Illinois General Assembly - Full Text of HB5420
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Full Text of HB5420  96th General Assembly

HB5420sam002 96TH GENERAL ASSEMBLY

Sen. Heather Steans

Filed: 1/5/2011

 

 


 

 


 
09600HB5420sam002LRB096 18878 KTG 44731 a

1
AMENDMENT TO HOUSE BILL 5420

2    AMENDMENT NO. ______. Amend House Bill 5420, AS AMENDED, by
3replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The State Budget Law of the Civil
6Administrative Code of Illinois is amended by adding Section
750-30 as follows:
 
8    (15 ILCS 20/50-30 new)
9    Sec. 50-30. Long-term care rebalancing. In light of the
10increasing demands confronting the State in meeting the needs
11of individuals utilizing long-term care services under the
12medical assistance program and any other long-term care related
13benefit program administered by the State, it is the intent of
14the General Assembly to address the needs of both the State and
15the individuals eligible for such services by cost effective
16and efficient means through the advancement of a long-term care

 

 

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1rebalancing initiative. Notwithstanding any State law to the
2contrary, and subject to federal laws, regulations, and court
3decrees, the following shall apply to the long-term care
4rebalancing initiative:
5        (1) "Long-term care rebalancing", as used in this
6    Section, means removing barriers to community living for
7    people of all ages with disabilities and long-term
8    illnesses by offering individuals utilizing long-term care
9    services a reasonable array of options, in particular
10    adequate choices of community and institutional options,
11    to achieve a balance between the proportion of total
12    Medicaid long-term support expenditures used for
13    institutional services and those used for community-based
14    supports.
15        (2) Subject to the provisions of this Section, the
16    Governor shall create a unified budget report identifying
17    the budgets of all State agencies offering long-term care
18    services to persons in either institutional or community
19    settings, including the budgets of State-operated
20    facilities for persons with developmental disabilities
21    that shall include, but not be limited to, the following
22    service and financial data:
23            (A) A breakdown of long-term care services,
24        defined as institutional or community care, by the
25        State agency primarily responsible for administration
26        of the program.

 

 

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1            (B) Actual and estimated enrollment, caseload,
2        service hours, or service days provided for long-term
3        care services described in a consistent format for
4        those services, for each of the following age groups:
5        older adults 65 years of age and older, younger adults
6        21 years of age through 64 years of age, and children
7        under 21 years of age.
8            (C) Funding sources for long-term care services.
9            (D) Comparison of service and expenditure data, by
10        services, both in aggregate and per person enrolled.
11        (3) For each fiscal year, the unified budget report
12    described in subdivision (2) shall be prepared with
13    reference to the prioritized outcomes for that fiscal year
14    contemplated by Sections 50-5 and 50-25 of this Code.
15        (4) Each State agency responsible for the
16    administration of long-term care services shall provide an
17    analysis of the progress being made by the agency to
18    transition persons from institutional to community
19    settings, where appropriate, as part of the State's
20    long-term care rebalancing initiative.
21        (5) The Governor may designate amounts set aside for
22    institutional services appropriated from the General
23    Revenue Fund or any other State fund that receives monies
24    for long-term care services to be transferred to all State
25    agencies responsible for the administration of
26    community-based long-term care programs, including, but

 

 

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1    not limited to, community-based long-term care programs
2    administered by the Department of Healthcare and Family
3    Services, the Department of Human Services, and the
4    Department on Aging, provided that the Director of
5    Healthcare and Family Services first certifies that the
6    amounts being transferred are necessary for the purpose of
7    assisting persons in or at risk of being in institutional
8    care to transition to community-based settings, including
9    the financial data needed to prove the need for the
10    transfer of funds. The total amounts transferred shall not
11    exceed 4% in total of the amounts appropriated from the
12    General Revenue Fund or any other State fund that receives
13    monies for long-term care services for each fiscal year. A
14    notice of the fund transfer must be made to the General
15    Assembly and posted at a minimum on the Department of
16    Healthcare and Family Services website, the Governor's
17    Office of Management and Budget website, and any other
18    website the Governor sees fit. These postings shall serve
19    as notice to the General Assembly of the amounts to be
20    transferred. Notice shall be given at least 30 days prior
21    to transfer.
22        (6) This Section shall be liberally construed and
23    interpreted in a manner that allows the State to advance
24    its long-term care rebalancing initiatives.
 
25    Section 10. The State Finance Act is amended by changing

 

 

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1Sections 13.2 and 25 as follows:
 
2    (30 ILCS 105/13.2)  (from Ch. 127, par. 149.2)
3    Sec. 13.2. Transfers among line item appropriations.
4    (a) Transfers among line item appropriations from the same
5treasury fund for the objects specified in this Section may be
6made in the manner provided in this Section when the balance
7remaining in one or more such line item appropriations is
8insufficient for the purpose for which the appropriation was
9made.
10    (a-1) No transfers may be made from one agency to another
11agency, nor may transfers be made from one institution of
12higher education to another institution of higher education
13except as provided by subsection (a-4).
14    (a-2) Except as otherwise provided in this Section,
15transfers may be made only among the objects of expenditure
16enumerated in this Section, except that no funds may be
17transferred from any appropriation for personal services, from
18any appropriation for State contributions to the State
19Employees' Retirement System, from any separate appropriation
20for employee retirement contributions paid by the employer, nor
21from any appropriation for State contribution for employee
22group insurance. During State fiscal year 2005, an agency may
23transfer amounts among its appropriations within the same
24treasury fund for personal services, employee retirement
25contributions paid by employer, and State Contributions to

 

 

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1retirement systems; notwithstanding and in addition to the
2transfers authorized in subsection (c) of this Section, the
3fiscal year 2005 transfers authorized in this sentence may be
4made in an amount not to exceed 2% of the aggregate amount
5appropriated to an agency within the same treasury fund. During
6State fiscal year 2007, the Departments of Children and Family
7Services, Corrections, Human Services, and Juvenile Justice
8may transfer amounts among their respective appropriations
9within the same treasury fund for personal services, employee
10retirement contributions paid by employer, and State
11contributions to retirement systems. During State fiscal year
122010, the Department of Transportation may transfer amounts
13among their respective appropriations within the same treasury
14fund for personal services, employee retirement contributions
15paid by employer, and State contributions to retirement
16systems. During State fiscal year 2010 only, an agency may
17transfer amounts among its respective appropriations within
18the same treasury fund for personal services, employee
19retirement contributions paid by employer, and State
20contributions to retirement systems. Notwithstanding, and in
21addition to, the transfers authorized in subsection (c) of this
22Section, these transfers may be made in an amount not to exceed
232% of the aggregate amount appropriated to an agency within the
24same treasury fund.
25    (a-3) Further, if an agency receives a separate
26appropriation for employee retirement contributions paid by

 

 

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1the employer, any transfer by that agency into an appropriation
2for personal services must be accompanied by a corresponding
3transfer into the appropriation for employee retirement
4contributions paid by the employer, in an amount sufficient to
5meet the employer share of the employee contributions required
6to be remitted to the retirement system.
7    (a-4) Long-Term Care Rebalancing. The Governor may
8designate amounts set aside for institutional services
9appropriated from the General Revenue Fund or any other State
10fund that receives monies for long-term care services to be
11transferred to all State agencies responsible for the
12administration of community-based long-term care programs,
13including, but not limited to, community-based long-term care
14programs administered by the Department of Healthcare and
15Family Services, the Department of Human Services, and the
16Department on Aging, provided that the Director of Healthcare
17and Family Services first certifies that the amounts being
18transferred are necessary for the purpose of assisting persons
19in or at risk of being in institutional care to transition to
20community-based settings, including the financial data needed
21to prove the need for the transfer of funds. The total amounts
22transferred shall not exceed 4% in total of the amounts
23appropriated from the General Revenue Fund or any other State
24fund that receives monies for long-term care services for each
25fiscal year. A notice of the fund transfer must be made to the
26General Assembly and posted at a minimum on the Department of

 

 

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1Healthcare and Family Services website, the Governor's Office
2of Management and Budget website, and any other website the
3Governor sees fit. These postings shall serve as notice to the
4General Assembly of the amounts to be transferred. Notice shall
5be given at least 30 days prior to transfer.
6    (b) In addition to the general transfer authority provided
7under subsection (c), the following agencies have the specific
8transfer authority granted in this subsection:
9    The Department of Healthcare and Family Services is
10authorized to make transfers representing savings attributable
11to not increasing grants due to the births of additional
12children from line items for payments of cash grants to line
13items for payments for employment and social services for the
14purposes outlined in subsection (f) of Section 4-2 of the
15Illinois Public Aid Code.
16    The Department of Children and Family Services is
17authorized to make transfers not exceeding 2% of the aggregate
18amount appropriated to it within the same treasury fund for the
19following line items among these same line items: Foster Home
20and Specialized Foster Care and Prevention, Institutions and
21Group Homes and Prevention, and Purchase of Adoption and
22Guardianship Services.
23    The Department on Aging is authorized to make transfers not
24exceeding 2% of the aggregate amount appropriated to it within
25the same treasury fund for the following Community Care Program
26line items among these same line items: Homemaker and Senior

 

 

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1Companion Services, Alternative Senior Services, Case
2Coordination Units, and Adult Day Care Services.
3    The State Treasurer is authorized to make transfers among
4line item appropriations from the Capital Litigation Trust
5Fund, with respect to costs incurred in fiscal years 2002 and
62003 only, when the balance remaining in one or more such line
7item appropriations is insufficient for the purpose for which
8the appropriation was made, provided that no such transfer may
9be made unless the amount transferred is no longer required for
10the purpose for which that appropriation was made.
11    The State Board of Education is authorized to make
12transfers from line item appropriations within the same
13treasury fund for General State Aid and General State Aid -
14Hold Harmless, provided that no such transfer may be made
15unless the amount transferred is no longer required for the
16purpose for which that appropriation was made, to the line item
17appropriation for Transitional Assistance when the balance
18remaining in such line item appropriation is insufficient for
19the purpose for which the appropriation was made.
20    The State Board of Education is authorized to make
21transfers between the following line item appropriations
22within the same treasury fund: Disabled Student
23Services/Materials (Section 14-13.01 of the School Code),
24Disabled Student Transportation Reimbursement (Section
2514-13.01 of the School Code), Disabled Student Tuition -
26Private Tuition (Section 14-7.02 of the School Code),

 

 

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1Extraordinary Special Education (Section 14-7.02b of the
2School Code), Reimbursement for Free Lunch/Breakfast Program,
3Summer School Payments (Section 18-4.3 of the School Code), and
4Transportation - Regular/Vocational Reimbursement (Section
529-5 of the School Code). Such transfers shall be made only
6when the balance remaining in one or more such line item
7appropriations is insufficient for the purpose for which the
8appropriation was made and provided that no such transfer may
9be made unless the amount transferred is no longer required for
10the purpose for which that appropriation was made.
11    During State fiscal years 2010 and 2011 only, the
12Department of Healthcare and Family Services is authorized to
13make transfers not exceeding 4% of the aggregate amount
14appropriated to it, within the same treasury fund, among the
15various line items appropriated for Medical Assistance.
16    (c) The sum of such transfers for an agency in a fiscal
17year shall not exceed 2% of the aggregate amount appropriated
18to it within the same treasury fund for the following objects:
19Personal Services; Extra Help; Student and Inmate
20Compensation; State Contributions to Retirement Systems; State
21Contributions to Social Security; State Contribution for
22Employee Group Insurance; Contractual Services; Travel;
23Commodities; Printing; Equipment; Electronic Data Processing;
24Operation of Automotive Equipment; Telecommunications
25Services; Travel and Allowance for Committed, Paroled and
26Discharged Prisoners; Library Books; Federal Matching Grants

 

 

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1for Student Loans; Refunds; Workers' Compensation,
2Occupational Disease, and Tort Claims; and, in appropriations
3to institutions of higher education, Awards and Grants.
4Notwithstanding the above, any amounts appropriated for
5payment of workers' compensation claims to an agency to which
6the authority to evaluate, administer and pay such claims has
7been delegated by the Department of Central Management Services
8may be transferred to any other expenditure object where such
9amounts exceed the amount necessary for the payment of such
10claims.
11    (c-1) Special provisions for State fiscal year 2003.
12Notwithstanding any other provision of this Section to the
13contrary, for State fiscal year 2003 only, transfers among line
14item appropriations to an agency from the same treasury fund
15may be made provided that the sum of such transfers for an
16agency in State fiscal year 2003 shall not exceed 3% of the
17aggregate amount appropriated to that State agency for State
18fiscal year 2003 for the following objects: personal services,
19except that no transfer may be approved which reduces the
20aggregate appropriations for personal services within an
21agency; extra help; student and inmate compensation; State
22contributions to retirement systems; State contributions to
23social security; State contributions for employee group
24insurance; contractual services; travel; commodities;
25printing; equipment; electronic data processing; operation of
26automotive equipment; telecommunications services; travel and

 

 

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1allowance for committed, paroled, and discharged prisoners;
2library books; federal matching grants for student loans;
3refunds; workers' compensation, occupational disease, and tort
4claims; and, in appropriations to institutions of higher
5education, awards and grants.
6    (c-2) Special provisions for State fiscal year 2005.
7Notwithstanding subsections (a), (a-2), and (c), for State
8fiscal year 2005 only, transfers may be made among any line
9item appropriations from the same or any other treasury fund
10for any objects or purposes, without limitation, when the
11balance remaining in one or more such line item appropriations
12is insufficient for the purpose for which the appropriation was
13made, provided that the sum of those transfers by a State
14agency shall not exceed 4% of the aggregate amount appropriated
15to that State agency for fiscal year 2005.
16    (d) Transfers among appropriations made to agencies of the
17Legislative and Judicial departments and to the
18constitutionally elected officers in the Executive branch
19require the approval of the officer authorized in Section 10 of
20this Act to approve and certify vouchers. Transfers among
21appropriations made to the University of Illinois, Southern
22Illinois University, Chicago State University, Eastern
23Illinois University, Governors State University, Illinois
24State University, Northeastern Illinois University, Northern
25Illinois University, Western Illinois University, the Illinois
26Mathematics and Science Academy and the Board of Higher

 

 

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1Education require the approval of the Board of Higher Education
2and the Governor. Transfers among appropriations to all other
3agencies require the approval of the Governor.
4    The officer responsible for approval shall certify that the
5transfer is necessary to carry out the programs and purposes
6for which the appropriations were made by the General Assembly
7and shall transmit to the State Comptroller a certified copy of
8the approval which shall set forth the specific amounts
9transferred so that the Comptroller may change his records
10accordingly. The Comptroller shall furnish the Governor with
11information copies of all transfers approved for agencies of
12the Legislative and Judicial departments and transfers
13approved by the constitutionally elected officials of the
14Executive branch other than the Governor, showing the amounts
15transferred and indicating the dates such changes were entered
16on the Comptroller's records.
17    (e) The State Board of Education, in consultation with the
18State Comptroller, may transfer line item appropriations for
19General State Aid between the Common School Fund and the
20Education Assistance Fund. With the advice and consent of the
21Governor's Office of Management and Budget, the State Board of
22Education, in consultation with the State Comptroller, may
23transfer line item appropriations between the General Revenue
24Fund and the Education Assistance Fund for the following
25programs:
26        (1) Disabled Student Personnel Reimbursement (Section

 

 

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1    14-13.01 of the School Code);
2        (2) Disabled Student Transportation Reimbursement
3    (subsection (b) of Section 14-13.01 of the School Code);
4        (3) Disabled Student Tuition - Private Tuition
5    (Section 14-7.02 of the School Code);
6        (4) Extraordinary Special Education (Section 14-7.02b
7    of the School Code);
8        (5) Reimbursement for Free Lunch/Breakfast Programs;
9        (6) Summer School Payments (Section 18-4.3 of the
10    School Code);
11        (7) Transportation - Regular/Vocational Reimbursement
12    (Section 29-5 of the School Code);
13        (8) Regular Education Reimbursement (Section 18-3 of
14    the School Code); and
15        (9) Special Education Reimbursement (Section 14-7.03
16    of the School Code).
17(Source: P.A. 95-707, eff. 1-11-08; 96-37, eff. 7-13-09;
1896-820, eff. 11-18-09; 96-959, eff. 7-1-10; 96-1086, eff.
197-16-10.)
 
20    (30 ILCS 105/25)  (from Ch. 127, par. 161)
21    Sec. 25. Fiscal year limitations.
22    (a) All appropriations shall be available for expenditure
23for the fiscal year or for a lesser period if the Act making
24that appropriation so specifies. A deficiency or emergency
25appropriation shall be available for expenditure only through

 

 

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1June 30 of the year when the Act making that appropriation is
2enacted unless that Act otherwise provides.
3    (b) Outstanding liabilities as of June 30, payable from
4appropriations which have otherwise expired, may be paid out of
5the expiring appropriations during the 2-month period ending at
6the close of business on August 31. Any service involving
7professional or artistic skills or any personal services by an
8employee whose compensation is subject to income tax
9withholding must be performed as of June 30 of the fiscal year
10in order to be considered an "outstanding liability as of June
1130" that is thereby eligible for payment out of the expiring
12appropriation.
13    (b-1) However, payment of tuition reimbursement claims
14under Section 14-7.03 or 18-3 of the School Code may be made by
15the State Board of Education from its appropriations for those
16respective purposes for any fiscal year, even though the claims
17reimbursed by the payment may be claims attributable to a prior
18fiscal year, and payments may be made at the direction of the
19State Superintendent of Education from the fund from which the
20appropriation is made without regard to any fiscal year
21limitations, except as required by subsection (j) of this
22Section. Beginning on June 30, 2021, payment of tuition
23reimbursement claims under Section 14-7.03 or 18-3 of the
24School Code as of June 30, payable from appropriations that
25have otherwise expired, may be paid out of the expiring
26appropriation during the 4-month period ending at the close of

 

 

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1business on October 31.
2    (b-2) All outstanding liabilities as of June 30, 2010,
3payable from appropriations that would otherwise expire at the
4conclusion of the lapse period for fiscal year 2010, and
5interest penalties payable on those liabilities under the State
6Prompt Payment Act, may be paid out of the expiring
7appropriations until December 31, 2010, without regard to the
8fiscal year in which the payment is made, as long as vouchers
9for the liabilities are received by the Comptroller no later
10than August 31, 2010.
11    (b-3) Medical payments may be made by the Department of
12Veterans' Affairs from its appropriations for those purposes
13for any fiscal year, without regard to the fact that the
14medical services being compensated for by such payment may have
15been rendered in a prior fiscal year, except as required by
16subsection (j) of this Section. Beginning on June 30, 2021,
17medical payments payable from appropriations that have
18otherwise expired may be paid out of the expiring appropriation
19during the 4-month period ending at the close of business on
20October 31.
21    (b-4) Medical payments may be made by the Department of
22Healthcare and Family Services and medical payments and child
23care payments may be made by the Department of Human Services
24(as successor to the Department of Public Aid) from
25appropriations for those purposes for any fiscal year, without
26regard to the fact that the medical or child care services

 

 

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

 

 

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1Department of Human Services relating to substance abuse
2treatment services payable from appropriations that have
3otherwise expired may be paid out of the expiring appropriation
4during the 4-month period ending at the close of business on
5October 31.
6    (b-6) Additionally, payments may be made by the Department
7of Human Services from its appropriations, or any other State
8agency from its appropriations with the approval of the
9Department of Human Services, from the Immigration Reform and
10Control Fund for purposes authorized pursuant to the
11Immigration Reform and Control Act of 1986, without regard to
12any fiscal year limitations, except as required by subsection
13(j) of this Section. Beginning on June 30, 2021, payments made
14by the Department of Human Services from the Immigration Reform
15and Control Fund for purposes authorized pursuant to the
16Immigration Reform and Control Act of 1986 payable from
17appropriations that have otherwise expired may be paid out of
18the expiring appropriation during the 4-month period ending at
19the close of business on October 31.
20    Further, with respect to costs incurred in fiscal years
212002 and 2003 only, payments may be made by the State Treasurer
22from its appropriations from the Capital Litigation Trust Fund
23without regard to any fiscal year limitations.
24    Lease payments may be made by the Department of Central
25Management Services under the sale and leaseback provisions of
26Section 7.4 of the State Property Control Act with respect to

 

 

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1the James R. Thompson Center and the Elgin Mental Health Center
2and surrounding land from appropriations for that purpose
3without regard to any fiscal year limitations.
4    Lease payments may be made under the sale and leaseback
5provisions of Section 7.5 of the State Property Control Act
6with respect to the Illinois State Toll Highway Authority
7headquarters building and surrounding land without regard to
8any fiscal year limitations.
9    (b-7) Payments may be made in accordance with a plan
10authorized by paragraph (11) or (12) of Section 405-105 of the
11Department of Central Management Services Law from
12appropriations for those payments without regard to fiscal year
13limitations.
14    (c) Further, payments may be made by the Department of
15Public Health, and the Department of Human Services (acting as
16successor to the Department of Public Health under the
17Department of Human Services Act), and the Department of
18Healthcare and Family Services from their respective
19appropriations for grants for medical care to or on behalf of
20persons suffering from chronic renal disease, persons
21suffering from hemophilia, rape victims, and premature and
22high-mortality risk infants and their mothers and for grants
23for supplemental food supplies provided under the United States
24Department of Agriculture Women, Infants and Children
25Nutrition Program, for any fiscal year without regard to the
26fact that the services being compensated for by such payment

 

 

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1may have been rendered in a prior fiscal year, except as
2required by subsection (j) of this Section. Beginning on June
330, 2021, payments made by the Department of Public Health, the
4Department of Human Services, and the Department of Healthcare
5and Family Services from their respective appropriations for
6grants for medical care to or on behalf of persons suffering
7from chronic renal disease, persons suffering from hemophilia,
8rape victims, and premature and high-mortality risk infants and
9their mothers and for grants for supplemental food supplies
10provided under the United States Department of Agriculture
11Women, Infants and Children Nutrition Program payable from
12appropriations that have otherwise expired may be paid out of
13the expiring appropriations during the 4-month period ending at
14the close of business on October 31.
15    (d) The Department of Public Health and the Department of
16Human Services (acting as successor to the Department of Public
17Health under the Department of Human Services Act) shall each
18annually submit to the State Comptroller, Senate President,
19Senate Minority Leader, Speaker of the House, House Minority
20Leader, and the respective Chairmen and Minority Spokesmen of
21the Appropriations Committees of the Senate and the House, on
22or before December 31, a report of fiscal year funds used to
23pay for services provided in any prior fiscal year. This report
24shall document by program or service category those
25expenditures from the most recently completed fiscal year used
26to pay for services provided in prior fiscal years.

 

 

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1    (e) The Department of Healthcare and Family Services, the
2Department of Human Services (acting as successor to the
3Department of Public Aid), and the Department of Human Services
4making fee-for-service payments relating to substance abuse
5treatment services provided during a previous fiscal year shall
6each annually submit to the State Comptroller, Senate
7President, Senate Minority Leader, Speaker of the House, House
8Minority Leader, the respective Chairmen and Minority
9Spokesmen of the Appropriations Committees of the Senate and
10the House, on or before November 30, a report that shall
11document by program or service category those expenditures from
12the most recently completed fiscal year used to pay for (i)
13services provided in prior fiscal years and (ii) services for
14which claims were received in prior fiscal years.
15    (f) The Department of Human Services (as successor to the
16Department of Public Aid) shall annually submit to the State
17Comptroller, Senate President, Senate Minority Leader, Speaker
18of the House, House Minority Leader, and the respective
19Chairmen and Minority Spokesmen of the Appropriations
20Committees of the Senate and the House, on or before December
2131, a report of fiscal year funds used to pay for services
22(other than medical care) provided in any prior fiscal year.
23This report shall document by program or service category those
24expenditures from the most recently completed fiscal year used
25to pay for services provided in prior fiscal years.
26    (g) In addition, each annual report required to be

 

 

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

 

 

09600HB5420sam002- 23 -LRB096 18878 KTG 44731 a

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

 

 

09600HB5420sam002- 24 -LRB096 18878 KTG 44731 a

1received by September 30th following the end of the fiscal year
2in which the service was rendered.
3    (j) Notwithstanding any other provision of this Act, the
4aggregate amount of payments to be made without regard for
5fiscal year limitations as contained in subsections (b-1),
6(b-3), (b-4), (b-5), (b-6), and (c) of this Section, and
7determined by using Generally Accepted Accounting Principles,
8shall not exceed the following amounts:
9        (1) $6,000,000,000 for outstanding liabilities related
10    to fiscal year 2012;
11        (2) $5,300,000,000 for outstanding liabilities related
12    to fiscal year 2013;
13        (3) $4,600,000,000 for outstanding liabilities related
14    to fiscal year 2014;
15        (4) $4,000,000,000 for outstanding liabilities related
16    to fiscal year 2015;
17        (5) $3,300,000,000 for outstanding liabilities related
18    to fiscal year 2016;
19        (6) $2,600,000,000 for outstanding liabilities related
20    to fiscal year 2017;
21        (7) $2,000,000,000 for outstanding liabilities related
22    to fiscal year 2018;
23        (8) $1,300,000,000 for outstanding liabilities related
24    to fiscal year 2019;
25        (9) $600,000,000 for outstanding liabilities related
26    to fiscal year 2020; and

 

 

09600HB5420sam002- 25 -LRB096 18878 KTG 44731 a

1        (10) $0 for outstanding liabilities related to fiscal
2    year 2021 and fiscal years thereafter.
3(Source: P.A. 95-331, eff. 8-21-07; 96-928, eff. 6-15-10;
496-958, eff. 7-1-10; revised 7-22-10.)
 
5    Section 15. The State Prompt Payment Act is amended by
6changing Section 3-2 as follows:
 
7    (30 ILCS 540/3-2)
8    Sec. 3-2. Beginning July 1, 1993, in any instance where a
9State official or agency is late in payment of a vendor's bill
10or invoice for goods or services furnished to the State, as
11defined in Section 1, properly approved in accordance with
12rules promulgated under Section 3-3, the State official or
13agency shall pay interest to the vendor in accordance with the
14following:
15        (1) Any bill, except a bill submitted under Article V
16    of the Illinois Public Aid Code, approved for payment under
17    this Section must be paid or the payment issued to the
18    payee within 60 days of receipt of a proper bill or
19    invoice. If payment is not issued to the payee within this
20    60 day period, an interest penalty of 1.0% of any amount
21    approved and unpaid shall be added for each month or
22    fraction thereof after the end of this 60 day period, until
23    final payment is made. Any bill, except a bill for pharmacy
24    services or goods, submitted under Article V of the

 

 

09600HB5420sam002- 26 -LRB096 18878 KTG 44731 a

1    Illinois Public Aid Code approved for payment under this
2    Section must be paid or the payment issued to the payee
3    within 60 days after receipt of a proper bill or invoice,
4    and, if payment is not issued to the payee within this
5    60-day period, an interest penalty of 2.0% of any amount
6    approved and unpaid shall be added for each month or
7    fraction thereof after the end of this 60-day period, until
8    final payment is made. Any bill for pharmacy services or
9    goods submitted under Article V of the Illinois Public Aid
10    Code, approved for payment under this Section must be paid
11    or the payment issued to the payee within 60 days of
12    receipt of a proper bill or invoice. If payment is not
13    issued to the payee within this 60 day period, an interest
14    penalty of 1.0% of any amount approved and unpaid shall be
15    added for each month or fraction thereof after the end of
16    this 60 day period, until final payment is made.
17        (1.1) A State agency shall review in a timely manner
18    each bill or invoice after its receipt. If the State agency
19    determines that the bill or invoice contains a defect
20    making it unable to process the payment request, the agency
21    shall notify the vendor requesting payment as soon as
22    possible after discovering the defect pursuant to rules
23    promulgated under Section 3-3; provided, however, that the
24    notice for construction related bills or invoices must be
25    given not later than 30 days after the bill or invoice was
26    first submitted. The notice shall identify the defect and

 

 

09600HB5420sam002- 27 -LRB096 18878 KTG 44731 a

1    any additional information necessary to correct the
2    defect. If one or more items on a construction related bill
3    or invoice are disapproved, but not the entire bill or
4    invoice, then the portion that is not disapproved shall be
5    paid.
6        (2) Where a State official or agency is late in payment
7    of a vendor's bill or invoice properly approved in
8    accordance with this Act, and different late payment terms
9    are not reduced to writing as a contractual agreement, the
10    State official or agency shall automatically pay interest
11    penalties required by this Section amounting to $50 or more
12    to the appropriate vendor. Each agency shall be responsible
13    for determining whether an interest penalty is owed and for
14    paying the interest to the vendor. Interest due to a vendor
15    that amounts to less than $50 shall not be paid but shall
16    be accrued until all interest due the vendor for all
17    similar warrants exceeds $50, at which time the accrued
18    interest shall be payable and interest will begin accruing
19    again, except that interest accrued as of the end of the
20    fiscal year that does not exceed $50 shall be payable at
21    that time. In the event an individual has paid a vendor for
22    services in advance, the provisions of this Section shall
23    apply until payment is made to that individual.
24        (3) The provisions of this amendatory Act of the 96th
25    General Assembly reducing the interest rate on pharmacy
26    claims under Article V of the Illinois Public Aid Code to

 

 

09600HB5420sam002- 28 -LRB096 18878 KTG 44731 a

1    1.0% per month shall apply to any pharmacy bills for
2    services and goods under Article V of the Illinois Public
3    Aid Code received on or after the date 60 days before the
4    effective date of this amendatory Act of the 96th General
5    Assembly.
6(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10;
796-959, eff. 7-1-10; 96-1000, eff. 7-2-10.)
 
8    Section 20. The Illinois Income Tax Act is amended by
9changing Section 917 as follows:
 
10    (35 ILCS 5/917)  (from Ch. 120, par. 9-917)
11    Sec. 917. Confidentiality and information sharing.
12    (a) Confidentiality. Except as provided in this Section,
13all information received by the Department from returns filed
14under this Act, or from any investigation conducted under the
15provisions of this Act, shall be confidential, except for
16official purposes within the Department or pursuant to official
17procedures for collection of any State tax or pursuant to an
18investigation or audit by the Illinois State Scholarship
19Commission of a delinquent student loan or monetary award or
20enforcement of any civil or criminal penalty or sanction
21imposed by this Act or by another statute imposing a State tax,
22and any person who divulges any such information in any manner,
23except for such purposes and pursuant to order of the Director
24or in accordance with a proper judicial order, shall be guilty

 

 

09600HB5420sam002- 29 -LRB096 18878 KTG 44731 a

1of a Class A misdemeanor. However, the provisions of this
2paragraph are not applicable to information furnished to (i)
3the Department of Healthcare and Family Services (formerly
4Department of Public Aid), State's Attorneys, and the Attorney
5General for child support enforcement purposes and (ii) a
6licensed attorney representing the taxpayer where an appeal or
7a protest has been filed on behalf of the taxpayer. If it is
8necessary to file information obtained pursuant to this Act in
9a child support enforcement proceeding, the information shall
10be filed under seal.
11    (b) Public information. Nothing contained in this Act shall
12prevent the Director from publishing or making available to the
13public the names and addresses of persons filing returns under
14this Act, or from publishing or making available reasonable
15statistics concerning the operation of the tax wherein the
16contents of returns are grouped into aggregates in such a way
17that the information contained in any individual return shall
18not be disclosed.
19    (c) Governmental agencies. The Director may make available
20to the Secretary of the Treasury of the United States or his
21delegate, or the proper officer or his delegate of any other
22state imposing a tax upon or measured by income, for
23exclusively official purposes, information received by the
24Department in the administration of this Act, but such
25permission shall be granted only if the United States or such
26other state, as the case may be, grants the Department

 

 

09600HB5420sam002- 30 -LRB096 18878 KTG 44731 a

1substantially similar privileges. The Director may exchange
2information with the Department of Healthcare and Family
3Services and the Department of Human Services (acting as
4successor to the Department of Public Aid under the Department
5of Human Services Act) for the purpose of verifying sources and
6amounts of income and for other purposes directly connected
7with the administration of this Act, the Illinois Public Aid
8Code, and any other health benefit program administered by the
9State and the Illinois Public Aid Code. The Director may
10exchange information with the Director of the Department of
11Employment Security for the purpose of verifying sources and
12amounts of income and for other purposes directly connected
13with the administration of this Act and Acts administered by
14the Department of Employment Security. The Director may make
15available to the Illinois Workers' Compensation Commission
16information regarding employers for the purpose of verifying
17the insurance coverage required under the Workers'
18Compensation Act and Workers' Occupational Diseases Act. The
19Director may exchange information with the Illinois Department
20on Aging for the purpose of verifying sources and amounts of
21income for purposes directly related to confirming eligibility
22for participation in the programs of benefits authorized by the
23Senior Citizens and Disabled Persons Property Tax Relief and
24Pharmaceutical Assistance Act.
25    The Director may make available to any State agency,
26including the Illinois Supreme Court, which licenses persons to

 

 

09600HB5420sam002- 31 -LRB096 18878 KTG 44731 a

1engage in any occupation, information that a person licensed by
2such agency has failed to file returns under this Act or pay
3the tax, penalty and interest shown therein, or has failed to
4pay any final assessment of tax, penalty or interest due under
5this Act. The Director may make available to any State agency,
6including the Illinois Supreme Court, information regarding
7whether a bidder, contractor, or an affiliate of a bidder or
8contractor has failed to file returns under this Act or pay the
9tax, penalty, and interest shown therein, or has failed to pay
10any final assessment of tax, penalty, or interest due under
11this Act, for the limited purpose of enforcing bidder and
12contractor certifications. For purposes of this Section, the
13term "affiliate" means any entity that (1) directly,
14indirectly, or constructively controls another entity, (2) is
15directly, indirectly, or constructively controlled by another
16entity, or (3) is subject to the control of a common entity.
17For purposes of this subsection (a), an entity controls another
18entity if it owns, directly or individually, more than 10% of
19the voting securities of that entity. As used in this
20subsection (a), the term "voting security" means a security
21that (1) confers upon the holder the right to vote for the
22election of members of the board of directors or similar
23governing body of the business or (2) is convertible into, or
24entitles the holder to receive upon its exercise, a security
25that confers such a right to vote. A general partnership
26interest is a voting security.

 

 

09600HB5420sam002- 32 -LRB096 18878 KTG 44731 a

1    The Director may make available to any State agency,
2including the Illinois Supreme Court, units of local
3government, and school districts, information regarding
4whether a bidder or contractor is an affiliate of a person who
5is not collecting and remitting Illinois Use taxes, for the
6limited purpose of enforcing bidder and contractor
7certifications.
8    The Director may also make available to the Secretary of
9State information that a corporation which has been issued a
10certificate of incorporation by the Secretary of State has
11failed to file returns under this Act or pay the tax, penalty
12and interest shown therein, or has failed to pay any final
13assessment of tax, penalty or interest due under this Act. An
14assessment is final when all proceedings in court for review of
15such assessment have terminated or the time for the taking
16thereof has expired without such proceedings being instituted.
17For taxable years ending on or after December 31, 1987, the
18Director may make available to the Director or principal
19officer of any Department of the State of Illinois, information
20that a person employed by such Department has failed to file
21returns under this Act or pay the tax, penalty and interest
22shown therein. For purposes of this paragraph, the word
23"Department" shall have the same meaning as provided in Section
243 of the State Employees Group Insurance Act of 1971.
25    (d) The Director shall make available for public inspection
26in the Department's principal office and for publication, at

 

 

09600HB5420sam002- 33 -LRB096 18878 KTG 44731 a

1cost, administrative decisions issued on or after January 1,
21995. These decisions are to be made available in a manner so
3that the following taxpayer information is not disclosed:
4        (1) The names, addresses, and identification numbers
5    of the taxpayer, related entities, and employees.
6        (2) At the sole discretion of the Director, trade
7    secrets or other confidential information identified as
8    such by the taxpayer, no later than 30 days after receipt
9    of an administrative decision, by such means as the
10    Department shall provide by rule.
11    The Director shall determine the appropriate extent of the
12deletions allowed in paragraph (2). In the event the taxpayer
13does not submit deletions, the Director shall make only the
14deletions specified in paragraph (1).
15    The Director shall make available for public inspection and
16publication an administrative decision within 180 days after
17the issuance of the administrative decision. The term
18"administrative decision" has the same meaning as defined in
19Section 3-101 of Article III of the Code of Civil Procedure.
20Costs collected under this Section shall be paid into the Tax
21Compliance and Administration Fund.
22    (e) Nothing contained in this Act shall prevent the
23Director from divulging information to any person pursuant to a
24request or authorization made by the taxpayer, by an authorized
25representative of the taxpayer, or, in the case of information
26related to a joint return, by the spouse filing the joint

 

 

09600HB5420sam002- 34 -LRB096 18878 KTG 44731 a

1return with the taxpayer.
2(Source: P.A. 94-1074, eff. 12-26-06; 95-331, eff. 8-21-07.)
 
3    Section 25. The Illinois Insurance Code is amended by
4changing Section 5.5 as follows:
 
5    (215 ILCS 5/5.5)
6    Sec. 5.5. Compliance with the Department of Healthcare and
7Family Services. A company authorized to do business in this
8State or accredited by the State to issue policies of health
9insurance, including but not limited to, self-insured plans,
10group health plans (as defined in Section 607(1) of the
11Employee Retirement Income Security Act of 1974), service
12benefit plans, managed care organizations, pharmacy benefit
13managers, or other parties that are by statute, contract, or
14agreement legally responsible for payment of a claim for a
15health care item or service as a condition of doing business in
16the State must:
17        (1) provide to the Department of Healthcare and Family
18    Services, or any successor agency, on at least a quarterly
19    basis if so requested by the Department, information upon
20    request information to determine during what period any
21    individual may be, or may have been, covered by a health
22    insurer and the nature of the coverage that is or was
23    provided by the health insurer, including the name,
24    address, and identifying number of the plan;

 

 

09600HB5420sam002- 35 -LRB096 18878 KTG 44731 a

1        (2) accept the State's right of recovery and the
2    assignment to the State of any right of an individual or
3    other entity to payment from the party for an item or
4    service for which payment has been made under the medical
5    programs of the Department of Healthcare and Family
6    Services, or any successor agency, under this Code or the
7    Illinois Public Aid Code;
8        (3) respond to any inquiry by the Department of
9    Healthcare and Family Services regarding a claim for
10    payment for any health care item or service that is
11    submitted not later than 3 years after the date of the
12    provision of such health care item or service; and
13        (4) agree not to deny a claim submitted by the
14    Department of Healthcare and Family Services solely on the
15    basis of the date of submission of the claim, the type or
16    format of the claim form, or a failure to present proper
17    documentation at the point-of-sale that is the basis of the
18    claim if (i) the claim is submitted by the Department of
19    Healthcare and Family Services within the 3-year period
20    beginning on the date on which the item or service was
21    furnished and (ii) any action by the Department of
22    Healthcare and Family Services to enforce its rights with
23    respect to such claim is commenced within 6 years of its
24    submission of such claim.
25    In cases in which the Department of Healthcare and Family
26Services has determined that an entity that provides health

 

 

09600HB5420sam002- 36 -LRB096 18878 KTG 44731 a

1insurance coverage has established a pattern of failure to
2provide the information required under this Section, and has
3subsequently certified that determination, along with
4supporting documentation, to the Director of the Department of
5Insurance, the Director of the Department of Insurance, based
6upon the certification of determination made by the Department
7of Healthcare and Family Services, may commence regulatory
8proceedings in accordance with all applicable provisions of the
9Illinois Insurance Code.
10(Source: P.A. 95-632, eff. 9-25-07.)
 
11    Section 30. The Children's Health Insurance Program Act is
12amended by changing Section 15 and by adding Sections 7, 21,
1323, and 26 as follows:
 
14    (215 ILCS 106/7 new)
15    Sec. 7. Eligibility verification. Notwithstanding any
16other provision of this Act, with respect to applications for
17benefits provided under the Program, eligibility shall be
18determined in a manner that ensures program integrity and that
19complies with federal law and regulations while minimizing
20unnecessary barriers to enrollment. To this end, as soon as
21practicable, and unless the Department receives written denial
22from the federal government, this Section shall be implemented:
23    (a) The Department of Healthcare and Family Services or its
24designees shall:

 

 

09600HB5420sam002- 37 -LRB096 18878 KTG 44731 a

1        (1) By no later than July 1, 2011, require verification
2    of, at a minimum, one month's income from all sources
3    required for determining the eligibility of applicants to
4    the Program. Such verification shall take the form of pay
5    stubs, business or income and expense records for
6    self-employed persons, letters from employers, and any
7    other valid documentation of income including data
8    obtained electronically by the Department or its designees
9    from other sources as described in subsection (b) of this
10    Section.
11        (2) By no later than October 1, 2011, require
12    verification of, at a minimum, one month's income from all
13    sources required for determining the continued eligibility
14    of recipients at their annual review of eligibility under
15    the Program. Such verification shall take the form of pay
16    stubs, business or income and expense records for
17    self-employed persons, letters from employers, and any
18    other valid documentation of income including data
19    obtained electronically by the Department or its designees
20    from other sources as described in subsection (b) of this
21    Section. The Department shall send a notice to the
22    recipient at least 60 days prior to the end of the period
23    of eligibility that informs them of the requirements for
24    continued eligibility. If a recipient does not fulfill the
25    requirements for continued eligibility by the deadline
26    established in the notice, a notice of cancellation shall

 

 

09600HB5420sam002- 38 -LRB096 18878 KTG 44731 a

1    be issued to the recipient and coverage shall end on the
2    last day of the eligibility period. A recipient's
3    eligibility may be reinstated without requiring a new
4    application if the recipient fulfills the requirements for
5    continued eligibility prior to the end of the month
6    following the last date of coverage. Nothing in this
7    Section shall prevent an individual whose coverage has been
8    cancelled from reapplying for health benefits at any time.
9        (3) By no later than July 1, 2011, require verification
10    of Illinois residency.
11    (b) The Department shall establish or continue cooperative
12arrangements with the Social Security Administration, the
13Illinois Secretary of State, the Department of Human Services,
14the Department of Revenue, the Department of Employment
15Security, and any other appropriate entity to gain electronic
16access, to the extent allowed by law, to information available
17to those entities that may be appropriate for electronically
18verifying any factor of eligibility for benefits under the
19Program. Data relevant to eligibility shall be provided for no
20other purpose than to verify the eligibility of new applicants
21or current recipients of health benefits under the Program.
22Data will be requested or provided for any new applicant or
23current recipient only insofar as that individual's
24circumstances are relevant to that individual's or another
25individual's eligibility.
26    (c) Within 90 days of the effective date of this amendatory

 

 

09600HB5420sam002- 39 -LRB096 18878 KTG 44731 a

1Act of the 96th General Assembly, the Department of Healthcare
2and Family Services shall send notice to current recipients
3informing them of the changes regarding their eligibility
4verification.
 
5    (215 ILCS 106/15)
6    Sec. 15. Operation of the Program. There is hereby created
7a Children's Health Insurance Program. The Program shall
8operate subject to appropriation and shall be administered by
9the Department of Healthcare and Family Services. The
10Department shall have the powers and authority granted to the
11Department under the Illinois Public Aid Code, including, but
12not limited to, Section 11-5.1 of the Code. The Department may
13contract with a Third Party Administrator or other entities to
14administer and oversee any portion of this Program.
15(Source: P.A. 95-331, eff. 8-21-07.)
 
16    (215 ILCS 106/21 new)
17    Sec. 21. Presumptive eligibility. Beginning on the
18effective date of this amendatory Act of the 96th General
19Assembly and except where federal law requires presumptive
20eligibility, no adult may be presumed eligible for health care
21coverage under the Program, and the Department may not cover
22any service rendered to an adult unless the adult has completed
23an application for benefits, all required verifications have
24been received and the Department or its designee has found the

 

 

09600HB5420sam002- 40 -LRB096 18878 KTG 44731 a

1adult eligible for the date on which that service was provided.
2Nothing in this Section shall apply to pregnant women.
 
3    (215 ILCS 106/23 new)
4    Sec. 23. Care coordination.
5    (a) At least 50% of recipients eligible for comprehensive
6medical benefits in all medical assistance programs or other
7health benefit programs administered by the Department,
8including the Children's Health Insurance Program Act and the
9Covering ALL KIDS Health Insurance Act, shall be enrolled in a
10care coordination program by no later than January 1, 2015. For
11purposes of this Section, "coordinated care" or "care
12coordination" means delivery systems where recipients will
13receive their care from providers who participate under
14contract in integrated delivery systems that are responsible
15for providing or arranging the majority of care, including
16primary care physician services, referrals from primary care
17physicians, diagnostic and treatment services, behavioral
18health services, in-patient and outpatient hospital services,
19dental services, and rehabilitation and long-term care
20services. The Department shall designate or contract for such
21integrated delivery systems (i) to ensure enrollees have a
22choice of systems and of primary care providers within such
23systems; (ii) to ensure that enrollees receive quality care in
24a culturally and linguistically appropriate manner; and (iii)
25to ensure that coordinated care programs meet the diverse needs

 

 

09600HB5420sam002- 41 -LRB096 18878 KTG 44731 a

1of enrollees with developmental, mental health, physical, and
2age-related disabilities.
3    (b) Payment for such coordinated care shall be based on
4arrangements where the State pays for performance related to
5health care outcomes, the use of evidence-based practices, the
6use of primary care delivered through comprehensive medical
7homes, the use of electronic medical records, and the
8appropriate exchange of health information electronically made
9either on a capitated basis in which a fixed monthly premium
10per recipient is paid and full financial risk is assumed for
11the delivery of services, or through other risk-based payment
12arrangements.
13    (c) To qualify for compliance with this Section, the 50%
14goal shall be achieved by enrolling medical assistance
15enrollees from each medical assistance enrollment category,
16including parents, children, seniors, and people with
17disabilities to the extent that current State Medicaid payment
18laws would not limit federal matching funds for recipients in
19care coordination programs. In addition, services must be more
20comprehensively defined and more risk shall be assumed than in
21the Department's primary care case management program as of the
22effective date of this amendatory Act of the 96th General
23Assembly.
24    (d) The Department shall report to the General Assembly in
25a separate part of its annual medical assistance program
26report, beginning April, 2012 until April, 2016, on the

 

 

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1progress and implementation of the care coordination program
2initiatives established by the provisions of this amendatory
3Act of the 96th General Assembly. The Department shall include
4in its April 2011 report a full analysis of federal laws or
5regulations regarding upper payment limitations to providers
6and the necessary revisions or adjustments in rate
7methodologies and payments to providers under this Code that
8would be necessary to implement coordinated care with full
9financial risk by a party other than the Department.
 
10    (215 ILCS 106/26 new)
11    Sec. 26. Moratorium on eligibility expansions. Beginning
12on the effective date of this amendatory Act of the 96th
13General Assembly, there shall be a 2-year moratorium on the
14expansion of eligibility through increasing financial
15eligibility standards, or through increasing income
16disregards, or through the creation of new programs that would
17add new categories of eligible individuals under the medical
18assistance program under the Illinois Public Aid Code in
19addition to those categories covered on January 1, 2011. This
20moratorium shall not apply to expansions required as a federal
21condition of State participation in the medical assistance
22program.
 
23    Section 35. The Covering ALL KIDS Health Insurance Act is
24amended by changing Sections 15, 20, and 98 and by adding

 

 

09600HB5420sam002- 43 -LRB096 18878 KTG 44731 a

1Sections 7, 21, 26, 36, and 56 as follows:
 
2    (215 ILCS 170/7 new)
3    Sec. 7. Eligibility verification. Notwithstanding any
4other provision of this Act, with respect to applications for
5benefits provided under the Program, eligibility shall be
6determined in a manner that ensures program integrity and that
7complies with federal law and regulations while minimizing
8unnecessary barriers to enrollment. To this end, as soon as
9practicable, and unless the Department receives written denial
10from the federal government, this Section shall be implemented:
11    (a) The Department of Healthcare and Family Services or its
12designees shall:
13        (1) By July 1, 2011, require verification of, at a
14    minimum, one month's income from all sources required for
15    determining the eligibility of applicants to the Program.
16    Such verification shall take the form of pay stubs,
17    business or income and expense records for self-employed
18    persons, letters from employers, and any other valid
19    documentation of income including data obtained
20    electronically by the Department or its designees from
21    other sources as described in subsection (b) of this
22    Section.
23        (2) By October 1, 2011, require verification of, at a
24    minimum, one month's income from all sources required for
25    determining the continued eligibility of recipients at

 

 

09600HB5420sam002- 44 -LRB096 18878 KTG 44731 a

1    their annual review of eligibility under the Program. Such
2    verification shall take the form of pay stubs, business or
3    income and expense records for self-employed persons,
4    letters from employers, and any other valid documentation
5    of income including data obtained electronically by the
6    Department or its designees from other sources as described
7    in subsection (b) of this Section. The Department shall
8    send a notice to recipients at least 60 days prior to the
9    end of their period of eligibility that informs them of the
10    requirements for continued eligibility. If a recipient
11    does not fulfill the requirements for continued
12    eligibility by the deadline established in the notice, a
13    notice of cancellation shall be issued to the recipient and
14    coverage shall end on the last day of the eligibility
15    period. A recipient's eligibility may be reinstated
16    without requiring a new application if the recipient
17    fulfills the requirements for continued eligibility prior
18    to the end of the month following the last date of
19    coverage. Nothing in this Section shall prevent an
20    individual whose coverage has been cancelled from
21    reapplying for health benefits at any time.
22        (3) By July 1, 2011, require verification of Illinois
23    residency.
24    (b) The Department shall establish or continue cooperative
25arrangements with the Social Security Administration, the
26Illinois Secretary of State, the Department of Human Services,

 

 

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1the Department of Revenue, the Department of Employment
2Security, and any other appropriate entity to gain electronic
3access, to the extent allowed by law, to information available
4to those entities that may be appropriate for electronically
5verifying any factor of eligibility for benefits under the
6Program. Data relevant to eligibility shall be provided for no
7other purpose than to verify the eligibility of new applicants
8or current recipients of health benefits under the Program.
9Data will be requested or provided for any new applicant or
10current recipient only insofar as that individual's
11circumstances are relevant to that individual's or another
12individual's eligibility.
13    (c) Within 90 days of the effective date of this amendatory
14Act of the 96th General Assembly, the Department of Healthcare
15and Family Services shall send notice to current recipients
16informing them of the changes regarding their eligibility
17verification.
 
18    (215 ILCS 170/15)
19    (Section scheduled to be repealed on July 1, 2011)
20    Sec. 15. Operation of Program. The Covering ALL KIDS Health
21Insurance Program is created. The Program shall be administered
22by the Department of Healthcare and Family Services. The
23Department shall have the same powers and authority to
24administer the Program as are provided to the Department in
25connection with the Department's administration of the

 

 

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1Illinois Public Aid Code, including, but not limited to, the
2provisions under Section 11-5.1 of the Code, and the Children's
3Health Insurance Program Act. The Department shall coordinate
4the Program with the existing children's health programs
5operated by the Department and other State agencies.
6(Source: P.A. 94-693, eff. 7-1-06.)
 
7    (215 ILCS 170/20)
8    (Section scheduled to be repealed on July 1, 2011)
9    Sec. 20. Eligibility.
10    (a) To be eligible for the Program, a person must be a
11child:
12        (1) who is a resident of the State of Illinois; and
13        (2) who is ineligible for medical assistance under the
14    Illinois Public Aid Code or benefits under the Children's
15    Health Insurance Program Act; and
16        (3) either (i) who has been without health insurance
17    coverage for a period set forth by the Department in rules,
18    but not less than 6 months during the first month of
19    operation of the Program, 7 months during the second month
20    of operation, 8 months during the third month of operation,
21    9 months during the fourth month of operation, 10 months
22    during the fifth month of operation, 11 months during the
23    sixth month of operation, and 12 months thereafter, (ii)
24    whose parent has lost employment that made available
25    affordable dependent health insurance coverage, until such

 

 

09600HB5420sam002- 47 -LRB096 18878 KTG 44731 a

1    time as affordable employer-sponsored dependent health
2    insurance coverage is again available for the child as set
3    forth by the Department in rules, (iii) who is a newborn
4    whose responsible relative does not have available
5    affordable private or employer-sponsored health insurance,
6    or (iv) who, within one year of applying for coverage under
7    this Act, lost medical benefits under the Illinois Public
8    Aid Code or the Children's Health Insurance Program Act;
9    and .
10        (3.5) whose household income, as determined by the
11    Department, is at or below 300% of the federal poverty
12    level. This item (3.5) is effective July 1, 2011.
13    An entity that provides health insurance coverage (as
14defined in Section 2 of the Comprehensive Health Insurance Plan
15Act) to Illinois residents shall provide health insurance data
16match to the Department of Healthcare and Family Services as
17provided by and subject to Section 5.5 of the Illinois
18Insurance Code for the purpose of determining eligibility for
19the Program under this Act.
20    The Department of Healthcare and Family Services, in
21collaboration with the Department of Financial and
22Professional Regulation, Division of Insurance, shall adopt
23rules governing the exchange of information under this Section.
24The rules shall be consistent with all laws relating to the
25confidentiality or privacy of personal information or medical
26records, including provisions under the Federal Health

 

 

09600HB5420sam002- 48 -LRB096 18878 KTG 44731 a

1Insurance Portability and Accountability Act (HIPAA).
2    (b) The Department shall monitor the availability and
3retention of employer-sponsored dependent health insurance
4coverage and shall modify the period described in subdivision
5(a)(3) if necessary to promote retention of private or
6employer-sponsored health insurance and timely access to
7healthcare services, but at no time shall the period described
8in subdivision (a)(3) be less than 6 months.
9    (c) The Department, at its discretion, may take into
10account the affordability of dependent health insurance when
11determining whether employer-sponsored dependent health
12insurance coverage is available upon reemployment of a child's
13parent as provided in subdivision (a)(3).
14    (d) A child who is determined to be eligible for the
15Program shall remain eligible for 12 months, provided that the
16child maintains his or her residence in this State, has not yet
17attained 19 years of age, and is not excluded under subsection
18(e).
19    (e) A child is not eligible for coverage under the Program
20if:
21        (1) the premium required under Section 40 has not been
22    timely paid; if the required premiums are not paid, the
23    liability of the Program shall be limited to benefits
24    incurred under the Program for the time period for which
25    premiums have been paid; re-enrollment shall be completed
26    before the next covered medical visit, and the first

 

 

09600HB5420sam002- 49 -LRB096 18878 KTG 44731 a

1    month's required premium shall be paid in advance of the
2    next covered medical visit; or
3        (2) the child is an inmate of a public institution or
4    an institution for mental diseases.
5    (f) The Department may shall adopt eligibility rules,
6including, but not limited to: rules regarding annual renewals
7of eligibility for the Program in conformance with Section 7 of
8this Act; rules regarding annual renewals of eligibility for
9the Program; rules providing for re-enrollment, grace periods,
10notice requirements, and hearing procedures under subdivision
11(e)(1) of this Section; and rules regarding what constitutes
12availability and affordability of private or
13employer-sponsored health insurance, with consideration of
14such factors as the percentage of income needed to purchase
15children or family health insurance, the availability of
16employer subsidies, and other relevant factors.
17    (g) Each child enrolled in the Program as of July 1, 2011
18whose family income, as established by the Department, exceeds
19300% of the federal poverty level may remain enrolled in the
20Program for 12 additional months commencing July 1, 2011.
21Continued enrollment pursuant to this subsection shall be
22available only if the child continues to meet all eligibility
23criteria established under the Program as of the effective date
24of this amendatory Act of the 96th General Assembly without a
25break in coverage. Nothing contained in this subsection shall
26prevent a child from qualifying for any other health benefits

 

 

09600HB5420sam002- 50 -LRB096 18878 KTG 44731 a

1program operated by the Department.
2(Source: P.A. 96-1272, eff. 1-1-11.)
 
3    (215 ILCS 170/21 new)
4    Sec. 21. Presumptive eligibility. Beginning on the
5effective date of this amendatory Act of the 96th General
6Assembly and except where federal law or regulation requires
7presumptive eligibility, no adult may be presumed eligible for
8health care coverage under the Program and the Department may
9not cover any service rendered to an adult unless the adult has
10completed an application for benefits, all required
11verifications have been received, and the Department or its
12designee has found the adult eligible for the date on which
13that service was provided. Nothing in this Section shall apply
14to pregnant women.
 
15    (215 ILCS 170/36 new)
16    Sec. 36. Moratorium on eligibility expansions. Beginning
17on the effective date of this amendatory Act of the 96th
18General Assembly, there shall be a 2-year moratorium on the
19expansion of eligibility through increasing financial
20eligibility standards, or through increasing income
21disregards, or through the creation of new programs that would
22add new categories of eligible individuals under the medical
23assistance program under the Illinois Public Aid Code in
24addition to those categories covered on January 1, 2011. This

 

 

09600HB5420sam002- 51 -LRB096 18878 KTG 44731 a

1moratorium shall not apply to expansions required as a federal
2condition of State participation in the medical assistance
3program.
 
4    (215 ILCS 170/56 new)
5    Sec. 56. Care coordination.
6    (a) At least 50% of recipients eligible for comprehensive
7medical benefits in all medical assistance programs or other
8health benefit programs administered by the Department,
9including the Children's Health Insurance Program Act and the
10Covering ALL KIDS Health Insurance Act, shall be enrolled in a
11care coordination program by no later than January 1, 2015. For
12purposes of this Section, "coordinated care" or "care
13coordination" means delivery systems where recipients will
14receive their care from providers who participate under
15contract in integrated delivery systems that are responsible
16for providing or arranging the majority of care, including
17primary care physician services, referrals from primary care
18physicians, diagnostic and treatment services, behavioral
19health services, in-patient and outpatient hospital services,
20dental services, and rehabilitation and long-term care
21services. The Department shall designate or contract for such
22integrated delivery systems (i) to ensure enrollees have a
23choice of systems and of primary care providers within such
24systems; (ii) to ensure that enrollees receive quality care in
25a culturally and linguistically appropriate manner; and (iii)

 

 

09600HB5420sam002- 52 -LRB096 18878 KTG 44731 a

1to ensure that coordinated care programs meet the diverse needs
2of enrollees with developmental, mental health, physical, and
3age-related disabilities.
4    (b) Payment for such coordinated care shall be based on
5arrangements where the State pays for performance related to
6health care outcomes, the use of evidence-based practices, the
7use of primary care delivered through comprehensive medical
8homes, the use of electronic medical records, and the
9appropriate exchange of health information electronically made
10either on a capitated basis in which a fixed monthly premium
11per recipient is paid and full financial risk is assumed for
12the delivery of services, or through other risk-based payment
13arrangements.
14    (c) To qualify for compliance with this Section, the 50%
15goal shall be achieved by enrolling medical assistance
16enrollees from each medical assistance enrollment category,
17including parents, children, seniors, and people with
18disabilities to the extent that current State Medicaid payment
19laws would not limit federal matching funds for recipients in
20care coordination programs. In addition, services must be more
21comprehensively defined and more risk shall be assumed than in
22the Department's primary care case management program as of the
23effective date of this amendatory Act of the 96th General
24Assembly.
25    (d) The Department shall report to the General Assembly in
26a separate part of its annual medical assistance program

 

 

09600HB5420sam002- 53 -LRB096 18878 KTG 44731 a

1report, beginning April, 2012 until April, 2016, on the
2progress and implementation of the care coordination program
3initiatives established by the provisions of this amendatory
4Act of the 96th General Assembly. The Department shall include
5in its April 2011 report a full analysis of federal laws or
6regulations regarding upper payment limitations to providers
7and the necessary revisions or adjustments in rate
8methodologies and payments to providers under this Code that
9would be necessary to implement coordinated care with full
10financial risk by a party other than the Department.
 
11    (215 ILCS 170/98)
12    (Section scheduled to be repealed on July 1, 2011)
13    Sec. 98. Repealer. This Act is repealed on July 1, 2016
14July 1, 2011.
15(Source: P.A. 94-693, eff. 7-1-06.)
 
16    Section 40. The Illinois Public Aid Code is amended by
17changing Sections 5-4.1, 5-5.12, 5-11, 8A-2.5, and 11-26 and by
18adding Sections 5-1.3, 5-1.4, 5-2.03, 5-11a, 5-29, 5-30, and
1911-5.1 as follows:
 
20    (305 ILCS 5/5-1.3 new)
21    Sec. 5-1.3. Payer of last resort. To the extent permissible
22under federal law, the State may pay for medical services only
23after payment from all other sources of payment have been

 

 

09600HB5420sam002- 54 -LRB096 18878 KTG 44731 a

1exhausted, or after the Department has determined that pursuit
2of such payment is economically unfeasible. Applicants for, and
3recipients of, medical assistance under this Code shall
4disclose to the State all insurance coverage they have. To the
5extent permissible under federal law, the State shall require
6vendors of medical services to bill third-party payers for
7services that may be covered by those third-party payers prior
8to submission of a request for payment to the State. The
9Department shall, to the extent permissible under federal law,
10reject a request for payment of a medical service that should
11first have been submitted to a third-party payer.
 
12    (305 ILCS 5/5-1.4 new)
13    Sec. 5-1.4. Moratorium on eligibility expansions.
14Beginning on the effective date of this amendatory Act of the
1596th General Assembly, there shall be a 2-year moratorium on
16the expansion of eligibility through increasing financial
17eligibility standards, or through increasing income
18disregards, or through the creation of new programs which would
19add new categories of eligible individuals under the medical
20assistance program in addition to those categories covered on
21January 1, 2011. This moratorium shall not apply to expansions
22required as a federal condition of State participation in the
23medical assistance program.
 
24    (305 ILCS 5/5-2.03 new)

 

 

09600HB5420sam002- 55 -LRB096 18878 KTG 44731 a

1    Sec. 5-2.03. Presumptive eligibility. Beginning on the
2effective date of this amendatory Act of the 96th General
3Assembly and except where federal law requires presumptive
4eligibility, no adult may be presumed eligible for medical
5assistance under this Code and the Department may not cover any
6service rendered to an adult unless the adult has completed an
7application for benefits, all required verifications have been
8received, and the Department or its designee has found the
9adult eligible for the date on which that service was provided.
10Nothing in this Section shall apply to pregnant women.
 
11    (305 ILCS 5/5-4.1)  (from Ch. 23, par. 5-4.1)
12    Sec. 5-4.1. Co-payments. The Department may by rule provide
13that recipients under any Article of this Code shall pay a fee
14as a co-payment for services. Co-payments shall be maximized to
15the extent permitted by federal law may not exceed $3 for brand
16name drugs, $1 for other pharmacy services other than for
17generic drugs, and $2 for physicians services, dental services,
18optical services and supplies, chiropractic services, podiatry
19services, and encounter rate clinic services. There shall be no
20co-payment for generic drugs. Co-payments may not exceed $3 for
21hospital outpatient and clinic services. Provided, however,
22that any such rule must provide that no co-payment requirement
23can exist for renal dialysis, radiation therapy, cancer
24chemotherapy, or insulin, and other products necessary on a
25recurring basis, the absence of which would be life

 

 

09600HB5420sam002- 56 -LRB096 18878 KTG 44731 a

1threatening, or where co-payment expenditures for required
2services and/or medications for chronic diseases that the
3Illinois Department shall by rule designate shall cause an
4extensive financial burden on the recipient, and provided no
5co-payment shall exist for emergency room encounters which are
6for medical emergencies. The Department shall seek approval of
7a State plan amendment that allows pharmacies to refuse to
8dispense drugs in circumstances where the recipient does not
9pay the required co-payment. In the event the State plan
10amendment is rejected, co-payments may not exceed $3 for brand
11name drugs, $1 for other pharmacy services other than for
12generic drugs, and $2 for physician services, dental services,
13optical services and supplies, chiropractic services, podiatry
14services, and encounter rate clinic services. There shall be no
15co-payment for generic drugs. Co-payments may not exceed $3 for
16hospital outpatient and clinic services.
17(Source: P.A. 92-597, eff. 6-28-02; 93-593, eff. 8-25-03.)
 
18    (305 ILCS 5/5-5.12)  (from Ch. 23, par. 5-5.12)
19    Sec. 5-5.12. Pharmacy payments.
20    (a) Every request submitted by a pharmacy for reimbursement
21under this Article for prescription drugs provided to a
22recipient of aid under this Article shall include the name of
23the prescriber or an acceptable identification number as
24established by the Department.
25    (b) Pharmacies providing prescription drugs under this

 

 

09600HB5420sam002- 57 -LRB096 18878 KTG 44731 a

1Article shall be reimbursed at a rate which shall include a
2professional dispensing fee as determined by the Illinois
3Department, plus the current acquisition cost of the
4prescription drug dispensed. The Illinois Department shall
5update its information on the acquisition costs of all
6prescription drugs no less frequently than every 30 days.
7However, the Illinois Department may set the rate of
8reimbursement for the acquisition cost, by rule, at a
9percentage of the current average wholesale acquisition cost.
10    (c) (Blank).
11    (d) The Department shall not impose requirements for prior
12approval based on a preferred drug list for anti-retroviral,
13anti-hemophilic factor concentrates, or any atypical
14antipsychotics, conventional antipsychotics, or
15anticonvulsants used for the treatment of serious mental
16illnesses until 30 days after it has conducted a study of the
17impact of such requirements on patient care and submitted a
18report to the Speaker of the House of Representatives and the
19President of the Senate. The Department shall review
20utilization of narcotic medications in the medical assistance
21program and impose utilization controls that protect against
22abuse.
23    (e) When making determinations as to which drugs shall be
24on a prior approval list, the Department shall include as part
25of the analysis for this determination, the degree to which a
26drug may affect individuals in different ways based on factors

 

 

09600HB5420sam002- 58 -LRB096 18878 KTG 44731 a

1including the gender of the person taking the medication.
2    (f) (e) The Department shall cooperate with the Department
3of Public Health and the Department of Human Services Division
4of Mental Health in identifying psychotropic medications that,
5when given in a particular form, manner, duration, or frequency
6(including "as needed") in a dosage, or in conjunction with
7other psychotropic medications to a nursing home resident, may
8constitute a chemical restraint or an "unnecessary drug" as
9defined by the Nursing Home Care Act or Titles XVIII and XIX of
10the Social Security Act and the implementing rules and
11regulations. The Department shall require prior approval for
12any such medication prescribed for a nursing home resident that
13appears to be a chemical restraint or an unnecessary drug. The
14Department shall consult with the Department of Human Services
15Division of Mental Health in developing a protocol and criteria
16for deciding whether to grant such prior approval.
17    (g) The Department may by rule provide for reimbursement of
18the dispensing of a 90-day supply of a generic, non-narcotic
19maintenance medication in circumstances where it is cost
20effective.
21(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10;
22revised 9-2-10.)
 
23    (305 ILCS 5/5-11)  (from Ch. 23, par. 5-11)
24    Sec. 5-11. Co-operative arrangements; contracts with other
25State agencies, health care and rehabilitation organizations,

 

 

09600HB5420sam002- 59 -LRB096 18878 KTG 44731 a

1and fiscal intermediaries.
2    (a) The Illinois Department may enter into co-operative
3arrangements with State agencies responsible for administering
4or supervising the administration of health services and
5vocational rehabilitation services to the end that there may be
6maximum utilization of such services in the provision of
7medical assistance.
8    The Illinois Department shall, not later than June 30,
91993, enter into one or more co-operative arrangements with the
10Department of Mental Health and Developmental Disabilities
11providing that the Department of Mental Health and
12Developmental Disabilities will be responsible for
13administering or supervising all programs for services to
14persons in community care facilities for persons with
15developmental disabilities, including but not limited to
16intermediate care facilities, that are supported by State funds
17or by funding under Title XIX of the federal Social Security
18Act. The responsibilities of the Department of Mental Health
19and Developmental Disabilities under these agreements are
20transferred to the Department of Human Services as provided in
21the Department of Human Services Act.
22    The Department may also contract with such State health and
23rehabilitation agencies and other public or private health care
24and rehabilitation organizations to act for it in supplying
25designated medical services to persons eligible therefor under
26this Article. Any contracts with health services or health

 

 

09600HB5420sam002- 60 -LRB096 18878 KTG 44731 a

1maintenance organizations shall be restricted to organizations
2which have been certified as being in compliance with standards
3promulgated pursuant to the laws of this State governing the
4establishment and operation of health services or health
5maintenance organizations. The Department shall renegotiate
6the contracts with health maintenance organizations and
7managed care community networks that took effect August 1,
82003, so as to produce $70,000,000 savings to the Department
9net of resulting increases to the fee-for-service program for
10State fiscal year 2006. The Department may also contract with
11insurance companies or other corporate entities serving as
12fiscal intermediaries in this State for the Federal Government
13in respect to Medicare payments under Title XVIII of the
14Federal Social Security Act to act for the Department in paying
15medical care suppliers. The provisions of Section 9 of "An Act
16in relation to State finance", approved June 10, 1919, as
17amended, notwithstanding, such contracts with State agencies,
18other health care and rehabilitation organizations, or fiscal
19intermediaries may provide for advance payments.
20    (b) For purposes of this subsection (b), "managed care
21community network" means an entity, other than a health
22maintenance organization, that is owned, operated, or governed
23by providers of health care services within this State and that
24provides or arranges primary, secondary, and tertiary managed
25health care services under contract with the Illinois
26Department exclusively to persons participating in programs

 

 

09600HB5420sam002- 61 -LRB096 18878 KTG 44731 a

1administered by the Illinois Department.
2    The Illinois Department may certify managed care community
3networks, including managed care community networks owned,
4operated, managed, or governed by State-funded medical
5schools, as risk-bearing entities eligible to contract with the
6Illinois Department as Medicaid managed care organizations.
7The Illinois Department may contract with those managed care
8community networks to furnish health care services to or
9arrange those services for individuals participating in
10programs administered by the Illinois Department. The rates for
11those provider-sponsored organizations may be determined on a
12prepaid, capitated basis. A managed care community network may
13choose to contract with the Illinois Department to provide only
14pediatric health care services. The Illinois Department shall
15by rule adopt the criteria, standards, and procedures by which
16a managed care community network may be permitted to contract
17with the Illinois Department and shall consult with the
18Department of Insurance in adopting these rules.
19    A county provider as defined in Section 15-1 of this Code
20may contract with the Illinois Department to provide primary,
21secondary, or tertiary managed health care services as a
22managed care community network without the need to establish a
23separate entity and shall be deemed a managed care community
24network for purposes of this Code only to the extent it
25provides services to participating individuals. A county
26provider is entitled to contract with the Illinois Department

 

 

09600HB5420sam002- 62 -LRB096 18878 KTG 44731 a

1with respect to any contracting region located in whole or in
2part within the county. A county provider is not required to
3accept enrollees who do not reside within the county.
4    In order to (i) accelerate and facilitate the development
5of integrated health care in contracting areas outside counties
6with populations in excess of 3,000,000 and counties adjacent
7to those counties and (ii) maintain and sustain the high
8quality of education and residency programs coordinated and
9associated with local area hospitals, the Illinois Department
10may develop and implement a demonstration program from managed
11care community networks owned, operated, managed, or governed
12by State-funded medical schools. The Illinois Department shall
13prescribe by rule the criteria, standards, and procedures for
14effecting this demonstration program.
15    A managed care community network that contracts with the
16Illinois Department to furnish health care services to or
17arrange those services for enrollees participating in programs
18administered by the Illinois Department shall do all of the
19following:
20        (1) Provide that any provider affiliated with the
21    managed care community network may also provide services on
22    a fee-for-service basis to Illinois Department clients not
23    enrolled in such managed care entities.
24        (2) Provide client education services as determined
25    and approved by the Illinois Department, including but not
26    limited to (i) education regarding appropriate utilization

 

 

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1    of health care services in a managed care system, (ii)
2    written disclosure of treatment policies and restrictions
3    or limitations on health services, including, but not
4    limited to, physical services, clinical laboratory tests,
5    hospital and surgical procedures, prescription drugs and
6    biologics, and radiological examinations, and (iii)
7    written notice that the enrollee may receive from another
8    provider those covered services that are not provided by
9    the managed care community network.
10        (3) Provide that enrollees within the system may choose
11    the site for provision of services and the panel of health
12    care providers.
13        (4) Not discriminate in enrollment or disenrollment
14    practices among recipients of medical services or
15    enrollees based on health status.
16        (5) Provide a quality assurance and utilization review
17    program that meets the requirements established by the
18    Illinois Department in rules that incorporate those
19    standards set forth in the Health Maintenance Organization
20    Act.
21        (6) Issue a managed care community network
22    identification card to each enrollee upon enrollment. The
23    card must contain all of the following:
24            (A) The enrollee's health plan.
25            (B) The name and telephone number of the enrollee's
26        primary care physician or the site for receiving

 

 

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1        primary care services.
2            (C) A telephone number to be used to confirm
3        eligibility for benefits and authorization for
4        services that is available 24 hours per day, 7 days per
5        week.
6        (7) Ensure that every primary care physician and
7    pharmacy in the managed care community network meets the
8    standards established by the Illinois Department for
9    accessibility and quality of care. The Illinois Department
10    shall arrange for and oversee an evaluation of the
11    standards established under this paragraph (7) and may
12    recommend any necessary changes to these standards.
13        (8) Provide a procedure for handling complaints that
14    meets the requirements established by the Illinois
15    Department in rules that incorporate those standards set
16    forth in the Health Maintenance Organization Act.
17        (9) Maintain, retain, and make available to the
18    Illinois Department records, data, and information, in a
19    uniform manner determined by the Illinois Department,
20    sufficient for the Illinois Department to monitor
21    utilization, accessibility, and quality of care.
22        (10) (Blank) Provide that the pharmacy formulary used
23    by the managed care community network and its contract
24    providers be no more restrictive than the Illinois
25    Department's pharmaceutical program on the effective date
26    of this amendatory Act of 1998 and as amended after that

 

 

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1    date.
2    The Illinois Department shall contract with an entity or
3entities to provide external peer-based quality assurance
4review for the managed health care programs administered by the
5Illinois Department. The entity shall meet all federal
6requirements for an external quality review organization be
7representative of Illinois physicians licensed to practice
8medicine in all its branches and have statewide geographic
9representation in all specialities of medical care that are
10provided in managed health care programs administered by the
11Illinois Department. The entity may not be a third party payer
12and shall maintain offices in locations around the State in
13order to provide service and continuing medical education to
14physician participants within those managed health care
15programs administered by the Illinois Department. The review
16process shall be developed and conducted by Illinois physicians
17licensed to practice medicine in all its branches. In
18consultation with the entity, the Illinois Department may
19contract with other entities for professional peer-based
20quality assurance review of individual categories of services
21other than services provided, supervised, or coordinated by
22physicians licensed to practice medicine in all its branches.
23The Illinois Department shall establish, by rule, criteria to
24avoid conflicts of interest in the conduct of quality assurance
25activities consistent with professional peer-review standards.
26All quality assurance activities shall be coordinated by the

 

 

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1Illinois Department.
2    Each managed care community network must demonstrate its
3ability to bear the financial risk of serving individuals under
4this program. The Illinois Department shall by rule adopt
5standards for assessing the solvency and financial soundness of
6each managed care community network. Any solvency and financial
7standards adopted for managed care community networks shall be
8no more restrictive than the solvency and financial standards
9adopted under Section 1856(a) of the Social Security Act for
10provider-sponsored organizations under Part C of Title XVIII of
11the Social Security Act.
12    The Illinois Department may implement the amendatory
13changes to this Code made by this amendatory Act of 1998
14through the use of emergency rules in accordance with Section
155-45 of the Illinois Administrative Procedure Act. For purposes
16of that Act, the adoption of rules to implement these changes
17is deemed an emergency and necessary for the public interest,
18safety, and welfare.
19    (c) Not later than June 30, 1996, the Illinois Department
20shall enter into one or more cooperative arrangements with the
21Department of Public Health for the purpose of developing a
22single survey for nursing facilities, including but not limited
23to facilities funded under Title XVIII or Title XIX of the
24federal Social Security Act or both, which shall be
25administered and conducted solely by the Department of Public
26Health. The Departments shall test the single survey process on

 

 

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1a pilot basis, with both the Departments of Public Aid and
2Public Health represented on the consolidated survey team. The
3pilot will sunset June 30, 1997. After June 30, 1997, unless
4otherwise determined by the Governor, a single survey shall be
5implemented by the Department of Public Health which would not
6preclude staff from the Department of Healthcare and Family
7Services (formerly Department of Public Aid) from going on-site
8to nursing facilities to perform necessary audits and reviews
9which shall not replicate the single State agency survey
10required by this Act. This Section shall not apply to community
11or intermediate care facilities for persons with developmental
12disabilities.
13    (d) Nothing in this Code in any way limits or otherwise
14impairs the authority or power of the Illinois Department to
15enter into a negotiated contract pursuant to this Section with
16a managed care community network or a health maintenance
17organization, as defined in the Health Maintenance
18Organization Act, that provides for termination or nonrenewal
19of the contract without cause, upon notice as provided in the
20contract, and without a hearing.
21(Source: P.A. 94-48, eff. 7-1-05; 95-331, eff. 8-21-07.)
 
22    (305 ILCS 5/5-11a new)
23    Sec. 5-11a. Health Benefit Information Systems.
24    (a) It is the intent of the General Assembly to support
25unified electronic systems initiatives that will improve

 

 

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1management of information related to medical assistance
2programs. This will include improved management capabilities
3and new systems for Eligibility, Verification, and Enrollment
4(EVE) that will simplify and increase efficiencies in and
5access to the medical assistance programs and ensure program
6integrity. The Department of Healthcare and Family Services, in
7coordination with the Department of Human Services and other
8appropriate state agencies, shall develop a plan by July 1,
92011, that will:
10        (1) Subject to federal and State privacy and
11    confidentiality laws and regulations, meet standards for
12    timely eligibility verification and enrollment, and annual
13    redetermination of eligibility, of applicants for and
14    recipients of means-tested health benefits sponsored by
15    the State, including medical assistance under this Code.
16        (2) Receive and update data electronically from the
17    Social Security Administration, the U.S. Postal Service,
18    the Illinois Secretary of State, the Department of Revenue,
19    the Department of Employment Security, and other
20    governmental entities, as appropriate and to the extent
21    allowed by law, for verification of any factor of
22    eligibility for medical assistance and for updating
23    addresses of applicants and recipients of medical
24    assistance and other health benefit programs administered
25    by the Department. Data relevant to eligibility shall be
26    provided for no other purpose than to verify the

 

 

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1    eligibility of new applicants or current recipients of
2    health benefits provided by the State. Data shall be
3    requested or provided for any individual only insofar as
4    that new applicant or current recipient's circumstances
5    are relevant to that individual's or another individual's
6    eligibility for State-sponsored health benefits.
7        (3) Meet federal requirements for timely installation
8    by January 1, 2014 to provide integration with a Health
9    Benefits Exchange pursuant to the requirements of the
10    federal Affordable Care Act and the Reconciliation Act and
11    any subsequent amendments thereto and to ensure capture of
12    the maximum available federal financial participation
13    (FFP).
14        (4) Meet federal requirements for compliance with
15    architectural standards, including, but not limited to,
16    (i) the use of a module development as outlined by the
17    Medicaid Information Technology Architecture standards,
18    (ii) the use of federally approved open-interfaces where
19    they exist, (iii) the use or the creation of
20    open-interfaces where necessary, and (iv) the use of rules
21    technology that can dynamically accept and modify rules in
22    standard formats.
23        (5) Include plans to ensure coordination with the State
24    of Illinois Framework Project that will (i) expedite and
25    simplify access to services provided by Illinois human
26    services programs; (ii) streamline administration and data

 

 

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1    sharing; (iii) enhance planning capacity, program
2    evaluation, and fraud detection or prevention with access
3    to cross-agency data; and (iv) simplify service reporting
4    for contracted providers.
5    (b) The Department of Healthcare and Family Services shall
6continue to plan for and implement a new Medicaid Management
7Information System (MMIS) and upgrade the capabilities of the
8MMIS data warehouse. Upgrades shall include, among other
9things, enhanced capabilities in data analysis including the
10ability to identify risk factors that could impact the
11treatment and resulting quality of care, and tools that perform
12predictive analytics on data applying to newborns, women with
13high risk pregnancies, and other populations served by the
14Department.
15    (c) The Department of Healthcare and Family Services shall
16report in its annual Medical Assistance program report each
17April through April, 2015 on the progress and implementation of
18this plan.
 
19    (305 ILCS 5/5-29 new)
20    Sec. 5-29. Income Limits and Parental Responsibility. In
21light of the unprecedented fiscal crisis confronting the State,
22it is the intent of the General Assembly to explore whether the
23income limits and income counting methods established for
24children under the Covering ALL KIDS Health Insurance Act,
25pursuant to this amendatory Act of the 96th General Assembly,

 

 

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1should apply to medical assistance programs available to
2children made eligible under the Illinois Public Aid Code,
3including through home and community based services waiver
4programs authorized under Section 1915(c) of the Social
5Security Act, where parental income is currently not considered
6in determining a child's eligibility for medical assistance.
7The Department of Healthcare and Family Services is hereby
8directed, with the participation of the Department of Human
9Services and stakeholders, to conduct an analysis of these
10programs to determine parental cost sharing opportunities, how
11these opportunities may impact the children currently in the
12programs, waivers and on the waiting list, and any other
13factors which may increase efficiencies and decrease State
14costs. The Department is further directed to review how
15services under these programs and waivers may be provided by
16the use of a combination of skilled, unskilled, and
17uncompensated care and to advise as to what revisions to the
18Nurse Practice Act, and Acts regulating other relevant
19professions, are necessary to accomplish this combination of
20care. The Department shall submit a written analysis on the
21children's programs and waivers as part of the Department's
22annual Medicaid reports due to the General Assembly in 2011 and
232012.
 
24    (305 ILCS 5/5-30 new)
25    Sec. 5-30. Care coordination.

 

 

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1    (a) At least 50% of recipients eligible for comprehensive
2medical benefits in all medical assistance programs or other
3health benefit programs administered by the Department,
4including the Children's Health Insurance Program Act and the
5Covering ALL KIDS Health Insurance Act, shall be enrolled in a
6care coordination program by no later than January 1, 2015. For
7purposes of this Section, "coordinated care" or "care
8coordination" means delivery systems where recipients will
9receive their care from providers who participate under
10contract in integrated delivery systems that are responsible
11for providing or arranging the majority of care, including
12primary care physician services, referrals from primary care
13physicians, diagnostic and treatment services, behavioral
14health services, in-patient and outpatient hospital services,
15dental services, and rehabilitation and long-term care
16services. The Department shall designate or contract for such
17integrated delivery systems (i) to ensure enrollees have a
18choice of systems and of primary care providers within such
19systems; (ii) to ensure that enrollees receive quality care in
20a culturally and linguistically appropriate manner; and (iii)
21to ensure that coordinated care programs meet the diverse needs
22of enrollees with developmental, mental health, physical, and
23age-related disabilities.
24    (b) Payment for such coordinated care shall be based on
25arrangements where the State pays for performance related to
26health care outcomes, the use of evidence-based practices, the

 

 

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1use of primary care delivered through comprehensive medical
2homes, the use of electronic medical records, and the
3appropriate exchange of health information electronically made
4either on a capitated basis in which a fixed monthly premium
5per recipient is paid and full financial risk is assumed for
6the delivery of services, or through other risk-based payment
7arrangements.
8    (c) To qualify for compliance with this Section, the 50%
9goal shall be achieved by enrolling medical assistance
10enrollees from each medical assistance enrollment category,
11including parents, children, seniors, and people with
12disabilities to the extent that current State Medicaid payment
13laws would not limit federal matching funds for recipients in
14care coordination programs. In addition, services must be more
15comprehensively defined and more risk shall be assumed than in
16the Department's primary care case management program as of the
17effective date of this amendatory Act of the 96th General
18Assembly.
19    (d) The Department shall report to the General Assembly in
20a separate part of its annual medical assistance program
21report, beginning April, 2012 until April, 2016, on the
22progress and implementation of the care coordination program
23initiatives established by the provisions of this amendatory
24Act of the 96th General Assembly. The Department shall include
25in its April 2011 report a full analysis of federal laws or
26regulations regarding upper payment limitations to providers

 

 

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1and the necessary revisions or adjustments in rate
2methodologies and payments to providers under this Code that
3would be necessary to implement coordinated care with full
4financial risk by a party other than the Department.
 
5    (305 ILCS 5/8A-2.5)
6    Sec. 8A-2.5. Unauthorized use of medical assistance.
7    (a) Any person who knowingly uses, acquires, possesses, or
8transfers a medical card in any manner not authorized by law or
9by rules and regulations of the Illinois Department, or who
10knowingly alters a medical card, or who knowingly uses,
11acquires, possesses, or transfers an altered medical card, is
12guilty of a violation of this Article and shall be punished as
13provided in Section 8A-6.
14    (b) Any person who knowingly obtains unauthorized medical
15benefits with or without use of a medical card is guilty of a
16violation of this Article and shall be punished as provided in
17Section 8A-6.
18    (c) The Department may seek to recover any and all State
19and federal monies for which it has improperly and erroneously
20paid benefits as a result of a fraudulent action and any civil
21penalties authorized in this Section. Pursuant to Section
2211-14.5 of this Code, the Department may determine the monetary
23value of benefits improperly and erroneously received. The
24Department may recover the monies paid for such benefits and
25interest on that amount at the rate of 5% per annum for the

 

 

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1period from which payment was made to the date upon which
2repayment is made to the State. Prior to the recovery of any
3amount paid for benefits allegedly obtained by fraudulent
4means, the recipient of such benefits shall be afforded an
5opportunity for a hearing after reasonable notice. The notice
6shall be served personally or by certified or registered mail
7or as otherwise provided by law upon the parties or their
8agents appointed to receive service of process and shall
9include the following:
10        (1) A statement of the time, place and nature of the
11    hearing.
12        (2) A statement of the legal authority and jurisdiction
13    under which the hearing is to be held.
14        (3) A reference to the particular Sections of the
15    substantive and procedural statutes and rules involved.
16        (4) Except where a more detailed statement is otherwise
17    provided for by law, a short and plain statement of the
18    matters asserted, the consequences of a failure to respond,
19    and the official file or other reference number.
20        (5) A statement of the monetary value of the benefits
21    fraudulently received by the person accused.
22        (6) A statement that, in addition to any other
23    penalties provided by law, a civil penalty in an amount not
24    to exceed $2,000 may be imposed for each fraudulent claim
25    for benefits or payments.
26        (7) A statement providing that the determination of the

 

 

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1    monetary value may be contested by petitioning the
2    Department for an administrative hearing within 30 days
3    from the date of mailing the notice.
4        (8) The names and mailing addresses of the
5    administrative law judge, all parties, and all other
6    persons to whom the agency gives notice of the hearing
7    unless otherwise confidential by law.
8    An opportunity shall be afforded all parties to be
9represented by legal counsel and to respond and present
10evidence and argument.
11    Unless precluded by law, disposition may be made of any
12contested case by stipulation, agreed settlement, consent
13order, or default.
14    Any final order, decision, or other determination made,
15issued or executed by the Director under the provisions of this
16Article whereby any person is aggrieved shall be subject to
17review in accordance with the provisions of the Administrative
18Review Law, and the rules adopted pursuant thereto, which shall
19apply to and govern all proceeding for the judicial review of
20final administrative decisions of the Director.
21    Upon entry of a final administrative decision for repayment
22of any benefits obtained by fraudulent means, or for any civil
23penalties assessed, a lien shall attach to all property and
24assets of such person, firm, corporation, association, agency,
25institution, or other legal entity until the judgment is
26satisfied.

 

 

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1    Within 12 months of the effective date of this amendatory
2Act of the 96th General Assembly, the Department of Healthcare
3and Family Services will report to the General Assembly on the
4number of fraud cases identified and pursued, and the fines
5assessed and collected. The report will also include the
6Department's analysis as to the use of private sector resources
7to bring action, investigate, and collect monies owed.
8(Source: P.A. 89-289, eff. 1-1-96.)
 
9    (305 ILCS 5/11-5.1 new)
10    Sec. 11-5.1. Eligibility verification. Notwithstanding any
11other provision of this Code, with respect to applications for
12medical assistance provided under Article V of this Code,
13eligibility shall be determined in a manner that ensures
14program integrity and complies with federal laws and
15regulations while minimizing unnecessary barriers to
16enrollment. To this end, as soon as practicable, and unless the
17Department receives written denial from the federal
18government, this Section shall be implemented:
19    (a) The Department of Healthcare and Family Services or its
20designees shall:
21        (1) By no later than July 1, 2011, require verification
22    of, at a minimum, one month's income from all sources
23    required for determining the eligibility of applicants for
24    medical assistance under this Code. Such verification
25    shall take the form of pay stubs, business or income and

 

 

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1    expense records for self-employed persons, letters from
2    employers, and any other valid documentation of income
3    including data obtained electronically by the Department
4    or its designees from other sources as described in
5    subsection (b) of this Section.
6        (2) By no later than October 1, 2011, require
7    verification of, at a minimum, one month's income from all
8    sources required for determining the continued eligibility
9    of recipients at their annual review of eligibility for
10    medical assistance under this Code. Such verification
11    shall take the form of pay stubs, business or income and
12    expense records for self-employed persons, letters from
13    employers, and any other valid documentation of income
14    including data obtained electronically by the Department
15    or its designees from other sources as described in
16    subsection (b) of this Section. The Department shall send a
17    notice to recipients at least 60 days prior to the end of
18    their period of eligibility that informs them of the
19    requirements for continued eligibility. If a recipient
20    does not fulfill the requirements for continued
21    eligibility by the deadline established in the notice a
22    notice of cancellation shall be issued to the recipient and
23    coverage shall end on the last day of the eligibility
24    period. A recipient's eligibility may be reinstated
25    without requiring a new application if the recipient
26    fulfills the requirements for continued eligibility prior

 

 

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1    to the end of the month following the last date of
2    coverage. Nothing in this Section shall prevent an
3    individual whose coverage has been cancelled from
4    reapplying for health benefits at any time.
5        (3) By no later than July 1, 2011, require verification
6    of Illinois residency.
7    (b) The Department shall establish or continue cooperative
8arrangements with the Social Security Administration, the
9Illinois Secretary of State, the Department of Human Services,
10the Department of Revenue, the Department of Employment
11Security, and any other appropriate entity to gain electronic
12access, to the extent allowed by law, to information available
13to those entities that may be appropriate for electronically
14verifying any factor of eligibility for benefits under the
15Program. Data relevant to eligibility shall be provided for no
16other purpose than to verify the eligibility of new applicants
17or current recipients of health benefits under the Program.
18Data shall be requested or provided for any new applicant or
19current recipient only insofar as that individual's
20circumstances are relevant to that individual's or another
21individual's eligibility.
22    (c) Within 90 days of the effective date of this amendatory
23Act of the 96th General Assembly, the Department of Healthcare
24and Family Services shall send notice to current recipients
25informing them of the changes regarding their eligibility
26verification.
 

 

 

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1    (305 ILCS 5/11-26)  (from Ch. 23, par. 11-26)
2    Sec. 11-26. Recipient's abuse of medical care;
3restrictions on access to medical care.
4    (a) When the Department determines, on the basis of
5statistical norms and medical judgment, that a medical care
6recipient has received medical services in excess of need and
7with such frequency or in such a manner as to constitute an
8abuse of the recipient's medical care privileges, the
9recipient's access to medical care may be restricted.
10    (b) When the Department has determined that a recipient is
11abusing his or her medical care privileges as described in this
12Section, it may require that the recipient designate a primary
13provider type primary care provider, primary care pharmacy, or
14health maintenance organization of the recipient's own
15choosing to assume responsibility for the recipient's care. For
16the purposes of this subsection, "primary provider type" means
17a primary care provider, primary care pharmacy, primary
18dentist, primary podiatrist, or primary durable medical
19equipment provider. Instead of requiring a recipient to make a
20designation as provided in this subsection, the Department,
21pursuant to rules adopted by the Department and without regard
22to any choice of an entity that the recipient might otherwise
23make, may initially designate a primary provider type provided
24that the primary provider type is willing to provide that care
25primary care provider, primary care pharmacy, or health

 

 

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1maintenance organization to assume responsibility for the
2recipient's care, provided that the primary care provider,
3primary care pharmacy, or health maintenance organization is
4willing to provide that care.
5    (c) When the Department has requested that a recipient
6designate a primary provider type primary care provider,
7primary care pharmacy or health maintenance organization and
8the recipient fails or refuses to do so, the Department may,
9after a reasonable period of time, assign the recipient to a
10primary provider type of its own choice and determination,
11provided such primary provider type is willing to provide such
12care primary care provider, primary care pharmacy or health
13maintenance organization of its own choice and determination,
14provided such primary care provider, primary care pharmacy or
15health maintenance organization is willing to provide such
16care.
17    (d) When a recipient has been restricted to a designated
18primary provider type primary care provider, primary care
19pharmacy or health maintenance organization, the recipient may
20change the primary provider type primary care provider, primary
21care pharmacy or health maintenance organization:
22        (1) when the designated source becomes unavailable, as
23    the Department shall determine by rule; or
24        (2) when the designated primary provider type primary
25    care provider, primary care pharmacy or health maintenance
26    organization notifies the Department that it wishes to

 

 

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1    withdraw from any obligation as primary provider type
2    primary care provider, primary care pharmacy or health
3    maintenance organization; or
4        (3) in other situations, as the Department shall
5    provide by rule.
6    The Department shall, by rule, establish procedures for
7providing medical or pharmaceutical services when the
8designated source becomes unavailable or wishes to withdraw
9from any obligation as primary provider type primary care
10provider, primary care pharmacy or health maintenance
11organization, shall, by rule, take into consideration the need
12for emergency or temporary medical assistance and shall ensure
13that the recipient has continuous and unrestricted access to
14medical care from the date on which such unavailability or
15withdrawal becomes effective until such time as the recipient
16designates a primary provider type or a primary provider type
17care source or a primary care source willing to provide such
18care is designated by the Department consistent with
19subsections (b) and (c) and such restriction becomes effective.
20    (e) Prior to initiating any action to restrict a
21recipient's access to medical or pharmaceutical care, the
22Department shall notify the recipient of its intended action.
23Such notification shall be in writing and shall set forth the
24reasons for and nature of the proposed action. In addition, the
25notification shall:
26        (1) inform the recipient that (i) the recipient has a

 

 

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1    right to designate a primary provider type primary care
2    provider, primary care pharmacy, or health maintenance
3    organization of the recipient's own choosing willing to
4    accept such designation and that the recipient's failure to
5    do so within a reasonable time may result in such
6    designation being made by the Department or (ii) the
7    Department has designated a primary provider type primary
8    care provider, primary care pharmacy, or health
9    maintenance organization to assume responsibility for the
10    recipient's care; and
11        (2) inform the recipient that the recipient has a right
12    to appeal the Department's determination to restrict the
13    recipient's access to medical care and provide the
14    recipient with an explanation of how such appeal is to be
15    made. The notification shall also inform the recipient of
16    the circumstances under which unrestricted medical
17    eligibility shall continue until a decision is made on
18    appeal and that if the recipient chooses to appeal, the
19    recipient will be able to review the medical payment data
20    that was utilized by the Department to decide that the
21    recipient's access to medical care should be restricted.
22    (f) The Department shall, by rule or regulation, establish
23procedures for appealing a determination to restrict a
24recipient's access to medical care, which procedures shall, at
25a minimum, provide for a reasonable opportunity to be heard
26and, where the appeal is denied, for a written statement of the

 

 

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1reason or reasons for such denial.
2    (g) Except as otherwise provided in this subsection, when a
3recipient has had his or her medical card restricted for 4 full
4quarters (without regard to any period of ineligibility for
5medical assistance under this Code, or any period for which the
6recipient voluntarily terminates his or her receipt of medical
7assistance, that may occur before the expiration of those 4
8full quarters), the Department shall reevaluate the
9recipient's medical usage to determine whether it is still in
10excess of need and with such frequency or in such a manner as
11to constitute an abuse of the receipt of medical assistance. If
12it is still in excess of need, the restriction shall be
13continued for another 4 full quarters. If it is no longer in
14excess of need, the restriction shall be discontinued. If a
15recipient's access to medical care has been restricted under
16this Section and the Department then determines, either at
17reevaluation or after the restriction has been discontinued, to
18restrict the recipient's access to medical care a second or
19subsequent time, the second or subsequent restriction may be
20imposed for a period of more than 4 full quarters. If the
21Department restricts a recipient's access to medical care for a
22period of more than 4 full quarters, as determined by rule, the
23Department shall reevaluate the recipient's medical usage
24after the end of the restriction period rather than after the
25end of 4 full quarters. The Department shall notify the
26recipient, in writing, of any decision to continue the

 

 

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1restriction and the reason or reasons therefor. A "quarter",
2for purposes of this Section, shall be defined as one of the
3following 3-month periods of time: January-March, April-June,
4July-September or October-December.
5    (h) In addition to any other recipient whose acquisition of
6medical care is determined to be in excess of need, the
7Department may restrict the medical care privileges of the
8following persons:
9        (1) recipients found to have loaned or altered their
10    cards or misused or falsely represented medical coverage;
11        (2) recipients found in possession of blank or forged
12    prescription pads;
13        (3) recipients who knowingly assist providers in
14    rendering excessive services or defrauding the medical
15    assistance program.
16    The procedural safeguards in this Section shall apply to
17the above individuals.
18    (i) Restrictions under this Section shall be in addition to
19and shall not in any way be limited by or limit any actions
20taken under Article VIII-A of this Code.
21(Source: P.A. 88-554, eff. 7-26-94.)
 
22    (305 ILCS 5/5-5.15 rep.)
23    Section 45. The Illinois Public Aid Code is amended by
24repealing Section 5-5.15.
 

 

 

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1    Section 50. The Illinois Vehicle Code is amended by
2changing Section 2-123 as follows:
 
3    (625 ILCS 5/2-123)  (from Ch. 95 1/2, par. 2-123)
4    Sec. 2-123. Sale and Distribution of Information.
5    (a) Except as otherwise provided in this Section, the
6Secretary may make the driver's license, vehicle and title
7registration lists, in part or in whole, and any statistical
8information derived from these lists available to local
9governments, elected state officials, state educational
10institutions, and all other governmental units of the State and
11Federal Government requesting them for governmental purposes.
12The Secretary shall require any such applicant for services to
13pay for the costs of furnishing such services and the use of
14the equipment involved, and in addition is empowered to
15establish prices and charges for the services so furnished and
16for the use of the electronic equipment utilized.
17    (b) The Secretary is further empowered to and he may, in
18his discretion, furnish to any applicant, other than listed in
19subsection (a) of this Section, vehicle or driver data on a
20computer tape, disk, other electronic format or computer
21processable medium, or printout at a fixed fee of $250 for
22orders received before October 1, 2003 and $500 for orders
23received on or after October 1, 2003, in advance, and require
24in addition a further sufficient deposit based upon the
25Secretary of State's estimate of the total cost of the

 

 

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1information requested and a charge of $25 for orders received
2before October 1, 2003 and $50 for orders received on or after
3October 1, 2003, per 1,000 units or part thereof identified or
4the actual cost, whichever is greater. The Secretary is
5authorized to refund any difference between the additional
6deposit and the actual cost of the request. This service shall
7not be in lieu of an abstract of a driver's record nor of a
8title or registration search. This service may be limited to
9entities purchasing a minimum number of records as required by
10administrative rule. The information sold pursuant to this
11subsection shall be the entire vehicle or driver data list, or
12part thereof. The information sold pursuant to this subsection
13shall not contain personally identifying information unless
14the information is to be used for one of the purposes
15identified in subsection (f-5) of this Section. Commercial
16purchasers of driver and vehicle record databases shall enter
17into a written agreement with the Secretary of State that
18includes disclosure of the commercial use of the information to
19be purchased.
20    (b-1) The Secretary is further empowered to and may, in his
21or her discretion, furnish vehicle or driver data on a computer
22tape, disk, or other electronic format or computer processible
23medium, at no fee, to any State or local governmental agency
24that uses the information provided by the Secretary to transmit
25data back to the Secretary that enables the Secretary to
26maintain accurate driving records, including dispositions of

 

 

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1traffic cases. This information may be provided without fee not
2more often than once every 6 months.
3    (c) Secretary of State may issue registration lists. The
4Secretary of State may compile a list of all registered
5vehicles. Each list of registered vehicles shall be arranged
6serially according to the registration numbers assigned to
7registered vehicles and may contain in addition the names and
8addresses of registered owners and a brief description of each
9vehicle including the serial or other identifying number
10thereof. Such compilation may be in such form as in the
11discretion of the Secretary of State may seem best for the
12purposes intended.
13    (d) The Secretary of State shall furnish no more than 2
14current available lists of such registrations to the sheriffs
15of all counties and to the chiefs of police of all cities and
16villages and towns of 2,000 population and over in this State
17at no cost. Additional copies may be purchased by the sheriffs
18or chiefs of police at the fee of $500 each or at the cost of
19producing the list as determined by the Secretary of State.
20Such lists are to be used for governmental purposes only.
21    (e) (Blank).
22    (e-1) (Blank).
23    (f) The Secretary of State shall make a title or
24registration search of the records of his office and a written
25report on the same for any person, upon written application of
26such person, accompanied by a fee of $5 for each registration

 

 

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1or title search. The written application shall set forth the
2intended use of the requested information. No fee shall be
3charged for a title or registration search, or for the
4certification thereof requested by a government agency. The
5report of the title or registration search shall not contain
6personally identifying information unless the request for a
7search was made for one of the purposes identified in
8subsection (f-5) of this Section. The report of the title or
9registration search shall not contain highly restricted
10personal information unless specifically authorized by this
11Code.
12    The Secretary of State shall certify a title or
13registration record upon written request. The fee for
14certification shall be $5 in addition to the fee required for a
15title or registration search. Certification shall be made under
16the signature of the Secretary of State and shall be
17authenticated by Seal of the Secretary of State.
18    The Secretary of State may notify the vehicle owner or
19registrant of the request for purchase of his title or
20registration information as the Secretary deems appropriate.
21    No information shall be released to the requestor until
22expiration of a 10 day period. This 10 day period shall not
23apply to requests for information made by law enforcement
24officials, government agencies, financial institutions,
25attorneys, insurers, employers, automobile associated
26businesses, persons licensed as a private detective or firms

 

 

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1licensed as a private detective agency under the Private
2Detective, Private Alarm, Private Security, Fingerprint
3Vendor, and Locksmith Act of 2004, who are employed by or are
4acting on behalf of law enforcement officials, government
5agencies, financial institutions, attorneys, insurers,
6employers, automobile associated businesses, and other
7business entities for purposes consistent with the Illinois
8Vehicle Code, the vehicle owner or registrant or other entities
9as the Secretary may exempt by rule and regulation.
10    Any misrepresentation made by a requestor of title or
11vehicle information shall be punishable as a petty offense,
12except in the case of persons licensed as a private detective
13or firms licensed as a private detective agency which shall be
14subject to disciplinary sanctions under Section 40-10 of the
15Private Detective, Private Alarm, Private Security,
16Fingerprint Vendor, and Locksmith Act of 2004.
17    (f-5) The Secretary of State shall not disclose or
18otherwise make available to any person or entity any personally
19identifying information obtained by the Secretary of State in
20connection with a driver's license, vehicle, or title
21registration record unless the information is disclosed for one
22of the following purposes:
23        (1) For use by any government agency, including any
24    court or law enforcement agency, in carrying out its
25    functions, or any private person or entity acting on behalf
26    of a federal, State, or local agency in carrying out its

 

 

09600HB5420sam002- 91 -LRB096 18878 KTG 44731 a

1    functions.
2        (2) For use in connection with matters of motor vehicle
3    or driver safety and theft; motor vehicle emissions; motor
4    vehicle product alterations, recalls, or advisories;
5    performance monitoring of motor vehicles, motor vehicle
6    parts, and dealers; and removal of non-owner records from
7    the original owner records of motor vehicle manufacturers.
8        (3) For use in the normal course of business by a
9    legitimate business or its agents, employees, or
10    contractors, but only:
11            (A) to verify the accuracy of personal information
12        submitted by an individual to the business or its
13        agents, employees, or contractors; and
14            (B) if such information as so submitted is not
15        correct or is no longer correct, to obtain the correct
16        information, but only for the purposes of preventing
17        fraud by, pursuing legal remedies against, or
18        recovering on a debt or security interest against, the
19        individual.
20        (4) For use in research activities and for use in
21    producing statistical reports, if the personally
22    identifying information is not published, redisclosed, or
23    used to contact individuals.
24        (5) For use in connection with any civil, criminal,
25    administrative, or arbitral proceeding in any federal,
26    State, or local court or agency or before any

 

 

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1    self-regulatory body, including the service of process,
2    investigation in anticipation of litigation, and the
3    execution or enforcement of judgments and orders, or
4    pursuant to an order of a federal, State, or local court.
5        (6) For use by any insurer or insurance support
6    organization or by a self-insured entity or its agents,
7    employees, or contractors in connection with claims
8    investigation activities, antifraud activities, rating, or
9    underwriting.
10        (7) For use in providing notice to the owners of towed
11    or impounded vehicles.
12        (8) For use by any person licensed as a private
13    detective or firm licensed as a private detective agency
14    under the Private Detective, Private Alarm, Private
15    Security, Fingerprint Vendor, and Locksmith Act of 2004,
16    private investigative agency or security service licensed
17    in Illinois for any purpose permitted under this
18    subsection.
19        (9) For use by an employer or its agent or insurer to
20    obtain or verify information relating to a holder of a
21    commercial driver's license that is required under chapter
22    313 of title 49 of the United States Code.
23        (10) For use in connection with the operation of
24    private toll transportation facilities.
25        (11) For use by any requester, if the requester
26    demonstrates it has obtained the written consent of the

 

 

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1    individual to whom the information pertains.
2        (12) For use by members of the news media, as defined
3    in Section 1-148.5, for the purpose of newsgathering when
4    the request relates to the operation of a motor vehicle or
5    public safety.
6        (13) For any other use specifically authorized by law,
7    if that use is related to the operation of a motor vehicle
8    or public safety.
9    (f-6) The Secretary of State shall not disclose or
10otherwise make available to any person or entity any highly
11restricted personal information obtained by the Secretary of
12State in connection with a driver's license, vehicle, or title
13registration record unless specifically authorized by this
14Code.
15    (g) 1. The Secretary of State may, upon receipt of a
16    written request and a fee of $6 before October 1, 2003 and
17    a fee of $12 on and after October 1, 2003, furnish to the
18    person or agency so requesting a driver's record. Such
19    document may include a record of: current driver's license
20    issuance information, except that the information on
21    judicial driving permits shall be available only as
22    otherwise provided by this Code; convictions; orders
23    entered revoking, suspending or cancelling a driver's
24    license or privilege; and notations of accident
25    involvement. All other information, unless otherwise
26    permitted by this Code, shall remain confidential.

 

 

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1    Information released pursuant to a request for a driver's
2    record shall not contain personally identifying
3    information, unless the request for the driver's record was
4    made for one of the purposes set forth in subsection (f-5)
5    of this Section. The Secretary of State may, without fee,
6    allow a parent or guardian of a person under the age of 18
7    years, who holds an instruction permit or graduated
8    driver's license, to view that person's driving record
9    online, through a computer connection. The parent or
10    guardian's online access to the driving record will
11    terminate when the instruction permit or graduated
12    driver's license holder reaches the age of 18.
13        2. The Secretary of State shall not disclose or
14    otherwise make available to any person or entity any highly
15    restricted personal information obtained by the Secretary
16    of State in connection with a driver's license, vehicle, or
17    title registration record unless specifically authorized
18    by this Code. The Secretary of State may certify an
19    abstract of a driver's record upon written request
20    therefor. Such certification shall be made under the
21    signature of the Secretary of State and shall be
22    authenticated by the Seal of his office.
23        3. All requests for driving record information shall be
24    made in a manner prescribed by the Secretary and shall set
25    forth the intended use of the requested information.
26        The Secretary of State may notify the affected driver

 

 

09600HB5420sam002- 95 -LRB096 18878 KTG 44731 a

1    of the request for purchase of his driver's record as the
2    Secretary deems appropriate.
3        No information shall be released to the requester until
4    expiration of a 10 day period. This 10 day period shall not
5    apply to requests for information made by law enforcement
6    officials, government agencies, financial institutions,
7    attorneys, insurers, employers, automobile associated
8    businesses, persons licensed as a private detective or
9    firms licensed as a private detective agency under the
10    Private Detective, Private Alarm, Private Security,
11    Fingerprint Vendor, and Locksmith Act of 2004, who are
12    employed by or are acting on behalf of law enforcement
13    officials, government agencies, financial institutions,
14    attorneys, insurers, employers, automobile associated
15    businesses, and other business entities for purposes
16    consistent with the Illinois Vehicle Code, the affected
17    driver or other entities as the Secretary may exempt by
18    rule and regulation.
19        Any misrepresentation made by a requestor of driver
20    information shall be punishable as a petty offense, except
21    in the case of persons licensed as a private detective or
22    firms licensed as a private detective agency which shall be
23    subject to disciplinary sanctions under Section 40-10 of
24    the Private Detective, Private Alarm, Private Security,
25    Fingerprint Vendor, and Locksmith Act of 2004.
26        4. The Secretary of State may furnish without fee, upon

 

 

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1    the written request of a law enforcement agency, any
2    information from a driver's record on file with the
3    Secretary of State when such information is required in the
4    enforcement of this Code or any other law relating to the
5    operation of motor vehicles, including records of
6    dispositions; documented information involving the use of
7    a motor vehicle; whether such individual has, or previously
8    had, a driver's license; and the address and personal
9    description as reflected on said driver's record.
10        5. Except as otherwise provided in this Section, the
11    Secretary of State may furnish, without fee, information
12    from an individual driver's record on file, if a written
13    request therefor is submitted by any public transit system
14    or authority, public defender, law enforcement agency, a
15    state or federal agency, or an Illinois local
16    intergovernmental association, if the request is for the
17    purpose of a background check of applicants for employment
18    with the requesting agency, or for the purpose of an
19    official investigation conducted by the agency, or to
20    determine a current address for the driver so public funds
21    can be recovered or paid to the driver, or for any other
22    purpose set forth in subsection (f-5) of this Section.
23        The Secretary may also furnish the courts a copy of an
24    abstract of a driver's record, without fee, subsequent to
25    an arrest for a violation of Section 11-501 or a similar
26    provision of a local ordinance. Such abstract may include

 

 

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1    records of dispositions; documented information involving
2    the use of a motor vehicle as contained in the current
3    file; whether such individual has, or previously had, a
4    driver's license; and the address and personal description
5    as reflected on said driver's record.
6        6. Any certified abstract issued by the Secretary of
7    State or transmitted electronically by the Secretary of
8    State pursuant to this Section, to a court or on request of
9    a law enforcement agency, for the record of a named person
10    as to the status of the person's driver's license shall be
11    prima facie evidence of the facts therein stated and if the
12    name appearing in such abstract is the same as that of a
13    person named in an information or warrant, such abstract
14    shall be prima facie evidence that the person named in such
15    information or warrant is the same person as the person
16    named in such abstract and shall be admissible for any
17    prosecution under this Code and be admitted as proof of any
18    prior conviction or proof of records, notices, or orders
19    recorded on individual driving records maintained by the
20    Secretary of State.
21        7. Subject to any restrictions contained in the
22    Juvenile Court Act of 1987, and upon receipt of a proper
23    request and a fee of $6 before October 1, 2003 and a fee of
24    $12 on or after October 1, 2003, the Secretary of State
25    shall provide a driver's record to the affected driver, or
26    the affected driver's attorney, upon verification. Such

 

 

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1    record shall contain all the information referred to in
2    paragraph 1 of this subsection (g) plus: any recorded
3    accident involvement as a driver; information recorded
4    pursuant to subsection (e) of Section 6-117 and paragraph
5    (4) of subsection (a) of Section 6-204 of this Code. All
6    other information, unless otherwise permitted by this
7    Code, shall remain confidential.
8    (h) The Secretary shall not disclose social security
9numbers or any associated information obtained from the Social
10Security Administration except pursuant to a written request
11by, or with the prior written consent of, the individual
12except: (1) to officers and employees of the Secretary who have
13a need to know the social security numbers in performance of
14their official duties, (2) to law enforcement officials for a
15lawful, civil or criminal law enforcement investigation, and if
16the head of the law enforcement agency has made a written
17request to the Secretary specifying the law enforcement
18investigation for which the social security numbers are being
19sought, (3) to the United States Department of Transportation,
20or any other State, pursuant to the administration and
21enforcement of the Commercial Motor Vehicle Safety Act of 1986,
22(4) pursuant to the order of a court of competent jurisdiction,
23(5) to the Department of Healthcare and Family Services
24(formerly Department of Public Aid) for utilization in the
25child support enforcement duties assigned to that Department
26under provisions of the Illinois Public Aid Code after the

 

 

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1individual has received advanced meaningful notification of
2what redisclosure is sought by the Secretary in accordance with
3the federal Privacy Act, (5.5) to the Department of Healthcare
4and Family Services and the Department of Human Services solely
5for the purpose of verifying Illinois residency where such
6residency is an eligibility requirement for benefits under the
7Illinois Public Aid Code or any other health benefit program
8administered by the Department of Healthcare and Family
9Services or the Department of Human Services, or (6) to the
10Illinois Department of Revenue solely for use by the Department
11in the collection of any tax or debt that the Department of
12Revenue is authorized or required by law to collect, provided
13that the Department shall not disclose the social security
14number to any person or entity outside of the Department.
15    (i) (Blank).
16    (j) Medical statements or medical reports received in the
17Secretary of State's Office shall be confidential. No
18confidential information may be open to public inspection or
19the contents disclosed to anyone, except officers and employees
20of the Secretary who have a need to know the information
21contained in the medical reports and the Driver License Medical
22Advisory Board, unless so directed by an order of a court of
23competent jurisdiction.
24    (k) All fees collected under this Section shall be paid
25into the Road Fund of the State Treasury, except that (i) for
26fees collected before October 1, 2003, $3 of the $6 fee for a

 

 

09600HB5420sam002- 100 -LRB096 18878 KTG 44731 a

1driver's record shall be paid into the Secretary of State
2Special Services Fund, (ii) for fees collected on and after
3October 1, 2003, of the $12 fee for a driver's record, $3 shall
4be paid into the Secretary of State Special Services Fund and
5$6 shall be paid into the General Revenue Fund, and (iii) for
6fees collected on and after October 1, 2003, 50% of the amounts
7collected pursuant to subsection (b) shall be paid into the
8General Revenue Fund.
9    (l) (Blank).
10    (m) Notations of accident involvement that may be disclosed
11under this Section shall not include notations relating to
12damage to a vehicle or other property being transported by a
13tow truck. This information shall remain confidential,
14provided that nothing in this subsection (m) shall limit
15disclosure of any notification of accident involvement to any
16law enforcement agency or official.
17    (n) Requests made by the news media for driver's license,
18vehicle, or title registration information may be furnished
19without charge or at a reduced charge, as determined by the
20Secretary, when the specific purpose for requesting the
21documents is deemed to be in the public interest. Waiver or
22reduction of the fee is in the public interest if the principal
23purpose of the request is to access and disseminate information
24regarding the health, safety, and welfare or the legal rights
25of the general public and is not for the principal purpose of
26gaining a personal or commercial benefit. The information

 

 

09600HB5420sam002- 101 -LRB096 18878 KTG 44731 a

1provided pursuant to this subsection shall not contain
2personally identifying information unless the information is
3to be used for one of the purposes identified in subsection
4(f-5) of this Section.
5    (o) The redisclosure of personally identifying information
6obtained pursuant to this Section is prohibited, except to the
7extent necessary to effectuate the purpose for which the
8original disclosure of the information was permitted.
9    (p) The Secretary of State is empowered to adopt rules to
10effectuate this Section.
11(Source: P.A. 95-201, eff. 1-1-08; 95-287, eff. 1-1-08; 95-331,
12eff. 8-21-07; 95-613, eff. 9-11-07; 95-876, eff. 8-21-08;
1396-1383, eff. 1-1-11.)
 
14    Section 95. Severability. If any provision of this Act or
15application thereof to any person or circumstance is held
16invalid, such invalidity does not affect other provisions or
17applications of this Act which can be given effect without the
18invalid application or provision, and to this end the
19provisions of this Act are declared to be severable.
 
20    Section 99. Effective date. This Act takes effect upon
21becoming law.".