Full Text of HB4277 100th General Assembly
HB4277ham003 100TH GENERAL ASSEMBLY | Rep. Norine K. Hammond Filed: 4/12/2018
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| 1 | | AMENDMENT TO HOUSE BILL 4277
| 2 | | AMENDMENT NO. ______. Amend House Bill 4277 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) The General Assembly finds that it is in the best
| 10 | | interest of the State to process on an expedited basis
| 11 | | applications for Medicaid and Medicaid long-term care benefits
| 12 | | that are submitted by or on behalf of elderly persons in need
| 13 | | of long-term care services in order to comply with federal
| 14 | | deadlines for eligibility determinations as provided in 42
| 15 | | U.S.C. 1396a(a)(8) and 42 CFR 435. It is the intent of the | 16 | | General Assembly that the
provisions of this Section be |
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| 1 | | liberally construed to permit the
maximum number of applicants | 2 | | to benefit, regardless of the age
of the application, and for | 3 | | the State to meet the federal
eligibility processing deadlines. | 4 | | An expedited long-term care eligibility determination and | 5 | | enrollment system shall be established to reduce long-term care | 6 | | determinations to 90 days or fewer by July 1, 2014 and | 7 | | streamline the long-term care enrollment process. | 8 | | Establishment of the system shall be a joint venture of the | 9 | | Department of Human Services and Healthcare and Family Services | 10 | | and the Department on Aging. The Governor shall name a lead | 11 | | agency no later than 30 days after the effective date of this | 12 | | amendatory Act of the 98th General Assembly to assume | 13 | | responsibility for the full implementation of the | 14 | | establishment and maintenance of the system. Project outcomes | 15 | | shall include an enhanced eligibility determination tracking | 16 | | system accessible to providers and a centralized application | 17 | | review and eligibility determination with all applicants | 18 | | reviewed within 90 days of receipt by the State of a complete | 19 | | application. If the Department of Healthcare and Family | 20 | | Services' Office of the Inspector General determines that there | 21 | | is a likelihood that a non-allowable transfer of assets has | 22 | | occurred, and the facility in which the applicant resides is | 23 | | notified, an extension of up to 90 days shall be permissible. | 24 | | On or before December 31, 2015, a streamlined application and | 25 | | enrollment process shall be put in place based on the following | 26 | | principles: |
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| 1 | | (1) Minimize the burden on applicants by collecting | 2 | | only the data necessary to determine eligibility for | 3 | | medical services, long-term care services, and spousal | 4 | | impoverishment offset. | 5 | | (2) Integrate online data sources to simplify the | 6 | | application process by reducing the amount of information | 7 | | needed to be entered and to expedite eligibility | 8 | | verification. | 9 | | (3) Provide online prompts to alert the applicant that | 10 | | information is missing or not complete. | 11 | | (b) The Department shall, on or before July 1, 2014, assess | 12 | | the feasibility of incorporating all information needed to | 13 | | determine eligibility for long-term care services, including | 14 | | asset transfer and spousal impoverishment financials, into the | 15 | | State's integrated eligibility system identifying all | 16 | | resources needed and reasonable timeframes for achieving the | 17 | | specified integration. | 18 | | (c) The lead agency shall file interim reports with the | 19 | | Chairs and Minority Spokespersons of the House and Senate Human | 20 | | Services Committees no later than September 1, 2013 and on | 21 | | February 1, 2014. The Department of Healthcare and Family | 22 | | Services shall include in the annual Medicaid report for State | 23 | | Fiscal Year 2014 and every fiscal year thereafter information | 24 | | concerning implementation of the provisions of this Section. | 25 | | (d) No later than August 1, 2014, the Auditor General shall | 26 | | report to the General Assembly concerning the extent to which |
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| 1 | | the timeframes specified in this Section have been met and the | 2 | | extent to which State staffing levels are adequate to meet the | 3 | | requirements of this Section.
| 4 | | (e) The Department of Healthcare and Family Services, the | 5 | | Department of Human Services, and the Department on Aging shall | 6 | | take the following steps to achieve federally established | 7 | | timeframes for eligibility determinations for Medicaid and | 8 | | long-term care benefits and shall work toward the federal goal | 9 | | of real time determinations: | 10 | | (1) The Departments shall review, in collaboration | 11 | | with representatives of affected providers, all forms and | 12 | | procedures currently in use, federal guidelines either | 13 | | suggested or mandated, and staff deployment by September | 14 | | 30, 2014 to identify additional measures that can improve | 15 | | long-term care eligibility processing and make adjustments | 16 | | where possible. | 17 | | (2) No later than June 30, 2014, the Department of | 18 | | Healthcare and Family Services shall issue vouchers for | 19 | | advance payments not to exceed $50,000,000 to nursing | 20 | | facilities with significant outstanding Medicaid liability | 21 | | associated with services provided to residents with | 22 | | Medicaid applications pending and residents facing the | 23 | | greatest delays. Each facility with an advance payment | 24 | | shall state in writing whether its own recoupment schedule | 25 | | will be in 3 or 6 equal monthly installments, as long as | 26 | | all advances are recouped by June 30, 2015. |
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| 1 | | (3) The Department of Healthcare and Family Services' | 2 | | Office of Inspector General and the Department of Human | 3 | | Services shall immediately forgo resource review and | 4 | | review of transfers during the relevant look-back period | 5 | | for applications that were submitted prior to September 1, | 6 | | 2013. An applicant who applied prior to September 1, 2013, | 7 | | who was denied for failure to cooperate in providing | 8 | | required information, and whose application was | 9 | | incorrectly reviewed under the wrong look-back period | 10 | | rules may request review and correction of the denial based | 11 | | on this subsection. If found eligible upon review, such | 12 | | applicants shall be retroactively enrolled. | 13 | | (4) As soon as practicable, the Department of | 14 | | Healthcare and Family Services shall implement policies | 15 | | and promulgate rules to simplify financial eligibility | 16 | | verification in the following instances: (A) for | 17 | | applicants or recipients who are receiving Supplemental | 18 | | Security Income payments or who had been receiving such | 19 | | payments at the time they were admitted to a nursing | 20 | | facility and (B) for applicants or recipients with verified | 21 | | income at or below 100% of the federal poverty level when | 22 | | the declared value of their countable resources is no | 23 | | greater than the allowable amounts pursuant to Section 5-2 | 24 | | of this Code for classes of eligible persons for whom a | 25 | | resource limit applies. Such simplified verification | 26 | | policies shall apply to community cases as well as |
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| 1 | | long-term care cases. | 2 | | (5) As soon as practicable, but not later than July 1, | 3 | | 2014, the Department of Healthcare and Family Services and | 4 | | the Department of Human Services shall jointly begin a | 5 | | special enrollment project by using simplified eligibility | 6 | | verification policies and by redeploying caseworkers | 7 | | trained to handle long-term care cases to prioritize those | 8 | | cases, until the backlog is eliminated and processing time | 9 | | is within 90 days. This project shall apply to applications | 10 | | for long-term care received by the State on or before May | 11 | | 15, 2014. | 12 | | (6) As soon as practicable, but not later than | 13 | | September 1, 2014, the Department on Aging shall make | 14 | | available to long-term care facilities and community | 15 | | providers upon request, through an electronic method, the | 16 | | information contained within the Interagency Certification | 17 | | of Screening Results completed by the pre-screener, in a | 18 | | form and manner acceptable to the Department of Human | 19 | | Services. | 20 | | (7) Effective 30 days after the completion of 3 | 21 | | regionally based trainings, nursing facilities shall | 22 | | submit all applications for medical assistance online via | 23 | | the Application for Benefits Eligibility (ABE) website. | 24 | | This requirement shall extend to scanning and uploading | 25 | | with the online application any required additional forms | 26 | | such as the Long Term Care Facility Notification and the |
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| 1 | | Additional Financial Information for Long Term Care | 2 | | Applicants as well as scanned copies of any supporting | 3 | | documentation. Long-term care facility admission documents | 4 | | must be submitted as required in Section 5-5 of this Code. | 5 | | No local Department of Human Services office shall refuse | 6 | | to accept an electronically filed application. | 7 | | (8) Notwithstanding any other provision of this Code, | 8 | | the Department of Human Services and the Department of | 9 | | Healthcare and Family Services' Office of the Inspector | 10 | | General shall, upon request, allow an applicant additional | 11 | | time to submit information and documents needed as part of | 12 | | a review of available resources or resources transferred | 13 | | during the look-back period. The initial extension shall | 14 | | not exceed 30 days. A second extension of 30 days may be | 15 | | granted upon request. Any request for information issued by | 16 | | the State to an applicant shall include the following: an | 17 | | explanation of the information required and the date by | 18 | | which the information must be submitted; a statement that | 19 | | failure to respond in a timely manner can result in denial | 20 | | of the application; a statement that the applicant or the | 21 | | facility in the name of the applicant may seek an | 22 | | extension; and the name and contact information of a | 23 | | caseworker in case of questions. Any such request for | 24 | | information shall also be sent to the facility. In deciding | 25 | | whether to grant an extension, the Department of Human | 26 | | Services or the Department of Healthcare and Family |
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| 1 | | Services' Office of the Inspector General shall take into | 2 | | account what is in the best interest of the applicant. The | 3 | | time limits for processing an application shall be tolled | 4 | | during the period of any extension granted under this | 5 | | subsection. | 6 | | (9) The Department of Human Services and the Department | 7 | | of Healthcare and Family Services must jointly compile data | 8 | | on pending applications, denials, appeals, and | 9 | | redeterminations into a monthly report, which shall be | 10 | | posted on each Department's website for the purposes of | 11 | | monitoring long-term care eligibility processing. The | 12 | | report must specify the number of applications and | 13 | | redeterminations pending long-term care eligibility | 14 | | determination and admission and the number of appeals of | 15 | | denials in the following categories: | 16 | | (A) Length of time applications, redeterminations, | 17 | | and appeals are pending - 0 to 45 days, 46 days to 90 | 18 | | days, 91 days to 180 days, 181 days to 12 months, over | 19 | | 12 months to 18 months, over 18 months to 24 months, | 20 | | and over 24 months. | 21 | | (B) Percentage of applications and | 22 | | redeterminations pending in the Department of Human | 23 | | Services' Family Community Resource Centers, in the | 24 | | Department of Human Services' long-term care hubs, | 25 | | with the Department of Healthcare and Family Services' | 26 | | Office of Inspector General, and those applications |
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| 1 | | which are being tolled due to requests for extension of | 2 | | time for additional information. | 3 | | (C) Status of pending applications, denials, | 4 | | appeals, and redeterminations. | 5 | | (f) Beginning on July 1, 2017, the Auditor General shall | 6 | | report every 3 years to the General Assembly on the performance | 7 | | and compliance of the Department of Healthcare and Family | 8 | | Services, the Department of Human Services, and the Department | 9 | | on Aging in meeting the requirements of this Section and the | 10 | | federal requirements concerning eligibility determinations for | 11 | | Medicaid long-term care services and supports, and shall report | 12 | | any issues or deficiencies and make recommendations. The | 13 | | Auditor General shall, at a minimum, review, consider, and | 14 | | evaluate the following: | 15 | | (1) compliance with federal regulations on furnishing | 16 | | services as related to Medicaid long-term care services and | 17 | | supports as provided under 42 CFR 435.930; | 18 | | (2) compliance with federal regulations on the timely | 19 | | determination of eligibility as provided under 42 CFR | 20 | | 435.912; | 21 | | (3) the accuracy and completeness of the report | 22 | | required under paragraph (9) of subsection (e); | 23 | | (4) the efficacy and efficiency of the task-based | 24 | | process used for making eligibility determinations in the | 25 | | centralized offices of the Department of Human Services for | 26 | | long-term care services, including the role of the State's |
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| 1 | | integrated eligibility system, as opposed to the | 2 | | traditional caseworker-specific process from which these | 3 | | central offices have converted; and | 4 | | (5) any issues affecting eligibility determinations | 5 | | related to the Department of Human Services' staff | 6 | | completing Medicaid eligibility determinations instead of | 7 | | the designated single-state Medicaid agency in Illinois, | 8 | | the Department of Healthcare and Family Services. | 9 | | The Auditor General's report shall include any and all | 10 | | other areas or issues which are identified through an annual | 11 | | review. Paragraphs (1) through (5) of this subsection shall not | 12 | | be construed to limit the scope of the annual review and the | 13 | | Auditor General's authority to thoroughly and completely | 14 | | evaluate any and all processes, policies, and procedures | 15 | | concerning compliance with federal and State law requirements | 16 | | on eligibility determinations for Medicaid long-term care | 17 | | services and supports. | 18 | | (Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
| 19 | | Section 99. Effective date. This Act takes effect upon | 20 | | becoming law.".
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