SB1784 EngrossedLRB097 06803 KTG 50212 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 3. The Illinois Administrative Procedure Act is
5amended by changing Section 5-70 as follows:
 
6    (5 ILCS 100/5-70)  (from Ch. 127, par. 1005-70)
7    Sec. 5-70. Form and publication of notices.
8    (a) The Secretary of State may prescribe reasonable rules
9concerning the form of documents to be filed with the Secretary
10of State and may refuse to accept for filing certified copies
11that do not comply with the rules. In addition, the Secretary
12of State shall publish and maintain the Illinois Register and
13may prescribe reasonable rules setting forth the manner in
14which agencies shall submit notices required by this Act for
15publication in the Illinois Register. The Illinois Register
16shall be published at least once each week on the same day
17(unless that day is an official State holiday, in which case
18the Illinois Register shall be published on the next following
19business day) and sent to subscribers who subscribe for the
20publication with the Secretary of State. The Secretary of State
21may charge a subscription price to subscribers that covers
22mailing and publication costs.
23    (b) The Secretary of State shall accept for publication in

 

 

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1the Illinois Register all Pollution Control Board documents,
2including but not limited to Board opinions, the results of
3Board determinations concerning adjusted standards
4proceedings, notices of petitions for individual adjusted
5standards, results of Board determinations concerning the
6necessity for economic impact studies, restricted status
7lists, hearing notices, and any other documents related to the
8activities of the Pollution Control Board that the Board deems
9appropriate for publication.
10    (c) The Secretary of State shall accept for publication in
11the Illinois Register notices initiated by the Department of
12Healthcare and Family Services in its capacity as the designate
13Title XIX single State agency pursuant to the requirements
14found at 42 CFR 447.205, and any other documents related to the
15activities of the programs administered by the Department of
16Healthcare and Family Services that the Department deems
17appropriate for publication.
18(Source: P.A. 87-823.)
 
19    (20 ILCS 10/Act rep.)
20    Section 4. The Illinois Welfare and Rehabilitation
21Services Planning Act is repealed.
 
22    Section 6. The State Finance Act is amended by changing
23Sections 5.573 and 6z-58 as follows:
 

 

 

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1    (30 ILCS 105/5.573)
2    Sec. 5.573. The Medical Interagency Program Family Care
3Fund.
4(Source: P.A. 95-331, eff. 8-21-07.)
 
5    (30 ILCS 105/6z-58)
6    Sec. 6z-58. The Medical Interagency Program Family Care
7Fund.
8    (a) There is created in the State treasury the Medical
9Interagency Program Family Care Fund. Interest earned by the
10Fund shall be credited to the Fund.
11    (b) The Fund is created for the purposes of receiving,
12investing, and distributing moneys in accordance with (i) an
13approved State plan or waiver under the Social Security Act
14resulting from the Family Care waiver request submitted by the
15Illinois Department of Public Aid on February 15, 2002 and (ii)
16an interagency agreement between the Department of Healthcare
17and Family Services (formerly Department of Public Aid) and
18another agency of State government. The Fund shall consist of:
19        (1) All federal financial participation moneys
20    received pursuant to expenditures from the Fund the
21    approved waiver, except for moneys received pursuant to
22    expenditures for medical services by the Department of
23    Healthcare and Family Services (formerly Department of
24    Public Aid) from any other fund; and
25        (2) All other moneys received by the Fund from any

 

 

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1    source, including interest thereon.
2    (c) Subject to appropriation, the moneys in the Fund shall
3be disbursed for reimbursement of medical services and other
4costs associated with persons receiving such services:
5        (1) under programs administered by the Department of
6    Healthcare and Family Services (formerly Department of
7    Public Aid); and
8        (2) pursuant to an interagency agreement, under
9    programs administered by another agency of State
10    government.
11(Source: P.A. 95-331, eff. 8-21-07.)
 
12    Section 10. The Nursing Home Care Act is amended by
13changing Section 2-201.5 as follows:
 
14    (210 ILCS 45/2-201.5)
15    Sec. 2-201.5. Screening prior to admission.
16    (a) All persons age 18 or older seeking admission to a
17nursing facility must be screened to determine the need for
18nursing facility services prior to being admitted, regardless
19of income, assets, or funding source. In addition, any person
20who seeks to become eligible for medical assistance from the
21Medical Assistance Program under the Illinois Public Aid Code
22to pay for long term care services while residing in a facility
23must be screened prior to receiving those benefits. Screening
24for nursing facility services shall be administered through

 

 

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1procedures established by administrative rule. Screening may
2be done by agencies other than the Department as established by
3administrative rule. This Section applies on and after July 1,
41996. No later than October 1, 2010, the Department of
5Healthcare and Family Services, in collaboration with the
6Department on Aging, the Department of Human Services, and the
7Department of Public Health, shall file administrative rules
8providing for the gathering, during the screening process, of
9information relevant to determining each person's potential
10for placing other residents, employees, and visitors at risk of
11harm.
12    (a-1) Any screening performed pursuant to subsection (a) of
13this Section shall include a determination of whether any
14person is being considered for admission to a nursing facility
15due to a need for mental health services. For a person who
16needs mental health services, the screening shall also include
17an evaluation of whether there is permanent supportive housing,
18or an array of community mental health services, including but
19not limited to supported housing, assertive community
20treatment, and peer support services, that would enable the
21person to live in the community. The person shall be told about
22the existence of any such services that would enable the person
23to live safely and humanely and about available appropriate
24nursing home services that would enable the person to live
25safely and humanely, and the person shall be given the
26assistance necessary to avail himself or herself of any

 

 

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1available services.
2    (a-2) Pre-screening for persons with a serious mental
3illness shall be performed by a psychiatrist, a psychologist, a
4registered nurse certified in psychiatric nursing, a licensed
5clinical professional counselor, or a licensed clinical social
6worker, who is competent to (i) perform a clinical assessment
7of the individual, (ii) certify a diagnosis, (iii) make a
8determination about the individual's current need for
9treatment, including substance abuse treatment, and recommend
10specific treatment, and (iv) determine whether a facility or a
11community-based program is able to meet the needs of the
12individual.
13    For any person entering a nursing facility, the
14pre-screening agent shall make specific recommendations about
15what care and services the individual needs to receive,
16beginning at admission, to attain or maintain the individual's
17highest level of independent functioning and to live in the
18most integrated setting appropriate for his or her physical and
19personal care and developmental and mental health needs. These
20recommendations shall be revised as appropriate by the
21pre-screening or re-screening agent based on the results of
22resident review and in response to changes in the resident's
23wishes, needs, and interest in transition.
24    Upon the person entering the nursing facility, the
25Department of Human Services or its designee shall assist the
26person in establishing a relationship with a community mental

 

 

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1health agency or other appropriate agencies in order to (i)
2promote the person's transition to independent living and (ii)
3support the person's progress in meeting individual goals.
4    (a-3) The Department of Human Services, by rule, shall
5provide for a prohibition on conflicts of interest for
6pre-admission screeners. The rule shall provide for waiver of
7those conflicts by the Department of Human Services if the
8Department of Human Services determines that a scarcity of
9qualified pre-admission screeners exists in a given community
10and that, absent a waiver of conflicts, an insufficient number
11of pre-admission screeners would be available. If a conflict is
12waived, the pre-admission screener shall disclose the conflict
13of interest to the screened individual in the manner provided
14for by rule of the Department of Human Services. For the
15purposes of this subsection, a "conflict of interest" includes,
16but is not limited to, the existence of a professional or
17financial relationship between (i) a PAS-MH corporate or a
18PAS-MH agent and (ii) a community provider or long-term care
19facility.
20    (b) In addition to the screening required by subsection
21(a), a facility, except for those licensed as long term care
22for under age 22 facilities, shall, within 24 hours after
23admission, request a criminal history background check
24pursuant to the Uniform Conviction Information Act for all
25persons age 18 or older seeking admission to the facility,
26unless a background check was initiated by a hospital pursuant

 

 

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1to subsection (d) of Section 6.09 of the Hospital Licensing
2Act. Background checks conducted pursuant to this Section shall
3be based on the resident's name, date of birth, and other
4identifiers as required by the Department of State Police. If
5the results of the background check are inconclusive, the
6facility shall initiate a fingerprint-based check, unless the
7fingerprint check is waived by the Director of Public Health
8based on verification by the facility that the resident is
9completely immobile or that the resident meets other criteria
10related to the resident's health or lack of potential risk
11which may be established by Departmental rule. A waiver issued
12pursuant to this Section shall be valid only while the resident
13is immobile or while the criteria supporting the waiver exist.
14The facility shall provide for or arrange for any required
15fingerprint-based checks to be taken on the premises of the
16facility. If a fingerprint-based check is required, the
17facility shall arrange for it to be conducted in a manner that
18is respectful of the resident's dignity and that minimizes any
19emotional or physical hardship to the resident.
20    (c) If the results of a resident's criminal history
21background check reveal that the resident is an identified
22offender as defined in Section 1-114.01, the facility shall do
23the following:
24        (1) Immediately notify the Department of State Police,
25    in the form and manner required by the Department of State
26    Police, in collaboration with the Department of Public

 

 

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1    Health, that the resident is an identified offender.
2        (2) Within 72 hours, arrange for a fingerprint-based
3    criminal history record inquiry to be requested on the
4    identified offender resident. The inquiry shall be based on
5    the subject's name, sex, race, date of birth, fingerprint
6    images, and other identifiers required by the Department of
7    State Police. The inquiry shall be processed through the
8    files of the Department of State Police and the Federal
9    Bureau of Investigation to locate any criminal history
10    record information that may exist regarding the subject.
11    The Federal Bureau of Investigation shall furnish to the
12    Department of State Police, pursuant to an inquiry under
13    this paragraph (2), any criminal history record
14    information contained in its files.
15    The facility shall comply with all applicable provisions
16contained in the Uniform Conviction Information Act.
17    All name-based and fingerprint-based criminal history
18record inquiries shall be submitted to the Department of State
19Police electronically in the form and manner prescribed by the
20Department of State Police. The Department of State Police may
21charge the facility a fee for processing name-based and
22fingerprint-based criminal history record inquiries. The fee
23shall be deposited into the State Police Services Fund. The fee
24shall not exceed the actual cost of processing the inquiry.
25    (d) (Blank).
26    (e) The Department shall develop and maintain a

 

 

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1de-identified database of residents who have injured facility
2staff, facility visitors, or other residents, and the attendant
3circumstances, solely for the purposes of evaluating and
4improving resident pre-screening and assessment procedures
5(including the Criminal History Report prepared under Section
62-201.6) and the adequacy of Department requirements
7concerning the provision of care and services to residents. A
8resident shall not be listed in the database until a Department
9survey confirms the accuracy of the listing. The names of
10persons listed in the database and information that would allow
11them to be individually identified shall not be made public.
12Neither the Department nor any other agency of State government
13may use information in the database to take any action against
14any individual, licensee, or other entity, unless the
15Department or agency receives the information independent of
16this subsection (e). All information collected, maintained, or
17developed under the authority of this subsection (e) for the
18purposes of the database maintained under this subsection (e)
19shall be treated in the same manner as information that is
20subject to Part 21 of Article VIII of the Code of Civil
21Procedure.
22(Source: P.A. 96-1372, eff. 7-29-10.)
 
23    Section 15. The Illinois Public Aid Code is amended by
24changing Sections 5-2, 5-5, 5-26, 5A-9, 12-4.42, and 12-10.5 as
25follows:
 

 

 

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1    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
2    Sec. 5-2. Classes of Persons Eligible. Medical assistance
3under this Article shall be available to any of the following
4classes of persons in respect to whom a plan for coverage has
5been submitted to the Governor by the Illinois Department and
6approved by him:
7        1. Recipients of basic maintenance grants under
8    Articles III and IV.
9        2. Persons otherwise eligible for basic maintenance
10    under Articles III and IV, excluding any eligibility
11    requirements that are inconsistent with any federal law or
12    federal regulation, as interpreted by the U.S. Department
13    of Health and Human Services, but who fail to qualify
14    thereunder on the basis of need or who qualify but are not
15    receiving basic maintenance under Article IV, and who have
16    insufficient income and resources to meet the costs of
17    necessary medical care, including but not limited to the
18    following:
19            (a) All persons otherwise eligible for basic
20        maintenance under Article III but who fail to qualify
21        under that Article on the basis of need and who meet
22        either of the following requirements:
23                (i) their income, as determined by the
24            Illinois Department in accordance with any federal
25            requirements, is equal to or less than 70% in

 

 

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1            fiscal year 2001, equal to or less than 85% in
2            fiscal year 2002 and until a date to be determined
3            by the Department by rule, and equal to or less
4            than 100% beginning on the date determined by the
5            Department by rule, of the nonfarm income official
6            poverty line, as defined by the federal Office of
7            Management and Budget and revised annually in
8            accordance with Section 673(2) of the Omnibus
9            Budget Reconciliation Act of 1981, applicable to
10            families of the same size; or
11                (ii) their income, after the deduction of
12            costs incurred for medical care and for other types
13            of remedial care, is equal to or less than 70% in
14            fiscal year 2001, equal to or less than 85% in
15            fiscal year 2002 and until a date to be determined
16            by the Department by rule, and equal to or less
17            than 100% beginning on the date determined by the
18            Department by rule, of the nonfarm income official
19            poverty line, as defined in item (i) of this
20            subparagraph (a).
21            (b) All persons who, excluding any eligibility
22        requirements that are inconsistent with any federal
23        law or federal regulation, as interpreted by the U.S.
24        Department of Health and Human Services, would be
25        determined eligible for such basic maintenance under
26        Article IV by disregarding the maximum earned income

 

 

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1        permitted by federal law.
2        3. Persons who would otherwise qualify for Aid to the
3    Medically Indigent under Article VII.
4        4. Persons not eligible under any of the preceding
5    paragraphs who fall sick, are injured, or die, not having
6    sufficient money, property or other resources to meet the
7    costs of necessary medical care or funeral and burial
8    expenses.
9        5.(a) Women during pregnancy, after the fact of
10    pregnancy has been determined by medical diagnosis, and
11    during the 60-day period beginning on the last day of the
12    pregnancy, together with their infants and children born
13    after September 30, 1983, whose income and resources are
14    insufficient to meet the costs of necessary medical care to
15    the maximum extent possible under Title XIX of the Federal
16    Social Security Act.
17        (b) The Illinois Department and the Governor shall
18    provide a plan for coverage of the persons eligible under
19    paragraph 5(a) by April 1, 1990. Such plan shall provide
20    ambulatory prenatal care to pregnant women during a
21    presumptive eligibility period and establish an income
22    eligibility standard that is equal to 133% of the nonfarm
23    income official poverty line, as defined by the federal
24    Office of Management and Budget and revised annually in
25    accordance with Section 673(2) of the Omnibus Budget
26    Reconciliation Act of 1981, applicable to families of the

 

 

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1    same size, provided that costs incurred for medical care
2    are not taken into account in determining such income
3    eligibility.
4        (c) The Illinois Department may conduct a
5    demonstration in at least one county that will provide
6    medical assistance to pregnant women, together with their
7    infants and children up to one year of age, where the
8    income eligibility standard is set up to 185% of the
9    nonfarm income official poverty line, as defined by the
10    federal Office of Management and Budget. The Illinois
11    Department shall seek and obtain necessary authorization
12    provided under federal law to implement such a
13    demonstration. Such demonstration may establish resource
14    standards that are not more restrictive than those
15    established under Article IV of this Code.
16        6. Persons under the age of 18 who fail to qualify as
17    dependent under Article IV and who have insufficient income
18    and resources to meet the costs of necessary medical care
19    to the maximum extent permitted under Title XIX of the
20    Federal Social Security Act.
21        7. Persons who are under 21 years of age and would
22    qualify as disabled as defined under the Federal
23    Supplemental Security Income Program, provided medical
24    service for such persons would be eligible for Federal
25    Financial Participation, and provided the Illinois
26    Department determines that:

 

 

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1            (a) the person requires a level of care provided by
2        a hospital, skilled nursing facility, or intermediate
3        care facility, as determined by a physician licensed to
4        practice medicine in all its branches;
5            (b) it is appropriate to provide such care outside
6        of an institution, as determined by a physician
7        licensed to practice medicine in all its branches;
8            (c) the estimated amount which would be expended
9        for care outside the institution is not greater than
10        the estimated amount which would be expended in an
11        institution.
12        8. Persons who become ineligible for basic maintenance
13    assistance under Article IV of this Code in programs
14    administered by the Illinois Department due to employment
15    earnings and persons in assistance units comprised of
16    adults and children who become ineligible for basic
17    maintenance assistance under Article VI of this Code due to
18    employment earnings. The plan for coverage for this class
19    of persons shall:
20            (a) extend the medical assistance coverage for up
21        to 12 months following termination of basic
22        maintenance assistance; and
23            (b) offer persons who have initially received 6
24        months of the coverage provided in paragraph (a) above,
25        the option of receiving an additional 6 months of
26        coverage, subject to the following:

 

 

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1                (i) such coverage shall be pursuant to
2            provisions of the federal Social Security Act;
3                (ii) such coverage shall include all services
4            covered while the person was eligible for basic
5            maintenance assistance;
6                (iii) no premium shall be charged for such
7            coverage; and
8                (iv) such coverage shall be suspended in the
9            event of a person's failure without good cause to
10            file in a timely fashion reports required for this
11            coverage under the Social Security Act and
12            coverage shall be reinstated upon the filing of
13            such reports if the person remains otherwise
14            eligible.
15        9. Persons with acquired immunodeficiency syndrome
16    (AIDS) or with AIDS-related conditions with respect to whom
17    there has been a determination that but for home or
18    community-based services such individuals would require
19    the level of care provided in an inpatient hospital,
20    skilled nursing facility or intermediate care facility the
21    cost of which is reimbursed under this Article. Assistance
22    shall be provided to such persons to the maximum extent
23    permitted under Title XIX of the Federal Social Security
24    Act.
25        10. Participants in the long-term care insurance
26    partnership program established under the Illinois

 

 

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1    Long-Term Care Partnership Program Act who meet the
2    qualifications for protection of resources described in
3    Section 15 of that Act.
4        11. Persons with disabilities who are employed and
5    eligible for Medicaid, pursuant to Section
6    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
7    subject to federal approval, persons with a medically
8    improved disability who are employed and eligible for
9    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
10    the Social Security Act, as provided by the Illinois
11    Department by rule. In establishing eligibility standards
12    under this paragraph 11, the Department shall, subject to
13    federal approval:
14            (a) set the income eligibility standard at not
15        lower than 350% of the federal poverty level;
16            (b) exempt retirement accounts that the person
17        cannot access without penalty before the age of 59 1/2,
18        and medical savings accounts established pursuant to
19        26 U.S.C. 220;
20            (c) allow non-exempt assets up to $25,000 as to
21        those assets accumulated during periods of eligibility
22        under this paragraph 11; and
23            (d) continue to apply subparagraphs (b) and (c) in
24        determining the eligibility of the person under this
25        Article even if the person loses eligibility under this
26        paragraph 11.

 

 

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1        12. Subject to federal approval, persons who are
2    eligible for medical assistance coverage under applicable
3    provisions of the federal Social Security Act and the
4    federal Breast and Cervical Cancer Prevention and
5    Treatment Act of 2000. Those eligible persons are defined
6    to include, but not be limited to, the following persons:
7            (1) persons who have been screened for breast or
8        cervical cancer under the U.S. Centers for Disease
9        Control and Prevention Breast and Cervical Cancer
10        Program established under Title XV of the federal
11        Public Health Services Act in accordance with the
12        requirements of Section 1504 of that Act as
13        administered by the Illinois Department of Public
14        Health; and
15            (2) persons whose screenings under the above
16        program were funded in whole or in part by funds
17        appropriated to the Illinois Department of Public
18        Health for breast or cervical cancer screening.
19        "Medical assistance" under this paragraph 12 shall be
20    identical to the benefits provided under the State's
21    approved plan under Title XIX of the Social Security Act.
22    The Department must request federal approval of the
23    coverage under this paragraph 12 within 30 days after the
24    effective date of this amendatory Act of the 92nd General
25    Assembly.
26        In addition to the persons who are eligible for medical

 

 

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1    assistance pursuant to subparagraphs (1) and (2) of this
2    paragraph 12, and to be paid from funds appropriated to the
3    Department for its medical programs, any uninsured person
4    as defined by the Department in rules residing in Illinois
5    who is younger than 65 years of age, who has been screened
6    for breast and cervical cancer in accordance with standards
7    and procedures adopted by the Department of Public Health
8    for screening, and who is referred to the Department by the
9    Department of Public Health as being in need of treatment
10    for breast or cervical cancer is eligible for medical
11    assistance benefits that are consistent with the benefits
12    provided to those persons described in subparagraphs (1)
13    and (2). Medical assistance coverage for the persons who
14    are eligible under the preceding sentence is not dependent
15    on federal approval, but federal moneys may be used to pay
16    for services provided under that coverage upon federal
17    approval.
18        13. Subject to appropriation and to federal approval,
19    persons living with HIV/AIDS who are not otherwise eligible
20    under this Article and who qualify for services covered
21    under Section 5-5.04 as provided by the Illinois Department
22    by rule.
23        14. Subject to the availability of funds for this
24    purpose, the Department may provide coverage under this
25    Article to persons who reside in Illinois who are not
26    eligible under any of the preceding paragraphs and who meet

 

 

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1    the income guidelines of paragraph 2(a) of this Section and
2    (i) have an application for asylum pending before the
3    federal Department of Homeland Security or on appeal before
4    a court of competent jurisdiction and are represented
5    either by counsel or by an advocate accredited by the
6    federal Department of Homeland Security and employed by a
7    not-for-profit organization in regard to that application
8    or appeal, or (ii) are receiving services through a
9    federally funded torture treatment center. Medical
10    coverage under this paragraph 14 may be provided for up to
11    24 continuous months from the initial eligibility date so
12    long as an individual continues to satisfy the criteria of
13    this paragraph 14. If an individual has an appeal pending
14    regarding an application for asylum before the Department
15    of Homeland Security, eligibility under this paragraph 14
16    may be extended until a final decision is rendered on the
17    appeal. The Department may adopt rules governing the
18    implementation of this paragraph 14.
19        15. Family Care Eligibility.
20            (a) A caretaker relative who is 19 years of age or
21        older when countable income is at or below 185% of the
22        Federal Poverty Level Guidelines, as published
23        annually in the Federal Register, for the appropriate
24        family size. A person may not spend down to become
25        eligible under this paragraph 15.
26            (b) Eligibility shall be reviewed annually.

 

 

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1            (c) Caretaker relatives enrolled under this
2        paragraph 15 in families with countable income above
3        150% and at or below 185% of the Federal Poverty Level
4        Guidelines shall be counted as family members and pay
5        premiums as established under the Children's Health
6        Insurance Program Act.
7            (d) Premiums shall be billed by and payable to the
8        Department or its authorized agent, on a monthly basis.
9            (e) The premium due date is the last day of the
10        month preceding the month of coverage.
11            (f) Individuals shall have a grace period through
12        60 30 days of coverage to pay the premium.
13            (g) Failure to pay the full monthly premium by the
14        last day of the grace period shall result in
15        termination of coverage.
16            (h) Partial premium payments shall not be
17        refunded.
18            (i) Following termination of an individual's
19        coverage under this paragraph 15, the following action
20        is required before the individual can be re-enrolled:
21                (1) A new application must be completed and the
22            individual must be determined otherwise eligible.
23                (2) There must be full payment of premiums due
24            under this Code, the Children's Health Insurance
25            Program Act, the Covering ALL KIDS Health
26            Insurance Act, or any other healthcare program

 

 

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1            administered by the Department for periods in
2            which a premium was owed and not paid for the
3            individual.
4                (3) The first month's premium must be paid if
5            there was an unpaid premium on the date the
6            individual's previous coverage was canceled.
7        The Department is authorized to implement the
8    provisions of this amendatory Act of the 95th General
9    Assembly by adopting the medical assistance rules in effect
10    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
11    89 Ill. Admin. Code 120.32 along with only those changes
12    necessary to conform to federal Medicaid requirements,
13    federal laws, and federal regulations, including but not
14    limited to Section 1931 of the Social Security Act (42
15    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
16    of Health and Human Services, and the countable income
17    eligibility standard authorized by this paragraph 15. The
18    Department may not otherwise adopt any rule to implement
19    this increase except as authorized by law, to meet the
20    eligibility standards authorized by the federal government
21    in the Medicaid State Plan or the Title XXI Plan, or to
22    meet an order from the federal government or any court.
23        16. Subject to appropriation, uninsured persons who
24    are not otherwise eligible under this Section who have been
25    certified and referred by the Department of Public Health
26    as having been screened and found to need diagnostic

 

 

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1    evaluation or treatment, or both diagnostic evaluation and
2    treatment, for prostate or testicular cancer. For the
3    purposes of this paragraph 16, uninsured persons are those
4    who do not have creditable coverage, as defined under the
5    Health Insurance Portability and Accountability Act, or
6    have otherwise exhausted any insurance benefits they may
7    have had, for prostate or testicular cancer diagnostic
8    evaluation or treatment, or both diagnostic evaluation and
9    treatment. To be eligible, a person must furnish a Social
10    Security number. A person's assets are exempt from
11    consideration in determining eligibility under this
12    paragraph 16. Such persons shall be eligible for medical
13    assistance under this paragraph 16 for so long as they need
14    treatment for the cancer. A person shall be considered to
15    need treatment if, in the opinion of the person's treating
16    physician, the person requires therapy directed toward
17    cure or palliation of prostate or testicular cancer,
18    including recurrent metastatic cancer that is a known or
19    presumed complication of prostate or testicular cancer and
20    complications resulting from the treatment modalities
21    themselves. Persons who require only routine monitoring
22    services are not considered to need treatment. "Medical
23    assistance" under this paragraph 16 shall be identical to
24    the benefits provided under the State's approved plan under
25    Title XIX of the Social Security Act. Notwithstanding any
26    other provision of law, the Department (i) does not have a

 

 

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1    claim against the estate of a deceased recipient of
2    services under this paragraph 16 and (ii) does not have a
3    lien against any homestead property or other legal or
4    equitable real property interest owned by a recipient of
5    services under this paragraph 16.
6    In implementing the provisions of Public Act 96-20, the
7Department is authorized to adopt only those rules necessary,
8including emergency rules. Nothing in Public Act 96-20 permits
9the Department to adopt rules or issue a decision that expands
10eligibility for the FamilyCare Program to a person whose income
11exceeds 185% of the Federal Poverty Level as determined from
12time to time by the U.S. Department of Health and Human
13Services, unless the Department is provided with express
14statutory authority.
15    The Illinois Department and the Governor shall provide a
16plan for coverage of the persons eligible under paragraph 7 as
17soon as possible after July 1, 1984.
18    The eligibility of any such person for medical assistance
19under this Article is not affected by the payment of any grant
20under the Senior Citizens and Disabled Persons Property Tax
21Relief and Pharmaceutical Assistance Act or any distributions
22or items of income described under subparagraph (X) of
23paragraph (2) of subsection (a) of Section 203 of the Illinois
24Income Tax Act. The Department shall by rule establish the
25amounts of assets to be disregarded in determining eligibility
26for medical assistance, which shall at a minimum equal the

 

 

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1amounts to be disregarded under the Federal Supplemental
2Security Income Program. The amount of assets of a single
3person to be disregarded shall not be less than $2,000, and the
4amount of assets of a married couple to be disregarded shall
5not be less than $3,000.
6    To the extent permitted under federal law, any person found
7guilty of a second violation of Article VIIIA shall be
8ineligible for medical assistance under this Article, as
9provided in Section 8A-8.
10    The eligibility of any person for medical assistance under
11this Article shall not be affected by the receipt by the person
12of donations or benefits from fundraisers held for the person
13in cases of serious illness, as long as neither the person nor
14members of the person's family have actual control over the
15donations or benefits or the disbursement of the donations or
16benefits.
17(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
1896-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.
198-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123,
20eff. 1-1-11; 96-1270, eff. 7-26-10; revised 9-16-10.)
 
21    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
22    Sec. 5-5. Medical services. The Illinois Department, by
23rule, shall determine the quantity and quality of and the rate
24of reimbursement for the medical assistance for which payment
25will be authorized, and the medical services to be provided,

 

 

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1which may include all or part of the following: (1) inpatient
2hospital services; (2) outpatient hospital services; (3) other
3laboratory and X-ray services; (4) skilled nursing home
4services; (5) physicians' services whether furnished in the
5office, the patient's home, a hospital, a skilled nursing home,
6or elsewhere; (6) medical care, or any other type of remedial
7care furnished by licensed practitioners; (7) home health care
8services; (8) private duty nursing service; (9) clinic
9services; (10) dental services, including prevention and
10treatment of periodontal disease and dental caries disease for
11pregnant women, provided by an individual licensed to practice
12dentistry or dental surgery; for purposes of this item (10),
13"dental services" means diagnostic, preventive, or corrective
14procedures provided by or under the supervision of a dentist in
15the practice of his or her profession; (11) physical therapy
16and related services; (12) prescribed drugs, dentures, and
17prosthetic devices; and eyeglasses prescribed by a physician
18skilled in the diseases of the eye, or by an optometrist,
19whichever the person may select; (13) other diagnostic,
20screening, preventive, and rehabilitative services, for
21children and adults; (14) transportation and such other
22expenses as may be necessary; (15) medical treatment of sexual
23assault survivors, as defined in Section 1a of the Sexual
24Assault Survivors Emergency Treatment Act, for injuries
25sustained as a result of the sexual assault, including
26examinations and laboratory tests to discover evidence which

 

 

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1may be used in criminal proceedings arising from the sexual
2assault; (16) the diagnosis and treatment of sickle cell
3anemia; and (17) any other medical care, and any other type of
4remedial care recognized under the laws of this State, but not
5including abortions, or induced miscarriages or premature
6births, unless, in the opinion of a physician, such procedures
7are necessary for the preservation of the life of the woman
8seeking such treatment, or except an induced premature birth
9intended to produce a live viable child and such procedure is
10necessary for the health of the mother or her unborn child. The
11Illinois Department, by rule, shall prohibit any physician from
12providing medical assistance to anyone eligible therefor under
13this Code where such physician has been found guilty of
14performing an abortion procedure in a wilful and wanton manner
15upon a woman who was not pregnant at the time such abortion
16procedure was performed. The term "any other type of remedial
17care" shall include nursing care and nursing home service for
18persons who rely on treatment by spiritual means alone through
19prayer for healing.
20    Notwithstanding any other provision of this Section, a
21comprehensive tobacco use cessation program that includes
22purchasing prescription drugs or prescription medical devices
23approved by the Food and Drug Administration shall be covered
24under the medical assistance program under this Article for
25persons who are otherwise eligible for assistance under this
26Article.

 

 

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1    Notwithstanding any other provision of this Code, the
2Illinois Department may not require, as a condition of payment
3for any laboratory test authorized under this Article, that a
4physician's handwritten signature appear on the laboratory
5test order form. The Illinois Department may, however, impose
6other appropriate requirements regarding laboratory test order
7documentation.
8    The Department of Healthcare and Family Services shall
9provide the following services to persons eligible for
10assistance under this Article who are participating in
11education, training or employment programs operated by the
12Department of Human Services as successor to the Department of
13Public Aid:
14        (1) dental services provided by or under the
15    supervision of a dentist; and
16        (2) eyeglasses prescribed by a physician skilled in the
17    diseases of the eye, or by an optometrist, whichever the
18    person may select.
19    Notwithstanding any other provision of this Code and
20subject to federal approval, the Department may adopt rules to
21allow a dentist who is volunteering his or her service at no
22cost to render dental services through an enrolled
23not-for-profit health clinic without the dentist personally
24enrolling as a participating provider in the medical assistance
25program. A not-for-profit health clinic shall include a public
26health clinic or Federally Qualified Health Center or other

 

 

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1enrolled provider, as determined by the Department, through
2which dental services covered under this Section are performed.
3The Department shall establish a process for payment of claims
4for reimbursement for covered dental services rendered under
5this provision.
6    The Illinois Department, by rule, may distinguish and
7classify the medical services to be provided only in accordance
8with the classes of persons designated in Section 5-2.
9    The Department of Healthcare and Family Services must
10provide coverage and reimbursement for amino acid-based
11elemental formulas, regardless of delivery method, for the
12diagnosis and treatment of (i) eosinophilic disorders and (ii)
13short bowel syndrome when the prescribing physician has issued
14a written order stating that the amino acid-based elemental
15formula is medically necessary.
16    The Illinois Department shall authorize the provision of,
17and shall authorize payment for, screening by low-dose
18mammography for the presence of occult breast cancer for women
1935 years of age or older who are eligible for medical
20assistance under this Article, as follows:
21        (A) A baseline mammogram for women 35 to 39 years of
22    age.
23        (B) An annual mammogram for women 40 years of age or
24    older.
25        (C) A mammogram at the age and intervals considered
26    medically necessary by the woman's health care provider for

 

 

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1    women under 40 years of age and having a family history of
2    breast cancer, prior personal history of breast cancer,
3    positive genetic testing, or other risk factors.
4        (D) A comprehensive ultrasound screening of an entire
5    breast or breasts if a mammogram demonstrates
6    heterogeneous or dense breast tissue, when medically
7    necessary as determined by a physician licensed to practice
8    medicine in all of its branches.
9    All screenings shall include a physical breast exam,
10instruction on self-examination and information regarding the
11frequency of self-examination and its value as a preventative
12tool. For purposes of this Section, "low-dose mammography"
13means the x-ray examination of the breast using equipment
14dedicated specifically for mammography, including the x-ray
15tube, filter, compression device, and image receptor, with an
16average radiation exposure delivery of less than one rad per
17breast for 2 views of an average size breast. The term also
18includes digital mammography.
19    On and after July 1, 2008, screening and diagnostic
20mammography shall be reimbursed at the same rate as the
21Medicare program's rates, including the increased
22reimbursement for digital mammography.
23    The Department shall convene an expert panel including
24representatives of hospitals, free-standing mammography
25facilities, and doctors, including radiologists, to establish
26quality standards. Based on these quality standards, the

 

 

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1Department shall provide for bonus payments to mammography
2facilities meeting the standards for screening and diagnosis.
3The bonus payments shall be at least 15% higher than the
4Medicare rates for mammography.
5    Subject to federal approval, the Department shall
6establish a rate methodology for mammography at federally
7qualified health centers and other encounter-rate clinics.
8These clinics or centers may also collaborate with other
9hospital-based mammography facilities.
10    The Department shall establish a methodology to remind
11women who are age-appropriate for screening mammography, but
12who have not received a mammogram within the previous 18
13months, of the importance and benefit of screening mammography.
14    The Department shall establish a performance goal for
15primary care providers with respect to their female patients
16over age 40 receiving an annual mammogram. This performance
17goal shall be used to provide additional reimbursement in the
18form of a quality performance bonus to primary care providers
19who meet that goal.
20    The Department shall devise a means of case-managing or
21patient navigation for beneficiaries diagnosed with breast
22cancer. This program shall initially operate as a pilot program
23in areas of the State with the highest incidence of mortality
24related to breast cancer. At least one pilot program site shall
25be in the metropolitan Chicago area and at least one site shall
26be outside the metropolitan Chicago area. An evaluation of the

 

 

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1pilot program shall be carried out measuring health outcomes
2and cost of care for those served by the pilot program compared
3to similarly situated patients who are not served by the pilot
4program.
5    Any medical or health care provider shall immediately
6recommend, to any pregnant woman who is being provided prenatal
7services and is suspected of drug abuse or is addicted as
8defined in the Alcoholism and Other Drug Abuse and Dependency
9Act, referral to a local substance abuse treatment provider
10licensed by the Department of Human Services or to a licensed
11hospital which provides substance abuse treatment services.
12The Department of Healthcare and Family Services shall assure
13coverage for the cost of treatment of the drug abuse or
14addiction for pregnant recipients in accordance with the
15Illinois Medicaid Program in conjunction with the Department of
16Human Services.
17    All medical providers providing medical assistance to
18pregnant women under this Code shall receive information from
19the Department on the availability of services under the Drug
20Free Families with a Future or any comparable program providing
21case management services for addicted women, including
22information on appropriate referrals for other social services
23that may be needed by addicted women in addition to treatment
24for addiction.
25    The Illinois Department, in cooperation with the
26Departments of Human Services (as successor to the Department

 

 

SB1784 Engrossed- 33 -LRB097 06803 KTG 50212 b

1of Alcoholism and Substance Abuse) and Public Health, through a
2public awareness campaign, may provide information concerning
3treatment for alcoholism and drug abuse and addiction, prenatal
4health care, and other pertinent programs directed at reducing
5the number of drug-affected infants born to recipients of
6medical assistance.
7    Neither the Department of Healthcare and Family Services
8nor the Department of Human Services shall sanction the
9recipient solely on the basis of her substance abuse.
10    The Illinois Department shall establish such regulations
11governing the dispensing of health services under this Article
12as it shall deem appropriate. The Department should seek the
13advice of formal professional advisory committees appointed by
14the Director of the Illinois Department for the purpose of
15providing regular advice on policy and administrative matters,
16information dissemination and educational activities for
17medical and health care providers, and consistency in
18procedures to the Illinois Department.
19    Notwithstanding any other provision of law, a health care
20provider under the medical assistance program may elect, in
21lieu of receiving direct payment for services provided under
22that program, to participate in the State Employees Deferred
23Compensation Plan adopted under Article 24 of the Illinois
24Pension Code. A health care provider who elects to participate
25in the plan does not have a cause of action against the State
26for any damages allegedly suffered by the provider as a result

 

 

SB1784 Engrossed- 34 -LRB097 06803 KTG 50212 b

1of any delay by the State in crediting the amount of any
2contribution to the provider's plan account.
3    The Illinois Department may develop and contract with
4Partnerships of medical providers to arrange medical services
5for persons eligible under Section 5-2 of this Code.
6Implementation of this Section may be by demonstration projects
7in certain geographic areas. The Partnership shall be
8represented by a sponsor organization. The Department, by rule,
9shall develop qualifications for sponsors of Partnerships.
10Nothing in this Section shall be construed to require that the
11sponsor organization be a medical organization.
12    The sponsor must negotiate formal written contracts with
13medical providers for physician services, inpatient and
14outpatient hospital care, home health services, treatment for
15alcoholism and substance abuse, and other services determined
16necessary by the Illinois Department by rule for delivery by
17Partnerships. Physician services must include prenatal and
18obstetrical care. The Illinois Department shall reimburse
19medical services delivered by Partnership providers to clients
20in target areas according to provisions of this Article and the
21Illinois Health Finance Reform Act, except that:
22        (1) Physicians participating in a Partnership and
23    providing certain services, which shall be determined by
24    the Illinois Department, to persons in areas covered by the
25    Partnership may receive an additional surcharge for such
26    services.

 

 

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1        (2) The Department may elect to consider and negotiate
2    financial incentives to encourage the development of
3    Partnerships and the efficient delivery of medical care.
4        (3) Persons receiving medical services through
5    Partnerships may receive medical and case management
6    services above the level usually offered through the
7    medical assistance program.
8    Medical providers shall be required to meet certain
9qualifications to participate in Partnerships to ensure the
10delivery of high quality medical services. These
11qualifications shall be determined by rule of the Illinois
12Department and may be higher than qualifications for
13participation in the medical assistance program. Partnership
14sponsors may prescribe reasonable additional qualifications
15for participation by medical providers, only with the prior
16written approval of the Illinois Department.
17    Nothing in this Section shall limit the free choice of
18practitioners, hospitals, and other providers of medical
19services by clients. In order to ensure patient freedom of
20choice, the Illinois Department shall immediately promulgate
21all rules and take all other necessary actions so that provided
22services may be accessed from therapeutically certified
23optometrists to the full extent of the Illinois Optometric
24Practice Act of 1987 without discriminating between service
25providers.
26    The Department shall apply for a waiver from the United

 

 

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1States Health Care Financing Administration to allow for the
2implementation of Partnerships under this Section.
3    The Illinois Department shall require health care
4providers to maintain records that document the medical care
5and services provided to recipients of Medical Assistance under
6this Article. Such records must be retained for a period of not
7less than 6 years from the date of service or as provided by
8applicable State law, whichever period is longer, except that
9if an audit is initiated within the required retention period
10then the records must be retained until the audit is completed
11and every exception is resolved. The Illinois Department shall
12require health care providers to make available, when
13authorized by the patient, in writing, the medical records in a
14timely fashion to other health care providers who are treating
15or serving persons eligible for Medical Assistance under this
16Article. All dispensers of medical services shall be required
17to maintain and retain business and professional records
18sufficient to fully and accurately document the nature, scope,
19details and receipt of the health care provided to persons
20eligible for medical assistance under this Code, in accordance
21with regulations promulgated by the Illinois Department. The
22rules and regulations shall require that proof of the receipt
23of prescription drugs, dentures, prosthetic devices and
24eyeglasses by eligible persons under this Section accompany
25each claim for reimbursement submitted by the dispenser of such
26medical services. No such claims for reimbursement shall be

 

 

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1approved for payment by the Illinois Department without such
2proof of receipt, unless the Illinois Department shall have put
3into effect and shall be operating a system of post-payment
4audit and review which shall, on a sampling basis, be deemed
5adequate by the Illinois Department to assure that such drugs,
6dentures, prosthetic devices and eyeglasses for which payment
7is being made are actually being received by eligible
8recipients. Within 90 days after the effective date of this
9amendatory Act of 1984, the Illinois Department shall establish
10a current list of acquisition costs for all prosthetic devices
11and any other items recognized as medical equipment and
12supplies reimbursable under this Article and shall update such
13list on a quarterly basis, except that the acquisition costs of
14all prescription drugs shall be updated no less frequently than
15every 30 days as required by Section 5-5.12.
16    The rules and regulations of the Illinois Department shall
17require that a written statement including the required opinion
18of a physician shall accompany any claim for reimbursement for
19abortions, or induced miscarriages or premature births. This
20statement shall indicate what procedures were used in providing
21such medical services.
22    The Illinois Department shall require all dispensers of
23medical services, other than an individual practitioner or
24group of practitioners, desiring to participate in the Medical
25Assistance program established under this Article to disclose
26all financial, beneficial, ownership, equity, surety or other

 

 

SB1784 Engrossed- 38 -LRB097 06803 KTG 50212 b

1interests in any and all firms, corporations, partnerships,
2associations, business enterprises, joint ventures, agencies,
3institutions or other legal entities providing any form of
4health care services in this State under this Article.
5    The Illinois Department may require that all dispensers of
6medical services desiring to participate in the medical
7assistance program established under this Article disclose,
8under such terms and conditions as the Illinois Department may
9by rule establish, all inquiries from clients and attorneys
10regarding medical bills paid by the Illinois Department, which
11inquiries could indicate potential existence of claims or liens
12for the Illinois Department.
13    Enrollment of a vendor that provides non-emergency medical
14transportation, defined by the Department by rule, shall be
15conditional for 180 days. During that time, the Department of
16Healthcare and Family Services may terminate the vendor's
17eligibility to participate in the medical assistance program
18without cause. That termination of eligibility is not subject
19to the Department's hearing process.
20    The Illinois Department shall establish policies,
21procedures, standards and criteria by rule for the acquisition,
22repair and replacement of orthotic and prosthetic devices and
23durable medical equipment. Such rules shall provide, but not be
24limited to, the following services: (1) immediate repair or
25replacement of such devices by recipients without medical
26authorization; and (2) rental, lease, purchase or

 

 

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1lease-purchase of durable medical equipment in a
2cost-effective manner, taking into consideration the
3recipient's medical prognosis, the extent of the recipient's
4needs, and the requirements and costs for maintaining such
5equipment. Such rules shall enable a recipient to temporarily
6acquire and use alternative or substitute devices or equipment
7pending repairs or replacements of any device or equipment
8previously authorized for such recipient by the Department.
9    The Department shall execute, relative to the nursing home
10prescreening project, written inter-agency agreements with the
11Department of Human Services and the Department on Aging, to
12effect the following: (i) intake procedures and common
13eligibility criteria for those persons who are receiving
14non-institutional services; and (ii) the establishment and
15development of non-institutional services in areas of the State
16where they are not currently available or are undeveloped.
17    The Illinois Department shall develop and operate, in
18cooperation with other State Departments and agencies and in
19compliance with applicable federal laws and regulations,
20appropriate and effective systems of health care evaluation and
21programs for monitoring of utilization of health care services
22and facilities, as it affects persons eligible for medical
23assistance under this Code.
24    The Illinois Department shall report annually to the
25General Assembly, no later than the second Friday in April of
261979 and each year thereafter, in regard to:

 

 

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1        (a) actual statistics and trends in utilization of
2    medical services by public aid recipients;
3        (b) actual statistics and trends in the provision of
4    the various medical services by medical vendors;
5        (c) current rate structures and proposed changes in
6    those rate structures for the various medical vendors; and
7        (d) efforts at utilization review and control by the
8    Illinois Department.
9    The period covered by each report shall be the 3 years
10ending on the June 30 prior to the report. The report shall
11include suggested legislation for consideration by the General
12Assembly. The filing of one copy of the report with the
13Speaker, one copy with the Minority Leader and one copy with
14the Clerk of the House of Representatives, one copy with the
15President, one copy with the Minority Leader and one copy with
16the Secretary of the Senate, one copy with the Legislative
17Research Unit, and such additional copies with the State
18Government Report Distribution Center for the General Assembly
19as is required under paragraph (t) of Section 7 of the State
20Library Act shall be deemed sufficient to comply with this
21Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on
26Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 95-331, eff. 8-21-07; 95-520, eff. 8-28-07;
395-1045, eff. 3-27-09; 96-156, eff. 1-1-10; 96-806, eff.
47-1-10; 96-926, eff. 1-1-11; 96-1000, eff. 7-2-10.)
 
5    (305 ILCS 5/5-26)
6    Sec. 5-26. Federal Family Opportunity Act.
7    (a) As used in this Section, "the federal Act" means the
8federal Family Opportunity Act, enacted as part of the Deficit
9Reduction Act of 2005.
10    (b) Subject to appropriations for program administration
11and services, the The Department of Human Services, in
12conjunction with the Department of Healthcare and Family
13Services, shall implement the Medical Assistance provisions of
14the federal Act as soon as possible after the effective date of
15this amendatory Act of the 95th General Assembly.
16    (c) As soon as possible after the effective date of this
17amendatory Act of the 95th General Assembly, the Department of
18Human Services, in conjunction with the Department of
19Healthcare and Family Services, shall take all necessary and
20appropriate steps to try to secure (i) any available federal
21funds for a demonstration project regarding home and
22community-based alternatives to psychiatric residential
23treatment facilities for children, as authorized by the federal
24Act, and (ii) the location in Illinois of a family-to-family
25health information center, as authorized by the federal Act.

 

 

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1(Source: P.A. 95-37, eff. 8-10-07.)
 
2    (305 ILCS 5/5A-9)  (from Ch. 23, par. 5A-9)
3    Sec. 5A-9. Emergency services audits. The Illinois
4Department may audit hospital claims for payment for emergency
5services provided to a recipient who does not require admission
6as an inpatient. The Illinois Department shall adopt rules that
7describe how the emergency services audit process will be
8conducted. These rules shall include, but need not be limited
9to, the following provisions:
10        (1) The determination that an emergency medical
11    condition exists shall be based upon the symptoms and
12    condition of the recipient at the time the recipient is
13    initially examined by the hospital emergency department
14    and not upon the final determination of the recipient's
15    actual medical condition.
16        (2) The Illinois Department or its authorized
17    representative shall meet with the chief executive officer
18    of the hospital, or a person designated by the chief
19    executive officer, upon arrival at the hospital to conduct
20    the audit and before leaving the hospital at the conclusion
21    of the audit. The purpose of the pre-audit meeting shall be
22    to inform the hospital concerning the scope of the audit.
23    The purpose of the post-audit meeting shall be to provide
24    the hospital with the preliminary findings of the audit.
25        (3) An emergency services audit shall be limited to a

 

 

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1    review of records related to services rendered within 6 3
2    years of the date of the audit. The hospital's business and
3    professional records for at least 12 previous calendar
4    months shall be maintained and available for inspection by
5    authorized Illinois Department personnel on the premises
6    of the hospital. Illinois Department personnel shall make
7    requests in writing to inspect records more than 12 months
8    old at least 2 business days in advance of the date they
9    must be produced.
10        (4) Where the purpose of the audit is to determine the
11    appropriateness of the emergency services provided, any
12    final determination that would result in a denial of or
13    reduction in payment to the hospital shall be made by a
14    physician licensed to practice medicine in all of its
15    branches who is board certified in emergency medicine or by
16    the appropriate health care professionals under the
17    supervision of the physician.
18        (5) The preliminary audit findings shall be provided to
19    the hospital within 120 days of the date on which the audit
20    conducted on the hospital premises was completed.
21        (6) The Illinois Department or its designated review
22    agent shall use statistically valid sampling techniques
23    when conducting audits.
24(Source: P.A. 87-861.)
 
25    (305 ILCS 5/12-4.42)

 

 

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1    Sec. 12-4.42 12-4.40. Medicaid Revenue Maximization.
2    (a) Purpose. The General Assembly finds that there is a
3need to make changes to the administration of services provided
4by State and local governments in order to maximize federal
5financial participation.
6    (b) Definitions. As used in this Section:
7    "Community Medicaid mental health services" means all
8mental health services outlined in Section 132 of Title 59 of
9the Illinois Administrative Code that are funded through DHS,
10eligible for federal financial participation, and provided by a
11community-based provider.
12    "Community-based provider" means an entity enrolled as a
13provider pursuant to Sections 140.11 and 140.12 of Title 89 of
14the Illinois Administrative Code and certified to provide
15community Medicaid mental health services in accordance with
16Section 132 of Title 59 of the Illinois Administrative Code.
17    "DCFS" means the Department of Children and Family
18Services.
19    "Department" means the Illinois Department of Healthcare
20and Family Services.
21    "Developmentally disabled care facility" means an
22intermediate care facility for the mentally retarded within the
23meaning of Title XIX of the Social Security Act, whether public
24or private and whether organized for profit or not-for-profit,
25but shall not include any facility operated by the State.
26    "Developmentally disabled care provider" means a person

 

 

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1conducting, operating, or maintaining a developmentally
2disabled care facility. For purposes of this definition,
3"person" means any political subdivision of the State,
4municipal corporation, individual, firm, partnership,
5corporation, company, limited liability company, association,
6joint stock association, or trust, or a receiver, executor,
7trustee, guardian, or other representative appointed by order
8of any court.
9    "DHS" means the Illinois Department of Human Services.
10    "Hospital" means an institution, place, building, or
11agency located in this State that is licensed as a general
12acute hospital by the Illinois Department of Public Health
13under the Hospital Licensing Act, whether public or private and
14whether organized for profit or not-for-profit.
15    "Long term care facility" means (i) a skilled nursing or
16intermediate long term care facility, whether public or private
17and whether organized for profit or not-for-profit, that is
18subject to licensure by the Illinois Department of Public
19Health under the Nursing Home Care Act, including a county
20nursing home directed and maintained under Section 5-1005 of
21the Counties Code, and (ii) a part of a hospital in which
22skilled or intermediate long term care services within the
23meaning of Title XVIII or XIX of the Social Security Act are
24provided; except that the term "long term care facility" does
25not include a facility operated solely as an intermediate care
26facility for the mentally retarded within the meaning of Title

 

 

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1XIX of the Social Security Act.
2    "Long term care provider" means (i) a person licensed by
3the Department of Public Health to operate and maintain a
4skilled nursing or intermediate long term care facility or (ii)
5a hospital provider that provides skilled or intermediate long
6term care services within the meaning of Title XVIII or XIX of
7the Social Security Act. For purposes of this definition,
8"person" means any political subdivision of the State,
9municipal corporation, individual, firm, partnership,
10corporation, company, limited liability company, association,
11joint stock association, or trust, or a receiver, executor,
12trustee, guardian, or other representative appointed by order
13of any court.
14    "State-operated developmentally disabled care facility"
15means an intermediate care facility for the mentally retarded
16within the meaning of Title XIX of the Social Security Act
17operated by the State.
18    (c) Administration and deposit of Revenues. The Department
19shall coordinate the implementation of changes required by this
20amendatory Act of the 96th General Assembly amongst the various
21State and local government bodies that administer programs
22referred to in this Section.
23    Revenues generated by program changes mandated by any
24provision in this Section, less reasonable administrative
25costs associated with the implementation of these program
26changes, which would otherwise be deposited into the General

 

 

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1Revenue Fund shall be deposited into the Healthcare Provider
2Relief Fund.
3    The Department shall issue a report to the General Assembly
4detailing the implementation progress of this amendatory Act of
5the 96th General Assembly as a part of the Department's Medical
6Programs annual report for fiscal years 2010 and 2011.
7    (d) Acceleration of payment vouchers. To the extent
8practicable and permissible under federal law, the Department
9shall create all vouchers for long term care facilities and
10developmentally disabled care facilities for dates of service
11in the month in which the enhanced federal medical assistance
12percentage (FMAP) originally set forth in the American Recovery
13and Reinvestment Act (ARRA) expires and for dates of service in
14the month prior to that month and shall, no later than the 15th
15of the month in which the enhanced FMAP expires, submit these
16vouchers to the Comptroller for payment.
17    The Department of Human Services shall create the necessary
18documentation for State-operated developmentally disabled care
19facilities so that the necessary data for all dates of service
20before the expiration of the enhanced FMAP originally set forth
21in the ARRA can be adjudicated by the Department no later than
22the 15th of the month in which the enhanced FMAP expires.
23    (e) Billing of DHS community Medicaid mental health
24services. No later than July 1, 2011, community Medicaid mental
25health services provided by a community-based provider must be
26billed directly to the Department.

 

 

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1    (f) DCFS Medicaid services. The Department shall work with
2DCFS to identify existing programs, pending qualifying
3services, that can be converted in an economically feasible
4manner to Medicaid in order to secure federal financial
5revenue.
6    (g) Third Party Liability recoveries. The Department shall
7contract with a vendor to support the Department in
8coordinating benefits for Medicaid enrollees. The scope of work
9shall include, at a minimum, the identification of other
10insurance for Medicaid enrollees and the recovery of funds paid
11by the Department when another payer was liable. The vendor may
12be paid a percentage of actual cash recovered when practical
13and subject to federal law.
14    (h) Public health departments. The Department shall
15identify unreimbursed costs for persons covered by Medicaid who
16are served by the Chicago Department of Public Health.
17    The Department shall assist the Chicago Department of
18Public Health in determining total unreimbursed costs
19associated with the provision of healthcare services to
20Medicaid enrollees.
21    The Department shall determine and draw the maximum
22allowable federal matching dollars associated with the cost of
23Chicago Department of Public Health services provided to
24Medicaid enrollees.
25    (i) Acceleration of hospital-based payments. The
26Department shall, by the 10th day of the month in which the

 

 

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1enhanced FMAP originally set forth in the ARRA expires, create
2vouchers for all State fiscal year 2011 hospital payments
3exempt from the prompt payment requirements of the ARRA. The
4Department shall submit these vouchers to the Comptroller for
5payment.
6(Source: P.A. 96-1405, eff. 7-29-10; revised 9-9-10.)
 
7    (305 ILCS 5/12-10.5)
8    Sec. 12-10.5. Medical Special Purposes Trust Fund.
9    (a) The Medical Special Purposes Trust Fund ("the Fund") is
10created. Any grant, gift, donation, or legacy of money or
11securities that the Department of Healthcare and Family
12Services is authorized to receive under Section 12-4.18 or
13Section 12-4.19, and that is dedicated for functions connected
14with the administration of any medical program administered by
15the Department, shall be deposited into the Fund. All federal
16moneys received by the Department as reimbursement for
17disbursements authorized to be made from the Fund shall also be
18deposited into the Fund. In addition, federal moneys received
19on account of State expenditures made in connection with
20obtaining compliance with the federal Health Insurance
21Portability and Accountability Act (HIPAA) shall be deposited
22into the Fund.
23    (b) No moneys received from a service provider or a
24governmental or private entity that is enrolled with the
25Department as a provider of medical services shall be deposited

 

 

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1into the Fund.
2    (c) Disbursements may be made from the Fund for the
3purposes connected with the grants, gifts, donations, or
4legacies deposited into the Fund, including, but not limited
5to, medical quality assessment projects, eligibility
6population studies, medical information systems evaluations,
7and other administrative functions that assist the Department
8in fulfilling its health care mission under any medical program
9administered by the Department the Illinois Public Aid Code and
10the Children's Health Insurance Program Act.
11(Source: P.A. 95-331, eff. 8-21-07.)
 
12    (305 ILCS 5/5-2.4 rep.)
13    (305 ILCS 5/9A-9.5 rep.)
14    Section 20. The Illinois Public Aid Code is amended by
15repealing Sections 5-2.4 and 9A-9.5.
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 100/5-70from Ch. 127, par. 1005-70
4    20 ILCS 10/Act rep.
5    30 ILCS 105/5.573
6    30 ILCS 105/6z-58
7    210 ILCS 45/2-201.5
8    305 ILCS 5/5-2from Ch. 23, par. 5-2
9    305 ILCS 5/5-5from Ch. 23, par. 5-5
10    305 ILCS 5/5-26
11    305 ILCS 5/5A-9from Ch. 23, par. 5A-9
12    305 ILCS 5/12-4.42
13    305 ILCS 5/12-10.5
14    305 ILCS 5/5-2.4 rep.
15    305 ILCS 5/9A-9.5 rep.