HB4076 103RD GENERAL ASSEMBLY

LRB103 32309 KTG 61622 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4076

Introduced 5/9/2023, by Rep. Camille Y. Lilly

SYNOPSIS AS INTRODUCED:

305 ILCS 5/11-5.3a new

Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by adding Section 11-5.3a as follows:

(305 ILCS 5/11-5.3a new)

Sec. 11-5.3a. Business Enterprise Program certified vendor for redetermination system.

(a) The General Assembly finds that there is a real and current need for automation of the process of determination, redetermination (generally "determination"), certification, or recertification of entry into any type of regulated program while also providing for an automatic system of facilitating the determination process where recalcitrance or reticence is detected. Further, there is a need for a system that includes finding, informing, recruiting, and securing an individual's participation in programs such as the medical assistance program under Article V to the benefit of the individual.

(b) The Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, shall select a State vendor to redetermine the eligibility of medical assistance enrollees not covered by the federal waivers provided under Section 1902(e)(14)(A) of the Social Security Act. The selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois as of the effective date of this amendatory Act of the 103rd General Assembly. The selected vendor shall conduct redeterminations utilizing a system that meets the following requirements:

(1) The redetermination system must be hosted on a cloud-based platform that is secure and compliant with standards under the federal Health Insurance Portability and Accountability Act of 1996.

(2) The redetermination system must also use a cloud communication platform to programmatically perform calls, text messages, and other communication functions using web services or application programming interface services.

(3) The redetermination system must be able to make contact with a medical assistance enrollee in an automated fashion, using the last known contact information to contact the medical assistance enrollee, and if the redetermination contact process is advised that contact was not made, the process must use public and private databases to find and test newly found contact information until the medical assistance enrollee is reached and redetermination is started, or the medical assistance enrollee opts out of the redetermination contact process. The redetermination system must be designed to continue until contact is made and confirmed and contact information is updated to facilitate the following year's redetermination contact process. A relentless search to find medical assistance enrollees and complete the redetermination process must be made, such that no eligible medical assistance enrollee or applicant is left behind.

(4) The redetermination system must also have the ability to reward a medical assistance enrollee who successfully completes the redetermination process, such as with a gift card or other rewards that can be provided to the medical assistance enrollee when the process is completed. The amount of the gift card may be conditioned on the responsiveness of the medical assistance enrollee or dependent on other factors such as age, living conditions, or abode as well as other factors or criteria.

(5) The redetermination system must have the ability to simplify and greatly facilitate medical assistance enrollees to engage in the redetermination process and easily enter, update, and transmit their required information and data by being able to go from using a voice virtual agent or text virtual agent to an online web form and back to a human assistant seamlessly and without losing any data input.

(6) The redetermination system must allow the medical assistance enrollee to start the process through one of the means available, stop at some point, and then resume using the same means or transferring the process to another means available through the system without missing a beat.

(7) The redetermination system must allow the medical assistance enrollee to switch between the voice virtual agent (using artificial intelligence), the text virtual agent, and an online web form.

(8) The redetermination system must also perform the function of pre-populating forms with the information confirmed by the medical assistance enrollee, which can be uploaded during the redetermination process as the medical assistance enrollee proceeds through the data fields so as to confirm or update the medical assistance recipient's information.

(9) The redetermination system must be designed to be compliant with the Americans with Disabilities Act (ADA). ADA compliance must be found regardless of which of the different ways a medical assistance enrollee enters the data, and then, any of the other means to which the medical assistance enrollee can switch, continues to be ADA compliant regardless of the stage of the redetermination process that the enrollee is in and regardless of the number of transitions from one data entry means to another.

(10) The redetermination system must provide an out-of-the-box analytics dashboard that is tethered to the cloud-based system with no additional software installation on the user's computer or mobile devices.

(11) The redetermination system must allow for a scouring of the laws, rules, and regulations to review any changes to the medical assistance program and institute those changes in the questionnaires and forms utilized to assess the candidate and enroll the applicant.

(12) Using the redetermination system shall not be considered "assistance" but rather a different modality of applying for redetermination.

(13) The redetermination system must have a cloud data processing platform to accumulate enrollee data to begin the process in an automated fashion. This includes data validation, rejection, and preparation for communication such as call or text.

(14) The redetermination system must have a cloud data processing platform to be able to provide data submitted by medical assistance enrollees to managed care organizations at a predefined frequency, such as daily, weekly, or monthly.

(c) All vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations as provided in subsection (b) shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. The Department of Innovation and Technology shall allow 7 days for a letter of intent and shall issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. To qualify for a grant award under this Section, the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of this amendatory Act of the 103rd General Assembly.

(d) Nothing in this amendatory Act of the 103rd General Assembly shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services. If any provision of this amendatory Act of the 103rd General Assembly or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of this amendatory Act that can be given effect without the invalid provision or application. The provisions of this amendatory Act of the 103rd General Assembly are declared to be severable.