Illinois General Assembly - Bill Status for HB4771

Amends the Illinois Public Aid Code. Requires the Department of Human Services and the Department of Healthcare and Family Services' Office of the Inspector General to perform the following actions to ensure that applicants submit completed applications for long-term care benefits: (i) provide each applicant with a checklist of information and documents the applicant must submit to complete an application for long-term care benefits; (ii) notify each applicant of the date upon which such information or documents were received by the Department; (iii) update and maintain the Department's computer hardware and software to ensure each applicant receives a timely response to any email sent by the applicant to the Department; and (iv) notify each applicant of the 30-day time period to submit all requested information or documents to the Department.

Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. Requires long-term care providers to submit all changes in resident status, including, but not limited to, death, discharge, changes in patient credit, third party liability, and Medicare coverage to the Department of Healthcare and Family Services through the Medical Electronic Data Interchange System, the Recipient Eligibility Verification System, or the Electronic Data Interchange System under a specified schedule. Requires the Department of Healthcare and Family Services to serve as the lead agency assuming primary responsibility for the full implementation of provisions concerning expedited long-term care eligibility determinations, renewals, enrollments, and payments, including the establishment and operation of the expedited long-term care system. Provides that beginning on June 29, 2018, provisional eligibility must be issued to any individual who has not received a final eligibility determination on the individual's application for Medicaid or Medicaid long-term care benefits or a notice of an opportunity for a hearing within the federally prescribed deadlines for the processing of such applications. Requires the Department to maintain the individual's provisional Medicaid enrollment status until a final eligibility determination is approved or the individual's appeal has been adjudicated and eligibility is denied. Provides that the Department or the managed care organization, if applicable, must reimburse providers for all services rendered during an individual's provisional eligibility period. Requires the Department to adopt, by rules, policies and procedures to ensure prospective compliance with the federal deadlines for Medicaid and Medicaid long-term care benefits eligibility determinations. Sets forth certain standards and principles the policies must address, including: (i) a streamlined application and enrollment process; (ii) protocols to expedite the eligibility processing system for applicants meeting certain guidelines, regardless of the age of the application; (iii) the review of applications for long-term care benefits when there exists credible evidence that an applicant has transferred assets with the intent of defrauding the State; and other matters. Contains provisions concerning: (1) the adoption of policies and procedures to improve communication between long-term care benefits central office personnel, applicants, and facilities in which the applicants reside; the establishment of policies and procedures to improve accountability and provide for the expedited payment of services rendered; (3) the Department's investigation of public-private partnerships in use in Ohio, Michigan, and Minnesota that are aimed at redeploying caseworkers to targeted high-Medicaid facilities for the purpose of expediting initial Medicaid and Medicaid long-term care benefits applications, renewals, and all other things related to enrollment, reimbursement, and application processing; (4) provider association meetings; (5) presumptive eligibility of benefits; (6) the prioritization of processing applications on a last-in, first-out basis; and other matters.

Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill, but with the following changes: Provides that an applicant with provisional enrollment status must have his or her benefits paid for under the State's fee-for-service system until such time as the State makes a final determination on the applicant's Medicaid or Medicaid long-term care application (rather than an applicant with provisional enrollment status, who is not enrolled in a managed care organization at the time the applicant's provisional status is issued, must continue to have his or her benefits paid for under the State's fee-for-service system until such time as the State makes a final determination on the applicant's Medicaid or Medicaid long-term care application). Provides that if an individual is enrolled with a managed care organization for community benefits at the time the individual's provisional status is issued, the managed care organization is only responsible for paying benefits covered under the capitation payment received by the managed care organization for the individual. Requires the Department of Healthcare and Family Services to clearly identify as provisional eligibility vouchers those vouchers submitted to the Office of the Comptroller on behalf of applicants with provisional enrollment status. Adds a definition for the term "renewal". Effective immediately.

Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. Provides that, beginning on June 29, 2018, provisional eligibility, in the form of a recipient identification number and any other necessary credentials to permit an applicant to receive benefits, must be issued to any applicant who has not received a final eligibility determination on his or her application for Medicaid or Medicaid long-term care benefits or a notice of an opportunity for a hearing within the federally prescribed deadlines for the processing of such applications. Requires the Department of Healthcare and Family Services to maintain the applicant's provisional Medicaid enrollment status until a final eligibility determination is approved or the applicant's appeal has been adjudicated and eligibility is denied. Provides that the Department or the managed care organization, if applicable, must reimburse providers for services rendered during an applicant's provisional eligibility period. Provides: (i) that claims for services rendered to an applicant with provisional eligibility status must be submitted and processed in the same manner as those submitted on behalf of beneficiaries determined to qualify for benefits; (2) that an applicant with provisional enrollment status must have his or her benefits paid for under the State's fee-for-service system until the State makes a final determination on the applicant's Medicaid or Medicaid long-term care application; and that the Department, within 10 business days of issuing provisional eligibility to an applicant, must submit to the Office of the Comptroller for payment a voucher for all retroactive reimbursement due. Requires the Department to adopt rules. Effective immediately.

Recommends the following changes to provisions added by the bill to the Illinois Public Aid Code: Removes a provision that prohibits rulemaking from delaying the full implementation of certain provisions concerning Medicaid expedited long-term care eligibility determinations and enrollment. Provides that provisional eligibility must be issued to any applicant who, due to delay by the State, has not received an eligibility determination on his or her application for Medicaid long-term care benefits (rather than beginning on June 29, 2018, provisional eligibility must be issued to any applicant who has not received a final determination on his or her application for Medicaid or Medicaid long-term care benefits). Requires the Department of Healthcare and Family Services to maintain an applicant's provisional Medicaid enrollment status until an eligibility determination is made (rather than until a final eligibility determination is approved or the applicant's appeal has been adjudicated and eligibility is denied). Provides that an applicant with provisional enrollment status must have his or her benefits paid under the State's fee-for-service system until the State makes a determination (rather than a final determination) on the applicant's Medicaid long-term care application (rather than the applicant's Medicaid or Medicaid long-term care application). Removes a provision making managed care organizations responsible for paying benefits covered under the capitation payments they received for individuals with provisional eligibility status. Removes a provision requiring the Department to submit a voucher to the Office of the Comptroller for all retroactive reimbursement due. Provides that provisional eligibility for Medicaid long-term care benefits shall be repealed when the combined backlog of long-term care applications and admissions has been reduced by 80% or more from its 2018 peak. Requires the Department to recover all amounts paid to a provider for any individual while provisionally eligible if the individual's application is not approved.

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