Bill Amendment: IL SB2913 | 2017-2018 | 100th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

---

Bill Title: DHFS-EXPEDITED LONG-TERM CARE

Status: 2018-08-02 - Public Act . . . . . . . . . 100-0665 [SB2913 Detail]

Download: Illinois-2017-SB2913-Senate_Amendment_002.html

---

Sen. John G. Mulroe

Filed: 4/24/2018

10000SB2913sam002 LRB100 18099 KTG 39173 a
AMENDMENT TO SENATE BILL 2913
AMENDMENT NO. ______. Amend Senate Bill 2913, AS AMENDED,
by replacing everything after the enacting clause with the
following:
"Section 5. The Illinois Public Aid Code is amended by
changing Section 11-5.4 and by adding Section 5-5g as follows:
(305 ILCS 5/5-5g new)
Sec. 5-5g. Long-term care patient; resident status.
Long-term care providers shall submit all changes in resident
status, including, but not limited to, death, discharge,
changes in patient credit, third party liability, and Medicare
coverage, to the Department through the Medical Electronic Data
Interchange System, the Recipient Eligibility Verification
System, or the Electronic Data Interchange System established
under 89 Ill. Adm. Code 140.55(b) in compliance with the
schedule below:

10000SB2913sam002 - 2 - LRB100 18099 KTG 39173 a
(1) 15 calendar days after a resident's death;
(2) 15 calendar days after a resident's discharge;
(3) 45 calendar days after being informed of a change
in the resident's income;
(4) 45 calendar days after being informed of a change
in a resident's third party liability;
(5) 45 calendar days after a resident's move to
exceptional care services; and
(6) 45 calendar days after a resident's need for
services requiring reimbursement under the ventilator or
traumatic brain injury enhanced rate.
(305 ILCS 5/11-5.4)
Sec. 11-5.4. Expedited long-term care eligibility
determination, renewal, and enrollment, and payment.
(a) The General Assembly finds that it is in the best
interest of the State to process on an expedited basis
applications and renewal applications for Medicaid and
Medicaid long-term care benefits that are submitted by or on
behalf of elderly persons in need of long-term care services.
It is the intent of the General Assembly that the provisions of
this Section be liberally construed to permit the maximum
number of applicants to benefit, regardless of the age of the
application, and for the State to complete all processing as
required under 42 U.S.C. 1396a(a)(8) and 42 CFR 435. An
expedited long-term care eligibility determination and

10000SB2913sam002 - 3 - LRB100 18099 KTG 39173 a
enrollment system shall be established to reduce long-term care
determinations to 90 days or fewer by July 1, 2014 and
streamline the long-term care enrollment process.
Establishment of the system shall be a joint venture of the
Department of Human Services and Healthcare and Family Services
and the Department on Aging. The Governor shall name a lead
agency no later than 30 days after the effective date of this
amendatory Act of the 98th General Assembly to assume
responsibility for the full implementation of the
establishment and maintenance of the system. Project outcomes
shall include an enhanced eligibility determination tracking
system accessible to providers and a centralized application
review and eligibility determination with all applicants
reviewed within 90 days of receipt by the State of a complete
application. If the Department of Healthcare and Family
Services' Office of the Inspector General determines that there
is a likelihood that a non-allowable transfer of assets has
occurred, and the facility in which the applicant resides is
notified, an extension of up to 90 days shall be permissible.
On or before December 31, 2015, a streamlined application and
enrollment process shall be put in place based on the following
principles:
(1) 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.

10000SB2913sam002 - 4 - LRB100 18099 KTG 39173 a
(2) Integrate online data sources to simplify the
application process by reducing the amount of information
needed to be entered and to expedite eligibility
verification.
(3) Provide online prompts to alert the applicant that
information is missing or not complete.
(a-5) As used in this Section:
"Department" means the Department of Healthcare and Family
Services.
"Managed care organization" has the meaning ascribed to
that term in Section 5-30.1 of this Code.
(b) The Department of Healthcare and Family Services must
serve as the lead agency assuming primary responsibility for
the full implementation of this Section, including the
establishment and operation of the system. The Department
shall, on or before July 1, 2014, assess the feasibility of
incorporating all information needed to determine eligibility
for long-term care services, including asset transfer and
spousal impoverishment financials, into the State's integrated
eligibility system identifying all resources needed and
reasonable timeframes for achieving the specified integration.
(c) 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

10000SB2913sam002 - 5 - LRB100 18099 KTG 39173 a
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 all
services rendered during an applicant's provisional
eligibility period.
(1) The Department must immediately notify the managed
care organization, if applicable, in which the applicant is
an enrollee of the enrollee's change in status.
(2) The Department or the managed care organization,
when applicable, must begin processing claims for services
rendered by the end of the month in which the applicant is
given provisional eligibility status. Claims for services
rendered must be submitted and processed by the Department
and managed care organizations in the same manner as those
submitted on behalf of beneficiaries determined to qualify
for benefits.
(3) An applicant with provisional enrollment status,
who is not enrolled in a managed care organization at the
time the applicant's provisional status is issued, must
continue to have his or her benefits paid for under the
State's fee-for-service system until such time as the State

10000SB2913sam002 - 6 - LRB100 18099 KTG 39173 a
makes a final determination on the applicant's Medicaid or
Medicaid long-term care application.
(4) The Department, within 10 business days of issuing
provisional eligibility to an applicant not covered by a
managed care organization, must submit to the Office of the
Comptroller for payment a voucher for all retroactive
reimbursement due and the State Comptroller must place such
vouchers on expedited payment status. However, if the
provisional beneficiary is enrolled with a managed care
organization, the Department must submit the same to the
managed care organization and the managed care
organization must pay the provider on an expedited basis.
The lead agency shall file interim reports with the Chairs
and Minority Spokespersons of the House and Senate Human
Services Committees no later than September 1, 2013 and on
February 1, 2014. The Department of Healthcare and Family
Services shall include in the annual Medicaid report for
State Fiscal Year 2014 and every fiscal year thereafter
information concerning implementation of the provisions of
this Section.
(d) The Department must establish, by rule, policies and
procedures to ensure prospective compliance with the federal
deadlines for Medicaid and Medicaid long-term care benefits
eligibility determinations required under 42 U.S.C.
1396a(a)(8) and 42 CFR 435.912, which must include, but need
not be limited to, the following:

10000SB2913sam002 - 7 - LRB100 18099 KTG 39173 a
(1) The Department, assisted by the Department of Human
Services and the Department on Aging, must establish, no
later than January 1, 2019, a streamlined application and
enrollment process that includes, but is not limited to,
the following:
(A) collect only the data necessary to determine
eligibility for medical services, long-term care
services, and spousal impoverishment offset;
(B) integrate online data and other third party
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 incomplete; and
(D) provide training and step-by-step written
instructions for caseworkers, applicants, and
providers.
(2) The Department must expedite the eligibility
processing system for applicants meeting certain
guidelines, regardless of the age of the application. The
guidelines must be established by rule and must include,
but 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

10000SB2913sam002 - 8 - LRB100 18099 KTG 39173 a
federally prescribed look-back time period, as
specified by federal law.
(C) Receives Supplemental Security Income payments
or was receiving such payments at the time the
applicant was admitted to a nursing facility.
(D) Verified income at or below 100% of the federal
poverty level when the declared value of the
applicant's 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.
(3) The Department must establish, by rule, renewal
policies and procedures to reduce the likelihood of
unnecessary interruptions in services as a result of
improper denials of applicants who would otherwise be
approved.
(A) Effective January 1, 2019, the Department must
implement a paperless passive renewal protocol that
provides for the electronic verification of all
necessary information including bank accounts.
(B) A beneficiary who is a resident of a facility
and whose previous renewal application showed an
income of no greater than the federal poverty level and
who has no discernible means of generating income
greater than the federal poverty level must be deemed
to qualify for renewal. The beneficiary and the

10000SB2913sam002 - 9 - LRB100 18099 KTG 39173 a
facility must not receive an application for renewal
and must instead receive notification of the
beneficiary's renewal.
(C) A beneficiary for whom the processing of a
renewal application exceeds federally prescribed
timeframes must be deemed to meet renewal guidelines
and the Department must notify the beneficiary and the
facility in which the beneficiary resides. The
Department must also immediately notify the managed
care organization in which the beneficiary is
enrolled, if applicable. Both the Department and the
managed care organization must accept claims for
services rendered to the beneficiary without an
interruption in benefits to the enrollee and payment
for all services rendered to providers.
(4) The Department of Human Services must not penalize
an applicant for having an attorney complete a Medicaid
application on the applicant's behalf or for seeking to
understand the applicant's rights under federal and State
Medicaid laws and regulations. This must not include
targeting applications and applicants so described for
additional scrutiny by the Department of Healthcare and
Family Services' Office of the Inspector General.
(5) The Department of Healthcare and Family Services'
Office of the Inspector General must review applications
for long-term care benefits when the Office obtains

10000SB2913sam002 - 10 - LRB100 18099 KTG 39173 a
credible evidence that an applicant has transferred assets
with the intent of defrauding the State. If proof of the
allegations does not exist, the application must be
released by the Office and must be assigned to the
appropriate caseworker for an expedited review.
(6) The Department of Human Services must implement a
process to notify an applicant, the applicant's legally
authorized representative, and the facility where the
applicant resides of the receipt of an initial or renewal
application and supporting documentation within 5 business
days of the date the application or supporting documents
are submitted. The notices should indicate any
documentation required, but not received, and provide
instructions for submission.
(7) The Department must make available one release form
that permits the applicant to grant permission to a third
party to pursue approval of Medicaid and Medicaid long-term
care benefits, track the status of applications, and pursue
a post-denial appeal on behalf of the applicant, which must
remain in force after the applicant's death.
(8) The Department must develop one eligibility system
for both Modified Adjusted Gross Income (MAGI) and non-MAGI
applicants by incorporating Affordable Care Act upgrades
with the goal of establishing real time approval of
applications for Medicaid services and Medicaid long-term
care benefits, as permissible.

10000SB2913sam002 - 11 - LRB100 18099 KTG 39173 a
(9) The Department must have operational a fully
electronic application process that encompasses initial
applications, admission packet, renewals, and appeals no
later than 12 months after the effective date of this
amendatory Act of the 100th General Assembly. The
Department must not require submission of any application
or supporting documentation in hard copy. No later than
August 1, 2014, the Auditor General shall report to the
General Assembly concerning the extent to which the
timeframes specified in this Section have been met and the
extent to which State staffing levels are adequate to meet
the requirements of this Section.
(e) The Department must adopt policies and procedures to
improve communication between long-term care benefits central
office personnel, applicants, or the applicants'
representatives, and facilities in which the applicants
reside. The Department must establish, by rule, such policies
and procedures that are necessary to meet the requirements of
this Section, which must include, but need not be limited to,
the following:
(1) The establishment of a centralized,
caseworker-based processing system with contact numbers
for caseworkers and supervisors that are made readily
available to all affected providers and are prominently
displayed on all communications with applicants,
beneficiaries, and providers.

10000SB2913sam002 - 12 - LRB100 18099 KTG 39173 a
(2) Allowing facilities access to the State's
integrated eligibility system for tracking the status of
applications for applicants who have signed appropriate
releases, and the development and distribution of
applicable instructional materials and release forms. The
Department of Healthcare and Family Services, the
Department of Human Services, and the Department on Aging
shall take the following steps to achieve federally
established timeframes for eligibility determinations for
Medicaid and long-term care benefits and shall work toward
the federal goal of real time determinations:
(1) The Departments shall review, in collaboration
with representatives of affected providers, all forms and
procedures currently in use, federal guidelines either
suggested or mandated, and staff deployment by September
30, 2014 to identify additional measures that can improve
long-term care eligibility processing and make adjustments
where possible.
(2) No later than June 30, 2014, the Department of
Healthcare and Family Services shall issue vouchers for
advance payments not to exceed $50,000,000 to nursing
facilities with significant outstanding Medicaid liability
associated with services provided to residents with
Medicaid applications pending and residents facing the
greatest delays. Each facility with an advance payment
shall state in writing whether its own recoupment schedule

10000SB2913sam002 - 13 - LRB100 18099 KTG 39173 a
will be in 3 or 6 equal monthly installments, as long as
all advances are recouped by June 30, 2015.
(3) The Department of Healthcare and Family Services'
Office of Inspector General and the Department of Human
Services shall immediately forgo resource review and
review of transfers during the relevant look-back period
for applications that were submitted prior to September 1,
2013. An applicant who applied prior to September 1, 2013,
who was denied for failure to cooperate in providing
required information, and whose application was
incorrectly reviewed under the wrong look-back period
rules may request review and correction of the denial based
on this subsection. If found eligible upon review, such
applicants shall be retroactively enrolled.
(4) As soon as practicable, the Department of
Healthcare and Family Services shall implement policies
and promulgate rules to simplify financial eligibility
verification in the following instances: (A) for
applicants or recipients who are receiving Supplemental
Security Income payments or who had been receiving such
payments at the time they were admitted to a nursing
facility and (B) 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

10000SB2913sam002 - 14 - LRB100 18099 KTG 39173 a
resource limit applies. Such simplified verification
policies shall apply to community cases as well as
long-term care cases.
(5) As soon as practicable, but not later than July 1,
2014, the Department of Healthcare and Family Services and
the Department of Human Services shall jointly begin a
special enrollment project by using simplified eligibility
verification policies and by redeploying caseworkers
trained to handle long-term care cases to prioritize those
cases, until the backlog is eliminated and processing time
is within 90 days. This project shall apply to applications
for long-term care received by the State on or before May
15, 2014.
(6) As soon as practicable, but not later than
September 1, 2014, the Department on Aging shall make
available to long-term care facilities and community
providers upon request, through an electronic method, the
information contained within the Interagency Certification
of Screening Results completed by the pre-screener, in a
form and manner acceptable to the Department of Human
Services.
(f) The Department must establish, by rule, policies and
procedures to improve accountability and provide for the
expedited payment of services rendered, which must include, but
need not be limited to, the following:
(1) The Department must apply the most current resident

10000SB2913sam002 - 15 - LRB100 18099 KTG 39173 a
income data entered into the Department's Medical
Electronic Data Interchange (MEDI) system to the payment of
a claim even if a caseworker has not completed a review.
(2) The Department and the Department of Human Services
must notify the applicant, or the applicant's legal
representative, and the facility submitting the initial,
renewal, or appeal application of all missing supporting
documentation or information and the date of the request
when an application, renewal, or appeal is denied for
failure to submit such documentation and information.
(g) No later than January 1, 2019, the Department of
Healthcare and Family Services must investigate the
public-private partnerships in use in Ohio, Michigan, and
Minnesota aimed at redeploying caseworkers to targeted
high-Medicaid facilities for the purpose of expediting initial
Medicaid and Medicaid long-term care benefits applications,
renewals, asset discovery, and all other things related to
enrollment, reimbursement, and application processing. No
later than March 1, 2019, the Department of Healthcare and
Family Services must post on the long-term care pages of the
Department's website the agencies' joint recommendations and
must assist provider groups in educating their members on such
partnerships.
(h) The Director of Healthcare and Family Services, in
coordination with the Secretary of Human Services and the
Director of Aging, must host a provider association meeting

10000SB2913sam002 - 16 - LRB100 18099 KTG 39173 a
every 6 weeks, beginning no later than 30 days after the
effective date of this amendatory Act of the 100th General
Assembly, until all applications that are 45 days or older have
been adjudicated and the application process has been reduced
to 45 or fewer days, at which time the meetings shall be held
quarterly, for those associations representing facilities
licensed under the Nursing Home Care Act and certified as a
supportive living program. Each agency must be represented by
senior staff with hands-on knowledge of the processing of
applications for Medicaid and Medicaid long-term care
benefits, renewals, and such ancillary issues as income and
address adjustments, release forms, and screening reports.
Agenda items must be solicited from the associations.
(i) The Department must not delay the implementation of the
presumptive eligibility, as ordered by Koss v. Norwood, Case
No. 17 C 2762 (N.D. Ill. Mar. 29, 2018), in anticipation of
this amendatory Act of the 100th General Assembly.
(j) As mandated by federal regulations under 42 CFR
435.912, the Department and the Department of Human Services
must not deny applications for Medicaid or Medicaid long-term
care benefits to comply with the federal timeliness standards
or avoid authorizing provisional eligibility under this
Section. To ensure compliance, the percentage of denials in a
given month must not increase by more than 1% of the denial
rate that occurred in the same month of the preceding year.
(k) The Department of Human Services must prioritize

10000SB2913sam002 - 17 - LRB100 18099 KTG 39173 a
processing applications on a last-in, first-out basis. The
Department is expressly prohibited from prioritizing the
processing of applications from applicants who have been issued
provisional eligibility status over other applicants.
(l) Unless otherwise specified, all provisions of this
amendatory Act of the 100th General Assembly must be fully
operational by January 1, 2019.
(m) Nothing in this Section shall defeat the provisions
contained in the State Prompt Payment Act or the timely pay
provisions contained in Section 368a of the Illinois Insurance
Code.
(n) The Department must offer regionally based training
covering all aspects of this Section and must include long-term
care provider associations in the design and presentation of
the training. The training shall be recorded and posted on the
Department's website to allow new employees to be trained and
older employers to complete refresher courses.
(o) The Department and the Department of Human Services
must not require an applicant for Medicaid or Medicaid
long-term care benefits to submit a new application solely
because there is a change in the applicant's legal
representative.
(p) The Department and the Department of Human Services
must implement the requirements under this Section even if the
required rules are not yet adopted by the dates specified in
this Section. If the Department is required to adopt rules

10000SB2913sam002 - 18 - LRB100 18099 KTG 39173 a
under this Section or if the Department determines that rules
are necessary to achieve full implementation, the Department
must adopt policies and procedures to allow for full
implementation by the date specified in this Section and must
publish all policies and procedures on the Department's
website. The Department must submit proposed permanent rules
for public comment no later than January 1, 2019.
(q) (7) 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.
(r) (8) 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

10000SB2913sam002 - 19 - LRB100 18099 KTG 39173 a
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.
(s) (9) The Department of Human Services and the Department
of Healthcare and Family Services must jointly compile data on
pending applications, denials, appeals, and renewals
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 renewals redeterminations
pending long-term care eligibility determination and admission
and the number of appeals of denials in the following

10000SB2913sam002 - 20 - LRB100 18099 KTG 39173 a
categories:
(1) (A) Length of time applications, renewals
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.
(2) (B) Percentage of applications and renewals
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.
(3) (C) Status of pending applications, denials,
appeals, and renewals redeterminations.
(4) For applications, renewals, and appeals pending
more than 45 days, the reason for the delay as required by
federal regulations under 42 CFR 435.912.
(t) (f) 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

10000SB2913sam002 - 21 - LRB100 18099 KTG 39173 a
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

10000SB2913sam002 - 22 - LRB100 18099 KTG 39173 a
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.
(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
Section 99. Effective date. This Act takes effect upon
becoming law.".