Sen. John G. Mulroe

Filed: 4/24/2018

 

 


 

 


 
10000SB2913sam002LRB100 18099 KTG 39173 a

1
AMENDMENT TO SENATE BILL 2913

2    AMENDMENT NO. ______. Amend Senate Bill 2913, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The Illinois Public Aid Code is amended by
6changing Section 11-5.4 and by adding Section 5-5g as follows:
 
7    (305 ILCS 5/5-5g new)
8    Sec. 5-5g. Long-term care patient; resident status.
9Long-term care providers shall submit all changes in resident
10status, including, but not limited to, death, discharge,
11changes in patient credit, third party liability, and Medicare
12coverage, to the Department through the Medical Electronic Data
13Interchange System, the Recipient Eligibility Verification
14System, or the Electronic Data Interchange System established
15under 89 Ill. Adm. Code 140.55(b) in compliance with the
16schedule below:

 

 

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1        (1) 15 calendar days after a resident's death;
2        (2) 15 calendar days after a resident's discharge;
3        (3) 45 calendar days after being informed of a change
4    in the resident's income;
5        (4) 45 calendar days after being informed of a change
6    in a resident's third party liability;
7        (5) 45 calendar days after a resident's move to
8    exceptional care services; and
9        (6) 45 calendar days after a resident's need for
10    services requiring reimbursement under the ventilator or
11    traumatic brain injury enhanced rate.
 
12    (305 ILCS 5/11-5.4)
13    Sec. 11-5.4. Expedited long-term care eligibility
14determination, renewal, and enrollment, and payment.
15    (a) The General Assembly finds that it is in the best
16interest of the State to process on an expedited basis
17applications and renewal applications for Medicaid and
18Medicaid long-term care benefits that are submitted by or on
19behalf of elderly persons in need of long-term care services.
20It is the intent of the General Assembly that the provisions of
21this Section be liberally construed to permit the maximum
22number of applicants to benefit, regardless of the age of the
23application, and for the State to complete all processing as
24required under 42 U.S.C. 1396a(a)(8) and 42 CFR 435. An
25expedited long-term care eligibility determination and

 

 

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1enrollment system shall be established to reduce long-term care
2determinations to 90 days or fewer by July 1, 2014 and
3streamline the long-term care enrollment process.
4Establishment of the system shall be a joint venture of the
5Department of Human Services and Healthcare and Family Services
6and the Department on Aging. The Governor shall name a lead
7agency no later than 30 days after the effective date of this
8amendatory Act of the 98th General Assembly to assume
9responsibility for the full implementation of the
10establishment and maintenance of the system. Project outcomes
11shall include an enhanced eligibility determination tracking
12system accessible to providers and a centralized application
13review and eligibility determination with all applicants
14reviewed within 90 days of receipt by the State of a complete
15application. If the Department of Healthcare and Family
16Services' Office of the Inspector General determines that there
17is a likelihood that a non-allowable transfer of assets has
18occurred, and the facility in which the applicant resides is
19notified, an extension of up to 90 days shall be permissible.
20On or before December 31, 2015, a streamlined application and
21enrollment process shall be put in place based on the following
22principles:
23        (1) Minimize the burden on applicants by collecting
24    only the data necessary to determine eligibility for
25    medical services, long-term care services, and spousal
26    impoverishment offset.

 

 

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1        (2) Integrate online data sources to simplify the
2    application process by reducing the amount of information
3    needed to be entered and to expedite eligibility
4    verification.
5        (3) Provide online prompts to alert the applicant that
6    information is missing or not complete.
7    (a-5) As used in this Section:
8    "Department" means the Department of Healthcare and Family
9Services.
10    "Managed care organization" has the meaning ascribed to
11that term in Section 5-30.1 of this Code.
12    (b) The Department of Healthcare and Family Services must
13serve as the lead agency assuming primary responsibility for
14the full implementation of this Section, including the
15establishment and operation of the system. The Department
16shall, on or before July 1, 2014, assess the feasibility of
17incorporating all information needed to determine eligibility
18for long-term care services, including asset transfer and
19spousal impoverishment financials, into the State's integrated
20eligibility system identifying all resources needed and
21reasonable timeframes for achieving the specified integration.
22    (c) Beginning on June 29, 2018, provisional eligibility, in
23the form of a recipient identification number and any other
24necessary credentials to permit an applicant to receive
25benefits, must be issued to any applicant who has not received
26a final eligibility determination on his or her application for

 

 

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1Medicaid or Medicaid long-term care benefits or a notice of an
2opportunity for a hearing within the federally prescribed
3deadlines for the processing of such applications. The
4Department must maintain the applicant's provisional Medicaid
5enrollment status until a final eligibility determination is
6approved or the applicant's appeal has been adjudicated and
7eligibility is denied. The Department or the managed care
8organization, if applicable, must reimburse providers for all
9services rendered during an applicant's provisional
10eligibility period.
11        (1) The Department must immediately notify the managed
12    care organization, if applicable, in which the applicant is
13    an enrollee of the enrollee's change in status.
14        (2) The Department or the managed care organization,
15    when applicable, must begin processing claims for services
16    rendered by the end of the month in which the applicant is
17    given provisional eligibility status. Claims for services
18    rendered must be submitted and processed by the Department
19    and managed care organizations in the same manner as those
20    submitted on behalf of beneficiaries determined to qualify
21    for benefits.
22        (3) An applicant with provisional enrollment status,
23    who is not enrolled in a managed care organization at the
24    time the applicant's provisional status is issued, must
25    continue to have his or her benefits paid for under the
26    State's fee-for-service system until such time as the State

 

 

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1    makes a final determination on the applicant's Medicaid or
2    Medicaid long-term care application.
3        (4) The Department, within 10 business days of issuing
4    provisional eligibility to an applicant not covered by a
5    managed care organization, must submit to the Office of the
6    Comptroller for payment a voucher for all retroactive
7    reimbursement due and the State Comptroller must place such
8    vouchers on expedited payment status. However, if the
9    provisional beneficiary is enrolled with a managed care
10    organization, the Department must submit the same to the
11    managed care organization and the managed care
12    organization must pay the provider on an expedited basis.
13    The lead agency shall file interim reports with the Chairs
14    and Minority Spokespersons of the House and Senate Human
15    Services Committees no later than September 1, 2013 and on
16    February 1, 2014. The Department of Healthcare and Family
17    Services shall include in the annual Medicaid report for
18    State Fiscal Year 2014 and every fiscal year thereafter
19    information concerning implementation of the provisions of
20    this Section.
21    (d) The Department must establish, by rule, policies and
22procedures to ensure prospective compliance with the federal
23deadlines for Medicaid and Medicaid long-term care benefits
24eligibility determinations required under 42 U.S.C.
251396a(a)(8) and 42 CFR 435.912, which must include, but need
26not be limited to, the following:

 

 

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1        (1) The Department, assisted by the Department of Human
2    Services and the Department on Aging, must establish, no
3    later than January 1, 2019, a streamlined application and
4    enrollment process that includes, but is not limited to,
5    the following:
6            (A) collect only the data necessary to determine
7        eligibility for medical services, long-term care
8        services, and spousal impoverishment offset;
9            (B) integrate online data and other third party
10        data sources to simplify the application process by
11        reducing the amount of information needed to be entered
12        and to expedite eligibility verification;
13            (C) provide online prompts to alert the applicant
14        that information is missing or incomplete; and
15            (D) provide training and step-by-step written
16        instructions for caseworkers, applicants, and
17        providers.
18        (2) The Department must expedite the eligibility
19    processing system for applicants meeting certain
20    guidelines, regardless of the age of the application. The
21    guidelines must be established by rule and must include,
22    but not be limited to, the following individually or
23    collectively:
24            (A) Full Medicaid benefits in the community for a
25        specified period of time.
26            (B) No transfer of assets or resources during the

 

 

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1        federally prescribed look-back time period, as
2        specified by federal law.
3            (C) Receives Supplemental Security Income payments
4        or was receiving such payments at the time the
5        applicant was admitted to a nursing facility.
6            (D) Verified income at or below 100% of the federal
7        poverty level when the declared value of the
8        applicant's countable resources is no greater than the
9        allowable amounts pursuant to Section 5-2 of this Code
10        for classes of eligible persons for whom a resource
11        limit applies.
12        (3) The Department must establish, by rule, renewal
13    policies and procedures to reduce the likelihood of
14    unnecessary interruptions in services as a result of
15    improper denials of applicants who would otherwise be
16    approved.
17            (A) Effective January 1, 2019, the Department must
18        implement a paperless passive renewal protocol that
19        provides for the electronic verification of all
20        necessary information including bank accounts.
21            (B) A beneficiary who is a resident of a facility
22        and whose previous renewal application showed an
23        income of no greater than the federal poverty level and
24        who has no discernible means of generating income
25        greater than the federal poverty level must be deemed
26        to qualify for renewal. The beneficiary and the

 

 

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1        facility must not receive an application for renewal
2        and must instead receive notification of the
3        beneficiary's renewal.
4            (C) A beneficiary for whom the processing of a
5        renewal application exceeds federally prescribed
6        timeframes must be deemed to meet renewal guidelines
7        and the Department must notify the beneficiary and the
8        facility in which the beneficiary resides. The
9        Department must also immediately notify the managed
10        care organization in which the beneficiary is
11        enrolled, if applicable. Both the Department and the
12        managed care organization must accept claims for
13        services rendered to the beneficiary without an
14        interruption in benefits to the enrollee and payment
15        for all services rendered to providers.
16        (4) The Department of Human Services must not penalize
17    an applicant for having an attorney complete a Medicaid
18    application on the applicant's behalf or for seeking to
19    understand the applicant's rights under federal and State
20    Medicaid laws and regulations. This must not include
21    targeting applications and applicants so described for
22    additional scrutiny by the Department of Healthcare and
23    Family Services' Office of the Inspector General.
24        (5) The Department of Healthcare and Family Services'
25    Office of the Inspector General must review applications
26    for long-term care benefits when the Office obtains

 

 

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1    credible evidence that an applicant has transferred assets
2    with the intent of defrauding the State. If proof of the
3    allegations does not exist, the application must be
4    released by the Office and must be assigned to the
5    appropriate caseworker for an expedited review.
6        (6) The Department of Human Services must implement a
7    process to notify an applicant, the applicant's legally
8    authorized representative, and the facility where the
9    applicant resides of the receipt of an initial or renewal
10    application and supporting documentation within 5 business
11    days of the date the application or supporting documents
12    are submitted. The notices should indicate any
13    documentation required, but not received, and provide
14    instructions for submission.
15        (7) The Department must make available one release form
16    that permits the applicant to grant permission to a third
17    party to pursue approval of Medicaid and Medicaid long-term
18    care benefits, track the status of applications, and pursue
19    a post-denial appeal on behalf of the applicant, which must
20    remain in force after the applicant's death.
21        (8) The Department must develop one eligibility system
22    for both Modified Adjusted Gross Income (MAGI) and non-MAGI
23    applicants by incorporating Affordable Care Act upgrades
24    with the goal of establishing real time approval of
25    applications for Medicaid services and Medicaid long-term
26    care benefits, as permissible.

 

 

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1        (9) The Department must have operational a fully
2    electronic application process that encompasses initial
3    applications, admission packet, renewals, and appeals no
4    later than 12 months after the effective date of this
5    amendatory Act of the 100th General Assembly. The
6    Department must not require submission of any application
7    or supporting documentation in hard copy. No later than
8    August 1, 2014, the Auditor General shall report to the
9    General Assembly concerning the extent to which the
10    timeframes specified in this Section have been met and the
11    extent to which State staffing levels are adequate to meet
12    the requirements of this Section.
13    (e) The Department must adopt policies and procedures to
14improve communication between long-term care benefits central
15office personnel, applicants, or the applicants'
16representatives, and facilities in which the applicants
17reside. The Department must establish, by rule, such policies
18and procedures that are necessary to meet the requirements of
19this Section, which must include, but need not be limited to,
20the following:
21        (1) The establishment of a centralized,
22    caseworker-based processing system with contact numbers
23    for caseworkers and supervisors that are made readily
24    available to all affected providers and are prominently
25    displayed on all communications with applicants,
26    beneficiaries, and providers.

 

 

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1        (2) Allowing facilities access to the State's
2    integrated eligibility system for tracking the status of
3    applications for applicants who have signed appropriate
4    releases, and the development and distribution of
5    applicable instructional materials and release forms. The
6    Department of Healthcare and Family Services, the
7    Department of Human Services, and the Department on Aging
8    shall take the following steps to achieve federally
9    established timeframes for eligibility determinations for
10    Medicaid and long-term care benefits and shall work toward
11    the federal goal of real time determinations:
12        (1) The Departments shall review, in collaboration
13    with representatives of affected providers, all forms and
14    procedures currently in use, federal guidelines either
15    suggested or mandated, and staff deployment by September
16    30, 2014 to identify additional measures that can improve
17    long-term care eligibility processing and make adjustments
18    where possible.
19        (2) No later than June 30, 2014, the Department of
20    Healthcare and Family Services shall issue vouchers for
21    advance payments not to exceed $50,000,000 to nursing
22    facilities with significant outstanding Medicaid liability
23    associated with services provided to residents with
24    Medicaid applications pending and residents facing the
25    greatest delays. Each facility with an advance payment
26    shall state in writing whether its own recoupment schedule

 

 

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1    will be in 3 or 6 equal monthly installments, as long as
2    all advances are recouped by June 30, 2015.
3        (3) The Department of Healthcare and Family Services'
4    Office of Inspector General and the Department of Human
5    Services shall immediately forgo resource review and
6    review of transfers during the relevant look-back period
7    for applications that were submitted prior to September 1,
8    2013. An applicant who applied prior to September 1, 2013,
9    who was denied for failure to cooperate in providing
10    required information, and whose application was
11    incorrectly reviewed under the wrong look-back period
12    rules may request review and correction of the denial based
13    on this subsection. If found eligible upon review, such
14    applicants shall be retroactively enrolled.
15        (4) As soon as practicable, the Department of
16    Healthcare and Family Services shall implement policies
17    and promulgate rules to simplify financial eligibility
18    verification in the following instances: (A) for
19    applicants or recipients who are receiving Supplemental
20    Security Income payments or who had been receiving such
21    payments at the time they were admitted to a nursing
22    facility and (B) for applicants or recipients with verified
23    income at or below 100% of the federal poverty level when
24    the declared value of their countable resources is no
25    greater than the allowable amounts pursuant to Section 5-2
26    of this Code for classes of eligible persons for whom a

 

 

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1    resource limit applies. Such simplified verification
2    policies shall apply to community cases as well as
3    long-term care cases.
4        (5) As soon as practicable, but not later than July 1,
5    2014, the Department of Healthcare and Family Services and
6    the Department of Human Services shall jointly begin a
7    special enrollment project by using simplified eligibility
8    verification policies and by redeploying caseworkers
9    trained to handle long-term care cases to prioritize those
10    cases, until the backlog is eliminated and processing time
11    is within 90 days. This project shall apply to applications
12    for long-term care received by the State on or before May
13    15, 2014.
14        (6) As soon as practicable, but not later than
15    September 1, 2014, the Department on Aging shall make
16    available to long-term care facilities and community
17    providers upon request, through an electronic method, the
18    information contained within the Interagency Certification
19    of Screening Results completed by the pre-screener, in a
20    form and manner acceptable to the Department of Human
21    Services.
22    (f) The Department must establish, by rule, policies and
23procedures to improve accountability and provide for the
24expedited payment of services rendered, which must include, but
25need not be limited to, the following:
26        (1) The Department must apply the most current resident

 

 

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1    income data entered into the Department's Medical
2    Electronic Data Interchange (MEDI) system to the payment of
3    a claim even if a caseworker has not completed a review.
4        (2) The Department and the Department of Human Services
5    must notify the applicant, or the applicant's legal
6    representative, and the facility submitting the initial,
7    renewal, or appeal application of all missing supporting
8    documentation or information and the date of the request
9    when an application, renewal, or appeal is denied for
10    failure to submit such documentation and information.
11    (g) No later than January 1, 2019, the Department of
12Healthcare and Family Services must investigate the
13public-private partnerships in use in Ohio, Michigan, and
14Minnesota aimed at redeploying caseworkers to targeted
15high-Medicaid facilities for the purpose of expediting initial
16Medicaid and Medicaid long-term care benefits applications,
17renewals, asset discovery, and all other things related to
18enrollment, reimbursement, and application processing. No
19later than March 1, 2019, the Department of Healthcare and
20Family Services must post on the long-term care pages of the
21Department's website the agencies' joint recommendations and
22must assist provider groups in educating their members on such
23partnerships.
24    (h) The Director of Healthcare and Family Services, in
25coordination with the Secretary of Human Services and the
26Director of Aging, must host a provider association meeting

 

 

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1every 6 weeks, beginning no later than 30 days after the
2effective date of this amendatory Act of the 100th General
3Assembly, until all applications that are 45 days or older have
4been adjudicated and the application process has been reduced
5to 45 or fewer days, at which time the meetings shall be held
6quarterly, for those associations representing facilities
7licensed under the Nursing Home Care Act and certified as a
8supportive living program. Each agency must be represented by
9senior staff with hands-on knowledge of the processing of
10applications for Medicaid and Medicaid long-term care
11benefits, renewals, and such ancillary issues as income and
12address adjustments, release forms, and screening reports.
13Agenda items must be solicited from the associations.
14    (i) The Department must not delay the implementation of the
15presumptive eligibility, as ordered by Koss v. Norwood, Case
16No. 17 C 2762 (N.D. Ill. Mar. 29, 2018), in anticipation of
17this amendatory Act of the 100th General Assembly.
18    (j) As mandated by federal regulations under 42 CFR
19435.912, the Department and the Department of Human Services
20must not deny applications for Medicaid or Medicaid long-term
21care benefits to comply with the federal timeliness standards
22or avoid authorizing provisional eligibility under this
23Section. To ensure compliance, the percentage of denials in a
24given month must not increase by more than 1% of the denial
25rate that occurred in the same month of the preceding year.
26    (k) The Department of Human Services must prioritize

 

 

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1processing applications on a last-in, first-out basis. The
2Department is expressly prohibited from prioritizing the
3processing of applications from applicants who have been issued
4provisional eligibility status over other applicants.
5    (l) Unless otherwise specified, all provisions of this
6amendatory Act of the 100th General Assembly must be fully
7operational by January 1, 2019.
8    (m) Nothing in this Section shall defeat the provisions
9contained in the State Prompt Payment Act or the timely pay
10provisions contained in Section 368a of the Illinois Insurance
11Code.
12    (n) The Department must offer regionally based training
13covering all aspects of this Section and must include long-term
14care provider associations in the design and presentation of
15the training. The training shall be recorded and posted on the
16Department's website to allow new employees to be trained and
17older employers to complete refresher courses.
18    (o) The Department and the Department of Human Services
19must not require an applicant for Medicaid or Medicaid
20long-term care benefits to submit a new application solely
21because there is a change in the applicant's legal
22representative.
23    (p) The Department and the Department of Human Services
24must implement the requirements under this Section even if the
25required rules are not yet adopted by the dates specified in
26this Section. If the Department is required to adopt rules

 

 

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1under this Section or if the Department determines that rules
2are necessary to achieve full implementation, the Department
3must adopt policies and procedures to allow for full
4implementation by the date specified in this Section and must
5publish all policies and procedures on the Department's
6website. The Department must submit proposed permanent rules
7for public comment no later than January 1, 2019.
8    (q) (7) Effective 30 days after the completion of 3
9regionally based trainings, nursing facilities shall submit
10all applications for medical assistance online via the
11Application for Benefits Eligibility (ABE) website. This
12requirement shall extend to scanning and uploading with the
13online application any required additional forms such as the
14Long Term Care Facility Notification and the Additional
15Financial Information for Long Term Care Applicants as well as
16scanned copies of any supporting documentation. Long-term care
17facility admission documents must be submitted as required in
18Section 5-5 of this Code. No local Department of Human Services
19office shall refuse to accept an electronically filed
20application.
21    (r) (8) Notwithstanding any other provision of this Code,
22the Department of Human Services and the Department of
23Healthcare and Family Services' Office of the Inspector General
24shall, upon request, allow an applicant additional time to
25submit information and documents needed as part of a review of
26available resources or resources transferred during the

 

 

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

 

 

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1categories:
2        (1) (A) Length of time applications, renewals
3    redeterminations, and appeals are pending - 0 to 45 days,
4    46 days to 90 days, 91 days to 180 days, 181 days to 12
5    months, over 12 months to 18 months, over 18 months to 24
6    months, and over 24 months.
7        (2) (B) Percentage of applications and renewals
8    redeterminations pending in the Department of Human
9    Services' Family Community Resource Centers, in the
10    Department of Human Services' long-term care hubs, with the
11    Department of Healthcare and Family Services' Office of
12    Inspector General, and those applications which are being
13    tolled due to requests for extension of time for additional
14    information.
15        (3) (C) Status of pending applications, denials,
16    appeals, and renewals redeterminations.
17        (4) For applications, renewals, and appeals pending
18    more than 45 days, the reason for the delay as required by
19    federal regulations under 42 CFR 435.912.
20    (t) (f) Beginning on July 1, 2017, the Auditor General
21shall report every 3 years to the General Assembly on the
22performance and compliance of the Department of Healthcare and
23Family Services, the Department of Human Services, and the
24Department on Aging in meeting the requirements of this Section
25and the federal requirements concerning eligibility
26determinations for Medicaid long-term care services and

 

 

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

 

 

10000SB2913sam002- 22 -LRB100 18099 KTG 39173 a

1be construed to limit the scope of the annual review and the
2Auditor General's authority to thoroughly and completely
3evaluate any and all processes, policies, and procedures
4concerning compliance with federal and State law requirements
5on eligibility determinations for Medicaid long-term care
6services and supports.
7(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.".