Bill Text: IL HB4771 | 2017-2018 | 100th General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Illinois Public Aid Code. Requires the Department of Human Services and the Department of Healthcare and Family Services' Office of the Inspector General to perform the following actions to ensure that applicants submit completed applications for long-term care benefits: (i) provide each applicant with a checklist of information and documents the applicant must submit to complete an application for long-term care benefits; (ii) notify each applicant of the date upon which such information or documents were received by the Department; (iii) update and maintain the Department's computer hardware and software to ensure each applicant receives a timely response to any email sent by the applicant to the Department; and (iv) notify each applicant of the 30-day time period to submit all requested information or documents to the Department.

Spectrum: Slight Partisan Bill (Democrat 44-17)

Status: (Passed) 2018-11-30 - Public Act . . . . . . . . . 100-1141 [HB4771 Detail]

Download: Illinois-2017-HB4771-Enrolled.html

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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) 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
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.)
Section 99. Effective date. This Act takes effect upon
becoming law.