98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB0027

 

Introduced 1/9/2013, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Creates the Excellence in Academic Medicine Act of 2013 with provisions similar to those of the Excellence in Academic Medicine Act as it existed before its repeal by Public Act 97-689 and creates special funds in accordance with the new Act. Amends the State Finance Act. Removes provisions added by Public Act 97-691 concerning the maximum amounts of annual unpaid Medical Assistance bills that may be paid in total from future fiscal year Medical Assistance appropriations. Restores provisions concerning fiscal year limitations relating to payments for medical care as those provisions existed before the enactment of Public Act 97-691. Amends the Senior Citizens and Disabled Persons Property Tax Relief Act by reinstituting the pharmaceutical assistance program that was eliminated by Public Act 97-689 and changing the short title to the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act. Amends various Acts by restoring various provisions concerning nursing home staffing requirements, the moratorium on the expansion of eligibility for medical assistance, rate reductions and payments for various Medicaid services, vendor enrollment, care coordination, and other matters as those provisions existed before the enactment of Public Acts 97-687 and 97-689. Repeals various provisions added by Public Act 97-689 concerning safety-net hospitals, the elimination and limitation of certain medical assistance services, medical assistance for medically fragile and technology dependent children, and other matters. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4
ARTICLE 1.

 
5    Section 1-1. Short title. This Act may be cited as the
6Excellence in Academic Medicine Act of 2013.
 
7    Section 1-5. Purpose. This Act is intended to stimulate
8excellence in academic medicine in Illinois for this and future
9generations, to elevate Illinois as a national center for
10academic medicine and for health care innovation in the United
11States, and to reverse the current health care trade imbalance
12so that Illinois citizens may obtain highest quality
13post-tertiary care at home in Illinois.
 
14    Section 1-10. Findings. Medical research and development
15is required for placing Illinois health care in the position of
16national leadership appropriate to Illinois' location and
17institutional infrastructure. A reduction in the total cost of
18care for Illinois citizens can be accomplished by an assertion
19of local medical science leadership, which leads to greater
20provision of excellent care within the State avoiding
21out-migration.

 

 

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1    Excellence in academic medicine must be regarded not as a
2cost drag on the economy but as a stimulant to economic growth
3because it reduces the cost of work force replacement, further
4develops an academic medical center hospital network in
5Illinois, and stimulates spin-off technological breakthroughs
6with positive economic consequences.
7    Research and development is an essential strategy for
8controlling current costs of medical care. Such developments as
9biologic alternatives to skin for trauma-necessitated
10grafting, minimally invasive surgery, understanding, managing,
11and avoiding excessive cerebral vascular events in minority
12communities, and developments in pediatric eye trauma are
13fundamental to avoidance of lengthy periods of
14hospitalization.
15    The General Assembly hereby finds that Title XIX of the
16Social Security Act has fundamentally changed the structure of
17medical delivery in the State of Illinois. The failure of
18Congress to match its desire to broaden access to health care
19with commensurate fiscal resources has led to a growing burden
20of Congressional access mandates falling upon the State and its
21medical provider partners. Development of medical services and
22research on medical technology is increasingly captive to the
23Title XIX program and its strait-jacketing fiscal and
24programmatic limitations. Advanced medical technology is
25likely to be a successful method of controlling Title XIX
26expenditures.
 

 

 

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1    Section 1-15. Definitions. As used in this Act:
2    "Academic medical center hospital" means a hospital
3located in Illinois which is either (i) under common ownership
4with the college of medicine of a college or university or (ii)
5a free-standing hospital in which the majority of the clinical
6chiefs of service are department chairmen in an affiliated
7medical school.
8    "Academic medical center children's hospital" means a
9children's hospital which is separately incorporated and
10non-integrated into the academic medical center hospital but
11which is the pediatric partner for an academic medical center
12hospital and which serves as the primary teaching hospital for
13pediatrics for its affiliated medical school; children's
14hospitals which are separately incorporated but integrated
15into the academic medical center hospital are considered part
16of the academic medical center hospital.
17    "Chicago Medicare Metropolitan Statistical Area academic
18medical center hospital" means an academic medical center
19hospital located in the Chicago Medicare Metropolitan
20Statistical Area.
21    "Independent academic medical center hospital" means the
22primary teaching hospital for the University of Illinois at
23Urbana.
24    "Non-Chicago Medicare Metropolitan Statistical Area
25academic medical center hospital" means an academic medical

 

 

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1center hospital located outside the Chicago Medicare
2Metropolitan Statistical Area.
3    "Qualified Chicago Medicare Metropolitan Statistical Area
4academic medical center hospital" means any Chicago Medicare
5Metropolitan Statistical Area academic medical center hospital
6that either directly or in connection with its affiliated
7medical school receives in excess of $8,000,000 in grants or
8contracts from the National Institutes of Health during the
9calendar year preceding the beginning of the State fiscal year;
10except that for the purposes of Section 1-25, the term also
11includes the entity specified in subsection (e) of that
12Section.
13    "Qualified Non-Chicago Medicare Metropolitan Statistical
14Area academic medical center hospital" means the primary
15teaching hospital for the University of Illinois School of
16Medicine at Peoria and the primary teaching hospital for the
17University of Illinois School of Medicine at Rockford and the
18primary teaching hospitals for Southern Illinois University
19School of Medicine in Springfield.
20    "Qualified academic medical center hospital" means (i) a
21qualified Chicago Medicare Metropolitan Statistical Area
22academic medical center hospital, (ii) a qualified Non-Chicago
23Medicare Metropolitan Statistical Area academic medical center
24hospital, or (iii) an academic medical center children's
25hospital.
26    "Qualified programs" include:

 

 

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1        (i) Thoracic Transplantation: heart and lung, in
2    particular;
3        (ii) Cancer: particularly biologic modifiers of tumor
4    response, and mechanisms of drug resistance in cancer
5    therapy;
6        (iii) Shock/Burn: development of biological
7    alternatives to skin for grafting in burn injury, and
8    research in mechanisms of shock and tissue injury in severe
9    injury;
10        (iv) Abdominal transplantation: kidney, liver,
11    pancreas, and development of islet cell and small bowel
12    transplantation technologies;
13        (v) Minimally invasive surgery: particularly
14    laparoscopic surgery;
15        (vi) High performance medical computing: telemedicine
16    and teleradiology;
17        (vii) Transmyocardial laser revascularization: a laser
18    creates holes in heart muscles to allow new blood flow;
19        (viii) Pet scanning: viewing how organs function (CT
20    and MRI only allow viewing of the structure of an organ);
21        (ix) Strokes in the African-American community:
22    particularly risk factors for cerebral vascular accident
23    (strokes) in the African-American community at much higher
24    risk than the general population;
25        (x) Neurosurgery: particularly focusing on
26    interventional neuroradiology;

 

 

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1        (xi) Comprehensive eye center: including further
2    development in pediatric eye trauma;
3        (xii) Cancers: particularly melanoma, head and neck;
4        (xiii) Pediatric cancer;
5        (xiv) Invasive pediatric cardiology;
6        (xv) Pediatric organ transplantation: transplantation
7    of solid organs, marrow, and other stem cells; and
8        (xvi) Such other programs as may be identified.
 
9    Section 1-20. Establishment of Funds.
10    (a) The Medical Research and Development Fund is created in
11the State Treasury to which the General Assembly may from time
12to time appropriate funds and from which the Comptroller shall
13pay amounts as authorized by law. The amount appropriated for
14any fiscal year after 2014 shall not be less than the amount
15appropriated for fiscal year 2014.
16        (i) The following accounts are created in the Medical
17    Research and Development Fund: The National Institutes of
18    Health Account; the Philanthropic Medical Research
19    Account; and the Market Medical Research Account.
20        (ii) Funds appropriated to the Medical Research and
21    Development Fund shall be assigned in equal amounts to each
22    account within the Fund, subject to transferability of
23    funds under subsection (c) of Section 1-25.
24    (b) The Post-Tertiary Clinical Services Fund is created in
25the State Treasury to which the General Assembly may from time

 

 

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1to time appropriate funds and from which the Comptroller shall
2pay amounts as authorized by law. The amount appropriated for
3any fiscal year after 2014 shall not be less than the amount
4appropriated for fiscal year 2014.
5    (c) The Independent Academic Medical Center Fund is created
6as a special fund in the State Treasury, to which the General
7Assembly shall from time to time appropriate funds for the
8purposes of the Independent Academic Medical Center Program.
9The amount appropriated for any fiscal year after 2014 shall
10not be less than the amount appropriated for fiscal year 2014.
11The State Comptroller shall pay amounts from the Fund as
12authorized by law.
 
13    Section 1-25. Medical Research and Development Challenge
14Program.
15    (a) The State shall provide the following financial
16incentives to draw private and federal funding for biomedical
17research, technology, and programmatic development:
18        (1) Each qualified Chicago Medicare Metropolitan
19    Statistical Area academic medical center hospital shall
20    receive a percentage of the amount available for
21    distribution from the National Institutes of Health
22    Account, equal to that hospital's percentage of the total
23    contracts and grants from the National Institutes of Health
24    awarded to qualified Chicago Medicare Metropolitan
25    Statistical Area academic medical center hospitals and

 

 

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1    their affiliated medical schools during the preceding
2    calendar year. These amounts shall be paid from the
3    National Institutes of Health Account.
4        (2) Each qualified Chicago Medicare Metropolitan
5    Statistical Area academic medical center hospital shall
6    receive a payment from the State equal to 25% of all funded
7    grants (other than grants funded by the State of Illinois
8    or the National Institutes of Health) for biomedical
9    research, technology, or programmatic development received
10    by that qualified Chicago Medicare Metropolitan
11    Statistical Area academic medical center hospital during
12    the preceding calendar year. These amounts shall be paid
13    from the Philanthropic Medical Research Account.
14        (3) Each qualified Chicago Medicare Metropolitan
15    Statistical Area academic medical center hospital that (i)
16    contributes 40% of the funding for a biomedical research or
17    technology project or a programmatic development project
18    and (ii) obtains contributions from the private sector
19    equal to 40% of the funding for the project shall receive
20    from the State an amount equal to 20% of the funding for
21    the project upon submission of documentation demonstrating
22    those facts to the Comptroller; however, the State shall
23    not be required to make the payment unless the contribution
24    of the qualified Chicago Medicare Metropolitan Statistical
25    Area academic medical center hospital exceeds $100,000.
26    The documentation must be submitted within 180 days of the

 

 

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1    beginning of the fiscal year. These amounts shall be paid
2    from the Market Medical Research Account.
3    (b) No hospital under the Medical Research and Development
4Challenge Program shall receive more than 20% of the total
5amount appropriated to the Medical Research and Development
6Fund.
7    The amounts received under the Medical Research and
8Development Challenge Program by the Southern Illinois
9University School of Medicine in Springfield and its affiliated
10primary teaching hospitals, considered as a single entity,
11shall not exceed an amount equal to one-sixth of the total
12amount available for distribution from the Medical Research and
13Development Fund, multiplied by a fraction, the numerator of
14which is the amount awarded the Southern Illinois University
15School of Medicine and its affiliated teaching hospitals in
16grants or contracts by the National Institutes of Health and
17the denominator of which is $8,000,000.
18    (c) On or after the 180th day of the fiscal year the
19Comptroller may transfer unexpended funds in any account of the
20Medical Research and Development Fund to pay appropriate claims
21against another account.
22    (d) The amounts due each qualified Chicago Medicare
23Metropolitan Statistical Area academic medical center hospital
24under the Medical Research and Development Fund from the
25National Institutes of Health Account, the Philanthropic
26Medical Research Account, and the Market Medical Research

 

 

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1Account shall be combined and one quarter of the amount payable
2to each qualified Chicago Medicare Metropolitan Statistical
3Area academic medical center hospital shall be paid on the
4fifteenth working day after July 1, October 1, January 1, and
5March 1 or on a schedule determined by the Department of
6Healthcare and Family Services by rule that results in a more
7expeditious payment of the amounts due.
8    (e) The Southern Illinois University School of Medicine in
9Springfield and its affiliated primary teaching hospitals,
10considered as a single entity, shall be deemed to be a
11qualified Chicago Medicare Metropolitan Statistical Area
12academic medical center hospital for the purposes of this
13Section.
14    (f) In each State fiscal year, beginning in fiscal year
152014, the full amount appropriated for the Medical research and
16development challenge program for that fiscal year shall be
17distributed as described in this Section.
 
18    Section 1-30. Post-Tertiary Clinical Services Program. The
19State shall provide incentives to develop and enhance
20post-tertiary clinical services. Qualified academic medical
21center hospitals as defined in Section 1-15 may receive funding
22under the Post-Tertiary Clinical Services Program for up to 3
23qualified programs as defined in Section 1-15 in any given
24year; however, qualified academic medical center hospitals may
25receive continued funding for previously funded qualified

 

 

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1programs rather than receive funding for a new program so long
2as the number of qualified programs receiving funding does not
3exceed 3. Each qualified academic medical center hospital as
4defined in Section 1-15 shall receive an equal percentage of
5the Post-Tertiary Clinical Services Fund to be used in the
6funding of qualified programs. In each State fiscal year,
7beginning in fiscal year 2014, the full amount appropriated for
8the Post-Tertiary Clinical Services Program for that fiscal
9year shall be distributed as described in this Section. One
10quarter of the amount payable to each qualified academic
11medical center hospital shall be paid on the fifteenth working
12day after July 1, October 1, January 1, and March 1 or on a
13schedule determined by the Department of Healthcare and Family
14Services by rule that results in a more expeditious payment of
15the amounts due.
 
16    Section 1-35. Independent Academic Medical Center Program.
17There is created an Independent Academic Medical Center Program
18to provide incentives to develop and enhance the independent
19academic medical center hospital. In each State fiscal year,
20beginning in fiscal year 2014, the independent academic medical
21center hospital shall receive funding under the Program, equal
22to the full amount appropriated for that purpose for that
23fiscal year. In each fiscal year, one quarter of the amount
24payable to the independent academic medical center hospital
25shall be paid on the fifteenth working day after July 1,

 

 

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1October 1, January 1, and March 1 or on a schedule determined
2by the Department of Healthcare and Family Services by rule
3that results in a more expeditious payment of the amounts due.
 
4    Section 1-55. Payment of funds. The Comptroller shall pay
5funds appropriated to the Post-Tertiary Clinical Services Fund
6and the Medical Research and Development Fund to the
7appropriate qualified academic medical center hospitals as the
8funds are appropriated by the General Assembly and come due
9under this Act. The payment of all funds under this Act by the
10State shall be made directly to the academic medical center
11hospital due the funds, except any funds due to any institution
12of the University of Illinois as defined in Section 1-15 shall
13be paid to the University of Illinois at Chicago Medical
14Center, which shall be bound to expend the funds on the
15institution due the funds.
 
16    Section 1-60. Restriction on funds. No academic medical
17center hospital shall be eligible for payments from the Medical
18Research and Development Fund unless the academic medical
19center hospital qualifies under Section 1-15 as a qualified
20Chicago Medicare Metropolitan Statistical Area academic
21medical center hospital which in connection with its affiliated
22medical school received at least $8,000,000 in the preceding
23calendar year in grants or contracts from the National
24Institutes of Health; except that this restriction does not

 

 

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1apply to the entity specified in subsection (e) of Section 25.
2    If a hospital is eligible for funds from the Independent
3Academic Medical Center Fund, that hospital shall not receive
4funds from the Medical Research and Development Fund or the
5Post-Tertiary Clinical Services Fund. If a hospital receives
6funds from the Medical Research and Development Fund or the
7Post-Tertiary Clinical Services Fund, that hospital is
8ineligible to receive funds from the Independent Academic
9Medical Center Fund.
 
10    Section 1-65. Reporting requirements. On or before May 1 of
11each year, the chief executive officer of each Qualified
12Academic Medical Center Hospital shall submit a report to the
13Comptroller regarding the effects of the programs authorized by
14this Act. The report shall also report the total amount of
15grants from and contracts with the National Institutes of
16Health in the preceding calendar year. It shall assess whether
17the programs funded are likely to be successful, require
18further study, or no longer appear to be promising avenues of
19research. It shall discuss the probable use of the
20developmental program in mainstream medicine including both
21cost impact and medical effect. The report shall address the
22effects the programs may have on containing Title XIX and Title
23XXI costs in Illinois. The Comptroller shall immediately
24forward the report to the Director of Healthcare and Family
25Services and the Director of Public Health who shall evaluate

 

 

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1the contents in a letter submitted to the President of the
2Senate and the Speaker of the House of Representatives.
 
3    Section 1-70. Restriction on advertising as a State
4designated center of excellence in health care. A hospital
5receiving funds under this Act shall not advertise itself to
6the public or to government or private funding sources as a
7State designated center of excellence in health care.
8    Hospitals that qualify for funding under this Act are
9permitted to inform the public and government or private
10funding sources that they are eligible for State matching
11funds. If sufficient evidence is found that hospitals are
12violating this prohibition, the Comptroller may summarily
13remove them from the program.
 
14    Section 1-74. Reimbursement methodology. The Department of
15Healthcare and Family Services may develop a reimbursement
16methodology consistent with this Act for distribution of moneys
17from the funds in a manner that would allow distributions from
18these funds to be matchable under Title XIX of the Social
19Security Act. The Department may promulgate rules necessary to
20make these distributions matchable.
 
21    Section 1-75. Reimbursements or payments by the State.
22Nothing in this Act may be used to reduce reimbursements or
23payments by the State to a hospital under any other Act.
 

 

 

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1    Section 1-80. Contravention of law. Funds received under
2this Act shall not be used in contravention of any law of this
3State.
 
4
ARTICLE 2.

 
5    Section 2-1. The Illinois Administrative Procedure Act is
6amended by changing Section 5-45 as follows:
 
7    (5 ILCS 100/5-45)  (from Ch. 127, par. 1005-45)
8    Sec. 5-45. Emergency rulemaking.
9    (a) "Emergency" means the existence of any situation that
10any agency finds reasonably constitutes a threat to the public
11interest, safety, or welfare.
12    (b) If any agency finds that an emergency exists that
13requires adoption of a rule upon fewer days than is required by
14Section 5-40 and states in writing its reasons for that
15finding, the agency may adopt an emergency rule without prior
16notice or hearing upon filing a notice of emergency rulemaking
17with the Secretary of State under Section 5-70. The notice
18shall include the text of the emergency rule and shall be
19published in the Illinois Register. Consent orders or other
20court orders adopting settlements negotiated by an agency may
21be adopted under this Section. Subject to applicable
22constitutional or statutory provisions, an emergency rule

 

 

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1becomes effective immediately upon filing under Section 5-65 or
2at a stated date less than 10 days thereafter. The agency's
3finding and a statement of the specific reasons for the finding
4shall be filed with the rule. The agency shall take reasonable
5and appropriate measures to make emergency rules known to the
6persons who may be affected by them.
7    (c) An emergency rule may be effective for a period of not
8longer than 150 days, but the agency's authority to adopt an
9identical rule under Section 5-40 is not precluded. No
10emergency rule may be adopted more than once in any 24 month
11period, except that this limitation on the number of emergency
12rules that may be adopted in a 24 month period does not apply
13to (i) emergency rules that make additions to and deletions
14from the Drug Manual under Section 5-5.16 of the Illinois
15Public Aid Code or the generic drug formulary under Section
163.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
17emergency rules adopted by the Pollution Control Board before
18July 1, 1997 to implement portions of the Livestock Management
19Facilities Act, (iii) emergency rules adopted by the Illinois
20Department of Public Health under subsections (a) through (i)
21of Section 2 of the Department of Public Health Act when
22necessary to protect the public's health, (iv) emergency rules
23adopted pursuant to subsection (n) of this Section, (v)
24emergency rules adopted pursuant to subsection (o) of this
25Section, or (vi) emergency rules adopted pursuant to subsection
26(c-5) of this Section. Two or more emergency rules having

 

 

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1substantially the same purpose and effect shall be deemed to be
2a single rule for purposes of this Section.
3    (c-5) To facilitate the maintenance of the program of group
4health benefits provided to annuitants, survivors, and retired
5employees under the State Employees Group Insurance Act of
61971, rules to alter the contributions to be paid by the State,
7annuitants, survivors, retired employees, or any combination
8of those entities, for that program of group health benefits,
9shall be adopted as emergency rules. The adoption of those
10rules shall be considered an emergency and necessary for the
11public interest, safety, and welfare.
12    (d) In order to provide for the expeditious and timely
13implementation of the State's fiscal year 1999 budget,
14emergency rules to implement any provision of Public Act 90-587
15or 90-588 or any other budget initiative for fiscal year 1999
16may be adopted in accordance with this Section by the agency
17charged with administering that provision or initiative,
18except that the 24-month limitation on the adoption of
19emergency rules and the provisions of Sections 5-115 and 5-125
20do not apply to rules adopted under this subsection (d). The
21adoption of emergency rules authorized by this subsection (d)
22shall be deemed to be necessary for the public interest,
23safety, and welfare.
24    (e) In order to provide for the expeditious and timely
25implementation of the State's fiscal year 2000 budget,
26emergency rules to implement any provision of this amendatory

 

 

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1Act of the 91st General Assembly or any other budget initiative
2for fiscal year 2000 may be adopted in accordance with this
3Section by the agency charged with administering that provision
4or initiative, except that the 24-month limitation on the
5adoption of emergency rules and the provisions of Sections
65-115 and 5-125 do not apply to rules adopted under this
7subsection (e). The adoption of emergency rules authorized by
8this subsection (e) shall be deemed to be necessary for the
9public interest, safety, and welfare.
10    (f) In order to provide for the expeditious and timely
11implementation of the State's fiscal year 2001 budget,
12emergency rules to implement any provision of this amendatory
13Act of the 91st General Assembly or any other budget initiative
14for fiscal year 2001 may be adopted in accordance with this
15Section by the agency charged with administering that provision
16or initiative, except that the 24-month limitation on the
17adoption of emergency rules and the provisions of Sections
185-115 and 5-125 do not apply to rules adopted under this
19subsection (f). The adoption of emergency rules authorized by
20this subsection (f) shall be deemed to be necessary for the
21public interest, safety, and welfare.
22    (g) In order to provide for the expeditious and timely
23implementation of the State's fiscal year 2002 budget,
24emergency rules to implement any provision of this amendatory
25Act of the 92nd General Assembly or any other budget initiative
26for fiscal year 2002 may be adopted in accordance with this

 

 

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1Section by the agency charged with administering that provision
2or initiative, except that the 24-month limitation on the
3adoption of emergency rules and the provisions of Sections
45-115 and 5-125 do not apply to rules adopted under this
5subsection (g). The adoption of emergency rules authorized by
6this subsection (g) shall be deemed to be necessary for the
7public interest, safety, and welfare.
8    (h) In order to provide for the expeditious and timely
9implementation of the State's fiscal year 2003 budget,
10emergency rules to implement any provision of this amendatory
11Act of the 92nd General Assembly or any other budget initiative
12for fiscal year 2003 may be adopted in accordance with this
13Section by the agency charged with administering that provision
14or initiative, except that the 24-month limitation on the
15adoption of emergency rules and the provisions of Sections
165-115 and 5-125 do not apply to rules adopted under this
17subsection (h). The adoption of emergency rules authorized by
18this subsection (h) shall be deemed to be necessary for the
19public interest, safety, and welfare.
20    (i) In order to provide for the expeditious and timely
21implementation of the State's fiscal year 2004 budget,
22emergency rules to implement any provision of this amendatory
23Act of the 93rd General Assembly or any other budget initiative
24for fiscal year 2004 may be adopted in accordance with this
25Section by the agency charged with administering that provision
26or initiative, except that the 24-month limitation on the

 

 

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1adoption of emergency rules and the provisions of Sections
25-115 and 5-125 do not apply to rules adopted under this
3subsection (i). The adoption of emergency rules authorized by
4this subsection (i) shall be deemed to be necessary for the
5public interest, safety, and welfare.
6    (j) In order to provide for the expeditious and timely
7implementation of the provisions of the State's fiscal year
82005 budget as provided under the Fiscal Year 2005 Budget
9Implementation (Human Services) Act, emergency rules to
10implement any provision of the Fiscal Year 2005 Budget
11Implementation (Human Services) Act may be adopted in
12accordance with this Section by the agency charged with
13administering that provision, except that the 24-month
14limitation on the adoption of emergency rules and the
15provisions of Sections 5-115 and 5-125 do not apply to rules
16adopted under this subsection (j). The Department of Public Aid
17may also adopt rules under this subsection (j) necessary to
18administer the Illinois Public Aid Code and the Children's
19Health Insurance Program Act. The adoption of emergency rules
20authorized by this subsection (j) shall be deemed to be
21necessary for the public interest, safety, and welfare.
22    (k) In order to provide for the expeditious and timely
23implementation of the provisions of the State's fiscal year
242006 budget, emergency rules to implement any provision of this
25amendatory Act of the 94th General Assembly or any other budget
26initiative for fiscal year 2006 may be adopted in accordance

 

 

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1with this Section by the agency charged with administering that
2provision or initiative, except that the 24-month limitation on
3the adoption of emergency rules and the provisions of Sections
45-115 and 5-125 do not apply to rules adopted under this
5subsection (k). The Department of Healthcare and Family
6Services may also adopt rules under this subsection (k)
7necessary to administer the Illinois Public Aid Code, the
8Senior Citizens and Disabled Persons Property Tax Relief and
9Pharmaceutical Assistance Act, the Senior Citizens and
10Disabled Persons Prescription Drug Discount Program Act (now
11the Illinois Prescription Drug Discount Program Act), and the
12Children's Health Insurance Program Act. The adoption of
13emergency rules authorized by this subsection (k) shall be
14deemed to be necessary for the public interest, safety, and
15welfare.
16    (l) In order to provide for the expeditious and timely
17implementation of the provisions of the State's fiscal year
182007 budget, the Department of Healthcare and Family Services
19may adopt emergency rules during fiscal year 2007, including
20rules effective July 1, 2007, in accordance with this
21subsection to the extent necessary to administer the
22Department's responsibilities with respect to amendments to
23the State plans and Illinois waivers approved by the federal
24Centers for Medicare and Medicaid Services necessitated by the
25requirements of Title XIX and Title XXI of the federal Social
26Security Act. The adoption of emergency rules authorized by

 

 

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1this subsection (l) shall be deemed to be necessary for the
2public interest, safety, and welfare.
3    (m) In order to provide for the expeditious and timely
4implementation of the provisions of the State's fiscal year
52008 budget, the Department of Healthcare and Family Services
6may adopt emergency rules during fiscal year 2008, including
7rules effective July 1, 2008, in accordance with this
8subsection to the extent necessary to administer the
9Department's responsibilities with respect to amendments to
10the State plans and Illinois waivers approved by the federal
11Centers for Medicare and Medicaid Services necessitated by the
12requirements of Title XIX and Title XXI of the federal Social
13Security Act. The adoption of emergency rules authorized by
14this subsection (m) shall be deemed to be necessary for the
15public interest, safety, and welfare.
16    (n) In order to provide for the expeditious and timely
17implementation of the provisions of the State's fiscal year
182010 budget, emergency rules to implement any provision of this
19amendatory Act of the 96th General Assembly or any other budget
20initiative authorized by the 96th General Assembly for fiscal
21year 2010 may be adopted in accordance with this Section by the
22agency charged with administering that provision or
23initiative. The adoption of emergency rules authorized by this
24subsection (n) shall be deemed to be necessary for the public
25interest, safety, and welfare. The rulemaking authority
26granted in this subsection (n) shall apply only to rules

 

 

HB0027- 23 -LRB098 00027 KTG 30027 b

1promulgated during Fiscal Year 2010.
2    (o) In order to provide for the expeditious and timely
3implementation of the provisions of the State's fiscal year
42011 budget, emergency rules to implement any provision of this
5amendatory Act of the 96th General Assembly or any other budget
6initiative authorized by the 96th General Assembly for fiscal
7year 2011 may be adopted in accordance with this Section by the
8agency charged with administering that provision or
9initiative. The adoption of emergency rules authorized by this
10subsection (o) is deemed to be necessary for the public
11interest, safety, and welfare. The rulemaking authority
12granted in this subsection (o) applies only to rules
13promulgated on or after the effective date of this amendatory
14Act of the 96th General Assembly through June 30, 2011.
15    (p) (Blank). In order to provide for the expeditious and
16timely implementation of the provisions of this amendatory Act
17of the 97th General Assembly, emergency rules to implement any
18provision of this amendatory Act of the 97th General Assembly
19may be adopted in accordance with this subsection (p) by the
20agency charged with administering that provision or
21initiative. The 150-day limitation of the effective period of
22emergency rules does not apply to rules adopted under this
23subsection (p), and the effective period may continue through
24June 30, 2013. The 24-month limitation on the adoption of
25emergency rules does not apply to rules adopted under this
26subsection (p). The adoption of emergency rules authorized by

 

 

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1this subsection (p) is deemed to be necessary for the public
2interest, safety, and welfare.
3(Source: P.A. 96-45, eff. 7-15-09; 96-958, eff. 7-1-10;
496-1500, eff. 1-18-11; 97-689, eff. 6-14-12; 97-695, eff.
57-1-12; revised 7-10-12.)
 
6    Section 2-2. The State Comptroller Act is amended by
7changing Section 10.05 as follows:
 
8    (15 ILCS 405/10.05)  (from Ch. 15, par. 210.05)
9    Sec. 10.05. Deductions from warrants; statement of reason
10for deduction. Whenever any person shall be entitled to a
11warrant or other payment from the treasury or other funds held
12by the State Treasurer, on any account, against whom there
13shall be any then due and payable account or claim in favor of
14the State, the United States upon certification by the
15Secretary of the Treasury of the United States, or his or her
16delegate, pursuant to a reciprocal offset agreement under
17subsection (i-1) of Section 10 of the Illinois State Collection
18Act of 1986, or a unit of local government, a school district,
19a public institution of higher education, as defined in Section
201 of the Board of Higher Education Act, or the clerk of a
21circuit court, upon certification by that entity, the
22Comptroller, upon notification thereof, shall ascertain the
23amount due and payable to the State, the United States, the
24unit of local government, the school district, the public

 

 

HB0027- 25 -LRB098 00027 KTG 30027 b

1institution of higher education, or the clerk of the circuit
2court, as aforesaid, and draw a warrant on the treasury or on
3other funds held by the State Treasurer, stating the amount for
4which the party was entitled to a warrant or other payment, the
5amount deducted therefrom, and on what account, and directing
6the payment of the balance; which warrant or payment as so
7drawn shall be entered on the books of the Treasurer, and such
8balance only shall be paid. The Comptroller may deduct any one
9or more of the following: (i) the entire amount due and payable
10to the State or a portion of the amount due and payable to the
11State in accordance with the request of the notifying agency;
12(ii) the entire amount due and payable to the United States or
13a portion of the amount due and payable to the United States in
14accordance with a reciprocal offset agreement under subsection
15(i-1) of Section 10 of the Illinois State Collection Act of
161986; or (iii) the entire amount due and payable to the unit of
17local government, school district, public institution of
18higher education, or clerk of the circuit court, or a portion
19of the amount due and payable to that entity, in accordance
20with an intergovernmental agreement authorized under this
21Section and Section 10.05d. No request from a notifying agency,
22the Secretary of the Treasury of the United States, a unit of
23local government, a school district, a public institution of
24higher education, or the clerk of a circuit court for an amount
25to be deducted under this Section from a wage or salary
26payment, or from a contractual payment to an individual for

 

 

HB0027- 26 -LRB098 00027 KTG 30027 b

1personal services, shall exceed 25% of the net amount of such
2payment. "Net amount" means that part of the earnings of an
3individual remaining after deduction of any amounts required by
4law to be withheld. For purposes of this provision, wage,
5salary or other payments for personal services shall not
6include final compensation payments for the value of accrued
7vacation, overtime or sick leave. Whenever the Comptroller
8draws a warrant or makes a payment involving a deduction
9ordered under this Section, the Comptroller shall notify the
10payee and the State agency that submitted the voucher of the
11reason for the deduction and he or she shall retain a record of
12such statement in his or her records. As used in this Section,
13an "account or claim in favor of the State" includes all
14amounts owing to "State agencies" as defined in Section 7 of
15this Act. However, the Comptroller shall not be required to
16accept accounts or claims owing to funds not held by the State
17Treasurer, where such accounts or claims do not exceed $50, nor
18shall the Comptroller deduct from funds held by the State
19Treasurer under the Senior Citizens and Disabled Persons
20Property Tax Relief and Pharmaceutical Assistance Act or for
21payments to institutions from the Illinois Prepaid Tuition
22Trust Fund (unless the Trust Fund moneys are used for child
23support). The Comptroller shall not deduct from payments to be
24disbursed from the Child Support Enforcement Trust Fund as
25provided for under Section 12-10.2 of the Illinois Public Aid
26Code, except for payments representing interest on child

 

 

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1support obligations under Section 10-16.5 of that Code. The
2Comptroller and the Department of Revenue shall enter into an
3interagency agreement to establish responsibilities, duties,
4and procedures relating to deductions from lottery prizes
5awarded under Section 20.1 of the Illinois Lottery Law. The
6Comptroller may enter into an intergovernmental agreement with
7the Department of Revenue and the Secretary of the Treasury of
8the United States, or his or her delegate, to establish
9responsibilities, duties, and procedures relating to
10reciprocal offset of delinquent State and federal obligations
11pursuant to subsection (i-1) of Section 10 of the Illinois
12State Collection Act of 1986. The Comptroller may enter into
13intergovernmental agreements with any unit of local
14government, school district, public institution of higher
15education, or clerk of a circuit court to establish
16responsibilities, duties, and procedures to provide for the
17offset, by the Comptroller, of obligations owed to those
18entities.
19    For the purposes of this Section, "clerk of a circuit
20court" means the clerk of a circuit court in any county in the
21State.
22(Source: P.A. 97-269, eff. 12-16-11 (see Section 15 of P.A.
2397-632 for the effective date of changes made by P.A. 97-269);
2497-632, eff. 12-16-11; 97-689, eff. 6-14-12; 97-884, eff.
258-2-12; 97-970, eff. 8-16-12; revised 8-23-12.)
 

 

 

HB0027- 28 -LRB098 00027 KTG 30027 b

1    Section 2-12. The Personnel Code is amended by changing
2Section 4d as follows:
 
3    (20 ILCS 415/4d)  (from Ch. 127, par. 63b104d)
4    Sec. 4d. Partial exemptions. The following positions in
5State service are exempt from jurisdictions A, B, and C to the
6extent stated for each, unless those jurisdictions are extended
7as provided in this Act:
8        (1) In each department, board or commission that now
9    maintains or may hereafter maintain a major administrative
10    division, service or office in both Sangamon County and
11    Cook County, 2 private secretaries for the director or
12    chairman thereof, one located in the Cook County office and
13    the other located in the Sangamon County office, shall be
14    exempt from jurisdiction B; in all other departments,
15    boards and commissions one private secretary for the
16    director or chairman thereof shall be exempt from
17    jurisdiction B. In all departments, boards and commissions
18    one confidential assistant for the director or chairman
19    thereof shall be exempt from jurisdiction B. This paragraph
20    is subject to such modifications or waiver of the
21    exemptions as may be necessary to assure the continuity of
22    federal contributions in those agencies supported in whole
23    or in part by federal funds.
24        (2) The resident administrative head of each State
25    charitable, penal and correctional institution, the

 

 

HB0027- 29 -LRB098 00027 KTG 30027 b

1    chaplains thereof, and all member, patient and inmate
2    employees are exempt from jurisdiction B.
3        (3) The Civil Service Commission, upon written
4    recommendation of the Director of Central Management
5    Services, shall exempt from jurisdiction B other positions
6    which, in the judgment of the Commission, involve either
7    principal administrative responsibility for the
8    determination of policy or principal administrative
9    responsibility for the way in which policies are carried
10    out, except positions in agencies which receive federal
11    funds if such exemption is inconsistent with federal
12    requirements, and except positions in agencies supported
13    in whole by federal funds.
14        (4) All beauticians and teachers of beauty culture and
15    teachers of barbering, and all positions heretofore paid
16    under Section 1.22 of "An Act to standardize position
17    titles and salary rates", approved June 30, 1943, as
18    amended, shall be exempt from jurisdiction B.
19        (5) Licensed attorneys in positions as legal or
20    technical advisors, positions in the Department of Natural
21    Resources requiring incumbents to be either a registered
22    professional engineer or to hold a bachelor's degree in
23    engineering from a recognized college or university,
24    licensed physicians in positions of medical administrator
25    or physician or physician specialist (including
26    psychiatrists), and registered nurses (except those

 

 

HB0027- 30 -LRB098 00027 KTG 30027 b

1    registered nurses employed by the Department of Public
2    Health), except those in positions in agencies which
3    receive federal funds if such exemption is inconsistent
4    with federal requirements and except those in positions in
5    agencies supported in whole by federal funds, are exempt
6    from jurisdiction B only to the extent that the
7    requirements of Section 8b.1, 8b.3 and 8b.5 of this Code
8    need not be met.
9        (6) All positions established outside the geographical
10    limits of the State of Illinois to which appointments of
11    other than Illinois citizens may be made are exempt from
12    jurisdiction B.
13        (7) Staff attorneys reporting directly to individual
14    Commissioners of the Illinois Workers' Compensation
15    Commission are exempt from jurisdiction B.
16        (8) Twenty Twenty-one senior public service
17    administrator positions within the Department of
18    Healthcare and Family Services, as set forth in this
19    paragraph (8), requiring the specific knowledge of
20    healthcare administration, healthcare finance, healthcare
21    data analytics, or information technology described are
22    exempt from jurisdiction B only to the extent that the
23    requirements of Sections 8b.1, 8b.3, and 8b.5 of this Code
24    need not be met. The General Assembly finds that these
25    positions are all senior policy makers and have
26    spokesperson authority for the Director of the Department

 

 

HB0027- 31 -LRB098 00027 KTG 30027 b

1    of Healthcare and Family Services. When filling positions
2    so designated, the Director of Healthcare and Family
3    Services shall cause a position description to be published
4    which allots points to various qualifications desired.
5    After scoring qualified applications, the Director shall
6    add Veteran's Preference points as enumerated in Section
7    8b.7 of this Code. The following are the minimum
8    qualifications for the senior public service administrator
9    positions provided for in this paragraph (8):
10            (A) HEALTHCARE ADMINISTRATION.
11                Medical Director: Licensed Medical Doctor in
12            good standing; experience in healthcare payment
13            systems, pay for performance initiatives, medical
14            necessity criteria or federal or State quality
15            improvement programs; preferred experience serving
16            Medicaid patients or experience in population
17            health programs with a large provider, health
18            insurer, government agency, or research
19            institution.
20                Chief, Bureau of Quality Management: Advanced
21            degree in health policy or health professional
22            field preferred; at least 3 years experience in
23            implementing or managing healthcare quality
24            improvement initiatives in a clinical setting.
25                Quality Management Bureau: Manager, Care
26            Coordination/Managed Care Quality: Clinical degree

 

 

HB0027- 32 -LRB098 00027 KTG 30027 b

1            or advanced degree in relevant field required;
2            experience in the field of managed care quality
3            improvement, with knowledge of HEDIS measurements,
4            coding, and related data definitions.
5                Quality Management Bureau: Manager, Primary
6            Care Provider Quality and Practice Development:
7            Clinical degree or advanced degree in relevant
8            field required; experience in practice
9            administration in the primary care setting with a
10            provider or a provider association or an
11            accrediting body; knowledge of practice standards
12            for medical homes and best evidence based
13            standards of care for primary care.
14                Director of Care Coordination Contracts and
15            Compliance: Bachelor's degree required; multi-year
16            experience in negotiating managed care contracts,
17            preferably on behalf of a payer; experience with
18            health care contract compliance.
19                Manager, Long Term Care Policy: Bachelor's
20            degree required; social work, gerontology, or
21            social service degree preferred; knowledge of
22            Olmstead and other relevant court decisions
23            required; experience working with diverse long
24            term care populations and service systems, federal
25            initiatives to create long term care community
26            options, and home and community-based waiver

 

 

HB0027- 33 -LRB098 00027 KTG 30027 b

1            services required. The General Assembly finds that
2            this position is necessary for the timely and
3            effective implementation of this amendatory Act of
4            the 97th General Assembly.
5                Manager, Behavioral Health Programs: Clinical
6            license or Advanced degree required, preferably in
7            psychology, social work, or relevant field;
8            knowledge of medical necessity criteria and
9            governmental policies and regulations governing
10            the provision of mental health services to
11            Medicaid populations, including children and
12            adults, in community and institutional settings of
13            care. The General Assembly finds that this
14            position is necessary for the timely and effective
15            implementation of this amendatory Act of the 97th
16            General Assembly.
17                Chief, Bureau of Pharmacy Services: Bachelor's
18            degree required; pharmacy degree preferred; in
19            formulary development and management from both a
20            clinical and financial perspective, experience in
21            prescription drug utilization review and
22            utilization control policies, knowledge of retail
23            pharmacy reimbursement policies and methodologies
24            and available benchmarks, knowledge of Medicare
25            Part D benefit design.
26                Chief, Bureau of Maternal and Child Health

 

 

HB0027- 34 -LRB098 00027 KTG 30027 b

1            Promotion: Bachelor's degree required, advanced
2            degree preferred, in public health, health care
3            management, or a clinical field; multi-year
4            experience in health care or public health
5            management; knowledge of federal EPSDT
6            requirements and strategies for improving health
7            care for children as well as improving birth
8            outcomes.
9                Director of Dental Program: Bachelor's degree
10            required, advanced degree preferred, in healthcare
11            management or relevant field; experience in
12            healthcare administration; experience in
13            administering dental healthcare programs,
14            knowledge of practice standards for dental care
15            and treatment services; knowledge of the public
16            dental health infrastructure.
17                Manager of Medicare/Medicaid Coordination:
18            Bachelor's degree required, knowledge and
19            experience with Medicare Advantage rules and
20            regulations, knowledge of Medicaid laws and
21            policies; experience with contract drafting
22            preferred.
23                Chief, Bureau of Eligibility Integrity:
24            Bachelor's degree required, advanced degree in
25            public administration or business administration
26            preferred; experience equivalent to 4 years of

 

 

HB0027- 35 -LRB098 00027 KTG 30027 b

1            administration in a public or business
2            organization required; experience with managing
3            contract compliance required; knowledge of
4            Medicaid eligibility laws and policy preferred;
5            supervisory experience preferred. The General
6            Assembly finds that this position is necessary for
7            the timely and effective implementation of this
8            amendatory Act of the 97th General Assembly.
9            (B) HEALTHCARE FINANCE.
10                Director of Care Coordination Rate and
11            Finance: MBA, CPA, or Actuarial degree required;
12            experience in managed care rate setting,
13            including, but not limited to, baseline costs and
14            growth trends; knowledge and experience with
15            Medical Loss Ratio standards and measurements.
16                Director of Encounter Data Program: Bachelor's
17            degree required, advanced degree preferred,
18            preferably in business or information systems; at
19            least 2 years healthcare data reporting
20            experience, including, but not limited to, data
21            definitions, submission, and editing; strong
22            background in HIPAA transactions relevant to
23            encounter data submission; knowledge of healthcare
24            claims systems.
25                Chief, Bureau of Rate Development and
26            Analysis: Bachelor's degree required, advanced

 

 

HB0027- 36 -LRB098 00027 KTG 30027 b

1            degree preferred, with preferred coursework in
2            business or public administration, accounting,
3            finance, data analysis, or statistics; experience
4            with Medicaid reimbursement methodologies and
5            regulations; experience with extracting data from
6            large systems for analysis.
7                Manager of Medical Finance, Division of
8            Finance: Requires relevant advanced degree or
9            certification in relevant field, such as Certified
10            Public Accountant; coursework in business or
11            public administration, accounting, finance, data
12            analysis, or statistics preferred; experience in
13            control systems and GAAP; financial management
14            experience in a healthcare or government entity
15            utilizing Medicaid funding.
16            (C) HEALTHCARE DATA ANALYTICS.
17                Data Quality Assurance Manager: Bachelor's
18            degree required, advanced degree preferred,
19            preferably in business, information systems, or
20            epidemiology; at least 3 years of extensive
21            healthcare data reporting experience with a large
22            provider, health insurer, government agency, or
23            research institution; previous data quality
24            assurance role or formal data quality assurance
25            training.
26                Data Analytics Unit Manager: Bachelor's degree

 

 

HB0027- 37 -LRB098 00027 KTG 30027 b

1            required, advanced degree preferred, in
2            information systems, applied mathematics, or
3            another field with a strong analytics component;
4            extensive healthcare data reporting experience
5            with a large provider, health insurer, government
6            agency, or research institution; experience as a
7            business analyst interfacing between business and
8            information technology departments; in-depth
9            knowledge of health insurance coding and evolving
10            healthcare quality metrics; working knowledge of
11            SQL and/or SAS.
12                Data Analytics Platform Manager: Bachelor's
13            degree required, advanced degree preferred,
14            preferably in business or information systems;
15            extensive healthcare data reporting experience
16            with a large provider, health insurer, government
17            agency, or research institution; previous
18            experience working on a health insurance data
19            analytics platform; experience managing contracts
20            and vendors preferred.
21            (D) HEALTHCARE INFORMATION TECHNOLOGY.
22                Manager of Recipient Provider Reference Unit:
23            Bachelor's degree required; experience equivalent
24            to 4 years of administration in a public or
25            business organization; 3 years of administrative
26            experience in a computer-based management

 

 

HB0027- 38 -LRB098 00027 KTG 30027 b

1            information system.
2                Manager of MMIS Claims Unit: Bachelor's degree
3            required, with preferred coursework in business,
4            public administration, information systems;
5            experience equivalent to 4 years of administration
6            in a public or business organization; working
7            knowledge with design and implementation of
8            technical solutions to medical claims payment
9            systems; extensive technical writing experience,
10            including, but not limited to, the development of
11            RFPs, APDs, feasibility studies, and related
12            documents; thorough knowledge of IT system design,
13            commercial off the shelf software packages and
14            hardware components.
15                Assistant Bureau Chief, Office of Information
16            Systems: Bachelor's degree required, with
17            preferred coursework in business, public
18            administration, information systems; experience
19            equivalent to 5 years of administration in a public
20            or private business organization; extensive
21            technical writing experience, including, but not
22            limited to, the development of RFPs, APDs,
23            feasibility studies and related documents;
24            extensive healthcare technology experience with a
25            large provider, health insurer, government agency,
26            or research institution; experience as a business

 

 

HB0027- 39 -LRB098 00027 KTG 30027 b

1            analyst interfacing between business and
2            information technology departments; thorough
3            knowledge of IT system design, commercial off the
4            shelf software packages and hardware components.
5                Technical System Architect: Bachelor's degree
6            required, with preferred coursework in computer
7            science or information technology; prior
8            experience equivalent to 5 years of computer
9            science or IT administration in a public or
10            business organization; extensive healthcare
11            technology experience with a large provider,
12            health insurer, government agency, or research
13            institution; experience as a business analyst
14            interfacing between business and information
15            technology departments.
16    The provisions of this paragraph (8), other than this
17    sentence, are inoperative after January 1, 2014.
18(Source: P.A. 97-649, eff. 12-30-11; 97-689, eff. 6-14-12.)
 
19    (30 ILCS 5/2-20 rep.)
20    Section 2-14. The Illinois State Auditing Act is amended by
21repealing Section 2-20.
 
22    Section 2-15. The State Finance Act is amended by changing
23Sections 6z-52 and 6z-81 and by adding Sections 5.826, 5.827,
24and 5.828 as follows:
 

 

 

HB0027- 40 -LRB098 00027 KTG 30027 b

1    (30 ILCS 105/5.826 new)
2    Sec. 5.826. The Medical Research and Development Fund.
 
3    (30 ILCS 105/5.827 new)
4    Sec. 5.827. The Post-Tertiary Clinical Services Fund.
 
5    (30 ILCS 105/5.828 new)
6    Sec. 5.828. The Independent Academic Medical Center Fund.
 
7    (30 ILCS 105/6z-52)
8    Sec. 6z-52. Drug Rebate Fund.
9    (a) There is created in the State Treasury a special fund
10to be known as the Drug Rebate Fund.
11    (b) The Fund is created for the purpose of receiving and
12disbursing moneys in accordance with this Section.
13Disbursements from the Fund shall be made, subject to
14appropriation, only as follows:
15        (1) For payments for reimbursement or coverage for
16    prescription drugs and other pharmacy products provided to
17    a recipient of medical assistance under the Illinois Public
18    Aid Code, the Children's Health Insurance Program Act, the
19    Covering ALL KIDS Health Insurance Act, and the Veterans'
20    Health Insurance Program Act of 2008, and the Senior
21    Citizens and Disabled Persons Property Tax Relief and
22    Pharmaceutical Assistance Act.

 

 

HB0027- 41 -LRB098 00027 KTG 30027 b

1        (2) For reimbursement of moneys collected by the
2    Department of Healthcare and Family Services (formerly
3    Illinois Department of Public Aid) through error or
4    mistake.
5        (3) For payments of any amounts that are reimbursable
6    to the federal government resulting from a payment into
7    this Fund.
8        (4) (Blank). For payments of operational and
9    administrative expenses related to providing and managing
10    coverage for prescription drugs and other pharmacy
11    products provided to a recipient of medical assistance
12    under the Illinois Public Aid Code, the Children's Health
13    Insurance Program Act, the Covering ALL KIDS Health
14    Insurance Act, the Veterans' Health Insurance Program Act
15    of 2008, and the Senior Citizens and Disabled Persons
16    Property Tax Relief and Pharmaceutical Assistance Act.
17    (c) The Fund shall consist of the following:
18        (1) Upon notification from the Director of Healthcare
19    and Family Services, the Comptroller shall direct and the
20    Treasurer shall transfer the net State share (disregarding
21    the reduction in net State share attributable to the
22    American Recovery and Reinvestment Act of 2009 or any other
23    federal economic stimulus program) of all moneys received
24    by the Department of Healthcare and Family Services
25    (formerly Illinois Department of Public Aid) from drug
26    rebate agreements with pharmaceutical manufacturers

 

 

HB0027- 42 -LRB098 00027 KTG 30027 b

1    pursuant to Title XIX of the federal Social Security Act,
2    including any portion of the balance in the Public Aid
3    Recoveries Trust Fund on July 1, 2001 that is attributable
4    to such receipts.
5        (2) All federal matching funds received by the Illinois
6    Department as a result of expenditures made by the
7    Department that are attributable to moneys deposited in the
8    Fund.
9        (3) Any premium collected by the Illinois Department
10    from participants under a waiver approved by the federal
11    government relating to provision of pharmaceutical
12    services.
13        (4) All other moneys received for the Fund from any
14    other source, including interest earned thereon.
15(Source: P.A. 96-8, eff. 4-28-09; 96-1100, eff. 1-1-11; 97-689,
16eff. 7-1-12.)
 
17    (30 ILCS 105/6z-81)
18    Sec. 6z-81. Healthcare Provider Relief Fund.
19    (a) There is created in the State treasury a special fund
20to be known as the Healthcare Provider Relief Fund.
21    (b) The Fund is created for the purpose of receiving and
22disbursing moneys in accordance with this Section.
23Disbursements from the Fund shall be made only as follows:
24        (1) Subject to appropriation, for payment by the
25    Department of Healthcare and Family Services or by the

 

 

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1    Department of Human Services of medical bills and related
2    expenses, including administrative expenses, for which the
3    State is responsible under Titles XIX and XXI of the Social
4    Security Act, the Illinois Public Aid Code, the Children's
5    Health Insurance Program Act, the Covering ALL KIDS Health
6    Insurance Act, and the Senior Citizens and Disabled Persons
7    Property Tax Relief and Pharmaceutical Assistance Act. and
8    the Long Term Acute Care Hospital Quality Improvement
9    Transfer Program Act.
10        (2) For repayment of funds borrowed from other State
11    funds or from outside sources, including interest thereon.
12    (c) The Fund shall consist of the following:
13        (1) Moneys received by the State from short-term
14    borrowing pursuant to the Short Term Borrowing Act on or
15    after the effective date of this amendatory Act of the 96th
16    General Assembly.
17        (2) All federal matching funds received by the Illinois
18    Department of Healthcare and Family Services as a result of
19    expenditures made by the Department that are attributable
20    to moneys deposited in the Fund.
21        (3) All federal matching funds received by the Illinois
22    Department of Healthcare and Family Services as a result of
23    federal approval of Title XIX State plan amendment
24    transmittal number 07-09.
25        (4) All other moneys received for the Fund from any
26    other source, including interest earned thereon.

 

 

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1    (d) In addition to any other transfers that may be provided
2for by law, on the effective date of this amendatory Act of the
397th General Assembly, or as soon thereafter as practical, the
4State Comptroller shall direct and the State Treasurer shall
5transfer the sum of $365,000,000 from the General Revenue Fund
6into the Healthcare Provider Relief Fund.
7    (e) In addition to any other transfers that may be provided
8for by law, on July 1, 2011, or as soon thereafter as
9practical, the State Comptroller shall direct and the State
10Treasurer shall transfer the sum of $160,000,000 from the
11General Revenue Fund to the Healthcare Provider Relief Fund.
12    (f) Notwithstanding any other State law to the contrary,
13and in addition to any other transfers that may be provided for
14by law, the State Comptroller shall order transferred and the
15State Treasurer shall transfer $500,000,000 to the Healthcare
16Provider Relief Fund from the General Revenue Fund in equal
17monthly installments of $100,000,000, with the first transfer
18to be made on July 1, 2012, or as soon thereafter as practical,
19and with each of the remaining transfers to be made on August
201, 2012, September 1, 2012, October 1, 2012, and November 1,
212012, or as soon thereafter as practical. This transfer may
22assist the Department of Healthcare and Family Services in
23improving Medical Assistance bill processing timeframes or in
24meeting the possible requirements of Senate Bill 3397, or other
25similar legislation, of the 97th General Assembly should it
26become law.

 

 

HB0027- 45 -LRB098 00027 KTG 30027 b

1(Source: P.A. 96-820, eff. 11-18-09; 96-1100, eff. 1-1-11;
297-44, eff. 6-28-11; 97-641, eff. 12-19-11; 97-689, eff.
36-14-12; 97-732, eff. 6-30-12; revised 7-10-12.)
 
4    Section 2-25. The Illinois Procurement Code is amended by
5changing Section 1-10 as follows:
 
6    (30 ILCS 500/1-10)
7    Sec. 1-10. Application.
8    (a) This Code applies only to procurements for which
9contractors were first solicited on or after July 1, 1998. This
10Code shall not be construed to affect or impair any contract,
11or any provision of a contract, entered into based on a
12solicitation prior to the implementation date of this Code as
13described in Article 99, including but not limited to any
14covenant entered into with respect to any revenue bonds or
15similar instruments. All procurements for which contracts are
16solicited between the effective date of Articles 50 and 99 and
17July 1, 1998 shall be substantially in accordance with this
18Code and its intent.
19    (b) This Code shall apply regardless of the source of the
20funds with which the contracts are paid, including federal
21assistance moneys. This Code shall not apply to:
22        (1) Contracts between the State and its political
23    subdivisions or other governments, or between State
24    governmental bodies except as specifically provided in

 

 

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1    this Code.
2        (2) Grants, except for the filing requirements of
3    Section 20-80.
4        (3) Purchase of care.
5        (4) Hiring of an individual as employee and not as an
6    independent contractor, whether pursuant to an employment
7    code or policy or by contract directly with that
8    individual.
9        (5) Collective bargaining contracts.
10        (6) Purchase of real estate, except that notice of this
11    type of contract with a value of more than $25,000 must be
12    published in the Procurement Bulletin within 7 days after
13    the deed is recorded in the county of jurisdiction. The
14    notice shall identify the real estate purchased, the names
15    of all parties to the contract, the value of the contract,
16    and the effective date of the contract.
17        (7) Contracts necessary to prepare for anticipated
18    litigation, enforcement actions, or investigations,
19    provided that the chief legal counsel to the Governor shall
20    give his or her prior approval when the procuring agency is
21    one subject to the jurisdiction of the Governor, and
22    provided that the chief legal counsel of any other
23    procuring entity subject to this Code shall give his or her
24    prior approval when the procuring entity is not one subject
25    to the jurisdiction of the Governor.
26        (8) Contracts for services to Northern Illinois

 

 

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1    University by a person, acting as an independent
2    contractor, who is qualified by education, experience, and
3    technical ability and is selected by negotiation for the
4    purpose of providing non-credit educational service
5    activities or products by means of specialized programs
6    offered by the university.
7        (9) Procurement expenditures by the Illinois
8    Conservation Foundation when only private funds are used.
9        (10) Procurement expenditures by the Illinois Health
10    Information Exchange Authority involving private funds
11    from the Health Information Exchange Fund. "Private funds"
12    means gifts, donations, and private grants.
13        (11) Public-private agreements entered into according
14    to the procurement requirements of Section 20 of the
15    Public-Private Partnerships for Transportation Act and
16    design-build agreements entered into according to the
17    procurement requirements of Section 25 of the
18    Public-Private Partnerships for Transportation Act.
19    (c) This Code does not apply to the electric power
20procurement process provided for under Section 1-75 of the
21Illinois Power Agency Act and Section 16-111.5 of the Public
22Utilities Act.
23    (d) Except for Section 20-160 and Article 50 of this Code,
24and as expressly required by Section 9.1 of the Illinois
25Lottery Law, the provisions of this Code do not apply to the
26procurement process provided for under Section 9.1 of the

 

 

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1Illinois Lottery Law.
2    (e) This Code does not apply to the process used by the
3Capital Development Board to retain a person or entity to
4assist the Capital Development Board with its duties related to
5the determination of costs of a clean coal SNG brownfield
6facility, as defined by Section 1-10 of the Illinois Power
7Agency Act, as required in subsection (h-3) of Section 9-220 of
8the Public Utilities Act, including calculating the range of
9capital costs, the range of operating and maintenance costs, or
10the sequestration costs or monitoring the construction of clean
11coal SNG brownfield facility for the full duration of
12construction.
13    (f) This Code does not apply to the process used by the
14Illinois Power Agency to retain a mediator to mediate sourcing
15agreement disputes between gas utilities and the clean coal SNG
16brownfield facility, as defined in Section 1-10 of the Illinois
17Power Agency Act, as required under subsection (h-1) of Section
189-220 of the Public Utilities Act.
19    (g) This Code does not apply to the processes used by the
20Illinois Power Agency to retain a mediator to mediate contract
21disputes between gas utilities and the clean coal SNG facility
22and to retain an expert to assist in the review of contracts
23under subsection (h) of Section 9-220 of the Public Utilities
24Act. This Code does not apply to the process used by the
25Illinois Commerce Commission to retain an expert to assist in
26determining the actual incurred costs of the clean coal SNG

 

 

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1facility and the reasonableness of those costs as required
2under subsection (h) of Section 9-220 of the Public Utilities
3Act.
4    (h) (Blank). This Code does not apply to the process to
5procure or contracts entered into in accordance with Sections
611-5.2 and 11-5.3 of the Illinois Public Aid Code.
7    (i) (h) Each chief procurement officer may access records
8necessary to review whether a contract, purchase, or other
9expenditure is or is not subject to the provisions of this
10Code, unless such records would be subject to attorney-client
11privilege.
12(Source: P.A. 96-840, eff. 12-23-09; 96-1331, eff. 7-27-10;
1397-96, eff. 7-13-11; 97-239, eff. 8-2-11; 97-502, eff. 8-23-11;
1497-689, eff. 6-14-12; 97-813, eff. 7-13-12; 97-895, eff.
158-3-12; revised 8-23-12.)
 
16    Section 2-26. The Downstate Public Transportation Act is
17amended by changing Sections 2-15.2 and 2-15.3 as follows:
 
18    (30 ILCS 740/2-15.2)
19    Sec. 2-15.2. Free services; eligibility.
20    (a) Notwithstanding any law to the contrary, no later than
2160 days following the effective date of this amendatory Act of
22the 95th General Assembly and until subsection (b) is
23implemented, any fixed route public transportation services
24provided by, or under grant or purchase of service contracts

 

 

HB0027- 50 -LRB098 00027 KTG 30027 b

1of, every participant, as defined in Section 2-2.02 (1)(a),
2shall be provided without charge to all senior citizen
3residents of the participant aged 65 and older, under such
4conditions as shall be prescribed by the participant.
5    (b) Notwithstanding any law to the contrary, no later than
6180 days following the effective date of this amendatory Act of
7the 96th General Assembly, any fixed route public
8transportation services provided by, or under grant or purchase
9of service contracts of, every participant, as defined in
10Section 2-2.02 (1)(a), shall be provided without charge to
11senior citizens aged 65 and older who meet the income
12eligibility limitation set forth in subsection (a-5) of Section
134 of the Senior Citizens and Disabled Persons Property Tax
14Relief and Pharmaceutical Assistance Act, under such
15conditions as shall be prescribed by the participant. The
16Department on Aging shall furnish all information reasonably
17necessary to determine eligibility, including updated lists of
18individuals who are eligible for services without charge under
19this Section. Nothing in this Section shall relieve the
20participant from providing reduced fares as may be required by
21federal law.
22(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
 
23    (30 ILCS 740/2-15.3)
24    Sec. 2-15.3. Transit services for disabled individuals.
25Notwithstanding any law to the contrary, no later than 60 days

 

 

HB0027- 51 -LRB098 00027 KTG 30027 b

1following the effective date of this amendatory Act of the 95th
2General Assembly, all fixed route public transportation
3services provided by, or under grant or purchase of service
4contract of, any participant shall be provided without charge
5to all disabled persons who meet the income eligibility
6limitation set forth in subsection (a-5) of Section 4 of the
7Senior Citizens and Disabled Persons Property Tax Relief and
8Pharmaceutical Assistance Act, under such procedures as shall
9be prescribed by the participant. The Department on Aging shall
10furnish all information reasonably necessary to determine
11eligibility, including updated lists of individuals who are
12eligible for services without charge under this Section.
13(Source: P.A. 97-689, eff. 6-14-12.)
 
14    Section 2-27. The Property Tax Code is amended by changing
15Sections 15-172, 15-175, 20-15, and 21-27 as follows:
 
16    (35 ILCS 200/15-172)
17    Sec. 15-172. Senior Citizens Assessment Freeze Homestead
18Exemption.
19    (a) This Section may be cited as the Senior Citizens
20Assessment Freeze Homestead Exemption.
21    (b) As used in this Section:
22    "Applicant" means an individual who has filed an
23application under this Section.
24    "Base amount" means the base year equalized assessed value

 

 

HB0027- 52 -LRB098 00027 KTG 30027 b

1of the residence plus the first year's equalized assessed value
2of any added improvements which increased the assessed value of
3the residence after the base year.
4    "Base year" means the taxable year prior to the taxable
5year for which the applicant first qualifies and applies for
6the exemption provided that in the prior taxable year the
7property was improved with a permanent structure that was
8occupied as a residence by the applicant who was liable for
9paying real property taxes on the property and who was either
10(i) an owner of record of the property or had legal or
11equitable interest in the property as evidenced by a written
12instrument or (ii) had a legal or equitable interest as a
13lessee in the parcel of property that was single family
14residence. If in any subsequent taxable year for which the
15applicant applies and qualifies for the exemption the equalized
16assessed value of the residence is less than the equalized
17assessed value in the existing base year (provided that such
18equalized assessed value is not based on an assessed value that
19results from a temporary irregularity in the property that
20reduces the assessed value for one or more taxable years), then
21that subsequent taxable year shall become the base year until a
22new base year is established under the terms of this paragraph.
23For taxable year 1999 only, the Chief County Assessment Officer
24shall review (i) all taxable years for which the applicant
25applied and qualified for the exemption and (ii) the existing
26base year. The assessment officer shall select as the new base

 

 

HB0027- 53 -LRB098 00027 KTG 30027 b

1year the year with the lowest equalized assessed value. An
2equalized assessed value that is based on an assessed value
3that results from a temporary irregularity in the property that
4reduces the assessed value for one or more taxable years shall
5not be considered the lowest equalized assessed value. The
6selected year shall be the base year for taxable year 1999 and
7thereafter until a new base year is established under the terms
8of this paragraph.
9    "Chief County Assessment Officer" means the County
10Assessor or Supervisor of Assessments of the county in which
11the property is located.
12    "Equalized assessed value" means the assessed value as
13equalized by the Illinois Department of Revenue.
14    "Household" means the applicant, the spouse of the
15applicant, and all persons using the residence of the applicant
16as their principal place of residence.
17    "Household income" means the combined income of the members
18of a household for the calendar year preceding the taxable
19year.
20    "Income" has the same meaning as provided in Section 3.07
21of the Senior Citizens and Disabled Persons Property Tax Relief
22and Pharmaceutical Assistance Act, except that, beginning in
23assessment year 2001, "income" does not include veteran's
24benefits.
25    "Internal Revenue Code of 1986" means the United States
26Internal Revenue Code of 1986 or any successor law or laws

 

 

HB0027- 54 -LRB098 00027 KTG 30027 b

1relating to federal income taxes in effect for the year
2preceding the taxable year.
3    "Life care facility that qualifies as a cooperative" means
4a facility as defined in Section 2 of the Life Care Facilities
5Act.
6    "Maximum income limitation" means:
7        (1) $35,000 prior to taxable year 1999;
8        (2) $40,000 in taxable years 1999 through 2003;
9        (3) $45,000 in taxable years 2004 through 2005;
10        (4) $50,000 in taxable years 2006 and 2007; and
11        (5) $55,000 in taxable year 2008 and thereafter.
12    "Residence" means the principal dwelling place and
13appurtenant structures used for residential purposes in this
14State occupied on January 1 of the taxable year by a household
15and so much of the surrounding land, constituting the parcel
16upon which the dwelling place is situated, as is used for
17residential purposes. If the Chief County Assessment Officer
18has established a specific legal description for a portion of
19property constituting the residence, then that portion of
20property shall be deemed the residence for the purposes of this
21Section.
22    "Taxable year" means the calendar year during which ad
23valorem property taxes payable in the next succeeding year are
24levied.
25    (c) Beginning in taxable year 1994, a senior citizens
26assessment freeze homestead exemption is granted for real

 

 

HB0027- 55 -LRB098 00027 KTG 30027 b

1property that is improved with a permanent structure that is
2occupied as a residence by an applicant who (i) is 65 years of
3age or older during the taxable year, (ii) has a household
4income that does not exceed the maximum income limitation,
5(iii) is liable for paying real property taxes on the property,
6and (iv) is an owner of record of the property or has a legal or
7equitable interest in the property as evidenced by a written
8instrument. This homestead exemption shall also apply to a
9leasehold interest in a parcel of property improved with a
10permanent structure that is a single family residence that is
11occupied as a residence by a person who (i) is 65 years of age
12or older during the taxable year, (ii) has a household income
13that does not exceed the maximum income limitation, (iii) has a
14legal or equitable ownership interest in the property as
15lessee, and (iv) is liable for the payment of real property
16taxes on that property.
17    In counties of 3,000,000 or more inhabitants, the amount of
18the exemption for all taxable years is the equalized assessed
19value of the residence in the taxable year for which
20application is made minus the base amount. In all other
21counties, the amount of the exemption is as follows: (i)
22through taxable year 2005 and for taxable year 2007 and
23thereafter, the amount of this exemption shall be the equalized
24assessed value of the residence in the taxable year for which
25application is made minus the base amount; and (ii) for taxable
26year 2006, the amount of the exemption is as follows:

 

 

HB0027- 56 -LRB098 00027 KTG 30027 b

1        (1) For an applicant who has a household income of
2    $45,000 or less, the amount of the exemption is the
3    equalized assessed value of the residence in the taxable
4    year for which application is made minus the base amount.
5        (2) For an applicant who has a household income
6    exceeding $45,000 but not exceeding $46,250, the amount of
7    the exemption is (i) the equalized assessed value of the
8    residence in the taxable year for which application is made
9    minus the base amount (ii) multiplied by 0.8.
10        (3) For an applicant who has a household income
11    exceeding $46,250 but not exceeding $47,500, the amount of
12    the exemption is (i) the equalized assessed value of the
13    residence in the taxable year for which application is made
14    minus the base amount (ii) multiplied by 0.6.
15        (4) For an applicant who has a household income
16    exceeding $47,500 but not exceeding $48,750, the amount of
17    the exemption is (i) the equalized assessed value of the
18    residence in the taxable year for which application is made
19    minus the base amount (ii) multiplied by 0.4.
20        (5) For an applicant who has a household income
21    exceeding $48,750 but not exceeding $50,000, the amount of
22    the exemption is (i) the equalized assessed value of the
23    residence in the taxable year for which application is made
24    minus the base amount (ii) multiplied by 0.2.
25    When the applicant is a surviving spouse of an applicant
26for a prior year for the same residence for which an exemption

 

 

HB0027- 57 -LRB098 00027 KTG 30027 b

1under this Section has been granted, the base year and base
2amount for that residence are the same as for the applicant for
3the prior year.
4    Each year at the time the assessment books are certified to
5the County Clerk, the Board of Review or Board of Appeals shall
6give to the County Clerk a list of the assessed values of
7improvements on each parcel qualifying for this exemption that
8were added after the base year for this parcel and that
9increased the assessed value of the property.
10    In the case of land improved with an apartment building
11owned and operated as a cooperative or a building that is a
12life care facility that qualifies as a cooperative, the maximum
13reduction from the equalized assessed value of the property is
14limited to the sum of the reductions calculated for each unit
15occupied as a residence by a person or persons (i) 65 years of
16age or older, (ii) with a household income that does not exceed
17the maximum income limitation, (iii) who is liable, by contract
18with the owner or owners of record, for paying real property
19taxes on the property, and (iv) who is an owner of record of a
20legal or equitable interest in the cooperative apartment
21building, other than a leasehold interest. In the instance of a
22cooperative where a homestead exemption has been granted under
23this Section, the cooperative association or its management
24firm shall credit the savings resulting from that exemption
25only to the apportioned tax liability of the owner who
26qualified for the exemption. Any person who willfully refuses

 

 

HB0027- 58 -LRB098 00027 KTG 30027 b

1to credit that savings to an owner who qualifies for the
2exemption is guilty of a Class B misdemeanor.
3    When a homestead exemption has been granted under this
4Section and an applicant then becomes a resident of a facility
5licensed under the Assisted Living and Shared Housing Act, the
6Nursing Home Care Act, the Specialized Mental Health
7Rehabilitation Act, or the ID/DD Community Care Act, the
8exemption shall be granted in subsequent years so long as the
9residence (i) continues to be occupied by the qualified
10applicant's spouse or (ii) if remaining unoccupied, is still
11owned by the qualified applicant for the homestead exemption.
12    Beginning January 1, 1997, when an individual dies who
13would have qualified for an exemption under this Section, and
14the surviving spouse does not independently qualify for this
15exemption because of age, the exemption under this Section
16shall be granted to the surviving spouse for the taxable year
17preceding and the taxable year of the death, provided that,
18except for age, the surviving spouse meets all other
19qualifications for the granting of this exemption for those
20years.
21    When married persons maintain separate residences, the
22exemption provided for in this Section may be claimed by only
23one of such persons and for only one residence.
24    For taxable year 1994 only, in counties having less than
253,000,000 inhabitants, to receive the exemption, a person shall
26submit an application by February 15, 1995 to the Chief County

 

 

HB0027- 59 -LRB098 00027 KTG 30027 b

1Assessment Officer of the county in which the property is
2located. In counties having 3,000,000 or more inhabitants, for
3taxable year 1994 and all subsequent taxable years, to receive
4the exemption, a person may submit an application to the Chief
5County Assessment Officer of the county in which the property
6is located during such period as may be specified by the Chief
7County Assessment Officer. The Chief County Assessment Officer
8in counties of 3,000,000 or more inhabitants shall annually
9give notice of the application period by mail or by
10publication. In counties having less than 3,000,000
11inhabitants, beginning with taxable year 1995 and thereafter,
12to receive the exemption, a person shall submit an application
13by July 1 of each taxable year to the Chief County Assessment
14Officer of the county in which the property is located. A
15county may, by ordinance, establish a date for submission of
16applications that is different than July 1. The applicant shall
17submit with the application an affidavit of the applicant's
18total household income, age, marital status (and if married the
19name and address of the applicant's spouse, if known), and
20principal dwelling place of members of the household on January
211 of the taxable year. The Department shall establish, by rule,
22a method for verifying the accuracy of affidavits filed by
23applicants under this Section, and the Chief County Assessment
24Officer may conduct audits of any taxpayer claiming an
25exemption under this Section to verify that the taxpayer is
26eligible to receive the exemption. Each application shall

 

 

HB0027- 60 -LRB098 00027 KTG 30027 b

1contain or be verified by a written declaration that it is made
2under the penalties of perjury. A taxpayer's signing a
3fraudulent application under this Act is perjury, as defined in
4Section 32-2 of the Criminal Code of 1961. The applications
5shall be clearly marked as applications for the Senior Citizens
6Assessment Freeze Homestead Exemption and must contain a notice
7that any taxpayer who receives the exemption is subject to an
8audit by the Chief County Assessment Officer.
9    Notwithstanding any other provision to the contrary, in
10counties having fewer than 3,000,000 inhabitants, if an
11applicant fails to file the application required by this
12Section in a timely manner and this failure to file is due to a
13mental or physical condition sufficiently severe so as to
14render the applicant incapable of filing the application in a
15timely manner, the Chief County Assessment Officer may extend
16the filing deadline for a period of 30 days after the applicant
17regains the capability to file the application, but in no case
18may the filing deadline be extended beyond 3 months of the
19original filing deadline. In order to receive the extension
20provided in this paragraph, the applicant shall provide the
21Chief County Assessment Officer with a signed statement from
22the applicant's physician stating the nature and extent of the
23condition, that, in the physician's opinion, the condition was
24so severe that it rendered the applicant incapable of filing
25the application in a timely manner, and the date on which the
26applicant regained the capability to file the application.

 

 

HB0027- 61 -LRB098 00027 KTG 30027 b

1    Beginning January 1, 1998, notwithstanding any other
2provision to the contrary, in counties having fewer than
33,000,000 inhabitants, if an applicant fails to file the
4application required by this Section in a timely manner and
5this failure to file is due to a mental or physical condition
6sufficiently severe so as to render the applicant incapable of
7filing the application in a timely manner, the Chief County
8Assessment Officer may extend the filing deadline for a period
9of 3 months. In order to receive the extension provided in this
10paragraph, the applicant shall provide the Chief County
11Assessment Officer with a signed statement from the applicant's
12physician stating the nature and extent of the condition, and
13that, in the physician's opinion, the condition was so severe
14that it rendered the applicant incapable of filing the
15application in a timely manner.
16    In counties having less than 3,000,000 inhabitants, if an
17applicant was denied an exemption in taxable year 1994 and the
18denial occurred due to an error on the part of an assessment
19official, or his or her agent or employee, then beginning in
20taxable year 1997 the applicant's base year, for purposes of
21determining the amount of the exemption, shall be 1993 rather
22than 1994. In addition, in taxable year 1997, the applicant's
23exemption shall also include an amount equal to (i) the amount
24of any exemption denied to the applicant in taxable year 1995
25as a result of using 1994, rather than 1993, as the base year,
26(ii) the amount of any exemption denied to the applicant in

 

 

HB0027- 62 -LRB098 00027 KTG 30027 b

1taxable year 1996 as a result of using 1994, rather than 1993,
2as the base year, and (iii) the amount of the exemption
3erroneously denied for taxable year 1994.
4    For purposes of this Section, a person who will be 65 years
5of age during the current taxable year shall be eligible to
6apply for the homestead exemption during that taxable year.
7Application shall be made during the application period in
8effect for the county of his or her residence.
9    The Chief County Assessment Officer may determine the
10eligibility of a life care facility that qualifies as a
11cooperative to receive the benefits provided by this Section by
12use of an affidavit, application, visual inspection,
13questionnaire, or other reasonable method in order to insure
14that the tax savings resulting from the exemption are credited
15by the management firm to the apportioned tax liability of each
16qualifying resident. The Chief County Assessment Officer may
17request reasonable proof that the management firm has so
18credited that exemption.
19    Except as provided in this Section, all information
20received by the chief county assessment officer or the
21Department from applications filed under this Section, or from
22any investigation conducted under the provisions of this
23Section, shall be confidential, except for official purposes or
24pursuant to official procedures for collection of any State or
25local tax or enforcement of any civil or criminal penalty or
26sanction imposed by this Act or by any statute or ordinance

 

 

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1imposing a State or local tax. Any person who divulges any such
2information in any manner, except in accordance with a proper
3judicial order, is guilty of a Class A misdemeanor.
4    Nothing contained in this Section shall prevent the
5Director or chief county assessment officer from publishing or
6making available reasonable statistics concerning the
7operation of the exemption contained in this Section in which
8the contents of claims are grouped into aggregates in such a
9way that information contained in any individual claim shall
10not be disclosed.
11    (d) Each Chief County Assessment Officer shall annually
12publish a notice of availability of the exemption provided
13under this Section. The notice shall be published at least 60
14days but no more than 75 days prior to the date on which the
15application must be submitted to the Chief County Assessment
16Officer of the county in which the property is located. The
17notice shall appear in a newspaper of general circulation in
18the county.
19    Notwithstanding Sections 6 and 8 of the State Mandates Act,
20no reimbursement by the State is required for the
21implementation of any mandate created by this Section.
22(Source: P.A. 96-339, eff. 7-1-10; 96-355, eff. 1-1-10;
2396-1000, eff. 7-2-10; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
2497-689, eff. 6-14-12; 97-813, eff. 7-13-12.)
 
25    (35 ILCS 200/15-175)

 

 

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1    Sec. 15-175. General homestead exemption.
2    (a) Except as provided in Sections 15-176 and 15-177,
3homestead property is entitled to an annual homestead exemption
4limited, except as described here with relation to
5cooperatives, to a reduction in the equalized assessed value of
6homestead property equal to the increase in equalized assessed
7value for the current assessment year above the equalized
8assessed value of the property for 1977, up to the maximum
9reduction set forth below. If however, the 1977 equalized
10assessed value upon which taxes were paid is subsequently
11determined by local assessing officials, the Property Tax
12Appeal Board, or a court to have been excessive, the equalized
13assessed value which should have been placed on the property
14for 1977 shall be used to determine the amount of the
15exemption.
16    (b) Except as provided in Section 15-176, the maximum
17reduction before taxable year 2004 shall be $4,500 in counties
18with 3,000,000 or more inhabitants and $3,500 in all other
19counties. Except as provided in Sections 15-176 and 15-177, for
20taxable years 2004 through 2007, the maximum reduction shall be
21$5,000, for taxable year 2008, the maximum reduction is $5,500,
22and, for taxable years 2009 and thereafter, the maximum
23reduction is $6,000 in all counties. If a county has elected to
24subject itself to the provisions of Section 15-176 as provided
25in subsection (k) of that Section, then, for the first taxable
26year only after the provisions of Section 15-176 no longer

 

 

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1apply, for owners who, for the taxable year, have not been
2granted a senior citizens assessment freeze homestead
3exemption under Section 15-172 or a long-time occupant
4homestead exemption under Section 15-177, there shall be an
5additional exemption of $5,000 for owners with a household
6income of $30,000 or less.
7    (c) In counties with fewer than 3,000,000 inhabitants, if,
8based on the most recent assessment, the equalized assessed
9value of the homestead property for the current assessment year
10is greater than the equalized assessed value of the property
11for 1977, the owner of the property shall automatically receive
12the exemption granted under this Section in an amount equal to
13the increase over the 1977 assessment up to the maximum
14reduction set forth in this Section.
15    (d) If in any assessment year beginning with the 2000
16assessment year, homestead property has a pro-rata valuation
17under Section 9-180 resulting in an increase in the assessed
18valuation, a reduction in equalized assessed valuation equal to
19the increase in equalized assessed value of the property for
20the year of the pro-rata valuation above the equalized assessed
21value of the property for 1977 shall be applied to the property
22on a proportionate basis for the period the property qualified
23as homestead property during the assessment year. The maximum
24proportionate homestead exemption shall not exceed the maximum
25homestead exemption allowed in the county under this Section
26divided by 365 and multiplied by the number of days the

 

 

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1property qualified as homestead property.
2    (e) The chief county assessment officer may, when
3considering whether to grant a leasehold exemption under this
4Section, require the following conditions to be met:
5        (1) that a notarized application for the exemption,
6    signed by both the owner and the lessee of the property,
7    must be submitted each year during the application period
8    in effect for the county in which the property is located;
9        (2) that a copy of the lease must be filed with the
10    chief county assessment officer by the owner of the
11    property at the time the notarized application is
12    submitted;
13        (3) that the lease must expressly state that the lessee
14    is liable for the payment of property taxes; and
15        (4) that the lease must include the following language
16    in substantially the following form:
17            "Lessee shall be liable for the payment of real
18        estate taxes with respect to the residence in
19        accordance with the terms and conditions of Section
20        15-175 of the Property Tax Code (35 ILCS 200/15-175).
21        The permanent real estate index number for the premises
22        is (insert number), and, according to the most recent
23        property tax bill, the current amount of real estate
24        taxes associated with the premises is (insert amount)
25        per year. The parties agree that the monthly rent set
26        forth above shall be increased or decreased pro rata

 

 

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1        (effective January 1 of each calendar year) to reflect
2        any increase or decrease in real estate taxes. Lessee
3        shall be deemed to be satisfying Lessee's liability for
4        the above mentioned real estate taxes with the monthly
5        rent payments as set forth above (or increased or
6        decreased as set forth herein).".
7    In addition, if there is a change in lessee, or if the
8lessee vacates the property, then the chief county assessment
9officer may require the owner of the property to notify the
10chief county assessment officer of that change.
11    This subsection (e) does not apply to leasehold interests
12in property owned by a municipality.
13    (f) "Homestead property" under this Section includes
14residential property that is occupied by its owner or owners as
15his or their principal dwelling place, or that is a leasehold
16interest on which a single family residence is situated, which
17is occupied as a residence by a person who has an ownership
18interest therein, legal or equitable or as a lessee, and on
19which the person is liable for the payment of property taxes.
20For land improved with an apartment building owned and operated
21as a cooperative or a building which is a life care facility as
22defined in Section 15-170 and considered to be a cooperative
23under Section 15-170, the maximum reduction from the equalized
24assessed value shall be limited to the increase in the value
25above the equalized assessed value of the property for 1977, up
26to the maximum reduction set forth above, multiplied by the

 

 

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1number of apartments or units occupied by a person or persons
2who is liable, by contract with the owner or owners of record,
3for paying property taxes on the property and is an owner of
4record of a legal or equitable interest in the cooperative
5apartment building, other than a leasehold interest. For
6purposes of this Section, the term "life care facility" has the
7meaning stated in Section 15-170.
8    "Household", as used in this Section, means the owner, the
9spouse of the owner, and all persons using the residence of the
10owner as their principal place of residence.
11    "Household income", as used in this Section, means the
12combined income of the members of a household for the calendar
13year preceding the taxable year.
14    "Income", as used in this Section, has the same meaning as
15provided in Section 3.07 of the Senior Citizens and Disabled
16Persons Property Tax Relief and Pharmaceutical Assistance Act,
17except that "income" does not include veteran's benefits.
18    (g) In a cooperative where a homestead exemption has been
19granted, the cooperative association or its management firm
20shall credit the savings resulting from that exemption only to
21the apportioned tax liability of the owner who qualified for
22the exemption. Any person who willfully refuses to so credit
23the savings shall be guilty of a Class B misdemeanor.
24    (h) Where married persons maintain and reside in separate
25residences qualifying as homestead property, each residence
26shall receive 50% of the total reduction in equalized assessed

 

 

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1valuation provided by this Section.
2    (i) In all counties, the assessor or chief county
3assessment officer may determine the eligibility of
4residential property to receive the homestead exemption and the
5amount of the exemption by application, visual inspection,
6questionnaire or other reasonable methods. The determination
7shall be made in accordance with guidelines established by the
8Department, provided that the taxpayer applying for an
9additional general exemption under this Section shall submit to
10the chief county assessment officer an application with an
11affidavit of the applicant's total household income, age,
12marital status (and, if married, the name and address of the
13applicant's spouse, if known), and principal dwelling place of
14members of the household on January 1 of the taxable year. The
15Department shall issue guidelines establishing a method for
16verifying the accuracy of the affidavits filed by applicants
17under this paragraph. The applications shall be clearly marked
18as applications for the Additional General Homestead
19Exemption.
20    (j) In counties with fewer than 3,000,000 inhabitants, in
21the event of a sale of homestead property the homestead
22exemption shall remain in effect for the remainder of the
23assessment year of the sale. The assessor or chief county
24assessment officer may require the new owner of the property to
25apply for the homestead exemption for the following assessment
26year.

 

 

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1    (k) Notwithstanding Sections 6 and 8 of the State Mandates
2Act, no reimbursement by the State is required for the
3implementation of any mandate created by this Section.
4(Source: P.A. 97-689, eff. 6-14-12; 97-1125, eff. 8-28-12;
5revised 9-20-12.)
 
6    (35 ILCS 200/20-15)
7    Sec. 20-15. Information on bill or separate statement.
8There shall be printed on each bill, or on a separate slip
9which shall be mailed with the bill:
10        (a) a statement itemizing the rate at which taxes have
11    been extended for each of the taxing districts in the
12    county in whose district the property is located, and in
13    those counties utilizing electronic data processing
14    equipment the dollar amount of tax due from the person
15    assessed allocable to each of those taxing districts,
16    including a separate statement of the dollar amount of tax
17    due which is allocable to a tax levied under the Illinois
18    Local Library Act or to any other tax levied by a
19    municipality or township for public library purposes,
20        (b) a separate statement for each of the taxing
21    districts of the dollar amount of tax due which is
22    allocable to a tax levied under the Illinois Pension Code
23    or to any other tax levied by a municipality or township
24    for public pension or retirement purposes,
25        (c) the total tax rate,

 

 

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1        (d) the total amount of tax due, and
2        (e) the amount by which the total tax and the tax
3    allocable to each taxing district differs from the
4    taxpayer's last prior tax bill.
5    The county treasurer shall ensure that only those taxing
6districts in which a parcel of property is located shall be
7listed on the bill for that property.
8    In all counties the statement shall also provide:
9        (1) the property index number or other suitable
10    description,
11        (2) the assessment of the property,
12        (3) the equalization factors imposed by the county and
13    by the Department, and
14        (4) the equalized assessment resulting from the
15    application of the equalization factors to the basic
16    assessment.
17    In all counties which do not classify property for purposes
18of taxation, for property on which a single family residence is
19situated the statement shall also include a statement to
20reflect the fair cash value determined for the property. In all
21counties which classify property for purposes of taxation in
22accordance with Section 4 of Article IX of the Illinois
23Constitution, for parcels of residential property in the lowest
24assessment classification the statement shall also include a
25statement to reflect the fair cash value determined for the
26property.

 

 

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1    In all counties, the statement must include information
2that certain taxpayers may be eligible for tax exemptions,
3abatements, and other assistance programs and that, for more
4information, taxpayers should consult with the office of their
5township or county assessor and with the Illinois Department of
6Revenue.
7    In all counties, the statement shall include information
8that certain taxpayers may be eligible for the Senior Citizens
9and Disabled Persons Property Tax Relief and Pharmaceutical
10Assistance Act and that applications are available from the
11Illinois Department on Aging.
12    In counties which use the estimated or accelerated billing
13methods, these statements shall only be provided with the final
14installment of taxes due. The provisions of this Section create
15a mandatory statutory duty. They are not merely directory or
16discretionary. The failure or neglect of the collector to mail
17the bill, or the failure of the taxpayer to receive the bill,
18shall not affect the validity of any tax, or the liability for
19the payment of any tax.
20(Source: P.A. 97-689, eff. 6-14-12.)
 
21    (35 ILCS 200/21-27)
22    Sec. 21-27. Waiver of interest penalty.
23    (a) On the recommendation of the county treasurer, the
24county board may adopt a resolution under which an interest
25penalty for the delinquent payment of taxes for any year that

 

 

HB0027- 73 -LRB098 00027 KTG 30027 b

1otherwise would be imposed under Section 21-15, 21-20, or 21-25
2shall be waived in the case of any person who meets all of the
3following criteria:
4        (1) The person is determined eligible for a grant under
5    the Senior Citizens and Disabled Persons Property Tax
6    Relief and Pharmaceutical Assistance Act with respect to
7    the taxes for that year.
8        (2) The person requests, in writing, on a form approved
9    by the county treasurer, a waiver of the interest penalty,
10    and the request is filed with the county treasurer on or
11    before the first day of the month that an installment of
12    taxes is due.
13        (3) The person pays the installment of taxes due, in
14    full, on or before the third day of the month that the
15    installment is due.
16        (4) The county treasurer approves the request for a
17    waiver.
18    (b) With respect to property that qualifies as a brownfield
19site under Section 58.2 of the Environmental Protection Act,
20the county board, upon the recommendation of the county
21treasurer, may adopt a resolution to waive an interest penalty
22for the delinquent payment of taxes for any year that otherwise
23would be imposed under Section 21-15, 21-20, or 21-25 if all of
24the following criteria are met:
25        (1) the property has delinquent taxes and an
26    outstanding interest penalty and the amount of that

 

 

HB0027- 74 -LRB098 00027 KTG 30027 b

1    interest penalty is so large as to, possibly, result in all
2    of the taxes becoming uncollectible;
3        (2) the property is part of a redevelopment plan of a
4    unit of local government and that unit of local government
5    does not oppose the waiver of the interest penalty;
6        (3) the redevelopment of the property will benefit the
7    public interest by remediating the brownfield
8    contamination;
9        (4) the taxpayer delivers to the county treasurer (i) a
10    written request for a waiver of the interest penalty, on a
11    form approved by the county treasurer, and (ii) a copy of
12    the redevelopment plan for the property;
13        (5) the taxpayer pays, in full, the amount of up to the
14    amount of the first 2 installments of taxes due, to be held
15    in escrow pending the approval of the waiver, and enters
16    into an agreement with the county treasurer setting forth a
17    schedule for the payment of any remaining taxes due; and
18        (6) the county treasurer approves the request for a
19    waiver.
20(Source: P.A. 97-655, eff. 1-13-12; 97-689, eff. 6-14-12.)
 
21    Section 2-28. The Mobile Home Local Services Tax Act is
22amended by changing Section 7 as follows:
 
23    (35 ILCS 515/7)  (from Ch. 120, par. 1207)
24    Sec. 7. The local services tax for owners of mobile homes

 

 

HB0027- 75 -LRB098 00027 KTG 30027 b

1who (a) are actually residing in such mobile homes, (b) hold
2title to such mobile home as provided in the Illinois Vehicle
3Code, and (c) are 65 years of age or older or are disabled
4persons within the meaning of Section 3.14 of the "Senior
5Citizens and Disabled Persons Property Tax Relief and
6Pharmaceutical Assistance Act" on the annual billing date shall
7be reduced to 80 percent of the tax provided for in Section 3
8of this Act. Proof that a claimant has been issued an Illinois
9Person with a Disability Identification Card stating that the
10claimant is under a Class 2 disability, as provided in Section
114A of the Illinois Identification Card Act, shall constitute
12proof that the person thereon named is a disabled person within
13the meaning of this Act. An application for reduction of the
14tax shall be filed with the county clerk by the individuals who
15are entitled to the reduction. If the application is filed
16after May 1, the reduction in tax shall begin with the next
17annual bill. Application for the reduction in tax shall be done
18by submitting proof that the applicant has been issued an
19Illinois Person with a Disability Identification Card
20designating the applicant's disability as a Class 2 disability,
21or by affidavit in substantially the following form:
22
APPLICATION FOR REDUCTION OF MOBILE HOME LOCAL SERVICES TAX
23    I hereby make application for a reduction to 80% of the
24total tax imposed under "An Act to provide for a local services
25tax on mobile homes".
26    (1) Senior Citizens

 

 

HB0027- 76 -LRB098 00027 KTG 30027 b

1    (a) I actually reside in the mobile home ....
2    (b) I hold title to the mobile home as provided in the
3Illinois Vehicle Code ....
4    (c) I reached the age of 65 on or before either January 1
5(or July 1) of the year in which this statement is filed. My
6date of birth is: ...
7    (2) Disabled Persons
8    (a) I actually reside in the mobile home...
9    (b) I hold title to the mobile home as provided in the
10Illinois Vehicle Code ....
11    (c) I was totally disabled on ... and have remained
12disabled until the date of this application. My Social
13Security, Veterans, Railroad or Civil Service Total Disability
14Claim Number is ... The undersigned declares under the penalty
15of perjury that the above statements are true and correct.
16Dated (insert date).
17
...........................
18
Signature of owner
19
...........................
20
(Address)
21
...........................
22
(City) (State) (Zip)
23Approved by:
24.............................
25(Assessor)
 

 

 

HB0027- 77 -LRB098 00027 KTG 30027 b

1This application shall be accompanied by a copy of the
2applicant's most recent application filed with the Illinois
3Department on Aging under the Senior Citizens and Disabled
4Persons Property Tax Relief Act.
5(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12;
697-1064, eff. 1-1-13; revised 9-20-12.)
 
7    Section 2-29. The Metropolitan Transit Authority Act is
8amended by changing Sections 51 and 52 as follows:
 
9    (70 ILCS 3605/51)
10    Sec. 51. Free services; eligibility.
11    (a) Notwithstanding any law to the contrary, no later than
1260 days following the effective date of this amendatory Act of
13the 95th General Assembly and until subsection (b) is
14implemented, any fixed route public transportation services
15provided by, or under grant or purchase of service contracts
16of, the Board shall be provided without charge to all senior
17citizens of the Metropolitan Region (as such term is defined in
1870 ILCS 3615/1.03) aged 65 and older, under such conditions as
19shall be prescribed by the Board.
20    (b) Notwithstanding any law to the contrary, no later than
21180 days following the effective date of this amendatory Act of
22the 96th General Assembly, any fixed route public
23transportation services provided by, or under grant or purchase
24of service contracts of, the Board shall be provided without

 

 

HB0027- 78 -LRB098 00027 KTG 30027 b

1charge to senior citizens aged 65 and older who meet the income
2eligibility limitation set forth in subsection (a-5) of Section
34 of the Senior Citizens and Disabled Persons Property Tax
4Relief and Pharmaceutical Assistance Act, under such
5conditions as shall be prescribed by the Board. The Department
6on Aging shall furnish all information reasonably necessary to
7determine eligibility, including updated lists of individuals
8who are eligible for services without charge under this
9Section. Nothing in this Section shall relieve the Board from
10providing reduced fares as may be required by federal law.
11(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
 
12    (70 ILCS 3605/52)
13    Sec. 52. Transit services for disabled individuals.
14Notwithstanding any law to the contrary, no later than 60 days
15following the effective date of this amendatory Act of the 95th
16General Assembly, all fixed route public transportation
17services provided by, or under grant or purchase of service
18contract of, the Board shall be provided without charge to all
19disabled persons who meet the income eligibility limitation set
20forth in subsection (a-5) of Section 4 of the Senior Citizens
21and Disabled Persons Property Tax Relief and Pharmaceutical
22Assistance Act, under such procedures as shall be prescribed by
23the Board. The Department on Aging shall furnish all
24information reasonably necessary to determine eligibility,
25including updated lists of individuals who are eligible for

 

 

HB0027- 79 -LRB098 00027 KTG 30027 b

1services without charge under this Section.
2(Source: P.A. 97-689, eff. 6-14-12.)
 
3    Section 2-30. The Local Mass Transit District Act is
4amended by changing Sections 8.6 and 8.7 as follows:
 
5    (70 ILCS 3610/8.6)
6    Sec. 8.6. Free services; eligibility.
7    (a) Notwithstanding any law to the contrary, no later than
860 days following the effective date of this amendatory Act of
9the 95th General Assembly and until subsection (b) is
10implemented, any fixed route public transportation services
11provided by, or under grant or purchase of service contracts
12of, every District shall be provided without charge to all
13senior citizens of the District aged 65 and older, under such
14conditions as shall be prescribed by the District.
15    (b) Notwithstanding any law to the contrary, no later than
16180 days following the effective date of this amendatory Act of
17the 96th General Assembly, any fixed route public
18transportation services provided by, or under grant or purchase
19of service contracts of, every District shall be provided
20without charge to senior citizens aged 65 and older who meet
21the income eligibility limitation set forth in subsection (a-5)
22of Section 4 of the Senior Citizens and Disabled Persons
23Property Tax Relief and Pharmaceutical Assistance Act, under
24such conditions as shall be prescribed by the District. The

 

 

HB0027- 80 -LRB098 00027 KTG 30027 b

1Department on Aging shall furnish all information reasonably
2necessary to determine eligibility, including updated lists of
3individuals who are eligible for services without charge under
4this Section. Nothing in this Section shall relieve the
5District from providing reduced fares as may be required by
6federal law.
7(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
 
8    (70 ILCS 3610/8.7)
9    Sec. 8.7. Transit services for disabled individuals.
10Notwithstanding any law to the contrary, no later than 60 days
11following the effective date of this amendatory Act of the 95th
12General Assembly, all fixed route public transportation
13services provided by, or under grant or purchase of service
14contract of, any District shall be provided without charge to
15all disabled persons who meet the income eligibility limitation
16set forth in subsection (a-5) of Section 4 of the Senior
17Citizens and Disabled Persons Property Tax Relief and
18Pharmaceutical Assistance Act, under such procedures as shall
19be prescribed by the District. The Department on Aging shall
20furnish all information reasonably necessary to determine
21eligibility, including updated lists of individuals who are
22eligible for services without charge under this Section.
23(Source: P.A. 97-689, eff. 6-14-12.)
 
24    Section 2-31. The Regional Transportation Authority Act is

 

 

HB0027- 81 -LRB098 00027 KTG 30027 b

1amended by changing Sections 3A.15, 3A.16, 3B.14, and 3B.15 as
2follows:
 
3    (70 ILCS 3615/3A.15)
4    Sec. 3A.15. Free services; eligibility.
5    (a) Notwithstanding any law to the contrary, no later than
660 days following the effective date of this amendatory Act of
7the 95th General Assembly and until subsection (b) is
8implemented, any fixed route public transportation services
9provided by, or under grant or purchase of service contracts
10of, the Suburban Bus Board shall be provided without charge to
11all senior citizens of the Metropolitan Region aged 65 and
12older, under such conditions as shall be prescribed by the
13Suburban Bus Board.
14    (b) Notwithstanding any law to the contrary, no later than
15180 days following the effective date of this amendatory Act of
16the 96th General Assembly, any fixed route public
17transportation services provided by, or under grant or purchase
18of service contracts of, the Suburban Bus Board shall be
19provided without charge to senior citizens aged 65 and older
20who meet the income eligibility limitation set forth in
21subsection (a-5) of Section 4 of the Senior Citizens and
22Disabled Persons Property Tax Relief and Pharmaceutical
23Assistance Act, under such conditions as shall be prescribed by
24the Suburban Bus Board. The Department on Aging shall furnish
25all information reasonably necessary to determine eligibility,

 

 

HB0027- 82 -LRB098 00027 KTG 30027 b

1including updated lists of individuals who are eligible for
2services without charge under this Section. Nothing in this
3Section shall relieve the Suburban Bus Board from providing
4reduced fares as may be required by federal law.
5(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
 
6    (70 ILCS 3615/3A.16)
7    Sec. 3A.16. Transit services for disabled individuals.
8Notwithstanding any law to the contrary, no later than 60 days
9following the effective date of this amendatory Act of the 95th
10General Assembly, all fixed route public transportation
11services provided by, or under grant or purchase of service
12contract of, the Suburban Bus Board shall be provided without
13charge to all disabled persons who meet the income eligibility
14limitation set forth in subsection (a-5) of Section 4 of the
15Senior Citizens and Disabled Persons Property Tax Relief and
16Pharmaceutical Assistance Act, under such procedures as shall
17be prescribed by the Board. The Department on Aging shall
18furnish all information reasonably necessary to determine
19eligibility, including updated lists of individuals who are
20eligible for services without charge under this Section.
21(Source: P.A. 97-689, eff. 6-14-12.)
 
22    (70 ILCS 3615/3B.14)
23    Sec. 3B.14. Free services; eligibility.
24    (a) Notwithstanding any law to the contrary, no later than

 

 

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160 days following the effective date of this amendatory Act of
2the 95th General Assembly and until subsection (b) is
3implemented, any fixed route public transportation services
4provided by, or under grant or purchase of service contracts
5of, the Commuter Rail Board shall be provided without charge to
6all senior citizens of the Metropolitan Region aged 65 and
7older, under such conditions as shall be prescribed by the
8Commuter Rail Board.
9    (b) Notwithstanding any law to the contrary, no later than
10180 days following the effective date of this amendatory Act of
11the 96th General Assembly, any fixed route public
12transportation services provided by, or under grant or purchase
13of service contracts of, the Commuter Rail Board shall be
14provided without charge to senior citizens aged 65 and older
15who meet the income eligibility limitation set forth in
16subsection (a-5) of Section 4 of the Senior Citizens and
17Disabled Persons Property Tax Relief and Pharmaceutical
18Assistance Act, under such conditions as shall be prescribed by
19the Commuter Rail Board. The Department on Aging shall furnish
20all information reasonably necessary to determine eligibility,
21including updated lists of individuals who are eligible for
22services without charge under this Section. Nothing in this
23Section shall relieve the Commuter Rail Board from providing
24reduced fares as may be required by federal law.
25(Source: P.A. 96-1527, eff. 2-14-11; 97-689, eff. 6-14-12.)
 

 

 

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1    (70 ILCS 3615/3B.15)
2    Sec. 3B.15. Transit services for disabled individuals.
3Notwithstanding any law to the contrary, no later than 60 days
4following the effective date of this amendatory Act of the 95th
5General Assembly, all fixed route public transportation
6services provided by, or under grant or purchase of service
7contract of, the Commuter Rail Board shall be provided without
8charge to all disabled persons who meet the income eligibility
9limitation set forth in subsection (a-5) of Section 4 of the
10Senior Citizens and Disabled Persons Property Tax Relief and
11Pharmaceutical Assistance Act, under such procedures as shall
12be prescribed by the Board. The Department on Aging shall
13furnish all information reasonably necessary to determine
14eligibility, including updated lists of individuals who are
15eligible for services without charge under this Section.
16(Source: P.A. 97-689, eff. 6-14-12.)
 
17    Section 2-32. The Senior Citizen Courses Act is amended by
18changing Section 1 as follows:
 
19    (110 ILCS 990/1)  (from Ch. 144, par. 1801)
20    Sec. 1. Definitions. For the purposes of this Act:
21    (a) "Public institutions of higher education" means the
22University of Illinois, Southern Illinois University, Chicago
23State University, Eastern Illinois University, Governors State
24University, Illinois State University, Northeastern Illinois

 

 

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1University, Northern Illinois University, Western Illinois
2University, and the public community colleges subject to the
3"Public Community College Act".
4    (b) "Credit Course" means any program of study for which
5public institutions of higher education award credit hours.
6    (c) "Senior citizen" means any person 65 years or older
7whose annual household income is less than the threshold amount
8provided in Section 4 of the "Senior Citizens and Disabled
9Persons Property Tax Relief and Pharmaceutical Assistance
10Act", approved July 17, 1972, as amended.
11(Source: P.A. 97-689, eff. 6-14-12.)
 
12    Section 2-45. The Nursing Home Care Act is amended by
13changing Section 3-202.05 as follows:
 
14    (210 ILCS 45/3-202.05)
15    Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
16thereafter.
17    (a) For the purpose of computing staff to resident ratios,
18direct care staff shall include:
19        (1) registered nurses;
20        (2) licensed practical nurses;
21        (3) certified nurse assistants;
22        (4) psychiatric services rehabilitation aides;
23        (5) rehabilitation and therapy aides;
24        (6) psychiatric services rehabilitation coordinators;

 

 

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1        (7) assistant directors of nursing;
2        (8) 50% of the Director of Nurses' time; and
3        (9) 30% of the Social Services Directors' time.
4    The Department shall, by rule, allow certain facilities
5subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
6S) and 300.6000 and following (Subpart T) to utilize
7specialized clinical staff, as defined in rules, to count
8towards the staffing ratios.
9    Within 120 days of the effective date of this amendatory
10Act of the 97th General Assembly, the Department shall
11promulgate rules specific to the staffing requirements for
12facilities federally defined as Institutions for Mental
13Disease. These rules shall recognize the unique nature of
14individuals with chronic mental health conditions, shall
15include minimum requirements for specialized clinical staff,
16including clinical social workers, psychiatrists,
17psychologists, and direct care staff set forth in paragraphs
18(4) through (6) and any other specialized staff which may be
19utilized and deemed necessary to count toward staffing ratios.
20    Within 120 days of the effective date of this amendatory
21Act of the 97th General Assembly, the Department shall
22promulgate rules specific to the staffing requirements for
23facilities licensed under the Specialized Mental Health
24Rehabilitation Act. These rules shall recognize the unique
25nature of individuals with chronic mental health conditions,
26shall include minimum requirements for specialized clinical

 

 

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1staff, including clinical social workers, psychiatrists,
2psychologists, and direct care staff set forth in paragraphs
3(4) through (6) and any other specialized staff which may be
4utilized and deemed necessary to count toward staffing ratios.
5    (b) Beginning January 1, 2011, and thereafter, light
6intermediate care shall be staffed at the same staffing ratio
7as intermediate care.
8    (c) Facilities shall notify the Department within 60 days
9after the effective date of this amendatory Act of the 96th
10General Assembly, in a form and manner prescribed by the
11Department, of the staffing ratios in effect on the effective
12date of this amendatory Act of the 96th General Assembly for
13both intermediate and skilled care and the number of residents
14receiving each level of care.
15    (d)(1) Effective July 1, 2010, for each resident needing
16skilled care, a minimum staffing ratio of 2.5 hours of nursing
17and personal care each day must be provided; for each resident
18needing intermediate care, 1.7 hours of nursing and personal
19care each day must be provided.
20    (2) Effective January 1, 2011, the minimum staffing ratios
21shall be increased to 2.7 hours of nursing and personal care
22each day for a resident needing skilled care and 1.9 hours of
23nursing and personal care each day for a resident needing
24intermediate care.
25    (3) Effective January 1, 2012, the minimum staffing ratios
26shall be increased to 3.0 hours of nursing and personal care

 

 

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1each day for a resident needing skilled care and 2.1 hours of
2nursing and personal care each day for a resident needing
3intermediate care.
4    (4) Effective January 1, 2013, the minimum staffing ratios
5shall be increased to 3.4 hours of nursing and personal care
6each day for a resident needing skilled care and 2.3 hours of
7nursing and personal care each day for a resident needing
8intermediate care.
9    (5) Effective January 1, 2014, the minimum staffing ratios
10shall be increased to 3.8 hours of nursing and personal care
11each day for a resident needing skilled care and 2.5 hours of
12nursing and personal care each day for a resident needing
13intermediate care.
14    (e) (Blank). Ninety days after the effective date of this
15amendatory Act of the 97th General Assembly, a minimum of 25%
16of nursing and personal care time shall be provided by licensed
17nurses, with at least 10% of nursing and personal care time
18provided by registered nurses. These minimum requirements
19shall remain in effect until an acuity based registered nurse
20requirement is promulgated by rule concurrent with the adoption
21of the Resource Utilization Group classification-based payment
22methodology, as provided in Section 5-5.2 of the Illinois
23Public Aid Code. Registered nurses and licensed practical
24nurses employed by a facility in excess of these requirements
25may be used to satisfy the remaining 75% of the nursing and
26personal care time requirements. Notwithstanding this

 

 

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1subsection, no staffing requirement in statute in effect on the
2effective date of this amendatory Act of the 97th General
3Assembly shall be reduced on account of this subsection.
4(Source: P.A. 96-1372, eff. 7-29-10; 96-1504, eff. 1-27-11;
597-689, eff. 6-14-12.)
 
6    Section 2-50. The Emergency Medical Services (EMS) Systems
7Act is amended by changing Section 3.86 as follows:
 
8    (210 ILCS 50/3.86)
9    Sec. 3.86. Stretcher van providers.
10    (a) In this Section, "stretcher van provider" means an
11entity licensed by the Department to provide non-emergency
12transportation of passengers on a stretcher in compliance with
13this Act or the rules adopted by the Department pursuant to
14this Act, utilizing stretcher vans.
15    (b) The Department has the authority and responsibility to
16do the following:
17        (1) Require all stretcher van providers, both publicly
18    and privately owned, to be licensed by the Department.
19        (2) Establish licensing and safety standards and
20    requirements for stretcher van providers, through rules
21    adopted pursuant to this Act, including but not limited to:
22            (A) Vehicle design, specification, operation, and
23        maintenance standards.
24            (B) Safety equipment requirements and standards.

 

 

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1            (C) Staffing requirements.
2            (D) Annual license renewal.
3        (3) License all stretcher van providers that have met
4    the Department's requirements for licensure.
5        (4) Annually inspect all licensed stretcher van
6    providers, and relicense providers that have met the
7    Department's requirements for license renewal.
8        (5) Suspend, revoke, refuse to issue, or refuse to
9    renew the license of any stretcher van provider, or that
10    portion of a license pertaining to a specific vehicle
11    operated by a provider, after an opportunity for a hearing,
12    when findings show that the provider or one or more of its
13    vehicles has failed to comply with the standards and
14    requirements of this Act or the rules adopted by the
15    Department pursuant to this Act.
16        (6) Issue an emergency suspension order for any
17    provider or vehicle licensed under this Act when the
18    Director or his or her designee has determined that an
19    immediate or serious danger to the public health, safety,
20    and welfare exists. Suspension or revocation proceedings
21    that offer an opportunity for a hearing shall be promptly
22    initiated after the emergency suspension order has been
23    issued.
24        (7) Prohibit any stretcher van provider from
25    advertising, identifying its vehicles, or disseminating
26    information in a false or misleading manner concerning the

 

 

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1    provider's type and level of vehicles, location, response
2    times, level of personnel, licensure status, or EMS System
3    participation.
4        (8) Charge each stretcher van provider a fee, to be
5    submitted with each application for licensure and license
6    renewal.
7    (c) A stretcher van provider may provide transport of a
8passenger on a stretcher, provided the passenger meets all of
9the following requirements:
10        (1) He or she needs no medical equipment, except
11    self-administered medications. (Blank).
12        
13        (2) He or she needs no medical monitoring or medical
14    observation clinical observation.
15        (3) He or she needs routine transportation to or from a
16    medical appointment or service if the passenger is
17    convalescent or otherwise bed-confined and does not
18    require medical monitoring clinical observation, aid,
19    care, or treatment during transport.
20    (d) A stretcher van provider may not transport a passenger
21who meets any of the following conditions:
22        (1) He or she is currently admitted to a hospital or is
23    being transported to a hospital for admission or emergency
24    treatment. He or she is being transported to a hospital for
25    emergency medical treatment.
26        (2) He or she is acutely ill, wounded, or medically

 

 

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1    unstable as determined by a licensed physician. He or she
2    is experiencing an emergency medical condition or needs
3    active medical monitoring, including isolation
4    precautions, supplemental oxygen that is not
5    self-administered, continuous airway management,
6    suctioning during transport, or the administration of
7    intravenous fluids during transport.
8        (3) He or she is experiencing an emergency medical
9    condition, an acute medical condition, an exacerbation of a
10    chronic medical condition, or a sudden illness or injury.
11        (4) He or she was administered a medication that might
12    prevent the passenger from caring for himself or herself.
13        (5) He or she was moved from one environment where
14    24-hour medical monitoring or medical observation will
15    take place by certified or licensed nursing personnel to
16    another such environment. Such environments shall include,
17    but not be limited to, hospitals licensed under the
18    Hospital Licensing Act or operated under the University of
19    Illinois Hospital Act, and nursing facilities licensed
20    under the Nursing Home Care Act.
21    (e) The Stretcher Van Licensure Fund is created as a
22special fund within the State treasury. All fees received by
23the Department in connection with the licensure of stretcher
24van providers under this Section shall be deposited into the
25fund. Moneys in the fund shall be subject to appropriation to
26the Department for use in implementing this Section.

 

 

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1(Source: P.A. 96-702, eff. 8-25-09; 96-1469, eff. 1-1-11;
297-689, eff. 6-14-12.)
 
3    Section 2-53. The Long Term Acute Care Hospital Quality
4Improvement Transfer Program Act is amended by changing
5Sections 35, 40, and 45 as follows:
 
6    (210 ILCS 155/35)
7    Sec. 35. LTAC supplemental per diem rate.
8    (a) The Department must pay an LTAC supplemental per diem
9rate calculated under this Section to LTAC hospitals that meet
10the requirements of Section 15 of this Act for patients:
11        (1) who upon admission to the LTAC hospital meet LTAC
12    hospital criteria; and
13        (2) whose care is primarily paid for by the Department
14    under Title XIX of the Social Security Act or whose care is
15    primarily paid for by the Department after the patient has
16    exhausted his or her benefits under Medicare.
17    (b) The Department must not pay the LTAC supplemental per
18diem rate calculated under this Section if any of the following
19conditions are met:
20        (1) the LTAC hospital no longer meets the requirements
21    under Section 15 of this Act or terminates the agreement
22    specified under Section 15 of this Act;
23        (2) the patient does not meet the LTAC hospital
24    criteria upon admission; or

 

 

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1        (3) the patient's care is primarily paid for by
2    Medicare and the patient has not exhausted his or her
3    Medicare benefits, resulting in the Department becoming
4    the primary payer.
5    (c) The Department may adjust the LTAC supplemental per
6diem rate calculated under this Section based only on the
7conditions and requirements described under Section 40 and
8Section 45 of this Act.
9    (d) The LTAC supplemental per diem rate shall be calculated
10using the LTAC hospital's inflated cost per diem, defined in
11subsection (f) of this Section, and subtracting the following:
12        (1) The LTAC hospital's Medicaid per diem inpatient
13    rate as calculated under 89 Ill. Adm. Code 148.270(c)(4).
14        (2) The LTAC hospital's disproportionate share (DSH)
15    rate as calculated under 89 Ill. Adm. Code 148.120.
16        (3) The LTAC hospital's Medicaid Percentage Adjustment
17    (MPA) rate as calculated under 89 Ill. Adm. Code 148.122.
18        (4) The LTAC hospital's Medicaid High Volume
19    Adjustment (MHVA) rate as calculated under 89 Ill. Adm.
20    Code 148.290(d).
21    (e) LTAC supplemental per diem rates are effective for 12
22months beginning on October 1 of each year and must be updated
23every 12 months July 1, 2012 shall be the amount in effect as
24of October 1, 2010. No new hospital may qualify for the program
25after the effective date of this amendatory Act of the 97th
26General Assembly.

 

 

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1    (f) For the purposes of this Section, "inflated cost per
2diem" means the quotient resulting from dividing the hospital's
3inpatient Medicaid costs by the hospital's Medicaid inpatient
4days and inflating it to the most current period using
5methodologies consistent with the calculation of the rates
6described in paragraphs (2), (3), and (4) of subsection (d).
7The data is obtained from the LTAC hospital's most recent cost
8report submitted to the Department as mandated under 89 Ill.
9Adm. Code 148.210.
10    (g) (Blank). On and after July 1, 2012, the Department
11shall reduce any rate of reimbursement for services or other
12payments or alter any methodologies authorized by this Act or
13the Illinois Public Aid Code to reduce any rate of
14reimbursement for services or other payments in accordance with
15Section 5-5e of the Illinois Public Aid Code.
16(Source: P.A. 96-1130, eff. 7-20-10; 97-689, eff. 6-14-12.)
 
17    (210 ILCS 155/40)
18    Sec. 40. Rate adjustments for quality measures.
19    (a) The Department may adjust the LTAC supplemental per
20diem rate calculated under Section 35 of this Act based on the
21requirements of this Section.
22    (b) After the first year of operation of the Program
23established by this Act, the Department may reduce the LTAC
24supplemental per diem rate calculated under Section 35 of this
25Act by no more than 5% for an LTAC hospital that does not meet

 

 

HB0027- 96 -LRB098 00027 KTG 30027 b

1benchmarks or targets set by the Department under paragraph (2)
2of subsection (b) of Section 50.
3    (c) After the first year of operation of the Program
4established by this Act, the Department may increase the LTAC
5supplemental per diem rate calculated under Section 35 of this
6Act by no more than 5% for an LTAC hospital that exceeds the
7benchmarks or targets set by the Department under paragraph (2)
8of subsection (a) of Section 50.
9    (d) If an LTAC hospital misses a majority of the benchmarks
10for quality measures for 3 consecutive years, the Department
11may reduce the LTAC supplemental per diem rate calculated under
12Section 35 of this Act to zero.
13    (e) An LTAC hospital whose rate is reduced under subsection
14(d) of this Section may have the LTAC supplemental per diem
15rate calculated under Section 35 of this Act reinstated once
16the LTAC hospital achieves the necessary benchmarks or targets.
17    (f) The Department may apply the reduction described in
18subsection (d) of this Section after one year instead of 3 to
19an LTAC hospital that has had its rate previously reduced under
20subsection (d) of this Section and later has had it reinstated
21under subsection (e) of this Section.
22    (g) The rate adjustments described in this Section shall be
23determined and applied only at the beginning of each rate year.
24    (h) (Blank). On and after July 1, 2012, the Department
25shall reduce any rate of reimbursement for services or other
26payments or alter any methodologies authorized by this Act or

 

 

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1the Illinois Public Aid Code to reduce any rate of
2reimbursement for services or other payments in accordance with
3Section 5-5e of the Illinois Public Aid Code.
4(Source: P.A. 96-1130, eff. 7-20-10; 97-689, eff. 6-14-12.)
 
5    (210 ILCS 155/45)
6    Sec. 45. Program evaluation.
7    (a) After the Program completes the 3rd full year of
8operation on September 30, 2013 By September 30, 2012, the
9Department must complete an evaluation of the Program to
10determine the actual savings or costs generated by the Program,
11both on an aggregate basis and on an LTAC hospital-specific
12basis. The evaluation must be conducted in each subsequent
13year.
14    (b) The Department and shall consult with qualified LTAC
15hospitals must to determine the appropriate methodology to
16accurately calculate the Program's savings and costs. The
17calculation shall take into consideration, but shall not be
18limited to, the length of stay in an acute care hospital prior
19to transfer, the length of stay in the LTAC taking into account
20the acuity of the patient at the time of the LTAC admission,
21and admissions to the LTAC from settings other than an STAC
22hospital.
23    (c) The evaluation must also determine the effects the
24Program has had in improving patient satisfaction and health
25outcomes.

 

 

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1    (d) If the evaluation indicates that the Program generates
2a net cost to the Department, the Department may prospectively
3adjust an individual hospital's LTAC supplemental per diem rate
4under Section 35 of this Act to establish cost neutrality. The
5rate adjustments applied under this subsection (d) do not need
6to be applied uniformly to all qualified LTAC hospitals as long
7as the adjustments are based on data from the evaluation on
8hospital-specific information. Cost neutrality under this
9Section means that the cost to the Department resulting from
10the LTAC supplemental per diem rate must not exceed the savings
11generated from transferring the patient from a STAC hospital.
12    (e) The rate adjustment described in subsection (d) of this
13Section, if necessary, shall be applied to the LTAC
14supplemental per diem rate for the rate year beginning October
151, 2014. The Department may apply this rate adjustment in
16subsequent rate years if the conditions under subsection (d) of
17this Section are met. The Department must apply the rate
18adjustment to an individual LTAC hospital's LTAC supplemental
19per diem rate only in years when the Program evaluation
20indicates a net cost for the Department.
21    (f) The rate adjustments described in this Section shall be
22determined and applied only at the beginning of each rate year.
23The Department may establish a shared savings program for
24qualified LTAC hospitals.
25(Source: P.A. 96-1130, eff. 7-20-10; 97-689, eff. 6-14-12.)
 

 

 

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1    (210 ILCS 155/55 rep.)
2    Section 2-54. The Long Term Acute Care Hospital Quality
3Improvement Transfer Program Act is amended by repealing
4Section 55.
 
5    Section 2-65. The Children's Health Insurance Program Act
6is amended by changing Sections 25 and 40 as follows:
 
7    (215 ILCS 106/25)
8    Sec. 25. Health benefits for children.
9    (a) The Department shall, subject to appropriation,
10provide health benefits coverage to eligible children by:
11        (1) Subsidizing the cost of privately sponsored health
12    insurance, including employer based health insurance, to
13    assist families to take advantage of available privately
14    sponsored health insurance for their eligible children;
15    and
16        (2) Purchasing or providing health care benefits for
17    eligible children. The health benefits provided under this
18    subdivision (a)(2) shall, subject to appropriation and
19    without regard to any applicable cost sharing under Section
20    30, be identical to the benefits provided for children
21    under the State's approved plan under Title XIX of the
22    Social Security Act. Providers under this subdivision
23    (a)(2) shall be subject to approval by the Department to
24    provide health care under the Illinois Public Aid Code and

 

 

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1    shall be reimbursed at the same rate as providers under the
2    State's approved plan under Title XIX of the Social
3    Security Act. In addition, providers may retain
4    co-payments when determined appropriate by the Department.
5    (b) The subsidization provided pursuant to subdivision
6(a)(1) shall be credited to the family of the eligible child.
7    (c) The Department is prohibited from denying coverage to a
8child who is enrolled in a privately sponsored health insurance
9plan pursuant to subdivision (a)(1) because the plan does not
10meet federal benchmarking standards or cost sharing and
11contribution requirements. To be eligible for inclusion in the
12Program, the plan shall contain comprehensive major medical
13coverage which shall consist of physician and hospital
14inpatient services. The Department is prohibited from denying
15coverage to a child who is enrolled in a privately sponsored
16health insurance plan pursuant to subdivision (a)(1) because
17the plan offers benefits in addition to physician and hospital
18inpatient services.
19    (d) The total dollar amount of subsidizing coverage per
20child per month pursuant to subdivision (a)(1) shall be equal
21to the average dollar payments, less premiums incurred, per
22child per month pursuant to subdivision (a)(2). The Department
23shall set this amount prospectively based upon the prior fiscal
24year's experience adjusted for incurred but not reported claims
25and estimated increases or decreases in the cost of medical
26care. Payments obligated before July 1, 1999, will be computed

 

 

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1using State Fiscal Year 1996 payments for children eligible for
2Medical Assistance and income assistance under the Aid to
3Families with Dependent Children Program, with appropriate
4adjustments for cost and utilization changes through January 1,
51999. The Department is prohibited from providing a subsidy
6pursuant to subdivision (a)(1) that is more than the
7individual's monthly portion of the premium.
8    (e) An eligible child may obtain immediate coverage under
9this Program only once during a medical visit. If coverage
10lapses, re-enrollment shall be completed in advance of the next
11covered medical visit and the first month's required premium
12shall be paid in advance of any covered medical visit.
13    (f) In order to accelerate and facilitate the development
14of networks to deliver services to children in areas outside
15counties with populations in excess of 3,000,000, in the event
16less than 25% of the eligible children in a county or
17contiguous counties has enrolled with a Health Maintenance
18Organization pursuant to Section 5-11 of the Illinois Public
19Aid Code, the Department may develop and implement
20demonstration projects to create alternative networks designed
21to enhance enrollment and participation in the program. The
22Department shall prescribe by rule the criteria, standards, and
23procedures for effecting demonstration projects under this
24Section.
25    (g) (Blank). On and after July 1, 2012, the Department
26shall reduce any rate of reimbursement for services or other

 

 

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1payments or alter any methodologies authorized by this Act or
2the Illinois Public Aid Code to reduce any rate of
3reimbursement for services or other payments in accordance with
4Section 5-5e of the Illinois Public Aid Code.
5(Source: P.A. 97-689, eff. 6-14-12.)
 
6    (215 ILCS 106/40)
7    Sec. 40. Waivers. (a) The Department shall request any
8necessary waivers of federal requirements in order to allow
9receipt of federal funding for: .
10        (1) the coverage of families with eligible children
11    under this Act; and
12        (2) the coverage of children who would otherwise be
13    eligible under this Act, but who have health insurance.
14    (b) The failure of the responsible federal agency to
15approve a waiver for children who would otherwise be eligible
16under this Act but who have health insurance shall not prevent
17the implementation of any Section of this Act provided that
18there are sufficient appropriated funds.
19    (c) Eligibility of a person under an approved waiver due to
20the relationship with a child pursuant to Article V of the
21Illinois Public Aid Code or this Act shall be limited to such a
22person whose countable income is determined by the Department
23to be at or below such income eligibility standard as the
24Department by rule shall establish. The income level
25established by the Department shall not be below 90% of the

 

 

HB0027- 103 -LRB098 00027 KTG 30027 b

1federal poverty level. Such persons who are determined to be
2eligible must reapply, or otherwise establish eligibility, at
3least annually. An eligible person shall be required, as
4determined by the Department by rule, to report promptly those
5changes in income and other circumstances that affect
6eligibility. The eligibility of a person may be redetermined
7based on the information reported or may be terminated based on
8the failure to report or failure to report accurately. A person
9may also be held liable to the Department for any payments made
10by the Department on such person's behalf that were
11inappropriate. An applicant shall be provided with notice of
12these obligations.
13(Source: P.A. 96-328, eff. 8-11-09; 97-689, eff. 6-14-12.)
 
14    Section 2-70. The Covering ALL KIDS Health Insurance Act is
15amended by changing Sections 30 and 35 as follows:
 
16    (215 ILCS 170/30)
17    (Section scheduled to be repealed on July 1, 2016)
18    Sec. 30. Program outreach and marketing. The Department may
19provide grants to application agents and other community-based
20organizations to educate the public about the availability of
21the Program. The Department shall adopt rules regarding
22performance standards and outcomes measures expected of
23organizations that are awarded grants under this Section,
24including penalties for nonperformance of contract standards.

 

 

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1    The Department shall annually publish electronically on a
2State website and in no less than 2 newspapers in the State the
3premiums or other cost sharing requirements of the Program.
4(Source: P.A. 97-689, eff. 6-14-12.)
 
5    (215 ILCS 170/35)
6    (Section scheduled to be repealed on July 1, 2016)
7    Sec. 35. Health care benefits for children.
8    (a) The Department shall purchase or provide health care
9benefits for eligible children that are identical to the
10benefits provided for children under the Illinois Children's
11Health Insurance Program Act, except for non-emergency
12transportation.
13    (b) As an alternative to the benefits set forth in
14subsection (a), and when cost-effective, the Department may
15offer families subsidies toward the cost of privately sponsored
16health insurance, including employer-sponsored health
17insurance.
18    (c) Notwithstanding clause (i) of subdivision (a)(3) of
19Section 20, the Department may consider offering, as an
20alternative to the benefits set forth in subsection (a),
21partial coverage to children who are enrolled in a
22high-deductible private health insurance plan.
23    (d) Notwithstanding clause (i) of subdivision (a)(3) of
24Section 20, the Department may consider offering, as an
25alternative to the benefits set forth in subsection (a), a

 

 

HB0027- 105 -LRB098 00027 KTG 30027 b

1limited package of benefits to children in families who have
2private or employer-sponsored health insurance that does not
3cover certain benefits such as dental or vision benefits.
4    (e) The content and availability of benefits described in
5subsections (b), (c), and (d), and the terms of eligibility for
6those benefits, shall be at the Department's discretion and the
7Department's determination of efficacy and cost-effectiveness
8as a means of promoting retention of private or
9employer-sponsored health insurance.
10    (f) (Blank). On and after July 1, 2012, the Department
11shall reduce any rate of reimbursement for services or other
12payments or alter any methodologies authorized by this Act or
13the Illinois Public Aid Code to reduce any rate of
14reimbursement for services or other payments in accordance with
15Section 5-5e of the Illinois Public Aid Code.
16(Source: P.A. 97-689, eff. 6-14-12.)
 
17    Section 2-71. The Citizens Utility Board Act is amended by
18changing Section 9 as follows:
 
19    (220 ILCS 10/9)  (from Ch. 111 2/3, par. 909)
20    Sec. 9. Mailing procedure.
21    (1) As used in this Section:
22        (a) "Enclosure" means a card, leaflet, envelope or
23    combination thereof furnished by the corporation under
24    this Section.

 

 

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1        (b) "Mailing" means any communication by a State
2    agency, other than a mailing made under the Senior Citizens
3    and Disabled Persons Property Tax Relief and
4    Pharmaceutical Assistance Act, that is sent through the
5    United States Postal Service to more than 50,000 persons
6    within a 12-month period.
7        (c) "State agency" means any officer, department,
8    board, commission, institution or entity of the executive
9    or legislative branches of State government.
10    (2) To accomplish its powers and duties under Section 5
11this Act, the corporation, subject to the following
12limitations, may prepare and furnish to any State agency an
13enclosure to be included with a mailing by that agency.
14        (a) A State agency furnished with an enclosure shall
15    include the enclosure within the mailing designated by the
16    corporation.
17        (b) An enclosure furnished by the corporation under
18    this Section shall be provided to the State agency a
19    reasonable period of time in advance of the mailing.
20        (c) An enclosure furnished by the corporation under
21    this Section shall be limited to informing the reader of
22    the purpose, nature and activities of the corporation as
23    set forth in this Act and informing the reader that it may
24    become a member in the corporation, maintain membership in
25    the corporation and contribute money to the corporation
26    directly.

 

 

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1        (d) Prior to furnishing an enclosure to the State
2    agency, the corporation shall seek and obtain approval of
3    the content of the enclosure from the Illinois Commerce
4    Commission. The Commission shall approve the enclosure if
5    it determines that the enclosure (i) is not false or
6    misleading and (ii) satisfies the requirements of this Act.
7    The Commission shall be deemed to have approved the
8    enclosure unless it disapproves the enclosure within 14
9    days from the date of receipt.
10    (3) The corporation shall reimburse each State agency for
11all reasonable incremental costs incurred by the State agency
12in complying with this Section above the agency's normal
13mailing and handling costs, provided that:
14        (a) The State agency shall first furnish the
15    corporation with an itemized accounting of such additional
16    cost; and
17        (b) The corporation shall not be required to reimburse
18    the State agency for postage costs if the weight of the
19    corporation's enclosure does not exceed .35 ounce
20    avoirdupois. If the corporation's enclosure exceeds that
21    weight, then it shall only be required to reimburse the
22    State agency for postage cost over and above what the
23    agency's postage cost would have been had the enclosure
24    weighed only .35 ounce avoirdupois.
25(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 

 

 

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1    Section 2-75. The Illinois Public Aid Code is amended by
2changing Sections 3-1.2, 3-5, 4-1.6, 4-2, 5-2, 5-4, 5-4.1,
35-4.2, 5-5, 5-5.02, 5-5.05, 5-5.2, 5-5.3, 5-5.4, 5-5.4e, 5-5.5,
45-5.8b, 5-5.12, 5-5.17, 5-5.20, 5-5.23, 5-5.24, 5-5.25,
55-16.7, 5-16.7a, 5-16.8, 5-16.9, 5-17, 5-19, 5-24, 5-30, 5A-1,
65A-2, 5A-3, 5A-4, 5A-5, 5A-6, 5A-8, 5A-10, 5A-12.2, 5A-14,
76-1.2, 6-2, 6-11, 11-13, 11-26, 12-4.25, 12-4.38, 12-4.39,
812-9, 12-10.5, 12-13.1, 14-8, and 15-1 and by adding Sections
95-5.4h and 5-5.4i as follows:
 
10    (305 ILCS 5/3-1.2)  (from Ch. 23, par. 3-1.2)
11    Sec. 3-1.2. Need. Income available to the person, when
12added to contributions in money, substance, or services from
13other sources, including contributions from legally
14responsible relatives, must be insufficient to equal the grant
15amount established by Department regulation for such person.
16    In determining earned income to be taken into account,
17consideration shall be given to any expenses reasonably
18attributable to the earning of such income. If federal law or
19regulations permit or require exemption of earned or other
20income and resources, the Illinois Department shall provide by
21rule and regulation that the amount of income to be disregarded
22be increased (1) to the maximum extent so required and (2) to
23the maximum extent permitted by federal law or regulation in
24effect as of the date this Amendatory Act becomes law. The
25Illinois Department may also provide by rule and regulation

 

 

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1that the amount of resources to be disregarded be increased to
2the maximum extent so permitted or required. Subject to federal
3approval, resources (for example, land, buildings, equipment,
4supplies, or tools), including farmland property and personal
5property used in the income-producing operations related to the
6farmland (for example, equipment and supplies, motor vehicles,
7or tools), necessary for self-support, up to $6,000 of the
8person's equity in the income-producing property, provided
9that the property produces a net annual income of at least 6%
10of the excluded equity value of the property, are exempt.
11Equity value in excess of $6,000 shall not be excluded if the
12activity produces income that is less than 6% of the exempt
13equity due to reasons beyond the person's control (for example,
14the person's illness or crop failure) and there is a reasonable
15expectation that the property will again produce income equal
16to or greater than 6% of the equity value (for example, a
17medical prognosis that the person is expected to respond to
18treatment or that drought-resistant corn will be planted). If
19the person owns more than one piece of property and each
20produces income, each piece of property shall be looked at to
21determine whether the 6% rule is met, and then the amounts of
22the person's equity in all of those properties shall be totaled
23to determine whether the total equity is $6,000 or less. The
24total equity value of all properties that is exempt shall be
25limited to $6,000.
26    In determining the resources of an individual or any

 

 

HB0027- 110 -LRB098 00027 KTG 30027 b

1dependents, the Department shall exclude from consideration
2the value of funeral and burial spaces, grave markers and other
3funeral and burial merchandise, funeral and burial insurance
4the proceeds of which can only be used to pay the funeral and
5burial expenses of the insured and funds specifically set aside
6for the funeral and burial arrangements of the individual or
7his or her dependents, including prepaid funeral and burial
8plans, to the same extent that such items are excluded from
9consideration under the federal Supplemental Security Income
10program (SSI).
11    Prepaid funeral or burial contracts are exempt to the
12following extent:
13        (1) Funds in a revocable prepaid funeral or burial
14    contract are exempt up to $1,500, except that any portion
15    of a contract that clearly represents the purchase of
16    burial space, as that term is defined for purposes of the
17    Supplemental Security Income program, is exempt regardless
18    of value.
19        (2) Funds in an irrevocable prepaid funeral or burial
20    contract are exempt up to $5,874, except that any portion
21    of a contract that clearly represents the purchase of
22    burial space, as that term is defined for purposes of the
23    Supplemental Security Income program, is exempt regardless
24    of value. This amount shall be adjusted annually for any
25    increase in the Consumer Price Index. The amount exempted
26    shall be limited to the price of the funeral goods and

 

 

HB0027- 111 -LRB098 00027 KTG 30027 b

1    services to be provided upon death. The contract must
2    provide a complete description of the funeral goods and
3    services to be provided and the price thereof. Any amount
4    in the contract not so specified shall be treated as a
5    transfer of assets for less than fair market value.
6        (3) A prepaid, guaranteed-price funeral or burial
7    contract, funded by an irrevocable assignment of a person's
8    life insurance policy to a trust, is exempt. The amount
9    exempted shall be limited to the amount of the insurance
10    benefit designated for the cost of the funeral goods and
11    services to be provided upon the person's death. The
12    contract must provide a complete description of the funeral
13    goods and services to be provided and the price thereof.
14    Any amount in the contract not so specified shall be
15    treated as a transfer of assets for less than fair market
16    value. The trust must include a statement that, upon the
17    death of the person, the State will receive all amounts
18    remaining in the trust, including any remaining payable
19    proceeds under the insurance policy up to an amount equal
20    to the total medical assistance paid on behalf of the
21    person. The trust is responsible for ensuring that the
22    provider of funeral services under the contract receives
23    the proceeds of the policy when it provides the funeral
24    goods and services specified under the contract. The
25    irrevocable assignment of ownership of the insurance
26    policy must be acknowledged by the insurance company.

 

 

HB0027- 112 -LRB098 00027 KTG 30027 b

1    Notwithstanding any other provision of this Code to the
2contrary, an irrevocable trust containing the resources of a
3person who is determined to have a disability shall be
4considered exempt from consideration. Such trust must be
5established and managed by a non-profit association that pools
6funds but maintains a separate account for each beneficiary.
7The trust may be established by the person, a parent,
8grandparent, legal guardian, or court. It must be established
9for the sole benefit of the person and language contained in
10the trust shall stipulate that any amount remaining in the
11trust (up to the amount expended by the Department on medical
12assistance) that is not retained by the trust for reasonable
13administrative costs related to wrapping up the affairs of the
14subaccount shall be paid to the Department upon the death of
15the person. After a person reaches age 65, any funding by or on
16behalf of the person to the trust shall be treated as a
17transfer of assets for less than fair market value unless the
18person is a ward of a county public guardian or the State
19guardian pursuant to Section 13-5 of the Probate Act of 1975 or
20Section 30 of the Guardianship and Advocacy Act and lives in
21the community, or the person is a ward of a county public
22guardian or the State guardian pursuant to Section 13-5 of the
23Probate Act of 1975 or Section 30 of the Guardianship and
24Advocacy Act and a court has found that any expenditures from
25the trust will maintain or enhance the person's quality of
26life. If the trust contains proceeds from a personal injury

 

 

HB0027- 113 -LRB098 00027 KTG 30027 b

1settlement, any Department charge must be satisfied in order
2for the transfer to the trust to be treated as a transfer for
3fair market value.
4    The homestead shall be exempt from consideration except to
5the extent that it meets the income and shelter needs of the
6person. "Homestead" means the dwelling house and contiguous
7real estate owned and occupied by the person, regardless of its
8value. Subject to federal approval, a person shall not be
9eligible for long-term care services, however, if the person's
10equity interest in his or her homestead exceeds the minimum
11home equity as allowed and increased annually under federal
12law. Subject to federal approval, on and after the effective
13date of this amendatory Act of the 97th General Assembly,
14homestead property transferred to a trust shall no longer be
15considered homestead property.
16    Occasional or irregular gifts in cash, goods or services
17from persons who are not legally responsible relatives which
18are of nominal value or which do not have significant effect in
19meeting essential requirements shall be disregarded. The
20eligibility of any applicant for or recipient of public aid
21under this Article is not affected by the payment of any grant
22under the "Senior Citizens and Disabled Persons Property Tax
23Relief and Pharmaceutical Assistance Act" or any distributions
24or items of income described under subparagraph (X) of
25paragraph (2) of subsection (a) of Section 203 of the Illinois
26Income Tax Act.

 

 

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1    The Illinois Department may, after appropriate
2investigation, establish and implement a consolidated standard
3to determine need and eligibility for and amount of benefits
4under this Article or a uniform cash supplement to the federal
5Supplemental Security Income program for all or any part of the
6then current recipients under this Article; provided, however,
7that the establishment or implementation of such a standard or
8supplement shall not result in reductions in benefits under
9this Article for the then current recipients of such benefits.
10(Source: P.A. 97-689, eff. 6-14-12.)
 
11    (305 ILCS 5/3-5)  (from Ch. 23, par. 3-5)
12    Sec. 3-5. Amount of aid. The amount and nature of financial
13aid granted to or in behalf of aged, blind, or disabled persons
14shall be determined in accordance with the standards, grant
15amounts, rules and regulations of the Illinois Department. Due
16regard shall be given to the requirements and conditions
17existing in each case, and to the amount of property owned and
18the income, money contributions, and other support, and
19resources received or obtainable by the person, from whatever
20source. However, the amount and nature of any financial aid is
21not affected by the payment of any grant under the "Senior
22Citizens and Disabled Persons Property Tax Relief and
23Pharmaceutical Assistance Act" or any distributions or items of
24income described under subparagraph (X) of paragraph (2) of
25subsection (a) of Section 203 of the Illinois Income Tax Act.

 

 

HB0027- 115 -LRB098 00027 KTG 30027 b

1The aid shall be sufficient, when added to all other income,
2money contributions and support, to provide the person with a
3grant in the amount established by Department regulation for
4such a person, based upon standards providing a livelihood
5compatible with health and well-being. Financial aid under this
6Article granted to persons who have been found ineligible for
7Supplemental Security Income (SSI) due to expiration of the
8period of eligibility for refugees and asylees pursuant to 8
9U.S.C. 1612(a)(2) shall not exceed $500 per month.
10(Source: P.A. 97-689, eff. 6-14-12.)
 
11    (305 ILCS 5/4-1.6)  (from Ch. 23, par. 4-1.6)
12    Sec. 4-1.6. Need. Income available to the family as defined
13by the Illinois Department by rule, or to the child in the case
14of a child removed from his or her home, when added to
15contributions in money, substance or services from other
16sources, including income available from parents absent from
17the home or from a stepparent, contributions made for the
18benefit of the parent or other persons necessary to provide
19care and supervision to the child, and contributions from
20legally responsible relatives, must be equal to or less than
21the grant amount established by Department regulation for such
22a person. For purposes of eligibility for aid under this
23Article, the Department shall disregard all earned income
24between the grant amount and 50% of the Federal Poverty Level.
25    In considering income to be taken into account,

 

 

HB0027- 116 -LRB098 00027 KTG 30027 b

1consideration shall be given to any expenses reasonably
2attributable to the earning of such income. Three-fourths of
3the earned income of a household eligible for aid under this
4Article shall be disregarded when determining the level of
5assistance for which a household is eligible. The Illinois
6Department may also permit all or any portion of earned or
7other income to be set aside for the future identifiable needs
8of a child. The Illinois Department may provide by rule and
9regulation for the exemptions thus permitted or required. The
10eligibility of any applicant for or recipient of public aid
11under this Article is not affected by the payment of any grant
12under the "Senior Citizens and Disabled Persons Property Tax
13Relief and Pharmaceutical Assistance Act" or any distributions
14or items of income described under subparagraph (X) of
15paragraph (2) of subsection (a) of Section 203 of the Illinois
16Income Tax Act.
17    The Illinois Department may, by rule, set forth criteria
18under which an assistance unit is ineligible for cash
19assistance under this Article for a specified number of months
20due to the receipt of a lump sum payment.
21(Source: P.A. 96-866, eff. 7-1-10; 97-689, eff. 6-14-12.)
 
22    (305 ILCS 5/4-2)  (from Ch. 23, par. 4-2)
23    Sec. 4-2. Amount of aid.
24    (a) The amount and nature of financial aid shall be
25determined in accordance with the grant amounts, rules and

 

 

HB0027- 117 -LRB098 00027 KTG 30027 b

1regulations of the Illinois Department. Due regard shall be
2given to the self-sufficiency requirements of the family and to
3the income, money contributions and other support and resources
4available, from whatever source. However, the amount and nature
5of any financial aid is not affected by the payment of any
6grant under the "Senior Citizens and Disabled Persons Property
7Tax Relief and Pharmaceutical Assistance Act" or any
8distributions or items of income described under subparagraph
9(X) of paragraph (2) of subsection (a) of Section 203 of the
10Illinois Income Tax Act. The aid shall be sufficient, when
11added to all other income, money contributions and support to
12provide the family with a grant in the amount established by
13Department regulation.
14    Subject to appropriation, beginning on July 1, 2008, the
15Department of Human Services shall increase TANF grant amounts
16in effect on June 30, 2008 by 15%. The Department is authorized
17to administer this increase but may not otherwise adopt any
18rule to implement this increase.
19    (b) The Illinois Department may conduct special projects,
20which may be known as Grant Diversion Projects, under which
21recipients of financial aid under this Article are placed in
22jobs and their grants are diverted to the employer who in turn
23makes payments to the recipients in the form of salary or other
24employment benefits. The Illinois Department shall by rule
25specify the terms and conditions of such Grant Diversion
26Projects. Such projects shall take into consideration and be

 

 

HB0027- 118 -LRB098 00027 KTG 30027 b

1coordinated with the programs administered under the Illinois
2Emergency Employment Development Act.
3    (c) The amount and nature of the financial aid for a child
4requiring care outside his own home shall be determined in
5accordance with the rules and regulations of the Illinois
6Department, with due regard to the needs and requirements of
7the child in the foster home or institution in which he has
8been placed.
9    (d) If the Department establishes grants for family units
10consisting exclusively of a pregnant woman with no dependent
11child or including her husband if living with her, the grant
12amount for such a unit shall be equal to the grant amount for
13an assistance unit consisting of one adult, or 2 persons if the
14husband is included. Other than as herein described, an unborn
15child shall not be counted in determining the size of an
16assistance unit or for calculating grants.
17    Payments for basic maintenance requirements of a child or
18children and the relative with whom the child or children are
19living shall be prescribed, by rule, by the Illinois
20Department.
21    Grants under this Article shall not be supplemented by
22General Assistance provided under Article VI.
23    (e) Grants shall be paid to the parent or other person with
24whom the child or children are living, except for such amount
25as is paid in behalf of the child or his parent or other
26relative to other persons or agencies pursuant to this Code or

 

 

HB0027- 119 -LRB098 00027 KTG 30027 b

1the rules and regulations of the Illinois Department.
2    (f) Subject to subsection (f-5), an assistance unit,
3receiving financial aid under this Article or temporarily
4ineligible to receive aid under this Article under a penalty
5imposed by the Illinois Department for failure to comply with
6the eligibility requirements or that voluntarily requests
7termination of financial assistance under this Article and
8becomes subsequently eligible for assistance within 9 months,
9shall not receive any increase in the amount of aid solely on
10account of the birth of a child; except that an increase is not
11prohibited when the birth is (i) of a child of a pregnant woman
12who became eligible for aid under this Article during the
13pregnancy, or (ii) of a child born within 10 months after the
14date of implementation of this subsection, or (iii) of a child
15conceived after a family became ineligible for assistance due
16to income or marriage and at least 3 months of ineligibility
17expired before any reapplication for assistance. This
18subsection does not, however, prevent a unit from receiving a
19general increase in the amount of aid that is provided to all
20recipients of aid under this Article.
21    The Illinois Department is authorized to transfer funds,
22and shall use any budgetary savings attributable to not
23increasing the grants due to the births of additional children,
24to supplement existing funding for employment and training
25services for recipients of aid under this Article IV. The
26Illinois Department shall target, to the extent the

 

 

HB0027- 120 -LRB098 00027 KTG 30027 b

1supplemental funding allows, employment and training services
2to the families who do not receive a grant increase after the
3birth of a child. In addition, the Illinois Department shall
4provide, to the extent the supplemental funding allows, such
5families with up to 24 months of transitional child care
6pursuant to Illinois Department rules. All remaining
7supplemental funds shall be used for employment and training
8services or transitional child care support.
9    In making the transfers authorized by this subsection, the
10Illinois Department shall first determine, pursuant to
11regulations adopted by the Illinois Department for this
12purpose, the amount of savings attributable to not increasing
13the grants due to the births of additional children. Transfers
14may be made from General Revenue Fund appropriations for
15distributive purposes authorized by Article IV of this Code
16only to General Revenue Fund appropriations for employability
17development services including operating and administrative
18costs and related distributive purposes under Article IXA of
19this Code. The Director, with the approval of the Governor,
20shall certify the amount and affected line item appropriations
21to the State Comptroller.
22    Nothing in this subsection shall be construed to prohibit
23the Illinois Department from using funds under this Article IV
24to provide assistance in the form of vouchers that may be used
25to pay for goods and services deemed by the Illinois
26Department, by rule, as suitable for the care of the child such

 

 

HB0027- 121 -LRB098 00027 KTG 30027 b

1as diapers, clothing, school supplies, and cribs.
2    (f-5) Subsection (f) shall not apply to affect the monthly
3assistance amount of any family as a result of the birth of a
4child on or after January 1, 2004. As resources permit after
5January 1, 2004, the Department may cease applying subsection
6(f) to limit assistance to families receiving assistance under
7this Article on January 1, 2004, with respect to children born
8prior to that date. In any event, subsection (f) shall be
9completely inoperative on and after July 1, 2007.
10    (g) (Blank).
11    (h) Notwithstanding any other provision of this Code, the
12Illinois Department is authorized to reduce payment levels used
13to determine cash grants under this Article after December 31
14of any fiscal year if the Illinois Department determines that
15the caseload upon which the appropriations for the current
16fiscal year are based have increased by more than 5% and the
17appropriation is not sufficient to ensure that cash benefits
18under this Article do not exceed the amounts appropriated for
19those cash benefits. Reductions in payment levels may be
20accomplished by emergency rule under Section 5-45 of the
21Illinois Administrative Procedure Act, except that the
22limitation on the number of emergency rules that may be adopted
23in a 24-month period shall not apply and the provisions of
24Sections 5-115 and 5-125 of the Illinois Administrative
25Procedure Act shall not apply. Increases in payment levels
26shall be accomplished only in accordance with Section 5-40 of

 

 

HB0027- 122 -LRB098 00027 KTG 30027 b

1the Illinois Administrative Procedure Act. Before any rule to
2increase payment levels promulgated under this Section shall
3become effective, a joint resolution approving the rule must be
4adopted by a roll call vote by a majority of the members
5elected to each chamber of the General Assembly.
6(Source: P.A. 96-1000, eff. 7-2-10; 97-689, eff. 6-14-12.)
 
7    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
8    Sec. 5-2. Classes of Persons Eligible. Medical assistance
9under this Article shall be available to any of the following
10classes of persons in respect to whom a plan for coverage has
11been submitted to the Governor by the Illinois Department and
12approved by him:
13        1. Recipients of basic maintenance grants under
14    Articles III and IV.
15        2. Persons otherwise eligible for basic maintenance
16    under Articles III and IV, excluding any eligibility
17    requirements that are inconsistent with any federal law or
18    federal regulation, as interpreted by the U.S. Department
19    of Health and Human Services, but who fail to qualify
20    thereunder on the basis of need or who qualify but are not
21    receiving basic maintenance under Article IV, and who have
22    insufficient income and resources to meet the costs of
23    necessary medical care, including but not limited to the
24    following:
25            (a) All persons otherwise eligible for basic

 

 

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

 

 

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

 

 

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1    presumptive eligibility period and establish an income
2    eligibility standard that is equal to 133% of the nonfarm
3    income official poverty line, as defined by the federal
4    Office of Management and Budget and revised annually in
5    accordance with Section 673(2) of the Omnibus Budget
6    Reconciliation Act of 1981, applicable to families of the
7    same size, provided that costs incurred for medical care
8    are not taken into account in determining such income
9    eligibility.
10        (c) The Illinois Department may conduct a
11    demonstration in at least one county that will provide
12    medical assistance to pregnant women, together with their
13    infants and children up to one year of age, where the
14    income eligibility standard is set up to 185% of the
15    nonfarm income official poverty line, as defined by the
16    federal Office of Management and Budget. The Illinois
17    Department shall seek and obtain necessary authorization
18    provided under federal law to implement such a
19    demonstration. Such demonstration may establish resource
20    standards that are not more restrictive than those
21    established under Article IV of this Code.
22        6. Persons under the age of 18 who fail to qualify as
23    dependent under Article IV and who have insufficient income
24    and resources to meet the costs of necessary medical care
25    to the maximum extent permitted under Title XIX of the
26    Federal Social Security Act.

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    approved plan under Title XIX of the Social Security Act.
2    The Department must request federal approval of the
3    coverage under this paragraph 12 within 30 days after the
4    effective date of this amendatory Act of the 92nd General
5    Assembly.
6        In addition to the persons who are eligible for medical
7    assistance pursuant to subparagraphs (1) and (2) of this
8    paragraph 12, and to be paid from funds appropriated to the
9    Department for its medical programs, any uninsured person
10    as defined by the Department in rules residing in Illinois
11    who is younger than 65 years of age, who has been screened
12    for breast and cervical cancer in accordance with standards
13    and procedures adopted by the Department of Public Health
14    for screening, and who is referred to the Department by the
15    Department of Public Health as being in need of treatment
16    for breast or cervical cancer is eligible for medical
17    assistance benefits that are consistent with the benefits
18    provided to those persons described in subparagraphs (1)
19    and (2). Medical assistance coverage for the persons who
20    are eligible under the preceding sentence is not dependent
21    on federal approval, but federal moneys may be used to pay
22    for services provided under that coverage upon federal
23    approval.
24        13. Subject to appropriation and to federal approval,
25    persons living with HIV/AIDS who are not otherwise eligible
26    under this Article and who qualify for services covered

 

 

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1    under Section 5-5.04 as provided by the Illinois Department
2    by rule.
3        14. Subject to the availability of funds for this
4    purpose, the Department may provide coverage under this
5    Article to persons who reside in Illinois who are not
6    eligible under any of the preceding paragraphs and who meet
7    the income guidelines of paragraph 2(a) of this Section and
8    (i) have an application for asylum pending before the
9    federal Department of Homeland Security or on appeal before
10    a court of competent jurisdiction and are represented
11    either by counsel or by an advocate accredited by the
12    federal Department of Homeland Security and employed by a
13    not-for-profit organization in regard to that application
14    or appeal, or (ii) are receiving services through a
15    federally funded torture treatment center. Medical
16    coverage under this paragraph 14 may be provided for up to
17    24 continuous months from the initial eligibility date so
18    long as an individual continues to satisfy the criteria of
19    this paragraph 14. If an individual has an appeal pending
20    regarding an application for asylum before the Department
21    of Homeland Security, eligibility under this paragraph 14
22    may be extended until a final decision is rendered on the
23    appeal. The Department may adopt rules governing the
24    implementation of this paragraph 14.
25        15. Family Care Eligibility.
26            (a) Through December 31, 2013 On and after July 1,

 

 

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1        2012, a caretaker relative who is 19 years of age or
2        older when countable income is at or below 185% 133% of
3        the Federal Poverty Level Guidelines, as published
4        annually in the Federal Register, for the appropriate
5        family size. Beginning January 1, 2014, a caretaker
6        relative who is 19 years of age or older when countable
7        income is at or below 133% of the Federal Poverty Level
8        Guidelines, as published annually in the Federal
9        Register, for the appropriate family size. A person may
10        not spend down to become eligible under this paragraph
11        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. (Blank).
19            (d) Premiums shall be billed by and payable to the
20        Department or its authorized agent, on a monthly basis.
21        (Blank).
22            (e) The premium due date is the last day of the
23        month preceding the month of coverage. (Blank).
24            (f) Individuals shall have a grace period through
25        60 days of coverage to pay the premium. (Blank).
26            (g) Failure to pay the full monthly premium by the

 

 

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1        last day of the grace period shall result in
2        termination of coverage. (Blank).
3            (h) Partial premium payments shall not be
4        refunded. (Blank).
5            (i) Following termination of an individual's
6        coverage under this paragraph 15, the following action
7        is required before the individual can be re-enrolled:
8        individual must be determined eligible before the
9        person can be re-enrolled.
10                (1) A new application must be completed and the
11            individual must be determined otherwise eligible.
12                (2) There must be full payment of premiums due
13            under this Code, the Children's Health Insurance
14            Program Act, the Covering ALL KIDS Health
15            Insurance Act, or any other healthcare program
16            administered by the Department for periods in
17            which a premium was owed and not paid for the
18            individual.
19                (3) The first month's premium must be paid if
20            there was an unpaid premium on the date the
21            individual's previous coverage was canceled.
22        The Department is authorized to implement the
23    provisions of this amendatory Act of the 98th General
24    Assembly by adopting the medical assistance rules in effect
25    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
26    89 Ill. Admin. Code 120.32 along with only those changes

 

 

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1    necessary to conform to federal Medicaid requirements,
2    federal laws, and federal regulations, including but not
3    limited to Section 1931 of the Social Security Act (42
4    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
5    of Health and Human Services, and the countable income
6    eligibility standard authorized by this paragraph 15. The
7    Department may not otherwise adopt any rule to implement
8    this increase except as authorized by law, to meet the
9    eligibility standards authorized by the federal government
10    in the Medicaid State Plan or the Title XXI Plan, or to
11    meet an order from the federal government or any court.
12        16. Subject to appropriation, uninsured persons who
13    are not otherwise eligible under this Section who have been
14    certified and referred by the Department of Public Health
15    as having been screened and found to need diagnostic
16    evaluation or treatment, or both diagnostic evaluation and
17    treatment, for prostate or testicular cancer. For the
18    purposes of this paragraph 16, uninsured persons are those
19    who do not have creditable coverage, as defined under the
20    Health Insurance Portability and Accountability Act, or
21    have otherwise exhausted any insurance benefits they may
22    have had, for prostate or testicular cancer diagnostic
23    evaluation or treatment, or both diagnostic evaluation and
24    treatment. To be eligible, a person must furnish a Social
25    Security number. A person's assets are exempt from
26    consideration in determining eligibility under this

 

 

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1    paragraph 16. Such persons shall be eligible for medical
2    assistance under this paragraph 16 for so long as they need
3    treatment for the cancer. A person shall be considered to
4    need treatment if, in the opinion of the person's treating
5    physician, the person requires therapy directed toward
6    cure or palliation of prostate or testicular cancer,
7    including recurrent metastatic cancer that is a known or
8    presumed complication of prostate or testicular cancer and
9    complications resulting from the treatment modalities
10    themselves. Persons who require only routine monitoring
11    services are not considered to need treatment. "Medical
12    assistance" under this paragraph 16 shall be identical to
13    the benefits provided under the State's approved plan under
14    Title XIX of the Social Security Act. Notwithstanding any
15    other provision of law, the Department (i) does not have a
16    claim against the estate of a deceased recipient of
17    services under this paragraph 16 and (ii) does not have a
18    lien against any homestead property or other legal or
19    equitable real property interest owned by a recipient of
20    services under this paragraph 16.
21        17. (Blank). Persons who, pursuant to a waiver approved
22    by the Secretary of the U.S. Department of Health and Human
23    Services, are eligible for medical assistance under Title
24    XIX or XXI of the federal Social Security Act.
25    Notwithstanding any other provision of this Code and
26    consistent with the terms of the approved waiver, the

 

 

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1    Illinois Department, may by rule:
2            (a) Limit the geographic areas in which the waiver
3        program operates.
4            (b) Determine the scope, quantity, duration, and
5        quality, and the rate and method of reimbursement, of
6        the medical services to be provided, which may differ
7        from those for other classes of persons eligible for
8        assistance under this Article.
9            (c) Restrict the persons' freedom in choice of
10        providers.
11    In implementing the provisions of Public Act 96-20, the
12Department is authorized to adopt only those rules necessary,
13including emergency rules. Nothing in Public Act 96-20 permits
14the Department to adopt rules or issue a decision that expands
15eligibility for the FamilyCare Program to a person whose income
16exceeds 185% of the Federal Poverty Level as determined from
17time to time by the U.S. Department of Health and Human
18Services, unless the Department is provided with express
19statutory authority.
20    The Illinois Department and the Governor shall provide a
21plan for coverage of the persons eligible under paragraph 7 as
22soon as possible after July 1, 1984.
23    The eligibility of any such person for medical assistance
24under this Article is not affected by the payment of any grant
25under the Senior Citizens and Disabled Persons Property Tax
26Relief and Pharmaceutical Assistance Act or any distributions

 

 

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1or items of income described under subparagraph (X) of
2paragraph (2) of subsection (a) of Section 203 of the Illinois
3Income Tax Act. The Department shall by rule establish the
4amounts of assets to be disregarded in determining eligibility
5for medical assistance, which shall at a minimum equal the
6amounts to be disregarded under the Federal Supplemental
7Security Income Program. The amount of assets of a single
8person to be disregarded shall not be less than $2,000, and the
9amount of assets of a married couple to be disregarded shall
10not be less than $3,000.
11    To the extent permitted under federal law, any person found
12guilty of a second violation of Article VIIIA shall be
13ineligible for medical assistance under this Article, as
14provided in Section 8A-8.
15    The eligibility of any person for medical assistance under
16this Article shall not be affected by the receipt by the person
17of donations or benefits from fundraisers held for the person
18in cases of serious illness, as long as neither the person nor
19members of the person's family have actual control over the
20donations or benefits or the disbursement of the donations or
21benefits.
22    Notwithstanding any other provision of this Code, if the
23United States Supreme Court holds Title II, Subtitle A, Section
242001(a) of Public Law 111-148 to be unconstitutional, or if a
25holding of Public Law 111-148 makes Medicaid eligibility
26allowed under Section 2001(a) inoperable, the State or a unit

 

 

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1of local government shall be prohibited from enrolling
2individuals in the Medical Assistance Program as the result of
3federal approval of a State Medicaid waiver on or after the
4effective date of this amendatory Act of the 97th General
5Assembly, and any individuals enrolled in the Medical
6Assistance Program pursuant to eligibility permitted as a
7result of such a State Medicaid waiver shall become immediately
8ineligible.
9    Notwithstanding any other provision of this Code, if an Act
10of Congress that becomes a Public Law eliminates Section
112001(a) of Public Law 111-148, the State or a unit of local
12government shall be prohibited from enrolling individuals in
13the Medical Assistance Program as the result of federal
14approval of a State Medicaid waiver on or after the effective
15date of this amendatory Act of the 97th General Assembly, and
16any individuals enrolled in the Medical Assistance Program
17pursuant to eligibility permitted as a result of such a State
18Medicaid waiver shall become immediately ineligible.
19(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
2096-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
217-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
22eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
2397-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff.
247-13-12; revised 7-23-12.)
 
25    (305 ILCS 5/5-4)  (from Ch. 23, par. 5-4)

 

 

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1    Sec. 5-4. Amount and nature of medical assistance.
2    (a) The amount and nature of medical assistance shall be
3determined by the County Departments in accordance with the
4standards, rules, and regulations of the Department of
5Healthcare and Family Services, with due regard to the
6requirements and conditions in each case, including
7contributions available from legally responsible relatives.
8However, the amount and nature of such medical assistance shall
9not be affected by the payment of any grant under the Senior
10Citizens and Disabled Persons Property Tax Relief and
11Pharmaceutical Assistance Act or any distributions or items of
12income described under subparagraph (X) of paragraph (2) of
13subsection (a) of Section 203 of the Illinois Income Tax Act.
14The amount and nature of medical assistance shall not be
15affected by the receipt of donations or benefits from
16fundraisers in cases of serious illness, as long as neither the
17person nor members of the person's family have actual control
18over the donations or benefits or the disbursement of the
19donations or benefits.
20    In determining the income and assets resources available to
21the institutionalized spouse and to the community spouse, the
22Department of Healthcare and Family Services shall follow the
23procedures established by federal law. If an institutionalized
24spouse or community spouse refuses to comply with the
25requirements of Title XIX of the federal Social Security Act
26and the regulations duly promulgated thereunder by failing to

 

 

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1provide the total value of assets, including income and
2resources, to the extent either the institutionalized spouse or
3community spouse has an ownership interest in them pursuant to
442 U.S.C. 1396r-5, such refusal may result in the
5institutionalized spouse being denied eligibility and
6continuing to remain ineligible for the medical assistance
7program based on failure to cooperate.
8    The Subject to federal approval, the community spouse
9resource allowance shall be established and maintained at the
10maximum higher of $109,560 or the minimum level permitted
11pursuant to Section 1924(f)(2) of the Social Security Act, as
12now or hereafter amended, or an amount set after a fair
13hearing, whichever is greater. The monthly maintenance
14allowance for the community spouse shall be established and
15maintained at the maximum higher of $2,739 per month or the
16minimum level permitted pursuant to Section 1924(d)(3)(C) of
17the Social Security Act, as now or hereafter amended, or an
18amount set after a fair hearing, whichever is greater. Subject
19to the approval of the Secretary of the United States
20Department of Health and Human Services, the provisions of this
21Section shall be extended to persons who but for the provision
22of home or community-based services under Section 4.02 of the
23Illinois Act on the Aging, would require the level of care
24provided in an institution, as is provided for in federal law.
25    (b) Spousal support for institutionalized spouses
26receiving medical assistance.

 

 

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1        (i) The Department may seek support for an
2    institutionalized spouse, who has assigned his or her right
3    of support from his or her spouse to the State, from the
4    resources and income available to the community spouse.
5        (ii) The Department may bring an action in the circuit
6    court to establish support orders or itself establish
7    administrative support orders by any means and procedures
8    authorized in this Code, as applicable, except that the
9    standard and regulations for determining ability to
10    support in Section 10-3 shall not limit the amount of
11    support that may be ordered.
12        (iii) Proceedings may be initiated to obtain support,
13    or for the recovery of aid granted during the period such
14    support was not provided, or both, for the obtainment of
15    support and the recovery of the aid provided. Proceedings
16    for the recovery of aid may be taken separately or they may
17    be consolidated with actions to obtain support. Such
18    proceedings may be brought in the name of the person or
19    persons requiring support or may be brought in the name of
20    the Department, as the case requires.
21        (iv) The orders for the payment of moneys for the
22    support of the person shall be just and equitable and may
23    direct payment thereof for such period or periods of time
24    as the circumstances require, including support for a
25    period before the date the order for support is entered. In
26    no event shall the orders reduce the community spouse

 

 

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1    resource allowance below the level established in
2    subsection (a) of this Section or an amount set after a
3    fair hearing, whichever is greater, or reduce the monthly
4    maintenance allowance for the community spouse below the
5    level permitted pursuant to subsection (a) of this Section.
6    The Department of Human Services shall notify in writing
7each institutionalized spouse who is a recipient of medical
8assistance under this Article, and each such person's community
9spouse, of the changes in treatment of income and resources,
10including provisions for protecting income for a community
11spouse and permitting the transfer of resources to a community
12spouse, required by enactment of the federal Medicare
13Catastrophic Coverage Act of 1988 (Public Law 100-360). The
14notification shall be in language likely to be easily
15understood by those persons. The Department of Human Services
16also shall reassess the amount of medical assistance for which
17each such recipient is eligible as a result of the enactment of
18that federal Act, whether or not a recipient requests such a
19reassessment.
20(Source: P.A. 97-689, eff. 6-14-12.)
 
21    (305 ILCS 5/5-4.1)  (from Ch. 23, par. 5-4.1)
22    Sec. 5-4.1. Co-payments. The Department may by rule provide
23that recipients under any Article of this Code shall pay a fee
24as a co-payment for services. Co-payments shall be maximized to
25the extent permitted by federal law, except that the Department

 

 

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1shall impose a co-pay of $2 on generic drugs. Provided,
2however, that any such rule must provide that no co-payment
3requirement can exist for renal dialysis, radiation therapy,
4cancer chemotherapy, or insulin, and other products necessary
5on a recurring basis, the absence of which would be life
6threatening, or where co-payment expenditures for required
7services and/or medications for chronic diseases that the
8Illinois Department shall by rule designate shall cause an
9extensive financial burden on the recipient, and provided no
10co-payment shall exist for emergency room encounters which are
11for medical emergencies. The Department shall seek approval of
12a State plan amendment that allows pharmacies to refuse to
13dispense drugs in circumstances where the recipient does not
14pay the required co-payment. In the event the State plan
15amendment is rejected, co-payments may not exceed $3 for brand
16name drugs, $1 for other pharmacy services other than for
17generic drugs, and $2 for physician services, dental services,
18optical services and supplies, chiropractic services, podiatry
19services, and encounter rate clinic services. There shall be no
20co-payment for generic drugs. Co-payments may not exceed $10
21for emergency room use for a non-emergency situation as defined
22by the Department by rule and subject to federal approval.
23(Source: P.A. 96-1501, eff. 1-25-11; 97-74, eff. 6-30-11;
2497-689, eff. 6-14-12.)
 
25    (305 ILCS 5/5-4.2)  (from Ch. 23, par. 5-4.2)

 

 

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1    Sec. 5-4.2. Ambulance services payments.
2    (a) For ambulance services provided to a recipient of aid
3under this Article on or after January 1, 1993, the Illinois
4Department shall reimburse ambulance service providers at
5rates calculated in accordance with this Section. It is the
6intent of the General Assembly to provide adequate
7reimbursement for ambulance services so as to ensure adequate
8access to services for recipients of aid under this Article and
9to provide appropriate incentives to ambulance service
10providers to provide services in an efficient and
11cost-effective manner. Thus, it is the intent of the General
12Assembly that the Illinois Department implement a
13reimbursement system for ambulance services that, to the extent
14practicable and subject to the availability of funds
15appropriated by the General Assembly for this purpose, is
16consistent with the payment principles of Medicare. To ensure
17uniformity between the payment principles of Medicare and
18Medicaid, the Illinois Department shall follow, to the extent
19necessary and practicable and subject to the availability of
20funds appropriated by the General Assembly for this purpose,
21the statutes, laws, regulations, policies, procedures,
22principles, definitions, guidelines, and manuals used to
23determine the amounts paid to ambulance service providers under
24Title XVIII of the Social Security Act (Medicare).
25    (b) For ambulance services provided to a recipient of aid
26under this Article on or after January 1, 1996, the Illinois

 

 

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1Department shall reimburse ambulance service providers based
2upon the actual distance traveled if a natural disaster,
3weather conditions, road repairs, or traffic congestion
4necessitates the use of a route other than the most direct
5route.
6    (c) For purposes of this Section, "ambulance services"
7includes medical transportation services provided by means of
8an ambulance, medi-car, service car, or taxi.
9    (c-1) For purposes of this Section, "ground ambulance
10service" means medical transportation services that are
11described as ground ambulance services by the Centers for
12Medicare and Medicaid Services and provided in a vehicle that
13is licensed as an ambulance by the Illinois Department of
14Public Health pursuant to the Emergency Medical Services (EMS)
15Systems Act.
16    (c-2) For purposes of this Section, "ground ambulance
17service provider" means a vehicle service provider as described
18in the Emergency Medical Services (EMS) Systems Act that
19operates licensed ambulances for the purpose of providing
20emergency ambulance services, or non-emergency ambulance
21services, or both. For purposes of this Section, this includes
22both ambulance providers and ambulance suppliers as described
23by the Centers for Medicare and Medicaid Services.
24    (d) This Section does not prohibit separate billing by
25ambulance service providers for oxygen furnished while
26providing advanced life support services.

 

 

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1    (e) Beginning with services rendered on or after July 1,
22008, all providers of non-emergency medi-car and service car
3transportation must certify that the driver and employee
4attendant, as applicable, have completed a safety program
5approved by the Department to protect both the patient and the
6driver, prior to transporting a patient. The provider must
7maintain this certification in its records. The provider shall
8produce such documentation upon demand by the Department or its
9representative. Failure to produce documentation of such
10training shall result in recovery of any payments made by the
11Department for services rendered by a non-certified driver or
12employee attendant. Medi-car and service car providers must
13maintain legible documentation in their records of the driver
14and, as applicable, employee attendant that actually
15transported the patient. Providers must recertify all drivers
16and employee attendants every 3 years.
17    Notwithstanding the requirements above, any public
18transportation provider of medi-car and service car
19transportation that receives federal funding under 49 U.S.C.
205307 and 5311 need not certify its drivers and employee
21attendants under this Section, since safety training is already
22federally mandated.
23    (f) With respect to any policy or program administered by
24the Department or its agent regarding approval of non-emergency
25medical transportation by ground ambulance service providers,
26including, but not limited to, the Non-Emergency

 

 

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1Transportation Services Prior Approval Program (NETSPAP), the
2Department shall establish by rule a process by which ground
3ambulance service providers of non-emergency medical
4transportation may appeal any decision by the Department or its
5agent for which no denial was received prior to the time of
6transport that either (i) denies a request for approval for
7payment of non-emergency transportation by means of ground
8ambulance service or (ii) grants a request for approval of
9non-emergency transportation by means of ground ambulance
10service at a level of service that entitles the ground
11ambulance service provider to a lower level of compensation
12from the Department than the ground ambulance service provider
13would have received as compensation for the level of service
14requested. The rule shall be established within 12 months after
15the effective date of this amendatory Act of the 98th General
16Assembly filed by December 15, 2012 and shall provide that, for
17any decision rendered by the Department or its agent on or
18after the date the rule takes effect, the ground ambulance
19service provider shall have 60 days from the date the decision
20is received to file an appeal. The rule established by the
21Department shall be, insofar as is practical, consistent with
22the Illinois Administrative Procedure Act. The Director's
23decision on an appeal under this Section shall be a final
24administrative decision subject to review under the
25Administrative Review Law.
26    (f-5) (g) Beginning 90 days after July 20, 2012 (the

 

 

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1effective date of Public Act 97-842) this amendatory Act of the
297th General Assembly, (i) no denial of a request for approval
3for payment of non-emergency transportation by means of ground
4ambulance service, and (ii) no approval of non-emergency
5transportation by means of ground ambulance service at a level
6of service that entitles the ground ambulance service provider
7to a lower level of compensation from the Department than would
8have been received at the level of service submitted by the
9ground ambulance service provider, may be issued by the
10Department or its agent unless the Department has submitted the
11criteria for determining the appropriateness of the transport
12for first notice publication in the Illinois Register pursuant
13to Section 5-40 of the Illinois Administrative Procedure Act.
14    (g) (Blank). Whenever a patient covered by a medical
15assistance program under this Code or by another medical
16program administered by the Department is being discharged from
17a facility, a physician discharge order as described in this
18Section shall be required for each patient whose discharge
19requires medically supervised ground ambulance services.
20Facilities shall develop procedures for a physician with
21medical staff privileges to provide a written and signed
22physician discharge order. The physician discharge order shall
23specify the level of ground ambulance services needed and
24complete a medical certification establishing the criteria for
25approval of non-emergency ambulance transportation, as
26published by the Department of Healthcare and Family Services,

 

 

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1that is met by the patient. This order and the medical
2certification shall be completed prior to ordering an ambulance
3service and prior to patient discharge.
4    Pursuant to subsection (E) of Section 12-4.25 of this Code,
5the Department is entitled to recover overpayments paid to a
6provider or vendor, including, but not limited to, from the
7discharging physician, the discharging facility, and the
8ground ambulance service provider, in instances where a
9non-emergency ground ambulance service is rendered as the
10result of improper or false certification.
11    (h) (Blank). On and after July 1, 2012, the Department
12shall reduce any rate of reimbursement for services or other
13payments or alter any methodologies authorized by this Code to
14reduce any rate of reimbursement for services or other payments
15in accordance with Section 5-5e.
16(Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12;
1797-842, eff. 7-20-12; revised 8-3-12.)
 
18    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
19    Sec. 5-5. Medical services. The Illinois Department, by
20rule, shall determine the quantity and quality of and the rate
21of reimbursement for the medical assistance for which payment
22will be authorized, and the medical services to be provided,
23which may include all or part of the following: (1) inpatient
24hospital services; (2) outpatient hospital services; (3) other
25laboratory and X-ray services; (4) skilled nursing home

 

 

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1services; (5) physicians' services whether furnished in the
2office, the patient's home, a hospital, a skilled nursing home,
3or elsewhere; (6) medical care, or any other type of remedial
4care furnished by licensed practitioners; (7) home health care
5services; (8) private duty nursing service; (9) clinic
6services; (10) dental services, including prevention and
7treatment of periodontal disease and dental caries disease for
8pregnant women, provided by an individual licensed to practice
9dentistry or dental surgery; for purposes of this item (10),
10"dental services" means diagnostic, preventive, or corrective
11procedures provided by or under the supervision of a dentist in
12the practice of his or her profession; (11) physical therapy
13and related services; (12) prescribed drugs, dentures, and
14prosthetic devices; and eyeglasses prescribed by a physician
15skilled in the diseases of the eye, or by an optometrist,
16whichever the person may select; (13) other diagnostic,
17screening, preventive, and rehabilitative services, including
18to ensure that the individual's need for intervention or
19treatment of mental disorders or substance use disorders or
20co-occurring mental health and substance use disorders is
21determined using a uniform screening, assessment, and
22evaluation process inclusive of criteria, for children and
23adults; for purposes of this item (13), a uniform screening,
24assessment, and evaluation process refers to a process that
25includes an appropriate evaluation and, as warranted, a
26referral; "uniform" does not mean the use of a singular

 

 

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1instrument, tool, or process that all must utilize; (14)
2transportation and such other expenses as may be necessary;
3(15) medical treatment of sexual assault survivors, as defined
4in Section 1a of the Sexual Assault Survivors Emergency
5Treatment Act, for injuries sustained as a result of the sexual
6assault, including examinations and laboratory tests to
7discover evidence which may be used in criminal proceedings
8arising from the sexual assault; (16) the diagnosis and
9treatment of sickle cell anemia; and (17) any other medical
10care, and any other type of remedial care recognized under the
11laws of this State, but not including abortions, or induced
12miscarriages or premature births, unless, in the opinion of a
13physician, such procedures are necessary for the preservation
14of the life of the woman seeking such treatment, or except an
15induced premature birth intended to produce a live viable child
16and such procedure is necessary for the health of the mother or
17her unborn child. The Illinois Department, by rule, shall
18prohibit any physician from providing medical assistance to
19anyone eligible therefor under this Code where such physician
20has been found guilty of performing an abortion procedure in a
21wilful and wanton manner upon a woman who was not pregnant at
22the time such abortion procedure was performed. The term "any
23other type of remedial care" shall include nursing care and
24nursing home service for persons who rely on treatment by
25spiritual means alone through prayer for healing.
26    Notwithstanding any other provision of this Section, a

 

 

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1comprehensive tobacco use cessation program that includes
2purchasing prescription drugs or prescription medical devices
3approved by the Food and Drug Administration shall be covered
4under the medical assistance program under this Article for
5persons who are otherwise eligible for assistance under this
6Article.
7    Notwithstanding any other provision of this Code, the
8Illinois Department may not require, as a condition of payment
9for any laboratory test authorized under this Article, that a
10physician's handwritten signature appear on the laboratory
11test order form. The Illinois Department may, however, impose
12other appropriate requirements regarding laboratory test order
13documentation.
14    The On and after July 1, 2012, the Department of Healthcare
15and Family Services shall may provide the following services to
16persons eligible for assistance under this Article who are
17participating in education, training or employment programs
18operated by the Department of Human Services as successor to
19the Department of Public Aid:
20        (1) dental services provided by or under the
21    supervision of a dentist; and
22        (2) eyeglasses prescribed by a physician skilled in the
23    diseases of the eye, or by an optometrist, whichever the
24    person may select.
25    Notwithstanding any other provision of this Code and
26subject to federal approval, the Department may adopt rules to

 

 

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1allow a dentist who is volunteering his or her service at no
2cost to render dental services through an enrolled
3not-for-profit health clinic without the dentist personally
4enrolling as a participating provider in the medical assistance
5program. A not-for-profit health clinic shall include a public
6health clinic or Federally Qualified Health Center or other
7enrolled provider, as determined by the Department, through
8which dental services covered under this Section are performed.
9The Department shall establish a process for payment of claims
10for reimbursement for covered dental services rendered under
11this provision.
12    The Illinois Department, by rule, may distinguish and
13classify the medical services to be provided only in accordance
14with the classes of persons designated in Section 5-2.
15    The Department of Healthcare and Family Services must
16provide coverage and reimbursement for amino acid-based
17elemental formulas, regardless of delivery method, for the
18diagnosis and treatment of (i) eosinophilic disorders and (ii)
19short bowel syndrome when the prescribing physician has issued
20a written order stating that the amino acid-based elemental
21formula is medically necessary.
22    The Illinois Department shall authorize the provision of,
23and shall authorize payment for, screening by low-dose
24mammography for the presence of occult breast cancer for women
2535 years of age or older who are eligible for medical
26assistance under this Article, as follows:

 

 

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1        (A) A baseline mammogram for women 35 to 39 years of
2    age.
3        (B) An annual mammogram for women 40 years of age or
4    older.
5        (C) A mammogram at the age and intervals considered
6    medically necessary by the woman's health care provider for
7    women under 40 years of age and having a family history of
8    breast cancer, prior personal history of breast cancer,
9    positive genetic testing, or other risk factors.
10        (D) A comprehensive ultrasound screening of an entire
11    breast or breasts if a mammogram demonstrates
12    heterogeneous or dense breast tissue, when medically
13    necessary as determined by a physician licensed to practice
14    medicine in all of its branches.
15    All screenings shall include a physical breast exam,
16instruction on self-examination and information regarding the
17frequency of self-examination and its value as a preventative
18tool. For purposes of this Section, "low-dose mammography"
19means the x-ray examination of the breast using equipment
20dedicated specifically for mammography, including the x-ray
21tube, filter, compression device, and image receptor, with an
22average radiation exposure delivery of less than one rad per
23breast for 2 views of an average size breast. The term also
24includes digital mammography.
25    On and after January 1, 2012, providers participating in a
26quality improvement program approved by the Department shall be

 

 

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1reimbursed for screening and diagnostic mammography at the same
2rate as the Medicare program's rates, including the increased
3reimbursement for digital mammography.
4    The Department shall convene an expert panel including
5representatives of hospitals, free-standing mammography
6facilities, and doctors, including radiologists, to establish
7quality standards.
8    Subject to federal approval, the Department shall
9establish a rate methodology for mammography at federally
10qualified health centers and other encounter-rate clinics.
11These clinics or centers may also collaborate with other
12hospital-based mammography facilities.
13    The Department shall establish a methodology to remind
14women who are age-appropriate for screening mammography, but
15who have not received a mammogram within the previous 18
16months, of the importance and benefit of screening mammography.
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 program
26in areas of the State with the highest incidence of mortality

 

 

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1related to breast cancer. At least one pilot program site shall
2be in the metropolitan Chicago area and at least one site shall
3be outside the metropolitan Chicago area. An evaluation of the
4pilot program shall be carried out measuring health outcomes
5and cost of care for those served by the pilot program compared
6to similarly situated patients who are not served by the pilot
7program.
8    Any medical or health care provider shall immediately
9recommend, to any pregnant woman who is being provided prenatal
10services and is suspected of drug abuse or is addicted as
11defined in the Alcoholism and Other Drug Abuse and Dependency
12Act, referral to a local substance abuse treatment provider
13licensed by the Department of Human Services or to a licensed
14hospital which provides substance abuse treatment services.
15The Department of Healthcare and Family Services shall assure
16coverage for the cost of treatment of the drug abuse or
17addiction for pregnant recipients in accordance with the
18Illinois Medicaid Program in conjunction with the Department of
19Human Services.
20    All medical providers providing medical assistance to
21pregnant women under this Code shall receive information from
22the Department on the availability of services under the Drug
23Free Families with a Future or any comparable program providing
24case management services for addicted women, including
25information on appropriate referrals for other social services
26that may be needed by addicted women in addition to treatment

 

 

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1for addiction.
2    The Illinois Department, in cooperation with the
3Departments of Human Services (as successor to the Department
4of Alcoholism and Substance Abuse) and Public Health, through a
5public awareness campaign, may provide information concerning
6treatment for alcoholism and drug abuse and addiction, prenatal
7health care, and other pertinent programs directed at reducing
8the number of drug-affected infants born to recipients of
9medical assistance.
10    Neither the Department of Healthcare and Family Services
11nor the Department of Human Services shall sanction the
12recipient solely on the basis of her substance abuse.
13    The Illinois Department shall establish such regulations
14governing the dispensing of health services under this Article
15as it shall deem appropriate. The Department should seek the
16advice of formal professional advisory committees appointed by
17the Director of the Illinois Department for the purpose of
18providing regular advice on policy and administrative matters,
19information dissemination and educational activities for
20medical and health care providers, and consistency in
21procedures to the Illinois Department.
22    Notwithstanding any other provision of law, a health care
23provider under the medical assistance program may elect, in
24lieu of receiving direct payment for services provided under
25that program, to participate in the State Employees Deferred
26Compensation Plan adopted under Article 24 of the Illinois

 

 

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1Pension Code. A health care provider who elects to participate
2in the plan does not have a cause of action against the State
3for any damages allegedly suffered by the provider as a result
4of any delay by the State in crediting the amount of any
5contribution to the provider's plan account.
6    The Illinois Department may develop and contract with
7Partnerships of medical providers to arrange medical services
8for persons eligible under Section 5-2 of this Code.
9Implementation of this Section may be by demonstration projects
10in certain geographic areas. The Partnership shall be
11represented by a sponsor organization. The Department, by rule,
12shall develop qualifications for sponsors of Partnerships.
13Nothing in this Section shall be construed to require that the
14sponsor organization be a medical organization.
15    The sponsor must negotiate formal written contracts with
16medical providers for physician services, inpatient and
17outpatient hospital care, home health services, treatment for
18alcoholism and substance abuse, and other services determined
19necessary by the Illinois Department by rule for delivery by
20Partnerships. Physician services must include prenatal and
21obstetrical care. The Illinois Department shall reimburse
22medical services delivered by Partnership providers to clients
23in target areas according to provisions of this Article and the
24Illinois Health Finance Reform Act, except that:
25        (1) Physicians participating in a Partnership and
26    providing certain services, which shall be determined by

 

 

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1    the Illinois Department, to persons in areas covered by the
2    Partnership may receive an additional surcharge for such
3    services.
4        (2) The Department may elect to consider and negotiate
5    financial incentives to encourage the development of
6    Partnerships and the efficient delivery of medical care.
7        (3) Persons receiving medical services through
8    Partnerships may receive medical and case management
9    services above the level usually offered through the
10    medical assistance program.
11    Medical providers shall be required to meet certain
12qualifications to participate in Partnerships to ensure the
13delivery of high quality medical services. These
14qualifications shall be determined by rule of the Illinois
15Department and may be higher than qualifications for
16participation in the medical assistance program. Partnership
17sponsors may prescribe reasonable additional qualifications
18for participation by medical providers, only with the prior
19written approval of the Illinois Department.
20    Nothing in this Section shall limit the free choice of
21practitioners, hospitals, and other providers of medical
22services by clients. In order to ensure patient freedom of
23choice, the Illinois Department shall immediately promulgate
24all rules and take all other necessary actions so that provided
25services may be accessed from therapeutically certified
26optometrists to the full extent of the Illinois Optometric

 

 

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1Practice Act of 1987 without discriminating between service
2providers.
3    The Department shall apply for a waiver from the United
4States Health Care Financing Administration to allow for the
5implementation of Partnerships under this Section.
6    The Illinois Department shall require health care
7providers to maintain records that document the medical care
8and services provided to recipients of Medical Assistance under
9this Article. Such records must be retained for a period of not
10less than 6 years from the date of service or as provided by
11applicable State law, whichever period is longer, except that
12if an audit is initiated within the required retention period
13then the records must be retained until the audit is completed
14and every exception is resolved. The Illinois Department shall
15require health care providers to make available, when
16authorized by the patient, in writing, the medical records in a
17timely fashion to other health care providers who are treating
18or serving persons eligible for Medical Assistance under this
19Article. All dispensers of medical services shall be required
20to maintain and retain business and professional records
21sufficient to fully and accurately document the nature, scope,
22details and receipt of the health care provided to persons
23eligible for medical assistance under this Code, in accordance
24with regulations promulgated by the Illinois Department. The
25rules and regulations shall require that proof of the receipt
26of prescription drugs, dentures, prosthetic devices and

 

 

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1eyeglasses by eligible persons under this Section accompany
2each claim for reimbursement submitted by the dispenser of such
3medical services. No such claims for reimbursement shall be
4approved for payment by the Illinois Department without such
5proof of receipt, unless the Illinois Department shall have put
6into effect and shall be operating a system of post-payment
7audit and review which shall, on a sampling basis, be deemed
8adequate by the Illinois Department to assure that such drugs,
9dentures, prosthetic devices and eyeglasses for which payment
10is being made are actually being received by eligible
11recipients. Within 90 days after the effective date of this
12amendatory Act of 1984, the Illinois Department shall establish
13a current list of acquisition costs for all prosthetic devices
14and any other items recognized as medical equipment and
15supplies reimbursable under this Article and shall update such
16list on a quarterly basis, except that the acquisition costs of
17all prescription drugs shall be updated no less frequently than
18every 30 days as required by Section 5-5.12.
19    The rules and regulations of the Illinois Department shall
20require that a written statement including the required opinion
21of a physician shall accompany any claim for reimbursement for
22abortions, or induced miscarriages or premature births. This
23statement shall indicate what procedures were used in providing
24such medical services.
25    The Illinois Department shall require all dispensers of
26medical services, other than an individual practitioner or

 

 

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1group of practitioners, desiring to participate in the Medical
2Assistance program established under this Article to disclose
3all financial, beneficial, ownership, equity, surety or other
4interests in any and all firms, corporations, partnerships,
5associations, business enterprises, joint ventures, agencies,
6institutions or other legal entities providing any form of
7health care services in this State under this Article.
8    The Illinois Department may require that all dispensers of
9medical services desiring to participate in the medical
10assistance program established under this Article disclose,
11under such terms and conditions as the Illinois Department may
12by rule establish, all inquiries from clients and attorneys
13regarding medical bills paid by the Illinois Department, which
14inquiries could indicate potential existence of claims or liens
15for the Illinois Department.
16    Enrollment of a vendor that provides non-emergency medical
17transportation, defined by the Department by rule, shall be
18subject to a provisional period and shall be conditional for
19180 days one year. During that time the period of conditional
20enrollment, the Department of Healthcare and Family Services
21may terminate the vendor's eligibility to participate in, or
22may disenroll the vendor from, the medical assistance program
23without cause. That Unless otherwise specified, such
24termination of eligibility or disenrollment is not subject to
25the Department's hearing process. However, a disenrolled
26vendor may reapply without penalty.

 

 

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

 

 

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

 

 

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1documents shall be submitted within 30 days of an admission to
2the facility through the Medical Electronic Data Interchange
3(MEDI) or the Recipient Eligibility Verification (REV) System,
4or shall be submitted directly to the Department of Human
5Services using required admission forms. Confirmation numbers
6assigned to an accepted transaction shall be retained by a
7facility to verify timely submittal. Once an admission
8transaction has been completed, all resubmitted claims
9following prior rejection are subject to receipt no later than
10180 days after the admission transaction has been completed.
11    Claims that are not submitted and received in compliance
12with the foregoing requirements shall not be eligible for
13payment under the medical assistance program, and the State
14shall have no liability for payment of those claims.
15    To the extent consistent with applicable information and
16privacy, security, and disclosure laws, State and federal
17agencies and departments shall provide the Illinois Department
18access to confidential and other information and data necessary
19to perform eligibility and payment verifications and other
20Illinois Department functions. This includes, but is not
21limited to: information pertaining to licensure;
22certification; earnings; immigration status; citizenship; wage
23reporting; unearned and earned income; pension income;
24employment; supplemental security income; social security
25numbers; National Provider Identifier (NPI) numbers; the
26National Practitioner Data Bank (NPDB); program and agency

 

 

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1exclusions; taxpayer identification numbers; tax delinquency;
2corporate information; and death records.
3    The Illinois Department shall enter into agreements with
4State agencies and departments, and is authorized to enter into
5agreements with federal agencies and departments, under which
6such agencies and departments shall share data necessary for
7medical assistance program integrity functions and oversight.
8The Illinois Department shall develop, in cooperation with
9other State departments and agencies, and in compliance with
10applicable federal laws and regulations, appropriate and
11effective methods to share such data. At a minimum, and to the
12extent necessary to provide data sharing, the Illinois
13Department shall enter into agreements with State agencies and
14departments, and is authorized to enter into agreements with
15federal agencies and departments, including but not limited to:
16the Secretary of State; the Department of Revenue; the
17Department of Public Health; the Department of Human Services;
18and the Department of Financial and Professional Regulation.
19    Beginning in fiscal year 2013, the Illinois Department
20shall set forth a request for information to identify the
21benefits of a pre-payment, post-adjudication, and post-edit
22claims system with the goals of streamlining claims processing
23and provider reimbursement, reducing the number of pending or
24rejected claims, and helping to ensure a more transparent
25adjudication process through the utilization of: (i) provider
26data verification and provider screening technology; and (ii)

 

 

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1clinical code editing; and (iii) pre-pay, pre- or
2post-adjudicated predictive modeling with an integrated case
3management system with link analysis. Such a request for
4information shall not be considered as a request for proposal
5or as an obligation on the part of the Illinois Department to
6take any action or acquire any products or services.
7    The Illinois Department shall establish policies,
8procedures, standards and criteria by rule for the acquisition,
9repair and replacement of orthotic and prosthetic devices and
10durable medical equipment. Such rules shall provide, but not be
11limited to, the following services: (1) immediate repair or
12replacement of such devices by recipients without medical
13authorization; and (2) rental, lease, purchase or
14lease-purchase of durable medical equipment in a
15cost-effective manner, taking into consideration the
16recipient's medical prognosis, the extent of the recipient's
17needs, and the requirements and costs for maintaining such
18equipment. Such Subject to prior approval, such rules shall
19enable a recipient to temporarily acquire and use alternative
20or substitute devices or equipment pending repairs or
21replacements of any device or equipment previously authorized
22for such recipient by the Department.
23    The Department shall execute, relative to the nursing home
24prescreening project, written inter-agency agreements with the
25Department of Human Services and the Department on Aging, to
26effect the following: (i) intake procedures and common

 

 

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1eligibility criteria for those persons who are receiving
2non-institutional services; and (ii) the establishment and
3development of non-institutional services in areas of the State
4where they are not currently available or are undeveloped; and
5(iii) notwithstanding any other provision of law, subject to
6federal approval, on and after July 1, 2012, an increase in the
7determination of need (DON) scores from 29 to 37 for applicants
8for institutional and home and community-based long term care;
9if and only if federal approval is not granted, the Department
10may, in conjunction with other affected agencies, implement
11utilization controls or changes in benefit packages to
12effectuate a similar savings amount for this population; and
13(iv) no later than July 1, 2013, minimum level of care
14eligibility criteria for institutional and home and
15community-based long term care. In order to select the minimum
16level of care eligibility criteria, the Governor shall
17establish a workgroup that includes affected agency
18representatives and stakeholders representing the
19institutional and home and community-based long term care
20interests. This Section shall not restrict the Department from
21implementing lower level of care eligibility criteria for
22community-based services in circumstances where federal
23approval has been granted.
24    The Illinois Department shall develop and operate, in
25cooperation with other State Departments and agencies and in
26compliance with applicable federal laws and regulations,

 

 

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1appropriate and effective systems of health care evaluation and
2programs for monitoring of utilization of health care services
3and facilities, as it affects persons eligible for medical
4assistance under this Code.
5    The Illinois Department shall report annually to the
6General Assembly, no later than the second Friday in April of
71979 and each year thereafter, in regard to:
8        (a) actual statistics and trends in utilization of
9    medical services by public aid recipients;
10        (b) actual statistics and trends in the provision of
11    the various medical services by medical vendors;
12        (c) current rate structures and proposed changes in
13    those rate structures for the various medical vendors; and
14        (d) efforts at utilization review and control by the
15    Illinois Department.
16    The period covered by each report shall be the 3 years
17ending on the June 30 prior to the report. The report shall
18include suggested legislation for consideration by the General
19Assembly. The filing of one copy of the report with the
20Speaker, one copy with the Minority Leader and one copy with
21the Clerk of the House of Representatives, one copy with the
22President, one copy with the Minority Leader and one copy with
23the Secretary of the Senate, one copy with the Legislative
24Research Unit, and such additional copies with the State
25Government Report Distribution Center for the General Assembly
26as is required under paragraph (t) of Section 7 of the State

 

 

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1Library Act shall be deemed sufficient to comply with this
2Section.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9    On and after July 1, 2012, the Department shall reduce any
10rate of reimbursement for services or other payments or alter
11any methodologies authorized by this Code to reduce any rate of
12reimbursement for services or other payments in accordance with
13Section 5-5e.
14(Source: P.A. 96-156, eff. 1-1-10; 96-806, eff. 7-1-10; 96-926,
15eff. 1-1-11; 96-1000, eff. 7-2-10; 97-48, eff. 6-28-11; 97-638,
16eff. 1-1-12; 97-689, eff. 6-14-12; 97-1061, eff. 8-24-12;
17revised 9-20-12.)
 
18    (305 ILCS 5/5-5.02)  (from Ch. 23, par. 5-5.02)
19    Sec. 5-5.02. Hospital reimbursements.
20    (a) Reimbursement to Hospitals; July 1, 1992 through
21September 30, 1992. Notwithstanding any other provisions of
22this Code or the Illinois Department's Rules promulgated under
23the Illinois Administrative Procedure Act, reimbursement to
24hospitals for services provided during the period July 1, 1992
25through September 30, 1992, shall be as follows:

 

 

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1        (1) For inpatient hospital services rendered, or if
2    applicable, for inpatient hospital discharges occurring,
3    on or after July 1, 1992 and on or before September 30,
4    1992, the Illinois Department shall reimburse hospitals
5    for inpatient services under the reimbursement
6    methodologies in effect for each hospital, and at the
7    inpatient payment rate calculated for each hospital, as of
8    June 30, 1992. For purposes of this paragraph,
9    "reimbursement methodologies" means all reimbursement
10    methodologies that pertain to the provision of inpatient
11    hospital services, including, but not limited to, any
12    adjustments for disproportionate share, targeted access,
13    critical care access and uncompensated care, as defined by
14    the Illinois Department on June 30, 1992.
15        (2) For the purpose of calculating the inpatient
16    payment rate for each hospital eligible to receive
17    quarterly adjustment payments for targeted access and
18    critical care, as defined by the Illinois Department on
19    June 30, 1992, the adjustment payment for the period July
20    1, 1992 through September 30, 1992, shall be 25% of the
21    annual adjustment payments calculated for each eligible
22    hospital, as of June 30, 1992. The Illinois Department
23    shall determine by rule the adjustment payments for
24    targeted access and critical care beginning October 1,
25    1992.
26        (3) For the purpose of calculating the inpatient

 

 

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1    payment rate for each hospital eligible to receive
2    quarterly adjustment payments for uncompensated care, as
3    defined by the Illinois Department on June 30, 1992, the
4    adjustment payment for the period August 1, 1992 through
5    September 30, 1992, shall be one-sixth of the total
6    uncompensated care adjustment payments calculated for each
7    eligible hospital for the uncompensated care rate year, as
8    defined by the Illinois Department, ending on July 31,
9    1992. The Illinois Department shall determine by rule the
10    adjustment payments for uncompensated care beginning
11    October 1, 1992.
12    (b) Inpatient payments. For inpatient services provided on
13or after October 1, 1993, in addition to rates paid for
14hospital inpatient services pursuant to the Illinois Health
15Finance Reform Act, as now or hereafter amended, or the
16Illinois Department's prospective reimbursement methodology,
17or any other methodology used by the Illinois Department for
18inpatient services, the Illinois Department shall make
19adjustment payments, in an amount calculated pursuant to the
20methodology described in paragraph (c) of this Section, to
21hospitals that the Illinois Department determines satisfy any
22one of the following requirements:
23        (1) Hospitals that are described in Section 1923 of the
24    federal Social Security Act, as now or hereafter amended;
25    or
26        (2) Illinois hospitals that have a Medicaid inpatient

 

 

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1    utilization rate which is at least one-half a standard
2    deviation above the mean Medicaid inpatient utilization
3    rate for all hospitals in Illinois receiving Medicaid
4    payments from the Illinois Department; or
5        (3) Illinois hospitals that on July 1, 1991 had a
6    Medicaid inpatient utilization rate, as defined in
7    paragraph (h) of this Section, that was at least the mean
8    Medicaid inpatient utilization rate for all hospitals in
9    Illinois receiving Medicaid payments from the Illinois
10    Department and which were located in a planning area with
11    one-third or fewer excess beds as determined by the Health
12    Facilities and Services Review Board, and that, as of June
13    30, 1992, were located in a federally designated Health
14    Manpower Shortage Area; or
15        (4) Illinois hospitals that:
16            (A) have a Medicaid inpatient utilization rate
17        that is at least equal to the mean Medicaid inpatient
18        utilization rate for all hospitals in Illinois
19        receiving Medicaid payments from the Department; and
20            (B) also have a Medicaid obstetrical inpatient
21        utilization rate that is at least one standard
22        deviation above the mean Medicaid obstetrical
23        inpatient utilization rate for all hospitals in
24        Illinois receiving Medicaid payments from the
25        Department for obstetrical services; or
26        (5) Any children's hospital, which means a hospital

 

 

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1    devoted exclusively to caring for children. A hospital
2    which includes a facility devoted exclusively to caring for
3    children shall be considered a children's hospital to the
4    degree that the hospital's Medicaid care is provided to
5    children if either (i) the facility devoted exclusively to
6    caring for children is separately licensed as a hospital by
7    a municipality prior to September 30, 1998 or (ii) the
8    hospital has been designated by the State as a Level III
9    perinatal care facility, has a Medicaid Inpatient
10    Utilization rate greater than 55% for the rate year 2003
11    disproportionate share determination, and has more than
12    10,000 qualified children days as defined by the Department
13    in rulemaking.
14    (c) Inpatient adjustment payments. The adjustment payments
15required by paragraph (b) shall be calculated based upon the
16hospital's Medicaid inpatient utilization rate as follows:
17        (1) hospitals with a Medicaid inpatient utilization
18    rate below the mean shall receive a per day adjustment
19    payment equal to $25;
20        (2) hospitals with a Medicaid inpatient utilization
21    rate that is equal to or greater than the mean Medicaid
22    inpatient utilization rate but less than one standard
23    deviation above the mean Medicaid inpatient utilization
24    rate shall receive a per day adjustment payment equal to
25    the sum of $25 plus $1 for each one percent that the
26    hospital's Medicaid inpatient utilization rate exceeds the

 

 

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1    mean Medicaid inpatient utilization rate;
2        (3) hospitals with a Medicaid inpatient utilization
3    rate that is equal to or greater than one standard
4    deviation above the mean Medicaid inpatient utilization
5    rate but less than 1.5 standard deviations above the mean
6    Medicaid inpatient utilization rate shall receive a per day
7    adjustment payment equal to the sum of $40 plus $7 for each
8    one percent that the hospital's Medicaid inpatient
9    utilization rate exceeds one standard deviation above the
10    mean Medicaid inpatient utilization rate; and
11        (4) hospitals with a Medicaid inpatient utilization
12    rate that is equal to or greater than 1.5 standard
13    deviations above the mean Medicaid inpatient utilization
14    rate shall receive a per day adjustment payment equal to
15    the sum of $90 plus $2 for each one percent that the
16    hospital's Medicaid inpatient utilization rate exceeds 1.5
17    standard deviations above the mean Medicaid inpatient
18    utilization rate.
19    (d) Supplemental adjustment payments. In addition to the
20adjustment payments described in paragraph (c), hospitals as
21defined in clauses (1) through (5) of paragraph (b), excluding
22county hospitals (as defined in subsection (c) of Section 15-1
23of this Code) and a hospital organized under the University of
24Illinois Hospital Act, shall be paid supplemental inpatient
25adjustment payments of $60 per day. For purposes of Title XIX
26of the federal Social Security Act, these supplemental

 

 

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1adjustment payments shall not be classified as adjustment
2payments to disproportionate share hospitals.
3    (e) The inpatient adjustment payments described in
4paragraphs (c) and (d) shall be increased on October 1, 1993
5and annually thereafter by a percentage equal to the lesser of
6(i) the increase in the DRI hospital cost index for the most
7recent 12 month period for which data are available, or (ii)
8the percentage increase in the statewide average hospital
9payment rate over the previous year's statewide average
10hospital payment rate. The sum of the inpatient adjustment
11payments under paragraphs (c) and (d) to a hospital, other than
12a county hospital (as defined in subsection (c) of Section 15-1
13of this Code) or a hospital organized under the University of
14Illinois Hospital Act, however, shall not exceed $275 per day;
15that limit shall be increased on October 1, 1993 and annually
16thereafter by a percentage equal to the lesser of (i) the
17increase in the DRI hospital cost index for the most recent
1812-month period for which data are available or (ii) the
19percentage increase in the statewide average hospital payment
20rate over the previous year's statewide average hospital
21payment rate.
22    (f) Children's hospital inpatient adjustment payments. For
23children's hospitals, as defined in clause (5) of paragraph
24(b), the adjustment payments required pursuant to paragraphs
25(c) and (d) shall be multiplied by 2.0.
26    (g) County hospital inpatient adjustment payments. For

 

 

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1county hospitals, as defined in subsection (c) of Section 15-1
2of this Code, there shall be an adjustment payment as
3determined by rules issued by the Illinois Department.
4    (h) For the purposes of this Section the following terms
5shall be defined as follows:
6        (1) "Medicaid inpatient utilization rate" means a
7    fraction, the numerator of which is the number of a
8    hospital's inpatient days provided in a given 12-month
9    period to patients who, for such days, were eligible for
10    Medicaid under Title XIX of the federal Social Security
11    Act, and the denominator of which is the total number of
12    the hospital's inpatient days in that same period.
13        (2) "Mean Medicaid inpatient utilization rate" means
14    the total number of Medicaid inpatient days provided by all
15    Illinois Medicaid-participating hospitals divided by the
16    total number of inpatient days provided by those same
17    hospitals.
18        (3) "Medicaid obstetrical inpatient utilization rate"
19    means the ratio of Medicaid obstetrical inpatient days to
20    total Medicaid inpatient days for all Illinois hospitals
21    receiving Medicaid payments from the Illinois Department.
22    (i) Inpatient adjustment payment limit. In order to meet
23the limits of Public Law 102-234 and Public Law 103-66, the
24Illinois Department shall by rule adjust disproportionate
25share adjustment payments.
26    (j) University of Illinois Hospital inpatient adjustment

 

 

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1payments. For hospitals organized under the University of
2Illinois Hospital Act, there shall be an adjustment payment as
3determined by rules adopted by the Illinois Department.
4    (k) The Illinois Department may by rule establish criteria
5for and develop methodologies for adjustment payments to
6hospitals participating under this Article.
7    (l) (Blank). On and after July 1, 2012, the Department
8shall reduce any rate of reimbursement for services or other
9payments or alter any methodologies authorized by this Code to
10reduce any rate of reimbursement for services or other payments
11in accordance with Section 5-5e.
12(Source: P.A. 96-31, eff. 6-30-09; 97-689, eff. 6-14-12.)
 
13    (305 ILCS 5/5-5.05)
14    Sec. 5-5.05. Hospitals; psychiatric services.
15    (a) On and after July 1, 2008, the inpatient, per diem rate
16to be paid to a hospital for inpatient psychiatric services
17shall be $363.77.
18    (b) For purposes of this Section, "hospital" means the
19following:
20        (1) Advocate Christ Hospital, Oak Lawn, Illinois.
21        (2) Barnes-Jewish Hospital, St. Louis, Missouri.
22        (3) BroMenn Healthcare, Bloomington, Illinois.
23        (4) Jackson Park Hospital, Chicago, Illinois.
24        (5) Katherine Shaw Bethea Hospital, Dixon, Illinois.
25        (6) Lawrence County Memorial Hospital, Lawrenceville,

 

 

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1    Illinois.
2        (7) Advocate Lutheran General Hospital, Park Ridge,
3    Illinois.
4        (8) Mercy Hospital and Medical Center, Chicago,
5    Illinois.
6        (9) Methodist Medical Center of Illinois, Peoria,
7    Illinois.
8        (10) Provena United Samaritans Medical Center,
9    Danville, Illinois.
10        (11) Rockford Memorial Hospital, Rockford, Illinois.
11        (12) Sarah Bush Lincoln Health Center, Mattoon,
12    Illinois.
13        (13) Provena Covenant Medical Center, Urbana,
14    Illinois.
15        (14) Rush-Presbyterian-St. Luke's Medical Center,
16    Chicago, Illinois.
17        (15) Mt. Sinai Hospital, Chicago, Illinois.
18        (16) Gateway Regional Medical Center, Granite City,
19    Illinois.
20        (17) St. Mary of Nazareth Hospital, Chicago, Illinois.
21        (18) Provena St. Mary's Hospital, Kankakee, Illinois.
22        (19) St. Mary's Hospital, Decatur, Illinois.
23        (20) Memorial Hospital, Belleville, Illinois.
24        (21) Swedish Covenant Hospital, Chicago, Illinois.
25        (22) Trinity Medical Center, Rock Island, Illinois.
26        (23) St. Elizabeth Hospital, Chicago, Illinois.

 

 

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1        (24) Richland Memorial Hospital, Olney, Illinois.
2        (25) St. Elizabeth's Hospital, Belleville, Illinois.
3        (26) Samaritan Health System, Clinton, Iowa.
4        (27) St. John's Hospital, Springfield, Illinois.
5        (28) St. Mary's Hospital, Centralia, Illinois.
6        (29) Loretto Hospital, Chicago, Illinois.
7        (30) Kenneth Hall Regional Hospital, East St. Louis,
8    Illinois.
9        (31) Hinsdale Hospital, Hinsdale, Illinois.
10        (32) Pekin Hospital, Pekin, Illinois.
11        (33) University of Chicago Medical Center, Chicago,
12    Illinois.
13        (34) St. Anthony's Health Center, Alton, Illinois.
14        (35) OSF St. Francis Medical Center, Peoria, Illinois.
15        (36) Memorial Medical Center, Springfield, Illinois.
16        (37) A hospital with a distinct part unit for
17    psychiatric services that begins operating on or after July
18    1, 2008.
19    For purposes of this Section, "inpatient psychiatric
20services" means those services provided to patients who are in
21need of short-term acute inpatient hospitalization for active
22treatment of an emotional or mental disorder.
23    (c) No rules shall be promulgated to implement this
24Section. For purposes of this Section, "rules" is given the
25meaning contained in Section 1-70 of the Illinois
26Administrative Procedure Act.

 

 

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1    (d) This Section shall not be in effect during any period
2of time that the State has in place a fully operational
3hospital assessment plan that has been approved by the Centers
4for Medicare and Medicaid Services of the U.S. Department of
5Health and Human Services.
6    (e) (Blank). On and after July 1, 2012, the Department
7shall reduce any rate of reimbursement for services or other
8payments or alter any methodologies authorized by this Code to
9reduce any rate of reimbursement for services or other payments
10in accordance with Section 5-5e.
11(Source: P.A. 97-689, eff. 6-14-12.)
 
12    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
13    Sec. 5-5.2. Payment.
14    (a) All nursing facilities that are grouped pursuant to
15Section 5-5.1 of this Act shall receive the same rate of
16payment for similar services.
17    (b) It shall be a matter of State policy that the Illinois
18Department shall utilize a uniform billing cycle throughout the
19State for the long-term care providers.
20    (c) Notwithstanding any other provisions of this Code,
21beginning July 1, 2013 the methodologies for reimbursement of
22nursing facility services as provided under this Article shall
23no longer be applicable for bills payable for State fiscal
24years 2014 and thereafter. The Department of Healthcare and
25Family Services shall, effective July 1, 2013, implement an

 

 

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1evidence-based payment methodology for the reimbursement of
2nursing facility services. The methodology shall continue to
3take into consideration the needs of individual residents, as
4assessed and reported by the most current version of the
5nursing facility Resident Assessment Instrument, adopted and
6in use by the federal government. nursing services rendered on
7or after a new reimbursement system based on the Resource
8Utilization Groups (RUGs) has been fully operationalized,
9which shall take effect for services provided on or after
10January 1, 2014.
11    (d) (Blank). A new nursing services reimbursement
12methodology utilizing RUGs IV 48 grouper model shall be
13established and may include an Illinois-specific default
14group, as needed. The new RUGs-based nursing services
15reimbursement methodology shall be resident-driven,
16facility-specific, and cost-based. Costs shall be annually
17rebased and case mix index quarterly updated. The methodology
18shall include regional wage adjustors based on the Health
19Service Areas (HSA) groupings in effect on April 30, 2012. The
20Department shall assign a case mix index to each resident class
21based on the Centers for Medicare and Medicaid Services staff
22time measurement study utilizing an index maximization
23approach.
24    (e) (Blank). Notwithstanding any other provision of this
25Code, the Department shall by rule develop a reimbursement
26methodology reflective of the intensity of care and services

 

 

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1requirements of low need residents in the lowest RUG IV
2groupers and corresponding regulations.
3    (f) (Blank). Notwithstanding any other provision of this
4Code, on and after July 1, 2012, reimbursement rates associated
5with the nursing or support components of the current nursing
6facility rate methodology shall not increase beyond the level
7effective May 1, 2011 until a new reimbursement system based on
8the RUGs IV 48 grouper model has been fully operationalized.
9    (g) (Blank). Notwithstanding any other provision of this
10Code, on and after July 1, 2012, for facilities not designated
11by the Department of Healthcare and Family Services as
12"Institutions for Mental Disease", rates effective May 1, 2011
13shall be adjusted as follows:
14        (1) Individual nursing rates for residents classified
15    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
16    ending March 31, 2012 shall be reduced by 10%;
17        (2) Individual nursing rates for residents classified
18    in all other RUG IV groups shall be reduced by 1.0%;
19        (3) Facility rates for the capital and support
20    components shall be reduced by 1.7%.
21    (h) (Blank). Notwithstanding any other provision of this
22Code, on and after July 1, 2012, nursing facilities designated
23by the Department of Healthcare and Family Services as
24"Institutions for Mental Disease" and "Institutions for Mental
25Disease" that are facilities licensed under the Specialized
26Mental Health Rehabilitation Act shall have the nursing,

 

 

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1socio-developmental, capital, and support components of their
2reimbursement rate effective May 1, 2011 reduced in total by
32.7%.
4(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
 
5    (305 ILCS 5/5-5.3)  (from Ch. 23, par. 5-5.3)
6    Sec. 5-5.3. Conditions of Payment - Prospective Rates -
7Accounting Principles. This amendatory Act establishes certain
8conditions for the Department of Healthcare and Family Services
9in instituting rates for the care of recipients of medical
10assistance in nursing facilities and ICF/DDs. Such conditions
11shall assure a method under which the payment for nursing
12facility and ICF/DD services provided to recipients under the
13Medical Assistance Program shall be on a reasonable cost
14related basis, which is prospectively determined at least
15annually by the Department of Public Aid (now Healthcare and
16Family Services). The annually established payment rate shall
17take effect on July 1 in 1984 and subsequent years. There shall
18be no rate increase during calendar year 1983 and the first six
19months of calendar year 1984.
20    The determination of the payment shall be made on the basis
21of generally accepted accounting principles that shall take
22into account the actual costs to the facility of providing
23nursing facility and ICF/DD services to recipients under the
24medical assistance program.
25    The resultant total rate for a specified type of service

 

 

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1shall be an amount which shall have been determined to be
2adequate to reimburse allowable costs of a facility that is
3economically and efficiently operated. The Department shall
4establish an effective date for each facility or group of
5facilities after which rates shall be paid on a reasonable cost
6related basis which shall be no sooner than the effective date
7of this amendatory Act of 1977.
8    On and after July 1, 2012, the Department shall reduce any
9rate of reimbursement for services or other payments or alter
10any methodologies authorized by this Code to reduce any rate of
11reimbursement for services or other payments in accordance with
12Section 5-5e.
13(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
 
14    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
15    Sec. 5-5.4. Standards of Payment - Department of Healthcare
16and Family Services. The Department of Healthcare and Family
17Services shall develop standards of payment of nursing facility
18and ICF/DD services in facilities providing such services under
19this Article which:
20    (1) Provide for the determination of a facility's payment
21for nursing facility or ICF/DD services on a prospective basis.
22The amount of the payment rate for all nursing facilities
23certified by the Department of Public Health under the ID/DD
24Community Care Act or the Nursing Home Care Act as Intermediate
25Care for the Developmentally Disabled facilities, Long Term

 

 

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1Care for Under Age 22 facilities, Skilled Nursing facilities,
2or Intermediate Care facilities under the medical assistance
3program shall be prospectively established annually on the
4basis of historical, financial, and statistical data
5reflecting actual costs from prior years, which shall be
6applied to the current rate year and updated for inflation,
7except that the capital cost element for newly constructed
8facilities shall be based upon projected budgets. The annually
9established payment rate shall take effect on July 1 in 1984
10and subsequent years. No rate increase and no update for
11inflation shall be provided on or after July 1, 1994 and before
12July 1, 2014 January 1, 2014, unless specifically provided for
13in this Section. The changes made by Public Act 93-841
14extending the duration of the prohibition against a rate
15increase or update for inflation are effective retroactive to
16July 1, 2004.
17    For facilities licensed by the Department of Public Health
18under the Nursing Home Care Act as Intermediate Care for the
19Developmentally Disabled facilities or Long Term Care for Under
20Age 22 facilities, the rates taking effect on July 1, 1998
21shall include an increase of 3%. For facilities licensed by the
22Department of Public Health under the Nursing Home Care Act as
23Skilled Nursing facilities or Intermediate Care facilities,
24the rates taking effect on July 1, 1998 shall include an
25increase of 3% plus $1.10 per resident-day, as defined by the
26Department. For facilities licensed by the Department of Public

 

 

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1Health under the Nursing Home Care Act as Intermediate Care
2Facilities for the Developmentally Disabled or Long Term Care
3for Under Age 22 facilities, the rates taking effect on January
41, 2006 shall include an increase of 3%. For facilities
5licensed by the Department of Public Health under the Nursing
6Home Care Act as Intermediate Care Facilities for the
7Developmentally Disabled or Long Term Care for Under Age 22
8facilities, the rates taking effect on January 1, 2009 shall
9include an increase sufficient to provide a $0.50 per hour wage
10increase for non-executive staff.
11    For facilities licensed by the Department of Public Health
12under the Nursing Home Care Act as Intermediate Care for the
13Developmentally Disabled facilities or Long Term Care for Under
14Age 22 facilities, the rates taking effect on July 1, 1999
15shall include an increase of 1.6% plus $3.00 per resident-day,
16as defined by the Department. For facilities licensed by the
17Department of Public Health under the Nursing Home Care Act as
18Skilled Nursing facilities or Intermediate Care facilities,
19the rates taking effect on July 1, 1999 shall include an
20increase of 1.6% and, for services provided on or after October
211, 1999, shall be increased by $4.00 per resident-day, as
22defined by the Department.
23    For facilities licensed by the Department of Public Health
24under the Nursing Home Care Act as Intermediate Care for the
25Developmentally Disabled facilities or Long Term Care for Under
26Age 22 facilities, the rates taking effect on July 1, 2000

 

 

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1shall include an increase of 2.5% per resident-day, as defined
2by the Department. For facilities licensed by the Department of
3Public Health under the Nursing Home Care Act as Skilled
4Nursing facilities or Intermediate Care facilities, the rates
5taking effect on July 1, 2000 shall include an increase of 2.5%
6per resident-day, as defined by the Department.
7    For facilities licensed by the Department of Public Health
8under the Nursing Home Care Act as skilled nursing facilities
9or intermediate care facilities, a new payment methodology must
10be implemented for the nursing component of the rate effective
11July 1, 2003. The Department of Public Aid (now Healthcare and
12Family Services) shall develop the new payment methodology
13using the Minimum Data Set (MDS) as the instrument to collect
14information concerning nursing home resident condition
15necessary to compute the rate. The Department shall develop the
16new payment methodology to meet the unique needs of Illinois
17nursing home residents while remaining subject to the
18appropriations provided by the General Assembly. A transition
19period from the payment methodology in effect on June 30, 2003
20to the payment methodology in effect on July 1, 2003 shall be
21provided for a period not exceeding 3 years and 184 days after
22implementation of the new payment methodology as follows:
23        (A) For a facility that would receive a lower nursing
24    component rate per patient day under the new system than
25    the facility received effective on the date immediately
26    preceding the date that the Department implements the new

 

 

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1    payment methodology, the nursing component rate per
2    patient day for the facility shall be held at the level in
3    effect on the date immediately preceding the date that the
4    Department implements the new payment methodology until a
5    higher nursing component rate of reimbursement is achieved
6    by that facility.
7        (B) For a facility that would receive a higher nursing
8    component rate per patient day under the payment
9    methodology in effect on July 1, 2003 than the facility
10    received effective on the date immediately preceding the
11    date that the Department implements the new payment
12    methodology, the nursing component rate per patient day for
13    the facility shall be adjusted.
14        (C) Notwithstanding paragraphs (A) and (B), the
15    nursing component rate per patient day for the facility
16    shall be adjusted subject to appropriations provided by the
17    General Assembly.
18    For facilities licensed by the Department of Public Health
19under the Nursing Home Care Act as Intermediate Care for the
20Developmentally Disabled facilities or Long Term Care for Under
21Age 22 facilities, the rates taking effect on March 1, 2001
22shall include a statewide increase of 7.85%, as defined by the
23Department.
24    Notwithstanding any other provision of this Section, for
25facilities licensed by the Department of Public Health under
26the Nursing Home Care Act as skilled nursing facilities or

 

 

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1intermediate care facilities, except facilities participating
2in the Department's demonstration program pursuant to the
3provisions of Title 77, Part 300, Subpart T of the Illinois
4Administrative Code, the numerator of the ratio used by the
5Department of Healthcare and Family Services to compute the
6rate payable under this Section using the Minimum Data Set
7(MDS) methodology shall incorporate the following annual
8amounts as the additional funds appropriated to the Department
9specifically to pay for rates based on the MDS nursing
10component methodology in excess of the funding in effect on
11December 31, 2006:
12        (i) For rates taking effect January 1, 2007,
13    $60,000,000.
14        (ii) For rates taking effect January 1, 2008,
15    $110,000,000.
16        (iii) For rates taking effect January 1, 2009,
17    $194,000,000.
18        (iv) For rates taking effect April 1, 2011, or the
19    first day of the month that begins at least 45 days after
20    the effective date of this amendatory Act of the 96th
21    General Assembly, $416,500,000 or an amount as may be
22    necessary to complete the transition to the MDS methodology
23    for the nursing component of the rate. Increased payments
24    under this item (iv) are not due and payable, however,
25    until (i) the methodologies described in this paragraph are
26    approved by the federal government in an appropriate State

 

 

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1    Plan amendment and (ii) the assessment imposed by Section
2    5B-2 of this Code is determined to be a permissible tax
3    under Title XIX of the Social Security Act.
4    Notwithstanding any other provision of this Section, for
5facilities licensed by the Department of Public Health under
6the Nursing Home Care Act as skilled nursing facilities or
7intermediate care facilities, the support component of the
8rates taking effect on January 1, 2008 shall be computed using
9the most recent cost reports on file with the Department of
10Healthcare and Family Services no later than April 1, 2005,
11updated for inflation to January 1, 2006.
12    For facilities licensed by the Department of Public Health
13under the Nursing Home Care Act as Intermediate Care for the
14Developmentally Disabled facilities or Long Term Care for Under
15Age 22 facilities, the rates taking effect on April 1, 2002
16shall include a statewide increase of 2.0%, as defined by the
17Department. This increase terminates on July 1, 2002; beginning
18July 1, 2002 these rates are reduced to the level of the rates
19in effect on March 31, 2002, as defined by the Department.
20    For facilities licensed by the Department of Public Health
21under the Nursing Home Care Act as skilled nursing facilities
22or intermediate care facilities, the rates taking effect on
23July 1, 2001 shall be computed using the most recent cost
24reports on file with the Department of Public Aid no later than
25April 1, 2000, updated for inflation to January 1, 2001. For
26rates effective July 1, 2001 only, rates shall be the greater

 

 

HB0027- 192 -LRB098 00027 KTG 30027 b

1of the rate computed for July 1, 2001 or the rate effective on
2June 30, 2001.
3    Notwithstanding any other provision of this Section, for
4facilities licensed by the Department of Public Health under
5the Nursing Home Care Act as skilled nursing facilities or
6intermediate care facilities, the Illinois Department shall
7determine by rule the rates taking effect on July 1, 2002,
8which shall be 5.9% less than the rates in effect on June 30,
92002.
10    Notwithstanding any other provision of this Section, for
11facilities licensed by the Department of Public Health under
12the Nursing Home Care Act as skilled nursing facilities or
13intermediate care facilities, if the payment methodologies
14required under Section 5A-12 and the waiver granted under 42
15CFR 433.68 are approved by the United States Centers for
16Medicare and Medicaid Services, the rates taking effect on July
171, 2004 shall be 3.0% greater than the rates in effect on June
1830, 2004. These rates shall take effect only upon approval and
19implementation of the payment methodologies required under
20Section 5A-12.
21    Notwithstanding any other provisions of this Section, for
22facilities licensed by the Department of Public Health under
23the Nursing Home Care Act as skilled nursing facilities or
24intermediate care facilities, the rates taking effect on
25January 1, 2005 shall be 3% more than the rates in effect on
26December 31, 2004.

 

 

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1    Notwithstanding any other provision of this Section, for
2facilities licensed by the Department of Public Health under
3the Nursing Home Care Act as skilled nursing facilities or
4intermediate care facilities, effective January 1, 2009, the
5per diem support component of the rates effective on January 1,
62008, computed using the most recent cost reports on file with
7the Department of Healthcare and Family Services no later than
8April 1, 2005, updated for inflation to January 1, 2006, shall
9be increased to the amount that would have been derived using
10standard Department of Healthcare and Family Services methods,
11procedures, and inflators.
12    Notwithstanding any other provisions of this Section, for
13facilities licensed by the Department of Public Health under
14the Nursing Home Care Act as intermediate care facilities that
15are federally defined as Institutions for Mental Disease, or
16facilities licensed by the Department of Public Health under
17the Specialized Mental Health Rehabilitation Facilities Act, a
18socio-development component rate equal to 6.6% of the
19facility's nursing component rate as of January 1, 2006 shall
20be established and paid effective July 1, 2006. The
21socio-development component of the rate shall be increased by a
22factor of 2.53 on the first day of the month that begins at
23least 45 days after January 11, 2008 (the effective date of
24Public Act 95-707). As of August 1, 2008, the socio-development
25component rate shall be equal to 6.6% of the facility's nursing
26component rate as of January 1, 2006, multiplied by a factor of

 

 

HB0027- 194 -LRB098 00027 KTG 30027 b

13.53. For services provided on or after April 1, 2011, or the
2first day of the month that begins at least 45 days after the
3effective date of this amendatory Act of the 96th General
4Assembly, whichever is later, the Illinois Department may by
5rule adjust these socio-development component rates, and may
6use different adjustment methodologies for those facilities
7participating, and those not participating, in the Illinois
8Department's demonstration program pursuant to the provisions
9of Title 77, Part 300, Subpart T of the Illinois Administrative
10Code, but in no case may such rates be diminished below those
11in effect on August 1, 2008.
12    For facilities licensed by the Department of Public Health
13under the Nursing Home Care Act as Intermediate Care for the
14Developmentally Disabled facilities or as long-term care
15facilities for residents under 22 years of age, the rates
16taking effect on July 1, 2003 shall include a statewide
17increase of 4%, as defined by the Department.
18    For facilities licensed by the Department of Public Health
19under the Nursing Home Care Act as Intermediate Care for the
20Developmentally Disabled facilities or Long Term Care for Under
21Age 22 facilities, the rates taking effect on the first day of
22the month that begins at least 45 days after the effective date
23of this amendatory Act of the 95th General Assembly shall
24include a statewide increase of 2.5%, as defined by the
25Department.
26    Notwithstanding any other provision of this Section, for

 

 

HB0027- 195 -LRB098 00027 KTG 30027 b

1facilities licensed by the Department of Public Health under
2the Nursing Home Care Act as skilled nursing facilities or
3intermediate care facilities, effective January 1, 2005,
4facility rates shall be increased by the difference between (i)
5a facility's per diem property, liability, and malpractice
6insurance costs as reported in the cost report filed with the
7Department of Public Aid and used to establish rates effective
8July 1, 2001 and (ii) those same costs as reported in the
9facility's 2002 cost report. These costs shall be passed
10through to the facility without caps or limitations, except for
11adjustments required under normal auditing procedures.
12    Rates established effective each July 1 shall govern
13payment for services rendered throughout that fiscal year,
14except that rates established on July 1, 1996 shall be
15increased by 6.8% for services provided on or after January 1,
161997. Such rates will be based upon the rates calculated for
17the year beginning July 1, 1990, and for subsequent years
18thereafter until June 30, 2001 shall be based on the facility
19cost reports for the facility fiscal year ending at any point
20in time during the previous calendar year, updated to the
21midpoint of the rate year. The cost report shall be on file
22with the Department no later than April 1 of the current rate
23year. Should the cost report not be on file by April 1, the
24Department shall base the rate on the latest cost report filed
25by each skilled care facility and intermediate care facility,
26updated to the midpoint of the current rate year. In

 

 

HB0027- 196 -LRB098 00027 KTG 30027 b

1determining rates for services rendered on and after July 1,
21985, fixed time shall not be computed at less than zero. The
3Department shall not make any alterations of regulations which
4would reduce any component of the Medicaid rate to a level
5below what that component would have been utilizing in the rate
6effective on July 1, 1984.
7    (2) Shall take into account the actual costs incurred by
8facilities in providing services for recipients of skilled
9nursing and intermediate care services under the medical
10assistance program.
11    (3) Shall take into account the medical and psycho-social
12characteristics and needs of the patients.
13    (4) Shall take into account the actual costs incurred by
14facilities in meeting licensing and certification standards
15imposed and prescribed by the State of Illinois, any of its
16political subdivisions or municipalities and by the U.S.
17Department of Health and Human Services pursuant to Title XIX
18of the Social Security Act.
19    The Department of Healthcare and Family Services shall
20develop precise standards for payments to reimburse nursing
21facilities for any utilization of appropriate rehabilitative
22personnel for the provision of rehabilitative services which is
23authorized by federal regulations, including reimbursement for
24services provided by qualified therapists or qualified
25assistants, and which is in accordance with accepted
26professional practices. Reimbursement also may be made for

 

 

HB0027- 197 -LRB098 00027 KTG 30027 b

1utilization of other supportive personnel under appropriate
2supervision.
3    The Department shall develop enhanced payments to offset
4the additional costs incurred by a facility serving exceptional
5need residents and shall allocate at least $8,000,000 of the
6funds collected from the assessment established by Section 5B-2
7of this Code for such payments. For the purpose of this
8Section, "exceptional needs" means, but need not be limited to,
9ventilator care, tracheotomy care, bariatric care, complex
10wound care, and traumatic brain injury care. The enhanced
11payments for exceptional need residents under this paragraph
12are not due and payable, however, until (i) the methodologies
13described in this paragraph are approved by the federal
14government in an appropriate State Plan amendment and (ii) the
15assessment imposed by Section 5B-2 of this Code is determined
16to be a permissible tax under Title XIX of the Social Security
17Act.
18    (5) Beginning July 1, 2014 January 1, 2014 the
19methodologies for reimbursement of nursing facility services
20as provided under this Section 5-5.4 shall no longer be
21applicable for bills payable for State fiscal years 2014 and
22thereafter services provided on or after January 1, 2014.
23    (6) No payment increase under this Section for the MDS
24methodology, exceptional care residents, or the
25socio-development component rate established by Public Act
2696-1530 of the 96th General Assembly and funded by the

 

 

HB0027- 198 -LRB098 00027 KTG 30027 b

1assessment imposed under Section 5B-2 of this Code shall be due
2and payable until after the Department notifies the long-term
3care providers, in writing, that the payment methodologies to
4long-term care providers required under this Section have been
5approved by the Centers for Medicare and Medicaid Services of
6the U.S. Department of Health and Human Services and the
7waivers under 42 CFR 433.68 for the assessment imposed by this
8Section, if necessary, have been granted by the Centers for
9Medicare and Medicaid Services of the U.S. Department of Health
10and Human Services. Upon notification to the Department of
11approval of the payment methodologies required under this
12Section and the waivers granted under 42 CFR 433.68, all
13increased payments otherwise due under this Section prior to
14the date of notification shall be due and payable within 90
15days of the date federal approval is received.
16    On and after July 1, 2012, the Department shall reduce any
17rate of reimbursement for services or other payments or alter
18any methodologies authorized by this Code to reduce any rate of
19reimbursement for services or other payments in accordance with
20Section 5-5e.
21(Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959,
22eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11;
2397-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
2497-584, eff. 8-26-11; 97-689, eff. 6-14-12; 97-813, eff.
257-13-12.)
 

 

 

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1    (305 ILCS 5/5-5.4e)
2    Sec. 5-5.4e. Nursing facilities; ventilator rates. On and
3after October 1, 2009, the Department of Healthcare and Family
4Services shall adopt rules to provide medical assistance
5reimbursement under this Article for the care of persons on
6ventilators in skilled nursing facilities licensed under the
7Nursing Home Care Act and certified to participate under the
8medical assistance program. Accordingly, necessary amendments
9to the rules implementing the Minimum Data Set (MDS) payment
10methodology shall also be made to provide a separate per diem
11ventilator rate based on days of service. The Department may
12adopt rules necessary to implement this amendatory Act of the
1396th General Assembly through the use of emergency rulemaking
14in accordance with Section 5-45 of the Illinois Administrative
15Procedure Act, except that the 24-month limitation on the
16adoption of emergency rules under Section 5-45 and the
17provisions of Sections 5-115 and 5-125 of that Act do not apply
18to rules adopted under this Section. For purposes of that Act,
19the General Assembly finds that the adoption of rules to
20implement this amendatory Act of the 96th General Assembly is
21deemed an emergency and necessary for the public interest,
22safety, and welfare.
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 of
26reimbursement for services or other payments in accordance with

 

 

HB0027- 200 -LRB098 00027 KTG 30027 b

1Section 5-5e.
2(Source: P.A. 96-743, eff. 8-25-09; 97-689, eff. 6-14-12.)
 
3    (305 ILCS 5/5-5.4h new)
4    Sec. 5-5.4h. Intermediate Care Facility for the
5Developmentally Disabled; bed reserve payments. The Department
6shall promulgate rules that establish a policy of bed reserve
7payments to ICF/DDs which addresses the needs of residents of
8ICF/DDs and their families.
9    (a) When a resident of an ICF/DD is absent from the
10facility in which he or she is a resident for purposes of
11physician authorized in-patient admission to a hospital, the
12Department's rules shall, at a minimum, provide (1) bed reserve
13payments at a daily rate which is 100% of the client's current
14per diem rate, for a period not exceeding 10 consecutive days;
15(2) bed reserve payments at a daily rate which is 75% of a
16client's current per diem rate, for a period which exceeds 10
17consecutive days but does not exceed 30 consecutive days; and
18(3) bed reserve payments at a daily rate which is 50% of a
19client's current per diem rate for a period which exceeds
20thirty consecutive days but does not exceed 45 consecutive
21days.
22    (b) When a resident of an ICF/DD is absent from the
23facility in which he or she is a resident for purposes of a
24home visit with a family member the Department's rules shall,
25at a minimum, provide (1) bed reserve payments at a rate which

 

 

HB0027- 201 -LRB098 00027 KTG 30027 b

1is 100% of a client's current per diem rate, for a period not
2exceeding 10 days per State fiscal year; and (2) bed reserve
3payments at a rate which is 75% of a client's current per diem
4rate, for a period which exceeds 10 days per State fiscal year
5but does not exceed 30 days per State fiscal year.
6    (c) No Department rule regarding bed reserve payments shall
7require an ICF/DD to have a specified percentage of total
8facility occupancy as a requirement for receiving bed reserve
9payments.
10    This Section 5-5.4h shall not apply to any State operated
11facilities.
 
12    (305 ILCS 5/5-5.4i new)
13    Sec. 5-5.4i. Bed reserves; approval. The Department of
14Healthcare and Family Services shall approve bed reserves at a
15daily rate of 75% of an individual's current Medicaid per diem,
16for nursing facilities 90% or more of whose residents are
17Medicaid recipients and that have occupancy levels of at least
1893% for resident bed reserves not exceeding 10 days.
 
19    (305 ILCS 5/5-5.5)  (from Ch. 23, par. 5-5.5)
20    Sec. 5-5.5. Elements of Payment Rate.
21    (a) The Department of Healthcare and Family Services shall
22develop a prospective method for determining payment rates for
23nursing facility and ICF/DD services in nursing facilities
24composed of the following cost elements:

 

 

HB0027- 202 -LRB098 00027 KTG 30027 b

1        (1) Standard Services, with the cost of this component
2    being determined by taking into account the actual costs to
3    the facilities of these services subject to cost ceilings
4    to be defined in the Department's rules.
5        (2) Resident Services, with the cost of this component
6    being determined by taking into account the actual costs,
7    needs and utilization of these services, as derived from an
8    assessment of the resident needs in the nursing facilities.
9        (3) Ancillary Services, with the payment rate being
10    developed for each individual type of service. Payment
11    shall be made only when authorized under procedures
12    developed by the Department of Healthcare and Family
13    Services.
14        (4) Nurse's Aide Training, with the cost of this
15    component being determined by taking into account the
16    actual cost to the facilities of such training.
17        (5) Real Estate Taxes, with the cost of this component
18    being determined by taking into account the figures
19    contained in the most currently available cost reports
20    (with no imposition of maximums) updated to the midpoint of
21    the current rate year for long term care services rendered
22    between July 1, 1984 and June 30, 1985, and with the cost
23    of this component being determined by taking into account
24    the actual 1983 taxes for which the nursing homes were
25    assessed (with no imposition of maximums) updated to the
26    midpoint of the current rate year for long term care

 

 

HB0027- 203 -LRB098 00027 KTG 30027 b

1    services rendered between July 1, 1985 and June 30, 1986.
2    (b) In developing a prospective method for determining
3payment rates for nursing facility and ICF/DD services in
4nursing facilities and ICF/DDs, the Department of Healthcare
5and Family Services shall consider the following cost elements:
6        (1) Reasonable capital cost determined by utilizing
7    incurred interest rate and the current value of the
8    investment, including land, utilizing composite rates, or
9    by utilizing such other reasonable cost related methods
10    determined by the Department. However, beginning with the
11    rate reimbursement period effective July 1, 1987, the
12    Department shall be prohibited from establishing,
13    including, and implementing any depreciation factor in
14    calculating the capital cost element.
15        (2) Profit, with the actual amount being produced and
16    accruing to the providers in the form of a return on their
17    total investment, on the basis of their ability to
18    economically and efficiently deliver a type of service. The
19    method of payment may assure the opportunity for a profit,
20    but shall not guarantee or establish a specific amount as a
21    cost.
22    (c) The Illinois Department may implement the amendatory
23changes to this Section made by this amendatory Act of 1991
24through the use of emergency rules in accordance with the
25provisions of Section 5.02 of the Illinois Administrative
26Procedure Act. For purposes of the Illinois Administrative

 

 

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1Procedure Act, the adoption of rules to implement the
2amendatory changes to this Section made by this amendatory Act
3of 1991 shall be deemed an emergency and necessary for the
4public interest, safety and welfare.
5    (d) No later than January 1, 2001, the Department of Public
6Aid shall file with the Joint Committee on Administrative
7Rules, pursuant to the Illinois Administrative Procedure Act, a
8proposed rule, or a proposed amendment to an existing rule,
9regarding payment for appropriate services, including
10assessment, care planning, discharge planning, and treatment
11provided by nursing facilities to residents who have a serious
12mental illness.
13    (e) (Blank). On and after July 1, 2012, the Department
14shall reduce any rate of reimbursement for services or other
15payments or alter any methodologies authorized by this Code to
16reduce any rate of reimbursement for services or other payments
17in accordance with Section 5-5e.
18(Source: P.A. 96-1123, eff. 1-1-11; 96-1530, eff. 2-16-11;
1997-689, eff. 6-14-12.)
 
20    (305 ILCS 5/5-5.8b)  (from Ch. 23, par. 5-5.8b)
21    Sec. 5-5.8b. Payment to Campus Facilities. There is hereby
22established a separate payment category for campus facilities.
23A "campus facility" is defined as an entity which consists of a
24long term care facility (or group of facilities if the
25facilities are on the same contiguous parcel of real estate)

 

 

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1which meets all of the following criteria as of May 1, 1987:
2the entity provides care for both children and adults;
3residents of the entity reside in three or more separate
4buildings with congregate and small group living arrangements
5on a single campus; the entity provides three or more separate
6licensed levels of care; the entity (or a part of the entity)
7is enrolled with the Department of Healthcare and Family
8Services as a provider of long term care services and receives
9payments from that Department; the entity (or a part of the
10entity) receives funding from the Department of Human Services;
11and the entity (or a part of the entity) holds a current
12license as a child care institution issued by the Department of
13Children and Family Services.
14    The Department of Healthcare and Family Services, the
15Department of Human Services, and the Department of Children
16and Family Services shall develop jointly a rate methodology or
17methodologies for campus facilities. Such methodology or
18methodologies may establish a single rate to be paid by all the
19agencies, or a separate rate to be paid by each agency, or
20separate components to be paid to different parts of the campus
21facility. All campus facilities shall receive the same rate of
22payment for similar services. Any methodology developed
23pursuant to this section shall take into account the actual
24costs to the facility of providing services to residents, and
25shall be adequate to reimburse the allowable costs of a campus
26facility which is economically and efficiently operated. Any

 

 

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1methodology shall be established on the basis of historical,
2financial, and statistical data submitted by campus
3facilities, and shall take into account the actual costs
4incurred by campus facilities in providing services, and in
5meeting licensing and certification standards imposed and
6prescribed by the State of Illinois, any of its political
7subdivisions or municipalities and by the United States
8Department of Health and Human Services. Rates may be
9established on a prospective or retrospective basis. Any
10methodology shall provide reimbursement for appropriate
11payment elements, including the following: standard services,
12patient services, real estate taxes, and capital costs.
13    On and after July 1, 2012, the Department shall reduce any
14rate of reimbursement for services or other payments or alter
15any methodologies authorized by this Code to reduce any rate of
16reimbursement for services or other payments in accordance with
17Section 5-5e.
18(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
 
19    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
20    Sec. 5-5.12. Pharmacy payments.
21    (a) Every request submitted by a pharmacy for reimbursement
22under this Article for prescription drugs provided to a
23recipient of aid under this Article shall include the name of
24the prescriber or an acceptable identification number as
25established by the Department.

 

 

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1    (b) Pharmacies providing prescription drugs under this
2Article shall be reimbursed at a rate which shall include a
3professional dispensing fee as determined by the Illinois
4Department, plus the current acquisition cost of the
5prescription drug dispensed. The Illinois Department shall
6update its information on the acquisition costs of all
7prescription drugs no less frequently than every 30 days.
8However, the Illinois Department may set the rate of
9reimbursement for the acquisition cost, by rule, at a
10percentage of the current average wholesale acquisition cost.
11    (c) (Blank).
12    (d) The Department shall not impose requirements for prior
13approval based on a preferred drug list for anti-retroviral,
14anti-hemophilic factor concentrates, or any atypical
15antipsychotics, conventional antipsychotics, or
16anticonvulsants used for the treatment of serious mental
17illnesses until 30 days after it has conducted a study of the
18impact of such requirements on patient care and submitted a
19report to the Speaker of the House of Representatives and the
20President of the Senate. The Department shall review
21utilization of narcotic medications in the medical assistance
22program and impose utilization controls that protect against
23abuse.
24    (e) When making determinations as to which drugs shall be
25on a prior approval list, the Department shall include as part
26of the analysis for this determination, the degree to which a

 

 

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1drug may affect individuals in different ways based on factors
2including the gender of the person taking the medication.
3    (f) The Department shall cooperate with the Department of
4Public Health and the Department of Human Services Division of
5Mental Health in identifying psychotropic medications that,
6when given in a particular form, manner, duration, or frequency
7(including "as needed") in a dosage, or in conjunction with
8other psychotropic medications to a nursing home resident or to
9a resident of a facility licensed under the ID/DD Community
10Care Act, may constitute a chemical restraint or an
11"unnecessary drug" as defined by the Nursing Home Care Act or
12Titles XVIII and XIX of the Social Security Act and the
13implementing rules and regulations. The Department shall
14require prior approval for any such medication prescribed for a
15nursing home resident or to a resident of a facility licensed
16under the ID/DD Community Care Act, that appears to be a
17chemical restraint or an unnecessary drug. The Department shall
18consult with the Department of Human Services Division of
19Mental Health in developing a protocol and criteria for
20deciding whether to grant such prior approval.
21    (g) The Department may by rule provide for reimbursement of
22the dispensing of a 90-day supply of a generic or brand name,
23non-narcotic maintenance medication in circumstances where it
24is cost effective.
25    (g-5) (Blank). On and after July 1, 2012, the Department
26may require the dispensing of drugs to nursing home residents

 

 

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1be in a 7-day supply or other amount less than a 31-day supply.
2The Department shall pay only one dispensing fee per 31-day
3supply.
4    (h) Effective July 1, 2011, the Department shall
5discontinue coverage of select over-the-counter drugs,
6including analgesics and cough and cold and allergy
7medications.
8    (h-5) (Blank). On and after July 1, 2012, the Department
9shall impose utilization controls, including, but not limited
10to, prior approval on specialty drugs, oncolytic drugs, drugs
11for the treatment of HIV or AIDS, immunosuppressant drugs, and
12biological products in order to maximize savings on these
13drugs. The Department may adjust payment methodologies for
14non-pharmacy billed drugs in order to incentivize the selection
15of lower-cost drugs. For drugs for the treatment of AIDS, the
16Department shall take into consideration the potential for
17non-adherence by certain populations, and shall develop
18protocols with organizations or providers primarily serving
19those with HIV/AIDS, as long as such measures intend to
20maintain cost neutrality with other utilization management
21controls such as prior approval. For hemophilia, the Department
22shall develop a program of utilization review and control which
23may include, in the discretion of the Department, prior
24approvals. The Department may impose special standards on
25providers that dispense blood factors which shall include, in
26the discretion of the Department, staff training and education;

 

 

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1patient outreach and education; case management; in-home
2patient assessments; assay management; maintenance of stock;
3emergency dispensing timeframes; data collection and
4reporting; dispensing of supplies related to blood factor
5infusions; cold chain management and packaging practices; care
6coordination; product recalls; and emergency clinical
7consultation. The Department may require patients to receive a
8comprehensive examination annually at an appropriate provider
9in order to be eligible to continue to receive blood factor.
10    (i) On and after July 1, 2012, the Department shall reduce
11any rate of reimbursement for services or other payments or
12alter any methodologies authorized by this Code to reduce any
13rate of reimbursement for services or other payments in
14accordance with Section 5-5e.
15    (i) The Department shall seek any necessary waiver from the
16federal government in order to establish a program limiting the
17pharmacies eligible to dispense specialty drugs and shall issue
18a Request for Proposals in order to maximize savings on these
19drugs. The Department shall by rule establish the drugs
20required to be dispensed in this program. (Blank).
21    (j) (Blank). On and after July 1, 2012, the Department
22shall impose limitations on prescription drugs such that the
23Department shall not provide reimbursement for more than 4
24prescriptions, including 3 brand name prescriptions, for
25distinct drugs in a 30-day period, unless prior approval is
26received for all prescriptions in excess of the 4-prescription

 

 

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1limit. Drugs in the following therapeutic classes shall not be
2subject to prior approval as a result of the 4-prescription
3limit: immunosuppressant drugs, oncolytic drugs, and
4anti-retroviral drugs.
5    (k) (Blank). No medication therapy management program
6implemented by the Department shall be contrary to the
7provisions of the Pharmacy Practice Act.
8    (l) (Blank). Any provider enrolled with the Department that
9bills the Department for outpatient drugs and is eligible to
10enroll in the federal Drug Pricing Program under Section 340B
11of the federal Public Health Services Act shall enroll in that
12program. No entity participating in the federal Drug Pricing
13Program under Section 340B of the federal Public Health
14Services Act may exclude Medicaid from their participation in
15that program, although the Department may exclude entities
16defined in Section 1905(l)(2)(B) of the Social Security Act
17from this requirement.
18(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
1996-1501, eff. 1-25-11; 97-38, eff. 6-28-11; 97-74, eff.
206-30-11; 97-333, eff. 8-12-11; 97-426, eff. 1-1-12; 97-689,
21eff. 6-14-12; 97-813, eff. 7-13-12; revised 8-3-12.)
 
22    (305 ILCS 5/5-5.17)  (from Ch. 23, par. 5-5.17)
23    Sec. 5-5.17. Separate reimbursement rate. The Illinois
24Department may by rule establish a separate reimbursement rate
25to be paid to long term care facilities for adult developmental

 

 

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1training services as defined in Section 15.2 of the Mental
2Health and Developmental Disabilities Administrative Act which
3are provided to intellectually disabled residents of such
4facilities who receive aid under this Article. Any such
5reimbursement shall be based upon cost reports submitted by the
6providers of such services and shall be paid by the long term
7care facility to the provider within such time as the Illinois
8Department shall prescribe by rule, but in no case less than 3
9business days after receipt of the reimbursement by such
10facility from the Illinois Department. The Illinois Department
11may impose a penalty upon a facility which does not make
12payment to the provider of adult developmental training
13services within the time so prescribed, up to the amount of
14payment not made to the provider.
15    On and after July 1, 2012, the Department shall reduce any
16rate of reimbursement for services or other payments or alter
17any methodologies authorized by this Code to reduce any rate of
18reimbursement for services or other payments in accordance with
19Section 5-5e.
20(Source: P.A. 97-227, eff. 1-1-12; 97-689, eff. 6-14-12.)
 
21    (305 ILCS 5/5-5.20)
22    Sec. 5-5.20. Clinic payments. For services provided by
23federally qualified health centers as defined in Section 1905
24(l)(2)(B) of the federal Social Security Act, on or after April
251, 1989, and as long as required by federal law, the Illinois

 

 

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1Department shall reimburse those health centers for those
2services according to a prospective cost-reimbursement
3methodology.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate of
7reimbursement for services or other payments in accordance with
8Section 5-5e.
9(Source: P.A. 97-689, eff. 6-14-12.)
 
10    (305 ILCS 5/5-5.23)
11    Sec. 5-5.23. Children's mental health services.
12    (a) The Department of Healthcare and Family Services, by
13rule, shall require the screening and assessment of a child
14prior to any Medicaid-funded admission to an inpatient hospital
15for psychiatric services to be funded by Medicaid. The
16screening and assessment shall include a determination of the
17appropriateness and availability of out-patient support
18services for necessary treatment. The Department, by rule,
19shall establish methods and standards of payment for the
20screening, assessment, and necessary alternative support
21services.
22    (b) The Department of Healthcare and Family Services, to
23the extent allowable under federal law, shall secure federal
24financial participation for Individual Care Grant expenditures
25made by the Department of Human Services for the Medicaid

 

 

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1optional service authorized under Section 1905(h) of the
2federal Social Security Act, pursuant to the provisions of
3Section 7.1 of the Mental Health and Developmental Disabilities
4Administrative Act.
5    (c) The Department of Healthcare and Family Services shall
6work jointly with the Department of Human Services to implement
7subsections (a) and (b).
8    (d) (Blank). On and after July 1, 2012, the Department
9shall reduce any rate of reimbursement for services or other
10payments or alter any methodologies authorized by this Code to
11reduce any rate of reimbursement for services or other payments
12in accordance with Section 5-5e.
13(Source: P.A. 97-689, eff. 6-14-12.)
 
14    (305 ILCS 5/5-5.24)
15    Sec. 5-5.24. Prenatal and perinatal care. The Department of
16Healthcare and Family Services may provide reimbursement under
17this Article for all prenatal and perinatal health care
18services that are provided for the purpose of preventing
19low-birthweight infants, reducing the need for neonatal
20intensive care hospital services, and promoting perinatal
21health. These services may include comprehensive risk
22assessments for pregnant women, women with infants, and
23infants, lactation counseling, nutrition counseling,
24childbirth support, psychosocial counseling, treatment and
25prevention of periodontal disease, and other support services

 

 

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1that have been proven to improve birth outcomes. The Department
2shall maximize the use of preventive prenatal and perinatal
3health care services consistent with federal statutes, rules,
4and regulations. The Department of Public Aid (now Department
5of Healthcare and Family Services) shall develop a plan for
6prenatal and perinatal preventive health care and shall present
7the plan to the General Assembly by January 1, 2004. On or
8before January 1, 2006 and every 2 years thereafter, the
9Department shall report to the General Assembly concerning the
10effectiveness of prenatal and perinatal health care services
11reimbursed under this Section in preventing low-birthweight
12infants and reducing the need for neonatal intensive care
13hospital services. Each such report shall include an evaluation
14of how the ratio of expenditures for treating low-birthweight
15infants compared with the investment in promoting healthy
16births and infants in local community areas throughout Illinois
17relates to healthy infant development in those areas.
18    On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate of
21reimbursement for services or other payments in accordance with
22Section 5-5e.
23(Source: P.A. 97-689, eff. 6-14-12.)
 
24    (305 ILCS 5/5-5.25)
25    Sec. 5-5.25. Access to psychiatric mental health services.

 

 

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1The General Assembly finds that providing access to psychiatric
2mental health services in a timely manner will improve the
3quality of life for persons suffering from mental illness and
4will contain health care costs by avoiding the need for more
5costly inpatient hospitalization. The Department of Healthcare
6and Family Services shall reimburse psychiatrists and
7federally qualified health centers as defined in Section
81905(l)(2)(B) of the federal Social Security Act for mental
9health services provided by psychiatrists, as authorized by
10Illinois law, to recipients via telepsychiatry. The
11Department, by rule, shall establish (i) criteria for such
12services to be reimbursed, including appropriate facilities
13and equipment to be used at both sites and requirements for a
14physician or other licensed health care professional to be
15present at the site where the patient is located, and (ii) a
16method to reimburse providers for mental health services
17provided by telepsychiatry.
18    On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate of
21reimbursement for services or other payments in accordance with
22Section 5-5e.
23(Source: P.A. 97-689, eff. 6-14-12.)
 
24    (305 ILCS 5/5-16.7)
25    Sec. 5-16.7. Post-parturition care. The medical assistance

 

 

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1program shall provide the post-parturition care benefits
2required to be covered by a policy of accident and health
3insurance under Section 356s of the Illinois Insurance Code.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate of
7reimbursement for services or other payments in accordance with
8Section 5-5e.
9(Source: P.A. 97-689, eff. 6-14-12.)
 
10    (305 ILCS 5/5-16.7a)
11    Sec. 5-16.7a. Reimbursement for epidural anesthesia
12services. In addition to other procedures authorized by the
13Department under this Code, the Department shall provide
14reimbursement to medical providers for epidural anesthesia
15services when ordered by the attending practitioner at the time
16of delivery.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate of
20reimbursement for services or other payments in accordance with
21Section 5-5e.
22(Source: P.A. 97-689, eff. 6-14-12.)
 
23    (305 ILCS 5/5-16.8)
24    Sec. 5-16.8. Required health benefits. The medical

 

 

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1assistance program shall (i) provide the post-mastectomy care
2benefits required to be covered by a policy of accident and
3health insurance under Section 356t and the coverage required
4under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the
5Illinois Insurance Code and (ii) be subject to the provisions
6of Sections 356z.19 and 364.01 of the Illinois Insurance Code.
7    On and after July 1, 2012, the Department shall reduce any
8rate of reimbursement for services or other payments or alter
9any methodologies authorized by this Code to reduce any rate of
10reimbursement for services or other payments in accordance with
11Section 5-5e.
12(Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)
 
13    (305 ILCS 5/5-16.9)
14    Sec. 5-16.9. Woman's health care provider. The medical
15assistance program is subject to the provisions of Section 356r
16of the Illinois Insurance Code. The Illinois Department shall
17adopt rules to implement the requirements of Section 356r of
18the Illinois Insurance Code in the medical assistance program
19including managed care components.
20    On and after July 1, 2012, the Department shall reduce any
21rate of reimbursement for services or other payments or alter
22any methodologies authorized by this Code to reduce any rate of
23reimbursement for services or other payments in accordance with
24Section 5-5e.
25(Source: P.A. 97-689, eff. 6-14-12.)
 

 

 

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1    (305 ILCS 5/5-17)  (from Ch. 23, par. 5-17)
2    Sec. 5-17. Programs to improve access to hospital care.
3    (a) (1) The General Assembly finds:
4            (A) That while hospitals have traditionally
5        provided charitable care to indigent patients, this
6        burden is not equally borne by all hospitals operating
7        in this State. Some hospitals continue to provide
8        significant amounts of care to low-income persons
9        while others provide very little such care; and
10            (B) That access to hospital care in this State by
11        the indigent citizens of Illinois would be seriously
12        impaired by the closing of hospitals that provide
13        significant amounts of care to low-income persons.
14        (2) To help expand the availability of hospital care
15    for all citizens of this State, it is the policy of the
16    State to implement programs that more equitably distribute
17    the burden of providing hospital care to Illinois'
18    low-income population and that improve access to health
19    care in Illinois.
20        (3) The Illinois Department may develop and implement a
21    program that lessens the burden of providing hospital care
22    to Illinois' low-income population, taking into account
23    the costs that must be incurred by hospitals providing
24    significant amounts of care to low-income persons, and may
25    develop adjustments to increase rates to improve access to

 

 

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1    health care in Illinois. The Illinois Department shall
2    prescribe by rule the criteria, standards and procedures
3    for effecting such adjustments in the rates of hospital
4    payments for services provided to eligible low-income
5    persons (under Articles V, VI and VII of this Code) under
6    this Article.
7    (b) The Illinois Department shall require hospitals
8certified to participate in the federal Medicaid program to:
9        (1) provide equal access to available services to
10    low-income persons who are eligible for assistance under
11    Articles V, VI and VII of this Code;
12        (2) provide data and reports on the provision of
13    uncompensated care.
14    (c) From the effective date of this amendatory Act of 1992
15until July 1, 1992, nothing in this Section 5-17 shall be
16construed as creating a private right of action on behalf of
17any individual.
18    (d) (Blank). On and after July 1, 2012, the Department
19shall reduce any rate of reimbursement for services or other
20payments or alter any methodologies authorized by this Code to
21reduce any rate of reimbursement for services or other payments
22in accordance with Section 5-5e.
23(Source: P.A. 97-689, eff. 6-14-12.)
 
24    (305 ILCS 5/5-19)  (from Ch. 23, par. 5-19)
25    Sec. 5-19. Healthy Kids Program.

 

 

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1    (a) Any child under the age of 21 eligible to receive
2Medical Assistance from the Illinois Department under Article V
3of this Code shall be eligible for Early and Periodic
4Screening, Diagnosis and Treatment services provided by the
5Healthy Kids Program of the Illinois Department under the
6Social Security Act, 42 U.S.C. 1396d(r).
7    (b) Enrollment of Children in Medicaid. The Illinois
8Department shall provide for receipt and initial processing of
9applications for Medical Assistance for all pregnant women and
10children under the age of 21 at locations in addition to those
11used for processing applications for cash assistance,
12including disproportionate share hospitals, federally
13qualified health centers and other sites as selected by the
14Illinois Department.
15    (c) Healthy Kids Examinations. The Illinois Department
16shall consider any examination of a child eligible for the
17Healthy Kids services provided by a medical provider meeting
18the requirements and complying with the rules and regulations
19of the Illinois Department to be reimbursed as a Healthy Kids
20examination.
21    (d) Medical Screening Examinations.
22        (1) The Illinois Department shall insure Medicaid
23    coverage for periodic health, vision, hearing, and dental
24    screenings for children eligible for Healthy Kids services
25    scheduled from a child's birth up until the child turns 21
26    years. The Illinois Department shall pay for vision,

 

 

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1    hearing, dental and health screening examinations for any
2    child eligible for Healthy Kids services by qualified
3    providers at intervals established by Department rules.
4        (2) The Illinois Department shall pay for an
5    interperiodic health, vision, hearing, or dental screening
6    examination for any child eligible for Healthy Kids
7    services whenever an examination is:
8            (A) requested by a child's parent, guardian, or
9        custodian, or is determined to be necessary or
10        appropriate by social services, developmental, health,
11        or educational personnel; or
12            (B) necessary for enrollment in school; or
13            (C) necessary for enrollment in a licensed day care
14        program, including Head Start; or
15            (D) necessary for placement in a licensed child
16        welfare facility, including a foster home, group home
17        or child care institution; or
18            (E) necessary for attendance at a camping program;
19        or
20            (F) necessary for participation in an organized
21        athletic program; or
22            (G) necessary for enrollment in an early childhood
23        education program recognized by the Illinois State
24        Board of Education; or
25            (H) necessary for participation in a Women,
26        Infant, and Children (WIC) program; or

 

 

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1            (I) deemed appropriate by the Illinois Department.
2    (e) Minimum Screening Protocols For Periodic Health
3Screening Examinations. Health Screening Examinations must
4include the following services:
5        (1) Comprehensive Health and Development Assessment
6    including:
7            (A) Development/Mental Health/Psychosocial
8        Assessment; and
9            (B) Assessment of nutritional status including
10        tests for iron deficiency and anemia for children at
11        the following ages: 9 months, 2 years, 8 years, and 18
12        years;
13        (2) Comprehensive unclothed physical exam;
14        (3) Appropriate immunizations at a minimum, as
15    required by the Secretary of the U.S. Department of Health
16    and Human Services under 42 U.S.C. 1396d(r).
17        (4) Appropriate laboratory tests including blood lead
18    levels appropriate for age and risk factors.
19            (A) Anemia test.
20            (B) Sickle cell test.
21            (C) Tuberculin test at 12 months of age and every
22        1-2 years thereafter unless the treating health care
23        professional determines that testing is medically
24        contraindicated.
25            (D) Other -- The Illinois Department shall insure
26        that testing for HIV, drug exposure, and sexually

 

 

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1        transmitted diseases is provided for as clinically
2        indicated.
3        (5) Health Education. The Illinois Department shall
4    require providers to provide anticipatory guidance as
5    recommended by the American Academy of Pediatrics.
6        (6) Vision Screening. The Illinois Department shall
7    require providers to provide vision screenings consistent
8    with those set forth in the Department of Public Health's
9    Administrative Rules.
10        (7) Hearing Screening. The Illinois Department shall
11    require providers to provide hearing screenings consistent
12    with those set forth in the Department of Public Health's
13    Administrative Rules.
14        (8) Dental Screening. The Illinois Department shall
15    require providers to provide dental screenings consistent
16    with those set forth in the Department of Public Health's
17    Administrative Rules.
18    (f) Covered Medical Services. The Illinois Department
19shall provide coverage for all necessary health care,
20diagnostic services, treatment and other measures to correct or
21ameliorate defects, physical and mental illnesses, and
22conditions whether discovered by the screening services or not
23for all children eligible for Medical Assistance under Article
24V of this Code.
25    (g) Notice of Healthy Kids Services.
26        (1) The Illinois Department shall inform any child

 

 

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1    eligible for Healthy Kids services and the child's family
2    about the benefits provided under the Healthy Kids Program,
3    including, but not limited to, the following: what services
4    are available under Healthy Kids, including discussion of
5    the periodicity schedules and immunization schedules, that
6    services are provided at no cost to eligible children, the
7    benefits of preventive health care, where the services are
8    available, how to obtain them, and that necessary
9    transportation and scheduling assistance is available.
10        (2) The Illinois Department shall widely disseminate
11    information regarding the availability of the Healthy Kids
12    Program throughout the State by outreach activities which
13    shall include, but not be limited to, (i) the development
14    of cooperation agreements with local school districts,
15    public health agencies, clinics, hospitals and other
16    health care providers, including developmental disability
17    and mental health providers, and with charities, to notify
18    the constituents of each of the Program and assist
19    individuals, as feasible, with applying for the Program,
20    (ii) using the media for public service announcements and
21    advertisements of the Program, and (iii) developing
22    posters advertising the Program for display in hospital and
23    clinic waiting rooms.
24        (3) The Illinois Department shall utilize accepted
25    methods for informing persons who are illiterate, blind,
26    deaf, or cannot understand the English language, including

 

 

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1    but not limited to public services announcements and
2    advertisements in the foreign language media of radio,
3    television and newspapers.
4        (4) The Illinois Department shall provide notice of the
5    Healthy Kids Program to every child eligible for Healthy
6    Kids services and his or her family at the following times:
7            (A) orally by the intake worker and in writing at
8        the time of application for Medical Assistance;
9            (B) at the time the applicant is informed that he
10        or she is eligible for Medical Assistance benefits; and
11            (C) at least 20 days before the date of any
12        periodic health, vision, hearing, and dental
13        examination for any child eligible for Healthy Kids
14        services. Notice given under this subparagraph (C)
15        must state that a screening examination is due under
16        the periodicity schedules and must advise the eligible
17        child and his or her family that the Illinois
18        Department will provide assistance in scheduling an
19        appointment and arranging medical transportation.
20    (h) Data Collection. The Illinois Department shall collect
21data in a usable form to track utilization of Healthy Kids
22screening examinations by children eligible for Healthy Kids
23services, including but not limited to data showing screening
24examinations and immunizations received, a summary of
25follow-up treatment received by children eligible for Healthy
26Kids services and the number of children receiving dental,

 

 

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1hearing and vision services.
2    (i) (Blank). On and after July 1, 2012, the Department
3shall reduce any rate of reimbursement for services or other
4payments or alter any methodologies authorized by this Code to
5reduce any rate of reimbursement for services or other payments
6in accordance with Section 5-5e.
7(Source: P.A. 97-689, eff. 6-14-12.)
 
8    (305 ILCS 5/5-24)
9    (Section scheduled to be repealed on January 1, 2014)
10    Sec. 5-24. Disease management programs and services for
11chronic conditions; pilot project.
12    (a) In this Section, "disease management programs and
13services" means services administered to patients in order to
14improve their overall health and to prevent clinical
15exacerbations and complications, using cost-effective,
16evidence-based practice guidelines and patient self-management
17strategies. Disease management programs and services include
18all of the following:
19        (1) A population identification process.
20        (2) Evidence-based or consensus-based clinical
21    practice guidelines, risk identification, and matching of
22    interventions with clinical need.
23        (3) Patient self-management and disease education.
24        (4) Process and outcomes measurement, evaluation,
25    management, and reporting.

 

 

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1    (b) Subject to appropriations, the Department of
2Healthcare and Family Services may undertake a pilot project to
3study patient outcomes, for patients with chronic diseases or
4patients at risk of low birth weight or premature birth,
5associated with the use of disease management programs and
6services for chronic condition management. "Chronic diseases"
7include, but are not limited to, diabetes, congestive heart
8failure, and chronic obstructive pulmonary disease. Low birth
9weight and premature birth include all medical and other
10conditions that lead to poor birth outcomes or problematic
11pregnancies.
12    (c) The disease management programs and services pilot
13project shall examine whether chronic disease management
14programs and services for patients with specific chronic
15conditions do any or all of the following:
16        (1) Improve the patient's overall health in a more
17    expeditious manner.
18        (2) Lower costs in other aspects of the medical
19    assistance program, such as hospital admissions, days in
20    skilled nursing homes, emergency room visits, or more
21    frequent physician office visits.
22    (d) In carrying out the pilot project, the Department of
23Healthcare and Family Services shall examine all relevant
24scientific literature and shall consult with health care
25practitioners including, but not limited to, physicians,
26surgeons, registered pharmacists, and registered nurses.

 

 

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1    (e) The Department of Healthcare and Family Services shall
2consult with medical experts, disease advocacy groups, and
3academic institutions to develop criteria to be used in
4selecting a vendor for the pilot project.
5    (f) The Department of Healthcare and Family Services may
6adopt rules to implement this Section.
7    (g) This Section is repealed 10 years after the effective
8date of this amendatory Act of the 93rd General Assembly.
9    (h) (Blank). On and after July 1, 2012, the Department
10shall reduce any rate of reimbursement for services or other
11payments or alter any methodologies authorized by this Code to
12reduce any rate of reimbursement for services or other payments
13in accordance with Section 5-5e.
14(Source: P.A. 96-799, eff. 10-28-09; 97-689, eff. 6-14-12.)
 
15    (305 ILCS 5/5-30)
16    Sec. 5-30. Care coordination.
17    (a) At least 50% of recipients eligible for comprehensive
18medical benefits in all medical assistance programs or other
19health benefit programs administered by the Department,
20including the Children's Health Insurance Program Act and the
21Covering ALL KIDS Health Insurance Act, shall be enrolled in a
22care coordination program by no later than January 1, 2015. For
23purposes of this Section, "coordinated care" or "care
24coordination" means delivery systems where recipients will
25receive their care from providers who participate under

 

 

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1contract in integrated delivery systems that are responsible
2for providing or arranging the majority of care, including
3primary care physician services, referrals from primary care
4physicians, diagnostic and treatment services, behavioral
5health services, in-patient and outpatient hospital services,
6dental services, and rehabilitation and long-term care
7services. The Department shall designate or contract for such
8integrated delivery systems (i) to ensure enrollees have a
9choice of systems and of primary care providers within such
10systems; (ii) to ensure that enrollees receive quality care in
11a culturally and linguistically appropriate manner; and (iii)
12to ensure that coordinated care programs meet the diverse needs
13of enrollees with developmental, mental health, physical, and
14age-related disabilities.
15    (b) Payment for such coordinated care shall be based on
16arrangements where the State pays for performance related to
17health care outcomes, the use of evidence-based practices, the
18use of primary care delivered through comprehensive medical
19homes, the use of electronic medical records, and the
20appropriate exchange of health information electronically made
21either on a capitated basis in which a fixed monthly premium
22per recipient is paid and full financial risk is assumed for
23the delivery of services, or through other risk-based payment
24arrangements.
25    (c) To qualify for compliance with this Section, the 50%
26goal shall be achieved by enrolling medical assistance

 

 

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1enrollees from each medical assistance enrollment category,
2including parents, children, seniors, and people with
3disabilities to the extent that current State Medicaid payment
4laws would not limit federal matching funds for recipients in
5care coordination programs. In addition, services must be more
6comprehensively defined and more risk shall be assumed than in
7the Department's primary care case management program as of the
8effective date of this amendatory Act of the 96th General
9Assembly.
10    (d) The Department shall report to the General Assembly in
11a separate part of its annual medical assistance program
12report, beginning April, 2012 until April, 2016, on the
13progress and implementation of the care coordination program
14initiatives established by the provisions of this amendatory
15Act of the 96th General Assembly. The Department shall include
16in its April 2011 report a full analysis of federal laws or
17regulations regarding upper payment limitations to providers
18and the necessary revisions or adjustments in rate
19methodologies and payments to providers under this Code that
20would be necessary to implement coordinated care with full
21financial risk by a party other than the Department.
22    (e) (Blank). Integrated Care Program for individuals with
23chronic mental health conditions.
24        (1) The Integrated Care Program shall encompass
25    services administered to recipients of medical assistance
26    under this Article to prevent exacerbations and

 

 

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1    complications using cost-effective, evidence-based
2    practice guidelines and mental health management
3    strategies.
4        (2) The Department may utilize and expand upon existing
5    contractual arrangements with integrated care plans under
6    the Integrated Care Program for providing the coordinated
7    care provisions of this Section.
8        (3) Payment for such coordinated care shall be based on
9    arrangements where the State pays for performance related
10    to mental health outcomes on a capitated basis in which a
11    fixed monthly premium per recipient is paid and full
12    financial risk is assumed for the delivery of services, or
13    through other risk-based payment arrangements such as
14    provider-based care coordination.
15        (4) The Department shall examine whether chronic
16    mental health management programs and services for
17    recipients with specific chronic mental health conditions
18    do any or all of the following:
19            (A) Improve the patient's overall mental health in
20        a more expeditious and cost-effective manner.
21            (B) Lower costs in other aspects of the medical
22        assistance program, such as hospital admissions,
23        emergency room visits, or more frequent and
24        inappropriate psychotropic drug use.
25        (5) The Department shall work with the facilities and
26    any integrated care plan participating in the program to

 

 

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1    identify and correct barriers to the successful
2    implementation of this subsection (e) prior to and during
3    the implementation to best facilitate the goals and
4    objectives of this subsection (e).
5    (f) (Blank). A hospital that is located in a county of the
6State in which the Department mandates some or all of the
7beneficiaries of the Medical Assistance Program residing in the
8county to enroll in a Care Coordination Program, as set forth
9in Section 5-30 of this Code, shall not be eligible for any
10non-claims based payments not mandated by Article V-A of this
11Code for which it would otherwise be qualified to receive,
12unless the hospital is a Coordinated Care Participating
13Hospital no later than 60 days after the effective date of this
14amendatory Act of the 97th General Assembly or 60 days after
15the first mandatory enrollment of a beneficiary in a
16Coordinated Care program. For purposes of this subsection,
17"Coordinated Care Participating Hospital" means a hospital
18that meets one of the following criteria:
19        (1) The hospital has entered into a contract to provide
20    hospital services to enrollees of the care coordination
21    program.
22        (2) The hospital has not been offered a contract by a
23    care coordination plan that pays at least as much as the
24    Department would pay, on a fee-for-service basis, not
25    including disproportionate share hospital adjustment
26    payments or any other supplemental adjustment or add-on

 

 

HB0027- 234 -LRB098 00027 KTG 30027 b

1    payment to the base fee-for-service rate.
2(Source: P.A. 96-1501, eff. 1-25-11; 97-689, eff. 6-14-12.)
 
3    (305 ILCS 5/5A-1)  (from Ch. 23, par. 5A-1)
4    Sec. 5A-1. Definitions. As used in this Article, unless
5the context requires otherwise:
6    "Adjusted gross hospital revenue" shall be determined
7separately for inpatient and outpatient services for each
8hospital conducted, operated or maintained by a hospital
9provider, and means the hospital provider's total gross
10revenues less: (i) gross revenue attributable to non-hospital
11based services including home dialysis services, durable
12medical equipment, ambulance services, outpatient clinics and
13any other non-hospital based services as determined by the
14Illinois Department by rule; and (ii) gross revenues
15attributable to the routine services provided to persons
16receiving skilled or intermediate long-term care services
17within the meaning of Title XVIII or XIX of the Social Security
18Act; and (iii) Medicare gross revenue (excluding the Medicare
19gross revenue attributable to clauses (i) and (ii) of this
20paragraph and the Medicare gross revenue attributable to the
21routine services provided to patients in a psychiatric
22hospital, a rehabilitation hospital, a distinct part
23psychiatric unit, a distinct part rehabilitation unit, or swing
24beds). Adjusted gross hospital revenue shall be determined
25using the most recent data available from each hospital's 2003

 

 

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1Medicare cost report as contained in the Healthcare Cost Report
2Information System file, for the quarter ending on December 31,
32004, without regard to any subsequent adjustments or changes
4to such data. If a hospital's 2003 Medicare cost report is not
5contained in the Healthcare Cost Report Information System, the
6hospital provider shall furnish such cost report or the data
7necessary to determine its adjusted gross hospital revenue as
8required by rule by the Illinois Department.
9    "Fund" means the Hospital Provider Fund.
10    "Hospital" means an institution, place, building, or
11agency located in this State that is subject to licensure by
12the Illinois Department of Public Health under the Hospital
13Licensing Act, whether public or private and whether organized
14for profit or not-for-profit.
15    "Hospital provider" means a person licensed by the
16Department of Public Health to conduct, operate, or maintain a
17hospital, regardless of whether the person is a Medicaid
18provider. For purposes of this paragraph, "person" means any
19political subdivision of the State, municipal corporation,
20individual, firm, partnership, corporation, company, limited
21liability company, association, joint stock association, or
22trust, or a receiver, executor, trustee, guardian, or other
23representative appointed by order of any court.
24    "Medicare bed days" means, for each hospital, the sum of
25the number of days that each bed was occupied by a patient who
26was covered by Title XVIII of the Social Security Act,

 

 

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1excluding days attributable to the routine services provided to
2persons receiving skilled or intermediate long term care
3services. Medicare bed days shall be computed separately for
4each hospital operated or maintained by a hospital provider.
5    "Occupied bed days" means the sum of the number of days
6that each bed was occupied by a patient for all beds, excluding
7days attributable to the routine services provided to persons
8receiving skilled or intermediate long term care services.
9Occupied bed days shall be computed separately for each
10hospital operated or maintained by a hospital provider.
11    "Outpatient gross revenue" means, for each hospital, its
12total gross charges attributed to outpatient services as
13reported on the Medicare cost report at Worksheet C, Part I,
14Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65,
1566, 67, and 68 (and any subsets of those lines).
16    "Proration factor" means a fraction, the numerator of which
17is 53 and the denominator of which is 365.
18(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
 
19    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
20    (Section scheduled to be repealed on January 1, 2015)
21    Sec. 5A-2. Assessment.
22    (a) (Blank).
23    Subject to Sections 5A-3 and 5A-10, for State fiscal years
242009 through 2014, and from July 1, 2014 through December 31,
252014, an annual assessment on inpatient services is imposed on

 

 

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1each hospital provider in an amount equal to $218.38 multiplied
2by the difference of the hospital's occupied bed days less the
3hospital's Medicare bed days.
4    For State fiscal years 2009 through 2014, and after a
5hospital's occupied bed days and Medicare bed days shall be
6determined using the most recent data available from each
7hospital's 2005 Medicare cost report as contained in the
8Healthcare Cost Report Information System file, for the quarter
9ending on December 31, 2006, without regard to any subsequent
10adjustments or changes to such data. If a hospital's 2005
11Medicare cost report is not contained in the Healthcare Cost
12Report Information System, then the Illinois Department may
13obtain the hospital provider's occupied bed days and Medicare
14bed days from any source available, including, but not limited
15to, records maintained by the hospital provider, which may be
16inspected at all times during business hours of the day by the
17Illinois Department or its duly authorized agents and
18employees.
19    (b) (Blank).
20    (b-5) Subject to Sections 5A-3 and 5A-10, for State fiscal
21years 2013 through 2014, and July 1, 2014 through December 31,
222014, an annual assessment on outpatient services is imposed on
23each hospital provider in an amount equal to .008766 multiplied
24by the hospital's outpatient gross revenue.
25    For State fiscal years 2013 through 2014, and July 1, 2014
26through December 31, 2014, a hospital's outpatient gross

 

 

HB0027- 238 -LRB098 00027 KTG 30027 b

1revenue shall be determined using the most recent data
2available from each hospital's 2009 Medicare cost report as
3contained in the Healthcare Cost Report Information System
4file, for the quarter ending on June 30, 2011, without regard
5to any subsequent adjustments or changes to such data. If a
6hospital's 2009 Medicare cost report is not contained in the
7Healthcare Cost Report Information System, then the Department
8may obtain the hospital provider's outpatient gross revenue
9from any source available, including, but not limited to,
10records maintained by the hospital provider, which may be
11inspected at all times during business hours of the day by the
12Department or its duly authorized agents and employees.
13    (c) (Blank).
14    (d) Notwithstanding any of the other provisions of this
15Section, the Department is authorized, during this 98th General
16Assembly, to adopt rules to reduce the rate of any annual
17assessment imposed under this Section, as authorized by Section
185-46.2 of the Illinois Administrative Procedure Act.
19    (e) Notwithstanding any other provision of this Section,
20any plan providing for an assessment on a hospital provider as
21a permissible tax under Title XIX of the federal Social
22Security Act and Medicaid-eligible payments to hospital
23providers from the revenues derived from that assessment shall
24be reviewed by the Illinois Department of Healthcare and Family
25Services, as the Single State Medicaid Agency required by
26federal law, to determine whether those assessments and

 

 

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1hospital provider payments meet federal Medicaid standards. If
2the Department determines that the elements of the plan may
3meet federal Medicaid standards and a related State Medicaid
4Plan Amendment is prepared in a manner and form suitable for
5submission, that State Plan Amendment shall be submitted in a
6timely manner for review by the Centers for Medicare and
7Medicaid Services of the United States Department of Health and
8Human Services and subject to approval by the Centers for
9Medicare and Medicaid Services of the United States Department
10of Health and Human Services. No such plan shall become
11effective without approval by the Illinois General Assembly by
12the enactment into law of related legislation. Notwithstanding
13any other provision of this Section, the Department is
14authorized to adopt rules to reduce the rate of any annual
15assessment imposed under this Section. Any such rules may be
16adopted by the Department under Section 5-50 of the Illinois
17Administrative Procedure Act.
18(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
1997-689, eff. 6-14-12.)
 
20    (305 ILCS 5/5A-3)  (from Ch. 23, par. 5A-3)
21    Sec. 5A-3. Exemptions.
22    (a) (Blank).
23    (b) A hospital provider that is a State agency, a State
24university, or a county with a population of 3,000,000 or more
25is exempt from the assessment imposed by Section 5A-2.

 

 

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1    (b-2) A hospital provider that is a county with a
2population of less than 3,000,000 or a township, municipality,
3hospital district, or any other local governmental unit is
4exempt from the assessment imposed by Section 5A-2.
5    (b-5) (Blank).
6    (b-10) For State fiscal year 2014, a hospital provider,
7described in Section 1903(w)(3)(F) of the Social Security Act,
8whose hospital does not charge for its services is exempt from
9the assessment imposed by Section 5A-2, unless the exemption is
10adjudged to be unconstitutional or otherwise invalid, in which
11case the hospital provider shall pay the assessment imposed by
12Section 5A-2. (Blank).
13    (b-15) (Blank).
14    (b-20) (Blank).
15    (b-25) (Blank).
16    (c) (Blank).
17(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
 
18    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
19    Sec. 5A-4. Payment of assessment; penalty.
20    (a) Except as provided in subsection (a-5) of this Section,
21the The assessment imposed by Section 5A-2 for State fiscal
22year 2009 and each subsequent State fiscal year shall be due
23and payable in monthly installments, each equaling one-twelfth
24of the assessment for the year, on the fourteenth State
25business day of each month. No installment payment of an

 

 

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1assessment imposed by Section 5A-2 shall be due and payable,
2however, until after : (i) the Department notifies the hospital
3provider, in writing, that the payment methodologies to
4hospitals required under Section 5A-12, Section 5A-12.1, or
5Section 5A-12.2, whichever is applicable for that fiscal year,
6have been approved by the Centers for Medicare and Medicaid
7Services of the U.S. Department of Health and Human Services
8and the waiver under 42 CFR 433.68 for the assessment imposed
9by Section 5A-2, if necessary, has been granted by the Centers
10for Medicare and Medicaid Services of the U.S. Department of
11Health and Human Services; and (ii) the Comptroller has issued
12the payments required under Section 5A-12, Section 5A-12.1, or
13Section 5A-12.2, whichever is applicable for that fiscal year.
14Upon notification to the Department of approval of the payment
15methodologies required under Section 5A-12, Section 5A-12.1,
16or Section 5A-12.2, whichever is applicable for that fiscal
17year, and the waiver granted under 42 CFR 433.68, all
18installments otherwise due under Section 5A-2 prior to the date
19of notification shall be due and payable to the Department upon
20written direction from the Department and issuance by the
21Comptroller of the payments required under Section 5A-12.1 or
22Section 5A-12.2, whichever is applicable for that fiscal year.
23the Comptroller has issued the payments required under this
24Article.
25    Except as provided in subsection (a-5) of this Section, the
26assessment imposed by subsection (b-5) of Section 5A-2 for

 

 

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1State fiscal year 2013 and each subsequent State fiscal year
2shall be due and payable in monthly installments, each equaling
3one-twelfth of the assessment for the year, on the 14th State
4business day of each month. No installment payment of an
5assessment imposed by subsection (b-5) of Section 5A-2 shall be
6due and payable, however, until after: (i) the Department
7notifies the hospital provider, in writing, that the payment
8methodologies to hospitals required under Section 5A-12.4,
9have been approved by the Centers for Medicare and Medicaid
10Services of the U.S. Department of Health and Human Services,
11and the waiver under 42 CFR 433.68 for the assessment imposed
12by subsection (b-5) of Section 5A-2, if necessary, has been
13granted by the Centers for Medicare and Medicaid Services of
14the U.S. Department of Health and Human Services; and (ii) the
15Comptroller has issued the payments required under Section
165A-12.4. Upon notification to the Department of approval of the
17payment methodologies required under Section 5A-12.4 and the
18waiver granted under 42 CFR 433.68, if necessary, all
19installments otherwise due under subsection (b-5) of Section
205A-2 prior to the date of notification shall be due and payable
21to the Department upon written direction from the Department
22and issuance by the Comptroller of the payments required under
23Section 5A-12.4.
24    (a-5) The Illinois Department may accelerate the schedule
25upon which assessment installments are due and payable by
26hospitals with a payment ratio greater than or equal to one.

 

 

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1Such acceleration of due dates for payment of the assessment
2may be made only in conjunction with a corresponding
3acceleration in access payments identified in Section 5A-12.2
4or Section 5A-12.4 to the same hospitals. For the purposes of
5this subsection (a-5), a hospital's payment ratio is defined as
6the quotient obtained by dividing the total payments for the
7State fiscal year, as authorized under Section 5A-12.2 or
8Section 5A-12.4, by the total assessment for the State fiscal
9year imposed under Section 5A-2 or subsection (b-5) of Section
105A-2.
11    (b) The Illinois Department is authorized to establish
12delayed payment schedules for hospital providers that are
13unable to make installment payments when due under this Section
14due to financial difficulties, as determined by the Illinois
15Department.
16    (c) If a hospital provider fails to pay the full amount of
17an installment when due (including any extensions granted under
18subsection (b)), there shall, unless waived by the Illinois
19Department for reasonable cause, be added to the assessment
20imposed by Section 5A-2 a penalty assessment equal to the
21lesser of (i) 5% of the amount of the installment not paid on
22or before the due date plus 5% of the portion thereof remaining
23unpaid on the last day of each 30-day period thereafter or (ii)
24100% of the installment amount not paid on or before the due
25date. For purposes of this subsection, payments will be
26credited first to unpaid installment amounts (rather than to

 

 

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1penalty or interest), beginning with the most delinquent
2installments.
3    (d) Any assessment amount that is due and payable to the
4Illinois Department more frequently than once per calendar
5quarter shall be remitted to the Illinois Department by the
6hospital provider by means of electronic funds transfer. The
7Illinois Department may provide for remittance by other means
8if (i) the amount due is less than $10,000 or (ii) electronic
9funds transfer is unavailable for this purpose.
10(Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12;
1197-689, eff. 6-14-12.)
 
12    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
13    Sec. 5A-5. Notice; penalty; maintenance of records.
14    (a) The Department of Healthcare and Family Services
15Illinois Department shall send a notice of assessment to every
16hospital provider subject to assessment under this Article. The
17notice of assessment shall notify the hospital of its
18assessment and shall be sent after receipt by the Department of
19notification from the Centers for Medicare and Medicaid
20Services of the U.S. Department of Health and Human Services
21that the payment methodologies required under Section 5A-12,
22Section 5A-12.1, or Section 5A-12.2, whichever is applicable
23for that fiscal year this Article and, if necessary, the waiver
24granted under 42 CFR 433.68 have been approved. The notice
25shall be on a form prepared by the Illinois Department and

 

 

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1shall state the following:
2        (1) The name of the hospital provider.
3        (2) The address of the hospital provider's principal
4    place of business from which the provider engages in the
5    occupation of hospital provider in this State, and the name
6    and address of each hospital operated, conducted, or
7    maintained by the provider in this State.
8        (3) The occupied bed days, occupied bed days less
9    Medicare days, adjusted gross hospital revenue, or
10    outpatient gross revenue of the hospital provider
11    (whichever is applicable), the amount of assessment
12    imposed under Section 5A-2 for the State fiscal year for
13    which the notice is sent, and the amount of each
14    installment to be paid during the State fiscal year.
15        (4) (Blank).
16        (5) Other reasonable information as determined by the
17    Illinois Department.
18    (b) If a hospital provider conducts, operates, or maintains
19more than one hospital licensed by the Illinois Department of
20Public Health, the provider shall pay the assessment for each
21hospital separately.
22    (c) Notwithstanding any other provision in this Article, in
23the case of a person who ceases to conduct, operate, or
24maintain a hospital in respect of which the person is subject
25to assessment under this Article as a hospital provider, the
26assessment for the State fiscal year in which the cessation

 

 

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1occurs shall be adjusted by multiplying the assessment computed
2under Section 5A-2 by a fraction, the numerator of which is the
3number of days in the year during which the provider conducts,
4operates, or maintains the hospital and the denominator of
5which is 365. Immediately upon ceasing to conduct, operate, or
6maintain a hospital, the person shall pay the assessment for
7the year as so adjusted (to the extent not previously paid).
8    (d) Notwithstanding any other provision in this Article, a
9provider who commences conducting, operating, or maintaining a
10hospital, upon notice by the Illinois Department, shall pay the
11assessment computed under Section 5A-2 and subsection (e) in
12installments on the due dates stated in the notice and on the
13regular installment due dates for the State fiscal year
14occurring after the due dates of the initial notice.
15    (e) Notwithstanding any other provision in this Article,
16for State fiscal years 2009 through 2014 2015, in the case of a
17hospital provider that did not conduct, operate, or maintain a
18hospital in 2005, the assessment for that State fiscal year
19shall be computed on the basis of hypothetical occupied bed
20days for the full calendar year as determined by the Illinois
21Department. Notwithstanding any other provision in this
22Article, for State fiscal years 2013 through 2014, and for July
231, 2014 through December 31, 2014, in the case of a hospital
24provider that did not conduct, operate, or maintain a hospital
25in 2009, the assessment under subsection (b-5) of Section 5A-2
26for that State fiscal year shall be computed on the basis of

 

 

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1hypothetical gross outpatient revenue for the full calendar
2year as determined by the Illinois Department.
3    (f) Every hospital provider subject to assessment under
4this Article shall keep sufficient records to permit the
5determination of adjusted gross hospital revenue for the
6hospital's fiscal year. All such records shall be kept in the
7English language and shall, at all times during regular
8business hours of the day, be subject to inspection by the
9Illinois Department or its duly authorized agents and
10employees.
11    (g) The Illinois Department may, by rule, provide a
12hospital provider a reasonable opportunity to request a
13clarification or correction of any clerical or computational
14errors contained in the calculation of its assessment, but such
15corrections shall not extend to updating the cost report
16information used to calculate the assessment.
17    (h) (Blank).
18(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
1997-689, eff. 6-14-12; revised 10-17-12.)
 
20    (305 ILCS 5/5A-6)  (from Ch. 23, par. 5A-6)
21    Sec. 5A-6. Disposition of proceeds. The Illinois
22Department shall pay deposit all moneys received from hospital
23providers under this Article into the Hospital Provider Fund.
24Upon certification by the Illinois Department to the State
25Comptroller of its intent to withhold payments from a provider

 

 

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1under pursuant to Section 5A-7(b), the State Comptroller shall
2draw a warrant on the treasury or other fund held by the State
3Treasurer, as appropriate. The warrant shall state the amount
4for which the provider is entitled to a warrant, the amount of
5the deduction, and the reason therefor and shall direct the
6State Treasurer to pay the balance to the provider, all in
7accordance with Section 10.05 of the State Comptroller Act. The
8warrant also shall direct the State Treasurer to transfer the
9amount of the deduction so ordered from the treasury or other
10fund into the Hospital Provider Fund.
11(Source: P.A. 97-689, eff. 6-14-12.)
 
12    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
13    Sec. 5A-8. Hospital Provider Fund.
14    (a) There is created in the State Treasury the Hospital
15Provider Fund. Interest earned by the Fund shall be credited to
16the Fund. The Fund shall not be used to replace any moneys
17appropriated to the Medicaid program by the General Assembly.
18    (b) The Fund is created for the purpose of receiving moneys
19in accordance with Section 5A-6 and disbursing moneys only for
20the following purposes, notwithstanding any other provision of
21law:
22        (1) For making payments to hospitals as required under
23    this Code, under the Children's Health Insurance Program
24    Act, under the Covering ALL KIDS Health Insurance Act, and
25    under the Long Term Acute Care Hospital Quality Improvement

 

 

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1    Transfer Program Act.
2        (2) For the reimbursement of moneys collected by the
3    Illinois Department from hospitals or hospital providers
4    through error or mistake in performing the activities
5    authorized under this Code.
6        (3) For payment of administrative expenses incurred by
7    the Illinois Department or its agent in performing
8    activities under this Code, under the Children's Health
9    Insurance Program Act, under the Covering ALL KIDS Health
10    Insurance Act, and under the Long Term Acute Care Hospital
11    Quality Improvement Transfer Program Act.
12        (4) For payments of any amounts which are reimbursable
13    to the federal government for payments from this Fund which
14    are required to be paid by State warrant.
15        (5) For making transfers, as those transfers are
16    authorized in the proceedings authorizing debt under the
17    Short Term Borrowing Act, but transfers made under this
18    paragraph (5) shall not exceed the principal amount of debt
19    issued in anticipation of the receipt by the State of
20    moneys to be deposited into the Fund.
21        (6) For making transfers to any other fund in the State
22    treasury, but transfers made under this paragraph (6) shall
23    not exceed the amount transferred previously from that
24    other fund into the Hospital Provider Fund plus any
25    interest that would have been earned by that fund on the
26    monies that had been transferred.

 

 

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1        (6.5) For making transfers to the Healthcare Provider
2    Relief Fund, except that transfers made under this
3    paragraph (6.5) shall not exceed $60,000,000 in the
4    aggregate.
5        (7) (Blank). For making transfers not exceeding the
6    following amounts, in State fiscal years 2013 and 2014 in
7    each State fiscal year during which an assessment is
8    imposed pursuant to Section 5A-2, to the following
9    designated funds:
10            Health and Human Services Medicaid Trust
11                Fund..............................$20,000,000
12            Long-Term Care Provider Fund..........$30,000,000
13            General Revenue Fund.................$80,000,000.
14    Transfers under this paragraph shall be made within 7 days
15    after the payments have been received pursuant to the
16    schedule of payments provided in subsection (a) of Section
17    5A-4.
18        (7.1) For making transfers not exceeding the following
19    amounts, in State fiscal year 2015, to the following
20    designated funds:
21            Health and Human Services Medicaid Trust
22                 Fund..............................$10,000,000
23            Long-Term Care Provider Fund..........$15,000,000
24            General Revenue Fund.................$40,000,000.
25    Transfers under this paragraph shall be made within 7 days
26    after the payments have been received pursuant to the

 

 

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1    schedule of payments provided in subsection (a) of Section
2    5A-4.
3        (7.5) (Blank).
4        (7.8) (Blank).
5        (7.9) For State fiscal year 2014, for making transfers
6    of the moneys received from hospital providers under
7    Section 5A-4 and transferred into the Hospital Provider
8    Fund under Section 5A-6 to the designated funds not
9    exceeding the following amounts in that State fiscal year:
10    (Blank).
11        Health and Human Services
12            Medicaid Trust Fund...................$20,000,000
13        Long Term Care Provider Fund..............$30,000,000
14        General Revenue Fund.....................$80,000,000.
15        Except as provided under this paragraph, transfers
16    under this paragraph shall be made within 7 business days
17    after the payments have been received pursuant to the
18    schedule of payments provided in subsection (a) of Section
19    5A-4.
20        (7.10) For State fiscal years 2013 and 2014, for making
21    transfers of the moneys resulting from the assessment under
22    subsection (b-5) of Section 5A-2 and received from hospital
23    providers under Section 5A-4 and transferred into the
24    Hospital Provider Fund under Section 5A-6 to the designated
25    funds not exceeding the following amounts in that State
26    fiscal year:

 

 

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1            Health Care Provider Relief Fund......$50,000,000
2        Transfers under this paragraph shall be made within 7
3    days after the payments have been received pursuant to the
4    schedule of payments provided in subsection (a) of Section
5    5A-4.
6        (7.11) For State fiscal year 2015, for making transfers
7    of the moneys resulting from the assessment under
8    subsection (b-5) of Section 5A-2 and received from hospital
9    providers under Section 5A-4 and transferred into the
10    Hospital Provider Fund under Section 5A-6 to the designated
11    funds not exceeding the following amounts in that State
12    fiscal year:
13            Health Care Provider Relief Fund.....$25,000,000
14        Transfers under this paragraph shall be made within 7
15    days after the payments have been received pursuant to the
16    schedule of payments provided in subsection (a) of Section
17    5A-4.
18        (8) For making refunds to hospital providers pursuant
19    to Section 5A-10.
20    Disbursements from the Fund, other than transfers
21authorized under paragraphs (5) and (6) of this subsection,
22shall be by warrants drawn by the State Comptroller upon
23receipt of vouchers duly executed and certified by the Illinois
24Department.
25    (c) The Fund shall consist of the following:
26        (1) All moneys collected or received by the Illinois

 

 

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1    Department from the hospital provider assessment imposed
2    by this Article.
3        (2) All federal matching funds received by the Illinois
4    Department as a result of expenditures made by the Illinois
5    Department that are attributable to moneys deposited in the
6    Fund.
7        (3) Any interest or penalty levied in conjunction with
8    the administration of this Article.
9        (4) Moneys transferred from another fund in the State
10    treasury.
11        (5) All other moneys received for the Fund from any
12    other source, including interest earned thereon.
13    (d) (Blank).
14(Source: P.A. 96-3, eff. 2-27-09; 96-45, eff. 7-15-09; 96-821,
15eff. 11-20-09; 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
1697-689, eff. 6-14-12; revised 10-17-12.)
 
17    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
18    Sec. 5A-10. Applicability.
19    (a) The assessment imposed by subsection (a) of Section
205A-2 shall not take effect or shall cease to be imposed and the
21Department's obligation to make payments shall immediately
22cease, and any moneys remaining in the Fund shall be refunded
23to hospital providers in proportion to the amounts paid by
24them, if:
25        (1) The annual appropriation for State fiscal year

 

 

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1    2014, from the General Revenue Fund combined with the
2    Hospital Provider Fund as authorized in Section 5A-8 for
3    hospital payments under the medical assistance program, is
4    less than the amount appropriated for State fiscal year
5    2009, adjusted annually to reflect any change in the number
6    of recipients, excluding State fiscal year 2009
7    supplemental appropriations made necessary by the
8    enactment of the American Recovery and Reinvestment Act of
9    2009. The payments to hospitals required under this Article
10    are not eligible for federal matching funds under Title XIX
11    or XXI of the Social Security Act;
12        (2.1) (2) For State fiscal years 2009 through 2014, and
13    July 1, 2014 through December 31, 2014, the Department of
14    Healthcare and Family Services adopts any administrative
15    rule change to reduce payment rates or alters any payment
16    methodology that reduces any payment rates made to
17    operating hospitals under the approved Title XIX or Title
18    XXI State plan in effect January 1, 2008 except for:
19            (A) any changes for hospitals described in
20        subsection (b) of Section 5A-3;
21            (B) any rates for payments made under this Article
22        V-A;
23            (C) any changes proposed in State plan amendment
24        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
25        08-07; or
26            (D) in relation to any admissions on or after

 

 

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1        January 1, 2011, a modification in the methodology for
2        calculating outlier payments to hospitals for
3        exceptionally costly stays, for hospitals reimbursed
4        under the diagnosis-related grouping methodology in
5        effect on July 1, 2011 January 1, 2011; provided that
6        the Department shall be limited to one such
7        modification during the 36-month period after the
8        effective date of this amendatory Act of the 96th
9        General Assembly; or
10            (E) (Blank). any changes affecting hospitals
11        authorized by this amendatory Act of the 97th General
12        Assembly.
13        (3) The payments to hospitals required under Section
14    5A-12 or Section 5A-12.2 are changed or are not eligible
15    for federal matching funds under Title XIX or XXI of the
16    Social Security Act.
17    (b) The assessment imposed by Section 5A-2 shall not take
18effect or shall cease to be imposed, and the Department's
19obligation to make payments shall immediately cease, if the
20assessment is determined to be an impermissible tax under Title
21XIX of the Social Security Act. Moneys in the Hospital Provider
22Fund derived from assessments imposed prior thereto shall be
23disbursed in accordance with Section 5A-8 to the extent federal
24financial participation is not reduced due to the
25impermissibility of the assessments, and any remaining moneys
26shall be refunded to hospital providers in proportion to the

 

 

HB0027- 256 -LRB098 00027 KTG 30027 b

1amounts paid by them.
2    (c) The assessments imposed by subsection (b-5) of Section
35A-2 shall not take effect or shall cease to be imposed, the
4Department's obligation to make payments shall immediately
5cease, and any moneys remaining in the Fund shall be refunded
6to hospital providers in proportion to the amounts paid by
7them, if the payments to hospitals required under Section
85A-12.4 are not eligible for federal matching funds under Title
9XIX of the Social Security Act.
10    (d) The assessments imposed by Section 5A-2 shall not take
11effect or shall cease to be imposed, the Department's
12obligation to make payments shall immediately cease, and any
13moneys remaining in the Fund shall be refunded to hospital
14providers in proportion to the amounts paid by them, if:
15        (1) for State fiscal years 2013 through 2014, and July
16    1, 2014 through December 31, 2014, the Department reduces
17    any payment rates to hospitals as in effect on May 1, 2012,
18    or alters any payment methodology as in effect on May 1,
19    2012, that has the effect of reducing payment rates to
20    hospitals, except for any changes affecting hospitals
21    authorized in Senate Bill 2840 of the 97th General Assembly
22    in the form in which it becomes law, and except for any
23    changes authorized under Section 5A-15; or
24        (2) for State fiscal years 2013 through 2014, and July
25    1, 2014 through December 31, 2014, the Department reduces
26    any supplemental payments made to hospitals below the

 

 

HB0027- 257 -LRB098 00027 KTG 30027 b

1    amounts paid for services provided in State fiscal year
2    2011 as implemented by administrative rules adopted and in
3    effect on or prior to June 30, 2011, except for any changes
4    affecting hospitals authorized in Senate Bill 2840 of the
5    97th General Assembly in the form in which it becomes law,
6    and except for any changes authorized under Section 5A-15.
7(Source: P.A. 96-8, eff. 4-28-09; 96-1530, eff. 2-16-11; 97-72,
8eff. 7-1-11; 97-74, eff. 6-30-11; 97-688, eff. 6-14-12; 97-689,
9eff. 6-14-12; revised 10-17-12.)
 
10    (305 ILCS 5/5A-12.2)
11    (Section scheduled to be repealed on January 1, 2015)
12    Sec. 5A-12.2. Hospital access payments on or after July 1,
132008.
14    (a) To preserve and improve access to hospital services,
15for hospital services rendered on or after July 1, 2008, the
16Illinois Department shall, except for hospitals described in
17subsection (b) of Section 5A-3, make payments to hospitals as
18set forth in this Section. These payments shall be paid in 12
19equal installments on or before the seventh State business day
20of each month, except that no payment shall be due within 100
21days after the later of the date of notification of federal
22approval of the payment methodologies required under this
23Section or any waiver required under 42 CFR 433.68, at which
24time the sum of amounts required under this Section prior to
25the date of notification is due and payable. Payments under

 

 

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1this Section are not due and payable, however, until (i) the
2methodologies described in this Section are approved by the
3federal government in an appropriate State Plan amendment and
4(ii) the assessment imposed under this Article is determined to
5be a permissible tax under Title XIX of the Social Security
6Act.
7    (a-5) The Illinois Department may, when practicable,
8accelerate the schedule upon which payments authorized under
9this Section are made.
10    (b) Across-the-board inpatient adjustment.
11        (1) In addition to rates paid for inpatient hospital
12    services, the Department shall pay to each Illinois general
13    acute care hospital an amount equal to 40% of the total
14    base inpatient payments paid to the hospital for services
15    provided in State fiscal year 2005.
16        (2) In addition to rates paid for inpatient hospital
17    services, the Department shall pay to each freestanding
18    Illinois specialty care hospital as defined in 89 Ill. Adm.
19    Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
20    the total base inpatient payments paid to the hospital for
21    services provided in State fiscal year 2005.
22        (3) In addition to rates paid for inpatient hospital
23    services, the Department shall pay to each freestanding
24    Illinois rehabilitation or psychiatric hospital an amount
25    equal to $1,000 per Medicaid inpatient day multiplied by
26    the increase in the hospital's Medicaid inpatient

 

 

HB0027- 259 -LRB098 00027 KTG 30027 b

1    utilization ratio (determined using the positive
2    percentage change from the rate year 2005 Medicaid
3    inpatient utilization ratio to the rate year 2007 Medicaid
4    inpatient utilization ratio, as calculated by the
5    Department for the disproportionate share determination).
6        (4) In addition to rates paid for inpatient hospital
7    services, the Department shall pay to each Illinois
8    children's hospital an amount equal to 20% of the total
9    base inpatient payments paid to the hospital for services
10    provided in State fiscal year 2005 and an additional amount
11    equal to 20% of the base inpatient payments paid to the
12    hospital for psychiatric services provided in State fiscal
13    year 2005.
14        (5) In addition to rates paid for inpatient hospital
15    services, the Department shall pay to each Illinois
16    hospital eligible for a pediatric inpatient adjustment
17    payment under 89 Ill. Adm. Code 148.298, as in effect for
18    State fiscal year 2007, a supplemental pediatric inpatient
19    adjustment payment equal to:
20            (i) For freestanding children's hospitals as
21        defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
22        multiplied by the hospital's pediatric inpatient
23        adjustment payment required under 89 Ill. Adm. Code
24        148.298, as in effect for State fiscal year 2008.
25            (ii) For hospitals other than freestanding
26        children's hospitals as defined in 89 Ill. Adm. Code

 

 

HB0027- 260 -LRB098 00027 KTG 30027 b

1        149.50(c)(3)(B), 1.0 multiplied by the hospital's
2        pediatric inpatient adjustment payment required under
3        89 Ill. Adm. Code 148.298, as in effect for State
4        fiscal year 2008.
5    (c) Outpatient adjustment.
6        (1) In addition to the rates paid for outpatient
7    hospital services, the Department shall pay each Illinois
8    hospital an amount equal to 2.2 multiplied by the
9    hospital's ambulatory procedure listing payments for
10    categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
11    148.140(b), for State fiscal year 2005.
12        (2) In addition to the rates paid for outpatient
13    hospital services, the Department shall pay each Illinois
14    freestanding psychiatric hospital an amount equal to 3.25
15    multiplied by the hospital's ambulatory procedure listing
16    payments for category 5b, as defined in 89 Ill. Adm. Code
17    148.140(b)(1)(E), for State fiscal year 2005.
18    (d) Medicaid high volume adjustment. In addition to rates
19paid for inpatient hospital services, the Department shall pay
20to each Illinois general acute care hospital that provided more
21than 20,500 Medicaid inpatient days of care in State fiscal
22year 2005 amounts as follows:
23        (1) For hospitals with a case mix index equal to or
24    greater than the 85th percentile of hospital case mix
25    indices, $350 for each Medicaid inpatient day of care
26    provided during that period; and

 

 

HB0027- 261 -LRB098 00027 KTG 30027 b

1        (2) For hospitals with a case mix index less than the
2    85th percentile of hospital case mix indices, $100 for each
3    Medicaid inpatient day of care provided during that period.
4    (e) Capital adjustment. In addition to rates paid for
5inpatient hospital services, the Department shall pay an
6additional payment to each Illinois general acute care hospital
7that has a Medicaid inpatient utilization rate of at least 10%
8(as calculated by the Department for the rate year 2007
9disproportionate share determination) amounts as follows:
10        (1) For each Illinois general acute care hospital that
11    has a Medicaid inpatient utilization rate of at least 10%
12    and less than 36.94% and whose capital cost is less than
13    the 60th percentile of the capital costs of all Illinois
14    hospitals, the amount of such payment shall equal the
15    hospital's Medicaid inpatient days multiplied by the
16    difference between the capital costs at the 60th percentile
17    of the capital costs of all Illinois hospitals and the
18    hospital's capital costs.
19        (2) For each Illinois general acute care hospital that
20    has a Medicaid inpatient utilization rate of at least
21    36.94% and whose capital cost is less than the 75th
22    percentile of the capital costs of all Illinois hospitals,
23    the amount of such payment shall equal the hospital's
24    Medicaid inpatient days multiplied by the difference
25    between the capital costs at the 75th percentile of the
26    capital costs of all Illinois hospitals and the hospital's

 

 

HB0027- 262 -LRB098 00027 KTG 30027 b

1    capital costs.
2    (f) Obstetrical care adjustment.
3        (1) In addition to rates paid for inpatient hospital
4    services, the Department shall pay $1,500 for each Medicaid
5    obstetrical day of care provided in State fiscal year 2005
6    by each Illinois rural hospital that had a Medicaid
7    obstetrical percentage (Medicaid obstetrical days divided
8    by Medicaid inpatient days) greater than 15% for State
9    fiscal year 2005.
10        (2) In addition to rates paid for inpatient hospital
11    services, the Department shall pay $1,350 for each Medicaid
12    obstetrical day of care provided in State fiscal year 2005
13    by each Illinois general acute care hospital that was
14    designated a level III perinatal center as of December 31,
15    2006, and that had a case mix index equal to or greater
16    than the 45th percentile of the case mix indices for all
17    level III perinatal centers.
18        (3) In addition to rates paid for inpatient hospital
19    services, the Department shall pay $900 for each Medicaid
20    obstetrical day of care provided in State fiscal year 2005
21    by each Illinois general acute care hospital that was
22    designated a level II or II+ perinatal center as of
23    December 31, 2006, and that had a case mix index equal to
24    or greater than the 35th percentile of the case mix indices
25    for all level II and II+ perinatal centers.
26    (g) Trauma adjustment.

 

 

HB0027- 263 -LRB098 00027 KTG 30027 b

1        (1) In addition to rates paid for inpatient hospital
2    services, the Department shall pay each Illinois general
3    acute care hospital designated as a trauma center as of
4    July 1, 2007, a payment equal to 3.75 multiplied by the
5    hospital's State fiscal year 2005 Medicaid capital
6    payments.
7        (2) In addition to rates paid for inpatient hospital
8    services, the Department shall pay $400 for each Medicaid
9    acute inpatient day of care provided in State fiscal year
10    2005 by each Illinois general acute care hospital that was
11    designated a level II trauma center, as defined in 89 Ill.
12    Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
13    2007.
14        (3) In addition to rates paid for inpatient hospital
15    services, the Department shall pay $235 for each Illinois
16    Medicaid acute inpatient day of care provided in State
17    fiscal year 2005 by each level I pediatric trauma center
18    located outside of Illinois that had more than 8,000
19    Illinois Medicaid inpatient days in State fiscal year 2005.
20    (h) Supplemental tertiary care adjustment. In addition to
21rates paid for inpatient services, the Department shall pay to
22each Illinois hospital eligible for tertiary care adjustment
23payments under 89 Ill. Adm. Code 148.296, as in effect for
24State fiscal year 2007, a supplemental tertiary care adjustment
25payment equal to the tertiary care adjustment payment required
26under 89 Ill. Adm. Code 148.296, as in effect for State fiscal

 

 

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1year 2007.
2    (i) Crossover adjustment. In addition to rates paid for
3inpatient services, the Department shall pay each Illinois
4general acute care hospital that had a ratio of crossover days
5to total inpatient days for medical assistance programs
6administered by the Department (utilizing information from
72005 paid claims) greater than 50%, and a case mix index
8greater than the 65th percentile of case mix indices for all
9Illinois hospitals, a rate of $1,125 for each Medicaid
10inpatient day including crossover days.
11    (j) Magnet hospital adjustment. In addition to rates paid
12for inpatient hospital services, the Department shall pay to
13each Illinois general acute care hospital and each Illinois
14freestanding children's hospital that, as of February 1, 2008,
15was recognized as a Magnet hospital by the American Nurses
16Credentialing Center and that had a case mix index greater than
17the 75th percentile of case mix indices for all Illinois
18hospitals amounts as follows:
19        (1) For hospitals located in a county whose eligibility
20    growth factor is greater than the mean, $450 multiplied by
21    the eligibility growth factor for the county in which the
22    hospital is located for each Medicaid inpatient day of care
23    provided by the hospital during State fiscal year 2005.
24        (2) For hospitals located in a county whose eligibility
25    growth factor is less than or equal to the mean, $225
26    multiplied by the eligibility growth factor for the county

 

 

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1    in which the hospital is located for each Medicaid
2    inpatient day of care provided by the hospital during State
3    fiscal year 2005.
4    For purposes of this subsection, "eligibility growth
5factor" means the percentage by which the number of Medicaid
6recipients in the county increased from State fiscal year 1998
7to State fiscal year 2005.
8    (k) For purposes of this Section, a hospital that is
9enrolled to provide Medicaid services during State fiscal year
102005 shall have its utilization and associated reimbursements
11annualized prior to the payment calculations being performed
12under this Section.
13    (l) For purposes of this Section, the terms "Medicaid
14days", "ambulatory procedure listing services", and
15"ambulatory procedure listing payments" do not include any
16days, charges, or services for which Medicare or a managed care
17organization reimbursed on a capitated basis was liable for
18payment, except where explicitly stated otherwise in this
19Section.
20    (m) For purposes of this Section, in determining the
21percentile ranking of an Illinois hospital's case mix index or
22capital costs, hospitals described in subsection (b) of Section
235A-3 shall be excluded from the ranking.
24    (n) Definitions. Unless the context requires otherwise or
25unless provided otherwise in this Section, the terms used in
26this Section for qualifying criteria and payment calculations

 

 

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1shall have the same meanings as those terms have been given in
2the Illinois Department's administrative rules as in effect on
3March 1, 2008. Other terms shall be defined by the Illinois
4Department by rule.
5    As used in this Section, unless the context requires
6otherwise:
7    "Base inpatient payments" means, for a given hospital, the
8sum of base payments for inpatient services made on a per diem
9or per admission (DRG) basis, excluding those portions of per
10admission payments that are classified as capital payments.
11Disproportionate share hospital adjustment payments, Medicaid
12Percentage Adjustments, Medicaid High Volume Adjustments, and
13outlier payments, as defined by rule by the Department as of
14January 1, 2008, are not base payments.
15    "Capital costs" means, for a given hospital, the total
16capital costs determined using the most recent 2005 Medicare
17cost report as contained in the Healthcare Cost Report
18Information System file, for the quarter ending on December 31,
192006, divided by the total inpatient days from the same cost
20report to calculate a capital cost per day. The resulting
21capital cost per day is inflated to the midpoint of State
22fiscal year 2009 utilizing the national hospital market price
23proxies (DRI) hospital cost index. If a hospital's 2005
24Medicare cost report is not contained in the Healthcare Cost
25Report Information System, the Department may obtain the data
26necessary to compute the hospital's capital costs from any

 

 

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1source available, including, but not limited to, records
2maintained by the hospital provider, which may be inspected at
3all times during business hours of the day by the Illinois
4Department or its duly authorized agents and employees.
5    "Case mix index" means, for a given hospital, the sum of
6the DRG relative weighting factors in effect on January 1,
72005, for all general acute care admissions for State fiscal
8year 2005, excluding Medicare crossover admissions and
9transplant admissions reimbursed under 89 Ill. Adm. Code
10148.82, divided by the total number of general acute care
11admissions for State fiscal year 2005, excluding Medicare
12crossover admissions and transplant admissions reimbursed
13under 89 Ill. Adm. Code 148.82.
14    "Medicaid inpatient day" means, for a given hospital, the
15sum of days of inpatient hospital days provided to recipients
16of medical assistance under Title XIX of the federal Social
17Security Act, excluding days for individuals eligible for
18Medicare under Title XVIII of that Act (Medicaid/Medicare
19crossover days), as tabulated from the Department's paid claims
20data for admissions occurring during State fiscal year 2005
21that was adjudicated by the Department through March 23, 2007.
22    "Medicaid obstetrical day" means, for a given hospital, the
23sum of days of inpatient hospital days grouped by the
24Department to DRGs of 370 through 375 provided to recipients of
25medical assistance under Title XIX of the federal Social
26Security Act, excluding days for individuals eligible for

 

 

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1Medicare under Title XVIII of that Act (Medicaid/Medicare
2crossover days), as tabulated from the Department's paid claims
3data for admissions occurring during State fiscal year 2005
4that was adjudicated by the Department through March 23, 2007.
5    "Outpatient ambulatory procedure listing payments" means,
6for a given hospital, the sum of payments for ambulatory
7procedure listing services, as described in 89 Ill. Adm. Code
8148.140(b), provided to recipients of medical assistance under
9Title XIX of the federal Social Security Act, excluding
10payments for individuals eligible for Medicare under Title
11XVIII of the Act (Medicaid/Medicare crossover days), as
12tabulated from the Department's paid claims data for services
13occurring in State fiscal year 2005 that were adjudicated by
14the Department through March 23, 2007.
15    (o) The Department may adjust payments made under this
16Section 5A-12.2 to comply with federal law or regulations
17regarding hospital-specific payment limitations on
18government-owned or government-operated hospitals.
19    (p) Notwithstanding any of the other provisions of this
20Section, the Department is authorized to adopt rules that
21change the hospital access improvement payments specified in
22this Section, but only to the extent necessary to conform to
23any federally approved amendment to the Title XIX State plan.
24Any such rules shall be adopted by the Department as authorized
25by Section 5-50 of the Illinois Administrative Procedure Act.
26Notwithstanding any other provision of law, any changes

 

 

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1implemented as a result of this subsection (p) shall be given
2retroactive effect so that they shall be deemed to have taken
3effect as of the effective date of this Section.
4    (q) For State fiscal year 2014, the Department may make
5recommendations to the General Assembly regarding the use of
6more recent data for purposes of calculating the assessment
7authorized under Section 5A-2 and the payments authorized under
8this Section 5A-12.2. (Blank).
9    (r) (Blank). On and after July 1, 2012, the Department
10shall reduce any rate of reimbursement for services or other
11payments or alter any methodologies authorized by this Code to
12reduce any rate of reimbursement for services or other payments
13in accordance with Section 5-5e.
14(Source: P.A. 96-821, eff. 11-20-09; 97-689, eff. 6-14-12.)
 
15    (305 ILCS 5/5A-14)
16    Sec. 5A-14. Repeal of assessments and disbursements.
17    (a) Section 5A-2 is repealed on July 1, 2014 January 1,
182015.
19    (b) Section 5A-12 is repealed on July 1, 2005.
20    (c) Section 5A-12.1 is repealed on July 1, 2008.
21    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
22July 1, 2014 January 1, 2015.
23    (e) Section 5A-12.3 is repealed on July 1, 2011.
24(Source: P.A. 96-821, eff. 11-20-09; 96-1530, eff. 2-16-11;
2597-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
 

 

 

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1    (305 ILCS 5/6-1.2)  (from Ch. 23, par. 6-1.2)
2    Sec. 6-1.2. Need. Income available to the person, when
3added to contributions in money, substance, or services from
4other sources, including contributions from legally
5responsible relatives, must be insufficient to equal the grant
6amount established by Department regulation (or by local
7governmental unit in units which do not receive State funds)
8for such a person.
9    In determining income to be taken into account:
10        (1) The first $75 of earned income in income assistance
11    units comprised exclusively of one adult person shall be
12    disregarded, and for not more than 3 months in any 12
13    consecutive months that portion of earned income beyond the
14    first $75 that is the difference between the standard of
15    assistance and the grant amount, shall be disregarded.
16        (2) For income assistance units not comprised
17    exclusively of one adult person, when authorized by rules
18    and regulations of the Illinois Department, a portion of
19    earned income, not to exceed the first $25 a month plus 50%
20    of the next $75, may be disregarded for the purpose of
21    stimulating and aiding rehabilitative effort and
22    self-support activity.
23    "Earned income" means money earned in self-employment or
24wages, salary, or commission for personal services performed as
25an employee. The eligibility of any applicant for or recipient

 

 

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1of public aid under this Article is not affected by the payment
2of any grant under the "Senior Citizens and Disabled Persons
3Property Tax Relief and Pharmaceutical Assistance Act", any
4refund or payment of the federal Earned Income Tax Credit, or
5any distributions or items of income described under
6subparagraph (X) of paragraph (2) of subsection (a) of Section
7203 of the Illinois Income Tax Act.
8(Source: P.A. 97-689, eff. 6-14-12.)
 
9    (305 ILCS 5/6-2)  (from Ch. 23, par. 6-2)
10    Sec. 6-2. Amount of aid. The amount and nature of General
11Assistance for basic maintenance requirements shall be
12determined in accordance with local budget standards for local
13governmental units which do not receive State funds. For local
14governmental units which do receive State funds, the amount and
15nature of General Assistance for basic maintenance
16requirements shall be determined in accordance with the
17standards, rules and regulations of the Illinois Department.
18However, the amount and nature of any financial aid is not
19affected by the payment of any grant under the Senior Citizens
20and Disabled Persons Property Tax Relief and Pharmaceutical
21Assistance Act or any distributions or items of income
22described under subparagraph (X) of paragraph (2) of subsection
23(a) of Section 203 of the Illinois Income Tax Act. Due regard
24shall be given to the requirements and the conditions existing
25in each case, and to the income, money contributions and other

 

 

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1support and resources available, from whatever source. In local
2governmental units which do not receive State funds, the grant
3shall be sufficient when added to all other income, money
4contributions and support in excess of any excluded income or
5resources, to provide the person with a grant in the amount
6established for such a person by the local governmental unit
7based upon standards meeting basic maintenance requirements.
8In local governmental units which do receive State funds, the
9grant shall be sufficient when added to all other income, money
10contributions and support in excess of any excluded income or
11resources, to provide the person with a grant in the amount
12established for such a person by Department regulation based
13upon standards providing a livelihood compatible with health
14and well-being, as directed by Section 12-4.11 of this Code.
15    The Illinois Department may conduct special projects,
16which may be known as Grant Diversion Projects, under which
17recipients of financial aid under this Article are placed in
18jobs and their grants are diverted to the employer who in turn
19makes payments to the recipients in the form of salary or other
20employment benefits. The Illinois Department shall by rule
21specify the terms and conditions of such Grant Diversion
22Projects. Such projects shall take into consideration and be
23coordinated with the programs administered under the Illinois
24Emergency Employment Development Act.
25    The allowances provided under Article IX for recipients
26participating in the training and rehabilitation programs

 

 

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1shall be in addition to such maximum payment.
2    Payments may also be made to provide persons receiving
3basic maintenance support with necessary treatment, care and
4supplies required because of illness or disability or with
5acute medical treatment, care, and supplies. Payments for
6necessary or acute medical care under this paragraph may be
7made to or in behalf of the person. Obligations incurred for
8such services but not paid for at the time of a recipient's
9death may be paid, subject to the rules and regulations of the
10Illinois Department, after the death of the recipient.
11(Source: P.A. 97-689, eff. 6-14-12.)
 
12    (305 ILCS 5/6-11)  (from Ch. 23, par. 6-11)
13    Sec. 6-11. State funded General Assistance.
14    (a) Effective July 1, 1992, all State funded General
15Assistance and related medical benefits shall be governed by
16this Section, provided that, notwithstanding any other
17provisions of this Code to the contrary, on and after July 1,
182012, the State shall not fund the programs outlined in this
19Section. Other parts of this Code or other laws related to
20General Assistance shall remain in effect to the extent they do
21not conflict with the provisions of this Section. If any other
22part of this Code or other laws of this State conflict with the
23provisions of this Section, the provisions of this Section
24shall control.
25    (b) State funded General Assistance shall may consist of 2

 

 

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1separate programs. One program shall be for adults with no
2children and shall be known as State Transitional Assistance.
3The other program shall may be for families with children and
4for pregnant women and shall be known as State Family and
5Children Assistance.
6    (c) (1) To be eligible for State Transitional Assistance on
7or after July 1, 1992, an individual must be ineligible for
8assistance under any other Article of this Code, must be
9determined chronically needy, and must be one of the following:
10        (A) age 18 or over or
11        (B) married and living with a spouse, regardless of
12    age.
13    (2) The Illinois Department or the local governmental unit
14shall determine whether individuals are chronically needy as
15follows:
16        (A) Individuals who have applied for Supplemental
17    Security Income (SSI) and are awaiting a decision on
18    eligibility for SSI who are determined disabled by the
19    Illinois Department using the SSI standard shall be
20    considered chronically needy, except that individuals
21    whose disability is based solely on substance addictions
22    (drug abuse and alcoholism) and whose disability would
23    cease were their addictions to end shall be eligible only
24    for medical assistance and shall not be eligible for cash
25    assistance under the State Transitional Assistance
26    program.

 

 

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1        (B) If an individual has been denied SSI due to a
2    finding of "not disabled" (either at the Administrative Law
3    Judge level or above, or at a lower level if that
4    determination was not appealed), the Illinois Department
5    shall adopt that finding and the individual shall not be
6    eligible for State Transitional Assistance or any related
7    medical benefits. Such an individual may not be determined
8    disabled by the Illinois Department for a period of 12
9    months, unless the individual shows that there has been a
10    substantial change in his or her medical condition or that
11    there has been a substantial change in other factors, such
12    as age or work experience, that might change the
13    determination of disability. (Blank).
14        (C) The Illinois Department, by rule, unit of local
15    government may specify other categories of individuals as
16    chronically needy; nothing in this Section, however, shall
17    be deemed to require the inclusion of any specific category
18    other than as specified in paragraphs paragraph (A) and
19    (B).
20    (3) For individuals in State Transitional Assistance,
21medical assistance shall may be provided by the unit of local
22government in an amount and nature determined by the Department
23of Healthcare and Family Services by rule. The amount and
24nature of medical assistance provided need not be the same as
25that provided under paragraph (4) of subsection (d) of this
26Section, and nothing unit of local government. Nothing in this

 

 

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1paragraph (3) shall be construed to require the coverage of any
2particular medical service. In addition, the amount and nature
3of medical assistance provided may be different for different
4categories of individuals determined chronically needy.
5    (4) The Illinois Department shall determine, by rule, those
6assistance recipients under Article VI who shall be subject to
7employment, training, or education programs including
8Earnfare, the content of those programs, and the penalties for
9failure to cooperate in those programs. (Blank).
10    (5) The Illinois Department shall, by rule, establish
11further eligibility requirements, including but not limited to
12residence, need, and the level of payments. (Blank).
13    (d) (1) To be eligible for State Family and Children
14Assistance, a family unit must be ineligible for assistance
15under any other Article of this Code and must contain a child
16who is:
17        (A) under age 18 or
18        (B) age 18 and a full-time student in a secondary
19    school or the equivalent level of vocational or technical
20    training, and who may reasonably be expected to complete
21    the program before reaching age 19.
22    Those children shall be eligible for State Family and
23Children Assistance.
24    (2) The natural or adoptive parents of the child living in
25the same household may be eligible for State Family and
26Children Assistance.

 

 

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1    (3) A pregnant woman whose pregnancy has been verified
2shall be eligible for income maintenance assistance under the
3State Family and Children Assistance program.
4    (4) The amount and nature of medical assistance provided
5under the State Family and Children Assistance program shall be
6determined by the Department of Healthcare and Family Services
7by rule unit of local government. The amount and nature of
8medical assistance provided need not be the same as that
9provided under paragraph (3) of subsection (c) of this Section,
10and nothing in this paragraph (4) shall be construed to require
11the coverage of any particular medical service.
12    (5) The Illinois Department shall, by rule, establish
13further eligibility requirements, including but not limited to
14residence, need, and the level of payments. (Blank).
15    (e) A local governmental unit that chooses to participate
16in a General Assistance program under this Section shall
17provide funding in accordance with Section 12-21.13 of this
18Act. Local governmental funds used to qualify for State funding
19may only be expended for clients eligible for assistance under
20this Section 6-11 and related administrative expenses.
21    (f) In order to qualify for State funding under this
22Section, a local governmental unit shall be subject to the
23supervision and the rules and regulations of the Illinois
24Department. (Blank).
25    (g) Notwithstanding any other provision in this Code, the
26Illinois Department is authorized to reduce payment levels used

 

 

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1to determine cash grants provided to recipients of State
2Transitional Assistance at any time within a Fiscal Year in
3order to ensure that cash benefits for State Transitional
4Assistance do not exceed the amounts appropriated for those
5cash benefits. Changes in payment levels may be accomplished by
6emergency rule under Section 5-45 of the Illinois
7Administrative Procedure Act, except that the limitation on the
8number of emergency rules that may be adopted in a 24-month
9period shall not apply and the provisions of Sections 5-115 and
105-125 of the Illinois Administrative Procedure Act shall not
11apply. This provision shall also be applicable to any reduction
12in payment levels made upon implementation of this amendatory
13Act of the 98th General Assembly. (Blank).
14(Source: P.A. 97-689, eff. 6-14-12.)
 
15    (305 ILCS 5/11-13)  (from Ch. 23, par. 11-13)
16    Sec. 11-13. Conditions For Receipt of Vendor Payments -
17Limitation Period For Vendor Action - Penalty For Violation. A
18vendor payment, as defined in Section 2-5 of Article II, shall
19constitute payment in full for the goods or services covered
20thereby. Acceptance of the payment by or in behalf of the
21vendor shall bar him from obtaining, or attempting to obtain,
22additional payment therefor from the recipient or any other
23person. A vendor payment shall not, however, bar recovery of
24the value of goods and services the obligation for which, under
25the rules and regulations of the Illinois Department, is to be

 

 

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1met from the income and resources available to the recipient,
2and in respect to which the vendor payment of the Illinois
3Department or the local governmental unit represents
4supplementation of such available income and resources.
5    Vendors seeking to enforce obligations of a governmental
6unit or the Illinois Department for goods or services (1)
7furnished to or in behalf of recipients and (2) subject to a
8vendor payment as defined in Section 2-5, shall commence their
9actions in the appropriate Circuit Court or the Court of
10Claims, as the case may require, within one year next after the
11cause of action accrued.
12    A cause of action accrues within the meaning of this
13Section upon the following date:
14        (1) If the vendor can prove that he submitted a bill
15    for the service rendered to the Illinois Department or a
16    governmental unit within 12 months of 180 days after the
17    date the service was rendered, then (a) upon the date the
18    Illinois Department or a governmental unit mails to the
19    vendor information that it is paying a bill in part or is
20    refusing to pay a bill in whole or in part, or (b) upon the
21    date one year following the date the vendor submitted such
22    bill if the Illinois Department or a governmental unit
23    fails to mail to the vendor such payment information within
24    one year following the date the vendor submitted the bill;
25    or
26        (2) If the vendor cannot prove that he submitted a bill

 

 

HB0027- 280 -LRB098 00027 KTG 30027 b

1    for the service rendered within 12 months of 180 days after
2    the date the service was rendered, then upon the date 12
3    months following the date the vendor rendered the service
4    to the recipient.
5    In the case of long term care facilities, where the
6Illinois Department initiates the monthly billing process for
7the vendor, the cause of action shall accrue 12 months after
8the last day of the month the service was rendered.
9    This paragraph governs only vendor payments as defined in
10this Code and as limited by regulations of the Illinois
11Department; it does not apply to goods or services purchased or
12contracted for by a recipient under circumstances in which the
13payment is to be made directly by the recipient.
14    Any vendor who accepts a vendor payment and who knowingly
15obtains or attempts to obtain additional payment for the goods
16or services covered by the vendor payment from the recipient or
17any other person shall be guilty of a Class B misdemeanor.
18(Source: P.A. 97-689, eff. 6-14-12.)
 
19    (305 ILCS 5/11-26)  (from Ch. 23, par. 11-26)
20    Sec. 11-26. Recipient's abuse of medical care;
21restrictions on access to medical care.
22    (a) When the Department determines, on the basis of
23statistical norms and medical judgment, that a medical care
24recipient has received medical services in excess of need and
25with such frequency or in such a manner as to constitute an

 

 

HB0027- 281 -LRB098 00027 KTG 30027 b

1abuse of the recipient's medical care privileges, the
2recipient's access to medical care may be restricted.
3    (b) When the Department has determined that a recipient is
4abusing his or her medical care privileges as described in this
5Section, it may require that the recipient designate a primary
6provider type of the recipient's own choosing to assume
7responsibility for the recipient's care. For the purposes of
8this subsection, "primary provider type" means a primary care
9provider, primary care pharmacy, primary dentist, primary
10podiatrist, or primary durable medical equipment provider
11provider type as determined by the Department. Instead of
12requiring a recipient to make a designation as provided in this
13subsection, the Department, pursuant to rules adopted by the
14Department and without regard to any choice of an entity that
15the recipient might otherwise make, may initially designate a
16primary provider type provided that the primary provider type
17is willing to provide that care.
18    (c) When the Department has requested that a recipient
19designate a primary provider type and the recipient fails or
20refuses to do so, the Department may, after a reasonable period
21of time, assign the recipient to a primary provider type of its
22own choice and determination, provided such primary provider
23type is willing to provide such care.
24    (d) When a recipient has been restricted to a designated
25primary provider type, the recipient may change the primary
26provider type:

 

 

HB0027- 282 -LRB098 00027 KTG 30027 b

1        (1) when the designated source becomes unavailable, as
2    the Department shall determine by rule; or
3        (2) when the designated primary provider type notifies
4    the Department that it wishes to withdraw from any
5    obligation as primary provider type; or
6        (3) in other situations, as the Department shall
7    provide by rule.
8    The Department shall, by rule, establish procedures for
9providing medical or pharmaceutical services when the
10designated source becomes unavailable or wishes to withdraw
11from any obligation as primary provider type, shall, by rule,
12take into consideration the need for emergency or temporary
13medical assistance and shall ensure that the recipient has
14continuous and unrestricted access to medical care from the
15date on which such unavailability or withdrawal becomes
16effective until such time as the recipient designates a primary
17provider type or a primary provider type willing to provide
18such care is designated by the Department consistent with
19subsections (b) and (c) and such restriction becomes effective.
20    (e) Prior to initiating any action to restrict a
21recipient's access to medical or pharmaceutical care, the
22Department shall notify the recipient of its intended action.
23Such notification shall be in writing and shall set forth the
24reasons for and nature of the proposed action. In addition, the
25notification shall:
26        (1) inform the recipient that (i) the recipient has a

 

 

HB0027- 283 -LRB098 00027 KTG 30027 b

1    right to designate a primary provider type of the
2    recipient's own choosing willing to accept such
3    designation and that the recipient's failure to do so
4    within a reasonable time may result in such designation
5    being made by the Department or (ii) the Department has
6    designated a primary provider type to assume
7    responsibility for the recipient's care; and
8        (2) inform the recipient that the recipient has a right
9    to appeal the Department's determination to restrict the
10    recipient's access to medical care and provide the
11    recipient with an explanation of how such appeal is to be
12    made. The notification shall also inform the recipient of
13    the circumstances under which unrestricted medical
14    eligibility shall continue until a decision is made on
15    appeal and that if the recipient chooses to appeal, the
16    recipient will be able to review the medical payment data
17    that was utilized by the Department to decide that the
18    recipient's access to medical care should be restricted.
19    (f) The Department shall, by rule or regulation, establish
20procedures for appealing a determination to restrict a
21recipient's access to medical care, which procedures shall, at
22a minimum, provide for a reasonable opportunity to be heard
23and, where the appeal is denied, for a written statement of the
24reason or reasons for such denial.
25    (g) Except as otherwise provided in this subsection, when a
26recipient has had his or her medical card restricted for 4 full

 

 

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1quarters (without regard to any period of ineligibility for
2medical assistance under this Code, or any period for which the
3recipient voluntarily terminates his or her receipt of medical
4assistance, that may occur before the expiration of those 4
5full quarters), the Department shall reevaluate the
6recipient's medical usage to determine whether it is still in
7excess of need and with such frequency or in such a manner as
8to constitute an abuse of the receipt of medical assistance. If
9it is still in excess of need, the restriction shall be
10continued for another 4 full quarters. If it is no longer in
11excess of need, the restriction shall be discontinued. If a
12recipient's access to medical care has been restricted under
13this Section and the Department then determines, either at
14reevaluation or after the restriction has been discontinued, to
15restrict the recipient's access to medical care a second or
16subsequent time, the second or subsequent restriction may be
17imposed for a period of more than 4 full quarters. If the
18Department restricts a recipient's access to medical care for a
19period of more than 4 full quarters, as determined by rule, the
20Department shall reevaluate the recipient's medical usage
21after the end of the restriction period rather than after the
22end of 4 full quarters. The Department shall notify the
23recipient, in writing, of any decision to continue the
24restriction and the reason or reasons therefor. A "quarter",
25for purposes of this Section, shall be defined as one of the
26following 3-month periods of time: January-March, April-June,

 

 

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1July-September or October-December.
2    (h) In addition to any other recipient whose acquisition of
3medical care is determined to be in excess of need, the
4Department may restrict the medical care privileges of the
5following persons:
6        (1) recipients found to have loaned or altered their
7    cards or misused or falsely represented medical coverage;
8        (2) recipients found in possession of blank or forged
9    prescription pads;
10        (3) recipients who knowingly assist providers in
11    rendering excessive services or defrauding the medical
12    assistance program.
13    The procedural safeguards in this Section shall apply to
14the above individuals.
15    (i) Restrictions under this Section shall be in addition to
16and shall not in any way be limited by or limit any actions
17taken under Article VIIIA VIII-A of this Code.
18(Source: P.A. 96-1501, eff. 1-25-11; 97-689, eff. 6-14-12;
19revised 8-3-12.)
 
20    (305 ILCS 5/12-4.25)  (from Ch. 23, par. 12-4.25)
21    Sec. 12-4.25. Medical assistance program; vendor
22participation.
23    (A) The Illinois Department may deny, suspend, or terminate
24the eligibility of any person, firm, corporation, association,
25agency, institution or other legal entity to participate as a

 

 

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1vendor of goods or services to recipients under the medical
2assistance program under Article V, or may exclude any such
3person or entity from participation as such a vendor, and may
4deny, suspend, or recover payments, if after reasonable notice
5and opportunity for a hearing the Illinois Department finds:
6        (a) Such vendor is not complying with the Department's
7    policy or rules and regulations, or with the terms and
8    conditions prescribed by the Illinois Department in its
9    vendor agreement, which document shall be developed by the
10    Department as a result of negotiations with each vendor
11    category, including physicians, hospitals, long term care
12    facilities, pharmacists, optometrists, podiatrists and
13    dentists setting forth the terms and conditions applicable
14    to the participation of each vendor group in the program;
15    or
16        (b) Such vendor has failed to keep or make available
17    for inspection, audit or copying, after receiving a written
18    request from the Illinois Department, such records
19    regarding payments claimed for providing services. This
20    section does not require vendors to make available patient
21    records of patients for whom services are not reimbursed
22    under this Code; or
23        (c) Such vendor has failed to furnish any information
24    requested by the Department regarding payments for
25    providing goods or services; or
26        (d) Such vendor has knowingly made, or caused to be

 

 

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1    made, any false statement or representation of a material
2    fact in connection with the administration of the medical
3    assistance program; or
4        (e) Such vendor has furnished goods or services to a
5    recipient which are (1) in excess of his or her needs need,
6    (2) harmful to the recipient, or (3) of grossly inferior
7    quality, all of such determinations to be based upon
8    competent medical judgment and evaluations; or
9        (f) The vendor; a person with management
10    responsibility for a vendor; an officer or person owning,
11    either directly or indirectly, 5% or more of the shares of
12    stock or other evidences of ownership in a corporate
13    vendor; an owner of a sole proprietorship which is a
14    vendor; or a partner in a partnership which is a vendor,
15    either:
16            (1) was previously terminated, suspended, or
17        excluded from participation in the Illinois medical
18        assistance program, or was terminated, suspended, or
19        excluded from participation in a medical assistance
20        program in another state that is of the same kind as
21        the program of medical assistance provided under
22        Article V of this Code another state or federal medical
23        assistance or health care program; or
24            (2) was a person with management responsibility
25        for a vendor previously terminated, suspended, or
26        excluded from participation in the Illinois medical

 

 

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1        assistance program, or terminated, suspended, or
2        excluded from participation in a another state or
3        federal medical assistance program in another state
4        that is of the same kind as the program of medical
5        assistance provided under Article V of this Code, or
6        health care program during the time of conduct which
7        was the basis for that vendor's termination,
8        suspension, or exclusion; or
9            (3) was an officer, or person owning, either
10        directly or indirectly, 5% or more of the shares of
11        stock or other evidences of ownership in a corporate or
12        limited liability company vendor previously
13        terminated, suspended, or excluded from participation
14        in the Illinois medical assistance program, or
15        terminated, suspended, or excluded from participation
16        in a state or federal medical assistance or health care
17        program in another state that is of the same kind as
18        the program of medical assistance provided under
19        Article V of this Code, during the time of conduct
20        which was the basis for that vendor's termination,
21        suspension, or exclusion; or
22            (4) was an owner of a sole proprietorship or
23        partner of a partnership previously terminated,
24        suspended, or excluded from participation in the
25        Illinois medical assistance program, or terminated,
26        suspended, or excluded from participation in a state or

 

 

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1        federal medical assistance program in another state
2        that is of the same kind as the program of medical
3        assistance provided under Article V of this Code, or
4        health care program during the time of conduct which
5        was the basis for that vendor's termination,
6        suspension, or exclusion; or
7        (f-1) (Blank); or Such vendor has a delinquent debt
8    owed to the Illinois Department; or
9        (g) The vendor; a person with management
10    responsibility for a vendor; an officer or person owning,
11    either directly or indirectly, 5% or more of the shares of
12    stock or other evidences of ownership in a corporate or
13    limited liability company vendor; an owner of a sole
14    proprietorship which is a vendor; or a partner in a
15    partnership which is a vendor, either:
16            (1) has engaged in practices prohibited by
17        applicable federal or State law or regulation relating
18        to the medical assistance program; or
19            (2) was a person with management responsibility
20        for a vendor at the time that such vendor engaged in
21        practices prohibited by applicable federal or State
22        law or regulation relating to the medical assistance
23        program; or
24            (3) was an officer, or person owning, either
25        directly or indirectly, 5% or more of the shares of
26        stock or other evidences of ownership in a vendor at

 

 

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1        the time such vendor engaged in practices prohibited by
2        applicable federal or State law or regulation relating
3        to the medical assistance program; or
4            (4) was an owner of a sole proprietorship or
5        partner of a partnership which was a vendor at the time
6        such vendor engaged in practices prohibited by
7        applicable federal or State law or regulation relating
8        to the medical assistance program; or
9        (h) The direct or indirect ownership of the vendor
10    (including the ownership of a vendor that is a sole
11    proprietorship, a partner's interest in a vendor that is a
12    partnership, or ownership of 5% or more of the shares of
13    stock or other evidences of ownership in a corporate
14    vendor) has been transferred by an individual who is
15    terminated, suspended, or excluded or barred from
16    participating as a vendor to the individual's spouse,
17    child, brother, sister, parent, grandparent, grandchild,
18    uncle, aunt, niece, nephew, cousin, or relative by
19    marriage.
20    (A-5) The Illinois Department may deny, suspend, or
21terminate the eligibility of any person, firm, corporation,
22association, agency, institution, or other legal entity to
23participate as a vendor of goods or services to recipients
24under the medical assistance program under Article V, or may
25exclude any such person or entity from participation as such a
26vendor, if, after reasonable notice and opportunity for a

 

 

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1hearing, the Illinois Department finds that the vendor; a
2person with management responsibility for a vendor; an officer
3or person owning, either directly or indirectly, 5% or more of
4the shares of stock or other evidences of ownership in a
5corporate vendor; an owner of a sole proprietorship that is a
6vendor; or a partner in a partnership that is a vendor has been
7convicted of a felony an offense based on fraud or willful
8misrepresentation related to any of the following:
9        (1) The medical assistance program under Article V of
10    this Code.
11        (2) A medical assistance or health care program in
12    another state that is of the same kind as the program of
13    medical assistance provided under Article V of this Code.
14        (3) The Medicare program under Title XVIII of the
15    Social Security Act.
16        (4) The provision of health care services.
17        (5) (Blank). A violation of this Code, as provided in
18    Article VIIIA, or another state or federal medical
19    assistance program or health care program.
20    (A-10) The Illinois Department may deny, suspend, or
21terminate the eligibility of any person, firm, corporation,
22association, agency, institution, or other legal entity to
23participate as a vendor of goods or services to recipients
24under the medical assistance program under Article V, or may
25exclude any such person or entity from participation as such a
26vendor, if, after reasonable notice and opportunity for a

 

 

HB0027- 292 -LRB098 00027 KTG 30027 b

1hearing, the Illinois Department finds that (i) the vendor,
2(ii) a person with management responsibility for a vendor,
3(iii) an officer or person owning, either directly or
4indirectly, 5% or more of the shares of stock or other
5evidences of ownership in a corporate vendor, (iv) an owner of
6a sole proprietorship that is a vendor, or (v) a partner in a
7partnership that is a vendor has been convicted of a felony an
8offense related to any of the following:
9        (1) Murder.
10        (2) A Class X felony under the Criminal Code of 1961.
11        (3) (Blank). Sexual misconduct that may subject
12    recipients to an undue risk of harm.
13        (4) (Blank). A criminal offense that may subject
14    recipients to an undue risk of harm.
15        (5) (Blank). A crime of fraud or dishonesty.
16        (6) (Blank). A crime involving a controlled substance.
17        (7) (Blank). A misdemeanor relating to fraud, theft,
18    embezzlement, breach of fiduciary responsibility, or other
19    financial misconduct related to a health care program.
20    (A-15) (Blank). The Illinois Department may deny the
21eligibility of any person, firm, corporation, association,
22agency, institution, or other legal entity to participate as a
23vendor of goods or services to recipients under the medical
24assistance program under Article V if, after reasonable notice
25and opportunity for a hearing, the Illinois Department finds:
26        (1) The applicant or any person with management

 

 

HB0027- 293 -LRB098 00027 KTG 30027 b

1    responsibility for the applicant; an officer or member of
2    the board of directors of an applicant; an entity owning
3    (directly or indirectly) 5% or more of the shares of stock
4    or other evidences of ownership in a corporate vendor
5    applicant; an owner of a sole proprietorship applicant; a
6    partner in a partnership applicant; or a technical or other
7    advisor to an applicant has a debt owed to the Illinois
8    Department, and no payment arrangements acceptable to the
9    Illinois Department have been made by the applicant.
10        (2) The applicant or any person with management
11    responsibility for the applicant; an officer or member of
12    the board of directors of an applicant; an entity owning
13    (directly or indirectly) 5% or more of the shares of stock
14    or other evidences of ownership in a corporate vendor
15    applicant; an owner of a sole proprietorship applicant; a
16    partner in a partnership vendor applicant; or a technical
17    or other advisor to an applicant was (i) a person with
18    management responsibility, (ii) an officer or member of the
19    board of directors of an applicant, (iii) an entity owning
20    (directly or indirectly) 5% or more of the shares of stock
21    or other evidences of ownership in a corporate vendor, (iv)
22    an owner of a sole proprietorship, (v) a partner in a
23    partnership vendor, (vi) a technical or other advisor to a
24    vendor, during a period of time where the conduct of that
25    vendor resulted in a debt owed to the Illinois Department,
26    and no payment arrangements acceptable to the Illinois

 

 

HB0027- 294 -LRB098 00027 KTG 30027 b

1    Department have been made by that vendor.
2        (3) There is a credible allegation of the use,
3    transfer, or lease of assets of any kind to an applicant
4    from a current or prior vendor who has a debt owed to the
5    Illinois Department, no payment arrangements acceptable to
6    the Illinois Department have been made by that vendor or
7    the vendor's alternate payee, and the applicant knows or
8    should have known of such debt.
9        (4) There is a credible allegation of a transfer of
10    management responsibilities, or direct or indirect
11    ownership, to an applicant from a current or prior vendor
12    who has a debt owed to the Illinois Department, and no
13    payment arrangements acceptable to the Illinois Department
14    have been made by that vendor or the vendor's alternate
15    payee, and the applicant knows or should have known of such
16    debt.
17        (5) There is a credible allegation of the use,
18    transfer, or lease of assets of any kind to an applicant
19    who is a spouse, child, brother, sister, parent,
20    grandparent, grandchild, uncle, aunt, niece, relative by
21    marriage, nephew, cousin, or relative of a current or prior
22    vendor who has a debt owed to the Illinois Department and
23    no payment arrangements acceptable to the Illinois
24    Department have been made.
25        (6) There is a credible allegation that the applicant's
26    previous affiliations with a provider of medical services

 

 

HB0027- 295 -LRB098 00027 KTG 30027 b

1    that has an uncollected debt, a provider that has been or
2    is subject to a payment suspension under a federal health
3    care program, or a provider that has been previously
4    excluded from participation in the medical assistance
5    program, poses a risk of fraud, waste, or abuse to the
6    Illinois Department.
7    As used in this subsection, "credible allegation" is
8defined to include an allegation from any source, including,
9but not limited to, fraud hotline complaints, claims data
10mining, patterns identified through provider audits, civil
11actions filed under the False Claims Act, and law enforcement
12investigations. An allegation is considered to be credible when
13it has indicia of reliability.
14    (B) The Illinois Department shall deny, suspend or
15terminate the eligibility of any person, firm, corporation,
16association, agency, institution or other legal entity to
17participate as a vendor of goods or services to recipients
18under the medical assistance program under Article V, or may
19exclude any such person or entity from participation as such a
20vendor:
21        (1) immediately, if such vendor is not properly
22    licensed, certified, or authorized;
23        (2) within 30 days of the date when such vendor's
24    professional license, certification or other authorization
25    has been refused renewal or has been , restricted, revoked,
26    suspended, or otherwise terminated; or

 

 

HB0027- 296 -LRB098 00027 KTG 30027 b

1        (3) if such vendor has been convicted of a violation of
2    this Code, as provided in Article VIIIA.
3    (C) Upon termination, suspension, or exclusion of a vendor
4of goods or services from participation in the medical
5assistance program authorized by this Article, a person with
6management responsibility for such vendor during the time of
7any conduct which served as the basis for that vendor's
8termination, suspension, or exclusion is barred from
9participation in the medical assistance program.
10    Upon termination, suspension, or exclusion of a corporate
11vendor, the officers and persons owning, directly or
12indirectly, 5% or more of the shares of stock or other
13evidences of ownership in the vendor during the time of any
14conduct which served as the basis for that vendor's
15termination, suspension, or exclusion are barred from
16participation in the medical assistance program. A person who
17owns, directly or indirectly, 5% or more of the shares of stock
18or other evidences of ownership in a terminated corporate ,
19suspended, or excluded vendor may not transfer his or her
20ownership interest in that vendor to his or her spouse, child,
21brother, sister, parent, grandparent, grandchild, uncle, aunt,
22niece, nephew, cousin, or relative by marriage.
23    Upon termination, suspension, or exclusion of a sole
24proprietorship or partnership, the owner or partners during the
25time of any conduct which served as the basis for that vendor's
26termination, suspension, or exclusion are barred from

 

 

HB0027- 297 -LRB098 00027 KTG 30027 b

1participation in the medical assistance program. The owner of a
2terminated, suspended, or excluded vendor that is a sole
3proprietorship, and a partner in a terminated, suspended, or
4excluded vendor that is a partnership, may not transfer his or
5her ownership or partnership interest in that vendor to his or
6her spouse, child, brother, sister, parent, grandparent,
7grandchild, uncle, aunt, niece, nephew, cousin, or relative by
8marriage.
9    A person who owns, directly or indirectly, 5% or more of
10the shares of stock or other evidences of ownership in a
11corporate or limited liability company vendor who owes a debt
12to the Department, if that vendor has not made payment
13arrangements acceptable to the Department, shall not transfer
14his or her ownership interest in that vendor, or vendor assets
15of any kind, to his or her spouse, child, brother, sister,
16parent, grandparent, grandchild, uncle, aunt, niece, nephew,
17cousin, or relative by marriage.
18    Rules adopted by the Illinois Department to implement these
19provisions shall specifically include a definition of the term
20"management responsibility" as used in this Section. Such
21definition shall include, but not be limited to, typical job
22titles, and duties and descriptions which will be considered as
23within the definition of individuals with management
24responsibility for a provider.
25    A vendor or a prior vendor who has been terminated,
26excluded, or suspended from the medical assistance program, or

 

 

HB0027- 298 -LRB098 00027 KTG 30027 b

1from another state or federal medical assistance or health care
2program, and any individual currently or previously barred from
3the medical assistance program, or from another state or
4federal medical assistance or health care program, as a result
5of being an officer or a person owning, directly or indirectly,
65% or more of the shares of stock or other evidences of
7ownership in a corporate or limited liability company vendor
8during the time of any conduct which served as the basis for
9that vendor's termination, suspension, or exclusion, may be
10required to post a surety bond as part of a condition of
11enrollment or participation in the medical assistance program.
12The Illinois Department shall establish, by rule, the criteria
13and requirements for determining when a surety bond must be
14posted and the value of the bond.
15    A vendor or a prior vendor who has a debt owed to the
16Illinois Department and any individual currently or previously
17barred from the medical assistance program, or from another
18state or federal medical assistance or health care program, as
19a result of being an officer or a person owning, directly or
20indirectly, 5% or more of the shares of stock or other
21evidences of ownership in that corporate or limited liability
22company vendor during the time of any conduct which served as
23the basis for the debt, may be required to post a surety bond
24as part of a condition of enrollment or participation in the
25medical assistance program. The Illinois Department shall
26establish, by rule, the criteria and requirements for

 

 

HB0027- 299 -LRB098 00027 KTG 30027 b

1determining when a surety bond must be posted and the value of
2the bond.
3    (D) If a vendor has been suspended from the medical
4assistance program under Article V of the Code, the Director
5may require that such vendor correct any deficiencies which
6served as the basis for the suspension. The Director shall
7specify in the suspension order a specific period of time,
8which shall not exceed one year from the date of the order,
9during which a suspended vendor shall not be eligible to
10participate. At the conclusion of the period of suspension the
11Director shall reinstate such vendor, unless he finds that such
12vendor has not corrected deficiencies upon which the suspension
13was based.
14    If a vendor has been terminated, suspended, or excluded
15from the medical assistance program under Article V, such
16vendor shall be barred from participation for at least one
17year, except that if a vendor has been terminated, suspended,
18or excluded based on a conviction of a violation of Article
19VIIIA or a conviction of a felony based on fraud or a willful
20misrepresentation related to (i) the medical assistance
21program under Article V, (ii) a federal or another state's
22medical assistance or health care program in another state that
23is of the kind provided under Article V, (iii) the Medicare
24program under Title XVIII of the Social Security Act, or (iv)
25(iii) the provision of health care services, then the vendor
26shall be barred from participation for 5 years or for the

 

 

HB0027- 300 -LRB098 00027 KTG 30027 b

1length of the vendor's sentence for that conviction, whichever
2is longer. At the end of one year a vendor who has been
3terminated, suspended, or excluded may apply for reinstatement
4to the program. Upon proper application to be reinstated such
5vendor may be deemed eligible by the Director providing that
6such vendor meets the requirements for eligibility under this
7Code. If such vendor is deemed not eligible for reinstatement,
8he shall be barred from again applying for reinstatement for
9one year from the date his application for reinstatement is
10denied.
11    A vendor whose termination, suspension, or exclusion from
12participation in the Illinois medical assistance program under
13Article V was based solely on an action by a governmental
14entity other than the Illinois Department may, upon
15reinstatement by that governmental entity or upon reversal of
16the termination, suspension, or exclusion, apply for
17rescission of the termination, suspension, or exclusion from
18participation in the Illinois medical assistance program. Upon
19proper application for rescission, the vendor may be deemed
20eligible by the Director if the vendor meets the requirements
21for eligibility under this Code.
22    If a vendor has been terminated, suspended, or excluded and
23reinstated to the medical assistance program under Article V
24and the vendor is terminated, suspended, or excluded a second
25or subsequent time from the medical assistance program, the
26vendor shall be barred from participation for at least 2 years,

 

 

HB0027- 301 -LRB098 00027 KTG 30027 b

1except that if a vendor has been terminated, suspended, or
2excluded a second time based on a conviction of a violation of
3Article VIIIA or a conviction of a felony based on fraud or a
4willful misrepresentation related to (i) the medical
5assistance program under Article V, (ii) a federal or another
6state's medical assistance or health care program in another
7state that is of the kind provided under Article V, (iii) the
8Medicare program under Title XVIII of the Social Security Act,
9or (iv) (iii) the provision of health care services, then the
10vendor shall be barred from participation for life. At the end
11of 2 years, a vendor who has been terminated, suspended, or
12excluded may apply for reinstatement to the program. Upon
13application to be reinstated, the vendor may be deemed eligible
14if the vendor meets the requirements for eligibility under this
15Code. If the vendor is deemed not eligible for reinstatement,
16the vendor shall be barred from again applying for
17reinstatement for 2 years from the date the vendor's
18application for reinstatement is denied.
19    (E) The Illinois Department may recover money improperly or
20erroneously paid, or overpayments, either by setoff, crediting
21against future billings or by requiring direct repayment to the
22Illinois Department. The Illinois Department may suspend or
23deny payment, in whole or in part, if such payment would be
24improper or erroneous or would otherwise result in overpayment.
25        (1) Payments may be suspended, denied, or recovered
26    from a vendor or alternate payee: (i) for services rendered

 

 

HB0027- 302 -LRB098 00027 KTG 30027 b

1    in violation of the Illinois Department's provider
2    notices, statutes, rules, and regulations; (ii) for
3    services rendered in violation of the terms and conditions
4    prescribed by the Illinois Department in its vendor
5    agreement; (iii) for any vendor who fails to grant the
6    Office of Inspector General timely access to full and
7    complete records, including, but not limited to, records
8    relating to recipients under the medical assistance
9    program for the most recent 6 years, in accordance with
10    Section 140.28 of Title 89 of the Illinois Administrative
11    Code, and other information for the purpose of audits,
12    investigations, or other program integrity functions,
13    after reasonable written request by the Inspector General;
14    this subsection (E) does not require vendors to make
15    available the medical records of patients for whom services
16    are not reimbursed under this Code or to provide access to
17    medical records more than 6 years old; (iv) when the vendor
18    has knowingly made, or caused to be made, any false
19    statement or representation of a material fact in
20    connection with the administration of the medical
21    assistance program; or (v) when the vendor previously
22    rendered services while terminated, suspended, or excluded
23    from participation in the medical assistance program or
24    while terminated or excluded from participation in another
25    state or federal medical assistance or health care program.
26        (2) Notwithstanding any other provision of law, if a

 

 

HB0027- 303 -LRB098 00027 KTG 30027 b

1    vendor has the same taxpayer identification number
2    (assigned under Section 6109 of the Internal Revenue Code
3    of 1986) as is assigned to a vendor with past-due financial
4    obligations to the Illinois Department, the Illinois
5    Department may make any necessary adjustments to payments
6    to that vendor in order to satisfy any past-due
7    obligations, regardless of whether the vendor is assigned a
8    different billing number under the medical assistance
9    program.
10    If the Illinois Department establishes through an
11administrative hearing that the overpayments resulted from the
12vendor or alternate payee willfully knowingly making, using, or
13causing to be made or used, a false record or statement or
14misrepresentation of a material fact in connection with
15billings and payments under to obtain payment or other benefit
16from the medical assistance program under Article V, the
17Department may recover interest on the amount of the
18overpayments payment or other benefit at the rate of 5% per
19annum. In addition to any other penalties that may be
20prescribed by law, such a vendor or alternate payee shall be
21subject to civil penalties consisting of an amount not to
22exceed 3 times the amount of payment or other benefit resulting
23from each such false record or statement, and the sum of $2,000
24for each such false record or statement for payment or other
25benefit. For purposes of this paragraph, "willfully"
26"knowingly" means that a person makes a statement or

 

 

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1representation with vendor or alternate payee with respect to
2information: (i) has actual knowledge that it was false, or
3makes a statement or representation with knowledge of facts or
4information that would cause one to be aware that the statement
5or representation was false when made. of the information, (ii)
6acts in deliberate ignorance of the truth or falsity of the
7information, or (iii) acts in reckless disregard of the truth
8or falsity of the information. No proof of specific intent to
9defraud is required.
10    (F) The Illinois Department may withhold payments to any
11vendor or alternate payee prior to or during the pendency of
12any audit or proceeding under this Section, and through the
13pendency of any administrative appeal or administrative review
14by any court proceeding. The Illinois Department shall state by
15rule with as much specificity as practicable the conditions
16under which payments will not be withheld during the pendency
17of any proceeding under this Section. Payments may be denied
18for bills submitted with service dates occurring during the
19pendency of a proceeding, after a final decision has been
20rendered, or after the conclusion of any administrative appeal,
21where the final administrative decision is to terminate,
22exclude, or suspend eligibility to participate in the medical
23assistance program. The Illinois Department shall state by rule
24with as much specificity as practicable the conditions under
25which payments will not be denied for such bills. The Illinois
26Department shall state by rule a process and criteria by which

 

 

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1a vendor or alternate payee may request full or partial release
2of payments withheld under this subsection. The Department must
3complete a proceeding under this Section in a timely manner.
4    Notwithstanding recovery allowed under subsection (E) or
5this subsection (F), the Illinois Department may withhold
6payments to any vendor or alternate payee who is not properly
7licensed, certified, or in compliance with State or federal
8agency regulations. Payments may be denied for bills submitted
9with service dates occurring during the period of time that a
10vendor is not properly licensed, certified, or in compliance
11with State or federal regulations. Facilities licensed under
12the Nursing Home Care Act shall have payments denied or
13withheld pursuant to subsection (I) of this Section.
14    (F-5) The Illinois Department may temporarily withhold
15payments to a vendor or alternate payee if any of the following
16individuals have been indicted or otherwise charged under a law
17of the United States or this or any other state with a felony
18an offense that is based on alleged fraud or willful
19misrepresentation on the part of the individual related to (i)
20the medical assistance program under Article V of this Code,
21(ii) a federal or another state's medical assistance or health
22care program provided in another state which is of the kind
23provided under Article V of this Code, (iii) the Medicare
24program under Title XVIII of the Social Security Act, or (iv)
25(iii) the provision of health care services:
26        (1) If the vendor or alternate payee is a corporation:

 

 

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1    an officer of the corporation or an individual who owns,
2    either directly or indirectly, 5% or more of the shares of
3    stock or other evidence of ownership of the corporation.
4        (2) If the vendor is a sole proprietorship: the owner
5    of the sole proprietorship.
6        (3) If the vendor or alternate payee is a partnership:
7    a partner in the partnership.
8        (4) If the vendor or alternate payee is any other
9    business entity authorized by law to transact business in
10    this State: an officer of the entity or an individual who
11    owns, either directly or indirectly, 5% or more of the
12    evidences of ownership of the entity.
13    If the Illinois Department withholds payments to a vendor
14or alternate payee under this subsection, the Department shall
15not release those payments to the vendor or alternate payee
16while any criminal proceeding related to the indictment or
17charge is pending unless the Department determines that there
18is good cause to release the payments before completion of the
19proceeding. If the indictment or charge results in the
20individual's conviction, the Illinois Department shall retain
21all withheld payments, which shall be considered forfeited to
22the Department. If the indictment or charge does not result in
23the individual's conviction, the Illinois Department shall
24release to the vendor or alternate payee all withheld payments.
25    (F-10) (Blank). If the Illinois Department establishes
26that the vendor or alternate payee owes a debt to the Illinois

 

 

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1Department, and the vendor or alternate payee subsequently
2fails to pay or make satisfactory payment arrangements with the
3Illinois Department for the debt owed, the Illinois Department
4may seek all remedies available under the law of this State to
5recover the debt, including, but not limited to, wage
6garnishment or the filing of claims or liens against the vendor
7or alternate payee.
8    (F-15) (Blank). Enforcement of judgment.
9        (1) Any fine, recovery amount, other sanction, or costs
10    imposed, or part of any fine, recovery amount, other
11    sanction, or cost imposed, remaining unpaid after the
12    exhaustion of or the failure to exhaust judicial review
13    procedures under the Illinois Administrative Review Law is
14    a debt due and owing the State and may be collected using
15    all remedies available under the law.
16        (2) After expiration of the period in which judicial
17    review under the Illinois Administrative Review Law may be
18    sought for a final administrative decision, unless stayed
19    by a court of competent jurisdiction, the findings,
20    decision, and order of the Director may be enforced in the
21    same manner as a judgment entered by a court of competent
22    jurisdiction.
23        (3) In any case in which any person or entity has
24    failed to comply with a judgment ordering or imposing any
25    fine or other sanction, any expenses incurred by the
26    Illinois Department to enforce the judgment, including,

 

 

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1    but not limited to, attorney's fees, court costs, and costs
2    related to property demolition or foreclosure, after they
3    are fixed by a court of competent jurisdiction or the
4    Director, shall be a debt due and owing the State and may
5    be collected in accordance with applicable law. Prior to
6    any expenses being fixed by a final administrative decision
7    pursuant to this subsection (F-15), the Illinois
8    Department shall provide notice to the individual or entity
9    that states that the individual or entity shall appear at a
10    hearing before the administrative hearing officer to
11    determine whether the individual or entity has failed to
12    comply with the judgment. The notice shall set the date for
13    such a hearing, which shall not be less than 7 days from
14    the date that notice is served. If notice is served by
15    mail, the 7-day period shall begin to run on the date that
16    the notice was deposited in the mail.
17        (4) Upon being recorded in the manner required by
18    Article XII of the Code of Civil Procedure or by the
19    Uniform Commercial Code, a lien shall be imposed on the
20    real estate or personal estate, or both, of the individual
21    or entity in the amount of any debt due and owing the State
22    under this Section. The lien may be enforced in the same
23    manner as a judgment of a court of competent jurisdiction.
24    A lien shall attach to all property and assets of such
25    person, firm, corporation, association, agency,
26    institution, or other legal entity until the judgment is

 

 

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1    satisfied.
2        (5) The Director may set aside any judgment entered by
3    default and set a new hearing date upon a petition filed at
4    any time (i) if the petitioner's failure to appear at the
5    hearing was for good cause, or (ii) if the petitioner
6    established that the Department did not provide proper
7    service of process. If any judgment is set aside pursuant
8    to this paragraph (5), the hearing officer shall have
9    authority to enter an order extinguishing any lien which
10    has been recorded for any debt due and owing the Illinois
11    Department as a result of the vacated default judgment.
12    (G) The provisions of the Administrative Review Law, as now
13or hereafter amended, and the rules adopted pursuant thereto,
14shall apply to and govern all proceedings for the judicial
15review of final administrative decisions of the Illinois
16Department under this Section. The term "administrative
17decision" is defined as in Section 3-101 of the Code of Civil
18Procedure.
19    (G-5) Non-emergency transportation Vendors who pose a risk
20of fraud, waste, abuse, or harm.
21        (1) Notwithstanding any other provision in this
22    Section, for non-emergency transportation vendors, the
23    Department may terminate the vendor , suspend, or exclude
24    vendors who pose a risk of fraud, waste, abuse, or harm
25    from participation in the medical assistance program prior
26    to an evidentiary hearing but after reasonable notice and

 

 

HB0027- 310 -LRB098 00027 KTG 30027 b

1    opportunity to respond as established by the Department by
2    rule.
3        (2) Vendors of non-emergency medical transportation
4    services, as defined by the Department by rule, who pose a
5    risk of fraud, waste, abuse, or harm shall submit to a
6    fingerprint-based criminal background check on current and
7    future information available in the State system and
8    current information available through the Federal Bureau
9    of Investigation's system by submitting all necessary fees
10    and information in the form and manner prescribed by the
11    Department of State Police. The following individuals
12    shall be subject to the check:
13            (A) In the case of a vendor that is a corporation,
14        every shareholder who owns, directly or indirectly, 5%
15        or more of the outstanding shares of the corporation.
16            (B) In the case of a vendor that is a partnership,
17        every partner.
18            (C) In the case of a vendor that is a sole
19        proprietorship, the sole proprietor.
20            (D) Each officer or manager of the vendor.
21        Each such vendor shall be responsible for payment of
22    the cost of the criminal background check.
23        (3) Vendors of non-emergency medical transportation
24    services who pose a risk of fraud, waste, abuse, or harm
25    may be required to post a surety bond. The Department shall
26    establish, by rule, the criteria and requirements for

 

 

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1    determining when a surety bond must be posted and the value
2    of the bond.
3        (4) The Department, or its agents, may refuse to accept
4    requests for non-emergency transportation authorizations
5    authorization from specific vendors who pose a risk of
6    fraud, waste, abuse, or harm, including prior-approval and
7    post-approval requests, if:
8            (A) the Department has initiated a notice of
9        termination, suspension, or exclusion of the vendor
10        from participation in the medical assistance program;
11        or
12            (B) the Department has issued notification of its
13        withholding of payments pursuant to subsection (F-5)
14        of this Section; or
15            (C) the Department has issued a notification of its
16        withholding of payments due to reliable evidence of
17        fraud or willful misrepresentation pending
18        investigation.
19        (5) (Blank). As used in this subsection, the following
20    terms are defined as follows:
21            (A) "Fraud" means an intentional deception or
22        misrepresentation made by a person with the knowledge
23        that the deception could result in some unauthorized
24        benefit to himself or herself or some other person. It
25        includes any act that constitutes fraud under
26        applicable federal or State law.

 

 

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1            (B) "Abuse" means provider practices that are
2        inconsistent with sound fiscal, business, or medical
3        practices and that result in an unnecessary cost to the
4        medical assistance program or in reimbursement for
5        services that are not medically necessary or that fail
6        to meet professionally recognized standards for health
7        care. It also includes recipient practices that result
8        in unnecessary cost to the medical assistance program.
9        Abuse does not include diagnostic or therapeutic
10        measures conducted primarily as a safeguard against
11        possible vendor liability.
12            (C) "Waste" means the unintentional misuse of
13        medical assistance resources, resulting in unnecessary
14        cost to the medical assistance program. Waste does not
15        include diagnostic or therapeutic measures conducted
16        primarily as a safeguard against possible vendor
17        liability.
18            (D) "Harm" means physical, mental, or monetary
19        damage to recipients or to the medical assistance
20        program.
21    (G-6) (Blank). The Illinois Department, upon making a
22determination based upon information in the possession of the
23Illinois Department that continuation of participation in the
24medical assistance program by a vendor would constitute an
25immediate danger to the public, may immediately suspend such
26vendor's participation in the medical assistance program

 

 

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1without a hearing. In instances in which the Illinois
2Department immediately suspends the medical assistance program
3participation of a vendor under this Section, a hearing upon
4the vendor's participation must be convened by the Illinois
5Department within 15 days after such suspension and completed
6without appreciable delay. Such hearing shall be held to
7determine whether to recommend to the Director that the
8vendor's medical assistance program participation be denied,
9terminated, suspended, placed on provisional status, or
10reinstated. In the hearing, any evidence relevant to the vendor
11constituting an immediate danger to the public may be
12introduced against such vendor; provided, however, that the
13vendor, or his or her counsel, shall have the opportunity to
14discredit, impeach, and submit evidence rebutting such
15evidence.
16    (H) Nothing contained in this Code shall in any way limit
17or otherwise impair the authority or power of any State agency
18responsible for licensing of vendors.
19    (I) Based on a finding of noncompliance on the part of a
20nursing home with any requirement for certification under Title
21XVIII or XIX of the Social Security Act (42 U.S.C. Sec. 1395 et
22seq. or 42 U.S.C. Sec. 1396 et seq.), the Illinois Department
23may impose one or more of the following remedies after notice
24to the facility:
25        (1) Termination of the provider agreement.
26        (2) Temporary management.

 

 

HB0027- 314 -LRB098 00027 KTG 30027 b

1        (3) Denial of payment for new admissions.
2        (4) Civil money penalties.
3        (5) Closure of the facility in emergency situations or
4    transfer of residents, or both.
5        (6) State monitoring.
6        (7) Denial of all payments when the Health Care Finance
7    Administration U.S. Department of Health and Human
8    Services has imposed this sanction.
9    The Illinois Department shall by rule establish criteria
10governing continued payments to a nursing facility subsequent
11to termination of the facility's provider agreement if, in the
12sole discretion of the Illinois Department, circumstances
13affecting the health, safety, and welfare of the facility's
14residents require those continued payments. The Illinois
15Department may condition those continued payments on the
16appointment of temporary management, sale of the facility to
17new owners or operators, or other arrangements that the
18Illinois Department determines best serve the needs of the
19facility's residents.
20    Except in the case of a facility that has a right to a
21hearing on the finding of noncompliance before an agency of the
22federal government, a facility may request a hearing before a
23State agency on any finding of noncompliance within 60 days
24after the notice of the intent to impose a remedy. Except in
25the case of civil money penalties, a request for a hearing
26shall not delay imposition of the penalty. The choice of

 

 

HB0027- 315 -LRB098 00027 KTG 30027 b

1remedies is not appealable at a hearing. The level of
2noncompliance may be challenged only in the case of a civil
3money penalty. The Illinois Department shall provide by rule
4for the State agency that will conduct the evidentiary
5hearings.
6    The Illinois Department may collect interest on unpaid
7civil money penalties.
8    The Illinois Department may adopt all rules necessary to
9implement this subsection (I).
10    (J) The Illinois Department, by rule, may permit individual
11practitioners to designate that Department payments that may be
12due the practitioner be made to an alternate payee or alternate
13payees.
14        (a) Such alternate payee or alternate payees shall be
15    required to register as an alternate payee in the Medical
16    Assistance Program with the Illinois Department.
17        (b) If a practitioner designates an alternate payee,
18    the alternate payee and practitioner shall be jointly and
19    severally liable to the Department for payments made to the
20    alternate payee. Pursuant to subsection (E) of this
21    Section, any Department action to suspend or deny payment
22    or recover money or overpayments from an alternate payee
23    shall be subject to an administrative hearing.
24        (c) Registration as an alternate payee or alternate
25    payees in the Illinois Medical Assistance Program shall be
26    conditional. At any time, the Illinois Department may deny

 

 

HB0027- 316 -LRB098 00027 KTG 30027 b

1    or cancel any alternate payee's registration in the
2    Illinois Medical Assistance Program without cause. Any
3    such denial or cancellation is not subject to an
4    administrative hearing.
5        (d) The Illinois Department may seek a revocation of
6    any alternate payee, and all owners, officers, and
7    individuals with management responsibility for such
8    alternate payee shall be permanently prohibited from
9    participating as an owner, an officer, or an individual
10    with management responsibility with an alternate payee in
11    the Illinois Medical Assistance Program, if after
12    reasonable notice and opportunity for a hearing the
13    Illinois Department finds that:
14            (1) the alternate payee is not complying with the
15        Department's policy or rules and regulations, or with
16        the terms and conditions prescribed by the Illinois
17        Department in its alternate payee registration
18        agreement; or
19            (2) the alternate payee has failed to keep or make
20        available for inspection, audit, or copying, after
21        receiving a written request from the Illinois
22        Department, such records regarding payments claimed as
23        an alternate payee; or
24            (3) the alternate payee has failed to furnish any
25        information requested by the Illinois Department
26        regarding payments claimed as an alternate payee; or

 

 

HB0027- 317 -LRB098 00027 KTG 30027 b

1            (4) the alternate payee has knowingly made, or
2        caused to be made, any false statement or
3        representation of a material fact in connection with
4        the administration of the Illinois Medical Assistance
5        Program; or
6            (5) the alternate payee, a person with management
7        responsibility for an alternate payee, an officer or
8        person owning, either directly or indirectly, 5% or
9        more of the shares of stock or other evidences of
10        ownership in a corporate alternate payee, or a partner
11        in a partnership which is an alternate payee:
12                (a) was previously terminated, suspended, or
13            excluded from participation as a vendor in the
14            Illinois Medical Assistance Program, or was
15            previously revoked as an alternate payee in the
16            Illinois Medical Assistance Program, or was
17            terminated, suspended, or excluded from
18            participation as a vendor in a medical assistance
19            program in another state that is of the same kind
20            as the program of medical assistance provided
21            under Article V of this Code; or
22                (b) was a person with management
23            responsibility for a vendor previously terminated,
24            suspended, or excluded from participation as a
25            vendor in the Illinois Medical Assistance Program,
26            or was previously revoked as an alternate payee in

 

 

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1            the Illinois Medical Assistance Program, or was
2            terminated, suspended, or excluded from
3            participation as a vendor in a medical assistance
4            program in another state that is of the same kind
5            as the program of medical assistance provided
6            under Article V of this Code, during the time of
7            conduct which was the basis for that vendor's
8            termination, suspension, or exclusion or alternate
9            payee's revocation; or
10                (c) was an officer, or person owning, either
11            directly or indirectly, 5% or more of the shares of
12            stock or other evidences of ownership in a
13            corporate vendor previously terminated, suspended,
14            or excluded from participation as a vendor in the
15            Illinois Medical Assistance Program, or was
16            previously revoked as an alternate payee in the
17            Illinois Medical Assistance Program, or was
18            terminated, suspended, or excluded from
19            participation as a vendor in a medical assistance
20            program in another state that is of the same kind
21            as the program of medical assistance provided
22            under Article V of this Code, during the time of
23            conduct which was the basis for that vendor's
24            termination, suspension, or exclusion; or
25                (d) was an owner of a sole proprietorship or
26            partner in a partnership previously terminated,

 

 

HB0027- 319 -LRB098 00027 KTG 30027 b

1            suspended, or excluded from participation as a
2            vendor in the Illinois Medical Assistance Program,
3            or was previously revoked as an alternate payee in
4            the Illinois Medical Assistance Program, or was
5            terminated, suspended, or excluded from
6            participation as a vendor in a medical assistance
7            program in another state that is of the same kind
8            as the program of medical assistance provided
9            under Article V of this Code, during the time of
10            conduct which was the basis for that vendor's
11            termination, suspension, or exclusion or alternate
12            payee's revocation; or
13            (6) the alternate payee, a person with management
14        responsibility for an alternate payee, an officer or
15        person owning, either directly or indirectly, 5% or
16        more of the shares of stock or other evidences of
17        ownership in a corporate alternate payee, or a partner
18        in a partnership which is an alternate payee:
19                (a) has engaged in conduct prohibited by
20            applicable federal or State law or regulation
21            relating to the Illinois Medical Assistance
22            Program; or
23                (b) was a person with management
24            responsibility for a vendor or alternate payee at
25            the time that the vendor or alternate payee engaged
26            in practices prohibited by applicable federal or

 

 

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1            State law or regulation relating to the Illinois
2            Medical Assistance Program; or
3                (c) was an officer, or person owning, either
4            directly or indirectly, 5% or more of the shares of
5            stock or other evidences of ownership in a vendor
6            or alternate payee at the time such vendor or
7            alternate payee engaged in practices prohibited by
8            applicable federal or State law or regulation
9            relating to the Illinois Medical Assistance
10            Program; or
11                (d) was an owner of a sole proprietorship or
12            partner in a partnership which was a vendor or
13            alternate payee at the time such vendor or
14            alternate payee engaged in practices prohibited by
15            applicable federal or State law or regulation
16            relating to the Illinois Medical Assistance
17            Program; or
18            (7) the direct or indirect ownership of the vendor
19        or alternate payee (including the ownership of a vendor
20        or alternate payee that is a partner's interest in a
21        vendor or alternate payee, or ownership of 5% or more
22        of the shares of stock or other evidences of ownership
23        in a corporate vendor or alternate payee) has been
24        transferred by an individual who is terminated,
25        suspended, or excluded or barred from participating as
26        a vendor or is prohibited or revoked as an alternate

 

 

HB0027- 321 -LRB098 00027 KTG 30027 b

1        payee to the individual's spouse, child, brother,
2        sister, parent, grandparent, grandchild, uncle, aunt,
3        niece, nephew, cousin, or relative by marriage.
4    (K) The Illinois Department of Healthcare and Family
5Services may withhold payments, in whole or in part, to a
6provider or alternate payee upon receipt of where there is
7credible evidence, received from State or federal law
8enforcement or federal oversight agencies or from the results
9of a preliminary Department audit and determined by the
10Department to be credible, that the circumstances giving rise
11to the need for a withholding of payments may involve fraud or
12willful misrepresentation under the Illinois Medical
13Assistance program. The Department shall by rule define what
14constitutes "credible" evidence for purposes of this
15subsection. The Department may withhold payments without first
16notifying the provider or alternate payee of its intention to
17withhold such payments. A provider or alternate payee may
18request a reconsideration of payment withholding, and the
19Department must grant such a request. The Department shall
20state by rule a process and criteria by which a provider or
21alternate payee may request full or partial release of payments
22withheld under this subsection. This request may be made at any
23time after the Department first withholds such payments.
24        (a) The Illinois Department must send notice of its
25    withholding of program payments within 5 days of taking
26    such action. The notice must set forth the general

 

 

HB0027- 322 -LRB098 00027 KTG 30027 b

1    allegations as to the nature of the withholding action, but
2    need not disclose any specific information concerning its
3    ongoing investigation. The notice must do all of the
4    following:
5            (1) State that payments are being withheld in
6        accordance with this subsection.
7            (2) State that the withholding is for a temporary
8        period, as stated in paragraph (b) of this subsection,
9        and cite the circumstances under which withholding
10        will be terminated.
11            (3) Specify, when appropriate, which type or types
12        of Medicaid claims withholding is effective.
13            (4) Inform the provider or alternate payee of the
14        right to submit written evidence for reconsideration
15        of the withholding by the Illinois Department.
16            (5) Inform the provider or alternate payee that a
17        written request may be made to the Illinois Department
18        for full or partial release of withheld payments and
19        that such requests may be made at any time after the
20        Department first withholds such payments.
21        (b) All withholding-of-payment actions under this
22    subsection shall be temporary and shall not continue after
23    any of the following:
24            (1) The Illinois Department or the prosecuting
25        authorities determine that there is insufficient
26        evidence of fraud or willful misrepresentation by the

 

 

HB0027- 323 -LRB098 00027 KTG 30027 b

1        provider or alternate payee.
2            (2) Legal proceedings related to the provider's or
3        alternate payee's alleged fraud, willful
4        misrepresentation, violations of this Act, or
5        violations of the Illinois Department's administrative
6        rules are completed.
7            (3) The withholding of payments for a period of 3
8        years.
9        (c) The Illinois Department may adopt all rules
10    necessary to implement this subsection (K).
11    (K-5) (Blank). The Illinois Department may withhold
12payments, in whole or in part, to a provider or alternate payee
13upon initiation of an audit, quality of care review,
14investigation when there is a credible allegation of fraud, or
15the provider or alternate payee demonstrating a clear failure
16to cooperate with the Illinois Department such that the
17circumstances give rise to the need for a withholding of
18payments. As used in this subsection, "credible allegation" is
19defined to include an allegation from any source, including,
20but not limited to, fraud hotline complaints, claims data
21mining, patterns identified through provider audits, civil
22actions filed under the False Claims Act, and law enforcement
23investigations. An allegation is considered to be credible when
24it has indicia of reliability. The Illinois Department may
25withhold payments without first notifying the provider or
26alternate payee of its intention to withhold such payments. A

 

 

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1provider or alternate payee may request a hearing or a
2reconsideration of payment withholding, and the Illinois
3Department must grant such a request. The Illinois Department
4shall state by rule a process and criteria by which a provider
5or alternate payee may request a hearing or a reconsideration
6for the full or partial release of payments withheld under this
7subsection. This request may be made at any time after the
8Illinois Department first withholds such payments.
9        (a) The Illinois Department must send notice of its
10    withholding of program payments within 5 days of taking
11    such action. The notice must set forth the general
12    allegations as to the nature of the withholding action but
13    need not disclose any specific information concerning its
14    ongoing investigation. The notice must do all of the
15    following:
16            (1) State that payments are being withheld in
17        accordance with this subsection.
18            (2) State that the withholding is for a temporary
19        period, as stated in paragraph (b) of this subsection,
20        and cite the circumstances under which withholding
21        will be terminated.
22            (3) Specify, when appropriate, which type or types
23        of claims are withheld.
24            (4) Inform the provider or alternate payee of the
25        right to request a hearing or a reconsideration of the
26        withholding by the Illinois Department, including the

 

 

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1        ability to submit written evidence.
2            (5) Inform the provider or alternate payee that a
3        written request may be made to the Illinois Department
4        for a hearing or a reconsideration for the full or
5        partial release of withheld payments and that such
6        requests may be made at any time after the Illinois
7        Department first withholds such payments.
8        (b) All withholding of payment actions under this
9    subsection shall be temporary and shall not continue after
10    any of the following:
11            (1) The Illinois Department determines that there
12        is insufficient evidence of fraud, or the provider or
13        alternate payee demonstrates clear cooperation with
14        the Illinois Department, as determined by the Illinois
15        Department, such that the circumstances do not give
16        rise to the need for withholding of payments; or
17            (2) The withholding of payments has lasted for a
18        period in excess of 3 years.
19        (c) The Illinois Department may adopt all rules
20    necessary to implement this subsection (K-5).
21    (L) (Blank). The Illinois Department shall establish a
22protocol to enable health care providers to disclose an actual
23or potential violation of this Section pursuant to a
24self-referral disclosure protocol, referred to in this
25subsection as "the protocol". The protocol shall include
26direction for health care providers on a specific person,

 

 

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1official, or office to whom such disclosures shall be made. The
2Illinois Department shall post information on the protocol on
3the Illinois Department's public website. The Illinois
4Department may adopt rules necessary to implement this
5subsection (L). In addition to other factors that the Illinois
6Department finds appropriate, the Illinois Department may
7consider a health care provider's timely use or failure to use
8the protocol in considering the provider's failure to comply
9with this Code.
10    (M) (Blank). Notwithstanding any other provision of this
11Code, the Illinois Department, at its discretion, may exempt an
12entity licensed under the Nursing Home Care Act and the ID/DD
13Community Care Act from the provisions of subsections (A-15),
14(B), and (C) of this Section if the licensed entity is in
15receivership.
16(Source: P.A. 97-689, eff. 6-14-12; revised 8-3-12.)
 
17    (305 ILCS 5/12-4.38)
18    Sec. 12-4.38. Special FamilyCare provisions.
19    (a) The Department of Healthcare and Family Services may
20submit to the Comptroller, and the Comptroller is authorized to
21pay, on behalf of persons enrolled in the FamilyCare Program,
22claims for services rendered to an enrollee during the period
23beginning October 1, 2007, and ending on the effective date of
24any rules adopted to implement the provisions of this
25amendatory Act of the 96th General Assembly. The authorization

 

 

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1for payment of claims applies only to bona fide claims for
2payment for services rendered. Any claim for payment which is
3authorized pursuant to the provisions of this amendatory Act of
4the 96th General Assembly must adhere to all other applicable
5rules, regulations, and requirements.
6    (b) Each person enrolled in the FamilyCare Program as of
7the effective date of this amendatory Act of the 98th General
8Assembly whose income exceeds 185% of the Federal Poverty
9Level, but is not more than 400% of the Federal Poverty Level,
10may remain enrolled in the FamilyCare Program pursuant to this
11subsection so long as that person continues to meet the
12eligibility criteria established under the emergency rule at 89
13Ill. Adm. Code 120 (Illinois Register Volume 31, page 15854)
14filed November 7, 2007. In no case may a person continue to be
15enrolled in the FamilyCare Program pursuant to this subsection
16if the person's income rises above 400% of the Federal Poverty
17Level or falls below 185% of the Federal Poverty Level at any
18subsequent time. Nothing contained in this subsection shall
19prevent an individual from enrolling in the FamilyCare Program
20as authorized by paragraph 15 of Section 5-2 of this Code if he
21or she otherwise qualifies under that Section.
22    (c) In implementing the provisions of this amendatory Act
23of the 98th General Assembly, the Department of Healthcare and
24Family Services is authorized to adopt only those rules
25necessary, including emergency rules. Nothing in this
26amendatory Act of the 98th General Assembly permits the

 

 

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1Department to adopt rules or issue a decision that expands
2eligibility for the FamilyCare Program to a person whose income
3exceeds 185% of the Federal Poverty Level as determined from
4time to time by the U.S. Department of Health and Human
5Services, unless the Department is provided with express
6statutory authority.
7(Source: P.A. 96-20, eff. 6-30-09; 97-689, eff. 6-14-12.)
 
8    (305 ILCS 5/12-4.39)
9    Sec. 12-4.39. Dental clinic grant program.
10    (a) Grant program. Subject On and after July 1, 2012, and
11subject to funding availability, the Department of Healthcare
12and Family Services shall may administer a grant program. The
13purpose of this grant program shall be to build the public
14infrastructure for dental care and to make grants to local
15health departments, federally qualified health clinics
16(FQHCs), and rural health clinics (RHCs) for development of
17comprehensive dental clinics for dental care services. The
18primary purpose of these new dental clinics will be to increase
19dental access for low-income and Department of Healthcare and
20Family Services clients who have no dental arrangements with a
21dental provider in a project's service area. The dental clinic
22must be willing to accept out-of-area clients who need dental
23services, including emergency services for adults and Early and
24Periodic Screening, Diagnosis and Treatment (EPSDT)-referral
25children. Medically Underserved Areas (MUAs) and Health

 

 

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1Professional Shortage Areas (HPSAs) shall receive special
2priority for grants under this program.
3    (b) Eligible applicants. The following entities are
4eligible to apply for grants:
5        (1) Local health departments.
6        (2) Federally Qualified Health Centers (FQHCs).
7        (3) Rural health clinics (RHCs).
8    (c) Use of grant moneys. Grant moneys must be used to
9support projects that develop dental services to meet the
10dental health care needs of Department of Healthcare and Family
11Services Dental Program clients. Grant moneys must be used for
12operating expenses, including, but not limited to: insurance;
13dental supplies and equipment; dental support services; and
14renovation expenses. Grant moneys may not be used to offset
15existing indebtedness, supplant existing funds, purchase real
16property, or pay for personnel service salaries for dental
17employees.
18    (d) Application process. The Department shall establish
19procedures for applying for dental clinic grants.
20(Source: P.A. 96-67, eff. 7-23-09; 96-1000, eff. 7-2-10;
2197-689, eff. 6-14-12.)
 
22    (305 ILCS 5/12-9)  (from Ch. 23, par. 12-9)
23    Sec. 12-9. Public Aid Recoveries Trust Fund; uses. The
24Public Aid Recoveries Trust Fund shall consist of (1)
25recoveries by the Department of Healthcare and Family Services

 

 

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1(formerly Illinois Department of Public Aid) authorized by this
2Code in respect to applicants or recipients under Articles III,
3IV, V, and VI, including recoveries made by the Department of
4Healthcare and Family Services (formerly Illinois Department
5of Public Aid) from the estates of deceased recipients, (2)
6recoveries made by the Department of Healthcare and Family
7Services (formerly Illinois Department of Public Aid) in
8respect to applicants and recipients under the Children's
9Health Insurance Program Act, and the Covering ALL KIDS Health
10Insurance Act, and the Senior Citizens and Disabled Persons
11Property Tax Relief and Pharmaceutical Assistance Act, (3)
12federal funds received on behalf of and earned by State
13universities and local governmental entities for services
14provided to applicants or recipients covered under this Code,
15the Children's Health Insurance Program Act, and the Covering
16ALL KIDS Health Insurance Act, and the Senior Citizens and
17Disabled Persons Property Tax Relief and Pharmaceutical
18Assistance Act, (3.5) federal financial participation revenue
19related to eligible disbursements made by the Department of
20Healthcare and Family Services from appropriations required by
21this Section, and (4) all other moneys received to the Fund,
22including interest thereon. The Fund shall be held as a special
23fund in the State Treasury.
24    Disbursements from this Fund shall be only (1) for the
25reimbursement of claims collected by the Department of
26Healthcare and Family Services (formerly Illinois Department

 

 

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1of Public Aid) through error or mistake, (2) for payment to
2persons or agencies designated as payees or co-payees on any
3instrument, whether or not negotiable, delivered to the
4Department of Healthcare and Family Services (formerly
5Illinois Department of Public Aid) as a recovery under this
6Section, such payment to be in proportion to the respective
7interests of the payees in the amount so collected, (3) for
8payments to the Department of Human Services for collections
9made by the Department of Healthcare and Family Services
10(formerly Illinois Department of Public Aid) on behalf of the
11Department of Human Services under this Code, the Children's
12Health Insurance Program Act, and the Covering ALL KIDS Health
13Insurance Act, (4) for payment of administrative expenses
14incurred in performing the activities authorized under this
15Code, the Children's Health Insurance Program Act, and the
16Covering ALL KIDS Health Insurance Act, and the Senior Citizens
17and Disabled Persons Property Tax Relief and Pharmaceutical
18Assistance Act, (5) for payment of fees to persons or agencies
19in the performance of activities pursuant to the collection of
20monies owed the State that are collected under this Code, the
21Children's Health Insurance Program Act, and the Covering ALL
22KIDS Health Insurance Act, (6) for payments of any amounts
23which are reimbursable to the federal government which are
24required to be paid by State warrant by either the State or
25federal government, and (7) for payments to State universities
26and local governmental entities of federal funds for services

 

 

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1provided to applicants or recipients covered under this Code,
2the Children's Health Insurance Program Act, and the Covering
3ALL KIDS Health Insurance Act, and the Senior Citizens and
4Disabled Persons Property Tax Relief and Pharmaceutical
5Assistance Act. Disbursements from this Fund for purposes of
6items (4) and (5) of this paragraph shall be subject to
7appropriations from the Fund to the Department of Healthcare
8and Family Services (formerly Illinois Department of Public
9Aid).
10    The balance in this Fund on the first day of each calendar
11quarter, after payment therefrom of any amounts reimbursable to
12the federal government, and minus the amount reasonably
13anticipated to be needed to make the disbursements during that
14quarter authorized by this Section, shall be certified by the
15Director of Healthcare and Family Services and transferred by
16the State Comptroller to the Drug Rebate Fund or the Healthcare
17Provider Relief Fund in the State Treasury, as appropriate,
18within 30 days of the first day of each calendar quarter. The
19Director of Healthcare and Family Services may certify and the
20State Comptroller shall transfer to the Drug Rebate Fund
21amounts on a more frequent basis.
22    On July 1, 1999, the State Comptroller shall transfer the
23sum of $5,000,000 from the Public Aid Recoveries Trust Fund
24(formerly the Public Assistance Recoveries Trust Fund) into the
25DHS Recoveries Trust Fund.
26(Source: P.A. 96-1100, eff. 1-1-11; 97-647, eff. 1-1-12;

 

 

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197-689, eff. 6-14-12.)
 
2    (305 ILCS 5/12-10.5)
3    Sec. 12-10.5. Medical Special Purposes Trust Fund.
4    (a) The Medical Special Purposes Trust Fund ("the Fund") is
5created. Any grant, gift, donation, or legacy of money or
6securities that the Department of Healthcare and Family
7Services is authorized to receive under Section 12-4.18 or
8Section 12-4.19 or any monies from any other source, and that
9is are dedicated for functions connected with the
10administration of any medical program administered by the
11Department, shall be deposited into the Fund. All federal
12moneys received by the Department as reimbursement for
13disbursements authorized to be made from the Fund shall also be
14deposited into the Fund. In addition, federal moneys received
15on account of State expenditures made in connection with
16obtaining compliance with the federal Health Insurance
17Portability and Accountability Act (HIPAA) shall be deposited
18into the Fund.
19    (b) No moneys received from a service provider or a
20governmental or private entity that is enrolled with the
21Department as a provider of medical services shall be deposited
22into the Fund.
23    (c) Disbursements may be made from the Fund for the
24purposes connected with the grants, gifts, donations, or
25legacies, or other monies deposited into the Fund, including,

 

 

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1but not limited to, medical quality assessment projects,
2eligibility population studies, medical information systems
3evaluations, and other administrative functions that assist
4the Department in fulfilling its health care mission under any
5medical program administered by the Department.
6(Source: P.A. 97-48, eff. 6-28-11; 97-689, eff. 6-14-12.)
 
7    (305 ILCS 5/12-13.1)
8    Sec. 12-13.1. Inspector General.
9    (a) The Governor shall appoint, and the Senate shall
10confirm, an Inspector General who shall function within the
11Illinois Department of Public Aid (now Healthcare and Family
12Services) and report to the Governor. The term of the Inspector
13General shall expire on the third Monday of January, 1997 and
14every 4 years thereafter.
15    (b) In order to prevent, detect, and eliminate fraud,
16waste, abuse, mismanagement, and misconduct, the Inspector
17General shall oversee the Department of Healthcare and Family
18Services' integrity functions, which include, but are not
19limited to, the following:
20        (1) Investigation of misconduct by employees, vendors,
21    contractors and medical providers, except for allegations
22    of violations of the State Officials and Employees Ethics
23    Act which shall be referred to the Office of the Governor's
24    Executive Inspector General for investigation.
25        (2) Audits Prepayment and post-payment audits of

 

 

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1    medical providers related to ensuring that appropriate
2    payments are made for services rendered and to the
3    prevention and recovery of overpayments.
4        (3) Monitoring of quality assurance programs generally
5    related to the medical assistance program and specifically
6    related to any managed care program administered by the
7    Department of Healthcare and Family Services.
8        (4) Quality control measurements of the programs
9    administered by the Department of Healthcare and Family
10    Services.
11        (5) Investigations of fraud or intentional program
12    violations committed by clients of the Department of
13    Healthcare and Family Services.
14        (6) Actions initiated against contractors, vendors, or
15    medical providers for any of the following reasons:
16            (A) Violations of the medical assistance program.
17            (B) Sanctions against providers brought in
18        conjunction with the Department of Public Health or the
19        Department of Human Services (as successor to the
20        Department of Mental Health and Developmental
21        Disabilities).
22            (C) Recoveries of assessments against hospitals
23        and long-term care facilities.
24            (D) Sanctions mandated by the United States
25        Department of Health and Human Services against
26        medical providers.

 

 

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1            (E) Violations of contracts related to any managed
2        care programs programs administered by the Department
3        of Healthcare and Family Services.
4        (7) Representation of the Department of Healthcare and
5    Family Services at hearings with the Illinois Department of
6    Financial and Professional Regulation in actions taken
7    against professional licenses held by persons who are in
8    violation of orders for child support payments.
9    (b-5) At the request of the Secretary of Human Services,
10the Inspector General shall, in relation to any function
11performed by the Department of Human Services as successor to
12the Department of Public Aid, exercise one or more of the
13powers provided under this Section as if those powers related
14to the Department of Human Services; in such matters, the
15Inspector General shall report his or her findings to the
16Secretary of Human Services.
17    (c) The Notwithstanding, and in addition to, any other
18provision of law, the Inspector General shall have access to
19all information, personnel and facilities of the Department of
20Healthcare and Family Services and the Department of Human
21Services (as successor to the Department of Public Aid), their
22employees, vendors, contractors and medical providers and any
23federal, State or local governmental agency that are necessary
24to perform the duties of the Office as directly related to
25public assistance programs administered by those departments.
26No medical provider shall be compelled, however, to provide

 

 

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1individual medical records of patients who are not clients of
2the Medical Assistance Program programs administered by the
3Department of Healthcare and Family Services. State and local
4governmental agencies are authorized and directed to provide
5the requested information, assistance or cooperation.
6    For purposes of enhanced program integrity functions and
7oversight, and to the extent consistent with applicable
8information and privacy, security, and disclosure laws, State
9agencies and departments shall provide the Office of Inspector
10General access to confidential and other information and data,
11and the Inspector General is authorized to enter into
12agreements with appropriate federal agencies and departments
13to secure similar data. This includes, but is not limited to,
14information pertaining to: licensure; certification; earnings;
15immigration status; citizenship; wage reporting; unearned and
16earned income; pension income; employment; supplemental
17security income; social security numbers; National Provider
18Identifier (NPI) numbers; the National Practitioner Data Bank
19(NPDB); program and agency exclusions; taxpayer identification
20numbers; tax delinquency; corporate information; and death
21records.
22    The Inspector General shall enter into agreements with
23State agencies and departments, and is authorized to enter into
24agreements with federal agencies and departments, under which
25such agencies and departments shall share data necessary for
26medical assistance program integrity functions and oversight.

 

 

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1The Inspector General shall enter into agreements with State
2agencies and departments, and is authorized to enter into
3agreements with federal agencies and departments, under which
4such agencies shall share data necessary for recipient and
5vendor screening, review, and investigation, including but not
6limited to vendor payment and recipient eligibility
7verification. The Inspector General shall develop, in
8cooperation with other State and federal agencies and
9departments, and in compliance with applicable federal laws and
10regulations, appropriate and effective methods to share such
11data. The Inspector General shall enter into agreements with
12State agencies and departments, and is authorized to enter into
13agreements with federal agencies and departments, including,
14but not limited to: the Secretary of State; the Department of
15Revenue; the Department of Public Health; the Department of
16Human Services; and the Department of Financial and
17Professional Regulation.
18    The Inspector General shall have the authority to deny
19payment, prevent overpayments, and recover overpayments.
20    The Inspector General shall have the authority to deny or
21suspend payment to, and deny, terminate, or suspend the
22eligibility of, any vendor who fails to grant the Inspector
23General timely access to full and complete records, including
24records of recipients under the medical assistance program for
25the most recent 6 years, in accordance with Section 140.28 of
26Title 89 of the Illinois Administrative Code, and other

 

 

HB0027- 339 -LRB098 00027 KTG 30027 b

1information for the purpose of audits, investigations, or other
2program integrity functions, after reasonable written request
3by the Inspector General.
4    (d) The Inspector General shall serve as the Department of
5Healthcare and Family Services' primary liaison with law
6enforcement, investigatory and prosecutorial agencies,
7including but not limited to the following:
8        (1) The Department of State Police.
9        (2) The Federal Bureau of Investigation and other
10    federal law enforcement agencies.
11        (3) The various Inspectors General of federal agencies
12    overseeing the programs administered by the Department of
13    Healthcare and Family Services.
14        (4) The various Inspectors General of any other State
15    agencies with responsibilities for portions of programs
16    primarily administered by the Department of Healthcare and
17    Family Services.
18        (5) The Offices of the several United States Attorneys
19    in Illinois.
20        (6) The several State's Attorneys.
21        (7) (Blank). The offices of the Centers for Medicare
22    and Medicaid Services that administer the Medicare and
23    Medicaid integrity programs.
24    The Inspector General shall meet on a regular basis with
25these entities to share information regarding possible
26misconduct by any persons or entities involved with the public

 

 

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1aid programs administered by the Department of Healthcare and
2Family Services.
3    (e) All investigations conducted by the Inspector General
4shall be conducted in a manner that ensures the preservation of
5evidence for use in criminal prosecutions. If the Inspector
6General determines that a possible criminal act relating to
7fraud in the provision or administration of the medical
8assistance program has been committed, the Inspector General
9shall immediately notify the Medicaid Fraud Control Unit. If
10the Inspector General determines that a possible criminal act
11has been committed within the jurisdiction of the Office, the
12Inspector General may request the special expertise of the
13Department of State Police. The Inspector General may present
14for prosecution the findings of any criminal investigation to
15the Office of the Attorney General, the Offices of the several
16United States Attorneys in Illinois or the several State's
17Attorneys.
18    (f) To carry out his or her duties as described in this
19Section, the Inspector General and his or her designees shall
20have the power to compel by subpoena the attendance and
21testimony of witnesses and the production of books, electronic
22records and papers as directly related to public assistance
23programs administered by the Department of Healthcare and
24Family Services or the Department of Human Services (as
25successor to the Department of Public Aid). No medical provider
26shall be compelled, however, to provide individual medical

 

 

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1records of patients who are not clients of the Medical
2Assistance Program.
3    (g) The Inspector General shall report all convictions,
4terminations, and suspensions taken against vendors,
5contractors and medical providers to the Department of
6Healthcare and Family Services and to any agency responsible
7for licensing or regulating those persons or entities.
8    (h) The Inspector General shall make annual reports,
9findings, and recommendations regarding the Office's
10investigations into reports of fraud, waste, abuse,
11mismanagement, or misconduct relating to any public aid
12programs administered by the Department of Healthcare and
13Family Services or the Department of Human Services (as
14successor to the Department of Public Aid) to the General
15Assembly and the Governor. These reports shall include, but not
16be limited to, the following information:
17        (1) Aggregate provider billing and payment
18    information, including the number of providers at various
19    Medicaid earning levels.
20        (2) The number of audits of the medical assistance
21    program and the dollar savings resulting from those audits.
22        (3) The number of prescriptions rejected annually
23    under the Department of Healthcare and Family Services'
24    Refill Too Soon program and the dollar savings resulting
25    from that program.
26        (4) Provider sanctions, in the aggregate, including

 

 

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1    terminations and suspensions.
2        (5) A detailed summary of the investigations
3    undertaken in the previous fiscal year. These summaries
4    shall comply with all laws and rules regarding maintaining
5    confidentiality in the public aid programs.
6    (i) Nothing in this Section shall limit investigations by
7the Department of Healthcare and Family Services or the
8Department of Human Services that may otherwise be required by
9law or that may be necessary in their capacity as the central
10administrative authorities responsible for administration of
11public aid their agency's programs in this State.
12    (j) The Inspector General may issue shields or other
13distinctive identification to his or her employees not
14exercising the powers of a peace officer if the Inspector
15General determines that a shield or distinctive identification
16is needed by an employee to carry out his or her
17responsibilities.
18(Source: P.A. 96-555, eff. 8-18-09; 96-1316, eff. 1-1-11;
1997-689, eff. 6-14-12.)
 
20    (305 ILCS 5/14-8)  (from Ch. 23, par. 14-8)
21    Sec. 14-8. Disbursements to Hospitals.
22    (a) For inpatient hospital services rendered on and after
23September 1, 1991, the Illinois Department shall reimburse
24hospitals for inpatient services at an inpatient payment rate
25calculated for each hospital based upon the Medicare

 

 

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1Prospective Payment System as set forth in Sections 1886(b),
2(d), (g), and (h) of the federal Social Security Act, and the
3regulations, policies, and procedures promulgated thereunder,
4except as modified by this Section. Payment rates for inpatient
5hospital services rendered on or after September 1, 1991 and on
6or before September 30, 1992 shall be calculated using the
7Medicare Prospective Payment rates in effect on September 1,
81991. Payment rates for inpatient hospital services rendered on
9or after October 1, 1992 and on or before March 31, 1994 shall
10be calculated using the Medicare Prospective Payment rates in
11effect on September 1, 1992. Payment rates for inpatient
12hospital services rendered on or after April 1, 1994 shall be
13calculated using the Medicare Prospective Payment rates
14(including the Medicare grouping methodology and weighting
15factors as adjusted pursuant to paragraph (1) of this
16subsection) in effect 90 days prior to the date of admission.
17For services rendered on or after July 1, 1995, the
18reimbursement methodology implemented under this subsection
19shall not include those costs referred to in Sections
201886(d)(5)(B) and 1886(h) of the Social Security Act. The
21additional payment amounts required under Section
221886(d)(5)(F) of the Social Security Act, for hospitals serving
23a disproportionate share of low-income or indigent patients,
24are not required under this Section. For hospital inpatient
25services rendered on or after July 1, 1995, the Illinois
26Department shall reimburse hospitals using the relative

 

 

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1weighting factors and the base payment rates calculated for
2each hospital that were in effect on June 30, 1995, less the
3portion of such rates attributed by the Illinois Department to
4the cost of medical education.
5        (1) The weighting factors established under Section
6    1886(d)(4) of the Social Security Act shall not be used in
7    the reimbursement system established under this Section.
8    Rather, the Illinois Department shall establish by rule
9    Medicaid weighting factors to be used in the reimbursement
10    system established under this Section.
11        (2) The Illinois Department shall define by rule those
12    hospitals or distinct parts of hospitals that shall be
13    exempt from the reimbursement system established under
14    this Section. In defining such hospitals, the Illinois
15    Department shall take into consideration those hospitals
16    exempt from the Medicare Prospective Payment System as of
17    September 1, 1991. For hospitals defined as exempt under
18    this subsection, the Illinois Department shall by rule
19    establish a reimbursement system for payment of inpatient
20    hospital services rendered on and after September 1, 1991.
21    For all hospitals that are children's hospitals as defined
22    in Section 5-5.02 of this Code, the reimbursement
23    methodology shall, through June 30, 1992, net of all
24    applicable fees, at least equal each children's hospital
25    1990 ICARE payment rates, indexed to the current year by
26    application of the DRI hospital cost index from 1989 to the

 

 

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1    year in which payments are made. Excepting county providers
2    as defined in Article XV of this Code, hospitals licensed
3    under the University of Illinois Hospital Act, and
4    facilities operated by the Department of Mental Health and
5    Developmental Disabilities (or its successor, the
6    Department of Human Services) for hospital inpatient
7    services rendered on or after July 1, 1995, the Illinois
8    Department shall reimburse children's hospitals, as
9    defined in 89 Illinois Administrative Code Section
10    149.50(c)(3), at the rates in effect on June 30, 1995, and
11    shall reimburse all other hospitals at the rates in effect
12    on June 30, 1995, less the portion of such rates attributed
13    by the Illinois Department to the cost of medical
14    education. For inpatient hospital services provided on or
15    after August 1, 1998, the Illinois Department may establish
16    by rule a means of adjusting the rates of children's
17    hospitals, as defined in 89 Illinois Administrative Code
18    Section 149.50(c)(3), that did not meet that definition on
19    June 30, 1995, in order for the inpatient hospital rates of
20    such hospitals to take into account the average inpatient
21    hospital rates of those children's hospitals that did meet
22    the definition of children's hospitals on June 30, 1995.
23        (3) (Blank).
24        (4) Notwithstanding any other provision of this
25    Section, hospitals that on August 31, 1991, have a contract
26    with the Illinois Department under Section 3-4 of the

 

 

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1    Illinois Health Finance Reform Act may elect to continue to
2    be reimbursed at rates stated in such contracts for general
3    and specialty care.
4        (5) In addition to any payments made under this
5    subsection (a), the Illinois Department shall make the
6    adjustment payments required by Section 5-5.02 of this
7    Code; provided, that in the case of any hospital reimbursed
8    under a per case methodology, the Illinois Department shall
9    add an amount equal to the product of the hospital's
10    average length of stay, less one day, multiplied by 20, for
11    inpatient hospital services rendered on or after September
12    1, 1991 and on or before September 30, 1992.
13    (b) (Blank).
14    (b-5) Excepting county providers as defined in Article XV
15of this Code, hospitals licensed under the University of
16Illinois Hospital Act, and facilities operated by the Illinois
17Department of Mental Health and Developmental Disabilities (or
18its successor, the Department of Human Services), for
19outpatient services rendered on or after July 1, 1995 and
20before July 1, 1998 the Illinois Department shall reimburse
21children's hospitals, as defined in the Illinois
22Administrative Code Section 149.50(c)(3), at the rates in
23effect on June 30, 1995, less that portion of such rates
24attributed by the Illinois Department to the outpatient
25indigent volume adjustment and shall reimburse all other
26hospitals at the rates in effect on June 30, 1995, less the

 

 

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1portions of such rates attributed by the Illinois Department to
2the cost of medical education and attributed by the Illinois
3Department to the outpatient indigent volume adjustment. For
4outpatient services provided on or after July 1, 1998,
5reimbursement rates shall be established by rule.
6    (c) In addition to any other payments under this Code, the
7Illinois Department shall develop a hospital disproportionate
8share reimbursement methodology that, effective July 1, 1991,
9through September 30, 1992, shall reimburse hospitals
10sufficiently to expend the fee monies described in subsection
11(b) of Section 14-3 of this Code and the federal matching funds
12received by the Illinois Department as a result of expenditures
13made by the Illinois Department as required by this subsection
14(c) and Section 14-2 that are attributable to fee monies
15deposited in the Fund, less amounts applied to adjustment
16payments under Section 5-5.02.
17    (d) Critical Care Access Payments.
18        (1) In addition to any other payments made under this
19    Code, the Illinois Department shall develop a
20    reimbursement methodology that shall reimburse Critical
21    Care Access Hospitals for the specialized services that
22    qualify them as Critical Care Access Hospitals. No
23    adjustment payments shall be made under this subsection on
24    or after July 1, 1995.
25        (2) "Critical Care Access Hospitals" includes, but is
26    not limited to, hospitals that meet at least one of the

 

 

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1    following criteria:
2            (A) Hospitals located outside of a metropolitan
3        statistical area that are designated as Level II
4        Perinatal Centers and that provide a disproportionate
5        share of perinatal services to recipients; or
6            (B) Hospitals that are designated as Level I Trauma
7        Centers (adult or pediatric) and certain Level II
8        Trauma Centers as determined by the Illinois
9        Department; or
10            (C) Hospitals located outside of a metropolitan
11        statistical area and that provide a disproportionate
12        share of obstetrical services to recipients.
13    (e) Inpatient high volume adjustment. For hospital
14inpatient services, effective with rate periods beginning on or
15after October 1, 1993, in addition to rates paid for inpatient
16services by the Illinois Department, the Illinois Department
17shall make adjustment payments for inpatient services
18furnished by Medicaid high volume hospitals. The Illinois
19Department shall establish by rule criteria for qualifying as a
20Medicaid high volume hospital and shall establish by rule a
21reimbursement methodology for calculating these adjustment
22payments to Medicaid high volume hospitals. No adjustment
23payment shall be made under this subsection for services
24rendered on or after July 1, 1995.
25    (f) The Illinois Department shall modify its current rules
26governing adjustment payments for targeted access, critical

 

 

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1care access, and uncompensated care to classify those
2adjustment payments as not being payments to disproportionate
3share hospitals under Title XIX of the federal Social Security
4Act. Rules adopted under this subsection shall not be effective
5with respect to services rendered on or after July 1, 1995. The
6Illinois Department has no obligation to adopt or implement any
7rules or make any payments under this subsection for services
8rendered on or after July 1, 1995.
9    (f-5) The State recognizes that adjustment payments to
10hospitals providing certain services or incurring certain
11costs may be necessary to assure that recipients of medical
12assistance have adequate access to necessary medical services.
13These adjustments include payments for teaching costs and
14uncompensated care, trauma center payments, rehabilitation
15hospital payments, perinatal center payments, obstetrical care
16payments, targeted access payments, Medicaid high volume
17payments, and outpatient indigent volume payments. On or before
18April 1, 1995, the Illinois Department shall issue
19recommendations regarding (i) reimbursement mechanisms or
20adjustment payments to reflect these costs and services,
21including methods by which the payments may be calculated and
22the method by which the payments may be financed, and (ii)
23reimbursement mechanisms or adjustment payments to reflect
24costs and services of federally qualified health centers with
25respect to recipients of medical assistance.
26    (g) If one or more hospitals file suit in any court

 

 

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1challenging any part of this Article XIV, payments to hospitals
2under this Article XIV shall be made only to the extent that
3sufficient monies are available in the Fund and only to the
4extent that any monies in the Fund are not prohibited from
5disbursement under any order of the court.
6    (h) Payments under the disbursement methodology described
7in this Section are subject to approval by the federal
8government in an appropriate State plan amendment.
9    (i) The Illinois Department may by rule establish criteria
10for and develop methodologies for adjustment payments to
11hospitals participating under this Article.
12    (j) Hospital Residing Long Term Care Services. In addition
13to any other payments made under this Code, the Illinois
14Department may by rule establish criteria and develop
15methodologies for payments to hospitals for Hospital Residing
16Long Term Care Services.
17    (k) Critical Access Hospital outpatient payments. In
18addition to any other payments authorized under this Code, the
19Illinois Department shall reimburse critical access hospitals,
20as designated by the Illinois Department of Public Health in
21accordance with 42 CFR 485, Subpart F, for outpatient services
22at an amount that is no less than the cost of providing such
23services, based on Medicare cost principles. Payments under
24this subsection shall be subject to appropriation.
25    (l) (Blank). On and after July 1, 2012, the Department
26shall reduce any rate of reimbursement for services or other

 

 

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1payments or alter any methodologies authorized by this Code to
2reduce any rate of reimbursement for services or other payments
3in accordance with Section 5-5e.
4(Source: P.A. 96-1382, eff. 1-1-11; 97-689, eff. 6-14-12;
5revised 8-3-12.)
 
6    (305 ILCS 5/15-1)  (from Ch. 23, par. 15-1)
7    Sec. 15-1. Definitions. As used in this Article, unless the
8context requires otherwise:
9    (a) "Base amount" means $108,800,000 multiplied by a
10fraction, the numerator of which is the number of days
11represented by the payments in question and the denominator of
12which is 365. (Blank).
13    (a-5) "County provider" means a health care provider that
14is, or is operated by, a county with a population greater than
153,000,000.
16    (b) "Fund" means the County Provider Trust Fund.
17    (c) "Hospital" or "County hospital" means a hospital, as
18defined in Section 14-1 of this Code, which is a county
19hospital located in a county of over 3,000,000 population.
20(Source: P.A. 97-687, eff. 6-14-12; 97-689, eff. 6-14-12.)
 
21    (305 ILCS 5/5-2b rep.)
22    (305 ILCS 5/5-2.1d rep.)
23    (305 ILCS 5/5-5e rep.)
24    305 ILCS 5/5-5e.1 rep.)

 

 

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1    (305 ILCS 5/5-5f rep.)
2    (305 ILCS 5/5A-15 rep.)
3    (305 ILCS 5/11-5.2 rep.)
4    (305 ILCS 5/11-5.3 rep.)
5    (305 ILCS 5/14-11 rep.)
6    Section 2-76. The Illinois Public Aid Code is amended by
7repealing Sections 5-2b, 5-2.1d, 5-5e, 5-5e.1, 5-5f, 5A-15,
811-5.2, 11-5.3, and 14-11.
 
9    (305 ILCS 60/3 rep.)
10    Section 2-85.The Pediatric Palliative Care Act is amended
11by repealing Section 3.
 
12    Section 2-90. The Senior Citizens and Disabled Persons
13Property Tax Relief Act is amended by changing the title of the
14Act and Sections 1, 1.5, 2, 3.05a, 3.10, 4, 4.05, 5, 6, 7, 8, 9,
1512, and 13 and by adding Section 4.2 as follows:
 
16    (320 ILCS 25/Act title)
17An Act in relation to the payment of grants to enable the
18elderly and the disabled to acquire or retain private housing
19and to acquire prescription drugs.
 
20    (320 ILCS 25/1)  (from Ch. 67 1/2, par. 401)
21    Sec. 1. Short title; common name. This Article shall be
22known and may be cited as the Senior Citizens and Disabled

 

 

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1Persons Property Tax Relief and Pharmaceutical Assistance Act.
2Common references to the "Circuit Breaker Act" mean this
3Article. As used in this Article, "this Act" means this
4Article.
5(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
6    (320 ILCS 25/1.5)
7    Sec. 1.5. Implementation of Executive Order No. 3 of 2004;
8termination of the Illinois Senior Citizens and Disabled
9Persons Pharmaceutical Assistance Program. Executive Order No.
103 of 2004, in part, provided for the transfer of the programs
11under this Act from the Department of Revenue to the Department
12on Aging and the Department of Healthcare and Family Services.
13It is the purpose of this amendatory Act of the 96th General
14Assembly to conform this Act and certain related provisions of
15other statutes to that Executive Order. This amendatory Act of
16the 96th General Assembly also makes other substantive changes
17to this Act.
18    It is the purpose of this amendatory Act of the 97th
19General Assembly to terminate the Illinois Senior Citizens and
20Disabled Persons Pharmaceutical Assistance Program on July 1,
212012.
22(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
23    (320 ILCS 25/2)  (from Ch. 67 1/2, par. 402)
24    Sec. 2. Purpose. The purpose of this Act is to provide

 

 

HB0027- 354 -LRB098 00027 KTG 30027 b

1incentives to the senior citizens and disabled persons of this
2State to acquire and retain private housing of their choice and
3at the same time to relieve those citizens from the burdens of
4extraordinary property taxes and rising drug costs against
5their increasingly restricted earning power, and thereby to
6reduce the requirements for public housing in this State.
7(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
8    (320 ILCS 25/3.05a)
9    Sec. 3.05a. Additional resident. "Additional resident"
10means a person who (i) is living in the same residence with a
11claimant for the claim year and at the time of filing the
12claim, (ii) is not the spouse of the claimant, (iii) does not
13file a separate claim under this Act for the same period, and
14(iv) receives more than half of his or her total financial
15support for that claim year from the household. An Prior to
16July 1, 2012, an additional resident who meets qualifications
17may receive pharmaceutical assistance based on a claimant's
18application.
19(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
20    (320 ILCS 25/3.10)  (from Ch. 67 1/2, par. 403.10)
21    Sec. 3.10. Regulations. "Regulations" includes both rules
22promulgated and forms prescribed by the applicable Department.
23In this Act, references to the rules of the Department on Aging
24or the Department of Healthcare and Family Services, in effect

 

 

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1prior to July 1, 2012, shall be deemed to include, in
2appropriate cases, the corresponding rules adopted by the
3Department of Revenue, to the extent that those rules continue
4in force under Executive Order No. 3 of 2004.
5(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
6    (320 ILCS 25/4)  (from Ch. 67 1/2, par. 404)
7    Sec. 4. Amount of Grant.
8    (a) In general. Any individual 65 years or older or any
9individual who will become 65 years old during the calendar
10year in which a claim is filed, and any surviving spouse of
11such a claimant, who at the time of death received or was
12entitled to receive a grant pursuant to this Section, which
13surviving spouse will become 65 years of age within the 24
14months immediately following the death of such claimant and
15which surviving spouse but for his or her age is otherwise
16qualified to receive a grant pursuant to this Section, and any
17disabled person whose annual household income is less than the
18income eligibility limitation, as defined in subsection (a-5)
19and whose household is liable for payment of property taxes
20accrued or has paid rent constituting property taxes accrued
21and is domiciled in this State at the time he or she files his
22or her claim is entitled to claim a grant under this Act. With
23respect to claims filed by individuals who will become 65 years
24old during the calendar year in which a claim is filed, the
25amount of any grant to which that household is entitled shall

 

 

HB0027- 356 -LRB098 00027 KTG 30027 b

1be an amount equal to 1/12 of the amount to which the claimant
2would otherwise be entitled as provided in this Section,
3multiplied by the number of months in which the claimant was 65
4in the calendar year in which the claim is filed.
5    (a-5) Income eligibility limitation. For purposes of this
6Section, "income eligibility limitation" means an amount for
7grant years 2008 and thereafter:
8        (1) less than $22,218 for a household containing one
9    person;
10        (2) less than $29,480 for a household containing 2
11    persons; or
12        (3) less than $36,740 for a household containing 3 or
13    more persons.
14    For 2009 claim year applications submitted during calendar
15year 2010, a household must have annual household income of
16less than $27,610 for a household containing one person; less
17than $36,635 for a household containing 2 persons; or less than
18$45,657 for a household containing 3 or more persons.
19    The Department on Aging may adopt rules such that on
20January 1, 2011, and thereafter, the foregoing household income
21eligibility limits may be changed to reflect the annual cost of
22living adjustment in Social Security and Supplemental Security
23Income benefits that are applicable to the year for which those
24benefits are being reported as income on an application.
25    If a person files as a surviving spouse, then only his or
26her income shall be counted in determining his or her household

 

 

HB0027- 357 -LRB098 00027 KTG 30027 b

1income.
2    (b) Limitation. Except as otherwise provided in
3subsections (a) and (f) of this Section, the maximum amount of
4grant which a claimant is entitled to claim is the amount by
5which the property taxes accrued which were paid or payable
6during the last preceding tax year or rent constituting
7property taxes accrued upon the claimant's residence for the
8last preceding taxable year exceeds 3 1/2% of the claimant's
9household income for that year but in no event is the grant to
10exceed (i) $700 less 4.5% of household income for that year for
11those with a household income of $14,000 or less or (ii) $70 if
12household income for that year is more than $14,000.
13    (c) Public aid recipients. If household income in one or
14more months during a year includes cash assistance in excess of
15$55 per month from the Department of Healthcare and Family
16Services or the Department of Human Services (acting as
17successor to the Department of Public Aid under the Department
18of Human Services Act) which was determined under regulations
19of that Department on a measure of need that included an
20allowance for actual rent or property taxes paid by the
21recipient of that assistance, the amount of grant to which that
22household is entitled, except as otherwise provided in
23subsection (a), shall be the product of (1) the maximum amount
24computed as specified in subsection (b) of this Section and (2)
25the ratio of the number of months in which household income did
26not include such cash assistance over $55 to the number twelve.

 

 

HB0027- 358 -LRB098 00027 KTG 30027 b

1If household income did not include such cash assistance over
2$55 for any months during the year, the amount of the grant to
3which the household is entitled shall be the maximum amount
4computed as specified in subsection (b) of this Section. For
5purposes of this paragraph (c), "cash assistance" does not
6include any amount received under the federal Supplemental
7Security Income (SSI) program.
8    (d) Joint ownership. If title to the residence is held
9jointly by the claimant with a person who is not a member of
10his or her household, the amount of property taxes accrued used
11in computing the amount of grant to which he or she is entitled
12shall be the same percentage of property taxes accrued as is
13the percentage of ownership held by the claimant in the
14residence.
15    (e) More than one residence. If a claimant has occupied
16more than one residence in the taxable year, he or she may
17claim only one residence for any part of a month. In the case
18of property taxes accrued, he or she shall prorate 1/12 of the
19total property taxes accrued on his or her residence to each
20month that he or she owned and occupied that residence; and, in
21the case of rent constituting property taxes accrued, shall
22prorate each month's rent payments to the residence actually
23occupied during that month.
24    (f) (Blank).
25    (g) Effective January 1, 2006, there is hereby established
26a program of pharmaceutical assistance to the aged and

 

 

HB0027- 359 -LRB098 00027 KTG 30027 b

1disabled, entitled the Illinois Seniors and Disabled Drug
2Coverage Program, which shall be administered by the Department
3of Healthcare and Family Services and the Department on Aging
4in accordance with this subsection, to consist of coverage of
5specified prescription drugs on behalf of beneficiaries of the
6program as set forth in this subsection. Notwithstanding any
7provisions of this Act to the contrary, on and after July 1,
82012, pharmaceutical assistance under this Act shall no longer
9be provided, and on July 1, 2012 the Illinois Senior Citizens
10and Disabled Persons Pharmaceutical Assistance Program shall
11terminate. The following provisions that concern the Illinois
12Senior Citizens and Disabled Persons Pharmaceutical Assistance
13Program shall continue to apply on and after July 1, 2012 to
14the extent necessary to pursue any actions authorized by
15subsection (d) of Section 9 of this Act with respect to acts
16which took place prior to July 1, 2012.
17    To become a beneficiary under the program established under
18this subsection, a person must:
19        (1) be (i) 65 years of age or older or (ii) disabled;
20    and
21        (2) be domiciled in this State; and
22        (3) enroll with a qualified Medicare Part D
23    Prescription Drug Plan if eligible and apply for all
24    available subsidies under Medicare Part D; and
25        (4) for the 2006 and 2007 claim years, have a maximum
26    household income of (i) less than $21,218 for a household

 

 

HB0027- 360 -LRB098 00027 KTG 30027 b

1    containing one person, (ii) less than $28,480 for a
2    household containing 2 persons, or (iii) less than $35,740
3    for a household containing 3 or more persons; and
4        (5) for the 2008 claim year, have a maximum household
5    income of (i) less than $22,218 for a household containing
6    one person, (ii) $29,480 for a household containing 2
7    persons, or (iii) $36,740 for a household containing 3 or
8    more persons; and
9        (6) for 2009 claim year applications submitted during
10    calendar year 2010, have annual household income of less
11    than (i) $27,610 for a household containing one person;
12    (ii) less than $36,635 for a household containing 2
13    persons; or (iii) less than $45,657 for a household
14    containing 3 or more persons; and
15        (7) as of September 1, 2011, have a maximum household
16    income at or below 200% of the federal poverty level.
17    All individuals enrolled as of December 31, 2005, in the
18pharmaceutical assistance program operated pursuant to
19subsection (f) of this Section and all individuals enrolled as
20of December 31, 2005, in the SeniorCare Medicaid waiver program
21operated pursuant to Section 5-5.12a of the Illinois Public Aid
22Code shall be automatically enrolled in the program established
23by this subsection for the first year of operation without the
24need for further application, except that they must apply for
25Medicare Part D and the Low Income Subsidy under Medicare Part
26D. A person enrolled in the pharmaceutical assistance program

 

 

HB0027- 361 -LRB098 00027 KTG 30027 b

1operated pursuant to subsection (f) of this Section as of
2December 31, 2005, shall not lose eligibility in future years
3due only to the fact that they have not reached the age of 65.
4    To the extent permitted by federal law, the Department may
5act as an authorized representative of a beneficiary in order
6to enroll the beneficiary in a Medicare Part D Prescription
7Drug Plan if the beneficiary has failed to choose a plan and,
8where possible, to enroll beneficiaries in the low-income
9subsidy program under Medicare Part D or assist them in
10enrolling in that program.
11    Beneficiaries under the program established under this
12subsection shall be divided into the following 4 eligibility
13groups:
14        (A) Eligibility Group 1 shall consist of beneficiaries
15    who are not eligible for Medicare Part D coverage and who
16    are:
17            (i) disabled and under age 65; or
18            (ii) age 65 or older, with incomes over 200% of the
19        Federal Poverty Level; or
20            (iii) age 65 or older, with incomes at or below
21        200% of the Federal Poverty Level and not eligible for
22        federally funded means-tested benefits due to
23        immigration status.
24        (B) Eligibility Group 2 shall consist of beneficiaries
25    who are eligible for Medicare Part D coverage.
26        (C) Eligibility Group 3 shall consist of beneficiaries

 

 

HB0027- 362 -LRB098 00027 KTG 30027 b

1    age 65 or older, with incomes at or below 200% of the
2    Federal Poverty Level, who are not barred from receiving
3    federally funded means-tested benefits due to immigration
4    status and are not eligible for Medicare Part D coverage.
5        If the State applies and receives federal approval for
6    a waiver under Title XIX of the Social Security Act,
7    persons in Eligibility Group 3 shall continue to receive
8    benefits through the approved waiver, and Eligibility
9    Group 3 may be expanded to include disabled persons under
10    age 65 with incomes under 200% of the Federal Poverty Level
11    who are not eligible for Medicare and who are not barred
12    from receiving federally funded means-tested benefits due
13    to immigration status.
14        (D) Eligibility Group 4 shall consist of beneficiaries
15    who are otherwise described in Eligibility Group 2 who have
16    a diagnosis of HIV or AIDS.
17    The program established under this subsection shall cover
18the cost of covered prescription drugs in excess of the
19beneficiary cost-sharing amounts set forth in this paragraph
20that are not covered by Medicare. The Department of Healthcare
21and Family Services may establish by emergency rule changes in
22cost-sharing necessary to conform the cost of the program to
23the amounts appropriated for State fiscal year 2012 and future
24fiscal years except that the 24-month limitation on the
25adoption of emergency rules and the provisions of Sections
265-115 and 5-125 of the Illinois Administrative Procedure Act

 

 

HB0027- 363 -LRB098 00027 KTG 30027 b

1shall not apply to rules adopted under this subsection (g). The
2adoption of emergency rules authorized by this subsection (g)
3shall be deemed to be necessary for the public interest,
4safety, and welfare.
5    For purposes of the program established under this
6subsection, the term "covered prescription drug" has the
7following meanings:
8        For Eligibility Group 1, "covered prescription drug"
9    means: (1) any cardiovascular agent or drug; (2) any
10    insulin or other prescription drug used in the treatment of
11    diabetes, including syringe and needles used to administer
12    the insulin; (3) any prescription drug used in the
13    treatment of arthritis; (4) any prescription drug used in
14    the treatment of cancer; (5) any prescription drug used in
15    the treatment of Alzheimer's disease; (6) any prescription
16    drug used in the treatment of Parkinson's disease; (7) any
17    prescription drug used in the treatment of glaucoma; (8)
18    any prescription drug used in the treatment of lung disease
19    and smoking-related illnesses; (9) any prescription drug
20    used in the treatment of osteoporosis; and (10) any
21    prescription drug used in the treatment of multiple
22    sclerosis. The Department may add additional therapeutic
23    classes by rule. The Department may adopt a preferred drug
24    list within any of the classes of drugs described in items
25    (1) through (10) of this paragraph. The specific drugs or
26    therapeutic classes of covered prescription drugs shall be

 

 

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1    indicated by rule.
2        For Eligibility Group 2, "covered prescription drug"
3    means those drugs covered by the Medicare Part D
4    Prescription Drug Plan in which the beneficiary is
5    enrolled.
6        For Eligibility Group 3, "covered prescription drug"
7    means those drugs covered by the Medical Assistance Program
8    under Article V of the Illinois Public Aid Code.
9        For Eligibility Group 4, "covered prescription drug"
10    means those drugs covered by the Medicare Part D
11    Prescription Drug Plan in which the beneficiary is
12    enrolled.
13    Any person otherwise eligible for pharmaceutical
14assistance under this subsection whose covered drugs are
15covered by any public program is ineligible for assistance
16under this subsection to the extent that the cost of those
17drugs is covered by the other program.
18    The Department of Healthcare and Family Services shall
19establish by rule the methods by which it will provide for the
20coverage called for in this subsection. Those methods may
21include direct reimbursement to pharmacies or the payment of a
22capitated amount to Medicare Part D Prescription Drug Plans.
23    For a pharmacy to be reimbursed under the program
24established under this subsection, it must comply with rules
25adopted by the Department of Healthcare and Family Services
26regarding coordination of benefits with Medicare Part D

 

 

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1Prescription Drug Plans. A pharmacy may not charge a
2Medicare-enrolled beneficiary of the program established under
3this subsection more for a covered prescription drug than the
4appropriate Medicare cost-sharing less any payment from or on
5behalf of the Department of Healthcare and Family Services.
6    The Department of Healthcare and Family Services or the
7Department on Aging, as appropriate, may adopt rules regarding
8applications, counting of income, proof of Medicare status,
9mandatory generic policies, and pharmacy reimbursement rates
10and any other rules necessary for the cost-efficient operation
11of the program established under this subsection.
12    (h) A qualified individual is not entitled to duplicate
13benefits in a coverage period as a result of the changes made
14by this amendatory Act of the 96th General Assembly.
15(Source: P.A. 96-804, eff. 1-1-10; 97-74, eff. 6-30-11; 97-333,
16eff. 8-12-11; 97-689, eff. 6-14-12.)
 
17    (320 ILCS 25/4.05)
18    Sec. 4.05. Application.
19    (a) The Department on Aging shall establish the content,
20required eligibility and identification information, use of
21social security numbers, and manner of applying for benefits in
22a simplified format under this Act, including claims filed for
23new or renewed prescription drug benefits.
24    (b) An application may be filed on paper or over the
25Internet to enable persons to apply separately or for both a

 

 

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1property tax relief grant and pharmaceutical assistance on the
2same application. An application may also enable persons to
3apply for other State or federal programs that provide medical
4or pharmaceutical assistance or other benefits, as determined
5by the Department on Aging in conjunction with the Department
6of Healthcare and Family Services.
7    (c) Applications must be filed during the time period
8prescribed by the Department.
9(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
10    (320 ILCS 25/4.2 new)
11    Sec. 4.2. Information to the Department. Notwithstanding
12any other law to the contrary, entities subject to the Illinois
13Insurance Code, Comprehensive Health Insurance Plan Act,
14Dental Service Plan Act, Children's Health Insurance Program
15Act, Health Care Purchasing Group Act, Health Maintenance
16Organization Act, Limited Health Service Organization Act,
17Voluntary Health Services Plans Act, and the Workers'
18Compensation Act, including, but not limited to, insurers,
19health maintenance organizations, pharmacy benefit managers,
20third party administrators, fraternal benefit societies,
21group-funded workers' compensation pools, municipal
22group-funded pools, self-funded or self-insured welfare or
23benefit plans or programs, and any other entities that provide
24health coverage through an employer, union, trade association
25or other organization or source, or any other entities, must

 

 

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1provide information to the Department, or its designee, that is
2necessary to carry out the purposes of this Act, including, but
3not limited to, the name, social security number, address, date
4of birth, and coverage of their policyholders, their
5subscribers, or the beneficiaries of their plans, benefits, or
6services who participate in the programs under this Act. The
7provision of this information to the Department or its designee
8is subject to the confidentiality provisions in Section 8a of
9this Act.
 
10    (320 ILCS 25/5)  (from Ch. 67 1/2, par. 405)
11    Sec. 5. Procedure.
12    (a) In general. Claims must be filed after January 1, on
13forms prescribed by the Department. No claim may be filed more
14than one year after December 31 of the year for which the claim
15is filed. The pharmaceutical assistance identification card
16provided for in subsection (f) of Section 4 shall be valid for
17a period determined by the Department of Healthcare and Family
18Services.
19    (b) Claim is Personal. The right to file a claim under this
20Act shall be personal to the claimant and shall not survive his
21death, but such right may be exercised on behalf of a claimant
22by his legal guardian or attorney-in-fact. If a claimant dies
23after having filed a timely claim, the amount thereof shall be
24disbursed to his surviving spouse or, if no spouse survives, to
25his surviving dependent minor children in equal parts, provided

 

 

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1the spouse or child, as the case may be, resided with the
2claimant at the time he filed his claim. If at the time of
3disbursement neither the claimant nor his spouse is surviving,
4and no dependent minor children of the claimant are surviving
5the amount of the claim shall escheat to the State.
6    (c) One claim per household. Only one member of a household
7may file a claim under this Act in any calendar year; where
8both members of a household are otherwise entitled to claim a
9grant under this Act, they must agree as to which of them will
10file a claim for that year.
11    (d) (Blank).
12    (e) Pharmaceutical Assistance Procedures. The Prior to
13July 1, 2012, the Department of Healthcare and Family Services
14shall determine eligibility for pharmaceutical assistance
15using the applicant's current income. The Department shall
16determine a person's current income in the manner provided by
17the Department by rule.
18    (f) A person may not under any circumstances charge a fee
19to a claimant under this Act for assistance in completing an
20application form for a property tax relief grant or
21pharmaceutical assistance under this Act.
22(Source: P.A. 96-491, eff. 8-14-09; 96-804, eff. 1-1-10;
2396-1000, eff. 7-2-10; 97-689, eff. 6-14-12.)
 
24    (320 ILCS 25/6)  (from Ch. 67 1/2, par. 406)
25    Sec. 6. Administration.

 

 

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1    (a) In general. Upon receipt of a timely filed claim, the
2Department shall determine whether the claimant is a person
3entitled to a grant under this Act and the amount of grant to
4which he is entitled under this Act. The Department may require
5the claimant to furnish reasonable proof of the statements of
6domicile, household income, rent paid, property taxes accrued
7and other matters on which entitlement is based, and may
8withhold payment of a grant until such additional proof is
9furnished.
10    (b) Rental determination. If the Department finds that the
11gross rent used in the computation by a claimant of rent
12constituting property taxes accrued exceeds the fair rental
13value for the right to occupy that residence, the Department
14may determine the fair rental value for that residence and
15recompute rent constituting property taxes accrued
16accordingly.
17    (c) Fraudulent claims. The Department shall deny claims
18which have been fraudulently prepared or when it finds that the
19claimant has acquired title to his residence or has paid rent
20for his residence primarily for the purpose of receiving a
21grant under this Act.
22    (d) Pharmaceutical Assistance. The Department shall allow
23all pharmacies licensed under the Pharmacy Practice Act to
24participate as authorized pharmacies unless they have been
25removed from that status for cause pursuant to the terms of
26this Section. The Director of the Department may enter into a

 

 

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1written contract with any State agency, instrumentality or
2political subdivision, or a fiscal intermediary for the purpose
3of making payments to authorized pharmacies for covered
4prescription drugs and coordinating the program of
5pharmaceutical assistance established by this Act with other
6programs that provide payment for covered prescription drugs.
7Such agreement shall establish procedures for properly
8contracting for pharmacy services, validating reimbursement
9claims, validating compliance of dispensing pharmacists with
10the contracts for participation required under this Section,
11validating the reasonable costs of covered prescription drugs,
12and otherwise providing for the effective administration of
13this Act. (Blank).
14    The Department shall promulgate rules and regulations to
15implement and administer the program of pharmaceutical
16assistance required by this Act, which shall include the
17following:
18        (1) Execution of contracts with pharmacies to dispense
19    covered prescription drugs. Such contracts shall stipulate
20    terms and conditions for authorized pharmacies
21    participation and the rights of the State to terminate such
22    participation for breach of such contract or for violation
23    of this Act or related rules and regulations of the
24    Department;
25        (2) Establishment of maximum limits on the size of
26    prescriptions, new or refilled, which shall be in amounts

 

 

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1    sufficient for 34 days, except as otherwise specified by
2    rule for medical or utilization control reasons;
3        (3) Establishment of liens upon any and all causes of
4    action which accrue to a beneficiary as a result of
5    injuries for which covered prescription drugs are directly
6    or indirectly required and for which the Director made
7    payment or became liable for under this Act;
8        (4) Charge or collection of payments from third parties
9    or private plans of assistance, or from other programs of
10    public assistance for any claim that is properly chargeable
11    under the assignment of benefits executed by beneficiaries
12    as a requirement of eligibility for the pharmaceutical
13    assistance identification card under this Act;
14        (4.5) Provision for automatic enrollment of
15    beneficiaries into a Medicare Discount Card program
16    authorized under the federal Medicare Modernization Act of
17    2003 (P.L. 108-391) to coordinate coverage including
18    Medicare Transitional Assistance;
19        (5) Inspection of appropriate records and audit of
20    participating authorized pharmacies to ensure contract
21    compliance, and to determine any fraudulent transactions
22    or practices under this Act;
23        (6) Payment to pharmacies under this Act in accordance
24    with the State Prompt Payment Act.
25    The Department shall annually report to the Governor and
26the General Assembly by March 1st of each year on the

 

 

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1administration of pharmaceutical assistance under this Act.
2(Source: P.A. 96-328, eff. 8-11-09; 97-333, eff. 8-12-11;
397-689, eff. 6-14-12.)
 
4    (320 ILCS 25/7)  (from Ch. 67 1/2, par. 407)
5    Sec. 7. Payment and denial of claims.
6    (a) In general. The Director shall order the payment from
7appropriations made for that purpose of grants to claimants
8under this Act in the amounts to which the Department has
9determined they are entitled, respectively. If a claim is
10denied, the Director shall cause written notice of that denial
11and the reasons for that denial to be sent to the claimant.
12    (b) Payment of claims one dollar and under. Where the
13amount of the grant computed under Section 4 is less than one
14dollar, the Department shall pay to the claimant one dollar.
15    (c) Right to appeal. Any person aggrieved by an action or
16determination of the Department on Aging arising under any of
17its powers or duties under this Act may request in writing that
18the Department on Aging reconsider its action or determination,
19setting out the facts upon which the request is based. The
20Department on Aging shall consider the request and either
21modify or affirm its prior action or determination. The
22Department on Aging may adopt, by rule, procedures for
23conducting its review under this Section.
24    Any person aggrieved by an action or determination of the
25Department of Healthcare and Family Services arising under any

 

 

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1of its powers or duties under this Act may request in writing
2that the Department of Healthcare and Family Services
3reconsider its action or determination, setting out the facts
4upon which the request is based. The Department of Healthcare
5and Family Services shall consider the request and either
6modify or affirm its prior action or determination. The
7Department of Healthcare and Family Services may adopt, by
8rule, procedures for conducting its review under this Section.
9    (d) (Blank).
10(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
11    (320 ILCS 25/8)  (from Ch. 67 1/2, par. 408)
12    Sec. 8. Records. Every claimant of a grant under this Act
13and, prior to July 1, 2012, every applicant for pharmaceutical
14assistance under this Act shall keep such records, render such
15statements, file such forms and comply with such rules and
16regulations as the Department on Aging may from time to time
17prescribe. The Department on Aging may by regulations require
18landlords to furnish to tenants statements as to gross rent or
19rent constituting property taxes accrued.
20(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
21    (320 ILCS 25/9)  (from Ch. 67 1/2, par. 409)
22    Sec. 9. Fraud; error.
23    (a) Any person who files a fraudulent claim for a grant
24under this Act, or who for compensation prepares a claim for a

 

 

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1grant and knowingly enters false information on an application
2for any claimant under this Act, or who fraudulently files
3multiple applications, or who fraudulently states that a
4nondisabled person is disabled, or who, prior to July 1, 2012,
5fraudulently procures pharmaceutical assistance benefits, or
6who fraudulently uses such assistance to procure covered
7prescription drugs, or who, on behalf of an authorized
8pharmacy, files a fraudulent request for payment, is guilty of
9a Class 4 felony for the first offense and is guilty of a Class
103 felony for each subsequent offense.
11    (b) The Department on Aging and the Department of
12Healthcare and Family Services shall immediately suspend the
13pharmaceutical assistance benefits of any person suspected of
14fraudulent procurement or fraudulent use of such assistance,
15and shall revoke such assistance upon a conviction. A person
16convicted of fraud under subsection (a) shall be permanently
17barred from all of the programs established under this Act.
18(Blank).
19    (c) The Department on Aging may recover from a claimant any
20amount paid to that claimant under this Act on account of an
21erroneous or fraudulent claim, together with 6% interest per
22year. Amounts recoverable from a claimant by the Department on
23Aging under this Act may, but need not, be recovered by
24offsetting the amount owed against any future grant payable to
25the person under this Act.
26    The Department of Healthcare and Family Services may

 

 

HB0027- 375 -LRB098 00027 KTG 30027 b

1recover for acts prior to July 1, 2012 from an authorized
2pharmacy any amount paid to that pharmacy under the
3pharmaceutical assistance program on account of an erroneous or
4fraudulent request for payment under that program, together
5with 6% interest per year. The Department of Healthcare and
6Family Services may recover from a person who erroneously or
7fraudulently obtains benefits under the pharmaceutical
8assistance program the value of the benefits so obtained,
9together with 6% interest per year.
10    (d) A prosecution for a violation of this Section may be
11commenced at any time within 3 years of the commission of that
12violation.
13(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
14    (320 ILCS 25/12)  (from Ch. 67 1/2, par. 412)
15    Sec. 12. Regulations - Department on Aging.
16    (a) Regulations. Notwithstanding any other provision to
17the contrary, the Department on Aging may adopt rules regarding
18applications, proof of eligibility, required identification
19information, use of social security numbers, counting of
20income, and a method of computing "gross rent" in the case of a
21claimant living in a nursing or sheltered care home, and any
22other rules necessary for the cost-efficient operation of the
23program established under Section 4.
24    (b) The Department on Aging shall, to the extent of
25appropriations made for that purpose:

 

 

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1        (1) attempt to secure the cooperation of appropriate
2    federal, State and local agencies in securing the names and
3    addresses of persons to whom this Act pertains;
4        (2) prepare a mailing list of persons eligible for
5    grants under this Act;
6        (3) secure the cooperation of the Department of
7    Revenue, the Department of Healthcare and Family Services,
8    other State agencies, and local business establishments to
9    facilitate distribution of applications under this Act to
10    those eligible to file claims; and
11        (4) through use of direct mail, newspaper
12    advertisements and radio and television advertisements,
13    and all other appropriate means of communication, conduct
14    an on-going public relations program to increase awareness
15    of eligible citizens of the benefits under this Act and the
16    procedures for applying for them.
17(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
18    (320 ILCS 25/13)  (from Ch. 67 1/2, par. 413)
19    Sec. 13. List of persons who have qualified. The Department
20on Aging shall maintain a list of all persons who have
21qualified under this Act and shall make the list available to
22the Department of Healthcare and Family Services, the
23Department of Public Health, the Secretary of State,
24municipalities, and public transit authorities upon request.
25    All information received by a State agency, municipality,

 

 

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1or public transit authority under this Section shall be
2confidential, except for official purposes, and any person who
3divulges or uses that information in any manner, except in
4accordance with a proper judicial order, shall be guilty of a
5Class B misdemeanor.
6(Source: P.A. 96-804, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
7    Section 2-91. The Senior Citizens Real Estate Tax Deferral
8Act is amended by changing Sections 2 and 8 as follows:
 
9    (320 ILCS 30/2)  (from Ch. 67 1/2, par. 452)
10    Sec. 2. Definitions. As used in this Act:
11    (a) "Taxpayer" means an individual whose household income
12for the year is no greater than: (i) $40,000 through tax year
132005; (ii) $50,000 for tax years 2006 through 2011; and (iii)
14$55,000 for tax year 2012 and thereafter.
15    (b) "Tax deferred property" means the property upon which
16real estate taxes are deferred under this Act.
17    (c) "Homestead" means the land and buildings thereon,
18including a condominium or a dwelling unit in a multidwelling
19building that is owned and operated as a cooperative, occupied
20by the taxpayer as his residence or which are temporarily
21unoccupied by the taxpayer because such taxpayer is temporarily
22residing, for not more than 1 year, in a licensed facility as
23defined in Section 1-113 of the Nursing Home Care Act.
24    (d) "Real estate taxes" or "taxes" means the taxes on real

 

 

HB0027- 378 -LRB098 00027 KTG 30027 b

1property for which the taxpayer would be liable under the
2Property Tax Code, including special service area taxes, and
3special assessments on benefited real property for which the
4taxpayer would be liable to a unit of local government.
5    (e) "Department" means the Department of Revenue.
6    (f) "Qualifying property" means a homestead which (a) the
7taxpayer or the taxpayer and his spouse own in fee simple or
8are purchasing in fee simple under a recorded instrument of
9sale, (b) is not income-producing property, (c) is not subject
10to a lien for unpaid real estate taxes when a claim under this
11Act is filed, and (d) is not held in trust, other than an
12Illinois land trust with the taxpayer identified as the sole
13beneficiary, if the taxpayer is filing for the program for the
14first time effective as of the January 1, 2011 assessment year
15or tax year 2012 and thereafter.
16    (g) "Equity interest" means the current assessed valuation
17of the qualified property times the fraction necessary to
18convert that figure to full market value minus any outstanding
19debts or liens on that property. In the case of qualifying
20property not having a separate assessed valuation, the
21appraised value as determined by a qualified real estate
22appraiser shall be used instead of the current assessed
23valuation.
24    (h) "Household income" has the meaning ascribed to that
25term in the Senior Citizens and Disabled Persons Property Tax
26Relief and Pharmaceutical Assistance Act.

 

 

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1    (i) "Collector" means the county collector or, if the taxes
2to be deferred are special assessments, an official designated
3by a unit of local government to collect special assessments.
4(Source: P.A. 97-481, eff. 8-22-11; 97-689, eff. 6-14-12.)
 
5    (320 ILCS 30/8)  (from Ch. 67 1/2, par. 458)
6    Sec. 8. Nothing in this Act (a) affects any provision of
7any mortgage or other instrument relating to land requiring a
8person to pay real estate taxes or (b) affects the eligibility
9of any person to receive any grant pursuant to the "Senior
10Citizens and Disabled Persons Property Tax Relief and
11Pharmaceutical Assistance Act".
12(Source: P.A. 97-689, eff. 6-14-12.)
 
13    Section 2-92. The Senior Pharmaceutical Assistance Act is
14amended by changing Section 5 as follows:
 
15    (320 ILCS 50/5)
16    Sec. 5. Findings. The General Assembly finds:
17    (1) Senior citizens identify pharmaceutical assistance as
18the single most critical factor to their health, well-being,
19and continued independence.
20    (2) The State of Illinois currently operates 2
21pharmaceutical assistance programs that benefit seniors: (i)
22the program of pharmaceutical assistance under the Senior
23Citizens and Disabled Persons Property Tax Relief and

 

 

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1Pharmaceutical Assistance Act and (ii) the Aid to the Aged,
2Blind, or Disabled program under the Illinois Public Aid Code.
3The State has been given authority to establish a third
4program, SeniorRx Care, through a federal Medicaid waiver.
5    (3) Each year, numerous pieces of legislation are filed
6seeking to establish additional pharmaceutical assistance
7benefits for seniors or to make changes to the existing
8programs.
9    (4) Establishment of a pharmaceutical assistance review
10committee will ensure proper coordination of benefits,
11diminish the likelihood of duplicative benefits, and ensure
12that the best interests of seniors are served.
13    (5) In addition to the State pharmaceutical assistance
14programs, several private entities, such as drug manufacturers
15and pharmacies, also offer prescription drug discount or
16coverage programs.
17    (6) Many seniors are unaware of the myriad of public and
18private programs available to them.
19    (7) Establishing a pharmaceutical clearinghouse with a
20toll-free hot-line and local outreach workers will educate
21seniors about the vast array of options available to them and
22enable seniors to make an educated and informed choice that is
23best for them.
24    (8) Estimates indicate that almost one-third of senior
25citizens lack prescription drug coverage. The federal
26government, states, and the pharmaceutical industry each have a

 

 

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1role in helping these uninsured seniors gain access to
2life-saving medications.
3    (9) The State of Illinois has recognized its obligation to
4assist Illinois' neediest seniors in purchasing prescription
5medications, and it is now time for pharmaceutical
6manufacturers to recognize their obligation to make their
7medications affordable to seniors.
8(Source: P.A. 97-689, eff. 6-14-12.)
 
9    Section 2-100. The Sexual Assault Survivors Emergency
10Treatment Act is amended by changing Section 7 as follows:
 
11    (410 ILCS 70/7)  (from Ch. 111 1/2, par. 87-7)
12    Sec. 7. Charges and reimbursement Reimbursement.
13    (a) When any ambulance provider furnishes transportation,
14hospital provides hospital emergency services and forensic
15services, hospital or health care professional or laboratory
16provides follow-up healthcare, or pharmacy dispenses
17prescribed medications to any sexual assault survivor, as
18defined by the Department of Healthcare and Family Services,
19who is neither eligible to receive such services under the
20Illinois Public Aid Code nor covered as to such services by a
21policy of insurance, the ambulance provider, hospital, health
22care professional, pharmacy, or laboratory shall furnish such
23services to that person without charge and shall be entitled to
24be reimbursed for its billed charges in providing such services

 

 

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1by the Illinois Sexual Assault Emergency Treatment Program
2under the Department of Healthcare and Family Services.
3Pharmacies shall dispense prescribed medications without
4charge to the survivor and shall be reimbursed and at the
5Department of Healthcare and Family Services' Medicaid
6allowable rates under the Illinois Public Aid Code.
7    (b) The hospital is responsible for submitting the request
8for reimbursement for ambulance services, hospital emergency
9services, and forensic services to the Illinois Sexual Assault
10Emergency Treatment Program. Nothing in this Section precludes
11hospitals from providing follow-up healthcare and receiving
12reimbursement under this Section.
13    (c) The health care professional who provides follow-up
14healthcare and the pharmacy that dispenses prescribed
15medications to a sexual assault survivor are responsible for
16submitting the request for reimbursement for follow-up
17healthcare or pharmacy services to the Illinois Sexual Assault
18Emergency Treatment Program.
19    (d) (Blank). On and after July 1, 2012, the Department
20shall reduce any rate of reimbursement for services or other
21payments or alter any methodologies authorized by this Act or
22the Illinois Public Aid Code to reduce any rate of
23reimbursement for services or other payments in accordance with
24Section 5-5e of the Illinois Public Aid Code.
25    (e) (d) The Department of Healthcare and Family Services
26shall establish standards, rules, and regulations to implement

 

 

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1this Section.
2(Source: P.A. 97-689, eff. 6-14-12; revised 8-3-12.)
 
3    Section 2-102. The Hemophilia Care Act is amended by
4changing Section 3 as follows:
 
5    (410 ILCS 420/3)  (from Ch. 111 1/2, par. 2903)
6    Sec. 3. The powers and duties of the Department shall
7include the following:
8        (1) With the advice and counsel of the Committee,
9    develop standards for determining eligibility for care and
10    treatment under this program. Among other standards
11    developed under this Section, persons suffering from
12    hemophilia must be evaluated in a center properly staffed
13    and equipped for such evaluation, but not operated by the
14    Department.
15        (2) (Blank).
16        (3) Extend financial assistance to eligible persons in
17    order that they may obtain blood and blood derivatives for
18    use in hospitals, in medical and dental facilities, or at
19    home. The Department shall extend financial assistance in
20    each fiscal year to each family containing one or more
21    eligible persons in the amount of (a) the family's eligible
22    cost of hemophilia services for that fiscal year, minus (b)
23    one fifth of its available family income for its next
24    preceding taxable year. The Director may extend financial

 

 

HB0027- 384 -LRB098 00027 KTG 30027 b

1    assistance in the case of unusual hardships, according to
2    specific procedures and conditions adopted for this
3    purpose in the rules and regulations promulgated by the
4    Department to implement and administer this Act.
5        (4) (Blank).
6        (5) Promulgate rules and regulations with the advice
7    and counsel of the Committee for the implementation and
8    administration of this Act.
9    On and after July 1, 2012, the Department shall reduce any
10rate of reimbursement for services or other payments or alter
11any methodologies authorized by this Act or the Illinois Public
12Aid Code to reduce any rate of reimbursement for services or
13other payments in accordance with Section 5-5e of the Illinois
14Public Aid Code.
15(Source: P.A. 97-689, eff. 6-14-12.)
 
16    Section 2-103. The Renal Disease Treatment Act is amended
17by changing Section 3 as follows:
 
18    (410 ILCS 430/3)  (from Ch. 111 1/2, par. 22.33)
19    Sec. 3. Duties of Departments of Healthcare and Family
20Services and Public Health.
21    (A) The Department of Healthcare and Family Services shall:
22        (a) With the advice of the Renal Disease Advisory
23    Committee, develop standards for determining eligibility
24    for care and treatment under this program. Among other

 

 

HB0027- 385 -LRB098 00027 KTG 30027 b

1    standards so developed under this paragraph, candidates,
2    to be eligible for care and treatment, must be evaluated in
3    a center properly staffed and equipped for such evaluation.
4        (b) (Blank).
5        (c) (Blank).
6        (d) Extend financial assistance to persons suffering
7    from chronic renal diseases in obtaining the medical,
8    surgical, nursing, pharmaceutical, and technical services
9    necessary in caring for such diseases, including the
10    renting of home dialysis equipment. The Renal Disease
11    Advisory Committee shall recommend to the Department the
12    extent of financial assistance, including the reasonable
13    charges and fees, for:
14            (1) Treatment in a dialysis facility;
15            (2) Hospital treatment for dialysis and transplant
16        surgery;
17            (3) Treatment in a limited care facility;
18            (4) Home dialysis training; and
19            (5) Home dialysis.
20        (e) Assist in equipping dialysis centers.
21        (f) (Blank). On and after July 1, 2012, the Department
22    shall reduce any rate of reimbursement for services or
23    other payments or alter any methodologies authorized by
24    this Act or the Illinois Public Aid Code to reduce any rate
25    of reimbursement for services or other payments in
26    accordance with Section 5-5e of the Illinois Public Aid

 

 

HB0027- 386 -LRB098 00027 KTG 30027 b

1    Code.
2    (B) The Department of Public Health shall:
3        (a) Assist in the development and expansion of programs
4    for the care and treatment of persons suffering from
5    chronic renal diseases, including dialysis and other
6    medical or surgical procedures and techniques that will
7    have a lifesaving effect in the care and treatment of
8    persons suffering from these diseases.
9        (b) Assist in the development of programs for the
10    prevention of chronic renal diseases.
11        (c) Institute and carry on an educational program among
12    physicians, hospitals, public health departments, and the
13    public concerning chronic renal diseases, including the
14    dissemination of information and the conducting of
15    educational programs concerning the prevention of chronic
16    renal diseases and the methods for the care and treatment
17    of persons suffering from these diseases.
18(Source: P.A. 97-689, eff. 6-14-12.)
 
19    Section 2-104. The Illinois Vehicle Code is amended by
20changing Sections 3-609, 3-623, 3-626, 3-667, 3-683, 3-806.3,
21and 11-1301.2 as follows:
 
22    (625 ILCS 5/3-609)  (from Ch. 95 1/2, par. 3-609)
23    Sec. 3-609. Disabled Veterans' Plates.
24    (a) Any veteran who holds proof of a service-connected

 

 

HB0027- 387 -LRB098 00027 KTG 30027 b

1disability from the United States Department of Veterans
2Affairs, and who has obtained certification from a licensed
3physician, physician assistant, or advanced practice nurse
4that the service-connected disability qualifies the veteran
5for issuance of registration plates or decals to a person with
6disabilities in accordance with Section 3-616, may, without the
7payment of any registration fee, make application to the
8Secretary of State for disabled veterans license plates
9displaying the international symbol of access, for the
10registration of one motor vehicle of the first division or one
11motor vehicle of the second division weighing not more than
128,000 pounds.
13    (b) Any veteran who holds proof of a service-connected
14disability from the United States Department of Veterans
15Affairs, and whose degree of disability has been declared to be
1650% or more, but whose disability does not qualify the veteran
17for a plate or decal for persons with disabilities under
18Section 3-616, may, without the payment of any registration
19fee, make application to the Secretary for a special
20registration plate without the international symbol of access
21for the registration of one motor vehicle of the first division
22or one motor vehicle of the second division weighing not more
23than 8,000 pounds.
24    (c) Renewal of such registration must be accompanied with
25documentation for eligibility of registration without fee
26unless the applicant has a permanent qualifying disability, and

 

 

HB0027- 388 -LRB098 00027 KTG 30027 b

1such registration plates may not be issued to any person not
2eligible therefor. The Illinois Department of Veterans'
3Affairs may assist in providing the documentation of
4disability.
5    (d) The design and color of the plates shall be within the
6discretion of the Secretary, except that the plates issued
7under subsection (b) of this Section shall not contain the
8international symbol of access. The Secretary may, in his or
9her discretion, allow the plates to be issued as vanity or
10personalized plates in accordance with Section 3-405.1 of this
11Code. Registration shall be for a multi-year period and may be
12issued staggered registration.
13    (e) Any person eligible to receive license plates under
14this Section who has been approved for benefits under the
15Senior Citizens and Disabled Persons Property Tax Relief and
16Pharmaceutical Assistance Act, or who has claimed and received
17a grant under that Act, shall pay a fee of $24 instead of the
18fee otherwise provided in this Code for passenger cars
19displaying standard multi-year registration plates issued
20under Section 3-414.1, for motor vehicles registered at 8,000
21pounds or less under Section 3-815(a), or for recreational
22vehicles registered at 8,000 pounds or less under Section
233-815(b), for a second set of plates under this Section.
24(Source: P.A. 96-79, eff. 1-1-10; 97-689, eff. 6-14-12; 97-918,
25eff. 1-1-13; revised 8-23-12.)
 

 

 

HB0027- 389 -LRB098 00027 KTG 30027 b

1    (625 ILCS 5/3-623)  (from Ch. 95 1/2, par. 3-623)
2    Sec. 3-623. Purple Heart Plates. The Secretary, upon
3receipt of an application made in the form prescribed by the
4Secretary of State, may issue to recipients awarded the Purple
5Heart by a branch of the armed forces of the United States who
6reside in Illinois, special registration plates. The
7Secretary, upon receipt of the proper application, may also
8issue these special registration plates to an Illinois resident
9who is the surviving spouse of a person who was awarded the
10Purple Heart by a branch of the armed forces of the United
11States. The special plates issued pursuant to this Section
12should be affixed only to passenger vehicles of the 1st
13division, including motorcycles, or motor vehicles of the 2nd
14division weighing not more than 8,000 pounds. The Secretary
15may, in his or her discretion, allow the plates to be issued as
16vanity or personalized plates in accordance with Section
173-405.1 of this Code. The Secretary of State must make a
18version of the special registration plates authorized under
19this Section in a form appropriate for motorcycles.
20    The design and color of such plates shall be wholly within
21the discretion of the Secretary of State. Appropriate
22documentation, as determined by the Secretary, and the
23appropriate registration fee shall accompany the application.
24However, for an individual who has been issued Purple Heart
25plates for a vehicle and who has been approved for benefits
26under the Senior Citizens and Disabled Persons Property Tax

 

 

HB0027- 390 -LRB098 00027 KTG 30027 b

1Relief and Pharmaceutical Assistance Act, the annual fee for
2the registration of the vehicle shall be as provided in Section
33-806.3 of this Code.
4(Source: P.A. 96-1101, eff. 1-1-11; 97-689, eff. 6-14-12.)
 
5    (625 ILCS 5/3-626)
6    Sec. 3-626. Korean War Veteran license plates.
7    (a) In addition to any other special license plate, the
8Secretary, upon receipt of all applicable fees and applications
9made in the form prescribed by the Secretary of State, may
10issue special registration plates designated as Korean War
11Veteran license plates to residents of Illinois who
12participated in the United States Armed Forces during the
13Korean War. The special plate issued under this Section shall
14be affixed only to passenger vehicles of the first division,
15motorcycles, motor vehicles of the second division weighing not
16more than 8,000 pounds, and recreational vehicles as defined by
17Section 1-169 of this Code. Plates issued under this Section
18shall expire according to the staggered multi-year procedure
19established by Section 3-414.1 of this Code.
20    (b) The design, color, and format of the plates shall be
21wholly within the discretion of the Secretary of State. The
22Secretary may, in his or her discretion, allow the plates to be
23issued as vanity plates or personalized in accordance with
24Section 3-405.1 of this Code. The plates are not required to
25designate "Land Of Lincoln", as prescribed in subsection (b) of

 

 

HB0027- 391 -LRB098 00027 KTG 30027 b

1Section 3-412 of this Code. The Secretary shall prescribe the
2eligibility requirements and, in his or her discretion, shall
3approve and prescribe stickers or decals as provided under
4Section 3-412.
5    (c) (Blank).
6    (d) The Korean War Memorial Construction Fund is created as
7a special fund in the State treasury. All moneys in the Korean
8War Memorial Construction Fund shall, subject to
9appropriation, be used by the Department of Veteran Affairs to
10provide grants for construction of the Korean War Memorial to
11be located at Oak Ridge Cemetery in Springfield, Illinois. Upon
12the completion of the Memorial, the Department of Veteran
13Affairs shall certify to the State Treasurer that the
14construction of the Memorial has been completed. Upon the
15certification by the Department of Veteran Affairs, the State
16Treasurer shall transfer all moneys in the Fund and any future
17deposits into the Fund into the Secretary of State Special
18License Plate Fund.
19    (e) An individual who has been issued Korean War Veteran
20license plates for a vehicle and who has been approved for
21benefits under the Senior Citizens and Disabled Persons
22Property Tax Relief and Pharmaceutical Assistance Act shall pay
23the original issuance and the regular annual fee for the
24registration of the vehicle as provided in Section 3-806.3 of
25this Code in addition to the fees specified in subsection (c)
26of this Section.

 

 

HB0027- 392 -LRB098 00027 KTG 30027 b

1(Source: P.A. 96-1409, eff. 1-1-11; 97-689, eff. 6-14-12.)
 
2    (625 ILCS 5/3-667)
3    Sec. 3-667. Korean Service license plates.
4    (a) In addition to any other special license plate, the
5Secretary, upon receipt of all applicable fees and applications
6made in the form prescribed by the Secretary of State, may
7issue special registration plates designated as Korean Service
8license plates to residents of Illinois who, on or after July
927, 1954, participated in the United States Armed Forces in
10Korea. The special plate issued under this Section shall be
11affixed only to passenger vehicles of the first division,
12motorcycles, motor vehicles of the second division weighing not
13more than 8,000 pounds, and recreational vehicles as defined by
14Section 1-169 of this Code. Plates issued under this Section
15shall expire according to the staggered multi-year procedure
16established by Section 3-414.1 of this Code.
17    (b) The design, color, and format of the plates shall be
18wholly within the discretion of the Secretary of State. The
19Secretary may, in his or her discretion, allow the plates to be
20issued as vanity or personalized plates in accordance with
21Section 3-405.1 of this Code. The plates are not required to
22designate "Land of Lincoln", as prescribed in subsection (b) of
23Section 3-412 of this Code. The Secretary shall prescribe the
24eligibility requirements and, in his or her discretion, shall
25approve and prescribe stickers or decals as provided under

 

 

HB0027- 393 -LRB098 00027 KTG 30027 b

1Section 3-412.
2    (c) An applicant shall be charged a $2 fee for original
3issuance in addition to the applicable registration fee. This
4additional fee shall be deposited into the Korean War Memorial
5Construction Fund a special fund in the State treasury.
6    (d) An individual who has been issued Korean Service
7license plates for a vehicle and who has been approved for
8benefits under the Senior Citizens and Disabled Persons
9Property Tax Relief and Pharmaceutical Assistance Act shall pay
10the original issuance and the regular annual fee for the
11registration of the vehicle as provided in Section 3-806.3 of
12this Code in addition to the fees specified in subsection (c)
13of this Section.
14(Source: P.A. 97-306, eff. 1-1-12; 97-689, eff. 6-14-12.)
 
15    (625 ILCS 5/3-683)
16    Sec. 3-683. Distinguished Service Cross license plates.
17The Secretary, upon receipt of an application made in the form
18prescribed by the Secretary of State, shall issue special
19registration plates to any Illinois resident who has been
20awarded the Distinguished Service Cross by a branch of the
21armed forces of the United States. The Secretary, upon receipt
22of the proper application, shall also issue these special
23registration plates to an Illinois resident who is the
24surviving spouse of a person who was awarded the Distinguished
25Service Cross by a branch of the armed forces of the United

 

 

HB0027- 394 -LRB098 00027 KTG 30027 b

1States. The special plates issued under this Section should be
2affixed only to passenger vehicles of the first division,
3including motorcycles, or motor vehicles of the second division
4weighing not more than 8,000 pounds.
5    The design and color of the plates shall be wholly within
6the discretion of the Secretary of State. Appropriate
7documentation, as determined by the Secretary, and the
8appropriate registration fee shall accompany the application.
9However, for an individual who has been issued Distinguished
10Service Cross plates for a vehicle and who has been approved
11for benefits under the Senior Citizens and Disabled Persons
12Property Tax Relief and Pharmaceutical Assistance Act, the
13annual fee for the registration of the vehicle shall be as
14provided in Section 3-806.3 of this Code.
15(Source: P.A. 96-328, eff. 8-11-09; 97-689, eff. 6-14-12.)
 
16    (625 ILCS 5/3-806.3)  (from Ch. 95 1/2, par. 3-806.3)
17    Sec. 3-806.3. Senior Citizens. Commencing with the 2009
18registration year, the registration fee paid by any vehicle
19owner who has been approved for benefits under the Senior
20Citizens and Disabled Persons Property Tax Relief and
21Pharmaceutical Assistance Act or who is the spouse of such a
22person shall be $24 instead of the fee otherwise provided in
23this Code for passenger cars displaying standard multi-year
24registration plates issued under Section 3-414.1, motor
25vehicles displaying special registration plates issued under

 

 

HB0027- 395 -LRB098 00027 KTG 30027 b

1Section 3-609, 3-616, 3-621, 3-622, 3-623, 3-624, 3-625, 3-626,
23-628, 3-638, 3-642, 3-645, 3-647, 3-650, 3-651, or 3-663,
3motor vehicles registered at 8,000 pounds or less under Section
43-815(a), and recreational vehicles registered at 8,000 pounds
5or less under Section 3-815(b). Widows and widowers of
6claimants shall also be entitled to this reduced registration
7fee for the registration year in which the claimant was
8eligible.
9    Commencing with the 2009 registration year, the
10registration fee paid by any vehicle owner who has claimed and
11received a grant under the Senior Citizens and Disabled Persons
12Property Tax Relief and Pharmaceutical Assistance Act or who is
13the spouse of such a person shall be $24 instead of the fee
14otherwise provided in this Code for passenger cars displaying
15standard multi-year registration plates issued under Section
163-414.1, motor vehicles displaying special registration plates
17issued under Section 3-607, 3-609, 3-616, 3-621, 3-622, 3-623,
183-624, 3-625, 3-626, 3-628, 3-638, 3-642, 3-645, 3-647, 3-650,
193-651, 3-663, or 3-664, motor vehicles registered at 8,000
20pounds or less under Section 3-815(a), and recreational
21vehicles registered at 8,000 pounds or less under Section
223-815(b). Widows and widowers of claimants shall also be
23entitled to this reduced registration fee for the registration
24year in which the claimant was eligible.
25    No more than one reduced registration fee under this
26Section shall be allowed during any 12 month period based on

 

 

HB0027- 396 -LRB098 00027 KTG 30027 b

1the primary eligibility of any individual, whether such reduced
2registration fee is allowed to the individual or to the spouse,
3widow or widower of such individual. This Section does not
4apply to the fee paid in addition to the registration fee for
5motor vehicles displaying vanity or special license plates.
6(Source: P.A. 96-554, eff. 1-1-10; 97-689, eff. 6-14-12.)
 
7    (625 ILCS 5/11-1301.2)  (from Ch. 95 1/2, par. 11-1301.2)
8    Sec. 11-1301.2. Special decals for parking; persons with
9disabilities.
10    (a) The Secretary of State shall provide for, by
11administrative rules, the design, size, color, and placement of
12a person with disabilities motorist decal or device and shall
13provide for, by administrative rules, the content and form of
14an application for a person with disabilities motorist decal or
15device, which shall be used by local authorities in the
16issuance thereof to a person with temporary disabilities,
17provided that the decal or device is valid for no more than 90
18days, subject to renewal for like periods based upon continued
19disability, and further provided that the decal or device
20clearly sets forth the date that the decal or device expires.
21The application shall include the requirement of an Illinois
22Identification Card number or a State of Illinois driver's
23license number. This decal or device may be used by the
24authorized holder to designate and identify a vehicle not owned
25or displaying a registration plate as provided in Sections

 

 

HB0027- 397 -LRB098 00027 KTG 30027 b

13-609 and 3-616 of this Act to designate when the vehicle is
2being used to transport said person or persons with
3disabilities, and thus is entitled to enjoy all the privileges
4that would be afforded a person with disabilities licensed
5vehicle. Person with disabilities decals or devices issued and
6displayed pursuant to this Section shall be recognized and
7honored by all local authorities regardless of which local
8authority issued such decal or device.
9    The decal or device shall be issued only upon a showing by
10adequate documentation that the person for whose benefit the
11decal or device is to be used has a temporary disability as
12defined in Section 1-159.1 of this Code.
13    (b) The local governing authorities shall be responsible
14for the provision of such decal or device, its issuance and
15designated placement within the vehicle. The cost of such decal
16or device shall be at the discretion of such local governing
17authority.
18    (c) The Secretary of State may, pursuant to Section
193-616(c), issue a person with disabilities parking decal or
20device to a person with disabilities as defined by Section
211-159.1. Any person with disabilities parking decal or device
22issued by the Secretary of State shall be registered to that
23person with disabilities in the form to be prescribed by the
24Secretary of State. The person with disabilities parking decal
25or device shall not display that person's address. One
26additional decal or device may be issued to an applicant upon

 

 

HB0027- 398 -LRB098 00027 KTG 30027 b

1his or her written request and with the approval of the
2Secretary of State. The written request must include a
3justification of the need for the additional decal or device.
4    (c-5) Beginning January 1, 2014, the Secretary shall
5provide by administrative rule for the issuance of a separate
6and distinct parking decal or device for persons with
7disabilities as defined by Section 1-159.1 of this Code. The
8authorized holder of a decal or device issued under this
9subsection (c-5) shall be exempt from the payment of fees
10generated by parking in a metered space, a parking area subject
11to paragraph (10) of subsection (a) of Section 11-209 of this
12Code, or a publicly owned parking structure or area.
13    The Secretary shall issue a meter-exempt decal or device to
14a person with disabilities who: (i) has been issued
15registration plates under Section 3-609 or 3-616 of this Code
16or a special decal or device under this Section, (ii) holds a
17valid Illinois driver's license, ; and (iii) is unable to do one
18or more of the following:
19        (1) manage, manipulate, or insert coins, or obtain
20    tickets or tokens in parking meters or ticket machines in
21    parking lots or parking structures, due to the lack of fine
22    motor control of both hands;
23        (2) reach above his or her head to a height of 42
24    inches from the ground, due to a lack of finger, hand, or
25    upper extremity strength or mobility;
26        (3) approach a parking meter due to his or her use of a

 

 

HB0027- 399 -LRB098 00027 KTG 30027 b

1    wheelchair or other device for mobility; or
2        (4) walk more than 20 feet due to an orthopedic,
3    neurological, cardiovascular, or lung condition in which
4    the degree of debilitation is so severe that it almost
5    completely impedes the ability to walk.
6    The application for a meter-exempt parking decal or device
7shall contain a statement certified by a licensed physician,
8physician assistant, or advanced practice nurse attesting to
9the nature and estimated duration of the applicant's condition
10and verifying that the applicant meets the physical
11qualifications specified in this subsection (c-5).
12    Notwithstanding the requirements of this subsection (c-5),
13the Secretary shall issue a meter-exempt decal or device to a
14person who has been issued registration plates under Section
153-616 of this Code or a special decal or device under this
16Section, if the applicant is the parent or guardian of a person
17with disabilities who is under 18 years of age and incapable of
18driving.
19    (d) Replacement decals or devices may be issued for lost,
20stolen, or destroyed decals upon application and payment of a
21$10 fee. The replacement fee may be waived for individuals that
22have claimed and received a grant under the Senior Citizens and
23Disabled Persons Property Tax Relief and Pharmaceutical
24Assistance Act.
25(Source: P.A. 96-72, eff. 1-1-10; 96-79, eff. 1-1-10; 96-1000,
26eff. 7-2-10; 97-689, eff. 6-14-12; 97-845, eff. 1-1-13; revised

 

 

HB0027- 400 -LRB098 00027 KTG 30027 b

18-3-12.)
 
2    Section 2-105. The Criminal Code of 2012 is amended by
3changing Section 17-6.5 as follows:
 
4    (720 ILCS 5/17-6.5)
5    Sec. 17-6.5. Persons under deportation order;
6ineligibility for benefits.
7    (a) An individual against whom a United States Immigration
8Judge has issued an order of deportation which has been
9affirmed by the Board of Immigration Review, as well as an
10individual who appeals such an order pending appeal, under
11paragraph 19 of Section 241(a) of the Immigration and
12Nationality Act relating to persecution of others on account of
13race, religion, national origin or political opinion under the
14direction of or in association with the Nazi government of
15Germany or its allies, shall be ineligible for the following
16benefits authorized by State law:
17        (1) The homestead exemptions and homestead improvement
18    exemption under Sections 15-170, 15-175, 15-176, and
19    15-180 of the Property Tax Code.
20        (2) Grants under the Senior Citizens and Disabled
21    Persons Property Tax Relief and Pharmaceutical Assistance
22    Act.
23        (3) The double income tax exemption conferred upon
24    persons 65 years of age or older by Section 204 of the

 

 

HB0027- 401 -LRB098 00027 KTG 30027 b

1    Illinois Income Tax Act.
2        (4) Grants provided by the Department on Aging.
3        (5) Reductions in vehicle registration fees under
4    Section 3-806.3 of the Illinois Vehicle Code.
5        (6) Free fishing and reduced fishing license fees under
6    Sections 20-5 and 20-40 of the Fish and Aquatic Life Code.
7        (7) Tuition free courses for senior citizens under the
8    Senior Citizen Courses Act.
9        (8) Any benefits under the Illinois Public Aid Code.
10    (b) If a person has been found by a court to have knowingly
11received benefits in violation of subsection (a) and:
12        (1) the total monetary value of the benefits received
13    is less than $150, the person is guilty of a Class A
14    misdemeanor; a second or subsequent violation is a Class 4
15    felony;
16        (2) the total monetary value of the benefits received
17    is $150 or more but less than $1,000, the person is guilty
18    of a Class 4 felony; a second or subsequent violation is a
19    Class 3 felony;
20        (3) the total monetary value of the benefits received
21    is $1,000 or more but less than $5,000, the person is
22    guilty of a Class 3 felony; a second or subsequent
23    violation is a Class 2 felony;
24        (4) the total monetary value of the benefits received
25    is $5,000 or more but less than $10,000, the person is
26    guilty of a Class 2 felony; a second or subsequent

 

 

HB0027- 402 -LRB098 00027 KTG 30027 b

1    violation is a Class 1 felony; or
2        (5) the total monetary value of the benefits received
3    is $10,000 or more, the person is guilty of a Class 1
4    felony.
5    (c) For purposes of determining the classification of an
6offense under this Section, all of the monetary value of the
7benefits received as a result of the unlawful act, practice, or
8course of conduct may be accumulated.
9    (d) Any grants awarded to persons described in subsection
10(a) may be recovered by the State of Illinois in a civil action
11commenced by the Attorney General in the circuit court of
12Sangamon County or the State's Attorney of the county of
13residence of the person described in subsection (a).
14    (e) An individual described in subsection (a) who has been
15deported shall be restored to any benefits which that
16individual has been denied under State law pursuant to
17subsection (a) if (i) the Attorney General of the United States
18has issued an order cancelling deportation and has adjusted the
19status of the individual to that of an alien lawfully admitted
20for permanent residence in the United States or (ii) the
21country to which the individual has been deported adjudicates
22or exonerates the individual in a judicial or administrative
23proceeding as not being guilty of the persecution of others on
24account of race, religion, national origin, or political
25opinion under the direction of or in association with the Nazi
26government of Germany or its allies.

 

 

HB0027- 403 -LRB098 00027 KTG 30027 b

1(Source: P.A. 96-1551, eff. 7-1-11; 97-689, eff. 6-14-12.)
 
2    Section 2-106. The Code of Civil Procedure is amended by
3changing Section 5-105 as follows:
 
4    (735 ILCS 5/5-105)  (from Ch. 110, par. 5-105)
5    Sec. 5-105. Leave to sue or defend as an indigent person.
6    (a) As used in this Section:
7        (1) "Fees, costs, and charges" means payments imposed
8    on a party in connection with the prosecution or defense of
9    a civil action, including, but not limited to: filing fees;
10    appearance fees; fees for service of process and other
11    papers served either within or outside this State,
12    including service by publication pursuant to Section 2-206
13    of this Code and publication of necessary legal notices;
14    motion fees; jury demand fees; charges for participation
15    in, or attendance at, any mandatory process or procedure
16    including, but not limited to, conciliation, mediation,
17    arbitration, counseling, evaluation, "Children First",
18    "Focus on Children" or similar programs; fees for
19    supplementary proceedings; charges for translation
20    services; guardian ad litem fees; charges for certified
21    copies of court documents; and all other processes and
22    procedures deemed by the court to be necessary to commence,
23    prosecute, defend, or enforce relief in a civil action.
24        (2) "Indigent person" means any person who meets one or

 

 

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1    more of the following criteria:
2            (i) He or she is receiving assistance under one or
3        more of the following public benefits programs:
4        Supplemental Security Income (SSI), Aid to the Aged,
5        Blind and Disabled (AABD), Temporary Assistance for
6        Needy Families (TANF), Food Stamps, General
7        Assistance, State Transitional Assistance, or State
8        Children and Family Assistance.
9            (ii) His or her available income is 125% or less of
10        the current poverty level as established by the United
11        States Department of Health and Human Services, unless
12        the applicant's assets that are not exempt under Part 9
13        or 10 of Article XII of this Code are of a nature and
14        value that the court determines that the applicant is
15        able to pay the fees, costs, and charges.
16            (iii) He or she is, in the discretion of the court,
17        unable to proceed in an action without payment of fees,
18        costs, and charges and whose payment of those fees,
19        costs, and charges would result in substantial
20        hardship to the person or his or her family.
21            (iv) He or she is an indigent person pursuant to
22        Section 5-105.5 of this Code.
23    (b) On the application of any person, before, or after the
24commencement of an action, a court, on finding that the
25applicant is an indigent person, shall grant the applicant
26leave to sue or defend the action without payment of the fees,

 

 

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1costs, and charges of the action.
2    (c) An application for leave to sue or defend an action as
3an indigent person shall be in writing and supported by the
4affidavit of the applicant or, if the applicant is a minor or
5an incompetent adult, by the affidavit of another person having
6knowledge of the facts. The contents of the affidavit shall be
7established by Supreme Court Rule. The court shall provide,
8through the office of the clerk of the court, simplified forms
9consistent with the requirements of this Section and applicable
10Supreme Court Rules to any person seeking to sue or defend an
11action who indicates an inability to pay the fees, costs, and
12charges of the action. The application and supporting affidavit
13may be incorporated into one simplified form. The clerk of the
14court shall post in a conspicuous place in the courthouse a
15notice no smaller than 8.5 x 11 inches, using no smaller than
1630-point typeface printed in English and in Spanish, advising
17the public that they may ask the court for permission to sue or
18defend a civil action without payment of fees, costs, and
19charges. The notice shall be substantially as follows:
20        "If you are unable to pay the fees, costs, and charges
21    of an action you may ask the court to allow you to proceed
22    without paying them. Ask the clerk of the court for forms."
23    (d) The court shall rule on applications under this Section
24in a timely manner based on information contained in the
25application unless the court, in its discretion, requires the
26applicant to personally appear to explain or clarify

 

 

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1information contained in the application. If the court finds
2that the applicant is an indigent person, the court shall enter
3an order permitting the applicant to sue or defend without
4payment of fees, costs, or charges. If the application is
5denied, the court shall enter an order to that effect stating
6the specific reasons for the denial. The clerk of the court
7shall promptly mail or deliver a copy of the order to the
8applicant.
9    (e) The clerk of the court shall not refuse to accept and
10file any complaint, appearance, or other paper presented by the
11applicant if accompanied by an application to sue or defend in
12forma pauperis, and those papers shall be considered filed on
13the date the application is presented. If the application is
14denied, the order shall state a date certain by which the
15necessary fees, costs, and charges must be paid. The court, for
16good cause shown, may allow an applicant whose application is
17denied to defer payment of fees, costs, and charges, make
18installment payments, or make payment upon reasonable terms and
19conditions stated in the order. The court may dismiss the
20claims or defenses of any party failing to pay the fees, costs,
21or charges within the time and in the manner ordered by the
22court. A determination concerning an application to sue or
23defend in forma pauperis shall not be construed as a ruling on
24the merits.
25    (f) The court may order an indigent person to pay all or a
26portion of the fees, costs, or charges waived pursuant to this

 

 

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1Section out of moneys recovered by the indigent person pursuant
2to a judgment or settlement resulting from the civil action.
3However, nothing in this Section shall be construed to limit
4the authority of a court to order another party to the action
5to pay the fees, costs, or charges of the action.
6    (g) A court, in its discretion, may appoint counsel to
7represent an indigent person, and that counsel shall perform
8his or her duties without fees, charges, or reward.
9    (h) Nothing in this Section shall be construed to affect
10the right of a party to sue or defend an action in forma
11pauperis without the payment of fees, costs, or charges, or the
12right of a party to court-appointed counsel, as authorized by
13any other provision of law or by the rules of the Illinois
14Supreme Court.
15    (i) The provisions of this Section are severable under
16Section 1.31 of the Statute on Statutes.
17(Source: P.A. 97-689, eff. 6-14-12; 97-813, eff. 7-13-12.)
 
18    Section 2-107. The Unemployment Insurance Act is amended by
19changing Sections 1400.2, 1402, 1404, 1405, 1801.1, and 1900 as
20follows:
 
21    (820 ILCS 405/1400.2)
22    Sec. 1400.2. Annual reporting and paying; household
23workers. This Section applies to an employer who solely employs
24one or more household workers with respect to whom the employer

 

 

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1files federal unemployment taxes as part of his or her federal
2income tax return, or could file federal unemployment taxes as
3part of his or her federal income tax return if the worker or
4workers were providing services in employment for purposes of
5the federal unemployment tax. For purposes of this Section,
6"household worker" has the meaning ascribed to it for purposes
7of Section 3510 of the federal Internal Revenue Code. If an
8employer to whom this Section applies notifies the Director, in
9writing, that he or she wishes to pay his or her contributions
10for each quarter and submit his or her wage and contribution
11reports for each month or quarter, as the case may be, on an
12annual basis, then the due date for filing the reports and
13paying the contributions shall be April 15 of the calendar year
14immediately following the close of the months or quarters to
15which the reports and quarters to which the contributions
16apply, except that the Director may, by rule, establish a
17different due date for good cause.
18(Source: P.A. 97-689, eff. 6-14-12.)
 
19    (820 ILCS 405/1402)  (from Ch. 48, par. 552)
20    Sec. 1402. Penalties.
21    A. If any employer fails, within the time prescribed in
22this Act as amended and in effect on October 5, 1980, and the
23regulations of the Director, to file a report of wages paid to
24each of his workers, or to file a sufficient report of such
25wages after having been notified by the Director to do so, for

 

 

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1any period which begins prior to January 1, 1982, he shall pay
2to the Department as a penalty a sum determined in accordance
3with the provisions of this Act as amended and in effect on
4October 5, 1980.
5    B. Except as otherwise provided in this Section, any
6employer who fails to file a report of wages paid to each of
7his workers for any period which begins on or after January 1,
81982, within the time prescribed by the provisions of this Act
9and the regulations of the Director, or, if the Director
10pursuant to such regulations extends the time for filing the
11report, fails to file it within the extended time, shall, in
12addition to any sum otherwise payable by him under the
13provisions of this Act, pay to the Department as a penalty a
14sum equal to the lesser of (1) $5 for each $10,000 or fraction
15thereof of the total wages for insured work paid by him during
16the period or (2) $2,500, for each month or part thereof of
17such failure to file the report. With respect to an employer
18who has elected to file reports of wages on an annual basis
19pursuant to Section 1400.2, in assessing penalties for the
20failure to submit all reports by the due date established
21pursuant to that Section, the 30-day period immediately
22following the due date shall be considered as one month.
23    If the Director deems an employer's report of wages paid to
24each of his workers for any period which begins on or after
25January 1, 1982, insufficient, he shall notify the employer to
26file a sufficient report. If the employer fails to file such

 

 

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1sufficient report within 30 days after the mailing of the
2notice to him, he shall, in addition to any sum otherwise
3payable by him under the provisions of this Act, pay to the
4Department as a penalty a sum determined in accordance with the
5provisions of the first paragraph of this subsection, for each
6month or part thereof of such failure to file such sufficient
7report after the date of the notice.
8    For wages paid in calendar years prior to 1988, the penalty
9or penalties which accrue under the two foregoing paragraphs
10with respect to a report for any period shall not be less than
11$100, and shall not exceed the lesser of (1) $10 for each
12$10,000 or fraction thereof of the total wages for insured work
13paid during the period or (2) $5,000. For wages paid in
14calendar years after 1987, the penalty or penalties which
15accrue under the 2 foregoing paragraphs with respect to a
16report for any period shall not be less than $50, and shall not
17exceed the lesser of (1) $10 for each $10,000 or fraction of
18the total wages for insured work paid during the period or (2)
19$5,000. With respect to an employer who has elected to file
20reports of wages on an annual basis pursuant to Section 1400.2,
21for purposes of calculating the minimum penalty prescribed by
22this Section for failure to file the reports on a timely basis,
23a calendar year shall constitute a single period. For reports
24of wages paid after 1986, the Director shall not, however,
25impose a penalty pursuant to either of the two foregoing
26paragraphs on any employer who can prove within 30 working days

 

 

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1after the mailing of a notice of his failure to file such a
2report, that (1) the failure to file the report is his first
3such failure during the previous 20 consecutive calendar
4quarters, and (2) the amount of the total contributions due for
5the calendar quarter of such report (or, in the case of an
6employer who is required to file the reports on a monthly
7basis, the amount of the total contributions due for the
8calendar quarter that includes the month of such report) is
9less than $500.
10    For any month which begins on or after January 1, 2013, a
11report of the wages paid to each of an employer's workers shall
12be due on or before the last day of the month next following
13the calendar month in which the wages were paid if the employer
14is required to report such wages electronically pursuant to the
15regulations of the Director; otherwise a report of the wages
16paid to each of the employer's workers shall be due on or
17before the last day of the month next following the calendar
18quarter in which the wages were paid.
19    Any employer who wilfully fails to pay any contribution or
20part thereof, based upon wages paid prior to 1987, when
21required by the provisions of this Act and the regulations of
22the Director, with intent to defraud the Director, shall in
23addition to such contribution or part thereof pay to the
24Department a penalty equal to 50 percent of the amount of such
25contribution or part thereof, as the case may be, provided that
26the penalty shall not be less than $200.

 

 

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1    Any employer who willfully fails to pay any contribution or
2part thereof, based upon wages paid in 1987 and in each
3calendar year thereafter, when required by the provisions of
4this Act and the regulations of the Director, with intent to
5defraud the Director, shall in addition to such contribution or
6part thereof pay to the Department a penalty equal to 60% of
7the amount of such contribution or part thereof, as the case
8may be, provided that the penalty shall not be less than $400.
9    However, all or part of any penalty may be waived by the
10Director for good cause shown.
11(Source: P.A. 97-689, eff. 6-14-12; 97-791, eff. 1-1-13;
12revised 7-23-12.)
 
13    (820 ILCS 405/1404)  (from Ch. 48, par. 554)
14    Sec. 1404. Payments in lieu of contributions by nonprofit
15organizations.
16    A. For the year 1972 and for each calendar year thereafter,
17contributions shall accrue and become payable, pursuant to
18Section 1400, by each nonprofit organization (defined in
19Section 211.2) upon the wages paid by it with respect to
20employment after 1971, unless the nonprofit organization
21elects, in accordance with the provisions of this Section, to
22pay, in lieu of contributions, an amount equal to the amount of
23regular benefits and one-half the amount of extended benefits
24(defined in Section 409) paid to individuals, for any weeks
25which begin on or after the effective date of the election, on

 

 

HB0027- 413 -LRB098 00027 KTG 30027 b

1the basis of wages for insured work paid to them by such
2nonprofit organization during the effective period of such
3election. Notwithstanding the preceding provisions of this
4subsection and the provisions of subsection D, with respect to
5benefit years beginning prior to July 1, 1989, any adjustment
6after September 30, 1989 to the base period wages paid to the
7individual by any employer shall not affect the ratio for
8determining the payments in lieu of contributions of a
9nonprofit organization which has elected to make payments in
10lieu of contributions. Provided, however, that with respect to
11benefit years beginning on or after July 1, 1989, the nonprofit
12organization shall be required to make payments equal to 100%
13of regular benefits, including dependents' allowances, and 50%
14of extended benefits, including dependents' allowances, paid
15to an individual with respect to benefit years beginning during
16the effective period of the election, but only if the nonprofit
17organization: (a) is the last employer as provided in Section
181502.1 and (b) paid to the individual receiving benefits, wages
19for insured work during his base period. If the nonprofit
20organization described in this paragraph meets the
21requirements of (a) but not (b), with respect to benefit years
22beginning on or after July 1, 1989, it shall be required to
23make payments in an amount equal to 50% of regular benefits,
24including dependents' allowances, and 25% of extended
25benefits, including dependents' allowances, paid to an
26individual with respect to benefit years beginning during the

 

 

HB0027- 414 -LRB098 00027 KTG 30027 b

1effective period of the election.
2        1. Any employing unit which becomes a nonprofit
3    organization on January 1, 1972, may elect to make payments
4    in lieu of contributions for not less than one calendar
5    year beginning with January 1, 1972, provided that it files
6    its written election with the Director not later than
7    January 31, 1972.
8        2. Any employing unit which becomes a nonprofit
9    organization after January 1, 1972, may elect to make
10    payments in lieu of contributions for a period of not less
11    than one calendar year beginning as of the first day with
12    respect to which it would, in the absence of its election,
13    incur liability for the payment of contributions, provided
14    that it files its written election with the Director not
15    later than 30 days immediately following the end of the
16    calendar quarter in which it becomes a nonprofit
17    organization.
18        3. A nonprofit organization which has incurred
19    liability for the payment of contributions for at least 2
20    calendar years and is not delinquent in such payment and in
21    the payment of any interest or penalties which may have
22    accrued, may elect to make payments in lieu of
23    contributions beginning January 1 of any calendar year,
24    provided that it files its written election with the
25    Director prior to such January 1, and provided, further,
26    that such election shall be for a period of not less than 2

 

 

HB0027- 415 -LRB098 00027 KTG 30027 b

1    calendar years.
2        4. An election to make payments in lieu of
3    contributions shall not terminate any liability incurred
4    by an employer for the payment of contributions, interest
5    or penalties with respect to any calendar quarter (or
6    month, as the case may be) which ends prior to the
7    effective period of the election.
8        5. A nonprofit organization which has elected,
9    pursuant to paragraph 1, 2, or 3, to make payments in lieu
10    of contributions may terminate the effective period of the
11    election as of January 1 of any calendar year subsequent to
12    the required minimum period of the election only if, prior
13    to such January 1, it files with the Director a written
14    notice to that effect. Upon such termination, the
15    organization shall become liable for the payment of
16    contributions upon wages for insured work paid by it on and
17    after such January 1 and, notwithstanding such
18    termination, it shall continue to be liable for payments in
19    lieu of contributions with respect to benefits paid to
20    individuals on and after such January 1, with respect to
21    benefit years beginning prior to July 1, 1989, on the basis
22    of wages for insured work paid to them by the nonprofit
23    organization prior to such January 1, and, with respect to
24    benefit years beginning after June 30, 1989, if such
25    employer was the last employer as provided in Section
26    1502.1 during a benefit year beginning prior to such

 

 

HB0027- 416 -LRB098 00027 KTG 30027 b

1    January 1.
2        6. Written elections to make payments in lieu of
3    contributions and written notices of termination of
4    election shall be filed in such form and shall contain such
5    information as the Director may prescribe. Upon the filing
6    of such election or notice, the Director shall either order
7    it approved, or, if it appears to the Director that the
8    nonprofit organization has not filed such election or
9    notice within the time prescribed, he shall order it
10    disapproved. The Director shall serve notice of his order
11    upon the nonprofit organization. The Director's order
12    shall be final and conclusive upon the nonprofit
13    organization unless, within 15 days after the date of
14    mailing of notice thereof, the nonprofit organization
15    files with the Director an application for its review,
16    setting forth its reasons in support thereof. Upon receipt
17    of an application for review within the time prescribed,
18    the Director shall order it allowed, or shall order that it
19    be denied, and shall serve notice upon the nonprofit
20    organization of his order. All of the provisions of Section
21    1509, applicable to orders denying applications for review
22    of determinations of employers' rates of contribution and
23    not inconsistent with the provisions of this subsection,
24    shall be applicable to an order denying an application for
25    review filed pursuant to this subsection.
26    B. As soon as practicable following the close of each

 

 

HB0027- 417 -LRB098 00027 KTG 30027 b

1calendar quarter, the Director shall mail to each nonprofit
2organization which has elected to make payments in lieu of
3contributions a Statement of the amount due from it for the
4regular and one-half the extended benefits paid (or the amounts
5otherwise provided for in subsection A) during the calendar
6quarter, together with the names of its workers or former
7workers and the amounts of benefits paid to each of them during
8the calendar quarter, with respect to benefit years beginning
9prior to July 1, 1989, on the basis of wages for insured work
10paid to them by the nonprofit organization; or, with respect to
11benefit years beginning after June 30, 1989, if such nonprofit
12organization was the last employer as provided in Section
131502.1 with respect to a benefit year beginning during the
14effective period of the election. The amount due shall be
15payable, and the nonprofit organization shall make payment of
16such amount not later than 30 days after the date of mailing of
17the Statement. The Statement shall be final and conclusive upon
18the nonprofit organization unless, within 20 days after the
19date of mailing of the Statement, the nonprofit organization
20files with the Director an application for revision thereof.
21Such application shall specify wherein the nonprofit
22organization believes the Statement to be incorrect, and shall
23set forth its reasons for such belief. All of the provisions of
24Section 1508, applicable to applications for revision of
25Statements of Benefit Wages and Statements of Benefit Charges
26and not inconsistent with the provisions of this subsection,

 

 

HB0027- 418 -LRB098 00027 KTG 30027 b

1shall be applicable to an application for revision of a
2Statement filed pursuant to this subsection.
3        1. Payments in lieu of contributions made by any
4    nonprofit organization shall not be deducted or
5    deductible, in whole or in part, from the remuneration of
6    individuals in the employ of the organization, nor shall
7    any nonprofit organization require or accept any waiver of
8    any right under this Act by an individual in its employ.
9    The making of any such deduction or the requirement or
10    acceptance of any such waiver is a Class A misdemeanor. Any
11    agreement by an individual in the employ of any person or
12    concern to pay all or any portion of a payment in lieu of
13    contributions, required under this Act from a nonprofit
14    organization, is void.
15        2. A nonprofit organization which fails to make any
16    payment in lieu of contributions when due under the
17    provisions of this subsection shall pay interest thereon at
18    the rates specified in Section 1401. A nonprofit
19    organization which has elected to make payments in lieu of
20    contributions shall be subject to the penalty provisions of
21    Section 1402. In the making of any payment in lieu of
22    contributions or in the payment of any interest or
23    penalties, a fractional part of a cent shall be disregarded
24    unless it amounts to one-half cent or more, in which case
25    it shall be increased to one cent.
26        3. All of the remedies available to the Director under

 

 

HB0027- 419 -LRB098 00027 KTG 30027 b

1    the provisions of this Act or of any other law to enforce
2    the payment of contributions, interest, or penalties under
3    this Act, including the making of determinations and
4    assessments pursuant to Section 2200, are applicable to the
5    enforcement of payments in lieu of contributions and of
6    interest and penalties, due under the provisions of this
7    Section. For the purposes of this paragraph, the term
8    "contribution" or "contributions" which appears in any
9    such provision means "payment in lieu of contributions" or
10    "payments in lieu of contributions." The term
11    "contribution" which appears in Section 2800 also means
12    "payment in lieu of contributions."
13        4. All of the provisions of Sections 2201 and 2201.1,
14    applicable to adjustment or refund of contributions,
15    interest and penalties erroneously paid and not
16    inconsistent with the provisions of this Section, shall be
17    applicable to payments in lieu of contributions
18    erroneously made or interest or penalties erroneously paid
19    by a nonprofit organization.
20        5. Payment in lieu of contributions shall be due with
21    respect to any sum erroneously paid as benefits to an
22    individual unless such sum has been recouped pursuant to
23    Section 900 or has otherwise been recovered. If such
24    payment in lieu of contributions has been made, the amount
25    thereof shall be adjusted or refunded in accordance with
26    the provisions of paragraph 4 and Section 2201 if

 

 

HB0027- 420 -LRB098 00027 KTG 30027 b

1    recoupment or other recovery has been made.
2        6. A nonprofit organization which has elected to make
3    payments in lieu of contributions and thereafter ceases to
4    be an employer shall continue to be liable for payments in
5    lieu of contributions with respect to benefits paid to
6    individuals on and after the date it has ceased to be an
7    employer, with respect to benefit years beginning prior to
8    July 1, 1989, on the basis of wages for insured work paid
9    to them by it prior to the date it ceased to be an
10    employer, and, with respect to benefit years beginning
11    after June 30, 1989, if such employer was the last employer
12    as provided in Section 1502.1 prior to the date that it
13    ceased to be an employer.
14        7. With respect to benefit years beginning prior to
15    July 1, 1989, wages paid to an individual during his base
16    period, by a nonprofit organization which elects to make
17    payments in lieu of contributions, for less than full time
18    work, performed during the same weeks in the base period
19    during which the individual had other insured work, shall
20    not be subject to payments in lieu of contributions (upon
21    such employer's request pursuant to the regulation of the
22    Director) so long as the employer continued after the end
23    of the base period, and continues during the applicable
24    benefit year, to furnish such less than full time work to
25    the individual on the same basis and in substantially the
26    same amount as during the base period. If the individual is

 

 

HB0027- 421 -LRB098 00027 KTG 30027 b

1    paid benefits with respect to a week (in the applicable
2    benefit year) after the employer has ceased to furnish the
3    work hereinabove described, the nonprofit organization
4    shall be liable for payments in lieu of contributions with
5    respect to the benefits paid to the individual after the
6    date on which the nonprofit organization ceases to furnish
7    the work.
8    C. With respect to benefit years beginning prior to July 1,
91989, whenever benefits have been paid to an individual on the
10basis of wages for insured work paid to him by a nonprofit
11organization, and the organization incurred liability for the
12payment of contributions on some of the wages because only a
13part of the individual's base period was within the effective
14period of the organization's written election to make payments
15in lieu of contributions, the organization shall pay an amount
16in lieu of contributions which bears the same ratio to the
17total benefits paid to the individual as the total wages for
18insured work paid to him during the base period by the
19organization upon which it did not incur liability for the
20payment of contributions (for the aforesaid reason) bear to the
21total wages for insured work paid to the individual during the
22base period by the organization.
23    D. With respect to benefit years beginning prior to July 1,
241989, whenever benefits have been paid to an individual on the
25basis of wages for insured work paid to him by a nonprofit
26organization which has elected to make payments in lieu of

 

 

HB0027- 422 -LRB098 00027 KTG 30027 b

1contributions, and by one or more other employers, the
2nonprofit organization shall pay an amount in lieu of
3contributions which bears the same ratio to the total benefits
4paid to the individual as the wages for insured work paid to
5the individual during his base period by the nonprofit
6organization bear to the total wages for insured work paid to
7the individual during the base period by all of the employers.
8If the nonprofit organization incurred liability for the
9payment of contributions on some of the wages for insured work
10paid to the individual, it shall be treated, with respect to
11such wages, as one of the other employers for the purposes of
12this paragraph.
13    E. Two or more nonprofit organizations which have elected
14to make payments in lieu of contributions may file a joint
15application with the Director for the establishment of a group
16account, effective January 1 of any calendar year, for the
17purpose of sharing the cost of benefits paid on the basis of
18the wages for insured work paid by such nonprofit
19organizations, provided that such joint application is filed
20with the Director prior to such January 1. The application
21shall identify and authorize a group representative to act as
22the group's agent for the purposes of this paragraph, and shall
23be filed in such form and shall contain such information as the
24Director may prescribe. Upon his approval of a joint
25application, the Director shall, by order, establish a group
26account for the applicants and shall serve notice upon the

 

 

HB0027- 423 -LRB098 00027 KTG 30027 b

1group's representative of such order. Such account shall remain
2in effect for not less than 2 calendar years and thereafter
3until terminated by the Director for good cause or, as of the
4close of any calendar quarter, upon application by the group.
5Upon establishment of the account, the group shall be liable to
6the Director for payments in lieu of contributions in an amount
7equal to the total amount for which, in the absence of the
8group account, liability would have been incurred by all of its
9members; provided, with respect to benefit years beginning
10prior to July 1, 1989, that the liability of any member to the
11Director with respect to any payment in lieu of contributions,
12interest or penalties not paid by the group when due with
13respect to any calendar quarter shall be in an amount which
14bears the same ratio to the total benefits paid during such
15quarter on the basis of the wages for insured work paid by all
16members of the group as the total wages for insured work paid
17by such member during such quarter bear to the total wages for
18insured work paid during the quarter by all members of the
19group, and, with respect to benefit years beginning on or after
20July 1, 1989, that the liability of any member to the Director
21with respect to any payment in lieu of contributions, interest
22or penalties not paid by the group when due with respect to any
23calendar quarter shall be in an amount which bears the same
24ratio to the total benefits paid during such quarter to
25individuals with respect to whom any member of the group was
26the last employer as provided in Section 1502.1 as the total

 

 

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1wages for insured work paid by such member during such quarter
2bear to the total wages for insured work paid during the
3quarter by all members of the group. With respect to calendar
4months and quarters beginning on or after January 1, 2013, the
5liability of any member to the Director with respect to any
6penalties that are assessed for failure to file a timely and
7sufficient report of wages and which are not paid by the group
8when due with respect to the calendar month or quarter, as the
9case may be, shall be in an amount which bears the same ratio
10to the total penalties due with respect to such month or
11quarter as the total wages for insured work paid by such member
12during such month or quarter bear to the total wages for
13insured work paid during the month or quarter by all members of
14the group. All of the provisions of this Section applicable to
15nonprofit organizations which have elected to make payments in
16lieu of contributions, and not inconsistent with the provisions
17of this paragraph, shall apply to a group account and, upon its
18termination, to each former member thereof. The Director shall
19by regulation prescribe the conditions for establishment,
20maintenance and termination of group accounts, and for addition
21of new members to and withdrawal of active members from such
22accounts.
23    F. Whenever service of notice is required by this Section,
24such notice may be given and be complete by depositing it with
25the United States Mail, addressed to the nonprofit organization
26(or, in the case of a group account, to its representative) at

 

 

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1its last known address. If such organization is represented by
2counsel in proceedings before the Director, service of notice
3may be made upon the nonprofit organization by mailing the
4notice to such counsel.
5(Source: P.A. 97-689, eff. 6-14-12.)
 
6    (820 ILCS 405/1405)  (from Ch. 48, par. 555)
7    Sec. 1405. Financing Benefits for Employees of Local
8Governments.
9    A. 1. For the year 1978 and for each calendar year
10thereafter, contributions shall accrue and become payable,
11pursuant to Section 1400, by each governmental entity (other
12than the State of Illinois and its wholly owned
13instrumentalities) referred to in clause (B) of Section 211.1,
14upon the wages paid by such entity with respect to employment
15after 1977, unless the entity elects to make payments in lieu
16of contributions pursuant to the provisions of subsection B.
17Notwithstanding the provisions of Sections 1500 to 1510,
18inclusive, a governmental entity which has not made such
19election shall, for liability for contributions incurred prior
20to January 1, 1984, pay contributions equal to 1 percent with
21respect to wages for insured work paid during each such
22calendar year or portion of such year as may be applicable. As
23used in this subsection, the word "wages", defined in Section
24234, is subject to all of the provisions of Section 235.
25    2. An Indian tribe for which service is exempted from the

 

 

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1federal unemployment tax under Section 3306(c)(7) of the
2Federal Unemployment Tax Act may elect to make payments in lieu
3of contributions in the same manner and subject to the same
4conditions as provided in this Section with regard to
5governmental entities, except as otherwise provided in
6paragraphs 7, 8, and 9 of subsection B.
7    B. Any governmental entity subject to subsection A may
8elect to make payments in lieu of contributions, in amounts
9equal to the amounts of regular and extended benefits paid to
10individuals, for any weeks which begin on or after the
11effective date of the election, on the basis of wages for
12insured work paid to them by the entity during the effective
13period of such election. Notwithstanding the preceding
14provisions of this subsection and the provisions of subsection
15D of Section 1404, with respect to benefit years beginning
16prior to July 1, 1989, any adjustment after September 30, 1989
17to the base period wages paid to the individual by any employer
18shall not affect the ratio for determining payments in lieu of
19contributions of a governmental entity which has elected to
20make payments in lieu of contributions. Provided, however, that
21with respect to benefit years beginning on or after July 1,
221989, the governmental entity shall be required to make
23payments equal to 100% of regular benefits, including
24dependents' allowances, and 100% of extended benefits,
25including dependents' allowances, paid to an individual with
26respect to benefit years beginning during the effective period

 

 

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1of the election, but only if the governmental entity: (a) is
2the last employer as provided in Section 1502.1 and (b) paid to
3the individual receiving benefits, wages for insured work
4during his base period. If the governmental entity described in
5this paragraph meets the requirements of (a) but not (b), with
6respect to benefit years beginning on or after July 1, 1989, it
7shall be required to make payments in an amount equal to 50% of
8regular benefits, including dependents' allowances, and 50% of
9extended benefits, including dependents' allowances, paid to
10an individual with respect to benefit years beginning during
11the effective period of the election.
12    1. Any such governmental entity which becomes an employer
13on January 1, 1978 pursuant to Section 205 may elect to make
14payments in lieu of contributions for not less than one
15calendar year beginning with January 1, 1978, provided that it
16files its written election with the Director not later than
17January 31, 1978.
18    2. A governmental entity newly created after January 1,
191978, may elect to make payments in lieu of contributions for a
20period of not less than one calendar year beginning as of the
21first day with respect to which it would, in the absence of its
22election, incur liability for the payment of contributions,
23provided that it files its written election with the Director
24not later than 30 days immediately following the end of the
25calendar quarter in which it has been created.
26    3. A governmental entity which has incurred liability for

 

 

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1the payment of contributions for at least 2 calendar years, and
2is not delinquent in such payment and in the payment of any
3interest or penalties which may have accrued, may elect to make
4payments in lieu of contributions beginning January 1 of any
5calendar year, provided that it files its written election with
6the Director prior to such January 1, and provided, further,
7that such election shall be for a period of not less than 2
8calendar years.
9    4. An election to make payments in lieu of contributions
10shall not terminate any liability incurred by a governmental
11entity for the payment of contributions, interest or penalties
12with respect to any calendar quarter (or month, as the case may
13be) which ends prior to the effective period of the election.
14    5. The termination by a governmental entity of the
15effective period of its election to make payments in lieu of
16contributions, and the filing of and subsequent action upon
17written notices of termination of election, shall be governed
18by the provisions of paragraphs 5 and 6 of Section 1404A,
19pertaining to nonprofit organizations.
20    6. With respect to benefit years beginning prior to July 1,
211989, wages paid to an individual during his base period by a
22governmental entity which elects to make payments in lieu of
23contributions for less than full time work, performed during
24the same weeks in the base period during which the individual
25had other insured work, shall not be subject to payments in
26lieu of contribution (upon such employer's request pursuant to

 

 

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1the regulation of the Director) so long as the employer
2continued after the end of the base period, and continues
3during the applicable benefit year, to furnish such less than
4full time work to the individual on the same basis and in
5substantially the same amount as during the base period. If the
6individual is paid benefits with respect to a week (in the
7applicable benefit year) after the employer has ceased to
8furnish the work hereinabove described, the governmental
9entity shall be liable for payments in lieu of contributions
10with respect to the benefits paid to the individual after the
11date on which the governmental entity ceases to furnish the
12work.
13    7. An Indian tribe may elect to make payments in lieu of
14contributions for calendar year 2003, provided that it files
15its written election with the Director not later than January
1631, 2003, and provided further that it is not delinquent in the
17payment of any contributions, interest, or penalties.
18    8. Failure of an Indian tribe to make a payment in lieu of
19contributions, or a payment of interest or penalties due under
20this Act, within 90 days after the Department serves notice of
21the finality of a determination and assessment shall cause the
22Indian tribe to lose the option of making payments in lieu of
23contributions, effective as of the calendar year immediately
24following the date on which the Department serves the notice.
25Notice of the loss of the option to make payments in lieu of
26contributions may be protested in the same manner as a

 

 

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1determination and assessment under Section 2200 of this Act.
2    9. An Indian tribe that, pursuant to paragraph 8, loses the
3option of making payments in lieu of contributions may again
4elect to make payments in lieu of contributions for a calendar
5year if: (a) the Indian tribe has incurred liability for the
6payment of contributions for at least one calendar year since
7losing the option pursuant to paragraph 8, (b) the Indian tribe
8is not delinquent in the payment of any liabilities under the
9Act, including interest or penalties, and (c) the Indian tribe
10files its written election with the Director not later than
11January 31 of the year with respect to which it is making the
12election.
13    C. As soon as practicable following the close of each
14calendar quarter, the Director shall mail to each governmental
15entity which has elected to make payments in lieu of
16contributions a Statement of the amount due from it for all the
17regular and extended benefits paid during the calendar quarter,
18together with the names of its workers or former workers and
19the amounts of benefits paid to each of them during the
20calendar quarter with respect to benefit years beginning prior
21to July 1, 1989, on the basis of wages for insured work paid to
22them by the governmental entity; or, with respect to benefit
23years beginning after June 30, 1989, if such governmental
24entity was the last employer as provided in Section 1502.1 with
25respect to a benefit year beginning during the effective period
26of the election. All of the provisions of subsection B of

 

 

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1Section 1404 pertaining to nonprofit organizations, not
2inconsistent with the preceding sentence, shall be applicable
3to payments in lieu of contributions by a governmental entity.
4    D. The provisions of subsections C through F, inclusive, of
5Section 1404, pertaining to nonprofit organizations, shall be
6applicable to each governmental entity which has elected to
7make payments in lieu of contributions.
8    E. 1. If an Indian tribe fails to pay any liability under
9this Act (including assessments of interest or penalty) within
1090 days after the Department issues a notice of the finality of
11a determination and assessment, the Director shall immediately
12notify the United States Internal Revenue Service and the
13United States Department of Labor.
14    2. Notices of payment and reporting delinquencies to Indian
15tribes shall include information that failure to make full
16payment within the prescribed time frame:
17        a. will cause the Indian tribe to lose the exemption
18    provided by Section 3306(c)(7) of the Federal Unemployment
19    Tax Act with respect to the federal unemployment tax;
20        b. will cause the Indian tribe to lose the option to
21    make payments in lieu of contributions.
22(Source: P.A. 97-689, eff. 6-14-12.)
 
23    (820 ILCS 405/1801.1)
24    Sec. 1801.1. Directory of New Hires.
25    A. The Director shall establish and operate an automated

 

 

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1directory of newly hired employees which shall be known as the
2"Illinois Directory of New Hires" which shall contain the
3information required to be reported by employers to the
4Department under subsection B. In the administration of the
5Directory, the Director shall comply with any requirements
6concerning the Employer New Hire Reporting Program established
7by the federal Personal Responsibility and Work Opportunity
8Reconciliation Act of 1996. The Director is authorized to use
9the information contained in the Directory of New Hires to
10administer any of the provisions of this Act.
11    B. Each employer in Illinois, except a department, agency,
12or instrumentality of the United States, shall file with the
13Department a report in accordance with rules adopted by the
14Department (but in any event not later than 20 days after the
15date the employer hires the employee or, in the case of an
16employer transmitting reports magnetically or electronically,
17by 2 monthly transmissions, if necessary, not less than 12 days
18nor more than 16 days apart) providing the following
19information concerning each newly hired employee: the
20employee's name, address, and social security number, the date
21services for remuneration were first performed by the employee,
22the employee's projected monthly wages, and the employer's
23name, address, Federal Employer Identification Number assigned
24under Section 6109 of the Internal Revenue Code of 1986, and
25such other information as may be required by federal law or
26regulation, provided that each employer may voluntarily file

 

 

HB0027- 433 -LRB098 00027 KTG 30027 b

1the address to which the employer wants income withholding
2orders to be mailed, if it is different from the address given
3on the Federal Employer Identification Number. An employer in
4Illinois which transmits its reports electronically or
5magnetically and which also has employees in another state may
6report all newly hired employees to a single designated state
7in which the employer has employees if it has so notified the
8Secretary of the United States Department of Health and Human
9Services in writing. An employer may, at its option, submit
10information regarding any rehired employee in the same manner
11as information is submitted regarding a newly hired employee.
12Each report required under this subsection shall, to the extent
13practicable, be made on an Internal Revenue Service Form W-4
14or, at the option of the employer, an equivalent form, and may
15be transmitted by first class mail, by telefax, magnetically,
16or electronically.
17    C. An employer which knowingly fails to comply with the
18reporting requirements established by this Section shall be
19subject to a civil penalty of $15 for each individual whom it
20fails to report. An employer shall be considered to have
21knowingly failed to comply with the reporting requirements
22established by this Section with respect to an individual if
23the employer has been notified by the Department that it has
24failed to report an individual, and it fails, without
25reasonable cause, to supply the required information to the
26Department within 21 days after the date of mailing of the

 

 

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1notice. Any individual who knowingly conspires with the newly
2hired employee to cause the employer to fail to report the
3information required by this Section or who knowingly conspires
4with the newly hired employee to cause the employer to file a
5false or incomplete report shall be guilty of a Class B
6misdemeanor with a fine not to exceed $500 with respect to each
7employee with whom the individual so conspires.
8    D. As used in this Section, "newly hired employee" means an
9individual who (i) is an employee within the meaning of Chapter
1024 of the Internal Revenue Code of 1986 and (ii) either has not
11previously been employed by the employer or was previously
12employed by the employer but has been separated from that prior
13employment for at least 60 consecutive days; however, "newly
14hired employee" does not include an employee of a federal or
15State agency performing intelligence or counterintelligence
16functions, if the head of that agency has determined that the
17filing of the report required by this Section with respect to
18the employee could endanger the safety of the employee or
19compromise an ongoing investigation or intelligence mission.
20    Notwithstanding Section 205, and for the purposes of this
21Section only, the term "employer" has the meaning given by
22Section 3401(d) of the Internal Revenue Code of 1986 and
23includes any governmental entity and labor organization as
24defined by Section 2(5) of the National Labor Relations Act,
25and includes any entity (also known as a hiring hall) which is
26used by the organization and an employer to carry out the

 

 

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1requirements described in Section 8(f)(3) of that Act of an
2agreement between the organization and the employer.
3(Source: P.A. 97-621, eff. 11-18-11; 97-689, eff. 6-14-12;
497-791, eff. 1-1-13; revised 7-23-12.)
 
5    (820 ILCS 405/1900)  (from Ch. 48, par. 640)
6    Sec. 1900. Disclosure of information.
7    A. Except as provided in this Section, information obtained
8from any individual or employing unit during the administration
9of this Act shall:
10        1. be confidential,
11        2. not be published or open to public inspection,
12        3. not be used in any court in any pending action or
13    proceeding,
14        4. not be admissible in evidence in any action or
15    proceeding other than one arising out of this Act.
16    B. No finding, determination, decision, ruling or order
17(including any finding of fact, statement or conclusion made
18therein) issued pursuant to this Act shall be admissible or
19used in evidence in any action other than one arising out of
20this Act, nor shall it be binding or conclusive except as
21provided in this Act, nor shall it constitute res judicata,
22regardless of whether the actions were between the same or
23related parties or involved the same facts.
24    C. Any officer or employee of this State, any officer or
25employee of any entity authorized to obtain information

 

 

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1pursuant to this Section, and any agent of this State or of
2such entity who, except with authority of the Director under
3this Section, shall disclose information shall be guilty of a
4Class B misdemeanor and shall be disqualified from holding any
5appointment or employment by the State.
6    D. An individual or his duly authorized agent may be
7supplied with information from records only to the extent
8necessary for the proper presentation of his claim for benefits
9or with his existing or prospective rights to benefits.
10Discretion to disclose this information belongs solely to the
11Director and is not subject to a release or waiver by the
12individual. Notwithstanding any other provision to the
13contrary, an individual or his or her duly authorized agent may
14be supplied with a statement of the amount of benefits paid to
15the individual during the 18 months preceding the date of his
16or her request.
17    E. An employing unit may be furnished with information,
18only if deemed by the Director as necessary to enable it to
19fully discharge its obligations or safeguard its rights under
20the Act. Discretion to disclose this information belongs solely
21to the Director and is not subject to a release or waiver by
22the employing unit.
23    F. The Director may furnish any information that he may
24deem proper to any public officer or public agency of this or
25any other State or of the federal government dealing with:
26        1. the administration of relief,

 

 

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1        2. public assistance,
2        3. unemployment compensation,
3        4. a system of public employment offices,
4        5. wages and hours of employment, or
5        6. a public works program.
6    The Director may make available to the Illinois Workers'
7Compensation Commission information regarding employers for
8the purpose of verifying the insurance coverage required under
9the Workers' Compensation Act and Workers' Occupational
10Diseases Act.
11    G. The Director may disclose information submitted by the
12State or any of its political subdivisions, municipal
13corporations, instrumentalities, or school or community
14college districts, except for information which specifically
15identifies an individual claimant.
16    H. The Director shall disclose only that information
17required to be disclosed under Section 303 of the Social
18Security Act, as amended, including:
19        1. any information required to be given the United
20    States Department of Labor under Section 303(a)(6); and
21        2. the making available upon request to any agency of
22    the United States charged with the administration of public
23    works or assistance through public employment, the name,
24    address, ordinary occupation and employment status of each
25    recipient of unemployment compensation, and a statement of
26    such recipient's right to further compensation under such

 

 

HB0027- 438 -LRB098 00027 KTG 30027 b

1    law as required by Section 303(a)(7); and
2        3. records to make available to the Railroad Retirement
3    Board as required by Section 303(c)(1); and
4        4. information that will assure reasonable cooperation
5    with every agency of the United States charged with the
6    administration of any unemployment compensation law as
7    required by Section 303(c)(2); and
8        5. information upon request and on a reimbursable basis
9    to the United States Department of Agriculture and to any
10    State food stamp agency concerning any information
11    required to be furnished by Section 303(d); and
12        6. any wage information upon request and on a
13    reimbursable basis to any State or local child support
14    enforcement agency required by Section 303(e); and
15        7. any information required under the income
16    eligibility and verification system as required by Section
17    303(f); and
18        8. information that might be useful in locating an
19    absent parent or that parent's employer, establishing
20    paternity or establishing, modifying, or enforcing child
21    support orders for the purpose of a child support
22    enforcement program under Title IV of the Social Security
23    Act upon the request of and on a reimbursable basis to the
24    public agency administering the Federal Parent Locator
25    Service as required by Section 303(h); and
26        9. information, upon request, to representatives of

 

 

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1    any federal, State or local governmental public housing
2    agency with respect to individuals who have signed the
3    appropriate consent form approved by the Secretary of
4    Housing and Urban Development and who are applying for or
5    participating in any housing assistance program
6    administered by the United States Department of Housing and
7    Urban Development as required by Section 303(i).
8    I. The Director, upon the request of a public agency of
9Illinois, of the federal government or of any other state
10charged with the investigation or enforcement of Section 10-5
11of the Criminal Code of 1961 (or a similar federal law or
12similar law of another State), may furnish the public agency
13information regarding the individual specified in the request
14as to:
15        1. the current or most recent home address of the
16    individual, and
17        2. the names and addresses of the individual's
18    employers.
19    J. Nothing in this Section shall be deemed to interfere
20with the disclosure of certain records as provided for in
21Section 1706 or with the right to make available to the
22Internal Revenue Service of the United States Department of the
23Treasury, or the Department of Revenue of the State of
24Illinois, information obtained under this Act.
25    K. The Department shall make available to the Illinois
26Student Assistance Commission, upon request, information in

 

 

HB0027- 440 -LRB098 00027 KTG 30027 b

1the possession of the Department that may be necessary or
2useful to the Commission in the collection of defaulted or
3delinquent student loans which the Commission administers.
4    L. The Department shall make available to the State
5Employees' Retirement System, the State Universities
6Retirement System, the Teachers' Retirement System of the State
7of Illinois, and the Department of Central Management Services,
8Risk Management Division, upon request, information in the
9possession of the Department that may be necessary or useful to
10the System or the Risk Management Division for the purpose of
11determining whether any recipient of a disability benefit from
12the System or a workers' compensation benefit from the Risk
13Management Division is gainfully employed.
14    M. This Section shall be applicable to the information
15obtained in the administration of the State employment service,
16except that the Director may publish or release general labor
17market information and may furnish information that he may deem
18proper to an individual, public officer or public agency of
19this or any other State or the federal government (in addition
20to those public officers or public agencies specified in this
21Section) as he prescribes by Rule.
22    N. The Director may require such safeguards as he deems
23proper to insure that information disclosed pursuant to this
24Section is used only for the purposes set forth in this
25Section.
26    O. Nothing in this Section prohibits communication with an

 

 

HB0027- 441 -LRB098 00027 KTG 30027 b

1individual or entity through unencrypted e-mail or other
2unencrypted electronic means as long as the communication does
3not contain the individual's or entity's name in combination
4with any one or more of the individual's or entity's social
5security number; driver's license or State identification
6number; account number or credit or debit card number; or any
7required security code, access code, or password that would
8permit access to further information pertaining to the
9individual or entity.
10    P. Within 30 days after the effective date of this
11amendatory Act of 1993 and annually thereafter, the Department
12shall provide to the Department of Financial Institutions a
13list of individuals or entities that, for the most recently
14completed calendar year, report to the Department as paying
15wages to workers. The lists shall be deemed confidential and
16may not be disclosed to any other person.
17    Q. The Director shall make available to an elected federal
18official the name and address of an individual or entity that
19is located within the jurisdiction from which the official was
20elected and that, for the most recently completed calendar
21year, has reported to the Department as paying wages to
22workers, where the information will be used in connection with
23the official duties of the official and the official requests
24the information in writing, specifying the purposes for which
25it will be used. For purposes of this subsection, the use of
26information in connection with the official duties of an

 

 

HB0027- 442 -LRB098 00027 KTG 30027 b

1official does not include use of the information in connection
2with the solicitation of contributions or expenditures, in
3money or in kind, to or on behalf of a candidate for public or
4political office or a political party or with respect to a
5public question, as defined in Section 1-3 of the Election
6Code, or in connection with any commercial solicitation. Any
7elected federal official who, in submitting a request for
8information covered by this subsection, knowingly makes a false
9statement or fails to disclose a material fact, with the intent
10to obtain the information for a purpose not authorized by this
11subsection, shall be guilty of a Class B misdemeanor.
12    R. The Director may provide to any State or local child
13support agency, upon request and on a reimbursable basis,
14information that might be useful in locating an absent parent
15or that parent's employer, establishing paternity, or
16establishing, modifying, or enforcing child support orders.
17    S. The Department shall make available to a State's
18Attorney of this State or a State's Attorney's investigator,
19upon request, the current address or, if the current address is
20unavailable, current employer information, if available, of a
21victim of a felony or a witness to a felony or a person against
22whom an arrest warrant is outstanding.
23    T. The Director shall make available to the Department of
24State Police, a county sheriff's office, or a municipal police
25department, upon request, any information concerning the
26current address and place of employment or former places of

 

 

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1employment of a person who is required to register as a sex
2offender under the Sex Offender Registration Act that may be
3useful in enforcing the registration provisions of that Act.
4    U. (Blank). The Director shall make information available
5to the Department of Healthcare and Family Services and the
6Department of Human Services for the purpose of determining
7eligibility for public benefit programs authorized under the
8Illinois Public Aid Code and related statutes administered by
9those departments, for verifying sources and amounts of income,
10and for other purposes directly connected with the
11administration of those programs.
12(Source: P.A. 96-420, eff. 8-13-09; 97-621, eff. 11-18-11;
1397-689, eff. 6-14-12.)
 
14
ARTICLE 99.

 
15    Section 99-95. Severability. If any provision of this Act
16or application thereof to any person or circumstance is held
17invalid, such invalidity does not affect other provisions or
18applications of this Act which can be given effect without the
19invalid application or provision, and to this end the
20provisions of this Act are declared to be severable.
 
21    Section 99-99. Effective date. This Act takes effect upon
22becoming law.

 

 

HB0027- 444 -LRB098 00027 KTG 30027 b

1 INDEX
2 Statutes amended in order of appearance
3    New Act
4    5 ILCS 100/5-45from Ch. 127, par. 1005-45
5    15 ILCS 405/10.05from Ch. 15, par. 210.05
6    20 ILCS 415/4dfrom Ch. 127, par. 63b104d
7    30 ILCS 5/2-20 rep.
8    30 ILCS 105/5.826 new
9    30 ILCS 105/5.827 new
10    30 ILCS 105/5.828 new
11    30 ILCS 105/6z-52
12    30 ILCS 105/6z-81
13    30 ILCS 500/1-10
14    30 ILCS 740/2-15.2
15    30 ILCS 740/2-15.3
16    35 ILCS 200/15-172
17    35 ILCS 200/15-175
18    35 ILCS 200/20-15
19    35 ILCS 200/21-27
20    35 ILCS 515/7from Ch. 120, par. 1207
21    70 ILCS 3605/51
22    70 ILCS 3605/52
23    70 ILCS 3610/8.6
24    70 ILCS 3610/8.7
25    70 ILCS 3615/3A.15

 

 

HB0027- 445 -LRB098 00027 KTG 30027 b

1    70 ILCS 3615/3A.16
2    70 ILCS 3615/3B.14
3    70 ILCS 3615/3B.15
4    110 ILCS 990/1from Ch. 144, par. 1801
5    210 ILCS 45/3-202.05
6    210 ILCS 50/3.86
7    210 ILCS 155/35
8    210 ILCS 155/40
9    210 ILCS 155/45
10    210 ILCS 155/55 rep.
11    215 ILCS 106/25
12    215 ILCS 106/40
13    215 ILCS 170/30
14    215 ILCS 170/35
15    220 ILCS 10/9from Ch. 111 2/3, par. 909
16    305 ILCS 5/3-1.2from Ch. 23, par. 3-1.2
17    305 ILCS 5/3-5from Ch. 23, par. 3-5
18    305 ILCS 5/4-1.6from Ch. 23, par. 4-1.6
19    305 ILCS 5/4-2from Ch. 23, par. 4-2
20    305 ILCS 5/5-2from Ch. 23, par. 5-2
21    305 ILCS 5/5-4from Ch. 23, par. 5-4
22    305 ILCS 5/5-4.1from Ch. 23, par. 5-4.1
23    305 ILCS 5/5-4.2from Ch. 23, par. 5-4.2
24    305 ILCS 5/5-5from Ch. 23, par. 5-5
25    305 ILCS 5/5-5.02from Ch. 23, par. 5-5.02
26    305 ILCS 5/5-5.05

 

 

HB0027- 446 -LRB098 00027 KTG 30027 b

1    305 ILCS 5/5-5.2from Ch. 23, par. 5-5.2
2    305 ILCS 5/5-5.3from Ch. 23, par. 5-5.3
3    305 ILCS 5/5-5.4from Ch. 23, par. 5-5.4
4    305 ILCS 5/5-5.4e
5    305 ILCS 5/5-5.4h new
6    305 ILCS 5/5-5.4i new
7    305 ILCS 5/5-5.5from Ch. 23, par. 5-5.5
8    305 ILCS 5/5-5.8bfrom Ch. 23, par. 5-5.8b
9    305 ILCS 5/5-5.12from Ch. 23, par. 5-5.12
10    305 ILCS 5/5-5.17from Ch. 23, par. 5-5.17
11    305 ILCS 5/5-5.20
12    305 ILCS 5/5-5.23
13    305 ILCS 5/5-5.24
14    305 ILCS 5/5-5.25
15    305 ILCS 5/5-16.7
16    305 ILCS 5/5-16.7a
17    305 ILCS 5/5-16.8
18    305 ILCS 5/5-16.9
19    305 ILCS 5/5-17from Ch. 23, par. 5-17
20    305 ILCS 5/5-19from Ch. 23, par. 5-19
21    305 ILCS 5/5-24
22    305 ILCS 5/5-30
23    305 ILCS 5/5A-1from Ch. 23, par. 5A-1
24    305 ILCS 5/5A-2from Ch. 23, par. 5A-2
25    305 ILCS 5/5A-3from Ch. 23, par. 5A-3
26    305 ILCS 5/5A-4from Ch. 23, par. 5A-4

 

 

HB0027- 447 -LRB098 00027 KTG 30027 b

1    305 ILCS 5/5A-5from Ch. 23, par. 5A-5
2    305 ILCS 5/5A-6from Ch. 23, par. 5A-6
3    305 ILCS 5/5A-8from Ch. 23, par. 5A-8
4    305 ILCS 5/5A-10from Ch. 23, par. 5A-10
5    305 ILCS 5/5A-12.2
6    305 ILCS 5/5A-14
7    305 ILCS 5/6-1.2from Ch. 23, par. 6-1.2
8    305 ILCS 5/6-2from Ch. 23, par. 6-2
9    305 ILCS 5/6-11from Ch. 23, par. 6-11
10    305 ILCS 5/11-13from Ch. 23, par. 11-13
11    305 ILCS 5/11-26from Ch. 23, par. 11-26
12    305 ILCS 5/12-4.25from Ch. 23, par. 12-4.25
13    305 ILCS 5/12-4.38
14    305 ILCS 5/12-4.39
15    305 ILCS 5/12-9from Ch. 23, par. 12-9
16    305 ILCS 5/12-10.5
17    305 ILCS 5/12-13.1
18    305 ILCS 5/14-8from Ch. 23, par. 14-8
19    305 ILCS 5/15-1from Ch. 23, par. 15-1
20    305 ILCS 5/5-2b rep.
21    305 ILCS 5/5-2.1d rep.
22    305 ILCS 5/5-5e rep.
23    305 ILCS 5/5-5e.1 rep.
24    305 ILCS 5/5-5f rep.
25    305 ILCS 5/5A-15 rep.
26    305 ILCS 5/11-5.2 rep.

 

 

HB0027- 448 -LRB098 00027 KTG 30027 b

1    305 ILCS 5/11-5.3 rep.
2    305 ILCS 5/14-11 rep.
3    305 ILCS 60/3 rep.
4    320 ILCS 25/Act title
5    320 ILCS 25/1from Ch. 67 1/2, par. 401
6    320 ILCS 25/1.5
7    320 ILCS 25/2from Ch. 67 1/2, par. 402
8    320 ILCS 25/3.05a
9    320 ILCS 25/3.10from Ch. 67 1/2, par. 403.10
10    320 ILCS 25/4from Ch. 67 1/2, par. 404
11    320 ILCS 25/4.05
12    320 ILCS 25/4.2 new
13    320 ILCS 25/5from Ch. 67 1/2, par. 405
14    320 ILCS 25/6from Ch. 67 1/2, par. 406
15    320 ILCS 25/7from Ch. 67 1/2, par. 407
16    320 ILCS 25/8from Ch. 67 1/2, par. 408
17    320 ILCS 25/9from Ch. 67 1/2, par. 409
18    320 ILCS 25/12from Ch. 67 1/2, par. 412
19    320 ILCS 25/13from Ch. 67 1/2, par. 413
20    320 ILCS 30/2from Ch. 67 1/2, par. 452
21    320 ILCS 30/8from Ch. 67 1/2, par. 458
22    320 ILCS 50/5
23    410 ILCS 70/7from Ch. 111 1/2, par. 87-7
24    410 ILCS 420/3from Ch. 111 1/2, par. 2903
25    410 ILCS 430/3from Ch. 111 1/2, par. 22.33
26    625 ILCS 5/3-609from Ch. 95 1/2, par. 3-609

 

 

HB0027- 449 -LRB098 00027 KTG 30027 b

1    625 ILCS 5/3-623from Ch. 95 1/2, par. 3-623
2    625 ILCS 5/3-626
3    625 ILCS 5/3-667
4    625 ILCS 5/3-683
5    625 ILCS 5/3-806.3from Ch. 95 1/2, par. 3-806.3
6    625 ILCS 5/11-1301.2from Ch. 95 1/2, par. 11-1301.2
7    720 ILCS 5/17-6.5
8    735 ILCS 5/5-105from Ch. 110, par. 5-105
9    820 ILCS 405/1400.2
10    820 ILCS 405/1402from Ch. 48, par. 552
11    820 ILCS 405/1404from Ch. 48, par. 554
12    820 ILCS 405/1405from Ch. 48, par. 555
13    820 ILCS 405/1801.1
14    820 ILCS 405/1900from Ch. 48, par. 640