Rep. Kathleen Willis

Filed: 3/25/2019

 

 


 

 


 
10100HB2353ham001LRB101 08329 KTG 57388 a

1
AMENDMENT TO HOUSE BILL 2353

2    AMENDMENT NO. ______. Amend House Bill 2353 by replacing
3everything after the enacting clause with the following:
 
4    "Section 1. Short title. This Act may be referred to as the
5Medicaid Eligibility Determination and Renewal Reform Act.
 
6    Section 5. Purpose. The processes currently in place for
7eligibility determination and renewal (also known as
8redetermination) under the State's medical assistance programs
9lead to delayed access to benefits, disruptions in care
10delivery, decreased quality of care, waste in spending on
11unnecessary administrative costs, and worse overall health and
12well-being for enrollees. To improve continuity of care for
13beneficiaries and remedy significant administrative
14challenges, to the benefit of both the State and beneficiaries,
15this Act implements improvements and efficiencies to increase
16accountability and transparency, minimize delay and procedural

 

 

10100HB2353ham001- 2 -LRB101 08329 KTG 57388 a

1terminations, and improve the overall integrity of the State's
2medical assistance programs.
 
3    Section 10. Medicaid eligibility determination and renewal
4goals.
5    (a) The Department of Healthcare and Family Services shall
6work with the Department of Human Services, as well as other
7stakeholders, to achieve the following goals related to
8eligibility determinations and renewals under the Medical
9Assistance Program established under Article V of the Illinois
10Public Aid Code:
11        (1) Reduce procedural terminations under the Medical
12    Assistance Program so that no more than 10% of medical
13    assistance beneficiaries who remain eligible for medical
14    assistance experience any lapse in contemporaneous medical
15    coverage.
16        (2) Use technology to lower administrative burdens and
17    increase beneficiary continuity of coverage by providing
18    real-time eligibility determination decisions under the
19    Medical Assistance Program for at least 75% of all medical
20    assistance applicants, increasing automatic renewals for
21    medical assistance beneficiaries, and offering an
22    electronic means by which a broad array of medical
23    assistance beneficiaries can track and maintain their
24    benefits.
25    (b) The Department of Healthcare and Family Services and

 

 

10100HB2353ham001- 3 -LRB101 08329 KTG 57388 a

1the Department of Human Services shall work together with
2stakeholders, including, but not limited to, beneficiaries of
3medical assistance, consumer advocates, governmental staff,
4provider, and managed care organizations, to achieve the goals
5described in subsection (a) by December 31, 2020. The
6Department of Healthcare and Family Services shall provide a
7report to the General Assembly on the Department's progress
8toward achieving those goals by December 31, 2019. The report
9shall be posted on the Department of Healthcare and Family
10Services' website and shall describe the policy changes the
11Department has made, any challenges the Department has faced,
12the Department's plan to achieve the goals by the deadline, and
13the current rate of procedural termination, data-driven
14renewals, and electronic portal use.
 
15    Section 15. Express lane eligibility State Plan amendment;
16implementation timeline.
17    (a) As used in this Section:
18        "CHIP" means the Children's Health Insurance Program
19    established under the Children's Health Insurance Program
20    Act.
21        "Medicaid" means medical assistance authorized under
22    Section 1902 of the Social Security Act.    
23    (b) Federal approval for express lane eligibility. The
24Department of Healthcare and Family Services shall submit
25Medicaid and CHIP State Plan amendments to the federal Centers

 

 

10100HB2353ham001- 4 -LRB101 08329 KTG 57388 a

1for Medicare and Medicaid Services to implement express lane
2eligibility for all Medicaid and CHIP beneficiaries as
3permitted by Section 203 of the Children's Health Insurance
4Program Reauthorization Act of 2009 (Public Law 111-3), no
5later than 90 days after the effective date of this Act. The
6Department of Healthcare and Family Services shall cooperate
7with the federal Centers for Medicare and Medicaid Services to
8obtain approval, if necessary, to implement an express lane
9eligibility option to ensure that children eligible for
10Medicaid or CHIP have a fast and simplified process for having
11their eligibility determined or renewed to facilitate
12enrollment in Medicaid and CHIP.
13    (c) Content of State Plan amendment. At a minimum, the
14State Plan amendment shall specify that express lane
15eligibility shall apply to all Medicaid and CHIP beneficiaries.
16If federal approval is granted, the Department of Healthcare
17and Family Services shall seek an 1115 waiver to apply the
18express lane eligibility option to beneficiaries age 21 or
19older no later than 90 days after approval. The State Plan
20amendment shall identify, at a minimum, the Supplemental
21Nutrition Assistance Program as its express lane agency. The
22State Plan amendment shall also specify that the express lane
23eligibility option will be used for both applications and
24renewals. The Department of Healthcare and Family Services may
25select more than one express lane agency, consistent with the
26Centers for Medicare and Medicaid Services' rules governing

 

 

10100HB2353ham001- 5 -LRB101 08329 KTG 57388 a

1express lane eligibility. The Department of Healthcare and
2Family Services may also elect to obtain and use information
3directly from State income tax records or returns, consistent
4with the Centers for Medicare and Medicaid Services' rules
5governing express lane eligibility.
6    (d) Implementation. After the Department of Healthcare and
7Family Services secures federal approval (if required) from the
8Centers for Medicare and Medicaid Services, the Department
9shall implement express lane eligibility within 90 days after
10the date of federal approval.
 
11    Section 20. Reinstatement upon renewal.
12    (a) If an individual who failed to cooperate during the
13renewal process cooperates and submits all required
14verifications prior to the end of the third month (or 90 days
15if longer) following the last day of coverage, and the case
16remains eligible, the Department of Healthcare and Family
17Services shall restore assistance immediately, with no loss of
18coverage and back to the date of cancellation, without
19requiring a new application from the individual. In restoring
20assistance, the Department shall act to ensure that an eligible
21individual has the shortest time possible, if any, when his or
22her case shows as inactive to providers. Retroactive coverage
23alone does not satisfy the objective of this Section if
24eligible individuals still experience real-time periods of an
25inactive case.

 

 

10100HB2353ham001- 6 -LRB101 08329 KTG 57388 a

1    (b) Individuals who are reinstated and who are enrolled in
2a managed care organization prior to initial cancellation of
3coverage shall be reinstated to the same managed care
4organization, regardless of when the individual's coverage is
5reinstated, and the annual HealthChoice Illinois open
6enrollment period for the individual shall remain the same.
7Managed care organizations shall be paid the appropriate per
8member per month payment retroactively for reinstated members.
9    (c) Providers serving individuals in the State's
10fee-for-service system may submit prior approval requests to
11the Department of Healthcare and Family Services for review and
12retroactive processing for medical assistance provided during
13the reinstatement period. Providers serving individuals
14enrolled in managed care may have their prior approval requests
15submitted and processed retroactively for medical assistance
16provided during the reinstatement period, provided that
17appropriate member attribution and associated payment are also
18made to the managed care organization for the reinstated
19coverage period.
 
20    Section 25. Community-based enrollment and redetermination
21assistance.
22    (a) The Department of Healthcare and Family Services shall
23create and support agency-associated permission and enhanced
24user permission within the Department's integrated eligibility
25system to provide authorized access to client cases to better

 

 

10100HB2353ham001- 7 -LRB101 08329 KTG 57388 a

1enable providers and community-based organizations to support
2applicants and clients enrolling in, renewing, or otherwise
3maintaining their benefits.
4    (b) Creation of agency-associated permission.
5        (1) The Department of Healthcare and Family Services
6    shall authorize, create, support, and administer a process
7    by which a provider or community-based organization can
8    access each client case that is associated with that
9    provider or community-based organization in the
10    Department's integrated eligibility system for each
11    client, provider, and community-based organization that
12    seeks such access, and cooperates with the Department's
13    screening, training, and security protocols. Such access
14    shall enable the provider or community-based organization
15    to assist its clients with their benefits cases.
16        (2) A client must authorize the Department of
17    Healthcare and Family Services to associate his or her case
18    with one or more particular providers or community-based
19    organizations before the provider or organization may
20    access the client's case. Such authorization must be given
21    in writing and may be revoked in writing by the client,
22    provider, or community-based organization at any time. The
23    permission to access the case shall be granted to the
24    provider or community-based organization as a whole and not
25    specific to any particular employee or staff member. The
26    Department of Healthcare and Family Services shall process

 

 

10100HB2353ham001- 8 -LRB101 08329 KTG 57388 a

1    all requests to associate a case or revoke an association
2    with particular providers or community-based organizations
3    promptly.
4        (3) For each provider and community-based organization
5    that seeks such access, the Department of Healthcare and
6    Family Services shall authorize and create
7    agency-associated permission within the Department's
8    integrated eligibility system to view the specific case for
9    each client associated with the provider or
10    community-based organization. This agency-associated
11    permission shall permit staff authorized by the provider or
12    community-based organization to access and interact with
13    all client cases associated with the provider or
14    community-based organization in ways that are otherwise
15    accessible to the client. The provider or community-based
16    organization shall identify and supervise authorized
17    staff. Such agency-associated permission shall enable the
18    provider or community-based organization to access all
19    client-facing aspects of the case for each client
20    associated with the provider or community-based
21    organization who has authorized such access.
22        (4) The Department of Healthcare and Family Services
23    shall ensure that the provider or community-based
24    organization has been granted permission within the
25    Department's integrated eligibility system (or other
26    electronic systems) to receive and view notifications and

 

 

10100HB2353ham001- 9 -LRB101 08329 KTG 57388 a

1    alerts for all associated client cases, and to perform
2    certain actions in associated client cases. Permitted
3    actions shall include, but are not limited to: (i) viewing
4    notifications, (ii) uploading documentation such as
5    spend-down verifications and renewal forms, and (iii)
6    initiating contact with and continuing communication with
7    Department staff.
8    (c) Administration of agency-associated permission.
9        (1) The Department of Healthcare and Family Services
10    shall develop criteria and policies for granting
11    permission to providers and community-based organizations
12    that seek agency-associated permission.
13        (2) The Department of Healthcare and Family Services
14    shall create criteria and policies to ensure that
15    agency-associated permission is granted only for accounts
16    where the authorized user has agreed to (i) obtain the
17    written consent of the individual, (ii) act in the best
18    interest of the individual, (iii) maintain the integrity of
19    the Department's programs, and (iv) act in compliance with
20    applicable State and federal law.
21        (3) Agency-associated permission shall be authorized
22    by the Department of Healthcare and Family Services in
23    accordance with the criteria and policies to be developed
24    by the Department under this Act.
25        (4) The Department of Healthcare and Family Services
26    shall not unreasonably restrict or limit agency-associated

 

 

10100HB2353ham001- 10 -LRB101 08329 KTG 57388 a

1    permission.
2    (d) Creation of enhanced user permission.
3        (1) The Department of Healthcare and Family Services
4    shall authorize, create, support, and administer an
5    enhanced user permission under which particular
6    individuals have authority to manually verify information
7    and work around error messages in the Department's
8    integrated eligibility system. Individuals who are
9    associated with navigators, providers, or community-based
10    organizations may apply for such access, and the Department
11    shall grant enhanced user permission in compliance with
12    this Section to those who cooperate with the Department's
13    screening, training, and security protocols.
14        (2) Enhanced user permissions shall permit individuals
15    to work in the integrated eligibility system with enhanced
16    permissions beyond the consumer-facing portal. Such
17    enhanced permissions shall include, but not be limited to,
18    addressing common challenges, including (i) resolving
19    common error codes, (ii) manually verifying data in the
20    integrated eligibility system, and (iii) performing
21    identity verification for the purposes of eligibility
22    determination in accordance with requirements set forth by
23    State and federal law. Nothing in this Act shall be
24    interpreted as changing program eligibility or renewal
25    criteria.
26    (e) Administration of enhanced user permission.

 

 

10100HB2353ham001- 11 -LRB101 08329 KTG 57388 a

1        (1) Providers and community-based organizations shall
2    nominate and supervise individual staff that serve as
3    assisters, navigators, or who are otherwise proficient
4    with Manage My Case to be granted enhanced user permissions
5    by the Department of Healthcare and Family Services.
6        (2) The Department of Healthcare and Family Services
7    shall develop criteria and policies for granting enhanced
8    user permission.
9        (3) The Department of Healthcare and Family Services
10    shall provide support and training to individuals granted
11    enhanced user permission.
12        (4) The Department of Healthcare and Family Services
13    shall maintain and publish online a list of providers and
14    community-based organizations that employ staff who have
15    been granted enhanced user permission, to help individuals
16    and families looking for assistance enrolling in and
17    maintaining benefits.
18        (5) The Department of Healthcare and Family Services
19    shall create criteria and policies to ensure that
20    individuals with enhanced user permission agree to (i)
21    obtain the written consent of the individual, (ii) act in
22    the best interest of the individual, (iii) maintain the
23    integrity of the Department's programs, and (iv) act in
24    compliance with applicable State and federal law.
25        (6) Enhanced user permission shall be authorized by the
26    Department of Healthcare and Family Services in accordance

 

 

10100HB2353ham001- 12 -LRB101 08329 KTG 57388 a

1    with the criteria and policies to be developed by the
2    Department under this Act.
3        (7) The Department of Healthcare and Family Services
4    shall not unreasonably restrict or limit enhanced user
5    permission.
 
6    Section 30. The Department shall adopt any rules or
7policies necessary to implement this Act.
 
8    Section 35. The Illinois Public Aid Code is amended by
9changing Section 11-5.2 as follows:
 
10    (305 ILCS 5/11-5.2)
11    Sec. 11-5.2. Income, Residency, and Identity Verification
12System.
13    (a) The Department shall ensure that its proposed
14integrated eligibility system shall include the computerized
15functions of income, residency, and identity eligibility
16verification to verify eligibility, eliminate duplication of
17medical assistance, and deter fraud, reduce administrative
18burdens on the Department and the applicant or recipient, and
19minimize delay. Until the integrated eligibility system is
20operational, the Department may enter into a contract with the
21vendor selected pursuant to Section 11-5.3 as necessary to
22obtain the electronic data matching described in this Section.
23This contract shall be exempt from the Illinois Procurement

 

 

10100HB2353ham001- 13 -LRB101 08329 KTG 57388 a

1Code pursuant to subsection (h) of Section 1-10 of that Code.
2    (b) Prior to awarding medical assistance at application
3under Article V of this Code, the Department shall, to the
4extent such databases are available to the Department, conduct
5data matches using the name, date of birth, address, and Social
6Security Number of each applicant or recipient or responsible
7relative of an applicant or recipient through one or more
8federal or State electronic data sources including against the
9following:
10        (1) Income tax information.
11        (2) Employer reports of income and unemployment
12    insurance payment information maintained by the Department
13    of Employment Security.
14        (3) Earned and unearned income, citizenship and death,
15    and other relevant information maintained by the Social
16    Security Administration.
17        (4) Immigration status information maintained by the
18    United States Citizenship and Immigration Services.
19        (5) Wage reporting and similar information maintained
20    by states contiguous to this State.
21        (6) Employment information maintained by the
22    Department of Employment Security in its New Hire Directory
23    database.
24        (7) Employment information maintained by the United
25    States Department of Health and Human Services in its
26    National Directory of New Hires database.

 

 

10100HB2353ham001- 14 -LRB101 08329 KTG 57388 a

1        (8) Veterans' benefits information maintained by the
2    United States Department of Health and Human Services, in
3    coordination with the Department of Health and Human
4    Services and the Department of Veterans' Affairs, in the
5    federal Public Assistance Reporting Information System
6    (PARIS) database.
7        (9) Residency information maintained by the Illinois
8    Secretary of State.
9        (10) A database which is substantially similar to or a
10    successor of a database described in this Section that
11    contains information relevant for verifying eligibility
12    for medical assistance.
13    (c) (Blank).
14    (c-5) Financial information shall be data matched by first
15using the electronic data source with the most recent data. The
16most recent data source shall be accepted as a reliable
17electronic data source for determining reasonable
18compatibility with the applicant's or recipient's attestation
19or records. The Department may use a less recent data source
20only if it will maximize accuracy, minimize delay, and meet
21other applicable requirements.
22    (d) If information provided by or on behalf of an
23individual (on the application or renewal form or otherwise) is
24reasonably compatible with the information obtained by the
25Department in accordance with subsection (b), the Department
26must determine or renew eligibility based on such information

 

 

10100HB2353ham001- 15 -LRB101 08329 KTG 57388 a

1without making additional requests for verification,
2information, or documentation to the individual. "Reasonable
3compatibility" means an allowable difference or discrepancy
4between the income reported by an applicant or recipient and
5the income reported by an electronic data source. a discrepancy
6results between information provided by an applicant,
7recipient, or responsible relative and information contained
8in one or more of the databases or information tools listed
9under subsection (b) of this Section or subsection (c) of
10Section 11-5.3 and that discrepancy calls into question the
11accuracy of information relevant to a condition of eligibility
12provided by the applicant, recipient, or responsible relative,
13the Department or its contractor shall review the applicant's
14or recipient's case using the following procedures:
15        (1) Income information obtained through an electronic
16    data source shall be considered reasonably compatible with
17    income information provided by or on behalf of the
18    individual if both are either above or at or below the
19    applicable income threshold. If the information discovered
20    under subsection (b) of this Section or subsection (c) of
21    Section 11-5.3 does not result in the Department finding
22    the applicant or recipient ineligible for assistance under
23    Article V of this Code, the Department shall finalize the
24    determination or redetermination of eligibility.
25        (1.5) Income information is reasonably compatible if
26    the discrepancy between the information provided by or on

 

 

10100HB2353ham001- 16 -LRB101 08329 KTG 57388 a

1    behalf of the individual is within 10% of the federal
2    poverty level (above or below) of the information from the
3    electronic data source. "Federal poverty level" means the
4    poverty guidelines updated periodically in the Federal
5    Register by the U.S. Department of Health and Human
6    Services. These guidelines set poverty levels by family
7    size.
8        (1.6) The reasonable compatibility standard for
9    financial information shall also be met when the
10    information provided by or on behalf of the individual is
11    zero income or income that is below the program's
12    applicable income standard, or when no income data is
13    available from electronic data sources.
14        (1.7) If information provided by or on behalf of the
15    individual is not reasonably compatible with information
16    obtained through an electronic data match, the Department
17    shall provide written notice to the applicant or recipient
18    which shall describe in sufficient detail the
19    circumstances and sources of the discrepancy, the
20    information or documentation required, the manner in which
21    the applicant or recipient may respond, and the
22    consequences of failing to take action. The applicant or
23    recipient shall have 10 business days to respond.
24        (2) If the information from both the electronic data
25    source and the applicant or recipient discovered results in
26    the Department finding the applicant or recipient

 

 

10100HB2353ham001- 17 -LRB101 08329 KTG 57388 a

1    ineligible for assistance, the Department shall provide
2    notice as set forth in Section 11-7 of this Article.
3        (3) (Blank). If the information discovered is
4    insufficient to determine that the applicant or recipient
5    is eligible or ineligible, the Department shall provide
6    written notice to the applicant or recipient which shall
7    describe in sufficient detail the circumstances of the
8    discrepancy, the information or documentation required,
9    the manner in which the applicant or recipient may respond,
10    and the consequences of failing to take action. The
11    applicant or recipient shall have 10 business days to
12    respond.
13        (4) If the applicant or recipient does not respond to
14    the notice, the Department shall deny assistance for
15    failure to cooperate, in which case the Department shall
16    provide notice as set forth in Section 11-7. Eligibility
17    for assistance shall not be established until the
18    discrepancy has been resolved.
19        (5) If an applicant or recipient responds to the
20    notice, the Department shall determine the effect of the
21    information or documentation provided on the applicant's
22    or recipient's case and shall take appropriate action.
23    Written notice of the Department's action shall be provided
24    as set forth in Section 11-7 of this Article.
25        (6) Suspected cases of fraud shall be referred to the
26    Department's Inspector General.

 

 

10100HB2353ham001- 18 -LRB101 08329 KTG 57388 a

1    (e) Excepting citizenship and satisfactory immigration
2status, the Department may waive its verification requirements
3for exceptional circumstances, including: The Department shall
4adopt any rules necessary to implement this Section.
5        (1) homelessness;
6        (2) domestic violence;
7        (3) instances where a noncustodial parent refuses to
8    release documentation germane to verification of one or
9    more eligibility factors;
10        (4) natural disaster; and
11        (5) other circumstances as identified on a
12    case-by-case basis and approved by the Department,
13    including, but not limited to, when documentation does not
14    exist at the time of application or renewal or is not
15    reasonably available.
16    (f) The Department shall ensure the integrated eligibility
17system shall include an applicant portal that allows electronic
18submission of eligibility documentation, updating of family
19and demographic information, tracking application status, and
20receiving electronic notifications from the Department. The
21Department shall actively promote the use of this portal
22through materials provided at Family and Community Resource
23Centers, staff communications with applicants, and electronic
24and print media. The portal and materials used to promote the
25portal must be available, at a minimum, in English, Spanish,
26and the next 4 most commonly used languages. The portal shall

 

 

10100HB2353ham001- 19 -LRB101 08329 KTG 57388 a

1be available to all applicants and recipients of medical
2assistance provided they satisfy electronic identity
3verification requirements through one of the following
4processes:
5        (1) Providing personally identifying credit history
6    information.
7        (2) Providing requested personally identifying
8    documentation to the Department.
9        (3) Completing an email, text, or mobile phone
10    verification where a message is sent to the email or phone
11    associated with the account and the applicant or recipient
12    must respond to that message.
13        (4) Completing any alternative process developed by
14    the Department for ensuring the electronic security of
15    applicants and recipients.
16    (g) The Department shall adopt any rules necessary to
17implement this Section.
18(Source: P.A. 97-689, eff. 6-14-12; 98-756, eff. 7-16-14.)
 
19    Section 99. Effective date. This Act takes effect upon
20becoming law.".