Full Text of HB2814 100th General Assembly
HB2814ham001 100TH GENERAL ASSEMBLY | Rep. Norine K. Hammond Filed: 3/16/2017
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| 1 | | AMENDMENT TO HOUSE BILL 2814
| 2 | | AMENDMENT NO. ______. Amend House Bill 2814 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 as follows: | 6 | | (305 ILCS 5/11-5.4) | 7 | | Sec. 11-5.4. Expedited long-term care eligibility | 8 | | determination and enrollment. | 9 | | (a) An expedited long-term care eligibility determination | 10 | | and enrollment system shall be established to reduce long-term | 11 | | care determinations to 90 days or fewer by July 1, 2014 and | 12 | | streamline the long-term care enrollment process. | 13 | | Establishment of the system shall be a joint venture of the | 14 | | Department of Human Services and Healthcare and Family Services | 15 | | and the Department on Aging. The Governor shall name a lead | 16 | | agency no later than 30 days after the effective date of this |
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| 1 | | amendatory Act of the 98th General Assembly to assume | 2 | | responsibility for the full implementation of the | 3 | | establishment and maintenance of the system. Project outcomes | 4 | | shall include an enhanced eligibility determination tracking | 5 | | system accessible to providers and a centralized application | 6 | | review and eligibility determination with all applicants | 7 | | reviewed within 90 days of receipt by the State of a complete | 8 | | application. If the Department of Healthcare and Family | 9 | | Services' Office of the Inspector General determines that there | 10 | | is a likelihood that a non-allowable transfer of assets has | 11 | | occurred, and the facility in which the applicant resides is | 12 | | notified, an extension of up to 90 days shall be permissible. | 13 | | On or before December 31, 2015, a streamlined application and | 14 | | enrollment process shall be put in place based on the following | 15 | | principles: | 16 | | (1) Minimize the burden on applicants by collecting | 17 | | only the data necessary to determine eligibility for | 18 | | medical services, long-term care services, and spousal | 19 | | impoverishment offset. | 20 | | (2) Integrate online data sources to simplify the | 21 | | application process by reducing the amount of information | 22 | | needed to be entered and to expedite eligibility | 23 | | verification. | 24 | | (3) Provide online prompts to alert the applicant that | 25 | | information is missing or not complete. | 26 | | (b) The Department shall, on or before July 1, 2014, assess |
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| 1 | | the feasibility of incorporating all information needed to | 2 | | determine eligibility for long-term care services, including | 3 | | asset transfer and spousal impoverishment financials, into the | 4 | | State's integrated eligibility system identifying all | 5 | | resources needed and reasonable timeframes for achieving the | 6 | | specified integration. | 7 | | (c) The lead agency shall file interim reports with the | 8 | | Chairs and Minority Spokespersons of the House and Senate Human | 9 | | Services Committees no later than September 1, 2013 and on | 10 | | February 1, 2014. The Department of Healthcare and Family | 11 | | Services shall include in the annual Medicaid report for State | 12 | | Fiscal Year 2014 and every fiscal year thereafter information | 13 | | concerning implementation of the provisions of this Section. | 14 | | (d) No later than August 1, 2014, the Auditor General shall | 15 | | report to the General Assembly concerning the extent to which | 16 | | the timeframes specified in this Section have been met and the | 17 | | extent to which State staffing levels are adequate to meet the | 18 | | requirements of this Section.
| 19 | | (e) The Department of Healthcare and Family Services, the | 20 | | Department of Human Services, and the Department on Aging shall | 21 | | take the following steps to achieve federally established | 22 | | timeframes for eligibility determinations for Medicaid and | 23 | | long-term care benefits and shall work toward the federal goal | 24 | | of real time determinations: | 25 | | (1) The Departments shall review, in collaboration | 26 | | with representatives of affected providers, all forms and |
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| 1 | | procedures currently in use, federal guidelines either | 2 | | suggested or mandated, and staff deployment by September | 3 | | 30, 2014 to identify additional measures that can improve | 4 | | long-term care eligibility processing and make adjustments | 5 | | where possible. | 6 | | (2) No later than June 30, 2014, the Department of | 7 | | Healthcare and Family Services shall issue vouchers for | 8 | | advance payments not to exceed $50,000,000 to nursing | 9 | | facilities with significant outstanding Medicaid liability | 10 | | associated with services provided to residents with | 11 | | Medicaid applications pending and residents facing the | 12 | | greatest delays. Each facility with an advance payment | 13 | | shall state in writing whether its own recoupment schedule | 14 | | will be in 3 or 6 equal monthly installments, as long as | 15 | | all advances are recouped by June 30, 2015. | 16 | | (3) The Department of Healthcare and Family Services' | 17 | | Office of Inspector General and the Department of Human | 18 | | Services shall immediately forgo resource review and | 19 | | review of transfers during the relevant look-back period | 20 | | for applications that were submitted prior to September 1, | 21 | | 2013. An applicant who applied prior to September 1, 2013, | 22 | | who was denied for failure to cooperate in providing | 23 | | required information, and whose application was | 24 | | incorrectly reviewed under the wrong look-back period | 25 | | rules may request review and correction of the denial based | 26 | | on this subsection. If found eligible upon review, such |
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| 1 | | applicants shall be retroactively enrolled. | 2 | | (4) As soon as practicable, the Department of | 3 | | Healthcare and Family Services shall implement policies | 4 | | and promulgate rules to simplify financial eligibility | 5 | | verification in the following instances: (A) for | 6 | | applicants or recipients who are receiving Supplemental | 7 | | Security Income payments or who had been receiving such | 8 | | payments at the time they were admitted to a nursing | 9 | | facility and (B) for applicants or recipients with verified | 10 | | income at or below 100% of the federal poverty level when | 11 | | the declared value of their countable resources is no | 12 | | greater than the allowable amounts pursuant to Section 5-2 | 13 | | of this Code for classes of eligible persons for whom a | 14 | | resource limit applies. Such simplified verification | 15 | | policies shall apply to community cases as well as | 16 | | long-term care cases. | 17 | | (5) As soon as practicable, but not later than July 1, | 18 | | 2014, the Department of Healthcare and Family Services and | 19 | | the Department of Human Services shall jointly begin a | 20 | | special enrollment project by using simplified eligibility | 21 | | verification policies and by redeploying caseworkers | 22 | | trained to handle long-term care cases to prioritize those | 23 | | cases, until the backlog is eliminated and processing time | 24 | | is within 90 days. This project shall apply to applications | 25 | | for long-term care received by the State on or before May | 26 | | 15, 2014. |
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| 1 | | (6) As soon as practicable, but not later than | 2 | | September 1, 2014, the Department on Aging shall make | 3 | | available to long-term care facilities and community | 4 | | providers upon request, through an electronic method, the | 5 | | information contained within the Interagency Certification | 6 | | of Screening Results completed by the pre-screener, in a | 7 | | form and manner acceptable to the Department of Human | 8 | | Services. | 9 | | (7) Effective 30 days after the completion of 3 | 10 | | regionally based trainings, nursing facilities shall | 11 | | submit all applications for medical assistance online via | 12 | | the Application for Benefits Eligibility (ABE) website. | 13 | | This requirement shall extend to scanning and uploading | 14 | | with the online application any required additional forms | 15 | | such as the Long Term Care Facility Notification and the | 16 | | Additional Financial Information for Long Term Care | 17 | | Applicants as well as scanned copies of any supporting | 18 | | documentation. Long-term care facility admission documents | 19 | | must be submitted as required in Section 5-5 of this Code. | 20 | | No local Department of Human Services office shall refuse | 21 | | to accept an electronically filed application. | 22 | | (8) Notwithstanding any other provision of this Code, | 23 | | the Department of Human Services and the Department of | 24 | | Healthcare and Family Services' Office of the Inspector | 25 | | General shall, upon request, allow an applicant additional | 26 | | time to submit information and documents needed as part of |
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| 1 | | a review of available resources or resources transferred | 2 | | during the look-back period. The initial extension shall | 3 | | not exceed 30 days. A second extension of 30 days may be | 4 | | granted upon request. Any request for information issued by | 5 | | the State to an applicant shall include the following: an | 6 | | explanation of the information required and the date by | 7 | | which the information must be submitted; a statement that | 8 | | failure to respond in a timely manner can result in denial | 9 | | of the application; a statement that the applicant or the | 10 | | facility in the name of the applicant may seek an | 11 | | extension; and the name and contact information of a | 12 | | 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 | 15 | | Services or the Department of Healthcare and Family | 16 | | Services' Office of the Inspector General shall take into | 17 | | account what is in the best interest of the applicant. The | 18 | | time limits for processing an application shall be tolled | 19 | | during the period of any extension granted under this | 20 | | subsection. | 21 | | (9) The Department of Human Services and the Department | 22 | | of Healthcare and Family Services must jointly compile data | 23 | | on pending applications, denials, appeals, and | 24 | | redeterminations into a monthly report, which shall be | 25 | | posted on each Department's website for the purposes of | 26 | | monitoring long-term care eligibility processing. The |
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| 1 | | report must specify the number of applications and | 2 | | redeterminations pending long-term care eligibility | 3 | | determination and admission and the number of appeals of | 4 | | denials in the following categories: | 5 | | (A) Length of time applications, redeterminations, | 6 | | and appeals are pending - 0 to 45 days, 46 days to 90 | 7 | | days 0 to 90 days , 91 days to 180 days, 181 days to 12 | 8 | | months, over 12 months to 18 months, over 18 months to | 9 | | 24 months, and over 24 months. | 10 | | (B) Percentage of applications and | 11 | | redeterminations pending in the Department of Human | 12 | | Services' Family Community Resource Centers, in the | 13 | | Department of Human Services' long-term care hubs, | 14 | | with the Department of Healthcare and Family Services' | 15 | | Office of Inspector General, and those applications | 16 | | which are being tolled due to requests for extension of | 17 | | time for additional information. | 18 | | (C) Status of pending applications, denials, | 19 | | appeals, and redeterminations. | 20 | | (f) On and after July 1, 2017, the Department of Healthcare | 21 | | and Family Services, the Department of Human Services, and the | 22 | | Department on Aging must, at a minimum, take the following | 23 | | actions to protect the right of Medicaid beneficiaries to | 24 | | receive Medicaid services, especially long-term care services | 25 | | and supports, promptly without any delay caused by the agency's | 26 | | administrative procedures as mandated under 42 CFR 435.930: |
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| 1 | | (1) For a beneficiary aged 65 years or older who is | 2 | | enrolled in Medicaid at the time he or she applies for | 3 | | Medicaid long-term care services and supports and who has | 4 | | received a Determination of Need indicating the need for | 5 | | such services, the Departments must begin paying for | 6 | | Medicaid long-term care services and supports no later than | 7 | | the 46th day after the date upon which the beneficiary | 8 | | applied for such services. Payments for Medicaid long-term | 9 | | care services and supports must begin even if the review of | 10 | | the beneficiary's income and assets is incomplete and the | 11 | | amount of the beneficiary's income and assets to be applied | 12 | | to the cost of services has not been determined. The | 13 | | Department of Healthcare and Family Services shall apply | 14 | | the beneficiary's excess income and assets prospectively | 15 | | to the cost of care once the final amounts are determined. | 16 | | Delay in reviewing the available income and assets beyond | 17 | | the 45th day after the date upon which the beneficiary | 18 | | applied for Medicaid long-term care services and supports | 19 | | may not delay the furnishing of such services nor the | 20 | | payment for such services by the Department of Healthcare | 21 | | and Family Services. | 22 | | (2) For a beneficiary aged 64 years or younger who is | 23 | | enrolled in Medicaid at the time he or she applies for | 24 | | Medicaid long-term care services and supports, whose | 25 | | Medicaid eligibility is based upon a disability, and who | 26 | | has received a Determination of Need indicating the need |
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| 1 | | for Medicaid long-term care services and supports, the | 2 | | Departments must begin paying for Medicaid long-term care | 3 | | services and supports no later than the 91st day after the | 4 | | date upon which the beneficiary applied for such services. | 5 | | Payments for Medicaid long-term care services and supports | 6 | | must begin even if the review of the beneficiary's income | 7 | | and assets is incomplete and the amount of the | 8 | | beneficiary's income and assets to be applied to the cost | 9 | | of services has not been determined. The Department of | 10 | | Healthcare and Family Services shall apply the | 11 | | beneficiary's excess income and assets prospectively to | 12 | | the cost of care once the final amounts are determined. | 13 | | Delay in reviewing the available income and assets beyond | 14 | | the 90th day after the date upon which the beneficiary | 15 | | applied for Medicaid long-term care services and supports | 16 | | may not delay the furnishing of such services nor the | 17 | | payment for such services by the Department of Healthcare | 18 | | and Family Services. The deadlines specified in this | 19 | | paragraph are the federally required timeliness standards | 20 | | set forth under 42 CFR 435.912. | 21 | | (3) For an applicant who is not enrolled in Medicaid at | 22 | | the time he or she applies for Medicaid long-term care | 23 | | services and supports and who has received a Determination | 24 | | of Need indicating the need for such services, the | 25 | | Departments must begin paying for Medicaid long-term care | 26 | | services and supports immediately once the applicant is |
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| 1 | | determined eligible for Medicaid services. Payments for | 2 | | community services and Medicaid long-term care services | 3 | | and supports must begin even if the review of the | 4 | | applicant's income and assets is incomplete and the amount | 5 | | of the applicant's income and assets to be applied to the | 6 | | cost of services has not been determined. The Department of | 7 | | Healthcare and Family Services shall apply the applicant's | 8 | | excess income and assets prospectively to the cost of | 9 | | services once the final amounts are determined. Delay in | 10 | | reviewing the available income and assets beyond the 45th | 11 | | day after the date upon which the applicant applied for | 12 | | Medicaid enrollment may not delay the furnishing of such | 13 | | services nor the payment for such services by the | 14 | | Department of Healthcare and Family Services. | 15 | | As used in this subsection, "Determination of Need" means | 16 | | the current and any future assessment tool adopted by and used | 17 | | by the State of Illinois to assess the amount, intensity, or | 18 | | level of services needed to properly care for the medical, | 19 | | physical, and behavioral health needs of any individual | 20 | | requesting Medicaid long-term care services and supports. | 21 | | For the purposes of this subsection, the process of | 22 | | determining the amount of an individuals' income and assets to | 23 | | be applied to the cost of the individual's care refers to the | 24 | | federal regulations concerning the post-eligibility treatment | 25 | | of income as provided under 42 CFR 435.733. | 26 | | (g) Beginning on July 1, 2017, the Auditor General shall |
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| 1 | | report annually to the General Assembly on the performance and | 2 | | compliance of the Department of Healthcare and Family Services, | 3 | | the Department of Human Services, and the Department on Aging | 4 | | in meeting the requirements of this Section and the federal | 5 | | requirements concerning eligibility determinations for | 6 | | Medicaid long-term care services and supports, and shall report | 7 | | any issues or deficiencies and make recommendations. The | 8 | | Auditor General shall, at a minimum, review, consider, and | 9 | | evaluate the following: | 10 | | (1) compliance with federal regulations on furnishing | 11 | | services as related to Medicaid long-term care services and | 12 | | supports as provided under 42 CFR 435.930; | 13 | | (2) compliance with federal regulations on the timely | 14 | | determination of eligibility as provided under 42 CFR | 15 | | 435.912; | 16 | | (3) the accuracy and completeness of the report | 17 | | required under paragraph (9) of subsection (e); | 18 | | (4) the efficacy and efficiency of the task-based | 19 | | process used for making eligibility determinations in the | 20 | | centralized offices of the Department of Human Services for | 21 | | long-term care services as opposed to the traditional | 22 | | caseworker-specific process from which these central | 23 | | offices have converted; | 24 | | (5) the use of technology systems including the | 25 | | Integrated Eligibility System, the Application for | 26 | | Benefits Eligibility website, the Medicaid Management |
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| 1 | | Information System, and any other technology issues | 2 | | related to eligibility determinations; | 3 | | (6) the effect of staffing levels and personnel | 4 | | policies in relation to eligibility determinations; and | 5 | | (7) any issues affecting eligibility determinations | 6 | | that are related to the authority over staff completing | 7 | | Medicaid eligibility determinations residing with the | 8 | | Department of Human Services instead of the designated | 9 | | single-state Medicaid agency in Illinois, the Department | 10 | | of Healthcare and Family Services. | 11 | | The Auditor General's report shall include any and all | 12 | | other areas or issues which are identified through an annual | 13 | | review. Paragraphs 1 through 7 of this subsection shall not be | 14 | | construed to limit the scope of the annual review and the | 15 | | Auditor General's authority to thoroughly and completely | 16 | | evaluate any and all processes, policies, and procedures | 17 | | concerning compliance with federal and State law requirements | 18 | | on eligibility determinations for Medicaid long-term care | 19 | | services and supports. | 20 | | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; | 21 | | 99-153, eff. 7-28-15.)
| 22 | | Section 99. Effective date. This Act takes effect upon | 23 | | becoming law.".
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