Illinois General Assembly - Full Text of HB2814
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Full Text of HB2814  100th General Assembly


Rep. Norine K. Hammond

Filed: 3/31/2017





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2    AMENDMENT NO. ______. Amend House Bill 2814 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.4 as follows:
6    (305 ILCS 5/11-5.4)
7    Sec. 11-5.4. Expedited long-term care eligibility
8determination and enrollment.
9    (a) An expedited long-term care eligibility determination
10and enrollment system shall be established to reduce long-term
11care determinations to 90 days or fewer by July 1, 2014 and
12streamline the long-term care enrollment process.
13Establishment of the system shall be a joint venture of the
14Department of Human Services and Healthcare and Family Services
15and the Department on Aging. The Governor shall name a lead
16agency no later than 30 days after the effective date of this



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1amendatory Act of the 98th General Assembly to assume
2responsibility for the full implementation of the
3establishment and maintenance of the system. Project outcomes
4shall include an enhanced eligibility determination tracking
5system accessible to providers and a centralized application
6review and eligibility determination with all applicants
7reviewed within 90 days of receipt by the State of a complete
8application. If the Department of Healthcare and Family
9Services' Office of the Inspector General determines that there
10is a likelihood that a non-allowable transfer of assets has
11occurred, and the facility in which the applicant resides is
12notified, an extension of up to 90 days shall be permissible.
13On or before December 31, 2015, a streamlined application and
14enrollment process shall be put in place based on the following
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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1the feasibility of incorporating all information needed to
2determine eligibility for long-term care services, including
3asset transfer and spousal impoverishment financials, into the
4State's integrated eligibility system identifying all
5resources needed and reasonable timeframes for achieving the
6specified integration.
7    (c) The lead agency shall file interim reports with the
8Chairs and Minority Spokespersons of the House and Senate Human
9Services Committees no later than September 1, 2013 and on
10February 1, 2014. The Department of Healthcare and Family
11Services shall include in the annual Medicaid report for State
12Fiscal Year 2014 and every fiscal year thereafter information
13concerning implementation of the provisions of this Section.
14    (d) No later than August 1, 2014, the Auditor General shall
15report to the General Assembly concerning the extent to which
16the timeframes specified in this Section have been met and the
17extent to which State staffing levels are adequate to meet the
18requirements of this Section.
19    (e) The Department of Healthcare and Family Services, the
20Department of Human Services, and the Department on Aging shall
21take the following steps to achieve federally established
22timeframes for eligibility determinations for Medicaid and
23long-term care benefits and shall work toward the federal goal
24of 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) Beginning on July 1, 2017, the Auditor General shall
21report every 3 years to the General Assembly on the performance
22and compliance of the Department of Healthcare and Family
23Services, the Department of Human Services, and the Department
24on Aging in meeting the requirements of this Section and the
25federal requirements concerning eligibility determinations for
26Medicaid long-term care services and supports, and shall report



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1any issues or deficiencies and make recommendations. The
2Auditor General shall, at a minimum, review, consider, and
3evaluate the following:
4        (1) compliance with federal regulations on furnishing
5    services as related to Medicaid long-term care services and
6    supports as provided under 42 CFR 435.930;
7        (2) compliance with federal regulations on the timely
8    determination of eligibility as provided under 42 CFR
9    435.912;
10        (3) the accuracy and completeness of the report
11    required under paragraph (9) of subsection (e);
12        (4) the efficacy and efficiency of the task-based
13    process used for making eligibility determinations in the
14    centralized offices of the Department of Human Services for
15    long-term care services, including the role of the State's
16    integrated eligibility system, as opposed to the
17    traditional caseworker-specific process from which these
18    central offices have converted; and
19        (5) any issues affecting eligibility determinations
20    related to the Department of Human Services' staff
21    completing Medicaid eligibility determinations instead of
22    the designated single-state Medicaid agency in Illinois,
23    the Department of Healthcare and Family Services.
24    The Auditor General's report shall include any and all
25other areas or issues which are identified through an annual
26review. Paragraphs (1) through (5) of this subsection shall not



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1be construed to limit the scope of the annual review and the
2Auditor General's authority to thoroughly and completely
3evaluate any and all processes, policies, and procedures
4concerning compliance with federal and State law requirements
5on eligibility determinations for Medicaid long-term care
6services and supports.
7(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;
899-153, eff. 7-28-15.)
9    Section 99. Effective date. This Act takes effect upon
10becoming law.".