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| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB2496 Introduced , by Rep. LaToya Greenwood SYNOPSIS AS INTRODUCED:
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Amends the Illinois Act on the Aging, the Disabled Persons Rehabilitation Act, and the Illinois Public Aid Code. Regarding services under the Community Care Program (CCP), the Home Services Program, the supportive living facilities program, and the nursing home prescreening project, provides that individuals with a score of 29 or higher based on the determination of need assessment tool shall be eligible to receive institutional and home and community-based long term care services until the State receives federal approval and implements an updated assessment tool, and those individuals are found to be ineligible under that updated assessment tool. Requires the Department on Aging and the Departments of Human Services and Healthcare and Family Services to adopt rules, but not emergency rules, regarding the updated assessment tool. Contains provisions concerning continued eligibility for persons made ineligible for services under the updated assessment tool. Amends the Illinois Act on the Aging. Prohibits the Department on Aging from adopting any rule that: (i) restricts eligibility under CCP to persons who qualify for medical assistance; or (ii) establishes a separate program of home and community-based long term care services for persons eligible for CCP services but not eligible for medical assistance. Prohibits the Department from increasing copayment levels under CCP to those levels in effect on January 1, 2016. Amends the Illinois Public Aid Code. Deletes a provision concerning an increase in the determination of need scores, on and after July 1, 2012, from 29 to 37. Amends the Nursing Home Care Act. Prohibits the involuntary discharge of an individual receiving care in an institutional setting as the result of the updated assessment tool until a transition plan has been developed. Effective immediately.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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1 | | AN ACT concerning State government.
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2 | | Be it enacted by the People of the State of Illinois,
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3 | | represented in the General Assembly:
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4 | | Section 5. The Illinois Act on the Aging is amended by |
5 | | changing Section 4.02 as follows:
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6 | | (20 ILCS 105/4.02) (from Ch. 23, par. 6104.02)
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7 | | Sec. 4.02. Community Care Program. The Department shall |
8 | | establish a program of services to
prevent unnecessary |
9 | | institutionalization of persons age 60 and older in
need of |
10 | | long term care or who are established as persons who suffer |
11 | | from
Alzheimer's disease or a related disorder under the |
12 | | Alzheimer's Disease
Assistance Act, thereby enabling them
to |
13 | | remain in their own homes or in other living arrangements. Such
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14 | | preventive services, which may be coordinated with other |
15 | | programs for the
aged and monitored by area agencies on aging |
16 | | in cooperation with the
Department, may include, but are not |
17 | | limited to, any or all of the following:
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18 | | (a) (blank);
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19 | | (b) (blank);
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20 | | (c) home care aide services;
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21 | | (d) personal assistant services;
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22 | | (e) adult day services;
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23 | | (f) home-delivered meals;
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1 | | (g) education in self-care;
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2 | | (h) personal care services;
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3 | | (i) adult day health services;
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4 | | (j) habilitation services;
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5 | | (k) respite care;
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6 | | (k-5) community reintegration services;
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7 | | (k-6) flexible senior services; |
8 | | (k-7) medication management; |
9 | | (k-8) emergency home response;
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10 | | (l) other nonmedical social services that may enable |
11 | | the person
to become self-supporting; or
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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.
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15 | | Individuals who meet the following criteria shall have |
16 | | equal access to services under the Community Care Program: The |
17 | | Department shall establish eligibility standards for such
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18 | | services. |
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 nonexempt assets of $17,500 or less; nonexempt |
23 | | assets do not include home, car, or personal furnishings; |
24 | | 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. |
3 | | In determining the amount and nature of services
for which a |
4 | | person may qualify, consideration shall not be given to the
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5 | | value of cash, property or other assets held in the name of the |
6 | | person's
spouse pursuant to a written agreement dividing |
7 | | marital property into equal
but separate shares or pursuant to |
8 | | a transfer of the person's interest in a
home to his spouse, |
9 | | provided that the spouse's share of the marital
property is not |
10 | | made available to the person seeking such services.
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11 | | Need for long term care shall be determined as follows: |
12 | | Individuals with a score of 29 or higher based on the |
13 | | determination of need (DON) assessment tool shall be eligible |
14 | | to receive institutional and home and community-based long term |
15 | | care services until the State receives federal approval and |
16 | | implements an updated assessment tool, and those individuals |
17 | | are found to be ineligible under that updated assessment tool. |
18 | | Anyone determined to be ineligible for services due to the |
19 | | updated assessment tool shall continue to be eligible for |
20 | | services for at least one year following that determination and |
21 | | must be reassessed no earlier than 11 months after that |
22 | | determination. The Department must adopt rules through the |
23 | | regular rulemaking process regarding the updated assessment |
24 | | tool, and shall not adopt emergency or peremptory rules |
25 | | regarding the updated assessment tool. The State shall not |
26 | | implement an updated assessment tool that causes more than 1% |
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1 | | of then-current recipients to lose eligibility. |
2 | | Service cost maximums shall be set at levels no lower than |
3 | | the service cost maximums that were in effect as of January 1, |
4 | | 2016. Service cost maximums shall be increased accordingly to |
5 | | reflect any rate increases. |
6 | | Beginning January 1, 2008, the Department shall require as |
7 | | a condition of eligibility that all new financially eligible |
8 | | applicants apply for and enroll in medical assistance under |
9 | | Article V of the Illinois Public Aid Code in accordance with |
10 | | rules promulgated by the Department.
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11 | | The Department shall not: (i) adopt any rule that restricts |
12 | | eligibility under the Community Care Program to persons who |
13 | | qualify for medical assistance under Article V of the Illinois |
14 | | Public Aid Code; or (ii) establish, by rule, a separate program |
15 | | of home and community-based long term care services for persons |
16 | | who are otherwise eligible for services under the Community |
17 | | Care Program but who do not qualify for medical assistance |
18 | | under Article V of the Illinois Public Aid Code. |
19 | | The Department shall, in conjunction with the Department of |
20 | | Public Aid (now Department of Healthcare and Family Services),
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21 | | seek appropriate amendments under Sections 1915 and 1924 of the |
22 | | Social
Security Act. The purpose of the amendments shall be to |
23 | | extend eligibility
for home and community based services under |
24 | | Sections 1915 and 1924 of the
Social Security Act to persons |
25 | | who transfer to or for the benefit of a
spouse those amounts of |
26 | | income and resources allowed under Section 1924 of
the Social |
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1 | | Security Act. Subject to the approval of such amendments, the
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2 | | Department shall extend the provisions of Section 5-4 of the |
3 | | Illinois
Public Aid Code to persons who, but for the provision |
4 | | of home or
community-based services, would require the level of |
5 | | care provided in an
institution, as is provided for in federal |
6 | | law. Those persons no longer
found to be eligible for receiving |
7 | | noninstitutional services due to changes
in the eligibility |
8 | | criteria shall be given 45 days notice prior to actual
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9 | | termination. Those persons receiving notice of termination may |
10 | | contact the
Department and request the determination be |
11 | | appealed at any time during the
45 day notice period. The |
12 | | target
population identified for the purposes of this Section |
13 | | are persons age 60
and older with an identified service need. |
14 | | Priority shall be given to those
who are at imminent risk of |
15 | | institutionalization. The services shall be
provided to |
16 | | eligible persons age 60 and older to the extent that the cost
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17 | | of the services together with the other personal maintenance
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18 | | expenses of the persons are reasonably related to the standards
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19 | | established for care in a group facility appropriate to the |
20 | | person's
condition. These non-institutional services, pilot |
21 | | projects or
experimental facilities may be provided as part of |
22 | | or in addition to
those authorized by federal law or those |
23 | | funded and administered by the
Department of Human Services. |
24 | | The Departments of Human Services, Healthcare and Family |
25 | | Services,
Public Health, Veterans' Affairs, and Commerce and |
26 | | Economic Opportunity and
other appropriate agencies of State, |
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1 | | federal and local governments shall
cooperate with the |
2 | | Department on Aging in the establishment and development
of the |
3 | | non-institutional services. The Department shall require an |
4 | | annual
audit from all personal assistant
and home care aide |
5 | | vendors contracting with
the Department under this Section. The |
6 | | annual audit shall assure that each
audited vendor's procedures |
7 | | are in compliance with Department's financial
reporting |
8 | | guidelines requiring an administrative and employee wage and |
9 | | benefits cost split as defined in administrative rules. The |
10 | | audit is a public record under
the Freedom of Information Act. |
11 | | The Department shall execute, relative to
the nursing home |
12 | | prescreening project, written inter-agency
agreements with the |
13 | | Department of Human Services and the Department
of Healthcare |
14 | | and Family Services, to effect the following: (1) intake |
15 | | procedures and common
eligibility criteria for those persons |
16 | | who are receiving non-institutional
services; and (2) the |
17 | | establishment and development of non-institutional
services in |
18 | | areas of the State where they are not currently available or |
19 | | are
undeveloped. On and after July 1, 1996, all nursing home |
20 | | prescreenings for
individuals 60 years of age or older shall be |
21 | | conducted by the Department.
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22 | | As part of the Department on Aging's routine training of |
23 | | case managers and case manager supervisors, the Department may |
24 | | include information on family futures planning for persons who |
25 | | are age 60 or older and who are caregivers of their adult |
26 | | children with developmental disabilities. The content of the |
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1 | | training shall be at the Department's discretion. |
2 | | The Department is authorized to establish a system of |
3 | | recipient copayment
for services provided under this Section, |
4 | | such copayment to be based upon
the recipient's ability to pay |
5 | | but in no case to exceed the actual cost of
the services |
6 | | provided. Additionally, any portion of a person's income which
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7 | | is equal to or less than the federal poverty standard shall not |
8 | | be
considered by the Department in determining the copayment. |
9 | | The level of
such copayment shall be adjusted whenever |
10 | | necessary to reflect any change
in the officially designated |
11 | | federal poverty standard. The Department shall not increase |
12 | | copayment levels to the levels that were in effect on January |
13 | | 1, 2016, except to make an adjustment for inflation.
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14 | | The Department, or the Department's authorized |
15 | | representative, may
recover the amount of moneys expended for |
16 | | services provided to or in
behalf of a person under this |
17 | | Section by a claim against the person's
estate or against the |
18 | | estate of the person's surviving spouse, but no
recovery may be |
19 | | had until after the death of the surviving spouse, if
any, and |
20 | | then only at such time when there is no surviving child who
is |
21 | | under age 21 or blind or who has a permanent and total |
22 | | disability. This
paragraph, however, shall not bar recovery, at |
23 | | the death of the person, of
moneys for services provided to the |
24 | | person or in behalf of the person under
this Section to which |
25 | | the person was not entitled;
provided that such recovery shall |
26 | | not be enforced against any real estate while
it is occupied as |
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1 | | a homestead by the surviving spouse or other dependent, if no
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2 | | claims by other creditors have been filed against the estate, |
3 | | or, if such
claims have been filed, they remain dormant for |
4 | | failure of prosecution or
failure of the claimant to compel |
5 | | administration of the estate for the purpose
of payment. This |
6 | | paragraph shall not bar recovery from the estate of a spouse,
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7 | | under Sections 1915 and 1924 of the Social Security Act and |
8 | | Section 5-4 of the
Illinois Public Aid Code, who precedes a |
9 | | person receiving services under this
Section in death. All |
10 | | moneys for services
paid to or in behalf of the person under |
11 | | this Section shall be claimed for
recovery from the deceased |
12 | | spouse's estate. "Homestead", as used
in this paragraph, means |
13 | | the dwelling house and
contiguous real estate occupied by a |
14 | | surviving spouse
or relative, as defined by the rules and |
15 | | regulations of the Department of Healthcare and Family |
16 | | Services, regardless of the value of the property.
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17 | | The Department shall increase the effectiveness of the |
18 | | existing 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 |
7 | | Counseling Demonstration Project as is practicable, the |
8 | | Department may, based on its evaluation of the demonstration |
9 | | project, promulgate rules concerning personal assistant |
10 | | services, to include, but need not be limited to, |
11 | | qualifications, employment screening, rights under fair labor |
12 | | standards, training, fiduciary agent, and supervision |
13 | | requirements. All applicants shall be subject to the provisions |
14 | | of the Health Care Worker Background Check Act.
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15 | | The Department shall develop procedures to enhance |
16 | | availability of
services on evenings, weekends, and on an |
17 | | emergency basis to meet the
respite needs of caregivers. |
18 | | Procedures shall be developed to permit the
utilization of |
19 | | services in successive blocks of 24 hours up to the monthly
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20 | | maximum established by the Department. Workers providing these |
21 | | services
shall be appropriately trained.
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22 | | Beginning on the effective date of this amendatory Act of |
23 | | 1991, no person
may perform chore/housekeeping and home care |
24 | | aide services under a program
authorized by this Section unless |
25 | | that person has been issued a certificate
of pre-service to do |
26 | | so by his or her employing agency. Information
gathered to |
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1 | | effect such certification shall include (i) the person's name,
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2 | | (ii) the date the person was hired by his or her current |
3 | | employer, and
(iii) the training, including dates and levels. |
4 | | Persons engaged in the
program authorized by this Section |
5 | | before the effective date of this
amendatory Act of 1991 shall |
6 | | be issued a certificate of all pre- and
in-service training |
7 | | from his or her employer upon submitting the necessary
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8 | | information. The employing agency shall be required to retain |
9 | | records of
all staff pre- and in-service training, and shall |
10 | | provide such records to
the Department upon request and upon |
11 | | termination of the employer's contract
with the Department. In |
12 | | addition, the employing agency is responsible for
the issuance |
13 | | of certifications of in-service training completed to their
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14 | | employees.
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15 | | The Department is required to develop a system to ensure |
16 | | that persons
working as home care aides and personal assistants
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17 | | receive increases in their
wages when the federal minimum wage |
18 | | is increased by requiring vendors to
certify that they are |
19 | | meeting the federal minimum wage statute for home care aides
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20 | | and personal assistants. An employer that cannot ensure that |
21 | | the minimum
wage increase is being given to home care aides and |
22 | | personal assistants
shall be denied any increase in |
23 | | reimbursement costs.
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24 | | The Community Care Program Advisory Committee is created in |
25 | | the Department on Aging. The Director shall appoint individuals |
26 | | to serve in the Committee, who shall serve at their own |
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1 | | expense. Members of the Committee must abide by all applicable |
2 | | ethics laws. The Committee shall advise the Department on |
3 | | issues related to the Department's program of services to |
4 | | prevent unnecessary institutionalization. The Committee shall |
5 | | meet on a bi-monthly basis and shall serve to identify and |
6 | | advise the Department on present and potential issues affecting |
7 | | the service delivery network, the program's clients, and the |
8 | | Department and to recommend solution strategies. Persons |
9 | | appointed to the Committee shall be appointed on, but not |
10 | | limited to, their own and their agency's experience with the |
11 | | program, geographic representation, and willingness to serve. |
12 | | The Director shall appoint members to the Committee to |
13 | | represent provider, advocacy, policy research, and other |
14 | | constituencies committed to the delivery of high quality home |
15 | | and community-based services to older adults. Representatives |
16 | | shall be appointed to ensure representation from community care |
17 | | providers including, but not limited to, adult day service |
18 | | providers, homemaker providers, case coordination and case |
19 | | management units, emergency home response providers, statewide |
20 | | trade or labor unions that represent home care
aides and direct |
21 | | care staff, area agencies on aging, adults over age 60, |
22 | | membership organizations representing older adults, and other |
23 | | organizational entities, providers of care, or individuals |
24 | | with demonstrated interest and expertise in the field of home |
25 | | and community care as determined by the Director. |
26 | | Nominations may be presented from any agency or State |
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1 | | association with interest in the program. The Director, or his |
2 | | or her designee, shall serve as the permanent co-chair of the |
3 | | advisory committee. One other co-chair shall be nominated and |
4 | | approved by the members of the committee on an annual basis. |
5 | | Committee members' terms of appointment shall be for 4 years |
6 | | with one-quarter of the appointees' terms expiring each year. A |
7 | | member shall continue to serve until his or her replacement is |
8 | | named. The Department shall fill vacancies that have a |
9 | | remaining term of over one year, and this replacement shall |
10 | | occur through the annual replacement of expiring terms. The |
11 | | Director shall designate Department staff to provide technical |
12 | | assistance and staff support to the committee. Department |
13 | | representation shall not constitute membership of the |
14 | | committee. All Committee papers, issues, recommendations, |
15 | | reports, and meeting memoranda are advisory only. The Director, |
16 | | or his or her designee, shall make a written report, as |
17 | | requested by the Committee, regarding issues before the |
18 | | Committee.
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19 | | The Department on Aging and the Department of Human |
20 | | Services
shall cooperate in the development and submission of |
21 | | an annual report on
programs and services provided under this |
22 | | Section. Such joint report
shall be filed with the Governor and |
23 | | the General Assembly on or before
September 30 each year.
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24 | | The requirement for reporting to the General Assembly shall |
25 | | be satisfied
by filing copies of the report
as required by |
26 | | Section 3.1 of the General Assembly Organization Act and
filing |
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1 | | such additional copies with the State Government Report |
2 | | Distribution
Center for the General Assembly as is required |
3 | | under paragraph (t) of
Section 7 of the State Library Act.
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4 | | Those persons previously found eligible for receiving |
5 | | non-institutional
services whose services were discontinued |
6 | | under the Emergency Budget Act of
Fiscal Year 1992, and who do |
7 | | not meet the eligibility standards in effect
on or after July |
8 | | 1, 1992, shall remain ineligible on and after July 1,
1992. |
9 | | Those persons previously not required to cost-share and who |
10 | | were
required to cost-share effective March 1, 1992, shall |
11 | | continue to meet
cost-share requirements on and after July 1, |
12 | | 1992. Beginning July 1, 1992,
all clients will be required to |
13 | | meet
eligibility, cost-share, and other requirements and will |
14 | | have services
discontinued or altered when they fail to meet |
15 | | these requirements. |
16 | | For the purposes of this Section, "flexible senior |
17 | | services" refers to services that require one-time or periodic |
18 | | expenditures including, but not limited to, respite care, home |
19 | | modification, assistive technology, housing assistance, and |
20 | | transportation.
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21 | | The Department shall implement an electronic service |
22 | | verification based on global positioning systems or other |
23 | | cost-effective technology for the Community Care Program no |
24 | | later than January 1, 2014. |
25 | | The Department shall require, as a condition of |
26 | | eligibility, enrollment in the medical assistance program |
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1 | | under Article V of the Illinois Public Aid Code (i) beginning |
2 | | August 1, 2013, if the Auditor General has reported that the |
3 | | Department has failed
to comply with the reporting requirements |
4 | | of Section 2-27 of
the Illinois State Auditing Act; or (ii) |
5 | | beginning June 1, 2014, if the Auditor General has reported |
6 | | that the
Department has not undertaken the required actions |
7 | | listed in
the report required by subsection (a) of Section 2-27 |
8 | | of the
Illinois State Auditing Act. |
9 | | The Department shall delay Community Care Program services |
10 | | until an applicant is determined eligible for medical |
11 | | assistance under Article V of the Illinois Public Aid Code (i) |
12 | | beginning August 1, 2013, if the Auditor General has reported |
13 | | that the Department has failed
to comply with the reporting |
14 | | requirements of Section 2-27 of
the Illinois State Auditing |
15 | | Act; or (ii) beginning June 1, 2014, if the Auditor General has |
16 | | reported that the
Department has not undertaken the required |
17 | | actions listed in
the report required by subsection (a) of |
18 | | Section 2-27 of the
Illinois State Auditing Act. |
19 | | The Department shall implement co-payments for the |
20 | | Community Care Program at the federally allowable maximum level |
21 | | (i) beginning August 1, 2013, if the Auditor General has |
22 | | reported that the Department has failed
to comply with the |
23 | | reporting requirements of Section 2-27 of
the Illinois State |
24 | | Auditing Act; or (ii) beginning June 1, 2014, if the Auditor |
25 | | General has reported that the
Department has not undertaken the |
26 | | required actions listed in
the report required by subsection |
|
| | HB2496 | - 18 - | LRB101 10944 KTG 56118 b |
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1 | | (a) of Section 2-27 of the
Illinois State Auditing Act. |
2 | | The Department shall provide a bi-monthly report on the |
3 | | progress of the Community Care Program reforms set forth in |
4 | | this amendatory Act of the 98th General Assembly to the |
5 | | Governor, the Speaker of the House of Representatives, the |
6 | | Minority Leader of the House of Representatives, the
President |
7 | | of the
Senate, and the Minority Leader of the Senate. |
8 | | The Department shall conduct a quarterly review of Care |
9 | | Coordination Unit performance and adherence to service |
10 | | guidelines. The quarterly review shall be reported to the |
11 | | Speaker of the House of Representatives, the Minority Leader of |
12 | | the House of Representatives, the
President of the
Senate, and |
13 | | the Minority Leader of the Senate. The Department shall collect |
14 | | and report longitudinal data on the performance of each care |
15 | | coordination unit. Nothing in this paragraph shall be construed |
16 | | to require the Department to identify specific care |
17 | | coordination units. |
18 | | In regard to community care providers, failure to comply |
19 | | with Department on Aging policies shall be cause for |
20 | | disciplinary action, including, but not limited to, |
21 | | disqualification from serving Community Care Program clients. |
22 | | Each provider, upon submission of any bill or invoice to the |
23 | | Department for payment for services rendered, shall include a |
24 | | notarized statement, under penalty of perjury pursuant to |
25 | | Section 1-109 of the Code of Civil Procedure, that the provider |
26 | | has complied with all Department policies. |
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1 | | The Director of the Department on Aging shall make |
2 | | information available to the State Board of Elections as may be |
3 | | required by an agreement the State Board of Elections has |
4 | | entered into with a multi-state voter registration list |
5 | | maintenance system. |
6 | | Within 30 days after July 6, 2017 (the effective date of |
7 | | Public Act 100-23), rates shall be increased to $18.29 per |
8 | | hour, for the purpose of increasing, by at least $.72 per hour, |
9 | | the wages paid by those vendors to their employees who provide |
10 | | homemaker services. The Department shall pay an enhanced rate |
11 | | under the Community Care Program to those in-home service |
12 | | provider agencies that offer health insurance coverage as a |
13 | | benefit to their direct service worker employees consistent |
14 | | with the mandates of Public Act 95-713. For State fiscal years |
15 | | 2018 and 2019, the enhanced rate shall be $1.77 per hour. The |
16 | | rate shall be adjusted using actuarial analysis based on the |
17 | | cost of care, but shall not be set below $1.77 per hour. The |
18 | | Department shall adopt rules, including emergency rules under |
19 | | subsections (y) and (bb) of Section 5-45 of the Illinois |
20 | | Administrative Procedure Act, to implement the provisions of |
21 | | this paragraph. |
22 | | The General Assembly finds it necessary to authorize an |
23 | | aggressive Medicaid enrollment initiative designed to maximize |
24 | | federal Medicaid funding for the Community Care Program which |
25 | | produces significant savings for the State of Illinois. The |
26 | | Department on Aging shall establish and implement a Community |
|
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1 | | Care Program Medicaid Initiative. Under the Initiative, the
|
2 | | Department on Aging shall, at a minimum: (i) provide an |
3 | | enhanced rate to adequately compensate care coordination units |
4 | | to enroll eligible Community Care Program clients into |
5 | | Medicaid; (ii) use recommendations from a stakeholder |
6 | | committee on how best to implement the Initiative; and (iii) |
7 | | establish requirements for State agencies to make enrollment in |
8 | | the State's Medical Assistance program easier for seniors. |
9 | | The Community Care Program Medicaid Enrollment Oversight |
10 | | Subcommittee is created as a subcommittee of the Older Adult |
11 | | Services Advisory Committee established in Section 35 of the |
12 | | Older Adult Services Act to make recommendations on how best to |
13 | | increase the number of medical assistance recipients who are |
14 | | enrolled in the Community Care Program. The Subcommittee shall |
15 | | consist of all of the following persons who must be appointed |
16 | | within 30 days after the effective date of this amendatory Act |
17 | | of the 100th General Assembly: |
18 | | (1) The Director of Aging, or his or her designee, who |
19 | | shall serve as the chairperson of the Subcommittee. |
20 | | (2) One representative of the Department of Healthcare |
21 | | and Family Services, appointed by the Director of |
22 | | Healthcare and Family Services. |
23 | | (3) One representative of the Department of Human |
24 | | Services, appointed by the Secretary of Human Services. |
25 | | (4) One individual representing a care coordination |
26 | | unit, appointed by the Director of Aging. |
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1 | | (5) One individual from a non-governmental statewide |
2 | | organization that advocates for seniors, appointed by the |
3 | | Director of Aging. |
4 | | (6) One individual representing Area Agencies on |
5 | | Aging, appointed by the Director of Aging. |
6 | | (7) One individual from a statewide association |
7 | | dedicated to Alzheimer's care, support, and research, |
8 | | appointed by the Director of Aging. |
9 | | (8) One individual from an organization that employs |
10 | | persons who provide services under the Community Care |
11 | | Program, appointed by the Director of Aging. |
12 | | (9) One member of a trade or labor union representing |
13 | | persons who provide services under the Community Care |
14 | | Program, appointed by the Director of Aging. |
15 | | (10) One member of the Senate, who shall serve as |
16 | | co-chairperson, appointed by the President of the Senate. |
17 | | (11) One member of the Senate, who shall serve as |
18 | | co-chairperson, appointed by the Minority Leader of the |
19 | | Senate. |
20 | | (12) One member of the House of
Representatives, who |
21 | | shall serve as co-chairperson, appointed by the Speaker of |
22 | | the House of Representatives. |
23 | | (13) One member of the House of Representatives, who |
24 | | shall serve as co-chairperson, appointed by the Minority |
25 | | Leader of the House of Representatives. |
26 | | (14) One individual appointed by a labor organization |
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| | HB2496 | - 22 - | LRB101 10944 KTG 56118 b |
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1 | | representing frontline employees at the Department of |
2 | | Human Services. |
3 | | The Subcommittee shall provide oversight to the Community |
4 | | Care Program Medicaid Initiative and shall meet quarterly. At |
5 | | each Subcommittee meeting the Department on Aging shall provide |
6 | | the following data sets to the Subcommittee: (A) the number of |
7 | | Illinois residents, categorized by planning and service area, |
8 | | who are receiving services under the Community Care Program and |
9 | | are enrolled in the State's Medical Assistance Program; (B) the |
10 | | number of Illinois residents, categorized by planning and |
11 | | service area, who are receiving services under the Community |
12 | | Care Program, but are not enrolled in the State's Medical |
13 | | Assistance Program; and (C) the number of Illinois residents, |
14 | | categorized by planning and service area, who are receiving |
15 | | services under the Community Care Program and are eligible for |
16 | | benefits under the State's Medical Assistance Program, but are |
17 | | not enrolled in the State's Medical Assistance Program. In |
18 | | addition to this data, the Department on Aging shall provide |
19 | | the Subcommittee with plans on how the Department on Aging will |
20 | | reduce the number of Illinois residents who are not enrolled in |
21 | | the State's Medical Assistance Program but who are eligible for |
22 | | medical assistance benefits. The Department on Aging shall |
23 | | enroll in the State's Medical Assistance Program those Illinois |
24 | | residents who receive services under the Community Care Program |
25 | | and are eligible for medical assistance benefits but are not |
26 | | enrolled in the State's Medicaid Assistance Program. The data |
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1 | | provided to the Subcommittee shall be made available to the |
2 | | public via the Department on Aging's website. |
3 | | The Department on Aging, with the involvement of the |
4 | | Subcommittee, shall collaborate with the Department of Human |
5 | | Services and the Department of Healthcare and Family Services |
6 | | on how best to achieve the responsibilities of the Community |
7 | | Care Program Medicaid Initiative. |
8 | | The Department on Aging, the Department of Human Services, |
9 | | and the Department of Healthcare and Family Services shall |
10 | | coordinate and implement a streamlined process for seniors to |
11 | | access benefits under the State's Medical Assistance Program. |
12 | | The Subcommittee shall collaborate with the Department of |
13 | | Human Services on the adoption of a uniform application |
14 | | submission process. The Department of Human Services and any |
15 | | other State agency involved with processing the medical |
16 | | assistance application of any person enrolled in the Community |
17 | | Care Program shall include the appropriate care coordination |
18 | | unit in all communications related to the determination or |
19 | | status of the application. |
20 | | The Community Care Program Medicaid Initiative shall |
21 | | provide targeted funding to care coordination units to help |
22 | | seniors complete their applications for medical assistance |
23 | | benefits. On and after July 1, 2019, care coordination units |
24 | | shall receive no less than $200 per completed application. |
25 | | The Community Care Program Medicaid Initiative shall cease |
26 | | operation 5 years after the effective date of this amendatory |
|
| | HB2496 | - 24 - | LRB101 10944 KTG 56118 b |
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1 | | Act of the 100th General Assembly, after which the Subcommittee |
2 | | shall dissolve. |
3 | | (Source: P.A. 99-143, eff. 7-27-15; 100-23, eff. 7-6-17; |
4 | | 100-587, eff. 6-4-18; 100-1148, eff. 12-10-18.)
|
5 | | Section 10. The Rehabilitation of Persons with |
6 | | Disabilities Act is amended by changing Section 3 as follows:
|
7 | | (20 ILCS 2405/3) (from Ch. 23, par. 3434)
|
8 | | Sec. 3. Powers and duties. The Department shall have the |
9 | | powers and
duties enumerated
herein:
|
10 | | (a) To co-operate with the federal government in the |
11 | | administration
of the provisions of the federal |
12 | | Rehabilitation Act of 1973, as amended,
of the Workforce
|
13 | | Innovation and Opportunity Act,
and of the federal Social |
14 | | Security Act to the extent and in the manner
provided in |
15 | | these Acts.
|
16 | | (b) To prescribe and supervise such courses of |
17 | | vocational training
and provide such other services as may |
18 | | be necessary for the habilitation
and rehabilitation of |
19 | | persons with one or more disabilities, including the
|
20 | | administrative activities under subsection (e) of this |
21 | | Section, and to
co-operate with State and local school |
22 | | authorities and other recognized
agencies engaged in |
23 | | habilitation, rehabilitation and comprehensive
|
24 | | rehabilitation services; and to cooperate with the |
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1 | | Department of Children
and Family Services regarding the |
2 | | care and education of children with one
or more |
3 | | disabilities.
|
4 | | (c) (Blank).
|
5 | | (d) To report in writing, to the Governor, annually on |
6 | | or before the
first day of December, and at such other |
7 | | times and in such manner and
upon such subjects as the |
8 | | Governor may require. The annual report shall
contain (1) a |
9 | | statement of the existing condition of comprehensive
|
10 | | rehabilitation services, habilitation and rehabilitation |
11 | | in the State;
(2) a statement of suggestions and |
12 | | recommendations with reference to the
development of |
13 | | comprehensive rehabilitation services, habilitation and
|
14 | | rehabilitation in the State; and (3) an itemized statement |
15 | | of the
amounts of money received from federal, State and |
16 | | other sources, and of
the objects and purposes to which the |
17 | | respective items of these several
amounts have been |
18 | | devoted.
|
19 | | (e) (Blank).
|
20 | | (f) To establish a program of services to prevent the |
21 | | unnecessary
institutionalization of persons in need of |
22 | | long term care and who meet the criteria for blindness or |
23 | | disability as defined by the Social Security Act, thereby |
24 | | enabling them to
remain in their own homes. Such preventive
|
25 | | services include any or all of the following:
|
26 | | (1) personal assistant services;
|
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1 | | (2) homemaker services;
|
2 | | (3) home-delivered meals;
|
3 | | (4) adult day care services;
|
4 | | (5) respite care;
|
5 | | (6) home modification or assistive equipment;
|
6 | | (7) home health services;
|
7 | | (8) electronic home response;
|
8 | | (9) brain injury behavioral/cognitive services;
|
9 | | (10) brain injury habilitation;
|
10 | | (11) brain injury pre-vocational services; or
|
11 | | (12) brain injury supported employment.
|
12 | | The Department shall establish eligibility
standards |
13 | | for such services taking into consideration the unique
|
14 | | economic and social needs of the population for whom they |
15 | | are to
be provided. Such eligibility standards may be based |
16 | | on the recipient's
ability to pay for services; provided, |
17 | | however, that any portion of a
person's income that is |
18 | | equal to or less than the "protected income" level
shall |
19 | | not be considered by the Department in determining |
20 | | eligibility. The
"protected income" level shall be |
21 | | determined by the Department, shall never be
less than the |
22 | | federal poverty standard, and shall be adjusted each year |
23 | | to
reflect changes in the Consumer Price Index For All |
24 | | Urban Consumers as
determined by the United States |
25 | | Department of Labor. The standards must
provide that a |
26 | | person may not have more than $10,000 in assets to be |
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1 | | eligible for the services, and the Department may increase |
2 | | or decrease the asset limitation by rule. The Department |
3 | | may not decrease the asset level below $10,000.
|
4 | | Individuals with a score of 29 or higher based on the |
5 | | determination of need (DON) assessment tool shall be eligible |
6 | | to receive institutional and home and community-based long term |
7 | | care services until the State receives federal approval and |
8 | | implements an updated assessment tool, and those individuals |
9 | | are found to be ineligible under that updated assessment tool. |
10 | | Anyone determined to be ineligible for services due to the |
11 | | updated assessment tool shall continue to be eligible for |
12 | | services for at least one year following that determination and |
13 | | must be reassessed no earlier than 11 months after that |
14 | | determination. The Department must adopt rules through the |
15 | | regular rulemaking process regarding the updated assessment |
16 | | tool, and shall not adopt emergency or peremptory rules |
17 | | regarding the updated assessment tool. The State shall not |
18 | | implement an updated assessment tool that causes more than 1% |
19 | | of then-current recipients to lose eligibility. |
20 | | Service cost maximums shall be set at levels no lower than |
21 | | the service cost maximums that were in effect as of January 1, |
22 | | 2016. Service cost maximums shall be increased accordingly to |
23 | | reflect any rate increases. |
24 | | The services shall be provided, as established by the
|
25 | | Department by rule, to eligible persons
to prevent |
26 | | unnecessary or premature institutionalization, to
the |
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1 | | extent that the cost of the services, together with the
|
2 | | other personal maintenance expenses of the persons, are |
3 | | reasonably
related to the standards established for care in |
4 | | a group facility
appropriate to their condition. These |
5 | | non-institutional
services, pilot projects or experimental |
6 | | facilities may be provided as part of
or in addition to |
7 | | those authorized by federal law or those funded and
|
8 | | administered by the Illinois Department on Aging. The |
9 | | Department shall set rates and fees for services in a fair |
10 | | and equitable manner. Services identical to those offered |
11 | | by the Department on Aging shall be paid at the same rate.
|
12 | | Except as otherwise provided in this paragraph, |
13 | | personal assistants shall be paid at a rate negotiated
|
14 | | between the State and an exclusive representative of |
15 | | personal
assistants under a collective bargaining |
16 | | agreement. In no case
shall the Department pay personal |
17 | | assistants an hourly wage
that is less than the federal |
18 | | minimum wage. Within 30 days after July 6, 2017 (the |
19 | | effective date of Public Act 100-23), the hourly wage paid |
20 | | to personal assistants and individual maintenance home |
21 | | health workers shall be increased by $0.48 per hour.
|
22 | | Solely for the purposes of coverage under the Illinois |
23 | | Public Labor
Relations
Act, personal assistants providing
|
24 | | services under
the Department's Home Services Program |
25 | | shall be considered to be public
employees
and the State of |
26 | | Illinois shall be considered to be their employer as of |
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| | HB2496 | - 29 - | LRB101 10944 KTG 56118 b |
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1 | | July 16, 2003 (the
effective date of Public Act 93-204), |
2 | | but not before. Solely for the purposes of coverage under |
3 | | the Illinois Public Labor Relations Act, home care and home |
4 | | health workers who function as personal assistants and |
5 | | individual maintenance home health workers and who also |
6 | | provide services under the Department's Home Services |
7 | | Program shall be considered to be public employees, no |
8 | | matter whether the State provides such services through |
9 | | direct fee-for-service arrangements, with the assistance |
10 | | of a managed care organization or other intermediary, or |
11 | | otherwise, and the State of Illinois shall be considered to |
12 | | be the employer of those persons as of January 29, 2013 |
13 | | (the effective date of Public Act 97-1158), but not before |
14 | | except as otherwise provided under this subsection (f). The |
15 | | State
shall
engage in collective bargaining with an |
16 | | exclusive representative of home care and home health |
17 | | workers who function as personal assistants and individual |
18 | | maintenance home health workers working under the Home |
19 | | Services Program
concerning
their terms and conditions of |
20 | | employment that are within the State's control.
Nothing in
|
21 | | this paragraph shall be understood to limit the right of |
22 | | the persons receiving
services
defined in this Section to |
23 | | hire and fire
home care and home health workers who |
24 | | function as personal assistants
and individual maintenance |
25 | | home health workers working under the Home Services Program |
26 | | or to supervise them within the limitations set by the Home |
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| | HB2496 | - 30 - | LRB101 10944 KTG 56118 b |
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1 | | Services Program. The
State
shall not be considered to be |
2 | | the employer of
home care and home health workers who |
3 | | function as personal
assistants and individual maintenance |
4 | | home health workers working under the Home Services Program |
5 | | for any purposes not specifically provided in Public Act |
6 | | 93-204 or Public Act 97-1158, including but not limited to, |
7 | | purposes of vicarious liability
in tort and
purposes of |
8 | | statutory retirement or health insurance benefits. Home |
9 | | care and home health workers who function as personal |
10 | | assistants and individual maintenance home health workers |
11 | | and who also provide services under the Department's Home |
12 | | Services Program shall not be covered by the State |
13 | | Employees Group
Insurance Act
of 1971.
|
14 | | The Department shall execute, relative to nursing home |
15 | | prescreening, as authorized by Section 4.03 of the Illinois |
16 | | Act on the Aging,
written inter-agency agreements with the |
17 | | Department on Aging and
the Department of Healthcare and |
18 | | Family Services, to effect the intake procedures
and |
19 | | eligibility criteria for those persons who may need long |
20 | | term care. On and after July 1, 1996, all nursing
home |
21 | | prescreenings for individuals 18 through 59 years of age |
22 | | shall be
conducted by the Department, or a designee of the
|
23 | | Department.
|
24 | | The Department is authorized to establish a system of |
25 | | recipient cost-sharing
for services provided under this |
26 | | Section. The cost-sharing shall be based upon
the |
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1 | | recipient's ability to pay for services, but in no case |
2 | | shall the
recipient's share exceed the actual cost of the |
3 | | services provided. Protected
income shall not be |
4 | | considered by the Department in its determination of the
|
5 | | recipient's ability to pay a share of the cost of services. |
6 | | The level of
cost-sharing shall be adjusted each year to |
7 | | reflect changes in the "protected
income" level. The |
8 | | Department shall deduct from the recipient's share of the
|
9 | | cost of services any money expended by the recipient for |
10 | | disability-related
expenses.
|
11 | | To the extent permitted under the federal Social |
12 | | Security Act, the Department, or the Department's |
13 | | authorized representative, may recover
the amount of |
14 | | moneys expended for services provided to or in behalf of a |
15 | | person
under this Section by a claim against the person's |
16 | | estate or against the estate
of the person's surviving |
17 | | spouse, but no recovery may be had until after the
death of |
18 | | the surviving spouse, if any, and then only at such time |
19 | | when there is
no surviving child who is under age 21 or |
20 | | blind or who has a permanent and total disability. This |
21 | | paragraph, however, shall not bar recovery, at the death of |
22 | | the
person, of moneys for services provided to the person |
23 | | or in behalf of the
person under this Section to which the |
24 | | person was not entitled; provided that
such recovery shall |
25 | | not be enforced against any real estate while
it is |
26 | | occupied as a homestead by the surviving spouse or other |
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1 | | dependent, if no
claims by other creditors have been filed |
2 | | against the estate, or, if such
claims have been filed, |
3 | | they remain dormant for failure of prosecution or
failure |
4 | | of the claimant to compel administration of the estate for |
5 | | the purpose
of payment. This paragraph shall not bar |
6 | | recovery from the estate of a spouse,
under Sections 1915 |
7 | | and 1924 of the Social Security Act and Section 5-4 of the
|
8 | | Illinois Public Aid Code, who precedes a person receiving |
9 | | services under this
Section in death. All moneys for |
10 | | services
paid to or in behalf of the person under this |
11 | | Section shall be claimed for
recovery from the deceased |
12 | | spouse's estate. "Homestead", as used in this
paragraph, |
13 | | means the dwelling house and
contiguous real estate |
14 | | occupied by a surviving spouse or relative, as defined
by |
15 | | the rules and regulations of the Department of Healthcare |
16 | | and Family Services,
regardless of the value of the |
17 | | property.
|
18 | | The Department shall submit an annual report on |
19 | | programs and
services provided under this Section. The |
20 | | report shall be filed
with the Governor and the General |
21 | | Assembly on or before March
30
each year.
|
22 | | The requirement for reporting to the General Assembly |
23 | | shall be satisfied
by filing copies of the report
as |
24 | | required by Section 3.1 of the General Assembly |
25 | | Organization Act, and filing
additional copies with the |
26 | | State
Government Report Distribution Center for the |
|
| | HB2496 | - 33 - | LRB101 10944 KTG 56118 b |
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|
1 | | General Assembly as
required under paragraph (t) of Section |
2 | | 7 of the State Library Act.
|
3 | | (g) To establish such subdivisions of the Department
as |
4 | | shall be desirable and assign to the various subdivisions |
5 | | the
responsibilities and duties placed upon the Department |
6 | | by law.
|
7 | | (h) To cooperate and enter into any necessary |
8 | | agreements with the
Department of Employment Security for |
9 | | the provision of job placement and
job referral services to |
10 | | clients of the Department, including job
service |
11 | | registration of such clients with Illinois Employment |
12 | | Security
offices and making job listings maintained by the |
13 | | Department of Employment
Security available to such |
14 | | clients.
|
15 | | (i) To possess all powers reasonable and necessary for
|
16 | | the exercise and administration of the powers, duties and
|
17 | | responsibilities of the Department which are provided for |
18 | | by law.
|
19 | | (j) (Blank).
|
20 | | (k) (Blank).
|
21 | | (l) To establish, operate, and maintain a Statewide |
22 | | Housing Clearinghouse
of information on available |
23 | | government subsidized housing accessible to
persons with |
24 | | disabilities and available privately owned housing |
25 | | accessible to
persons with disabilities. The information |
26 | | shall include, but not be limited to, the
location, rental |
|
| | HB2496 | - 34 - | LRB101 10944 KTG 56118 b |
|
|
1 | | requirements, access features and proximity to public
|
2 | | transportation of available housing. The Clearinghouse |
3 | | shall consist
of at least a computerized database for the |
4 | | storage and retrieval of
information and a separate or |
5 | | shared toll free telephone number for use by
those seeking |
6 | | information from the Clearinghouse. Department offices and
|
7 | | personnel throughout the State shall also assist in the |
8 | | operation of the
Statewide Housing Clearinghouse. |
9 | | Cooperation with local, State, and federal
housing |
10 | | managers shall be sought and extended in order to |
11 | | frequently and
promptly update the Clearinghouse's |
12 | | information.
|
13 | | (m) To assure that the names and case records of |
14 | | persons who received or
are
receiving services from the |
15 | | Department, including persons receiving vocational
|
16 | | rehabilitation, home services, or other services, and |
17 | | those attending one of
the Department's schools or other |
18 | | supervised facility shall be confidential and
not be open |
19 | | to the general public. Those case records and reports or |
20 | | the
information contained in those records and reports |
21 | | shall be disclosed by the
Director only to proper law |
22 | | enforcement officials, individuals authorized by a
court, |
23 | | the General Assembly or any committee or commission of the |
24 | | General
Assembly, and other persons and for reasons as the |
25 | | Director designates by rule.
Disclosure by the Director may |
26 | | be only in accordance with other applicable
law.
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1 | | (Source: P.A. 99-143, eff. 7-27-15; 100-23, eff. 7-6-17; |
2 | | 100-477, eff. 9-8-17; 100-587, eff. 6-4-18; 100-863, eff. |
3 | | 8-14-18; 100-1148, eff. 12-10-18.)
|
4 | | Section 13. The Nursing Home Care Act is amended by |
5 | | changing Section 3-402 as follows:
|
6 | | (210 ILCS 45/3-402) (from Ch. 111 1/2, par. 4153-402) |
7 | | Sec. 3-402. Involuntary transfer or discharge. |
8 | | Involuntary transfer or discharge of a resident from a |
9 | | facility
shall be preceded by the discussion required under |
10 | | Section 3-408 and by
a minimum written notice
of 21 days, |
11 | | except in one of the following instances: |
12 | | (a) When an emergency transfer or discharge is ordered
|
13 | | by the resident's attending physician because of the |
14 | | resident's health
care needs. |
15 | | (b) When the transfer or discharge is mandated by the |
16 | | physical safety of
other residents, the facility staff, or |
17 | | facility visitors, as
documented in the clinical record.
|
18 | | The Department shall be notified prior to any such |
19 | | involuntary transfer
or discharge. The Department shall |
20 | | immediately offer transfer, or discharge
and relocation |
21 | | assistance to residents transferred or discharged under |
22 | | this
subparagraph (b), and the Department may place |
23 | | relocation teams as
provided in Section 3-419 of this Act. |
24 | | (c) When an identified offender is within the |
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1 | | provisional admission period defined in Section 1-120.3. |
2 | | If the Identified Offender Report and Recommendation |
3 | | prepared under Section 2-201.6 shows that the identified |
4 | | offender poses a serious threat or danger to the physical |
5 | | safety of other residents, the facility staff, or facility |
6 | | visitors in the admitting facility and the facility |
7 | | determines that it is unable to provide a safe environment |
8 | | for the other residents, the facility staff, or facility |
9 | | visitors, the facility shall transfer or discharge the |
10 | | identified offender within 3 days after its receipt of the |
11 | | Identified Offender Report and Recommendation. |
12 | | No individual receiving care in an institutional setting |
13 | | shall be involuntarily discharged as the result of the updated |
14 | | determination of need (DON) assessment tool as provided in |
15 | | Section 5-5 of the Illinois Public Aid Code until a transition |
16 | | plan has been developed by the Department on Aging or its |
17 | | designee and all care identified in the transition plan is |
18 | | available to the resident immediately upon discharge. |
19 | | (Source: P.A. 96-1372, eff. 7-29-10.)
|
20 | | Section 15. The Illinois Public Aid Code is amended by |
21 | | changing Sections 5-5 and 5-5.01a as follows:
|
22 | | (305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
|
23 | | Sec. 5-5. Medical services. The Illinois Department, by |
24 | | rule, shall
determine the quantity and quality of and the rate |
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1 | | of reimbursement for the
medical assistance for which
payment |
2 | | will be authorized, and the medical services to be provided,
|
3 | | which may include all or part of the following: (1) inpatient |
4 | | hospital
services; (2) outpatient hospital services; (3) other |
5 | | laboratory and
X-ray services; (4) skilled nursing home |
6 | | services; (5) physicians'
services whether furnished in the |
7 | | office, the patient's home, a
hospital, a skilled nursing home, |
8 | | or elsewhere; (6) medical care, or any
other type of remedial |
9 | | care furnished by licensed practitioners; (7)
home health care |
10 | | services; (8) private duty nursing service; (9) clinic
|
11 | | services; (10) dental services, including prevention and |
12 | | treatment of periodontal disease and dental caries disease for |
13 | | pregnant women, provided by an individual licensed to practice |
14 | | dentistry or dental surgery; for purposes of this item (10), |
15 | | "dental services" means diagnostic, preventive, or corrective |
16 | | procedures provided by or under the supervision of a dentist in |
17 | | the practice of his or her profession; (11) physical therapy |
18 | | and related
services; (12) prescribed drugs, dentures, and |
19 | | prosthetic devices; and
eyeglasses prescribed by a physician |
20 | | skilled in the diseases of the eye,
or by an optometrist, |
21 | | whichever the person may select; (13) other
diagnostic, |
22 | | screening, preventive, and rehabilitative services, including |
23 | | to ensure that the individual's need for intervention or |
24 | | treatment of mental disorders or substance use disorders or |
25 | | co-occurring mental health and substance use disorders is |
26 | | determined using a uniform screening, assessment, and |
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1 | | evaluation process inclusive of criteria, for children and |
2 | | adults; for purposes of this item (13), a uniform screening, |
3 | | assessment, and evaluation process refers to a process that |
4 | | includes an appropriate evaluation and, as warranted, a |
5 | | referral; "uniform" does not mean the use of a singular |
6 | | instrument, tool, or process that all must utilize; (14)
|
7 | | transportation and such other expenses as may be necessary; |
8 | | (15) medical
treatment of sexual assault survivors, as defined |
9 | | in
Section 1a of the Sexual Assault Survivors Emergency |
10 | | Treatment Act, for
injuries sustained as a result of the sexual |
11 | | assault, including
examinations and laboratory tests to |
12 | | discover evidence which may be used in
criminal proceedings |
13 | | arising from the sexual assault; (16) the
diagnosis and |
14 | | treatment of sickle cell anemia; and (17)
any other medical |
15 | | care, and any other type of remedial care recognized
under the |
16 | | laws of this State. The term "any other type of remedial care" |
17 | | shall
include nursing care and nursing home service for persons |
18 | | who rely on
treatment by spiritual means alone through prayer |
19 | | for healing.
|
20 | | Notwithstanding any other provision of this Section, a |
21 | | comprehensive
tobacco use cessation program that includes |
22 | | purchasing prescription drugs or
prescription medical devices |
23 | | approved by the Food and Drug Administration shall
be covered |
24 | | under the medical assistance
program under this Article for |
25 | | persons who are otherwise eligible for
assistance under this |
26 | | Article.
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1 | | Notwithstanding any other provision of this Code, |
2 | | reproductive health care that is otherwise legal in Illinois |
3 | | shall be covered under the medical assistance program for |
4 | | persons who are otherwise eligible for medical assistance under |
5 | | this Article. |
6 | | Notwithstanding any other provision of this Code, the |
7 | | Illinois
Department may not require, as a condition of payment |
8 | | for any laboratory
test authorized under this Article, that a |
9 | | physician's handwritten signature
appear on the laboratory |
10 | | test order form. The Illinois Department may,
however, impose |
11 | | other appropriate requirements regarding laboratory test
order |
12 | | documentation.
|
13 | | Upon receipt of federal approval of an amendment to the |
14 | | Illinois Title XIX State Plan for this purpose, the Department |
15 | | shall authorize the Chicago Public Schools (CPS) to procure a |
16 | | vendor or vendors to manufacture eyeglasses for individuals |
17 | | enrolled in a school within the CPS system. CPS shall ensure |
18 | | that its vendor or vendors are enrolled as providers in the |
19 | | medical assistance program and in any capitated Medicaid |
20 | | managed care entity (MCE) serving individuals enrolled in a |
21 | | school within the CPS system. Under any contract procured under |
22 | | this provision, the vendor or vendors must serve only |
23 | | individuals enrolled in a school within the CPS system. Claims |
24 | | for services provided by CPS's vendor or vendors to recipients |
25 | | of benefits in the medical assistance program under this Code, |
26 | | the Children's Health Insurance Program, or the Covering ALL |
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1 | | KIDS Health Insurance Program shall be submitted to the |
2 | | Department or the MCE in which the individual is enrolled for |
3 | | payment and shall be reimbursed at the Department's or the |
4 | | MCE's established rates or rate methodologies for eyeglasses. |
5 | | On and after July 1, 2012, the Department of Healthcare and |
6 | | Family Services may provide the following services to
persons
|
7 | | eligible for assistance under this Article who are |
8 | | participating in
education, training or employment programs |
9 | | operated by the Department of Human
Services as successor to |
10 | | the Department of Public Aid:
|
11 | | (1) dental services provided by or under the |
12 | | supervision of a dentist; and
|
13 | | (2) eyeglasses prescribed by a physician skilled in the |
14 | | diseases of the
eye, or by an optometrist, whichever the |
15 | | person may select.
|
16 | | On and after July 1, 2018, the Department of Healthcare and |
17 | | Family Services shall provide dental services to any adult who |
18 | | is otherwise eligible for assistance under the medical |
19 | | assistance program. As used in this paragraph, "dental |
20 | | services" means diagnostic, preventative, restorative, or |
21 | | corrective procedures, including procedures and services for |
22 | | the prevention and treatment of periodontal disease and dental |
23 | | caries disease, provided by an individual who is licensed to |
24 | | practice dentistry or dental surgery or who is under the |
25 | | supervision of a dentist in the practice of his or her |
26 | | profession. |
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1 | | On and after July 1, 2018, targeted dental services, as set |
2 | | forth in Exhibit D of the Consent Decree entered by the United |
3 | | States District Court for the Northern District of Illinois, |
4 | | Eastern Division, in the matter of Memisovski v. Maram, Case |
5 | | No. 92 C 1982, that are provided to adults under the medical |
6 | | assistance program shall be established at no less than the |
7 | | rates set forth in the "New Rate" column in Exhibit D of the |
8 | | Consent Decree for targeted dental services that are provided |
9 | | to persons under the age of 18 under the medical assistance |
10 | | program. |
11 | | Notwithstanding any other provision of this Code and |
12 | | subject to federal approval, the Department may adopt rules to |
13 | | allow a dentist who is volunteering his or her service at no |
14 | | cost to render dental services through an enrolled |
15 | | not-for-profit health clinic without the dentist personally |
16 | | enrolling as a participating provider in the medical assistance |
17 | | program. A not-for-profit health clinic shall include a public |
18 | | health clinic or Federally Qualified Health Center or other |
19 | | enrolled provider, as determined by the Department, through |
20 | | which dental services covered under this Section are performed. |
21 | | The Department shall establish a process for payment of claims |
22 | | for reimbursement for covered dental services rendered under |
23 | | this provision. |
24 | | The Illinois Department, by rule, may distinguish and |
25 | | classify the
medical services to be provided only in accordance |
26 | | with the classes of
persons designated in Section 5-2.
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1 | | The Department of Healthcare and Family Services must |
2 | | provide coverage and reimbursement for amino acid-based |
3 | | elemental formulas, regardless of delivery method, for the |
4 | | diagnosis and treatment of (i) eosinophilic disorders and (ii) |
5 | | short bowel syndrome when the prescribing physician has issued |
6 | | a written order stating that the amino acid-based elemental |
7 | | formula is medically necessary.
|
8 | | The Illinois Department shall authorize the provision of, |
9 | | and shall
authorize payment for, screening by low-dose |
10 | | mammography for the presence of
occult breast cancer for women |
11 | | 35 years of age or older who are eligible
for medical |
12 | | assistance under this Article, as follows: |
13 | | (A) A baseline
mammogram for women 35 to 39 years of |
14 | | age.
|
15 | | (B) An annual mammogram for women 40 years of age or |
16 | | older. |
17 | | (C) A mammogram at the age and intervals considered |
18 | | medically necessary by the woman's health care provider for |
19 | | women under 40 years of age and having a family history of |
20 | | breast cancer, prior personal history of breast cancer, |
21 | | positive genetic testing, or other risk factors. |
22 | | (D) A comprehensive ultrasound screening and MRI of an |
23 | | entire breast or breasts if a mammogram demonstrates |
24 | | heterogeneous or dense breast tissue, when medically |
25 | | necessary as determined by a physician licensed to practice |
26 | | medicine in all of its branches. |
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1 | | (E) A screening MRI when medically necessary, as |
2 | | determined by a physician licensed to practice medicine in |
3 | | all of its branches. |
4 | | All screenings
shall
include a physical breast exam, |
5 | | instruction on self-examination and
information regarding the |
6 | | frequency of self-examination and its value as a
preventative |
7 | | tool. For purposes of this Section, "low-dose mammography" |
8 | | means
the x-ray examination of the breast using equipment |
9 | | dedicated specifically
for mammography, including the x-ray |
10 | | tube, filter, compression device,
and image receptor, with an |
11 | | average radiation exposure delivery
of less than one rad per |
12 | | breast for 2 views of an average size breast.
The term also |
13 | | includes digital mammography and includes breast |
14 | | tomosynthesis. As used in this Section, the term "breast |
15 | | tomosynthesis" means a radiologic procedure that involves the |
16 | | acquisition of projection images over the stationary breast to |
17 | | produce cross-sectional digital three-dimensional images of |
18 | | the breast. If, at any time, the Secretary of the United States |
19 | | Department of Health and Human Services, or its successor |
20 | | agency, promulgates rules or regulations to be published in the |
21 | | Federal Register or publishes a comment in the Federal Register |
22 | | or issues an opinion, guidance, or other action that would |
23 | | require the State, pursuant to any provision of the Patient |
24 | | Protection and Affordable Care Act (Public Law 111-148), |
25 | | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any |
26 | | successor provision, to defray the cost of any coverage for |
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1 | | breast tomosynthesis outlined in this paragraph, then the |
2 | | requirement that an insurer cover breast tomosynthesis is |
3 | | inoperative other than any such coverage authorized under |
4 | | Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and |
5 | | the State shall not assume any obligation for the cost of |
6 | | coverage for breast tomosynthesis set forth in this paragraph.
|
7 | | On and after January 1, 2016, the Department shall ensure |
8 | | that all networks of care for adult clients of the Department |
9 | | include access to at least one breast imaging Center of Imaging |
10 | | Excellence as certified by the American College of Radiology. |
11 | | On and after January 1, 2012, providers participating in a |
12 | | quality improvement program approved by the Department shall be |
13 | | reimbursed for screening and diagnostic mammography at the same |
14 | | rate as the Medicare program's rates, including the increased |
15 | | reimbursement for digital mammography. |
16 | | The Department shall convene an expert panel including |
17 | | representatives of hospitals, free-standing mammography |
18 | | facilities, and doctors, including radiologists, to establish |
19 | | quality standards for mammography. |
20 | | On and after January 1, 2017, providers participating in a |
21 | | breast cancer treatment quality improvement program approved |
22 | | by the Department shall be reimbursed for breast cancer |
23 | | treatment at a rate that is no lower than 95% of the Medicare |
24 | | program's rates for the data elements included in the breast |
25 | | cancer treatment quality program. |
26 | | The Department shall convene an expert panel, including |
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1 | | representatives of hospitals, free-standing breast cancer |
2 | | treatment centers, breast cancer quality organizations, and |
3 | | doctors, including breast surgeons, reconstructive breast |
4 | | surgeons, oncologists, and primary care providers to establish |
5 | | quality standards for breast cancer treatment. |
6 | | Subject to federal approval, the Department shall |
7 | | establish a rate methodology for mammography at federally |
8 | | qualified health centers and other encounter-rate clinics. |
9 | | These clinics or centers may also collaborate with other |
10 | | hospital-based mammography facilities. By January 1, 2016, the |
11 | | Department shall report to the General Assembly on the status |
12 | | of the provision set forth in this paragraph. |
13 | | The Department shall establish a methodology to remind |
14 | | women who are age-appropriate for screening mammography, but |
15 | | who have not received a mammogram within the previous 18 |
16 | | months, of the importance and benefit of screening mammography. |
17 | | The Department shall work with experts in breast cancer |
18 | | outreach and patient navigation to optimize these reminders and |
19 | | shall establish a methodology for evaluating their |
20 | | effectiveness and modifying the methodology based on the |
21 | | evaluation. |
22 | | The Department shall establish a performance goal for |
23 | | primary care providers with respect to their female patients |
24 | | over age 40 receiving an annual mammogram. This performance |
25 | | goal shall be used to provide additional reimbursement in the |
26 | | form of a quality performance bonus to primary care providers |
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1 | | who meet that goal. |
2 | | The Department shall devise a means of case-managing or |
3 | | patient navigation for beneficiaries diagnosed with breast |
4 | | cancer. This program shall initially operate as a pilot program |
5 | | in areas of the State with the highest incidence of mortality |
6 | | related to breast cancer. At least one pilot program site shall |
7 | | be in the metropolitan Chicago area and at least one site shall |
8 | | be outside the metropolitan Chicago area. On or after July 1, |
9 | | 2016, the pilot program shall be expanded to include one site |
10 | | in western Illinois, one site in southern Illinois, one site in |
11 | | central Illinois, and 4 sites within metropolitan Chicago. An |
12 | | evaluation of the pilot program shall be carried out measuring |
13 | | health outcomes and cost of care for those served by the pilot |
14 | | program compared to similarly situated patients who are not |
15 | | served by the pilot program. |
16 | | The Department shall require all networks of care to |
17 | | develop a means either internally or by contract with experts |
18 | | in navigation and community outreach to navigate cancer |
19 | | patients to comprehensive care in a timely fashion. The |
20 | | Department shall require all networks of care to include access |
21 | | for patients diagnosed with cancer to at least one academic |
22 | | commission on cancer-accredited cancer program as an |
23 | | in-network covered benefit. |
24 | | Any medical or health care provider shall immediately |
25 | | recommend, to
any pregnant woman who is being provided prenatal |
26 | | services and is suspected
of having a substance use disorder as |
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1 | | defined in the Substance Use Disorder Act, referral to a local |
2 | | substance use disorder treatment program licensed by the |
3 | | Department of Human Services or to a licensed
hospital which |
4 | | provides substance abuse treatment services. The Department of |
5 | | Healthcare and Family Services
shall assure coverage for the |
6 | | cost of treatment of the drug abuse or
addiction for pregnant |
7 | | recipients in accordance with the Illinois Medicaid
Program in |
8 | | conjunction with the Department of Human Services.
|
9 | | All medical providers providing medical assistance to |
10 | | pregnant women
under this Code shall receive information from |
11 | | the Department on the
availability of services under any
|
12 | | program providing case management services for addicted women,
|
13 | | including information on appropriate referrals for other |
14 | | social services
that may be needed by addicted women in |
15 | | addition to treatment for addiction.
|
16 | | The Illinois Department, in cooperation with the |
17 | | Departments of Human
Services (as successor to the Department |
18 | | of Alcoholism and Substance
Abuse) and Public Health, through a |
19 | | public awareness campaign, may
provide information concerning |
20 | | treatment for alcoholism and drug abuse and
addiction, prenatal |
21 | | health care, and other pertinent programs directed at
reducing |
22 | | the number of drug-affected infants born to recipients of |
23 | | medical
assistance.
|
24 | | Neither the Department of Healthcare and Family Services |
25 | | nor the Department of Human
Services shall sanction the |
26 | | recipient solely on the basis of
her substance abuse.
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1 | | The Illinois Department shall establish such regulations |
2 | | governing
the dispensing of health services under this Article |
3 | | as it shall deem
appropriate. The Department
should
seek the |
4 | | advice of formal professional advisory committees appointed by
|
5 | | the Director of the Illinois Department for the purpose of |
6 | | providing regular
advice on policy and administrative matters, |
7 | | information dissemination and
educational activities for |
8 | | medical and health care providers, and
consistency in |
9 | | procedures to the Illinois Department.
|
10 | | The Illinois Department may develop and contract with |
11 | | Partnerships of
medical providers to arrange medical services |
12 | | for persons eligible under
Section 5-2 of this Code. |
13 | | Implementation of this Section may be by
demonstration projects |
14 | | in certain geographic areas. The Partnership shall
be |
15 | | represented by a sponsor organization. The Department, by rule, |
16 | | shall
develop qualifications for sponsors of Partnerships. |
17 | | Nothing in this
Section shall be construed to require that the |
18 | | sponsor organization be a
medical organization.
|
19 | | The sponsor must negotiate formal written contracts with |
20 | | medical
providers for physician services, inpatient and |
21 | | outpatient hospital care,
home health services, treatment for |
22 | | alcoholism and substance abuse, and
other services determined |
23 | | necessary by the Illinois Department by rule for
delivery by |
24 | | Partnerships. Physician services must include prenatal and
|
25 | | obstetrical care. The Illinois Department shall reimburse |
26 | | medical services
delivered by Partnership providers to clients |
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1 | | in target areas according to
provisions of this Article and the |
2 | | Illinois Health Finance Reform Act,
except that:
|
3 | | (1) Physicians participating in a Partnership and |
4 | | providing certain
services, which shall be determined by |
5 | | the Illinois Department, to persons
in areas covered by the |
6 | | Partnership may receive an additional surcharge
for such |
7 | | services.
|
8 | | (2) The Department may elect to consider and negotiate |
9 | | financial
incentives to encourage the development of |
10 | | Partnerships and the efficient
delivery of medical care.
|
11 | | (3) Persons receiving medical services through |
12 | | Partnerships may receive
medical and case management |
13 | | services above the level usually offered
through the |
14 | | medical assistance program.
|
15 | | Medical providers shall be required to meet certain |
16 | | qualifications to
participate in Partnerships to ensure the |
17 | | delivery of high quality medical
services. These |
18 | | qualifications shall be determined by rule of the Illinois
|
19 | | Department and may be higher than qualifications for |
20 | | participation in the
medical assistance program. Partnership |
21 | | sponsors may prescribe reasonable
additional qualifications |
22 | | for participation by medical providers, only with
the prior |
23 | | written approval of the Illinois Department.
|
24 | | Nothing in this Section shall limit the free choice of |
25 | | practitioners,
hospitals, and other providers of medical |
26 | | services by clients.
In order to ensure patient freedom of |
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1 | | choice, the Illinois Department shall
immediately promulgate |
2 | | all rules and take all other necessary actions so that
provided |
3 | | services may be accessed from therapeutically certified |
4 | | optometrists
to the full extent of the Illinois Optometric |
5 | | Practice Act of 1987 without
discriminating between service |
6 | | providers.
|
7 | | The Department shall apply for a waiver from the United |
8 | | States Health
Care Financing Administration to allow for the |
9 | | implementation of
Partnerships under this Section.
|
10 | | The Illinois Department shall require health care |
11 | | providers to maintain
records that document the medical care |
12 | | and services provided to recipients
of Medical Assistance under |
13 | | this Article. Such records must be retained for a period of not |
14 | | less than 6 years from the date of service or as provided by |
15 | | applicable State law, whichever period is longer, except that |
16 | | if an audit is initiated within the required retention period |
17 | | then the records must be retained until the audit is completed |
18 | | and every exception is resolved. The Illinois Department shall
|
19 | | require health care providers to make available, when |
20 | | authorized by the
patient, in writing, the medical records in a |
21 | | timely fashion to other
health care providers who are treating |
22 | | or serving persons eligible for
Medical Assistance under this |
23 | | Article. All dispensers of medical services
shall be required |
24 | | to maintain and retain business and professional records
|
25 | | sufficient to fully and accurately document the nature, scope, |
26 | | details and
receipt of the health care provided to persons |
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1 | | eligible for medical
assistance under this Code, in accordance |
2 | | with regulations promulgated by
the Illinois Department. The |
3 | | rules and regulations shall require that proof
of the receipt |
4 | | of prescription drugs, dentures, prosthetic devices and
|
5 | | eyeglasses by eligible persons under this Section accompany |
6 | | each claim
for reimbursement submitted by the dispenser of such |
7 | | medical services.
No such claims for reimbursement shall be |
8 | | approved for payment by the Illinois
Department without such |
9 | | proof of receipt, unless the Illinois Department
shall have put |
10 | | into effect and shall be operating a system of post-payment
|
11 | | audit and review which shall, on a sampling basis, be deemed |
12 | | adequate by
the Illinois Department to assure that such drugs, |
13 | | dentures, prosthetic
devices and eyeglasses for which payment |
14 | | is being made are actually being
received by eligible |
15 | | recipients. Within 90 days after September 16, 1984 (the |
16 | | effective date of Public Act 83-1439), the Illinois Department |
17 | | shall establish a
current list of acquisition costs for all |
18 | | prosthetic devices and any
other items recognized as medical |
19 | | equipment and supplies reimbursable under
this Article and |
20 | | shall update such list on a quarterly basis, except that
the |
21 | | acquisition costs of all prescription drugs shall be updated no
|
22 | | less frequently than every 30 days as required by Section |
23 | | 5-5.12.
|
24 | | Notwithstanding any other law to the contrary, the Illinois |
25 | | Department shall, within 365 days after July 22, 2013 (the |
26 | | effective date of Public Act 98-104), establish procedures to |
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1 | | permit skilled care facilities licensed under the Nursing Home |
2 | | Care Act to submit monthly billing claims for reimbursement |
3 | | purposes. Following development of these procedures, the |
4 | | Department shall, by July 1, 2016, test the viability of the |
5 | | new system and implement any necessary operational or |
6 | | structural changes to its information technology platforms in |
7 | | order to allow for the direct acceptance and payment of nursing |
8 | | home claims. |
9 | | Notwithstanding any other law to the contrary, the Illinois |
10 | | Department shall, within 365 days after August 15, 2014 (the |
11 | | effective date of Public Act 98-963), establish procedures to |
12 | | permit ID/DD facilities licensed under the ID/DD Community Care |
13 | | Act and MC/DD facilities licensed under the MC/DD Act to submit |
14 | | monthly billing claims for reimbursement purposes. Following |
15 | | development of these procedures, the Department shall have an |
16 | | additional 365 days to test the viability of the new system and |
17 | | to ensure that any necessary operational or structural changes |
18 | | to its information technology platforms are implemented. |
19 | | The Illinois Department shall require all dispensers of |
20 | | medical
services, other than an individual practitioner or |
21 | | group of practitioners,
desiring to participate in the Medical |
22 | | Assistance program
established under this Article to disclose |
23 | | all financial, beneficial,
ownership, equity, surety or other |
24 | | interests in any and all firms,
corporations, partnerships, |
25 | | associations, business enterprises, joint
ventures, agencies, |
26 | | institutions or other legal entities providing any
form of |
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1 | | health care services in this State under this Article.
|
2 | | The Illinois Department may require that all dispensers of |
3 | | medical
services desiring to participate in the medical |
4 | | assistance program
established under this Article disclose, |
5 | | under such terms and conditions as
the Illinois Department may |
6 | | by rule establish, all inquiries from clients
and attorneys |
7 | | regarding medical bills paid by the Illinois Department, which
|
8 | | inquiries could indicate potential existence of claims or liens |
9 | | for the
Illinois Department.
|
10 | | Enrollment of a vendor
shall be
subject to a provisional |
11 | | period and shall be conditional for one year. During the period |
12 | | of conditional enrollment, the Department may
terminate the |
13 | | vendor's eligibility to participate in, or may disenroll the |
14 | | vendor from, the medical assistance
program without cause. |
15 | | Unless otherwise specified, such termination of eligibility or |
16 | | disenrollment is not subject to the
Department's hearing |
17 | | process.
However, a disenrolled vendor may reapply without |
18 | | penalty.
|
19 | | The Department has the discretion to limit the conditional |
20 | | enrollment period for vendors based upon category of risk of |
21 | | the vendor. |
22 | | Prior to enrollment and during the conditional enrollment |
23 | | period in the medical assistance program, all vendors shall be |
24 | | subject to enhanced oversight, screening, and review based on |
25 | | the risk of fraud, waste, and abuse that is posed by the |
26 | | category of risk of the vendor. The Illinois Department shall |
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1 | | establish the procedures for oversight, screening, and review, |
2 | | which may include, but need not be limited to: criminal and |
3 | | financial background checks; fingerprinting; license, |
4 | | certification, and authorization verifications; unscheduled or |
5 | | unannounced site visits; database checks; prepayment audit |
6 | | reviews; audits; payment caps; payment suspensions; and other |
7 | | screening as required by federal or State law. |
8 | | The Department shall define or specify the following: (i) |
9 | | by provider notice, the "category of risk of the vendor" for |
10 | | each type of vendor, which shall take into account the level of |
11 | | screening applicable to a particular category of vendor under |
12 | | federal law and regulations; (ii) by rule or provider notice, |
13 | | the maximum length of the conditional enrollment period for |
14 | | each category of risk of the vendor; and (iii) by rule, the |
15 | | hearing rights, if any, afforded to a vendor in each category |
16 | | of risk of the vendor that is terminated or disenrolled during |
17 | | the conditional enrollment period. |
18 | | To be eligible for payment consideration, a vendor's |
19 | | payment claim or bill, either as an initial claim or as a |
20 | | resubmitted claim following prior rejection, must be received |
21 | | by the Illinois Department, or its fiscal intermediary, no |
22 | | later than 180 days after the latest date on the claim on which |
23 | | medical goods or services were provided, with the following |
24 | | exceptions: |
25 | | (1) In the case of a provider whose enrollment is in |
26 | | process by the Illinois Department, the 180-day period |
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1 | | shall not begin until the date on the written notice from |
2 | | the Illinois Department that the provider enrollment is |
3 | | complete. |
4 | | (2) In the case of errors attributable to the Illinois |
5 | | Department or any of its claims processing intermediaries |
6 | | which result in an inability to receive, process, or |
7 | | adjudicate a claim, the 180-day period shall not begin |
8 | | until the provider has been notified of the error. |
9 | | (3) In the case of a provider for whom the Illinois |
10 | | Department initiates the monthly billing process. |
11 | | (4) In the case of a provider operated by a unit of |
12 | | local government with a population exceeding 3,000,000 |
13 | | when local government funds finance federal participation |
14 | | for claims payments. |
15 | | For claims for services rendered during a period for which |
16 | | a recipient received retroactive eligibility, claims must be |
17 | | filed within 180 days after the Department determines the |
18 | | applicant is eligible. For claims for which the Illinois |
19 | | Department is not the primary payer, claims must be submitted |
20 | | to the Illinois Department within 180 days after the final |
21 | | adjudication by the primary payer. |
22 | | In the case of long term care facilities, within 45 |
23 | | calendar days of receipt by the facility of required |
24 | | prescreening information, new admissions with associated |
25 | | admission documents shall be submitted through the Medical |
26 | | Electronic Data Interchange (MEDI) or the Recipient |
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1 | | Eligibility Verification (REV) System or shall be submitted |
2 | | directly to the Department of Human Services using required |
3 | | admission forms. Effective September
1, 2014, admission |
4 | | documents, including all prescreening
information, must be |
5 | | submitted through MEDI or REV. Confirmation numbers assigned to |
6 | | an accepted transaction shall be retained by a facility to |
7 | | verify timely submittal. Once an admission transaction has been |
8 | | completed, all resubmitted claims following prior rejection |
9 | | are subject to receipt no later than 180 days after the |
10 | | admission transaction has been completed. |
11 | | Claims that are not submitted and received in compliance |
12 | | with the foregoing requirements shall not be eligible for |
13 | | payment under the medical assistance program, and the State |
14 | | shall have no liability for payment of those claims. |
15 | | To the extent consistent with applicable information and |
16 | | privacy, security, and disclosure laws, State and federal |
17 | | agencies and departments shall provide the Illinois Department |
18 | | access to confidential and other information and data necessary |
19 | | to perform eligibility and payment verifications and other |
20 | | Illinois Department functions. This includes, but is not |
21 | | limited to: information pertaining to licensure; |
22 | | certification; earnings; immigration status; citizenship; wage |
23 | | reporting; unearned and earned income; pension income; |
24 | | employment; supplemental security income; social security |
25 | | numbers; National Provider Identifier (NPI) numbers; the |
26 | | National Practitioner Data Bank (NPDB); program and agency |
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1 | | exclusions; taxpayer identification numbers; tax delinquency; |
2 | | corporate information; and death records. |
3 | | The Illinois Department shall enter into agreements with |
4 | | State agencies and departments, and is authorized to enter into |
5 | | agreements with federal agencies and departments, under which |
6 | | such agencies and departments shall share data necessary for |
7 | | medical assistance program integrity functions and oversight. |
8 | | The Illinois Department shall develop, in cooperation with |
9 | | other State departments and agencies, and in compliance with |
10 | | applicable federal laws and regulations, appropriate and |
11 | | effective methods to share such data. At a minimum, and to the |
12 | | extent necessary to provide data sharing, the Illinois |
13 | | Department shall enter into agreements with State agencies and |
14 | | departments, and is authorized to enter into agreements with |
15 | | federal agencies and departments, including but not limited to: |
16 | | the Secretary of State; the Department of Revenue; the |
17 | | Department of Public Health; the Department of Human Services; |
18 | | and the Department of Financial and Professional Regulation. |
19 | | Beginning in fiscal year 2013, the Illinois Department |
20 | | shall set forth a request for information to identify the |
21 | | benefits of a pre-payment, post-adjudication, and post-edit |
22 | | claims system with the goals of streamlining claims processing |
23 | | and provider reimbursement, reducing the number of pending or |
24 | | rejected claims, and helping to ensure a more transparent |
25 | | adjudication process through the utilization of: (i) provider |
26 | | data verification and provider screening technology; and (ii) |
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1 | | clinical code editing; and (iii) pre-pay, pre- or |
2 | | post-adjudicated predictive modeling with an integrated case |
3 | | management system with link analysis. Such a request for |
4 | | information shall not be considered as a request for proposal |
5 | | or as an obligation on the part of the Illinois Department to |
6 | | take any action or acquire any products or services. |
7 | | The Illinois Department shall establish policies, |
8 | | procedures,
standards and criteria by rule for the acquisition, |
9 | | repair and replacement
of orthotic and prosthetic devices and |
10 | | durable medical equipment. Such
rules shall provide, but not be |
11 | | limited to, the following services: (1)
immediate repair or |
12 | | replacement of such devices by recipients; and (2) rental, |
13 | | lease, purchase or lease-purchase of
durable medical equipment |
14 | | in a cost-effective manner, taking into
consideration the |
15 | | recipient's medical prognosis, the extent of the
recipient's |
16 | | needs, and the requirements and costs for maintaining such
|
17 | | equipment. Subject to prior approval, such rules shall enable a |
18 | | recipient to temporarily acquire and
use alternative or |
19 | | substitute devices or equipment pending repairs or
|
20 | | replacements of any device or equipment previously authorized |
21 | | for such
recipient by the Department. Notwithstanding any |
22 | | provision of Section 5-5f to the contrary, the Department may, |
23 | | by rule, exempt certain replacement wheelchair parts from prior |
24 | | approval and, for wheelchairs, wheelchair parts, wheelchair |
25 | | accessories, and related seating and positioning items, |
26 | | determine the wholesale price by methods other than actual |
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1 | | acquisition costs. |
2 | | The Department shall require, by rule, all providers of |
3 | | durable medical equipment to be accredited by an accreditation |
4 | | organization approved by the federal Centers for Medicare and |
5 | | Medicaid Services and recognized by the Department in order to |
6 | | bill the Department for providing durable medical equipment to |
7 | | recipients. No later than 15 months after the effective date of |
8 | | the rule adopted pursuant to this paragraph, all providers must |
9 | | meet the accreditation requirement.
|
10 | | In order to promote environmental responsibility, meet the |
11 | | needs of recipients and enrollees, and achieve significant cost |
12 | | savings, the Department, or a managed care organization under |
13 | | contract with the Department, may provide recipients or managed |
14 | | care enrollees who have a prescription or Certificate of |
15 | | Medical Necessity access to refurbished durable medical |
16 | | equipment under this Section (excluding prosthetic and |
17 | | orthotic devices as defined in the Orthotics, Prosthetics, and |
18 | | Pedorthics Practice Act and complex rehabilitation technology |
19 | | products and associated services) through the State's |
20 | | assistive technology program's reutilization program, using |
21 | | staff with the Assistive Technology Professional (ATP) |
22 | | Certification if the refurbished durable medical equipment: |
23 | | (i) is available; (ii) is less expensive, including shipping |
24 | | costs, than new durable medical equipment of the same type; |
25 | | (iii) is able to withstand at least 3 years of use; (iv) is |
26 | | cleaned, disinfected, sterilized, and safe in accordance with |
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1 | | federal Food and Drug Administration regulations and guidance |
2 | | governing the reprocessing of medical devices in health care |
3 | | settings; and (v) equally meets the needs of the recipient or |
4 | | enrollee. The reutilization program shall confirm that the |
5 | | recipient or enrollee is not already in receipt of same or |
6 | | similar equipment from another service provider, and that the |
7 | | refurbished durable medical equipment equally meets the needs |
8 | | of the recipient or enrollee. Nothing in this paragraph shall |
9 | | be construed to limit recipient or enrollee choice to obtain |
10 | | new durable medical equipment or place any additional prior |
11 | | authorization conditions on enrollees of managed care |
12 | | organizations. |
13 | | The Department shall execute, relative to the nursing home |
14 | | prescreening
project, written inter-agency agreements with the |
15 | | Department of Human
Services and the Department on Aging, to |
16 | | effect the following: (i) intake
procedures and common |
17 | | eligibility criteria for those persons who are receiving
|
18 | | non-institutional services; and (ii) the establishment and |
19 | | development of
non-institutional services in areas of the State |
20 | | where they are not currently
available or are undeveloped; and |
21 | | (iii) notwithstanding any other provision of law, subject to |
22 | | federal approval, on and after July 1, 2012, an increase in the |
23 | | determination of need (DON) scores from 29 to 37 for applicants |
24 | | for institutional and home and community-based long term care; |
25 | | if and only if federal approval is not granted, the Department |
26 | | may, in conjunction with other affected agencies, implement |
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1 | | utilization controls or changes in benefit packages to |
2 | | effectuate a similar savings amount for this population; and |
3 | | (iv) no later than July 1, 2013, minimum level of care |
4 | | eligibility criteria for institutional and home and |
5 | | community-based long term care; and (iv) (v) no later than |
6 | | October 1, 2013, establish procedures to permit long term care |
7 | | providers access to eligibility scores for individuals with an |
8 | | admission date who are seeking or receiving services from the |
9 | | long term care provider. In order to select the minimum level |
10 | | of care eligibility criteria, the Governor shall establish a |
11 | | workgroup that includes affected agency representatives and |
12 | | stakeholders representing the institutional and home and |
13 | | community-based long term care interests. This Section shall |
14 | | not restrict the Department from implementing lower level of |
15 | | care eligibility criteria for community-based services in |
16 | | circumstances where federal approval has been granted. |
17 | | Individuals with a score of 29 or higher based on the |
18 | | determination of need (DON) assessment tool shall be eligible |
19 | | to receive institutional and home and community-based long term |
20 | | care services until the State receives federal approval and |
21 | | implements an updated assessment tool, and those individuals |
22 | | are found to be ineligible under that updated assessment tool. |
23 | | Anyone determined to be ineligible for services due to the |
24 | | updated assessment tool shall continue to be eligible for |
25 | | services for at least one year following that determination and |
26 | | must be reassessed no earlier than 11 months after that |
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1 | | determination. The Department must adopt rules through the |
2 | | regular rulemaking process regarding the updated assessment |
3 | | tool, and shall not adopt emergency or peremptory rules |
4 | | regarding the updated assessment tool. The State shall not |
5 | | implement an updated assessment tool that causes more than 1% |
6 | | of then-current recipients to lose eligibility. No individual |
7 | | receiving care in an institutional setting shall be |
8 | | involuntarily discharged as the result of the updated |
9 | | assessment tool until a transition plan has been developed by |
10 | | the Department on Aging or its designee and all care identified |
11 | | in the transition plan is available to the resident immediately |
12 | | upon discharge.
|
13 | | The Illinois Department shall develop and operate, in |
14 | | cooperation
with other State Departments and agencies and in |
15 | | compliance with
applicable federal laws and regulations, |
16 | | appropriate and effective
systems of health care evaluation and |
17 | | programs for monitoring of
utilization of health care services |
18 | | and facilities, as it affects
persons eligible for medical |
19 | | assistance under this Code.
|
20 | | The Illinois Department shall report annually to the |
21 | | General Assembly,
no later than the second Friday in April of |
22 | | 1979 and each year
thereafter, in regard to:
|
23 | | (a) actual statistics and trends in utilization of |
24 | | medical services by
public aid recipients;
|
25 | | (b) actual statistics and trends in the provision of |
26 | | the various medical
services by medical vendors;
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1 | | (c) current rate structures and proposed changes in |
2 | | those rate structures
for the various medical vendors; and
|
3 | | (d) efforts at utilization review and control by the |
4 | | Illinois Department.
|
5 | | The period covered by each report shall be the 3 years |
6 | | ending on the June
30 prior to the report. The report shall |
7 | | include suggested legislation
for consideration by the General |
8 | | Assembly. The requirement for reporting to the General Assembly |
9 | | shall be satisfied
by filing copies of the report as required |
10 | | by Section 3.1 of the General Assembly Organization Act, and |
11 | | filing such additional
copies
with the State Government Report |
12 | | Distribution Center for the General
Assembly as is required |
13 | | under paragraph (t) of Section 7 of the State
Library Act.
|
14 | | Rulemaking authority to implement Public Act 95-1045, if |
15 | | any, is conditioned on the rules being adopted in accordance |
16 | | with all provisions of the Illinois Administrative Procedure |
17 | | Act and all rules and procedures of the Joint Committee on |
18 | | Administrative Rules; any purported rule not so adopted, for |
19 | | whatever reason, is unauthorized. |
20 | | On and after July 1, 2012, the Department shall reduce any |
21 | | rate of reimbursement for services or other payments or alter |
22 | | any methodologies authorized by this Code to reduce any rate of |
23 | | reimbursement for services or other payments in accordance with |
24 | | Section 5-5e. |
25 | | Because kidney transplantation can be an appropriate, |
26 | | cost-effective
alternative to renal dialysis when medically |
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1 | | necessary and notwithstanding the provisions of Section 1-11 of |
2 | | this Code, beginning October 1, 2014, the Department shall |
3 | | cover kidney transplantation for noncitizens with end-stage |
4 | | renal disease who are not eligible for comprehensive medical |
5 | | benefits, who meet the residency requirements of Section 5-3 of |
6 | | this Code, and who would otherwise meet the financial |
7 | | requirements of the appropriate class of eligible persons under |
8 | | Section 5-2 of this Code. To qualify for coverage of kidney |
9 | | transplantation, such person must be receiving emergency renal |
10 | | dialysis services covered by the Department. Providers under |
11 | | this Section shall be prior approved and certified by the |
12 | | Department to perform kidney transplantation and the services |
13 | | under this Section shall be limited to services associated with |
14 | | kidney transplantation. |
15 | | Notwithstanding any other provision of this Code to the |
16 | | contrary, on or after July 1, 2015, all FDA approved forms of |
17 | | medication assisted treatment prescribed for the treatment of |
18 | | alcohol dependence or treatment of opioid dependence shall be |
19 | | covered under both fee for service and managed care medical |
20 | | assistance programs for persons who are otherwise eligible for |
21 | | medical assistance under this Article and shall not be subject |
22 | | to any (1) utilization control, other than those established |
23 | | under the American Society of Addiction Medicine patient |
24 | | placement criteria,
(2) prior authorization mandate, or (3) |
25 | | lifetime restriction limit
mandate. |
26 | | On or after July 1, 2015, opioid antagonists prescribed for |
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1 | | the treatment of an opioid overdose, including the medication |
2 | | product, administration devices, and any pharmacy fees related |
3 | | to the dispensing and administration of the opioid antagonist, |
4 | | shall be covered under the medical assistance program for |
5 | | persons who are otherwise eligible for medical assistance under |
6 | | this Article. As used in this Section, "opioid antagonist" |
7 | | means a drug that binds to opioid receptors and blocks or |
8 | | inhibits the effect of opioids acting on those receptors, |
9 | | including, but not limited to, naloxone hydrochloride or any |
10 | | other similarly acting drug approved by the U.S. Food and Drug |
11 | | Administration. |
12 | | Upon federal approval, the Department shall provide |
13 | | coverage and reimbursement for all drugs that are approved for |
14 | | marketing by the federal Food and Drug Administration and that |
15 | | are recommended by the federal Public Health Service or the |
16 | | United States Centers for Disease Control and Prevention for |
17 | | pre-exposure prophylaxis and related pre-exposure prophylaxis |
18 | | services, including, but not limited to, HIV and sexually |
19 | | transmitted infection screening, treatment for sexually |
20 | | transmitted infections, medical monitoring, assorted labs, and |
21 | | counseling to reduce the likelihood of HIV infection among |
22 | | individuals who are not infected with HIV but who are at high |
23 | | risk of HIV infection. |
24 | | A federally qualified health center, as defined in Section |
25 | | 1905(l)(2)(B) of the federal
Social Security Act, shall be |
26 | | reimbursed by the Department in accordance with the federally |
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1 | | qualified health center's encounter rate for services provided |
2 | | to medical assistance recipients that are performed by a dental |
3 | | hygienist, as defined under the Illinois Dental Practice Act, |
4 | | working under the general supervision of a dentist and employed |
5 | | by a federally qualified health center. |
6 | | Notwithstanding any other provision of this Code, the |
7 | | Illinois Department shall authorize licensed dietitian |
8 | | nutritionists and certified diabetes educators to counsel |
9 | | senior diabetes patients in the senior diabetes patients' homes |
10 | | to remove the hurdle of transportation for senior diabetes |
11 | | patients to receive treatment. |
12 | | (Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15; |
13 | | 99-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for |
14 | | the effective date of P.A. 99-407); 99-433, eff. 8-21-15; |
15 | | 99-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff. |
16 | | 7-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201, |
17 | | eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18; |
18 | | 100-538, eff. 1-1-18; 100-587, eff. 6-4-18; 100-759, eff. |
19 | | 1-1-19; 100-863, eff. 8-14-18; 100-974, eff. 8-19-18; |
20 | | 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19; 100-1148, eff. |
21 | | 12-10-18.)
|
22 | | (305 ILCS 5/5-5.01a)
|
23 | | Sec. 5-5.01a. Supportive living facilities program. |
24 | | (a) The
Department shall establish and provide oversight |
25 | | for a program of supportive living facilities that seek to |
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1 | | promote
resident independence, dignity, respect, and |
2 | | well-being in the most
cost-effective manner.
|
3 | | A supportive living facility is (i) a free-standing |
4 | | facility or (ii) a distinct
physical and operational entity |
5 | | within a mixed-use building that meets the criteria established |
6 | | in subsection (d). A supportive
living facility integrates |
7 | | housing with health, personal care, and supportive
services and |
8 | | is a designated setting that offers residents their own
|
9 | | separate, private, and distinct living units.
|
10 | | Sites for the operation of the program
shall be selected by |
11 | | the Department based upon criteria
that may include the need |
12 | | for services in a geographic area, the
availability of funding, |
13 | | and the site's ability to meet the standards.
|
14 | | (b) Beginning July 1, 2014, subject to federal approval, |
15 | | the Medicaid rates for supportive living facilities shall be |
16 | | equal to the supportive living facility Medicaid rate effective |
17 | | on June 30, 2014 increased by 8.85%.
Once the assessment |
18 | | imposed at Article V-G of this Code is determined to be a |
19 | | permissible tax under Title XIX of the Social Security Act, the |
20 | | Department shall increase the Medicaid rates for supportive |
21 | | living facilities effective on July 1, 2014 by 9.09%. The |
22 | | Department shall apply this increase retroactively to coincide |
23 | | with the imposition of the assessment in Article V-G of this |
24 | | Code in accordance with the approval for federal financial |
25 | | participation by the Centers for Medicare and Medicaid |
26 | | Services. |
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1 | | The Medicaid rates for supportive living facilities |
2 | | effective on July 1, 2017 must be equal to the rates in effect |
3 | | for supportive living facilities on June 30, 2017 increased by |
4 | | 2.8%. |
5 | | The Medicaid rates for supportive living facilities |
6 | | effective on July 1, 2018 must be equal to the rates in effect |
7 | | for supportive living facilities on June 30, 2018. |
8 | | (c) The Department may adopt rules to implement this |
9 | | Section. Rules that
establish or modify the services, |
10 | | standards, and conditions for participation
in the program |
11 | | shall be adopted by the Department in consultation
with the |
12 | | Department on Aging, the Department of Rehabilitation |
13 | | Services, and
the Department of Mental Health and Developmental |
14 | | Disabilities (or their
successor agencies).
|
15 | | (d) Subject to federal approval by the Centers for Medicare |
16 | | and Medicaid Services, the Department shall accept for |
17 | | consideration of certification under the program any |
18 | | application for a site or building where distinct parts of the |
19 | | site or building are designated for purposes other than the |
20 | | provision of supportive living services, but only if: |
21 | | (1) those distinct parts of the site or building are |
22 | | not designated for the purpose of providing assisted living |
23 | | services as required under the Assisted Living and Shared |
24 | | Housing Act; |
25 | | (2) those distinct parts of the site or building are |
26 | | completely separate from the part of the building used for |
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1 | | the provision of supportive living program services, |
2 | | including separate entrances; |
3 | | (3) those distinct parts of the site or building do not |
4 | | share any common spaces with the part of the building used |
5 | | for the provision of supportive living program services; |
6 | | and |
7 | | (4) those distinct parts of the site or building do not |
8 | | share staffing with the part of the building used for the |
9 | | provision of supportive living program services. |
10 | | (e) Facilities or distinct parts of facilities which are |
11 | | selected as supportive
living facilities and are in good |
12 | | standing with the Department's rules are
exempt from the |
13 | | provisions of the Nursing Home Care Act and the Illinois Health
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14 | | Facilities Planning Act.
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15 | | Individuals with a score of 29 or higher based on the |
16 | | determination of need (DON) assessment tool shall be eligible |
17 | | to receive institutional and home and community-based long term |
18 | | care services until the State receives federal approval and |
19 | | implements an updated assessment tool, and those individuals |
20 | | are found to be ineligible under that updated assessment tool. |
21 | | Anyone determined to be ineligible for services due to the |
22 | | updated assessment tool shall continue to be eligible for |
23 | | services for at least one year following that determination and |
24 | | must be reassessed no earlier than 11 months after that |
25 | | determination. The Department must adopt rules through the |
26 | | regular rulemaking process regarding the updated assessment |
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1 | | tool, and shall not adopt emergency or peremptory rules |
2 | | regarding the updated assessment tool. The State shall not |
3 | | implement an updated assessment tool that causes more than 1% |
4 | | of then-current recipients to lose eligibility. No individual |
5 | | receiving care in an institutional setting shall be |
6 | | involuntarily discharged as the result of the updated |
7 | | assessment tool until a transition plan has been developed by |
8 | | the Department on Aging or its designee and all care identified |
9 | | in the transition plan is available to the resident immediately |
10 | | upon discharge. |
11 | | (Source: P.A. 100-23, eff. 7-6-17; 100-583, eff. 4-6-18; |
12 | | 100-587, eff. 6-4-18.)
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13 | | Section 99. Effective date. This Act takes effect upon |
14 | | becoming law.
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| 1 | |
INDEX
| 2 | |
Statutes amended in order of appearance
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