Bill Text: IL HB4076 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-05-31 - House Committee Amendment No. 2 Rule 19(c) / Re-referred to Rules Committee [HB4076 Detail]

Download: Illinois-2023-HB4076-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4076 Introduced , by Rep. Camille Y. Lilly SYNOPSIS AS INTRODUCED:
305 ILCS 5/11-5.3a new
Amends the Illinois Public Aid Code. Requires the Department of Innovation and Technology, in conjunction with the Department of Healthcare and Family Services, to hire a State vendor to redetermine the eligibility of medical assistance enrollees not covered by specified federal waivers provided under the Social Security Act. Provides that the selected vendor must be certified by the Business Enterprise Program and have no less than 60% of its owners with established residency in Illinois. Requires the selected vendor to conduct redeterminations utilizing a system that meets certain requirements. Provides that all vendors applying for consideration as the State vendor to conduct medical assistance eligibility redeterminations shall submit a letter of intent to the Department of Innovation and Technology in a form and manner required by the Department of Innovation and Technology. Requires the Department of Innovation and Technology to allow 7 days for a letter of intent and to issue a grant award to the selected vendor within 2 weeks after the end of the 7-day period. Provides that, to qualify for a grant award the selected vendor must already have all contracts in place with any relevant subvendors no later than 5 business days after the effective date of the amendatory Act. Provides that nothing in the amendatory Act shall be construed to contravene any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services; and that if any provision of the amendatory Act or its application is found to be in violation of any federal regulation, policy, or requirement of the Centers for Medicare and Medicaid Services, that provision is declared invalid but does not affect any other provision or application of the amendatory Act that can be given effect without the invalid provision or application.
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A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
adding Section 11-5.3a as follows:
(305 ILCS 5/11-5.3a new)
Sec. 11-5.3a. Business Enterprise Program certified vendor
for redetermination system.
(a) The General Assembly finds that there is a real and
current need for automation of the process of determination,
redetermination (generally "determination"), certification,
or recertification of entry into any type of regulated program
while also providing for an automatic system of facilitating
the determination process where recalcitrance or reticence is
detected. Further, there is a need for a system that includes
finding, informing, recruiting, and securing an individual's
participation in programs such as the medical assistance
program under Article V to the benefit of the individual.
(b) The Department of Innovation and Technology, in
conjunction with the Department of Healthcare and Family
Services, shall select a State vendor to redetermine the
eligibility of medical assistance enrollees not covered by the
federal waivers provided under Section 1902(e)(14)(A) of the

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Social Security Act. The selected vendor must be certified by
the Business Enterprise Program and have no less than 60% of
its owners with established residency in Illinois as of the
effective date of this amendatory Act of the 103rd General
Assembly. The selected vendor shall conduct redeterminations
utilizing a system that meets the following requirements:
(1) The redetermination system must be hosted on a
cloud-based platform that is secure and compliant with
standards under the federal Health Insurance Portability
and Accountability Act of 1996.
(2) The redetermination system must also use a cloud
communication platform to programmatically perform calls,
text messages, and other communication functions using web
services or application programming interface services.
(3) The redetermination system must be able to make
contact with a medical assistance enrollee in an automated
fashion, using the last known contact information to
contact the medical assistance enrollee, and if the
redetermination contact process is advised that contact
was not made, the process must use public and private
databases to find and test newly found contact information
until the medical assistance enrollee is reached and
redetermination is started, or the medical assistance
enrollee opts out of the redetermination contact process.
The redetermination system must be designed to continue
until contact is made and confirmed and contact

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information is updated to facilitate the following year's
redetermination contact process. A relentless search to
find medical assistance enrollees and complete the
redetermination process must be made, such that no
eligible medical assistance enrollee or applicant is left
behind.
(4) The redetermination system must also have the
ability to reward a medical assistance enrollee who
successfully completes the redetermination process, such
as with a gift card or other rewards that can be provided
to the medical assistance enrollee when the process is
completed. The amount of the gift card may be conditioned
on the responsiveness of the medical assistance enrollee
or dependent on other factors such as age, living
conditions, or abode as well as other factors or criteria.
(5) The redetermination system must have the ability
to simplify and greatly facilitate medical assistance
enrollees to engage in the redetermination process and
easily enter, update, and transmit their required
information and data by being able to go from using a voice
virtual agent or text virtual agent to an online web form
and back to a human assistant seamlessly and without
losing any data input.
(6) The redetermination system must allow the medical
assistance enrollee to start the process through one of
the means available, stop at some point, and then resume

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using the same means or transferring the process to
another means available through the system without missing
a beat.
(7) The redetermination system must allow the medical
assistance enrollee to switch between the voice virtual
agent (using artificial intelligence), the text virtual
agent, and an online web form.
(8) The redetermination system must also perform the
function of pre-populating forms with the information
confirmed by the medical assistance enrollee, which can be
uploaded during the redetermination process as the medical
assistance enrollee proceeds through the data fields so as
to confirm or update the medical assistance recipient's
information.
(9) The redetermination system must be designed to be
compliant with the Americans with Disabilities Act (ADA).
ADA compliance must be found regardless of which of the
different ways a medical assistance enrollee enters the
data, and then, any of the other means to which the medical
assistance enrollee can switch, continues to be ADA
compliant regardless of the stage of the redetermination
process that the enrollee is in and regardless of the
number of transitions from one data entry means to
another.
(10) The redetermination system must provide an
out-of-the-box analytics dashboard that is tethered to the

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cloud-based system with no additional software
installation on the user's computer or mobile devices.
(11) The redetermination system must allow for a
scouring of the laws, rules, and regulations to review any
changes to the medical assistance program and institute
those changes in the questionnaires and forms utilized to
assess the candidate and enroll the applicant.
(12) Using the redetermination system shall not be
considered "assistance" but rather a different modality of
applying for redetermination.
(13) The redetermination system must have a cloud data
processing platform to accumulate enrollee data to begin
the process in an automated fashion. This includes data
validation, rejection, and preparation for communication
such as call or text.
(14) The redetermination system must have a cloud data
processing platform to be able to provide data submitted
by medical assistance enrollees to managed care
organizations at a predefined frequency, such as daily,
weekly, or monthly.
(c) All vendors applying for consideration as the State
vendor to conduct medical assistance eligibility
redeterminations as provided in subsection (b) shall submit a
letter of intent to the Department of Innovation and
Technology in a form and manner required by the Department of
Innovation and Technology. The Department of Innovation and

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Technology shall allow 7 days for a letter of intent and shall
issue a grant award to the selected vendor within 2 weeks after
the end of the 7-day period. To qualify for a grant award under
this Section, the selected vendor must already have all
contracts in place with any relevant subvendors no later than
5 business days after the effective date of this amendatory
Act of the 103rd General Assembly.
(d) Nothing in this amendatory Act of the 103rd General
Assembly shall be construed to contravene any federal
regulation, policy, or requirement of the Centers for Medicare
and Medicaid Services. If any provision of this amendatory Act
of the 103rd General Assembly or its application is found to be
in violation of any federal regulation, policy, or requirement
of the Centers for Medicare and Medicaid Services, that
provision is declared invalid but does not affect any other
provision or application of this amendatory Act that can be
given effect without the invalid provision or application. The
provisions of this amendatory Act of the 103rd General
Assembly are declared to be severable.