Bill Text: IL SB1573 | 2019-2020 | 101st General Assembly | Enrolled


Bill Title: Amends the Illinois Public Aid Code. Makes technical changes to specify in provisions concerning provisional eligibility for long-term care services that: (i) the Department of Healthcare and Family Services 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; (ii) the Department of Healthcare and Family Services or the managed care organization, if applicable, must reimburse providers for services rendered during an applicant's provisional eligibility period; (iii) the Department of Healthcare and Family Services must submit payment vouchers for all retroactive reimbursement due to the Office of the Comptroller within 10 business days of issuing provisional eligibility to an applicant; and (iv) the Department of Healthcare and Family Services must adopt rules.

Spectrum: Moderate Partisan Bill (Democrat 23-3)

Status: (Enrolled) 2019-06-28 - Sent to the Governor [SB1573 Detail]

Download: Illinois-2019-SB1573-Enrolled.html



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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 1. The Equity in Long-term Care Quality Act is
5amended by adding Section 25 as follows:
6 (30 ILCS 772/25 new)
7 Sec. 25. Nursing home labor force program.
8 (a) The Department of Public Health, contingent upon
9approval by the Centers for Medicare and Medicaid Services,
10shall establish a nursing home labor force promotion,
11expansion, and retention program no later than January 1, 2020
12using moneys appropriated from the Equity in Long-term Care
13Quality Fund.
14 (b) Components of the program shall include, but are not
15limited to: (1) a public relations campaign to encourage people
16to become nursing home workers; (2) scholarships for certified
17nursing assistants, licensed practical nurses, and registered
18nurses; and (3) retention incentives for nursing home workers.
19 (c) The Department shall establish partnerships with one or
20more community colleges or universities to execute the program.
21Sixty percent of the scholarships provided by the program shall
22be distributed to candidates living in counties with 3,000,000
23or more residents. Preferential scholarship consideration

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1shall be given to certified nursing assistants, single parents,
2and applicants from communities that are economically
3depressed or that have high percentages of Medicaid
4beneficiaries, immigrants, or racial or ethnic minorities.
5 (d) The Department shall report to the General Assembly no
6later than January 30, 2020 on the status of the establishment
7of the program. No later than January 1, 2021, and each January
81 thereafter, the Department shall report to the General
9Assembly the number of scholarships awarded during the
10preceding year and the demographics of the awardees.
11 Section 5. The Illinois Public Aid Code is amended by
12changing Section 11-5.4 as follows:
13 (305 ILCS 5/11-5.4)
14 Sec. 11-5.4. Expedited long-term care eligibility
15determination and enrollment.
16 (a) Establishment of the expedited long-term care
17eligibility determination and enrollment system shall be a
18joint venture of the Departments of Human Services and
19Healthcare and Family Services and the Department on Aging.
20 (b) Streamlined application enrollment process; expedited
21eligibility process. The streamlined application and
22enrollment process must include, but need not be limited to,
23the following:
24 (1) On or before July 1, 2019, a streamlined

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1 application and enrollment process shall be put in place
2 which must include, but need not be limited to, the
3 following:
4 (A) Minimize the burden on applicants by
5 collecting only the data necessary to determine
6 eligibility for medical services, long-term care
7 services, and spousal impoverishment offset.
8 (B) Integrate online data sources to simplify the
9 application process by reducing the amount of
10 information needed to be entered and to expedite
11 eligibility verification.
12 (C) Provide online prompts to alert the applicant
13 that information is missing or not complete.
14 (D) Provide training and step-by-step written
15 instructions for caseworkers, applicants, and
16 providers.
17 (2) The State must expedite the eligibility process for
18 applicants meeting specified guidelines, regardless of the
19 age of the application. The guidelines, subject to federal
20 approval, must include, but need not be limited to, the
21 following individually or collectively:
22 (A) Full Medicaid benefits in the community for a
23 specified period of time.
24 (B) No transfer of assets or resources during the
25 federally prescribed look-back period, as specified in
26 federal law.

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1 (C) Receives Supplemental Security Income payments
2 or was receiving such payments at the time of admission
3 to a nursing facility.
4 (D) For applicants or recipients with verified
5 income at or below 100% of the federal poverty level
6 when the declared value of their countable resources is
7 no greater than the allowable amounts pursuant to
8 Section 5-2 of this Code for classes of eligible
9 persons for whom a resource limit applies. Such
10 simplified verification policies shall apply to
11 community cases as well as long-term care cases.
12 (3) Subject to federal approval, the Department of
13 Healthcare and Family Services must implement an ex parte
14 renewal process for Medicaid-eligible individuals residing
15 in long-term care facilities. "Renewal" has the same
16 meaning as "redetermination" in State policies,
17 administrative rule, and federal Medicaid law. The ex parte
18 renewal process must be fully operational on or before
19 January 1, 2019.
20 (4) The Department of Human Services must use the
21 standards and distribution requirements described in this
22 subsection and in Section 11-6 for notification of missing
23 supporting documents and information during all phases of
24 the application process: initial, renewal, and appeal.
25 (c) The Department of Human Services must adopt policies
26and procedures to improve communication between long-term care

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1benefits central office personnel, applicants and their
2representatives, and facilities in which the applicants
3reside. Such policies and procedures must at a minimum permit
4applicants and their representatives and the facility in which
5the applicants reside to speak directly to an individual
6trained to take telephone inquiries and provide appropriate
7responses.
8 (d) Effective 30 days after the completion of 3 regionally
9based trainings, nursing facilities shall submit all
10applications for medical assistance online via the Application
11for Benefits Eligibility (ABE) website. This requirement shall
12extend to scanning and uploading with the online application
13any required additional forms such as the Long Term Care
14Facility Notification and the Additional Financial Information
15for Long Term Care Applicants as well as scanned copies of any
16supporting documentation. Long-term care facility admission
17documents must be submitted as required in Section 5-5 of this
18Code. No local Department of Human Services office shall refuse
19to accept an electronically filed application. No Department of
20Human Services office shall request submission of any document
21in hard copy.
22 (e) Notwithstanding any other provision of this Code, the
23Department of Human Services and the Department of Healthcare
24and Family Services' Office of the Inspector General shall,
25upon request, allow an applicant additional time to submit
26information and documents needed as part of a review of

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1available resources or resources transferred during the
2look-back period. The initial extension shall not exceed 30
3days. A second extension of 30 days may be granted upon
4request. Any request for information issued by the State to an
5applicant shall include the following: an explanation of the
6information required and the date by which the information must
7be submitted; a statement that failure to respond in a timely
8manner can result in denial of the application; a statement
9that the applicant or the facility in the name of the applicant
10may seek an extension; and the name and contact information of
11a caseworker in case of questions. Any such request for
12information shall also be sent to the facility. In deciding
13whether to grant an extension, the Department of Human Services
14or the Department of Healthcare and Family Services' Office of
15the Inspector General shall take into account what is in the
16best interest of the applicant. The time limits for processing
17an application shall be tolled during the period of any
18extension granted under this subsection.
19 (f) The Department of Human Services and the Department of
20Healthcare and Family Services must jointly compile data on
21pending applications, denials, appeals, and redeterminations
22into a monthly report, which shall be posted on each
23Department's website for the purposes of monitoring long-term
24care eligibility processing. The report must specify the number
25of applications and redeterminations pending long-term care
26eligibility determination and admission and the number of

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1appeals of denials in the following categories:
2 (A) Length of time applications, redeterminations, and
3 appeals are pending - 0 to 45 days, 46 days to 90 days, 91
4 days to 180 days, 181 days to 12 months, over 12 months to
5 18 months, over 18 months to 24 months, and over 24 months.
6 (B) Percentage of applications and redeterminations
7 pending in the Department of Human Services' Family
8 Community Resource Centers, in the Department of Human
9 Services' long-term care hubs, with the Department of
10 Healthcare and Family Services' Office of Inspector
11 General, and those applications which are being tolled due
12 to requests for extension of time for additional
13 information.
14 (C) Status of pending applications, denials, appeals,
15 and redeterminations.
16 (g) Beginning on July 1, 2017, the Auditor General shall
17report every 3 years to the General Assembly on the performance
18and compliance of the Department of Healthcare and Family
19Services, the Department of Human Services, and the Department
20on Aging in meeting the requirements of this Section and the
21federal requirements concerning eligibility determinations for
22Medicaid long-term care services and supports, and shall report
23any issues or deficiencies and make recommendations. The
24Auditor General shall, at a minimum, review, consider, and
25evaluate the following:
26 (1) compliance with federal regulations on furnishing

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1 services as related to Medicaid long-term care services and
2 supports as provided under 42 CFR 435.930;
3 (2) compliance with federal regulations on the timely
4 determination of eligibility as provided under 42 CFR
5 435.912;
6 (3) the accuracy and completeness of the report
7 required under paragraph (9) of subsection (e);
8 (4) the efficacy and efficiency of the task-based
9 process used for making eligibility determinations in the
10 centralized offices of the Department of Human Services for
11 long-term care services, including the role of the State's
12 integrated eligibility system, as opposed to the
13 traditional caseworker-specific process from which these
14 central offices have converted; and
15 (5) any issues affecting eligibility determinations
16 related to the Department of Human Services' staff
17 completing Medicaid eligibility determinations instead of
18 the designated single-state Medicaid agency in Illinois,
19 the Department of Healthcare and Family Services.
20 The Auditor General's report shall include any and all
21other areas or issues which are identified through an annual
22review. Paragraphs (1) through (5) of this subsection shall not
23be construed to limit the scope of the annual review and the
24Auditor General's authority to thoroughly and completely
25evaluate any and all processes, policies, and procedures
26concerning compliance with federal and State law requirements

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1on eligibility determinations for Medicaid long-term care
2services and supports.
3 (h) The Department of Healthcare and Family Services shall
4adopt any rules necessary to administer and enforce any
5provision of this Section. Rulemaking shall not delay the full
6implementation of this Section.
7 (g) The Department shall adopt rules necessary to
8administer and enforce any provision of this Section.
9Rulemaking shall not delay the full implementation of this
10Section.
11 (i) (h) Beginning on June 29, 2018, provisional
12eligibility, in the form of a recipient identification number
13and any other necessary credentials to permit an applicant to
14receive benefits, must be issued to any applicant who has not
15received a final eligibility determination on his or her
16application for Medicaid or Medicaid long-term care benefits or
17a notice of an opportunity for a hearing within the federally
18prescribed deadlines for the processing of such applications.
19The Department of Healthcare and Family Services must maintain
20the applicant's provisional Medicaid enrollment status until a
21final eligibility determination is approved or the applicant's
22appeal has been adjudicated and eligibility is denied. The
23Department of Healthcare and Family Services or the managed
24care organization, if applicable, must reimburse providers for
25services rendered during an applicant's provisional
26eligibility period.

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1 (1) Claims for services rendered to an applicant with
2 provisional eligibility status must be submitted and
3 processed in the same manner as those submitted on behalf
4 of beneficiaries determined to qualify for benefits.
5 (2) An applicant with provisional enrollment status
6 must have his or her benefits paid for under the State's
7 fee-for-service system until the State makes a final
8 determination on the applicant's Medicaid or Medicaid
9 long-term care application. If an individual is enrolled
10 with a managed care organization for community benefits at
11 the time the individual's provisional status is issued, the
12 managed care organization is only responsible for paying
13 benefits covered under the capitation payment received by
14 the managed care organization for the individual.
15 (3) The Department of Healthcare and Family Services,
16 within 10 business days of issuing provisional eligibility
17 to an applicant, must submit to the Office of the
18 Comptroller for payment a voucher for all retroactive
19 reimbursement due. The Department of Healthcare and Family
20 Services must clearly identify such vouchers as
21 provisional eligibility vouchers.
22(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17;
23100-665, eff. 8-2-18; 100-1141, eff. 11-28-18.)
24 Section 99. Effective date. This Act takes effect upon
25becoming law.
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