HB5420 Enrolled LRB096 18878 JDS 34265 b
1		AN ACT concerning State government.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The State Budget Law of the Civil Administrative
5		Code of Illinois is amended by adding Section 50-30 as follows:
6		(15 ILCS 20/50-30 new)
7		Sec. 50-30. Long-term care rebalancing. In light of the
8		increasing demands confronting the State in meeting the needs
9		of individuals utilizing long-term care services under the
10		medical assistance program and any other long-term care related
11		benefit program administered by the State, it is the intent of
12		the General Assembly to address the needs of both the State and
13		the individuals eligible for such services by cost effective
14		and efficient means through the advancement of a long-term care
15		rebalancing initiative. Notwithstanding any State law to the
16		contrary, and subject to federal laws, regulations, and court
17		decrees, the following shall apply to the long-term care
18		rebalancing initiative:
19		(1) "Long-term care rebalancing", as used in this
20		Section, means removing barriers to community living for
21		people of all ages with disabilities and long-term
22		illnesses by offering individuals utilizing long-term care
23		services a reasonable array of options, in particular

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1		adequate choices of community and institutional options,
2		to achieve a balance between the proportion of total
3		Medicaid long-term support expenditures used for
4		institutional services and those used for community-based
5		supports.
6		(2) Subject to the provisions of this Section, the
7		Governor shall create a unified budget report identifying
8		the budgets of all State agencies offering long-term care
9		services to persons in either institutional or community
10		settings, including the budgets of State-operated
11		facilities for persons with developmental disabilities
12		that shall include, but not be limited to, the following
13		service and financial data:
14		(A) A breakdown of long-term care services,
15		defined as institutional or community care, by the
16		State agency primarily responsible for administration
17		of the program.
18		(B) Actual and estimated enrollment, caseload,
19		service hours, or service days provided for long-term
20		care services described in a consistent format for
21		those services, for each of the following age groups:
22		older adults 65 years of age and older, younger adults
23		21 years of age through 64 years of age, and children
24		under 21 years of age.
25		(C) Funding sources for long-term care services.
26		(D) Comparison of service and expenditure data, by

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1		services, both in aggregate and per person enrolled.
2		(3) For each fiscal year, the unified budget report
3		described in subdivision (2) shall be prepared with
4		reference to the prioritized outcomes for that fiscal year
5		contemplated by Sections 50-5 and 50-25 of this Code.
6		(4) Each State agency responsible for the
7		administration of long-term care services shall provide an
8		analysis of the progress being made by the agency to
9		transition persons from institutional to community
10		settings, where appropriate, as part of the State's
11		long-term care rebalancing initiative.
12		(5) The Governor may designate amounts set aside for
13		institutional services appropriated from the General
14		Revenue Fund or any other State fund that receives monies
15		for long-term care services to be transferred to all State
16		agencies responsible for the administration of
17		community-based long-term care programs, including, but
18		not limited to, community-based long-term care programs
19		administered by the Department of Healthcare and Family
20		Services, the Department of Human Services, and the
21		Department on Aging, provided that the Director of
22		Healthcare and Family Services first certifies that the
23		amounts being transferred are necessary for the purpose of
24		assisting persons in or at risk of being in institutional
25		care to transition to community-based settings, including
26		the financial data needed to prove the need for the

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1		transfer of funds. The total amounts transferred shall not
2		exceed 4% in total of the amounts appropriated from the
3		General Revenue Fund or any other State fund that receives
4		monies for long-term care services for each fiscal year. A
5		notice of the fund transfer must be made to the General
6		Assembly and posted at a minimum on the Department of
7		Healthcare and Family Services website, the Governor's
8		Office of Management and Budget website, and any other
9		website the Governor sees fit. These postings shall serve
10		as notice to the General Assembly of the amounts to be
11		transferred. Notice shall be given at least 30 days prior
12		to transfer.
13		(6) This Section shall be liberally construed and
14		interpreted in a manner that allows the State to advance
15		its long-term care rebalancing initiatives.
16		Section 10. The State Finance Act is amended by changing
17		Sections 13.2 and 25 as follows:
18		(30 ILCS 105/13.2) (from Ch. 127, par. 149.2)
19		Sec. 13.2. Transfers among line item appropriations.
20		(a) Transfers among line item appropriations from the same
21		treasury fund for the objects specified in this Section may be
22		made in the manner provided in this Section when the balance
23		remaining in one or more such line item appropriations is
24		insufficient for the purpose for which the appropriation was

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1		made.
2		(a-1) No transfers may be made from one agency to another
3		agency, nor may transfers be made from one institution of
4		higher education to another institution of higher education
5		except as provided by subsection (a-4).
6		(a-2) Except as otherwise provided in this Section,
7		transfers may be made only among the objects of expenditure
8		enumerated in this Section, except that no funds may be
9		transferred from any appropriation for personal services, from
10		any appropriation for State contributions to the State
11		Employees' Retirement System, from any separate appropriation
12		for employee retirement contributions paid by the employer, nor
13		from any appropriation for State contribution for employee
14		group insurance. During State fiscal year 2005, an agency may
15		transfer amounts among its appropriations within the same
16		treasury fund for personal services, employee retirement
17		contributions paid by employer, and State Contributions to
18		retirement systems; notwithstanding and in addition to the
19		transfers authorized in subsection (c) of this Section, the
20		fiscal year 2005 transfers authorized in this sentence may be
21		made in an amount not to exceed 2% of the aggregate amount
22		appropriated to an agency within the same treasury fund. During
23		State fiscal year 2007, the Departments of Children and Family
24		Services, Corrections, Human Services, and Juvenile Justice
25		may transfer amounts among their respective appropriations
26		within the same treasury fund for personal services, employee

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1		retirement contributions paid by employer, and State
2		contributions to retirement systems. During State fiscal year
3		2010, the Department of Transportation may transfer amounts
4		among their respective appropriations within the same treasury
5		fund for personal services, employee retirement contributions
6		paid by employer, and State contributions to retirement
7		systems. During State fiscal year 2010 only, an agency may
8		transfer amounts among its respective appropriations within
9		the same treasury fund for personal services, employee
10		retirement contributions paid by employer, and State
11		contributions to retirement systems. Notwithstanding, and in
12		addition to, the transfers authorized in subsection (c) of this
13		Section, these transfers may be made in an amount not to exceed
14		2% of the aggregate amount appropriated to an agency within the
15		same treasury fund.
16		(a-3) Further, if an agency receives a separate
17		appropriation for employee retirement contributions paid by
18		the employer, any transfer by that agency into an appropriation
19		for personal services must be accompanied by a corresponding
20		transfer into the appropriation for employee retirement
21		contributions paid by the employer, in an amount sufficient to
22		meet the employer share of the employee contributions required
23		to be remitted to the retirement system.
24		(a-4) Long-Term Care Rebalancing. The Governor may
25		designate amounts set aside for institutional services
26		appropriated from the General Revenue Fund or any other State

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1		fund that receives monies for long-term care services to be
2		transferred to all State agencies responsible for the
3		administration of community-based long-term care programs,
4		including, but not limited to, community-based long-term care
5		programs administered by the Department of Healthcare and
6		Family Services, the Department of Human Services, and the
7		Department on Aging, provided that the Director of Healthcare
8		and Family Services first certifies that the amounts being
9		transferred are necessary for the purpose of assisting persons
10		in or at risk of being in institutional care to transition to
11		community-based settings, including the financial data needed
12		to prove the need for the transfer of funds. The total amounts
13		transferred shall not exceed 4% in total of the amounts
14		appropriated from the General Revenue Fund or any other State
15		fund that receives monies for long-term care services for each
16		fiscal year. A notice of the fund transfer must be made to the
17		General Assembly and posted at a minimum on the Department of
18		Healthcare and Family Services website, the Governor's Office
19		of Management and Budget website, and any other website the
20		Governor sees fit. These postings shall serve as notice to the
21		General Assembly of the amounts to be transferred. Notice shall
22		be given at least 30 days prior to transfer.
23		(b) In addition to the general transfer authority provided
24		under subsection (c), the following agencies have the specific
25		transfer authority granted in this subsection:
26		The Department of Healthcare and Family Services is

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1		authorized to make transfers representing savings attributable
2		to not increasing grants due to the births of additional
3		children from line items for payments of cash grants to line
4		items for payments for employment and social services for the
5		purposes outlined in subsection (f) of Section 4-2 of the
6		Illinois Public Aid Code.
7		The Department of Children and Family Services is
8		authorized to make transfers not exceeding 2% of the aggregate
9		amount appropriated to it within the same treasury fund for the
10		following line items among these same line items: Foster Home
11		and Specialized Foster Care and Prevention, Institutions and
12		Group Homes and Prevention, and Purchase of Adoption and
13		Guardianship Services.
14		The Department on Aging is authorized to make transfers not
15		exceeding 2% of the aggregate amount appropriated to it within
16		the same treasury fund for the following Community Care Program
17		line items among these same line items: Homemaker and Senior
18		Companion Services, Alternative Senior Services, Case
19		Coordination Units, and Adult Day Care Services.
20		The State Treasurer is authorized to make transfers among
21		line item appropriations from the Capital Litigation Trust
22		Fund, with respect to costs incurred in fiscal years 2002 and
23		2003 only, when the balance remaining in one or more such line
24		item appropriations is insufficient for the purpose for which
25		the appropriation was made, provided that no such transfer may
26		be made unless the amount transferred is no longer required for

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1		the purpose for which that appropriation was made.
2		The State Board of Education is authorized to make
3		transfers from line item appropriations within the same
4		treasury fund for General State Aid and General State Aid -
5		Hold Harmless, provided that no such transfer may be made
6		unless the amount transferred is no longer required for the
7		purpose for which that appropriation was made, to the line item
8		appropriation for Transitional Assistance when the balance
9		remaining in such line item appropriation is insufficient for
10		the purpose for which the appropriation was made.
11		The State Board of Education is authorized to make
12		transfers between the following line item appropriations
13		within the same treasury fund: Disabled Student
14		Services/Materials (Section 14-13.01 of the School Code),
15		Disabled Student Transportation Reimbursement (Section
16		14-13.01 of the School Code), Disabled Student Tuition -
17		Private Tuition (Section 14-7.02 of the School Code),
18		Extraordinary Special Education (Section 14-7.02b of the
19		School Code), Reimbursement for Free Lunch/Breakfast Program,
20		Summer School Payments (Section 18-4.3 of the School Code), and
21		Transportation - Regular/Vocational Reimbursement (Section
22		29-5 of the School Code). Such transfers shall be made only
23		when the balance remaining in one or more such line item
24		appropriations is insufficient for the purpose for which the
25		appropriation was made and provided that no such transfer may
26		be made unless the amount transferred is no longer required for

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1		the purpose for which that appropriation was made.
2		During State fiscal years 2010 and 2011 only, the
3		Department of Healthcare and Family Services is authorized to
4		make transfers not exceeding 4% of the aggregate amount
5		appropriated to it, within the same treasury fund, among the
6		various line items appropriated for Medical Assistance.
7		(c) The sum of such transfers for an agency in a fiscal
8		year shall not exceed 2% of the aggregate amount appropriated
9		to it within the same treasury fund for the following objects:
10		Personal Services; Extra Help; Student and Inmate
11		Compensation; State Contributions to Retirement Systems; State
12		Contributions to Social Security; State Contribution for
13		Employee Group Insurance; Contractual Services; Travel;
14		Commodities; Printing; Equipment; Electronic Data Processing;
15		Operation of Automotive Equipment; Telecommunications
16		Services; Travel and Allowance for Committed, Paroled and
17		Discharged Prisoners; Library Books; Federal Matching Grants
18		for Student Loans; Refunds; Workers' Compensation,
19		Occupational Disease, and Tort Claims; and, in appropriations
20		to institutions of higher education, Awards and Grants.
21		Notwithstanding the above, any amounts appropriated for
22		payment of workers' compensation claims to an agency to which
23		the authority to evaluate, administer and pay such claims has
24		been delegated by the Department of Central Management Services
25		may be transferred to any other expenditure object where such
26		amounts exceed the amount necessary for the payment of such

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1		claims.
2		(c-1) Special provisions for State fiscal year 2003.
3		Notwithstanding any other provision of this Section to the
4		contrary, for State fiscal year 2003 only, transfers among line
5		item appropriations to an agency from the same treasury fund
6		may be made provided that the sum of such transfers for an
7		agency in State fiscal year 2003 shall not exceed 3% of the
8		aggregate amount appropriated to that State agency for State
9		fiscal year 2003 for the following objects: personal services,
10		except that no transfer may be approved which reduces the
11		aggregate appropriations for personal services within an
12		agency; extra help; student and inmate compensation; State
13		contributions to retirement systems; State contributions to
14		social security; State contributions for employee group
15		insurance; contractual services; travel; commodities;
16		printing; equipment; electronic data processing; operation of
17		automotive equipment; telecommunications services; travel and
18		allowance for committed, paroled, and discharged prisoners;
19		library books; federal matching grants for student loans;
20		refunds; workers' compensation, occupational disease, and tort
21		claims; and, in appropriations to institutions of higher
22		education, awards and grants.
23		(c-2) Special provisions for State fiscal year 2005.
24		Notwithstanding subsections (a), (a-2), and (c), for State
25		fiscal year 2005 only, transfers may be made among any line
26		item appropriations from the same or any other treasury fund

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1		for any objects or purposes, without limitation, when the
2		balance remaining in one or more such line item appropriations
3		is insufficient for the purpose for which the appropriation was
4		made, provided that the sum of those transfers by a State
5		agency shall not exceed 4% of the aggregate amount appropriated
6		to that State agency for fiscal year 2005.
7		(d) Transfers among appropriations made to agencies of the
8		Legislative and Judicial departments and to the
9		constitutionally elected officers in the Executive branch
10		require the approval of the officer authorized in Section 10 of
11		this Act to approve and certify vouchers. Transfers among
12		appropriations made to the University of Illinois, Southern
13		Illinois University, Chicago State University, Eastern
14		Illinois University, Governors State University, Illinois
15		State University, Northeastern Illinois University, Northern
16		Illinois University, Western Illinois University, the Illinois
17		Mathematics and Science Academy and the Board of Higher
18		Education require the approval of the Board of Higher Education
19		and the Governor. Transfers among appropriations to all other
20		agencies require the approval of the Governor.
21		The officer responsible for approval shall certify that the
22		transfer is necessary to carry out the programs and purposes
23		for which the appropriations were made by the General Assembly
24		and shall transmit to the State Comptroller a certified copy of
25		the approval which shall set forth the specific amounts
26		transferred so that the Comptroller may change his records

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1		accordingly. The Comptroller shall furnish the Governor with
2		information copies of all transfers approved for agencies of
3		the Legislative and Judicial departments and transfers
4		approved by the constitutionally elected officials of the
5		Executive branch other than the Governor, showing the amounts
6		transferred and indicating the dates such changes were entered
7		on the Comptroller's records.
8		(e) The State Board of Education, in consultation with the
9		State Comptroller, may transfer line item appropriations for
10		General State Aid between the Common School Fund and the
11		Education Assistance Fund. With the advice and consent of the
12		Governor's Office of Management and Budget, the State Board of
13		Education, in consultation with the State Comptroller, may
14		transfer line item appropriations between the General Revenue
15		Fund and the Education Assistance Fund for the following
16		programs:
17		(1) Disabled Student Personnel Reimbursement (Section
18		14-13.01 of the School Code);
19		(2) Disabled Student Transportation Reimbursement
20		(subsection (b) of Section 14-13.01 of the School Code);
21		(3) Disabled Student Tuition - Private Tuition
22		(Section 14-7.02 of the School Code);
23		(4) Extraordinary Special Education (Section 14-7.02b
24		of the School Code);
25		(5) Reimbursement for Free Lunch/Breakfast Programs;
26		(6) Summer School Payments (Section 18-4.3 of the

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1		School Code);
2		(7) Transportation - Regular/Vocational Reimbursement
3		(Section 29-5 of the School Code);
4		(8) Regular Education Reimbursement (Section 18-3 of
5		the School Code); and
6		(9) Special Education Reimbursement (Section 14-7.03
7		of the School Code).
8		(Source: P.A. 95-707, eff. 1-11-08; 96-37, eff. 7-13-09;
9		96-820, eff. 11-18-09; 96-959, eff. 7-1-10; 96-1086, eff.
10		7-16-10.)
11		(30 ILCS 105/25) (from Ch. 127, par. 161)
12		Sec. 25. Fiscal year limitations.
13		(a) All appropriations shall be available for expenditure
14		for the fiscal year or for a lesser period if the Act making
15		that appropriation so specifies. A deficiency or emergency
16		appropriation shall be available for expenditure only through
17		June 30 of the year when the Act making that appropriation is
18		enacted unless that Act otherwise provides.
19		(b) Outstanding liabilities as of June 30, payable from
20		appropriations which have otherwise expired, may be paid out of
21		the expiring appropriations during the 2-month period ending at
22		the close of business on August 31. Any service involving
23		professional or artistic skills or any personal services by an
24		employee whose compensation is subject to income tax
25		withholding must be performed as of June 30 of the fiscal year

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1		in order to be considered an "outstanding liability as of June
2		30" that is thereby eligible for payment out of the expiring
3		appropriation.
4		(b-1) However, payment of tuition reimbursement claims
5		under Section 14-7.03 or 18-3 of the School Code may be made by
6		the State Board of Education from its appropriations for those
7		respective purposes for any fiscal year, even though the claims
8		reimbursed by the payment may be claims attributable to a prior
9		fiscal year, and payments may be made at the direction of the
10		State Superintendent of Education from the fund from which the
11		appropriation is made without regard to any fiscal year
12		limitations, except as required by subsection (j) of this
13		Section. Beginning on June 30, 2021, payment of tuition
14		reimbursement claims under Section 14-7.03 or 18-3 of the
15		School Code as of June 30, payable from appropriations that
16		have otherwise expired, may be paid out of the expiring
17		appropriation during the 4-month period ending at the close of
18		business on October 31.
19		(b-2) All outstanding liabilities as of June 30, 2010,
20		payable from appropriations that would otherwise expire at the
21		conclusion of the lapse period for fiscal year 2010, and
22		interest penalties payable on those liabilities under the State
23		Prompt Payment Act, may be paid out of the expiring
24		appropriations until December 31, 2010, without regard to the
25		fiscal year in which the payment is made, as long as vouchers
26		for the liabilities are received by the Comptroller no later

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1		than August 31, 2010.
2		(b-3) Medical payments may be made by the Department of
3		Veterans' Affairs from its appropriations for those purposes
4		for any fiscal year, without regard to the fact that the
5		medical services being compensated for by such payment may have
6		been rendered in a prior fiscal year, except as required by
7		subsection (j) of this Section. Beginning on June 30, 2021,
8		medical payments payable from appropriations that have
9		otherwise expired may be paid out of the expiring appropriation
10		during the 4-month period ending at the close of business on
11		October 31.
12		(b-4) Medical payments may be made by the Department of
13		Healthcare and Family Services and medical payments and child
14		care payments may be made by the Department of Human Services
15		(as successor to the Department of Public Aid) from
16		appropriations for those purposes for any fiscal year, without
17		regard to the fact that the medical or child care services
18		being compensated for by such payment may have been rendered in
19		a prior fiscal year; and payments may be made at the direction
20		of the Department of Healthcare and Family Services Central
21		Management Services from the Health Insurance Reserve Fund and
22		the Local Government Health Insurance Reserve Fund without
23		regard to any fiscal year limitations, except as required by
24		subsection (j) of this Section. Beginning on June 30, 2021,
25		medical payments made by the Department of Healthcare and
26		Family Services, child care payments made by the Department of

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1		Human Services, and payments made at the discretion of the
2		Department of Healthcare and Family Services from the Health
3		Insurance Reserve Fund and the Local Government Health
4		Insurance Reserve Fund payable from appropriations that have
5		otherwise expired may be paid out of the expiring appropriation
6		during the 4-month period ending at the close of business on
7		October 31.
8		(b-5) Medical payments may be made by the Department of
9		Human Services from its appropriations relating to substance
10		abuse treatment services for any fiscal year, without regard to
11		the fact that the medical services being compensated for by
12		such payment may have been rendered in a prior fiscal year,
13		provided the payments are made on a fee-for-service basis
14		consistent with requirements established for Medicaid
15		reimbursement by the Department of Healthcare and Family
16		Services, except as required by subsection (j) of this Section.
17		Beginning on June 30, 2021, medical payments made by the
18		Department of Human Services relating to substance abuse
19		treatment services payable from appropriations that have
20		otherwise expired may be paid out of the expiring appropriation
21		during the 4-month period ending at the close of business on
22		October 31.
23		(b-6) Additionally, payments may be made by the Department
24		of Human Services from its appropriations, or any other State
25		agency from its appropriations with the approval of the
26		Department of Human Services, from the Immigration Reform and

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1		Control Fund for purposes authorized pursuant to the
2		Immigration Reform and Control Act of 1986, without regard to
3		any fiscal year limitations, except as required by subsection
4		(j) of this Section. Beginning on June 30, 2021, payments made
5		by the Department of Human Services from the Immigration Reform
6		and Control Fund for purposes authorized pursuant to the
7		Immigration Reform and Control Act of 1986 payable from
8		appropriations that have otherwise expired may be paid out of
9		the expiring appropriation during the 4-month period ending at
10		the close of business on October 31.
11		Further, with respect to costs incurred in fiscal years
12		2002 and 2003 only, payments may be made by the State Treasurer
13		from its appropriations from the Capital Litigation Trust Fund
14		without regard to any fiscal year limitations.
15		Lease payments may be made by the Department of Central
16		Management Services under the sale and leaseback provisions of
17		Section 7.4 of the State Property Control Act with respect to
18		the James R. Thompson Center and the Elgin Mental Health Center
19		and surrounding land from appropriations for that purpose
20		without regard to any fiscal year limitations.
21		Lease payments may be made under the sale and leaseback
22		provisions of Section 7.5 of the State Property Control Act
23		with respect to the Illinois State Toll Highway Authority
24		headquarters building and surrounding land without regard to
25		any fiscal year limitations.
26		(b-7) Payments may be made in accordance with a plan

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1		authorized by paragraph (11) or (12) of Section 405-105 of the
2		Department of Central Management Services Law from
3		appropriations for those payments without regard to fiscal year
4		limitations.
5		(c) Further, payments may be made by the Department of
6		Public Health, and the Department of Human Services (acting as
7		successor to the Department of Public Health under the
8		Department of Human Services Act), and the Department of
9		Healthcare and Family Services from their respective
10		appropriations for grants for medical care to or on behalf of
11		persons suffering from chronic renal disease, persons
12		suffering from hemophilia, rape victims, and premature and
13		high-mortality risk infants and their mothers and for grants
14		for supplemental food supplies provided under the United States
15		Department of Agriculture Women, Infants and Children
16		Nutrition Program, for any fiscal year without regard to the
17		fact that the services being compensated for by such payment
18		may have been rendered in a prior fiscal year, except as
19		required by subsection (j) of this Section. Beginning on June
20		30, 2021, payments made by the Department of Public Health, the
21		Department of Human Services, and the Department of Healthcare
22		and Family Services from their respective appropriations for
23		grants for medical care to or on behalf of persons suffering
24		from chronic renal disease, persons suffering from hemophilia,
25		rape victims, and premature and high-mortality risk infants and
26		their mothers and for grants for supplemental food supplies

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1		provided under the United States Department of Agriculture
2		Women, Infants and Children Nutrition Program payable from
3		appropriations that have otherwise expired may be paid out of
4		the expiring appropriations during the 4-month period ending at
5		the close of business on October 31.
6		(d) The Department of Public Health and the Department of
7		Human Services (acting as successor to the Department of Public
8		Health under the Department of Human Services Act) shall each
9		annually submit to the State Comptroller, Senate President,
10		Senate Minority Leader, Speaker of the House, House Minority
11		Leader, and the respective Chairmen and Minority Spokesmen of
12		the Appropriations Committees of the Senate and the House, on
13		or before December 31, a report of fiscal year funds used to
14		pay for services provided in any prior fiscal year. This report
15		shall document by program or service category those
16		expenditures from the most recently completed fiscal year used
17		to pay for services provided in prior fiscal years.
18		(e) The Department of Healthcare and Family Services, the
19		Department of Human Services (acting as successor to the
20		Department of Public Aid), and the Department of Human Services
21		making fee-for-service payments relating to substance abuse
22		treatment services provided during a previous fiscal year shall
23		each annually submit to the State Comptroller, Senate
24		President, Senate Minority Leader, Speaker of the House, House
25		Minority Leader, the respective Chairmen and Minority
26		Spokesmen of the Appropriations Committees of the Senate and

HB5420 Enrolled - 21 - LRB096 18878 JDS 34265 b
1		the House, on or before November 30, a report that shall
2		document by program or service category those expenditures from
3		the most recently completed fiscal year used to pay for (i)
4		services provided in prior fiscal years and (ii) services for
5		which claims were received in prior fiscal years.
6		(f) The Department of Human Services (as successor to the
7		Department of Public Aid) shall annually submit to the State
8		Comptroller, Senate President, Senate Minority Leader, Speaker
9		of the House, House Minority Leader, and the respective
10		Chairmen and Minority Spokesmen of the Appropriations
11		Committees of the Senate and the House, on or before December
12		31, a report of fiscal year funds used to pay for services
13		(other than medical care) provided in any prior fiscal year.
14		This report shall document by program or service category those
15		expenditures from the most recently completed fiscal year used
16		to pay for services provided in prior fiscal years.
17		(g) In addition, each annual report required to be
18		submitted by the Department of Healthcare and Family Services
19		under subsection (e) shall include the following information
20		with respect to the State's Medicaid program:
21		(1) Explanations of the exact causes of the variance
22		between the previous year's estimated and actual
23		liabilities.
24		(2) Factors affecting the Department of Healthcare and
25		Family Services' liabilities, including but not limited to
26		numbers of aid recipients, levels of medical service

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1		utilization by aid recipients, and inflation in the cost of
2		medical services.
3		(3) The results of the Department's efforts to combat
4		fraud and abuse.
5		(h) As provided in Section 4 of the General Assembly
6		Compensation Act, any utility bill for service provided to a
7		General Assembly member's district office for a period
8		including portions of 2 consecutive fiscal years may be paid
9		from funds appropriated for such expenditure in either fiscal
10		year.
11		(i) An agency which administers a fund classified by the
12		Comptroller as an internal service fund may issue rules for:
13		(1) billing user agencies in advance for payments or
14		authorized inter-fund transfers based on estimated charges
15		for goods or services;
16		(2) issuing credits, refunding through inter-fund
17		transfers, or reducing future inter-fund transfers during
18		the subsequent fiscal year for all user agency payments or
19		authorized inter-fund transfers received during the prior
20		fiscal year which were in excess of the final amounts owed
21		by the user agency for that period; and
22		(3) issuing catch-up billings to user agencies during
23		the subsequent fiscal year for amounts remaining due when
24		payments or authorized inter-fund transfers received from
25		the user agency during the prior fiscal year were less than
26		the total amount owed for that period.

HB5420 Enrolled - 23 - LRB096 18878 JDS 34265 b
1		User agencies are authorized to reimburse internal service
2		funds for catch-up billings by vouchers drawn against their
3		respective appropriations for the fiscal year in which the
4		catch-up billing was issued or by increasing an authorized
5		inter-fund transfer during the current fiscal year. For the
6		purposes of this Act, "inter-fund transfers" means transfers
7		without the use of the voucher-warrant process, as authorized
8		by Section 9.01 of the State Comptroller Act.
9		(i-1) Beginning on July 1, 2021, all outstanding
10		liabilities, not payable during the 4-month lapse period as
11		described in subsections (b-1), (b-3), (b-4), (b-5), (b-6), and
12		(c) of this Section, that are made from appropriations for that
13		purpose for any fiscal year, without regard to the fact that
14		the services being compensated for by those payments may have
15		been rendered in a prior fiscal year, are limited to only those
16		claims that have been incurred but for which a proper bill or
17		invoice as defined by the State Prompt Payment Act has not been
18		received by September 30th following the end of the fiscal year
19		in which the service was rendered.
20		(j) Notwithstanding any other provision of this Act, the
21		aggregate amount of payments to be made without regard for
22		fiscal year limitations as contained in subsections (b-1),
23		(b-3), (b-4), (b-5), (b-6), and (c) of this Section, and
24		determined by using Generally Accepted Accounting Principles,
25		shall not exceed the following amounts:
26		(1) $6,000,000,000 for outstanding liabilities related

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1		to fiscal year 2012;
2		(2) $5,300,000,000 for outstanding liabilities related
3		to fiscal year 2013;
4		(3) $4,600,000,000 for outstanding liabilities related
5		to fiscal year 2014;
6		(4) $4,000,000,000 for outstanding liabilities related
7		to fiscal year 2015;
8		(5) $3,300,000,000 for outstanding liabilities related
9		to fiscal year 2016;
10		(6) $2,600,000,000 for outstanding liabilities related
11		to fiscal year 2017;
12		(7) $2,000,000,000 for outstanding liabilities related
13		to fiscal year 2018;
14		(8) $1,300,000,000 for outstanding liabilities related
15		to fiscal year 2019;
16		(9) $600,000,000 for outstanding liabilities related
17		to fiscal year 2020; and
18		(10) $0 for outstanding liabilities related to fiscal
19		year 2021 and fiscal years thereafter.
20		(Source: P.A. 95-331, eff. 8-21-07; 96-928, eff. 6-15-10;
21		96-958, eff. 7-1-10; revised 7-22-10.)
22		Section 15. The State Prompt Payment Act is amended by
23		changing Section 3-2 as follows:
24		(30 ILCS 540/3-2)

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1		Sec. 3-2. Beginning July 1, 1993, in any instance where a
2		State official or agency is late in payment of a vendor's bill
3		or invoice for goods or services furnished to the State, as
4		defined in Section 1, properly approved in accordance with
5		rules promulgated under Section 3-3, the State official or
6		agency shall pay interest to the vendor in accordance with the
7		following:
8		(1) Any bill, except a bill submitted under Article V
9		of the Illinois Public Aid Code, approved for payment under
10		this Section must be paid or the payment issued to the
11		payee within 60 days of receipt of a proper bill or
12		invoice. If payment is not issued to the payee within this
13		60 day period, an interest penalty of 1.0% of any amount
14		approved and unpaid shall be added for each month or
15		fraction thereof after the end of this 60 day period, until
16		final payment is made. Any bill, except a bill for pharmacy
17		services or goods, submitted under Article V of the
18		Illinois Public Aid Code approved for payment under this
19		Section must be paid or the payment issued to the payee
20		within 60 days after receipt of a proper bill or invoice,
21		and, if payment is not issued to the payee within this
22		60-day period, an interest penalty of 2.0% of any amount
23		approved and unpaid shall be added for each month or
24		fraction thereof after the end of this 60-day period, until
25		final payment is made. Any bill for pharmacy services or
26		goods submitted under Article V of the Illinois Public Aid

HB5420 Enrolled - 26 - LRB096 18878 JDS 34265 b
1		Code, approved for payment under this Section must be paid
2		or the payment issued to the payee within 60 days of
3		receipt of a proper bill or invoice. If payment is not
4		issued to the payee within this 60 day period, an interest
5		penalty of 1.0% of any amount approved and unpaid shall be
6		added for each month or fraction thereof after the end of
7		this 60 day period, until final payment is made.
8		(1.1) A State agency shall review in a timely manner
9		each bill or invoice after its receipt. If the State agency
10		determines that the bill or invoice contains a defect
11		making it unable to process the payment request, the agency
12		shall notify the vendor requesting payment as soon as
13		possible after discovering the defect pursuant to rules
14		promulgated under Section 3-3; provided, however, that the
15		notice for construction related bills or invoices must be
16		given not later than 30 days after the bill or invoice was
17		first submitted. The notice shall identify the defect and
18		any additional information necessary to correct the
19		defect. If one or more items on a construction related bill
20		or invoice are disapproved, but not the entire bill or
21		invoice, then the portion that is not disapproved shall be
22		paid.
23		(2) Where a State official or agency is late in payment
24		of a vendor's bill or invoice properly approved in
25		accordance with this Act, and different late payment terms
26		are not reduced to writing as a contractual agreement, the

HB5420 Enrolled - 27 - LRB096 18878 JDS 34265 b
1		State official or agency shall automatically pay interest
2		penalties required by this Section amounting to $50 or more
3		to the appropriate vendor. Each agency shall be responsible
4		for determining whether an interest penalty is owed and for
5		paying the interest to the vendor. Interest due to a vendor
6		that amounts to less than $50 shall not be paid but shall
7		be accrued until all interest due the vendor for all
8		similar warrants exceeds $50, at which time the accrued
9		interest shall be payable and interest will begin accruing
10		again, except that interest accrued as of the end of the
11		fiscal year that does not exceed $50 shall be payable at
12		that time. In the event an individual has paid a vendor for
13		services in advance, the provisions of this Section shall
14		apply until payment is made to that individual.
15		(3) The provisions of this amendatory Act of the 96th
16		General Assembly reducing the interest rate on pharmacy
17		claims under Article V of the Illinois Public Aid Code to
18		1.0% per month shall apply to any pharmacy bills for
19		services and goods under Article V of the Illinois Public
20		Aid Code received on or after the date 60 days before the
21		effective date of this amendatory Act of the 96th General
22		Assembly.
23		(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10;
24		96-959, eff. 7-1-10; 96-1000, eff. 7-2-10.)
25		Section 20. The Illinois Income Tax Act is amended by

HB5420 Enrolled - 28 - LRB096 18878 JDS 34265 b
1		changing Section 917 as follows:
2		(35 ILCS 5/917) (from Ch. 120, par. 9-917)
3		Sec. 917. Confidentiality and information sharing.
4		(a) Confidentiality. Except as provided in this Section,
5		all information received by the Department from returns filed
6		under this Act, or from any investigation conducted under the
7		provisions of this Act, shall be confidential, except for
8		official purposes within the Department or pursuant to official
9		procedures for collection of any State tax or pursuant to an
10		investigation or audit by the Illinois State Scholarship
11		Commission of a delinquent student loan or monetary award or
12		enforcement of any civil or criminal penalty or sanction
13		imposed by this Act or by another statute imposing a State tax,
14		and any person who divulges any such information in any manner,
15		except for such purposes and pursuant to order of the Director
16		or in accordance with a proper judicial order, shall be guilty
17		of a Class A misdemeanor. However, the provisions of this
18		paragraph are not applicable to information furnished to (i)
19		the Department of Healthcare and Family Services (formerly
20		Department of Public Aid), State's Attorneys, and the Attorney
21		General for child support enforcement purposes and (ii) a
22		licensed attorney representing the taxpayer where an appeal or
23		a protest has been filed on behalf of the taxpayer. If it is
24		necessary to file information obtained pursuant to this Act in
25		a child support enforcement proceeding, the information shall

HB5420 Enrolled - 29 - LRB096 18878 JDS 34265 b
1		be filed under seal.
2		(b) Public information. Nothing contained in this Act shall
3		prevent the Director from publishing or making available to the
4		public the names and addresses of persons filing returns under
5		this Act, or from publishing or making available reasonable
6		statistics concerning the operation of the tax wherein the
7		contents of returns are grouped into aggregates in such a way
8		that the information contained in any individual return shall
9		not be disclosed.
10		(c) Governmental agencies. The Director may make available
11		to the Secretary of the Treasury of the United States or his
12		delegate, or the proper officer or his delegate of any other
13		state imposing a tax upon or measured by income, for
14		exclusively official purposes, information received by the
15		Department in the administration of this Act, but such
16		permission shall be granted only if the United States or such
17		other state, as the case may be, grants the Department
18		substantially similar privileges. The Director may exchange
19		information with the Department of Healthcare and Family
20		Services and the Department of Human Services (acting as
21		successor to the Department of Public Aid under the Department
22		of Human Services Act) for the purpose of verifying sources and
23		amounts of income and for other purposes directly connected
24		with the administration of this Act, the Illinois Public Aid
25		Code, and any other health benefit program administered by the
26		State and the Illinois Public Aid Code. The Director may

HB5420 Enrolled - 30 - LRB096 18878 JDS 34265 b
1		exchange information with the Director of the Department of
2		Employment Security for the purpose of verifying sources and
3		amounts of income and for other purposes directly connected
4		with the administration of this Act and Acts administered by
5		the Department of Employment Security. The Director may make
6		available to the Illinois Workers' Compensation Commission
7		information regarding employers for the purpose of verifying
8		the insurance coverage required under the Workers'
9		Compensation Act and Workers' Occupational Diseases Act. The
10		Director may exchange information with the Illinois Department
11		on Aging for the purpose of verifying sources and amounts of
12		income for purposes directly related to confirming eligibility
13		for participation in the programs of benefits authorized by the
14		Senior Citizens and Disabled Persons Property Tax Relief and
15		Pharmaceutical Assistance Act.
16		The Director may make available to any State agency,
17		including the Illinois Supreme Court, which licenses persons to
18		engage in any occupation, information that a person licensed by
19		such agency has failed to file returns under this Act or pay
20		the tax, penalty and interest shown therein, or has failed to
21		pay any final assessment of tax, penalty or interest due under
22		this Act. The Director may make available to any State agency,
23		including the Illinois Supreme Court, information regarding
24		whether a bidder, contractor, or an affiliate of a bidder or
25		contractor has failed to file returns under this Act or pay the
26		tax, penalty, and interest shown therein, or has failed to pay

HB5420 Enrolled - 31 - LRB096 18878 JDS 34265 b
1		any final assessment of tax, penalty, or interest due under
2		this Act, for the limited purpose of enforcing bidder and
3		contractor certifications. For purposes of this Section, the
4		term "affiliate" means any entity that (1) directly,
5		indirectly, or constructively controls another entity, (2) is
6		directly, indirectly, or constructively controlled by another
7		entity, or (3) is subject to the control of a common entity.
8		For purposes of this subsection (a), an entity controls another
9		entity if it owns, directly or individually, more than 10% of
10		the voting securities of that entity. As used in this
11		subsection (a), the term "voting security" means a security
12		that (1) confers upon the holder the right to vote for the
13		election of members of the board of directors or similar
14		governing body of the business or (2) is convertible into, or
15		entitles the holder to receive upon its exercise, a security
16		that confers such a right to vote. A general partnership
17		interest is a voting security.
18		The Director may make available to any State agency,
19		including the Illinois Supreme Court, units of local
20		government, and school districts, information regarding
21		whether a bidder or contractor is an affiliate of a person who
22		is not collecting and remitting Illinois Use taxes, for the
23		limited purpose of enforcing bidder and contractor
24		certifications.
25		The Director may also make available to the Secretary of
26		State information that a corporation which has been issued a

HB5420 Enrolled - 32 - LRB096 18878 JDS 34265 b
1		certificate of incorporation by the Secretary of State has
2		failed to file returns under this Act or pay the tax, penalty
3		and interest shown therein, or has failed to pay any final
4		assessment of tax, penalty or interest due under this Act. An
5		assessment is final when all proceedings in court for review of
6		such assessment have terminated or the time for the taking
7		thereof has expired without such proceedings being instituted.
8		For taxable years ending on or after December 31, 1987, the
9		Director may make available to the Director or principal
10		officer of any Department of the State of Illinois, information
11		that a person employed by such Department has failed to file
12		returns under this Act or pay the tax, penalty and interest
13		shown therein. For purposes of this paragraph, the word
14		"Department" shall have the same meaning as provided in Section
15		3 of the State Employees Group Insurance Act of 1971.
16		(d) The Director shall make available for public inspection
17		in the Department's principal office and for publication, at
18		cost, administrative decisions issued on or after January 1,
19		1995. These decisions are to be made available in a manner so
20		that the following taxpayer information is not disclosed:
21		(1) The names, addresses, and identification numbers
22		of the taxpayer, related entities, and employees.
23		(2) At the sole discretion of the Director, trade
24		secrets or other confidential information identified as
25		such by the taxpayer, no later than 30 days after receipt
26		of an administrative decision, by such means as the

HB5420 Enrolled - 33 - LRB096 18878 JDS 34265 b
1		Department shall provide by rule.
2		The Director shall determine the appropriate extent of the
3		deletions allowed in paragraph (2). In the event the taxpayer
4		does not submit deletions, the Director shall make only the
5		deletions specified in paragraph (1).
6		The Director shall make available for public inspection and
7		publication an administrative decision within 180 days after
8		the issuance of the administrative decision. The term
9		"administrative decision" has the same meaning as defined in
10		Section 3-101 of Article III of the Code of Civil Procedure.
11		Costs collected under this Section shall be paid into the Tax
12		Compliance and Administration Fund.
13		(e) Nothing contained in this Act shall prevent the
14		Director from divulging information to any person pursuant to a
15		request or authorization made by the taxpayer, by an authorized
16		representative of the taxpayer, or, in the case of information
17		related to a joint return, by the spouse filing the joint
18		return with the taxpayer.
19		(Source: P.A. 94-1074, eff. 12-26-06; 95-331, eff. 8-21-07.)
20		Section 25. The Illinois Insurance Code is amended by
21		changing Section 5.5 as follows:
22		(215 ILCS 5/5.5)
23		Sec. 5.5. Compliance with the Department of Healthcare and
24		Family Services. A company authorized to do business in this

HB5420 Enrolled - 34 - LRB096 18878 JDS 34265 b
1		State or accredited by the State to issue policies of health
2		insurance, including but not limited to, self-insured plans,
3		group health plans (as defined in Section 607(1) of the
4		Employee Retirement Income Security Act of 1974), service
5		benefit plans, managed care organizations, pharmacy benefit
6		managers, or other parties that are by statute, contract, or
7		agreement legally responsible for payment of a claim for a
8		health care item or service as a condition of doing business in
9		the State must:
10		(1) provide to the Department of Healthcare and Family
11		Services, or any successor agency, on at least a quarterly
12		basis if so requested by the Department, information upon
13		request information to determine during what period any
14		individual may be, or may have been, covered by a health
15		insurer and the nature of the coverage that is or was
16		provided by the health insurer, including the name,
17		address, and identifying number of the plan;
18		(2) accept the State's right of recovery and the
19		assignment to the State of any right of an individual or
20		other entity to payment from the party for an item or
21		service for which payment has been made under the medical
22		programs of the Department of Healthcare and Family
23		Services, or any successor agency, under this Code or the
24		Illinois Public Aid Code;
25		(3) respond to any inquiry by the Department of
26		Healthcare and Family Services regarding a claim for

HB5420 Enrolled - 35 - LRB096 18878 JDS 34265 b
1		payment for any health care item or service that is
2		submitted not later than 3 years after the date of the
3		provision of such health care item or service; and
4		(4) agree not to deny a claim submitted by the
5		Department of Healthcare and Family Services solely on the
6		basis of the date of submission of the claim, the type or
7		format of the claim form, or a failure to present proper
8		documentation at the point-of-sale that is the basis of the
9		claim if (i) the claim is submitted by the Department of
10		Healthcare and Family Services within the 3-year period
11		beginning on the date on which the item or service was
12		furnished and (ii) any action by the Department of
13		Healthcare and Family Services to enforce its rights with
14		respect to such claim is commenced within 6 years of its
15		submission of such claim.
16		In cases in which the Department of Healthcare and Family
17		Services has determined that an entity that provides health
18		insurance coverage has established a pattern of failure to
19		provide the information required under this Section, and has
20		subsequently certified that determination, along with
21		supporting documentation, to the Director of the Department of
22		Insurance, the Director of the Department of Insurance, based
23		upon the certification of determination made by the Department
24		of Healthcare and Family Services, may commence regulatory
25		proceedings in accordance with all applicable provisions of the
26		Illinois Insurance Code.

HB5420 Enrolled - 36 - LRB096 18878 JDS 34265 b
1		(Source: P.A. 95-632, eff. 9-25-07.)
2		Section 30. The Children's Health Insurance Program Act is
3		amended by changing Section 15 and by adding Sections 7, 21,
4		23, and 26 as follows:
5		(215 ILCS 106/7 new)
6		Sec. 7. Eligibility verification. Notwithstanding any
7		other provision of this Act, with respect to applications for
8		benefits provided under the Program, eligibility shall be
9		determined in a manner that ensures program integrity and that
10		complies with federal law and regulations while minimizing
11		unnecessary barriers to enrollment. To this end, as soon as
12		practicable, and unless the Department receives written denial
13		from the federal government, this Section shall be implemented:
14		(a) The Department of Healthcare and Family Services or its
15		designees shall:
16		(1) By no later than July 1, 2011, require verification
17		of, at a minimum, one month's income from all sources
18		required for determining the eligibility of applicants to
19		the Program. Such verification shall take the form of pay
20		stubs, business or income and expense records for
21		self-employed persons, letters from employers, and any
22		other valid documentation of income including data
23		obtained electronically by the Department or its designees
24		from other sources as described in subsection (b) of this

HB5420 Enrolled - 37 - LRB096 18878 JDS 34265 b
1		Section.
2		(2) By no later than October 1, 2011, require
3		verification of, at a minimum, one month's income from all
4		sources required for determining the continued eligibility
5		of recipients at their annual review of eligibility under
6		the Program. Such verification shall take the form of pay
7		stubs, business or income and expense records for
8		self-employed persons, letters from employers, and any
9		other valid documentation of income including data
10		obtained electronically by the Department or its designees
11		from other sources as described in subsection (b) of this
12		Section. The Department shall send a notice to the
13		recipient at least 60 days prior to the end of the period
14		of eligibility that informs them of the requirements for
15		continued eligibility. If a recipient does not fulfill the
16		requirements for continued eligibility by the deadline
17		established in the notice, a notice of cancellation shall
18		be issued to the recipient and coverage shall end on the
19		last day of the eligibility period. A recipient's
20		eligibility may be reinstated without requiring a new
21		application if the recipient fulfills the requirements for
22		continued eligibility prior to the end of the month
23		following the last date of coverage. Nothing in this
24		Section shall prevent an individual whose coverage has been
25		cancelled from reapplying for health benefits at any time.
26		(3) By no later than July 1, 2011, require verification

HB5420 Enrolled - 38 - LRB096 18878 JDS 34265 b
1		of Illinois residency.
2		(b) The Department shall establish or continue cooperative
3		arrangements with the Social Security Administration, the
4		Illinois Secretary of State, the Department of Human Services,
5		the Department of Revenue, the Department of Employment
6		Security, and any other appropriate entity to gain electronic
7		access, to the extent allowed by law, to information available
8		to those entities that may be appropriate for electronically
9		verifying any factor of eligibility for benefits under the
10		Program. Data relevant to eligibility shall be provided for no
11		other purpose than to verify the eligibility of new applicants
12		or current recipients of health benefits under the Program.
13		Data will be requested or provided for any new applicant or
14		current recipient only insofar as that individual's
15		circumstances are relevant to that individual's or another
16		individual's eligibility.
17		(c) Within 90 days of the effective date of this amendatory
18		Act of the 96th General Assembly, the Department of Healthcare
19		and Family Services shall send notice to current recipients
20		informing them of the changes regarding their eligibility
21		verification.
22		(215 ILCS 106/15)
23		Sec. 15. Operation of the Program. There is hereby created
24		a Children's Health Insurance Program. The Program shall
25		operate subject to appropriation and shall be administered by

HB5420 Enrolled - 39 - LRB096 18878 JDS 34265 b
1		the Department of Healthcare and Family Services. The
2		Department shall have the powers and authority granted to the
3		Department under the Illinois Public Aid Code, including, but
4		not limited to, Section 11-5.1 of the Code. The Department may
5		contract with a Third Party Administrator or other entities to
6		administer and oversee any portion of this Program.
7		(Source: P.A. 95-331, eff. 8-21-07.)
8		(215 ILCS 106/21 new)
9		Sec. 21. Presumptive eligibility. Beginning on the
10		effective date of this amendatory Act of the 96th General
11		Assembly and except where federal law requires presumptive
12		eligibility, no adult may be presumed eligible for health care
13		coverage under the Program, and the Department may not cover
14		any service rendered to an adult unless the adult has completed
15		an application for benefits, all required verifications have
16		been received and the Department or its designee has found the
17		adult eligible for the date on which that service was provided.
18		Nothing in this Section shall apply to pregnant women.
19		(215 ILCS 106/23 new)
20		Sec. 23. Care coordination.
21		(a) At least 50% of recipients eligible for comprehensive
22		medical benefits in all medical assistance programs or other
23		health benefit programs administered by the Department,
24		including the Children's Health Insurance Program Act and the

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1		Covering ALL KIDS Health Insurance Act, shall be enrolled in a
2		care coordination program by no later than January 1, 2015. For
3		purposes of this Section, "coordinated care" or "care
4		coordination" means delivery systems where recipients will
5		receive their care from providers who participate under
6		contract in integrated delivery systems that are responsible
7		for providing or arranging the majority of care, including
8		primary care physician services, referrals from primary care
9		physicians, diagnostic and treatment services, behavioral
10		health services, in-patient and outpatient hospital services,
11		dental services, and rehabilitation and long-term care
12		services. The Department shall designate or contract for such
13		integrated delivery systems (i) to ensure enrollees have a
14		choice of systems and of primary care providers within such
15		systems; (ii) to ensure that enrollees receive quality care in
16		a culturally and linguistically appropriate manner; and (iii)
17		to ensure that coordinated care programs meet the diverse needs
18		of enrollees with developmental, mental health, physical, and
19		age-related disabilities.
20		(b) Payment for such coordinated care shall be based on
21		arrangements where the State pays for performance related to
22		health care outcomes, the use of evidence-based practices, the
23		use of primary care delivered through comprehensive medical
24		homes, the use of electronic medical records, and the
25		appropriate exchange of health information electronically made
26		either on a capitated basis in which a fixed monthly premium

HB5420 Enrolled - 41 - LRB096 18878 JDS 34265 b
1		per recipient is paid and full financial risk is assumed for
2		the delivery of services, or through other risk-based payment
3		arrangements.
4		(c) To qualify for compliance with this Section, the 50%
5		goal shall be achieved by enrolling medical assistance
6		enrollees from each medical assistance enrollment category,
7		including parents, children, seniors, and people with
8		disabilities to the extent that current State Medicaid payment
9		laws would not limit federal matching funds for recipients in
10		care coordination programs. In addition, services must be more
11		comprehensively defined and more risk shall be assumed than in
12		the Department's primary care case management program as of the
13		effective date of this amendatory Act of the 96th General
14		Assembly.
15		(d) The Department shall report to the General Assembly in
16		a separate part of its annual medical assistance program
17		report, beginning April, 2012 until April, 2016, on the
18		progress and implementation of the care coordination program
19		initiatives established by the provisions of this amendatory
20		Act of the 96th General Assembly. The Department shall include
21		in its April 2011 report a full analysis of federal laws or
22		regulations regarding upper payment limitations to providers
23		and the necessary revisions or adjustments in rate
24		methodologies and payments to providers under this Code that
25		would be necessary to implement coordinated care with full
26		financial risk by a party other than the Department.

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1		(215 ILCS 106/26 new)
2		Sec. 26. Moratorium on eligibility expansions. Beginning
3		on the effective date of this amendatory Act of the 96th
4		General Assembly, there shall be a 2-year moratorium on the
5		expansion of eligibility through increasing financial
6		eligibility standards, or through increasing income
7		disregards, or through the creation of new programs that would
8		add new categories of eligible individuals under the medical
9		assistance program under the Illinois Public Aid Code in
10		addition to those categories covered on January 1, 2011. This
11		moratorium shall not apply to expansions required as a federal
12		condition of State participation in the medical assistance
13		program.
14		Section 35. The Covering ALL KIDS Health Insurance Act is
15		amended by changing Sections 15, 20, and 98 and by adding
16		Sections 7, 21, 36, and 56 as follows:
17		(215 ILCS 170/7 new)
18		Sec. 7. Eligibility verification. Notwithstanding any
19		other provision of this Act, with respect to applications for
20		benefits provided under the Program, eligibility shall be
21		determined in a manner that ensures program integrity and that
22		complies with federal law and regulations while minimizing
23		unnecessary barriers to enrollment. To this end, as soon as

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1		practicable, and unless the Department receives written denial
2		from the federal government, this Section shall be implemented:
3		(a) The Department of Healthcare and Family Services or its
4		designees shall:
5		(1) By July 1, 2011, require verification of, at a
6		minimum, one month's income from all sources required for
7		determining the eligibility of applicants to the Program.
8		Such verification shall take the form of pay stubs,
9		business or income and expense records for self-employed
10		persons, letters from employers, and any other valid
11		documentation of income including data obtained
12		electronically by the Department or its designees from
13		other sources as described in subsection (b) of this
14		Section.
15		(2) By October 1, 2011, require verification of, at a
16		minimum, one month's income from all sources required for
17		determining the continued eligibility of recipients at
18		their annual review of eligibility under the Program. Such
19		verification shall take the form of pay stubs, business or
20		income and expense records for self-employed persons,
21		letters from employers, and any other valid documentation
22		of income including data obtained electronically by the
23		Department or its designees from other sources as described
24		in subsection (b) of this Section. The Department shall
25		send a notice to recipients at least 60 days prior to the
26		end of their period of eligibility that informs them of the

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1		requirements for continued eligibility. If a recipient
2		does not fulfill the requirements for continued
3		eligibility by the deadline established in the notice, a
4		notice of cancellation shall be issued to the recipient and
5		coverage shall end on the last day of the eligibility
6		period. A recipient's eligibility may be reinstated
7		without requiring a new application if the recipient
8		fulfills the requirements for continued eligibility prior
9		to the end of the month following the last date of
10		coverage. Nothing in this Section shall prevent an
11		individual whose coverage has been cancelled from
12		reapplying for health benefits at any time.
13		(3) By July 1, 2011, require verification of Illinois
14		residency.
15		(b) The Department shall establish or continue cooperative
16		arrangements with the Social Security Administration, the
17		Illinois Secretary of State, the Department of Human Services,
18		the Department of Revenue, the Department of Employment
19		Security, and any other appropriate entity to gain electronic
20		access, to the extent allowed by law, to information available
21		to those entities that may be appropriate for electronically
22		verifying any factor of eligibility for benefits under the
23		Program. Data relevant to eligibility shall be provided for no
24		other purpose than to verify the eligibility of new applicants
25		or current recipients of health benefits under the Program.
26		Data will be requested or provided for any new applicant or

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1		current recipient only insofar as that individual's
2		circumstances are relevant to that individual's or another
3		individual's eligibility.
4		(c) Within 90 days of the effective date of this amendatory
5		Act of the 96th General Assembly, the Department of Healthcare
6		and Family Services shall send notice to current recipients
7		informing them of the changes regarding their eligibility
8		verification.
9		(215 ILCS 170/15)
10		(Section scheduled to be repealed on July 1, 2011)
11		Sec. 15. Operation of Program. The Covering ALL KIDS Health
12		Insurance Program is created. The Program shall be administered
13		by the Department of Healthcare and Family Services. The
14		Department shall have the same powers and authority to
15		administer the Program as are provided to the Department in
16		connection with the Department's administration of the
17		Illinois Public Aid Code, including, but not limited to, the
18		provisions under Section 11-5.1 of the Code, and the Children's
19		Health Insurance Program Act. The Department shall coordinate
20		the Program with the existing children's health programs
21		operated by the Department and other State agencies.
22		(Source: P.A. 94-693, eff. 7-1-06.)
23		(215 ILCS 170/20)
24		(Section scheduled to be repealed on July 1, 2011)

HB5420 Enrolled - 46 - LRB096 18878 JDS 34265 b
1		Sec. 20. Eligibility.
2		(a) To be eligible for the Program, a person must be a
3		child:
4		(1) who is a resident of the State of Illinois; and
5		(2) who is ineligible for medical assistance under the
6		Illinois Public Aid Code or benefits under the Children's
7		Health Insurance Program Act; and
8		(3) either (i) who has been without health insurance
9		coverage for a period set forth by the Department in rules,
10		but not less than 6 months during the first month of
11		operation of the Program, 7 months during the second month
12		of operation, 8 months during the third month of operation,
13		9 months during the fourth month of operation, 10 months
14		during the fifth month of operation, 11 months during the
15		sixth month of operation, and 12 months thereafter, (ii)
16		whose parent has lost employment that made available
17		affordable dependent health insurance coverage, until such
18		time as affordable employer-sponsored dependent health
19		insurance coverage is again available for the child as set
20		forth by the Department in rules, (iii) who is a newborn
21		whose responsible relative does not have available
22		affordable private or employer-sponsored health insurance,
23		or (iv) who, within one year of applying for coverage under
24		this Act, lost medical benefits under the Illinois Public
25		Aid Code or the Children's Health Insurance Program Act;
26		and .

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1		(3.5) whose household income, as determined by the
2		Department, is at or below 300% of the federal poverty
3		level. This item (3.5) is effective July 1, 2011.
4		An entity that provides health insurance coverage (as
5		defined in Section 2 of the Comprehensive Health Insurance Plan
6		Act) to Illinois residents shall provide health insurance data
7		match to the Department of Healthcare and Family Services as
8		provided by and subject to Section 5.5 of the Illinois
9		Insurance Code for the purpose of determining eligibility for
10		the Program under this Act.
11		The Department of Healthcare and Family Services, in
12		collaboration with the Department of Financial and
13		Professional Regulation, Division of Insurance, shall adopt
14		rules governing the exchange of information under this Section.
15		The rules shall be consistent with all laws relating to the
16		confidentiality or privacy of personal information or medical
17		records, including provisions under the Federal Health
18		Insurance Portability and Accountability Act (HIPAA).
19		(b) The Department shall monitor the availability and
20		retention of employer-sponsored dependent health insurance
21		coverage and shall modify the period described in subdivision
22		(a)(3) if necessary to promote retention of private or
23		employer-sponsored health insurance and timely access to
24		healthcare services, but at no time shall the period described
25		in subdivision (a)(3) be less than 6 months.
26		(c) The Department, at its discretion, may take into

HB5420 Enrolled - 48 - LRB096 18878 JDS 34265 b
1		account the affordability of dependent health insurance when
2		determining whether employer-sponsored dependent health
3		insurance coverage is available upon reemployment of a child's
4		parent as provided in subdivision (a)(3).
5		(d) A child who is determined to be eligible for the
6		Program shall remain eligible for 12 months, provided that the
7		child maintains his or her residence in this State, has not yet
8		attained 19 years of age, and is not excluded under subsection
9		(e).
10		(e) A child is not eligible for coverage under the Program
11		if:
12		(1) the premium required under Section 40 has not been
13		timely paid; if the required premiums are not paid, the
14		liability of the Program shall be limited to benefits
15		incurred under the Program for the time period for which
16		premiums have been paid; re-enrollment shall be completed
17		before the next covered medical visit, and the first
18		month's required premium shall be paid in advance of the
19		next covered medical visit; or
20		(2) the child is an inmate of a public institution or
21		an institution for mental diseases.
22		(f) The Department may shall adopt eligibility rules,
23		including, but not limited to: rules regarding annual renewals
24		of eligibility for the Program in conformance with Section 7 of
25		this Act; rules regarding annual renewals of eligibility for
26		the Program; rules providing for re-enrollment, grace periods,

HB5420 Enrolled - 49 - LRB096 18878 JDS 34265 b
1		notice requirements, and hearing procedures under subdivision
2		(e)(1) of this Section; and rules regarding what constitutes
3		availability and affordability of private or
4		employer-sponsored health insurance, with consideration of
5		such factors as the percentage of income needed to purchase
6		children or family health insurance, the availability of
7		employer subsidies, and other relevant factors.
8		(g) Each child enrolled in the Program as of July 1, 2011
9		whose family income, as established by the Department, exceeds
10		300% of the federal poverty level may remain enrolled in the
11		Program for 12 additional months commencing July 1, 2011.
12		Continued enrollment pursuant to this subsection shall be
13		available only if the child continues to meet all eligibility
14		criteria established under the Program as of the effective date
15		of this amendatory Act of the 96th General Assembly without a
16		break in coverage. Nothing contained in this subsection shall
17		prevent a child from qualifying for any other health benefits
18		program operated by the Department.
19		(Source: P.A. 96-1272, eff. 1-1-11.)
20		(215 ILCS 170/21 new)
21		Sec. 21. Presumptive eligibility. Beginning on the
22		effective date of this amendatory Act of the 96th General
23		Assembly and except where federal law or regulation requires
24		presumptive eligibility, no adult may be presumed eligible for
25		health care coverage under the Program and the Department may

HB5420 Enrolled - 50 - LRB096 18878 JDS 34265 b
1		not cover any service rendered to an adult unless the adult has
2		completed an application for benefits, all required
3		verifications have been received, and the Department or its
4		designee has found the adult eligible for the date on which
5		that service was provided. Nothing in this Section shall apply
6		to pregnant women.
7		(215 ILCS 170/36 new)
8		Sec. 36. Moratorium on eligibility expansions. Beginning
9		on the effective date of this amendatory Act of the 96th
10		General Assembly, there shall be a 2-year moratorium on the
11		expansion of eligibility through increasing financial
12		eligibility standards, or through increasing income
13		disregards, or through the creation of new programs that would
14		add new categories of eligible individuals under the medical
15		assistance program under the Illinois Public Aid Code in
16		addition to those categories covered on January 1, 2011. This
17		moratorium shall not apply to expansions required as a federal
18		condition of State participation in the medical assistance
19		program.
20		(215 ILCS 170/56 new)
21		Sec. 56. Care coordination.
22		(a) At least 50% of recipients eligible for comprehensive
23		medical benefits in all medical assistance programs or other
24		health benefit programs administered by the Department,

HB5420 Enrolled - 51 - LRB096 18878 JDS 34265 b
1		including the Children's Health Insurance Program Act and the
2		Covering ALL KIDS Health Insurance Act, shall be enrolled in a
3		care coordination program by no later than January 1, 2015. For
4		purposes of this Section, "coordinated care" or "care
5		coordination" means delivery systems where recipients will
6		receive their care from providers who participate under
7		contract in integrated delivery systems that are responsible
8		for providing or arranging the majority of care, including
9		primary care physician services, referrals from primary care
10		physicians, diagnostic and treatment services, behavioral
11		health services, in-patient and outpatient hospital services,
12		dental services, and rehabilitation and long-term care
13		services. The Department shall designate or contract for such
14		integrated delivery systems (i) to ensure enrollees have a
15		choice of systems and of primary care providers within such
16		systems; (ii) to ensure that enrollees receive quality care in
17		a culturally and linguistically appropriate manner; and (iii)
18		to ensure that coordinated care programs meet the diverse needs
19		of enrollees with developmental, mental health, physical, and
20		age-related disabilities.
21		(b) Payment for such coordinated care shall be based on
22		arrangements where the State pays for performance related to
23		health care outcomes, the use of evidence-based practices, the
24		use of primary care delivered through comprehensive medical
25		homes, the use of electronic medical records, and the
26		appropriate exchange of health information electronically made

HB5420 Enrolled - 52 - LRB096 18878 JDS 34265 b
1		either on a capitated basis in which a fixed monthly premium
2		per recipient is paid and full financial risk is assumed for
3		the delivery of services, or through other risk-based payment
4		arrangements.
5		(c) To qualify for compliance with this Section, the 50%
6		goal shall be achieved by enrolling medical assistance
7		enrollees from each medical assistance enrollment category,
8		including parents, children, seniors, and people with
9		disabilities to the extent that current State Medicaid payment
10		laws would not limit federal matching funds for recipients in
11		care coordination programs. In addition, services must be more
12		comprehensively defined and more risk shall be assumed than in
13		the Department's primary care case management program as of the
14		effective date of this amendatory Act of the 96th General
15		Assembly.
16		(d) The Department shall report to the General Assembly in
17		a separate part of its annual medical assistance program
18		report, beginning April, 2012 until April, 2016, on the
19		progress and implementation of the care coordination program
20		initiatives established by the provisions of this amendatory
21		Act of the 96th General Assembly. The Department shall include
22		in its April 2011 report a full analysis of federal laws or
23		regulations regarding upper payment limitations to providers
24		and the necessary revisions or adjustments in rate
25		methodologies and payments to providers under this Code that
26		would be necessary to implement coordinated care with full

HB5420 Enrolled - 53 - LRB096 18878 JDS 34265 b
1		financial risk by a party other than the Department.
2		(215 ILCS 170/98)
3		(Section scheduled to be repealed on July 1, 2011)
4		Sec. 98. Repealer. This Act is repealed on July 1, 2016
5		July 1, 2011.
6		(Source: P.A. 94-693, eff. 7-1-06.)
7		Section 40. The Illinois Public Aid Code is amended by
8		changing Sections 5-4.1, 5-5.12, 5-11, 8A-2.5, and 11-26 and by
9		adding Sections 5-1.3, 5-1.4, 5-2.03, 5-11a, 5-29, 5-30, and
10		11-5.1 as follows:
11		(305 ILCS 5/5-1.3 new)
12		Sec. 5-1.3. Payer of last resort. To the extent permissible
13		under federal law, the State may pay for medical services only
14		after payment from all other sources of payment have been
15		exhausted, or after the Department has determined that pursuit
16		of such payment is economically unfeasible. Applicants for, and
17		recipients of, medical assistance under this Code shall
18		disclose to the State all insurance coverage they have. To the
19		extent permissible under federal law, the State shall require
20		vendors of medical services to bill third-party payers for
21		services that may be covered by those third-party payers prior
22		to submission of a request for payment to the State. The
23		Department shall, to the extent permissible under federal law,

HB5420 Enrolled - 54 - LRB096 18878 JDS 34265 b
1		reject a request for payment of a medical service that should
2		first have been submitted to a third-party payer.
3		(305 ILCS 5/5-1.4 new)
4		Sec. 5-1.4. Moratorium on eligibility expansions.
5		Beginning on the effective date of this amendatory Act of the
6		96th General Assembly, there shall be a 2-year moratorium on
7		the expansion of eligibility through increasing financial
8		eligibility standards, or through increasing income
9		disregards, or through the creation of new programs which would
10		add new categories of eligible individuals under the medical
11		assistance program in addition to those categories covered on
12		January 1, 2011. This moratorium shall not apply to expansions
13		required as a federal condition of State participation in the
14		medical assistance program.
15		(305 ILCS 5/5-2.03 new)
16		Sec. 5-2.03. Presumptive eligibility. Beginning on the
17		effective date of this amendatory Act of the 96th General
18		Assembly and except where federal law requires presumptive
19		eligibility, no adult may be presumed eligible for medical
20		assistance under this Code and the Department may not cover any
21		service rendered to an adult unless the adult has completed an
22		application for benefits, all required verifications have been
23		received, and the Department or its designee has found the
24		adult eligible for the date on which that service was provided.

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1		Nothing in this Section shall apply to pregnant women.
2		(305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
3		Sec. 5-4.1. Co-payments. The Department may by rule provide
4		that recipients under any Article of this Code shall pay a fee
5		as a co-payment for services. Co-payments shall be maximized to
6		the extent permitted by federal law may not exceed $3 for brand
7		name drugs, $1 for other pharmacy services other than for
8		generic drugs, and $2 for physicians services, dental services,
9		optical services and supplies, chiropractic services, podiatry
10		services, and encounter rate clinic services. There shall be no
11		co-payment for generic drugs. Co-payments may not exceed $3 for
12		hospital outpatient and clinic services. Provided, however,
13		that any such rule must provide that no co-payment requirement
14		can exist for renal dialysis, radiation therapy, cancer
15		chemotherapy, or insulin, and other products necessary on a
16		recurring basis, the absence of which would be life
17		threatening, or where co-payment expenditures for required
18		services and/or medications for chronic diseases that the
19		Illinois Department shall by rule designate shall cause an
20		extensive financial burden on the recipient, and provided no
21		co-payment shall exist for emergency room encounters which are
22		for medical emergencies. The Department shall seek approval of
23		a State plan amendment that allows pharmacies to refuse to
24		dispense drugs in circumstances where the recipient does not
25		pay the required co-payment. In the event the State plan

HB5420 Enrolled - 56 - LRB096 18878 JDS 34265 b
1		amendment is rejected, co-payments may not exceed $3 for brand
2		name drugs, $1 for other pharmacy services other than for
3		generic drugs, and $2 for physician services, dental services,
4		optical services and supplies, chiropractic services, podiatry
5		services, and encounter rate clinic services. There shall be no
6		co-payment for generic drugs. Co-payments may not exceed $3 for
7		hospital outpatient and clinic services.
8		(Source: P.A. 92-597, eff. 6-28-02; 93-593, eff. 8-25-03.)
9		(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
10		Sec. 5-5.12. Pharmacy payments.
11		(a) Every request submitted by a pharmacy for reimbursement
12		under this Article for prescription drugs provided to a
13		recipient of aid under this Article shall include the name of
14		the prescriber or an acceptable identification number as
15		established by the Department.
16		(b) Pharmacies providing prescription drugs under this
17		Article shall be reimbursed at a rate which shall include a
18		professional dispensing fee as determined by the Illinois
19		Department, plus the current acquisition cost of the
20		prescription drug dispensed. The Illinois Department shall
21		update its information on the acquisition costs of all
22		prescription drugs no less frequently than every 30 days.
23		However, the Illinois Department may set the rate of
24		reimbursement for the acquisition cost, by rule, at a
25		percentage of the current average wholesale acquisition cost.

HB5420 Enrolled - 57 - LRB096 18878 JDS 34265 b
1		(c) (Blank).
2		(d) The Department shall not impose requirements for prior
3		approval based on a preferred drug list for anti-retroviral,
4		anti-hemophilic factor concentrates, or any atypical
5		antipsychotics, conventional antipsychotics, or
6		anticonvulsants used for the treatment of serious mental
7		illnesses until 30 days after it has conducted a study of the
8		impact of such requirements on patient care and submitted a
9		report to the Speaker of the House of Representatives and the
10		President of the Senate. The Department shall review
11		utilization of narcotic medications in the medical assistance
12		program and impose utilization controls that protect against
13		abuse.
14		(e) When making determinations as to which drugs shall be
15		on a prior approval list, the Department shall include as part
16		of the analysis for this determination, the degree to which a
17		drug may affect individuals in different ways based on factors
18		including the gender of the person taking the medication.
19		(f) (e) The Department shall cooperate with the Department
20		of Public Health and the Department of Human Services Division
21		of Mental Health in identifying psychotropic medications that,
22		when given in a particular form, manner, duration, or frequency
23		(including "as needed") in a dosage, or in conjunction with
24		other psychotropic medications to a nursing home resident, may
25		constitute a chemical restraint or an "unnecessary drug" as
26		defined by the Nursing Home Care Act or Titles XVIII and XIX of

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1		the Social Security Act and the implementing rules and
2		regulations. The Department shall require prior approval for
3		any such medication prescribed for a nursing home resident that
4		appears to be a chemical restraint or an unnecessary drug. The
5		Department shall consult with the Department of Human Services
6		Division of Mental Health in developing a protocol and criteria
7		for deciding whether to grant such prior approval.
8		(g) The Department may by rule provide for reimbursement of
9		the dispensing of a 90-day supply of a generic, non-narcotic
10		maintenance medication in circumstances where it is cost
11		effective.
12		(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
13		revised 9-2-10.)
14		(305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
15		Sec. 5-11. Co-operative arrangements; contracts with other
16		State agencies, health care and rehabilitation organizations,
17		and fiscal intermediaries.
18		(a) The Illinois Department may enter into co-operative
19		arrangements with State agencies responsible for administering
20		or supervising the administration of health services and
21		vocational rehabilitation services to the end that there may be
22		maximum utilization of such services in the provision of
23		medical assistance.
24		The Illinois Department shall, not later than June 30,
25		1993, enter into one or more co-operative arrangements with the

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1		Department of Mental Health and Developmental Disabilities
2		providing that the Department of Mental Health and
3		Developmental Disabilities will be responsible for
4		administering or supervising all programs for services to
5		persons in community care facilities for persons with
6		developmental disabilities, including but not limited to
7		intermediate care facilities, that are supported by State funds
8		or by funding under Title XIX of the federal Social Security
9		Act. The responsibilities of the Department of Mental Health
10		and Developmental Disabilities under these agreements are
11		transferred to the Department of Human Services as provided in
12		the Department of Human Services Act.
13		The Department may also contract with such State health and
14		rehabilitation agencies and other public or private health care
15		and rehabilitation organizations to act for it in supplying
16		designated medical services to persons eligible therefor under
17		this Article. Any contracts with health services or health
18		maintenance organizations shall be restricted to organizations
19		which have been certified as being in compliance with standards
20		promulgated pursuant to the laws of this State governing the
21		establishment and operation of health services or health
22		maintenance organizations. The Department shall renegotiate
23		the contracts with health maintenance organizations and
24		managed care community networks that took effect August 1,
25		2003, so as to produce $70,000,000 savings to the Department
26		net of resulting increases to the fee-for-service program for

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1		State fiscal year 2006. The Department may also contract with
2		insurance companies or other corporate entities serving as
3		fiscal intermediaries in this State for the Federal Government
4		in respect to Medicare payments under Title XVIII of the
5		Federal Social Security Act to act for the Department in paying
6		medical care suppliers. The provisions of Section 9 of "An Act
7		in relation to State finance", approved June 10, 1919, as
8		amended, notwithstanding, such contracts with State agencies,
9		other health care and rehabilitation organizations, or fiscal
10		intermediaries may provide for advance payments.
11		(b) For purposes of this subsection (b), "managed care
12		community network" means an entity, other than a health
13		maintenance organization, that is owned, operated, or governed
14		by providers of health care services within this State and that
15		provides or arranges primary, secondary, and tertiary managed
16		health care services under contract with the Illinois
17		Department exclusively to persons participating in programs
18		administered by the Illinois Department.
19		The Illinois Department may certify managed care community
20		networks, including managed care community networks owned,
21		operated, managed, or governed by State-funded medical
22		schools, as risk-bearing entities eligible to contract with the
23		Illinois Department as Medicaid managed care organizations.
24		The Illinois Department may contract with those managed care
25		community networks to furnish health care services to or
26		arrange those services for individuals participating in

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1		programs administered by the Illinois Department. The rates for
2		those provider-sponsored organizations may be determined on a
3		prepaid, capitated basis. A managed care community network may
4		choose to contract with the Illinois Department to provide only
5		pediatric health care services. The Illinois Department shall
6		by rule adopt the criteria, standards, and procedures by which
7		a managed care community network may be permitted to contract
8		with the Illinois Department and shall consult with the
9		Department of Insurance in adopting these rules.
10		A county provider as defined in Section 15-1 of this Code
11		may contract with the Illinois Department to provide primary,
12		secondary, or tertiary managed health care services as a
13		managed care community network without the need to establish a
14		separate entity and shall be deemed a managed care community
15		network for purposes of this Code only to the extent it
16		provides services to participating individuals. A county
17		provider is entitled to contract with the Illinois Department
18		with respect to any contracting region located in whole or in
19		part within the county. A county provider is not required to
20		accept enrollees who do not reside within the county.
21		In order to (i) accelerate and facilitate the development
22		of integrated health care in contracting areas outside counties
23		with populations in excess of 3,000,000 and counties adjacent
24		to those counties and (ii) maintain and sustain the high
25		quality of education and residency programs coordinated and
26		associated with local area hospitals, the Illinois Department

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1		may develop and implement a demonstration program from managed
2		care community networks owned, operated, managed, or governed
3		by State-funded medical schools. The Illinois Department shall
4		prescribe by rule the criteria, standards, and procedures for
5		effecting this demonstration program.
6		A managed care community network that contracts with the
7		Illinois Department to furnish health care services to or
8		arrange those services for enrollees participating in programs
9		administered by the Illinois Department shall do all of the
10		following:
11		(1) Provide that any provider affiliated with the
12		managed care community network may also provide services on
13		a fee-for-service basis to Illinois Department clients not
14		enrolled in such managed care entities.
15		(2) Provide client education services as determined
16		and approved by the Illinois Department, including but not
17		limited to (i) education regarding appropriate utilization
18		of health care services in a managed care system, (ii)
19		written disclosure of treatment policies and restrictions
20		or limitations on health services, including, but not
21		limited to, physical services, clinical laboratory tests,
22		hospital and surgical procedures, prescription drugs and
23		biologics, and radiological examinations, and (iii)
24		written notice that the enrollee may receive from another
25		provider those covered services that are not provided by
26		the managed care community network.

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1		(3) Provide that enrollees within the system may choose
2		the site for provision of services and the panel of health
3		care providers.
4		(4) Not discriminate in enrollment or disenrollment
5		practices among recipients of medical services or
6		enrollees based on health status.
7		(5) Provide a quality assurance and utilization review
8		program that meets the requirements established by the
9		Illinois Department in rules that incorporate those
10		standards set forth in the Health Maintenance Organization
11		Act.
12		(6) Issue a managed care community network
13		identification card to each enrollee upon enrollment. The
14		card must contain all of the following:
15		(A) The enrollee's health plan.
16		(B) The name and telephone number of the enrollee's
17		primary care physician or the site for receiving
18		primary care services.
19		(C) A telephone number to be used to confirm
20		eligibility for benefits and authorization for
21		services that is available 24 hours per day, 7 days per
22		week.
23		(7) Ensure that every primary care physician and
24		pharmacy in the managed care community network meets the
25		standards established by the Illinois Department for
26		accessibility and quality of care. The Illinois Department

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1		shall arrange for and oversee an evaluation of the
2		standards established under this paragraph (7) and may
3		recommend any necessary changes to these standards.
4		(8) Provide a procedure for handling complaints that
5		meets the requirements established by the Illinois
6		Department in rules that incorporate those standards set
7		forth in the Health Maintenance Organization Act.
8		(9) Maintain, retain, and make available to the
9		Illinois Department records, data, and information, in a
10		uniform manner determined by the Illinois Department,
11		sufficient for the Illinois Department to monitor
12		utilization, accessibility, and quality of care.
13		(10) (Blank) Provide that the pharmacy formulary used
14		by the managed care community network and its contract
15		providers be no more restrictive than the Illinois
16		Department's pharmaceutical program on the effective date
17		of this amendatory Act of 1998 and as amended after that
18		date.
19		The Illinois Department shall contract with an entity or
20		entities to provide external peer-based quality assurance
21		review for the managed health care programs administered by the
22		Illinois Department. The entity shall meet all federal
23		requirements for an external quality review organization be
24		representative of Illinois physicians licensed to practice
25		medicine in all its branches and have statewide geographic
26		representation in all specialities of medical care that are

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1		provided in managed health care programs administered by the
2		Illinois Department. The entity may not be a third party payer
3		and shall maintain offices in locations around the State in
4		order to provide service and continuing medical education to
5		physician participants within those managed health care
6		programs administered by the Illinois Department. The review
7		process shall be developed and conducted by Illinois physicians
8		licensed to practice medicine in all its branches. In
9		consultation with the entity, the Illinois Department may
10		contract with other entities for professional peer-based
11		quality assurance review of individual categories of services
12		other than services provided, supervised, or coordinated by
13		physicians licensed to practice medicine in all its branches.
14		The Illinois Department shall establish, by rule, criteria to
15		avoid conflicts of interest in the conduct of quality assurance
16		activities consistent with professional peer-review standards.
17		All quality assurance activities shall be coordinated by the
18		Illinois Department.
19		Each managed care community network must demonstrate its
20		ability to bear the financial risk of serving individuals under
21		this program. The Illinois Department shall by rule adopt
22		standards for assessing the solvency and financial soundness of
23		each managed care community network. Any solvency and financial
24		standards adopted for managed care community networks shall be
25		no more restrictive than the solvency and financial standards
26		adopted under Section 1856(a) of the Social Security Act for

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1		provider-sponsored organizations under Part C of Title XVIII of
2		the Social Security Act.
3		The Illinois Department may implement the amendatory
4		changes to this Code made by this amendatory Act of 1998
5		through the use of emergency rules in accordance with Section
6		5-45 of the Illinois Administrative Procedure Act. For purposes
7		of that Act, the adoption of rules to implement these changes
8		is deemed an emergency and necessary for the public interest,
9		safety, and welfare.
10		(c) Not later than June 30, 1996, the Illinois Department
11		shall enter into one or more cooperative arrangements with the
12		Department of Public Health for the purpose of developing a
13		single survey for nursing facilities, including but not limited
14		to facilities funded under Title XVIII or Title XIX of the
15		federal Social Security Act or both, which shall be
16		administered and conducted solely by the Department of Public
17		Health. The Departments shall test the single survey process on
18		a pilot basis, with both the Departments of Public Aid and
19		Public Health represented on the consolidated survey team. The
20		pilot will sunset June 30, 1997. After June 30, 1997, unless
21		otherwise determined by the Governor, a single survey shall be
22		implemented by the Department of Public Health which would not
23		preclude staff from the Department of Healthcare and Family
24		Services (formerly Department of Public Aid) from going on-site
25		to nursing facilities to perform necessary audits and reviews
26		which shall not replicate the single State agency survey

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1		required by this Act. This Section shall not apply to community
2		or intermediate care facilities for persons with developmental
3		disabilities.
4		(d) Nothing in this Code in any way limits or otherwise
5		impairs the authority or power of the Illinois Department to
6		enter into a negotiated contract pursuant to this Section with
7		a managed care community network or a health maintenance
8		organization, as defined in the Health Maintenance
9		Organization Act, that provides for termination or nonrenewal
10		of the contract without cause, upon notice as provided in the
11		contract, and without a hearing.
12		(Source: P.A. 94-48, eff. 7-1-05; 95-331, eff. 8-21-07.)
13		(305 ILCS 5/5-11a new)
14		Sec. 5-11a. Health Benefit Information Systems.
15		(a) It is the intent of the General Assembly to support
16		unified electronic systems initiatives that will improve
17		management of information related to medical assistance
18		programs. This will include improved management capabilities
19		and new systems for Eligibility, Verification, and Enrollment
20		(EVE) that will simplify and increase efficiencies in and
21		access to the medical assistance programs and ensure program
22		integrity. The Department of Healthcare and Family Services, in
23		coordination with the Department of Human Services and other
24		appropriate state agencies, shall develop a plan by July 1,
25		2011, that will:

HB5420 Enrolled - 68 - LRB096 18878 JDS 34265 b
1		(1) Subject to federal and State privacy and
2		confidentiality laws and regulations, meet standards for
3		timely eligibility verification and enrollment, and annual
4		redetermination of eligibility, of applicants for and
5		recipients of means-tested health benefits sponsored by
6		the State, including medical assistance under this Code.
7		(2) Receive and update data electronically from the
8		Social Security Administration, the U.S. Postal Service,
9		the Illinois Secretary of State, the Department of Revenue,
10		the Department of Employment Security, and other
11		governmental entities, as appropriate and to the extent
12		allowed by law, for verification of any factor of
13		eligibility for medical assistance and for updating
14		addresses of applicants and recipients of medical
15		assistance and other health benefit programs administered
16		by the Department. Data relevant to eligibility shall be
17		provided for no other purpose than to verify the
18		eligibility of new applicants or current recipients of
19		health benefits provided by the State. Data shall be
20		requested or provided for any individual only insofar as
21		that new applicant or current recipient's circumstances
22		are relevant to that individual's or another individual's
23		eligibility for State-sponsored health benefits.
24		(3) Meet federal requirements for timely installation
25		by January 1, 2014 to provide integration with a Health
26		Benefits Exchange pursuant to the requirements of the

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1		federal Affordable Care Act and the Reconciliation Act and
2		any subsequent amendments thereto and to ensure capture of
3		the maximum available federal financial participation
4		(FFP).
5		(4) Meet federal requirements for compliance with
6		architectural standards, including, but not limited to,
7		(i) the use of a module development as outlined by the
8		Medicaid Information Technology Architecture standards,
9		(ii) the use of federally approved open-interfaces where
10		they exist, (iii) the use or the creation of
11		open-interfaces where necessary, and (iv) the use of rules
12		technology that can dynamically accept and modify rules in
13		standard formats.
14		(5) Include plans to ensure coordination with the State
15		of Illinois Framework Project that will (i) expedite and
16		simplify access to services provided by Illinois human
17		services programs; (ii) streamline administration and data
18		sharing; (iii) enhance planning capacity, program
19		evaluation, and fraud detection or prevention with access
20		to cross-agency data; and (iv) simplify service reporting
21		for contracted providers.
22		(b) The Department of Healthcare and Family Services shall
23		continue to plan for and implement a new Medicaid Management
24		Information System (MMIS) and upgrade the capabilities of the
25		MMIS data warehouse. Upgrades shall include, among other
26		things, enhanced capabilities in data analysis including the

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1		ability to identify risk factors that could impact the
2		treatment and resulting quality of care, and tools that perform
3		predictive analytics on data applying to newborns, women with
4		high risk pregnancies, and other populations served by the
5		Department.
6		(c) The Department of Healthcare and Family Services shall
7		report in its annual Medical Assistance program report each
8		April through April, 2015 on the progress and implementation of
9		this plan.
10		(305 ILCS 5/5-29 new)
11		Sec. 5-29. Income Limits and Parental Responsibility. In
12		light of the unprecedented fiscal crisis confronting the State,
13		it is the intent of the General Assembly to explore whether the
14		income limits and income counting methods established for
15		children under the Covering ALL KIDS Health Insurance Act,
16		pursuant to this amendatory Act of the 96th General Assembly,
17		should apply to medical assistance programs available to
18		children made eligible under the Illinois Public Aid Code,
19		including through home and community based services waiver
20		programs authorized under Section 1915(c) of the Social
21		Security Act, where parental income is currently not considered
22		in determining a child's eligibility for medical assistance.
23		The Department of Healthcare and Family Services is hereby
24		directed, with the participation of the Department of Human
25		Services and stakeholders, to conduct an analysis of these

HB5420 Enrolled - 71 - LRB096 18878 JDS 34265 b
1		programs to determine parental cost sharing opportunities, how
2		these opportunities may impact the children currently in the
3		programs, waivers and on the waiting list, and any other
4		factors which may increase efficiencies and decrease State
5		costs. The Department is further directed to review how
6		services under these programs and waivers may be provided by
7		the use of a combination of skilled, unskilled, and
8		uncompensated care and to advise as to what revisions to the
9		Nurse Practice Act, and Acts regulating other relevant
10		professions, are necessary to accomplish this combination of
11		care. The Department shall submit a written analysis on the
12		children's programs and waivers as part of the Department's
13		annual Medicaid reports due to the General Assembly in 2011 and
14		2012.
15		(305 ILCS 5/5-30 new)
16		Sec. 5-30. Care coordination.
17		(a) At least 50% of recipients eligible for comprehensive
18		medical benefits in all medical assistance programs or other
19		health benefit programs administered by the Department,
20		including the Children's Health Insurance Program Act and the
21		Covering ALL KIDS Health Insurance Act, shall be enrolled in a
22		care coordination program by no later than January 1, 2015. For
23		purposes of this Section, "coordinated care" or "care
24		coordination" means delivery systems where recipients will
25		receive their care from providers who participate under

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1		contract in integrated delivery systems that are responsible
2		for providing or arranging the majority of care, including
3		primary care physician services, referrals from primary care
4		physicians, diagnostic and treatment services, behavioral
5		health services, in-patient and outpatient hospital services,
6		dental services, and rehabilitation and long-term care
7		services. The Department shall designate or contract for such
8		integrated delivery systems (i) to ensure enrollees have a
9		choice of systems and of primary care providers within such
10		systems; (ii) to ensure that enrollees receive quality care in
11		a culturally and linguistically appropriate manner; and (iii)
12		to ensure that coordinated care programs meet the diverse needs
13		of enrollees with developmental, mental health, physical, and
14		age-related disabilities.
15		(b) Payment for such coordinated care shall be based on
16		arrangements where the State pays for performance related to
17		health care outcomes, the use of evidence-based practices, the
18		use of primary care delivered through comprehensive medical
19		homes, the use of electronic medical records, and the
20		appropriate exchange of health information electronically made
21		either on a capitated basis in which a fixed monthly premium
22		per recipient is paid and full financial risk is assumed for
23		the delivery of services, or through other risk-based payment
24		arrangements.
25		(c) To qualify for compliance with this Section, the 50%
26		goal shall be achieved by enrolling medical assistance

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1		enrollees from each medical assistance enrollment category,
2		including parents, children, seniors, and people with
3		disabilities to the extent that current State Medicaid payment
4		laws would not limit federal matching funds for recipients in
5		care coordination programs. In addition, services must be more
6		comprehensively defined and more risk shall be assumed than in
7		the Department's primary care case management program as of the
8		effective date of this amendatory Act of the 96th General
9		Assembly.
10		(d) The Department shall report to the General Assembly in
11		a separate part of its annual medical assistance program
12		report, beginning April, 2012 until April, 2016, on the
13		progress and implementation of the care coordination program
14		initiatives established by the provisions of this amendatory
15		Act of the 96th General Assembly. The Department shall include
16		in its April 2011 report a full analysis of federal laws or
17		regulations regarding upper payment limitations to providers
18		and the necessary revisions or adjustments in rate
19		methodologies and payments to providers under this Code that
20		would be necessary to implement coordinated care with full
21		financial risk by a party other than the Department.
22		(305 ILCS 5/8A-2.5)
23		Sec. 8A-2.5. Unauthorized use of medical assistance.
24		(a) Any person who knowingly uses, acquires, possesses, or
25		transfers a medical card in any manner not authorized by law or

HB5420 Enrolled - 74 - LRB096 18878 JDS 34265 b
1		by rules and regulations of the Illinois Department, or who
2		knowingly alters a medical card, or who knowingly uses,
3		acquires, possesses, or transfers an altered medical card, is
4		guilty of a violation of this Article and shall be punished as
5		provided in Section 8A-6.
6		(b) Any person who knowingly obtains unauthorized medical
7		benefits with or without use of a medical card is guilty of a
8		violation of this Article and shall be punished as provided in
9		Section 8A-6.
10		(c) The Department may seek to recover any and all State
11		and federal monies for which it has improperly and erroneously
12		paid benefits as a result of a fraudulent action and any civil
13		penalties authorized in this Section. Pursuant to Section
14		11-14.5 of this Code, the Department may determine the monetary
15		value of benefits improperly and erroneously received. The
16		Department may recover the monies paid for such benefits and
17		interest on that amount at the rate of 5% per annum for the
18		period from which payment was made to the date upon which
19		repayment is made to the State. Prior to the recovery of any
20		amount paid for benefits allegedly obtained by fraudulent
21		means, the recipient of such benefits shall be afforded an
22		opportunity for a hearing after reasonable notice. The notice
23		shall be served personally or by certified or registered mail
24		or as otherwise provided by law upon the parties or their
25		agents appointed to receive service of process and shall
26		include the following:

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1		(1) A statement of the time, place and nature of the
2		hearing.
3		(2) A statement of the legal authority and jurisdiction
4		under which the hearing is to be held.
5		(3) A reference to the particular Sections of the
6		substantive and procedural statutes and rules involved.
7		(4) Except where a more detailed statement is otherwise
8		provided for by law, a short and plain statement of the
9		matters asserted, the consequences of a failure to respond,
10		and the official file or other reference number.
11		(5) A statement of the monetary value of the benefits
12		fraudulently received by the person accused.
13		(6) A statement that, in addition to any other
14		penalties provided by law, a civil penalty in an amount not
15		to exceed $2,000 may be imposed for each fraudulent claim
16		for benefits or payments.
17		(7) A statement providing that the determination of the
18		monetary value may be contested by petitioning the
19		Department for an administrative hearing within 30 days
20		from the date of mailing the notice.
21		(8) The names and mailing addresses of the
22		administrative law judge, all parties, and all other
23		persons to whom the agency gives notice of the hearing
24		unless otherwise confidential by law.
25		An opportunity shall be afforded all parties to be
26		represented by legal counsel and to respond and present

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1		evidence and argument.
2		Unless precluded by law, disposition may be made of any
3		contested case by stipulation, agreed settlement, consent
4		order, or default.
5		Any final order, decision, or other determination made,
6		issued or executed by the Director under the provisions of this
7		Article whereby any person is aggrieved shall be subject to
8		review in accordance with the provisions of the Administrative
9		Review Law, and the rules adopted pursuant thereto, which shall
10		apply to and govern all proceedings for the judicial review of
11		final administrative decisions of the Director.
12		Upon entry of a final administrative decision for repayment
13		of any benefits obtained by fraudulent means, or for any civil
14		penalties assessed, a lien shall attach to all property and
15		assets of such person, firm, corporation, association, agency,
16		institution, or other legal entity until the judgment is
17		satisfied.
18		Within 12 months of the effective date of this amendatory
19		Act of the 96th General Assembly, the Department of Healthcare
20		and Family Services will report to the General Assembly on the
21		number of fraud cases identified and pursued, and the fines
22		assessed and collected. The report will also include the
23		Department's analysis as to the use of private sector resources
24		to bring action, investigate, and collect monies owed.
25		(Source: P.A. 89-289, eff. 1-1-96.)

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1		(305 ILCS 5/11-5.1 new)
2		Sec. 11-5.1. Eligibility verification. Notwithstanding any
3		other provision of this Code, with respect to applications for
4		medical assistance provided under Article V of this Code,
5		eligibility shall be determined in a manner that ensures
6		program integrity and complies with federal laws and
7		regulations while minimizing unnecessary barriers to
8		enrollment. To this end, as soon as practicable, and unless the
9		Department receives written denial from the federal
10		government, this Section shall be implemented:
11		(a) The Department of Healthcare and Family Services or its
12		designees shall:
13		(1) By no later than July 1, 2011, require verification
14		of, at a minimum, one month's income from all sources
15		required for determining the eligibility of applicants for
16		medical assistance under this Code. Such verification
17		shall take the form of pay stubs, business or income and
18		expense records for self-employed persons, letters from
19		employers, and any other valid documentation of income
20		including data obtained electronically by the Department
21		or its designees from other sources as described in
22		subsection (b) of this Section.
23		(2) By no later than October 1, 2011, require
24		verification of, at a minimum, one month's income from all
25		sources required for determining the continued eligibility
26		of recipients at their annual review of eligibility for

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1		medical assistance under this Code. Such verification
2		shall take the form of pay stubs, business or income and
3		expense records for self-employed persons, letters from
4		employers, and any other valid documentation of income
5		including data obtained electronically by the Department
6		or its designees from other sources as described in
7		subsection (b) of this Section. The Department shall send a
8		notice to recipients at least 60 days prior to the end of
9		their period of eligibility that informs them of the
10		requirements for continued eligibility. If a recipient
11		does not fulfill the requirements for continued
12		eligibility by the deadline established in the notice a
13		notice of cancellation shall be issued to the recipient and
14		coverage shall end on the last day of the eligibility
15		period. A recipient's eligibility may be reinstated
16		without requiring a new application if the recipient
17		fulfills the requirements for continued eligibility prior
18		to the end of the month following the last date of
19		coverage. Nothing in this Section shall prevent an
20		individual whose coverage has been cancelled from
21		reapplying for health benefits at any time.
22		(3) By no later than July 1, 2011, require verification
23		of Illinois residency.
24		(b) The Department shall establish or continue cooperative
25		arrangements with the Social Security Administration, the
26		Illinois Secretary of State, the Department of Human Services,

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1		the Department of Revenue, the Department of Employment
2		Security, and any other appropriate entity to gain electronic
3		access, to the extent allowed by law, to information available
4		to those entities that may be appropriate for electronically
5		verifying any factor of eligibility for benefits under the
6		Program. Data relevant to eligibility shall be provided for no
7		other purpose than to verify the eligibility of new applicants
8		or current recipients of health benefits under the Program.
9		Data shall be requested or provided for any new applicant or
10		current recipient only insofar as that individual's
11		circumstances are relevant to that individual's or another
12		individual's eligibility.
13		(c) Within 90 days of the effective date of this amendatory
14		Act of the 96th General Assembly, the Department of Healthcare
15		and Family Services shall send notice to current recipients
16		informing them of the changes regarding their eligibility
17		verification.
18		(305 ILCS 5/11-26) (from Ch. 23, par. 11-26)
19		Sec. 11-26. Recipient's abuse of medical care;
20		restrictions on access to medical care.
21		(a) When the Department determines, on the basis of
22		statistical norms and medical judgment, that a medical care
23		recipient has received medical services in excess of need and
24		with such frequency or in such a manner as to constitute an
25		abuse of the recipient's medical care privileges, the

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1		recipient's access to medical care may be restricted.
2		(b) When the Department has determined that a recipient is
3		abusing his or her medical care privileges as described in this
4		Section, it may require that the recipient designate a primary
5		provider type primary care provider, primary care pharmacy, or
6		health maintenance organization of the recipient's own
7		choosing to assume responsibility for the recipient's care. For
8		the purposes of this subsection, "primary provider type" means
9		a primary care provider, primary care pharmacy, primary
10		dentist, primary podiatrist, or primary durable medical
11		equipment provider. Instead of requiring a recipient to make a
12		designation as provided in this subsection, the Department,
13		pursuant to rules adopted by the Department and without regard
14		to any choice of an entity that the recipient might otherwise
15		make, may initially designate a primary provider type provided
16		that the primary provider type is willing to provide that care
17		primary care provider, primary care pharmacy, or health
18		maintenance organization to assume responsibility for the
19		recipient's care, provided that the primary care provider,
20		primary care pharmacy, or health maintenance organization is
21		willing to provide that care.
22		(c) When the Department has requested that a recipient
23		designate a primary provider type primary care provider,
24		primary care pharmacy or health maintenance organization and
25		the recipient fails or refuses to do so, the Department may,
26		after a reasonable period of time, assign the recipient to a

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1		primary provider type of its own choice and determination,
2		provided such primary provider type is willing to provide such
3		care primary care provider, primary care pharmacy or health
4		maintenance organization of its own choice and determination,
5		provided such primary care provider, primary care pharmacy or
6		health maintenance organization is willing to provide such
7		care.
8		(d) When a recipient has been restricted to a designated
9		primary provider type primary care provider, primary care
10		pharmacy or health maintenance organization, the recipient may
11		change the primary provider type primary care provider, primary
12		care pharmacy or health maintenance organization:
13		(1) when the designated source becomes unavailable, as
14		the Department shall determine by rule; or
15		(2) when the designated primary provider type primary
16		care provider, primary care pharmacy or health maintenance
17		organization notifies the Department that it wishes to
18		withdraw from any obligation as primary provider type
19		primary care provider, primary care pharmacy or health
20		maintenance organization; or
21		(3) in other situations, as the Department shall
22		provide by rule.
23		The Department shall, by rule, establish procedures for
24		providing medical or pharmaceutical services when the
25		designated source becomes unavailable or wishes to withdraw
26		from any obligation as primary provider type primary care

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1		provider, primary care pharmacy or health maintenance
2		organization, shall, by rule, take into consideration the need
3		for emergency or temporary medical assistance and shall ensure
4		that the recipient has continuous and unrestricted access to
5		medical care from the date on which such unavailability or
6		withdrawal becomes effective until such time as the recipient
7		designates a primary provider type or a primary provider type
8		care source or a primary care source willing to provide such
9		care is designated by the Department consistent with
10		subsections (b) and (c) and such restriction becomes effective.
11		(e) Prior to initiating any action to restrict a
12		recipient's access to medical or pharmaceutical care, the
13		Department shall notify the recipient of its intended action.
14		Such notification shall be in writing and shall set forth the
15		reasons for and nature of the proposed action. In addition, the
16		notification shall:
17		(1) inform the recipient that (i) the recipient has a
18		right to designate a primary provider type primary care
19		provider, primary care pharmacy, or health maintenance
20		organization of the recipient's own choosing willing to
21		accept such designation and that the recipient's failure to
22		do so within a reasonable time may result in such
23		designation being made by the Department or (ii) the
24		Department has designated a primary provider type primary
25		care provider, primary care pharmacy, or health
26		maintenance organization to assume responsibility for the

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1		recipient's care; and
2		(2) inform the recipient that the recipient has a right
3		to appeal the Department's determination to restrict the
4		recipient's access to medical care and provide the
5		recipient with an explanation of how such appeal is to be
6		made. The notification shall also inform the recipient of
7		the circumstances under which unrestricted medical
8		eligibility shall continue until a decision is made on
9		appeal and that if the recipient chooses to appeal, the
10		recipient will be able to review the medical payment data
11		that was utilized by the Department to decide that the
12		recipient's access to medical care should be restricted.
13		(f) The Department shall, by rule or regulation, establish
14		procedures for appealing a determination to restrict a
15		recipient's access to medical care, which procedures shall, at
16		a minimum, provide for a reasonable opportunity to be heard
17		and, where the appeal is denied, for a written statement of the
18		reason or reasons for such denial.
19		(g) Except as otherwise provided in this subsection, when a
20		recipient has had his or her medical card restricted for 4 full
21		quarters (without regard to any period of ineligibility for
22		medical assistance under this Code, or any period for which the
23		recipient voluntarily terminates his or her receipt of medical
24		assistance, that may occur before the expiration of those 4
25		full quarters), the Department shall reevaluate the
26		recipient's medical usage to determine whether it is still in

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1		excess of need and with such frequency or in such a manner as
2		to constitute an abuse of the receipt of medical assistance. If
3		it is still in excess of need, the restriction shall be
4		continued for another 4 full quarters. If it is no longer in
5		excess of need, the restriction shall be discontinued. If a
6		recipient's access to medical care has been restricted under
7		this Section and the Department then determines, either at
8		reevaluation or after the restriction has been discontinued, to
9		restrict the recipient's access to medical care a second or
10		subsequent time, the second or subsequent restriction may be
11		imposed for a period of more than 4 full quarters. If the
12		Department restricts a recipient's access to medical care for a
13		period of more than 4 full quarters, as determined by rule, the
14		Department shall reevaluate the recipient's medical usage
15		after the end of the restriction period rather than after the
16		end of 4 full quarters. The Department shall notify the
17		recipient, in writing, of any decision to continue the
18		restriction and the reason or reasons therefor. A "quarter",
19		for purposes of this Section, shall be defined as one of the
20		following 3-month periods of time: January-March, April-June,
21		July-September or October-December.
22		(h) In addition to any other recipient whose acquisition of
23		medical care is determined to be in excess of need, the
24		Department may restrict the medical care privileges of the
25		following persons:
26		(1) recipients found to have loaned or altered their

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1		cards or misused or falsely represented medical coverage;
2		(2) recipients found in possession of blank or forged
3		prescription pads;
4		(3) recipients who knowingly assist providers in
5		rendering excessive services or defrauding the medical
6		assistance program.
7		The procedural safeguards in this Section shall apply to
8		the above individuals.
9		(i) Restrictions under this Section shall be in addition to
10		and shall not in any way be limited by or limit any actions
11		taken under Article VIII-A of this Code.
12		(Source: P.A. 88-554, eff. 7-26-94.)
13		(305 ILCS 5/5-5.15 rep.)
14		Section 45. The Illinois Public Aid Code is amended by
15		repealing Section 5-5.15.
16		Section 50. The Illinois Vehicle Code is amended by
17		changing Section 2-123 as follows:
18		(625 ILCS 5/2-123) (from Ch. 95 1/2, par. 2-123)
19		Sec. 2-123. Sale and Distribution of Information.
20		(a) Except as otherwise provided in this Section, the
21		Secretary may make the driver's license, vehicle and title
22		registration lists, in part or in whole, and any statistical
23		information derived from these lists available to local

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1		governments, elected state officials, state educational
2		institutions, and all other governmental units of the State and
3		Federal Government requesting them for governmental purposes.
4		The Secretary shall require any such applicant for services to
5		pay for the costs of furnishing such services and the use of
6		the equipment involved, and in addition is empowered to
7		establish prices and charges for the services so furnished and
8		for the use of the electronic equipment utilized.
9		(b) The Secretary is further empowered to and he may, in
10		his discretion, furnish to any applicant, other than listed in
11		subsection (a) of this Section, vehicle or driver data on a
12		computer tape, disk, other electronic format or computer
13		processable medium, or printout at a fixed fee of $250 for
14		orders received before October 1, 2003 and $500 for orders
15		received on or after October 1, 2003, in advance, and require
16		in addition a further sufficient deposit based upon the
17		Secretary of State's estimate of the total cost of the
18		information requested and a charge of $25 for orders received
19		before October 1, 2003 and $50 for orders received on or after
20		October 1, 2003, per 1,000 units or part thereof identified or
21		the actual cost, whichever is greater. The Secretary is
22		authorized to refund any difference between the additional
23		deposit and the actual cost of the request. This service shall
24		not be in lieu of an abstract of a driver's record nor of a
25		title or registration search. This service may be limited to
26		entities purchasing a minimum number of records as required by

HB5420 Enrolled - 87 - LRB096 18878 JDS 34265 b
1		administrative rule. The information sold pursuant to this
2		subsection shall be the entire vehicle or driver data list, or
3		part thereof. The information sold pursuant to this subsection
4		shall not contain personally identifying information unless
5		the information is to be used for one of the purposes
6		identified in subsection (f-5) of this Section. Commercial
7		purchasers of driver and vehicle record databases shall enter
8		into a written agreement with the Secretary of State that
9		includes disclosure of the commercial use of the information to
10		be purchased.
11		(b-1) The Secretary is further empowered to and may, in his
12		or her discretion, furnish vehicle or driver data on a computer
13		tape, disk, or other electronic format or computer processible
14		medium, at no fee, to any State or local governmental agency
15		that uses the information provided by the Secretary to transmit
16		data back to the Secretary that enables the Secretary to
17		maintain accurate driving records, including dispositions of
18		traffic cases. This information may be provided without fee not
19		more often than once every 6 months.
20		(c) Secretary of State may issue registration lists. The
21		Secretary of State may compile a list of all registered
22		vehicles. Each list of registered vehicles shall be arranged
23		serially according to the registration numbers assigned to
24		registered vehicles and may contain in addition the names and
25		addresses of registered owners and a brief description of each
26		vehicle including the serial or other identifying number

HB5420 Enrolled - 88 - LRB096 18878 JDS 34265 b
1		thereof. Such compilation may be in such form as in the
2		discretion of the Secretary of State may seem best for the
3		purposes intended.
4		(d) The Secretary of State shall furnish no more than 2
5		current available lists of such registrations to the sheriffs
6		of all counties and to the chiefs of police of all cities and
7		villages and towns of 2,000 population and over in this State
8		at no cost. Additional copies may be purchased by the sheriffs
9		or chiefs of police at the fee of $500 each or at the cost of
10		producing the list as determined by the Secretary of State.
11		Such lists are to be used for governmental purposes only.
12		(e) (Blank).
13		(e-1) (Blank).
14		(f) The Secretary of State shall make a title or
15		registration search of the records of his office and a written
16		report on the same for any person, upon written application of
17		such person, accompanied by a fee of $5 for each registration
18		or title search. The written application shall set forth the
19		intended use of the requested information. No fee shall be
20		charged for a title or registration search, or for the
21		certification thereof requested by a government agency. The
22		report of the title or registration search shall not contain
23		personally identifying information unless the request for a
24		search was made for one of the purposes identified in
25		subsection (f-5) of this Section. The report of the title or
26		registration search shall not contain highly restricted

HB5420 Enrolled - 89 - LRB096 18878 JDS 34265 b
1		personal information unless specifically authorized by this
2		Code.
3		The Secretary of State shall certify a title or
4		registration record upon written request. The fee for
5		certification shall be $5 in addition to the fee required for a
6		title or registration search. Certification shall be made under
7		the signature of the Secretary of State and shall be
8		authenticated by Seal of the Secretary of State.
9		The Secretary of State may notify the vehicle owner or
10		registrant of the request for purchase of his title or
11		registration information as the Secretary deems appropriate.
12		No information shall be released to the requestor until
13		expiration of a 10 day period. This 10 day period shall not
14		apply to requests for information made by law enforcement
15		officials, government agencies, financial institutions,
16		attorneys, insurers, employers, automobile associated
17		businesses, persons licensed as a private detective or firms
18		licensed as a private detective agency under the Private
19		Detective, Private Alarm, Private Security, Fingerprint
20		Vendor, and Locksmith Act of 2004, who are employed by or are
21		acting on behalf of law enforcement officials, government
22		agencies, financial institutions, attorneys, insurers,
23		employers, automobile associated businesses, and other
24		business entities for purposes consistent with the Illinois
25		Vehicle Code, the vehicle owner or registrant or other entities
26		as the Secretary may exempt by rule and regulation.

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1		Any misrepresentation made by a requestor of title or
2		vehicle information shall be punishable as a petty offense,
3		except in the case of persons licensed as a private detective
4		or firms licensed as a private detective agency which shall be
5		subject to disciplinary sanctions under Section 40-10 of the
6		Private Detective, Private Alarm, Private Security,
7		Fingerprint Vendor, and Locksmith Act of 2004.
8		(f-5) The Secretary of State shall not disclose or
9		otherwise make available to any person or entity any personally
10		identifying information obtained by the Secretary of State in
11		connection with a driver's license, vehicle, or title
12		registration record unless the information is disclosed for one
13		of the following purposes:
14		(1) For use by any government agency, including any
15		court or law enforcement agency, in carrying out its
16		functions, or any private person or entity acting on behalf
17		of a federal, State, or local agency in carrying out its
18		functions.
19		(2) For use in connection with matters of motor vehicle
20		or driver safety and theft; motor vehicle emissions; motor
21		vehicle product alterations, recalls, or advisories;
22		performance monitoring of motor vehicles, motor vehicle
23		parts, and dealers; and removal of non-owner records from
24		the original owner records of motor vehicle manufacturers.
25		(3) For use in the normal course of business by a
26		legitimate business or its agents, employees, or

HB5420 Enrolled - 91 - LRB096 18878 JDS 34265 b
1		contractors, but only:
2		(A) to verify the accuracy of personal information
3		submitted by an individual to the business or its
4		agents, employees, or contractors; and
5		(B) if such information as so submitted is not
6		correct or is no longer correct, to obtain the correct
7		information, but only for the purposes of preventing
8		fraud by, pursuing legal remedies against, or
9		recovering on a debt or security interest against, the
10		individual.
11		(4) For use in research activities and for use in
12		producing statistical reports, if the personally
13		identifying information is not published, redisclosed, or
14		used to contact individuals.
15		(5) For use in connection with any civil, criminal,
16		administrative, or arbitral proceeding in any federal,
17		State, or local court or agency or before any
18		self-regulatory body, including the service of process,
19		investigation in anticipation of litigation, and the
20		execution or enforcement of judgments and orders, or
21		pursuant to an order of a federal, State, or local court.
22		(6) For use by any insurer or insurance support
23		organization or by a self-insured entity or its agents,
24		employees, or contractors in connection with claims
25		investigation activities, antifraud activities, rating, or
26		underwriting.

HB5420 Enrolled - 92 - LRB096 18878 JDS 34265 b
1		(7) For use in providing notice to the owners of towed
2		or impounded vehicles.
3		(8) For use by any person licensed as a private
4		detective or firm licensed as a private detective agency
5		under the Private Detective, Private Alarm, Private
6		Security, Fingerprint Vendor, and Locksmith Act of 2004,
7		private investigative agency or security service licensed
8		in Illinois for any purpose permitted under this
9		subsection.
10		(9) For use by an employer or its agent or insurer to
11		obtain or verify information relating to a holder of a
12		commercial driver's license that is required under chapter
13		313 of title 49 of the United States Code.
14		(10) For use in connection with the operation of
15		private toll transportation facilities.
16		(11) For use by any requester, if the requester
17		demonstrates it has obtained the written consent of the
18		individual to whom the information pertains.
19		(12) For use by members of the news media, as defined
20		in Section 1-148.5, for the purpose of newsgathering when
21		the request relates to the operation of a motor vehicle or
22		public safety.
23		(13) For any other use specifically authorized by law,
24		if that use is related to the operation of a motor vehicle
25		or public safety.
26		(f-6) The Secretary of State shall not disclose or

HB5420 Enrolled - 93 - LRB096 18878 JDS 34265 b
1		otherwise make available to any person or entity any highly
2		restricted personal information obtained by the Secretary of
3		State in connection with a driver's license, vehicle, or title
4		registration record unless specifically authorized by this
5		Code.
6		(g) 1. The Secretary of State may, upon receipt of a
7		written request and a fee of $6 before October 1, 2003 and
8		a fee of $12 on and after October 1, 2003, furnish to the
9		person or agency so requesting a driver's record. Such
10		document may include a record of: current driver's license
11		issuance information, except that the information on
12		judicial driving permits shall be available only as
13		otherwise provided by this Code; convictions; orders
14		entered revoking, suspending or cancelling a driver's
15		license or privilege; and notations of accident
16		involvement. All other information, unless otherwise
17		permitted by this Code, shall remain confidential.
18		Information released pursuant to a request for a driver's
19		record shall not contain personally identifying
20		information, unless the request for the driver's record was
21		made for one of the purposes set forth in subsection (f-5)
22		of this Section. The Secretary of State may, without fee,
23		allow a parent or guardian of a person under the age of 18
24		years, who holds an instruction permit or graduated
25		driver's license, to view that person's driving record
26		online, through a computer connection. The parent or

HB5420 Enrolled - 94 - LRB096 18878 JDS 34265 b
1		guardian's online access to the driving record will
2		terminate when the instruction permit or graduated
3		driver's license holder reaches the age of 18.
4		2. The Secretary of State shall not disclose or
5		otherwise make available to any person or entity any highly
6		restricted personal information obtained by the Secretary
7		of State in connection with a driver's license, vehicle, or
8		title registration record unless specifically authorized
9		by this Code. The Secretary of State may certify an
10		abstract of a driver's record upon written request
11		therefor. Such certification shall be made under the
12		signature of the Secretary of State and shall be
13		authenticated by the Seal of his office.
14		3. All requests for driving record information shall be
15		made in a manner prescribed by the Secretary and shall set
16		forth the intended use of the requested information.
17		The Secretary of State may notify the affected driver
18		of the request for purchase of his driver's record as the
19		Secretary deems appropriate.
20		No information shall be released to the requester until
21		expiration of a 10 day period. This 10 day period shall not
22		apply to requests for information made by law enforcement
23		officials, government agencies, financial institutions,
24		attorneys, insurers, employers, automobile associated
25		businesses, persons licensed as a private detective or
26		firms licensed as a private detective agency under the

HB5420 Enrolled - 95 - LRB096 18878 JDS 34265 b
1		Private Detective, Private Alarm, Private Security,
2		Fingerprint Vendor, and Locksmith Act of 2004, who are
3		employed by or are acting on behalf of law enforcement
4		officials, government agencies, financial institutions,
5		attorneys, insurers, employers, automobile associated
6		businesses, and other business entities for purposes
7		consistent with the Illinois Vehicle Code, the affected
8		driver or other entities as the Secretary may exempt by
9		rule and regulation.
10		Any misrepresentation made by a requestor of driver
11		information shall be punishable as a petty offense, except
12		in the case of persons licensed as a private detective or
13		firms licensed as a private detective agency which shall be
14		subject to disciplinary sanctions under Section 40-10 of
15		the Private Detective, Private Alarm, Private Security,
16		Fingerprint Vendor, and Locksmith Act of 2004.
17		4. The Secretary of State may furnish without fee, upon
18		the written request of a law enforcement agency, any
19		information from a driver's record on file with the
20		Secretary of State when such information is required in the
21		enforcement of this Code or any other law relating to the
22		operation of motor vehicles, including records of
23		dispositions; documented information involving the use of
24		a motor vehicle; whether such individual has, or previously
25		had, a driver's license; and the address and personal
26		description as reflected on said driver's record.

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1		5. Except as otherwise provided in this Section, the
2		Secretary of State may furnish, without fee, information
3		from an individual driver's record on file, if a written
4		request therefor is submitted by any public transit system
5		or authority, public defender, law enforcement agency, a
6		state or federal agency, or an Illinois local
7		intergovernmental association, if the request is for the
8		purpose of a background check of applicants for employment
9		with the requesting agency, or for the purpose of an
10		official investigation conducted by the agency, or to
11		determine a current address for the driver so public funds
12		can be recovered or paid to the driver, or for any other
13		purpose set forth in subsection (f-5) of this Section.
14		The Secretary may also furnish the courts a copy of an
15		abstract of a driver's record, without fee, subsequent to
16		an arrest for a violation of Section 11-501 or a similar
17		provision of a local ordinance. Such abstract may include
18		records of dispositions; documented information involving
19		the use of a motor vehicle as contained in the current
20		file; whether such individual has, or previously had, a
21		driver's license; and the address and personal description
22		as reflected on said driver's record.
23		6. Any certified abstract issued by the Secretary of
24		State or transmitted electronically by the Secretary of
25		State pursuant to this Section, to a court or on request of
26		a law enforcement agency, for the record of a named person

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1		as to the status of the person's driver's license shall be
2		prima facie evidence of the facts therein stated and if the
3		name appearing in such abstract is the same as that of a
4		person named in an information or warrant, such abstract
5		shall be prima facie evidence that the person named in such
6		information or warrant is the same person as the person
7		named in such abstract and shall be admissible for any
8		prosecution under this Code and be admitted as proof of any
9		prior conviction or proof of records, notices, or orders
10		recorded on individual driving records maintained by the
11		Secretary of State.
12		7. Subject to any restrictions contained in the
13		Juvenile Court Act of 1987, and upon receipt of a proper
14		request and a fee of $6 before October 1, 2003 and a fee of
15		$12 on or after October 1, 2003, the Secretary of State
16		shall provide a driver's record to the affected driver, or
17		the affected driver's attorney, upon verification. Such
18		record shall contain all the information referred to in
19		paragraph 1 of this subsection (g) plus: any recorded
20		accident involvement as a driver; information recorded
21		pursuant to subsection (e) of Section 6-117 and paragraph
22		(4) of subsection (a) of Section 6-204 of this Code. All
23		other information, unless otherwise permitted by this
24		Code, shall remain confidential.
25		(h) The Secretary shall not disclose social security
26		numbers or any associated information obtained from the Social

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1		Security Administration except pursuant to a written request
2		by, or with the prior written consent of, the individual
3		except: (1) to officers and employees of the Secretary who have
4		a need to know the social security numbers in performance of
5		their official duties, (2) to law enforcement officials for a
6		lawful, civil or criminal law enforcement investigation, and if
7		the head of the law enforcement agency has made a written
8		request to the Secretary specifying the law enforcement
9		investigation for which the social security numbers are being
10		sought, (3) to the United States Department of Transportation,
11		or any other State, pursuant to the administration and
12		enforcement of the Commercial Motor Vehicle Safety Act of 1986,
13		(4) pursuant to the order of a court of competent jurisdiction,
14		(5) to the Department of Healthcare and Family Services
15		(formerly Department of Public Aid) for utilization in the
16		child support enforcement duties assigned to that Department
17		under provisions of the Illinois Public Aid Code after the
18		individual has received advanced meaningful notification of
19		what redisclosure is sought by the Secretary in accordance with
20		the federal Privacy Act, (5.5) to the Department of Healthcare
21		and Family Services and the Department of Human Services solely
22		for the purpose of verifying Illinois residency where such
23		residency is an eligibility requirement for benefits under the
24		Illinois Public Aid Code or any other health benefit program
25		administered by the Department of Healthcare and Family
26		Services or the Department of Human Services, or (6) to the

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1		Illinois Department of Revenue solely for use by the Department
2		in the collection of any tax or debt that the Department of
3		Revenue is authorized or required by law to collect, provided
4		that the Department shall not disclose the social security
5		number to any person or entity outside of the Department.
6		(i) (Blank).
7		(j) Medical statements or medical reports received in the
8		Secretary of State's Office shall be confidential. No
9		confidential information may be open to public inspection or
10		the contents disclosed to anyone, except officers and employees
11		of the Secretary who have a need to know the information
12		contained in the medical reports and the Driver License Medical
13		Advisory Board, unless so directed by an order of a court of
14		competent jurisdiction.
15		(k) All fees collected under this Section shall be paid
16		into the Road Fund of the State Treasury, except that (i) for
17		fees collected before October 1, 2003, $3 of the $6 fee for a
18		driver's record shall be paid into the Secretary of State
19		Special Services Fund, (ii) for fees collected on and after
20		October 1, 2003, of the $12 fee for a driver's record, $3 shall
21		be paid into the Secretary of State Special Services Fund and
22		$6 shall be paid into the General Revenue Fund, and (iii) for
23		fees collected on and after October 1, 2003, 50% of the amounts
24		collected pursuant to subsection (b) shall be paid into the
25		General Revenue Fund.
26		(l) (Blank).

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1		(m) Notations of accident involvement that may be disclosed
2		under this Section shall not include notations relating to
3		damage to a vehicle or other property being transported by a
4		tow truck. This information shall remain confidential,
5		provided that nothing in this subsection (m) shall limit
6		disclosure of any notification of accident involvement to any
7		law enforcement agency or official.
8		(n) Requests made by the news media for driver's license,
9		vehicle, or title registration information may be furnished
10		without charge or at a reduced charge, as determined by the
11		Secretary, when the specific purpose for requesting the
12		documents is deemed to be in the public interest. Waiver or
13		reduction of the fee is in the public interest if the principal
14		purpose of the request is to access and disseminate information
15		regarding the health, safety, and welfare or the legal rights
16		of the general public and is not for the principal purpose of
17		gaining a personal or commercial benefit. The information
18		provided pursuant to this subsection shall not contain
19		personally identifying information unless the information is
20		to be used for one of the purposes identified in subsection
21		(f-5) of this Section.
22		(o) The redisclosure of personally identifying information
23		obtained pursuant to this Section is prohibited, except to the
24		extent necessary to effectuate the purpose for which the
25		original disclosure of the information was permitted.
26		(p) The Secretary of State is empowered to adopt rules to

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1		effectuate this Section.
2		(Source: P.A. 95-201, eff. 1-1-08; 95-287, eff. 1-1-08; 95-331,
3		eff. 8-21-07; 95-613, eff. 9-11-07; 95-876, eff. 8-21-08;
4		96-1383, eff. 1-1-11.)
5		Section 95. Severability. If any provision of this Act or
6		application thereof to any person or circumstance is held
7		invalid, such invalidity does not affect other provisions or
8		applications of this Act which can be given effect without the
9		invalid application or provision, and to this end the
10		provisions of this Act are declared to be severable.
11		Section 99. Effective date. This Act takes effect upon
12		becoming law.