Full Text of HB5420 96th General Assembly
HB5420enr 96TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning State government.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The State Budget Law of the Civil Administrative | 5 | | Code of Illinois is amended by adding Section 50-30 as follows: | 6 | | (15 ILCS 20/50-30 new) | 7 | | Sec. 50-30. Long-term care rebalancing. In light of the | 8 | | increasing demands confronting the State in meeting the needs | 9 | | of individuals utilizing long-term care services under the | 10 | | medical assistance program and any other long-term care related | 11 | | benefit program administered by the State, it is the intent of | 12 | | the General Assembly to address the needs of both the State and | 13 | | the individuals eligible for such services by cost effective | 14 | | and efficient means through the advancement of a long-term care | 15 | | rebalancing initiative. Notwithstanding any State law to the | 16 | | contrary, and subject to federal laws, regulations, and court | 17 | | decrees, the following shall apply to the long-term care | 18 | | rebalancing initiative: | 19 | | (1) "Long-term care rebalancing", as used in this | 20 | | Section, means removing barriers to community living for | 21 | | people of all ages with disabilities and long-term | 22 | | illnesses by offering individuals utilizing long-term care | 23 | | services a reasonable array of options, in particular |
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| 1 | | adequate choices of community and institutional options, | 2 | | to achieve a balance between the proportion of total | 3 | | Medicaid long-term support expenditures used for | 4 | | institutional services and those used for community-based | 5 | | supports. | 6 | | (2) Subject to the provisions of this Section, the | 7 | | Governor shall create a unified budget report identifying | 8 | | the budgets of all State agencies offering long-term care | 9 | | services to persons in either institutional or community | 10 | | settings, including the budgets of State-operated | 11 | | facilities for persons with developmental disabilities | 12 | | that shall include, but not be limited to, the following | 13 | | service and financial data: | 14 | | (A) A breakdown of long-term care services, | 15 | | defined as institutional or community care, by the | 16 | | State agency primarily responsible for administration | 17 | | of the program. | 18 | | (B) Actual and estimated enrollment, caseload, | 19 | | service hours, or service days provided for long-term | 20 | | care services described in a consistent format for | 21 | | those services, for each of the following age groups: | 22 | | older adults 65 years of age and older, younger adults | 23 | | 21 years of age through 64 years of age, and children | 24 | | under 21 years of age. | 25 | | (C) Funding sources for long-term care services. | 26 | | (D) Comparison of service and expenditure data, by |
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| 1 | | services, both in aggregate and per person enrolled. | 2 | | (3) For each fiscal year, the unified budget report | 3 | | described in subdivision (2) shall be prepared with | 4 | | reference to the prioritized outcomes for that fiscal year | 5 | | contemplated by Sections 50-5 and 50-25 of this Code. | 6 | | (4) Each State agency responsible for the | 7 | | administration of long-term care services shall provide an | 8 | | analysis of the progress being made by the agency to | 9 | | transition persons from institutional to community | 10 | | settings, where appropriate, as part of the State's | 11 | | long-term care rebalancing initiative. | 12 | | (5) The Governor may designate amounts set aside for | 13 | | institutional services appropriated from the General | 14 | | Revenue Fund or any other State fund that receives monies | 15 | | for long-term care services to be transferred to all State | 16 | | agencies responsible for the administration of | 17 | | community-based long-term care programs, including, but | 18 | | not limited to, community-based long-term care programs | 19 | | administered by the Department of Healthcare and Family | 20 | | Services, the Department of Human Services, and the | 21 | | Department on Aging, provided that the Director of | 22 | | Healthcare and Family Services first certifies that the | 23 | | amounts being transferred are necessary for the purpose of | 24 | | assisting persons in or at risk of being in institutional | 25 | | care to transition to community-based settings, including | 26 | | the financial data needed to prove the need for the |
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| 1 | | transfer of funds. The total amounts transferred shall not | 2 | | exceed 4% in total of the amounts appropriated from the | 3 | | General Revenue Fund or any other State fund that receives | 4 | | monies for long-term care services for each fiscal year. A | 5 | | notice of the fund transfer must be made to the General | 6 | | Assembly and posted at a minimum on the Department of | 7 | | Healthcare and Family Services website, the Governor's | 8 | | Office of Management and Budget website, and any other | 9 | | website the Governor sees fit. These postings shall serve | 10 | | as notice to the General Assembly of the amounts to be | 11 | | transferred. Notice shall be given at least 30 days prior | 12 | | to transfer. | 13 | | (6) This Section shall be liberally construed and | 14 | | interpreted in a manner that allows the State to advance | 15 | | its long-term care rebalancing initiatives. | 16 | | Section 10. The State Finance Act is amended by changing | 17 | | Sections 13.2 and 25 as follows:
| 18 | | (30 ILCS 105/13.2) (from Ch. 127, par. 149.2)
| 19 | | Sec. 13.2. Transfers among line item appropriations. | 20 | | (a) Transfers among line item appropriations from the same
| 21 | | treasury fund for the objects specified in this Section may be | 22 | | made in
the manner provided in this Section when the balance | 23 | | remaining in one or
more such line item appropriations is | 24 | | insufficient for the purpose for
which the appropriation was |
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| 1 | | made. | 2 | | (a-1) No transfers may be made from one
agency to another | 3 | | agency, nor may transfers be made from one institution
of | 4 | | higher education to another institution of higher education | 5 | | except as provided by subsection (a-4) .
| 6 | | (a-2) Except as otherwise provided in this Section, | 7 | | transfers may be made only among the objects of expenditure | 8 | | enumerated
in this Section, except that no funds may be | 9 | | transferred from any
appropriation for personal services, from | 10 | | any appropriation for State
contributions to the State | 11 | | Employees' Retirement System, from any
separate appropriation | 12 | | for employee retirement contributions paid by the
employer, nor | 13 | | from any appropriation for State contribution for
employee | 14 | | group insurance. During State fiscal year 2005, an agency may | 15 | | transfer amounts among its appropriations within the same | 16 | | treasury fund for personal services, employee retirement | 17 | | contributions paid by employer, and State Contributions to | 18 | | retirement systems; notwithstanding and in addition to the | 19 | | transfers authorized in subsection (c) of this Section, the | 20 | | fiscal year 2005 transfers authorized in this sentence may be | 21 | | made in an amount not to exceed 2% of the aggregate amount | 22 | | appropriated to an agency within the same treasury fund. During | 23 | | State fiscal year 2007, the Departments of Children and Family | 24 | | Services, Corrections, Human Services, and Juvenile Justice | 25 | | may transfer amounts among their respective appropriations | 26 | | within the same treasury fund for personal services, employee |
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| 1 | | retirement contributions paid by employer, and State | 2 | | contributions to retirement systems. During State fiscal year | 3 | | 2010, the Department of Transportation may transfer amounts | 4 | | among their respective appropriations within the same treasury | 5 | | fund for personal services, employee retirement contributions | 6 | | paid by employer, and State contributions to retirement | 7 | | systems. During State fiscal year 2010 only, an agency may | 8 | | transfer amounts among its respective appropriations within | 9 | | the same treasury fund for personal services, employee | 10 | | retirement contributions paid by employer, and State | 11 | | contributions to retirement systems. Notwithstanding, and in | 12 | | addition to, the transfers authorized in subsection (c) of this | 13 | | Section, these transfers may be made in an amount not to exceed | 14 | | 2% of the aggregate amount appropriated to an agency within the | 15 | | same treasury fund.
| 16 | | (a-3) Further, if an agency receives a separate
| 17 | | appropriation for employee retirement contributions paid by | 18 | | the employer,
any transfer by that agency into an appropriation | 19 | | for personal services
must be accompanied by a corresponding | 20 | | transfer into the appropriation for
employee retirement | 21 | | contributions paid by the employer, in an amount
sufficient to | 22 | | meet the employer share of the employee contributions
required | 23 | | to be remitted to the retirement system. | 24 | | (a-4) Long-Term Care Rebalancing. The Governor may | 25 | | designate amounts set aside for institutional services | 26 | | appropriated from the General Revenue Fund or any other State |
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| 1 | | fund that receives monies for long-term care services to be | 2 | | transferred to all State agencies responsible for the | 3 | | administration of community-based long-term care programs, | 4 | | including, but not limited to, community-based long-term care | 5 | | programs administered by the Department of Healthcare and | 6 | | Family Services, the Department of Human Services, and the | 7 | | Department on Aging, provided that the Director of Healthcare | 8 | | and Family Services first certifies that the amounts being | 9 | | transferred are necessary for the purpose of assisting persons | 10 | | in or at risk of being in institutional care to transition to | 11 | | community-based settings, including the financial data needed | 12 | | to prove the need for the transfer of funds. The total amounts | 13 | | transferred shall not exceed 4% in total of the amounts | 14 | | appropriated from the General Revenue Fund or any other State | 15 | | fund that receives monies for long-term care services for each | 16 | | fiscal year. A notice of the fund transfer must be made to the | 17 | | General Assembly and posted at a minimum on the Department of | 18 | | Healthcare and Family Services website, the Governor's Office | 19 | | of Management and Budget website, and any other website the | 20 | | Governor sees fit. These postings shall serve as notice to the | 21 | | General Assembly of the amounts to be transferred. Notice shall | 22 | | be given at least 30 days prior to transfer. | 23 | | (b) In addition to the general transfer authority provided | 24 | | under
subsection (c), the following agencies have the specific | 25 | | transfer authority
granted in this subsection: | 26 | | The Department of Healthcare and Family Services is |
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| 1 | | authorized to make transfers
representing savings attributable | 2 | | to not increasing grants due to the
births of additional | 3 | | children from line items for payments of cash grants to
line | 4 | | items for payments for employment and social services for the | 5 | | purposes
outlined in subsection (f) of Section 4-2 of the | 6 | | Illinois Public Aid Code. | 7 | | The Department of Children and Family Services is | 8 | | authorized to make
transfers not exceeding 2% of the aggregate | 9 | | amount appropriated to it within
the same treasury fund for the | 10 | | following line items among these same line
items: Foster Home | 11 | | and Specialized Foster Care and Prevention, Institutions
and | 12 | | Group Homes and Prevention, and Purchase of Adoption and | 13 | | Guardianship
Services. | 14 | | The Department on Aging is authorized to make transfers not
| 15 | | exceeding 2% of the aggregate amount appropriated to it within | 16 | | the same
treasury fund for the following Community Care Program | 17 | | line items among these
same line items: Homemaker and Senior | 18 | | Companion Services, Alternative Senior Services, Case | 19 | | Coordination
Units, and Adult Day Care Services. | 20 | | The State Treasurer is authorized to make transfers among | 21 | | line item
appropriations
from the Capital Litigation Trust | 22 | | Fund, with respect to costs incurred in
fiscal years 2002 and | 23 | | 2003 only, when the balance remaining in one or
more such
line | 24 | | item appropriations is insufficient for the purpose for which | 25 | | the
appropriation was
made, provided that no such transfer may | 26 | | be made unless the amount transferred
is no
longer required for |
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| 1 | | the purpose for which that appropriation was made. | 2 | | The State Board of Education is authorized to make | 3 | | transfers from line item appropriations within the same | 4 | | treasury fund for General State Aid and General State Aid - | 5 | | Hold Harmless, provided that no such transfer may be made | 6 | | unless the amount transferred is no longer required for the | 7 | | purpose for which that appropriation was made, to the line item | 8 | | appropriation for Transitional Assistance when the balance | 9 | | remaining in such line item appropriation is insufficient for | 10 | | the purpose for which the appropriation was made. | 11 | | The State Board of Education is authorized to make | 12 | | transfers between the following line item appropriations | 13 | | within the same treasury fund: Disabled Student | 14 | | Services/Materials (Section 14-13.01 of the School Code), | 15 | | Disabled Student Transportation Reimbursement (Section | 16 | | 14-13.01 of the School Code), Disabled Student Tuition - | 17 | | Private Tuition (Section 14-7.02 of the School Code), | 18 | | Extraordinary Special Education (Section 14-7.02b of the | 19 | | School Code), Reimbursement for Free Lunch/Breakfast Program, | 20 | | Summer School Payments (Section 18-4.3 of the School Code), and | 21 | | Transportation - Regular/Vocational Reimbursement (Section | 22 | | 29-5 of the School Code). Such transfers shall be made only | 23 | | when the balance remaining in one or more such line item | 24 | | appropriations is insufficient for the purpose for which the | 25 | | appropriation was made and provided that no such transfer may | 26 | | be made unless the amount transferred is no longer required for |
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| 1 | | the purpose for which that appropriation was made. | 2 | | During State fiscal years 2010 and 2011 only, the | 3 | | Department of Healthcare and Family Services is authorized to | 4 | | make transfers not exceeding 4% of the aggregate amount | 5 | | appropriated to it, within the same treasury fund, among the | 6 | | various line items appropriated for Medical Assistance. | 7 | | (c) The sum of such transfers for an agency in a fiscal | 8 | | year shall not
exceed 2% of the aggregate amount appropriated | 9 | | to it within the same treasury
fund for the following objects: | 10 | | Personal Services; Extra Help; Student and
Inmate | 11 | | Compensation; State Contributions to Retirement Systems; State
| 12 | | Contributions to Social Security; State Contribution for | 13 | | Employee Group
Insurance; Contractual Services; Travel; | 14 | | Commodities; Printing; Equipment;
Electronic Data Processing; | 15 | | Operation of Automotive Equipment;
Telecommunications | 16 | | Services; Travel and Allowance for Committed, Paroled
and | 17 | | Discharged Prisoners; Library Books; Federal Matching Grants | 18 | | for
Student Loans; Refunds; Workers' Compensation, | 19 | | Occupational Disease, and
Tort Claims; and, in appropriations | 20 | | to institutions of higher education,
Awards and Grants. | 21 | | Notwithstanding the above, any amounts appropriated for
| 22 | | payment of workers' compensation claims to an agency to which | 23 | | the authority
to evaluate, administer and pay such claims has | 24 | | been delegated by the
Department of Central Management Services | 25 | | may be transferred to any other
expenditure object where such | 26 | | amounts exceed the amount necessary for the
payment of such |
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| 1 | | claims. | 2 | | (c-1) Special provisions for State fiscal year 2003. | 3 | | Notwithstanding any
other provision of this Section to the | 4 | | contrary, for State fiscal year 2003
only, transfers among line | 5 | | item appropriations to an agency from the same
treasury fund | 6 | | may be made provided that the sum of such transfers for an | 7 | | agency
in State fiscal year 2003 shall not exceed 3% of the | 8 | | aggregate amount
appropriated to that State agency for State | 9 | | fiscal year 2003 for the following
objects: personal services, | 10 | | except that no transfer may be approved which
reduces the | 11 | | aggregate appropriations for personal services within an | 12 | | agency;
extra help; student and inmate compensation; State
| 13 | | contributions to retirement systems; State contributions to | 14 | | social security;
State contributions for employee group | 15 | | insurance; contractual services; travel;
commodities; | 16 | | printing; equipment; electronic data processing; operation of
| 17 | | automotive equipment; telecommunications services; travel and | 18 | | allowance for
committed, paroled, and discharged prisoners; | 19 | | library books; federal matching
grants for student loans; | 20 | | refunds; workers' compensation, occupational disease,
and tort | 21 | | claims; and, in appropriations to institutions of higher | 22 | | education,
awards and grants. | 23 | | (c-2) Special provisions for State fiscal year 2005. | 24 | | Notwithstanding subsections (a), (a-2), and (c), for State | 25 | | fiscal year 2005 only, transfers may be made among any line | 26 | | item appropriations from the same or any other treasury fund |
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| 1 | | for any objects or purposes, without limitation, when the | 2 | | balance remaining in one or more such line item appropriations | 3 | | is insufficient for the purpose for which the appropriation was | 4 | | made, provided that the sum of those transfers by a State | 5 | | agency shall not exceed 4% of the aggregate amount appropriated | 6 | | to that State agency for fiscal year 2005.
| 7 | | (d) Transfers among appropriations made to agencies of the | 8 | | Legislative
and Judicial departments and to the | 9 | | constitutionally elected officers in the
Executive branch | 10 | | require the approval of the officer authorized in Section 10
of | 11 | | this Act to approve and certify vouchers. Transfers among | 12 | | appropriations
made to the University of Illinois, Southern | 13 | | Illinois University, Chicago State
University, Eastern | 14 | | Illinois University, Governors State University, Illinois
| 15 | | State University, Northeastern Illinois University, Northern | 16 | | Illinois
University, Western Illinois University, the Illinois | 17 | | Mathematics and Science
Academy and the Board of Higher | 18 | | Education require the approval of the Board of
Higher Education | 19 | | and the Governor. Transfers among appropriations to all other
| 20 | | agencies require the approval of the Governor. | 21 | | The officer responsible for approval shall certify that the
| 22 | | transfer is necessary to carry out the programs and purposes | 23 | | for which
the appropriations were made by the General Assembly | 24 | | and shall transmit
to the State Comptroller a certified copy of | 25 | | the approval which shall
set forth the specific amounts | 26 | | transferred so that the Comptroller may
change his records |
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| 1 | | accordingly. The Comptroller shall furnish the
Governor with | 2 | | information copies of all transfers approved for agencies
of | 3 | | the Legislative and Judicial departments and transfers | 4 | | approved by
the constitutionally elected officials of the | 5 | | Executive branch other
than the Governor, showing the amounts | 6 | | transferred and indicating the
dates such changes were entered | 7 | | on the Comptroller's records. | 8 | | (e) The State Board of Education, in consultation with the | 9 | | State Comptroller, may transfer line item appropriations for | 10 | | General State Aid between the Common School Fund and the | 11 | | Education Assistance Fund. With the advice and consent of the | 12 | | Governor's Office of Management and Budget, the State Board of | 13 | | Education, in consultation with the State Comptroller, may | 14 | | transfer line item appropriations between the General Revenue | 15 | | Fund and the Education Assistance Fund for the following | 16 | | programs: | 17 | | (1) Disabled Student Personnel Reimbursement (Section | 18 | | 14-13.01 of the School Code); | 19 | | (2) Disabled Student Transportation Reimbursement | 20 | | (subsection (b) of Section 14-13.01 of the School Code); | 21 | | (3) Disabled Student Tuition - Private Tuition | 22 | | (Section 14-7.02 of the School Code); | 23 | | (4) Extraordinary Special Education (Section 14-7.02b | 24 | | of the School Code); | 25 | | (5) Reimbursement for Free Lunch/Breakfast Programs; | 26 | | (6) Summer School Payments (Section 18-4.3 of the |
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| 1 | | School Code); | 2 | | (7) Transportation - Regular/Vocational Reimbursement | 3 | | (Section 29-5 of the School Code); | 4 | | (8) Regular Education Reimbursement (Section 18-3 of | 5 | | the School Code); and | 6 | | (9) Special Education Reimbursement (Section 14-7.03 | 7 | | of the School Code). | 8 | | (Source: P.A. 95-707, eff. 1-11-08; 96-37, eff. 7-13-09; | 9 | | 96-820, eff. 11-18-09; 96-959, eff. 7-1-10; 96-1086, eff. | 10 | | 7-16-10.)
| 11 | | (30 ILCS 105/25) (from Ch. 127, par. 161)
| 12 | | Sec. 25. Fiscal year limitations.
| 13 | | (a) All appropriations shall be
available for expenditure | 14 | | for the fiscal year or for a lesser period if the
Act making | 15 | | that appropriation so specifies. A deficiency or emergency
| 16 | | appropriation shall be available for expenditure only through | 17 | | June 30 of
the year when the Act making that appropriation is | 18 | | enacted unless that Act
otherwise provides.
| 19 | | (b) Outstanding liabilities as of June 30, payable from | 20 | | appropriations
which have otherwise expired, may be paid out of | 21 | | the expiring
appropriations during the 2-month period ending at | 22 | | the
close of business on August 31. Any service involving
| 23 | | professional or artistic skills or any personal services by an | 24 | | employee whose
compensation is subject to income tax | 25 | | withholding must be performed as of June
30 of the fiscal year |
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| 1 | | in order to be considered an "outstanding liability as of
June | 2 | | 30" that is thereby eligible for payment out of the expiring
| 3 | | appropriation.
| 4 | | (b-1) However, payment of tuition reimbursement claims | 5 | | under Section 14-7.03 or
18-3 of the School Code may be made by | 6 | | the State Board of Education from its
appropriations for those | 7 | | respective purposes for any fiscal year, even though
the claims | 8 | | reimbursed by the payment may be claims attributable to a prior
| 9 | | fiscal year, and payments may be made at the direction of the | 10 | | State
Superintendent of Education from the fund from which the | 11 | | appropriation is made
without regard to any fiscal year | 12 | | limitations , except as required by subsection (j) of this | 13 | | Section. Beginning on June 30, 2021, payment of tuition | 14 | | reimbursement claims under Section 14-7.03 or 18-3 of the | 15 | | School Code as of June 30, payable from appropriations that | 16 | | have otherwise expired, may be paid out of the expiring | 17 | | appropriation during the 4-month period ending at the close of | 18 | | business on October 31 .
| 19 | | (b-2) All outstanding liabilities as of June 30, 2010, | 20 | | payable from appropriations that would otherwise expire at the | 21 | | conclusion of the lapse period for fiscal year 2010, and | 22 | | interest penalties payable on those liabilities under the State | 23 | | Prompt Payment Act, may be paid out of the expiring | 24 | | appropriations until December 31, 2010, without regard to the | 25 | | fiscal year in which the payment is made, as long as vouchers | 26 | | for the liabilities are received by the Comptroller no later |
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| 1 | | than August 31, 2010. | 2 | | (b-3) Medical payments may be made by the Department of | 3 | | Veterans' Affairs from
its
appropriations for those purposes | 4 | | for any fiscal year, without regard to the
fact that the | 5 | | medical services being compensated for by such payment may have
| 6 | | been rendered in a prior fiscal year , except as required by | 7 | | subsection (j) of this Section. Beginning on June 30, 2021, | 8 | | medical payments payable from appropriations that have | 9 | | otherwise expired may be paid out of the expiring appropriation | 10 | | during the 4-month period ending at the close of business on | 11 | | October 31 .
| 12 | | (b-4) Medical payments may be made by the Department of | 13 | | Healthcare and Family Services and medical payments and child | 14 | | care
payments may be made by the Department of
Human Services | 15 | | (as successor to the Department of Public Aid) from
| 16 | | appropriations for those purposes for any fiscal year,
without | 17 | | regard to the fact that the medical or child care services | 18 | | being
compensated for by such payment may have been rendered in | 19 | | a prior fiscal
year; and payments may be made at the direction | 20 | | of the Department of
Healthcare and Family Services Central | 21 | | Management Services from the Health Insurance Reserve Fund and | 22 | | the
Local Government Health Insurance Reserve Fund without | 23 | | regard to any fiscal
year limitations , except as required by | 24 | | subsection (j) of this Section. Beginning on June 30, 2021, | 25 | | medical payments made by the Department of Healthcare and | 26 | | Family Services, child care payments made by the Department of |
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| 1 | | Human Services, and payments made at the discretion of the | 2 | | Department of Healthcare and Family Services from the Health | 3 | | Insurance Reserve Fund and the Local Government Health | 4 | | Insurance Reserve Fund payable from appropriations that have | 5 | | otherwise expired may be paid out of the expiring appropriation | 6 | | during the 4-month period ending at the close of business on | 7 | | October 31 .
| 8 | | (b-5) Medical payments may be made by the Department of | 9 | | Human Services from its appropriations relating to substance | 10 | | abuse treatment services for any fiscal year, without regard to | 11 | | the fact that the medical services being compensated for by | 12 | | such payment may have been rendered in a prior fiscal year, | 13 | | provided the payments are made on a fee-for-service basis | 14 | | consistent with requirements established for Medicaid | 15 | | reimbursement by the Department of Healthcare and Family | 16 | | Services , except as required by subsection (j) of this Section. | 17 | | Beginning on June 30, 2021, medical payments made by the | 18 | | Department of Human Services relating to substance abuse | 19 | | treatment services payable from appropriations that have | 20 | | otherwise expired may be paid out of the expiring appropriation | 21 | | during the 4-month period ending at the close of business on | 22 | | October 31 . | 23 | | (b-6) Additionally, payments may be made by the Department | 24 | | of Human Services from
its appropriations, or any other State | 25 | | agency from its appropriations with
the approval of the | 26 | | Department of Human Services, from the Immigration Reform
and |
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| 1 | | Control Fund for purposes authorized pursuant to the | 2 | | Immigration Reform
and Control Act of 1986, without regard to | 3 | | any fiscal year limitations , except as required by subsection | 4 | | (j) of this Section. Beginning on June 30, 2021, payments made | 5 | | by the Department of Human Services from the Immigration Reform | 6 | | and Control Fund for purposes authorized pursuant to the | 7 | | Immigration Reform and Control Act of 1986 payable from | 8 | | appropriations that have otherwise expired may be paid out of | 9 | | the expiring appropriation during the 4-month period ending at | 10 | | the close of business on October 31 .
| 11 | | Further, with respect to costs incurred in fiscal years | 12 | | 2002 and 2003 only,
payments may be made by the State Treasurer | 13 | | from its
appropriations
from the Capital Litigation Trust Fund | 14 | | without regard to any fiscal year
limitations.
| 15 | | Lease payments may be made by the Department of Central | 16 | | Management
Services under the sale and leaseback provisions of
| 17 | | Section 7.4 of
the State Property Control Act with respect to | 18 | | the James R. Thompson Center and
the
Elgin Mental Health Center | 19 | | and surrounding land from appropriations for that
purpose | 20 | | without regard to any fiscal year
limitations.
| 21 | | Lease payments may be made under the sale and leaseback | 22 | | provisions of
Section 7.5 of the State Property Control Act | 23 | | with
respect to the
Illinois State Toll Highway Authority | 24 | | headquarters building and surrounding
land
without regard to | 25 | | any fiscal year
limitations.
| 26 | | (b-7) Payments may be made in accordance with a plan |
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| 1 | | authorized by paragraph (11) or (12) of Section 405-105 of the | 2 | | Department of Central Management Services Law from | 3 | | appropriations for those payments without regard to fiscal year | 4 | | limitations. | 5 | | (c) Further, payments may be made by the Department of | 6 | | Public Health , and the
Department of Human Services (acting as | 7 | | successor to the Department of Public
Health under the | 8 | | Department of Human Services Act) , and the Department of | 9 | | Healthcare and Family Services
from their respective | 10 | | appropriations for grants for medical care to or on
behalf of | 11 | | persons
suffering from chronic renal disease, persons | 12 | | suffering from hemophilia, rape
victims, and premature and | 13 | | high-mortality risk infants and their mothers and
for grants | 14 | | for supplemental food supplies provided under the United States
| 15 | | Department of Agriculture Women, Infants and Children | 16 | | Nutrition Program,
for any fiscal year without regard to the | 17 | | fact that the services being
compensated for by such payment | 18 | | may have been rendered in a prior fiscal year , except as | 19 | | required by subsection (j) of this Section. Beginning on June | 20 | | 30, 2021, payments made by the Department of Public Health, the | 21 | | Department of Human Services, and the Department of Healthcare | 22 | | and Family Services from their respective appropriations for | 23 | | grants for medical care to or on behalf of persons suffering | 24 | | from chronic renal disease, persons suffering from hemophilia, | 25 | | rape victims, and premature and high-mortality risk infants and | 26 | | their mothers and for grants for supplemental food supplies |
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| 1 | | provided under the United States Department of Agriculture | 2 | | Women, Infants and Children Nutrition Program payable from | 3 | | appropriations that have otherwise expired may be paid out of | 4 | | the expiring appropriations during the 4-month period ending at | 5 | | the close of business on October 31 .
| 6 | | (d) The Department of Public Health and the Department of | 7 | | Human Services
(acting as successor to the Department of Public | 8 | | Health under the Department of
Human Services Act) shall each | 9 | | annually submit to the State Comptroller, Senate
President, | 10 | | Senate
Minority Leader, Speaker of the House, House Minority | 11 | | Leader, and the
respective Chairmen and Minority Spokesmen of | 12 | | the
Appropriations Committees of the Senate and the House, on | 13 | | or before
December 31, a report of fiscal year funds used to | 14 | | pay for services
provided in any prior fiscal year. This report | 15 | | shall document by program or
service category those | 16 | | expenditures from the most recently completed fiscal
year used | 17 | | to pay for services provided in prior fiscal years.
| 18 | | (e) The Department of Healthcare and Family Services, the | 19 | | Department of Human Services
(acting as successor to the | 20 | | Department of Public Aid), and the Department of Human Services | 21 | | making fee-for-service payments relating to substance abuse | 22 | | treatment services provided during a previous fiscal year shall | 23 | | each annually
submit to the State
Comptroller, Senate | 24 | | President, Senate Minority Leader, Speaker of the House,
House | 25 | | Minority Leader, the respective Chairmen and Minority | 26 | | Spokesmen of the
Appropriations Committees of the Senate and |
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| 1 | | the House, on or before November
30, a report that shall | 2 | | document by program or service category those
expenditures from | 3 | | the most recently completed fiscal year used to pay for (i)
| 4 | | services provided in prior fiscal years and (ii) services for | 5 | | which claims were
received in prior fiscal years.
| 6 | | (f) The Department of Human Services (as successor to the | 7 | | Department of
Public Aid) shall annually submit to the State
| 8 | | Comptroller, Senate President, Senate Minority Leader, Speaker | 9 | | of the House,
House Minority Leader, and the respective | 10 | | Chairmen and Minority Spokesmen of
the Appropriations | 11 | | Committees of the Senate and the House, on or before
December | 12 | | 31, a report
of fiscal year funds used to pay for services | 13 | | (other than medical care)
provided in any prior fiscal year. | 14 | | This report shall document by program or
service category those | 15 | | expenditures from the most recently completed fiscal
year used | 16 | | to pay for services provided in prior fiscal years.
| 17 | | (g) In addition, each annual report required to be | 18 | | submitted by the
Department of Healthcare and Family Services | 19 | | under subsection (e) shall include the following
information | 20 | | with respect to the State's Medicaid program:
| 21 | | (1) Explanations of the exact causes of the variance | 22 | | between the previous
year's estimated and actual | 23 | | liabilities.
| 24 | | (2) Factors affecting the Department of Healthcare and | 25 | | Family Services' liabilities,
including but not limited to | 26 | | numbers of aid recipients, levels of medical
service |
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| 1 | | utilization by aid recipients, and inflation in the cost of | 2 | | medical
services.
| 3 | | (3) The results of the Department's efforts to combat | 4 | | fraud and abuse.
| 5 | | (h) As provided in Section 4 of the General Assembly | 6 | | Compensation Act,
any utility bill for service provided to a | 7 | | General Assembly
member's district office for a period | 8 | | including portions of 2 consecutive
fiscal years may be paid | 9 | | from funds appropriated for such expenditure in
either fiscal | 10 | | year.
| 11 | | (i) An agency which administers a fund classified by the | 12 | | Comptroller as an
internal service fund may issue rules for:
| 13 | | (1) billing user agencies in advance for payments or | 14 | | authorized inter-fund transfers
based on estimated charges | 15 | | for goods or services;
| 16 | | (2) issuing credits, refunding through inter-fund | 17 | | transfers, or reducing future inter-fund transfers
during
| 18 | | the subsequent fiscal year for all user agency payments or | 19 | | authorized inter-fund transfers received during the
prior | 20 | | fiscal year which were in excess of the final amounts owed | 21 | | by the user
agency for that period; and
| 22 | | (3) issuing catch-up billings to user agencies
during | 23 | | the subsequent fiscal year for amounts remaining due when | 24 | | payments or authorized inter-fund transfers
received from | 25 | | the user agency during the prior fiscal year were less than | 26 | | the
total amount owed for that period.
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| 1 | | User agencies are authorized to reimburse internal service | 2 | | funds for catch-up
billings by vouchers drawn against their | 3 | | respective appropriations for the
fiscal year in which the | 4 | | catch-up billing was issued or by increasing an authorized | 5 | | inter-fund transfer during the current fiscal year. For the | 6 | | purposes of this Act, "inter-fund transfers" means transfers | 7 | | without the use of the voucher-warrant process, as authorized | 8 | | by Section 9.01 of the State Comptroller Act.
| 9 | | (i-1) Beginning on July 1, 2021, all outstanding | 10 | | liabilities, not payable during the 4-month lapse period as | 11 | | described in subsections (b-1), (b-3), (b-4), (b-5), (b-6), and | 12 | | (c) of this Section, that are made from appropriations for that | 13 | | purpose for any fiscal year, without regard to the fact that | 14 | | the services being compensated for by those payments may have | 15 | | been rendered in a prior fiscal year, are limited to only those | 16 | | claims that have been incurred but for which a proper bill or | 17 | | invoice as defined by the State Prompt Payment Act has not been | 18 | | received by September 30th following the end of the fiscal year | 19 | | in which the service was rendered. | 20 | | (j) Notwithstanding any other provision of this Act, the | 21 | | aggregate amount of payments to be made without regard for | 22 | | fiscal year limitations as contained in subsections (b-1), | 23 | | (b-3), (b-4), (b-5), (b-6), and (c) of this Section, and | 24 | | determined by using Generally Accepted Accounting Principles, | 25 | | shall not exceed the following amounts: | 26 | | (1) $6,000,000,000 for outstanding liabilities related |
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| 1 | | to fiscal year 2012; | 2 | | (2) $5,300,000,000 for outstanding liabilities related | 3 | | to fiscal year 2013; | 4 | | (3) $4,600,000,000 for outstanding liabilities related | 5 | | to fiscal year 2014; | 6 | | (4) $4,000,000,000 for outstanding liabilities related | 7 | | to fiscal year 2015; | 8 | | (5) $3,300,000,000 for outstanding liabilities related | 9 | | to fiscal year 2016; | 10 | | (6) $2,600,000,000 for outstanding liabilities related | 11 | | to fiscal year 2017; | 12 | | (7) $2,000,000,000 for outstanding liabilities related | 13 | | to fiscal year 2018; | 14 | | (8) $1,300,000,000 for outstanding liabilities related | 15 | | to fiscal year 2019; | 16 | | (9) $600,000,000 for outstanding liabilities related | 17 | | to fiscal year 2020; and | 18 | | (10) $0 for outstanding liabilities related to fiscal | 19 | | year 2021 and fiscal years thereafter. | 20 | | (Source: P.A. 95-331, eff. 8-21-07; 96-928, eff. 6-15-10; | 21 | | 96-958, eff. 7-1-10; revised 7-22-10.)
| 22 | | Section 15. The State Prompt Payment Act is amended by | 23 | | changing Section 3-2 as follows:
| 24 | | (30 ILCS 540/3-2)
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| 1 | | Sec. 3-2. Beginning July 1, 1993, in any instance where a | 2 | | State official or
agency is late in payment of a vendor's bill | 3 | | or invoice for goods or services
furnished to the State, as | 4 | | defined in Section 1, properly approved in
accordance with | 5 | | rules promulgated under Section 3-3, the State official or
| 6 | | agency shall pay interest to the vendor in accordance with the | 7 | | following:
| 8 | | (1) Any bill, except a bill submitted under Article V | 9 | | of the Illinois Public Aid Code, approved for payment under | 10 | | this Section must be paid
or the payment issued to the | 11 | | payee within 60 days of receipt
of a proper bill or | 12 | | invoice.
If payment is not issued to the payee within this | 13 | | 60 day
period, an
interest penalty of 1.0% of any amount | 14 | | approved and unpaid shall be added
for each month or | 15 | | fraction thereof after the end of this 60 day period,
until | 16 | | final payment is made. Any bill , except a bill for pharmacy | 17 | | services or goods, submitted under Article V of the | 18 | | Illinois Public Aid Code approved for payment under this | 19 | | Section must be paid
or the payment issued to the payee | 20 | | within 60 days after receipt
of a proper bill or invoice, | 21 | | and,
if payment is not issued to the payee within this | 22 | | 60-day
period, an
interest penalty of 2.0% of any amount | 23 | | approved and unpaid shall be added
for each month or | 24 | | fraction thereof after the end of this 60-day period,
until | 25 | | final payment is made. Any bill for pharmacy services or | 26 | | goods submitted under Article V of the Illinois Public Aid |
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| 1 | | Code, approved for payment under this Section must be paid | 2 | | or the payment issued to the payee within 60 days of | 3 | | receipt of a proper bill or invoice. If payment is not | 4 | | issued to the payee within this 60 day period, an interest | 5 | | penalty of 1.0% of any amount approved and unpaid shall be | 6 | | added for each month or fraction thereof after the end of | 7 | | this 60 day period, until final payment is made.
| 8 | | (1.1) A State agency shall review in a timely manner | 9 | | each bill or
invoice after its receipt. If the
State agency | 10 | | determines that the bill or invoice contains a defect | 11 | | making it
unable to process the payment request, the agency
| 12 | | shall notify the vendor requesting payment as soon as | 13 | | possible after
discovering the
defect pursuant to rules | 14 | | promulgated under Section 3-3; provided, however, that the | 15 | | notice for construction related bills or invoices must be | 16 | | given not later than 30 days after the bill or invoice was | 17 | | first submitted. The notice shall
identify the defect and | 18 | | any additional information
necessary to correct the | 19 | | defect. If one or more items on a construction related bill | 20 | | or invoice are disapproved, but not the entire bill or | 21 | | invoice, then the portion that is not disapproved shall be | 22 | | paid.
| 23 | | (2) Where a State official or agency is late in payment | 24 | | of a
vendor's bill or invoice properly approved in | 25 | | accordance with this Act, and
different late payment terms | 26 | | are not reduced to writing as a contractual
agreement, the |
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| 1 | | State official or agency shall automatically pay interest
| 2 | | penalties required by this Section amounting to $50 or more | 3 | | to the appropriate
vendor. Each agency shall be responsible | 4 | | for determining whether an interest
penalty
is
owed and
for | 5 | | paying the interest to the vendor.
Interest due to a vendor | 6 | | that amounts to less than $50 shall not be paid but shall | 7 | | be accrued until all interest due the vendor for all | 8 | | similar warrants exceeds $50, at which time the accrued | 9 | | interest shall be payable and interest will begin accruing | 10 | | again, except that interest accrued as of the end of the | 11 | | fiscal year that does not exceed $50 shall be payable at | 12 | | that time. In the event an
individual has paid a vendor for | 13 | | services in advance, the provisions of this
Section shall | 14 | | apply until payment is made to that individual.
| 15 | | (3) The provisions of this amendatory Act of the 96th | 16 | | General Assembly reducing the interest rate on pharmacy | 17 | | claims under Article V of the Illinois Public Aid Code to | 18 | | 1.0% per month shall apply to any pharmacy bills for | 19 | | services and goods under Article V of the Illinois Public | 20 | | Aid Code received on or after the date 60 days before the | 21 | | effective date of this amendatory Act of the 96th General | 22 | | Assembly. | 23 | | (Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10; | 24 | | 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10.)
| 25 | | Section 20. The Illinois Income Tax Act is amended by |
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| 1 | | changing Section 917 as follows:
| 2 | | (35 ILCS 5/917) (from Ch. 120, par. 9-917)
| 3 | | Sec. 917. Confidentiality and information sharing.
| 4 | | (a) Confidentiality.
Except as provided in this Section, | 5 | | all information received by the Department
from returns filed | 6 | | under this Act, or from any investigation conducted under
the | 7 | | provisions of this Act, shall be confidential, except for | 8 | | official purposes
within the Department or pursuant to official | 9 | | procedures for collection
of any State tax or pursuant to an | 10 | | investigation or audit by the Illinois
State Scholarship | 11 | | Commission of a delinquent student loan or monetary award
or | 12 | | enforcement of any civil or criminal penalty or sanction
| 13 | | imposed by this Act or by another statute imposing a State tax, | 14 | | and any
person who divulges any such information in any manner, | 15 | | except for such
purposes and pursuant to order of the Director | 16 | | or in accordance with a proper
judicial order, shall be guilty | 17 | | of a Class A misdemeanor. However, the
provisions of this | 18 | | paragraph are not applicable to information furnished
to (i) | 19 | | the Department of Healthcare and Family Services (formerly
| 20 | | Department of Public Aid), State's Attorneys, and the Attorney | 21 | | General for child support enforcement purposes and (ii) a | 22 | | licensed attorney representing the taxpayer where an appeal or | 23 | | a protest
has been filed on behalf of the taxpayer. If it is | 24 | | necessary to file information obtained pursuant to this Act in | 25 | | a child support enforcement proceeding, the information shall |
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| 1 | | be filed under seal.
| 2 | | (b) Public information. Nothing contained in this Act shall | 3 | | prevent
the Director from publishing or making available to the | 4 | | public the names
and addresses of persons filing returns under | 5 | | this Act, or from publishing
or making available reasonable | 6 | | statistics concerning the operation of the
tax wherein the | 7 | | contents of returns are grouped into aggregates in such a
way | 8 | | that the information contained in any individual return shall | 9 | | not be
disclosed.
| 10 | | (c) Governmental agencies. The Director may make available | 11 | | to the
Secretary of the Treasury of the United States or his | 12 | | delegate, or the
proper officer or his delegate of any other | 13 | | state imposing a tax upon or
measured by income, for | 14 | | exclusively official purposes, information received
by the | 15 | | Department in the administration of this Act, but such | 16 | | permission
shall be granted only if the United States or such | 17 | | other state, as the case
may be, grants the Department | 18 | | substantially similar privileges. The Director
may exchange | 19 | | information with the Department of Healthcare and Family | 20 | | Services and the
Department of Human Services (acting as | 21 | | successor to the Department of Public
Aid under the Department | 22 | | of Human Services Act) for
the purpose of verifying sources and | 23 | | amounts of income and for other purposes
directly connected | 24 | | with the administration of this Act , the Illinois Public Aid | 25 | | Code, and any other health benefit program administered by the | 26 | | State and the Illinois
Public Aid Code . The Director may |
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| 1 | | exchange information with the Director of
the Department of | 2 | | Employment Security for the purpose of verifying sources
and | 3 | | amounts of income and for other purposes directly connected | 4 | | with the
administration of this Act and Acts administered by | 5 | | the Department of
Employment
Security.
The Director may make | 6 | | available to the Illinois Workers' Compensation Commission
| 7 | | information regarding employers for the purpose of verifying | 8 | | the insurance
coverage required under the Workers' | 9 | | Compensation Act and Workers'
Occupational Diseases Act. The | 10 | | Director may exchange information with the Illinois Department | 11 | | on Aging for the purpose of verifying sources and amounts of | 12 | | income for purposes directly related to confirming eligibility | 13 | | for participation in the programs of benefits authorized by the | 14 | | Senior Citizens and Disabled Persons Property Tax Relief and | 15 | | Pharmaceutical Assistance Act.
| 16 | | The Director may make available to any State agency, | 17 | | including the
Illinois Supreme Court, which licenses persons to | 18 | | engage in any occupation,
information that a person licensed by | 19 | | such agency has failed to file
returns under this Act or pay | 20 | | the tax, penalty and interest shown therein,
or has failed to | 21 | | pay any final assessment of tax, penalty or interest due
under | 22 | | this Act.
The Director may make available to any State agency, | 23 | | including the Illinois
Supreme
Court, information regarding | 24 | | whether a bidder, contractor, or an affiliate of a
bidder or
| 25 | | contractor has failed to file returns under this Act or pay the | 26 | | tax, penalty,
and interest
shown therein, or has failed to pay |
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| 1 | | any final assessment of tax, penalty, or
interest due
under | 2 | | this Act, for the limited purpose of enforcing bidder and | 3 | | contractor
certifications.
For purposes of this Section, the | 4 | | term "affiliate" means any entity that (1)
directly,
| 5 | | indirectly, or constructively controls another entity, (2) is | 6 | | directly,
indirectly, or
constructively controlled by another | 7 | | entity, or (3) is subject to the control
of
a common
entity. | 8 | | For purposes of this subsection (a), an entity controls another | 9 | | entity
if
it owns,
directly or individually, more than 10% of | 10 | | the voting securities of that
entity.
As used in
this | 11 | | subsection (a), the term "voting security" means a security | 12 | | that (1)
confers upon the
holder the right to vote for the | 13 | | election of members of the board of directors
or similar
| 14 | | governing body of the business or (2) is convertible into, or | 15 | | entitles the
holder to receive
upon its exercise, a security | 16 | | that confers such a right to vote. A general
partnership
| 17 | | interest is a voting security.
| 18 | | The Director may make available to any State agency, | 19 | | including the
Illinois
Supreme Court, units of local | 20 | | government, and school districts, information
regarding
| 21 | | whether a bidder or contractor is an affiliate of a person who | 22 | | is not
collecting
and
remitting Illinois Use taxes, for the | 23 | | limited purpose of enforcing bidder and
contractor
| 24 | | certifications.
| 25 | | The Director may also make available to the Secretary of | 26 | | State
information that a corporation which has been issued a |
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| 1 | | certificate of
incorporation by the Secretary of State has | 2 | | failed to file returns under
this Act or pay the tax, penalty | 3 | | and interest shown therein, or has failed
to pay any final | 4 | | assessment of tax, penalty or interest due under this Act.
An | 5 | | assessment is final when all proceedings in court for
review of | 6 | | such assessment have terminated or the time for the taking
| 7 | | thereof has expired without such proceedings being instituted. | 8 | | For
taxable years ending on or after December 31, 1987, the | 9 | | Director may make
available to the Director or principal | 10 | | officer of any Department of the
State of Illinois, information | 11 | | that a person employed by such Department
has failed to file | 12 | | returns under this Act or pay the tax, penalty and
interest | 13 | | shown therein. For purposes of this paragraph, the word
| 14 | | "Department" shall have the same meaning as provided in Section | 15 | | 3 of the
State Employees Group Insurance Act of 1971.
| 16 | | (d) The Director shall make available for public
inspection | 17 | | in the Department's principal office and for publication, at | 18 | | cost,
administrative decisions issued on or after January
1, | 19 | | 1995. These decisions are to be made available in a manner so | 20 | | that the
following
taxpayer information is not disclosed:
| 21 | | (1) The names, addresses, and identification numbers | 22 | | of the taxpayer,
related entities, and employees.
| 23 | | (2) At the sole discretion of the Director, trade | 24 | | secrets
or other confidential information identified as | 25 | | such by the taxpayer, no later
than 30 days after receipt | 26 | | of an administrative decision, by such means as the
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| 1 | | Department shall provide by rule.
| 2 | | The Director shall determine the
appropriate extent of the
| 3 | | deletions allowed in paragraph (2). In the event the taxpayer | 4 | | does not submit
deletions,
the Director shall make only the | 5 | | deletions specified in paragraph (1).
| 6 | | The Director shall make available for public inspection and | 7 | | publication an
administrative decision within 180 days after | 8 | | the issuance of the
administrative
decision. The term | 9 | | "administrative decision" has the same meaning as defined in
| 10 | | Section 3-101 of Article III of the Code of Civil Procedure. | 11 | | Costs collected
under this Section shall be paid into the Tax | 12 | | Compliance and Administration
Fund.
| 13 | | (e) Nothing contained in this Act shall prevent the | 14 | | Director from
divulging
information to any person pursuant to a | 15 | | request or authorization made by the
taxpayer, by an authorized | 16 | | representative of the taxpayer, or, in the case of
information | 17 | | related to a joint return, by the spouse filing the joint | 18 | | return
with the taxpayer.
| 19 | | (Source: P.A. 94-1074, eff. 12-26-06; 95-331, eff. 8-21-07.)
| 20 | | Section 25. The Illinois Insurance Code is amended by | 21 | | changing Section 5.5 as follows: | 22 | | (215 ILCS 5/5.5) | 23 | | Sec. 5.5. Compliance with the Department of Healthcare and | 24 | | Family Services. A company authorized to do business in this |
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| 1 | | State or accredited by the State to issue policies of health | 2 | | insurance, including but not limited to, self-insured plans, | 3 | | group health plans (as defined in Section 607(1) of the | 4 | | Employee Retirement Income Security Act of 1974), service | 5 | | benefit plans, managed care organizations, pharmacy benefit | 6 | | managers, or other parties that are by statute, contract, or | 7 | | agreement legally responsible for payment of a claim for a | 8 | | health care item or service as a condition of doing business in | 9 | | the State must: | 10 | | (1) provide to the Department of Healthcare and Family | 11 | | Services, or any successor agency, on at least a quarterly | 12 | | basis if so requested by the Department, information upon | 13 | | request information to determine during what period any | 14 | | individual may be, or may have been, covered by a health | 15 | | insurer and the nature of the coverage that is or was | 16 | | provided by the health insurer, including the name, | 17 | | address, and identifying number of the plan; | 18 | | (2) accept the State's right of recovery and the | 19 | | assignment to the State of any right of an individual or | 20 | | other entity to payment from the party for an item or | 21 | | service for which payment has been made under the medical | 22 | | programs of the Department of Healthcare and Family | 23 | | Services, or any successor agency, under this Code or the | 24 | | Illinois Public Aid Code; | 25 | | (3) respond to any inquiry by the Department of | 26 | | Healthcare and Family Services regarding a claim for |
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| 1 | | payment for any health care item or service that is | 2 | | submitted not later than 3 years after the date of the | 3 | | provision of such health care item or service; and | 4 | | (4) agree not to deny a claim submitted by the | 5 | | Department of Healthcare and Family Services solely on the | 6 | | basis of the date of submission of the claim, the type or | 7 | | format of the claim form, or a failure to present proper | 8 | | documentation at the point-of-sale that is the basis of the | 9 | | claim if (i) the claim is submitted by the Department of | 10 | | Healthcare and Family Services within the 3-year period | 11 | | beginning on the date on which the item or service was | 12 | | furnished and (ii) any action by the Department of | 13 | | Healthcare and Family Services to enforce its rights with | 14 | | respect to such claim is commenced within 6 years of its | 15 | | submission of such claim.
| 16 | | In cases in which the Department of Healthcare and Family | 17 | | Services has determined that an entity that provides health | 18 | | insurance coverage has established a pattern of failure to | 19 | | provide the information required under this Section, and has | 20 | | subsequently certified that determination, along with | 21 | | supporting documentation, to the Director of the Department of | 22 | | Insurance, the Director of the Department of Insurance, based | 23 | | upon the certification of determination made by the Department | 24 | | of Healthcare and Family Services, may commence regulatory | 25 | | proceedings in accordance with all applicable provisions of the | 26 | | Illinois Insurance Code. |
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| 1 | | (Source: P.A. 95-632, eff. 9-25-07.) | 2 | | Section 30. The Children's Health Insurance Program Act is | 3 | | amended by changing Section 15 and by adding Sections 7, 21, | 4 | | 23, and 26 as follows: | 5 | | (215 ILCS 106/7 new) | 6 | | Sec. 7. Eligibility verification. Notwithstanding any | 7 | | other provision of this Act, with respect to applications for | 8 | | benefits provided under the Program, eligibility shall be | 9 | | determined in a manner that ensures program integrity and that | 10 | | complies with federal law and regulations while minimizing | 11 | | unnecessary barriers to enrollment. To this end, as soon as | 12 | | practicable, and unless the Department receives written denial | 13 | | from the federal government, this Section shall be implemented: | 14 | | (a) The Department of Healthcare and Family Services or its | 15 | | designees shall: | 16 | | (1) By no later than July 1, 2011, require verification | 17 | | of, at a minimum, one month's income from all sources | 18 | | required for determining the eligibility of applicants to | 19 | | the Program. Such verification shall take the form of pay | 20 | | stubs, business or income and expense records for | 21 | | self-employed persons, letters from employers, and any | 22 | | other valid documentation of income including data | 23 | | obtained electronically by the Department or its designees | 24 | | from other sources as described in subsection (b) of this |
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| 1 | | Section. | 2 | | (2) By no later than October 1, 2011, require | 3 | | verification of, at a minimum, one month's income from all | 4 | | sources required for determining the continued eligibility | 5 | | of recipients at their annual review of eligibility under | 6 | | the Program. Such verification shall take the form of pay | 7 | | stubs, business or income and expense records for | 8 | | self-employed persons, letters from employers, and any | 9 | | other valid documentation of income including data | 10 | | obtained electronically by the Department or its designees | 11 | | from other sources as described in subsection (b) of this | 12 | | Section. The Department shall send a notice to the | 13 | | recipient at least 60 days prior to the end of the period | 14 | | of eligibility that informs them of the requirements for | 15 | | continued eligibility. If a recipient does not fulfill the | 16 | | requirements for continued eligibility by the deadline | 17 | | established in the notice, a notice of cancellation shall | 18 | | be issued to the recipient and coverage shall end on the | 19 | | last day of the eligibility period. A recipient's | 20 | | eligibility may be reinstated without requiring a new | 21 | | application if the recipient fulfills the requirements for | 22 | | continued eligibility prior to the end of the month | 23 | | following the last date of coverage. Nothing in this | 24 | | Section shall prevent an individual whose coverage has been | 25 | | cancelled from reapplying for health benefits at any time. | 26 | | (3) By no later than July 1, 2011, require verification |
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| 1 | | of Illinois residency. | 2 | | (b) The Department shall establish or continue cooperative
| 3 | | arrangements with the Social Security Administration, the
| 4 | | Illinois Secretary of State, the Department of Human Services,
| 5 | | the Department of Revenue, the Department of Employment | 6 | | Security, and any other appropriate entity to gain electronic
| 7 | | access, to the extent allowed by law, to information available | 8 | | to those entities that may be appropriate for electronically
| 9 | | verifying any factor of eligibility for benefits under the
| 10 | | Program. Data relevant to eligibility shall be provided for no
| 11 | | other purpose than to verify the eligibility of new applicants | 12 | | or current recipients of health benefits under the Program. | 13 | | Data will be requested or provided for any new applicant or | 14 | | current recipient only insofar as that individual's | 15 | | circumstances are relevant to that individual's or another | 16 | | individual's eligibility. | 17 | | (c) Within 90 days of the effective date of this amendatory | 18 | | Act of the 96th General Assembly, the Department of Healthcare | 19 | | and Family Services shall send notice to current recipients | 20 | | informing them of the changes regarding their eligibility | 21 | | verification.
| 22 | | (215 ILCS 106/15)
| 23 | | Sec. 15. Operation of the Program. There is hereby created | 24 | | a
Children's Health Insurance Program. The Program shall | 25 | | operate subject
to appropriation and shall be administered by |
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| 1 | | the Department of Healthcare and Family Services. The | 2 | | Department shall have the powers and authority granted to the
| 3 | | Department under the Illinois Public Aid Code , including, but | 4 | | not limited to, Section 11-5.1 of the Code . The Department may | 5 | | contract
with a Third Party Administrator or other entities to | 6 | | administer and oversee
any portion of this Program.
| 7 | | (Source: P.A. 95-331, eff. 8-21-07.)
| 8 | | (215 ILCS 106/21 new) | 9 | | Sec. 21. Presumptive eligibility. Beginning on the | 10 | | effective date of this amendatory Act of the 96th General | 11 | | Assembly and except where federal law requires presumptive | 12 | | eligibility, no adult may be presumed eligible for health care | 13 | | coverage under the Program, and the Department may not cover | 14 | | any service rendered to an adult unless the adult has completed | 15 | | an application for benefits, all required verifications have | 16 | | been received and the Department or its designee has found the | 17 | | adult eligible for the date on which that service was provided. | 18 | | Nothing in this Section shall apply to pregnant women. | 19 | | (215 ILCS 106/23 new) | 20 | | Sec. 23. Care coordination. | 21 | | (a) At least 50% of recipients eligible for comprehensive | 22 | | medical benefits in all medical assistance programs or other | 23 | | health benefit programs administered by the Department, | 24 | | including the Children's Health Insurance Program Act and the |
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| 1 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | 2 | | care coordination program by no later than January 1, 2015. For | 3 | | purposes of this Section, "coordinated care" or "care | 4 | | coordination" means delivery systems where recipients will | 5 | | receive their care from providers who participate under | 6 | | contract in integrated delivery systems that are responsible | 7 | | for providing or arranging the majority of care, including | 8 | | primary care physician services, referrals from primary care | 9 | | physicians, diagnostic and treatment services, behavioral | 10 | | health services, in-patient and outpatient hospital services, | 11 | | dental services, and rehabilitation and long-term care | 12 | | services. The Department shall designate or contract for such | 13 | | integrated delivery systems (i) to ensure enrollees have a | 14 | | choice of systems and of primary care providers within such | 15 | | systems; (ii) to ensure that enrollees receive quality care in | 16 | | a culturally and linguistically appropriate manner; and (iii) | 17 | | to ensure that coordinated care programs meet the diverse needs | 18 | | of enrollees with developmental, mental health, physical, and | 19 | | age-related disabilities. | 20 | | (b) Payment for such coordinated care shall be based on | 21 | | arrangements where the State pays for performance related to | 22 | | health care outcomes, the use of evidence-based practices, the | 23 | | use of primary care delivered through comprehensive medical | 24 | | homes, the use of electronic medical records, and the | 25 | | appropriate exchange of health information electronically made | 26 | | either on a capitated basis in which a fixed monthly premium |
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| 1 | | per recipient is paid and full financial risk is assumed for | 2 | | the delivery of services, or through other risk-based payment | 3 | | arrangements. | 4 | | (c) To qualify for compliance with this Section, the 50% | 5 | | goal shall be achieved by enrolling medical assistance | 6 | | enrollees from each medical assistance enrollment category, | 7 | | including parents, children, seniors, and people with | 8 | | disabilities to the extent that current State Medicaid payment | 9 | | laws would not limit federal matching funds for recipients in | 10 | | care coordination programs. In addition, services must be more | 11 | | comprehensively defined and more risk shall be assumed than in | 12 | | the Department's primary care case management program as of the | 13 | | effective date of this amendatory Act of the 96th General | 14 | | Assembly. | 15 | | (d) The Department shall report to the General Assembly in | 16 | | a separate part of its annual medical assistance program | 17 | | report, beginning April, 2012 until April, 2016, on the | 18 | | progress and implementation of the care coordination program | 19 | | initiatives established by the provisions of this amendatory | 20 | | Act of the 96th General Assembly. The Department shall include | 21 | | in its April 2011 report a full analysis of federal laws or | 22 | | regulations regarding upper payment limitations to providers | 23 | | and the necessary revisions or adjustments in rate | 24 | | methodologies and payments to providers under this Code that | 25 | | would be necessary to implement coordinated care with full | 26 | | financial risk by a party other than the Department. |
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| 1 | | (215 ILCS 106/26 new) | 2 | | Sec. 26. Moratorium on eligibility expansions. Beginning | 3 | | on the effective date of this amendatory Act of the 96th | 4 | | General Assembly, there shall be a 2-year moratorium on the | 5 | | expansion of eligibility through increasing financial | 6 | | eligibility standards, or through increasing income | 7 | | disregards, or through the creation of new programs that would | 8 | | add new categories of eligible individuals under the medical | 9 | | assistance program under the Illinois Public Aid Code in | 10 | | addition to those categories covered on January 1, 2011. This | 11 | | moratorium shall not apply to expansions required as a federal | 12 | | condition of State participation in the medical assistance | 13 | | program. | 14 | | Section 35. The Covering ALL KIDS Health Insurance Act is | 15 | | amended by changing Sections 15, 20, and 98 and by adding | 16 | | Sections 7, 21, 36, and 56 as follows: | 17 | | (215 ILCS 170/7 new) | 18 | | Sec. 7. Eligibility verification. Notwithstanding any | 19 | | other provision of this Act, with respect to applications for | 20 | | benefits provided under the Program, eligibility shall be | 21 | | determined in a manner that ensures program integrity and that | 22 | | complies with federal law and regulations while minimizing | 23 | | unnecessary barriers to enrollment. To this end, as soon as |
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| 1 | | practicable, and unless the Department receives written denial | 2 | | from the federal government, this Section shall be implemented: | 3 | | (a) The Department of Healthcare and Family Services or its | 4 | | designees shall: | 5 | | (1) By July 1, 2011, require verification of, at a | 6 | | minimum, one month's income from all sources required for | 7 | | determining the eligibility of applicants to the Program.
| 8 | | Such verification shall take the form of pay stubs, | 9 | | business or income and expense records for self-employed | 10 | | persons, letters from employers, and any other valid | 11 | | documentation of income including data obtained | 12 | | electronically by the Department or its designees from | 13 | | other sources as described in subsection (b) of this | 14 | | Section. | 15 | | (2) By October 1, 2011, require verification of, at a | 16 | | minimum, one month's income from all sources required for | 17 | | determining the continued eligibility of recipients at | 18 | | their annual review of eligibility under the Program. Such | 19 | | verification shall take the form of pay stubs, business or | 20 | | income and expense records for self-employed persons, | 21 | | letters from employers, and any other valid documentation | 22 | | of income including data obtained electronically by the | 23 | | Department or its designees from other sources as described | 24 | | in subsection (b) of this Section. The Department shall | 25 | | send a notice to
recipients at least 60 days prior to the | 26 | | end of their period
of eligibility that informs them of the
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| 1 | | requirements for continued eligibility. If a recipient
| 2 | | does not fulfill the requirements for continued | 3 | | eligibility by the
deadline established in the notice, a | 4 | | notice of cancellation shall be issued to the recipient and | 5 | | coverage shall end on the last day of the eligibility | 6 | | period. A recipient's eligibility may be reinstated | 7 | | without requiring a new application if the recipient | 8 | | fulfills the requirements for continued eligibility prior | 9 | | to the end of the month following the last date of | 10 | | coverage. Nothing in this Section shall prevent an | 11 | | individual whose coverage has been cancelled from | 12 | | reapplying for health benefits at any time. | 13 | | (3) By July 1, 2011, require verification of Illinois | 14 | | residency. | 15 | | (b) The Department shall establish or continue cooperative
| 16 | | arrangements with the Social Security Administration, the
| 17 | | Illinois Secretary of State, the Department of Human Services,
| 18 | | the Department of Revenue, the Department of Employment
| 19 | | Security, and any other appropriate entity to gain electronic
| 20 | | access, to the extent allowed by law, to information available
| 21 | | to those entities that may be appropriate for electronically
| 22 | | verifying any factor of eligibility for benefits under the
| 23 | | Program. Data relevant to eligibility shall be provided for no
| 24 | | other purpose than to verify the eligibility of new applicants | 25 | | or current recipients of health benefits under the Program. | 26 | | Data will be requested or provided for any new applicant or |
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| 1 | | current recipient only insofar as that individual's | 2 | | circumstances are relevant to that individual's or another | 3 | | individual's eligibility. | 4 | | (c) Within 90 days of the effective date of this amendatory | 5 | | Act of the 96th General Assembly, the Department of Healthcare | 6 | | and Family Services shall send notice to current recipients | 7 | | informing them of the changes regarding their eligibility | 8 | | verification. | 9 | | (215 ILCS 170/15) | 10 | | (Section scheduled to be repealed on July 1, 2011)
| 11 | | Sec. 15. Operation of Program. The Covering ALL KIDS Health | 12 | | Insurance Program is created. The Program shall be administered | 13 | | by the Department of Healthcare and Family Services. The | 14 | | Department shall have the same powers and authority to | 15 | | administer the Program as are provided to the Department in | 16 | | connection with the Department's administration of the | 17 | | Illinois Public Aid Code , including, but not limited to, the | 18 | | provisions under Section 11-5.1 of the Code, and the Children's | 19 | | Health Insurance Program Act. The Department shall coordinate | 20 | | the Program with the existing children's health programs | 21 | | operated by the Department and other State agencies.
| 22 | | (Source: P.A. 94-693, eff. 7-1-06 .) | 23 | | (215 ILCS 170/20) | 24 | | (Section scheduled to be repealed on July 1, 2011)
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| 1 | | Sec. 20. Eligibility. | 2 | | (a) To be eligible for the Program, a person must be a | 3 | | child:
| 4 | | (1) who is a resident of the State of Illinois; and | 5 | | (2) who is ineligible for medical assistance under the | 6 | | Illinois Public Aid Code or benefits under the Children's | 7 | | Health Insurance Program Act; and
| 8 | | (3) either (i) who has been without health insurance | 9 | | coverage for a period set forth by the Department in rules, | 10 | | but not less than 6 months during the first month of | 11 | | operation of the Program, 7 months during the second month | 12 | | of operation, 8 months during the third month of operation, | 13 | | 9 months during the fourth month of operation, 10 months | 14 | | during the fifth month of operation, 11 months during the | 15 | | sixth month of operation, and 12 months thereafter , (ii) | 16 | | whose parent has lost employment that made available | 17 | | affordable dependent health insurance coverage, until such | 18 | | time as affordable employer-sponsored dependent health | 19 | | insurance coverage is again available for the child as set | 20 | | forth by the Department in rules, (iii) who is a newborn | 21 | | whose responsible relative does not have available | 22 | | affordable private or employer-sponsored health insurance, | 23 | | or (iv) who, within one year of applying for coverage under | 24 | | this Act, lost medical benefits under the Illinois Public | 25 | | Aid Code or the Children's Health Insurance Program Act ; | 26 | | and . |
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| 1 | | (3.5) whose household income, as determined by the | 2 | | Department, is at or below 300% of the federal poverty | 3 | | level. This item (3.5) is effective July 1, 2011. | 4 | | An entity that provides health insurance coverage (as | 5 | | defined in Section 2 of the Comprehensive Health Insurance Plan | 6 | | Act) to Illinois residents shall provide health insurance data | 7 | | match to the Department of Healthcare and Family Services as | 8 | | provided by and subject to Section 5.5 of the Illinois | 9 | | Insurance Code for the purpose of determining eligibility for | 10 | | the Program under this Act . | 11 | | The Department of Healthcare and Family Services, in | 12 | | collaboration with the Department of Financial and | 13 | | Professional Regulation, Division of Insurance, shall adopt | 14 | | rules governing the exchange of information under this Section. | 15 | | The rules shall be consistent with all laws relating to the | 16 | | confidentiality or privacy of personal information or medical | 17 | | records, including provisions under the Federal Health | 18 | | Insurance Portability and Accountability Act (HIPAA). | 19 | | (b) The Department shall monitor the availability and | 20 | | retention of employer-sponsored dependent health insurance | 21 | | coverage and shall modify the period described in subdivision | 22 | | (a)(3) if necessary to promote retention of private or | 23 | | employer-sponsored health insurance and timely access to | 24 | | healthcare services, but at no time shall the period described | 25 | | in subdivision (a)(3) be less than 6 months.
| 26 | | (c) The Department, at its discretion, may take into |
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| 1 | | account the affordability of dependent health insurance when | 2 | | determining whether employer-sponsored dependent health | 3 | | insurance coverage is available upon reemployment of a child's | 4 | | parent as provided in subdivision (a)(3). | 5 | | (d) A child who is determined to be eligible for the | 6 | | Program shall remain eligible for 12 months, provided that the | 7 | | child maintains his or her residence in this State, has not yet | 8 | | attained 19 years of age, and is not excluded under subsection | 9 | | (e). | 10 | | (e) A child is not eligible for coverage under the Program | 11 | | if: | 12 | | (1) the premium required under Section 40 has not been | 13 | | timely paid; if the required premiums are not paid, the | 14 | | liability of the Program shall be limited to benefits | 15 | | incurred under the Program for the time period for which | 16 | | premiums have been paid; re-enrollment shall be completed | 17 | | before the next covered medical visit, and the first | 18 | | month's required premium shall be paid in advance of the | 19 | | next covered medical visit; or | 20 | | (2) the child is an inmate of a public institution or | 21 | | an institution for mental diseases.
| 22 | | (f) The Department may shall adopt eligibility rules, | 23 | | including, but not limited to: rules regarding annual renewals | 24 | | of eligibility for the Program in conformance with Section 7 of | 25 | | this Act; rules regarding annual renewals of eligibility for | 26 | | the Program; rules providing for re-enrollment, grace periods, |
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| 1 | | notice requirements, and hearing procedures under subdivision | 2 | | (e)(1) of this Section; and rules regarding what constitutes | 3 | | availability and affordability of private or | 4 | | employer-sponsored health insurance, with consideration of | 5 | | such factors as the percentage of income needed to purchase | 6 | | children or family health insurance, the availability of | 7 | | employer subsidies, and other relevant factors.
| 8 | | (g) Each child enrolled in the Program as of July 1, 2011 | 9 | | whose family income, as established by the Department, exceeds | 10 | | 300% of the federal poverty level may remain enrolled in the | 11 | | Program for 12 additional months commencing July 1, 2011. | 12 | | Continued enrollment pursuant to this subsection shall be | 13 | | available only if the child continues to meet all eligibility | 14 | | criteria established under the Program as of the effective date | 15 | | of this amendatory Act of the 96th General Assembly without a | 16 | | break in coverage. Nothing contained in this subsection shall | 17 | | prevent a child from qualifying for any other health benefits | 18 | | program operated by the Department. | 19 | | (Source: P.A. 96-1272, eff. 1-1-11.) | 20 | | (215 ILCS 170/21 new) | 21 | | Sec. 21. Presumptive eligibility. Beginning on the | 22 | | effective date of this amendatory Act of the 96th General | 23 | | Assembly and except where federal law or regulation requires | 24 | | presumptive eligibility, no adult may be presumed eligible for | 25 | | health care coverage under the Program and the Department may |
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| 1 | | not cover any service rendered to an adult unless the adult has | 2 | | completed an application for benefits, all required | 3 | | verifications have been received, and the Department or its | 4 | | designee has found the adult eligible for the date on which | 5 | | that service was provided. Nothing in this Section shall apply | 6 | | to pregnant women. | 7 | | (215 ILCS 170/36 new) | 8 | | Sec. 36. Moratorium on eligibility expansions. Beginning | 9 | | on the effective date of this amendatory Act of the 96th | 10 | | General Assembly, there shall be a 2-year moratorium on the | 11 | | expansion of eligibility through increasing financial | 12 | | eligibility standards, or through increasing income | 13 | | disregards, or through the creation of new programs that would | 14 | | add new categories of eligible individuals under the medical | 15 | | assistance program under the Illinois Public Aid Code in | 16 | | addition to those categories covered on January 1, 2011. This | 17 | | moratorium shall not apply to expansions required as a federal | 18 | | condition of State participation in the medical assistance | 19 | | program. | 20 | | (215 ILCS 170/56 new) | 21 | | Sec. 56. Care coordination. | 22 | | (a) At least 50% of recipients eligible for comprehensive | 23 | | medical benefits in all medical assistance programs or other | 24 | | health benefit programs administered by the Department, |
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| 1 | | including the Children's Health Insurance Program Act and the | 2 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | 3 | | care coordination program by no later than January 1, 2015. For | 4 | | purposes of this Section, "coordinated care" or "care | 5 | | coordination" means delivery systems where recipients will | 6 | | receive their care from providers who participate under | 7 | | contract in integrated delivery systems that are responsible | 8 | | for providing or arranging the majority of care, including | 9 | | primary care physician services, referrals from primary care | 10 | | physicians, diagnostic and treatment services, behavioral | 11 | | health services, in-patient and outpatient hospital services, | 12 | | dental services, and rehabilitation and long-term care | 13 | | services. The Department shall designate or contract for such | 14 | | integrated delivery systems (i) to ensure enrollees have a | 15 | | choice of systems and of primary care providers within such | 16 | | systems; (ii) to ensure that enrollees receive quality care in | 17 | | a culturally and linguistically appropriate manner; and (iii) | 18 | | to ensure that coordinated care programs meet the diverse needs | 19 | | of enrollees with developmental, mental health, physical, and | 20 | | age-related disabilities. | 21 | | (b) Payment for such coordinated care shall be based on | 22 | | arrangements where the State pays for performance related to | 23 | | health care outcomes, the use of evidence-based practices, the | 24 | | use of primary care delivered through comprehensive medical | 25 | | homes, the use of electronic medical records, and the | 26 | | appropriate exchange of health information electronically made |
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| 1 | | either on a capitated basis in which a fixed monthly premium | 2 | | per recipient is paid and full financial risk is assumed for | 3 | | the delivery of services, or through other risk-based payment | 4 | | arrangements. | 5 | | (c) To qualify for compliance with this Section, the 50% | 6 | | goal shall be achieved by enrolling medical assistance | 7 | | enrollees from each medical assistance enrollment category, | 8 | | including parents, children, seniors, and people with | 9 | | disabilities to the extent that current State Medicaid payment | 10 | | laws would not limit federal matching funds for recipients in | 11 | | care coordination programs. In addition, services must be more | 12 | | comprehensively defined and more risk shall be assumed than in | 13 | | the Department's primary care case management program as of the | 14 | | effective date of this amendatory Act of the 96th General | 15 | | Assembly. | 16 | | (d) The Department shall report to the General Assembly in | 17 | | a separate part of its annual medical assistance program | 18 | | report, beginning April, 2012 until April, 2016, on the | 19 | | progress and implementation of the care coordination program | 20 | | initiatives established by the provisions of this amendatory | 21 | | Act of the 96th General Assembly. The Department shall include | 22 | | in its April 2011 report a full analysis of federal laws or | 23 | | regulations regarding upper payment limitations to providers | 24 | | and the necessary revisions or adjustments in rate | 25 | | methodologies and payments to providers under this Code that | 26 | | would be necessary to implement coordinated care with full |
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| 1 | | financial risk by a party other than the Department. | 2 | | (215 ILCS 170/98) | 3 | | (Section scheduled to be repealed on July 1, 2011)
| 4 | | Sec. 98. Repealer. This Act is repealed on July 1, 2016 | 5 | | July 1, 2011 .
| 6 | | (Source: P.A. 94-693, eff. 7-1-06 .) | 7 | | Section 40. The Illinois Public Aid Code is amended by | 8 | | changing Sections 5-4.1, 5-5.12, 5-11, 8A-2.5, and 11-26 and by | 9 | | adding Sections 5-1.3, 5-1.4, 5-2.03, 5-11a, 5-29, 5-30, and | 10 | | 11-5.1 as follows: | 11 | | (305 ILCS 5/5-1.3 new) | 12 | | Sec. 5-1.3. Payer of last resort. To the extent permissible | 13 | | under federal law, the State may pay for medical services only | 14 | | after payment from all other sources of payment have been | 15 | | exhausted, or after the Department has determined that pursuit | 16 | | of such payment is economically unfeasible. Applicants for, and | 17 | | recipients of, medical assistance under this Code shall | 18 | | disclose to the State all insurance coverage they have. To the | 19 | | extent permissible under federal law, the State shall require | 20 | | vendors of medical services to bill third-party payers for | 21 | | services that may be covered by those third-party payers prior | 22 | | to submission of a request for payment to the State. The | 23 | | Department shall, to the extent permissible under federal law, |
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| 1 | | reject a request for payment of a medical service that should | 2 | | first have been submitted to a third-party payer. | 3 | | (305 ILCS 5/5-1.4 new) | 4 | | Sec. 5-1.4. Moratorium on eligibility expansions. | 5 | | Beginning on the effective date of this amendatory Act of the | 6 | | 96th General Assembly, there shall be a 2-year moratorium on | 7 | | the expansion of eligibility through increasing financial | 8 | | eligibility standards, or through increasing income | 9 | | disregards, or through the creation of new programs which would | 10 | | add new categories of eligible individuals under the medical | 11 | | assistance program in addition to those categories covered on | 12 | | January 1, 2011. This moratorium shall not apply to expansions | 13 | | required as a federal condition of State participation in the | 14 | | medical assistance program. | 15 | | (305 ILCS 5/5-2.03 new) | 16 | | Sec. 5-2.03. Presumptive eligibility. Beginning on the | 17 | | effective date of this amendatory Act of the 96th General | 18 | | Assembly and except where federal law requires presumptive | 19 | | eligibility, no adult may be presumed eligible for medical | 20 | | assistance under this Code and the Department may not cover any | 21 | | service rendered to an adult unless the adult has completed an | 22 | | application for benefits, all required verifications have been | 23 | | received, and the Department or its designee has found the | 24 | | adult eligible for the date on which that service was provided. |
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| 1 | | Nothing in this Section shall apply to pregnant women.
| 2 | | (305 ILCS 5/5-4.1) (from Ch. 23, par. 5-4.1)
| 3 | | Sec. 5-4.1. Co-payments. The Department may by rule provide | 4 | | that recipients
under any Article of this Code shall pay a fee | 5 | | as a co-payment for services.
Co-payments shall be maximized to | 6 | | the extent permitted by federal law may not exceed $3 for brand | 7 | | name drugs, $1 for other pharmacy
services other than for | 8 | | generic drugs, and $2 for physicians services, dental
services, | 9 | | optical services and supplies, chiropractic services, podiatry
| 10 | | services, and encounter rate clinic services. There shall be no | 11 | | co-payment for
generic drugs. Co-payments may not exceed $3 for | 12 | | hospital outpatient and clinic
services . Provided, however, | 13 | | that any such rule must provide that no
co-payment requirement | 14 | | can exist
for renal dialysis, radiation therapy, cancer | 15 | | chemotherapy, or insulin, and
other products necessary on a | 16 | | recurring basis, the absence of which would
be life | 17 | | threatening, or where co-payment expenditures for required | 18 | | services
and/or medications for chronic diseases that the | 19 | | Illinois Department shall
by rule designate shall cause an | 20 | | extensive financial burden on the
recipient, and provided no | 21 | | co-payment shall exist for emergency room
encounters which are | 22 | | for medical emergencies. The Department shall seek approval of | 23 | | a State plan amendment that allows pharmacies to refuse to | 24 | | dispense drugs in circumstances where the recipient does not | 25 | | pay the required co-payment. In the event the State plan |
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| 1 | | amendment is rejected, co-payments may not exceed $3 for brand | 2 | | name drugs, $1 for other pharmacy
services other than for | 3 | | generic drugs, and $2 for physician services, dental
services, | 4 | | optical services and supplies, chiropractic services, podiatry
| 5 | | services, and encounter rate clinic services. There shall be no | 6 | | co-payment for
generic drugs. Co-payments may not exceed $3 for | 7 | | hospital outpatient and clinic
services.
| 8 | | (Source: P.A. 92-597, eff. 6-28-02; 93-593, eff. 8-25-03 .)
| 9 | | (305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
| 10 | | Sec. 5-5.12. Pharmacy payments.
| 11 | | (a) Every request submitted by a pharmacy for reimbursement | 12 | | under this
Article for prescription drugs provided to a | 13 | | recipient of aid under this
Article shall include the name of | 14 | | the prescriber or an acceptable
identification number as | 15 | | established by the Department.
| 16 | | (b) Pharmacies providing prescription drugs under
this | 17 | | Article shall be reimbursed at a rate which shall include
a | 18 | | professional dispensing fee as determined by the Illinois
| 19 | | Department, plus the current acquisition cost of the | 20 | | prescription
drug dispensed. The Illinois Department shall | 21 | | update its
information on the acquisition costs of all | 22 | | prescription drugs
no less frequently than every 30 days. | 23 | | However, the Illinois
Department may set the rate of | 24 | | reimbursement for the acquisition
cost, by rule, at a | 25 | | percentage of the current average wholesale
acquisition cost.
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| 1 | | (c) (Blank).
| 2 | | (d) The Department shall not impose requirements for prior | 3 | | approval
based on a preferred drug list for anti-retroviral, | 4 | | anti-hemophilic factor
concentrates,
or
any atypical | 5 | | antipsychotics, conventional antipsychotics,
or | 6 | | anticonvulsants used for the treatment of serious mental
| 7 | | illnesses
until 30 days after it has conducted a study of the | 8 | | impact of such
requirements on patient care and submitted a | 9 | | report to the Speaker of the
House of Representatives and the | 10 | | President of the Senate. The Department shall review | 11 | | utilization of narcotic medications in the medical assistance | 12 | | program and impose utilization controls that protect against | 13 | | abuse.
| 14 | | (e) When making determinations as to which drugs shall be | 15 | | on a prior approval list, the Department shall include as part | 16 | | of the analysis for this determination, the degree to which a | 17 | | drug may affect individuals in different ways based on factors | 18 | | including the gender of the person taking the medication. | 19 | | (f) (e) The Department shall cooperate with the Department | 20 | | of Public Health and the Department of Human Services Division | 21 | | of Mental Health in identifying psychotropic medications that, | 22 | | when given in a particular form, manner, duration, or frequency | 23 | | (including "as needed") in a dosage, or in conjunction with | 24 | | other psychotropic medications to a nursing home resident, may | 25 | | constitute a chemical restraint or an "unnecessary drug" as | 26 | | defined by the Nursing Home Care Act or Titles XVIII and XIX of |
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| 1 | | the Social Security Act and the implementing rules and | 2 | | regulations. The Department shall require prior approval for | 3 | | any such medication prescribed for a nursing home resident that | 4 | | appears to be a chemical restraint or an unnecessary drug. The | 5 | | Department shall consult with the Department of Human Services | 6 | | Division of Mental Health in developing a protocol and criteria | 7 | | for deciding whether to grant such prior approval. | 8 | | (g) The Department may by rule provide for reimbursement of | 9 | | the dispensing of a 90-day supply of a generic, non-narcotic | 10 | | maintenance medication in circumstances where it is cost | 11 | | effective. | 12 | | (Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; | 13 | | revised 9-2-10.)
| 14 | | (305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
| 15 | | Sec. 5-11. Co-operative arrangements; contracts with other | 16 | | State
agencies, health care and rehabilitation organizations, | 17 | | and fiscal
intermediaries.
| 18 | | (a) The Illinois Department may enter into co-operative | 19 | | arrangements
with
State agencies responsible for administering | 20 | | or supervising the
administration of health services and | 21 | | vocational rehabilitation services to
the end that there may be | 22 | | maximum utilization of such services in the
provision of | 23 | | medical assistance.
| 24 | | The Illinois Department shall, not later than June 30, | 25 | | 1993, enter into
one or more co-operative arrangements with the |
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| 1 | | Department of Mental Health
and Developmental Disabilities | 2 | | providing that the Department of Mental
Health and | 3 | | Developmental Disabilities will be responsible for | 4 | | administering
or supervising all programs for services to | 5 | | persons in community care
facilities for persons with | 6 | | developmental disabilities, including but not
limited to | 7 | | intermediate care facilities, that are supported by State funds | 8 | | or
by funding under Title XIX of the federal Social Security | 9 | | Act. The
responsibilities of the Department of Mental Health | 10 | | and Developmental
Disabilities under these agreements are | 11 | | transferred to the Department of
Human Services as provided in | 12 | | the Department of Human Services Act.
| 13 | | The Department may also contract with such State health and
| 14 | | rehabilitation agencies and other public or private health care | 15 | | and
rehabilitation organizations to act for it in supplying | 16 | | designated medical
services to persons eligible therefor under | 17 | | this Article. Any contracts
with health services or health | 18 | | maintenance organizations shall be
restricted to organizations | 19 | | which have been certified as being in
compliance with standards | 20 | | promulgated pursuant to the laws of this State
governing the | 21 | | establishment and operation of health services or health
| 22 | | maintenance organizations. The Department shall renegotiate | 23 | | the contracts with health maintenance organizations and | 24 | | managed care community
networks that took effect August 1, | 25 | | 2003, so as to produce $70,000,000 savings to the Department | 26 | | net of resulting increases to the fee-for-service program for |
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| 1 | | State fiscal year 2006. The Department may also contract with | 2 | | insurance
companies or other corporate entities serving as | 3 | | fiscal intermediaries in
this State for the Federal Government | 4 | | in respect to Medicare payments under
Title XVIII of the | 5 | | Federal Social Security Act to act for the Department in
paying | 6 | | medical care suppliers. The provisions of Section 9 of "An Act | 7 | | in
relation to State finance", approved June 10, 1919, as | 8 | | amended,
notwithstanding, such contracts with State agencies, | 9 | | other health care and
rehabilitation organizations, or fiscal | 10 | | intermediaries may provide for
advance payments.
| 11 | | (b) For purposes of this subsection (b), "managed care | 12 | | community
network" means an entity, other than a health | 13 | | maintenance organization, that
is owned, operated, or governed | 14 | | by providers of health care services within
this State and that | 15 | | provides or arranges primary, secondary, and tertiary
managed | 16 | | health care services under contract with the Illinois | 17 | | Department
exclusively to persons participating in programs | 18 | | administered by the Illinois
Department.
| 19 | | The Illinois Department may certify managed care community
| 20 | | networks, including managed care community networks owned, | 21 | | operated, managed,
or
governed by State-funded medical | 22 | | schools, as risk-bearing entities eligible to
contract with the | 23 | | Illinois Department as Medicaid managed care
organizations. | 24 | | The Illinois Department may contract with those managed
care | 25 | | community networks to furnish health care services to or | 26 | | arrange those
services for individuals participating in |
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| 1 | | programs administered by the Illinois
Department. The rates for | 2 | | those provider-sponsored organizations may be
determined on a | 3 | | prepaid, capitated basis. A managed care community
network may | 4 | | choose to contract with the Illinois Department to provide only
| 5 | | pediatric
health care services.
The
Illinois Department shall | 6 | | by rule adopt the criteria, standards, and procedures
by
which | 7 | | a managed care community network may be permitted to contract | 8 | | with
the Illinois Department and shall consult with the | 9 | | Department of Insurance in
adopting these rules.
| 10 | | A county provider as defined in Section 15-1 of this Code | 11 | | may
contract with the Illinois Department to provide primary, | 12 | | secondary, or
tertiary managed health care services as a | 13 | | managed care
community network without the need to establish a | 14 | | separate entity and shall
be deemed a managed care community | 15 | | network for purposes of this Code
only to the extent it | 16 | | provides services to participating individuals. A county
| 17 | | provider is entitled to contract with the Illinois Department | 18 | | with respect to
any contracting region located in whole or in | 19 | | part within the county. A
county provider is not required to | 20 | | accept enrollees who do not reside within
the county.
| 21 | | In order
to (i) accelerate and facilitate the development | 22 | | of integrated health care in
contracting areas outside counties | 23 | | with populations in excess of 3,000,000 and
counties adjacent | 24 | | to those counties and (ii) maintain and sustain the high
| 25 | | quality of education and residency programs coordinated and | 26 | | associated with
local area hospitals, the Illinois Department |
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| 1 | | may develop and implement a
demonstration program from managed | 2 | | care community networks owned, operated,
managed, or
governed | 3 | | by State-funded medical schools. The Illinois Department shall
| 4 | | prescribe by rule the criteria, standards, and procedures for | 5 | | effecting this
demonstration program.
| 6 | | A managed care community network that
contracts with the | 7 | | Illinois Department to furnish health care services to or
| 8 | | arrange those services for enrollees participating in programs | 9 | | administered by
the Illinois Department shall do all of the | 10 | | following:
| 11 | | (1) Provide that any provider affiliated with the | 12 | | managed care community
network may also provide services on | 13 | | a
fee-for-service basis to Illinois Department clients not | 14 | | enrolled in such
managed care entities.
| 15 | | (2) Provide client education services as determined | 16 | | and approved by the
Illinois Department, including but not | 17 | | limited to (i) education regarding
appropriate utilization | 18 | | of health care services in a managed care system, (ii)
| 19 | | written disclosure of treatment policies and restrictions | 20 | | or limitations on
health services, including, but not | 21 | | limited to, physical services, clinical
laboratory tests, | 22 | | hospital and surgical procedures, prescription drugs and
| 23 | | biologics, and radiological examinations, and (iii) | 24 | | written notice that the
enrollee may receive from another | 25 | | provider those covered services that are not
provided by | 26 | | the managed care community network.
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| 1 | | (3) Provide that enrollees within the system may choose | 2 | | the site for
provision of services and the panel of health | 3 | | care providers.
| 4 | | (4) Not discriminate in enrollment or disenrollment | 5 | | practices among
recipients of medical services or | 6 | | enrollees based on health status.
| 7 | | (5) Provide a quality assurance and utilization review | 8 | | program that
meets
the requirements established by the | 9 | | Illinois Department in rules that
incorporate those | 10 | | standards set forth in the Health Maintenance Organization
| 11 | | Act.
| 12 | | (6) Issue a managed care community network
| 13 | | identification card to each enrollee upon enrollment. The | 14 | | card
must contain all of the following:
| 15 | | (A) The enrollee's health plan.
| 16 | | (B) The name and telephone number of the enrollee's | 17 | | primary care
physician or the site for receiving | 18 | | primary care services.
| 19 | | (C) A telephone number to be used to confirm | 20 | | eligibility for benefits
and authorization for | 21 | | services that is available 24 hours per day, 7 days per
| 22 | | week.
| 23 | | (7) Ensure that every primary care physician and | 24 | | pharmacy in the managed
care community network meets the | 25 | | standards
established by the Illinois Department for | 26 | | accessibility and quality of care.
The Illinois Department |
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| 1 | | shall arrange for and oversee an evaluation of the
| 2 | | standards established under this paragraph (7) and may | 3 | | recommend any necessary
changes to these standards.
| 4 | | (8) Provide a procedure for handling complaints that
| 5 | | meets the
requirements established by the Illinois | 6 | | Department in rules that incorporate
those standards set | 7 | | forth in the Health Maintenance Organization Act.
| 8 | | (9) Maintain, retain, and make available to the | 9 | | Illinois Department
records, data, and information, in a | 10 | | uniform manner determined by the Illinois
Department, | 11 | | sufficient for the Illinois Department to monitor | 12 | | utilization,
accessibility, and quality of care.
| 13 | | (10) (Blank) Provide that the pharmacy formulary used | 14 | | by the managed care
community
network and its contract | 15 | | providers be no
more restrictive than the Illinois | 16 | | Department's pharmaceutical program on the
effective date | 17 | | of this amendatory Act of 1998 and as amended after that | 18 | | date .
| 19 | | The Illinois Department shall contract with an entity or | 20 | | entities to provide
external peer-based quality assurance | 21 | | review for the managed health care
programs administered by the | 22 | | Illinois Department. The entity shall meet all federal | 23 | | requirements for an external quality review organization be
| 24 | | representative of Illinois physicians licensed to practice | 25 | | medicine in all its
branches and have statewide geographic | 26 | | representation in all specialities of
medical care that are |
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| 1 | | provided in managed health care programs administered by
the | 2 | | Illinois Department. The entity may not be a third party payer | 3 | | and shall
maintain offices in locations around the State in | 4 | | order to provide service and
continuing medical education to | 5 | | physician participants within those managed
health care | 6 | | programs administered by the Illinois Department. The review
| 7 | | process shall be developed and conducted by Illinois physicians | 8 | | licensed to
practice medicine in all its branches. In | 9 | | consultation with the entity, the
Illinois Department may | 10 | | contract with other entities for professional
peer-based | 11 | | quality assurance review of individual
categories of services | 12 | | other than services provided, supervised, or coordinated
by | 13 | | physicians licensed to practice medicine in all its branches. | 14 | | The Illinois
Department shall establish, by rule, criteria to | 15 | | avoid conflicts of interest in
the conduct of quality assurance | 16 | | activities consistent with professional
peer-review standards. | 17 | | All quality assurance activities shall be coordinated
by the | 18 | | Illinois Department .
| 19 | | Each managed care community network must demonstrate its | 20 | | ability to
bear the financial risk of serving individuals under | 21 | | this program.
The Illinois Department shall by rule adopt | 22 | | standards for assessing the
solvency and financial soundness of | 23 | | each managed care community network.
Any solvency and financial | 24 | | standards adopted for managed care community
networks
shall be | 25 | | no more restrictive than the solvency and financial standards | 26 | | adopted
under
Section 1856(a) of the Social Security Act for |
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| 1 | | provider-sponsored
organizations under Part C of Title XVIII of | 2 | | the Social Security Act.
| 3 | | The Illinois
Department may implement the amendatory | 4 | | changes to this
Code made by this amendatory Act of 1998 | 5 | | through the use of emergency
rules in accordance with Section | 6 | | 5-45 of the Illinois Administrative Procedure
Act. For purposes | 7 | | of that Act, the adoption of rules to implement these
changes | 8 | | is deemed an emergency and necessary for the public interest,
| 9 | | safety, and welfare.
| 10 | | (c) Not later than June 30, 1996, the Illinois Department | 11 | | shall
enter into one or more cooperative arrangements with the | 12 | | Department of Public
Health for the purpose of developing a | 13 | | single survey for
nursing facilities, including but not limited | 14 | | to facilities funded under Title
XVIII or Title XIX of the | 15 | | federal Social Security Act or both, which shall be
| 16 | | administered and conducted solely by the Department of Public | 17 | | Health.
The Departments shall test the single survey process on | 18 | | a pilot basis, with
both the Departments of Public Aid and | 19 | | Public Health represented on the
consolidated survey team. The | 20 | | pilot will sunset June 30, 1997. After June 30,
1997, unless | 21 | | otherwise determined by the Governor, a single survey shall be
| 22 | | implemented by the Department of Public Health which would not | 23 | | preclude staff
from the Department of Healthcare and Family | 24 | | Services (formerly Department of Public Aid) from going on-site | 25 | | to nursing facilities to
perform necessary audits and reviews | 26 | | which shall not replicate the single State
agency survey |
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| 1 | | required by this Act. This Section shall not apply to community
| 2 | | or intermediate care facilities for persons with developmental | 3 | | disabilities.
| 4 | | (d) Nothing in this Code in any way limits or otherwise | 5 | | impairs the
authority or power of the Illinois Department to | 6 | | enter into a negotiated
contract pursuant to this Section with | 7 | | a managed care community network or
a health maintenance | 8 | | organization, as defined in the Health Maintenance
| 9 | | Organization Act, that provides for
termination or nonrenewal | 10 | | of the contract without cause, upon notice as
provided in the | 11 | | contract, and without a hearing.
| 12 | | (Source: P.A. 94-48, eff. 7-1-05; 95-331, eff. 8-21-07.)
| 13 | | (305 ILCS 5/5-11a new) | 14 | | Sec. 5-11a. Health Benefit Information Systems. | 15 | | (a) It is the intent of the General Assembly to support | 16 | | unified electronic systems initiatives that will improve | 17 | | management of information related to medical assistance | 18 | | programs. This will include improved management capabilities | 19 | | and new systems for Eligibility, Verification, and Enrollment | 20 | | (EVE) that will simplify and increase efficiencies in and | 21 | | access to the medical assistance programs and ensure program | 22 | | integrity. The Department of Healthcare and Family Services, in | 23 | | coordination with the Department of Human Services and other | 24 | | appropriate state agencies, shall develop a plan by July 1, | 25 | | 2011, that will: |
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| 1 | | (1) Subject to federal and State privacy and | 2 | | confidentiality laws and regulations, meet standards for | 3 | | timely eligibility verification and enrollment, and annual | 4 | | redetermination of eligibility, of applicants for and | 5 | | recipients of means-tested health benefits sponsored by | 6 | | the State, including medical assistance under this Code. | 7 | | (2) Receive and update data electronically from the | 8 | | Social Security Administration, the U.S. Postal Service, | 9 | | the Illinois Secretary of State, the Department of Revenue, | 10 | | the Department of Employment Security, and other | 11 | | governmental entities, as appropriate and to the extent | 12 | | allowed by law, for verification of any factor of | 13 | | eligibility for medical assistance and for updating | 14 | | addresses of applicants and recipients of medical | 15 | | assistance and other health benefit programs administered | 16 | | by the Department. Data relevant to eligibility shall be | 17 | | provided for no other purpose than to verify the | 18 | | eligibility of new applicants or current recipients of | 19 | | health benefits provided by the State. Data shall be | 20 | | requested or provided for any individual only insofar as | 21 | | that new applicant or current recipient's circumstances | 22 | | are relevant to that individual's or another individual's | 23 | | eligibility for State-sponsored health benefits. | 24 | | (3) Meet federal requirements for timely installation | 25 | | by January 1, 2014 to provide integration with a Health | 26 | | Benefits Exchange pursuant to the requirements of the |
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| 1 | | federal Affordable Care Act and the Reconciliation Act and | 2 | | any subsequent amendments thereto and to ensure capture of | 3 | | the maximum available federal financial
participation | 4 | | (FFP). | 5 | | (4) Meet federal requirements for compliance with | 6 | | architectural standards, including, but not limited to, | 7 | | (i) the use of a module development as outlined by the | 8 | | Medicaid Information Technology Architecture standards, | 9 | | (ii) the use of federally approved open-interfaces where | 10 | | they exist, (iii) the use or the creation of | 11 | | open-interfaces where necessary, and (iv) the use of rules | 12 | | technology that can dynamically accept and modify rules in | 13 | | standard formats. | 14 | | (5) Include plans to ensure coordination with the State | 15 | | of Illinois Framework Project that will (i) expedite and | 16 | | simplify access to services provided by Illinois human | 17 | | services programs; (ii) streamline administration and data | 18 | | sharing; (iii) enhance planning capacity, program | 19 | | evaluation, and fraud detection or prevention with access | 20 | | to cross-agency data; and (iv) simplify service reporting | 21 | | for contracted providers. | 22 | | (b) The Department of Healthcare and Family Services shall | 23 | | continue to plan for and implement a new Medicaid Management | 24 | | Information System (MMIS) and upgrade the capabilities of the | 25 | | MMIS data warehouse. Upgrades shall include, among other | 26 | | things, enhanced capabilities in data analysis including the |
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| 1 | | ability to identify risk factors that could impact the | 2 | | treatment and resulting quality of care, and tools that perform | 3 | | predictive analytics on data applying to newborns, women with | 4 | | high risk pregnancies, and other populations served by the | 5 | | Department. | 6 | | (c) The Department of Healthcare and Family Services shall | 7 | | report in its annual Medical Assistance program report each | 8 | | April through April, 2015 on the progress and implementation of | 9 | | this plan. | 10 | | (305 ILCS 5/5-29 new) | 11 | | Sec. 5-29. Income Limits and Parental Responsibility. In | 12 | | light of the unprecedented fiscal crisis confronting the State, | 13 | | it is the intent of the General Assembly to explore whether the | 14 | | income limits and income counting methods established for | 15 | | children under the Covering ALL KIDS Health Insurance Act, | 16 | | pursuant to this amendatory Act of the 96th General Assembly, | 17 | | should apply to medical assistance programs available to | 18 | | children made eligible under the Illinois Public Aid Code, | 19 | | including through home and community based services waiver | 20 | | programs authorized under Section 1915(c) of the Social | 21 | | Security Act, where parental income is currently not considered | 22 | | in determining a child's eligibility for medical assistance. | 23 | | The Department of Healthcare and Family Services is hereby | 24 | | directed, with the participation of the Department of Human | 25 | | Services and stakeholders, to conduct an analysis of these |
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| 1 | | programs to determine parental cost sharing opportunities, how | 2 | | these opportunities may impact the children currently in the | 3 | | programs, waivers and on the waiting list, and any other | 4 | | factors which may increase efficiencies and decrease State | 5 | | costs. The Department is further directed to review how | 6 | | services under these programs and waivers may be provided by | 7 | | the use of a combination of skilled, unskilled, and | 8 | | uncompensated care and to advise as to what revisions to the | 9 | | Nurse Practice Act, and Acts regulating other relevant | 10 | | professions, are necessary to accomplish this combination of | 11 | | care. The Department shall submit a written analysis on the | 12 | | children's programs and waivers as part of the Department's | 13 | | annual Medicaid reports due to the General Assembly in 2011 and | 14 | | 2012. | 15 | | (305 ILCS 5/5-30 new) | 16 | | Sec. 5-30. Care coordination. | 17 | | (a) At least 50% of recipients eligible for comprehensive | 18 | | medical benefits in all medical assistance programs or other | 19 | | health benefit programs administered by the Department, | 20 | | including the Children's Health Insurance Program Act and the | 21 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | 22 | | care coordination program by no later than January 1, 2015. For | 23 | | purposes of this Section, "coordinated care" or "care | 24 | | coordination" means delivery systems where recipients will | 25 | | receive their care from providers who participate under |
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| 1 | | contract in integrated delivery systems that are responsible | 2 | | for providing or arranging the majority of care, including | 3 | | primary care physician services, referrals from primary care | 4 | | physicians, diagnostic and treatment services, behavioral | 5 | | health services, in-patient and outpatient hospital services, | 6 | | dental services, and rehabilitation and long-term care | 7 | | services. The Department shall designate or contract for such | 8 | | integrated delivery systems (i) to ensure enrollees have a | 9 | | choice of systems and of primary care providers within such | 10 | | systems; (ii) to ensure that enrollees receive quality care in | 11 | | a culturally and linguistically appropriate manner; and (iii) | 12 | | to ensure that coordinated care programs meet the diverse needs | 13 | | of enrollees with developmental, mental health, physical, and | 14 | | age-related disabilities. | 15 | | (b) Payment for such coordinated care shall be based on | 16 | | arrangements where the State pays for performance related to | 17 | | health care outcomes, the use of evidence-based practices, the | 18 | | use of primary care delivered through comprehensive medical | 19 | | homes, the use of electronic medical records, and the | 20 | | appropriate exchange of health information electronically made | 21 | | either on a capitated basis in which a fixed monthly premium | 22 | | per recipient is paid and full financial risk is assumed for | 23 | | the delivery of services, or through other risk-based payment | 24 | | arrangements. | 25 | | (c) To qualify for compliance with this Section, the 50% | 26 | | goal shall be achieved by enrolling medical assistance |
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| 1 | | enrollees from each medical assistance enrollment category, | 2 | | including parents, children, seniors, and people with | 3 | | disabilities to the extent that current State Medicaid payment | 4 | | laws would not limit federal matching funds for recipients in | 5 | | care coordination programs. In addition, services must be more | 6 | | comprehensively defined and more risk shall be assumed than in | 7 | | the Department's primary care case management program as of the | 8 | | effective date of this amendatory Act of the 96th General | 9 | | Assembly. | 10 | | (d) The Department shall report to the General Assembly in | 11 | | a separate part of its annual medical assistance program | 12 | | report, beginning April, 2012 until April, 2016, on the | 13 | | progress and implementation of the care coordination program | 14 | | initiatives established by the provisions of this amendatory | 15 | | Act of the 96th General Assembly. The Department shall include | 16 | | in its April 2011 report a full analysis of federal laws or | 17 | | regulations regarding upper payment limitations to providers | 18 | | and the necessary revisions or adjustments in rate | 19 | | methodologies and payments to providers under this Code that | 20 | | would be necessary to implement coordinated care with full | 21 | | financial risk by a party other than the Department.
| 22 | | (305 ILCS 5/8A-2.5)
| 23 | | Sec. 8A-2.5. Unauthorized use of medical assistance.
| 24 | | (a) Any person who knowingly uses, acquires, possesses, or | 25 | | transfers a
medical card in any manner not authorized by law or |
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| 1 | | by rules and regulations of
the Illinois Department, or who | 2 | | knowingly alters a medical card, or who
knowingly uses, | 3 | | acquires, possesses, or transfers an altered medical card, is
| 4 | | guilty of a violation of this Article and shall be punished as | 5 | | provided in
Section 8A-6.
| 6 | | (b) Any person who knowingly obtains unauthorized medical | 7 | | benefits with or
without use of a medical card is guilty of a | 8 | | violation of this Article and
shall be punished as provided in | 9 | | Section 8A-6.
| 10 | | (c) The Department may seek to recover any and all State | 11 | | and federal monies for which it has improperly and erroneously | 12 | | paid benefits as a result of a fraudulent action and any civil | 13 | | penalties authorized in this Section. Pursuant to Section | 14 | | 11-14.5 of this Code, the Department may determine the monetary | 15 | | value of benefits improperly and erroneously received. The | 16 | | Department may recover the monies paid for such benefits and | 17 | | interest on that amount at the rate of 5% per annum for the | 18 | | period from which payment was made to the date upon which | 19 | | repayment is made to the State. Prior to the recovery of any | 20 | | amount paid for benefits allegedly obtained by fraudulent | 21 | | means, the recipient of such benefits shall be afforded an | 22 | | opportunity for a hearing after reasonable notice. The notice | 23 | | shall be served personally or by certified or registered mail | 24 | | or as otherwise provided by law upon the parties or their | 25 | | agents appointed to receive service of process and shall | 26 | | include the following: |
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| 1 | | (1) A statement of the time, place and nature of the | 2 | | hearing. | 3 | | (2) A statement of the legal authority and jurisdiction | 4 | | under which the hearing is to be held. | 5 | | (3) A reference to the particular Sections of the | 6 | | substantive and procedural statutes and rules involved. | 7 | | (4) Except where a more detailed statement is otherwise | 8 | | provided for by law, a short and plain statement of the | 9 | | matters asserted, the consequences of a failure to respond, | 10 | | and the official file or other reference number. | 11 | | (5) A statement of the monetary value of the benefits | 12 | | fraudulently received by the person accused. | 13 | | (6) A statement that, in addition to any other | 14 | | penalties provided by law, a civil penalty in an amount not | 15 | | to exceed $2,000 may be imposed for each fraudulent claim | 16 | | for benefits or payments. | 17 | | (7) A statement providing that the determination of the | 18 | | monetary value may be contested by petitioning the | 19 | | Department for an administrative hearing within 30 days | 20 | | from the date of mailing the notice. | 21 | | (8) The names and mailing addresses of the | 22 | | administrative law judge, all parties, and all other | 23 | | persons to whom the agency gives notice of the hearing | 24 | | unless otherwise confidential by law. | 25 | | An opportunity shall be afforded all parties to be | 26 | | represented by legal counsel and to respond and present |
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| 1 | | evidence and argument. | 2 | | Unless precluded by law, disposition may be made of any | 3 | | contested case by stipulation, agreed settlement, consent | 4 | | order, or default. | 5 | | Any final order, decision, or other determination made, | 6 | | issued or executed by the Director under the provisions of this | 7 | | Article whereby any person is aggrieved shall be subject to | 8 | | review in accordance with the provisions of the Administrative | 9 | | Review Law, and the rules adopted pursuant thereto, which shall | 10 | | apply to and govern all proceedings for the judicial review of | 11 | | final administrative decisions of the Director. | 12 | | Upon entry of a final administrative decision for repayment | 13 | | of any benefits obtained by fraudulent means, or for any civil | 14 | | penalties assessed, a lien shall attach to all property and | 15 | | assets of such person, firm, corporation, association, agency, | 16 | | institution, or other legal entity until the judgment is | 17 | | satisfied. | 18 | | Within 12 months of the effective date of this amendatory | 19 | | Act of the 96th General Assembly, the Department of Healthcare | 20 | | and Family Services will report to the General Assembly on the | 21 | | number of fraud cases identified and pursued, and the fines | 22 | | assessed and collected. The report will also include the | 23 | | Department's analysis as to the use of private sector resources | 24 | | to bring action, investigate, and collect monies owed. | 25 | | (Source: P.A. 89-289, eff. 1-1-96.)
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| 1 | | (305 ILCS 5/11-5.1 new) | 2 | | Sec. 11-5.1. Eligibility verification. Notwithstanding any | 3 | | other provision of this Code, with respect to applications for | 4 | | medical assistance provided under Article V of this Code, | 5 | | eligibility shall be determined in a manner that ensures | 6 | | program integrity and complies with federal laws and | 7 | | regulations while minimizing unnecessary barriers to | 8 | | enrollment. To this end, as soon as practicable, and unless the | 9 | | Department receives written denial from the federal | 10 | | government, this Section shall be implemented: | 11 | | (a) The Department of Healthcare and Family Services or its | 12 | | designees shall: | 13 | | (1) By no later than July 1, 2011, require verification | 14 | | of, at a minimum, one month's income from all sources | 15 | | required for determining the eligibility of applicants for | 16 | | medical assistance under this Code. Such verification | 17 | | shall take the form of pay stubs, business or income and | 18 | | expense records for self-employed persons, letters from | 19 | | employers, and any other valid documentation of income | 20 | | including data obtained electronically by the Department | 21 | | or its designees from other sources as described in | 22 | | subsection (b) of this Section. | 23 | | (2) By no later than October 1, 2011, require | 24 | | verification of, at a minimum, one month's income from all | 25 | | sources required for determining the continued eligibility | 26 | | of recipients at their annual review of eligibility for |
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| 1 | | medical assistance under this Code. Such verification | 2 | | shall take the form of pay stubs, business or income and | 3 | | expense records for self-employed persons, letters from | 4 | | employers, and any other valid documentation of income | 5 | | including data obtained electronically by the Department | 6 | | or its designees from other sources as described in | 7 | | subsection (b) of this Section. The
Department shall send a | 8 | | notice to
recipients at least 60 days prior to the end of | 9 | | their period
of eligibility that informs them of the
| 10 | | requirements for continued eligibility. If a recipient
| 11 | | does not fulfill the requirements for continued | 12 | | eligibility by the
deadline established in the notice a | 13 | | notice of cancellation shall be issued to the recipient and | 14 | | coverage shall end on the last day of the eligibility | 15 | | period. A recipient's eligibility may be reinstated | 16 | | without requiring a new application if the recipient | 17 | | fulfills the requirements for continued eligibility prior | 18 | | to the end of the month following the last date of | 19 | | coverage. Nothing in this Section shall prevent an | 20 | | individual whose coverage has been cancelled from | 21 | | reapplying for health benefits at any time. | 22 | | (3) By no later than July 1, 2011, require verification | 23 | | of Illinois residency. | 24 | | (b) The Department shall establish or continue cooperative
| 25 | | arrangements with the Social Security Administration, the
| 26 | | Illinois Secretary of State, the Department of Human Services,
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| 1 | | the Department of Revenue, the Department of Employment
| 2 | | Security, and any other appropriate entity to gain electronic
| 3 | | access, to the extent allowed by law, to information available
| 4 | | to those entities that may be appropriate for electronically
| 5 | | verifying any factor of eligibility for benefits under the
| 6 | | Program. Data relevant to eligibility shall be provided for no
| 7 | | other purpose than to verify the eligibility of new applicants | 8 | | or current recipients of health benefits under the Program. | 9 | | Data shall be requested or provided for any new applicant or | 10 | | current recipient only insofar as that individual's | 11 | | circumstances are relevant to that individual's or another | 12 | | individual's eligibility. | 13 | | (c) Within 90 days of the effective date of this amendatory | 14 | | Act of the 96th General Assembly, the Department of Healthcare | 15 | | and Family Services shall send notice to current recipients | 16 | | informing them of the changes regarding their eligibility | 17 | | verification.
| 18 | | (305 ILCS 5/11-26) (from Ch. 23, par. 11-26)
| 19 | | Sec. 11-26.
Recipient's abuse of medical care; | 20 | | restrictions on access to
medical care.
| 21 | | (a) When the Department determines, on the basis of | 22 | | statistical norms and
medical judgment, that a medical care | 23 | | recipient has received medical services
in excess of need and | 24 | | with such frequency or in such a manner as to constitute
an | 25 | | abuse of the recipient's medical care privileges, the |
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| 1 | | recipient's access to
medical care may be restricted.
| 2 | | (b) When the Department has determined that a recipient is | 3 | | abusing his or
her medical care privileges as described in this | 4 | | Section, it may require that
the recipient designate a primary | 5 | | provider type primary care provider, primary care pharmacy, or
| 6 | | health maintenance organization of the recipient's own | 7 | | choosing to assume
responsibility for the recipient's care. For | 8 | | the purposes of this subsection, "primary provider type" means | 9 | | a primary care provider, primary care pharmacy, primary | 10 | | dentist, primary podiatrist, or primary durable medical | 11 | | equipment provider. Instead of requiring a recipient to
make a | 12 | | designation as provided in this subsection, the Department, | 13 | | pursuant to
rules adopted by the Department and without regard | 14 | | to any choice of an entity
that the recipient might otherwise | 15 | | make, may initially designate a primary provider type provided | 16 | | that the primary provider type is willing to provide that care | 17 | | primary care
provider, primary care pharmacy, or health | 18 | | maintenance organization to assume
responsibility for the | 19 | | recipient's care, provided that the primary care
provider, | 20 | | primary care pharmacy, or health maintenance organization is | 21 | | willing
to provide that care .
| 22 | | (c) When the Department has requested that a recipient | 23 | | designate a
primary provider type primary care provider, | 24 | | primary care pharmacy or health maintenance
organization and | 25 | | the recipient fails or refuses to do so, the Department
may, | 26 | | after a reasonable period of time, assign the recipient to a |
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| 1 | | primary provider type of its own choice and determination, | 2 | | provided such primary provider type is willing to provide such | 3 | | care primary care
provider, primary care pharmacy or health | 4 | | maintenance organization of its own
choice and determination, | 5 | | provided such primary care provider, primary care
pharmacy or | 6 | | health maintenance organization is willing to provide such | 7 | | care .
| 8 | | (d) When a recipient has been restricted to a designated | 9 | | primary provider type primary care
provider, primary care | 10 | | pharmacy or health maintenance organization , the
recipient may | 11 | | change the primary provider type primary care provider, primary | 12 | | care pharmacy or
health maintenance organization :
| 13 | | (1) when the designated source becomes unavailable, as | 14 | | the Department
shall determine by rule; or
| 15 | | (2) when the designated primary provider type primary | 16 | | care provider, primary care pharmacy or
health maintenance | 17 | | organization notifies the Department that it wishes to
| 18 | | withdraw from any obligation as primary provider type | 19 | | primary care provider, primary care pharmacy or health | 20 | | maintenance organization ; or
| 21 | | (3) in other situations, as the Department shall | 22 | | provide by rule.
| 23 | | The Department shall, by rule, establish procedures for | 24 | | providing medical or
pharmaceutical services when the | 25 | | designated source becomes unavailable or
wishes to withdraw | 26 | | from any obligation as primary provider type primary care |
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| 1 | | provider, primary care
pharmacy or health maintenance | 2 | | organization , shall, by rule, take into
consideration the need | 3 | | for emergency or temporary medical assistance and shall
ensure | 4 | | that the recipient has continuous and unrestricted access to | 5 | | medical
care from the date on which such unavailability or | 6 | | withdrawal becomes effective
until such time as the recipient | 7 | | designates a primary provider type or a primary provider type | 8 | | care source or a primary
care source willing to provide such | 9 | | care is designated by the Department
consistent with | 10 | | subsections (b) and (c) and such restriction becomes effective.
| 11 | | (e) Prior to initiating any action to restrict a | 12 | | recipient's access to
medical or pharmaceutical care, the | 13 | | Department shall notify the recipient
of its intended action. | 14 | | Such notification shall be in writing and shall set
forth the | 15 | | reasons for and nature of the proposed action. In addition, the
| 16 | | notification shall:
| 17 | | (1) inform the recipient that (i) the recipient has a | 18 | | right to
designate a primary provider type primary care | 19 | | provider, primary care pharmacy, or health maintenance
| 20 | | organization of the recipient's own choosing willing to | 21 | | accept such designation
and that the recipient's failure to | 22 | | do so within a reasonable time may result
in such | 23 | | designation being made by the Department or (ii) the | 24 | | Department has
designated a primary provider type primary | 25 | | care provider, primary care pharmacy, or health
| 26 | | maintenance organization to assume responsibility for the |
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| 1 | | recipient's care; and
| 2 | | (2) inform the recipient that the recipient has a right | 3 | | to appeal the
Department's determination to restrict the | 4 | | recipient's access to medical care
and provide the | 5 | | recipient with an explanation of how such appeal is to be
| 6 | | made. The notification shall also inform the recipient of | 7 | | the circumstances
under which unrestricted medical | 8 | | eligibility shall continue until a decision is
made on | 9 | | appeal and that if the recipient chooses to appeal, the | 10 | | recipient will
be able to review the medical payment data | 11 | | that was utilized by the Department
to decide that the | 12 | | recipient's access to medical care should be restricted.
| 13 | | (f) The Department shall, by rule or regulation, establish | 14 | | procedures for
appealing a determination to restrict a | 15 | | recipient's access to medical care,
which procedures shall, at | 16 | | a minimum, provide for a reasonable opportunity
to be heard | 17 | | and, where the appeal is denied, for a written statement
of the | 18 | | reason or reasons for such denial.
| 19 | | (g) Except as otherwise provided in this subsection, when a | 20 | | recipient
has had his or her medical card restricted for 4 full | 21 | | quarters (without regard
to any period of ineligibility for | 22 | | medical assistance under this Code, or any
period for which the | 23 | | recipient voluntarily terminates his or her receipt of
medical | 24 | | assistance, that may occur before the expiration of those 4 | 25 | | full
quarters), the Department shall reevaluate the | 26 | | recipient's medical usage to
determine whether it is still in |
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| 1 | | excess of need and with such frequency or in
such a manner as | 2 | | to constitute an abuse of the receipt of medical assistance.
If | 3 | | it is still in excess of need, the restriction shall be | 4 | | continued for
another 4 full quarters. If it is no longer in | 5 | | excess of need, the restriction
shall be discontinued. If a | 6 | | recipient's access to medical care has been
restricted under | 7 | | this Section and the Department then determines, either at
| 8 | | reevaluation or after the restriction has been discontinued, to | 9 | | restrict the
recipient's access to medical care a second or | 10 | | subsequent time, the second or
subsequent restriction may be | 11 | | imposed for a period of more than 4 full
quarters. If the | 12 | | Department restricts a recipient's access to medical care for
a | 13 | | period of more than 4 full quarters, as determined by rule, the | 14 | | Department
shall reevaluate the recipient's medical usage | 15 | | after the end of the restriction
period rather than after the | 16 | | end of 4 full quarters. The Department shall
notify the | 17 | | recipient, in writing, of any decision to continue the | 18 | | restriction
and the reason or reasons therefor. A "quarter", | 19 | | for purposes of this Section,
shall be defined as one of the | 20 | | following 3-month periods of time:
January-March, April-June, | 21 | | July-September or October-December.
| 22 | | (h) In addition to any other recipient whose acquisition of | 23 | | medical care
is determined to be in excess of need, the | 24 | | Department may restrict the medical
care privileges of the | 25 | | following persons:
| 26 | | (1) recipients found to have loaned or altered their |
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| 1 | | cards or misused or
falsely represented medical coverage;
| 2 | | (2) recipients found in possession of blank or forged | 3 | | prescription pads;
| 4 | | (3) recipients who knowingly assist providers in | 5 | | rendering excessive
services or defrauding the medical | 6 | | assistance program.
| 7 | | The procedural safeguards in this Section shall apply to | 8 | | the above
individuals.
| 9 | | (i) Restrictions under this Section shall be in addition to | 10 | | and shall
not in any way be limited by or limit any actions | 11 | | taken under Article
VIII-A of this Code.
| 12 | | (Source: P.A. 88-554, eff. 7-26-94 .)
| 13 | | (305 ILCS 5/5-5.15 rep.)
| 14 | | Section 45. The Illinois Public Aid Code is amended by | 15 | | repealing Section 5-5.15. | 16 | | Section 50. The Illinois Vehicle Code is amended by | 17 | | changing Section 2-123 as follows:
| 18 | | (625 ILCS 5/2-123) (from Ch. 95 1/2, par. 2-123)
| 19 | | Sec. 2-123. Sale and Distribution of Information.
| 20 | | (a) Except as otherwise provided in this Section, the | 21 | | Secretary may make the
driver's license, vehicle and title | 22 | | registration lists, in part or in whole,
and any statistical | 23 | | information derived from these lists available to local
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| 1 | | governments, elected state officials, state educational | 2 | | institutions, and all
other governmental units of the State and | 3 | | Federal
Government
requesting them for governmental purposes. | 4 | | The Secretary shall require any such
applicant for services to | 5 | | pay for the costs of furnishing such services and the
use of | 6 | | the equipment involved, and in addition is empowered to | 7 | | establish prices
and charges for the services so furnished and | 8 | | for the use of the electronic
equipment utilized.
| 9 | | (b) The Secretary is further empowered to and he may, in | 10 | | his discretion,
furnish to any applicant, other than listed in | 11 | | subsection (a) of this Section,
vehicle or driver data on a | 12 | | computer tape, disk, other electronic format or
computer | 13 | | processable medium, or printout at a fixed fee of
$250 for | 14 | | orders received before October 1, 2003 and $500 for orders | 15 | | received
on or after October 1, 2003, in advance, and require | 16 | | in addition a
further sufficient
deposit based upon the | 17 | | Secretary of State's estimate of the total cost of the
| 18 | | information requested and a charge of $25 for orders received | 19 | | before October
1, 2003 and $50 for orders received on or after | 20 | | October 1, 2003, per 1,000
units or part
thereof identified or | 21 | | the actual cost, whichever is greater. The Secretary is
| 22 | | authorized to refund any difference between the additional | 23 | | deposit and the
actual cost of the request. This service shall | 24 | | not be in lieu of an abstract
of a driver's record nor of a | 25 | | title or registration search. This service may
be limited to | 26 | | entities purchasing a minimum number of records as required by
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| 1 | | administrative rule. The information
sold pursuant to this | 2 | | subsection shall be the entire vehicle or driver data
list, or | 3 | | part thereof. The information sold pursuant to this subsection
| 4 | | shall not contain personally identifying information unless | 5 | | the information is
to be used for one of the purposes | 6 | | identified in subsection (f-5) of this
Section. Commercial | 7 | | purchasers of driver and vehicle record databases shall
enter | 8 | | into a written agreement with the Secretary of State that | 9 | | includes
disclosure of the commercial use of the information to | 10 | | be purchased. | 11 | | (b-1) The Secretary is further empowered to and may, in his | 12 | | or her discretion, furnish vehicle or driver data on a computer | 13 | | tape, disk, or other electronic format or computer processible | 14 | | medium, at no fee, to any State or local governmental agency | 15 | | that uses the information provided by the Secretary to transmit | 16 | | data back to the Secretary that enables the Secretary to | 17 | | maintain accurate driving records, including dispositions of | 18 | | traffic cases. This information may be provided without fee not | 19 | | more often than once every 6 months.
| 20 | | (c) Secretary of State may issue registration lists. The | 21 | | Secretary
of State may compile a list of all registered
| 22 | | vehicles. Each list of registered vehicles shall be arranged | 23 | | serially
according to the registration numbers assigned to | 24 | | registered vehicles and
may contain in addition the names and | 25 | | addresses of registered owners and
a brief description of each | 26 | | vehicle including the serial or other
identifying number |
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| 1 | | thereof. Such compilation may be in such form as in the
| 2 | | discretion of the Secretary of State may seem best for the | 3 | | purposes intended.
| 4 | | (d) The Secretary of State shall furnish no more than 2 | 5 | | current available
lists of such registrations to the sheriffs | 6 | | of all counties and to the chiefs
of police of all cities and | 7 | | villages and towns of 2,000 population and over
in this State | 8 | | at no cost. Additional copies may be purchased by the sheriffs
| 9 | | or chiefs of police at the fee
of $500 each or at the cost of | 10 | | producing the list as determined
by the Secretary of State. | 11 | | Such lists are to be used for governmental
purposes only.
| 12 | | (e) (Blank).
| 13 | | (e-1) (Blank).
| 14 | | (f) The Secretary of State shall make a title or | 15 | | registration search of the
records of his office and a written | 16 | | report on the same for any person, upon
written application of | 17 | | such person, accompanied by a fee of $5 for
each registration | 18 | | or title search. The written application shall set forth
the | 19 | | intended use of the requested information. No fee shall be | 20 | | charged for a
title or
registration search, or for the | 21 | | certification thereof requested by a government
agency. The | 22 | | report of the title or registration search shall not contain
| 23 | | personally identifying information unless the request for a | 24 | | search was made for
one of the purposes identified in | 25 | | subsection (f-5) of this Section. The report of the title or | 26 | | registration search shall not contain highly
restricted |
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| 1 | | personal
information unless specifically authorized by this | 2 | | Code.
| 3 | | The Secretary of State shall certify a title or | 4 | | registration record upon
written request. The fee for | 5 | | certification shall be $5 in addition
to the fee required for a | 6 | | title or registration search. Certification shall
be made under | 7 | | the signature of the Secretary of State and shall be
| 8 | | authenticated by Seal of the Secretary of State.
| 9 | | The Secretary of State may notify the vehicle owner or | 10 | | registrant of
the request for purchase of his title or | 11 | | registration information as the
Secretary deems appropriate.
| 12 | | No information shall be released to the requestor until | 13 | | expiration of a
10 day period. This 10 day period shall not | 14 | | apply to requests for
information made by law enforcement | 15 | | officials, government agencies,
financial institutions, | 16 | | attorneys, insurers, employers, automobile
associated | 17 | | businesses, persons licensed as a private detective or firms
| 18 | | licensed as a private detective agency under the Private | 19 | | Detective, Private
Alarm, Private Security, Fingerprint | 20 | | Vendor, and Locksmith Act of 2004, who are employed by or are
| 21 | | acting on
behalf of law enforcement officials, government | 22 | | agencies, financial
institutions, attorneys, insurers, | 23 | | employers, automobile associated businesses,
and other | 24 | | business entities for purposes consistent with the Illinois | 25 | | Vehicle
Code, the vehicle owner or registrant or other entities | 26 | | as the Secretary may
exempt by rule and regulation.
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| 1 | | Any misrepresentation made by a requestor of title or | 2 | | vehicle information
shall be punishable as a petty offense, | 3 | | except in the case of persons
licensed as a private detective | 4 | | or firms licensed as a private detective agency
which shall be | 5 | | subject to disciplinary sanctions under Section 40-10 of the
| 6 | | Private Detective, Private Alarm, Private Security, | 7 | | Fingerprint Vendor, and Locksmith Act of 2004.
| 8 | | (f-5) The Secretary of State shall not disclose or | 9 | | otherwise make
available to
any person or entity any personally | 10 | | identifying information obtained by the
Secretary
of State in | 11 | | connection with a driver's license, vehicle, or title | 12 | | registration
record
unless the information is disclosed for one | 13 | | of the following purposes:
| 14 | | (1) For use by any government agency, including any | 15 | | court or law
enforcement agency, in carrying out its | 16 | | functions, or any private person or
entity acting on behalf | 17 | | of a federal, State, or local agency in carrying out
its
| 18 | | functions.
| 19 | | (2) For use in connection with matters of motor vehicle | 20 | | or driver safety
and theft; motor vehicle emissions; motor | 21 | | vehicle product alterations, recalls,
or advisories; | 22 | | performance monitoring of motor vehicles, motor vehicle | 23 | | parts,
and dealers; and removal of non-owner records from | 24 | | the original owner
records of motor vehicle manufacturers.
| 25 | | (3) For use in the normal course of business by a | 26 | | legitimate business or
its agents, employees, or |
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| 1 | | contractors, but only:
| 2 | | (A) to verify the accuracy of personal information | 3 | | submitted by
an individual to the business or its | 4 | | agents, employees, or contractors;
and
| 5 | | (B) if such information as so submitted is not | 6 | | correct or is no
longer correct, to obtain the correct | 7 | | information, but only for the
purposes of preventing | 8 | | fraud by, pursuing legal remedies against, or
| 9 | | recovering on a debt or security interest against, the | 10 | | individual.
| 11 | | (4) For use in research activities and for use in | 12 | | producing statistical
reports, if the personally | 13 | | identifying information is not published,
redisclosed, or | 14 | | used to
contact individuals.
| 15 | | (5) For use in connection with any civil, criminal, | 16 | | administrative, or
arbitral proceeding in any federal, | 17 | | State, or local court or agency or before
any
| 18 | | self-regulatory body, including the service of process, | 19 | | investigation in
anticipation of litigation, and the | 20 | | execution or enforcement of judgments and
orders, or | 21 | | pursuant to an order of a federal, State, or local court.
| 22 | | (6) For use by any insurer or insurance support | 23 | | organization or by a
self-insured entity or its agents, | 24 | | employees, or contractors in connection with
claims | 25 | | investigation activities, antifraud activities, rating, or | 26 | | underwriting.
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| 1 | | (7) For use in providing notice to the owners of towed | 2 | | or
impounded vehicles.
| 3 | | (8) For use by any person licensed as a private | 4 | | detective or firm licensed as a private
detective agency | 5 | | under
the Private Detective, Private Alarm, Private | 6 | | Security, Fingerprint Vendor, and Locksmith Act of
2004, | 7 | | private investigative agency or security service
licensed | 8 | | in Illinois for any purpose permitted under this | 9 | | subsection.
| 10 | | (9) For use by an employer or its agent or insurer to | 11 | | obtain or verify
information relating to a holder of a | 12 | | commercial driver's license that is
required under chapter | 13 | | 313 of title 49 of the United States Code.
| 14 | | (10) For use in connection with the operation of | 15 | | private toll
transportation facilities.
| 16 | | (11) For use by any requester, if the requester | 17 | | demonstrates it has
obtained the written consent of the | 18 | | individual to whom the information
pertains.
| 19 | | (12) For use by members of the news media, as defined | 20 | | in
Section 1-148.5, for the purpose of newsgathering when | 21 | | the request relates to
the
operation of a motor vehicle or | 22 | | public safety.
| 23 | | (13) For any other use specifically authorized by law, | 24 | | if that use is
related to the operation of a motor vehicle | 25 | | or public safety. | 26 | | (f-6) The Secretary of State shall not disclose or |
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| 1 | | otherwise make
available to any
person or entity any highly | 2 | | restricted personal information obtained by the
Secretary of
| 3 | | State in connection with a driver's license, vehicle, or
title | 4 | | registration
record unless
specifically authorized by this | 5 | | Code.
| 6 | | (g) 1. The Secretary of State may, upon receipt of a | 7 | | written request
and a fee of $6 before October 1, 2003 and | 8 | | a fee of $12 on and after October
1, 2003, furnish to the | 9 | | person or agency so requesting a
driver's record. Such | 10 | | document may include a record of: current driver's
license | 11 | | issuance information, except that the information on | 12 | | judicial driving
permits shall be available only as | 13 | | otherwise provided by this Code;
convictions; orders | 14 | | entered revoking, suspending or cancelling a
driver's
| 15 | | license or privilege; and notations of accident | 16 | | involvement. All other
information, unless otherwise | 17 | | permitted by
this Code, shall remain confidential. | 18 | | Information released pursuant to a
request for a driver's | 19 | | record shall not contain personally identifying
| 20 | | information, unless the request for the driver's record was | 21 | | made for one of the
purposes set forth in subsection (f-5) | 22 | | of this Section. The Secretary of State may, without fee, | 23 | | allow a parent or guardian of a person under the age of 18 | 24 | | years, who holds an instruction permit or graduated | 25 | | driver's license, to view that person's driving record | 26 | | online, through a computer connection.
The parent or |
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| 1 | | guardian's online access to the driving record will | 2 | | terminate when the instruction permit or graduated | 3 | | driver's license holder reaches the age of 18.
| 4 | | 2. The Secretary of State shall not disclose or | 5 | | otherwise make available
to any
person or
entity any highly | 6 | | restricted personal information obtained by the Secretary | 7 | | of
State in
connection with a driver's license, vehicle, or | 8 | | title
registration record
unless specifically
authorized | 9 | | by this Code. The Secretary of State may certify an | 10 | | abstract of a driver's record
upon written request | 11 | | therefor. Such certification
shall be made under the | 12 | | signature of the Secretary of State and shall be
| 13 | | authenticated by the Seal of his office.
| 14 | | 3. All requests for driving record information shall be | 15 | | made in a manner
prescribed by the Secretary and shall set | 16 | | forth the intended use of the
requested information.
| 17 | | The Secretary of State may notify the affected driver | 18 | | of the request
for purchase of his driver's record as the | 19 | | Secretary deems appropriate.
| 20 | | No information shall be released to the requester until | 21 | | expiration of a
10 day period. This 10 day period shall not | 22 | | apply to requests for information
made by law enforcement | 23 | | officials, government agencies, financial institutions,
| 24 | | attorneys, insurers, employers, automobile associated | 25 | | businesses, persons
licensed as a private detective or | 26 | | firms licensed as a private detective agency
under the |
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| 1 | | Private Detective, Private Alarm, Private Security, | 2 | | Fingerprint Vendor, and Locksmith Act
of 2004,
who are | 3 | | employed by or are acting on behalf of law enforcement | 4 | | officials,
government agencies, financial institutions, | 5 | | attorneys, insurers, employers,
automobile associated | 6 | | businesses, and other business entities for purposes
| 7 | | consistent with the Illinois Vehicle Code, the affected | 8 | | driver or other
entities as the Secretary may exempt by | 9 | | rule and regulation.
| 10 | | Any misrepresentation made by a requestor of driver | 11 | | information shall
be punishable as a petty offense, except | 12 | | in the case of persons licensed as
a private detective or | 13 | | firms licensed as a private detective agency which shall
be | 14 | | subject to disciplinary sanctions under Section 40-10 of | 15 | | the Private
Detective, Private Alarm, Private Security, | 16 | | Fingerprint Vendor, and Locksmith Act of 2004.
| 17 | | 4. The Secretary of State may furnish without fee, upon | 18 | | the written
request of a law enforcement agency, any | 19 | | information from a driver's
record on file with the | 20 | | Secretary of State when such information is required
in the | 21 | | enforcement of this Code or any other law relating to the | 22 | | operation
of motor vehicles, including records of | 23 | | dispositions; documented
information involving the use of | 24 | | a motor vehicle; whether such individual
has, or previously | 25 | | had, a driver's license; and the address and personal
| 26 | | description as reflected on said driver's record.
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| 1 | | 5. Except as otherwise provided in this Section, the | 2 | | Secretary of
State may furnish, without fee, information | 3 | | from an individual driver's
record on file, if a written | 4 | | request therefor is submitted
by any public transit system | 5 | | or authority, public defender, law enforcement
agency, a | 6 | | state or federal agency, or an Illinois local | 7 | | intergovernmental
association, if the request is for the | 8 | | purpose of a background check of
applicants for employment | 9 | | with the requesting agency, or for the purpose of
an | 10 | | official investigation conducted by the agency, or to | 11 | | determine a
current address for the driver so public funds | 12 | | can be recovered or paid to
the driver, or for any other | 13 | | purpose set forth in subsection (f-5)
of this Section.
| 14 | | The Secretary may also furnish the courts a copy of an | 15 | | abstract of a
driver's record, without fee, subsequent to | 16 | | an arrest for a violation of
Section 11-501 or a similar | 17 | | provision of a local ordinance. Such abstract
may include | 18 | | records of dispositions; documented information involving
| 19 | | the use of a motor vehicle as contained in the current | 20 | | file; whether such
individual has, or previously had, a | 21 | | driver's license; and the address and
personal description | 22 | | as reflected on said driver's record.
| 23 | | 6. Any certified abstract issued by the Secretary of | 24 | | State or
transmitted electronically by the Secretary of | 25 | | State pursuant to this
Section,
to a court or on request of | 26 | | a law enforcement agency, for the record of a
named person |
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| 1 | | as to the status of the person's driver's license shall be
| 2 | | prima facie evidence of the facts therein stated and if the | 3 | | name appearing
in such abstract is the same as that of a | 4 | | person named in an information or
warrant, such abstract | 5 | | shall be prima facie evidence that the person named
in such | 6 | | information or warrant is the same person as the person | 7 | | named in
such abstract and shall be admissible for any | 8 | | prosecution under this Code and
be admitted as proof of any | 9 | | prior conviction or proof of records, notices, or
orders | 10 | | recorded on individual driving records maintained by the | 11 | | Secretary of
State.
| 12 | | 7. Subject to any restrictions contained in the | 13 | | Juvenile Court Act of
1987, and upon receipt of a proper | 14 | | request and a fee of $6 before October 1,
2003 and a fee of | 15 | | $12 on or after October 1, 2003, the
Secretary of
State | 16 | | shall provide a driver's record to the affected driver, or | 17 | | the affected
driver's attorney, upon verification. Such | 18 | | record shall contain all the
information referred to in | 19 | | paragraph 1 of this subsection (g) plus: any
recorded | 20 | | accident involvement as a driver; information recorded | 21 | | pursuant to
subsection (e) of Section 6-117 and paragraph | 22 | | (4) of subsection (a) of
Section 6-204 of this Code. All | 23 | | other information, unless otherwise permitted
by this | 24 | | Code, shall remain confidential.
| 25 | | (h) The Secretary shall not disclose social security | 26 | | numbers or any associated information obtained from the Social |
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| 1 | | Security Administration except pursuant
to a written request | 2 | | by, or with the prior written consent of, the
individual | 3 | | except: (1) to officers and employees of the Secretary
who
have | 4 | | a need to know the social security numbers in performance of | 5 | | their
official duties, (2) to law enforcement officials for a | 6 | | lawful, civil or
criminal law enforcement investigation, and if | 7 | | the head of the law enforcement
agency has made a written | 8 | | request to the Secretary specifying the law
enforcement | 9 | | investigation for which the social security numbers are being
| 10 | | sought, (3) to the United States Department of Transportation, | 11 | | or any other
State, pursuant to the administration and | 12 | | enforcement of the Commercial
Motor Vehicle Safety Act of 1986, | 13 | | (4) pursuant to the order of a court
of competent jurisdiction, | 14 | | (5) to the Department of Healthcare and Family Services | 15 | | (formerly Department of Public Aid) for
utilization
in the | 16 | | child support enforcement duties assigned to that Department | 17 | | under
provisions of the Illinois Public Aid Code after the | 18 | | individual has received advanced
meaningful notification of | 19 | | what redisclosure is sought by the Secretary in
accordance with | 20 | | the federal Privacy Act, (5.5) to the Department of Healthcare | 21 | | and Family Services and the Department of Human Services solely | 22 | | for the purpose of verifying Illinois residency where such | 23 | | residency is an eligibility requirement for benefits under the | 24 | | Illinois Public Aid Code or any other health benefit program | 25 | | administered by the Department of Healthcare and Family | 26 | | Services or the Department of Human Services, or (6) to the |
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| 1 | | Illinois Department of Revenue solely for use by the Department | 2 | | in the collection of any tax or debt that the Department of | 3 | | Revenue is authorized or required by law to collect, provided | 4 | | that the Department shall not disclose the social security | 5 | | number to any person or entity outside of the Department.
| 6 | | (i) (Blank).
| 7 | | (j) Medical statements or medical reports received in the | 8 | | Secretary of
State's Office shall be confidential. No | 9 | | confidential information may be
open to public inspection or | 10 | | the contents disclosed to anyone, except
officers and employees | 11 | | of the Secretary who have a need to know the information
| 12 | | contained in the medical reports and the Driver License Medical | 13 | | Advisory
Board, unless so directed by an order of a court of | 14 | | competent jurisdiction.
| 15 | | (k) All fees collected under this Section shall be paid | 16 | | into the Road
Fund of the State Treasury, except that (i) for | 17 | | fees collected before October
1, 2003, $3 of the $6 fee for a
| 18 | | driver's record shall be paid into the Secretary of State | 19 | | Special Services
Fund, (ii) for fees collected on and after | 20 | | October 1, 2003, of the $12 fee
for a driver's record, $3 shall | 21 | | be paid into the Secretary of State Special
Services Fund and | 22 | | $6 shall be paid into the General Revenue Fund, and (iii) for
| 23 | | fees collected on and after October 1, 2003, 50% of the amounts | 24 | | collected
pursuant to subsection (b) shall be paid into the | 25 | | General Revenue Fund.
| 26 | | (l) (Blank).
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| 1 | | (m) Notations of accident involvement that may be disclosed | 2 | | under this
Section shall not include notations relating to | 3 | | damage to a vehicle or other
property being transported by a | 4 | | tow truck. This information shall remain
confidential, | 5 | | provided that nothing in this subsection (m) shall limit
| 6 | | disclosure of any notification of accident involvement to any | 7 | | law enforcement
agency or official.
| 8 | | (n) Requests made by the news media for driver's license, | 9 | | vehicle, or
title registration information may be furnished | 10 | | without charge or at a reduced
charge, as determined by the | 11 | | Secretary, when the specific purpose for
requesting the | 12 | | documents is deemed to be in the public interest. Waiver or
| 13 | | reduction of the fee is in the public interest if the principal | 14 | | purpose of the
request is to access and disseminate information | 15 | | regarding the health, safety,
and welfare or the legal rights | 16 | | of the general public and is not for the
principal purpose of | 17 | | gaining a personal or commercial benefit.
The information | 18 | | provided pursuant to this subsection shall not contain
| 19 | | personally identifying information unless the information is | 20 | | to be used for one
of the
purposes identified in subsection | 21 | | (f-5) of this Section.
| 22 | | (o) The redisclosure of personally identifying information
| 23 | | obtained
pursuant
to this Section is prohibited, except to the | 24 | | extent necessary to effectuate the
purpose
for which the | 25 | | original disclosure of the information was permitted.
| 26 | | (p) The Secretary of State is empowered to adopt rules
to
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| 1 | | effectuate this Section.
| 2 | | (Source: P.A. 95-201, eff. 1-1-08; 95-287, eff. 1-1-08; 95-331, | 3 | | eff. 8-21-07; 95-613, eff. 9-11-07; 95-876, eff. 8-21-08; | 4 | | 96-1383, eff. 1-1-11.)
| 5 | | Section 95. Severability. If any provision of this Act or | 6 | | application thereof to any person or circumstance is held | 7 | | invalid, such invalidity does not affect other provisions or | 8 | | applications of this Act which can be given effect without the | 9 | | invalid application or provision, and to this end the | 10 | | provisions of this Act are declared to be severable.
| 11 | | Section 99. Effective date. This Act takes effect upon | 12 | | becoming law.
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