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1     AN ACT concerning public aid.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Alternative Health Care Delivery Act is
5 amended by changing Section 30 as follows:
 
6     (210 ILCS 3/30)
7     Sec. 30. Demonstration program requirements. The
8 requirements set forth in this Section shall apply to
9 demonstration programs.
10     (a) There shall be no more than:
11         (i) 3 subacute care hospital alternative health care
12     models in the City of Chicago (one of which shall be
13     located on a designated site and shall have been licensed
14     as a hospital under the Illinois Hospital Licensing Act
15     within the 10 years immediately before the application for
16     a license);
17         (ii) 2 subacute care hospital alternative health care
18     models in the demonstration program for each of the
19     following areas:
20             (1) Cook County outside the City of Chicago.
21             (2) DuPage, Kane, Lake, McHenry, and Will
22         Counties.
23             (3) Municipalities with a population greater than

 

 

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1         50,000 not located in the areas described in item (i)
2         of subsection (a) and paragraphs (1) and (2) of item
3         (ii) of subsection (a); and
4         (iii) 4 subacute care hospital alternative health care
5     models in the demonstration program for rural areas.
6     In selecting among applicants for these licenses in rural
7 areas, the Health Facilities and Services Review Board and the
8 Department shall give preference to hospitals that may be
9 unable for economic reasons to provide continued service to the
10 community in which they are located unless the hospital were to
11 receive an alternative health care model license.
12     (a-5) There shall be no more than the total number of
13 postsurgical recovery care centers with a certificate of need
14 for beds as of January 1, 2008.
15     (a-10) There shall be no more than a total of 9 children's
16 respite care center alternative health care models in the
17 demonstration program, which shall be located as follows:
18         (1) Two in the City of Chicago.
19         (2) One in Cook County outside the City of Chicago.
20         (3) A total of 2 in the area comprised of DuPage, Kane,
21     Lake, McHenry, and Will counties.
22         (4) A total of 2 in municipalities with a population of
23     50,000 or more and not located in the areas described in
24     paragraphs (1), (2), or (3).
25         (5) A total of 2 in rural areas, as defined by the
26     Health Facilities and Services Review Board.

 

 

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1     No more than one children's respite care model owned and
2 operated by a licensed skilled pediatric facility shall be
3 located in each of the areas designated in this subsection
4 (a-10).
5     (a-15) There shall be 2 authorized community-based
6 residential rehabilitation center alternative health care
7 models in the demonstration program.
8     (a-20) There shall be an authorized Alzheimer's disease
9 management center alternative health care model in the
10 demonstration program. The Alzheimer's disease management
11 center shall be located in Will County, owned by a
12 not-for-profit entity, and endorsed by a resolution approved by
13 the county board before the effective date of this amendatory
14 Act of the 91st General Assembly.
15     (a-25) There shall be no more than 10 birth center
16 alternative health care models in the demonstration program,
17 located as follows:
18         (1) Four in the area comprising Cook, DuPage, Kane,
19     Lake, McHenry, and Will counties, one of which shall be
20     owned or operated by a hospital and one of which shall be
21     owned or operated by a federally qualified health center.
22         (2) Three in municipalities with a population of 50,000
23     or more not located in the area described in paragraph (1)
24     of this subsection, one of which shall be owned or operated
25     by a hospital and one of which shall be owned or operated
26     by a federally qualified health center.

 

 

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1         (3) Three in rural areas, one of which shall be owned
2     or operated by a hospital and one of which shall be owned
3     or operated by a federally qualified health center.
4     The first 3 birth centers authorized to operate by the
5 Department shall be located in or predominantly serve the
6 residents of a health professional shortage area as determined
7 by the United States Department of Health and Human Services.
8 There shall be no more than 2 birth centers authorized to
9 operate in any single health planning area for obstetric
10 services as determined under the Illinois Health Facilities
11 Planning Act. If a birth center is located outside of a health
12 professional shortage area, (i) the birth center shall be
13 located in a health planning area with a demonstrated need for
14 obstetrical service beds, as determined by the Health
15 Facilities and Services Review Board or (ii) there must be a
16 reduction in the existing number of obstetrical service beds in
17 the planning area so that the establishment of the birth center
18 does not result in an increase in the total number of
19 obstetrical service beds in the health planning area.
20     (b) Alternative health care models, other than a model
21 authorized under subsection (a-10) or subsections (a-10) and
22 (a-20), shall obtain a certificate of need from the Health
23 Facilities and Services Review Board under the Illinois Health
24 Facilities Planning Act before receiving a license by the
25 Department. If, after obtaining its initial certificate of
26 need, an alternative health care delivery model that is a

 

 

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1 community based residential rehabilitation center seeks to
2 increase the bed capacity of that center, it must obtain a
3 certificate of need from the Health Facilities and Services
4 Review Board before increasing the bed capacity. Alternative
5 health care models in medically underserved areas shall receive
6 priority in obtaining a certificate of need.
7     (c) An alternative health care model license shall be
8 issued for a period of one year and shall be annually renewed
9 if the facility or program is in substantial compliance with
10 the Department's rules adopted under this Act. A licensed
11 alternative health care model that continues to be in
12 substantial compliance after the conclusion of the
13 demonstration program shall be eligible for annual renewals
14 unless and until a different licensure program for that type of
15 health care model is established by legislation, except that a
16 postsurgical recovery care center meeting the following
17 requirements may apply within 3 years after August 25, 2009
18 (the effective date of Public Act 96-669) this amendatory Act
19 of the 96th General Assembly for a Certificate of Need permit
20 to operate as a hospital:
21         (1) The postsurgical recovery care center shall apply
22     to the Illinois Health Facilities Planning Board for a
23     Certificate of Need permit to discontinue the postsurgical
24     recovery care center and to establish a hospital.
25         (2) If the postsurgical recovery care center obtains a
26     Certificate of Need permit to operate as a hospital, it

 

 

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1     shall apply for licensure as a hospital under the Hospital
2     Licensing Act and shall meet all statutory and regulatory
3     requirements of a hospital.
4         (3) After obtaining licensure as a hospital, any
5     license as an ambulatory surgical treatment center and any
6     license as a post-surgical recovery care center shall be
7     null and void.
8         (4) The former postsurgical recovery care center that
9     receives a hospital license must seek and use its best
10     efforts to maintain certification under Titles XVIII and
11     XIX of the federal Social Security Act.
12     The Department may issue a provisional license to any
13 alternative health care model that does not substantially
14 comply with the provisions of this Act and the rules adopted
15 under this Act if (i) the Department finds that the alternative
16 health care model has undertaken changes and corrections which
17 upon completion will render the alternative health care model
18 in substantial compliance with this Act and rules and (ii) the
19 health and safety of the patients of the alternative health
20 care model will be protected during the period for which the
21 provisional license is issued. The Department shall advise the
22 licensee of the conditions under which the provisional license
23 is issued, including the manner in which the alternative health
24 care model fails to comply with the provisions of this Act and
25 rules, and the time within which the changes and corrections
26 necessary for the alternative health care model to

 

 

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1 substantially comply with this Act and rules shall be
2 completed.
3     (d) Alternative health care models shall seek
4 certification under Titles XVIII and XIX of the federal Social
5 Security Act. In addition, alternative health care models shall
6 provide charitable care consistent with that provided by
7 comparable health care providers in the geographic area.
8     (d-5) (Blank) The Department of Healthcare and Family
9 Services (formerly Illinois Department of Public Aid), in
10 cooperation with the Illinois Department of Public Health,
11 shall develop and implement a reimbursement methodology for all
12 facilities participating in the demonstration program. The
13 Department of Healthcare and Family Services shall keep a
14 record of services provided under the demonstration program to
15 recipients of medical assistance under the Illinois Public Aid
16 Code and shall submit an annual report of that information to
17 the Illinois Department of Public Health.
18     (e) Alternative health care models shall, to the extent
19 possible, link and integrate their services with nearby health
20 care facilities.
21     (f) Each alternative health care model shall implement a
22 quality assurance program with measurable benefits and at
23 reasonable cost.
24 (Source: P.A. 95-331, eff. 8-21-07; 95-445, eff. 1-1-08; 96-31,
25 eff. 6-30-09; 96-129, eff. 8-4-09; 96-669, eff. 8-25-09;
26 96-812, eff. 1-1-10; revised 11-4-09.)
 

 

 

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1     Section 10. The Illinois Public Aid Code is amended by
2 changing Sections 5-2 and 5-5.5 and by adding Section 12-8.2 as
3 follows:
 
4     (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
5     Sec. 5-2. Classes of Persons Eligible. Medical assistance
6 under this Article shall be available to any of the following
7 classes of persons in respect to whom a plan for coverage has
8 been submitted to the Governor by the Illinois Department and
9 approved by him:
10         1. Recipients of basic maintenance grants under
11     Articles III and IV.
12         2. Persons otherwise eligible for basic maintenance
13     under Articles III and IV, excluding any eligibility
14     requirements that are inconsistent with any federal law or
15     federal regulation, as interpreted by the U.S. Department
16     of Health and Human Services, but who fail to qualify
17     thereunder on the basis of need or who qualify but are not
18     receiving basic maintenance under Article IV, and who have
19     insufficient income and resources to meet the costs of
20     necessary medical care, including but not limited to the
21     following:
22             (a) All persons otherwise eligible for basic
23         maintenance under Article III but who fail to qualify
24         under that Article on the basis of need and who meet

 

 

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1         either of the following requirements:
2                 (i) their income, as determined by the
3             Illinois Department in accordance with any federal
4             requirements, is equal to or less than 70% in
5             fiscal year 2001, equal to or less than 85% in
6             fiscal year 2002 and until a date to be determined
7             by the Department by rule, and equal to or less
8             than 100% beginning on the date determined by the
9             Department by rule, of the nonfarm income official
10             poverty line, as defined by the federal Office of
11             Management and Budget and revised annually in
12             accordance with Section 673(2) of the Omnibus
13             Budget Reconciliation Act of 1981, applicable to
14             families of the same size; or
15                 (ii) their income, after the deduction of
16             costs incurred for medical care and for other types
17             of remedial care, is equal to or less than 70% in
18             fiscal year 2001, equal to or less than 85% in
19             fiscal year 2002 and until a date to be determined
20             by the Department by rule, and equal to or less
21             than 100% beginning on the date determined by the
22             Department by rule, of the nonfarm income official
23             poverty line, as defined in item (i) of this
24             subparagraph (a).
25             (b) All persons who, excluding any eligibility
26         requirements that are inconsistent with any federal

 

 

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1         law or federal regulation, as interpreted by the U.S.
2         Department of Health and Human Services, would be
3         determined eligible for such basic maintenance under
4         Article IV by disregarding the maximum earned income
5         permitted by federal law.
6         3. Persons who would otherwise qualify for Aid to the
7     Medically Indigent under Article VII.
8         4. Persons not eligible under any of the preceding
9     paragraphs who fall sick, are injured, or die, not having
10     sufficient money, property or other resources to meet the
11     costs of necessary medical care or funeral and burial
12     expenses.
13         5.(a) Women during pregnancy, after the fact of
14     pregnancy has been determined by medical diagnosis, and
15     during the 60-day period beginning on the last day of the
16     pregnancy, together with their infants and children born
17     after September 30, 1983, whose income and resources are
18     insufficient to meet the costs of necessary medical care to
19     the maximum extent possible under Title XIX of the Federal
20     Social Security Act.
21         (b) The Illinois Department and the Governor shall
22     provide a plan for coverage of the persons eligible under
23     paragraph 5(a) by April 1, 1990. Such plan shall provide
24     ambulatory prenatal care to pregnant women during a
25     presumptive eligibility period and establish an income
26     eligibility standard that is equal to 133% of the nonfarm

 

 

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1     income official poverty line, as defined by the federal
2     Office of Management and Budget and revised annually in
3     accordance with Section 673(2) of the Omnibus Budget
4     Reconciliation Act of 1981, applicable to families of the
5     same size, provided that costs incurred for medical care
6     are not taken into account in determining such income
7     eligibility.
8         (c) The Illinois Department may conduct a
9     demonstration in at least one county that will provide
10     medical assistance to pregnant women, together with their
11     infants and children up to one year of age, where the
12     income eligibility standard is set up to 185% of the
13     nonfarm income official poverty line, as defined by the
14     federal Office of Management and Budget. The Illinois
15     Department shall seek and obtain necessary authorization
16     provided under federal law to implement such a
17     demonstration. Such demonstration may establish resource
18     standards that are not more restrictive than those
19     established under Article IV of this Code.
20         6. Persons under the age of 18 who fail to qualify as
21     dependent under Article IV and who have insufficient income
22     and resources to meet the costs of necessary medical care
23     to the maximum extent permitted under Title XIX of the
24     Federal Social Security Act.
25         7. Persons who are under 21 years of age and would
26     qualify as disabled as defined under the Federal

 

 

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1     Supplemental Security Income Program, provided medical
2     service for such persons would be eligible for Federal
3     Financial Participation, and provided the Illinois
4     Department determines that:
5             (a) the person requires a level of care provided by
6         a hospital, skilled nursing facility, or intermediate
7         care facility, as determined by a physician licensed to
8         practice medicine in all its branches;
9             (b) it is appropriate to provide such care outside
10         of an institution, as determined by a physician
11         licensed to practice medicine in all its branches;
12             (c) the estimated amount which would be expended
13         for care outside the institution is not greater than
14         the estimated amount which would be expended in an
15         institution.
16         8. Persons who become ineligible for basic maintenance
17     assistance under Article IV of this Code in programs
18     administered by the Illinois Department due to employment
19     earnings and persons in assistance units comprised of
20     adults and children who become ineligible for basic
21     maintenance assistance under Article VI of this Code due to
22     employment earnings. The plan for coverage for this class
23     of persons shall:
24             (a) extend the medical assistance coverage for up
25         to 12 months following termination of basic
26         maintenance assistance; and

 

 

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1             (b) offer persons who have initially received 6
2         months of the coverage provided in paragraph (a) above,
3         the option of receiving an additional 6 months of
4         coverage, subject to the following:
5                 (i) such coverage shall be pursuant to
6             provisions of the federal Social Security Act;
7                 (ii) such coverage shall include all services
8             covered while the person was eligible for basic
9             maintenance assistance;
10                 (iii) no premium shall be charged for such
11             coverage; and
12                 (iv) such coverage shall be suspended in the
13             event of a person's failure without good cause to
14             file in a timely fashion reports required for this
15             coverage under the Social Security Act and
16             coverage shall be reinstated upon the filing of
17             such reports if the person remains otherwise
18             eligible.
19         9. Persons with acquired immunodeficiency syndrome
20     (AIDS) or with AIDS-related conditions with respect to whom
21     there has been a determination that but for home or
22     community-based services such individuals would require
23     the level of care provided in an inpatient hospital,
24     skilled nursing facility or intermediate care facility the
25     cost of which is reimbursed under this Article. Assistance
26     shall be provided to such persons to the maximum extent

 

 

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1     permitted under Title XIX of the Federal Social Security
2     Act.
3         10. Participants in the long-term care insurance
4     partnership program established under the Illinois
5     Long-Term Care Partnership Program Act who meet the
6     qualifications for protection of resources described in
7     Section 15 of that Act.
8         11. Persons with disabilities who are employed and
9     eligible for Medicaid, pursuant to Section
10     1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
11     subject to federal approval, persons with a medically
12     improved disability who are employed and eligible for
13     Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
14     the Social Security Act, as provided by the Illinois
15     Department by rule. In establishing eligibility standards
16     under this paragraph 11, the Department shall, subject to
17     federal approval:
18             (a) set the income eligibility standard at not
19         lower than 350% of the federal poverty level;
20             (b) exempt retirement accounts that the person
21         cannot access without penalty before the age of 59 1/2,
22         and medical savings accounts established pursuant to
23         26 U.S.C. 220;
24             (c) allow non-exempt assets up to $25,000 as to
25         those assets accumulated during periods of eligibility
26         under this paragraph 11; and

 

 

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1             (d) continue to apply subparagraphs (b) and (c) in
2         determining the eligibility of the person under this
3         Article even if the person loses eligibility under this
4         paragraph 11.
5         12. Subject to federal approval, persons who are
6     eligible for medical assistance coverage under applicable
7     provisions of the federal Social Security Act and the
8     federal Breast and Cervical Cancer Prevention and
9     Treatment Act of 2000. Those eligible persons are defined
10     to include, but not be limited to, the following persons:
11             (1) persons who have been screened for breast or
12         cervical cancer under the U.S. Centers for Disease
13         Control and Prevention Breast and Cervical Cancer
14         Program established under Title XV of the federal
15         Public Health Services Act in accordance with the
16         requirements of Section 1504 of that Act as
17         administered by the Illinois Department of Public
18         Health; and
19             (2) persons whose screenings under the above
20         program were funded in whole or in part by funds
21         appropriated to the Illinois Department of Public
22         Health for breast or cervical cancer screening.
23         "Medical assistance" under this paragraph 12 shall be
24     identical to the benefits provided under the State's
25     approved plan under Title XIX of the Social Security Act.
26     The Department must request federal approval of the

 

 

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1     coverage under this paragraph 12 within 30 days after the
2     effective date of this amendatory Act of the 92nd General
3     Assembly.
4         13. Subject to appropriation and to federal approval,
5     persons living with HIV/AIDS who are not otherwise eligible
6     under this Article and who qualify for services covered
7     under Section 5-5.04 as provided by the Illinois Department
8     by rule.
9         14. Subject to the availability of funds for this
10     purpose, the Department may provide coverage under this
11     Article to persons who reside in Illinois who are not
12     eligible under any of the preceding paragraphs and who meet
13     the income guidelines of paragraph 2(a) of this Section and
14     (i) have an application for asylum pending before the
15     federal Department of Homeland Security or on appeal before
16     a court of competent jurisdiction and are represented
17     either by counsel or by an advocate accredited by the
18     federal Department of Homeland Security and employed by a
19     not-for-profit organization in regard to that application
20     or appeal, or (ii) are receiving services through a
21     federally funded torture treatment center. Medical
22     coverage under this paragraph 14 may be provided for up to
23     24 continuous months from the initial eligibility date so
24     long as an individual continues to satisfy the criteria of
25     this paragraph 14. If an individual has an appeal pending
26     regarding an application for asylum before the Department

 

 

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1     of Homeland Security, eligibility under this paragraph 14
2     may be extended until a final decision is rendered on the
3     appeal. The Department may adopt rules governing the
4     implementation of this paragraph 14.
5         15. Family Care Eligibility.
6             (a) A caretaker relative who is 19 years of age or
7         older when countable income is at or below 185% of the
8         Federal Poverty Level Guidelines, as published
9         annually in the Federal Register, for the appropriate
10         family size. A person may not spend down to become
11         eligible under this paragraph 15.
12             (b) Eligibility shall be reviewed annually.
13             (c) Caretaker relatives enrolled under this
14         paragraph 15 in families with countable income above
15         150% and at or below 185% of the Federal Poverty Level
16         Guidelines shall be counted as family members and pay
17         premiums as established under the Children's Health
18         Insurance Program Act.
19             (d) Premiums shall be billed by and payable to the
20         Department or its authorized agent, on a monthly basis.
21             (e) The premium due date is the last day of the
22         month preceding the month of coverage.
23             (f) Individuals shall have a grace period through
24         30 days the month of coverage to pay the premium.
25             (g) Failure to pay the full monthly premium by the
26         last day of the grace period shall result in

 

 

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1         termination of coverage.
2             (h) Partial premium payments shall not be
3         refunded.
4             (i) Following termination of an individual's
5         coverage under this paragraph 15, the following action
6         is required before the individual can be re-enrolled:
7                 (1) A new application must be completed and the
8             individual must be determined otherwise eligible.
9                 (2) There must be full payment of premiums due
10             under this Code, the Children's Health Insurance
11             Program Act, the Covering ALL KIDS Health
12             Insurance Act, or any other healthcare program
13             administered by the Department for periods in
14             which a premium was owed and not paid for the
15             individual.
16                 (3) The first month's premium must be paid if
17             there was an unpaid premium on the date the
18             individual's previous coverage was canceled.
19         The Department is authorized to implement the
20     provisions of this amendatory Act of the 95th General
21     Assembly by adopting the medical assistance rules in effect
22     as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
23     89 Ill. Admin. Code 120.32 along with only those changes
24     necessary to conform to federal Medicaid requirements,
25     federal laws, and federal regulations, including but not
26     limited to Section 1931 of the Social Security Act (42

 

 

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1     U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
2     of Health and Human Services, and the countable income
3     eligibility standard authorized by this paragraph 15. The
4     Department may not otherwise adopt any rule to implement
5     this increase except as authorized by law, to meet the
6     eligibility standards authorized by the federal government
7     in the Medicaid State Plan or the Title XXI Plan, or to
8     meet an order from the federal government or any court.
9         16. 15. Subject to appropriation, uninsured persons
10     who are not otherwise eligible under this Section who have
11     been certified and referred by the Department of Public
12     Health as having been screened and found to need diagnostic
13     evaluation or treatment, or both diagnostic evaluation and
14     treatment, for prostate or testicular cancer. For the
15     purposes of this paragraph 16 15, uninsured persons are
16     those who do not have creditable coverage, as defined under
17     the Health Insurance Portability and Accountability Act,
18     or have otherwise exhausted any insurance benefits they may
19     have had, for prostate or testicular cancer diagnostic
20     evaluation or treatment, or both diagnostic evaluation and
21     treatment. To be eligible, a person must furnish a Social
22     Security number. A person's assets are exempt from
23     consideration in determining eligibility under this
24     paragraph 16 15. Such persons shall be eligible for medical
25     assistance under this paragraph 16 15 for so long as they
26     need treatment for the cancer. A person shall be considered

 

 

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1     to need treatment if, in the opinion of the person's
2     treating physician, the person requires therapy directed
3     toward cure or palliation of prostate or testicular cancer,
4     including recurrent metastatic cancer that is a known or
5     presumed complication of prostate or testicular cancer and
6     complications resulting from the treatment modalities
7     themselves. Persons who require only routine monitoring
8     services are not considered to need treatment. "Medical
9     assistance" under this paragraph 16 15 shall be identical
10     to the benefits provided under the State's approved plan
11     under Title XIX of the Social Security Act. Notwithstanding
12     any other provision of law, the Department (i) does not
13     have a claim against the estate of a deceased recipient of
14     services under this paragraph 16 15 and (ii) does not have
15     a lien against any homestead property or other legal or
16     equitable real property interest owned by a recipient of
17     services under this paragraph 16 15.
18     In implementing the provisions of Public Act 96-20 this
19 amendatory Act of the 96th General Assembly, the Department is
20 authorized to adopt only those rules necessary, including
21 emergency rules. Nothing in Public Act 96-20 this amendatory
22 Act of the 96th General Assembly permits the Department to
23 adopt rules or issue a decision that expands eligibility for
24 the FamilyCare Program to a person whose income exceeds 185% of
25 the Federal Poverty Level as determined from time to time by
26 the U.S. Department of Health and Human Services, unless the

 

 

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1 Department is provided with express statutory authority.
2     The Illinois Department and the Governor shall provide a
3 plan for coverage of the persons eligible under paragraph 7 as
4 soon as possible after July 1, 1984.
5     The eligibility of any such person for medical assistance
6 under this Article is not affected by the payment of any grant
7 under the Senior Citizens and Disabled Persons Property Tax
8 Relief and Pharmaceutical Assistance Act or any distributions
9 or items of income described under subparagraph (X) of
10 paragraph (2) of subsection (a) of Section 203 of the Illinois
11 Income Tax Act. The Department shall by rule establish the
12 amounts of assets to be disregarded in determining eligibility
13 for medical assistance, which shall at a minimum equal the
14 amounts to be disregarded under the Federal Supplemental
15 Security Income Program. The amount of assets of a single
16 person to be disregarded shall not be less than $2,000, and the
17 amount of assets of a married couple to be disregarded shall
18 not be less than $3,000.
19     To the extent permitted under federal law, any person found
20 guilty of a second violation of Article VIIIA shall be
21 ineligible for medical assistance under this Article, as
22 provided in Section 8A-8.
23     The eligibility of any person for medical assistance under
24 this Article shall not be affected by the receipt by the person
25 of donations or benefits from fundraisers held for the person
26 in cases of serious illness, as long as neither the person nor

 

 

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1 members of the person's family have actual control over the
2 donations or benefits or the disbursement of the donations or
3 benefits.
4 (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
5 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.
6 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
 
7     (305 ILCS 5/5-5.5)  (from Ch. 23, par. 5-5.5)
8     Sec. 5-5.5. Elements of Payment Rate.
9     (a) The Department of Healthcare and Family Services shall
10 develop a prospective method for determining payment rates for
11 skilled nursing and intermediate care services in nursing
12 facilities composed of the following cost elements:
13         (1) Standard Services, with the cost of this component
14     being determined by taking into account the actual costs to
15     the facilities of these services subject to cost ceilings
16     to be defined in the Department's rules.
17         (2) Resident Services, with the cost of this component
18     being determined by taking into account the actual costs,
19     needs and utilization of these services, as derived from an
20     assessment of the resident needs in the nursing facilities.
21     The Department shall adopt rules governing reimbursement
22     for resident services as listed in Section 5-1.1. Surveys
23     or assessments of resident needs under this Section shall
24     include a review by the facility of the results of such
25     assessments and a discussion of issues in dispute with

 

 

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1     authorized survey staff, unless the facility elects not to
2     participate in such a review process. Surveys or
3     assessments of resident needs under this Section may be
4     conducted semi-annually and payment rates relating to
5     resident services may be changed on a semi-annual basis.
6     The Illinois Department shall initiate a project, either on
7     a pilot basis or Statewide, to reimburse the cost of
8     resident services based on a methodology which utilizes an
9     assessment of resident needs to determine the level of
10     reimbursement. This methodology shall be different from
11     the payment criteria for resident services utilized by the
12     Illinois Department on July 1, 1981. On March 1, 1982, and
13     each year thereafter, until such time when the Illinois
14     Department adopts the methodology used in such project for
15     use statewide, the Illinois Department shall report to the
16     General Assembly on the implementation and progress of such
17     project. The report shall include:
18             (A) A statement of the Illinois Department's goals
19         and objectives for such project;
20             (B) A description of such project, including the
21         number and type of nursing facilities involved in the
22         project;
23             (C) A description of the methodology used in such
24         project;
25             (D) A description of the Illinois Department's
26         application of the methodology;

 

 

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1             (E) A statement on the methodology's effect on the
2         quality of care given to residents in the sample
3         nursing facilities; and
4             (F) A statement on the cost of the methodology used
5         in such project and a comparison of this cost with the
6         cost of the current payment criteria.
7         (3) Ancillary Services, with the payment rate being
8     developed for each individual type of service. Payment
9     shall be made only when authorized under procedures
10     developed by the Department of Healthcare and Family
11     Services.
12         (4) Nurse's Aide Training, with the cost of this
13     component being determined by taking into account the
14     actual cost to the facilities of such training.
15         (5) Real Estate Taxes, with the cost of this component
16     being determined by taking into account the figures
17     contained in the most currently available cost reports
18     (with no imposition of maximums) updated to the midpoint of
19     the current rate year for long term care services rendered
20     between July 1, 1984 and June 30, 1985, and with the cost
21     of this component being determined by taking into account
22     the actual 1983 taxes for which the nursing homes were
23     assessed (with no imposition of maximums) updated to the
24     midpoint of the current rate year for long term care
25     services rendered between July 1, 1985 and June 30, 1986.
26     (b) In developing a prospective method for determining

 

 

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1 payment rates for skilled nursing and intermediate care
2 services in nursing facilities, the Department of Healthcare
3 and Family Services shall consider the following cost elements:
4         (1) Reasonable capital cost determined by utilizing
5     incurred interest rate and the current value of the
6     investment, including land, utilizing composite rates, or
7     by utilizing such other reasonable cost related methods
8     determined by the Department. However, beginning with the
9     rate reimbursement period effective July 1, 1987, the
10     Department shall be prohibited from establishing,
11     including, and implementing any depreciation factor in
12     calculating the capital cost element.
13         (2) Profit, with the actual amount being produced and
14     accruing to the providers in the form of a return on their
15     total investment, on the basis of their ability to
16     economically and efficiently deliver a type of service. The
17     method of payment may assure the opportunity for a profit,
18     but shall not guarantee or establish a specific amount as a
19     cost.
20     (c) The Illinois Department may implement the amendatory
21 changes to this Section made by this amendatory Act of 1991
22 through the use of emergency rules in accordance with the
23 provisions of Section 5.02 of the Illinois Administrative
24 Procedure Act. For purposes of the Illinois Administrative
25 Procedure Act, the adoption of rules to implement the
26 amendatory changes to this Section made by this amendatory Act

 

 

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1 of 1991 shall be deemed an emergency and necessary for the
2 public interest, safety and welfare.
3     (d) No later than January 1, 2001, the Department of Public
4 Aid shall file with the Joint Committee on Administrative
5 Rules, pursuant to the Illinois Administrative Procedure Act, a
6 proposed rule, or a proposed amendment to an existing rule,
7 regarding payment for appropriate services, including
8 assessment, care planning, discharge planning, and treatment
9 provided by nursing facilities to residents who have a serious
10 mental illness.
11 (Source: P.A. 95-331, eff. 8-21-07.)
 
12     (305 ILCS 5/12-8.2 new)
13     Sec. 12-8.2. Medical Assistance Dental Reimbursement
14 Revolving Fund. There is created a revolving fund to be known
15 as the Medical Assistance Dental Reimbursement Revolving Fund,
16 to be held by the Director of the Department of Healthcare and
17 Family Services, outside of the State treasury, for the
18 following purposes:
19         (1) The deposit of all funds to pay for dental services
20     provided by enrolled dental service providers for services
21     to participants in the medical programs administered by the
22     Department.
23         (2) The deposit of any interest accrued by the
24     revolving fund, which interest shall be available to pay
25     for dental services provided by enrolled dental service

 

 

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1     providers for services to participants in the medical
2     programs administered by the Department.
3         (3) The payment of amounts to enrolled dental service
4     providers for dental services provided to participants in
5     the medical programs administered by the Department.
 
6     (305 ILCS 5/5-5.8a rep.)
7     (305 ILCS 5/5-22 rep.)
8     Section 15. The Illinois Public Aid Code is amended by
9 repealing Sections 5-5.8a and 5-22.