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



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1    exceptional care services; and
2        (6) 45 calendar days after a resident's need for
3    services requiring reimbursement under the ventilator or
4    traumatic brain injury enhanced rate.
5    (305 ILCS 5/11-5.4)
6    Sec. 11-5.4. Expedited long-term care eligibility
7determination and enrollment.
8    (a) Establishment of the expedited long-term care
9eligibility determination and enrollment system shall be a
10joint venture of the Departments of Human Services and
11Healthcare and Family Services and the Department on Aging. An
12expedited long-term care eligibility determination and
13enrollment system shall be established to reduce long-term care
14determinations to 90 days or fewer by July 1, 2014 and
15streamline the long-term care enrollment process.
16Establishment of the system shall be a joint venture of the
17Department of Human Services and Healthcare and Family Services
18and the Department on Aging. The Governor shall name a lead
19agency no later than 30 days after the effective date of this
20amendatory Act of the 98th General Assembly to assume
21responsibility for the full implementation of the
22establishment and maintenance of the system. Project outcomes
23shall include an enhanced eligibility determination tracking
24system accessible to providers and a centralized application
25review and eligibility determination with all applicants



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1reviewed within 90 days of receipt by the State of a complete
2application. If the Department of Healthcare and Family
3Services' Office of the Inspector General determines that there
4is a likelihood that a non-allowable transfer of assets has
5occurred, and the facility in which the applicant resides is
6notified, an extension of up to 90 days shall be permissible.
7    (b) Streamlined application enrollment process; expedited
8eligibility process. The streamlined application and
9enrollment process must include, but need not be limited to,
10the following:
11        (1) On or before July 1, 2019, December 31, 2015, a
12    streamlined application and enrollment process shall be
13    put in place which must include, but need not be limited
14    to, the following: based on the following principles:
15            (A) (1) Minimize the burden on applicants by
16        collecting only the data necessary to determine
17        eligibility for medical services, long-term care
18        services, and spousal impoverishment offset.
19            (B) (2) Integrate online data sources to simplify
20        the application process by reducing the amount of
21        information needed to be entered and to expedite
22        eligibility verification.
23            (C) (3) Provide online prompts to alert the
24        applicant that information is missing or not complete.
25            (D) Provide training and step-by-step written
26        instructions for caseworkers, applicants, and



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1        providers.
2        (2) The State must expedite the eligibility process for
3    applicants meeting specified guidelines, regardless of the
4    age of the application. The guidelines, subject to federal
5    approval, must include, but need not be limited to, the
6    following individually or collectively:
7            (A) Full Medicaid benefits in the community for a
8        specified period of time.
9            (B) No transfer of assets or resources during the
10        federally prescribed look-back period, as specified in
11        federal law.
12            (C) Receives Supplemental Security Income payments
13        or was receiving such payments at the time of admission
14        to a nursing facility.
15            (D) For applicants or recipients with verified
16        income at or below 100% of the federal poverty level
17        when the declared value of their countable resources is
18        no greater than the allowable amounts pursuant to
19        Section 5-2 of this Code for classes of eligible
20        persons for whom a resource limit applies. Such
21        simplified verification policies shall apply to
22        community cases as well as long-term care cases.
23        (3) Subject to federal approval, the Department of
24    Healthcare and Family Services must implement an ex parte
25    renewal process for Medicaid-eligible individuals residing
26    in long-term care facilities. "Renewal" has the same



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1    meaning as "redetermination" in State policies,
2    administrative rule, and federal Medicaid law. The ex parte
3    renewal process must be fully operational on or before
4    January 1, 2019.
5        (4) The Department of Human Services must use the
6    standards and distribution requirements described in this
7    subsection and in Section 11-6 for notification of missing
8    supporting documents and information during all phases of
9    the application process: initial, renewal, and appeal.
10    (c) The Department of Human Services must adopt policies
11and procedures to improve communication between long-term care
12benefits central office personnel, applicants and their
13representatives, and facilities in which the applicants
14reside. Such policies and procedures must at a minimum permit
15applicants and their representatives and the facility in which
16the applicants reside to speak directly to an individual
17trained to take telephone inquiries and provide appropriate
19    (b) The Department shall, on or before July 1, 2014, assess
20the feasibility of incorporating all information needed to
21determine eligibility for long-term care services, including
22asset transfer and spousal impoverishment financials, into the
23State's integrated eligibility system identifying all
24resources needed and reasonable timeframes for achieving the
25specified integration.
26    (c) The lead agency shall file interim reports with the



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1Chairs and Minority Spokespersons of the House and Senate Human
2Services Committees no later than September 1, 2013 and on
3February 1, 2014. The Department of Healthcare and Family
4Services shall include in the annual Medicaid report for State
5Fiscal Year 2014 and every fiscal year thereafter information
6concerning implementation of the provisions of this Section.
7    (d) No later than August 1, 2014, the Auditor General shall
8report to the General Assembly concerning the extent to which
9the timeframes specified in this Section have been met and the
10extent to which State staffing levels are adequate to meet the
11requirements of this Section.
12    (e) The Department of Healthcare and Family Services, the
13Department of Human Services, and the Department on Aging shall
14take the following steps to achieve federally established
15timeframes for eligibility determinations for Medicaid and
16long-term care benefits and shall work toward the federal goal
17of real time determinations:
18        (1) The Departments shall review, in collaboration
19    with representatives of affected providers, all forms and
20    procedures currently in use, federal guidelines either
21    suggested or mandated, and staff deployment by September
22    30, 2014 to identify additional measures that can improve
23    long-term care eligibility processing and make adjustments
24    where possible.
25        (2) No later than June 30, 2014, the Department of
26    Healthcare and Family Services shall issue vouchers for



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1    advance payments not to exceed $50,000,000 to nursing
2    facilities with significant outstanding Medicaid liability
3    associated with services provided to residents with
4    Medicaid applications pending and residents facing the
5    greatest delays. Each facility with an advance payment
6    shall state in writing whether its own recoupment schedule
7    will be in 3 or 6 equal monthly installments, as long as
8    all advances are recouped by June 30, 2015.
9        (3) The Department of Healthcare and Family Services'
10    Office of Inspector General and the Department of Human
11    Services shall immediately forgo resource review and
12    review of transfers during the relevant look-back period
13    for applications that were submitted prior to September 1,
14    2013. An applicant who applied prior to September 1, 2013,
15    who was denied for failure to cooperate in providing
16    required information, and whose application was
17    incorrectly reviewed under the wrong look-back period
18    rules may request review and correction of the denial based
19    on this subsection. If found eligible upon review, such
20    applicants shall be retroactively enrolled.
21        (4) As soon as practicable, the Department of
22    Healthcare and Family Services shall implement policies
23    and promulgate rules to simplify financial eligibility
24    verification in the following instances: (A) for
25    applicants or recipients who are receiving Supplemental
26    Security Income payments or who had been receiving such



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1    payments at the time they were admitted to a nursing
2    facility and (B) for applicants or recipients with verified
3    income at or below 100% of the federal poverty level when
4    the declared value of their countable resources is no
5    greater than the allowable amounts pursuant to Section 5-2
6    of this Code for classes of eligible persons for whom a
7    resource limit applies. Such simplified verification
8    policies shall apply to community cases as well as
9    long-term care cases.
10        (5) As soon as practicable, but not later than July 1,
11    2014, the Department of Healthcare and Family Services and
12    the Department of Human Services shall jointly begin a
13    special enrollment project by using simplified eligibility
14    verification policies and by redeploying caseworkers
15    trained to handle long-term care cases to prioritize those
16    cases, until the backlog is eliminated and processing time
17    is within 90 days. This project shall apply to applications
18    for long-term care received by the State on or before May
19    15, 2014.
20        (6) As soon as practicable, but not later than
21    September 1, 2014, the Department on Aging shall make
22    available to long-term care facilities and community
23    providers upon request, through an electronic method, the
24    information contained within the Interagency Certification
25    of Screening Results completed by the pre-screener, in a
26    form and manner acceptable to the Department of Human



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1    Services.
2    (d) (7) Effective 30 days after the completion of 3
3regionally based trainings, nursing facilities shall submit
4all applications for medical assistance online via the
5Application for Benefits Eligibility (ABE) website. This
6requirement shall extend to scanning and uploading with the
7online application any required additional forms such as the
8Long Term Care Facility Notification and the Additional
9Financial Information for Long Term Care Applicants as well as
10scanned copies of any supporting documentation. Long-term care
11facility admission documents must be submitted as required in
12Section 5-5 of this Code. No local Department of Human Services
13office shall refuse to accept an electronically filed
14application. No Department of Human Services office shall
15request submission of any document in hard copy.
16    (e) (8) Notwithstanding any other provision of this Code,
17the Department of Human Services and the Department of
18Healthcare and Family Services' Office of the Inspector General
19shall, upon request, allow an applicant additional time to
20submit information and documents needed as part of a review of
21available resources or resources transferred during the
22look-back period. The initial extension shall not exceed 30
23days. A second extension of 30 days may be granted upon
24request. Any request for information issued by the State to an
25applicant shall include the following: an explanation of the
26information required and the date by which the information must



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



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



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1    required under paragraph (9) of subsection (e);
2        (4) the efficacy and efficiency of the task-based
3    process used for making eligibility determinations in the
4    centralized offices of the Department of Human Services for
5    long-term care services, including the role of the State's
6    integrated eligibility system, as opposed to the
7    traditional caseworker-specific process from which these
8    central offices have converted; and
9        (5) any issues affecting eligibility determinations
10    related to the Department of Human Services' staff
11    completing Medicaid eligibility determinations instead of
12    the designated single-state Medicaid agency in Illinois,
13    the Department of Healthcare and Family Services.
14    The Auditor General's report shall include any and all
15other areas or issues which are identified through an annual
16review. Paragraphs (1) through (5) of this subsection shall not
17be construed to limit the scope of the annual review and the
18Auditor General's authority to thoroughly and completely
19evaluate any and all processes, policies, and procedures
20concerning compliance with federal and State law requirements
21on eligibility determinations for Medicaid long-term care
22services and supports.
23    (h) The Department of Healthcare and Family Services shall
24adopt any rules necessary to administer and enforce any
25provision of this Section. Rulemaking shall not delay the full
26implementation of this Section.



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1(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
2    (305 ILCS 5/11-6)  (from Ch. 23, par. 11-6)
3    Sec. 11-6. Decisions on applications. Within 10 days after
4a decision is reached on an application, the applicant shall be
5notified in writing of the decision. If the applicant resides
6in a facility licensed under the Nursing Home Care Act or a
7supportive living facility authorized under Section 5-5.01a,
8the facility shall also receive written notice of the decision,
9provided that the notification is related to a Department
10payment for services received by the applicant in the facility.
11Only facilities enrolled in and subject to a provider agreement
12under the medical assistance program under Article V may
13receive such notices of decisions. The Department shall
14consider eligibility for, and the notice shall contain a
15decision on, each of the following assistance programs for
16which the client may be eligible based on the information
17contained in the application: Temporary Assistance for to Needy
18Families, Medical Assistance, Aid to the Aged, Blind and
19Disabled, General Assistance (in the City of Chicago), and food
20stamps. No decision shall be required for any assistance
21program for which the applicant has expressly declined in
22writing to apply. If the applicant is determined to be
23eligible, the notice shall include a statement of the amount of
24financial aid to be provided and a statement of the reasons for
25any partial grant amounts. If the applicant is determined



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1ineligible for any public assistance the notice shall include
2the reason why the applicant is ineligible. If the application
3for any public assistance is denied, the notice shall include a
4statement defining the applicant's right to appeal the
5decision. The Illinois Department, by rule, shall determine the
6date on which assistance shall begin for applicants determined
7eligible. That date may be no later than 30 days after the date
8of the application.
9    Under no circumstances may any application be denied solely
10to meet an application-processing deadline. As used in this
11Section, "application" also refers to requests for admission
12approval to facilities licensed under the Nursing Home Care Act
13or to supportive living facilities authorized under Section
15(Source: P.A. 96-206, eff. 1-1-10; revised 10-4-17.)
16    Section 99. Effective date. This Act takes effect upon
17becoming law.