Public Act 100-1141
 
HB4771 EnrolledLRB100 18554 KTG 33773 b


  
    AN ACT concerning public aid.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  


 
    Section 5. The Illinois Public Aid Code is amended  by 
changing Section 11-5.4 as follows:
 
    (305 ILCS 5/11-5.4)
    Sec. 11-5.4. Expedited long-term care eligibility 
determination and enrollment.
    (a) An expedited long-term care eligibility determination 
and enrollment system shall be established to reduce long-term 
care determinations to 90 days or fewer by July 1, 2014 and 
streamline the long-term care enrollment process.  
Establishment of the system shall be a joint venture of the 
Department of Human Services and Healthcare and Family Services 
and the Department on Aging.  The Governor shall name a lead 
agency no later than 30 days after the effective date of this 
amendatory Act of the 98th General Assembly to assume 
responsibility for the full implementation of the 
establishment and maintenance of the system.  Project outcomes 
shall include an enhanced eligibility determination tracking 
system accessible to providers and a centralized application 
review and eligibility determination with all applicants 
reviewed within 90 days of receipt by the State of a complete 
application.  If the Department of Healthcare and Family 
Services' Office of the Inspector General determines that there 
is a likelihood that a non-allowable transfer of assets has 
occurred, and the facility in which the applicant resides is 
notified, an extension of up to 90 days shall be permissible.  
On or before December 31, 2015, a streamlined application and 
enrollment process shall be put in place based on the following 
principles: 
        (1) Minimize the burden on applicants by collecting 
    only the data necessary to determine eligibility for 
    medical services, long-term care services, and spousal 
    impoverishment offset. 
        (2) Integrate online data sources to simplify the 
    application process by reducing the amount of information 
    needed to be entered and to expedite eligibility 
    verification. 
        (3) Provide online prompts to alert the applicant that 
    information is missing or not complete. 
    (b) The Department shall, on or before July 1, 2014, assess 
the feasibility of incorporating all information needed to 
determine eligibility for long-term care services, including 
asset transfer and spousal impoverishment financials, into the 
State's integrated eligibility system identifying all 
resources needed and reasonable timeframes for achieving the 
specified integration. 
    (c) The lead agency shall file interim reports with the 
Chairs and Minority Spokespersons of the House and Senate Human 
Services Committees no later than September 1, 2013 and on 
February 1, 2014. The Department of Healthcare and Family 
Services shall include in the annual Medicaid report for State 
Fiscal Year 2014 and every fiscal year thereafter information 
concerning implementation of the provisions of this Section. 
    (d) No later than August 1, 2014, the Auditor General shall 
report to the General Assembly concerning the extent to which 
the timeframes specified in this Section have been met and the 
extent to which State staffing levels are adequate to meet the 
requirements of this Section. 

    (e) The Department of Healthcare and Family Services, the 
Department of Human Services, and the Department on Aging shall 
take the following steps to achieve federally established 
timeframes for eligibility determinations for Medicaid and 
long-term care benefits and shall work toward the federal goal 
of real time determinations: 
        (1) The Departments shall review, in collaboration 
    with representatives of affected providers, all forms and 
    procedures currently in use, federal guidelines either 
    suggested or mandated, and staff deployment by September 
    30, 2014 to identify additional measures that can improve 
    long-term care eligibility processing and make adjustments 
    where possible.
        (2) No later than June 30, 2014, the  Department of 
    Healthcare and Family Services shall issue vouchers for 
    advance payments not to exceed $50,000,000 to nursing 
    facilities with significant outstanding Medicaid liability 
    associated with services provided to residents with 
    Medicaid applications pending and residents facing the 
    greatest delays. Each facility with an advance payment 
    shall state in writing whether its own recoupment schedule 
    will be in 3 or 6 equal monthly installments, as long as 
    all advances are recouped by June 30, 2015. 
        (3) The Department of Healthcare and Family Services' 
    Office of  Inspector General and the Department of Human 
    Services shall immediately forgo resource review and 
    review of transfers during the relevant look-back period 
    for applications that were submitted prior to September 1, 
    2013. An applicant who applied prior to September 1, 2013, 
    who was denied for failure to cooperate in providing 
    required information, and whose application was 
    incorrectly reviewed under the wrong look-back period 
    rules may request review and correction of the denial based 
    on this subsection.  If found eligible upon review, such 
    applicants shall be retroactively enrolled. 
        (4) As soon as practicable, the Department of 
    Healthcare and Family Services shall implement policies 
    and promulgate rules to simplify financial eligibility 
    verification in the following instances:  (A) for 
    applicants  or recipients who are receiving Supplemental 
    Security Income payments or who had been receiving such 
    payments at the time they were admitted to a nursing 
    facility and (B) for applicants or recipients with verified 
    income at or below 100% of the federal poverty level when 
    the declared value of their countable resources is no 
    greater than the allowable amounts pursuant to Section 5-2 
    of this Code for classes of eligible  persons for whom a 
    resource limit applies.  Such simplified verification 
    policies shall apply to community cases as well as 
    long-term care cases. 
        (5) As soon as practicable, but not later than July 1, 
    2014, the Department of Healthcare and Family Services and 
    the Department of Human Services shall jointly begin a 
    special enrollment project by using simplified eligibility 
    verification policies and by redeploying caseworkers 
    trained to handle long-term care cases to prioritize those 
    cases, until the backlog is eliminated and processing time 
    is within 90 days.  This project shall apply to applications 
    for long-term care received by the State on or before May 
    15, 2014. 
        (6) As soon as practicable, but not later than 
    September 1, 2014, the Department on Aging shall make 
    available to long-term care facilities and community 
    providers upon request, through an electronic method, the 
    information contained within the Interagency Certification 
    of Screening Results completed by the pre-screener, in a 
    form and manner acceptable to the Department of Human 
    Services.
        (7) Effective 30 days after the completion of 3 
    regionally based trainings, nursing facilities shall 
    submit all applications for medical assistance online via 
    the Application for Benefits Eligibility (ABE) website. 
    This requirement shall extend to scanning and uploading 
    with the online application any required additional forms 
    such as the Long Term Care Facility Notification and the 
    Additional Financial Information for Long Term Care 
    Applicants as well as scanned copies of any supporting 
    documentation.  Long-term care facility admission documents 
    must be submitted as required in Section 5-5 of this Code. 
    No local Department of Human Services office shall refuse 
    to accept an electronically filed application. 
        (8) Notwithstanding any other provision of this Code, 
    the Department of Human Services and the Department of 
    Healthcare and Family Services' Office of the Inspector 
    General shall, upon request, allow an applicant additional 
    time to submit information and documents needed as part of 
    a review of available resources or resources transferred 
    during the look-back period.  The initial extension shall 
    not exceed 30 days.  A second extension of 30 days may be 
    granted upon request. Any request for information issued by 
    the State to an applicant shall include the following: an 
    explanation of  the information required and the date by 
    which the information must be submitted; a statement that 
    failure to respond in a timely manner can result in denial 
    of the application; a statement that the applicant or the 
    facility in the name of the applicant may seek an 
    extension; and the name and contact information of a 
    caseworker in case of questions.  Any such request for 
    information shall also be sent to the facility.  In deciding 
    whether to grant an extension, the Department of Human 
    Services or the Department of Healthcare and Family 
    Services' Office of the Inspector General shall take into 
    account what is in the best interest of the applicant. The 
    time limits for processing an application shall be tolled 
    during the period of any extension granted under this 
    subsection. 
        (9) The Department of Human Services and the Department 
    of Healthcare and Family Services must jointly compile data 
    on pending applications, denials, appeals, and 
    redeterminations into a monthly report, which shall be 
    posted on each Department's website for the purposes of 
    monitoring long-term care eligibility processing. The 
    report must specify the number of applications and 
    redeterminations pending long-term care eligibility 
    determination and admission and  the number of appeals of 
    denials in the following categories: 
            (A) Length of time applications, redeterminations, 
        and appeals are pending - 0 to 45 days, 46 days  to 90 
        days, 91 days to 180 days, 181 days to 12 months, over 
        12 months to 18 months, over 18 months to 24 months, 
        and over 24 months.
            (B) Percentage of applications and 
        redeterminations pending in the Department of Human 
        Services' Family Community Resource Centers, in the 
        Department of Human Services' long-term care hubs, 
        with the Department of Healthcare and Family Services' 
        Office of Inspector General, and those applications 
        which are being tolled due to requests for extension of 
        time for additional information.
            (C) Status of pending applications, denials, 
        appeals, and redeterminations. 
    (f) Beginning on July 1, 2017, the Auditor General shall 
report every 3 years to the General Assembly on the performance 
and compliance of the Department of Healthcare and Family 
Services, the Department of Human Services, and the Department 
on Aging in meeting the requirements of this Section and the 
federal requirements concerning eligibility determinations for 
Medicaid long-term care services and supports, and shall report 
any issues or deficiencies and make recommendations. The 
Auditor General shall, at a minimum,  review, consider, and 
evaluate the following:
        (1) compliance with federal regulations on furnishing 
    services as related to Medicaid long-term care services and 
    supports as provided under 42 CFR 435.930;
        (2) compliance with federal regulations on the timely 
    determination of eligibility as provided under 42 CFR 
    435.912;
        (3) the accuracy and completeness of the report 
    required under paragraph (9) of subsection (e); 
        (4) the efficacy and efficiency of the task-based 
    process used for making eligibility determinations in the 
    centralized offices of the Department of Human Services for 
    long-term care services, including the role of the State's 
    integrated eligibility system, as opposed to the 
    traditional caseworker-specific process from which these 
    central offices have converted; and
        (5) any issues affecting eligibility determinations 
    related to the Department of Human Services' staff 
    completing Medicaid eligibility determinations instead of 
    the designated single-state Medicaid agency in Illinois, 
    the Department of Healthcare and Family Services. 
    The Auditor General's report shall include any and all 
other areas or issues which are identified through an annual 
review. Paragraphs (1) through (5) of this subsection shall not 
be construed to limit the scope of the annual review and the 
Auditor General's authority to thoroughly and completely 
evaluate any and all processes, policies, and procedures 
concerning compliance with federal and State law requirements 
on eligibility determinations for Medicaid long-term care 
services and supports. 
    (g) The Department shall adopt rules necessary to 
administer and enforce any provision of this Section. 
Rulemaking shall not delay the full implementation of this 
Section. 
    (h) Beginning on June 29, 2018, provisional eligibility, in

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

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