prior approval. |
(g) The Department may by rule provide for reimbursement of |
the dispensing of a 90-day supply of a generic, non-narcotic |
maintenance medication in circumstances where it is cost |
effective. |
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; |
revised 9-2-10.)
|
(305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
|
Sec. 5-11. Co-operative arrangements; contracts with other |
State
agencies, health care and rehabilitation organizations, |
and fiscal
intermediaries.
|
(a) The Illinois Department may enter into co-operative |
arrangements
with
State agencies responsible for administering |
or supervising the
administration of health services and |
vocational rehabilitation services to
the end that there may be |
maximum utilization of such services in the
provision of |
medical assistance.
|
The Illinois Department shall, not later than June 30, |
1993, enter into
one or more co-operative arrangements with the |
|
Department of Mental Health
and Developmental Disabilities |
providing that the Department of Mental
Health and |
Developmental Disabilities will be responsible for |
administering
or supervising all programs for services to |
persons in community care
facilities for persons with |
developmental disabilities, including but not
limited to |
intermediate care facilities, that are supported by State funds |
or
by funding under Title XIX of the federal Social Security |
Act. The
responsibilities of the Department of Mental Health |
and Developmental
Disabilities under these agreements are |
transferred to the Department of
Human Services as provided in |
the Department of Human Services Act.
|
The Department may also contract with such State health and
|
rehabilitation agencies and other public or private health care |
and
rehabilitation organizations to act for it in supplying |
designated medical
services to persons eligible therefor under |
this Article. Any contracts
with health services or health |
maintenance organizations shall be
restricted to organizations |
which have been certified as being in
compliance with standards |
promulgated pursuant to the laws of this State
governing the |
establishment and operation of health services or health
|
maintenance organizations. The Department shall renegotiate |
the contracts with health maintenance organizations and |
managed care community
networks that took effect August 1, |
2003, so as to produce $70,000,000 savings to the Department |
net of resulting increases to the fee-for-service program for |
|
State fiscal year 2006. The Department may also contract with |
insurance
companies or other corporate entities serving as |
fiscal intermediaries in
this State for the Federal Government |
in respect to Medicare payments under
Title XVIII of the |
Federal Social Security Act to act for the Department in
paying |
medical care suppliers. The provisions of Section 9 of "An Act |
in
relation to State finance", approved June 10, 1919, as |
amended,
notwithstanding, such contracts with State agencies, |
other health care and
rehabilitation organizations, or fiscal |
intermediaries may provide for
advance payments.
|
(b) For purposes of this subsection (b), "managed care |
community
network" means an entity, other than a health |
maintenance organization, that
is owned, operated, or governed |
by providers of health care services within
this State and that |
provides or arranges primary, secondary, and tertiary
managed |
health care services under contract with the Illinois |
Department
exclusively to persons participating in programs |
administered by the Illinois
Department.
|
The Illinois Department may certify managed care community
|
networks, including managed care community networks owned, |
operated, managed,
or
governed by State-funded medical |
schools, as risk-bearing entities eligible to
contract with the |
Illinois Department as Medicaid managed care
organizations. |
The Illinois Department may contract with those managed
care |
community networks to furnish health care services to or |
arrange those
services for individuals participating in |
|
programs administered by the Illinois
Department. The rates for |
those provider-sponsored organizations may be
determined on a |
prepaid, capitated basis. A managed care community
network may |
choose to contract with the Illinois Department to provide only
|
pediatric
health care services.
The
Illinois Department shall |
by rule adopt the criteria, standards, and procedures
by
which |
a managed care community network may be permitted to contract |
with
the Illinois Department and shall consult with the |
Department of Insurance in
adopting these rules.
|
A county provider as defined in Section 15-1 of this Code |
may
contract with the Illinois Department to provide primary, |
secondary, or
tertiary managed health care services as a |
managed care
community network without the need to establish a |
separate entity and shall
be deemed a managed care community |
network for purposes of this Code
only to the extent it |
provides services to participating individuals. A county
|
provider is entitled to contract with the Illinois Department |
with respect to
any contracting region located in whole or in |
part within the county. A
county provider is not required to |
accept enrollees who do not reside within
the county.
|
In order
to (i) accelerate and facilitate the development |
of integrated health care in
contracting areas outside counties |
with populations in excess of 3,000,000 and
counties adjacent |
to those counties and (ii) maintain and sustain the high
|
quality of education and residency programs coordinated and |
associated with
local area hospitals, the Illinois Department |
|
may develop and implement a
demonstration program from managed |
care community networks owned, operated,
managed, or
governed |
by State-funded medical schools. The Illinois Department shall
|
prescribe by rule the criteria, standards, and procedures for |
effecting this
demonstration program.
|
A managed care community network that
contracts with the |
Illinois Department to furnish health care services to or
|
arrange those services for enrollees participating in programs |
administered by
the Illinois Department shall do all of the |
following:
|
(1) Provide that any provider affiliated with the |
managed care community
network may also provide services on |
a
fee-for-service basis to Illinois Department clients not |
enrolled in such
managed care entities.
|
(2) Provide client education services as determined |
and approved by the
Illinois Department, including but not |
limited to (i) education regarding
appropriate utilization |
of health care services in a managed care system, (ii)
|
written disclosure of treatment policies and restrictions |
or limitations on
health services, including, but not |
limited to, physical services, clinical
laboratory tests, |
hospital and surgical procedures, prescription drugs and
|
biologics, and radiological examinations, and (iii) |
written notice that the
enrollee may receive from another |
provider those covered services that are not
provided by |
the managed care community network.
|
|
(3) Provide that enrollees within the system may choose |
the site for
provision of services and the panel of health |
care providers.
|
(4) Not discriminate in enrollment or disenrollment |
practices among
recipients of medical services or |
enrollees based on health status.
|
(5) Provide a quality assurance and utilization review |
program that
meets
the requirements established by the |
Illinois Department in rules that
incorporate those |
standards set forth in the Health Maintenance Organization
|
Act.
|
(6) Issue a managed care community network
|
identification card to each enrollee upon enrollment. The |
card
must contain all of the following:
|
(A) The enrollee's health plan.
|
(B) The name and telephone number of the enrollee's |
primary care
physician or the site for receiving |
primary care services.
|
(C) A telephone number to be used to confirm |
eligibility for benefits
and authorization for |
services that is available 24 hours per day, 7 days per
|
week.
|
(7) Ensure that every primary care physician and |
pharmacy in the managed
care community network meets the |
standards
established by the Illinois Department for |
accessibility and quality of care.
The Illinois Department |
|
shall arrange for and oversee an evaluation of the
|
standards established under this paragraph (7) and may |
recommend any necessary
changes to these standards.
|
(8) Provide a procedure for handling complaints that
|
meets the
requirements established by the Illinois |
Department in rules that incorporate
those standards set |
forth in the Health Maintenance Organization Act.
|
(9) Maintain, retain, and make available to the |
Illinois Department
records, data, and information, in a |
uniform manner determined by the Illinois
Department, |
sufficient for the Illinois Department to monitor |
utilization,
accessibility, and quality of care.
|
(10) (Blank) Provide that the pharmacy formulary used |
by the managed care
community
network and its contract |
providers be no
more restrictive than the Illinois |
Department's pharmaceutical program on the
effective date |
of this amendatory Act of 1998 and as amended after that |
date .
|
The Illinois Department shall contract with an entity or |
entities to provide
external peer-based quality assurance |
review for the managed health care
programs administered by the |
Illinois Department. The entity shall meet all federal |
requirements for an external quality review organization be
|
representative of Illinois physicians licensed to practice |
medicine in all its
branches and have statewide geographic |
representation in all specialities of
medical care that are |
|
provided in managed health care programs administered by
the |
Illinois Department. The entity may not be a third party payer |
and shall
maintain offices in locations around the State in |
order to provide service and
continuing medical education to |
physician participants within those managed
health care |
programs administered by the Illinois Department. The review
|
process shall be developed and conducted by Illinois physicians |
licensed to
practice medicine in all its branches. In |
consultation with the entity, the
Illinois Department may |
contract with other entities for professional
peer-based |
quality assurance review of individual
categories of services |
other than services provided, supervised, or coordinated
by |
physicians licensed to practice medicine in all its branches. |
The Illinois
Department shall establish, by rule, criteria to |
avoid conflicts of interest in
the conduct of quality assurance |
activities consistent with professional
peer-review standards. |
All quality assurance activities shall be coordinated
by the |
Illinois Department .
|
Each managed care community network must demonstrate its |
ability to
bear the financial risk of serving individuals under |
this program.
The Illinois Department shall by rule adopt |
standards for assessing the
solvency and financial soundness of |
each managed care community network.
Any solvency and financial |
standards adopted for managed care community
networks
shall be |
no more restrictive than the solvency and financial standards |
adopted
under
Section 1856(a) of the Social Security Act for |
|
provider-sponsored
organizations under Part C of Title XVIII of |
the Social Security Act.
|
The Illinois
Department may implement the amendatory |
changes to this
Code made by this amendatory Act of 1998 |
through the use of emergency
rules in accordance with Section |
5-45 of the Illinois Administrative Procedure
Act. For purposes |
of that Act, the adoption of rules to implement these
changes |
is deemed an emergency and necessary for the public interest,
|
safety, and welfare.
|
(c) Not later than June 30, 1996, the Illinois Department |
shall
enter into one or more cooperative arrangements with the |
Department of Public
Health for the purpose of developing a |
single survey for
nursing facilities, including but not limited |
to facilities funded under Title
XVIII or Title XIX of the |
federal Social Security Act or both, which shall be
|
administered and conducted solely by the Department of Public |
Health.
The Departments shall test the single survey process on |
a pilot basis, with
both the Departments of Public Aid and |
Public Health represented on the
consolidated survey team. The |
pilot will sunset June 30, 1997. After June 30,
1997, unless |
otherwise determined by the Governor, a single survey shall be
|
implemented by the Department of Public Health which would not |
preclude staff
from the Department of Healthcare and Family |
Services (formerly Department of Public Aid) from going on-site |
to nursing facilities to
perform necessary audits and reviews |
which shall not replicate the single State
agency survey |
|
required by this Act. This Section shall not apply to community
|
or intermediate care facilities for persons with developmental |
disabilities.
|
(d) Nothing in this Code in any way limits or otherwise |
impairs the
authority or power of the Illinois Department to |
enter into a negotiated
contract pursuant to this Section with |
a managed care community network or
a health maintenance |
organization, as defined in the Health Maintenance
|
Organization Act, that provides for
termination or nonrenewal |
of the contract without cause, upon notice as
provided in the |
contract, and without a hearing.
|
(Source: P.A. 94-48, eff. 7-1-05; 95-331, eff. 8-21-07.)
|
(305 ILCS 5/5-11a new) |
Sec. 5-11a. Health Benefit Information Systems. |
(a) It is the intent of the General Assembly to support |
unified electronic systems initiatives that will improve |
management of information related to medical assistance |
programs. This will include improved management capabilities |
and new systems for Eligibility, Verification, and Enrollment |
(EVE) that will simplify and increase efficiencies in and |
access to the medical assistance programs and ensure program |
integrity. The Department of Healthcare and Family Services, in |
coordination with the Department of Human Services and other |
appropriate state agencies, shall develop a plan by July 1, |
2011, that will: |
|
(1) Subject to federal and State privacy and |
confidentiality laws and regulations, meet standards for |
timely eligibility verification and enrollment, and annual |
redetermination of eligibility, of applicants for and |
recipients of means-tested health benefits sponsored by |
the State, including medical assistance under this Code. |
(2) Receive and update data electronically from the |
Social Security Administration, the U.S. Postal Service, |
the Illinois Secretary of State, the Department of Revenue, |
the Department of Employment Security, and other |
governmental entities, as appropriate and to the extent |
allowed by law, for verification of any factor of |
eligibility for medical assistance and for updating |
addresses of applicants and recipients of medical |
assistance and other health benefit programs administered |
by the Department. Data relevant to eligibility shall be |
provided for no other purpose than to verify the |
eligibility of new applicants or current recipients of |
health benefits provided by the State. Data shall be |
requested or provided for any individual only insofar as |
that new applicant or current recipient's circumstances |
are relevant to that individual's or another individual's |
eligibility for State-sponsored health benefits. |
(3) Meet federal requirements for timely installation |
by January 1, 2014 to provide integration with a Health |
Benefits Exchange pursuant to the requirements of the |
|
federal Affordable Care Act and the Reconciliation Act and |
any subsequent amendments thereto and to ensure capture of |
the maximum available federal financial
participation |
(FFP). |
(4) Meet federal requirements for compliance with |
architectural standards, including, but not limited to, |
(i) the use of a module development as outlined by the |
Medicaid Information Technology Architecture standards, |
(ii) the use of federally approved open-interfaces where |
they exist, (iii) the use or the creation of |
open-interfaces where necessary, and (iv) the use of rules |
technology that can dynamically accept and modify rules in |
standard formats. |
(5) Include plans to ensure coordination with the State |
of Illinois Framework Project that will (i) expedite and |
simplify access to services provided by Illinois human |
services programs; (ii) streamline administration and data |
sharing; (iii) enhance planning capacity, program |
evaluation, and fraud detection or prevention with access |
to cross-agency data; and (iv) simplify service reporting |
for contracted providers. |
(b) The Department of Healthcare and Family Services shall |
continue to plan for and implement a new Medicaid Management |
Information System (MMIS) and upgrade the capabilities of the |
MMIS data warehouse. Upgrades shall include, among other |
things, enhanced capabilities in data analysis including the |
|
ability to identify risk factors that could impact the |
treatment and resulting quality of care, and tools that perform |
predictive analytics on data applying to newborns, women with |
high risk pregnancies, and other populations served by the |
Department. |
(c) The Department of Healthcare and Family Services shall |
report in its annual Medical Assistance program report each |
April through April, 2015 on the progress and implementation of |
this plan. |
(305 ILCS 5/5-29 new) |
Sec. 5-29. Income Limits and Parental Responsibility. In |
light of the unprecedented fiscal crisis confronting the State, |
it is the intent of the General Assembly to explore whether the |
income limits and income counting methods established for |
children under the Covering ALL KIDS Health Insurance Act, |
pursuant to this amendatory Act of the 96th General Assembly, |
should apply to medical assistance programs available to |
children made eligible under the Illinois Public Aid Code, |
including through home and community based services waiver |
programs authorized under Section 1915(c) of the Social |
Security Act, where parental income is currently not considered |
in determining a child's eligibility for medical assistance. |
The Department of Healthcare and Family Services is hereby |
directed, with the participation of the Department of Human |
Services and stakeholders, to conduct an analysis of these |
|
programs to determine parental cost sharing opportunities, how |
these opportunities may impact the children currently in the |
programs, waivers and on the waiting list, and any other |
factors which may increase efficiencies and decrease State |
costs. The Department is further directed to review how |
services under these programs and waivers may be provided by |
the use of a combination of skilled, unskilled, and |
uncompensated care and to advise as to what revisions to the |
Nurse Practice Act, and Acts regulating other relevant |
professions, are necessary to accomplish this combination of |
care. The Department shall submit a written analysis on the |
children's programs and waivers as part of the Department's |
annual Medicaid reports due to the General Assembly in 2011 and |
2012. |
(305 ILCS 5/5-30 new) |
Sec. 5-30. Care coordination. |
(a) At least 50% of recipients eligible for comprehensive |
medical benefits in all medical assistance programs or other |
health benefit programs administered by the Department, |
including the Children's Health Insurance Program Act and the |
Covering ALL KIDS Health Insurance Act, shall be enrolled in a |
care coordination program by no later than January 1, 2015. For |
purposes of this Section, "coordinated care" or "care |
coordination" means delivery systems where recipients will |
receive their care from providers who participate under |
|
contract in integrated delivery systems that are responsible |
for providing or arranging the majority of care, including |
primary care physician services, referrals from primary care |
physicians, diagnostic and treatment services, behavioral |
health services, in-patient and outpatient hospital services, |
dental services, and rehabilitation and long-term care |
services. The Department shall designate or contract for such |
integrated delivery systems (i) to ensure enrollees have a |
choice of systems and of primary care providers within such |
systems; (ii) to ensure that enrollees receive quality care in |
a culturally and linguistically appropriate manner; and (iii) |
to ensure that coordinated care programs meet the diverse needs |
of enrollees with developmental, mental health, physical, and |
age-related disabilities. |
(b) Payment for such coordinated care shall be based on |
arrangements where the State pays for performance related to |
health care outcomes, the use of evidence-based practices, the |
use of primary care delivered through comprehensive medical |
homes, the use of electronic medical records, and the |
appropriate exchange of health information electronically made |
either on a capitated basis in which a fixed monthly premium |
per recipient is paid and full financial risk is assumed for |
the delivery of services, or through other risk-based payment |
arrangements. |
(c) To qualify for compliance with this Section, the 50% |
goal shall be achieved by enrolling medical assistance |
|
enrollees from each medical assistance enrollment category, |
including parents, children, seniors, and people with |
disabilities to the extent that current State Medicaid payment |
laws would not limit federal matching funds for recipients in |
care coordination programs. In addition, services must be more |
comprehensively defined and more risk shall be assumed than in |
the Department's primary care case management program as of the |
effective date of this amendatory Act of the 96th General |
Assembly. |
(d) The Department shall report to the General Assembly in |
a separate part of its annual medical assistance program |
report, beginning April, 2012 until April, 2016, on the |
progress and implementation of the care coordination program |
initiatives established by the provisions of this amendatory |
Act of the 96th General Assembly. The Department shall include |
in its April 2011 report a full analysis of federal laws or |
regulations regarding upper payment limitations to providers |
and the necessary revisions or adjustments in rate |
methodologies and payments to providers under this Code that |
would be necessary to implement coordinated care with full |
financial risk by a party other than the Department.
|
(305 ILCS 5/8A-2.5)
|
Sec. 8A-2.5. Unauthorized use of medical assistance.
|
(a) Any person who knowingly uses, acquires, possesses, or |
transfers a
medical card in any manner not authorized by law or |
|
by rules and regulations of
the Illinois Department, or who |
knowingly alters a medical card, or who
knowingly uses, |
acquires, possesses, or transfers an altered medical card, is
|
guilty of a violation of this Article and shall be punished as |
provided in
Section 8A-6.
|
(b) Any person who knowingly obtains unauthorized medical |
benefits with or
without use of a medical card is guilty of a |
violation of this Article and
shall be punished as provided in |
Section 8A-6.
|
(c) The Department may seek to recover any and all State |
and federal monies for which it has improperly and erroneously |
paid benefits as a result of a fraudulent action and any civil |
penalties authorized in this Section. Pursuant to Section |
11-14.5 of this Code, the Department may determine the monetary |
value of benefits improperly and erroneously received. The |
Department may recover the monies paid for such benefits and |
interest on that amount at the rate of 5% per annum for the |
period from which payment was made to the date upon which |
repayment is made to the State. Prior to the recovery of any |
amount paid for benefits allegedly obtained by fraudulent |
means, the recipient of such benefits shall be afforded an |
opportunity for a hearing after reasonable notice. The notice |
shall be served personally or by certified or registered mail |
or as otherwise provided by law upon the parties or their |
agents appointed to receive service of process and shall |
include the following: |
|
(1) A statement of the time, place and nature of the |
hearing. |
(2) A statement of the legal authority and jurisdiction |
under which the hearing is to be held. |
(3) A reference to the particular Sections of the |
substantive and procedural statutes and rules involved. |
(4) Except where a more detailed statement is otherwise |
provided for by law, a short and plain statement of the |
matters asserted, the consequences of a failure to respond, |
and the official file or other reference number. |
(5) A statement of the monetary value of the benefits |
fraudulently received by the person accused. |
(6) A statement that, in addition to any other |
penalties provided by law, a civil penalty in an amount not |
to exceed $2,000 may be imposed for each fraudulent claim |
for benefits or payments. |
(7) A statement providing that the determination of the |
monetary value may be contested by petitioning the |
Department for an administrative hearing within 30 days |
from the date of mailing the notice. |
(8) The names and mailing addresses of the |
administrative law judge, all parties, and all other |
persons to whom the agency gives notice of the hearing |
unless otherwise confidential by law. |
An opportunity shall be afforded all parties to be |
represented by legal counsel and to respond and present |
|
evidence and argument. |
Unless precluded by law, disposition may be made of any |
contested case by stipulation, agreed settlement, consent |
order, or default. |
Any final order, decision, or other determination made, |
issued or executed by the Director under the provisions of this |
Article whereby any person is aggrieved shall be subject to |
review in accordance with the provisions of the Administrative |
Review Law, and the rules adopted pursuant thereto, which shall |
apply to and govern all proceedings for the judicial review of |
final administrative decisions of the Director. |
Upon entry of a final administrative decision for repayment |
of any benefits obtained by fraudulent means, or for any civil |
penalties assessed, a lien shall attach to all property and |
assets of such person, firm, corporation, association, agency, |
institution, or other legal entity until the judgment is |
satisfied. |
Within 12 months of the effective date of this amendatory |
Act of the 96th General Assembly, the Department of Healthcare |
and Family Services will report to the General Assembly on the |
number of fraud cases identified and pursued, and the fines |
assessed and collected. The report will also include the |
Department's analysis as to the use of private sector resources |
to bring action, investigate, and collect monies owed. |
(Source: P.A. 89-289, eff. 1-1-96.)
|
|
(305 ILCS 5/11-5.1 new) |
Sec. 11-5.1. Eligibility verification. Notwithstanding any |
other provision of this Code, with respect to applications for |
medical assistance provided under Article V of this Code, |
eligibility shall be determined in a manner that ensures |
program integrity and complies with federal laws and |
regulations while minimizing unnecessary barriers to |
enrollment. To this end, as soon as practicable, and unless the |
Department receives written denial from the federal |
government, this Section shall be implemented: |
(a) The Department of Healthcare and Family Services or its |
designees shall: |
(1) By no later than July 1, 2011, require verification |
of, at a minimum, one month's income from all sources |
required for determining the eligibility of applicants for |
medical assistance under this Code. Such verification |
shall take the form of pay stubs, business or income and |
expense records for self-employed persons, letters from |
employers, and any other valid documentation of income |
including data obtained electronically by the Department |
or its designees from other sources as described in |
subsection (b) of this Section. |
(2) By no later than October 1, 2011, require |
verification of, at a minimum, one month's income from all |
sources required for determining the continued eligibility |
of recipients at their annual review of eligibility for |
|
medical assistance under this Code. Such verification |
shall take the form of pay stubs, business or income and |
expense records for self-employed persons, letters from |
employers, and any other valid documentation of income |
including data obtained electronically by the Department |
or its designees from other sources as described in |
subsection (b) of this Section. The
Department shall send a |
notice to
recipients at least 60 days prior to the end of |
their period
of eligibility that informs them of the
|
requirements for continued eligibility. If a recipient
|
does not fulfill the requirements for continued |
eligibility by the
deadline established in the notice a |
notice of cancellation shall be issued to the recipient and |
coverage shall end on the last day of the eligibility |
period. A recipient's eligibility may be reinstated |
without requiring a new application if the recipient |
fulfills the requirements for continued eligibility prior |
to the end of the month following the last date of |
coverage. Nothing in this Section shall prevent an |
individual whose coverage has been cancelled from |
reapplying for health benefits at any time. |
(3) By no later than July 1, 2011, require verification |
of Illinois residency. |
(b) The Department shall establish or continue cooperative
|
arrangements with the Social Security Administration, the
|
Illinois Secretary of State, the Department of Human Services,
|
|
the Department of Revenue, the Department of Employment
|
Security, and any other appropriate entity to gain electronic
|
access, to the extent allowed by law, to information available
|
to those entities that may be appropriate for electronically
|
verifying any factor of eligibility for benefits under the
|
Program. Data relevant to eligibility shall be provided for no
|
other purpose than to verify the eligibility of new applicants |
or current recipients of health benefits under the Program. |
Data shall be requested or provided for any new applicant or |
current recipient only insofar as that individual's |
circumstances are relevant to that individual's or another |
individual's eligibility. |
(c) Within 90 days of the effective date of this amendatory |
Act of the 96th General Assembly, the Department of Healthcare |
and Family Services shall send notice to current recipients |
informing them of the changes regarding their eligibility |
verification.
|
(305 ILCS 5/11-26) (from Ch. 23, par. 11-26)
|
Sec. 11-26.
Recipient's abuse of medical care; |
restrictions on access to
medical care.
|
(a) When the Department determines, on the basis of |
statistical norms and
medical judgment, that a medical care |
recipient has received medical services
in excess of need and |
with such frequency or in such a manner as to constitute
an |
abuse of the recipient's medical care privileges, the |
|
recipient's access to
medical care may be restricted.
|
(b) When the Department has determined that a recipient is |
abusing his or
her medical care privileges as described in this |
Section, it may require that
the recipient designate a primary |
provider type primary care provider, primary care pharmacy, or
|
health maintenance organization of the recipient's own |
choosing to assume
responsibility for the recipient's care. For |
the purposes of this subsection, "primary provider type" means |
a primary care provider, primary care pharmacy, primary |
dentist, primary podiatrist, or primary durable medical |
equipment provider. Instead of requiring a recipient to
make a |
designation as provided in this subsection, the Department, |
pursuant to
rules adopted by the Department and without regard |
to any choice of an entity
that the recipient might otherwise |
make, may initially designate a primary provider type provided |
that the primary provider type is willing to provide that care |
primary care
provider, primary care pharmacy, or health |
maintenance organization to assume
responsibility for the |
recipient's care, provided that the primary care
provider, |
primary care pharmacy, or health maintenance organization is |
willing
to provide that care .
|
(c) When the Department has requested that a recipient |
designate a
primary provider type primary care provider, |
primary care pharmacy or health maintenance
organization and |
the recipient fails or refuses to do so, the Department
may, |
after a reasonable period of time, assign the recipient to a |
|
primary provider type of its own choice and determination, |
provided such primary provider type is willing to provide such |
care primary care
provider, primary care pharmacy or health |
maintenance organization of its own
choice and determination, |
provided such primary care provider, primary care
pharmacy or |
health maintenance organization is willing to provide such |
care .
|
(d) When a recipient has been restricted to a designated |
primary provider type primary care
provider, primary care |
pharmacy or health maintenance organization , the
recipient may |
change the primary provider type primary care provider, primary |
care pharmacy or
health maintenance organization :
|
(1) when the designated source becomes unavailable, as |
the Department
shall determine by rule; or
|
(2) when the designated primary provider type primary |
care provider, primary care pharmacy or
health maintenance |
organization notifies the Department that it wishes to
|
withdraw from any obligation as primary provider type |
primary care provider, primary care pharmacy or health |
maintenance organization ; or
|
(3) in other situations, as the Department shall |
provide by rule.
|
The Department shall, by rule, establish procedures for |
providing medical or
pharmaceutical services when the |
designated source becomes unavailable or
wishes to withdraw |
from any obligation as primary provider type primary care |
|
provider, primary care
pharmacy or health maintenance |
organization , shall, by rule, take into
consideration the need |
for emergency or temporary medical assistance and shall
ensure |
that the recipient has continuous and unrestricted access to |
medical
care from the date on which such unavailability or |
withdrawal becomes effective
until such time as the recipient |
designates a primary provider type or a primary provider type |
care source or a primary
care source willing to provide such |
care is designated by the Department
consistent with |
subsections (b) and (c) and such restriction becomes effective.
|
(e) Prior to initiating any action to restrict a |
recipient's access to
medical or pharmaceutical care, the |
Department shall notify the recipient
of its intended action. |
Such notification shall be in writing and shall set
forth the |
reasons for and nature of the proposed action. In addition, the
|
notification shall:
|
(1) inform the recipient that (i) the recipient has a |
right to
designate a primary provider type primary care |
provider, primary care pharmacy, or health maintenance
|
organization of the recipient's own choosing willing to |
accept such designation
and that the recipient's failure to |
do so within a reasonable time may result
in such |
designation being made by the Department or (ii) the |
Department has
designated a primary provider type primary |
care provider, primary care pharmacy, or health
|
maintenance organization to assume responsibility for the |
|
recipient's care; and
|
(2) inform the recipient that the recipient has a right |
to appeal the
Department's determination to restrict the |
recipient's access to medical care
and provide the |
recipient with an explanation of how such appeal is to be
|
made. The notification shall also inform the recipient of |
the circumstances
under which unrestricted medical |
eligibility shall continue until a decision is
made on |
appeal and that if the recipient chooses to appeal, the |
recipient will
be able to review the medical payment data |
that was utilized by the Department
to decide that the |
recipient's access to medical care should be restricted.
|
(f) The Department shall, by rule or regulation, establish |
procedures for
appealing a determination to restrict a |
recipient's access to medical care,
which procedures shall, at |
a minimum, provide for a reasonable opportunity
to be heard |
and, where the appeal is denied, for a written statement
of the |
reason or reasons for such denial.
|
(g) Except as otherwise provided in this subsection, when a |
recipient
has had his or her medical card restricted for 4 full |
quarters (without regard
to any period of ineligibility for |
medical assistance under this Code, or any
period for which the |
recipient voluntarily terminates his or her receipt of
medical |
assistance, that may occur before the expiration of those 4 |
full
quarters), the Department shall reevaluate the |
recipient's medical usage to
determine whether it is still in |
|
excess of need and with such frequency or in
such a manner as |
to constitute an abuse of the receipt of medical assistance.
If |
it is still in excess of need, the restriction shall be |
continued for
another 4 full quarters. If it is no longer in |
excess of need, the restriction
shall be discontinued. If a |
recipient's access to medical care has been
restricted under |
this Section and the Department then determines, either at
|
reevaluation or after the restriction has been discontinued, to |
restrict the
recipient's access to medical care a second or |
subsequent time, the second or
subsequent restriction may be |
imposed for a period of more than 4 full
quarters. If the |
Department restricts a recipient's access to medical care for
a |
period of more than 4 full quarters, as determined by rule, the |
Department
shall reevaluate the recipient's medical usage |
after the end of the restriction
period rather than after the |
end of 4 full quarters. The Department shall
notify the |
recipient, in writing, of any decision to continue the |
restriction
and the reason or reasons therefor. A "quarter", |
for purposes of this Section,
shall be defined as one of the |
following 3-month periods of time:
January-March, April-June, |
July-September or October-December.
|
(h) In addition to any other recipient whose acquisition of |
medical care
is determined to be in excess of need, the |
Department may restrict the medical
care privileges of the |
following persons:
|
(1) recipients found to have loaned or altered their |
|
cards or misused or
falsely represented medical coverage;
|
(2) recipients found in possession of blank or forged |
prescription pads;
|
(3) recipients who knowingly assist providers in |
rendering excessive
services or defrauding the medical |
assistance program.
|
The procedural safeguards in this Section shall apply to |
the above
individuals.
|
(i) Restrictions under this Section shall be in addition to |
and shall
not in any way be limited by or limit any actions |
taken under Article
VIII-A of this Code.
|
(Source: P.A. 88-554, eff. 7-26-94 .)
|
(305 ILCS 5/5-5.15 rep.)
|
Section 45. The Illinois Public Aid Code is amended by |
repealing Section 5-5.15. |
Section 50. The Illinois Vehicle Code is amended by |
changing Section 2-123 as follows:
|
(625 ILCS 5/2-123) (from Ch. 95 1/2, par. 2-123)
|
Sec. 2-123. Sale and Distribution of Information.
|
(a) Except as otherwise provided in this Section, the |
Secretary may make the
driver's license, vehicle and title |
registration lists, in part or in whole,
and any statistical |
information derived from these lists available to local
|
|
governments, elected state officials, state educational |
institutions, and all
other governmental units of the State and |
Federal
Government
requesting them for governmental purposes. |
The Secretary shall require any such
applicant for services to |
pay for the costs of furnishing such services and the
use of |
the equipment involved, and in addition is empowered to |
establish prices
and charges for the services so furnished and |
for the use of the electronic
equipment utilized.
|
(b) The Secretary is further empowered to and he may, in |
his discretion,
furnish to any applicant, other than listed in |
subsection (a) of this Section,
vehicle or driver data on a |
computer tape, disk, other electronic format or
computer |
processable medium, or printout at a fixed fee of
$250 for |
orders received before October 1, 2003 and $500 for orders |
received
on or after October 1, 2003, in advance, and require |
in addition a
further sufficient
deposit based upon the |
Secretary of State's estimate of the total cost of the
|
information requested and a charge of $25 for orders received |
before October
1, 2003 and $50 for orders received on or after |
October 1, 2003, per 1,000
units or part
thereof identified or |
the actual cost, whichever is greater. The Secretary is
|
authorized to refund any difference between the additional |
deposit and the
actual cost of the request. This service shall |
not be in lieu of an abstract
of a driver's record nor of a |
title or registration search. This service may
be limited to |
entities purchasing a minimum number of records as required by
|
|
administrative rule. The information
sold pursuant to this |
subsection shall be the entire vehicle or driver data
list, or |
part thereof. The information sold pursuant to this subsection
|
shall not contain personally identifying information unless |
the information is
to be used for one of the purposes |
identified in subsection (f-5) of this
Section. Commercial |
purchasers of driver and vehicle record databases shall
enter |
into a written agreement with the Secretary of State that |
includes
disclosure of the commercial use of the information to |
be purchased. |
(b-1) The Secretary is further empowered to and may, in his |
or her discretion, furnish vehicle or driver data on a computer |
tape, disk, or other electronic format or computer processible |
medium, at no fee, to any State or local governmental agency |
that uses the information provided by the Secretary to transmit |
data back to the Secretary that enables the Secretary to |
maintain accurate driving records, including dispositions of |
traffic cases. This information may be provided without fee not |
more often than once every 6 months.
|
(c) Secretary of State may issue registration lists. The |
Secretary
of State may compile a list of all registered
|
vehicles. Each list of registered vehicles shall be arranged |
serially
according to the registration numbers assigned to |
registered vehicles and
may contain in addition the names and |
addresses of registered owners and
a brief description of each |
vehicle including the serial or other
identifying number |
|
thereof. Such compilation may be in such form as in the
|
discretion of the Secretary of State may seem best for the |
purposes intended.
|
(d) The Secretary of State shall furnish no more than 2 |
current available
lists of such registrations to the sheriffs |
of all counties and to the chiefs
of police of all cities and |
villages and towns of 2,000 population and over
in this State |
at no cost. Additional copies may be purchased by the sheriffs
|
or chiefs of police at the fee
of $500 each or at the cost of |
producing the list as determined
by the Secretary of State. |
Such lists are to be used for governmental
purposes only.
|
(e) (Blank).
|
(e-1) (Blank).
|
(f) The Secretary of State shall make a title or |
registration search of the
records of his office and a written |
report on the same for any person, upon
written application of |
such person, accompanied by a fee of $5 for
each registration |
or title search. The written application shall set forth
the |
intended use of the requested information. No fee shall be |
charged for a
title or
registration search, or for the |
certification thereof requested by a government
agency. The |
report of the title or registration search shall not contain
|
personally identifying information unless the request for a |
search was made for
one of the purposes identified in |
subsection (f-5) of this Section. The report of the title or |
registration search shall not contain highly
restricted |
|
personal
information unless specifically authorized by this |
Code.
|
The Secretary of State shall certify a title or |
registration record upon
written request. The fee for |
certification shall be $5 in addition
to the fee required for a |
title or registration search. Certification shall
be made under |
the signature of the Secretary of State and shall be
|
authenticated by Seal of the Secretary of State.
|
The Secretary of State may notify the vehicle owner or |
registrant of
the request for purchase of his title or |
registration information as the
Secretary deems appropriate.
|
No information shall be released to the requestor until |
expiration of a
10 day period. This 10 day period shall not |
apply to requests for
information made by law enforcement |
officials, government agencies,
financial institutions, |
attorneys, insurers, employers, automobile
associated |
businesses, persons licensed as a private detective or firms
|
licensed as a private detective agency under the Private |
Detective, Private
Alarm, Private Security, Fingerprint |
Vendor, and Locksmith Act of 2004, who are employed by or are
|
acting on
behalf of law enforcement officials, government |
agencies, financial
institutions, attorneys, insurers, |
employers, automobile associated businesses,
and other |
business entities for purposes consistent with the Illinois |
Vehicle
Code, the vehicle owner or registrant or other entities |
as the Secretary may
exempt by rule and regulation.
|
|
Any misrepresentation made by a requestor of title or |
vehicle information
shall be punishable as a petty offense, |
except in the case of persons
licensed as a private detective |
or firms licensed as a private detective agency
which shall be |
subject to disciplinary sanctions under Section 40-10 of the
|
Private Detective, Private Alarm, Private Security, |
Fingerprint Vendor, and Locksmith Act of 2004.
|
(f-5) The Secretary of State shall not disclose or |
otherwise make
available to
any person or entity any personally |
identifying information obtained by the
Secretary
of State in |
connection with a driver's license, vehicle, or title |
registration
record
unless the information is disclosed for one |
of the following purposes:
|
(1) For use by any government agency, including any |
court or law
enforcement agency, in carrying out its |
functions, or any private person or
entity acting on behalf |
of a federal, State, or local agency in carrying out
its
|
functions.
|
(2) For use in connection with matters of motor vehicle |
or driver safety
and theft; motor vehicle emissions; motor |
vehicle product alterations, recalls,
or advisories; |
performance monitoring of motor vehicles, motor vehicle |
parts,
and dealers; and removal of non-owner records from |
the original owner
records of motor vehicle manufacturers.
|
(3) For use in the normal course of business by a |
legitimate business or
its agents, employees, or |
|
contractors, but only:
|
(A) to verify the accuracy of personal information |
submitted by
an individual to the business or its |
agents, employees, or contractors;
and
|
(B) if such information as so submitted is not |
correct or is no
longer correct, to obtain the correct |
information, but only for the
purposes of preventing |
fraud by, pursuing legal remedies against, or
|
recovering on a debt or security interest against, the |
individual.
|
(4) For use in research activities and for use in |
producing statistical
reports, if the personally |
identifying information is not published,
redisclosed, or |
used to
contact individuals.
|
(5) For use in connection with any civil, criminal, |
administrative, or
arbitral proceeding in any federal, |
State, or local court or agency or before
any
|
self-regulatory body, including the service of process, |
investigation in
anticipation of litigation, and the |
execution or enforcement of judgments and
orders, or |
pursuant to an order of a federal, State, or local court.
|
(6) For use by any insurer or insurance support |
organization or by a
self-insured entity or its agents, |
employees, or contractors in connection with
claims |
investigation activities, antifraud activities, rating, or |
underwriting.
|
|
(7) For use in providing notice to the owners of towed |
or
impounded vehicles.
|
(8) For use by any person licensed as a private |
detective or firm licensed as a private
detective agency |
under
the Private Detective, Private Alarm, Private |
Security, Fingerprint Vendor, and Locksmith Act of
2004, |
private investigative agency or security service
licensed |
in Illinois for any purpose permitted under this |
subsection.
|
(9) For use by an employer or its agent or insurer to |
obtain or verify
information relating to a holder of a |
commercial driver's license that is
required under chapter |
313 of title 49 of the United States Code.
|
(10) For use in connection with the operation of |
private toll
transportation facilities.
|
(11) For use by any requester, if the requester |
demonstrates it has
obtained the written consent of the |
individual to whom the information
pertains.
|
(12) For use by members of the news media, as defined |
in
Section 1-148.5, for the purpose of newsgathering when |
the request relates to
the
operation of a motor vehicle or |
public safety.
|
(13) For any other use specifically authorized by law, |
if that use is
related to the operation of a motor vehicle |
or public safety. |
(f-6) The Secretary of State shall not disclose or |
|
otherwise make
available to any
person or entity any highly |
restricted personal information obtained by the
Secretary of
|
State in connection with a driver's license, vehicle, or
title |
registration
record unless
specifically authorized by this |
Code.
|
(g) 1. The Secretary of State may, upon receipt of a |
written request
and a fee of $6 before October 1, 2003 and |
a fee of $12 on and after October
1, 2003, furnish to the |
person or agency so requesting a
driver's record. Such |
document may include a record of: current driver's
license |
issuance information, except that the information on |
judicial driving
permits shall be available only as |
otherwise provided by this Code;
convictions; orders |
entered revoking, suspending or cancelling a
driver's
|
license or privilege; and notations of accident |
involvement. All other
information, unless otherwise |
permitted by
this Code, shall remain confidential. |
Information released pursuant to a
request for a driver's |
record shall not contain personally identifying
|
information, unless the request for the driver's record was |
made for one of the
purposes set forth in subsection (f-5) |
of this Section. The Secretary of State may, without fee, |
allow a parent or guardian of a person under the age of 18 |
years, who holds an instruction permit or graduated |
driver's license, to view that person's driving record |
online, through a computer connection.
The parent or |
|
guardian's online access to the driving record will |
terminate when the instruction permit or graduated |
driver's license holder reaches the age of 18.
|
2. The Secretary of State shall not disclose or |
otherwise make available
to any
person or
entity any highly |
restricted personal information obtained by the Secretary |
of
State in
connection with a driver's license, vehicle, or |
title
registration record
unless specifically
authorized |
by this Code. The Secretary of State may certify an |
abstract of a driver's record
upon written request |
therefor. Such certification
shall be made under the |
signature of the Secretary of State and shall be
|
authenticated by the Seal of his office.
|
3. All requests for driving record information shall be |
made in a manner
prescribed by the Secretary and shall set |
forth the intended use of the
requested information.
|
The Secretary of State may notify the affected driver |
of the request
for purchase of his driver's record as the |
Secretary deems appropriate.
|
No information shall be released to the requester until |
expiration of a
10 day period. This 10 day period shall not |
apply to requests for information
made by law enforcement |
officials, government agencies, financial institutions,
|
attorneys, insurers, employers, automobile associated |
businesses, persons
licensed as a private detective or |
firms licensed as a private detective agency
under the |
|
Private Detective, Private Alarm, Private Security, |
Fingerprint Vendor, and Locksmith Act
of 2004,
who are |
employed by or are acting on behalf of law enforcement |
officials,
government agencies, financial institutions, |
attorneys, insurers, employers,
automobile associated |
businesses, and other business entities for purposes
|
consistent with the Illinois Vehicle Code, the affected |
driver or other
entities as the Secretary may exempt by |
rule and regulation.
|
Any misrepresentation made by a requestor of driver |
information shall
be punishable as a petty offense, except |
in the case of persons licensed as
a private detective or |
firms licensed as a private detective agency which shall
be |
subject to disciplinary sanctions under Section 40-10 of |
the Private
Detective, Private Alarm, Private Security, |
Fingerprint Vendor, and Locksmith Act of 2004.
|
4. The Secretary of State may furnish without fee, upon |
the written
request of a law enforcement agency, any |
information from a driver's
record on file with the |
Secretary of State when such information is required
in the |
enforcement of this Code or any other law relating to the |
operation
of motor vehicles, including records of |
dispositions; documented
information involving the use of |
a motor vehicle; whether such individual
has, or previously |
had, a driver's license; and the address and personal
|
description as reflected on said driver's record.
|
|
5. Except as otherwise provided in this Section, the |
Secretary of
State may furnish, without fee, information |
from an individual driver's
record on file, if a written |
request therefor is submitted
by any public transit system |
or authority, public defender, law enforcement
agency, a |
state or federal agency, or an Illinois local |
intergovernmental
association, if the request is for the |
purpose of a background check of
applicants for employment |
with the requesting agency, or for the purpose of
an |
official investigation conducted by the agency, or to |
determine a
current address for the driver so public funds |
can be recovered or paid to
the driver, or for any other |
purpose set forth in subsection (f-5)
of this Section.
|
The Secretary may also furnish the courts a copy of an |
abstract of a
driver's record, without fee, subsequent to |
an arrest for a violation of
Section 11-501 or a similar |
provision of a local ordinance. Such abstract
may include |
records of dispositions; documented information involving
|
the use of a motor vehicle as contained in the current |
file; whether such
individual has, or previously had, a |
driver's license; and the address and
personal description |
as reflected on said driver's record.
|
6. Any certified abstract issued by the Secretary of |
State or
transmitted electronically by the Secretary of |
State pursuant to this
Section,
to a court or on request of |
a law enforcement agency, for the record of a
named person |
|
as to the status of the person's driver's license shall be
|
prima facie evidence of the facts therein stated and if the |
name appearing
in such abstract is the same as that of a |
person named in an information or
warrant, such abstract |
shall be prima facie evidence that the person named
in such |
information or warrant is the same person as the person |
named in
such abstract and shall be admissible for any |
prosecution under this Code and
be admitted as proof of any |
prior conviction or proof of records, notices, or
orders |
recorded on individual driving records maintained by the |
Secretary of
State.
|
7. Subject to any restrictions contained in the |
Juvenile Court Act of
1987, and upon receipt of a proper |
request and a fee of $6 before October 1,
2003 and a fee of |
$12 on or after October 1, 2003, the
Secretary of
State |
shall provide a driver's record to the affected driver, or |
the affected
driver's attorney, upon verification. Such |
record shall contain all the
information referred to in |
paragraph 1 of this subsection (g) plus: any
recorded |
accident involvement as a driver; information recorded |
pursuant to
subsection (e) of Section 6-117 and paragraph |
(4) of subsection (a) of
Section 6-204 of this Code. All |
other information, unless otherwise permitted
by this |
Code, shall remain confidential.
|
(h) The Secretary shall not disclose social security |
numbers or any associated information obtained from the Social |
|
Security Administration except pursuant
to a written request |
by, or with the prior written consent of, the
individual |
except: (1) to officers and employees of the Secretary
who
have |
a need to know the social security numbers in performance of |
their
official duties, (2) to law enforcement officials for a |
lawful, civil or
criminal law enforcement investigation, and if |
the head of the law enforcement
agency has made a written |
request to the Secretary specifying the law
enforcement |
investigation for which the social security numbers are being
|
sought, (3) to the United States Department of Transportation, |
or any other
State, pursuant to the administration and |
enforcement of the Commercial
Motor Vehicle Safety Act of 1986, |
(4) pursuant to the order of a court
of competent jurisdiction, |
(5) to the Department of Healthcare and Family Services |
(formerly Department of Public Aid) for
utilization
in the |
child support enforcement duties assigned to that Department |
under
provisions of the Illinois Public Aid Code after the |
individual has received advanced
meaningful notification of |
what redisclosure is sought by the Secretary in
accordance with |
the federal Privacy Act, (5.5) to the Department of Healthcare |
and Family Services and the Department of Human Services solely |
for the purpose of verifying Illinois residency where such |
residency is an eligibility requirement for benefits under the |
Illinois Public Aid Code or any other health benefit program |
administered by the Department of Healthcare and Family |
Services or the Department of Human Services, or (6) to the |
|
Illinois Department of Revenue solely for use by the Department |
in the collection of any tax or debt that the Department of |
Revenue is authorized or required by law to collect, provided |
that the Department shall not disclose the social security |
number to any person or entity outside of the Department.
|
(i) (Blank).
|
(j) Medical statements or medical reports received in the |
Secretary of
State's Office shall be confidential. No |
confidential information may be
open to public inspection or |
the contents disclosed to anyone, except
officers and employees |
of the Secretary who have a need to know the information
|
contained in the medical reports and the Driver License Medical |
Advisory
Board, unless so directed by an order of a court of |
competent jurisdiction.
|
(k) All fees collected under this Section shall be paid |
into the Road
Fund of the State Treasury, except that (i) for |
fees collected before October
1, 2003, $3 of the $6 fee for a
|
driver's record shall be paid into the Secretary of State |
Special Services
Fund, (ii) for fees collected on and after |
October 1, 2003, of the $12 fee
for a driver's record, $3 shall |
be paid into the Secretary of State Special
Services Fund and |
$6 shall be paid into the General Revenue Fund, and (iii) for
|
fees collected on and after October 1, 2003, 50% of the amounts |
collected
pursuant to subsection (b) shall be paid into the |
General Revenue Fund.
|
(l) (Blank).
|
|
(m) Notations of accident involvement that may be disclosed |
under this
Section shall not include notations relating to |
damage to a vehicle or other
property being transported by a |
tow truck. This information shall remain
confidential, |
provided that nothing in this subsection (m) shall limit
|
disclosure of any notification of accident involvement to any |
law enforcement
agency or official.
|
(n) Requests made by the news media for driver's license, |
vehicle, or
title registration information may be furnished |
without charge or at a reduced
charge, as determined by the |
Secretary, when the specific purpose for
requesting the |
documents is deemed to be in the public interest. Waiver or
|
reduction of the fee is in the public interest if the principal |
purpose of the
request is to access and disseminate information |
regarding the health, safety,
and welfare or the legal rights |
of the general public and is not for the
principal purpose of |
gaining a personal or commercial benefit.
The information |
provided pursuant to this subsection shall not contain
|
personally identifying information unless the information is |
to be used for one
of the
purposes identified in subsection |
(f-5) of this Section.
|
(o) The redisclosure of personally identifying information
|
obtained
pursuant
to this Section is prohibited, except to the |
extent necessary to effectuate the
purpose
for which the |
original disclosure of the information was permitted.
|
(p) The Secretary of State is empowered to adopt rules
to
|
|
effectuate this Section.
|
(Source: P.A. 95-201, eff. 1-1-08; 95-287, eff. 1-1-08; 95-331, |
eff. 8-21-07; 95-613, eff. 9-11-07; 95-876, eff. 8-21-08; |
96-1383, eff. 1-1-11.)
|
Section 95. Severability. If any provision of this Act or |
application thereof to any person or circumstance is held |
invalid, such invalidity does not affect other provisions or |
applications of this Act which can be given effect without the |
invalid application or provision, and to this end the |
provisions of this Act are declared to be severable.
|
Section 99. Effective date. This Act takes effect upon |
becoming law.
|