Bill Text: IL HB4277 | 2017-2018 | 100th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. In order to protect the right of Medicaid beneficiaries to receive Medicaid long-term care services and supports (LTSS) promptly without any delay caused by administrative procedures, requires the Department of Healthcare and Family Services and other specified Departments to take the following actions: (i) for a Medicaid beneficiary aged 65 years or older who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services no later than the 46th day after the date upon which the beneficiary applied for the services; (ii) for a Medicaid beneficiary aged 64 years or younger whose Medicaid eligibility is based upon a disability and who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services no later than the 91st day after the date upon which the beneficiary applied for the services; (iii) for a Medicaid applicant who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services immediately once the applicant is determined eligible for Medicaid; (iv) by July 1, 2018, the Department of Healthcare and Family Services, in conjunction with the State Comptroller, must develop a process to expedite payment claims for Medicaid services provided during the time any application for Medicaid eligibility or LTSS services is pending beyond federally required timeliness standards; and (v) by July 1, 2018, the Department of Healthcare and Family Services and the Department of Human Services must waive all deadline requirements for applications for Medicaid eligibility or LTSS services if pending beyond federally required timeliness standards. Makes other changes. Effective immediately.

Sponsorship: Slight Partisan Bill (Democrat 8-4)

Status: (Failed) 2019-01-08 - Session Sine Die [HB4277 Detail]

Download: Illinois-2017-HB4277-Introduced.html

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100TH GENERAL ASSEMBLY State of Illinois 2017 and 2018 HB4277 Introduced , by Rep. Norine K. Hammond SYNOPSIS AS INTRODUCED:
305 ILCS 5/11-5.4
Amends the Illinois Public Aid Code. In order to protect the right of Medicaid beneficiaries to receive Medicaid long-term care services and supports (LTSS) promptly without any delay caused by administrative procedures, requires the Department of Healthcare and Family Services and other specified Departments to take the following actions: (i) for a Medicaid beneficiary aged 65 years or older who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services no later than the 46th day after the date upon which the beneficiary applied for the services; (ii) for a Medicaid beneficiary aged 64 years or younger whose Medicaid eligibility is based upon a disability and who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services no later than the 91st day after the date upon which the beneficiary applied for the services; (iii) for a Medicaid applicant who has received a Determination of Need indicating the need for LTSS services, the Departments must begin paying for such services immediately once the applicant is determined eligible for Medicaid; (iv) by July 1, 2018, the Department of Healthcare and Family Services, in conjunction with the State Comptroller, must develop a process to expedite payment claims for Medicaid services provided during the time any application for Medicaid eligibility or LTSS services is pending beyond federally required timeliness standards; and (v) by July 1, 2018, the Department of Healthcare and Family Services and the Department of Human Services must waive all deadline requirements for applications for Medicaid eligibility or LTSS services if pending beyond federally required timeliness standards. Makes other changes. Effective immediately.
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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.
(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 45 days, 46 days to 90
days, 91 days to 180 days, 181 days to 12 months, over

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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
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.
(f) Beginning on July 1, 2017, the Auditor General shall
report every 3 years to the General Assembly on the performance
and compliance of the Department of Healthcare and Family
Services, the Department of Human Services, and the Department
on Aging in meeting the requirements of this Section and the
federal requirements concerning eligibility determinations for
Medicaid long-term care services and supports, and shall report
any issues or deficiencies and make recommendations. The
Auditor General shall, at a minimum, review, consider, and
evaluate the following:
(1) compliance with federal regulations on furnishing
services as related to Medicaid long-term care services and
supports as provided under 42 CFR 435.930;
(2) compliance with federal regulations on the timely

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determination of eligibility as provided under 42 CFR
435.912;
(3) the accuracy and completeness of the report
required under paragraph (9) of subsection (e);
(4) the efficacy and efficiency of the task-based
process used for making eligibility determinations in the
centralized offices of the Department of Human Services for
long-term care services, including the role of the State's
integrated eligibility system, as opposed to the
traditional caseworker-specific process from which these
central offices have converted; and
(5) any issues affecting eligibility determinations
related to the Department of Human Services' staff
completing Medicaid eligibility determinations instead of
the designated single-state Medicaid agency in Illinois,
the Department of Healthcare and Family Services.
The Auditor General's report shall include any and all
other areas or issues which are identified through an annual
review. Paragraphs (1) through (5) of this subsection shall not
be construed to limit the scope of the annual review and the
Auditor General's authority to thoroughly and completely
evaluate any and all processes, policies, and procedures
concerning compliance with federal and State law requirements
on eligibility determinations for Medicaid long-term care
services and supports.
(g) In order to protect the right of Medicaid beneficiaries

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to receive Medicaid services, especially long-term care
services and supports, promptly without any delay caused by the
agency's administrative procedures as mandated under 42 CFR
435.930, on and after July 1, 2018, the Department of
Healthcare and Family Services, the Department of Human
Services, and the Department on Aging must, at a minimum, take
the following actions:
(1) For a beneficiary aged 65 years or older who is
enrolled in Medicaid at the time he or she applies for
Medicaid long-term care services and supports and who has
received a Determination of Need indicating the need for
such services, the Departments must begin paying for
Medicaid long-term care services and supports no later than
the 46th day after the date upon which the beneficiary
applied for such services. Payments for Medicaid long-term
care services and supports must begin even if the review of
the beneficiary's income and assets is incomplete and the
amount of the beneficiary's income and assets to be applied
to the cost of services has not been determined. The
Department of Healthcare and Family Services shall apply
the beneficiary's excess income and assets prospectively
to the cost of care once the final amounts are determined.
Delay in reviewing the available income and assets beyond
the 45th day after the date upon which the beneficiary
applied for Medicaid long-term care services and supports
may not delay the furnishing of such services nor the

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payment for such services by the Department of Healthcare
and Family Services.
(2) For a beneficiary aged 64 years or younger who is
enrolled in Medicaid at the time he or she applies for
Medicaid long-term care services and supports, whose
Medicaid eligibility is based upon a disability, and who
has received a Determination of Need indicating the need
for Medicaid long-term care services and supports, the
Departments must begin paying for Medicaid long-term care
services and supports no later than the 91st day after the
date upon which the beneficiary applied for such services.
Payments for Medicaid long-term care services and supports
must begin even if the review of the beneficiary's income
and assets is incomplete and the amount of the
beneficiary's income and assets to be applied to the cost
of services has not been determined. The Department of
Healthcare and Family Services shall apply the
beneficiary's excess income and assets prospectively to
the cost of care once the final amounts are determined.
Delay in reviewing the available income and assets beyond
the 90th day after the date upon which the beneficiary
applied for Medicaid long-term care services and supports
may not delay the furnishing of such services nor the
payment for such services by the Department of Healthcare
and Family Services. The deadlines specified in this
paragraph are the federally required timeliness standards

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set forth under 42 CFR 435.912.
(3) For an applicant who is not enrolled in Medicaid at
the time he or she applies for Medicaid long-term care
services and supports and who has received a Determination
of Need indicating the need for such services, the
Departments must begin paying for Medicaid long-term care
services and supports immediately once the applicant is
determined eligible for Medicaid services. Payments for
community services and Medicaid long-term care services
and supports must begin even if the review of the
applicant's income and assets is incomplete and the amount
of the applicant's income and assets to be applied to the
cost of services has not been determined. The Department of
Healthcare and Family Services shall apply the applicant's
excess income and assets prospectively to the cost of
services once the final amounts are determined. Delay in
reviewing the available income and assets beyond the 45th
day after the date upon which the applicant applied for
Medicaid enrollment may not delay the furnishing of such
services nor the payment for such services by the
Department of Healthcare and Family Services.
(4) By July 1, 2018, the Department of Healthcare and
Family Services and the Department of Human Services may
not require an applicant for Medicaid or Medicaid long-term
care services and supports to submit a new application for
benefits or services whenever a new entity or person is

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designated or appointed to act as the applicant's legally
authorized representative, representative payee, guardian,
agent named in a power of attorney, or as any other
personal representative who is authorized to make legal or
health care decisions for the applicant.
(5) By July 1, 2018, the Department of Healthcare and
Family Services, in conjunction with the State
Comptroller, must develop a process to expedite payment for
any claims for Medicaid services provided during the time
any application for Medicaid eligibility or Medicaid
long-term care services and supports is pending beyond
federally required timeliness standards set forth under 42
CFR 435.912. The Department must also require managed care
organizations contracted with the Department to follow the
same expedited payment process.
(6) By July 1, 2018, the Department of Healthcare and
Family Services and the Department of Human Services must
develop a common form that permits a Medicaid applicant's
legally authorized representative, representative payee,
agent named in a power of attorney, guardian, or any other
person or entity who is authorized to make legal or health
care decisions for the applicant to make all Medicaid
decisions including the right to file an appeal on the
applicant's behalf under this Article.
(7) By July 1, 2018, the Department of Healthcare and
Family Services and the Department of Human Services must

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waive all deadline requirements for applications for
Medicaid eligibility or Medicaid long-term care services
and supports if pending beyond federally required
timeliness standards set forth under 42 CFR 435.912.
(8) By July 1, 2018, the Department of Healthcare and
Family Services and the Department of Human Services must
develop a process to notify an applicant or their legally
authorized representative of the receipt of their
application and all supporting documentation. The notice
should indicate any documentation required but not
received.
(9) By July 1, 2018, in the case of a denial for
missing information, the Department of Healthcare and
Family Services and the Department of Human Services must
notify an applicant or their legally authorized
representative of any and all documentation or information
that was missing and provide information on when the
information was requested.
(10) The Department of Healthcare and Family Services
and the Department of Human Services may adopt rules as
allowed by the Illinois Administrative Procedure Act to
implement the requirements of this subsection (g);
however, the requirements under this subsection (g) must be
implemented by all Departments even if the proposed rules
are not yet adopted by the implementation date of July 1,
2018.

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As used in this subsection, "Determination of Need" means
the current and any future assessment tool adopted by and used
by the State to assess the amount, intensity, or level of
services needed to properly care for the medical, physical, and
behavioral health needs of any individual requesting Medicaid
long-term care services and supports.
For the purposes of this subsection, the process of
determining the amount of an individual's income and assets to
be applied to the cost of the individual's care refers to the
federal regulations concerning the post-eligibility treatment
of income as provided under 42 CFR 435.733.
(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
Section 99. Effective date. This Act takes effect upon
becoming law.