Full Text of SB3290 96th General Assembly
SB3290enr 96TH GENERAL ASSEMBLY
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Alternative Health Care Delivery Act is | 5 |
| amended by changing Section 30 as follows:
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| (210 ILCS 3/30)
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| Sec. 30. Demonstration program requirements. The | 8 |
| requirements set forth in
this Section shall apply to | 9 |
| demonstration programs.
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| (a) There shall be no more than:
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| (i) 3 subacute care hospital alternative health care | 12 |
| models in the City of
Chicago (one of which shall be | 13 |
| located on a designated site and shall have been
licensed | 14 |
| as a hospital under the Illinois Hospital Licensing Act | 15 |
| within the 10
years immediately before the application for | 16 |
| a license);
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| (ii) 2 subacute care hospital alternative health care | 18 |
| models in the
demonstration program for each of the | 19 |
| following areas:
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| (1) Cook County outside the City of Chicago.
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| (2) DuPage, Kane, Lake, McHenry, and Will | 22 |
| Counties.
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| (3) Municipalities with a population greater than |
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| 50,000 not
located in the areas described in item (i) | 2 |
| of subsection (a) and paragraphs
(1) and (2) of item | 3 |
| (ii) of subsection (a); and
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| (iii) 4 subacute care hospital alternative health care
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| models in the demonstration program for rural areas.
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| In selecting among applicants for these
licenses in rural | 7 |
| areas, the Health Facilities and Services Review Board and the
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| Department shall give preference to hospitals that may be | 9 |
| unable for economic
reasons to provide continued service to the | 10 |
| community in which they are located
unless the hospital were to | 11 |
| receive an alternative health care model license.
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| (a-5) There shall be no more than the total number of | 13 |
| postsurgical
recovery care centers with a certificate of need | 14 |
| for beds as of January 1, 2008.
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| (a-10) There shall be no more than a total of 9 children's | 16 |
| respite care
center alternative health care models in the | 17 |
| demonstration program, which shall
be located as follows:
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| (1) Two in the City of Chicago.
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| (2) One in Cook County outside the City of Chicago.
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| (3) A total of 2 in the area comprised of DuPage, Kane, | 21 |
| Lake, McHenry, and
Will counties.
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| (4) A total of 2 in municipalities with a population of | 23 |
| 50,000 or more and
not
located in the areas described in | 24 |
| paragraphs (1), (2), or (3).
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| (5) A total of 2 in rural areas, as defined by the | 26 |
| Health Facilities
and Services Review Board.
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| No more than one children's respite care model owned and | 2 |
| operated by a
licensed skilled pediatric facility shall be | 3 |
| located in each of the areas
designated in this subsection | 4 |
| (a-10).
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| (a-15) There shall be 2 authorized community-based | 6 |
| residential
rehabilitation center alternative health care | 7 |
| models in the demonstration
program.
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| (a-20) There shall be an authorized
Alzheimer's disease | 9 |
| management center alternative health care model in the
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| demonstration program. The Alzheimer's disease management | 11 |
| center shall be
located in Will
County, owned by a
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| not-for-profit entity, and endorsed by a resolution approved by | 13 |
| the county
board before the effective date of this amendatory | 14 |
| Act of the 91st General
Assembly.
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| (a-25) There shall be no more than 10 birth center | 16 |
| alternative health care
models in the demonstration program, | 17 |
| located as follows:
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| (1) Four in the area comprising Cook, DuPage, Kane, | 19 |
| Lake, McHenry, and
Will counties, one of
which shall be | 20 |
| owned or operated by a hospital and one of which shall be | 21 |
| owned
or operated by a federally qualified health center.
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| (2) Three in municipalities with a population of 50,000 | 23 |
| or more not
located in the area described in paragraph (1) | 24 |
| of this subsection, one of
which shall be owned or operated | 25 |
| by a hospital and one of which shall be owned
or operated | 26 |
| by a federally qualified health center.
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| (3) Three in rural areas, one of which shall be owned | 2 |
| or operated by a
hospital and one of which shall be owned | 3 |
| or operated by a federally qualified
health center.
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| The first 3 birth centers authorized to operate by the | 5 |
| Department shall be
located in or predominantly serve the | 6 |
| residents of a health professional
shortage area as determined | 7 |
| by the United States Department of Health and Human
Services. | 8 |
| There shall be no more than 2 birth centers authorized to | 9 |
| operate in
any single health planning area for obstetric | 10 |
| services as determined under the
Illinois Health Facilities | 11 |
| Planning Act. If a birth center is located outside
of a
health | 12 |
| professional shortage area, (i) the birth center shall be | 13 |
| located in a
health planning
area with a demonstrated need for | 14 |
| obstetrical service beds, as determined by
the Health | 15 |
| Facilities and Services Review Board or (ii) there must be a
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| reduction in
the existing number of obstetrical service beds in | 17 |
| the planning area so that
the establishment of the birth center | 18 |
| does not result in an increase in the
total number of | 19 |
| obstetrical service beds in the health planning area.
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| (b) Alternative health care models, other than a model | 21 |
| authorized under subsection (a-10) or subsections (a-10) and
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| (a-20), shall obtain a certificate of
need from the Health | 23 |
| Facilities and Services Review Board under the Illinois
Health | 24 |
| Facilities Planning Act before receiving a license by the
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| Department.
If, after obtaining its initial certificate of | 26 |
| need, an alternative health
care delivery model that is a |
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| community based residential rehabilitation center
seeks to
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| increase the bed capacity of that center, it must obtain a | 3 |
| certificate of need
from the Health Facilities and Services | 4 |
| Review Board before increasing the bed
capacity. Alternative
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| health care models in medically underserved areas
shall receive | 6 |
| priority in obtaining a certificate of need.
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| (c) An alternative health care model license shall be | 8 |
| issued for a
period of one year and shall be annually renewed | 9 |
| if the facility or
program is in substantial compliance with | 10 |
| the Department's rules
adopted under this Act. A licensed | 11 |
| alternative health care model that continues
to be in | 12 |
| substantial compliance after the conclusion of the | 13 |
| demonstration
program shall be eligible for annual renewals | 14 |
| unless and until a different
licensure program for that type of | 15 |
| health care model is established by
legislation, except that a | 16 |
| postsurgical recovery care center meeting the following | 17 |
| requirements may apply within 3 years after August 25, 2009 | 18 |
| ( the effective date of Public Act 96-669) this amendatory Act | 19 |
| of the 96th General Assembly for a Certificate of Need permit | 20 |
| to operate as a hospital: | 21 |
| (1) The postsurgical recovery care center shall apply | 22 |
| to the Illinois Health Facilities Planning Board for a | 23 |
| Certificate of Need permit to discontinue the postsurgical | 24 |
| recovery care center and to establish a hospital. | 25 |
| (2) If the postsurgical recovery care center obtains a | 26 |
| Certificate of Need permit to operate as a hospital, it |
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| shall apply for licensure as a hospital under the Hospital | 2 |
| Licensing Act and shall meet all statutory and regulatory | 3 |
| requirements of a hospital. | 4 |
| (3) After obtaining licensure as a hospital, any | 5 |
| license as an ambulatory surgical treatment center and any | 6 |
| license as a post-surgical recovery care center shall be | 7 |
| null and void. | 8 |
| (4) The former postsurgical recovery care center that | 9 |
| receives a hospital license must seek and use its best | 10 |
| efforts to maintain certification under Titles XVIII and | 11 |
| XIX of the federal Social Security Act. | 12 |
| The Department may issue a provisional license to any
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| alternative health care model that does not substantially | 14 |
| comply with the
provisions of this Act and the rules adopted | 15 |
| under this Act if (i)
the Department finds that the alternative | 16 |
| health care model has undertaken
changes and corrections which | 17 |
| upon completion will render the alternative
health care model | 18 |
| in substantial compliance with this Act and rules and
(ii) the | 19 |
| health and safety of the patients of the alternative
health | 20 |
| care model will be protected during the period for which the | 21 |
| provisional
license is issued. The Department shall advise the | 22 |
| licensee of
the conditions under which the provisional license | 23 |
| is issued, including
the manner in which the alternative health | 24 |
| care model fails to comply with
the provisions of this Act and | 25 |
| rules, and the time within which the changes
and corrections | 26 |
| necessary for the alternative health care model to
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| substantially comply with this Act and rules shall be | 2 |
| completed.
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| (d) Alternative health care models shall seek | 4 |
| certification under Titles
XVIII and XIX of the federal Social | 5 |
| Security Act. In addition, alternative
health care models shall | 6 |
| provide charitable care consistent with that provided
by | 7 |
| comparable health care providers in the geographic area.
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| (d-5) (Blank) The Department of Healthcare and Family | 9 |
| Services (formerly Illinois Department of Public Aid), in | 10 |
| cooperation with the
Illinois Department of
Public Health, | 11 |
| shall develop and implement a reimbursement methodology for all
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| facilities participating in the demonstration program. The | 13 |
| Department of Healthcare and Family Services shall keep a | 14 |
| record of services provided under the demonstration
program to | 15 |
| recipients of medical assistance under the Illinois Public Aid | 16 |
| Code
and shall submit an annual report of that information to | 17 |
| the Illinois
Department of Public Health .
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| (e) Alternative health care models shall, to the extent | 19 |
| possible,
link and integrate their services with nearby health | 20 |
| care facilities.
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| (f) Each alternative health care model shall implement a | 22 |
| quality
assurance program with measurable benefits and at | 23 |
| reasonable cost.
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| (Source: P.A. 95-331, eff. 8-21-07; 95-445, eff. 1-1-08; 96-31, | 25 |
| eff. 6-30-09; 96-129, eff. 8-4-09; 96-669, eff. 8-25-09; | 26 |
| 96-812, eff. 1-1-10; revised 11-4-09.)
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| Section 10. The Illinois Public Aid Code is amended by | 2 |
| changing Sections 5-2 and 5-5.5 and by adding Section 12-8.2 as | 3 |
| follows:
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| (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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| Sec. 5-2. Classes of Persons Eligible. Medical assistance | 6 |
| under this
Article shall be available to any of the following | 7 |
| classes of persons in
respect to whom a plan for coverage has | 8 |
| been submitted to the Governor
by the Illinois Department and | 9 |
| approved by him:
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| 1. Recipients of basic maintenance grants under | 11 |
| Articles III and IV.
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| 2. Persons otherwise eligible for basic maintenance | 13 |
| under Articles
III and IV, excluding any eligibility | 14 |
| requirements that are inconsistent with any federal law or | 15 |
| federal regulation, as interpreted by the U.S. Department | 16 |
| of Health and Human Services, but who fail to qualify | 17 |
| thereunder on the basis of need or who qualify but are not | 18 |
| receiving basic maintenance under Article IV, and
who have | 19 |
| insufficient income and resources to meet the costs of
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| necessary medical care, including but not limited to the | 21 |
| following:
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| (a) All persons otherwise eligible for basic | 23 |
| maintenance under Article
III but who fail to qualify | 24 |
| under that Article on the basis of need and who
meet |
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| either of the following requirements:
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| (i) their income, as determined by the | 3 |
| Illinois Department in
accordance with any federal | 4 |
| requirements, is equal to or less than 70% in
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| fiscal year 2001, equal to or less than 85% in | 6 |
| fiscal year 2002 and until
a date to be determined | 7 |
| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the | 9 |
| Department by rule, of the nonfarm income official | 10 |
| poverty
line, as defined by the federal Office of | 11 |
| Management and Budget and revised
annually in | 12 |
| accordance with Section 673(2) of the Omnibus | 13 |
| Budget Reconciliation
Act of 1981, applicable to | 14 |
| families of the same size; or
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| (ii) their income, after the deduction of | 16 |
| costs incurred for medical
care and for other types | 17 |
| of remedial care, is equal to or less than 70% in
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| fiscal year 2001, equal to or less than 85% in | 19 |
| fiscal year 2002 and until
a date to be determined | 20 |
| by the Department by rule, and equal to or less
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| than 100% beginning on the date determined by the | 22 |
| Department by rule, of the nonfarm income official | 23 |
| poverty
line, as defined in item (i) of this | 24 |
| subparagraph (a).
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| (b) All persons who, excluding any eligibility | 26 |
| requirements that are inconsistent with any federal |
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| law or federal regulation, as interpreted by the U.S. | 2 |
| Department of Health and Human Services, would be | 3 |
| determined eligible for such basic
maintenance under | 4 |
| Article IV by disregarding the maximum earned income
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| permitted by federal law.
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| 3. Persons who would otherwise qualify for Aid to the | 7 |
| Medically
Indigent under Article VII.
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| 4. Persons not eligible under any of the preceding | 9 |
| paragraphs who fall
sick, are injured, or die, not having | 10 |
| sufficient money, property or other
resources to meet the | 11 |
| costs of necessary medical care or funeral and burial
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| expenses.
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| 5.(a) Women during pregnancy, after the fact
of | 14 |
| pregnancy has been determined by medical diagnosis, and | 15 |
| during the
60-day period beginning on the last day of the | 16 |
| pregnancy, together with
their infants and children born | 17 |
| after September 30, 1983,
whose income and
resources are | 18 |
| insufficient to meet the costs of necessary medical care to
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| the maximum extent possible under Title XIX of the
Federal | 20 |
| Social Security Act.
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| (b) The Illinois Department and the Governor shall | 22 |
| provide a plan for
coverage of the persons eligible under | 23 |
| paragraph 5(a) by April 1, 1990. Such
plan shall provide | 24 |
| ambulatory prenatal care to pregnant women during a
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| presumptive eligibility period and establish an income | 26 |
| eligibility standard
that is equal to 133%
of the nonfarm |
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| income official poverty line, as defined by
the federal | 2 |
| Office of Management and Budget and revised annually in
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| accordance with Section 673(2) of the Omnibus Budget | 4 |
| Reconciliation Act of
1981, applicable to families of the | 5 |
| same size, provided that costs incurred
for medical care | 6 |
| are not taken into account in determining such income
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| eligibility.
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| (c) The Illinois Department may conduct a | 9 |
| demonstration in at least one
county that will provide | 10 |
| medical assistance to pregnant women, together
with their | 11 |
| infants and children up to one year of age,
where the | 12 |
| income
eligibility standard is set up to 185% of the | 13 |
| nonfarm income official
poverty line, as defined by the | 14 |
| federal Office of Management and Budget.
The Illinois | 15 |
| Department shall seek and obtain necessary authorization
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| provided under federal law to implement such a | 17 |
| demonstration. Such
demonstration may establish resource | 18 |
| standards that are not more
restrictive than those | 19 |
| established under Article IV of this Code.
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| 6. Persons under the age of 18 who fail to qualify as | 21 |
| dependent under
Article IV and who have insufficient income | 22 |
| and resources to meet the costs
of necessary medical care | 23 |
| to the maximum extent permitted under Title XIX
of the | 24 |
| Federal Social Security Act.
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| 7. Persons who are under 21 years of age and would
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| qualify as
disabled as defined under the Federal |
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| Supplemental Security Income Program,
provided medical | 2 |
| service for such persons would be eligible for Federal
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| Financial Participation, and provided the Illinois | 4 |
| Department determines that:
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| (a) the person requires a level of care provided by | 6 |
| a hospital, skilled
nursing facility, or intermediate | 7 |
| care facility, as determined by a physician
licensed to | 8 |
| practice medicine in all its branches;
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| (b) it is appropriate to provide such care outside | 10 |
| of an institution, as
determined by a physician | 11 |
| licensed to practice medicine in all its branches;
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| (c) the estimated amount which would be expended | 13 |
| for care outside the
institution is not greater than | 14 |
| the estimated amount which would be
expended in an | 15 |
| institution.
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| 8. Persons who become ineligible for basic maintenance | 17 |
| assistance
under Article IV of this Code in programs | 18 |
| administered by the Illinois
Department due to employment | 19 |
| earnings and persons in
assistance units comprised of | 20 |
| adults and children who become ineligible for
basic | 21 |
| maintenance assistance under Article VI of this Code due to
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| employment earnings. The plan for coverage for this class | 23 |
| of persons shall:
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| (a) extend the medical assistance coverage for up | 25 |
| to 12 months following
termination of basic | 26 |
| maintenance assistance; and
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| (b) offer persons who have initially received 6 | 2 |
| months of the
coverage provided in paragraph (a) above, | 3 |
| the option of receiving an
additional 6 months of | 4 |
| coverage, subject to the following:
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| (i) such coverage shall be pursuant to | 6 |
| provisions of the federal
Social Security Act;
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| (ii) such coverage shall include all services | 8 |
| covered while the person
was eligible for basic | 9 |
| maintenance assistance;
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| (iii) no premium shall be charged for such | 11 |
| coverage; and
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| (iv) such coverage shall be suspended in the | 13 |
| event of a person's
failure without good cause to | 14 |
| file in a timely fashion reports required for
this | 15 |
| coverage under the Social Security Act and | 16 |
| coverage shall be reinstated
upon the filing of | 17 |
| such reports if the person remains otherwise | 18 |
| eligible.
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| 9. Persons with acquired immunodeficiency syndrome | 20 |
| (AIDS) or with
AIDS-related conditions with respect to whom | 21 |
| there has been a determination
that but for home or | 22 |
| community-based services such individuals would
require | 23 |
| the level of care provided in an inpatient hospital, | 24 |
| skilled
nursing facility or intermediate care facility the | 25 |
| cost of which is
reimbursed under this Article. Assistance | 26 |
| shall be provided to such
persons to the maximum extent |
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| permitted under Title
XIX of the Federal Social Security | 2 |
| Act.
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| 10. Participants in the long-term care insurance | 4 |
| partnership program
established under the Illinois | 5 |
| Long-Term Care Partnership Program Act who meet the
| 6 |
| qualifications for protection of resources described in | 7 |
| Section 15 of that
Act.
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| 11. Persons with disabilities who are employed and | 9 |
| eligible for Medicaid,
pursuant to Section | 10 |
| 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | 11 |
| subject to federal approval, persons with a medically | 12 |
| improved disability who are employed and eligible for | 13 |
| Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | 14 |
| the Social Security Act, as
provided by the Illinois | 15 |
| Department by rule. In establishing eligibility standards | 16 |
| under this paragraph 11, the Department shall, subject to | 17 |
| federal approval: | 18 |
| (a) set the income eligibility standard at not | 19 |
| lower than 350% of the federal poverty level; | 20 |
| (b) exempt retirement accounts that the person | 21 |
| cannot access without penalty before the age
of 59 1/2, | 22 |
| and medical savings accounts established pursuant to | 23 |
| 26 U.S.C. 220; | 24 |
| (c) allow non-exempt assets up to $25,000 as to | 25 |
| those assets accumulated during periods of eligibility | 26 |
| under this paragraph 11; and
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| (d) continue to apply subparagraphs (b) and (c) in | 2 |
| determining the eligibility of the person under this | 3 |
| Article even if the person loses eligibility under this | 4 |
| paragraph 11.
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| 12. Subject to federal approval, persons who are | 6 |
| eligible for medical
assistance coverage under applicable | 7 |
| provisions of the federal Social Security
Act and the | 8 |
| federal Breast and Cervical Cancer Prevention and | 9 |
| Treatment Act of
2000. Those eligible persons are defined | 10 |
| to include, but not be limited to,
the following persons:
| 11 |
| (1) persons who have been screened for breast or | 12 |
| cervical cancer under
the U.S. Centers for Disease | 13 |
| Control and Prevention Breast and Cervical Cancer
| 14 |
| Program established under Title XV of the federal | 15 |
| Public Health Services Act in
accordance with the | 16 |
| requirements of Section 1504 of that Act as | 17 |
| administered by
the Illinois Department of Public | 18 |
| Health; and
| 19 |
| (2) persons whose screenings under the above | 20 |
| program were funded in whole
or in part by funds | 21 |
| appropriated to the Illinois Department of Public | 22 |
| Health
for breast or cervical cancer screening.
| 23 |
| "Medical assistance" under this paragraph 12 shall be | 24 |
| identical to the benefits
provided under the State's | 25 |
| approved plan under Title XIX of the Social Security
Act. | 26 |
| The Department must request federal approval of the |
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| coverage under this
paragraph 12 within 30 days after the | 2 |
| effective date of this amendatory Act of
the 92nd General | 3 |
| Assembly.
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| 13. Subject to appropriation and to federal approval, | 5 |
| persons living with HIV/AIDS who are not otherwise eligible | 6 |
| under this Article and who qualify for services covered | 7 |
| under Section 5-5.04 as provided by the Illinois Department | 8 |
| by rule.
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| 14. Subject to the availability of funds for this | 10 |
| purpose, the Department may provide coverage under this | 11 |
| Article to persons who reside in Illinois who are not | 12 |
| eligible under any of the preceding paragraphs and who meet | 13 |
| the income guidelines of paragraph 2(a) of this Section and | 14 |
| (i) have an application for asylum pending before the | 15 |
| federal Department of Homeland Security or on appeal before | 16 |
| a court of competent jurisdiction and are represented | 17 |
| either by counsel or by an advocate accredited by the | 18 |
| federal Department of Homeland Security and employed by a | 19 |
| not-for-profit organization in regard to that application | 20 |
| or appeal, or (ii) are receiving services through a | 21 |
| federally funded torture treatment center. Medical | 22 |
| coverage under this paragraph 14 may be provided for up to | 23 |
| 24 continuous months from the initial eligibility date so | 24 |
| long as an individual continues to satisfy the criteria of | 25 |
| this paragraph 14. If an individual has an appeal pending | 26 |
| regarding an application for asylum before the Department |
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| of Homeland Security, eligibility under this paragraph 14 | 2 |
| may be extended until a final decision is rendered on the | 3 |
| appeal. The Department may adopt rules governing the | 4 |
| implementation of this paragraph 14.
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| 15. Family Care Eligibility. | 6 |
| (a) A caretaker relative who is 19 years of age or | 7 |
| older when countable income is at or below 185% of the | 8 |
| Federal Poverty Level Guidelines, as published | 9 |
| annually in the Federal Register, for the appropriate | 10 |
| family size. A person may not spend down to become | 11 |
| eligible under this paragraph 15. | 12 |
| (b) Eligibility shall be reviewed annually. | 13 |
| (c) Caretaker relatives enrolled under this | 14 |
| paragraph 15 in families with countable income above | 15 |
| 150% and at or below 185% of the Federal Poverty Level | 16 |
| Guidelines shall be counted as family members and pay | 17 |
| premiums as established under the Children's Health | 18 |
| Insurance Program Act. | 19 |
| (d) Premiums shall be billed by and payable to the | 20 |
| Department or its authorized agent, on a monthly basis. | 21 |
| (e) The premium due date is the last day of the | 22 |
| month preceding the month of coverage. | 23 |
| (f) Individuals shall have a grace period through | 24 |
| 30 days the month of coverage to pay the premium. | 25 |
| (g) Failure to pay the full monthly premium by the | 26 |
| last day of the grace period shall result in |
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| termination of coverage. | 2 |
| (h) Partial premium payments shall not be | 3 |
| refunded. | 4 |
| (i) Following termination of an individual's | 5 |
| coverage under this paragraph 15, the following action | 6 |
| is required before the individual can be re-enrolled: | 7 |
| (1) A new application must be completed and the | 8 |
| individual must be determined otherwise eligible. | 9 |
| (2) There must be full payment of premiums due | 10 |
| under this Code, the Children's Health Insurance | 11 |
| Program Act, the Covering ALL KIDS Health | 12 |
| Insurance Act, or any other healthcare program | 13 |
| administered by the Department for periods in | 14 |
| which a premium was owed and not paid for the | 15 |
| individual. | 16 |
| (3) The first month's premium must be paid if | 17 |
| there was an unpaid premium on the date the | 18 |
| individual's previous coverage was canceled. | 19 |
| The Department is authorized to implement the | 20 |
| provisions of this amendatory Act of the 95th General | 21 |
| Assembly by adopting the medical assistance rules in effect | 22 |
| as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | 23 |
| 89 Ill. Admin. Code 120.32 along with only those changes | 24 |
| necessary to conform to federal Medicaid requirements, | 25 |
| federal laws, and federal regulations, including but not | 26 |
| limited to Section 1931 of the Social Security Act (42 |
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| U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | 2 |
| of Health and Human Services, and the countable income | 3 |
| eligibility standard authorized by this paragraph 15. The | 4 |
| Department may not otherwise adopt any rule to implement | 5 |
| this increase except as authorized by law, to meet the | 6 |
| eligibility standards authorized by the federal government | 7 |
| in the Medicaid State Plan or the Title XXI Plan, or to | 8 |
| meet an order from the federal government or any court. | 9 |
| 16. 15. Subject to appropriation, uninsured persons | 10 |
| who are not otherwise eligible under this Section who have | 11 |
| been certified and referred by the Department of Public | 12 |
| Health as having been screened and found to need diagnostic | 13 |
| evaluation or treatment, or both diagnostic evaluation and | 14 |
| treatment, for prostate or testicular cancer. For the | 15 |
| purposes of this paragraph 16 15 , uninsured persons are | 16 |
| those who do not have creditable coverage, as defined under | 17 |
| the Health Insurance Portability and Accountability Act, | 18 |
| or have otherwise exhausted any insurance benefits they may | 19 |
| have had, for prostate or testicular cancer diagnostic | 20 |
| evaluation or treatment, or both diagnostic evaluation and | 21 |
| treatment.
To be eligible, a person must furnish a Social | 22 |
| Security number.
A person's assets are exempt from | 23 |
| consideration in determining eligibility under this | 24 |
| paragraph 16 15 .
Such persons shall be eligible for medical | 25 |
| assistance under this paragraph 16 15 for so long as they | 26 |
| need treatment for the cancer. A person shall be considered |
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| to need treatment if, in the opinion of the person's | 2 |
| treating physician, the person requires therapy directed | 3 |
| toward cure or palliation of prostate or testicular cancer, | 4 |
| including recurrent metastatic cancer that is a known or | 5 |
| presumed complication of prostate or testicular cancer and | 6 |
| complications resulting from the treatment modalities | 7 |
| themselves. Persons who require only routine monitoring | 8 |
| services are not considered to need treatment.
"Medical | 9 |
| assistance" under this paragraph 16 15 shall be identical | 10 |
| to the benefits provided under the State's approved plan | 11 |
| under Title XIX of the Social Security Act.
Notwithstanding | 12 |
| any other provision of law, the Department (i) does not | 13 |
| have a claim against the estate of a deceased recipient of | 14 |
| services under this paragraph 16 15 and (ii) does not have | 15 |
| a lien against any homestead property or other legal or | 16 |
| equitable real property interest owned by a recipient of | 17 |
| services under this paragraph 16 15 . | 18 |
| In implementing the provisions of Public Act 96-20 this | 19 |
| amendatory Act of the 96th General Assembly , the Department is | 20 |
| authorized to adopt only those rules necessary, including | 21 |
| emergency rules. Nothing in Public Act 96-20 this amendatory | 22 |
| Act of the 96th General Assembly permits the Department to | 23 |
| adopt rules or issue a decision that expands eligibility for | 24 |
| the FamilyCare Program to a person whose income exceeds 185% of | 25 |
| the Federal Poverty Level as determined from time to time by | 26 |
| the U.S. Department of Health and Human Services, unless the |
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| Department is provided with express statutory authority. | 2 |
| The Illinois Department and the Governor shall provide a | 3 |
| plan for
coverage of the persons eligible under paragraph 7 as | 4 |
| soon as possible after
July 1, 1984.
| 5 |
| The eligibility of any such person for medical assistance | 6 |
| under this
Article is not affected by the payment of any grant | 7 |
| under the Senior
Citizens and Disabled Persons Property Tax | 8 |
| Relief and Pharmaceutical
Assistance Act or any distributions | 9 |
| or items of income described under
subparagraph (X) of
| 10 |
| paragraph (2) of subsection (a) of Section 203 of the Illinois | 11 |
| Income Tax
Act. The Department shall by rule establish the | 12 |
| amounts of
assets to be disregarded in determining eligibility | 13 |
| for medical assistance,
which shall at a minimum equal the | 14 |
| amounts to be disregarded under the
Federal Supplemental | 15 |
| Security Income Program. The amount of assets of a
single | 16 |
| person to be disregarded
shall not be less than $2,000, and the | 17 |
| amount of assets of a married couple
to be disregarded shall | 18 |
| not be less than $3,000.
| 19 |
| To the extent permitted under federal law, any person found | 20 |
| guilty of a
second violation of Article VIIIA
shall be | 21 |
| ineligible for medical assistance under this Article, as | 22 |
| provided
in Section 8A-8.
| 23 |
| The eligibility of any person for medical assistance under | 24 |
| this Article
shall not be affected by the receipt by the person | 25 |
| of donations or benefits
from fundraisers held for the person | 26 |
| in cases of serious illness,
as long as neither the person nor |
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| members of the person's family
have actual control over the | 2 |
| donations or benefits or the disbursement
of the donations or | 3 |
| benefits.
| 4 |
| (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; | 5 |
| 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. | 6 |
| 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
| 7 |
| (305 ILCS 5/5-5.5) (from Ch. 23, par. 5-5.5)
| 8 |
| Sec. 5-5.5. Elements of Payment Rate.
| 9 |
| (a) The Department of Healthcare and Family Services shall | 10 |
| develop a prospective method for
determining payment rates for | 11 |
| skilled nursing and intermediate care
services in nursing | 12 |
| facilities composed of the following cost elements:
| 13 |
| (1) Standard Services, with the cost of this component | 14 |
| being determined
by taking into account the actual costs to | 15 |
| the facilities of these services
subject to cost ceilings | 16 |
| to be defined in the Department's rules.
| 17 |
| (2) Resident Services, with the cost of this component | 18 |
| being
determined by taking into account the actual costs, | 19 |
| needs and utilization
of these services, as derived from an | 20 |
| assessment of the resident needs in
the nursing facilities. | 21 |
| The Department shall adopt rules governing
reimbursement | 22 |
| for resident services as listed in Section 5-1.1. Surveys | 23 |
| or
assessments of resident needs under this Section shall | 24 |
| include a review by
the facility of the results of such | 25 |
| assessments and a discussion of issues
in dispute with |
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| authorized survey staff, unless the facility elects not to
| 2 |
| participate in such a review process. Surveys or | 3 |
| assessments of resident
needs under this Section may be | 4 |
| conducted semi-annually and payment rates
relating to | 5 |
| resident services may be changed on a semi-annual basis. | 6 |
| The
Illinois Department shall initiate a project, either on | 7 |
| a pilot basis or
Statewide, to reimburse the cost of | 8 |
| resident services based on a
methodology which utilizes an | 9 |
| assessment of resident needs to determine the
level of | 10 |
| reimbursement. This methodology shall be different from | 11 |
| the
payment criteria for resident services utilized by the | 12 |
| Illinois Department
on July 1, 1981. On March 1, 1982, and | 13 |
| each year thereafter, until such
time when the Illinois | 14 |
| Department adopts the methodology used in such
project for | 15 |
| use statewide,
the Illinois Department shall report to the | 16 |
| General Assembly on the
implementation and progress of such | 17 |
| project. The report shall include:
| 18 |
| (A) A statement of the Illinois Department's goals | 19 |
| and objectives
for such project;
| 20 |
| (B) A description of such project, including the | 21 |
| number and type of
nursing facilities involved in the | 22 |
| project;
| 23 |
| (C) A description of the methodology used in such | 24 |
| project;
| 25 |
| (D) A description of the Illinois Department's | 26 |
| application of the
methodology;
|
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| (E) A statement on the methodology's effect on the | 2 |
| quality of care
given to residents in the sample | 3 |
| nursing facilities; and
| 4 |
| (F) A statement on the cost of the methodology used | 5 |
| in such project
and a comparison of this cost with the | 6 |
| cost of the current payment criteria.
| 7 |
| (3) Ancillary Services, with the payment rate being | 8 |
| developed for
each individual type of service. Payment | 9 |
| shall be made only when
authorized under procedures | 10 |
| developed by the Department of Healthcare and Family | 11 |
| Services.
| 12 |
| (4) Nurse's Aide Training, with the cost of this | 13 |
| component being
determined by taking into account the | 14 |
| actual cost to the facilities of
such training.
| 15 |
| (5) Real Estate Taxes, with the cost of this component | 16 |
| being
determined by taking into account the figures | 17 |
| contained in the most
currently available cost reports | 18 |
| (with no imposition of maximums) updated
to the midpoint of | 19 |
| the current rate year for long term care services
rendered | 20 |
| between July 1, 1984 and June 30, 1985, and with the cost | 21 |
| of this
component being determined by taking into account | 22 |
| the actual 1983 taxes for
which the nursing homes were | 23 |
| assessed (with no imposition of maximums)
updated to the | 24 |
| midpoint of the current rate year for long term care
| 25 |
| services rendered between July 1, 1985 and June 30, 1986.
| 26 |
| (b) In developing a prospective method for determining |
|
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| payment rates
for skilled nursing and intermediate care | 2 |
| services in nursing facilities,
the Department of Healthcare | 3 |
| and Family Services shall consider the following cost elements:
| 4 |
| (1) Reasonable capital cost determined by utilizing | 5 |
| incurred interest
rate and the current value of the | 6 |
| investment, including land, utilizing
composite rates, or | 7 |
| by utilizing such other reasonable cost related methods
| 8 |
| determined by the Department. However, beginning with the | 9 |
| rate
reimbursement period effective July 1, 1987, the | 10 |
| Department shall be
prohibited from establishing, | 11 |
| including, and implementing any depreciation
factor in | 12 |
| calculating the capital cost element.
| 13 |
| (2) Profit, with the actual amount being produced and | 14 |
| accruing to
the providers in the form of a return on their | 15 |
| total investment, on the
basis of their ability to | 16 |
| economically and efficiently deliver a type
of service. The | 17 |
| method of payment may assure the opportunity for a
profit, | 18 |
| but shall not guarantee or establish a specific amount as a | 19 |
| cost.
| 20 |
| (c) The Illinois Department may implement the amendatory | 21 |
| changes to
this Section made by this amendatory Act of 1991 | 22 |
| through the use of
emergency rules in accordance with the | 23 |
| provisions of Section 5.02 of the
Illinois Administrative | 24 |
| Procedure Act. For purposes of the Illinois
Administrative | 25 |
| Procedure Act, the adoption of rules to implement the
| 26 |
| amendatory changes to this Section made by this amendatory
Act |
|
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| of 1991 shall be deemed an emergency and necessary for the | 2 |
| public
interest, safety and welfare.
| 3 |
| (d) No later than January 1, 2001, the Department of Public | 4 |
| Aid shall file
with the Joint Committee on Administrative | 5 |
| Rules, pursuant to the Illinois
Administrative Procedure
Act,
a | 6 |
| proposed rule, or a proposed amendment to an existing rule, | 7 |
| regarding payment
for appropriate services, including | 8 |
| assessment, care planning, discharge
planning, and treatment
| 9 |
| provided by nursing facilities to residents who have a serious | 10 |
| mental
illness.
| 11 |
| (Source: P.A. 95-331, eff. 8-21-07.)
| 12 |
| (305 ILCS 5/12-8.2 new) | 13 |
| Sec. 12-8.2. Medical Assistance Dental Reimbursement | 14 |
| Revolving Fund. There is created a revolving fund to be known | 15 |
| as the Medical Assistance Dental Reimbursement Revolving Fund, | 16 |
| to be held by the Director of the Department of Healthcare and | 17 |
| Family Services, outside of the State treasury, for the | 18 |
| following purposes: | 19 |
| (1) The deposit of all funds to pay for dental services | 20 |
| provided by enrolled dental service providers for services | 21 |
| to participants in the medical programs administered by the | 22 |
| Department. | 23 |
| (2) The deposit of any interest accrued by the | 24 |
| revolving fund, which interest shall be available to pay | 25 |
| for dental services provided by enrolled dental service |
|
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| providers for services to participants in the medical | 2 |
| programs administered by the Department. | 3 |
| (3) The payment of amounts to enrolled dental service | 4 |
| providers for dental services provided to participants in | 5 |
| the medical programs administered by the Department.
| 6 |
| (305 ILCS 5/5-5.8a rep.)
| 7 |
| (305 ILCS 5/5-22 rep.)
| 8 |
| Section 15. The Illinois Public Aid Code is amended by | 9 |
| repealing Sections 5-5.8a and 5-22.
|
|