Public Act 101-0265
 
HB2659 EnrolledLRB101 09331 KTG 54427 b


  
    AN ACT concerning public aid.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    Section 5. The Illinois Public Aid Code is amended  by 
changing Section 11-5.4 as follows:
 
    (305 ILCS 5/11-5.4)
    Sec. 11-5.4. Expedited long-term care eligibility 
determination and enrollment.
    (a) Establishment of the expedited long-term care 
eligibility determination and enrollment system shall be a 
joint venture of the Departments of Human Services and 
Healthcare and Family Services and the Department on Aging.
    (b) Streamlined application enrollment process; expedited 
eligibility process. The  streamlined application and 
enrollment process must include, but need not be limited to, 
the following: 
        (1)  On or before July 1, 2019, a streamlined 
    application and enrollment process shall be put in place 
    which must include, but need not be limited to, the 
    following: 
            (A) Minimize the burden on applicants by 
        collecting only the data necessary to determine 
        eligibility for medical services, long-term care 
        services, and spousal impoverishment offset. 
            (B) Integrate online data sources to simplify the 
        application process by reducing the amount of 
        information needed to be entered and to expedite 
        eligibility verification. 
            (C) Provide online prompts to alert the applicant 
        that information is missing or not complete. 
            (D) Provide training and step-by-step written 
        instructions for caseworkers, applicants, and 
        providers. 
        (2) The State must expedite the eligibility process  for 
    applicants meeting specified guidelines, regardless of the 
    age of the application.  The guidelines, subject to federal 
    approval, must include, but need not be limited to, the 
    following individually or collectively: 
            (A) Full Medicaid benefits in the community for a 
        specified period of time.
            (B) No transfer of assets or resources during the 
        federally prescribed look-back period, as specified in 
        federal law.
            (C) Receives
Supplemental Security Income payments 
        or was receiving such payments at the time of admission 
        to a nursing facility.
            (D) For applicants or recipients with verified 
        income at or below 100% of the federal poverty level 
        when the declared value of their countable resources is 
        no greater than the allowable amounts pursuant to 
        Section 5-2 of this Code for classes of eligible  
        persons for whom a resource limit applies.  Such 
        simplified verification policies shall apply to 
        community cases as well as long-term care cases.
        (3) Subject to federal approval, the Department of 
    Healthcare and Family Services must implement an ex parte 
    renewal process for Medicaid-eligible individuals residing 
    in long-term care facilities. "Renewal" has the same 
    meaning as "redetermination" in State policies, 
    administrative rule, and federal Medicaid law. The ex parte 
    renewal process must be fully operational on or before 
    January 1, 2019.
        (4) The Department of Human Services must use the 
    standards and distribution requirements described in this 
    subsection and in Section 11-6 for notification of missing 
    supporting documents and information during all phases of 
    the application  process: initial, renewal, and appeal.
    (c) The Department of Human Services must adopt policies 
and procedures to improve communication between long-term care 
benefits central office personnel, applicants and their 
representatives, and facilities in which the applicants 
reside.  Such policies and procedures must at a minimum permit 
applicants and their representatives and the facility in which 
the applicants reside to speak directly to an individual 
trained to take telephone inquiries and provide appropriate 
responses.

    (d) Effective 30 days after the completion of 3 regionally 
based trainings, nursing facilities shall submit all 
applications for medical assistance online via the Application 
for Benefits Eligibility (ABE) website. This requirement shall 
extend to scanning and uploading with the online application 
any required additional forms such as the Long Term Care 
Facility Notification and the Additional Financial Information 
for Long Term Care Applicants as well as scanned copies of any 
supporting documentation.  Long-term care facility admission 
documents must be submitted as required in Section 5-5 of this 
Code. No local Department of Human Services office shall refuse 
to accept an electronically filed application.  No Department of 
Human Services office shall request submission of any document 
in hard copy. 
    (e) Notwithstanding any other provision of this Code, the 
Department of Human Services and the Department of Healthcare 
and Family Services' Office of the Inspector General shall, 
upon request, allow an applicant additional time to submit 
information and documents needed as part of a review of 
available resources or resources transferred during the 
look-back period.  The initial extension shall not exceed 30 
days.  A second extension of 30 days may be granted upon 
request. Any request for information issued by the State to an 
applicant shall include the following: an explanation of  the 
information required and the date by which the information must 
be submitted; a statement that failure to respond in a timely 
manner can result in denial of the application; a statement 
that the applicant or the facility in the name of the applicant 
may seek an extension; and the name and contact information of 
a caseworker in case of questions.  Any such request for 
information shall also be sent to the facility.  In deciding 
whether to grant an extension, the Department of Human Services 
or the Department of Healthcare and Family Services' Office of 
the Inspector General shall take into account what is in the 
best interest of the applicant. The time limits for processing 
an application shall be tolled during the period of any 
extension granted under this subsection. 
    (f) The Department of Human Services and the Department of 
Healthcare and Family Services must jointly compile data on 
pending applications, denials, appeals, and redeterminations 
into a monthly report, which shall be posted on each 
Department's website for the purposes of monitoring long-term 
care eligibility processing. The report must specify the number 
of applications and redeterminations pending long-term care 
eligibility determination and admission and  the number of 
appeals of denials in the following categories: 
        (A) Length of time applications, redeterminations, and 
    appeals are pending - 0 to 45 days, 46 days  to 90 days, 91 
    days to 180 days, 181 days to 12 months, over 12 months to 
    18 months, over 18 months to 24 months, and over 24 months.
        (B) Percentage of applications and redeterminations 
    pending in the Department of Human Services' Family 
    Community Resource Centers, in the Department of Human 
    Services' long-term care hubs, with the Department of 
    Healthcare and Family Services' Office of Inspector 
    General, and those applications which are being tolled due 
    to requests for extension of time for additional 
    information.
        (C) Status of pending applications, denials, appeals, 
    and redeterminations. 
    (g) Beginning on July 1, 2017, the Auditor General shall 
report every 3 years to the General Assembly on the performance 
and compliance of the Department of Healthcare and Family 
Services, the Department of Human Services, and the Department 
on Aging in meeting the requirements of this Section and the 
federal requirements concerning eligibility determinations for 
Medicaid long-term care services and supports, and shall report 
any issues or deficiencies and make recommendations. The 
Auditor General shall, at a minimum,  review, consider, and 
evaluate the following:
        (1) compliance with federal regulations on furnishing 
    services as related to Medicaid long-term care services and 
    supports as provided under 42 CFR 435.930;
        (2) compliance with federal regulations on the timely 
    determination of eligibility as provided under 42 CFR 
    435.912;
        (3) the accuracy and completeness of the report 
    required under paragraph (9) of subsection (e); 
        (4) the efficacy and efficiency of the task-based 
    process used for making eligibility determinations in the 
    centralized offices of the Department of Human Services for 
    long-term care services, including the role of the State's 
    integrated eligibility system, as opposed to the 
    traditional caseworker-specific process from which these 
    central offices have converted; and
        (5) any issues affecting eligibility determinations 
    related to the Department of Human Services' staff 
    completing Medicaid eligibility determinations instead of 
    the designated single-state Medicaid agency in Illinois, 
    the Department of Healthcare and Family Services. 
    The Auditor General's report shall include any and all 
other areas or issues which are identified through an annual 
review. Paragraphs (1) through (5) of this subsection shall not 
be construed to limit the scope of the annual review and the 
Auditor General's authority to thoroughly and completely 
evaluate any and all processes, policies, and procedures 
concerning compliance with federal and State law requirements 
on eligibility determinations for Medicaid long-term care 
services and supports. 
    (h) The Department of Healthcare and Family Services shall 
adopt any rules necessary to administer and enforce any 
provision of this Section. Rulemaking shall not delay the full 
implementation of this Section. 
    (g) The Department shall adopt rules necessary to 
administer and enforce any provision of this Section. 
Rulemaking shall not delay the full implementation of this 
Section. 
    (i) (h) Beginning on June 29, 2018, provisional 
eligibility, in
the form of a recipient identification number 
and any other necessary credentials to permit an applicant to 
receive benefits, must be issued to any applicant who has not 
received a final eligibility determination on his or her 
application for Medicaid or Medicaid long-term care benefits or 
a notice of an opportunity for a hearing within the federally 
prescribed deadlines for the processing of such applications.  
The Department must maintain the applicant's provisional 
Medicaid enrollment status until a final eligibility 
determination is approved or the applicant's appeal has been 
adjudicated and eligibility is denied. The Department or the 
managed care organization, if applicable, must reimburse 
providers for services rendered during an applicant's 
provisional eligibility period. 
        (1) Claims for services rendered to an applicant with 
    provisional eligibility status must be submitted and 
    processed in the same manner as those submitted on behalf 
    of beneficiaries determined to qualify for benefits. 
        (2) An applicant with provisional enrollment status 
    must have his or her benefits paid for under the State's   
    fee-for-service system until the State makes a final 
    determination on the applicant's Medicaid or Medicaid 
    long-term care application. If an individual is enrolled 
    with a managed care organization for community benefits at 
    the time the individual's provisional status is issued, the 
    managed care organization is only responsible for paying 
    benefits covered under the capitation payment received by 
    the managed care organization for the individual. 
        (3) The Department, within 10 business days of issuing 
    provisional eligibility to an applicant, must submit to the 
    Office of the Comptroller for payment a voucher for all 
    retroactive reimbursement due. The Department must clearly 
    identify such vouchers as provisional eligibility 
    vouchers. 
(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17; 
100-665, eff. 8-2-18; 100-1141, eff. 11-28-18.)
 
 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law. 
  


Effective Date:  8/9/2019