Illinois General Assembly - Full Text of HB0422
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Full Text of HB0422  102nd General Assembly

HB0422 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB0422

 

Introduced 2/8/2021, by Rep. LaToya Greenwood

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Act on the Aging, the Disabled Persons Rehabilitation Act, and the Illinois Public Aid Code. Regarding services under the Community Care Program (CCP), the Home Services Program, the supportive living facilities program, and the nursing home prescreening project, provides that individuals with a score of 29 or higher based on the determination of need assessment tool shall be eligible to receive institutional and home and community-based long term care services until the State receives federal approval and implements an updated assessment tool, and those individuals are found to be ineligible under that updated assessment tool. Requires the Department on Aging and the Departments of Human Services and Healthcare and Family Services to adopt rules, but not emergency rules, regarding the updated assessment tool. Contains provisions concerning continued eligibility for persons made ineligible for services under the updated assessment tool. Amends the Illinois Act on the Aging. Prohibits the Department on Aging from adopting any rule that: (i) restricts eligibility under CCP to persons who qualify for medical assistance; or (ii) establishes a separate program of home and community-based long term care services for persons eligible for CCP services but not eligible for medical assistance. Prohibits the Department from increasing copayment levels under CCP to those levels in effect on January 1, 2016. Amends the Illinois Public Aid Code. Deletes a provision concerning an increase in the determination of need scores, on and after July 1, 2012, from 29 to 37. Amends the Nursing Home Care Act. Prohibits the involuntary discharge of an individual receiving care in an institutional setting as the result of the updated assessment tool until a transition plan has been developed. Effective immediately.


LRB102 10090 KTG 15410 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB0422LRB102 10090 KTG 15410 b

1    AN ACT concerning State government.
 
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    Individuals who meet the following criteria shall have
16equal access to services under the Community Care Program: The
17Department shall establish eligibility standards for such
18services.
19        (a) are 60 years old or older;
20        (b) are U.S. citizens or legal aliens;
21        (c) are residents of Illinois;
22        (d) have nonexempt assets of $17,500 or less;
23    nonexempt assets do not include home, car, or personal
24    furnishings; and
25        (e) have an assessed need for long term care, as
26    provided in this Section, and are at risk for nursing

 

 

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1    facility placement as measured by the determination of
2    need assessment tool or a future updated assessment tool.
3In determining the amount and nature of services for which a
4person may qualify, consideration shall not be given to the
5value of cash, property or other assets held in the name of the
6person's spouse pursuant to a written agreement dividing
7marital property into equal but separate shares or pursuant to
8a transfer of the person's interest in a home to his spouse,
9provided that the spouse's share of the marital property is
10not made available to the person seeking such services.
11    Need for long term care shall be determined as follows:
12Individuals with a score of 29 or higher based on the
13determination of need (DON) assessment tool shall be eligible
14to receive institutional and home and community-based long
15term care services until the State receives federal approval
16and implements an updated assessment tool, and those
17individuals are found to be ineligible under that updated
18assessment tool. Anyone determined to be ineligible for
19services due to the updated assessment tool shall continue to
20be eligible for services for at least one year following that
21determination and must be reassessed no earlier than 11 months
22after that determination. The Department must adopt rules
23through the regular rulemaking process regarding the updated
24assessment tool, and shall not adopt emergency or peremptory
25rules regarding the updated assessment tool. The State shall
26not implement an updated assessment tool that causes more than

 

 

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11% of then-current recipients to lose eligibility.
2    Service cost maximums shall be set at levels no lower than
3the service cost maximums that were in effect as of January 1,
42016. Service cost maximums shall be increased accordingly to
5reflect any rate increases.
6    Beginning January 1, 2008, the Department shall require as
7a condition of eligibility that all new financially eligible
8applicants apply for and enroll in medical assistance under
9Article V of the Illinois Public Aid Code in accordance with
10rules promulgated by the Department.
11    The Department shall not: (i) adopt any rule that
12restricts eligibility under the Community Care Program to
13persons who qualify for medical assistance under Article V of
14the Illinois Public Aid Code; or (ii) establish, by rule, a
15separate program of home and community-based long term care
16services for persons who are otherwise eligible for services
17under the Community Care Program but who do not qualify for
18medical assistance under Article V of the Illinois Public Aid
19Code.
20    The Department shall, in conjunction with the Department
21of Public Aid (now Department of Healthcare and Family
22Services), seek appropriate amendments under Sections 1915 and
231924 of the Social Security Act. The purpose of the amendments
24shall be to extend eligibility for home and community based
25services under Sections 1915 and 1924 of the Social Security
26Act to persons who transfer to or for the benefit of a spouse

 

 

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1those amounts of income and resources allowed under Section
21924 of the Social Security Act. Subject to the approval of
3such amendments, the Department shall extend the provisions of
4Section 5-4 of the Illinois Public Aid Code to persons who, but
5for the provision of home or community-based services, would
6require the level of care provided in an institution, as is
7provided for in federal law. Those persons no longer found to
8be eligible for receiving noninstitutional services due to
9changes in the eligibility criteria shall be given 45 days
10notice prior to actual termination. Those persons receiving
11notice of termination may contact the Department and request
12the determination be appealed at any time during the 45 day
13notice period. The target population identified for the
14purposes of this Section are persons age 60 and older with an
15identified service need. Priority shall be given to those who
16are at imminent risk of institutionalization. The services
17shall be provided to eligible persons age 60 and older to the
18extent that the cost of the services together with the other
19personal maintenance expenses of the persons are reasonably
20related to the standards established for care in a group
21facility appropriate to the person's condition. These
22non-institutional services, pilot projects or experimental
23facilities may be provided as part of or in addition to those
24authorized by federal law or those funded and administered by
25the Department of Human Services. The Departments of Human
26Services, Healthcare and Family Services, Public Health,

 

 

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

 

 

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1are age 60 or older and who are caregivers of their adult
2children with developmental disabilities. The content of the
3training shall be at the Department's discretion.
4    The Department is authorized to establish a system of
5recipient copayment for services provided under this Section,
6such copayment to be based upon the recipient's ability to pay
7but in no case to exceed the actual cost of the services
8provided. Additionally, any portion of a person's income which
9is equal to or less than the federal poverty standard shall not
10be considered by the Department in determining the copayment.
11The level of such copayment shall be adjusted whenever
12necessary to reflect any change in the officially designated
13federal poverty standard. The Department shall not increase
14copayment levels to the levels that were in effect on January
151, 2016, except to make an adjustment for inflation.
16    The Department, or the Department's authorized
17representative, may recover the amount of moneys expended for
18services provided to or in behalf of a person under this
19Section by a claim against the person's estate or against the
20estate of the person's surviving spouse, but no recovery may
21be had until after the death of the surviving spouse, if any,
22and then only at such time when there is no surviving child who
23is under age 21 or blind or who has a permanent and total
24disability. This paragraph, however, shall not bar recovery,
25at the death of the person, of moneys for services provided to
26the person or in behalf of the person under this Section to

 

 

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1which the person was not entitled; provided that such recovery
2shall not be enforced against any real estate while it is
3occupied as a homestead by the surviving spouse or other
4dependent, if no claims by other creditors have been filed
5against the estate, or, if such claims have been filed, they
6remain dormant for failure of prosecution or failure of the
7claimant to compel administration of the estate for the
8purpose of payment. This paragraph shall not bar recovery from
9the estate of a spouse, under Sections 1915 and 1924 of the
10Social Security Act and Section 5-4 of the Illinois Public Aid
11Code, who precedes a person receiving services under this
12Section in death. All moneys for services paid to or in behalf
13of the person under this Section shall be claimed for recovery
14from the deceased spouse's estate. "Homestead", as used in
15this paragraph, means the dwelling house and contiguous real
16estate occupied by a surviving spouse or relative, as defined
17by the rules and regulations of the Department of Healthcare
18and Family Services, regardless of the value of the property.
19    The Department shall increase the effectiveness of the
20existing Community Care Program by:
21        (1) ensuring that in-home services included in the
22    care plan are available on evenings and weekends;
23        (2) ensuring that care plans contain the services that
24    eligible participants need based on the number of days in
25    a month, not limited to specific blocks of time, as
26    identified by the comprehensive assessment tool selected

 

 

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

 

 

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

 

 

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

 

 

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1    promulgating any rules, no later than January 1, 2014, to
2    assist the Department of Healthcare and Family Services in
3    moving as many participants as possible, consistent with
4    federal regulations, into coordinated care plans if a care
5    coordination plan that covers long term care is available
6    in the recipient's area; and
7        (13) maintaining fiscal year 2014 rates at the same
8    level established on January 1, 2013.
9    By January 1, 2009 or as soon after the end of the Cash and
10Counseling Demonstration Project as is practicable, the
11Department may, based on its evaluation of the demonstration
12project, promulgate rules concerning personal assistant
13services, to include, but need not be limited to,
14qualifications, employment screening, rights under fair labor
15standards, training, fiduciary agent, and supervision
16requirements. All applicants shall be subject to the
17provisions of the Health Care Worker Background Check Act.
18    The Department shall develop procedures to enhance
19availability of services on evenings, weekends, and on an
20emergency basis to meet the respite needs of caregivers.
21Procedures shall be developed to permit the utilization of
22services in successive blocks of 24 hours up to the monthly
23maximum established by the Department. Workers providing these
24services shall be appropriately trained.
25    Beginning on the effective date of this amendatory Act of
261991, no person may perform chore/housekeeping and home care

 

 

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1aide services under a program authorized by this Section
2unless that person has been issued a certificate of
3pre-service to do so by his or her employing agency.
4Information gathered to effect such certification shall
5include (i) the person's name, (ii) the date the person was
6hired by his or her current employer, and (iii) the training,
7including dates and levels. Persons engaged in the program
8authorized by this Section before the effective date of this
9amendatory Act of 1991 shall be issued a certificate of all
10pre- and in-service training from his or her employer upon
11submitting the necessary information. The employing agency
12shall be required to retain records of all staff pre- and
13in-service training, and shall provide such records to the
14Department upon request and upon termination of the employer's
15contract with the Department. In addition, the employing
16agency is responsible for the issuance of certifications of
17in-service training completed to their employees.
18    The Department is required to develop a system to ensure
19that persons working as home care aides and personal
20assistants receive increases in their wages when the federal
21minimum wage is increased by requiring vendors to certify that
22they are meeting the federal minimum wage statute for home
23care aides and personal assistants. An employer that cannot
24ensure that the minimum wage increase is being given to home
25care aides and personal assistants shall be denied any
26increase in reimbursement costs.

 

 

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1    The Community Care Program Advisory Committee is created
2in the Department on Aging. The Director shall appoint
3individuals to serve in the Committee, who shall serve at
4their own expense. Members of the Committee must abide by all
5applicable ethics laws. The Committee shall advise the
6Department on issues related to the Department's program of
7services to prevent unnecessary institutionalization. The
8Committee shall meet on a bi-monthly basis and shall serve to
9identify and advise the Department on present and potential
10issues affecting the service delivery network, the program's
11clients, and the Department and to recommend solution
12strategies. Persons appointed to the Committee shall be
13appointed on, but not limited to, their own and their agency's
14experience with the program, geographic representation, and
15willingness to serve. The Director shall appoint members to
16the Committee to represent provider, advocacy, policy
17research, and other constituencies committed to the delivery
18of high quality home and community-based services to older
19adults. Representatives shall be appointed to ensure
20representation from community care providers including, but
21not limited to, adult day service providers, homemaker
22providers, case coordination and case management units,
23emergency home response providers, statewide trade or labor
24unions that represent home care aides and direct care staff,
25area agencies on aging, adults over age 60, membership
26organizations representing older adults, and other

 

 

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1organizational entities, providers of care, or individuals
2with demonstrated interest and expertise in the field of home
3and community care as determined by the Director.
4    Nominations may be presented from any agency or State
5association with interest in the program. The Director, or his
6or her designee, shall serve as the permanent co-chair of the
7advisory committee. One other co-chair shall be nominated and
8approved by the members of the committee on an annual basis.
9Committee members' terms of appointment shall be for 4 years
10with one-quarter of the appointees' terms expiring each year.
11A member shall continue to serve until his or her replacement
12is named. The Department shall fill vacancies that have a
13remaining term of over one year, and this replacement shall
14occur through the annual replacement of expiring terms. The
15Director shall designate Department staff to provide technical
16assistance and staff support to the committee. Department
17representation shall not constitute membership of the
18committee. All Committee papers, issues, recommendations,
19reports, and meeting memoranda are advisory only. The
20Director, or his or her designee, shall make a written report,
21as requested by the Committee, regarding issues before the
22Committee.
23    The Department on Aging and the Department of Human
24Services shall cooperate in the development and submission of
25an annual report on programs and services provided under this
26Section. Such joint report shall be filed with the Governor

 

 

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1and the General Assembly on or before September 30 each year.
2    The requirement for reporting to the General Assembly
3shall be satisfied by filing copies of the report as required
4by Section 3.1 of the General Assembly Organization Act and
5filing such additional copies with the State Government Report
6Distribution Center for the General Assembly as is required
7under paragraph (t) of Section 7 of the State Library Act.
8    Those persons previously found eligible for receiving
9non-institutional services whose services were discontinued
10under the Emergency Budget Act of Fiscal Year 1992, and who do
11not meet the eligibility standards in effect on or after July
121, 1992, shall remain ineligible on and after July 1, 1992.
13Those persons previously not required to cost-share and who
14were required to cost-share effective March 1, 1992, shall
15continue to meet cost-share requirements on and after July 1,
161992. Beginning July 1, 1992, all clients will be required to
17meet eligibility, cost-share, and other requirements and will
18have services discontinued or altered when they fail to meet
19these requirements.
20    For the purposes of this Section, "flexible senior
21services" refers to services that require one-time or periodic
22expenditures including, but not limited to, respite care, home
23modification, assistive technology, housing assistance, and
24transportation.
25    The Department shall implement an electronic service
26verification based on global positioning systems or other

 

 

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1cost-effective technology for the Community Care Program no
2later than January 1, 2014.
3    The Department shall require, as a condition of
4eligibility, enrollment in the medical assistance program
5under Article V of the Illinois Public Aid Code (i) beginning
6August 1, 2013, if the Auditor General has reported that the
7Department has failed to comply with the reporting
8requirements of Section 2-27 of the Illinois State Auditing
9Act; or (ii) beginning June 1, 2014, if the Auditor General has
10reported that the Department has not undertaken the required
11actions listed in the report required by subsection (a) of
12Section 2-27 of the Illinois State Auditing Act.
13    The Department shall delay Community Care Program services
14until an applicant is determined eligible for medical
15assistance under Article V of the Illinois Public Aid Code (i)
16beginning August 1, 2013, if the Auditor General has reported
17that the Department has failed to comply with the reporting
18requirements of Section 2-27 of the Illinois State Auditing
19Act; or (ii) beginning June 1, 2014, if the Auditor General has
20reported that the Department has not undertaken the required
21actions listed in the report required by subsection (a) of
22Section 2-27 of the Illinois State Auditing Act.
23    The Department shall implement co-payments for the
24Community Care Program at the federally allowable maximum
25level (i) beginning August 1, 2013, if the Auditor General has
26reported that the Department has failed to comply with the

 

 

HB0422- 18 -LRB102 10090 KTG 15410 b

1reporting requirements of Section 2-27 of the Illinois State
2Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
3General has reported that the Department has not undertaken
4the required actions listed in the report required by
5subsection (a) of Section 2-27 of the Illinois State Auditing
6Act.
7    The Department shall provide a bi-monthly report on the
8progress of the Community Care Program reforms set forth in
9this amendatory Act of the 98th General Assembly to the
10Governor, the Speaker of the House of Representatives, the
11Minority Leader of the House of Representatives, the President
12of the Senate, and the Minority Leader of the Senate.
13    The Department shall conduct a quarterly review of Care
14Coordination Unit performance and adherence to service
15guidelines. The quarterly review shall be reported to the
16Speaker of the House of Representatives, the Minority Leader
17of the House of Representatives, the President of the Senate,
18and the Minority Leader of the Senate. The Department shall
19collect and report longitudinal data on the performance of
20each care coordination unit. Nothing in this paragraph shall
21be construed to require the Department to identify specific
22care coordination units.
23    In regard to community care providers, failure to comply
24with Department on Aging policies shall be cause for
25disciplinary action, including, but not limited to,
26disqualification from serving Community Care Program clients.

 

 

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1Each provider, upon submission of any bill or invoice to the
2Department for payment for services rendered, shall include a
3notarized statement, under penalty of perjury pursuant to
4Section 1-109 of the Code of Civil Procedure, that the
5provider has complied with all Department policies.
6    The Director of the Department on Aging shall make
7information available to the State Board of Elections as may
8be required by an agreement the State Board of Elections has
9entered into with a multi-state voter registration list
10maintenance system.
11    Within 30 days after July 6, 2017 (the effective date of
12Public Act 100-23), rates shall be increased to $18.29 per
13hour, for the purpose of increasing, by at least $.72 per hour,
14the wages paid by those vendors to their employees who provide
15homemaker services. The Department shall pay an enhanced rate
16under the Community Care Program to those in-home service
17provider agencies that offer health insurance coverage as a
18benefit to their direct service worker employees consistent
19with the mandates of Public Act 95-713. For State fiscal years
202018 and 2019, the enhanced rate shall be $1.77 per hour. The
21rate shall be adjusted using actuarial analysis based on the
22cost of care, but shall not be set below $1.77 per hour. The
23Department shall adopt rules, including emergency rules under
24subsections (y) and (bb) of Section 5-45 of the Illinois
25Administrative Procedure Act, to implement the provisions of
26this paragraph.

 

 

HB0422- 20 -LRB102 10090 KTG 15410 b

1    The General Assembly finds it necessary to authorize an
2aggressive Medicaid enrollment initiative designed to maximize
3federal Medicaid funding for the Community Care Program which
4produces significant savings for the State of Illinois. The
5Department on Aging shall establish and implement a Community
6Care Program Medicaid Initiative. Under the Initiative, the
7Department on Aging shall, at a minimum: (i) provide an
8enhanced rate to adequately compensate care coordination units
9to enroll eligible Community Care Program clients into
10Medicaid; (ii) use recommendations from a stakeholder
11committee on how best to implement the Initiative; and (iii)
12establish requirements for State agencies to make enrollment
13in the State's Medical Assistance program easier for seniors.
14    The Community Care Program Medicaid Enrollment Oversight
15Subcommittee is created as a subcommittee of the Older Adult
16Services Advisory Committee established in Section 35 of the
17Older Adult Services Act to make recommendations on how best
18to increase the number of medical assistance recipients who
19are enrolled in the Community Care Program. The Subcommittee
20shall consist of all of the following persons who must be
21appointed within 30 days after the effective date of this
22amendatory Act of the 100th General Assembly:
23        (1) The Director of Aging, or his or her designee, who
24    shall serve as the chairperson of the Subcommittee.
25        (2) One representative of the Department of Healthcare
26    and Family Services, appointed by the Director of

 

 

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1    Healthcare and Family Services.
2        (3) One representative of the Department of Human
3    Services, appointed by the Secretary of Human Services.
4        (4) One individual representing a care coordination
5    unit, appointed by the Director of Aging.
6        (5) One individual from a non-governmental statewide
7    organization that advocates for seniors, appointed by the
8    Director of Aging.
9        (6) One individual representing Area Agencies on
10    Aging, appointed by the Director of Aging.
11        (7) One individual from a statewide association
12    dedicated to Alzheimer's care, support, and research,
13    appointed by the Director of Aging.
14        (8) One individual from an organization that employs
15    persons who provide services under the Community Care
16    Program, appointed by the Director of Aging.
17        (9) One member of a trade or labor union representing
18    persons who provide services under the Community Care
19    Program, appointed by the Director of Aging.
20        (10) One member of the Senate, who shall serve as
21    co-chairperson, appointed by the President of the Senate.
22        (11) One member of the Senate, who shall serve as
23    co-chairperson, appointed by the Minority Leader of the
24    Senate.
25        (12) One member of the House of Representatives, who
26    shall serve as co-chairperson, appointed by the Speaker of

 

 

HB0422- 22 -LRB102 10090 KTG 15410 b

1    the House of Representatives.
2        (13) One member of the House of Representatives, who
3    shall serve as co-chairperson, appointed by the Minority
4    Leader of the House of Representatives.
5        (14) One individual appointed by a labor organization
6    representing frontline employees at the Department of
7    Human Services.
8    The Subcommittee shall provide oversight to the Community
9Care Program Medicaid Initiative and shall meet quarterly. At
10each Subcommittee meeting the Department on Aging shall
11provide the following data sets to the Subcommittee: (A) the
12number of Illinois residents, categorized by planning and
13service area, who are receiving services under the Community
14Care Program and are enrolled in the State's Medical
15Assistance Program; (B) the number of Illinois residents,
16categorized by planning and service area, who are receiving
17services under the Community Care Program, but are not
18enrolled in the State's Medical Assistance Program; and (C)
19the number of Illinois residents, categorized by planning and
20service area, who are receiving services under the Community
21Care Program and are eligible for benefits under the State's
22Medical Assistance Program, but are not enrolled in the
23State's Medical Assistance Program. In addition to this data,
24the Department on Aging shall provide the Subcommittee with
25plans on how the Department on Aging will reduce the number of
26Illinois residents who are not enrolled in the State's Medical

 

 

HB0422- 23 -LRB102 10090 KTG 15410 b

1Assistance Program but who are eligible for medical assistance
2benefits. The Department on Aging shall enroll in the State's
3Medical Assistance Program those Illinois residents who
4receive services under the Community Care Program and are
5eligible for medical assistance benefits but are not enrolled
6in the State's Medicaid Assistance Program. The data provided
7to the Subcommittee shall be made available to the public via
8the Department on Aging's website.
9    The Department on Aging, with the involvement of the
10Subcommittee, shall collaborate with the Department of Human
11Services and the Department of Healthcare and Family Services
12on how best to achieve the responsibilities of the Community
13Care Program Medicaid Initiative.
14    The Department on Aging, the Department of Human Services,
15and the Department of Healthcare and Family Services shall
16coordinate and implement a streamlined process for seniors to
17access benefits under the State's Medical Assistance Program.
18    The Subcommittee shall collaborate with the Department of
19Human Services on the adoption of a uniform application
20submission process. The Department of Human Services and any
21other State agency involved with processing the medical
22assistance application of any person enrolled in the Community
23Care Program shall include the appropriate care coordination
24unit in all communications related to the determination or
25status of the application.
26    The Community Care Program Medicaid Initiative shall

 

 

HB0422- 24 -LRB102 10090 KTG 15410 b

1provide targeted funding to care coordination units to help
2seniors complete their applications for medical assistance
3benefits. On and after July 1, 2019, care coordination units
4shall receive no less than $200 per completed application,
5which rate may be included in a bundled rate for initial intake
6services when Medicaid application assistance is provided in
7conjunction with the initial intake process for new program
8participants.
9    The Community Care Program Medicaid Initiative shall cease
10operation 5 years after the effective date of this amendatory
11Act of the 100th General Assembly, after which the
12Subcommittee shall dissolve.
13(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18;
14100-1148, eff. 12-10-18; 101-10, eff. 6-5-19.)
 
15    Section 10. The Rehabilitation of Persons with
16Disabilities Act is amended by changing Section 3 as follows:
 
17    (20 ILCS 2405/3)  (from Ch. 23, par. 3434)
18    Sec. 3. Powers and duties. The Department shall have the
19powers and duties enumerated herein:
20        (a) To co-operate with the federal government in the
21    administration of the provisions of the federal
22    Rehabilitation Act of 1973, as amended, of the Workforce
23    Innovation and Opportunity Act, and of the federal Social
24    Security Act to the extent and in the manner provided in

 

 

HB0422- 25 -LRB102 10090 KTG 15410 b

1    these Acts.
2        (b) To prescribe and supervise such courses of
3    vocational training and provide such other services as may
4    be necessary for the habilitation and rehabilitation of
5    persons with one or more disabilities, including the
6    administrative activities under subsection (e) of this
7    Section, and to co-operate with State and local school
8    authorities and other recognized agencies engaged in
9    habilitation, rehabilitation and comprehensive
10    rehabilitation services; and to cooperate with the
11    Department of Children and Family Services regarding the
12    care and education of children with one or more
13    disabilities.
14        (c) (Blank).
15        (d) To report in writing, to the Governor, annually on
16    or before the first day of December, and at such other
17    times and in such manner and upon such subjects as the
18    Governor may require. The annual report shall contain (1)
19    a statement of the existing condition of comprehensive
20    rehabilitation services, habilitation and rehabilitation
21    in the State; (2) a statement of suggestions and
22    recommendations with reference to the development of
23    comprehensive rehabilitation services, habilitation and
24    rehabilitation in the State; and (3) an itemized statement
25    of the amounts of money received from federal, State and
26    other sources, and of the objects and purposes to which

 

 

HB0422- 26 -LRB102 10090 KTG 15410 b

1    the respective items of these several amounts have been
2    devoted.
3        (e) (Blank).
4        (f) To establish a program of services to prevent the
5    unnecessary institutionalization of persons in need of
6    long term care and who meet the criteria for blindness or
7    disability as defined by the Social Security Act, thereby
8    enabling them to remain in their own homes. Such
9    preventive services include any or all of the following:
10            (1) personal assistant services;
11            (2) homemaker services;
12            (3) home-delivered meals;
13            (4) adult day care services;
14            (5) respite care;
15            (6) home modification or assistive equipment;
16            (7) home health services;
17            (8) electronic home response;
18            (9) brain injury behavioral/cognitive services;
19            (10) brain injury habilitation;
20            (11) brain injury pre-vocational services; or
21            (12) brain injury supported employment.
22        The Department shall establish eligibility standards
23    for such services taking into consideration the unique
24    economic and social needs of the population for whom they
25    are to be provided. Such eligibility standards may be
26    based on the recipient's ability to pay for services;

 

 

HB0422- 27 -LRB102 10090 KTG 15410 b

1    provided, however, that any portion of a person's income
2    that is equal to or less than the "protected income" level
3    shall not be considered by the Department in determining
4    eligibility. The "protected income" level shall be
5    determined by the Department, shall never be less than the
6    federal poverty standard, and shall be adjusted each year
7    to reflect changes in the Consumer Price Index For All
8    Urban Consumers as determined by the United States
9    Department of Labor. The standards must provide that a
10    person may not have more than $10,000 in assets to be
11    eligible for the services, and the Department may increase
12    or decrease the asset limitation by rule. The Department
13    may not decrease the asset level below $10,000.
14    Individuals with a score of 29 or higher based on the
15determination of need (DON) assessment tool shall be eligible
16to receive institutional and home and community-based long
17term care services until the State receives federal approval
18and implements an updated assessment tool, and those
19individuals are found to be ineligible under that updated
20assessment tool. Anyone determined to be ineligible for
21services due to the updated assessment tool shall continue to
22be eligible for services for at least one year following that
23determination and must be reassessed no earlier than 11 months
24after that determination. The Department must adopt rules
25through the regular rulemaking process regarding the updated
26assessment tool, and shall not adopt emergency or peremptory

 

 

HB0422- 28 -LRB102 10090 KTG 15410 b

1rules regarding the updated assessment tool. The State shall
2not implement an updated assessment tool that causes more than
31% of then-current recipients to lose eligibility.
4    Service cost maximums shall be set at levels no lower than
5the service cost maximums that were in effect as of January 1,
62016. Service cost maximums shall be increased accordingly to
7reflect any rate increases.
8        The services shall be provided, as established by the
9    Department by rule, to eligible persons to prevent
10    unnecessary or premature institutionalization, to the
11    extent that the cost of the services, together with the
12    other personal maintenance expenses of the persons, are
13    reasonably related to the standards established for care
14    in a group facility appropriate to their condition. These
15    non-institutional services, pilot projects or experimental
16    facilities may be provided as part of or in addition to
17    those authorized by federal law or those funded and
18    administered by the Illinois Department on Aging. The
19    Department shall set rates and fees for services in a fair
20    and equitable manner. Services identical to those offered
21    by the Department on Aging shall be paid at the same rate.
22        Except as otherwise provided in this paragraph,
23    personal assistants shall be paid at a rate negotiated
24    between the State and an exclusive representative of
25    personal assistants under a collective bargaining
26    agreement. In no case shall the Department pay personal

 

 

HB0422- 29 -LRB102 10090 KTG 15410 b

1    assistants an hourly wage that is less than the federal
2    minimum wage. Within 30 days after July 6, 2017 (the
3    effective date of Public Act 100-23), the hourly wage paid
4    to personal assistants and individual maintenance home
5    health workers shall be increased by $0.48 per hour.
6        Solely for the purposes of coverage under the Illinois
7    Public Labor Relations Act, personal assistants providing
8    services under the Department's Home Services Program
9    shall be considered to be public employees and the State
10    of Illinois shall be considered to be their employer as of
11    July 16, 2003 (the effective date of Public Act 93-204),
12    but not before. Solely for the purposes of coverage under
13    the Illinois Public Labor Relations Act, home care and
14    home health workers who function as personal assistants
15    and individual maintenance home health workers and who
16    also provide services under the Department's Home Services
17    Program shall be considered to be public employees, no
18    matter whether the State provides such services through
19    direct fee-for-service arrangements, with the assistance
20    of a managed care organization or other intermediary, or
21    otherwise, and the State of Illinois shall be considered
22    to be the employer of those persons as of January 29, 2013
23    (the effective date of Public Act 97-1158), but not before
24    except as otherwise provided under this subsection (f).
25    The State shall engage in collective bargaining with an
26    exclusive representative of home care and home health

 

 

HB0422- 30 -LRB102 10090 KTG 15410 b

1    workers who function as personal assistants and individual
2    maintenance home health workers working under the Home
3    Services Program concerning their terms and conditions of
4    employment that are within the State's control. Nothing in
5    this paragraph shall be understood to limit the right of
6    the persons receiving services defined in this Section to
7    hire and fire home care and home health workers who
8    function as personal assistants and individual maintenance
9    home health workers working under the Home Services
10    Program or to supervise them within the limitations set by
11    the Home Services Program. The State shall not be
12    considered to be the employer of home care and home health
13    workers who function as personal assistants and individual
14    maintenance home health workers working under the Home
15    Services Program for any purposes not specifically
16    provided in Public Act 93-204 or Public Act 97-1158,
17    including but not limited to, purposes of vicarious
18    liability in tort and purposes of statutory retirement or
19    health insurance benefits. Home care and home health
20    workers who function as personal assistants and individual
21    maintenance home health workers and who also provide
22    services under the Department's Home Services Program
23    shall not be covered by the State Employees Group
24    Insurance Act of 1971.
25        The Department shall execute, relative to nursing home
26    prescreening, as authorized by Section 4.03 of the

 

 

HB0422- 31 -LRB102 10090 KTG 15410 b

1    Illinois Act on the Aging, written inter-agency agreements
2    with the Department on Aging and the Department of
3    Healthcare and Family Services, to effect the intake
4    procedures and eligibility criteria for those persons who
5    may need long term care. On and after July 1, 1996, all
6    nursing home prescreenings for individuals 18 through 59
7    years of age shall be conducted by the Department, or a
8    designee of the Department.
9        The Department is authorized to establish a system of
10    recipient cost-sharing for services provided under this
11    Section. The cost-sharing shall be based upon the
12    recipient's ability to pay for services, but in no case
13    shall the recipient's share exceed the actual cost of the
14    services provided. Protected income shall not be
15    considered by the Department in its determination of the
16    recipient's ability to pay a share of the cost of
17    services. The level of cost-sharing shall be adjusted each
18    year to reflect changes in the "protected income" level.
19    The Department shall deduct from the recipient's share of
20    the cost of services any money expended by the recipient
21    for disability-related expenses.
22        To the extent permitted under the federal Social
23    Security Act, the Department, or the Department's
24    authorized representative, may recover the amount of
25    moneys expended for services provided to or in behalf of a
26    person under this Section by a claim against the person's

 

 

HB0422- 32 -LRB102 10090 KTG 15410 b

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

 

 

HB0422- 33 -LRB102 10090 KTG 15410 b

1    regulations of the Department of Healthcare and Family
2    Services, regardless of the value of the property.
3        The Department shall submit an annual report on
4    programs and services provided under this Section. The
5    report shall be filed with the Governor and the General
6    Assembly on or before March 30 each year.
7        The requirement for reporting to the General Assembly
8    shall be satisfied by filing copies of the report as
9    required by Section 3.1 of the General Assembly
10    Organization Act, and filing additional copies with the
11    State Government Report Distribution Center for the
12    General Assembly as required under paragraph (t) of
13    Section 7 of the State Library Act.
14        (g) To establish such subdivisions of the Department
15    as shall be desirable and assign to the various
16    subdivisions the responsibilities and duties placed upon
17    the Department by law.
18        (h) To cooperate and enter into any necessary
19    agreements with the Department of Employment Security for
20    the provision of job placement and job referral services
21    to clients of the Department, including job service
22    registration of such clients with Illinois Employment
23    Security offices and making job listings maintained by the
24    Department of Employment Security available to such
25    clients.
26        (i) To possess all powers reasonable and necessary for

 

 

HB0422- 34 -LRB102 10090 KTG 15410 b

1    the exercise and administration of the powers, duties and
2    responsibilities of the Department which are provided for
3    by law.
4        (j) (Blank).
5        (k) (Blank).
6        (l) To establish, operate, and maintain a Statewide
7    Housing Clearinghouse of information on available
8    government subsidized housing accessible to persons with
9    disabilities and available privately owned housing
10    accessible to persons with disabilities. The information
11    shall include, but not be limited to, the location, rental
12    requirements, access features and proximity to public
13    transportation of available housing. The Clearinghouse
14    shall consist of at least a computerized database for the
15    storage and retrieval of information and a separate or
16    shared toll free telephone number for use by those seeking
17    information from the Clearinghouse. Department offices and
18    personnel throughout the State shall also assist in the
19    operation of the Statewide Housing Clearinghouse.
20    Cooperation with local, State, and federal housing
21    managers shall be sought and extended in order to
22    frequently and promptly update the Clearinghouse's
23    information.
24        (m) To assure that the names and case records of
25    persons who received or are receiving services from the
26    Department, including persons receiving vocational

 

 

HB0422- 35 -LRB102 10090 KTG 15410 b

1    rehabilitation, home services, or other services, and
2    those attending one of the Department's schools or other
3    supervised facility shall be confidential and not be open
4    to the general public. Those case records and reports or
5    the information contained in those records and reports
6    shall be disclosed by the Director only to proper law
7    enforcement officials, individuals authorized by a court,
8    the General Assembly or any committee or commission of the
9    General Assembly, and other persons and for reasons as the
10    Director designates by rule. Disclosure by the Director
11    may be only in accordance with other applicable law.
12(Source: P.A. 99-143, eff. 7-27-15; 100-23, eff. 7-6-17;
13100-477, eff. 9-8-17; 100-587, eff. 6-4-18; 100-863, eff.
148-14-18; 100-1148, eff. 12-10-18.)
 
15    Section 13. The Nursing Home Care Act is amended by
16changing Section 3-402 as follows:
 
17    (210 ILCS 45/3-402)  (from Ch. 111 1/2, par. 4153-402)
18    Sec. 3-402. Involuntary transfer or discharge.
19    Involuntary transfer or discharge of a resident from a
20facility shall be preceded by the discussion required under
21Section 3-408 and by a minimum written notice of 21 days,
22except in one of the following instances:
23        (a) When an emergency transfer or discharge is ordered
24    by the resident's attending physician because of the

 

 

HB0422- 36 -LRB102 10090 KTG 15410 b

1    resident's health care needs.
2        (b) When the transfer or discharge is mandated by the
3    physical safety of other residents, the facility staff, or
4    facility visitors, as documented in the clinical record.
5    The Department shall be notified prior to any such
6    involuntary transfer or discharge. The Department shall
7    immediately offer transfer, or discharge and relocation
8    assistance to residents transferred or discharged under
9    this subparagraph (b), and the Department may place
10    relocation teams as provided in Section 3-419 of this Act.
11        (c) When an identified offender is within the
12    provisional admission period defined in Section 1-120.3.
13    If the Identified Offender Report and Recommendation
14    prepared under Section 2-201.6 shows that the identified
15    offender poses a serious threat or danger to the physical
16    safety of other residents, the facility staff, or facility
17    visitors in the admitting facility and the facility
18    determines that it is unable to provide a safe environment
19    for the other residents, the facility staff, or facility
20    visitors, the facility shall transfer or discharge the
21    identified offender within 3 days after its receipt of the
22    Identified Offender Report and Recommendation.
23    No individual receiving care in an institutional setting
24shall be involuntarily discharged as the result of the updated
25determination of need (DON) assessment tool as provided in
26Section 5-5 of the Illinois Public Aid Code until a transition

 

 

HB0422- 37 -LRB102 10090 KTG 15410 b

1plan has been developed by the Department on Aging or its
2designee and all care identified in the transition plan is
3available to the resident immediately upon discharge.
4(Source: P.A. 96-1372, eff. 7-29-10.)
 
5    Section 15. The Illinois Public Aid Code is amended by
6changing Sections 5-5 and 5-5.01a as follows:
 
7    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
8    Sec. 5-5. Medical services. The Illinois Department, by
9rule, shall determine the quantity and quality of and the rate
10of reimbursement for the medical assistance for which payment
11will be authorized, and the medical services to be provided,
12which may include all or part of the following: (1) inpatient
13hospital services; (2) outpatient hospital services; (3) other
14laboratory and X-ray services; (4) skilled nursing home
15services; (5) physicians' services whether furnished in the
16office, the patient's home, a hospital, a skilled nursing
17home, or elsewhere; (6) medical care, or any other type of
18remedial care furnished by licensed practitioners; (7) home
19health care services; (8) private duty nursing service; (9)
20clinic services; (10) dental services, including prevention
21and treatment of periodontal disease and dental caries disease
22for pregnant women, provided by an individual licensed to
23practice dentistry or dental surgery; for purposes of this
24item (10), "dental services" means diagnostic, preventive, or

 

 

HB0422- 38 -LRB102 10090 KTG 15410 b

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

 

 

HB0422- 39 -LRB102 10090 KTG 15410 b

1laws of this State. The term "any other type of remedial care"
2shall include nursing care and nursing home service for
3persons who rely on treatment by spiritual means alone through
4prayer for healing.
5    Notwithstanding any other provision of this Section, a
6comprehensive tobacco use cessation program that includes
7purchasing prescription drugs or prescription medical devices
8approved by the Food and Drug Administration shall be covered
9under the medical assistance program under this Article for
10persons who are otherwise eligible for assistance under this
11Article.
12    Notwithstanding any other provision of this Code,
13reproductive health care that is otherwise legal in Illinois
14shall be covered under the medical assistance program for
15persons who are otherwise eligible for medical assistance
16under this Article.
17    Notwithstanding any other provision of this Code, the
18Illinois Department may not require, as a condition of payment
19for any laboratory test authorized under this Article, that a
20physician's handwritten signature appear on the laboratory
21test order form. The Illinois Department may, however, impose
22other appropriate requirements regarding laboratory test order
23documentation.
24    Upon receipt of federal approval of an amendment to the
25Illinois Title XIX State Plan for this purpose, the Department
26shall authorize the Chicago Public Schools (CPS) to procure a

 

 

HB0422- 40 -LRB102 10090 KTG 15410 b

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

 

 

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1    On and after July 1, 2018, the Department of Healthcare
2and Family Services shall provide dental services to any adult
3who is otherwise eligible for assistance under the medical
4assistance program. As used in this paragraph, "dental
5services" means diagnostic, preventative, restorative, or
6corrective procedures, including procedures and services for
7the prevention and treatment of periodontal disease and dental
8caries disease, provided by an individual who is licensed to
9practice dentistry or dental surgery or who is under the
10supervision of a dentist in the practice of his or her
11profession.
12    On and after July 1, 2018, targeted dental services, as
13set forth in Exhibit D of the Consent Decree entered by the
14United States District Court for the Northern District of
15Illinois, Eastern Division, in the matter of Memisovski v.
16Maram, Case No. 92 C 1982, that are provided to adults under
17the medical assistance program shall be established at no less
18than the rates set forth in the "New Rate" column in Exhibit D
19of the Consent Decree for targeted dental services that are
20provided to persons under the age of 18 under the medical
21assistance program.
22    Notwithstanding any other provision of this Code and
23subject to federal approval, the Department may adopt rules to
24allow a dentist who is volunteering his or her service at no
25cost to render dental services through an enrolled
26not-for-profit health clinic without the dentist personally

 

 

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1enrolling as a participating provider in the medical
2assistance program. A not-for-profit health clinic shall
3include a public health clinic or Federally Qualified Health
4Center or other enrolled provider, as determined by the
5Department, through which dental services covered under this
6Section are performed. The Department shall establish a
7process for payment of claims for reimbursement for covered
8dental services rendered under this provision.
9    The Illinois Department, by rule, may distinguish and
10classify the medical services to be provided only in
11accordance with the classes of persons designated in Section
125-2.
13    The Department of Healthcare and Family Services must
14provide coverage and reimbursement for amino acid-based
15elemental formulas, regardless of delivery method, for the
16diagnosis and treatment of (i) eosinophilic disorders and (ii)
17short bowel syndrome when the prescribing physician has issued
18a written order stating that the amino acid-based elemental
19formula is medically necessary.
20    The Illinois Department shall authorize the provision of,
21and shall authorize payment for, screening by low-dose
22mammography for the presence of occult breast cancer for women
2335 years of age or older who are eligible for medical
24assistance under this Article, as follows:
25        (A) A baseline mammogram for women 35 to 39 years of
26    age.

 

 

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1        (B) An annual mammogram for women 40 years of age or
2    older.
3        (C) A mammogram at the age and intervals considered
4    medically necessary by the woman's health care provider
5    for women under 40 years of age and having a family history
6    of breast cancer, prior personal history of breast cancer,
7    positive genetic testing, or other risk factors.
8        (D) A comprehensive ultrasound screening and MRI of an
9    entire breast or breasts if a mammogram demonstrates
10    heterogeneous or dense breast tissue or when medically
11    necessary as determined by a physician licensed to
12    practice medicine in all of its branches.
13        (E) A screening MRI when medically necessary, as
14    determined by a physician licensed to practice medicine in
15    all of its branches.
16        (F) A diagnostic mammogram when medically necessary,
17    as determined by a physician licensed to practice medicine
18    in all its branches, advanced practice registered nurse,
19    or physician assistant.
20    The Department shall not impose a deductible, coinsurance,
21copayment, or any other cost-sharing requirement on the
22coverage provided under this paragraph; except that this
23sentence does not apply to coverage of diagnostic mammograms
24to the extent such coverage would disqualify a high-deductible
25health plan from eligibility for a health savings account
26pursuant to Section 223 of the Internal Revenue Code (26

 

 

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1U.S.C. 223).
2    All screenings shall include a physical breast exam,
3instruction on self-examination and information regarding the
4frequency of self-examination and its value as a preventative
5tool.
6     For purposes of this Section:
7    "Diagnostic mammogram" means a mammogram obtained using
8diagnostic mammography.
9    "Diagnostic mammography" means a method of screening that
10is designed to evaluate an abnormality in a breast, including
11an abnormality seen or suspected on a screening mammogram or a
12subjective or objective abnormality otherwise detected in the
13breast.
14    "Low-dose mammography" means the x-ray examination of the
15breast using equipment dedicated specifically for mammography,
16including the x-ray tube, filter, compression device, and
17image receptor, with an average radiation exposure delivery of
18less than one rad per breast for 2 views of an average size
19breast. The term also includes digital mammography and
20includes breast tomosynthesis.
21    "Breast tomosynthesis" means a radiologic procedure that
22involves the acquisition of projection images over the
23stationary breast to produce cross-sectional digital
24three-dimensional images of the breast.
25    If, at any time, the Secretary of the United States
26Department of Health and Human Services, or its successor

 

 

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1agency, promulgates rules or regulations to be published in
2the Federal Register or publishes a comment in the Federal
3Register or issues an opinion, guidance, or other action that
4would require the State, pursuant to any provision of the
5Patient Protection and Affordable Care Act (Public Law
6111-148), including, but not limited to, 42 U.S.C.
718031(d)(3)(B) or any successor provision, to defray the cost
8of any coverage for breast tomosynthesis outlined in this
9paragraph, then the requirement that an insurer cover breast
10tomosynthesis is inoperative other than any such coverage
11authorized under Section 1902 of the Social Security Act, 42
12U.S.C. 1396a, and the State shall not assume any obligation
13for the cost of coverage for breast tomosynthesis set forth in
14this paragraph.
15    On and after January 1, 2016, the Department shall ensure
16that all networks of care for adult clients of the Department
17include access to at least one breast imaging Center of
18Imaging Excellence as certified by the American College of
19Radiology.
20    On and after January 1, 2012, providers participating in a
21quality improvement program approved by the Department shall
22be reimbursed for screening and diagnostic mammography at the
23same rate as the Medicare program's rates, including the
24increased reimbursement for digital mammography.
25    The Department shall convene an expert panel including
26representatives of hospitals, free-standing mammography

 

 

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1facilities, and doctors, including radiologists, to establish
2quality standards for mammography.
3    On and after January 1, 2017, providers participating in a
4breast cancer treatment quality improvement program approved
5by the Department shall be reimbursed for breast cancer
6treatment at a rate that is no lower than 95% of the Medicare
7program's rates for the data elements included in the breast
8cancer treatment quality program.
9    The Department shall convene an expert panel, including
10representatives of hospitals, free-standing breast cancer
11treatment centers, breast cancer quality organizations, and
12doctors, including breast surgeons, reconstructive breast
13surgeons, oncologists, and primary care providers to establish
14quality standards for breast cancer treatment.
15    Subject to federal approval, the Department shall
16establish a rate methodology for mammography at federally
17qualified health centers and other encounter-rate clinics.
18These clinics or centers may also collaborate with other
19hospital-based mammography facilities. By January 1, 2016, the
20Department shall report to the General Assembly on the status
21of the provision set forth in this paragraph.
22    The Department shall establish a methodology to remind
23women who are age-appropriate for screening mammography, but
24who have not received a mammogram within the previous 18
25months, of the importance and benefit of screening
26mammography. The Department shall work with experts in breast

 

 

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

 

 

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1in navigation and community outreach to navigate cancer
2patients to comprehensive care in a timely fashion. The
3Department shall require all networks of care to include
4access for patients diagnosed with cancer to at least one
5academic commission on cancer-accredited cancer program as an
6in-network covered benefit.
7    Any medical or health care provider shall immediately
8recommend, to any pregnant woman who is being provided
9prenatal services and is suspected of having a substance use
10disorder as defined in the Substance Use Disorder Act,
11referral to a local substance use disorder treatment program
12licensed by the Department of Human Services or to a licensed
13hospital which provides substance abuse treatment services.
14The Department of Healthcare and Family Services shall assure
15coverage for the cost of treatment of the drug abuse or
16addiction for pregnant recipients in accordance with the
17Illinois Medicaid Program in conjunction with the Department
18of Human Services.
19    All medical providers providing medical assistance to
20pregnant women under this Code shall receive information from
21the Department on the availability of services under any
22program providing case management services for addicted women,
23including information on appropriate referrals for other
24social services that may be needed by addicted women in
25addition to treatment for addiction.
26    The Illinois Department, in cooperation with the

 

 

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

 

 

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

 

 

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1qualifications to participate in Partnerships to ensure the
2delivery of high quality medical services. These
3qualifications shall be determined by rule of the Illinois
4Department and may be higher than qualifications for
5participation in the medical assistance program. Partnership
6sponsors may prescribe reasonable additional qualifications
7for participation by medical providers, only with the prior
8written approval of the Illinois Department.
9    Nothing in this Section shall limit the free choice of
10practitioners, hospitals, and other providers of medical
11services by clients. In order to ensure patient freedom of
12choice, the Illinois Department shall immediately promulgate
13all rules and take all other necessary actions so that
14provided services may be accessed from therapeutically
15certified optometrists to the full extent of the Illinois
16Optometric Practice Act of 1987 without discriminating between
17service providers.
18    The Department shall apply for a waiver from the United
19States Health Care Financing Administration to allow for the
20implementation of Partnerships under this Section.
21    The Illinois Department shall require health care
22providers to maintain records that document the medical care
23and services provided to recipients of Medical Assistance
24under this Article. Such records must be retained for a period
25of not less than 6 years from the date of service or as
26provided by applicable State law, whichever period is longer,

 

 

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1except that if an audit is initiated within the required
2retention period then the records must be retained until the
3audit is completed and every exception is resolved. The
4Illinois Department shall require health care providers to
5make available, when authorized by the patient, in writing,
6the medical records in a timely fashion to other health care
7providers who are treating or serving persons eligible for
8Medical Assistance under this Article. All dispensers of
9medical services shall be required to maintain and retain
10business and professional records sufficient to fully and
11accurately document the nature, scope, details and receipt of
12the health care provided to persons eligible for medical
13assistance under this Code, in accordance with regulations
14promulgated by the Illinois Department. The rules and
15regulations shall require that proof of the receipt of
16prescription drugs, dentures, prosthetic devices and
17eyeglasses by eligible persons under this Section accompany
18each claim for reimbursement submitted by the dispenser of
19such medical services. No such claims for reimbursement shall
20be approved for payment by the Illinois Department without
21such proof of receipt, unless the Illinois Department shall
22have put into effect and shall be operating a system of
23post-payment audit and review which shall, on a sampling
24basis, be deemed adequate by the Illinois Department to assure
25that such drugs, dentures, prosthetic devices and eyeglasses
26for which payment is being made are actually being received by

 

 

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1eligible recipients. Within 90 days after September 16, 1984
2(the effective date of Public Act 83-1439), the Illinois
3Department shall establish a current list of acquisition costs
4for all prosthetic devices and any other items recognized as
5medical equipment and supplies reimbursable under this Article
6and shall update such list on a quarterly basis, except that
7the acquisition costs of all prescription drugs shall be
8updated no less frequently than every 30 days as required by
9Section 5-5.12.
10    Notwithstanding any other law to the contrary, the
11Illinois Department shall, within 365 days after July 22, 2013
12(the effective date of Public Act 98-104), establish
13procedures to permit skilled care facilities licensed under
14the Nursing Home Care Act to submit monthly billing claims for
15reimbursement purposes. Following development of these
16procedures, the Department shall, by July 1, 2016, test the
17viability of the new system and implement any necessary
18operational or structural changes to its information
19technology platforms in order to allow for the direct
20acceptance and payment of nursing home claims.
21    Notwithstanding any other law to the contrary, the
22Illinois Department shall, within 365 days after August 15,
232014 (the effective date of Public Act 98-963), establish
24procedures to permit ID/DD facilities licensed under the ID/DD
25Community Care Act and MC/DD facilities licensed under the
26MC/DD Act to submit monthly billing claims for reimbursement

 

 

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1purposes. Following development of these procedures, the
2Department shall have an additional 365 days to test the
3viability of the new system and to ensure that any necessary
4operational or structural changes to its information
5technology platforms are implemented.
6    The Illinois Department shall require all dispensers of
7medical services, other than an individual practitioner or
8group of practitioners, desiring to participate in the Medical
9Assistance program established under this Article to disclose
10all financial, beneficial, ownership, equity, surety or other
11interests in any and all firms, corporations, partnerships,
12associations, business enterprises, joint ventures, agencies,
13institutions or other legal entities providing any form of
14health care services in this State under this Article.
15    The Illinois Department may require that all dispensers of
16medical services desiring to participate in the medical
17assistance program established under this Article disclose,
18under such terms and conditions as the Illinois Department may
19by rule establish, all inquiries from clients and attorneys
20regarding medical bills paid by the Illinois Department, which
21inquiries could indicate potential existence of claims or
22liens for the Illinois Department.
23    Enrollment of a vendor shall be subject to a provisional
24period and shall be conditional for one year. During the
25period of conditional enrollment, the Department may terminate
26the vendor's eligibility to participate in, or may disenroll

 

 

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

 

 

HB0422- 56 -LRB102 10090 KTG 15410 b

1each category of risk of the vendor; and (iii) by rule, the
2hearing rights, if any, afforded to a vendor in each category
3of risk of the vendor that is terminated or disenrolled during
4the conditional enrollment period.
5    To be eligible for payment consideration, a vendor's
6payment claim or bill, either as an initial claim or as a
7resubmitted claim following prior rejection, must be received
8by the Illinois Department, or its fiscal intermediary, no
9later than 180 days after the latest date on the claim on which
10medical goods or services were provided, with the following
11exceptions:
12        (1) In the case of a provider whose enrollment is in
13    process by the Illinois Department, the 180-day period
14    shall not begin until the date on the written notice from
15    the Illinois Department that the provider enrollment is
16    complete.
17        (2) In the case of errors attributable to the Illinois
18    Department or any of its claims processing intermediaries
19    which result in an inability to receive, process, or
20    adjudicate a claim, the 180-day period shall not begin
21    until the provider has been notified of the error.
22        (3) In the case of a provider for whom the Illinois
23    Department initiates the monthly billing process.
24        (4) In the case of a provider operated by a unit of
25    local government with a population exceeding 3,000,000
26    when local government funds finance federal participation

 

 

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

 

 

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

 

 

HB0422- 59 -LRB102 10090 KTG 15410 b

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

 

 

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1and (2) rental, lease, purchase or lease-purchase of durable
2medical equipment in a cost-effective manner, taking into
3consideration the recipient's medical prognosis, the extent of
4the recipient's needs, and the requirements and costs for
5maintaining such equipment. Subject to prior approval, such
6rules shall enable a recipient to temporarily acquire and use
7alternative or substitute devices or equipment pending repairs
8or replacements of any device or equipment previously
9authorized for such recipient by the Department.
10Notwithstanding any provision of Section 5-5f to the contrary,
11the Department may, by rule, exempt certain replacement
12wheelchair parts from prior approval and, for wheelchairs,
13wheelchair parts, wheelchair accessories, and related seating
14and positioning items, determine the wholesale price by
15methods other than actual acquisition costs.
16    The Department shall require, by rule, all providers of
17durable medical equipment to be accredited by an accreditation
18organization approved by the federal Centers for Medicare and
19Medicaid Services and recognized by the Department in order to
20bill the Department for providing durable medical equipment to
21recipients. No later than 15 months after the effective date
22of the rule adopted pursuant to this paragraph, all providers
23must meet the accreditation requirement.
24    In order to promote environmental responsibility, meet the
25needs of recipients and enrollees, and achieve significant
26cost savings, the Department, or a managed care organization

 

 

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

 

 

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1    The Department shall execute, relative to the nursing home
2prescreening project, written inter-agency agreements with the
3Department of Human Services and the Department on Aging, to
4effect the following: (i) intake procedures and common
5eligibility criteria for those persons who are receiving
6non-institutional services; and (ii) the establishment and
7development of non-institutional services in areas of the
8State where they are not currently available or are
9undeveloped; and (iii) notwithstanding any other provision of
10law, subject to federal approval, on and after July 1, 2012, an
11increase in the determination of need (DON) scores from 29 to
1237 for applicants for institutional and home and
13community-based long term care; if and only if federal
14approval is not granted, the Department may, in conjunction
15with other affected agencies, implement utilization controls
16or changes in benefit packages to effectuate a similar savings
17amount for this population; and (iv) no later than July 1,
182013, minimum level of care eligibility criteria for
19institutional and home and community-based long term care; and
20(iv) (v) no later than October 1, 2013, establish procedures
21to permit long term care providers access to eligibility
22scores for individuals with an admission date who are seeking
23or receiving services from the long term care provider. In
24order to select the minimum level of care eligibility
25criteria, the Governor shall establish a workgroup that
26includes affected agency representatives and stakeholders

 

 

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1representing the institutional and home and community-based
2long term care interests. This Section shall not restrict the
3Department from implementing lower level of care eligibility
4criteria for community-based services in circumstances where
5federal approval has been granted. Individuals with a score of
629 or higher based on the determination of need (DON)
7assessment tool shall be eligible to receive institutional and
8home and community-based long term care services until the
9State receives federal approval and implements an updated
10assessment tool, and those individuals are found to be
11ineligible under that updated assessment tool. Anyone
12determined to be ineligible for services due to the updated
13assessment tool shall continue to be eligible for services for
14at least one year following that determination and must be
15reassessed no earlier than 11 months after that determination.
16The Department must adopt rules through the regular rulemaking
17process regarding the updated assessment tool, and shall not
18adopt emergency or peremptory rules regarding the updated
19assessment tool. The State shall not implement an updated
20assessment tool that causes more than 1% of then-current
21recipients to lose eligibility. No individual receiving care
22in an institutional setting shall be involuntarily discharged
23as the result of the updated assessment tool until a
24transition plan has been developed by the Department on Aging
25or its designee and all care identified in the transition plan
26is available to the resident immediately upon discharge.

 

 

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1    The Illinois Department shall develop and operate, in
2cooperation with other State Departments and agencies and in
3compliance with applicable federal laws and regulations,
4appropriate and effective systems of health care evaluation
5and programs for monitoring of utilization of health care
6services and facilities, as it affects persons eligible for
7medical assistance under this Code.
8    The Illinois Department shall report annually to the
9General Assembly, no later than the second Friday in April of
101979 and each year thereafter, in regard to:
11        (a) actual statistics and trends in utilization of
12    medical services by public aid recipients;
13        (b) actual statistics and trends in the provision of
14    the various medical services by medical vendors;
15        (c) current rate structures and proposed changes in
16    those rate structures for the various medical vendors; and
17        (d) efforts at utilization review and control by the
18    Illinois Department.
19    The period covered by each report shall be the 3 years
20ending on the June 30 prior to the report. The report shall
21include suggested legislation for consideration by the General
22Assembly. The requirement for reporting to the General
23Assembly shall be satisfied by filing copies of the report as
24required by Section 3.1 of the General Assembly Organization
25Act, and filing such additional copies with the State
26Government Report Distribution Center for the General Assembly

 

 

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

 

 

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1certified by the Department to perform kidney transplantation
2and the services under this Section shall be limited to
3services associated with kidney transplantation.
4    Notwithstanding any other provision of this Code to the
5contrary, on or after July 1, 2015, all FDA approved forms of
6medication assisted treatment prescribed for the treatment of
7alcohol dependence or treatment of opioid dependence shall be
8covered under both fee for service and managed care medical
9assistance programs for persons who are otherwise eligible for
10medical assistance under this Article and shall not be subject
11to any (1) utilization control, other than those established
12under the American Society of Addiction Medicine patient
13placement criteria, (2) prior authorization mandate, or (3)
14lifetime restriction limit mandate.
15    On or after July 1, 2015, opioid antagonists prescribed
16for the treatment of an opioid overdose, including the
17medication product, administration devices, and any pharmacy
18fees related to the dispensing and administration of the
19opioid antagonist, shall be covered under the medical
20assistance program for persons who are otherwise eligible for
21medical assistance under this Article. As used in this
22Section, "opioid antagonist" means a drug that binds to opioid
23receptors and blocks or inhibits the effect of opioids acting
24on those receptors, including, but not limited to, naloxone
25hydrochloride or any other similarly acting drug approved by
26the U.S. Food and Drug Administration.

 

 

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1    Upon federal approval, the Department shall provide
2coverage and reimbursement for all drugs that are approved for
3marketing by the federal Food and Drug Administration and that
4are recommended by the federal Public Health Service or the
5United States Centers for Disease Control and Prevention for
6pre-exposure prophylaxis and related pre-exposure prophylaxis
7services, including, but not limited to, HIV and sexually
8transmitted infection screening, treatment for sexually
9transmitted infections, medical monitoring, assorted labs, and
10counseling to reduce the likelihood of HIV infection among
11individuals who are not infected with HIV but who are at high
12risk of HIV infection.
13    A federally qualified health center, as defined in Section
141905(l)(2)(B) of the federal Social Security Act, shall be
15reimbursed by the Department in accordance with the federally
16qualified health center's encounter rate for services provided
17to medical assistance recipients that are performed by a
18dental hygienist, as defined under the Illinois Dental
19Practice Act, working under the general supervision of a
20dentist and employed by a federally qualified health center.
21(Source: P.A. 100-201, eff. 8-18-17; 100-395, eff. 1-1-18;
22100-449, eff. 1-1-18; 100-538, eff. 1-1-18; 100-587, eff.
236-4-18; 100-759, eff. 1-1-19; 100-863, eff. 8-14-18; 100-974,
24eff. 8-19-18; 100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19;
25100-1148, eff. 12-10-18; 101-209, eff. 8-5-19; 101-580, eff.
261-1-20; revised 9-18-19.)
 

 

 

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1    (305 ILCS 5/5-5.01a)
2    Sec. 5-5.01a. Supportive living facilities program.
3    (a) The Department shall establish and provide oversight
4for a program of supportive living facilities that seek to
5promote resident independence, dignity, respect, and
6well-being in the most cost-effective manner.
7    A supportive living facility is (i) a free-standing
8facility or (ii) a distinct physical and operational entity
9within a mixed-use building that meets the criteria
10established in subsection (d). A supportive living facility
11integrates housing with health, personal care, and supportive
12services and is a designated setting that offers residents
13their own separate, private, and distinct living units.
14    Sites for the operation of the program shall be selected
15by the Department based upon criteria that may include the
16need for services in a geographic area, the availability of
17funding, and the site's ability to meet the standards.
18    (b) Beginning July 1, 2014, subject to federal approval,
19the Medicaid rates for supportive living facilities shall be
20equal to the supportive living facility Medicaid rate
21effective on June 30, 2014 increased by 8.85%. Once the
22assessment imposed at Article V-G of this Code is determined
23to be a permissible tax under Title XIX of the Social Security
24Act, the Department shall increase the Medicaid rates for
25supportive living facilities effective on July 1, 2014 by

 

 

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19.09%. The Department shall apply this increase retroactively
2to coincide with the imposition of the assessment in Article
3V-G of this Code in accordance with the approval for federal
4financial participation by the Centers for Medicare and
5Medicaid Services.
6    The Medicaid rates for supportive living facilities
7effective on July 1, 2017 must be equal to the rates in effect
8for supportive living facilities on June 30, 2017 increased by
92.8%.
10    Subject to federal approval, the Medicaid rates for
11supportive living services on and after July 1, 2019 must be at
12least 54.3% of the average total nursing facility services per
13diem for the geographic areas defined by the Department while
14maintaining the rate differential for dementia care and must
15be updated whenever the total nursing facility service per
16diems are updated.
17    (c) The Department may adopt rules to implement this
18Section. Rules that establish or modify the services,
19standards, and conditions for participation in the program
20shall be adopted by the Department in consultation with the
21Department on Aging, the Department of Rehabilitation
22Services, and the Department of Mental Health and
23Developmental Disabilities (or their successor agencies).
24    (d) Subject to federal approval by the Centers for
25Medicare and Medicaid Services, the Department shall accept
26for consideration of certification under the program any

 

 

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1application for a site or building where distinct parts of the
2site or building are designated for purposes other than the
3provision of supportive living services, but only if:
4        (1) those distinct parts of the site or building are
5    not designated for the purpose of providing assisted
6    living services as required under the Assisted Living and
7    Shared Housing Act;
8        (2) those distinct parts of the site or building are
9    completely separate from the part of the building used for
10    the provision of supportive living program services,
11    including separate entrances;
12        (3) those distinct parts of the site or building do
13    not share any common spaces with the part of the building
14    used for the provision of supportive living program
15    services; and
16        (4) those distinct parts of the site or building do
17    not share staffing with the part of the building used for
18    the provision of supportive living program services.
19    (e) Facilities or distinct parts of facilities which are
20selected as supportive living facilities and are in good
21standing with the Department's rules are exempt from the
22provisions of the Nursing Home Care Act and the Illinois
23Health Facilities Planning Act.
24    Individuals with a score of 29 or higher based on the
25determination of need (DON) assessment tool shall be eligible
26to receive institutional and home and community-based long

 

 

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1term care services until the State receives federal approval
2and implements an updated assessment tool, and those
3individuals are found to be ineligible under that updated
4assessment tool. Anyone determined to be ineligible for
5services due to the updated assessment tool shall continue to
6be eligible for services for at least one year following that
7determination and must be reassessed no earlier than 11 months
8after that determination. The Department must adopt rules
9through the regular rulemaking process regarding the updated
10assessment tool, and shall not adopt emergency or peremptory
11rules regarding the updated assessment tool. The State shall
12not implement an updated assessment tool that causes more than
131% of then-current recipients to lose eligibility. No
14individual receiving care in an institutional setting shall be
15involuntarily discharged as the result of the updated
16assessment tool until a transition plan has been developed by
17the Department on Aging or its designee and all care
18identified in the transition plan is available to the resident
19immediately upon discharge.
20(Source: P.A. 100-23, eff. 7-6-17; 100-583, eff. 4-6-18;
21100-587, eff. 6-4-18; 101-10, eff. 6-5-19.)
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    20 ILCS 105/4.02from Ch. 23, par. 6104.02
4    20 ILCS 2405/3from Ch. 23, par. 3434
5    210 ILCS 45/3-402from Ch. 111 1/2, par. 4153-402
6    305 ILCS 5/5-5from Ch. 23, par. 5-5
7    305 ILCS 5/5-5.01a