Full Text of HB5903 96th General Assembly
HB5903 96TH GENERAL ASSEMBLY
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96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010 HB5903
Introduced 2/10/2010, by Rep. Elizabeth Coulson SYNOPSIS AS INTRODUCED: |
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20 ILCS 2310/2310-432 new |
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305 ILCS 5/5-2 |
from Ch. 23, par. 5-2 |
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Amends the Department of Public Health Powers and Duties Law of the
Civil Administrative Code of Illinois and the Illinois Public Aid Code. Creates the Center for Women's Heart Health within the Department of Public Health. Provides that the Center shall administer the Women's Heart Disease Prevention, Detection, and Treatment program, in partnership with the Department of Healthcare and Family Services. Provides that the program shall provide screenings for heart disease to all uninsured women, including by means of electron beam tomography. Provides that the Department of Public Health shall make every effort to ensure that program services are made available in rural and medically underserved areas in Illinois, including by means of telemedicine. Provides that coverage of services under the program is not dependent on federal approval, but federal moneys may be used to pay for such services upon federal approval. Provides that women who qualify for services under the program are eligible for coverage of those services under the medical assistance program. Effective immediately.
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A BILL FOR
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HB5903 |
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LRB096 18842 KTG 34228 b |
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| AN ACT concerning State government.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Department of Public Health Powers and | 5 |
| Duties Law of the
Civil Administrative Code of Illinois is | 6 |
| amended by adding Section 2310-432 as follows: | 7 |
| (20 ILCS 2310/2310-432 new) | 8 |
| Sec. 2310-432. Center for Women's Heart Health. | 9 |
| (a) The Center for Women's Heart Health is created within | 10 |
| the Department. The Center shall oversee the development of a | 11 |
| comprehensive Women's Heart Disease Prevention, Detection, and | 12 |
| Treatment program ("the program") for women residents of | 13 |
| Illinois. The Center shall administer the program in | 14 |
| partnership with the Department of Healthcare and Family | 15 |
| Services. | 16 |
| (b) The program shall provide services including, but not | 17 |
| limited to, electron beam tomography scans of the heart, blood | 18 |
| pressure checks, cholesterol checks, blood glucose checks, | 19 |
| family history checks, and nutrition education. The program | 20 |
| shall provide services to all women residents of Illinois who | 21 |
| are uninsured. The program shall provide electron beam | 22 |
| tomography services to women residents of Illinois who are | 23 |
| insured but whose individual or group insurance policy or |
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| managed care plan does not cover those services. | 2 |
| (c) There shall be no co-payment or other cost-sharing | 3 |
| requirement in connection with any services provided under the | 4 |
| program. In the case of a woman who is insured and who receives | 5 |
| electron beam tomography services under the program, the | 6 |
| receipt of those services shall not count against any annual or | 7 |
| lifetime maximum benefit limit imposed under the terms of her | 8 |
| insurance policy or managed care plan. | 9 |
| (d) If services provided to a woman under the program | 10 |
| result in the detection of heart disease, or if a physician | 11 |
| licensed to practice medicine in all its branches recommends | 12 |
| that a woman who has received services under the program | 13 |
| undergo further tests, any treatment or further testing | 14 |
| provided under the program shall be consistent with the | 15 |
| services provided under the State's approved plan under Title | 16 |
| XIX of the Social Security Act. | 17 |
| (e) The Department shall make every effort to ensure that | 18 |
| services under the program are made available in rural and | 19 |
| medically underserved areas in Illinois, including by means of | 20 |
| telemedicine. | 21 |
| (f) Coverage of services under the program is not dependent | 22 |
| on federal approval, but federal moneys may be used to pay for | 23 |
| such services upon federal approval. | 24 |
| Section 10. The Illinois Public Aid Code is amended by | 25 |
| changing Section 5-2 as follows:
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| (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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| Sec. 5-2. Classes of Persons Eligible. Medical assistance | 3 |
| under this
Article shall be available to any of the following | 4 |
| classes of persons in
respect to whom a plan for coverage has | 5 |
| been submitted to the Governor
by the Illinois Department and | 6 |
| approved by him:
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| 1. Recipients of basic maintenance grants under | 8 |
| Articles III and IV.
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| 2. Persons otherwise eligible for basic maintenance | 10 |
| under Articles
III and IV, excluding any eligibility | 11 |
| requirements that are inconsistent with any federal law or | 12 |
| federal regulation, as interpreted by the U.S. Department | 13 |
| of Health and Human Services, but who fail to qualify | 14 |
| thereunder on the basis of need or who qualify but are not | 15 |
| receiving basic maintenance under Article IV, and
who have | 16 |
| insufficient income and resources to meet the costs of
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| necessary medical care, including but not limited to the | 18 |
| following:
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| (a) All persons otherwise eligible for basic | 20 |
| maintenance under Article
III but who fail to qualify | 21 |
| under that Article on the basis of need and who
meet | 22 |
| either of the following requirements:
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| (i) their income, as determined by the | 24 |
| Illinois Department in
accordance with any federal | 25 |
| requirements, is equal to or less than 70% in
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| fiscal year 2001, equal to or less than 85% in | 2 |
| fiscal year 2002 and until
a date to be determined | 3 |
| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the | 5 |
| Department by rule, of the nonfarm income official | 6 |
| poverty
line, as defined by the federal Office of | 7 |
| Management and Budget and revised
annually in | 8 |
| accordance with Section 673(2) of the Omnibus | 9 |
| Budget Reconciliation
Act of 1981, applicable to | 10 |
| families of the same size; or
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| (ii) their income, after the deduction of | 12 |
| costs incurred for medical
care and for other types | 13 |
| 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 | 15 |
| fiscal year 2002 and until
a date to be determined | 16 |
| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the | 18 |
| Department by rule, of the nonfarm income official | 19 |
| poverty
line, as defined in item (i) of this | 20 |
| subparagraph (a).
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| (b) All persons who, excluding any eligibility | 22 |
| requirements that are inconsistent with any federal | 23 |
| law or federal regulation, as interpreted by the U.S. | 24 |
| Department of Health and Human Services, would be | 25 |
| determined eligible for such basic
maintenance under | 26 |
| Article IV by disregarding the maximum earned income
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| permitted by federal law.
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| 3. Persons who would otherwise qualify for Aid to the | 3 |
| Medically
Indigent under Article VII.
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| 4. Persons not eligible under any of the preceding | 5 |
| paragraphs who fall
sick, are injured, or die, not having | 6 |
| sufficient money, property or other
resources to meet the | 7 |
| costs of necessary medical care or funeral and burial
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| expenses.
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| 5.(a) Women during pregnancy, after the fact
of | 10 |
| pregnancy has been determined by medical diagnosis, and | 11 |
| during the
60-day period beginning on the last day of the | 12 |
| pregnancy, together with
their infants and children born | 13 |
| after September 30, 1983,
whose income and
resources are | 14 |
| insufficient to meet the costs of necessary medical care to
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| the maximum extent possible under Title XIX of the
Federal | 16 |
| Social Security Act.
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| (b) The Illinois Department and the Governor shall | 18 |
| provide a plan for
coverage of the persons eligible under | 19 |
| paragraph 5(a) by April 1, 1990. Such
plan shall provide | 20 |
| ambulatory prenatal care to pregnant women during a
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| presumptive eligibility period and establish an income | 22 |
| eligibility standard
that is equal to 133%
of the nonfarm | 23 |
| income official poverty line, as defined by
the federal | 24 |
| Office of Management and Budget and revised annually in
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| accordance with Section 673(2) of the Omnibus Budget | 26 |
| Reconciliation Act of
1981, applicable to families of the |
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| same size, provided that costs incurred
for medical care | 2 |
| are not taken into account in determining such income
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| eligibility.
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| (c) The Illinois Department may conduct a | 5 |
| demonstration in at least one
county that will provide | 6 |
| medical assistance to pregnant women, together
with their | 7 |
| infants and children up to one year of age,
where the | 8 |
| income
eligibility standard is set up to 185% of the | 9 |
| nonfarm income official
poverty line, as defined by the | 10 |
| federal Office of Management and Budget.
The Illinois | 11 |
| Department shall seek and obtain necessary authorization
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| provided under federal law to implement such a | 13 |
| demonstration. Such
demonstration may establish resource | 14 |
| standards that are not more
restrictive than those | 15 |
| established under Article IV of this Code.
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| 6. Persons under the age of 18 who fail to qualify as | 17 |
| dependent under
Article IV and who have insufficient income | 18 |
| and resources to meet the costs
of necessary medical care | 19 |
| to the maximum extent permitted under Title XIX
of the | 20 |
| Federal Social Security Act.
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| 7. Persons who are under 21 years of age and would
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| qualify as
disabled as defined under the Federal | 23 |
| Supplemental Security Income Program,
provided medical | 24 |
| service for such persons would be eligible for Federal
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| Financial Participation, and provided the Illinois | 26 |
| Department determines that:
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| (a) the person requires a level of care provided by | 2 |
| a hospital, skilled
nursing facility, or intermediate | 3 |
| care facility, as determined by a physician
licensed to | 4 |
| practice medicine in all its branches;
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| (b) it is appropriate to provide such care outside | 6 |
| of an institution, as
determined by a physician | 7 |
| licensed to practice medicine in all its branches;
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| (c) the estimated amount which would be expended | 9 |
| for care outside the
institution is not greater than | 10 |
| the estimated amount which would be
expended in an | 11 |
| institution.
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| 8. Persons who become ineligible for basic maintenance | 13 |
| assistance
under Article IV of this Code in programs | 14 |
| administered by the Illinois
Department due to employment | 15 |
| earnings and persons in
assistance units comprised of | 16 |
| adults and children who become ineligible for
basic | 17 |
| maintenance assistance under Article VI of this Code due to
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| employment earnings. The plan for coverage for this class | 19 |
| of persons shall:
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| (a) extend the medical assistance coverage for up | 21 |
| to 12 months following
termination of basic | 22 |
| maintenance assistance; and
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| (b) offer persons who have initially received 6 | 24 |
| months of the
coverage provided in paragraph (a) above, | 25 |
| the option of receiving an
additional 6 months of | 26 |
| coverage, subject to the following:
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| (i) such coverage shall be pursuant to | 2 |
| provisions of the federal
Social Security Act;
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| (ii) such coverage shall include all services | 4 |
| covered while the person
was eligible for basic | 5 |
| maintenance assistance;
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| (iii) no premium shall be charged for such | 7 |
| coverage; and
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| (iv) such coverage shall be suspended in the | 9 |
| event of a person's
failure without good cause to | 10 |
| file in a timely fashion reports required for
this | 11 |
| coverage under the Social Security Act and | 12 |
| coverage shall be reinstated
upon the filing of | 13 |
| such reports if the person remains otherwise | 14 |
| eligible.
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| 9. Persons with acquired immunodeficiency syndrome | 16 |
| (AIDS) or with
AIDS-related conditions with respect to whom | 17 |
| there has been a determination
that but for home or | 18 |
| community-based services such individuals would
require | 19 |
| the level of care provided in an inpatient hospital, | 20 |
| skilled
nursing facility or intermediate care facility the | 21 |
| cost of which is
reimbursed under this Article. Assistance | 22 |
| shall be provided to such
persons to the maximum extent | 23 |
| permitted under Title
XIX of the Federal Social Security | 24 |
| Act.
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| 10. Participants in the long-term care insurance | 26 |
| partnership program
established under the Illinois |
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| Long-Term Care Partnership Program Act who meet the
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| qualifications for protection of resources described in | 3 |
| Section 15 of that
Act.
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| 11. Persons with disabilities who are employed and | 5 |
| eligible for Medicaid,
pursuant to Section | 6 |
| 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | 7 |
| subject to federal approval, persons with a medically | 8 |
| improved disability who are employed and eligible for | 9 |
| Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | 10 |
| the Social Security Act, as
provided by the Illinois | 11 |
| Department by rule. In establishing eligibility standards | 12 |
| under this paragraph 11, the Department shall, subject to | 13 |
| federal approval: | 14 |
| (a) set the income eligibility standard at not | 15 |
| lower than 350% of the federal poverty level; | 16 |
| (b) exempt retirement accounts that the person | 17 |
| cannot access without penalty before the age
of 59 1/2, | 18 |
| and medical savings accounts established pursuant to | 19 |
| 26 U.S.C. 220; | 20 |
| (c) allow non-exempt assets up to $25,000 as to | 21 |
| those assets accumulated during periods of eligibility | 22 |
| under this paragraph 11; and
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| (d) continue to apply subparagraphs (b) and (c) in | 24 |
| determining the eligibility of the person under this | 25 |
| Article even if the person loses eligibility under this | 26 |
| paragraph 11.
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| 12. Subject to federal approval, persons who are | 2 |
| eligible for medical
assistance coverage under applicable | 3 |
| provisions of the federal Social Security
Act and the | 4 |
| federal Breast and Cervical Cancer Prevention and | 5 |
| Treatment Act of
2000. Those eligible persons are defined | 6 |
| to include, but not be limited to,
the following persons:
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| (1) persons who have been screened for breast or | 8 |
| cervical cancer under
the U.S. Centers for Disease | 9 |
| Control and Prevention Breast and Cervical Cancer
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| Program established under Title XV of the federal | 11 |
| Public Health Services Act in
accordance with the | 12 |
| requirements of Section 1504 of that Act as | 13 |
| administered by
the Illinois Department of Public | 14 |
| Health; and
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| (2) persons whose screenings under the above | 16 |
| program were funded in whole
or in part by funds | 17 |
| appropriated to the Illinois Department of Public | 18 |
| Health
for breast or cervical cancer screening.
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| "Medical assistance" under this paragraph 12 shall be | 20 |
| identical to the benefits
provided under the State's | 21 |
| approved plan under Title XIX of the Social Security
Act. | 22 |
| The Department must request federal approval of the | 23 |
| coverage under this
paragraph 12 within 30 days after the | 24 |
| effective date of this amendatory Act of
the 92nd General | 25 |
| Assembly.
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| 13. Subject to appropriation and to federal approval, |
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| persons living with HIV/AIDS who are not otherwise eligible | 2 |
| under this Article and who qualify for services covered | 3 |
| under Section 5-5.04 as provided by the Illinois Department | 4 |
| by rule.
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| 14. Subject to the availability of funds for this | 6 |
| purpose, the Department may provide coverage under this | 7 |
| Article to persons who reside in Illinois who are not | 8 |
| eligible under any of the preceding paragraphs and who meet | 9 |
| the income guidelines of paragraph 2(a) of this Section and | 10 |
| (i) have an application for asylum pending before the | 11 |
| federal Department of Homeland Security or on appeal before | 12 |
| a court of competent jurisdiction and are represented | 13 |
| either by counsel or by an advocate accredited by the | 14 |
| federal Department of Homeland Security and employed by a | 15 |
| not-for-profit organization in regard to that application | 16 |
| or appeal, or (ii) are receiving services through a | 17 |
| federally funded torture treatment center. Medical | 18 |
| coverage under this paragraph 14 may be provided for up to | 19 |
| 24 continuous months from the initial eligibility date so | 20 |
| long as an individual continues to satisfy the criteria of | 21 |
| this paragraph 14. If an individual has an appeal pending | 22 |
| regarding an application for asylum before the Department | 23 |
| of Homeland Security, eligibility under this paragraph 14 | 24 |
| may be extended until a final decision is rendered on the | 25 |
| appeal. The Department may adopt rules governing the | 26 |
| implementation of this paragraph 14.
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| 15. Family Care Eligibility. | 2 |
| (a) A caretaker relative who is 19 years of age or | 3 |
| older when countable income is at or below 185% of the | 4 |
| Federal Poverty Level Guidelines, as published | 5 |
| annually in the Federal Register, for the appropriate | 6 |
| family size. A person may not spend down to become | 7 |
| eligible under this paragraph 15. | 8 |
| (b) Eligibility shall be reviewed annually. | 9 |
| (c) Caretaker relatives enrolled under this | 10 |
| paragraph 15 in families with countable income above | 11 |
| 150% and at or below 185% of the Federal Poverty Level | 12 |
| Guidelines shall be counted as family members and pay | 13 |
| premiums as established under the Children's Health | 14 |
| Insurance Program Act. | 15 |
| (d) Premiums shall be billed by and payable to the | 16 |
| Department or its authorized agent, on a monthly basis. | 17 |
| (e) The premium due date is the last day of the | 18 |
| month preceding the month of coverage. | 19 |
| (f) Individuals shall have a grace period through | 20 |
| the month of coverage to pay the premium. | 21 |
| (g) Failure to pay the full monthly premium by the | 22 |
| last day of the grace period shall result in | 23 |
| termination of coverage. | 24 |
| (h) Partial premium payments shall not be | 25 |
| refunded. | 26 |
| (i) Following termination of an individual's |
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| coverage under this paragraph 15, the following action | 2 |
| is required before the individual can be re-enrolled: | 3 |
| (1) A new application must be completed and the | 4 |
| individual must be determined otherwise eligible. | 5 |
| (2) There must be full payment of premiums due | 6 |
| under this Code, the Children's Health Insurance | 7 |
| Program Act, the Covering ALL KIDS Health | 8 |
| Insurance Act, or any other healthcare program | 9 |
| administered by the Department for periods in | 10 |
| which a premium was owed and not paid for the | 11 |
| individual. | 12 |
| (3) The first month's premium must be paid if | 13 |
| there was an unpaid premium on the date the | 14 |
| individual's previous coverage was canceled. | 15 |
| The Department is authorized to implement the | 16 |
| provisions of this amendatory Act of the 95th General | 17 |
| Assembly by adopting the medical assistance rules in effect | 18 |
| as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | 19 |
| 89 Ill. Admin. Code 120.32 along with only those changes | 20 |
| necessary to conform to federal Medicaid requirements, | 21 |
| federal laws, and federal regulations, including but not | 22 |
| limited to Section 1931 of the Social Security Act (42 | 23 |
| U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | 24 |
| of Health and Human Services, and the countable income | 25 |
| eligibility standard authorized by this paragraph 15. The | 26 |
| Department may not otherwise adopt any rule to implement |
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| this increase except as authorized by law, to meet the | 2 |
| eligibility standards authorized by the federal government | 3 |
| in the Medicaid State Plan or the Title XXI Plan, or to | 4 |
| meet an order from the federal government or any court. | 5 |
| 16. 15. Subject to appropriation, uninsured persons | 6 |
| who are not otherwise eligible under this Section who have | 7 |
| been certified and referred by the Department of Public | 8 |
| Health as having been screened and found to need diagnostic | 9 |
| evaluation or treatment, or both diagnostic evaluation and | 10 |
| treatment, for prostate or testicular cancer. For the | 11 |
| purposes of this paragraph 16 15 , uninsured persons are | 12 |
| those who do not have creditable coverage, as defined under | 13 |
| the Health Insurance Portability and Accountability Act, | 14 |
| or have otherwise exhausted any insurance benefits they may | 15 |
| have had, for prostate or testicular cancer diagnostic | 16 |
| evaluation or treatment, or both diagnostic evaluation and | 17 |
| treatment.
To be eligible, a person must furnish a Social | 18 |
| Security number.
A person's assets are exempt from | 19 |
| consideration in determining eligibility under this | 20 |
| paragraph 16 15 .
Such persons shall be eligible for medical | 21 |
| assistance under this paragraph 16 15 for so long as they | 22 |
| need treatment for the cancer. A person shall be considered | 23 |
| to need treatment if, in the opinion of the person's | 24 |
| treating physician, the person requires therapy directed | 25 |
| toward cure or palliation of prostate or testicular cancer, | 26 |
| including recurrent metastatic cancer that is a known or |
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| presumed complication of prostate or testicular cancer and | 2 |
| complications resulting from the treatment modalities | 3 |
| themselves. Persons who require only routine monitoring | 4 |
| services are not considered to need treatment.
"Medical | 5 |
| assistance" under this paragraph 16 15 shall be identical | 6 |
| to the benefits provided under the State's approved plan | 7 |
| under Title XIX of the Social Security Act.
Notwithstanding | 8 |
| any other provision of law, the Department (i) does not | 9 |
| have a claim against the estate of a deceased recipient of | 10 |
| services under this paragraph 16 15 and (ii) does not have | 11 |
| a lien against any homestead property or other legal or | 12 |
| equitable real property interest owned by a recipient of | 13 |
| services under this paragraph 16 15 . | 14 |
| 17. Women who qualify for services under the Women's | 15 |
| Heart Disease Prevention, Detection, and Treatment program | 16 |
| established under Section 2310-432 of the Department of | 17 |
| Public Health Powers and Duties Law of the
Civil | 18 |
| Administrative Code of Illinois. | 19 |
| In implementing the provisions of Public Act 96-20 this | 20 |
| amendatory Act of the 96th General Assembly , the Department is | 21 |
| authorized to adopt only those rules necessary, including | 22 |
| emergency rules. Nothing in Public Act 96-20 this amendatory | 23 |
| Act of the 96th General Assembly permits the Department to | 24 |
| adopt rules or issue a decision that expands eligibility for | 25 |
| the FamilyCare Program to a person whose income exceeds 185% of | 26 |
| the Federal Poverty Level as determined from time to time by |
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| the U.S. Department of Health and Human Services, unless the | 2 |
| Department is provided with express statutory authority. | 3 |
| The Illinois Department and the Governor shall provide a | 4 |
| plan for
coverage of the persons eligible under paragraph 7 as | 5 |
| soon as possible after
July 1, 1984.
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| The eligibility of any such person for medical assistance | 7 |
| under this
Article is not affected by the payment of any grant | 8 |
| under the Senior
Citizens and Disabled Persons Property Tax | 9 |
| Relief and Pharmaceutical
Assistance Act or any distributions | 10 |
| or items of income described under
subparagraph (X) of
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| paragraph (2) of subsection (a) of Section 203 of the Illinois | 12 |
| Income Tax
Act. The Department shall by rule establish the | 13 |
| amounts of
assets to be disregarded in determining eligibility | 14 |
| for medical assistance,
which shall at a minimum equal the | 15 |
| amounts to be disregarded under the
Federal Supplemental | 16 |
| Security Income Program. The amount of assets of a
single | 17 |
| person to be disregarded
shall not be less than $2,000, and the | 18 |
| amount of assets of a married couple
to be disregarded shall | 19 |
| not be less than $3,000.
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| To the extent permitted under federal law, any person found | 21 |
| guilty of a
second violation of Article VIIIA
shall be | 22 |
| ineligible for medical assistance under this Article, as | 23 |
| provided
in Section 8A-8.
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| The eligibility of any person for medical assistance under | 25 |
| this Article
shall not be affected by the receipt by the person | 26 |
| of donations or benefits
from fundraisers held for the person |
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| in cases of serious illness,
as long as neither the person nor | 2 |
| members of the person's family
have actual control over the | 3 |
| donations or benefits or the disbursement
of the donations or | 4 |
| benefits.
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| (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; | 6 |
| 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. | 7 |
| 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
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| Section 99. Effective date. This Act takes effect upon | 9 |
| becoming law.
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