Illinois General Assembly - Full Text of SB2913
Illinois General Assembly

Previous General Assemblies

Full Text of SB2913  100th General Assembly


Rep. Jay Hoffman

Filed: 5/15/2018





10000SB2913ham001LRB100 18099 KTG 40087 a


2    AMENDMENT NO. ______. Amend Senate Bill 2913 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Sections 11-5.4 and 11-6 and by adding Section 5-5g as
7    (305 ILCS 5/5-5g new)
8    Sec. 5-5g. Long-term care patient; resident status.
9Long-term care providers shall submit all changes in resident
10status, including, but not limited to, death, discharge,
11changes in patient credit, third party liability, and Medicare
12coverage, to the Department through the Medical Electronic Data
13Interchange System, the Recipient Eligibility Verification
14System, or the Electronic Data Interchange System established
15under 89 Ill. Adm. Code 140.55(b) in compliance with the
16schedule below:



10000SB2913ham001- 2 -LRB100 18099 KTG 40087 a

1        (1) 15 calendar days after a resident's death;
2        (2) 15 calendar days after a resident's discharge;
3        (3) 45 calendar days after being informed of a change
4    in the resident's income;
5        (4) 45 calendar days after being informed of a change
6    in a resident's third party liability;
7        (5) 45 calendar days after a resident's move to
8    exceptional care services; and
9        (6) 45 calendar days after a resident's need for
10    services requiring reimbursement under the ventilator or
11    traumatic brain injury enhanced rate.
12    (305 ILCS 5/11-5.4)
13    Sec. 11-5.4. Expedited long-term care eligibility
14determination and enrollment.
15    (a) The Department of Healthcare and Family Services must
16serve as the lead agency assuming primary responsibility for
17the full implementation of this Section, including the
18establishment and operation of the system. An expedited
19long-term care eligibility determination and enrollment system
20shall be established to reduce long-term care determinations to
2190 days or fewer by July 1, 2014 and streamline the long-term
22care enrollment process. Establishment of the system shall be a
23joint venture of the Department of Human Services and
24Healthcare and Family Services and the Department on Aging. The
25Governor shall name a lead agency no later than 30 days after



10000SB2913ham001- 3 -LRB100 18099 KTG 40087 a

1the effective date of this amendatory Act of the 98th General
2Assembly to assume responsibility for the full implementation
3of the establishment and maintenance of the system. Project
4outcomes shall include an enhanced eligibility determination
5tracking system accessible to providers and a centralized
6application review and eligibility determination with all
7applicants reviewed within 90 days of receipt by the State of a
8complete application. If the Department of Healthcare and
9Family Services' Office of the Inspector General determines
10that there is a likelihood that a non-allowable transfer of
11assets has occurred, and the facility in which the applicant
12resides is notified, an extension of up to 90 days shall be
14    (b) The Department of Healthcare and Family Services must
15establish policies and procedures to ensure prospective
16compliance with the federal deadlines for Medicaid and Medicaid
17long-term care benefits eligibility determinations required
18under 42 U.S.C. 1396a(a)(8) and 42 CFR 435.912, which must
19include, but need not be limited to, the following:
20        (1) On or before January 1, 2019, December 31, 2015, a
21    streamlined application and enrollment process shall be
22    put in place which must include, but need not be limited
23    to, the following: based on the following principles:
24            (A) (1) Minimize the burden on applicants by
25        collecting only the data necessary to determine
26        eligibility for medical services, long-term care



10000SB2913ham001- 4 -LRB100 18099 KTG 40087 a

1        services, and spousal impoverishment offset.
2            (B) (2) Integrate online data sources to simplify
3        the application process by reducing the amount of
4        information needed to be entered and to expedite
5        eligibility verification.
6            (C) (3) Provide online prompts to alert the
7        applicant that information is missing or not complete.
8            (D) Provide training and step-by-step written
9        instructions for caseworkers, applicants, and
10        providers.
11        (2) The Department of Healthcare and Family Services
12    must expedite the eligibility processing system for
13    applicants meeting specified guidelines, regardless of the
14    age of the application. The guidelines must include, but
15    need not be limited to, the following individually or
16    collectively:
17            (A) Full Medicaid benefits in the community for a
18        specified period of time.
19            (B) No transfer of assets or resources during the
20        federally prescribed look-back period, as specified in
21        federal law.
22            (C) Receives Supplemental Security Income payments
23        or was receiving such payments at the time of admission
24        to a nursing facility.
25            (D) For applicants or recipients with verified
26        income at or below 100% of the federal poverty level



10000SB2913ham001- 5 -LRB100 18099 KTG 40087 a

1        when the declared value of their countable resources is
2        no greater than the allowable amounts pursuant to
3        Section 5-2 of this Code for classes of eligible
4        persons for whom a resource limit applies. Such
5        simplified verification policies shall apply to
6        community cases as well as long-term care cases.
7        (3) Subject to federal approval, the Department of
8    Healthcare and Family Services must implement an ex parte
9    renewal process for Medicaid-eligible individuals residing
10    in long-term care facilities. "Renewal" has the same
11    meaning as "redetermination" in State policies,
12    administrative rule, and federal Medicaid law. The ex parte
13    renewal process must be fully operational by January 1,
14    2019.
15        (4) The Department of Healthcare and Family Services
16    must use the standards and distribution requirements
17    described in this subsection and in Section 11-6 for
18    notification of missing supporting documents and
19    information during all phases of the application process:
20    initial, renewal, and appeal.
21    (c) The Department of Healthcare and Family Services must
22adopt policies and procedures to improve communication between
23long-term care benefits central office personnel, applicants
24and their representatives, and facilities in which the
25applicants reside. Such policies and procedures must at a
26minimum permit applicants and their representatives and the



10000SB2913ham001- 6 -LRB100 18099 KTG 40087 a

1facility in which the applicants reside to speak directly to an
2individual trained to take telephone inquiries and provide
3appropriate responses in real time.
4    (b) The Department shall, on or before July 1, 2014, assess
5the feasibility of incorporating all information needed to
6determine eligibility for long-term care services, including
7asset transfer and spousal impoverishment financials, into the
8State's integrated eligibility system identifying all
9resources needed and reasonable timeframes for achieving the
10specified integration.
11    (c) The lead agency shall file interim reports with the
12Chairs and Minority Spokespersons of the House and Senate Human
13Services Committees no later than September 1, 2013 and on
14February 1, 2014. The Department of Healthcare and Family
15Services shall include in the annual Medicaid report for State
16Fiscal Year 2014 and every fiscal year thereafter information
17concerning implementation of the provisions of this Section.
18    (d) No later than August 1, 2014, the Auditor General shall
19report to the General Assembly concerning the extent to which
20the timeframes specified in this Section have been met and the
21extent to which State staffing levels are adequate to meet the
22requirements of this Section.
23    (e) The Department of Healthcare and Family Services, the
24Department of Human Services, and the Department on Aging shall
25take the following steps to achieve federally established
26timeframes for eligibility determinations for Medicaid and



10000SB2913ham001- 7 -LRB100 18099 KTG 40087 a

1long-term care benefits and shall work toward the federal goal
2of real time determinations:
3        (1) The Departments shall review, in collaboration
4    with representatives of affected providers, all forms and
5    procedures currently in use, federal guidelines either
6    suggested or mandated, and staff deployment by September
7    30, 2014 to identify additional measures that can improve
8    long-term care eligibility processing and make adjustments
9    where possible.
10        (2) No later than June 30, 2014, the Department of
11    Healthcare and Family Services shall issue vouchers for
12    advance payments not to exceed $50,000,000 to nursing
13    facilities with significant outstanding Medicaid liability
14    associated with services provided to residents with
15    Medicaid applications pending and residents facing the
16    greatest delays. Each facility with an advance payment
17    shall state in writing whether its own recoupment schedule
18    will be in 3 or 6 equal monthly installments, as long as
19    all advances are recouped by June 30, 2015.
20        (3) The Department of Healthcare and Family Services'
21    Office of Inspector General and the Department of Human
22    Services shall immediately forgo resource review and
23    review of transfers during the relevant look-back period
24    for applications that were submitted prior to September 1,
25    2013. An applicant who applied prior to September 1, 2013,
26    who was denied for failure to cooperate in providing



10000SB2913ham001- 8 -LRB100 18099 KTG 40087 a

1    required information, and whose application was
2    incorrectly reviewed under the wrong look-back period
3    rules may request review and correction of the denial based
4    on this subsection. If found eligible upon review, such
5    applicants shall be retroactively enrolled.
6        (4) As soon as practicable, the Department of
7    Healthcare and Family Services shall implement policies
8    and promulgate rules to simplify financial eligibility
9    verification in the following instances: (A) for
10    applicants or recipients who are receiving Supplemental
11    Security Income payments or who had been receiving such
12    payments at the time they were admitted to a nursing
13    facility and (B) for applicants or recipients with verified
14    income at or below 100% of the federal poverty level when
15    the declared value of their countable resources is no
16    greater than the allowable amounts pursuant to Section 5-2
17    of this Code for classes of eligible persons for whom a
18    resource limit applies. Such simplified verification
19    policies shall apply to community cases as well as
20    long-term care cases.
21        (5) As soon as practicable, but not later than July 1,
22    2014, the Department of Healthcare and Family Services and
23    the Department of Human Services shall jointly begin a
24    special enrollment project by using simplified eligibility
25    verification policies and by redeploying caseworkers
26    trained to handle long-term care cases to prioritize those



10000SB2913ham001- 9 -LRB100 18099 KTG 40087 a

1    cases, until the backlog is eliminated and processing time
2    is within 90 days. This project shall apply to applications
3    for long-term care received by the State on or before May
4    15, 2014.
5        (6) As soon as practicable, but not later than
6    September 1, 2014, the Department on Aging shall make
7    available to long-term care facilities and community
8    providers upon request, through an electronic method, the
9    information contained within the Interagency Certification
10    of Screening Results completed by the pre-screener, in a
11    form and manner acceptable to the Department of Human
12    Services.
13    (d) (7) Effective 30 days after the completion of 3
14regionally based trainings, nursing facilities shall submit
15all applications for medical assistance online via the
16Application for Benefits Eligibility (ABE) website. This
17requirement shall extend to scanning and uploading with the
18online application any required additional forms such as the
19Long Term Care Facility Notification and the Additional
20Financial Information for Long Term Care Applicants as well as
21scanned copies of any supporting documentation. Long-term care
22facility admission documents must be submitted as required in
23Section 5-5 of this Code. No local Department of Human Services
24office shall refuse to accept an electronically filed
26    (e) (8) Notwithstanding any other provision of this Code,



10000SB2913ham001- 10 -LRB100 18099 KTG 40087 a

1the Department of Human Services and the Department of
2Healthcare and Family Services' Office of the Inspector General
3shall, upon request, allow an applicant additional time to
4submit information and documents needed as part of a review of
5available resources or resources transferred during the
6look-back period. The initial extension shall not exceed 30
7days. A second extension of 30 days may be granted upon
8request. Any request for information issued by the State to an
9applicant shall include the following: an explanation of the
10information required and the date by which the information must
11be submitted; a statement that failure to respond in a timely
12manner can result in denial of the application; a statement
13that the applicant or the facility in the name of the applicant
14may seek an extension; and the name and contact information of
15a caseworker in case of questions. Any such request for
16information shall also be sent to the facility. In deciding
17whether to grant an extension, the Department of Human Services
18or the Department of Healthcare and Family Services' Office of
19the Inspector General shall take into account what is in the
20best interest of the applicant. The time limits for processing
21an application shall be tolled during the period of any
22extension granted under this subsection.
23    (f) (9) The Department of Human Services and the Department
24of Healthcare and Family Services must jointly compile data on
25pending applications, denials, appeals, and redeterminations
26into a monthly report, which shall be posted on each



10000SB2913ham001- 11 -LRB100 18099 KTG 40087 a

1Department's website for the purposes of monitoring long-term
2care eligibility processing. The report must specify the number
3of applications and redeterminations pending long-term care
4eligibility determination and admission and the number of
5appeals of denials in the following categories:
6        (A) Length of time applications, redeterminations, and
7    appeals are pending - 0 to 45 days, 46 days to 90 days, 91
8    days to 180 days, 181 days to 12 months, over 12 months to
9    18 months, over 18 months to 24 months, and over 24 months.
10        (B) Percentage of applications and redeterminations
11    pending in the Department of Human Services' Family
12    Community Resource Centers, in the Department of Human
13    Services' long-term care hubs, with the Department of
14    Healthcare and Family Services' Office of Inspector
15    General, and those applications which are being tolled due
16    to requests for extension of time for additional
17    information.
18        (C) Status of pending applications, denials, appeals,
19    and redeterminations.
20    (g) (f) Beginning on July 1, 2017, the Auditor General
21shall report every 3 years to the General Assembly on the
22performance and compliance of the Department of Healthcare and
23Family Services, the Department of Human Services, and the
24Department on Aging in meeting the requirements of this Section
25and the federal requirements concerning eligibility
26determinations for Medicaid long-term care services and



10000SB2913ham001- 12 -LRB100 18099 KTG 40087 a

1supports, and shall report any issues or deficiencies and make
2recommendations. The Auditor General shall, at a minimum,
3review, consider, and evaluate 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



10000SB2913ham001- 13 -LRB100 18099 KTG 40087 a

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    (h) The Department of Healthcare and Family Services shall
8adopt any rules necessary to administer and enforce any
9provision of this Section. Rulemaking shall not delay the full
10implementation of this Section.
11(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
12    (305 ILCS 5/11-6)  (from Ch. 23, par. 11-6)
13    Sec. 11-6. Decisions on applications. Within 10 days after
14a decision is reached on an application, the applicant shall be
15notified in writing of the decision. If the applicant resides
16in a facility licensed under the Nursing Home Care Act or a
17supportive living facility authorized under Section 5-5.01a,
18the facility shall also receive written notice of the decision,
19provided that the notification is related to a Department
20payment for services received by the applicant in the facility.
21Only facilities enrolled in and subject to a provider agreement
22under the medical assistance program under Article V may
23receive such notices of decisions. The Department shall
24consider eligibility for, and the notice shall contain a
25decision on, each of the following assistance programs for



10000SB2913ham001- 14 -LRB100 18099 KTG 40087 a

1which the client may be eligible based on the information
2contained in the application: Temporary Assistance for to Needy
3Families, Medical Assistance, Aid to the Aged, Blind and
4Disabled, General Assistance (in the City of Chicago), and food
5stamps. No decision shall be required for any assistance
6program for which the applicant has expressly declined in
7writing to apply. If the applicant is determined to be
8eligible, the notice shall include a statement of the amount of
9financial aid to be provided and a statement of the reasons for
10any partial grant amounts. If the applicant is determined
11ineligible for any public assistance the notice shall include
12the reason why the applicant is ineligible and a list of all
13missing supporting documents and information and the date the
14documents were requested. If the application for any public
15assistance is denied, the notice shall include a statement
16defining the applicant's right to appeal the decision. The
17Illinois Department, by rule, shall determine the date on which
18assistance shall begin for applicants determined eligible.
19That date may be no later than 30 days after the date of the
21    Under no circumstances may any application be denied solely
22to meet an application-processing deadline.
23(Source: P.A. 96-206, eff. 1-1-10; revised 10-4-17.)
24    Section 99. Effective date. This Act takes effect upon
25becoming law.".