Illinois General Assembly - Full Text of HB2420
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Full Text of HB2420  102nd General Assembly

HB2420 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2420

 

Introduced 2/17/2021, by Rep. Maurice A. West, II

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 105/4.02  from Ch. 23, par. 6104.02
20 ILCS 2405/3  from Ch. 23, par. 3434
305 ILCS 5/5-2b
305 ILCS 5/5-5  from Ch. 23, par. 5-5
305 ILCS 5/5-5.01a

    Amends the Illinois Act on Aging, the Rehabilitation of Persons with Disabilities Act, and the Illinois Public Aid Code. Provides that individuals with a score of 29 or higher based on the determination of need (DON) assessment tool shall be eligible to receive services through the Community Care Program, services to prevent unnecessary or premature institutionalization, and services through the program of supportive living facilities. Further amends the Illinois Public Aid Code. Provides that on and after July 1, 2023, level of care eligibility criteria for home and community-based services for medically fragile and technology dependent children shall be no more restrictive than the level of care criteria in place on January 1, 2021. Requires the Department of Healthcare and Family Services to execute, relative to the nursing home prescreening project, written agreements with the Department of Human Services and the Department on Aging to effect, on and after July 1, 2023, an increase in the DON score threshold to 37 for applicants for institutional long term care, subject to federal approval. Provides that on and after July 1, 2023 but before July 1, 2025, continuation of a nursing facility stay that began on or before June 30, 2023 by a person with a DON score between 29 and 36 may be covered when such stay would be otherwise eligible under this Code, provided the nursing facility performs certain actions. Requires the Department to, by rule, set a maximum total number of individuals to be covered and other limits on utilization that it deems appropriate. Effective July 1, 2023.


LRB102 14877 KTG 20230 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB2420LRB102 14877 KTG 20230 b

1    AN ACT concerning home and community-based services.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Act on the Aging is amended by
5changing Section 4.02 as follows:
 
6    (20 ILCS 105/4.02)  (from Ch. 23, par. 6104.02)
7    Sec. 4.02. Community Care Program. The Department shall
8establish a program of services to prevent unnecessary
9institutionalization of persons age 60 and older in need of
10long term care or who are established as persons who suffer
11from Alzheimer's disease or a related disorder under the
12Alzheimer's Disease Assistance Act, thereby enabling them to
13remain in their own homes or in other living arrangements.
14Such preventive services, which may be coordinated with other
15programs for the aged and monitored by area agencies on aging
16in cooperation with the Department, may include, but are not
17limited to, any or all of the following:
18        (a) (blank);
19        (b) (blank);
20        (c) home care aide services;
21        (d) personal assistant services;
22        (e) adult day services;
23        (f) home-delivered meals;

 

 

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1        (g) education in self-care;
2        (h) personal care services;
3        (i) adult day health services;
4        (j) habilitation services;
5        (k) respite care;
6        (k-5) community reintegration services;
7        (k-6) flexible senior services;
8        (k-7) medication management;
9        (k-8) emergency home response;
10        (l) other nonmedical social services that may enable
11    the person to become self-supporting; or
12        (m) clearinghouse for information provided by senior
13    citizen home owners who want to rent rooms to or share
14    living space with other senior citizens.
15    The Department shall establish eligibility standards for
16such services. In determining the amount and nature of
17services for which a person may qualify, consideration shall
18not be given to the value of cash, property or other assets
19held in the name of the person's spouse pursuant to a written
20agreement dividing marital property into equal but separate
21shares or pursuant to a transfer of the person's interest in a
22home to his spouse, provided that the spouse's share of the
23marital property is not made available to the person seeking
24such services.
25    Beginning January 1, 2008, the Department shall require as
26a condition of eligibility that all new financially eligible

 

 

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1applicants apply for and enroll in medical assistance under
2Article V of the Illinois Public Aid Code in accordance with
3rules promulgated by the Department.
4    The Department shall, in conjunction with the Department
5of Public Aid (now Department of Healthcare and Family
6Services), seek appropriate amendments under Sections 1915 and
71924 of the Social Security Act. The purpose of the amendments
8shall be to extend eligibility for home and community based
9services under Sections 1915 and 1924 of the Social Security
10Act to persons who transfer to or for the benefit of a spouse
11those amounts of income and resources allowed under Section
121924 of the Social Security Act. Subject to the approval of
13such amendments, the Department shall extend the provisions of
14Section 5-4 of the Illinois Public Aid Code to persons who, but
15for the provision of home or community-based services, would
16require the level of care provided in an institution, as is
17provided for in federal law. Those persons no longer found to
18be eligible for receiving noninstitutional services due to
19changes in the eligibility criteria shall be given 45 days
20notice prior to actual termination. Those persons receiving
21notice of termination may contact the Department and request
22the determination be appealed at any time during the 45 day
23notice period. The target population identified for the
24purposes of this Section are persons age 60 and older with an
25identified service need. Priority shall be given to those who
26are at imminent risk of institutionalization. The services

 

 

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1shall be provided to eligible persons age 60 and older to the
2extent that the cost of the services together with the other
3personal maintenance expenses of the persons are reasonably
4related to the standards established for care in a group
5facility appropriate to the person's condition. These
6non-institutional services, pilot projects or experimental
7facilities may be provided as part of or in addition to those
8authorized by federal law or those funded and administered by
9the Department of Human Services. The Departments of Human
10Services, Healthcare and Family Services, Public Health,
11Veterans' Affairs, and Commerce and Economic Opportunity and
12other appropriate agencies of State, federal and local
13governments shall cooperate with the Department on Aging in
14the establishment and development of the non-institutional
15services. The Department shall require an annual audit from
16all personal assistant and home care aide vendors contracting
17with the Department under this Section. The annual audit shall
18assure that each audited vendor's procedures are in compliance
19with Department's financial reporting guidelines requiring an
20administrative and employee wage and benefits cost split as
21defined in administrative rules. The audit is a public record
22under the Freedom of Information Act. The Department shall
23execute, relative to the nursing home prescreening project,
24written inter-agency agreements with the Department of Human
25Services and the Department of Healthcare and Family Services,
26to effect the following: (1) intake procedures and common

 

 

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1eligibility criteria for those persons who are receiving
2non-institutional services; and (2) the establishment and
3development of non-institutional services in areas of the
4State where they are not currently available or are
5undeveloped. On and after July 1, 1996, all nursing home
6prescreenings for individuals 60 years of age or older shall
7be conducted by the Department.
8    As part of the Department on Aging's routine training of
9case managers and case manager supervisors, the Department may
10include information on family futures planning for persons who
11are age 60 or older and who are caregivers of their adult
12children with developmental disabilities. The content of the
13training shall be at the Department's discretion.
14    The Department is authorized to establish a system of
15recipient copayment for services provided under this Section,
16such copayment to be based upon the recipient's ability to pay
17but in no case to exceed the actual cost of the services
18provided. Additionally, any portion of a person's income which
19is equal to or less than the federal poverty standard shall not
20be considered by the Department in determining the copayment.
21The level of such copayment shall be adjusted whenever
22necessary to reflect any change in the officially designated
23federal poverty standard.
24    The Department, or the Department's authorized
25representative, may recover the amount of moneys expended for
26services provided to or in behalf of a person under this

 

 

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1Section by a claim against the person's estate or against the
2estate of the person's surviving spouse, but no recovery may
3be had until after the death of the surviving spouse, if any,
4and then only at such time when there is no surviving child who
5is under age 21 or blind or who has a permanent and total
6disability. This paragraph, however, shall not bar recovery,
7at the death of the person, of moneys for services provided to
8the person or in behalf of the person under this Section to
9which the person was not entitled; provided that such recovery
10shall not be enforced against any real estate while it is
11occupied as a homestead by the surviving spouse or other
12dependent, if no claims by other creditors have been filed
13against the estate, or, if such claims have been filed, they
14remain dormant for failure of prosecution or failure of the
15claimant to compel administration of the estate for the
16purpose of payment. This paragraph shall not bar recovery from
17the estate of a spouse, under Sections 1915 and 1924 of the
18Social Security Act and Section 5-4 of the Illinois Public Aid
19Code, who precedes a person receiving services under this
20Section in death. All moneys for services paid to or in behalf
21of the person under this Section shall be claimed for recovery
22from the deceased spouse's estate. "Homestead", as used in
23this paragraph, means the dwelling house and contiguous real
24estate occupied by a surviving spouse or relative, as defined
25by the rules and regulations of the Department of Healthcare
26and Family Services, regardless of the value of the property.

 

 

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1    Individuals with a score of 29 or higher based on the
2determination of need assessment tool shall be eligible to
3receive services through the Community Care Program.
4    The Department shall increase the effectiveness of the
5existing Community Care Program by:
6        (1) ensuring that in-home services included in the
7    care plan are available on evenings and weekends;
8        (2) ensuring that care plans contain the services that
9    eligible participants need based on the number of days in
10    a month, not limited to specific blocks of time, as
11    identified by the comprehensive assessment tool selected
12    by the Department for use statewide, not to exceed the
13    total monthly service cost maximum allowed for each
14    service; the Department shall develop administrative rules
15    to implement this item (2);
16        (3) ensuring that the participants have the right to
17    choose the services contained in their care plan and to
18    direct how those services are provided, based on
19    administrative rules established by the Department;
20        (4) ensuring that the determination of need tool is
21    accurate in determining the participants' level of need;
22    to achieve this, the Department, in conjunction with the
23    Older Adult Services Advisory Committee, shall institute a
24    study of the relationship between the Determination of
25    Need scores, level of need, service cost maximums, and the
26    development and utilization of service plans no later than

 

 

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1    May 1, 2008; findings and recommendations shall be
2    presented to the Governor and the General Assembly no
3    later than January 1, 2009; recommendations shall include
4    all needed changes to the service cost maximums schedule
5    and additional covered services;
6        (5) ensuring that homemakers can provide personal care
7    services that may or may not involve contact with clients,
8    including but not limited to:
9            (A) bathing;
10            (B) grooming;
11            (C) toileting;
12            (D) nail care;
13            (E) transferring;
14            (F) respiratory services;
15            (G) exercise; or
16            (H) positioning;
17        (6) ensuring that homemaker program vendors are not
18    restricted from hiring homemakers who are family members
19    of clients or recommended by clients; the Department may
20    not, by rule or policy, require homemakers who are family
21    members of clients or recommended by clients to accept
22    assignments in homes other than the client;
23        (7) ensuring that the State may access maximum federal
24    matching funds by seeking approval for the Centers for
25    Medicare and Medicaid Services for modifications to the
26    State's home and community based services waiver and

 

 

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1    additional waiver opportunities, including applying for
2    enrollment in the Balance Incentive Payment Program by May
3    1, 2013, in order to maximize federal matching funds; this
4    shall include, but not be limited to, modification that
5    reflects all changes in the Community Care Program
6    services and all increases in the services cost maximum;
7        (8) ensuring that the determination of need tool
8    accurately reflects the service needs of individuals with
9    Alzheimer's disease and related dementia disorders;
10        (9) ensuring that services are authorized accurately
11    and consistently for the Community Care Program (CCP); the
12    Department shall implement a Service Authorization policy
13    directive; the purpose shall be to ensure that eligibility
14    and services are authorized accurately and consistently in
15    the CCP program; the policy directive shall clarify
16    service authorization guidelines to Care Coordination
17    Units and Community Care Program providers no later than
18    May 1, 2013;
19        (10) working in conjunction with Care Coordination
20    Units, the Department of Healthcare and Family Services,
21    the Department of Human Services, Community Care Program
22    providers, and other stakeholders to make improvements to
23    the Medicaid claiming processes and the Medicaid
24    enrollment procedures or requirements as needed,
25    including, but not limited to, specific policy changes or
26    rules to improve the up-front enrollment of participants

 

 

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1    in the Medicaid program and specific policy changes or
2    rules to insure more prompt submission of bills to the
3    federal government to secure maximum federal matching
4    dollars as promptly as possible; the Department on Aging
5    shall have at least 3 meetings with stakeholders by
6    January 1, 2014 in order to address these improvements;
7        (11) requiring home care service providers to comply
8    with the rounding of hours worked provisions under the
9    federal Fair Labor Standards Act (FLSA) and as set forth
10    in 29 CFR 785.48(b) by May 1, 2013;
11        (12) implementing any necessary policy changes or
12    promulgating any rules, no later than January 1, 2014, to
13    assist the Department of Healthcare and Family Services in
14    moving as many participants as possible, consistent with
15    federal regulations, into coordinated care plans if a care
16    coordination plan that covers long term care is available
17    in the recipient's area; and
18        (13) maintaining fiscal year 2014 rates at the same
19    level established on January 1, 2013.
20    By January 1, 2009 or as soon after the end of the Cash and
21Counseling Demonstration Project as is practicable, the
22Department may, based on its evaluation of the demonstration
23project, promulgate rules concerning personal assistant
24services, to include, but need not be limited to,
25qualifications, employment screening, rights under fair labor
26standards, training, fiduciary agent, and supervision

 

 

HB2420- 11 -LRB102 14877 KTG 20230 b

1requirements. All applicants shall be subject to the
2provisions of the Health Care Worker Background Check Act.
3    The Department shall develop procedures to enhance
4availability of services on evenings, weekends, and on an
5emergency basis to meet the respite needs of caregivers.
6Procedures shall be developed to permit the utilization of
7services in successive blocks of 24 hours up to the monthly
8maximum established by the Department. Workers providing these
9services shall be appropriately trained.
10    Beginning on the effective date of this amendatory Act of
111991, no person may perform chore/housekeeping and home care
12aide services under a program authorized by this Section
13unless that person has been issued a certificate of
14pre-service to do so by his or her employing agency.
15Information gathered to effect such certification shall
16include (i) the person's name, (ii) the date the person was
17hired by his or her current employer, and (iii) the training,
18including dates and levels. Persons engaged in the program
19authorized by this Section before the effective date of this
20amendatory Act of 1991 shall be issued a certificate of all
21pre- and in-service training from his or her employer upon
22submitting the necessary information. The employing agency
23shall be required to retain records of all staff pre- and
24in-service training, and shall provide such records to the
25Department upon request and upon termination of the employer's
26contract with the Department. In addition, the employing

 

 

HB2420- 12 -LRB102 14877 KTG 20230 b

1agency is responsible for the issuance of certifications of
2in-service training completed to their employees.
3    The Department is required to develop a system to ensure
4that persons working as home care aides and personal
5assistants receive increases in their wages when the federal
6minimum wage is increased by requiring vendors to certify that
7they are meeting the federal minimum wage statute for home
8care aides and personal assistants. An employer that cannot
9ensure that the minimum wage increase is being given to home
10care aides and personal assistants shall be denied any
11increase in reimbursement costs.
12    The Community Care Program Advisory Committee is created
13in the Department on Aging. The Director shall appoint
14individuals to serve in the Committee, who shall serve at
15their own expense. Members of the Committee must abide by all
16applicable ethics laws. The Committee shall advise the
17Department on issues related to the Department's program of
18services to prevent unnecessary institutionalization. The
19Committee shall meet on a bi-monthly basis and shall serve to
20identify and advise the Department on present and potential
21issues affecting the service delivery network, the program's
22clients, and the Department and to recommend solution
23strategies. Persons appointed to the Committee shall be
24appointed on, but not limited to, their own and their agency's
25experience with the program, geographic representation, and
26willingness to serve. The Director shall appoint members to

 

 

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1the Committee to represent provider, advocacy, policy
2research, and other constituencies committed to the delivery
3of high quality home and community-based services to older
4adults. Representatives shall be appointed to ensure
5representation from community care providers including, but
6not limited to, adult day service providers, homemaker
7providers, case coordination and case management units,
8emergency home response providers, statewide trade or labor
9unions that represent home care aides and direct care staff,
10area agencies on aging, adults over age 60, membership
11organizations representing older adults, and other
12organizational entities, providers of care, or individuals
13with demonstrated interest and expertise in the field of home
14and community care as determined by the Director.
15    Nominations may be presented from any agency or State
16association with interest in the program. The Director, or his
17or her designee, shall serve as the permanent co-chair of the
18advisory committee. One other co-chair shall be nominated and
19approved by the members of the committee on an annual basis.
20Committee members' terms of appointment shall be for 4 years
21with one-quarter of the appointees' terms expiring each year.
22A member shall continue to serve until his or her replacement
23is named. The Department shall fill vacancies that have a
24remaining term of over one year, and this replacement shall
25occur through the annual replacement of expiring terms. The
26Director shall designate Department staff to provide technical

 

 

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1assistance and staff support to the committee. Department
2representation shall not constitute membership of the
3committee. All Committee papers, issues, recommendations,
4reports, and meeting memoranda are advisory only. The
5Director, or his or her designee, shall make a written report,
6as requested by the Committee, regarding issues before the
7Committee.
8    The Department on Aging and the Department of Human
9Services shall cooperate in the development and submission of
10an annual report on programs and services provided under this
11Section. Such joint report shall be filed with the Governor
12and the General Assembly on or before September 30 each year.
13    The requirement for reporting to the General Assembly
14shall be satisfied by filing copies of the report as required
15by Section 3.1 of the General Assembly Organization Act and
16filing such additional copies with the State Government Report
17Distribution Center for the General Assembly as is required
18under paragraph (t) of Section 7 of the State Library Act.
19    Those persons previously found eligible for receiving
20non-institutional services whose services were discontinued
21under the Emergency Budget Act of Fiscal Year 1992, and who do
22not meet the eligibility standards in effect on or after July
231, 1992, shall remain ineligible on and after July 1, 1992.
24Those persons previously not required to cost-share and who
25were required to cost-share effective March 1, 1992, shall
26continue to meet cost-share requirements on and after July 1,

 

 

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11992. Beginning July 1, 1992, all clients will be required to
2meet eligibility, cost-share, and other requirements and will
3have services discontinued or altered when they fail to meet
4these requirements.
5    For the purposes of this Section, "flexible senior
6services" refers to services that require one-time or periodic
7expenditures including, but not limited to, respite care, home
8modification, assistive technology, housing assistance, and
9transportation.
10    The Department shall implement an electronic service
11verification based on global positioning systems or other
12cost-effective technology for the Community Care Program no
13later than January 1, 2014.
14    The Department shall require, as a condition of
15eligibility, enrollment in the medical assistance program
16under Article V of the Illinois Public Aid Code (i) beginning
17August 1, 2013, if the Auditor General has reported that the
18Department has failed to comply with the reporting
19requirements of Section 2-27 of the Illinois State Auditing
20Act; or (ii) beginning June 1, 2014, if the Auditor General has
21reported that the Department has not undertaken the required
22actions listed in the report required by subsection (a) of
23Section 2-27 of the Illinois State Auditing Act.
24    The Department shall delay Community Care Program services
25until an applicant is determined eligible for medical
26assistance under Article V of the Illinois Public Aid Code (i)

 

 

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1beginning August 1, 2013, if the Auditor General has reported
2that the Department has failed to comply with the reporting
3requirements of Section 2-27 of the Illinois State Auditing
4Act; or (ii) beginning June 1, 2014, if the Auditor General has
5reported that the Department has not undertaken the required
6actions listed in the report required by subsection (a) of
7Section 2-27 of the Illinois State Auditing Act.
8    The Department shall implement co-payments for the
9Community Care Program at the federally allowable maximum
10level (i) beginning August 1, 2013, if the Auditor General has
11reported that the Department has failed to comply with the
12reporting requirements of Section 2-27 of the Illinois State
13Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
14General has reported that the Department has not undertaken
15the required actions listed in the report required by
16subsection (a) of Section 2-27 of the Illinois State Auditing
17Act.
18    The Department shall provide a bi-monthly report on the
19progress of the Community Care Program reforms set forth in
20this amendatory Act of the 98th General Assembly to the
21Governor, the Speaker of the House of Representatives, the
22Minority Leader of the House of Representatives, the President
23of the Senate, and the Minority Leader of the Senate.
24    The Department shall conduct a quarterly review of Care
25Coordination Unit performance and adherence to service
26guidelines. The quarterly review shall be reported to the

 

 

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1Speaker of the House of Representatives, the Minority Leader
2of the House of Representatives, the President of the Senate,
3and the Minority Leader of the Senate. The Department shall
4collect and report longitudinal data on the performance of
5each care coordination unit. Nothing in this paragraph shall
6be construed to require the Department to identify specific
7care coordination units.
8    In regard to community care providers, failure to comply
9with Department on Aging policies shall be cause for
10disciplinary action, including, but not limited to,
11disqualification from serving Community Care Program clients.
12Each provider, upon submission of any bill or invoice to the
13Department for payment for services rendered, shall include a
14notarized statement, under penalty of perjury pursuant to
15Section 1-109 of the Code of Civil Procedure, that the
16provider has complied with all Department policies.
17    The Director of the Department on Aging shall make
18information available to the State Board of Elections as may
19be required by an agreement the State Board of Elections has
20entered into with a multi-state voter registration list
21maintenance system.
22    Within 30 days after July 6, 2017 (the effective date of
23Public Act 100-23), rates shall be increased to $18.29 per
24hour, for the purpose of increasing, by at least $.72 per hour,
25the wages paid by those vendors to their employees who provide
26homemaker services. The Department shall pay an enhanced rate

 

 

HB2420- 18 -LRB102 14877 KTG 20230 b

1under the Community Care Program to those in-home service
2provider agencies that offer health insurance coverage as a
3benefit to their direct service worker employees consistent
4with the mandates of Public Act 95-713. For State fiscal years
52018 and 2019, the enhanced rate shall be $1.77 per hour. The
6rate shall be adjusted using actuarial analysis based on the
7cost of care, but shall not be set below $1.77 per hour. The
8Department shall adopt rules, including emergency rules under
9subsections (y) and (bb) of Section 5-45 of the Illinois
10Administrative Procedure Act, to implement the provisions of
11this paragraph.
12    The General Assembly finds it necessary to authorize an
13aggressive Medicaid enrollment initiative designed to maximize
14federal Medicaid funding for the Community Care Program which
15produces significant savings for the State of Illinois. The
16Department on Aging shall establish and implement a Community
17Care Program Medicaid Initiative. Under the Initiative, the
18Department on Aging shall, at a minimum: (i) provide an
19enhanced rate to adequately compensate care coordination units
20to enroll eligible Community Care Program clients into
21Medicaid; (ii) use recommendations from a stakeholder
22committee on how best to implement the Initiative; and (iii)
23establish requirements for State agencies to make enrollment
24in the State's Medical Assistance program easier for seniors.
25    The Community Care Program Medicaid Enrollment Oversight
26Subcommittee is created as a subcommittee of the Older Adult

 

 

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1Services Advisory Committee established in Section 35 of the
2Older Adult Services Act to make recommendations on how best
3to increase the number of medical assistance recipients who
4are enrolled in the Community Care Program. The Subcommittee
5shall consist of all of the following persons who must be
6appointed within 30 days after the effective date of this
7amendatory Act of the 100th General Assembly:
8        (1) The Director of Aging, or his or her designee, who
9    shall serve as the chairperson of the Subcommittee.
10        (2) One representative of the Department of Healthcare
11    and Family Services, appointed by the Director of
12    Healthcare and Family Services.
13        (3) One representative of the Department of Human
14    Services, appointed by the Secretary of Human Services.
15        (4) One individual representing a care coordination
16    unit, appointed by the Director of Aging.
17        (5) One individual from a non-governmental statewide
18    organization that advocates for seniors, appointed by the
19    Director of Aging.
20        (6) One individual representing Area Agencies on
21    Aging, appointed by the Director of Aging.
22        (7) One individual from a statewide association
23    dedicated to Alzheimer's care, support, and research,
24    appointed by the Director of Aging.
25        (8) One individual from an organization that employs
26    persons who provide services under the Community Care

 

 

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1    Program, appointed by the Director of Aging.
2        (9) One member of a trade or labor union representing
3    persons who provide services under the Community Care
4    Program, appointed by the Director of Aging.
5        (10) One member of the Senate, who shall serve as
6    co-chairperson, appointed by the President of the Senate.
7        (11) One member of the Senate, who shall serve as
8    co-chairperson, appointed by the Minority Leader of the
9    Senate.
10        (12) One member of the House of Representatives, who
11    shall serve as co-chairperson, appointed by the Speaker of
12    the House of Representatives.
13        (13) One member of the House of Representatives, who
14    shall serve as co-chairperson, appointed by the Minority
15    Leader of the House of Representatives.
16        (14) One individual appointed by a labor organization
17    representing frontline employees at the Department of
18    Human Services.
19    The Subcommittee shall provide oversight to the Community
20Care Program Medicaid Initiative and shall meet quarterly. At
21each Subcommittee meeting the Department on Aging shall
22provide the following data sets to the Subcommittee: (A) the
23number of Illinois residents, categorized by planning and
24service area, who are receiving services under the Community
25Care Program and are enrolled in the State's Medical
26Assistance Program; (B) the number of Illinois residents,

 

 

HB2420- 21 -LRB102 14877 KTG 20230 b

1categorized by planning and service area, who are receiving
2services under the Community Care Program, but are not
3enrolled in the State's Medical Assistance Program; and (C)
4the number of Illinois residents, categorized by planning and
5service area, who are receiving services under the Community
6Care Program and are eligible for benefits under the State's
7Medical Assistance Program, but are not enrolled in the
8State's Medical Assistance Program. In addition to this data,
9the Department on Aging shall provide the Subcommittee with
10plans on how the Department on Aging will reduce the number of
11Illinois residents who are not enrolled in the State's Medical
12Assistance Program but who are eligible for medical assistance
13benefits. The Department on Aging shall enroll in the State's
14Medical Assistance Program those Illinois residents who
15receive services under the Community Care Program and are
16eligible for medical assistance benefits but are not enrolled
17in the State's Medicaid Assistance Program. The data provided
18to the Subcommittee shall be made available to the public via
19the Department on Aging's website.
20    The Department on Aging, with the involvement of the
21Subcommittee, shall collaborate with the Department of Human
22Services and the Department of Healthcare and Family Services
23on how best to achieve the responsibilities of the Community
24Care Program Medicaid Initiative.
25    The Department on Aging, the Department of Human Services,
26and the Department of Healthcare and Family Services shall

 

 

HB2420- 22 -LRB102 14877 KTG 20230 b

1coordinate and implement a streamlined process for seniors to
2access benefits under the State's Medical Assistance Program.
3    The Subcommittee shall collaborate with the Department of
4Human Services on the adoption of a uniform application
5submission process. The Department of Human Services and any
6other State agency involved with processing the medical
7assistance application of any person enrolled in the Community
8Care Program shall include the appropriate care coordination
9unit in all communications related to the determination or
10status of the application.
11    The Community Care Program Medicaid Initiative shall
12provide targeted funding to care coordination units to help
13seniors complete their applications for medical assistance
14benefits. On and after July 1, 2019, care coordination units
15shall receive no less than $200 per completed application,
16which rate may be included in a bundled rate for initial intake
17services when Medicaid application assistance is provided in
18conjunction with the initial intake process for new program
19participants.
20    The Community Care Program Medicaid Initiative shall cease
21operation 5 years after the effective date of this amendatory
22Act of the 100th General Assembly, after which the
23Subcommittee shall dissolve.
24(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18;
25100-1148, eff. 12-10-18; 101-10, eff. 6-5-19.)
 

 

 

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1    Section 10. The Rehabilitation of Persons with
2Disabilities Act is amended by changing Section 3 as follows:
 
3    (20 ILCS 2405/3)  (from Ch. 23, par. 3434)
4    Sec. 3. Powers and duties. The Department shall have the
5powers and duties enumerated herein:
6        (a) To co-operate with the federal government in the
7    administration of the provisions of the federal
8    Rehabilitation Act of 1973, as amended, of the Workforce
9    Innovation and Opportunity Act, and of the federal Social
10    Security Act to the extent and in the manner provided in
11    these Acts.
12        (b) To prescribe and supervise such courses of
13    vocational training and provide such other services as may
14    be necessary for the habilitation and rehabilitation of
15    persons with one or more disabilities, including the
16    administrative activities under subsection (e) of this
17    Section, and to co-operate with State and local school
18    authorities and other recognized agencies engaged in
19    habilitation, rehabilitation and comprehensive
20    rehabilitation services; and to cooperate with the
21    Department of Children and Family Services regarding the
22    care and education of children with one or more
23    disabilities.
24        (c) (Blank).
25        (d) To report in writing, to the Governor, annually on

 

 

HB2420- 24 -LRB102 14877 KTG 20230 b

1    or before the first day of December, and at such other
2    times and in such manner and upon such subjects as the
3    Governor may require. The annual report shall contain (1)
4    a statement of the existing condition of comprehensive
5    rehabilitation services, habilitation and rehabilitation
6    in the State; (2) a statement of suggestions and
7    recommendations with reference to the development of
8    comprehensive rehabilitation services, habilitation and
9    rehabilitation in the State; and (3) an itemized statement
10    of the amounts of money received from federal, State and
11    other sources, and of the objects and purposes to which
12    the respective items of these several amounts have been
13    devoted.
14        (e) (Blank).
15        (f) To establish a program of services to prevent the
16    unnecessary institutionalization of persons in need of
17    long term care and who meet the criteria for blindness or
18    disability as defined by the Social Security Act, thereby
19    enabling them to remain in their own homes. Such
20    preventive services include any or all of the following:
21            (1) personal assistant services;
22            (2) homemaker services;
23            (3) home-delivered meals;
24            (4) adult day care services;
25            (5) respite care;
26            (6) home modification or assistive equipment;

 

 

HB2420- 25 -LRB102 14877 KTG 20230 b

1            (7) home health services;
2            (8) electronic home response;
3            (9) brain injury behavioral/cognitive services;
4            (10) brain injury habilitation;
5            (11) brain injury pre-vocational services; or
6            (12) brain injury supported employment.
7        The Department shall establish eligibility standards
8    for such services taking into consideration the unique
9    economic and social needs of the population for whom they
10    are to be provided. Such eligibility standards may be
11    based on the recipient's ability to pay for services;
12    provided, however, that any portion of a person's income
13    that is equal to or less than the "protected income" level
14    shall not be considered by the Department in determining
15    eligibility. The "protected income" level shall be
16    determined by the Department, shall never be less than the
17    federal poverty standard, and shall be adjusted each year
18    to reflect changes in the Consumer Price Index For All
19    Urban Consumers as determined by the United States
20    Department of Labor. The standards must provide that a
21    person may not have more than $10,000 in assets to be
22    eligible for the services, and the Department may increase
23    or decrease the asset limitation by rule. The Department
24    may not decrease the asset level below $10,000.
25    Individuals with a score of 29 or higher based on the
26determination of need assessment tool shall be eligible to

 

 

HB2420- 26 -LRB102 14877 KTG 20230 b

1receive services.
2        The services shall be provided, as established by the
3    Department by rule, to eligible persons to prevent
4    unnecessary or premature institutionalization, to the
5    extent that the cost of the services, together with the
6    other personal maintenance expenses of the persons, are
7    reasonably related to the standards established for care
8    in a group facility appropriate to their condition. These
9    non-institutional services, pilot projects or experimental
10    facilities may be provided as part of or in addition to
11    those authorized by federal law or those funded and
12    administered by the Illinois Department on Aging. The
13    Department shall set rates and fees for services in a fair
14    and equitable manner. Services identical to those offered
15    by the Department on Aging shall be paid at the same rate.
16        Except as otherwise provided in this paragraph,
17    personal assistants shall be paid at a rate negotiated
18    between the State and an exclusive representative of
19    personal assistants under a collective bargaining
20    agreement. In no case shall the Department pay personal
21    assistants an hourly wage that is less than the federal
22    minimum wage. Within 30 days after July 6, 2017 (the
23    effective date of Public Act 100-23), the hourly wage paid
24    to personal assistants and individual maintenance home
25    health workers shall be increased by $0.48 per hour.
26        Solely for the purposes of coverage under the Illinois

 

 

HB2420- 27 -LRB102 14877 KTG 20230 b

1    Public Labor Relations Act, personal assistants providing
2    services under the Department's Home Services Program
3    shall be considered to be public employees and the State
4    of Illinois shall be considered to be their employer as of
5    July 16, 2003 (the effective date of Public Act 93-204),
6    but not before. Solely for the purposes of coverage under
7    the Illinois Public Labor Relations Act, home care and
8    home health workers who function as personal assistants
9    and individual maintenance home health workers and who
10    also provide services under the Department's Home Services
11    Program shall be considered to be public employees, no
12    matter whether the State provides such services through
13    direct fee-for-service arrangements, with the assistance
14    of a managed care organization or other intermediary, or
15    otherwise, and the State of Illinois shall be considered
16    to be the employer of those persons as of January 29, 2013
17    (the effective date of Public Act 97-1158), but not before
18    except as otherwise provided under this subsection (f).
19    The State shall engage in collective bargaining with an
20    exclusive representative of home care and home health
21    workers who function as personal assistants and individual
22    maintenance home health workers working under the Home
23    Services Program concerning their terms and conditions of
24    employment that are within the State's control. Nothing in
25    this paragraph shall be understood to limit the right of
26    the persons receiving services defined in this Section to

 

 

HB2420- 28 -LRB102 14877 KTG 20230 b

1    hire and fire home care and home health workers who
2    function as personal assistants and individual maintenance
3    home health workers working under the Home Services
4    Program or to supervise them within the limitations set by
5    the Home Services Program. The State shall not be
6    considered to be the employer of home care and home health
7    workers who function as personal assistants and individual
8    maintenance home health workers working under the Home
9    Services Program for any purposes not specifically
10    provided in Public Act 93-204 or Public Act 97-1158,
11    including but not limited to, purposes of vicarious
12    liability in tort and purposes of statutory retirement or
13    health insurance benefits. Home care and home health
14    workers who function as personal assistants and individual
15    maintenance home health workers and who also provide
16    services under the Department's Home Services Program
17    shall not be covered by the State Employees Group
18    Insurance Act of 1971.
19        The Department shall execute, relative to nursing home
20    prescreening, as authorized by Section 4.03 of the
21    Illinois Act on the Aging, written inter-agency agreements
22    with the Department on Aging and the Department of
23    Healthcare and Family Services, to effect the intake
24    procedures and eligibility criteria for those persons who
25    may need long term care. On and after July 1, 1996, all
26    nursing home prescreenings for individuals 18 through 59

 

 

HB2420- 29 -LRB102 14877 KTG 20230 b

1    years of age shall be conducted by the Department, or a
2    designee of the Department.
3        The Department is authorized to establish a system of
4    recipient cost-sharing for services provided under this
5    Section. The cost-sharing shall be based upon the
6    recipient's ability to pay for services, but in no case
7    shall the recipient's share exceed the actual cost of the
8    services provided. Protected income shall not be
9    considered by the Department in its determination of the
10    recipient's ability to pay a share of the cost of
11    services. The level of cost-sharing shall be adjusted each
12    year to reflect changes in the "protected income" level.
13    The Department shall deduct from the recipient's share of
14    the cost of services any money expended by the recipient
15    for disability-related expenses.
16        To the extent permitted under the federal Social
17    Security Act, the Department, or the Department's
18    authorized representative, may recover the amount of
19    moneys expended for services provided to or in behalf of a
20    person under this Section by a claim against the person's
21    estate or against the estate of the person's surviving
22    spouse, but no recovery may be had until after the death of
23    the surviving spouse, if any, and then only at such time
24    when there is no surviving child who is under age 21 or
25    blind or who has a permanent and total disability. This
26    paragraph, however, shall not bar recovery, at the death

 

 

HB2420- 30 -LRB102 14877 KTG 20230 b

1    of the person, of moneys for services provided to the
2    person or in behalf of the person under this Section to
3    which the person was not entitled; provided that such
4    recovery shall not be enforced against any real estate
5    while it is occupied as a homestead by the surviving
6    spouse or other dependent, if no claims by other creditors
7    have been filed against the estate, or, if such claims
8    have been filed, they remain dormant for failure of
9    prosecution or failure of the claimant to compel
10    administration of the estate for the purpose of payment.
11    This paragraph shall not bar recovery from the estate of a
12    spouse, under Sections 1915 and 1924 of the Social
13    Security Act and Section 5-4 of the Illinois Public Aid
14    Code, who precedes a person receiving services under this
15    Section in death. All moneys for services paid to or in
16    behalf of the person under this Section shall be claimed
17    for recovery from the deceased spouse's estate.
18    "Homestead", as used in this paragraph, means the dwelling
19    house and contiguous real estate occupied by a surviving
20    spouse or relative, as defined by the rules and
21    regulations of the Department of Healthcare and Family
22    Services, regardless of the value of the property.
23        The Department shall submit an annual report on
24    programs and services provided under this Section. The
25    report shall be filed with the Governor and the General
26    Assembly on or before March 30 each year.

 

 

HB2420- 31 -LRB102 14877 KTG 20230 b

1        The requirement for reporting to the General Assembly
2    shall be satisfied by filing copies of the report as
3    required by Section 3.1 of the General Assembly
4    Organization Act, and filing additional copies with the
5    State Government Report Distribution Center for the
6    General Assembly as required under paragraph (t) of
7    Section 7 of the State Library Act.
8        (g) To establish such subdivisions of the Department
9    as shall be desirable and assign to the various
10    subdivisions the responsibilities and duties placed upon
11    the Department by law.
12        (h) To cooperate and enter into any necessary
13    agreements with the Department of Employment Security for
14    the provision of job placement and job referral services
15    to clients of the Department, including job service
16    registration of such clients with Illinois Employment
17    Security offices and making job listings maintained by the
18    Department of Employment Security available to such
19    clients.
20        (i) To possess all powers reasonable and necessary for
21    the exercise and administration of the powers, duties and
22    responsibilities of the Department which are provided for
23    by law.
24        (j) (Blank).
25        (k) (Blank).
26        (l) To establish, operate, and maintain a Statewide

 

 

HB2420- 32 -LRB102 14877 KTG 20230 b

1    Housing Clearinghouse of information on available
2    government subsidized housing accessible to persons with
3    disabilities and available privately owned housing
4    accessible to persons with disabilities. The information
5    shall include, but not be limited to, the location, rental
6    requirements, access features and proximity to public
7    transportation of available housing. The Clearinghouse
8    shall consist of at least a computerized database for the
9    storage and retrieval of information and a separate or
10    shared toll free telephone number for use by those seeking
11    information from the Clearinghouse. Department offices and
12    personnel throughout the State shall also assist in the
13    operation of the Statewide Housing Clearinghouse.
14    Cooperation with local, State, and federal housing
15    managers shall be sought and extended in order to
16    frequently and promptly update the Clearinghouse's
17    information.
18        (m) To assure that the names and case records of
19    persons who received or are receiving services from the
20    Department, including persons receiving vocational
21    rehabilitation, home services, or other services, and
22    those attending one of the Department's schools or other
23    supervised facility shall be confidential and not be open
24    to the general public. Those case records and reports or
25    the information contained in those records and reports
26    shall be disclosed by the Director only to proper law

 

 

HB2420- 33 -LRB102 14877 KTG 20230 b

1    enforcement officials, individuals authorized by a court,
2    the General Assembly or any committee or commission of the
3    General Assembly, and other persons and for reasons as the
4    Director designates by rule. Disclosure by the Director
5    may be only in accordance with other applicable law.
6(Source: P.A. 99-143, eff. 7-27-15; 100-23, eff. 7-6-17;
7100-477, eff. 9-8-17; 100-587, eff. 6-4-18; 100-863, eff.
88-14-18; 100-1148, eff. 12-10-18.)
 
9    Section 15. The Illinois Public Aid Code is amended by
10changing Sections 5-2b, 5-5, and 5-5.01a as follows:
 
11    (305 ILCS 5/5-2b)
12    Sec. 5-2b. Medically fragile and technology dependent
13children eligibility and program. Notwithstanding any other
14provision of law except as provided in Section 5-30a, on and
15after September 1, 2012, subject to federal approval, medical
16assistance under this Article shall be available to children
17who qualify as persons with a disability, as defined under the
18federal Supplemental Security Income program and who are
19medically fragile and technology dependent. The program shall
20allow eligible children to receive the medical assistance
21provided under this Article in the community and must
22maximize, to the fullest extent permissible under federal law,
23federal reimbursement and family cost-sharing, including
24co-pays, premiums, or any other family contributions, except

 

 

HB2420- 34 -LRB102 14877 KTG 20230 b

1that the Department shall be permitted to incentivize the
2utilization of selected services through the use of
3cost-sharing adjustments. The Department shall establish the
4policies, procedures, standards, services, and criteria for
5this program by rule. Notwithstanding any other provision of
6law, on and after July 1, 2023, level of care eligibility
7criteria for home and community-based services for medically
8fragile and technology dependent children shall be no more
9restrictive than the level of care criteria in place on
10January 1, 2021.
11(Source: P.A. 100-990, eff. 1-1-19.)
 
12    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
13    Sec. 5-5. Medical services. The Illinois Department, by
14rule, shall determine the quantity and quality of and the rate
15of reimbursement for the medical assistance for which payment
16will be authorized, and the medical services to be provided,
17which may include all or part of the following: (1) inpatient
18hospital services; (2) outpatient hospital services; (3) other
19laboratory and X-ray services; (4) skilled nursing home
20services; (5) physicians' services whether furnished in the
21office, the patient's home, a hospital, a skilled nursing
22home, or elsewhere; (6) medical care, or any other type of
23remedial care furnished by licensed practitioners; (7) home
24health care services; (8) private duty nursing service; (9)
25clinic services; (10) dental services, including prevention

 

 

HB2420- 35 -LRB102 14877 KTG 20230 b

1and treatment of periodontal disease and dental caries disease
2for pregnant women, provided by an individual licensed to
3practice dentistry or dental surgery; for purposes of this
4item (10), "dental services" means diagnostic, preventive, or
5corrective procedures provided by or under the supervision of
6a dentist in the practice of his or her profession; (11)
7physical therapy and related services; (12) prescribed drugs,
8dentures, and prosthetic devices; and eyeglasses prescribed by
9a physician skilled in the diseases of the eye, or by an
10optometrist, whichever the person may select; (13) other
11diagnostic, screening, preventive, and rehabilitative
12services, including to ensure that the individual's need for
13intervention or treatment of mental disorders or substance use
14disorders or co-occurring mental health and substance use
15disorders is determined using a uniform screening, assessment,
16and evaluation process inclusive of criteria, for children and
17adults; for purposes of this item (13), a uniform screening,
18assessment, and evaluation process refers to a process that
19includes an appropriate evaluation and, as warranted, a
20referral; "uniform" does not mean the use of a singular
21instrument, tool, or process that all must utilize; (14)
22transportation and such other expenses as may be necessary;
23(15) medical treatment of sexual assault survivors, as defined
24in Section 1a of the Sexual Assault Survivors Emergency
25Treatment Act, for injuries sustained as a result of the
26sexual assault, including examinations and laboratory tests to

 

 

HB2420- 36 -LRB102 14877 KTG 20230 b

1discover evidence which may be used in criminal proceedings
2arising from the sexual assault; (16) the diagnosis and
3treatment of sickle cell anemia; and (17) any other medical
4care, and any other type of remedial care recognized under the
5laws of this State. The term "any other type of remedial care"
6shall include nursing care and nursing home service for
7persons who rely on treatment by spiritual means alone through
8prayer for healing.
9    Notwithstanding any other provision of this Section, a
10comprehensive tobacco use cessation program that includes
11purchasing prescription drugs or prescription medical devices
12approved by the Food and Drug Administration shall be covered
13under the medical assistance program under this Article for
14persons who are otherwise eligible for assistance under this
15Article.
16    Notwithstanding any other provision of this Code,
17reproductive health care that is otherwise legal in Illinois
18shall be covered under the medical assistance program for
19persons who are otherwise eligible for medical assistance
20under this Article.
21    Notwithstanding any other provision of this Code, the
22Illinois Department may not require, as a condition of payment
23for any laboratory test authorized under this Article, that a
24physician's handwritten signature appear on the laboratory
25test order form. The Illinois Department may, however, impose
26other appropriate requirements regarding laboratory test order

 

 

HB2420- 37 -LRB102 14877 KTG 20230 b

1documentation.
2    Upon receipt of federal approval of an amendment to the
3Illinois Title XIX State Plan for this purpose, the Department
4shall authorize the Chicago Public Schools (CPS) to procure a
5vendor or vendors to manufacture eyeglasses for individuals
6enrolled in a school within the CPS system. CPS shall ensure
7that its vendor or vendors are enrolled as providers in the
8medical assistance program and in any capitated Medicaid
9managed care entity (MCE) serving individuals enrolled in a
10school within the CPS system. Under any contract procured
11under this provision, the vendor or vendors must serve only
12individuals enrolled in a school within the CPS system. Claims
13for services provided by CPS's vendor or vendors to recipients
14of benefits in the medical assistance program under this Code,
15the Children's Health Insurance Program, or the Covering ALL
16KIDS Health Insurance Program shall be submitted to the
17Department or the MCE in which the individual is enrolled for
18payment and shall be reimbursed at the Department's or the
19MCE's established rates or rate methodologies for eyeglasses.
20    On and after July 1, 2012, the Department of Healthcare
21and Family Services may provide the following services to
22persons eligible for assistance under this Article who are
23participating in education, training or employment programs
24operated by the Department of Human Services as successor to
25the Department of Public Aid:
26        (1) dental services provided by or under the

 

 

HB2420- 38 -LRB102 14877 KTG 20230 b

1    supervision of a dentist; and
2        (2) eyeglasses prescribed by a physician skilled in
3    the diseases of the eye, or by an optometrist, whichever
4    the person may select.
5    On and after July 1, 2018, the Department of Healthcare
6and Family Services shall provide dental services to any adult
7who is otherwise eligible for assistance under the medical
8assistance program. As used in this paragraph, "dental
9services" means diagnostic, preventative, restorative, or
10corrective procedures, including procedures and services for
11the prevention and treatment of periodontal disease and dental
12caries disease, provided by an individual who is licensed to
13practice dentistry or dental surgery or who is under the
14supervision of a dentist in the practice of his or her
15profession.
16    On and after July 1, 2018, targeted dental services, as
17set forth in Exhibit D of the Consent Decree entered by the
18United States District Court for the Northern District of
19Illinois, Eastern Division, in the matter of Memisovski v.
20Maram, Case No. 92 C 1982, that are provided to adults under
21the medical assistance program shall be established at no less
22than the rates set forth in the "New Rate" column in Exhibit D
23of the Consent Decree for targeted dental services that are
24provided to persons under the age of 18 under the medical
25assistance program.
26    Notwithstanding any other provision of this Code and

 

 

HB2420- 39 -LRB102 14877 KTG 20230 b

1subject to federal approval, the Department may adopt rules to
2allow a dentist who is volunteering his or her service at no
3cost to render dental services through an enrolled
4not-for-profit health clinic without the dentist personally
5enrolling as a participating provider in the medical
6assistance program. A not-for-profit health clinic shall
7include a public health clinic or Federally Qualified Health
8Center or other enrolled provider, as determined by the
9Department, through which dental services covered under this
10Section are performed. The Department shall establish a
11process for payment of claims for reimbursement for covered
12dental services rendered under this provision.
13    The Illinois Department, by rule, may distinguish and
14classify the medical services to be provided only in
15accordance with the classes of persons designated in Section
165-2.
17    The Department of Healthcare and Family Services must
18provide coverage and reimbursement for amino acid-based
19elemental formulas, regardless of delivery method, for the
20diagnosis and treatment of (i) eosinophilic disorders and (ii)
21short bowel syndrome when the prescribing physician has issued
22a written order stating that the amino acid-based elemental
23formula is medically necessary.
24    The Illinois Department shall authorize the provision of,
25and shall authorize payment for, screening by low-dose
26mammography for the presence of occult breast cancer for women

 

 

HB2420- 40 -LRB102 14877 KTG 20230 b

135 years of age or older who are eligible for medical
2assistance under this Article, as follows:
3        (A) A baseline mammogram for women 35 to 39 years of
4    age.
5        (B) An annual mammogram for women 40 years of age or
6    older.
7        (C) A mammogram at the age and intervals considered
8    medically necessary by the woman's health care provider
9    for women under 40 years of age and having a family history
10    of breast cancer, prior personal history of breast cancer,
11    positive genetic testing, or other risk factors.
12        (D) A comprehensive ultrasound screening and MRI of an
13    entire breast or breasts if a mammogram demonstrates
14    heterogeneous or dense breast tissue or when medically
15    necessary as determined by a physician licensed to
16    practice medicine in all of its branches.
17        (E) A screening MRI when medically necessary, as
18    determined by a physician licensed to practice medicine in
19    all of its branches.
20        (F) A diagnostic mammogram when medically necessary,
21    as determined by a physician licensed to practice medicine
22    in all its branches, advanced practice registered nurse,
23    or physician assistant.
24    The Department shall not impose a deductible, coinsurance,
25copayment, or any other cost-sharing requirement on the
26coverage provided under this paragraph; except that this

 

 

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1sentence does not apply to coverage of diagnostic mammograms
2to the extent such coverage would disqualify a high-deductible
3health plan from eligibility for a health savings account
4pursuant to Section 223 of the Internal Revenue Code (26
5U.S.C. 223).
6    All screenings shall include a physical breast exam,
7instruction on self-examination and information regarding the
8frequency of self-examination and its value as a preventative
9tool.
10     For purposes of this Section:
11    "Diagnostic mammogram" means a mammogram obtained using
12diagnostic mammography.
13    "Diagnostic mammography" means a method of screening that
14is designed to evaluate an abnormality in a breast, including
15an abnormality seen or suspected on a screening mammogram or a
16subjective or objective abnormality otherwise detected in the
17breast.
18    "Low-dose mammography" means the x-ray examination of the
19breast using equipment dedicated specifically for mammography,
20including the x-ray tube, filter, compression device, and
21image receptor, with an average radiation exposure delivery of
22less than one rad per breast for 2 views of an average size
23breast. The term also includes digital mammography and
24includes breast tomosynthesis.
25    "Breast tomosynthesis" means a radiologic procedure that
26involves the acquisition of projection images over the

 

 

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1stationary breast to produce cross-sectional digital
2three-dimensional images of the breast.
3    If, at any time, the Secretary of the United States
4Department of Health and Human Services, or its successor
5agency, promulgates rules or regulations to be published in
6the Federal Register or publishes a comment in the Federal
7Register or issues an opinion, guidance, or other action that
8would require the State, pursuant to any provision of the
9Patient Protection and Affordable Care Act (Public Law
10111-148), including, but not limited to, 42 U.S.C.
1118031(d)(3)(B) or any successor provision, to defray the cost
12of any coverage for breast tomosynthesis outlined in this
13paragraph, then the requirement that an insurer cover breast
14tomosynthesis is inoperative other than any such coverage
15authorized under Section 1902 of the Social Security Act, 42
16U.S.C. 1396a, and the State shall not assume any obligation
17for the cost of coverage for breast tomosynthesis set forth in
18this paragraph.
19    On and after January 1, 2016, the Department shall ensure
20that all networks of care for adult clients of the Department
21include access to at least one breast imaging Center of
22Imaging Excellence as certified by the American College of
23Radiology.
24    On and after January 1, 2012, providers participating in a
25quality improvement program approved by the Department shall
26be reimbursed for screening and diagnostic mammography at the

 

 

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1same rate as the Medicare program's rates, including the
2increased reimbursement for digital mammography.
3    The Department shall convene an expert panel including
4representatives of hospitals, free-standing mammography
5facilities, and doctors, including radiologists, to establish
6quality standards for mammography.
7    On and after January 1, 2017, providers participating in a
8breast cancer treatment quality improvement program approved
9by the Department shall be reimbursed for breast cancer
10treatment at a rate that is no lower than 95% of the Medicare
11program's rates for the data elements included in the breast
12cancer treatment quality program.
13    The Department shall convene an expert panel, including
14representatives of hospitals, free-standing breast cancer
15treatment centers, breast cancer quality organizations, and
16doctors, including breast surgeons, reconstructive breast
17surgeons, oncologists, and primary care providers to establish
18quality standards for breast cancer treatment.
19    Subject to federal approval, the Department shall
20establish a rate methodology for mammography at federally
21qualified health centers and other encounter-rate clinics.
22These clinics or centers may also collaborate with other
23hospital-based mammography facilities. By January 1, 2016, the
24Department shall report to the General Assembly on the status
25of the provision set forth in this paragraph.
26    The Department shall establish a methodology to remind

 

 

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1women who are age-appropriate for screening mammography, but
2who have not received a mammogram within the previous 18
3months, of the importance and benefit of screening
4mammography. The Department shall work with experts in breast
5cancer outreach and patient navigation to optimize these
6reminders and shall establish a methodology for evaluating
7their effectiveness and modifying the methodology based on the
8evaluation.
9    The Department shall establish a performance goal for
10primary care providers with respect to their female patients
11over age 40 receiving an annual mammogram. This performance
12goal shall be used to provide additional reimbursement in the
13form of a quality performance bonus to primary care providers
14who meet that goal.
15    The Department shall devise a means of case-managing or
16patient navigation for beneficiaries diagnosed with breast
17cancer. This program shall initially operate as a pilot
18program in areas of the State with the highest incidence of
19mortality related to breast cancer. At least one pilot program
20site shall be in the metropolitan Chicago area and at least one
21site shall be outside the metropolitan Chicago area. On or
22after July 1, 2016, the pilot program shall be expanded to
23include one site in western Illinois, one site in southern
24Illinois, one site in central Illinois, and 4 sites within
25metropolitan Chicago. An evaluation of the pilot program shall
26be carried out measuring health outcomes and cost of care for

 

 

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1those served by the pilot program compared to similarly
2situated patients who are not served by the pilot program.
3    The Department shall require all networks of care to
4develop a means either internally or by contract with experts
5in navigation and community outreach to navigate cancer
6patients to comprehensive care in a timely fashion. The
7Department shall require all networks of care to include
8access for patients diagnosed with cancer to at least one
9academic commission on cancer-accredited cancer program as an
10in-network covered benefit.
11    Any medical or health care provider shall immediately
12recommend, to any pregnant woman who is being provided
13prenatal services and is suspected of having a substance use
14disorder as defined in the Substance Use Disorder Act,
15referral to a local substance use disorder treatment program
16licensed by the Department of Human Services or to a licensed
17hospital which provides substance abuse treatment services.
18The Department of Healthcare and Family Services shall assure
19coverage for the cost of treatment of the drug abuse or
20addiction for pregnant recipients in accordance with the
21Illinois Medicaid Program in conjunction with the Department
22of Human Services.
23    All medical providers providing medical assistance to
24pregnant women under this Code shall receive information from
25the Department on the availability of services under any
26program providing case management services for addicted women,

 

 

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1including information on appropriate referrals for other
2social services that may be needed by addicted women in
3addition to treatment for addiction.
4    The Illinois Department, in cooperation with the
5Departments of Human Services (as successor to the Department
6of Alcoholism and Substance Abuse) and Public Health, through
7a public awareness campaign, may provide information
8concerning treatment for alcoholism and drug abuse and
9addiction, prenatal health care, and other pertinent programs
10directed at reducing the number of drug-affected infants born
11to recipients of medical assistance.
12    Neither the Department of Healthcare and Family Services
13nor the Department of Human Services shall sanction the
14recipient solely on the basis of her substance abuse.
15    The Illinois Department shall establish such regulations
16governing the dispensing of health services under this Article
17as it shall deem appropriate. The Department should seek the
18advice of formal professional advisory committees appointed by
19the Director of the Illinois Department for the purpose of
20providing regular advice on policy and administrative matters,
21information dissemination and educational activities for
22medical and health care providers, and consistency in
23procedures to the Illinois Department.
24    The Illinois Department may develop and contract with
25Partnerships of medical providers to arrange medical services
26for persons eligible under Section 5-2 of this Code.

 

 

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1Implementation of this Section may be by demonstration
2projects in certain geographic areas. The Partnership shall be
3represented by a sponsor organization. The Department, by
4rule, shall develop qualifications for sponsors of
5Partnerships. Nothing in this Section shall be construed to
6require that the sponsor organization be a medical
7organization.
8    The sponsor must negotiate formal written contracts with
9medical providers for physician services, inpatient and
10outpatient hospital care, home health services, treatment for
11alcoholism and substance abuse, and other services determined
12necessary by the Illinois Department by rule for delivery by
13Partnerships. Physician services must include prenatal and
14obstetrical care. The Illinois Department shall reimburse
15medical services delivered by Partnership providers to clients
16in target areas according to provisions of this Article and
17the Illinois Health Finance Reform Act, except that:
18        (1) Physicians participating in a Partnership and
19    providing certain services, which shall be determined by
20    the Illinois Department, to persons in areas covered by
21    the Partnership may receive an additional surcharge for
22    such services.
23        (2) The Department may elect to consider and negotiate
24    financial incentives to encourage the development of
25    Partnerships and the efficient delivery of medical care.
26        (3) Persons receiving medical services through

 

 

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1    Partnerships may receive medical and case management
2    services above the level usually offered through the
3    medical assistance program.
4    Medical providers shall be required to meet certain
5qualifications to participate in Partnerships to ensure the
6delivery of high quality medical services. These
7qualifications shall be determined by rule of the Illinois
8Department and may be higher than qualifications for
9participation in the medical assistance program. Partnership
10sponsors may prescribe reasonable additional qualifications
11for participation by medical providers, only with the prior
12written approval of the Illinois Department.
13    Nothing in this Section shall limit the free choice of
14practitioners, hospitals, and other providers of medical
15services by clients. In order to ensure patient freedom of
16choice, the Illinois Department shall immediately promulgate
17all rules and take all other necessary actions so that
18provided services may be accessed from therapeutically
19certified optometrists to the full extent of the Illinois
20Optometric Practice Act of 1987 without discriminating between
21service providers.
22    The Department shall apply for a waiver from the United
23States Health Care Financing Administration to allow for the
24implementation of Partnerships under this Section.
25    The Illinois Department shall require health care
26providers to maintain records that document the medical care

 

 

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1and services provided to recipients of Medical Assistance
2under this Article. Such records must be retained for a period
3of not less than 6 years from the date of service or as
4provided by applicable State law, whichever period is longer,
5except that if an audit is initiated within the required
6retention period then the records must be retained until the
7audit is completed and every exception is resolved. The
8Illinois Department shall require health care providers to
9make available, when authorized by the patient, in writing,
10the medical records in a timely fashion to other health care
11providers who are treating or serving persons eligible for
12Medical Assistance under this Article. All dispensers of
13medical services shall be required to maintain and retain
14business and professional records sufficient to fully and
15accurately document the nature, scope, details and receipt of
16the health care provided to persons eligible for medical
17assistance under this Code, in accordance with regulations
18promulgated by the Illinois Department. The rules and
19regulations shall require that proof of the receipt of
20prescription drugs, dentures, prosthetic devices and
21eyeglasses by eligible persons under this Section accompany
22each claim for reimbursement submitted by the dispenser of
23such medical services. No such claims for reimbursement shall
24be approved for payment by the Illinois Department without
25such proof of receipt, unless the Illinois Department shall
26have put into effect and shall be operating a system of

 

 

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1post-payment audit and review which shall, on a sampling
2basis, be deemed adequate by the Illinois Department to assure
3that such drugs, dentures, prosthetic devices and eyeglasses
4for which payment is being made are actually being received by
5eligible recipients. Within 90 days after September 16, 1984
6(the effective date of Public Act 83-1439), the Illinois
7Department shall establish a current list of acquisition costs
8for all prosthetic devices and any other items recognized as
9medical equipment and supplies reimbursable under this Article
10and shall update such list on a quarterly basis, except that
11the acquisition costs of all prescription drugs shall be
12updated no less frequently than every 30 days as required by
13Section 5-5.12.
14    Notwithstanding any other law to the contrary, the
15Illinois Department shall, within 365 days after July 22, 2013
16(the effective date of Public Act 98-104), establish
17procedures to permit skilled care facilities licensed under
18the Nursing Home Care Act to submit monthly billing claims for
19reimbursement purposes. Following development of these
20procedures, the Department shall, by July 1, 2016, test the
21viability of the new system and implement any necessary
22operational or structural changes to its information
23technology platforms in order to allow for the direct
24acceptance and payment of nursing home claims.
25    Notwithstanding any other law to the contrary, the
26Illinois Department shall, within 365 days after August 15,

 

 

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12014 (the effective date of Public Act 98-963), establish
2procedures to permit ID/DD facilities licensed under the ID/DD
3Community Care Act and MC/DD facilities licensed under the
4MC/DD Act to submit monthly billing claims for reimbursement
5purposes. Following development of these procedures, the
6Department shall have an additional 365 days to test the
7viability of the new system and to ensure that any necessary
8operational or structural changes to its information
9technology platforms are implemented.
10    The Illinois Department shall require all dispensers of
11medical services, other than an individual practitioner or
12group of practitioners, desiring to participate in the Medical
13Assistance program established under this Article to disclose
14all financial, beneficial, ownership, equity, surety or other
15interests in any and all firms, corporations, partnerships,
16associations, business enterprises, joint ventures, agencies,
17institutions or other legal entities providing any form of
18health care services in this State under this Article.
19    The Illinois Department may require that all dispensers of
20medical services desiring to participate in the medical
21assistance program established under this Article disclose,
22under such terms and conditions as the Illinois Department may
23by rule establish, all inquiries from clients and attorneys
24regarding medical bills paid by the Illinois Department, which
25inquiries could indicate potential existence of claims or
26liens for the Illinois Department.

 

 

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1    Enrollment of a vendor shall be subject to a provisional
2period and shall be conditional for one year. During the
3period of conditional enrollment, the Department may terminate
4the vendor's eligibility to participate in, or may disenroll
5the vendor from, the medical assistance program without cause.
6Unless otherwise specified, such termination of eligibility or
7disenrollment is not subject to the Department's hearing
8process. However, a disenrolled vendor may reapply without
9penalty.
10    The Department has the discretion to limit the conditional
11enrollment period for vendors based upon category of risk of
12the vendor.
13    Prior to enrollment and during the conditional enrollment
14period in the medical assistance program, all vendors shall be
15subject to enhanced oversight, screening, and review based on
16the risk of fraud, waste, and abuse that is posed by the
17category of risk of the vendor. The Illinois Department shall
18establish the procedures for oversight, screening, and review,
19which may include, but need not be limited to: criminal and
20financial background checks; fingerprinting; license,
21certification, and authorization verifications; unscheduled or
22unannounced site visits; database checks; prepayment audit
23reviews; audits; payment caps; payment suspensions; and other
24screening as required by federal or State law.
25    The Department shall define or specify the following: (i)
26by provider notice, the "category of risk of the vendor" for

 

 

HB2420- 53 -LRB102 14877 KTG 20230 b

1each type of vendor, which shall take into account the level of
2screening applicable to a particular category of vendor under
3federal law and regulations; (ii) by rule or provider notice,
4the maximum length of the conditional enrollment period for
5each category of risk of the vendor; and (iii) by rule, the
6hearing rights, if any, afforded to a vendor in each category
7of risk of the vendor that is terminated or disenrolled during
8the conditional enrollment period.
9    To be eligible for payment consideration, a vendor's
10payment claim or bill, either as an initial claim or as a
11resubmitted claim following prior rejection, must be received
12by the Illinois Department, or its fiscal intermediary, no
13later than 180 days after the latest date on the claim on which
14medical goods or services were provided, with the following
15exceptions:
16        (1) In the case of a provider whose enrollment is in
17    process by the Illinois Department, the 180-day period
18    shall not begin until the date on the written notice from
19    the Illinois Department that the provider enrollment is
20    complete.
21        (2) In the case of errors attributable to the Illinois
22    Department or any of its claims processing intermediaries
23    which result in an inability to receive, process, or
24    adjudicate a claim, the 180-day period shall not begin
25    until the provider has been notified of the error.
26        (3) In the case of a provider for whom the Illinois

 

 

HB2420- 54 -LRB102 14877 KTG 20230 b

1    Department initiates the monthly billing process.
2        (4) In the case of a provider operated by a unit of
3    local government with a population exceeding 3,000,000
4    when local government funds finance federal participation
5    for claims payments.
6    For claims for services rendered during a period for which
7a recipient received retroactive eligibility, claims must be
8filed within 180 days after the Department determines the
9applicant is eligible. For claims for which the Illinois
10Department is not the primary payer, claims must be submitted
11to the Illinois Department within 180 days after the final
12adjudication by the primary payer.
13    In the case of long term care facilities, within 45
14calendar days of receipt by the facility of required
15prescreening information, new admissions with associated
16admission documents shall be submitted through the Medical
17Electronic Data Interchange (MEDI) or the Recipient
18Eligibility Verification (REV) System or shall be submitted
19directly to the Department of Human Services using required
20admission forms. Effective September 1, 2014, admission
21documents, including all prescreening information, must be
22submitted through MEDI or REV. Confirmation numbers assigned
23to an accepted transaction shall be retained by a facility to
24verify timely submittal. Once an admission transaction has
25been completed, all resubmitted claims following prior
26rejection are subject to receipt no later than 180 days after

 

 

HB2420- 55 -LRB102 14877 KTG 20230 b

1the admission transaction has been completed.
2    Claims that are not submitted and received in compliance
3with the foregoing requirements shall not be eligible for
4payment under the medical assistance program, and the State
5shall have no liability for payment of those claims.
6    To the extent consistent with applicable information and
7privacy, security, and disclosure laws, State and federal
8agencies and departments shall provide the Illinois Department
9access to confidential and other information and data
10necessary to perform eligibility and payment verifications and
11other Illinois Department functions. This includes, but is not
12limited to: information pertaining to licensure;
13certification; earnings; immigration status; citizenship; wage
14reporting; unearned and earned income; pension income;
15employment; supplemental security income; social security
16numbers; National Provider Identifier (NPI) numbers; the
17National Practitioner Data Bank (NPDB); program and agency
18exclusions; taxpayer identification numbers; tax delinquency;
19corporate information; and death records.
20    The Illinois Department shall enter into agreements with
21State agencies and departments, and is authorized to enter
22into agreements with federal agencies and departments, under
23which such agencies and departments shall share data necessary
24for medical assistance program integrity functions and
25oversight. The Illinois Department shall develop, in
26cooperation with other State departments and agencies, and in

 

 

HB2420- 56 -LRB102 14877 KTG 20230 b

1compliance with applicable federal laws and regulations,
2appropriate and effective methods to share such data. At a
3minimum, and to the extent necessary to provide data sharing,
4the Illinois Department shall enter into agreements with State
5agencies and departments, and is authorized to enter into
6agreements with federal agencies and departments, including,
7but not limited to: the Secretary of State; the Department of
8Revenue; the Department of Public Health; the Department of
9Human Services; and the Department of Financial and
10Professional Regulation.
11    Beginning in fiscal year 2013, the Illinois Department
12shall set forth a request for information to identify the
13benefits of a pre-payment, post-adjudication, and post-edit
14claims system with the goals of streamlining claims processing
15and provider reimbursement, reducing the number of pending or
16rejected claims, and helping to ensure a more transparent
17adjudication process through the utilization of: (i) provider
18data verification and provider screening technology; and (ii)
19clinical code editing; and (iii) pre-pay, pre- or
20post-adjudicated predictive modeling with an integrated case
21management system with link analysis. Such a request for
22information shall not be considered as a request for proposal
23or as an obligation on the part of the Illinois Department to
24take any action or acquire any products or services.
25    The Illinois Department shall establish policies,
26procedures, standards and criteria by rule for the

 

 

HB2420- 57 -LRB102 14877 KTG 20230 b

1acquisition, repair and replacement of orthotic and prosthetic
2devices and durable medical equipment. Such rules shall
3provide, but not be limited to, the following services: (1)
4immediate repair or replacement of such devices by recipients;
5and (2) rental, lease, purchase or lease-purchase of durable
6medical equipment in a cost-effective manner, taking into
7consideration the recipient's medical prognosis, the extent of
8the recipient's needs, and the requirements and costs for
9maintaining such equipment. Subject to prior approval, such
10rules shall enable a recipient to temporarily acquire and use
11alternative or substitute devices or equipment pending repairs
12or replacements of any device or equipment previously
13authorized for such recipient by the Department.
14Notwithstanding any provision of Section 5-5f to the contrary,
15the Department may, by rule, exempt certain replacement
16wheelchair parts from prior approval and, for wheelchairs,
17wheelchair parts, wheelchair accessories, and related seating
18and positioning items, determine the wholesale price by
19methods other than actual acquisition costs.
20    The Department shall require, by rule, all providers of
21durable medical equipment to be accredited by an accreditation
22organization approved by the federal Centers for Medicare and
23Medicaid Services and recognized by the Department in order to
24bill the Department for providing durable medical equipment to
25recipients. No later than 15 months after the effective date
26of the rule adopted pursuant to this paragraph, all providers

 

 

HB2420- 58 -LRB102 14877 KTG 20230 b

1must meet the accreditation requirement.
2    In order to promote environmental responsibility, meet the
3needs of recipients and enrollees, and achieve significant
4cost savings, the Department, or a managed care organization
5under contract with the Department, may provide recipients or
6managed care enrollees who have a prescription or Certificate
7of Medical Necessity access to refurbished durable medical
8equipment under this Section (excluding prosthetic and
9orthotic devices as defined in the Orthotics, Prosthetics, and
10Pedorthics Practice Act and complex rehabilitation technology
11products and associated services) through the State's
12assistive technology program's reutilization program, using
13staff with the Assistive Technology Professional (ATP)
14Certification if the refurbished durable medical equipment:
15(i) is available; (ii) is less expensive, including shipping
16costs, than new durable medical equipment of the same type;
17(iii) is able to withstand at least 3 years of use; (iv) is
18cleaned, disinfected, sterilized, and safe in accordance with
19federal Food and Drug Administration regulations and guidance
20governing the reprocessing of medical devices in health care
21settings; and (v) equally meets the needs of the recipient or
22enrollee. The reutilization program shall confirm that the
23recipient or enrollee is not already in receipt of same or
24similar equipment from another service provider, and that the
25refurbished durable medical equipment equally meets the needs
26of the recipient or enrollee. Nothing in this paragraph shall

 

 

HB2420- 59 -LRB102 14877 KTG 20230 b

1be construed to limit recipient or enrollee choice to obtain
2new durable medical equipment or place any additional prior
3authorization conditions on enrollees of managed care
4organizations.
5    The Department shall execute, relative to the nursing home
6prescreening project, written inter-agency agreements with the
7Department of Human Services and the Department on Aging, to
8effect the following: (i) intake procedures and common
9eligibility criteria for those persons who are receiving
10non-institutional services; and (ii) the establishment and
11development of non-institutional services in areas of the
12State where they are not currently available or are
13undeveloped; and (iii) notwithstanding any other provision of
14law, subject to federal approval, on and after July 1, 2012, an
15increase in the determination of need (DON) scores from 29 to
1637 for applicants for institutional and home and
17community-based long term care; if and only if federal
18approval is not granted, the Department may, in conjunction
19with other affected agencies, implement utilization controls
20or changes in benefit packages to effectuate a similar savings
21amount for this population; and (iv) no later than July 1,
222013, minimum level of care eligibility criteria for
23institutional and home and community-based long term care; and
24(v) no later than October 1, 2013, establish procedures to
25permit long term care providers access to eligibility scores
26for individuals with an admission date who are seeking or

 

 

HB2420- 60 -LRB102 14877 KTG 20230 b

1receiving services from the long term care provider; and (iv)
2notwithstanding any other provision of law, subject to federal
3approval, on and after July 1, 2023, an increase in the
4determination of need score (DON) threshold to 37 for
5applicants for institutional long term care. In order to
6select the minimum level of care eligibility criteria, the
7Governor shall establish a workgroup that includes affected
8agency representatives and stakeholders representing the
9institutional and home and community-based long term care
10interests. This Section shall not restrict the Department from
11implementing lower level of care eligibility criteria for
12community-based services in circumstances where federal
13approval has been granted. The Department shall pursue such
14approvals and any other measures necessary to implement
15changes in this amendatory Act of the 102nd General Assembly.
16    Notwithstanding any other provision of this Section, on
17and after July 1, 2023 but before July 1, 2025, continuation of
18a nursing facility stay that began on or before June 30, 2023
19by a person with a DON score between 29 and 36 may be covered
20when such stay would be otherwise eligible under this Code,
21provided the nursing facility: (i) has documented that the
22individual was offered and declined appropriate home and
23community-based services; (ii) documents that each month the
24individual has been reassessed with a DON score in the
25qualifying range; and (iii) for such individuals who at any
26time choose to transition to community living, arranges for

 

 

HB2420- 61 -LRB102 14877 KTG 20230 b

1the appropriate housing, transitional supports, and home and
2community-based services to effectuate a successful
3transition. The Department shall, by rule, set a maximum total
4number of individuals to be covered under this paragraph and
5other limits on utilization that it deems appropriate.
6    The Illinois Department shall develop and operate, in
7cooperation with other State Departments and agencies and in
8compliance with applicable federal laws and regulations,
9appropriate and effective systems of health care evaluation
10and programs for monitoring of utilization of health care
11services and facilities, as it affects persons eligible for
12medical assistance under this Code.
13    The Illinois Department shall report annually to the
14General Assembly, no later than the second Friday in April of
151979 and each year thereafter, in regard to:
16        (a) actual statistics and trends in utilization of
17    medical services by public aid recipients;
18        (b) actual statistics and trends in the provision of
19    the various medical services by medical vendors;
20        (c) current rate structures and proposed changes in
21    those rate structures for the various medical vendors; and
22        (d) efforts at utilization review and control by the
23    Illinois Department.
24    The period covered by each report shall be the 3 years
25ending on the June 30 prior to the report. The report shall
26include suggested legislation for consideration by the General

 

 

HB2420- 62 -LRB102 14877 KTG 20230 b

1Assembly. The requirement for reporting to the General
2Assembly shall be satisfied by filing copies of the report as
3required by Section 3.1 of the General Assembly Organization
4Act, and filing such additional copies with the State
5Government Report Distribution Center for the General Assembly
6as is required under paragraph (t) of Section 7 of the State
7Library Act.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14    On and after July 1, 2012, the Department shall reduce any
15rate of reimbursement for services or other payments or alter
16any methodologies authorized by this Code to reduce any rate
17of reimbursement for services or other payments in accordance
18with Section 5-5e.
19    Because kidney transplantation can be an appropriate,
20cost-effective alternative to renal dialysis when medically
21necessary and notwithstanding the provisions of Section 1-11
22of this Code, beginning October 1, 2014, the Department shall
23cover kidney transplantation for noncitizens with end-stage
24renal disease who are not eligible for comprehensive medical
25benefits, who meet the residency requirements of Section 5-3
26of this Code, and who would otherwise meet the financial

 

 

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1requirements of the appropriate class of eligible persons
2under Section 5-2 of this Code. To qualify for coverage of
3kidney transplantation, such person must be receiving
4emergency renal dialysis services covered by the Department.
5Providers under this Section shall be prior approved and
6certified by the Department to perform kidney transplantation
7and the services under this Section shall be limited to
8services associated with kidney transplantation.
9    Notwithstanding any other provision of this Code to the
10contrary, on or after July 1, 2015, all FDA approved forms of
11medication assisted treatment prescribed for the treatment of
12alcohol dependence or treatment of opioid dependence shall be
13covered under both fee for service and managed care medical
14assistance programs for persons who are otherwise eligible for
15medical assistance under this Article and shall not be subject
16to any (1) utilization control, other than those established
17under the American Society of Addiction Medicine patient
18placement criteria, (2) prior authorization mandate, or (3)
19lifetime restriction limit mandate.
20    On or after July 1, 2015, opioid antagonists prescribed
21for the treatment of an opioid overdose, including the
22medication product, administration devices, and any pharmacy
23fees related to the dispensing and administration of the
24opioid antagonist, shall be covered under the medical
25assistance program for persons who are otherwise eligible for
26medical assistance under this Article. As used in this

 

 

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1Section, "opioid antagonist" means a drug that binds to opioid
2receptors and blocks or inhibits the effect of opioids acting
3on those receptors, including, but not limited to, naloxone
4hydrochloride or any other similarly acting drug approved by
5the U.S. Food and Drug Administration.
6    Upon federal approval, the Department shall provide
7coverage and reimbursement for all drugs that are approved for
8marketing by the federal Food and Drug Administration and that
9are recommended by the federal Public Health Service or the
10United States Centers for Disease Control and Prevention for
11pre-exposure prophylaxis and related pre-exposure prophylaxis
12services, including, but not limited to, HIV and sexually
13transmitted infection screening, treatment for sexually
14transmitted infections, medical monitoring, assorted labs, and
15counseling to reduce the likelihood of HIV infection among
16individuals who are not infected with HIV but who are at high
17risk of HIV infection.
18    A federally qualified health center, as defined in Section
191905(l)(2)(B) of the federal Social Security Act, shall be
20reimbursed by the Department in accordance with the federally
21qualified health center's encounter rate for services provided
22to medical assistance recipients that are performed by a
23dental hygienist, as defined under the Illinois Dental
24Practice Act, working under the general supervision of a
25dentist and employed by a federally qualified health center.
26(Source: P.A. 100-201, eff. 8-18-17; 100-395, eff. 1-1-18;

 

 

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1100-449, eff. 1-1-18; 100-538, eff. 1-1-18; 100-587, eff.
26-4-18; 100-759, eff. 1-1-19; 100-863, eff. 8-14-18; 100-974,
3eff. 8-19-18; 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19;
4100-1148, eff. 12-10-18; 101-209, eff. 8-5-19; 101-580, eff.
51-1-20; revised 9-18-19.)
 
6    (305 ILCS 5/5-5.01a)
7    Sec. 5-5.01a. Supportive living facilities program.
8    (a) The Department shall establish and provide oversight
9for a program of supportive living facilities that seek to
10promote resident independence, dignity, respect, and
11well-being in the most cost-effective manner.
12    A supportive living facility is (i) a free-standing
13facility or (ii) a distinct physical and operational entity
14within a mixed-use building that meets the criteria
15established in subsection (d). A supportive living facility
16integrates housing with health, personal care, and supportive
17services and is a designated setting that offers residents
18their own separate, private, and distinct living units.
19    Sites for the operation of the program shall be selected
20by the Department based upon criteria that may include the
21need for services in a geographic area, the availability of
22funding, and the site's ability to meet the standards.
23    Individuals with a score of 29 or higher based on the
24determination of need assessment tool shall be eligible to
25receive services through the program of supportive living

 

 

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1facilities.
2    (b) Beginning July 1, 2014, subject to federal approval,
3the Medicaid rates for supportive living facilities shall be
4equal to the supportive living facility Medicaid rate
5effective on June 30, 2014 increased by 8.85%. Once the
6assessment imposed at Article V-G of this Code is determined
7to be a permissible tax under Title XIX of the Social Security
8Act, the Department shall increase the Medicaid rates for
9supportive living facilities effective on July 1, 2014 by
109.09%. The Department shall apply this increase retroactively
11to coincide with the imposition of the assessment in Article
12V-G of this Code in accordance with the approval for federal
13financial participation by the Centers for Medicare and
14Medicaid Services.
15    The Medicaid rates for supportive living facilities
16effective on July 1, 2017 must be equal to the rates in effect
17for supportive living facilities on June 30, 2017 increased by
182.8%.
19    Subject to federal approval, the Medicaid rates for
20supportive living services on and after July 1, 2019 must be at
21least 54.3% of the average total nursing facility services per
22diem for the geographic areas defined by the Department while
23maintaining the rate differential for dementia care and must
24be updated whenever the total nursing facility service per
25diems are updated.
26    (c) The Department may adopt rules to implement this

 

 

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1Section. Rules that establish or modify the services,
2standards, and conditions for participation in the program
3shall be adopted by the Department in consultation with the
4Department on Aging, the Department of Rehabilitation
5Services, and the Department of Mental Health and
6Developmental Disabilities (or their successor agencies).
7    (d) Subject to federal approval by the Centers for
8Medicare and Medicaid Services, the Department shall accept
9for consideration of certification under the program any
10application for a site or building where distinct parts of the
11site or building are designated for purposes other than the
12provision of supportive living services, but only if:
13        (1) those distinct parts of the site or building are
14    not designated for the purpose of providing assisted
15    living services as required under the Assisted Living and
16    Shared Housing Act;
17        (2) those distinct parts of the site or building are
18    completely separate from the part of the building used for
19    the provision of supportive living program services,
20    including separate entrances;
21        (3) those distinct parts of the site or building do
22    not share any common spaces with the part of the building
23    used for the provision of supportive living program
24    services; and
25        (4) those distinct parts of the site or building do
26    not share staffing with the part of the building used for

 

 

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1    the provision of supportive living program services.
2    (e) Facilities or distinct parts of facilities which are
3selected as supportive living facilities and are in good
4standing with the Department's rules are exempt from the
5provisions of the Nursing Home Care Act and the Illinois
6Health Facilities Planning Act.
7(Source: P.A. 100-23, eff. 7-6-17; 100-583, eff. 4-6-18;
8100-587, eff. 6-4-18; 101-10, eff. 6-5-19.)
 
9    Section 99. Effective date. This Act takes effect July 1,
102023.