Illinois General Assembly - Full Text of SB2913
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Full Text of SB2913  100th General Assembly


Rep. Jay Hoffman

Filed: 5/21/2018





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



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1schedule below:
2        (1) 15 calendar days after a resident's death;
3        (2) 15 calendar days after a resident's discharge;
4        (3) 45 calendar days after being informed of a change
5    in the resident's income;
6        (4) 45 calendar days after being informed of a change
7    in a resident's third party liability;
8        (5) 45 calendar days after a resident's move to
9    exceptional care services; and
10        (6) 45 calendar days after a resident's need for
11    services requiring reimbursement under the ventilator or
12    traumatic brain injury enhanced rate.
13    (305 ILCS 5/11-5.4)
14    Sec. 11-5.4. Expedited long-term care eligibility
15determination and enrollment.
16    (a) Establishment of the expedited long-term care
17eligibility determination and enrollment system shall be a
18joint venture of the Departments of Human Services and
19Healthcare and Family Services and the Department on Aging. An
20expedited long-term care eligibility determination and
21enrollment system shall be established to reduce long-term care
22determinations to 90 days or fewer by July 1, 2014 and
23streamline the long-term care enrollment process.
24Establishment of the system shall be a joint venture of the
25Department of Human Services and Healthcare and Family Services



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1and the Department on Aging. The Governor shall name a lead
2agency no later than 30 days after the effective date of this
3amendatory Act of the 98th General Assembly to assume
4responsibility for the full implementation of the
5establishment and maintenance of the system. Project outcomes
6shall include an enhanced eligibility determination tracking
7system accessible to providers and a centralized application
8review and eligibility determination with all applicants
9reviewed within 90 days of receipt by the State of a complete
10application. If the Department of Healthcare and Family
11Services' Office of the Inspector General determines that there
12is a likelihood that a non-allowable transfer of assets has
13occurred, and the facility in which the applicant resides is
14notified, an extension of up to 90 days shall be permissible.
15    (b) Streamlined application enrollment process; expedited
16eligibility process. The streamlined application and
17enrollment process must include, but need not be limited to,
18the following:
19        (1) On or before July 1, 2019, December 31, 2015, a
20    streamlined application and enrollment process shall be
21    put in place which must include, but need not be limited
22    to, the following: based on the following principles:
23            (A) (1) Minimize the burden on applicants by
24        collecting only the data necessary to determine
25        eligibility for medical services, long-term care
26        services, and spousal impoverishment offset.



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



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1        Section 5-2 of this Code for classes of eligible
2        persons for whom a resource limit applies. Such
3        simplified verification policies shall apply to
4        community cases as well as long-term care cases.
5        (3) Subject to federal approval, the Department of
6    Healthcare and Family Services must implement an ex parte
7    renewal process for Medicaid-eligible individuals residing
8    in long-term care facilities. "Renewal" has the same
9    meaning as "redetermination" in State policies,
10    administrative rule, and federal Medicaid law. The ex parte
11    renewal process must be fully operational on or before
12    January 1, 2019.
13        (4) The Department of Healthcare and Family Services
14    must use the standards and distribution requirements
15    described in this subsection and in Section 11-6 for
16    notification of missing supporting documents and
17    information during all phases of the application process:
18    initial, renewal, and appeal.
19    (c) The Department of Healthcare and Family Services must
20adopt policies and procedures to improve communication between
21long-term care benefits central office personnel, applicants
22and their representatives, and facilities in which the
23applicants reside. Such policies and procedures must at a
24minimum permit applicants and their representatives and the
25facility in which the applicants reside to speak directly to an
26individual trained to take telephone inquiries and provide



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



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



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1    rules may request review and correction of the denial based
2    on this subsection. If found eligible upon review, such
3    applicants shall be retroactively enrolled.
4        (4) As soon as practicable, the Department of
5    Healthcare and Family Services shall implement policies
6    and promulgate rules to simplify financial eligibility
7    verification in the following instances: (A) for
8    applicants or recipients who are receiving Supplemental
9    Security Income payments or who had been receiving such
10    payments at the time they were admitted to a nursing
11    facility and (B) for applicants or recipients with verified
12    income at or below 100% of the federal poverty level when
13    the declared value of their countable resources is no
14    greater than the allowable amounts pursuant to Section 5-2
15    of this Code for classes of eligible persons for whom a
16    resource limit applies. Such simplified verification
17    policies shall apply to community cases as well as
18    long-term care cases.
19        (5) As soon as practicable, but not later than July 1,
20    2014, the Department of Healthcare and Family Services and
21    the Department of Human Services shall jointly begin a
22    special enrollment project by using simplified eligibility
23    verification policies and by redeploying caseworkers
24    trained to handle long-term care cases to prioritize those
25    cases, until the backlog is eliminated and processing time
26    is within 90 days. This project shall apply to applications



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



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



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



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



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1Auditor General's authority to thoroughly and completely
2evaluate any and all processes, policies, and procedures
3concerning compliance with federal and State law requirements
4on eligibility determinations for Medicaid long-term care
5services and supports.
6    (h) The Department of Healthcare and Family Services shall
7adopt any rules necessary to administer and enforce any
8provision of this Section. Rulemaking shall not delay the full
9implementation of this Section.
10(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17.)
11    (305 ILCS 5/11-6)  (from Ch. 23, par. 11-6)
12    Sec. 11-6. Decisions on applications. Within 10 days after
13a decision is reached on an application, the applicant shall be
14notified in writing of the decision. If the applicant resides
15in a facility licensed under the Nursing Home Care Act or a
16supportive living facility authorized under Section 5-5.01a,
17the facility shall also receive written notice of the decision,
18provided that the notification is related to a Department
19payment for services received by the applicant in the facility.
20Only facilities enrolled in and subject to a provider agreement
21under the medical assistance program under Article V may
22receive such notices of decisions. The Department shall
23consider eligibility for, and the notice shall contain a
24decision on, each of the following assistance programs for
25which the client may be eligible based on the information



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



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1    Section 99. Effective date. This Act takes effect upon
2becoming law.".