Illinois General Assembly - Full Text of HB5095
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Full Text of HB5095  103rd General Assembly



HB5095 EnrolledLRB103 39315 CES 69469 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Nursing Home Care Act is amended by
5changing Section 3-401.1 as follows:
6    (210 ILCS 45/3-401.1)  (from Ch. 111 1/2, par. 4153-401.1)
7    Sec. 3-401.1. (a) A facility participating in the Medical
8Assistance Program is prohibited from failing or refusing to
9retain as a resident any person because he or she is a
10recipient of or an applicant for the Medical Assistance
12    (a-5) A After the effective date of this amendatory Act of
131997, a facility of which only a distinct part is certified to
14participate in the Medical Assistance Program may refuse to
15retain as a resident any person who resides in a part of the
16facility that does not participate in the Medical Assistance
17Program and who is unable to pay for his or her care in the
18facility without Medical Assistance only if:
19        (1) the facility, no later than at the time of
20    admission and at the time of the resident's contract
21    renewal, explains to the resident (unless he or she is
22    incompetent), and to the resident's representative, and to
23    the person making payment on behalf of the resident for



HB5095 Enrolled- 2 -LRB103 39315 CES 69469 b

1    the resident's stay, in writing, that the facility may
2    discharge the resident if the resident is no longer able
3    to pay for his or her care in the facility without Medical
4    Assistance;
5        (2) the resident (unless he or she is incompetent),
6    the resident's representative, and the person making
7    payment on behalf of the resident for the resident's stay,
8    acknowledge in writing that they have received the written
9    explanation; .
10        (3) in circumstances where the Medicare coverage is
11    ending prior to the full 100-day benefit period, the
12    facility provides notice to the resident and to the
13    resident's representative that the resident's Medicare
14    coverage will likely end in 5 days. This notification
15    shall specify that the resident shall not be required to
16    move under this Section until these 5 days are up. In cases
17    where the facility is notified in a shorter time frame
18    than 5 days by a managed care organization or the time
19    frame is shorter than 5 days due to inaccurate reporting
20    by an outside entity, the facility must provide a minimum
21    of 2 days' notification.
22    (a-10) For the purposes of this Section, a recipient or
23applicant shall be considered a resident in the facility
24during any hospital stay totaling 10 days or less following a
25hospital admission. The Department of Healthcare and Family
26Services shall recoup funds from a facility when, as a result



HB5095 Enrolled- 3 -LRB103 39315 CES 69469 b

1of the facility's refusal to readmit a recipient after
2hospitalization for 10 days or less, the recipient incurs
3hospital bills in an amount greater than the amount that would
4have been paid by that Department (formerly the Illinois
5Department of Public Aid) for care of the recipient in the
6facility. The amount of the recoupment shall be the difference
7between the Department of Healthcare and Family Services'
8(formerly the Illinois Department of Public Aid's) payment for
9hospital care and the amount that Department would have paid
10for care in the facility.
11    (b) A facility which violates this Section shall be guilty
12of a business offense and fined not less than $500 nor more
13than $1,000 for the first offense and not less than $1,000 nor
14more than $5,000 for each subsequent offense.
15(Source: P.A. 95-331, eff. 8-21-07.)