State of Illinois
2017 and 2018


Introduced 2/14/2018, by Sen. John G. Mulroe


305 ILCS 5/5-5g new
305 ILCS 5/11-5.4

    Amends the Illinois Public Aid Code. Requires long-term care providers to submit all changes in resident status, including, but not limited to, death, discharge, changes in patient credit, third party liability, and Medicare coverage to the Department of Healthcare and Family Services through the Medical Electronic Data Interchange System, the Recipient Eligibility Verification System, or the Electronic Data Interchange System under a specified schedule. Requires the Department and other agencies to establish an expedited long-term care eligibility determination and enrollment system. Requires the Director of Healthcare and Family Services, in coordination with the Secretary of Human Services and the Director of Aging, to hold meetings for provider associations representing facilities licensed under the Nursing Home Care Act and certified as supportive living programs. Provides that the meetings shall be held every 6 weeks until all backlogged cases have been adjudicated and the application process has been reduced to the federal timeframe. Contains provisions concerning a 45-day extension of the federal eligibility application processing deadline in suspected cases of fraud; the identification of applicants who had full Medicaid benefits in the community for 6 months or more immediately before entering the long-term care facility; reporting requirements; public-private partnerships aimed at redeploying caseworkers to targeted high-Medicaid facilities for the purpose of expediting initial Medicaid and long-term care benefits applications; the establishment of a Health Insurance Portability and Accountability Act compliant database; and other matters. Effective immediately.

LRB100 18099 KTG 34358 b






SB2913LRB100 18099 KTG 34358 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 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.4 and by adding Section 5-5g as follows:
6    (305 ILCS 5/5-5g new)
7    Sec. 5-5g. Long-term care patient; resident status.
8Long-term care providers shall submit all changes in resident
9status, including, but not limited to, death, discharge,
10changes in patient credit, third party liability, and Medicare
11coverage to the Department through the Medical Electronic Data
12Interchange System, the Recipient Eligibility Verification
13System, or the Electronic Data Interchange System established
14under 89 Ill. Adm. Code 140.55(b) in compliance with the
15schedule below:
16        (1) 15 calendar days after a resident's death;
17        (2) 15 calendar days after a resident's discharge;
18        (3) 45 calendar days after being informed of a change
19    in the resident's income;
20        (4) 45 calendar days after being informed of a change
21    in a resident's third party liability;
22        (5) 45 calendar days after a resident's need for
23    services requiring reimbursement under the ventilator or



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1    traumatic brain injury enhanced rate.
2    (305 ILCS 5/11-5.4)
3    Sec. 11-5.4. Expedited long-term care eligibility
4determination and enrollment.
5    (a) The General Assembly finds that it is in the best
6interest of the State to process on an expedited basis
7applications for Medicaid and Medicaid long-term care benefits
8that are submitted by or on behalf of elderly persons in need
9of long-term care services. It is the intent of the General
10Assembly that the provisions of this Section be liberally
11construed to permit the maximum number of applicants to
12benefit, regardless of the age of the application, and for the
13State to meet the federal eligibility processing deadlines. An
14expedited long-term care eligibility determination and
15enrollment system shall be established to reduce long-term care
16determinations to 90 days or fewer by July 1, 2014 and
17streamline the long-term care enrollment process.
18Establishment of the system shall be a joint venture of the
19        (1) The Department of Human Services and Healthcare and
20    Family Services and the Department on Aging shall establish
21    an expedited long-term care eligibility determination and
22    enrollment system. The Department of Healthcare and Family
23    Services shall serve as the lead agency assuming primary
24    responsibility for the full implementation of this
25    Section, including the establishment and maintenance of



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1    the system. The Governor shall name a lead agency no later
2    than 30 days after the effective date of this amendatory
3    Act of the 98th General Assembly to assume responsibility
4    for the full implementation of the establishment and
5    maintenance of the system. Project outcomes shall include
6    an enhanced eligibility determination tracking system
7    accessible to providers and a centralized application
8    review and eligibility determination with all applicants
9    reviewed within 90 days of receipt by the State of a
10    complete application.
11        (2) The Director of Healthcare and Family Services, in
12    coordination with the Secretary of Human Services and the
13    Director of Aging, shall hold meetings for provider
14    associations representing facilities licensed under the
15    Nursing Home Care Act and certified as supportive living
16    programs. The first meeting shall be held no later than 30
17    days after the effective date of this amendatory Act of the
18    100th General Assembly. The meetings shall be held every 6
19    weeks until all backlogged cases have been adjudicated and
20    the application process has been reduced to the federal
21    timeframe. After all backlogged cases have been
22    adjudicated and the application process has been reduced to
23    the federal timeframe, the meetings shall be held
24    quarterly. Each agency shall be represented by senior staff
25    with hands-on knowledge of the processing of applications
26    for Medicaid, long-term care benefits, and



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1    redeterminations and such ancillary issues as income and
2    address adjustments, release forms, and screening reports.
3    Agenda items shall be solicited from the associations.
4        (3) If the Department of Healthcare and Family
5    Services' Office of the Inspector General obtains credible
6    evidence that an applicant has transferred assets with the
7    intent of defrauding the State, the federal eligibility
8    application processing deadline shall be extended by 45
9    days. If at the end of the extended deadline proof of the
10    allegations does not exist, the application shall be
11    assigned for an expedited resolve. determines that there is
12    a likelihood that a non-allowable transfer of assets has
13    occurred, and the facility in which the applicant resides
14    is notified, an extension of up to 90 days shall be
15    permissible. On or before December 31, 2015, a streamlined
16    application and enrollment process shall be put in place
17    based on the following principles:
18            (A) (1) Minimize the burden on applicants by
19        collecting only the data necessary to determine
20        eligibility for medical services, long-term care
21        services, and spousal impoverishment offset.
22            (B) (2) Integrate online data sources to simplify
23        the application process by reducing the amount of
24        information needed to be entered and to expedite
25        eligibility verification.
26            (C) (3) Provide online prompts to alert the



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1        applicant that information is missing or not complete.
2            (D) On or before January 1, 2019, triage new
3        applications and backlogged applications to identify
4        applicants who had full Medicaid benefits in the
5        community for a period of 6 months or more immediately
6        before entering the long-term care facility.
7    (b) The Department shall, on or before July 1, 2014, assess
8the feasibility of incorporating all information needed to
9determine eligibility for long-term care services, including
10asset transfer and spousal impoverishment financials, into the
11State's integrated eligibility system identifying all
12resources needed and reasonable timeframes for achieving the
13specified integration.
14    (c) The Department of Healthcare and Family Services lead
15agency shall file a report with the 4 legislative leaders no
16later than January 1, 2019, and every January 1 thereafter,
17describing what each agency had accomplished in the preceding
18year to: reduce the backlog of Medicaid and long-term care
19benefits applications and redeterminations, reduce initial
20application processing to the federal timeframe, and eliminate
21the occurrence of hospital patients being discharged prior to
22the completion of preadmission screens. interim reports with
23the Chairs and Minority Spokespersons of the House and Senate
24Human Services Committees no later than September 1, 2013 and
25on February 1, 2014. The Department of Healthcare and Family
26Services shall include in the annual Medicaid report for State



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1Fiscal Year 2014 and every fiscal year thereafter information
2concerning implementation of the provisions of this Section.
3    (d) (Blank). No later than August 1, 2014, the Auditor
4General shall report to the General Assembly concerning the
5extent to which the timeframes specified in this Section have
6been met and the extent to which State staffing levels are
7adequate to meet the requirements of this Section.
8    (e) The Department of Healthcare and Family Services, the
9Department of Human Services, and the Department on Aging shall
10take all necessary the following steps to achieve federally
11established timeframes for eligibility determinations for
12Medicaid and long-term care benefits, including, but not
13limited to, implementing policies and adopting rules to
14simplify financial eligibility verification, including, but
15not limited to, the following instances: and shall work toward
16the federal goal of real time determinations:
17        (1) (Blank). The Departments shall review, in
18    collaboration with representatives of affected providers,
19    all forms and procedures currently in use, federal
20    guidelines either suggested or mandated, and staff
21    deployment by September 30, 2014 to identify additional
22    measures that can improve long-term care eligibility
23    processing and make adjustments where possible.
24        (2) (Blank). No later than June 30, 2014, the
25    Department of Healthcare and Family Services shall issue
26    vouchers for advance payments not to exceed $50,000,000 to



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1    nursing facilities with significant outstanding Medicaid
2    liability associated with services provided to residents
3    with Medicaid applications pending and residents facing
4    the greatest delays. Each facility with an advance payment
5    shall state in writing whether its own recoupment schedule
6    will be in 3 or 6 equal monthly installments, as long as
7    all advances are recouped by June 30, 2015.
8        (3) (Blank). The Department of Healthcare and Family
9    Services' Office of Inspector General and the Department of
10    Human Services shall immediately forgo resource review and
11    review of transfers during the relevant look-back period
12    for applications that were submitted prior to September 1,
13    2013. An applicant who applied prior to September 1, 2013,
14    who was denied for failure to cooperate in providing
15    required information, and whose application was
16    incorrectly reviewed under the wrong look-back period
17    rules may request review and correction of the denial based
18    on this subsection. If found eligible upon review, such
19    applicants shall be retroactively enrolled.
20        (4) As soon as practicable, the Department of
21    Healthcare and Family Services shall implement policies
22    and promulgate rules to simplify financial eligibility
23    verification in the following instances: (A) for
24    applicants or recipients who are receiving Supplemental
25    Security Income payments or who had been receiving such
26    payments at the time they were admitted to a nursing



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1    facility, and (B) for applicants or recipients with
2    verified income at or below 100% of the federal poverty
3    level when the declared value of their countable resources
4    is no greater than the allowable amounts pursuant to
5    Section 5-2 of this Code for classes of eligible persons
6    for whom a resource limit applies, (C) for applicants who
7    have had a full Medicaid case active in the community for 6
8    or more months prior to entering the long-term care
9    facility and who have not transferred assets during the
10    preceding 60 months, regardless of the age of the
11    application.
12        The provisions of this subsection (e) . Such simplified
13    verification policies shall apply to community cases as
14    well as long-term care cases. Rules, policies, and
15    procedures adopted to implement this subsection shall be
16    liberally construed to effectuate the stated purpose of
17    this subsection.
18        (5) As soon as practicable, but not later than July 1,
19    2014, the Department of Healthcare and Family Services and
20    the Department of Human Services shall jointly investigate
21    the public-private partnerships in use in Ohio, Michigan,
22    and Minnesota that are aimed at redeploying caseworkers to
23    targeted high-Medicaid facilities for the purpose of
24    expediting initial Medicaid and long-term care benefits
25    applications, redeterminations, asset discovery, and all
26    other things related to enrollment, reimbursement, and



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1    application processing. No later than January 1, 2019, the
2    Department of Healthcare and Family Services shall post the
3    agencies' joint recommendations on the web pages of the
4    Department's website that contain information on long-term
5    care benefits and shall assist provider groups in educating
6    their members on the public-private partnerships. begin a
7    special enrollment project by using simplified eligibility
8    verification policies and by redeploying caseworkers
9    trained to handle long-term care cases to prioritize those
10    cases, until the backlog is eliminated and processing time
11    is within 90 days. This project shall apply to applications
12    for long-term care received by the State on or before May
13    15, 2014.
14        (6) As soon as practicable, but not later than March 1,
15    2019, September 1, 2014, the Department on Aging shall
16    establish an online Health Insurance Portability and
17    Accountability Act compliant database that allows make
18    available to long-term care facilities and community
19    providers to access upon request, through an electronic
20    method, the information contained within the Interagency
21    Certification of Screening Results completed by the
22    pre-screener, in a form and manner acceptable to the
23    Department of Human Services.
24        (6.5) No later than March 1, 2019, the Department on
25    Aging shall initiate a public-private partnership with
26    hospitals enrolled in the State's Medicaid program to train



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1    discharge planners to perform preadmission screenings on
2    patients in need of long-term care placements or home and
3    community based services. Upon successfully completing the
4    Department's training course, the discharge planner shall
5    be certified to perform preadmission screens and the
6    hospital shall be offered a contract to administer the
7    screens before the patient is discharged. The Department on
8    Aging shall report to the Governor and the 4 legislative
9    leaders on the number of hospitals participating in the
10    public-private partnership, the number of trained
11    discharge planners, and the number of patients transferred
12    to nursing homes prior to a screening being completed
13    within 90 days of the project being initiated and every 90
14    days thereafter until such time as the number of patients
15    transferred without screens is reduced to zero and then
16    annually thereafter.
17        (7) Effective 30 days after the completion of 3
18    regionally based trainings, nursing facilities shall
19    submit all applications for medical assistance online via
20    the Application for Benefits Eligibility (ABE) website.
21    This requirement shall extend to scanning and uploading
22    with the online application any required additional forms
23    such as the Long Term Care Facility Notification and the
24    Additional Financial Information for Long Term Care
25    Applicants as well as scanned copies of any supporting
26    documentation. Long-term care facility admission documents



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1    must be submitted as required in Section 5-5 of this Code.
2    No local Department of Human Services office shall refuse
3    to accept an electronically filed application.
4        (7.5) As part of a public-private partnership with
5    long-term care provider associations, the Department shall
6    offer regionally based training as upgrades to the
7    Application for Benefits Eligibility website are
8    operationalized. The training shall be recorded and posted
9    on the Department's website to allow new employees to be
10    trained and older employers to complete refresher courses.
11        (8) Notwithstanding any other provision of this Code,
12    the Department of Human Services and the Department of
13    Healthcare and Family Services' Office of the Inspector
14    General shall, upon request, allow an applicant additional
15    time to submit information and documents needed as part of
16    a review of available resources or resources transferred
17    during the look-back period. The initial extension shall
18    not exceed 30 days. A second extension of 30 days may be
19    granted upon request. Any request for information issued by
20    the State to an applicant shall include the following: an
21    explanation of the information required and the date by
22    which the information must be submitted; a statement that
23    failure to respond in a timely manner can result in denial
24    of the application; a statement that the applicant or the
25    facility in the name of the applicant may seek an
26    extension; and the name and contact information of a



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1    caseworker in case of questions. Any such request for
2    information shall also be sent to the facility. In deciding
3    whether to grant an extension, the Department of Human
4    Services or the Department of Healthcare and Family
5    Services' Office of the Inspector General shall take into
6    account what is in the best interest of the applicant. The
7    time limits for processing an application shall be tolled
8    during the period of any extension granted under this
9    subsection.
10        (9) The Department of Human Services and the Department
11    of Healthcare and Family Services must jointly compile data
12    on pending applications, denials, appeals, and
13    redeterminations into a monthly report, which shall be
14    posted on each Department's website for the purposes of
15    monitoring long-term care eligibility processing. The
16    report must specify the number of applications and
17    redeterminations pending long-term care eligibility
18    determination and admission and the number of appeals of
19    denials in the following categories:
20            (A) Length of time applications, redeterminations,
21        and appeals are pending - 0 to 45 days, 46 days to 90
22        days, 91 days to 180 days, 181 days to 12 months, over
23        12 months to 18 months, over 18 months to 24 months,
24        and over 24 months.
25            (B) Percentage of applications and
26        redeterminations pending in the Department of Human



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1        Services' Family Community Resource Centers, in the
2        Department of Human Services' long-term care hubs,
3        with the Department of Healthcare and Family Services'
4        Office of Inspector General, and those applications
5        which are being tolled due to requests for extension of
6        time for additional information.
7            (C) Status of pending applications, denials,
8        appeals, and redeterminations.
9    (f) Beginning on July 1, 2017, the Auditor General shall
10report every 3 years to the General Assembly on the performance
11and compliance of the Department of Healthcare and Family
12Services, the Department of Human Services, and the Department
13on Aging in meeting the requirements of this Section and the
14federal requirements concerning eligibility determinations for
15Medicaid long-term care services and supports, and shall report
16any issues or deficiencies and make recommendations. The
17Auditor General shall, at a minimum, review, consider, and
18evaluate the following:
19        (1) compliance with federal regulations on furnishing
20    services as related to Medicaid long-term care services and
21    supports as provided under 42 CFR 435.930;
22        (2) compliance with federal regulations on the timely
23    determination of eligibility as provided under 42 CFR
24    435.912;
25        (3) the accuracy and completeness of the report
26    required under paragraph (9) of subsection (e);



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1        (4) the efficacy and efficiency of the task-based
2    process used for making eligibility determinations in the
3    centralized offices of the Department of Human Services for
4    long-term care services, including the role of the State's
5    integrated eligibility system, as opposed to the
6    traditional caseworker-specific process from which these
7    central offices have converted; and
8        (5) any issues affecting eligibility determinations
9    related to the Department of Human Services' staff
10    completing Medicaid eligibility determinations instead of
11    the designated single-state Medicaid agency in Illinois,
12    the Department of Healthcare and Family Services.
13    The Auditor General's report shall include any and all
14other areas or issues which are identified through an annual
15review. Paragraphs (1) through (5) of this subsection shall not
16be construed to limit the scope of the annual review and the
17Auditor General's authority to thoroughly and completely
18evaluate any and all processes, policies, and procedures
19concerning compliance with federal and State law requirements
20on eligibility determinations for Medicaid long-term care
21services and supports.
22(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
23    Section 99. Effective date. This Act takes effect upon
24becoming law.