Bill Text: IL HB3383 | 2017-2018 | 100th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. In provisions requiring the Department of Healthcare and Family Services, the Department of Human Services, and the Department on Aging to take certain steps to achieve federally established timeframes for eligibility determinations for Medicaid and long-term care benefits, provides that notwithstanding any other provision of the Code or the Illinois Administrative Code to the contrary, for the purpose of determining Medicaid reimbursement, the Department of Healthcare and Family Services shall use the most recent income adjustments entered into the Medical Electronic Data Interchange (MEDI) System, the Recipient Eligibility Verification (REV) System, or the Electronic Data Interchange (EDI) System by a facility, which shall be presumed accurate until the Office of the Inspector General determines to the contrary. Provides that a facility shall, within 10 business days of acquiring knowledge of a change in income, enter such information into the MEDI, REV, or EDI system. Requires the facility to retain verification of the income change information it receives. Provides that in the event of an audit finding that the income adjustment entered was not accurate and that the facility benefited from the inaccuracy, a facility must be found to have entered inaccurate information with the intent to defraud in order to be subject to fines or penalties of any kind. Provides that in all instances, the facility shall be permitted the opportunity to challenge such a finding and provide documentation to the contrary.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2019-01-08 - Session Sine Die [HB3383 Detail]

Download: Illinois-2017-HB3383-Introduced.html

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100TH GENERAL ASSEMBLY State of Illinois 2017 and 2018 HB3383 Introduced , by Rep. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
305 ILCS 5/11-5.4
Amends the Illinois Public Aid Code. In provisions requiring the Department of Healthcare and Family Services, the Department of Human Services, and the Department on Aging to take certain steps to achieve federally established timeframes for eligibility determinations for Medicaid and long-term care benefits, provides that notwithstanding any other provision of the Code or the Illinois Administrative Code to the contrary, for the purpose of determining Medicaid reimbursement, the Department of Healthcare and Family Services shall use the most recent income adjustments entered into the Medical Electronic Data Interchange (MEDI) System, the Recipient Eligibility Verification (REV) System, or the Electronic Data Interchange (EDI) System by a facility, which shall be presumed accurate until the Office of the Inspector General determines to the contrary. Provides that a facility shall, within 10 business days of acquiring knowledge of a change in income, enter such information into the MEDI, REV, or EDI system. Requires the facility to retain verification of the income change information it receives. Provides that in the event of an audit finding that the income adjustment entered was not accurate and that the facility benefited from the inaccuracy, a facility must be found to have entered inaccurate information with the intent to defraud in order to be subject to fines or penalties of any kind. Provides that in all instances, the facility shall be permitted the opportunity to challenge such a finding and provide documentation to the contrary.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 11-5.4 as follows:
(305 ILCS 5/11-5.4)
Sec. 11-5.4. Expedited long-term care eligibility
determination and enrollment.
(a) An expedited long-term care eligibility determination
and enrollment system shall be established to reduce long-term
care determinations to 90 days or fewer by July 1, 2014 and
streamline the long-term care enrollment process.
Establishment of the system shall be a joint venture of the
Department of Human Services and Healthcare and Family Services
and the Department on Aging. The Governor shall name a lead
agency no later than 30 days after the effective date of this
amendatory Act of the 98th General Assembly to assume
responsibility for the full implementation of the
establishment and maintenance of the system. Project outcomes
shall include an enhanced eligibility determination tracking
system accessible to providers and a centralized application
review and eligibility determination with all applicants
reviewed within 90 days of receipt by the State of a complete

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

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

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

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

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

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failure to respond in a timely manner can result in denial
of the application; a statement that the applicant or the
facility in the name of the applicant may seek an
extension; and the name and contact information of a
caseworker in case of questions. Any such request for
information shall also be sent to the facility. In deciding
whether to grant an extension, the Department of Human
Services or the Department of Healthcare and Family
Services' Office of the Inspector General shall take into
account what is in the best interest of the applicant. The
time limits for processing an application shall be tolled
during the period of any extension granted under this
subsection.
(8.5) Notwithstanding any other provision of this Code
or the Illinois Administrative Code to the contrary, for
the purpose of determining Medicaid reimbursement, the
Department of Healthcare and Family Services shall use the
most recent income adjustments entered into the Medical
Electronic Data Interchange (MEDI) System, the Recipient
Eligibility Verification (REV) System, or the Electronic
Data Interchange (EDI) System by a facility, which shall be
presumed accurate until the Office of the Inspector General
determines to the contrary. A facility shall, within 10
business days of acquiring knowledge of a change in income,
enter such information into the MEDI, REV, or EDI system.
The facility shall retain verification of the income change

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information it receives. In the event of an audit finding
that the income adjustment entered was not accurate and
that the facility benefited from the inaccuracy, a facility
must be found to have entered inaccurate information with
the intent to defraud in order to be subject to fines or
penalties of any kind. In all instances, the facility shall
be permitted the opportunity to challenge such a finding
and provide documentation to the contrary.
(9) The Department of Human Services and the Department
of Healthcare and Family Services must jointly compile data
on pending applications, denials, appeals, and
redeterminations into a monthly report, which shall be
posted on each Department's website for the purposes of
monitoring long-term care eligibility processing. The
report must specify the number of applications and
redeterminations pending long-term care eligibility
determination and admission and the number of appeals of
denials in the following categories:
(A) Length of time applications, redeterminations,
and appeals are pending - 0 to 90 days, 91 days to 180
days, 181 days to 12 months, over 12 months to 18
months, over 18 months to 24 months, and over 24
months.
(B) Percentage of applications and
redeterminations pending in the Department of Human
Services' Family Community Resource Centers, in the

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Department of Human Services' long-term care hubs,
with the Department of Healthcare and Family Services'
Office of Inspector General, and those applications
which are being tolled due to requests for extension of
time for additional information.
(C) Status of pending applications, denials,
appeals, and redeterminations.
(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;
99-153, eff. 7-28-15.)