Sen. James F. Clayborne, Jr.
Filed: 3/15/2010
 
 

 




 

 		












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AMENDMENT TO SENATE BILL 3773




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    AMENDMENT NO. ______. Amend Senate Bill 3773 by replacing 
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everything after the enacting clause with the following:

 
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    "Section 5. The Illinois Public Aid Code is amended  by 
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adding Section 5-11.01 as follows:
 
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    (305 ILCS 5/5-11.01 new)
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    Sec. 5-11.01. Presumption of eligibility; long term care 
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services. 
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    (a) For the purposes of this Section, "facility" means a 
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facility licensed under the Nursing Home Care Act to provide 
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intermediate or skilled geriatric care.
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    (b) Transferring from hospital. Prior to transferring a 
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patient to a facility, a hospital shall review the patient's 
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financial records to determine the likelihood that the patient 
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will qualify for medical assistance coverage, when that 
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patient's care is not eligible for reimbursement by a long term 
 


 






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care insurance policy or Medicare and is not already determined 
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to be eligible for Medicaid. If in the best judgment of the 
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hospital, the patient would qualify for medical assistance 
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coverage, the patient shall be presumed to be eligible until 
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the presumption is rebutted by a formal determination of 
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ineligibility by the Department of Human Services.
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    (c) Entering from community. A pre-admission screener 
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under contract with the Department of Aging shall review the 
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financial records of an individual entering a facility from the 
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community to determine the likelihood that the individual will 
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qualify for medical assistance coverage, when the individual's  
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care is not eligible for reimbursement by a long term care 
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insurance policy or Medicare and is not already determined to 
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be eligible for medical assistance coverage. If in the best 
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judgment of the pre-admission screener, the individual would 
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qualify for medical assistance coverage, the individual shall 
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be presumed to be eligible until the presumption is rebutted by 
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a formal determination of ineligibility by the Department of 
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Human Services.
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    (d) Spending down. Residents of a facility shall notify the 
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facility 60 days prior to depleting their financial resources 
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and becoming unable to cover the cost of their care. Upon 
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notification, the facility shall offer to assist the resident 
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in completing the application for medical assistance coverage 
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or offer to arrange for the Department of Human Services to 
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meet with the resident to assist in completing the application. 
 


 






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If the resident has not been formally determined to be eligible 
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or ineligible for medical assistance coverage at the end of the 
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60 days or if the resident fails to give the facility 60 days 
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notice, the facility shall review the resident's financial 
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records to determine the likelihood that the resident will 
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qualify for medical assistance coverage. If in the best 
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judgment of the facility, the individual would qualify for 
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medical assistance coverage, the individual shall be presumed 
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to be eligible until the presumption is rebutted by a formal 
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determination of ineligibility by the Department of Human 
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Services. 
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    (e) If upon admission, the facility determines that the 
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resident is not eligible to have his or her care reimbursed by 
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Medicare or a private long term care insurance policy and their 
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eligibility for medical assistance coverage has not been 
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determined, the facility shall offer to assist the resident in 
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completing the application or, in the alternative, offer to 
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arrange for the Department of Human Services to meet with the 
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resident at the facility for the purpose of assisting the 
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resident in completing the application. 
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    (f) A facility admitting an individual presumed to be 
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eligible for medical assistance coverage shall have all 
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services provided to the individual reimbursed from the date of 
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admission and until such time that the presumption is rebutted 
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regardless of when the individual's pre-admission screening 
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has occurred. The facility shall not be liable to reimburse the 
 


 






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State for any reimbursement made during the presumptive 
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eligibility period. 
 

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    Section 99. Effective date. This Act takes effect upon 
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becoming law.".