Full Text of HB0175 100th General Assembly
HB0175sam001 100TH GENERAL ASSEMBLY | Sen. John G. Mulroe Filed: 5/7/2018
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| 1 | | AMENDMENT TO HOUSE BILL 175
| 2 | | AMENDMENT NO. ______. Amend House Bill 175 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 11-5.4 and by adding Section 5-5g as follows: | 6 | | (305 ILCS 5/5-5g new) | 7 | | Sec. 5-5g. Long-term care patient; resident status. | 8 | | Long-term care providers shall submit all changes in resident | 9 | | status, including, but not limited to, death, discharge, | 10 | | changes in patient credit, third party liability, and Medicare | 11 | | coverage, to the Department through the Medical Electronic Data | 12 | | Interchange System, the Recipient Eligibility Verification | 13 | | System, or the Electronic Data Interchange System established | 14 | | under 89 Ill. Adm. Code 140.55(b) in compliance with the | 15 | | schedule below: | 16 | | (1) 15 calendar days after a resident's death; |
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| 1 | | (2) 15 calendar days after a resident's discharge; | 2 | | (3) 45 calendar days after being informed of a change | 3 | | in the resident's income; | 4 | | (4) 45 calendar days after being informed of a change | 5 | | in a resident's third party liability; | 6 | | (5) 45 calendar days after a resident's move to | 7 | | exceptional care services; and | 8 | | (6) 45 calendar days after a resident's need for | 9 | | services requiring reimbursement under the ventilator or | 10 | | traumatic brain injury enhanced rate. | 11 | | (305 ILCS 5/11-5.4) | 12 | | Sec. 11-5.4. Expedited long-term care eligibility | 13 | | determination , renewal, and enrollment , and payment . | 14 | | (a) The General Assembly finds that it is in the best | 15 | | interest of the State to process on an expedited basis | 16 | | applications and renewal applications for Medicaid and | 17 | | Medicaid long-term care benefits that are submitted by or on | 18 | | behalf of elderly persons in need of long-term care services. | 19 | | It is the intent of the General Assembly that the provisions of | 20 | | this Section be liberally construed to permit the maximum | 21 | | number of applicants to benefit, regardless of the age of the | 22 | | application, and for the State to complete all processing as | 23 | | required under 42 U.S.C. 1396a(a)(8) and 42 CFR 435. An | 24 | | expedited long-term care eligibility determination and | 25 | | enrollment system shall be established to reduce long-term care |
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| 1 | | determinations to 90 days or fewer by July 1, 2014 and | 2 | | streamline the long-term care enrollment process. | 3 | | Establishment of the system shall be a joint venture of the | 4 | | Department of Human Services and Healthcare and Family Services | 5 | | and the Department on Aging. The Governor shall name a lead | 6 | | agency no later than 30 days after the effective date of this | 7 | | amendatory Act of the 98th General Assembly to assume | 8 | | responsibility for the full implementation of the | 9 | | establishment and maintenance of the system. Project outcomes | 10 | | shall include an enhanced eligibility determination tracking | 11 | | system accessible to providers and a centralized application | 12 | | review and eligibility determination with all applicants | 13 | | reviewed within 90 days of receipt by the State of a complete | 14 | | application. If the Department of Healthcare and Family | 15 | | Services' Office of the Inspector General determines that there | 16 | | is a likelihood that a non-allowable transfer of assets has | 17 | | occurred, and the facility in which the applicant resides is | 18 | | notified, an extension of up to 90 days shall be permissible. | 19 | | On or before December 31, 2015, a streamlined application and | 20 | | enrollment process shall be put in place based on the following | 21 | | principles: | 22 | | (1) Minimize the burden on applicants by collecting | 23 | | only the data necessary to determine eligibility for | 24 | | medical services, long-term care services, and spousal | 25 | | impoverishment offset. | 26 | | (2) Integrate online data sources to simplify the |
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| 1 | | application process by reducing the amount of information | 2 | | needed to be entered and to expedite eligibility | 3 | | verification. | 4 | | (3) Provide online prompts to alert the applicant that | 5 | | information is missing or not complete. | 6 | | (a-5) As used in this Section: | 7 | | "Department" means the Department of Healthcare and Family | 8 | | Services. | 9 | | "Managed care organization" has the meaning ascribed to | 10 | | that term in Section 5-30.1 of this Code. | 11 | | "Renewal" has the same meaning as "redetermination" in | 12 | | State policies, administrative rules, and federal Medicaid | 13 | | law. | 14 | | (b) The Department of Healthcare and Family Services must | 15 | | serve as the lead agency assuming primary responsibility for | 16 | | the full implementation of this Section, including the | 17 | | establishment and operation of the system. The Department | 18 | | shall, on or before July 1, 2014, assess the feasibility of | 19 | | incorporating all information needed to determine eligibility | 20 | | for long-term care services, including asset transfer and | 21 | | spousal impoverishment financials, into the State's integrated | 22 | | eligibility system identifying all resources needed and | 23 | | reasonable timeframes for achieving the specified integration. | 24 | | (c) Beginning on June 29, 2018, provisional eligibility, in | 25 | | the form of a recipient identification number and any other | 26 | | necessary credentials to permit an applicant to receive |
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| 1 | | benefits, must be issued to any applicant who has not received | 2 | | a final eligibility determination on his or her application for | 3 | | Medicaid or Medicaid long-term care benefits or a notice of an | 4 | | opportunity for a hearing within the federally prescribed | 5 | | deadlines for the processing of such applications. The | 6 | | Department must maintain the applicant's provisional Medicaid | 7 | | enrollment status until a final eligibility determination is | 8 | | approved or the applicant's appeal has been adjudicated and | 9 | | eligibility is denied. The Department or the managed care | 10 | | organization, if applicable, must reimburse providers for all | 11 | | services rendered during an applicant's provisional | 12 | | eligibility period. | 13 | | (1) The Department must immediately notify the managed | 14 | | care organization, if applicable, in which the applicant is | 15 | | an enrollee of the enrollee's change in status. | 16 | | (2) The Department or the managed care organization, | 17 | | when applicable, must begin processing claims for services | 18 | | rendered by the end of the month in which the applicant is | 19 | | given provisional eligibility status. Claims for services | 20 | | rendered must be submitted and processed by the Department | 21 | | and managed care organizations in the same manner as those | 22 | | submitted on behalf of beneficiaries determined to qualify | 23 | | for benefits. | 24 | | (3)
An applicant with provisional enrollment status | 25 | | must have his or her benefits paid for under the State's | 26 | | fee-for-service system until such time as the State makes a |
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| 1 | | final determination on the applicant's Medicaid or | 2 | | Medicaid long-term care application. If an individual is | 3 | | enrolled with a managed care organization for community | 4 | | benefits at the time the individual's provisional status is | 5 | | issued, the managed care organization is only responsible | 6 | | for paying benefits covered under the capitation payment | 7 | | received by the managed care organization for the | 8 | | individual. | 9 | | (4)
The Department, within 10 business days of issuing | 10 | | provisional eligibility to an applicant not covered by a | 11 | | managed care organization, must submit to the Office of the | 12 | | Comptroller for payment a voucher for all retroactive | 13 | | reimbursement due. The Department must clearly identify | 14 | | such vouchers as provisional eligibility vouchers. The | 15 | | lead agency shall file interim reports with the Chairs and | 16 | | Minority Spokespersons of the House and Senate Human | 17 | | Services Committees no later than September 1, 2013 and on | 18 | | February 1, 2014. The Department of Healthcare and Family | 19 | | Services shall include in the annual Medicaid report for | 20 | | State Fiscal Year 2014 and every fiscal year thereafter | 21 | | information concerning implementation of the provisions of | 22 | | this Section. | 23 | | (d) The Department must establish, by rule, policies and | 24 | | procedures to ensure prospective compliance with the federal | 25 | | deadlines for Medicaid and Medicaid long-term care benefits | 26 | | eligibility determinations required under 42 U.S.C. |
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| 1 | | 1396a(a)(8) and 42 CFR 435.912, which must include, but need | 2 | | not be limited to, the following: | 3 | | (1) The Department, assisted by the Department of Human | 4 | | Services and the Department on Aging, must establish, no | 5 | | later than January 1, 2019, a streamlined application and | 6 | | enrollment process that includes, but is not limited to, | 7 | | the following: | 8 | | (A) collect only the data necessary to determine | 9 | | eligibility for medical services, long-term care | 10 | | services, and spousal impoverishment offset; | 11 | | (B)
integrate online data and other third party | 12 | | data sources to simplify the application process by | 13 | | reducing the amount of information needed to be entered | 14 | | and to expedite eligibility verification; | 15 | | (C)
provide online prompts to alert the applicant | 16 | | that information is missing or incomplete; and | 17 | | (D)
provide training and step-by-step written | 18 | | instructions for caseworkers, applicants, and | 19 | | providers. | 20 | | (2) The Department must expedite the eligibility | 21 | | processing system for applicants meeting certain | 22 | | guidelines, regardless of the age of the application. The | 23 | | guidelines must be established by rule and must include, | 24 | | but not be limited to, the following individually or | 25 | | collectively: | 26 | | (A) Full Medicaid benefits in the community for a |
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| 1 | | specified period of time. | 2 | | (B)
No transfer of assets or resources during the | 3 | | federally prescribed look-back time period, as | 4 | | specified by federal law. | 5 | | (C)
Receives Supplemental Security Income payments | 6 | | or was receiving such payments at the time the | 7 | | applicant was admitted to a nursing facility. | 8 | | (D)
Verified income at or below 100% of the federal | 9 | | poverty level when the declared value of the | 10 | | applicant's countable resources is no greater than the | 11 | | allowable amounts pursuant to Section 5-2 of this Code | 12 | | for classes of eligible persons for whom a resource | 13 | | limit applies. | 14 | | (3) The Department must establish, by rule, renewal | 15 | | policies and procedures to reduce the likelihood of | 16 | | unnecessary interruptions in services as a result of | 17 | | improper denials of applicants who would otherwise be | 18 | | approved. | 19 | | (A) Effective January 1, 2019, the Department must | 20 | | implement a paperless passive renewal protocol that | 21 | | provides for the electronic verification of all | 22 | | necessary information including bank accounts. | 23 | | (B) A beneficiary who is a resident of a facility | 24 | | and whose previous renewal application showed an | 25 | | income of no greater than the federal poverty level and | 26 | | who has no discernible means of generating income |
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| 1 | | greater than the federal poverty level must be deemed | 2 | | to qualify for renewal. The beneficiary and the | 3 | | facility must not receive an application for renewal | 4 | | and must instead receive notification of the | 5 | | beneficiary's renewal. | 6 | | (C) A beneficiary for whom the processing of a | 7 | | renewal application exceeds federally prescribed | 8 | | timeframes must be deemed to meet renewal guidelines | 9 | | and the Department must notify the beneficiary and the | 10 | | facility in which the beneficiary resides. The | 11 | | Department must also immediately notify the managed | 12 | | care organization in which the beneficiary is | 13 | | enrolled, if applicable. Both the Department and the | 14 | | managed care organization must accept claims for | 15 | | services rendered to the beneficiary without an | 16 | | interruption in benefits to the enrollee and payment | 17 | | for all services rendered to providers. | 18 | | (4) The Department of Human Services must not penalize | 19 | | an applicant for having an attorney complete a Medicaid | 20 | | application on the applicant's behalf or for seeking to | 21 | | understand the applicant's rights under federal and State | 22 | | Medicaid laws and regulations. This must not include | 23 | | targeting applications and applicants so described for | 24 | | additional scrutiny by the Department of Healthcare and | 25 | | Family Services' Office of the Inspector General. | 26 | | (5) The Department of Healthcare and Family Services' |
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| 1 | | Office of the Inspector General must review applications | 2 | | for long-term care benefits when the Office obtains | 3 | | credible evidence that an applicant has transferred assets | 4 | | with the intent of defrauding the State. If proof of the | 5 | | allegations does not exist, the application must be | 6 | | released by the Office and must be assigned to the | 7 | | appropriate caseworker for an expedited review. | 8 | | (6) The Department of Human Services must implement a | 9 | | process to notify an applicant, the applicant's legally | 10 | | authorized representative, and the facility where the | 11 | | applicant resides of the receipt of an initial or renewal | 12 | | application and supporting documentation within 5 business | 13 | | days of the date the application or supporting documents | 14 | | are submitted. The notices should indicate any | 15 | | documentation required, but not received, and provide | 16 | | instructions for submission. | 17 | | (7) The Department must make available one release form | 18 | | that permits the applicant to grant permission to a third | 19 | | party to pursue approval of Medicaid and Medicaid long-term | 20 | | care benefits, track the status of applications, and pursue | 21 | | a post-denial appeal on behalf of the applicant, which must | 22 | | remain in force after the applicant's death. | 23 | | (8) The Department must develop one eligibility system | 24 | | for both Modified Adjusted Gross Income (MAGI) and non-MAGI | 25 | | applicants by incorporating Affordable Care Act upgrades | 26 | | with the goal of establishing real time approval of |
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| 1 | | applications for Medicaid services and Medicaid long-term | 2 | | care benefits, as permissible. | 3 | | (9) The Department must have operational a fully | 4 | | electronic application process that encompasses initial | 5 | | applications, admission packet, renewals, and appeals no | 6 | | later than 12 months after the effective date of this | 7 | | amendatory Act of the 100th General Assembly. The | 8 | | Department must not require submission of any application | 9 | | or supporting documentation in hard copy. No later than | 10 | | August 1, 2014, the Auditor General shall report to the | 11 | | General Assembly concerning the extent to which the | 12 | | timeframes specified in this Section have been met and the | 13 | | extent to which State staffing levels are adequate to meet | 14 | | the requirements of this Section.
| 15 | | (e) The Department must adopt policies and procedures to | 16 | | improve communication between long-term care benefits central | 17 | | office personnel, applicants, or the applicants' | 18 | | representatives, and facilities in which the applicants | 19 | | reside. The Department must establish, by rule, such policies | 20 | | and procedures that are necessary to meet the requirements of | 21 | | this Section, which must include, but need not be limited to, | 22 | | the following: | 23 | | (1) The establishment of a centralized, | 24 | | caseworker-based processing system with contact numbers | 25 | | for caseworkers and supervisors that are made readily | 26 | | available to all affected providers and are prominently |
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| 1 | | displayed on all communications with applicants, | 2 | | beneficiaries, and providers. | 3 | | (2) Allowing facilities access to the State's | 4 | | integrated eligibility system for tracking the status of | 5 | | applications for applicants who have signed appropriate | 6 | | releases, and the development and distribution of | 7 | | applicable instructional materials and release forms. The | 8 | | Department of Healthcare and Family Services, the | 9 | | Department of Human Services, and the Department on Aging | 10 | | shall take the following steps to achieve federally | 11 | | established timeframes for eligibility determinations for | 12 | | Medicaid and long-term care benefits and shall work toward | 13 | | the federal goal of real time determinations: | 14 | | (1) The Departments shall review, in collaboration | 15 | | with representatives of affected providers, all forms and | 16 | | procedures currently in use, federal guidelines either | 17 | | suggested or mandated, and staff deployment by September | 18 | | 30, 2014 to identify additional measures that can improve | 19 | | long-term care eligibility processing and make adjustments | 20 | | where possible. | 21 | | (2) No later than June 30, 2014, the Department of | 22 | | Healthcare and Family Services shall issue vouchers for | 23 | | advance payments not to exceed $50,000,000 to nursing | 24 | | facilities with significant outstanding Medicaid liability | 25 | | associated with services provided to residents with | 26 | | Medicaid applications pending and residents facing the |
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| 1 | | greatest delays. Each facility with an advance payment | 2 | | shall state in writing whether its own recoupment schedule | 3 | | will be in 3 or 6 equal monthly installments, as long as | 4 | | all advances are recouped by June 30, 2015. | 5 | | (3) The Department of Healthcare and Family Services' | 6 | | Office of Inspector General and the Department of Human | 7 | | Services shall immediately forgo resource review and | 8 | | review of transfers during the relevant look-back period | 9 | | for applications that were submitted prior to September 1, | 10 | | 2013. An applicant who applied prior to September 1, 2013, | 11 | | who was denied for failure to cooperate in providing | 12 | | required information, and whose application was | 13 | | incorrectly reviewed under the wrong look-back period | 14 | | rules may request review and correction of the denial based | 15 | | on this subsection. If found eligible upon review, such | 16 | | applicants shall be retroactively enrolled. | 17 | | (4) As soon as practicable, the Department of | 18 | | Healthcare and Family Services shall implement policies | 19 | | and promulgate rules to simplify financial eligibility | 20 | | verification in the following instances: (A) for | 21 | | applicants or recipients who are receiving Supplemental | 22 | | Security Income payments or who had been receiving such | 23 | | payments at the time they were admitted to a nursing | 24 | | facility and (B) for applicants or recipients with verified | 25 | | income at or below 100% of the federal poverty level when | 26 | | the declared value of their countable resources is no |
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| 1 | | greater than the allowable amounts pursuant to Section 5-2 | 2 | | of this Code for classes of eligible persons for whom a | 3 | | resource limit applies. Such simplified verification | 4 | | policies shall apply to community cases as well as | 5 | | long-term care cases. | 6 | | (5) As soon as practicable, but not later than July 1, | 7 | | 2014, the Department of Healthcare and Family Services and | 8 | | the Department of Human Services shall jointly begin a | 9 | | special enrollment project by using simplified eligibility | 10 | | verification policies and by redeploying caseworkers | 11 | | trained to handle long-term care cases to prioritize those | 12 | | cases, until the backlog is eliminated and processing time | 13 | | is within 90 days. This project shall apply to applications | 14 | | for long-term care received by the State on or before May | 15 | | 15, 2014. | 16 | | (6) As soon as practicable, but not later than | 17 | | September 1, 2014, the Department on Aging shall make | 18 | | available to long-term care facilities and community | 19 | | providers upon request, through an electronic method, the | 20 | | information contained within the Interagency Certification | 21 | | of Screening Results completed by the pre-screener, in a | 22 | | form and manner acceptable to the Department of Human | 23 | | Services. | 24 | | (f) The Department must establish, by rule, policies and | 25 | | procedures to improve accountability and provide for the | 26 | | expedited payment of services rendered, which must include, but |
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| 1 | | need not be limited to, the following: | 2 | | (1) The Department must apply the most current resident | 3 | | income data entered into the Department's Medical | 4 | | Electronic Data Interchange (MEDI) system to the payment of | 5 | | a claim even if a caseworker has not completed a review. | 6 | | (2) The Department and the Department of Human Services | 7 | | must notify the applicant, or the applicant's legal | 8 | | representative, and the facility submitting the initial, | 9 | | renewal, or appeal application of all missing supporting | 10 | | documentation or information and the date of the request | 11 | | when an application, renewal, or appeal is denied for | 12 | | failure to submit such documentation and information. | 13 | | (g) No later than January 1, 2019, the Department of | 14 | | Healthcare and Family Services must investigate the | 15 | | public-private partnerships in use in Ohio, Michigan, and | 16 | | Minnesota aimed at redeploying caseworkers to targeted | 17 | | high-Medicaid facilities for the purpose of expediting initial | 18 | | Medicaid and Medicaid long-term care benefits applications, | 19 | | renewals, asset discovery, and all other things related to | 20 | | enrollment, reimbursement, and application processing. No | 21 | | later than March 1, 2019, the Department of Healthcare and | 22 | | Family Services must post on the long-term care pages of the | 23 | | Department's website the agencies' joint recommendations and | 24 | | must assist provider groups in educating their members on such | 25 | | partnerships. | 26 | | (h) The Director of Healthcare and Family Services, in |
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| 1 | | coordination with the Secretary of Human Services and the | 2 | | Director of Aging, must host a provider association meeting | 3 | | every 6 weeks, beginning no later than 30 days after the | 4 | | effective date of this amendatory Act of the 100th General | 5 | | Assembly, until all applications that are 45 days or older have | 6 | | been adjudicated and the application process has been reduced | 7 | | to 45 or fewer days, at which time the meetings shall be held | 8 | | quarterly, for those associations representing facilities | 9 | | licensed under the Nursing Home Care Act and certified as a | 10 | | supportive living program. Each agency must be represented by | 11 | | senior staff with hands-on knowledge of the processing of | 12 | | applications for Medicaid and Medicaid long-term care | 13 | | benefits, renewals, and such ancillary issues as income and | 14 | | address adjustments, release forms, and screening reports. | 15 | | Agenda items must be solicited from the associations. | 16 | | (i) The Department must not delay the implementation of the | 17 | | presumptive eligibility, as ordered by Koss v. Norwood, Case | 18 | | No. 17 C 2762 (N.D. Ill. Mar. 29, 2018), in anticipation of | 19 | | this amendatory Act of the 100th General Assembly. | 20 | | (j) As mandated by federal regulations under 42 CFR | 21 | | 435.912, the Department and the Department of Human Services | 22 | | must not deny applications for Medicaid or Medicaid long-term | 23 | | care benefits to comply with the federal timeliness standards | 24 | | or avoid authorizing provisional eligibility under this | 25 | | Section. To ensure compliance, the percentage of denials in a | 26 | | given month must not increase by more than 1% of the denial |
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| 1 | | rate that occurred in the same month of the preceding year. | 2 | | (k) The Department of Human Services must prioritize | 3 | | processing applications on a last-in, first-out basis. The | 4 | | Department is expressly prohibited from prioritizing the | 5 | | processing of applications from applicants who have been issued | 6 | | provisional eligibility status over other applicants. | 7 | | (l) Unless otherwise specified, all provisions of this | 8 | | amendatory Act of the 100th General Assembly must be fully | 9 | | operational by January 1, 2019. | 10 | | (m) Nothing in this Section shall defeat the provisions | 11 | | contained in the State Prompt Payment Act or the timely pay | 12 | | provisions contained in Section 368a of the Illinois Insurance | 13 | | Code. | 14 | | (n) The Department must offer regionally based training | 15 | | covering all aspects of this Section and must include long-term | 16 | | care provider associations in the design and presentation of | 17 | | the training. The training shall be recorded and posted on the | 18 | | Department's website to allow new employees to be trained and | 19 | | older employers to complete refresher courses. | 20 | | (o) The Department and the Department of Human Services | 21 | | must not require an applicant for Medicaid or Medicaid | 22 | | long-term care benefits to submit a new application solely | 23 | | because there is a change in the applicant's legal | 24 | | representative. | 25 | | (p) The Department and the Department of Human Services | 26 | | must implement the requirements under this Section even if the |
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| 1 | | required rules are not yet adopted by the dates specified in | 2 | | this Section. If the Department is required to adopt rules | 3 | | under this Section or if the Department determines that rules | 4 | | are necessary to achieve full implementation, the Department | 5 | | must adopt policies and procedures to allow for full | 6 | | implementation by the date specified in this Section and must | 7 | | publish all policies and procedures on the Department's | 8 | | website. The Department must submit proposed permanent rules | 9 | | for public comment no later than January 1, 2019. | 10 | | (q) (7) Effective 30 days after the completion of 3 | 11 | | regionally based trainings, nursing facilities shall submit | 12 | | all applications for medical assistance online via the | 13 | | Application for Benefits Eligibility (ABE) website. This | 14 | | requirement shall extend to scanning and uploading with the | 15 | | online application any required additional forms such as the | 16 | | Long Term Care Facility Notification and the Additional | 17 | | Financial Information for Long Term Care Applicants as well as | 18 | | scanned copies of any supporting documentation. Long-term care | 19 | | facility admission documents must be submitted as required in | 20 | | Section 5-5 of this Code. No local Department of Human Services | 21 | | office shall refuse to accept an electronically filed | 22 | | application. | 23 | | (r) (8) Notwithstanding any other provision of this Code, | 24 | | the Department of Human Services and the Department of | 25 | | Healthcare and Family Services' Office of the Inspector General | 26 | | shall, upon request, allow an applicant additional time to |
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| 1 | | submit information and documents needed as part of a review of | 2 | | available resources or resources transferred during the | 3 | | look-back period. The initial extension shall not exceed 30 | 4 | | days. A second extension of 30 days may be granted upon | 5 | | request. Any request for information issued by the State to an | 6 | | applicant shall include the following: an explanation of the | 7 | | information required and the date by which the information must | 8 | | be submitted; a statement that failure to respond in a timely | 9 | | manner can result in denial of the application; a statement | 10 | | that the applicant or the facility in the name of the applicant | 11 | | may seek an extension; and the name and contact information of | 12 | | a caseworker in case of questions. Any such request for | 13 | | information shall also be sent to the facility. In deciding | 14 | | whether to grant an extension, the Department of Human Services | 15 | | or the Department of Healthcare and Family Services' Office of | 16 | | the Inspector General shall take into account what is in the | 17 | | best interest of the applicant. The time limits for processing | 18 | | an application shall be tolled during the period of any | 19 | | extension granted under this subsection. | 20 | | (s) (9) The Department of Human Services and the Department | 21 | | of Healthcare and Family Services must jointly compile data on | 22 | | pending applications, denials, appeals, and renewals | 23 | | redeterminations into a monthly report, which shall be posted | 24 | | on each Department's website for the purposes of monitoring | 25 | | long-term care eligibility processing. The report must specify | 26 | | the number of applications and renewals redeterminations |
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| 1 | | pending long-term care eligibility determination and admission | 2 | | and the number of appeals of denials in the following | 3 | | categories: | 4 | | (1) (A) Length of time applications, renewals | 5 | | redeterminations , and appeals are pending - 0 to 45 days, | 6 | | 46 days to 90 days, 91 days to 180 days, 181 days to 12 | 7 | | months, over 12 months to 18 months, over 18 months to 24 | 8 | | months, and over 24 months. | 9 | | (2) (B) Percentage of applications and renewals | 10 | | redeterminations pending in the Department of Human | 11 | | Services' Family Community Resource Centers, in the | 12 | | Department of Human Services' long-term care hubs, with the | 13 | | Department of Healthcare and Family Services' Office of | 14 | | Inspector General, and those applications which are being | 15 | | tolled due to requests for extension of time for additional | 16 | | information. | 17 | | (3) (C) Status of pending applications, denials, | 18 | | appeals, and renewals redeterminations . | 19 | | (4) For applications, renewals, and appeals pending | 20 | | more than 45 days, the reason for the delay as required by | 21 | | federal regulations under 42 CFR 435.912. | 22 | | (t) (f) Beginning on July 1, 2017, the Auditor General | 23 | | shall report every 3 years to the General Assembly on the | 24 | | performance and compliance of the Department of Healthcare and | 25 | | Family Services, the Department of Human Services, and the | 26 | | Department on Aging in meeting the requirements of this Section |
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| 1 | | and the federal requirements concerning eligibility | 2 | | determinations for Medicaid long-term care services and | 3 | | supports, and shall report any issues or deficiencies and make | 4 | | recommendations. The Auditor General shall, at a minimum, | 5 | | review, consider, and evaluate the following: | 6 | | (1) compliance with federal regulations on furnishing | 7 | | services as related to Medicaid long-term care services and | 8 | | supports as provided under 42 CFR 435.930; | 9 | | (2) compliance with federal regulations on the timely | 10 | | determination of eligibility as provided under 42 CFR | 11 | | 435.912; | 12 | | (3) the accuracy and completeness of the report | 13 | | required under paragraph (9) of subsection (e); | 14 | | (4) the efficacy and efficiency of the task-based | 15 | | process used for making eligibility determinations in the | 16 | | centralized offices of the Department of Human Services for | 17 | | long-term care services, including the role of the State's | 18 | | integrated eligibility system, as opposed to the | 19 | | traditional caseworker-specific process from which these | 20 | | central offices have converted; and | 21 | | (5) any issues affecting eligibility determinations | 22 | | related to the Department of Human Services' staff | 23 | | completing Medicaid eligibility determinations instead of | 24 | | the designated single-state Medicaid agency in Illinois, | 25 | | the Department of Healthcare and Family Services. | 26 | | The Auditor General's report shall include any and all |
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| 1 | | other areas or issues which are identified through an annual | 2 | | review. Paragraphs (1) through (5) of this subsection shall not | 3 | | be construed to limit the scope of the annual review and the | 4 | | Auditor General's authority to thoroughly and completely | 5 | | evaluate any and all processes, policies, and procedures | 6 | | concerning compliance with federal and State law requirements | 7 | | on eligibility determinations for Medicaid long-term care | 8 | | services and supports. | 9 | | (Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.".
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