HB2814 Engrossed LRB100 07016 KTG 17070 b
1		AN ACT concerning public aid.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Public Aid Code is amended by
5		changing Section 11-5.4 as follows:
6		(305 ILCS 5/11-5.4)
7		Sec. 11-5.4. Expedited long-term care eligibility
8		determination and enrollment.
9		(a) An expedited long-term care eligibility determination
10		and enrollment system shall be established to reduce long-term
11		care determinations to 90 days or fewer by July 1, 2014 and
12		streamline the long-term care enrollment process.
13		Establishment of the system shall be a joint venture of the
14		Department of Human Services and Healthcare and Family Services
15		and the Department on Aging. The Governor shall name a lead
16		agency no later than 30 days after the effective date of this
17		amendatory Act of the 98th General Assembly to assume
18		responsibility for the full implementation of the
19		establishment and maintenance of the system. Project outcomes
20		shall include an enhanced eligibility determination tracking
21		system accessible to providers and a centralized application
22		review and eligibility determination with all applicants
23		reviewed within 90 days of receipt by the State of a complete

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1		application. If the Department of Healthcare and Family
2		Services' Office of the Inspector General determines that there
3		is a likelihood that a non-allowable transfer of assets has
4		occurred, and the facility in which the applicant resides is
5		notified, an extension of up to 90 days shall be permissible.
6		On or before December 31, 2015, a streamlined application and
7		enrollment process shall be put in place based on the following
8		principles:
9		(1) Minimize the burden on applicants by collecting
10		only the data necessary to determine eligibility for
11		medical services, long-term care services, and spousal
12		impoverishment offset.
13		(2) Integrate online data sources to simplify the
14		application process by reducing the amount of information
15		needed to be entered and to expedite eligibility
16		verification.
17		(3) Provide online prompts to alert the applicant that
18		information is missing or not complete.
19		(b) The Department shall, on or before July 1, 2014, assess
20		the feasibility of incorporating all information needed to
21		determine eligibility for long-term care services, including
22		asset transfer and spousal impoverishment financials, into the
23		State's integrated eligibility system identifying all
24		resources needed and reasonable timeframes for achieving the
25		specified integration.
26		(c) The lead agency shall file interim reports with the

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1		Chairs and Minority Spokespersons of the House and Senate Human
2		Services Committees no later than September 1, 2013 and on
3		February 1, 2014. The Department of Healthcare and Family
4		Services shall include in the annual Medicaid report for State
5		Fiscal Year 2014 and every fiscal year thereafter information
6		concerning implementation of the provisions of this Section.
7		(d) No later than August 1, 2014, the Auditor General shall
8		report to the General Assembly concerning the extent to which
9		the timeframes specified in this Section have been met and the
10		extent to which State staffing levels are adequate to meet the
11		requirements of this Section.
12		(e) The Department of Healthcare and Family Services, the
13		Department of Human Services, and the Department on Aging shall
14		take the following steps to achieve federally established
15		timeframes for eligibility determinations for Medicaid and
16		long-term care benefits and shall work toward the federal goal
17		of real time determinations:
18		(1) The Departments shall review, in collaboration
19		with representatives of affected providers, all forms and
20		procedures currently in use, federal guidelines either
21		suggested or mandated, and staff deployment by September
22		30, 2014 to identify additional measures that can improve
23		long-term care eligibility processing and make adjustments
24		where possible.
25		(2) No later than June 30, 2014, the Department of
26		Healthcare and Family Services shall issue vouchers for

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1		advance payments not to exceed $50,000,000 to nursing
2		facilities with significant outstanding Medicaid liability
3		associated with services provided to residents with
4		Medicaid applications pending and residents facing the
5		greatest delays. Each facility with an advance payment
6		shall state in writing whether its own recoupment schedule
7		will be in 3 or 6 equal monthly installments, as long as
8		all advances are recouped by June 30, 2015.
9		(3) The Department of Healthcare and Family Services'
10		Office of Inspector General and the Department of Human
11		Services shall immediately forgo resource review and
12		review of transfers during the relevant look-back period
13		for applications that were submitted prior to September 1,
14		2013. An applicant who applied prior to September 1, 2013,
15		who was denied for failure to cooperate in providing
16		required information, and whose application was
17		incorrectly reviewed under the wrong look-back period
18		rules may request review and correction of the denial based
19		on this subsection. If found eligible upon review, such
20		applicants shall be retroactively enrolled.
21		(4) As soon as practicable, the Department of
22		Healthcare and Family Services shall implement policies
23		and promulgate rules to simplify financial eligibility
24		verification in the following instances: (A) for
25		applicants or recipients who are receiving Supplemental
26		Security Income payments or who had been receiving such

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1		payments at the time they were admitted to a nursing
2		facility and (B) for applicants or recipients with verified
3		income at or below 100% of the federal poverty level when
4		the declared value of their countable resources is no
5		greater than the allowable amounts pursuant to Section 5-2
6		of this Code for classes of eligible persons for whom a
7		resource limit applies. Such simplified verification
8		policies shall apply to community cases as well as
9		long-term care cases.
10		(5) As soon as practicable, but not later than July 1,
11		2014, the Department of Healthcare and Family Services and
12		the Department of Human Services shall jointly begin a
13		special enrollment project by using simplified eligibility
14		verification policies and by redeploying caseworkers
15		trained to handle long-term care cases to prioritize those
16		cases, until the backlog is eliminated and processing time
17		is within 90 days. This project shall apply to applications
18		for long-term care received by the State on or before May
19		15, 2014.
20		(6) As soon as practicable, but not later than
21		September 1, 2014, the Department on Aging shall make
22		available to long-term care facilities and community
23		providers upon request, through an electronic method, the
24		information contained within the Interagency Certification
25		of Screening Results completed by the pre-screener, in a
26		form and manner acceptable to the Department of Human

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1		Services.
2		(7) Effective 30 days after the completion of 3
3		regionally based trainings, nursing facilities shall
4		submit all applications for medical assistance online via
5		the Application for Benefits Eligibility (ABE) website.
6		This requirement shall extend to scanning and uploading
7		with the online application any required additional forms
8		such as the Long Term Care Facility Notification and the
9		Additional Financial Information for Long Term Care
10		Applicants as well as scanned copies of any supporting
11		documentation. Long-term care facility admission documents
12		must be submitted as required in Section 5-5 of this Code.
13		No local Department of Human Services office shall refuse
14		to accept an electronically filed application.
15		(8) Notwithstanding any other provision of this Code,
16		the Department of Human Services and the Department of
17		Healthcare and Family Services' Office of the Inspector
18		General shall, upon request, allow an applicant additional
19		time to submit information and documents needed as part of
20		a review of available resources or resources transferred
21		during the look-back period. The initial extension shall
22		not exceed 30 days. A second extension of 30 days may be
23		granted upon request. Any request for information issued by
24		the State to an applicant shall include the following: an
25		explanation of the information required and the date by
26		which the information must be submitted; a statement that

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1		failure to respond in a timely manner can result in denial
2		of the application; a statement that the applicant or the
3		facility in the name of the applicant may seek an
4		extension; and the name and contact information of a
5		caseworker in case of questions. Any such request for
6		information shall also be sent to the facility. In deciding
7		whether to grant an extension, the Department of Human
8		Services or the Department of Healthcare and Family
9		Services' Office of the Inspector General shall take into
10		account what is in the best interest of the applicant. The
11		time limits for processing an application shall be tolled
12		during the period of any extension granted under this
13		subsection.
14		(9) The Department of Human Services and the Department
15		of Healthcare and Family Services must jointly compile data
16		on pending applications, denials, appeals, and
17		redeterminations into a monthly report, which shall be
18		posted on each Department's website for the purposes of
19		monitoring long-term care eligibility processing. The
20		report must specify the number of applications and
21		redeterminations pending long-term care eligibility
22		determination and admission and the number of appeals of
23		denials in the following categories:
24		(A) Length of time applications, redeterminations,
25		and appeals are pending - 0 to 45 days, 46 days to 90
26		days 0 to 90 days, 91 days to 180 days, 181 days to 12

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1		months, over 12 months to 18 months, over 18 months to
2		24 months, and over 24 months.
3		(B) Percentage of applications and
4		redeterminations pending in the Department of Human
5		Services' Family Community Resource Centers, in the
6		Department of Human Services' long-term care hubs,
7		with the Department of Healthcare and Family Services'
8		Office of Inspector General, and those applications
9		which are being tolled due to requests for extension of
10		time for additional information.
11		(C) Status of pending applications, denials,
12		appeals, and redeterminations.
13		(f) Beginning on July 1, 2017, the Auditor General shall
14		report every 3 years to the General Assembly on the performance
15		and compliance of the Department of Healthcare and Family
16		Services, the Department of Human Services, and the Department
17		on Aging in meeting the requirements of this Section and the
18		federal requirements concerning eligibility determinations for
19		Medicaid long-term care services and supports, and shall report
20		any issues or deficiencies and make recommendations. The
21		Auditor General shall, at a minimum, review, consider, and
22		evaluate the following:
23		(1) compliance with federal regulations on furnishing
24		services as related to Medicaid long-term care services and
25		supports as provided under 42 CFR 435.930;
26		(2) compliance with federal regulations on the timely

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1		determination of eligibility as provided under 42 CFR
2		435.912;
3		(3) the accuracy and completeness of the report
4		required under paragraph (9) of subsection (e);
5		(4) the efficacy and efficiency of the task-based
6		process used for making eligibility determinations in the
7		centralized offices of the Department of Human Services for
8		long-term care services, including the role of the State's
9		integrated eligibility system, as opposed to the
10		traditional caseworker-specific process from which these
11		central offices have converted; and
12		(5) any issues affecting eligibility determinations
13		related to the Department of Human Services' staff
14		completing Medicaid eligibility determinations instead of
15		the designated single-state Medicaid agency in Illinois,
16		the Department of Healthcare and Family Services.
17		The Auditor General's report shall include any and all
18		other areas or issues which are identified through an annual
19		review. Paragraphs (1) through (5) of this subsection shall not
20		be construed to limit the scope of the annual review and the
21		Auditor General's authority to thoroughly and completely
22		evaluate any and all processes, policies, and procedures
23		concerning compliance with federal and State law requirements
24		on eligibility determinations for Medicaid long-term care
25		services and supports.
26		(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;

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1		99-153, eff. 7-28-15.)
2		Section 99. Effective date. This Act takes effect upon
3		becoming law.