Bill Text: IL HB6173 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Provides that the 2-year moratorium on eligibility expansions does not apply to expansions approved by the federal government that are financed entirely by units of local government and federal matching funds. Regarding classes of persons eligible under the Medical Assistance Program, deletes provisions extending eligibility to persons who are under age 21 and would qualify as disabled as defined under the Federal SSI Program, under certain conditions. Regarding eligibility under the Family Care program, provides that on and after July 1, 2012 (rather than through December 31, 2013), eligibility shall extend to a caretaker relative who is 19 years of age or older when countable income is at or below 133% (rather than 185%) of the Federal Poverty Level Guidelines for the appropriate family size. Makes other changes regarding eligibility under the Family Care program. Extends eligibility to persons who, pursuant to a waiver approved by the Secretary of the U.S. Department of Health and Human Services, are eligible for medical assistance under Title XIX or XXI of the Social Security Act. Permits the Department of Healthcare and Family Services to adopt rules concerning the waiver program. Provides that if the United States Supreme Court holds Title II, Subtitle A, Section 2001(a) of Public Law 111-148 to be unconstitutional, or if a holding of Public Law 111-148 makes Medicaid eligibility allowed under Section 2001(a) inoperable, or if an Act of Congress that becomes a Public Law eliminates Section 2001(a) of Public Law 111-148, the State or a unit of local government shall be prohibited from enrolling individuals in the Medical Assistance Program as the result of federal approval of a State Medicaid waiver on or after the effective date of this amendatory Act. Makes other changes. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-01-08 - Session Sine Die [HB6173 Detail]

Download: Illinois-2011-HB6173-Introduced.html

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97TH GENERAL ASSEMBLY State of Illinois 2011 and 2012 HB6173 Introduced , by Rep. André M. Thapedi SYNOPSIS AS INTRODUCED:
See Index
Amends the Illinois Public Aid Code. Provides that the 2-year moratorium on eligibility expansions does not apply to expansions approved by the federal government that are financed entirely by units of local government and federal matching funds. Regarding classes of persons eligible under the Medical Assistance Program, deletes provisions extending eligibility to persons who are under age 21 and would qualify as disabled as defined under the Federal SSI Program, under certain conditions. Regarding eligibility under the Family Care program, provides that on and after July 1, 2012 (rather than through December 31, 2013), eligibility shall extend to a caretaker relative who is 19 years of age or older when countable income is at or below 133% (rather than 185%) of the Federal Poverty Level Guidelines for the appropriate family size. Makes other changes regarding eligibility under the Family Care program. Extends eligibility to persons who, pursuant to a waiver approved by the Secretary of the U.S. Department of Health and Human Services, are eligible for medical assistance under Title XIX or XXI of the Social Security Act. Permits the Department of Healthcare and Family Services to adopt rules concerning the waiver program. Provides that if the United States Supreme Court holds Title II, Subtitle A, Section 2001(a) of Public Law 111-148 to be unconstitutional, or if a holding of Public Law 111-148 makes Medicaid eligibility allowed under Section 2001(a) inoperable, or if an Act of Congress that becomes a Public Law eliminates Section 2001(a) of Public Law 111-148, the State or a unit of local government shall be prohibited from enrolling individuals in the Medical Assistance Program as the result of federal approval of a State Medicaid waiver on or after the effective date of this amendatory Act. Makes other changes. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Sections 5-1.4, 5-2.03, 5-2, 15-1, 15-2, 15-5, and
15-11 as follows:
(305 ILCS 5/5-1.4)
Sec. 5-1.4. Moratorium on eligibility expansions.
Beginning on the effective date of this amendatory Act of the
96th General Assembly, there shall be a 2-year moratorium on
the expansion of eligibility through increasing financial
eligibility standards, or through increasing income
disregards, or through the creation of new programs which would
add new categories of eligible individuals under the medical
assistance program in addition to those categories covered on
January 1, 2011. This moratorium shall not apply to expansions
required as a federal condition of State participation in the
medical assistance program or to expansions approved by the
federal government that are financed entirely by units of local
government and federal matching funds. If the State of Illinois
finds that the State has borne a cost related to such an
expansion, the unit of local government shall reimburse the
State. All federal funds associated with an expansion funded by

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a unit of local government shall be returned to the health care
provider. Within 10 calendar days of the effective date of this
amendatory Act of the 97th General Assembly, the Department of
Healthcare and Family Services shall formally advise the
Centers for Medicare and Medicaid Services of the passage of
this amendatory Act of the 97th General Assembly. The State is
prohibited from submitting additional waiver requests that
expand or allow for an increase in the classes of persons
eligible for medical assistance under this Article to the
federal government for its consideration beginning on the 20th
calendar day following the effective date of this amendatory
Act of the 97th General Assembly until January 25, 2013.
(Source: P.A. 96-1501, eff. 1-25-11.)
(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
Sec. 5-2. Classes of Persons Eligible. Medical assistance
under this Article shall be available to any of the following
classes of persons in respect to whom a plan for coverage has
been submitted to the Governor by the Illinois Department and
approved by him:
1. Recipients of basic maintenance grants under
Articles III and IV.
2. Persons otherwise eligible for basic maintenance
under Articles III and IV, excluding any eligibility
requirements that are inconsistent with any federal law or
federal regulation, as interpreted by the U.S. Department

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of Health and Human Services, but who fail to qualify
thereunder on the basis of need or who qualify but are not
receiving basic maintenance under Article IV, and who have
insufficient income and resources to meet the costs of
necessary medical care, including but not limited to the
following:
(a) All persons otherwise eligible for basic
maintenance under Article III but who fail to qualify
under that Article on the basis of need and who meet
either of the following requirements:
(i) their income, as determined by the
Illinois Department in accordance with any federal
requirements, is equal to or less than 70% in
fiscal year 2001, equal to or less than 85% in
fiscal year 2002 and until a date to be determined
by the Department by rule, and equal to or less
than 100% beginning on the date determined by the
Department by rule, of the nonfarm income official
poverty line, as defined by the federal Office of
Management and Budget and revised annually in
accordance with Section 673(2) of the Omnibus
Budget Reconciliation Act of 1981, applicable to
families of the same size; or
(ii) their income, after the deduction of
costs incurred for medical care and for other types
of remedial care, is equal to or less than 70% in

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fiscal year 2001, equal to or less than 85% in
fiscal year 2002 and until a date to be determined
by the Department by rule, and equal to or less
than 100% beginning on the date determined by the
Department by rule, of the nonfarm income official
poverty line, as defined in item (i) of this
subparagraph (a).
(b) All persons who, excluding any eligibility
requirements that are inconsistent with any federal
law or federal regulation, as interpreted by the U.S.
Department of Health and Human Services, would be
determined eligible for such basic maintenance under
Article IV by disregarding the maximum earned income
permitted by federal law.
3. Persons who would otherwise qualify for Aid to the
Medically Indigent under Article VII.
4. Persons not eligible under any of the preceding
paragraphs who fall sick, are injured, or die, not having
sufficient money, property or other resources to meet the
costs of necessary medical care or funeral and burial
expenses.
5.(a) Women during pregnancy, after the fact of
pregnancy has been determined by medical diagnosis, and
during the 60-day period beginning on the last day of the
pregnancy, together with their infants and children born
after September 30, 1983, whose income and resources are

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insufficient to meet the costs of necessary medical care to
the maximum extent possible under Title XIX of the Federal
Social Security Act.
(b) The Illinois Department and the Governor shall
provide a plan for coverage of the persons eligible under
paragraph 5(a) by April 1, 1990. Such plan shall provide
ambulatory prenatal care to pregnant women during a
presumptive eligibility period and establish an income
eligibility standard that is equal to 133% of the nonfarm
income official poverty line, as defined by the federal
Office of Management and Budget and revised annually in
accordance with Section 673(2) of the Omnibus Budget
Reconciliation Act of 1981, applicable to families of the
same size, provided that costs incurred for medical care
are not taken into account in determining such income
eligibility.
(c) The Illinois Department may conduct a
demonstration in at least one county that will provide
medical assistance to pregnant women, together with their
infants and children up to one year of age, where the
income eligibility standard is set up to 185% of the
nonfarm income official poverty line, as defined by the
federal Office of Management and Budget. The Illinois
Department shall seek and obtain necessary authorization
provided under federal law to implement such a
demonstration. Such demonstration may establish resource

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standards that are not more restrictive than those
established under Article IV of this Code.
6. Persons under the age of 18 who fail to qualify as
dependent under Article IV and who have insufficient income
and resources to meet the costs of necessary medical care
to the maximum extent permitted under Title XIX of the
Federal Social Security Act.
7. (Blank). Persons who are under 21 years of age and
would qualify as disabled as defined under the Federal
Supplemental Security Income Program, provided medical
service for such persons would be eligible for Federal
Financial Participation, and provided the Illinois
Department determines that:
(a) the person requires a level of care provided by
a hospital, skilled nursing facility, or intermediate
care facility, as determined by a physician licensed to
practice medicine in all its branches;
(b) it is appropriate to provide such care outside
of an institution, as determined by a physician
licensed to practice medicine in all its branches;
(c) the estimated amount which would be expended
for care outside the institution is not greater than
the estimated amount which would be expended in an
institution.
8. Persons who become ineligible for basic maintenance
assistance under Article IV of this Code in programs

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administered by the Illinois Department due to employment
earnings and persons in assistance units comprised of
adults and children who become ineligible for basic
maintenance assistance under Article VI of this Code due to
employment earnings. The plan for coverage for this class
of persons shall:
(a) extend the medical assistance coverage for up
to 12 months following termination of basic
maintenance assistance; and
(b) offer persons who have initially received 6
months of the coverage provided in paragraph (a) above,
the option of receiving an additional 6 months of
coverage, subject to the following:
(i) such coverage shall be pursuant to
provisions of the federal Social Security Act;
(ii) such coverage shall include all services
covered while the person was eligible for basic
maintenance assistance;
(iii) no premium shall be charged for such
coverage; and
(iv) such coverage shall be suspended in the
event of a person's failure without good cause to
file in a timely fashion reports required for this
coverage under the Social Security Act and
coverage shall be reinstated upon the filing of
such reports if the person remains otherwise

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eligible.
9. Persons with acquired immunodeficiency syndrome
(AIDS) or with AIDS-related conditions with respect to whom
there has been a determination that but for home or
community-based services such individuals would require
the level of care provided in an inpatient hospital,
skilled nursing facility or intermediate care facility the
cost of which is reimbursed under this Article. Assistance
shall be provided to such persons to the maximum extent
permitted under Title XIX of the Federal Social Security
Act.
10. Participants in the long-term care insurance
partnership program established under the Illinois
Long-Term Care Partnership Program Act who meet the
qualifications for protection of resources described in
Section 15 of that Act.
11. Persons with disabilities who are employed and
eligible for Medicaid, pursuant to Section
1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
subject to federal approval, persons with a medically
improved disability who are employed and eligible for
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
the Social Security Act, as provided by the Illinois
Department by rule. In establishing eligibility standards
under this paragraph 11, the Department shall, subject to
federal approval:

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(a) set the income eligibility standard at not
lower than 350% of the federal poverty level;
(b) exempt retirement accounts that the person
cannot access without penalty before the age of 59 1/2,
and medical savings accounts established pursuant to
26 U.S.C. 220;
(c) allow non-exempt assets up to $25,000 as to
those assets accumulated during periods of eligibility
under this paragraph 11; and
(d) continue to apply subparagraphs (b) and (c) in
determining the eligibility of the person under this
Article even if the person loses eligibility under this
paragraph 11.
12. Subject to federal approval, persons who are
eligible for medical assistance coverage under applicable
provisions of the federal Social Security Act and the
federal Breast and Cervical Cancer Prevention and
Treatment Act of 2000. Those eligible persons are defined
to include, but not be limited to, the following persons:
(1) persons who have been screened for breast or
cervical cancer under the U.S. Centers for Disease
Control and Prevention Breast and Cervical Cancer
Program established under Title XV of the federal
Public Health Services Act in accordance with the
requirements of Section 1504 of that Act as
administered by the Illinois Department of Public

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Health; and
(2) persons whose screenings under the above
program were funded in whole or in part by funds
appropriated to the Illinois Department of Public
Health for breast or cervical cancer screening.
"Medical assistance" under this paragraph 12 shall be
identical to the benefits provided under the State's
approved plan under Title XIX of the Social Security Act.
The Department must request federal approval of the
coverage under this paragraph 12 within 30 days after the
effective date of this amendatory Act of the 92nd General
Assembly.
In addition to the persons who are eligible for medical
assistance pursuant to subparagraphs (1) and (2) of this
paragraph 12, and to be paid from funds appropriated to the
Department for its medical programs, any uninsured person
as defined by the Department in rules residing in Illinois
who is younger than 65 years of age, who has been screened
for breast and cervical cancer in accordance with standards
and procedures adopted by the Department of Public Health
for screening, and who is referred to the Department by the
Department of Public Health as being in need of treatment
for breast or cervical cancer is eligible for medical
assistance benefits that are consistent with the benefits
provided to those persons described in subparagraphs (1)
and (2). Medical assistance coverage for the persons who

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are eligible under the preceding sentence is not dependent
on federal approval, but federal moneys may be used to pay
for services provided under that coverage upon federal
approval.
13. Subject to appropriation and to federal approval,
persons living with HIV/AIDS who are not otherwise eligible
under this Article and who qualify for services covered
under Section 5-5.04 as provided by the Illinois Department
by rule.
14. Subject to the availability of funds for this
purpose, the Department may provide coverage under this
Article to persons who reside in Illinois who are not
eligible under any of the preceding paragraphs and who meet
the income guidelines of paragraph 2(a) of this Section and
(i) have an application for asylum pending before the
federal Department of Homeland Security or on appeal before
a court of competent jurisdiction and are represented
either by counsel or by an advocate accredited by the
federal Department of Homeland Security and employed by a
not-for-profit organization in regard to that application
or appeal, or (ii) are receiving services through a
federally funded torture treatment center. Medical
coverage under this paragraph 14 may be provided for up to
24 continuous months from the initial eligibility date so
long as an individual continues to satisfy the criteria of
this paragraph 14. If an individual has an appeal pending

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regarding an application for asylum before the Department
of Homeland Security, eligibility under this paragraph 14
may be extended until a final decision is rendered on the
appeal. The Department may adopt rules governing the
implementation of this paragraph 14.
15. Family Care Eligibility.
(a) On and after July 1, 2012 Through December 31,
2013, a caretaker relative who is 19 years of age or
older when countable income is at or below 133% 185% of
the Federal Poverty Level Guidelines, as published
annually in the Federal Register, for the appropriate
family size. Beginning January 1, 2014, a caretaker
relative who is 19 years of age or older when countable
income is at or below 133% of the Federal Poverty Level
Guidelines, as published annually in the Federal
Register, for the appropriate family size. A person may
not spend down to become eligible under this paragraph
15.
(b) Eligibility shall be reviewed annually.
(c) (Blank). Caretaker relatives enrolled under
this paragraph 15 in families with countable income
above 150% and at or below 185% of the Federal Poverty
Level Guidelines shall be counted as family members and
pay premiums as established under the Children's
Health Insurance Program Act.
(d) (Blank). Premiums shall be billed by and

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payable to the Department or its authorized agent, on a
monthly basis.
(e) (Blank). The premium due date is the last day
of the month preceding the month of coverage.
(f) (Blank). Individuals shall have a grace period
through 60 days of coverage to pay the premium.
(g) (Blank). Failure to pay the full monthly
premium by the last day of the grace period shall
result in termination of coverage.
(h) (Blank). Partial premium payments shall not be
refunded.
(i) Following termination of an individual's
coverage under this paragraph 15, the individual must
be determined eligible before the person can be
re-enrolled. following action is required before the
individual can be re-enrolled:
(1) A new application must be completed and the
individual must be determined otherwise eligible.
(2) There must be full payment of premiums due
under this Code, the Children's Health Insurance
Program Act, the Covering ALL KIDS Health
Insurance Act, or any other healthcare program
administered by the Department for periods in
which a premium was owed and not paid for the
individual.
(3) The first month's premium must be paid if

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there was an unpaid premium on the date the
individual's previous coverage was canceled.
The Department is authorized to implement the
provisions of this amendatory Act of the 95th General
Assembly by adopting the medical assistance rules in effect
as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
89 Ill. Admin. Code 120.32 along with only those changes
necessary to conform to federal Medicaid requirements,
federal laws, and federal regulations, including but not
limited to Section 1931 of the Social Security Act (42
U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
of Health and Human Services, and the countable income
eligibility standard authorized by this paragraph 15. The
Department may not otherwise adopt any rule to implement
this increase except as authorized by law, to meet the
eligibility standards authorized by the federal government
in the Medicaid State Plan or the Title XXI Plan, or to
meet an order from the federal government or any court.
16. Subject to appropriation, uninsured persons who
are not otherwise eligible under this Section who have been
certified and referred by the Department of Public Health
as having been screened and found to need diagnostic
evaluation or treatment, or both diagnostic evaluation and
treatment, for prostate or testicular cancer. For the
purposes of this paragraph 16, uninsured persons are those
who do not have creditable coverage, as defined under the

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Health Insurance Portability and Accountability Act, or
have otherwise exhausted any insurance benefits they may
have had, for prostate or testicular cancer diagnostic
evaluation or treatment, or both diagnostic evaluation and
treatment. To be eligible, a person must furnish a Social
Security number. A person's assets are exempt from
consideration in determining eligibility under this
paragraph 16. Such persons shall be eligible for medical
assistance under this paragraph 16 for so long as they need
treatment for the cancer. A person shall be considered to
need treatment if, in the opinion of the person's treating
physician, the person requires therapy directed toward
cure or palliation of prostate or testicular cancer,
including recurrent metastatic cancer that is a known or
presumed complication of prostate or testicular cancer and
complications resulting from the treatment modalities
themselves. Persons who require only routine monitoring
services are not considered to need treatment. "Medical
assistance" under this paragraph 16 shall be identical to
the benefits provided under the State's approved plan under
Title XIX of the Social Security Act. Notwithstanding any
other provision of law, the Department (i) does not have a
claim against the estate of a deceased recipient of
services under this paragraph 16 and (ii) does not have a
lien against any homestead property or other legal or
equitable real property interest owned by a recipient of

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services under this paragraph 16.
17. Persons who, pursuant to a waiver approved by the
Secretary of the U.S. Department of Health and Human
Services, are eligible for medical assistance under Title
XIX or XXI of the federal Social Security Act.
Notwithstanding any other provision of this Code and
consistent with the terms of the approved waiver, the
Illinois Department, may by rule:
(a) Limit the geographic areas in which the waiver
program operates.
(b) Determine the scope, quantity, duration, and
quality, and the rate and method of reimbursement, of
the medical services to be provided, which may differ
from those for other classes of persons eligible for
assistance under this Article.
(c) Restrict the persons' freedom in choice of
providers.
In implementing the provisions of Public Act 96-20, the
Department is authorized to adopt only those rules necessary,
including emergency rules. Nothing in Public Act 96-20 permits
the Department to adopt rules or issue a decision that expands
eligibility for the FamilyCare Program to a person whose income
exceeds 185% of the Federal Poverty Level as determined from
time to time by the U.S. Department of Health and Human
Services, unless the Department is provided with express
statutory authority.

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The Illinois Department and the Governor shall provide a
plan for coverage of the persons eligible under paragraph 7 as
soon as possible after July 1, 1984.
The eligibility of any such person for medical assistance
under this Article is not affected by the payment of any grant
under the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act or any distributions
or items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois
Income Tax Act. The Department shall by rule establish the
amounts of assets to be disregarded in determining eligibility
for medical assistance, which shall at a minimum equal the
amounts to be disregarded under the Federal Supplemental
Security Income Program. The amount of assets of a single
person to be disregarded shall not be less than $2,000, and the
amount of assets of a married couple to be disregarded shall
not be less than $3,000.
To the extent permitted under federal law, any person found
guilty of a second violation of Article VIIIA shall be
ineligible for medical assistance under this Article, as
provided in Section 8A-8.
The eligibility of any person for medical assistance under
this Article shall not be affected by the receipt by the person
of donations or benefits from fundraisers held for the person
in cases of serious illness, as long as neither the person nor
members of the person's family have actual control over the

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donations or benefits or the disbursement of the donations or
benefits.
Notwithstanding any other provision of this Code, if the
United States Supreme Court holds Title II, Subtitle A, Section
2001(a) of Public Law 111-148 to be unconstitutional, or if a
holding of Public Law 111-148 makes Medicaid eligibility
allowed under Section 2001(a) inoperable, the State or a unit
of local government shall be prohibited from enrolling
individuals in the Medical Assistance Program as the result of
federal approval of a State Medicaid waiver on or after the
effective date of this amendatory Act of the 97th General
Assembly, and any individuals enrolled in the Medical
Assistance Program pursuant to eligibility permitted as a
result of such a State Medicaid waiver shall become immediately
ineligible.
Notwithstanding any other provision of this Code, if an Act
of Congress that becomes a Public Law eliminates Section
2001(a) of Public Law 111-148, the State or a unit of local
government shall be prohibited from enrolling individuals in
the Medical Assistance Program as the result of federal
approval of a State Medicaid waiver on or after the effective
date of this amendatory Act of the 97th General Assembly, and
any individuals enrolled in the Medical Assistance Program
pursuant to eligibility permitted as a result of such a State
Medicaid waiver shall become immediately ineligible.
(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;

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96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
revised 10-4-11.)
(305 ILCS 5/5-2.03)
Sec. 5-2.03. Presumptive eligibility. Beginning on the
effective date of this amendatory Act of the 96th General
Assembly and except where federal law requires presumptive
eligibility, no adult may be presumed eligible for medical
assistance under this Code and the Department may not cover any
service rendered to an adult unless the adult has completed an
application for benefits, all required verifications have been
received, and the Department or its designee has found the
adult eligible for the date on which that service was provided.
Nothing in this Section shall apply to pregnant women or to
persons enrolled under the medical assistance program due to
expansions approved by the federal government that are financed
entirely by units of local government and federal matching
funds.
(Source: P.A. 96-1501, eff. 1-25-11.)
(305 ILCS 5/15-1) (from Ch. 23, par. 15-1)
Sec. 15-1. Definitions. As used in this Article, unless the
context requires otherwise:
(a) (Blank). "Base amount" means $108,800,000 multiplied

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by a fraction, the numerator of which is the number of days
represented by the payments in question and the denominator of
which is 365.
(a-5) "County provider" means a health care provider that
is, or is operated by, a county with a population greater than
3,000,000.
(b) "Fund" means the County Provider Trust Fund.
(c) "Hospital" or "County hospital" means a hospital, as
defined in Section 14-1 of this Code, which is a county
hospital located in a county of over 3,000,000 population.
(Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
(305 ILCS 5/15-2) (from Ch. 23, par. 15-2)
Sec. 15-2. County Provider Trust Fund.
(a) There is created in the State Treasury the County
Provider Trust Fund. Interest earned by the Fund shall be
credited to the Fund. The Fund shall not be used to replace any
funds appropriated to the Medicaid program by the General
Assembly.
(b) The Fund is created solely for the purposes of
receiving, investing, and distributing monies in accordance
with this Article XV. The Fund shall consist of:
(1) All monies collected or received by the Illinois
Department under Section 15-3 of this Code;
(2) All federal financial participation monies
received by the Illinois Department pursuant to Title XIX

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of the Social Security Act, 42 U.S.C. 1396b, attributable
to eligible expenditures made by the Illinois Department
pursuant to Section 15-5 of this Code;
(3) All federal moneys received by the Illinois
Department pursuant to Title XXI of the Social Security Act
attributable to eligible expenditures made by the Illinois
Department pursuant to Section 15-5 of this Code; and
(4) All other monies received by the Fund from any
source, including interest thereon.
(c) Disbursements from the Fund shall be by warrants drawn
by the State Comptroller upon receipt of vouchers duly executed
and certified by the Illinois Department and shall be made
only:
(1) For hospital inpatient care, hospital outpatient
care, care provided by other outpatient facilities
operated by a county, and disproportionate share hospital
adjustment payments made under Title XIX of the Social
Security Act and Article V of this Code as required by
Section 15-5 of this Code;
(1.5) For services provided or purchased by county
providers pursuant to Section 5-11 of this Code;
(2) For the reimbursement of administrative expenses
incurred by county providers on behalf of the Illinois
Department as permitted by Section 15-4 of this Code;
(3) For the reimbursement of monies received by the
Fund through error or mistake;

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(4) For the payment of administrative expenses
necessarily incurred by the Illinois Department or its
agent in performing the activities required by this Article
XV;
(5) For the payment of any amounts that are
reimbursable to the federal government, attributable
solely to the Fund, and required to be paid by State
warrant; and
(6) For hospital inpatient care, hospital outpatient
care, care provided by other outpatient facilities
operated by a county, and disproportionate share hospital
adjustment payments made under Title XXI of the Social
Security Act, pursuant to Section 15-5 of this Code.
(7) For medical care and related services provided
pursuant to a contract with a county.
(Source: P.A. 95-859, eff. 8-19-08.)
(305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
Sec. 15-5. Disbursements from the Fund.
(a) The monies in the Fund shall be disbursed only as
provided in Section 15-2 of this Code and as follows:
(1) To the extent that such costs are reimbursable
under federal law, to pay the county hospitals' inpatient
reimbursement rates based on actual costs incurred,
trended forward annually by an inflation index.
(2) To the extent that such costs are reimbursable

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under federal law, to pay county hospitals and county
operated outpatient facilities for outpatient services
based on a federally approved methodology to cover the
maximum allowable costs.
(3) To pay the county hospitals disproportionate share
hospital adjustment payments as may be specified in the
Illinois Title XIX State plan.
(3.5) To pay county providers for services provided or
purchased pursuant to Section 5-11 of this Code.
(4) To reimburse the county providers for expenses
contractually assumed pursuant to Section 15-4 of this
Code.
(5) To pay the Illinois Department its necessary
administrative expenses relative to the Fund and other
amounts agreed to, if any, by the county providers in the
agreement provided for in subsection (c).
(6) To pay the county providers any other amount due
according to a federally approved State plan, including but
not limited to payments made under the provisions of
Section 701(d)(3)(B) of the federal Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000.
Intergovernmental transfers supporting payments under this
paragraph (6) shall not be subject to the computation
described in subsection (a) of Section 15-3 of this Code,
but shall be computed as the difference between the total
of such payments made by the Illinois Department to county

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providers less any amount of federal financial
participation due the Illinois Department under Titles XIX
and XXI of the Social Security Act as a result of such
payments to county providers.
(b) The Illinois Department shall promptly seek all
appropriate amendments to the Illinois Title XIX State Plan to
maximize reimbursement, including disproportionate share
hospital adjustment payments, to the county providers.
(c) (Blank).
(d) The payments provided for herein are intended to cover
services rendered on and after July 1, 1991, and any agreement
executed between a qualifying county and the Illinois
Department pursuant to this Section may relate back to that
date, provided the Illinois Department obtains federal
approval. Any changes in payment rates resulting from the
provisions of Article 3 of this amendatory Act of 1992 are
intended to apply to services rendered on or after October 1,
1992, and any agreement executed between a qualifying county
and the Illinois Department pursuant to this Section may be
effective as of that date.
(e) If one or more hospitals file suit in any court
challenging any part of this Article XV, payments to hospitals
from the Fund under this Article XV shall be made only to the
extent that sufficient monies are available in the Fund and
only to the extent that any monies in the Fund are not
prohibited from disbursement and may be disbursed under any

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order of the court.
(f) All payments under this Section are contingent upon
federal approval of changes to the Title XIX State plan, if
that approval is required.
(Source: P.A. 95-859, eff. 8-19-08.)
(305 ILCS 5/15-11)
Sec. 15-11. Uses of State funds.
(a) At any point, if State revenues referenced in
subsection (b) or (c) of Section 15-10 or additional State
grants are disbursed to the Cook County Health and Hospitals
System, all funds may be used only for the following:
(1) medical services provided at hospitals or clinics
owned and operated by the Cook County Health and Hospitals
System Bureau of Health Services; or
(2) information technology to enhance billing
capabilities for medical claiming and reimbursement; or .
(3) services purchased by county providers pursuant to
Section 5-11 of this Code.
(b) State funds may not be used for the following:
(1) non-clinical services, except services that may be
required by accreditation bodies or State or federal
regulatory or licensing authorities;
(2) non-clinical support staff, except as pursuant to
paragraph (1) of this subsection; or
(3) capital improvements, other than investments in

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medical technology, except for capital improvements that
may be required by accreditation bodies or State or federal
regulatory or licensing authorities.
(Source: P.A. 95-859, eff. 8-19-08.)
Section 99. Effective date. This Act takes effect upon
becoming law.
HB6173 - 27 - LRB097 21594 KTG 69823 b
INDEX
Statutes amended in order of appearance