| ||||
Public Act 101-0559 | ||||
| ||||
| ||||
AN ACT concerning public aid.
| ||||
Be it enacted by the People of the State of Illinois,
| ||||
represented in the General Assembly:
| ||||
Section 1. The Equity in Long-term Care Quality Act is | ||||
amended by adding Section 25 as follows: | ||||
(30 ILCS 772/25 new) | ||||
Sec. 25. Nursing home labor force program. | ||||
(a) The Department of Public Health, contingent upon | ||||
approval by the Centers for Medicare and Medicaid Services, | ||||
shall establish a nursing home labor force promotion, | ||||
expansion, and retention program no later than January 1, 2020 | ||||
using moneys appropriated from the Equity in Long-term Care | ||||
Quality Fund. | ||||
(b) Components of the program shall include, but are not | ||||
limited to: (1) a public relations campaign to encourage people | ||||
to become nursing home workers; (2) scholarships for certified | ||||
nursing assistants, licensed practical nurses, and registered | ||||
nurses; and (3) retention incentives for nursing home workers. | ||||
(c) The Department shall establish partnerships with one or | ||||
more community colleges or universities to execute the program. | ||||
Sixty percent of the scholarships provided by the program shall | ||||
be distributed to candidates living in counties with 3,000,000 | ||||
or more residents. Preferential scholarship consideration |
shall be given to certified nursing assistants, single parents, | ||
and applicants from communities that are economically | ||
depressed or that have high percentages of Medicaid | ||
beneficiaries, immigrants, or racial or ethnic minorities. | ||
(d) The Department shall report to the General Assembly no | ||
later than January 30, 2020 on the status of the establishment | ||
of the program. No later than January 1, 2021, and each January | ||
1 thereafter, the Department shall report to the General | ||
Assembly the number of scholarships awarded during the | ||
preceding year and the demographics of the awardees. | ||
Section 5. The Illinois Public Aid Code is amended by | ||
changing Section 11-5.4 as follows: | ||
(305 ILCS 5/11-5.4) | ||
Sec. 11-5.4. Expedited long-term care eligibility | ||
determination and enrollment. | ||
(a) Establishment of the expedited long-term care | ||
eligibility determination and enrollment system shall be a | ||
joint venture of the Departments of Human Services and | ||
Healthcare and Family Services and the Department on Aging. | ||
(b) Streamlined application enrollment process; expedited | ||
eligibility process. The streamlined application and | ||
enrollment process must include, but need not be limited to, | ||
the following: | ||
(1) On or before July 1, 2019, a streamlined |
application and enrollment process shall be put in place | ||
which must include, but need not be limited to, the | ||
following: | ||
(A) Minimize the burden on applicants by | ||
collecting only the data necessary to determine | ||
eligibility for medical services, long-term care | ||
services, and spousal impoverishment offset. | ||
(B) Integrate online data sources to simplify the | ||
application process by reducing the amount of | ||
information needed to be entered and to expedite | ||
eligibility verification. | ||
(C) Provide online prompts to alert the applicant | ||
that information is missing or not complete. | ||
(D) Provide training and step-by-step written | ||
instructions for caseworkers, applicants, and | ||
providers. | ||
(2) The State must expedite the eligibility process for | ||
applicants meeting specified guidelines, regardless of the | ||
age of the application. The guidelines, subject to federal | ||
approval, must include, but need not be limited to, the | ||
following individually or collectively: | ||
(A) Full Medicaid benefits in the community for a | ||
specified period of time. | ||
(B) No transfer of assets or resources during the | ||
federally prescribed look-back period, as specified in | ||
federal law. |
(C) Receives
Supplemental Security Income payments | ||
or was receiving such payments at the time of admission | ||
to a nursing facility. | ||
(D) For applicants or recipients with verified | ||
income at or below 100% of the federal poverty level | ||
when the declared value of their countable resources is | ||
no greater than the allowable amounts pursuant to | ||
Section 5-2 of this Code for classes of eligible | ||
persons for whom a resource limit applies. Such | ||
simplified verification policies shall apply to | ||
community cases as well as long-term care cases. | ||
(3) Subject to federal approval, the Department of | ||
Healthcare and Family Services must implement an ex parte | ||
renewal process for Medicaid-eligible individuals residing | ||
in long-term care facilities. "Renewal" has the same | ||
meaning as "redetermination" in State policies, | ||
administrative rule, and federal Medicaid law. The ex parte | ||
renewal process must be fully operational on or before | ||
January 1, 2019. | ||
(4) The Department of Human Services must use the | ||
standards and distribution requirements described in this | ||
subsection and in Section 11-6 for notification of missing | ||
supporting documents and information during all phases of | ||
the application process: initial, renewal, and appeal. | ||
(c) The Department of Human Services must adopt policies | ||
and procedures to improve communication between long-term care |
benefits central office personnel, applicants and their | ||
representatives, and facilities in which the applicants | ||
reside. Such policies and procedures must at a minimum permit | ||
applicants and their representatives and the facility in which | ||
the applicants reside to speak directly to an individual | ||
trained to take telephone inquiries and provide appropriate | ||
responses.
| ||
(d) Effective 30 days after the completion of 3 regionally | ||
based trainings, nursing facilities shall submit all | ||
applications for medical assistance online via the Application | ||
for Benefits Eligibility (ABE) website. This requirement shall | ||
extend to scanning and uploading with the online application | ||
any required additional forms such as the Long Term Care | ||
Facility Notification and the Additional Financial Information | ||
for Long Term Care Applicants as well as scanned copies of any | ||
supporting documentation. Long-term care facility admission | ||
documents must be submitted as required in Section 5-5 of this | ||
Code. No local Department of Human Services office shall refuse | ||
to accept an electronically filed application. No Department of | ||
Human Services office shall request submission of any document | ||
in hard copy. | ||
(e) Notwithstanding any other provision of this Code, the | ||
Department of Human Services and the Department of Healthcare | ||
and Family Services' Office of the Inspector General shall, | ||
upon request, allow an applicant additional time to submit | ||
information and documents needed as part of a review of |
available resources or resources transferred during the | ||
look-back period. The initial extension shall not exceed 30 | ||
days. A second extension of 30 days may be granted upon | ||
request. Any request for information issued by the State to an | ||
applicant shall include the following: an explanation of the | ||
information required and the date by which the information must | ||
be submitted; a statement that failure to respond in a timely | ||
manner can result in denial of the application; a statement | ||
that the applicant or the facility in the name of the applicant | ||
may seek an extension; and the name and contact information of | ||
a caseworker in case of questions. Any such request for | ||
information shall also be sent to the facility. In deciding | ||
whether to grant an extension, the Department of Human Services | ||
or the Department of Healthcare and Family Services' Office of | ||
the Inspector General shall take into account what is in the | ||
best interest of the applicant. The time limits for processing | ||
an application shall be tolled during the period of any | ||
extension granted under this subsection. | ||
(f) The Department of Human Services and the Department of | ||
Healthcare and Family Services must jointly compile data on | ||
pending applications, denials, appeals, and redeterminations | ||
into a monthly report, which shall be posted on each | ||
Department's website for the purposes of monitoring long-term | ||
care eligibility processing. The report must specify the number | ||
of applications and redeterminations pending long-term care | ||
eligibility determination and admission and the number of |
appeals of denials in the following categories: | ||
(A) Length of time applications, redeterminations, and | ||
appeals are pending - 0 to 45 days, 46 days to 90 days, 91 | ||
days to 180 days, 181 days to 12 months, over 12 months to | ||
18 months, over 18 months to 24 months, and over 24 months. | ||
(B) Percentage of applications and redeterminations | ||
pending in the Department of Human Services' Family | ||
Community Resource Centers, in the Department of Human | ||
Services' long-term care hubs, with the Department of | ||
Healthcare and Family Services' Office of Inspector | ||
General, and those applications which are being tolled due | ||
to requests for extension of time for additional | ||
information. | ||
(C) Status of pending applications, denials, appeals, | ||
and redeterminations. | ||
(g) Beginning on July 1, 2017, the Auditor General shall | ||
report every 3 years to the General Assembly on the performance | ||
and compliance of the Department of Healthcare and Family | ||
Services, the Department of Human Services, and the Department | ||
on Aging in meeting the requirements of this Section and the | ||
federal requirements concerning eligibility determinations for | ||
Medicaid long-term care services and supports, and shall report | ||
any issues or deficiencies and make recommendations. The | ||
Auditor General shall, at a minimum, review, consider, and | ||
evaluate the following: | ||
(1) compliance with federal regulations on furnishing |
services as related to Medicaid long-term care services and | ||
supports as provided under 42 CFR 435.930; | ||
(2) compliance with federal regulations on the timely | ||
determination of eligibility as provided under 42 CFR | ||
435.912; | ||
(3) the accuracy and completeness of the report | ||
required under paragraph (9) of subsection (e); | ||
(4) the efficacy and efficiency of the task-based | ||
process used for making eligibility determinations in the | ||
centralized offices of the Department of Human Services for | ||
long-term care services, including the role of the State's | ||
integrated eligibility system, as opposed to the | ||
traditional caseworker-specific process from which these | ||
central offices have converted; and | ||
(5) any issues affecting eligibility determinations | ||
related to the Department of Human Services' staff | ||
completing Medicaid eligibility determinations instead of | ||
the designated single-state Medicaid agency in Illinois, | ||
the Department of Healthcare and Family Services. | ||
The Auditor General's report shall include any and all | ||
other areas or issues which are identified through an annual | ||
review. Paragraphs (1) through (5) of this subsection shall not | ||
be construed to limit the scope of the annual review and the | ||
Auditor General's authority to thoroughly and completely | ||
evaluate any and all processes, policies, and procedures | ||
concerning compliance with federal and State law requirements |
on eligibility determinations for Medicaid long-term care | ||
services and supports. | ||
(h) The Department of Healthcare and Family Services shall | ||
adopt any rules necessary to administer and enforce any | ||
provision of this Section. Rulemaking shall not delay the full | ||
implementation of this Section. | ||
(g) The Department shall adopt rules necessary to | ||
administer and enforce any provision of this Section. | ||
Rulemaking shall not delay the full implementation of this | ||
Section. | ||
(i) (h) Beginning on June 29, 2018, provisional | ||
eligibility, in
the form of a recipient identification number | ||
and any other necessary credentials to permit an applicant to | ||
receive benefits, must be issued to any applicant who has not | ||
received a final eligibility determination on his or her | ||
application for Medicaid or Medicaid long-term care benefits or | ||
a notice of an opportunity for a hearing within the federally | ||
prescribed deadlines for the processing of such applications. | ||
The Department of Healthcare and Family Services must maintain | ||
the applicant's provisional Medicaid enrollment status until a | ||
final eligibility determination is approved or the applicant's | ||
appeal has been adjudicated and eligibility is denied. The | ||
Department of Healthcare and Family Services or the managed | ||
care organization, if applicable, must reimburse providers for | ||
services rendered during an applicant's provisional | ||
eligibility period. |
(1) Claims for services rendered to an applicant with | ||
provisional eligibility status must be submitted and | ||
processed in the same manner as those submitted on behalf | ||
of beneficiaries determined to qualify for benefits. | ||
(2) An applicant with provisional enrollment status | ||
must have his or her benefits paid for under the State's | ||
fee-for-service system until the State makes a final | ||
determination on the applicant's Medicaid or Medicaid | ||
long-term care application. If an individual is enrolled | ||
with a managed care organization for community benefits at | ||
the time the individual's provisional status is issued, the | ||
managed care organization is only responsible for paying | ||
benefits covered under the capitation payment received by | ||
the managed care organization for the individual. | ||
(3) The Department of Healthcare and Family Services , | ||
within 10 business days of issuing provisional eligibility | ||
to an applicant, must submit to the Office of the | ||
Comptroller for payment a voucher for all retroactive | ||
reimbursement due. The Department of Healthcare and Family | ||
Services must clearly identify such vouchers as | ||
provisional eligibility vouchers. | ||
(Source: P.A. 99-153, eff. 7-28-15; 100-380, eff. 8-25-17; | ||
100-665, eff. 8-2-18; 100-1141, eff. 11-28-18.)
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law.
|