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Public Act 101-0101
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| HB3040 Enrolled | LRB101 06841 KTG 51870 b |
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Public Aid Code is amended by |
changing Section 11-5.4 as follows:
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(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 |
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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 |
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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. If an individual has transferred to |
another long-term care facility, any annual notice |
concerning redetermination of eligibility must be sent to |
the long-term care facility where the individual resides as |
well as to the individual. |
(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 |
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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.
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(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 |
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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 |
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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; |
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(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. |