Bill Text: IL HB1424 | 2017-2018 | 100th General Assembly | Engrossed


Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section describing the termination of the AFDC program and the beginning of the TANF program.

Spectrum: Partisan Bill (Democrat 22-0)

Status: (Engrossed) 2017-08-04 - Rule 3-9(a) / Re-referred to Assignments [HB1424 Detail]

Download: Illinois-2017-HB1424-Engrossed.html



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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The Illinois Act on the Aging is amended by
5changing Section 4.02 as follows:
6 (20 ILCS 105/4.02) (from Ch. 23, par. 6104.02)
7 Sec. 4.02. Community Care Program. The Department shall
8establish a program of services to prevent unnecessary
9institutionalization of persons age 60 and older in need of
10long term care or who are established as persons who suffer
11from Alzheimer's disease or a related disorder under the
12Alzheimer's Disease Assistance Act, thereby enabling them to
13remain in their own homes or in other living arrangements. Such
14preventive services, which may be coordinated with other
15programs for the aged and monitored by area agencies on aging
16in cooperation with the Department, may include, but are not
17limited to, any or all of the following:
18 (a) (blank);
19 (b) (blank);
20 (c) home care aide services;
21 (d) personal assistant services;
22 (e) adult day services;
23 (f) home-delivered meals;

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1 (g) education in self-care;
2 (h) personal care services;
3 (i) adult day health services;
4 (j) habilitation services;
5 (k) respite care;
6 (k-5) community reintegration services;
7 (k-6) flexible senior services;
8 (k-7) medication management;
9 (k-8) emergency home response;
10 (l) other nonmedical social services that may enable
11 the person to become self-supporting; or
12 (m) clearinghouse for information provided by senior
13 citizen home owners who want to rent rooms to or share
14 living space with other senior citizens.
15 Individuals who meet the following criteria shall have
16equal access to services under the Community Care Program: The
17Department shall establish eligibility standards for such
18services.
19 (a) are 60 years old or older;
20 (b) are U.S. citizens or legal aliens;
21 (c) are residents of Illinois;
22 (d) have non-exempt assets of $17,500 or less;
23 non-exempt assets do not include home, car, or personal
24 furnishings; and
25 (e) have an assessed need for long term care, as
26 provided in this Section, and are at risk for nursing

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1 facility placement as measured by the determination of need
2 assessment tool or a future updated assessment tool.
3In determining the amount and nature of services for which a
4person may qualify, consideration shall not be given to the
5value of cash, property or other assets held in the name of the
6person's spouse pursuant to a written agreement dividing
7marital property into equal but separate shares or pursuant to
8a transfer of the person's interest in a home to his spouse,
9provided that the spouse's share of the marital property is not
10made available to the person seeking such services.
11 Need for long term care shall be determined as follows:
12Individuals with a score of 29 or higher based on the
13determination of need (DON) assessment tool shall be eligible
14to receive institutional and home and community-based long term
15care services until the State receives federal approval and
16implements an updated assessment tool, and those individuals
17are found to be ineligible under that updated assessment tool.
18Anyone determined to be ineligible for services due to the
19updated assessment tool shall continue to be eligible for
20services for at least one year following that determination and
21must be reassessed no earlier than 11 months after that
22determination. The Department must adopt rules through the
23regular rulemaking process regarding the updated assessment
24tool, and shall not adopt emergency or peremptory rules
25regarding the updated assessment tool. The State shall not
26implement an updated assessment tool that causes more than 1%

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1of then-current recipients to lose eligibility.
2 Service cost maximums shall be set at levels no lower than
3the service cost maximums that were in effect as of January 1,
42016. Service cost maximums shall be increased accordingly to
5reflect any rate increases.
6 Beginning January 1, 2008, the Department shall require as
7a condition of eligibility that all new financially eligible
8applicants apply for and enroll in medical assistance under
9Article V of the Illinois Public Aid Code in accordance with
10rules promulgated by the Department.
11 The Department shall not: (i) adopt any rule that restricts
12eligibility under the Community Care Program to persons who
13qualify for medical assistance under Article V of the Illinois
14Public Aid Code; or (ii) establish, by rule, a separate program
15of home and community-based long term care services for persons
16who are otherwise eligible for services under the Community
17Care Program but who do not qualify for medical assistance
18under Article V of the Illinois Public Aid Code.
19 The Department shall, in conjunction with the Department of
20Public Aid (now Department of Healthcare and Family Services),
21seek appropriate amendments under Sections 1915 and 1924 of the
22Social Security Act. The purpose of the amendments shall be to
23extend eligibility for home and community based services under
24Sections 1915 and 1924 of the Social Security Act to persons
25who transfer to or for the benefit of a spouse those amounts of
26income and resources allowed under Section 1924 of the Social

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1Security Act. Subject to the approval of such amendments, the
2Department shall extend the provisions of Section 5-4 of the
3Illinois Public Aid Code to persons who, but for the provision
4of home or community-based services, would require the level of
5care provided in an institution, as is provided for in federal
6law. Those persons no longer found to be eligible for receiving
7noninstitutional services due to changes in the eligibility
8criteria shall be given 45 days notice prior to actual
9termination. Those persons receiving notice of termination may
10contact the Department and request the determination be
11appealed at any time during the 45 day notice period. The
12target population identified for the purposes of this Section
13are persons age 60 and older with an identified service need.
14Priority shall be given to those who are at imminent risk of
15institutionalization. The services shall be provided to
16eligible persons age 60 and older to the extent that the cost
17of the services together with the other personal maintenance
18expenses of the persons are reasonably related to the standards
19established for care in a group facility appropriate to the
20person's condition. These non-institutional services, pilot
21projects or experimental facilities may be provided as part of
22or in addition to those authorized by federal law or those
23funded and administered by the Department of Human Services.
24The Departments of Human Services, Healthcare and Family
25Services, Public Health, Veterans' Affairs, and Commerce and
26Economic Opportunity and other appropriate agencies of State,

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1federal and local governments shall cooperate with the
2Department on Aging in the establishment and development of the
3non-institutional services. The Department shall require an
4annual audit from all personal assistant and home care aide
5vendors contracting with the Department under this Section. The
6annual audit shall assure that each audited vendor's procedures
7are in compliance with Department's financial reporting
8guidelines requiring an administrative and employee wage and
9benefits cost split as defined in administrative rules. The
10audit is a public record under the Freedom of Information Act.
11The Department shall execute, relative to the nursing home
12prescreening project, written inter-agency agreements with the
13Department of Human Services and the Department of Healthcare
14and Family Services, to effect the following: (1) intake
15procedures and common eligibility criteria for those persons
16who are receiving non-institutional services; and (2) the
17establishment and development of non-institutional services in
18areas of the State where they are not currently available or
19are undeveloped. On and after July 1, 1996, all nursing home
20prescreenings for individuals 60 years of age or older shall be
21conducted by the Department.
22 As part of the Department on Aging's routine training of
23case managers and case manager supervisors, the Department may
24include information on family futures planning for persons who
25are age 60 or older and who are caregivers of their adult
26children with developmental disabilities. The content of the

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1training shall be at the Department's discretion.
2 The Department is authorized to establish a system of
3recipient copayment for services provided under this Section,
4such copayment to be based upon the recipient's ability to pay
5but in no case to exceed the actual cost of the services
6provided. Additionally, any portion of a person's income which
7is equal to or less than the federal poverty standard shall not
8be considered by the Department in determining the copayment.
9The level of such copayment shall be adjusted whenever
10necessary to reflect any change in the officially designated
11federal poverty standard. The Department shall not increase
12copayment levels to the levels that were in effect on January
131, 2016, except to make an adjustment for inflation.
14 The Department, or the Department's authorized
15representative, may recover the amount of moneys expended for
16services provided to or in behalf of a person under this
17Section by a claim against the person's estate or against the
18estate of the person's surviving spouse, but no recovery may be
19had until after the death of the surviving spouse, if any, and
20then only at such time when there is no surviving child who is
21under age 21 or blind or who has a permanent and total
22disability. This paragraph, however, shall not bar recovery, at
23the death of the person, of moneys for services provided to the
24person or in behalf of the person under this Section to which
25the person was not entitled; provided that such recovery shall
26not be enforced against any real estate while it is occupied as

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1a homestead by the surviving spouse or other dependent, if no
2claims by other creditors have been filed against the estate,
3or, if such claims have been filed, they remain dormant for
4failure of prosecution or failure of the claimant to compel
5administration of the estate for the purpose of payment. This
6paragraph shall not bar recovery from the estate of a spouse,
7under Sections 1915 and 1924 of the Social Security Act and
8Section 5-4 of the Illinois Public Aid Code, who precedes a
9person receiving services under this Section in death. All
10moneys for services paid to or in behalf of the person under
11this Section shall be claimed for recovery from the deceased
12spouse's estate. "Homestead", as used in this paragraph, means
13the dwelling house and contiguous real estate occupied by a
14surviving spouse or relative, as defined by the rules and
15regulations of the Department of Healthcare and Family
16Services, regardless of the value of the property.
17 The Department shall increase the effectiveness of the
18existing Community Care Program by:
19 (1) ensuring that in-home services included in the care
20 plan are available on evenings and weekends;
21 (2) ensuring that care plans contain the services that
22 eligible participants need based on the number of days in a
23 month, not limited to specific blocks of time, as
24 identified by the comprehensive assessment tool selected
25 by the Department for use statewide, not to exceed the
26 total monthly service cost maximum allowed for each

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1 service; the Department shall develop administrative rules
2 to implement this item (2);
3 (3) ensuring that the participants have the right to
4 choose the services contained in their care plan and to
5 direct how those services are provided, based on
6 administrative rules established by the Department;
7 (4) ensuring that the determination of need tool is
8 accurate in determining the participants' level of need; to
9 achieve this, the Department, in conjunction with the Older
10 Adult Services Advisory Committee, shall institute a study
11 of the relationship between the Determination of Need
12 scores, level of need, service cost maximums, and the
13 development and utilization of service plans no later than
14 May 1, 2008; findings and recommendations shall be
15 presented to the Governor and the General Assembly no later
16 than January 1, 2009; recommendations shall include all
17 needed changes to the service cost maximums schedule and
18 additional covered services;
19 (5) ensuring that homemakers can provide personal care
20 services that may or may not involve contact with clients,
21 including but not limited to:
22 (A) bathing;
23 (B) grooming;
24 (C) toileting;
25 (D) nail care;
26 (E) transferring;

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1 (F) respiratory services;
2 (G) exercise; or
3 (H) positioning;
4 (6) ensuring that homemaker program vendors are not
5 restricted from hiring homemakers who are family members of
6 clients or recommended by clients; the Department may not,
7 by rule or policy, require homemakers who are family
8 members of clients or recommended by clients to accept
9 assignments in homes other than the client;
10 (7) ensuring that the State may access maximum federal
11 matching funds by seeking approval for the Centers for
12 Medicare and Medicaid Services for modifications to the
13 State's home and community based services waiver and
14 additional waiver opportunities, including applying for
15 enrollment in the Balance Incentive Payment Program by May
16 1, 2013, in order to maximize federal matching funds; this
17 shall include, but not be limited to, modification that
18 reflects all changes in the Community Care Program services
19 and all increases in the services cost maximum;
20 (8) ensuring that the determination of need tool
21 accurately reflects the service needs of individuals with
22 Alzheimer's disease and related dementia disorders;
23 (9) ensuring that services are authorized accurately
24 and consistently for the Community Care Program (CCP); the
25 Department shall implement a Service Authorization policy
26 directive; the purpose shall be to ensure that eligibility

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1 and services are authorized accurately and consistently in
2 the CCP program; the policy directive shall clarify service
3 authorization guidelines to Care Coordination Units and
4 Community Care Program providers no later than May 1, 2013;
5 (10) working in conjunction with Care Coordination
6 Units, the Department of Healthcare and Family Services,
7 the Department of Human Services, Community Care Program
8 providers, and other stakeholders to make improvements to
9 the Medicaid claiming processes and the Medicaid
10 enrollment procedures or requirements as needed,
11 including, but not limited to, specific policy changes or
12 rules to improve the up-front enrollment of participants in
13 the Medicaid program and specific policy changes or rules
14 to insure more prompt submission of bills to the federal
15 government to secure maximum federal matching dollars as
16 promptly as possible; the Department on Aging shall have at
17 least 3 meetings with stakeholders by January 1, 2014 in
18 order to address these improvements;
19 (11) requiring home care service providers to comply
20 with the rounding of hours worked provisions under the
21 federal Fair Labor Standards Act (FLSA) and as set forth in
22 29 CFR 785.48(b) by May 1, 2013;
23 (12) implementing any necessary policy changes or
24 promulgating any rules, no later than January 1, 2014, to
25 assist the Department of Healthcare and Family Services in
26 moving as many participants as possible, consistent with

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1 federal regulations, into coordinated care plans if a care
2 coordination plan that covers long term care is available
3 in the recipient's area; and
4 (13) maintaining fiscal year 2014 rates at the same
5 level established on January 1, 2013.
6 By January 1, 2009 or as soon after the end of the Cash and
7Counseling Demonstration Project as is practicable, the
8Department may, based on its evaluation of the demonstration
9project, promulgate rules concerning personal assistant
10services, to include, but need not be limited to,
11qualifications, employment screening, rights under fair labor
12standards, training, fiduciary agent, and supervision
13requirements. All applicants shall be subject to the provisions
14of the Health Care Worker Background Check Act.
15 The Department shall develop procedures to enhance
16availability of services on evenings, weekends, and on an
17emergency basis to meet the respite needs of caregivers.
18Procedures shall be developed to permit the utilization of
19services in successive blocks of 24 hours up to the monthly
20maximum established by the Department. Workers providing these
21services shall be appropriately trained.
22 Beginning on the effective date of this amendatory Act of
231991, no person may perform chore/housekeeping and home care
24aide services under a program authorized by this Section unless
25that person has been issued a certificate of pre-service to do
26so by his or her employing agency. Information gathered to

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1effect such certification shall include (i) the person's name,
2(ii) the date the person was hired by his or her current
3employer, and (iii) the training, including dates and levels.
4Persons engaged in the program authorized by this Section
5before the effective date of this amendatory Act of 1991 shall
6be issued a certificate of all pre- and in-service training
7from his or her employer upon submitting the necessary
8information. The employing agency shall be required to retain
9records of all staff pre- and in-service training, and shall
10provide such records to the Department upon request and upon
11termination of the employer's contract with the Department. In
12addition, the employing agency is responsible for the issuance
13of certifications of in-service training completed to their
14employees.
15 The Department is required to develop a system to ensure
16that persons working as home care aides and personal assistants
17receive increases in their wages when the federal minimum wage
18is increased by requiring vendors to certify that they are
19meeting the federal minimum wage statute for home care aides
20and personal assistants. An employer that cannot ensure that
21the minimum wage increase is being given to home care aides and
22personal assistants shall be denied any increase in
23reimbursement costs.
24 The Community Care Program Advisory Committee is created in
25the Department on Aging. The Director shall appoint individuals
26to serve in the Committee, who shall serve at their own

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1expense. Members of the Committee must abide by all applicable
2ethics laws. The Committee shall advise the Department on
3issues related to the Department's program of services to
4prevent unnecessary institutionalization. The Committee shall
5meet on a bi-monthly basis and shall serve to identify and
6advise the Department on present and potential issues affecting
7the service delivery network, the program's clients, and the
8Department and to recommend solution strategies. Persons
9appointed to the Committee shall be appointed on, but not
10limited to, their own and their agency's experience with the
11program, geographic representation, and willingness to serve.
12The Director shall appoint members to the Committee to
13represent provider, advocacy, policy research, and other
14constituencies committed to the delivery of high quality home
15and community-based services to older adults. Representatives
16shall be appointed to ensure representation from community care
17providers including, but not limited to, adult day service
18providers, homemaker providers, case coordination and case
19management units, emergency home response providers, statewide
20trade or labor unions that represent home care aides and direct
21care staff, area agencies on aging, adults over age 60,
22membership organizations representing older adults, and other
23organizational entities, providers of care, or individuals
24with demonstrated interest and expertise in the field of home
25and community care as determined by the Director.
26 Nominations may be presented from any agency or State

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1association with interest in the program. The Director, or his
2or her designee, shall serve as the permanent co-chair of the
3advisory committee. One other co-chair shall be nominated and
4approved by the members of the committee on an annual basis.
5Committee members' terms of appointment shall be for 4 years
6with one-quarter of the appointees' terms expiring each year. A
7member shall continue to serve until his or her replacement is
8named. The Department shall fill vacancies that have a
9remaining term of over one year, and this replacement shall
10occur through the annual replacement of expiring terms. The
11Director shall designate Department staff to provide technical
12assistance and staff support to the committee. Department
13representation shall not constitute membership of the
14committee. All Committee papers, issues, recommendations,
15reports, and meeting memoranda are advisory only. The Director,
16or his or her designee, shall make a written report, as
17requested by the Committee, regarding issues before the
18Committee.
19 The Department on Aging and the Department of Human
20Services shall cooperate in the development and submission of
21an annual report on programs and services provided under this
22Section. Such joint report shall be filed with the Governor and
23the General Assembly on or before September 30 each year.
24 The requirement for reporting to the General Assembly shall
25be satisfied by filing copies of the report with the Speaker,
26the Minority Leader and the Clerk of the House of

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1Representatives and the President, the Minority Leader and the
2Secretary of the Senate and the Legislative Research Unit, as
3required by Section 3.1 of the General Assembly Organization
4Act and filing such additional copies with the State Government
5Report Distribution Center for the General Assembly as is
6required under paragraph (t) of Section 7 of the State Library
7Act.
8 Those persons previously found eligible for receiving
9non-institutional services whose services were discontinued
10under the Emergency Budget Act of Fiscal Year 1992, and who do
11not meet the eligibility standards in effect on or after July
121, 1992, shall remain ineligible on and after July 1, 1992.
13Those persons previously not required to cost-share and who
14were required to cost-share effective March 1, 1992, shall
15continue to meet cost-share requirements on and after July 1,
161992. Beginning July 1, 1992, all clients will be required to
17meet eligibility, cost-share, and other requirements and will
18have services discontinued or altered when they fail to meet
19these requirements.
20 For the purposes of this Section, "flexible senior
21services" refers to services that require one-time or periodic
22expenditures including, but not limited to, respite care, home
23modification, assistive technology, housing assistance, and
24transportation.
25 The Department shall implement an electronic service
26verification based on global positioning systems or other

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1cost-effective technology for the Community Care Program no
2later than January 1, 2014.
3 The Department shall require, as a condition of
4eligibility, enrollment in the medical assistance program
5under Article V of the Illinois Public Aid Code (i) beginning
6August 1, 2013, if the Auditor General has reported that the
7Department has failed to comply with the reporting requirements
8of Section 2-27 of the Illinois State Auditing Act; or (ii)
9beginning June 1, 2014, if the Auditor General has reported
10that the Department has not undertaken the required actions
11listed in the report required by subsection (a) of Section 2-27
12of the Illinois State Auditing Act.
13 The Department shall delay Community Care Program services
14until an applicant is determined eligible for medical
15assistance under Article V of the Illinois Public Aid Code (i)
16beginning August 1, 2013, if the Auditor General has reported
17that the Department has failed to comply with the reporting
18requirements of Section 2-27 of the Illinois State Auditing
19Act; or (ii) beginning June 1, 2014, if the Auditor General has
20reported that the Department has not undertaken the required
21actions listed in the report required by subsection (a) of
22Section 2-27 of the Illinois State Auditing Act.
23 The Department shall implement co-payments for the
24Community Care Program at the federally allowable maximum level
25(i) beginning August 1, 2013, if the Auditor General has
26reported that the Department has failed to comply with the

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1reporting requirements of Section 2-27 of the Illinois State
2Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
3General has reported that the Department has not undertaken the
4required actions listed in the report required by subsection
5(a) of Section 2-27 of the Illinois State Auditing Act.
6 The Department shall provide a bi-monthly report on the
7progress of the Community Care Program reforms set forth in
8this amendatory Act of the 98th General Assembly to the
9Governor, the Speaker of the House of Representatives, the
10Minority Leader of the House of Representatives, the President
11of the Senate, and the Minority Leader of the Senate.
12 The Department shall conduct a quarterly review of Care
13Coordination Unit performance and adherence to service
14guidelines. The quarterly review shall be reported to the
15Speaker of the House of Representatives, the Minority Leader of
16the House of Representatives, the President of the Senate, and
17the Minority Leader of the Senate. The Department shall collect
18and report longitudinal data on the performance of each care
19coordination unit. Nothing in this paragraph shall be construed
20to require the Department to identify specific care
21coordination units.
22 In regard to community care providers, failure to comply
23with Department on Aging policies shall be cause for
24disciplinary action, including, but not limited to,
25disqualification from serving Community Care Program clients.
26Each provider, upon submission of any bill or invoice to the

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1Department for payment for services rendered, shall include a
2notarized statement, under penalty of perjury pursuant to
3Section 1-109 of the Code of Civil Procedure, that the provider
4has complied with all Department policies.
5 The Director of the Department on Aging shall make
6information available to the State Board of Elections as may be
7required by an agreement the State Board of Elections has
8entered into with a multi-state voter registration list
9maintenance system.
10(Source: P.A. 98-8, eff. 5-3-13; 98-1171, eff. 6-1-15; 99-143,
11eff. 7-27-15.)
12 Section 10. The Rehabilitation of Persons with
13Disabilities Act is amended by changing Section 3 as follows:
14 (20 ILCS 2405/3) (from Ch. 23, par. 3434)
15 Sec. 3. Powers and duties. The Department shall have the
16powers and duties enumerated herein:
17 (a) To co-operate with the federal government in the
18administration of the provisions of the federal Rehabilitation
19Act of 1973, as amended, of the Workforce Investment Act of
201998, and of the federal Social Security Act to the extent and
21in the manner provided in these Acts.
22 (b) To prescribe and supervise such courses of vocational
23training and provide such other services as may be necessary
24for the habilitation and rehabilitation of persons with one or

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1more disabilities, including the administrative activities
2under subsection (e) of this Section, and to co-operate with
3State and local school authorities and other recognized
4agencies engaged in habilitation, rehabilitation and
5comprehensive rehabilitation services; and to cooperate with
6the Department of Children and Family Services regarding the
7care and education of children with one or more disabilities.
8 (c) (Blank).
9 (d) To report in writing, to the Governor, annually on or
10before the first day of December, and at such other times and
11in such manner and upon such subjects as the Governor may
12require. The annual report shall contain (1) a statement of the
13existing condition of comprehensive rehabilitation services,
14habilitation and rehabilitation in the State; (2) a statement
15of suggestions and recommendations with reference to the
16development of comprehensive rehabilitation services,
17habilitation and rehabilitation in the State; and (3) an
18itemized statement of the amounts of money received from
19federal, State and other sources, and of the objects and
20purposes to which the respective items of these several amounts
21have been devoted.
22 (e) (Blank).
23 (f) To establish a program of services to prevent the
24unnecessary institutionalization of persons in need of long
25term care and who meet the criteria for blindness or disability
26as defined by the Social Security Act, thereby enabling them to

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1remain in their own homes. Such preventive services include any
2or all of the following:
3 (1) personal assistant services;
4 (2) homemaker services;
5 (3) home-delivered meals;
6 (4) adult day care services;
7 (5) respite care;
8 (6) home modification or assistive equipment;
9 (7) home health services;
10 (8) electronic home response;
11 (9) brain injury behavioral/cognitive services;
12 (10) brain injury habilitation;
13 (11) brain injury pre-vocational services; or
14 (12) brain injury supported employment.
15 The Department shall establish eligibility standards for
16such services taking into consideration the unique economic and
17social needs of the population for whom they are to be
18provided. Such eligibility standards may be based on the
19recipient's ability to pay for services; provided, however,
20that any portion of a person's income that is equal to or less
21than the "protected income" level shall not be considered by
22the Department in determining eligibility. The "protected
23income" level shall be determined by the Department, shall
24never be less than the federal poverty standard, and shall be
25adjusted each year to reflect changes in the Consumer Price
26Index For All Urban Consumers as determined by the United

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1States Department of Labor. The standards must provide that a
2person may not have more than $10,000 in assets to be eligible
3for the services, and the Department may increase or decrease
4the asset limitation by rule. The Department may not decrease
5the asset level below $10,000.
6 Individuals with a score of 29 or higher based on the
7determination of need (DON) assessment tool shall be eligible
8to receive institutional and home and community-based long term
9care services until the State receives federal approval and
10implements an updated assessment tool, and those individuals
11are found to be ineligible under that updated assessment tool.
12Anyone determined to be ineligible for services due to the
13updated assessment tool shall continue to be eligible for
14services for at least one year following that determination and
15must be reassessed no earlier than 11 months after that
16determination. The Department must adopt rules through the
17regular rulemaking process regarding the updated assessment
18tool, and shall not adopt emergency or peremptory rules
19regarding the updated assessment tool. The State shall not
20implement an updated assessment tool that causes more than 1%
21of then-current recipients to lose eligibility.
22 Service cost maximums shall be set at levels no lower than
23the service cost maximums that were in effect as of January 1,
242016. Service cost maximums shall be increased accordingly to
25reflect any rate increases.
26 The services shall be provided, as established by the

HB1424 Engrossed- 23 -LRB100 03847 KTG 13852 b
1Department by rule, to eligible persons to prevent unnecessary
2or premature institutionalization, to the extent that the cost
3of the services, together with the other personal maintenance
4expenses of the persons, are reasonably related to the
5standards established for care in a group facility appropriate
6to their condition. These non-institutional services, pilot
7projects or experimental facilities may be provided as part of
8or in addition to those authorized by federal law or those
9funded and administered by the Illinois Department on Aging.
10The Department shall set rates and fees for services in a fair
11and equitable manner. Services identical to those offered by
12the Department on Aging shall be paid at the same rate.
13 Personal assistants shall be paid at a rate negotiated
14between the State and an exclusive representative of personal
15assistants under a collective bargaining agreement. In no case
16shall the Department pay personal assistants an hourly wage
17that is less than the federal minimum wage.
18 Solely for the purposes of coverage under the Illinois
19Public Labor Relations Act (5 ILCS 315/), personal assistants
20providing services under the Department's Home Services
21Program shall be considered to be public employees and the
22State of Illinois shall be considered to be their employer as
23of the effective date of this amendatory Act of the 93rd
24General Assembly, but not before. Solely for the purposes of
25coverage under the Illinois Public Labor Relations Act, home
26care and home health workers who function as personal

HB1424 Engrossed- 24 -LRB100 03847 KTG 13852 b
1assistants and individual maintenance home health workers and
2who also provide services under the Department's Home Services
3Program shall be considered to be public employees, no matter
4whether the State provides such services through direct
5fee-for-service arrangements, with the assistance of a managed
6care organization or other intermediary, or otherwise, and the
7State of Illinois shall be considered to be the employer of
8those persons as of January 29, 2013 (the effective date of
9Public Act 97-1158), but not before except as otherwise
10provided under this subsection (f). The State shall engage in
11collective bargaining with an exclusive representative of home
12care and home health workers who function as personal
13assistants and individual maintenance home health workers
14working under the Home Services Program concerning their terms
15and conditions of employment that are within the State's
16control. Nothing in this paragraph shall be understood to limit
17the right of the persons receiving services defined in this
18Section to hire and fire home care and home health workers who
19function as personal assistants and individual maintenance
20home health workers working under the Home Services Program or
21to supervise them within the limitations set by the Home
22Services Program. The State shall not be considered to be the
23employer of home care and home health workers who function as
24personal assistants and individual maintenance home health
25workers working under the Home Services Program for any
26purposes not specifically provided in Public Act 93-204 or

HB1424 Engrossed- 25 -LRB100 03847 KTG 13852 b
1Public Act 97-1158, including but not limited to, purposes of
2vicarious liability in tort and purposes of statutory
3retirement or health insurance benefits. Home care and home
4health workers who function as personal assistants and
5individual maintenance home health workers and who also provide
6services under the Department's Home Services Program shall not
7be covered by the State Employees Group Insurance Act of 1971
8(5 ILCS 375/).
9 The Department shall execute, relative to nursing home
10prescreening, as authorized by Section 4.03 of the Illinois Act
11on the Aging, written inter-agency agreements with the
12Department on Aging and the Department of Healthcare and Family
13Services, to effect the intake procedures and eligibility
14criteria for those persons who may need long term care. On and
15after July 1, 1996, all nursing home prescreenings for
16individuals 18 through 59 years of age shall be conducted by
17the Department, or a designee of the Department.
18 The Department is authorized to establish a system of
19recipient cost-sharing for services provided under this
20Section. The cost-sharing shall be based upon the recipient's
21ability to pay for services, but in no case shall the
22recipient's share exceed the actual cost of the services
23provided. Protected income shall not be considered by the
24Department in its determination of the recipient's ability to
25pay a share of the cost of services. The level of cost-sharing
26shall be adjusted each year to reflect changes in the

HB1424 Engrossed- 26 -LRB100 03847 KTG 13852 b
1"protected income" level. The Department shall deduct from the
2recipient's share of the cost of services any money expended by
3the recipient for disability-related expenses.
4 To the extent permitted under the federal Social Security
5Act, the Department, or the Department's authorized
6representative, may recover the amount of moneys expended for
7services provided to or in behalf of a person under this
8Section by a claim against the person's estate or against the
9estate of the person's surviving spouse, but no recovery may be
10had until after the death of the surviving spouse, if any, and
11then only at such time when there is no surviving child who is
12under age 21 or blind or who has a permanent and total
13disability. This paragraph, however, shall not bar recovery, at
14the death of the person, of moneys for services provided to the
15person or in behalf of the person under this Section to which
16the person was not entitled; provided that such recovery shall
17not be enforced against any real estate while it is occupied as
18a homestead by the surviving spouse or other dependent, if no
19claims by other creditors have been filed against the estate,
20or, if such claims have been filed, they remain dormant for
21failure of prosecution or failure of the claimant to compel
22administration of the estate for the purpose of payment. This
23paragraph shall not bar recovery from the estate of a spouse,
24under Sections 1915 and 1924 of the Social Security Act and
25Section 5-4 of the Illinois Public Aid Code, who precedes a
26person receiving services under this Section in death. All

HB1424 Engrossed- 27 -LRB100 03847 KTG 13852 b
1moneys for services paid to or in behalf of the person under
2this Section shall be claimed for recovery from the deceased
3spouse's estate. "Homestead", as used in this paragraph, means
4the dwelling house and contiguous real estate occupied by a
5surviving spouse or relative, as defined by the rules and
6regulations of the Department of Healthcare and Family
7Services, regardless of the value of the property.
8 The Department shall submit an annual report on programs
9and services provided under this Section. The report shall be
10filed with the Governor and the General Assembly on or before
11March 30 each year.
12 The requirement for reporting to the General Assembly shall
13be satisfied by filing copies of the report with the Speaker,
14the Minority Leader and the Clerk of the House of
15Representatives and the President, the Minority Leader and the
16Secretary of the Senate and the Legislative Research Unit, as
17required by Section 3.1 of the General Assembly Organization
18Act, and filing additional copies with the State Government
19Report Distribution Center for the General Assembly as required
20under paragraph (t) of Section 7 of the State Library Act.
21 (g) To establish such subdivisions of the Department as
22shall be desirable and assign to the various subdivisions the
23responsibilities and duties placed upon the Department by law.
24 (h) To cooperate and enter into any necessary agreements
25with the Department of Employment Security for the provision of
26job placement and job referral services to clients of the

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1Department, including job service registration of such clients
2with Illinois Employment Security offices and making job
3listings maintained by the Department of Employment Security
4available to such clients.
5 (i) To possess all powers reasonable and necessary for the
6exercise and administration of the powers, duties and
7responsibilities of the Department which are provided for by
8law.
9 (j) (Blank).
10 (k) (Blank).
11 (l) To establish, operate and maintain a Statewide Housing
12Clearinghouse of information on available, government
13subsidized housing accessible to persons with disabilities and
14available privately owned housing accessible to persons with
15disabilities. The information shall include but not be limited
16to the location, rental requirements, access features and
17proximity to public transportation of available housing. The
18Clearinghouse shall consist of at least a computerized database
19for the storage and retrieval of information and a separate or
20shared toll free telephone number for use by those seeking
21information from the Clearinghouse. Department offices and
22personnel throughout the State shall also assist in the
23operation of the Statewide Housing Clearinghouse. Cooperation
24with local, State and federal housing managers shall be sought
25and extended in order to frequently and promptly update the
26Clearinghouse's information.

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1 (m) To assure that the names and case records of persons
2who received or are receiving services from the Department,
3including persons receiving vocational rehabilitation, home
4services, or other services, and those attending one of the
5Department's schools or other supervised facility shall be
6confidential and not be open to the general public. Those case
7records and reports or the information contained in those
8records and reports shall be disclosed by the Director only to
9proper law enforcement officials, individuals authorized by a
10court, the General Assembly or any committee or commission of
11the General Assembly, and other persons and for reasons as the
12Director designates by rule. Disclosure by the Director may be
13only in accordance with other applicable law.
14(Source: P.A. 98-1004, eff. 8-18-14; 99-143, eff. 7-27-15.)
15 Section 13. The Nursing Home Care Act is amended by
16changing Section 3-402 as follows:
17 (210 ILCS 45/3-402) (from Ch. 111 1/2, par. 4153-402)
18 Sec. 3-402. Involuntary transfer or discharge.
19 Involuntary transfer or discharge of a resident from a
20facility shall be preceded by the discussion required under
21Section 3-408 and by a minimum written notice of 21 days,
22except in one of the following instances:
23 (a) When an emergency transfer or discharge is ordered
24 by the resident's attending physician because of the

HB1424 Engrossed- 30 -LRB100 03847 KTG 13852 b
1 resident's health care needs.
2 (b) When the transfer or discharge is mandated by the
3 physical safety of other residents, the facility staff, or
4 facility visitors, as documented in the clinical record.
5 The Department shall be notified prior to any such
6 involuntary transfer or discharge. The Department shall
7 immediately offer transfer, or discharge and relocation
8 assistance to residents transferred or discharged under
9 this subparagraph (b), and the Department may place
10 relocation teams as provided in Section 3-419 of this Act.
11 (c) When an identified offender is within the
12 provisional admission period defined in Section 1-120.3.
13 If the Identified Offender Report and Recommendation
14 prepared under Section 2-201.6 shows that the identified
15 offender poses a serious threat or danger to the physical
16 safety of other residents, the facility staff, or facility
17 visitors in the admitting facility and the facility
18 determines that it is unable to provide a safe environment
19 for the other residents, the facility staff, or facility
20 visitors, the facility shall transfer or discharge the
21 identified offender within 3 days after its receipt of the
22 Identified Offender Report and Recommendation.
23 No individual receiving care in an institutional setting
24shall be involuntarily discharged as the result of the updated
25determination of need (DON) assessment tool as provided in
26Section 5-5 of the Illinois Public Aid Code until a transition

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1plan has been developed by the Department on Aging or its
2designee and all care identified in the transition plan is
3available to the resident immediately upon discharge.
4(Source: P.A. 96-1372, eff. 7-29-10.)
5 Section 15. The Illinois Public Aid Code is amended by
6changing Sections 5-5 and 5-5.01a as follows:
7 (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
8 Sec. 5-5. Medical services. The Illinois Department, by
9rule, shall determine the quantity and quality of and the rate
10of reimbursement for the medical assistance for which payment
11will be authorized, and the medical services to be provided,
12which may include all or part of the following: (1) inpatient
13hospital services; (2) outpatient hospital services; (3) other
14laboratory and X-ray services; (4) skilled nursing home
15services; (5) physicians' services whether furnished in the
16office, the patient's home, a hospital, a skilled nursing home,
17or elsewhere; (6) medical care, or any other type of remedial
18care furnished by licensed practitioners; (7) home health care
19services; (8) private duty nursing service; (9) clinic
20services; (10) dental services, including prevention and
21treatment of periodontal disease and dental caries disease for
22pregnant women, provided by an individual licensed to practice
23dentistry or dental surgery; for purposes of this item (10),
24"dental services" means diagnostic, preventive, or corrective

HB1424 Engrossed- 32 -LRB100 03847 KTG 13852 b
1procedures provided by or under the supervision of a dentist in
2the practice of his or her profession; (11) physical therapy
3and related services; (12) prescribed drugs, dentures, and
4prosthetic devices; and eyeglasses prescribed by a physician
5skilled in the diseases of the eye, or by an optometrist,
6whichever the person may select; (13) other diagnostic,
7screening, preventive, and rehabilitative services, including
8to ensure that the individual's need for intervention or
9treatment of mental disorders or substance use disorders or
10co-occurring mental health and substance use disorders is
11determined using a uniform screening, assessment, and
12evaluation process inclusive of criteria, for children and
13adults; for purposes of this item (13), a uniform screening,
14assessment, and evaluation process refers to a process that
15includes an appropriate evaluation and, as warranted, a
16referral; "uniform" does not mean the use of a singular
17instrument, tool, or process that all must utilize; (14)
18transportation and such other expenses as may be necessary;
19(15) medical treatment of sexual assault survivors, as defined
20in Section 1a of the Sexual Assault Survivors Emergency
21Treatment Act, for injuries sustained as a result of the sexual
22assault, including examinations and laboratory tests to
23discover evidence which may be used in criminal proceedings
24arising from the sexual assault; (16) the diagnosis and
25treatment of sickle cell anemia; and (17) any other medical
26care, and any other type of remedial care recognized under the

HB1424 Engrossed- 33 -LRB100 03847 KTG 13852 b
1laws of this State, but not including abortions, or induced
2miscarriages or premature births, unless, in the opinion of a
3physician, such procedures are necessary for the preservation
4of the life of the woman seeking such treatment, or except an
5induced premature birth intended to produce a live viable child
6and such procedure is necessary for the health of the mother or
7her unborn child. The Illinois Department, by rule, shall
8prohibit any physician from providing medical assistance to
9anyone eligible therefor under this Code where such physician
10has been found guilty of performing an abortion procedure in a
11wilful and wanton manner upon a woman who was not pregnant at
12the time such abortion procedure was performed. The term "any
13other type of remedial care" shall include nursing care and
14nursing home service for persons who rely on treatment by
15spiritual means alone through prayer for healing.
16 Notwithstanding any other provision of this Section, a
17comprehensive tobacco use cessation program that includes
18purchasing prescription drugs or prescription medical devices
19approved by the Food and Drug Administration shall be covered
20under the medical assistance program under this Article for
21persons who are otherwise eligible for assistance under this
22Article.
23 Notwithstanding any other provision of this Code, the
24Illinois Department may not require, as a condition of payment
25for any laboratory test authorized under this Article, that a
26physician's handwritten signature appear on the laboratory

HB1424 Engrossed- 34 -LRB100 03847 KTG 13852 b
1test order form. The Illinois Department may, however, impose
2other appropriate requirements regarding laboratory test order
3documentation.
4 Upon receipt of federal approval of an amendment to the
5Illinois Title XIX State Plan for this purpose, the Department
6shall authorize the Chicago Public Schools (CPS) to procure a
7vendor or vendors to manufacture eyeglasses for individuals
8enrolled in a school within the CPS system. CPS shall ensure
9that its vendor or vendors are enrolled as providers in the
10medical assistance program and in any capitated Medicaid
11managed care entity (MCE) serving individuals enrolled in a
12school within the CPS system. Under any contract procured under
13this provision, the vendor or vendors must serve only
14individuals enrolled in a school within the CPS system. Claims
15for services provided by CPS's vendor or vendors to recipients
16of benefits in the medical assistance program under this Code,
17the Children's Health Insurance Program, or the Covering ALL
18KIDS Health Insurance Program shall be submitted to the
19Department or the MCE in which the individual is enrolled for
20payment and shall be reimbursed at the Department's or the
21MCE's established rates or rate methodologies for eyeglasses.
22 On and after July 1, 2012, the Department of Healthcare and
23Family Services may provide the following services to persons
24eligible for assistance under this Article who are
25participating in education, training or employment programs
26operated by the Department of Human Services as successor to

HB1424 Engrossed- 35 -LRB100 03847 KTG 13852 b
1the Department of Public Aid:
2 (1) dental services provided by or under the
3 supervision of a dentist; and
4 (2) eyeglasses prescribed by a physician skilled in the
5 diseases of the eye, or by an optometrist, whichever the
6 person may select.
7 Notwithstanding any other provision of this Code and
8subject to federal approval, the Department may adopt rules to
9allow a dentist who is volunteering his or her service at no
10cost to render dental services through an enrolled
11not-for-profit health clinic without the dentist personally
12enrolling as a participating provider in the medical assistance
13program. A not-for-profit health clinic shall include a public
14health clinic or Federally Qualified Health Center or other
15enrolled provider, as determined by the Department, through
16which dental services covered under this Section are performed.
17The Department shall establish a process for payment of claims
18for reimbursement for covered dental services rendered under
19this provision.
20 The Illinois Department, by rule, may distinguish and
21classify the medical services to be provided only in accordance
22with the classes of persons designated in Section 5-2.
23 The Department of Healthcare and Family Services must
24provide coverage and reimbursement for amino acid-based
25elemental formulas, regardless of delivery method, for the
26diagnosis and treatment of (i) eosinophilic disorders and (ii)

HB1424 Engrossed- 36 -LRB100 03847 KTG 13852 b
1short bowel syndrome when the prescribing physician has issued
2a written order stating that the amino acid-based elemental
3formula is medically necessary.
4 The Illinois Department shall authorize the provision of,
5and shall authorize payment for, screening by low-dose
6mammography for the presence of occult breast cancer for women
735 years of age or older who are eligible for medical
8assistance under this Article, as follows:
9 (A) A baseline mammogram for women 35 to 39 years of
10 age.
11 (B) An annual mammogram for women 40 years of age or
12 older.
13 (C) A mammogram at the age and intervals considered
14 medically necessary by the woman's health care provider for
15 women under 40 years of age and having a family history of
16 breast cancer, prior personal history of breast cancer,
17 positive genetic testing, or other risk factors.
18 (D) A comprehensive ultrasound screening of an entire
19 breast or breasts if a mammogram demonstrates
20 heterogeneous or dense breast tissue, when medically
21 necessary as determined by a physician licensed to practice
22 medicine in all of its branches.
23 (E) A screening MRI when medically necessary, as
24 determined by a physician licensed to practice medicine in
25 all of its branches.
26 All screenings shall include a physical breast exam,

HB1424 Engrossed- 37 -LRB100 03847 KTG 13852 b
1instruction on self-examination and information regarding the
2frequency of self-examination and its value as a preventative
3tool. For purposes of this Section, "low-dose mammography"
4means the x-ray examination of the breast using equipment
5dedicated specifically for mammography, including the x-ray
6tube, filter, compression device, and image receptor, with an
7average radiation exposure delivery of less than one rad per
8breast for 2 views of an average size breast. The term also
9includes digital mammography and includes breast
10tomosynthesis. As used in this Section, the term "breast
11tomosynthesis" means a radiologic procedure that involves the
12acquisition of projection images over the stationary breast to
13produce cross-sectional digital three-dimensional images of
14the breast. If, at any time, the Secretary of the United States
15Department of Health and Human Services, or its successor
16agency, promulgates rules or regulations to be published in the
17Federal Register or publishes a comment in the Federal Register
18or issues an opinion, guidance, or other action that would
19require the State, pursuant to any provision of the Patient
20Protection and Affordable Care Act (Public Law 111-148),
21including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
22successor provision, to defray the cost of any coverage for
23breast tomosynthesis outlined in this paragraph, then the
24requirement that an insurer cover breast tomosynthesis is
25inoperative other than any such coverage authorized under
26Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and

HB1424 Engrossed- 38 -LRB100 03847 KTG 13852 b
1the State shall not assume any obligation for the cost of
2coverage for breast tomosynthesis set forth in this paragraph.
3 On and after January 1, 2016, the Department shall ensure
4that all networks of care for adult clients of the Department
5include access to at least one breast imaging Center of Imaging
6Excellence as certified by the American College of Radiology.
7 On and after January 1, 2012, providers participating in a
8quality improvement program approved by the Department shall be
9reimbursed for screening and diagnostic mammography at the same
10rate as the Medicare program's rates, including the increased
11reimbursement for digital mammography.
12 The Department shall convene an expert panel including
13representatives of hospitals, free-standing mammography
14facilities, and doctors, including radiologists, to establish
15quality standards for mammography.
16 On and after January 1, 2017, providers participating in a
17breast cancer treatment quality improvement program approved
18by the Department shall be reimbursed for breast cancer
19treatment at a rate that is no lower than 95% of the Medicare
20program's rates for the data elements included in the breast
21cancer treatment quality program.
22 The Department shall convene an expert panel, including
23representatives of hospitals, free standing breast cancer
24treatment centers, breast cancer quality organizations, and
25doctors, including breast surgeons, reconstructive breast
26surgeons, oncologists, and primary care providers to establish

HB1424 Engrossed- 39 -LRB100 03847 KTG 13852 b
1quality standards for breast cancer treatment.
2 Subject to federal approval, the Department shall
3establish a rate methodology for mammography at federally
4qualified health centers and other encounter-rate clinics.
5These clinics or centers may also collaborate with other
6hospital-based mammography facilities. By January 1, 2016, the
7Department shall report to the General Assembly on the status
8of the provision set forth in this paragraph.
9 The Department shall establish a methodology to remind
10women who are age-appropriate for screening mammography, but
11who have not received a mammogram within the previous 18
12months, of the importance and benefit of screening mammography.
13The Department shall work with experts in breast cancer
14outreach and patient navigation to optimize these reminders and
15shall establish a methodology for evaluating their
16effectiveness and modifying the methodology based on the
17evaluation.
18 The Department shall establish a performance goal for
19primary care providers with respect to their female patients
20over age 40 receiving an annual mammogram. This performance
21goal shall be used to provide additional reimbursement in the
22form of a quality performance bonus to primary care providers
23who meet that goal.
24 The Department shall devise a means of case-managing or
25patient navigation for beneficiaries diagnosed with breast
26cancer. This program shall initially operate as a pilot program

HB1424 Engrossed- 40 -LRB100 03847 KTG 13852 b
1in areas of the State with the highest incidence of mortality
2related to breast cancer. At least one pilot program site shall
3be in the metropolitan Chicago area and at least one site shall
4be outside the metropolitan Chicago area. On or after July 1,
52016, the pilot program shall be expanded to include one site
6in western Illinois, one site in southern Illinois, one site in
7central Illinois, and 4 sites within metropolitan Chicago. An
8evaluation of the pilot program shall be carried out measuring
9health outcomes and cost of care for those served by the pilot
10program compared to similarly situated patients who are not
11served by the pilot program.
12 The Department shall require all networks of care to
13develop a means either internally or by contract with experts
14in navigation and community outreach to navigate cancer
15patients to comprehensive care in a timely fashion. The
16Department shall require all networks of care to include access
17for patients diagnosed with cancer to at least one academic
18commission on cancer-accredited cancer program as an
19in-network covered benefit.
20 Any medical or health care provider shall immediately
21recommend, to any pregnant woman who is being provided prenatal
22services and is suspected of drug abuse or is addicted as
23defined in the Alcoholism and Other Drug Abuse and Dependency
24Act, referral to a local substance abuse treatment provider
25licensed by the Department of Human Services or to a licensed
26hospital which provides substance abuse treatment services.

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1The Department of Healthcare and Family Services shall assure
2coverage for the cost of treatment of the drug abuse or
3addiction for pregnant recipients in accordance with the
4Illinois Medicaid Program in conjunction with the Department of
5Human Services.
6 All medical providers providing medical assistance to
7pregnant women under this Code shall receive information from
8the Department on the availability of services under the Drug
9Free Families with a Future or any comparable program providing
10case management services for addicted women, including
11information on appropriate referrals for other social services
12that may be needed by addicted women in addition to treatment
13for addiction.
14 The Illinois Department, in cooperation with the
15Departments of Human Services (as successor to the Department
16of Alcoholism and Substance Abuse) and Public Health, through a
17public awareness campaign, may provide information concerning
18treatment for alcoholism and drug abuse and addiction, prenatal
19health care, and other pertinent programs directed at reducing
20the number of drug-affected infants born to recipients of
21medical assistance.
22 Neither the Department of Healthcare and Family Services
23nor the Department of Human Services shall sanction the
24recipient solely on the basis of her substance abuse.
25 The Illinois Department shall establish such regulations
26governing the dispensing of health services under this Article

HB1424 Engrossed- 42 -LRB100 03847 KTG 13852 b
1as it shall deem appropriate. The Department should seek the
2advice of formal professional advisory committees appointed by
3the Director of the Illinois Department for the purpose of
4providing regular advice on policy and administrative matters,
5information dissemination and educational activities for
6medical and health care providers, and consistency in
7procedures to the Illinois Department.
8 The Illinois Department may develop and contract with
9Partnerships of medical providers to arrange medical services
10for persons eligible under Section 5-2 of this Code.
11Implementation of this Section may be by demonstration projects
12in certain geographic areas. The Partnership shall be
13represented by a sponsor organization. The Department, by rule,
14shall develop qualifications for sponsors of Partnerships.
15Nothing in this Section shall be construed to require that the
16sponsor organization be a medical organization.
17 The sponsor must negotiate formal written contracts with
18medical providers for physician services, inpatient and
19outpatient hospital care, home health services, treatment for
20alcoholism and substance abuse, and other services determined
21necessary by the Illinois Department by rule for delivery by
22Partnerships. Physician services must include prenatal and
23obstetrical care. The Illinois Department shall reimburse
24medical services delivered by Partnership providers to clients
25in target areas according to provisions of this Article and the
26Illinois Health Finance Reform Act, except that:

HB1424 Engrossed- 43 -LRB100 03847 KTG 13852 b
1 (1) Physicians participating in a Partnership and
2 providing certain services, which shall be determined by
3 the Illinois Department, to persons in areas covered by the
4 Partnership may receive an additional surcharge for such
5 services.
6 (2) The Department may elect to consider and negotiate
7 financial incentives to encourage the development of
8 Partnerships and the efficient delivery of medical care.
9 (3) Persons receiving medical services through
10 Partnerships may receive medical and case management
11 services above the level usually offered through the
12 medical assistance program.
13 Medical providers shall be required to meet certain
14qualifications to participate in Partnerships to ensure the
15delivery of high quality medical services. These
16qualifications shall be determined by rule of the Illinois
17Department and may be higher than qualifications for
18participation in the medical assistance program. Partnership
19sponsors may prescribe reasonable additional qualifications
20for participation by medical providers, only with the prior
21written approval of the Illinois Department.
22 Nothing in this Section shall limit the free choice of
23practitioners, hospitals, and other providers of medical
24services by clients. In order to ensure patient freedom of
25choice, the Illinois Department shall immediately promulgate
26all rules and take all other necessary actions so that provided

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1services may be accessed from therapeutically certified
2optometrists to the full extent of the Illinois Optometric
3Practice Act of 1987 without discriminating between service
4providers.
5 The Department shall apply for a waiver from the United
6States Health Care Financing Administration to allow for the
7implementation of Partnerships under this Section.
8 The Illinois Department shall require health care
9providers to maintain records that document the medical care
10and services provided to recipients of Medical Assistance under
11this Article. Such records must be retained for a period of not
12less than 6 years from the date of service or as provided by
13applicable State law, whichever period is longer, except that
14if an audit is initiated within the required retention period
15then the records must be retained until the audit is completed
16and every exception is resolved. The Illinois Department shall
17require health care providers to make available, when
18authorized by the patient, in writing, the medical records in a
19timely fashion to other health care providers who are treating
20or serving persons eligible for Medical Assistance under this
21Article. All dispensers of medical services shall be required
22to maintain and retain business and professional records
23sufficient to fully and accurately document the nature, scope,
24details and receipt of the health care provided to persons
25eligible for medical assistance under this Code, in accordance
26with regulations promulgated by the Illinois Department. The

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1rules and regulations shall require that proof of the receipt
2of prescription drugs, dentures, prosthetic devices and
3eyeglasses by eligible persons under this Section accompany
4each claim for reimbursement submitted by the dispenser of such
5medical services. No such claims for reimbursement shall be
6approved for payment by the Illinois Department without such
7proof of receipt, unless the Illinois Department shall have put
8into effect and shall be operating a system of post-payment
9audit and review which shall, on a sampling basis, be deemed
10adequate by the Illinois Department to assure that such drugs,
11dentures, prosthetic devices and eyeglasses for which payment
12is being made are actually being received by eligible
13recipients. Within 90 days after September 16, 1984 (the
14effective date of Public Act 83-1439), the Illinois Department
15shall establish a current list of acquisition costs for all
16prosthetic devices and any other items recognized as medical
17equipment and supplies reimbursable under this Article and
18shall update such list on a quarterly basis, except that the
19acquisition costs of all prescription drugs shall be updated no
20less frequently than every 30 days as required by Section
215-5.12.
22 The rules and regulations of the Illinois Department shall
23require that a written statement including the required opinion
24of a physician shall accompany any claim for reimbursement for
25abortions, or induced miscarriages or premature births. This
26statement shall indicate what procedures were used in providing

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1such medical services.
2 Notwithstanding any other law to the contrary, the Illinois
3Department shall, within 365 days after July 22, 2013 (the
4effective date of Public Act 98-104), establish procedures to
5permit skilled care facilities licensed under the Nursing Home
6Care Act to submit monthly billing claims for reimbursement
7purposes. Following development of these procedures, the
8Department shall, by July 1, 2016, test the viability of the
9new system and implement any necessary operational or
10structural changes to its information technology platforms in
11order to allow for the direct acceptance and payment of nursing
12home claims.
13 Notwithstanding any other law to the contrary, the Illinois
14Department shall, within 365 days after August 15, 2014 (the
15effective date of Public Act 98-963), establish procedures to
16permit ID/DD facilities licensed under the ID/DD Community Care
17Act and MC/DD facilities licensed under the MC/DD Act to submit
18monthly billing claims for reimbursement purposes. Following
19development of these procedures, the Department shall have an
20additional 365 days to test the viability of the new system and
21to ensure that any necessary operational or structural changes
22to its information technology platforms are implemented.
23 The Illinois Department shall require all dispensers of
24medical services, other than an individual practitioner or
25group of practitioners, desiring to participate in the Medical
26Assistance program established under this Article to disclose

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1all financial, beneficial, ownership, equity, surety or other
2interests in any and all firms, corporations, partnerships,
3associations, business enterprises, joint ventures, agencies,
4institutions or other legal entities providing any form of
5health care services in this State under this Article.
6 The Illinois Department may require that all dispensers of
7medical services desiring to participate in the medical
8assistance program established under this Article disclose,
9under such terms and conditions as the Illinois Department may
10by rule establish, all inquiries from clients and attorneys
11regarding medical bills paid by the Illinois Department, which
12inquiries could indicate potential existence of claims or liens
13for the Illinois Department.
14 Enrollment of a vendor shall be subject to a provisional
15period and shall be conditional for one year. During the period
16of conditional enrollment, the Department may terminate the
17vendor's eligibility to participate in, or may disenroll the
18vendor from, the medical assistance program without cause.
19Unless otherwise specified, such termination of eligibility or
20disenrollment is not subject to the Department's hearing
21process. However, a disenrolled vendor may reapply without
22penalty.
23 The Department has the discretion to limit the conditional
24enrollment period for vendors based upon category of risk of
25the vendor.
26 Prior to enrollment and during the conditional enrollment

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1period in the medical assistance program, all vendors shall be
2subject to enhanced oversight, screening, and review based on
3the risk of fraud, waste, and abuse that is posed by the
4category of risk of the vendor. The Illinois Department shall
5establish the procedures for oversight, screening, and review,
6which may include, but need not be limited to: criminal and
7financial background checks; fingerprinting; license,
8certification, and authorization verifications; unscheduled or
9unannounced site visits; database checks; prepayment audit
10reviews; audits; payment caps; payment suspensions; and other
11screening as required by federal or State law.
12 The Department shall define or specify the following: (i)
13by provider notice, the "category of risk of the vendor" for
14each type of vendor, which shall take into account the level of
15screening applicable to a particular category of vendor under
16federal law and regulations; (ii) by rule or provider notice,
17the maximum length of the conditional enrollment period for
18each category of risk of the vendor; and (iii) by rule, the
19hearing rights, if any, afforded to a vendor in each category
20of risk of the vendor that is terminated or disenrolled during
21the conditional enrollment period.
22 To be eligible for payment consideration, a vendor's
23payment claim or bill, either as an initial claim or as a
24resubmitted claim following prior rejection, must be received
25by the Illinois Department, or its fiscal intermediary, no
26later than 180 days after the latest date on the claim on which

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1medical goods or services were provided, with the following
2exceptions:
3 (1) In the case of a provider whose enrollment is in
4 process by the Illinois Department, the 180-day period
5 shall not begin until the date on the written notice from
6 the Illinois Department that the provider enrollment is
7 complete.
8 (2) In the case of errors attributable to the Illinois
9 Department or any of its claims processing intermediaries
10 which result in an inability to receive, process, or
11 adjudicate a claim, the 180-day period shall not begin
12 until the provider has been notified of the error.
13 (3) In the case of a provider for whom the Illinois
14 Department initiates the monthly billing process.
15 (4) In the case of a provider operated by a unit of
16 local government with a population exceeding 3,000,000
17 when local government funds finance federal participation
18 for claims payments.
19 For claims for services rendered during a period for which
20a recipient received retroactive eligibility, claims must be
21filed within 180 days after the Department determines the
22applicant is eligible. For claims for which the Illinois
23Department is not the primary payer, claims must be submitted
24to the Illinois Department within 180 days after the final
25adjudication by the primary payer.
26 In the case of long term care facilities, within 5 days of

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1receipt by the facility of required prescreening information,
2data for new admissions shall be entered into the Medical
3Electronic Data Interchange (MEDI) or the Recipient
4Eligibility Verification (REV) System or successor system, and
5within 15 days of receipt by the facility of required
6prescreening information, admission documents shall be
7submitted through MEDI or REV or shall be submitted directly to
8the Department of Human Services using required admission
9forms. Effective September 1, 2014, admission documents,
10including all prescreening information, must be submitted
11through MEDI or REV. Confirmation numbers assigned to an
12accepted transaction shall be retained by a facility to verify
13timely submittal. Once an admission transaction has been
14completed, all resubmitted claims following prior rejection
15are subject to receipt no later than 180 days after the
16admission transaction has been completed.
17 Claims that are not submitted and received in compliance
18with the foregoing requirements shall not be eligible for
19payment under the medical assistance program, and the State
20shall have no liability for payment of those claims.
21 To the extent consistent with applicable information and
22privacy, security, and disclosure laws, State and federal
23agencies and departments shall provide the Illinois Department
24access to confidential and other information and data necessary
25to perform eligibility and payment verifications and other
26Illinois Department functions. This includes, but is not

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1limited to: information pertaining to licensure;
2certification; earnings; immigration status; citizenship; wage
3reporting; unearned and earned income; pension income;
4employment; supplemental security income; social security
5numbers; National Provider Identifier (NPI) numbers; the
6National Practitioner Data Bank (NPDB); program and agency
7exclusions; taxpayer identification numbers; tax delinquency;
8corporate information; and death records.
9 The Illinois Department shall enter into agreements with
10State agencies and departments, and is authorized to enter into
11agreements with federal agencies and departments, under which
12such agencies and departments shall share data necessary for
13medical assistance program integrity functions and oversight.
14The Illinois Department shall develop, in cooperation with
15other State departments and agencies, and in compliance with
16applicable federal laws and regulations, appropriate and
17effective methods to share such data. At a minimum, and to the
18extent necessary to provide data sharing, the Illinois
19Department shall enter into agreements with State agencies and
20departments, and is authorized to enter into agreements with
21federal agencies and departments, including but not limited to:
22the Secretary of State; the Department of Revenue; the
23Department of Public Health; the Department of Human Services;
24and the Department of Financial and Professional Regulation.
25 Beginning in fiscal year 2013, the Illinois Department
26shall set forth a request for information to identify the

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1benefits of a pre-payment, post-adjudication, and post-edit
2claims system with the goals of streamlining claims processing
3and provider reimbursement, reducing the number of pending or
4rejected claims, and helping to ensure a more transparent
5adjudication process through the utilization of: (i) provider
6data verification and provider screening technology; and (ii)
7clinical code editing; and (iii) pre-pay, pre- or
8post-adjudicated predictive modeling with an integrated case
9management system with link analysis. Such a request for
10information shall not be considered as a request for proposal
11or as an obligation on the part of the Illinois Department to
12take any action or acquire any products or services.
13 The Illinois Department shall establish policies,
14procedures, standards and criteria by rule for the acquisition,
15repair and replacement of orthotic and prosthetic devices and
16durable medical equipment. Such rules shall provide, but not be
17limited to, the following services: (1) immediate repair or
18replacement of such devices by recipients; and (2) rental,
19lease, purchase or lease-purchase of durable medical equipment
20in a cost-effective manner, taking into consideration the
21recipient's medical prognosis, the extent of the recipient's
22needs, and the requirements and costs for maintaining such
23equipment. Subject to prior approval, such rules shall enable a
24recipient to temporarily acquire and use alternative or
25substitute devices or equipment pending repairs or
26replacements of any device or equipment previously authorized

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1for such recipient by the Department. Notwithstanding any
2provision of Section 5-5f to the contrary, the Department may,
3by rule, exempt certain replacement wheelchair parts from prior
4approval and, for wheelchairs, wheelchair parts, wheelchair
5accessories, and related seating and positioning items,
6determine the wholesale price by methods other than actual
7acquisition costs.
8 The Department shall require, by rule, all providers of
9durable medical equipment to be accredited by an accreditation
10organization approved by the federal Centers for Medicare and
11Medicaid Services and recognized by the Department in order to
12bill the Department for providing durable medical equipment to
13recipients. No later than 15 months after the effective date of
14the rule adopted pursuant to this paragraph, all providers must
15meet the accreditation requirement.
16 The Department shall execute, relative to the nursing home
17prescreening project, written inter-agency agreements with the
18Department of Human Services and the Department on Aging, to
19effect the following: (i) intake procedures and common
20eligibility criteria for those persons who are receiving
21non-institutional services; and (ii) the establishment and
22development of non-institutional services in areas of the State
23where they are not currently available or are undeveloped; and
24(iii) notwithstanding any other provision of law, subject to
25federal approval, on and after July 1, 2012, an increase in the
26determination of need (DON) scores from 29 to 37 for applicants

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1for institutional and home and community-based long term care;
2if and only if federal approval is not granted, the Department
3may, in conjunction with other affected agencies, implement
4utilization controls or changes in benefit packages to
5effectuate a similar savings amount for this population; and
6(iv) no later than July 1, 2013, minimum level of care
7eligibility criteria for institutional and home and
8community-based long term care; and (iv) (v) no later than
9October 1, 2013, establish procedures to permit long term care
10providers access to eligibility scores for individuals with an
11admission date who are seeking or receiving services from the
12long term care provider. In order to select the minimum level
13of care eligibility criteria, the Governor shall establish a
14workgroup that includes affected agency representatives and
15stakeholders representing the institutional and home and
16community-based long term care interests. This Section shall
17not restrict the Department from implementing lower level of
18care eligibility criteria for community-based services in
19circumstances where federal approval has been granted.
20Individuals with a score of 29 or higher based on the
21determination of need (DON) assessment tool shall be eligible
22to receive institutional and home and community-based long term
23care services until the State receives federal approval and
24implements an updated assessment tool, and those individuals
25are found to be ineligible under that updated assessment tool.
26Anyone determined to be ineligible for services due to the

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1updated assessment tool shall continue to be eligible for
2services for at least one year following that determination and
3must be reassessed no earlier than 11 months after that
4determination. The Department must adopt rules through the
5regular rulemaking process regarding the updated assessment
6tool, and shall not adopt emergency or peremptory rules
7regarding the updated assessment tool. The State shall not
8implement an updated assessment tool that causes more than 1%
9of then-current recipients to lose eligibility. No individual
10receiving care in an institutional setting shall be
11involuntarily discharged as the result of the updated
12assessment tool until a transition plan has been developed by
13the Department on Aging or its designee and all care identified
14in the transition plan is available to the resident immediately
15upon discharge.
16 The Illinois Department shall develop and operate, in
17cooperation with other State Departments and agencies and in
18compliance with applicable federal laws and regulations,
19appropriate and effective systems of health care evaluation and
20programs for monitoring of utilization of health care services
21and facilities, as it affects persons eligible for medical
22assistance under this Code.
23 The Illinois Department shall report annually to the
24General Assembly, no later than the second Friday in April of
251979 and each year thereafter, in regard to:
26 (a) actual statistics and trends in utilization of

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1 medical services by public aid recipients;
2 (b) actual statistics and trends in the provision of
3 the various medical services by medical vendors;
4 (c) current rate structures and proposed changes in
5 those rate structures for the various medical vendors; and
6 (d) efforts at utilization review and control by the
7 Illinois Department.
8 The period covered by each report shall be the 3 years
9ending on the June 30 prior to the report. The report shall
10include suggested legislation for consideration by the General
11Assembly. The filing of one copy of the report with the
12Speaker, one copy with the Minority Leader and one copy with
13the Clerk of the House of Representatives, one copy with the
14President, one copy with the Minority Leader and one copy with
15the Secretary of the Senate, one copy with the Legislative
16Research Unit, and such additional copies with the State
17Government Report Distribution Center for the General Assembly
18as is required under paragraph (t) of Section 7 of the State
19Library Act shall be deemed sufficient to comply with this
20Section.
21 Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on
25Administrative Rules; any purported rule not so adopted, for
26whatever reason, is unauthorized.

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1 On and after July 1, 2012, the Department shall reduce any
2rate of reimbursement for services or other payments or alter
3any methodologies authorized by this Code to reduce any rate of
4reimbursement for services or other payments in accordance with
5Section 5-5e.
6 Because kidney transplantation can be an appropriate, cost
7effective alternative to renal dialysis when medically
8necessary and notwithstanding the provisions of Section 1-11 of
9this Code, beginning October 1, 2014, the Department shall
10cover kidney transplantation for noncitizens with end-stage
11renal disease who are not eligible for comprehensive medical
12benefits, who meet the residency requirements of Section 5-3 of
13this Code, and who would otherwise meet the financial
14requirements of the appropriate class of eligible persons under
15Section 5-2 of this Code. To qualify for coverage of kidney
16transplantation, such person must be receiving emergency renal
17dialysis services covered by the Department. Providers under
18this Section shall be prior approved and certified by the
19Department to perform kidney transplantation and the services
20under this Section shall be limited to services associated with
21kidney transplantation.
22 Notwithstanding any other provision of this Code to the
23contrary, on or after July 1, 2015, all FDA approved forms of
24medication assisted treatment prescribed for the treatment of
25alcohol dependence or treatment of opioid dependence shall be
26covered under both fee for service and managed care medical

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1assistance programs for persons who are otherwise eligible for
2medical assistance under this Article and shall not be subject
3to any (1) utilization control, other than those established
4under the American Society of Addiction Medicine patient
5placement criteria, (2) prior authorization mandate, or (3)
6lifetime restriction limit mandate.
7 On or after July 1, 2015, opioid antagonists prescribed for
8the treatment of an opioid overdose, including the medication
9product, administration devices, and any pharmacy fees related
10to the dispensing and administration of the opioid antagonist,
11shall be covered under the medical assistance program for
12persons who are otherwise eligible for medical assistance under
13this Article. As used in this Section, "opioid antagonist"
14means a drug that binds to opioid receptors and blocks or
15inhibits the effect of opioids acting on those receptors,
16including, but not limited to, naloxone hydrochloride or any
17other similarly acting drug approved by the U.S. Food and Drug
18Administration.
19 Upon federal approval, the Department shall provide
20coverage and reimbursement for all drugs that are approved for
21marketing by the federal Food and Drug Administration and that
22are recommended by the federal Public Health Service or the
23United States Centers for Disease Control and Prevention for
24pre-exposure prophylaxis and related pre-exposure prophylaxis
25services, including, but not limited to, HIV and sexually
26transmitted infection screening, treatment for sexually

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1transmitted infections, medical monitoring, assorted labs, and
2counseling to reduce the likelihood of HIV infection among
3individuals who are not infected with HIV but who are at high
4risk of HIV infection.
5(Source: P.A. 98-104, Article 9, Section 9-5, eff. 7-22-13;
698-104, Article 12, Section 12-20, eff. 7-22-13; 98-303, eff.
78-9-13; 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 98-756,
8eff. 7-16-14; 98-963, eff. 8-15-14; 99-78, eff. 7-20-15;
999-180, eff. 7-29-15; 99-236, eff. 8-3-15; 99-407 (see Section
1020 of P.A. 99-588 for the effective date of P.A. 99-407);
1199-433, eff. 8-21-15; 99-480, eff. 9-9-15; 99-588, eff.
127-20-16; 99-642, eff. 7-28-16; 99-772, eff. 1-1-17; 99-895,
13eff. 1-1-17; revised 9-20-16.)
14 (305 ILCS 5/5-5.01a)
15 Sec. 5-5.01a. Supportive living facilities program. The
16Department shall establish and provide oversight for a program
17of supportive living facilities that seek to promote resident
18independence, dignity, respect, and well-being in the most
19cost-effective manner.
20 A supportive living facility is either a free-standing
21facility or a distinct physical and operational entity within a
22nursing facility. A supportive living facility integrates
23housing with health, personal care, and supportive services and
24is a designated setting that offers residents their own
25separate, private, and distinct living units.

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1 Sites for the operation of the program shall be selected by
2the Department based upon criteria that may include the need
3for services in a geographic area, the availability of funding,
4and the site's ability to meet the standards.
5 Beginning July 1, 2014, subject to federal approval, the
6Medicaid rates for supportive living facilities shall be equal
7to the supportive living facility Medicaid rate effective on
8June 30, 2014 increased by 8.85%. Once the assessment imposed
9at Article V-G of this Code is determined to be a permissible
10tax under Title XIX of the Social Security Act, the Department
11shall increase the Medicaid rates for supportive living
12facilities effective on July 1, 2014 by 9.09%. The Department
13shall apply this increase retroactively to coincide with the
14imposition of the assessment in Article V-G of this Code in
15accordance with the approval for federal financial
16participation by the Centers for Medicare and Medicaid
17Services.
18 The Department may adopt rules to implement this Section.
19Rules that establish or modify the services, standards, and
20conditions for participation in the program shall be adopted by
21the Department in consultation with the Department on Aging,
22the Department of Rehabilitation Services, and the Department
23of Mental Health and Developmental Disabilities (or their
24successor agencies).
25 Facilities or distinct parts of facilities which are
26selected as supportive living facilities and are in good

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1standing with the Department's rules are exempt from the
2provisions of the Nursing Home Care Act and the Illinois Health
3Facilities Planning Act.
4 Individuals with a score of 29 or higher based on the
5determination of need (DON) assessment tool shall be eligible
6to receive institutional and home and community-based long term
7care services until the State receives federal approval and
8implements an updated assessment tool, and those individuals
9are found to be ineligible under that updated assessment tool.
10Anyone determined to be ineligible for services due to the
11updated assessment tool shall continue to be eligible for
12services for at least one year following that determination and
13must be reassessed no earlier than 11 months after that
14determination. The Department must adopt rules through the
15regular rulemaking process regarding the updated assessment
16tool, and shall not adopt emergency or peremptory rules
17regarding the updated assessment tool. The State shall not
18implement an updated assessment tool that causes more than 1%
19of then-current recipients to lose eligibility. No individual
20receiving care in an institutional setting shall be
21involuntarily discharged as the result of the updated
22assessment tool until a transition plan has been developed by
23the Department on Aging or its designee and all care identified
24in the transition plan is available to the resident immediately
25upon discharge.
26(Source: P.A. 98-651, eff. 6-16-14.)

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1 Section 99. Effective date. This Act takes effect upon
2becoming law.
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