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SB3290 Enrolled |
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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 |
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| 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 |
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| requirements set forth in
this Section shall apply to |
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| 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 |
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| models in the City of
Chicago (one of which shall be |
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| located on a designated site and shall have been
licensed |
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| as a hospital under the Illinois Hospital Licensing Act |
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| within the 10
years immediately before the application for |
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| a license);
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| (ii) 2 subacute care hospital alternative health care |
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| models in the
demonstration program for each of the |
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| 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 |
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| 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) |
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| of subsection (a) and paragraphs
(1) and (2) of item |
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| (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 |
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| areas, the Health Facilities and Services Review Board and the
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| Department shall give preference to hospitals that may be |
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| unable for economic
reasons to provide continued service to the |
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| community in which they are located
unless the hospital were to |
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| receive an alternative health care model license.
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| (a-5) There shall be no more than the total number of |
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| postsurgical
recovery care centers with a certificate of need |
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| 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 |
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| respite care
center alternative health care models in the |
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| 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, |
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| Lake, McHenry, and
Will counties.
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| (4) A total of 2 in municipalities with a population of |
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| 50,000 or more and
not
located in the areas described in |
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| paragraphs (1), (2), or (3).
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| (5) A total of 2 in rural areas, as defined by the |
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| Health Facilities
and Services Review Board.
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LRB096 20040 KTG 35543 b |
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| No more than one children's respite care model owned and |
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| operated by a
licensed skilled pediatric facility shall be |
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| located in each of the areas
designated in this subsection |
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| (a-10).
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| (a-15) There shall be 2 authorized community-based |
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| residential
rehabilitation center alternative health care |
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| models in the demonstration
program.
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| (a-20) There shall be an authorized
Alzheimer's disease |
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| management center alternative health care model in the
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| demonstration program. The Alzheimer's disease management |
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| 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 |
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| the county
board before the effective date of this amendatory |
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| Act of the 91st General
Assembly.
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| (a-25) There shall be no more than 10 birth center |
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| alternative health care
models in the demonstration program, |
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| located as follows:
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| (1) Four in the area comprising Cook, DuPage, Kane, |
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| Lake, McHenry, and
Will counties, one of
which shall be |
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| owned or operated by a hospital and one of which shall be |
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| owned
or operated by a federally qualified health center.
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| (2) Three in municipalities with a population of 50,000 |
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| or more not
located in the area described in paragraph (1) |
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| of this subsection, one of
which shall be owned or operated |
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| by a hospital and one of which shall be owned
or operated |
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| by a federally qualified health center.
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| (3) Three in rural areas, one of which shall be owned |
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| or operated by a
hospital and one of which shall be owned |
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| or operated by a federally qualified
health center.
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| The first 3 birth centers authorized to operate by the |
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| Department shall be
located in or predominantly serve the |
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| residents of a health professional
shortage area as determined |
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| by the United States Department of Health and Human
Services. |
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| There shall be no more than 2 birth centers authorized to |
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| operate in
any single health planning area for obstetric |
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| services as determined under the
Illinois Health Facilities |
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| Planning Act. If a birth center is located outside
of a
health |
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| professional shortage area, (i) the birth center shall be |
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| located in a
health planning
area with a demonstrated need for |
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| obstetrical service beds, as determined by
the Health |
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| 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 |
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| the planning area so that
the establishment of the birth center |
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| does not result in an increase in the
total number of |
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| obstetrical service beds in the health planning area.
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| (b) Alternative health care models, other than a model |
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| 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 |
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| Facilities and Services Review Board under the Illinois
Health |
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| Facilities Planning Act before receiving a license by the
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| Department.
If, after obtaining its initial certificate of |
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| 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 |
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| certificate of need
from the Health Facilities and Services |
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| Review Board before increasing the bed
capacity. Alternative
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| health care models in medically underserved areas
shall receive |
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| priority in obtaining a certificate of need.
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| (c) An alternative health care model license shall be |
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| issued for a
period of one year and shall be annually renewed |
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| if the facility or
program is in substantial compliance with |
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| the Department's rules
adopted under this Act. A licensed |
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| alternative health care model that continues
to be in |
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| substantial compliance after the conclusion of the |
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| demonstration
program shall be eligible for annual renewals |
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| unless and until a different
licensure program for that type of |
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| health care model is established by
legislation, except that a |
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| postsurgical recovery care center meeting the following |
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| requirements may apply within 3 years after August 25, 2009 |
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| ( the effective date of Public Act 96-669) this amendatory Act |
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| of the 96th General Assembly for a Certificate of Need permit |
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| to operate as a hospital: |
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| (1) The postsurgical recovery care center shall apply |
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| to the Illinois Health Facilities Planning Board for a |
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| Certificate of Need permit to discontinue the postsurgical |
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| recovery care center and to establish a hospital. |
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| (2) If the postsurgical recovery care center obtains a |
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| Certificate of Need permit to operate as a hospital, it |
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LRB096 20040 KTG 35543 b |
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| shall apply for licensure as a hospital under the Hospital |
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| Licensing Act and shall meet all statutory and regulatory |
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| requirements of a hospital. |
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| (3) After obtaining licensure as a hospital, any |
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| license as an ambulatory surgical treatment center and any |
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| license as a post-surgical recovery care center shall be |
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| null and void. |
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| (4) The former postsurgical recovery care center that |
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| receives a hospital license must seek and use its best |
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| efforts to maintain certification under Titles XVIII and |
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| XIX of the federal Social Security Act. |
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| The Department may issue a provisional license to any
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| alternative health care model that does not substantially |
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| comply with the
provisions of this Act and the rules adopted |
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| under this Act if (i)
the Department finds that the alternative |
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| health care model has undertaken
changes and corrections which |
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| upon completion will render the alternative
health care model |
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| in substantial compliance with this Act and rules and
(ii) the |
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| health and safety of the patients of the alternative
health |
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| care model will be protected during the period for which the |
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| provisional
license is issued. The Department shall advise the |
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| licensee of
the conditions under which the provisional license |
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| is issued, including
the manner in which the alternative health |
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| care model fails to comply with
the provisions of this Act and |
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| rules, and the time within which the changes
and corrections |
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| necessary for the alternative health care model to
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LRB096 20040 KTG 35543 b |
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| substantially comply with this Act and rules shall be |
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| completed.
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| (d) Alternative health care models shall seek |
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| certification under Titles
XVIII and XIX of the federal Social |
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| Security Act. In addition, alternative
health care models shall |
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| provide charitable care consistent with that provided
by |
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| comparable health care providers in the geographic area.
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| (d-5) (Blank) The Department of Healthcare and Family |
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| Services (formerly Illinois Department of Public Aid), in |
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| cooperation with the
Illinois Department of
Public Health, |
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| shall develop and implement a reimbursement methodology for all
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| facilities participating in the demonstration program. The |
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| Department of Healthcare and Family Services shall keep a |
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| record of services provided under the demonstration
program to |
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| recipients of medical assistance under the Illinois Public Aid |
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| Code
and shall submit an annual report of that information to |
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| the Illinois
Department of Public Health .
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| (e) Alternative health care models shall, to the extent |
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| possible,
link and integrate their services with nearby health |
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| care facilities.
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| (f) Each alternative health care model shall implement a |
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| quality
assurance program with measurable benefits and at |
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| reasonable cost.
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| (Source: P.A. 95-331, eff. 8-21-07; 95-445, eff. 1-1-08; 96-31, |
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| eff. 6-30-09; 96-129, eff. 8-4-09; 96-669, eff. 8-25-09; |
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| 96-812, eff. 1-1-10; revised 11-4-09.)
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SB3290 Enrolled |
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LRB096 20040 KTG 35543 b |
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| Section 10. The Illinois Public Aid Code is amended by |
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| changing Sections 5-2 and 5-5.5 and by adding Section 12-8.2 as |
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| 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 |
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| under this
Article shall be available to any of the following |
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| classes of persons in
respect to whom a plan for coverage has |
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| been submitted to the Governor
by the Illinois Department and |
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| approved by him:
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| 1. Recipients of basic maintenance grants under |
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| Articles III and IV.
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| 2. Persons otherwise eligible for basic maintenance |
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| under Articles
III and IV, excluding any eligibility |
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| requirements that are inconsistent with any federal law or |
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| federal regulation, as interpreted by the U.S. Department |
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| of Health and Human Services, but who fail to qualify |
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| thereunder on the basis of need or who qualify but are not |
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| receiving basic maintenance under Article IV, and
who have |
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| insufficient income and resources to meet the costs of
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| necessary medical care, including but not limited to the |
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| following:
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| (a) All persons otherwise eligible for basic |
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| maintenance under Article
III but who fail to qualify |
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| under that Article on the basis of need and who
meet |
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LRB096 20040 KTG 35543 b |
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| either of the following requirements:
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| (i) their income, as determined by the |
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| Illinois Department in
accordance with any federal |
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| requirements, is equal to or less than 70% in
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| fiscal year 2001, equal to or less than 85% in |
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| fiscal year 2002 and until
a date to be determined |
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| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the |
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| Department by rule, of the nonfarm income official |
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| poverty
line, as defined by the federal Office of |
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| Management and Budget and revised
annually in |
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| accordance with Section 673(2) of the Omnibus |
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| Budget Reconciliation
Act of 1981, applicable to |
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| families of the same size; or
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| (ii) their income, after the deduction of |
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| costs incurred for medical
care and for other types |
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| 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 |
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| fiscal year 2002 and until
a date to be determined |
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| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the |
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| Department by rule, of the nonfarm income official |
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| poverty
line, as defined in item (i) of this |
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| subparagraph (a).
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| (b) All persons who, excluding any eligibility |
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| requirements that are inconsistent with any federal |
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| law or federal regulation, as interpreted by the U.S. |
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| Department of Health and Human Services, would be |
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| determined eligible for such basic
maintenance under |
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| 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 |
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| Medically
Indigent under Article VII.
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| 4. Persons not eligible under any of the preceding |
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| paragraphs who fall
sick, are injured, or die, not having |
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| sufficient money, property or other
resources to meet the |
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| 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 |
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| pregnancy has been determined by medical diagnosis, and |
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| during the
60-day period beginning on the last day of the |
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| pregnancy, together with
their infants and children born |
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| after September 30, 1983,
whose income and
resources are |
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| insufficient to meet the costs of necessary medical care to
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| the maximum extent possible under Title XIX of the
Federal |
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| Social Security Act.
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| (b) The Illinois Department and the Governor shall |
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| provide a plan for
coverage of the persons eligible under |
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| paragraph 5(a) by April 1, 1990. Such
plan shall provide |
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| ambulatory prenatal care to pregnant women during a
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| presumptive eligibility period and establish an income |
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| eligibility standard
that is equal to 133%
of the nonfarm |
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LRB096 20040 KTG 35543 b |
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| income official poverty line, as defined by
the federal |
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| Office of Management and Budget and revised annually in
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| accordance with Section 673(2) of the Omnibus Budget |
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| Reconciliation Act of
1981, applicable to families of the |
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| same size, provided that costs incurred
for medical care |
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| 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 |
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| demonstration in at least one
county that will provide |
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| medical assistance to pregnant women, together
with their |
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| infants and children up to one year of age,
where the |
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| income
eligibility standard is set up to 185% of the |
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| nonfarm income official
poverty line, as defined by the |
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| federal Office of Management and Budget.
The Illinois |
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| Department shall seek and obtain necessary authorization
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| provided under federal law to implement such a |
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| demonstration. Such
demonstration may establish resource |
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| standards that are not more
restrictive than those |
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| established under Article IV of this Code.
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| 6. Persons under the age of 18 who fail to qualify as |
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| dependent under
Article IV and who have insufficient income |
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| and resources to meet the costs
of necessary medical care |
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| to the maximum extent permitted under Title XIX
of the |
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| 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 |
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| service for such persons would be eligible for Federal
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| Financial Participation, and provided the Illinois |
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| Department determines that:
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| (a) the person requires a level of care provided by |
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| a hospital, skilled
nursing facility, or intermediate |
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| care facility, as determined by a physician
licensed to |
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| practice medicine in all its branches;
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| (b) it is appropriate to provide such care outside |
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| of an institution, as
determined by a physician |
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| licensed to practice medicine in all its branches;
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| (c) the estimated amount which would be expended |
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| for care outside the
institution is not greater than |
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| the estimated amount which would be
expended in an |
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| institution.
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| 8. Persons who become ineligible for basic maintenance |
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| assistance
under Article IV of this Code in programs |
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| administered by the Illinois
Department due to employment |
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| earnings and persons in
assistance units comprised of |
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| adults and children who become ineligible for
basic |
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| maintenance assistance under Article VI of this Code due to
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| employment earnings. The plan for coverage for this class |
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| of persons shall:
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| (a) extend the medical assistance coverage for up |
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| to 12 months following
termination of basic |
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| maintenance assistance; and
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| (b) offer persons who have initially received 6 |
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| months of the
coverage provided in paragraph (a) above, |
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| the option of receiving an
additional 6 months of |
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| coverage, subject to the following:
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| (i) such coverage shall be pursuant to |
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| provisions of the federal
Social Security Act;
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| (ii) such coverage shall include all services |
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| covered while the person
was eligible for basic |
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| maintenance assistance;
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| (iii) no premium shall be charged for such |
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| coverage; and
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| (iv) such coverage shall be suspended in the |
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| event of a person's
failure without good cause to |
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| file in a timely fashion reports required for
this |
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| coverage under the Social Security Act and |
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| coverage shall be reinstated
upon the filing of |
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| such reports if the person remains otherwise |
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| eligible.
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| 9. Persons with acquired immunodeficiency syndrome |
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| (AIDS) or with
AIDS-related conditions with respect to whom |
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| there has been a determination
that but for home or |
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| community-based services such individuals would
require |
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| the level of care provided in an inpatient hospital, |
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| skilled
nursing facility or intermediate care facility the |
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| cost of which is
reimbursed under this Article. Assistance |
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| shall be provided to such
persons to the maximum extent |
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| permitted under Title
XIX of the Federal Social Security |
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| Act.
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| 10. Participants in the long-term care insurance |
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| 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 |
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| Section 15 of that
Act.
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| 11. Persons with disabilities who are employed and |
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| eligible for Medicaid,
pursuant to Section |
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| 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, |
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| subject to federal approval, persons with a medically |
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| improved disability who are employed and eligible for |
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| Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of |
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| the Social Security Act, as
provided by the Illinois |
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| Department by rule. In establishing eligibility standards |
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| under this paragraph 11, the Department shall, subject to |
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| federal approval: |
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| (a) set the income eligibility standard at not |
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| lower than 350% of the federal poverty level; |
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| (b) exempt retirement accounts that the person |
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| cannot access without penalty before the age
of 59 1/2, |
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| and medical savings accounts established pursuant to |
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| 26 U.S.C. 220; |
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| (c) allow non-exempt assets up to $25,000 as to |
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| those assets accumulated during periods of eligibility |
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| under this paragraph 11; and
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| (d) continue to apply subparagraphs (b) and (c) in |
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| determining the eligibility of the person under this |
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| Article even if the person loses eligibility under this |
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| paragraph 11.
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| 12. Subject to federal approval, persons who are |
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| eligible for medical
assistance coverage under applicable |
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| provisions of the federal Social Security
Act and the |
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| federal Breast and Cervical Cancer Prevention and |
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| Treatment Act of
2000. Those eligible persons are defined |
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| to include, but not be limited to,
the following persons:
|
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| (1) persons who have been screened for breast or |
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| cervical cancer under
the U.S. Centers for Disease |
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| Control and Prevention Breast and Cervical Cancer
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| Program established under Title XV of the federal |
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| Public Health Services Act in
accordance with the |
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| requirements of Section 1504 of that Act as |
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| administered by
the Illinois Department of Public |
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| Health; and
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| (2) persons whose screenings under the above |
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| program were funded in whole
or in part by funds |
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| appropriated to the Illinois Department of Public |
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| Health
for breast or cervical cancer screening.
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| "Medical assistance" under this paragraph 12 shall be |
24 |
| identical to the benefits
provided under the State's |
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| approved plan under Title XIX of the Social Security
Act. |
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| The Department must request federal approval of the |
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LRB096 20040 KTG 35543 b |
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| coverage under this
paragraph 12 within 30 days after the |
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| effective date of this amendatory Act of
the 92nd General |
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| Assembly.
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4 |
| 13. Subject to appropriation and to federal approval, |
5 |
| persons living with HIV/AIDS who are not otherwise eligible |
6 |
| under this Article and who qualify for services covered |
7 |
| under Section 5-5.04 as provided by the Illinois Department |
8 |
| by rule.
|
9 |
| 14. Subject to the availability of funds for this |
10 |
| purpose, the Department may provide coverage under this |
11 |
| Article to persons who reside in Illinois who are not |
12 |
| eligible under any of the preceding paragraphs and who meet |
13 |
| the income guidelines of paragraph 2(a) of this Section and |
14 |
| (i) have an application for asylum pending before the |
15 |
| federal Department of Homeland Security or on appeal before |
16 |
| a court of competent jurisdiction and are represented |
17 |
| either by counsel or by an advocate accredited by the |
18 |
| federal Department of Homeland Security and employed by a |
19 |
| not-for-profit organization in regard to that application |
20 |
| or appeal, or (ii) are receiving services through a |
21 |
| federally funded torture treatment center. Medical |
22 |
| coverage under this paragraph 14 may be provided for up to |
23 |
| 24 continuous months from the initial eligibility date so |
24 |
| long as an individual continues to satisfy the criteria of |
25 |
| this paragraph 14. If an individual has an appeal pending |
26 |
| regarding an application for asylum before the Department |
|
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| of Homeland Security, eligibility under this paragraph 14 |
2 |
| may be extended until a final decision is rendered on the |
3 |
| appeal. The Department may adopt rules governing the |
4 |
| implementation of this paragraph 14.
|
5 |
| 15. Family Care Eligibility. |
6 |
| (a) A caretaker relative who is 19 years of age or |
7 |
| older when countable income is at or below 185% of the |
8 |
| Federal Poverty Level Guidelines, as published |
9 |
| annually in the Federal Register, for the appropriate |
10 |
| family size. A person may not spend down to become |
11 |
| eligible under this paragraph 15. |
12 |
| (b) Eligibility shall be reviewed annually. |
13 |
| (c) Caretaker relatives enrolled under this |
14 |
| paragraph 15 in families with countable income above |
15 |
| 150% and at or below 185% of the Federal Poverty Level |
16 |
| Guidelines shall be counted as family members and pay |
17 |
| premiums as established under the Children's Health |
18 |
| Insurance Program Act. |
19 |
| (d) Premiums shall be billed by and payable to the |
20 |
| Department or its authorized agent, on a monthly basis. |
21 |
| (e) The premium due date is the last day of the |
22 |
| month preceding the month of coverage. |
23 |
| (f) Individuals shall have a grace period through |
24 |
| 30 days the month of coverage to pay the premium. |
25 |
| (g) Failure to pay the full monthly premium by the |
26 |
| last day of the grace period shall result in |
|
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| termination of coverage. |
2 |
| (h) Partial premium payments shall not be |
3 |
| refunded. |
4 |
| (i) Following termination of an individual's |
5 |
| coverage under this paragraph 15, the following action |
6 |
| is required before the individual can be re-enrolled: |
7 |
| (1) A new application must be completed and the |
8 |
| individual must be determined otherwise eligible. |
9 |
| (2) There must be full payment of premiums due |
10 |
| under this Code, the Children's Health Insurance |
11 |
| Program Act, the Covering ALL KIDS Health |
12 |
| Insurance Act, or any other healthcare program |
13 |
| administered by the Department for periods in |
14 |
| which a premium was owed and not paid for the |
15 |
| individual. |
16 |
| (3) The first month's premium must be paid if |
17 |
| there was an unpaid premium on the date the |
18 |
| individual's previous coverage was canceled. |
19 |
| The Department is authorized to implement the |
20 |
| provisions of this amendatory Act of the 95th General |
21 |
| Assembly by adopting the medical assistance rules in effect |
22 |
| as of October 1, 2007, at 89 Ill. Admin. Code 125, and at |
23 |
| 89 Ill. Admin. Code 120.32 along with only those changes |
24 |
| necessary to conform to federal Medicaid requirements, |
25 |
| federal laws, and federal regulations, including but not |
26 |
| 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 |
2 |
| of Health and Human Services, and the countable income |
3 |
| eligibility standard authorized by this paragraph 15. The |
4 |
| Department may not otherwise adopt any rule to implement |
5 |
| this increase except as authorized by law, to meet the |
6 |
| eligibility standards authorized by the federal government |
7 |
| in the Medicaid State Plan or the Title XXI Plan, or to |
8 |
| meet an order from the federal government or any court. |
9 |
| 16. 15. Subject to appropriation, uninsured persons |
10 |
| who are not otherwise eligible under this Section who have |
11 |
| been certified and referred by the Department of Public |
12 |
| Health as having been screened and found to need diagnostic |
13 |
| evaluation or treatment, or both diagnostic evaluation and |
14 |
| treatment, for prostate or testicular cancer. For the |
15 |
| purposes of this paragraph 16 15 , uninsured persons are |
16 |
| those who do not have creditable coverage, as defined under |
17 |
| the Health Insurance Portability and Accountability Act, |
18 |
| or have otherwise exhausted any insurance benefits they may |
19 |
| have had, for prostate or testicular cancer diagnostic |
20 |
| evaluation or treatment, or both diagnostic evaluation and |
21 |
| treatment.
To be eligible, a person must furnish a Social |
22 |
| Security number.
A person's assets are exempt from |
23 |
| consideration in determining eligibility under this |
24 |
| paragraph 16 15 .
Such persons shall be eligible for medical |
25 |
| assistance under this paragraph 16 15 for so long as they |
26 |
| 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 |
2 |
| treating physician, the person requires therapy directed |
3 |
| toward cure or palliation of prostate or testicular cancer, |
4 |
| including recurrent metastatic cancer that is a known or |
5 |
| presumed complication of prostate or testicular cancer and |
6 |
| complications resulting from the treatment modalities |
7 |
| themselves. Persons who require only routine monitoring |
8 |
| services are not considered to need treatment.
"Medical |
9 |
| assistance" under this paragraph 16 15 shall be identical |
10 |
| to the benefits provided under the State's approved plan |
11 |
| under Title XIX of the Social Security Act.
Notwithstanding |
12 |
| any other provision of law, the Department (i) does not |
13 |
| have a claim against the estate of a deceased recipient of |
14 |
| services under this paragraph 16 15 and (ii) does not have |
15 |
| a lien against any homestead property or other legal or |
16 |
| equitable real property interest owned by a recipient of |
17 |
| services under this paragraph 16 15 . |
18 |
| In implementing the provisions of Public Act 96-20 this |
19 |
| amendatory Act of the 96th General Assembly , the Department is |
20 |
| authorized to adopt only those rules necessary, including |
21 |
| emergency rules. Nothing in Public Act 96-20 this amendatory |
22 |
| Act of the 96th General Assembly permits the Department to |
23 |
| adopt rules or issue a decision that expands eligibility for |
24 |
| the FamilyCare Program to a person whose income exceeds 185% of |
25 |
| the Federal Poverty Level as determined from time to time by |
26 |
| the U.S. Department of Health and Human Services, unless the |
|
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| Department is provided with express statutory authority. |
2 |
| The Illinois Department and the Governor shall provide a |
3 |
| plan for
coverage of the persons eligible under paragraph 7 as |
4 |
| soon as possible after
July 1, 1984.
|
5 |
| The eligibility of any such person for medical assistance |
6 |
| under this
Article is not affected by the payment of any grant |
7 |
| under the Senior
Citizens and Disabled Persons Property Tax |
8 |
| Relief and Pharmaceutical
Assistance Act or any distributions |
9 |
| or items of income described under
subparagraph (X) of
|
10 |
| paragraph (2) of subsection (a) of Section 203 of the Illinois |
11 |
| Income Tax
Act. The Department shall by rule establish the |
12 |
| amounts of
assets to be disregarded in determining eligibility |
13 |
| for medical assistance,
which shall at a minimum equal the |
14 |
| amounts to be disregarded under the
Federal Supplemental |
15 |
| Security Income Program. The amount of assets of a
single |
16 |
| person to be disregarded
shall not be less than $2,000, and the |
17 |
| amount of assets of a married couple
to be disregarded shall |
18 |
| not be less than $3,000.
|
19 |
| To the extent permitted under federal law, any person found |
20 |
| guilty of a
second violation of Article VIIIA
shall be |
21 |
| ineligible for medical assistance under this Article, as |
22 |
| provided
in Section 8A-8.
|
23 |
| The eligibility of any person for medical assistance under |
24 |
| this Article
shall not be affected by the receipt by the person |
25 |
| of donations or benefits
from fundraisers held for the person |
26 |
| 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 |
2 |
| donations or benefits or the disbursement
of the donations or |
3 |
| benefits.
|
4 |
| (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; |
5 |
| 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. |
6 |
| 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
|
7 |
| (305 ILCS 5/5-5.5) (from Ch. 23, par. 5-5.5)
|
8 |
| Sec. 5-5.5. Elements of Payment Rate.
|
9 |
| (a) The Department of Healthcare and Family Services shall |
10 |
| develop a prospective method for
determining payment rates for |
11 |
| skilled nursing and intermediate care
services in nursing |
12 |
| facilities composed of the following cost elements:
|
13 |
| (1) Standard Services, with the cost of this component |
14 |
| being determined
by taking into account the actual costs to |
15 |
| the facilities of these services
subject to cost ceilings |
16 |
| to be defined in the Department's rules.
|
17 |
| (2) Resident Services, with the cost of this component |
18 |
| being
determined by taking into account the actual costs, |
19 |
| needs and utilization
of these services, as derived from an |
20 |
| assessment of the resident needs in
the nursing facilities. |
21 |
| The Department shall adopt rules governing
reimbursement |
22 |
| for resident services as listed in Section 5-1.1. Surveys |
23 |
| or
assessments of resident needs under this Section shall |
24 |
| include a review by
the facility of the results of such |
25 |
| assessments and a discussion of issues
in dispute with |
|
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| authorized survey staff, unless the facility elects not to
|
2 |
| participate in such a review process. Surveys or |
3 |
| assessments of resident
needs under this Section may be |
4 |
| conducted semi-annually and payment rates
relating to |
5 |
| resident services may be changed on a semi-annual basis. |
6 |
| The
Illinois Department shall initiate a project, either on |
7 |
| a pilot basis or
Statewide, to reimburse the cost of |
8 |
| resident services based on a
methodology which utilizes an |
9 |
| assessment of resident needs to determine the
level of |
10 |
| reimbursement. This methodology shall be different from |
11 |
| the
payment criteria for resident services utilized by the |
12 |
| Illinois Department
on July 1, 1981. On March 1, 1982, and |
13 |
| each year thereafter, until such
time when the Illinois |
14 |
| Department adopts the methodology used in such
project for |
15 |
| use statewide,
the Illinois Department shall report to the |
16 |
| General Assembly on the
implementation and progress of such |
17 |
| project. The report shall include:
|
18 |
| (A) A statement of the Illinois Department's goals |
19 |
| and objectives
for such project;
|
20 |
| (B) A description of such project, including the |
21 |
| number and type of
nursing facilities involved in the |
22 |
| project;
|
23 |
| (C) A description of the methodology used in such |
24 |
| project;
|
25 |
| (D) A description of the Illinois Department's |
26 |
| application of the
methodology;
|
|
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| (E) A statement on the methodology's effect on the |
2 |
| quality of care
given to residents in the sample |
3 |
| nursing facilities; and
|
4 |
| (F) A statement on the cost of the methodology used |
5 |
| in such project
and a comparison of this cost with the |
6 |
| cost of the current payment criteria.
|
7 |
| (3) Ancillary Services, with the payment rate being |
8 |
| developed for
each individual type of service. Payment |
9 |
| shall be made only when
authorized under procedures |
10 |
| developed by the Department of Healthcare and Family |
11 |
| Services.
|
12 |
| (4) Nurse's Aide Training, with the cost of this |
13 |
| component being
determined by taking into account the |
14 |
| actual cost to the facilities of
such training.
|
15 |
| (5) Real Estate Taxes, with the cost of this component |
16 |
| being
determined by taking into account the figures |
17 |
| contained in the most
currently available cost reports |
18 |
| (with no imposition of maximums) updated
to the midpoint of |
19 |
| the current rate year for long term care services
rendered |
20 |
| between July 1, 1984 and June 30, 1985, and with the cost |
21 |
| of this
component being determined by taking into account |
22 |
| the actual 1983 taxes for
which the nursing homes were |
23 |
| assessed (with no imposition of maximums)
updated to the |
24 |
| midpoint of the current rate year for long term care
|
25 |
| services rendered between July 1, 1985 and June 30, 1986.
|
26 |
| (b) In developing a prospective method for determining |
|
|
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| payment rates
for skilled nursing and intermediate care |
2 |
| services in nursing facilities,
the Department of Healthcare |
3 |
| and Family Services shall consider the following cost elements:
|
4 |
| (1) Reasonable capital cost determined by utilizing |
5 |
| incurred interest
rate and the current value of the |
6 |
| investment, including land, utilizing
composite rates, or |
7 |
| by utilizing such other reasonable cost related methods
|
8 |
| determined by the Department. However, beginning with the |
9 |
| rate
reimbursement period effective July 1, 1987, the |
10 |
| Department shall be
prohibited from establishing, |
11 |
| including, and implementing any depreciation
factor in |
12 |
| calculating the capital cost element.
|
13 |
| (2) Profit, with the actual amount being produced and |
14 |
| accruing to
the providers in the form of a return on their |
15 |
| total investment, on the
basis of their ability to |
16 |
| economically and efficiently deliver a type
of service. The |
17 |
| method of payment may assure the opportunity for a
profit, |
18 |
| but shall not guarantee or establish a specific amount as a |
19 |
| cost.
|
20 |
| (c) The Illinois Department may implement the amendatory |
21 |
| changes to
this Section made by this amendatory Act of 1991 |
22 |
| through the use of
emergency rules in accordance with the |
23 |
| provisions of Section 5.02 of the
Illinois Administrative |
24 |
| Procedure Act. For purposes of the Illinois
Administrative |
25 |
| Procedure Act, the adoption of rules to implement the
|
26 |
| amendatory changes to this Section made by this amendatory
Act |
|
|
|
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| of 1991 shall be deemed an emergency and necessary for the |
2 |
| public
interest, safety and welfare.
|
3 |
| (d) No later than January 1, 2001, the Department of Public |
4 |
| Aid shall file
with the Joint Committee on Administrative |
5 |
| Rules, pursuant to the Illinois
Administrative Procedure
Act,
a |
6 |
| proposed rule, or a proposed amendment to an existing rule, |
7 |
| regarding payment
for appropriate services, including |
8 |
| assessment, care planning, discharge
planning, and treatment
|
9 |
| provided by nursing facilities to residents who have a serious |
10 |
| mental
illness.
|
11 |
| (Source: P.A. 95-331, eff. 8-21-07.)
|
12 |
| (305 ILCS 5/12-8.2 new) |
13 |
| Sec. 12-8.2. Medical Assistance Dental Reimbursement |
14 |
| Revolving Fund. There is created a revolving fund to be known |
15 |
| as the Medical Assistance Dental Reimbursement Revolving Fund, |
16 |
| to be held by the Director of the Department of Healthcare and |
17 |
| Family Services, outside of the State treasury, for the |
18 |
| following purposes: |
19 |
| (1) The deposit of all funds to pay for dental services |
20 |
| provided by enrolled dental service providers for services |
21 |
| to participants in the medical programs administered by the |
22 |
| Department. |
23 |
| (2) The deposit of any interest accrued by the |
24 |
| revolving fund, which interest shall be available to pay |
25 |
| for dental services provided by enrolled dental service |