Full Text of HB3040 101st General Assembly
HB3040enr 101ST GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 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) Establishment of the expedited long-term care | 10 | | eligibility determination and enrollment system shall be a | 11 | | joint venture of the Departments of Human Services and | 12 | | Healthcare and Family Services and the Department on Aging. | 13 | | (b) Streamlined application enrollment process; expedited | 14 | | eligibility process. The streamlined application and | 15 | | enrollment process must include, but need not be limited to, | 16 | | the following: | 17 | | (1) On or before July 1, 2019, a streamlined | 18 | | application and enrollment process shall be put in place | 19 | | which must include, but need not be limited to, the | 20 | | following: | 21 | | (A) Minimize the burden on applicants by | 22 | | collecting only the data necessary to determine | 23 | | eligibility for medical services, long-term care |
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| 1 | | services, and spousal impoverishment offset. | 2 | | (B) Integrate online data sources to simplify the | 3 | | application process by reducing the amount of | 4 | | information needed to be entered and to expedite | 5 | | eligibility verification. | 6 | | (C) Provide online prompts to alert the applicant | 7 | | 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 State must expedite the eligibility process for | 12 | | applicants meeting specified guidelines, regardless of the | 13 | | age of the application. The guidelines, subject to federal | 14 | | approval, must include, but need not be limited to, the | 15 | | following individually or collectively: | 16 | | (A) Full Medicaid benefits in the community for a | 17 | | specified period of time. | 18 | | (B) No transfer of assets or resources during the | 19 | | federally prescribed look-back period, as specified in | 20 | | federal law. | 21 | | (C) Receives
Supplemental Security Income payments | 22 | | or was receiving such payments at the time of admission | 23 | | to a nursing facility. | 24 | | (D) For applicants or recipients with verified | 25 | | income at or below 100% of the federal poverty level | 26 | | when the declared value of their countable resources is |
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| 1 | | no greater than the allowable amounts pursuant to | 2 | | Section 5-2 of this Code for classes of eligible | 3 | | persons for whom a resource limit applies. Such | 4 | | simplified verification policies shall apply to | 5 | | community cases as well as long-term care cases. | 6 | | (3) Subject to federal approval, the Department of | 7 | | Healthcare and Family Services must implement an ex parte | 8 | | renewal process for Medicaid-eligible individuals residing | 9 | | in long-term care facilities. "Renewal" has the same | 10 | | meaning as "redetermination" in State policies, | 11 | | administrative rule, and federal Medicaid law. The ex parte | 12 | | renewal process must be fully operational on or before | 13 | | January 1, 2019. If an individual has transferred to | 14 | | another long-term care facility, any annual notice | 15 | | concerning redetermination of eligibility must be sent to | 16 | | the long-term care facility where the individual resides as | 17 | | well as to the individual. | 18 | | (4) The Department of Human Services must use the | 19 | | standards and distribution requirements described in this | 20 | | subsection and in Section 11-6 for notification of missing | 21 | | supporting documents and information during all phases of | 22 | | the application process: initial, renewal, and appeal. | 23 | | (c) The Department of Human Services must adopt policies | 24 | | and procedures to improve communication between long-term care | 25 | | benefits central office personnel, applicants and their | 26 | | representatives, and facilities in which the applicants |
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| 1 | | reside. Such policies and procedures must at a minimum permit | 2 | | applicants and their representatives and the facility in which | 3 | | the applicants reside to speak directly to an individual | 4 | | trained to take telephone inquiries and provide appropriate | 5 | | responses.
| 6 | | (d) Effective 30 days after the completion of 3 regionally | 7 | | based trainings, nursing facilities shall submit all | 8 | | applications for medical assistance online via the Application | 9 | | for Benefits Eligibility (ABE) website. This requirement shall | 10 | | extend to scanning and uploading with the online application | 11 | | any required additional forms such as the Long Term Care | 12 | | Facility Notification and the Additional Financial Information | 13 | | for Long Term Care Applicants as well as scanned copies of any | 14 | | supporting documentation. Long-term care facility admission | 15 | | documents must be submitted as required in Section 5-5 of this | 16 | | Code. No local Department of Human Services office shall refuse | 17 | | to accept an electronically filed application. No Department of | 18 | | Human Services office shall request submission of any document | 19 | | in hard copy. | 20 | | (e) Notwithstanding any other provision of this Code, the | 21 | | Department of Human Services and the Department of Healthcare | 22 | | and Family Services' Office of the Inspector General shall, | 23 | | upon request, allow an applicant additional time to submit | 24 | | information and documents needed as part of a review of | 25 | | available resources or resources transferred during the | 26 | | look-back period. The initial extension shall not exceed 30 |
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| 1 | | days. A second extension of 30 days may be granted upon | 2 | | request. Any request for information issued by the State to an | 3 | | applicant shall include the following: an explanation of the | 4 | | information required and the date by which the information must | 5 | | be submitted; a statement that failure to respond in a timely | 6 | | manner can result in denial of the application; a statement | 7 | | that the applicant or the facility in the name of the applicant | 8 | | may seek an extension; and the name and contact information of | 9 | | a caseworker in case of questions. Any such request for | 10 | | information shall also be sent to the facility. In deciding | 11 | | whether to grant an extension, the Department of Human Services | 12 | | or the Department of Healthcare and Family Services' Office of | 13 | | the Inspector General shall take into account what is in the | 14 | | best interest of the applicant. The time limits for processing | 15 | | an application shall be tolled during the period of any | 16 | | extension granted under this subsection. | 17 | | (f) The Department of Human Services and the Department of | 18 | | Healthcare and Family Services must jointly compile data on | 19 | | pending applications, denials, appeals, and redeterminations | 20 | | into a monthly report, which shall be posted on each | 21 | | Department's website for the purposes of monitoring long-term | 22 | | care eligibility processing. The report must specify the number | 23 | | of applications and redeterminations pending long-term care | 24 | | eligibility determination and admission and the number of | 25 | | appeals of denials in the following categories: | 26 | | (A) Length of time applications, redeterminations, and |
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| 1 | | appeals are pending - 0 to 45 days, 46 days to 90 days, 91 | 2 | | days to 180 days, 181 days to 12 months, over 12 months to | 3 | | 18 months, over 18 months to 24 months, and over 24 months. | 4 | | (B) Percentage of applications and redeterminations | 5 | | pending in the Department of Human Services' Family | 6 | | Community Resource Centers, in the Department of Human | 7 | | Services' long-term care hubs, with the Department of | 8 | | Healthcare and Family Services' Office of Inspector | 9 | | General, and those applications which are being tolled due | 10 | | to requests for extension of time for additional | 11 | | information. | 12 | | (C) Status of pending applications, denials, appeals, | 13 | | and redeterminations. | 14 | | (g) Beginning on July 1, 2017, the Auditor General shall | 15 | | report every 3 years to the General Assembly on the performance | 16 | | and compliance of the Department of Healthcare and Family | 17 | | Services, the Department of Human Services, and the Department | 18 | | on Aging in meeting the requirements of this Section and the | 19 | | federal requirements concerning eligibility determinations for | 20 | | Medicaid long-term care services and supports, and shall report | 21 | | any issues or deficiencies and make recommendations. The | 22 | | Auditor General shall, at a minimum, review, consider, and | 23 | | evaluate the following: | 24 | | (1) compliance with federal regulations on furnishing | 25 | | services as related to Medicaid long-term care services and | 26 | | supports as provided under 42 CFR 435.930; |
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| 1 | | (2) compliance with federal regulations on the timely | 2 | | determination of eligibility as provided under 42 CFR | 3 | | 435.912; | 4 | | (3) the accuracy and completeness of the report | 5 | | required under paragraph (9) of subsection (e); | 6 | | (4) the efficacy and efficiency of the task-based | 7 | | process used for making eligibility determinations in the | 8 | | centralized offices of the Department of Human Services for | 9 | | long-term care services, including the role of the State's | 10 | | integrated eligibility system, as opposed to the | 11 | | traditional caseworker-specific process from which these | 12 | | central offices have converted; and | 13 | | (5) any issues affecting eligibility determinations | 14 | | related to the Department of Human Services' staff | 15 | | completing Medicaid eligibility determinations instead of | 16 | | the designated single-state Medicaid agency in Illinois, | 17 | | the Department of Healthcare and Family Services. | 18 | | The Auditor General's report shall include any and all | 19 | | other areas or issues which are identified through an annual | 20 | | review. Paragraphs (1) through (5) of this subsection shall not | 21 | | be construed to limit the scope of the annual review and the | 22 | | Auditor General's authority to thoroughly and completely | 23 | | evaluate any and all processes, policies, and procedures | 24 | | concerning compliance with federal and State law requirements | 25 | | on eligibility determinations for Medicaid long-term care | 26 | | services and supports. |
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| 1 | | (h) The Department of Healthcare and Family Services shall | 2 | | adopt any rules necessary to administer and enforce any | 3 | | provision of this Section. Rulemaking shall not delay the full | 4 | | implementation of this Section. | 5 | | (Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17; | 6 | | 100-665, eff. 8-2-18.)
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