Rep. Sara Feigenholtz

Filed: 4/12/2013

 

 


 

 


 
09800HB2275ham001LRB098 07652 KTG 44461 a

1
AMENDMENT TO HOUSE BILL 2275

2    AMENDMENT NO. ______. Amend House Bill 2275 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Act on the Aging is amended by
5changing Sections 4.01 and 4.02 as follows:
 
6    (20 ILCS 105/4.01)  (from Ch. 23, par. 6104.01)
7    Sec. 4.01. Additional powers and duties of the Department.
8In addition to powers and duties otherwise provided by law, the
9Department shall have the following powers and duties:
10    (1) To evaluate all programs, services, and facilities for
11the aged and for minority senior citizens within the State and
12determine the extent to which present public or private
13programs, services and facilities meet the needs of the aged.
14    (2) To coordinate and evaluate all programs, services, and
15facilities for the Aging and for minority senior citizens
16presently furnished by State agencies and make appropriate

 

 

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1recommendations regarding such services, programs and
2facilities to the Governor and/or the General Assembly.
3    (2-a) To request, receive, and share information
4electronically through the use of data-sharing agreements for
5the purpose of (i) establishing and verifying the initial and
6continuing eligibility of older adults to participate in
7programs administered by the Department; (ii) maximizing
8federal financial participation in State assistance
9expenditures; and (iii) investigating allegations of fraud or
10other abuse of publicly funded benefits. Notwithstanding any
11other law to the contrary, but only for the limited purposes
12identified in the preceding sentence, this paragraph (2-a)
13expressly authorizes the exchanges of income, identification,
14and other pertinent eligibility information by and among the
15Department and the Social Security Administration, the
16Department of Employment Security, the Department of
17Healthcare and Family Services, the Department of Human
18Services, the Department of Revenue, the Secretary of State,
19the U.S. Department of Veterans Affairs, and any other
20governmental entity. The confidentiality of information
21otherwise shall be maintained as required by law. In addition,
22the Department on Aging shall verify employment information at
23the request of a community care provider for the purpose of
24ensuring program integrity under the Community Care Program.
25    (3) To function as the sole State agency to develop a
26comprehensive plan to meet the needs of the State's senior

 

 

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1citizens and the State's minority senior citizens.
2    (4) To receive and disburse State and federal funds made
3available directly to the Department including those funds made
4available under the Older Americans Act and the Senior
5Community Service Employment Program for providing services
6for senior citizens and minority senior citizens or for
7purposes related thereto, and shall develop and administer any
8State Plan for the Aging required by federal law.
9    (5) To solicit, accept, hold, and administer in behalf of
10the State any grants or legacies of money, securities, or
11property to the State of Illinois for services to senior
12citizens and minority senior citizens or purposes related
13thereto.
14    (6) To provide consultation and assistance to communities,
15area agencies on aging, and groups developing local services
16for senior citizens and minority senior citizens.
17    (7) To promote community education regarding the problems
18of senior citizens and minority senior citizens through
19institutes, publications, radio, television and the local
20press.
21    (8) To cooperate with agencies of the federal government in
22studies and conferences designed to examine the needs of senior
23citizens and minority senior citizens and to prepare programs
24and facilities to meet those needs.
25    (9) To establish and maintain information and referral
26sources throughout the State when not provided by other

 

 

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1agencies.
2    (10) To provide the staff support that may reasonably be
3required by the Council.
4    (11) To make and enforce rules and regulations necessary
5and proper to the performance of its duties.
6    (12) To establish and fund programs or projects or
7experimental facilities that are specially designed as
8alternatives to institutional care.
9    (13) To develop a training program to train the counselors
10presently employed by the Department's aging network to provide
11Medicare beneficiaries with counseling and advocacy in
12Medicare, private health insurance, and related health care
13coverage plans. The Department shall report to the General
14Assembly on the implementation of the training program on or
15before December 1, 1986.
16    (14) To make a grant to an institution of higher learning
17to study the feasibility of establishing and implementing an
18affirmative action employment plan for the recruitment,
19hiring, training and retraining of persons 60 or more years old
20for jobs for which their employment would not be precluded by
21law.
22    (15) To present one award annually in each of the
23categories of community service, education, the performance
24and graphic arts, and the labor force to outstanding Illinois
25senior citizens and minority senior citizens in recognition of
26their individual contributions to either community service,

 

 

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1education, the performance and graphic arts, or the labor
2force. The awards shall be presented to 4 senior citizens and
3minority senior citizens selected from a list of 44 nominees
4compiled annually by the Department. Nominations shall be
5solicited from senior citizens' service providers, area
6agencies on aging, senior citizens' centers, and senior
7citizens' organizations. The Department shall establish a
8central location within the State to be designated as the
9Senior Illinoisans Hall of Fame for the public display of all
10the annual awards, or replicas thereof.
11    (16) To establish multipurpose senior centers through area
12agencies on aging and to fund those new and existing
13multipurpose senior centers through area agencies on aging, the
14establishment and funding to begin in such areas of the State
15as the Department shall designate by rule and as specifically
16appropriated funds become available.
17    (17) To develop the content and format of the
18acknowledgment regarding non-recourse reverse mortgage loans
19under Section 6.1 of the Illinois Banking Act; to provide
20independent consumer information on reverse mortgages and
21alternatives; and to refer consumers to independent counseling
22services with expertise in reverse mortgages.
23    (18) To develop a pamphlet in English and Spanish which may
24be used by physicians licensed to practice medicine in all of
25its branches pursuant to the Medical Practice Act of 1987,
26pharmacists licensed pursuant to the Pharmacy Practice Act, and

 

 

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1Illinois residents 65 years of age or older for the purpose of
2assisting physicians, pharmacists, and patients in monitoring
3prescriptions provided by various physicians and to aid persons
465 years of age or older in complying with directions for
5proper use of pharmaceutical prescriptions. The pamphlet may
6provide space for recording information including but not
7limited to the following:
8        (a) name and telephone number of the patient;
9        (b) name and telephone number of the prescribing
10    physician;
11        (c) date of prescription;
12        (d) name of drug prescribed;
13        (e) directions for patient compliance; and
14        (f) name and telephone number of dispensing pharmacy.
15    In developing the pamphlet, the Department shall consult
16with the Illinois State Medical Society, the Center for
17Minority Health Services, the Illinois Pharmacists Association
18and senior citizens organizations. The Department shall
19distribute the pamphlets to physicians, pharmacists and
20persons 65 years of age or older or various senior citizen
21organizations throughout the State.
22    (19) To conduct a study of the feasibility of implementing
23the Senior Companion Program throughout the State.
24    (20) The reimbursement rates paid through the community
25care program for chore housekeeping services and home care
26aides shall be the same.

 

 

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1    (21) From funds appropriated to the Department from the
2Meals on Wheels Fund, a special fund in the State treasury that
3is hereby created, and in accordance with State and federal
4guidelines and the intrastate funding formula, to make grants
5to area agencies on aging, designated by the Department, for
6the sole purpose of delivering meals to homebound persons 60
7years of age and older.
8    (22) To distribute, through its area agencies on aging,
9information alerting seniors on safety issues regarding
10emergency weather conditions, including extreme heat and cold,
11flooding, tornadoes, electrical storms, and other severe storm
12weather. The information shall include all necessary
13instructions for safety and all emergency telephone numbers of
14organizations that will provide additional information and
15assistance.
16    (23) To develop guidelines for the organization and
17implementation of Volunteer Services Credit Programs to be
18administered by Area Agencies on Aging or community based
19senior service organizations. The Department shall hold public
20hearings on the proposed guidelines for public comment,
21suggestion, and determination of public interest. The
22guidelines shall be based on the findings of other states and
23of community organizations in Illinois that are currently
24operating volunteer services credit programs or demonstration
25volunteer services credit programs. The Department shall offer
26guidelines for all aspects of the programs including, but not

 

 

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1limited to, the following:
2        (a) types of services to be offered by volunteers;
3        (b) types of services to be received upon the
4    redemption of service credits;
5        (c) issues of liability for the volunteers and the
6    administering organizations;
7        (d) methods of tracking service credits earned and
8    service credits redeemed;
9        (e) issues of time limits for redemption of service
10    credits;
11        (f) methods of recruitment of volunteers;
12        (g) utilization of community volunteers, community
13    service groups, and other resources for delivering
14    services to be received by service credit program clients;
15        (h) accountability and assurance that services will be
16    available to individuals who have earned service credits;
17    and
18        (i) volunteer screening and qualifications.
19The Department shall submit a written copy of the guidelines to
20the General Assembly by July 1, 1998.
21(Source: P.A. 95-298, eff. 8-20-07; 95-689, eff. 10-29-07;
2295-876, eff. 8-21-08; 96-918, eff. 6-9-10.)
 
23    (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
24    Sec. 4.02. Community Care Program. The Department shall
25establish a program of services to prevent unnecessary

 

 

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1institutionalization of persons age 60 and older in need of
2long term care or who are established as persons who suffer
3from Alzheimer's disease or a related disorder under the
4Alzheimer's Disease Assistance Act, thereby enabling them to
5remain in their own homes or in other living arrangements. Such
6preventive services, which may be coordinated with other
7programs for the aged and monitored by area agencies on aging
8in cooperation with the Department, may include, but are not
9limited to, any or all of the following:
10        (a) (blank);
11        (b) (blank);
12        (c) home care aide services;
13        (d) personal assistant services;
14        (e) adult day services;
15        (f) home-delivered meals;
16        (g) education in self-care;
17        (h) personal care services;
18        (i) adult day health services;
19        (j) habilitation services;
20        (k) respite care;
21        (k-5) community reintegration services;
22        (k-6) flexible senior services;
23        (k-7) medication management;
24        (k-8) emergency home response;
25        (l) other nonmedical social services that may enable
26    the person to become self-supporting; or

 

 

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1        (m) clearinghouse for information provided by senior
2    citizen home owners who want to rent rooms to or share
3    living space with other senior citizens.
4    The Department shall establish eligibility standards for
5such services. In determining the amount and nature of services
6for which a person may qualify, consideration shall not be
7given to the value of cash, property or other assets held in
8the name of the person's spouse pursuant to a written agreement
9dividing marital property into equal but separate shares or
10pursuant to a transfer of the person's interest in a home to
11his spouse, provided that the spouse's share of the marital
12property is not made available to the person seeking such
13services.
14    Beginning January 1, 2008, the Department shall require as
15a condition of eligibility that all new financially eligible
16applicants apply for and enroll in medical assistance under
17Article V of the Illinois Public Aid Code in accordance with
18rules promulgated by the Department.
19    The Department shall, in conjunction with the Department of
20Public Aid (now Department of Healthcare and Family Services),
21seek appropriate amendments under Sections 1915 and 1924 of the
22Social Security Act. The purpose of the amendments shall be to
23extend eligibility for home and community based services under
24Sections 1915 and 1924 of the Social Security Act to persons
25who transfer to or for the benefit of a spouse those amounts of
26income and resources allowed under Section 1924 of the Social

 

 

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1Security Act. Subject to the approval of such amendments, the
2Department shall extend the provisions of Section 5-4 of the
3Illinois Public Aid Code to persons who, but for the provision
4of home or community-based services, would require the level of
5care provided in an institution, as is provided for in federal
6law. Those persons no longer found to be eligible for receiving
7noninstitutional services due to changes in the eligibility
8criteria shall be given 45 days notice prior to actual
9termination. Those persons receiving notice of termination may
10contact the Department and request the determination be
11appealed at any time during the 45 day notice period. The
12target population identified for the purposes of this Section
13are persons age 60 and older with an identified service need.
14Priority shall be given to those who are at imminent risk of
15institutionalization. The services shall be provided to
16eligible persons age 60 and older to the extent that the cost
17of the services together with the other personal maintenance
18expenses of the persons are reasonably related to the standards
19established for care in a group facility appropriate to the
20person's condition. These non-institutional services, pilot
21projects or experimental facilities may be provided as part of
22or in addition to those authorized by federal law or those
23funded and administered by the Department of Human Services.
24The Departments of Human Services, Healthcare and Family
25Services, Public Health, Veterans' Affairs, and Commerce and
26Economic Opportunity and other appropriate agencies of State,

 

 

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

 

 

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

 

 

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1claims have been filed, they remain dormant for failure of
2prosecution or failure of the claimant to compel administration
3of the estate for the purpose of payment. This paragraph shall
4not bar recovery from the estate of a spouse, under Sections
51915 and 1924 of the Social Security Act and Section 5-4 of the
6Illinois Public Aid Code, who precedes a person receiving
7services under this Section in death. All moneys for services
8paid to or in behalf of the person under this Section shall be
9claimed for recovery from the deceased spouse's estate.
10"Homestead", as used in this paragraph, means the dwelling
11house and contiguous real estate occupied by a surviving spouse
12or relative, as defined by the rules and regulations of the
13Department of Healthcare and Family Services, regardless of the
14value of the property.
15    The Department shall increase the effectiveness of the
16existing Community Care Program by:
17        (1) ensuring that in-home services included in the care
18    plan are available on evenings and weekends;
19        (2) ensuring that care plans contain the services that
20    eligible participants need based on the number of days in a
21    month, not limited to specific blocks of time, as
22    identified by the comprehensive assessment tool selected
23    by the Department for use statewide, not to exceed the
24    total monthly service cost maximum allowed for each
25    service; the Department shall develop administrative rules
26    to implement this item (2);

 

 

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

 

 

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

 

 

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

 

 

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1    in the recipient's area; and
2        (13) maintaining fiscal year 2014 rates at the same
3    level established on January 1, 2013.
4    By January 1, 2009 or as soon after the end of the Cash and
5Counseling Demonstration Project as is practicable, the
6Department may, based on its evaluation of the demonstration
7project, promulgate rules concerning personal assistant
8services, to include, but need not be limited to,
9qualifications, employment screening, rights under fair labor
10standards, training, fiduciary agent, and supervision
11requirements. All applicants shall be subject to the provisions
12of the Health Care Worker Background Check Act.
13    The Department shall develop procedures to enhance
14availability of services on evenings, weekends, and on an
15emergency basis to meet the respite needs of caregivers.
16Procedures shall be developed to permit the utilization of
17services in successive blocks of 24 hours up to the monthly
18maximum established by the Department. Workers providing these
19services shall be appropriately trained.
20    Beginning on the effective date of this Amendatory Act of
211991, no person may perform chore/housekeeping and home care
22aide services under a program authorized by this Section unless
23that person has been issued a certificate of pre-service to do
24so by his or her employing agency. Information gathered to
25effect such certification shall include (i) the person's name,
26(ii) the date the person was hired by his or her current

 

 

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

 

 

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

 

 

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

 

 

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1required by Section 3.1 of the General Assembly Organization
2Act and filing such additional copies with the State Government
3Report Distribution Center for the General Assembly as is
4required under paragraph (t) of Section 7 of the State Library
5Act.
6    Those persons previously found eligible for receiving
7non-institutional services whose services were discontinued
8under the Emergency Budget Act of Fiscal Year 1992, and who do
9not meet the eligibility standards in effect on or after July
101, 1992, shall remain ineligible on and after July 1, 1992.
11Those persons previously not required to cost-share and who
12were required to cost-share effective March 1, 1992, shall
13continue to meet cost-share requirements on and after July 1,
141992. Beginning July 1, 1992, all clients will be required to
15meet eligibility, cost-share, and other requirements and will
16have services discontinued or altered when they fail to meet
17these requirements.
18    For the purposes of this Section, "flexible senior
19services" refers to services that require one-time or periodic
20expenditures including, but not limited to, respite care, home
21modification, assistive technology, housing assistance, and
22transportation.
23    The Department shall implement an electronic service
24verification based on global positioning systems or other
25cost-effective technology for the Community Care Program no
26later than January 1, 2014.

 

 

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

 

 

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

 

 

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1Section 1-109 of the Code of Civil Procedure, that the provider
2has complied with all Department policies.
3(Source: P.A. 96-918, eff. 6-9-10; 96-1129, eff. 7-20-10;
497-333, eff. 8-12-11.)
 
5    Section 9. The Illinois State Auditing Act is amended by
6adding Section 2-27 as follows:
 
7    (30 ILCS 5/2-27 new)
8    Sec. 2-27. Certification of Community Care Program reform
9implementation.
10    (a) No later than July 1, 2013, the Department on Aging
11shall file a report with the Auditor General, the Governor, the
12Speaker of the House of Representatives, the Minority Leader of
13the House of Representatives, the President of the Senate, and
14the Minority Leader of the Senate listing any necessary
15amendment to the Illinois Title XIX State plan, any federal
16waiver request, any State administrative rule, or any State
17Policy changes and notifications required to implement this
18amendatory Act of the 98th General Assembly.
19    (b) No later than February 1, 2014, the Department on Aging
20shall provide evidence to the Auditor General that it has
21undertaken the required actions listed in the report required
22by subsection (a).
23    (c) No later than April 1, 2014, the Auditor General shall
24submit a report to the Governor, the Speaker of the House of

 

 

09800HB2275ham001- 26 -LRB098 07652 KTG 44461 a

1Representatives, the Minority Leader of the House of
2Representatives, the President of the Senate, and the Minority
3Leader of the Senate as to whether the Department on Aging has
4undertaken the required actions listed in the report required
5by subsection (a).
 
6    Section 10. The State Finance Act is amended by changing
7Section 25 as follows:
 
8    (30 ILCS 105/25)  (from Ch. 127, par. 161)
9    Sec. 25. Fiscal year limitations.
10    (a) All appropriations shall be available for expenditure
11for the fiscal year or for a lesser period if the Act making
12that appropriation so specifies. A deficiency or emergency
13appropriation shall be available for expenditure only through
14June 30 of the year when the Act making that appropriation is
15enacted unless that Act otherwise provides.
16    (b) Outstanding liabilities as of June 30, payable from
17appropriations which have otherwise expired, may be paid out of
18the expiring appropriations during the 2-month period ending at
19the close of business on August 31. Any service involving
20professional or artistic skills or any personal services by an
21employee whose compensation is subject to income tax
22withholding must be performed as of June 30 of the fiscal year
23in order to be considered an "outstanding liability as of June
2430" that is thereby eligible for payment out of the expiring

 

 

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1appropriation.
2    (b-1) However, payment of tuition reimbursement claims
3under Section 14-7.03 or 18-3 of the School Code may be made by
4the State Board of Education from its appropriations for those
5respective purposes for any fiscal year, even though the claims
6reimbursed by the payment may be claims attributable to a prior
7fiscal year, and payments may be made at the direction of the
8State Superintendent of Education from the fund from which the
9appropriation is made without regard to any fiscal year
10limitations, except as required by subsection (j) of this
11Section. Beginning on June 30, 2021, payment of tuition
12reimbursement claims under Section 14-7.03 or 18-3 of the
13School Code as of June 30, payable from appropriations that
14have otherwise expired, may be paid out of the expiring
15appropriation during the 4-month period ending at the close of
16business on October 31.
17    (b-2) All outstanding liabilities as of June 30, 2010,
18payable from appropriations that would otherwise expire at the
19conclusion of the lapse period for fiscal year 2010, and
20interest penalties payable on those liabilities under the State
21Prompt Payment Act, may be paid out of the expiring
22appropriations until December 31, 2010, without regard to the
23fiscal year in which the payment is made, as long as vouchers
24for the liabilities are received by the Comptroller no later
25than August 31, 2010.
26    (b-2.5) All outstanding liabilities as of June 30, 2011,

 

 

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1payable from appropriations that would otherwise expire at the
2conclusion of the lapse period for fiscal year 2011, and
3interest penalties payable on those liabilities under the State
4Prompt Payment Act, may be paid out of the expiring
5appropriations until December 31, 2011, without regard to the
6fiscal year in which the payment is made, as long as vouchers
7for the liabilities are received by the Comptroller no later
8than August 31, 2011.
9    (b-2.6) All outstanding liabilities as of June 30, 2012,
10payable from appropriations that would otherwise expire at the
11conclusion of the lapse period for fiscal year 2012, and
12interest penalties payable on those liabilities under the State
13Prompt Payment Act, may be paid out of the expiring
14appropriations until December 31, 2012, without regard to the
15fiscal year in which the payment is made, as long as vouchers
16for the liabilities are received by the Comptroller no later
17than August 31, 2012.
18    (b-2.7) (b-2.6) For fiscal years 2012 and 2013, interest
19penalties payable under the State Prompt Payment Act associated
20with a voucher for which payment is issued after June 30 may be
21paid out of the next fiscal year's appropriation. The future
22year appropriation must be for the same purpose and from the
23same fund as the original payment. An interest penalty voucher
24submitted against a future year appropriation must be submitted
25within 60 days after the issuance of the associated voucher,
26and the Comptroller must issue the interest payment within 60

 

 

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1days after acceptance of the interest voucher.
2    (b-3) Medical payments may be made by the Department of
3Veterans' Affairs from its appropriations for those purposes
4for any fiscal year, without regard to the fact that the
5medical services being compensated for by such payment may have
6been rendered in a prior fiscal year, except as required by
7subsection (j) of this Section. Beginning on June 30, 2021,
8medical payments payable from appropriations that have
9otherwise expired may be paid out of the expiring appropriation
10during the 4-month period ending at the close of business on
11October 31.
12    (b-4) Medical payments and child care payments may be made
13by the Department of Human Services (as successor to the
14Department of Public Aid) from appropriations for those
15purposes for any fiscal year, without regard to the fact that
16the medical or child care services being compensated for by
17such payment may have been rendered in a prior fiscal year; and
18payments may be made at the direction of the Department of
19Healthcare and Family Services (or successor agency) from the
20Health Insurance Reserve Fund without regard to any fiscal year
21limitations, except as required by subsection (j) of this
22Section. Beginning on June 30, 2021, medical and child care
23payments made by the Department of Human Services, and payments
24made at the discretion of the Department of Healthcare and
25Family Services (or successor agency) from the Health Insurance
26Reserve Fund and payable from appropriations that have

 

 

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1otherwise expired may be paid out of the expiring appropriation
2during the 4-month period ending at the close of business on
3October 31.
4    (b-5) Medical payments may be made by the Department of
5Human Services from its appropriations relating to substance
6abuse treatment services for any fiscal year, without regard to
7the fact that the medical services being compensated for by
8such payment may have been rendered in a prior fiscal year,
9provided the payments are made on a fee-for-service basis
10consistent with requirements established for Medicaid
11reimbursement by the Department of Healthcare and Family
12Services, except as required by subsection (j) of this Section.
13Beginning on June 30, 2021, medical payments made by the
14Department of Human Services relating to substance abuse
15treatment services payable from appropriations that have
16otherwise expired may be paid out of the expiring appropriation
17during the 4-month period ending at the close of business on
18October 31.
19    (b-6) Additionally, payments may be made by the Department
20of Human Services from its appropriations, or any other State
21agency from its appropriations with the approval of the
22Department of Human Services, from the Immigration Reform and
23Control Fund for purposes authorized pursuant to the
24Immigration Reform and Control Act of 1986, without regard to
25any fiscal year limitations, except as required by subsection
26(j) of this Section. Beginning on June 30, 2021, payments made

 

 

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1by the Department of Human Services from the Immigration Reform
2and Control Fund for purposes authorized pursuant to the
3Immigration Reform and Control Act of 1986 payable from
4appropriations that have otherwise expired may be paid out of
5the expiring appropriation during the 4-month period ending at
6the close of business on October 31.
7    (b-7) Payments may be made in accordance with a plan
8authorized by paragraph (11) or (12) of Section 405-105 of the
9Department of Central Management Services Law from
10appropriations for those payments without regard to fiscal year
11limitations.
12    (b-9) Medical payments not exceeding $150,000,000 may be
13made by the Department on Aging from its appropriations
14relating to the Community Care Program for fiscal year 2014,
15without regard to the fact that the medical services being
16compensated for by such payment may have been rendered in a
17prior fiscal year, provided the payments are made on a
18fee-for-service basis consistent with requirements established
19for Medicaid reimbursement by the Department of Healthcare and
20Family Services, except as required by subsection (j) of this
21Section.
22    (c) Further, payments may be made by the Department of
23Public Health and the Department of Human Services (acting as
24successor to the Department of Public Health under the
25Department of Human Services Act) from their respective
26appropriations for grants for medical care to or on behalf of

 

 

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1premature and high-mortality risk infants and their mothers and
2for grants for supplemental food supplies provided under the
3United States Department of Agriculture Women, Infants and
4Children Nutrition Program, for any fiscal year without regard
5to the fact that the services being compensated for by such
6payment may have been rendered in a prior fiscal year, except
7as required by subsection (j) of this Section. Beginning on
8June 30, 2021, payments made by the Department of Public Health
9and the Department of Human Services from their respective
10appropriations for grants for medical care to or on behalf of
11premature and high-mortality risk infants and their mothers and
12for grants for supplemental food supplies provided under the
13United States Department of Agriculture Women, Infants and
14Children Nutrition Program payable from appropriations that
15have otherwise expired may be paid out of the expiring
16appropriations during the 4-month period ending at the close of
17business on October 31.
18    (d) The Department of Public Health and the Department of
19Human Services (acting as successor to the Department of Public
20Health under the Department of Human Services Act) shall each
21annually submit to the State Comptroller, Senate President,
22Senate Minority Leader, Speaker of the House, House Minority
23Leader, and the respective Chairmen and Minority Spokesmen of
24the Appropriations Committees of the Senate and the House, on
25or before December 31, a report of fiscal year funds used to
26pay for services provided in any prior fiscal year. This report

 

 

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1shall document by program or service category those
2expenditures from the most recently completed fiscal year used
3to pay for services provided in prior fiscal years.
4    (e) The Department of Healthcare and Family Services, the
5Department of Human Services (acting as successor to the
6Department of Public Aid), and the Department of Human Services
7making fee-for-service payments relating to substance abuse
8treatment services provided during a previous fiscal year shall
9each annually submit to the State Comptroller, Senate
10President, Senate Minority Leader, Speaker of the House, House
11Minority Leader, the respective Chairmen and Minority
12Spokesmen of the Appropriations Committees of the Senate and
13the House, on or before November 30, a report that shall
14document by program or service category those expenditures from
15the most recently completed fiscal year used to pay for (i)
16services provided in prior fiscal years and (ii) services for
17which claims were received in prior fiscal years.
18    (f) The Department of Human Services (as successor to the
19Department of Public Aid) shall annually submit to the State
20Comptroller, Senate President, Senate Minority Leader, Speaker
21of the House, House Minority Leader, and the respective
22Chairmen and Minority Spokesmen of the Appropriations
23Committees of the Senate and the House, on or before December
2431, a report of fiscal year funds used to pay for services
25(other than medical care) provided in any prior fiscal year.
26This report shall document by program or service category those

 

 

09800HB2275ham001- 34 -LRB098 07652 KTG 44461 a

1expenditures from the most recently completed fiscal year used
2to pay for services provided in prior fiscal years.
3    (g) In addition, each annual report required to be
4submitted by the Department of Healthcare and Family Services
5under subsection (e) shall include the following information
6with respect to the State's Medicaid program:
7        (1) Explanations of the exact causes of the variance
8    between the previous year's estimated and actual
9    liabilities.
10        (2) Factors affecting the Department of Healthcare and
11    Family Services' liabilities, including but not limited to
12    numbers of aid recipients, levels of medical service
13    utilization by aid recipients, and inflation in the cost of
14    medical services.
15        (3) The results of the Department's efforts to combat
16    fraud and abuse.
17    (h) As provided in Section 4 of the General Assembly
18Compensation Act, any utility bill for service provided to a
19General Assembly member's district office for a period
20including portions of 2 consecutive fiscal years may be paid
21from funds appropriated for such expenditure in either fiscal
22year.
23    (i) An agency which administers a fund classified by the
24Comptroller as an internal service fund may issue rules for:
25        (1) billing user agencies in advance for payments or
26    authorized inter-fund transfers based on estimated charges

 

 

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1    for goods or services;
2        (2) issuing credits, refunding through inter-fund
3    transfers, or reducing future inter-fund transfers during
4    the subsequent fiscal year for all user agency payments or
5    authorized inter-fund transfers received during the prior
6    fiscal year which were in excess of the final amounts owed
7    by the user agency for that period; and
8        (3) issuing catch-up billings to user agencies during
9    the subsequent fiscal year for amounts remaining due when
10    payments or authorized inter-fund transfers received from
11    the user agency during the prior fiscal year were less than
12    the total amount owed for that period.
13User agencies are authorized to reimburse internal service
14funds for catch-up billings by vouchers drawn against their
15respective appropriations for the fiscal year in which the
16catch-up billing was issued or by increasing an authorized
17inter-fund transfer during the current fiscal year. For the
18purposes of this Act, "inter-fund transfers" means transfers
19without the use of the voucher-warrant process, as authorized
20by Section 9.01 of the State Comptroller Act.
21    (i-1) Beginning on July 1, 2021, all outstanding
22liabilities, not payable during the 4-month lapse period as
23described in subsections (b-1), (b-3), (b-4), (b-5), (b-6), and
24(c) of this Section, that are made from appropriations for that
25purpose for any fiscal year, without regard to the fact that
26the services being compensated for by those payments may have

 

 

09800HB2275ham001- 36 -LRB098 07652 KTG 44461 a

1been rendered in a prior fiscal year, are limited to only those
2claims that have been incurred but for which a proper bill or
3invoice as defined by the State Prompt Payment Act has not been
4received by September 30th following the end of the fiscal year
5in which the service was rendered.
6    (j) Notwithstanding any other provision of this Act, the
7aggregate amount of payments to be made without regard for
8fiscal year limitations as contained in subsections (b-1),
9(b-3), (b-4), (b-5), (b-6), and (c) of this Section, and
10determined by using Generally Accepted Accounting Principles,
11shall not exceed the following amounts:
12        (1) $6,000,000,000 for outstanding liabilities related
13    to fiscal year 2012;
14        (2) $5,300,000,000 for outstanding liabilities related
15    to fiscal year 2013;
16        (3) $4,600,000,000 for outstanding liabilities related
17    to fiscal year 2014;
18        (4) $4,000,000,000 for outstanding liabilities related
19    to fiscal year 2015;
20        (5) $3,300,000,000 for outstanding liabilities related
21    to fiscal year 2016;
22        (6) $2,600,000,000 for outstanding liabilities related
23    to fiscal year 2017;
24        (7) $2,000,000,000 for outstanding liabilities related
25    to fiscal year 2018;
26        (8) $1,300,000,000 for outstanding liabilities related

 

 

09800HB2275ham001- 37 -LRB098 07652 KTG 44461 a

1    to fiscal year 2019;
2        (9) $600,000,000 for outstanding liabilities related
3    to fiscal year 2020; and
4        (10) $0 for outstanding liabilities related to fiscal
5    year 2021 and fiscal years thereafter.
6    (k) Department of Healthcare and Family Services Medical
7Assistance Payments.
8        (1) Definition of Medical Assistance.
9            For purposes of this subsection, the term "Medical
10        Assistance" shall include, but not necessarily be
11        limited to, medical programs and services authorized
12        under Titles XIX and XXI of the Social Security Act,
13        the Illinois Public Aid Code, the Children's Health
14        Insurance Program Act, the Covering ALL KIDS Health
15        Insurance Act, the Long Term Acute Care Hospital
16        Quality Improvement Transfer Program Act, and medical
17        care to or on behalf of persons suffering from chronic
18        renal disease, persons suffering from hemophilia, and
19        victims of sexual assault.
20        (2) Limitations on Medical Assistance payments that
21    may be paid from future fiscal year appropriations.
22            (A) The maximum amounts of annual unpaid Medical
23        Assistance bills received and recorded by the
24        Department of Healthcare and Family Services on or
25        before June 30th of a particular fiscal year
26        attributable in aggregate to the General Revenue Fund,

 

 

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1        Healthcare Provider Relief Fund, Tobacco Settlement
2        Recovery Fund, Long-Term Care Provider Fund, and the
3        Drug Rebate Fund that may be paid in total by the
4        Department from future fiscal year Medical Assistance
5        appropriations to those funds are: $700,000,000 for
6        fiscal year 2013 and $100,000,000 for fiscal year 2014
7        and each fiscal year thereafter.
8            (B) Bills for Medical Assistance services rendered
9        in a particular fiscal year, but received and recorded
10        by the Department of Healthcare and Family Services
11        after June 30th of that fiscal year, may be paid from
12        either appropriations for that fiscal year or future
13        fiscal year appropriations for Medical Assistance.
14        Such payments shall not be subject to the requirements
15        of subparagraph (A).
16            (C) Medical Assistance bills received by the
17        Department of Healthcare and Family Services in a
18        particular fiscal year, but subject to payment amount
19        adjustments in a future fiscal year may be paid from a
20        future fiscal year's appropriation for Medical
21        Assistance. Such payments shall not be subject to the
22        requirements of subparagraph (A).
23            (D) Medical Assistance payments made by the
24        Department of Healthcare and Family Services from
25        funds other than those specifically referenced in
26        subparagraph (A) may be made from appropriations for

 

 

09800HB2275ham001- 39 -LRB098 07652 KTG 44461 a

1        those purposes for any fiscal year without regard to
2        the fact that the Medical Assistance services being
3        compensated for by such payment may have been rendered
4        in a prior fiscal year. Such payments shall not be
5        subject to the requirements of subparagraph (A).
6        (3) Extended lapse period for Department of Healthcare
7    and Family Services Medical Assistance payments.
8    Notwithstanding any other State law to the contrary,
9    outstanding Department of Healthcare and Family Services
10    Medical Assistance liabilities, as of June 30th, payable
11    from appropriations which have otherwise expired, may be
12    paid out of the expiring appropriations during the 6-month
13    period ending at the close of business on December 31st.
14    (l) The changes to this Section made by Public Act 97-691
15this amendatory Act of the 97th General Assembly shall be
16effective for payment of Medical Assistance bills incurred in
17fiscal year 2013 and future fiscal years. The changes to this
18Section made by Public Act 97-691 this amendatory Act of the
1997th General Assembly shall not be applied to Medical
20Assistance bills incurred in fiscal year 2012 or prior fiscal
21years.
22    (m) (k) The Comptroller must issue payments against
23outstanding liabilities that were received prior to the lapse
24period deadlines set forth in this Section as soon thereafter
25as practical, but no payment may be issued after the 4 months
26following the lapse period deadline without the signed

 

 

09800HB2275ham001- 40 -LRB098 07652 KTG 44461 a

1authorization of the Comptroller and the Governor.
2(Source: P.A. 96-928, eff. 6-15-10; 96-958, eff. 7-1-10;
396-1501, eff. 1-25-11; 97-75, eff. 6-30-11; 97-333, eff.
48-12-11; 97-691, eff. 7-1-12; 97-732, eff. 6-30-12; 97-932,
5eff. 8-10-12; revised 8-23-12.)
 
6    Section 15. The Illinois Public Aid Code is amended by
7changing Section 12-13.1 as follows:
 
8    (305 ILCS 5/12-13.1)
9    Sec. 12-13.1. Inspector General.
10    (a) The Governor shall appoint, and the Senate shall
11confirm, an Inspector General who shall function within the
12Illinois Department of Public Aid (now Healthcare and Family
13Services) and report to the Governor. The term of the Inspector
14General shall expire on the third Monday of January, 1997 and
15every 4 years thereafter.
16    (b) In order to prevent, detect, and eliminate fraud,
17waste, abuse, mismanagement, and misconduct, the Inspector
18General shall oversee the Department of Healthcare and Family
19Services' and the Department on Aging's integrity functions,
20which include, but are not limited to, the following:
21        (1) Investigation of misconduct by employees, vendors,
22    contractors and medical providers, except for allegations
23    of violations of the State Officials and Employees Ethics
24    Act which shall be referred to the Office of the Governor's

 

 

09800HB2275ham001- 41 -LRB098 07652 KTG 44461 a

1    Executive Inspector General for investigation.
2        (2) Prepayment and post-payment audits of medical
3    providers related to ensuring that appropriate payments
4    are made for services rendered and to the prevention and
5    recovery of overpayments.
6        (3) Monitoring of quality assurance programs
7    administered by the Department of Healthcare and Family
8    Services and the Community Care Program administered by the
9    Department on Aging.
10        (4) Quality control measurements of the programs
11    administered by the Department of Healthcare and Family
12    Services and the Community Care Program administered by the
13    Department on Aging.
14        (5) Investigations of fraud or intentional program
15    violations committed by clients of the Department of
16    Healthcare and Family Services and the Community Care
17    Program administered by the Department on Aging.
18        (6) Actions initiated against contractors, vendors, or
19    medical providers for any of the following reasons:
20            (A) Violations of the medical assistance program
21        and the Community Care Program administered by the
22        Department on Aging.
23            (B) Sanctions against providers brought in
24        conjunction with the Department of Public Health or the
25        Department of Human Services (as successor to the
26        Department of Mental Health and Developmental

 

 

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1        Disabilities).
2            (C) Recoveries of assessments against hospitals
3        and long-term care facilities.
4            (D) Sanctions mandated by the United States
5        Department of Health and Human Services against
6        medical providers.
7            (E) Violations of contracts related to any
8        programs administered by the Department of Healthcare
9        and Family Services and the Community Care Program
10        administered by the Department on Aging.
11        (7) Representation of the Department of Healthcare and
12    Family Services at hearings with the Illinois Department of
13    Financial and Professional Regulation in actions taken
14    against professional licenses held by persons who are in
15    violation of orders for child support payments.
16    (b-5) At the request of the Secretary of Human Services,
17the Inspector General shall, in relation to any function
18performed by the Department of Human Services as successor to
19the Department of Public Aid, exercise one or more of the
20powers provided under this Section as if those powers related
21to the Department of Human Services; in such matters, the
22Inspector General shall report his or her findings to the
23Secretary of Human Services.
24    (c) Notwithstanding, and in addition to, any other
25provision of law, the Inspector General shall have access to
26all information, personnel and facilities of the Department of

 

 

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1Healthcare and Family Services and the Department of Human
2Services (as successor to the Department of Public Aid), their
3employees, vendors, contractors and medical providers and any
4federal, State or local governmental agency that are necessary
5to perform the duties of the Office as directly related to
6public assistance programs administered by those departments.
7No medical provider shall be compelled, however, to provide
8individual medical records of patients who are not clients of
9the programs administered by the Department of Healthcare and
10Family Services. State and local governmental agencies are
11authorized and directed to provide the requested information,
12assistance or cooperation.
13    For purposes of enhanced program integrity functions and
14oversight, and to the extent consistent with applicable
15information and privacy, security, and disclosure laws, State
16agencies and departments shall provide the Office of Inspector
17General access to confidential and other information and data,
18and the Inspector General is authorized to enter into
19agreements with appropriate federal agencies and departments
20to secure similar data. This includes, but is not limited to,
21information pertaining to: licensure; certification; earnings;
22immigration status; citizenship; wage reporting; unearned and
23earned income; pension income; employment; supplemental
24security income; social security numbers; National Provider
25Identifier (NPI) numbers; the National Practitioner Data Bank
26(NPDB); program and agency exclusions; taxpayer identification

 

 

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1numbers; tax delinquency; corporate information; and death
2records.
3    The Inspector General 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 Inspector General shall enter into agreements with State
9agencies and departments, and is authorized to enter into
10agreements with federal agencies and departments, under which
11such agencies shall share data necessary for recipient and
12vendor screening, review, and investigation, including but not
13limited to vendor payment and recipient eligibility
14verification. The Inspector General shall develop, in
15cooperation with other State and federal agencies and
16departments, and in compliance with applicable federal laws and
17regulations, appropriate and effective methods to share such
18data. The Inspector General shall enter into agreements with
19State agencies and departments, and is authorized to enter into
20agreements with federal agencies and departments, including,
21but not limited to: the Secretary of State; the Department of
22Revenue; the Department of Public Health; the Department of
23Human Services; and the Department of Financial and
24Professional Regulation.
25    The Inspector General shall have the authority to deny
26payment, prevent overpayments, and recover overpayments.

 

 

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1    The Inspector General shall have the authority to deny or
2suspend payment to, and deny, terminate, or suspend the
3eligibility of, any vendor who fails to grant the Inspector
4General timely access to full and complete records, including
5records of recipients under the medical assistance program for
6the most recent 6 years, in accordance with Section 140.28 of
7Title 89 of the Illinois Administrative Code, and other
8information for the purpose of audits, investigations, or other
9program integrity functions, after reasonable written request
10by the Inspector General.
11    (d) The Inspector General shall serve as the Department of
12Healthcare and Family Services' primary liaison with law
13enforcement, investigatory and prosecutorial agencies,
14including but not limited to the following:
15        (1) The Department of State Police.
16        (2) The Federal Bureau of Investigation and other
17    federal law enforcement agencies.
18        (3) The various Inspectors General of federal agencies
19    overseeing the programs administered by the Department of
20    Healthcare and Family Services.
21        (4) The various Inspectors General of any other State
22    agencies with responsibilities for portions of programs
23    primarily administered by the Department of Healthcare and
24    Family Services.
25        (5) The Offices of the several United States Attorneys
26    in Illinois.

 

 

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1        (6) The several State's Attorneys.
2        (7) The offices of the Centers for Medicare and
3    Medicaid Services that administer the Medicare and
4    Medicaid integrity programs.
5    The Inspector General shall meet on a regular basis with
6these entities to share information regarding possible
7misconduct by any persons or entities involved with the public
8aid programs administered by the Department of Healthcare and
9Family Services.
10    (e) All investigations conducted by the Inspector General
11shall be conducted in a manner that ensures the preservation of
12evidence for use in criminal prosecutions. If the Inspector
13General determines that a possible criminal act relating to
14fraud in the provision or administration of the medical
15assistance program has been committed, the Inspector General
16shall immediately notify the Medicaid Fraud Control Unit. If
17the Inspector General determines that a possible criminal act
18has been committed within the jurisdiction of the Office, the
19Inspector General may request the special expertise of the
20Department of State Police. The Inspector General may present
21for prosecution the findings of any criminal investigation to
22the Office of the Attorney General, the Offices of the several
23United States Attorneys in Illinois or the several State's
24Attorneys.
25    (f) To carry out his or her duties as described in this
26Section, the Inspector General and his or her designees shall

 

 

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1have the power to compel by subpoena the attendance and
2testimony of witnesses and the production of books, electronic
3records and papers as directly related to public assistance
4programs administered by the Department of Healthcare and
5Family Services or the Department of Human Services (as
6successor to the Department of Public Aid). No medical provider
7shall be compelled, however, to provide individual medical
8records of patients who are not clients of the Medical
9Assistance Program.
10    (g) The Inspector General shall report all convictions,
11terminations, and suspensions taken against vendors,
12contractors and medical providers to the Department of
13Healthcare and Family Services and to any agency responsible
14for licensing or regulating those persons or entities.
15    (h) The Inspector General shall make annual reports,
16findings, and recommendations regarding the Office's
17investigations into reports of fraud, waste, abuse,
18mismanagement, or misconduct relating to any programs
19administered by the Department of Healthcare and Family
20Services or the Department of Human Services (as successor to
21the Department of Public Aid) to the General Assembly and the
22Governor. These reports shall include, but not be limited to,
23the following information:
24        (1) Aggregate provider billing and payment
25    information, including the number of providers at various
26    Medicaid earning levels.

 

 

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1        (2) The number of audits of the medical assistance
2    program and the dollar savings resulting from those audits.
3        (3) The number of prescriptions rejected annually
4    under the Department of Healthcare and Family Services'
5    Refill Too Soon program and the dollar savings resulting
6    from that program.
7        (4) Provider sanctions, in the aggregate, including
8    terminations and suspensions.
9        (5) A detailed summary of the investigations
10    undertaken in the previous fiscal year. These summaries
11    shall comply with all laws and rules regarding maintaining
12    confidentiality in the public aid programs.
13    (i) Nothing in this Section shall limit investigations by
14the Department of Healthcare and Family Services or the
15Department of Human Services that may otherwise be required by
16law or that may be necessary in their capacity as the central
17administrative authorities responsible for administration of
18their agency's programs in this State.
19    (j) The Inspector General may issue shields or other
20distinctive identification to his or her employees not
21exercising the powers of a peace officer if the Inspector
22General determines that a shield or distinctive identification
23is needed by an employee to carry out his or her
24responsibilities.
25(Source: P.A. 96-555, eff. 8-18-09; 96-1316, eff. 1-1-11;
2697-689, eff. 6-14-12.)
 

 

 

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1    (320 ILCS 50/15 rep.)
2    Section 20. The Senior Pharmaceutical Assistance Act is
3amended by repealing Section 15.
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.".