Bill Text: IL HB0175 | 2017-2018 | 100th General Assembly | Engrossed
Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning conditions for basic maintenance grants of aid to the aged, blind, or disabled.
Spectrum: Partisan Bill (Democrat 10-0)
Status: (Failed) 2019-01-08 - Session Sine Die [HB0175 Detail]
Download: Illinois-2017-HB0175-Engrossed.html
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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois, | ||||||
3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 11-5.4 and by adding Section 5-5g as follows:
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6 | (305 ILCS 5/5-5g new) | ||||||
7 | Sec. 5-5g. Long-term care patient; resident status. | ||||||
8 | Long-term care providers shall submit all changes in resident | ||||||
9 | status, including, but not limited to, death, discharge, | ||||||
10 | changes in patient credit, third party liability, and Medicare | ||||||
11 | coverage, to the Department through the Medical Electronic Data | ||||||
12 | Interchange System, the Recipient Eligibility Verification | ||||||
13 | System, or the Electronic Data Interchange System established | ||||||
14 | under 89 Ill. Adm. Code 140.55(b) in compliance with the | ||||||
15 | schedule below: | ||||||
16 | (1) 15 calendar days after a resident's death; | ||||||
17 | (2) 15 calendar days after a resident's discharge; | ||||||
18 | (3) 45 calendar days after being informed of a change | ||||||
19 | in the resident's income; | ||||||
20 | (4) 45 calendar days after being informed of a change | ||||||
21 | in a resident's third party liability; | ||||||
22 | (5) 45 calendar days after a resident's move to | ||||||
23 | exceptional care services; and |
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1 | (6) 45 calendar days after a resident's need for | ||||||
2 | services requiring reimbursement under the ventilator or | ||||||
3 | traumatic brain injury enhanced rate.
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4 | (305 ILCS 5/11-5.4) | ||||||
5 | Sec. 11-5.4. Expedited long-term care eligibility | ||||||
6 | determination , renewal, and enrollment , and payment . | ||||||
7 | (a) The General Assembly finds that it is in the best | ||||||
8 | interest of the State to process on an expedited basis | ||||||
9 | applications and renewal applications for Medicaid and | ||||||
10 | Medicaid long-term care benefits that are submitted by or on | ||||||
11 | behalf of elderly persons in need of long-term care services. | ||||||
12 | It is the intent of the General Assembly that the provisions of | ||||||
13 | this Section be liberally construed to permit the maximum | ||||||
14 | number of applicants to benefit, regardless of the age of the | ||||||
15 | application, and for the State to complete all processing as | ||||||
16 | required under 42 U.S.C. 1396a(a)(8) and 42 CFR 435. An | ||||||
17 | expedited long-term care eligibility determination and | ||||||
18 | enrollment system shall be established to reduce long-term care | ||||||
19 | determinations to 90 days or fewer by July 1, 2014 and | ||||||
20 | streamline the long-term care enrollment process. | ||||||
21 | Establishment of the system shall be a joint venture of the | ||||||
22 | Department of Human Services and Healthcare and Family Services | ||||||
23 | and the Department on Aging. The Governor shall name a lead | ||||||
24 | agency no later than 30 days after the effective date of this | ||||||
25 | amendatory Act of the 98th General Assembly to assume |
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1 | responsibility for the full implementation of the | ||||||
2 | establishment and maintenance of the system. Project outcomes | ||||||
3 | shall include an enhanced eligibility determination tracking | ||||||
4 | system accessible to providers and a centralized application | ||||||
5 | review and eligibility determination with all applicants | ||||||
6 | reviewed within 90 days of receipt by the State of a complete | ||||||
7 | application. If the Department of Healthcare and Family | ||||||
8 | Services' Office of the Inspector General determines that there | ||||||
9 | is a likelihood that a non-allowable transfer of assets has | ||||||
10 | occurred, and the facility in which the applicant resides is | ||||||
11 | notified, an extension of up to 90 days shall be permissible. | ||||||
12 | On or before December 31, 2015, a streamlined application and | ||||||
13 | enrollment process shall be put in place based on the following | ||||||
14 | principles: | ||||||
15 | (1) Minimize the burden on applicants by collecting | ||||||
16 | only the data necessary to determine eligibility for | ||||||
17 | medical services, long-term care services, and spousal | ||||||
18 | impoverishment offset. | ||||||
19 | (2) Integrate online data sources to simplify the | ||||||
20 | application process by reducing the amount of information | ||||||
21 | needed to be entered and to expedite eligibility | ||||||
22 | verification. | ||||||
23 | (3) Provide online prompts to alert the applicant that | ||||||
24 | information is missing or not complete. | ||||||
25 | (a-5) As used in this Section: | ||||||
26 | "Department" means the Department of Healthcare and Family |
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1 | Services. | ||||||
2 | "Managed care organization" has the meaning ascribed to | ||||||
3 | that term in Section 5-30.1 of this Code. | ||||||
4 | (b) The Department of Healthcare and Family Services must | ||||||
5 | serve as the lead agency assuming primary responsibility for | ||||||
6 | the full implementation of this Section, including the | ||||||
7 | establishment and operation of the system. The Department | ||||||
8 | shall, on or before July 1, 2014, assess the feasibility of | ||||||
9 | incorporating all information needed to determine eligibility | ||||||
10 | for long-term care services, including asset transfer and | ||||||
11 | spousal impoverishment financials, into the State's integrated | ||||||
12 | eligibility system identifying all resources needed and | ||||||
13 | reasonable timeframes for achieving the specified integration. | ||||||
14 | (c) Beginning on June 29, 2018, provisional eligibility, in | ||||||
15 | the form of a recipient identification number and any other | ||||||
16 | necessary credentials to permit an applicant to receive | ||||||
17 | benefits, must be issued to any applicant who has not received | ||||||
18 | a final eligibility determination on his or her application for | ||||||
19 | Medicaid or Medicaid long-term care benefits or a notice of an | ||||||
20 | opportunity for a hearing within the federally prescribed | ||||||
21 | deadlines for the processing of such applications. The | ||||||
22 | Department must maintain the applicant's provisional Medicaid | ||||||
23 | enrollment status until a final eligibility determination is | ||||||
24 | approved or the applicant's appeal has been adjudicated and | ||||||
25 | eligibility is denied. The Department or the managed care | ||||||
26 | organization, if applicable, must reimburse providers for all |
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1 | services rendered during an applicant's provisional | ||||||
2 | eligibility period. | ||||||
3 | (1) The Department must immediately notify the managed | ||||||
4 | care organization, if applicable, in which the applicant is | ||||||
5 | an enrollee of the enrollee's change in status. | ||||||
6 | (2) The Department or the managed care organization, | ||||||
7 | when applicable, must begin processing claims for services | ||||||
8 | rendered by the end of the month in which the applicant is | ||||||
9 | given provisional eligibility status. Claims for services | ||||||
10 | rendered must be submitted and processed by the Department | ||||||
11 | and managed care organizations in the same manner as those | ||||||
12 | submitted on behalf of beneficiaries determined to qualify | ||||||
13 | for benefits. | ||||||
14 | (3)
An applicant with provisional enrollment status, | ||||||
15 | who is not enrolled in a managed care organization at the | ||||||
16 | time the applicant's provisional status is issued, must | ||||||
17 | continue to have his or her benefits paid for under the | ||||||
18 | State's fee-for-service system until such time as the State | ||||||
19 | makes a final determination on the applicant's Medicaid or | ||||||
20 | Medicaid long-term care application . | ||||||
21 | (4)
The Department, within 10 business days of issuing | ||||||
22 | provisional eligibility to an applicant not covered by a | ||||||
23 | managed care organization, must submit to the Office of the | ||||||
24 | Comptroller for payment a voucher for all retroactive | ||||||
25 | reimbursement due and the State Comptroller must place such | ||||||
26 | vouchers on expedited payment status. However, if the |
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1 | provisional beneficiary is enrolled with a managed care | ||||||
2 | organization, the Department must submit the same to the | ||||||
3 | managed care organization and the managed care | ||||||
4 | organization must pay the provider on an expedited basis. | ||||||
5 | The lead agency shall file interim reports with the Chairs | ||||||
6 | and Minority Spokespersons of the House and Senate Human | ||||||
7 | Services Committees no later than September 1, 2013 and on | ||||||
8 | February 1, 2014. The Department of Healthcare and Family | ||||||
9 | Services shall include in the annual Medicaid report for | ||||||
10 | State Fiscal Year 2014 and every fiscal year thereafter | ||||||
11 | information concerning implementation of the provisions of | ||||||
12 | this Section. | ||||||
13 | (d) The Department must establish, by rule, policies and | ||||||
14 | procedures to ensure prospective compliance with the federal | ||||||
15 | deadlines for Medicaid and Medicaid long-term care benefits | ||||||
16 | eligibility determinations required under 42 U.S.C. | ||||||
17 | 1396a(a)(8) and 42 CFR 435.912, which must include, but need | ||||||
18 | not be limited to, the following: | ||||||
19 | (1) The Department, assisted by the Department of Human | ||||||
20 | Services and the Department on Aging, must establish, no | ||||||
21 | later than January 1, 2019, a streamlined application and | ||||||
22 | enrollment process that includes, but is not limited to, | ||||||
23 | the following: | ||||||
24 | (A) collect only the data necessary to determine | ||||||
25 | eligibility for medical services, long-term care | ||||||
26 | services, and spousal impoverishment offset; |
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1 | (B)
integrate online data and other third party | ||||||
2 | data sources to simplify the application process by | ||||||
3 | reducing the amount of information needed to be entered | ||||||
4 | and to expedite eligibility verification; | ||||||
5 | (C)
provide online prompts to alert the applicant | ||||||
6 | that information is missing or incomplete; and | ||||||
7 | (D)
provide training and step-by-step written | ||||||
8 | instructions for caseworkers, applicants, and | ||||||
9 | providers. | ||||||
10 | (2) The Department must expedite the eligibility | ||||||
11 | processing system for applicants meeting certain | ||||||
12 | guidelines, regardless of the age of the application. The | ||||||
13 | guidelines must be established by rule and must include, | ||||||
14 | but not be limited to, the following individually or | ||||||
15 | collectively: | ||||||
16 | (A) Full Medicaid benefits in the community for a | ||||||
17 | specified period of time. | ||||||
18 | (B)
No transfer of assets or resources during the | ||||||
19 | federally prescribed look-back time period, as | ||||||
20 | specified by federal law. | ||||||
21 | (C)
Receives Supplemental Security Income payments | ||||||
22 | or was receiving such payments at the time the | ||||||
23 | applicant was admitted to a nursing facility. | ||||||
24 | (D)
Verified income at or below 100% of the federal | ||||||
25 | poverty level when the declared value of the | ||||||
26 | applicant's countable resources is no greater than the |
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1 | allowable amounts pursuant to Section 5-2 of this Code | ||||||
2 | for classes of eligible persons for whom a resource | ||||||
3 | limit applies. | ||||||
4 | (3) The Department must establish, by rule, renewal | ||||||
5 | policies and procedures to reduce the likelihood of | ||||||
6 | unnecessary interruptions in services as a result of | ||||||
7 | improper denials of applicants who would otherwise be | ||||||
8 | approved. | ||||||
9 | (A) Effective January 1, 2019, the Department must | ||||||
10 | implement a paperless passive renewal protocol that | ||||||
11 | provides for the electronic verification of all | ||||||
12 | necessary information including bank accounts. | ||||||
13 | (B) A beneficiary who is a resident of a facility | ||||||
14 | and whose previous renewal application showed an | ||||||
15 | income of no greater than the federal poverty level and | ||||||
16 | who has no discernible means of generating income | ||||||
17 | greater than the federal poverty level must be deemed | ||||||
18 | to qualify for renewal. The beneficiary and the | ||||||
19 | facility must not receive an application for renewal | ||||||
20 | and must instead receive notification of the | ||||||
21 | beneficiary's renewal. | ||||||
22 | (C) A beneficiary for whom the processing of a | ||||||
23 | renewal application exceeds federally prescribed | ||||||
24 | timeframes must be deemed to meet renewal guidelines | ||||||
25 | and the Department must notify the beneficiary and the | ||||||
26 | facility in which the beneficiary resides. The |
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1 | Department must also immediately notify the managed | ||||||
2 | care organization in which the beneficiary is | ||||||
3 | enrolled, if applicable. Both the Department and the | ||||||
4 | managed care organization must accept claims for | ||||||
5 | services rendered to the beneficiary without an | ||||||
6 | interruption in benefits to the enrollee and payment | ||||||
7 | for all services rendered to providers. | ||||||
8 | (4) The Department of Human Services must not penalize | ||||||
9 | an applicant for having an attorney complete a Medicaid | ||||||
10 | application on the applicant's behalf or for seeking to | ||||||
11 | understand the applicant's rights under federal and State | ||||||
12 | Medicaid laws and regulations. This must not include | ||||||
13 | targeting applications and applicants so described for | ||||||
14 | additional scrutiny by the Department of Healthcare and | ||||||
15 | Family Services' Office of the Inspector General. | ||||||
16 | (5) The Department of Healthcare and Family Services' | ||||||
17 | Office of the Inspector General must review applications | ||||||
18 | for long-term care benefits when the Office obtains | ||||||
19 | credible evidence that an applicant has transferred assets | ||||||
20 | with the intent of defrauding the State. If proof of the | ||||||
21 | allegations does not exist, the application must be | ||||||
22 | released by the Office and must be assigned to the | ||||||
23 | appropriate caseworker for an expedited review. | ||||||
24 | (6) The Department of Human Services must implement a | ||||||
25 | process to notify an applicant, the applicant's legally | ||||||
26 | authorized representative, and the facility where the |
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1 | applicant resides of the receipt of an initial or renewal | ||||||
2 | application and supporting documentation within 5 business | ||||||
3 | days of the date the application or supporting documents | ||||||
4 | are submitted. The notices should indicate any | ||||||
5 | documentation required, but not received, and provide | ||||||
6 | instructions for submission. | ||||||
7 | (7) The Department must make available one release form | ||||||
8 | that permits the applicant to grant permission to a third | ||||||
9 | party to pursue approval of Medicaid and Medicaid long-term | ||||||
10 | care benefits, track the status of applications, and pursue | ||||||
11 | a post-denial appeal on behalf of the applicant, which must | ||||||
12 | remain in force after the applicant's death. | ||||||
13 | (8) The Department must develop one eligibility system | ||||||
14 | for both Modified Adjusted Gross Income (MAGI) and non-MAGI | ||||||
15 | applicants by incorporating Affordable Care Act upgrades | ||||||
16 | with the goal of establishing real time approval of | ||||||
17 | applications for Medicaid services and Medicaid long-term | ||||||
18 | care benefits, as permissible. | ||||||
19 | (9) The Department must have operational a fully | ||||||
20 | electronic application process that encompasses initial | ||||||
21 | applications, admission packet, renewals, and appeals no | ||||||
22 | later than 12 months after the effective date of this | ||||||
23 | amendatory Act of the 100th General Assembly. The | ||||||
24 | Department must not require submission of any application | ||||||
25 | or supporting documentation in hard copy. No later than | ||||||
26 | August 1, 2014, the Auditor General shall report to the |
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1 | General Assembly concerning the extent to which the | ||||||
2 | timeframes specified in this Section have been met and the | ||||||
3 | extent to which State staffing levels are adequate to meet | ||||||
4 | the requirements of this Section.
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5 | (e) The Department must improve communication between | ||||||
6 | long-term care benefits central office personnel, applicants, | ||||||
7 | or the applicants' representatives, and facilities in which the | ||||||
8 | applicants reside. The Department must establish, by rule, such | ||||||
9 | policies and procedures that are necessary to meet the | ||||||
10 | requirements of this Section, which must include, but need not | ||||||
11 | be limited to, the following: | ||||||
12 | (1) The establishment of a centralized, | ||||||
13 | caseworker-based processing system with contact numbers | ||||||
14 | for caseworkers and supervisors that are made readily | ||||||
15 | available to all affected providers and are prominently | ||||||
16 | displayed on all communications with applicants, | ||||||
17 | beneficiaries, and providers. | ||||||
18 | (2) Allowing facilities access to the State's | ||||||
19 | integrated eligibility system for tracking the status of | ||||||
20 | applications for applicants who have signed appropriate | ||||||
21 | releases, and the development and distribution of | ||||||
22 | applicable instructional materials and release forms. The | ||||||
23 | Department of Healthcare and Family Services, the | ||||||
24 | Department of Human Services, and the Department on Aging | ||||||
25 | shall take the following steps to achieve federally | ||||||
26 | established timeframes for eligibility determinations for |
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1 | Medicaid and long-term care benefits and shall work toward | ||||||
2 | the federal goal of real time determinations: | ||||||
3 | (1) The Departments shall review, in collaboration | ||||||
4 | with representatives of affected providers, all forms and | ||||||
5 | procedures currently in use, federal guidelines either | ||||||
6 | suggested or mandated, and staff deployment by September | ||||||
7 | 30, 2014 to identify additional measures that can improve | ||||||
8 | long-term care eligibility processing and make adjustments | ||||||
9 | where possible. | ||||||
10 | (2) No later than June 30, 2014, the Department of | ||||||
11 | Healthcare and Family Services shall issue vouchers for | ||||||
12 | advance payments not to exceed $50,000,000 to nursing | ||||||
13 | facilities with significant outstanding Medicaid liability | ||||||
14 | associated with services provided to residents with | ||||||
15 | Medicaid applications pending and residents facing the | ||||||
16 | greatest delays. Each facility with an advance payment | ||||||
17 | shall state in writing whether its own recoupment schedule | ||||||
18 | will be in 3 or 6 equal monthly installments, as long as | ||||||
19 | all advances are recouped by June 30, 2015. | ||||||
20 | (3) The Department of Healthcare and Family Services' | ||||||
21 | Office of Inspector General and the Department of Human | ||||||
22 | Services shall immediately forgo resource review and | ||||||
23 | review of transfers during the relevant look-back period | ||||||
24 | for applications that were submitted prior to September 1, | ||||||
25 | 2013. An applicant who applied prior to September 1, 2013, | ||||||
26 | who was denied for failure to cooperate in providing |
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1 | required information, and whose application was | ||||||
2 | incorrectly reviewed under the wrong look-back period | ||||||
3 | rules may request review and correction of the denial based | ||||||
4 | on this subsection. If found eligible upon review, such | ||||||
5 | applicants shall be retroactively enrolled. | ||||||
6 | (4) As soon as practicable, the Department of | ||||||
7 | Healthcare and Family Services shall implement policies | ||||||
8 | and promulgate rules to simplify financial eligibility | ||||||
9 | verification in the following instances: (A) for | ||||||
10 | applicants or recipients who are receiving Supplemental | ||||||
11 | Security Income payments or who had been receiving such | ||||||
12 | payments at the time they were admitted to a nursing | ||||||
13 | facility and (B) for applicants or recipients with verified | ||||||
14 | income at or below 100% of the federal poverty level when | ||||||
15 | the declared value of their countable resources is no | ||||||
16 | greater than the allowable amounts pursuant to Section 5-2 | ||||||
17 | of this Code for classes of eligible persons for whom a | ||||||
18 | resource limit applies. Such simplified verification | ||||||
19 | policies shall apply to community cases as well as | ||||||
20 | long-term care cases. | ||||||
21 | (5) As soon as practicable, but not later than July 1, | ||||||
22 | 2014, the Department of Healthcare and Family Services and | ||||||
23 | the Department of Human Services shall jointly begin a | ||||||
24 | special enrollment project by using simplified eligibility | ||||||
25 | verification policies and by redeploying caseworkers | ||||||
26 | trained to handle long-term care cases to prioritize those |
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1 | cases, until the backlog is eliminated and processing time | ||||||
2 | is within 90 days. This project shall apply to applications | ||||||
3 | for long-term care received by the State on or before May | ||||||
4 | 15, 2014. | ||||||
5 | (6) As soon as practicable, but not later than | ||||||
6 | September 1, 2014, the Department on Aging shall make | ||||||
7 | available to long-term care facilities and community | ||||||
8 | providers upon request, through an electronic method, the | ||||||
9 | information contained within the Interagency Certification | ||||||
10 | of Screening Results completed by the pre-screener, in a | ||||||
11 | form and manner acceptable to the Department of Human | ||||||
12 | Services. | ||||||
13 | (f) The Department must establish, by rule, policies and | ||||||
14 | procedures to improve accountability and provide for the | ||||||
15 | expedited payment of services rendered, which must include, but | ||||||
16 | need not be limited to, the following: | ||||||
17 | (1) The Department must apply the most current resident | ||||||
18 | income data entered into the Department's Medical | ||||||
19 | Electronic Data Interchange (MEDI) system to the payment of | ||||||
20 | a claim even if a caseworker has not completed a review. | ||||||
21 | (2) The Department and the Department of Human Services | ||||||
22 | must notify the applicant, or the applicant's legal | ||||||
23 | representative, and the facility submitting the initial, | ||||||
24 | renewal, or appeal application of all missing supporting | ||||||
25 | documentation or information and the date of the request | ||||||
26 | when an application, renewal, or appeal is denied for |
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1 | failure to submit such documentation and information. | ||||||
2 | (g) No later than January 1, 2019, the Department of | ||||||
3 | Healthcare and Family Services must investigate the | ||||||
4 | public-private partnerships in use in Ohio, Michigan, and | ||||||
5 | Minnesota aimed at redeploying caseworkers to targeted | ||||||
6 | high-Medicaid facilities for the purpose of expediting initial | ||||||
7 | Medicaid and Medicaid long-term care benefits applications, | ||||||
8 | renewals, asset discovery, and all other things related to | ||||||
9 | enrollment, reimbursement, and application processing. No | ||||||
10 | later than March 1, 2019, the Department of Healthcare and | ||||||
11 | Family Services must post on the long-term care pages of the | ||||||
12 | Department's website the agencies' joint recommendations and | ||||||
13 | must assist provider groups in educating their members on such | ||||||
14 | partnerships. | ||||||
15 | (h) The Director of Healthcare and Family Services, in | ||||||
16 | coordination with the Secretary of Human Services and the | ||||||
17 | Director of Aging, must host a provider association meeting | ||||||
18 | every 6 weeks, beginning no later than 30 days after the | ||||||
19 | effective date of this amendatory Act of the 100th General | ||||||
20 | Assembly, until all applications that are 45 days or older have | ||||||
21 | been adjudicated and the application process has been reduced | ||||||
22 | to 45 or fewer days, at which time the meetings shall be held | ||||||
23 | quarterly, for those associations representing facilities | ||||||
24 | licensed under the Nursing Home Care Act and certified as a | ||||||
25 | supportive living program. Each agency must be represented by | ||||||
26 | senior staff with hands-on knowledge of the processing of |
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1 | applications for Medicaid and Medicaid long-term care | ||||||
2 | benefits, renewals, and such ancillary issues as income and | ||||||
3 | address adjustments, release forms, and screening reports. | ||||||
4 | Agenda items must be solicited from the associations. | ||||||
5 | (i) The Department must not delay the implementation of the | ||||||
6 | presumptive eligibility, as ordered by Koss v. Norwood, Case | ||||||
7 | No. 17 C 2762 (N.D. Ill. Mar. 29, 2018), in anticipation of | ||||||
8 | this amendatory Act of the 100th General Assembly. | ||||||
9 | (j) As mandated by federal regulations under 42 CFR | ||||||
10 | 435.912, the Department and the Department of Human Services | ||||||
11 | must not deny applications for Medicaid or Medicaid long-term | ||||||
12 | care benefits to comply with the federal timeliness standards | ||||||
13 | or avoid authorizing provisional eligibility under this | ||||||
14 | Section. To ensure compliance, the percentage of denials in a | ||||||
15 | given month must not increase by more than 1% of the denial | ||||||
16 | rate that occurred in the same month of the preceding year. | ||||||
17 | (k) The Department of Human Services must prioritize | ||||||
18 | processing applications on a last-in, first-out basis. The | ||||||
19 | Department is expressly prohibited from prioritizing the | ||||||
20 | processing of applications from applicants who have been issued | ||||||
21 | provisional eligibility status over other applicants. | ||||||
22 | (l) Unless otherwise specified, all provisions of this | ||||||
23 | amendatory Act of the 100th General Assembly must be fully | ||||||
24 | operational by January 1, 2019. | ||||||
25 | (m) Nothing in this Section shall defeat the provisions | ||||||
26 | contained in the State Prompt Payment Act or the timely pay |
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1 | provisions contained in Section 368a of the Illinois Insurance | ||||||
2 | Code. | ||||||
3 | (n) The Department must offer regionally based training | ||||||
4 | covering all aspects of this Section and must include long-term | ||||||
5 | care provider associations in the design and presentation of | ||||||
6 | the training. The training shall be recorded and posted on the | ||||||
7 | Department's website to allow new employees to be trained and | ||||||
8 | older employers to complete refresher courses. | ||||||
9 | (o) The Department and the Department of Human Services | ||||||
10 | must not require an applicant for Medicaid or Medicaid | ||||||
11 | long-term care benefits to submit a new application solely | ||||||
12 | because there is a change in the applicant's legal | ||||||
13 | representative. | ||||||
14 | (p) The Department and the Department of Human Services | ||||||
15 | must implement the requirements under this Section even if the | ||||||
16 | required rules are not yet adopted by the dates specified in | ||||||
17 | this Section. If the Department is required to adopt rules | ||||||
18 | under this Section or if the Department determines that rules | ||||||
19 | are necessary to achieve full implementation, the Department | ||||||
20 | must adopt policies and procedures to allow for full | ||||||
21 | implementation by the date specified in this Section and must | ||||||
22 | publish all policies and procedures on the Department's | ||||||
23 | website. The Department must submit proposed permanent rules | ||||||
24 | for public comment no later than January 1, 2019. | ||||||
25 | (q) (7) Effective 30 days after the completion of 3 | ||||||
26 | regionally based trainings, nursing facilities shall submit |
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1 | all applications for medical assistance online via the | ||||||
2 | Application for Benefits Eligibility (ABE) website. This | ||||||
3 | requirement shall extend to scanning and uploading with the | ||||||
4 | online application any required additional forms such as the | ||||||
5 | Long Term Care Facility Notification and the Additional | ||||||
6 | Financial Information for Long Term Care Applicants as well as | ||||||
7 | scanned copies of any supporting documentation. Long-term care | ||||||
8 | facility admission documents must be submitted as required in | ||||||
9 | Section 5-5 of this Code. No local Department of Human Services | ||||||
10 | office shall refuse to accept an electronically filed | ||||||
11 | application. | ||||||
12 | (r) (8) Notwithstanding any other provision of this Code, | ||||||
13 | the Department of Human Services and the Department of | ||||||
14 | Healthcare and Family Services' Office of the Inspector General | ||||||
15 | shall, upon request, allow an applicant additional time to | ||||||
16 | submit information and documents needed as part of a review of | ||||||
17 | available resources or resources transferred during the | ||||||
18 | look-back period. The initial extension shall not exceed 30 | ||||||
19 | days. A second extension of 30 days may be granted upon | ||||||
20 | request. Any request for information issued by the State to an | ||||||
21 | applicant shall include the following: an explanation of the | ||||||
22 | information required and the date by which the information must | ||||||
23 | be submitted; a statement that failure to respond in a timely | ||||||
24 | manner can result in denial of the application; a statement | ||||||
25 | that the applicant or the facility in the name of the applicant | ||||||
26 | may seek an extension; and the name and contact information of |
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1 | a caseworker in case of questions. Any such request for | ||||||
2 | information shall also be sent to the facility. In deciding | ||||||
3 | whether to grant an extension, the Department of Human Services | ||||||
4 | or the Department of Healthcare and Family Services' Office of | ||||||
5 | the Inspector General shall take into account what is in the | ||||||
6 | best interest of the applicant. The time limits for processing | ||||||
7 | an application shall be tolled during the period of any | ||||||
8 | extension granted under this subsection. | ||||||
9 | (s) (9) The Department of Human Services and the Department | ||||||
10 | of Healthcare and Family Services must jointly compile data on | ||||||
11 | pending applications, denials, appeals, and renewals | ||||||
12 | redeterminations into a monthly report, which shall be posted | ||||||
13 | on each Department's website for the purposes of monitoring | ||||||
14 | long-term care eligibility processing. The report must specify | ||||||
15 | the number of applications and renewals redeterminations | ||||||
16 | pending long-term care eligibility determination and admission | ||||||
17 | and the number of appeals of denials in the following | ||||||
18 | categories: | ||||||
19 | (1) (A) Length of time applications, renewals | ||||||
20 | redeterminations , and appeals are pending - 0 to 45 days, | ||||||
21 | 46 days to 90 days, 91 days to 180 days, 181 days to 12 | ||||||
22 | months, over 12 months to 18 months, over 18 months to 24 | ||||||
23 | months, and over 24 months. | ||||||
24 | (2) (B) Percentage of applications and renewals | ||||||
25 | redeterminations pending in the Department of Human | ||||||
26 | Services' Family Community Resource Centers, in the |
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1 | Department of Human Services' long-term care hubs, with the | ||||||
2 | Department of Healthcare and Family Services' Office of | ||||||
3 | Inspector General, and those applications which are being | ||||||
4 | tolled due to requests for extension of time for additional | ||||||
5 | information. | ||||||
6 | (3) (C) Status of pending applications, denials, | ||||||
7 | appeals, and renewals redeterminations . | ||||||
8 | (4) For applications, renewals, and appeals pending | ||||||
9 | more than 45 days, the reason for the delay as required by | ||||||
10 | federal regulations under 42 CFR 435.912. | ||||||
11 | (t) (f) Beginning on July 1, 2017, the Auditor General | ||||||
12 | shall report every 3 years to the General Assembly on the | ||||||
13 | performance and compliance of the Department of Healthcare and | ||||||
14 | Family Services, the Department of Human Services, and the | ||||||
15 | Department on Aging in meeting the requirements of this Section | ||||||
16 | and the federal requirements concerning eligibility | ||||||
17 | determinations for Medicaid long-term care services and | ||||||
18 | supports, and shall report any issues or deficiencies and make | ||||||
19 | recommendations. The Auditor General shall, at a minimum, | ||||||
20 | review, consider, and evaluate the following: | ||||||
21 | (1) compliance with federal regulations on furnishing | ||||||
22 | services as related to Medicaid long-term care services and | ||||||
23 | supports as provided under 42 CFR 435.930; | ||||||
24 | (2) compliance with federal regulations on the timely | ||||||
25 | determination of eligibility as provided under 42 CFR | ||||||
26 | 435.912; |
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1 | (3) the accuracy and completeness of the report | ||||||
2 | required under paragraph (9) of subsection (e); | ||||||
3 | (4) the efficacy and efficiency of the task-based | ||||||
4 | process used for making eligibility determinations in the | ||||||
5 | centralized offices of the Department of Human Services for | ||||||
6 | long-term care services, including the role of the State's | ||||||
7 | integrated eligibility system, as opposed to the | ||||||
8 | traditional caseworker-specific process from which these | ||||||
9 | central offices have converted; and | ||||||
10 | (5) any issues affecting eligibility determinations | ||||||
11 | related to the Department of Human Services' staff | ||||||
12 | completing Medicaid eligibility determinations instead of | ||||||
13 | the designated single-state Medicaid agency in Illinois, | ||||||
14 | the Department of Healthcare and Family Services. | ||||||
15 | The Auditor General's report shall include any and all | ||||||
16 | other areas or issues which are identified through an annual | ||||||
17 | review. Paragraphs (1) through (5) of this subsection shall not | ||||||
18 | be construed to limit the scope of the annual review and the | ||||||
19 | Auditor General's authority to thoroughly and completely | ||||||
20 | evaluate any and all processes, policies, and procedures | ||||||
21 | concerning compliance with federal and State law requirements | ||||||
22 | on eligibility determinations for Medicaid long-term care | ||||||
23 | services and supports. | ||||||
24 | (Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
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25 | Section 99. Effective date. This Act takes effect upon | ||||||
26 | becoming law.
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