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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.
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(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) The Department shall adopt rules necessary to |
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administer and enforce any provision of this Section. |
Rulemaking shall not delay the full implementation of this |
Section. |
(h) Beginning on June 29, 2018, provisional eligibility, in
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the form of a recipient identification number and any other |
necessary credentials to permit an applicant to receive |
benefits, must be issued to any applicant who has not received |
a final eligibility determination on his or her application for |
Medicaid or Medicaid long-term care benefits or a notice of an |
opportunity for a hearing within the federally prescribed |
deadlines for the processing of such applications. The |
Department must maintain the applicant's provisional Medicaid |
enrollment status until a final eligibility determination is |
approved or the applicant's appeal has been adjudicated and |
eligibility is denied. The Department or the managed care |
organization, if applicable, must reimburse providers for |
services rendered during an applicant's provisional |
eligibility period. |
(1) Claims for services rendered to an applicant with |
provisional eligibility status must be submitted and |
processed in the same manner as those submitted on behalf |
of beneficiaries determined to qualify for benefits. |
(2) An applicant with provisional enrollment status |
must have his or her benefits paid for under the State's |
fee-for-service system until the State makes a final |
determination on the applicant's Medicaid or Medicaid |
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long-term care application. If an individual is enrolled |
with a managed care organization for community benefits at |
the time the individual's provisional status is issued, the |
managed care organization is only responsible for paying |
benefits covered under the capitation payment received by |
the managed care organization for the individual. |
(3) The Department, within 10 business days of issuing |
provisional eligibility to an applicant, must submit to the |
Office of the Comptroller for payment a voucher for all |
retroactive reimbursement due. The Department must clearly |
identify such vouchers as provisional eligibility |
vouchers. |
(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
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Section 99. Effective date. This Act takes effect upon |
becoming law.
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