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Public Act 096-1123 |
SB3290 Enrolled | LRB096 20040 KTG 35543 b |
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AN ACT concerning public aid.
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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 Alternative Health Care Delivery Act is |
amended by changing Section 30 as follows:
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(210 ILCS 3/30)
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Sec. 30. Demonstration program requirements. The |
requirements set forth in
this Section shall apply to |
demonstration programs.
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(a) There shall be no more than:
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(i) 3 subacute care hospital alternative health care |
models in the City of
Chicago (one of which shall be |
located on a designated site and shall have been
licensed |
as a hospital under the Illinois Hospital Licensing Act |
within the 10
years immediately before the application for |
a license);
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(ii) 2 subacute care hospital alternative health care |
models in the
demonstration program for each of the |
following areas:
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(1) Cook County outside the City of Chicago.
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(2) DuPage, Kane, Lake, McHenry, and Will |
Counties.
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(3) Municipalities with a population greater than |
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50,000 not
located in the areas described in item (i) |
of subsection (a) and paragraphs
(1) and (2) of item |
(ii) of subsection (a); and
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(iii) 4 subacute care hospital alternative health care
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models in the demonstration program for rural areas.
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In selecting among applicants for these
licenses in rural |
areas, the Health Facilities and Services Review Board and the
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Department shall give preference to hospitals that may be |
unable for economic
reasons to provide continued service to the |
community in which they are located
unless the hospital were to |
receive an alternative health care model license.
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(a-5) There shall be no more than the total number of |
postsurgical
recovery care centers with a certificate of need |
for beds as of January 1, 2008.
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(a-10) There shall be no more than a total of 9 children's |
respite care
center alternative health care models in the |
demonstration program, which shall
be located as follows:
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(1) Two in the City of Chicago.
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(2) One in Cook County outside the City of Chicago.
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(3) A total of 2 in the area comprised of DuPage, Kane, |
Lake, McHenry, and
Will counties.
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(4) A total of 2 in municipalities with a population of |
50,000 or more and
not
located in the areas described in |
paragraphs (1), (2), or (3).
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(5) A total of 2 in rural areas, as defined by the |
Health Facilities
and Services Review Board.
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No more than one children's respite care model owned and |
operated by a
licensed skilled pediatric facility shall be |
located in each of the areas
designated in this subsection |
(a-10).
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(a-15) There shall be 2 authorized community-based |
residential
rehabilitation center alternative health care |
models in the demonstration
program.
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(a-20) There shall be an authorized
Alzheimer's disease |
management center alternative health care model in the
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demonstration program. The Alzheimer's disease management |
center shall be
located in Will
County, owned by a
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not-for-profit entity, and endorsed by a resolution approved by |
the county
board before the effective date of this amendatory |
Act of the 91st General
Assembly.
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(a-25) There shall be no more than 10 birth center |
alternative health care
models in the demonstration program, |
located as follows:
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(1) Four in the area comprising Cook, DuPage, Kane, |
Lake, McHenry, and
Will counties, one of
which shall be |
owned or operated by a hospital and one of which shall be |
owned
or operated by a federally qualified health center.
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(2) Three in municipalities with a population of 50,000 |
or more not
located in the area described in paragraph (1) |
of this subsection, one of
which shall be owned or operated |
by a hospital and one of which shall be owned
or operated |
by a federally qualified health center.
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(3) Three in rural areas, one of which shall be owned |
or operated by a
hospital and one of which shall be owned |
or operated by a federally qualified
health center.
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The first 3 birth centers authorized to operate by the |
Department shall be
located in or predominantly serve the |
residents of a health professional
shortage area as determined |
by the United States Department of Health and Human
Services. |
There shall be no more than 2 birth centers authorized to |
operate in
any single health planning area for obstetric |
services as determined under the
Illinois Health Facilities |
Planning Act. If a birth center is located outside
of a
health |
professional shortage area, (i) the birth center shall be |
located in a
health planning
area with a demonstrated need for |
obstetrical service beds, as determined by
the Health |
Facilities and Services Review Board or (ii) there must be a
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reduction in
the existing number of obstetrical service beds in |
the planning area so that
the establishment of the birth center |
does not result in an increase in the
total number of |
obstetrical service beds in the health planning area.
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(b) Alternative health care models, other than a model |
authorized under subsection (a-10) or subsections (a-10) and
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(a-20), shall obtain a certificate of
need from the Health |
Facilities and Services Review Board under the Illinois
Health |
Facilities Planning Act before receiving a license by the
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Department.
If, after obtaining its initial certificate of |
need, an alternative health
care delivery model that is a |
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community based residential rehabilitation center
seeks to
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increase the bed capacity of that center, it must obtain a |
certificate of need
from the Health Facilities and Services |
Review Board before increasing the bed
capacity. Alternative
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health care models in medically underserved areas
shall receive |
priority in obtaining a certificate of need.
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(c) An alternative health care model license shall be |
issued for a
period of one year and shall be annually renewed |
if the facility or
program is in substantial compliance with |
the Department's rules
adopted under this Act. A licensed |
alternative health care model that continues
to be in |
substantial compliance after the conclusion of the |
demonstration
program shall be eligible for annual renewals |
unless and until a different
licensure program for that type of |
health care model is established by
legislation, except that a |
postsurgical recovery care center meeting the following |
requirements may apply within 3 years after August 25, 2009 |
( the effective date of Public Act 96-669) this amendatory Act |
of the 96th General Assembly for a Certificate of Need permit |
to operate as a hospital: |
(1) The postsurgical recovery care center shall apply |
to the Illinois Health Facilities Planning Board for a |
Certificate of Need permit to discontinue the postsurgical |
recovery care center and to establish a hospital. |
(2) If the postsurgical recovery care center obtains a |
Certificate of Need permit to operate as a hospital, it |
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shall apply for licensure as a hospital under the Hospital |
Licensing Act and shall meet all statutory and regulatory |
requirements of a hospital. |
(3) After obtaining licensure as a hospital, any |
license as an ambulatory surgical treatment center and any |
license as a post-surgical recovery care center shall be |
null and void. |
(4) The former postsurgical recovery care center that |
receives a hospital license must seek and use its best |
efforts to maintain certification under Titles XVIII and |
XIX of the federal Social Security Act. |
The Department may issue a provisional license to any
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alternative health care model that does not substantially |
comply with the
provisions of this Act and the rules adopted |
under this Act if (i)
the Department finds that the alternative |
health care model has undertaken
changes and corrections which |
upon completion will render the alternative
health care model |
in substantial compliance with this Act and rules and
(ii) the |
health and safety of the patients of the alternative
health |
care model will be protected during the period for which the |
provisional
license is issued. The Department shall advise the |
licensee of
the conditions under which the provisional license |
is issued, including
the manner in which the alternative health |
care model fails to comply with
the provisions of this Act and |
rules, and the time within which the changes
and corrections |
necessary for the alternative health care model to
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substantially comply with this Act and rules shall be |
completed.
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(d) Alternative health care models shall seek |
certification under Titles
XVIII and XIX of the federal Social |
Security Act. In addition, alternative
health care models shall |
provide charitable care consistent with that provided
by |
comparable health care providers in the geographic area.
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(d-5) (Blank) The Department of Healthcare and Family |
Services (formerly Illinois Department of Public Aid), in |
cooperation with the
Illinois Department of
Public Health, |
shall develop and implement a reimbursement methodology for all
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facilities participating in the demonstration program. The |
Department of Healthcare and Family Services shall keep a |
record of services provided under the demonstration
program to |
recipients of medical assistance under the Illinois Public Aid |
Code
and shall submit an annual report of that information to |
the Illinois
Department of Public Health .
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(e) Alternative health care models shall, to the extent |
possible,
link and integrate their services with nearby health |
care facilities.
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(f) Each alternative health care model shall implement a |
quality
assurance program with measurable benefits and at |
reasonable cost.
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(Source: P.A. 95-331, eff. 8-21-07; 95-445, eff. 1-1-08; 96-31, |
eff. 6-30-09; 96-129, eff. 8-4-09; 96-669, eff. 8-25-09; |
96-812, eff. 1-1-10; revised 11-4-09.)
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Section 10. The Illinois Public Aid Code is amended by |
changing Sections 5-2 and 5-5.5 and by adding Section 12-8.2 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 |
under this
Article shall be available to any of the following |
classes of persons in
respect to whom a plan for coverage has |
been submitted to the Governor
by the Illinois Department and |
approved by him:
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1. Recipients of basic maintenance grants under |
Articles III and IV.
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2. Persons otherwise eligible for basic maintenance |
under Articles
III and IV, excluding any eligibility |
requirements that are inconsistent with any federal law or |
federal regulation, as interpreted by the U.S. Department |
of Health and Human Services, but who fail to qualify |
thereunder on the basis of need or who qualify but are not |
receiving basic maintenance under Article IV, and
who have |
insufficient income and resources to meet the costs of
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necessary medical care, including but not limited to the |
following:
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(a) All persons otherwise eligible for basic |
maintenance under Article
III but who fail to qualify |
under that Article on the basis of need and who
meet |
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either of the following requirements:
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(i) their income, as determined by the |
Illinois Department in
accordance with any federal |
requirements, is equal to or less than 70% in
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fiscal year 2001, equal to or less than 85% in |
fiscal year 2002 and until
a date to be determined |
by the Department by rule, and equal to or less
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than 100% beginning on the date determined by the |
Department by rule, of the nonfarm income official |
poverty
line, as defined by the federal Office of |
Management and Budget and revised
annually in |
accordance with Section 673(2) of the Omnibus |
Budget Reconciliation
Act of 1981, applicable to |
families of the same size; or
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(ii) their income, after the deduction of |
costs incurred for medical
care and for other types |
of remedial care, is equal to or less than 70% in
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fiscal year 2001, equal to or less than 85% in |
fiscal year 2002 and until
a date to be determined |
by the Department by rule, and equal to or less
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than 100% beginning on the date determined by the |
Department by rule, of the nonfarm income official |
poverty
line, as defined in item (i) of this |
subparagraph (a).
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(b) All persons who, excluding any eligibility |
requirements that are inconsistent with any federal |
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law or federal regulation, as interpreted by the U.S. |
Department of Health and Human Services, would be |
determined eligible for such basic
maintenance under |
Article IV by disregarding the maximum earned income
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permitted by federal law.
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3. Persons who would otherwise qualify for Aid to the |
Medically
Indigent under Article VII.
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4. Persons not eligible under any of the preceding |
paragraphs who fall
sick, are injured, or die, not having |
sufficient money, property or other
resources to meet the |
costs of necessary medical care or funeral and burial
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expenses.
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5.(a) Women during pregnancy, after the fact
of |
pregnancy has been determined by medical diagnosis, and |
during the
60-day period beginning on the last day of the |
pregnancy, together with
their infants and children born |
after September 30, 1983,
whose income and
resources are |
insufficient to meet the costs of necessary medical care to
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the maximum extent possible under Title XIX of the
Federal |
Social Security Act.
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(b) The Illinois Department and the Governor shall |
provide a plan for
coverage of the persons eligible under |
paragraph 5(a) by April 1, 1990. Such
plan shall provide |
ambulatory prenatal care to pregnant women during a
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presumptive eligibility period and establish an income |
eligibility standard
that is equal to 133%
of the nonfarm |
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income official poverty line, as defined by
the federal |
Office of Management and Budget and revised annually in
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accordance with Section 673(2) of the Omnibus Budget |
Reconciliation Act of
1981, applicable to families of the |
same size, provided that costs incurred
for medical care |
are not taken into account in determining such income
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eligibility.
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(c) The Illinois Department may conduct a |
demonstration in at least one
county that will provide |
medical assistance to pregnant women, together
with their |
infants and children up to one year of age,
where the |
income
eligibility standard is set up to 185% of the |
nonfarm income official
poverty line, as defined by the |
federal Office of Management and Budget.
The Illinois |
Department shall seek and obtain necessary authorization
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provided under federal law to implement such a |
demonstration. Such
demonstration may establish resource |
standards that are not more
restrictive than those |
established under Article IV of this Code.
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6. Persons under the age of 18 who fail to qualify as |
dependent under
Article IV and who have insufficient income |
and resources to meet the costs
of necessary medical care |
to the maximum extent permitted under Title XIX
of the |
Federal Social Security Act.
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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 |
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Supplemental Security Income Program,
provided medical |
service for such persons would be eligible for Federal
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Financial Participation, and provided the Illinois |
Department determines that:
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(a) the person requires a level of care provided by |
a hospital, skilled
nursing facility, or intermediate |
care facility, as determined by a physician
licensed to |
practice medicine in all its branches;
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(b) it is appropriate to provide such care outside |
of an institution, as
determined by a physician |
licensed to practice medicine in all its branches;
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(c) the estimated amount which would be expended |
for care outside the
institution is not greater than |
the estimated amount which would be
expended in an |
institution.
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8. Persons who become ineligible for basic maintenance |
assistance
under Article IV of this Code in programs |
administered by the Illinois
Department due to employment |
earnings and persons in
assistance units comprised of |
adults and children who become ineligible for
basic |
maintenance assistance under Article VI of this Code due to
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employment earnings. The plan for coverage for this class |
of persons shall:
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(a) extend the medical assistance coverage for up |
to 12 months following
termination of basic |
maintenance assistance; and
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(b) offer persons who have initially received 6 |
months of the
coverage provided in paragraph (a) above, |
the option of receiving an
additional 6 months of |
coverage, subject to the following:
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(i) such coverage shall be pursuant to |
provisions of the federal
Social Security Act;
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(ii) such coverage shall include all services |
covered while the person
was eligible for basic |
maintenance assistance;
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(iii) no premium shall be charged for such |
coverage; and
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(iv) such coverage shall be suspended in the |
event of a person's
failure without good cause to |
file in a timely fashion reports required for
this |
coverage under the Social Security Act and |
coverage shall be reinstated
upon the filing of |
such reports if the person remains otherwise |
eligible.
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9. Persons with acquired immunodeficiency syndrome |
(AIDS) or with
AIDS-related conditions with respect to whom |
there has been a determination
that but for home or |
community-based services such individuals would
require |
the level of care provided in an inpatient hospital, |
skilled
nursing facility or intermediate care facility the |
cost of which is
reimbursed under this Article. Assistance |
shall be provided to such
persons to the maximum extent |
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permitted under Title
XIX of the Federal Social Security |
Act.
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10. Participants in the long-term care insurance |
partnership program
established under the Illinois |
Long-Term Care Partnership Program Act who meet the
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qualifications for protection of resources described in |
Section 15 of that
Act.
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11. Persons with disabilities who are employed and |
eligible for Medicaid,
pursuant to Section |
1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, |
subject to federal approval, persons with a medically |
improved disability who are employed and eligible for |
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of |
the Social Security Act, as
provided by the Illinois |
Department by rule. In establishing eligibility standards |
under this paragraph 11, the Department shall, subject to |
federal approval: |
(a) set the income eligibility standard at not |
lower than 350% of the federal poverty level; |
(b) exempt retirement accounts that the person |
cannot access without penalty before the age
of 59 1/2, |
and medical savings accounts established pursuant to |
26 U.S.C. 220; |
(c) allow non-exempt assets up to $25,000 as to |
those assets accumulated during periods of eligibility |
under this paragraph 11; and
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(d) continue to apply subparagraphs (b) and (c) in |
determining the eligibility of the person under this |
Article even if the person loses eligibility under this |
paragraph 11.
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12. Subject to federal approval, persons who are |
eligible for medical
assistance coverage under applicable |
provisions of the federal Social Security
Act and the |
federal Breast and Cervical Cancer Prevention and |
Treatment Act of
2000. Those eligible persons are defined |
to include, but not be limited to,
the following persons:
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(1) persons who have been screened for breast or |
cervical cancer under
the U.S. Centers for Disease |
Control and Prevention Breast and Cervical Cancer
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Program established under Title XV of the federal |
Public Health Services Act in
accordance with the |
requirements of Section 1504 of that Act as |
administered by
the Illinois Department of Public |
Health; and
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(2) persons whose screenings under the above |
program were funded in whole
or in part by funds |
appropriated to the Illinois Department of Public |
Health
for breast or cervical cancer screening.
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"Medical assistance" under this paragraph 12 shall be |
identical to the benefits
provided under the State's |
approved plan under Title XIX of the Social Security
Act. |
The Department must request federal approval of the |
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coverage under this
paragraph 12 within 30 days after the |
effective date of this amendatory Act of
the 92nd General |
Assembly.
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13. Subject to appropriation and to federal approval, |
persons living with HIV/AIDS who are not otherwise eligible |
under this Article and who qualify for services covered |
under Section 5-5.04 as provided by the Illinois Department |
by rule.
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14. Subject to the availability of funds for this |
purpose, the Department may provide coverage under this |
Article to persons who reside in Illinois who are not |
eligible under any of the preceding paragraphs and who meet |
the income guidelines of paragraph 2(a) of this Section and |
(i) have an application for asylum pending before the |
federal Department of Homeland Security or on appeal before |
a court of competent jurisdiction and are represented |
either by counsel or by an advocate accredited by the |
federal Department of Homeland Security and employed by a |
not-for-profit organization in regard to that application |
or appeal, or (ii) are receiving services through a |
federally funded torture treatment center. Medical |
coverage under this paragraph 14 may be provided for up to |
24 continuous months from the initial eligibility date so |
long as an individual continues to satisfy the criteria of |
this paragraph 14. If an individual has an appeal pending |
regarding an application for asylum before the Department |
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of Homeland Security, eligibility under this paragraph 14 |
may be extended until a final decision is rendered on the |
appeal. The Department may adopt rules governing the |
implementation of this paragraph 14.
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15. Family Care Eligibility. |
(a) A caretaker relative who is 19 years of age or |
older when countable income is at or below 185% of the |
Federal Poverty Level Guidelines, as published |
annually in the Federal Register, for the appropriate |
family size. A person may not spend down to become |
eligible under this paragraph 15. |
(b) Eligibility shall be reviewed annually. |
(c) Caretaker relatives enrolled under this |
paragraph 15 in families with countable income above |
150% and at or below 185% of the Federal Poverty Level |
Guidelines shall be counted as family members and pay |
premiums as established under the Children's Health |
Insurance Program Act. |
(d) Premiums shall be billed by and payable to the |
Department or its authorized agent, on a monthly basis. |
(e) The premium due date is the last day of the |
month preceding the month of coverage. |
(f) Individuals shall have a grace period through |
30 days the month of coverage to pay the premium. |
(g) Failure to pay the full monthly premium by the |
last day of the grace period shall result in |
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termination of coverage. |
(h) Partial premium payments shall not be |
refunded. |
(i) Following termination of an individual's |
coverage under this paragraph 15, the following action |
is required before the individual can be re-enrolled: |
(1) A new application must be completed and the |
individual must be determined otherwise eligible. |
(2) There must be full payment of premiums due |
under this Code, the Children's Health Insurance |
Program Act, the Covering ALL KIDS Health |
Insurance Act, or any other healthcare program |
administered by the Department for periods in |
which a premium was owed and not paid for the |
individual. |
(3) The first month's premium must be paid if |
there was an unpaid premium on the date the |
individual's previous coverage was canceled. |
The Department is authorized to implement the |
provisions of this amendatory Act of the 95th General |
Assembly by adopting the medical assistance rules in effect |
as of October 1, 2007, at 89 Ill. Admin. Code 125, and at |
89 Ill. Admin. Code 120.32 along with only those changes |
necessary to conform to federal Medicaid requirements, |
federal laws, and federal regulations, including but not |
limited to Section 1931 of the Social Security Act (42 |
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U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department |
of Health and Human Services, and the countable income |
eligibility standard authorized by this paragraph 15. The |
Department may not otherwise adopt any rule to implement |
this increase except as authorized by law, to meet the |
eligibility standards authorized by the federal government |
in the Medicaid State Plan or the Title XXI Plan, or to |
meet an order from the federal government or any court. |
16. 15. Subject to appropriation, uninsured persons |
who are not otherwise eligible under this Section who have |
been certified and referred by the Department of Public |
Health as having been screened and found to need diagnostic |
evaluation or treatment, or both diagnostic evaluation and |
treatment, for prostate or testicular cancer. For the |
purposes of this paragraph 16 15 , uninsured persons are |
those who do not have creditable coverage, as defined under |
the Health Insurance Portability and Accountability Act, |
or have otherwise exhausted any insurance benefits they may |
have had, for prostate or testicular cancer diagnostic |
evaluation or treatment, or both diagnostic evaluation and |
treatment.
To be eligible, a person must furnish a Social |
Security number.
A person's assets are exempt from |
consideration in determining eligibility under this |
paragraph 16 15 .
Such persons shall be eligible for medical |
assistance under this paragraph 16 15 for so long as they |
need treatment for the cancer. A person shall be considered |
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to need treatment if, in the opinion of the person's |
treating physician, the person requires therapy directed |
toward cure or palliation of prostate or testicular cancer, |
including recurrent metastatic cancer that is a known or |
presumed complication of prostate or testicular cancer and |
complications resulting from the treatment modalities |
themselves. Persons who require only routine monitoring |
services are not considered to need treatment.
"Medical |
assistance" under this paragraph 16 15 shall be identical |
to the benefits provided under the State's approved plan |
under Title XIX of the Social Security Act.
Notwithstanding |
any other provision of law, the Department (i) does not |
have a claim against the estate of a deceased recipient of |
services under this paragraph 16 15 and (ii) does not have |
a lien against any homestead property or other legal or |
equitable real property interest owned by a recipient of |
services under this paragraph 16 15 . |
In implementing the provisions of Public Act 96-20 this |
amendatory Act of the 96th General Assembly , the Department is |
authorized to adopt only those rules necessary, including |
emergency rules. Nothing in Public Act 96-20 this amendatory |
Act of the 96th General Assembly permits the Department to |
adopt rules or issue a decision that expands eligibility for |
the FamilyCare Program to a person whose income exceeds 185% of |
the Federal Poverty Level as determined from time to time by |
the U.S. Department of Health and Human Services, unless the |
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Department is provided with express statutory authority. |
The Illinois Department and the Governor shall provide a |
plan for
coverage of the persons eligible under paragraph 7 as |
soon as possible after
July 1, 1984.
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The eligibility of any such person for medical assistance |
under this
Article is not affected by the payment of any grant |
under the Senior
Citizens and Disabled Persons Property Tax |
Relief and Pharmaceutical
Assistance Act or any distributions |
or items of income described under
subparagraph (X) of
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paragraph (2) of subsection (a) of Section 203 of the Illinois |
Income Tax
Act. The Department shall by rule establish the |
amounts of
assets to be disregarded in determining eligibility |
for medical assistance,
which shall at a minimum equal the |
amounts to be disregarded under the
Federal Supplemental |
Security Income Program. The amount of assets of a
single |
person to be disregarded
shall not be less than $2,000, and the |
amount of assets of a married couple
to be disregarded shall |
not be less than $3,000.
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To the extent permitted under federal law, any person found |
guilty of a
second violation of Article VIIIA
shall be |
ineligible for medical assistance under this Article, as |
provided
in Section 8A-8.
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The eligibility of any person for medical assistance under |
this Article
shall not be affected by the receipt by the person |
of donations or benefits
from fundraisers held for the person |
in cases of serious illness,
as long as neither the person nor |
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members of the person's family
have actual control over the |
donations or benefits or the disbursement
of the donations or |
benefits.
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(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; |
96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. |
8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
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(305 ILCS 5/5-5.5) (from Ch. 23, par. 5-5.5)
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Sec. 5-5.5. Elements of Payment Rate.
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(a) The Department of Healthcare and Family Services shall |
develop a prospective method for
determining payment rates for |
skilled nursing and intermediate care
services in nursing |
facilities composed of the following cost elements:
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(1) Standard Services, with the cost of this component |
being determined
by taking into account the actual costs to |
the facilities of these services
subject to cost ceilings |
to be defined in the Department's rules.
|
(2) Resident Services, with the cost of this component |
being
determined by taking into account the actual costs, |
needs and utilization
of these services, as derived from an |
assessment of the resident needs in
the nursing facilities. |
The Department shall adopt rules governing
reimbursement |
for resident services as listed in Section 5-1.1. Surveys |
or
assessments of resident needs under this Section shall |
include a review by
the facility of the results of such |
assessments and a discussion of issues
in dispute with |
|
authorized survey staff, unless the facility elects not to
|
participate in such a review process. Surveys or |
assessments of resident
needs under this Section may be |
conducted semi-annually and payment rates
relating to |
resident services may be changed on a semi-annual basis. |
The
Illinois Department shall initiate a project, either on |
a pilot basis or
Statewide, to reimburse the cost of |
resident services based on a
methodology which utilizes an |
assessment of resident needs to determine the
level of |
reimbursement. This methodology shall be different from |
the
payment criteria for resident services utilized by the |
Illinois Department
on July 1, 1981. On March 1, 1982, and |
each year thereafter, until such
time when the Illinois |
Department adopts the methodology used in such
project for |
use statewide,
the Illinois Department shall report to the |
General Assembly on the
implementation and progress of such |
project. The report shall include:
|
(A) A statement of the Illinois Department's goals |
and objectives
for such project;
|
(B) A description of such project, including the |
number and type of
nursing facilities involved in the |
project;
|
(C) A description of the methodology used in such |
project;
|
(D) A description of the Illinois Department's |
application of the
methodology;
|
|
(E) A statement on the methodology's effect on the |
quality of care
given to residents in the sample |
nursing facilities; and
|
(F) A statement on the cost of the methodology used |
in such project
and a comparison of this cost with the |
cost of the current payment criteria.
|
(3) Ancillary Services, with the payment rate being |
developed for
each individual type of service. Payment |
shall be made only when
authorized under procedures |
developed by the Department of Healthcare and Family |
Services.
|
(4) Nurse's Aide Training, with the cost of this |
component being
determined by taking into account the |
actual cost to the facilities of
such training.
|
(5) Real Estate Taxes, with the cost of this component |
being
determined by taking into account the figures |
contained in the most
currently available cost reports |
(with no imposition of maximums) updated
to the midpoint of |
the current rate year for long term care services
rendered |
between July 1, 1984 and June 30, 1985, and with the cost |
of this
component being determined by taking into account |
the actual 1983 taxes for
which the nursing homes were |
assessed (with no imposition of maximums)
updated to the |
midpoint of the current rate year for long term care
|
services rendered between July 1, 1985 and June 30, 1986.
|
(b) In developing a prospective method for determining |
|
payment rates
for skilled nursing and intermediate care |
services in nursing facilities,
the Department of Healthcare |
and Family Services shall consider the following cost elements:
|
(1) Reasonable capital cost determined by utilizing |
incurred interest
rate and the current value of the |
investment, including land, utilizing
composite rates, or |
by utilizing such other reasonable cost related methods
|
determined by the Department. However, beginning with the |
rate
reimbursement period effective July 1, 1987, the |
Department shall be
prohibited from establishing, |
including, and implementing any depreciation
factor in |
calculating the capital cost element.
|
(2) Profit, with the actual amount being produced and |
accruing to
the providers in the form of a return on their |
total investment, on the
basis of their ability to |
economically and efficiently deliver a type
of service. The |
method of payment may assure the opportunity for a
profit, |
but shall not guarantee or establish a specific amount as a |
cost.
|
(c) The Illinois Department may implement the amendatory |
changes to
this Section made by this amendatory Act of 1991 |
through the use of
emergency rules in accordance with the |
provisions of Section 5.02 of the
Illinois Administrative |
Procedure Act. For purposes of the Illinois
Administrative |
Procedure Act, the adoption of rules to implement the
|
amendatory changes to this Section made by this amendatory
Act |
|
of 1991 shall be deemed an emergency and necessary for the |
public
interest, safety and welfare.
|
(d) No later than January 1, 2001, the Department of Public |
Aid shall file
with the Joint Committee on Administrative |
Rules, pursuant to the Illinois
Administrative Procedure
Act,
a |
proposed rule, or a proposed amendment to an existing rule, |
regarding payment
for appropriate services, including |
assessment, care planning, discharge
planning, and treatment
|
provided by nursing facilities to residents who have a serious |
mental
illness.
|
(Source: P.A. 95-331, eff. 8-21-07.)
|
(305 ILCS 5/12-8.2 new) |
Sec. 12-8.2. Medical Assistance Dental Reimbursement |
Revolving Fund. There is created a revolving fund to be known |
as the Medical Assistance Dental Reimbursement Revolving Fund, |
to be held by the Director of the Department of Healthcare and |
Family Services, outside of the State treasury, for the |
following purposes: |
(1) The deposit of all funds to pay for dental services |
provided by enrolled dental service providers for services |
to participants in the medical programs administered by the |
Department. |
(2) The deposit of any interest accrued by the |
revolving fund, which interest shall be available to pay |
for dental services provided by enrolled dental service |