102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5586

 

Introduced 1/31/2022, by Rep. Camille Y. Lilly

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 105/4.02  from Ch. 23, par. 6104.02
20 ILCS 2405/3  from Ch. 23, par. 3434
305 ILCS 5/5-5  from Ch. 23, par. 5-5
305 ILCS 5/5-5.01a

    Amends the Illinois Act on the Aging, the Disabled Persons Rehabilitation Act, and the Illinois Public Aid Code. Regarding services provided under the Community Care Program, the Home Services Program, and the supportive living facilities program, provides that, through December 31, 2022, individuals who reside in rural and other underserved communities that are disproportionately impacted by COVID-19 shall be exempt from determination of need approval for institutional and home and community-based long term services. Provides that beginning on the effective date of the amendatory Act through December 31, 2022, any hours of home health services, home health care services, in-home care services, or adult day health services not utilized in accordance with an individual's service plan due to staff shortages resulting from the COVID-19 public health emergency shall roll over into the next service month under the individual's plan. Effective immediately.


LRB102 25158 KTG 34421 b

 

 

A BILL FOR

 

HB5586LRB102 25158 KTG 34421 b

1    AN ACT concerning long term care services.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Act on the Aging is amended by
5changing Section 4.02 as follows:
 
6    (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
7    Sec. 4.02. Community Care Program. The Department shall
8establish a program of services to prevent unnecessary
9institutionalization of persons age 60 and older in need of
10long term care or who are established as persons who suffer
11from Alzheimer's disease or a related disorder under the
12Alzheimer's Disease Assistance Act, thereby enabling them to
13remain in their own homes or in other living arrangements.
14Such preventive services, which may be coordinated with other
15programs for the aged and monitored by area agencies on aging
16in cooperation with the Department, may include, but are not
17limited to, any or all of the following:
18        (a) (blank);
19        (b) (blank);
20        (c) home care aide services;
21        (d) personal assistant services;
22        (e) adult day services;
23        (f) home-delivered meals;

 

 

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1        (g) education in self-care;
2        (h) personal care services;
3        (i) adult day health services;
4        (j) habilitation services;
5        (k) respite care;
6        (k-5) community reintegration services;
7        (k-6) flexible senior services;
8        (k-7) medication management;
9        (k-8) emergency home response;
10        (l) other nonmedical social services that may enable
11    the person to become self-supporting; or
12        (m) clearinghouse for information provided by senior
13    citizen home owners who want to rent rooms to or share
14    living space with other senior citizens.
15    The Department shall establish eligibility standards for
16such services. In determining the amount and nature of
17services for which a person may qualify, consideration shall
18not be given to the value of cash, property or other assets
19held in the name of the person's spouse pursuant to a written
20agreement dividing marital property into equal but separate
21shares or pursuant to a transfer of the person's interest in a
22home to his spouse, provided that the spouse's share of the
23marital property is not made available to the person seeking
24such services.
25    Notwithstanding any other law or rule, beginning on the
26effective date of this amendatory Act of the 102nd General

 

 

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1Assembly through December 31, 2022, individuals who reside in
2rural and other underserved communities that are
3disproportionately impacted by COVID-19 shall be exempt from
4determination of need approval for institutional and home and
5community-based long term services. Notwithstanding any other
6law or rule, beginning on the effective date of this
7amendatory Act of the 102nd General Assembly through December
831, 2022, any hours of in-home care or adult day health
9services not utilized in accordance with an individual's
10service plan due to staff shortages resulting from the
11COVID-19 public health emergency shall roll over into the next
12service month under the individual's plan. The Department may
13adopt rules to implement this paragraph.
14    Beginning January 1, 2008, the Department shall require as
15a condition of eligibility that all new financially eligible
16applicants apply for and enroll in medical assistance under
17Article V of the Illinois Public Aid Code in accordance with
18rules promulgated by the Department.
19    The Department shall, in conjunction with the Department
20of Public Aid (now Department of Healthcare and Family
21Services), seek appropriate amendments under Sections 1915 and
221924 of the Social Security Act. The purpose of the amendments
23shall be to extend eligibility for home and community based
24services under Sections 1915 and 1924 of the Social Security
25Act to persons who transfer to or for the benefit of a spouse
26those amounts of income and resources allowed under Section

 

 

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11924 of the Social Security Act. Subject to the approval of
2such amendments, the Department shall extend the provisions of
3Section 5-4 of the Illinois Public Aid Code to persons who, but
4for the provision of home or community-based services, would
5require the level of care provided in an institution, as is
6provided for in federal law. Those persons no longer found to
7be eligible for receiving noninstitutional services due to
8changes in the eligibility criteria shall be given 45 days
9notice prior to actual termination. Those persons receiving
10notice of termination may contact the Department and request
11the determination be appealed at any time during the 45 day
12notice period. The target population identified for the
13purposes of this Section are persons age 60 and older with an
14identified service need. Priority shall be given to those who
15are at imminent risk of institutionalization. The services
16shall be provided to eligible persons age 60 and older to the
17extent that the cost of the services together with the other
18personal maintenance expenses of the persons are reasonably
19related to the standards established for care in a group
20facility appropriate to the person's condition. These
21non-institutional services, pilot projects or experimental
22facilities may be provided as part of or in addition to those
23authorized by federal law or those funded and administered by
24the Department of Human Services. The Departments of Human
25Services, Healthcare and Family Services, Public Health,
26Veterans' Affairs, and Commerce and Economic Opportunity and

 

 

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1other appropriate agencies of State, federal and local
2governments shall cooperate with the Department on Aging in
3the establishment and development of the non-institutional
4services. The Department shall require an annual audit from
5all personal assistant and home care aide vendors contracting
6with the Department under this Section. The annual audit shall
7assure that each audited vendor's procedures are in compliance
8with Department's financial reporting guidelines requiring an
9administrative and employee wage and benefits cost split as
10defined in administrative rules. The audit is a public record
11under the Freedom of Information Act. The Department shall
12execute, relative to the nursing home prescreening project,
13written inter-agency agreements with the Department of Human
14Services and the Department of Healthcare and Family Services,
15to effect the following: (1) intake procedures and common
16eligibility criteria for those persons who are receiving
17non-institutional services; and (2) the establishment and
18development of non-institutional services in areas of the
19State where they are not currently available or are
20undeveloped. On and after July 1, 1996, all nursing home
21prescreenings for individuals 60 years of age or older shall
22be conducted by the Department.
23    As part of the Department on Aging's routine training of
24case managers and case manager supervisors, the Department may
25include information on family futures planning for persons who
26are age 60 or older and who are caregivers of their adult

 

 

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1children with developmental disabilities. The content of the
2training shall be at the Department's discretion.
3    The Department is authorized to establish a system of
4recipient copayment for services provided under this Section,
5such copayment to be based upon the recipient's ability to pay
6but in no case to exceed the actual cost of the services
7provided. Additionally, any portion of a person's income which
8is equal to or less than the federal poverty standard shall not
9be considered by the Department in determining the copayment.
10The level of such copayment shall be adjusted whenever
11necessary to reflect any change in the officially designated
12federal poverty standard.
13    The Department, or the Department's authorized
14representative, may recover the amount of moneys expended for
15services provided to or in behalf of a person under this
16Section by a claim against the person's estate or against the
17estate of the person's surviving spouse, but no recovery may
18be had until after the death of the surviving spouse, if any,
19and then only at such time when there is no surviving child who
20is under age 21 or blind or who has a permanent and total
21disability. This paragraph, however, shall not bar recovery,
22at the death of the person, of moneys for services provided to
23the person or in behalf of the person under this Section to
24which the person was not entitled; provided that such recovery
25shall not be enforced against any real estate while it is
26occupied as a homestead by the surviving spouse or other

 

 

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1dependent, if no claims by other creditors have been filed
2against the estate, or, if such claims have been filed, they
3remain dormant for failure of prosecution or failure of the
4claimant to compel administration of the estate for the
5purpose of payment. This paragraph shall not bar recovery from
6the estate of a spouse, under Sections 1915 and 1924 of the
7Social Security Act and Section 5-4 of the Illinois Public Aid
8Code, who precedes a person receiving services under this
9Section in death. All moneys for services paid to or in behalf
10of the person under this Section shall be claimed for recovery
11from the deceased spouse's estate. "Homestead", as used in
12this paragraph, means the dwelling house and contiguous real
13estate occupied by a surviving spouse or relative, as defined
14by the rules and regulations of the Department of Healthcare
15and Family Services, regardless of the value of the property.
16    The Department shall increase the effectiveness of the
17existing Community Care Program by:
18        (1) ensuring that in-home services included in the
19    care plan are available on evenings and weekends;
20        (2) ensuring that care plans contain the services that
21    eligible participants need based on the number of days in
22    a month, not limited to specific blocks of time, as
23    identified by the comprehensive assessment tool selected
24    by the Department for use statewide, not to exceed the
25    total monthly service cost maximum allowed for each
26    service; the Department shall develop administrative rules

 

 

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1    to implement this item (2);
2        (3) ensuring that the participants have the right to
3    choose the services contained in their care plan and to
4    direct how those services are provided, based on
5    administrative rules established by the Department;
6        (4) ensuring that the determination of need tool is
7    accurate in determining the participants' level of need;
8    to achieve this, the Department, in conjunction with the
9    Older Adult Services Advisory Committee, shall institute a
10    study of the relationship between the Determination of
11    Need scores, level of need, service cost maximums, and the
12    development and utilization of service plans no later than
13    May 1, 2008; findings and recommendations shall be
14    presented to the Governor and the General Assembly no
15    later than January 1, 2009; recommendations shall include
16    all needed changes to the service cost maximums schedule
17    and additional covered services;
18        (5) ensuring that homemakers can provide personal care
19    services that may or may not involve contact with clients,
20    including but not limited to:
21            (A) bathing;
22            (B) grooming;
23            (C) toileting;
24            (D) nail care;
25            (E) transferring;
26            (F) respiratory services;

 

 

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1            (G) exercise; or
2            (H) positioning;
3        (6) ensuring that homemaker program vendors are not
4    restricted from hiring homemakers who are family members
5    of clients or recommended by clients; the Department may
6    not, by rule or policy, require homemakers who are family
7    members of clients or recommended by clients to accept
8    assignments in homes other than the client;
9        (7) ensuring that the State may access maximum federal
10    matching funds by seeking approval for the Centers for
11    Medicare and Medicaid Services for modifications to the
12    State's home and community based services waiver and
13    additional waiver opportunities, including applying for
14    enrollment in the Balance Incentive Payment Program by May
15    1, 2013, in order to maximize federal matching funds; this
16    shall include, but not be limited to, modification that
17    reflects all changes in the Community Care Program
18    services and all increases in the services cost maximum;
19        (8) ensuring that the determination of need tool
20    accurately reflects the service needs of individuals with
21    Alzheimer's disease and related dementia disorders;
22        (9) ensuring that services are authorized accurately
23    and consistently for the Community Care Program (CCP); the
24    Department shall implement a Service Authorization policy
25    directive; the purpose shall be to ensure that eligibility
26    and services are authorized accurately and consistently in

 

 

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1    the CCP program; the policy directive shall clarify
2    service authorization guidelines to Care Coordination
3    Units and Community Care Program providers no later than
4    May 1, 2013;
5        (10) working in conjunction with Care Coordination
6    Units, the Department of Healthcare and Family Services,
7    the Department of Human Services, Community Care Program
8    providers, and other stakeholders to make improvements to
9    the Medicaid claiming processes and the Medicaid
10    enrollment procedures or requirements as needed,
11    including, but not limited to, specific policy changes or
12    rules to improve the up-front enrollment of participants
13    in the Medicaid program and specific policy changes or
14    rules to insure more prompt submission of bills to the
15    federal government to secure maximum federal matching
16    dollars as promptly as possible; the Department on Aging
17    shall have at least 3 meetings with stakeholders by
18    January 1, 2014 in order to address these improvements;
19        (11) requiring home care service providers to comply
20    with the rounding of hours worked provisions under the
21    federal Fair Labor Standards Act (FLSA) and as set forth
22    in 29 CFR 785.48(b) by May 1, 2013;
23        (12) implementing any necessary policy changes or
24    promulgating any rules, no later than January 1, 2014, to
25    assist the Department of Healthcare and Family Services in
26    moving as many participants as possible, consistent with

 

 

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1    federal regulations, into coordinated care plans if a care
2    coordination plan that covers long term care is available
3    in the recipient's area; and
4        (13) maintaining fiscal year 2014 rates at the same
5    level established on January 1, 2013.
6    By January 1, 2009 or as soon after the end of the Cash and
7Counseling Demonstration Project as is practicable, the
8Department may, based on its evaluation of the demonstration
9project, promulgate rules concerning personal assistant
10services, to include, but need not be limited to,
11qualifications, employment screening, rights under fair labor
12standards, training, fiduciary agent, and supervision
13requirements. All applicants shall be subject to the
14provisions of the Health Care Worker Background Check Act.
15    The Department shall develop procedures to enhance
16availability of services on evenings, weekends, and on an
17emergency basis to meet the respite needs of caregivers.
18Procedures shall be developed to permit the utilization of
19services in successive blocks of 24 hours up to the monthly
20maximum established by the Department. Workers providing these
21services shall be appropriately trained.
22    Beginning on the effective date of this amendatory Act of
231991, no person may perform chore/housekeeping and home care
24aide services under a program authorized by this Section
25unless that person has been issued a certificate of
26pre-service to do so by his or her employing agency.

 

 

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1Information gathered to effect such certification shall
2include (i) the person's name, (ii) the date the person was
3hired by his or her current employer, and (iii) the training,
4including dates and levels. Persons engaged in the program
5authorized by this Section before the effective date of this
6amendatory Act of 1991 shall be issued a certificate of all
7pre- and in-service training from his or her employer upon
8submitting the necessary information. The employing agency
9shall be required to retain records of all staff pre- and
10in-service training, and shall provide such records to the
11Department upon request and upon termination of the employer's
12contract with the Department. In addition, the employing
13agency is responsible for the issuance of certifications of
14in-service training completed to their employees.
15    The Department is required to develop a system to ensure
16that persons working as home care aides and personal
17assistants receive increases in their wages when the federal
18minimum wage is increased by requiring vendors to certify that
19they are meeting the federal minimum wage statute for home
20care aides and personal assistants. An employer that cannot
21ensure that the minimum wage increase is being given to home
22care aides and personal assistants shall be denied any
23increase in reimbursement costs.
24    The Community Care Program Advisory Committee is created
25in the Department on Aging. The Director shall appoint
26individuals to serve in the Committee, who shall serve at

 

 

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1their own expense. Members of the Committee must abide by all
2applicable ethics laws. The Committee shall advise the
3Department on issues related to the Department's program of
4services to prevent unnecessary institutionalization. The
5Committee shall meet on a bi-monthly basis and shall serve to
6identify and advise the Department on present and potential
7issues affecting the service delivery network, the program's
8clients, and the Department and to recommend solution
9strategies. Persons appointed to the Committee shall be
10appointed on, but not limited to, their own and their agency's
11experience with the program, geographic representation, and
12willingness to serve. The Director shall appoint members to
13the Committee to represent provider, advocacy, policy
14research, and other constituencies committed to the delivery
15of high quality home and community-based services to older
16adults. Representatives shall be appointed to ensure
17representation from community care providers including, but
18not limited to, adult day service providers, homemaker
19providers, case coordination and case management units,
20emergency home response providers, statewide trade or labor
21unions that represent home care aides and direct care staff,
22area agencies on aging, adults over age 60, membership
23organizations representing older adults, and other
24organizational entities, providers of care, or individuals
25with demonstrated interest and expertise in the field of home
26and community care as determined by the Director.

 

 

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1    Nominations may be presented from any agency or State
2association with interest in the program. The Director, or his
3or her designee, shall serve as the permanent co-chair of the
4advisory committee. One other co-chair shall be nominated and
5approved by the members of the committee on an annual basis.
6Committee members' terms of appointment shall be for 4 years
7with one-quarter of the appointees' terms expiring each year.
8A member shall continue to serve until his or her replacement
9is named. The Department shall fill vacancies that have a
10remaining term of over one year, and this replacement shall
11occur through the annual replacement of expiring terms. The
12Director shall designate Department staff to provide technical
13assistance and staff support to the committee. Department
14representation shall not constitute membership of the
15committee. All Committee papers, issues, recommendations,
16reports, and meeting memoranda are advisory only. The
17Director, or his or her designee, shall make a written report,
18as requested by the Committee, regarding issues before the
19Committee.
20    The Department on Aging and the Department of Human
21Services shall cooperate in the development and submission of
22an annual report on programs and services provided under this
23Section. Such joint report shall be filed with the Governor
24and the General Assembly on or before September 30 each year.
25    The requirement for reporting to the General Assembly
26shall be satisfied by filing copies of the report as required

 

 

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1by Section 3.1 of the General Assembly Organization Act and
2filing such additional copies with the State Government Report
3Distribution Center for the General Assembly as is required
4under paragraph (t) of Section 7 of the State Library Act.
5    Those persons previously found eligible for receiving
6non-institutional services whose services were discontinued
7under the Emergency Budget Act of Fiscal Year 1992, and who do
8not meet the eligibility standards in effect on or after July
91, 1992, shall remain ineligible on and after July 1, 1992.
10Those persons previously not required to cost-share and who
11were required to cost-share effective March 1, 1992, shall
12continue to meet cost-share requirements on and after July 1,
131992. Beginning July 1, 1992, all clients will be required to
14meet eligibility, cost-share, and other requirements and will
15have services discontinued or altered when they fail to meet
16these requirements.
17    For the purposes of this Section, "flexible senior
18services" refers to services that require one-time or periodic
19expenditures including, but not limited to, respite care, home
20modification, assistive technology, housing assistance, and
21transportation.
22    The Department shall implement an electronic service
23verification based on global positioning systems or other
24cost-effective technology for the Community Care Program no
25later than January 1, 2014.
26    The Department shall require, as a condition of

 

 

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1eligibility, enrollment in the medical assistance program
2under Article V of the Illinois Public Aid Code (i) beginning
3August 1, 2013, if the Auditor General has reported that the
4Department has failed to comply with the reporting
5requirements of Section 2-27 of the Illinois State Auditing
6Act; or (ii) beginning June 1, 2014, if the Auditor General has
7reported that the Department has not undertaken the required
8actions listed in the report required by subsection (a) of
9Section 2-27 of the Illinois State Auditing Act.
10    The Department shall delay Community Care Program services
11until an applicant is determined eligible for medical
12assistance under Article V of the Illinois Public Aid Code (i)
13beginning August 1, 2013, if the Auditor General has reported
14that the Department has failed to comply with the reporting
15requirements of Section 2-27 of the Illinois State Auditing
16Act; or (ii) beginning June 1, 2014, if the Auditor General has
17reported that the Department has not undertaken the required
18actions listed in the report required by subsection (a) of
19Section 2-27 of the Illinois State Auditing Act.
20    The Department shall implement co-payments for the
21Community Care Program at the federally allowable maximum
22level (i) beginning August 1, 2013, if the Auditor General has
23reported that the Department has failed to comply with the
24reporting requirements of Section 2-27 of the Illinois State
25Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
26General has reported that the Department has not undertaken

 

 

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1the required actions listed in the report required by
2subsection (a) of Section 2-27 of the Illinois State Auditing
3Act.
4    The Department shall provide a bi-monthly report on the
5progress of the Community Care Program reforms set forth in
6this amendatory Act of the 98th General Assembly to the
7Governor, the Speaker of the House of Representatives, the
8Minority Leader of the House of Representatives, the President
9of the Senate, and the Minority Leader of the Senate.
10    The Department shall conduct a quarterly review of Care
11Coordination Unit performance and adherence to service
12guidelines. The quarterly review shall be reported to the
13Speaker of the House of Representatives, the Minority Leader
14of the House of Representatives, the President of the Senate,
15and the Minority Leader of the Senate. The Department shall
16collect and report longitudinal data on the performance of
17each care coordination unit. Nothing in this paragraph shall
18be construed to require the Department to identify specific
19care coordination units.
20    In regard to community care providers, failure to comply
21with Department on Aging policies shall be cause for
22disciplinary action, including, but not limited to,
23disqualification from serving Community Care Program clients.
24Each provider, upon submission of any bill or invoice to the
25Department for payment for services rendered, shall include a
26notarized statement, under penalty of perjury pursuant to

 

 

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1Section 1-109 of the Code of Civil Procedure, that the
2provider has complied with all Department policies.
3    The Director of the Department on Aging shall make
4information available to the State Board of Elections as may
5be required by an agreement the State Board of Elections has
6entered into with a multi-state voter registration list
7maintenance system.
8    Within 30 days after July 6, 2017 (the effective date of
9Public Act 100-23), rates shall be increased to $18.29 per
10hour, for the purpose of increasing, by at least $.72 per hour,
11the wages paid by those vendors to their employees who provide
12homemaker services. The Department shall pay an enhanced rate
13under the Community Care Program to those in-home service
14provider agencies that offer health insurance coverage as a
15benefit to their direct service worker employees consistent
16with the mandates of Public Act 95-713. For State fiscal years
172018 and 2019, the enhanced rate shall be $1.77 per hour. The
18rate shall be adjusted using actuarial analysis based on the
19cost of care, but shall not be set below $1.77 per hour. The
20Department shall adopt rules, including emergency rules under
21subsections (y) and (bb) of Section 5-45 of the Illinois
22Administrative Procedure Act, to implement the provisions of
23this paragraph.
24    The General Assembly finds it necessary to authorize an
25aggressive Medicaid enrollment initiative designed to maximize
26federal Medicaid funding for the Community Care Program which

 

 

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1produces significant savings for the State of Illinois. The
2Department on Aging shall establish and implement a Community
3Care Program Medicaid Initiative. Under the Initiative, the
4Department on Aging shall, at a minimum: (i) provide an
5enhanced rate to adequately compensate care coordination units
6to enroll eligible Community Care Program clients into
7Medicaid; (ii) use recommendations from a stakeholder
8committee on how best to implement the Initiative; and (iii)
9establish requirements for State agencies to make enrollment
10in the State's Medical Assistance program easier for seniors.
11    The Community Care Program Medicaid Enrollment Oversight
12Subcommittee is created as a subcommittee of the Older Adult
13Services Advisory Committee established in Section 35 of the
14Older Adult Services Act to make recommendations on how best
15to increase the number of medical assistance recipients who
16are enrolled in the Community Care Program. The Subcommittee
17shall consist of all of the following persons who must be
18appointed within 30 days after the effective date of this
19amendatory Act of the 100th General Assembly:
20        (1) The Director of Aging, or his or her designee, who
21    shall serve as the chairperson of the Subcommittee.
22        (2) One representative of the Department of Healthcare
23    and Family Services, appointed by the Director of
24    Healthcare and Family Services.
25        (3) One representative of the Department of Human
26    Services, appointed by the Secretary of Human Services.

 

 

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1        (4) One individual representing a care coordination
2    unit, appointed by the Director of Aging.
3        (5) One individual from a non-governmental statewide
4    organization that advocates for seniors, appointed by the
5    Director of Aging.
6        (6) One individual representing Area Agencies on
7    Aging, appointed by the Director of Aging.
8        (7) One individual from a statewide association
9    dedicated to Alzheimer's care, support, and research,
10    appointed by the Director of Aging.
11        (8) One individual from an organization that employs
12    persons who provide services under the Community Care
13    Program, appointed by the Director of Aging.
14        (9) One member of a trade or labor union representing
15    persons who provide services under the Community Care
16    Program, appointed by the Director of Aging.
17        (10) One member of the Senate, who shall serve as
18    co-chairperson, appointed by the President of the Senate.
19        (11) One member of the Senate, who shall serve as
20    co-chairperson, appointed by the Minority Leader of the
21    Senate.
22        (12) One member of the House of Representatives, who
23    shall serve as co-chairperson, appointed by the Speaker of
24    the House of Representatives.
25        (13) One member of the House of Representatives, who
26    shall serve as co-chairperson, appointed by the Minority

 

 

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1    Leader of the House of Representatives.
2        (14) One individual appointed by a labor organization
3    representing frontline employees at the Department of
4    Human Services.
5    The Subcommittee shall provide oversight to the Community
6Care Program Medicaid Initiative and shall meet quarterly. At
7each Subcommittee meeting the Department on Aging shall
8provide the following data sets to the Subcommittee: (A) the
9number of Illinois residents, categorized by planning and
10service area, who are receiving services under the Community
11Care Program and are enrolled in the State's Medical
12Assistance Program; (B) the number of Illinois residents,
13categorized by planning and service area, who are receiving
14services under the Community Care Program, but are not
15enrolled in the State's Medical Assistance Program; and (C)
16the number of Illinois residents, categorized by planning and
17service area, who are receiving services under the Community
18Care Program and are eligible for benefits under the State's
19Medical Assistance Program, but are not enrolled in the
20State's Medical Assistance Program. In addition to this data,
21the Department on Aging shall provide the Subcommittee with
22plans on how the Department on Aging will reduce the number of
23Illinois residents who are not enrolled in the State's Medical
24Assistance Program but who are eligible for medical assistance
25benefits. The Department on Aging shall enroll in the State's
26Medical Assistance Program those Illinois residents who

 

 

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1receive services under the Community Care Program and are
2eligible for medical assistance benefits but are not enrolled
3in the State's Medicaid Assistance Program. The data provided
4to the Subcommittee shall be made available to the public via
5the Department on Aging's website.
6    The Department on Aging, with the involvement of the
7Subcommittee, shall collaborate with the Department of Human
8Services and the Department of Healthcare and Family Services
9on how best to achieve the responsibilities of the Community
10Care Program Medicaid Initiative.
11    The Department on Aging, the Department of Human Services,
12and the Department of Healthcare and Family Services shall
13coordinate and implement a streamlined process for seniors to
14access benefits under the State's Medical Assistance Program.
15    The Subcommittee shall collaborate with the Department of
16Human Services on the adoption of a uniform application
17submission process. The Department of Human Services and any
18other State agency involved with processing the medical
19assistance application of any person enrolled in the Community
20Care Program shall include the appropriate care coordination
21unit in all communications related to the determination or
22status of the application.
23    The Community Care Program Medicaid Initiative shall
24provide targeted funding to care coordination units to help
25seniors complete their applications for medical assistance
26benefits. On and after July 1, 2019, care coordination units

 

 

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1shall receive no less than $200 per completed application,
2which rate may be included in a bundled rate for initial intake
3services when Medicaid application assistance is provided in
4conjunction with the initial intake process for new program
5participants.
6    The Community Care Program Medicaid Initiative shall cease
7operation 5 years after the effective date of this amendatory
8Act of the 100th General Assembly, after which the
9Subcommittee shall dissolve.
10(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18;
11100-1148, eff. 12-10-18; 101-10, eff. 6-5-19.)
 
12    Section 10. The Rehabilitation of Persons with
13Disabilities Act is amended by changing Section 3 as follows:
 
14    (20 ILCS 2405/3)  (from Ch. 23, par. 3434)
15    Sec. 3. Powers and duties. The Department shall have the
16powers and duties enumerated herein:
17        (a) To cooperate with the federal government in the
18    administration of the provisions of the federal
19    Rehabilitation Act of 1973, as amended by the Workforce
20    Innovation and Opportunity Act, and of the federal Social
21    Security Act to the extent and in the manner provided in
22    these Acts.
23        (b) To prescribe and supervise such courses of
24    vocational training and provide such other services as may

 

 

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1    be necessary for the vocational rehabilitation of persons
2    with one or more disabilities, including the
3    administrative activities under subsection (e) of this
4    Section; to cooperate with State and local school
5    authorities and other recognized agencies engaged in
6    vocational rehabilitation services; and to cooperate with
7    the Department of Children and Family Services, the
8    Illinois State Board of Education, and others regarding
9    the education of children with one or more disabilities.
10        (c) (Blank).
11        (d) To report in writing, to the Governor, annually on
12    or before the first day of December, and at such other
13    times and in such manner and upon such subjects as the
14    Governor may require. The annual report shall contain (1)
15    information on the programs and activities dedicated to
16    vocational rehabilitation, independent living, and other
17    community services and supports administered by the
18    Director; (2) information on the development of vocational
19    rehabilitation services, independent living services, and
20    supporting services administered by the Director in the
21    State; and (3) information detailing the amounts of money
22    received from federal, State, and other sources, and of
23    the objects and purposes to which the respective items of
24    these several amounts have been devoted.
25        (e) (Blank).
26        (f) To establish a program of services to prevent the

 

 

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1    unnecessary institutionalization of persons in need of
2    long term care and who meet the criteria for blindness or
3    disability as defined by the Social Security Act, thereby
4    enabling them to remain in their own homes. Such
5    preventive services include any or all of the following:
6            (1) personal assistant services;
7            (2) homemaker services;
8            (3) home-delivered meals;
9            (4) adult day care services;
10            (5) respite care;
11            (6) home modification or assistive equipment;
12            (7) home health services;
13            (8) electronic home response;
14            (9) brain injury behavioral/cognitive services;
15            (10) brain injury habilitation;
16            (11) brain injury pre-vocational services; or
17            (12) brain injury supported employment.
18        The Department shall establish eligibility standards
19    for such services taking into consideration the unique
20    economic and social needs of the population for whom they
21    are to be provided. Such eligibility standards may be
22    based on the recipient's ability to pay for services;
23    provided, however, that any portion of a person's income
24    that is equal to or less than the "protected income" level
25    shall not be considered by the Department in determining
26    eligibility. The "protected income" level shall be

 

 

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1    determined by the Department, shall never be less than the
2    federal poverty standard, and shall be adjusted each year
3    to reflect changes in the Consumer Price Index For All
4    Urban Consumers as determined by the United States
5    Department of Labor. The standards must provide that a
6    person may not have more than $10,000 in assets to be
7    eligible for the services, and the Department may increase
8    or decrease the asset limitation by rule. The Department
9    may not decrease the asset level below $10,000.
10        Notwithstanding any other law or rule, beginning on
11    the effective date of this amendatory Act of the 102nd
12    General Assembly through December 31, 2022, individuals
13    who reside in rural and other underserved communities that
14    are disproportionately impacted by COVID-19 shall be
15    exempt from determination of need approval for
16    institutional and home and community-based long term
17    services. Notwithstanding any other law or rule, beginning
18    on the effective date of this amendatory Act of the 102nd
19    General Assembly through December 31, 2022, any hours of
20    home health services not utilized in accordance with an
21    individual's service plan due to staff shortages resulting
22    from the COVID-19 public health emergency shall roll over
23    into the next service month under the individual's plan.
24    The Department may adopt rules to implement this
25    paragraph.
26        The services shall be provided, as established by the

 

 

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1    Department by rule, to eligible persons to prevent
2    unnecessary or premature institutionalization, to the
3    extent that the cost of the services, together with the
4    other personal maintenance expenses of the persons, are
5    reasonably related to the standards established for care
6    in a group facility appropriate to their condition. These
7    non-institutional services, pilot projects or experimental
8    facilities may be provided as part of or in addition to
9    those authorized by federal law or those funded and
10    administered by the Illinois Department on Aging. The
11    Department shall set rates and fees for services in a fair
12    and equitable manner. Services identical to those offered
13    by the Department on Aging shall be paid at the same rate.
14        Except as otherwise provided in this paragraph,
15    personal assistants shall be paid at a rate negotiated
16    between the State and an exclusive representative of
17    personal assistants under a collective bargaining
18    agreement. In no case shall the Department pay personal
19    assistants an hourly wage that is less than the federal
20    minimum wage. Within 30 days after July 6, 2017 (the
21    effective date of Public Act 100-23), the hourly wage paid
22    to personal assistants and individual maintenance home
23    health workers shall be increased by $0.48 per hour.
24        Solely for the purposes of coverage under the Illinois
25    Public Labor Relations Act, personal assistants providing
26    services under the Department's Home Services Program

 

 

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1    shall be considered to be public employees and the State
2    of Illinois shall be considered to be their employer as of
3    July 16, 2003 (the effective date of Public Act 93-204),
4    but not before. Solely for the purposes of coverage under
5    the Illinois Public Labor Relations Act, home care and
6    home health workers who function as personal assistants
7    and individual maintenance home health workers and who
8    also provide services under the Department's Home Services
9    Program shall be considered to be public employees, no
10    matter whether the State provides such services through
11    direct fee-for-service arrangements, with the assistance
12    of a managed care organization or other intermediary, or
13    otherwise, and the State of Illinois shall be considered
14    to be the employer of those persons as of January 29, 2013
15    (the effective date of Public Act 97-1158), but not before
16    except as otherwise provided under this subsection (f).
17    The State shall engage in collective bargaining with an
18    exclusive representative of home care and home health
19    workers who function as personal assistants and individual
20    maintenance home health workers working under the Home
21    Services Program concerning their terms and conditions of
22    employment that are within the State's control. Nothing in
23    this paragraph shall be understood to limit the right of
24    the persons receiving services defined in this Section to
25    hire and fire home care and home health workers who
26    function as personal assistants and individual maintenance

 

 

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1    home health workers working under the Home Services
2    Program or to supervise them within the limitations set by
3    the Home Services Program. The State shall not be
4    considered to be the employer of home care and home health
5    workers who function as personal assistants and individual
6    maintenance home health workers working under the Home
7    Services Program for any purposes not specifically
8    provided in Public Act 93-204 or Public Act 97-1158,
9    including but not limited to, purposes of vicarious
10    liability in tort and purposes of statutory retirement or
11    health insurance benefits. Home care and home health
12    workers who function as personal assistants and individual
13    maintenance home health workers and who also provide
14    services under the Department's Home Services Program
15    shall not be covered by the State Employees Group
16    Insurance Act of 1971.
17        The Department shall execute, relative to nursing home
18    prescreening, as authorized by Section 4.03 of the
19    Illinois Act on the Aging, written inter-agency agreements
20    with the Department on Aging and the Department of
21    Healthcare and Family Services, to effect the intake
22    procedures and eligibility criteria for those persons who
23    may need long term care. On and after July 1, 1996, all
24    nursing home prescreenings for individuals 18 through 59
25    years of age shall be conducted by the Department, or a
26    designee of the Department.

 

 

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1        The Department is authorized to establish a system of
2    recipient cost-sharing for services provided under this
3    Section. The cost-sharing shall be based upon the
4    recipient's ability to pay for services, but in no case
5    shall the recipient's share exceed the actual cost of the
6    services provided. Protected income shall not be
7    considered by the Department in its determination of the
8    recipient's ability to pay a share of the cost of
9    services. The level of cost-sharing shall be adjusted each
10    year to reflect changes in the "protected income" level.
11    The Department shall deduct from the recipient's share of
12    the cost of services any money expended by the recipient
13    for disability-related expenses.
14        To the extent permitted under the federal Social
15    Security Act, the Department, or the Department's
16    authorized representative, may recover the amount of
17    moneys expended for services provided to or in behalf of a
18    person under this Section by a claim against the person's
19    estate or against the estate of the person's surviving
20    spouse, but no recovery may be had until after the death of
21    the surviving spouse, if any, and then only at such time
22    when there is no surviving child who is under age 21 or
23    blind or who has a permanent and total disability. This
24    paragraph, however, shall not bar recovery, at the death
25    of the person, of moneys for services provided to the
26    person or in behalf of the person under this Section to

 

 

HB5586- 31 -LRB102 25158 KTG 34421 b

1    which the person was not entitled; provided that such
2    recovery shall not be enforced against any real estate
3    while it is occupied as a homestead by the surviving
4    spouse or other dependent, if no claims by other creditors
5    have been filed against the estate, or, if such claims
6    have been filed, they remain dormant for failure of
7    prosecution or failure of the claimant to compel
8    administration of the estate for the purpose of payment.
9    This paragraph shall not bar recovery from the estate of a
10    spouse, under Sections 1915 and 1924 of the Social
11    Security Act and Section 5-4 of the Illinois Public Aid
12    Code, who precedes a person receiving services under this
13    Section in death. All moneys for services paid to or in
14    behalf of the person under this Section shall be claimed
15    for recovery from the deceased spouse's estate.
16    "Homestead", as used in this paragraph, means the dwelling
17    house and contiguous real estate occupied by a surviving
18    spouse or relative, as defined by the rules and
19    regulations of the Department of Healthcare and Family
20    Services, regardless of the value of the property.
21        (g) To establish such subdivisions of the Department
22    as shall be desirable and assign to the various
23    subdivisions the responsibilities and duties placed upon
24    the Department by law.
25        (h) To cooperate and enter into any necessary
26    agreements with the Department of Employment Security for

 

 

HB5586- 32 -LRB102 25158 KTG 34421 b

1    the provision of job placement and job referral services
2    to clients of the Department, including job service
3    registration of such clients with Illinois Employment
4    Security offices and making job listings maintained by the
5    Department of Employment Security available to such
6    clients.
7        (i) To possess all powers reasonable and necessary for
8    the exercise and administration of the powers, duties and
9    responsibilities of the Department which are provided for
10    by law.
11        (j) (Blank).
12        (k) (Blank).
13        (l) To establish, operate, and maintain a Statewide
14    Housing Clearinghouse of information on available
15    government subsidized housing accessible to persons with
16    disabilities and available privately owned housing
17    accessible to persons with disabilities. The information
18    shall include, but not be limited to, the location, rental
19    requirements, access features and proximity to public
20    transportation of available housing. The Clearinghouse
21    shall consist of at least a computerized database for the
22    storage and retrieval of information and a separate or
23    shared toll free telephone number for use by those seeking
24    information from the Clearinghouse. Department offices and
25    personnel throughout the State shall also assist in the
26    operation of the Statewide Housing Clearinghouse.

 

 

HB5586- 33 -LRB102 25158 KTG 34421 b

1    Cooperation with local, State, and federal housing
2    managers shall be sought and extended in order to
3    frequently and promptly update the Clearinghouse's
4    information.
5        (m) To assure that the names and case records of
6    persons who received or are receiving services from the
7    Department, including persons receiving vocational
8    rehabilitation, home services, or other services, and
9    those attending one of the Department's schools or other
10    supervised facility shall be confidential and not be open
11    to the general public. Those case records and reports or
12    the information contained in those records and reports
13    shall be disclosed by the Director only to proper law
14    enforcement officials, individuals authorized by a court,
15    the General Assembly or any committee or commission of the
16    General Assembly, and other persons and for reasons as the
17    Director designates by rule. Disclosure by the Director
18    may be only in accordance with other applicable law.
19(Source: P.A. 102-264, eff. 8-6-21.)
 
20    Section 20. The Illinois Public Aid Code is amended by
21changing Sections 5-5 and 5-5.01a as follows:
 
22    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
23    Sec. 5-5. Medical services. The Illinois Department, by
24rule, shall determine the quantity and quality of and the rate

 

 

HB5586- 34 -LRB102 25158 KTG 34421 b

1of reimbursement for the medical assistance for which payment
2will be authorized, and the medical services to be provided,
3which may include all or part of the following: (1) inpatient
4hospital services; (2) outpatient hospital services; (3) other
5laboratory and X-ray services; (4) skilled nursing home
6services; (5) physicians' services whether furnished in the
7office, the patient's home, a hospital, a skilled nursing
8home, or elsewhere; (6) medical care, or any other type of
9remedial care furnished by licensed practitioners; (7) home
10health care services; (8) private duty nursing service; (9)
11clinic services; (10) dental services, including prevention
12and treatment of periodontal disease and dental caries disease
13for pregnant individuals, provided by an individual licensed
14to practice dentistry or dental surgery; for purposes of this
15item (10), "dental services" means diagnostic, preventive, or
16corrective procedures provided by or under the supervision of
17a dentist in the practice of his or her profession; (11)
18physical therapy and related services; (12) prescribed drugs,
19dentures, and prosthetic devices; and eyeglasses prescribed by
20a physician skilled in the diseases of the eye, or by an
21optometrist, whichever the person may select; (13) other
22diagnostic, screening, preventive, and rehabilitative
23services, including to ensure that the individual's need for
24intervention or treatment of mental disorders or substance use
25disorders or co-occurring mental health and substance use
26disorders is determined using a uniform screening, assessment,

 

 

HB5586- 35 -LRB102 25158 KTG 34421 b

1and evaluation process inclusive of criteria, for children and
2adults; for purposes of this item (13), a uniform screening,
3assessment, and evaluation process refers to a process that
4includes an appropriate evaluation and, as warranted, a
5referral; "uniform" does not mean the use of a singular
6instrument, tool, or process that all must utilize; (14)
7transportation and such other expenses as may be necessary;
8(15) medical treatment of sexual assault survivors, as defined
9in Section 1a of the Sexual Assault Survivors Emergency
10Treatment Act, for injuries sustained as a result of the
11sexual assault, including examinations and laboratory tests to
12discover evidence which may be used in criminal proceedings
13arising from the sexual assault; (16) the diagnosis and
14treatment of sickle cell anemia; (16.5) services performed by
15a chiropractic physician licensed under the Medical Practice
16Act of 1987 and acting within the scope of his or her license,
17including, but not limited to, chiropractic manipulative
18treatment; and (17) any other medical care, and any other type
19of remedial care recognized under the laws of this State. The
20term "any other type of remedial care" shall include nursing
21care and nursing home service for persons who rely on
22treatment by spiritual means alone through prayer for healing.
23    Notwithstanding any other provision of this Section, a
24comprehensive tobacco use cessation program that includes
25purchasing prescription drugs or prescription medical devices
26approved by the Food and Drug Administration shall be covered

 

 

HB5586- 36 -LRB102 25158 KTG 34421 b

1under the medical assistance program under this Article for
2persons who are otherwise eligible for assistance under this
3Article.
4    Notwithstanding any other provision of this Code,
5reproductive health care that is otherwise legal in Illinois
6shall be covered under the medical assistance program for
7persons who are otherwise eligible for medical assistance
8under this Article.
9    Notwithstanding any other provision of this Section, all
10tobacco cessation medications approved by the United States
11Food and Drug Administration and all individual and group
12tobacco cessation counseling services and telephone-based
13counseling services and tobacco cessation medications provided
14through the Illinois Tobacco Quitline shall be covered under
15the medical assistance program for persons who are otherwise
16eligible for assistance under this Article. The Department
17shall comply with all federal requirements necessary to obtain
18federal financial participation, as specified in 42 CFR
19433.15(b)(7), for telephone-based counseling services provided
20through the Illinois Tobacco Quitline, including, but not
21limited to: (i) entering into a memorandum of understanding or
22interagency agreement with the Department of Public Health, as
23administrator of the Illinois Tobacco Quitline; and (ii)
24developing a cost allocation plan for Medicaid-allowable
25Illinois Tobacco Quitline services in accordance with 45 CFR
2695.507. The Department shall submit the memorandum of

 

 

HB5586- 37 -LRB102 25158 KTG 34421 b

1understanding or interagency agreement, the cost allocation
2plan, and all other necessary documentation to the Centers for
3Medicare and Medicaid Services for review and approval.
4Coverage under this paragraph shall be contingent upon federal
5approval.
6    Notwithstanding any other provision of this Code, the
7Illinois Department may not require, as a condition of payment
8for any laboratory test authorized under this Article, that a
9physician's handwritten signature appear on the laboratory
10test order form. The Illinois Department may, however, impose
11other appropriate requirements regarding laboratory test order
12documentation.
13    Upon receipt of federal approval of an amendment to the
14Illinois Title XIX State Plan for this purpose, the Department
15shall authorize the Chicago Public Schools (CPS) to procure a
16vendor or vendors to manufacture eyeglasses for individuals
17enrolled in a school within the CPS system. CPS shall ensure
18that its vendor or vendors are enrolled as providers in the
19medical assistance program and in any capitated Medicaid
20managed care entity (MCE) serving individuals enrolled in a
21school within the CPS system. Under any contract procured
22under this provision, the vendor or vendors must serve only
23individuals enrolled in a school within the CPS system. Claims
24for services provided by CPS's vendor or vendors to recipients
25of benefits in the medical assistance program under this Code,
26the Children's Health Insurance Program, or the Covering ALL

 

 

HB5586- 38 -LRB102 25158 KTG 34421 b

1KIDS Health Insurance Program shall be submitted to the
2Department or the MCE in which the individual is enrolled for
3payment and shall be reimbursed at the Department's or the
4MCE's established rates or rate methodologies for eyeglasses.
5    On and after July 1, 2012, the Department of Healthcare
6and Family Services may provide the following services to
7persons eligible for assistance under this Article who are
8participating in education, training or employment programs
9operated by the Department of Human Services as successor to
10the Department of Public Aid:
11        (1) dental services provided by or under the
12    supervision of a dentist; and
13        (2) eyeglasses prescribed by a physician skilled in
14    the diseases of the eye, or by an optometrist, whichever
15    the person may select.
16    On and after July 1, 2018, the Department of Healthcare
17and Family Services shall provide dental services to any adult
18who is otherwise eligible for assistance under the medical
19assistance program. As used in this paragraph, "dental
20services" means diagnostic, preventative, restorative, or
21corrective procedures, including procedures and services for
22the prevention and treatment of periodontal disease and dental
23caries disease, provided by an individual who is licensed to
24practice dentistry or dental surgery or who is under the
25supervision of a dentist in the practice of his or her
26profession.

 

 

HB5586- 39 -LRB102 25158 KTG 34421 b

1    On and after July 1, 2018, targeted dental services, as
2set forth in Exhibit D of the Consent Decree entered by the
3United States District Court for the Northern District of
4Illinois, Eastern Division, in the matter of Memisovski v.
5Maram, Case No. 92 C 1982, that are provided to adults under
6the medical assistance program shall be established at no less
7than the rates set forth in the "New Rate" column in Exhibit D
8of the Consent Decree for targeted dental services that are
9provided to persons under the age of 18 under the medical
10assistance program.
11    Notwithstanding any other provision of this Code and
12subject to federal approval, the Department may adopt rules to
13allow a dentist who is volunteering his or her service at no
14cost to render dental services through an enrolled
15not-for-profit health clinic without the dentist personally
16enrolling as a participating provider in the medical
17assistance program. A not-for-profit health clinic shall
18include a public health clinic or Federally Qualified Health
19Center or other enrolled provider, as determined by the
20Department, through which dental services covered under this
21Section are performed. The Department shall establish a
22process for payment of claims for reimbursement for covered
23dental services rendered under this provision.
24    On and after January 1, 2022, the Department of Healthcare
25and Family Services shall administer and regulate a
26school-based dental program that allows for the out-of-office

 

 

HB5586- 40 -LRB102 25158 KTG 34421 b

1delivery of preventative dental services in a school setting
2to children under 19 years of age. The Department shall
3establish, by rule, guidelines for participation by providers
4and set requirements for follow-up referral care based on the
5requirements established in the Dental Office Reference Manual
6published by the Department that establishes the requirements
7for dentists participating in the All Kids Dental School
8Program. Every effort shall be made by the Department when
9developing the program requirements to consider the different
10geographic differences of both urban and rural areas of the
11State for initial treatment and necessary follow-up care. No
12provider shall be charged a fee by any unit of local government
13to participate in the school-based dental program administered
14by the Department. Nothing in this paragraph shall be
15construed to limit or preempt a home rule unit's or school
16district's authority to establish, change, or administer a
17school-based dental program in addition to, or independent of,
18the school-based dental program administered by the
19Department.
20    The Illinois Department, by rule, may distinguish and
21classify the medical services to be provided only in
22accordance with the classes of persons designated in Section
235-2.
24    The Department of Healthcare and Family Services must
25provide coverage and reimbursement for amino acid-based
26elemental formulas, regardless of delivery method, for the

 

 

HB5586- 41 -LRB102 25158 KTG 34421 b

1diagnosis and treatment of (i) eosinophilic disorders and (ii)
2short bowel syndrome when the prescribing physician has issued
3a written order stating that the amino acid-based elemental
4formula is medically necessary.
5    The Illinois Department shall authorize the provision of,
6and shall authorize payment for, screening by low-dose
7mammography for the presence of occult breast cancer for
8individuals 35 years of age or older who are eligible for
9medical assistance under this Article, as follows:
10        (A) A baseline mammogram for individuals 35 to 39
11    years of age.
12        (B) An annual mammogram for individuals 40 years of
13    age or older.
14        (C) A mammogram at the age and intervals considered
15    medically necessary by the individual's health care
16    provider for individuals under 40 years of age and having
17    a family history of breast cancer, prior personal history
18    of breast cancer, positive genetic testing, or other risk
19    factors.
20        (D) A comprehensive ultrasound screening and MRI of an
21    entire breast or breasts if a mammogram demonstrates
22    heterogeneous or dense breast tissue or when medically
23    necessary as determined by a physician licensed to
24    practice medicine in all of its branches.
25        (E) A screening MRI when medically necessary, as
26    determined by a physician licensed to practice medicine in

 

 

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1    all of its branches.
2        (F) A diagnostic mammogram when medically necessary,
3    as determined by a physician licensed to practice medicine
4    in all its branches, advanced practice registered nurse,
5    or physician assistant.
6    The Department shall not impose a deductible, coinsurance,
7copayment, or any other cost-sharing requirement on the
8coverage provided under this paragraph; except that this
9sentence does not apply to coverage of diagnostic mammograms
10to the extent such coverage would disqualify a high-deductible
11health plan from eligibility for a health savings account
12pursuant to Section 223 of the Internal Revenue Code (26
13U.S.C. 223).
14    All screenings shall include a physical breast exam,
15instruction on self-examination and information regarding the
16frequency of self-examination and its value as a preventative
17tool.
18     For purposes of this Section:
19    "Diagnostic mammogram" means a mammogram obtained using
20diagnostic mammography.
21    "Diagnostic mammography" means a method of screening that
22is designed to evaluate an abnormality in a breast, including
23an abnormality seen or suspected on a screening mammogram or a
24subjective or objective abnormality otherwise detected in the
25breast.
26    "Low-dose mammography" means the x-ray examination of the

 

 

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1breast using equipment dedicated specifically for mammography,
2including the x-ray tube, filter, compression device, and
3image receptor, with an average radiation exposure delivery of
4less than one rad per breast for 2 views of an average size
5breast. The term also includes digital mammography and
6includes breast tomosynthesis.
7    "Breast tomosynthesis" means a radiologic procedure that
8involves the acquisition of projection images over the
9stationary breast to produce cross-sectional digital
10three-dimensional images of the breast.
11    If, at any time, the Secretary of the United States
12Department of Health and Human Services, or its successor
13agency, promulgates rules or regulations to be published in
14the Federal Register or publishes a comment in the Federal
15Register or issues an opinion, guidance, or other action that
16would require the State, pursuant to any provision of the
17Patient Protection and Affordable Care Act (Public Law
18111-148), including, but not limited to, 42 U.S.C.
1918031(d)(3)(B) or any successor provision, to defray the cost
20of any coverage for breast tomosynthesis outlined in this
21paragraph, then the requirement that an insurer cover breast
22tomosynthesis is inoperative other than any such coverage
23authorized under Section 1902 of the Social Security Act, 42
24U.S.C. 1396a, and the State shall not assume any obligation
25for the cost of coverage for breast tomosynthesis set forth in
26this paragraph.

 

 

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1    On and after January 1, 2016, the Department shall ensure
2that all networks of care for adult clients of the Department
3include access to at least one breast imaging Center of
4Imaging Excellence as certified by the American College of
5Radiology.
6    On and after January 1, 2012, providers participating in a
7quality improvement program approved by the Department shall
8be reimbursed for screening and diagnostic mammography at the
9same rate as the Medicare program's rates, including the
10increased reimbursement for digital mammography.
11    The Department shall convene an expert panel including
12representatives of hospitals, free-standing mammography
13facilities, and doctors, including radiologists, to establish
14quality standards for mammography.
15    On and after January 1, 2017, providers participating in a
16breast cancer treatment quality improvement program approved
17by the Department shall be reimbursed for breast cancer
18treatment at a rate that is no lower than 95% of the Medicare
19program's rates for the data elements included in the breast
20cancer treatment quality program.
21    The Department shall convene an expert panel, including
22representatives of hospitals, free-standing breast cancer
23treatment centers, breast cancer quality organizations, and
24doctors, including breast surgeons, reconstructive breast
25surgeons, oncologists, and primary care providers to establish
26quality standards for breast cancer treatment.

 

 

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1    Subject to federal approval, the Department shall
2establish a rate methodology for mammography at federally
3qualified health centers and other encounter-rate clinics.
4These clinics or centers may also collaborate with other
5hospital-based mammography facilities. By January 1, 2016, the
6Department shall report to the General Assembly on the status
7of the provision set forth in this paragraph.
8    The Department shall establish a methodology to remind
9individuals who are age-appropriate for screening mammography,
10but who have not received a mammogram within the previous 18
11months, of the importance and benefit of screening
12mammography. The Department shall work with experts in breast
13cancer outreach and patient navigation to optimize these
14reminders and shall establish a methodology for evaluating
15their effectiveness and modifying the methodology based on the
16evaluation.
17    The Department shall establish a performance goal for
18primary care providers with respect to their female patients
19over age 40 receiving an annual mammogram. This performance
20goal shall be used to provide additional reimbursement in the
21form of a quality performance bonus to primary care providers
22who meet that goal.
23    The Department shall devise a means of case-managing or
24patient navigation for beneficiaries diagnosed with breast
25cancer. This program shall initially operate as a pilot
26program in areas of the State with the highest incidence of

 

 

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1mortality related to breast cancer. At least one pilot program
2site shall be in the metropolitan Chicago area and at least one
3site shall be outside the metropolitan Chicago area. On or
4after July 1, 2016, the pilot program shall be expanded to
5include one site in western Illinois, one site in southern
6Illinois, one site in central Illinois, and 4 sites within
7metropolitan Chicago. An evaluation of the pilot program shall
8be carried out measuring health outcomes and cost of care for
9those served by the pilot program compared to similarly
10situated patients who are not served by the pilot program.
11    The Department shall require all networks of care to
12develop a means either internally or by contract with experts
13in navigation and community outreach to navigate cancer
14patients to comprehensive care in a timely fashion. The
15Department shall require all networks of care to include
16access for patients diagnosed with cancer to at least one
17academic commission on cancer-accredited cancer program as an
18in-network covered benefit.
19    On or after July 1, 2022, individuals who are otherwise
20eligible for medical assistance under this Article shall
21receive coverage for perinatal depression screenings for the
2212-month period beginning on the last day of their pregnancy.
23Medical assistance coverage under this paragraph shall be
24conditioned on the use of a screening instrument approved by
25the Department.
26    Any medical or health care provider shall immediately

 

 

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1recommend, to any pregnant individual who is being provided
2prenatal services and is suspected of having a substance use
3disorder as defined in the Substance Use Disorder Act,
4referral to a local substance use disorder treatment program
5licensed by the Department of Human Services or to a licensed
6hospital which provides substance abuse treatment services.
7The Department of Healthcare and Family Services shall assure
8coverage for the cost of treatment of the drug abuse or
9addiction for pregnant recipients in accordance with the
10Illinois Medicaid Program in conjunction with the Department
11of Human Services.
12    All medical providers providing medical assistance to
13pregnant individuals under this Code shall receive information
14from the Department on the availability of services under any
15program providing case management services for addicted
16individuals, including information on appropriate referrals
17for other social services that may be needed by addicted
18individuals in addition to treatment for addiction.
19    The Illinois Department, in cooperation with the
20Departments of Human Services (as successor to the Department
21of Alcoholism and Substance Abuse) and Public Health, through
22a public awareness campaign, may provide information
23concerning treatment for alcoholism and drug abuse and
24addiction, prenatal health care, and other pertinent programs
25directed at reducing the number of drug-affected infants born
26to recipients of medical assistance.

 

 

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1    Neither the Department of Healthcare and Family Services
2nor the Department of Human Services shall sanction the
3recipient solely on the basis of the recipient's substance
4abuse.
5    The Illinois Department shall establish such regulations
6governing the dispensing of health services under this Article
7as it shall deem appropriate. The Department should seek the
8advice of formal professional advisory committees appointed by
9the Director of the Illinois Department for the purpose of
10providing regular advice on policy and administrative matters,
11information dissemination and educational activities for
12medical and health care providers, and consistency in
13procedures to the Illinois Department.
14    The Illinois Department may develop and contract with
15Partnerships of medical providers to arrange medical services
16for persons eligible under Section 5-2 of this Code.
17Implementation of this Section may be by demonstration
18projects in certain geographic areas. The Partnership shall be
19represented by a sponsor organization. The Department, by
20rule, shall develop qualifications for sponsors of
21Partnerships. Nothing in this Section shall be construed to
22require that the sponsor organization be a medical
23organization.
24    The sponsor must negotiate formal written contracts with
25medical providers for physician services, inpatient and
26outpatient hospital care, home health services, treatment for

 

 

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1alcoholism and substance abuse, and other services determined
2necessary by the Illinois Department by rule for delivery by
3Partnerships. Physician services must include prenatal and
4obstetrical care. The Illinois Department shall reimburse
5medical services delivered by Partnership providers to clients
6in target areas according to provisions of this Article and
7the Illinois Health Finance Reform Act, except that:
8        (1) Physicians participating in a Partnership and
9    providing certain services, which shall be determined by
10    the Illinois Department, to persons in areas covered by
11    the Partnership may receive an additional surcharge for
12    such services.
13        (2) The Department may elect to consider and negotiate
14    financial incentives to encourage the development of
15    Partnerships and the efficient delivery of medical care.
16        (3) Persons receiving medical services through
17    Partnerships may receive medical and case management
18    services above the level usually offered through the
19    medical assistance program.
20    Medical providers shall be required to meet certain
21qualifications to participate in Partnerships to ensure the
22delivery of high quality medical services. These
23qualifications shall be determined by rule of the Illinois
24Department and may be higher than qualifications for
25participation in the medical assistance program. Partnership
26sponsors may prescribe reasonable additional qualifications

 

 

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1for participation by medical providers, only with the prior
2written approval of the Illinois Department.
3    Nothing in this Section shall limit the free choice of
4practitioners, hospitals, and other providers of medical
5services by clients. In order to ensure patient freedom of
6choice, the Illinois Department shall immediately promulgate
7all rules and take all other necessary actions so that
8provided services may be accessed from therapeutically
9certified optometrists to the full extent of the Illinois
10Optometric Practice Act of 1987 without discriminating between
11service providers.
12    The Department shall apply for a waiver from the United
13States Health Care Financing Administration to allow for the
14implementation of Partnerships under this Section.
15    The Illinois Department shall require health care
16providers to maintain records that document the medical care
17and services provided to recipients of Medical Assistance
18under this Article. Such records must be retained for a period
19of not less than 6 years from the date of service or as
20provided by applicable State law, whichever period is longer,
21except that if an audit is initiated within the required
22retention period then the records must be retained until the
23audit is completed and every exception is resolved. The
24Illinois Department shall require health care providers to
25make available, when authorized by the patient, in writing,
26the medical records in a timely fashion to other health care

 

 

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1providers who are treating or serving persons eligible for
2Medical Assistance under this Article. All dispensers of
3medical services shall be required to maintain and retain
4business and professional records sufficient to fully and
5accurately document the nature, scope, details and receipt of
6the health care provided to persons eligible for medical
7assistance under this Code, in accordance with regulations
8promulgated by the Illinois Department. The rules and
9regulations shall require that proof of the receipt of
10prescription drugs, dentures, prosthetic devices and
11eyeglasses by eligible persons under this Section accompany
12each claim for reimbursement submitted by the dispenser of
13such medical services. No such claims for reimbursement shall
14be approved for payment by the Illinois Department without
15such proof of receipt, unless the Illinois Department shall
16have put into effect and shall be operating a system of
17post-payment audit and review which shall, on a sampling
18basis, be deemed adequate by the Illinois Department to assure
19that such drugs, dentures, prosthetic devices and eyeglasses
20for which payment is being made are actually being received by
21eligible recipients. Within 90 days after September 16, 1984
22(the effective date of Public Act 83-1439), the Illinois
23Department shall establish a current list of acquisition costs
24for all prosthetic devices and any other items recognized as
25medical equipment and supplies reimbursable under this Article
26and shall update such list on a quarterly basis, except that

 

 

HB5586- 52 -LRB102 25158 KTG 34421 b

1the acquisition costs of all prescription drugs shall be
2updated no less frequently than every 30 days as required by
3Section 5-5.12.
4    Notwithstanding any other law to the contrary, the
5Illinois Department shall, within 365 days after July 22, 2013
6(the effective date of Public Act 98-104), establish
7procedures to permit skilled care facilities licensed under
8the Nursing Home Care Act to submit monthly billing claims for
9reimbursement purposes. Following development of these
10procedures, the Department shall, by July 1, 2016, test the
11viability of the new system and implement any necessary
12operational or structural changes to its information
13technology platforms in order to allow for the direct
14acceptance and payment of nursing home claims.
15    Notwithstanding any other law to the contrary, the
16Illinois Department shall, within 365 days after August 15,
172014 (the effective date of Public Act 98-963), establish
18procedures to permit ID/DD facilities licensed under the ID/DD
19Community Care Act and MC/DD facilities licensed under the
20MC/DD Act to submit monthly billing claims for reimbursement
21purposes. Following development of these procedures, the
22Department shall have an additional 365 days to test the
23viability of the new system and to ensure that any necessary
24operational or structural changes to its information
25technology platforms are implemented.
26    The Illinois Department shall require all dispensers of

 

 

HB5586- 53 -LRB102 25158 KTG 34421 b

1medical services, other than an individual practitioner or
2group of practitioners, desiring to participate in the Medical
3Assistance program established under this Article to disclose
4all financial, beneficial, ownership, equity, surety or other
5interests in any and all firms, corporations, partnerships,
6associations, business enterprises, joint ventures, agencies,
7institutions or other legal entities providing any form of
8health care services in this State under this Article.
9    The Illinois Department may require that all dispensers of
10medical services desiring to participate in the medical
11assistance program established under this Article disclose,
12under such terms and conditions as the Illinois Department may
13by rule establish, all inquiries from clients and attorneys
14regarding medical bills paid by the Illinois Department, which
15inquiries could indicate potential existence of claims or
16liens for the Illinois Department.
17    Enrollment of a vendor shall be subject to a provisional
18period and shall be conditional for one year. During the
19period of conditional enrollment, the Department may terminate
20the vendor's eligibility to participate in, or may disenroll
21the vendor from, the medical assistance program without cause.
22Unless otherwise specified, such termination of eligibility or
23disenrollment is not subject to the Department's hearing
24process. However, a disenrolled vendor may reapply without
25penalty.
26    The Department has the discretion to limit the conditional

 

 

HB5586- 54 -LRB102 25158 KTG 34421 b

1enrollment period for vendors based upon category of risk of
2the vendor.
3    Prior to enrollment and during the conditional enrollment
4period in the medical assistance program, all vendors shall be
5subject to enhanced oversight, screening, and review based on
6the risk of fraud, waste, and abuse that is posed by the
7category of risk of the vendor. The Illinois Department shall
8establish the procedures for oversight, screening, and review,
9which may include, but need not be limited to: criminal and
10financial background checks; fingerprinting; license,
11certification, and authorization verifications; unscheduled or
12unannounced site visits; database checks; prepayment audit
13reviews; audits; payment caps; payment suspensions; and other
14screening as required by federal or State law.
15    The Department shall define or specify the following: (i)
16by provider notice, the "category of risk of the vendor" for
17each type of vendor, which shall take into account the level of
18screening applicable to a particular category of vendor under
19federal law and regulations; (ii) by rule or provider notice,
20the maximum length of the conditional enrollment period for
21each category of risk of the vendor; and (iii) by rule, the
22hearing rights, if any, afforded to a vendor in each category
23of risk of the vendor that is terminated or disenrolled during
24the conditional enrollment period.
25    To be eligible for payment consideration, a vendor's
26payment claim or bill, either as an initial claim or as a

 

 

HB5586- 55 -LRB102 25158 KTG 34421 b

1resubmitted claim following prior rejection, must be received
2by the Illinois Department, or its fiscal intermediary, no
3later than 180 days after the latest date on the claim on which
4medical goods or services were provided, with the following
5exceptions:
6        (1) In the case of a provider whose enrollment is in
7    process by the Illinois Department, the 180-day period
8    shall not begin until the date on the written notice from
9    the Illinois Department that the provider enrollment is
10    complete.
11        (2) In the case of errors attributable to the Illinois
12    Department or any of its claims processing intermediaries
13    which result in an inability to receive, process, or
14    adjudicate a claim, the 180-day period shall not begin
15    until the provider has been notified of the error.
16        (3) In the case of a provider for whom the Illinois
17    Department initiates the monthly billing process.
18        (4) In the case of a provider operated by a unit of
19    local government with a population exceeding 3,000,000
20    when local government funds finance federal participation
21    for claims payments.
22    For claims for services rendered during a period for which
23a recipient received retroactive eligibility, claims must be
24filed within 180 days after the Department determines the
25applicant is eligible. For claims for which the Illinois
26Department is not the primary payer, claims must be submitted

 

 

HB5586- 56 -LRB102 25158 KTG 34421 b

1to the Illinois Department within 180 days after the final
2adjudication by the primary payer.
3    In the case of long term care facilities, within 120
4calendar days of receipt by the facility of required
5prescreening information, new admissions with associated
6admission documents shall be submitted through the Medical
7Electronic Data Interchange (MEDI) or the Recipient
8Eligibility Verification (REV) System or shall be submitted
9directly to the Department of Human Services using required
10admission forms. Effective September 1, 2014, admission
11documents, including all prescreening information, must be
12submitted through MEDI or REV. Confirmation numbers assigned
13to an accepted transaction shall be retained by a facility to
14verify timely submittal. Once an admission transaction has
15been completed, all resubmitted claims following prior
16rejection are subject to receipt no later than 180 days after
17the admission transaction has been completed.
18    Claims that are not submitted and received in compliance
19with the foregoing requirements shall not be eligible for
20payment under the medical assistance program, and the State
21shall have no liability for payment of those claims.
22    To the extent consistent with applicable information and
23privacy, security, and disclosure laws, State and federal
24agencies and departments shall provide the Illinois Department
25access to confidential and other information and data
26necessary to perform eligibility and payment verifications and

 

 

HB5586- 57 -LRB102 25158 KTG 34421 b

1other Illinois Department functions. This includes, but is not
2limited to: information pertaining to licensure;
3certification; earnings; immigration status; citizenship; wage
4reporting; unearned and earned income; pension income;
5employment; supplemental security income; social security
6numbers; National Provider Identifier (NPI) numbers; the
7National Practitioner Data Bank (NPDB); program and agency
8exclusions; taxpayer identification numbers; tax delinquency;
9corporate information; and death records.
10    The Illinois Department shall enter into agreements with
11State agencies and departments, and is authorized to enter
12into agreements with federal agencies and departments, under
13which such agencies and departments shall share data necessary
14for medical assistance program integrity functions and
15oversight. The Illinois Department shall develop, in
16cooperation with other State departments and agencies, and in
17compliance with applicable federal laws and regulations,
18appropriate and effective methods to share such data. At a
19minimum, and to the extent necessary to provide data sharing,
20the Illinois Department shall enter into agreements with State
21agencies and departments, and is authorized to enter into
22agreements with federal agencies and departments, including,
23but not limited to: the Secretary of State; the Department of
24Revenue; the Department of Public Health; the Department of
25Human Services; and the Department of Financial and
26Professional Regulation.

 

 

HB5586- 58 -LRB102 25158 KTG 34421 b

1    Beginning in fiscal year 2013, the Illinois Department
2shall set forth a request for information to identify the
3benefits of a pre-payment, post-adjudication, and post-edit
4claims system with the goals of streamlining claims processing
5and provider reimbursement, reducing the number of pending or
6rejected claims, and helping to ensure a more transparent
7adjudication process through the utilization of: (i) provider
8data verification and provider screening technology; and (ii)
9clinical code editing; and (iii) pre-pay, pre- or
10post-adjudicated predictive modeling with an integrated case
11management system with link analysis. Such a request for
12information shall not be considered as a request for proposal
13or as an obligation on the part of the Illinois Department to
14take any action or acquire any products or services.
15    The Illinois Department shall establish policies,
16procedures, standards and criteria by rule for the
17acquisition, repair and replacement of orthotic and prosthetic
18devices and durable medical equipment. Such rules shall
19provide, but not be limited to, the following services: (1)
20immediate repair or replacement of such devices by recipients;
21and (2) rental, lease, purchase or lease-purchase of durable
22medical equipment in a cost-effective manner, taking into
23consideration the recipient's medical prognosis, the extent of
24the recipient's needs, and the requirements and costs for
25maintaining such equipment. Subject to prior approval, such
26rules shall enable a recipient to temporarily acquire and use

 

 

HB5586- 59 -LRB102 25158 KTG 34421 b

1alternative or substitute devices or equipment pending repairs
2or replacements of any device or equipment previously
3authorized for such recipient by the Department.
4Notwithstanding any provision of Section 5-5f to the contrary,
5the Department may, by rule, exempt certain replacement
6wheelchair parts from prior approval and, for wheelchairs,
7wheelchair parts, wheelchair accessories, and related seating
8and positioning items, determine the wholesale price by
9methods other than actual acquisition costs.
10    The Department shall require, by rule, all providers of
11durable medical equipment to be accredited by an accreditation
12organization approved by the federal Centers for Medicare and
13Medicaid Services and recognized by the Department in order to
14bill the Department for providing durable medical equipment to
15recipients. No later than 15 months after the effective date
16of the rule adopted pursuant to this paragraph, all providers
17must meet the accreditation requirement.
18    In order to promote environmental responsibility, meet the
19needs of recipients and enrollees, and achieve significant
20cost savings, the Department, or a managed care organization
21under contract with the Department, may provide recipients or
22managed care enrollees who have a prescription or Certificate
23of Medical Necessity access to refurbished durable medical
24equipment under this Section (excluding prosthetic and
25orthotic devices as defined in the Orthotics, Prosthetics, and
26Pedorthics Practice Act and complex rehabilitation technology

 

 

HB5586- 60 -LRB102 25158 KTG 34421 b

1products and associated services) through the State's
2assistive technology program's reutilization program, using
3staff with the Assistive Technology Professional (ATP)
4Certification if the refurbished durable medical equipment:
5(i) is available; (ii) is less expensive, including shipping
6costs, than new durable medical equipment of the same type;
7(iii) is able to withstand at least 3 years of use; (iv) is
8cleaned, disinfected, sterilized, and safe in accordance with
9federal Food and Drug Administration regulations and guidance
10governing the reprocessing of medical devices in health care
11settings; and (v) equally meets the needs of the recipient or
12enrollee. The reutilization program shall confirm that the
13recipient or enrollee is not already in receipt of the same or
14similar equipment from another service provider, and that the
15refurbished durable medical equipment equally meets the needs
16of the recipient or enrollee. Nothing in this paragraph shall
17be construed to limit recipient or enrollee choice to obtain
18new durable medical equipment or place any additional prior
19authorization conditions on enrollees of managed care
20organizations.
21    The Department shall execute, relative to the nursing home
22prescreening project, written inter-agency agreements with the
23Department of Human Services and the Department on Aging, to
24effect the following: (i) intake procedures and common
25eligibility criteria for those persons who are receiving
26non-institutional services; and (ii) the establishment and

 

 

HB5586- 61 -LRB102 25158 KTG 34421 b

1development of non-institutional services in areas of the
2State where they are not currently available or are
3undeveloped; and (iii) notwithstanding any other provision of
4law, subject to federal approval, on and after July 1, 2012, an
5increase in the determination of need (DON) scores from 29 to
637 for applicants for institutional and home and
7community-based long term care; if and only if federal
8approval is not granted, the Department may, in conjunction
9with other affected agencies, implement utilization controls
10or changes in benefit packages to effectuate a similar savings
11amount for this population; and (iv) no later than July 1,
122013, minimum level of care eligibility criteria for
13institutional and home and community-based long term care; and
14(v) no later than October 1, 2013, establish procedures to
15permit long term care providers access to eligibility scores
16for individuals with an admission date who are seeking or
17receiving services from the long term care provider. In order
18to select the minimum level of care eligibility criteria, the
19Governor shall establish a workgroup that includes affected
20agency representatives and stakeholders representing the
21institutional and home and community-based long term care
22interests. This Section shall not restrict the Department from
23implementing lower level of care eligibility criteria for
24community-based services in circumstances where federal
25approval has been granted.
26    Notwithstanding any other law or rule and subject to

 

 

HB5586- 62 -LRB102 25158 KTG 34421 b

1federal approval, beginning on the effective date of this
2amendatory Act of the 102nd General Assembly through December
331, 2022, individuals who reside in rural and other
4underserved communities that are disproportionately impacted
5by COVID-19 shall be exempt from determination of need
6approval for institutional and home and community-based long
7term services. Notwithstanding any other law or rule,
8beginning on the effective date of this amendatory Act of the
9102nd General Assembly through December 31, 2022, any hours of
10home health care services not utilized in accordance with an
11individual's service plan due to staff shortages resulting
12from the COVID-19 public health emergency shall roll over into
13the next service month under the individual's plan. The
14Department may adopt rules to implement this paragraph.
15    The Illinois Department shall develop and operate, in
16cooperation with other State Departments and agencies and in
17compliance with applicable federal laws and regulations,
18appropriate and effective systems of health care evaluation
19and programs for monitoring of utilization of health care
20services and facilities, as it affects persons eligible for
21medical assistance under this Code.
22    The Illinois Department shall report annually to the
23General Assembly, no later than the second Friday in April of
241979 and each year thereafter, in regard to:
25        (a) actual statistics and trends in utilization of
26    medical services by public aid recipients;

 

 

HB5586- 63 -LRB102 25158 KTG 34421 b

1        (b) actual statistics and trends in the provision of
2    the various medical services by medical vendors;
3        (c) current rate structures and proposed changes in
4    those rate structures for the various medical vendors; and
5        (d) efforts at utilization review and control by the
6    Illinois Department.
7    The period covered by each report shall be the 3 years
8ending on the June 30 prior to the report. The report shall
9include suggested legislation for consideration by the General
10Assembly. The requirement for reporting to the General
11Assembly shall be satisfied by filing copies of the report as
12required by Section 3.1 of the General Assembly Organization
13Act, and filing such additional copies with the State
14Government Report Distribution Center for the General Assembly
15as is required under paragraph (t) of Section 7 of the State
16Library Act.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23    On and after July 1, 2012, the Department shall reduce any
24rate of reimbursement for services or other payments or alter
25any methodologies authorized by this Code to reduce any rate
26of reimbursement for services or other payments in accordance

 

 

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1with Section 5-5e.
2    Because kidney transplantation can be an appropriate,
3cost-effective alternative to renal dialysis when medically
4necessary and notwithstanding the provisions of Section 1-11
5of this Code, beginning October 1, 2014, the Department shall
6cover kidney transplantation for noncitizens with end-stage
7renal disease who are not eligible for comprehensive medical
8benefits, who meet the residency requirements of Section 5-3
9of this Code, and who would otherwise meet the financial
10requirements of the appropriate class of eligible persons
11under Section 5-2 of this Code. To qualify for coverage of
12kidney transplantation, such person must be receiving
13emergency renal dialysis services covered by the Department.
14Providers under this Section shall be prior approved and
15certified by the Department to perform kidney transplantation
16and the services under this Section shall be limited to
17services associated with kidney transplantation.
18    Notwithstanding any other provision of this Code to the
19contrary, on or after July 1, 2015, all FDA approved forms of
20medication assisted treatment prescribed for the treatment of
21alcohol dependence or treatment of opioid dependence shall be
22covered under both fee for service and managed care medical
23assistance programs for persons who are otherwise eligible for
24medical assistance under this Article and shall not be subject
25to any (1) utilization control, other than those established
26under the American Society of Addiction Medicine patient

 

 

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1placement criteria, (2) prior authorization mandate, or (3)
2lifetime restriction limit mandate.
3    On or after July 1, 2015, opioid antagonists prescribed
4for the treatment of an opioid overdose, including the
5medication product, administration devices, and any pharmacy
6fees or hospital fees related to the dispensing, distribution,
7and administration of the opioid antagonist, shall be covered
8under the medical assistance program for persons who are
9otherwise eligible for medical assistance under this Article.
10As used in this Section, "opioid antagonist" means a drug that
11binds to opioid receptors and blocks or inhibits the effect of
12opioids acting on those receptors, including, but not limited
13to, naloxone hydrochloride or any other similarly acting drug
14approved by the U.S. Food and Drug Administration.
15    Upon federal approval, the Department shall provide
16coverage and reimbursement for all drugs that are approved for
17marketing by the federal Food and Drug Administration and that
18are recommended by the federal Public Health Service or the
19United States Centers for Disease Control and Prevention for
20pre-exposure prophylaxis and related pre-exposure prophylaxis
21services, including, but not limited to, HIV and sexually
22transmitted infection screening, treatment for sexually
23transmitted infections, medical monitoring, assorted labs, and
24counseling to reduce the likelihood of HIV infection among
25individuals who are not infected with HIV but who are at high
26risk of HIV infection.

 

 

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1    A federally qualified health center, as defined in Section
21905(l)(2)(B) of the federal Social Security Act, shall be
3reimbursed by the Department in accordance with the federally
4qualified health center's encounter rate for services provided
5to medical assistance recipients that are performed by a
6dental hygienist, as defined under the Illinois Dental
7Practice Act, working under the general supervision of a
8dentist and employed by a federally qualified health center.
9    Within 90 days after October 8, 2021 (the effective date
10of Public Act 102-665) this amendatory Act of the 102nd
11General Assembly, the Department shall seek federal approval
12of a State Plan amendment to expand coverage for family
13planning services that includes presumptive eligibility to
14individuals whose income is at or below 208% of the federal
15poverty level. Coverage under this Section shall be effective
16beginning no later than December 1, 2022.
17    Subject to approval by the federal Centers for Medicare
18and Medicaid Services of a Title XIX State Plan amendment
19electing the Program of All-Inclusive Care for the Elderly
20(PACE) as a State Medicaid option, as provided for by Subtitle
21I (commencing with Section 4801) of Title IV of the Balanced
22Budget Act of 1997 (Public Law 105-33) and Part 460
23(commencing with Section 460.2) of Subchapter E of Title 42 of
24the Code of Federal Regulations, PACE program services shall
25become a covered benefit of the medical assistance program,
26subject to criteria established in accordance with all

 

 

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1applicable laws.
2    Notwithstanding any other provision of this Code,
3community-based pediatric palliative care from a trained
4interdisciplinary team shall be covered under the medical
5assistance program as provided in Section 15 of the Pediatric
6Palliative Care Act.
7(Source: P.A. 101-209, eff. 8-5-19; 101-580, eff. 1-1-20;
8102-43, Article 30, Section 30-5, eff. 7-6-21; 102-43, Article
935, Section 35-5, eff. 7-6-21; 102-43, Article 55, Section
1055-5, eff. 7-6-21; 102-95, eff. 1-1-22; 102-123, eff. 1-1-22;
11102-558, eff. 8-20-21; 102-598, eff. 1-1-22; 102-655, eff.
121-1-22; 102-665, eff. 10-8-21; revised 11-18-21.)
 
13    (305 ILCS 5/5-5.01a)
14    Sec. 5-5.01a. Supportive living facilities program.
15    (a) The Department shall establish and provide oversight
16for a program of supportive living facilities that seek to
17promote resident independence, dignity, respect, and
18well-being in the most cost-effective manner.
19    A supportive living facility is (i) a free-standing
20facility or (ii) a distinct physical and operational entity
21within a mixed-use building that meets the criteria
22established in subsection (d). A supportive living facility
23integrates housing with health, personal care, and supportive
24services and is a designated setting that offers residents
25their own separate, private, and distinct living units.

 

 

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1    Sites for the operation of the program shall be selected
2by the Department based upon criteria that may include the
3need for services in a geographic area, the availability of
4funding, and the site's ability to meet the standards.
5    (b) Beginning July 1, 2014, subject to federal approval,
6the Medicaid rates for supportive living facilities shall be
7equal to the supportive living facility Medicaid rate
8effective on June 30, 2014 increased by 8.85%. Once the
9assessment imposed at Article V-G of this Code is determined
10to be a permissible tax under Title XIX of the Social Security
11Act, the Department shall increase the Medicaid rates for
12supportive living facilities effective on July 1, 2014 by
139.09%. The Department shall apply this increase retroactively
14to coincide with the imposition of the assessment in Article
15V-G of this Code in accordance with the approval for federal
16financial participation by the Centers for Medicare and
17Medicaid Services.
18    The Medicaid rates for supportive living facilities
19effective on July 1, 2017 must be equal to the rates in effect
20for supportive living facilities on June 30, 2017 increased by
212.8%.
22    Subject to federal approval, the Medicaid rates for
23supportive living services on and after July 1, 2019 must be at
24least 54.3% of the average total nursing facility services per
25diem for the geographic areas defined by the Department while
26maintaining the rate differential for dementia care and must

 

 

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1be updated whenever the total nursing facility service per
2diems are updated.
3    (c) The Department may adopt rules to implement this
4Section. Rules that establish or modify the services,
5standards, and conditions for participation in the program
6shall be adopted by the Department in consultation with the
7Department on Aging, the Department of Rehabilitation
8Services, and the Department of Mental Health and
9Developmental Disabilities (or their successor agencies).
10    (d) Subject to federal approval by the Centers for
11Medicare and Medicaid Services, the Department shall accept
12for consideration of certification under the program any
13application for a site or building where distinct parts of the
14site or building are designated for purposes other than the
15provision of supportive living services, but only if:
16        (1) those distinct parts of the site or building are
17    not designated for the purpose of providing assisted
18    living services as required under the Assisted Living and
19    Shared Housing Act;
20        (2) those distinct parts of the site or building are
21    completely separate from the part of the building used for
22    the provision of supportive living program services,
23    including separate entrances;
24        (3) those distinct parts of the site or building do
25    not share any common spaces with the part of the building
26    used for the provision of supportive living program

 

 

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1    services; and
2        (4) those distinct parts of the site or building do
3    not share staffing with the part of the building used for
4    the provision of supportive living program services.
5    (e) Facilities or distinct parts of facilities which are
6selected as supportive living facilities and are in good
7standing with the Department's rules are exempt from the
8provisions of the Nursing Home Care Act and the Illinois
9Health Facilities Planning Act.
10    (f) Section 9817 of the American Rescue Plan Act of 2021
11(Public Law 117-2) authorizes a 10% enhanced federal medical
12assistance percentage for supportive living services for a
1312-month period from April 1, 2021 through March 31, 2022.
14Subject to federal approval, including the approval of any
15necessary waiver amendments or other federally required
16documents or assurances, for a 12-month period the Department
17must pay a supplemental $26 per diem rate to all supportive
18living facilities with the additional federal financial
19participation funds that result from the enhanced federal
20medical assistance percentage from April 1, 2021 through March
2131, 2022. The Department may issue parameters around how the
22supplemental payment should be spent, including quality
23improvement activities. The Department may alter the form,
24methods, or timeframes concerning the supplemental per diem
25rate to comply with any subsequent changes to federal law,
26changes made by guidance issued by the federal Centers for

 

 

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1Medicare and Medicaid Services, or other changes necessary to
2receive the enhanced federal medical assistance percentage.
3    (g) Notwithstanding any other law or rule, beginning on
4the effective date of this amendatory Act of the 102nd General
5Assembly through December 31, 2022, individuals who reside in
6rural and other underserved communities that are
7disproportionately impacted by COVID-19 shall be exempt from
8determination of need approval for institutional and home and
9community-based long term services. Notwithstanding any other
10law or rule, beginning on the effective date of this
11amendatory Act of the 102nd General Assembly through December
1231, 2022, any hours of home health care services not utilized
13in accordance with an individual's service plan due to staff
14shortages resulting from the COVID-19 public health emergency
15shall roll over into the next service month under the
16individual's plan. The Department may adopt rules to implement
17this paragraph.
18(Source: P.A. 101-10, eff. 6-5-19; 102-43, eff. 7-6-21.)
 
19    Section 99. Effective date. This Act takes effect upon
20becoming law.