Bill Amendment: IL SB0636 | 2019-2020 | 101st General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: PUBLIC AID-TECH

Status: 2021-01-13 - Session Sine Die [SB0636 Detail]

Download: Illinois-2019-SB0636-Senate_Amendment_001.html

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Sen. Ram Villivalam

Filed: 3/13/2019

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AMENDMENT TO SENATE BILL 636
AMENDMENT NO. ______. Amend Senate Bill 636 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Act on the Aging is amended by
changing Section 4.02 as follows:
(20 ILCS 105/4.02) (from Ch. 23, par. 6104.02)
Sec. 4.02. Community Care Program. The Department shall
establish a program of services to prevent unnecessary
institutionalization of persons age 60 and older in need of
long term care or who are established as persons who suffer
from Alzheimer's disease or a related disorder under the
Alzheimer's Disease Assistance Act, thereby enabling them to
remain in their own homes or in other living arrangements. Such
preventive services, which may be coordinated with other
programs for the aged and monitored by area agencies on aging
in cooperation with the Department, may include, but are not

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limited to, any or all of the following:
(a) (blank);
(b) (blank);
(c) home care aide services;
(d) personal assistant services;
(e) adult day services;
(f) home-delivered meals;
(g) education in self-care;
(h) personal care services;
(i) adult day health services;
(j) habilitation services;
(k) respite care;
(k-5) community reintegration services;
(k-6) flexible senior services;
(k-7) medication management;
(k-8) emergency home response;
(l) other nonmedical social services that may enable
the person to become self-supporting; or
(m) clearinghouse for information provided by senior
citizen home owners who want to rent rooms to or share
living space with other senior citizens.
The Department shall establish eligibility standards for
such services. In determining the amount and nature of services
for which a person may qualify, consideration shall not be
given to the value of cash, property or other assets held in
the name of the person's spouse pursuant to a written agreement

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dividing marital property into equal but separate shares or
pursuant to a transfer of the person's interest in a home to
his spouse, provided that the spouse's share of the marital
property is not made available to the person seeking such
services.
Beginning January 1, 2008, the Department shall require as
a condition of eligibility that all new financially eligible
applicants apply for and enroll in medical assistance under
Article V of the Illinois Public Aid Code in accordance with
rules promulgated by the Department.
The Department shall, in conjunction with the Department of
Public Aid (now Department of Healthcare and Family Services),
seek appropriate amendments under Sections 1915 and 1924 of the
Social Security Act. The purpose of the amendments shall be to
extend eligibility for home and community based services under
Sections 1915 and 1924 of the Social Security Act to persons
who transfer to or for the benefit of a spouse those amounts of
income and resources allowed under Section 1924 of the Social
Security Act. Subject to the approval of such amendments, the
Department shall extend the provisions of Section 5-4 of the
Illinois Public Aid Code to persons who, but for the provision
of home or community-based services, would require the level of
care provided in an institution, as is provided for in federal
law. Those persons no longer found to be eligible for receiving
noninstitutional services due to changes in the eligibility
criteria shall be given 45 days notice prior to actual

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termination. Those persons receiving notice of termination may
contact the Department and request the determination be
appealed at any time during the 45 day notice period. The
target population identified for the purposes of this Section
are persons age 60 and older with an identified service need.
Priority shall be given to those who are at imminent risk of
institutionalization. The services shall be provided to
eligible persons age 60 and older to the extent that the cost
of the services together with the other personal maintenance
expenses of the persons are reasonably related to the standards
established for care in a group facility appropriate to the
person's condition. These non-institutional services, pilot
projects or experimental facilities may be provided as part of
or in addition to those authorized by federal law or those
funded and administered by the Department of Human Services.
The Departments of Human Services, Healthcare and Family
Services, Public Health, Veterans' Affairs, and Commerce and
Economic Opportunity and other appropriate agencies of State,
federal and local governments shall cooperate with the
Department on Aging in the establishment and development of the
non-institutional services. The Department shall require an
annual audit from all personal assistant and home care aide
vendors contracting with the Department under this Section. The
annual audit shall assure that each audited vendor's procedures
are in compliance with Department's financial reporting
guidelines requiring an administrative and employee wage and

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benefits cost split as defined in administrative rules. The
audit is a public record under the Freedom of Information Act.
The Department shall execute, relative to the nursing home
prescreening project, written inter-agency agreements with the
Department of Human Services and the Department of Healthcare
and Family Services, to effect the following: (1) intake
procedures and common eligibility criteria for those persons
who are receiving non-institutional services; and (2) the
establishment and development of non-institutional services in
areas of the State where they are not currently available or
are undeveloped. On and after July 1, 1996, all nursing home
prescreenings for individuals 60 years of age or older shall be
conducted by the Department.
As part of the Department on Aging's routine training of
case managers and case manager supervisors, the Department may
include information on family futures planning for persons who
are age 60 or older and who are caregivers of their adult
children with developmental disabilities. The content of the
training shall be at the Department's discretion.
The Department is authorized to establish a system of
recipient copayment for services provided under this Section,
such copayment to be based upon the recipient's ability to pay
but in no case to exceed the actual cost of the services
provided. Additionally, any portion of a person's income which
is equal to or less than the federal poverty standard shall not
be considered by the Department in determining the copayment.

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The level of such copayment shall be adjusted whenever
necessary to reflect any change in the officially designated
federal poverty standard.
The Department, or the Department's authorized
representative, may recover the amount of moneys expended for
services provided to or in behalf of a person under this
Section by a claim against the person's estate or against the
estate of the person's surviving spouse, but no recovery may be
had until after the death of the surviving spouse, if any, and
then only at such time when there is no surviving child who is
under age 21 or blind or who has a permanent and total
disability. This paragraph, however, shall not bar recovery, at
the death of the person, of moneys for services provided to the
person or in behalf of the person under this Section to which
the person was not entitled; provided that such recovery shall
not be enforced against any real estate while it is occupied as
a homestead by the surviving spouse or other dependent, if no
claims by other creditors have been filed against the estate,
or, if such claims have been filed, they remain dormant for
failure of prosecution or failure of the claimant to compel
administration of the estate for the purpose of payment. This
paragraph shall not bar recovery from the estate of a spouse,
under Sections 1915 and 1924 of the Social Security Act and
Section 5-4 of the Illinois Public Aid Code, who precedes a
person receiving services under this Section in death. All
moneys for services paid to or in behalf of the person under

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this Section shall be claimed for recovery from the deceased
spouse's estate. "Homestead", as used in this paragraph, means
the dwelling house and contiguous real estate occupied by a
surviving spouse or relative, as defined by the rules and
regulations of the Department of Healthcare and Family
Services, regardless of the value of the property.
The Department shall increase the effectiveness of the
existing Community Care Program by:
(1) ensuring that in-home services included in the care
plan are available on evenings and weekends;
(2) ensuring that care plans contain the services that
eligible participants need based on the number of days in a
month, not limited to specific blocks of time, as
identified by the comprehensive assessment tool selected
by the Department for use statewide, not to exceed the
total monthly service cost maximum allowed for each
service; the Department shall develop administrative rules
to implement this item (2);
(3) ensuring that the participants have the right to
choose the services contained in their care plan and to
direct how those services are provided, based on
administrative rules established by the Department;
(4) ensuring that the determination of need tool is
accurate in determining the participants' level of need; to
achieve this, the Department, in conjunction with the Older
Adult Services Advisory Committee, shall institute a study

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of the relationship between the Determination of Need
scores, level of need, service cost maximums, and the
development and utilization of service plans no later than
May 1, 2008; findings and recommendations shall be
presented to the Governor and the General Assembly no later
than January 1, 2009; recommendations shall include all
needed changes to the service cost maximums schedule and
additional covered services;
(5) ensuring that homemakers can provide personal care
services that may or may not involve contact with clients,
including but not limited to:
(A) bathing;
(B) grooming;
(C) toileting;
(D) nail care;
(E) transferring;
(F) respiratory services;
(G) exercise; or
(H) positioning;
(6) ensuring that homemaker program vendors are not
restricted from hiring homemakers who are family members of
clients or recommended by clients; the Department may not,
by rule or policy, require homemakers who are family
members of clients or recommended by clients to accept
assignments in homes other than the client;
(7) ensuring that the State may access maximum federal

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matching funds by seeking approval for the Centers for
Medicare and Medicaid Services for modifications to the
State's home and community based services waiver and
additional waiver opportunities, including applying for
enrollment in the Balance Incentive Payment Program by May
1, 2013, in order to maximize federal matching funds; this
shall include, but not be limited to, modification that
reflects all changes in the Community Care Program services
and all increases in the services cost maximum;
(8) ensuring that the determination of need tool
accurately reflects the service needs of individuals with
Alzheimer's disease and related dementia disorders;
(9) ensuring that services are authorized accurately
and consistently for the Community Care Program (CCP); the
Department shall implement a Service Authorization policy
directive; the purpose shall be to ensure that eligibility
and services are authorized accurately and consistently in
the CCP program; the policy directive shall clarify service
authorization guidelines to Care Coordination Units and
Community Care Program providers no later than May 1, 2013;
(10) working in conjunction with Care Coordination
Units, the Department of Healthcare and Family Services,
the Department of Human Services, Community Care Program
providers, and other stakeholders to make improvements to
the Medicaid claiming processes and the Medicaid
enrollment procedures or requirements as needed,

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including, but not limited to, specific policy changes or
rules to improve the up-front enrollment of participants in
the Medicaid program and specific policy changes or rules
to insure more prompt submission of bills to the federal
government to secure maximum federal matching dollars as
promptly as possible; the Department on Aging shall have at
least 3 meetings with stakeholders by January 1, 2014 in
order to address these improvements;
(11) requiring home care service providers to comply
with the rounding of hours worked provisions under the
federal Fair Labor Standards Act (FLSA) and as set forth in
29 CFR 785.48(b) by May 1, 2013;
(12) implementing any necessary policy changes or
promulgating any rules, no later than January 1, 2014, to
assist the Department of Healthcare and Family Services in
moving as many participants as possible, consistent with
federal regulations, into coordinated care plans if a care
coordination plan that covers long term care is available
in the recipient's area; and
(13) maintaining fiscal year 2014 rates at the same
level established on January 1, 2013.
By January 1, 2009 or as soon after the end of the Cash and
Counseling Demonstration Project as is practicable, the
Department may, based on its evaluation of the demonstration
project, promulgate rules concerning personal assistant
services, to include, but need not be limited to,

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qualifications, employment screening, rights under fair labor
standards, training, fiduciary agent, and supervision
requirements. All applicants shall be subject to the provisions
of the Health Care Worker Background Check Act.
The Department shall develop procedures to enhance
availability of services on evenings, weekends, and on an
emergency basis to meet the respite needs of caregivers.
Procedures shall be developed to permit the utilization of
services in successive blocks of 24 hours up to the monthly
maximum established by the Department. Workers providing these
services shall be appropriately trained.
Beginning on the effective date of this amendatory Act of
1991, no person may perform chore/housekeeping and home care
aide services under a program authorized by this Section unless
that person has been issued a certificate of pre-service to do
so by his or her employing agency. Information gathered to
effect such certification shall include (i) the person's name,
(ii) the date the person was hired by his or her current
employer, and (iii) the training, including dates and levels.
Persons engaged in the program authorized by this Section
before the effective date of this amendatory Act of 1991 shall
be issued a certificate of all pre- and in-service training
from his or her employer upon submitting the necessary
information. The employing agency shall be required to retain
records of all staff pre- and in-service training, and shall
provide such records to the Department upon request and upon

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termination of the employer's contract with the Department. In
addition, the employing agency is responsible for the issuance
of certifications of in-service training completed to their
employees.
The Department is required to develop a system to ensure
that persons working as home care aides and personal assistants
receive increases in their wages when the federal minimum wage
is increased by requiring vendors to certify that they are
meeting the federal minimum wage statute for home care aides
and personal assistants. An employer that cannot ensure that
the minimum wage increase is being given to home care aides and
personal assistants shall be denied any increase in
reimbursement costs.
The Community Care Program Advisory Committee is created in
the Department on Aging. The Director shall appoint individuals
to serve in the Committee, who shall serve at their own
expense. Members of the Committee must abide by all applicable
ethics laws. The Committee shall advise the Department on
issues related to the Department's program of services to
prevent unnecessary institutionalization. The Committee shall
meet on a bi-monthly basis and shall serve to identify and
advise the Department on present and potential issues affecting
the service delivery network, the program's clients, and the
Department and to recommend solution strategies. Persons
appointed to the Committee shall be appointed on, but not
limited to, their own and their agency's experience with the

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program, geographic representation, and willingness to serve.
The Director shall appoint members to the Committee to
represent provider, advocacy, policy research, and other
constituencies committed to the delivery of high quality home
and community-based services to older adults. Representatives
shall be appointed to ensure representation from community care
providers including, but not limited to, adult day service
providers, homemaker providers, case coordination and case
management units, emergency home response providers, statewide
trade or labor unions that represent home care aides and direct
care staff, area agencies on aging, adults over age 60,
membership organizations representing older adults, and other
organizational entities, providers of care, or individuals
with demonstrated interest and expertise in the field of home
and community care as determined by the Director.
Nominations may be presented from any agency or State
association with interest in the program. The Director, or his
or her designee, shall serve as the permanent co-chair of the
advisory committee. One other co-chair shall be nominated and
approved by the members of the committee on an annual basis.
Committee members' terms of appointment shall be for 4 years
with one-quarter of the appointees' terms expiring each year. A
member shall continue to serve until his or her replacement is
named. The Department shall fill vacancies that have a
remaining term of over one year, and this replacement shall
occur through the annual replacement of expiring terms. The

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Director shall designate Department staff to provide technical
assistance and staff support to the committee. Department
representation shall not constitute membership of the
committee. All Committee papers, issues, recommendations,
reports, and meeting memoranda are advisory only. The Director,
or his or her designee, shall make a written report, as
requested by the Committee, regarding issues before the
Committee.
The Department on Aging and the Department of Human
Services shall cooperate in the development and submission of
an annual report on programs and services provided under this
Section. Such joint report shall be filed with the Governor and
the General Assembly on or before September 30 each year.
The requirement for reporting to the General Assembly shall
be satisfied by filing copies of the report as required by
Section 3.1 of the General Assembly Organization Act and filing
such additional copies with the State Government Report
Distribution Center for the General Assembly as is required
under paragraph (t) of Section 7 of the State Library Act.
Those persons previously found eligible for receiving
non-institutional services whose services were discontinued
under the Emergency Budget Act of Fiscal Year 1992, and who do
not meet the eligibility standards in effect on or after July
1, 1992, shall remain ineligible on and after July 1, 1992.
Those persons previously not required to cost-share and who
were required to cost-share effective March 1, 1992, shall

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continue to meet cost-share requirements on and after July 1,
1992. Beginning July 1, 1992, all clients will be required to
meet eligibility, cost-share, and other requirements and will
have services discontinued or altered when they fail to meet
these requirements.
For the purposes of this Section, "flexible senior
services" refers to services that require one-time or periodic
expenditures including, but not limited to, respite care, home
modification, assistive technology, housing assistance, and
transportation.
The Department shall implement an electronic service
verification based on global positioning systems or other
cost-effective technology for the Community Care Program no
later than January 1, 2014.
The Department shall require, as a condition of
eligibility, enrollment in the medical assistance program
under Article V of the Illinois Public Aid Code (i) beginning
August 1, 2013, if the Auditor General has reported that the
Department has failed to comply with the reporting requirements
of Section 2-27 of the Illinois State Auditing Act; or (ii)
beginning June 1, 2014, if the Auditor General has reported
that the Department has not undertaken the required actions
listed in the report required by subsection (a) of Section 2-27
of the Illinois State Auditing Act.
The Department shall delay Community Care Program services
until an applicant is determined eligible for medical

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assistance under Article V of the Illinois Public Aid Code (i)
beginning August 1, 2013, if the Auditor General has reported
that the Department has failed to comply with the reporting
requirements of Section 2-27 of the Illinois State Auditing
Act; or (ii) beginning June 1, 2014, if the Auditor General has
reported that the Department has not undertaken the required
actions listed in the report required by subsection (a) of
Section 2-27 of the Illinois State Auditing Act.
The Department shall implement co-payments for the
Community Care Program at the federally allowable maximum level
(i) beginning August 1, 2013, if the Auditor General has
reported that the Department has failed to comply with the
reporting requirements of Section 2-27 of the Illinois State
Auditing Act; or (ii) beginning June 1, 2014, if the Auditor
General has reported that the Department has not undertaken the
required actions listed in the report required by subsection
(a) of Section 2-27 of the Illinois State Auditing Act.
The Department shall provide a bi-monthly report on the
progress of the Community Care Program reforms set forth in
this amendatory Act of the 98th General Assembly to the
Governor, the Speaker of the House of Representatives, the
Minority Leader of the House of Representatives, the President
of the Senate, and the Minority Leader of the Senate.
The Department shall conduct a quarterly review of Care
Coordination Unit performance and adherence to service
guidelines. The quarterly review shall be reported to the

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Speaker of the House of Representatives, the Minority Leader of
the House of Representatives, the President of the Senate, and
the Minority Leader of the Senate. The Department shall collect
and report longitudinal data on the performance of each care
coordination unit. Nothing in this paragraph shall be construed
to require the Department to identify specific care
coordination units.
In regard to community care providers, failure to comply
with Department on Aging policies shall be cause for
disciplinary action, including, but not limited to,
disqualification from serving Community Care Program clients.
Each provider, upon submission of any bill or invoice to the
Department for payment for services rendered, shall include a
notarized statement, under penalty of perjury pursuant to
Section 1-109 of the Code of Civil Procedure, that the provider
has complied with all Department policies.
The Director of the Department on Aging shall make
information available to the State Board of Elections as may be
required by an agreement the State Board of Elections has
entered into with a multi-state voter registration list
maintenance system.
Within 30 days after July 6, 2017 (the effective date of
Public Act 100-23), rates shall be increased to $18.29 per
hour, for the purpose of increasing, by at least $.72 per hour,
the wages paid by those vendors to their employees who provide
homemaker services. The Department shall pay an enhanced rate

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under the Community Care Program to those in-home service
provider agencies that offer health insurance coverage as a
benefit to their direct service worker employees consistent
with the mandates of Public Act 95-713. For State fiscal years
2018 and 2019, the enhanced rate shall be $1.77 per hour. The
rate shall be adjusted using actuarial analysis based on the
cost of care, but shall not be set below $1.77 per hour. The
Department shall adopt rules, including emergency rules under
subsections (y) and (bb) of Section 5-45 of the Illinois
Administrative Procedure Act, to implement the provisions of
this paragraph.
The General Assembly finds it necessary to authorize an
aggressive Medicaid enrollment initiative designed to maximize
federal Medicaid funding for the Community Care Program which
produces significant savings for the State of Illinois. The
Department on Aging shall establish and implement a Community
Care Program Medicaid Initiative. Under the Initiative, the
Department on Aging shall, at a minimum: (i) provide an
enhanced rate to adequately compensate care coordination units
to enroll eligible Community Care Program clients into
Medicaid; (ii) use recommendations from a stakeholder
committee on how best to implement the Initiative; and (iii)
establish requirements for State agencies to make enrollment in
the State's Medical Assistance program easier for seniors.
The Community Care Program Medicaid Enrollment Oversight
Subcommittee is created as a subcommittee of the Older Adult

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Services Advisory Committee established in Section 35 of the
Older Adult Services Act to make recommendations on how best to
increase the number of medical assistance recipients who are
enrolled in the Community Care Program. The Subcommittee shall
consist of all of the following persons who must be appointed
within 30 days after the effective date of this amendatory Act
of the 100th General Assembly:
(1) The Director of Aging, or his or her designee, who
shall serve as the chairperson of the Subcommittee.
(2) One representative of the Department of Healthcare
and Family Services, appointed by the Director of
Healthcare and Family Services.
(3) One representative of the Department of Human
Services, appointed by the Secretary of Human Services.
(4) One individual representing a care coordination
unit, appointed by the Director of Aging.
(5) One individual from a non-governmental statewide
organization that advocates for seniors, appointed by the
Director of Aging.
(6) One individual representing Area Agencies on
Aging, appointed by the Director of Aging.
(7) One individual from a statewide association
dedicated to Alzheimer's care, support, and research,
appointed by the Director of Aging.
(8) One individual from an organization that employs
persons who provide services under the Community Care

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Program, appointed by the Director of Aging.
(9) One member of a trade or labor union representing
persons who provide services under the Community Care
Program, appointed by the Director of Aging.
(10) One member of the Senate, who shall serve as
co-chairperson, appointed by the President of the Senate.
(11) One member of the Senate, who shall serve as
co-chairperson, appointed by the Minority Leader of the
Senate.
(12) One member of the House of Representatives, who
shall serve as co-chairperson, appointed by the Speaker of
the House of Representatives.
(13) One member of the House of Representatives, who
shall serve as co-chairperson, appointed by the Minority
Leader of the House of Representatives.
(14) One individual appointed by a labor organization
representing frontline employees at the Department of
Human Services.
The Subcommittee shall provide oversight to the Community
Care Program Medicaid Initiative and shall meet quarterly. At
each Subcommittee meeting the Department on Aging shall provide
the following data sets to the Subcommittee: (A) the number of
Illinois residents, categorized by planning and service area,
who are receiving services under the Community Care Program and
are enrolled in the State's Medical Assistance Program; (B) the
number of Illinois residents, categorized by planning and

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service area, who are receiving services under the Community
Care Program, but are not enrolled in the State's Medical
Assistance Program; and (C) the number of Illinois residents,
categorized by planning and service area, who are receiving
services under the Community Care Program and are eligible for
benefits under the State's Medical Assistance Program, but are
not enrolled in the State's Medical Assistance Program. In
addition to this data, the Department on Aging shall provide
the Subcommittee with plans on how the Department on Aging will
reduce the number of Illinois residents who are not enrolled in
the State's Medical Assistance Program but who are eligible for
medical assistance benefits. The Department on Aging shall
enroll in the State's Medical Assistance Program those Illinois
residents who receive services under the Community Care Program
and are eligible for medical assistance benefits but are not
enrolled in the State's Medicaid Assistance Program. The data
provided to the Subcommittee shall be made available to the
public via the Department on Aging's website.
The Department on Aging, with the involvement of the
Subcommittee, shall collaborate with the Department of Human
Services and the Department of Healthcare and Family Services
on how best to achieve the responsibilities of the Community
Care Program Medicaid Initiative.
The Department on Aging, the Department of Human Services,
and the Department of Healthcare and Family Services shall
coordinate and implement a streamlined process for seniors to

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access benefits under the State's Medical Assistance Program.
The Subcommittee shall collaborate with the Department of
Human Services on the adoption of a uniform application
submission process. The Department of Human Services and any
other State agency involved with processing the medical
assistance application of any person enrolled in the Community
Care Program shall include the appropriate care coordination
unit in all communications related to the determination or
status of the application.
The Community Care Program Medicaid Initiative shall
provide targeted funding to care coordination units to help
seniors complete their applications for medical assistance
benefits. On and after July 1, 2019, care coordination units
shall receive no less than $200 per completed application.
The Community Care Program Medicaid Initiative shall cease
operation 5 years after the effective date of this amendatory
Act of the 100th General Assembly, after which the Subcommittee
shall dissolve.
Within 30 days after the effective date of this amendatory
Act of the 101st General Assembly, rates shall be increased to
$15.02 per hour for adult day services and rates shall be
increased to $10.30 for each way transportation services for
adult day services.
(Source: P.A. 99-143, eff. 7-27-15; 100-23, eff. 7-6-17;
100-587, eff. 6-4-18; 100-1148, eff. 12-10-18.)

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Section 99. Effective date. This Act takes effect upon
becoming law.".