Rep. Lee A. Daniels
Filed: 5/28/2004
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1 | AMENDMENT TO SENATE BILL 2367
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2 | AMENDMENT NO. ______. Amend Senate Bill 2367, AS AMENDED, | ||||||
3 | by replacing everything after the enacting clause with the | ||||||
4 | following:
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5 | "Section 5. The Department of Human Services Act is amended | ||||||
6 | by adding Sections 1-35, 1-36, and 1-40 as follows: | ||||||
7 | (20 ILCS 1305/1-35 new) | ||||||
8 | Sec. 1-35. Community-based services contracting pilot | ||||||
9 | project. | ||||||
10 | (a) The Department of Human Services may initiate a 2-year | ||||||
11 | pilot project aimed at the improvement of delivery of | ||||||
12 | community-based services by contract, which will increase the | ||||||
13 | number of service contracts open to a competitive selection | ||||||
14 | process and utilize performance-based contracts in the | ||||||
15 | provision of such services. Only contracts for community-based | ||||||
16 | services executed under this project shall be subject to a | ||||||
17 | competitive selection process and performance measurement. | ||||||
18 | Nothing in this Section prohibits the continuation of contracts | ||||||
19 | that were subject to requests for proposals and executed before | ||||||
20 | June 30, 2004. | ||||||
21 | If implemented, the pilot project authorized by this | ||||||
22 | Section shall be directed toward community-based services that | ||||||
23 | assist Illinois residents in achieving self-sufficiency, | ||||||
24 | independence and health to the maximum extent possible by |
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1 | providing integrated family-oriented services, promoting | ||||||
2 | prevention, and establishing measurable outcomes in | ||||||
3 | partnership with communities. | ||||||
4 | The 2-year pilot project must be implemented in a manner | ||||||
5 | that ensures the continuation of existing client and provider | ||||||
6 | relationships to the maximum extent possible in cases where | ||||||
7 | there is an ongoing plan of treatment. The pilot project shall | ||||||
8 | ensure that "critical access" providers of services, as defined | ||||||
9 | by rule, continue to provide essential services to the | ||||||
10 | communities serving persons who need such services. | ||||||
11 | (b) For the fiscal year beginning July 1, 2004, the | ||||||
12 | Department shall limit the total amount of expenditures for the | ||||||
13 | contracts issued under this project to $64,000,000 with respect | ||||||
14 | to no more than the following services:
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15 | (1) Mental Health: Screening and Support Services.
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16 | (2) Mental Health: Preadmission Assessment and | ||||||
17 | Screening.
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18 | (3) Rehabilitation Services: Extended Services | ||||||
19 | Programs.
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20 | (4) Alcoholism and Substance Abuse: HIV Counseling and | ||||||
21 | Testing.
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22 | (5) Alcoholism and Substance Abuse: Technical | ||||||
23 | Assistance.
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24 | (6) Developmental Disabilities: Self-Advocacy | ||||||
25 | Training.
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26 | (7) Developmental Disabilities: Enhanced Respite | ||||||
27 | Services in Underserved Areas.
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28 | (8) Community Health and Prevention: Abstinence Only | ||||||
29 | Education.
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30 | (9) Community Health and Prevention: Early | ||||||
31 | Intervention and Family Connections.
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32 | (10) Community Health and Prevention: Crossroads | ||||||
33 | Program.
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34 | (11) Community Health and Prevention: Family Planning.
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1 | (12) Human Capital Development: Temporary Assistance | ||||||
2 | for Needy Families (TANF) - Work First.
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3 | (13) Human Capital Development: Temporary Assistance | ||||||
4 | for Needy Families (TANF) - Job Placement with Retention.
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5 | (14) Human Capital Development: Food Stamp Employment | ||||||
6 | and Training with retention.
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7 | (15) Human Capital Development: Emergency Food | ||||||
8 | Program.
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9 | (16) Human Capital Development: Emergency Food and | ||||||
10 | Shelter Program.
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11 | (17) Human Capital Development: Donated Funds | ||||||
12 | Initiative Employability Development Service (EDS). | ||||||
13 | The amount of the contracts to be issued and the programs | ||||||
14 | affected for subsequent fiscal years shall be established by | ||||||
15 | rule, which must be proposed by March 1 of each year. | ||||||
16 | (c) The Department must track real outcomes and | ||||||
17 | achievements that improve the quality of life for people. | ||||||
18 | Prospective bidders must provide affirmative statements in the | ||||||
19 | proposals submitted regarding the services to be provided and | ||||||
20 | the outcomes expected. Performance measurements must be | ||||||
21 | incorporated into the requests-for-proposals. Deliverables | ||||||
22 | must demonstrate performance and actual outcomes achieved. | ||||||
23 | Under the performance-based contracting system, providers must | ||||||
24 | be measured on the indicators set forth in the proposals | ||||||
25 | submitted and the contracts formally executed. Under this pilot | ||||||
26 | project, the Department shall not re-bid all of the community | ||||||
27 | service contracts under its jurisdiction. The Department may | ||||||
28 | only issue requests-for-proposals where an improved system is | ||||||
29 | expected to result. The Department may execute multi-year | ||||||
30 | agreements, when applicable, with annual renewals. | ||||||
31 | (d) Contracts under this Section shall include provisions | ||||||
32 | for (i) adequate and timely notice to a provider of any | ||||||
33 | determination by the Department that the provider is not in | ||||||
34 | compliance with the contract or any standards of performance |
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1 | and (ii) an opportunity for the provider to take corrective | ||||||
2 | action. A contract may be terminated if the provider fails to | ||||||
3 | take corrective action. In the event of a contract termination, | ||||||
4 | the Department must ensure that eligible persons receiving | ||||||
5 | services under the contract will otherwise continue to receive | ||||||
6 | necessary services in the community.
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7 | (e) Additional procedures, supplementary payments, or | ||||||
8 | special rates may be adopted and implemented by the Department | ||||||
9 | to ensure that unique circumstances of local areas, as defined | ||||||
10 | by rule, can be met, including but not limited to circumstances | ||||||
11 | in which there are not sufficient services available to meet | ||||||
12 | basic needs or in which there is a need for specialty care.
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13 | (f) The Department must consult with stakeholders and | ||||||
14 | consumers in the implementation of this pilot project. The | ||||||
15 | Department must periodically conduct regional focus group | ||||||
16 | discussions with stakeholders (including consumers and | ||||||
17 | providers), legislators, foundations, trade associations, and | ||||||
18 | advocacy groups in the administration of and evaluation of this | ||||||
19 | system. The Department must implement a system using internet | ||||||
20 | technology under which concerned individuals will be able to | ||||||
21 | submit inquiries and receive responses about the system. The | ||||||
22 | Department must issue quarterly reports and post on its | ||||||
23 | internet website information about this project, information | ||||||
24 | about roundtable discussions with stakeholders, the content | ||||||
25 | and postings regarding the request-for-proposal process, the | ||||||
26 | Department's work with foundations and other experts in | ||||||
27 | grant-making, the evaluation of the request-for-proposal | ||||||
28 | processes, and the Department's work with stakeholders in | ||||||
29 | establishing criteria that will govern the determination of | ||||||
30 | future additional program areas that may be included in the | ||||||
31 | request-for-proposal process. | ||||||
32 | (g) The Department must establish an "ombudsman" system | ||||||
33 | that will enable providers and consumers to resolve problems | ||||||
34 | and disputes. |
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1 | (h) The pilot project must be evaluated by an independent | ||||||
2 | contractor with expertise in such matters, and a preliminary | ||||||
3 | report on the progress and results of the project must be | ||||||
4 | submitted to the Governor and General Assembly by March 1, 2005 | ||||||
5 | and a final report March 1, 2006. The General Assembly may | ||||||
6 | authorize an expansion of this pilot project by adoption of a | ||||||
7 | joint resolution.
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8 | (20 ILCS 1305/1-36 new)
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9 | Sec. 1-36. Fee-for-service contracts. | ||||||
10 | (a) The Illinois Department of Human Services shall | ||||||
11 | implement policies and procedures for the procurement of | ||||||
12 | community services under its jurisdiction in a manner that will | ||||||
13 | ensure the maximum amount of federal financial participation in | ||||||
14 | the cost of such services. For the community services that may | ||||||
15 | be eligible for federal financial participation, the | ||||||
16 | Department of Human Services may issue and execute contracts | ||||||
17 | that include provisions for payment on a fee-for-service basis | ||||||
18 | after January 1, 2005 under the terms and conditions set forth | ||||||
19 | in this Section. The Department may implement, prior to January | ||||||
20 | 1, 2005, demonstrations of a payment system based on | ||||||
21 | fee-for-service contracts that will include any of the | ||||||
22 | categories of community services (alcoholism and substance | ||||||
23 | abuse, developmental disabilities, and mental health) for | ||||||
24 | which a memorandum of understanding has been issued under | ||||||
25 | subsection (d) of this Section. | ||||||
26 | (b) Contracts must ensure that the transition to a | ||||||
27 | fee-for-service payment methodology will not cause any person | ||||||
28 | receiving services to become ineligible or the level or quality | ||||||
29 | of their service to be diminished, nor cause any person to be | ||||||
30 | denied necessary services if the person is eligible for | ||||||
31 | services.
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32 | (c) The Department of Human Services, in consultation with | ||||||
33 | the departments of Public Aid, Public Health, and Children and |
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1 | Family Services and the Department on Aging, if applicable to | ||||||
2 | the services under contract, shall adopt rules establishing the | ||||||
3 | criteria, standards, and procedures for issuing the | ||||||
4 | fee-for-service contracts, including but not limited to the | ||||||
5 | conditions of participation, performance standards, fees to be | ||||||
6 | paid for the service, the schedule for payment of bills and | ||||||
7 | reimbursement of claims, and the methodology for reconciling | ||||||
8 | advance payments. The Department may adopt emergency rules for | ||||||
9 | the immediate implementation of the demonstrations authorized | ||||||
10 | by subsection (a) of this Section.
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11 | (d) The Department shall develop and issue a separate | ||||||
12 | memorandum of understanding in cooperation with community | ||||||
13 | providers of alcoholism and substance abuse services, | ||||||
14 | developmental disabilities services, and mental health | ||||||
15 | services. The memorandum shall delineate the criteria, | ||||||
16 | standards, and procedures agreed upon to be covered by the | ||||||
17 | rules. The Department may not issue any contracts under this | ||||||
18 | Section until it issues the memorandum.
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19 | (e) To ensure continuity of services for recipients of | ||||||
20 | community services administered by the Department, and to | ||||||
21 | ensure a smooth transition from any payment methodology not | ||||||
22 | based on fee-for-service contracts, the Department shall, | ||||||
23 | subject to appropriation, provide an aggregate amount of | ||||||
24 | funding through a combination of grants and contracts that will | ||||||
25 | at least maintain the same level of services in effect for the | ||||||
26 | prior fiscal year beginning July 1, 2003.
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27 | (f) The Department shall implement policies and procedures | ||||||
28 | for recipients and providers of services to submit inquiries | ||||||
29 | and resolve disputes with regard to the community services | ||||||
30 | subject to contracts under this Section.
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31 | (g) The Department shall require cost reports from | ||||||
32 | providers of community services, as prescribed by rule, for the | ||||||
33 | community services for which the Department of Human Services | ||||||
34 | will contract under this Section to determine the cost of |
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1 | services and other factors upon which the rates of payment | ||||||
2 | shall be based. The Department shall obtain an evaluation and | ||||||
3 | opinion by an independent certified public accountant | ||||||
4 | comparing reported costs and any proposed rates. | ||||||
5 | (h) The Department, in cooperation with representatives of | ||||||
6 | the providers of services through the Department's divisions of | ||||||
7 | Developmental Disabilities, Alcohol and Substance Abuse, and | ||||||
8 | Mental Health, shall, subject to the availability of funding, | ||||||
9 | conduct a comprehensive review of the methodology, used in | ||||||
10 | determining rates to be paid for community services after July | ||||||
11 | 1, 2004, that is in effect on the effective date of this | ||||||
12 | amendatory Act of the 93rd General Assembly. The Department | ||||||
13 | shall complete this review by November 1, 2004.
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14 | (20 ILCS 1305/1-40 new)
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15 | Sec. 1-40. Reserve of funding prohibited. Neither the | ||||||
16 | Governor nor the Governor's Office of Management and Budget, | ||||||
17 | nor anyone acting on behalf of either of those, shall direct or | ||||||
18 | require the reserve or impoundment, or otherwise prohibit the | ||||||
19 | expenditure, of moneys appropriated to the Department for the | ||||||
20 | purpose of funding services provided through the Department's | ||||||
21 | divisions of Developmental Disabilities, Alcohol and Substance | ||||||
22 | Abuse, and Mental Health, provided that any such expenditure is | ||||||
23 | made pursuant to the Department's powers and duties as provided | ||||||
24 | by law. | ||||||
25 | Section 10. The Mental Health and Developmental | ||||||
26 | Disabilities Administrative
Act is amended by adding Section | ||||||
27 | 18.5 as follows: | ||||||
28 | (20 ILCS 1705/18.5 new)
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29 | Sec. 18.5. Community Developmental Disability Services | ||||||
30 | Medicaid Trust Fund;
reimbursement.
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31 | (a) Any funds paid to the State by the federal government |
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1 | under Title XIX or
Title
XXI of the Social Security Act for | ||||||
2 | services delivered by community
developmental
disability | ||||||
3 | services providers, and any interest earned thereon, shall be
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4 | deposited directly
into the Community Developmental Disability | ||||||
5 | Services Medicaid Trust Fund.
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6 | (b) Moneys in the Community Developmental Disability | ||||||
7 | Services Medicaid Trust Fund, subject to annual appropriation, | ||||||
8 | shall be used to pay for Medicaid-reimbursed community | ||||||
9 | developmental disability services provided to eligible | ||||||
10 | individuals and chosen by the individual or his or her legal | ||||||
11 | guardian from available community services options. Once the | ||||||
12 | individual or legal guardian chooses the desired services, the | ||||||
13 | services are approved by the Department of Human Services, and | ||||||
14 | the provision of services is initiated, the Department shall | ||||||
15 | make payment to the community developmental disability | ||||||
16 | services provider. Prior to choosing a service or services, an | ||||||
17 | eligible individual or his or her legal guardian shall be fully | ||||||
18 | informed by the independent service coordination agency and the | ||||||
19 | provider of all available community services options.
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20 | (c) Funds spent under this Section shall not supplant other | ||||||
21 | funds appropriated from the General Revenue Fund for | ||||||
22 | community-based developmental disability services.
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23 | (d) For the purposes of this Section:
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24 | "Medicaid-reimbursed developmental disability services" | ||||||
25 | means services
provided by a community developmental | ||||||
26 | disability provider under an agreement
with the
Department that | ||||||
27 | is eligible for reimbursement under the federal Title XIX
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28 | program or
Title XXI program.
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29 | "Provider" means a community agency that is funded by the | ||||||
30 | Department to
provide a Medicaid-reimbursed service.
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31 | (20 ILCS 1705/18.1 rep.)
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32 | Section 11. The Mental Health and Developmental | ||||||
33 | Disabilities Administrative
Act is amended by repealing |
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1 | Section 18.1.
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2 | Section 15. The State Prompt Payment Act is amended by | ||||||
3 | changing Section 1 and adding Section 8 as follows:
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4 | (30 ILCS 540/1) (from Ch. 127, par. 132.401)
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5 | Sec. 1. This Act applies to any State official or agency | ||||||
6 | authorized to
provide for payment from State funds, by virtue | ||||||
7 | of any appropriation of the
General Assembly, for goods or | ||||||
8 | services furnished to the State.
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9 | For purposes of this Act, "goods or
services furnished to | ||||||
10 | the State" include but are not limited to covered health
care | ||||||
11 | provided to eligible members and their covered dependents in | ||||||
12 | accordance
with the State Employees Group Insurance Act of | ||||||
13 | 1971, including coverage
through a physician-owned health | ||||||
14 | maintenance organization under Section 6.1 of
that Act.
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15 | For the purposes of this Act, "appropriate State official | ||||||
16 | or agency" is
defined as the Director or Chief Executive or his | ||||||
17 | designee of that State
agency or department or facility of such | ||||||
18 | agency or department.
With respect to covered health care | ||||||
19 | provided to eligible members and
their dependents in accordance | ||||||
20 | with the State Employees Group Insurance Act
of 1971, | ||||||
21 | "appropriate State official or agency" also includes an
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22 | administrator of a program of health benefits under that Act.
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23 | As used in this Act, "eligible member" means a member who | ||||||
24 | is eligible for
health benefits under the State Employees Group | ||||||
25 | Insurance Act of 1971, and
"member" and "dependent" have the | ||||||
26 | meanings ascribed to those terms in that Act.
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27 | As used in this Act, "a proper bill or invoice" means a | ||||||
28 | bill or invoice
that
includes the
information necessary for | ||||||
29 | processing the payment as may be specified by a State
agency | ||||||
30 | and in rules adopted in accordance with this Act.
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31 | As used in this Act, "payment" means a payment of a | ||||||
32 | vendor's bill or invoice or a payment of a grant award, whether |
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1 | in whole or in part.
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2 | (Source: P.A. 91-266, eff. 7-23-99; 92-384, eff. 7-1-02.)
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3 | (30 ILCS 540/8 new)
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4 | Sec. 8. Priority of payment.
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5 | (a) Definition. As used in this Section, "qualified | ||||||
6 | provider" means a
not-for-profit
organization that provides | ||||||
7 | non-residential services for the mentally ill or
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8 | developmentally disabled and is reimbursed or
otherwise paid
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9 | for providing those services by
the Illinois Department of | ||||||
10 | Human Services. A "qualified provider" does not
include
a | ||||||
11 | hospital licensed under the Hospital Licensing
Act,
a long-term | ||||||
12 | care facility licensed under the Nursing Home Care Act only | ||||||
13 | with
respect to services provided in the licensed facility to | ||||||
14 | residents, or a
local governmental unit or university.
A | ||||||
15 | "qualified provider" also includes an entity licensed under the
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16 | Community-Integrated Living Arrangements Licensure and | ||||||
17 | Certification Act, but
only with respect to the services | ||||||
18 | provided for a community-integrated living
arrangement.
The | ||||||
19 | Department of Human Services shall make the determination of | ||||||
20 | who is a
"qualified
provider".
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21 | (b) Processing by official or agency. Except as provided in | ||||||
22 | subsection (d),
a bill or invoice for goods or
services
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23 | furnished to the State submitted by a qualified provider
and a | ||||||
24 | grant award payment to a qualified provider
must
be given
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25 | priority in processing. Any bill or invoice and any grant award | ||||||
26 | payment meeting
these criteria that is
submitted to an
official | ||||||
27 | or agency must be processed and forwarded for payment before
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28 | any other bill, invoice,
or grant award payment
is
processed or | ||||||
29 | forwarded for payment.
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30 | (c) A properly prepared voucher request to the Office of | ||||||
31 | the Comptroller for payment to a qualified provider, as defined | ||||||
32 | in this Section, shall be given priority by the Comptroller for | ||||||
33 | processing and warrant issuance after debt service obligations |
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1 | and payroll obligations of the State have been met unless the | ||||||
2 | Comptroller deems that other obligations of the State must be | ||||||
3 | satisfied prior to these categories of payment. If at any time | ||||||
4 | the Comptroller determines that there are insufficient funds | ||||||
5 | available to process priority payments as required under this | ||||||
6 | Section, then vouchers shall be processed and paid out in a | ||||||
7 | first-in, first-out manner as corresponding funds become | ||||||
8 | available.
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9 | Section 20. The Community Services Act is amended by adding | ||||||
10 | Section 4.4 as follows: | ||||||
11 | (405 ILCS 30/4.4 new) | ||||||
12 | Sec. 4.4. Medicaid recipients; separate billing. The | ||||||
13 | Department of Human Services must bill the Department of Public | ||||||
14 | Aid separately for services provided to recipients of medical | ||||||
15 | assistance under Article V of the Illinois Public Aid Code | ||||||
16 | through the Division of Mental Health and for services provided | ||||||
17 | to such recipients through the Division of Developmental | ||||||
18 | Disabilities.
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19 | Section 99. Effective date. This Act takes effect upon | ||||||
20 | becoming law.".
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